Overcoming Anxiety For Dummies, 2nd Edtion

by Smith, Laura L.

  You fear situations with unfamiliar people or ones where you may be observed or evaluated in some way.

  When forced into an uncomfortable social situation, your anxiety increases powerfully. For example, if you fear public speaking, your voice shakes and your knees tremble the moment that you start your speech.

  You realize that your fear is greater than the situation really warrants. For example, if you fear meeting new people, logically you know nothing horrible will happen, but tidal waves of adrenaline and fearful anticipation course through your veins.

  You avoid fearful situations as much as you can or endure them only with great distress.

  Check out the following prime example of a social phobic and see whether any of it seems familiar.

  Quinton, a 35-year-old bachelor, wants a serious relationship. Women consider him attractive and he has a high-paying job. Quinton's friends invite him to parties and other social events in an effort to set him up with women. Unfortunately, he detests the idea of going. Quinton conjures up a number of good excuses for backing out. However, his desire to meet potential dates eventually wins. Whenever he imagines scenes of meeting women, he feels intense, anxious anticipation.

  When Quinton arrives at the party, he heads to the bar to quell his mounting anxiety. His hands shake as he picks up his first drink. Quickly downing the drink, he orders another in hopes of numbing his emotions. After an hour of nonstop drinking, he feels much braver. He interrupts a cluster of attractive women and spews out a string of jokes that he has memorized for the occasion. Then he approaches various women throughout the night, sometimes making flirtatious, suggestive comments. His silly, drunken behavior doesn't get him any dates. The following day, he's embarrassed and ashamed.

  Quinton has social phobia. Drug and alcohol abuse often accompany social phobia because people with social phobia feel desperate to quell their anxious feelings. And drugs and alcohol offer a quick fix. Unfortunately, that fix often turns into an addiction.

  Panic disorder: Way beyond everyday anxiety

  Of course, everyone feels a little panicked from time to time. People often say they feel panicked about an upcoming deadline, an impending presentation, or planning for a party. You're likely to hear the term used to describe concerns about rather mundane events such as these.

  But people who suffer with panic disorder are talking about entirely different phenomena. They have periods of stunningly intense fear and anxiety. If you've never had a panic attack, trust us, you don't want one. The attacks usually last about ten minutes, and many people who have them fully believe that they will die during the attack. Not exactly the best ten minutes of their lives. Panic attacks normally include a range of robust, attention-grabbing symptoms, such as

  An irregular, rapid, or pounding heartbeat

  Perspiring

  A sense of choking, suffocation, or shortness of breath

  Vertigo or lightheadedness

  Pain or other discomfort in the chest

  A feeling that events are unreal or a sense of detachment

  Numbness or tingling

  Hot or cold flashes

  A fear of impending death, though without basis in fact

  Stomach nausea or upset

  Thoughts of going insane or completely losing control

  Panic attacks begin with an event that triggers some kind of sensation, such as physical exertion or normal variations in physiological reactions. This triggering event induces physiological responses, such as increased levels of adrenaline. No problem so far.

  But the otherwise normal process goes awry at the next step — when the person who suffers from panic attacks misinterprets the meaning of the physical symptoms. Rather than viewing the physical symptoms as normal, the person with panic disorder sees them as a signal that something dangerous is happening, such as a heart attack or stroke. That interpretation causes escalating fear and thus more physical arousal. Fortunately, the body can sustain such heightened physical responses only for a while, so it eventually calms down.

  Professionals say that in order to have full-blown panic disorder, panic attacks must occur more than once. People with panic disorder worry about when the next panic attack will come and whether they'll lose control. They often start changing their lives by avoiding certain places or activities.

  The good news: Many people have a single panic attack and never have another one. So don't panic if you have a panic attack. Maria's story is a good example of a one-time panic attack.

  Maria resolves to lose 20 pounds by exercising and watching what she eats. On her third visit to the gym, she sets the treadmill to a level six. Almost immediately, her heart rate accelerates. Alarmed, she decreases the level to three. She starts taking rapid, shallow breaths but feels she can't get enough air. Sweating profusely and feeling nauseous, she stops the machine and staggers to the locker room. She sits down; the symptoms intensify and her chest tightens. She wants to scream but can't get enough air. She's sure that she'll pass out and hopes someone will find her before she dies of a heart attack. She hears someone and weakly calls for help. An ambulance whisks her to a nearby emergency room.

  At the ER, Maria's symptoms subside, and the doctor explains the results of her examination. He says that she has apparently experienced a panic attack and inquires about what may have set it off. She answers that she was exercising because of concerns about her weight and health.

  "Ah, that explains it," the doctor reassures. "Your concerns about health made you hypersensitive to any bodily symptom. When your heart rate naturally increased on the treadmill, you became alarmed. That fear caused your body to produce more adrenaline, which in turn created more symptoms. The more symptoms you had, the more your fear and adrenaline increased. Knowing how this works may help you; hopefully, in the future, your body's normal physical variations won't frighten you. Your heart's in great shape. Go back to exercising.

  "Also, you might try some simple relaxation techniques; I'll have the nurse come in and tell you about those. I have every reason to believe that you won't have another episode like this one. Finally, you may want to read Overcoming Anxiety For Dummies by Drs. Charles Elliott and Laura Smith (Wiley); it's a great book!"

  Maria doesn't have a diagnosis of panic disorder because she hasn't experienced more than one attack, and she may never have an attack again. If she believes the doctor and takes his advice, the next time her heart races, she probably won't get so scared. She may even use the relaxation techniques that the nurse explained to her.

  Help! I'm dying!

  Panic attack symptoms, such as chest pain, shortness of breath, nausea, and intense fear, often mimic heart attacks. Alarmed, those who experience these terrifying episodes take off in the direction of the nearest emergency room. Then, after numerous tests come back negative, overworked doctors tell the victim of a panic attack in so many words that "It's all in your head." Many patients with panic attacks doubt the judgment of the physician and strongly suspect that something important was missed or wasn't found.

  The next time an attack occurs, panic attack victims are likely to return to the ER for another opinion again and again. The repeat visits frustrate people with panic attacks as well as ER staff. However, a simple 20- or 30-minute psychological intervention in the emergency room decreases the repeat visits dramatically. The intervention is pretty simple — just providing education about what the disorder is all about and describing a few deep relaxation techniques to try when panic hits.

  Agoraphobia: Panic's companion

  Approximately half of those who suffer from a panic disorder have an accompanying problem: agoraphobia. Unlike most fears or phobias, this strange disorder usually begins in adulthood. Individuals with agoraphobia live in terror of being trapped. In addition, they worry about having a panic attack, throwing up, or having diarrhea in public. They desperately avoid situations from which they can't readily escape, and they also fear places where help may not be readily forthcoming should they nee
d it.

  The agoraphobic may start with one fear, such as being in a crowd, but in many cases the feared situations multiply to the point that the person fears even leaving home. As agoraphobia teams up with panic, the double-barreled fears of not getting help and of feeling entombed with no way out can lead to paralyzing isolation.

  You or someone you love may have agoraphobia if

  You worry about being somewhere where you can't get out or can't get help in case something bad happens, like a panic attack.

  You tremble over everyday things like leaving home, being in large groups of people, or traveling.

  Because of your anxiety, you avoid the places that you fear so much that it takes over your life, and you become a prisoner of your fear.

  You may have concerns about feeling trapped or have anxiety about crowds and leaving home. Many people do. But if your life goes on without major changes or constraints, you're probably not agoraphobic.

  For example, imagine that you quake at the thought of entering large sports stadiums. You see images of crowds pushing and shoving, causing you to fall over the railing, landing below, only to be trampled by the mob as you cry out. You may be able to live an entire blissful life avoiding sports stadiums. On the other hand, if you love watching live sports events, or you just got a job as a sports reporter, this fear could be really bad.

  Patricia's story, which follows, demonstrates the overwhelming anxiety that often traps agoraphobics.

  Patricia celebrates her 40th birthday without having experienced significant emotional problems. She has gone through the usual bumps in the road of life like losing a parent, her child having a learning disability, and a divorce ten years earlier. She prides herself in coping with whatever cards life deals her.

  Lately, she feels stressed when shopping at the mall on weekends because of the crowds. She finds a parking spot at the end of a row. As she enters the mall, her sweaty hands leave a smudge on the revolving glass door. She feels as though the crowd of shoppers is crushing in on her, and she feels trapped. She's so scared that she flees the store.

  Over the next few months, her fears spread. Although they started at the mall, fear and anxiety now overwhelm her in crowded grocery stores as well. Later, simply driving in traffic scares her. Patricia suffers from agoraphobia. If not treated, Patricia could end up housebound.

  Many times, panic, agoraphobia, and anxiety strike people who are otherwise devoid of serious, deep-seated emotional problems. So if you suffer from anxiety, it doesn't necessarily mean you'll need years of psychotherapy. You may not like the anxiety, but you don't have to think you're nuts!

  Specific phobias: Spiders, snakes, airplanes, and other scary things

  Many fears appear to be hard-wired into the human brain. Cave men and women had good reasons to fear snakes, strangers, heights, darkness, open spaces, and the sight of blood — snakes could be poisonous, strangers could be enemies, a person could fall from a height, darkness could harbor unknown hazards, open spaces could leave a primitive tribe vulnerable to attack from all sides, and the sight of blood could signal a crisis, even potential death. Fear fuels caution and avoidance of harm. Those with these fears had a better chance of survival than the naively brave.

  That's why many of the most common fears today reflect the dangers of the world thousands of years ago. Even today, it makes sense to cautiously identify a spider before you pick it up. However, sometimes fears rise to a disabling level. You may have a specific phobia if

  You have an exaggerated fear of a specific situation or object.

  When you're in a fearful situation, you experience excessive anxiety immediately. Your anxiety may include sweating, rapid heartbeat, a desire to flee, tightness in the chest or throat, or images of something awful happening.

  You know the fear is unreasonable. However, kids with specific phobias don't always know that their phobia is unreasonable. For example, they may really think that all dogs bite. (See Chapter 19 for more on specific phobias in children.)

  You avoid your feared object or situation as much as you possibly can.

  Because your fear is so intense, you go so far as to change your day-to-day behavior at work, at home, or in relationships. Thus, your fear inconveniences you and perhaps others, and it restricts your life.

  Almost two thirds of people fear one thing or another. For the most part, those fears don't significantly interfere with everyday life. For example, if you fear snakes but don't run into too many snakes, then your fear can't really be considered a phobia. However, if your snake fear makes it impossible for you to walk around in your neighborhood, go on a picnic, or enjoy other activities, then it may be a specific phobia.

  The following description of Ted's life is a prime picture of what someone with a specific phobia goes through.

  Ted trudges up eight flights of stairs each morning to get to his office and tells everyone that he loves the exercise. When Ted passes the elevators on the way to the stairwell, his heart pounds, and he feels a sense of doom. Ted envisions being boxed inside the elevator — the doors slide shut, and there's no escape. In his mind, the elevator box rises on rusty cables, makes sudden jerks up and down, falls freely, and crashes into the basement.

  Ted has never experienced anything like his fantasy, nor has anyone he knows had this experience. Ted has never liked elevators, but he didn't start avoiding them until the past few years. It seems that the longer he stays away from riding them, the stronger his fear grows. He used to feel okay on escalators, but now he finds himself avoiding those as well. Several weeks ago at the airport, he had no alternative but to take the escalator. He managed to get on but became so frightened that he had to sit down for a while after he reached the second floor.

  One afternoon, Ted rushed down the stairs after work, running late for an appointment. He slipped and fell, breaking his leg. Now in a cast, Ted faces the challenge of his life — with a broken leg, he now must take the elevator to get to his office. Ted has a specific phobia.

  Ted's story illustrates how a specific phobia often starts out small and spreads. Such phobias gradually grow and affect one's life increasingly over time.

  Top ten fears

  Various polls and surveys collect information about what people fear most. The following list is our compilation of the most common fears. Do you have any of these?

  10. Dogs

  9. Being alone at night

  8. Thunder and lightning

  7. Spiders and insects

  6. Being trapped in a small space

  5. Flying

  4. Rodents

  3. Heights

  2. Giving a speech

  And finally, the number-one fear: Snakes

  Post-traumatic stress disorder: Feeling the aftermath

  Tragically, war, rape, terror, crashes, brutality, torture, and natural disasters are a part of life. You or someone you know may have experienced one of life's traumas. No one knows why for sure, but some people seem to recover from these events without disabling symptoms. However, many others suffer considerably after their tragedy, sometimes for a lifetime. Post-traumatic stress disorder (PTSD) sometimes results from such shocks.

  More often than not, trauma causes at least a few uncomfortable emotional and/or physical reactions for a while. These responses can show up immediately after the disaster, or, sometimes, they emerge years later. These symptoms are the way that the body and mind deal with and process what happened. If an extremely unfortunate event occurs, it's normal to react strongly.

  You may have PTSD if you experience or witness an event that you perceive as potentially life-threatening or causing serious injury and you feel terror, horror, or helplessness. In order to have a diagnosis of PTSD, three types of problems must also occur:

  You relive the event in one or more ways:

  • Having unwanted memories or flashbacks during the day or in your dreams

  • Feeling the trauma is happening again

  • Experiencing physical o
r emotional reactions when reminded of the event

  You avoid anything that reminds you of the trauma and try to suppress or numb your feelings in several ways: