ANXIETY

INTRODUCTION

Anxiety is a normal emotion. It would be abnormal if we did not react to certain situations by becoming anxious. It becomes abnormal if there is no apparent cause for the anxiety, or if the anxiety is out of proportion to the cause. or if it interferes with our daily life. Low or Moderate Anxiety Levels tend to improve our reactions and performance. However, as anxiety levels increase to High reactions and performance deteriorate.

ANXIETY STATES

[Generalized Anxiety Disorder, Anxiety Reaction]

In this disorder there is Free Floating anxiety. The patient feels continuously anxious but does not know why. They are tense all the time and have all of the physical effects of chronic anxiety, with Palpitations, Air Swallowing and Gastric and Bowel disturbances. Its Onset is usually in early adulthood and it affects women twice as often as men. There is evidence that there is a genetic influence.

INSIGHT PSYCHOTHERAPY

To uncover unconscious conflicts and increase self-knowledge.

RELAXATION TECHNIQUES

To help the patient gain some voluntary control over Autonomic Nervous System reactions.

PHYSICAL 

ANXIOLYTICS are usually prescribed for these patients and this creates problems when medication is withdrawn. Tricyclic Antidepressants are often used especially if there are Panic Attacks.

PROGNOSIS

Prognosis is poor with about one third of patients recovering completely. As the patient gets older the anxiety tends to reduce. At one time Psycho-surgery used to be carried out in order to relieve the symptoms.

PHOBIC STATES

In this disorder the anxiety is Focused on a particular object or situation. The phobia may be about a fear of Open or Closed Spaces or objects such as animals or insects. The fear is out of all proportion to the stimulus and often results in a Panic Attack where the patient Hyperventilates. and loses all ability to think clearly. The individual often realises that the fear is abnormal but can do nothing to control the reaction. They will go to great lengths to avoid the situation

which causes their fear. Some are so frightened of Open Spaces that they become trapped in their homes. often for years at a time. One patient I knew in Bahrain had not left her room for fifteen years. Within twelve weeks of treatment she was able to walk out in the streets.

PHOBIAS MAYBE DIVIDED INTO:

 SIMPLE: Fear of a specific Object. Animal or Situation eg : Snakes, Insects. Enclosed Spaces

 SOCIAL: Fear of Embarrassing themselves in a Social Situation eg: Eating or Speaking in Public

 AGORAPHOBIA: Fear of Open Spaces or Crowds. It is the most common Phobia [60%].

SIGNS and SYMPTOMS

Even thinking about the phobic object or situation provokes anxiety. As the object or situation becomes nearer anxiety increases until there is a PANIC ATTACK.

BEHAVIOUR THERAPY

Operates on the principal that the Phobic Object is a Conditioned Stimulus and that the Phobic Response is a Learned

Response. The most common form of Behavior Therapy used is a GRADUAL DECONDITIONING [SYSTEMATIC DESENSITIZATION]. The patient is gradually brought close to the Phobic Stimulus under Controlled Conditions while at the same time using Relaxation Techniques.

The patient makes a list of all the anxiety provoking situations from Least provoking to Most provoking. The patient then goes through this list in their imagination. As their Anxiety Increases they are supported psychologically and taught to use Relaxation Techniques to control that Anxiety. After they have learned to control the Anxiety in their imagination they learn to do this in the actual Phobic Situation.

FLOODING is another type of Behavior Therapy where the patient is confronted by the Phobic Stimuli without them being given the chance to escape. Eventually they "Bum Out" their fear and learn to accept that the situation cannot harm them. This is not used very often as it is very unpleasant and the results from Systematic Desensitization are just as good.

PHYSICAL 

Anxiolytics are often prescribed with Tricyclic Antidepressants to control the Panic Attacks.

NURSING CARE

• Nurses who have the appropriate training may be entirely responsible for the patient and carry out the Behaviour Therapy instead of a Psychologist. The results from clinical trials show that . Specially Qualified Nurses are just as effective as Psychologists.
• It is very important to build up a trusting relationship with these patients. The nurse has to be Calm and Competent to serve as a Role Model and give Psychological Support during Panic Attacks and Desensitization.
• The nurse's role in Behavior Therapy will depend on the type of therapy prescribed. Often these patients will be treated as Outpatients or in their Own Homes by a Community Psychiatric Nurse.
• It is the responsibility of the nurse to become expert in the techniques of Psychological therapy used with these patients. As well as giving Psychological Support they can reinforce specific Behavioral Techniques.

KEY POINTS:

1. Anxiety is a normal emotion. It becomes abnormal if there is no apparent cause for the anxiety, or if the anxiety is out of proportion to the cause, or if it interferes with our daily life.

2. Low or Moderate Anxiety Levels tend to improve our reactions and performance. High anxiety levels decrease performance.

3. In this disorder there is Free Floating anxiety. The patient feels continuously anxious but does not know why.

4. Treatment includes Insight Psychotherapy Relaxation Techniques, Anxiolytics and Tricyclic Antidepressants.

5. In Phobias the anxiety is Focused on a particular object or situation The fear is out of out proportion to the stimulus and often results in a Panic Attacks.

6. Phobias may be divided into Simple, Social and AGORAPHOBIA.

7. Treatment consists of Behavior Therapy, Systematic Desensitization Flooding, and Anxiolytics with Tricyclic Antidepressants

8. It is very important to build up a trusting relationship with these patients. The nurse has to be Calm and Competent to serve as a Role Model and give Psychological Support.

9. It is the responsibility of the nurse to become expert in the techniques of Psychological therapy used with these patients. As well as giving Psychological Support they can reinforce specific : Behavioral Techniques.