Concept of Anxiety

ELAIZA P. ABELLO

GLYDEL L. TASANI

What is Anxiety?
An abnormal and overwhelming sense of apprehension and fear often marked by
physiologic signs (as sweating, tension, and increased pulse), by doubt concerning
the reality and nature of the threat, and by self-doubt about ones capacity to cope
with it.
Anxiety: an aversive inner state that people seek to avoid or escape.

Reality Anxiety: the most basic form, rooted in reality. Fear of a dog bite,
fear arising from an impending accident. (Ego Based Anxiety). Most Common
Tension Reduction Method: Removing oneself from the harmful situation.

Neurotic Anxiety: Anxiety which arises from an unconscious fear that the
libidinal impulses of the ID will take control at an in opportune time. This type
of anxiety is driven by a fear of punishment that will result from expressing
the ID's desires without proper sublimation.

Moral Anxiety: Anxiety which results from fear of violating moral or societal
codes, moral anxiety appears as guilt or shame.

Defining characteristics:

Symptoms vary depending on the type of anxiety disorder, but general

symptoms include:

Feelings of panic, fear, and uneasiness.

Problems sleeping.

Cold or sweaty hands and/or feet.

Shortness of breath.

Heart palpitations.

An inability to be still and calm.

Dry mouth.

Numbness or tingling in the hands or feet.

Types of Anxiety

Sigmund Freud

Levels of Anxiety

Mild Anxiety

At this level, youre likely open-minded, although stressed. You might experience
this level of anxiety as you await a job performance review or if you're lost in a new
city. Symptoms might include fidgeting, irritability, sweaty palms and
heightened senses. Mild anxiety is typically motivational, meaning it helps you
focus on seeking a solution to the challenge you face.

Moderate Anxiety

At a moderate level of anxiety, you're likely to focus exclusively on the stressful

situation directly in front of you and ignore other tasks. Say you've taken a child to
the playground and lose sight of him. You might experience a faster heartbeat, dry
mouth, sweating and stomach pain or nausea. Your speech may be rapid
and high-pitched, and your hand and arm movements are likely more
exaggerated.

Severe Anxiety

With severe anxiety, symptoms intensify and others develop, such as a pounding
heartbeat, chest pain, headache, vomiting or diarrhea, trembling,
scattered thoughts, erratic behavior and a sense of dread. With severe
anxiety, your ability to focus and solve problems is impaired, which can lead to
further anxiety. You may not even be able to recognize or take care of your own
needs. Attempts of others to redirect your attention are likely to be unsuccessful.

Panic-Level Anxiety

Panic-level of anxiety is the most disruptive and challenging, as it overwhelms your

capacity to function normally. You may experience an inability to move or speak.
Some people take off running or find it impossible to sit or stay still. Your ability
to think rationally will likely be impaired, and your perceptions might be distorted.
You might not identify danger or understand your needs in the moment. Extreme life
stressors can provoke these types of reactions, such as being victim of a crime or
living through a disaster.

Manifestations of levels of Anxiety

A. Physiologic
The physical symptoms of anxiety refer to how we experience anxiety in our bodies.
Examples include:

A feeling of restlessness, feeling "keyed up," or "on-edge;"

Shortness of breath, or a feeling of choking;

Sweaty palms;

A racing heart;

Chest pain or discomfort;

Muscle tension, trembling, feeling shaky;

Nausea and/or diarrhea;

"Butterflies" in the stomach;

Dizziness, or feeling faint;

Hot flashes;

Chills;

Numbness, or tingling sensations;

An exaggerated startle response; and,

Sleep disturbance and fatigue.

B. Psychologic
The psychological symptoms of anxiety may include:

Problems with concentration, or difficulty with staying on task;

Memory difficulties; and,

Depressive symptoms such as hopelessness, lethargy, and poor appetite.

Ego defense mechanisms

Defense Mechanisms can be psychologically healthy or maladaptive, but tension

reduction is the overall goal in both cases.
When some type of anxiety occurs, the mind responds in two ways :

First, problem solving efforts are increases,

and Secondly, defense mechanisms are triggered. These are tactics which the
Ego develops to help deal with the ID and the Super Ego.

Types of defense mechanism

Repression
Sometimes referred to as: defensiveness
Repression can be conscious but is most commonly unconscious.
Advantages:
Can prevent inappropriate ID impulses from becoming behaviors.
Can prevent unpleasant thoughts from becoming conscious.
Can prevent memories of things we have done wrong from resurfacing.
Repression does not have to be total, partial memories where only the single piece
of damaging information is "forgotten" is common.

Denial
When people are overwhelmed by the anxiety present within a situation, they can
engage an even more severe form of memory repression.
Denial becomes more difficult with age, as the ego matures and understands more
about the "objective reality" it must operate within.
Repression and Denial are the two main defense mechanisms which everybody
uses.
Projection
In projection, anxiety is reduced by claiming another person actually has the
unpleasant thoughts that you are thinking. You are attributing your own repressed
thoughts to someone else.
Rationalization
This is a post-hoc (after the fact) defense mechanism.
Rationalization allows to find logical reasons for inexcusable actions. Rationalization
helps to protect our sense of self-esteem
Rationalization is closely tied to the Self-serving Bias : The tendency to interpret
success as inwardly achieved and to ascribe failure to outside factors.
Intellectualization
Thinking about events in cold, hard, rational terms.
Separating oneself from the emotional content of an event, focusing instead on the
facts.
Intellectualization protects against anxiety by repressing the emotions connected
with an event.
Regression
Because of partial fixations in any of the psychosexual stages of development,
regression can occur when an individual is faced with high levels of stress in their
life.
Regression is the giving up of mature problem solving methods in favor of child like
approaches to fixing problems.
Displacement
Displacement is the shifting of intended targets, especially when the initial target is
threatening.
The classic use of displacement is in the understanding of displaced aggression.

Four levels of defense

Level I - pathological defenses (i.e. psychotic denial, delusional projection)

Level II - immature defenses (i.e. fantasy, projection, passive aggression,

acting out)

Level III - neurotic defenses (i.e. intellectualization, reaction formation,

dissociation, displacement, repression)

Level IV - mature defenses (i.e. humor, sublimation, suppression, altruism,

anticipation)

Level 1 - Pathological

Delusional Projection: Grossly frank delusions about external reality,

usually of a persecutory nature.

Denial: Refusal to accept external reality because it is too threatening;

arguing against an anxiety-provoking stimulus by stating it doesn't exist;
resolution of emotional conflict and reduction of anxiety by refusing to
perceive or consciously acknowledge the more unpleasant aspects of external
reality.

Distortion: A gross reshaping of external reality to meet internal needs.

Splitting: A primitive defense. Negative and positive impulses are split off
and unintegrated. Fundamental example: An individual views other people as
either innately good or innately evil, rather than a whole continuous being.

Extreme projection: The blatant denial of a moral or psychological

deficiency, which is perceived as a deficiency in another individual or group.

Level 2 - Immature

Acting out: Direct expression of an unconscious wish or impulse in action,

without conscious awareness of the emotion that drives that expressive
behavior.

Fantasy: Tendency to retreat into fantasy in order to resolve inner and outer
conflicts.

Idealization: Unconsciously choosing to perceive another individual as

having more positive qualities than he or she may actually have.

Passive aggression: Aggression towards others expressed indirectly or

passively such as using procrastination.

Projection: Projection is a primitive form of paranoia. It is shifting one's

unacceptable thoughts, feelings and impulses within oneself onto someone
else, such that those same thoughts, feelings, beliefs and motivations are
perceived as being possessed by the other.

Projective identification: The object of projection invokes in that person

precisely the thoughts, feelings or behaviors projected.

Somatization: The transformation of negative feelings towards others into

negative feelings toward self, pain, illness, and anxiety.

Level 3 - Neurotic

Displacement: Defense mechanism that shifts sexual or aggressive

impulses to a more acceptable or less threatening target; redirecting emotion
to a safer outlet; separation of emotion from its real object and redirection of
the intense emotion toward someone or something that is less offensive or
threatening in order to avoid dealing directly with what is frightening or
threatening.

Dissociation: Temporary drastic modification of one's personal identity or

character to avoid emotional distress; separation or postponement of a
feeling that normally would accompany a situation or thought.

Hypochondriasis: An excessive preoccupation or worry about having a

serious illness.

Intellectualization: A form of isolation; concentrating on the intellectual

components of a situation so as to distance oneself from the associated
anxiety-provoking emotions; separation of emotion from ideas; thinking about
wishes in formal, affectively bland terms and not acting on them; avoiding
unacceptable emotions by focusing on the intellectual aspects (e.g. isolation,
rationalization, ritual, undoing, compensation, magical thinking).

Isolation: Separation of feelings from ideas and events, for example,

describing a murder with graphic details with no emotional response.

Rationalization (making excuses): Where a person convinces him or

herself that no wrong was done and that all is or was all right through faulty
and false reasoning. An indicator of this defense mechanism can be seen
socially as the formulation of convenient excuses - making excuses.

Reaction formation: Converting unconscious wishes or impulses that are

perceived to be dangerous into their opposites; behavior that is completely
the opposite of what one really wants or feels; taking the opposite belief
because the true belief causes anxiety. This defense can work effectively for
coping in the short term, but will eventually break down.

Regression: Temporary reversion of the ego to an earlier stage of

development rather than handling unacceptable impulses in a more adult
way.

Repression: The process of attempting to repel desires towards pleasurable

instincts, caused by a threat of suffering if the desire is satisfied; the desire is
moved to the unconscious in the attempt to prevent it from entering
consciousness; seemingly unexplainable naivety, memory lapse or lack of
awareness of one's own situation and condition; the emotion is conscious, but
the idea behind it is absent.

Undoing: A person tries to 'undo' an unhealthy, destructive or otherwise

threatening thought by engaging in contrary behavior.

Level 4 - Mature

Altruism: Constructive service to others that brings pleasure and personal

satisfaction.

Anticipation: Realistic planning for future discomfort.

Humor: Overt expression of ideas and feelings (especially those that are
unpleasant to focus on or too terrible to talk about) that gives pleasure to
others. The thoughts retain a portion of their innate distress, but they are
"skirted round" by witticism.

Identification: The unconscious modeling of one's self upon another

person's character and behavior.

Introjection: Identifying with some idea or object so deeply that it becomes

a part of that person.

Sublimation: Transformation of negative emotions or instincts into positive

actions, behavior, or emotion.

Thought suppression: The conscious process of pushing thoughts into the

preconscious; the conscious decision to delay paying attention to an emotion
or need in order to cope with the present reality; making it possible to later
access uncomfortable or distressing emotions while accepting them.

CRISIS

Crises can occur on a personal or society level. Personal Trauma is defined as

an individuals experience of a situation or event in which he/she perceives to
have exhausted his/her coping skill, self-esteem, social support, and power.
These can be situations where a person is making suicidal threats,
experiencing threat, witnessing homicide or suicide, or experiencing personal
loss. While a person is experiencing a crisis on the individual level it is
important for counselors to primarily assess safety. Counselors are
encouraged to ask questions pertaining to social supports and networks, as
well as give referrals for long term care.

TYPES OF CRISIS

Family disruption or family disturbance

Natural disasters- flooding, tornadoes, weather-related incidents, fire, or any

incident that is created by a weather disaster

Suicide- when a person threatens suicide or plans to commit suicide

Economic changes- loss of a job, medical bills, theft of a purse or cash, or

utilities being shut off

Community resources- a lack of housing resources, food resources, or

inadequate crime protection

Life events- the birth of a child, loss of a loved one, a child moving out, an
irrigational child, or any disturbance to daily activities.

STAGES OF CRISIS DEVELOPMENT

NORMAL STRESS AND ANXIETY LEVEL- the background of crisis development

brought about by the minor annoyances and frustrations of everyday life.
Individuals at this stage are rational and in control of their emotions and
behavior.

RISING ANXIETY LEVEL- a heightened condition typically including rapid heart

rate and respiration. The person might appear lost or confused about how to
solve a problem. Voice may be pitched higher or quaver with accelerated
speech patterns. Small nervous habits such as finger or foot tapping may be
manifested.

SEVERE STRESS AND INCREASING ANXIETY- a persons reasoning capacity is

seriously diminished, with fixation on the here and now. Behavior typically
becomes boisterous or disruptive. Communication may include shouting
swearing, argumentation, and threats. Physical indications include pacing,
clenched fists, perspiring, and rapid shallow breathing.

ACUTE CRISIS- characterized by unbearable anxiety and loss of cognitive,

emotional, and behavioral control, with urgent need to end the emotional
pain. A person in crisis is unable to solve problems or process information
rationally without help. Behaviors of persons in crisis are erratic and
unpredictable to a point that they may pose a danger to themselves and
others.

CHARACTERISTICS OF CRISIS

A. Presence of both danger and opportunity are in a crisis. Danger can exist when a
crisis overwhelms the person, bringing them to a point of suicide. Opportunity is
possible because of the chance for self-growth and self-realization while the person
receives help. Three ways of reacting to a crisis are;

coping with it themselves and growing from it

they can appear to survive, blocking it from their awareness so that it

haunts them throughout their lives

They can break down psychologically and be unable to go on with their lives
until they receive intense assistance.

B. Complicated Symptomology reminds us that crisis is complex and is intertwined

in all aspects of the individuals environment. The environment is important in
discovering how to handle the crisis.

C. Anxiety always accompanies crisis but it must often reach the boiling point before
it is addressed by the individual.
D. The quick fixes did not work in the first place and it takes time to work through
the crisis.
E. To choose to do nothing is a choice. When one chooses to do something it gives
an opportunity for setting goals and overcoming the dilemma.
F. Everyone has the ability to have a crisis overcome them and be unable to use
their own coping mechanisms.

CRISIS INTERVENTION

Is emergency psychological care aimed at assisting individuals in a crisis

situation to restore equilibrium to their biopsychosocial functioning and to
minimize the potential for psychological trauma. Crisis can be defined as
ones perception or experiencing of an event or situation as an intolerable
difficulty that exceeds the persons current resources
and coping mechanisms.

The priority of crisis intervention and counseling is to increase stabilization.

Crisis interventions occur at the spur of the moment and in a variety of
settings, as trauma can arise instantaneously. Crises are temporary, usually
with short span, no longer than a month, although the effects may become
long-lasting.