ANXIETY - Universitas Padjadjaranblogs.unpad.ac.id/tatyhernawaty/files/2010/12/ANXIETY1.pdf ·...

ANXIETY

Taty Hernawaty, S.K.p., M.Kep

Bagian Keperawatan Klinik

http://blogs.unpad.ac.id/tatyhernawaty

email: [email protected]

http://blogs.unpad.ac.id/tatyhernawaty

PREDISPOSING FACTORS

Biological Psychological Socialcultural

PRECIPITATING STRESSOR

Nature Origin Timing Number

APPRAISAL OF STRESSOR

Cognitive Affective Physiological Behavioral Social

COPING RESOURCES

Personal abilities Social support Material assets Positive belief

COPING MECHANISMS

Constructive Destructive

Continuum of Coping Responses

Adaptive respon Maladaptive respon

14 November 2010 doc.taty/ D-TATY-NEUROBEHAVIOR 2


Respon

Respon

Respon

Soc

Bio

Psycho

Psycho

Bio

Soc

Psycho

Bio

SocSoc-Cul

PsychoBio

Definition

Taylor (1953) : Suatu perasaan subyektif

mengenai ketegangan mental yang

menggelisahkan sbg reaksi umum dari

ketidakmampuan mengatasi suatu masalah

atau tidak adanya rasa aman.

Stuart and Sundeen (1998) is an emotion

and a subjective experience.


Predisposing Factors


Anxiety is a prime factor in the

development of the personality and

formation of individual character traits

PhychoanaliticView

• Freud believed that unexpressed sexual energy was

converted into anxiety therefore alleviation of

anxiety merely required improved sexual technique.

Predisposing…

Interpersonal View

Sullivan believed that…

Anxiety could not arise until the organism had some

awareness of its environment.

Originated in the early bond between the infant and

mother through this close emotional bond,

anxiety is first conveyed by the mother to the infant.

The anxiety in later life arises when a person

perceives that he/she will be viewed unfavorably or

will lose the love of a person he/she values.


Predisposing…

Behavioral View

Anxiety is a product frustation caused by anything

that interferes with attaining a desire goal, ex: the

loss of a job (external frustation), the young college

graduates who set unrealistically goal (internal

frustation)

Anxiety as a drive that is learned because of an

innate desire to avoid pain.


Predisposing…

Biological Basis

The anxiety is helped by benzodiazepines, the spesific

receptors in the brain.

This is related to the activity of the neurotransmitter

gammaaminobutyric acid (GABA).

the antianxiety class of drugs is reduced firing rate

of cells in areas implicated in anxiety disorders, the

clinical result is that the person becomes less

anxious.


Precipitating Factors


Clearly, experiencing or wtnessing a

source of trauma of any kind has been

associated with a variety of anxiety

disorders, particularly PTSD

Threats to Physical Integrity

• Internal sources may include the failure of

physiological mechanism such as the heart, immune

system, or temperature regulation.

Precipitating…

External sources may include exposure to viral

and bacterial infection, enviromental pollutants, safety

hazards, lack of adequate housing, food, or clothing,

and traumatic injury.

Threats to self-system

Internal sources may include interpersonal

difficulties at home or at work or assuming a new

role, such as parent, student, or employee.


Precipitating…

External sources may include the loss of a valued

person through death, divorce, or relocation, a

change in job status, an ethical dillema, and social or

cultural group pressure.


Coping Mechanisms

Task-Oriented Reactions

In attack behavior : a person attempts to remove or overcome obstacles to satisfy a need.

Withdrawl behavior : involves removing oneself from source of the threat. Biological such as smoke-filled rooms, exposure to irradiation, or contact with contagious diseases. Phychologicalsuch as by admitting defeat, becoming apathetic, or lowering aspirations.

Compromise : is necessary in situations that cannot be resolved through attack or withdrawl.


Coping…

Ego-Oriented Reactions

Not always successful in coping with

stressful situations (mild and moderate

level)

Also called ego defence mechanisms,

are the first line of psychic defence.


Ego…

Compensation : process by which a person makes up for a perceived deficiency by strongly emphasizing a feature that he/she regards as an asset.

Denial : avoidance of disagreeable realities by ignoring or refusing to recognize them; the simplest and most primitive of all defense mechanisms.

Displacement : shift of emotion from a person or object to another, usually neutral or less dangerous or object.

Dissociation : the separation of group of mental or behavioral processes from the rest of the person’s consciousness or identity.


Ego …

Identification : process by which a person tries to

become like someone he/she admires by taking on

thoughts, mannerisms, or tastes of that person.

Intellectualization : excessive reasioning or logic is

used to avoid experiencing disturbing feelings.

Introjection : intense identification in which a person

incorporates qualities or values of another person or

group into his/he own ego structure. It is one of the

earliest mechanisms of the child, important in

formation of conscience.


Ego …

Isolation : splitting off of emotional components of a

thought, which may be temporary or long term.

Projection : attributing one’s thoughts or impulses to

another person. Through this process one can

attribute intolerable wishes, emotional feelings, or

motivations to another person.

Rationalization : offering a socially acceptable or

apparently logical explanation to justify or make

acceptable otherwise unacceptable impulses, feelings,

behaviors, and motives.


Ego …

Reaction formation : development of conscious

attitudes and behavior patterns that are opposite

to what one really feels or would like to do.

Reggresion : retreat to behavior characteristic of

an earlier level of development.

Repression : involuntary exclusion of a painful or

conflictual thought, impulse, or memory from

awareness. It is the primary ego defence, and

other mechanisms tend to reinforce it.


Ego …

Splitting : viewing people and situations as either all good or all bad. Failure to integrate the positive and negative qualities of oneself.

Sublimation : acceptance od a socially approved substitute goal for a drive whose normal channel of expression is blocked.

Suppression : a process often listed as a defencemechanism buat really a conscious counterpart of repression. It is intentional exclusion of material from consciousness. At time, it may lead to repression.

Undoing : act or communication that partially negates a previous one; a primitive defence mechanisms.


Levels of Anxiety

Peplau identified four levels :

Mild anxiety

Associated with the tension of day-to-day living

alert

Perceptual field is increased

The person sees, hears, and graps more than before

Can motivate learning

Produce growth and creativity


Levels …

Moderate anxiety

The person focuses only on immediate concerns

Involves the narrowing of the perceptual field

The person sees, hears, and graps less

The person blocks out selected areas but can attend

to more if directed to do so


Levels …

Severe anxiety

Marked by a significant reduction in perceptual field

The person tends to focus on a specific detail and

not think about anything else

All behavior is aimed at relieving anxiety

Much direction needed to focus on another area


Levels …

Panic

Associated with awe, dread, and teror

Blown out of proportion

Unable to do things even with direction

Involves the disorganization of personalitry

A person can no longer function as an organized human being

Motor activity is increased

Decreased ability to relate to others

Distorted perceptions

Loss of rational thought


Physiological Responses to Anxiety


CardiovascularPalpitation

Racing heart

Increased blood pressure

Faintness

Actual fainting

Decreased pulse rate

RespiratoryRapid breathing

Shortness of breath

Pressure of chest

Shallow breathing

Lump in throat

Choking sensation

Gasping

Gastrointestinal

Loss of appetite

Revulsion toward food

Abdominal discomfort

Abdominal pain

Nausea

Heartburn

Diarrhea

NeuromuscularIncreased reflexes

Startle reaction

Eyelid twitching

Insomnia

Tremors

Rigidity

Fidgeting

Pacing

Strained face

Generalized weakness

Wobbly legs

Clumsy movement

Urinary tractPressure to urinate

Frequent urination

SkinFlushed face

Localized sweating

(palms)

Itching

Hot and cold spells

Pale face

Generalized sweating

The Responses…

BEHAVIORAL

Restlessness

Physical tension

Tremors

Startle reaction

Hypervigilance

Rapid speech

Lack of coordination

Accident proneness

Interpersonal withdrawl

Inhibition

Flight

Avoidance

Hyperventilation


COGNITIVE

Impaired attention

Poor concentration

Forgetfulness

Errors in judgment

Preoccupation

Blocking of thoughts

Decreased perceptual field

Reduced creativity

Diminished productivity

Confusion

Self-consciousness

Loss of objectivity

Fear of losing control

Frightening visual images

Fear of injury or death

Flashbacks

Nightmares

AFFECTIVEEdginess

Impatience

Uneasiness

Tension

Nervousness

Fear

Fright

Alarm

Terror

Jitteriness

Jumpiness

Numbing

Guilt

Shame

InterventionExpected outcome: the patient will demonstrate

adaptive ways of coping with stress

Short-term goal:

The patient will identify and describe feelings of

anxiety

The patient will identify antecedents of anxiety

The patient will describe adaptive and maladaptive

coping responses

The patient will implement two adaptive responses for

coping with anxiety


Intervention… Help the patient identify and describe underlying

feelings

Link the patient’s behavior with such feelings

Validate all inferences and assumptions with the

patient

Use open questions to move from nonthreatening

topics to issues of conflict.

Vary the amount of anxiety to enhance the patient’s

motivation.

In time, supportive confrontation may be used

judiciously.


Intervention… Help the patient describe the situations and

interactions that immediately precede anxiety.

Review the patient’s appraisal of the stressor, values

being threatened, and the way in which the conflict

developed.

Relate the patient’s present experiences with

relevant ones from the past.


Intervention… Explored how the patient reduced anxiety in the

past and what kinds of actions produced relief.

Point out the maladapative and destructive effects

of present coping responses.

Encourage the patient to use adaptive coping

responses that were effective in the past.

Focus responsibility for change on the patient.

Actively help the patient correlate cause-and –effect

relationships while maintaining anxiety within

appropriate limits.

Help the patient reappraise the value, nature, and

meaning of the stressor when appropriate.


Intervention… Help the patient identify ways to restructure

thoughts, modify behavior, use resources, and test

new coping responses.

Encourage physical activity to discharge energy.

Include significant others as resources and social

supports in helping the patients learn new coping

responses.

Teach the patient relaxation exercises to increase

control and self-reliance and reduce stress.


For severe/panic level of anxietyExpected outcome : the patient will reduce anxiety to a

moderate or mild level.

Short-term goals :

- The patient will be protected from harm

- The patient will experience fewer anxiety provoking

situations.

- The patient will engage in a daily schedule of

activities.

- The patient will experience relief from the

symptoms of severe anxiety.


Antianxiety drugs

Benzodiazepines

Alprazolam (Xanax)

Chlordiazepoxide

(Librium)

Clorazepate (Tranxene)

Clonazepam (Klonopin)

Diazepam (Valium)

Halazepam (Paxipam)

Lorazepam (Ativan)

Oxazepam (Serax)

Prazepam (Centrax)14 November 2010 doc.taty/ D-TATY-NEUROBEHAVIOR 31

Antihistamines

Diphenhydramine (Benadryl)

Hydroxyzine (Atarax)

Beta-adrenergic Blocker

Propanolol (Inderal)

Antidepressant

Anxiolytic

Buspirone (BuSpar)

Antidepresant drugs


Clomipramine (Anafranil)

Fluoxetine (Prozac)

Setraline (Zoloft)

Paroxetine (Paxil)

Fluvoxamine (Luvox)

Venlafaxine (Effexor)

Nefazodone (Serzone)

Phenelzine (Nardil)

The scales for anxiety Beck Anxiety Inventory (BAI)

Covi Anxiety Scale

Dissociative Experience Scale

Dissociative Disorders Interview Schedule (DDIS)

Hamilton Rating Scale for Anxiety (Ham-A)

Maudsley Obsessional Compulsive Inventory

Panic Disorder Outcomes Module (PDOM)

Spielberger Anxiety State-Trait

Taylor Anxiety Scale

Yale-Brown Obsessive Compulsive Scale (YBOCS)

Zung Anxiety Scale14 November 2010 doc.taty/ D-TATY-NEUROBEHAVIOR 33

ANXIETY - Universitas Padjadjaranblogs.unpad.ac.id/tatyhernawaty/files/2010/12/ANXIETY1.pdf ·...

Documents

Transcript of ANXIETY - Universitas Padjadjaranblogs.unpad.ac.id/tatyhernawaty/files/2010/12/ANXIETY1.pdf ·...