Fighting fear

Looking back, Jess suspected her daily pattern of laying awake at night worrying about what the next day at work would bring, dry retching in the toilet for 15 minutes before she had to catch the train to work, and being unable to eat until lunchtime, wasn't right. But it wasn't until she had a terrifying panic attack on the way to work one day that it all came to a head.

"I think it was my body's way of saying 'what the hell are you trying to do to me?' However, being the stubborn person that I can be it wasn't until I was diagnosed Generalised Panic Disorder (GPD) that it finally hit me that something was very wrong." Fears and phobias

A phobia is an irrational fear, says Professor Gavin Andrews, director of the Clinical Research Unit for Anxiety and Depression, based at St. Vincent's Hospital, Sydney.

In other words, your fear reaction - the 'fight or flight' response - is quite out of keeping with the actual danger. That's mostly because of what you think about the situation, rather than the situation itself.

The 'fight or flight' response is the changes in your body that you need if you have to run away from a dangerous situation. These changes can create symptoms of anxiety, apprehension, breathlessness, cold sweats, trembling, dilated pupils, nausea or shaking.

The most common type is a fear of small animals such as spiders and snakes. Much less common - but far more debilitating - are social phobias and agoraphobia.

Serious signs

At what point does a phobia become a serious health issue? The simple answer is when it stops you doing what you want. "The key early warning sign is if you are starting to avoid certain situations. Phobia means fear or avoidance of situations of which other people wouldn't be afraid," says Professor Andrews.

Jess is just one of the estimated 12 per cent of Australian women, and 7.1 per cent of men who are diagnosed each year with a serious anxiety disorder.

There are many different types of anxiety disorders but common types include: Phobias, such a fear of heights, claustrophobia (a fear of being enclosed in narrow or enclosed spaces), a fear of spiders or a fear of snakes.

One debilitating variant is social phobia. This is the fear of scrutiny by others, so people with social phobia avoid situations where they might be the centre of attention.

This means they will avoid going to social events, eating in front of others or even standing in a queue.

Generalised Anxiety Disorder (GAD). People with this condition have irrational fears and apprehension about minor things - harm affecting themselves or loved ones, for example, financial disaster, their health, work or personal relationships. They worry so much they can't relax or fall asleep.

Panic Disorder (PD). People who have this condition experience sudden and unpredictable episodes of panic in situations where other people would not be afraid.

They are convinced something disastrous will happen, that they may die or go crazy. They get chest pains, shortness of breath, dizziness, nausea, numbness, trembling.

They may be frightened of going out in case they have a panic attack. Agoraphobia is characterised by an uneasiness, fear or dread about leaving familiar surroundings.

"It's really a fear of having a panic attacks; more specifically of having a panic attack in a situation which is inescapable, or in which help couldn't get to you," says Andrews. In severe cases, a person with agoraphobia won't leave their home.

Facing your fears

Some phobias need to be faced less often than others, says Andrews. For example, a fear of spiders may only be triggered when a person is out in the garden; as opposed to a social phobia that may influence every area of a person's life.

He says the task for all phobias is to confront them, in a planned fashion "so that you overcome them, so they stop dominating you." Treatments may include: Cognitive behavioural therapy teaches people to change their negative, irrational thoughts into more rational ones.

This can be very successful because how you 'think' can affect how you 'feel'. Exposure therapy (i.e. facing your fears). Exposure therapy is a cognitive behavioural therapy technique for reducing fear and anxiety responses.

It is particularly useful for phobias such as a fear of snakes. The therapy involves the person (instructed and guided by a therapist) progressively exposing themselves to their fear, i.e. snakes.

Relaxation training techniques such as deep breathing and progressive muscle relaxation can play a role in relieving tension and anxiety.

Medication Pharmacological treatment can be used in conjunction with psychological treatment. For example, some anti-depressive medication can be effective in reducing the symptoms of generalized anxiety disorder.

Fighting back

Everyone's road to recovery is different.

Sally consulted a psychologist, a GP and watched self help videos. But what really worked for her were the cognitive behavioural therapy techniques she learnt from a private therapist. "We wrote my thoughts down on paper, which enabled me to look at them objectively, and realistically. Then we searched for alternative thoughts that may be just as realistic, or even more realistic ...", she says.

This was the beginning of the turning point in her life. "Step by step, I branched out and did things I had avoided previously....I also started answering my 'what if' questions with a logical and realistic answer."

"With these new thoughts, my anticipatory anxiety diminished substantially. I even went to some of my friends' 21st birthday parties - dinners included!"

Today, Sally is slowly reclaiming her life. She has a new boyfriend, recently gave a presentation at uni and went on an interstate holiday. "I still cannot believe how much my life has changed in one year.

All the things I've achieved that I never thought I would. I have a new part-time job and I'm looking forward to life [after uni]. I see it as an adventure rather than a big scary thing that I won't be able to cope with."

For Jess, education has been a key in her recovery.

"I am where I am today thanks to the loving support of my partner, doctors who took the time to really listen and psychologists who taught me how to relax."

"But the most important thing I did was educate myself about anxiety and take time out to attend some wonderful courses that put me in contact with other sufferers. It made me realise that I'm not alone," she says.

"I had to realise that to begin my recovery I had to really want to get better and ultimately only I had the power to control my thoughts and actions. I had to make peace with my anxiety and know that it doesn't make me any less of a person."

abc.net
 

 You can say 'NO'

Smoking not only kills you but others too:

Are you willing to say bye to the killer stick ? The addicts will say, mmmm... its hard because there are so many triggers that arouse their craving. But, if you are courage enough to do so just try the following steps which will prolong your life. Good luck lets try.

Listen
* Don't be afraid to ask for help.
* Ask family and friends not to smoke around you.
* Wash your clothes to get rid of the smell of smoke.
* Decide you'll only smoke during odd or even hours of the day.
* Write down the reasons you want to become a non-smoker.
* Each day, postpone lighting your first cigarette by one hour.
* Ask your partner or a friend to stop with you - make a contract with each other.
* Make a date and stick to it. Draw up a plan of action and consider all the methods available.
* Smoke in circumstances that aren't especially pleasurable.
* Decide how many cigarettes you'll smoke on a daily basis, and for each additional cigarette give a pound to charity.
* Smoke only those cigarettes you really want and catch yourself before you light up out of pure habit.
* Don't empty your ashtrays. This will remind you how many you smoke, and the sight and smell of stale cigarettes butts will be very unpleasant.
* Don't think of never smoking again. Think of stopping in terms of one day at a time.
* Keep busy on the day you plan to stop - go to the cinema, take some exercise, or do something you've been putting off.
* Make an appointment to see your GP or practice nurse, and see what help they can offer you to quit.

Positive steps
* Get more active - walk instead of driving or taking the bus and use the stairs instead of the lift. Exercise helps you relax and boosts morale.
* Change your routine to break the association of smoking with certain times of day or places.
* Change your surroundings when the urge to smoke seizes you. Research has shown that even a short walk can quash nicotine cravings.
* Put something other than a cigarette into your mouth. Try carrots, apples, celery, raisins, or sugarless gum.
* Tell all your friends and family that you've already quit - you'll be embarrassed if they catch you smoking.
* Stop carrying or hoarding cigarettes - at home, in your bag or at work. Don't 'borrow' any.
* Throw away all your cigarettes and matches. Hide or give away your lighters and ashtrays.
* Visit your dental hygienist and have your teeth cleaned to get rid of tobacco stains. Resolve to keep them that way.
* Enjoy having a clean taste in your mouth and maintain it by brushing your teeth frequently and using a mouthwash.
* Avoid a heavy intake of alcohol, caffeine, or other stimulants or mood-altering substances.
* Pay a family member or friend o5 (if they catch you smoking) as a deterrent.
* If your partner smokes, try to encourage him or her to quit, or at the very least not to smoke around you.
* Think positively - withdrawal can be unpleasant, but it's a sign your body is recovering from the effects of tobacco.

In times of temptation
* Ease withdrawal symptoms with nicotine replacement therapy (NRT).
* Keep busy - go for a walk, visit a friend or start a new project.
* Change your routine - avoid the shops where you usually buy cigarettes.
* End meals or snacks with something that won't lead to a cigarette.
* Avoid people who smoke - spend more time with non-smoking friends.
* Keep your hands busy - doodle, knit, send an email to someone you've lost touch with, or do the crossword
* Drink plenty of fluids - keep a glass of water or pure fruit juice by you and sip it steadily.
* When your desire for a cigarette is intense, clean your teeth or wash your hands to reinforce how pleasant it is not to smell of smoke.
* If you miss having something in your mouth, try toothpicks, or carrot or celery sticks.
* If you always smoke while driving, sing along to your favourite music instead, or use public transport.
* Never allow yourself to think that 'one won't hurt' - it will. It's a slippery slope.

Tackling mealtimes
* Be careful what you eat - try not to snack on fatty or salty foods.
* Help your body to get rid of nicotine - drink plenty of water, eat fresh fruit, vegetables, whole grains, and fibre-rich foods.
* Change your eating habits to help you cut down - for example, drink milk, which many people consider incompatible with smoking.
* Change your daily schedule - eat at different times, or eat frequent small meals instead of three large ones, sit in a different chair.
* Find other ways to close a meal. Play a tape or CD, get up and make a phone call, or get into the habit of going for a short walk.
* Instead of smoking after meals, get up from the table and brush your teeth.
* Try to avoid alcohol, coffee and other drinks that you associate with smoking.

It's a mind game
* Light incense or candles instead of a cigarette.
* Cut a drinking straw into cigarette-sized pieces. Inhale air.
* Collect all your cigarette butts in a large glass container to remind you how much you smoked.
* Take ten deep breaths and hold the last one while lighting a match. Exhale slowly and blow out the match. Pretend it's a cigarette and crush it out in an ashtray. Repeat.
* Decide positively that you want to stop. Try to avoid negative thoughts about how difficult it might be.
* When your cravings become overwhelming, have a warm bath or shower, go for a walk or meditate.
* If you miss the sensation of having a cigarette in your hand, hold a pencil, pen or toothpick.
* Identify the trigger - exactly what was it that prompted you to smoke? Decide now how you'll cope with it next time.
* Understand that withdrawal symptoms are temporary - they're healthy signs that your body is repairing itself from its long exposure to nicotine. Think of the savings - and the treats
* Make a calendar for the first 90 days and fill in how much you saved each day by not smoking.
* Take one day at a time - each day without a cigarette is good news for your health, family and bank balance.
* Make a list of things you'd like to buy for yourself or someone else. Estimate the money you've saved by not buying cigarettes or tobacco and buy some presents.
* Buy yourself flowers to celebrate totally smoke-free days - you may be surprised how much you can enjoy their scent now.

BBC health