Module 3: Part 1: Caring for Persons Experiencing Trauma and Anxiety Disorders (Reading 2) fully solved questions with 100% accurate solutions 2025-2026

Recent insights regarding anxiety

Recent insights reveal the bidirectional relationship between mind and body in influencing anxiety, where physiologic responses can shape behavior and thoughts can influence physiologic processes.

Treatment of anxiety disorders

Insights have led to the use of mind-body techniques, cognitive-behavioral therapies, combinations of mindfulness and cognitive therapies, and pharmaceutical interventions for treating anxiety disorders.

Core differences between fear and anxiety

Fear is an emotional response to a specific and immediate threat, while anxiety is characterized by apprehension or dread of a potentially threatening or uncertain future outcome.

Relationship between worry, fear, and anxiety

Worry involves thoughts about adverse outcomes, creating negative affect and is considered a symptom of both fear and anxiety.

Anxiety disorders discussed in the text

Generalized anxiety disorder (GAD), social anxiety disorder (social phobia), panic disorder (PD), specific phobias, obsessive-compulsive disorder (OCD), acute stress disorder (ASD), and posttraumatic stress disorder.

Treatment settings for anxiety disorders

Anxiety disorders are treated in inpatient psychiatric care, outpatient psychiatric clinics, primary care services, general practice settings, chronic disease management clinics, and private practice.

Distinguishing an anxiety disorder from normal anxiety

Anxiety disorders are distinguished by excessive intensity and/or duration relative to one's age and situation, interfering with quality of life and daily functioning, unlike normal anxiety.

Allostasis and its relation to stress

Allostasis is the adaptive process maintaining homeostasis through stress-related chemicals in response to perceived threats, with excessive allostatic load increasing the risk of stress-related disorders.

Parts of a normal emotional response to anxiety

Physiologic arousal signaling a threat, cognitive processes assessing the threat, and coping strategies used to resolve the threat are the three parts of a normal emotional response to anxiety.

Characterization of anxiety according to the text

Anxiety is characterized by apprehension or dread of a potentially threatening or uncertain outcome, triggered by the perception of a threat and manifesting in various ways.

Global prevalence of anxiety disorders

Anxiety disorders are the most common globally, with a lifetime prevalence as high as 31% higher than mood disorders and substance use disorders.

Prevalence of anxiety disorders in childhood and adolescence

Anxiety disorders are the most treated psychiatric disorders in childhood and adolescence, often beginning in adolescence and linked to increased risk of suicidal behavior and substance dependence.

Prevalence of anxiety disorders in Canadian adults

2.6% of Canadians aged 15 and older reported symptoms meeting diagnostic criteria for Generalized Anxiety Disorder (GAD) in the previous 12 months.

Gender differences in the prevalence of anxiety disorders

Girls and women are more likely to be diagnosed with anxiety disorders than boys and men, with higher lifetime prevalence rates in women.

Role of genetic and environmental factors in anxiety disorders

Panic disorder (PD), obsessive-compulsive disorder (OCD), and phobias show genetic vulnerability, while environmental factors also contribute to anxiety disorder development.

Impact of comorbidity on individuals with anxiety disorders

Anxiety disorders often co-occur with other conditions, leading to functional impairment, increased healthcare use, decreased productivity, and an association with suicidal ideation and attempts.

Key features of Generalized Anxiety Disorder (GAD)

GAD is characterized by unwarranted, enduring anxiety across various life situations, impacting functioning and associated with physical symptoms.

Prevalence rates of Generalized Anxiety Disorder (GAD)

Lifetime prevalence rates range between 2% and 9%, often beginning early in life and following a chronic course with comorbid depression.

Assessment of Generalized Anxiety Disorder (GAD) in clinical settings

Evaluation includes mood, somatic symptoms, specific worries, and worry management strategies, with tools like the GAD-7 scale aiding in assessing symptom severity and impacts.

Definition of Social Anxiety Disorder (Social Phobia)

Involves intense fear of social situations, feeling scrutinized and negatively evaluated, with sensitivity to disapproval, poor self-esteem, and distorted self-view causing functional impairment.

Prevalence of Social Anxiety Disorder (Social Phobia)

Lifetime prevalence ranges from 8% to 13%, with 12-month estimates at 2.6% for men and 3.4% for women, higher in specific subpopulations like those with chronic obstructive pulmonary disorder and the Canadian military.

Impact of comorbid depression on individuals with Social Anxiety Disorder

Those with both social phobia and depression experience more severe symptoms and greater functional impairment, often at a younger age with an earlier onset of major depression.

Characteristics of Panic Disorder (PD)

Characterized by repeated panic attacks, abrupt surges of intense fear or discomfort, recurrent unexpected attacks, and a fear of future attacks affecting social, occupational, and interpersonal functioning.

Variability in the prevalence of Panic Disorder (PD)

Prevalence varies, with individuals experiencing recurrent unexpected panic attacks and fearing future attacks, impacting social, occupational, and interpersonal functioning.

Lifetime prevalence estimates of Panic Disorder

Range widely from 1.4% to 20.5%, with 3.7% in Canada.

Recent findings regarding the risk associated with panic attacks

Having panic attacks increases the risk of developing mood and/or anxiety disorders.

Demographic factors influencing the prevalence of Panic Disorder

Higher rates in women and individuals aged 30 to 59, with mean onset at 23 years.

Risk factors implicated in the development of Panic Disorder

Include triggered panic attacks, family history of psychological difficulties, childhood trauma, being female, and mood disorder history.

Physical health problems commonly associated with Panic Disorder

Vertigo, cardiac disease, gastrointestinal disorders, and asthma.

Difference between Panic Disorder with agoraphobia and without

PD with agoraphobia has more coexisting anxiety disorders, anxiety attacks, and anticipatory anxiety.

Psychological and physical sensations accompanying panic attacks

Fear of death and symptoms mimicking a heart attack, leading to seeking emergency medical care.

Key concept related to panic in the context of anxiety

Panic as an extreme form triggered by life-threatening situations.

Definition of agoraphobia and its relation to Panic Disorder

Fear of certain environments co-occurring with PD, leading to avoidance behaviors.

How agoraphobia typically begins and affects individuals

Starts with fear of open spaces, leading to avoidance and interference with routine functioning.

Definition of specific phobia and its difference from agoraphobia

Irrational fear of a specific object or situation, differing from agoraphobia's broader fear of environments.

Prevalence rates for different types of specific phobias

Vary by subtype: natural environment, situational, animal, and blood injection injury phobias.

Effect of proximity of a feared object on anxiety in specific phobia

Anxiety increases as the object approaches and decreases as it moves away.

Significance of blood injection injury-type phobia in health care settings

Common in health care, leading to vasovagal response and fainting.

Factors predisposing individuals to specific phobias

Include prior traumatic events, panic attacks, observing trauma, and exposure to warnings.

Disorders in the cluster of Obsessive-Compulsive and Related Disorders

Include OCD, body dysmorphic disorder, hoarding disorder, trichotillomania, and excoriation disorder.

Characteristics of Obsessive-Compulsive Disorder (OCD)

Severe obsessions and compulsions aimed at reducing anxiety.

Common patterns of obsessions and compulsions in OCD

Obsessions include fear of contamination, pathological doubt, and compulsions like handwashing and checking.

Predictors of poorer treatment outcomes for OCD in adults and children

Include age of onset, symptom severity, comorbidity, and family history.

Typical age of onset for OCD and time before seeking help

Early 20s to mid-30s, with an average delay of 8 years in seeking help.

Key concept related to obsessions in OCD

Unwanted, intrusive thoughts causing anxiety and distress.

Key concept related to compulsions in OCD

Repetitive behaviors aimed at relieving anxiety caused by obsessions.

Role of genetic theories in understanding anxiety disorders

Genetic vulnerabilities contribute to anxiety sensitivity, childhood maltreatment, and neurotransmitter dysregulations.

Genes

Estimated to account for 30% to 50% of the risk for Panic Disorder (PD).

Serotonin transporter gene promoter region

Linked to stress sensitivity and anxiety symptoms, with significance debated.

Fear conditioning

Associating a neutral stimulus with an aversive one, leading to fear response.

Extinction

Occurs when repeated exposure to conditioned stimulus no longer elicits fear response.

Hippocampus and amygdala

Crucial for fear conditioning; hippocampus involved in memory, amygdala in storing fearful memories.

Serotonin

Implicated in anxiety disorders; SSRIs are first-line pharmacotherapy for anxiety and panic symptoms.

Norepinephrine

Affects physical sensations of anxiety by stimulating sympathetic nervous system.

GABA

Most abundant inhibitory neurotransmitter in the brain, affecting neuron firing rates.

Corticotropin-releasing hormone (CRH)

Activates the hypothalamic-pituitary-adrenal (HPA) axis, elevated during panic attacks.

CRH receptor antagonists

Suggested as a potential treatment for anxiety disorders, but not currently available.

Cholecystokinin (CCK)

Can induce panic attacks in PD patients and to a lesser extent in others; found in fear and stress response brain regions.

Neurochemicals and hormones

Associated with anxiety include GH, female sex hormones, AVP, and OT.

MRI studies

Show reductions in gray matter volume in fronto-limbic regions, thalamus, brainstem, and cerebellum in PD individuals.

Amygdala and prefrontal cortex

Significant in anxiety disorders; amygdala activated in fear situations, prefrontal cortex in emotional processing.

Psychodynamic theories

Emphasize early life experiences like separation and loss in anxiety disorders development.

Childhood risk factors

Maternal internalizing symptoms, low SES, maltreatment, inhibited temperament, and other factors.

Childhood trauma and neglect

Can lead to long-lasting alterations in neural networks, potentially resulting in persistent anxiety.

Primary setting for anxiety treatment

Primary care settings, outpatient clinics, or private practitioners; hospitalization for acute exacerbations or comorbid disorders.

Bio/psycho/social/spiritual assessment

Important in managing anxiety symptoms to identify contributing factors and develop individualized plans.

Biologic assessment questions

Include inquiries about symptoms, family history, and coping strategies related to anxiety.

Substance use assessment

Determines if substances contribute to anxiety symptoms and identifies self-treatment with substances.

Sleep patterns

Commonly disturbed in anxiety disorders, increasing risk of panic attacks and major depressive disorder.

Physical activity

Reduces frequency and severity of panic attacks, improves sleep, and aids in reassessing automatic thinking related to anxiety.

Breathing control technique

Abdominal or diaphragmatic breathing involving specific steps for anxiety management.

Abdominal or diaphragmatic breathing

Involves sitting upright, placing a hand on the abdomen, inhaling slowly through the nose for four counts, and exhaling slowly through the mouth for six counts to promote relaxation.

Nutrition planning importance for anxiety disorders

Reducing or eliminating stimulants like caffeine from the diet can help manage anxiety symptoms by avoiding exacerbation.

Relaxation techniques for anxiety disorders

Isometric exercises and progressive muscle relaxation help reduce muscle tension, alleviating anxiety.

Primary action of propranolol in anxiety treatment

Propranolol acts on beta-adrenergic receptors to reduce peripheral anxiety symptoms but is less effective against panic symptoms.

First-line pharmacotherapies for anxiety disorders

Selective Serotonin Reuptake Inhibitors (SSRIs) and Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) are considered first-line treatments for most anxiety disorders.

Benefits of SSRIs and SNRIs over other anxiety medications

SSRIs and SNRIs have fewer side effects, are safer, and are less lethal in overdose compared to other anxiety medications.

Tricyclic Antidepressants (TCAs) usage

TCAs reduce anxiety and panic symptoms through serotonin and norepinephrine reuptake inhibition, typically used when SSRIs or SNRIs are ineffective.

Comparison of benzodiazepines and antidepressants in anxiety treatment

Benzodiazepines provide rapid relief within hours compared to weeks for antidepressants, suitable for short-term acute anxiety management.

Commonly used benzodiazepines for anxiety disorders

Alprazolam (Xanax), lorazepam (Ativan), and clonazepam (Rivotril) are widely used for treating anxiety disorders.

Risks associated with benzodiazepine use

Risks include withdrawal symptoms, increased fall and memory difficulties in the elderly upon discontinuation.

Administration and monitoring of benzodiazepines in anxiety treatment

Benzodiazepines may be administered with antidepressants initially and tapered after 4 weeks, with dosing frequency adjusted based on type.

Importance of psychological assessment in anxiety management

Psychological assessment helps determine anxiety patterns, symptoms, cognitive responses, and comorbid depression symptoms.

Hamilton Rating Scale for Anxiety (HAM-A)

A 14-item clinician-rated scale assessing psychological and somatic aspects of anxiety.

Self-report scales for assessing anxiety disorders

Include State-Trait Anxiety Inventory (STAI), Penn State Worry Questionnaire (PSWQ), Beck Anxiety Inventory, and various panic, cognition, and phobia scales.

Impact of catastrophic misinterpretations on anxiety

Misinterpreting minor symptoms as severe can trigger intense anxiety and panic, requiring individualized patient education.

Statements by individuals with panic attack fears

Statements like feeling trapped, fearing death, hurting others, being alone, or losing control are common.

Combining pharmacotherapy and psychotherapy for anxiety disorders

Combining both therapies can be more effective in the short term than using either alone.

Relevance of Peplau's work in nursing interventions for anxiety

Peplau's guidelines help individuals manage anxiety by focusing on factors beyond subjective anxiety experiences.

Distraction activities for managing panic symptoms

Activities like conversations, physical exercises, and repetitive tasks can help manage early panic symptoms.

Positive self-talk in anxiety management

Involves countering negative thoughts with reassuring statements to challenge fear and manage anxiety.

Core principles of Cognitive-Behavioural Therapy (CBT)

CBT focuses on the interplay of thoughts, feelings, behaviors, and body sensations, encouraging self-awareness and skill development.

Effective treatments provided by CBT

CBT is effective for severe anxiety, GAD, PD, and social anxiety, using strategies like psychoeducation and cognitive restructuring.

Combining CBT with mindfulness techniques

Combining CBT with mindfulness enhances outcomes, especially for challenging anxiety disorders and OCD.

Four steps of the self-treatment method by Jeffrey Schwartz

The steps involve relabeling obsessive thoughts, understanding them as medical conditions, engaging in pleasurable activities, and revaluing life.

Exposure therapy and treated conditions

Involves exposing patients to anxiety-inducing situations to desensitize them, commonly used for agoraphobia, specific phobias, and OCD.

Systematic desensitization

Exposes patients to a hierarchy of feared situations while teaching muscle relaxation techniques to manage increasing anxiety.

Psychoeducation for anxiety disorders

Covers topics such as psychopharmacologic agents, breathing control measures, exercise, stress management strategies, and coping strategies.

Impact of anxiety on social and occupational functioning

Can lead to relationship deterioration, compromised success at work, extreme isolation, and work-life balance difficulties.

Cultural competence in anxiety assessment

Involves understanding cultural differences in interpreting anxiety-related sensations and feelings.