Treatment of acute procedure anxiety in adults
- Yujuan Choy, MD
Yujuan Choy, MD
- Assistant Clinical Professor of Psychiatry (volunteer faculty)
- University of California, Irvine
Acute procedure anxiety is an excessive fear of medical, dental, or surgical procedures that results in acute stress or avoidance. Patients may experience anxiety in anticipation of or during procedures used for screening (eg, mammography), diagnosis (eg, amniocentesis or endoscopy), and treatment (eg, angioplasty or major surgery). Avoidance of clinical procedures due to acute procedure anxiety can have negative health consequences [1-7].
Specific phobias are a subset of the varied manifestations of acute procedure anxiety, diagnosed under DSM-5 criteria only when the patient’s fears are specific to the procedure and its immediate effects (eg, fear of suffocation during an MRI) rather than fears not specific to the procedure itself (eg, a fear of the underlying illness that might be diagnosed). Specific phobias related to clinical procedures include blood-injection-injury phobia, dental phobia, and MRI claustrophobia.
This topic addresses the treatment of acute procedure anxiety that does not constitute a specific phobia. Treatment for specific phobias of clinical procedures (including blood-injection-injury phobia, dental phobia, and MRI claustrophobia) is addressed separately. The epidemiology, clinical manifestations, course, screening, assessment, and differential diagnosis of acute procedure anxiety are also discussed separately. The epidemiology, clinical manifestations, course, diagnosis, and treatment of other specific phobias are also discussed separately. (See "Treatment of specific phobias of clinical procedures in adults" and "Acute procedure anxiety in adults: Epidemiology and clinical presentation" and "Acute procedure anxiety in adults: Course, screening, assessment, and differential diagnosis" and "Specific phobia in adults: Epidemiology, clinical manifestations, course and diagnosis" and "Psychotherapy for specific phobia in adults" and "Pharmacotherapy for specific phobia in adults".)
Several general principles can be useful in the management of acute procedure anxiety. Unless otherwise specified, these guidelines are based on our clinical experience.
●Establish a trusting doctor-patient relationship – A trusted physician may be better able to explain to the patient why an indicated procedure is necessary, and to reassure him or her of its safety.
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- TREATMENT PRINCIPLES
- - Efficacy
- - Administration
- - Side effects
- Alternative medications
- Supplemental education
- Brief cognitive-behavioral therapy
- - Components
- - Efficacy
- - Administration
- Music therapy
- Video observation
- Spiritual training
- TREATMENT SELECTION
- SUMMARY AND RECOMMENDATIONS