Ch 2

Question 1

Mild anxiety

Answer 1

This level of anxiety is seldom a problem for the individual. It is associated with the tension experienced in response to the events of day-to-day living. Mild anxiety prepares people for action. It sharpens the senses, increases motivation for productivity, and results in a heightened awareness of the environment. Learning is enhanced, and the individual is able to function at his or her optimal level.

Question 2

Moderate anxiety

Answer 2

Moderate anxiety: As the level of anxiety increases, the extent of the perceptual field diminishes. The moderately anxious individual is less alert to events occurring in the environment. The individual’s attention span and ability to concentrate decrease, although he or she may still attend to needs with direction. Assistance with problem-solving may be required. Increased muscular tension and restlessness are evident.

Question 3

Panic anxiety

Answer 3

Panic anxiety: In this most intense state of anxiety, the individual is unable to focus on even one detail in the environment. Misperceptions are common, and a loss of contact with reality may occur. The individual may experience hallucinations or delusions. Behavior may be characterized by wild and desperate actions or extreme withdrawal. Human functioning and communication with others is ineffective. Panic anxiety is associated with a feeling of terror, and individuals may be convinced that they have a life-threatening illness or fear that they are “going crazy,” are losing control, or are emotionally weak. Prolonged panic anxiety can lead to physical and emotional exhaustion and can be a life-threatening situation.

Question 4

Coping mechanisms of mild anxiety

Answer 4

■Sleeping
■Yawning
■Eating
■Drinking
■Physical exercise
■Daydreaming
■Smoking
■Laughing
■Crying
■Cursing
■Pacing
■Nail biting
■Foot swinging
■Finger tapping
■Fidgeting
■Talking to someone with whom one feels comfortable

Question 5

Mild anxiety characteristics

Answer 5

Heightened perception (e.g., noises may seem louder; details within the environment are clearer)
Increased awareness
Increased alertness
Learning is enhanced
Restlessness Irritability
May remain superficial with others
Rarely experienced as distressful
Motivation is increased

Question 6

Moderate anxiety characteristic

Answer 6

Moderate
Reduction in perceptual field
Reduced alertness to environmental events (e.g., someone talking may not be heard; part of the room may not be noticed)
Learning still occurs but not at optimal ability
Decreased attention span
Decreased ability to concentrate
Increased restlessness
Increased heart and respiration rates
Increased perspiration
Gastric discomfort
Increased muscular tension
Increase in speech rate, volume, and pitch
A feeling of discontent
May lead to a degree of impairment in interpersonal relationships as individual begins to focus on self and the need to relieve personal discomfort

Question 7

Severe anxiety characteristics

Answer 7

Severe
Greatly diminished; only extraneous details are perceived, or fixation on a single detail may occur
May not take notice of an event even when attention is directed by another
Extremely limited attention span
Unable to concentrate or problem-solve
Effective learning cannot occur
Headaches
Dizziness
Nausea
Trembling
Insomnia
Palpitations
Tachycardia
Hyperventilation
Urinary frequency
Diarrhea
Feelings of dread, loathing, horror
Total focus on self and intense desire to relieve the anxiety

Question 8

Panic anxiety characteristics

Answer 8

Panic
Unable to focus on even one detail within the environment
Misperceptions of the environment common (e.g., a perceived detail may be elaborated and out of proportion)
Learning cannot occur
Unable to concentrate
Unable to comprehend even simple directions
Dilated pupils
Labored breathing
Severe trembling
Sleeplessness
Palpitations
Diaphoresis and pallor
Muscular incoordination
Immobility or purposeless hyperactivity
Incoherence or inability to verbalize
Sense of impending doom
Terror
Bizarre behavior, including shouting, screaming, running about wildly, clinging to anyone or anything from which a sense of safety and security is derived
Hallucinations, delusions
Extreme withdrawal into self

Question 9

Neurosis

Answer 9

Neuroses are psychiatric disturbances characterized by excessive anxiety that is expressed directly or altered through defense mechanisms. It appears as a symptom such as an obsession, compulsion, phobia, or sexual dysfunction. The following are common characteristics of people with neuroses:
■They are aware that they are experiencing distress.
■They are aware that their behaviors are maladaptive.
■They are unaware of any possible psychological causes of the distress.
■They feel helpless to change their situation.
■They experience no loss of contact with reality.

Question 10

Anxiety disorder

Answer 10

Anxiety disorders: Disorders in which the characteristic features are symptoms of anxiety and avoidance behavior (e.g., phobias, panic disorder, generalized anxiety disorder, and separation anxiety disorder).

Question 11

Somatic symptom disorder

Answer 11

Somatic symptom disorders: Disorders in which the characteristic features are physical symptoms for which there is no evident organic pathology. Psychological factors are judged to play a significant role in the onset, severity, exacerbation, or maintenance of the symptoms (e.g., somatic symptom disorder, illness anxiety disorder, conversion disorder, and factitious disorder).

Question 12

Dissociative disorder

Answer 12

Dissociative disorders: Disorders in which the characteristic feature is a disruption in the usually integrated functions of consciousness, memory, identity, or perception of the environment (e.g., dissociative amnesia, dissociative identity disorder, and depersonalization-derealization disorder).

Question 13

Compensation

Answer 13

COMPENSATION

Covering up a real or perceived weakness by emphasizing a trait one considers more desirable

Example:
A physically disabled boy is unable to participate in football, so he compensates by becoming a great scholar.

Question 14

Rationalization

Answer 14

RATIONALIZATION
Attempting to make excuses or formulate logical reasons to justify unacceptable feelings or behaviors

Example:
A patient tells the rehab nurse, “I drink because it’s the only way I can deal with my bad marriage and my worse job.”

Question 15

Denial

Answer 15

DENIAL
Refusing to acknowledge the existence of a real situation or the feelings associated with it

Example
A woman drinks alcohol every day and cannot stop, failing to acknowledge that she has a problem.

Question 16

Reaction formation

Answer 16

REACTION FORMATION
Preventing unacceptable or undesirable thoughts or behaviors from being expressed by exaggerating opposite thoughts or types of behaviors
A student hates nursing and only attended nursing school to please her parents. During career day, she speaks to prospective students about the excellence of nursing as a career.

Question 17

Displacement

Answer 17

DISPLACEMENT
The transfer of feelings from one target to another that is considered less threatening or that is neutral
A patient is angry with his physician, does not express it, but becomes verbally abusive with the nurse.

Question 18

Regression

Answer 18

REGRESSION
Retreating in response to stress to an earlier level of development and the comfort measures associated with that level of functioning
When a 2-year-old is hospitalized for tonsillitis, he will drink only from a bottle, even though his mother states he has been drinking from a cup for 6 months.

Question 19

Identification

Answer 19

IDENTIFICATION
An attempt to increase self-worth by acquiring certain attributes and characteristics of an individual one admires
A teenager who required lengthy rehabilitation after an accident decides to become a physical therapist as a result of his experiences.

Question 20

Repression

Answer 20

REPRESSION
Involuntarily blocking unpleasant feelings and experiences from one’s awareness
A trauma victim is unable to remember anything about the traumatic event.

Question 21

Intellectualization

Answer 21

INTELLECTUALIZATION
An attempt to avoid expressing actual emotions associated with a stressful situation by using the intellectual processes of logic, reasoning, and analysis
A woman’s husband is being transferred with his job to a city far away from her parents. She hides anxiety by explaining to her parents the advantages associated with the move.

Question 22

Sublimation

Answer 22

SUBLIMATION
Rechanneling of drives or impulses that are personally or socially unacceptable into activities that are constructive
A mother whose son was killed by a drunk driver channels her anger and energy into being the president of the local chapter of Mothers Against Drunk Driving.

Question 23

Introjection

Answer 23

INTROJECTION
Integrating the beliefs and values of another individual into one’s own ego structure
Children integrate their parents’ value system into the process of conscience formation. A child says to a friend, “Don’t cheat. It’s wrong.”

Question 24

Suppression

Answer 24

SUPPRESSION
The voluntary blocking of unpleasant feelings and experiences from one’s awareness
“I don’t want to think about that now. I’ll think about that tomorrow.”

Question 25

Isolation

Answer 25

ISOLATION
Separating a thought or memory from the feeling, tone, or emotion associated with it
A young woman describes being attacked and raped without showing any emotion.

Question 26

Undoing

Answer 26

UNDOING
Symbolically negating or canceling out an experience that one finds intolerable
A man is nervous about his new job and yells at his wife. On his way home he stops and buys her some flowers.

Question 27

Projection

Answer 27

PROJECTION
Attributing feelings or impulses unacceptable to one’s self to another person
A man who is addicted to alcohol blames his wife for his excessive drinking.

Question 28

Psychosis of panic anxiety

Answer 28

Psychosis is defined as a significant thought disturbance in which reality testing is impaired, resulting in delusions, hallucinations, disorganized speech, or catatonic behavior. The following are common characteristics of people with psychoses:

Question 29

Characteristic of psychosis

Answer 29

■They exhibit minimal distress (emotional tone is flat, bland, or inappropriate).
■They are unaware that their behavior is maladaptive.
■They are unaware of any psychological problems (anosognosia).
■They are exhibiting a flight from reality into a less stressful world or one in which they are attempting to adapt.

Examples of psychotic responses to anxiety include schizophrenic, schizoaffective, and delusional disorders.

Question 30

Panic anxiety

Answer 30

At this extreme level of anxiety, an individual is not capable of processing what is happening in the environment and may lose contact with reality.

Question 31

Grief

Answer 31

Grief is a subjective feeling of sorrow and sadness accompanied by emotional, physical, and social responses to the loss of a loved person or thing

Question 32

Grief

Answer 32

Most individuals experience intense emotional anguish in response to a significant personal loss. A loss is anything that is perceived as such by the individual. Any situation that creates change for an individual can be identified as a loss. Failure (either real or perceived) also can be viewed as a loss.

Question 33

Stages of Grief

Answer 33

Stage 1—Denial: This is a stage of shock and disbelief. The response may be one of “No, it can’t be true!” The reality of the loss is not acknowledged.
Stage 2—Anger: “Why me?” and “It’s not fair!” are comments often expressed during the anger stage. Envy and resentment toward individuals not affected by the loss are common.
Stage 3—Bargaining: During this stage, which is usually not visible or evident to others, a “bargain” is made with God in an attempt to reverse or postpone the loss:
Stage 4—Depression: During this stage, the full impact of the loss is experienced. The sense of loss is intense, and feelings of sadness and depression prevail.
Stage 5—Acceptance: The final stage brings a feeling of peace regarding the loss that has occurred.

Question 34

Problem with anticipatory grief

Answer 34

Problems arise, particularly in anticipating the death of a loved one, when family members experience anticipatory grieving and complete the mourning process prematurely. They disengage emotionally from the dying person, who may then experience feelings of rejection by loved ones at a time when this psychological support is so necessary.

Question 35

Bereavement overload

Answer 35

Length of the grieving process is also affected by the number of recent losses experienced by an individual and whether he or she is able to complete one grieving process before another loss occurs. Grief accumulates into a bereavement overload, which for some individuals is perceived as difficult or even impossible to overcome.

Question 36

Prolonged grief response

Answer 36

The prolonged response is characterized by an intense preoccupation with memories of the lost entity for many years after the loss has occurred. Behaviors associated with the stages of denial or anger are manifested, and disorganization of functioning and intense emotional pain related to the lost entity are evidenced.

Question 37

Delayed or inhibited response

Answer 37

In the delayed or inhibited response, the individual becomes fixed in the denial stage of the grieving process. The emotional pain associated with the loss is not experienced, but anxiety disorders (e.g., phobias, somatic symptom disorders) or sleeping and eating disorders (e.g., insomnia, anorexia) may be evident. The individual may remain in denial for many years until the grief response is triggered by a reminder of the loss or even by an unrelated loss.

Question 38

Distorted grief response

Answer 38

The individual who experiences a distorted response is fixed in the anger stage of grieving. In the distorted response, all the normal behaviors associated with grieving, such as helplessness, hopelessness, sadness, anger, and guilt, are exaggerated out of proportion to the situation. The individual turns the anger inward on the self, is consumed with overwhelming despair, and is unable to function in normal activities of daily living. Distorted grief reactions may culminate in pathological depression.

Question 39

Ego defense mechanisms

Answer 39

Compensation
Denial
Displacement
Identification
Isolation
Projection
Rationalization
Regression
Repression
Sublimation
Suppression
Undoing

Question 40

Psychophysiological

Answer 40

Headaches
Anorexia
Arthritis
Colitis
Ulcers
Asthma
Pain
Cancer
CHD
Sexual dysfunction

Question 41

Psychoneurotic
Responses

Answer 41

Phobias
Obsessions
Compulsions
Hypochondriasis
Conversion disorder
Multiple
personalities
Amnesia
Fugue

Question 42

Psychotic responses

Answer 42

Hallucinations and Delusions