10 Therapeutic Communication and Mental Well-Being

Watch or Listen to the Following Media Clip

Introduction

The Canadian Mental Health Association (CMHA), National (2019) proposes that 1 in 5 people experience an issue with their mental well-being in a given year, and mental health symptoms worsen if supports are difficult to access. The ability to recognize behaviours associated with mental health challenges assists in communicating effectively with those who are suffering from them. Studying and learning about common mental health illnesses, reduces fear, increases compassion, and allows for greater empathy when communicating with people suffering from issues with mental well-being. The health care administrator (HCA) who utilizes effective therapeutic communication techniques when communicating with clients experiencing a mental health issue, will assist the client and their family in accessing the supports that they need.

Assessing What You Already Know.

As you reflect upon the questions and statements consider what you already perceive about mental well-being.

Stress and Stressors

All people will experience stress during their lifetime, and people’s perception to stressors differs.  A small amount of eustress is considered helpful because it is short in duration and it works to sharpen senses and focus (Jenkins et al., 2021). Think about the few minutes before you begin a test, that feeling of butterflies in your stomach, then once the test begins you settle in and focus. While a certain level of eustress can be helpful, it can not be sustained for long periods of time, and once stress becomes overwhelming it is then considered distress. If levels of distress do not dissipate then it begins to impact a person’s well being both physical and mental (Jenkins et al., 2021).

Hans Seyle’s General Adaptation Syndrome

Hans Seyle’s General Adaptation Syndrome (GAS) model offers a three-stage explanation for how the body responds to stress and how repeated stressors can lead to a number of disorders and diseases. The first phase is the alarm phase when the fight-or-flight response in the body begins. In this phase the hypothalamus release hormones including Adrenaline and Cortisol into the bloodstream (Herkimer County Community College & Pelz. B., n.d.). Cortisol and Adrenaline provide that boost of energy that allows the body to fight or flee. If the stressor remains, then the person moves into the second phase, the resistance phase, where the initial jolt is gone but the body remains on alert with increased glucose levels, cortisol levels, and high blood pressure (Stangor. C., & Walinga. J., 2014). Long sustained levels of Cortisol will weaken the immune system and if chronic, may lead to disorders and disease (Stangor. C., & Walinga. J., 2014). The final phase is the exhaustion phase, the body is no longer able to adapt, the ability to resist combined with the constant levels of Cortisol takes it tole on the body resulting in damage to the body (Herkimer County Community College & Pelz. B., n.d.).

Physical Signs & Behavioural Manifestations of Stress

Signs that a person under stress may exhibit include:

• Physical
  • Dry mouth, heavy breathing, dilated pupils, sweaty palms, rapid heart rate, and trembling. Consider these are physical manifestations of the body’s flight or fight responses to the stressor (Stangor. C., & Walinga. J., 2014).
• Cognitive
  •  Difficulty concentrating or making decisions.
• Behavioural
  • Misuse of drugs & alcohol, excessive eating, or smoking (Herkimer County Community College & Pelz. B., n.d.).
  • Anger is a manifestation of stress and can range from being slightly annoyed for having to wait in line, to feelings of rage over a real or perceived injustice (Canadian Mental Health Association National, 2019).

Clients and their families seek health care when they are feeling unwell, dealing with life’s stressors and uncertainties. As a Health Care Administrator (HCA) you will see signs and behaviours that may seem on the surface as excessive or unreasonable responses to the situation.

Anxiety Disorders & Mood Disorders

Anxiety differs from stress, with anxiety the excessive worry is persistent even when the stressors are removed (American Psychological Association, 2020). Mood disorders  and anxiety disorders impact the daily lives of approximately 11.6% of Canadians 18 years or older (Government of Canada, 2015). 27% of people with mood or anxiety disorders, report that their daily life has been highly impacted by their disorder, and 95% of those reported seeing a health care provider for assistance (Government of Canada, 2015). Psychological disorders often occur together, this comorbidity means that the most severe disorders are concentrated in about 6% of the population (Stangor. C., & Walinga. J., 2014). It is likely that you will have clients and their families coming to the office suffering from an anxiety or mood disorder at some point in your career and learning about those disorders, and awareness about the signs, symptoms, behavioural manifestations will increase your empathy and ability to connect clients to supports.

Anxiety Disorders

General Anxiety Disorder (GAD)

General Anxiety Disorder (GAD) is a psychological disorder in which significant distress and dysfunction are caused by worrying excessively (six months or more), about common situations even though the person recognizes there is nothing to worry about (Government of Canada, 2009).  Physical symptoms of GAD may include irritability, insomnia, lack of concentration, trembling, and achy muscles, in which symptoms can range from mild anxiety to panic disorder (Stangor. C., & Walinga. J., 2014).

Levels of Anxiety

There are generally thought to be four levels of anxiety with signs and symptoms varying based on the level. Townsend (2014) proposes that low levels of anxiety provide motivation, but that anxiety can become problematic when symptoms are severe enough to interfere with a person’s daily life. Responding therapeutically to people in the various levels of anxiety will reduce their level of anxiety and provide an opportunity to meet their health care needs. A  Health Care Administrator  (HCA) will need to consider their scope of practice in responding to various situations involving people with anxiety. It may be necessary to report incidents to the Health Care Provider (HCP) or request the help of the HCP when situations exceed the HCA’s scope of practice.

Mild Anxiety

Mild Anxiety is a common experience of everyday life, and much like eustress is considered helpful since it heightens awareness and perceptions. A client experiencing mild anxiety may present as fidgety, irritable, bite their nails, swing their foot, and ask many questions as ways to relieve anxiety (Townsend. M., 2014).

• • Effective therapeutic responses to someone experiencing mild anxiety is answering questions, being direct, and offering reassurance through both verbal and  nonverbal communication.

Moderate Anxiety

Moderate Anxiety symptoms may present as decreased perception, single focus, dry mouth, rapid breathing, fast speech, and even anger as the body’s sympathetic system responds to the real or perceived threat. A person experiencing moderate anxiety may require more direction and assistance with solving problems (Townsend. M., 2014).

• • An effective therapeutic response to someone experiencing moderate anxiety is to use techniques such as observation and validation. For example, observe that the person is anxious and say something like, “you seem anxious about your appointment”, wait for the person’s response, and then validate their response.
  • Answer questions that the person asks you, speak in a calm and reassuring manner, begin to exaggerate your breath as you speak to them, in this way the person will begin to mimic your breath and as you begin to slow down breathing, so will they. Subsequently, their pace of speech will slow down too.

Severe Anxiety

Severe Anxiety symptoms may present as a lack of concentration, and the person may only be able to follow one instruction at a time (Townsend. M., 2014). Physical symptoms increase such as headaches, heart palpitations, and insomnia (Townsend. M., 2014).

• • In this circumstance an effective therapeutic response includes, giving one verbal instruction at a time, writing out any follow-up instructions, and giving written instructions to a client’s family member if they are available, and you have the client’s consent.

Panic Attack

A panic attack is characterized by an unexpected sudden surge of fear with physical symptoms that are similar to a heart attack; such as dizziness, heart palpitations, shortness of breath, trembling, choking, and nausea (Bridley. A. & Daffin Jr. L.W., 2018) (Stangor. C., & Walinga. J., 2014). A person who is experiencing a panic attack may want to leave the situation.

• • An effective therapeutic response to a person experiencing a panic attack is to allow them space to get up and move or lay down if they are experiencing dizziness. If they insist on leaving, ask if there is someone you can call, encourage a short walk around the block, and ask them to return. It would be best for a HCA to call the HCP for assistance with the client or the client’s family members in this situation.

Panic Disorder

Bridley.A., & Daffin JR. L.W. (2018) propose that panic disorder is a series of unexpected panic attacks and that people suffering from panic disorder manifest behavioural changes like fear of leaving their house because they do not know what caused the panic attack or when it might happen again. People suffering from panic disorder become anxious and may focus on cues to what might set off another attack, and as a result may avoid situations in which attacks have occurred, like driving, elevators, or specific spaces (Stangor. C., & Walinga. J., 2014).

Phobias

A phobia is a  fear of something specific such as an object, activity, or situation, and can range from a sense of unease, mild anxiety, or panic attack (Bridley. A., & Daffin JR. L.W., 2018). Most often the person will avoid what they fear, even if that avoidance is extreme. Depending on the severity of a person’s phobia , they can function without anyone noticing but for those whose phobias lead to panic disorder it can become debilitating and impact their daily life. Stangor. C., & Walinga. J. (2014) proposes that agoraphobia is one of the most severe phobias, in which suffers fear to leave their homes and interact with others.  See the list below of some common phobias.

Obsessive Compulsive Disorder (OCD)

Obsessive-compulsive disorder (OCD) is a psychological disorder in which a person engages in obsessions or compulsions as they attempt to calm frightening and distressing thoughts (Bridley. A., & Daffin JR. L.W., 2018). Unnecessary behaviours become ritualistic due to the calm they bring even when the person suffering from OCD recognizes the behaviours are not healthy (Stangor. C., & Walinga. J., 2014).

Posttraumatic Stress Disorder (PTSD)

People that witness, experience, or learn about someone close to them experiencing a traumatic event are at risk of suffering from posttraumatic stress disorder (PTSD) (Veteran’s Affairs Canada, 2019). Approximately 9.2 % of Canadians will experience PTSD in their lifetime with a higher incidence reported in women (Veteran’s Affairs Canada, 2019). Types of traumatic events include, but are not limited to, combat, sexual abuse, violent crimes, major accidents, and natural disasters (Government of Canada, 2021).

High levels of anxiety with flashbacks to the initial trauma are reported in people suffering from PTSD, and subsequently, people with PTSD wish to avoid reminders of that trauma (Stangor & Walinga, 2014). Manifestations of PTSD are similar to other types of anxiety disorders such as panic attacks, pain, headaches, digestive problems, as well as depression, alcohol misuse, and substance misuse (Veterans Affairs’ Canada, 2019). Since flashbacks can be intense with outbursts, this may lead to embarrassment and shame for the trauma survivor, causing them to withdraw, further exacerbating their symptoms because they have isolated themselves from others (Veteran’s Affairs Canada, 2019).

Since PTSD is the manifestation of a traumatic event, applying a trauma-informed approach (TIA) to communicate therapeutically with clients suffering from PTSD is important. As you will learn in the Trauma-Informed Communication chapter, a TIA is critical to building trust with the client, while promoting lifelong health and wellbeing for people who have suffered a trauma. For a Health Care Administrator (HCA) this starts with empathy and awareness that a person displaying behaviours that appear extreme or that you may find frightening, like an outburst related to a flashback, may be suffering from PTSD. It is important to remain empathetic and provide the person with as much privacy and discretion that is safe for you to do so. Consider the scope of practice of HCA, and with discretion, ask for assistance from the Health Care Provider (HCP).

Mood Disorders

Most people experience times of feeling low due to varying situational factors. For example, complex interpersonal relationships, loss, and even external factors such as low daylight hours during long Canadian winters. Consider Mrs. Weber (in the opening scenario) may be suffering from a mood disorder due to the situation of her partner moving into a long-term care home and the loss of what their relationship once was. Mood disorders negatively impact the way people think, socialize, perceive interactions, and can manifest into negative moods, sadness, and depression (Stangor. C., & Walinga J., 2014). Diagnosing depression is far beyond the scope of the health care administrator (HCA) but awareness about the signs, symptoms and behavioural manifestations will increase your empathy and ability to connect clients to support.

Depression

Levels of depression vary between people based on many factors such as situational factors, biological factors, and hereditary factors or a combination of factors. Dysthymia is considered a mild form of depression but long-lasting at a minimum of two years. Major depressive disorder, also referred to as clinical depression is considered a more severe form of depression since negative feelings of sadness, despair and loss of interest limit the person’s day-to-day activities (Stangor. C., & Walinga J., 2014). 

Stangor. C., & Walinga. J. (2014) proposes that people suffering from depression have overwhelming negative moods and this may be demonstrated by the following symptoms:

• Changes in appetite
• Difficulty concentrating
• Fatigue
• Feeling hopeless, helpless and pessimistic
• Misuse of alcohol or drugs
• Irritability
• Loss of interest in things that were once pleasurable
• Loss of interest in personal appearance
• Persistent aches and pains
• Sleep disorders
• Suicidal thoughts

Bipolar Disorder

Bipolar disorder differs from depression in that there are periods of depression, periods of stable mood, periods of mania, or mixed episodes that display both depression, and mania, at the same time (CAMH Bipolar Clinic Staff, 2013). During periods of mania, behaviour can range from exaggerated self-esteem, increased talking, racing thoughts, poor judgement, increased irritability, lack of concentration to hallucinations and suicidal thoughts (CAMH Bipolar Clinic Staff, 2013).  Stangor. C., & Walinga. J. (2014) proposes that if bipolar disorder is left untreated symptoms exacerbate leading to harm to self or others.

Schizophrenia

In Canada, one out of ten Canadians over the age of ten were living with diagnosed schizophrenia according to data gathered in 2016-2017 (Government of Canada, 2020). Stangor. C., & Walinga. J. (2014) proposes that schizophrenia is one of the most debilitating psychological disorders because symptoms impact daily life so severely. While symptoms vary in people with a Schizophrenia diagnosis the American Psychiatric Association divides them into three categories as seen in the chart below (Stangor. C., & Walinga, J., 2014).

Mental Illness, Substance Misuse, Addiction, and Homelessness

Due to behavioural manifestations of mental illness, people suffering from mental illness find it challenging to maintain regular employment and stable income. This may lead to housing insecurity, homelessness, and poor health care outcomes. The Canadian Mental Health Association (CMHA) Ontario (2021), estimates that 25 – 50 percent of homeless individuals suffer from a mental health illness. Without supports, people experiencing homelessness combined with the behavioural manifestation of mental illness may also suffer from substance misuse or addiction (CMHA Ontario, 2021). According to a 2018 report, approximately 25% of people who responded to the survey indicated that addiction or substance use was the reason that they were homeless (Baker. N., Cooper. I., Hunter. P., Quayum. S., Rivier. J., 2018).

Employment opportunities exist for Health Care Administrators with organizations that support people suffering from mental illness, addiction, and homelessness. Investigation into the reasons that people suffering from mental illness behave the way they do, will assist you in understanding the supports needed, reduce your fear of behaviours, and increase your confidence to competently and compassionately assist clients suffering from mental illness, substance misuse, addiction, and homelessness.

Check Your Understanding

Summary

In this chapter you have:

• Assessed the implication of stressors on anxiety disorders and mood disorders using common theoretical models.
• Explored symptoms and behavioural manifestations of common anxiety disorders and mood disorders.
• Reviewed effective therapeutic communication techniques when communicating with clients suffering from anxiety disorders and mood disorders.
• Considered the scope of practice of the health care administrator in supporting clients in various levels of mental well-being.

Key Terms

Addiction: A solid need to habitually use or do something. (Merriam-Webster, n.d)

Agoraphobia: Anxiety about being in places or situations where escape might not be possible (Stangor & Walinga, 2014).

Anxiety: Excessive worry, nervousness, or fear even when the stressors are removed.

Anxiety disorders: Psychological disturbances that include irrational fears of what most would perceive as everyday situations and objects (Stangor. C, & Walinga. J., 2014).

Alarm phase: First phase in Hans Seyle’s General Adaptation Syndrome. The fight-or flight response is activated (Pelz & Herkimer County Community College, n.d.).

Behaviours: The way a person act (Merriam-Webster, n.d).

Comorbidity: Suffering from two or more disorders at the same time.

Compulsions: Repetitive behaviours.

Distress: When the level of stress is no longer helpful and becomes overwhelming and debilitating (Pelz & Herkimer County Community College, n.d.).

Dysthymia: Mild form of depression.

Exacerbation: Increase in severity.

Exhaustion phase: The third and final phase of Hans Seyle’s General Adaptation Syndrome model. The body is no longer able to adapt and sustained levels of Cortisol takes it tole on the body (Pelz & Herkimer County Community College, n.d.)

Eustress: Stress for a short duration considered good stress eu/stress.

Fidgety: Inclined to easily upset (Merriam-Webster, n.d).

Flight-or-fight response: The activation of both sympathetic nervous system and the endocrine system in response to a real or perceived threat. Blood flow goes to essential organs allowing the body to either fight the threat or flee from the threat (Pelz & Herkimer County Community College, n.d.).

General Adaptation Syndrome (GAS): Hans Selye created this term to refer to the three phases in which the mind and body change in response to long-term stress.

Homelessness: Not having a place to live (Merriam-Webster, n.d).

Major depressive disorder: Clinical depression is a severe form of depression as it limits the person’s day-to-day activities.

Misuse: incorrect use of something (Merriam-Webster, n.d)

Mood disorders: Lowering of a person’s mood.

Obsessions: Repetitive thoughts.

Outburst: stern expression of a feeling (Merriam-Webster, n.d).

Panic Attack: An unexpected sudden surge of fear with physical symptoms.

Panic disorders: A series of unexpected panic attacks that becomes debilitating.

Phobia: Fear of something specific such as an object, activity, or situation.

Posttraumatic Stress Disorder (PTSD): A psychological condition occurring when a person experienced a highly stressing situation (Merriam-Webster, n.d).

Remission: A period of time when there is relief from symptoms.

Resistance phase: The second phase of Hans Seyle’s General Adaptation Syndrome model. The body remains on alert but the initial jolt is gone (Pelz & Herkimer County Community College, n.d.)

Stress: Researchers vary on their definition of stress but it is generally thought to be the response to a stimulus (stressor) or response to a perception of a stressor (Pelz & Herkimer County Community College, n.d.).

Stressor: Being something an individual determines is overwhelming or a potential threat to their wellbeing (Pelz & Herkimer County Community College, n.d.).

Sympathetic system: the part of the nervous system that prepares the body to react to situations of stress or alarm (Merriam-Webster, n.d).

Trembling: shaking involuntarily (Merriam-Webster, n.d).

References

American Psychological Association. (2020). What’s the difference between stress and anxiety? https://www.apa.org/topics/stress/anxiety-difference

Baker. N., Cooper. I., Hunter. P., Quayum. S., Rivier. J. (2018) Addiction, substance use and homelessness: An analysis from the nationally coordinated Point-in-Time counts. Employment and Social Development Canada, Government of Canada. https://www.canada.ca/en/employment-social-development/programs/homelessness/publications-bulletins/report-addiction.html

Bridley. A., Daffin Jr. L.W. (2018). Essentials of abnormal psychology (1st ed). Washington State University. https://opentext.wsu.edu/abnormalpsychology/front-matter/title-page/

CAMH Bipolar Clinic Staff. (2013). Bipolar disorder: An information guide (Revised ed.). Centre for Addiction and Mental Health. https://www.camh.ca//-/media/files/guides-and-publications/bipolar-guide-en.pdf [opens a PDF file]

Canadian Mental Health Association, National. (2021, July 19). Fast facts about mental health and mental illness. https://cmha.ca/brochure/fast-facts-about-mental-illness/

Canadian Mental Health Association Ontario. (2021) Housing and mental health. https://ontario.cmha.ca/documents/housing-and-mental-health

Fox. C. (2019, August 9.) Easing cancer’s burden on mental health. Cancer Care Ontario Blog. https://www.cancercareontario.ca/en/blog/Easing%20cancer%E2%80%99s%20burden%20on%20mental%20health

Government of Canada. (2009, July 22). Mental health – anxiety disorders. https://www.canada.ca/en/health-canada/services/healthy-living/your-health/diseases/mental-health-anxiety-disorders.html

Government of Canada. (2015, June 3). Mood and anxiety disorders in Canada: Fast facts from the 2014 Survey on living with chronic diseases in Canada. https://www.canada.ca/en/public-health/services/publications/diseases-conditions/mood-anxiety-disorders-canada.html

Government of Canada (2021, June 2) Posttraumatic stress disorder (PTSD): Learn what Canada is doing to address PTSD. https://www.canada.ca/en/public-health/topics/mental-health-wellness/post-traumatic-stress-disorder.html

Herkimer County Community College & Pelz. B. (n.d.). Introduction to Psychology: What is stress? Lumen Learning. https://library.achievingthedream.org/herkimerintropsych/chapter/what-is-stress/

Jenkins. W. J., Lovett. M. D., & Spielman. R. M. (2021). Psychology (2nd ed.). OpenStax. https://openstax.org/details/books/psychology-2e

OER Conestoga College (2021, December 17). Woman looking depressed [Photo]. Wikimedia Commons. https://commons.wikimedia.org/wiki/File:Woman_looking_depressed.jpg

Stangor. C., & Walinga. J. (2014). Introduction to psychology (1st Can. ed.). BCcampus. https://opentextbc.ca/introductiontopsychology/chapter/12-2-anxiety-and-dissociative-disorders-fearing-the-world-around-us/

Townsend, M. (2014). Psychiatric mental health nursing : Concepts of care in evidence-based practice [ProQuest Ebook Central].Philadelphia, Pennsylvania : F. A. Davis Company https://ebookcentral-proquest-com.conestoga.idm.oclc.org

Veterans Affairs Canada (2019, September 10). Learn about PTSD https://www.veterans.gc.ca/eng/health-support/mental-health-and-wellness/understanding-mental-health/learn-ptsd#b1