IMPORTANT NEWS: Anxiety Disorders in Long Term Care: The Role of Psychotherapy

  Affiliated COUNSELING AND REFERRAL SERVICES (ACRS)

 DR. Michael Shery, clinical psychology

  2615 Three Oaks Rd, Ste. 2A,  Cary, IL 60013

 www.carypsychology.com  847 516 0899 (24 Hrs);  drmike@carypsychology.com

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IMPORTANT NEWS: Anxiety Disorders in Long Term Care: The Role of Psychotherapy

Written by: Dr Mike Shery

Anyone experienced in long term care management knows that everyone feels anxious and under stress from time to time. Situations such as conflict-laden relationships, difficulty in performing important obligations or frustrating cognitive tasks, often bring about anxious feelings. Mild anxiety may help make a person become alert and focused while facing threatening or challenging circumstances, while severe anxiety is very debilitating.

Anxiety disorders cause severe distress over a period of time and disrupt the lives of individuals suffering from them. The frequency and intensity of anxiety involved in these disorders severely compromises quality of life. But fortunately, with proper and effective treatment, residents suffering from anxiety disorders can lead normal lives.

What are the major kinds of anxiety disorders?

It is important for those in long term care management to understand that there are several major types of anxiety disorders, each with its own characteristics.

People with generalized anxiety disorder have recurring fears or worries,  about health or finances etc, and they often have a persistent sense that something bad is just about to happen. The reason for the intense feelings may be difficult to identify. But the fears and worries are very real and often keep individuals from concentrating on daily tasks.

Panic disorder involves sudden, intense and unprovoked feelings of terror and dread. Residents who suffer from this disorder generally develop strong fears about when and where their next panic attack will occur, and they often restrict their activities.

A related disorder involves phobias, or intense fears, about certain objects or situations. Specific phobias may involve things such as encountering certain animals or flying in airplanes, whereas social phobias involve fear of social settings or public places.

Obsessive-compulsive disorder is characterized by persistent, uncontrollable and unwanted feelings or thoughts (obsessions) and routines or rituals in which individuals engage to try to prevent or rid themselves of these thoughts (compulsions). Examples of common compulsions include washing hands or cleaning house excessively for fear of germs, or checking over something repeatedly for errors.

Someone who suffers severe physical or emotional trauma, such as from a natural disaster or serious accident or crime, may experience post-traumatic stress disorder. With this problem, thoughts, feelings and behavior patterns become seriously affected by reminders of the event, sometimes months or even years after the traumatic experience.

Symptoms such as shortness of breath, racing heartbeat, trembling and dizziness often accompany these disorders. Although they may begin at any time, anxiety disorders often surface in adolescence or early adulthood. There is some evidence of a genetic or family predisposition to them.

Why is it important to seek treatment for these disorders?

If left untreated, anxiety disorders can have severe consequences. For example, some residents who suffer from recurring panic attacks avoid, at all costs, putting themselves in situations that they fear may trigger an attack. Such avoidance may create problems by conflicting with family obligations and basic activities in the facility.

Many residents who suffer from an untreated anxiety disorder are prone to other psychological disorders, such as depression, and they have a greater tendency to abuse alcohol and pain medications. Their relationships with family members and friends may become very strained.

Are there effective treatments available for anxiety disorders?

Absolutely. Most cases can be treated successfully by mental health care professionals.

Those in long term care management should realize that, according to the National Institute of Mental Health, research has demonstrated that both 'behavioral therapy' and 'cognitive therapy' can be highly effective in treating anxiety disorders. Behavioral therapy involves using techniques to reduce or stop the undesired behavior. For example, one approach involves training patients in relaxation and deep breathing techniques to counteract the agitation and hyperventilation (rapid, shallow breathing) that accompany certain anxiety disorders.

Through cognitive therapy, residents learn to understand how their thoughts contribute to their symptoms and how to change them to reduce the likelihood of occurrence and the intensity of reaction. The patient's increased cognitive awareness is often combined with behavioral techniques to help the resident gradually confront and tolerate fearful situations in the controlled, safe environment of the facility.

Proper and effective medications may have a role in treatment along with psychotherapy. In cases where medications are used, the patients care may be managed collaboratively by a psychologist and physician. It is important for patients to realize that there are side effects to any drugs, which must be monitored closely by the facility staff.

How can a psychologist help someone suffering from an anxiety disorder?

Psychologists are highly qualified to diagnose and treat anxiety disorders. Nursing home administrators, desirous of helping residents suffering from these disorders, should seek a provider who is competent in cognitive and behavioral therapies.

Family and group psychotherapy offer helpful approaches to treatment for patients with anxiety disorders.  

How long does psychological treatment take?

Long term care management professionals need to be aware that treatments for anxiety disorders do not work instantly. The resident should be comfortable from the outset with the treatment being proposed and with the psychologist with whom he or she is working. The patients cooperation is crucial, and there must be a strong sense that the patient and psychologist are collaborating as a team to reduce the anxiety.

No one plan works well for all elderly patients. Treatment needs to be tailored to the needs of the elderly patient and to the type of disorder from which she suffers. The psychologist and aged patient should work together to assess whether a treatment plan seems to be on track. Adjustments to the plan sometimes are necessary, since patients respond differently to different treatments.

However, many residents will begin to improve noticeably within eight to ten sessions, especially those who carefully follow the outlined treatment plan.

There is no question that the various kinds of anxiety disorders can severely impair a geriatric patients functioning with family and in the facility. Long term care management professionals should realize that the prospects for long-term recovery for most residents who receive appropriate professional help are very good.

Those who suffer from anxiety disorders can work with the psychologist to help them regain control of their feelings and thoughts -- and their lives.

  Make appointment for an assessment of your facility by calling 1 847 516 0899 or return to:  NURSING HOME MANAGERS: Drug-Free Ways to Eliminate Resident Depression

To return to:  Articles:  Eliminate Depression in your Nursing Home Residents