Essential Information for Patient and Family

• Phobias can be treated.
• Overcoming these fears will make life more enjoyable.
• Avoiding feared situations allows the fear to grow stronger.
• Confronting feared situation will reduce the fear.
• Following a set of specific steps can help a person overcome fear.
  

Specific Counselling to Patient and Family

• Teach the patient that the symptoms of anxiety are a normal response to threat. In phobias people have identified situations that are safe for most people as dangerous for them.Tthus it is not the situation but what they think about the situation that determines their response.
• Teach the patient to practice controlled breathing and relaxation methods to reduce the physical symptoms of fear.
• Discuss ways to challenge these exaggerated fears using cognitive therapy (Patient tells himself "I am feeling a little anxious because of this crowd. It will pass in a few minutes."). Identify exaggerated fears that occur in these situations (e.g. patient fears that he will faint in public)
• Ask the patient to make a list of all situations that he/she fears and avoid although other people do not. Have the patient arrange these into a list from the most feared situation to the least feared situation. Use the graded exposure technique to allow them to confront their fears Plan a series of steps to enable the patient to confront and get used to feared situations:
  • Identify a small first step toward the feared situation (e.g. take a short walk away from home with a family member).
  • Practice this step over and over until it no longer causes fear.
  • If entering the feared situation causes anxiety, do not leave until the fear subsides(this will always occur after a few minutes).
  • Move on to a slightly more difficult step and repeat the practice (e.g. spend a longer time away from home).
  • Continue this process until patient is able to manage the feared situation.
  • Take no alcohol or anti-anxiety medicine for at least four hours before practicising these steps.
• Identify a friend or family member who will help in overcoming the fear.
• Avoid using alcohol to cope with feared situations.
  

Medication

• With use of these counselling methods, many patients with phobias will not need medication.
• For patients with very limited fears (eg flying occasionally) then sedation with diazepam may be indicated. Regular use may lead to dependence, however, and is likely to result in return of symptoms when discontinued.
• If severe anxiety occurs frequently, or depression is also present, antidepressant medication may be helpful (e.g. imipramine 50 to 150 mg per day or paroxetine 20-40 mg per day).
• For management of performance anxiety, (e.g. fear of public speaking) beta-blockers may reduce physical symptoms.
  

Specialist Consultation

• Consider consultation if disabling fears (e.g. unable to leave home) continue after the above measures. Referral for cognitive behaviour therapy may be effective for patients who do not improve.

What a doctor might say to a person with social phobia, agoraphobia, or specific phobia

Edited by Gavin Andrews MD, UNSW, Jan 03
© 2003 CRUfAD