Freud defense mechanisms as coping responses to

Freud: Defense mechanisms as coping responses to anxiety: used by EVERYONE
• Reduces anxiety: maintain ego functioning
• Protects self-esteem
• Can be used consciously or unconsciously
• Necessary for survival when used sparingly:
• Overuse/ inappropriate use distorts reality, produces self-deception, and interferes with healthy
functioning
VI. Defense Mechanisms- RN should recognize
• Conscious attempts
- suppression: holding back urges
- rationalization: creating false but credible justification
- fantasy: conscious creations to distort reality
• Behavioral attempts
- identification: adolescents conceals inadequacies (example: individuals taking on identity of
someone else)
- internalization: (introjection): assimilation of behaviors belonging to others
- Undoing (restitution): behaviors to resolve unconscious guilt
- Displacement: redirecting thoughts, feelings and impulses upon another person or object
• Repressive attempts
- Compensation: attempts to makeup deficits, excelling in other areas
- reaction formation: opposite expression of true feeling
- sublimation: diversion of unacceptable instinctual drives
- projection: imputing onto others unpleasant aspects of one-self
- denial: disowning of tolerable/inappropriate ideas or behaviors
- conversion: channels unbearable anxiety through bodily expression
- repression: involuntary exclusion of anxiety provoking event (example: man who was sexually
abused as a young child who doesn’t remember anything)
• Regressive attempts: A form of disengagement
3

- dissociation: emotional separation and detachment
- regression: re-treatment into an earlier developmental level
VII. Pathological Anxiety (When anxiety is not managed)
• occurs from ineffective coping with anxiety
• response to anxiety is disproportionate to the threat
• anxiety continues beyond the threat (unable to “let go”, anxiety that lingers)
• Causes, impairment in ADL’s intellectual, social, occupational functioning, memory impairment, and
comprehension
• Creates psychosomatic or physical effects: headache, pain, discomfort
• Pathological Anxiety- etiology
- Psychoanalytic (Freud) : unresolved intra-psychic conflict, low self-esteem, and unworthy feeling
- Interpersonal theory : relationship with parent significant, disapproval from the relationship
- Behavioral theory : learned response to an unpleasant experience; example: immunizations at the
doctor visit, young child hospitalized now doesn’t want to go to the dr.
- Biological theory : adaption syndrome, fight or flight response impaired, limited GABA
neurotransmitters (can’t calm down)
- Genetic: nearly 50% of anxious pts have family history of anxiety (anxiety, panic, OCD)
• Pathological anxiety creates further disorganization and maladaptive responses (patient continues to
deteriorate, exhibited in behaviors and or thoughts, feelings)
• Occurs on a continuum from mild to moderate to severe to panic
VIII. Mild Anxiety : increase energy helps maximize productivity. Normal levels experienced by everyone,
every day, everyday there is an opportunity to exp. anxiety
• Increases alertness, enhances learning- problem solving
• Managing mild anxiety
- Every day reduce stress: calm down DAILY- keeps anxiety from