Anxiety
Page 7
How I dealt with my own nerves, I would bring the players in. I had the saying with the players, family first football second. Except on match days. Football dominates all of us on the Saturday. So what we’re going to do is we report quarter to ten on Saturday morning. We would go out at Vicarage Road, not the training ground, and we’d go out at ten o’clock and in that half an hour – it was half an hour only – I took it and it was a motivational talk. We would do some sprints and all the time I was talking to them, about the opposition and a bit about what we were going to do. They go in and have a shower and then go in their cars to the hotel for the pre-match meal; yours truly runs home. And now I’m in my bath, I’m relaxed, I know I’ve done everything. I’ve finished; it’s now up to you, the players.
My next bit now is quarter to three to three o’clock. In that quarter of an hour I’ve got to be very careful I don’t say too much because I’ve already said it. Right at the death I would get up on the bench and I’m now taller than all of them. As they went out, I knew the people that wanted a touch from me or have me say something as they were going past. As the manager I was above them – don’t worry, there’s no nerves from me, fine, come on …
I’m hoping to give them all the confidence that I can feel is in me. But I’ve been able to get that through my running, through the adrenaline you get through physical exercise. I’ve prepared myself both mentally and physically, without them knowing.
Before the match, you see the players going to the toilet a lot. But that never concerned me at all. I just saw that as a matter of human nature. I’ve had one or two people going in to be sick. That kind of thing never worried me.
I remember being a player for Grimsby Town and the manager petrified us and on the morning of a game I didn’t want to get out of bed. I was frightened and I used to say to myself if ever I become a manager whatever happens my players will not feel like this.
Getting to know the players as people, getting to know their families, was a big thing. Watford became known as the family club but people weren’t always aware exactly what that meant. When I signed players, if possible, I’d like their wives or girlfriends – this was before agents – to be there and if they had family to bring their family. But the thing is of course you are signing the whole family. At one stage, we obviously had the birthdays of all of our players but we tried to get the wedding anniversaries too and then like all good managers you sent them some flowers, at the expense of the club of course! You’re trying to make sure problems don’t develop. By getting to know the wives and trying to keep them onside you can settle people down more because when you met the wives at the club functions they would sometimes tell you things about their husband that helped you get a better picture.
By the time of the England job, 1990, I’d been a manager for eighteen years. Walking out at Wembley, the arrogance I suppose was in me in terms of what I’d achieved, there was no fear at all. This is where I should be. This is what I’ve worked so hard for. I’m coming out and we’re going to win.
I tended to be more nervous on the England games than I was on club games because I didn’t have control. I felt it in my stomach, the feeling in the pit of your stomach that you weren’t really in control of this whereas at club level you felt in control and you needed to be in control. You’ve got to experience a tournament before you know what international management is all about. You’ve only got ten games a season when you usually have 50. They’re not your players, they’re somebody else’s players. They’re not your staff, they’re somebody else’s staff. At that time you had no day-to-day contact with any of them at all. Mobiles were only just coming in; some of them didn’t have mobile phones: how do you keep in touch with them?
There is a dislike of you by a small group of managers because you’ve been an opponent to them. So some managers don’t want you to succeed. I’d been brought up at Scunthorpe and Scunthorpe was my side, and my second team was England. If England played everything stopped, and I took that into my managership of England – how naïve … Every one of us England managers has come out of being very successful at club level, so you expect that to continue. I found that very difficult. What I found difficult was not being in total control of the situation. And you can’t be as the England manager.
I never believed in telling a player where his weaknesses were. I believed in training and practising their strengths and it’s amazing how much their weaknesses improved. If you’re going to come in and say look your left foot is rank, what are you going to get? Now you can do some work on that, you can go out and say we’ll do some basic things, we want to make you into a two-footed player, you’ll be a better player, but your right foot is excellent, your right foot is magnificent, if you could get your left foot to be fifty per cent of that you’ll be a fantastic player. Now all of a sudden your left foot can be fifty per cent weaker than your right because your manager’s just told you how magnificent your right foot is and all he really wants you to do is get it half as good as that and you’ll be fantastic.
Chapter 5
Phobias
Matthew is a nine-year-old boy so frightened of newspapers that he cannot bear even to see them from a distance. Sheila is a twenty-eight-year-old mother of three; she is terrified of thunder and lightning, and will do all she can to avoid experiencing them alone. Robin’s fear of flying means that he will make train journeys lasting several days to avoid the misery of a few hours on a plane.
The names are fictitious, but in all other respects, these case studies are based on fact. Fears and phobias are endlessly varied, and extremely common. Think of a situation or object, and someone somewhere is probably afraid of it (you can find a comprehensive – and somewhat mind-boggling – catalogue at phobialist.com).
It’s quite usual to hear people discussing their ‘phobias’ – by which they often mean a mild fear or dislike. But being frightened is not the same as having a phobia. So let’s begin by setting out the precise, technical meaning of the term ‘phobia’, as defined by the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders.
What are phobias?
Here are the key symptoms a mental health professional will look for to decide whether a fear is severe enough to be termed a phobia:
• Marked and persistent fear that is excessive or unreasonable, cued by the presence or anticipation of a specific object or situation.
• Exposure to the phobic stimulus almost invariably provokes an immediate anxiety response.
• The person recognizes that the fear is excessive or unreasonable.
• The avoidance, anxious anticipation, or distress in the feared situation interferes significantly with the person’s normal routine, occupational (or academic) functioning, or social activities or relationships, or there is marked distress about having the phobia.
There are literally hundreds of different phobias. But experts have identified five broad categories:
• Animal phobias. Among the most common animal phobias are fears of insects, snakes, rats, and dogs.
• Natural environment phobias. These include fears of heights, storms, and water.
• Situational phobias. For example, fears of flying, enclosed spaces, public transport, tunnels, bridges, elevators, and driving.
• Blood-injection-injury phobias. These phobias include the fear of seeing blood or an injury, or of having an injection or similar medical procedure.
• Other types. Everything else! Common ‘other’ phobias are the fear of choking or of catching an illness (as opposed to hypochondriasis, the fear of actually being ill).
Most of the several hundred phobias recorded by doctors affect a tiny number of people. (How often have you met someone who is afraid of teeth or sitting down?) A very limited number of situations or objects account for the vast majority of phobias. These are, in descending order:
• Animals
• Heights
• Blood
• Enclo
sed spaces
• Water
• Flying
When someone with a phobia encounters (or even anticipates encountering) the situation they fear, they usually experience a feeling of panic. This can involve some very unpleasant sensations: for example, shortness of breath, sweating, chest pains, trembling, a choking feeling, dizziness, numbness, tingling in the limbs, and nausea.
It’s not uncommon for people when highly anxious, especially with panic disorder (see Chapter 7), to believe that they are about to faint, but this is an impossibility. When we’re frightened, our blood pressure increases. Fainting, however, occurs when blood pressure drops dramatically.
Like most rules, though, this one has an exception. People with blood-injection-injury phobias often experience a dramatic fall in blood pressure, sometimes causing them to faint (this reaction is called a vasovagal syncope). No one knows for sure why this occurs, but it makes evolutionary sense. Besides fainting, an additional consequence of lowered blood pressure is reduced blood flow. If you happened to be badly wounded, this might just save your life.
How common are phobias?
Most people are prey to unreasonable or exaggerated fears at some point in their lives. Many surveys have been done on the topic, with the proportion of individuals reporting such fears typically somewhere around 50–60%.
Unsurprisingly, the number of people whose fears are sufficiently debilitating to qualify as phobias is smaller, though still substantial. The US National Comorbidity Survey Replication (NCSR), for example, interviewed a representative national sample of over 9,000 adults from 2001 to 2003: 8.7% of those individuals had suffered from a phobia in the previous 12 months. Other surveys have produced similar results.
Phobias seem to be common in young people. A US survey of more than 10,000 teenagers found that almost 1 in 5 reported having suffered from a phobia at some point in their life.
It’s uncommon to suffer from just one phobia. For instance, the NCSR’s forerunner, the 1994 National Comorbidity Survey, found that, of the 22.7% of people reporting at least one phobia during their life, more than three-quarters had experienced two or more.
Most phobias begin early in life. For animal and blood-injection-injury phobias, that typically means childhood; for other phobias, onset is usually during adolescence. On average, it takes nine years for a fear to develop into a fully fledged phobia.
One striking finding is that females are more than twice as likely to suffer from phobias as males. Why is this? One theory is that men are less likely to admit they are afraid.
An experiment by Kent Pierce and Dwight Kirkpatrick provided a telling illustration of this tendency. A group of college students were asked how much they feared a number of objects and situations, including rats, mice, and rollercoaster rides.
The researchers then informed the participants that they were going to be shown a video of these objects and situations, after which they would be asked to retake the fear questionnaire. During the video, the participants’ heart rate would be monitored – a procedure that the researchers implied would allow them to measure just how scared the students really were. Believing – erroneously, as it turned out – that their responses could be verified, the male students admitted to greater levels of fear on the second questionnaire; the women’s scores remained unchanged.
Even allowing for the fact that the men in Pierce and Kirkpatrick’s study tended to under-report the extent of their fears, their scores were still significantly lower than those of the women. Exactly why women are more prone to fears and phobias is unclear. There is some evidence that women are genetically more vulnerable to fear. But environmental factors doubtless play a part too. In many cultures, for example, it is less acceptable for a man to display fear than it is for a woman. So while girls may be indulged in their fears, boys are taught to overcome them.
What causes phobias?
For many years, it has been believed that we acquire our fears and phobias through a process of conditioning: that is, we learn them through a traumatic experience, usually in childhood. (To refresh your memory on conditioning, see pages 17–22.) Imagine, for example, that you are walking to school and a large and very aggressive dog suddenly leaps up from behind a garden fence. Fortunately, the animal is unable to escape the garden. But the incident leaves you with a deep fear of dogs; you have only to glimpse one to feel again the terror you experienced that morning long ago. Consequently, you avoid dogs at all costs – and thus fail to discover that the chances of being hurt are minimal.
Conditioning is still a useful theory. Innumerable laboratory experiments have demonstrated that it is a very effective way of inducing fear in both animals and humans (the most famous of these experiments involved Little Albert; you can read about it on p. 18). Moreover, many people with phobias do indeed trace them back to an early traumatic incident (though we might wonder whether their accounts are always accurate: in many cases, they are attempting to recall experiences from the distant past). And the psychological therapies employed to treat phobias rely heavily on insights derived from conditioning. Avoiding the situation we fear, or making a rapid exit from it, maintains and builds up our fear, so patients are helped to spend time in precisely the situations they dread (this is called exposure therapy). As they do so, and provided they aren’t using any safety behaviours (see p. 26), their anxiety naturally diminishes. It’s a remarkably effective treatment – and often a very rapid one too: just one three-hour session can eradicate a phobia that has been causing anxiety for years.
But the classical conditioning theory developed by scientists like J. B. Watson (1878–1958) comes up short in regard to certain important questions. Why, for example, do individuals often acquire phobias without undergoing any traumatic formative experience? Why is it that most of those who do suffer scares in childhood don’t develop a phobia? (One study, for example, found that people without dog phobias were just as likely to have been attacked by dogs as those with such a phobia.) And why are some fears much more common than others? According to classical conditioning theory, any object or situation ought to be able to cause a lasting fear. How then to explain why the fear of heights is much more prevalent than the fear of travelling in a car, or why so many people are terrified of snakes and so few are frightened of electrical appliances?
In light of these questions, psychologists have rethought aspects of conditioning theory. For example, it’s now understood that we don’t simply learn our fears through the events we experience. We also pick up signals transmitted by the people around us. We seem to be most susceptible to these signals as children, and usually it’s our parents who make the biggest impression. So if your father repeatedly tells you that dogs are dangerous, there is a fair chance that you will come to believe it.
But we don’t only develop our fears on the basis of what we are told (a process known as informational learning). We also mimic other people’s behaviour. For a good example of this vicarious acquisition of fear, have a look back at the experiment by Friederike Gerull and Ronald Rapee described on p. 44.
These kinds of learning may be more difficult to remember than a single dramatic and distressing event, not least because they may play out over several years. This perhaps helps explain why many individuals are unable to call to mind an explanation for their fear.
Why are some fears more prevalent than others? The answer, for some experts, lies in the concept of biological preparedness, summarized here by Arne Öhman and Susan Mineka:
We are more likely to fear events and situations that provided threats to the survival of our ancestors, such as potentially deadly predators, heights, and wide open spaces, than to fear the most frequently encountered potentially deadly objects in our contemporary environment, such as weapons or motorcycles.
According to Öhman and Mineka, biological preparedness draws on a ‘fear module’ in the brain, centred on the amygdala. This fear module kicks in automatically and unconsciously. (For more on the role of the amy
gdala in anxiety, see pp. 30–32.)
In support of this idea, Mineka and Michael Cook conducted a series of experiments using laboratory-reared rhesus monkeys. The monkeys, who had never seen a snake before, displayed no fear when presented with both toy snakes and a real boa constrictor. That all changed, however, when they watched videotaped reactions of other monkeys responding fearfully to the real and artificial snakes. The lab monkeys learned to be afraid of snakes. On the other hand, footage which appeared to show monkeys reacting fearfully to flowers made no impression. If the lab monkeys could acquire a fear of snakes, why not a fear of flowers? The answer, according to Mineka and Cook, is that a fear of snakes is hard-wired in monkeys because of the danger they can pose. When the lab monkeys saw the other monkeys’ response to the snakes, their innate fear was activated. Flowers offer no such threat and therefore trigger no prepared fear.
Perhaps our evolutionary inheritance can also be detected in the close relationship that seems to exist between particular phobias and the feeling of disgust. Recent research has shown that people with phobias of certain small animals – such as spiders, rats, mice, cockroaches, slugs – and some blood-injection-injury phobias are abnormally susceptible to feelings of disgust. There is a logic here. Physical disgust is designed to prevent us coming into contact with substances that could cause illness. So a fear of rats, for example, might have its roots in the animal’s age-old reputation for spreading disease; a blood phobia might be based on a fear of contamination.