The Tribune

By DR MIKE NEVILLE

WE all feel nervous or frightened from time-to-time - exams and sports are the kind of school experiences that we remember with mixed emotions. They are normal and can spur us to greater success.

The fear of crime is now a part of our daily worries: despite being told by various politicians that we should not be afraid of crime, it is stupid not to be aware and very concerned with the horrors that the levels of murder, robberies and rape have caused.

Anxiety disorders are different in that they become so overwhelming that they make day-to-day living very difficult. Try to imagine that the fear that you would feel when confronted by a masked gunman is the same when you walk into a crowded room or even a fast food outlet. Total terror when confronted by a frog? It seems silly but for those who suffer with anxiety disorder it is a daily life experience.

It is no use knowing that the gunman is a coward or that social anxiety is illogical; the feeling of panic and terror remains the same.

One way to understand anxiety disorders is to see it as a malfunction of our stress response. First, our brains must be aware of something to be afraid or worried about; our brains then send a message to the adrenal glands (a small area on top of our kidneys), these secrete the hormones Adrenalin and Cortisol into the blood stream. They increase blood pressure, increase heart rate, move blood from our gut and skin and concentrate it in muscle and brain and the hormones change stored energy into sugars for immediate use.

This is known as the fight or flight response. It was probably very useful in caveman days when you could leave home with a club hunting for lunch - if, of course, lunch was bigger than you ... run as fast as you can. It also explains the cold, clammy feelings, the racing heart, breathlessness and butterflies in the stomach. These are all real physical responses to the hormones being released.

There are a number of fairly common anxiety disorders including:

• Panic attacks which cause feelings of complete terror that can appear for no apparent reason.

• Social anxiety disorder - this causes intense worry and self consciousness in everyday situations.

• Generalised anxiety disorder - this is really excessive worry about anything and everything.

• Obsessive Compulsive Disorder - this creates a need to check and count over and over again, interfering with normal existence.

• Phobias - heights, snakes and all sorts of things that can affect one's ability to manage a normal life.

It is unclear what sets off this type of mental illness but, like most of these disorders, the vulnerability seems to run in families and they are set in motion by some form of mental trauma. The good news is that they are treatable, there is no need for interminable suffering.

Thinking back to the stress response, the first thing to do is to learn to control your thoughts. If the thoughts set the stress response in motion then positive happy, thoughts can prevent it. This is the basis of the talking therapy called Cognitive Behaviour Therapy. Also meditation and relaxation techniques work well at preventing the stress response from getting out of control.

• Exercise can be of great help. The concept is that the stress builds up negative energy which can be burnt off by vigorous exercise.

• Social support can be from many different forms but the ability to talk and get support helps.

• Avoid the chemical haze of alcohol, caffeine and energy drinks they can all increase feelings of anxiety.

• Finally medication, it really works, but should be used in careful discussion with your doctor when the simple lifestyle changes have not worked.

I remember a sign in my father's general practice office - "Don't worry it may never happen".

• Dr Mike Neville is a forensic psychiatrist who has practiced for more than 40 years in the Bahamas, working at Sandilands, the prison and in private practice. Comments and responses to mneville@tribunemedia.net