Anxiety Defenses

  1. What is anxiety?
    • Universal human experience
    • Feeling of apprehension, uneasiness, uncertainty, dread
    • Resulting from a real or perceived threat
    • Actual source is unknown or unrecognized w/ exception of specific phobias
    • Can be differentiated from fear
    • Normal mild anxiety is healthy and motivated people to make changes
  2. Anxiety vs. fear
    • Anxiety:
    • Reaction to an unspecified danger
    • Results from real or perceived threats, source of threats is unknown or unrecognized
    • Acute anxiety - results from imminent loss or change/challenge that threatens person's sense of security (ex: performance on exam)
    • Chronic anxiety - trait anxiety; person has lived with for a long time; personality trait; permanent
    • SNS activates body's response during anxiety
    • PNS conserves responses
    • Fear:
    • Reaction to a specific danger or known danger
  3. Mild anxiety
    • Can enhance learning
    • Perceptual field heightened
    • Grasps what is happening
    • Identifies disturbed things
    • Can work toward a goal and examine alternatives
    • Slight discomfort, restlessness, irritability
    • Mild tension relieving behaviors
    • Some form of mild anxiety before an exam is good; motivates you to study
  4. Moderate anxiety
    • Perceptual field narrows
    • Selective attention to details and info
    • Needs to have things pointed out
    • Problem solving ability moderately impaired
    • Benefits from guidance
    • Shaky voice, concentration difficult
    • SNS symptoms: incr pulse, incr BP, feeling flushed
    • Somatic symptoms: headache, incr fatigue
    • Important to give discharge instructions verbally and in writing because pt only will hear part of what you are saying
    • Not healthy level for students taking exams
    • Task is to lower level to mild level
  5. Interventions for mild to moderate anxiety
    • Help identify anxiety and antecedents to anxiety
    • Anticipate anxiety-provoking situations
    • Demonstrate interest
    • Encourage talk about feelings and concerns
    • Keep communication open
    • Use clarification to understand
    • Encourage problem solving
    • Use role playing, modeling
    • Explore behaviors used in past
    • Provide outlets for excess energy
    • Build on their strengths
    • Work on one goal at a time; don't overwhelm pt
    • Keep milieu safe and calm
    • Decr stimuli; be aware pt's are watching and modeling their behavior on what they see
  6. Severe anxiety
    • Perceptual field greatly reduced; perceptions are distorted
    • Attention scattered; learning is impossible
    • Self-absorbed
    • Can't attend to events or see connections
    • Can only focus on 1 object
    • Feelings of dread/doom
    • SNS symptoms (headache, nausea, dizziness, pounding heart)
    • Confusion, purposeless activity but still basically functional
    • Can be redirected with firmness
  7. Panic level anxiety
    • Unable to focus on environment
    • Terror, emotional paralysis
    • Hallucinations/delusions
    • Muteness, severe withdrawal
    • Immobility or extreme agitation, severe shakiness
    • Disorganized, irrational thinking
    • Unintelligible speech
    • Sleepiness
    • Panic attack: severe form of anxiety; usually short lived; stay w/ pt make sure they are safe; give meds (benzos); speak calmly; help them gain a sense of control
  8. Interventions to severe to panic anxiety
    • Maintain calm manner
    • Remain with client
    • Minimize environmental stimuli
    • Use clear, simple statements and repetition
    • Low pitched voice, speak slowly
    • Reinforce reality if distortions occur
    • Listen for themes
    • Meet physical and safety needs
    • Set verbal limits and physical limits
    • Assess need for medication or seclusion
  9. Defenses against anxiety
    • Manage conflict and affect
    • Are relatively unconscious
    • Are discrete from one another
    • Are often hallmarks of psychiatric syndromes
    • Are reversible
    • Are adaptive as well as pathological, maladaptive
    • Done to block unconscious thoughts
    • Can be unlearned
  10. Mature defenses
    • Altruism
    • Sublimation
    • Humor
    • Suppression
  11. Altruism
    • Emotional conflicts and stressors are dealt with by meeting the needs of others
    • Decr anxiety by doing good deeds or reaching out toward others (ex: 12th step of AA program)
  12. Sublimation
    • Unconscious process
    • Substituting constructive and socially acceptable activity for strong impulses that are not acceptable
    • Consciously unacceptable instinctual drives are diverted into personally and socially acceptable channels
    • Transfer of anxiety related to unacceptable inner feelings of sexual or aggressive urges into a constructive or socially acceptable activity
    • Ex: someone with unacceptable sexual urges may go into art or music which is socially acceptable method of expressing these urges
  13. Humor
    • The individual deals with emotional conflicts or stressors by emphasizing the amusing or ironic aspects of the conflict through humor
    • Can be unhealthy if used too frequently
  14. Suppression
    • Conscious denial of a disturbing situation or feeling until you have to deal with the situation or feeling
    • Compartmentalize worry
    • Ex: I won't worry about paying my rent until after my exam tomorrow
  15. Neurotic (Intermediate) Defenses
    • Repression
    • Displacement
    • Intellectualization
    • Reaction formation
    • Somatization
    • Undoing
    • Rationalization
  16. Repression
    • Unconscious
    • Exclusion of unwanted experiences, emotions or ideas from conscious awareness
    • Keeps out of conscious what has never been conscious (sexual assault, war trauma; may experience weeping for no reason or feelings they don't understand)
    • Allows person to get through the anxiety-ridden event
    • Can become unhealthy when memories become deeply unconscious
    • Ex: nurse working in ER where pt is coding, nurse represses any anxiety may be feeling
  17. Displacement
    • Unconscious transfer of emotions associated with a particular person, object or situation to another person that is nonthreatening
    • Ex: a patient criticizes a nurse after his family fails to visit
  18. Intellectualization
    • Thinking about instinctual wishes in formal, affectively bland terms
    • Includes mechanisms of isolation, rationalization, undoing, magical thinking
    • Anxiety in conscious but feeling behind in conscious mind
    • Events are analyzed based on remote, cold facts and without passion, rather than incorporating feeling and emotion into the processing
  19. Reaction formation
    • Unacceptable feelings or behaviors are kept out of awareness by developing the opposite behavior or emotion
    • Overcompensation
    • Ex: ex-smoker who is still having anxiety about cravings begins speaking outwardly and poorly about smokers and not being around smokers
  20. Somatization
    • Transferring anxiety on a conscious level to a physical symptom that has no organic cause
    • Ex: feel nervous about giving a presentation, develop a sore throat or laryngitis so can't give lecture
  21. Introjection
    • Unconscious lowering of anxiety by incorporation of values or qualities of an admired person or group onto one's own ego structure
    • Found most commonly in adolescents
    • Ex: pick someone in peer group and unconsciously start dressing like that person or listening to same music, stc.
  22. Undoing
    • Unconscious undoing that makes up for an act or communication
    • Ex: get anxious and eat a pan of brownies and then go out and run for an hour and a half
    • Ex: domestic violence; try to undo negative behavior by giving victim flowers or gifts
  23. Rationalization
    • Justifying illogical or unreasonable ideas, actions or feelings by developing acceptable explanations that satisfy the teller as well as the listener
    • ex: A man who thinks his son was fathered by another man excuses his malicious treatment of the boy by saying, "he is lazy and disobedient", when that is not the case.
  24. Immature defenses (personality disorders)
    • Passive aggressive
    • Acting out behaviors
    • Dissociation
    • Devaluation
    • Idealization
    • Splittiing
    • Projection
    • Almost always maladaptive and negative
  25. Passive aggressive
    • Dealing with emotional conflicts/anxiety indirectly or unassertively
    • On the surface, appearance of acceptance that hides resistance, resentment, hostility
    • Ex: procrastination, inefficiency, failure, passivity, and illnesses that affect others more than oneself
    • Ex: smiling at someone and agreeing and then talking about the person behind their back and not following through
  26. Acting out behaviors
    • Dealing with emotional conflict/anxiety with physical behaviors
    • Primary gain: by lashing out, transfers the focus from the personal doubts/pain to some other person or object
    • Secondary gain: incr attention, comfort they get from acting out these behaviors
    • Children and adolescents
  27. Dissociation
    • Unconscious defense mechanism
    • Allows blocking of overwhelming anxiety
    • A disintegration of functions of consciousness, memory, identity or perceptions of environment
    • Derealization - feeling of unreality relative to environment
    • Depersonalization - feeling of being detached from oneself or out of body experience
  28. Devaluation
    • Unconscious
    • Attribute negative qualities to self or others in an attempt to decr anxiety regarding emotional conflicts/stressors
    • Ex: win student of the month but are very anxious that you can't maintain the standards; when someone congratulates student they devalue the achievement by saying that it doesn't mean anything
  29. Idealization
    • Overvaluing of a person in an attempt to decr anxiety
    • Ex: woman had multiple bad relationships, is in a new relationship and has anxiety that new relationship will also be a bad relationship
  30. Splitting
    • Inability to integrate the positive and negative qualities of oneself or others into a cohesive image
    • See all good or all bad
    • Common in borderline personality disorder
  31. Projection
    • Unconscious
    • Rejection of emotionally unacceptable personal features and attributes them to other people, objects or situations
    • Freq in people with paranoia
    • "What you say is what you are"
    • Person does a lot of blaming or scape-goating
    • Ex: Person that thinks low of self, thinks other people hate them too
    • Ex: New nurse that feels very inadequate at their job, projects blame onto another nurse when they make a mistake
  32. Denial
    • Unconscious
    • Escaping unpleasant realities by ignoring their existence
    • People who abuse substances
  33. Regression
    • Retreat to an earlier level of development and the comfort measures associated with that level of functioning
    • Ex: 3 and 4 year olds regress at birth of new sibling (i.e. start soiling their pants again)
Card Set
Anxiety Defenses
Psych Exam 3 - Anxiety Defenses