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Anxiety:
Etiology, Treatment, and
Christian Perspectives
By Debra Walker
and Jane Leach
Huan Tran / Alamy
84  JCN/Volume 31, Number 2
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Copyright (c) 2014 InterVarsity Christian Fellowship. Unauthorized reproduction of this article is prohibited.

Page 2
ABSTRACT: Anxiety disorders are the most common mental
illness in the United States, affecting 18% or more of adults.Anxiety
is a natural response to stress and danger but becomes pathological
when excessive and uncontrollable.This article discusses symptoms,
risk factors, neurobiology and pathophysiology, psychotherapies and
medications used in treatment, nursing interventions, and biblical
Christian understanding and support for managing anxiety.
KEY WORDS: anxiety disorders, inner peace, nursing interven
tions, psychopharmacology, psychotherapy, spiritual care, stress
management
"I
am so worried...I can't stop
thinking... if I could just sleep
. . . what if . . ."
ANXIETY EPIDEMIC
Anxiety reached epidemic propor
tions in the 1990s and has worsened in
the wake of economic instability and
terrorism (Bourne, 2005). In 2005, over
18% of people in the United States
experienced symptoms of anxiety
although only about one-third sought
treatment (Anxiety and Depression
Association of America [ADAA],
2013a; Kessler, Chiu, Demler, Merikan
gas, & Walters, 2005). In 2010, anxiety
disorders were one of the major
contributors to disability (U.S. Burden
of Disease Collaborators, 2013).The
National Institute of Mental Health
Debra Walker, DNP, RN, FNP-BC, is an  of Nursing at Midwestern State University
(MSU) and Graduate Coordinator for the Wilson
School of Nursing at MSU. Debra is the owner of
Quality Express Clinic, where she practices as a Family
Nurse Practitioner.
Jane Leach, PhD, RNC, IBCLC, is
of Nursing at Midwestern State University (MSU), and
teaches in the graduate program. Jane serves as faculty
advisor for Nurses Christian Fellowship called Nurses 4
Christ on the MSU campus.
Accepted by peer review 5/20/2013.
The authors declare no confict of interest.
DOI:10.1097/CNJ.0000000000000051
(NIMH) reports anxiety disorders
continue to affect 40 million adults
(18%) in a given year. Over their
lifetime, women are 60% more likely to
experience anxiety than men (NIMH,
2013).Anxiety disorders are the most
common mental illness in the United
States (ADAA, 2013a).
The long-term effects of undiag
nosed and undertreated anxiety
disorders result in psychosocial and
occupational dysfunctions, drug and
alcohol abuse, overeating, and increased
risk of suicide. Generalized anxiety
disorder (GAD) affects 6.8 million
adults or 3.1% of the U.S. population
(ADAA, 2013a) and the annual cost
of disability attributed to GAD is
estimated at well over $42 billion
(Kroenke, Spitzer,Williams, Monahan,
& Lowe, 2007).
Many of the patients we care for as
Advanced Practice Nurses are riddled
with anxiety.Although anxiety can
have physical pathology, we believe that
what we often see in patients is the
lack of peace since the mind is attacked
by anxiety, worry, and fear.The purpose
of this article is to help healthcare
providers understand anxiety, its
prevalence and common treatments,
and explore underlying spiritual issues
that may fuel anxiety and rob patients
of inner peace.
PEACE VERSUS ANXIETY
Culture has one defnition of peace
but there is a different defnition in
the Bible.The cultural view stresses
the importance of self-actualization
and lack of confict between people.
Generally, when people speak about
peace, it is within the framework of
freedom-for society and for indi
viduals.Although most understand that
freedom comes with a cost, freedom
alone does not ensure internal peace
of mind and spirit.
The word "peace" originally comes
from the Hebrew word Shalom
representing soundness, health,
prosperity, and general well being.
Shalom implies nothing is missing or
broken in the lives of God's people
(Strong, 2012). In the Tanakh or Old
Testament Scriptures, inward shalom
was the gift to the righteous who
chose to put their trust in God (i.e.,
Job 22:21). Isaiah 26:3 states,"You will
keep in perfect peace him whose mind
is steadfast because he trusts in you"
(NIV 84). Many of the psalms speak
about peace (i.e., Psalm 4:8, 29:11,
119:165). Shalom is the peace that
results from a spirit, soul, and body
completely at rest because of perfect
trust in God.
In contrast, the Bible provides a
vivid description of anxiety that would
Anxiety disorders
affect 40 million adults
in a given year.
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occur if the Israelites chose not to
follow God:
You will live in constant sus
pense, filled with dread both night
and day, never sure of your life. In
the morning you will say, 'If only it
were evening!' and in the evening,
'If only it were morning!'-because
of the terror that will fill your hearts
and the sights that your eyes will see.
Deuteronomy 28:66-67, NIV84
Furthermore, anxiety is contagious.
Deuteronomy 20:8 states,"Then the
offcers shall add,'Is any man afraid or
fainthearted? Let him go home so that
his brothers will not become disheart
ened too.'"
Jesus is referred to as the Prince of
Peace (Isaiah 9:6), one who brings
peace (Roman 5:1), and God is the
God of peace (Romans 15:33). Jesus
talked about peace, saying,"Peace I
leave with you; my peace I give you. I
do not give to you as the world gives.
Do not let your hearts be troubled and
do not be afraid" (John 14:27, NIV).A
common salutation of the frst century
apostles was "Peace, from God our
Father and the Lord Jesus Christ"
(Galatians 1:3; Ephesians 1:2; Philippians
1:2). Perhaps one of the strongest
passages about how to fnd and remain
peaceful is Philippians 4:6-9 (NIV84):
Do not be anxious about any
thing, but in everything, by prayer
and petition, with thanksgiving,
present your requests to God. And
the peace of God, which transcends
all understanding, will guard your
hearts and your minds in Christ
Jesus. Finally, brothers, whatever
is true, whatever is noble, whatever
is right, whatever is pure, whatever
is lovely, whatever is admirable-if
anything is excellent or praise
worthy-think about such things.
Whatever you have learned or
received or heard from me, or seen
in me-put it into practice. And the
God of peace will be with you.
From Scripture we learn that God's
plan for us is to have peace, but for
many the opposite is true as they live
in constant anxiety.
UNDERSTANDING ANXIETY
Anxiety is the response to an ambig
uous sense of threat or danger, now or
in the future. In contrast, fear is the
response to a real and often serious
threat of imminent danger. Despite
these differences, anxiety and fear have
similar physiologic and emotional
responses (Comer, 2012).Anxiety is a
natural response in humans as a
necessary warning signal, but becomes
pathological when excessive and
uncontrollable. It is normal to have a
"case of nerves" about an upcoming
important event (fnal exam, job
interview) or things like paying bills or
performing in public. But it is not
normal to constantly worry and have
such signifcant distress one cannot
function in daily life.
Anxiety disorders are mental illnesses
that share common features of excessive
fear and anxiety that lead to changes in
behavior (i.e., avoidance, obsessions)
and exhibit with certain physical
disturbances (i.e., stomach pain, heart
pounding).Anxiety disorder is excessive
and irrational anxiety and at times,
panic attacks.Twelve categories of
anxiety disorders are included in the
new Diagnostic and Statistical Manual of
Mental Disorder, Fifth Edition (Ameri
can Psychiatric Association, 2013) as
shown in Table 1. Post-traumatic stress
disorder (PTSD) is no longer categorized
as an anxiety disorder but is in a new
category "Trauma and Stress or Related
Disorders." Obsessive-compulsive
disorder (OCD) also is in a new
category "Obsessive Compulsive and
Related Disorders."
Each anxiety disorder has specifc
guidelines for diagnosis, and it should
be noted that diagnoses can be com
plicated by other psychiatric disor
ders or co-morbid conditions. Unfor
tunately, patients may have multiple
anxiety disorders as their condition
progresses and the mind and body are
held captive by symptoms.Anxiety
disorders are challenging to patients
and their family and caregivers because
patients often cannot specify what they
fear or why they are anxious.
There is no clear pathophysiology
for anxiety disorders, but physical and
emotional symptoms are believed to be
due to a disrupted modulation within
the central nervous system and brain.
Several neurotransmitter systems have
been implicated, including serotoniner
gic and noradrenergic systems, as well
as the gamma-aminobutyric acid
(GABA) system. In anxiety disorder, it
is thought that there is insuffcient
activation of the serotoninergic system
and a hyperactivation of the noradren
ergic system (Comer, 2012).
Understanding of the neurobiology
of anxiety disorders has advanced
"Do not be anxious about anything, but in everything,
by prayer and petition, with thanksgiving, present
your requests to God. And the peace of God, which
transcends all understanding, will guard your hearts
and your minds in Christ Jesus." Philippians 4:6-7.
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signifcantly in recent years.We know
the brain has two fear pathways.A fast
pathway mediated by the amygdala
mobilizes the body to fee a threat by
initiating the "fght or fight" response.
A slower pathway mediated by the
prefrontal cortex takes several millisec
onds longer and can interpret whether
a stimulus is truly dangerous or not. If
the stimulus turns out to be harmless,
the prefrontal cortex can slow down
the rapid amygdala activation. It is
known that panic, phobias, and
generalized anxiety appear to involve
one circuit of the brain, although OCD
involves a different circuit (Comer,
2012; Sadock & Sadock, 2007).
High cortisol levels have been found
where anxiety is present.The amygdala
signals the hypothalamus to secrete a
corticotrophin releasing factor, which
signals the pituitary to release an
adrenocorticotropic hormone. The
release of this hormone stimulates the
adrenal glands to secrete cortisol. It is
thought that repeated stimulation of
the adrenal glands over time to release
cortisol may prevent the amygdala from
properly turning off the "fght or
fight" response (Comer, 2012; Sadock
& Sadock, 2007).
RISK FACTORS
Individuals with unhealthy lifestyles,
poor coping skills, and environmental
stressors including emotional, physical,
or sexual abuse, are more prone to
anxiety disorders. Risk factors, including
poor social support, low socioeconom
ic status, and low educational levels may
increase the probability of the develop
ment of anxiety disorders (Sadock &
Sadock, 2007).The development of
anxiety also may be a learned behavior.
For example, approximately 15% to 20%
of children with at least one agorapho
bic parent become agoraphobic
themselves (Culpepper, 2002).
Research also points to possible
genetic risk factors for anxiety disor
ders. One genetic risk surrounds the
involvement of a single nucleotide,
polymorphism (C[-1019] G), on a
serotonin transporter gene 5-HT1A.
This common functional variation
effects serotonin signaling. If a patient
is born with a short form of the gene,
it results in decreased serotonin release
at postsynaptic targets in the forebrain.
With the short form, a patient may be
more vulnerable to life stressors and
more likely to develop an anxiety or
mood disorder, although being less
responsive to selective serotonin
reuptake inhibitor (SSRIs) medica
tions (Fakra et al., 2009).
A risk factor for anxiety that has not
been adequately researched is a lack of
spiritual faith and standards. In the last
30 to 50 years, we have experienced a
great deal of environmental and social
order chaos. It is diffcult to adjust to the
increased pace of modern society and
rapid technological change. People today
also are faced with a barrage of differ
ing worldviews and moral standards. In
a postmodern world of subjective truth,
the ability to judge between right and
wrong seems more complicated. Biblical
standards such as the Ten Command
ments (Exodus 20) or the Golden
Rule (Matthew 7:12) seem outdated.
Researchers have found that religion
and faith play a signifcant role in health
and response to illness (Koenig, King, &
Carson, 2012), and it is likely changing
societal factors and lack of spirituality
play a role in anxiety today.
SYMPTOMS OF ANXIETY
DISORDER
Symptoms of generalized anxiety
disorder or GAD may be manifested in
various presentations including a
physiological response, a psychological
response, or behavioral changes.A
patient may describe a combination of
responses.The body's stress response is
designed to be acute and limited to a
short period of time.When stress
becomes chronic, it can disturb the
physical and mental health of a patient.
Most pathophysiology textbooks
differentiate between the acute and
chronic effects of stress on the body.An
acute stress response is associated with
an expected "fght or fight" reaction
causing an increase in heart rate,
oxygen intake, and mental activity.A
patient may manifest a pounding
headache, cold moist skin, and a stiff
neck. In a truly life-threatening
Table 1. Diagnostic
and Statistical Manual
of Mental Disorders,
5th Edition (2013)
ClassificationofAnxiety
Disorders
-  Separation anxiety disorder
-  Selective mutism
-  Specific phobia
-  Social anxiety disorder (social phobia)
-   Panic disorder
-   Panic attack (specifier)
-   Agoraphobia
-   Generalized anxiety disorder
-   Substance/medication-induced
anxiety disorder
-   Anxiety disorder due to another
medical condition
-   Other specified anxiety disorder
-   Unspecified anxiety disorder
situation, these changes are considered
healthy, normal responses intended to
divert blood to more essential bodily
functions. For example, increases in
blood fow to large muscles would
enable someone to physically respond
to danger by increasing his/her
strength or ability to move rapidly
(Comer, 2012; Porth, 2010).
Stress signifcantly elevates blood
pressure and heart rate, causes broncho
dilation, increases blood sugar levels, and
diminishes the infammatory and
immune responses in the body (Gould
& Dyer, 2011).These changes can have
a profound impact on a patient who
has preexisting conditions, such as heart
problems, respiratory diseases, or
diabetes. For example, a patient with
heart disease may respond to stress with
dysrhythmias.The body usually recovers
quickly from the physiological changes
resulting from stressors, but when acute
stressors are continuous or when a
normal adaptation to stress is impaired,
individuals suffer more chronic effects.
On a psychological level, patients
with GAD typically report more
subjective symptoms such as a state of
apprehension or uneasiness, along with
complaints of depression; they may
experience crying spells.They often
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Page 5
There is no clear pathophysiology
for anxiety disorders...symptoms
are believed to be due to a disrupted
modulation within the central
nervous system.
cannot identify a cause for the constant
state of worry, but constantly feel on
edge as if something bad is about to
happen.As generalized anxiety escalates,
it can manifest as near panic or panic
disorders. Patients may complain of
feeling detached and express fears of
dying or going crazy. Other physical
symptoms include pounding heartbeat,
sweating palms, dizziness and feeling
faint, tunnel vision, shaking, and crying.
Most patients describe it as the most
terrifying feeling they have ever had and
trips to the emergency room are not
uncommon.According to the Substance
Abuse and Mental Health Services
Administration (SAMHSA, 2010), in
2008 there were over 3 million emer
gency room visits attributed to anxiety.
On a behavioral level, patients may
report that anxiety sabotages their
ability to act, express themselves, or
deal with everyday situations such as
driving, going to work, or shopping.
They often feel confused and have
short attention spans.These feelings
may cause them to change their
behaviors in anticipation of the anxiety.
For example, they may avoid going
places or give up driving.As GAD
progresses, worry cannot be controlled
and eventually affects health, family,
work, and fnances.
PATHOPHYSIOLOGY OF STRESS
The connections between stress
responses and diseases have been well
researched. Prolonged stress results in
large amounts of glucocorticoids being
released; effects of cortisol, aldosterone,
and ADH cause retained sodium and
water, increased blood pressure, and
increased blood volume.The physi
ologic effects of stress may result in
"hypertension, heart failure, insomnia,
tension headaches, peptic ulcer disease,
fatigue and increased risk for infection
and diabetes" (Gould & Dyer, 2011, p.
195; Comer, 2012).
Disease processes caused or aggra
vated by chronic stress from anxiety can
be found in numerous body systems.
For instance, prolonged vasoconstric
tion may cause infammation resulting
in damage to the gastrointestinal system.
Stress has been indicted for its role in
peptic ulcers, ulcerative colitis, nausea,
diarrhea, and periodontitis. Chronic
infections are likely to be aggravated
under stressful situations as noted by
herpes simplex that often erupts during
a crisis. Skin is responsive to stress as
evidenced by its aggravation of eczema
and acne. More serious are the
long-term impacts of severe stress.
Chronic elevation of blood pressure
may "lead to cardiac disease and
chronic severe vasoconstriction may
lead to acute renal failure" (Gould &
Dyer, 2011, p. 196; Comer, 2012).
Other potential complications due
to chronic stress include depression of
the infammatory response and the
immune system.These decreases in
defenses may set individuals up for
opportunistic infections that might not
become pathologic in an otherwise
healthy individual. Further, a "lack of a
normal infammatory response may
mask symptoms of infection or cause a
delay in healing" (Gould & Dyer, 2011,
p. 197). Psychological stressors, whether
acute or chronic, can lead to maladap
tive responses.The impact of this and
other traumatic events are thought to
create symptoms due to exaggerated
activation of the sympathetic nervous
system. Prevention of stress is indicated
to decrease the potential consequences
of stress on physical and mental health.
THERAPIES FOR ANXIETY
When someone has symptoms of
an anxiety disorder, removing one
contributing cause will not eliminate
anxiety. Likewise, there is no single
treatment that can eliminate anxiety.
Anxiety problems appear from diverse
sources operating on numerous levels
that require a combination of different
treatment regimens.Approach to
treatment should always start with
supportive listening and as appropriate,
education about anxiety and fear.
Healthcare providers can assist patients
in understanding their anxiety is
treatable and manageable, and in some
cases, curable. Practical applications
include the need to address the role a
person's thoughts play in their anxiety,
and possible lifestyle modifcation to
reduce or diminish symptoms.
Cognitive behavior therapy (CBT)
has been shown to be as effective as
medication and is the most commonly
used therapy in treating anxiety
(ADAA, 2013b; Culpepper, 2002).
CBT involves multiple sessions with
mental healthcare professionals trained
in CBT techniques.Therapy addresses
the response patients have to the
irrational thoughts of anxiety and panic
with a focus on replacement of
negative cognition with positive
thoughts.Treatment is based on the
theory that the patient develops a
negative feedback loop by reacting
and thinking negatively during a panic
attack. Negative behavior includes
avoidance of anxiety producing
situations thus reinforcing anxiety and
panic. In CBT, patients are taught to
recognize unwarranted worry and
actions and replace such thinking and
actions with more realistic problem-
solving thoughts and strategies (Covin,
Ouimet, Seeds, & Dozios, 2008).
Faith-based or religious CBT uses
faith-based concepts to replace negative
ideas (Ceramidas, 2012; Koenig, 2012).
Christian CBT "employs the use
of biblical Scripture or faith-based
concepts that recognize God as
Creator and One who is interested in
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TABLE 2. MedicationsUsedtoTreatAnxietyDisorders
CLASSIFICATION
DRUG NAME
BRAND NAME
USE
ACTION
Antidepressants
SSRIs
Citalopram
Escitalopram
Fluvoxamine
Paroxetine
Fluoxetine
Sertraline
Celexa
Lexapro
Luvox
Paxil
Prozac
Zoloft
GAD
Panic disorder
Social anxiety disorder
Increases serotonin in the
central nervous system (CNS)
by blocking reuptake at
presynaptic neurons
SSNRIs
Duloxetine
Venlafaxine
Cymbalta
Effexor
GAD
Panic disorder
Social anxiety disorder
Increases serotonin,
norepinephrine in the
CNS by blocking reuptake
Tri-cyclic antidepressants
(TCAs)
Doxepin
Clomipramine
Nortriptyline
Amitriptyline
Desipramine
Doxepin
Imipramine
Protriptyline
Silenor
Anafranil
Aventyl, Pamelor
Elavil
Norpramin
Silenor
Tofranil
Vivactil
GAD
Panic disorder
Increases serotonin,
norepinephrine in the
CNS by blocking reuptake
Monoamine oxidase
inhibitors (MAOIs)
Isocarboxazid
Phenelzine
Tranylcypromine
Marplan
Nardil
Parnate
Panic disorder
Social anxiety disorder
Prevents breakdown of
serotonin, norepinephrine;
used after other drugs fail
Anxiolytics
Azapirones
Buspirone
Buspar, Bustab
GAD
May inhibit neuronal firing,
increase serotonin
Benzodiazepines
Lorazepam
Flurazepam
Clonazepam
Triazolam
Chlordiazepoxide
Temazepam
Oxazepam
Clorazepate
Diazepam
Alprazolam
Ativan
Dalmane
Klonopin
Halcion
Librium
Restoril
Serax
Tranxene
Valium
Xanax
GAD
Panic disorder
Social anxiety disorder
May potentiate effects of
GABA; depresses the CNS;
Use with caution; highly
addictive
Antihistamines
Hydroxyzine
Atarax, Vistaril
GAD
Sedative effect; blocks
histamine receptors in CNS
Anticonvulsants
Augmentation
Therapy
Added to enhance
treatment response
Tiagabine
Gabapentin
Gabitril
Neurontin
Enhances GABA function
Valproate
Lamotrigine
Topiramate
Depakote
Lamictal
Topamax
May block sodium channel,
potentiate GABA, inhibit
amino acid receptor activation
Atypical Antipsychotics
Augmentation
Therapy
Added to enhance
treatment response
Aripiprazole
Ziprasidone
Risperidone
Quetiapine
Olanzapine
Abilify
Geodon
Risperdal
Seroquel
Zyprexa
May impact serotonin activity

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Page 7
increased from 1998 to 2008 by 17%
to 94 million a year.There were 46
million prescriptions written for
alprazolam in 2010 which was an
increase of more than 23% over the
previous year, making it the most
prescribed psychotropic (National
Library of Medicine National Institute
of Health, 2011). Benzodiazepines
can be addictive and lead to daytime
sedation and confusion, differ in
potency and duration, and may put
elderly patients at risk for injury.
Discontinuation of these drugs should
be done gradually and over several
weeks or months to help decrease
withdrawal symptoms.
WHOLE PERSON CARE
To treat patients holistically, health
care providers must consider the
physiologic, psychological, and spiritual
needs of their patients. Nurses are on
the front lines of healthcare, and as
such, are in a position to recognize
abnormal anxiety and the associated
symptoms. Nurses can provide insight
and patient education on the impact
stressors have on health and well-being.
They are in a situation that allows
them the opportunity to demonstrate
caring and provide presence. Sweat
(2012) in her discussion of how to put
care back into spiritual care, reminds
that "real care involves being present by
actively listening and asking good
questions" (p. 247). Nurses have gifts of
empathy and compassion, which makes
them especially cognizant of the
emotional status of their patients. Smith
(2007) defned presence as "an inter
vention that includes being physically
present, but also includes being psycho
logically present as part of the nurse
patient relationship" (p. 82). Presence is
evident by behaviors that refect caring.
Recognition of the need for a strong
support system is essential to decrease
the risk of ongoing stresses for patients
and caregivers.A well-informed nurse
may know of nonproft agencies and
faith community organizations that are
able to deliver practical help, providing
needed physical and emotional support.
When nurses recognize and
anticipate stressors for patients, they
the well-being of humankind" (Ce
ramidas, 2012, p. 43).This type of CBT
uses God's Word as found in the Bible
to replace negative thinking. Duke
University Center for Spirituality,
Theology, and Health is researching the
role of religious CBT in managing
depression and stress in chronic illness
with promising results (Koenig, 2012).
Biblical Framework Counseling
(BFC) is "based on the belief that the
Bible is adequate to treat the root
causes of mental disorders that are not
otherwise physiologically caused" (Oji,
2010, p. 76). BFC is treatment based
on spiritual means with Scripture as
the guide for therapy and as a model
for living.The Bible admonishes us to
think about God and his Son, Jesus; to
dwell on whatever is worthy of awe
and adoration, and to strive to keep
ANXIETY MEDICATIONS
The number of medications available
for the treatment of anxiety disorders
has increased in the past decade.The
selection of a specifc medication is
based on patient symptoms, adverse-
effect profles of the drug, and the
existence of co-morbid disorders (Kaven,
Elsasser, & Barone, 2009). Medications,
although effective, need to be pre
scribed with caution and accompanied
by other interventions.Table 2 offers a
comprehensive list of medications used
in treatment of anxiety disorders and
mechanisms of action.
SSRIs and selective serotonin
norepinephrine reuptake inhibitors
(SSNRIs) have been the mainstay of
treatment and frst in line of accepted
therapy for anxiety disorders. Major
advantages for using such agents are
Preventative teaching may
include how things such as fatigue,
inadequate nutrition, or lack of
emotional support can decrease
one's ability to cope with stress.
our thoughts in harmony with God's
promises and standards (Romans
12:2; Philippians 4:8-9).As a person
recognizes and trusts God's power and
authority, a sense of peace is possible
(John 14:27). In 2 Timothy 1:7 we are
reminded that "For God hath not given
us the spirit of fear, but of power, and
of love and of a sound mind" (KJV).
Other psychological therapies
reported by the ADAA (2013b) for
treating anxiety are Exposure Therapy,
Acceptance and Commitment Therapy,
Dialectical Behavior Therapy, Interper
sonal Therapy, and Eye Movement
Desensitization and Reprocessing.
Additional activities that can help
reduce anxiety are relaxation therapy,
exercise and stretching, patient
self-monitoring of thoughts and
irrational thinking, and recognition
of triggers of anxiety.
their effects on depression and the fact
that these medications are not addic
tive. Side effects include weight gain,
insomnia, sexual dysfunction, nausea,
and agitation.There is a delay in onset,
so treatment usually begins a few
weeks before symptoms are reduced.
Withdrawal symptoms such as nausea,
paresthesias, dizziness, and insomnia are
common and therefore these medica
tions need to be discontinued with a
slow taper over several weeks.
Benzodiazepines are widely used for
anxiety since these medications have a
rapid onset and are very effective at
controlling anxiety symptoms. Benzo
diazepines suppress the output of
neurotransmitters that interpret fear.
The most commonly prescribed are
Lorazepam (Ativan), clonazepam
(Klonopin), and alprazolam (Xanax).
Prescriptions for these medications
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Page 8
can provide anticipatory guidance.
Preventative teaching may include
information about how things such as
fatigue, inadequate nutrition, or lack of
emotional support can decrease one's
ability to cope with stress. Besides
teaching about the need for rest and a
healthy diet, patient education can
include concrete examples, such as
how even moderate exercise can
improve coping mechanisms and how
spiritual support can help ameliorate
stress. Other suggestions to minimize
stress include relaxation techniques,
imagery, music and art therapy, massage
therapy, and biofeedback (Gould &
Dyer, 2011; Porth, 2010). Massage
therapy, for example, can provide physi
ologic relaxation for some patients to
relieve stress and minimize its impact.
Each patient is unique and what works
for one patient may not work for
another. For Christian patients
practicing thankfulness, choosing to
do what is right, worship, meditation
on Scripture, and bringing concerns to
God in prayer (i.e., Ephesians 5:1-20;
Philippians 4:6-7) help decrease
anxiety.The importance of recognizing
maladaptive behaviors such as alcohol
abuse, stress eating, smoking, or other
coping behaviors likely to cause
additional stress in the long term
should be included in patient teaching.
Nursing interventions need to
include meeting spiritual needs.To be
effective, therapy must identify the root
causes of anxiety, and the possibility of
a spiritual component should be con
sidered. Nurses can explore spirituality
and encourage patients to connect with
their faith and spiritual experts or refer
to spiritual resources. Issues such as
guilt, lack of forgiveness, lack of
meaning and purpose, and fear can be
addressed by spiritual counselors.
FINDING PEACE
As Christians, we believe God's
Word brings healing and offers wisdom
for dealing with anxiety. Jesus spoke to
issues of fear when he stated,"Do not
worry about your life, what you will
eat or drink; or about your body, what
you will wear. Is not life more impor
tant than food, and the body more
important than clothes?" (Matthew
6:25, NIV84). God wants us to focus
on him and his presence and care in
our lives. God knows we are better off
when our minds are set on what is
above, not on the things that are of the
earth (Colossians 3:2). Jesus reminds us
that worry does not add to our lives,
"Who of you by worrying can add a
single hour to his life?" (Matthew 6:27).
A signifcant blessing of the good
news of salvation through Jesus Christ
is redemption. God wipes away our
past and encourages us to remember
the miraculous ways we have experi
enced him and his presence. God has
an open line of direct communication
always available to us. He cares about
the things that concern us. God is the
healer of hearts and the lifter of heads
(i.e., Psalm 3:1-4).Although God can
use medications, therapy, and other
treatments to provide patients with
relief, those who want to experience
the peace of God's presence are
encouraged to spend time getting to
know him well.The amazing by
product for those whose roots are
frmly placed in God is strength and a
peace that "transcends all understand
ing" (Philippians, 4:7). God wants to
be our resource, and nothing can
love the soul or sooth the mind
better than the Creator.
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