Anxiety

Whish nursing diagnoses are used to guide the plan of care for a client with an anxiety​ disorder?

1. Impaired social interaction 2. Risk for ineffective self-health management 3. Risk for sleep pattern disturbance 4. Potential for poor coping

A nurse is working in a flood disaster relief center.​ Sally, 57, is crying because she has lost her cat. Which statement by the nurse is the most appropriate at this​ time?

"I am so sorry that this happened"

During a home​ visit, the nurse evaluates an older adult client who has been prescribed medication for diabetes mellitus and generalized anxiety disorder​ (GAD). Which statement by the client indicates that a modification to the plan of care may be​ required?

"I had my wife prepare my meds when she was alive"

A female adolescent client is brought into the emergency department​ (ED) after she was found wandering in the streets. She is unable to stop crying and is jumpy whenever anyone approaches. Which assessment findings indicate the client may have experienced a​ trauma?

"Intense emotional reactions" "Hypervigilance" "diorientation"

The nurse is providing care to a client who is brought into the emergency department after being raped. Which questions can the nurse ask to help determine the client​'s social​ support?

"Is there someone you would like me to call?" "Do you have someone you would like to stay with?" "Who do you know that you think would be most helpful"

During a health history​ interview, the nurse is concerned that an​ 8-year-old client is exhibiting signs of developing separation anxiety disorder. Which information from the interview supports this​ diagnosis?

"Overwhelming fear of being lost that has resulted in missing school"

Diana​ Puli, a​ 45-year-old single​ mother, has brought her​ 12-year-old daughter Aria to the community health clinic for therapy. Aria witnessed a horrific car accident in which several​ people, including​ children, were killed. Her mother was with her at the​ time, and​ says, "I​ don't understand why Aria seems still affected by the crash.​ I'm not." What fact would the therapist share with​ Aria's mother to help her better understand her​ daughter's situation?

"a young person's response can very significantly from that of an adult"

The nurse is planning care for a client who has been prescribed cognitivedashbehavioral therapy​ (CBT) and medication for an anxiety disorder. What complementary and alternative therapy could the nurse suggest for this ​client?

-Mediation -Biofeedback -Guided Imagery -Massage

The teenage client has attended a community workshop on handling stress. What statements by the teenager would show understanding of the material​ presented?

1. "I have to learn to cope with the stress in my life" 2. "if I anticipate failing a test, my body reacts as if I had failed it" 3. "I can choose how I react to stress" Coping with stress is a learned skill. People can choose how they react to stress. The body reacts to anticipated stress the same as actual stress. Everyone does not react the same to the same stressful​ situation, and exercise does not trigger the stress response.

The nurse teaches a client about medications used in the treatment of​ obsessive-compulsive disorder​ (OCD). Which client statement indicates appropriate understanding of the teaching​ session?

1. Antipsychotic medication 2. Cognitive-behavioral therapy

The nurse believes that a client with severe PTSD will benefit from​ cognitive-behavioral therapy​ (CBT). What can the nurse describe as the characteristics of​ CBT?

1. Client can change unhealthy thoughts 2. Client can safely confront fears 3. Client can do CBT exercises In​ CBT, the client can safely confront​ fears, change unhealthy thoughts and do CBT exercises. It does not mean the client can discontinue medications or remove stressors.

A nurse therapist is assessing an older client. The client and the nurse are from different cultures. What situation could complicate the​ nurse's assessment of the​ client?

1. Client's normal, healthy cultural response A nurse therapist is assessing an older client. The client and the nurse are from different cultures. What situation could complicate the​ nurse's assessment of the​ client?

A public health nurse is working with a client complaining of multiple uncomfortable symptoms. Many laboratory tests have been ordered to rule out​ physical, rather than mental or​ emotional, causes. What roles can the nurse take to help this​ client?

1. Collecting samples for testing 2. Explaining the testing process 3. Educating about the meaning of test results

A client is brought into the emergency room after a fire has gutted the apartment he lives in. The physical assessment reveals that the client has suffered no bodily injuries. Which are some other actions the nurse should​ take?

1. Determine the client's thought processes 2. Identify coping strengths 3. Develop a follow-up plan 4. Listen supportively for emotional reactions

Which outcomes demonstrate success for the client who is experiencing​ anxiety?

1. Diminished anxiety 2. Vital signs at baseline 3. Self-moderation of anxiety response 4. Improved coping

A group of nursing students studying for final exams is talking about ways to better deal with stressful events in life. One student​ suggested, "During finals​ week, we should avoid biogenic​ stressors." How could the students follow that​ advice?

1. Don't go outside into freeing temps 2. Don't smoke cigarettes 3. Don't drink fluids with caffeine in them

The nurse is providing care to a client with​ obsessive-compulsive disorder​ (OCD). Which interventions are appropriate for this​ client?

1. Encourage the client to verbalize his or her feelings 2. Include time in the daily routine to perform the ritual 3. Assist the client with developing new coping mechanisms

Which activities facilitate adaptive coping and prevent progression to severe​ anxiety?

1. Exercise 2. Time management 3. Nutrition 4. Sleep/rest Alcohol can stimulate anxiety and should be avoided all​ together, not just limited.

what are the categories of types of stressors?

1. External Environmental stressors 2. Developmental stressors 3. Internal stressors

What are the risk factors for developing an anxiety​ disorder?

1. Family history of anxiety disorders 2. Immigrant 3. Adversity in childhood

What physical conditions could cause a similar tachycardia and nervousness as that found in an anxiety​ disorder?

1. Hypoglycemia 2. Hyperthyroidism What physical conditions could cause a similar tachycardia and nervousness as that found in an anxiety​ disorder?

When conducting a physical examination of a client with symptoms of​ anxiety, which medical conditions should the healthcare provider rule out before deciding the client is experiencing an anxiety​ disorder?

1. Hypoglycemia 2. Hyperthyroidism 3. Asthma

A nurse arrives right after the first responders on the scene of a town affected by a volcanic eruption. After providing triage and emergency​ treatment, which community assessment steps should the nurse quickly​ take?

1. Identify community support services 2. Identify organizational resources, such as disaster assistance 3. Assess living conditions and availability of basic resources 4. Identify community mental health services

The mental health nurse is working with a​ long-term client who has struggled through many​ issues, including homelessness. The client reports finding subsidized housing. The nurse​ responds, "You persisted until you found an apartment.​ Congratulations!" What kind of independent intervention is the nurse​ implementing?

1. Identifying successes in life 2. Reinforcing positive coping efforts The nurse reinforced the​ client's positive coping efforts and identified success in life tasks. The nurse did not validate​ client's feelings, implement cognitive behavioral therapy​ (CBT) interventions, or identify strategies to meet​ client's goals.

The nurse is planning care for a client diagnosed with a severe anxiety disorder. Which problems are appropriate for the nurse to include in the plan of ​care?

1. Impaired social interaction 2. Risk for sleep pattern disturbance 3. risk for ineffective self-health management When planning care for a client with a severe anxiety​ disorder, the nurse should include impaired social​ interaction, risk for sleep pattern​ disturbance, and risk for ineffective​ self-health management. Acute pain and disturbed body image are not appropriate problems to include in the plan of care for this client.

Which reasons would require the inclusion of family and friends in an individual​'s crisis​ assessment?

1. In order to identify stress-related concerns among the client's close associates 2. In order to get an understanding of the client's coping patterns 3. In order to determine the availability of social support

A client with diabetes is in the hallway outside the operating room suite. The client voices being scared of the​ outcome, and reports being very stressed. What changes from earlier data about vital signs and blood sugar would the operating room nurse expect to​ find?

1. Increased BP 2. INcreased Pulse 3. Increased serum glucose

What are ways that a young child with posttraumatic stress disorder can convey to a nurse mental health professional a message about the traumatic event that caused the​ child's problem?

1. Playing 2. Drawing Young children with posttraumatic stress disorder can​ re-create a traumatic event by playing and drawing.​ Jumping, dreaming, and crying do not give a coherent message.

The local​ woman's club has invited a public health nurse to give a seminar about mental health issues. The nurse begins by talking about the disorders that are more common among women than among men. Which disorders will the nurse​ list?

1. Post-traumatic stress disorder 2. Anxiety disorder Anxiety disorder and posttraumatic stress disorder​ (PTSD) are more common among women than among men.​ Obsessive-compulsive disorder is equally common among men and women. Phobia strikes men twice as often as women. Insomnia is a​ symptom, not a disorder.

Which symptoms are associated with generalized anxiety disorder?

1. Pronounced startle 2. Hot flashes 3. Headache and fatigue

Which are roles that the nurse plays during a response to​ crisis?

1. Resource expert 2. Facilitator 3. Communicator

Which are elements of Maslow​'s hierarchy of​ need?

1. Safety and security 2. Love and belonging 3. Self-actualization 4. Physiological

The nurse is caring for a client with​ obsessive-compulsive disorder​ (OCD) . Which clinical manifestations would the nurse expect to see in this​ client?

1. Sings of distress and increased anxiety 2. Physical complaints such as irritated skin 3. Repetitive actions or motions 4. Intrusive thoughts

The nurse in an endocrinology clinic is seeing a client who has both diabetes and hyperthyroidism. What clinical symptoms could the client have that would be similar to those of a client with​ anxiety?

1. Tachycardia 2. Nervousness The clinical symptoms that a client with diabetes and hyperthyroidism has in common with a client with anxiety are tachycardia and nervousness. The client with anxiety could have obsessive​ thoughts, feelings of​ fear, and ritualized routines. Those symptoms would not arise as a result of diabetes or hyperthyroidism.

What does the nurse assess during the evaluation phase of crisis​ care?

1. The client's response 2. The need to revise the plan 3. The achievement of goals

The nurse is conducting a nursing assessment for a client diagnosed with​ obsessive-compulsive disorder​ (OCD). Which findings are indicative of the repetitive acts associated with ​OCD?

1. The need to lock and unlock doors 2. Constant hand washing

A geriatric nurse is working with an older client who is having side effects from medications for an anxiety disorder. The nurse wants to refer the client for​ psychotherapy, but the client is adamant and​ states, "I​ don't want to see a​ psychiatrist; that's for crazy​ people!" What reassurance can the nurse give the​ client?

1. Therapists see many people who aren't crazy 2. Other professionals offer therapy besides psychiatrists 3. Therapy added to meds has more success than meds alone 4. Therapy can help manage the symptoms of anxiety

The nurse is planning home care for a client with panic disorder. What should the nurse include in this client​'s plan of ​care?

1. Use of transcendental medication 2. Participation in Cognitive-behavioral therapy 3. Participation in massage and yoga 4. Use of antianxiety meds as prescribed

The nurse is providing care to a client recently diagnosed with generalized anxiety disorder​ (GAD). The client​'s family asks the nurse how this could have occurred. Based on the client​'s ​history, which response is the most​ appropriate?

A lupus diagnosis has been specifically linked to generalized anxiety disorder.

A family comes to a homeless shelter after the father loses his job and their house goes into foreclosure. The father tells the nurse that he wants to work and get a place for his family to​ live, but he doesn​'t know what to do. Which referral is most appropriate for this​ client?

A referral for social services

In crisis​ care, how does the nursing process​ operate?

As a feedback loop A feedback loop gives the nurse information about interventions that have been implemented and guidance about those that need to be carried out. A​ step-by-step process does not incorporate essential feedback. A force field analysis is a management tool. Rapid response planning may be one part of the process.

The nurse is caring for a client who is experiencing severe anxiety. Which intervention should the nurse include on the plan of​ care?

Administering medications to the client as ordered

What is the term for the physical cost of adapting to a​ stressor?

Allostatic Load The allostatic load is defined as the physical cost of adapting to a stressor. Distress is the term for unhappy stress. Homeostasis is the​ body's effort to keep balance in the face of stress. A biogenic stressor directly triggers the stress response.

Where is the brain's "worry center"?

Amygdala The amygdala is the​ brain's worry center. The frontal lobe regulates​ decision-making. The brain stem controls basic survival functions. The hypothalamus controls the autonomic nervous system.

What is the most common mental health problem in the United​ States?

Anxiety disorder

A client experiences a sudden onset of​ diaphoresis, mydriasis,​ palpitations, and immobility. A physical illness has been ruled out. Which type of medication should the nurse anticipate being prescribed for this​ client?

Benzodiazepine

Jeremy​ Hilderbrand, a​ 30-year-old nurse​ manager, has guided his staff through several difficult​ times, including high turnover. Most of the time Jeremy has to assume a full schedule of clinical​ duties, in addition to administrative responsibilities. With his complaints of feeling drained and low​ energy, for which condition would the occupational nurse assess​ Jeremy?

Burnout

The nurse educator is teaching a group of students about​ obsessive-compulsive disorder​ (OCD). Which statement will the educator include in the teaching session regarding​ OCD?

Children who have had a streptococcal infection may be at risk of developing the disorder.

Felicia​ Gracial, a​ 40-year-old CEO of a​ family-owned business, tells her nurse therapist that she sometimes imagines herself escaping to a deserted island without any of the high tech communication devices that make her feel​ on-call 24/7. What defense mechanism is Ms. Gracial using to cope with her​ stress?

Fantasizing This client is using the defense mechanism of fantasizing​ (imagining the fulfillment of​ desires). She is not using suppression​ (conscious process of denying unacceptable​ emotions). She is not using cognitive structuring​ (making sense of​ stimuli). She is not using​ self-control (restraining from acting on impulse or delaying​ gratification).

A nurse is working in an emergency services van at the site of a plane crash. She sees​ Selma, 29, pacing back and forth in front of the van. The nurse notices that the woman is breathing rapidly and looking behind her. Based on the assessment​ findings, what does the nurse conclude that Selma is experiencing at this​ time?

Fight or flight syndrome

The nurse is completing the physical examination of a client experiencing symptoms of an anxiety disorder. Which information should the nurse​ collect?

General assessment During the physical examination of a client with symptoms of an anxiety​ disorder, the nurse needs to complete a general assessment. Medication​ regimen, current​ stressors, and use of alcohol are part of the client​'s psychosocial​ history, which is obtained when completing the health history.

The senior center audience clapped when the parish nurse talked about a​ "worry center" in the brain.​ "Makes sense to​ me," one senior commented out loud. What can the nurse tell them about how the​ "worry center" affects their risk for anxiety​ disorders?

Hypersensitivity of the​ "worry center" in the brain increases the risk of anxiety disorders. It is not a matter or​ perfusion, oxygenation, or hormone secretion.

The nurse teaches a client about medications used in the treatment of​ obsessive-compulsive disorder​ (OCD). Which client statement indicates appropriate understanding of the teaching​ session?

I may only have to take medication for​ 1-2 years and gradually be weaned off.

Rachel Weinstein is a​ 17-year-old woman​ who, according to her medical​ records, has been treated for persistent worry about harm to her​ parents, insomnia, and refusal to leave her home to go to school. Which problem should the nurse include in​ Rachel's plan of​ care?

Impaired social interaction Based on the​ symptoms, the client is experiencing separation anxiety disorder. The nurse should include impaired social interaction in the plan of care. There is no indication that the client is experiencing chronic​ pain, disturbed body​ image, or caregiver role strain.

The​ client, a​ psychologist, is interested in the mental health clinic​ nurse's viewpoint about​ Maslow's hierarchy of needs. When it comes to prioritizing a choice to react to a​ stressor, what do both of them know about this​ model?

Individuals might have their own priorities Individuals might have their own priorities. Not everyone chooses to satisfy the same basic requirements first. Coping with stressors can be part of any​ level, and there is no most important level of need.

A​ nurse, providing emergency services at the site of a building​ collapse, asks a displaced resident whether or not he has any plans for food and shelter for the evening. The resident​ says, open double quoteIt​'s none of your business. I​'ll take care of myself the way I always do.close double quote What information about the resident does this response give the​ nurse?

It provides some information about the resident​'s coping patterns.

A client asks the nurse how​ cognitive-behavioral therapy will help her to manage her​ obsessive-compulsive disorder. Which response by the nurse is the most​ appropriate?

It teaches techniques that will help you lower stress.

Roberto Gomez is a​ 45-year-old man who has come into the clinic for an assessment. While the nurse is conducting the​ interview, he has a panic attack. Which nursing intervention is not​ appropriate?

Leaving the client alone during the episode During a panic​ episode, the nurse should stay with the client and remain​ calm; use​ short, clear sentences when​ communicating; reduce environmental​ stimuli; and offer reassurance about distressing physical symptoms.

​Andrea, 14 years​ old, confides to the school nurse her confusion about her sexual identity and her suicidal feelings. What kind of crisis is the student​ experiencing?

Maturational crisis

An adult client is being assessed after a flood has destroyed her home. She tells the nurse that she realizes God is punishing her for the life she leads. Which member of the crisis counseling team should the nurse consider referring the client to​ see, based on the assessment​ findings?

Minister or religious counselor

The mother and father of the client with agoraphobia have accompanied the client to family therapy. Now the nurse therapist wants to recommend an outside organization that they can all join to get more support. What is the most relevant resource for the nurse to​ recommend?

NAMI: National Alliance of Mental Illness The most relevant resource is​ NAMI, the National Alliance on Mental Illness. The National Institute of Mental Health​ (NIMH), Alcoholics Anonymous​ (AA), and the American Association of Retired Persons abbreviation​ (AARP) are not as relevant to the​ client's needs.

Laura Campbell is a​ 25-year-old woman who has come to the emergency department. You observe that Ms. Campbell has dilated pupils and​ diaphoresis, and she reports palpitations and feelings of terror. Which anxiety disorder is Ms. Campbell likely​ experiencing?

Panic Disorder

A client presents to the emergency department with bizarre​ behavior, muscular​ incoordination, incoherence, and terror. Which condition should the nurse suspect the client is​ experiencing?

Panic disorder Clinical manifestations of panic disorder include bizarre​ behavior, muscular​ incoordination, incoherence, and terror. Clients with generalized anxiety disorder present with intense tension and​ worry, startle​ easily, and may have​ fatigue, headache, digestive​ issues, and irritability. Clients with separation anxiety disorder have severe anxiety around separation from home and major attachment figures. Clients with moderate anxiety disorder experience reduced​ alertness, feelings of discomfort and irritability with​ others, increased​ restlessness, and perspiration.

The pediatric nurse welcomes the parents of a child adopted from an international agency. The child was orphaned after a border war and still has nightmares. What diagnosis could the pediatric nurse be prepared to explain to the​ family?

Posttraumatic stress disorder (PTSD)

A​ first-year nursing student goes to the​ university's counseling services. The student hopes that anxiety levels experienced during test taking could be reduced. The nurse counselor asks the student about first thoughts when a test is announced. What kind of appraisal is the counselor having the student​ consider?

Primary appraisal Primary appraisal happens immediately upon knowledge of the​ stressor, the upcoming test. Secondary appraisal takes place after​ that, when deciding how to react. Cognitive appraisal is the combination of both primary and secondary appraisal. There is no model called​ "anxiety appraisal."

A client has been staying with his daughter and her family after he lost his home during a hurricane. The client reports to the nurse that he is unable to sleep in a strange environment. Which action should the nurse​ take?

Refer the client for an evaluation for sleep medication.

A client is relocated to a shelter after losing her home in a flood. She tells the nurse that all the mementos of her life in the theater have been​ destroyed, and she doesn​'t open double quotesee any reason to go on.close double quote Which nursing action is the priority for this​ client?

Refer to a mental health evaluation

An adolescent client is brought to the nurse​'s office by the principal and school guidance counselor. The client is visibly high but is able to function. Which action by the nurse would be a successful resolution to this​ crisis?

Referral to a drug treatment program

The nurse is assessing the mental health of a female adult client who has been under stress at work. The client wants to wash her hands every 2 to 3 minutes and wipes the flat surface areas in the clinic with a paper towel while talking to the nurse. Which aspect of​ obsessive-compulsive disorder​ (OCD) is this client​ exhibiting?

Repetitive behavior

A nurse is assessing the crisis response of a client who survived a hurricane that destroyed the family home. The nurse asks the client to describe her distress on a scale from 1 to​ 10, with 1 being no distress and 10 being unbearable distress. Which technique is the nurse using in order to make an accurate​ assessment?

Scaling

The school nurse is especially concerned about a specific​ first-grade student. What​ personality-related characteristic would the nurse identify as increasing the risk for development of an anxiety​ disorder?

Shy student Being shy increases the risk of a child developing an anxiety disorder.​ Weight, height, and nearsightedness are not personality characteristics.

Which syndrome is diagnosed when an individual feels intensely negative feelings about himself because of living through a​ disaster?

Survivor guilt Survivor guilt involves feelings of guilt for having survived a catastrophe in which others died. Stockholm syndrome is when hostages have positive feelings towards their captors.​ Disaster syndrome is​ long-term stress, related to loss of​ family, community,​ jobs, and social security. A quisling is a person who collaborates with an enemy occupying force.

During a home​ visit, the nurse evaluates a client recovering from generalized anxiety disorder​ (GAD). Which observation indicates that additional client teaching is​ required?

The client has withdrawn from cognitive/behavioral therapy​ (CBT)

When assessing multiple​ clients, the nurse determines that which clients are at risk for developing generalized anxiety​ disorder?

The client who reports excessive anxiety and worry about his​ job, relationship and finances for the past 6 months . The client who finds it hard to control the worry and exhibits poor hygiene The client who has difficulty​ concentrating, sleep​ disturbance, and muscle tension The​ DSM-5 diagnostic criteria for generalized anxiety disorder include excessive anxiety and worry occurring more days than not for at least 6​ months; client finds it hard to control the​ worry; the anxiety and worry are associated with difficulty​ concentrating, sleep​ disturbance, and muscle​ tension; the​ anxiety, work, or physical symptoms cause clinically significant distress or impairment in​ social, occupational, or other​ functioning; and the disturbance is not attributable to the physiological effects of a substance. The clients who report no significant impairment and who deny current stressors do not appear to be at risk.

A family is staying in a disaster relief center as a result of a flood that destroyed their home. The nurse serving the shelter plans care for the mother of the family based on the nursing diagnosis of anxiety. Which assessment finding would indicate that the client had achieved an appropriate goal for this​ condition?

The client will report a reduction in stressful feelings.

The nurse is teaching a​ 25-year-old female client about taking a selective serotonin reuptake inhibitor​ (SSRI) for anxiety. Which information should the nurse include in the​ teaching?

The medication takes a few weeks before achieving the full effects.

A family is being assessed in a disaster relief center after being rescued from their home during a flood. The​ school-age client,​ Adam, does not answer any of the questions the nurse asks. The client sits hunched over with his thumb in his mouth during the entire interview. How should the nurse address this​ issue?

The nurse should ask the parents whether or not this behavior was typical for Adam before the flood.

An adult Native American​ man, whose home has just been destroyed by a​ wildfire, is being treated in an emergency center for first degree burns. The nurse suggests that the client might need an​ analgesic, but he refuses. Which action by the nurse is the most​ appropriate?

The nurse should understand that the client​'s culture may have a different approach to addressing pain and ask whether the client would be willing to explain his experience.

After reviewing multiple medical​ records, the nurse determines that which client is at highest risk for developing an anxiety​ disorder?

The young adult female client who witnessed a car crash

The nurse is providing education to a client diagnosed with generalized anxiety disorder. The client is prescribed alprazolam​ (Xanax) and scheduled to receive​ cognitive-behavioral therapy​ (CBT). The client asks the nurse why medication and therapy are both needed. Which response by the nurse is the most​ appropriate?

behavioral therapy in combination with medication is most effective when dealing with an anxiety disorder.

Which symptom pattern is NOT indicative of a client with​ obsessive-compulsive disorder?

randomly placed objects A client with​ obsessive-compulsive disorder has a need for symmetry and precision and therefore would not tolerate randomly placed objects. Trichotillomania​ (hair pulling),​ hoarding, and nail biting are all symptom patterns commonly exhibited by clients with​ obsessive-compulsive disorder.

An adult female​ client, the victim of a​ flood, is discussing her family​'s losses with a nurse at the disaster recovery center. The client tells the​ nurse, open double quoteWe​'ve been through troubles before and we​'ll get through this​ one, too.close double quote Which response to adversity does the nurse see the client​ exhibiting?

resilience

An adult male client has been living in a shelter for 3 months after a tornado destroyed much of the town. The client is prescribed Isoniazid after a positive tuberculosis​ (TB) skin test and asks the nurse why it is important to take the​ medication, as he feels fine. How should the nurse respond to the​ client?

​"His test indicates a latent form of TB and the medication will kill the bacteria and prevent the disease from becoming​ active."

While reviewing the goals in a​ client's plan of​ care, the client reports to the nurse that she wants to be taken off her antianxiety medication. Which findings indicate that the client is successfully meeting the identified goals and expected​ outcomes?

​"I sleep well at night​ now." Your answer is correct. ​"I am taking a yoga class and a cooking​ class." Your answer is correct. ​"I feel​ good, not worried or​ anxious, most​ days." ​"I use what I learned in therapy to calm myself down when I start feeling​ anxious."