Week 6 Flashcards
(83 cards)
1
Q
What is agoraphobia?
A
anxiety about being in places or situations from which escape might be difficult ( or embarrassing) or in which help may not be available in the event of having a panic attack or panic like symptoms. Ie using public transport / shopping.
2
Q
What is Anacastic Personality?
A
associated with client’s with OCD where preoccupation with orderliness, need for control and detail, can be rigid and inflexible.
3
Q
What is Anxiety?
A
Feeling apprehension caused by anticipation of danger, which may be internal or external threat to one’s integrity.
4
Q
What is Behaviour Therapy?
A
interventions that reinforce desired behaviours and reducing undesirable behaviours.
5
Q
What is a compulsion?
A
the recurrent thought or behaviours such as counting, checking, touching.
6
Q
What is exposure Therapy?
A
the client is exposed to the feared item/situation until the client no longer experiences anxiety
7
Q
What is Fear?
A
intense unpleasant reactions to a known threat
8
Q
What is flooding?
A
a therapeutic approach used to expose the client to the anxiety provoking situation in a sustained manner until the client’s anxiety dissipates
9
Q
What are Obsessions?
A
intrusive ideas, emotions or impulses that a client cannot remove from their conscious state
10
Q
What is a Phobia?
A
an intense irrational fear of situations, places or people, where the level of distress experienced is excessive to the level of threat to the client.
11
Q
What is a Social Phobia?
A
client’s feel they will be negatively judged by others and believe themselves to be flawed / worthless if found to be incompetent, therefore avoid situations or complete tasks to perfection as means of coping.
12
Q
What is a Specific Phobia?
A
intense fear of a particular situation / object, when confronted with the item become highly anxious & have a panic attack and go to excess lengths to avoid the feared situation/object. Ie. Needle phobic
13
Q
What is systematic desensitization?
A
the client utilises muscle relaxation techniques when progressively exposed to the anxiety provoking situation
14
Q
What levels of Anxiety are there?
A
Anxiety can be a normal and healthy emotion that in mild forms can motivate us to act and complete tasks, i.e.; assignments.
However when anxiety is experienced in sustained moderate or severe levels this reduces your ability to complete tasks to the best of your ability and anxiety can manifest itself as disturbances in;
•Cognition
•Affect
•Behaviour
•Physical status
15
Q
Cognitive responses to Anxiety
A
Impaired attention •Poor concentration •Forgetfulness •Errors in judgement •Preoccupation •Blocking of thoughts •Decreased perceptual field •Frightening visual images •Reduced creativity •Diminished productivity •Confusion •Hyper vigilance •Self consciousness •Loss of objectivity •Fear of loosing control •Fear of injury or death
16
Q
Affective responses to Anxiety?
A
- Edgy
- Impatient
- Uneasy
- Tense
- Nervous
- Fearful
- Fright
- Alarm
- Terror
- Jittery
- Jumpy
17
Q
Behavioural responses to Anxiety
A
- Restlessness
- Physical tension
- Tremors
- Startle reactions
- Rapid speech
- Lack of coordination
- Accident prone
- Interpersonal withdrawal
- Inhibited
- Avoidance
- Hyperventilate
18
Q
Physical responses to Anxiety
A
- Increased blood pressure
- Palpitations
- Decreased blood pressure
- Low pulse rate
- Faint
- Rapid shallow breathing
- Shortness of breath
- Choking sensation
- Gasping for air
- Flushed face
- Face pale
- Increased perspiration
- Loss of appetite
- Abdominal discomfort / pain
- Diarrhoea
- Nausea
- Vomiting
- Dilated pupils
- Increased urine output
19
Q
What is Mild Anxiety?
A
- Slightly elevated heart rate and blood pressure
- Feels safe and comfortable
- Perceptual field increased
- Ability to learn is increased
20
Q
What is Moderate Anxiety?
A
- Occasional shortness of breath
- Mild gastric symptoms “butterflies in the stomach”
- Facial twitching, trembling lips
- Selective inattention
- Narrowing of the perceptual field
21
Q
What is Severe Anxiety?
A
- Frequent shortness of breath
- Increased heart rate
- Elevated blood pressure
- Dry mouth, upset stomach, anorexia, diarrhoea or constipation
- Bodily trembling, fearful facial expression, tense muscles, restless, exaggerated startle response, inability to relax, difficulty falling asleep
- Extremely narrowed perceptual field
- Difficulty problem solving or organizing
22
Q
What is Panic?
A
- Shortness of breath, choking or smothering sensation, sweating
- Hypotension, dizziness, chest pain or pressure, palpitations, chills or hot flushes
- Nausea
- Agitation, poor motor coordination, involuntary movements, entire body trembling, facial expression of terror
- Feeling of losing control, fear of dying
- Completely disrupted perceptual field
23
Q
What are coping mechanisms for Mild Anxiety?
A
•Exercise •Phone a friend •Cry •Eat – seek comfort foods •Sleep – avoid your stressors •Distraction – movies •Talk about your concerns •Relaxation techniques Read •Maladaptive coping mechanisms •Increased risk taking behaviours •Increased use of alcohol / illicit drugs to reduce anxiety
24
Q
What are coping mechanisms for moderate and severe anxiety?
A
When anxiety is perceived by the client to be painful, ego defence mechanisms are utilised at the unconscious level and are used to protect oneself. A range of ego defence mechanisms include: •Suppression Compensation •Repression Displacement •Regression Identification •Projection Introjections •Rationalisation Reaction Formation •Denial Splitting •Dissociation Sublimation
25
What are the ranges of Anxiety Disorders?
```
•General Anxiety Disorders (GAD)
•Panic Disorders
•Phobias
– Agoraphobia
–Specific Phobias
– Social Phobia
•Obsessional Compulsive Disorder (OCD)
•Post Traumatic Stress Disorder (PTSD)
```
26
What is generalised Anxiety disorder?
Generalised anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about several events or activities. (work or school performance)
•The client finds it difficult to control the worry (APA, 2000 p 476)
•No single factor has been established as the cause of GAD
•More prevalent in women than men
•Co morbid mood disorders & substance related disorders
•Headaches are common
•50 % of clients complain their symptoms have been present since childhood or adolescence.
27
What is the criteria for Generalised anxiety disorder?
The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms present for more days than not for the past 6 months.)
•Restlessness or feeling keyed up or on edge
•Being easily fatigued
•Difficulty concentrating or mind going blank
•Irritability
•Muscle tension
•Sleep disturbance (difficulty falling or staying asleep, restless unsatisfying sleep)
The above symptoms create significant distress / impairment in social/ occupational or other areas of functioning.
28
What is Panic Disorder?
* Most clients will experience extreme attacks in situations where most people would not be afraid
* Many client’s will have co-morbid Depression
* Peak onset is adolescence
* Rare in children & people over 45 yrs. of age
* Common in families – 8 times more likely
* Long term treatment
* Recurrent unexpected panic attacks
29
What is the criteria for Panic Disorder?
Criteria for Panic Attack:
A discrete period of intense fear or discomfort , in which four or more of the following symptoms developed abruptly and reached a peak within 10 mins:
• palpitations, pounding heart or accelerated heart rate
• sweating
• trembling or shaking
• sensation of shortness of breath or smothering
• feeling of choking
• chest pain or discomfort
feeling dizzy, unsteady gait, light headedness or faint
• derealisation or personalisation fear of losing control or going crazy
• fear of dying
• paraesthesia (numbness or tingling sensations)
• chills / hot flushes.
30
Panic attack and initial nursing management
* Stay with the client, reassure and encourage the client they will be ok
* If in a high stimulus environment, move to a quieter area
* Remove the trigger, remove the client from the trigger
* Reinforce desired behaviours
* Keep communication in short simple sentences
* Remain calm, use reassuring tone of voice with open body language
* Instruct the client to use abdominal breathing
* Administer benzodiazepine medications to assist the client resume control.
31
Panic attack and post Nursing Management
* Educate the client that they have experienced a “panic attack” provide written materials where possible due to residual anxiety
* Many client’s will be fearful of a reoccurrence.
* Keep explanations short and simple to assist retention of information
* Provide the client with a list of symptoms associated with panic attacks
* If no history of panic attacks and or prior symptoms, refer the client to the GP for further investigations
32
Panic disorder without Agoraphobia
•At least one of the attacks has been followed by 1 month (or more) of one (or more) of the following:
• persistent concern about having additional attacks
• worry about the implications of the attack or its consequences (e.g.
losing control, having a heart attack, “going crazy”)
• a significant change in behaviour related to the attacks
• the panic attacks are not due to the direct physiological effect of a
substance (e.g. drug abuse, medications) or a general medical
condition (hyperthyroidism)
• the panic attacks are not better accounted for another mental
disorder
33
What is Agoraphobia?
Agoraphobia – anxiety about being in places or situations from which escape might be difficult ( or embarrassing) or in which help may not be available in the event of having a panic attack or panic like symptoms. i.e.; using public transport / shopping.
The situation is avoided (travel is restricted) or endured with marked distress or anxiety about having a panic attack or panic – like symptoms, or client may require the presence of a companion
34
Key elements necessary to diagnose phobias?
* P – persistent intense fear
* H - handicaps / restricts lifestyle
* O – object / situation
* B - behaviour avoidance
* I – irrational fears (recognised by client)
* A – anxiety response
35
What are specific phobias?
•Intense fears about particular objects or situations which interfere in their lives:
- animals (dogs / snakes / spiders / rats)
- natural environment (thunderstorms)
- blood / injections /injury
- situational (lifts / shopping centres)
- other
•When faced with the fear they become highly anxious, may have a situational panic attack.
•The client goes to great lengths to avoid the situation.
•Co-morbid Anxiety Disorder & Substance related disorder are common.
36
Nursing management of specific phobias
```
Educate, support and reassurance from the health professional
Psychological treatments
- anxiety education
- relaxation training
- cognitive therapy
- exposure therapy
- slow breathing training
- assertiveness training
- systematic desensitization
```
37
What is a Social Phobia?
•Clients feel people will judge everything they do and they will be judged by others in a negative manner.
•Client’s feel flawed and worthless if found to be incompetent
•Client’s cope by doing things to perfection or avoid situations.
•Initially observed in mid teens and persist throughout the lifetime fluctuating in response to the stressor.
•Common course in families and common co-morbid conditions are;
- anorexia
- mood disorders
- substance related disorders
38
What is the nursing Management of Social Phobia?
```
Reassurance, education & support from the health professional
•Psychological treatment
- anxiety education
- relaxation training
- cognitive therapy
- exposure therapy
- slow breathing training
- assertiveness training
```
39
What is Obsessive Compulsive Disorder (OCD)
Is characterized by recurrent intrusive / unwanted obsessions which cause marked anxiety / distress
•Compulsions are the behavioural actions the client conducts in a attempt to neutralize their anxiety / distress.
(APA, 2000, p429)
•Obsessions are persistent ideas, thoughts, impulses or images
Common obsessions are:
- thoughts of being contaminated by shaking hands
- repeated doubts whether they have performed / completed a task
such as checking doors are locked / gas is turned off
- a need for items in a particular order & be symmetrical – lining items up / placing objects together
40
What are compulsion?
* The obsession of being contaminated by hand shaking often leads to excessive and repeated hand washing, resulting in open and bleeding wounds from repeated frenetic scrubbing accompanied by the client using excessive quantities of soap, falsely believing more germs will be removed by increased soap use.
* Clients compulsions can escalate in frequency and complexity forming a “ritual” and if no intervention occurs, the ritual duration and associated distress escalates further. This impairs the client’s ability to then complete other tasks & interferes with social / occupational / educational functioning.
* The following link depicts a gentleman’s daily struggle with agoraphobia and OCD behaviours.
* Note his affect, his escalating anxiety, his rapid shallow breathing and his repeated compulsions, this condition is very disabling.
* Note his absence from work when he is faced with adversity in the context of no supports / maladaptive coping skills
41
What are the compulsion features of OCD?
* High rates of co-morbid depression
* Onset occurs earlier in males
* Peak onset in adolescence / early adulthood
* Usually has a gradual onset
* Males 6- 15yrs.
* Females 20 – 29 yrs.
* Up to 50 % of client’s with Tourette’s have OCD
42
What is the nursing management for OCD?
•Establish therapeutic rapport & sustain therapeutic relationship
•Assess and identify client obsessions & compulsions
•Identify frequency, duration & limitations arising from OCD
•Utilise Yale – Brown’s Obsessive – Compulsive scale
(Videbeck 2009 p258 – 259)
•Cognitive Behaviour Therapy – ritual prevention
•Encourage & support the client to gradually tolerate anxiety provoking situations – exposure therapy
•Administer SSRI’s, reduce OCD Sx’s by 20 – 40 %
•Be firm that the client’s situation can improve & celebrate success
43
What is Post Traumatic Stress Disorder (PTSD)?
The client must have experienced a traumatic event prior to the onset of symptoms.
The event must be of magnitude of being traumatic to almost everyone.
-Military combat (wars)
-Experience of disasters (Black Saturday Bushfires / Burnley Tunnel)
-Rape
-Personal violence (serious physical assault)
-Severe car accident
-Child sexual abuse
44
What are the synptoms of PTSD?
Client’s will re-experience the event, visualising the event in their mind – often in slow motion.
Have flashbacks or dreams about the event, usually as nightmares.
Clients will persistently avoid stimuli associated with the trauma & numbing of responsiveness.
Physiological reactivity on exposure to cues associated to the event.
Increased arousal symptoms of two or more symptoms;
- difficulty falling or staying asleep
- irritability or anger outbursts
- difficulty concentrating
- hyper-vigilance
- exaggerated startle response
45
What kind of impairment will symptoms cause in PTSD?
Symptoms must cause distress or impairment in social / occupational or other areas of functioning.
Acute Onset – symptoms is less than 3 months duration
Chronic Onset – symptoms is 3 months or more
With Delayed Onset – onset of symptoms 6 months after the traumatic incident
46
Anxiety disorder due to a medical condition
•Can occur due to the direct physiological effects of a general medical condition
•Anxiety, panic attacks or OCD symptoms can also be observed
•Some common medical conditions include:
- endocrine system (hyper/hypothyroidism)
- cardiovascular conditions – (congestive heart failure)
- respiratory conditions – (pneumonia / chronic obstructive airway disease)
- metabolic conditions – (vitamin B12 deficiency)
- neurological conditions – (encephalitis)
47
What are the behavioural changes experienced with Anxiety disorder due to a medical condition?
Behavioural changes in the last two weeks
•Increased worrying about common problems like finances, work
•Unwilling to go out and socialise
•Not being able to sleep
•Increased use of drugs and alcohol
•Avoidance of crowded places – shopping centres
•Unable to finish school or work projects
•Increased irritability and sensitivity to criticism
48
Substance induced Anxiety Disorder
Essential features are prominent anxiety symptoms that are due to the direct physiological effects of a substance, medication or due to toxin exposure.
Anxiety symptoms occur post ingestion of the substance, medication or toxin.
Is also observed in association with withdrawal.
- Amphetamine induced anxiety disorder
- Cocaine
- Caffeine
- LSD
- Marijuana
49
Acute stress related disorders?
Adjustment Disorder – an exaggerated emotional or behavioural response to a significant life change or stressor such as a relationship break-up, bereavement, divorce, business difficulties, illness, migration
Onset is within 3 months of exposure to the stressor
Acute Stress Disorder – is a transient response to a severe trauma such as an accident, natural disaster, crime or combat.
Onset occurs within 1 month of the event.
If symptoms lasts more than 4 weeks than it is reclassified as PTSD
50
How can you establish if someone is Anxious?
* Behavioural changes in the last two weeks
* Increased worrying about common problems like finances, work
* Unwilling to go out and socialise
* Not being able to sleep
* Increased use of drugs and alcohol
* Avoidance of crowded places – shopping centres
* Unable to finish school or work projects
* Increased irritability and sensitivity to criticism
51
Anxiety Vs Fear
* Anxiety
* The threat is unknown
* Internal
* Vague
* Psychological Conflict
* Fear
* The threat is known
* External
* Definite
* No psychological conflict
52
What types of panic is there?
Panic
- panic attack – can occur in any anxiety disorder
- panic disorder without agoraphobia
- panic disorder with agoraphobia
53
What type of fear is there?
Fear
- agoraphobia
- social phobia
- specific phobias
54
Stress Vs Worry
```
Stress
•Adjustment disorder with anxiety
•Acute stress disorder
•Post traumatic stress disorder
Worry
•Generalized anxiety disorder
•Obsessions and rituals
•Obsessive compulsive disorder
```
55
What types of theories for Anxiety are there?
* Stress
* Behavioural
* Personality / developmental
* Psychodynamic
* Interpersonal
* Biological theories
56
What is the stress theory?
Developed by Hans Seyle (1956, 1974) an endocrinologist
Identified three stages of stress:
Alarm reaction – physical responses to stress
Resistance – fight or flight response
Exhaustion
57
What are Behavioural Theories?
All behaviour has meaning
Anxiety can be learnt through experiences
- dog bite
Fear can be learnt, watching others being fearful results in anxiety
- waiting near other students to enter the exam room
58
personality/development
Temperament – cluster of traits displayed by children developing personality
A study conducted by Australian Institute of Family Bureau and subsequent analysis of data indicates
Shy inhibited temperament is associated with anxiety problems in adolescence.
59
Psychoanalytic Theory?
Anxiety occurs when the individual represses unacceptable thoughts and emotions (Elder et al 2005)
When these thoughts and emotions are not dealt with it causes anxiety
Psychoanalyst work to uncover repressed emotions
When repressed material is resolved = resolution of anxiety
60
Interpersonal Theory?
Anxiety is a response to the individual external environment
Symptom’s form and conflict between the individual & primary group occur (family, work colleagues)
The individual’s first experience of anxiety is the infant’s perception of the mothering person… the individual develops in the context of approval or disapproval from significant others.
Disapproval results in a threat to the individual, a fear of rejection occurs … resulting in anxiety.
61
What is the genetics theory?
Genetics
Increased incidence in first degree relatives to panic disorder.
Specific anxiety disorders are not shown to be inherited in twins
but a general neurotic tendency encompassing anxiety, mood
and eating disorders is inherited.
Environment also has influence.
62
What is the neurochemical Theory?
Neurochemical
Benzodiazepines reduce anxiety by facilitating the action of
gamma-aminobutryic acid (GABA).
Reduced GABA and Serotonin serum levels are associated in anxiety.
Increased noradrenaline is believed to increase anxiety.
Serotonin is associated with anxiety, mood disorders and
aggression.
63
Communicating with the client with an Anxiety disorder?
•Establish a therapeutic rapport.
•Remain client centred & responsive to the clients immediate needs
utilising active listening skills, being supportive & providing reassurance.
•Encourage the client to discuss their feelings & share their inner thoughts and associated experiences.
Acknowledge, validate, clarify & empathise.
•Convey a shared understanding of the client’s situation and accept the client's feelings.
Join with the client in commitment to overcome their adversity.
•Be mindful that clients with anxiety disorders will be sensitive to any indication of being judged and will fear perceived rejection.
64
Transference and counter transference reactions?
* Be aware of your own feelings toward the client as this can influence your provision of care.
* The feelings and associated distress that the client shares can raise your own anxiety levels, ensure you access clinical supervision or clinical debrief to manage this.
65
Assessing the client with an Anxiety disorder?
* MSE – fidgeting / worried /tense / depersonalisation & derealisation
* Risk Ax – impaired decision making / assoc. heightened impulsivity
* Level of Anxiety – mild / moderate/ severe
* Physical Ax – exclude organic factors contributing to presentation
* Drug & Alcohol Ax – amount / frequency / last use / interaction between substances
* Medications – prescribed / over the counter preparations
* Social / professional supports – family / friends / existing professional supports
* Utilise specialty Ax tools once diagnosis is suspected, they will aid in quantifying the clients level of associated impairment.
* Hamilton Rating Scale for Anxiety
* Yale – Brown Obsessive-Compulsive Scale
66
How should the nurse behave around the Anxious client?
Convey calmness and confidence, assist contain their anxiety
Reduce the immediate demands on the client, where possible move the client to a quieter environment
Respond to their immediate needs
Avoid medical terminology & jargon that will impede the therapeutic relationship
Utilise diversion activities when the client displays signs of escalating anxiety levels
Give the client regular feedback
67
How can the nurse intervene with the Anxious Client?
* Assist the client to explore and mutually identify any events / factors that may have precipitated their distress
* Assist the client to identify adaptive coping mechanisms that were previously trialled and successful
* Explore a plan to re- implement these adaptive coping mechanisms
* Promote relaxation techniques – guided visualisation
* Evaluate the above and assess the need for medications
* Continue to reassess the clients fluctuating level of anxiety in response to previous interventions – mild / moderate / severe
* Provide the client with genuine & honest feedback
* If anxiety is reoccurring obtain a physical evaluation and further psychological assessment
68
What approaches can the nurse take with the panic client?
* Stay calm & stay with the client
* Use short simple sentences
* Use a firm & clear voice
* Tell the client you will take control for them & help them
* Encourage the client to concentrate on you
69
What interventions can the nurse use for the panic client?
•Administer anxiolytic medications as ordered
•Encourage the client to control their breathing –
abdominal breathing using the 6 sec cycle
•Provide support post above & identify this as a panic attack
•Client may need to rest post the above
•Educate your client and focus on early identification / intervention for future episodes
70
What psychological approaches can the nurse use with the anxious client?
```
•Cognitive Behaviour Therapy
•Relaxation training
•Systematic desensitisation
•Thought Stopping
•Behaviour Substitution
•Flooding
Psychotherapy
Family Therapy
```
71
How is Psychotherapy delivered?
Psychotherapy
- insight orientated therapy
- group therapy
- support groups
72
How does Family therapy work?
Family Therapy
- ensures the client is not scapegoated
- assists family members to support and respond to the client
- enhances family members understanding of the client’s situation
- enhance consistency in daily management of client difficulties
- family members can gain support in their role of carers
73
What are the medications used?
•Medications from several classifications can be used to treat anxiety disorders however medications should not be used as the sole method of treatment when adaptive coping skills can be mastered through CBT and other psychological process.
(Eby & Brown, 2005, p 209)
•Given the role of reduced GABA & serotonin in clients with an anxiety disorders, adjunctive medications used in combination with psychological approaches includes;
SSRI antidepressants & short term use of Benzodiazepines.
74
Benzodiazepines
* Benzodiazepines are also know as anxiolytics - anti anxiety medications.
* Given their high propensity for physical & psychological dependence, their use is normally restricted with the focus on using psychotherapeutic interventions.
* Benzodiazepines suppress the CNS and enhance the effects of GABA.
* GABA is a inhibitory neurotransmitter making the neurons less responsive to excitatory neurotransmitters of norepinephrine, serotonin, and dopamine therefore reduce symptoms of anxiety, increased heart rate, fearfulness, sense of dread, relaxing muscles, sever agitation.
* Benzodiazepines can be used in social phobia, generalized anxiety disorder and panic disorder.
75
What are common Benzodiazepines?
* Alprazolam (Xanax)
* Clonazepam (Rivotril)
* Diazepam (Valium)
* Lorazepam (Ativan)
76
Non-Benzodiazepines?
* Buspirone (Buspar) is a non benzodiazepine antianxiety medication
* It acts as a serotonin agonist & is not sedating.
* Buspirone does not cause tolerance or withdrawal effects.
* It can take up to 7 – 10 days prior to any anxiety reduction effects are observed. Up to 6 weeks for the full therapeutic effect.
* Side effects include : dizziness, headaches, nausea, nervousness & excitement.
77
Adjunctive medications to treat Anxiety?
SSRI’s
•Tricyclic antidepressants
•MAOI’s – Nardil / Parnate
78
Treatment approaches for treating Generalized Anxiety Disorder?
CBT – supportive, solution focused therapy & stress management
skills – relaxation techniques
SSRI’s – Paroxetine 20 mgs & increase as indicated
SNRI’s – Venlafaxine XR 37.5 mg & increase as indicated
Acute Episodes : Benzodiazepines for short term use only.
79
Treatment approaches for OCD
CBT – exposure therapy & decrease compulsive behaviours
SSRI’s – Fluoxetine, Fluvoxamine, Paroxetine, Sertraline,
Citalopram.
Low doses is usually sufficient in up to 40 % of clients.
In severe cases of OCD, additional Tricyclic antidepressant of Clomipramine has also displayed therapeutic benefits.
80
Treatment approaches for panic disorder with/without agoraphobia
CBT – exposure therapy & slow breathing
focus on controlling the symptoms
Education on the condition
Any of the antidepressant group can be used to reduce avoidant behaviours, precipitator anxiety while reduce frequency & intensity of the clients of panic attacks.
Benzodiazepines use in acute situations assist up to 75 % of clients.
81
Treatment approaches for PTSD
Exposure therapies – systematised desensitization, flooding.
CBT to reduce PTSD symptoms & increase social functioning.
Slow breathing techniques.
SSRI’s – reduce intrusive thoughts, avoidance & sleep problems
reduce depressive symptoms.
Mood stabilisers – Valproate, Carbamazepine & Topirimate reduce
nightmares and flashbacks.
82
Treatment approaches for Social Phobia
Exposure therapies & CBT techniques to reduce symptoms focusing on early recognition of faulty thinking.
Social skills training & relaxation techniques.
Short term use of benzodiazepines.
SSRI’s can also be used.
83
Treatment approaches for Specific phobias?
Exposure therapies to reduce key elements of the specific phobia.
CBT.
Benzodiazepines when above strategies have had sustained limit affect.
