Anxiety Defenses

• Anxiety:
• Reaction to an unspecified danger
• Fear:
• Reaction to a specific danger or known danger

• Mild - can enhance learning and can be healthy
• Moderate - Selective inattention, needs guidance
• Severe - Can't concentrate, feeling doomed
• Panic - Feeling like you're going to die, terrors, hallucinations

• Mild to Moderate
• Demonstrate interest
• Encourage talk about feelings and concerns
• Keep communication open
• Use clarification to understand

• Severe to Panic
• Stay with patient
• Listen
• Use clear and repititive statements
• Assess medicinal needs

• 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

• Altruism
• Sublimation
• Humor
• Suppression

Emotional conflicts and stressors are dealt with by meeting the needs of others

Decrease anxiety by doing good deeds or reaching out toward others (ex: 12th step of AA program)

• Unconscious process
• Substituting constructive and socially acceptable activity for strong impulses that are not acceptable

Ex: someone with unacceptable sexual urges may go into art or music which is socially acceptable method of expressing these urges

Emphasizing the amusing or ironic aspects of the conflict through humor

Can be unhealthy if used too frequently

Conscious denial of a disturbing situation or feeling

Ex: I won't worry about paying my rent until after my exam tomorrow

• Repression
• Displacement
• Intellectualization
• Reaction formation
• Somatization
• Undoing
• Rationalization

• Unconscious
• Exclusion of unwanted experiences, emotions or ideas from conscious awareness

Ex: nurse working in ER where pt is coding, nurse represses any anxiety may be feeling

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

• Thinking about instinctual wishes in formal, affectively bland terms
• Includes mechanisms of isolation, rationalization, undoing, magical thinking

• 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

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

• 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

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

Justifying illogical or unreasonable ideas, actions or feelings by developing acceptable explanations that satisfy the teller as well as the listener

EX: Robbing a bank thinking it's no big deal since the bank has plenty of money in it.

• Passive aggressive
• Acting out behaviors
• Dissociation
• Devaluation
• Idealization
• Splittiing
• Projection
• Almost always maladaptive and negative

• Dealing with emotional conflicts/anxiety indirectly or unassertively
• On the surface, appearance of acceptance that hides resistance, resentment, hostility

Ex: smiling at someone and agreeing and then talking about the person behind their back and not following through

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

• 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

• Unconscious
• Attribute negative qualities to self or others in an attempt to decrease anxiety regarding emotional conflicts/stressors

Ex: win student of the month but are very anxious that you can't maintain the standards

Overvaluing of a person in an attempt to decrease anxiety

Ex: woman had multiple bad relationships, is in a new relationship and has anxiety that new relationship will also be a bad relationship

• 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

• Unconscious
• Rejection of emotionally unacceptable personal features and attributes them to other people, objects or situations
• "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

• Unconscious
• Escaping unpleasant realities by ignoring their existence
• People who abuse substances

• 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)