Understanding Anxiety

Anxiety vs. Fear

ANXIETY

• Reaction to an unspecified danger

FEAR

• Reaction to a specific danger

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13-313-3

Anxiety operationally defined

(Fig. 13-1)(Fig. 13-1)

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Yerkes-Dodson Anxiety Graph

Mild Anxiety

Perceptual field heightened Grasps what is happening Identifies disturbing things Can work toward a goal Can examine alternatives Experiences slight discomfort Restlessness, irritability Mild tension relieving behaviors

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Moderate Anxiety

Perceptual field narrows Selective inattention Needs to have things pointed out Problem solving ability moderately impaired Benefits from guidance Shaky voice, concentration difficult Sympathetic nervous system symptoms Somatic complaints

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Severe Anxiety

Perceptual field greatly reduced Attention scattered Self-absorbed Can’t attend to events or see connections Perceptions distorted Feelings of dread/doom Sympathetic nervous system symptoms Confusion, purposeless activity

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Panic Level Anxiety

Unable to focus on environment Terror, emotional paralysis Hallucinations/delusions Muteness, severe withdrawal Immobility or extreme agitation, severe shakiness Disorganized, irrational thinking Unintelligible speech Sleeplessness Heart attack symtoms

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Defenses against Anxiety

Manage conflict and affect Are relatively unconscious Are discrete from one another Are often hallmarks of psychiatric syndromes Are reversible Are adaptive as well as pathological

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13-913-9

Sublimation

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13-1013-10

Humor

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13-1113-11

Suppression

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13-1213-12

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13-1413-14

Identification

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13-1513-15

Repression

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13-1713-17

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13-1813-18

Somatization

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Conversion

This blind referee is an an example of conversion-a somatization that is displayed in the central nervous system Sometimes described as hysterical blindness or hysterical paralysis.

No physical cause.

13-1913-19

Undoing

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13-2013-20

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13-2113-21

Regression

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13-2213-22

Projection

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13-2313-23

Denial

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Interventions: Mild to Moderate Anxiety

Help identify anxiety and antecedents to anxiety Anticipate anxiety-provoking situations Demonstrate interest Encourage talk about feelings and concerns Keep communication open Use clarification to understand Encourage problem solving Use role playing, modeling Explore behaviors used in past Provide outlets for excess energy

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Interventions: Severe to Panic Anxiety

Maintain calm manner Remain with client Minimize environmental stimuli Use clear, simple statements and repetition Low pitched voice; speak slowly Reinforce reality if distortions occur Listen for themes Meet physical and safety needs Set verbal limits/physical limits Assess need for medication or seclusion

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