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Advice for health professionals: Dealing with a person who is anxious

Anxiety and sexually transmitted infections (STIs) go hand-in-hand.[1,2]  Worry can take many forms and is often related to fears about social stigma.[2,3]  Waiting for the right time to get tested or waiting for results can also increase anxiety. Given these things, it’s not surprising that people present to you as worried or anxious.[1,2] 

There is a continuum of anxiety. Some people have a few symptoms, while other people are so anxious that they become incapacitated and are unable to continue with their daily routines, such as going to work.

Signs of anxiety

Some people are unaware of their feelings of anxiety and how anxiety is presenting in their body. In trying to regulate their emotions, they exhibit certain behaviors such as information seeking and testing, especially when HIV is a concern.

Information seeking can take the form of repeat visits to health professionals, calling information lines, or using the internet to search for information, chat or post questions to health forums.[2]  Repeat visits can be frustrating for health professionals, leading to thoughts such as, “I’ve already explained this to the patient several times, why don’t they understand?” and “They’ve already tested for HIV, why don’t they wait longer before testing again?”.

How to help

Health professionals can play an important role in helping a person realize that much of their behavior is about trying to cope with uncomfortable emotions. This is called emotion regulation, which involves normalizing and validating that it is alright to feel anxious and worried, while at the same time, talking about strategies for reducing anxiety. This will give people some skills to help regulate their uncomfortable emotions.

Make a plan with your patient about how they will gather information and from what sources. The internet makes it easy to find a wealth of material, yet much of it is inaccurate. Link people with reliable information and encourage them to stop checking the internet once they have that information. Encourage them to practice emotion regulation exercises instead of knowledge gathering.

Repeated testing can increase anxiety rather than alleviate it. Make a plan about when to test in the context of behavior and window periods.

If a person is experiencing high levels of anxiety, or has anxiety associated with other situations in their life, it may be appropriate to refer the person to a mental health care provider (e.g., community mental health, employee assistance programs, registered clinical counselors, psychologists).

References

  1. Chen, Y., Wu, J., Yi, Q., Huang, G., and T. Wong. Depression associated with sexually transmitted infection in Canada. Sex. Transm. Infect. 2008; 84:535-540 doi:10.1136/sti.2007.029306. http://sti.bmj.com/content/84/7/535.abstract
  2. Hood, J. and A. Friedman. Unveiling the hidden epidemic: a review of stigma associated with sexually transmissible infections.  Sexual Health 2011; 8(2) 159–170. http://www.publish.csiro.au/?paper=SH10070
  3. Arkell, J., Osborn, D., Ivens, D., and M. King. Factors associated with anxiety in patients attending a sexually transmitted infection clinic: qualitative survey. International Journal of STD & AIDS 2006; 17: 299–303. http://std.sagepub.com/content/17/5/299.short

Categories: Current practice

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