Chapter 13

Understanding Anxiety and

Anxiety Defenses

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Anxiety vs. Fear

ANXIETY FEAR
• Reaction to an • Reaction to a specific
unspecified danger danger

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Anxiety operationally defined

Slide 13-3 (Fig. 13-1)

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Mild Anxiety
● Perceptual field heightened
● Grasps what is happening
● Identifies disturbing things
● Can work toward a goal
● Can examine alternatives
● Experiences slight discomfort
● Restlessness, irritability
● Mild tension relieving behaviors

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Moderate Anxiety
● Perceptual field narrows
● Selective inattention
● Needs to have things pointed out
● Problem solving ability moderately impaired
● Benefits from guidance
● Shaky voice, concentration difficult
● Sympathetic nervous system symptoms
● Somatic complaints

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Severe Anxiety
● Perceptual field greatly reduced
● Attention scattered
● Self-absorbed
● Can’t attend to events or see connections
● Perceptions distorted
● Feelings of dread/doom
● Sympathetic nervous system symptoms
● Confusion, purposeless activity

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Panic Level Anxiety
● Unable to focus on environment
● Terror, emotional paralysis
● Hallucinations/delusions
● Muteness, severe withdrawal
● Immobility or extreme agitation, severe shakiness
● Disorganized, irrational thinking
● Unintelligible speech
● Sleeplessness

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Defenses against Anxiety
● Manage conflict and affect
● Are relatively unconscious
● Are discrete from one another
● Are often hallmarks of psychiatric syndromes
● Are reversible
● Are adaptive as well as pathological

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Sublimation

Slide 13-9

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Humor

Slide 13-10

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Suppression

Slide 13-11

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Compensation

Slide 13-12

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Introjection

Slide 13-13

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Identification

Slide 13-14

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Repression

Slide 13-15

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Displacement

Slide 13-16

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Reaction Formation

Slide 13-17

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Somatization

Slide 13-18

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Undoing

Slide 13-19

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Rationalization

Slide 13-20

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Regression

Slide 13-21

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Projection

Slide 13-22

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Denial

Slide 13-23

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Interventions: Mild to Moderate Anxiety
● Help identify anxiety and antecedents to anxiety
● Anticipate anxiety-provoking situations
● Demonstrate interest
● Encourage talk about feelings and concerns
● Keep communication open
● Use clarification to understand
● Encourage problem solving
● Use role playing, modeling
● Explore behaviors used in past
● Provide outlets for excess energy
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Interventions: Severe to Panic Anxiety
● Maintain calm manner
● Remain with client
● Minimize environmental stimuli
● Use clear, simple statements and repetition
● Low pitched voice; speak slowly
● Reinforce reality if distortions occur
● Listen for themes
● Meet physical and safety needs
● Set verbal limits/physical limits
● Assess need for medication or seclusion
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