Not all in the mind

Dr Raymond H Hamden is a clinical and forensic psychologist and the director of the Human Relations Institute in Dubai. He has been advising people in the UAE for 18 years, and, in the last five years, on his radio phone-in programme, In the Psychologist's Chair.

Anxiety is a fact of life for most people, and in limited amounts it is actually a helpful thing. It enables us to react quickly to possible dangers - such as falling down a step or hitting someone with a car, for example. A small dose of anxiety, which, physically, is caused by an increase in adrenalin - allows us to think more clearly and respond accordingly. The chemicals involved with anxiety interact with the hippocampus, a region of the brain that regulates memory. So if you have to give a speech, make a presentation or play in a recital, a little anxiety can help because it increases memory and alertness. Too much anxiety, however, is counterproductive. It can cause something like a circuit break in the brain, which you get in cases of test anxiety and performance apprehension. This can happens when people have been revising for an exam for days and weeks, then go completely blank, or perhaps before they are due to perform in public - whether at a musical recital or a boardroom presentation - and then become so apprehensive and fearful that their adrenalin level shoots up, making them forget everything.

Anxiety has both internal and external components. The internal component refers to the physical symptoms that it produces, such as erratic breathing, palpitations and shaking. The external component refers to the situational factors that give rise to anxiety. Anxiety can be a normal reaction to disruption - to something like a child running out in front of your car chasing a ball - or any type of perceived situation that can compromise a person's physical integrity, psychological integrity, or both.

In the case of people with thyroid disorders, the physical symptoms of anxiety can be produced without any external input. But for most people, anxiety is about how they handle stressful events. Something like making a boardroom presentation is obviously not a life-threatening situation, but, depending on how such tasks are perceived, they can cause extremely high levels of stress and anxiety. A situation such as this could make someone with an anxiety disorder feel embarrassed, ashamed, or guilty if they were not able to perform to the level of expectation. Even though there is no real threat, in cases of irrational or illogical fear, it is the perceived threat that is reacted to.

Anxiety disorders include phobias, stress disorders, depression and obsessive compulsive disorder. Fortunately, a variety of techniques and strategies are available to help sufferers control the cognitive processes that lead to anxiety. These include diet, exercise and various psychological measures. For instance, sufferers may be recommended to reduce or cut out sugar and caffeine from their diet. Both have natural effects on the body that can be interpreted as anxiety. For exercise, patients may also be told that brisk walking or swimming for 30 minutes a day would be beneficial. Programmes to improve the sleep pattern, or muscle-relaxation techniques may also help.

However, appropriate techniques differ from person to person and depend on the particular problems that they are facing. For this reason, it is a good idea to see a psychologist who can give individually tailored advice. Cognitive restructuring, systematic desensitisation, neurolinguistic programming, and hypnosis can all help to reduce excessive anxiety. Working with a qualified therapist, individual sufferers are usually able find a combination of approaches that work for them.