Anxiety and Worry

Definitions

• Anxiety Disorder refers to a group of conditions marked by a level of distress that interferes with day-to-day living. It is the most prevalent of mental health conditions and disproportionately affects women.
• Forms of anxiety include:
  • Generalized Anxiety Disorder, which causes a general sense of tension or fear that doesn't always have a clear cause.
  • Specific anxiety, involving fears about a particular event.
  • Phobias of specific objects or situations, which may cause the phobic person to avoid certain circumstances or places.
• Social Anxiety Disorder is a formal diagnosis given to someone who has persistent patterns of anxiety about social situations.
• Separation Anxiety Disorder is a formal diagnosis given to a child who experiences persistent fear related to being separated from one or both caregivers or other family members. While some separation anxiety is a normal part of development, children with this disorder have a greater degree of separation anxiety than their peers or experience it later in their development. This may be related to:
  • The loss of a loved one.
  • Moving residence or other transitions.
  • Frequent abandonment by caregivers or other family members.
  • Loss of culture.
• Panic Disorder involves a sense of terror that can seem to strike at random. It may include chest pains, sweat, and an irregular heartbeat (palpitations). People with a panic disorder can even feel like they are choking or having a heart attack.
  • Panic attacks typically last around 10 minutes, and rarely are longer than 20 minutes. A client who complains of symptoms lasting hours is likely experiencing elevated anxiety symptoms, not a panic attack.
• Postpartum Anxiety is a form of anxiety that a woman can get in the first year after having a baby. It can make it difficult for her to eat or sleep and cause obsessive thoughts.
• Compulsive behaviors are caused by anxiety. The client feels an irresistible urge to act a certain way, even if he does not really want to act that way. Examples of compulsive behavior include:
  • Counting the number of steps it takes to get from room to room.
  • Repeating words over and over.
  • Refusing to eat food until it is situated a specific way on his plate.
  • Washing hands a certain number of times before considering them clean.

• Anxiety problems can seriously interfere with a client’s life. Reassure the client and, if applicable, the caregiver, partner, or parent that there are many effective forms of treatment for problems related to anxiety.
• Anxiety often co-occurs with other mental health conditions or life changes. Be sure to screen or refer the client for an assessment if there are other symptoms and concerns, including:
  • Past trauma.
  • Symptoms of depression.
  • Developmental issues.
  • Family-related stressors.
  • Recent life changes.
  • Problems related to social functioning.
• Women who experience high levels of anxiety after childbirth are often written off as overly nervous or overprotective new moms. It's important to validate their experiences and encourage them to practice coping strategies that will help them to calm their anxieties.
• Anxiety can increase the risk for suicide, self-harm, and substance abuse. If you suspect any of these, see the appropriate chapter.
  • Chapter D-6: Suicidal Thoughts and Plans.
  • Chapter D-7: Self-Harm and Self-Injury.
  • Chapter D-2: Substance Use and Abuse.
  Note: Refer the client to a CHA/P if the client has physical injuries that require medical attention.
• If the client has been prescribed medication to manage his anxiety, regularly monitor him for his ability to take his medication as it was prescribed.
• Children and adolescents who experience anxiety and worry may not talk about or express their worries. Instead, they may act out or appear hyperactive.
• Social Anxiety Disorder may be evidenced by the client’s avoidance of social events, recess, group activities, birthday parties, or other community events.
• Compulsive behaviors often include patterns of obsessive thoughts that typically do not go away until the client has acted out the behavior.
• Family members of those struggling with anxiety may need extra support and education on how to help their loved one.
• People who are bullied may also experience anxiety in social situations.

Referral information, including reports from medical providers, school staff, clinicians, or other sources regarding the client's wellbeing.

Releases of Information (ROIs)that are current or updated before getting information about the client from other sources.

Client history, related to general development and psychological history, including past exposure to trauma.

Treatment Plan, including a history of the presenting problem and recommended course of treatment. Review the DSM-5 for criteria on anxiety-related disorders.

General concerns

• Substance abuse
• Loss of a loved one, important relationship, job, or home
• Behavioral changes
• Physical illnesses or conditions
• Major life changes or stressors
• Family history of anxiety

Anxiety-related concerns

• Excessive worry or fear
• Feeling tense or on edge
• Avoidance of situations that trigger anxiety
• Racing thoughts
• Difficulty concentrating or paying attention
• Shortness of breath
• Uncontrollable shaking
• Sweating that is not related to exercise
• Chest pain
• Feeling dizzy or nauseated
• Easily startled
• Inability to sleep due to anxious thoughts or fears
• Extreme response to being away from parent or caregiver
• Stopping previously enjoyed activities

• Do you ever feel worried or fearful? How often do you feel this way?
• How often do you think that bad things might happen?
  • Do you ever have to check things or do certain behaviors to make sure nothing bad happens? (If yes) When did this start? How often does it happen?
  • How long have you felt this way?
• Do you avoid certain places or situations that make you feel worried or afraid?
  • What places or situations?
  • When did this start?
• How do these feelings impact your ability to take care of responsibilities at home, at work, in your family, at school, or in the community?
• Have you been experiencing:
  • Difficulty concentrating?
  • Difficulty relaxing?
  • Difficulty sleeping?
  • Feelings of fear?
  • Racing thoughts?
• When you are worried or fearful, do you ever experience:
  • Shortness of breath?
  • Shaking or trembling?
  • Excessive sweating?
  • Feeling tense?
  • Racing heartbeat?
  • Unexplained aches or pains (particularly pains in your chest)?
  • Feelings of dizziness or nausea?

Routinely review BHA/P Services and Common Interventions for how to prepare for and conduct interventions during appointments and for information on the levels of service available throughout Alaska.

When working with clients experiencing anxiety and worry, try to help them figure out what factors contribute to symptoms of anxiety. Do they have an environmental cue or trigger, such as going to the store for groceries, knowing that they are on a very tight budget, or riding on a four-wheeler after being in an accident? Internal experiences can also lead to anxiety and worry. Regardless of what precipitates the symptoms, to help the client, you will want to understand the frequency, intensity, and duration of anxiety symptoms. Tracking and understanding the process of their anxiety can be an extremely beneficial intervention in and of itself; however, strategies to target and reduce the intensity and duration of anxious symptoms are also very important.

Some evidence-based strategies include:

• Diaphragmatic breathing.
• Mindfulness/grounding exercises.
• Self-monitoring.
• Psychoeducation about anxiety symptoms and emotionally driven behaviors.

• A medical provider to address concerns physical health concerns or consider the prescription for medications related to the anxiety.
• A clinician for a mental health assessment related to the anxiety.

Be sure you are familiar with the information in Mandatory Reporting and Duty to Warn and Documentation and Billing. Report instances of the following, consistent with your organization's policies and procedures:

• Child abuse or neglect.
• Suicidal thoughts or plans.
• Intentions to cause harm or injury to the self or others.