Mental Health Defense/Cognitive Flashcards
Catastrophizing
Cognitive Distortion
assuming the worst will happen
“I’m afraid to go to the doctor. I know this breast lump is cancer and I’m going to die.”
DIchotomous thinking
Cognitive Distortion
using all-or-nothing, black-or-white reasoning that interferes with a realistic self-perception
“Either my life has to be absolutely perfect, or I’ll kill myself.”
Labeling
Cognitive Distortion
labeling an event as a character flaw, so that instead of “I made a mistake,” a person says to himself,
“I’m a jerk,” or “I’m a loser.”
Magnification
Cognitive Distortion
attributing a high level of importance to an insignificant event – blowing things out of proportion
“I know he saw the coffee stain on my tie when I had my interview. Now I won’t get the job.”
Mind-reading
Cognitive Distortion
assuming knowledge of another person’s thoughts or motivations without validating perceptions
“I know him. He won’t care what I say. He’ll just do whatever he pleases anyway.”
Overgeneralization
Cognitive Distortion
taking information or an impression from one event and attaching it to a wide variety of situations
“Women always turn mean after you marry them.”
Personalization
Cognitive Distortion
interpreting events as pertaining only to oneself, also referred to as ideas of reference:
“I walked into the classroom and everyone stopped talking. I know they were talking about me.”
Selective abstraction
Cognitive Distortion
focusing on certain information while ignoring contradictory information
“That was just a fling. I know my husband loves me and will never leave me.”
Superstitious Thinking
Cognitive Distortion
believing that some unrelated action will magically influence the course of events
“If I wear my lucky socks, the ones I wore when we won the championship, my team will win today.”
Hallucinations
Perceptual Disturbance
auditory, visual, tactile (bugs crawling on skin), olfactory, gustatory, cenesthetic (feels internal bodily functions such as urine collecting), kinesthetic (sensation of bodily movement when client is still, such as floating above ground)
Illusion
Perceptual Disturbance
misperceptions of real external stimuli, i.e., a widower hears someone speak and believes it is his dead wife’s voice
Derealization
Perceptual Disturbance
feelings of unreality related to the environment, i.e., objects appear to shimmer, breathe; objects are diminished in size
Depersonalization
Perceptual Disturbance
feelings of unreality related to oneself, i.e., extremities have changed size; perceives self from a distance; robot-like
Defense Mechanisms
unconscious ways to avoid anxiety-producing situations, real or imagined
Acting Out
Defense Mechanism (Common) The use of actions versus reflection or true experiencing of feelings to handle stress or conflict (angry teen punches hole in wall).
Altruism
Defense Mechanism
Devoting oneself to serving others as a way to manage conflict and stress; differs from reaction formation because it is personally gratifying, not self-sacrificing (woman with history of childhood abuse seeks rewarding healing experience by volunteering for abuse hot-line).
Compensation
Defense Mechanism
Covering up for deficiencies in one area by excelling in another area (poor student academically excels in sports).
Denial
Defense Mechanism (Common)
Unconscious refusal to perceive or face unpleasant reality, an unacceptable idea or behavior (alcoholic says he doesn’t have a problem
Displacement
Defense Mechanism (Common)
The discharge of pent-up feelings (frequently hostility) onto something or someone else in the environment less threatening than the original source (Angry man takes it out on his wife after a stressful day at work; wife then yells at kids).
Dissociation
Defense Mechanism
Unconscious separation of painful feelings from an unacceptable idea, situation or object (amnesia for yesterday’s auto accident).
Fantasy
Defense Mechanism (Common)
Gratification of frustrated desires, achievements and relationships by substituting them with daydreams and imagery (alcoholic expects wife to stop divorce proceedings because he went through detox, even though he has no intention of going into rehab, attending AA).
Identification
Defense Mechanism
A conscious or unconscious attempt to model oneself after a respected (or counter-culture) person (preschooler uses gang hand gestures).
Intellectualization
Defense Mechanism (Common)
Using only abstract thinking or generalizations to control or minimize painful feelings (depressed man keeps conversation superficial).
Introjection
Defense Mechanism
Unconsciously incorporating wishes, values, and attitudes of others as if they are one’s own (without realizing it, client talks and acts like his therapist, analyzing other patients).
Isolation of affect
Defense Mechanism (Common)
Separation of feelings from thoughts and ideas that are originally associated with them (flat affect while describing recent death of son).
Help-rejecting complaining
Defense Mechanism
Repeated requests for help, suggestions or advice that is then rejected; the request disguises covert feelings of hostility towards others; complaints may be about problems of life, physical or psychological symptoms (“Yes, but that won’t work….”).
Humor
Defense Mechanism (Common)
Emphasis on ironic or amusing components of a crisis, conflict or stressor (woman makes fun of her own obesity).
Minimizing
Defense Mechanism (Common)
Not acknowledging the significance of one’s behavior in order to avoid personal responsibility (“I only hit her once.”).
Omnipotence
Defense Mechanism (Common)
Feeling or acting superior to others or as if one has special abilities or power (psychotic man says he’s Jesus).
Passive-aggression
Defense Mechanism (Common)
Expression of aggression toward others in indirect and nonassertive ways; covert hostility and resentment masked by overt compliance (patient agrees with need for medication, but throws out prescription).
Projection
Defense Mechanism (Common)
Blaming others or the environment for unacceptable desires, thoughts, shortcomings and mistakes (student blames teacher for failing).
Rationalization
Defense Mechanism (Common)
Justifying or excusing own behavior to avoid guilt, responsibility, conflict, loss of self respect (alcoholic says one drink is okay)
Reaction Formation
Defense Mechanism
Acting the opposite of what one thinks or feels in self-sacrificing way (woman who didn’t want children becomes super-mom).
Regression
Defense Mechanism (Common)
Returning to an earlier level of adaptation (5 year old asks for a bottle when baby brother is being fed; 45 year old requires mothering).
Repression
Defense Mechanism (Common)
Unconscious and involuntary process of forgetting painful ideas, events, conflicts, or impulses that are unacceptable.
Resistance
Defense Mechanism (Common)
Overt or covert antagonism toward remembering or processing anxiety-producing information (“Leave me alone!”).
Splitting
Defense Mechanism (Common)
Failure to integrate positive and negative aspects of oneself or others, resulting in polarized images of individuals as either all good or all bad (a common characteristic of borderline personality disorder. In the hospital, it is referred to as staff splitting).
Sublimation
Defense Mechanism
Channeling a socially unacceptable impulse into constructive, acceptable behavior (ruthless businessman donates to charity).
Substitution
Defense Mechanism
Substituting a socially acceptable activity for an unacceptable impulse (chewing gum rather than smoking).
Suppression
Defense Mechanism (Common)
Conscious inhibition of anxiety-producing impulse, idea, or feelings (“I don’t want to talk about it.” Or changes subject ).
Undoing
Defense Mechanism
Atonement for or an attempt to make up for unacceptable acts or wishes (unfaithful husband buys wife a car).
Coping Strategies
ways to cope with anxiety-producing situations, real or imagined
Effective/Adaptive Coping Strategies
solves the problem causing anxiety. Example: Client being discharged learns about meds, self-help groups in community. Keeps follow-up appointments, takes meds as prescribed, transitions back to community smoothly.
Anticipation
Effective/Adaptive Coping Strategy
Solves problem by anticipating consequences of events yet to come and thinking of options, solutions and alternatives; also can include experiencing the feelings associated with these thoughts. This is the problem-solving process.
Self-assertion
Effective/Adaptive Coping Strategy
Solves problem by expressing thoughts and feelings in direct ways that are not manipulative or intimidating
Self-observation
Effective/Adaptive Coping Strategy
Solves problem by reflecting on one’s own behavior, thoughts and feelings, followed by appropriate response.
Ineffective Coping Strategies
attempts to solve the anxiety generated by the problem, not the problem itself.
Palliative
Ineffective Coping Strategy
Momentarily decreases anxiety. Problem may or may not be solved eventually. Examples: avoiding eye contact, looking away, finding distractions in environment, changing subject, lying, pacing, foot swinging, fidgeting, yawning, nail biting, hair twisting, finger tapping, praying, crying, self-soothing, using humor, day dreaming, watching TV, minor anger outbursts, swearing, briefly focusing on others rather than self, brief periods of procrastination, alcohol use.
Anxiety about discharge is handled by watching TV all evening, then asking about meds and self-help groups before discharge the following morning. Follows through on recommendations given.
Maladaptive
Ineffective Coping Strategy
Less successful attempts to decrease anxiety with minimal attempts to solve the problem. Anxiety remains. Examples: relying on others to solve problem, withdrawal, avoidance, procrastination, oversleeping, overeating, alcohol or drug abuse, smoking, excessive physical exercise, excessive TV watching, codependent behaviors, covering up or more extensive lying, petty crime, suicidal ideation without a plan.
Discharge anxiety is handled by telling nurses he can remember appointment dates, medication instructions, and meeting locations. Fails to follow through completely. Remains anxious at work and home after discharge.
Dysfunctional
Ineffective Coping Strategy
Unsuccessful in reducing anxiety or solving problem. Anxiety remains. Examples: SI ideation with plan, suicide attempt, compulsions-self harm, drugs, alcohol, gambling, lying, spending, sex, binge/purge behaviors; impulsivity, physical aggression towards animate or inanimate objects, crime to support drug addiction, medication noncompliance requiring hospital readmission.
Discharge anxiety is handled by ignoring the nurse, leaving instructions in hospital, fighting with another patient, leaving AMA, failure to fill Rx. Readmission within weeks of discharge.
Thought-blocking
Cognitive Impairment: Form of Thought
sudden stop in speech or train of thought, lasts several seconds to a minute
Derailment
Cognitive Impairment: Form of Thought
speech is blocked and then begins again on unrelated topic
Circumstantial Speech
Cognitive Impairment: Form of Thought
includes many unnecessary, tedious details before arriving at the main idea; usually requires prompting from interviewer to keep client on track
Tangential Speech
Cognitive Impairment: Form of Thought
thoughts veer from main idea and never get back – irrelevant topics are introduced
Illogical Thinking
Cognitive Impairment: Form of Thought
expressed ideas are inconsistent, irrational, self contradictory
Confabulation
Cognitive Impairment: Form of Thought
unconsciously fills in memory gaps with imagined material – common in alcoholism
Flight of ideas
Cognitive Impairment: Form of Thought
racing thoughts with some connection – common in mania
Pressured Speech
Cognitive Impairment: Form of Thought
rapid, tense, strained, difficult to interrupt – typically present with flight of ideas
Loose Associations
Cognitive Impairment: Form of Thought
client unaware that there is no apparent relationship between thoughts – “We wanted to take the bus but the airport took all the traffic. Driving is the ticket when you want to get somewhere. No one needs a ticket to heaven. We all have it in our pockets.”
Clang associations
Cognitive Impairment: Form of Thought
usually rhyming, “Very cold, cold and bold, gold has been sold.”
Word Salad
Cognitive Impairment: Form of Thought
complete disorganization, “Most forward action grows life double plays circle uniform.”
Echolalia
Cognitive Impairment: Form of Thought
repetition of own words or words of others, sometimes in sing-song fashion
Perseveration
Cognitive Impairment: Form of Thought
repetition of own words, phrases, ideas – common in dementia
Neologism
Cognitive Impairment: Form of Thought
invents new words not understood by others, “She gave me a ride in her uniphonum.”
Poverty of speech
Cognitive Impairment: Form of Thought
restricted amount of speech, limited details – common in dementia
Concrete thinking
Cognitive Impairment: Form of Thought
literal interpretation of words such as proverbs, or expressions like “climbing the walls.”
Absence of abstract thinking
Cognitive Impairment: Form of Thought
causes inability to generalize, evaluate consequences
Persecutory/paranoid
Cognitive Impairment: Content of Thought (Delusion)
someone is trying to harm, spy on, follow, ridicule, belittle client
Grandiose
Cognitive Impairment: Content of Thought (Delusion)
client claims he associates with famous people or celebrities, or is famous, capable of great feats
Religious
Cognitive Impairment: Content of Thought (Delusion)
false beliefs with religious or spiritual themes, commonly centered on second coming of Christ
Erotomatic
Cognitive Impairment: Content of Thought (Delusion)
someone famous is in love with client
Somatic
Cognitive Impairment: Content of Thought (Delusion)
something abnormal, dangerous is happening to client’s body; diagnostic testing doesn’t change belief
Control
Cognitive Impairment: Content of Thought (Delusion)
feelings, thoughts, impulses, actions are imposed by an external force
Reference
Cognitive Impairment: Content of Thought (Delusion)
remarks of others are interpreted as related to client; TV broadcasts, music, newspaper articles have special meaning for client (such as with John Nash in the movie, A Beautiful Mind)
Thought broadcasting
Cognitive Impairment: Content of Thought (Delusion)
others can hear client’s unspoken thoughts
Thought withdrawal
Cognitive Impairment: Content of Thought (Delusion)
others are able to remove unspoken thoughts from client’s mind against his/her will
Thought insertion
Cognitive Impairment: Content of Thought (Delusion)
others can insert unspoken thoughts into client’s mind against his/her will
Thoughts of harming self/others
Cognitive Impairment: Content of Thought
Phobias
Cognitive Impairment: Content of Thought
Preoccupations
Cognitive Impairment: Content of Thought
Obsessions
Cognitive Impairment: Content of Thought
Compulsive Thoughts
Cognitive Impairment: Content of Thought
Suspiciousness
Cognitive Impairment: Content of Thought
Ruminations
Cognitive Impairment: Content of Thought
