When anxiety is a response to specific situations or objects (e.g. phobic or obsessive-compulsive reactions), the treatment of choice is systematic exposure to the anxiety-evoking situations.1 Accompanying relaxation contributes little to the therapeutic effect. When anxiety is pervasive, that is, without a specific focus, exposure methods are less successful. Among psychiatric out-patients, pervasive anxiety is more frequent than specific phobias, and is present in about one quarter of patients seen by GPs because of emotional upset.2 Patients typically complain of a feeling of apprehension without obvious cause. The anxiety may be chronic, frequently with episodic exacerbations, and is usually accompanied by one or more somatic symptoms such as palpitations, dizziness, tremor or headache. Reducing stress by discussing the patient’s problems and strongly reassuring him that he is not physically ill is part of routine management3 and is not discussed further here.
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