Lecture 3 - Anxiety, Anger, Aggression, Trauma Flashcards
What role do genetics play in stress?
Genetics determine stress reactivity, but do not predispose someone to dissociation
How does repeated trauma effect the brain?
Repeated trauma alters release of NTs and changes anatomy of the brain
What did Freud believe about anxiety?
Anxiety occurs when there is a threat of breakthrough of repressed emotions or ideas. The ego uses defense mechanisms to keep anxiety to manageable levels
What did Harry Stack Sullivan believe about anxiety?
Anxiety is linked to emotional distress d/t early needs going unmet or disapproval.
He also suggests that anxiety is contagious from mother to infant.
What did Dworkin et al determine about mental illness in sexual assault survivors?
Survivors of SA have a higher prevalence of mental disorders than those who are not, with depressive disorders and PTSD being the most common. The prevalence of PTSD in SA survivors is higher than with any other form of trauma.
What is stress vs anxiety?
Stress
–> A response to a threat in a situation, comes from the pressures we feel in life: adrenaline is released, extended stay of hormone causes depression, rise in the blood pressure and other changes
Anxiety
–> A reaction to stress that may go on after the stressor is gone
–> Anxiety is a feeling of apprehension or fear, the source is not always recognized which leads to further distress
Anxiety is a feeling of apprehension or terror or dread that occurs as a result of….
a threat to a person’s being, self-esteem, or identity
What is the normal response to anxiety?
- physiological arousal (fight or flight)
- Cognitive processes (identify threat and whether it should be approaches or avoided)
- Coping strategies
What is anticipation and mild anxiety?
Associated with tensions of daily living, motivates learning, growth and creativity
Person is alert and perceptual field increased. S/S: restlessness, irritability, relieving behaviour
What is moderate anxiety?
Person focuses on immediate concerns, narrowing perceptual field
S/S: voice tremors, difficulty concentrating, pacing, increase VS, urinary frequency, headache,
What is severe anxiety?
Significant reduction in perceptual field, all activity is directed to relieving anxiety. Focus is on self and environment is blocked out, sense of impending doom.
S/S: inability to process info and make decisions, purposeless activity
What is panic?
Associated with dread and terror, person is unable to do things even with direction. Disorganized personality and loss of rational thought. Distorted perception and emotionally paralyzed. Unable to communicate and function.
S/S: terror, dilated pupils, pallor, unintelligible or mute, severe tremors, hallucinations, withdrawal or agitation.
How should you treat a person with moderate anxiety?
ask focused questions to allow client to voice concerns, to ventilate, remain calm, provide direction, provide outlet for tension.
Can put in place coping skills that are already learned (in vivo support)
How should you treat a person with severe anxiety?
maintain a calm disposition, remain with person give direction and assure safety, reduce environmental stimuli, use calm low-pitched voice, short clear directions.
Can put in place coping skills that are already learned (in vivo support)
How should you treat a person in panic?
remain with client, offer support and keep talking to the person even though they may not be able to respond, provide safety, solitude, kindness. If person extremely agitated provide for physical safety.
Sole goal is safety of nurse and patient.
What is the difference between anger and rage?
Anger is a normal emotional response that can be released appropriately or inappropriately, can be suppressed over period of times. Occurs when the self becomes threatened, anger is a coping mechanism.
Rage is an uncontrollable state of anger, is thinking illogically and unclearly. Behavioural interventions are useless.
Would we use behavioural interventions on a person experiencing rage?
No, behavioural interventions are useless.
Safety is top priority.
What is the difference between a stressful experience and being traumatized?
The level of experienced helplessness. (Levine, 2010)
The strength of the social network and healthy relationships plays a substantial role in protecting from stress, distress, and trauma.
What are the three E’s of trauma?
Event, Experience, Effect
What is the difference between cultural competence and cultural humility?
Competence
–> providing care based on a person’s culture; impossible and reductive to the individual
Humility
–> Derived from a critique of competence notion: ask the person about the normative practices and behaviours of their culture and subcultures.
What is a crisis?
Acute state of psychological imbalance caused by intensely felt threat or event, resulting in poor coping with causes distress and functional impairment.
What are the three types of crisis?
Maturational - related to development
Situational - related to extraordinary life situations
Adventitious - not part of everyday life
What are the four phases of crisis?
1 - crisis occurs and threatens self - trigger coping mechanisms
2 - failed coping mechanisms and extreme discomfort and disorganized behaviours
3 - If trial and error fails and panic sets in, the person searches for automatic relief such as flight or withdrawal. Resolution such as compromising needs or redefining the situation to reach a acceptable solution might be made
4 - Problem remains unresolved and the person transitions into mental health emergency: self-care limitations, self-harm, harm to others. Personality disorganization, depression, confusion.
What are the four priorities in an assessment during a crisis?
- Safety of all parties
- Perceptions about crisis situations (precipitating factors)
- Situational supports (friends, family, community based support services)
- Evaluate anxiety level and coping skills utilized (smoking, drinking, overeating, screaming, yelling, fighting, etc.)
What is the difference between different levels of nursing counselling interventions?
Primary - health promotion and reduce incidents of crises by teaching coping mechanisms
Secondary - During an acute crisis situation
Tertiary - After severe crisis and now recovering from disabling mental state
What is a Critical Incident Stress Debriefing (CISD)?
Group intervention post crises to talk about situation, emotions, behavioural responses and health education (situational support and coping)
What is the difference between aggression and violence?
Aggression
–> Emotion that results in a verbal or physical attack (emotional or reactive aggression)
Violence
–> Aggression with the intent to harm. Includes psychological, emotional, damage to property, suicide and self-harm
What are the phases of the cycle of violence?
Acute explosion –> Honeymoon –> Tension building
All hinges in denial.
In which phase of the IPV cycle of violence does the victim employ coping mechanisms and makes up excuses for the behaviour?
Tension building
What did Fallot and Harris Identify as the core values of trauma informed care?
–> Safety
–> Trustworthiness and transparency
–> Peer support
–> Collaboration and mutuality
–> Empowerment, voice, choice
–> Cultural, historical, and gender issues
What is the goal of IPV?
Power and control
What are the two phases of rape-trauma syndrome
Acute Phase
–> Lasts 2-3 weeks
–> Disorganization in life and somatic symptoms
–> Dissociation and impaired cognitive functions
–> Possible restlessness or lability
–> Minimization of experience
Long-Term Phase
–> Intrusive thoughts and increased activity due to fear of reoccurrence.
–> Lability, phobias and fears, disruption of sex life.
What is the goal during Pre-assaultive phase in anger?
Facilitate expression of anger in a nonviolent manner though assessing behaviours, approaching calmly, and actively listening to the patient.
What is the goal during the assaultive or aggressive stage of anger?
Ensure safety and attempt de-escalation techniques
Walk around with a patient with increased psychomotor agitation
What are de-escalation techniques?
Maintain dignity, honesty, avoid struggles.
What should be included in an assessment of victims of aggression and violence?
–> Level of Anxiety and Coping Response
–> Family Coping/abuse Patterns
–> Support systems
–> Suicide/homicide potential
–> Drug and alcohol use
Which populations require mandatory reporting of abuse?
Children (always) and elders in care situations
A nursing assessment of a Victim of Aggression and Violence includes what?
–> Level of Anxiety and Coping Response
–> Family Coping Patterns (hx of abuse)
–> Suicide and homicide potential
–> Drug/alcohol use
What individual an family therapy types might to helpful to victims of violence?
Individual to build sense of self and help manage depression, anxiety, PTSD
Family - DBT
