For a client with obsessive compulsive disorder which event will increase the clients anxiety level

Exposure therapy is a psychological treatment that was developed to help people confront their fears. When people are fearful of something, they tend to avoid the feared objects, activities or situations. Although this avoidance might help reduce feelings of fear in the short term, over the long term it can make the fear become even worse. In such situations, a psychologist might recommend a program of exposure therapy in order to help break the pattern of avoidance and fear. In this form of therapy, psychologists create a safe environment in which to “expose” individuals to the things they fear and avoid. The exposure to the feared objects, activities or situations in a safe environment helps reduce fear and decrease avoidance.

Exposure therapy has been scientifically demonstrated to be a helpful treatment or treatment component for a range of problems, including:

• Phobias
• Panic Disorder
• Social Anxiety Disorder
• Obsessive-Compulsive Disorder
• Posttraumatic Stress Disorder
• Generalized Anxiety Disorder

There are several variations of exposure therapy. Your psychologist can help you determine which strategy is best for you. These include:

• In vivo exposure: Directly facing a feared object, situation or activity in real life. For example, someone with a fear of snakes might be instructed to handle a snake, or someone with social anxiety might be instructed to give a speech in front of an audience.
• Imaginal exposure: Vividly imagining the feared object, situation or activity. For example, someone with Posttraumatic Stress Disorder might be asked to recall and describe his or her traumatic experience in order to reduce feelings of fear.
• Virtual reality exposure: In some cases, virtual reality technology can be used when in vivo exposure is not practical. For example, someone with a fear of flying might take a virtual flight in the psychologist's office, using equipment that provides the sights, sounds and smells of an airplane.
• Interoceptive exposure: Deliberately bringing on physical sensations that are harmless, yet feared. For example, someone with Panic Disorder might be instructed to run in place in order to make his or her heart speed up, and therefore learn that this sensation is not dangerous.

Exposure therapy can also be paced in different ways. These include:

• Graded exposure: The psychologist helps the client construct an exposure fear hierarchy, in which feared objects, activities or situations are ranked according to difficulty. They begin with mildly or moderately difficult exposures, then progress to harder ones.
• Flooding: Using the exposure fear hierarchy to begin exposure with the most difficult tasks.
• Systematic desensitization: In some cases, exposure can be combined with relaxation exercises to make them feel more manageable and to associate the feared objects, activities or situations with relaxation.

Exposure therapy is thought to help in several ways, including:

• Habituation: Over time, people find that their reactions to feared objects or situations decrease.
• Extinction: Exposure can help weaken previously learned associations between feared objects, activities or situations and bad outcomes.
• Self-efficacy: Exposure can help show the client that he/she is capable of confronting his/her fears and can manage the feelings of anxiety.
• Emotional processing: During exposure, the client can learn to attach new, more realistic beliefs about feared objects, activities or situations, and can become more comfortable with the experience of fear.

Source: APA Div. 12 (Society of Clinical Psychology)

Date created: July 2017

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January 19, 2022

A newly admitted client with an obsessive-compulsive personality disorder frequently performs a hand-washing ritual. When attempts are made to set limits on the frequency or length of the ritual, the client’s anxiety escalates and the client becomes verbally aggressive. What is most important for the nurse to do when the client performs the ritual?

Show Answer

Correct! The answer is number 1

Rationale:

1. Rituals provide a means for the individual to control anxiety. If not permitted to carry out the ritual, the client probably will experience unbearable anxiety. The client has exhibited verbally aggressive behavior in the past, and this behavior may escalate. Safety of the client and others becomes an issue.

2. The client probably understands this already but is unable to stop the activity.

3. Clients with obsessive-compulsive disorder have no idea what the ritual means, only that they must continue the ritual.

4. Interrupting the ritual will have the effect of increasing anxiety, possibly to panic levels.

Additional info:

Clinical Area: Comprehensive Examination

Client Needs: Safe and Infection Control

Cognitive Level: Application

Nursing Process: Planning/Implementation

Integrated Process: Caring

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