THREE THEORIES COMMONLY CITED TO EXPLAIN THE ORIGIN OF

ANXIETY DISORDERS
Our knowledge about successful treatment for anxiety disorders continues to advance at an
accelerated rate. This progress is due to the hundreds of past and ongoing research studies. Many
of these studies are dedicated to testing and developing effective treatment approaches. In fact,
anxiety disorders are one of the most treatable psychiatric conditions; meaning, treatment is
highly likely to produce a positive outcome (i.e., a reduction in symptoms). Not only do we
know what does work, but research has also identified what does not work.
1. Behavioral Learning Theory
As the name implies, behavioral learning theory concerns itself with the way behaviors are
learned, and subsequently "unlearned." Since the word "learning" is often used throughout this
article, it is important to understand what psychologists mean by this term. According to
behavioral psychologists, "learning" is indicated by a relatively permanent change in behavior or
knowledge, as a result of a "learning" experience. Thus, "learning" is not limited to the most
common usage of the word referencing academic learning (school). In psychological terms,
learning can occur without any intention to learn, and without a conscious awareness that
something has been learned. Any change in behavior suggests the person has learned a new
response to a particular situation. The term will become clearer as we examine the two primary
ways that organisms learn: classical conditioning and operant conditioning.
2. Operant Conditioning and Avoidance Learning Theory

The principles of operant conditioning have taught us to recognize how certain coping
techniques can reward, and therefore continue anxiety disorders. Two similar coping strategies
for dealing with anxiety symptoms are called avoidance and escape. As the name
implies, avoidance refers to behaviors that attempt to prevent exposure to a fear-provoking
stimulus. Escape means to quickly exit a fear-provoking situation. These coping strategies are
considered maladaptive because they ultimately serve to maintain the disorder and decrease
functioning. Operant conditioning enables us to understand the powerful impact of these two
coping strategies. Both coping strategies are highly reinforcing because they remove or diminish
the unpleasant symptoms. Unfortunately, they do nothing to prevent the symptoms from reoccurring again and again in the future. These two-factor theories combined the learning
principles of classical and operant conditioning. Based upon the principles of classical
conditioning, it was assumed that phobias develop as a result of a paired association between a
neutral stimulus and feared stimulus. However, classical learning theory could not explain the
continuation of avoidance and escape behaviors. These behaviors often led to further distress and
interference in a person's life such as: 1) the avoidance of pleasurable activities; 2) the inability
to engage in daily activities and responsibilities; and 3) the inability to maintain interpersonal
relationships. The therapeutic implication of operant conditioning and its relationship to
avoidance learning was extremely important. When maladaptive copying strategies that serve to
maintain an anxiety disorder are discontinued, these maladaptive behaviors become extinct. The
research has demonstrated this to be correct. This understanding formed the foundation
for effective treatments.
3. Cognitive Theory

Although behavioral learning theory offered promising therapeutic techniques, there were some
significant problems. Behaviorism sought to make psychology a respected science by studying
observable (measurable) human behavior. To achieve this goal using systematic, scientific
methods of research it was necessary to discount internal, mental events such as thoughts,
beliefs, motivations, feelings, and perceptions. This is because these internal events, called
cognitions, are not observable, nor readily measurable. Cognitive theorists have since recognized
the importance of these internal events (collectively referred to as cognitions). They subsequently
developed methods to study their effects. Cognitive therapy also rose in popularity due to the
public's misinterpretation that behaviorism had the potential to control and manipulate people.
People were philosophically opposed to the notion that human beings could be reduced to a
collection of behaviors that could be easily manipulated through environmental rewards and
punishments. Other factors also contributed to the decline of pure behaviorism, such as the
increasing awareness of genetic influences on behavior. According to cognitive theory, our
dysfunctional thoughts lead to extreme emotions. These extreme emotions in turn, lead to
maladaptive behaviors. To illustrate the powerful effect of these thoughts, consider the following
example. Suppose I am preparing to take a difficult test. While doing so I think to myself "I can't
do anything right, I'll probably fail this test." This thought will likely cause me to feel
apprehensive. When I eventually take the test, this degree of anxiety will affect my ability to
concentrate and earn a good grade. In addition, these negative thoughts will affect the amount of
effort I put forth when studying for the test. When I incorrectly believe that I will certainly fail, it
seems rather futile to invest a great deal of energy in attempting to succeed. As a result, I may
indeed fail, simply because I didn't invest much time and energy in preparation for the exam.
Ironically, this failure will serve to strengthen my faulty belief; i.e., my poor test score "proves"
my belief is correct- I am a failure. However, the true reason for my failure was due to my lack
of effort and preparation, and not because I am inherently a failure. Quite a different outcome
would occur if I were to think to myself, "Yes, this test is going to be quite difficult but I have
succeeded before. I will study hard and put forth my best effort. Besides, I am just as competent
as any of the other students in the class." These thoughts would cause me to feel confident and
ready to face the challenge. I would put forth the extra effort needed to succeed. Clearly, these
two different ways to think about the same event result in very different behaviors and outcomes.

CHARACTERISTICS OF ANXIETY DISORDERS

Everyone gets nervous or anxious from time to timewhen speaking in public, for instance, or
when going through financial difficulty. For some people, however, anxiety becomes so frequent,
or so forceful, that it begins to take over their lives.

Excessive worry

The hallmark of generalized anxiety disorder (GAD)the broadest type of

anxietyis worrying too much about everyday things, large and small. But
what constitutes "too much"? In the case of GAD, it means having persistent
anxious thoughts on most days of the week, for six months. Also, the anxiety
must be so bad that it interferes with daily life and is accompanied by
noticeable symptoms, such as fatigue. "The distinction between an anxiety
disorder and just having normal anxiety is whether your emotions are

causing a lot of suffering and dysfunction," says Sally Winston, PsyD, codirector of the Anxiety and Stress Disorder Institute of Maryland in Towson.

Sleep Problems

Trouble falling asleep or staying asleep is associated with a wide range of

health conditions, both physical and psychological. And, of course, it's not
unusual to toss and turn with anticipation on the night before a big speech or
job interview. But if you chronically find yourself lying awake, worried or
agitatedabout specific problems (like money), or nothing in particularit
might be a sign of an anxiety disorder. By some estimates, fully half of all
people with GAD experience sleep problems. Another tip-off that anxiety
might be involved? You wake up feeling wired, your mind is racing, and
you're unable to calm yourself down.

Irrational fears

Some anxiety isn't generalized at all; on the contrary, it's attached to a

specific situation or thinglike flying, animals, or crowds. If the fear becomes
overwhelming, disruptive, and way out of proportion to the actual risk
involved, it's a telltale sign of phobia, a type of anxiety disorder. Although
phobias can be crippling, they're not obvious at all times. In fact, they may
not surface until you confront a specific situation and discover you're
incapable of overcoming your fear. "A person who's afraid of snakes can go
for years without having a problem," Winston says. "But then suddenly their
kid wants to go camping, and they realize they need treatment."

Muscle tension

Near-constant muscle tensionwhether it consists of clenching your jaw,

balling your fists, or flexing muscles throughout your bodyoften
accompanies anxiety disorders. This symptom can be so persistent and
pervasive that people who have lived with it for a long time may stop
noticing it after a while. Regular exercise can help keep muscle tension under
control, but the tension may flare up if an injury or other unforeseen event
disrupts a person's workout habits, Winston says. "Suddenly they're a wreck,
because they can't handle their anxiety in that way and now they're
incredibly restless and irritable."

Chronic Indigestion

Anxiety may start in the mind, but it often manifests itself in the body
through physical symptoms, like chronic digestive problems. Irritable bowel
syndrome (IBS), a condition characterized by stomachaches, cramping,
bloating, gas, constipation, and/or diarrhea, "is basically an anxiety in the
digestive tract," Winston says. IBS isn't always related to anxiety, but the two
often occur together and can make each other worse. The gut is very
sensitive to psychological stressand, vice versa, the physical and social
discomfort of chronic digestive problems can make a person feel more
anxious.

Stage Fright

Most people get at least a few butterflies before addressing a group of

people or otherwise being in the spotlight. But if the fear is so strong that no
amount of coaching or practice will alleviate it, or if you spend a lot of time
thinking and worrying about it, you may have a form of social anxiety
disorder (also known as social phobia). People with social anxiety tend to
worry for days or weeks leading up to a particular event or situation. And if
they do manage to go through with it, they tend to be deeply uncomfortable
and may dwell on it for a long time afterward, wondering how they were
judged.

Compulsive Behaviors

In order to be diagnosed with obsessive-compulsive disorder, a person's

obsessiveness and intrusive thoughts must be accompanied by compulsive
behavior, whether it's mental (telling yourself itll be all right over and over
again) or physical (hand-washing, straightening items). Obsessive thinking
and compulsive behavior become a full-blown disorder when the need to
complete the behaviorsalso known as "rituals"begins to drive your life,
Winston says. "If you like your radio at volume level 3, for example and it
breaks and gets stuck on 4, would you be in a total panic until you could get
it fixed?"

Self-doubt

Persistent self-doubt and second-guessing is a common feature of anxiety

disorders, including generalized anxiety disorder and OCD. In some cases,
the doubt may revolve around a question that's central to a person's identity,
like "What if I'm gay?" or "Do I love my husband as much as he loves me?" In
OCD, Winston says, these "doubt attacks" are especially common when a
question is unanswerable. People with OCD "think, 'If only I would know
100% for sure whether I was gay or straight, either one would be fine,' but

they have this intolerance for uncertainty that turns the question into an
obsession," she says.

RESPONSES TO ANXIETY DISORDERS

PHYSIOLOGICAL

Anxiety is part of the bodys natural defense system. It takes over when
youre threatened and doesnt let up until youre safe again. While youre in
this state, you feel strong emotions such as fear, and physical sensations
such as a pounding heartbeat. These feelings make you want to react to the
threat. An anxiety response is normal in many situations. But when you have
an anxiety disorder, the same response can occur at the wrong times.
Anxiety is like an alarm bell in your brain. When youre threatened, the alarm
goes off and tells your body to protect you. This is part of the same fight or
flight response that helped our early ancestors survive. It made them react
quickly to physical threats such as wild animals.

When youre in danger: Anxiety prompts you to run out of a burning building, or to swerve
while driving to avoid hitting another car. In these cases, the anxiety response makes you react
quickly to protect yourself. When you need to succeed: You may feel anxious when you open an
overdue bill, study for a test, or prepare to give a speech. In these situations, the anxiety response
helps you focus on the task at hand so you do a better job. With an anxiety disorder, your body
has the response described above, but in inappropriate ways. The response a person has depends
on the anxiety disorder he or she has. With some disorders, the anxiety is way out of proportion
to the threat that triggers it. With others, anxiety may occur even when there isnt a clear threat or
trigger.

BEHAVIORAL

Anxiety is the faulty activation of your fight or flight system at times when there is no fear
causing stimuli present. When anxiety hits, it automatically changes "behaviors" in the sense that
it prepares your body to fight or run away by increasing your heart rate, causing sweating, etc.
But anxiety can also change the way you act on a day to day basis, both when you have anxiety
and when you don't. In this article, we'll explore some of the common and unusual behavioral
changes that occur as a result of anxiety. Your behaviors are mostly under your control, but
anxiety can make it extremely hard to control habits and behavioral desires. Behaviors are
actually a significant part of most anxiety disorders, because by definition anxiety needs to
change your behavior in some way to qualify as an anxiety disorder.
For example, you cannot quality for a phobia if you dont show fear at the site of your phobic
stimulus. You can't qualify for panic disorder if you don't have panic attacks, which are a
behavioral reaction. All of these are examples of ways that anxiety affects behavior. But in this

case, we're talking about very specific types of changes to behaviors that result from anxiety, and
there are many. The following are just a few of the ways anxiety can affect behavior.

The strangest behaviors caused by anxiety are most likely compulsions. Compulsions affect
those with obsessive compulsive disorder, and they're behaviors that a person does compulsively
to rid themselves of their negative, anxiety producing thoughts.
Compulsive behaviors can refer to anything. Sometimes they relate directly to the fear/obsession.
For example, a fear of germs may have someone compulsively wash their hands. Sometimes they
relate to a need for order, and a person will compulsively place objects or items in a specific
order or pattern. But in some cases these disorders may not have any relationship to the fear at
all, or may be only slightly related. For example: Skipping cracks in the ground because you are
afraid of your mother getting hurt, Closing a door three times before leaving, Turning a switch on
and off 5 times and having to start over if you are interrupted.
These compulsions are generally created because they provide some type of relief for the person
with the negative, anxiety producing thought. It is not clear what causes these thoughts or why
certain behaviors reduce them in some cases it can even be coincidental, such as one day you
realized when you walked through a door backwards your anxious thought went away. But no
matter what these compulsions can make a person feel unusual, and do result in behaviors that
are seen as "different" by the norm.

COGNITIVE

These reflects of worry about performance will also prevent the athlete from entering a 'peak
flow' state as this type of response changes attention which affects information processing, and
without an unaffected information processing an athlete will not be able to maintain low
cognitive arousal that is needed to enter a 'peak flow' state, and instead a high level of cognitive
arousal will form. Attention changes due to apprehension, doubts and negative thoughts that
occur when an athlete reflects worry about their performance. Cognitive response does differ as
it instead causes apprehension, doubts and negative thoughts because anxiety cause an athlete to
reflect worry about their performance in turn resulting in a change of attention which affects
information processing, due to symptoms that reflect worry about performance triggers which
are worry, stress, mumbling, speechless as well as many more such as hyper ventilating.

The cognitive effects of anxiety may include thoughts about suspected dangers, such as fear of
dying. "You may ... fear that the chest pains are a deadly heart attack or that the shooting pains in
your head are the result of a tumor or aneurysm. You feel an intense fear when you think of
dying, or you may think of it more often than normal, or can't get it out of your mind." It also
include "feelings of apprehension or dread, trouble concentrating, feeling tense or jumpy,
anticipating the worst, irritability, restlessness, watching (and waiting) for signs (and
occurrences) of danger, and, feeling like your mind's gone blank" as well as "nightmares/bad
dreams, obsessions about sensations, deja vu, a trapped in your mind feeling, and feeling like
everything is scary."

AFFECTIVE

"Mood swings" has often been an incorrectly used term. People talk about those that are
emotional as though they have mood swings, when it truth their emotions are perfectly normal
reactions to life events. Someone that cries often or someone that's angry isn't necessarily
suffering from a "swing" simply because they have a strong emotion. They just have stronger
emotions. True mood swings occur when you can go from happy to sad in a moment, without
anything apparently triggering it. Unfortunately, many people with anxiety suffer from extreme

mood swings as a response to their anxiety symptoms, and unfortunately those swings tend
almost always be negative. Mood swings are one of those symptoms that may be a symptom of
anxiety directly, or they may be a symptom of symptoms in other words, for some people,
other symptoms of anxiety cause so much distress that they cause mood swings, rather than the
anxiety itself leading to mood swings. This is common in those with more severe symptoms,
which find that while their symptoms essentially cause them to become more emotional, which
in turn leads to mood swings.

Anxiety also creates fear, and fear itself is a powerful emotion. When you encounter a fearful
thought, or a fear-inducing problem, the more afraid you are the more you are being emotional as
a response to that fear. Once you experience one heavy emotion, it's possible to experience others
especially when those emotions are so negative. It's not unlikely to find that your fear was so
pronounce that you ultimately become more prone to sadness, anger, etc. as a result.

Anxiety can also be incredibly tiring. So much so, in fact, that some people are simply unable to
handle it anymore to the point where they become incredibly stressed every time they feel
anxious and are rarely able to contain their discomfort. This doesn't have a proper term, but it can
best be described as "mental fatigue." You become essentially so tired of dealing with anxiety
that you start to become emotional at the slightest hint of anxiety symptoms. It's very common in
those with panic attacks. Some people with panic attacks get genuinely depressed and emotional
every time they have an attack, because they become so debilitated from dealing with them.
These types of mood swings are very common.

SPECIFIC TREATMENT MODALITIES

Since all anxiety disorders can have medical cause or component, it is important for individuals
to be thoroughly medically checked out before consulting psychological or psychiatric care. For
instance, individuals who drink a lot of caffeine can present with many similar symptoms of
anxiety, and even panic attacks. A good medical examination will rule out this and other
biological or environmental causes and possibilities.
Anxiety is often a component found within many other mental disorders as well. The most
common mental disorder which presents with anxiety is depression. Clinicians generally regard
such anxiety as a good sign, because it means that the individual hasn't simply accepted their
depressed mood as they would a free meal... They are depressed and they are anxious because
they are concerned about the ego dystonic nature of their depressed mood. A thorough initial
evaluation is rudimentary to ruling out other possible and more appropriate diagnoses.
Treatment for generalized anxiety disorder (also known as GAD) is varied and a number of
approaches work equally well. Typically the most effective treatment will be an approach which
incorporates both psychological and psychopharmacologic approaches. Medications, while
usually helpful in treating the bodily symptoms of acute anxiety (e.g., panic attacks), are best
used for this disorder as a short-term treatment only (a few months). Clinicians should be
especially watchful of the individual becoming psychologically or physiologically addicted to
certain anti-anxiety medications, such as Xanax.
*MEDICATIONS
Medication should be prescribed if the anxiety symptoms are serious and interfering with normal
daily functioning. Psychotherapy and relaxation techniques can't be worked on effectively if the
individual is overwhelmed by anxiety or cannot concentrate.
The most commonly prescribed anti-anxiety agent for this disorder has historically been
benzodiazepines, despite a dearth of clinical research that shows this particular class of drugs is

any more effective than others. Diazepam (Valium) and lorazepam (Ativan) are the two most
prescribed benzodiazepines. Lorazepam will produce a more lengthy sedating effect than
diazepam, although it will take longer to appear. Individuals on these medications should always
be advised about the medications' side effects, especially their sedative properties and
impairment on performance.
Tricyclic antidepressants often are an effective treatment alternative to benzodiazepines and may
be a better choice over a longer treatment period.
Medication for this disorder should only be used to treat acute symptoms of anxiety. Medication
should be tapered off when it is discontinued.

*PSYCHOTHERAPY
Psychotherapy for GAD should be oriented toward combating the individual's low-level, everpresent anxiety. Such anxiety is often accompanied by poor planning skills, high stress levels,
and difficulty in relaxing. This last point is important because it the easiest one in which the
therapist can play an especially effective teaching role.
Relaxation skills can be taught either alone or with the use of biofeedback. Education about
relaxation and simple relaxation exercises, such as deep breathing, are excellent places to begin
therapy. While biofeedback (the ability to allow the patient to hear or see feedback of their body's
physiological state) is beneficial, it is not required for effective relaxation to be taught to most
people. Progressive muscle relaxation and more general imagery techniques can be used as
therapy progresses. Teaching an individual how to relax, and the ability to do it in any place or
situation is vital to reducing the low-level anxiety levels. Individuals who learn these skills,
which can be taught in a brief-therapy framework, go on to lead productive, generally anxietyfree lives once therapy is complete. A common reason for failure to make any gains with
relaxation skills is simply because the client does not practice them outside of the therapy
session. From the onset of therapy, the individual who suffers from GAD should be encouraged
to set a regular schedule in which to practice relaxation skills learned in session, at least twice a
day for a minimum of 20 minutes (although more often and for longer periods of time is better).
Lack of treatment progress can often be traced to a failure to follow through with homework
assignments of practicing relaxation.
Reducing stress and increasing overall coping skills may also be beneficial in helping the client.
Many people who have GAD also lead very active (some would say, "Hectic") lives. Helping the
individual find a better balance in their lives between self-enrichment, family, significant other,
and work may be important. People who have GAD have lived with their anxiety for such a long
time they may not recognize a life without constant worrying and activity. Helping the individual
realize that life doesn't have to boring just because one isn't always worrying or doing things may
also help

*SELF-HELP

Self-help methods for the treatment of this disorder are often overlooked by the medical
profession because very few professionals are involved in them. Many support groups exist
within communities throughout the world which are devoted to helping individuals with this
disorder share their commons experiences and feelings of anxiety. Individuals should first be
able to tolerate and effectively handle a social group interaction. Pushing an individual into a

group setting, whether it be self-help or a regular group therapy experience, is counterproductive

and may lead to a worsening of symptoms.

CASE STUDY 1 (ANXIETY)

An anxious client hospitalized on a psychiatric ward indicates her goal is to
feel more comfortable around with other people. The client states, I get
so tense around the other people my muscle hurt. I just dont know how to
talk to other people. I am afraid I will do something wrong and offend
someone. So I just stay home where it is safe. I dont have any friends here
on the unit. I know I should go to the activities, but I just cant make myself
do it. I wish I could relax more around others.

1. WHAT WOULD BE THE MOST IMPORTANT NURSING DIAGNOSIS FOR

THIS CLIENT?

Fear/anxiety related to unfamiliar environment

2. WHAT ADDITIONAL INFORMATION WOULD YOU NEED TO OBTAIN FROM

THIS CLIENT?

Identifies object of fear

Stimulus believed to be threat

3. HOW COULD YOU GET THIS CLIENT INVOLVED IN THE ACTIVITIES ON

THE UNIT?

Orient client to environment, equipment, and routine

Assure client that staff members are nearby

Maintain a calm, supportive, confident manner when interacting with client

Encourage verbalization of fear and anxiety; provide feedback
Provide a calm, restful environment
Instruct client in relaxation techniques and encourage participation in diversional
activities
Include significant others in orientation and teaching sessions and encourage their
continued support of the client
Encourage significant others to project a caring, concerned attitude without obvious
anxiousness

4. WHICH RELAXATION EXERCISE WOULD IT BE THE BEST FOR YOU TO

TEACH THIS CLIENT?

Slow breathing
Progressive muscle relaxation
Isometric relaxation
Meditation
Visualization
Self hypnosis

5. HOW WOULD YOU DETERMINE THAT THE CLIENT HAD ATTAINED HER
GOAL?

Client will experience a reduction in fear and anxiety as evidenced by:

Verbalization of feeling less anxious

Usual sleep pattern

Relaxed facial expression and body movements
Stable vital signs
Usual perceptual ability and interactions with other.

CASE STUDY 2 (SOMATOFROM DISORDERS)

G.A, a middle-aged man diagnosed with pain disorder, has been

unable to work for the past year. Usually affable and gregarious, G.A. has
become increasingly irritable with friends and family and prefers to spend
time alone. An infrequent drinker (several beers a month) in the past, he
now easily finishes a pack of beer every evening. G.A. is now hospitalized in
a psychiatric inpatient unit.

1. G.A. REQUESTS A PRN PAIN MEDICATION THAT HAS BEEN ORDERED.

WHAT PRINCIPLES WOULD GUIDE THE NURSE IN HANDLING HIS
REQUEST?

BENEFICENCE
Beneficence is defined as doing well for an individual. Most nurses and other clinicians
easily ascribe to this tenet because they entered the healthcare profession, ostensibly, to
do well for others and provide comfort and pain relief. In the modern hospital setting, it is
very rare that pain must be allowed for diagnostic reasons; and it is even rarer that severe
pain cannot be controlled in some fashion. Undertreated pain can lead to respiratory,
cardiac, and endocrine complications as well as delay healing and potentiate the onset of
chronic pain issues for an individual. Although complete relief may not always be
possible, the means for bringing pain under control quickly is usually available and must
be done to be considered good patient care.
Making decisions regarding pain treatment and doing well, however, can take on a
distinct complexity. Many reasons are often given for not providing pain relief
expeditiously. Excuses range from nurses being too busy, to difficulties in getting
medication orders from physicians and pharmacy departments. Patients sometime wait
hours for pain relief. If nurses do not make the management of pain a priority for their
patients, and do not do all they can to advocate to the physician for a patients need for
increased dosages in medication so as to properly combat pain, they are guilty of
neglecting the principle of beneficence. Likewise, when adequate pain relief is withheld
because the patient has a history of substance abuse, the nurse has not given good care
to the patient. The principle of beneficence is upheld when the appropriate amount of
medication or other treatment is administered to the patient in a timely fashion resulting
in the best pain control with acceptable side effects.

2. IN A MEETING WITH G.A. AND HIS WIFE, SHE ASKS WHY SHE IS SO
IRRITABLE. HOW COULD THE NURSE EXPLAIN HIS MOOD CHANGE?

The nurse could possible explain the changes of mood of the client by elaborating to the
wife what does the diagnosis of the client means. The nurse can state that with

somatization disorder, the client experiences the recurrence of many clinically significant
somatic problems. She can also profound it by thoroughly explaining that the disorder,
however, is probably related to brain functioning or emotional regulation rather than the
area of the body that has become the focus of the patient's attention. The symptoms are
real and are not under the person's conscious control; also, a diagnosis of a somatoform
disorder can create a lot of stress and frustration for patients. They may feel unsatisfied
that there's no known explanation for their symptoms. Stress often leads patients to
become more worried about their health. This creates a vicious cycle that can persist for
years.
3. G.A. QUESTIONS GOING TO GROUP THERAPY. I NEED MY PAIN MEDS,
NOT THIS JABBERING ABOUT SO-CALLED PROBLEMS. WHAT IS THE
BEST RESPONSE?

The best response on this scenario is by implying the communication strategies that the
somatoform disorder has. Responding the client that the discussion helps him understand
the sources of somatic symptoms. The nurse just have to do is to encourage the client to
discuss emotions and relate them to the current situation. Showing conveys sincere
interest in the client rather in physical problems.

4. ONE OF THE STAFF MEMBERS COMMENTS THAT HE JUST THINKS G.A.

IS TRYING TO GET OUT OF WORKING. EXPLAIN WHAT IS KNOWN
ABOUT THE ORIGIN OF SOMATOFORM DISORDERS, AND THE ROLES OF
PRIMARY AND SECONDARY GAIN.

A person with somatization disorder is chronically preoccupied with numerous "somatic"

(physical) symptoms over many years. These symptoms, however, cannot be explained
fully by a non-psychiatric diagnosis. Nonetheless, the symptoms cause significant distress
or impair the person's ability to function. The person is not "faking." Somatization
disorder is a medical problem. The disorder, however, is probably related to brain
functioning or emotional regulation rather than the area of the body that has become the
focus of the patient's attention. The symptoms are real and are not under the person's
conscious control. People with somatization disorder report multiple medical problems
over many years, involving several different areas of the body. For example, the same
person might have back pain, headaches, chest discomfort, and stomach or urinary
distress. Women often report irregular periods. Men may report erectile dysfunction
(impotence). The person may:
Describe symptoms in dramatic and emotional terms
Seek care from more than one physician at the same time
Describe symptoms in vague terms
Lack signs of defined medical illness
Have complaints that medical tests fail to support

People with somatization disorder do get diagnosable medical illnesses, too, so doctors
must be careful not to dismiss symptoms too easily. A person with somatization disorder
also may have symptoms of anxiety and depression. He or she may begin to feel hopeless
and attempt suicide, or may have trouble adapting to the stresses of life. The person may
abuse alcohol or drugs, including prescription medications. Spouses and other family

members may become distressed because the person's symptoms continue for long
periods of time and no medical treatment seems to help. Symptoms of somatization
disorder vary by culture, sometimes depending on how illness or "sick roles" are viewed
in a given culture. Cultural factors also affect the proportions of men and women with the
disorder. Female relatives of people with somatization disorder are more likely to develop
the disorder. Male relatives are more likely to develop alcoholism and personality
disorder.

5. WHAT ARE THE POSSIBLE PAIN MANAGEMENT STRATEGIES THAT

COULD INCLUDE IN A TEACHING PLAN FOR G.A.?

Stay active. Pain or the fear of pain can lead people to stop doing the things they
enjoy. It's important not to let pain take over your life.
Know your limits. Continue to be active in a way that acknowledges your physical
limitations. Make a plan about how to manage your pain, and don't push yourself to do
more than you can handle.
Exercise. Stay healthy with low-impact exercise such as stretching, yoga, walking and
swimming.
Make social connections. Call a family member, invite a friend to lunch or make a date
for coffee with a pal you haven't seen in a while. Research shows that people with greater
social support are more resilient and experience less depression and anxiety. Ask for help
when you need it.
Distract yourself. When pain flares, find ways to distract your mind from it. Watch a
movie, take a walk, engage in a hobby or visit a museum. Pleasant experiences can help
you cope with pain.
Don't lose hope. With the right kind of psychological treatments, many people learn to
manage their pain and think of it in a different way.
Follow prescriptions carefully. If medications are part of your treatment plan, be sure to
use them as prescribed by your doctor to avoid possible dangerous side effects. In
addition to helping you develop better ways to cope with and manage pain; psychologists
can help you develop a routine to stay on track with your treatment.