Anxiety Disorders and Stress Q 45
The psychiatric nurse uses cognitive-behavioral techniques when working with a client who experiences panic attacks. Which of the following techniques are common to this theoretical framework? Select all that apply.
A. Administering anti-anxiety medication as prescribed.
B. Encouraging the client to restructure thoughts.
C. Helping the client to use controlled relaxation breathing.
D. Helping the client examine evidence of stressors.
E. Questioning the client about early childhood relationships.
F. Teaching the client about anxiety and panic.
Correct Answers: B, C, D, F
These are all appropriate techniques based on the framework of cognitive-behavioral therapy. The main approaches to the treatment of panic disorder include both psychological and pharmacological interventions. Psychological interventions consist of cognitive-behavioral therapy. As an added benefit in patients with a panic disorder that also has concomitant comorbid medical conditions, there are components of their therapeutic regimens which may also secondarily improve their respective medical illnesses.
Option A: Antidepressants and benzodiazepines are the mainstays of pharmacologic treatment. Among the different classes of antidepressants, selective serotonin reuptake inhibitors (SSRIs) are recommended over monoamine oxidase inhibitors and tricyclic antidepressants. SSRIs are considered the first-line treatment option for patients with panic disorder.
Option B: Suggest that the client substitute positive thoughts for negative ones. Emotion connected to thought, and changing to a more positive thought can decrease the level of anxiety experienced. This also gives the client an alternative way of looking at the problem. Include the client in making decisions related to selection of alternative coping strategies. Allowing the client choices provides a measure of control and serves to increase feelings of self-worth.
Option C: Breathing training is a method of reducing panic symptomatology by utilizing capnometry biofeedback to decrease the number of episodes of hyperventilation. Several of these slow breathing techniques have been shown to benefit patients with asthma and hypertension. Hyperventilation reduction can help patients with cardiovascular disease. Anxiety and stress-reduction techniques can lower adverse outcomes in cardiovascular illness by decreasing sympathetic activity.
Option D: Encourage the client to explore underlying feelings that may be contributing to irrational fears. Help the client to understand how facing these feelings, rather than suppressing them, can result in more adaptive coping abilities. Verbalization of feelings in a non threatening environment may help the client come to terms with unresolved issues. Discuss the process of thinking about the feared object/situation before it occurs. Anticipation of a future phobic reaction allows the client to deal with the physical manifestations of fear.
Option E: Encourage the client to share the seemingly unnatural fears and feelings with others, especially the nurse therapist. Clients are often reluctant to share feelings for fear of ridicule and may have repeatedly been told to ignore feelings. Once the client begins to acknowledge and talk about these fears, it becomes apparent that the feelings are manageable.
Option F: Explore things that may lower fear level and keep it manageable (e.g. singing while dressing, repeating a mantra, practicing positive self-talk while in a fearful situation); provides the client with a sense of control over the fear. Distracts the client so that fear is not totally focused on and allowed to escalate. Educate the patient and/or SO that anxiety. disorders are treatable. Pharmacological therapy is an effective treatment for anxiety disorders; treatment regimen may include antidepressants and anxiolytics.