Care of Clients with Maladaptive Patterns of

Behavior, Acute and Chronic

INSTRUCTOR’S GUIDE BS NURSING / THIRD YEAR
Session # 14

LESSON TITLE: ANXIETY-RELATED DISORDERS Materials:

Textbook, Notebook, Bondpaper, Pen, and Paper
LEARNING OUTCOMES:
References
At the end of the lesson, the nursing student can:

1. Identify and differentiate various anxiety-related disorders Videbeck, S. L. (2014). Mental and Psychiatric
2. Assess the mental and physical symptoms of anxiety- Health Nursing. 6th Edition. Lippincott, Williams
related disorders and Wilkins. Philadelphia, PA.
3. Develop and implement evidence-based care plans
4. Apply therapeutic communication techniques in the care of [Link]
patients with anxiety-related disorders families/anxiety-disorders/what-are-anxiety-
5. Evaluate the effectiveness of interventions for anxiety- disorders
related disorders
[Link]
73566/

LESSON REVIEW / PREVIEW & HOOK ACTIVITY (20 minutes)

Instruction: It is time to test your vocabulary. In the spaces provided, write the equivalent words of the words given below:
a. Panic Attack: ________________________
b. Phobia: ________________________
c. Generalized Anxiety: ________________________
d. Social Anxiety: ________________________
e. Separation Anxiety: ________________________

MAIN LESSON (50 minutes)

In general, for a person to be diagnosed with an anxiety disorder, the fear or anxiety must:
1. Be out of proportion to the situation or age inappropriate
2. Hinder ability to function normally

TYPES OF ANXIETY DISORDERS

A. Panic Attack/Disorder
➢ Composed of discrete episodes of panic attacks lasting 15-30 minutes
➢ Described by clients as rapid, intense, and escalating fear and anxiety
➢ Client experiences great emotional fear, and physiologic discomfort associated with severe or panic anxiety
➢ A feeling of overwhelmingly intense anxiety. Symptoms generally include: sweating; palpitations; tremors;
shortness of breath; chest pain; suffocation; nausea; dizziness; abdominal distress; chills; paresthesia; hot flashes;
being worried, tense, depressed or sad; depersonalization; derealization; feeling of losing control or going insane;
being consumed by worry; being confused or disoriented
➢ Diagnosed through recurrent, unexpected panic attacks followed by 1 month of persistent worry over future attacks
➢ 75% of panic disorder cases occur with no environmental trigger or are due to an experience of agoraphobia (fear
of places with no exits or escape)

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 ➢ Mostly affects those in their late adolescence to mid-30s
➢ In extreme cases, clients become home-bound; they fear going out of the house or out of a specific area
(avoidance behavior, displayed through agoraphobia)

Avoidance Behavior is a result of:

1. Primary Gain: relief of anxiety by performing anxiety-relieving activities such as staying in the house if going to a
place is causing the client anxiety
2. Secondary Gain: the attention received from others as a result of these behaviors. For instance, the person with
agoraphobia may receive attention and caring concern from family members, who also assume all the
responsibilities of family life outside the home (e.g., work, shopping). Essentially these compassionate significant
others become enablers of the self-imprisonment of the person with agoraphobia.

B. Phobias
➢ An illogical, intense, and persistent fear of a specific object or social situation
➢ Causes extreme distress and interferes with normal functioning of the individual as this leads to anxiety and fear
➢ People know that their fear is unusual and irrational but are powerless to stop it
➢ Individuals then develop anticipatory anxiety even by just thinking about the object or situation
➢ They engage in avoidance behaviors to minimize/control their anxiety and fear which may limit their lives
➢ Symptoms of a phobia are generally similar to the signs and symptoms of a panic attack
➢ Occurs upon exposure to the object, animal, or situation or when thinking that they will be exposed to the trigger
(cause of the phobia)

3 Categories of Phobias
1. Agoraphobia: fear or anxiety of places from which escape is difficult
2. Specific Phobia: fear or anxiety caused by an object
3. Social Phobia: fear or anxiety caused by social or performance situations which leads the person to panic and
become incapacitated (unable to move or perform)

Common Phobias
• Acrophobia: fear of heights
• Arachnophobia: fear of spiders
• Astraphobia: fear of thunder and lightning
• Autophobia: fear of being alone
• Claustrophobia: fear of confined or crowded spaces
• Hemophobia: fear of blood
• Hydrophobia: fear of water
• Ophidiophobia: fear of snakes
• Zoophobia: fear of animals

Therapy
1. Behavior Therapy: helps identify anxiety responses and relaxation techniques when phobia occurs
2. Systematic Desensitization: progressive exposure to phobia-inducing object or situation, done gradually and
progressively
3. Flooding: rapid desensitization; direct confrontation with a phobia-inducing object or situation

C. Generalized Anxiety Disorder

➢ Involves persistent and excessive worry that interferes with daily activities.
➢ This ongoing worry and tension may be accompanied by physical symptoms, such as restlessness, feeling on
edge or easily fatigued, difficulty concentrating, muscle tension or problems sleeping.
➢ The worries focus on everyday things such as job responsibilities, family health, or minor matters such as chores,
car repairs, or appointments.

D. Social Anxiety Disorder (previously called Social Phobia)

➢ A person with social anxiety disorder has significant anxiety and discomfort about being embarrassed, humiliated,
rejected, or looked down on in social interactions.

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 ➢ People with this disorder will try to avoid the situation or endure it with great anxiety
➢ Common examples are extreme fear of public speaking, meeting new people or eating/drinking in public.
➢ The fear or anxiety causes problems with daily functioning and lasts at least six months.

E. Separation Anxiety Disorder

➢ A person with separation anxiety disorder is excessively fearful or anxious about separation from those with
whom he or she is attached.
➢ The feeling is beyond what is appropriate for the person’s age, persists (at least four weeks in children and six
months in adults) and causes problems functioning.
➢ A person with separation anxiety disorder may be persistently worried about losing the person closest to him or
her, may be reluctant or refuse to go out or sleep away from home or without that person, or may experience
nightmares about separation.
➢ Physical symptoms of distress often develop in childhood, but symptoms can carry though adulthood.

Treatment
For most anxiety disorders, the following are given:
• Antidepressants. Modern antidepressants (SSRIs and SNRIs) are typically the first drugs prescribed to
someone with an anxiety disorder. Examples of SSRIs are Escitalopram (Lexapro) and Fluoxetine (Prozac).
SNRIs include Duloxetine (Cymbalta)and Venlafaxine (Effexor).
• Cognitive behavioral therapy (CBT): This common type of psychotherapy that teaches clients how to turn
negative or panic-causing thoughts and behaviors into positive ones. Clients learn ways to carefully approach
and manage fearful or worrisome situations without anxiety.

CASELET: Agoraphobia

Background

In the bustling city of Manila, a 32-year-old woman named Rosa lives with her extended family in a small apartment. Rosa
used to work as a sales assistant in a busy mall but has been unemployed for the past year due to her worsening
agoraphobia. This condition has severely limited her ability to leave the house, causing distress for her and her family.

The Case of Rosa

Rosa’s agoraphobia began subtly. Initially, she avoided crowded places like markets and public transportation. Gradually,
her fear extended to more everyday situations, such as going to church or attending family gatherings. Her heart races, she
sweats profusely, and experiences overwhelming panic when she even thinks about leaving the safety of her home.

Rosa's condition has significantly affected her daily life. She relies heavily on her family for all outside tasks, such as grocery
shopping and attending important appointments. Her family, though supportive, struggles to understand her condition. They
are concerned about the cultural stigma associated with mental health issues in their community and often suggest that she
is just being overly sensitive or should pray more to overcome her fears.

Specific scenarios unique to Rosa’s experience include:

• Fiestas and Community Events: In her tightly-knit barangay, community events are a major part of social life.
Rosa’s inability to participate in these events, such as town fiestas and religious processions, has led to feelings of
isolation and embarrassment.
• Daily Commute and Transportation: The chaotic nature of Manila’s public transportation system, with its
crowded jeepneys and buses, exacerbates Rosa’s anxiety. The mere thought of commuting triggers intense fear,
further isolating her from opportunities and social interactions.
• Family Expectations and Responsibilities: Rosa feels guilty for not being able to contribute to the household
and worries about being a burden to her family. This guilt worsens her mental state, creating a vicious cycle.

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Questions

1. What specific nursing interventions can be implemented to help Rosa manage her agoraphobia?
2. What strategies can be employed by nurses to gradually desensitize Rosa to her fears of leaving the
house?
3. What role can telehealth and virtual consultations play in Rosa’s treatment plan, and how can nurses
facilitate access to these services?

CHECK FOR UNDERSTANDING (20 minutes)

You will answer and rationalize this by yourself. This will be recorded as your quiz. One (1) point will be given to the correct
answer and another one (1) point for the correct rationale. Superimpositions or erasures in your answer/rationale are not
allowed. You are given 20 minutes for this activity:

Multiple Choice

1. The best goal for a client learning a relaxation technique is that the client will:
A. Confront the source of anxiety directly C. Report no episodes of anxiety
B. Experience anxiety without feeling overwhelmed D. Suppress anxious feelings
ANSWER: _____
RATIONALE: ______________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

2. Which of the following would be the initial intervention for a client having a panic attack?
A. Involve the client in a physical activity. C. Remain with the client.
B. Offer a distraction such as music. D. Teach the client a relaxation technique.
ANSWER: _____
RATIONALE: ______________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

3. A child being constantly bullied in school has developed an aversion to going to school exhibited by excessive
drowsiness while preparing for school, crying and temper tantrums in the morning and not wanting to go to school. This
behavior is an example of:
A. Primary Gain C. Panic Attack
B. Secondary Gain D. School Phobia
ANSWER: _____
RATIONALE: ______________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

4. While assessing an outpatient client with a panic disorder, the nurse completes a thorough health history and physical
examination. Which of the following is most significant for this client?
A. Compulsive behavior C. Fear of flying
B. Sense of impending doom D. Predictable episodes
ANSWER: _____
RATIONALE: ______________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

5. A client experiencing a panic attack would display which physical symptom?

A. Fear of dying C. Palpitations and abdominal distress
B. Depersonalization D. Restlessness and pacing
ANSWER: _____
RATIONALE: ______________________________________________________________________________________

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6. You are caring for a man who has a fear of the outside world. He only comes outside when accompanied by his wife.
Based on this situation, the man is likely experiencing:
A. Social Phobia C. Claustrophobia
B. Agoraphobia D. Hypochondriasis
ANSWER: _____
RATIONALE: ______________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

7. Jordan is a client with a fear of air travel. He is being treated for phobic disorder. The treatment method involves
systematic desensitization. The nurse would consider the treatment successful if:
A. Jordan plans a trip requiring air travel.
B. Jordan takes a short trip in an airplane.
C. Jordan recognizes the unrealistic nature of the fear of riding on airplanes.
D. Jordan verbalizes a decreased fear about air travel.
ANSWER: _____
RATIONALE: ______________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

8. Social anxiety disorder is:

A. Excessive worry bouts triggered by object or situation
B. Anxiety and discomfort from being embarrassed
C. Intense anxiety from separation with significant others
D. A persistent fear of heights
ANSWER: _____
RATIONALE: ______________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

9. One important issue in therapy for specific phobias is to address:

A. Ensure the individual never comes in contact with the phobic event or situation
B. The phobic beliefs that sufferers hold about their phobic event or situation
C. The individual has ample opportunity to talk about the phobic event
D. That any dreams about the phobic event or situation are analyzed
ANSWER: _____
RATIONALE: ______________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

10. A nurse who is planning a quick remedy to her male client’s phobia plans to introduce him to the fear-inducing stimuli
during the first session of therapy. This treatment is known as:
A. Desensitization C. Behavior Desensitization
B. Systematic Desensitization D. Flooding Desensitization
ANSWER: _____
RATIONALE: ______________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

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RATIONALIZATION ACTIVITY (THIS WILL BE DONE DURING THE FACE-TO-FACE INTERACTION)
The instructor will now rationalize the answers to the students. You can now ask questions and debate among yourselves.
Write the correct answer and correct/additional ratio in the space provided.

1. ANSWER: _____
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2. ANSWER: _____
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10. ANSWER: _____

RATIONALE: __________________________________________________________________________________
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LESSON WRAP-UP (20 minutes)

You will now mark (encircle) the session you have finished today in the tracker below. This is simply a visual to help you
track how much work you have accomplished and how much work there is left to do.

You are done with the session! Let’s track your progress.

AL Strategy: Think, Pair, Share

Instruction: Form a pair with the person on your right. You will be sharing insights on the question provided below. You will
then be writing your answer on a sheet of paper. After preparing your answer, you will be called randomly to share your
insights to the class.

The question goes like this:

“What do you think is the most common anxiety disorder today and what will be your nursing
interventions?”

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