Managing Surgical Anxiety: Evidence-Based Coping Strategies and Treatments

Surgical anxiety (preoperative anxiety) affects 60–80% of patients. Severe, impairing fear may meet criteria for specific phobia (blood-injection-injury type) or anxiety disorder.

Evidence-Based Interventions

1. Cognitive-Behavioral Therapy (CBT): Cognitive restructuring of catastrophic thoughts; relaxation training; graded exposure to surgical cues.
2. Relaxation Techniques: Diaphragmatic breathing, progressive muscle relaxation (PMR), guided imagery, autogenic training.
3. Exposure Therapy: Systematic desensitization using VR simulation of OR environment.
4. Preoperative Education: Structured information (procedure, anesthesia, recovery) reduces uncertainty. Multimedia tools effective.
5. Peer Support: Patient navigator programs, support groups.
6. Pharmacologic: Short-acting benzodiazepine (midazolam) preoperatively; beta-blockers for tachycardia. Avoid long-term anxiolytics.
7. Virtual Reality (VR): Immersive distraction and rehearsal.
8. Mindfulness-Based Stress Reduction (MBSR): Present-moment awareness, non-judgmental acceptance.

Multimodal approach yields best outcomes. Screen preoperatively (Amsterdam Preoperative Anxiety and Information Scale - APAIS). Refer to psychology/psychiatry if severe.