Anxiety is a feeling of uneasiness, uncertainly, and helpness. It is a state of tension.

Sometimes it
associated with feelings of draed or doom. Anxiety is the normal emotional response to a real or
imagined threat or stressor.

Anxiety serves several puposes. It is a warning of impending danger. Mild anxiety can increase learning
by helping with concentration and focus. Anxiety can also provide motivation. However, uncontrolled
anxiety often leads to ineffective and maladaltive behaviors. Anxiety is a normal part of survival and
growth. How individuals use and control anxiety is a measure of mental health and illness.

Continuum of anxiety responses

Reactions to anxiety occur along a continuum of behavioural responses (Stuart, 2013)(Fig. 18.1).
adaptive responses to anxiety result in positive outcomes. New learning and greater self esteem result
from coping successfully with anxiety. Positively focused anxiety helps us to adapt, learn, and grow from
our experiences. Maladaptive responses to anxiety are ineffective to attempts to cope. They do nothing
to resolve the problem or eliminate uneasy feelings.

Reponses to anxiety occur on four levels, ranging from mild to panic. During periods of anxiety, physical,
intellectual, emotional, and behavioral responses help us cope. In periods of severe anxiety, the
autonomic nervous system stimulates the fight-or-flight response, which triggers ,many physical
changes. Decreasing anxiety is an important intervention in every health care situation.

Types of anxiety

Anxiety occurs as the result of a perceived threat to one’s self. The threat itself may be real or occur in
response to what we think is happening. The actual object of anxiety often cannot be identified, but the
feelings associated with the experience are all too real. For the sake of discussion, anxiety is calssified
by types. Signal anxiety is a learned response to an anticipated event. The usually calm student who
becomes nauseated during examinations illustrates signal anxiety. An anxiety state occurs when one’s
coping abilities become overwhelmed and emotional control is lost. Many emergencies, accidents, and
traumas are associated with anxiety states. Last is an anxiety trait, which is a learned component of the
personality. Persons with anxiety traits react with anxiety in relatively low stress situations. The
adolescent who always gives reasons for his or her behavior, even when not requested, illustrates an
example of a person with an anxiety trait.

Types of anxiety responses

“People usually experience anxiety about events they cannot control or predict or about events that
seem threatening or dangerous” (Microsoft Encarta Online Encyclopedia, 2011). We all experience
anxiety. New situations, unfamiliar environments, or tasks for which we are not prepared are often
associated with anxiety.

Levels of Anxiety

1. Mild
 a. Physical

- Vital signs normal

- Minimal muscle tension

- Pupils normal, constricted

b. Cognitive/Perceptual

- Perceptual filed is broad

- Awareness of multiple environmental and internal stimuli

- Thoughts may be random, but controlled

c. Emotional/Behavioral

- Feelings of relative comfort and safety

- Relaxed, calm appearance and voice

- Performance is automatic; habitual behaviors occur

2. Moderate

a. Physical

- Vital signs normal or slightly elevated

- Tension experienced may be uncomfortable or pleasurable (labeled as “tense” or

“excited”)

b. Cognitive/Perceptual

- Alert; perception narrowed, focused

- Optimal state problem solving and learning

- Attentive

c. Emotional/Behavioral

- Feelings of readliness and challenge, energized

- Engange in competitive activity and learn new skills

- Voice, facial expression interested or concerned

3. Severe
 a. Physical

- Fight-or-flight response

- Autonomic nervous system excessively stimulated (vital signs increased, sweating

increased, urinary urgency and frequency, diarrhea, dry mouth, appetite decreased,
pupils dilated)

- Muscles rigid, tense

- Sense affected; hearing decreased, pain sensation decreased

b. Cognitive/Perceptual

- Perceptual field greatly narrowed

- Problem solving difficult

- Selective attention (focus on one detail)

- Selective inattention (block out threatening stimuli)

- Distortion of time (things seem faster or slower than actual)

- Dissociative tendencies; vigilambulism (automatic behavior)

c. Emotional/Behavioral

- Feelz threatened; startles with new stimuli; feels on “overload”

- Activity may increase or decrease (may pace, run away, wring hands, moan, shake,
stutter, become very disorganized or withdrawn, freeze in position/unable to move)

- May seem and feel depressed

- Demonstrates denial; may complain of aches or pains; may be agitated or irritable

- Need for space increased

- Eyes may dart around room, or gaze may be fixed

- May close eyes to shut out environment

4. Panic

a. Physical

- The preceding symptoms escalate until sympathetic nervous system release occurs

- Person may become pale, blod pressure decreases, hypotension

 - Muscle coordination poor

- Pain, hearing sensations minimal

b. Cognitive/Perceptual

- Perception totally scattered or closed

- Unable to take in stimuli

- Problem solving and logical thinking highly improbable

- Perception on unreality about self, environment, or event

- Dissociation may occur

c. Emotional/Behavioral

- Feels helpless with total loss of control

- May be angry, terrified; may become combative or totally withdrawn, cry, run

- Completely disorganized

- Behavior is usually extremely active or inactive

The physical symptoms of anxiety include muscle tension, fidgeting, headaches, and problems with
sleep. Higher levels of anxiety trigger the fight-orflight reaction and result nausea, dizziness, sweating,
increased heart rate, and elevated blood pressure.

Most individuals deal with anxiety by using a number of behaviors or coping mechanism that help
decrease discomfort. All coping methods reduce anxiety, but if used to extreme, serious mental and
physical health problems can result. Anxiety is not produced. A good example is the individual who sees
everyone in his audience smiling when he is about to give speech. The threat (audience disampproval) is
reduced by the perception of smiling faces. Another coping mechanism in the intellectual realm is
meditation, which helps clear and refocus one’s mental energies.

Spiritual coping methods include faith, prayer, and ritual. Attending religious services or communing
with nature can reduce anxiety. Many cultural rituals also help individuals cope.

Emotional responses include crying, communicating or sharing one’s anxious feelings, and using ego
defense mechanisms.

Defense mechanisms
The psychological strategies that help to lessen anxietious feelings are called (ego) defense mechanisms.
These are normal psychological self-preserving behaviors. Their purpose is to reduce or avoid negative
states such as conflict, frustration, anxiety, and stress. They are used when one feels threatened.
Employing defense mechanisms helps to avoid negative emotional states, but usually individuals are not
consciously aware of their use. No matter which mechanism is used, the goal is to reduce uncomfortable
negative emotions. Common defense mechanism

1. Compensation

Compensation is attempt to overcome feelings of inferiority or make up for deficiency. Example

a girl who thinks she cannot sing studies to become an expert pianist.

2. Conversion

Conversation is channeling of unbearable anxieties into body signs and symptoms. Example a
boy who injured an animal by kicking it develops a painful limp.

3. Denial

Denial is refusal to acknowledge conflict and thus escapes reality of situation. Example a child
covered wih chocolate refuses to admit eating candy.

4. Displacement

Displacement is redirecting of energies to another person or object. Example a husband shouts

at his wife, the wife then berates her child, who then scolds the dog.

5. Dissociation

Dissociation is separation of emotions from situation; removal of painful anxieties from

conscious awareness. Example soldier casually describes the battle in which he lost his legs.

6. Fantasy

Fantasy is distortion of unacceptable wishes behaviors. Example a teenager doing poorly in

school daydreams about owning private jet.

7. Identification

Identification is taking on of personal characteristics of admired person to conceal own feelings

of inadequacy. Example adolescent dress and behave like the member of a popular singing
group.

8. Intellectualization
 Intellectualization is focusing of attention on technical or logical aspects of threatening situation.
Example a wife describes the details of nurses unsuccessful attempts to prevent the death of her
husband.

9. Isolation

Isolation is separation of anxious feelings from content to cope unemotionally with topics that
would normally be overwhelming. Example a soldier humorously describes how he was seriously
wounded in combat.

10. Projection

Projection is putting of one’s own unacceptable thoughts, wishes emotions onto others.
Esample a woman is afraid to left her house because she knows people will ridicule her.

11. Rationalization

Rationalization is use of a “good” (but not real) reason explain behavior to make unacceptable
motivation more acceptable. Example, a student just justifies failing an examination by saying
that there was too much material to cover.

12. Reaction formation

Reaction formation is development of conscious attitudes and behavior patterns that are
opposite to what one really would like to have (Stuart, 2013). Example a young man with
homosexual feelings, which he finds to be threatening, engages in excessive heterosexual
activities.

13. Regression

Regression is coping with present conflict, stress by returning to earlier, more secure stage of
life. Example a 4-year-old boy whose parents are going through divorce starts to suck his thumb
and wet his pants.

14. Restitution

Restitution is giving back to resolve guilt feelings. Example a man argues with his wife and then
buys her roses.

15. Sublimation

Sublimation is unconscious channeling of unacceptable behaviors into constructive, more

socially approved areas. Example a hostile young man who enjoys fighting becomes a football
player.

16. Substitution
 Substitution is suppressing anxiety by replacing inappropriate behavior with one that is more
acceptable. Example a man who is attracted to pornography campaigns to ban adult bookstores
in his community.

17. Suppression

Suppression is removal of conflict by removing anxiety from consciousness. Example a woman

with a family history of breast cancer “forgets” her appointment for a mammogram.

18. Symbolization

Symbolization iis use of an unrelated object to represent hidden area. Example a girl who feels
significant draws a picture of her family in which she is the smallest character.

19. Undoing

Undoing is inappropriate behavior that is followed by acts to take away or reverse action and
decrease guilt and anxiety. Example a man physically abuses his wife and then cleans her
wounds and nurses her back to health.

Crisis

When one’s ability to cope with anxiety is overwhelmed, a crisis results. One’s defense mechanisms are
no longer useful. No efforts to cope with the situation lessen one’s anxiety. During a crisis, new coping
behaviors must be developed to successfully resolve the source problem.

Ineffective coping

Anxiety is a normal part of everyday life. It occurs in all cultures. Anxiety is a protective state that
motivates us to pursue goals and respon to threats. However, too little or too much anxiety can lead to
ineffective coping behaviors and cause more problems. Too little anxiety can result in lack of attention or
focus in important situations. Too much anxiety can overwhelm and immobilize an individual and result
in an inability to accomplish important tasks. When ego defense mechanisms become the primary
means of dealing with anxiety, they replace problem solving and other positive ways to coping. The use
of ineffective coping behaviors can lead to too much anxiety and result in an anxiety disorder.

Self awareness and Anxiety

A basic characteristic of anxiety is that it is contagious. Like a cold or influenza virus, anxiety is easily
transmitted to others. Slients have an uncanny ability to focus on the anxiety levels of their health care
providers. Sometimes the client becomes the therapeutic agent for an anxious caregiver.

The therapeutic relationship is built on trust. Inherent n that trust is the care provider’s responsibility to
listen and communicate ineffectively. High levels of anxiety can impair our ability to interact
therapeutically with the client. For this reason, it is important for caregivers to recognize and cope
effectively with their own anxieties. Remember, we may not choose our anxieties, but we do choose
how we deal with them.

Theories relating to Anxiety

A number of theories have been developed since Sigmund Freud first listed anxiety as a defense
mechanism. Today the causes of anxiety are still uncertain, but research indicates that a combination of
biological, psychosocial, and environmental factors is involved. A few of the more well known theories
of anxiety are discussed here.

Biological Models

The biological group of theories attempts to find a biological or physical basis for anxiety. The work of
Charles Darwin first posed the possibility of a link between emotions and the ability to adapt. Later,
Hans Selye demonstrated a connection between the perception of stress and physical changes in the
body with his fight-or-flight response. During 1990s, “the decade of the brain,” many advances in the
understanding of emotions and mental illness were made. Today we are beginning to gain an
understanding of the role emotions play in health and illness as researchers unveil new information.

One of the most popular current theories of anxiety relates to the role of neurochemicals. Research into
the role of these body chemicals, called neurotransmitters, has resulted in evidence that emotions may
be linked to changes brain biochemistry. Anxiety is thought to result from the dysfunction of two or
more neurotransmitters. Some studies have demonstrated inappropriately activated norepinephrine
and imbalances between this and other neurotransmitters. Further research is being done to investigate
specific medications designs to alter neurotransmitter activity. Other ongoing studies are investigating
the role of the autonomic nervous system in the development of anxiety. Anxiety commonly occurs with
other problems. Many medical disorders, hormonal and imbalance, problems with substance use, eating
and sleeping disorders, headaches, and even fatigue are related to anxiety.

Psychodynamic Model

According to Freud, anxiety results from a conflict between two opposing forces within the personality
the ego and the id. Neurotic or maladaptive behaviors are the result of attempts to defend oneself
against anxiety, just as adaptive behaviors do. Psychotherapists today have broadened the
psychoanalytic theory to define anxiety as the result of a conflict between two opposing forces within an
individual.

Interpersonal Model

With the interpersonal model, anxiety is explained in terms of interactions with others. Anxiety develops
when early childhood interactions with significant others result in negative outcomes, such as
disaaproval. Over time, an individual’s responses to anxiety form the basis for low self esteem and por
self concept.
Interpersonal theorists work with a broad definition of anxiety. Harry Stack Sullivan believed that
children acquire the values of their parents because they are dependent on others for approval or
disapproval. In adulthood, individuals cope with anxiety based on their perceptions in addition to how
they were taught to cope with conflict as children. Using this interpersonal model, one can see the
importance of early assessment and intervention for children who are anxious.

Behavioral Model

The bahvioral theories consider anxiety a learned response. Children who experienced anxiety in one
situation link those feelings to more general situations. Anxiety results when individuals encounter a
sginal that reminds them of earlier anxious times. Thus individuals learn to react with anxiety by linking
anxious experiences.

Other Model

Other theories explain anxiety as the result of a loss of life’s meaning (existential theory). Environmental
models tie anxiety with uncontrollable events or situations. Fires, floods, and other natural disasters,
along with assaults and human-induced traumas. All serve as stressors for the individual.

Many health care providers have closen to view anxiety from a holistic mode. Anxiety is viewed as in
fluencing every realm of human functioning. Physical reactions, such as the fight-or-filght reaction, result
from anxiety.

Dapus :

Morrison, Valfre. 2017. Foundations of Mental Health Care Six Edition. Elsevier