Anxiety Defenses

  1. Anxiety vs. Fear
    • Anxiety:
    • Reaction to an unspecified danger
    • Fear:
    • Reaction to a specific danger or known danger
  2. Levels of Anxiety:
    • 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
  3. Interventions
    Mild to Moderate
    Severe to Panic
    • 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
  4. 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
  5. Mature defenses
    • Altruism
    • Sublimation
    • Humor
    • Suppression
  6. Altruism
    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)
  7. Sublimation
    • 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
  8. Humor
    Emphasizing the amusing or ironic aspects of the conflict through humor

    Can be unhealthy if used too frequently
  9. Suppression
    Conscious denial of a disturbing situation or feeling

    Ex: I won't worry about paying my rent until after my exam tomorrow
  10. Neurotic (Intermediate) Defenses
    • Repression
    • Displacement
    • Intellectualization
    • Reaction formation
    • Somatization
    • Undoing
    • Rationalization
  11. Repression
    • 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
  12. 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
  13. Intellectualization
    • Thinking about instinctual wishes in formal, affectively bland terms
    • Includes mechanisms of isolation, rationalization, undoing, magical thinking
  14. 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
  15. 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
  16. 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
  17. 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
  18. Rationalization
    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.
  19. Immature defenses (personality disorders)
    • Passive aggressive
    • Acting out behaviors
    • Dissociation
    • Devaluation
    • Idealization
    • Splittiing
    • Projection
    • Almost always maladaptive and negative
  20. Passive aggressive
    • 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
  21. 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
  22. 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
  23. Devaluation
    • 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
  24. Idealization
    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
  25. 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
  26. Projection
    • 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
  27. Denial
    • Unconscious
    • Escaping unpleasant realities by ignoring their existence
    • People who abuse substances
  28. 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