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Strategies for Reduction of Student Anxiety

Clinical instructors (CIs) mentor many different types of physical therapy (PT) students. Mentoring anxious DPT students may pose a challenge and it is important to recognize behaviors, which could result from anxiety---a giggle at an inappropriate time; inability to think quickly; difficulty with a simple question, uncontrollable shaking; or even sweating.

How do you respond to anxious behaviors? Once anxious behaviors are observed, it is important to provide constructive feedback, promptly. Students need to know you recognize the symptoms (i.e., clearly state your observations) and be assured this is a normal response when someone is placed in an unfamiliar environment or is unsure how to respond to a particular situation. It is helpful for the student to reflect on those behaviors to facilitate an awareness and discover the underlying cause(s) and potential triggers. Reflection may be supported with the use of journaling and discussion with the student. If the student is not completely aware of the behavior or the consequences of their behavior, videotaping can also be assistive. It is also important students are not overwhelmed by numerous negative comments about behaviors from the CI and other staff members; rather to provide unconditional positive regard. In short, the first phase is the students’ discovery about what causes the anxious behaviors to surface and the potential triggers.

The next phase is the development of confidence and control of anxious behaviors. The CI needs to list out clear, concise expectations with regards to controlling the anxious behaviors. These expectations need to be appropriate for the student’s level of professional development and realistic for the entry-level practitioner.1 The student and clinical instructor can develop short-term goals for improving specific behaviors (i.e., start with one and work to diminish others). After determining those goals, the CI must provide multiple opportunities for the student to reduce the anxious behaviors, followed by ongoing assessment and feedback of those behaviors.1 Several strategies that may be used include: deep breathing and yoga; daily journaling with weekly CI input; role playing, using specific patient scenarios; or mental imagery prior to a patient care session.

In time, the alleviation of anxious behaviors will be replaced by confidence, which may be strengthened through positive reinforcement. The final phase consists of the CI providing positive feedback through the use of reinforcers, such as verbal complements; positive comments written in the journal; discussion about specific situations with patients. It is through this strategy of ongoing assessment and constructive feedback that students’ professional development and growth are facilitated.1

Yes, anxiety behaviors may be a challenge for the Clinical Instructor. Yet it is a wonderful opportunity to witness the transformation of DPT students into professional, entry-level physical therapists and to ensure the future of our profession!

1. Foord-May L, May W. Facilitating professionalism in physical therapy: theoretical

foundations for the facilitation process. JPTE. 2007;21(3):6-12.

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