Anxiety for Stephen Ministers and others who care June 11, 2013 Tess Judge-Ellis DNP, FNP-BC, PMHNP-BC

By the end of the evening… Understand anxiety as a psychiatric illness – What are anxiety disorders? – How does anxiety differ from nervousness? – What causes anxiety disorders? – Treatment overview. Plenty of time to talk and dialogue

“Worrying is carrying tomorrow's load with today's strength- carrying two days at once. It is moving into tomorrow ahead of time. Worrying doesn't empty tomorrow of its sorrow, it empties today of its strength.” ― Corrie ten BoomCorrie ten Boom

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

Normal reaction to fear Can be very helpful and motivating Obvious external threat Short lived Anxiety disorder Overwhelming Time consuming Excessive response No obvious external threat Physical, cognitive, emotional and behavioral components Normal nerves or anxiety disorder?

Anxiety disorders-most common Generalized anxiety disorder Panic disorder Social anxiety/phobias Obsessive compulsive disorder Post traumatic stress disorder

Generalized anxiety disorder – Excessive anxiety, difficulty controlling the worry, out of proportion worry. – Other symptoms (e.g. concentration off, trouble sleeping, musculoskeletal complaints) – Most common anxiety disorder

Panic disorder – Recurrent, unexpected panic attacks along with concern that another will reoccur or fear of the consequences of another attack “e.g. heart attack.” – May or may not have agoraphobia

Social anxiety/phobia – Fear of social situations where the person may become embarrassed or feel subject to high degree of scrutiny. – Disruptive to family, social or work.

Obsessive compulsive disorder – Obsessive thoughts that cause distress or anxiety. Compulsive thoughts or behaviors are done in attempt to neutralize the obsessive thoughts. – Time consuming – Interfering – Men=women

Post traumatic stress disorder – Exposure to traumatic event where the person felt intense fear or helplessness followed with re- experiencing, avoidance/numbing and arousal. – Prevalence General public= 6-8% Vietnam veterans= 30% Iraq/Afghanistan= 15%

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

Anxiety

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

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

Why do anxiety disorders develop? A combination of multiple factors Genetic Developmental Environmental Psychological Biologic

Chemical imbalance Neurotransmitters Serotonin GABA Glutamate Norepinephrine

Don't believe everything you think. “ Man is not worried by real problems so much as by his imagined anxieties about real problems” ― EpictetusEpictetus

Anxiety disorders-treatment Psychotherapy/counseling – Cognitive behavioral therapy (CBT) “stinkin’ thinkin’”

Anxiety disorders-treatment Medications – Antidepressants – Examples: Prozac (fluoxetine), Zoloft (sertraline), Effexor (venlafaxine) – Antianxiety medications – Examples: Klonapin (clonazepam), Ativan (lorazepam), Xanax (alprazolam)

Exercise Substance use/misuse Yoga Meditation

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

Resources Community Mental Health Center for Mid- Eastern Iowa – – The Crisis Center of Johnson County – Mindfulness Based Stress Reduction – Classes at UIHC