Anxiety & Stress Flashcards
What is anxiety disorder?
An abnormal extreme, unnecessary and pathological fear and anxiety starts to take over individuals lives
What is general anxiety disorder (GAD)?
One of a range of anxiety disorders inc. panic disorder, PTSD, OCD, social phobia, specific phobias (e.g. of spiders) and acute stress disorder
What are some psychological symptoms of general anxiety disorder (GAD)?
- Worry (difficult to control) leading to decreased occupational and social functioning
- Interrupted sleep
- Poor concentration
- Increased sensitivity to noise
What are physical symptoms of general anxiety disorder (GAD) due to overactive ANS?
- Sweating
- Dry mouth
- Urinary frequency
- Hyperventilation (SOB + dizziness)
- Palpitations
What is the DSM-IV diagnostic definition of general anxiety disorder (GAD)?
Excessive anxiety and worry that is difficult to control, occurring more days than not for at least 6 months, about a no. of events or activities (such as work or school performance)
Anxiety and worry are associated with three or more of the following 6 symptoms:
- Restlessness or feeling keyed up or on edge
- Being easily fatigued
- Difficulty concentrating or mind going blank/forgetfulness
- Irritability/sensitized to situations
- Muscle tension
- Sleep disturbance (difficulty falling or staying asleep or restless unsatisfying sleep)
What impacts can general anxiety disorder (GAD) have?
- Chronic
- Can occur with other physical conditions e.g. chronic pain
- Daily living
- Work
- Social interactions
- Relationships
- Suicidal ideation and attempts are higher
What gives a person a predisposition to general anxiety disorder (GAD)?
- Bio-psycho-social factors
- Brain imaging studies show neural activity associated with abnormal cognitions e.g. increased attention to threat
- Social environment (e.g. early childhood)
- Perceived control (i.e. if lower than normal)
How can individuals cope with anxiety?
- Pharmacologically
- Relaxation/Mindfulness
- CBT
- Thought diary
What is Cognitive Behavioural Therapy (CBT)?
Helping patients to learn the link between physiological changes and the psychological response - teach them how there thoughts, emotions and behaviour interact giving them skills to adapt thoughts and helping them to gain back control
What are the 3 different types of anxiety-related thought patterns?
- Selective attention: seeing only the -ve features of an event
- Magnification: exaggerating the importance of undesirable events
- Overgeneralisation: drawing broad -ve conclusions on the basis of a single insignificant event
What are the 4 classes of effect of stress? Give a few examples of each.
- Affective: shock, distress, anxiety, fear, depression, anger
- Behavioural: smoking, alcohol, illicit drugs, sexual function
- Cognitive: poor attention, errors in decision-making, hypervigilance for threats, memory loss
- Physiological: activation of NS, hormone production, immune function, fatigue
Stress not only increases risk of illness amongst the healthy but also:
Impedes recovery/worsens prognosis among the ill
What are the results on the ward of a stress-in patient?
- Slower wound healing
- More post-surgery complications
- Longer in-patient stay
- More staff time per day
- More analgesia use
- Less satisfaction with treatment (associated with poor adherence)
What are the effects after discharge of a stressed in-patient?
- Longer recovery (e.g. return to work)
- More service use (e.g. related symptoms)
- Less use of rehabilitation services
- Increased risk of co-morbidity and early mortality
What are the 3 perspectives to understanding stress?
- Stimulus: focus on cause (stressor)
- Response
(physiological) : focus on effect
BUT cannot look at these individually as everyone responds differently to stress so look at:
- Process: focus on person-environment interaction (transaction)
What is the fight or flight response?
- CNS activates SNS acute stress response
- Increased HR, BP, RR, glycogenolysis, peripheral diversion of blood + cortisol
- Decreased immune surveillance, gut function, kidney function, fat stores + sex steroids
What is the rest and digest response?
- CNS activates the PNS conservation response
- Decreased HR, BP, RR, glycogenolysis, peripheral diversion of blood + cortisol
- Increased immune surveillance, gut function, kidney function, fat stores + sex steroids
Why do we get physiological symptoms of stress?
As stress will naturally activate our SNS acute stress response when it is not needed
What is stress?
Non-specific physiological response to a threat to one’s physical or emotional well-being
What are the 3 stages of physiological response to stress?
- Alarm: fight or flight response - nervous, endocrine + immune systems activated for defence against threat initially
- Resistance: conservation response initiated to return homeostasis but becomes counterproductive if alarm continues
- Exhaustion: depletion of physiological resources - collapse of adaptive responses, immune failures + disease outcomes
What is the direct and indirect subjective process of stress?
- Direct: stimulus event causes stress response
- Indirect: stimulus events causes appraisal + coping and then the stress response happens (changes reaction to stress to a healthy one)
What is the transactional model of stress?
Causal chain of influence where the stimulus events are indirectly related to stress experience as there are processes of appraisal and coping intervene in the stressor-stress relationship and stress then comes about as a subjective post-appraisal outcome
What are the steps of the transactional model of stress?
- Stimulus event (potential stressor)
- Primary appraisal (event demands)
- Secondary appraisal (oneself)
- Response (coping)
- Health-related outcome (stress)
Describe the steps in the intervening process in the transactional model of stress.
- Primary appraisal: determines adaptational significance of event i.e. is event relevant to me, what are its demands and if so, is it a challenge, harm or threat?
- Secondary appraisal: evaluates available response options + opportunities i.e. am I able to copy adequately with the events adaptational demands? Do I need help to do so?
- Coping: cognitive + behavioural activities initiated in response to the appraisal process in order to manage the adaptational demands of the event and evaluation of coping
What is problem-focused coping and when is it effective?
Attempt to manage or change concrete aspects of the stressor - most effective when stressor is amenable to change e.g. medical school stress as students can revise and get help from students/staff to help
What is emotion-focused coping and when is it effective?
Attempt to remove or reduce the emotional distress of a situation (e.g. mindfulness/relavation) - most effective when stressor cannot be changed e.g. chronic pain
What are the sources of stress and anxiety in the medical profession?
- Job: workload, time pressure, admin duties, sleep deprivation, no regular meals + threat of malpractice suits
- Organisation: career structure, career uncertainties, lack or resources + support, culture + climate of the organisation
- Individual: personality, high demands on self/others, dealing with death/dying
- Relationship with others: staff conflicts, bullying, professional isolation, patient expectations/demands
- Work-life balance: stress over-spill from work to home life + vice versa, lack of free time/exercise + leisure activities, home demands + disruption to social life
Why did medical students felt stress impact on their patient care?
Tiredness Pressured by overwork Depression/anxiety Alcohol effects Irritability/anger
What are good techniques for stress and anxiety management?
- Relaxation (visualisation/imagery, progressive or passive muscles relaxation + autogenic relaxation)
- Mindfulness
- CBT
- Counselling
- Pharmacotherapy
- Self-help
