Managing symptoms of anxiety, panic, or agitation

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The presence of an anxiety disorder can significantly increase the risk of relapse to AOD use [699]. Techniques for managing clients with symptoms of anxiety are outlined in Table 39. Clients may also be encouraged to try relaxation techniques to manage the distressing and distracting symptoms of anxiety [700, 701].

Some useful relaxation methods include:

  • Progressive muscle relaxation.
  • Controlled or abdominal breathing.
  • Calming response.
  • Visualisation and imagery.
  • Grounding.

Each method works best if practiced daily by clients for 10–20 minutes; however, not every technique may be appropriate for every client. These techniques are described in detail in Appendix U. Some of the cognitive behavioural techniques described in Appendix T (i.e., cognitive restructuring, structured problem solving, and goal setting) may also be useful in managing symptoms of anxiety [66, 385, 702, 703], but again, no one strategy is effective for all clients. If the client experiences unpleasant effects from any strategy, he/she should discontinue its use.

Like depressive symptoms, many anxiety symptoms will subside after a period of abstinence and stabilisation [35, 290, 299, 704]. It is useful to explain to clients that it is quite normal to feel anxious when entering treatment but that these feelings usually improve over a period of weeks. During and after this time, constant monitoring of symptoms will allow the AOD worker to determine if the client requires further treatment for these symptoms. If the client has a history of anxiety in circumstances when he/she is not intoxicated or withdrawing, he/she may have an independent anxiety disorder. For these clients, it is unlikely that their anxiety symptoms will resolve completely with abstinence – indeed their symptoms may even increase. In such cases, clients should be assessed for an anxiety disorder and the treatment options should be considered.

Table 39: Dos and don’ts of managing a client with symptoms of anxiety

Do:

  • Approach the client in a calm, confident, and receptive way.
  • Move and speak at an unhurried speed.
  • Be patient in order to allow the client to feel comfortable to disclose information.
  • Minimise the number of staff present and attending to the client.
  • Minimise surrounding noise to reduce stimulation.
  • Reassure the client frequently (e.g., ‘This won’t take much longer’).
  • Explain the purpose of interventions.
  • Remain with the client to calm him/her down.

Don’t:

  • Crowd or pressure the client.
  • Get frustrated or impatient.
  • Panic. The more relaxed you are the more relaxed the client is likely to feel.
  • Act shocked by what the client may reveal.

Adapted from NSW Department of Health [277] and Clancy and Terry [296].