Understanding Anxiety

Managing Anxiety

• Anxiety involves feelings of uneasiness, uncertainty, and helplessness.
• Anxiety is a normal emotional reaction to both real and imagined threats or stressors.
• It warns of possible danger, and mild anxiety can sharpen focus.
• Uncontrolled anxiety often leads to maladaptive behavior, but it is a normal part of growth and survival.

Continuum of Anxiety Responses

• Reactions to anxiety exist on a range of behavioral responses.
• Adaptive responses result in new learning and self-esteem, thus helping growth.
• Maladaptive responses are ineffective coping attempts resolving no problems.
• Anxiety responses exist on four levels from mild to panic.

Anxiety Levels

• Mild anxiety includes minimal muscle tension and random but controlled thoughts, leading to feelings of relative comfort and safety.
• Moderate anxiety comes with tension and elevated vital signs, bringing alertness and focus, and feelings of readiness and challenge.
• Severe anxiety induces a fight-or-flight response with increased vital signs, sweating, and urinary urgency, making problem-solving difficult and inducing feelings of threat.
• Panic involves potential paleness, decreased blood pressure, poor muscle coordination, scattered or closed perception, and feelings of helplessness.

Types of Anxiety

• Signal anxiety is a learned response to an anticipated event, such as feeling nauseated during an exam.
• Anxiety state happens when abilities to cope are overwhelmed and emotional control is lost, like in accidents or emergencies.
• Anxiety trait is a learned component of someone's personality, causing anxiety in low-stress situations.

Types of Anxiety Reponses

• Physical symptoms include muscle tension, fidgeting, headaches, sleep problems, and fight-or-flight reactions.

Coping Mechanisms

• Coping mechanisms directly confront and manage the source of anxiety, like a woman fighting a thief.
• Intellectual coping makes threats seem less harmful by altering perception.
• Anxiety isn't produced if the event is not threatening.
• Spiritual coping: faith, prayer, and ritual are examples.
• Emotional responses consist of; crying, sharing anxious feelings, and using ego defense mechanisms.

Defense Mechanisms

• Defense mechanisms are psychological strategies to reduce anxiety.
• Compensation is used as a way to make up for a deficiency.
• Conversion channels anxiety into physical symptoms.
• Denial means the refusal to to acknowledge something.
• Displacement redirects emotions to another person or object.
• Dissociation separates emotions from situations.
• Fantasy is a distortion of unacceptable wishes or behaviors.
• Restitution involves "giving back" in order to resolve guilty feelings.
• The goal is to reduce negative emotions.

Crisis

• Crisis happens when one's ability to cope with anxiety is overwhelmed.
• Defense mechanisms no longer work under such conditions.
• New coping behaviors must be developed to resolve the problem.

Culture Considerations

• Japanese individuals may somatize anxiety or become physically ill.
• Dominican Republic mothers may wear red and save the umbilical cord to ward off anxiety about the evil eye.
• Many Greek men view body hair as a sign of manhood, which can cause anxiety when shaving for surgery.
• Vietnamese individuals experiencing panic attacks outdoors are labeled as trúng gió (hit by the wind).

Self-Awareness

• Anxiety is contagious.
• Clients are able to sense anxiety levels in healthcare providers.
• Caregivers need to acknowledge and handle their own anxieties.
• While we can't always choose what causes anxiety, we can control how to manage it.

Theories Related to Anxiety

• Biological models suggest dysfunction of neurotransmitters(chemical signals) is the reason.
• Psychodynamic models attribute it to conflicts between opposing forces within the personality.
• Interpersonal models claim anxiety coping is based on childhood perception and teachings.
• Behavioral Model: Anxiety is a learned response to an earlier anxious time.
• Environmental models point to uncontrolled events like disasters or traumas.

Anxiety Throughout the Life Cycle

Childhood

• Anxiety is learned and can be helped with early intervention and coping mechanism teaching.
• Infants experience discomfort when needs aren’t met.
• Toddlers fear things bigger or more "furious" than themselves.
• Preschoolers become anxious when separated from parents.
• Thumb sucking, biting nails, hair pulling and rhythmic body movements relieve anxiety.
• Separation Anxiety Disorder: anxiety when children are unable to be without their parents, they can develop severe panic.
• Common physical complaints are headaches, nausea and or vomitting.
• Nightmares, and fear of death, animals, monsters, and harmful situations.

Overanxious disorder

• Lasts longer than 6 months.
• Occurs in children whose parents focus on overachievement and downplay actual achievements.

Situational/Avoidant behaviors

• Exists when a child refuses to cope with issues, such as divorce, death or separation.

Unresolved Anxiety

• Can lead to post traumatic stress disorder, depression and/or suicide.

Adolescence

• Adolescents may express themselves inappropriately if they ineffectively cope with anxiety
• Can be expressed behaviorally through; running away, anger, defiance, aggression, or manipulative, experimenting with drugs, or engaging in high-risk behaviors.
• Often, denial is used as a coping mechanism
• Can lead to self-mutilation, anorexia, or bulimia.
• Health care providers must assess adolescents' anxiety levels and offer early intervention and education.

Adulthood

• Adults cope using earlier-established coping mechanisms.
• Establishing a career and family, presents several stressors.
• Uncontrollable situations can result in lasting anxiety and posttraumatic stress syndrome.
• Maladaptive responses include panic disorders, phobias, behavioral addictions, obsessions, and compulsive activities.

Older Adulthood

• Elders often refuse to recognize their anxiety.
• They may somatize, which is the physical expression of their feelings.
• Have been taught that it is inappropriate to share their anxieties.
• Changes in eating/sleeping habits, ability to concentrate, impatience and fatigue.
• One of the most effective methods for assessing anxiety is to simply ask.
• Older adults appreciate the interest of caregivers.

Anxiety Disorders

• Exists when anxiety is expressed in ineffective/maladaptive ways, and do not properly relieve distress.
• Coping can be physical, intellectual and/or spiritual.
• Diagnosing an anxiety disorder is based on behavioral observations.

Anxiety disorders

• Separation anxiety disorder: inappropriate fear and anxiety when separated from loved ones.
• Generalized anxiety disorder: anxiety that is broad, long-lasting, and excessive and the emotional response is out of proportion to situations and is difficult to control.

Panic Disorders

• Panic attack is a brief period of intense fear or discomfort.
• Duration of the attack is short, 1–15 minutes.
• Agoraphobia: Anxiety about a possible situation in which a panic attack can occur.
• The individual avoids people, places, or events from which escape would be difficult or embarrassing.
• Treatment Education about the disorder, use of medications, and adaptive coping strategies.
• Cognitive therapy to help people identify emotions and behaviors.
• Psychotherapy facilitates exploration of social and personal difficulties.

Phobic Disorders

• A phobia is an internal fear reaction that stems from specific situations, objects etc.
• Phobias are obsessive in nature.
• Characteristcis vary with the culture, such as; Fears of hexes, spells, magical spirits, and unseen forces.

Obsessive-Compulsive Disorder

• Involves specific behaviors to reduce anxiety.
• Most common obsessions: cleanliness, dirt, and germs; aggressive and sexual impulses; health concerns; safety concerns; order and symmetry.
• Possible as early as 3 years of age, but usually begins in adolescence.

Further Anxiety Disorders

• Body dysmorphic disorder: Obsession with a flaw in the body, that interferes daily, causing them to belive the flaw makes them ugly.
• This leads to to seek unnecessary cosmetic surgery, depression, eating orders and suicide.
• Use of Antidepressants and cognitive behavior is treatment, with a goal to accept self appearence without anxiety,.
• Hoarding disorder: Difficulty in parting with possessions.
• Complications; unclean living conditions, inability to perform basic tasks, risk of falls, infestation, isolation, and legal issues.
• Treatment with antidepressants and psychotherapy to understand need vs clutter.
• Hair-pulling: Complications include social problems, skin and hair damage, infections.
• Skin picking with causes lesions, tissue damage and infections that can be treated ruling out physical causes or drug abuse, implementing psychotherapy and support groups.

Additional behavioral Addictions

• Behaviors such as gambling, working, shopping, or excessive sexual activity, can destory personal and professional relationships.

Stressor and Trauma disorders

• Rape-Trauma Syndrome has reactions after trauma, especially rape-trauma syndrome (Anguish, repair and adaptation).
• The most imporant aspects are psychological stabilty, emotional support and advodcacy.
• Acute stress disorder from responses that follow an overwhelmingly stressful event.
• The individual relives/reacts to anxiety that causes; negative mood, sleep problems with concentration.
• Treatments include; stress reduction, safe environment, coping mechanisms, and emotional help.

Adjustment Disorder

• Distress out of proportion to event that occurs wihtin 3 months of event.
• Triggers impaired social, occupational functions with depression and suicide present.
• Treatment is Antidepressants and psychotherapy.
• Posttraumatic stress disorder: Occurs after sever trauma that is terrifying or life-threatening.
• Has features; intense fear, numbness, guarded with flashbacks that lead to reorientation and safety,.

Therapeutic Interventions

• Easiest way to cope with anxiety is to prevent it.
• Cognitive behavioral therapy helps understand ineffective behaviors, and replace them with better ones.
• Clients learn to cope with one anxiety-provoking stimulus at a time with systematic desensitization.
• Flooding uses rapid/repeated exposure to feared objects to diminish anxiety.
• Meditation and Therapy Animals can help.
• Medications like Benzodiazepines, Antidepressants, Antihistamines and Anxiolytics, help with anxiety with potential side effects (tables 18.3 and 18.4)
• Benzodiazepines are taken no alcahol with with food or milk and tapered after 4 months, otherwise Dependency, tolerance and rebound effects occur.
• Important; to gather Information, and client goals, along thorough physical examination.
• Protection if first priority, with a therapeutic relationship and coping mechanisms.
• Techniques involving relaxation, meditation, and exercising.

Explore the nature, purpose, and impact of anxiety. Questions cover coping mechanisms, emotional responses, and potential consequences of unresolved anxiety. Learn about anxiety's role in survival and adaptation.