CONCEPT OF

ANXIETY

Prepared by: Eric F. Pazziuagan, RN, MAN

AnxietyThe initial responses to a psychic

threat (Peplau).Anxiety in response to stress is

inevitable in everyday life.The way in which individuals

cope with anxiety and stress is important in understanding the quality with which individuals are functioning in their personal, social, and occupational roles.

LEVELS OF ANXIETY

Mild: +1

Psychomotor symptoms:◦Preparation of body for constructive action.

◦Slight muscle tension.◦Slight fidgeting.◦Energetic.◦Good eye contact.

Emotional symptoms:◦Occasional slight irritability.◦Feeling challenged.◦Confident (Use of adaptive coping

mechanisms)Cognitive symptoms:

◦Alertness◦Awareness of surroundings◦Concentration◦Accurate perceptions◦Attentiveness◦Logical reasoning and problem-solving

skills

Interventions:◦Discuss source of anxiety (steps of learning)

◦Problem solve◦Accept anxiety as natural; tolerate and benefit from it.

Moderate: +2Psychomotor Symptom:

◦Preparation of body for protective action.◦Moderate muscle tension.◦Increased BP, pulse, and respirations.◦Startle reflex.◦Slight perspiration.◦Difficulty sitting still.◦Repeated fidgeting.◦Periodic slow pacing.◦Increased rate of speech.◦Sporadic eye contact.

Emotional symptoms:◦Feeling uncomfortable, on edge, keyed up

◦Motivated to decrease anxiety.◦Increased irritability.◦Decreased confidence (use of palliative coping mechanisms).

Cognitive symptoms:◦Difficulty in concentrating ◦Easily distracted, can focus with

assistance◦Circumstantiality◦Tangentiality◦Loose associations◦Narrowed perceptions◦Decreased attention span◦Misperception of stimuli◦Problem solving and reasoning skills

with effort, or assistance.

Interventions:◦Decrease anxiety- ventilation, crying, exercise, relaxation techniques.

◦Refocus attention; relate feelings and behaviors to anxiety; then use problem-solving techniques; give oral medication, if needed.

Severe: +3Psychomotor signs:

◦Preparation of body for fight or flight.◦Extreme muscle tension.◦Increased perspiration.◦Continuous and rapid pacing.◦Reflex responses.◦Loud or rapid speech, or both.◦Poor eye contact.◦Somatic symptoms.◦Sleep disturbance.

Emotional symptoms:◦Extreme discomfort.◦Feeling of dread.◦Hypersensitivity.◦Defensiveness with threats and demand.

◦Use of maladaptive coping mechanisms.

Cognitive symptoms:◦Distorted perceptions.◦Difficulty focusing, even with assistance.

◦Flight of ideas.◦Ineffective reasoning and problem- solving skills

◦Disorientation.◦Delusions and hallucinations, if prolonged.

◦Suicidal or homicidal ideations, if prolonged.

Interventions:◦Decrease anxiety, stimuli and pressure.

◦Use kind, firm, simple directions.

◦Use time out (seclusion)◦Give intramuscular medications, if needed.

Panic: +4

Psychomotor symptoms:◦Actual flight, fight, or immobilization.

◦Suicide attempts or violence.

◦Depletion of body resources.◦Eyes fixed.◦Hysterical or mute.◦Incoherent.

Emotional symptoms:◦Feeling overwhelmed and out of control.

◦Rage◦Desperation.◦Feeling totally drained (Use of dysfunctional coping mechanisms)

Cognitive symptoms:◦Disorganized perceptions◦Disorganized or irrational reasoning and problem solving

◦Neologisms.◦Clang associations.◦Word salad.◦Out of contact with reality.◦Personality disorganization.

Interventions:◦Guide firmly, or physically take control

◦Give intramuscular injection

◦Order restraints, if needed

COPING WITH ANXIETY

Adaptive Solves the problem that is causing the anxiety, so the anxiety is decreased.

The patient is objective, rational and productive.

PalliativeTemporarily decreases the anxiety but does not solve the problem, so the anxiety eventually returns.

Temporary relief allows the patient to return to problem solving.

MaladaptiveUnsuccessful attempts to decrease the anxiety without attempting to solve the problem.

The anxiety remains.

DysfunctionalIs not successful in reducing anxiety or solving the problem.

Even minimal functioning becomes difficult, and new problems begin to develop.

Most common adaptive techniques:

Problem-solvingAssertivenessPositive self-talk and self-

acceptanceStress and anger managementLearning skills needed for

communication and relationshipsConflict managementTime managementCommunity living skills

Assignment:1. Give actual patient examples of the

following types of coping:◦ Adaptive ◦ Palliative◦ Maladaptive◦ Dysfunctional

2. What are the palliative techniques that can be used to decrease the effects of anxiety?

3. What is crisis? How does it differ from stress?

4. What are the strategies for crisis intervention?