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Fear not!;Mind amp; Body

You're not alone - about 16 million Britons suffer from some form of anxiety disorder. But you should be able to overcome your phobia without resorting to expensive therapies. Reva Klein visits the world of irrational fears

Somewhere not far from you there is a person so fearful of being trapped in a confined space that he has to position himself near a door throughout the day. There is someone else whose journey into work across London is twice as long as it needs to be because she insists on travelling by bus - sitting in an aisle seat as close to the exit as possible - instead of the much faster but terrifyingly claustrophobic Tube.

Another person will routinely cross the road to avoid something that makes them feel panicky: a dog perhaps, or a cluster of pigeons on the pavement, or a large crowd of people.

And at school, there are a few pupils you see only intermittently because they're afraid of coming to school. Their fear may be of bullies, of humiliation at not knowing the right answer, of being excluded from a social group. However seemingly trivial the fear may seem to others, it is larger than life to the children who experience it.

We're all afraid of something. If you were to ask people what they feared, they might say spiders or snakes or rats. But there is a difference between rational fears, which you could stretch to include all the above if you really tried hard enough, and irrational fears that have no basis in reality. Things like the fear of birds, dogs, flowers, fog, crossing the road, heights, aeroplanes, darkness, open spaces, unfamiliar surroundings, foreign countries, germs, even leaves. Or the fear of actions like speaking in public, walking on cracks in the pavement, taking exams, having injections, being sick.

Phobias come in a frightening range of guises. There are between 300 and 400 known phobias, and the numbers of sufferers seem to be growing in line with the increased stress levels that people face in the industrialised West. The Royal Society of Psychiatrists estimates that there are around 16 million people in the UK who have some form of anxiety disorder, ranging from low-level stress to severe social phobias.

When it comes to phobias, you name it and there'll be someone who's afraid of it. When I was little, I used to scream blue murder whenever I saw a bearded man (a slight social handicap when you're surrounded by Orthodox Jews, among them your own grandfather). Apparently, I wasn't alone. There's actually a word for the fear of beards, as there are for most phobias: pogonphobia. My grandmother had another word for it: meshuga, which is Yiddish for crazy.

Give it a few minutes' thought and you'll discover that you're surrounded by people who live with fears, successfully or otherwise. I have an ostensibly sane relative who is so afraid ofcontracting illnesses from other people that he carries around baby wipes to clean his hands after he's touched door handles and bannisters in public buildings. And I have friends who would rather sail on treacherous seas for days on end than sit in a plane for a couple of hours.

You can tell the difference between dislike and full-blown phobia because the latter is accompanied by physical symptoms such as breathing difficulties, racing heart, palpitations, sweating and nausea. It's all very nasty. So when presented with the choice of facing something you're phobic about or avoiding it, you jump at the opportunity to steer clear. And that's when you really know you've got problems.

Psychologist Stephen Palmer, director of the Centre for Stress Management in London, says that at least half of all the patients he treats admit to being phobic about speaking in front of a group of people. When you're ambitious, whether it's in a school or a multinational corporation, you won't get very far if you always find excuses to avoid addressing meetings or giving presentations. At worst, it can seriously hamper your job prospects or even compromise your existing position.

Dr Palmer uses cognitive behavioural therapy (CBT) with his phobic patients. He describes it as an approach that "deals with issues in the here and now. When I work with people, let's say it's someone who gets panic attacks on trains, we look at the reasons behind the response. I'll ask 'What don't you like about being closed in? What do you think will happen to you?' "

While it's a million miles away from using psychoanalysis to find the cause of a problem, the success of CBT in dealing with phobias and anxieties is well documented in research.

Stephen Palmer believes that, in spite of the hundreds of therapies available that claim to help, "with the average phobia, you can sort the thing out yourself. Obviously, if you're feeling suicidal you would need to see somebody, but there are some extremely good self-help books that can help people overcome phobias on their own."

The fact that you don't have to lie on a shrink's couch for at least a decade to overcome your fears is good news. So, too, is the fact that for some people, anxiety attacks and fearfulness are brought on by specific events and, when dealt with effectively, can be overcome relatively quickly. Recent bereavement is a classic example of a life experience that can trigger temporary bouts of claustrophobia, agoraphobia (fear of being in unfamiliar surroundings) or hypochondria (the certainty that you have something seriously wrong with you).

Whatever the reason, whatever the fear, it helps to know that you're not alone and that there is a way out of what can, for some people, seem like a prison. When Winston Churchill said, "There is nothing to fear but fear itself", he probably wasn't talking about arachnophobia (fear of spiders), but he had a useful point to make in this context. With all the modern approaches available (see box above) that help you to look at the problem, you can consider your fear in perspective and, with time and understanding, conquer it.

Centre for Stress Management, 156 Westcombe Hill, London SE3 7DH, tel: 0181 293 4114. The centre has a resource list for self-help books, etc. For a copy, send a self-addressed stamped envelope. The National Phobics Society (Assistant director Nicky Lidbetter, see box) can be contacted on 0161 881 1937. The society supports people suffering from all forms of anxiety disorders, conducts research, offers counselling, recommends a range of conventional and alternative therapies, runs anxiety management groups, provides a self-help information pack, newsletters, contact lists and has its own clinical hypnotherapy service in Greater Manchester and in the West Midlands.


The National Phobics Society publishes a list of tried and tested therapies for anxiety disorders and phobias. Says Nicky Lidbetter, assistant director: "To begin with, individuals have to assess themselves to work out what the problem is and to decide what they want to do about it. It may be that the person has vested interests in holding on to their phobia if it means getting the attention or love or control they feel they otherwise wouldn't have. While the majority of phobics could be treated successfully with cognitive therapy, agoraphobics and people with social phobias might need drug therapy. In the end, each case has to be judged on its own merit."

* Self-exposure therapy: a form of behavioural therapy that involves gradually being exposed to the thing that you fear. It is most effective with specific phobias such as the fear of spiders or snakes. Available on the NHS through GP referral or through support groups.

* Hypnotherapy: for many people, a quick "one-stop phobia shop". More effective when dealing with specific phobias rather than the complex conditions like agoraphobia and social phobias. But little follow-up research has been done to show that hypnotherapy has long-term results. If administered by an amateur, it can be dangerous. Only consult members of the UK College of Hypnotherapists.

* Neuro-linguistic programming (NLP): NLP therapists ask patients to recall the bad experience associated with their phobia and then to rewrite it in their imagination, making the phobia harmless. To date, there is little research or clinical follow-up on its effectiveness.

* Relaxation techniques: some people with phobias find that yoga, breathing techniques and physical exercise help to calm anxiety.

* Medication: drugs will provide temporary relief from symptoms, rather than solve the anxiety disorder. For the more disabling conditions like agoraphobia and social phobias, Seroxat has been clinically proven to raise the level of seratonin in the brain, making patients calmer and reducing the incidence of panic attacks.

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