12.5 Therapeutic Communication and Mental Well-Being
Kimberlee Carter, Marie Rutherford, Connie Stevens (adapted by Brock Cook)
Learning Objectives
In this chapter, you will:
- assess the implication of stressors on anxiety disorders and mood disorders using common theoretical models
- explore symptoms and behavioural manifestations of common anxiety disorders and mood disorders
- review effective therapeutic communication techniques when communicating with a client suffering from anxiety disorders and mood disorders
- consider the scope of practice of the healthcare administrator in supporting clients in various levels of mental well-being.
Introduction
The Australian Bureau of Statistics (2023), in its National Study of Mental Health and Wellbeing, reveals that a staggering 42.9% of individuals aged between 16 and 85 years have encountered a mental disorder at some point in their lives. This statistic underscores the pervasive nature of mental health challenges across the Australian population. The ability to identify and understand symptoms associated with mental health issues is pivotal in fostering constructive dialogues with those affected. By delving into the common mental health conditions, one not only reduces stigma but also cultivates a deeper sense of empathy and compassion. Healthcare administrators (HCAs) in Australia, who are adept in employing effective therapeutic communication techniques, play an instrumental role in guiding individuals and their families towards obtaining the essential support needed in their journey towards mental wellness.
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 of 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 releases hormones including Adrenaline and Cortisol into the bloodstream (Herkimer County Community College & Pelz, 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 & Walinga, 2014). Long-sustained levels of Cortisol will weaken the immune system and if chronic, may lead to disorders and disease (Stangor & Walinga, 2014). The final phase is the exhaustion phase, where the body is no longer able to adapt, and the ability to resist combined with the constant levels of Cortisol takes its toll on the body resulting in damage to the body (Herkimer County Community College & Pelz, n.d.).
Consider this Situation
Consider for a moment that Jamal has just been told by Dr. Livingstone that he has cancer. Jamal doesn’t hear anything Dr. Livingstone is telling them after the word cancer. Luckily Jermaine has come with Jamal and can take down the information. It is likely that Jamal’s body is preparing to flee.
Jamal later accepts the diagnosis and begins their treatment. Over the course of two years, there are periods of exacerbation and remission. Each time, Jamal adapts and stays resistant but over the course of treatment these types of stressors along with the disease they are fighting, take their toll not only on Jamal’s physical health but on their mental well-being.
Jamal has been in remission for more than five years and is considered cured. Jamal’s anxiety about cancer coming back and chronic depression makes it impossible for Jamal to hold down steady employment. Jermaine is tired all of the time, suffers from chronic headaches, worries that Jamal will never be able to contribute to the family household and feels guilty for resenting Jamal. Fox (2019) suggests that cancer survivors may suffer from anxiety and depression, and their families from caregiver burnout. The good news is there are supports available to assist.
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 & Walinga, 2014)
- Cognitive
- difficulty concentrating or making decisions
- Behavioural
- misuse of drugs & alcohol, excessive eating, or smoking (Herkimer County Community College & Pelz, 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 healthcare when they are feeling unwell, and dealing with life’s stressors and uncertainties. As a HCA you will see signs and behaviours that may seem on the surface as excessive or unreasonable responses to the situation.
Consider this Situation
Karla, arrived an hour early for their appointment, is pacing back and forth in the waiting room and comes to the check-in window numerous times to find out how long the wait will be. Each time that Karla comes to the window they are increasingly agitated to the point that you sense they are getting angry.
- You might be thinking the client came an hour early so this is an unreasonable response.
- Consider that the behaviour is related to the stressor:
- Karla is here to obtain recent test results.
- Perhaps their agitation is related to the stressor of wondering what the test results will reveal and not that they have to wait.
Awareness that stressors may be behind those behaviours, will assist you to empathise with the client and to show them compassion.
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). Twenty-seven percent 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 healthcare 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 & Walinga, 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, and 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 recognises 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 & Walinga, 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 with various levels of anxiety will reduce their level of anxiety and provide an opportunity to meet their healthcare needs. The 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 Healthcare 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, biting their nails, swinging their foot, and asking many questions as ways to relieve anxiety (Townsend, 2014).
Effective therapeutic responses to someone experiencing mild anxiety are 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, 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, and 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, 2014). Physical symptoms increase such as headaches, heart palpitations, and insomnia (Townsend, 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 characterised 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 & Daffin, 2018; Stangor & Walinga, 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 and Daffin (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 & Walinga, 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 to mild anxiety, or panic attack (Bridley & Daffin, 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 & Walinga (2014), propose that agoraphobia is one of the most severe phobias, in which sufferers fear to leave their homes and interact with others. See the list below of some common phobias.
| Name | Description |
| Acrophobia | Fear of heights |
| Agoraphobia | Fear of situations that are difficult to escape from |
| Arachnophobia | Fear of spiders |
| Astraphobia | Fear of thunder and lightning |
| Claustrophobia | Fear of closed-in-spaces |
| Cynophobia | Fear of dogs |
| Mysophobia | Fear of germs or dirt |
| Ophidiophobia | Fear of snakes |
| Pteromerhanophobia | Fear of flying |
| Social phobia | Fear of social situations |
| Trypanophobia | Fear of injections |
| Zoophobia | Fear of small animals |
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 & Daffin, 2018). Unnecessary behaviours become ritualistic due to the calm they bring even when the person suffering from OCD recognises the behaviours are not healthy (Stangor & Walinga, 2014).
Post-Traumatic Stress Disorder (PTSD)
People who witness, experience, or learn about someone close to them experiencing a traumatic event are at risk of suffering from 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 Healthcare 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 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, socialise, and perceive interactions, and can manifest into negative moods, sadness, and depression (Stangor & Walinga, 2014). Diagnosing depression is far beyond the scope of the HCP 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 & Walinga, 2014).
Stangor and Walinga (2014) propose 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.
Types of Depression Diagnoses
The following is a list of common types of depression diagnoses that are not covered in this chapter. You are encouraged to explore them on your own. Are there any others that you would add to this list?
- postpartum depression
- seasonal affective disorder (SAD)
- situational depression
- persistent depressive disorder
- atypical depression
- treatment-resistant depression
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, and lack of concentration to hallucinations and suicidal thoughts (CAMH Bipolar Clinic Staff, 2013). Stangor and Walinga (2014) propose that if bipolar disorder is left untreated symptoms exacerbate leading to harm to self or others.
Schizophrenia
Demonstration of Behavioural Manifestations in a Client with Schizophrenia
Stangor and Walinga (2014) propose 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 & Walinga, 2014).
| Positive Symptoms (not seen in the general population) |
Negative Symptoms (seen in the general population) |
Cognitive Symptoms (changes due to Schizophrenia) |
| Hallucinations | Social withdrawal | Poor executive control |
| Delusions (of grandeur or persecution) | Flat affect and lack of pleasure in everyday life | Trouble focusing |
| Derailment | Apathy and loss of motivation | Working memory problems |
| Grossly disorganised behaviour | Distorted sense of time | Poor problem-solving abilities |
| Inappropriate affect | Lack of goal-orientated activity | |
| Movement disorders | Limited speech | |
| Poor hygiene and grooming |
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 healthcare outcomes. The Canadian Mental Health Association (CMHA) Ontario (2021), estimates that 25 – 50 percent of homeless individuals suffer from a mental health illness. Without support, 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 et al., 2018).
Employment opportunities exist for healthcare administrators with organisations 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.
For further training consider the following:
Check Your Understanding
Key Takeaways
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 healthcare administrator in supporting clients in various levels of mental well-being.
References
American Psychological Association. (2020). What’s the difference between stress and anxiety? https://www.apa.org/topics/stress/anxiety-difference
Australian Bureau of Statistics. (2023). National study of mental health and wellbeing. Australian Government. https://www.abs.gov.au/statistics/health/mental-health/national-study-mental-health-and-wellbeing/latest-release#:~:text=In%202020%E2%80%932022%2C%20of%20the,or%20Post%2DTraumatic%20Stress%20Disorder
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, L. W., Jr. (2018). Essentials of abnormal psychology. Washington State University. https://opentext.wsu.edu/abnormalpsychology/front-matter/title-page/
CAMH Bipolar Clinic Staff. (2013). Bipolar disorder: An information guide. Centre for Addiction and Mental Health. https://www.camh.ca//-/media/files/guides-and-publications/bipolar-guide-en.pdf
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
Stangor, C., & Walinga, J. (2014). Introduction to psychology (1st Canadian 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. F. A. Davis Company.
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
Chapter Attribution
Content adapted, with editorial changes, from:
Carter, K., Rutherford, M., & Stevens, C. (2022). Therapeutic communication for health care administrators. Conestoga College. https://ecampusontario.pressbooks.pub/therapeuticcommunicationforhealthofficeadministrators Used under a CC BY 4.0 licence.
