Introduction to Anxiety Disorders and Coping vs. Defense Mechanisms (Nursing)

00:01 This lecture will talk about general anxiety disorder, phobias, OCD and other anxiety disorders.

00:08 Some of which are general anxiety disorder, panic disorder, phobias, anxiety due to medical disorders and substance use, obsessive compulsive disorders, other anxiety related diagnoses.

00:25 About these various anxiety disorders.

00:29 We also want to learn about coping mechanisms, about defense mechanisms, and about the nursing diagnosis and interventions that we would use.

00:41 It's always important to understand that anxiety itself is a normal response to fear and stress.

00:49 And when we have low levels of anxiety, they are very adaptive, they can motivate us so that we have increased productivity.

00:59 Sometimes a level of anxiety is required for survival.

01:05 The nursing theory and anxiety comes from Peplau, who identified four levels of anxiety.

01:15 She said there is mild anxiety, there is moderate anxiety, there is severe anxiety and then there is panic.

01:24 And when we're looking at mild and even moderate, they don't necessarily impact our activities of daily living.

01:33 But when our fear and our anxiety gets to a severe level, or to a panic level, there is a inability for us to be able to engage in our activities of normal living.

01:50 So when a person experiences anxiety, we activate our coping skills.

01:56 Some of these coping skills are like daydreaming, or maybe nail biting.

02:03 So it helps you to feel a little bit better.

02:06 Other people, when they are trying to use behavioral adaptation coping, they might be eating more, perhaps they're drinking alcohol or using a substance to reduce that anxiety.

02:21 You might find that laughing at the anxiety and the moment helps, whereas other people might find that they use crying to cope.

02:32 Our coping strategies are very individual, and that the coping strategies that relieve the sense of anxiety, they can become hardwired to us, meaning that we use them without even thinking they are an intrinsic part of who we are as people.

02:53 And this is the way we might have to move through moments of anxiety, especially when our anxiety starts at an early age.

03:03 When we find that we can do something and that relieves our anxiety and we repeated each time that anxiety comes up.

03:12 That's when it becomes what we call "hard-wired".

03:17 What are some defense mechanisms? Now, coping and defense mechanisms are very different.

03:23 Coping is what we engage in to try and buffer the time of anxiety, to get us through that anxiety, to lessen that sense of fear.

03:36 Ego defense mechanisms, on the other hand is a way that we actually cognitively tell ourselves something like a story.

03:48 And then we use that to not have to take responsibility for the behavior that this anxiety is causing us.

05:09 Compensation.

05:11 Compensation is an ego defense mechanism.

05:14 Compensation is when we hide a weakness by developing a separate skill to focus on.

05:20 So say, I am not very good at riding a bike.

05:25 And I don't want people to know that I'm not good at riding a bike.

05:29 So I might go out and become the best motorcyclist.

05:36 And people will say, "Come on Brandon, let's go ride a bike." And I'll say, "No, no, I'd rather use my motorcycle." I'm compensating for the fact that I can't ride the bike by becoming really good at something else.

05:48 Maybe I can't spell and so I become really good at math.

05:53 It's hiding a weakness by developing a separate skill to focus on.

05:59 A lot of our patients in mental health use the ego defense mechanism of denial.

06:06 They just don't want to accept that that's situation is real.

06:11 So you may have a client or a patient who is drinking 5 or 6 beers every single day.

06:19 And when you are interviewing them, and you say, "Well, 5 or 6 beers, do you feel that that's a lot?" They'll say, "Well, it's nothing, that's nothing, everyone drinks that." "I don't have a drinking problem, do you understand?" "I don't have a drinking problem." They deny that the situation is real.

06:39 Denial occurs in the face of overwhelming proof.

06:43 They will still deny that situation that you are presenting is real.

06:50 Displacement is when a person starts taking their anxiety and discomfort out on a person that is not even the cause of the feelings.

07:01 So for example, a person is at work, and they get yelled at by their boss.

07:07 And when they get out of work, they go in to buy some milk in the store and the person who's selling him the milk says to them, "Do you want paper or plastic?" And they start yelling at that person.

07:20 They have displaced their feelings of anger, and their desire to yell at their boss.

07:27 They take that out on the next person, even though that person is not the cause of their feelings.

07:34 When you're thinking about this as being ego defense mechanisms, can you see how this can protect a person? The person who wants to yell at their boss could lose their job, they can't take it out on that person.

07:49 And so they defend themselves by getting through it, but then displacing those feelings on someone else.

08:00 Another ego defense mechanism is projection.

08:04 And that is when you might see your own unacceptable thoughts or feelings and you project them onto someone else, where you might want to go to the beach in a very slim bathing suit that you think is really beautiful.

08:24 But you won't do that because for some reason in your own culture that is not done.

08:30 And then when you get to the beach, you look at someone and say that is disgraceful to see a person in a bathing suit like that.

08:40 That is projecting those unacceptable thoughts and feelings onto someone else.

08:48 Isolation is de-humanizing a memory and presenting it without any feeling.

08:55 So isolation may be that you are interviewing a patient who had been in a terrible car accident.

09:04 And when you ask them about that car accident, they say, "I drove up to the light, the light turned green, I went forward, another car came speeding, the car hit my car, my car spun out.

09:20 I don't remember anything after that." You would not expect a person to give you that kind of report.

09:29 You would expect some feeling that would come along with it.

09:32 But their own mind is protecting them by making sure that they are removing themselves from being in that car.

09:43 And this way they can present that memory without any feeling whatsoever.

09:51 Rationalization is one that and we all use rationalization.

09:57 That's finding excuses to normalize unacceptable feelings, thoughts or behaviors.

10:03 Well, I had to eat the whole pie.

10:06 Because if I left it, my brother would have eaten it and my brother is diabetic.

10:14 That's an excuse, it normalizes me eating an entire pie.

10:20 I'm saying, "Oh, that's because I have to protect my brother." But that's an excuse because I could throw the pie out.

10:27 Rationalization finding excuses.

10:30 And those excuses tried to normalize what is an unacceptable feeling, thought or behavior.

10:38 Regression is another one that we often say.

10:41 And that is when the person starts reacting to the situation from an earlier developmental stage.

10:48 So somebody who is talking to you and becomes very activated, and suddenly starts acting like a child.

11:02 And you can see regression happen in front of you.

11:06 I've worked with many patients who as we're having a conversation, they're 55 years old, and we hit upon some situations.

11:17 Suddenly, I become like their mother and they start looking at me like a little kid, and you see it.

11:30 It is a reaction that comes up from an earlier developmental stage.

11:35 And sublimation that is moving some unacceptable urges or emotions into areas that are now acceptable.

11:45 So let's say I have a problem.

11:50 Again, I'll go to eating, eating a lot and I want to eat every single thing on the table.

11:57 And instead, I decide that I will be arranging the food on the table and I will arrange it in such a way that I am engaged in arrangement rather than eating.

12:12 So this way, I have sublimated my urge to to gorge with a behavior that is acceptable which is arranging the foods.

12:24 Sublimation.

12:27 By there's also suppression.

12:29 Suppression is when you block the thoughts and your memories on purpose.

12:34 And that means that somebody says to you, "Do you remember that car accident?" You say, "No, I have no memory whatsoever." And it's over, no more talking.

12:45 I am blocking that thought.

12:46 I am blocking that memory.

12:48 I am doing it on purpose.

12:52 Undoing is when we are taking actions to undo a negative experience with another.

12:59 I often see undoing in cases where there is some abuse between perhaps two partners and one partner screams and yells, and storms out of a meeting, only to come back with a bunch of roses.

13:23 That's trying to undo the screaming and yelling by coming back with a different experience of providing the roses.