Recognising Distress

Question 1

What is distress?

Answer 1

A mix of anxiety and depressive symptoms—may cause sleeplessness, lack of appetite, trouble concentrating and difficulty carrying on regular activities.

Question 2

What are the observable signs of anxiety?

Answer 2

• Panic attacks
• Shaking
• Talking faster (or very little)
• Very tense
• Rapid breathing
• Sweating
• Feeling weak or fatigued
• Fast heart rate
• Difficulty concentrating
• Excessive worry
• Ruminating on the same topic or concern
• Illogical or intense fears
• Nervous habits

Question 3

What are the observable signs of anger?

Answer 3

• Visibly tense
• Clenching jaws or grinding teeth
• Resentful
• Visibly aggressive
• Agitated
• Pacing
• Use of sarcasm or losing sense of humour
• Being abrasive
• Raising voice
• Silence
• Staring

Question 4

What happens when distress reaches its limit?

Answer 4

• Once distress has reached a peak (often described as being outside of the normal emotional window of tolerance) the brain an enter a survival mode
• When this occurs the amygdala (deep seated evolutionary response) takes over and the rational mind is no longer in control

Question 5

What is fight/flight?

Answer 5

Fight: Increased aggression and feelings of being threatened
-Flight: The desire to run away or leave the situation, often high levels of anxiety

Question 6

What is freeze/fawn?

Answer 6

• Freeze: Body may shut down and person cannot react to the situation at all
• Fawn: In some instances when the amygdala response is triggered people may become overly attached and react positively to the source of the threat (can be seen in traumatic/abusive relationships)

Question 7

How do you communicate with someone who is distressed?

Answer 7

• Be empathetic
• Understand that their experience is what it is, even if it may not be ‘justified’ in your opinion
• Be attentive and actively listen, learning about their experience
• Ask open questions
• Give the person the time and space to answer, do not rush the assessment

Question 8

What questionnaires can be used to assess distress?

Answer 8

• Whooley’s questions
• Hospital anxiety and depression scale (HADS)
• General anxiety disorder-7 (GAD-7)
• Patient health questionnaire (PHQ-9)
• Becks depression inventory (BDI-II)

Question 9

What do you do if a patient says they have thoughts of self harm/suicide?

Answer 9

• Stay calm- overreacting at this point can be detrimental
• Be empathetic and thank them for telling you
• Ask if there’s anything you can do
• Risk assessment whether it is safe for them to leave
• Explain that you have a duty of care and will need to raise this with your mentor

Question 10

What is incongruent communication?

Answer 10

• If someone is acting in a way that’s different from the behaviour they are exhibiting, for e.g a person says they are not angry but they are visibly tense, pacing and beginning to raise their voice
• A person says they feel fine to continue with the assessment but they are clearly very distressed
• Lightly bring attention to what you notice “you say you are okay to go on but I’ve noticed you seem quite anxious, are you sure?”