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Psychiatric-Mental Health Nursing

17.2 Anxiety-Related Disorders

Psychiatric-Mental Health Nursing17.2 Anxiety-Related Disorders

Learning Objectives

By the end of this section, you will be able to:

  • Describe causes and treatment approaches for generalized anxiety disorder
  • Understand and plan the nursing interventions for a person with a phobia
  • Outline the attributes of, and approaches to care for, a person suffering from a panic attack

Anxiety disorders encompass a wide range of mental health conditions characterized by persistent and excessive fear or anxiety. These emotions are typically disproportionate to the situation and can interfere with daily activities, relationships, and overall quality of life. Anxiety disorders are among the most common psychiatric disorders in the United States (American Psychiatric Association, 2013).

Generalized Anxiety Disorder

Anxiety becomes classified as a disorder when it exceeds expected levels of worry or fear and begins to interfere with daily functioning. While it is normal to experience anxiety in response to stressful situations or challenges, anxiety disorders are characterized by persistent, excessive, and often irrational fears disproportionate to the triggering event or situation (American Psychiatric Association, 2013). Anxiety becomes problematic when it persists for extended periods, often six months or more, without a specific or rational cause. Sometimes anxiety is so severe that it leads to physical symptoms, such as heart palpitations, sweating, or shaking. Also, if anxiety hinders a person’s ability to function normally, it will likely be considered a disorder (National Institute of Mental Health, 2023). When it is characterized by persistent and excessive worry about everyday events and activities, it is considered generalized anxiety disorder (GAD) and can develop in children or adults.

Causes of Generalized Anxiety Disorder

The exact causes of GAD are not fully understood, but several factors are believed to contribute to the development of this disorder (National Institute of Mental Health, 2023). One of the leading causes of GAD is believed to be genetics. Studies have shown that individuals with a family history of anxiety disorders are more likely to develop GAD. Another potential cause of GAD is environmental factors, such as stress and trauma. Traumatic experiences, such as physical or emotional abuse, can lead to GAD in some individuals. Chronic stress due to professional or financial challenges can contribute to the development of GAD, and so can a medical diagnosis, particularly one with a poor prognosis (National Institute of Mental Health, 2023).

Additionally, brain chemistry and function may play a role in the development of GAD. People with GAD have been found to have imbalances in neurotransmitters, such as serotonin and norepinephrine, that regulate mood and anxiety. These imbalances can lead to persistent anxiety and worry (Nuss, 2015).

Signs and Symptoms of Generalized Anxiety Disorder

GAD can manifest in various ways, including physical, cognitive, and behavioral symptoms. Physical symptoms of GAD can include muscle tension, headaches, nausea, sweating, trembling, fatigue, and difficulty sleeping. Cognitive symptoms of GAD can include persistent and excessive worrying about everyday events, difficulty controlling or stopping worrying, overthinking or ruminating, and feeling on edge or restless. Behavioral symptoms of GAD can include avoiding situations or activities that might trigger worry or anxiety, seeking reassurance from others, and engaging in compulsive or repetitive behaviors to reduce anxiety (National Institute of Mental Health, 2023).

Symptoms of GAD vary between adults and children. Symptoms associated with GAD in adults include:

  • restlessness
  • feeling on edge or irritable
  • fatigue
  • shortness of breath
  • heart palpitations
  • difficulty concentrating
  • muscle tension
  • sleep problems
  • unexplained pains, such as headaches, muscle aches, and stomachaches

GAD in children and adolescents may be seen as excessive anxiety and worry about events or activities, such as school. The child or adolescent may have difficulty controlling worries. There may also be restlessness, fatigue, difficulty concentrating, irritability, muscle tension, and sleep difficulties (American Academy of Child and Adolescent Psychiatry, 2022). Symptoms associated with GAD in children include:

  • excessive worry
  • increased muscle aches
  • impaired concentration
  • fatigue
  • irritability
  • restlessness
  • difficulty sleeping

Diagnosing Generalized Anxiety Disorder

An in-depth interview conducted by a mental health professional is crucial to understanding the client’s symptoms, history, and anxiety’s impact on daily life. Questions should focus on the nature of the anxiety, its duration and severity, potential triggers, and coping strategies.

Because anxiety may have physical manifestations or be linked to other medical conditions, a physical examination should rule out underlying medical issues. Continuous observation of symptoms, such as restlessness, fatigue, difficulty concentrating, irritability, muscle tension, and sleep disturbances, helps form a diagnosis. A comprehensive medical and psychiatric history can provide essential insights into the individual’s overall health and potential factors contributing to anxiety. An evaluation of how anxiety affects daily functioning, relationships, and occupational performance is essential (Cleveland Clinic, 2022).

Treatment of Generalized Anxiety Disorder

Psychotherapy is a common treatment for GAD. CBT has been shown to be effective for GAD. CBT helps individuals identify and change negative thought patterns and behaviors contributing to anxiety (Nakao et al., 2021). An example of a use for CBT in GAD would be when a client constantly worries about failing at work, even though they are performing well. A therapist might help them identify this as an irrational fear and work on understanding why this thought pattern occurs. Another client may believe that any mistake will lead to catastrophe. CBT teaches them to challenge this belief, considering alternative outcomes, and replacing the thought with something more positive and realistic. Other types of therapy, such as acceptance and commitment therapy (ACT) and interpersonal therapy (IPT), may also be helpful. ACT focuses on accepting thoughts and feelings rather than attempting to eliminate or control them. It emphasizes mindfulness and commitment to personal values. During ACT, clients may learn to observe their anxiety as a passing experience rather than a constant problem. IPT focuses on interpersonal relationships and how they impact mental health. A client with GAD may struggle with conflict in their relationship with a sibling, contributing to their anxiety. IPT helps clients understand and address conflict, improving their relationships and reducing anxiety (Bright et al., 2019).

Medications, such as antidepressants and benzodiazepines, may also be used to treat GAD. Antidepressants can help regulate brain chemistry and improve mood. Benzodiazepines can quickly relieve anxiety symptoms but can also be habit-forming and have other potential side effects. Table 17.5 lists the medications used for GAD.

Medication Classification Use
Sertraline SSRI Often used for GAD and other anxiety disorders
Escitalopram SSRI Commonly prescribed for GAD
Venlafaxine SNRI Used to treat GAD, may have fewer side effects
Buspirone Azapirone A non-benzodiazepine option for chronic anxiety
Alprazolam Benzodiazepine Short-term relief, risk of dependence
Diazepam Benzodiazepine Used for acute anxiety, not typically long-term
Table 17.5 Medication Treatment for GAD (Bandelow, Michaelis, et al., 2017)

Self-help strategies, such as exercise, relaxation techniques, and stress management, can also help manage symptoms of GAD. Regular exercise can help to reduce anxiety and improve mood. Relaxation techniques, such as deep breathing and progressive muscle relaxation, can help to reduce muscle tension and promote relaxation. Stress management techniques, such as time management and problem-solving, can help individuals cope better with stressors (Gautam et al., 2017).

Client education and counseling are essential components of the treatment of GAD. Clients with GAD often have misconceptions about their symptoms and may benefit from learning more about the nature of anxiety and effective coping strategies. Some individuals may dismiss their symptoms of GAD as normal stress or everyday worry, failing to recognize that the persistent and excessive anxiety they experience is a treatable medical condition (National Institute of Mental Health, 2022a). There may also be an expectation that treatment, whether medication or therapy, will provide immediate relief. In truth, treatment for GAD often requires time and consistent effort, and progress may be gradual (Mayo Clinic, 2017).

Educating clients involves informing them about the nature of GAD, including common symptoms, such as persistent worry, restlessness, and physical symptoms like fatigue and muscle tension (American Psychiatric Association, 2013). Clients should be aware that treatment may include a combination of medication and psychotherapy tailored to their unique needs and symptoms (Bandelow, Michaelis, et al., 2017). During education sessions, encouraging self-help strategies, such as mindfulness practices, stress management, and maintaining a healthy lifestyle can also be important. Engaging clients in shared decision-making and facilitating open communication with health-care providers can foster a sense of empowerment and active participation in their care, leading to better outcomes (Bandelow, Michaelis, et al., 2017). In addition, clients can benefit from learning problem-solving and communication skills to improve their relationships and reduce stress in their daily lives. Client education and counseling can be delivered in individual or group settings and supplemented with self-help books and online resources (Bandelow, Michaelis, et al., 2017).

Psychosocial Considerations

Generalized Anxiety Disorder and Aggravating Factors

The following psychosocial factors may contribute to the degree, development, and maintenance of GAD:

  • Early life experiences: Traumatic or stressful experiences in childhood or adolescence, such as abuse, neglect, or loss, can increase the risk of developing GAD in adulthood.
  • Family and social environment: Family and social factors, including familial stress, cultural background, and social support networks, can contribute to the development and maintenance of GAD.
  • Personality traits: Individuals with certain personality traits, such as perfectionism, difficulty with uncertainty, and a high need for control, may be more prone to developing GAD.
  • Cognitive and behavioral patterns: Cognitive patterns, including negative thinking and catastrophizing, as well as avoidance behaviors, can contribute to the persistence of anxiety symptoms in GAD.
  • Interpersonal relationships: Difficulty with assertiveness, conflict resolution, and social skills can impact the individual’s ability to manage stress and cope with anxiety symptoms.
  • Work and academic stress: High levels of stress in the workplace or academic setting can trigger or exacerbate anxiety symptoms in individuals with GAD.

(National Institute of Mental Health, 2022a)

Nursing Interventions

Nurses will encounter clients suffering from GAD in all settings and at all stages of life. Nursing interventions for GAD may include assessing and monitoring the client’s anxiety level and related physical symptoms, such as increased heart rate or muscle tension. Nurses can also encourage clients to express their feelings and concerns, provide active listening and support, and teach the client relaxation techniques, such as deep breathing, progressive muscle relaxation, and mindfulness. Nurses will also assist the client with identifying and challenging negative thought patterns and developing coping skills. They can educate the client and their family members on the nature of GAD, the importance of self-care, and the benefits of seeking professional help. Collaborating with the client’s health-care team to develop and implement an individualized treatment plan is part of the nurse’s responsibility as is administering medications as prescribed and monitoring for potential side effects. Nurses will also refer clients to community resources, such as support groups or counseling services (American Nurses Association, 2022).

Cultural Context

Anxiety and Culture

Culture plays an important role in the manifestation, expression, and treatment of anxiety disorders. Different cultures may have different ways of describing and experiencing anxiety symptoms, which can impact the identification and diagnosis of anxiety disorders. For example, some cultures may express anxiety symptoms primarily through somatic complaints, such as headaches or gastrointestinal problems, rather than through psychological symptoms. In addition, cultural factors, such as stigma, religious beliefs, and social support can influence an individual’s willingness to seek help for anxiety symptoms and their preference for certain treatments. Some cultures may prefer traditional healing practices, such as herbal remedies or acupuncture, over Western-style psychotherapy or medication. Mental health professionals must be aware of these cultural considerations and tailor their assessment and treatment approach to provide effective care for individuals of different cultures with anxiety disorders (Tse & Haslam, 2021).


A phobia is an excessive and irrational fear of a specific object, situation, or activity that is typically harmless. Unlike general fear or discomfort, a phobia is characterized by intense anxiety that can lead to avoidance behavior, severely impacting a person’s daily life and functioning (American Psychiatric Association, 2013). Phobias are categorized into different types, such as specific phobias, which focus on particular objects or situations (e.g., spiders, flying); social phobias; and agoraphobia, the fear of being in places or situations where escape might be difficult (Mayo Clinic, 2023a).

Causes of Phobia

The development of phobias is thought to be influenced by a combination of genetic, environmental, and cognitive factors. One theory proposes that individuals may be genetically predisposed to developing phobias. Certain phobias (such as a fear of heights or spiders) appear more common across cultures and may have an evolutionary basis. Environmental factors, such as experiencing a traumatic event or being repeatedly exposed to a phobic stimulus, can also contribute to the development of phobias. Cognitive factors, such as a tendency to catastrophize or engage in negative self-talk, can amplify feelings of fear and anxiety in response to phobic stimuli. Additionally, social learning theory suggests that individuals may learn phobic responses through observation or the influence of significant others (Choy et al., 2007).

Several risk factors have been identified as potentially contributing to the development of phobias. One risk factor is a family history of anxiety disorders or phobias, which suggests a genetic predisposition to these conditions. Other risk factors may include exposure to traumatic events, such as physical or sexual abuse, or a history of childhood adversity. Social factors, such as being raised in an overprotective or controlling environment, may also increase the likelihood of developing phobias. In addition, temperament and personality traits, such as neuroticism or behavioral inhibition, have been associated with an increased risk of anxiety disorders and phobias. Finally, life stressors, such as job loss or relationship difficulties, may trigger the onset of phobias in susceptible individuals (Bandelow, Michaelis, et al., 2017).

Signs and Symptoms of Phobias

Phobias can manifest in both physical and psychological ways. Physical symptoms may include increased heart rate, sweating, trembling, nausea, and hyperventilation. Physical symptoms may sometimes be severe enough to cause a panic attack. Psychological/behavioral symptoms may include intense fear or anxiety, a sense of impending doom or danger, and avoidance behavior. Individuals with phobias may go to great lengths to avoid the phobic stimulus, which can interfere with daily functioning and lead to social isolation. In addition, the fear associated with phobias is often disproportionate to the actual level of danger posed by the phobic stimulus. Some individuals with phobias may also experience feelings of guilt, shame, or embarrassment about their symptoms, which can exacerbate their anxiety (Choy et al., 2007).

Types of Phobias

Phobias can be broadly categorized into specific phobias, social phobias, and agoraphobia. Intense and irrational fear of a specific object or situation, such as heights, spiders, or flying, characterizes specific phobias. Social phobia, or social anxiety disorder, is characterized by an intense and persistent fear of social or performance situations in which others may observe or evaluate the individual. Agoraphobia is characterized by an intense fear of situations or places where escape might be difficult, or help might not be available. This fear may lead individuals to avoid situations, such as public transportation or crowded places, and make them anxious about being outside of the home. While each type of phobia has unique features, they all share a common element of fear or anxiety that interferes with daily functioning (American Psychiatric Association, 2013). Table 17.6 lists some common phobias.

Phobia Description
Arachnophobia Fear of spiders
Acrophobia Fear of heights
Agoraphobia Fear of open or crowded spaces or situations where escape might be difficult
Claustrophobia Fear of enclosed or tight spaces
Social phobia Fear of social or performance situations that may lead to embarrassment
Aerophobia Fear of flying
Trypanophobia Fear of needles or injections
Ophidiophobia Fear of snakes
Table 17.6 Common Phobias (American Psychiatric Association, 2013)

Life-Stage Context

Phobias in Children, Adolescents, and Older Adults

Phobias can affect individuals of any age, but age-related concerns may impact the diagnosis and treatment of phobias. In older adults, phobias may be more likely to co-occur with other medical or psychiatric conditions, complicating treatment. Older adults may also be more likely to have mobility or health problems that make it difficult to access treatment. In addition, phobias may be underdiagnosed or misdiagnosed in children and adolescents due to their unique developmental needs and concerns. For example, children may express fear or anxiety through physical symptoms or have difficulty articulating their fears. Children may be more likely to express fear or anxiety through crying, clinging to caregivers, or freezing in place. They may also have difficulty articulating their fears and may not fully understand the implications of their phobia. Adolescents may experience symptoms similar to those of adults but may have additional concerns about their social identity, such as fear of embarrassment or humiliation (Choy et al., 2007). The prevalence and specific types of phobias may vary by age group. For example, specific phobias, such as fear of animals or the dark, are more common in children, while social phobia becomes more prevalent in adolescence and young adulthood (Davis et al., 2009).

Treatment Options for Phobias

Treatment for phobias in children and adolescents may involve play therapy, parent-child interaction therapy, other age-appropriate interventions, and cognitive behavioral therapy (Davis et al., 2009). Treatment for phobias in adults may involve cognitive behavioral therapy, exposure therapy, or medication, depending on the severity of the symptoms and the individual’s preferences and needs (American Psychiatric Association, 2013).

Cognitive Behavioral Therapy

Treatment for phobias typically involves a combination of psychotherapy and medication. CBT is a commonly used approach that involves cognitive restructuring techniques to assist individuals in recognizing and challenging their irrational thoughts related to the phobia, promoting healthier thinking patterns (Choy et al., 2007).

Exposure Therapy

Exposure therapy is a widely used treatment for phobias, particularly specific phobias. This therapy involves gradually exposing the individual to the phobic stimulus in a controlled setting to reduce their fear response. Exposure therapy can be conducted in vivo, in which the individual is exposed to the actual phobic stimulus, or imaginal, in which the individual is asked to imagine the phobic stimulus. Virtual reality exposure therapy (VRET) uses technology to create controlled and safe virtual environments for exposure, proving useful for specific phobias like acrophobia or fear of flying (Donnelly et al., 2021). Exposure therapy is thought to work by allowing the individual to experience the phobic stimulus and develop new, less fearful associations with it. While exposure therapy can be challenging and uncomfortable for some individuals, it has been shown to be an effective treatment for phobias, with long-lasting benefits even after treatment has ended (Choy et al., 2007).


Medications, such as SSRIs and benzodiazepines, may also be used to treat phobias alone or in combination with psychotherapy. Medication is typically not a first-line treatment option, however, and is usually reserved for individuals with more severe symptoms or who have not responded to psychotherapy alone (Choy et al., 2007). While medications like benzodiazepines or SSRIs may reduce anxiety symptoms, they often do not address the underlying cognitive and behavioral patterns contributing to the phobia (Mayo Clinic, 2023a). As a result, discontinuation of medication might lead to a return of symptoms, whereas the skills learned in CBT can provide ongoing management (Choy et al., 2007). Additionally, medication may come with potential side effects and risks, such as dependency on benzodiazepines, which could outweigh the benefits (Baldwin et al., 2014).

Alternative Treatments

In addition to CBT and medications, individuals with phobias may benefit from self-help techniques, such as mindfulness and relaxation techniques, that teach individuals to manage anxiety through deep breathing and focusing on the present moment, as well as lifestyle modifications, such as regular exercise and healthy sleep habits (Choy et al., 2007). Additionally, methods such as eye movement desensitization and reprocessing (EMDR) are often employed for trauma-related disorders but have been adapted to treat phobias (De Jongh et al., 2013). The effectiveness of these alternative approaches varies and might depend on individual factors, including the type and severity of the phobia, previous treatment experiences, and personal preferences.

Nursing Interventions

Nursing interventions for phobias may involve a combination of client education, counseling, and medication management. Client education can help individuals with phobias understand the nature of their symptoms and how they can effectively manage them. In addition, nurses can support clients in medication management, for example, by monitoring for potential side effects and ensuring adherence to medication regimens. Nurses may also work with individuals to develop personalized treatment plans, including exposure therapy or other forms of psychotherapy. Nurses play a crucial role in providing emotional support and helping individuals build self-confidence and self-efficacy in managing their symptoms (Yamamoto-Mitani et al., 2016).

Panic Disorders

A panic disorder is an anxiety reaction to stress that results in a panic attack. This can be an upsetting experience for the person having the panic attack and the people they are with. Treatment aims to reduce the number of panic attacks a person might suffer and focuses on psychological therapies and psychopharmacology (National Institute of Mental Health, 2023).

Anxiety and Panic

Anxiety and panic are common emotional responses but differ in several important ways. Anxiety is a general feeling of apprehension or worry, often about future events or uncertain situations. Panic is a sudden and intense feeling of fear or terror, often accompanied by physical symptoms, such as sweating, heart palpitations, and shortness of breath. Panic is a sudden and unexpected response to a perceived threat and is often experienced as a feeling of loss of control. Panic attacks can be triggered by a specific situation or occur spontaneously, leading to avoidance behaviors or the development of panic disorder (National Institute of Mental Health, 2023). Table 17.7 contrasts characteristics of anxiety and panic.

Anxiety Panic
Duration May be short or long Typically short
Onset Typically gradual Typically sudden
Symptoms Typically mild and may include:
  • restlessness
  • irritability
  • muscle tension
  • difficulty sleeping
  • fatigue
Typically intense and may include:
  • rapid heart rate
  • shortness of breath
  • nausea
  • dizziness
  • numbness
Table 17.7 Anxiety vs. Panic (Catchings, 2019)

Panic Attack

A panic attack is a sudden episode of intense fear or discomfort lasting several minutes or longer. During a panic attack, an individual may experience physical symptoms, such as sweating, trembling, heart palpitations, shortness of breath, and chest pain. They may also experience psychological symptoms, such as a feeling of impending doom or a sense of losing control. Panic attacks can be triggered by a specific situation, such as public speaking or flying, or can occur spontaneously. They are a hallmark symptom of panic disorder. Panic attack symptoms can resemble symptoms of other serious health problems, so it is essential to rule out a medical reason for the physical symptoms, such as an allergic reaction, asthma attack, or myocardial infarction (National Institute of Mental Health, 2016).

According to Craske and Barlow (2008), there are two types of panic attacks: expected and unexpected. Expected panic attacks are triggered by a specific situation or object, such as public speaking or flying. The fear of having a panic attack in these situations can lead individuals to avoid them altogether, interfering with daily life. On the other hand, unexpected panic attacks occur without a clear trigger or warning. They can happen at any time, including during sleep, and can be distressing and disruptive to daily life. While the type of panic attack may differ, the symptoms and severity are similar. Panic attacks can be very intense and overwhelming and can lead to feelings of fear and loss of control.

Causes of Panic Disorder

The underlying causes of panic disorder are complex and multifactorial, often involving a combination of genetic, neurobiological, psychological, and environmental factors (Cleveland Clinic, 2023). Research has revealed a familial aggregation of panic disorder, suggesting a genetic predisposition (Na et al., 2011). Neurobiological studies have found abnormalities in certain brain structures that regulate fear and anxiety, such as the amygdala (Goddard, 2017). Psychological factors include cognitive processes that may influence the development of panic attacks, such as heightened sensitivity to bodily sensations and misinterpretation of these sensations as life-threatening (Cleveland Clinic, 2023). Additionally, exposure to stressful life events and chronic stress can contribute to the onset of panic disorder. Individuals with panic disorders have been found to have imbalances in neurotransmitters, such as serotonin and norepinephrine, which regulate mood and anxiety. These imbalances can lead to sudden and intense feelings of fear and panic (National Institute of Mental Health, 2022a).

Management of Panic Disorder

Managing panic disorder, and panic attacks specifically, requires tailoring treatment to specific clients and their triggers and symptoms. Exposure therapy and medication are common interventions, as are alternative therapies like breathing and meditation.

Exposure Therapy

Exposure therapy is a common CBT method that focuses on confronting the fears and beliefs associated with panic disorder to help individuals engage in activities they have avoided. Exposure therapy is sometimes used along with relaxation exercises. In the context of treating panic attacks, exposure therapy might include both interoceptive and situational exposures. Interoceptive exposure involves simulating bodily sensations associated with panic, such as rapid breathing or heart palpitations, to help clients confront and become accustomed to these sensations without panic. Situational exposure, on the other hand, would involve confronting feared situations or places that might trigger a panic attack (American Psychological Association, 2017).

Exposure therapy aims to reduce the exaggerated fear response by allowing the individual to experience the feared stimulus in a safe environment. Through repeated exposures, the individual can learn to tolerate the anxiety, reevaluate the threat posed by the feared situation, and build confidence in their ability to cope (Knowles & Olatunji, 2019). Research has shown that exposure therapy can be an effective treatment for panic disorder, often leading to significant reductions in the frequency and severity of panic attacks (Kaplan & Tolin, 2011).


Medications for panic attacks typically fall into two categories: antidepressants and benzodiazepines. Antidepressants such as SSRIs and SNRIs are commonly used to treat panic attacks. These medications work by regulating levels of neurotransmitters in the brain that are associated with mood and anxiety. Antidepressants may take several weeks to start working and cause side effects, such as nausea, dry mouth, and sexual dysfunction.

Benzodiazepines are another class of medications commonly used to treat panic attacks. These medications work by enhancing the effects of a neurotransmitter called GABA, which has a calming effect on the brain. Benzodiazepines work quickly to reduce symptoms of panic but can be habit-forming and may cause drowsiness, dizziness, and impaired coordination. Medications may be combined with psychotherapy and self-help strategies to provide the most effective treatment for panic attacks (Mayo Clinic, 2018b).

Nursing Strategies and Interventions

When managing a panic attack, it is crucial for the nurse to remain calm and focused and to encourage the individual experiencing the panic attack to do the same. Rapid breathing can exacerbate the symptoms of a panic attack, so encouraging slow, deep breathing can help to reduce symptoms and promote relaxation. The nurse can coach the individual to breathe in slowly through their nose, hold for a few seconds, and then exhale slowly through their mouth.

Offering reassurance to the client can be another useful strategy. The nurse should let the individual know they are not alone and that panic attacks are a common experience. Offering encouragement and support and reminding the individual that the panic attack will pass will assist in lessening the length and severity of the attack. Grounding techniques can help the individual to stay present and focused in the moment. The nurse can encourage the individual to focus on their senses, such as the feeling of their feet on the ground or the sound of their breathing. If possible, the nurse should move the individual to a quiet, calm environment free from distractions and stimuli that may exacerbate their symptoms. The nurse may also encourage the individual to engage in self-care practices, such as exercise, healthy eating, and getting enough rest. These practices can help to reduce the frequency and intensity of panic attacks over time (Department of Respiratory Medicine, 2022).

Specific nursing interventions for panic attacks may include:

  • Assessing and monitoring the client’s history of panic, anxiety level, and related physical symptoms. Perform a rapid assessment of vital signs, including heart rate, blood pressure, and respiratory rate. Note any chest pain, difficulty breathing, or other symptoms.
  • Encouraging clients to express their feelings and concerns and providing active listening and support.
  • Using therapeutic communication techniques, such as offering reassurance and exploring coping strategies.
  • Teaching the client relaxation techniques, such as deep breathing, progressive muscle relaxation, and mindfulness.
  • Assisting the client with identifying and challenging negative thought patterns and developing coping skills.
  • Educating the client and their family members on the nature of panic attacks, the importance of self-care, and the benefits of seeking professional help.
  • Collaborating with the client’s health-care team to develop and implement an individualized treatment plan.
  • Administering medications as prescribed and monitoring for potential side effects.
  • Documenting thoroughly by keeping detailed notes of the client’s presentation, the nursing assessment, interventions, and the client’s response for proper continuity of care.
  • Referring the client to community resources, such as support groups or counseling services (American Nurses Association, 2022).

It is also critical to understand how to assist clients in coping after they have experienced a panic attack.

Coping after a Panic Attack

After a panic attack, it is important to encourage the client to practice self-care. Encourage the client to engage in relaxation techniques, such as deep breathing, progressive muscle relaxation, or guided imagery to help reduce stress and anxiety. Mindfulness can help the client stay present in the moment and reduce worry about future panic attacks. Encourage the client to focus on their breathing, body sensations, or surroundings to ground themselves in the present moment. Exercise can also help to reduce anxiety and promote overall physical and mental well-being. Identifying support systems is another important step in coping after a panic attack. Clients should be encouraged to reach out to family and friends for support or consider joining a support group for individuals with similar disorders. Clients should be encouraged to be kind and compassionate to themselves and avoid self-criticism or negative self-talk. Also, clients who stick to a regular routine often report reduced stress and a sense of stability and predictability (National Institute of Mental Health, 2023).

It is important to teach individuals strategies to help prevent future panic attacks. Individuals should first be educated about panic attacks, explaining the physiological and psychological components that can help reduce fear and stigma. Assisting individuals to identify and challenge irrational thoughts that may contribute to panic and replacing them with more balanced perspectives is also a good strategy. Breathing retraining exercises can also teach clients to control hyperventilation and other panic-related physical symptoms.


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