What are the two types of psychological adaptation to stress?
Anxiety and grief
What kinds of threats can anxiety cause?
Threats to biologic integrity and threats to security and self (our personhood)
What are threats to our biologic integrity?
Maslow lower levels of needs–food, drink, shelter, warmth, safety
What are threats of self or our personhood?
Maslow higher level needs of love and security
____ is a major psychological response to stress. What is believed about this?
Anxiety–believed to be the most uncomfortable feeling a person can experience
Can anxiety be positive?
Yes–it can cue arousal to a perceived threat
What are Peplau’s 4 levels of anxiety?
- Mild
- Moderate
- Severe
- Panic
What anxiety: Hightened perception Enhanced learning Restlessness, irritability Increased motivation
Mild anxiety
Is mild anxiety a problem? What is it associated with? What happens with mild anxiety?
- Seldom a problem
- Associated with the tension of day to day living
- Senses sharpen, motivation increase, awareness of environment heightened, learning enhanced
*Prepares you for action!
Mild to moderate anxiety provide demand created by the id, superego, and reality..the ego has a variety of ____ to cope with anxiety.
Defense mechanisms
What are ego defense?
Psychological tools that work to protect the ego from anxiety
Are ego defenses always unhealthy?
No
What if we over use or use ego defenses at inappropriate times?
Can cause problems
Do ego defenses act consciously?
Yes
Do ego defenses act unconcsciously?
Yes
Ego defenses can ___, ___, or ___ reality
Distort, transform, or falsify reality
Some defense mechanisms are ____ and allow us to function normally, while others are ____
Some are adaptive, others are maladaptive
The greatest problems arise when defense mechanisms are overused in order to ________
Avoid taking responsibility for and dealing with problems
What may the goal be in psychoanalytic therapy, in regards to ego defenses?
To help the client uncover defense mechanisms and find better, more healthy ways of coping
Who identified and described defense mechanisms used by the ego?
Anna Freud–Sigmund Frueud’s daughter
There are a lot of defense mechanisms—
Talking about them in another deck
What type of anxiety is this:
- Reduced alertness to environmental events
- Decreased attention span
- Decreased ability to concentrate
- Less than optimal ability to learn
- Increased restlessness, pulse rate, BP, muscular tension, gastric discontent
- Some impairment in relationships, focus on self to relieve personal discomfort
Moderate anxiety
What anxiety contributes to the development of physiological disorders?
Moderate to severe
Moderate to severe anxiety can ____ affect physiological disorders and _____ symptoms of a disorder. This type of anxiety can also _____ from a disorder and ____ with treatment of a medical disorder
- adversely affect physiological disorders
- Exacerbate symptoms of a disorder
- Delay recovery from a disorder
- Interfere with treatment of a medical disorder
How is the perceptual field in severe anxiety?
Greatly diminished
What is the attention span like in severe anxiety?
Extremely limited
Is it easy to concentrate or problem solve if experiencing severe anxiety?
No, there is an inability to concentrate and problem solve
What are some symptoms of severe anxiety?
Headaches
Trembling
Insomnia
Pain
What do you feel if you are experiencing severe anxiety?
Feelings of dread, loathing
What is the focus the person has when experiencing severe anxiety?
Total focus on self and intense desire to relieve anxiety
Psychoneurotic responses are also referred to as neuroses. What are neuroses?
Excessive anxiety that is expressed directly or altered through defense mechanisms
How does the neurosis appear?
A symptom–such as an obsession, compulsion, phobia, or sexual dysfunction
What are examples of some psychoneurotic responses to chronic severe anxiety?
Anxiety disorders
Somatic symptom disorder
Dissociative disorder
Excessive anxiety and avoidance behaviors. Examples?
Anxiety disorders
Phobias, OCD, panic disorder, GAD
Physical symptoms which have no identifiable organic pathology. Examples?
Somatic symptom disorders
EX: Somatic symptom disorder, illness anxiety disorder, conversion disorder, factitious disorder
Disruption in consciousness, memory, identity. Examples?
Dissociative disorders
EX: Dissociate amnesia, dissociative identity disorder, depersonalization-derealization disorder
What type of psychoneurotic response is this: Somatic symptom disorder
Somatic symptoms disorders
What type of psychoneurotic response is this: Phobias
Anxiety disorders
What type of psychoneurotic response is this: Conversion disorder
Somatic symptom disorder
What type of psychoneurotic response is this: Dissociative amnesia
Dissociative disorder
What type of psychoneurotic response is this: Factitious disorder
Somatic symptom disorder
What type of psychoneurotic response is this: GAD
Anxiety disorder
What type of psychoneurotic response is this: Depersonalized-derealization disorder
Dissociative disorder
What type of psychoneurotic response is this: Illness anxiety disorder
Somatic symptom
What type of psychoneurotic response is this: OCD
Anxiety disorder
What type of psychoneurotic response is this: Panic disorder
Anxiety disorder
What type of psychoneurotic response is this: Dissociative identity disorder
Dissociative disorder
If you have panic can you focus?
No, not even on one detail
If you have panic can you concentrate?
No
T/F: People with panic can comprehend simple directions
FALSE
What kind of activity does panic cause?
Immobility or purposeless HYPERactivity
If you experience panic, is it easy for you to verbalize?
No, and if you can, you may be incoherent
Panic can cause ____ and there may be a _____
terrors and may be a psychotic response
What is the most intense state of anxiety? What happens?
PANIC–there may be a loss of contact with reality and/or a psychotic response to anxiety!
“A severe mental disorder characterized by gross impairment in reality testing, typically manifested by delusions, hallucinations, disorganized speech, or disorganized or catatonic behavior”
Psychosis
What are examples of psychotic responses to anxiety?
Schizophrenia
Shizoaffective disorder
Delusional disorder
What are common characteristic of people with psychosis?
- Exhibit minimal distress (bland or inappropriate tone)
- Unaware their behavior is MALADAPTIVE
- Unaware of any psychological problems
- Exhibit a flight from reality into a less stressful world
What psychotic response to anxiety is this:
-Delusions, hallucinations, disorganized speech, unusual or catatonic behavior, flat affect
Schizophrenic
What psychotic response to anxiety is this:
-Milder symptoms of schizophrenia–better prognosis
Schizoaffective
What psychotic response to anxiety is this:
-Characterized by the presence of delusions–if present hallucinations are not prominent, behavior is not bizzare
Delusional disorder
What are some common symptoms of anxiety?
Insomnia Tenseness Feels anxious Shakiness Increased BP Sweating Restlessness Elevated HR, breathing, and BP Over/under eating GI distress Self-focused behaviors
What are 2 nursing diagnosis for anxiety?
Anxiety r/t
Ineffective coping r/t
Response to the physical, emotional, social, and cognitive stress related to loss or anticipated loss
Grief
5 stages of grief?
Denial Anger Bargaining Depression Acceptance
What is the process of grieving?
Mourning characterized by feelings of sadness, guilt, anger, helplessness, hopelessness, despair
Occurs when loss is anticipated and begin the work of grieving
Anticipatory grief
Anticipatory grief facilitates the process of mouring–_____ the length and intensity
Decreasing
Can anticipatory grief be complete before the death of a loved one (person, pet, marriage, relationship, health)?
Yes, it is sometimes completed before the death
Clousure to mourning and moving forward without the sadness and/or anger related to the loss
Resolution
Why may grief be prolonged?
Conflicted feelings: guilt, love-hate relationships, number of losses experienced
Occurs when the person can reflect on the relationship with the lost entity and accept the pleasures and disappointments–no longer preoccupied with the lost entity and is ready for new relationships
Resolution
Occurs when the individual is unable to progress through the stages of grieving to achieve resolution; may remain angry for years and may become disabled with depression unable to tend to activities of daily living
Maladaptive grieving
What are the 3 types of maladaptive grieving?
- Prolonged
- Delayed
- Distored
Maladaptive grieving-which one?
characterized by an intense preoccupation with memories of the lost entity for MANY YEARS after the loss has occurred. What can this lead to?
Prolonged–can lead to depression
Maladaptive grieving–which one?
Individual becomes fixed in the denial stage of the grieving process; emotional pain associated with grieving is not present–but what is?
Delayed (inhibited)—emotional pain not present but ANXIETY disorders are!
Maladaptive grieving–which one?
Fixed in the anger stage of grieving; all normal responses with grieving are exaggerated out of proportion
Distorted
Why may grief be prolonged (4)?
- Ambivalence of relationship (unfinished business)
- Guilt
- Number of recent losses (especially elderly)
- Bereavement overload (accumulation of grief)