Generalized Anxiety Disorder/Stress

Positive Functions of Anxiety

• Increases motivation

• Promotes learning

• Improves focus

• Encourages problem-solving

• Signals the need for change

General Adaptation Syndrome (GAS)

• Alarm reaction

• Resistance

• Exhaustion

• Autonomic and Parasympathetic

• Different people respond differently

Physical Signs of Stress

• high resting heart rate

• excessive sweating

• excessive urination

• frequent constipation and/or gastrointestinal upset

• frequent headaches

• excessive fatigue

• low heart rate variability

Minimal/Mild Anxiety

• Little to no physical symptoms

• Occasional mild worry or anxiety

• Able to focus and complete tasks

Mild/Moderate Anxiety

• Intermittent anxiety

• Changes in sleep patterns

• Difficulty focusing at times

• Muscle tension

• Stomach discomfort

Moderate/Severe Anxiety

• Anxiety throughout much of the day

• Periodic feelings of panic

• Headaches

• Fatigue

• Avoidance behaviors

Severe/Panic Anxiety

• Anxiety throughout the day

• Isolation from others

• Inability to concentrate

• Sensory overload

• Breathlessness

• Chest tightness

• Digestive problems

Cognitive Behavioral Therapy (CBT)

Changes unhealthy thoughts and behaviors to improve feelings and coping.

Psychodynamic Therapy

Explores how past experiences and unconscious feelings affect current behavior.

Interpersonal Therapy (IPT)

Focuses on improving relationships, communication, and coping with life changes

Dialectical Behavior Therapy (DBT)

Teaches skills to manage strong emotions, tolerate distress, and improve relationships

Supportive Therapy

Provides encouragement, emotional support, problem-solving, and coping strategies

Exposure Therapy

A treatment that helps people overcome fears by gradually facing what makes them anxious

SSRIs (Selective Serotonin Reuptake Inhibitors)

Sertraline (Zoloft), Escitalopram (Lexapro), Fluoxetine (Prozac), Paroxetine (Paxil)

• First-line treatment for GAD, panic disorder, social anxiety

• May take 2-6 weeks for effect; monitor for suicidal ideation when initiating treatment

SNRIs (Serotonin-Norepinephrine Reuptake Inhibitors)

Venlafaxine (Effexor XR), Duloxetine (Cymbalta)

• First-line treatment for anxiety disorders, especially GAD

• Can increase blood pressure; do not stop abruptly

Benzodiazepines

Lorazepam (Ativan), Alprazolam (Xanax), Clonazepam (Klonopin), Diazepam (Valium)

• Rapid relief of acute anxiety or panic attacks

• Risk for dependence, sedation, falls, and withdrawal symptoms

Non-Benzodiazepine Anxiolytic

Buspirone (BuSpar)— works well with SSRI

• for Generalized Anxiety Disorder (GAD)

• Less sedation and no significant dependence risk; delayed onset (2-4 weeks)

Antihistamine

Hydroxyzine (Vistaril, Atarax)

• Short-term anxiety relief

• Causes drowsiness; often used PRN

Beta Blockers

Propranolol (Inderal), Atenolol (Tenormin)

• Performance anxiety, test anxiety, public speaking

• Reduces physical symptoms such as tremor, tachycardia, and sweating

Sleep/Anxiety Adjuncts

Trazodone, Melatonin (OTC)

• Anxiety-related insomnia

• Monitor for daytime sedation; used primarily for sleep disturbances

Panic Disorder

• Repeated, unexpected panic attacks

• Followed by persistent worry about another attack

• Sudden surge of intense fear that usually peaks within minutes.

Panic Disorder Nursing Assesment

• Physical Symptoms

• Frequency, triggers and effects on daily functioning

• Caffeine, medications and substance use

• Suicide and self-harm risk

• Rule out medical emergencies

Panic Disorder Treatment

During an attack: Stay with the patient, reduce stimulation, speak calmly, use short, simple

statements.

• Encourage slow breathing and relaxation techniques

Long-term: Cognitive behavioral therapy (CBT), exposure therapy

• SSRIs or SNRIs (first-line)

• Benzodiazepines may be used short term but carry risks of dependence, sedation and falls

Generalized Anxiety Disorder

Excessive, difficult-to-control worry about several areas of life occurring more days than not for at least six months

Generalized Anxiety Disorder Nursing Assessment

• Assess worry, restlessness, fatigue, poor concentration, muscle tension, sleep, and level of functioning/ADLs

• Depression affect

• Substance use and suicide risk

• Medical conditions, medications, caffeine and stimulant use

Generalized Anxiety Disorder Treatment

• CBT

• Relaxation, mindfulness and stress-management techniques

• Regular sleep, exercise and reduction of caffeine

• SSRIs or SNRIs

• Buspirone may also be prescribed.

• Benzodiazepines are generally limited to short- term use.

Social Anxiety Disorder

Intense fear of being judged, embarrassed, or rejected in social situations.

Social Anxiety Disorder Nursing Assessment

Assess feared situations, physical symptoms, avoidance, functioning, substance use,

depression, and safety.

Social Anxiety Disorder Treatment

CBT, gradual exposure, social-skills training, and SSRIs/SNRIs

Specific phobia

Excessive fear of a particular object or situation, such as needles, spiders, or flying.

Specific phobia Nursing Assessment

Identify the trigger, fear response, avoidance, and effect on daily life or healthcare.

Specific phobia Treatment

Gradual exposure therapy and CBT. Medications are not usually the main treatment

Agoraphobia

Fear of situations where escape or help may be difficult, such as crowds or public transportation.

Agoraphobia Nursing Assessment

Assess feared places, avoidance, isolation, need for a companion, panic symptoms, functioning, and safety.

Agoraphobia Treatment

CBT, gradual exposure, coping skills, and SSRIs/SNRIs

Separation Anxiety Disorder

Excessive fear or distress about being separated from a person to whom the individual is strongly attached. It can occur in children or adults.

Separation Anxiety Disorder Nursing Assessment

Assess distress during separation, refusal to leave home or attend school/work, worry about losing the attachment figure, nightmares, physical complaints, and effects on daily functioning.

Separation Anxiety Disorder Treatment

CBT with gradual exposure to separation, family education and support, coping skills, and sometimes an SSRI for severe symptoms.