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Chapter 13

Understanding Anxiety and Anxiety Defenses

Chapter 13

Understanding Anxiety and Anxiety Defenses

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Anxiety vs. FearAnxiety vs. Fear

ANXIETY

• Reaction to an unspecified danger

FEAR

• Reaction to a specific danger

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Anxiety operationally definedAnxiety operationally defined

13-313-3 (Fig. 13-1)(Fig. 13-1)

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Perceptual field heightened

Grasps what is happening

Identifies disturbing things

Can work toward a goal

Can examine alternatives

Experiences slight discomfort

Restlessness, irritability

Mild tension relieving behaviors

Perceptual field heightened

Grasps what is happening

Identifies disturbing things

Can work toward a goal

Can examine alternatives

Experiences slight discomfort

Restlessness, irritability

Mild tension relieving behaviors

Mild AnxietyMild Anxiety

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Perceptual field narrows

Selective inattention

Needs to have things pointed out

Problem solving ability moderately impaired

Benefits from guidance

Shaky voice, concentration difficult

Sympathetic nervous system symptoms

Somatic complaints

Perceptual field narrows

Selective inattention

Needs to have things pointed out

Problem solving ability moderately impaired

Benefits from guidance

Shaky voice, concentration difficult

Sympathetic nervous system symptoms

Somatic complaints

Moderate AnxietyModerate Anxiety

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Perceptual field greatly reduced

Attention scattered

Self-absorbed

Can’t attend to events or see connections

Perceptions distorted

Feelings of dread/doom

Sympathetic nervous system symptoms

Confusion, purposeless activity

Perceptual field greatly reduced

Attention scattered

Self-absorbed

Can’t attend to events or see connections

Perceptions distorted

Feelings of dread/doom

Sympathetic nervous system symptoms

Confusion, purposeless activity

Severe AnxietySevere Anxiety

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Unable to focus on environment

Terror, emotional paralysis

Hallucinations/delusions

Muteness, severe withdrawal

Immobility or extreme agitation, severe shakiness

Disorganized, irrational thinking

Unintelligible speech

Sleeplessness

Unable to focus on environment

Terror, emotional paralysis

Hallucinations/delusions

Muteness, severe withdrawal

Immobility or extreme agitation, severe shakiness

Disorganized, irrational thinking

Unintelligible speech

Sleeplessness

Panic Level AnxietyPanic Level Anxiety

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Manage conflict and affect

Are relatively unconscious

Are discrete from one another

Are often hallmarks of psychiatric syndromes

Are reversible

Are adaptive as well as pathological

Manage conflict and affect

Are relatively unconscious

Are discrete from one another

Are often hallmarks of psychiatric syndromes

Are reversible

Are adaptive as well as pathological

Defenses against AnxietyDefenses against Anxiety

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SublimationSublimation

13-913-9

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HumorHumor

13-1013-10

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SuppressionSuppression

13-1113-11

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CompensationCompensation

13-1213-12

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IntrojectionIntrojection

13-1313-13

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IdentificationIdentification

13-1413-14

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RepressionRepression

13-1513-15

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DisplacementDisplacement

13-1613-16

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Reaction FormationReaction Formation

13-1713-17

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SomatizationSomatization

13-1813-18

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UndoingUndoing

13-1913-19

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RationalizationRationalization

13-2013-20

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RegressionRegression

13-2113-21

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ProjectionProjection

13-2213-22

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DenialDenial

13-2313-23

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Help identify anxiety and antecedents to anxiety

Anticipate anxiety-provoking situations

Demonstrate interest

Encourage talk about feelings and concerns

Keep communication open

Use clarification to understand

Encourage problem solving

Use role playing, modeling

Explore behaviors used in past

Provide outlets for excess energy

Help identify anxiety and antecedents to anxiety

Anticipate anxiety-provoking situations

Demonstrate interest

Encourage talk about feelings and concerns

Keep communication open

Use clarification to understand

Encourage problem solving

Use role playing, modeling

Explore behaviors used in past

Provide outlets for excess energy

Interventions: Mild to Moderate AnxietyInterventions: Mild to Moderate Anxiety

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Maintain calm manner

Remain with client

Minimize environmental stimuli

Use clear, simple statements and repetition

Low pitched voice; speak slowly

Reinforce reality if distortions occur

Listen for themes

Meet physical and safety needs

Set verbal limits/physical limits

Assess need for medication or seclusion

Maintain calm manner

Remain with client

Minimize environmental stimuli

Use clear, simple statements and repetition

Low pitched voice; speak slowly

Reinforce reality if distortions occur

Listen for themes

Meet physical and safety needs

Set verbal limits/physical limits

Assess need for medication or seclusion

Interventions: Severe to Panic AnxietyInterventions: Severe to Panic Anxiety

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