Anxiety and Phobias
Introduction
This leaflet is aimed at:
- anyone who cares for and supports a person
with anxiety and/or phobias (referred to as 'carers' in this
leaflet)
- any professional who provides care and
treatment for someone with these difficulties.
It looks at ways of encouraging patients,
carers and professionals to communicate more clearly and to work
together more closely.
For the carer
About anxiety and phobias
Anxiety is a normal human feeling which we all
experience when faced with situations we find threatening or
difficult. In fact, fear and anxiety can be useful as they make us
more alert, helping us to avoid dangerous situations, and give us
the motivation to deal with problems. Sometimes, however,
an anxiety or phobia can take over a person’s life.
- Anxiety disorder: some people have feelings of fear and
dread which are too strong, go on for too long, or are experienced
in the absence of any apparent threat.
- Panic: sudden unexpected surges of anxiety
which usually lead to the person having to quickly get out of
whatever situation they are in.
- Phobia: some people have very strong anxiety when faced
by a particular situation (e.g. meeting new people) or objects
(e.g. spiders) which are not dangerous and which most people do not
find troublesome.
- Obsessive-compulsive disorder:
extreme anxiety which ends up
dominating the person’s life through obsessions, unreasonable
fears/thoughts and compulsions (rituals carried out in response to
the obsession).
- Post-Traumatic Stress Disorder
(PTSD): occurs to people who have been exposed to
life-threatening situations such as car or train crashes, fires, or
violent attacks. They can feel nervous and anxious for months and
years after the event.
Early changes in the person’s behaviour
You may notice that your friend or relative is
behaving out of character and is no longer able to live life
normally. They may:
- appear unusually worried or fearful much of the time
- be easily startled by normal sounds
- try to avoid certain situations, sometimes taking drastic
actions to do so (eg. never leaving the house)
- be irritable and tired
- appear pale and tense
- lose confidence in themselves
- have trouble falling and staying asleep at night
- change in appetite
- not be able to keep up with shaving, washing, doing the
laundry
- in the case of PTSD, have nightmares and flashbacks.
They complain of physical symptoms such
as:
- sweating
- palpitations
- dizziness and faintness.
Making a diagnosis
A doctor or other professional will make the
diagnosis by talking to the person and/or a close relative or
friend. The professional needs to understand:
- the person’s past – what may have laid the foundations for the
anxiety
- recent events which may have triggered the anxiety
- how they live their life now – what may be keeping the anxiety
going
- any other possible causes – commonly alcohol and street
drugs.
A number of treatments are available for
anxiety and panic such as:
- relaxation techniques
- self help – books and computer courses.
- lifestyle changes – exercise, occupation etc.
- talking therapies (psychotherapy and counselling)
- Cognitive Behavioural
Therapy (CBT) which helps the person think about
themselves and others in a different way
- medication, such as tranquillisers and antidepressants.
As the carer, you may feel worried about:
- admitting there is a problem
- losing the person you knew
- what will happen in the future
- how you can cope
- how to get help
- the effect on the rest of the family
- the impact on your finances
- how other people react to the person’s illness - the stigma
associated with it
- how to talk to the person about what they are feeling.
You may also find yourself impatient with the
person’s behaviour – and exhausted by caring for them.
For carers:
Partnership with your doctor and members of the health
team
It's important that there is clear, regular
communication between the doctor, other professionals, the person
with anxiety and their carer. It doesn't happen automatically and
will take time and effort. For instance, if you really feel that
you need more time than usual to talk about what is happening with
your GP, you can book a double appointment, which will give you
more time.
Most people with anxiety disorders are seen by
their GP and will not need to go into hospital. Your GP may be able
to refer a person directly to a counsellor, psychotherapist or
cognitive therapist.
However, some people do need to see a
psychiatrist and/or other members of the Community
Mental Health Team (CMHT). You may meet:
- psychiatrists
- psychologists
- psychotherapists
- counsellors
- psychiatric nurses
- other members of the CMHT.
Decision-making/partnership
People have different views about how much
they want to be involved in making decisions about their care and
treatment. Some people are happy to leave it to the doctor, some
people like to make the decision for themselves, and others prefer
a collaboration of some sort. Whatever the patient's 'decision
preference', they and their carer should be as involved as
they want to be in any discussions about treatment or care plans. A
vital part of this is that you and your friend or relative get all
the information you need to make the decisions you have to.
Making a trusting relationship with all the
staff involved really helps. The staff get a clearer picture of
what is happening – and how much help and support you can offer.
You get a clearer idea of the choices available and what to expect
– and how you can get some support yourself.
Questions to ask the doctor
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Can you explain what the
diagnosis means? |
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What
can we expect in the near future and over time? |
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What
treatments are available? |
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Why have you chosen this
particular treatment?
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How long
will it take for the medication to work? |
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How
long will the person have to take the medication? |
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What are
the possible side-effects - and how common (or uncommon) are
they? |
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Would
talking therapies or CBT be helpful? |
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How often
should the person come to see you? |
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Are
there things we can do to help ourselves? |
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Is it
safe for the person to drive? |
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Do you have any written material
about anxiety/phobias and its treatment? If not, who
does? |
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Are there
any organisations or local community services that may be of
help? |
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Who
do we contact if we need help 'out of hours'? |
Remember to
arrange the next appointment before you leave.
Regular and well prepared visits to the doctor
or other members of the mental health team will make sure that you
both get the best care and support.
Planning for a follow up visit
- Discuss any new worries or changes in anxiety, thoughts and
behaviour.
- Keep a note of these changes as they happen, with the
dates.
- Keep a note of any reactions to medication, again with the
dates if possible.
- Just before the next visit, look at your notes and decide, with
your friend or relative, the most important points.
- Write down your top three concerns to make sure that you
discuss these, and take the other notes with you. These could
include:
- changes in symptoms and
behaviour
- side-effects of medication
- general physical health, eg
putting on or losing weight
- your own health as a carer
- any extra help you need
- when the person will be fit to
return to normal activities, including work and driving.
During the visit
- If either of you do not understand something, ask questions
until you do.
- Encourage your friend or relative to tell the professional
about how they feel.
- Take notes of what you are told. At the end, tell the doctor
what you and the person have understood, so that any
misunderstandings or omissions can be cleared up.
Confidentiality
All professionals working in mental health
services have a duty of confidentiality. This means that, unless
there are exceptional circumstances, they cannot release
information about a patient without the patient's consent.
This means that professionals can sometimes be
uneasy about sharing such information with a carer – or even refuse
to do so at all.
However, more and more health professionals
want to involve carers and will encourage the patient to allow them
to do so. (See our leaflet ‘Carers and confidentiality in
mental health’).
Even if the patient has not consented to
sharing their personal information, professionals can give carers
general information on conditions, rights and services, as long as
the information provided does not breach confidentiality.
If the doctor is unwilling to involve you as a carer,
there are a number of things you can do:
- ask the person you are caring for if you can stay with them at
some of their appointments, or for part of their appointment
- talk to other members of the health team
- contact the helplines listed at the end of this leaflet
- involve local mental health advocacy workers.
Don’t forget to take care of yourself
- Share your worries with trusted friends and family members –
but do respect the patient's right to privacy and
confidentiality.
- Don’t struggle on alone, do ask for help when you feel you need
it.
- Make time for yourself and leisure activities.
- Make sue you eat well and get enough exercise.
- Go and see your own doctor if you find it hard to sleep, or are
anxious or depressed.
- If you live in England, you may be entitled to a carer’s
assessment to identify what you need. This can be arranged through
the doctor or a member of the mental health team. They should also
be able to refer you to your local carers’ support
organisation
- Ask if a family support worker is available.
For professionals
As a professional working with people with
anxiety and their carers, we hope that the following is a helpful
guide to good practice.
The assessment
Remember, you can see the patient and the
carer separately, as well as together.
Is there enough time to?
- Listen, ask, listen?
- Obtain a life history?
- Ask about any bereavements, possible abuse,
or other traumatic events?
- Explain how you arrived at the
diagnosis?
- Talk about short- and long-term
prognoses?
- Have questions and discussion?
In the management of anxiety, do you?
- Discuss all possible treatments including medical,
psychological and self-help?
- Talk about the possible side effects of medication?
- Discuss how to meet the care needs of both the patient and the
carer?
- Talk about positive outcomes?
- Spend time asking about the carer’s physical and emotional
health?
- Have detailsof local resources and support services for both
the patient and the carer?
Points to remember
- The carer may be in need of respite.
- Make it clear that you will be happy to talk to other members
of the family.
- Make sure there is a professional available whom the family can
contact during working hours.
- Give an ‘out of hours’ telephone number.
- Make sure that the patient and carer have the information they
need about:
- their care and treatment
- the whole range of local services
available – exercise, nutrition or self-help groups, for
example
- depression and its treatment
- relevant mental health or carer
organisations.
- Do send copies of letters to the patient and the carer.
Further help
Anxiety UK
Promotes the relief and rehabilitation of
persons suffering with anxiety disorders through information and
provision of self-help services.
Carers' Trust
Carers Trust is a new charity which was formed by the merger of
The Princess Royal Trust for Carers and Crossroads Care in April
2012. Carers Trust works to improve support, services and
recognition for anyone living with the challenges of caring,
unpaid, for a family member or friend who is ill, frail, disabled
or has mental health or addiction problems. With our Network
Partners, we aim to ensure that information, advice and practical
support are available to all carers across the UK.
This leaflet was produced as part of the
Partners in Care campaign, a joint initiative between the Royal
College of Psychiatrists and The Princess Royal Trust for
Carers.
One of the aims of the Partners in Care campaign was to show
that if all
those involved in the care of people with mental health problems or
learning disabilities can work together, a trusting partnership can
be developed between carers, patients and professionals which will
be of benefit to all.
Original author: Dr Mike Launer
User and carer input: members of Depression Alliance
Editor: Dr Philip Timms, chair, Royal College of Psychiatrists'
Public Education Editorial Board.
© June 2010. Review date: June 2012.
Royal College
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