Sullivan 1953 postulated that learning occurs through an anxiety gradient extending from mild to severe. A client with mild anxiety can focus energy on most of what is really occurring. A client with moderate anxiety has limited ability to what is really occurring and tends to distort distort reality. A client with severe anxiety cannot focus energy on what is really happening and thus cannot participate effectively in problem solving or decision making. Because the effective nursing process requires that both the nurse and the client focus on what really happening. it is seential to control anxiety in the communication process.