ANXIETY

Ma. Joya J. Genzola, RN

CSA-B College of Nursing
AY 2009-2010, 2nd Semester, Final Term
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Anxiety
Is the subjective emotional response
to stress characterized by feelings of
apprehension, uneasiness,
uncertainty or dread, resulting from a
real or perceived threat

Anxiety vs Stress

Anxiety vs Fear

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Process of Anxiety

Stressor Anxiety Neurochemical,

physiologic &
emotional reactions

Adaptive

Palliative
Coping
behaviors
Maladaptive

Dysfunctional
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General Etiologic of Anxiety

•Psychodynamic Model

•Interpersonal Model

•Biologic Model

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 Levels of Anxiety
SYMPTOMS

LEVELS OF
Psychomotor Emotional Cognitive
ANXIETY

Mild +1 CONSTRUCTIVE CHALLENGED ALERTNESS

DIFFICULTY
Moderate +2 PROTECTIVE UNCOMFORTABLE
CONCENTRATING

EXTREME DISTORTED
Severe +3 FIGHT OR FLIGHT
DISCOMFORT PERCEPTION

ACTUAL F or FL OVERWHELMED, PERSONALITY

Panic +4
IMMOBILIZATION OUT OF CONTROL DISORGANIZATION

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 Nursing Intervention
LEVELS OF
ANXIETY Nursing Intervention

Use cognitive strat, stress management education, problem solving

Mild +1
approach, accept anxiety as natural; tolerate and benefit from it

Decrease anxiety – ventilation, crying, exercise, relaxation tech.,

Moderate +2
assist in using problem-solving tech., teach coping strat

Decrease anxiety, stimuli & pressure, use kind, firm, simple

Severe +3
directions, use time out, encourage physical activity

Panic +4 Guide firmly or physically take control, order restraints

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 Coping with Anxiety
Type of Coping Description

Solves the problem that is causing the anxiety.

ADAPTIVE
The patient is objective, rational and productive.

Temporarily decreases the anxiety but does not solve the

PALLIATIVE problem.
Temporary relief allows the patient to return to problem solving.

Unsuccessful attempts to decrease the anxiety without

MALADAPTIVE attempting to solve the problem.
The anxiety remains.

DYSFUNCTIONAL Is not successful in reducing anxiety or solving the problem.

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Anxiety can be considered
abnormal or pathological if

1. It is out of proportion to the situation

that is creating it.

2. The anxiety interferes with social,

occupational or other areas of
functioning.

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I. Panic Disorder
Is characterized by panic attacks that recur at
unpredictable times with intense apprehension,
fear and terror

HALLMARK: Panic attacks produce various

physiologic and psychologic symptoms.

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SYMPTOMS:

1. Palpitations
2. Sweating
3. Trembling, shaking
4. Sensation of SOB or smothering
5. Feeling of choking
6. Chest pain or discomfort
7. Nausea or abdominal distress
8. Feeling dizzy, unsteady, faint
9. Derealization or depersonalization
10.Fear of losing control or going crazy
11.Fear of dying
12.Paresthesias
13.Chills or hot flashes

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Limited-Symptom Attack
Panic disorder may occur with or without agoraphobia

a. Panic attack w/o agoraphobia – characterized

by recurrent, unexpected panic attacks followed by
at least one month of persistent concern about
having another attack, worry about the possible
implications or consequences of the attack.

b. Panic attack with agoraphobia – defined as

recurrent, unexpected attacks along with
agoraphobia

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Agoraphobia
Anxiety or fear of being in places or situations from
which escape might be difficult or embarrassing,
or in which help may not be available in the event
that a panic attack should occur.

Common agoraphobic situations:

1. Being outside the home alone

2. Being in the crowd or standing in a line
3. Being on a bridge
4. Traveling in a bus, train or car

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Associated factors:
1. Biologic Vulnerability

2. Lactate Sensitivity

3. Suffocation Alarm Theory

4. Mitral Valve Prolapse

5. Family History

6. Psychosocial Factors

7. Psychodynamic Theory

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Treatment
1. Antianxiety medication (Anxiolytics)
a. Benzodiazepines (alprazolam, lorazepam,
clonazepam)

b. Azapirones (buspirones)

2. Antidepressants
a. Tricyclics (clomipramine, imipramine)
b. SSRI (paroxetine, sertraline)

3. MAOI Inhibitors

4. Beta-blockers

5. Cognitive behavioral therapy

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II. Generalized Anxiety Disorder
Characterized by chronic, unrealistic & excessive
anxiety & worry

Symptoms existed fro 6 months and are not

attributed to specific organic factors

Symptoms must cause clinically significant distress

or impairment in social, occupational or other
important areas of functioning

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SYMPTOMS:

1. Excessive worry or anxiety about a number of

events that the individual finds difficult to
control
2. Restlessness or feeling keyed up or on edge
3. Being easily fatigue
4. Difficulty concentrating or mind “going blank”
5. Irritability
6. Muscle tension
7. Sleep disturbance

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Associated factors:
1. Biologic Vulnerability

2. Gender

3. Other psychiatric disorders

4. Psychosocial Factors

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Treatment
1. Antianxiety & Antidepressants

2. Cognitive-behavioral therapy

3. Specific techniques
1. Relaxation training & biofeedback
2. Questioning evidence
3. Examining alternatives
4. Reframing

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III. Obsessive-Compulsive Disorder
Characterized by obsessions or compulsions that
are severe enough to be time consuming or to
cause marked distress or significant impairment

Essential features: recurrent obsession &

compulsion that commonly occur together

Obsession – unwanted, intrusive, persistent ideas,

thoughts, impulses or images that cause
marked anxiety or distress

Compulsions – denote unwanted repetitive

behavior pattern or mental acts that are
intended to reduce anxiety, not to provide
pleasure or gratification Page 19
Obsession – unwanted, intrusive, persistent ideas,
thoughts, impulses or images that cause
marked anxiety or distress

Compulsions – denote unwanted repetitive

behavior pattern or mental acts that are
intended to reduce anxiety, not to provide
pleasure or gratification

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1. Individual is aware of the unrealistic, intrusive
and inappropriate nature of the obsessions and
compulsions.

2. Attempts to resist obsessive thought or

compulsive behavior causes the individual to
experience increased anxiety.

3. Indulgence in obsessive thoughts and

performance of compulsive behaviors causes
temporary anxiety relief.

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Associated factors:
1. Biologic Vulnerability

2. Striatum Dysfunction Theory

3. Genetic Vulnerability

4. Psychoanalytical theory

5. Learning Theory

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Treatment
1. Antidepressants (Tricyclics & SSRI)

2. Cognitive Behavioral theory

3. Specific Techniques
1. Flooding & Response prevention

2. Cognitive restructuring

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IV. Phobic Disorder
Is an irrational fear of a specific object, activity,
situation or event accompanied by avoidance of
the object, person or situation.

Simple phobia – fear of specific things

Social phobia – fear of potentially embarrassing

social situations

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Associated factors:
1. Psychoanalytical theory

2. Learning theory

3. Cognitive theory

4. Biological aspects

5. Life experiences

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Associated factors:
1. Animal type

2. Natural environment

3. Blood-injection-injury

4. Situational type

5. Other type

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Treatment
1. Antidepressants

2. Benzodiazepines

*Social phobia can be treated with beta-

blockers + antidepressants & benzo

3. Systemic desensitization

4. Cognitive restructuring techniques

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V. Post Traumatic Stress Disorder
Characterized by recurrent thoughts and feelings
associated with severe, specific trauma

Symptoms:
1. Exxagerated startle response

2. Sleep disorders

3. Guilt

4. Nightmares and flashbacks

5. Anger with numbing of emotions

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Contributing factors:
1. Direct relationship

2. Psychosocial factors

*variables
1. the trauma experience
2. the individual
3. the recovery envt

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