From the Guidelines
I strongly recommend addressing these feelings of internal unsafety through a combination of trauma-focused therapy and practical coping strategies, prioritizing the most recent and highest quality study available 1. When considering the management of feelings of internal unsafety triggered by upcoming life changes, it's essential to focus on interventions that have been proven to reduce distress and improve quality of life.
Key Recommendations
- Trauma-focused therapy: Consider seeking therapy specifically designed for trauma processing, such as Cognitive Processing Therapy (CPT), Eye Movement Desensitization and Reprocessing (EMDR), or trauma-focused Cognitive Behavioral Therapy (CBT) 1.
- Grounding techniques: Implement grounding techniques like the 5-4-3-2-1 method to manage acute distress.
- Deep breathing exercises: Practice deep breathing exercises several times daily, especially when feeling triggered.
- Safety plan: Create a detailed safety plan with identified support people, safe places, and self-soothing activities to provide structure during difficult moments.
- Medication options: If symptoms are severe, medication options like SSRIs may help manage anxiety and trauma symptoms, though these require evaluation by a psychiatrist 1.
Rationale
These approaches are supported by recent studies that highlight the importance of addressing trauma and anxiety in a comprehensive manner 1. The use of trauma-focused therapy, grounding techniques, deep breathing exercises, and safety planning can help regulate the nervous system and process difficult experiences in a safe environment.
Additional Considerations
- Crisis response plan: A crisis response plan, as outlined in recent guidelines 1, can be beneficial for individuals at risk of suicide or severe distress, involving a collaborative approach between patient and clinician to identify clear signs of crisis and self-management skills.
- Problem-solving therapy: Problem-solving therapy, a type of CBT, has been found to be helpful for patients at risk for suicide, improving one's ability to cope with stressful life experiences through active problem solving 1.
From the Research
Feeling Internally Unsafe
- The client's feeling of internal unsafety when thinking about upcoming life changes triggering trauma is a complex issue that may be related to anxiety and depression 2.
- Research suggests that patients' feelings of unsafety can be triggered by various factors, including loss of control, impersonal care, and a lack of staff experience and knowledge 2.
- In the context of anxiety disorders, selective serotonin reuptake inhibitors (SSRIs) have been shown to be effective in reducing symptoms of anxiety and depression 3, 4, 5.
- A study on the dose-response curve of SSRIs and SNRIs in anxiety disorders found that higher doses of SSRIs were associated with greater symptom improvement and likelihood of treatment response 4.
- Another study found that escitalopram was more effective than other SSRIs in terms of response rate, remission rate, and withdrawal rate in the treatment of major depressive disorder 5.
Treatment Options
- Cognitive behavioral therapy (CBT) combined with SSRIs has been shown to be effective in treating depression and anxiety in youth 6.
- The combination of CBT and SSRIs has been found to produce greater improvement than either treatment alone, with the fastest response seen in patients who are younger and have milder baseline symptoms 6.
- However, the added value of CBT over SSRI monotherapy may not be statistically significant until later in treatment 6.
Patient Perspectives
- Patients' perspectives on feeling unsafe in the healthcare setting suggest that factors such as information and communication, staff presence, and impersonal care can contribute to feelings of unsafety 2.
- Nurses can play a crucial role in reducing patients' feelings of unsafety and vulnerability by providing high-quality care and addressing patients' emotional and physical needs 2.