Definition  A feeling of uneasiness that activates the autonomic nervous system in response to a vague, nonspecific threat  Differs from fear because fear is a response to a known threat.

4 Degrees of Anxiety  MILD  Perceptual field widens slightly. Increased ability to see relationships among data.  Person is alert, more perceptive, able to recognize the anxiety.

 MODERATE  Perceptual field narrows slightly. Can change attention if directed.  Person is able to sustain attention on a focal point. May talk faster, V/S begin to increase, able to recognize and express anxiety.

 SEVERE  Perceptual field is greatly reduced. Does not notice external events. Unable to redirect attention even with direction.  Attention is focused on a small part of a specific area. May be unaware of anxiety, V/S increasing, coping relief measures are used.

 PANIC  Perception is distorted, may jump from one detail to another (flight of ideas) Person feels dread or terror.  Feeling of unreality, confusion, terror, self-absorption. Mat be expressed with violence toward self or others. Loss of control. Can result in exhaustion if prolonged.

Signs & Symptoms  Increased heart rate  Increased blood pressure  Dilated pupils  Cool skin  Piloerection (hair “standing on end”)  Decreased GI motility

Coping with anxiety  Coping behaviors are:  ADAPTIVE ~  A student receives a bad grade on an exam. The student goes to the instructor to see what her faults are (problem solving).  MALADAPTIVE~  A student receives a bad grade on an exam. The student does not seek advice or help, keeps studying the way he always does, hoping it will pay off (avoidance)

Task Oriented Reactions  Reactions to anxiety that are conscious ways to cope with problems or to meet needs.  Attack Behavior~ actively removing obstacles through problem solving while considering the rights of others  Withdrawal Behavior~ removing self either physically or emotionally from a stressful situation  Compromise~ changing the usual ways of behaving, substituting goals, or giving up aspects of person needs.

Attack Behavior  Adaptive attack behavior:  Example~ A nurse asking another nurse to help figure out why a client’s condition is changing  Maladaptive attack behavior:  Example~ A nurse shouting at a nursing assistant that made a mistake.

Withdrawal Behavior  Adaptive Withdrawal behavior:  Example~ Person with asthma leaves a smoke- filled room  Maladaptive Withdrawal behavior:  Example~ Avoiding visiting family or friends to avoid arguments

Compromise  Compromise is usually adaptive  Example~ Nursing student wanted to go on vacation to Disney World a week during school but would be penalized for it. She compromised by still going to Disney World, but on break from school.

Types of Anxiety Disorders  Generalized Anxiety Disorder  Panic Disorder (with or without Agoraphobia)  Agoraphobia (with out Panic Disorder)  Obsessive-Compulsive Disorder (OCD)  Acute Stress Disorder  Posttraumatic Stress Disorder (PTSD)

Generalized Anxiety Disorder  Characterized by excessive anxiety and worry occurring on most days for at least 6 months. Anxiety can be for a number of different events or activities, and the individual finds it difficult to control.  Must have at least 3 of the following:  Restlessness  Fatigue  Difficulty Concentrating  Irritability  Muscle Tension  Disturbed Sleep

Generalized Anxiety Disorder  Persons with GAD report they feel:  Significant stress  Difficulty controlling the worry  Impairment in social occupational functioning

Physical Symptoms of GAD  Fatigue  Headaches  Muscle tension  Muscle pain  Irritability  Sweating  Nausea/Vomiting  Difficulty breathing/swallowing  Trembling  Hot flashes

Panic Disorder  Panic Attack:  Characterized by an episode of intense fear or discomfort  People with Panic Disorder have recurrent, unexpected panic attacks followed by at least one month of persistent concern about having another one.  May occur without warning, or are associated with stressor(s)  Can occur at anytime (even sleep)  Peaks in severity within 10 minutes  Can severely limit an individual’s ability to function

Panic Disorder  During a panic attack, four or more of the following are present:  Palpitations, pounding heart, or increased heart rate  Sweating  Trembling/shaking  Sensations of shortness of breath or smothering  Feeling of choking  Chest pain or discomfort  Nausea of abdominal distress  Feeling dizzy, unsteady, lightheaded or faint  Derealization (feeling of unreality) o depersonalization (feeling detached from oneself)  Fear of losing control or going crazy  Fear of dying  Paresthesias (numbness or tingling)  Chills or hot flashes

Agoraphobia  Agoraphobia:  Characterized by anxiety about being in places or situations where escape may be difficult (or embarrassing) or when help might not be available in the case of a panic attack  Commonly associated with Panic Disorder  More likely to occur in females than in males  Often include situation that involve being alone away from home in a crowd or standing in line; on a bridge; or traveling in a plane, train, bus, or automobile.

Post-traumatic Stress Disorder (PTSD)  PTSD:  Debilitating condition that follows an extreme traumatic stressor  Stressor may be and even that threatens the individual’s life, serious injury, or personal integrity.

Characteristics of PTSD  Persistent re- experiencing the traumatic event  Increased arousal (difficulty sleeping, nightmares, exaggerated startle response, and hypervigilance or alertness for danger)  Numbing of general responsiveness (“psychic numbing” or “emotional anesthesia”)  Avoidance of stimuli associated with the trauma

Types of Phobias  Acrophobia  Agoraphobia  Ailurophobia  Apiphobia  Aviophobia  Claustrophobia  Cynophobia  Entomophobia  Hematophobia  Iatrophobia  Hydrophobia  Microphobia  Monophobia (autophobia)  Mysophobia  Nyctophobia  Pyrophobia  Xenophobia