Major Psychiatric Disorder(s): F 41.1 Generalized anxiety disorder
Rationale
The client is a female who presents with symptoms of excessive anxiety. Ashley has been in a marriage for three years. The client meets criterion A because she experiences anxiety and worries about several events such as her marriage, education, and work performance. Furthermore, the anxiety never subsides. The woman meets criterion B because she finds it difficult to control her symptoms (APA, 2013). Three out of the six key elements of criterion C are met by the client. The woman is restless, which is evidence by her intense exercise schedule. She feels muscle tension and reports being easily fatigued. Ashley meets criterion D because the symptoms she experiences interfere with her professional and social life. For example, the client states that she displays warning signs in the relationship with her husband. At this point, the symptoms cannot be attributed to substance abuse; therefore, criterion E is also met. However, the client consumes an excessive amount of caffeine, which might be contributing to the severity of her symptoms. Taking into consideration the fact that Ashley has not experienced traumatic events and does not have physical complaints that can explain her anxiety and worry, it can be argued that criterion F applies to the client’s case (APA, 2013).
Developmental Disorder(s): No diagnosis
Rationale
In the client’s case, it is not possible to make a developmental diagnosis because the woman has a bachelor’s degree in journalism obtained at the University of Florida. The client has no psychiatric conditions originating in childhood. No language, motor, or post-traumatic stress disorders have been diagnosed so far. Also, Ashley is gainfully employed, which suggests that she does not show signs of behavioral or communication problems associated with developmental disorders.
Personality Disorder(s): No diagnosis
Rationale
Ashley has a successful career, which reduces the likelihood of her having a personality disorder. Also, the woman does not have mood swings or other signs of personality disorder. Moreover, the client reports a happy marriage. She has a lovely family and feels an overall satisfaction with her job. The woman has no concerns regarding communication with other people; the only misunderstandings arise when she tries communicating with her husband. There is no long-standing pattern of intrusive symptoms related to social relationships. Good functioning at her job and the desire to care about her health lead to the conclusion that none of the personal disorders are present at the moment.
Medical Disorder(s): No diagnosis
Rationale
Ashley denies having medical issues. She seems to be caring about her health. The client maintains an intensive exercise schedule. However, the woman reports having regular migraines; therefore, it is necessary to conduct a series of laboratory tests to eliminate the possibility of underlying medical issues.
Client Strengths
Ashley has a loving husband who can provide her with emotional support.
The woman has a caring family, which is essential for quick recovery.
The client holds a bachelor’s degree from the prestigious educational institution, which provides her a wide range of employment opportunities.
She does not have suicidal ideations.
The woman is willing to improve her relationship with her husband, which might help to reduce her stress level.
The woman cares about her health.
She tries to maintain regular exercise.
Ashley continues her education despite her stress, which points to the fact that she is highly resilient.
Comments/Differential Diagnosis
The client shows a preference for staying at home; therefore, social anxiety disorder has been considered for a differential diagnosis. However, Ashley does not seem to be preoccupied with evaluations of others. Furthermore, she regularly exercises and attends her work and school; therefore, the diagnosis has been discarded. The woman worries about her performance at school. Also, she experiences anxiety associated with the fear of getting fired. These are common sources of anxiety for adults (APA, 2013). A considerable number of studies on generalized anxiety disorder have been conducted in recent years. The majority of these studies point to the fact that intolerance of uncertainty mediates anxiety symptoms, which might apply to the client’s case (McEvoy & Mahoney, 2012).
References
APA. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: American Psychiatric Publishing.
McEvoy, P., & Mahoney, P. (2012). To be sure, to be sure: Intolerance of uncertainty mediates symptoms of various anxiety disorders and depression. Behavior Therapy, 43(1), 533-545.
Lavender, De Young, Wonderlich, Crosby, Engel, Mitchell, Crow, and Peterson (2013) tend to look into the relationship between various types of anxiety in anorexia nervosa associated with eating disorder behaviors. The researchers examined the probability of the prevalence of the food consumption disorders, chronological distribution of food consumption behaviors on daily basis and the level on the propensity to demonstrate particular concern as related to baseline investigative and variability in individuality traits. According to the researchers, anxiety in Anorexia Nervosa (AN) particularly related to eating disorders behavior patterns has not been fully studied.
Organization of the article, research questions and literature review
Essentially, the researchers tended to address the following questions in their study. Whether there is any relationship between eating disorders and anxiety in AN, the existence of anxiety among individuals diagnosed with AN as well as whether the symptoms of anxiety may cause variations in patients experiencing remissions from AN. However, the research questions are not explicit in terms of the objectives of the study. Even though the article is organized in such a way that the main problem is clearly brought out from the beginning, the organization of the article does not meet the standards required on a research paper.
The researchers failed to indicate the distinct and important sections such as the study objectives and the significance of the study. Most importantly, literature review of the study topic is not clearly indicated. Moreover, the literature review is not exhaustive since findings of various researches and the work of other scholars have not been thoroughly included in the article. Nevertheless, the article provides a clear findings and explanations to the targeted audience.
Research methods, samples and data analysis
Lavender, De Young, Wonderlich, Crosby, Engel, Mitchell, Crow, and Peterson (2013) majorly applied quantitative research method in their data collection. The quantitative aspect focused on the primary information from the sampled population of the study. In fact, the researchers were explicit in their sample selection criteria and came up with appropriate sample in terms of quality and distribution. However, the number of respondents making the sample was too small taking into consideration the objectives of the study. The model the researchers used to analyze the data was designed to attain the reliable and verifiable results.
The researchers achieved validity and reliability of the study through adoption of appropriate modeling design as well as the application of standard instruments for collection and analysis of data. The validity and reliability means that the findings of the study can be applied in the intervention and treatment of anorexia nervosa.
Findings and conclusions
The overall findings indicate that there is close correlation between eating disorder behavior patterns and anxiety in anorexia nervosa. The findings indicate the presence of individual variability in the patterns of daily anxiety on people diagnosed with AN. Further, the results indicate a correlation between the anxiety patterns and the individual eating disorder behaviors. The researchers found an increased rate of changes in eating behaviors, stimulated nausea, increased body checking patterns, frequent skipping of meals as well as dietary limitations. Moreover, the results indicated close relationship between eating disorder behaviors and increased anxiety.
The findings were common across the study trajectories. In addition, the personality pathology and co-occurrence of mood disorder were also found to be closely linked to the daily anxiety. The conclusion made was that anxiety measures in various models are closely linked to the anorexia nervosa. Therefore, prevention or any intervention and treatment should be based on the ways that would reduce anxiety among individuals with anorexia nervosa.
Limitations of the study
Even though the study applied appropriate sampling procedure, the sample was too small considering the aspect of the study to make conclusive results. In addition, various limitations also exist particularly in the study design as well as in models used in the data analysis. Therefore, the deductions drawn from the study cannot be conclusively admitted. As such, there is need for further researches on this area. In particular, the studies conducted using larger group to ascertain results for adoption. In other words, this study is limited to inform the full adoption of the results in practice.
The contributions of the article in clinical application and future research
The findings of the study provide immense understanding of the relationship between anxiety and anorexia nervosa and the causes of such anxieties. The article achieves this contribution by looking into the theoretical perspectives as well as new modeling criteria that helps in the advanced understanding of the behavioral patterns as well as related anxiety disorders believed to be associated with AN.
The analysis provides a reliable and valid results that can be used to develop appropriate clinical interventions for prevention and diagnosis of AN. Secondly, the researchers presented a concise empirical study and outlined the valid and reliable results that are critical in the understanding of the causes of anxieties associated with AN. However, the article is not exhaustive. More researches applying various models as well as using large samples are needed to ascertain results for adoption in clinical practice.
Reference
Lavender, J. M., De Young, K. P., Wonderlich, S. A., Crosby, R. D., Engel, S. G., Mitchell, J. E., Crow, S. J. & Peterson, C. B. (2013). Daily patterns of anxiety in anorexia nervosa: associations with eating disorder behaviors in the natural environment. Journal of Abnormal Psychology, 122(3), 672–683.
Anxiety disorders should be diagnosed as quickly as possible for the prevention of severe consequences. I succeeded in distinguishing the normal, disordered anxiety, and fear, according to the certain criteria. The provided objectives helped in the understanding of the learning process.
There are several features of the depressive disorders, namely the presence of a bad mood, certain changes in the somatic and cognitive functions, and the significant deterioration of functioning. The depressive disorder affects the overall health of the patient and impacts the illness (Strakowski and Nelson 23). According to the recent experiments in the field of psychology, the depressive disorders are commonly divided into unipolar (depression) and bipolar (depression and mania) (Strakowski 132).
I would like to point out that the understanding of major symptoms of the depressive disorders will help to evaluate the diagnosis and prevent dire consequences. The main features of the depression disorder are depressed mood and empty feelings every the day, the low interest during the daily activities, weight loss, fatigue, thoughts of death.
I learned that the depressive disorder that is believed to be hardly discovered is commonly viewed as dysthymia. It should be stated that the main criteria for the diagnosis are the irritable mood for more than one year, poor appetite, the lack of energy, and fatigue. The depressive disorders in Saudi Arabia are commonly explained as a result of gender inequality (Koenig et al. 226).
I would like to make an accent that according to the theory of Aaron Beck the individual with the depressive feelings makes cognitive errors; depressed person thinks negatively concerning oneself, the future, the world around. The social and cultural factors can cause the depressive disorders. I succeed in the understanding of how the depression and mood disorders should be treated and the significant effect of the depression on a human life.
The deeper understanding of the nature of substance-related disorders, physiological, and psychological effects of alcohol, sedatives, hypnotics, anxiolytics, and stimulants is beneficial for the consideration of how the addiction should be treated. One of the most widespread substance-related disorders is caffeine, tobacco, alcohol, or cannabis addiction. To provide the appropriate treatment to the patient the psychological side of the problem should also be taken into consideration.
I would like to make an accent that personality disorders become widespread nowadays, and that is, the essential features of such disorders should be examined. According to the recent researches, the personality disorders often depend on gender. It should be highlighted that women tend more to suffer from this kind of disorder. Having personality disorders men tend to act in a more aggressive way, whereas women usually display more emotionally insecure state. The index of women who suffer from personality disorders is high, and can be explained because of gender inequality. I succeeded in understanding the difference between paranoid personality disorder, antisocial disorder, avoidant personality disorder, and the needed treatment.
Aside from personal disorder, schizophrenia and other psychotic issues should be distinguished. I managed to understand the difference between psychotic disorders, the nature of schizophrenia, and the appropriate treatment for such kind of disorders. According to the recent studies concerning the connection between schizophrenia and Arabian culture, the patients suffers from visual and kinesthetic hallucinations more often than people belonging to other religious or cultural groups. Patients in Saudi Arabia suffer from hallucinations on the religious base (Kasper and Papadimitriou 364).
Works Cited
Kasper, Siegfried, and George Papadimitriou. Schizophrenia. 2nd ed. Boca Raton: CRC, 2010. Print.
Koenig, Harold, Faten Al Zaben, Mohammad Gamal Sehlo, Doaa Ahmed Khalifa, and Mahmoud Shaheen Al Ahwal. “Current State of Psychiatry in Saudi Arabia.” The International Journal of Psychiatry in Medicine 46.3 (2013): 223-242. Print.
Strakowski, Stephen M. The Bipolar Brain: Integrating Neuroimaging with Genetics. New York: Oxford UP, 2012. Print.
Strakowski, Stephen M., and Erik Nelson. Major Depressive Disorder. Oxford: Oxford UP, 2015. Print.
Physical assessment of a child differs from that of an adult in various ways. Arguably the most crucial difference is that children are often distrustful of medical professionals and scared of physical examinations, and thus adjustments have to be made to make the exam more comfortable. For example, care providers are encouraged to stay on the child’s level as much as possible and to structure the exam by the level of discomfort, from least to most distressing (University of Utah, n.d.).
Main body
Hence, the painful area should be examined last regardless of the standard order. Additionally, care providers should be truthful in warning children about any discomfort that they might experience, explain it, and use distractions instead of lying (University of Utah, n.d.). Lastly, young children should be observed firstly before the exam as their position, posture, and behavior might reveal more than they or their caregivers could in a conversation.
To offer instruction during the assessment, the nurse should remain at the child’s eye level and speak in a calm, soft voice. Children who have severe anxiety should be calmed down through a conversation or distracted by books or toys to make the assessment more comfortable for them. In offering explanations, the nurse should tailor the language to the patient’s developmental level and avoid using medical terminology or complicated wording. Simple, plain language would be more useful when speaking to young children, and information should be explained to them with limited details so as to avoid confusion. Adolescents, however, might require more information and have more questions about their condition.
Conclusion
To encourage engagement during a physical assessment, the nurse should explain each step of the evaluation and support the conversation. This can be done by asking the child health-related questions or, if in need of a distraction, about their interests, toys, or hobbies. These communication and engagement strategies can help nurses to ensure that the exam goes smoothly and that the child is comfortable and cooperative.
The title is explicit and clearly delineates the key variables though it does not mention the population covered. The abstract summarises the main features of the study report and includes the title, aim, background, methods, findings and conclusion. This randomized controlled study aims at determining the effectiveness of relaxation of jaw and total body relaxation for postoperative pain, anxiety, level of relaxation and the patient expectancy effects if any. The problem statement and research questions have not been defined but the review of literature reveals that very little work has been done on the topic of effectiveness of relaxation for post operative pain and the title mentions the objective of the study. The technique of body relaxation whether total or partial has been indicated as one that can be used by nurses in their daily practice (Schaffer and Yucha, 2004). However the authors have a found a dearth of literature regarding the topic. The question also arises as to whether the precious time of the nursing staff must be spent on this technique of relaxation for post operative pain when there are not many takers or studies to back it.
A scarcity of literature
It has found that Seers had undertaken a systematic review in 1998 with another researcher Carroll on the effectiveness of relaxation for post operative relief that appears to be the earliest anyone did a study on this topic. Several poorly designed studies followed. They had flaws and did not allow a continuity of conclusions or statistics. Small groups only were involved or power calculations were lacking and the type and frequency of relaxations varied. Moreover these various relaxations had never been compared.
The next well-done review was by Kwekkeboom and Grettarsdottir in 2006. They reviewed randomized trials of relaxation interventions used for the treatment of pain in adults and synthesized evidence regarding the efficacy of specific techniques (Kwekkeboom amd Grettarsdottir, 2006, p.269). The 15 studies reviewed found that 8 had supporters for the relaxation interventions. Progressive muscle relaxation was the most popular. Some support was found for jaw relaxation and systematic relaxation intervention. However autogenic training, rhythmic breathing or other relaxation techniques were not popular.
An integrative review and critique by Good highlighted the effectiveness of relaxation and music on postoperative pain (1996, p. 906). Limitations and gaps were also identified. Relaxation and music were found to reduce postoperative pain but the methodologies that were adopted were not considered feasible (p.912). Marian Good and her group of researchers had conducted a secondary analysis of a randomized controlled trial to investigate the effects of relaxation and music and a combination of both on post-operative pain (2001, p. 208). It was found that the post operative days were all equally influenced by the music and relaxation techniques. There appeared no difference between the first day or other days (p.214). The relaxation interventions were more effective during the ambulant period. However there was no difference noted between the two activities for any particular day whether at rest or ambulatory.
A randomized controlled study by Roykulcharoen and Good examined the effects of systemic relaxation on post operative pain (2004, p. 140). How the systemic relaxation relieved the body of the sensory and affective components of pain, anxiety and opioid intake after the beginning of ambulation had been investigated. Control groups were also used. It was found that postoperative patients who used systemic relaxation had less distress from pain than the control group. No significant effect was seen on anxiety or opioid intake (p.146).
Relaxation was investigated in Good’s study of 2001 where she used the jaw relaxation method while Roykulcharoen used the systemic relaxation. The systemic relaxation was found to reduce pain sensation by 55% and produced less distress by 56% while the jaw relaxation had figures of 11% and 13% less. This study (2008) has compared 4 groups. Total relaxation, jaw relaxation, attention control and usual care postoperative patients formed the groups.
It is to be noticed that only a handful researchers are interested in the topic of relaxation for post operative patients and they have been repeatedly doing research with different colleague researchers. However the number of studies with definite conclusions still remains low.
Interventions
The total body relaxation in this study used the technique of tensing and relaxing groups of muscles (Bernstein and Borkovec, 1973). The teaching of the interventions at the pre-admission interview was reinforced by supervised training by trained nurses. The participants were requested to start practicing one week before surgery. Total body relaxation was further detailed by using an audio cassette tape with instructions. The study by Seers in 1993 used total body relaxation by concentrating on the feelings accompanying the activities and suggestions made to indirectly enhance the relaxation
(Payne, 1995). The teaching of the interventions there (Seers, 1993) was done at the preadmission interview. Short teaching tapes were used for those with interventions in Good’s study. Jaw relaxation was similar to the method described by Jacobsen (1938). It was as used by Flaherty and Fitzpatrick (1978) and Good et al (2001). One of the control groups in Seer’s study being critiqued was for attention control and the other was just a group of normal postoperative patients getting the usual care. Attention control was also used by Borkovec and Mathews (1988) who gave it another name, ‘non active intervention’. Pre and post intervention questions have been asked and data collected (Seers, 2008). Here absolute privacy was accorded and bias eliminated by having the participants seal the answers before handing over to the researchers. The interventions here were applied and assessed during the rest period, during movement, anxiety and relaxation. Seers in 1993 had used a second researcher blinded to the intervention to reduce bias.
Implication for nursing
Effective management of pain is a significant part of nursing practice. Complete dependence on drugs and sedation may lead to addiction. Systematic relaxation techniques can be easily learnt by nursing staff as they can be recorded and used by them to teach others who need them. It should be done in bed where maximum relaxation is possible. Nurse education programs need to include these interventions in the training of nurses. The techniques for relaxation are self-care procedures which are vital for effective management of pain. Many researchers have spoken for non-pharmacological interventions along with pharmacological treatment of pain (Mandle et al, 1996).
Relaxation has been recommended by the National Health Institute. Technological.
Systemic relaxation is an accepted nursing strategy that gives effective pain relief.
The protection of participants’ rights
Approval had been obtained from the appropriate ethics committee. Consent from the participants was obtained much before the pre-admission interview so that the possibility of coercion was eliminated at the advice of the committee. The researchers were not permitted to approach participants who did not return the consent form. So the rights of the participants had been protected. A pilot study was done before the actual study to understand the acceptance of the methods proposed to patients and health staff.
Appropriateness of design
The design used is the randomized control study. This is appropriate as the literature review has not revealed many comparative studies and none have used an attention control group yet. The control groups and the attention control group are thereby justified. The weaknesses of earlier studies, flaws and power calculations needed a good study with sufficient randomization. This has been achieved here. Powerful detection of differences, a well-defined sample of participants, standards methods of relaxation, a well-defined setting and reliable outcomes are the strengths of this study.
Population sample and study limitations
The population was identified and described in fair detail. The 200 participants in this study, recruited from an original group of 813, comprised of patients admitted for total hip replacement or total knee replacement in an orthopaedic hospital in the United Kingdom. Willing patients above the age of 18 and speaking English were selected to participate. Most of the participants were finally lost to follow-up leaving a small balance. Roykulcharoen’s study of 2004 had 102 participants who underwent abdominal surgery in Thailand. Good’s study of 2001 had 468 participants who had abdominal surgery in 5 hospitals in the United States. This was the first study using orthopaedic patients.
The setting was a single hospital and the post -operative patients were all undergoing a replacement surgery of hip or knee. The sample’s representativeness of postoperative patients may not have been adequate because of the confinement to one kind of postoperative patient. The planned power calculation could not be achieved because of difficulty to recruit patients in the setting selected and because these patients had been recruited for another study. Admission dates kept changing making it difficult to track them. 59 per group coming to a total of 236 were required to obtain a mean effect of 15mm. and a standard deviation of 25mm. The number was less and the study was underpowered. To get sufficient numbers, the period of study recruitment was extended for six months which was again to no avail. Patients who did not reply on their own were not to be approached according to the ethics committee. The researchers were therefore not sure as to what the reply of those who failed to do so could have been. It was later understood that many would have liked to be on the study but did not get round to answering.
Data collection, measurement and analysis
The best methods of data collection have been used reducing the possibility of bias. The participants were randomly assigned by interventions used into the groups of total body relaxation, jaw relaxation and the 2 control groups of attention control and usual care. They were taught the intervention for their group at the pre admission clinic before their surgery and asked to begin practicing it one week before the surgery. Written instructions were given to all groups and the total body relaxation group were given an audio cassette too. They were reminded one week prior to the surgery by post to start their intervention. They were visited on the second and third postoperative days. The questions asked before the intervention were repeated and then the intervention given. Bias was reduced by having the answers written by the patients in privacy and placed in an envelope which was sealed and handed over. This method was selected over the blinding of a second researcher to rule out the possibility of the patient revealing the intervention to the second researcher. Each hour the patient had to repeat this process for the next 4 hours after post intervention data was collected.
The instruments used were reliable and accepted. The primary outcome of pain at rest and on movement was measured using the 0-100 mm. Visual Analogue Scale (VAS). The secondary outcome of anxiety was measured using a similar scale and the Spielberger State Trait Anxiety Inventory (STAI). Reliability and validity of VAS has been proved several times (Bijur et al, 2001). It has also been found that VAS meaningfully quantifies differences in efficacy (Myles et al, 1999). Reliability and validity of STAI has also been accepted (Marteau and Bekker, 1992). The instruments have not been described in detail but the scores have been tabulated with results. They probably have been good choices.
Analysis was done with SPSS version 12. The change scores for the four groups were compared using repeat measures ANOVA. Data showed hardly any difference among the four groups for relaxations as an effective intervention for pain. It was also found that orthopaedic patients were already in a great amount of pain before the surgery and that surgery actually alleviated their pain to a great extent. There was no difference between the relaxation group and the attention control group. Since relaxation does not have a significant effect on pain, asking the nurses to offer any intervention for relaxation may not be right as it has been seen to have practically no effect of relief.
However jaw relaxation which is easy to teach and learn may be advocated among the nurses to be used with doubtful expectations to provide short lasting periods of relief along with anti-analgesics as patients consider them worthwhile.
Findings
Patients have said that their pain before the surgery was what brought them to the hospital. They had been suffering for years together the intense pain which has been a real problem. The pain is different in the post operative period and it is less intense. Other groups with less or no pre-operative pain may have delivered better results than this group of postoperative orthopaedic patients who have always had severe pain.
However there have been many patients who have accepted the relaxation techniques and taught members of their families. All the members believed that their intervention would relieve them of pain. Even the usual care group believed this. This showed the high level of trust in healthcare interventions.
The paper
The paper is well-worded and well organized and has carried the message of this less investigated topic of relaxation for post operative pain. Their credibility is impressive though their study did not produce results as expected. Relaxation was not useful for the orthopaedic postoperative patients. They have shown that systematic studies with powered calculations are the method of ensuring a good resourceful study. The implication of the subject in nursing practice has been detailed. Kate Seers, the main researcher, is the Director of the RCN Research Institute, School of Health and Social Studies, University of Warwick, Coventry, UK. Her colleagues include nursing professionals and a statistician all from UK. Nurses may employ the jaw relaxation method for postoperative patients. Future studies may dwell on other post operative patients who do not have preoperative pain.
References
Bernstein D.A. & Borkovec T.D. (1973) Progressive Relaxation Training. A Manual for the Helping Professions. Research Press, Champaign.
Bijur P.E., Silver W. & Gallagher E.J. (2001). “Reliability of the visual analog scale for measurement of acute pain. Academic Emergency Medicine 8(12), 1153–1157.
Borkovec T.D. & Mathews A.M. (1988) Treatment of nonphobic anxiety disorders: a comparison of non-directive, cognitive, and coping desensitisation therapy. Journal of Consulting and Clinical Psychology 56(6), 877–884.
Flaherty G.G. & Fitzpatrick J.J. (1978). “Relaxation technique to increase comfort levels of postoperative patients: a preliminary study. Nursing Research 27(6), 352–355.
Good, M. (1996). “Effects of relaxation and music on postoperative pain: a review”. Journal of Advanced Nursing, Vol. 24, Pgs.905-914, Blackwell Science Ltd.
Good, M. et al. (2001). “Relaxation and music to reduce postsurgical pain”. Journal of Advanced Nursing, Vol. 33, No. 2, Pgs. 208-215, Blackwell Science Ltd.
Jacobsen E. (1938). Progressive Relaxation. 2nd edn, University of Chicago Press, Chicago.
Marteau T. & Bekker H. (1992) The development of a six-item short form Spielberger State-Trait Anxiety Inventory. British Journal of Clinical Psychology 31, 301–306.
Myles P.S., Troedel S., Boquest M. & Reeves M. (1999). “The pain visual analog scale: is it linear or nonlinear? Anesthesia and Analgesia 89, 1517–1520.
Payne R.A. (1995) “Relaxation Techniques. A Practical Handbook for the Health Care Professional”. Churchill Livingstone, Edinburgh.
Roykulcharoen V. and Good, M. (2004). “Systematic relaxation to relieve postoperative pain”. Journal of Advanced Nursing, Vol. 48, No. 2, Pgs 140-148
Schaffer S.D. & Yucha C.B. (2004) Relaxation and pain management: the relaxation response can play a role in managing chronic and acute pain. American Journal of Nursing 104(8), 75–76, 78–79,81–82.
Seers K. (1993) “Maintaining people with chronic non-malignant pain in the community: teaching relaxation as a coping skill”. Report to Department of Health, London.
Preoperative education entails the training of pre-surgical patients on what to expect before, during and after surgery. The education is believed by many medical practitioners to decrease the length of stay (LOS) in a health facility by providing the patients with substantial information on strategies to adopt to endure and go through psychological problem: categorically anxiety, encountered due to surgical operation as rapidly as possible.
According to Lepczyk, Raleigh and Rowley (1990), preoperative education is ineffective, nonexistent or even fragmented due to interference by preoperative environment, which is normally busy (p. 23). The doubts of these stand, is on whether this claim is based on evidence that is collected and analyzed statically. The claim argue that preoperative education is normally in competition with some other crucial priorities for instance physician visits, treatment of patients, history taking which more often than not precede it. The admission process, which usually fast, does not give the patient adequate time for psychological and physical preparation to face actual surgery process. Furthermore, Fugate (1998, p.8) and Melnyk and Fineout-Overholt (2005, p.2) argue that in the protocol order of necessity, preoperative education is always left to be the last thing and hence posing a serious challenge for the patient’s quick recovery of the psychological turmoil incurred during surgical procedures.
Problem Justification
Evaluating the effects of preoperative education on anxiety of surgical patients and incorporating nursing resolution for existing loopholes, if any, is essential so as to clear the arguments such as one advocated for by Lepczyk et al (1990). Preoperative education comes in handy in amicably reducing the patient’s anxiety on the planned surgical operation and hence encouraging the patients to participate proactively both in rapid rehabilitation and recovery process (Mitchell, 1994, p.45). Numerous studies have been undertaken with the objective of recognition of techniques of identification and consequently reducing preoperative anxiety in pre surgical patients (Asilioghu & Celik, 2004, p.68: Melamed, 1975, p.95). The studies focus on total alleviation of the patient’s surgical anxiety with reference to the kind of surgical operation, the nature of the anxiety or some combination of the two.
Purpose and Objective of the Project
The purpose of the proposed project is to determine the effects of preoperative education on anxiety of surgical patients. It is hypothesized that patients going through preoperative educational as the first thing after surgical interventions are identified as the only way to correct the patient’s medical problem has been recommended, have higher capacity to recover from anxiety faster than those who either do not or post undergo surgical education on anxiety. Since the clarification of the hypothesis will be evidence-based, the project should be purely experimental. Realistic and measurable parameters, which can be expressed in statistical measures, are desirable. Controlled groups, special treatment groups, and intervention groups will be drawn from different populations characterized by subjects going through different nature of surgical operations. The controlled group will be subjected to preoperative education for a reasonable time before actual surgical operation. The non-controlled group is subjected to a process like the one described in paragraph two. Time in days will be measured for different groups to recover completely from surgical anxiety. Comparative analysis of the data so obtained will be done to establish various differences and relationships.
References
Asilioghu, K., & Celik, S. (2004). The effect of prerogative education on anxiety of open cardiac surgery patients. Education and Debate, 53(1), pp. 65-70.
Fugate, M. (1998).The Effects of Preoperative Education on the Reduction of Pre-anesthesia Anxiety. University of Tennessee Honors Thesis Projects. Web.
Lepczyk, M., Raleigh, E., & Rowley, C. (1990).Timing of preoperative patient teaching. Journal of Advanced Nursing, 15(30), pp. 81-105.
Melamed, B. (1975). Reduction of anxiety in children facing hospitalization and surgery by use of filmed modeling. Journal on Consult Clinic Psychology, 43(5), pp. 51-121.
Melnyk, B., & Fineout-Overholt, E. (2005). Evidence-based practice in nursing & healthcare: A guide to best practice. Philadelphia: Lippincott Williams & Wilkins
Mitchell, M. (1994).Pre-operative and post-operative psychological nursing care. Surgical Nurse Journal, 7(2), pp.22-25.
The phenomenon of the social anxiety disorder, also known as the social phobia, is typically interpreted as one of the numerous social communication disorders. In addition, according to the Diagnosis and statistical manual of mental disorders (5th ed.) (American Psychiatric Association, 2013), the subject matter is easily confused with some of the social communication disorders (Sureka, Desai, & Gupta, 2013). While admittedly having a range of characteristics in common, the above concepts are rarely interrelated. Therefore, the effects of the subject matter should be evaluated on their own merits as opposed to driving parallels with the social-communication-related issues (Sinacola, 2015; Yeun & Han, 2016).
Primary Objective
The efficacy of the intranasal Paroxetine as the SSRI tool (Hoang, Ha, & Quy, 2016) that may supposedly help address the issues related to the further development of the social anxiety disorder (SAD). The study is aimed, therefore, at proving that the use of the specified medicine allows for managing SAD efficiently as opposed to the use of placebo (Doobbs, 2013).
Secondary Objective
The research also seeks to locate the possible side effects of using the given medicine.
Design and Methodology
Design
Since the study focuses on the identification of qualitative relationships between the key variables, the adoption of a qualitative design seems a sensible approach to adopt. For example, the study may be conducted as a participant observation (Clarke, 2015).
However, one must also bear in mind that the research seeks to quantify the outcomes as well (Phillips et al., 2015). For instance, the location of the numerical correlation between the use of the identified types of medicine and the subsequent identification of the outcomes can be viewed as crucial to the assessment of the drug efficacy (Bryman, 2015).
Participants
In order to carry out the study, one will have to include two types of participants. The information necessary for the qualitative analysis will be gathered from the patients of the local healthcare facilities. Particularly, approximately 150 people will be recruited to participate in the study and respond to the questionnaire designed for a quantitative study (Bandelow et al., 2014).
As far as the qualitative element of the research is concerned, observations will be carried out in the experimental group (i.e., the participants that will be provided with Paroxetine) and the control group (i.e., the members of the study that will be given a daily amount of placebo). The changes in the patients’ behavioral patterns will be identified and evaluated carefully so that the dynamics of anxiety in both groups could be evaluated and compared consequently (Book et al., 2013; Parsons, 2015).
Inclusion criteria
The patients will be included based on the characteristics such as their diagnosis (particularly, the patients must have a social anxiety disorder), their age (it is preferable that people aged 16-20 should partake in the process), and any specific drug idiosyncrasy should be considered a candidate for the experiment.
Exclusion criteria
To participate in the study, one must not have any issues outside of the identified one and be mentally stable (Anney, 2014; Tomita et al., 2014).
Ethics
The research will be carried out base on the primary principles of confidentiality and consent. Therefore, the participants will be provided with complete anonymity, to the point, where their real names will be replaced by “Participant 1,” “Participant 2,” etc. In addition, patients under 18 will not be allowed to participate in the study unless they have the permit of their parents or guardians (Enck, Klosterhalfen, Weimer, Horing, & Zipfel, 2011).
Finally, every single member of the experiment will be provided with the informed consent form that will detail the objectives of the research, the information used in the experiment, and other essential characteristics thereof (Hoang, Ha, & Quy, 2016). The applicants in their turn, will be suggested to sign the form if they agree to take part in the study or to decline it if they do not. The above measures will be taken not to avoid possible legal repercussions but to ensure the safety and security of the people involved in the study (Roest et al., 2015; Upadhyaya et al., 2013).
Methodology
Time frame
It is expected that the research will be taking place for at leats two months. The choice of the specified time frame can be justified by the fact that the changes, which the medication is supposedly going to have on the patients, will only become easily identifiable after two weeks. Until the changes in the patients’ behavioral patterns can be deemed as permanent, the veracity of the research outcomes will remain dubious.
Sample size calculation
In order to carry out the calculations of the sample size, one should consider the formula that Charan and Biswas (2013) view as the primary means of extracting the information regarding the sample size. According to the authors of the study mentioned above, the sample size population can be estimated using the formula below:
where Z is the Type I error. Given the formula above, the sample size of the participants, who will contribute to the analysis of the study and the further production of the results will equal:
The sample size of the population, therefore, is 13.
Statistical analysis
Although carrying out vast qualitative research is crucial to understanding the relationships between the variables in the study, it is still necessary to quantify the specified links so that the effects thereof could be assessed and, therefore, a proper measurement instrument could be incorporated into the further treatment process. Seeing that the paper is primarily aimed at assessing the effects of a single factor, i.e., the consumption of the medicine identified above, it will be reasonable to suggest that a one-way ANOVA analysis strategy should be used.
Expenditures
Since the project under analysis involves a plethora of opportunities for using the latest technological advances and demands that the facilities and treatment of the finest quality should be provided for the patients, it will be necessary to consider some of the most likely expenditures to be taken. As the table below shows, the project under analysis is going to be rather costly as far as the purchase of the necessary components thereof is concerned (Larson et al., 2015). It should be noted, though, that the adoption of a lean approach will serve as the primary tool for retrieving the necessary financial resources within a comparatively short amount of time. Specifically, the approach outlined above requires that the current strategy of resources allocation should be renewed (Levenson et al., 2014).
Observation 1
Observation 2
Participants Number
25
225
Time Period
2 weeks
2 weeks
Staff
£40,000
£50,000
Participants
£12,000
£10,000
MRI
£50,000
£75,000
EKG
£800
£800
Blood pressure
£1,500
£1,500
Total/day
£113,500
£122,500
Total
£448,000
Rationale
Pharmacodynamics
N the course of the experiment, the participants will be exposed to the influence of Paroxetine and a placebo (Channareddy, 2013). Specifically, the m embers of Group A will be exposed to an increasing influence of the above drug. The dose will be increasing from 20 mg to 27 mg in the course of the two weeks that the experiment will last at the rate of a 0.5-mg change per day being the key rate (Kamaradova, Prasko, Sandoval, & Latalova, 2014).
Statistics
The quantitative study will demand to adopt descriptive statistics as the primary tool for extracting and analyzing data. It is recommended that the SPSS tools should be regarded as the primary means of data analysis. The reasons for choosing the above tool is that the software in question has been designed specifically or qualitative data analysis. However, one must admit that the use of Excel is also a possibility (Petersen & Aberg, 2014).
Strengths
The paper proposed has a range of strengths, the focus on the evidence-based approach being the primary one. As soon as the audience realizes that retrieving data is only possible after careful observations and the conclusions based solely on facts, a huge leap of science is expected. In addition, the adoption of the ANOVA tool as the means of carrying out a statistical analysis is the first step toward gaining academic credibility and delivering verified results. Therefore, premises for altering the current strategy of Paroxetine provision to the target denizens of the population may be altered (Roest et al., 2015).
Limitations
Naturally, the research has its limitations, the possibility for some of the participants to develop resistance towards Paroxetine being the primary one (Giménez et al., 2014). As a result of the above phenomenon, the objectivity of the research outcomes may be jeopardized. The specified limitation can be addressed by carrying out regular observations of the members of both groups so that the slightest changes in the pharmacokinetics. Therefore, there is a slight possibility that the veracity of the research results may be reduced significantly in case some of the patients develop resistance toward the identified medicine.
Reference List
American Psychiatric Association. (2013). Diagnosis and statistical manual of mental disorders (5th ed.). Washington, DC: APA.
Anney, V. N. (2014). Ensuring the quality of the findings of qualitative research: Looking at trustworthiness criteria. Journal of Emerging Trends in Educational Research and Policy Studies (JETERAPS), 5(2), 272-281.
Bandelow, B., Boerner, R. J., Kasper, S., Linden, M., Wittchen, H.-U., & Möller, H.-J. (2014). The Diagnosis and treatment of generalized anxiety disorder. Deutsches Ärzteblatt International, 110(17), 300-310.
Book, S. W., Thomas, S. E., Smith, J. P., Randall, P. K., Kushner, M. G., Bernstein, G…, & Randalla, C. L. (2013). Treating individuals with social anxiety disorder and at-risk drinking: Phasing in a brief alcohol intervention following Paroxetine. Journal of Anxiety Discord, 27(2), 252-258.
Bryman, A. (2015). Social research methods. Web.
Bystritsky, A., Khalsa, S. S., Cameron, M. E., & Schiffman, J. (2013). Current diagnosis and treatment of anxiety disorders. Pharmacology & Therapeutics, 38(1), 30-45.
Channareddy, L. R. (2013). Escitalopram reduces severity of depression and improves quality of life in patients with chronic obstructive pulmonary disease in an open label parallel group study. International Journal of Basic & Clinical Pharmacology, 5(2), 281-284.
Clarke, V. (2015). Review of the book ”Interpretative phenomenological analysis: Theory, method and research”. Psychology Learning & Teaching, 9(1). 57-56.
Dobbs, A. S. (2013). A little better than placebo is still better than nothing . Nature Medicine, 19(8), 962.
Enck, P., Klosterhalfen, S., Weimer, K., Horing, B., & Zipfel, S. (2011). The placebo response in clinical trials: More questions than answers. Philosophical Transactions of the Royal Society, 366(1572), 1889–1895.
Giménez, M., Ortiz, H., Soriano-Mas, C., López-Solà, M., Farré, M., Deus, J.,… & Merlo-Pichcorrespondence, E. (2014). Functional effects of chronic paroxetine versus placebo on the fear, stress and anxiety brain circuit in Social Anxiety Disorder: Initial validation of an imaging protocol for drug discovery. European Neuropsychopharmacology, 24(1), 105-116.
Goldin, P. R., Ziv, M., Jazaieri, H., Hahn, K., Heimberg, R., & Gross, J. J. (2013). Impact of cognitive behavioral therapy for social anxiety disorder on the neural dynamics of cognitive reappraisal of negative self-beliefs randomized clinical trial. JAMA Psychiatry, 70(10), 1048-1056. Web.
Hoang, T. P., Ha, T. N., & Quy, H. K. (2016). Factors affecting the service quality standards at the international airports when Viet Nam integrates TPP: A study at TAN Son Nhat Airport, Ho Chi Minh City, Vietnam. British Journal of Marketing Studies, 4(1), 43-52.
Kamaradova,D., Prasko, J., Sandoval, A., & Latalova, K. (2014). Therapeutic response to complex cognitive-behavioral and pharmacological treatment in patients with social phobia. Activitas Nervosa Superior Rediviva, 56(3–4), 91-99.
Larson, B. A., Bii, M., Henly-Thomas, S., McCoy, K., Sawe, F., Shaffer, D., & Rosen, S. (2013). ART treatment costs and retention in care in Kenya: a cohort study in three rural outpatient clinics. Journal of International AIDS Society, 16(18026), 15. Web.
Levenson, J. C., Troxel, W. M., Begley, A., Hall, M., Germain, A., Monk, T. H., & Buysse, D. J. (2014). A quantitative approach to distinguishing older adults with insomnia from good sleeper controls. ICSM, 9(2), 124-153.
Parsons, T. D. (2015). Virtual reality exposure therapy for anxiety and specific phobias. Psychology and Human Behavior, 1(1), 288-2296. Web.
Phillips. K., Zai, G., King, N. A., Menard, W., Kennedy, J. L., &. Richter, M. A. (2015). A preliminary candidate gene study in body dysmorphic disorder. Journal of Obsessive-Compulsive and Related Disorders, 6(1), 72-76.
Roest, A. M., Jonge, P. d., Williams, C. D., Vries, Y. A. d.,. Schoevers, R. A., & Turner, E. H. (2015). Reporting bias in clinical trials investigating the efficacy of second-generation antidepressants in the treatment of anxiety disorders. JAMA Psychiatry, 72(5), 500-510. Web.
Sinacola, R. S. (2015). Pharmacologic management of anxiety spectrum disorders. Audio-Digest Psychology, 4(1), 1-3.
Sureka, P., Desai, N., & Gupta, D. K. (2013). A study of subsyndromal and syndromal psychiatric morbidity among male patients with alcohol dependence. ASEAN Journal of Psychiatry, 14(2), 146-156.
Tomita, T., Norio, Y.-F., Sato, Y., Nakagami, T., Tsuchimine, S., Kaneda, A., & Kanek, S. (2014). Sex differences in the prediction of the effectiveness of paroxetine for patients with major depressive disorder identified using a receiver operating characteristic curve analysis for early response. Neuropsychiatric Disease and Treatment, 10, 599–606. Web.
Upadhyaya, H., Adler, L. A., Casas, M., Kutzelnigg, A., Williams, D., Tanaka, Y., Arsenault, J., Escobar, R., & Allen, A. J. (2013). Baseline characteristics of European and non-European adult patients with attention deficit hyperactivity disorder participating in a placebo-controlled, randomized treatment study with atomoxetine. Child and Adolescent Psychiatry and Mental Health, 7(1), 14-22.Web.
Yeun, Y.-R., & Han, J.-W. (2016). Effect of nurses’ organizational culture, workplace bullying and work burnout on turnover intention. International Journal of Bio-Science and Bio-Technology, 8(1), 372-380. Web.
Sean is a 52-year-old man, who has an impressive history of hypertension. He stopped using his HTN medications three months ago. His current visit to the practice clinic is caused by the sudden chest pain accompanied with short of breath, nausea, and sweaty feeling. That condition lasted for about three minutes, then stopped, and never repeated. From that period, Sean feels tired from time to time. He did not work a lot after that event happened to him. Today, he feels more energy in comparison to the amounts of energy he had when he walked on the treadmill.
Further Questions for Ed
Have you ever experienced heart failures before?
Have you noticed the changes in your health when you stopped using your HTN medications?
Have there been any changes in your life recently that could have some psychological or emotional effects?
Do you feel anxious during the last days?
How much time do you urinate per day?
Do you wake up to urinate or drink water at night?
Do you observe some changes or problems with your memory?
Do you want to take some physical exercises? Or do you consider them as the obligation or duty that should be fulfilled?
Do you want to change your place of life or make some other changes in your life?
Have you had quarrels with your family or relatives recently?
Do you always listen to the suggestions of your wife and follow her pieces of advice?
Differential Diagnoses
Pneumothorax, unspecified (J93.9): is a sudden attack that is characterized by severe unilateral chest pain that has a pleuritic nature (Buttaro, Trybulski, Bailey, & Sandburg, 2013, p. 528). This condition includes the collection of extra air or some gas in the pleural space that causes the collapse of lungs. According to Bobbio et al. (2015), this condition has specific characteristics that conclude that older aged male people have more chances to have pneumothorax (p. 657). In this case study, the patient is a 52-year-old male, whose main complaint is the pain in his chest and the inability to breathe free for a couple of minutes. It was a single episode that looked like a heart attack, and pneumothorax could be a complication to expect in the patient with hypertension and heart problems.
Atherosclerotic heart disease of native coronary artery without angina pectoris (I25.10): is the condition that is also known as coronary artery disease (CAD). This disease occurs when the damage to blood vessels that take responsibility for blood and oxygen transformation occurs. The main risk factors for this type of heart disease include hypertension, a high level of cholesterol, and smoking (Brown, 2014, p.52). In the situation under analysis, the patient has a rich hypertension history and a high level of cholesterol. He also smokes cigars while playing poker with his friends. Chest pain is the sign to check the condition of his heart in a short period of time.
Anxiety disorder, unspecified (F41.9): is the psychological disorder that is usually characterized by anxious feelings and fears, tension and dyspnea, irritability and phobias. The connection between anxiety and cardiovascular disease has been discussed and proved by a number of researchers (Allgulander, 2016, p. 13). Anxiety is also common with dyspnea (Buttaro et al., 2013, p. 546). Sean suffers from his shortness of breath. He also reports on pain in his chest that was sharp and lasted for about 3 minutes. Besides, during the last three days, he felt some concerns about his condition and his abilities. He wants to be confident that there is no threat to his health. Still, fear is one of the symptoms of anxiety (Gorini & Riva, 2015, p. 215).
Body Systems to Examine and Tests to Offer
Pneumothorax is the disease that affects the respiratory system including lungs and the pleural cavity. The most frequently used method to diagnose the possibility of pneumothorax is X-rays (Sandionigi, Cortellaro, Forni, & Coen, 2013, p. 6). At the same time, computerized tomography remains to be the most sensitive method to detect a pneumothorax case (Sandionigi et al., 2013, p. 6).
CAD is the disease that affects the work of the circulatory system in a number of ways. It could lead to the problems with the heart and provoke heart attacks and heart failures. Besides, it includes such health problems as weakness, pain in the chest, and dizziness. Electrocardiogram (ECG), echocardiogram, and stress echocardiography are usually used to diagnose CAD in people (Skelly et al., 2016, p. 62).
Anxiety is the psychological disorder that cannot be diagnosed with the help of specially developed tests. The peculiar feature of this disorder is that it could influence various systems of the body. Doctors and psychologists try to pose as many questions as possible to define if the patient has some threats of being anxious. For example, the revision of the Diagnostic and Statistical Manual of Mental Disorders could be used to identify if older people are at risk of having an anxiety disorder (Mohlman et al., 2012, p. 549).
References
Allgulander, C. (2016). Anxiety as a risk factor in cardiovascular disease. Current Opinion in Psychiatry, 29(1), 13-17.
Bobbio, A., Dechartres, A., Bouam, S., Damotte, D., Rabbat, A., Régnard, J. F.,… & Alifano, M. (2015). Epidemiology of spontaneous pneumothorax: Gender-related differences. Thorax, 70(7), 653-658.
Brown, C.H. (2014). Heart disease in women: Different than in men? US Pharmacist, 39(9), 51-54.
Buttaro, T.M., Trybulski, J., Bailey, P., & Sandburg-Cook, J. (2013). Primary care: A collaborative practice. (4th ed.). St. Louis, MO: Elsevier Mosby.
Gorini, A., & Riva, G. (2014). Virtual reality in anxiety disorders: The past and the future. Expert Review of Neurotherapeutics, 8(2), 215-233.
Mohlman, J., Bryant, C., Lenze, E. J., Stanley, M. A., Gum, A., Flint, A.,… & Craske, M. G. (2012). Improving recognition of late life anxiety disorders in diagnostic and statistical manual of mental disorders: Observations and recommendations of the advisory committee to the lifespan disorders work group. International journal of geriatric psychiatry, 27(6), 549-556.
Sandionigi, F., Cortellaro, F., Forni, E., & Coen, D. (2013). Lung ultrasound: A valid help in the differential diagnosis between pneumothorax and pulmonary blebs. Emergency Care Journal, 9(3), 6-8.
Skelly, A. C., Hashimoto, R., Buckley, D. I., Brodt, E. D., Noelck, N., Totten, A. M.,… & McDonagh, M. (2016). Noninvasive Testing for Coronary Artery Disease. Comparative Effectiveness Reviews, 171. Web.
There are two approaches in Generalized Anxiety Disorder’s (GAD) treatment – a drug therapy and a psychological treatment (Barlow et al., 2018). With the usage of the Benzodiazepines, the drug therapy proved to be relatively efficient and fast-acting. However, its effect is short-termed; this therapy is also conjugated with risks of impairing the patients’ cognitive and motor functioning (Barlow et al., 2018). Furthermore, Benzodiazepines are addictive, both physically and mentally, which makes it difficult for patients to overcome the sickness. Regarding psychological treatment, Cognitive Behavioral Therapy (CBT) was developed in the 1990s to address GAD (Barlow et al., 2018). According to Barlow et al. (2018) and Donadkar (2019), CBT shows positive results overall even in the long-term – patients’ anxiety decreases, and quality of life improves. Unfortunately, CBT only provides symptomatic improvement and is not able to fully heal the patient (Barlow et al., 2018). In an example case supplied in the Barlow et al. (2018) study, the subject overcame the worst consequences of GAD, although still remained vulnerable to its symptoms, especially when stressed.
According to Byrd-Bredbenner et al. (2021), anxiety is more prevalent in the female population, but the reasons behind the anxiety are similar for both sexes. It is also possible to assume that this tendency is applicable across the globe with a high probability. In their study, Dou et al. (2019) point out the reciprocal relationship between the anxiety level and subjects’ social interactions. Despite this relationship’s individuality, there is a general tendency of a decreased anxiety level amongst subjects who deliberately engage in different social activities (Dou et al., 2019). Thus, they encourage to foster the appropriate atmosphere in educational institutions. Dondakar (2019), in his study of different CBT researches, noted several vital facts as well. First, the Web-based version of CBT was implemented in the Midwestern University, which proved to be a valuable addition, not a replacement, though, to the face-to-face treatment. Second, CBT with mindfulness modification (attention/perception) was more efficient for GAD treatment than for the treatments of depression, Obsessive-Compulsive Disorder, and Posttraumatic Stress Disorder. Third, the conversation treatment has a more significant impact than simply providing relevant information for self-study.
The chosen literature suggests several possible steps of future research. Firstly, Barlow et al. (2018) researched the drug and psychological therapies for GAD separately, while the approach of combined therapies in other cases, for example, Panic Disorder, showed promising results. Consequently, thorough research of combined GAD treatment is needed. Secondly, in Byrd-Bredbenner et al. (2021) study, the high probability of the GAD symptoms’ similarity across nations is mentioned. However, the conclusion that led to this assumption bases on the comparison of only three researches from the USA, Portugal, and Korea, which is not enough for the factual statement and should be addressed accordingly. Thirdly, in Donadkar’s (2019) study, all three articles about GAD treatment with CBT lack the sample size or proper result processing. Thus, different cases of this matter have to be investigated and evaluated. Lastly, in the article written by Dou et al. (2019), the researchers propose further testing of anxiety levels amongst students outside the traditional learning environment. Specifically, they mean social networks or messengers, which can be considered an informal learning environment.
References
Barlow, D. H., Durand, V. M., & Hoffmann, S. G. (2018)..Abnormal psychology: An integrative approach (8th ed.). Cengage Learning.
Byrd-Bredbenner, C., Eck, K., & Quick, V. (2021). GAD-7, GAD-2, and GAD-mini: Psychometric properties and norms of university students in the United States. General hospital psychiatry, 69, pp. 61-66.
Donadkar, S. (2019). Effectiveness of cognitive behavioral therapy on generalized anxiety disorder in college and graduate students: Literature review. Indian Journal of Physical Therapy and Research, 1(2), pp. 71-74.
Dou, R., & Zwolak, J. P. (2019). Practitioner’s guide to social network analysis: Examining physics anxiety in an active-learning setting. Physical Review Physics Education Research, 15(2), p. 020105.
Anxiety is a natural response to stress that can be beneficial in certain circumstances. It is characterized by muscle tension and avoidance behavior in anticipation of future concerns. They are marked by excessive nervousness instead of normal emotions of apprehension, with the most common mental illnesses afflicting about one-third of all adults at some point in their lives (Muskin, 2021). People with anxiety disorders may try to avoid circumstances that exacerbate their symptoms, which impact workplace performance, personal relationships, and schoolwork. To be diagnosed with an anxiety disorder, a person’s fear or anxiety must be out of proportion to the scenario or age-inappropriate or prevent them from functioning correctly. While defense mechanisms can protect individuals from anxiety, they influence their everyday lives because they can cause self-deception and deter individuals from confronting reality.
Types of Anxiety Disorders
The various anxiety disorders include panic disorder, generalized anxiety disorder, separation anxiety disorder, and social anxiety disorder. Generalized anxiety disorders are characterized by persistent and excessive worry that disrupts daily activities (Mandal, 2019). The concerns and tension are non-specific and unnecessary and are often accompanied by symptoms such as fatigue, restlessness, muscle tension, and sleeping problems. In addition, they often focus on everyday activities such as family health, car maintenance, chores, appointments, or job commitments.
Another kind of anxiety is panic disorder which leads individuals to believe that they have had a heart attack. Its core symptom is recurrent panic attacks constituting an overwhelming combination of psychological and physical distress (Muskin, 2021). The average age of onset for panic disorder is 20-24 years old and can occur alongside other mental illnesses such as post-traumatic stress disorder (PTSD) or depression (Muskin, 2021). Panic attacks can be expected, such as a reaction to a feared object, or they can be unexpected, appearing out of nowhere.
The third kind of anxiety is the separation anxiety disorder. This disorder is characterized by extreme worry or anxiety over being separated from the person one is attached to (Mandal, 2019). The feeling is out of proportion to the person’s age and lasts for a long time, up to six months in adults and at least four weeks in children, not to mention interfering with the individual’s daily functioning (Muskin, 2021). For example, an individual with the disorder may be constantly concerned about losing the person closest to them, hesitant or unwilling to leave the house or sleep away from that person or have separation nightmares.
Last on the anxiety list is the social anxiety disorder. In social encounters, a person with a social anxiety disorder experiences substantial anxiety and discomfort about being humiliated, embarrassed, looked down on, or rejected (Muskin, 2021). As a result, individuals with this illness will strive to avoid or endure the circumstance with tremendous pressure (Mandal, 2019). Examples include extreme fear of meeting new people, drinking and eating in public, or public speaking. The fear causes problems with daily functioning and lasts a minimum of six months.
Anxiety Defense Mechanisms
It is believed that defense mechanisms prevent unpleasant thoughts and impulses from entering the conscious mind. Defense mechanisms are unconscious psychological responses that protect people from self-esteem threats, anxiety, and things they do not want to deal with or think about (Cherry, 2021). Therefore, they are believed to protect the mind from feelings and thoughts that are too tough for the conscious mind to handle. The common defense mechanisms include repression, projection, denial, regression, displacement, sublimation, repression, suppression, intellectualization, rationalization, and reaction formation.
Individuals constantly use denial and displacement approaches as their defense mechanisms. First, displacement is the act of venting our feelings, frustrations, and impulses to less threatening individuals or objects (Cherry, 2021). An example is displaced aggression, where one avoids arguing with their employer and directs their rage onto pets, spouses, or children. The second defense mechanism is denial which is the blatant refusal to recognize something has happened (Cherry, 2021). It protects the ego from things that an individual cannot cope with and is an outright rejection of the existence of reality; a well-known example is addiction.
Fourth on the list of protective mechanisms against anxiety is repression and suppression. Repression inhibits information from entering the conscious mind despite the memories impacting our behavior (Cherry, 2021). An example is struggling to develop relationships due to maltreatment as a youngster. Suppression involves consciously pushing unwelcome information out of one’s mind. One can use sublimation to carry out undesirable impulses by transforming them into more acceptable activities (Cherry, 2021). For instance, one becomes a boxer to express irritation from suffering tremendous rage.
Furthermore, individuals with anxiety use projection and intellectualization as their defense mechanisms. Projection involves attributing one’s undesired features or sentiments to other individuals (Cherry, 2021). For instance, believing someone dislikes you for intensely disliking them. Rationalization involves logically explaining an unwanted feeling or behavior to escape the underlying reasons for the behavior (Cherry, 2021). An instance is attributing a poor exam score to the instructor instead of a lack of preparation.
There are several types of anxiety disorders, such as panic disorder and generalized anxiety disorders, that affect the functioning of individuals. However, one employs defense mechanisms to protect themselves from anxiety. Defense mechanisms can be both beneficial and detrimental. They can be helpful in terms of protecting your ego from stress and offering a healthy outlet. However, these defense systems may prevent you from confronting reality and acting as a self-deception type in other cases. Therefore, should overusing specific defense mechanisms negatively impact one’s life, one should consider consulting a psychologist, doctor, or other mental health professional for further assistance and advice.
