Anxiety and anger: psychological perspectives and clinical treatment approaches

AAPT Level IV Cert / Written Test

Anxiety

Anxiety is fear that interferes with normal, daily functioning (Akiskal & Benazzi, 2006). There are several different categories, including generalized anxiety, panic disorder, and phobias. While these all present themselves in different ways, they are similar in the problems they can cause in daily life. Theories of anxiety and the psychopathology related to feeling anxious include issues with biological, cognitive, and learning perspectives. The biological perspective addresses the receptors in the brain and how the chemicals there work with one another. Cognitive theories deal more with the way people perceive issues, such as feeling as though they do not have control over something. The learning perspective focuses on how people actually learn to be anxious about something, and the changes they learn to make in their lives in order to lower the levels of anxiety they feel (Hockenbury & Hockenbury, 2004; Kato, 2011).

Regardless of the theory to which one subscribes, anxiety is still an adaptive response to a threat. When people have anxiety, they perceive something as a threat that is actually not dangerous, thereby triggering the "fight or flight" response when it is not needed and causing them to feel afraid of something of which they should really not be fearful. Caring for anxious clients has to be done properly, in order to ensure that their anxiety is not raised to an unacceptable level by the treatment. While many medications are prescribed for anxiety, there are other ways to treat clients. These can include cognitive behavioral therapy and exposure therapy. While both of those options can work well, they are often used in combination with medication. The medication brings the anxiety down to a lower level which is easier for the client to control, and from that point he or she can begin working on the issues that surround and contribute to the anxiety.

Anger

Anger is defined as a strong feeling of hostility, displeasure, or annoyance. While anger is normal in many cases, there are times when it is wholly inappropriate to the situation. There are also people who do not control their anger well, and that can make them dangerous to themselves and to the general population. Theories of anger involve the reasons behind why people get angry. Some believe, also, that releasing the pent-up anger that a person has is helpful because it causes that person to be less angry. There is significant psychopathology that comes with anger, including intermittent explosive and passive-aggressive personality disorders. These can be based on instinct, social behavior, or motivation (Alonso, et al., 2004). Passive-aggressive people often base their anger on motivation, which intermittent explosive disorder is often more focused on instinct (Weller & Eysenck, 1992).

There are important procedures in caring for angry clients, including ensuring that both the client and the therapist are safe. The risks of working with an angry client can include the client leaving, but can also include the client becoming verbally or even physically abusive. Because that is a concern, the client has to be treated with respect and with care. It can be important that a therapist not "coddle" a client, however, out of fear of making that client angry. That will not solve anything and will not teach the client to handle his or her anger properly. While antagonizing the client is not necessary, the therapist needs to focus on addressing why the client gets angry and what triggers that anger. From that point, the therapist can focus on helping the client find better ways to control, manage, and expel his or her anger. It is not that the client cannot become angry or that anger is an unhealthy emotion. Instead, the issues it that the client must understand that there are healthy and unhealthy ways to express being angry. Healthy ways must be learned and internalized, so they can be used.

Hope and Hopelessness

Hope is defined as a desire and expectation for something to happen. Hopelessness is the opposite of that, when hope has been abandoned (Katschnig, 2010). Depression is more than just sadness. It often also implies apathy, lethargy, and a lack of desire for anything, including things that were once enjoyed. Manic behavior is defined as elevated mood, energy level, or irritability that is abnormal. Suicide is when a person willingly and deliberately ends his or her life. Major depression and bipolar disorder both have interesting psychopathology, which involves both brain chemicals and learned behavior (Berrios, 1999; Clarke, et al., 1993). Issues that take place in a person's life can lead to a depressed state, but major depression does not lift just because life is technically going well. Depression is a chemical imbalance, and will remain a problem without therapy and medication to combat it. The same is true with bipolar disorder, which is not something that can be "cured" and must be managed -- generally with medication.

There are processes and procedures used in caring for clients who feel either hopeful or hopeless. Clients who feel hopeful may sound like a great thing, but if they are hopeful in a way that is delusional or not in keeping with reality, they must be made to understand that their hopefulness is misplaced. They will be continually disappointed if they spend all of their time hoping for things that cannot logically come to pass. As for those who feel hopeless, a combination of medication and talk therapy is often used. Cognitive behavioral therapy can help these patients, as can looking into their past in order to find out the issues they faced and how those issues may have played a part in the hopelessness that they are feeling in the present day. If the moment the client lost hope can be pinpointed, that client can then be helped through a better understanding of that moment and how it cannot and should not define him or her. While this takes time, the rewards can be significant.

Substance Abuse Disorders

The diagnostic criteria for psychoactive substance use disorders include use of the substance habitually, and use of the substance in ways that interfere with everyday life (Willemse, et al., 2004). When people use substances responsibly and do not abuse them, they do not meet the criteria for psychoactive substance use disorders because they are not causing problems for themselves or for others. There are common substances of addiction, including caffeine, nicotine, and alcohol. Their effects are numerous. Alcohol is a depressant, and can also lead to poor motor skills, lack of inhibition, and judgment that is unacceptable or even dangerous. Caffeine raises energy levels, but it also raises heart rate and can cause health problems in people who are sensitive to it. As a stimulant, it can cause jitters, nervousness, and anxiety attacks. Nicotine restricts blood vessels, and can harm many organs in the body. It can also stimulate the nervous system and cause anxiety.

If there are clients experiencing addictive behaviors, there are specific processes and procedures that are used to care for them. The most important issue to consider is that an addictive behavior does not have to an addiction to something like alcohol. Addictions can form to nearly anything. Realizing that there is a true problem is the client's first step toward improvement. While discussing the reasons behind the addiction can be helpful, the client will also want to focus on how to avoid the behavior and not go back to using or abusing the substances for which he or she originally sought therapy. Without healthy, learned behaviors to use when temptation is nearby, the client will not be able to avoid the substance(s) to which he or she was addicted. Many counselors work with clients to help them determine who in their lives may be causing them to revert back to their old ways, so they can avoid those people or find healthier ways to deal with them.

Manipulation

Manipulation is defined as exerting devious or shrewd influence for a person's own advantage (Wittchen & Jacobi, 2005). This is often used by people who have anti-social personality disorder. The psychopathology of anti-social personality disorder is important because most people are social without actually thinking about it. Humans are social creatures, and they like to be around other humans and work together for a common goal. People with anti-social personality disorder and similar issues, however, do not like to be around others and can even be hostile or harmful to other people (Wittchen & Jacobi, 2005). The psychopathology of adult anti-social behavior and malingering are also important. These are worth studying, because they tie into anti-social personality disorder but yet are slightly different. For example, adults can be anti-social without having an actual, diagnosable disorder. Additionally, malingering, or faking or exaggerating an illness to avoid work or some other duty, is anti-social in a different way than most would think of it, but still within that criteria.

There are important processes and procedures for caring with manipulative clients, such as challenging the client when he or she begins anti-social or malingering behaviors. These clients often have these kinds of behaviors so ingrained that they are just a part of life and can be difficult to change. The client may not even realize that he or she is performing the behaviors, especially if the behaviors have been ongoing for a very long time. Recognition is very important when it comes to addressing and correcting behaviors. Until the client realizes that his or her manipulation is harming himself or herself and other people, there is little that can be done to correct the issues. Talk therapy can help the client realize the damage that the behaviors are causing, which can then lead him or her to want to make a change. From that point, techniques can be taught that will help avoid manipulation.

Schizophrenia and Paranoid Disorders

The psychopathology of schizophrenia is particularly significant, because schizophrenia is not something that can be addressed and improved through talk therapy or cognitive behavioral work. Medication is necessary for people who have this disorder, as many of them have trouble functioning in society without it (Akiskal & Benazzi, 2006). Even properly medicated, the schizophrenic person can still struggle. Unfortunately, many people stop taking their medication, and that can lead them to regress back to deviant or even dangerous behaviors brought on by the voices they hear inside their heads. There are also delusional (paranoid) disorders and personality disorders such as schizoid, paranoid, and schizotypal that have significant psychopathology attached to them but are not the same as actual schizophrenia (Kato, 2011). There are many clients who mistrust in different ways and at different levels, and it is very important to use the proper process and procedures when caring for them.

These include finding ways to make the client feel as safe as possible during the therapy sessions. Clients who do not feel safe will not open up to the therapist, and that makes it much more difficult to help them. It is often necessary to medicate clients who exhibit paranoia to get them to a level where their thinking is more rational and they are open to other techniques that will improve their lives. However, one of the main problems comes into play because paranoid client may not be comfortable taking medication. They may feel as though the therapist is going to poison them or give them something that will control or otherwise harm them. This is a serious concern for treating clients who have mistrust issues, and cannot always be corrected. Some people who have schizophrenia and related disorders live in institutions because they cannot handle life on their own. While that is not the desired outcome, it is sometimes required for clients with severe mistrust disorders.

Skills

The three most important skills for the psychiatric technician are different based on the level he or she has attained. These are very important to focus on, because the technician must advance in his or her career. In addition to the education attained, there is significant information gained through work and interaction with clients who have various mental health issues. As a psychiatric technician moves through the levels of educational and work attainment, he or she is expected to know more and be able to handle more. As such, there are skills that should be developed at every level. At the lower levels, the skills will be less critical to the actual process and will be skills that are more expected or more common, while higher levels will require more specialized skills. These skills are:

Level One (HS diploma and work in the field): Listening, intake of patients, filling out forms. These are basic skills that will be learned early on and that can be expected to be used throughout a career.

Level Two (30 college credits and one year experience): Observation, patient assessment, patient education. As a technician develops his or her skills further, more is required of him or her on a daily basis.

Level Three (60 college credits and two years experience): Basic nursing, treatment plan development, treatment evaluation. Not only is the technician comfortable caring for patients at this point, but he or she should also be comfortable making decisions about that care.

Level Four (Bachelor's degree and three years experience): Medication administration, therapeutic activities, group process. At this point, the technician should be working unattended most of the time, and should be comfortable carrying out treatment plans and making decisions to properly care for the patient.

Essay Questions

Level One Essay Question: How can the psychiatric technician best learn to care for patients on a day-to-day basis?

This question is good for this level because it is very basic. During the time that a technician is just learning to do things, he or she needs to take things slow and work carefully with others in order to understand everything that really needs to be done. If the technician tries to do too much too soon, patient care could suffer because the technician will not have learned to properly care for the patient in the right way when it comes to daily activities and treatments the patient needs.

Essay Question Answer: To learn to properly care for a patient on a daily basis, a technician should be careful about doing things too quickly. Having a checklist can help, but there are generally differences between patients that are often relatively significant. With that in mind, making a checklist of the basics may help but the technician still has to take the time to learn about each individual person in his or her care in order to make sure those people are taken care of properly each day. There can be a significant number of daily tasks for a particular person, depending on their level of need. If the technician does not learn this, and also does not learn the proper way to handle the tasks themselves, he or she could end up with a high level of difficulty when it comes to completing the work each day and making sure all of the patients under his or her care have what they need.

Comments: Each technician and each patient is different. It is very important to keep that in mind, and not assume that everyone can be handled the same way. By understanding how to perform all the tasks correctly, the tasks can be mixed and matched to accommodate the patients no matter what they need.

Level Two Essay Question: What are the reasons for learning to record vital signs and other patient information?

This question is good for this level because technicians who have been working in the field for a while are learning how to do more things. They are still caring for the patient on a daily basis, but they are also becoming more focused on working with the patient to provide nursing services, to some extent. The more they learn, the more they are able to provide proper information to the psychiatrists and others who will be providing the top level of care to the patients.

Essay Question Answer: When a psychiatric technician learns to record vital signs and patient information, it allows them to perform another task and means that another person does not have to make the rounds to collect that information. That makes patient care faster and easier, and it also provides patients with the ability to get to know and recognize the people they see most often. That can help the patients become more comfortable and less agitated, and can also help the technicians learn more about the patients. While taking the vital signs and information, the patients may provide the technician with insight into an illness or a developing problem, which can help the technician start to address something before it becomes a much more serious issue. That is one of the best ways to handle things, and cannot generally be done when there are a larger number of people coming through and seeing the patients all the time. Getting to know the patients better can help everyone involved.

Comments: Many people do not realize the significance of having a technician take vital signs and information, but that translates to a lot more time with the patient. Helping patients feel more comfortable and spending more time with them makes a difference in mental and emotional health.

Level Three Essay Question: How can the technician best create treatment plans for patients and determine whether these plans are working correctly?

This question is good for this level because by the time the technician gets to this level he or she should be able to create treatment plans for patients. Even if the technician does not create the treatment plans alone yet, he or she should be able to work with others to do so, and the technician also needs to understand how to determine whether the treatment plan is actually working and whether the plan will need to be adjusted. How to adjust it, if necessary, is another vital issue when it comes to the treatment plans, because technicians must learn what changes to make and when.

Essay Question Answer: The best way for a technician to create treatment plans is to work with others to do so until full training is complete. If he or she is not sure about parts of the plan, asking is important. Technicians do not want to take it upon themselves to create and adjust treatment plans if they are unsure how to do so or not comfortable with the plans. In short, the best treatment plans are those that come with experience. Plans take time to create, and some patients are more challenging to work with and help than others. The technician has to be aware of that, and has to come up with a plan that will work with the patient specifically. Understanding the patient's needs, wants, conditions, and history can go a long way toward working on a plan that will be acceptable and that will move the patient toward a good outcome. Making changes to the plan is another important aspect, and is best accomplished when the plan has been in place long enough to see what is working and not working correctly.

Comments: It is important to create a plan quickly so that treatment can be started, but it is equally important to make sure that a high level of thought is put into the plan so that it works as well as possible in its original state and needs few, if any, changes.

Level Four Essay Question: How can the technician make a determination as to whether he or she wants to remain a technician or move toward nursing or another career?

This question is good for this level because the technician will have been working in the field for a number of years at this point. He or she will also have a degree, and will be better prepared to determine what he or she specifically wants to do for a career. That is not to say that the technician would want to get out of the field, but only that he or she may want to focus on moving even further into the mental health field in some capacity. Some psychiatric technicians may want to work toward becoming psychiatrists, but others may be very interested in nursing or related pursuits. Those who want to work in these kinds of fields will need additional work and schooling, and at some point they will have to make the choice regarding which direction they want to take.

Essay Question Answer: Making a determination about whether to remain as a technician or move toward a different but related field can be stressful. The best way to make the determination is to carefully consider all the factors surrounding it. Financial considerations are important, but that is not all that matters to the majority of people. They generally work in the mental health field because they want to help others, and they can do that in a lot of different capacities. Continuing to work as technicians is only one of the ways to focus on helping others with emotional and mental issues. Life and career satisfaction are also very important, because a technician who is unhappy will not do the best job. Changing jobs and finding something that makes that person happier can be a good choice.

Comments: Whether a person should stay working as a technician or should choose something else in a related field is a very individual choice. It is not something that can be decided by anyone other than the specific person.