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RNSG 2213 Mental Health

• Anxiety- a state of feeling apprehension,
uneasiness, uncertainity, or dread
resulting from a real or perceived threat
whose actual source is unknown or
• Universal human experience
• Normal anxiety provides energy to carry
out tasks involved with living and striving
toward goals
• Dysfunctional behavior is often a defense
against anxiety
• Body reacts in similar ways physiologically
to both fear and anxiety (fear reaction to
specific danger)
Levels of Anxiety
• Mild • Severe
• Normal response to • Perceptual field greatly
everyday living reduced
• Ability to perceive in • Learning & problem
sharp focus solving not possible
• Problem solving • Panic
becomes of effective
• Markedly disturbed
• Moderate behavior
• Perceptual field • Inability to process
narrows environmental stimuli
• Selective inattention • Possible loss of touch
• Problem solving with reality
Levels of Anxiety
• Mild • Severe
• Slight discomfort, • Appears dazed and
restlessness, or mild confused, experience a
tension-relieving behaviors sense of doom, &
intensified somatic
• Moderate complaints
• Physical tension, pounding
heart, increased pulse & • Panic
respiratory rate, • Hallucinations may be
diaphoresis, and mild experienced, physical
somatic symptoms behavior erratic,
uncoordinated, and
• Automatic behaviors are
used to reduce anxiety
• Mild to Moderate anxiety
– Help client focus and solve problems with
specific communication techniques
– Open-ended questions, broad openings, and clarification
– Provide a calm presence, recognition of
person’s distress, and willingness to listen
• Severe to panic levels
– Priority client safety and safety of others
– Meet physical needs (fluids & rest) to prevent
– Quiet, safe environment reduce
environmental stimuli
– Medications
– Restrain only if other methods have failed
– Communicate via firm, short, simple
statements, point out reality if are distortions
Defenses against Anxiety
• Defense mechanisms protect the
individual against anxiety and from the
awareness of internal or external dangers
or stressors.
• Used by everyone to lower anxiety,
maintain ego function, and protect the
sense of self
• Maladaptive use can lead to distortions in
reality and self-deception
Properties of Defense Mechanisms
• Defenses are a major means of managing
conflict & affect
• Defenses are relatively unconscious
• Defenses are discrete
• Defenses are reversible
• Defenses are adaptive as well as
Most Healthy Defenses
• Altruism
– emotional conflicts & stressors are dealt with by working with

• Sublimation
– the unconscious process of substituting constructive & socially
acceptable activity for strong impulses that are not acceptable

• Humor
– A way of dealing with stress or emotional conflicts using
amusing or ironic aspects of the conflict or stressors

• Suppression
– The conscious denial of disturbing situations or feelings
Intermediate Defenses
• Repression
– The exclusion of unwanted experiences or emotions from
the conscious awareness; also the cornerstone of the
defense mechanisms

• Displacement
– Placing emotions associated with a particular person,
object, or situation onto another person, object, or
situation that is nonthreatening

• Reaction formation
– overcompensation
Intermediate Defenses
• Somatization
– The transfer of anxiety from the psychological to a
physical symptom that has no organic cause

• Undoing
– Making up for an argument with someone by giving a gift
to “undo”

• Rationalization
– Justifying illogical or unreasonable ideas, actions, or
feelings by developing acceptable explanations that
satisfy the teller as well as the listener
Immature Defenses
• Passive aggression
– Dealing with emotional conflict or stressors by indirectly
& unassertively expressing aggression toward others
• Acting out behaviors
– Dealing with emotional conflicts or stressors by actions
rather than reflections or feelings
• Dissociation
– Feeling unattached to self, others, or environment
• Devaluation
– Giving negative value to self or others to try to appear
“good” and reduce stress & anxiety
Immature Defenses
• Idealization
– Emotional stressors are dealt with by idealizing or exaggerating
another’s qualities
• Splitting
– Inability to integrate positive & negative attributes to another at
the same time; the all or nothing way of dealing with stressors;
prevalent in individuals with borderline personality disorder
• Projection
– Placing one’s own negative attributes onto another person,
object, or situation; also called “blaming” or “scapegoating”
• Denial
– Escaping from unpleasant realities by ignoring their existence; a
hallmark defense mechanism in alcohol or drug addicted
individuals (“I can stop drinking or taking drugs anytime I want