Test 3 Anxiety Flashcards
anxiety disorders affect ?% of population
affect 15-25% of the US population
Anxiety disorders are frequently co morbid with?
Co morbid with other psychiatric disorders and physical illness
5 anxiety disorders
- Generalized anxiety disorder
- panic disorder
- phobias
- obsessive compulsive disorder
- post traumatic stress disorder
- affective/cognitive/behavioral/physiological response to real or imagined threat
- universal human experience
- life force that is necessary for survival
anxiety
-caused because the id, the ego, and the superego are in conflict
Freud’s theory of anxiety
Freud anxiety as a defense mechanism to…?
techniques to avoid or decrease anxiety back to equilibrium
Sullivan, Peplau, and Mays theory on anxiety
- anxiety arises from problems in therapeutic relationship
- anxiety lead to growth
- anxiety can be destructive
Who said that “anxiety protects individuals from feelings of inadequacy and prevent awareness of anxiety”
Freud on anxiety
autonomic nervous system response to anxiety is sometimes called?
“fight or flight”
adrenaline rush, pupils dilate, blood pressure goes up
sympathetic system response to anxiety
body tries to conserve resources, hr decreases, pupils constrict, blood pressure and pulse decrease, people may faint
parasympathetic response to anxiety
- coordination problems during anxiety
- involuntary movements
- type of behavioral expression*
Personal characteristics of behavioral expressions of anxiety
- withdrawn or out of character behaviors
* type of behavioral expression*
interpersonal characteristics of anxiety, behavioral expressions
-identification of anxiety is critical for good nursing care
Hildegard Peplau
Peplau said mild anxiety…?
does not need intervention
Peplau said moderate anxiety is reduced using ..?
problem solving, cognitive reframing, relaxation training, deep breathing
Peplau said severe anxiety is…?
not conducive to problem solving-focus is on concrete direction to protect the patient
Panic level of anxiety renders the person…?
Renders them unable to focus- remain with the patient until the episode subsides
Alert and aware anxiety level?
mild anxiety, +
Perceptual field narrows?
anxiety level
moderate anxiety, ++
Focus on relief of anxiety?
anxiety level
Severe anxiety, +++
Unable to communicate effectively?
anxiety level
Unable to communicate effectively, ++++
- protect the individual from painful awareness of feelings that can produce anxiety
- always on alert
- may be subject to overuse
Defense mechanisms
- Major means of managing conflict and affect
- predominantly unconscious
- discrete from one to another
- reversible
- adaptive as well as maladaptive
defense mechanisms
Adaptive defense mechanisms
Healthy, altruism and sublimation
altruism
A person has an emotional conflict or stressor, that person will go out of their way to do something for another
sublimation
unconscious process of substituting something acceptable for something that’s not in order to decrease anxiety
repression, displacement, reaction formation, somatization, rationalization
intermediate defenses
excluding an unwanted or experience you want to forget about, excluding it from your memory banks
repression, intermediate defense
transfer of emotions associated with a particular person or event to something that’s non-threatening
displacement, intermediate defense
you have unacceptable feelings, but you keep them out of your awareness because you try really hard to put them in your awareness
ex: person who hates animals decides to become a vet
reaction formation, intermediate defense
the unacceptable anxiety symptoms transfer themselves into a physical symptom
somatization, intermediate defense
justification of some illogical or unreasonable behavior by concocting an acceptable reason for it
ex: everyone else cheats on the test, why shouldn’t I
rationalization, intermediate defense
Passive aggression, acting out, dissociation, idealization, splitting, devaluation, projection, denial
immature defenses, often the ones that get us into trouble and are the least healthy of the defense mechanisms
dealing with anxiety or stressors by unassertively expressing aggression towards others
passive aggression, immature defense
transferring focus, making this anxiety an emotional conflict. Acting out with angry or aggressive feelings out in the open
acting out, immature defense
when a person, there’s a disruption in the conscious integration of experiences
ex: i have no idea what i did last night
dissociation, immature defense
attributing characteristics to a person that are over the top, they are perfect in every way.
idealization, immature defense
inability to integrate both a positive and negative attribute to a person or a system
ex: best nurse in the world! That one last night was the worst in the world
splitting, immature defense mechanism
attributing negative attributes to someone or something
devaluation, immature defense mechanism
scapegoating or blaming
projection, immature defense mechanism
escaping the situation by denying that it’s a problem
denial, immature defense mechanism
-restlessness, tremor, startle
behavioral assessment of anxiety
-inattention, poor concentration, confusion, fear
cognitive assessment of anxiety
-impatience, jittery, unease, nervousness
affective assessment of anxiety
- establishing and maintaining the therapeutic alliance to facilitate progress in health
- facilitates energy to progress
- interventions for _____ anxiety*
interventions for MILD anxiety
- trusting relationship; therapeutic alliance
- control personal anxiety (nurse)
- discuss cause/effect
- What is the relationship of anxiety to threat
- explore meaning of events
- provide information to decrease fears of unknown
- explore usual coping strategies
- relaxation/distraction
- supportive relationship/spiritual support
- modify physical environment
- interventions for ______ anxiety*
interventions for MODERATE anxiety
- stay with client
- calm voice; eye contact
- short, simple sentences
- one step direction
- firm, authoritative manner
- safe environment
- interventions for ___________ anxiety*
interventions for SEVERE anxiety
- Quiet
- safety
- modify environment
- focus on simple, repetitive task
- evaluate effectiveness of anti anxiety meds
- interventions for ______ and ____ levels of anxiety*
interventions for SEVERE and PANIC levels of anxiety
Benzodiazepines, antidepressants
ani-anxiety meds (2 types)
- unrealistic and excessive anxiety
- sustained feeling of distress
- physiologic symptoms of anxiety
- _______ anxiety disorder*
GENERALIZED anxiety disorder
Benzodiazepines, SSRI’s, sometimes tricyclic antidepressants
meds for _______ ?
meds for generalized anxiety disorder
- intense, discrete episode, intermittent
- physical exam to r/o medical causes
- ________ disorder*
PANIC disorder
- cognitive therapy: change self talk
- stress management
- antidepressant: SSRIs, SNRIs
- Benzodiazepines
- treatment for?*
Panic disorder treatment
- Marked and persistent fear of an object, place, or situation
- exposure to the stimulus provides an immediate anxiety response
- interferes with a person’s daily life
- distress is disproportionate to the actual event
- extreme care may be taken to avoid the stimulus
Phobias
- Behavioral therapies: desensitization
- Cognitive strategies: thought stopping
- hypnosis
- medication
- treatment for?*
treatment for phobias
- more than 10 minutes per day
- dual components: obsessive thinking and compulsive activity
Obsessive compulsive disorder
- desensitization
- thought stopping
- exposure/response prevention
- coping skills
- medication: antidepressants/anxiolytics
- treatment for?*
Treatment for OCD
- actual or threatened physical harm or death directed or witnessed or revealed to a person
- Traumatic event–>fear, helplessness, horror
- Post-Trauma–>hyper vigilance, intrusive memories, dissociation, numbing, avoidance
Post-Traumatic Stress Disorder
*treatment for?* Counseling: -safe environment -structure -acceptance of feelings -coping strategies -letting go rituals -grieving process -positive regard
Medication: symptom relief
- antidepressants
- antianxiety
Treatment of PTSD
ativan is a type of ? medicine.
Benzodiazepine, used for less than 14 days does not produce an addiction
Xanax (alprasolam)
- Shortest acting benzodiazepine, active in 15 minutes, gone in an hour
- good for stage fright, or fear of flying (needs a boost to get on a plane)
- other than that, it makes people go constantly up and down
why are antidepressants an attractive anxiety med
long acting, not addictive
-bad parts are side effects, dry mouth, hypotension
affexor, pristique
-SSRIs particularly helpful in decreasing long term anxiety
risk with benzodiazepines
-tolerance and dependence
klonopin
Benzodiazepine used to treat panic attack
Luvox
SSRI, particularly helpful in decreasing OCD activity. Cannot work alone, needs the behavioral therapy aspect with it
