anxiety for stephen ministers and others who care june 11, 2013 tess judge-ellis dnp, fnp-bc,...

Anxietyfor Stephen Ministers and others who care

June 11, 2013Tess Judge-Ellis

DNP, FNP-BC, PMHNP-BC

By the end of the evening…

• Understand anxiety as a psychiatric illness– What are anxiety

disorders?– How does anxiety differ

from nervousness?– What causes anxiety

disorders?– Treatment overview.

• Plenty of time to talk and dialogue

“Worrying is carrying tomorrow's load with today's strength- carrying two days at once. It is moving into tomorrow ahead of time. Worrying

doesn't empty tomorrow of its sorrow, it empties today of its strength.”

― Corrie ten Boom

Anxiety symptoms

• Apprehension, fear, obsession, physical tension, increased heart rate, increased respiratory rate, chest tightness, restlessness

Normal reaction to fear

Can be very helpful and motivatingObvious external threatShort lived

Anxiety disorder

• Overwhelming• Time consuming• Excessive response• No obvious external threat• Physical, cognitive,

emotional and behavioral components

Normal nerves or anxiety disorder?

Anxiety disorders-most common

• Generalized anxiety disorder• Panic disorder• Social anxiety/phobias• Obsessive compulsive disorder• Post traumatic stress disorder

• Generalized anxiety disorder– Excessive anxiety, difficulty controlling the worry,

out of proportion worry.– Other symptoms (e.g. concentration off, trouble

sleeping, musculoskeletal complaints)– Most common anxiety disorder

• Panic disorder– Recurrent, unexpected panic attacks along with

concern that another will reoccur or fear of the consequences of another attack “e.g. heart attack.”

– May or may not have agoraphobia

• Social anxiety/phobia– Fear of social situations where the person may

become embarrassed or feel subject to high degree of scrutiny.

– Disruptive to family, social or work.

• Obsessive compulsive disorder– Obsessive thoughts that cause distress or anxiety.

Compulsive thoughts or behaviors are done in attempt to neutralize the obsessive thoughts.

– Time consuming– Interfering – Men=women

• Post traumatic stress disorder– Exposure to traumatic event where the person felt

intense fear or helplessness followed with re-experiencing, avoidance/numbing and arousal.

– Prevalence• General public= 6-8%• Vietnam veterans= 30%• Iraq/Afghanistan= 15%

Medical causes of anxiety symptoms

• Hyperthyroidism• Heart disease• Asthma• Diabetes• Drug or alcohol withdrawal• Certain medications (e.g. albuterol, prednisone, methylphenidates**thorough physical if indicated

Anxiety

• “Anxiety's like a rocking chair. It gives you something to do, but it doesn't get you very far.” ― Jodi Picoult, Sing You Home

Anxiety disorders are the most common psychiatric disorder.18% of Americans

Why do anxiety disorders develop?

A combination of multiple factors• Genetic• Developmental• Environmental• Psychological• Biologic

Chemical imbalanceNeurotransmitters

• Serotonin • GABA• Glutamate• Norepinephrine

Don't believe everything you think.

“Man is not worried by real problems so much as by his

imagined anxieties about real problems” ― Epictetus

Anxiety disorders-treatment

• Psychotherapy/counseling– Cognitive behavioral therapy (CBT)• “stinkin’ thinkin’”

Anxiety disorders-treatment

• Medications– Antidepressants

– Examples: Prozac (fluoxetine), Zoloft (sertraline), Effexor (venlafaxine)

– Antianxiety medications– Examples: Klonapin (clonazepam), Ativan (lorazepam), Xanax

(alprazolam)

• Exercise

• Substance use/misuse

• Yoga• Meditation

(Slow breathing) is like an anchor in the midst of an emotional storm: the anchor won't make the storm goes away, but it will hold you steady until it passes. - Russ Harris

Resources

• Community Mental Health Center for Mid-Eastern Iowa– 338-7884– 1-800-697-3165

• The Crisis Center of Johnson County– 351-0140

• www.nami.org• Mindfulness Based Stress Reduction– Classes at UIHC