Week 4 Flashcards
define anxiety
- a subjectively distressful experience activated by the perception of threat, which has both a potential psychological and physiological etiology and expression
- an emotion characterized by apprehension or dread of a potentially threatening or uncertain outcome
what can trigger anxiety
- the perception of a threat
how is anxiety manifested
- in physical, emotional, cognitive, and/or behavioral ways
what is the difference between anxiety and fear
- anxiety is a vague sense of dread related to an
unspecified or unknown danger - fear is a reaction to a real or perceived specific danger
a normal response to anxiety includes changes in… (2)
- physiological arousal
- cognitive processes
- coping strategies
what physiological arousal occurs in response to anxiety
- flight or fight response
- freeze response
what cognitive processes occur in response to anxiety
- deciphers whether the threat should be approached or avoided
why are coping strategies employed in response to anxiety
- to resolve the threat
what are some examples of how anxiety can be motivating (5)
can act as a:
- warning sign (to bring attention to something that may need to be changed in one’s life)
- motivating (incentive to take action)
- built-in warning system (help one react to keep themselves safe)
- positive characteristic in one’s makeup (tend to be more empathetic, understanding, and supportive)
- leadership trait (good problem-solvers, decision-makers, contemplating consequences of decisions)
describe the scope of anxiety
ranges from:
no anxiety –> mild anxiety –> moderate anxiety –> severe anxiety –> panic
see pg. 202 of textbook for symptoms of each lvl
what are benefits of mild anxiety (4)
- increases lvls of energy
- motivates individuals on a day-to-day basis
- increases ability to be productive, creative, learn, and problem solve
- can cause “excitement”
what are some physical signs of mild anxety (4)
- butterflies
- increased HR
- pupils dilate
- perspiring
what changes occur w moderate anxiety (3)
- perceptual field decreases
- increasingly needs direction to learn, needs help focusing
- selective inattention (may fail to notice enviro stimuli unless brought to notice)
what are some physical signs of moderate anxiety (4)
- shakiness
- frequent urination
- increased resp
- nausea
what changes occur w severe anxiety (2)
- focuses on small or scattered details
- unable to problem-solve even w assistant
what are some physical signs of severe anxiety (6)
- rapid pulse
- dyspnea
- chest pain
- nausea, upset stomach
- diarrhea
- feeling of “impending doom”
what changes occur w panic (5)
- sense of terror/loss of control
- complete disorganization of thoughts
- unable to do things even w direction
- hyperactive, agitated
- may be dangerous or aggressive
what physical signs occur w panic (7)
- may feel like a heart attack
- palpitations, pounding heart
- feelings of choking
- dizziness, light headedness
- feelings of unreality
- paraesthesia
- fear of losing control, fear of dying
how do we protect ourselves from anxiety?
- coping/defence mechanisms
* see page 205 for different types of defence mechanisms*
what concepts are interrelated w anxiety (4)
- interpersonal violence
- stress
- coping
- mood & affect
what is the most common mental health problem in Canada
- anxiety disorders
describe who anxiety disorders affect (3)
- individuals of all ages
- higher in women than men
- affect 12% of the population
what are types of anxiety disorders (4)
- panic disorders
- generalized anxiety disorder
- phobias
- OCD
what is considered generalized anxiety disorder (GAD)
- excessive anxiety for 6 months or more
what are some signs of GAD (6)
- persistent and chronic signs of severe anxiety
- chronic hyperviligance for potential threats
- displays of impatience, irritability, feeling “on edge”
- chronically tense, apprehensive
- fatigue r/t sleep distrubances, long-term depression
- mixed anxiety-depression
what is the impact of GAD
- interferes w ADLs
- difficult to manage or control
what is a phobia
- phobia is a persistent, irrational fear of a specific object, activity, or situation that leads to a desire for avoidance or to actual avoidance of the object, activity, or situation despite the awareness and reassurance that it is not dangerous
what is social phobia (3)? what is it also known as
- fear of embarressment, humilitation, and being exposed to the scrutiny of what is in other people’s minds
- extreme shyness
- with or without agoraphobia
- aka social anxiety disorder
what is agoraphobia
- When individuals actively avoid situations from which escape might be difficult or embarrassing or in which help might not be available if panic-like symptoms were to occur
what is included in management of phobic disorders (2)
- exposure therapy
- cognitive behavior therapy
describe panic disorder
- recurrent persistent attacks
what are characteristics of panic disorders
- worry about having more attacks
- worry about implications of an attack (losing mind, dying, etc.)
- may be unpredictable in onset but often occurs in certain situations
- normal becomes abnormal when panic is experiences routinely or in situations that dont pose threats
define: panic attack
- intense fear or discomfort coming on abruptly and peaking within 10 minutes with 4 or more specific characteristics occur
what characteristics are considered w panic attacks (11)
- palpitations, pounding heart, accelerated heart rate
- sweating
- trembling, shaking
- SOB, feeling of choking
- chest pain or discomfort
- nausea, abdominal distress
- feeling dizzy, unsteady, light headed, faint, numbness, tingling
- chills, hot flsuhes
- derealisation, depersonalization
- fear of losing control
- fear of dying
define: obsessions
- involuntary, recurrent, persistant thoughts, impulses, or images
define: compulsions
- ritualistic behaviors the individual is compelled to perform
describe OCD
- includes obsessions & compulsions
- action prevents or reduces anxiety (“magical thinking”)
what is a form of OCD
- hoarding
what plays a role in anxiety disorders (5)
- genetic predisposition
- biochem (neurotransmitters: serotonin, dopamine, norepi, gaba)
- enviro factors/life experiences (early G&D, family enviro, trauma, stressful events)
- behavioralist theory (anxiety is learned)
- cognitive theory
describe cognitive theory r/t anxiety
- anxiety bc of irrational beliefs
- persons believe or predict that the result of a specific situation will be embarrassing or harmful
describe anxiety in infants
- stranger anxiety –> fear of unknown people, clinging to parents
describe anxiety in toddlers (10-18 months)
- separation anxiety (anxious when one or both parents are absent)
describe anxiety in children (4-6 years)
- anxiety of non-reality based things (ex. monsters)
describe anxiety in older children (7-12 years)
- anxiety of potential threats (natural disaster, bodily injury)
what is the key to assessment of anxiety
- a careful detailed history based on respectful reflective probing and listening skills
what should be assessed for r/t anxiety
- onset, freq, duration, type, severity
- impairment of function
- degree of avoidance
- harmfulness of rituals
- what makes it worse
- what helps alleviate it? (coping mechanisms)
what can be used to assess anxiety
- anxiety scales
* see page 219-220 of textbook*
what are some questions that may be asked in a client interview r/t anxiety
- how would you rate your anxiety from 1-10?
- how long have you been experiencing your current lvl of anxiety?
- are you aware of anything that may have precipitated or triggered ur anxiety?
- what has helped you in the past to deal w your anxiety?
- what do you perceive would be helpful now to lower ur anxiety?
what else should be considered r/t assessing anxiety (3)
- rule out of the organic (medical condtions, medication induced, stimulant intake)
- co-occurring disorders (psych history, mental health diagnosis)
- psychosocial variables (stressors, home enviro, available supports, cultural consideration)
what are some ways to help an individual who is anxious (6)
- observe for signs, determine the lvl of distress
- relief of immediate anxiety: provide safe enviro, calm manner
- connect anxiety w relief behavior (what helps you?)
- protect defenses (dont take away old coping until new strategies learned)
- investigate situation (antecedents of anxiety)
- learn self-help skills (coping, relaxation training, problem solving)
see textbook for more interventions
what is included in emergency care interventions for panic attack (7)
- stay w the pt
- reassure them that you will not leave
- give clear directions using a firm, authoritative voice (sound “in control”, reassurance okay)
- breathing control (exercises to decrease hyperventilation)
- walk w pt & move to quieter, less stimulating enviro
- short term use of ativan may be considered
- allow person to vent feelings afterwards
what are 2 types of meds that may be used for anxiety
- SSRIs
- benzos
what are SSRIs used for
- moderate to severe anxiety not relieved by other means
- current first line of treatment
what is the benefit of SSRIs (2)
- few side effects
- safer in overdose
what are some cons of benzos
- can lead to dependence
- intense rebound and withdrawal mimics anxiety
what are some benefits of benzos for anxiety
- faster onset than antidepressants
- treat acute panic & anxiety (short term)
what are 3 types of relaxation techniques
- progressive muscle relaxation
- relaxed breathing
- visualization
what is mindfulness
- about paying attention to and becoming more aware of ourselves and the world around us, without judgement
- being present in our own lives, being in the moment
what is included w CBT (4)
- involves recognizing automatic negative thoughts (catastrophic thoughts)
- involves methods to challenge and control the thoughts w realistic and calming thoughts (not positive thinking)
- face fears one step at a time through gradual exposure
- acceptance of unpredictability of life
what is CBT
- form of therapy that includes education about the influence of thoughts on feelings and behaviors
- considers how we are perceiving & interpreting situations & events is influential in affecting our emotions and behaviors
what is included in OCD interventions (3)
- specilized interventions
- specific psychotherapeutic interventions
- family education & support
what specific psychotherapeutic interventions are included for OCD
- exposure w response prevention (ERP)
- CBT
define trauma
- any experience that causes intense physical and psychological stress reactions
- an experience that threatens or harms an individual and has serious negative effects on someone’s physical, emotional, social, and spiritual wellbeing q
what is resilience
- the ability to work thru a traumatic event without the need for specialized services
what are 2 types of disorders that may result after trauma
- acute stress disorder (ASD)\
- PTSD
how common is ASD and PTSD
- less common than people think
what is acute stress disorder
- a normal response to a highly stressful situation
what does ASD occur as a result of
- one specific event rather than the experience of long-term or chronic exposure to trauma
what are symptoms of ASD
- feeling emotionally “numb”
- distressing memories of the evnt
- flashbacks
- problems w sleep & concentration
- angry outbursts
- exaggerated startle response
describe the onset and duration of ASD symptoms
- appear 2 days to 4 weeks after the event
- usually resolve by 4 weeks
what is the most commonly diagnosed trauma related disorder
- PTSD
describe how long symptoms of PTSD can last for
- more than 4 weeks
- very debilitating
what is developmental trauma
- refers to harmful experiences that happen during a person’s developing years –> in infancy, childhood, adolescence, young adulthood
most developmental trauma begins where?
- at home w the child’s caregivers
describe developmental trauma events
- may be chronic or sustained (ex. ongoing neglect)
- may be multiple or repeated
- can be single, one-time event w lasting impacts (ex. car crash)
what are adverse childhood experiences (ACEs)
- adverse conditions in the enviro that occur in the childhood
what are examples of ACEs (6)
- sexual, physical, and psychological abuse
- neglect
- witnessing violence in the home
- living in poverty
- living close to war & crime
- living w someone w a mental health or substance use disorder
who are ACEs often committed by
- trusted adults, caregivers, and/or older figures in the person’s life
describe the impacts of ACEs (9)
- linked to development of risk factors for health & social well-being
- change the structure and function of the developing brain
- negative impact on neuro, endocrine, and immune systems
- increase risk of a physical, mental, and substance use disorders
- increase risk of having more trauma events across the life span
- increase risk of developing PTSD
- teach a child fear
- disrupt learning
- negatively impact behaviors
what is historical trauma
- trauma that occurs over a lifespan to a large group of people
- events that contribute to it are widespread and severe
who does historica; trauma often affect
- an entire culture
ex. genocide, slavery, war, torture, and colonialism
what impact does historical trauma have
- impact future generations of that culture well beyond those who experienced them directly
- can contribute to physical and behavioral health problems (bc the grief and anger that can accompany historical trauma is often not recognized or ackowledged)
what is intergenerational trauma
- an aspect of historical trauma
- describes the psychological and/or emotional effects that can be experienced by people who have long term connection to trauma survivors
describe the impacts of intergenerational trauma
memories of the trauma and the coping strategies and the ways people adapt to make room for the trauma get passed from one generation to the next = high rates of:
- traumatic stress
- grief
- depression
- substance abuse
- domestic violence
- suicide
how can the effects of intergenerational trauma transfer from one generation to another (7)
- caregivers not able to attach w children
- family functioning and ability to parent
- physical and mental illness of parents
- disconnection or alienation from extended family
- disconnection from culture & identity
- large group/community dysfunction
- thru caregiver-child bond
define culture
- the norms, characteristics, attitudes, and knowledge of a particular group
what is cultural trauma
- events that challenge and may even destroy culture
- a broad range of conditions at a societal lvl that challenge a person’s sense of safety and belonging in the world (ex. racism, discrimination, poverty)
what is an important consideration w cultural trauma
- a traumatic event can only be understoof by looking at it thru a person’s cultural lens
what is vicarious trauma (3)
- a form of trauma associated w the “cost of caring”
- the emotional and physical reactions that service providers experience when continuously exposed to human suffering
- r/t bearing witness to the pain of others
describe examples of reactions to vicarious trauma (7)
- nightmares
- feeling emotionally numb
- loss of a sense of control
- difficulty trusting others
- increased illness and fatigue
- increased sense of danger
- shame
define interpersonal trauma
- events and experiences that take place between people who often know each other
- may also occur between people who do not know each other or are acquaintances
ex. elder abuse, childhood abuse, domestic abuse, sexual assault
what is frequently involved w interpersonal trauma
- substance abuse
what is domestic violencew
- violent behavior that is mostly between family members and intimate partners
what are common types of domestic violence
- family violence
- intiminate partner violence
the majority of nonfatal acts of violence and intimate partner homicides are committed against ____? ____ are the hidden casualities of IPV?
- women
- children
what is system oriented trauma
- when organizational systems may cause trauma or re-traumatization
ex. use of restraints in mental health system, child welfare causing sibling separation
how can we prevent system oriented trauma
- when systems, organizations, and service providers are more likely to experience success and achieve better outcomes when they adjust procedures, policies, and programs to be sensitive to histories and needs of people who have experiences past traumas
what are 2 categories of characteristics of trauma
- objective
- subjective
what are the objective characteristics of trauma
- those elements of an event that are factual
- the what, when, where, how
what are the subjective characteristics of trauma
- part of who a person is in the world and how they find meaning
- an individual’s interpretations of an event and their beliefs and assumptions about the world and how they contibute to how they process, react to, and cope w a traumatic event
what is considered w objective characteristics (5)
- at what age did the event occur?
- was it a single or multiple events?
- how does grief and loss related to the event impact the person?
- was the event expected or unexpeetced?
- was the trauma experienced directly or indirectly?
what should be considered w subjective characteristics of trauma (11)
- biology & genetics
- gender
- culture
- personal health practices
- social support networks
- social status
- social & physical enviro
- healthy child development
- education and literacy
- employment and working conditions
- living enviro & conditions
what can influence how well a person recovers from trauma
- social determinants of health
prolonged stress contributes to… (3)
- high BP
- promotes the formation of artery-clogging deposits
- brain changes that contribute to anxiety, depression, and addiction
what is PTSD
- a condition that develops in some people after experiencing traumatic events, particularly those that threaten life and/or cause injury, or sexual violence
what are 4 categories of symptoms of PTSD
- intrusion symptoms
- changes in thoughts, thought processes, and moods
- avoidance symptoms
- changes in arousal and activity
describe the intrusion symptoms of PTSD
- refers to repeated re-living and remembering the event
ex. vivid nightmares, flashbacks, and thoughts of the event come out of nowhere
describe the avoidance symptoms of PTSD
- refers to actively avoiding any reminders of the event including people, situation or events in order to shut out painful memories
what avoidance symptoms may occur w PTSD
- lapses or gaps in memory may occur
- becoming number to emotions
- isolation, depression, drug, and alcohol abuse
describe what changes in thoughts, thought processes, and mood may occur w PTSD (4)
- developing negative views or beliefs about the world and themselves
- blaming others for the event and what happened after the event
- having ongoing experiences w negative emotions –> fear, anger, horror, shame
- difficulty having positive emotions
what changes in arousal and reactions may occur w PTSD (3)
- may be reactive or aggressive (fight response)
- may be unable to stop moving or stop talking (flight/flee response)
- may seem to be detached pr separate from their body, thoughts, feelings, and emotions (freeze response)
what is included in treatment for PTSD
- trauma specific practices
- CBT
- eye movement desensitization and repossessing
- neurosequential model
- mindfulness
- somatic/body centered approaches
what is post traumatic growth & resilience
- refers to positive changes that are experienced by a person as a result of a struggle w highly challenging life circumstances
what are 5 types of post traumatiuc growth
- greater appreciation for life
- closer, more intimate relationships, greater compassion, and empathy for self and others
- setting new life goals, seeing new opportunities
- sense of icnreased personal strength
- positive spiritual change
describe growth r/t trauma
- does not occur as a direct consequence of the traumatic experience but as a result of the struggle to find a new normal
what 2 main processes are involved in achieving growth
- emotional processing (being aware of the emotions that occur w traumatic experiences)
- cognitive processing (making meaning of the experience)
what factors are linked to resiliency (8)
- attributes of the person
- support at school
- being sociable
- experiencing parental warmth
- social factors of a person’s life
- a strong and nurturing family unit
- success in at least one area of life
- having a sense of humour
- being hopeful
what is trauma informed care
- an overall way of working w people
- goal is to treat people in ways that create physical and emotional safety
- goal is to provide services that are appropriate to the needs of people affected by trauma
- understanding how common trauma is and how it affects people
- about creating environments that help people heal from trauma and does not contribute new difficultities/re-traumatize people
what are the 3 key elements of TIC
- realizing the prevalence of trauma
- recognizing how trauma affects all individuals involved w the program, organization, or system, including its own workforce
- responding by putting this knowledge into practice
