Anxiety in health care situations

Many aspects of health care are anxiety-provoking in themselves. Waiting to see a doctor may make patients anxious because they are already feeling ill and therefore vulnerable, or they are worried about what the doctor may say or do. They are dependent on the doctor for help, do not know what to expect and may find it difficult to say exactly what they want to say. Coming into hospital may produce the same effect, but has the added stress of being taken into a strange institution and having control taken away from them (pp. 102–103). It is easy to underestimate the degree of anxiety that patients feel when faced with a doctor. They may react in maladaptive ways: by not giving the right information, or by being defensive, hostile or tearful. They are frequently too anxious to understand, think about or remember what is said to them. They may show clinical signs of anxiety that may be mistakenly attributed to some other illness. Every effort should be made to reduce anxiety in order to get the most out of a clinical encounter (see pp. 96–97).

What is anxiety?

Anxiety refers to an emotional state that can usefully be divided into three components:

1. Thoughts – these often act as the trigger for creating the state of anxiety, e.g. ‘What if my foot slips off this ledge and I fall down the rockface?’, ‘What if I can’t answer key questions at the interview?’ or ‘What if we split up and I’m left on my own?’

2. Physical symptoms – these are numerous; most commonly they include an increased heart rate, increased blood pressure, feelings of tension in the muscles, sweating, nausea or indigestion, trembling, blushing, tightness or dryness in the throat and dizziness.

3. Behaviour – this is what you do in order to reduce anxiety, for example, refusing to go on up the rockface, or avoiding interviews or doing deep breathing in order to ease the physical symptoms of anxiety in an interview. Behaviour that reduces anxiety without damaging health or welfare is adaptive, but many of the ways in which we respond to anxiety are maladaptive, e.g. avoiding social occasions or using alcohol for relief (pp. 126–127).

How is anxiety maintained?

The three components listed above can interact to maintain anxiety and can also make it worse. The case study illustrates how anxiety can escalate. Whatever the initial cause of Andrew’s symptoms, he had interpreted the sensations as potentially threatening (the risk that he would faint in the shop and how embarrassing this would be). These anxious thoughts set off further symptoms (through the release of adrenaline and noradrenaline). Escaping reduced symptoms and avoidance prevented them.