Phobias and panic attacks

Part of the 'fight or flight' response, panic is an essential part of the body's defence system. But, occasionally, it becomes more serious, as with irrational fears and panic attacks.

Most of us have panicked with good reason at some time. The traffic light goes green, we start to cross the road, a car approaches fast and makes no sign of braking. To panic in this situation is normal - we run, and fast.

But what if a perfectly harmless everyday experience creates the same response. Or worse, if you experience panic for no apparent reason and completely without warning. While some people enjoy being scared - think of rollercoasters - it's quite a different thing if you have no idea why you're scared or when it's going to stop.

Common phobias

It's possible to be phobic about anything, but these are particularly common fears:

• dental treatment
• flying
• blood
• social phobias
• agoraphobia (open spaces).

When a person with a phobia comes into contact with the thing they're frightened of - or knows that they soon will - they develop some of the more immediate physical symptoms of anxiety. Anxiety is made up of a long list of symptoms, and different people develop different patterns of symptoms.

For many people, this is enough to make them completely avoid whatever they're dreading - a whole life can become structured around avoiding the situation or object. But sometimes it's unavoidable and a person with a phobia is forced into a situation they fear. For example, years of someone not going to the dentist ends in the need for emergency treatment, or someone suffers an accidental cut or has to attend a meeting that can't be avoided. Panic often follows.

The word 'often' is important here - panic isn't inevitable, and it doesn't always follow. Many people with a phobia surprise themselves and come through the situation, even though they find it highly unpleasant.

Symptoms of panic attacks

For those who do panic, the symptoms are:

• fast, pounding heartbeat
• difficulty catching your breath
• chest pain
• flushing and sweating
• feeling sick
• trembling
• dizziness
• dry mouth
• needing to go to the toilet
• feeling faint

This experience can be so intense that the person becomes convinced that they're having a heart attack, which adds to their feeling of panic.

Some people also begin to feel that the reactions of their body are so extreme and so out of control that they're simply an observer of it all.

Though they don't describe any kind of out-of-body experience, they do describe feeling as though they become detached from what's going on, as though the whole situation had taken on an unreal quality.

This is referred to as 'depersonalisation'. It sounds as though it may be a relief from the panic attack, but it is, in fact, even more unpleasant.

There's another group of people who experience panic attacks apparently spontaneously. This is often associated with general anxiety - ongoing, grumbling symptoms coming to a peak. But panic attacks also occur out of the blue. When this happens, the fear of it reoccurring in the same situation can easily develop, leading to a phobia or general anxiety that becomes self-feeding.

How many people are affected?

Some phobias are more common than others. Up to ten per cent of people a year experience a phobia of flying, dentists or of blood. These are referred to as the simple phobias.

Social phobia is less common, affecting about 25 people in 1,000 each year. Agoraphobia occurs in about 30 people in every 1,000 a year, and it's roughly twice as frequent among women. Panic disorder affects between ten and 30 people per 1,000 in a year - again, it's roughly twice as frequent among women.

What can I do to help myself?

The first step is to break the vicious cycle that builds up. Learning relaxation techniques is a good way to do this. Your body instinctively becomes tense - it's not a response that we learn - and relaxation also has to be consciously learned.

There are two types of relaxation exercise - 'guided fantasy' and 'muscle tension'. Relaxation is not an immediate fix for the problem and, like all skills, is only acquired through practice.

You can use the thought-monitoring charts to rate what goes through your mind and how anxious you feel in a phobic situation. Then, using the relaxation techniques, try to reduce your anxiety in the phobic situation. This takes practice.

Keep it hypnotic

David