Study Notes on Anxiety and Anxiety Disorders

Anxiety and Anxiety Disorders

Definition of Anxiety

  • Anxiety: A vague feeling of dread or apprehension that differs from fear, which is a response to an identifiable stimulus that represents danger.

  • Anxiety Disorders: Characterized by excessive anxiety accompanied by behavioral, emotional, cognitive, and physiological responses.

  • Stress: The wear and tear that life causes on the body.

Anxiety as a Response to Stress

  • General Adaptation Syndrome: A model identified by Hans Selye describing the physiological aspects of stress:

    • Alarm Reaction Stage: Preparation for defense; the body recognizes a threat.

    • Resistance Stage: Blood is shunted to areas needed for defense, maintaining function in an adverse environment.

    • Exhaustion Stage: When the body's stores are depleted; emotional components may remain unresolved.

Levels of Anxiety

  • Mild Anxiety: Awareness of something being different, leading to increased sensory stimulation and motivation.

  • Moderate Anxiety: The person feels that something is definitely wrong, leading to nervousness or agitation and difficulty concentrating. The individual can be redirected.

  • Severe Anxiety: Trouble with thinking and reasoning; muscles tighten, vital signs increase, and the individual becomes restless, irritable, and angry.

  • Panic Anxiety: Triggering the fight, flight, or freeze response; increased vital signs, enlarged pupils, cognitive processes focus specifically on defense mechanisms.

Working With Anxious Clients

  • Self-Awareness: It is crucial to maintain an awareness of one’s own level of anxiety when working with clients.

  • Assessment: Evaluate the person’s anxiety level.

  • Communication: Use short, simple, and easy-to-understand sentences to communicate effectively.

  • Anxiety Management: Lower the person's anxiety to a moderate or mild level before proceeding with interventions.

  • Vocal Tone: Speak in a low, calm, and soothing voice.

  • Panic Plans: In the case of panic, safety is the primary concern; consider short-term use of anxiolytics (refer to Table 14.2).

Question #1

  • True/False Statement: Anxiety and fear are considered to be two different things.

Types of Anxiety Disorders

  • Primary Types:

    • Agoraphobia

    • Panic Disorder

    • Specific Phobia

    • Social Anxiety Disorder (Social Phobia)

    • Generalized Anxiety Disorder (GAD)

  • Incidence: Anxiety disorders have the highest prevalence rates among mental disorders in the U.S.; more prevalent in women and individuals under 45.

  • Onset and Clinical Course: Highly variable; related disorders include:

    • Selective Mutism

    • Anxiety Disorder Due to Another Mental Condition

    • Substance/Medication-Induced Anxiety Disorder

    • Separation Anxiety Disorder

Etiology of Anxiety Disorders

  • Biologic Theories:

    • Genetic theories: Involvement of heredity.

    • Neurochemical theories: Key neurotransmitters involved include gamma-aminobutyric acid (GABA) and serotonin.

  • Psychodynamic Theories:

    • Intrapsychic/Psychoanalytic Theories: Freud and his concepts of defense mechanisms.

    • Interpersonal Theory: Influence of interpersonal relationships on anxiety (e.g., Sullivan, Peplau).

    • Behavioral Theory: Focus on learned responses to perceived threats.

Cultural Considerations

  • Recognition of cultural differences in expressing and dealing with anxiety:

    • Some cultures may express anxiety through somatic symptoms like headaches, fatigue, etc.

    • Others may attribute anxiety to supernatural causes.

  • Cultural Humility: Important for healthcare providers to be aware of cultural differences without stereotyping clients.

Treatment of Anxiety Disorders

  • Combination Treatments: Use both medications and therapy for comprehensive management.

  • Medications: Possible use of antidepressants.

  • Cognitive-Behavioral Therapy (CBT): Major therapeutic approaches include:

    • Positive Reframing: Transforming negative messages into positive ones.

    • Decatastrophizing: Making a realistic appraisal of situations to reduce anxiety.

    • Assertiveness Training: Skills enhancement to negotiate interpersonal situations constructively.

Question #2

  • True/False Statement: The neurotransmitter dopamine is associated with anxiety disorders.

Age-Related Considerations

  • Conditions in Children:

    • Selective Mutism

    • Separation Anxiety

    • Social Anxiety Disorder (may persist into adulthood)

  • Late-Life Anxiety Disorders:

    • Most common: Phobias (Agoraphobia, GAD).

    • Less common: Panic attacks, often related to other illnesses.

    • Ruminative thoughts are common in older adults, treatment typically includes selective serotonin reuptake inhibitors (SSRIs).

Mental Health Promotion

  • Understanding Anxiety: It serves as a warning signal that can reflect ineffective stress management.

  • Stress is Complex: Acknowledge that "positive events" can also be stressful.

  • Goal for Management: Effective management of stress and anxiety, rather than total elimination.

  • Medications: Important for relieving excessive anxiety but do not completely solve the issue.

Tips for Managing Stress

  • Maintain a positive attitude and self-belief; accept inability to control certain events.

  • Use assertive communication and express feelings (talking, laughing, crying).

  • Practice relaxation techniques.

  • Set realistic goals and engage in personally meaningful activities.

  • Ensure a well-balanced diet, regular exercise, and adequate rest/sleep.

  • Limit caffeine and alcohol intake.

  • Implement stress management techniques.

Panic Disorder

  • Characteristics: Defined by discrete episodes of panic attacks with no identifiable stimulus for the panic response.

  • Diagnosis: Requires recurrent, unexpected attacks followed by at least one month of concern or worry about future attacks.

  • Comorbidity: About half of individuals with panic disorder also experience agoraphobia.

    • Associated with increased risk of suicidality and avoidance behaviors.

    • Recognize primary and secondary gain, where avoidance behaviors provide relief temporarily but can worsen fear in the long term.

Treatment for Panic Disorder

  • Psychotherapeutic Approaches: Includes CBT, deep breathing, and relaxation techniques.

  • Medications: Use of benzodiazepines, selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants, and antihypertensives (e.g., clonidine, propranolol).

Nursing Process Application for Panic Disorder

  1. Assessment:

    • Utilize the Hamilton Rating Scale for Anxiety (see Box 14.1).

    • Gather comprehensive client history.

    • Observe general appearance and motor behavior (look for automatisms).

    • Assess mood and affect, focusing on potential symptoms of depersonalization and derealization.

    • Analyze thought processes; check for signs of disorganized thinking or loss of rational thought.

  2. Continued Assessment:

    • Evaluate sensorium and intellectual processes, looking for confusion or disorientation.

    • Assess judgment and insight; understanding client self-concept in terms of self-blame and excessive worry.

    • Investigate roles and relationships, noting any avoidance behaviors and how it impacts social interactions.

    • Monitor physiological needs and self-care concerns like sleeping and eating.

  3. Data Analysis and Identification of Priorities:

    • Identify common problems.

    • Set outcomes for the client.

    • Implement necessary actions:

      • Promoting safety and comfort.

      • Utilizing therapeutic communication techniques.

      • Managing anxiety through effective interventions.

      • Providing education to both client and family.

    • Evaluation: Regularly assess the effectiveness of interventions and modify strategies as needed.

Question #3

  • Assessment Expectation: Which finding would a nurse expect to assess in a client with a panic disorder?

    • A. Rational thinking

    • B. Blaming of others

    • C. Automatisms

    • D. Organized thoughts

Phobias

  • Definition: Intense, illogical, and persistent fear of a specific object or situation; responses are typically disproportionate to the actual circumstance.

  • Categories of Phobias:

    • Agoraphobia

    • Specific Phobia

    • Social Anxiety or Phobia

  • Categories of Specific Phobias: Include fears related to natural environment, blood/injection, situational, animals, and other specific types.

Treatment of Phobias

  • Behavioral Therapy: Strategies include positive reframing, assertiveness training, systematic desensitization, and flooding.

  • Medications: Consult Table 14.3 for additional medication options specific for treating phobias.

Question #4

  • True/False Statement: Phobias result from a past negative experience.

Self-Awareness Issues

  • Understanding Anxiety: Important for nurses to comprehend how anxiety behaviors function and their own vulnerabilities to stress.

  • Personal Experience: Acknowledge that everyone experiences stress and anxiety at times.

  • Client Interaction: Avoid attempts to "fix" the client’s problem outright; focus on facilitating their own management of anxiety.

  • Personal Techniques: It's crucial for nurses to use techniques in their personal lives to manage stress and anxiety effectively.