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
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- Spring '17
- Severe Anxiety, The Unconscious