Module 1E: Pychology

Question 1

Erik Erikson

Answer 1

Psychologist who developed the concepts of stages of life based on a person’s age.

Erikson believed that society and culture affect how the personality of an individual develops and that successful completion of each stage supports the healthy development of the person’s ego.

Question 2

Erik Erikson’s 8 Stages of Development

Answer 2

The eight stages of development offer a guideline for identifying the psychosocial challenges patients face at different periods in their lives and the tasks they must master before successfully transitioning to the next stage of development.

1. Trust vs. Mistrust
2. Autonomy vs. Shame and Doubt
3. Initiative vs. Guilt
4. Industry vs. Inferiority
5. Identity vs. Role Confusion
6. Intimacy vs. Isolation
7. Generativity vs. Stagnation
8. Ego Integrity vs. Despair

Question 3

Trust vs. Mistrust

Answer 3

Stage 1: Psychosocial crisis for infants.
- Successful outcome: trust
- Unsuccessful outcome: mistrust

The developmental tasks for infants are to form an attachment with and develop trust in their primary caregiver and then generalize those bonds to others. They also begin to trust their own body as they learn gross and then fine motor skills.

Question 4

Autonomy vs. Shame and Doubt

Answer 4

Stage 2: Psychosocial crisis for toddlers.
- Successful outcome: autonomy
- Unsuccessful outcome: shame and doubt

During this stage, toddlers begin to develop a sense of independence, autonomy, and self-control. They also acquire language skills. Parents should be firm but tolerant with toddlers.

Question 5

Initiative vs. Guilt

Answer 5

Stage 3: Psychosocial crisis for preschoolers.
- Successful outcome: Initiative
- Unsuccessful outcome: Guilt

During this stage, children look for new experiences but will hesitate when adults reprimand them or restrict them from trying new things. Preschoolers have an active imagination and are curious about everything around them. Eventually they will start feeling guilt for some of their actions, which is part of the natural development of moral judgment.

Question 6

Industry vs. Inferiority

Answer 6

Stage 4: Psychosocial crisis for school-age children
- Successful outcome: Industry
- Unsuccessful outcome: Inferiority

During this stage, children need to receive recognition for accomplishments to provide reinforcement and build self-confidence. If the achievements are met with a negative response, inferiority can be established. Children require acknowledgment of their successes.

Question 7

Identity vs. Role Confusion

Answer 7

Stage 5: Psychosocial crisis for adolescents
- Successful outcome: Identity
- Unsuccessful outcome: Role connection

During identify vs. role confusion, adolescents try to figure out where they fit in and what direction their life should take. If role confusion sets in, adolescents become followers, which can lead to poor decision-making

Question 8

Intimacy vs. Isolation

Answer 8

Stage 6: Psychosocial crisis for young adults
- Successful outcome: Intimacy
- Unsuccessful outcome: Isolation

During this stage, young adults begin to think about partnership, marriage, family, and career. Lack of fulfillment in this key area of life can lead to isolation and withdrawal.

Question 9

Generativity vs. Stagnation

Answer 9

Stage 7: Psychosocial crisis for middle adults
- Successful outcome: Generativity
- Unsuccessful outcome: Stagnation

During this stage, adults continue raising children, and some become grandparents. They want to help mold future generations, so they often involve themselves in teaching, coaching, writing, and social activism.

Question 10

Ego Integrity vs. Despair

Answer 10

Stage 8: Psychosocial crisis for older adults
- Successful outcome: Ego Integrity
- Unsuccessful outcome: Despair

During this stage, most adults retire; their children, if they have any, no longer live at home. Many will volunteer to retain a feeling of usefulness. Their bodies experience age-related changes, and health becomes a major concern, especially as friends and loved ones die.

Question 11

Mental Health

Answer 11

Refers to a person’s cognitive abilities, behaviors, and emotions.

There are over 300 recognized mental illnesses

Can be caused by:
- biological issues (such as genetics)
- environmental issues (such as learned behaviors, poor coping mechanisms, traumatic experiences)
- or a combination of both.

Question 12

Depression

Answer 12

Mood disorder that can be caused by a chemical imbalance in the brain

Signs and Symptoms: Extreme sadness, fatigue, lethargy, hopelessness, pain, digestive issues, extreme lack of motivation (even with activities and hobbies that previously were enjoyable), thoughts of suicide

Treatment: Typically managed best with a combination of therapy, healthy lifestyle, and medication

Question 13

Attention-deficit/hyperactivity disorder (ADHD)

Answer 13

Chronic condition that typically begins in childhood but can impact individuals throughout their life

Signs and Symptoms:
- Inattention in which the individual struggles to regulate attention and focus, making it difficult to follow directions and stay organized
- Hyperactivity and impulsivity can present as constant fidgeting, excessive talking, and struggling with quiet activities.
- More commonly diagnosed in boys

Treatment: Medications and behavior therapies

Question 14

Anxiety

Answer 14

Disorders that lead to extreme feelings of worry and fear, to the point that the person’s ability to function and respond to typical situations is inhibited

Signs and Symptoms: Uncontrolled levels of stress, fast heart rate, sweating, and being consumed by worry

Treatment: Therapy, healthy lifestyle, and medication

Question 15

Post-traumatic stress disorder (PTSD)

Answer 15

A condition resulting from a traumatic or terrifying event
- Not everyone who experiences a traumatic event will develop PTSD.
- War veterans; people who have experienced physical, emotional, or sexual abuse; people who have lived through an attack or natural disaster; and those who have lost a loved one might experience PTSD.

Signs and Symptoms: Intrusive memories (such as flashbacks to the event), negative changes (negative thoughts and hopelessness), changes in reactions (new and potentially aggressive behaviors), trouble with concentration and sleep, self-destructive behaviors, and avoidance (avoiding places, people, or experiences associated with the negative event; avoiding loved ones; avoidance of discussing the event)

Treatment: Psychotherapy, exposure therapy, and medication

Question 16

Stressor

Answer 16

Anything that causes anxiety or stress.

Many things in the environment cause stress, as do psychological factors (grief, depression, loss, guilt). Even things that are positive (taking a vacation, having an intimate experience, graduating from college) can be stressors.

Question 17

Environmental Stressors

Answer 17

(aka physical stressors) Are situations that cause enough stress to become obstacles to achieving goals or having positive experiences.

EX:
- Things in the environment: air pollution, ultraviolet rays from excessive sun exposure, overcrowding, language and cultural barriers, discrimination
- Events in the environment: death of a loved one, theft, vandalism, motor-vehicle crashes, physical assault, job, school problems, major disasters (fires, floods, tornadoes, earthquakes, hurricanes, war

Question 18

Socioeconomic Stressors

Answer 18

Financial stress

EX: retirement, changes in the economy that lead to a loss of investments, identity theft, lack of job security, involuntary job loss (getting fired), or the loss of a home or vehicle.

Question 19

Why do similar stressors affect people differently?

Answer 19

The mind interprets the severity of the situation and helps the person cope with it in a positive way. People deal with the stressor based on their perception, experience, and resources they have available to them.

Question 20

Communication Practices with Developmental Delays

Answer 20

1. When working with patients who have mental or emotional disabilities determine how they communicate and what level of communication they understand.
2. Always address the patient first. Family members and caregivers can assist with this, but do not assume the patient is incapable of communicating.
3. Remain calm, avoid showing impatience, and speak at a consistent volume.
4. Any time you cannot understand something the patient says, ask for clarification.
5. Advocate for patients and always treat them with respect and empathy.
6. Provide accommodations to meet patients’ needs and ask how to assist during their visit.

Question 21

Communication Practices with Chronic Illiness

Answer 21

1. Casual, routine opening lines like an excessively cheerful “How are you doing today?” can provoke defensive responses like, “How do you think I’m doing? I’m dying.” Even if the patient doesn’t say that, they might think it. Instead, welcome these patients warmly and respect their dignity. Treat them with kindness and care at all times.
2. Offer support and empathy, and allow the patient to set the tone of the conversation. Never say you know how the patient feels. All feelings are unique to the individual, so to express this belittles the person and shows a lack of respect for their individuality.
3. Listen carefully to the patient, maintain eye contact, and always ask how to help.
4. Prior to beginning medical data collection, use a broad opening like, “What would you like to talk about today?” How the patient answers will help set the tone for the remainder of the interaction.
5. Make sure the patient has all the services they need, such as hospice referrals, meal-delivery services, and home health assistance. Support groups and community services can also help; these services can provide social experiences and an outlet for dying patients and their families.

Question 22

Communication Practices with Physical Disabilities

Answer 22

Provide physical space and remove barriers for those in a wheel chair

Vision loss: provide Braille signs and reading materials along with large-print materials. Use descriptive language when speaking with these patients and avoid touching without verbally alerting the patient first.

Hearing loss: offer services such as online appointment scheduling. Patients might be able to communicate well in person but have considerable difficulty hearing and understanding speech on the telephone, making scheduling difficult. Stand directly in line with the patient’s face when speaking, not from the side or behind them. Pronounce words clearly to allow the individual to see lip movements as well as hear what is said. Do not shout. Clarity of speech is much more important in facilitating understanding. If a sign-language interpreter is requested, by federal law, the office must provide an interpreter.

Question 23

Defense Mechanisms

Answer 23

Coping strategies people use to protect themselves from negative emotions such as guilt, anxiety, fear, and shame.

• Can be adaptive and help the individual change or adjust as they come to terms with the stressor.
• Maladaptive defense mechanisms hinder change and adjustment.

Question 24

Apathy

Answer 24

Indifference; lack of interest, feeling, concern, or emotion

Ex: “I don’t care what she puts in my evaluation, it won’t change anything.”

Question 25

Compensation

Answer 25

Balancing a failure or inadequacy with an accomplishment

Ex: “I ate a lot of candy yesterday, but I also ate a big green salad.”

Question 26

Conversion

Answer 26

Transformation of an anxiety into a physical symptom that has no cause

Ex: “I get a severe headache every time I see my ex with his new wife.”

Question 27

Denial

Answer 27

Avoidance of unpleasant or anxiety-provoking situations or ideas by rejecting them or ignoring their existence

Ex: “I am healthy and fit. There is no way I have cancer, so I don’t need all those tests.”

Question 28

Displacement

Answer 28

Redirection of emotions away from the original subject or object onto another, less-threatening subject or object

Ex: “I had enough trouble handling that last patient. I don’t need to deal with this malfunctioning copier right now.”

Question 29

Dissociation

Answer 29

Disconnection of emotional importance from ideas or events and compartmentalizing those emotions in different parts of awareness

Ex: “I’m always getting into fights with my neighbors, which is odd because I teach an online course in conflict resolution.”

Question 30

Identification

Answer 30

Attribution of characteristics of someone else to oneself or the imitation of another

Ex: “I could pass that certification test just like she did, and I haven’t even studied the material.”

Question 31

Intellectualization

Answer 31

Analysis of a situation with facts and not emotions

Ex: “He didn’t break up with me because he didn’t love me. He just had too much on his plate at work at the time.”

Question 32

Introjection

Answer 32

Adoption of the thoughts or feelings of others

Ex: “My dad says I should stand up for myself, so I am going to be more assertive.”

Question 33

Physical avoidance

Answer 33

Keeping away from any person, place, or object that evokes memories of something unpleasant

Ex: “I can’t go to that hospital because that’s where my father died.”

Question 34

Projection

Answer 34

Transference of a person’s unpleasant ideas and emotions onto someone or something else

Ex: “She leaves more charts incomplete than I do, so why am I getting this warning?”

Question 35

Rationalization

Answer 35

Explanation that makes something negative or unacceptable seem justifiable or acceptable

Ex: “My partner drinks every night to make himself less anxious about work.”

Question 36

Reaction formation

Answer 36

Belief in and expression of the opposite of one’s true feelings

Ex: “I really hate being in the military, but I always sign some people up at recruitment events.”

Question 37

Regression

Answer 37

Reversion to an earlier, more childlike, developmental behavior

Ex: “I can’t do all that paperwork, and you can’t make me.”

Question 38

Repression

Answer 38

Elimination of unpleasant emotions, desires, or problems from the conscious mind

Ex: “They tell me I was hurt in that robbery, but I can’t remember anything about it.”

Question 39

Sarcasm

Answer 39

Use of words that have the opposite meaning, especially to be funny, insulting, or irritating

Ex: “You have a nice office if you like working in caves.”

Question 40

Sublimation

Answer 40

Rechanneling unacceptable urges or drives into something constructive or acceptable

Ex: “When I was a kid, I used to like to pull wings and legs off insects I’d catch. Now I am a biology teacher.”

Question 41

Suppression

Answer 41

Voluntary blocking of an unpleasant experience from one’s awareness

Ex: “The doctor said I need more tests, but I’m going to take my vacation first.”

Question 42

Undoing

Answer 42

Cancelling out an unacceptable behavior with a symbolic gesture

Ex: “I had a big fight with my wife last night, but I’m going to buy her some flowers on my way home today.”

Question 43

Verbal aggression

Answer 43

Verbal attack on a person without addressing the original intent of the conversation

Ex: “Why would you ask me that when you can’t even control your children?”

Question 44

Elisabeth Kübler-Ross

Answer 44

Developed the five stages of grief theory as a result of her extensive experience in working with dying patients

Question 45

5 Stages of Grief

Answer 45

1. Denial
2. Anger
3. Bargaining
4. Depression
5. Acceptance

*Not everyone grieves in the same way. While one person might navigate through the stages of grief one by one and in sequence, others can be in more than one stage simultaneously. Some might skip one or more stages. The duration of the process is also highly variable. There is no right way to grieve.

Question 46

Denial

Answer 46

During this stage, the grieving person cannot or will not believe that the loss is happening or has happened. They might deny the existence of the illness and refuse to discuss therapeutic interventions. Thought processes reflect the idea of “No, not me.”

Support the patient without reinforcing the denial. It might help to give the patient written information about the disease and treatment options with the approval of the provider.

Question 47

Anger

Answer 47

During this stage, the grieving person might aim feelings of hostility at others, including health care staff (because they cannot fix or cure the disease). Thought processes reflect the idea of “Why me?”

Do not take the patient’s anger personally. Instead, help them understand that becoming angry is an expected response to grief.

Question 48

Bargaining

Answer 48

During this stage, the grieving person attempts to avoid the loss by making a deal, such as wanting to live long enough to attend a particular family occasion. The patient might also be searching for alternative solutions. They are still hoping for their previous life, or life itself, or at least a postponement of death. Thought processes reflect the idea of “Yes, me, but…”

Listen with attention and encourage the patient to continue expressing their feelings.

Question 49

Depression

Answer 49

During this stage, the reality of the situation takes hold, and the grieving person feels sad, lonely, and helpless. For example, they might have feelings of regret and self-blame for not taking better care of themselves. They might talk openly about it or might withdraw and say nothing about it. Thought processes reflect the idea of “Yes, it’s me.”

Sit with the patient and do not put any pressure on them to share their feelings. Convey support and understanding. Referrals to a support group or for counseling can be helpful.

Question 50

Acceptance

Answer 50

During this stage, the grieving person comes to terms with the loss and starts making plans for moving on with life despite the loss or impending loss. They are willing to try to make the best of it and formulate new goals and enjoy new relationships. If death is imminent, they will start making funeral and burial arrangements and might reach out to friends and family who have not been a part of their recent years of life. There might still be some depression, but there might also be humor and friendly interaction. Thought processes reflect the idea of “Yes, me, and I’m ready.”

Offer encouragement, support, and additional education to the patient and their family and friends during this time.