1. Copyright © 2013 by Elsevier Inc. All rights reserved.
Chapter 18
Managing Anxiety
Copyright © 2013 by Elsevier Inc. All rights reserved.

2. Anxiety (p. 202)
A feeling of uneasiness, uncertainty, and helplessness
A normal emotional response to a real or imagined threat or stressor
Serves several purposes
A warning of impending danger
Mild anxiety can increase learning by enhancing concentration and focus
Uncontrolled anxiety often leads to ineffective and maladaptive behavior
A normal part of survival and growth
What are the disadvantages of having too much or too little anxiety? (Too little anxiety can result in a lack of focus or recklessness; too much anxiety can lead to inability to accomplish important tasks.)
Copyright © 2013 by Elsevier Inc. All rights reserved.

3. Continuum of Anxiety Responses (p. 202)
Reactions to anxiety occur along a continuum of behavioral responses.
Positively focused anxiety helps us to adapt, learn, and grow from our experiences.
Maladaptive responses to anxiety are ineffective attempts to cope.
Responses to anxiety occur on four levels, ranging from mild to panic.
Describe the continuum of responses to anxiety.
Copyright © 2013 by Elsevier Inc. All rights reserved.

4. Continuum of Anxiety Responses cont’d. (p. 203)
Anxiety occurs as the result of a perceived threat to one’s self.
Types of anxiety include the following:
Signal anxiety
Learned response to an anticipated event- such as when someone has to do something
Anxiety state
Individual’s coping abilities become overwhelmed and emotional control is lost.
Anxiety trait
Learned component of the personality
Copyright © 2013 by Elsevier Inc. All rights reserved.

5. Continuum of Anxiety Responses cont’d. (p. 203)
Levels of Anxiety
Mild-V/S and Pupils normal; minimal muscle tension; feelings of comfort & safety; appearance and voice relaxed and calm
Moderate-V/S normal or slightly elevated; feelings of readiness or energized; competitive; able to learn
Severe-ANS excessively stimulated; muscles tense; senses affected hearing and pain sensation decreased
Panic-Previous symptoms escalated; B/P decreases; poor muscle coordination; sensations lessened; feel helpless, may be angry, terrified, withdrawn, or combative
What are some other physical coping mechanisms for anxiety?
What would be an example of a coping mechanism used to an extreme?
Copyright © 2013 by Elsevier Inc. All rights reserved.

6. Continuum of Anxiety Responses cont’d (p. 204)
Defense mechanisms
Psychological strategies that help to lessen feelings of anxiety
Goal is to reduce uncomfortable negative emotions.
Crisis
One’s ability to cope with anxiety is overwhelmed.
New coping behaviors must be developed to successfully resolve the source problem.
Copyright © 2013 by Elsevier Inc. All rights reserved.

7. Continuum of Anxiety Responses cont’d. (p. 205)
Physical symptoms of anxiety
Muscle tension
Fidgeting
Headache
Problems with sleep
Fight-or-flight reaction
Coping methods
Coping mechanisms in the physical realm include efforts to directly face and handle the problem; or using doing some physical activity to help such as boxing or jogging
Intellectual coping mechanisms are aimed at making the threat less meaningful by changing one’s perception.; Table 18-2
What are some other physical coping mechanisms for anxiety?
What would be an example of a coping mechanism used to an extreme?
Copyright © 2013 by Elsevier Inc. All rights reserved.

8. Continuum of Anxiety Responses cont’d. (p. 205)
Common Defense Mechanisms:
Compensation
Denial
Displacement
Identification
Rationalization
Regression
Substitution
Suppression
Are among a few of the coping or defense mechanisms
What are some other physical coping mechanisms for anxiety?
What would be an example of a coping mechanism used to an extreme?
Copyright © 2013 by Elsevier Inc. All rights reserved.

9. Continuum of Anxiety Responses cont’d. (p. 206)
Self-awareness and anxiety
Anxiety is contagious.
It is important for caregivers to recognize and cope effectively with their own anxieties.
We may not choose our anxieties, but we do choose how we deal with them.
Copyright © 2013 by Elsevier Inc. All rights reserved.

10. Theories Related to Anxiety (p. 207)
Biological models
Psychodynamic models
Interpersonal models
Behavioral models
Other models
Existential theory-loss of life’s meaning
Environmental theory-ties to uncontrollable events or situations such as fires, floods, etc
Holistic theory-influenced by every realm of human functioning
Copyright © 2013 by Elsevier Inc. All rights reserved.

11. Anxiety Throughout the Life Cycle (p. 208)
Anxiety in childhood
Related to a child’s developmental level
Problems associated with anxiety in childhood compulsions
Phobia
Separation anxiety disorder
Overanxious disorder
Avoidant disorder
How is anxiety experienced through each life cycle?
How can adults model good coping behaviors for children?
Emotional problems that occur later in life are often linked to unmet needs in childhood.
What are some signs of stress in children?
Copyright © 2013 by Elsevier Inc. All rights reserved.

12. Anxiety Throughout the Life Cycle cont’d. (p. 209)
Anxiety in adolescence
Adolescents who ineffectively cope with anxiety often express themselves inappropriately.
Many initial symptoms of schizophrenia and other psychoses begin in adolescence.
Health care providers who work with adolescents must assess adolescents’ anxiety levels and offer early intervention and education.
What are some common ineffective responses to stress and anxiety displayed by adolescents?
Copyright © 2013 by Elsevier Inc. All rights reserved.

13. Anxiety Throughout the Life Cycle cont’d. (p. 209)
Anxiety in adulthood
Similar to their younger counterparts, adults handle anxiety by using earlier established coping mechanisms.
Developmental tasks, such as establishing a career and family, present numerous stressors.
When adult anxieties are not successfully managed, a number of mental health problems may result.
Adults continue to use coping mechanisms established in childhood.
Copyright © 2013 by Elsevier Inc. All rights reserved.

14. Anxiety Throughout the Life Cycle cont’d. (p. 209)
Anxiety in older adulthood
Elders often deny their anxiety.
They may use somatization (physical expression)
Socially, they were taught that it is inappropriate to share their fears and anxieties.
One of the most effective methods for assessing anxiety in older adults is to simply ask the client to explain his or her anxious feelings.
Older adults usually appreciate the interest of concerned caregivers.
Copyright © 2013 by Elsevier Inc. All rights reserved.

15. Anxiety Disorders (p. 209)
Diagnosis of an anxiety disorder is based on a description of the ineffective or maladaptive behaviors that express distress.
Generalized anxiety disorder
Individual’s anxiety is broad, long-lasting, and excessive.
Worried and anxious more often than not
Panic disorders
More common than once thought
Two types of panic disorders:
Associated with agoraphobia
Not associated with agoraphobia
Explain the difference between normal anxiety and an anxiety disorder.
Copyright © 2013 by Elsevier Inc. All rights reserved.

16. Panic Disorders (p. 210) Panic Disorders Panic Attack Criteria
About 70% of women population
Panic Attack Criteria
Palpitations, short of breath, sweating, trembling, feelings of unreality, fear of dying, chills or hot flashes, paresthesias
Agrophobia-anxiety about possible situations; avoid people, places, or events where would be hard to escape from.
Social isolation-when do not want to be surrounded by people.
Discuss the differences between phobic and obsessive-compulsive behaviors.
Copyright © 2013 by Elsevier Inc. All rights reserved.

17. Anxiety Disorders (p. 211) Phobic disorders
A phobia is an internal fear reaction.
Phobias differ from common fears.
Phobias are obsessive in nature.
People with phobias handle their anxieties ineffectively.
Characteristics of phobias vary with the culture.
Obsessive-compulsive disorder
Specific behaviors must be performed to reduce anxiety.
Obsession-distressing persistent thought
Compulsion-distressing recurring behavior
Most common obsessions are related to cleanliness, dirt, and germs; aggressive and sexual impulses; health concerns; safety concerns; and order and symmetry.
Can occur as early as 3 years of age
Discuss the differences between phobic and obsessive-compulsive behaviors.

18. Anxiety Disorders cont’d. (p. 212-213)
Traumatic stress reaction
Series of behavioral and emotional responses that follow an overwhelmingly stressful event
Posttraumatic stress disorder
Reliving of traumatic events or situations
Anxiety, depression, and nightmares can complicate the picture.
Symptoms-intense fear, horror or helplessness; emotionally numb, estremely alert and guarded and emotional distresses trigger flashbacks
What are the features of posttraumatic stress disorder?
Copyright © 2013 by Elsevier Inc. All rights reserved.

19. Other Disorders Body dysmorphic disorder—obsessed with flaw in body
Hoarding disorder—persistent difficulty in parting with things or possessions
Behavioral disorders-addictive behaviors such as gambling, shopping, working, or engaging excessive sexual activity
Copyright © 2013 by Elsevier Inc. All rights reserved.

20. Therapeutic Interventions (p. 213)
Cognitive behavioral therapy (CBT)-helps intellectually understand the ineffective behaviors and replace them with more successful behaviors
Systematic desensitization-gradually removes anxiety from distress causing event and develop more effective ways to work through anxiety
Flooding-opposite, where exposes client to feared object or situation until anxiety levels diminish
Animal therapy
List therapeutic interventions for the client with rape-trauma syndrome.
Explain the importance of monitoring medication use for clients with high levels of anxiety.
Describe the methods used to recognize and prevent anxiety.
Clients who undergo treatment with anxiety medications should be monitored carefully for adverse effects.
Copyright © 2013 by Elsevier Inc. All rights reserved.

21. Therapeutic Interventions (p. 213)
Prevention is the most effective way to cope with anxiety.
Mental health therapies and medications frequently are used as treatment.
History and thorough physical examination are performed.
Anxiety may be treated with various medications:
Benzodiazepines-take with food to help with nausea
Antidepressants
Antihistamines
Propranolol
Anxiolytics
List therapeutic interventions for the client with rape-trauma syndrome.
Explain the importance of monitoring medication use for clients with high levels of anxiety.
Describe the methods used to recognize and prevent anxiety.
Clients who undergo treatment with anxiety medications should be monitored carefully for adverse effects.
Copyright © 2013 by Elsevier Inc. All rights reserved.