Management of patient with Phobia

1. PHOBIC ANXIETY DISORDER
PREPARED BY
MRS. DIVYA PANCHOLI
ASSISTANT PROFESSOR, SSRCN, VAPI
MRS. DIVYA PANCHOLI 1

2. PHOBIA
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3. FEAR
It is a state of apprehension or unease
arising out in response to an external
danger
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4. ANXIETY
It is a state of apprehension or unease arising
out of anticipation of danger
(Here the danger is unknown)
• Normal anxiety becomes pathological when it
causes significant subject distress and
impairment of functioning of the individual.
MRS. DIVYA PANCHOLI 4

5. Levels of anxiety
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6. DEFINITION
• A phobia is an unreasonable fear of a
specific object, Activity or situation.
-SREEVANI
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7. FEATURES OF IRRATIONAL FEAR
• Fear is out of proportion to the
demands of the situation.
• Cannot be explained or reasoned
away.
• Beyond voluntary control.
• Fear leads to an avoidance of the
feared situations- marks.
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8. CLASSIFICATION OF PHOBIA
According to ICD IO
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9. MRS. DIVYA PANCHOLI 9

10. SIMPLE PHOBIA
( Specific phobia)
• It is an irrational fear of a specific
object or stimulus.
• It is common in childhood.
• Exposure to the phobic object often
results in panic attacks.
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11. EXAMPLES OF SOME SPECIFIC
PHOBIAS
ACROPHOBIA
- Fear of height.
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12. HEMATOPHOBIA
-Fear of sight of blood
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13. CLAUSTROPHOBIA
-Fear of closed spaces.
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14. GAMOPHOBIA
-Fear of marriage.
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15. INSECTOPHOBIA
-Fear of insects
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16. ZOOPHOBIA
-Fear of animals
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17. BRONTOPHOBIA
-Fear of thunder
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18. ALGOPHOBIA
-Fear of pain.
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19. HYDROPHOBIA
-Fear of water
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20. PHOTOPHOBIA
-Fear of light
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21. ERYTHROPHOBIA
-Fear of blushing
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22. XENOPHOBIA
-Fear of strangers
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23. NYCTOPHOBIA
-Fear of darkness
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24. PHARMACOPHOBIA
-Fear of medicines.
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25. BIBILIOPHOBIA
-Fear of book.
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26. CLINOPHOBIA
-Fear of going to
bed
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27. ARACHOPHOBIA
-Fear of spiders.
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28. MRS. DIVYA PANCHOLI 28

29. SIGNS AND
SYMPTOMS
OF
SPECIFIC
PHOBIA
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30. Irrational and persistent fear of
object or situation
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31. Immediate anxiety on contact
with feared object or situation.
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32. Loss of control, fainting or panic
response.
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33. Avoidance activities involving
feared stimulus.
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34. Anxiety when thinking about
stimulus.
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35. Worry with anticipatory anxiety.
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36. Possible impaired social or work
functioning.
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37. SOCIAL PHOBIA
•It is an irrational fear of performing
activities in the presence of others.
•The patient is afraid of his own
actions being viewed by others,
critically resulting in embarrassment
or humiliation.
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44. SIGNS AND SYMPTOMS
OF
SOCIAL PHOBIA
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45. Hyperventilation Sweating
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46. Blushing Palpitation
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47. Confusion Gastrointestinal
symptoms
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48. Urinary urgency Muscle tension
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49. Trembling
hands and voice
Fear of embarrassment
or ridicule
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50. AGORAPHOBIA
Irrational fear of being in
a place away from the
familiar setting of home,
in crowds, or in
situations that the patient
cannot leave easily.
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51. CONTI….
• As the agoraphobia increases in
severity, there is a gradual restriction
in normal day to day activities.
• The activity may become so severely
restricted that the person becomes
self-imprisoned at home.
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52. SIGNS AND SYMPTOMS OF
AGORAPHOBIA
•Overriding fear of open or public spaced.
 Deep concerned that help might not be
available in such places.
 Avoidance of public places and
confinement to home
• When accompanied by panic disorder,
fear that having panic attack in public will
lead to embarrassment or inability to
escape. MRS. DIVYA PANCHOLI 52

53. ETIOLOGY
•PSYCHODYNAMIC THEORY repression fails
-In phobia, secondary defense
mechanism is displacement.
-The other secondary defense
mechanism is ego come into action.
-The neutral object chosen
unconsciously is the one that can be easily
avoided in day to day activities, in contrast to
frightening object.
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54. LEARNING THEORY
•A stressful stimulus to produce an
unconditioned response fear.
•When stressful stimulus is repeatedly
paired with a harmless object, eventually,
the harmful objects alone produce fear.
•If the person avoids the harmless object
to avoid fear, the fear becomes a phobia.
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55. COGNITIVE THEORY
• The individual begins to seek out
avoidance behaviors to prevent the
anxiety reactions and phobias
result.
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56. COURSE
•The phobias are common in women
with an onset in late second decade or
early third decade.
•Onset is sudden without any cause
and sometimes phobias are remitting.
•Severe fears are present in 10 – 15 %
of children.
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57. TREATMENT
• PHARMACOTHERAPY
BENZODIAZEPINES
Ex : - Alprazolam
-Clonazepam
-Lorazepam
-Diazepam
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58. ANTI DEPRESSENTS
E.g. IMIPRAMINE
SERTRALINE
PHENELZINE
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59. PSYCHO THERAPY
BEHAVIOUR THERAPY
Desensitization therapy
- To gradually re introduce the feared situation
while coaching the patient on relaxation techniques.
(progressive muscle Relaxation, deep breathing
exercise, listening to music)
Flooding
ROLE – PLAYING
- In guided imaginary to allow the patient to
rehearse ways to relax while confronting a feared
object or situation MRS. DIVYA PANCHOLI 59

60. •ASSERTIVE TRAINING
-To help the patient become assertive in
her interpersonal interactions.
•MODELLING BEHAVIOUR
-Patient observes someone modeling, or
demonstrating, appropriate behavior when
confronted with the feared situation.
•SUPPORTIVE PSYCHO THERAPY
-It is helpful adjunct to behavior therapy
and drug treatment.
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61. NURSING MANAGEMENT
NURSING ASSESSMENT
•Assessment parameters focus on physical
symptoms
•Precipitating factors
•Avoidance behavior associated with phobia
•Normal coping ability
•Asses the patient somatic symptoms such as
fatigue, muscle aches ,etc.
•Asses for communicating pattern
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62. •Fear related to a specific stimulus (simple
phobia), or causing embarrassment to self
infront of others, evidenced by behvaiour
directed towards avoidance of the feared
object/ situation.
OBJECTIVE
-Patient will be able to function in the
presence of a phobic object or situation
without experiencing panic anxiety.
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63. Nursing interventions Rationale
- Reassure the patient
that he is safe
- Explore patients perception of the threat to
physical integrity or threat to self concept
- Include patient in making decisions related to
selection of alternative strategies.
- If the patient elects to work on eliminating the
fear, techniques to desensitization or implosion
therapy may be employed.
- Encourage patient to explore underlying
feelings that may be contributing to irrational
fears.
- At the panic level of anxiety patient may
fear for his own life.
- It is important to understand patients
perception of the phobic object.
.- Allowing the patient to choose provides a
measure of control and serves to increase
feelings of self worth.
- Fear decreases as the physical and
psychological sensations diminish in response to
repeated exposure to the phobic stimulus under
non threatening conditions.
- Facing these feelings rather than suppressing
them may result in more adaptive coping
abilities.
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64. •Social isolation related to fear of being in
a place from which one is unable to escape,
evidenced by staying alone, refusing to
leave the room/home.
OBJECTIVE
-Patient will voluntarily participate in group
activities with peers.
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65. NURSING INTERVENTIONS RATIONALE
- Convey an accepting attitude and
unconditional positive regard .make brief,
frequent contacts.
- Attend group activities with the patients
that may be frightening for him.
- Discuss with the patients sign and
symptoms of increasing anxiety and
techniques to interrupt the response.
- Administer medication as ordered by the
physician.
- Give recognition and positive
reinforcement for voluntary interactions
with others.
- These interventions increase feelings of
self-worth and facilitate a trusting
relationship.
- These presence of a trusted individual
provides emotional security.
- Mal adaptive behavior such as withdrawal
and suspiciousness are manifested during
times of increased anxiety.
- Medication helps to reduce the level of
anxiety in most individuals, there by
facilitating inter actions with others.
- To enhance self-esteem encourage
repetition of acceptable behavior.
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66. You can refer following link also
• https://www.youtube.com/watch?v=PCOg2G7
97ek&t=247s
• https://www.youtube.com/watch?v=wVTvcxE
WClg
• https://www.youtube.com/watch?v=9IV13gJ8
11c
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67. MOVIES RELATED TO PHOBIA
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