Chapter 18 Managing Anxiety Copyright 2013 by Elsevier

Learning Objectives 1) 2) 3) 4) Describe the continuum of responses to anxiety. Identify three types of coping mechanisms used to decrease anxiety. Explain how anxiety is experienced through each life cycle. Compare the difference between normal anxiety and an anxiety disorder. Copyright © 2013 by Elsevier Inc. All rights reserved. Slide 2

Learning Objectives 5) 6) 7) 8) 9) Discuss the difference between phobic and obsessive-compulsive behaviors. Examine three features of posttraumatic stress disorder. List two therapeutic interventions for the client with rape-trauma syndrome. Explain the importance of monitoring medication use for clients with high levels of anxiety. Examine three methods for recognizing and preventing anxiety. Copyright © 2013 by Elsevier Inc. All rights reserved. Slide 3

Anxiety (p. 202) 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 Ø Mild anxiety can increase learning by enhancing concentration and focus Ø Uncontrolled anxiety often leads to ineffective and maladaptive behavior Ø A normal part of survival and growth Ø Copyright © 2013 by Elsevier Inc. All rights reserved. Slide 4

Continuum of Anxiety Responses (p. 202) Reactions to anxiety occur along a continuum of behavioral responses. Positively focused anxiety helps us to adapt, learn, and grow from our experiences. Ø Maladaptive responses to anxiety are ineffective attempts to cope. Ø Responses to anxiety occur on four levels, ranging from mild to panic. Ø Copyright © 2013 by Elsevier Inc. All rights reserved. Slide 5

Continuum of Anxiety Responses cont’d. (p. 203) Anxiety occurs as the result of a perceived threat to one’s self. Types of anxiety include the following: Signal anxiety • Learned response to an anticipated event Ø Anxiety state • Individual’s coping abilities become overwhelmed and Ø emotional control is lost. Ø Anxiety trait • Learned component of the personality Copyright © 2013 by Elsevier Inc. All rights reserved. Slide 6

Continuum of Anxiety Responses cont’d. (p. 203) Physical symptoms of anxiety Ø Ø Ø Muscle tension Fidgeting Headache Problems with sleep Fight-or-flight reaction Coping methods Coping mechanisms in the physical realm include efforts to directly face and handle the problem. Ø Intellectual coping mechanisms are aimed at making the threat less meaningful by changing one’s perception. Ø Copyright © 2013 by Elsevier Inc. All rights reserved. Slide 7

Continuum of Anxiety Responses cont’d (p. 204) Defense mechanisms Psychological strategies that help to lessen feelings of anxiety Ø Goal is to reduce uncomfortable negative emotions. Ø Crisis One’s ability to cope with anxiety is overwhelmed. Ø New coping behaviors must be developed to successfully resolve the source problem. Ø Copyright © 2013 by Elsevier Inc. All rights reserved. Slide 8

Continuum of Anxiety Responses cont’d. (p. 205) Self-awareness and anxiety Anxiety is contagious. Ø It is important for caregivers to recognize and cope effectively with their own anxieties. Ø We may not choose our anxieties, but we do choose how we deal with them. Ø Copyright © 2013 by Elsevier Inc. All rights reserved. Slide 9

Theories Related to Anxiety (p. 206) Biological models Psychodynamic models Interpersonal models Behavioral models Other models Existential theory Ø Holistic theory Ø Copyright © 2013 by Elsevier Inc. All rights reserved. Slide 10

Anxiety Throughout the Life Cycle (p. 207) Anxiety in childhood Ø Related to a child’s developmental level Problems associated with anxiety in childhood compulsions Phobia Ø Separation anxiety disorder Ø Overanxious disorder Ø Avoidant disorder Ø Copyright © 2013 by Elsevier Inc. All rights reserved. Slide 11

Anxiety Throughout the Life Cycle cont’d. (p. 207) Anxiety in adolescence Adolescents who ineffectively cope with anxiety often express themselves inappropriately. Ø Many initial symptoms of schizophrenia and other psychoses begin in adolescence. Ø Health care providers who work with adolescents must assess adolescents’ anxiety levels and offer early intervention and education. Ø Copyright © 2013 by Elsevier Inc. All rights reserved. Slide 12

Anxiety Throughout the Life Cycle cont’d. (p. 208) Anxiety in adulthood Similar to their younger counterparts, adults handle anxiety by using earlier established coping mechanisms. Ø Developmental tasks, such as establishing a career and family, present numerous stressors. Ø When adult anxieties are not successfully managed, a number of mental health problems may result. Ø Copyright © 2013 by Elsevier Inc. All rights reserved. Slide 13

Anxiety Throughout the Life Cycle cont’d. (p. 208) Anxiety in older adulthood Elders often deny their anxiety. Ø Socially, they were taught that it is inappropriate to share their fears and anxieties. Ø 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 Ø caregivers. Copyright © 2013 by Elsevier Inc. All rights reserved. Slide 14

Anxiety Disorders (p. 208) Diagnosis of an anxiety disorder is based on a description of the behaviors that express distress. Generalized anxiety disorder Ø Individual’s anxiety is broad, long-lasting, and excessive. • Worried anxious more often than not Panic disorders More common than once thought Ø Two types of panic disorders: Ø • Associated with agoraphobia • Not associated with agoraphobia Copyright © 2013 by Elsevier Inc. All rights reserved. Slide 15

Anxiety Disorders cont’d (p. 209) Phobic disorders A phobia is an internal fear reaction. Ø Phobias differ from common fears. Ø • Phobias are obsessive in nature. People with phobias handle their anxieties ineffectively. Ø Characteristics of phobias vary with the culture. Ø Obsessive-compulsive disorder Specific behaviors must be performed to reduce anxiety. Ø Most common obsessions are related to cleanliness, dirt, and germs; aggressive and sexual impulses; health concerns; safety concerns; and order and symmetry. Ø Copyright © 2013 by Elsevier Inc. All rights reserved. Slide 16

Anxiety Disorders cont’d. (p. 210) Traumatic stress reaction Ø Series of behavioral and emotional responses that follow an overwhelmingly stressful event Posttraumatic stress disorder Reliving of traumatic events or situations Ø Anxiety, depression, and nightmares can complicate the picture. Ø Copyright © 2013 by Elsevier Inc. All rights reserved. Slide 17

Therapeutic Interventions (p. 211) Prevention is the most effective way to cope with anxiety. Mental health therapies and medications frequently are used as treatment. History and thorough physical examination are performed. Anxiety may be treated with various medications: Ø Ø Ø Benzodiazepines Antidepressants Antihistamines Propranolol Anxiolytics Copyright © 2013 by Elsevier Inc. All rights reserved. Slide 18

Question 1 Anxiety is a diffuse feeling of uneasiness, uncertainty, and helplessness. Most individuals deal with anxiety by using a number of behaviors or coping mechanisms to help decrease discomfort. Which type of coping mechanism includes efforts to face the problem directly? 1) Intellectual 2) Spiritual 3) Emotional 4) Physical Copyright © 2013 by Elsevier Inc. All rights reserved. Slide 19

Question 2 Billy is getting ready to give a speech tomorrow. He is very anxious about getting up in front of a large audience. He begins to close his eyes and to imagine that everyone in the audience is smiling while he is giving his speech. This is what type of coping mechanism? 1) Intellectual 2) Spiritual 3) Emotional 4) Physical Copyright © 2013 by Elsevier Inc. All rights reserved. Slide 20

Question 3 A client is being admitted to the psychiatric unit. He recently served in the Iraq war and lost his legs. He very casually describes how he lost both legs in the battle. What type of coping mechanism is this? 1) Compensation 2) Conversion 3) Dissociation 4) Denial Copyright © 2013 by Elsevier Inc. All rights reserved. Slide 21

Question 4 A teenager who is doing very poorly in school is consistently daydreaming about the private jet he will one day own. This is an example of what type of coping mechanism? 1) Denial 2) Substitution 3) Fantasy 4) Conversion Copyright © 2013 by Elsevier Inc. All rights reserved. Slide 22

Question 5 Mackenzie’s client is on benzodiazepines. Which of the following is a side effect that may result from use of this type of medication? 1) Increased appetite 2) Bradycardia 3) Blurred vision 4) Hypertension Copyright © 2013 by Elsevier Inc. All rights reserved. Slide 23