Lecture 3 - Anxiety, Anger, Aggression, Trauma

Question 1

What role do genetics play in stress?

Answer 1

Genetics determine stress reactivity, but do not predispose someone to dissociation

Question 2

How does repeated trauma effect the brain?

Answer 2

Repeated trauma alters release of NTs and changes anatomy of the brain

Question 3

What did Freud believe about anxiety?

Answer 3

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

Question 4

What did Harry Stack Sullivan believe about anxiety?

Answer 4

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.

Question 5

What did Dworkin et al determine about mental illness in sexual assault survivors?

Answer 5

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.

Question 6

What is stress vs anxiety?

Answer 6

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

Question 7

Anxiety is a feeling of apprehension or terror or dread that occurs as a result of….

Answer 7

a threat to a person’s being, self-esteem, or identity

Question 8

What is the normal response to anxiety?

Answer 8

1. physiological arousal (fight or flight)
2. Cognitive processes (identify threat and whether it should be approaches or avoided)
3. Coping strategies

Question 9

What is anticipation and mild anxiety?

Answer 9

Associated with tensions of daily living, motivates learning, growth and creativity

Person is alert and perceptual field increased. S/S: restlessness, irritability, relieving behaviour

Question 10

What is moderate anxiety?

Answer 10

Person focuses on immediate concerns, narrowing perceptual field

S/S: voice tremors, difficulty concentrating, pacing, increase VS, urinary frequency, headache,

Question 11

What is severe anxiety?

Answer 11

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

Question 12

What is panic?

Answer 12

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.

Question 13

How should you treat a person with moderate anxiety?

Answer 13

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)

Question 14

How should you treat a person with severe anxiety?

Answer 14

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)

Question 15

How should you treat a person in panic?

Answer 15

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.

Question 16

What is the difference between anger and rage?

Answer 16

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.

Question 17

Would we use behavioural interventions on a person experiencing rage?

Answer 17

No, behavioural interventions are useless.

Safety is top priority.

Question 18

What is the difference between a stressful experience and being traumatized?

Answer 18

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.

Question 19

What are the three E’s of trauma?

Answer 19

Event, Experience, Effect

Question 20

What is the difference between cultural competence and cultural humility?

Answer 20

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.

Question 21

What is a crisis?

Answer 21

Acute state of psychological imbalance caused by intensely felt threat or event, resulting in poor coping with causes distress and functional impairment.

Question 22

What are the three types of crisis?

Answer 22

Maturational - related to development
Situational - related to extraordinary life situations
Adventitious - not part of everyday life

Question 23

What are the four phases of crisis?

Answer 23

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.

Question 24

What are the four priorities in an assessment during a crisis?

Answer 24

1. Safety of all parties
2. Perceptions about crisis situations (precipitating factors)
3. Situational supports (friends, family, community based support services)
4. Evaluate anxiety level and coping skills utilized (smoking, drinking, overeating, screaming, yelling, fighting, etc.)

Question 25

What is the difference between different levels of nursing counselling interventions?

Answer 25

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

Question 26

What is a Critical Incident Stress Debriefing (CISD)?

Answer 26

Group intervention post crises to talk about situation, emotions, behavioural responses and health education (situational support and coping)

Question 27

What is the difference between aggression and violence?

Answer 27

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

Question 28

What are the phases of the cycle of violence?

Answer 28

Acute explosion –> Honeymoon –> Tension building

All hinges in denial.

Question 29

In which phase of the IPV cycle of violence does the victim employ coping mechanisms and makes up excuses for the behaviour?

Answer 29

Tension building

Question 30

What did Fallot and Harris Identify as the core values of trauma informed care?

Answer 30

–> Safety
–> Trustworthiness and transparency
–> Peer support
–> Collaboration and mutuality
–> Empowerment, voice, choice
–> Cultural, historical, and gender issues

Question 31

What is the goal of IPV?

Answer 31

Power and control

Question 32

What are the two phases of rape-trauma syndrome

Answer 32

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.

Question 33

What is the goal during Pre-assaultive phase in anger?

Answer 33

Facilitate expression of anger in a nonviolent manner though assessing behaviours, approaching calmly, and actively listening to the patient.

Question 34

What is the goal during the assaultive or aggressive stage of anger?

Answer 34

Ensure safety and attempt de-escalation techniques

Walk around with a patient with increased psychomotor agitation

Question 35

What are de-escalation techniques?

Answer 35

Maintain dignity, honesty, avoid struggles.

Question 36

What should be included in an assessment of victims of aggression and violence?

Answer 36

–> Level of Anxiety and Coping Response
–> Family Coping/abuse Patterns
–> Support systems
–> Suicide/homicide potential
–> Drug and alcohol use

Question 37

Which populations require mandatory reporting of abuse?

Answer 37

Children (always) and elders in care situations

Question 38

A nursing assessment of a Victim of Aggression and Violence includes what?

Answer 38

–> Level of Anxiety and Coping Response
–> Family Coping Patterns (hx of abuse)
–> Suicide and homicide potential
–> Drug/alcohol use

Question 39

What individual an family therapy types might to helpful to victims of violence?

Answer 39

Individual to build sense of self and help manage depression, anxiety, PTSD

Family - DBT