Post on 04-Apr-2022
Managing Life’s Anxieties
INDIANA UNIVERSITY
Alhuda Foundation
Presented by: Dr. Ukamaka Oruche, PhD, RN, PMHCNS-BC, FAAN
INDIANA UNIVERSITY
Children
SECTION 1
Mary is 58 years old woman who worries about her 17-year old son. He has become increasingly argumentative and defiant with his parents. He has delayed completing his college application, does not work, lavishes his pocket money on eating out. Then asks for more money to buy gas to drive his car to school and back. Mary thinks he will not amount to anything and that her hard work is in vain. She has kept all these worries to herself. Mary is so stressed out:
1. She can’t sleep
2. She cries a lot
3. She is not eating well
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Marriage
SECTION 1
Tonya is 42 years old woman craving more emotional attention from her husband. She has 4 young children in elementary school. They migrated to America a few years ago. Although, they have settled in for the most part, she complains that her husband is not very supportive. For example, he does not help around the house with chores or take the children to activities like birthday parties. Most importantly, Tonya said he is mot emotionally available to her. But she often finds herself stressed:
1. She cries a lot
2. She just wants to leave the house sometimes
3. She once sat in her car and felt like she just wants it all to stop.
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Career
SECTION 1
Shade is 38 years old woman who worries that she has neglected her career development. She is a physician and a mother of 3 very young children. Although, she works part-time, she has hard difficulty finding fulltime position that she really likes. She feels that all her classmates have passed her in their career. She does not feel comfortable telling her husband or even her mother how she feels. But she often feels stressed about this:
1. She feels lack of confidence and self-doubt
2. She feels self-doubt
3. She feels bad about her self
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Why is stress, anxiety, and depression a concern especially for women? An estimated 264 million people worldwide have an anxiety disorder
Women are twice as likely as men to be diagnosed with an anxiety disorder in their lifetime.
females (23.4%) more than males (14.3%). (ADAA, n.d.)
Nearly 15 million Americans will experience depression each year
The rate is twice as high for women than men
1 in 8 women will have a major depressive episode in their lifetime. (NAMI, 2009)
Up to 1 in 7 women will experience postpartum depression (Jordan & Minkel, 2019); Rates are 3x higher for postpartum anxiety.
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If Left Untreated
Stress: Some stress is important for productivity, but chronic or long term stress can lead to an increase in blood pressure, compromised immunity, inflammation, and diabetes. All risk factors of coronary heart disease. (Sumra & Schillaci, 2015)
Anxiety: Associated with comorbid depression, relationship problems alcohol/drug abuse, functional impairment, poor quality of life and suicidality. (ADAA, 2009)
Depression: Associated with insomnia, relationship problems, alcohol/drug abuse, poor quality of life, suicide. (ULifeline, n.d.)
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What stops people from seeking help?
Stigma - fear of judgement or embarrassment
Problems recognizing symptoms
Preference for self-reliance “I can do this on my own”
(Gulliver, Griffiths, & Christensen, 2010)
What is it?
Stress is an elevated state of emotional or physical arousal; and occurs when demands from the environment place pressure on an individuals’ capacity to adapt.
Or simply put, there’s a lot going on in the moment or in our lives in general that causes us trouble-mentally, emotionally, or physically.
(Sumra & Schillaci, 2015)
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Risk factors The Superwoman
Multiple roles: housemaker, caregiver for family, being a mother, wife, working professional
Finances
Societal expectations of beauty
Marriage, relationships, or finding love
Friendships
Health: illness or disease
Racial, cultural, or gender discrimination or prejudices
(Sumra & Schillaci, 2015)
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Treatment: Stress Reduction Focus on your needs
Manage your time
Meditation or prayer
Exercise (yoga)
Get enough sleep
Eat a well-balanced diet
Talk to significant others (friends, family)
Need someone unbiased? You can always seek with a therapist
(NAMI, 2015)
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What is it?
Feeling excessively frightened, distressed, or uneasy during situations in which most other people would not experience these same feelings.
Some levels of anxiety are normal.
It becomes a problem when it’s unmanageable, causing impairment in daily life activities.
(NAMI, 2012)
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Symptoms Feelings of apprehension or dread
Feeling tense and jumpy
Restlessness or irritability
Anticipating the worst and being watchful for signs of danger
Physical symptoms of
Pounding or racing heart and shortness of breath
Upset stomach
Sweating, tremors and twitches
Headaches, fatigue and insomnia
(NAMI, 2015)
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Risk Factors Unmanaged stress
Low self-esteem
Trauma
domestic violence
physical, sexual, or emotional abuse
migration
natural disasters
Genetics
Other mental health diagnoses
Depression
(Blanco et al., 2014)
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Treatment: Therapy
Psychotherapy
“Talk therapy”
A type of psychotherapy most commonly used is cognitive behavioral therapy (CBT)
Teaches different ways of thinking, reacting,
and behaving to an anxiety-producing event.
(NIH, 2018)
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Treatment: Complementary/Alternative
Yoga
Massage Therapy
Aromatherapy
Pet therapy
Acupuncture
Music therapy
Art therapy
(Sagarwala & Nasrallah, 2018)
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Treatment: Medication Antidepressants - SSRIs: selective serotonin reuptake inhibitors
Used for long-term management
Increases serotonin levels
Reduces anxiety and helps relieve symptoms
Popular brands: Lexapro, Paxil, Prozac, Zoloft
Benzodiazepines
Used for short-term management
Can be addictive
Popular brands: Xanax, Ativan, Klonopin
(NIH, 2018)
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Postpartum anxiety What is it? Anxiety observed after pregnancy
Symptoms
Same as other anxiety disorders + less bonding with infant
Risk factors
prior history of anxiety, fear of giving birth, fear of death (of both mother and baby), lack of control, lack of self-confidence, or lack of confidence in the medical system.
Treatment
Same as those for other anxiety disorders PLUS:
No benzodiazepines in breast feeding mothers
Increasing social support for mom
Enhancing bonding with infant
(Jordan & Minikel, 2019)
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Symptoms Feelings of hopelessness
Feelings of guilt, worthlessness, or helplessness
Loss of interest or pleasure in activities once enjoyed
Decreased energy, a feeling of fatigue or of being “slowed down”
Difficulty concentrating, remembering, making decisions
Irritability
Sleeping too much, or having trouble sleeping
Change in appetite or unintended weight loss or gain
Thoughts of death or suicide
(ADAA, 2016)
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Risk Factors
Genetics
Family history of depression
Trauma
Illness
Pregnancy
Other mental health disorders: most commonly co-occurs with anxiety.
(ADAA, 2016)
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Treatment: Therapy
Psychotherapy
Cognitive behavioral therapy (CBT)
Interpersonal therapy (IPT)
focuses on interpersonal issues such as relationships and major life events
Dialectical behavioral therapy (DBT)
uses a problem solving and acceptance-based framework
(ADAA, 2016)
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Treatment: Complementary/Alternative Yoga
Massage Therapy
Aromatherapy
Pet therapy
Acupuncture
Music therapy
Art therapy
Light therapy: exposure to light device that mimics outdoor lighting
Recommended for seasonal depression, but is beneficial for regular depression as well
(Oldham & Ciraulo, 2014)
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Treatment: Medication Antidepressants
SSRIs: selective serotonin reuptake inhibitors.
Increases serotonin levels.
Popular brands: Lexapro, Paxil, Prozac, Zoloft
SNRIs: Serotonin and norepinephrine reuptake inhibitors.
Increases both serotonin and norepinephrine levels
Popular brand: Wellbutrin
(ADAA, 2016)
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Postpartum Depression What is it? Depression observed after pregnancy
Symptoms: Same as seen in other depressive disorders
+ decrease bonding with infant
Risk factors
rapid decrease in some hormones after delivery, previous depressive episodes, complications during pregnancy or delivery.
Treatment
Same as those for other depressive disorders with the following adjustments PLUS
Strong focus on increasing social support for mom
Skills training geared toward enhancing bonding with infant
New FDA approved Medication: Zulresso
(ADAA, 2016)
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Culture of the patient
Beliefs, norms, values, and practices
Mental health disorder symptoms may present differently
Example: Asian cultures are less likely to speak about emotions, so they may present with a concern of heart palpitations instead of saying “I’m anxious”
Treatment
Nigerian cultures prefer meditation/prayer or talk therapy to medications.
(DHHS, 2001)
INDIANA UNIVERSITY
ADAA. (n.d). Women and anxiety. Retrieved from https://adaa.org/find-help-for/women/anxiety
ADAA. (2005). Anxiety disorders in women: Setting a research agenda. Retrieved from https://adaa.org/sites/default/files/ADAA_Womens_R1.pdf
ADAA. (2016). Depression. Retrieved from https://adaa.org/sites/default/files/Depression-ADAA_Brochure-2016.pdf
APAA. (2007). Postpartum depression. Retrieved from https://www.apa.org/pi/women/resources/reports/postpartum-depression-brochure-2007.pdf
Blanco, C., Rubio, J., Wall, M., Wang, S., Jiu, C. J., & Kendler, K. S. (2014). Risk factors for anxiety disorders: common and specific effects in a national sample. Depression and anxiety, 31(9), 756–764. doi:10.1002/da.22247
Gulliver, A., Griffiths, K. M., & Christensen, H. (2010). Perceived barriers and facilitators to mental health help-seeking in young people: a systematic review. BMC psychiatry, 10, 113. doi:10.1186/1471-244X-10-113
Jordan, V., & Minikel, M. (2019). Postpartum anxiety: More common than you think. Journal of Family Practice, 68(3), 165. Retrieved from https://search-ebscohost.com.proxy.ulib.uits.iu.edu/login.aspx?direct=true&db=ccm&AN=ccm=m=135871636&site=ehost-live
U.S. Department of Health and Human Services. (2001). Mental Health: culture, race, and ethnicity—A supplement to mental health: A Report of the Surgeon General. Rockville, MD.
NAMI. (2012). Anxiety disorders fact sheet. Retrieved from https://www.schizophrenia.sk.ca/wp-content/uploads/2012/12/Anxiety-Factsheet-Nami.pdf
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NAMI. (2015). Anxiety disorders. Retrieved from https://www.nami.org/NAMI/media/NAMI-Media/Images/FactSheets/Anxiety-Disorders-FS.pdf
NAMI. (2015). Mental Health: Managing Stress. Retrieved from https://www.nami.org/getattachment/Extranet/NAMI-State-Organization-and-NAMI-Affiliate-Leaders/Awareness/AKA/Mental-Health-Fact-Sheets/AKA-NAMI-Managing-Stress.pdf#page=1&zoom=auto,-91,798
NAMI. (2009). Women and depression fact sheet. Retrieved from http://www.networkofcare.org/library/womenanddepression.pdf
NIH. (2018). Anxiety disorders. Retrieved from https://www.nimh.nih.gov/health/topics/anxiety-disorders/index.shtml
Oldham, M. A., & Ciraulo, D. A. (2014). Bright light therapy for depression: a review of its effects on chronobiology and the autonomic nervous system. Chronobiology international, 31(3), 305–319. doi:10.3109/07420528.2013.833935 Sagarwala, R.S. & Nasrallah, H.A. (2018). Complementary treatments for anxiety: Beyond pharmacotherapy and psychotherapy. Current Psychiatry, 17(7), 29-30,32,34-36.
Sumra, M.K. & Schillaci, M.A. (2015) Stress and the Multiple-Role Woman: Taking a closer look at the “Superwoman”. Plos One. DOI:10.1371/journal.pone.012095
ULifeline. (n.d.). Dangers of depression. Retrieved from http://www.ulifeline.org/articles/396-the-dangers-of-depression