Anxiety in Late Life and Serious Illness: A Podcast with Alex Gamble and Brianna Williamson
Jun 27, 2024
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Join experts Alex Gamble, a triple-boarded palliative care specialist, and Brianna Williamson, a UCSF palliative care fellow, as they dive into the complex world of anxiety in late life and serious illness. They dissect the nature of anxiety, exploring how it can both motivate and overwhelm. Listeners will learn about the importance of personalized support, the empathy-boosting BATHE technique, and practical strategies like mindfulness for coping with anxiety. Their insights offer a fresh take on navigating emotional distress in healthcare.
Anxiety is a complex phenomenon influenced by personal, situational, and environmental factors, necessitating individualized understanding and approaches from clinicians.
Effective treatment of anxiety should emphasize non-pharmacological strategies, fostering therapeutic conversations and coping mechanisms before resorting to medication.
Clinicians must cultivate self-awareness and create open, supportive environments to enhance patient engagement and address their own anxieties effectively.
Deep dives
Understanding Anxiety
Anxiety is characterized as a future-oriented anticipation of negative outcomes, often experienced through intense physical sensations such as chest tightness or racing heart. It encompasses not just the emotional aspect but also the complex interplay of bodily reactions which may include feelings of dread. The subjective experience of anxiety can vary dramatically from person to person, making it crucial for clinicians to understand each individual's definition and perception of their anxiety. By learning how patients personally identify and articulate their emotions, clinicians can improve their communication and treatment approaches.
The Role of Context in Anxiety
The perception of anxiety hinges significantly on context, where some individuals may manage anxiety well with adequate support while others may become debilitated without such support. As anxiety is assessed, it is essential to consider how situational factors, personal histories, and environmental support systems influence an individual's ability to cope. Diagnostic criteria for anxiety can sometimes be arbitrary, as individuals might experience prolonged symptoms that disrupt their daily functioning, but these symptoms might not fit neatly into specific diagnostic categories. Effective treatment should therefore focus on the individual's experience rather than strictly adhering to predefined diagnostic frameworks.
Communication Techniques for Anxiety
Approaching a patient about their anxiety effectively requires nuanced communication that respects their individual context and emotional state. Utilizing techniques like the BATHE method allows clinicians to engage patients in a manner that explores their background, affects, and coping mechanisms while fostering an empathetic dialogue. Clinicians should be mindful of the potential stigma associated with anxiety labels and use supportive language to help patients feel safe discussing their experiences. By encouraging patients to articulate their feelings in their own words, practitioners can better understand the complexities of their emotional landscapes.
The Impact of Treatment Approaches
Non-pharmacological approaches should be prioritized to empower individuals to manage their anxiety, offering strategies beyond medication to address the underlying causes of their distress. Engaging in therapeutic conversations and validating patients' feelings can significantly contribute to reducing their anxiety. While medications such as SSRIs can play a role in treatment, especially for severe anxiety, the importance of therapeutic alliances and coping strategies should never be underestimated. Integrating these methods not only alleviates symptoms but also fosters resilience and coping skills that are essential for ongoing management of anxiety.
Self-awareness and Presence in Clinical Settings
Clinicians are encouraged to develop a heightened self-awareness regarding their own anxieties when treating patients experiencing anxiety. Establishing a comfortable space where anxiety can be openly discussed is crucial for effective patient engagement and support. By acknowledging their own feelings and creating an inclusive environment, practitioners can help patients feel less isolated in their experiences. This approach not only benefits patient outcomes but also enhances the clinician’s ability to manage their emotional response, ultimately leading to more productive therapeutic relationships.
“Anxiety is a lot like a toddler. It never stops talking, tells you you’re wrong about everything, and wakes you up at 3 a.m.” I’m not sure who wrote this quote, but it feels right to me. We’ve all had anxiety, and probably all recognize that anxiety can be a force of action or growth but can also spiral to quickly take over our lives and our sleep. How, though, do we navigate anxiety and help our patients who may end up in the anxiety spiral that becomes so hard to get out of?
On today’s podcast, we’ve invited Alex Gamble and Brianna Williamson to talk to us about anxiety. Alex is a triple-boarded (palliative care, internal medicine, and psychiatry) assistant professor of medicine at Stanford. Brianna is one of UCSF’s palliative care fellows who just completed her psychiatry residency.
We start by defining anxiety (harder said than done), move on to talking about when it becomes maladaptive or pathologic, and how DSM5 fits into all of this. We then walk through how we should screen for anxiety and how we should think about a differential. Lastly, we talk about both non-pharmacologic and pharmacologic treatments.
It’s a lot to cover in 45 minutes, so for those who like to take a deeper dive, here are some of the references we talked about:
Two books that Alex Gamble often recommends to patients can help build up your capacities to sit with anxiety (per Alex, both are from an Acceptance and Commitment Therapy framework)
