Managing Anxiety - Chapter 18 - PDF

Managing Anxiety Chapter 18 Copyright © 2021 by Elsevier, Inc. All rights reserved. 1  Learning Objectives Lesson 18.1: Managing Anxiety (Slide 1 of 2) 1. Describe the continuum of responses to anxiety. 2. Identify three types of coping mec...

Managing Anxiety Chapter 18 Copyright © 2021 by Elsevier, Inc. All rights reserved. 1  Learning Objectives Lesson 18.1: Managing Anxiety (Slide 1 of 2) 1. Describe the continuum of responses to anxiety. 2. Identify three types of coping mechanisms used to decrease anxiety. 3. Explain how anxiety is experienced through each stage of the life cycle. 4. Compare the difference between normal anxiety and an anxiety disorder. Copyright © 2021 by Elsevier, Inc. All rights reserved. 2  Learning Objectives Lesson 18.1: Managing Anxiety (Slide 2 of 2) 5. Discuss the difference between phobic and obsessive- compulsive behaviors. 6. Examine three features of posttraumatic stress disorder. 7. List two therapeutic interventions for the client with rape-trauma syndrome. 8. Explain the importance of monitoring medication use for clients with high levels of anxiety. 9. Examine three methods for recognizing and preventing anxiety. Copyright © 2021 by Elsevier, Inc. All rights reserved. 3  Anxiety ⬤A feeling of uneasiness, uncertainty, and helplessness. ⬤A normal emotional response to a real or imagined threat or stressor. ⬤Serves several purposes: ⮚ A warning of impending danger. ⮚ Mild anxiety can increase learning by enhancing concentration and focus. ⮚ Uncontrolled anxiety often leads to ineffective and maladaptive behavior. ⮚ A normal part of survival and growth. Copyright © 2021 by Elsevier, Inc. All rights reserved. 4  Continuum of Anxiety Responses ⬤Reactions to anxiety occur along a continuum of behavioral responses: ⮚ Adaptive (positive) response result in new learning and greater self-esteem. It helps us adapt, learn and grow from our experiences. ⮚ Maladaptive responses to anxiety are ineffective attempts to cope. The response does not resolve the problem. ⮚ Responses to anxiety occur on four levels, from mild to panic. (table 18.1) Copyright © 2021 by Elsevier, Inc. All rights reserved. 5  Anxiety Levels (table 18.1) Level Physical Cognitive/Perceptual Emotional Mild Minimal muscle tension Thoughts may be Feelings of relative random, but comfort and safety controlled Moderate Tense” or “excited” Alert; perception Feelings of Vital signs normal or slightly narrowed, focused readiness and elevated challenge, energized Severe Fight-or-flight response, Problem-solving Feels threatened; vital signs increased, difficult startles. Eyes may sweating increased, urinary dart around room, urgency or gaze may be fixed Panic May become pale, blood Perception scattered Feels helpless with pressure decreases, muscle or closed total loss of control coordination poor 6  Types of Anxiety ⮚ Signal anxiety: Learned response to an anticipated event. ⮞ Anxiety during an quiz (become nauseated during exam). ⮚ Anxiety state: Abilities to cope become overwhelmed and emotional control is lost. ⮞ Emergencies, accidents or trauma. ⮚ Anxiety trait: Learned component of the personality. Reacts with anxiety in low stress situations. ⮞ Adolescent who always gives a reason for behavior. Copyright © 2021 by Elsevier, Inc. All rights reserved. 7  Types of Anxiety Responses ⬤Physical symptoms of anxiety: ⮚ Muscle tension ⮚ Fidgeting ⮚ Headache ⮚ Problems with sleep ⮚ Fight-or-flight reaction (increased heart rate and blood pressure, sweating, nausea and dizziness). Copyright © 2021 by Elsevier, Inc. All rights reserved. 8  Coping Mechanisms ⬤ Coping mechanisms are efforts to directly face and handle the problem. ⬤ Example: woman fighting a thief who is attempting snatch her purse, is dealing with the source of anxiety. ⬤ Intellectual coping mechanisms: ⬤Aim at making the threat less meaningful by changing one’s perception. ⬤If we do not define(think) the event as threatening, then anxiety is not produced. ⬤ Spiritual coping methods: ⬤Include faith, prayer, and ritual. ⬤ Emotional responses: ⬤Crying, sharing one’s anxious feelings, and using ego defense mechanisms. 9  Defense Mechanisms ⮚ Psychological strategies that help to lessen feelings of anxiety (called ego).(table 18.2) ⮚ Compensation - to make up a deficiency. ⮚ Conversion - channeling anxiety into body signs and symptoms. ⮚ Denial - refuse to acknowledge. ⮚ Displacement - redirects to another person or object. ⮚ Dissociation - separates emotions from situation. ⮚ Fantasy - distortion of unacceptable wishes or behaviors. ⮚ Restitution -Giving back to resolve guilty feelings ⮚ Goal of defense mechanisms is to reduce uncomfortable negative emotions. Copyright © 2021 by Elsevier, Inc. All rights reserved. 10  Defense Mechanisms (cont’d) ⬤Crisis: ⮚ One’s ability to cope with anxiety is overwhelmed. ⮚ Defense mechanism are no longer useful. ⮚ New coping behaviors must be developed to resolve the problem. 11  Culture Considerations (box.) Japanese often tend to somatize(manifest through physical symptoms) or handle anxiety by becoming physically ill. Mothers in the Dominican Republic commonly cope with the anxiety of the “evil eye” by wearing red and saving the infant’s umbilical cord. Many Greek men consider body hair a sign of manhood. Shaving their hair in preparation for a surgical procedure can result in great anxiety. When a Vietnamese individual has a panic attack outdoors, he or she is frequently labeled as trúng gió (hit by the wind). 12 Self-awareness and anxiety ⮚ Basic characteristic - anxiety is contagious. ⮚ Clients have the ability to focus on anxiety levels of the healthcare providers. Sometimes the client becomes the therapeutic agent. ⮚ It is important for caregivers to recognize and cope effectively with their own anxieties. ⮚ We may not choose our anxieties, but we can choose how we deal with them. Copyright © 2021 by Elsevier, Inc. All rights reserved. 13  Theories Related to Anxiety ⬤Biological models: ⬤Result from a dysfunction of two or more neurotransmitters(chemical signal, messenger). ⬤Psychodynamic models: ⬤Result of a conflict between two opposing forces within the personality (ego and id). ⬤Interpersonal models: ⬤Individual copes with anxiety based on perception and how they were taught as children. Copyright © 2021 by Elsevier, Inc. All rights reserved. 14  Theories Related to Anxiety (cont’d) ❖ Behavioral models: ❖ It’s a learned response. ❖ An encounter reminds the person of a earlier anxious time. ⮚ Environmental models: ⮚ Uncontrolled events or situations, such as natural disasters or human induced traumas. 15  Anxiety Throughout the Life Cycle ⬤Anxiety in childhood: ⮚ Is learned by watching and imitating others. ⮚ Recognizing signs and early intervention are important. ⮚ To prevent anxiety from becoming overwhelming and teach coping mechanisms. ⮚ Child’s developmental level. ⮚ Infants, feel discomfort when needs are not met. ⮚ Toddlers, become anxious when they perceive something larger or more furious than themselves. ⮚ Preschool children, experience anxiety when separated from the security of their parents. Copyright © 2021 by Elsevier, Inc. All rights reserved. 16  Anxiety Throughout the Life Cycle (cont’d) ⮚ Development of certain habits relieve anxiety. ⮚ Thumb sucking, nail biting, hair pulling, rhythmic body movements. ⮚ Separation Anxiety Disorder: ⮚ Diagnosed when children are unable to be without their parents for any length of time. ⮚ Severe anxiety can develop into panic, when they are separated from significant others. ⮚ Common physical complaints are headaches, nausea, or vomiting. ⮚ Frequent nightmares. ⮚ Fears of death, animals, monsters, and harmful situations. 17  Anxiety Throughout the Life Cycle (cont’d) ⮚ Overanxious disorder: ⮚ Lasts longer than 6 months. ⮚ Occurs in children whose parents focus on overachievement and down plays actual achievements. ⮚ Situational/Avoidant behaviors: ⮚ Child refuses to cope with anxiety producing situation (divorce, death or separation). ⮚ Effects of unresolved anxiety: ⮚ Postramatic stress disorder, depression and suicide. 18  Anxiety Throughout the Life Cycle (cont’d) ⬤Anxiety in adolescence: ⮚ Adolescents who ineffectively cope with anxiety often express themselves inappropriately. ⮚ By running away, becoming angry, defiant, aggressive, or manipulative, experimenting with drugs, or engaging in high-risk behaviors. ⮚ They use denial to cope. ⮚ With extreme anxiety they may self mutilate, develop anorexia or bulimia. ⮚ Health care providers must assess adolescents’ anxiety levels and offer early intervention and education. Copyright © 2021 by Elsevier, Inc. All rights reserved. 19  Anxiety Throughout the Life Cycle (cont’d) ⬤Anxiety in adulthood: ⮚ Adults handle anxiety by using earlier established coping mechanisms. ⮚ Developmental tasks, such as establishing a career and family, present numerous stressors. ⮚ Uncontrollable situations, such as fires, floods, earthquakes, or wars, can result in long-lasting anxiety. If left unresolved, can evolve into posttraumatic stress syndrome. ⮚ Maladaptive responses include panic disorders, phobias, behavioral addictions, obsessions, and compulsive activities. Copyright © 2021 by Elsevier, Inc. All rights reserved. 20  Anxiety Throughout the Life Cycle (cont’d) ⬤Anxiety in older adulthood: ⮚ Elders often deny their anxiety. ⮚ Somatize - physically express feelings (nausea, headaches). ⮚ Many were taught that it is inappropriate to share their fears and anxieties. ⮚ Behaviors include; changes in eating, sleeping and ability to concentrate, impatience and fatigue. ⮚ One of the most effective methods for assessing anxiety in older adults is to simply ask the client to explain his or her anxious feelings. Older adults usually appreciate the interest of concerned caregivers Copyright © 2021 by Elsevier, Inc. All rights reserved. 21  Anxiety Disorders ⬤Exists when anxiety is expressed in ineffective or maladaptive ways. Coping mechanisms (behaviors) do not successfully relieve the distress. ⬤People cope by using every area of functioning. ⬤Physical: directly deals with source. ⬤Intellectual: analyzes the situation, problem-solve. ⬤Spiritual: prayer ⬤Diagnosis of an anxiety disorder is based on a description of the behaviors. 22  Anxiety Disorders ⬤Separation anxiety disorder: ⮚ Person becomes inappropriately fearful and anxious when separated from an important person or object. ⬤Generalized anxiety disorder: ⮚ Individual’s anxiety is broad, long-lasting, and excessive. ⮚ Emotional response is out of proportion to situation. ⮚ The individual frets about numerous things and finds it difficult to control worries. 23  Panic Disorder. 24  Panic Disorders ⬤Panic disorders: ⮚ Panic attack is a brief period of intense fear or discomfort. ⮚ Duration of the attack is short (1–15 minutes). 25  Panic Disorders (cont’d) ⬤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: ⬤Educate- (three goals) about the nature of the disorder, use of medications, and developing adaptive ways of coping with their anxieties. ⬤Cognitive therapy- helps identify emotion and behaviors. ⬤Psychotherapy- encourages exploration of social and personal difficulties. Copyright © 2021 by Elsevier, Inc. All rights reserved. 26  Phobic Disorders ⮚ A phobia is an internal fear reaction. ⮚ Involves specific situations or objects; it can stem from a fear of people, animals, objects, situations, or occurrences. ⮚ Phobias differ from common fears. Phobias are obsessive in nature (dwell on). ⮚ People with phobias handle their anxieties differently. ⮚ A phobia can produce high levels of anxiety that it is immobilizing. ⮚ Characteristics of phobias vary with the culture. ⮚ Fears of hexes, spells, magical spirits, and unseen forces result in phobic reactions. 27 Obsessive-compulsive disorder ⮚ Specific behaviors must be performed to reduce anxiety. ⮚ Most common obsessions are related to cleanliness, dirt, and germs; aggressive and sexual impulses; health concerns; safety concerns; order and symmetry. ⮚ Box 18.2 Obsession and Compulsive Criteria. ⮚ Can occur as early as 3 years of age, but usually begins in adolescence. 28  Anxiety Disorders ⬤Body dysmorphic disorder: ⬤Obsessed with flaw in body. ⬤Interferes with daily living. ⬤Believe flaw makes them ugly. ⬤Seek unnecessary cosmetic surgery. ⬤Depression, eating disorders and suicide are seen. ⬤Treatment: antidepressants and cognitive behavior. ⬤Goal: help accept own appearance without anxiety. Copyright © 2021 by Elsevier, Inc. All rights reserved. 29  Anxiety Disorders ⬤Hoarding disorder: ⬤Difficulty in parting with possessions no matter the value. ⬤Complications: unclean living conditions; inability to perform basic living tasks; increased risk of falls, fires, or injury; bug and rodent infestations; social isolation; and possible legal problems. ⬤Treatment: is difficult if client does not admit to problem, antidepressants and psychotherapy. ⬤Goal: understand need to hoard and plan to eliminate clutter. 30  Anxiety Disorders ⬤Hair-pulling (trichotillomania): ⬤Complications: social problems, skin and hair damage, infections. ⬤Excoriation disorder (skin picking): ⬤Skin picking causes lesions, tissue damage and infections. ⬤Treatment: rule out physical causes or drug use. ⬤Psychotherapy and support groups. 31  Anxiety Disorders ⬤Behavioral addictions: ⮚ Addictive behaviors such as gambling, working, shopping, or excessive sexual activity. ⮚ May destroy personal, professional and financial relationships. 32  Stressor and Trauma Disorders ⮚ Rape-Trauma Syndrome: ⮚ Reactions to trauma, especially rape-trauma syndrome. Fear and anguish Recovery and repair Adaptation ⮚ Most important therapeutic interventions: Providing psychological stability Emotional support Advocacy. Copyright © 2021 by Elsevier, Inc. All rights reserved. 33  Stressor and Trauma Disorders ⮚ Acute stress disorder: Series of behavioral and emotional responses that follow an overwhelmingly stressful event. Individual repeatedly relives or reacts to the anxiety from a traumatic event. Symptoms: Negative mood, an inability to experience happiness or positive feelings. Sleep disturbances, irritability, and problems with concentration. Treatment: Reduce stress, ensure a safe environment, promote effective coping mechanisms, and emotional support. 34  Stressor and Trauma Disorders (cont’d) ⬤Adjustment Disorder: ⬤Key feature: Distress that is out of proportion to the traumatic event. ⬤Symptoms usually occur within 3 months of the event and become so severe that social, occupational, and other areas of function are impaired. ⬤Depression and anxious moods prevail. They have an increased risk of suicide. ⬤Treatment: Antidepressants and psychotherapy. 35  Stressor and Trauma Disorders (cont’d) ⬤Posttraumatic stress disorder: ⮚ Occurs after an individual experiences or witnesses severe trauma that is terrifying or life-threatening. ⮚ Involves intense fear, horror or helplessness. ⮚ They are emotionally numb, extremely alert and guarded. ⮚ Reliving of traumatic events or situations. ⮚ Flashbacks (are typical symptoms)last from seconds to more than 30 minutes, experience is real and life threatening. ⮚ Intervention for flashbacks,: safety and reorient to surroundings. Copyright © 2021 by Elsevier, Inc. All rights reserved. 36  Therapeutic Interventions ⬤Most effective way to cope with anxiety is to prevent it. ⬤Three successful behavioral therapies: ⬤Cognitive behavioral therapy (CBT): helps clients intellectually understand ineffective behaviors used to cope with anxiety, and replace them with more successful behaviors. ⬤Systematic desensitization: Clients learn to cope with one anxiety-provoking stimulus at a time. ⬤Flooding: rapidly and repeatedly expose client to feared object or situation until anxiety diminishes. Copyright © 2021 by Elsevier, Inc. All rights reserved. 37  Therapeutic Interventions ⬤Meditation and Therapy animals. ⬤Anxiety can be treated with medications. ⮚ Benzodiazepines ⮚ Antidepressants ⮚ Antihistamines ⮚ Propranolol ⮚ Anxiolytics ⬤Each type of drug is associated with possible severe side effects (tables 18.3 and 18.4). ⬤Benzodiazepines; no alcohol, take with food or milk, loss of control over emotions, will be tapered after 4 months. Has dependency, tolerance and rebound effects. Copyright © 2021 by Elsevier, Inc. All rights reserved. 38  Therapeutic Interventions ⬤Complete nursing history and thorough physical examination. ⬤Information is brought to health care team, client goals are established, and therapeutic interventions are chosen. ⬤First priority is: Protect the client from injury to self and others. ⬤Establish a trusting therapeutic relationship. ⬤Problem-solving techniques help develop coping mechanisms. ⬤Relaxation techniques, meditation, exercise. Copyright © 2021 by Elsevier, Inc. All rights reserved. 39  Question Your client exhibit the following symptoms: nausea or headaches due to stress. What is the term for these symptoms? 1. Fantasy 2. Compensation 3. Denial 4. Somatization Copyright © 2021 by Elsevier, Inc. All rights reserved. 40  Answer 4. Somatization 41  Question Your client has Agoraphobia. She has not left her home in the last 3 years and occasionally answers her phone. Which diagnosis has the highest priority? 1.Disturbed thought process 2.Ineffective coping 3.Social isolation 4.Powerlessness 42  Answer 3. Social isolation Due to length of time in isolation 43