Anxiety and phobias
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
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
- 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
- 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
- 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
- in the case of PTSD, have nightmares and flashbacks.
They complain of physical symptoms such as:
- 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
- recent events which may have triggered the anxiety
- how they live their life now – what may be keeping the anxiety
- any other possible causes – commonly alcohol and street
A number of treatments are available for anxiety and panic such
- 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.
Partnership with your doctor and members of the health
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
However, some people do need to see a psychiatrist and/or other
members of the Mental Health
Team/Service. You may meet:
- psychiatric nurses
- other members of the Mental Health Team/Service.
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
Can you explain what the diagnosis
can we expect in the near future and over time?
What treatments are available?
Why have you chosen this
How long will it take for the medication to
long will the person have to take the medication?
What are the possible side-effects - and how common (or
uncommon) are they?
talking therapies or CBT be helpful?
How often should the person come to see you?
there things we can do to help ourselves?
Is it safe for the person to drive?
||Do you have any written material
about anxiety/phobias and its treatment? If not, who
Are there any organisations or local community services
that may be of help?
do we contact if we need help 'out of hours'?
Remember to arrange the next appointment before you
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
- Keep a note of these changes as they happen, with the
- 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
- changes in symptoms and
- 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.
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
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
- Don’t struggle on alone, do ask for help when you feel you need
- 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
- Ask if a family support worker is available.
As a professional working with people with
anxiety and their carers, we hope that the following is a helpful
guide to good practice.
Remember, you can see the patient and the carer separately, as well
Is there enough time to:
- Listen, ask, listen?
- Obtain a life history?
- Ask about any bereavements, possible abuse, or other traumatic
- 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
- Talk about positive outcomes?
- Spend time asking about the carer’s physical and emotional
- 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
- their care and treatment
- the whole range of local services
available – exercise, nutrition or self-help groups, for
- depression and its treatment
- relevant mental health or carer
- Do send copies of letters to the patient and the carer.
Promotes the relief and rehabilitation of persons suffering with
anxiety disorders through information and provision of self-help
Carers Trust is a 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
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
Editor: Dr Philip Timms, Chair, Royal College
of Psychiatrists' Public Engagement Editorial Board.
© July 2018.
Royal College of Psychiatrists.
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Royal College of Psychiatrists, 21 Prescot Street, London
E1 8BB. Telephone: 020 3701 2552.