Determine level of anxiety provide basis for

Determine level of anxiety, provide basis for intervention
 Accept patients’ feelings of anxiety
o Prevent anxiety transferred
o Prevent anxiety from escalating
 Provide emotional security
o Give factual information. Medication, time, procedure, treatment,
expectations. FACTS!
o Use self in a therapeutic way
o Nonjudgement, silence, offer self, interpersonal qualities, therapeutic
communication
 Promote safety
o Physical & physiologic (sitter)
o Meet basic needs (hydration, nutrition, elimination, hygiene)
 Avoid making demands or requiring decisions
o Reduce further anxiety, confusion, agitation
 Promote sleep (opposite of anxiety)
o Sleep reduces CNS tension

o Warm bath, light snack, quiet task, reading, music
 Provide medication
o Reduces anxiety at the bio-cellular level. Physiologic support
o Requires gradual, long term tapering
 Protect from impulsive acts
o Aggression, self-harm = frequent observation, 1:1 sitter
 Allow defense mechanisms
o Protective, add to patient
o Maladaptive, for survival if used sparingly
o Temporarily reduces anxiety
 Initially allow “worry time” or “compulsive time”
o Gradually reduce, wean-off
 Reduce physical stimulants
o Pain, discomfort, caffeine
 Reduce environmental stimulants
o Noise, lighting, temp
 Treat physical complaints as matter of fact
o Not to make a big deal out of it. Minimize. Don’t increase patient’s anxiety
o Decrease intensity of anxiety
o Avoid confrontation concerning the physical defense (patient says I cent
feed myself. Nurses sets up tray and tells them to try their best and you will
come back and check on them)
 Provide recreational and diversional activities
o Teaches new behavior
o Provide distraction and occupation
o Promote rest and activity (walks, puzzles, coloring books)
 Work in the “here and now”
o Prevent reoccurrence. What can be changed now to support the future
 Provide feedback on anxious behaviors
o Increase self-awareness, empowerment (point out picking at hair, kicking
leg)
 Identify sources of anxiety
o Increase awareness, empowerment (work, boss, relationships, kids, school)
 Discuss effects of ineffective coping
o Promote insight, alternatives for change (drinking, sleeping, smoking)
 Explore secondary gains
 Explore alternate coping behaviors
o Options for adaptive behaviors
Behavior modification: Based on premise that behaviors are learned; maladaptive
behaviors can be eliminated, and healthy behaviors can be learned!!!
 Role modeling
o Modeling adaptive behaviors through practice and imitation
o Deep breathing
o Guided imagery
o Exercise
o Journaling
 Operant conditioning

o Positive reinforcement
o Receiving rewards for adaptive behaviors
o Self “pat on the back”
 Systematic desensitization
o Exposure to phobic/obsessive stimulus in gradual amounts over time
o While avoiding use of the rituals or avoidant behaviors (no fear) Reduces
emotional response
o Develops tolerance “give it a try”
 Cognitive behavioral therapy (CBT)
o Mind over matter
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