Managing Life’s Anxieties

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Alhuda Foundation

Presented by: Dr. Ukamaka Oruche, PhD, RN, PMHCNS-BC, FAAN

Case study

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Children

SECTION 1

Mary is 58 years old woman who worries about her 17-year old son. He has become increasingly argumentative and defiant with his parents. He has delayed completing his college application, does not work, lavishes his pocket money on eating out. Then asks for more money to buy gas to drive his car to school and back. Mary thinks he will not amount to anything and that her hard work is in vain. She has kept all these worries to herself. Mary is so stressed out:

1. She can’t sleep

2. She cries a lot

3. She is not eating well

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Marriage

SECTION 1

Tonya is 42 years old woman craving more emotional attention from her husband. She has 4 young children in elementary school. They migrated to America a few years ago. Although, they have settled in for the most part, she complains that her husband is not very supportive. For example, he does not help around the house with chores or take the children to activities like birthday parties. Most importantly, Tonya said he is mot emotionally available to her. But she often finds herself stressed:

1. She cries a lot

2. She just wants to leave the house sometimes

3. She once sat in her car and felt like she just wants it all to stop.

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Career

SECTION 1

Shade is 38 years old woman who worries that she has neglected her career development. She is a physician and a mother of 3 very young children. Although, she works part-time, she has hard difficulty finding fulltime position that she really likes. She feels that all her classmates have passed her in their career. She does not feel comfortable telling her husband or even her mother how she feels. But she often feels stressed about this:

1. She feels lack of confidence and self-doubt

2. She feels self-doubt

3. She feels bad about her self

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Why is stress, anxiety, and depression a concern especially for women? An estimated 264 million people worldwide have an anxiety disorder

Women are twice as likely as men to be diagnosed with an anxiety disorder in their lifetime.

females (23.4%) more than males (14.3%). (ADAA, n.d.)

Nearly 15 million Americans will experience depression each year

The rate is twice as high for women than men

1 in 8 women will have a major depressive episode in their lifetime. (NAMI, 2009)

Up to 1 in 7 women will experience postpartum depression (Jordan & Minkel, 2019); Rates are 3x higher for postpartum anxiety.

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If Left Untreated

Stress: Some stress is important for productivity, but chronic or long term stress can lead to an increase in blood pressure, compromised immunity, inflammation, and diabetes. All risk factors of coronary heart disease. (Sumra & Schillaci, 2015)

Anxiety: Associated with comorbid depression, relationship problems alcohol/drug abuse, functional impairment, poor quality of life and suicidality. (ADAA, 2009)

Depression: Associated with insomnia, relationship problems, alcohol/drug abuse, poor quality of life, suicide. (ULifeline, n.d.)

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What stops people from seeking help?

Stigma - fear of judgement or embarrassment

Problems recognizing symptoms

Preference for self-reliance “I can do this on my own”

(Gulliver, Griffiths, & Christensen, 2010)

Stress

What is it?

Stress is an elevated state of emotional or physical arousal; and occurs when demands from the environment place pressure on an individuals’ capacity to adapt.

Or simply put, there’s a lot going on in the moment or in our lives in general that causes us trouble-mentally, emotionally, or physically.

(Sumra & Schillaci, 2015)

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Risk factors The Superwoman

Multiple roles: housemaker, caregiver for family, being a mother, wife, working professional

Finances

Societal expectations of beauty

Marriage, relationships, or finding love

Friendships

Health: illness or disease

Racial, cultural, or gender discrimination or prejudices

(Sumra & Schillaci, 2015)

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Treatment: Stress Reduction Focus on your needs

Manage your time

Meditation or prayer

Exercise (yoga)

Get enough sleep

Eat a well-balanced diet

Talk to significant others (friends, family)

Need someone unbiased? You can always seek with a therapist

(NAMI, 2015)

AnxietySECTION 2

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What is it?

Feeling excessively frightened, distressed, or uneasy during situations in which most other people would not experience these same feelings.

Some levels of anxiety are normal.

It becomes a problem when it’s unmanageable, causing impairment in daily life activities.

(NAMI, 2012)

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Symptoms Feelings of apprehension or dread

Feeling tense and jumpy

Restlessness or irritability

Anticipating the worst and being watchful for signs of danger

Physical symptoms of

Pounding or racing heart and shortness of breath

Upset stomach

Sweating, tremors and twitches

Headaches, fatigue and insomnia

(NAMI, 2015)

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Risk Factors Unmanaged stress

Low self-esteem

Trauma

domestic violence

physical, sexual, or emotional abuse

migration

natural disasters

Genetics

Other mental health diagnoses

Depression

(Blanco et al., 2014)

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Treatment: Therapy

Psychotherapy

“Talk therapy”

A type of psychotherapy most commonly used is cognitive behavioral therapy (CBT)

Teaches different ways of thinking, reacting,

and behaving to an anxiety-producing event.

(NIH, 2018)

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Treatment: Complementary/Alternative

Yoga

Massage Therapy

Aromatherapy

Pet therapy

Acupuncture

Music therapy

Art therapy

(Sagarwala & Nasrallah, 2018)

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Treatment: Medication Antidepressants - SSRIs: selective serotonin reuptake inhibitors

Used for long-term management

Increases serotonin levels

Reduces anxiety and helps relieve symptoms

Popular brands: Lexapro, Paxil, Prozac, Zoloft

Benzodiazepines

Used for short-term management

Can be addictive

Popular brands: Xanax, Ativan, Klonopin

(NIH, 2018)

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Postpartum anxiety What is it? Anxiety observed after pregnancy

Symptoms

Same as other anxiety disorders + less bonding with infant

Risk factors

prior history of anxiety, fear of giving birth, fear of death (of both mother and baby), lack of control, lack of self-confidence, or lack of confidence in the medical system.

Treatment

Same as those for other anxiety disorders PLUS:

No benzodiazepines in breast feeding mothers

Increasing social support for mom

Enhancing bonding with infant

(Jordan & Minikel, 2019)

Depression

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What is it?

More than just sadness

Interferes with daily life

(ADAA, 2016)

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Symptoms Feelings of hopelessness

Feelings of guilt, worthlessness, or helplessness

Loss of interest or pleasure in activities once enjoyed

Decreased energy, a feeling of fatigue or of being “slowed down”

Difficulty concentrating, remembering, making decisions

Irritability

Sleeping too much, or having trouble sleeping

Change in appetite or unintended weight loss or gain

Thoughts of death or suicide

(ADAA, 2016)

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Risk Factors

Genetics

Family history of depression

Trauma

Illness

Pregnancy

Other mental health disorders: most commonly co-occurs with anxiety.

(ADAA, 2016)

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Treatment: Therapy

Psychotherapy

Cognitive behavioral therapy (CBT)

Interpersonal therapy (IPT)

focuses on interpersonal issues such as relationships and major life events

Dialectical behavioral therapy (DBT)

uses a problem solving and acceptance-based framework

(ADAA, 2016)

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Treatment: Complementary/Alternative Yoga

Massage Therapy

Aromatherapy

Pet therapy

Acupuncture

Music therapy

Art therapy

Light therapy: exposure to light device that mimics outdoor lighting

Recommended for seasonal depression, but is beneficial for regular depression as well

(Oldham & Ciraulo, 2014)

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Treatment: Medication Antidepressants

SSRIs: selective serotonin reuptake inhibitors.

Increases serotonin levels.

Popular brands: Lexapro, Paxil, Prozac, Zoloft

SNRIs: Serotonin and norepinephrine reuptake inhibitors.

Increases both serotonin and norepinephrine levels

Popular brand: Wellbutrin

(ADAA, 2016)

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Postpartum Depression What is it? Depression observed after pregnancy

Symptoms: Same as seen in other depressive disorders

+ decrease bonding with infant

Risk factors

rapid decrease in some hormones after delivery, previous depressive episodes, complications during pregnancy or delivery.

Treatment

Same as those for other depressive disorders with the following adjustments PLUS

Strong focus on increasing social support for mom

Skills training geared toward enhancing bonding with infant

New FDA approved Medication: Zulresso

(ADAA, 2016)

Cultural Considerations

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Culture of the patient

Beliefs, norms, values, and practices

Mental health disorder symptoms may present differently

Example: Asian cultures are less likely to speak about emotions, so they may present with a concern of heart palpitations instead of saying “I’m anxious”

Treatment

Nigerian cultures prefer meditation/prayer or talk therapy to medications.

(DHHS, 2001)

References

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ADAA. (n.d). Women and anxiety. Retrieved from https://adaa.org/find-help-for/women/anxiety

ADAA. (2005). Anxiety disorders in women: Setting a research agenda. Retrieved from https://adaa.org/sites/default/files/ADAA_Womens_R1.pdf

ADAA. (2016). Depression. Retrieved from https://adaa.org/sites/default/files/Depression-ADAA_Brochure-2016.pdf

APAA. (2007). Postpartum depression. Retrieved from https://www.apa.org/pi/women/resources/reports/postpartum-depression-brochure-2007.pdf

Blanco, C., Rubio, J., Wall, M., Wang, S., Jiu, C. J., & Kendler, K. S. (2014). Risk factors for anxiety disorders: common and specific effects in a national sample. Depression and anxiety, 31(9), 756–764. doi:10.1002/da.22247

Gulliver, A., Griffiths, K. M., & Christensen, H. (2010). Perceived barriers and facilitators to mental health help-seeking in young people: a systematic review. BMC psychiatry, 10, 113. doi:10.1186/1471-244X-10-113

Jordan, V., & Minikel, M. (2019). Postpartum anxiety: More common than you think. Journal of Family Practice, 68(3), 165. Retrieved from https://search-ebscohost.com.proxy.ulib.uits.iu.edu/login.aspx?direct=true&db=ccm&AN=ccm=m=135871636&site=ehost-live

U.S. Department of Health and Human Services. (2001). Mental Health: culture, race, and ethnicity—A supplement to mental health: A Report of the Surgeon General. Rockville, MD.

NAMI. (2012). Anxiety disorders fact sheet. Retrieved from https://www.schizophrenia.sk.ca/wp-content/uploads/2012/12/Anxiety-Factsheet-Nami.pdf

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NAMI. (2015). Anxiety disorders. Retrieved from https://www.nami.org/NAMI/media/NAMI-Media/Images/FactSheets/Anxiety-Disorders-FS.pdf

NAMI. (2015). Mental Health: Managing Stress. Retrieved from https://www.nami.org/getattachment/Extranet/NAMI-State-Organization-and-NAMI-Affiliate-Leaders/Awareness/AKA/Mental-Health-Fact-Sheets/AKA-NAMI-Managing-Stress.pdf#page=1&zoom=auto,-91,798

NAMI. (2009). Women and depression fact sheet. Retrieved from http://www.networkofcare.org/library/womenanddepression.pdf

NIH. (2018). Anxiety disorders. Retrieved from https://www.nimh.nih.gov/health/topics/anxiety-disorders/index.shtml

Oldham, M. A., & Ciraulo, D. A. (2014). Bright light therapy for depression: a review of its effects on chronobiology and the autonomic nervous system. Chronobiology international, 31(3), 305–319. doi:10.3109/07420528.2013.833935 Sagarwala, R.S. & Nasrallah, H.A. (2018). Complementary treatments for anxiety: Beyond pharmacotherapy and psychotherapy. Current Psychiatry, 17(7), 29-30,32,34-36.

Sumra, M.K. & Schillaci, M.A. (2015) Stress and the Multiple-Role Woman: Taking a closer look at the “Superwoman”. Plos One. DOI:10.1371/journal.pone.012095

ULifeline. (n.d.). Dangers of depression. Retrieved from http://www.ulifeline.org/articles/396-the-dangers-of-depression

Questions?