2. Concept of Anxiety and
Psychiatric Nursing
• Anxiety
– Universal human experience
– Dysfunctional behavior often defends against
anxiety
• Legacy of Hildegard Peplau (1909-1999)
– Operationally defined concept and levels of anxiety
– Suggested specific nursing interventions
appropriate to each of four levels of anxiety
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3. Psychological Adaptation to
Stress
• Anxiety and grief have been described as two
major, primary psychological response patterns
to stress.
• A variety of thoughts, feelings, and behaviors
are associated with each of these response
patterns.
• Adaptation is determined by the extent to which
the thoughts, feelings, and behaviors interfere
with an individual’s functioning. 3
4. Anxiety and Fear
• Anxiety: feeling of apprehension,
uneasiness, uncertainty, or dread resulting
from real or perceived threat whose actual
source is unknown or unrecognized
• Fear: reaction to specific danger
• Similarity between anxiety and fear
– Physiological response to these experiences is
the same (fight-or-flight response)
4
5. Anxiety
• A diffuse apprehension that is unclear in
nature and is associated with feelings of
uncertainty and helplessness.
• Extremely common in our society.
• Mild anxiety is adaptive and can provide
motivation for survival.
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6. Types of Anxiety
• Normal
– Motivating force that provides energy to carry out tasks of
living
• Acute or state
– Anxiety that is precipitated by imminent loss or change that
threatens one’s security (crisis)
• Chronic or trait
– Anxiety that persists over time
• Mild
– Occurs in normal everyday living
– Increases perception, improves problem solving
– Manifested by restlessness, irritability, mild tension-relieving
behaviors 6
7. Types of Anxiety
• Moderate
– Escalation from normal experience
– Decreases productivity (selective inattention) and learning
– Manifested by increased heart rate, perspiration, mild somatic
symptoms
• Severe
– Greatly reduced perceptual field
– Learning and problem solving not possible
– Manifested by erratic, uncoordinated, and impulsive behavior
• Panic
– Results in loss of reality focus
– Markedly disturbed behavior occurs
– Manifested by confusion, shouting, screaming, withdrawal7
8. Peplau’s four levels of anxiety
• Mild – seldom a problem
• Moderate – perceptual field diminishes
• Severe – perceptual field is so diminished that
concentration centers on one detail only or on
many extraneous details
• Panic – the most intense state
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9. Behavioral adaptation responses
to anxiety
• At the mild level, individuals employ
various coping mechanisms to deal with
stress. A few of these include eating,
drinking, sleeping, physical exercise,
smoking, crying, laughing, and talking to
persons with whom they feel comfortable.
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10. Defense Mechanisms
• Help protect people from painful awareness
of feelings and memories that can cause
overwhelming anxiety
– Operate all the time
– Adaptive (healthy) or maladaptive (unhealthy)
• First outlined and described by Sigmund
Freud and his daughter Anna Freud
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11. Properties of Defense
Mechanisms
• Major means of managing conflict and affect
• Relatively unconscious
• Discrete from one another
• Hallmarks of major psychiatric disorders
• Can be reversible
• Can be adaptive as well as pathological
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14. • Anxiety at the moderate to severe level that
remains unresolved over an extended
period of time can contribute to a number of
physiological disorders – for example,
migraine headaches, IBS, and cardiac
arrhythmias.
• Extended periods of repressed severe
anxiety can result in psychoneurotic
patterns of behaving – for example, anxiety
disorders and somatoform disorders.
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