Health, Sports & Psychology

Fear: A doctor's advice

Updated Saturday 1st July 2006

As a GP, Dr Natheera Indrasenan is used to hearing the question 'how can I control my fears?'

Zeron overcomes his fear of snakes Copyrighted image Icon Copyright: Production team
 
Zeron overcomes his fear of snakes Copyrighted image Icon Copyright: Production team

Fear can be a good thing. We all know what it feels like; often it protects us from danger and we can usually control it. Yet, when fear takes over (for example in the form of panic attacks or phobias) it can become a problem.

Unfortunately these days, I see too many people who have perceived fears which limit their quality of life. This is when your subconscious mind imagines the world to be more dangerous than it really is.

Fear is a primitive survival response to protect the body from danger. So when the brain detects a threat (for example, when faced with an enormous tiger) it signals the body to prepare for fight or flight.

The body responds by releasing a lot of adrenaline in the body, and increases heart rate and blood pressure. Blood vessels dilate so more blood goes to the brain and muscles, and away from "unnecessary" areas like the gut.

Breathing rate increases to access more oxygen to supply the brain and muscles, and so the body is set up ready: to fight, or run away fast.

Panic attacks

So while the fear reaction is a good thing when you are in real danger, it's not always so welcome. Imagine having this reaction waiting for the train on a Monday morning or when you step out of your front door.

If you walk down a dark alley at night: you may imagine all sorts of fearful things and you may notice that your body starts to react with palpitations, a tightness in the chest and even hyperventilation.

But increasingly, patients I see are having panic attacks after experiencing these reactions while on a crowded tube - or even while walking to the station.

Unfortunately, with panic attacks, once a person has experienced one, they then can start to develop an understandable fear of it happening again; avoiding all situations that might set off another attack - perhaps trying to steer clear of their workplace, or social events.

Phobias

A phobia is an extreme example of reality twisted by imagination. Defined as an irrational fear, you cannot explain your exaggerated fearful response to a small spider, yet the subconscious mind believes it to be dangerous and produces the same response as if it were a tiger.

When the subject of your phobia is quite basic, such as with spiders, you can choose to avoid situations where you might run into them: keep out the attic or the shed.

But there are many people who suffer from more disabling phobias like agoraphobia, who avoid going out of their house because they fear the public places they subconsciously perceive as dangerous - although they can't rationally explain why.

Seeking help

In my surgery, I often see people who suffer panic attacks. They sometimes come thinking they are having a heart attack because they are only aware of the physical symptoms – pounding heart, tight chest, rapid breathing and dizziness.

Panic attacks are in fact the fifth most common problem we see as GPs. The good news is that there are a number of treatments available.

Perhaps because phobics don't have the extreme physical reaction, most people with phobias don't go to their GP for treatment and instead try to live with their fears. This limits their social, work and family life and can even lead to depression. But, equally, phobias can be managed - as Zeron and Mike demonstrated in the programme.

Managing fear

Whether you suffer panic attacks or phobias which are limiting your quality of life - from fear of flying or agoraphobia, the fear of public places - I strongly advise seeking help, as there are so many treatments that can work.

1. Hypnosis

Top of my list is hypnosis. As phobia and panic attack symptoms are the physical manifestations of an imagined fear they work at the subconscious level (particularly the amygdala centre in the brain). So it makes sense to undo the problem at a subconscious level - using hypnosis. This can be done in a single session and I have seen this give real results. The key is to find a very skilled hypnotist.

2. Behavioural and psychotherapy treatments

On the NHS you can be referred to have behavioural treatments like flooding therapy (as seen in the programme) or psychotherapy like CBT (cognitive behavioural therapy).

a) Behavioural therapy

the belief here is that patients who are exposed to the feared situation can become used to their anxiety either by being exposed slowly, or suddenly and extensively (flooding).

With Zeron, after the initial acute fear reaction, he became much calmer and his brain learnt that the situation wasn't as dangerous as his subconscious clearly believed. As Zeron developed greater confidence with his achievement he was then asked to touch a Boa Constrictor.

He is seen hyperventilating as it is placed on the table. The sweating "goes off the scale". He then begins to relax and touches the snake successfully with encouragement from the psychologist. He admits that "never in my wildest dream would I ever have believed this"; Finally he manages to hold the snake himself.

b) Cognitive behavioural therapy

This focuses on educating the patient to help them understand their beliefs about panic symptoms, and how to challenge and ultimately change them. This is sometimes combined with behavioural therapies.

3. Drugs

During a severe panic attack, or (in some cases) to avoid one happening, the patient will be prescribed a small dose of Diazepam to calm their psychological feeling of fear for a few hours.

This is only prescribed as a short-term measure. An alternative is the prescription of a beta-blocker, which can be taken regularly and can minimise the physical symptoms of the fear reaction.

There are also specific drugs which can be prescribed more long term to treat panic attacks and phobias.

So if you suffer panic attacks or phobias, don't suffer in silence! There are treatments out there, so speak to your GP and stop fears and phobias ruining your life.

 

For further information, take a look at our frequently asked questions which may give you the support you need.

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