Stress and anxiety have been with us since the beginning of mankind and with the increase in pressure from modern society, more and more people are suffering either the psychological or physical aspects of stress. Approximately 1 in 10 of the population suffers from anxiety states and a large number of this group will suffer from phobias (irrational fears) as well. Burn out syndromes are very common in the work situation, where the person feels apathetic and disinterested in their job and virtually become phobic about attending the work place. It is important to achieve a balance between too much and too little stress in our lives and people in high stress jobs, are just as vulnerable as people who are underperforming and are bored with their routine existence.

Some degree of stress is important in our everyday lives to help to motivate us and we cannot live without this. Man is an animal, and as animals, we respond to stress with the "flight or fight syndrome”. This produces adrenaline so that we can flee or fight our aggressors.

However, in modern day society, we are unable to do this, so that the adrenaline gets turned on ourselves, producing anxiety symptoms. Obviously some of us have long standing anxious personalities which can be traced back to early childhood and this group of people are more prone to developing anxiety states than the general population. However, everybody can develop anxiety if they are placed under sufficient stress.

Certain life events have been shown very clearly to relate to our performance and anxiety symptoms. Any change in our lives can be anxiety provoking. Grief is a common cause for anxiety where there is loss either through bereavement, divorce, loss of job, loss of financial status, change of house or our children leaving home. All of these life events produce a change in our life pattern and depending on the flexibility of our personality, we cope with them in different ways.

Many people use chemicals to cope with their stress and these include caffeine, alcohol, nicotine, illegal drugs as well as legally prescribed drugs such as tranquillisers.

Most people with anxiety become rather concerned about their physical health and feel that they are seriously physically ill. However, the mind is a powerful organ and it produces these psychosomatic symptoms. Hence when we're under severe stress, we are more prone to develop phobias, which may start when we have an acute panic attack in a specific situation, such as a supermarket, crowded shops, buses, trains, undergrounds and lifts.

Agrophopia, which is a fear of open spaces, is extremely common in women and this prevents them from leading normal lives, because they use the avoidance response frequently to cope with their panic attacks. In other words, they avoid going into situations which make them feel anxious and this increasingly limits their lifestyle.

Social phobia is more common in men and in these situations, the man is frightened of public speaking, authority figures and social situations in the work place. Most of these phobias are common, but people can develop a phobia to virtually anything.

The person who is suffering severe anxiety is out of control regarding their life and needs to regain control as rapidly as possible. There is often a temptation to blame external factors when this happens and the problem often lies within ourselves.

The first stage of recovery, is to be able to stand back from the problem and give ourselves 'space' to see the problem more clearly. The actual process of change requires determination, motivation and considerable courage. However, change can be very painful and it is important to face up to difficult habits of a life time.

It is necessary to realise that no human being is perfect and that we all have problems and difficulties in our life pattern. It is also important to be assertive about oneself, which often means writing lists of positive and specific factors which you are proud of in your life. To be able to talk to somebody close about your difficulties is very helpful and if this is not available, then your own family doctor or a priest may be able to help you. You could also arrange to see counsellors or psychotherapists, as well as voluntary organisations in the community which can provide counselling services.

If work is the major cause of stress, it is important to organise your work routine and maintain efficiency and enjoyment in the work situation. It is also valuable to allow sufficient time to complete the task and to learn to say 'no' when you are asked to do too many things at once and this takes in the need to delegate work to other people. Balancing your time is necessary between work, family social life and hobbies and leisure pursuits. Exercise is also important for 'burning off' the excess adrenaline and helping to relieve the anxiety symptoms.

More specific relaxation techniques include relaxation therapy, yoga, transcendental meditation, hypnosis and massage. Many Adult Education classes carry out these programmes, or there are practitioners in the community, or more specific relaxation techniques at local psychiatric units. If the person has a specific phobia, then a combination of relaxation and behaviour therapy is very effective.

Behaviour therapy is a way of modifying the response to the phobia and is often carried out in a slow 'step ladder' approach to gradually reverse the phobia. The person has to pursue increasingly more difficult tasks, whilst using relaxation therapy, to help to cope with their anxiety symptoms.

Most psychiatrists would be able to provide this type of treatment and failing that, a clinical psychologist would certainly be able to help to decondition the phobia with a behavioural programme. Psychotherapy is also very effective for those people who have unconscious conflicts which can be traced back to early childhood, which are producing marked anxiety symptoms at present. Psychotherapy is a process of talking about these fears and difficulties and it is certainly beneficial for a certain group of people.

A large number of patients receive drug treatment for their phobias and also anxiety states. Minor tranquillisers or benzodiazepines are very useful for relieving anxiety, but should only be given for a short course of no more than 4 to 6 weeks.

There has been considerable discussion about the risk of addiction with this medication and whilst these drugs are effective and safe, if anxiety symptoms continue, then it is important to try and find the cause of the symptoms and remove them with other treatment programmes.

Beta blocker drugs are also helpful for relieving psychosomatic symptoms of anxiety, as they block adrenaline which causes these symptoms and these drugs are not addictive. A large number of patients find anti depressants useful as well and there is no risk of addiction with this medication. For a certain group of people who lack assertion or self esteem, assertion training, self esteem enhancement, and social skills training are also effective techniques to help them to relieve these problems.

Obviously, it is difficult to explain in any great detail about the treatments that are available for anxiety states and phobias in a relatively short leaflet. People with these types of problems should initially go and see their family doctor who would be able to advise them accordingly and may, in certain cases, refer them to a consultant psychiatrist, a clinical psychologist or a counsellor for further assessment.

Godden Green is a registered private psychiatric clinic set in a peaceful location high in the Kentish Weald. Godden Green Clinic provides a high quality environment and excellent clinical care and is able to cater for all manner of psychological and emotional problems.

The facilities are particularly suited to the treatment of patients with various forms of mood disorder, depressive illness, anxiety and phobic states, eating disorders, alcohol problems, chronic fatigue syndrome, post viral fatigue, bereavement and relationship problems. Godden Green Clinic also has a dedicated Mother & Baby Unit, located in a separate wing of the Clinic and which is able to accommodate Mothers suffering from psychological disturbances associated with childbirth.

Dr Adrian Winbow is a Consultant Psychiatrist at Godden Green Clinic in Sevenoaks Kent and has been in independent private psychiatric practice since 1986. He runs out patient clinics in Croydon, Brentwood, Orpington and Tunbridge Wells.

He is a fellow of the Royal College of Psychiatrists and holds a Diploma in Psychological Medicine. He has worked as a Consultant Psychiatrist in the South East initially in the National Health Service since 1978 and still sees a variety of out patients in private medical/surgical hospitals every day as well as having in patients and day patients at Godden Green Clinic. His special interests include depressive illness, alcohol mis use, chronic fatigue syndromes and also eating disorders. His approach to psychiatric treatment is fairly eclectic and ran in from the use of psychotropic medication through psychotherapy and cognitive behavioural therapy as well as relaxation techniques, anxiety management and hypnosis.