Anxiety TUT support slides PP Flashcards
Physical Responses to anxiety include
Hyperventilation, fear, increase blood pressure, sweating, stress, dilated pupils, rapid breathing
What is a panic disorder and what does it look like physiologically and psychologically?
Unpredictable experiences of intense, episodic surges of anxiety
Physiological; tachycardia, sweating, shaking, dyspnoea, chest pain, dizziness, nausea, tingling and a sense of depersonalisation
Psychological; a sense of imminent death or doom, fear of losing consciousness, engaging in rapid safety behaviours i.e phoning ambulance
Panic attack: What do YOU do?
Calm coaching, cupped hands, paper bag, timed breathing, use the nose
Short, simple and audible sentences;
“Listen to my voice. Take some slow deep breaths. In, two, three; out two, three. Anxiety is taking over here. Listen to me so we can calm it down.”
Reduce stimuli
Stay with the person
SCENARIO; Moira. Although Moira acknowledges that the washing is excessive, and that her health is suffering because of the excessive hand washing, she still feels that it is necessary. Even if she is able to make an enormous effort to resist washing, the anxiety she feels afterwards is so great that she is compelled to wash her hands even more thoroughly and more often to make up for the omission.
OCD. OCD has two components, WHAT ARE THESE and definitions?
Obsession = intrusive thought Ritual = behaviour to manage the intrusive thought
What are some nursing diagnoses for Moira?
Distress and heightened anxiety related to intrusive and disturbing obsessive thoughts causing frequent, prolonged hand washing to avoid contamination.
Risk of infection, skin integrity and infected cuticles related to excessive and prolonged hand washing.
Risk of social isolation due to frequency of compulsion to wash which may lead to avoidance of situations where contamination may occur (which is everywhere!) On top of this, avoidance may result in financial hardship (no work), loneliness (no relationships) and malnutrition (no shopping!!)
What are some interventions for Moira? Think pharmacology
Pharmacological; benzodiazepines for short term use
Anti-depressants (SSRI’s) for long term use
Talking therapies (CBT, ACT)
Psychoeducation
Relaxation techniques
Problem solving
What is a trauma-informed approach?
Why is it important for nurses and assessment?
Trauma may be a major predisposing factor related to the experience of heightened anxiety
Trauma informed approach aims to reduce harm by ensuring sensitivity, choice and collaboration in care
Understand what is going on for the person rather than focusing on what is wrong with them
What is ACT therapy?
Acceptance and Commitment Therapy
Describe ACT Therapy and the benefits
A way of working with distress by changing the way we relate to it as opposed to challenge or change
Internal experiences (negative thoughts, emotional disturbance) are normal
We choose to accept and work with them rather than fight them.
Helps to identify and connect with values
Empowers people to make choice
Improves psychological flexibility
Finds resilience and clarity
Post Traumatic Stress Disorder. What is it?
‘Development of characteristic symptoms following exposure to an extreme traumatic stressor involving direct personal experience of an event that involves actual or threatened death or serious injury, or other threat to one’s integrity; or witnessing an event that involves death, injury, or a threat to the physical integrity of another person; or learning about unexpected or violent death, serious harm, or threat of death or injury experienced by a family member or close associate’
PTSD is Characterised by
distressing flashbacks and derealisation. Recurrent intrusive recollections of the event, distressing dreams and intense distress at exposure to cues (eg anniversaries)
Trauma and risk of PTSD. What are the triggers and what are people with PTSD at risk for?
Triggers; military combat, violent personal assault, disaster, accidents, childhood sexual abuse for example.
High risk of co-morbidity with substance misuse and mood disorders, particularly anxiety
Increased risk of suicide and self-harming behaviour
Risk of being misdiagnosed
Interventions for anxiety?
Trauma focused psychological interventions
EMDR (Eye Movement Desensitisation Reprocessing) (see notes below)
Trauma focused CBT [cognitive behavioural therapy]
SSRI’s are effective with co-morbidity with anxiety disorders
What is Cognitive behavioural therapy (CBT)
An attempt to make sense of the anxiety sufferers experiences, belief systems and reactions
Cognitive approaches to difficult, distressing situations are considered dependent on early perceptions of ourselves, the world in general and our belief systems which are shaped by early childhood.
CBT hopes to reshape thinking, test ways of changing thinking and gain ability to identify and work with historical trauma/experience that may drive the distress and anxiety.
Explain what the vicious circle is. [CBT Therapy]
Situation happens. 1. Automatic thought 2. Feelings 3. Behaviour 4. Reinforces
