Understanding Anxiety and Anxiety Disorders

1. Chapter 8 Anxiety and Anxiety Disorders

2. Anxiety • Definition • Feeling of apprehension, uneasiness, uncertainty or dread resulting from a real or perceived threat, whereas fear is reaction to a specific threat • Types • Normal: healthy life force necessary for survival • Acute: precipitated by imminent loss or change that threatens one’s sense of security • Chronic: anxiety that a person has lived with for a long time

3. Levels of anxiety • Mild Occurs in normal experience of everyday living • Moderate Occurs as anxiety escalates, perceptual field narrows and details are excluded from observation Selective inattention: only certain things are seen and heard • Severe Perceptual field is greatly reduced. May focus on particular detail or scattered details • Panic Most extreme form and results in markedly disturbed behavior

4. Anxiety interventions • Mild to Moderate -Use of specific communication techniques-open ended questions, giving broad openings, exploring and seeking clarification -Be calm, recognize persons distress, listen • Severe to Panic -Quiet environment with minimal stimulation and providing gross motor activities to drain some of the tension -Firm, short, and simple statements are useful

5. Defense mechanisms • The degree of distortion of reality and disruption in interpersonal relationships determines if the use of a defense mechanism is adaptive (healthy) or maladaptive (unhealthy) (Vaillant, 1994) • Defenses are major means of managing conflict and affect • Defenses are relatively unconscious • Defenses are discrete from one another • Although defenses are hallmark of psychiatric syndromes they are reversible • Defenses are adaptive as well as pathological

6. Healthy defenses • Altruism -Emotional conflicts and stressors are dealt with by meeting the needs of others • Sublimation -Unconscious process substituting constructive and socially acceptable activity for strong impulses that are not acceptable in original form • Humor -Emphasizing the amusing or ironic aspects of conflict or stressor • Suppression -Conscious denial of disturbing situation or feeling

7. Immediate defenses Repression: exclusion of unwanted experiences, emotions or ideas from conscious awareness Displacement: transfer of emotions associated with person, object or situation to another Reaction formation: unacceptable behavior or feelings are kept out of awareness by developing opposite behavior or emotion Somatization: transforming anxiety unconsciously to physical symptom Undoing: Making up for act or communication Rationalization: Justifying illogical ideas, actions by developing acceptable explanations that satisfy both

8. Immature defenses Passive Aggression: indirect aggression toward others Acting-Out Behavior: actions rather than feelings or reflections Dissociation: integrating consciousness, memory, identity or perception of environment Devaluation: attributing negative qualities to others Idealization: attributing exaggerated positive qualities to others Splitting: inability to integrate positive & negative qualities of oneself into cohesive image Projection: reject unacceptable personal features & attributes them to other people, objects or situations Denial: escaping unpleasant reality by ignoring their existence

9. Anxiety disorders • Refers to number of disorders including: panic disorders, phobias, obsessions, compulsions, and PTSH (post traumatic stress) • Prevalence and co-morbidity • Most prevalent lifetime psychiatric disorder in US • 1 in 4 will experience in lifetime • Co-occurs with other psychiatric disorders • Theory • Genetic, Biological, Learning, & Cognitive

10. Cultural considerations • Data on incidence in cultures is sparse • Some cultures express anxiety through physical symptoms (somatic) while in other cultures cognitive symptoms are predominant • Barrier for some cultural groups seeking health care for anxiety is the stigma associated with mental illness

11. Types of anxiety disorders • Panic Disorder • Sudden onset extreme apprehension or fear associated with impending doom • Panic Disorder with Agoraphobia • Combination of above symptoms and agoraphobia(intense phobic disorder) excessive anxiety or fear about being in places from which escape might be difficult or help unavailable • Phobias • Persistent, irrational fear of specific object, activity, or situation that leads to desire fro avoidance of the object, activity or situation • Social anxiety disorder • Severe anxiety or fear provoked by exposure to social or performance situation

12. Types of anxiety disorders • Obsessive-Compulsive Disorder -Obsessions: thoughts, impulses or images that persist & recur and can’t be dismissed from mind -Compulsions: ritualistic behavior that person feels driven to perform in order to reduce anxiety -Obsessions and compulsions that occur together • Generalized Anxiety Disorder -Excessive anxiety or worry about numerous things that lasts for 6 months or longer • Post Traumatic Stress Disorder (PTSD) -Repeated re-experiencing of highly traumatic event that involved actual or threatened death or serious injury to self or others • Acute Stress Disorder -Occurs 1 month after exposure to traumatic event • Anxiety cause by Medical Conditions -Anxiety caused by medical disorder (hyperthyroidism, cardiac, pulmonary embolus)

13. Applications of nursing process • Assessment -Symptoms of anxiety -Defenses used in anxiety disorders -Assessment guidelines • Diagnosis -NANDA • Outcomes Identification -NOC • Planning • Implementation -Follow psychiatric-mental health nursing: scope & standards of practice -Communication guidelines -Health teaching and health promotion -Milieu therapy -psychotherapy: CBT (Cognitive Behavioral Therapy)

14. Pharmacological, biological and integrative therapies • Antidepressants -SSRI’s - 1st line treatment for anxiety -Also treat co-morbid depressive disorders • Anxiolytic -Treat somatic and psychological symptoms of anxiety -Can be addictive (Seroquel, Xanax) • Other classes of medications -Beta-blockers, antihistamines (Vistaril) & anticonvulsants • Complementary interventions -“Natural” substances include kava kava, gotu kola & St John’s Wort -Not subject to same rigorous testing as prescription medications