A significant fear of a specific object or situation (e.g., flying, heights, storms, water, animals, receiving an injection, seeing blood). Exposure to the feared object almost always provokes immediate anxiety. The amount of fear is out of proportion to the actual danger involved.

Fear or anxiety is persistent (i.e., lasts 6 months or more). The last two sentences are important. You’ll note that many of the fears listed above are natural and common. It is only when such fears begin to interfere with one’s life that they become a disorder.

Social anxiety disorder involves excessive anxiety about one or more social situations (e.g., having a conversation, meeting new people, being observed by others when eating or drinking, giving a speech). The concern is almost always about being negatively evaluated, of being humiliated or embarrassed, or of being rejected. Social situations almost always provoke fear or anxiety and are often avoided or endured with intense fear or anxiety.

When someone experiences a sudden, intense, and overwhelming sense of anxiety, it is called a panic attack. Panic attacks come on quickly and often involve difficulty breathing, feelings of choking or smothering, dizziness, nausea, racing heart, chest pains, sweating, chills or heat sensations, fears of losing control or going crazy, and thoughts about death or that something serious is going wrong. Sometimes people feel like they are in a dream, that the experience is surreal, or that they are no longer themselves.

Panic attacks become Panic Disorder when they are experienced recurrently, happen unexpectedly, are accompanied by persistent concerns about the attacks, and frequent worries about having another attack.

Video: Case Example of Panic: Initial Interview

Agoraphobia involves a strong fear of being in certain situations, such as using public transportation, being in open spaces (e.g., parking lots, marketplaces), being in enclosed places (e.g., stores, theaters), standing in line or being in a crowd, or being outside of the home. These places are avoided because the individual fears that they might have a panic attack, lose control, or experience embarrassing symptoms (e.g., falling, getting sick to one’s stomach, losing control of one’s bladder).

Very often agoraphobia restricts the range of activities the person engages in. They always experience fear in these situations and avoid them or only go if a trusted companion accompanies them.

Video: Dr. Ali Mattu Explains the Basics of Agoraphobia

Behavior Therapy. This form of treatment directly exposes the individual to the feared object. It helps the individual to learn that they can cope with their fears.

Video: Case Example of Treating Snake Phobia

The following videos from a BBC special illustrates the basis of anxiety disorders through specific phobias and provides a good explanation of some treatment approaches.

• Primal Fear 1: Jackie, Fear of Birds
• Primal Fear 2: Ryan, Fear of Flying
• Primal Fear 3: Trevor Fear of Heights
• Primal Fear 4: Jackie and Salkovskis Exposure

Treatment for social anxiety often involves the development and practice of social skills (i.e., how to start and maintain a conversation, learning about assertiveness). Testing these skills out in real situations can be very helpful. Oftentimes, social anxiety also involves beliefs about oneself that sometimes are exaggerated by a focused attention on internal signs of nervousness and negative assumptions about what others may be thinking. Cognitive therapy helps the individual to see themselves more realistically and to modify thoughts that are unnecessarily anxiety provoking.

• Video: Demonstration of Techniques used in Cognitive Therapy for Social Anxiety Disorder
• Video: CBT for Social Anxiety Disorder: Using Downward Arrow and Thought Challenging Techniques
• Video: Social Anxiety Disorder: CBT Behavioral Experiment Case Example

This video by Dr. Greenwood provides a good explanation of the basis of panic disorder and how cognitive therapy can be used to treat panic disorder. The primary focus of treatment is often based on the primary symptom (internal sensation) that the individual experiences (e.g., heart racing, difficulty breathing) and the thoughts about that sensation (e.g., “I am having a heart attack” or “I am suffocating”). Education about the sympathetic nervous system, exposure to these sensations, along with changing one’s beliefs about their danger is the key to a successful outcome.

Video: How Cognitive Therapy can be Used to Treat Panic Disorder

Panic attacks and agoraphobia sometimes occur together. Exposure to feared situations allows the individual to learn that those situations aren’t often as dangerous as they sometimes seem and that coping with anxiety is possible.

Video: Example of Exposure Treatment for Panic Disorder with Agoraphobia