Care Setting
Community care, In-Patient Setting
Evidence Base for Practice
Lovibond, S.H. & Lovibond, P.F. (1995). Manual for the Depression Anxiety Stress Scales. (2nd. Ed.) Sydney: Psychology Foundation
Quality assurance/impact of practice
RESULTS
See additiional information.
DISCUSSION
The above graphs show the comparative data for the 5 individual patients in the group. This allows a visual display of individual scores at week 1 and week 6. It was expected that the patients would have reduced levels of anxiety having completed the Anxiety Management Course, however, the graphs show that
out of the 5 patients, 2 of the scores for anxiety stayed the same and only 1 reduced. The only person whose scores increased in all sections of the DASS was patient 1. The possible reasons for the increase include the patient’s memory problems and difficulty understanding the questions. Many of the questions were missed out therefore the validity of the DASS is compromised. Another possible explanation for an increase in DASS score is due to an increased awareness of feelings and emotions and a greater understanding of the symptoms they had been experiencing therefore they are more likely to relate to the statements. Patient 1 was socially isolated and had asked how she could attend the Day Hospital as she enjoyed the social aspect. Therefore it could be suggested that on the repeat DASS the patient exaggerated her symptomatology thinking this would increase her chances of continued attendance as a day patient.
3 of the 5 patients presented with memory difficulties. At the time of referral it was unknown whether the impairment was due to anxiety or an organically based problem. Subsequently one of the patients has received a diagnosis of Alzheimer’s disease. This obviously has a huge impact on an individual’s capacity to learn and retain new information.
RECOMMENDATIONS
It is interesting to note that prior to the anxiety management course, 3 patients presented with “moderate” anxiety, 1 with “Mild” and 1 with “Normal”. No patients presented with “Severe” or “Extremely Severe” levels or anxiety..... For full text please contact the contribtor.
Practice Summary
The Anxiety Management course run at Cairnie Day Hospital is a six-week programme based on the Anxiety Management material used in Weston Day hospital and adapted to suit the elderly population. It was developed using the principles of cognitive behavioural therapy (CBT).
CBT is based on the concept that changing negative thinking patterns and behaviours can have a powerful effect on a person's emotions. CBT helps identify, analyse and change counter-productive thoughts and behaviours, which helps to alleviate feelings of depression and anxiety. CBT is based on the scientific method, and the logic and belief in the power of the individual to "take charge" and change their negative thoughts, feelings, and actions. CBT utilizes a very directive, action-oriented approach, which teaches a person to explore, identify and analyse dysfunctional patterns of thinking and acting.
Practice Detail
Referrals were sent directly to the Occupational Therapy Department from CPN’s, SHO’s, SpR and GP’s. In total five patients completed the course, two of whom were referred from the day hospital and three were community patients. Due to transport arrangements, the patients were required to attend for the whole day, therefore arrangements were made for the Physiotherapist to facilitate a “Falls Prevention Group” to take place in the morning. The Anxiety Management took place in the afternoon, followed by a relaxation session.
OUTCOME MEASURE
The outcome measure used was the Depression, Anxiety and Stress Scale (DASS). The DASS is a set of three self-report scales designed to measure the negative emotional states of depression, anxiety and stress. Each of the three DASS scales contains 14 items, divided into subscales of 2-5 items with similar content. The Depression scale assesses dysphoria, hopelessness, devaluation of life, self-deprecation, lack of interest/involvement, anhedonia, and inertia. The Anxiety scale assesses autonomic arousal, skeletal muscle effects, situational anxiety, and subjective experience of anxious affect. The Stress scale is sensitive to levels of chronic non-specific arousal. It assesses difficulty relaxing, nervous arousal, and being easily upset/agitated, irritable/over-reactive and impatient. Subjects are asked to use 4-point severity/frequency scales to rate the extent to which they have experienced each state over the past week. Scores for Depression, Anxiety and Stress are calculated by summing the scores for the relevant items.
One of the reasons for using the DASS as an outcome measure was due to the fact that the Nursing Staff use the DASS and is their preferred rating scale. It is also the most commonly used scale used to feed back to the Consultant and so it was felt that it would be the most appropriate for continuity. Its use has been well documented and demonstrates high validity and reliability (Lovibond & Lovib
Additional Comments
ANXIETY MANAGEMENT – EVALUATION QUESTIONNAIRE
PLEASE COMPLETE AS FULLY AS POSSIBLE
(A) Cast your mind back to the first session, were you given ample opportunity to discuss your areas of concern and your expectations? YES/NO
(B) Has your emphasis been primarily to:
1. Learn about relaxation YES/NO
2. Understand more about anxiety YES/NO
3. Be alleviated from your symptoms YES/NO
4. Develop better techniques to cope with your anxiety YES/NO
Has this been met? Please expand.
(C) Were you satisfied with the presentations? YES/NO
(D) Has there been any part of the course you found especially useful for yourself?
(E) Was the course - too long/ too short/ just right?
(F) Was the pace – too fast/ too slow/ about right?
(G) Were you satisfied with the way the course was organised and run?
YES/NO
(H) Was the course informative and the techniques useful to your problem area?
YES/NO
(I) Do you have any other comments