Category: Anxiety

The symptoms Beatrice is manifesting align with 300.02 (F41.1) DSM V classification, namely Generalized Anxiety Disorder. The disease is characterized by excessive anxiety and negative expectations that manifest themselves for a period of over 6 months. The other symptoms of Generalized Anxiety Disorder, not listed in the given case, include restlessness, fatigue, irritability, difficulties in concentrating on work or studies, and sleep disturbance (American Psychiatric Association, 2018, p. 222). Moreover, in patients diagnosed with Generalized Anxiety Disorder, their anxious state severely impairs their everyday functioning and has a pronounced effect on everyday routine tasks. Associated symptoms of the disease comprise muscle tension, trembling, twitching, feeling shaky, and muscle aches or soreness as well as somatic symptoms and enhanced startle response (American Psychiatric Association, 2018, p. 223). Moreover, patients may experience conditions associated with stress such as headaches, increased heartbeat rate, and some others.

To help the diagnostics, the following questions may be asked:

• Were you very nervous, anxious or worried about something in the last 14 days?
• Were you unable to cope with the excitement and calm down on any occasion in the last 14 days?
• Was it difficult for you to relax in the last 14 days?
• Were you on any occasion so restless that it was hard for you to sit still?
• Are you easily annoyed or irritated?
• Have you ever experienced fear, as if something bad was going to happen?
• Have you ever been unable to finish work due to the anxiety and worries you experienced? If yes, on what occasions?

All the above listed questions serve to determine the level of anxiety and stress in an individuum as well as allow to conclude to what extent this stress impacts a persons quality of life.

Reference

American Psychiatric Association (2018). Diagnostic and statistical manual of mental disorders (5^th ed.). American Psychiatric Publishing. Web.

Biological Theories

Jeremys 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).

Pharmacological treatments for generalised anxiety disorder: A systematic review and network meta-analysis.The Lancet, 393(10173), 768-777. Web.

Currently, there are several pharmacological options for the management of General Anxiety Disorder (GAD). First of all the treatment may include the use of serotonergic or norepinephrinergic antidepressants (Garakani et al., 2020). Among the approved selective serotonin reuptake inhibitors (SSRIs) is Escitalopram; approved selective norepinephrine reuptake inhibitors (SNRIs) are Duloxetine and Venlafaxine (Garakani et al., 2020; Stein, 2021). SSRIs and SNRIs are considered as first-line agents for GAD; each agent has a specific adverse event profile (Stein et al., 2021, p. 54). The most widespread medication for GAD in the world is gamma aminobutyric acid (GABA), including Benzodiazepines, which is often prescribed before SSRIs due to their effectiveness. However, these drugs have an increased risk of developing dependence, tolerance, and misuse episodes (Ansara, 2020; Garakani et al., 2020). Hydroxyzine is the only antihistamine medication approved by the FDA for the treatment of GAD. It can be used to safely manage the condition in children and adolescents (Ansara, 2020; Garakani et al., 2020). Other drugs used in the world for the treatment of GAD are not approved for use by the FDA.

Factors that may alter the expected response to pharmacological treatment include primarily the individual tolerability of the components. For many patients, SSRIs and SSNIs are ineffective, requiring the inclusion of second-line inhibitors (Ansara, 2020). The factors influencing the effectiveness of treatment are mainly the age and genetic characteristics of patients (Ansara, 2020). Additionally, the outcomes of pharmacological treatment may be affected by the patients behavior and discipline in taking the prescribed treatment. With the development of resistance, the most effective means of pharmacological treatment are drugs of the GAMA class as a second-line treatment option (Ansara, 2020). To overcome the development of resistance to first-line drugs, the duration of the course and dosage should be selected depending on individual indicators.

References

Ansara, E. D. (2020). Management of treatment-resistant generalized anxiety disorder.The Mental Health Clinician, 10(6), 326-334.

Garakani, A., Murrough, J. M., Feire, R. C., Thom, R. P., Larkin, K., Buono, F. D., & Iosifescu, D. V. (2020). Pharmacotherapy of anxiety disorders: Current and emerging treatment options.Frontiers in Psychiatry, 11.

Stein, D. J. (2021). Evidence-based pharmacotherapy of generalised anxiety disorder: Focus on Agomelatine. Advances in Therapy, 38, 52-60.

Introduction to the Case

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 clients 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 patients 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 mans 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 patients 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 clients 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 clients 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 medications 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 clients 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 clients 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 patients 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 patients 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 medications sedating effects, and sleep may be enhanced, improving overall anxiety. Therefore, all the recommendations aim to ensure that the mans 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.

References

Generoso, M. B., Trevizol, A. P., Kasper, S., Cho, H. J., Cordeiro, Q., & Shiozawa, P. (2017). Pregabalin fora generalized anxiety disorder: an updated systematic review and meta-analysis.International clinical psychopharmacology, 32(1), 49-55.

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.

Strawn, J. R., Geracioti, L., Rajdev, N., Clemenza, K., & Levine, A. (2018). Pharmacotherapy for generalized anxiety disorder in adult and pediatric patients: an evidence-based treatment review. Expert opinion on pharmacotherapy, 19(10), 1057-1070.

Patients in critical conditions often experience anxiety, which exacerbates pain and causes insomnia. The problem attracts attention, as it is validated by the staffs 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 aromatherapys 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 methods restrictions. Moreover, although the authors mention limitations, they do not address them.

Conclusion and Value for EBP

Despite the studys 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 articles 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). Articles 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 methods 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 methods 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.

Introduction

College students experience a lot of changes in their lives during the first months of their studies. They move out of their homes, lose their schedule, and have no access to the support system of family and friends, which causes them to feel anxiety. Anxiety is an emotional state of an individual when they experience worry or fear (Drissi et al., 2020). This condition can have a depreciating effect on the wellbeing of a person. College students can manage anxiety by recognizing that they experience it, using self-management, and limiting the use of smartphones.

Background

Most students feel anxiety during their years at school or college. Drissi et al. (2020) define college anxiety as a common emotion that people often feel in certain situations, which prompts people to feel fear or be worried (p. 104243). Statistically, the University of Ottawa states that 60.6% of students rate their level of stress as above average (Awareness: Did you know?  n.d.). Moreover, 64.5% admit to feeling overwhelming anxiety within the last twelve months (Awareness: Did you know?  n.d.). Overwhelming anxiety may cause a feeling of hopelessness, inability to complete everyday activities, or even cause depression. Considering the large proportion of Canadian students who experience anxiety during their studies, universities should offer support and help their students manage anxiety.

First and foremost, managing anxiety begins with recognizing this problem, its symptoms, and the situations that trigger it. Stack (2018) argues that one issue with school anxiety is that it can resemble other issues, including ADHD or shyness. Due to this, educators and students may ignore the symptoms, making anxiety an underrecognized problem in Canada. Moreover, 46% of Canadiens perceive mental health problems as an excuse for bad behavior or laziness (Awareness: Did you know?  n.d.). As a result, students do not recognize that their mental health state is a result of the anxiety they feel because of the drastic changes that happened in their life and their stress continues to progress.

Effective Strategies for Anxiety Management

The first and most crucial step that college students can take to deal with anxiety is to acknowledge how they feel. LeBlank and Marques (2019) argue that avoidant behavior is often the cause of anxiety that is not recognized and addressed. For example, a student may skip classes, fail to study, or submit assignments as a result of avoidance caused by anxiety. However, this behavior will worsen the long-term symptoms since this individual will have more obligations to complete (LeBlank & Marques, 2019). Hence, to overcome anxiety, a student should recognize how they feel and what causes this state.

One way to manage anxiety is to have a healing environment and learn to self-manage the symptoms. Pelletier et al. (2017) argue that self-management is among the most effective ways of dealing with stress. This can include setting a schedule, exercising, getting enough sleep, as some examples of self-management. Kid et al. (2017) also report that self-management is effective when dealing with anxiety or even depression. Thus, college students should use self-management practices, such as techniques to calm themselves or do things that are generally known as relaxing. Apart from strategies tailored explicitly towards college students, some commonly used approaches to managing anxiety should be used. For example, it is common knowledge that long walks can help reduce stress. A similar effect on relieving stress can be achieved when creating a pleasant study environment. All of these factors are small steps that college students can incorporate into their routines to help them deal with the anxiety they experience upon transitioning to college.

College anxiety is linked to the rapid transition from living at home and having a support system of family and friends to living in dormitories and dealing with issues without support. LeBlank and Marques (2019) state that increases in anxiety levels is associated with the initial transition from home to college life. Hence, by helping students adjust and making this transition less stressful, colleges can relieve some of this anxiety from their students. Students can try to maintain their connection with friends and family to retain the support systems they had before college.

Modern-day students have higher levels of anxiety, and the prevalence rates are also more common when compared to previous generations. According to Cooper et al. (2018), the prevalence of anxiety has increased among college-aged students, while LeBanc and Marques (2019) argue that this may be linked with the communication technologies, such as smartphones (p. 23). One possible reason is that students are absorbed in their smartphones and the use of social media, which does not allow them to spend time coping with their new environment. Hence, one piece of advice is to limit the time students spend with their smartphones and instead try to adjust to the new schedule and find a sound support system.

Universities and colleges should encourage students to recognize their anxiety symptoms and teach simple self-management strategies. As was mentioned, anxiety is an under-recognized problem, and there is still a social stigma surrounding this problem (Stack, 2018). Consequently, although the proposed self-management strategies are easy to implement, students may not be aware of the problem and therefore not recognize the need to do something that would relieve their anxiety. Thus, colleges should encourage students to pay more attention to their mental health, especially during the first year when the anxiety levels are exceptionally high.

To counter the idea that students suffer from anxiety and should take measures to relieve it, one may claim that these feelings are a part of the college experience. It is necessary to go through the college years feeling anxious due to deadlines or assignments to be prepared for the real-world tasks one will face at work. However, anxiety is a serious problem that results in constant stress. The latter affects a persons mental and physical health and can result in symptoms.

Another counterargument is that the mental health of an individual should be their responsibility, and if a student feels overwhelming anxiety, that should reach out to a professional or their supervisor. However, as was discussed, college students and Canadians, in general, do not perceive mental health problems as serious and worthy of attention (Awareness: Did you know?  n.d.). Hence, it is essential to raise awareness about college anxiety to help them overcome it instead of assuming that these students can manage it by themselves.

Conclusion

Overall, college students feel a lot of pressure during their studies, which results in anxiety. Mental health struggles of students are underrecognized, despite the fact that 60% of this population reports feeling severe anxiety within the last 12 months, approximately half of the Canadian population views mental health struggles as an excuse (Awareness: Did you know?  n.d.). Hence, college anxiety affects the majority of students, making it an issue that requires more attention. LeBalnk and Marques (2019) recommend limiting time spend on smartphones, while Pelletier et al. (2017) suggest learning self-management techniques. Through exercise, limited use of technology, and schedule, college students can overcome the feeling of anxiety.

References

Awareness: Did you know? (n.d). 2021, Web.

Cooper, K.M., Downing, V.R. & Brownell, S.E. (2018). The influence of active learning practices on student anxiety in large-enrollment college science classrooms. IJ STEM Education, 5, 23. Web.

Drissi, N., Ouhbi, S., Janati Idrissi, M., & Ghogho, M. (2020). An analysis on self-management and treatment-related functionality and characteristics of highly rated anxiety apps. International Journal Of Medical Informatics, 141, 104243. Web.

Kidd, T., Carey, N., Mold, F., Westwood, S., Miklaucich, M., Konstantara, E., Sterr, A., & Cooke, D. (2017). A systematic review of the effectiveness of self-management interventions in people with multiple sclerosis at improving depression, anxiety and quality of life. PLOS ONE, 12(10), e0185931. Web.

LeBlanc, M. & Marques, L. (2019). Anxiety in college: What we know and how to cope. Harvard Health Blog. Web.

Pelletier, L., Shamila, S., Scott B., P., & Demers, A. (2017). Self-management of mood and/or anxiety disorders through physical activity/exercise. Health Promotion and Chronic Disease Prevention in Canada: Research, Policy and Practice, 37(5), 2732.

Stack, D. E. (2018). Managing anxiety in the classroom. Mental Health America. Web.

Is Alex having heart attack or panic attack? How would you distinguish the differences?

The symptoms that Alex shows indicate that he is suffering from panic attack. For instance, he has pain localized in the chest area. In heart attack, the pain spreads to the back, arms and the neck. Alex does not have these conditions. In addition, he does not experience nausea and vomiting. It is also worth noting that the condition causing the problem is psychological because he has missed his normal bus.

As a passerby, what would you do to assist Alex?

Alex needs encouragement by telling him that the pain will pass in a few minutes. He should also be encouraged to take slow and even breaths. The symptoms should not be minimized. It is also important to call the ambulance and take him to the nearest health center.

What would you report to the ambulance?

It is important to provide the detailed evidence of the patients condition. First, the ambulance should know that Alex has experienced short breaths and is having localized chest pain. I would also report that the condition came abruptly and caused the patient to lose strength. Thirdly, the patient feels hot. Alexs eyes are dilated and he has a tingling sensation in his fingers.

What would you include in your teaching plan?

A panic attack is a severe anxiety disorder that occurs suddenly and without prior warning. In most cases, it takes place without an apparent reason. It has a lot of side effects that are unpleasant because the body is responding to the threat. To manage the threat, a nurse should make a mask with his or her hands and put them firmly over the patients nose and mouth. The patient is then asked to break deeply through the nose. Breathing out should be done slowly with the mouth. A paper bag is required to be positioned over the mouth and nose. Then, creative visualization and affirmations should be provided. In this case, the nurse encourages the patient to re-train his or her imagination and get moving in a positive direction. The patient is asked to think about situations that make him feel better.

Elaborate on slow breathing.

Slow breathing involved breathing in deeply through the nose and breathing out through the mouth. The nurse should place his or her hands over the patients mouth and nose. This allows the patient to rebreathe in his exhaled air and restore the balance of carbon dioxide and gases. In this way, the patients oxygen will start to return to normal. The patient should be made calm. He should also relax by sitting quietly for a few minutes.

What is your advice for others who might in the future be faced with such a situation as Alexs panic attack?

People should avoid emotional conflicts and past difficulties in order to reduce the chances of developing panic attack. For instance, people should exercise frequently and involve themselves in situations that allow them to reduce stress, including leisure and entertainment. In addition, it is worth noting that panic attacks are sometimes associated with heart attacks. Therefore, one should go for diagnosis of heart attack when cases of panic attacks are observed.

Long-term strategies for managing panic attacks.

Alex should seek psychotherapy intervention. Psychotherapy allows him to reduce emotional and psychological stress in order to minimize chances of panic attacks in the future. Secondly, he should go for cognitive behavior therapy. In this case, he should be encouraged to change his habitual patterns of thought. He should not look for things and events that make him happy, including entertainment, traveling and other forms of leisure.

In psychology, self-esteem is a feeling that gives someone a source of purpose in life. On the other hand, anxiety is an extreme feeling resulting from imbalances in an individuals self-esteem. It may be worsened by uncertainty (Bryson, 2003).

We take a specific study of 10 nursing students and try to establish the effect of anxiety concerning self-esteem in their life. We will use observation and the questionnaire filling to collect data. We first prepare our questionnaire using Becks depression inventory methodology.

The students are selected randomly from a college that is close to the location of the study. Every 3 of the selected students are from different ethnic groups, but the last one could come from any. The students are then asked to fill in the questionnaires (Bryson, 2003).

From the above statistics, most of the students are less affected in their fourth and third years of study as compared to their first and second years in college by anxiety. It is observed that the student with the highest rank in the Becks score perform poorly in their classwork, while the ones who rank lower perform better academically (Bryson, 2003).

The poorly performing students face obscurity in both their curricular and extra-curricular activities because of the lack of balance in self-esteem. However, this is not observed in well-performing students. The good students can easily improve in performance with minimum difficulty. In a research study by Martina and Maja, they focused on establishing the relationship between eating behavior depression and self-esteem in high school students (Gareth, 2000).

In a study carried out by RUS-MAKOVEC, it was established that the eating behavior of girls is more affected by their desire to gain or lose weight as unlike in boys. In nearly all circumstances, their eating habit is determined by their anxiety level and the state of stability of their self-esteem, since this sets the boundaries for their behavior.

However, in most cases, the eating habit of boys is not affected by their level of depressions. Furthermore, the girls are more sensitive to self-esteem issues than the boys hence the need for most of them to slim through dieting (Gareth, 2000).

On the basis of the second methodology used, the Rosenberg model, the higher the score, the higher the persons self-esteem. When the student has a higher level of self-esteem, he/she performs better. Although there are various things that affect students in their daily life, they are expected to be more articulate and resilient (Halabi, 2007).

In a study done by Jihad Halabi, the nursing students are faced with the challenge of critical thinking being affected by the level of anxiety as well as the stress level of the student. According to their research, teachers are advised to help the student nurses by introducing programmers that will be more beneficial to them. It is proposed that the teachers need to introduce more emphasis on the major areas that perfect critical thinking abilities among students (Halabi, 2007).

References

Bryson, M. K. (2003). Changing the self-esteem of nursing students. Journal of Nursing, 42, 390401.

Gareth, R. J. (2000). Eating behavior, Expression, and self-esteem in high School Students. Journal of adolescent health, 26, 361367.

Halabi, J. (2007). Critical thinking, self-esteem, and state anxiety of Nursing students. Elsevier health journals, 30, 30-46.

Introduction

This critique is concerned with the qualitative article by Sharma et al. (2019) entitled Death anxiety among elderly people: Role of gender, spirituality, and mental health. The authors conceptualized spirituality and death anxiety and provided a brief literature review concerning the research on the matter. Sharma et al. (2019) mentioned that quite conflicting findings regarding the relationship between gender and death anxiety, as well as mental health, exist. The researchers also added that the topic had not been properly analyzed in the Indian context that differs from western settings in terms of spirituality.

Statement of the Problem

The authors paid specific attention to defining the major terms and describing the phenomena of interest. They provided clear and comprehensive definitions of death anxiety and spirituality, which suggests that the study has a proper focus. Although the authors did not provide a clear justification of the utilized methodology, Sharma et al. (2019) sharply indicated the objectives of the study. The study aiming at the identification of the relationship between death anxiety and spirituality, as well as gender and mental health, was based on the use of the qualitative research design.

A certain weakness of the article in question is its lack of theoretical background. The authors do not identify the theoretical framework or philosophical underpinning that guides their research. The lack of philosophical orientation may lead to difficulties in choosing proper variables and analyzing them (Jacobsen, 2016). If researchers fail to choose a theoretical paradigm and philosophical perspective, they can interpret their findings in an inappropriate manner, which will result in low validity, as well as the relevance of their study.

Methods

The researchers utilized valid data collection tools to address the established goals of the study. Such measurements as General Health Questionnaire 28 (GHQ28), Thakur Death Anxiety Scale, and Daily Spiritual Experience Scale (DSES) were employed. These tools enabled the researchers to identify a clear relationship between the chosen variables. The validation of these measurements was conducted by different researchers. For example, Dhillon (2018) utilized the Thakur Death Anxiety Scale when examining the link between death anxiety and learned optimism with a focus on such variables as gender.

The Hindu version of DSES was validated by Husain et al. (2016), who explored the reliability and validity of the tool. Van Zyl (2018) found that the GHQ28 was an effective instrument to identify the symptoms of death anxiety among the general population. Surveys are commonly used in qualitative studies as they are instrumental in identifying peoples attitudes and views regarding diverse topics (Jacobsen, 2016). It is noteworthy that the researchers do not provide sufficient details regarding the validation of the measures they employed. Sharma et al. (2019) only mention that standard validation procedures were utilized.

Surveys are also optimal for covering large samples, which contributes to the identification of more valuable insights and themes that can be explored. The chosen data collection method was properly designed as it enabled the researchers to identify the symptoms of anxiety, measure the level of spirituality, and explore the connection between anxiety and peoples spirituality. It is necessary to note that these tools have a considerable limitation, which is that they are based on self-reporting that can be associated with a certain degree of bias.

Sampling

The authors provide a detailed description of the participants and sampling methods. The demographic data were given, and recruiting procedures were described (Sharma et al., 2019). The researchers also mentioned exclusion and inclusion criteria, which adds clarity and makes the study repeatable. The sample is appropriate (160 older patients) and sufficient for the detection of the link between the chosen variables and participants attitudes, although it is not sufficient to generalize data.

Data Analysis

Data analysis procedures were described, but few details are available. It is mentioned that standard procedures were used to score and analyze the completed questionnaires. Sharma et al. (2019) noted that Pearsons Product moment method of correlation, independent sample t-tests, and regression analysis were implemented. This section of the article is rather weak and leaves the reader with a limited understanding of the procedures. This part of the article could benefit from the inclusion of more details regarding the exact tools utilized and the validation of these instruments. At the same time, the researchers manage to remain true to the chosen design and the data. All in all, the lack of information presented in this section makes it difficult to repeat the research.

Findings

As far as the findings are concerned, they are provided concisely. The authors included tables and explanations of the data provided to them. Sharma et al. (2019) placed their findings within the context. The researchers referred to other studies conducted in the Indian and western settings, which helps readers to apprehend the findings and the relevance of the study. Sharma et al. (2019) found a direct link between death anxiety and a low level of spirituality. Regarding gender, females were more likely to experience death anxiety than males, and these correlations have been identified by other researchers as well (Sharma et al., 2019). Overall, the obtained information was consistent with the results of studies implemented in different parts of the world.

The article under consideration has quite a weak final part, where the implications and conclusions of the study are discussed. Sharma et al. (2019) only mentioned the potential use of their findings in the clinical setting as the ground for developing spirituality-centered projects for older patients. At the same time, the researchers did not include data concerning the limitations of the study and further research areas.

It is necessary to add that the limitations are rather visible, but they need to be properly articulated. For instance, the article would have been more effective if the authors had noted that a comparatively small sample prevented them from generalizing the data. It could be effective to add that the measurement of the link between the variable in diverse socio-economic groups could be the further step. These gaps make the reader rather confused about the exact conclusions and implications of the findings.

Conclusion

On balance, it is possible to note that the article by Sharma et al. (2019) provides multiple insights into the relationship between death anxiety, spirituality, and gender among older patients in the Indian context. The authors employed valid tools and presented the obtained results in detail. However, the researchers failed to provide the necessary information regarding the validation of the data collection and analysis instruments. The researchers did not include a description of the limitations of the study, major implications, and further steps that could be undertaken. These gaps make the article of limited value as it can be difficult to repeat and verify. Nevertheless, the study is valuable as it includes important details concerning particular mental health issues among a specific population in an Indian setting.

References

Dhillon, S. K. (2018). Relation of learned optimism and death anxiety: A comparative study of gender and developmental differences. International journal of basic and applied research, 8(9), 658-669.

Husain, A., Singh, R., Khan, S. M., & Khan, S. (2016). Psychometrics and standardization of the Hindi adaptation of the Daily Spiritual Experience Scale. Clinical and Experimental Psychology, 2(2), 1-6.

Jacobsen, K. H. (2016). Introduction to health research methods. Jones & Bartlett Publishers.

Sharma, P., Asthana, H. S., Gambhir, I. S., & Ranjan, J. K. (2019). Death anxiety among elderly people: Role of gender, spirituality and mental health. Indian Journal of Gerontology, 33(3), 240-254.

Van Zyl, C. (2018). A network analysis of the General Health Questionnaire. Journal of Health Psychology, 1-11.

Introduction

Anxiety and depression are considerable problems for US society and the international community. According to the Anxiety and Depression Association of America (ADAA, n.d.), anxiety disorders are the most common mental illnesses affecting almost 40 million adults in the US. These conditions also affect 25% of children from 12 to 18, which may lead to decreased academic performance, missing critical social activities, and substance abuse (ADAA, n.d.).

According to Bailey Parnell (2017), numerous studies have linked high social media (SM) use with high levels of anxiety and depression in adults and children. In her speech called Is social media hurting your mental health? Parnell (2017) claims that inappropriate use of SM may lead to considerable complications for mental health. In other words, SM use is not connected with adverse outcomes, while SM abuse may lead to addiction and mental health implications. Therefore, SM should not be seen as a negative phenomenon, it is a tool that is to be used with caution to promote positive change and experience.

Social Media as an Addiction

In todays society, SM is often viewed as an addiction because frequent SM users often demonstrate behaviors similar to those of substance abusers and alcoholics. According to Parnell (2017), with every unit of social currency, which are likes and shares, a person gets a little dose of dopamine. People experience withdrawal symptoms when they do not have access to their accounts (Parnell, 2017).

Moreover, SM users often experience problems controlling the time spent on the matter, and they always want to make one more post or check the likes one more time (Parnell, 2017). According to Hartney (2019), addictions are associated with the inability to stop using, obsession, and taking initial large doses. Considering these symptoms, SM use can be often viewed as an addiction since most of the people have witnessed similar behavior in chronic SM users.

Some people may have a higher chance of developing addictions than others. For instance, recent research demonstrates that extraversion, neuroticism, attachment style, and younger age are positively associated with developing SM addiction (Blackwell, Leaman, Tramposch, Osborne, & Liss, 2017). At the same time, almost all users are affected by the fear of missing out (FOMO), which is a certain addictive feature of SM (Blackwell et al., 2017).

As cited by Parnell (2017), 70% of students of Canadian Universities claim that they would stop using SM if they were not afraid of being out of the loop. The fact that SM use has addictive features similar to drugs having addictive constituencies makes people believe that SM users will develop an addiction at a point in time.

However, not all the people using SM develop addictions, which is confirmed by numerous studies. Parnell (2017) claims that almost 90% of 18- to 29-year-olds are on social media, but only some of them develop addictions. While there are no official statistics, it seems evident that extreme addictive behaviors are not common among SM users. SM is generally used to maintain and develop relationships, which is a neutral action.

Moreover, recent research shows that there is no statistically significant correlation between SM use and satisfaction with life (Hawi & Samaha, 2016). The analysis shows that it is poor self-esteem that causes depression and anxiety associated with SM abuse and not SM use itself (Hawi & Samaha, 2016). Therefore, healthy online behaviors, such as using it for reassurance and motivation, may lead to positive personal changes.

Instead of being viewed as an addictive substance, SM can be considered to be a drug that should be used carefully to avoid side effects. Talking to people online, sharing a positive experience, reassuring peers, or looking at funny pictures is not a bad thing. Instead, it can help people to overcome their fears, improve their mood, and find motivation. However, abuse will lead to a negative experience, similar to drug overdose or improper use.

Following the rules is the key to receiving all the benefits and avoiding the side effects of both drugs and SM use. Parnell (2017) offers a coherent framework for averted adverse outcomes, which may be treated as a general guideline. It includes recognizing the problem, auditing social media diet, creating a better online experience, and modeling good behavior. While these steps seem intuitive, it is vital that they are formulated and maintained to ensure positive outcomes.

Social Media as a Tool

While the negative impact of SM is widely discussed, the benefits of social media are undeniable. In her speech, Parnell (2017) refers to SM as the most recent tool we use to do what we have always done: tell stories and communicate with each other (11:03). Indeed, people use SM to keep in touch with distant relatives or friends, create study and groups, learn essential job skills, and express themselves (Smart Social, 2019). SM can also be utilized to spread social awareness and kindness or promote civic engagement (Smart Social, 2019).

In other words, SM is a tool that can help to address the public, find followers or like-minded people, and share happiness. A recent study proved that the use of SM by adolescents improves their ability to understand and share the feelings of their peers (Vossen, & Valkenburg, 2016). The research can be characterized by high validity and reliability due to its longitudinal design. Therefore, instead of emphasizing the dark side of the phenomenon, people may need to focus on promoting positive behavior and empathy.

SM is also a powerful instrument used by marketing and public relations managers to assess and address the needs of potential customers. Duffett (2017) states that SM marketing communications have a positive on each attitude component among adolescents.

SM is convenient since most of the merchandise and services can be ordered using SM websites. Moreover, SM helps to share feedback and experience about products, which helps to avoid dishonest service providers. Increased participation and responsiveness is associated with improved customer satisfaction, which increases the possibility of second sales (Agnihotri, Dingus, Hu, & Krush, 2016). In short, SM is a convenient tool used by business people to sell their products and address their customers.

Instead of considering SM a drug with the possibility of side effects and addiction, it is better viewed as an instrument, which can harm if misused. One cannot cook without a knife, but a malicious intent can turn the tool into a weapon. Cars are vital for moving around the country, but an unskilled driver can take the lives of innocent people in an accident. SM used by people with unprepared minds is similar to tools being used by untrained people. The risk of adverse events may be averted by receiving a proper education, and Parnells four-step framework may help to establish the principles of such education.

A Note of Caution

While SM should be viewed as a powerful tool, which can facilitate positive change, it should be used with caution. Knowing about side effects is only the first step to averting them. Almost everyone in modern society knows about the side effect of addictions or unsafe driving. However, addicts are known to be arrogant and self-reliant, which can become a considerable barrier to recovery (Nowinski, Baker, & Carroll, 1998).

Learning is worthless if a person fails to believe in what he or she has learned and implement the findings. According to Blackwell et al. (2017), the possibility of addiction to SM decreases with age; therefore, parents and adults may need to take responsibility for the younger generation and help them gain sufficient coping strategies. As Parnell (2017) mentions, people should practice safe social to share all the benefits and avert all the adverse effects. In summary, SM requires cautiousness and responsibility to stay harmless.

Conclusion

The adverse effects of SM are widely discussed in the current literature. Its improper use may be associated with addiction-like symptoms and lead to anxiety and depression. However, instead of thinking of the SM as an addictive drug, it can be treated as a useful tool, which can cause harm if misused. Instead of focusing on the negative side of the phenomenon, the benefits of SM are to be emphasized. SM can be used for learning, sharing experiences, and expressing empathy. Moreover, it can be used to promote products or services efficiently. However, people are to be taught effective strategies and skills to cope with threats, such as FOMO, which leads to addiction.

References

Agnihotri, R., Dingus, R., Hu, M. Y., & Krush, M. T. (2016). Social media: Influencing customer satisfaction in B2B sales. Industrial Marketing Management, 53, 172-180.

Anxiety and Depression Association of America. (n.d.). Facts & Statistics. Web.

Blackwell, D., Leaman, C., Tramposch, R., Osborne, C., & Liss, M. (2017). Extraversion, neuroticism, attachment style and fear of missing out as predictors of social media use and addiction. Personality and Individual Differences, 116, 69-72.

Duffett, R. G. (2017). Influence of social media marketing communications on young consumers attitudes. Young Consumers, 18(1), 19-39.

Hartney, E. (2019). Signs and symptoms of addiction. Verywell Mind. Web.

Hawi, N. S., & Samaha, M. (2016). The relations among social media addiction, self-esteem, and life satisfaction in university students. Social Science Computer Review, 35(5), 576586. Web.

Nowinski, J., Baker, S., & Carroll, K. (1998). Twelve step facilitation therapy manual. Web.

Parnell, B. (2017). Is social media hurting your mental health? Web.

Smart Social. (2019). 10 examples of the positive impact of social media. Web.

Vossen, H. G., & Valkenburg, P. M. (2016). Do social media foster or curtail adolescents empathy? A longitudinal study. Computers in Human Behavior, 63, 118-124.