Anxiety

KEYPOINTS

• Anxiety is fear that doesn’t have a recognizable source
• Anxiety is a common experience for both patients and family/caregivers
• Prevalence of anxiety is influenced by type, stage and site of disease, coping mechanisms, and access to social and emotional support
• Unrelieved symptoms such as pain or dyspnea may create or worsen anxiety. Good symptom management of these and other symptoms is important
• Psychological, social, and spiritual distress are equally important contributing factors
• Anxiety can be reduced using both pharmacological and non-pharmacological interventions

CONSIDERATIONS

The following are some important factors to consider when assessing and managing anxiety:

• The person’s expressed experiences of their distress, including characteristics, severity and duration
• Assessment of the sources and causes for anxiety
• Previous experiences with anxiety
• Family/caregiver reactions and concerns to the patient’s distress
• Resources available to the patient, family/caregivers and team
• Weighing the benefits and pitfalls of treatment options
• On-going assessment and evaluation of patient’s responses to interventions

STRATEGIES

Anxiety can occur along a continuum of duration and intensity. Both pharmacological and non-pharmacological interventions may be of help:

Non-Pharmacological

• Interdisciplinary assessment (identifying and attending to range of physical/psychological/social/spiritual factors)
• Counselling support
• Therapeutic interventions:
  • Relaxation techniques
  • Guided imagery
  • Breathing exercises
  • Meditation
  • Coping skills (strengths-focused)
  • Cognitive behavioral approaches
  • Music/rituals

(see Therapeutic Interventions)

Pharmacological

• Low dose benzodiazepines (e.g., lorazepam, clonazepam, diazepam) may be helpful
• See section on agitation in Delirium for dosing and treatment options
  • Treatment with antidepressants (e.g., SSRIs) may also be of benefit to some individuals

SOURCES/REFERENCES

1. Downing GM, Wainwright W, editors. Medical care of the dying. 4th ed. Victoria (BC): Victoria Hospice Society; 2006.
2. Doyle D, Hanks G, Cherny N, Calman K, editors. Oxford textbook of palliative medicine. 3rd ed. Oxford: Oxford University Press; 2005.
3. Kabat-Zinn J. Full catastrophe living: using the wisdom of your body and mind to face stress, pain and illness. New York: Delacorte; 1990.
4. Levine P. Waking the tiger: healing trauma. California: North Atlantic Books; 1997.
5. Librach L, Gifford-Jones W. Ian Anderson continuing education program in end-of-life care. Module 6: psychological symptoms. [Online]. Available from: URL:http://www.cme.utoronto.ca/ENDOFLIFE/Modules/PSYCHOLOGICAL%20SYMPTOMS%20MODULE.pdf
6. Storey P, Knight C. Pocket guide to hospice/palliative medicine. Gainesville (FL): American Academy of Hospice and Palliative Medicine; 2005.
7. Storey P, Knight C. UNIPAC Two: Alleviating psychological and spiritual pain in the terminally ill. Gainesville (FL): American Academy of Hospice and Palliative Medicine; 1997.
8. Watson M, Lucas C, Hoy A, Back I. Oxford handbook of palliative care. Oxford: Oxford University Press; 2005.
9. Werth J, Blevins D, editors. Psychosocial issues near the end of life: a resource for professional care providers. Washington (DC); American Psychological Association; 2006.

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