CHAPTER 18 Managing Anxiety

1. CHAPTER 18Managing Anxiety

2. Anxiety • 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

3. Types of Anxiety • Signal- learned response to anticipated event • Anxiety State- coping abilities become overwhelmed and emotional control is lost • Anxiety Trail- learned component of personality

4. Continuum of Anxiety • Adaptive responses to anxiety describe a continuum of behavioral responses. • Responses to anxiety occur on four levels, ranging from mild to panic. • During periods of anxiety, physical, intellectual, emotional, and behavioral responses help us cope. • In periods of severe anxiety, the autonomic nervous system stimulates the fight-or-flight response.

5. Levels of Anxiety • Mild- relative comfort and safety • Moderate- feelings of readiness to the challenge, energized • Severe- feels threatened • Panic-helpless , total loss of control

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7. Coping Mechanisms Used to Decrease Anxiety • All coping mechanisms reduce anxiety, but if used to extremes, serious mental and physical problems can result. • Physical coping mechanisms include efforts to face and handle the problem directly. • Physical exercise • Yoga (Cont’d…)

8. Coping Mechanisms Used to Decrease Anxiety (…Cont’d) • Intellectual coping mechanisms diminish the threat by changing person’s perception. • Spiritual coping methods • Faith • Prayer • Ritual • Emotional responses • Crying • Communicating or sharing • Ego defense mechanisms

9. Defense Mechanisms • Strategies that help to lessen anxious feelings • Psychological, self preserving • Vs coping: efforts to directly face and handle the problem

10. Compensation Conversion Denial Displacement Dissociation Fantasy Identification intellectualization Isolation Projection Rationalization Reaction formation Regression Restitution Sublimation Substitution Suppression Symbolization undoing Common Defense Mechanisms

11. Ineffective Coping • Too little anxiety- lack of attention, or focus • Too much anxiety-overwhelm and immobilize • Inability to accomplish tasks • When defense mechanisms become primary means of dealing, they replace problem solving and other positive mechanisms

12. Anxiety Throughout the Life Cycle • Childhood • Children learn to cope with anxiety by watching and imitating others. • If a child’s needs for nurturing are not met, high anxiety can result. • Anxiety is experienced in relation to the developmental level. • Infants feel discomfort if needs are not met immediately. • Toddlers become anxious if they perceive something larger or more ferocious than themselves. (Cont’d…)

13. Anxiety Throughout the Life Cycle (…Cont’d) • Adolescence • Coping behaviors learned in childhood continue to be refined. • Running away, angry, defiant, aggressive, manipulative • Adulthood • Young adults have well-established coping behaviors. • Adults encounter many anxiety-producing situations. • Can evolve into PTSD • Late adulthood • Elders tend to express anxieties in less overt ways than younger people do. • When work and food are scarce • Elders face a combination of anxiety-producing life hazards.

14. Anxiety Disorders • An anxiety disorder exists when anxiety is expressed in ineffective or maladaptive ways and coping mechanisms do not successfully relieve the distress. • Diagnosis based on description of behaviors that express distress • Classification • Generalized • Panic • Phobic (Cont’d…)

15. Generalized • When individuals anxiety is broad, long lasting and excessive • Worried and anxious more often than not • In children- overanxious- school, performance, social events • Adults-everyday events

16. Panic Disorder • Attack- brief period of intense fear or discomfort • 2 types: • Agorophobic – avoid people , places or events • Non agorophobic

17. Phobias • Internal fear reaction • Specific objects or situation • Unrealistic, persistent • “Social phobes”- fear of any situation in which other people could be judging

18. Phobic Disorders • Phobia: Unnatural internal fear of people, animals, objects, situations or events • Phobic posttraumatic stress disorders are obsessive in nature. • Marked by a tendency to dwell on object of fear to the point of fascination • Those with phobias handle anxieties differently • Extreme immobilizing anxiety that prevents the person from acting in a way that could effectively alleviate anxiety.

19. Anxiety Disorders (…Cont’d) • Obsessive-compulsive • Behavioral • Posttraumatic

20. Obsessive-Compulsive Disorder • Obsessive-compulsive disorder (OCD) • An obsession is a distressing persistent and recurring, inappropriate thought. • A compulsion is a distressing recurring behavior that must be performed to reduce anxiety. • OCD clients are consumed by self-destructive, anxiety-reducing thoughts and actions. • Symptoms can occur as early as 3 years of age but usually begin in adolescence. (Cont’d…)

21. Obsessive-Compulsive Disorder (…Cont’d) • Men and women are equally affected, although in men symptoms usually appear 5 years earlier. • Those with other mental health disorders, especially depression or schizophrenia, have a high prevalence of OCD. • Common obsessions • Cleanliness • Dirt • Germs (Cont’d…)

22. Obsessive-Compulsive Disorder (…Cont’d) • Aggressive and sexual impulses • Health concerns • Safety concerns • Order and symmetry (Cont’d…)

23. Obsessive-Compulsive Disorder (…Cont’d) • Those with OCD use defense mechanism of repression to cope with obsession. • Intellectually, those with OCD know that their attempts to relieve anxiety are maladaptive but feel emotionally compelled to yield to their obsessions. • OCD is seen to run in families and may have a genetic or hormonal cause. (Cont’d…)

24. Traumatic Stress Disorder • A series of behavioral and emotional responses following an overwhelming stress. • Possible diagnosis for anyone who has been sexually assaulted • Rape-trauma syndrome follows predictable clinical course • Fear and anguish • Recovery and repair • Adaptation

25. Posttraumatic Stress Disorder • Result of traumatic experience outside the realm of normal life experiences • Intense fear, horror or helplessness was experienced • Traumatic event or situation is repeatedly relived • Symptoms include flashbacks • In vivid recollections of the event, the individual relives the experience. • Can last from a few seconds to longer than a half hour • Perceived as vividly real and life-threatening to the individual (Cont’d…)

26. Posttraumatic Stress Disorder (…Cont’d) • When caring for a PTSD client having a flashback, it is imperative that interventions ensure everyone’s safety while helping to reorient the client to present surroundings. • Those with severe PTSD isolate themselves from society by living in sparsely populated rural areas. • Children with PTSD express themselves through disorganized or agitated behaviors.

27. Therapeutic Interventions • Learn to recognize signs and symptoms of anxiety in yourself and others. • Include an anxiety level assessment for each client. • A combination of mental health therapies and medications are effective in treating maladaptive responses to anxiety. • Discover the basis or cause of anxiety. (Cont’d…)

28. Therapeutic Interventions (…Cont’d) • Problem-solving techniques • Relaxation therapy • Medications • Benzodiazepines • Antidepressants • Antihistamines • Propranolol