Dan J. Stein et al. published an article titled “Perceived Helpfulness of Treatment for Generalized Anxiety Disorder: A World Mental Health Surveys Report” in BMC Psychiatry scientific journal in 2021. The research is based on the theory of the importance of perceived helpfulness in treatment adherence; the actual findings of the study are detailed and portrayed accurately. The data came from World Mental Health (WMH) Survey Initiative and was collected in 23 countries of varying income levels (Stein et al. 2). The researchers’ hypothesis can be identified as such: perceived helpfulness is related to receiving treatment for patients suffering from DSM-5 generalized anxiety disorder (GAD).
The type of research conducted in the study is correlational; the data was collected through WMH surveys of people diagnosed with GAD. Since the variable of treatment helpfulness cannot be directly measured, the researchers operationally defined it through a series of questions. They include questions on the matter of contacting a professional, receiving effective in their opinion treatment, and the number of professionals they talked to until getting helpful therapy. Other variables can be clearly recognized and include socio-demographic characteristics, lifetime comorbid conditions apart from GAD, treatment type and timing, and childhood adversities (Stein et al. 4).
The WMH surveys acquired for the current research used probability samples from populations worldwide. This sample does not appear to be representative since out of 23 countries participating in the survey, only 9 are low-income, and 17 are high-income (Stein et al. 2). Since the overall prevalence rate of people suffering from GAD is 4.5%, and the survey questioned such a low percentage of populations, the findings can be considered not generalized. However, the participants represent many cultures, demographical differences, income levels, and backgrounds, increasing the generalizability level of the study among people diagnosed with GAD.
The results report that only 34.6% of respondents have obtained GAD treatment; 19.2% were located in low/middle-income countries (Stein et al. 11). Out of the people who received help, 70% perceived it as effective (Stein et al. 12). The researchers also demonstrate that all patients could have obtained helpful treatment if their help-seeking persistence drove them to contact up to 10 professionals (Stein et al. 10). However, only 29.7% of the patients would have managed to do it for that long (Stein et al. 11). Additionally, receiving adequate medical attention at the personal level was associated with the type of treatment received, other mental health disorders, and childhood trauma, predicting, most importantly, persistence in seeking treatment (Stein et al. 13). Overall, the research serves the purpose of advocating for perceived helpfulness and underlining patients’ income as essential elements affecting receiving GAD treatment.
Based on the study’s limitation on the information on the quality of received treatment, as well as the nature of interventions, a recommendation can be given. For future research on the topic of GAD perceived helpfulness, the correlation between specific types of medical help delivery and patients’ perceived effectiveness and treatment adherence can be examined. Based on the study’s findings, it can be recommended to include perceived helpfulness as a variable in treating GAD patients. Additionally, this variable should be investigated in relation to other mental health disorders.
The particularly interesting information discovered in the research’s findings involves the rate of people with GAD who obtained helpful treatment, which is 70%. Such a number is higher than expected due to the fact that it required the respondents to have persisted in seeking help from up to 3-4 professionals after initial unhelpful treatment (Stein et al. 13). This information can be considered encouraging since GAD is rarely diagnosed compared to other anxiety disorders.
Separation anxiety disorder (SAD) is an anxiety condition in which a person has extreme anxiety when they are separated from their home and/or from persons with whom they have a deep emotional bond. SAD is defined by the American Psychiatric Association (APA) as an overabundance of dread and anguish when confronted with circumstances that demand separation from home and/or from a specific authority figure (American Psychiatric Association, n.d.). It is most frequent in infants and toddlers, but it can also affect older children, teenagers, and adults. Separation anxiety is a normal element of childhood development.
Strategies for the Different Stages of Development
Toddler
At such a young age it is crucial to establish rules of behavior to make a child accustomed to separating from their parents. A good strategy is to create specific good-bye rituals, which has to be quick. Otherwise a toddler will start thinking it’s a game and would not want to separate. Taking longer time for goodbyes will make the transition process take longer and as a result anxiety will increase as well. However, if established properly, a goodbye tradition will prepare the child that it is time to say goodbye and accustom them to being without parents at this age.
Preschool
Consistency is particularly essential at this age. Whenever possible, try to conduct the same drop-off with the same ritual at the same time each day to prevent unexpected elements. A routine can help to ease the pain and enable a child to develop trust in both their independence and parents. Parents must also emphasize the need of “positive goodbyes” and explain the advantages of being apart from Parents or Siblings, such as spending time with friends at preschool.
School aged
For a school-aged youngster, the start of school is frequently the source of separation anxiety. In such instances, a parent should begin discussing what is about to occur before it occurs. It is necessary to begin talking about it a week in advance, including details concerning pick-up at the conclusion of the day. Furthermore, parents should discuss each future day with their children night before, and assist them in preparation. The less surprises there are, the better. Before kids have to go off on their own, it would be beneficial to show them their educational environment and meet the teachers.
Adolescent
A teen’s reluctance to attend or stay at school is frequently due to separation anxiety. Counseling can help anxious kids get back in gear, whether it is caused to by a nervous disposition, life stress, or the pandemic. It’s immensely gratifying to see teens overcome their separation anxiety with cognitive behavioral therapy. Such tactics assist the adolescent in examining their fear, anticipating situations where it is likely to emerge, and comprehending its consequences. When kids feel empowered and given the correct tools, the process can be surprisingly swift.
Post Operational Care a Child Requires After Abdominal/Bowel Surgery
The goal of post-surgical treatment is for a child’s intestine to restore function so that it can operate by itself. A newborn will have a lot of watery bowel movements just after the operation, leading them to lose a lot of critical fluids and minerals. To compensate for these losses, the infant will pee in order to get nourishment and fluids via an intravenous (IV) line. Parents must ensure that their children sleep when they are weary, but also take them for a walk every day. Getting adequate sleep can help you recover faster. Following surgery, a child’s appetite may be affected. However, it is critical that they consume a nutritious diet.
Assessments for a Postop Pediatric Patient
Postoperative patients must be constantly monitored and checked for any signs of worsening, and the appropriate postoperative care plan or pathway must be followed. If a child is in pain when they wake up after surgery, it’s critical to diagnose and treat it as quickly as possible. Inadequately handled pain will simply add to the child’s worry and anxiety during his or her hospital stay. Because self-reporting is the only direct measure of pain, it is frequently regarded the best technique. However, there are a variety of situations in which youngsters find it difficult or impossible to express their own discomfort levels. A proxy measure must be employed in children who are cognitively challenged, extremely ill, or too young to talk.
Pain Scales Used in Pediatrics
In order to assess pain in newborns and young children, age-appropriate scales must be used. CRIES (Crying, Oxygen Requirement, Increased Vital Signs, Facial Expression, and Sleep) is the first tool. Based on changes from baseline, an observer assigns a score of 0-2 to each parameter. The Neonatal/Newborns Pain Scale (NIPS) has been utilized mostly in infants under the age of one year. Before, during, and after an operation, a numeric value is given to each of the following: facial expression, cry, breathing pattern, arms, legs, and state of arousal. A score of more than 3 indicates that the person is in agony.
From 2 months to 7 years, the FLACC (Face, Legs, Activity, Crying, Consolability) measure has been validated. The scoring system is based on a scale of 0 to 10. The CHEOPS scale (Children’s Hospital of Eastern Ontario Scale) is for children aged 1 to 7. Examines the child’s cry, facial expression, verbalization, torso movement, whether the youngster touches the affected area, and leg posture. A pain score of more than 4 indicates that the person is in pain. Children aged 3 and above can use self reporting to rank their pain. Wong-Baker 6 cartoon expressions with varying degrees of distress on a scale of one to six. Face 0 means “no pain,” while face 5 means “worst pain you can conceive.” At the time of the assessment, the kid selects the face that best portrays pain.
References
American Psychiatric Association. (n.d.). Separation Anxiety. APA Dictionary of Psychology. Web.
The manifestations of anxiety are most often reduced to various episodes, accompanied by feelings of fear or anxiety (Vora, 2022). In Lauren’s case, the patient has unreasonable fears for her grandfather’s life; she is also afraid of saying something wrong to someone. The girl’s frustration is also accompanied by intense anxiety when her household chores are not done on time or the house is disrupted. This fear is accompanied by a physical reaction in the form of mild cramps.
Obsessive-compulsive manifestations include the girl’s tendency to correct things if they are not lying the way the patient had originally organized them. Lauren also prepares her grandfather’s breakfast every morning at 9 o’clock sharp, and the thought that one day she might not do it on time puts the girl in a serious panic state. Being in the company of other people, the patient tends to inertia to point out to others such little things as poorly tied shoelaces. Lauren herself admits that she cannot control such remarks and makes them unconsciously.
While talking to the patient, the nurse resorts to many different strategies. Noticing that Lauren is acting rather confused, the interviewer uses focusing as a way to concentrate the girl’s attention on key aspects of the conversation. The nurse also makes frequent clarifications to get a complete picture of the patient’s problem. The nurse often summarizes the information she hears to help the patient keep track of the dialogue.
Throughout the interview, the patient mainly seems confused. This fact determines the need for active listening tactics through which Lauren would feel validated by her interviewer. Moreover, as a nursing intervention, it might be suggested to provide broad openings. The latter consists of asking general questions and allowing patients to talk about whatever they want (Kenney, 2021). This strategy would help the girl feel her subjectivity while discussing her problems..
References
Kenney, P. (2021). Therapeutic techniques that work: Personal recovery journal. Independently published.
Vora, E. (2022). The anatomy of anxiety: Understanding and overcoming the body’s fear response. Harper Wave.
Anxiety causes fear, insomnia, chronic pain, premonition, difficulty concentrating, the effectiveness of selective serotonin reuptake inhibitors (SSRIs), and more.
The key point – sympathoadrenal, is associated with hypothalamic-pituitary-adrenal hyperreactivity.
An increase in the concentration of ACTH and cortisol (Anxiety disorder).
Anxiety decreases the brain-derived neurotrophic factor (BDNF).
Anxiety Disorder Treatment
Treatment should not be self-administered
The disorder regulatory effect on neurotransmitter systems, mainly serotonin (Anxiety disorder).
Together with the norepinephrine and dopamine systems, the concentration of ACTH and cortisol provides an adequate emotional response to the body.
Usually, 9-12 months of therapy is required to achieve complete remission
The appointment of medicines begins with half the starting dose with a gradual increase in dosage after a week to the standard dose
Definitions of the Two Drug (medication) Classes used for Anxiety Disorder
Drugs of selective serotonin reuptake inhibitors (SSRIs) help in anxiety treatment (Anxiety disorder).
SSRIs have a pathogenetic therapeutic focus.
Tranquilizers: maximum two weeks at the start of therapy.
Prescribing tranquilizers is warranted for a maximum of 2 weeks when initiating SSRI treatment to avoid increased anxiety during the first week of SSRIs (Anxiety disorder).
Medicines prescribed by a doctor.
Discussion of Medications
Examples of SSRIs: citalopram (Celexa), fluoxetine (Prozac).
Celexa stimulates synaptogenesis processes, restoring autophagy signals, and improving tissue immunoregulation with inhibition of immunogenic cytotoxicity of macrophages (Citalopram).
An analog is Prozac, the mechanism of action in the central nervous system, which block the reverse neuronal uptake of serotonin selectively (Fluoxetine).
Examples of tranquilizers: alprazolam (Xanax), clonazepam (Klonopin).
Xanax has a sedative, central muscle relaxant, anticonvulsant, hypnotic, anxiolytic, effect. It reduces the impact of motor, vegetative, emotive and helps the body in falling asleep (Alprazolam).
The anxiolytic effect of Klonopin is obtained as a result of the impact on the amygdala complex of the limbic system (Clonazepam). It is manifested in decreased fear, emotional stress, weakening and general anxiety.
Pharmacokinetics, Pharmacodynamics & Pregnancy/Lactation of Celexa
Celexa dissolves in the liver.
The action of the drug occurs because of central inhibition of serotonin reuptake.
Celexa has a strong effect on the heart and gastrointestinal tract, thus requires for ECG and/or monitoring of electrolytes.
Approved for use during pregnancy and lactation.
It has side effects include poor feeding, colic, and unusual drowsiness, irritability, or restlessness in a minimal number of children.
Pharmacokinetics, Pharmacodynamics, & Pregnancy/Lactation of Prozac
Absorbed from the gastrointestinal tract.
Delays the reverse capture of serotonin.
Monitoring is required.
Approved for use during pregnancy and lactation.
It increases the risk of genetic heart defects in the fetus, premature birth, and weight loss in a baby (Fluoxetine).
Pregnancy/Lactation during treatment for SSRIs
Approved for use during pregnancy and lactation.
It increases the risk of genetic heart defects in the fetus.
Medicines may cause premature birth.
In addition, weight loss in a baby is often.
Passes into milk, so may affect the baby.
Pregnancy/Lactation during treatment for Tranquilizers
Pregnancy and lactation are contraindicated.
Easily crosses the placenta.
Exceeds the concentration of diazepam in maternal blood.
Increases the incidence of birth defects in children.
Passes into milk, so may affect the baby.
Safety/Monitoring of Medications
Monitoring is required at any stage of the disease.
The medicine is prescribed by a doctor.
Additional medications are carried out if necessary.
Stop taking medications only on doctor’s orders.
Completely individual dosage.
Pharmacokinetics, Pharmacodynamics of Xanax
Absorbed from the gastrointestinal tract.
Binds γ-aminobutyric acid (GABA) type A receptors (GABA AR).
Completely individual dosage, therefore, requires monitoring and consultation with a doctor.
Alprazolam has a harmful effect on the fetus and raises the possibility of congenital malformations when used in the first three months of pregnancy, thus, prohibited during pregnancy (Alprazolam).
May cause drowsiness in newborns.
Makes breastfeeding difficult.
Pharmacokinetics, Pharmacodynamic of Klonopin
Plasma protein binding.
The activity of the inhibitory neurotransmitter gamma-aminobutyric acid (GABA) in the central nervous system.
Completely individual dosage, therefore, requires monitoring and consultation with a doctor.
Pregnancy and lactation are contraindicated.
Contraindications of the 4 Medications Discussed Earlier
Each drug has its characteristics and contraindications, so one needs to consult a doctor.
General contraindications include allergy, heart problems, problems with the gastrointestinal tract.
Tranquilizers are prohibited if a person has glaucoma and diseases of the respiratory system.
Long-term use is not justified because of the possibility of drug dependence.
In addition, after the abolition of drugs in this group, the return of painful symptoms occurs since the main pathophysiological mechanisms associated with impaired serotonin mediation are not resolved.
Conclusions
Anxiety disorder has different treatments.
It requires individual treatment.
Any drug must be prescribed by a doctor.
The drugs are taken only under the supervision of the attending physician.
One should always be aware of side effects and contraindications.
Anxiety disorder involves worrisome feelings, anxiety, and apprehension interfering with the victims’ routine activities. Soyara manifested anxiety disorder symptoms due to stress experienced from the increasing job obligations. She felt more nervous and fatigued any time she thought about her work. She believed that she was successful but the intense tasks worried her. Her feelings interfered with her sleeping cycle, and she could only get 4 to 5 hours of sleep. She was probably suffering from insomnia due to a lack of sufficient sleep.
Main Diagnosis and Diagnostic Tests
The main anxiety disorder diagnosis involves physical examination by a medical doctor who could recommend other tests for illnesses, such as insomnia, associated with the anxiety disorder. Comorbid diagnosis is often recommended when two or more disorders occur simultaneously (Weiss et al., 2021). Soyara suffered from anxiety disorder and a probable sleep disorder necessitating the comorbid diagnosis. The doctor may use various diagnostic tests like Hamilton Anxiety Scale (HAM-A) and Beck Anxiety Inventory (BAI) to asses the level of the anxiety.
Differential Diagnosis, Target Symptoms, and Treatment
Differential diagnoses for anxiety disorders include among others acute respiratory distress syndrome, acute gastritis, alcohol-related psychosis, Addison disease, and amphetamine-related psychiatric disorders. The target symptoms for the patient are extreme nervousness, rapid heartbeat, fatigue, worry, and sleeping problems. The doctor would examine the symptoms to identify effective treatment. Soyara’s negative ways of thinking fueled negative emotions and fear. Therefore, cognitive behavioral therapy (CBT) would help identify and correct her negative thoughts since changing her thoughts would change her feelings (Kazantzis et al., 2021). CBT with routine counselling would be the most efficient method of treatment for the anxiety disorder (Straw et al., 2022). The doctor could also opt for antidepressants like Benzodiazepines that are effective in enhancing neurotransmitter activity. The antidepressants would be effective for a quick sedative effect (Straw et al., 2022). Therefore, a combination of CBT and antidepressants would help Soyara recover quickly.
References
Kazantzis, N., Luong, H. K., McDonald, H. M., & Hofmann, S. G. (2021). Contemporary cognitive behavioral therapy. Web.
Strawn, J. R., Mills, J. A., Suresh, V., Peris, T. S., Walkup, J. T., & Croarkin, P. E. (2022). Combining selective serotonin reuptake inhibitors and cognitive behavioral therapy in youth with depression and anxiety. Journal of affective disorders, 298, 292-300.
Weiss, K. E., Steinman, K. J., Kodish, I., Sim, L., Yurs, S., Steggall, C., & Fobian, A. D. (2021). Functional neurological symptom disorder in children and adolescents within medical settings. Journal of Clinical Psychology in Medical Settings, 28(1), 90-101.
Jeremy’s presenting symptoms that meet the DSM-V criteria for generalized anxiety disorder (GAD) (Slee et al., 2019). According to its etiology, higher DNA methylation of corticotropin-releasing factor increases GAD risk and severity as do reduced “resting-state functional connectivity between the amygdala and prefrontal cortex” and overactivation of the sympathetic nervous system due to stimuli (Slee et al., 2019, p. 771). Thus, epigenetic mechanisms, limbic structures, and hypervigilance cause GAD.
Best Theory
The evidence from genetics, neurobiology, and psychophysiology implicates neurobiological factors in GAD development. Affected serotonin neurotransmission is associated with heightened feelings of worry and fear even in the absence of a threat (Slee et al., 2019). Thus, the neurobiological theory offers the best explanation for GAD etiology. The physiological states and behavioral components seen in GAD patients result from neurological differences between anxious and non-anxious cohorts.
Pharmacological Treatments
Antidepressants from different classes are indicated as first-line therapy for GAD. According to Slee et al. (2019), selective serotonin reuptake inhibitors (SSRIs), such as Lexapro, are effective medications for treating anxiety. Another class of anti-anxiety drugs, benzodiazepines, are used in GAD treatment when administered orally or parenterally. However, the risk of dependency is high with these medications; hence, they are not used as a first-line treatment.
Mechanism of Action
SSRIs target serotonergic neurons that occur in cortical and limbic areas. Their binding to the serotonin transporter (receptors) prevents the reuptake of neurotransmitters by the presynaptic neuron (Slee et al., 2019). Therefore, serotonin is not reabsorbed sooner but rather accumulates, inducing anxiolytic effects. In contrast, benzodiazepines target gamma-aminobutyric acid (GABA) receptors that are excited in an anxious state to induce anti-anxiety effects in GAD patients.
Possible Side Effects
Jitteriness, nausea, and migraines are common adverse effects of SSRIs. Patients treated with these drugs may also experience restlessness, low energy, poor appetite, and sexual dysfunction (Slee et al., 2019). They may manifest many behavioral symptoms such as confusion and agitation, drowsiness, and hallucinations. On the other hand, the adverse effects associated with benzodiazepine treatment include fatigue, vertigo, slow reaction time, and impaired cognitive functioning.
Interactions and Contraindications
SSRIs interact with non-steroidal anti-inflammatory drugs (NSAIDS) and blood thinners, reducing their effectiveness. Their interaction also increases the risk of bleeding in users. SSRIs are contraindicated in bipolar disorder, hemophilia, diabetes, and epilepsy (Slee et al., 2019). On the other hand, benzodiazepines are not suitable for patients with sleep apnea, chronic obstructive pulmonary disease, and bronchitis. These medications mostly interact with phenothiazines, antidepressants, and barbiturates.
References
Slee, A., Nazareth, I., Bondaronek, P., Liu, Y., Cheng, Z., & Freemantle, N. (2019).
The client is a 46-year-old white male who works as a welder at a local steel fabrication factory. He presents today after being referred by his primary care physician after a trip to the emergency room, where he felt he had a heart attack. He stated that he felt chest tightness, shortness of breath, and a feeling of impending doom. He does have some mild hypertension which is treated with a low sodium diet, and is about 15 lbs. overweight. He had his tonsils removed when he was eight years old, but his medical history since that time has been unremarkable. Myocardial infarction was ruled out in the emergency room, and his electrocardiogram was normal. The remainder of the physical exam was within normal limits. He admits that he still has problems with tightness in the chest and episodes of shortness of breath- he now terms these “anxiety attacks.” He will also report occasional feelings of impending doom and the need to “run” or “escape” from wherever he is at. The client occasionally uses ethanol alcohol to combat worries about work and to consume about 3-4 beers at night.
He is single and cares for his elderly parents in his home. He reports that the management at his place of employment is harsh, and he fears for his job. During the mental status exam, the client was alert and oriented to person, place, time, and event. He was appropriately dressed, and his speech was clear and coherent. The client’s self-reported mood is “bleh”, and he does endorse feeling “nervous”. The affect is blunted and broad but brightens several times throughout the clinical interview. The client denies visual or auditory hallucinations, and no overt delusional or paranoid thought processes are readily apparent. Judgment is grossly intact, as is insight. He has never been on psychotropic medication and denies suicidal or homicidal ideation. Considering all the factors and symptoms, the final diagnosis is a generalized anxiety disorder, and the Hamilton anxiety rating scale indicated 26 scores.
Decision #1
The first decision is to prescribe the man to begin buspirone 10 mg PO BID. This medication was supposed to reduce the anxiety and stabilize the patient’s mental health for a little bit. This course should last four weeks and aims to study the condition further to understand what treatment should follow next. This decision was selected to identify the seriousness of the problem and improve the man’s current condition so that he could be relatively stable during further procedures. This medication was supposed to reduce the symptoms and increase the amount of serotonin in the organism (Potter, 2019). Other options were incompatible with the purpose of the first treatment stage; therefore, in comparison, the current one seemed more appropriate for the situation. Buspirone treatment, for example, was necessary to include since it could reverse the anxious pattern of behavior (Thom et al., 2020). The primary goal of this decision was to decrease the intensity of the generalized anxiety disorder symptoms in the patient. This approach would prepare him for the next steps in the treatment and would allow him to assess the reaction to the certain medication and its amount (Strawn et al., 2019). Eventually, the patient felt slight changes in his state, although the disorder still affected him significantly. Some ethical considerations served as guidance for the prescribed treatment. The main one was that the symptoms would become more disturbing and complicate the healing process. Thus, to avoid it, specific treatment and medications were prescribed to decrease the symptoms or at least prevent them from worsening.
Decision #2
After four weeks, the client returned to the clinic for the evaluation and discussion of the further direction of the course. He reported a slight decrease in symptoms but still experienced anxiety. The Hamilton anxiety rating scale indicated that the initial 26 scores decreased to 23, which is already evidence of progress. The following step was to discontinue buspirone and begin Lexapro 10 mg orally daily. The reason for choosing the specific drug is to achieve better outcomes in the patient’s mental health so that he could feel less anxious during the course. Other options would not serve the purpose of the treatment; therefore, the choice was Lexapro. It “boosts neurotransmitter serotonin blocks serotonin reuptake pump, desensitizes serotonin receptors, and presumably increase serotonergic neurotransmission” (Potter, 2019, p. 1938). Moreover, although buspirone might be effective for treating generalized anxiety disorder, it does not demonstrate the best possible outcome (Thom et al., 2020). The primary goal of the decision was to achieve a significant increase in the client’s psychological wellbeing, considering the choice of medication for his age group (Strawn et al., 2019). In addition, the symptoms should have been notably decreased, and the anxiety would not concern the client that much eventually. However, the most expected outcome was the decrease in scores by the Hamilton anxiety rating, which would indicate the effectiveness of the implemented methods. Regarding the ethical considerations, there was a need to recognize the client’s fears and eliminate them by talking about all the possible outcomes of the treatment and explaining the necessity of following all the recommendations.
Decision #3
After another four-week course, the client returned for the appointment to assess the progress in the treatment. He reported that his mental state noticeably got better, and the anxiety was as troubling as it was before the medications. However, he noticed that he started to feel sleepy for several hours after taking the medication, but then the feeling disappeared over time. In addition, the Hamilton anxiety rating scale demonstrated that the score decreased from 23 to 13 points which means that the course was successful.
The next decision is to continue the same dose of Lexapro but change the administration time to bedtime. Since the medication demonstrated great results, seemed to suit the patient, and contributed to the successful treatment of the mental disorder. The selection of the decision has several important reasons for it. This way, the client will not be troubled by the medication’s sedating effects, and sleep may be enhanced, improving overall anxiety.
Other options would not be the best for the current situation and could even cause negative drawbacks. An adequate trial can be as long as 12 weeks, and there is no need to increase the drug at this point as it is unknown how much the current dose will improve the client’s symptoms (Generoso et al., 2017). It is possible to increase the dose, but this could increase the risk of side effects- especially the sleepiness the client complains about in the morning after taking the medication. It is plausible that an increase in the dose would increase morning sedation. At this point, nothing in the client’s presentation suggests the need to augment his Lexapro with any other agents; therefore, buspirone augmentation would not be an appropriate response (Thom et al., 2020). That decision aims to provide the patient with the possibility of being in a stable condition with a normal sleeping schedule and the lowest possible level of anxiety (Thom et al., 2020). Although, the main ethical concern the client might have is worries about the safety of the treatment and how it would affect his everyday life. Thus, it is necessary again to have a conversation about his conditions and supposed outcomes so that there are no misunderstandings between both sides.
Conclusion
In conclusion, the patient with a generalized anxiety disorder was provided certain treatment that demonstrated positive results. The first decision is to prescribe the man to begin buspirone ten mg PO BID. This medication was supposed to reduce the anxiety and stabilize the patient’s mental health for a little bit. Buspirone treatment, for example, was necessary to include since it could reverse the anxious pattern of behavior (Thom et al., 2020). The primary goal of this decision was to decrease the intensity of the generalized anxiety disorder symptoms in the patient. The following step was to discontinue buspirone and begin Lexapro 10 mg orally daily. The reason for choosing the specific drug is to achieve better outcomes in the patient’s mental health so that he could feel less anxious during the course. Other options would not serve the purpose of the treatment; therefore, the choice was Lexapro. Finally, the most prudent course of action would be to continue the same dose of medication but change the administration time to bedtime. This way, the client will not be troubled by the medication’s sedating effects, and sleep may be enhanced, improving overall anxiety. Therefore, all the recommendations aim to ensure that the man’s well-been illness improves over time, and he will be able to deal with the anxiety and reach a critical state. Prescribing certain medications in specific amounts is a primary source for successful recovery.
Potter, D. R. (2019). Major depression disorder in adults: a review of antidepressants. Int. J. Caring Sci, 12(3) 1936.
Thom, R. P., Keary, C. J., Waxler, J. L., Pober, B. R., & McDougle, C. J. (2020). Buspirone for treating generalized anxiety disorder in Williams syndrome: a case series. Journal of Autism and Developmental Disorders, 50(2), 676-682.
Patients in critical conditions often experience anxiety, which exacerbates pain and causes insomnia. The problem attracts attention, as it is validated by the staff’s practical observations, particularly in safety, risk management, and quality assessment issues. The anxiety problem is relevant, as it significantly impacts both patients and the organization providing care. Patients suffer because anxiety interferes with healing and can prolong their hospital stay. Consequently, patients’ satisfaction and safety levels are falling, hindering the organization and leading to additional expenses. The current practice focuses on medicines to reduce anxiety and its effect. However, pharmacological agents can interfere with treatment and have side effects. Therefore, studying and evaluating the effectiveness of alternative anxiety reduction methods can help solve the problem. Particularly, there is a need to investigate aromatherapy and its effect on patients experiencing anxiety.
PICO Components and EBP Question
PICO Components:
P (Patients) – patients at risk for anxiety. The target group for intervention to solve the described problem is patients at high risk of anxiety. They often include people with critical conditions or trauma survivors, preoperative patients, and those prone to anxiety in character.
I (Intervention) – aromatherapy. The proposed intervention as a method involves the use of essential oils in various ways as inhalation, massage, or bath for relaxation.
C (Comparison) – no application of aromatherapy. The comparison applies to patients’ conditions before the intervention implementation.
O (Outcome) – anxiety level reduction. Aromatherapy is expected to reduce anxiety and, as a consequence, improve treatment effects.
Question: Among the patients at risk for anxiety, does the aromatherapy reduce anxiety level compared to no aromatherapy application?
Research-Based Article
Background and Purpose
A research-based article was studied and evaluated to answer the proposed EBP question. “Effect of aromatherapy on preoperative anxiety in adult patients: A meta-analysis of randomized controlled trials” was written by a group of Chinese scientists (Huang et al., 2021). The authors note that anxiety among preoperative patients is common and leads to complications, but it is preventable. The research background also suggests that the aromatherapy method reduces anxiety and the manifestation of somatic symptoms. As a result, Huang et al.’s (2021) purpose is to evaluate aromatherapy’s effect on anxiety in preoperative patients. The authors conducted a meta-analysis of randomized controlled trials to achieve their goal.
Method, Evidence Level, and Ethical Considerations
Meta-analyses included the selection and review of topic-relevant trials and their subsequent analysis. According to the Research Evidence Appraisal Tool, the considered article corresponds to level I of evidence. The researchers used seven databases to find the sources and then checked publications with the help of the Cochrane Risk Assessment Tool and Grades of Recommendation, Assessment, Development, and Evaluation (GRADE). Ten randomized controlled trials were eventually included in the quantitative synthesis.
The authors used a random-effects model and inverse variance method to analyze extracted data. The meta-analysis did not work with humans or animals, and their work does not include ethical considerations. The article has several drawbacks, identifying a quality rating as B. Good quality. Publication does not meet high quality because its conclusions are not precise due to the method’s restrictions. Moreover, although the authors mention limitations, they do not address them.
Conclusion and Value for EBP
Despite the study’s shortcomings, the authors conclude that aromatherapy can reduce anxiety intensity for preoperative patients. The result is consistent with previous research indicating the effectiveness of the method. Such conclusions suggest that the answer to the posed EBP about aromatherapy benefits is positive. Although the influence of the technique has been compared with placebo and non-targeted anxiety rather than other methods of its management, aromatherapy has the advantage of no side effects. Considering the limitations of the article’s method and the focus on preoperative patients, it is worth expanding the study to confirm the effectiveness of aromatherapy for all patients with anxiety.
Non-Research Article
Background and Purpose
A non-research paper was also analyzed to find evidence for the problem under consideration. Meghani et al.’s (2017) article is devoted to “The effects of aromatherapy and guided imagery for the symptom management of anxiety, pain, and insomnia in critically ill patients” (p. 334). Article’s background notes that complementary and alternative therapies are popular, and even in hospitals, patients prefer to continue using them. The authors also suggest that anxiety, insomnia, and pain are common among patients in intensive care. They set a goal of whether aromatherapy and guided imagery help manage these conditions.
Evidence Level
This article is an integrative review, and it represents level V of evidence. Meghani et al. (2017) investigated three databases and searched for articles exploring two methods – aromatherapy and guided imagery. They selected six studies, including randomized controlled trials, quasi-experimental, and retrospective effectiveness studies, that aimed to investigate the aromatherapy method and its effects on patients. The authors examined the studies’ goals, methods, and findings and synthesized the information in their paper. The quality rating of the article corresponds to B. Good quality, since their results suggest the need for further research to validate the method’s effectiveness. The review does not have ethical consideration as it involves examining published material rather than working with humans or animals.
Conclusion and Value for EBP
The authors of the considered paper conclude that aromatherapy can benefit patients in critical conditions in managing their anxiety. 5 out of 6 publications studied indicate in favor of such a conclusion. Meghani et al. (2017) also note that aromatherapy may subsequently affect such essential aspects as service quality, length of stay, and use of anxiety medication. By evaluating aromatherapy intervention and its influence, the article helps answer the proposed EBP question and suggest assumptions’ validity.
Practice Change
The recommended practice change is aromatherapy application to reduce anxiety levels among patients. Huang et al.’s (2021) note that such a method is helpful and has no harmful effect compared with medicines. Meghani et al. (2017) also confirm the aromatherapy benefit and its potential to increase patient satisfaction and treatment effectiveness. The key stakeholders who need to support practice change are nurses, supply managers, and nurse educators. Nurses promote the method and make aromatherapy use possible, managers provide the necessary means, and educators inform about the possibilities. Their involvement is possible through reach – by phone, e-mail, and other ways to get an opinion. Another engagement strategy is creating focus groups to discuss and implement interventions.
Barriers and Outcomes
During the practice change recommendation implementation, there may be a barrier of nurses’ unwillingness to use aromatherapy. A strategy to overcome the obstacle may include proving the method’s effectiveness for patient outcomes and financial incentives for improving patient scores. Measurement of intervention outcome can be done through patient reports of anxiety levels before and after aromatherapy. Anxiety level reduction will indicate the success of the method.
Conclusion
Anxiety among patients poses a significant challenge to health care organizations. It worsens the condition of patients and thereby reduces the effectiveness of their treatment. Methods alternative to pharmacological intervention may be effective and have no side effects. Examination of the literature suggests that such an alternative method as aromatherapy can effectively reduce anxiety. However, the research highlights the difficulty of studying the issue and the further need for more comprehensive approaches to explore the efficacy of aromatherapy.
References
Huang, H., Wang, Q., Guan, X., Zhang, X., Kang, J., Zhang, Y., Zhang, Y., Zhang, Q., & Li, X. (2021). Effect of aromatherapy on preoperative anxiety in adult patients: A meta-analysis of randomized controlled trials. Complementary Therapies in Clinical Practice, 42, 101411. Web.
Meghani, N., Tracy, M. F., Hadidi, N. N., & Lindquist, R. (2017). Part II: The effects of aromatherapy and guided imagery for the symptom management of anxiety, pain, and insomnia in critically ill patients: An integrative review of current literature. Dimensions of Critical Care Nursing, 36(6), 334-348. Web.
The family doctor referred Eric for treatment of anxiety and further assessment. Moreover, Eric voluntarily seeks therapy to deal with stress, chronic worry, and concentration problems. Eric has been experiencing these symptoms for more than eight months at the moment of the first visit. As Eric is on medication, the referral for seeking psychological interventions can be viewed as complementary treatment and development of life skills.
Presenting Problem
Eric’s main reason for seeking treatment is anxiety and difficulty concentrating. However, he also expresses a range of other symptoms through his description of past events and his record of medical treatment. The combination of the mentioned issues has led Eric to lose his job and move in with his parents. The longevity of symptoms – more than eight months – worries Eric and leads to thoughts of personal failure and worthlessness, which further exacerbate his negative moods. He also expresses loneliness, fear of becoming a burden for his parents, and anxiety about events that may negatively affect him or his loved ones.
Client History
Family History
Eric’s family is supportive and close-knit; he has a father, a mother, an older brother, and two younger sisters. Eric’s mother has a history of being treated for anxiety, but his other siblings and father do not have any mental health history recorded. His siblings have achieved much in their careers, and the self-comparison of Eric to his older brother is a source of anxiety and depressive moods for Eric. His father and brother were at one point working for the federal police. His parents appear to acknowledge his struggles and are involved in his mental health improvement. Eric’s parents are in a somewhat tense relationship as they have differing views on control over Eric’s finances and activities. It is known that Eric’s father has tried to monitor Eric’s medication daily and tried to predict when the symptoms would worsen. He also interfered with Eric’s access to driving and money by making the car non-usable and taking away Eric’s credit card.
Childhood, School, and Social History
As a child, Eric was reserved and quiet; he struggled with some subjects due to stress, and his grades fluctuated between As and Cs. Eric feared he would not be able to go to college, comparing his school performance with that of his older brother, who had a scholarship. Nevertheless, Eric finished college with a business administration degree, but his anxiety about academic and job performance persisted, leading to problems at college.
Medical History
Eric has a long history of assessments and attempts at medical and psychotherapy. At 19 years old, Eric was hospitalized for an injury not related to suicidal attempts as he crashed his parents’ car. However, after diagnostic tests, it became apparent that Eric was not under the influence of any medication or alcohol, but his moods were persistently elevated. As a result, he was diagnosed with an emotional disorder and prescribed medications. Following the accident, Eric continued to take medications and go through assessments for psychosis and anxiety. He also got into two more car accidents which were caused by elevated moods. Finally, during one episode, he burned up his family car due to increased distractibility.
Potential Diagnosis(es) and Analysis of Symptoms
Eric’s symptoms range between prolonged depressive and manic episodes, and he does not feel any particular symptoms between these periods. At the moment of the visit, the primary symptom was anxiety – Eric worried about his career, family, other relationships, personal value, and other issues. At 19 years old, Eric had a 2-week period of elevated and agitated moods, where he engaged in reckless behavior by crashing his parents’ car. He was distractable and talkative, and his speech was described as quick and loud, which indicates euphoria and racing thoughts. One of the notable symptoms during such periods, which frequently occurred after the first episode, was that Eric heard voices and ideas about the Australian Security Intelligence Organisation, suggesting delusions and auditory hallucinations. Specifically, Eric was worried about being watched by the organization, fearing that it would act to prevent him from achieving success in life. Eric’s episodes outside of elevated moods were characterized by depressed moods, loss of pleasure and interest in activities, feelings of shame, guilt, worthlessness, suicide ideations, and attempts. At the latest visit, Eric expressed no particular symptoms of elevation or depression, stating that he felt anxious.
Some missing information may be the lack of available assessment information from previous events. While it is known that Eric was not under any influence during his first car accident, it would be helpful to see whether he went through assessments previously and how he performed in them. Moreover, explanations of the previous diagnoses or suspicions of psychosis and anxiety could demonstrate why other professionals made these particular conclusions, as they led to Eric taking medication.
The primary diagnosis for Eric is bipolar I disorder with anxious distress and mood-congruent psychotic features. The periods of elevated moods described by Eric are consistent with manic episodes as they are persistent, reoccurring, and last more than one week (American Psychiatric Association [APA], 2013). According to the APA (2013), one manic episode is enough for a person to be diagnosed with bipolar I disorder. During his first car accident, Eric expressed such key signs as talkativeness, racing thoughts, distractibility, agitation, engagement in dangerous activities, and social and job impairment (APA, 2013; Carvalho et al., 2020). As noted in his history, Eric’s first episode was confirmed as happening not under the influence of substances or alcohol and lasting for about two weeks, which is consistent with manic episode duration (APA, 2013). The following instances of manic episodes have similar traits, which leads one to conclude that one part of Eric’s psychological condition is mania.
Similarly, Eric’s depressive moods, which often followed periods of elevation, conform to the description of major depressive episodes. Eric showed diminished interest in hobbies and tasks, as he stated that even pleasurable activities did not bring any satisfaction, which is a significant symptom of depression. Furthermore, he expressed feelings of worthlessness, guilt, delusional thoughts of failure, indecisiveness, and suicidal ideations (Carvalho et al., 2020; McIntyre & Calabrese, 2019; Baldessarini et al., 2020; Miller & Black, 2020). Eric attempted suicide four times, one in high school and three in the last three years. While it is unclear during which episodes Eric showed suicidal ideation, this symptom is consistent with bipolar I disorder. As the APA (2013) finds, the rate of suicide among people with bipolar disorder is “15 times that of the general population” (p. 131). The strong consistency of symptoms and cycling between periods of depressive and elevated moods supports the primary diagnosis of bipolar I disorder. Additional features include increased anxiety and psychotic features such as auditory hallucinations.
The comorbid diagnosis is a generalized anxiety disorder, and Eric’s current symptoms suggest high anxiety at the present moment. The history of symptoms indicates persistent distress starting in high school and continuing during and after college. The persistence of stress and excessive worrying for more than eight months suggests the comorbid nature of this disorder rather than it being a part of bipolar I disorder (APA, 2013; McIntyre et al., 2020). Nevertheless, anxiety appears during Eric’s manic and depressive episodes, taking on different forms – delusions in manic periods and excessive worrying about personal failures during depressive ones.
The first differential diagnosis is bipolar II disorder, characterized by hypomanic and depressive episodes. In contrast to bipolar I, where manic episodes are interspersed with depressive ones, bipolar II is defined by hypomania. It is periods of elevated moods, engagement in risky behaviors, self-harm, quick communication, and hyperactivity (APA, 2013; McIntyre et al., 2020). However, hypomania is not linked to delusions and hallucinations, which are present in Eric’s symptom history (APA, 2013; Perrotta, 2019). Thus, this diagnosis does not fit Eric’s symptom analysis.
The second potential differential diagnosis is borderline personality disorder (BPD), characterized by extreme emotions and their changes, impulsive behavior, stress, and paranoia (Saccaro et al., 2021). Eric’s symptoms of self-harm, stress, paranoid thoughts, and impulsivity are consistent with BPD (Sanches, 2019). However, his presentation of interchanging periods of consistent mood patterns – two weeks of elevated moods and several weeks of depressed moods – is not present in BPD, which is defined by rapid changes (APA, 2013). Moreover, elevated moods are a strong sign of bipolar disorder while being a point of exclusion for BPD (Saccaro et al., 2021). Therefore, this differential diagnosis does not apply to the present case.
Case Formulation
Eric’s biological predisposing factor may be the history of his mother’s anxiety. His reserved personality and family position as the middle child and the youngest of two brothers is a predisposing social factors. It is a perpetuating aspect as Eric compares his achievements with his brother’s. The recent triggers include losing a job and moving in with his parents. The behavior of Eric’s father is a source of stress, as he monitors his son’s behavior, making Eric feel incompetent. However, Eric’s family bond appears to be strong, and he has a close friend, John, who is aware of Eric’s mental health struggles and is supportive.
Aetiological factors
Biopsychological factors
Biological
Psychological
Social
Predisposing
Mother’s anxiety
Precipitating
Job loss
Quiet personality
Perpetuating
Comparison to the older brother, anxiety
Father’s behavior
Protective
Personal desire to attend therapy
Strong family connections, friendships
Treatment Options
The first treatment option for Eric is cognitive behavioral therapy (CBT), and the second recommended approach is mindfulness-based cognitive therapy (MBCT). CBT is supported by Level I evidence, while mindfulness has Level II evidence (Australian Psychological Society, 2018). CBT has been found effective in treating bipolar disorder and lowering the rate of relapse (Miklowitz et al., 2021; Özdel et al., 2021). CBT is characterized by its proactive approach to negative thinking (Miklowitz et al., 2021; Özdel et al., 2021). When attending one-on-one or group CBT sessions, a person learns to recognize thinking and behavior patterns and alter them to avoid dangerous and depressive thoughts or analyze elevated moods (Miklowitz et al., 2021). Moreover, the individual learns problem-solving and communication skills to manage moods and deal with difficult situations. For example, CBT can be used to prevent manic episodes from occurring or treat the symptoms during an ongoing period (Özdel et al., 2021). Similarly, the person may use learned skills to prevent and treat depressive episodes.
MBCT is another approach to help individuals with bipolar disorder manage their moods. MBCT prevents relapses by adding mindfulness exercises to cognitive therapy (Lovas & Schuman-Olivier, 2018). Cognitive activities are similar in their strategy to CBT as they focus on skill acquisition for recognizing negative thinking patterns (Lovas & Schuman-Olivier, 2018). The mindfulness component involves medication and self-reflection, where the individual observes personal experiences and works to change their relationships to particular thoughts and emotions (Chu et al., 2018). In this case, self-acceptance, admission of negative patterns, and self-awareness are prioritized. Through reflection and meditation, the individual learns to regulate moods, manage stress, and gain more knowledge about his current state of mind.
Conclusion
In conclusion, both treatment approaches are covered in the literature in detail, but additional research into specific comorbidities such as anxiety and psychotic features can enhance the therapies’ success. For instance, Samamé (2021) suggests that individuals with comorbid bipolar and anxiety disorders would benefit from specific CBT techniques to address both conditions at the same time. Still, there exists a lack of research regarding such combinations. In the reviewed case, Eric has clear symptoms of both anxiety and bipolar disorders. Therefore, complex psychological treatments that acknowledge and deal with both conditions could be advantageous for helping him prevent future episodes and reduce his stress between them.
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Author.
Australian Psychological Society. (2018). Evidence-based psychological interventions in the treatment of mental disorders: A review of the literature (4th ed.). Author.
Baldessarini, R. J., Vázquez, G. H., & Tondo, L. (2020). Bipolar depression: A major unsolved challenge. International Journal of Bipolar Disorders, 8(1), 1-13.
Carvalho, A. F., Firth, J., & Vieta, E. (2020). Bipolar disorder. New England Journal of Medicine, 383(1), 58-66.
Chu, C. S., Stubbs, B., Chen, T. Y., Tang, C. H., Li, D. J., Yang, W. C., Wu, C-K., Carvalho, A., Vieta, E., Miklowitz, D., Tseng, P-T., & Lin, P. Y. (2018). The effectiveness of adjunct mindfulness-based intervention in treatment of bipolar disorder: A systematic review and meta-analysis. Journal of Affective Disorders, 225, 234-245.
Lovas, D. A., & Schuman-Olivier, Z. (2018). Mindfulness-based cognitive therapy for bipolar disorder: A systematic review. Journal of Affective Disorders, 240, 247-261.
McIntyre, R. S., & Calabrese, J. R. (2019). Bipolar depression: The clinical characteristics and unmet needs of a complex disorder. Current Medical Research and Opinion, 35(11), 1993-2005.
McIntyre, R. S., Berk, M., Brietzke, E., Goldstein, B. I., López-Jaramillo, C., Kessing, L. V., Malhi, G., Vieta, E., Vinberg, M., Young, A., & Mansur, R. B. (2020). Bipolar disorders. The Lancet, 396(10265), 1841-1856.
Miklowitz, D. J., Efthimiou, O., Furukawa, T. A., Scott, J., McLaren, R., Geddes, J. R., & Cipriani, A. (2021). Adjunctive psychotherapy for bipolar disorder: A systematic review and component network meta-analysis. JAMA Psychiatry, 78(2), 141-150.
Miller, J. N., & Black, D. W. (2020). Bipolar disorder and suicide: a review. Current psychiatry reports, 22(2), 1-10.
Özdel, K., Ayşegül, K. A. R. T., & Türkçapar, M. H. (2021). Cognitive behavioral therapy in treatment of bipolar disorder. Archives of Neuropsychiatry, 58(Suppl 1), S66-S76.
Perrotta, G. (2019). Bipolar disorder: definition, differential diagnosis, clinical contexts and therapeutic approaches. J Neuroscience and Neurological Surgery, 5(1), 1-6.
Saccaro, L. F., Schilliger, Z., Dayer, A., Perroud, N., & Piguet, C. (2021). Inflammation, anxiety, and stress in bipolar disorder and borderline personality disorder: A narrative review. Neuroscience & Biobehavioral Reviews, 127, 184-192.
Samamé, C. (2021). The rise and fall of cognitive-behavioral approaches to the treatment of bipolar disorder: A critical overview from a quaternary prevention perspective. Bipolar Disord, 23(8), 751-753.
Sanches, M. (2019). The limits between bipolar disorder and borderline personality disorder: A review of the evidence. Diseases, 7(3), 49.
Anxiety represents a condition that can aggravate the regular life of a person. In such a state, people may feel uneasiness, fear, or even dread. On the one hand, anxiety can serve as a coping reaction to stress and is normal when it does not last long. For instance, students can experience anxiety before exams, or an individual can feel anxious before making a life-changing decision. On the other hand, when anxiety does not disappear, worsens over time, and impedes daily activities, it means the development of anxiety disorders in the form of generalized anxiety disorder or panic disorder. These conditions are characterized by the inability to control disturbing thoughts and physical signs, namely increased heartbeat, shortness of breath, dizziness, and so further. Since people with anxiety disorders need to mitigate their symptoms, it is crucial to examine whether physical exercises can help them manage their condition better.
Effective exercises
The review of the literature generally demonstrates the significant effects of exercise in alleviating the symptoms of anxiety. For instance, Herbert et al. (2020) examined how short-term aerobic interventions help students reduce anxiety and found that these activities positively contribute to mitigating stress and depression. Similarly, Mikkelsen et al. (2017) have confirmed the effectiveness of physical exercises for mood disorders. Notably, in the course of their study, the authors have found that activities focused on cardiorespiratory conditioning and aerobic exercises prove to have a positive influence on anxiety, stress, and depression (Mikkelsen et al., 2017). Although there is less literature on the impact of non-aerobic exercises, including yoga or swimming, they can also minimize anger, tension, and confusion. Here, one may suggest that the type of physical activities may not play a significant role because any activity has been found to serve as a mitigator of symptoms of anxiety.
Types of Exercises
Nevertheless, the views on the kind of physical activities become divided. Aylett et al. (2018), who performed a systematic review of randomized controlled trials, also concluded that physical exercises can help to overcome anxiety. However, they emphasized the importance of intensive exercise programs as a favorable treatment option for the condition (Aylett et al., 2018). Luan et al. (2019) have approached the issue more thoroughly and investigated the effect of exercises within the context of various diseases, including anxiety. It has been found that aerobic, home-based, and resistance exercises represent powerful interventions for managing anxiety. For instance, walking, cycling, or Tai Chi at moderate intensity can even be utilized as a temporary alternative option instead of psychotherapy. Home-based exercises improve the metabolic index in anxiety patients, and resistance exercises alleviate symptoms of general anxiety disorder. Given the findings, it is possible to assume that exercises should be selected individually, according to the needs of patients having anxiety.
Research Questions and Survey Methods
The literature reviewed above provides the fundamental background to the current study. One research question is about the duration of exercises to help with anxiety. Another question says: “What type of exercise is best to help reduce anxiety?”. Fifteen people aged 18-65 years who exercised in the past but currently abandoned this practice represent the participants of the research. The participants have to fill out a smartphone-based questionnaire that will help reveal whether their condition has improved. The survey bears self-report characteristics and focuses on finding how daily physical exercises contribute to minimizing anxiety. The questionnaire was developed using the Rated Perceived Exertion scale and the Patient Health Questionnaire Anxiety and Depression Scale to investigate “exercise” and “anxiety” variables, respectively. This approach facilitates distinguishing and analyzing individual reports and drawing conclusions regarding the types of the most suitable exercises to alleviate anxiety symptoms.
Results, Limitations, and Questions for the Future
The results have shown that 40% of participants experience anxiety once a week or more. The anxiety triggers appeared to be various, and part of them are more related to daily life challenges and do not reveal any pathology, namely workload, stress, hunger, and so forth. Another part is attributed to genetics, fear of losing loved ones, thoughts about diseases and viruses, and other triggers that raise concerns about further examination by physicians and diagnosing a possible condition. Most participants (73.3%) lead an active lifestyle and have practiced mainly walking, jogging, and cycling. Almost half of the participants (46.7%) report their condition as good. The limitation here is the small number of participants and open-ended questions in the questionnaire, complicating the identification of clear patterns and relationships. In the future, one needs to focus on patients diagnosed with anxiety and investigate the types of exercises they do to improve their condition.
Conclusion
Finally, anxiety is a condition that must be appropriately managed through psychological interventions and physical exercises. Although these activities are proven effective in improving anxiety symptoms, one needs to adjust exercise intervention programs according to the individual state and needs. The current study has demonstrated that physical exercises such as walking, jogging, or cycling have positively impacted the symptoms of participants. However, the main limitation was the small number of participants, making it challenging to identify whether the mentioned activities would suit a wider group of people suffering from anxiety. Moreover, some findings suggested that people may experience stress rather than pathological anxiety. For further studies, it would be essential to examine the greater number of patients diagnosed with anxiety and identify what types of exercises helped them to alleviate the symptoms.