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The Royal College of Psychiatrists Improving the lives of people with mental illness

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 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 Mental Health Team/Service. You may meet:

  • psychiatrists
  • psychologists
  • psychotherapists
  • counsellors
  • 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


Check box   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.



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 logoCarers 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 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 Engagement Editorial Board.


RCPsych logo
© July 2018.
Royal College of Psychiatrists.
This leaflet may be downloaded, printed out, photocopied and distributed free of charge as long as the Royal College of Psychiatrists is properly credited and no profit is gained from its use. Permission to reproduce it in any other way must be obtained from  The College does not allow reposting of its leaflets on other sites, but allows them to be linked to directly.

For a catalogue of public education materials or copies of our leaflets contact: 
Leaflets Department, The Royal College of Psychiatrists, 21 Prescot Street, London E1 8BB. Telephone: 020 3701 2552.
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