Anxiety is common in patients with End Stage Renal Disease (ESRD) undergoing hemodialysis. To complicate matters, one in ten patients has a fear of needles, making hemodialysis treatment even more challenging.
An anxious hemodialysis (HD) patient can experience a variety of symptoms including nervousness, tremors, indigestion, sweating, shortness of breath and, at times, panic. It’s important to note that for some patients, anxiety can also manifest as behavioral issues like noncompliance or issues with staff.
While many people experience isolated episodes of anxiety from time to time, sometimes anxiety develops into a disorder interfering with the patient’s daily life.
People with serious illness often find themselves having to cope with anxiety on top of their medical issues. Often, something as simple as listening to and addressing your patient’s concerns can help reduce their anxiety. Thanks to developments in the field, there are scientifically-validated ways to cope with even the most acute forms of anxiety:
Mindfulness-based stress reduction (MBSR): This is an eight-week online program developed by Jon Kabat-Zinn, professor emeritus of medicine and creator of the Stress Reduction Clinic and the Center for Mindfulness in Medicine, Health Care, and Society at the University of Massachusetts Medical School.
Participants practice for 45 minutes a day at home by listening to guided audio meditations and meet with classmates and teachers throughout the eight week duration. If your patient can’t attend a formal program, they can work on the following elements:
Mindfulness-based stress reduction has been shown to reduce symptoms of depression, anxiety and stress. It’s also been shown to positively affect physical health and improve sleep. Some medical facilities even offer live MBSR classes.
CBT: Cognitive behavioral therapy has been scientifically proven to help reduce symptoms of anxiety. CBT is a short form of therapy that helps people problem solve as well as understand the relationship between their thoughts, feelings and behaviors. CBT practices can include journaling, challenging beliefs, mindfulness and relaxation.
EMDR: Eye movement desensitization and reprocessing therapy works by having the patient move their eyes (or engage in another bilateral movement) while an EMDR-trained therapist guides them in processing the traumatic event. This type of therapy has shown the most promise for patients that have experienced traumatic events or have been diagnosed with PTSD.
According to the EMDR International Association, “EMDR therapy, rather than focusing on changing the emotions, thoughts, or behaviors resulting from the distressing issue, allows the brain to resume its natural healing process.” Patients can complete EMDR therapy in fewer sessions than other forms of therapy.
Anxiety disorders are a common, yet underdiagnosed issue among ESRD patients. Furthermore, HD patients may present with symptoms of anxiety or an anxiety disorder at varying times during treatment and with varying symptoms. If you find your patient is struggling with anxiety, listening to their concerns, as well as referring them to a mental health professional, can be an important step on their healing journey.
We want to make sure hemodialysis patients have the best care possible, which is why we created a resource for HD patients and their care team: How Hemodialysis Patients Can Take Charge of Their Care.