Psychology information for inpatients

Stress and anxiety are terms that are often used, but do they mean the same thing or are they different?

Stress is usually caused by an external trigger, like a health scare, being in hospital, having a procedure, or having an argument with your partner. This is usually short-term stress and goes once the trigger disappears or improves. However, people can also experience long term stress (chronic stress) from triggers that hang around for a long time, such as being unemployed, being short of money, serious relationship problems, or chronic illness. When we are under stress, we may feel irritable, angry, have muscle tension, digestive problems and have trouble sleeping. Also, chronic stress can affect your mental and physical health and has been linked to some chronic health conditions.

Anxiety, is more about having excessive worries that don’t go away, even when there is no stressor. Anxiety leads to nearly the same symptoms as those experienced when stressed. There are many different types of anxiety, such as phobias and even health anxiety. Anxiety often changes our behaviour. For example, people with social anxiety will avoid social situations (but if they didn’t have anxiety, they would love to go out).

Panic attacks are episodes of high anxiety which trigger our biological flight and fight response to danger. It is important to note that panic attacks could happen even when there is no apparent danger! Sometimes there is a trigger. For example, having an MRI if you are afraid of tight spaces! Our flight and fight response is biological; our brain orders the body to release a range of chemicals that do things like make our heart rate increase, breathing to increase, and more blood going to our muscles for action. There are many symptoms that people could experience such as:

• Palpitations, pounding heart, or accelerated heart rate
• Sweating
• Trembling or shaking
• Sensations of shortness of breath or smothering
• Feeling of choking
• Chest pain or discomfort
• Nausea or abdominal distress
• Feeling dizzy, unsteady, lightheaded, or faint
• Derealization (feelings of unreality) or depersonalization (being detached from oneself)
• Fear of losing control or “going crazy”
• Fear of dying
• Paraesthesia (numbness or tingling sensation)
• Chills or heat sensations.

No wonder people often feel like they are having a heart attack or dying! The good news is that a panic attack is very unlikely to kill you. It can worsen your symptoms if you have conditions like Chronic Obstructive Pulmonary Disease (COPD).

The good news is that stress, anxiety and panic attacks can all be managed. You can learn some key skills to help get the physical symptoms under control. These skills include learning to breath properly (diaphragmatic breathing) and many different relaxation exercises. Symptoms can also be improved with such things as healthy eating and exercise. Seeing a psychologist can help you explore and understand your symptoms and undertake a therapy like Cognitive Behaviour Therapy (CBT) to learn new ways of thinking. Your GP or a psychiatrist may prescribe medications to assist with treating your mood or anxiety. You can also do therapy with a psychologist at the same time.

You are not alone, and help is available! Anxiety, stress, and panic affects many people, and it is nothing to be ashamed about. If you are in hospital, please let your doctor, or nurses or allied health staff know what you are experiencing and ask them to refer you to a hospital psychologist who can see you while you are an inpatient. Reach out to your GP (who can refer you to a private psychologist under Medicare). You can find out more on the Queensland Government Mental Health Pathways webpage.

The following websites are also good starting points:

• Head to Health
• eMHPrac - Digital Mental Health resources
• Anxiety - Beyond Blue

It is common for people to feel sad or low if they have been in hospital a long time or have had lots of health problems to deal with.

When you are in hospital, the way you are feeling is often strongly linked to your physical symptoms. Treatments can make you feel sick, tired and in pain all of which can lead to feelings of sadness and depression. People are also often worried about having new conditions, treatments and required lifestyle changes which can take a period of adjusting to.

Low moods can drain you of energy. You can lose interest in things you normally enjoy and feel like you just can’t be bothered doing anything.  When you don’t do anything, you just end up feeling even worse, and you have more time to think about how bad things seem.  This is known as the low mood – inactivity trap.

There are things you can do to make a difference to how you are feeling. This guide is designed to help you to develop some useful ways of coping for when you are feeling low and fed up. Remember, there are lots of people to help and support you, like your family, friends and staff at the hospital.

One way to help yourself is to make a list of things you think you could do. Be realistic and set yourself goals that you could achieve. Obviously, what you can do will often depend on how you are feeling each day and what treatments you may be having.

Some examples of mood improvement activities that could be completed within the hospital setting are included below. Remember to complete within your health and functional limits and ONLY IF SAFE to do so (it may be worth checking with your physiotherapist or occupational therapist if you are unsure):

• Maintain personal hygiene – daily showers, wash and brush hair, brush your teeth, shave
• Participate in physical activity with your physiotherapists and allied health assistant
• Challenge yourself to sit out of bed for your meals and go on incidental walks to the bathroom, common rooms or down the hallway if you are safe to do so
• If safe to do so, take a walk outside or ask a family member to assist you outside with the appropriate mobility aid
• Eat regularly and well
• Continue to take prescribed medications for your mental health – if you don’t have them with you or have not been prescribed them during your hospital stay, please discuss with your nurses/doctors
• Limit smoking and nicotine
• Reach out for support from your loved ones and if you feel comfortable, strike up some conversations with your fellow inpatients and hospital staff!
• Make use of the common rooms, the available TV’s, books, magazines and activities to keep your mind busy and distracted

Making a schedule or timetable to plan your activities or therapy throughout the day can be helpful in keeping track of all your achievements. People in hospital or who are ill often don’t think about their achievements, such as managing to get out of bed and get dressed, because they think that they are “nothing, because everyone should be able to do that”. When you are unwell normal everyday things can be much more difficult. You deserve to be proud and recognise how well you have done if you manage to meet any goal that you have set yourself (Newcastle Hospitals NHS Foundation Trust, 2023).

If you are finding that feelings of sadness persist, and you are needing extra support remember that we are here to support you and you can ask a member of your team to refer you to a psychologist during your inpatient stay.

Additional mood resources:

• Monitoring your mood
• Improving how you Feel 
• Behavioural activation
• Fun activities catalogue

It is normal to have strong emotional and physical reactions following a distressing event. On most occasions, these reactions subside as a part of the body’s natural healing and recovery process. There are many things you can do to help cope with and recover from such an experience.

A traumatic experience is any event in life that causes a threat to our safety and potentially places our own life or the lives of others at risk. As a result, a person experiences high levels of emotional, psychological, and physical distress that temporarily disrupts their ability to function normally in day-to-day life.

Examples of potentially traumatic experiences include natural disasters such as a bushfire or flood, witnessing an armed robbery, having a serious car accident, traumatic limb loss, being in a plane that is forced to make an emergency landing, or being physically assaulted (to name a few).

Reactions to Trauma

How a person reacts to trauma depends on many things, like the type and severity of the traumatic event, the amount of support available for the person following the incident, other stressors currently being experienced in the person’s life, the existence of certain personality traits, natural levels of resilience, and whether the person has had any traumatic experiences before.

Common reactions include a range of mental, emotional, physical, and behavioural responses. These reactions are normal and, in most cases, they subside as a part of the body’s natural healing and recovery process.

Examples of common reactions to trauma are:

• feeling as if you are in a state of “high alert” and are “on watch” for anything else that might happen,
• feeling emotionally numb, as if in a state of shock,
• becoming emotional and upset,
• feeling extremely fatigued and tired,
• feeling very stressed and/or anxious,
• being very protective of others including family and friends,
• not wanting to leave a particular place for fear of “what might happen”.

Mental reactions to trauma include:

• reduced concentration and memory,
• intrusive thoughts about the event,
• repeatedly playing parts of the event over in the mind,
• confusion or disorientation.

Emotional reactions to trauma can include:

• feeling fearful, anxious, panicky,
• shock – difficulty believing what has happened, feeling detached and confused,
• feeling numb,
• not wanting to connect with others or becoming withdrawn from those around you,
• continuing alarm – feeling like the danger is still there or the event is continuing,
• let-down – after the crisis is over, exhaustion may become obvious. Emotional reactions to the event are felt during the let-down phase, and include depression, avoidance, guilt, oversensitivity, and withdrawal.

Traumatic experiences can result in physical reactions including:

• fatigue or exhaustion,
• disturbed sleep,
• nausea, vomiting, and dizziness,
• headaches,
• excessive sweating,
• increased heart rate.

Common behaviour reactions to trauma include:

• avoiding reminders of the event,
• inability to stop focusing on what occurred,
• getting immersed in recovery-related tasks,
• losing touch with normal daily routines,
• changed appetite, such as eating a lot more or a lot less,
• turning to substances such as alcohol, cigarettes, and coffee,
• sleeping problems.

Making sense of the traumatic event

Once the distressing event is over, you may find yourself trying to make sense of the event. This can include thinking about how and why it happened, how and why you were involved, why you feel the way you do, whether feelings you now have reflect on what kind of person you are, whether the experience has changed your view on life, and how.

There are several strategies that can be put in place to help someone resolve traumatic reactions. Some common well-identified examples include:

• Recognising that you have been through a distressing or frightening experience and that you will have a reaction to it.
• Accepting that you will not feel your normal self for a while, but that it will also eventually pass.
• Reminding yourself daily that you are managing – try not to get angry or frustrated with yourself if you are not able to do things as well or efficiently as normal.
• Avoiding overuse of alcohol or drugs to help cope.
• Avoiding making major decisions or big life changes until you feel better.
• Gradually confronting what has happened – don’t try to block it out.
• Don’t bottle up your feelings – talk to someone who can support and understand you.
• Try to keep to your normal routine and stay busy.
• Don’t go out of your way to avoid certain places or activities. Don’t let the trauma confine your life - take your time to get back to normal.
• Rest when you feel exhausted.
• Make time for regular exercise – it helps cleanse your body and mind of tension.
• Help your family and friends to help you by telling them what you need, such as time out or someone to talk to.
• Relax – use relaxation techniques such as yoga, breathing or meditation, or do things you enjoy, such as listening to music or gardening.
• Express your feelings as they arise – talk to someone about your feelings or write them down.
• When the trauma brings up memories or feelings, try to confront them. Think about them, then put them aside. If it brings up other memories, try to keep them separate from the current problem and deal with them separately.

Healing and recovery

Any event that places a person’s own life or the lives of others at risk results in the human body going into a state of heightened arousal. This is like an ‘emergency mode’ that involves a series of internal alarms being turned on. Emergency mode gives people the capacity to access a lot of energy in a short period of time to maximise the chance of survival.

Most people only stay in emergency mode for a short period of time or until the immediate threat has passed. However, being in emergency mode uses up vital energy supplies and this is why people often feel quite tired afterwards.

The normal healing and recovery process involves the body coming down out of a state of heightened arousal. In other words, the internal alarms turn off, the high levels of energy subside, and the body re-sets itself to a normal state of balance and equilibrium. Typically, this should occur within approximately one month of the event.

Seeking professional help

Traumatic stress can cause very strong reactions in some people and may become chronic (ongoing). You should seek professional help if you:

• are unable to handle the intense feelings or physical sensations,
• continue to feel numb and empty,
• feel that you are not beginning to return to normal after three or four weeks,
• continue to have physical stress symptoms,
• continue to have disturbed sleep or nightmares,
• deliberately try to avoid anything that reminds you of the traumatic experience,
• have no one you can share your feelings with,
• find that relationships with family and friends are suffering,
• are becoming accident-prone and using more alcohol or drugs,
• cannot return to work or manage responsibilities,
• keep reliving the traumatic experience,
• feel very much on edge and can be easily startled.

Post-traumatic stress disorder (PTSD)

After a distressing event, some people find their reactions are serious and do not gradually subside after a month. Severe, prolonged reactions can be disabling, and can affect a person’s relationships with family and friends as well as their capacity to work. Such reactions might indicate PTSD. In this condition, the impact of the event continues to cause high levels of stress.

If you think you might be experiencing PTSD, you should seek help from a health professional. Your GP is a suitable person to speak to first. They can discuss your concerns with you and may prescribe a Mental Health Care Plan for further treatment if needed. If you are in crisis and need more immediate help, see the information provided in the Crisis Support section.

Things to remember:

• It is normal to have strong reactions following a distressing or frightening event, but these should begin to reduce after a few weeks.
• People can experience a range of physical, mental, emotional, and behavioural reactions.
• There are many things you can do to cope with and recover from trauma.
• Seek professional help if you don’t begin to return to normal after three or four weeks.

What is the right amount of sleep?

Different people need different amounts of sleep. Some people need more sleep than others. The range can be anything from seven to nine hours of sleep for adults (Australian Institute of Health and Welfare, 2021).

Please refer to the following resource for additional information on Australian sleep recommendations, common sleep problems, and common consequences of poor sleep:

• Sleep problems as a risk factor for chronic conditions

What is sleep hygiene?

"Sleep hygiene" refers to positive habits that help you have a good night's sleep. Scientific research shows there are many simple habits and strategies that not only improve your sleep but also address long-standing sleep difficulties.  By adding some of these habits and strategies to your sleep routine, you may be able to avoid the use of medications. Using medications to sleep is not helpful in the long term, and they have many side effects.

With improved sleep, you will find you feel better, have increased energy, and function better in your day-to-day activities! Keep reading below, as we have outlined some of these simple habits and strategies.

It's important to note that there are a variety of medical and mental health issues that can impact the quality of sleep. It's important to always consult with your treating health professional about your concerns if necessary.

Sleep hygiene simple habits and strategies:

• Go to bed at the same time each day – being regular is key!
• Get up from bed at the same time each day
• Having a hot bath/shower before bedtime
• Regular exercise/movement of your body
• Relaxation strategies such as deep breathing and muscle relaxation techniques
• Eating a balanced nutritious diet
• Darkening your environment and limiting light exposure, including from devices

For a better night's sleep, it's best to avoid the below habits:

• Daytime napping
• Consuming caffeine, nicotine, and energy drinks
  • It's best to avoid these substances for at least four to six hours before going to bed and try to limit them as much as possible in general if you have sleep disturbances.
• Drinking alcohol
• Clock-watching
• Avoiding stimulating or stressful activities near bedtime
  • It’s appreciated that sometimes these circumstances are out of our control, however when they are it is best to create a calming environment before you go to sleep

Please see attached resources for additional information and handouts of sleep hygiene:

• Sleep hygiene information sheet
• Sleep hygiene tips  (includes a Meditation on Sleep!)
• Sleep hygiene checklist

Suffering from pain easily effects our engagement in everyday activities and can have negative effects on our mental wellbeing. Rather than giving in and basing our actions on it, we can aim to manage the pain by doing things that are within our control and that can make the experience of pain more bearable, lead to a reduction in pain and improve our quality of life.

Pain has a function, which is usually to protect us from causing harm to our bodies. It can alert us of potential danger and motivate us to move, think and behave differently to avoid this danger. However, pain is a complex system and sometimes it can malfunction causing pain to occur in the absence of threat or danger. We refer to this type of pain as persistent pain. We differentiate between acute and persistent pain when the pain continues for more than 3 months despite resolution of the injury and treatment.

So, what can I do about persistent pain?

Several factors affect our experience of persistent pain. These include our behaviours (what we do), our thoughts (what we think), our emotions (what we feel), our physical state (what is going on in our bodies) and our social environment (the people we are with, our employment, where we spend time). The fact that several factors contribute to our experience of pain is good news, because it means that we can do many different things to alter our experience of pain. For example:

- Explore what you can do despite the pain and do this in a safe way (i.e working in collaboration with a physiotherapist or physician)

- Treat your mind and body well:

• Engage in activities that you enjoy.
• Exercise.
• Spend time outside.
• Socialise with family or friends.
• Do a relaxation exercise, such as the breathing exercise in link below.
• Eat a healthy and balanced diet.

- Talk to someone if you feel depressed, anxious or have any other concerns about your mental wellbeing. Your GP is a suitable person to speak to. They can discuss your concerns with you and are able to prescribe a Mental Health Care Plan for further treatment if needed.

Excessive rest might not be helpful in managing persistent pain and can make things worse. Finding a good balance between being active and resting is important. You may need to consult a clinician to clarify what your ideal balance looks like.

Resources:

• The biopsychosocial model of pain, demonstrating how it links in with other factors in our lifes.
• Breathing Exercise for Vagus Nerve Stimulation
• “This Way Up” is a free online chronic pain program of 8 session of Cognitive Behaviour Therapy

What is it and what does it look like?

Functional Neurological Disorder (FND), previously known as Conversion Disorder, and more recently Functional Neurological Symptom Disorder (FNSD) is a condition where patients experience neurological symptoms (i.e., weakness, tremors, or seizures) without an underlying pathological or medical cause. Research has identified these symptoms can arise from abnormal functioning of the nervous system and brain function, rather than structural damage, often (but not always) linked to psychological factors or stress. The responses we experience can be mild (e.g., crying) or sometimes strong (e.g., can’t walk or talk). We call this relationship the Mind-Body Connection. So, the same way a thought or a feeling can make us cry, blush, feel itchy after walking through a spider web – Is the same way it can stop our arm or leg from working properly. The definitive cause for this condition is still unknown, however seeking help from a team of health professionals can assist in treating symptoms and gaining a better understanding. Treatment typically involves a multidisciplinary (Neurologist, Psychologist, Physiotherapist, Occupational Therapist, and Speech Pathologists) approach, addressing both physical and psychological aspects of the condition.

Diagnosing Functional Neurological Symptom Disorder (FNSD)

Diagnosing FND involves a comprehensive evaluation of a patient’s medical history, neurological examinations, reviewing diagnostic criteria, and exclusion of organic neurological disorders. Often the diagnosis is determined by a Neurologist, however many medical officers can make this diagnosis. Receiving a diagnosis is an important step in your recovery journey.

Steps to take once you’ve received a diagnosis of FNSD

It is important to approach the management of FNSD holistically, addressing both the physical and psychological aspects of the condition. Some of the most important steps to take once you’ve received a diagnosis are listed below:

• Education: Learn about FNSD, it’s nature, and the contributing factors. Research has shown having an in depth understanding of your condition empowers you to better manage your symptoms
• Treatment Plan: Working collaboratively with your healthcare providers to develop a tailored treatment plan for your needs, can be an effective way to overcome your symptoms. This may include a combination of physical therapy, psychological intervention, and medication options.
• Support Groups: FND Australia has several resources that can link you with support groups. Sharing your experience and connecting with others can provide valuable emotional support and practical advice.
• Lifestyle Changes: Adopting healthy lifestyle habits, including regular exercise, adequate sleep, balanced nutrition, and stress management techniques can help improve overall well-being and symptom management.

Resources

FND Australia are an organisation that has helped provide support and resources to many individuals who have been diagnosed with FNSD. Visit their website to access a supportive community, expert guidance, educational resources, and local support groups. Their website also lists a range of health professionals who are passionate about working with individuals with FNSD.