Unreasonable Feelings of Fear: Hidden Causes and Effective Methods of Combating. How to get rid of anxiety

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Anxiety disorders and panic: causes of their occurrence, signs and symptoms, diagnosis and therapy

Under anxiety disorders imply conditions accompanied by excessive excitability of the nervous system, as well as a strong unreasonable feeling of anxiety and signs observed in the presence of certain pathologies of internal organs. This type of disorder can occur against the background of chronic fatigue, stress, or a serious illness. Such conditions are often called panic attacks.
Obvious signs of this condition include dizziness and an unreasonable feeling of anxiety, as well as pain in the abdomen and chest, fear of death or imminent disaster, difficulty breathing, and a feeling of a “lump in the throat.”
Both the diagnosis and treatment of this condition are carried out by a neurologist.
Treatment for anxiety disorders involves the use of anti-anxiety medications, psychotherapy, and numerous stress-relieving and relaxation techniques.

Anxiety disorders - what are they?

Anxiety disorders refer to a number of pathologies of the central nervous system, which are characterized by a constant feeling of anxiety that occurs for unknown or insignificant reasons. With the development of this condition, the patient may also complain of signs of some other ailments of the internal organs. So, for example, he may experience difficulty breathing, pain in the abdomen or chest, cough, feeling of a lump in the throat, and so on.

What are the causes of anxiety disorders?

Unfortunately, scientists have not yet been able to establish the true cause of the development of anxiety disorders, but the search for it is still ongoing. Some scientists argue that this disease is a consequence of a malfunction of certain parts of the brain. Psychologists have come to the conclusion that this type of disorder makes itself felt due to psychological trauma, against the background of excessive fatigue or severe stress. It is psychologists who are confident that this condition can also arise if a person has a very erroneous idea about certain things, which causes him a constant feeling of anxiety.

If we take into account the fact that the modern population is simply forced to lead an active lifestyle, it turns out that this condition can develop in each of us. Factors that can provoke the development of this type of disorder also include psychological trauma resulting from a serious illness.

How can we distinguish “normal” anxiety, which gives us the opportunity to survive in a dangerous situation, from pathological anxiety, which is a consequence of an anxiety disorder?

1. First of all, it is worth noting that senseless anxiety has nothing to do with a specific dangerous situation. It is always fictitious, since the patient simply imagines in his mind a situation that does not actually exist. The feeling of anxiety in this case exhausts the patient, both physically and emotionally. The person begins to experience a feeling of helplessness, as well as excessive fatigue.

2. “Normal” anxiety is always related to a real situation. It does not tend to disrupt a person’s performance. As soon as the threat disappears, the person’s anxiety immediately goes away.

Anxiety disorders – what are their signs and symptoms?

In addition to a constant feeling of anxiety, which is considered to be the main sign of this type of disorder, a person may also experience:

Fear of situations that do not actually exist, but the person himself believes that this can happen to him
Frequent mood swings, irritability, tearfulness
Fussiness, timidity
Wet palms, hot flashes, sweating
Excessive fatigue
Impatience
Feeling low on oxygen, unable to take deep breaths, or suddenly needing to take deep breaths
Insomnia, sleep disturbances, nightmares
Memory impairment, impaired concentration, decreased mental abilities
Feeling of a “lump in the throat”, difficulty swallowing
Feeling of constant tension that makes it impossible to relax
Dizziness, blurred vision, rapid heartbeat
Pain in the back, lower back and neck, feeling of muscle tension
Pain in the chest, around the navel, in the epigastric region, nausea, diarrhea

It is important to note the fact that all the symptoms that were presented to the attention of readers just above very often resemble signs of other pathologies. As a result, patients turn to a huge number of specialists for help, but not to a neurologist.

Quite often, such patients also have phobias - fear of certain objects or situations. The most common phobias are considered to be:

1. Nosophobia– fear of a specific illness or fear of getting sick in general ( for example, cancerophobia - fear of getting cancer).

2. Agoraphobia– fear of finding yourself in a crowd of people or in an excessively large open space, fear of not being able to get out of this space or crowd.

3. Social phobia– fear of eating in public places, fear of being in the company of strangers, fear of speaking in public, and so on.

4. Claustrophobia– fear of being in confined spaces. In this case, a person may be afraid to remain in a locked room, in transport, in an elevator, and so on.

5. Fear in front of insects, heights, snakes and the like.

It is worth noting that normal fear differs from pathological fear, first of all, in its paralyzing effect. It occurs for no reason, while completely changing a person’s behavior.
Another sign of an anxiety disorder is considered to be obsessive-compulsive syndrome, which is constantly emerging ideas and thoughts that provoke a person to some of the same actions. So, for example, people who constantly think about germs are forced to thoroughly wash their hands with soap almost every five minutes.
Mental disorder is one of the anxiety disorders, which is accompanied by sudden, recurring panic attacks that occur without any reason. During such an attack, a person experiences rapid heartbeat, shortness of breath, and fear of death.

Features of anxiety disorders in children

The feeling of panic and anxiety in a child in most cases is explained by his phobias. As a rule, all children who have this condition try not to communicate with their peers. For communication, they choose grandmothers or parents, since among them they feel out of danger. Quite often, such children have low self-esteem: the child considers himself worse than everyone else, and is also afraid that his parents will stop loving him.

Diagnosis of anxiety disorders and panic attacks

A little higher, we already said that in the presence of anxiety disorders, the patient experiences numerous symptoms similar to signs of diseases of the nervous system, digestive tract, goiter, asthma, and so on. As a rule, the diagnosis of this pathology can be established only after all pathologies accompanied by the same symptoms have been excluded. Both diagnosis and therapy of this disease are within the competence of a neurologist.

Anxiety Therapy

Therapy for this type of condition involves psychotherapy, as well as taking medications that tend to reduce anxiety. These medications are anxiolytics.
As for psychotherapy, this method of treatment is based on numerous techniques that enable the patient to really look at everything that is happening, and also help his body relax during an attack of anxiety. Psychotherapeutic techniques include breathing exercises, breathing into a bag, auto-training, as well as developing a calm attitude towards obsessive thoughts in the case of obsessive-compulsive syndrome.
This method of therapy can be used individually or to treat a small number of people at the same time. Patients are taught how to behave in certain life situations. Such training makes it possible to gain self-confidence, and, consequently, to overcome all threatening situations.
Therapy of this pathology through medications involves the use of medications that help restore normal metabolism in the brain. As a rule, in such cases, patients are prescribed anxiolytics, that is, sedatives. There are several groups of such medications, namely:

Neuroleptics (Tiapride, Sonapax and others) is very often prescribed to patients in order to relieve them of excessive feelings of anxiety. When using these medications, side effects such as obesity, decreased blood pressure, and lack of sexual desire may become apparent.
Benzodiazepine drugs (Clonazepam, Diazepam, Alprazolam ) make it possible to forget about the feeling of anxiety in a fairly short period of time. With all this, they can also cause the development of some side effects such as loss of coordination, decreased attention, addiction, and drowsiness. The course of therapy with these medications should not exceed four weeks.

Worry and anxiety in the soul are integral components of everyday life. Most often, people feel anxious when faced with an unfamiliar situation or some kind of danger. Concern can be caused by a sports competition, an exam, an important meeting, or an interview.

The feeling of anxiety has a dual effect on the body. On the one hand, it affects the psychological state, reduces concentration, makes you worry, and disrupts sleep. On the other hand, it greatly affects the physical condition, causing trembling, dizziness, sweating, indigestion, and other physiological disorders.

Anxiety can be considered painful if the resulting anxiety is stronger than the situation requires. Increased anxiety belongs to a separate group of diseases, they are called pathological anxiety states. Such ailments occur to one degree or another in 10% of people.

Symptoms:

1. Panic. It manifests itself in the form of unexpected, periodically repeated attacks of severe anxiety and fear, often without cause. Sometimes combined with agoraphobia, open spaces.

2. Obsessive In this state, a person has the same type of thoughts, desires and ideas. For example, he constantly checks whether the doors are locked, whether electrical appliances are turned off, and often washes his hands.

3. Phobias. These fears defy logic. These include social ones, which force a person to avoid appearing in public, and simple ones, which evoke a feeling of fear of spiders, snakes, and heights.

4. Generalized disorders based on anxiety. In this situation, a person experiences a constant feeling of anxiety. This may contribute to the appearance of mysterious physiological symptoms. There are cases when doctors cannot find the cause of a disease for a long time, and a large number of tests are prescribed to identify diseases of the digestive, nervous system, and heart. But the reason lies in psychological disorders.

5. Disorders accompanying post-traumatic stress. They are common among war veterans, but can occur in any person who has experienced an event outside their normal life. Often such events are experienced repeatedly in dreams.

What to do in such cases? requires contacting a doctor.

In your daily life, try to minimize factors that contribute to increased anxiety. These include:

drinks that stimulate the nervous system (coffee, strong tea, energy drinks);
smoking;
drinking alcohol, especially for sedative purposes.

Reduce anxiety:

Tinctures and teas based on (peony, motherwort, valerian).
relaxation, the ability to physically relax (bathing, yoga, aromatherapy). They go well with moderate physical activity beforehand.
Developing psychological stability and a healthy attitude towards the surrounding reality.

How can the doctor help?

Consultation with a specialist will be appropriate in any case, regardless of what caused your anxiety. These types of disorders are treated using several effective techniques. Short-term conditions allow drug therapy.

Behavioral treatment is also very popular these days. These methods help a person understand that he does not have any psychological illnesses and teach him to overcome anxiety. The patient gradually realizes the reasons for his anxiety. He learns to evaluate his behavior from a logical point of view, to look at the causes of anxiety in a new, more positive way. For example, the fear of flying on an airplane can be contrasted with the anticipation of a wonderful holiday abroad. This treatment is especially relevant for people suffering from agoraphobia, which often prevents them from using public transport during rush hours.

The most important thing is not to ignore increased feelings of anxiety. A healthy approach to solving this problem will help make your life calmer and more joyful.

Feelings of anxiety and fear are familiar to every person. They usually occur when there is a reason. As soon as the circumstances that caused them disappear, the psycho-emotional state also stabilizes. However, there are times when constant fear and anxiety become commonplace, these feelings begin to haunt and become a habitual state.

Fear and anxiety as symptoms of the disease

Feelings of constant fear and anxiety can be symptoms of a variety of diseases. Most of them are the area of work of a psychotherapist. In any case, you need to listen to your own feelings and decide whether you should contact a specialist, or you can try to solve the problem yourself.

The most common diagnosis, the symptoms of which are fear and anxiety, is anxiety or fear neurosis. However, this can be finally verified or refuted only by seeking qualified help.

Causes of fear and anxiety

If there are no obvious reasons to be afraid and worry, you should find out why the person is experiencing constant tension. In fact, the reasons lie in a combination of physiological and psychological factors. The connection between generations, that is, heredity, is of great importance in solving the problem. That is why, before diagnosing anxiety syndrome or another disease in a child, you need to find out whether parents and close relatives suffer from similar problems.

Psychological causes of constant fear and anxiety

Among the psychological reasons that cause constant fear and anxiety are:

strong emotional experiences, stress. For example, when changing place of residence, there is a fear of change and anxiety for the future;
suppression of one’s deepest desires and needs, restraining emotions.

Physical causes of constant fear and anxiety

The main cause of all nervous mental disorders usually lies in the malfunction of the thyroid gland. Disturbances in the endocrine system entail a hormonal imbalance, which leads to the active production of fear hormones. They are the ones who control a person’s mood, making them fear, worry and worry for no apparent reason.

In addition, it is of great importance:

strong physical activity;
severe course of the underlying disease;
presence of withdrawal syndrome.

Constant fear and anxiety in pregnant women

Pregnant women, as well as those who have recently become mothers, experience severe hormonal changes. Associated with this are unpleasant feelings of anxiety and fear for your life, for the life and health of the baby. Added to this is a lot of new knowledge gleaned from medical literature and the stories of those who have already gone through this. As a result, fear and anxiety become permanent, and the expectant mother does not need nervous stress at all.

If this happens to you, then enlist the support of your loved ones, as well as an experienced doctor who is ready to advise you on any issues.

Such symptoms are troubling in case of mental disorders or physical stress

Treating persistent fear and anxiety

Self-treatment of anxiety and fears

If you have just recently begun to feel that you are haunted by constant fear and anxiety, but there are no other symptoms and you have not experienced severe emotional distress, then you can take steps to self-treat. The word “treatment” here is conditional. Try the following tips:

think about switching to a healthy lifestyle and proper nutrition. This will not only help you maintain good physical shape, but also stabilize your hormonal levels;
sleep and rest more;
combine mental stress with physical exercise, only in conditions of such a balance will you feel in good shape;
Find something to do that gives you maximum emotional satisfaction. It can be any hobby;
communicate with people you like and limit unwanted contacts;
try not to think about what bothers you, especially if these events are in the past. There is no point in imagining an unfavorable future by deliberately exaggerating;
Find a relaxation method that suits you. This could be auto-training, a relaxing bath, massage and much more.

Observation by a specialist for fears and anxiety

If you feel that it is becoming difficult for you to live with a feeling of constant fear and anxiety, that these sensations interfere and change your usual way of life, then seek help from a psychotherapist. An argument in favor of consulting a specialist will be the accompanying feeling of heaviness in the chest, pressure in the heart area, and difficulty breathing.

Treatment may involve a combination of psychotherapy and medication. Only timely treatment will become the basis for effective relief from fears and anxieties. A psychiatrist or psychotherapist will determine how severe the stage of the disease or disorder is, based on the data obtained, he will prescribe an appropriate approach.

Not everyone who suffers from constant fear and anxiety needs pills. The drug method is used only if you need to quickly relieve symptoms and achieve results. In such situations, tranquilizers and antidepressants are prescribed.

Psychotherapeutic treatment can be combined with examinations of the whole body, especially to identify disorders of the thyroid gland.

The key to successful treatment is being attentive to yourself and following the doctor’s recommendations.

Anxiety and fear, how to get rid of these unpleasant sensations. Inexplicable tension, anticipation of trouble, mood swings, when you can cope on your own, and when you need the help of specialists. In order to understand how dangerous it is, how to get rid of them, why they arise, how you can remove anxiety from the subconscious, it is necessary to understand the causes and mechanisms of the appearance of these symptoms.

The main causes of anxiety and fear

Anxiety has no real basis and is an emotion, a fear of an unknown threat, a fictitious, vague premonition of danger. Fear appears upon contact with a certain situation or object.

The causes of fear and anxiety can be stress, anxiety, illness, resentment, and troubles at home. The main manifestations of anxiety and fear:

Physical manifestation. It is expressed by chills, rapid heartbeat, sweating, asthma attacks, insomnia, lack of appetite or the inability to get rid of hunger.
Emotional condition. It manifests itself as frequent excitement, anxiety, fear, emotional outbursts or complete apathy.

Fear and anxiety during pregnancy

The feeling of fear in pregnant women is associated with worry about their future children. Anxiety comes in waves or haunts you day after day.

The causes of anxiety and fear can be caused by various factors:

Hormonal changes in the body of some women make them calm and balanced, while others do not get rid of tearfulness;
Family relationships, financial situation, experience of previous pregnancies affect the level of stress;
An unfavorable medical prognosis and stories from those who have already given birth do not allow one to get rid of anxiety and fear.

Remember Every expectant mother's pregnancy proceeds differently, and the level of medicine makes it possible to achieve a favorable outcome in the most difficult situations.

Panic attack

A panic attack comes unexpectedly and usually occurs in crowded places (large shopping centers, metro, bus). There is no threat to life or visible reasons for fear at this moment. Panic disorders and associated phobias plague women from 20 to 30 years of age.

An attack is provoked by prolonged or one-time stress, hormone imbalance, diseases of internal organs, temperament, and genetic predisposition.

There are 3 types of attack:

Spontaneous panic. Appears unexpectedly, without reason. Accompanied by severe fear and anxiety;
Conditional situational panic. It is provoked by exposure to chemical (for example, alcohol) or biological (hormonal imbalance) substances;
Situational panic. The background for its manifestation is the reluctance to get rid of the expectation of problems or the traumatic component.

The most common symptoms include the following conditions:

Painful sensations in the chest;
Tachycardia;
VSD (vegetative-vascular dystonia);
High pressure;
Nausea, vomiting;
Fear of death;
Headaches and dizziness;
Flashes of hot and cold;
Shortness of breath, feelings of fear and anxiety;
Sudden fainting;
Unrealization;
Uncontrolled urination;
Deterioration of hearing and vision;
Impaired coordination of movements

Anxiety neurosis, features of appearance

Anxiety neurosis occurs under the influence of prolonged mental stress or severe stress and is associated with a malfunction of the autonomic system. This is a disease of the nervous system and psyche.

The main symptom is anxiety, accompanied by a number of symptoms:

Unreasonable anxiety;
Depressed state;
Insomnia;
Fear that you can’t get rid of;
Nervousness;
Intrusive anxious thoughts;
Arrhythmia and tachycardia;
Feeling of nausea;
Hypochondria;
Severe migraines;
Dizziness;
Digestive disorder.

Anxiety neurosis can be either an independent disease or a concomitant condition of phobic neurosis, depression or schizophrenia.

Attention! The disease quickly turns into a chronic disease, and the symptoms of anxiety and fear become constant companions; it is impossible to get rid of them if you do not consult a specialist in time.

During periods of exacerbation, attacks of anxiety, fear, tearfulness, and irritability appear. Anxiety can gradually degenerate into hypochondria or obsessive-compulsive neurosis.

Features of depression

The reason for its appearance is stress, failure, lack of fulfillment and emotional shock (divorce, death of a loved one, serious illness). Depression is a disease that mainly affects residents of large cities. Failure of the metabolic process of hormones responsible for emotions causes causeless depression.

Main manifestations:

Sad mood;
Apathy;
Feelings of anxiety, sometimes fear;
Constant fatigue;
Closedness;
Low self-esteem;
Indifference;
Reluctance to make decisions;
Lethargy.

Hangover anxiety

Intoxication of the body occurs in everyone who drinks alcoholic beverages.

To get rid of it, all organs join the fight against poisoning. The reaction from the nervous system is manifested in a person’s feeling of intoxication, accompanied by frequent mood swings that cannot be eliminated, and fear.

Then comes a hangover syndrome, accompanied by anxiety, manifested as follows:

Mood swings, neuroses in the morning;
Nausea, discomfort in the abdomen;
Tides;
Dizziness;
Memory losses;
Hallucinations accompanied by anxiety and fear;
Pressure surges;
Arrhythmia;
Despair;
Panic fear.

Psychological techniques to help get rid of anxiety

Even calm and balanced people periodically experience anxiety; what to do, how to get rid of anxiety and fear in order to regain peace of mind.

There are special psychological techniques for anxiety that will help get rid of problems:

Give in to anxiety and fear, set aside 20 minutes a day for this, just not before bed. Immerse yourself in a sore subject, give free rein to your tears, but as soon as time is up, proceed with your daily activities, get rid of anxieties, fears and worries;
Get rid of anxiety about the future, live in the present. Imagine anxiety and fear as a stream of smoke rising and dissolving high in the sky;
Don't dramatize what's happening. Get rid of the desire to control everything. Get rid of anxiety, fear and constant tension. Knitting and reading light literature make life calmer, relieve feelings of hopelessness and depression;
Play sports, get rid of despondency, it improves your mood and increases self-esteem. Even 2 half-hour workouts a week will help relieve many fears and get rid of anxiety;
An activity you enjoy, a hobby, will help you get rid of anxiety;
Meetings with loved ones, hikes, trips are the best way to get rid of internal experiences and anxiety.

How to get rid of fear

Before fear crosses all boundaries and turns into pathology, get rid of it:

Don’t concentrate on disturbing thoughts, get rid of them, learn to switch to positive aspects;
Do not dramatize the situation, realistically assess what is happening;
Learn to quickly get rid of fear. There are many ways: art therapy, yoga, switching techniques, meditation, listening to classical music;
Focus on the positive by repeating, “I am protected. I'm fine. I am safe,” until you get rid of fear;
Don’t be afraid of fear, psychologists advise studying it and even talking and writing letters to your fear. This allows you to get rid of it faster;
To get rid of fear within yourself, meet it, go through it over and over again until you manage to get rid of it;
There is a good breathing exercise for getting rid of fear and anxiety. You need to sit comfortably, straighten your back and begin to breathe slowly deeply, mentally imagining that you are inhaling courage and exhaling fear. In about 3-5 minutes you will be able to get rid of fear and anxiety.

What to do if you need to quickly get rid of fear?

There are times when you need to quickly get rid of fear. These can be emergency cases where life and death are at stake.

A psychologist's advice will help you get rid of shock, take the situation into your own hands, and suppress panic and anxiety:

Breathing techniques will help you calm down and get rid of anxiety and fear. Take a slow, deep breath in and out at least 10 times. This will make it possible to realize what is happening and get rid of anxiety and fear;
Get very angry, this will relieve fear and give you the opportunity to act immediately;
Talk to yourself, calling yourself by name. You will calm down internally, get rid of anxiety, be able to assess the situation you find yourself in and understand how to act;
A good way to get rid of anxiety, remember something funny and laugh heartily. The fear will quickly disappear.

When should you seek help from a doctor?

From time to time, every person experiences feelings of anxiety or fear. Usually these sensations do not last long, and you can get rid of them on your own. If your psychological state is out of control and you can no longer get rid of anxiety on your own, you need to consult a doctor.

Reasons for visiting:

Attacks of fear are accompanied by panic horror;
The desire to get rid of anxiety leads to isolation, isolation from people and an attempt by all means to get rid of an uncomfortable situation;
Physiological component: chest pain, lack of oxygen, dizziness, nausea, pressure surges, which cannot be eliminated.

An unstable emotional state, accompanied by physical exhaustion, leads to mental pathologies of varying severity with increased anxiety.

You cannot get rid of these types of anxiety on your own; you need medical help.

How to Get Rid of Worry and Anxiety with Medication

To relieve the patient of anxiety and fear, the doctor may prescribe treatment with pills. When treated with pills, patients often experience relapses, so in order to completely get rid of the disease, this method is combined with psychotherapy to achieve a good result.

Mild forms of mental illness can be treated by taking antidepressants. In order to finally get rid of symptoms with positive dynamics, a course of maintenance therapy is prescribed for a period of six months to a year.

In severe forms of the disease, the patient is treated inpatiently and placed in a hospital.

Antidepressants, antipsychotics and insulin are administered to the patient by injection.

Drugs that relieve anxiety and have a sedative effect can be purchased freely at pharmacies:

Valerian acts as a mild sedative. Taken for 2-3 weeks, 2 pieces per day.
Persen is drunk 2-3 times within 24 hours, 2-3 pieces each, to get rid of causeless anxiety, fear and restlessness for a maximum of 2 months.
Novo-passit is prescribed to get rid of causeless anxiety. Drink 1 tablet 3 times a day. The duration of the course depends on the clinical picture of the disease.
Grandaxin 3 times a day after meals to relieve anxiety.

Psychotherapy for anxiety disorders

Panic attacks and unreasonable anxiety are well treated with the help of cognitive behavioral psychotherapy, based on the findings that the causes of mental illness and psychological problems lie in the distortions of the patient's thinking. He is taught to get rid of inappropriate and illogical thoughts, taught to solve problems that previously seemed insurmountable.

It differs from psychoanalysis in that it does not attach importance to childhood memories, the emphasis is on the current moment. A person learns to act and think realistically, getting rid of fears. To get rid of anxiety you need from 5 to 20 sessions.

The technical side of the technique consists in repeatedly immersing the patient in a situation that causes fear and teaching him to control what is happening. Constant contact with the problem gradually allows you to get rid of anxiety and fear.

What is the treatment?

Generalized anxiety disorder is characterized by a general, persistent state of anxiety that is not related to specific situations or objects. It has a not very strong, but long-lasting, exhausting effect.

To get rid of the disease, the following methods are used:

Method of exposure and reaction prevention. It consists of completely immersing yourself in your fear or anxiety. Gradually, the symptom becomes weaker and it is possible to completely get rid of it;
Cognitive behavioral psychotherapy gives very good results in getting rid of causeless anxiety.

Coping with panic attacks and anxiety

Tranquilizers are traditionally used to relieve anxiety and panic attacks. These drugs quickly relieve symptoms, but have side effects and do not eliminate the causes.

In mild cases, you can use preparations made from herbs: birch leaves, chamomile, motherwort, valerian.

Attention! Drug therapy is not sufficient to get rid of all problems in the fight against panic attacks and anxiety. The best treatment method is psychotherapy.

A good doctor not only prescribes medications that relieve symptoms, but also helps to understand the causes of anxiety, making it possible to get rid of the possibility of the disease returning.

Conclusion

The modern level of development of medicine allows you to get rid of feelings of anxiety and fear in a short time if you contact specialists in a timely manner. An integrated approach is used in treatment. The best results are achieved with a combination of hypnosis, physical rehabilitation, cognitive behavioral psychotherapy and drug treatment (in difficult situations).