Having surgery is never a pleasant experience whether it’s for medical or aesthetic purposes. It’s common for a sterile and unfamiliar hospital environment to induce stress in patients, however, there is a difference between nervousness and a fear of surgery becoming a psychological issue. If your fear of surgery is causing extreme anxiety there are a few things you can do about it. We asked three therapists to give insight into the physical and mental effects of stress, and way to treat anxiety.

What are the symptoms of extreme fear of surgery? How do I know if I am just nervous or if I’m suffering from anxiety?

“It needs to be understood that anxiety and nerves are normal, we are supposed to be anxious or nervous in some situations and that is healthy. It's when that anxiety crosses the line of becoming an irrational fear or phobia.”
Alan Piper, Wise Blue Owl Therapy Centre

“Patients who are more relaxed prior to anaesthesia are shown to have fewer complications during surgery, and subsequent recovery. In this context, strong anxiety, as an emotion isn’t particularly useful.

Anxious thoughts are usually nothing more than ruminations about the future; a time that neither exists nor is relevant; when little or no influence is available. And it is perhaps that lack of ‘control’ which causes most anxiety. The ‘what if’s?’
If we must engage with ‘what if’s’, be sure to include “what if it turns out okay?”
Fear, on the other hand, is present moment emotion and is primarily involved with the reality of a clear and present ‘threat’ to our wellbeing. Now, arguably, depending on what has been discussed with your surgical team, there may be a threat to be considered. Be sure that the answers to questions you have asked before surgery are exactly what has been said! This means repeating back any ambiguity you may have.”
Bob Brotchie, Anglia Counselling

“The difference between feeling nervous or anxious is determined by:
a) How strongly you physically feel the fear
b) The thought patterns associated with the fear
c) The behaviours this creates

Perhaps, when thinking about your upcoming surgery, you have a mildly increased heart rate and butterflies in your stomach, you start thinking ‘this feels a bit scary but it will be ok’ and you cautiously proceed through the pre-op process. If you're exhibiting these feelings you're probably nervous.

If on the other hand, you feel dizzy, hot and cold and are about to vomit/need the toilet, then this is anxiety. Possible thought patterns may be ‘What if something bad happens? I can't do this!’ and resulting behaviour pattern might include exhibiting resistance to the surgery by finding excuses not to do it.

If you are experiencing a level of anxiety that is causing you distress it may be worth seeking help for this through therapeutic interventions.”
Gemma Greenland, New Steps Therapy

Where does fear of surgery come from? What are patients’ most common fears?

“Most phobia is due to some kind of past bad experience or learning. Either from what someone has said in the negative sense or what a person has experienced in a negative sense. That is what starts the irrational fear or phobia off."
Alan Piper, Wise Blue Owl Therapy Centre

“Less clear causes are often rooted in childhood. As children, we absorb information about the world around us and try to make sense of it the best we can. However, children don't always get this right; sometimes we create internal beliefs that may not be factually accurate. For example, perhaps, as a child, you might have known an elderly relative who had surgery to try and prolong their life, which was unsuccessful. The child's brain processes this to mean: ‘They had surgery and then they died, therefore surgery equals death.’ This message gets internalised and so even as we grow up and can logically assess this as inaccurate, there is still an emotion-led belief that this is the case.

Many other subtle experiences can lead to incorrect subconscious beliefs that result in fear. Maybe your mother experienced the difficult birth (C-section) of a younger sibling, and you lived through the strain at home that this can put on a family? Perhaps you had a friend at school who had an operation resulting in them being away from their friends for a long time, which you internalised as a negative experience? The possibilities are varied and numerous. The good news is that all of this can be resolved via therapy.“
Gemma Greenland, New Steps Therapy

What can I do as a patient to relax before surgery?

“In order to cope with reasonable fear it is helpful to acknowledge this emotion when it is present. The old adage is: ‘Name it to tame it.’
I am frightened … yes … it is true… and I can choose to find acceptance for this, for now.
With any and all these emotions, the challenge is learning to find new perspectives in order to relinquish our false sense of control – and trust in the outcome. This isn’t just a nice thing to do, as I mentioned earlier, it can actually influence the surgical procedure itself!”
Bob Brotchie, Anglia Counselling

“There are many techniques available to help you relax. Here are my top four:

1. Deep breathing Inhale through your nose, hold the breath, then exhale through your mouth. It can help to add a count to the breaths, for example, 4-4-4 breathing means to breathe in for a slow count of 4, hold it for 4 and breathe out for 4.

2. Muscle relaxation exercises Starting at the top of your head, focus on releasing and relaxing the muscles throughout your head and face, followed by neck and shoulders, then chest and arms, and so on, all the way down through your body, to the tips of your toes. A good way practice this is to relax a new muscle group each time you exhale during your deep breathing.

3. Positive self-talk Positive self-talk is a way of reassuring yourself, allowing you to feel safer and calmer. Choose a sentence or two that you can say to yourself, silently in your head that you would help you feel better, if you heard it from someone you trust. Perhaps it's "I'm safe, everything's okay", or maybe "I'm calm, relaxed and safe".

4. Visualisation Finally, picture in your head a place that makes you feel happy, relaxed and safe. Many people choose tropical beaches or cosy rooms with roaring fires. Pick what is right for you and imagine yourself there.

Techniques one and two relax your body, three and four calm the mind. When used together they work effectively to ease anxiety.”
Gemma Greenland, New Steps Therapy

How is fear of surgery treated with therapy?

“When a client and therapist collaborate, they can explore and understand what makes this situation overwhelming for the patient. Depending on the patient, and the skill and scope of practice of the therapist, one or more therapies may be employed for optimal results. These are likely to include exploration of the client’s past, how resilient they are ‘emotionally’, teaching relaxation techniques, and strategies for managing the thoughts associated with fears.

Ultimately, I want the patient to feel empowered over what they currently fear. That they feel (rightly so) they have a choice, and with all the information required available, they can safely choose surgery, and all that is associated with the process for recovery from whatever has brought them to this place in time.”
Bob Brotchie, Anglia Counselling

“Hypnosis is used to address the underlying subconscious fear. Here, the client is taught to relax body and mind, before listening to hypnotic suggestions designed to eliminate the fear. Often the client is asked to imagine themselves undergoing surgery whilst experiencing a strong feeling of safety and calm. From this, the subconscious mind is able to associate surgery with new, positive feelings, therefore removing the old fear response.

The client is also taught to identify their unique anxiety reactions and, based on these, shown how to use the relaxation techniques discussed above, and a number of others, in a way that is quickly effective.

Psycho-education and counselling are used to teach the client what anxiety actually is, and that it is nothing to be afraid of in itself, to allay any specific concerns through talking about them and to address any past incidents or connections that may have triggered the fear in the first place.
Through this powerful combination of therapeutic methods, the fear is removed on both a conscious and subconscious level, leaving the client feeling safe, relaxed, willing and able to undergo their surgery.”
Gemma Greenland, New Steps Therapy

Bob Brotchie

He is a counsellor at Anglia Counselling in Newmarket (www.angliacounselling.co.uk). He worked as a senior emergency paramedic for two decades during which time he won awards for his work, before receiving his license in Counselling and Psychotherapy and a Diploma in Cognitive Behaviour Therapy.

Gemma Greenland

She is a therapist at New Steps Therapy in Cardiff (www.cardiff-therapy.co.uk). Her qualifications include an Honours Degree in Psychology, a Diploma in Hypnotherapy, a Diploma in Psychotherapeutic Counselling and a Masters Degree in Play Therapy.

Alan Piper

He is a therapist at the Wise Blue Owl Therapy Centre in Surrey (www.wiseblueowl.co.uk). He is a member of the General Hypnotherapy Standards Council and General Hypnotherapy Register. He also holds a diploma in neuro-linguistic programming and complete mind therapy and is a Reiki and Shamanic master specialising in panic disorders.