Chapter 5 ANXIETY Margaret Chambers

Introduction In order to develop the skills to help people manage their anxiety is it essential to understand the mechanisms of stress and coping in the individual. This presentation summarises the key points from the printed text, to facilitate discussion in your student learning groups. Part 1 Stress, anxiety and coping Part 2 The effects of stress and anxiety on the body Part 3 Problem focused coping strategies Part 4 Emotion focused coping strategies

PART 1: Stress, Anxiety and Coping

Stress - Definitions Stress - when the demands of a situation outweigh the individual’s ability to cope. Stressors – those incidents affecting an individual that activate a stress response. Anxiety - the subjective experience of individuals undergoing stress.

Stress Appraisal Primary appraisal – how great is the threat we are facing? Secondary appraisal – how well can we cope with it?

Anxiety Two forms of anxiety have been described: State anxiety – a feeling of alarm or dread that has arisen in a particular social situation Trait anxiety – a personality characteristic

Coping [Coping is] “Confronting and adapting to the threats with which individuals are faced” (Keil 2004). In order to cope, individuals use a number of strategies: Problem focused strategies (Reducing threat by changing situation) Emotion focused strategies (dealing with feelings of threat)

Coping Styles and Strategies Coping styles are related to personality or temperament, are relatively stable through life and may be either: Inborn or innate Learned behaviours Coping strategies are cognitive or behavioural methods employed to deal with stress (Ryan-Wenger 1994) which are open to interventional change.

Locus of Control Internal locus of control – People who feel in charge of their own lives External locus of control – People who believe that they are at the mercy of others or chance (Forshaw 2002)

PART 2: The Effects of Stress and Anxiety on the Body

The Physiological Effects of Stress Q. Stress excites the autonomous nervous system and leads to the release of noradrenaline and stress hormones. What effects do these have on the body?

The General Adaptation Model (Seyle 1956) Stage of perceived stress Stage of alarm reaction Stage of fight or flight Stage of resistance Stage of exhaustion Q. In a response to a stressful situation, what would happen during each of these stages?

PART 3: Managing Anxiety in the Health Care Setting: Problem Focused Strategies

Problem Focused Strategies Involve breaking down problems into a number of smaller goals that can be more easily managed: Defining the stressor Setting realistic goals Examining alternatives Considering all other perspectives and motives Selecting an appropriate strategy Delineating necessary steps to reach the goal Rewarding behaviour for having tried (Adams 2004)

PART 4: Managing Anxiety in the Health Care Setting: Emotion Focused Strategies

Emotion Focused Strategies Communication and information giving Stress immunisation Physical activity Relaxation and meditation Thought stopping Positive self talk Guided imagery