Anxiety Disorder/Obsessive Compulsive Disorder
Anxiety disorders consist of disorders characterized by feelings of anxiety as the main feature with resulting emotional, physiological, behavioral, and cognitive responses. Defense mechanisms or adaptive behaviors by patients attempt to counter these uncomfortable responses. According to Bandelow, Michaelis, and Wedekind (2017), anxiety disorders constitute the most prevalent mental disorders. Obsessive-compulsive disorder involves recurrent, intrusive, and unwanted obsessions that cause pronounced anxiety and compulsions, which attempt to suppress anxiety. OCD is similar to but no longer included in this spectrum of anxiety disorders in the current Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition.
Lauren is a teen diagnosed with Social Anxiety Disorder, which has impacted her life. Her day-to-day functioning has been affected by frequent obsessive thoughts she experiences, which result in compulsive disorders. Her interaction with the nurse reveals clinical signs of anxiety, including nervousness, trembling, a never-ending worry about her grandfather’s well-being, and fear of being infected by people around her.
Lauren explains that she feels nervous being around her peers in school. The nervousness stems from the fear that she might appear clumsy or end up embarrassing herself by either tripping, knocking onto someone, hitting a locker, or saying something wrong. Lauren frequently feels nauseated and gets stomachaches being around her peers. Standing in front of her fellow students during class presentations makes her feel physically ill.
Additionally, she has a never-ending worry that people around her might infect her. Every day, she fears she might unknowingly get infected when she is around people and in school. She is also continuously concerned that something terrible might happen to her grandfather.
Finally, Lauren experienced anxiety shaking when she failed to prepare her grandfather’s breakfast in time. She usually made breakfast for her grandfather every day before 9 am to suppress the worry of something terrible happening to him. That day she trembled the whole day, and her hands kept on tapping. She felt uncomfortable and worried about her grandfather the entire day.
Lauren’s obsessive thoughts include the constant fear that something terrible could happen to her grandfather. She has had such worries since she was a child. Furthermore, she is obsessed with symmetry. Unbalanced things catch her attention. She mentions uneven shoelaces and backpack straps. She also states that she ensures the number of cars matches on both sides of the streets, lest she forces her parents to turn back to verify. She also confirms the number of kids in her class is the same.
A series of routines and rituals help her cope with intrusive thoughts. She prepares breakfast every day by 9:00 am to ensure the rest of the day is okay for her grandfather; otherwise, she will spend the rest of the day worrying. She only takes a shower when three different kinds of body washes are present, and the shower is at the same temperature.
Lauren ensures everything in her room is in order before she goes to sleep. Her drawers are color-coded. She puts everything exactly where they were the previous night; hence she spends most of the night redoing things to get them right. As a result, she is often tired on most mornings due to having fewer hours of sleep. Additionally, she repeats lines from the Goodnight moon’s story repeatedly in her head when she fears she may say an offensive statement aloud and embarrass herself.
One of the therapeutic communication techniques used by the nurse involves using silence. Occasionally, she lets Lauren break the silence during mid-conversation. This gives the client time to think and process an appropriate answer. Silence also allows Lauren to regain composure, reorganize her thoughts, and divulge more information.
Additionally, the nurse actively listens to Lauren using verbal and non-verbal cues. She shows interest in the client’s story and regularly acknowledges that she is listening and understanding. The nurse engages her throughout the conversation, and this encourages Lauren to continue talking. She offers general leads, which steers the discussion forward towards the main points.
The nurse tries to place events in time or sequence as Lauren explains her worries. She tries to establish whether Lauren has ever said something wrong, how often it is a worry for her, and when the worrying first began. This technique helps to put things in perspective and allows the nurse to gain information about repetitive patterns or themes in the client’s behaviors.
After listening to Lauren’s worries, the nurse explores the subject further to figure out how she copes. Though this upsets Lauren a bit, the nurse reassures her she cares, and she is only inquiring to determine the most appropriate treatment for her. Exploring enables the nurse to examine the superficial story in depth. The nurse receives Lauren’s permission to explore further.
Some nursing interventions include remaining calm in your approach, encouraging participation in relaxation exercises, teaching the use of relaxation techniques independently, and portraying mild anxiety as a good thing. A calm approach tends to make clients feel more secure and view you as being in control.
Relaxation therapy is a useful psychological intervention for patients with anxiety disorders (Kim & Kim, 2018). Participation in relaxation exercises such as deep breathing and meditation provides effective non-chemical ways to lower anxiety. Using the relaxation techniques independently will give the client confidence in having control over anxiety. Lastly, helping the client view mild anxiety especially among peers as a positive catalyst for change, will help the client realize that not all anxiety is bad and does not necessarily have to be avoided.
References
Bandelow, B., Michaelis, S., & Wedekind, D. (2017). Treatment of anxiety disorders. Dialogues in clinical neuroscience, 19(2), 93–107.
Kim, H., & Kim, E. J. (2018). Effects of Relaxation Therapy on Anxiety Disorders: A Systematic Review and Meta-analysis. Archives of Psychiatric Nursing, 32(2), 278–284. https://doi.org/10.1016/j.apnu.2017.11.015