3/30/22, 11:11 AM CODE 157- Set 1 - https://usl-tuguegarao.neolms.com/student_lesson/show/3165909?

from=%2Fstudent_quiz_assignment%2Fs…
Home

CODE 157- Set 1

Midterms Week 8

Learning Content
ANXIETY is a vague feeling of dread or apprehension; it is a response to external or internal stimuli that can have behavioral, emotional, cognitive, and physical symptoms.
Anxiety is distinguished from fear, which is feeling afraid or threatened by a clearly identifiable external stimulus that represents danger to the person. Anxiety is
unavoidable in life and can serve many positive functions such as motivating the person to take action to solve a problem or to resolve a crisis. It is considered normal when
it is appropriate to the situation and dissipates when the situation has been resolved.

Anxiety disorders comprise a group of conditions that share a key feature of excessive anxiety with ensuing behavioral, emotional, cognitive, and physiologic responses.
Clients suffering from anxiety disorders can demonstrate unusual behaviors such as panic without reason, unwarranted fear of objects or life conditions, uncontrollable
repetitive actions, reexperiencing of traumatic events, or unexplainable or overwhelming worry. They experience significant distress over time, and the disorder significantly
impairs their daily routines, social lives, and occupational functioning.

Anxiety disorders are diagnosed when anxiety no longer functions as a signal of danger or a motivation for needed change but becomes chronic and permeates major
portions of the person’s life, resulting in maladaptive behaviors and emotional disability. Anxiety disorders have many manifestations, but anxiety is the key feature of each

(American Psychiatric Association [APA], 2000).

Types of anxiety disorders

Agoraphobia with or without panic disorder

Panic disorder
Specific phobia
Social phobia
OCD
Generalized anxiety disorder (GAD)
Acute stress disorder
Posttraumatic stress disorder.

INCIDENCE

Anxiety disorders have the highest prevalence rates of all mental disorders in the United States. Nearly one in four adults in the United States is affected, and the magnitude
of anxiety disorders in young people is similar (Merikangas,2005). Anxiety disorders are more prevalent in women, people younger than age 45 years, people who are
divorced or separated, and people of lower socioeconomic status. The exception is OCD, which is equally prevalent in men and women but is more common among boys
than among girls.

ONSET AND CLINICAL COURSE

The onset and clinical course of anxiety disorders are extremely variable depending on the specific disorder.

ANXIETY AS A RESPONSE TO STRESS

Stress is the wear and tear that life causes on the body (Selye, 1956). It occurs when a person has difficulty dealing with life situations, problems, and goals. Each person
handles stress differently. One person can thrive in a situation that creates great distress for another. For example, many people view public speaking as scary, but for
teachers and actors, it is an everyday, enjoyable experience. Marriage, children, airplanes, snakes, a new job, a new school, and leaving home are examples of stress-causing
events.

Hans Selye (1956, 1974), an endocrinologist, identified the physiologic aspects of stress, which he labeled the general adaptation syndrome. He used laboratory animals
to assess biologic system changes; the stages of the body’s physical responses to pain, heat, toxins, and restraint; and, later, the mind’s emotional responses to real or
perceived stressors. He determined three stages of reaction to stress:

In the alarm reaction stage, stress stimulates the body to send messages from the hypothalamus to the glands (such as the adrenal gland, to send out adrenaline and
norepinephrine for fuel) and organs (such as the liver, to reconvert glycogen stores to glucose for food) to prepare for potential defense needs.
In the resistance stage, the digestive system reduces function to shunt blood to areas needed for defense. The lungs take in more air, and the heart beats faster and
harder so it can circulate this highly oxygenated and highly nourished blood to the muscles to defend the body by fight, flight, or freeze behaviors. If the person adapts
to the stress, the body responses relax, and the gland, organ, and systemic responses abate.
The exhaustion stage occurs when the person has responded negatively to anxiety and stress: body stores are depleted or the emotional components are not resolved,
resulting in continual arousal of the physiologic responses and little reserve capacity.

https://usl-tuguegarao.neolms.com/student_lesson/show/3165909?from=%2Fstudent_quiz_assignment%2Fshow%2F31059404&lesson_id=15128157 1/10
3/30/22, 11:11 AM CODE 157- Set 1 - https://usl-tuguegarao.neolms.com/student_lesson/show/3165909?from=%2Fstudent_quiz_assignment%2Fs…

Autonomic nervous system responses to fear and anxiety generate the involuntary activities of the body that are involved in self-preservation. Sympathetic nerve fibers
“charge up” the vital signs at any hint of danger to prepare the body’s defenses. The adrenal glands release adrenalin (epinephrine), which causes the body to take in more
oxygen, dilate the pupils, and increase arterial pressure and heart rate while constricting the peripheral vessels and shunting blood from the gastrointestinal and reproductive
systems and increasing glycogenolysis to free glucose for fuel for the heart, muscles, and central nervous system. When the danger has passed, parasympathetic nerve fibers
reverse this process and return the body to normal operating conditions until the next sign of threat reactivates the sympathetic responses.

Anxiety causes uncomfortable cognitive, psychomotor, and physiologic responses, such as difficulty with logical thought, increasingly agitated motor activity, and elevated
vital signs. To reduce these uncomfortable feelings, the person tries to reduce the level of discomfort by implementing new adaptive behaviors or defense mechanisms.
Adaptive behaviors can be positive and help the person to learn, for example, using imagery techniques to refocus attention on a pleasant scene, practicing sequential
relaxation of the body from head to toe, and breathing slowly and steadily to reduce muscle tension and vital signs. Negative responses to anxiety can result in maladaptive
behaviors such as tension headaches, pain syndromes, and stress-related responses that reduce the efficiency of the immune system. People can communicate anxiety to
others both verbally and nonverbally. If someone yells “fire,” others around them can become anxious as they picture a fire and the possible threat that represents. Viewing a
distraught mother searching for her lost child in a shopping mall can cause anxiety in others as they imagine the panic she is experiencing. They can convey anxiety
nonverbally through empathy, which is the sense of walking in another person’s shoes for a moment in time (Sullivan, 1952). Examples of nonverbal empathetic
communication are when the family of a client undergoing surgery can tell from the physician’s body language that their loved one has died, when the nurse reads a plea for
help in a client’s eyes, or when a person feels the tension in a room where two people have been arguing and are now not speaking to each other.

LEVELS OF ANXIETY

Mild
1. anxiety

-is a sensation that something is different and warrants special attention. Sensory stimulation increases and helps the person focus attention to learn, solve problems,
think, act, feel, and protect himself or herself. Mild anxiety often motivates people to make changes or to engage in goal-directed activity. For example, it helps
students to focus on studying for an examination.

- MANAGEMENT: requires no direct intervention. People with mild anxiety can learn and solve problems and are even eager for information. Teaching can be very
effective when the client is mildly anxious.

2. Moderate anxiety

- is the disturbing feeling that something is definitely wrong; the person becomes nervous or agitated. In moderate anxiety, the person can still process information,
solve problems, and learn new things with assistance from others. He or she has difficulty concentrating independently but can be redirected to the topic. For
example, the nurse might be giving preoperative instructions to a client who is anxious about the upcoming surgical procedure. As the nurse is teaching, the client’s
attention wanders but the nurse can regain the client’s attention and direct him or her back to the task at hand.

- MANAGEMENT: the nurse must be certain that the client is following what the nurse is saying. The client’s attention can wander, and he or she may have some
difficulty concentrating over time. Speaking in short, simple, and easy-to- understand sentences is effective; the nurse must stop to ensure that the client is still taking
in information correctly. The nurse may need to redirect the client back to the topic if the client goes off on an unrelated tangent.

3. Severe anxiety

- has trouble thinking and reasoning. Muscles tighten and vital signs increase. The person paces; is restless, irritable, and angry; or uses other similar emotional–
psychomotor means to release tension. In panic, the emotional–psychomotor realm predominates with accompanying fight, flight, or freeze responses. Adrenaline
surge greatly increases vital signs. Pupils enlarge to let in more light, and the only cognitive process focuses on the person’s defense.

- MANAGEMENT: lower the person’s anxiety level to moderate or mild before proceeding with anything else. It is also essential to remain with the person because
anxiety is likely to worsen if he or she is left alone. Talking to the client in a low, calm, and soothing voice can help. If the person cannot sit still, walking with him or
her while talking can be effective.

4. Panic

- the emotional–psychomotor realm predominates with accompanying fight, flight, or freeze responses. Adrenaline surge greatly increases vital signs. Pupils enlarge
to let in more light, and the only cognitive process focuses on the person’s defense.

https://usl-tuguegarao.neolms.com/student_lesson/show/3165909?from=%2Fstudent_quiz_assignment%2Fshow%2F31059404&lesson_id=15128157 2/10
3/30/22, 11:11 AM CODE 157- Set 1 - https://usl-tuguegarao.neolms.com/student_lesson/show/3165909?from=%2Fstudent_quiz_assignment%2Fs…
-MANAGEMENT: person’s safety is the primary concern. He or she cannot perceive potential harm and may have no capacity for rational thought. The nurse must
keep talking to the person in a comforting manner, even though the client cannot process what the nurse is saying. Going to a small, quiet, and non-stimulating
environment may help to reduce anxiety. The nurse can reassure the person that this is anxiety, that it will pass, and that

he or she is in a safe place. The nurse should remain with the client until the panic recedes. Panic-level anxiety is not sustained indefinitely but can last from 5–30
minutes.

When working with an anxious person, the nurse must be aware of his or her own anxiety level. It is easy for the nurse to become increasingly anxious. Remaining
calm and in control is essential if the nurse is going to work effectively with the client. Short-term anxiety can be treated with anxiolytic medications.

 Most of these drugs are benzodiazepines, which are commonly prescribed for anxiety. Benzodiazepines have a high potential for abuse and dependence, however, so
their use should be short-term, ideally no longer than 4 to 6 weeks. These drugs are designed to relieve anxiety so that the person can deal more effectively with whatever
crisis or situation is causing stress. Unfortunately, many people see these drugs as a “cure” for anxiety and continue to use them instead of learning more effective coping
skills or making needed changes.

RELATED DISORDERS

Anxiety disorder due to a general medical condition is diagnosed when the prominent symptoms of anxiety are judged to result directly from a physiologic condition. The
person may have panic attacks, generalized anxiety, or obsessions or compulsions. Medical conditions causing this disorder can include endocrine dysfunction, chronic
obstructive pulmonary disease, congestive heart failure, and neurologic conditions.

Substance-induced anxiety disorder is anxiety directly caused by drug abuse, a medication, or exposure to a toxin. Symptoms include prominent anxiety, panic attacks,
phobias, obsessions, or compulsions.

Separation anxiety disorder is excessive anxiety concerning separation from home or from persons, parents, or caregivers to whom the client is attached. It occurs when it
is no longer developmentally appropriate and before 18 years of age.

Adjustment disorder is an emotional response to a stressful event, such as one involving financial issues, medical illness, or a relationship problem, that results in clinically
significant symptoms such as marked distress or impaired functioning.

ETIOLOGY
https://usl-tuguegarao.neolms.com/student_lesson/show/3165909?from=%2Fstudent_quiz_assignment%2Fshow%2F31059404&lesson_id=15128157 3/10
3/30/22, 11:11 AM CODE 157- Set 1 - https://usl-tuguegarao.neolms.com/student_lesson/show/3165909?from=%2Fstudent_quiz_assignment%2Fs…
Biologic Theories

Genetic
1. Theories

Anxiety may have an inherited component because firstdegree relatives of clients with increased anxiety have higher rates of developing anxiety. Heritability refers
to the proportion of a disorder that can be attributed to genetic factors:

High heritabilities are greater than 0.6 and indicate that genetic influences dominate.
Moderate heritabilities are 0.3 to 0.5 and suggest an even greater influence of genetic and nongenetic factors.
Heritabilities less than 0.3 mean that genetics are negligible as a primary cause of the disorder. Panic disorder and social and specific phobias, including
agoraphobia, have moderate heritability. GAD and OCD tend to be more common in families, indicating a strong genetic component, but still require further
in-depth study (McMahon & Kassem, 2005). At this point, current research indicates a clear genetic susceptibility to or vulnerability for anxiety disorders;
however, additional factors are necessary for these disorders to actually develop.

Neurochemical
2. Theories

Gamma-aminobutyric acid (GABA) is the amino acid neurotransmitter believed to be dysfunctional in anxiety disorders. GABA, an inhibitory neurotransmitter,
functions as the body’s natural antianxiety agent by reducing cell excitability, thus decreasing the rate of neuronal firing. It is available in one third of the nerve
synapses, especially those in the limbic system and in the locus ceruleus, the area where the neurotransmitter norepinephrine, which   excites cellular function, is
produced. Because GABA reduces anxiety and norepinephrine increases it, researchers believe that a problem with the regulation of these neurotransmitters occurs in
anxiety disorders. Serotonin, the indolamine neurotransmitter usually implicated in psychosis and mood disorders, has many subtypes. 5 Hydroxytryptamine type 1a
plays a role in  anxiety, and it also affects aggression and mood. Serotonin is believed to play a distinct role in OCD, panic disorder, and GAD. An excess of
norepinephrine is suspected in panic disorder, GAD, and posttraumatic stress disorder (Neumeister, Bonne, & Charney, 2005).

Psychodynamic Theories

Intrapsychic
1. / Psychoanalytic Theories

Freud (1936) saw a person’s innate anxiety as the stimulus for behavior. He described defense mechanisms as the human’s attempt to control awareness of and to
reduce anxiety. Defense mechanisms are cognitive distortions that a person uses unconsciously to maintain a sense of being in control of a situation, to lessen
discomfort, and to deal with stress. Because defense mechanisms arise from the unconscious, the person is unaware of using them. Some people overuse defense
mechanisms, which stops them from learning a variety of appropriate methods to resolve anxiety-producing situations. The dependence on one or two defense
mechanisms also can inhibit emotional growth, lead to poor problem-solving skills, and create difficulty with relationships.

Interpersonal
2. Theory

Harry Stack Sullivan (1952) viewed anxiety as being generated from problems in interpersonal relationships. Caregivers can communicate anxiety to infants or
children through inadequate nurturing, agitation when holding or handling the child, and distorted messages. Such communicated anxiety can result in dysfunction
such as failure to achieve age-appropriate developmental tasks. In adults, anxiety arises from the person’s need to conform to the norms and values of his or her
cultural group. The higher the level of anxiety, the lower the ability to communicate and to solve problems and the greater the chance for anxiety disorders to
develop. Hildegard Peplau (1952) understood that humans exist in interpersonal and physiologic realms; thus, the nurse can better help the  client to achieve health
by attending to both areas. She identified the four levels of anxiety and developed nursing interventions and interpersonal communication techniques based on
Sullivan’s interpersonal view of anxiety. Nurses today use Peplau’s interpersonal therapeutic communication techniques to develop and to nurture the nurse–client
relationship and to apply the nursing process.

Behavioral
3. Theory

Behavioral theorists view anxiety as being learned through experiences. Conversely, people can change or “unlearn” behaviors through new experiences.
Behaviorists believe that people can modify maladaptive behaviors without gaining insight into their causes. They contend that disturbing behaviors that develop and
interfere with a person’s life can be extinguished or unlearned by repeated experiences guided by a trained therapist.

CULTURAL CONSIDERATIONS

Each culture has rules governing the appropriate ways to express and deal with anxiety. Culturally competent nurses should be aware of them while being careful not to
stereotype clients. People from Asian cultures often express anxiety through somatic symptoms such as headaches, backaches, fatigue, dizziness, and stomach problems.
One intense anxiety reaction is koro, or a man’s profound fear that his penis will retract into the abdomen and he will then die. Accepted forms of treatment include having
the person firmly hold his penis until the fear passes, often with assistance from family members or friends, and clamping the penis to a wooden box. In women, koro is the
fear that the vulva and nipples will disappear (Spector, 2008). Susto is diagnosed in some Hispanics (Peruvians, Bolivians, Colombians, and Central and South American
Indians) during cases of high anxiety, sadness, agitation, weight loss, weakness, and heart rate changes. The symptoms are believed to occur because supernatural spirits or
bad air from dangerous places and cemeteries invades the body.

TREATMENT

Treatment for anxiety disorders usually involves medication and therapy. This combination produces better results than either one alone.

https://usl-tuguegarao.neolms.com/student_lesson/show/3165909?from=%2Fstudent_quiz_assignment%2Fshow%2F31059404&lesson_id=15128157 4/10
3/30/22, 11:11 AM CODE 157- Set 1 - https://usl-tuguegarao.neolms.com/student_lesson/show/3165909?from=%2Fstudent_quiz_assignment%2Fs…

Cognitive–behavioral therapy is used successfully to treat anxiety disorders. Positive reframing means turning negative

messages into positive messages. The therapist teaches the person to create positive messages for use during panic episodes. For example, instead of thinking, “My heart is
pounding. I think I’m going to die!” the client thinks, “I can stand this. This is just anxiety. It will go away.” The client can write down these messages and keep them readily
accessible such as in an address book, a calendar, or a wallet.

Decatastrophizing involves the therapist’s use of questions to more realistically appraise the situation. The therapist may ask, “What is the worst thing that could happen? Is
that likely? Could you survive that? Is that as bad as you imagine?” The client uses thought-stopping and distraction techniques to jolt himself or herself from focusing on
negative thoughts. Splashing the face with cold water, snapping a rubber band worn on the wrist, or shouting are all techniques that can break the cycle of negative thoughts.

Assertiveness training helps the person take more control over life situations. Techniques help the person negotiate interpersonal situations and foster self- assurance. They
involve using “I” statements to identify feelings and to communicate concerns or needs to others. Examples include “I feel angry when you turn your back while I’m
talking,” “I want to have 5 minutes of your time for an uninterrupted conversation about something important,” and “I would like to have about 30 minutes in the evening to
relax without interruption.”

ELDER CONSIDERATIONS

Anxiety that starts for the first time in late life is frequently associated with another condition such as depression, dementia, physical illness, or medication toxicity or
withdrawal. Phobias, particularly agoraphobia, and GAD are the most common late-life anxiety disorders. Most people with late-onset agoraphobia attribute the start of the
disorder to the abrupt onset of a physical illness or as a response to a traumatic event such as a fall or mugging. Late-onset GAD is usually associated with depression.
Though less common, panic attacks can occur in later life and are often related to depression or a physical illness such as cardiovascular, gastrointestinal, or chronic
pulmonary diseases. Ruminative thoughts are common in late-life depression and can take the form of obsessions such as contamination fears, pathologic doubt, or fear of
harming others. The treatment of choice for anxiety disorders in the elderly is selective serotonin reuptake inhibitor (SSRI) antidepressants. Initial treatment involves doses
lower than the usual starting doses for adults to ensure the elderly client can tolerate the medication. if started on too high a dose, SSRIs can exacerbate anxiety symptoms in
elderly clients (Sakauye, 2008).

 
https://usl-tuguegarao.neolms.com/student_lesson/show/3165909?from=%2Fstudent_quiz_assignment%2Fshow%2F31059404&lesson_id=15128157 5/10
3/30/22, 11:11 AM CODE 157- Set 1 - https://usl-tuguegarao.neolms.com/student_lesson/show/3165909?from=%2Fstudent_quiz_assignment%2Fs…
COMMUNITY-BASED CARE

Nurses encounter many people with anxiety disorders in community settings rather than in inpatient settings. Formal treatment for these clients usually occurs in community
mental health clinics and in the offices of physicians, psychiatric clinical specialists, psychologists, or other mental health counselors. Because the person with an anxiety
disorder often believes the sporadic symptoms are related to medical problems, the family practitioner or advanced practice nurse can be the first health-care professional to
evaluate him or her. Knowledge of community resources helps the nurse guide the client to appropriate referrals for assessment, diagnosis, and treatment. The nurse can
refer the client to a psychiatrist or to an advanced practice psychiatric nurse for diagnosis, therapy, and medication. Other community resources such as anxiety disorder
groups or self-help groups can provide support and help the client feel less isolated and lonely.

MENTAL HEALTH PROMOTION

Too often, anxiety is viewed negatively as something to avoid at all costs. Actually, for many people, anxiety is a warning they are not dealing with stress effectively.
Learning to heed this warning and to make needed change is a healthy way to deal with the stress of daily events. Stress and resulting anxiety are not associated exclusively
with life problems. Events that are “positive” or desired, such as going away to college, getting a first job, getting married, and having children, are stressful and cause
anxiety. Managing the effects of stress and anxiety in one’s life is important to being healthy. Tips for managing stress include the following:

Keep a positive attitude and believe in yourself.

Accept there are events you cannot control.
Communicate assertively with others: talk about your feelings to others and express your feelings through laughing, crying, and so forth.
Learn to relax.
Exercise regularly.
Eat well-balanced meals.
Limit intake of caffeine and alcohol.
Get enough rest and sleep.
Set realistic goals and expectations and find an activity that is personally meaningful.
Learn stress management techniques, such as relaxation, guided imagery, and meditation; practice them as part of your daily routine.

For people with anxiety disorders, it is important to emphasize that the goal is effective management of stress and anxiety, not the total elimination of anxiety. Although
medication is important to relieve excessive anxiety, it does not solve or eliminate the problem entirely. Learning anxiety management techniques and effective methods for
coping with life and its stresses is essential for overall improvement in life quality.

EGO DEFENSE MECHANISM-FOUR LEVEL OF DEFENSE

Psychiatrist George Eman Vaillant introduced a four-level classification of defence mechanisms:

Level I – pathological defences (psychotic denial, delusional projection)

Level II – immature defences (fantasy, projection, passive aggression, acting out)
Level III – neurotic defences (intellectualization, reaction formation, dissociation, displacement, repression)
Level IV – mature defences (humour, sublimation, suppression, altruism, anticipation)

Level 1: pathological

When predominant, the mechanisms on this level are almost always severely pathological. These six defenses, in conjunction, permit one effectively to rearrange external
experiences to eliminate the need to cope with reality. Pathological users of these mechanisms frequently appear irrational or insane to others. These are the "pathological"
defenses, common in overt psychosis. However, they are normally found in dreams and throughout childhood as well. They include:

Delusional projection: Delusions about external reality, usually of a persecutory nature

Denial: Refusal to accept external reality because it is too threatening; arguing against an anxiety-provoking stimulus by stating it does not exist; resolution of
emotional conflict and reduction of anxiety by refusing to perceive or consciously acknowledge the more unpleasant aspects of external reality
Distortion: A gross reshaping of external reality to meet internal needs

Level 2: immature

These mechanisms are often present in adults. These mechanisms lessen distress and anxiety produced by threatening people or by an uncomfortable reality. Excessive use
of such defenses is seen as socially undesirable, in that they are immature, difficult to deal with and seriously out of touch with reality. These are the so-called "immature"
defenses and overuse almost always leads to serious problems in a person's ability to cope effectively. These defenses are often seen in major depression and personality
disorders.They include:

Acting out: Direct expression of an unconscious wish or impulse in action, without conscious awareness of the emotion that drives the expressive behavior
Hypochondriasis: An excessive preoccupation or worry about having a serious illness
Passive-aggressive behavior: Indirect expression of hostility
Projection: A primitive form of  paranoia. Projection reduces anxiety by allowing the expression of the undesirable impulses or desires without becoming
consciously aware of them; attributing one's own unacknowledged, unacceptable, or unwanted thoughts and emotions to another; includes
severe prejudice and jealousy, hypervigilance to external danger, and "injustice collecting", all with the aim of shifting one's unacceptable thoughts, feelings
and impulses onto someone else, such that those same thoughts, feelings, beliefs and motivations are perceived as being possessed by the other.
Schizoid fantasy: Tendency to retreat into fantasy in order to resolve inner and outer conflicts
https://usl-tuguegarao.neolms.com/student_lesson/show/3165909?from=%2Fstudent_quiz_assignment%2Fshow%2F31059404&lesson_id=15128157 6/10
3/30/22, 11:11 AM CODE 157- Set 1 - https://usl-tuguegarao.neolms.com/student_lesson/show/3165909?from=%2Fstudent_quiz_assignment%2Fs…
 

Level 3: neurotic

These mechanisms are considered neurotic, but fairly common in adults. Such defenses have short-term advantages in coping, but can often cause long-term problems in
relationships, work and in enjoying life when used as one's primary style of coping with the world. They include:

Displacement: Defense mechanism that shifts sexual or aggressive impulses to a more acceptable or less threatening target; redirecting emotion to a safer outlet;
separation of emotion from its real object and redirection of the intense emotion toward someone or something that is less offensive or threatening in order to
avoid dealing directly with what is frightening or threatening.
Dissociation: Temporary drastic modification of one's personal identity or character to avoid emotional distress; separation or postponement of a feeling that
normally would accompany a situation or thought
Intellectualization: A form of isolation; concentrating on the intellectual components of a situation so as to distance oneself from the associated anxiety-provoking
emotions; separation of emotion from ideas; thinking about wishes in formal, affectively bland terms and not acting on them; avoiding unacceptable emotions
by focusing on the intellectual aspects (solitude, rationalization, ritual, undoing, compensation, and magical thinking)
Reaction formation: Converting unconscious wishes or impulses that are perceived to be dangerous or unacceptable into their opposites; behavior that is
completely the opposite of what one really wants or feels; taking the opposite belief because the true belief causes anxiety
Repression: The process of attempting to repel desires towards pleasurable instincts, caused by a threat of suffering if the desire is satisfied; the desire is moved to
the unconscious in the attempt to prevent it from entering consciousness; seemingly unexplainable naivety, memory lapse or lack of awareness of one's own
situation and condition; the emotion is conscious, but the idea behind it is absent

Level 4: mature

These are commonly found among emotionally healthy adults and are considered mature, even though many have their origins in an immature stage of development. They
are conscious processes, adapted through the years in order to optimize success in human society and relationships. The use of these defenses enhances pleasure and feelings
of control. These defenses help to integrate conflicting emotions and thoughts, whilst still remaining effective. Those who use these mechanisms are usually
considered virtuous. Mature defenses include:

Altruism: Constructive service to others that brings pleasure and personal satisfaction
Anticipation: Realistic planning for future discomfort
Humour: Overt expression of ideas and feelings (especially those that are unpleasant to focus on or too terrible to talk about directly) that gives pleasure to others.
The thoughts retain a portion of their innate distress, but they are "skirted around" by witticism, for example, self-deprecation.
Sublimation: Transformation of unhelpful emotions or instincts into healthy actions, behaviours, or emotions, for example, playing a heavy contact sport such as
football or rugby can transform aggression into a game.
Suppression: The conscious decision to delay paying attention to a thought, emotion, or need in order to cope with the present reality; making it possible later to
access uncomfortable or distressing emotions whilst accepting them

CRISIS AND CRISIS INTERVENTION

CRISIS

A crisis is a turning point in an individual’s life that produces an overwhelming emotional response.
Situation that occurs when an individual’s habitual coping ability becomes ineffective to meet the demands of the situation.
is a time-limited event that usually lasts no longer than 4 to 6 weeks in which the person is unable to relieve prolonged stress through adaptive coping mechanisms.

STAGES OF CRISIS (Caplan,1964)

the
1. person is exposed to a stressor, experiences anxiety, and tries to cope in a customary fashion
anxiety
2. increases when customary coping skills are ineffective
the
3. person makes all possible effort to deal with the stressor including attempts at new methods of coping; and
when
4. coping attempts fail, the person experiences disequilibrium and significant distress.

For many individuals, modern everyday life is a series of events strung together with stress and anxiety. A crisis occurs when there is a real or perceived threat to a person’s
physical, social, or psychological self. Additionally, witnessing a trauma of another individual or of an entire community can also lead to crisis (Everly & Lating, 1995).

In crisis, an individual confronts a stressor and his or her coping mechanisms fail to resolve the perceived stress. Crisis is a time-limited state of disequilibrium accompanied
by increased anxiety that can trigger adaptive or nonadaptive biopsychosocial responses to maturational, situational, or interpersonal experiences (Boyd, 2008). Typically, a
crisis interrupts psychological balance or homeostasis. Subsequently, this disruption overwhelms a person’s ability to deal with the challenge or threat at hand (Fortinash &
Holoday Worret, 2007). Regardless of whether the stressor is internal or external, the change in the environment causes disequilibrium, interrupting the individual’s coping
patterns and usual behaviors.

Often, crisis is viewed as a negative occurrence. However, the experience of a crisis does not mean that a psychopathology exists. Crisis can also provide an opportunity for
personal growth and positive change (North & Pfefferbaum, 2013). For example, adaptation by the person during crisis allows the person to act and resolve the situation.

https://usl-tuguegarao.neolms.com/student_lesson/show/3165909?from=%2Fstudent_quiz_assignment%2Fshow%2F31059404&lesson_id=15128157 7/10
3/30/22, 11:11 AM CODE 157- Set 1 - https://usl-tuguegarao.neolms.com/student_lesson/show/3165909?from=%2Fstudent_quiz_assignment%2Fs…
The person can be supported to consider the incident from a fresh perspective and can develop new coping skills for use during future periods of stress. Mounting an
adaptive response allows individuals to seek and implement solutions, thus restoring homeostasis and promoting personal growth. When an individual’s responses are
maladaptive, he or she feels a sense of helplessness, unable to harness the internal or external resources needed to resolve the all-encompassing anxiety and stress. This
individual needs support from health care professionals to work through the crisis and restore homeostasis.

Individuals and families experience crises every day. Across the life span, from infancy to death, many situations in an individual’s life can lead to stress and precipitate a
crisis. For some, a single event, such as the unexpected death of a child, can cause a person to lose complete control and become unable to follow through with the simplest
daily functions. For others, a series of stressors, such as loss of a job followed by illness of a parent and then death of a loved one, can compound the anxiety. This series of
events leads to feelings of loss of control, becoming more than the individual can handle.

During a period of crisis, new emotional and physiological symptoms, such as nausea and/or emesis, head and body aches, and bowel changes, may emerge. These
symptoms, in combination with extreme impairment in daily functioning, signal crisis and need for professional intervention (Boyd, 2008). The Diagnostic and Statistical
Manual of Mental Disorders,  fifth edition (DSM-5, American Psychiatric Association, 2013), associates crisis with several different psychiatric diagnoses and disorders
including depression, anxiety, and posttraumatic stress disorder. However, it does not categorize crisis as a distinct diagnosis (Fortinash & Holoday Worret, 2007).

THREE CATEGORIES:

Maturational crises/developmental crises- are predictable events in the normal course of life such as leaving home for the first time, getting married, having a baby,
and beginning a career.
Situational crises- are unanticipated or sudden events that threaten the individual’s integrity such as the death of a loved one, loss of a job, and physical or emotional
illness in the individual of family member.
Adventitious crises/social crises-include natural disasters like floods, earthquakes, or hurricanes; war; terrorist attacks; riots; and violent crimes such as rape or
murder.

CHARACTERISTICS OF CRISIS STATE

highly
1. individualized
lasts
2. 4-6 weeks
person
3. affected becomes passive and submissive
affects
4. a person’s support system

PHASES OF CRISIS;

D – denial- Initial reaction 

I – increased tension-person recognizes the crisis and continues to do ADLs

D – disorganization- person is preoccupied with the crisis and unable to do ADLs

A – attempts to reorganize- individual mobilizes previous coping mechanisms

Factors Impacting an Individual’s Response to Crisis

Each individual’s response to crisis is unique. Not every person experiencing stress will go on to experience crisis. Additionally, individuals exposed to the same crisis will
exhibit completely different responses. As noted by Watson and Fulambarker (2012), individuals develop balancing factors that determine the manner in which they will
respond to crisis. These balancing factors include the individual’s perception of the event, availability of situational supports, and availability of adequate coping strategies. 

 Developmental factors can also impact a person’s response to stress and development of crisis. For adults, a crisis can be difficult to accept and impossible to understand,
eroding feelings of personal and community safety. Adolescents and children may be even more deeply affected (Davidhizar & Shearer, 2002). The effects of disaster and
crisis on a child may interfere with normal growth and development, leading to negative long-term physical and psychological health outcomes (Crane & Clements, 2005).
Therefore, both physical and psychological emergency interventions must be addressed promptly in crisis, including natural and man-made disasters.

Development of Crisis

Phase 1

https://usl-tuguegarao.neolms.com/student_lesson/show/3165909?from=%2Fstudent_quiz_assignment%2Fshow%2F31059404&lesson_id=15128157 8/10
3/30/22, 11:11 AM CODE 157- Set 1 - https://usl-tuguegarao.neolms.com/student_lesson/show/3165909?from=%2Fstudent_quiz_assignment%2Fs…
Phase 1 begins with exposure to a significant precipitating stressor. This stressor can be large or small in scale (affecting a single individual or many persons), a natural or
human-initiated disaster, or an accident or an intentional affront.

Large-scale stressors such as disasters affect millions of people annually. Some of the more publicly recognized events include such natural disasters as earthquakes,
tornadoes, hurricanes, and floods. However, equally stressful are man-made disasters such as acts of terrorism and school shootings. For days and weeks after these events,
the video tapes are repeated over and over again in the media. People are repeatedly exposed to the horror and stress that these depictions evoke. Small-scale stressors or
individual stressors, such as a murdered family member or the terminal illness of a spouse, can also affect the lives of individuals in overwhelming ways (Stanley et al.,
2012).

During this phase, the individual experiences anxiety and begins to use previous problem-solving strategies used for coping. For some individuals with strong coping skills,
the crisis ends at this point. When the stress level is manageable, the brain may initiate actions to restore internal balance and resolve the threat or stress. How is this possible
for some? The brain does a computer-like search: “Have I encountered this problem before? How did I deal with it then? Do I possess internal resources that I can use to
deal with this problem? Do I have friends or family to count on?” Most people are resilient and can rebound from a transient stressor. This stress response becomes
problematic, however, when it cannot be resolved by the individual and the crisis begins to interrupt daily functioning (DHHS, 2005).

Phase 2

The individual moves into the second phase of crisis when anxiety exacerbates to a level where problem-solving ability is arrested or becomes unsuccessful. Stress interferes
with daily activities and the person becomes increasingly uncomfortable. The person struggles to find a previously used coping strategy. The lack of success with its use or
the inability to find an appropriate coping strategy leads to a sense of restlessness, confusion, and helplessness.

Phase 3

On moving into the third phase, the individual expands the search for helpful resources in an effort to relieve the psychological discomfort caused by the stressor. He or she
draws on all available resources, internal and external, in an attempt to relieve the stress and discomfort. For example, the person may try to look at the situation from a
different perspective or possibly ignore certain aspects of the situation in an attempt to cope. At this juncture, the individual searches for possible new methods for solutions,
and may seek the assistance of professionals such as services of a nurse, psychologist, crisis worker, or some other external source for possible answers and resolution. If the
new methods are effective, the crisis will resolve, allowing the individual to return to a functional level, which may be the same, higher, or lower than the person’s previous
level of functioning.

Phase 4

If individuals cannot find resolution in the second or third phases, their anxiety levels continue to build. Either they build “beyond a further threshold” or the “burden
increases to a breaking point” (Caplan, 1964). Here, the level of anxiety can approach panic or despair, the hallmark of this phase. Emotions are fragile and labile; thought
processes are disrupted, possibly even with psychotic thinking; and external supports are necessary.

CRISIS INTERVENTION

a way of entering into the life situation of an individual, family, group or community to help them mobilize their resources and to decrease the effect of a crisis
inducing stress
refers to the methods used to offer immediate, short-term help to an individual who experiences an event that produces emotional, mental, physical and behavioral
distress or problems.
goal:
to enable the patient to attain an optimum level of functioning
to decrease the emotional stress and to protect the crisis victim from additional stress
to assist the victim in organizing and mobilizing resources or support system to meet unique needs and reach a solution for the particular
situation that precipitated the crisis
primary role of the nurse: active and directive assistance to the patient

TECHNIQUES OF CRISIS INTERVENTION

Catharsis: The release of feelings that takes place as the patient talks about emotionally charged areas.

Clarification: Encouraging the patient to express more clearly the relationship between certain events.

Suggestion: Influencing a person to accept an idea or belief, particularly the belief that the nurse can help and that person will in time feel better.

Reinforcement of behavior: Giving the patient positive response to adaptive behavior.

Support of defenses: Encouraging the use of healthy, adaptive defenses and discouraging those that are unhealthy or maladaptive.

Rising self-esteem: Helping the patient regain feelings of self-worth eg;- you are very strong person to be able to manage the family all the time.

https://usl-tuguegarao.neolms.com/student_lesson/show/3165909?from=%2Fstudent_quiz_assignment%2Fshow%2F31059404&lesson_id=15128157 9/10
3/30/22, 11:11 AM CODE 157- Set 1 - https://usl-tuguegarao.neolms.com/student_lesson/show/3165909?from=%2Fstudent_quiz_assignment%2Fs…
Exploration of solution: Examining alternative ways of solving the immediate problem.

https://usl-tuguegarao.neolms.com/student_lesson/show/3165909?from=%2Fstudent_quiz_assignment%2Fshow%2F31059404&lesson_id=151281… 10/10