Chapter 12
Anxiety and
Anxiety Disorders
Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc.
Anxiety
• Anxiety – apprehension, uneasiness,
uncertainty, or dread from real or
perceived threat
• Fear – reaction to specific danger
• Normal anxiety – necessary for survival
Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc.
2
Levels of Anxiety
• Mild anxiety
• Moderate anxiety
• Severe anxiety
• Panic
Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc.
3
• A parent is shopping with a 5-year-old
child in a large, busy urban mall. The
parent suddenly realizes the child is
missing. Which level of anxiety would
likely result?
Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc.
4
a. Mild
b. Moderate
c. Severe
d. Panic
Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc.
5
Defenses Against Anxiety
• Defense mechanisms
– Automatic coping styles
– Protect people from anxiety
– Maintain self-image by blocking
• feelings
• conflicts and
• memories
– Can be healthy or unhealthy
Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc.
6
Anxiety Disorders
• Clinical picture
• Epidemiology
• Comorbidity
• Etiology
– Biological
• Genetics
– Neurobiological
Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc.
7
Psychological Theories
• Psychodynamic theories
– Sigmund Freud
– Harry Stack Sullivan
– Behavior theories
– Cognitive theories
• Cultural considerations
Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc.
8
Panic Disorders (PD)
• Panic attack
• Panic disorder without agoraphobia
• Panic disorder with agoraphobia
• Simple agoraphobia
Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc.
9
Phobias
• Specific phobias
• Social phobia or social anxiety
disorder (SAD)
Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc.
10
Obsessive-Compulsive Disorder
(OCD)
• Obsessions
– Thoughts, impulses, or images that persist
and recur, so that they cannot be dismissed
from the mind
• Compulsions
– Ritualistic behaviors an individual feels
driven to perform in an attempt to reduce
anxiety
Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc.
11
Generalized Anxiety Disorder
(GAD)
• Excessive anxiety or worry about
numerous things
• Lasts for 6 months or longer
Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc.
12
Posttraumatic Stress Disorder
(PTSD)
• Flashbacks
• Avoidance of stimuli associated
with trauma
• Experience of persistent numbing
of responses
• Persistent symptoms of increased
arousal
Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc.
13
Acute Stress Disorder
• Occurs within 1 month after exposure
to highly traumatic event
• Must display at least 3 dissociative
symptoms – during or after event
• Resolves within 4 weeks
Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc.
14
Substance-Induced
Anxiety Disorder
• Symptoms of anxiety, panic attacks,
obsessions, and compulsions
• Develop with the use of a substance or
within a month of stopping use of the
substance
Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc.
15
Anxiety Due to
Medical Conditions
• Symptoms of anxiety are direct
physiological result of a medical
condition
Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc.
16
Application of the
Nursing Process
• Assessment
– General assessment of symptoms
– Self-assessment
– Assessment guidelines: anxiety disorders
• Nursing Diagnosis
• Outcomes Identification
• Planning
Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc.
17
Application of the
Nursing Process
Continued
• Implementation
– Mild to moderate levels of anxiety
– Severe to panic levels of anxiety
Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc.
18
Basic Level
Nursing Interventions
• Counseling
• Milieu therapy
• Promotion of self-care activities
• Pharmacological interventions
• Health teaching
Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc.
19
Advanced Practice
Interventions
• Cognitive therapy
• Behavioral therapy
– Relaxation training
– Modeling
– Systematic desensitization
Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc.
20
Advanced Practice
Interventions
Continued
• Behavioral therapy, continued
– Flooding
– Response prevention
– Thought stopping
• Cognitive-behavioral therapy
Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc.
21