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Firstly as a GP I never think a phobia is unfounded and all my colleagues Blog Presents: will say the same. Through thorough history taking I usually find a ‘trigger event’ that is linked to the phobia. I have been practicing for years and I Dr Nighat Arif on TREATING PHOBIAS rarely start patients on antidepressants “We have nothing to fear...but fear itself” these were the famous words of Franklin or anti-anxiety medication when I first see them. In my practice, the Roosevelt at his inauguration. initial consultation involves getting to understand the phobia and what The truth is we all have a fear of a something. This is a survival mechanism that we develop according physical symptoms the patient has. to our nurture. Having an inbuilt response to fear or pre-empting a fear makes us the most thriving Sometimes if the palpitations are species. Most of us will have an internal voice that will always ask ‘what if...’ before we do anything, the most over riding symptom then I know I ask myself that question more since becoming a mother. One suddenly understands the taking propranolol (B-blocker) can limit of our mortality and the huge sense of responsibility that comes with having children. These help calm down the heart rate. On negative thoughts are fleeting and on the whole the rational, optimistic part of the thought process the whole patient’s tends to have kicks in and I carry on with my life. coping mechanisms to deal with their phobia already and most phobias are However a phobia is a debilitating and overwhelming fear people tend to experience the physical symptoms of a successfully treated or even cured to an object, situation, place, person, animal or feeling that panic attack; this is known as anticipatory anxiety. The with the support of the GP and a self one cannot get rid off. Phobia is the most common type of symptoms include: help programme. So I say to patients that in order to get better, they have anxiety disorder. I have seen patients whose phobia has do the hard work themselves, so I initiate a computerised CBT course called taken over their lives and the sense of danger about a • Increased heart rate or palpitations ‘Fear Fighter’. http://www.fearfighter.com/ situation or object can be so extreme that it restricts their • Sweating daily life. • Nausea or even vomiting This is a NICE (National Institute for Health & Care Excellence) recommended • Trembling or shaking course effective in self help of anxiety and phobias. Then after a couple The list of phobias is endless and if they are a real concern for • Shortness of breath of consultations and when the patient is ready, Desensitisation or Self the person, then none of them are silly. I had a patient who • Chest pain Exposure Therapy works really well for simple phobias such as fear of dogs was terrified of trees (Hylophobia). The patient explained • Stomach aches or diarrhoea (cynophobia). Studies have shown that a combination of relaxation and that if there is a forest or woods, she cannot be near it. breathing techniques with mentally visualising the phobia helps. Then Her fear stemmed from a traumatic camping incident as Most people will try and deal with these symptoms by repeated exposure to dogs in a controlled environment can cure people a child which has subconsciously built up over years to the themselves before looking for support, because on of their phobia. If I find that the patient requires further specialist support, point that if she walks past a tree the shape of it terrifies her. the whole people are aware of their phobia and the then I refer the patient to a Cognitive Behavioural Therapist (CBT) or a avoidance of it works instantly. Some complex phobias psychotherapist. In today’s all consuming instant world of social media and such as agoraphobia (fear of outside spaces, and a the importance of one’s image, phobias are becoming feeling of being in an outside space where escape is more common place. People are more open about their difficult such as crowded supermarkets) can be very fears yet want to keep up the facade that they have it difficult to deal with alone. There is no ‘magic pill’ or ‘one size fits all’ when it all together and are living a fantastic life. That is sadly not comes to treating phobias. sustainable and when we come close to our phobias or even The best way to deal with a phobia is to go and talk to think about it, our body goes into an acute stress response, your GP. I find that patients then worry that the doctor will So come and see us and let us help you stop being and as adrenaline is released, the body is prepared for the put them on antidepressants, or as my patient who was anxious, scared and lonely. ‘fight or flight’ response. However in this modern age we terrified of trees said ‘please don’t tell me I am loony’. do not have a mammoth running towards us, yet our mind still responds in the same panic stricken manner. Therefore For more of Dr Nighat Arif’s blogs, check out: www.doctornow.org/news-category/blog