72 sarah weaver anxiety management ahna 2019 (sarah weaver)

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5/24/2019 1 Sarah Weaver MSN, FNP-C, HN-BC, IFMCP- Candidate AHNA National Conference June 2019 CENTERING AND SETTING INTENTION •Pause for a moment. Pick a focal point •Set aside any concerns regarding the past or the future. •These can be picked up later. •Gently close your eyes. •Breathe deeply and slowly. •Set an intention for the situation •Breathe mindfully, scan your body for tension and release • When needing to be connected with that feeling of love and compassion repeat again, “I am present to the moment.” OBJECTIVES Understand types of anxiety and how it manifests in our lives Anatomy of anxiety and risk factors Root causes of anxiety Holistic interventions ANXIETY IS COMMON AND UNTREATED 18.1% of adults have an anxiety disorder Only 36.9% of those with a disorder seek treatment https://www.nimh.nih.gov/health/statistics/prevalence/any-anxiety- disorder-among-adults.shtml/index.shtml

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Page 1: 72 Sarah Weaver Anxiety Management AHNA 2019 (Sarah Weaver)

5/24/2019

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Sarah Weaver MSN, FNP-C, HN-BC, IFMCP-Candidate

AHNA National Conference June 2019

CENTERING AND SETTING INTENTION

� •Pause for a moment. Pick a focal point

� •Set aside any concerns regarding the past or the future.

� •These can be picked up later.

� •Gently close your eyes.

� •Breathe deeply and slowly.

� •Set an intention for the situation

� •Breathe mindfully, scan your body for tension and release

� • When needing to be connected with that feeling of love and compassion repeat again, “I am present to the moment.”

OBJECTIVES

�Understand

types of

anxiety and

how it

manifests in

our lives

�Anatomy of

anxiety and

risk factors�Root causes

of anxiety

�Holistic

interventions

ANXIETY IS COMMON

AND

UNTREATED

� 18.1% of adults

have an anxiety

disorder

� Only 36.9% of

those with a

disorder seek

treatment

https://www.nimh.nih.gov/health/statistics/prevalence/any-anxiety-disorder-among-adults.shtml/index.shtml

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Types of Anxiety

• Acute anxiety is often related to

overwhelming circumstances.

• Chronic

� Generalized anxiety disorder (GAD)

� Obsessive Compulsive

� Panic

� Post-Traumatic

� Social Phobia

National Institutes of Health, 2014

HERE’S WHAT HAPPENS WITH

ACUTE ANXIETY…

� Insomnia

� Irritability

� Withdrawal

� Fatigue

� Nervousness

� Restlessness

� Trouble concentrating

� Muscle tension

� Headaches

� Lasts less than 6 months

CHRONIC

ANXIETY

LOOKS A LITTLE

DIFFERENT…

� Associated with

many mental health issues

� Generalized ill health

� Obsessive/repetitive thoughts and behaviors

� Trouble in

school/work

� Social withdrawal

� Substance abuse

� Depressive/suicidal thoughts

Panic Attacks

• Happens with acute or chronic

• Sense of danger or doom

• Trembling, dizziness, weakness

• Shortness of breath

• Excessive perspiration

• Numbness or tingling in the hands

• Rapid heartbeat, palpitations

• Chest pain

• Rapid breathing, hyperventilating

• Feeling cold or overheated

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Risk factors…

• Usually begins by middle age

• Women are 60% more

likely to develop

• Low self-esteem

• Illness and disease is rated as the “most stressful” life event

• White

• Lower educational attainment

• ACEs

• Parental loss

• Sexual abuse

RISK FACTORS FOR ANXIETY DISORDERS: COMMON AND SPECIFIC EFFECTS IN A NATIONAL SAMPLE: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4147018/

Functional Medicine Perspective

Institute for Functional Medicine, 2018

The Brain and Anxiety

http://anatomystructure.net/the-anatomy-of-anxiety-diagram/

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FEED YOUR BRAIN � Keep your blood sugar steady

� Water- your brain is made of ¾

water

� Healthy fats- cold water fish,

nuts, avocado, coconut, olive

oil, flax

� Antioxidants- at least 5 cups of

non-starchy vegetables a day

� Anti inflammatory- curcumin,

omega fatty acids

� Eat foods rich in B-vitamins (nuts, seeds, dark green vegetables,

legumes, animal protein,

brewer’s yeast)

� Trial a caffeine wean

Strasser B, Gostner JM, Fuchs D. Mood, food and cognition: role of tryptophan and serotonin. Current Opinions in Clinical Nutrition & Metabolic Care: January 2016;19(1):55-61.

Grosso G, Pajak A, Marventano S. Role of omega-3 fatty acids in the treatment of depressive disorders: a comprehensive meta-analysis of randomized clinical trials. PLOS One. May 7 2014; http://dx.doi.org/10.1371/journal.pone.0096905

Benton D and Young HA. A meta-analysis of the relationship between brain dopamine receptors and obesity: a matter of changes in behavior rather than food addiction? International Journal of Obesity. 2016;40:S12-S21.

https://www.hsph.harvard.edu/nutritionsource/what-should-you-eat/vitamins/vitamin-b/

Creating a Healing Environment

• Think about stimulation- is

there too much or too little?

• Do you have electronics free zone in your life?

• How does it smell?

• Sunlight?

• Noise?

• Clutter?

• Respite Rooms

• Hygge

Effectiveness of Therapeutic Massage for Generalized Anxiety Disorder: A Randomized Controlled Trial: http://psycnet.apa.org/buy/2003-11000-001

CHECK IN

WITH YOURSELF� What do I need right now?

� Sleep

� Hydrate and eat

� Respite room/ A walk outside as a way to calm down and process

� Give yourself permission to do self-care

� Are you empathic?

� Plug into a support system

� Self-massage

� Yoga

� Visit a spiritual place

Marsh, A. (2016). Neural, cognitive, and evolutionary foundations of human altruism. Wiley Interdisciplinary Reviews: Cognitive Science, 7(1), 59-71.

ARE YOU PRACTICING PLAY AND LAUGHTER DAILY?

� Simulated laughter vs spontaneous

laughter

� May improve cortisol,

neurotransmitters, immune system

and inflammation response

� Significant differences in perceived

stress, psychological stress response,

fasting blood sugar, interleukin-6, and

tumor necrosis factor alpha between

the two groups after laughter program

Effect of laughter yoga on salivary cortisol and dehydroepiandrosterone among healthy university students: A randomized controlled trial: https://doi.org/10.1016/j.ctcp.2018.04.005

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Guided Imagery

• Start with eyes closed, breath even

and deep, any comfortable position

• Pleasant

• Imagine being in a calm environment

• i.e., natural setting, fond memory, secure place

• i.e., real or imagined

• Physiologically focused

• Imagine a biologic function

• i.e., WBC eating infected cells, tumor shriveling like a

balloon, circulation coursing through body

• Mental rehearsal/reframe

• Imagine an accomplishment or a

better outcome of current situation

• i.e., see yourself winning a race, hear applause, see yourself calm and smiling talking to a difficult person

• Receptive

• Do a body scan

• i.e., focus on area of pain and imagine it relaxing, warming,

cooling

A Randomized Controlled Trial for the Effectiveness of Progressive Muscle Relaxation and Guided Imagery as Anxiety Reducing Interventions in Breast and Prostate Cancer Patients Undergoing Chemotherapy: https://www.hindawi.com/journals/ecam/2015/270876/abs/

The effects of guided imagery on state and trait anxiety and sleep quality among patients receiving hemodialysis: A randomized controlled trial: https://www.sciencedirect.com/science/article/pii/S0965229918300621

MUSIC

� Music therapy has been

shown to effect NA,

ACTH, IL-6, leptin and

cortisol levels

� Choose music that suits

the patient – it doesn’t

always need to be

instrumental. Try rock,

gospel or oldies

� Meta-analysis shows

music decreases the use

anxiety, pain,

� Care channel, Healing

Arts programs, playing

your instrument

STAND LIKE WONDER WOMAN

� Amy Cuddy,

Harvard Professor

and Social

Psychologist found

that “Power Posing”

for 2 minutes will:

� Decrease Cortisol

by 25%

� Increase

Testosterone by 20%

AFFIRMATION

• A repetitive verbal instrument to produce something in one’s mind, can be considered a form of meditation or prayer. Examples of mantra:

• I am breathing in love and breathing out peace

• I love myself deeply and unconditionally

• It is what it is

• I have compassion for myself and others

Attributions and affirmations for overcoming anxiety and depression: https://www.ncbi.nlm.nih.gov/pubmed/19091166Self-affirmation activates brain systems associated with self-related processing and reward and is reinforced by future orientation: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4814782/

Self-affirmation Reduces Stress and Improves Problem-solving: https://www.healthline.com/health-news/mental-self-affirmation-decreases-stress-increases-problem-solving-050113

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Breathe

• Acts like a natural tranquilizer

• Free and always with you!

• Simple awareness is all that is needed

Relaxation techniques: Breath control helps quell errant stress response: https://www.health.harvard.edu/mind-and-mood/relaxation-techniques-breath-control-helps-quell-

errant-stress-responseThe Effect of Diaphragmatic Breathing on Attention, Negative Affect and Stress in Healthy Adults : https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5455070/Effect of Modified Slow Breathing Exercise on Perceived Stress and Basal Cardiovascular Parameters: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5769199/

Cloud Breathing• Take a moment and focus all of your attention on your

breathing

• Visualize the air you are breathing in as fresh, pure and

energizing air, like white puffy clouds on a beautiful

sunny day

• Breathe in through your nose, allow yourself to feel the

sensation of the air traveling into your body and

energizing you

• Now, exhale and visualize the air that you are expelling is

dark, like that of a smoke stack, this symbolizes any stressors, worries, tension or frustrations you are

carrying with you.

• As you repeat this for a few moments the expelled air will begin to transform from dark to a lighter shade as you let

go of the negative stressors to move into a more relaxed

state.

Benefits of Breathing Techniques

• Relieves physical muscle

tension

• Allows the mental function

to slow and relax

• Body and mind connection

• Calms and centers

• Activates parasympathetic nervous system

• Releases natural wastes,

such as carbon dioxide

• Gives the internal organs a

gentle massage

• Increases the oxygen to all

cells

• Strengthens the lungs

• Slows your heart rate

• Lowers your blood

pressure

• Increases blood flow to muscles

• Improves concentration

• Reduces anger and frustration

• Boosts confidence

MASSAGE THERAPIES

� Effects may derive from stimulation of pressure

receptors leading to enhanced vagal activity and reduced cortisol levels

� Reduces pain, which decreases anxiety

� Self-massage is free and easy

A Meta-Analysis of Massage Therapy Research: http://psycnet.apa.org/buy/2003-11000-001Strine, T.W., Chapman, D.P., Kobau, R., Balluz, L. (2005). Associations of self-reported anxiety symptoms with health-related quality of life

and health behaviors. Soc Psychiatry Psychiatr Epidemiol, 40(8):680.

Massage therapy research review: https://www.sciencedirect.com/science/article/pii/S1744388116300214

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RESTORATIVE YOGA

MINDFULNESS

� A mental state achieved by focusing one's awareness on the present moment, while calmly acknowledging and accepting one's feelings, thoughts, and bodily sensations

� Changes brain activity, including in the amygdala

� Mindful eating

� Meditation

� Schedule weekly self-care

An Overview of the Research on Mindfulness‐Based Interventions for Treating Symptoms of Posttraumatic Stress Disorder: A Systematic Review : https://onlinelibrary.wiley.com/doi/abs/10.1002/jclp.22200

When science meets mindfulness : https://news.harvard.edu/gazette/story/2018/04/harvard-researchers-study-how-

mindfulness-may-change-the-brain-in-depressed-patients/

INTEGRATIVE MEDICINE

TOOLBOX

Testing….

Nutrient markers

Thyroid

Adrenals

Food allergies

Organic Acids

Hormones

Neurotransmitters

Treatment….

Psych Meds with genetic

testing

Magnesium, B vitamins

T4/T3

Amino Acids- Theanine, taurine, Inositol

Target NT- GABA, 5HTP

Progesterone, Melatonin

Herbals –Valerian,

Passionflower

MORE TOOLS FOR ANXIETY

� Reduce caffeine, sugar intake

� Weighted blankets- Vasovagal theory

� Essential Oils:

� Lavender- linalool and linalyl acetate inhibition of voltage-gated calcium channels, reduction of 5HT1A receptor activity, and increased parasympathetic tone

� Orange

� Rose

Lavender and the Nervous System: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3612440/The Effect of Aromatherapy on Anxiety in Patients: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5111093/

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SUGGESTIONS

� Cognitive Behavioral Therapy and Support Groups are

helpful

� There are many relaxation

apps to use with a smart phone QUESTIONS?