Levels of Anxiety
AnxietyOpens in new window has both healthy and harmful aspects depending on its degree and duration as well as on how well the person copes with it. Hildegard Peplau who had a profound role in shaping the specialty of psychiatric-mental health nursing, identified anxiety as a key element in her theory of interpersonal relationshipsOpens in new window. Peplau (1968) developed a useful anxiety model that consists of four levels: mild, moderate, severe, and panic.
The boundaries between these levels are not distinct, and the behaviors and characteristics of individuals experiencing anxiety can and often do overlap. Identification of a general level of anxiety is helpful in selecting interventions based on the degree of the patient’s anxiety.
- Mild Anxiety
Mild anxiety is a sensation that something is different and warrants special attention. Sensory stimulation increases and helps the person focus attention to learn, solve problems, think, act, feel and protect himself or herself.
Mild anxiety often motivates people to make changes or to engage in goal-directed activity. For example, it helps students to focus on studying for an examination.
Mild anxiety occurs in the normal experience of everyday living and allows an individual to perceive reality in sharp focus. A person experiencing a mild level of anxiety sees, hears, and grasps more information.
Physical symptoms of mild anxiety may include slight discomfort, restlessness, irritability, or mild tension-relieving behaviors (e.g., nail biting, foot or finger tapping, fidgeting).
- Moderat Anxiety
Moderate anxiety is the disturbing feeling that something is definitely wrong; the person becomes nervous or agitated. As anxiety increases, the perceptual field narrows, and details are excluded from observation.
The person experiencing moderate anxiety sees, hears, and grasps less information and may demonstrate selective inattention in which only certain things in the environment are seen or heard unless they are pointed out.
In moderate anxiety, the ability to think clearly is hampered, but learning and problem solving can still take place although not an at an optimal level.
Sympathetic nervous systemOpens in new window symptoms begin to kick in at this level. The individual may experience tension, pounding heart, increased pulse and respiratory rate, perspiration, and mild somatic symptoms (e.g., gastric discomfort, headacheOpens in new window, urinary urgencyOpens in new window). Voice tremors and shaking may be noticed. Mild or moderate anxiety levels can be constructive because anxiety may be signal that something in the person’s life needs attention or is dangerous.
- Severe Anxiety
The perceptual field of a person experiencing severe anxiety is greatly reduced.
A person with severe anxiety may focus on one particular detail or many scattered details and have difficulty noticing what is going on in the environment, even when another points it out.
Learning and problem solving are not possible at this level, and the person may be dazed and confused. Behavior is automatic and aimed at reducing or relieving anxiety.
Somatic symptoms (e.g., headache, nausea, dizziness, insomnia) often increase. Trembling and a pounding heart are common, and the person may experience hyperventilation and a sense of impending doom or dread.
Panic is the most extreme level of anxiety and results in markedly dysregulated behavior.
Panic is associated with awe, dread and terror. At this stage, details are blown out of proportion. Because of a complete loss of control, the person is unable to do things even with direction.
PanicOpens in new window involves the disorganization of the personality. A person can no longer function as an organized human being. There is increased motor activity, decreased ability to relate to others, distorted perceptions and loss of rational thought.
Panic is a frightening and paralyzing experience. The person in a state of panic is unable to process what is going on in the environment and may lose touch with reality. The behavior that results may be manifested as pacing, running, shouting, or withdrawal.
HallucinationsOpens in new window, or false sensory percepts (e.g., seeing people or objects not really there) may be experienced. Physical behavior may become erratic, uncoordinated, and impulsive.
Automatic behaviors are used to reduce and relieve anxiety, although such efforts may be ineffective. Acute panic may lead to exhaustion. This level of anxiety cannot persist indefinitely because it is incompatible with life.
- Bourne, E.J. (2005). The anxiety and phobias workbook. Oakland, CA: New Harbinger.
- Elliott, C.H., & Smith, L.L. (2002). Overcoming anxiety for dummies. New York: John Wiley.
- Ohman, A. (2008). Fear and anxiety. In M. Lewis, J. M. Haviland-Jones, & L. F. Barrett (Eds.), Handbook of emotions (3rd ed., pp. 709 – 729). New York: Guilford.