chapter 18 managing anxiety

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CHAPTER 18CHAPTER 18 Managing AnxietyManaging AnxietyCHAPTER 18CHAPTER 18 Managing AnxietyManaging Anxiety


• A feeling of uneasiness, uncertainty, and helplessness • A normal emotional response to a real or imagined threat or stressor • Serves several purposes

A warning of impending danger Mild anxiety can increase learning by enhancing concentration and

focus Uncontrolled anxiety often leads to ineffective and maladaptive

behavior A normal part of survival and growth

AnxietyAnxietyAnxietyAnxiety


Types of AnxietyTypes of Anxiety

Signal- learned response to anticipated Signal- learned response to anticipated eventevent

Anxiety State- coping abilities become Anxiety State- coping abilities become overwhelmed and emotional control is lostoverwhelmed and emotional control is lost

Anxiety Trail- learned component of Anxiety Trail- learned component of personalitypersonality


• Adaptive responses to anxiety describe a continuum of behavioral responses.

• Responses to anxiety occur on four levels, ranging from mild to panic.

• During periods of anxiety, physical, intellectual, emotional, and behavioral responses help us cope.

• In periods of severe anxiety, the autonomic nervous system stimulates the fight-or-flight response.

Continuum of AnxietyContinuum of AnxietyContinuum of AnxietyContinuum of Anxiety


Levels of AnxietyLevels of Anxiety

Mild- relative comfort and safetyMild- relative comfort and safety Moderate- feelings of readiness to the Moderate- feelings of readiness to the

challenge, energizedchallenge, energized Severe- feels threatenedSevere- feels threatened Panic-helpless , total loss of controlPanic-helpless , total loss of control


http://www.bbc.co.uk/cumbria/videonation/archive/b/mark_boustead/ocd/index.shtml


• All coping mechanisms reduce anxiety, but if used to extremes, serious mental and physical problems can result.

• Physical coping mechanisms include efforts to face and handle the problem directly. Physical exercise Yoga

(Cont’d…)

Coping Mechanisms Used to Decrease Coping Mechanisms Used to Decrease AnxietyAnxietyCoping Mechanisms Used to Decrease Coping Mechanisms Used to Decrease AnxietyAnxiety


(…Cont’d)

• Intellectual coping mechanisms diminish the threat by changing person’s perception.• Spiritual coping methods

Faith Prayer Ritual

• Emotional responses Crying Communicating or sharing Ego defense mechanisms

Coping Mechanisms Used to Decrease Coping Mechanisms Used to Decrease AnxietyAnxietyCoping Mechanisms Used to Decrease Coping Mechanisms Used to Decrease AnxietyAnxiety


Defense MechanismsDefense Mechanisms

Strategies that help to lessen anxious Strategies that help to lessen anxious feelingsfeelings

Psychological, self preservingPsychological, self preserving

Vs coping: efforts to directly face and Vs coping: efforts to directly face and handle the problemhandle the problem


Common Defense MechanismsCommon Defense Mechanisms

CompensationCompensation ConversionConversion DenialDenial DisplacementDisplacement DissociationDissociation FantasyFantasy IdentificationIdentification intellectualizationintellectualization

IsolationIsolation ProjectionProjection RationalizationRationalization Reaction formationReaction formation RegressionRegression RestitutionRestitution SublimationSublimation SubstitutionSubstitution SuppressionSuppression SymbolizationSymbolization undoingundoing


Ineffective CopingIneffective Coping

Too little anxiety- lack of attention, or Too little anxiety- lack of attention, or focusfocus

Too much anxiety-overwhelm and Too much anxiety-overwhelm and immobilizeimmobilize• Inability to accomplish tasksInability to accomplish tasks

• When defense mechanisms become primary When defense mechanisms become primary means of dealing, they replace problem means of dealing, they replace problem solving and other positive mechanismssolving and other positive mechanisms


• Childhood Children learn to cope with anxiety by watching and imitating

others. If a child’s needs for nurturing are not met, high anxiety can

result. Anxiety is experienced in relation to the developmental level.

• Infants feel discomfort if needs are not met immediately.• Toddlers become anxious if they perceive something larger or more

ferocious than themselves.

(Cont’d…)

Anxiety Throughout the Life CycleAnxiety Throughout the Life CycleAnxiety Throughout the Life CycleAnxiety Throughout the Life Cycle


(…Cont’d)

• Adolescence Coping behaviors learned in childhood continue to be refined. Running away, angry, defiant, aggressive, manipulative

• Adulthood Young adults have well-established coping behaviors. Adults encounter many anxiety-producing situations. Can evolve into PTSD

• Late adulthood Elders tend to express anxieties in less overt ways than younger people do. When work and food are scarce Elders face a combination of anxiety-producing life hazards.

Anxiety Throughout the Life CycleAnxiety Throughout the Life CycleAnxiety Throughout the Life CycleAnxiety Throughout the Life Cycle


• An anxiety disorder exists when anxiety is expressed in ineffective or maladaptive ways and coping mechanisms do not successfully relieve the distress.

• Diagnosis based on description of behaviors that express distress• Classification

Generalized Panic Phobic

(Cont’d…)

Anxiety DisordersAnxiety DisordersAnxiety DisordersAnxiety Disorders


GeneralizedGeneralized

When individuals anxiety is broad, long When individuals anxiety is broad, long lasting and excessivelasting and excessive

Worried and anxious more often than Worried and anxious more often than notnot

In children- overanxious- school, In children- overanxious- school, performance, social eventsperformance, social events

Adults-everyday eventsAdults-everyday events


Panic DisorderPanic Disorder

Attack- brief period of intense fear or Attack- brief period of intense fear or discomfortdiscomfort

2 types:2 types:• Agorophobic – avoid people , places or Agorophobic – avoid people , places or

eventsevents

• Non agorophobicNon agorophobic


PhobiasPhobias

Internal fear reactionInternal fear reaction Specific objects or situationSpecific objects or situation Unrealistic, persistentUnrealistic, persistent ““Social phobes”- fear of any situation Social phobes”- fear of any situation

in which other people could be in which other people could be judgingjudging


• Phobia: Unnatural internal fear of people, animals, objects, situations or events

• Phobic posttraumatic stress disorders are obsessive in nature.

• Marked by a tendency to dwell on object of fear to the point of fascination

• Those with phobias handle anxieties differently Extreme immobilizing anxiety that prevents the person from

acting in a way that could effectively alleviate anxiety.

Phobic DisordersPhobic DisordersPhobic DisordersPhobic Disorders


(…Cont’d)

Obsessive-compulsive Behavioral Posttraumatic

Anxiety DisordersAnxiety DisordersAnxiety DisordersAnxiety Disorders


• Obsessive-compulsive disorder (OCD) An obsession is a distressing persistent and recurring, inappropriate

thought. A compulsion is a distressing recurring behavior that must be performed to

reduce anxiety.

• OCD clients are consumed by self-destructive, anxiety-reducing thoughts and actions.

• Symptoms can occur as early as 3 years of age but usually begin in adolescence.

(Cont’d…)

Obsessive-Compulsive DisorderObsessive-Compulsive DisorderObsessive-Compulsive DisorderObsessive-Compulsive Disorder


(…Cont’d)

• Men and women are equally affected, although in men symptoms usually appear 5 years earlier.

• Those with other mental health disorders, especially depression or schizophrenia, have a high prevalence of OCD.

• Common obsessions Cleanliness Dirt Germs

(Cont’d…)



(…Cont’d)

Aggressive and sexual impulses Health concerns Safety concerns Order and symmetry

(Cont’d…)



(…Cont’d)

• Those with OCD use defense mechanism of repression to cope with obsession.

• Intellectually, those with OCD know that their attempts to relieve anxiety are maladaptive but feel emotionally compelled to yield to their obsessions.

• OCD is seen to run in families and may have a genetic or hormonal cause.

(Cont’d…)



• A series of behavioral and emotional responses following an overwhelming stress.

• Possible diagnosis for anyone who has been sexually assaulted Rape-trauma syndrome follows predictable clinical course

• Fear and anguish• Recovery and repair• Adaptation

Traumatic Stress DisorderTraumatic Stress DisorderTraumatic Stress DisorderTraumatic Stress Disorder


• Result of traumatic experience outside the realm of normal life experiences Intense fear, horror or helplessness was experienced Traumatic event or situation is repeatedly relived

• Symptoms include flashbacks In vivid recollections of the event, the individual relives the experience.

• Can last from a few seconds to longer than a half hour • Perceived as vividly real and life-threatening to the individual

(Cont’d…)

Posttraumatic Stress DisorderPosttraumatic Stress DisorderPosttraumatic Stress DisorderPosttraumatic Stress Disorder


(…Cont’d)

• When caring for a PTSD client having a flashback, it is imperative that interventions ensure everyone’s safety while helping to reorient the client to present surroundings.

• Those with severe PTSD isolate themselves from society by living in sparsely populated rural areas.

• Children with PTSD express themselves through disorganized or agitated behaviors.

Posttraumatic Stress DisorderPosttraumatic Stress DisorderPosttraumatic Stress DisorderPosttraumatic Stress Disorder


• Learn to recognize signs and symptoms of anxiety in yourself and others.

• Include an anxiety level assessment for each client.• A combination of mental health therapies and medications

are effective in treating maladaptive responses to anxiety.• Discover the basis or cause of anxiety.

(Cont’d…)

Therapeutic Interventions Therapeutic Interventions Therapeutic Interventions Therapeutic Interventions


(…Cont’d)

• Problem-solving techniques• Relaxation therapy• Medications

Benzodiazepines Antidepressants Antihistamines Propranolol

Therapeutic InterventionsTherapeutic InterventionsTherapeutic InterventionsTherapeutic Interventions

chapter 18 managing anxiety

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