Adrenaline: the hormone of the fight or flight response
Adrenaline, or epinephrine, is a hormone produced by the two adrenal glands that sit on top of each kidney.
The function of adrenaline is to prepare the body for action and activity in response to dangerous situations. It does this by increasing the supply of oxygen and glucose to the brain and muscles and suppressing other non-essential bodily processes. Thus, adrenaline increases respiration, heart rate and blood pressure. It dilates the pupils so that we can see as much as possible of the environment. It also evokes the primitive response of contracting the muscles at the base of our hairs so that the ‘hair stands up on the back of your neck’. In animals this response to danger makes the animal look fiercer, which can help it to scare off predators.
All these physical processes enable the body to function in an optimum state. While many people worry about the various physical changes that follow a release of adrenaline, the body – even in people with serious illnesses – can withstand the effects, no problem. Indeed, adrenaline is injected in emergencies when someone needs to be resuscitated. When the body is under the influence of high levels of adrenaline, the heart muscle is probably working at its optimum efficiency.
People are concerned about the long-term effects of the fight or flight response, also called the stress reaction, but the evidence for anxiety in itself shortening life or causing various illnesses is quite limited. There is even some evidence that anxious people live longer than their relaxed fellows.
What causes anxiety and phobias?
The simple answer is this: nobody can really provide a definitive account of how anxiety and phobias arise.
Brain imaging using MRI (magnetic resonance imaging) scans has shown clearly that certain areas of the brain are implicated in anxiety, and seems to suggest that the brains of those who experience states of anxiety may differ in subtle ways from those of people without anxiety states. There is now a strong probability that a great deal of anxiety may be genetically determined (for example, scientists are fairly certain that there is a substantial genetic component to panic disorder, agoraphobia and obsessive–compulsive disorder).
Research also seems to confirm the long-held view that most people with anxiety are biologically predisposed to reacting in a more marked way physiologically than other people, simply pumping out more adrenaline. This predisposition may combine with other psychological and social factors occurring during childhood and, later in life, a fear or a phobia may develop.
Sometimes, however, when I listen to the history of someone with an anxiety disorder, it becomes clear that it started after a specific trauma. For example, the person may have been involved in an accident or trapped in a lift, or experienced a sudden bereavement or separation.
Finally, social factors, such as poverty, social isolation, unemployment, and social support, are of great importance in the way that anxiety states evolve.
Treatments
The two central approaches to treating phobias and panic, supported by an enormous amount of research evidence, are:
•cognitive behaviour therapy
•medication.
Self-help organizations may also be helpful.
Cognitive behavioural therapy (CBT)
CBT is a process that emphasizes behaviour. Therefore, in overcoming phobias, people change their behaviour by gradually facing something that has previously been avoided. The central treatment technique in CBT for phobias and panic is exposure therapy, which has been shown to be an effective way of tackling the problem.
The IAPT (Improving Access to Psychological Therapies) initiative aims to make CBT more accessible, and there are some effective online programmes. Do ask your GP or practice nurse about this.
Medication
Drug treatments for panic and phobias are as old as history. Indeed, the commonest remedy for all forms of anxiety has been the drug alcohol. It is still very frequently used by those with phobias and panic and can, of course, lead to very serious problems.
Tranquillizers
The most commonly prescribed drug is diazepam (Valium), although several other varieties of benzodiazepines (such as Ativan and Xanax) have also been prescribed in large quantities. The great difficulty with these drugs is that they quickly lead to addiction and their beneficial effect on anxiety wears off after a few dozen doses. In terms of treating panic and phobias, these drugs are not to be recommended.
Over the years, a number of self-help groups, such as Beat the Benzos (<www.benzo.org.uk>), have grown up for people addicted to tranquillizers.
Antidepressants
There are various antidepressants that are marketed for the treatment of anxiety, mainly the selective serotonin reuptake inhibitors (SSRIs), such as Prozac (fluoxetine), Seroxat (paroxetine), Cipramil (citalopram) and Cipralex (escitalopram). There are also drugs related to SSRIs, such as Cymbalta (duloxetine) and Effexor (venlafaxine).
The older tricyclic antidepressants include imipramine and amitriptyline, but have serious long-term side effects, including enormous weight gain and effects on the heart and liver.
Alternative remedies
Many people take natural remedies and homeopathic preparations. While I have no doubt that some people derive benefit from them because of a placebo effect, there is no research evidence for any of these alternative remedies having a place in the treatment of anxiety. My one additional note of caution is that, because natural remedies are unregulated in the UK, you can never be completely sure what it is that you are taking.
Psychotherapy
The theory behind traditional psychotherapeutic treatments is that the symptoms are merely the product of an underlying conflict that often has its roots in childhood. One major difficulty associated with the psychoanalytical explanation of a variety of mental health problems is that they largely ignore any possible biological underpinnings of the problems. They also overlook the many and varied social factors that may be partly responsible for the cause and substantially maintain the difficulty in the longer term.
Self-help organizations
I certainly believe that one of the central principles behind the self-help movement should be the more the merrier! I am the proud president and founding patron of No Panic.
No Panic was set up for those with phobias, panic attacks, obsessive–compulsive disorders, general anxiety disorders and going through tranquillizer withdrawal. It offers a range of services, literature, audio and video cassettes and DVDs. The charity puts people in contact with others and offers a recovery programme delivered via the telephone.
The first port of call for anyone with a health problem should be your GP, who may refer you to a psychiatrist. I would, however, suggest that you first try a self-help programme, such as that outlined in this book. Try and carry it out in a systematic manner for at least three weeks and possibly up to three months.