Anxiety, Panic and Phobias
Under Review Feb 2018
Anxiety is a feeling we all get in a situation
that is threatening or difficult. The anxiety stops when you
get used to the situation, when the situation changes, or
if you just leave.
But if you feel anxious all the time, or for no obvious reason,
it can make life difficult.
This leaflet deals with three particular kinds of anxiety:
- general anxiety disorder
- panic attacks
We hope it will be helpful for anyone who finds their
anxiety is a problem - but also for any friends and relatives
who want to understand more about it.
What is anxiety?
Anxiety feels like fear. When it's there a lot of the time,
caused by a problem in our life that can't be solved, like money
difficulties, we call it worry. If it is a sudden reaction to a
threat, like looking over a cliff or being confronted by an angry
dog, we call it fear.
Although worry, fear and anxiety are unpleasant, they can all be
- psychologically - they keep us alert and give us the 'get up
and go' to deal with problems;
- physically - they make our body ready for action - to run away
from danger or to attack it - the 'fight or flight'
These feelings become a problem when they are too strong or when
they carry on even when we don't need them anymore. They can make
you uncomfortable, stop you from doing the things you want to - and
can generally make life difficult.
Isn't anxiety just 'stress'?
In English, 'stress' can mean two different things:
- the things that make us anxious - "my work is stressful"
- our anxious reaction to them - "I feel really stressed
This can make things confusing, so we don't use this term much
in this leaflet.
Isn't anxiety/stress bad for you?
Some anxiety is good for you. It keeps you alert and can help
you to perform well. But only some. If it gets too intense, or goes
on for too long, it can make you feel bad and interfere with your
life. It can make you depressed and damage your physical
What does anxiety feel like?
- Feeling worried all the time
- Fast or irregular heartbeats (palpitations)
- Numbness or tingling in fingers, toes or lips
It's easy to worry that these feelings are the signs of a
serious physical illness - and this can make the symptoms even
worse. When anxiety and panic go on for a while, it's easy to start
to feel depressed - you start to feel down, lose your appetite and
see the future as bleak and hopeless.
Anxiety seems to take three main forms, but they overlap and
most people will probably experience more than one type.
- Generalised anxiety disorder (GAD)
You have the symptoms of anxiety most of the time.
You get unpredictable, sudden and intense attacks of
anxiety - often in a situation that is likely to make you anxious.
The feelings come on suddenly and reach a peak in 10 minutes or
less. You may also feel:
- that you are going to die
- frightened or 'going crazy' or losing control
- short of breath and that you are choking.
About a quarter of people who go to an emergency department with
chest pain thinking that they may be having a heart attack are
actually having a panic attack. Although the symptoms are much the
same as those for GAD, they are much more powerful and only last a
You feel really frightened of something that is not actually
dangerous and which most people do not find troublesome. The nearer
you get to the thing that makes you anxious, the more anxious you
get ... and so you tend to avoid it. Away from it you feel
Common phobias include:
- agoraphobia - a fear of going where there are
other people - which can stop you from leaving the house;
- social phobias - a fear of being with other
people - which can make it hard to talk to other people.
Are these problems common?
About 1 in every 10 people will have troublesome
anxiety or phobias at some point in their lives. However, most
people with these problems never ask for treatment.
What causes these kinds of anxiety?
Some of us seem to be born a bit anxious - research suggests
that it can be inherited through our genes. However, even if
you aren't naturally anxious, you can become anxious if you are
under enough pressure.
A psychological explanation suggests that, for some people, it
is because they start to believe that the physical symptoms of mild
anxiety are symptoms of serious physical disease. This makes them
worry more, so the symptoms get worse, so they worry more ... and
Sometimes it is obvious what is causing anxiety. When the
problem disappears, so does the anxiety. However, there are
some circumstances that are so upsetting and threatening that the
anxiety they cause can go on long after the event. These are often
life threatening situations like car crashes, train crashes or
fires. If this happens to you, you can feel nervous for
months or years after the event, even if you weren't physically
It can also happen:
- if you have been neglected or abused in childhood;
- if you have been abused, persistently mistreated or tortured as
This is part of post-traumatic stress
Street drugs like amphetamines, LSD or Ecstasy don't help. Even
the caffeine in coffee can be enough to make some of us feel
Many mental health problems can make you anxious. About
half the people with depression get panic attacks at some
Some physical problems, like thyroid disease, can make you feel
- Some or all the above ...
On the other hand, it may not be clear at all why you feel
anxious. It's a mixture of your personality, the things that have
happened to you, or big changes in your life.
Anxiety is very common and many of us overcome it or cope with
it without professional help. However, if it is severe or goes on
for a long time, anxiety can affect your physical health,
and stop you doing the things you want to do. The good
news is that there are ways to help yourself.
- Talk about it. This can help when the anxiety
comes from recent knocks, like a partner leaving, a child becoming
ill or losing a job. Who should you talk to? Try a friend or
relative who you trust and respect, and who is a good listener.
They may have had the same problem themselves, or know someone else
- Self-help groups. These are a good way of
getting in touch with people who have similar problems. They can
understand what you are going through. As well as having the chance
to talk, you may be able to find out how other people have
coped. Some of these groups are specifically about anxieties
and phobias. Others may be for people who have been
through similar experiences - women's groups, bereaved parents'
groups, survivors of abuse.
- Learning to relax. It sounds too obvious -
surely everyone can relax? But if your anxiety just won't go away,
it can be really helpful to learn some special ways of relaxing, to
be a bit more in control of your anxiety and tension. You can learn
these through groups, with professionals, but there are
several books and self-help materials you can use to teach
yourself. It's a good idea to practice relaxation regularly, not
just at times of crisis.
- Using a self-help book. This works well for
many people. Most of the books use the principles of Cognitive
Behavioural Therapy (CBT) - see below.
Family and friends
Someone with troublesome anxiety or a phobia may not talk
about their feelings, even with family or close friends. Even so,
it is usually obvious that things are not right. The sufferer will
tend to look pale and tense, and may easily be startled by normal
sounds such as a door-bell ringing or a car's horn. They may be
irritable and this can cause arguments with those around them,
especially if they don't understand why the person feels that they
cannot do certain things. Although friends and family can
understand the distress of an anxious person, they can find them
difficult to live with, especially if the fear seems
If you have an anxiety problem which just won't go away, you may
not ask for help because you worry that people might think that you
are "mad". They won't. It's a common problem and it's much better
to get help rather than suffer in silence.
- Cognitive Behavioural Therapy
This is a talking treatment which can help you to
understand how some of your 'habits of thinking' can make anxiety
worse - or even cause it - and to come to terms with reasons for
your anxieties that you may not have recognised yourself. The
treatment can take place in groups or individually, and is usually
weekly for several weeks or months.
There are now a number of computer programmes which you can use
to give yourself CBT. The National Institute for Health
and Care Excellence (NICE) recommend a programme called
for panic or phobia. You can get this through your GP.
If this is not enough, there are several different kinds of
professionals who may be able to help - the GP, psychiatrist,
psychologist, social worker, nurse or counsellor. Psychotherapists
may or may not be medically qualified.
Medication can play a part in the treatment of some people with
anxiety or phobias, The most common tranquillisers are the
valium-like drugs, the benzodiazepines (most
sleeping tablets also belong to this class of drug). They are very
effective in relieving anxiety, but they are also very addictive
after four weeks regular use. When people try to stop taking them,
they may experience unpleasant withdrawal symptoms which can go on
for some time. These drugs should only be used for short periods,
usually up to 2 weeks, perhaps to help during a crisis.
- They should not be used for longer-term treatment
- They should not be used at all
in panic disorder.
Antidepressants can help
to relieve anxiety, as well as the depression for which they are
usually prescribed. They usually take 2 to 4 weeks to
work and have to be taken regularly to work properly. One of
the newer SSRI antidepressants will usually be tried first -
if that is not helpful, one of the older tricyclic
antidepressants can be tried or a newer antidepressant called
Beta-blockers in low doses can sometimes
control the physical shaking of anxiety. They can be taken shortly
before meeting people or before speaking in public, or having to
Studies suggest that Valeriana officinalis (valerian) does not
seem to be helpful in anxiety, although Matricaria recutitat
(German chamomile) and Melissa
officinalis (lemon balm) 'show promise'. Piper
methysticum (kava) does seem to be effective, but is currently
banned in the UK because of worries that it can cause liver
Which treatments work best?
The treatments that seem to work for the longest time are, in
- psychological therapy (CBT)
- pharmacological therapy (an SSRI)
- self-help (books based on CBT principles).
Anxiety and phobias in children
Most children go through times when they feel very frightened
about things. It's a normal part of growing up. For instance, a
toddler will be very attached to their parents or the people who
look after them. Separation from them, for any reason, can make
them very anxious and upset.
Many children are scared of the dark or of imaginary
monsters. These fears usually disappear as the child grows
older, but they do not usually spoil the child's life or interfere
with their development. Most will feel anxious about important
events like their first day at school. Once it is over, the child
stops being frightened and is able to get on and enjoy the new
Teenagers often feel anxious. They tend to be worried about how
they look, what other people think of them, how they get on with
people in general, but especially about forming close
relationships. These worries can usually be helped by talking
about them. However, if they are too strong, other people may
notice that they are doing badly at school, behaving differently,
or feeling physically unwell.
If a child or teenager feels so anxious or fearful that it is
spoiling their life, it's a good thing to ask your GP for
UK: Helpline: 08444 775 774; email: firstname.lastname@example.org.
Charity formed 30 years ago by a sufferer of agoraphobia for those
affected by anxiety disorders.
British Association for Behavioural
and Cognitive Psychotherapies (BABCP)
Tel: 0161 705 4306; email: email@example.com. Has a UK register of
Helpline: 0844 967 4848; Youth Helpline: 01753 840393 (13 to 20
year olds); email: firstname.lastname@example.org. National
Organisation for Phobias , Anxiety, Neurosis, Information and Care. Support for sufferers of Panic
Attacks, Phobias, Obsessive Compulsive Disorder, Generalised
Anxiety Disorder and Tranquilliser Withdrawal.
Reading Well Books on Prescription helps you manage your well-being
using self-help reading. The scheme is endorsed by health
professionals, including the Royal College of Psychiatrists, and is
supported by public libraries.
- Overcoming Anxiety by Helen Kennerley,
Constable & Robinson
- Overcoming Anxiety, Stress and Panic: A Five Areas Approach by
Chris Williams, CRC Press
- Feel the Fear and Do It Anyway by Susan Jeffers,
- Overcoming Panic and Agoraphobia by Derrick Silove and Vijaya
Manicavasagar, Constable & Robinson
- Panic Attacks: What They Are, Why They Happen and What You Can
Do About Them by Christine Ingram, HarperCollins
- An Introduction to Coping with Phobias by Brenda Hogan,
Constable & Robinson.
Free online CBT resources
Life to the Full: Free online life skills course
for people feeling distressed and their carers. Helps you
understand why you feel as you do and make changes in your
thinking, activities, sleep and relationships.
- FearFighter: (free
access can only be prescribed by your doctor in England and
- Barr Taylor, C. (2006) Panic disorder. BMJ: 332:
- Cohen, A. (2008) The primary care management
of anxiety and depression: a GP’s perspective. Advances in Psychiatric Treatment, 14: 98-105.
- Ernst, E. (2007) Herbal remedies for depression and anxiety.
Advances in Psychiatric Treatment, 13, 312–316.
(January 2011) Generalised anxiety disorder and panic disorder
(with or without agoraphobia): Management in primary, secondary and
community care: Quick Reference Guide.
(2008) Computerised cognitive behaviour therapy for depression and
anxiety. Review of Technology Appraisal 51. National Institute for
Health and Clinical Excellence: London.
- Sareen, J. et al (2006) Disability and poor
quality of life associated with comorbid anxiety disorders and
physical conditions. Archives of Internal Medicine, 166,
- Scott, A., Davidson, A. & Palmer, K.
(2001) Antidepressant drugs in the treatment of anxiety disorders.
Advances in Psychiatric Treatment, 7, 275–282.
This leaflet was produced by the Royal College of
Psychiatrists' Public Engagement Editorial Board.
Series editor: Dr Philip Timms
Expert review: Dr Paul
Illustration by Lo Cole; www.locole.co.uk
This leaflet reflects the best available evidence available at
the time of writing.
Under Review Feb 2018
Royal College of Psychiatrists.
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