Stress and Coping

A. Concept of Stress
- Definition of Stress
- Sources of Stress
- Effects of Stress
B. Models of Stress
- Stimulus Based Models
- Response Based
Models
- Transaction Based
Models

Stress and Coping
C. Indicators of Stress
- Physiologic Indicators
- Psychologic Indicators
- Cognitive Indicators
- Verbal and Motor Indicators
D. Coping
E. Nursing Management

Things YOU need to know
STRESS is a condition
in which a person
responds to changes
in a normal balanced
state.
STRESSOR is any
event or stimulus that
causes an individual
to experience stress.

STRESS
STRESSORS
D
I
E
S
COPING
RESPONSES
STIMULUS
BASED MODEL
RESPONSE
BASED MODEL
TRANSACTIONAL
BASED MODEL
INDICATORS OF STRESS:
PHYSIOLOGIC
COGNITIVE
PSYCHOLOGIC
VERBAL AND MOTOR
MANIFESTATIONS
EFFECTS OF STRESS:
P - PHYSICAL
I - INTELLECTUAL
E - EMOTIONAL
S - SOCIAL
S - SPIRITUAL
COPING STRATEGIES:
LONG TERM
SHORT TERM
PROBLEM FOCUSED
EMOTION FOCUSED

Things YOU need to know
STRESS is a condition
in which a person
responds to changes
in a normal balanced
state.
STRESSOR is any
event or stimulus that
causes an individual
to experience stress.

STRESSORS
According to
Occurrence
Developmental
Situational
According to
Origin
Internal
External
EFFECTS
Physical
Intellectual
Emotional
Social
Spiritual

CHARACTERISTICS OF
STRESSORS
> Stressors are
extreme stimuli.
extreme EXCESSES and
extreme DEFICIENCIES
may act as stressors.
> Stressors are
injurious or
unpleasant BUT
not always.
a PAINFUL BLOW and a
PASSIONATE KISS can be
equally stressful.

CHARACTERISTICS OF
STRESSORS
> Stressors are anything that an individual
perceives as a threat, whether real or imagined
that arouses fear or anxiety.
> Stressors differ in different individuals and in
one individual at different times.
a stressor for JUAN may not be a stressor for
PEDRO.
a stressor for Maria today, may not be a stressor
for her tomorrow.

Types of Stressors
SOURCES OF STRESS
(D.I.E.S.)
Developmental Internal External Situational

Types of Stressors
Developmental
Occurs at PREDICTABLE times throughout an
individuals life.
Occurs during certain developmental stage

Type of Stressor:
Developmental
CHILD
Beginning
School
Establishing
peer
relationships
Coping with
peer
competition

Type of Stressor:
Developmental
ADOLESCENT
Changing
physique
Developing
relationships
involving sexual
attraction
Exploring
independence
Choosing a career

Type of Stressor:
Developmental
YOUNG ADULT
Marriage
Leaving home
Managing own
home
Getting started in
an occupation
Continuing ones
education
Rearing children

Type of Stressor:
Developmental
MIDDLE ADULT
Accepting physical
changes of aging
Maintaining social
status & standard
of living
Helping teenage
children to
become
independent
Adjusting to aging
parents

Type of Stressor:
Developmental
OLDER ADULT
Accepting
decreasing
physical abilities
and health
Adjusting to
retirement
Adjusting to death
of spouse and
friends

Types of Stressors
SOURCES OF STRESS
(D.I.E.S.)
Developmental Internal External Situational

Type of Stressor:
Situational
SituationAl also
known as Accidental
stressor. Unpredictable
and may occur anytime
during life.
Death of a family
Divorce
New job
ILLNESS

Types of Stressors
SOURCES OF STRESS
(D.I.E.S.)
Developmental Internal External Situational

Type of Stressor:
Internal
Internal Stressor
originates WITHIN a
person
Physiological Failure
Heart
Lungs
Gastrointestinal
tract
Feelings
Depression

Types of Stressors
SOURCES OF STRESS
(D.I.E.S.)
Developmental Internal External Situational

Type of Stressor:
External
External Stressors
originates OUTSIDE an
individual.
Exposure to infection
Environmental pollutants
Traffic
Change in job status
Peer Pressure
Death in the Family
Move from another city

Effects of Stress
P - Physical threatens a persons physiologic
homeostasis.
I - Intellectual - influence persons problem
solving abilities
E - Emotional produces negative feelings about
self
S - Social alters relationship with others
S - Spiritual challenge ones belief and values


Review
A stress that occurs when a person
progresses through the stages of growth
and development.
a. Internal stress
b. External stress
c. Developmental stress
d. Situational stress

Review
All of the following are developmental
stressors EXCEPT:
a. Marriage
b. Choosing a career
c. Illness
d. Establishing peer relationship

Review
The clients mother stated My daughter
always stay alone at her room after the
death of his father. What effect of stress
is manifested by the client?
a. Intellectual c. Social
b. Emotional d. Physical

Review
The clients BP suddenly increases after
seeing his mother for the first time after 3
years. What effect of stress is manifested
by the client?
a. Intellectual c. Social
b. Emotional d. Physical

Review
The top student of the class failed his
prelim exam after breaking up with his
girlfriend two days ago. What effect of
stress is manifested by this student?
a. Intellectual c. Social
b. Emotional d. Physical

Review
The patient always resists when the nurse
will try to take her vital signs and states
Please, I want to be alone. What effect
of stress is manifested by the patient?
a. intellectual c. physical
b. social d. emotional

Review
Louie suddenly experiences increase
sweating and tachycardia upon seeing his
crush. What effect of stress is manifested
by Louie?
a. intellectual c. physical
b. social d. emotional


Models of Stress
Assists nurses to IDENTIFY the STRESSOR in
a particular situation and to PREDICT
individuals RESPONSE.
Nurses can use the knowledge of these models
TO ASSIST CLIENTS in STRENGTHENING
healthy COPING RESPONSES & in adjusting
unhealthy, unproductive responses.

Models of Stress
MODELS OF STRESS
(S, Re, T)
Stimulus based model Response based model Transaction based model

STIMULUS BASED MODEL
STRESS is defined as a STIMULUS.
Stress is a STIMULUS
or a set of circumstances
that arouses physiologic
& psychologic reaction
that may
increase individuals
vulnerability to illness.
What is a
STIMULUS?
Anything that
CAUSES an action
or activity

STIMULUS BASED MODEL
STRESS

Physiologic and Psychologic

Response

Increase vulnerability to
illness
*** STRESS when viewed as a
STIMULUS is defined as an EVENT
or SET OF EVENTS causing a
DISRUPTED RESPONSE.

STIMULUS BASED MODEL
HOLMES and RAHES STRESS SCALE
In 1967, Psychiatrists: THOMAS HOLMESand
RICHARD RAHE EXAMINED the MEDICAL RECORD
of 5,000 patients TO DETERMINE whether
STRESSFUL LIFE EVENTS might CAUSE
ILLNESS.
Patients were asked to tally a list of 43 LIFE EVENTS based
on a relative score.

STIMULUS BASED MODEL
Death of a Spouse 100
Divorce 73
Marital Separation 65
Imprisonment 63
Death of a Close Family Member 63
Personal Injury or Illness 53
Marriage 50
Dismissal from Work 47
Marital Reconciliation 45
Retirement 45
Change in Health of Family Member 44
Pregnancy 40

STIMULUS BASED MODEL
INTERPRETATION
Score of 300+:
At risk of illness
Score of 150-299:
Risk of illness is moderate
Score 150-:
Only have a slight risk of illness

STIMULUS BASED MODEL
In this view both (+) and (-) events
are considered stressful.

STIMULUS BASED MODEL
STRESS

Physiologic and
Psychologic
Response

Increase vulnerability
to illness
Unique for every individual

STIMULUS BASED MODEL
The research shows that PEOPLE with LEVEL
of STRESS are often MORE PRONE to ILLNESS
and SUBSEQUENT STRESS.
FOCUS: Disturbing events within the
environment
ADVANTAGE: The scale identifies events
stressful for most people.
DISADVANTAGE: Does not provide individual
differences.

Models of Stress
MODELS OF STRESS
(S, Re, T)
Stimulus based model Response based model Transaction based model

RESPONSE BASED MODEL
STRESS may be considered as a RESPONSE.
SELYE: STRESS is a NONSPECIFICresponse
of the body to any demand made upon it.
The arousal of the mind and body to the
demand made upon it (Schafer).

RESPONSE BASED MODEL
To DIFFERENTIATE the CAUSE of stress from RESPONSE to
STRESS HANS SELYE created the term STRESSOR!
CAUSE of STRESS:
STRESSOR any factor that produces stress & disturbs
the bodys equilibrium.
RESPONSE to STRESS:
(GAS) General Adaptation Syndrome or Stress
Syndrome the body acts as a whole
(LAS) Local Adaptation Syndrome LOCAL reaction of
the body wherein one organ or part of the body reacts
alone. Ex: Inflammation

RESPONSE BASED MODEL
STRESSOR

STRESS

Physiologic Response
GAS or LAS

RESPONSE BASED MODEL
FOCUS: Focus on the RESPONSE and not on the
event.
Characterized by the same pattern of PHYSIOLOGIC
RESPONSE.
ADVANTAGE: Response to stress is PURELY
PHYSIOLOGIC.
DISADVANTAGE: Does NOT consider INDIVIDUAL
DIFFRENCES.

RESPONSE BASED MODEL
BODY ORGANS AFFECETED BY
STRESS ARE THE: (GAL)
GASTROINTESTINAL TRACT STOMACH,
deep ulcers
ADRENAL GLANDS ADD - enlarge
LYMPHATIC STRUCTURES thymus,
spleen, lymph nodes, atrophy
(shrinks Liit )

RESPONSE BASED MODEL
Body can also react locally, one organ or
part of the body reacts alone.
LAS
Local Adaptation Syndrome

RESPONSE BASED MODEL:
(GAS) General Adaptation Syndrome
SELYE explained his choice of terminology as
follows:
"I call this syndrome general because it is
produced only by agents which have a general
effect upon large portions of the body.
I call it adaptive because it stimulates defense....
I call it a syndrome because its individual
manifestations are coordinated and even partly
dependent upon each other."

RESPONSE BASED MODEL:
(GAS) General Adaptation Syndrome
GAS body acts as a whole
GAS - is a term used to describe the body's
short-term and long-term reactions to stress

RESPONSE BASED MODEL:
(GAS) General Adaptation Syndrome
SHORT TERM
RESPONSE
Dry mouth
Feelings of nausea
Butterflies in your
stomach
Diarrhea /
Constipation
Cool skin
Cold hands and feet
Increased sweating
Rapid breathing
Faster heart rate
Tense muscles
LONG TERM
RESPONSE
Insomnia
Change in Appetite
Sexual disorders
Aches and pains
Frequent colds
Prone to illness
Feelings of intense
and long-term
tiredness

RESPONSE BASED MODEL:
(GAS) General Adaptation Syndrome
STAGES OF GAS:
A - ALARM
R - RESISTANCE
E - EXHAUSTION
SHOCK
COUNTERSHOCK

Stages of (GAS) General
Adaptation Syndrome
STRESSORS
ALARM REACTION immediate reaction to stress
RESISTANCE the body adapt to the stressor
EXHAUSTION
- the bodys resistance collapse
REST
ILLNESS
DEATH

Stages of (GAS) General
Adaptation Syndrome

1
st
Stage of (GAS):
ALARM REACTION
ALARM REACTION
Stage wherein man encounters the stressor
Immediate; 1 minute to 24 hours.
INITIAL reaction of the body which alerts body defenses.
Adrenaline / Epinephrine Fight or Flight Response
Activation of HPA axis Hypothalamus, Pituitary Gland
(Anterior), Adrenal Gland

1
st
Stage of (GAS):
ALARM REACTION
HPA AXIS: STRESSOR

Sympathetic Nervous System

Hypothalamus Corticotropin Releasing

Hormone (CRH)

Pituitary Gland Adrenocorticotropin Hormone

(ACTH)
(Anterior)

Adrenal Gland
Adrenal mEdulla Adrenal CORTEX
- Epinephrine - CORTICOSTEROIDS
-NorEpinephrine (GMA)
Glucocorticoids
Mineralocorticoids
Androgen

1
st
Stage of (GAS):
ALARM REACTION

ALARM REACTION

SHOCK PHASE
Adrenal mEdulla Adrenal CORTEx
Epinephrine CORTIcosteroids
-myocardial contractility
- Tachycardia GLUCOcorticoids
- bronchial dilation (Cortisol, Cortisone)
- blood clotting - blood sugar level
- metabolism; fat mobilization
NorEpinephrine MINERALOcorticoids
-blood kidney = urine output - Sodium and water
- renin = BP retention
STRESSOR

1
st
Stage of (GAS):
ALARM REACTION

ALARMREACTION

SHOCK PHASE
Adrenal mEdulla Adrenal CORTEx
Epinephrine CORTIcosteroids
-myocardial contractility
- Tachycardia GLUCOcorticoids
- bronchial dilation (Cortisol, Cortisone)
- blood clotting - blood sugar level
- metabolism; fat mobilization
NorEpinephrine MINERALOcorticoids
-blood kidney = urine output - Sodium and water
-renin = BP retention

COUNTER SHOCK PHASE

STRESSOR

2
nd
Stage of (GAS):
STAGE of RESISTANCE
STAGE OF RESISTANCE
o The body attempts to cope with the stressor
and to limit stressor to the smallest area of
the body that can deal with it.
o 2 things may occur:
o PERSON successfully ADAPTS to the STRESSOR
and returns to normal
o STRESSOR remains PRESENT adaptation FAILS

2
nd
Stage of (GAS):
STAGE of RESISTANCE
STRESSOR

ALARM REACTION

Shock Phase

Counter Shock Phase

STAGE OF RESISTANCE
ADAPTATION STAGE of EXHAUSTION

3rd Stage of (GAS):
STAGE of EXHAUSTION
STAGE OF EXHAUSTION
The adaptation that the body made during the
second stage cannot be maintained.
The ways to cope with the STRESSOR have
been EXHAUSTED.

3rd Stage of (GAS):
STAGE of EXHAUSTION
STRESSOR

ALARM REACTION

Shock Phase

Counter Shock Phase

STAGE OF RESISTANCE
ADAPTATION STAGE of EXHAUSTION
Rest Death

RESPONSE BASED MODEL
HANS SELYE, an endocrinologist,
identified the physiologic
aspects of stress,
which labeled the
General Adaptation Syndrome.
He used laboratory animals to assess biologic
system changes.

Models of Stress
MODELS OF STRESS
(S, Re, T)
Stimulus based model Response based model Transaction based model

TRANSACTION BASED
MODEL
This is Lazarus model (1966) which
suggests that it is the interaction between
stressful events and our interpretation of
those events that determines how much
stress we experience.

TRANSACTION BASED
MODEL
LAZARUS
STIMULUS and RESPONSE theory DO
NOT CONSIDER INDIVIDUAL
DIFFERENCES
He emphasizes: People and groups differ
in their sensitivity & vulnerability to certain
types of events as well as their
interpretation and reaction

TRANSACTION BASED
MODEL
STRESS
Interaction
between
the person
and the situation
RESPONSE

Summary of the Models of
STRESS
STRESS as a STIMULUS
Holmes and Rahe
STRESS when viewed as a
STIMULUS is defined as an
EVENT or SET OF
EVENTS causing a
DISRUPTED RESPONSE.
STRESS = Life Events

Increase vulnerability to
illness
STRESS as a RESPONSE
Hans Selye
STRESSOR

STRESS

Physiologic Response
GAS or LAS

Summary of the Models of
STRESS
STRESS as a TRANSACTION
Lazarus Model
STRESS
Interaction
between
the person
and the situation
RESPONSE

Review
STRESS is viewed as an event or set of
events which causes an increase in an
individuals susceptibility to illness?
a. STIMULUS based model
b. RESPONSE based model
c. TRANSACTION based model

Review
These are all short term response of a client
to STRESS EXCEPT:
a. Change in appetite
b. Increase heart rate
c. Increase sweating
d. Dry mouth

Review
Stage wherein man encounters stressor?
a. Alarm
b. Resistance
c. Exhaustion

Review
CHOICES:
a. epinephrine c. glucocorticoids
b. norepinephrine d. mineralocorticoids
_____1. increase CV function
_____2. sodium retention
_____3. gluconeogenesis
_____4. decrease renal perfusion
_____5. bronchodilation


INDICATORS OF STRESS
INDICATORS OF STRESS
PHYSIOLOGICCOGNITIVEPSYCHOLOGIC
VERBAL & MOTOR
MANIFESTATIONS

INDICATORS OF STRESS:
PHYSIOLOGIC
The physiologic signs and symptoms
of stress
result from activation of the
SYMPATHETIC
and
NEUROENDOCRINE SYSTEMS
(HPA axis)
of the body.

HPA axis:
Hypothalamus, Pituitary Gland, Adrenal
Gland
STRESSOR

Sympathetic Nervous System

Hypothalamus Corticotropin Releasing H.

(CRH)

Pituitary Gland Adrenocorticotropin Hormone

(ACTH)
(Anterior)

Adrenal Gland
Adrenal mEdulla Adrenal CORTEX
- Epinephrine - CORTICOSTEROIDS
-NorEpinephrine
Glucocorticoids
Mineralocorticoids

INDICATORS OF STRESS:
PHYSIOLOGIC
Dilated Pupils - visual perception
Pale Skin - Constrict: Peripheral
blood vessels (Norepinephrine)
Diaphoresis
Mental Alertness
Muscle Tension for rapid motor
activity
Heart Rate
Respiratory Rate
Dry Mouth
GIT: Constipation and Flatus
GUT: Decrease Urine Output
Blood sugar
(Glucocorticoids and
Gluconeogenesis)
Sodium and Water Retention
(Mineralocorticoids) = blood volume

INDICATORS OF STRESS:
PHYSIOLOGIC
Mental alertness
Tachycardia
High BP
Tense muscles
Tachypnea
Dilated
pupils

Review
The individual experiences diaphoresis
because of what reason?
a. Increase RR
b. Increase rate of metabolism
c. Increase HR
d. Decrease peristalsis

Review
What is true about hyperventilation?
a. Increase carbon dioxide level
b. Increase metabolism
c. Decrease oxygen level
d. Decrease carbon dioxide level

Review
Hyperventilation occurs because of a decrease
level of carbon dioxide, what initial nursing
intervention will you do upon admission of a
hyperventilating client?
a. Administer oxygen 1-2 L / min
b. Position the patient flat on bed
c. Allow the patient to breathe through a paper bag
d. Administer bronchodilators as ordered

INDICATORS OF STRESS
INDICATORS OF STRESS
PHYSIOLOGICCOGNITIVEPSYCHOLOGIC
VERBAL & MOTOR
MANIFESTATIONS

INDICATORS OF STRESS:
PSYCHOLOGIC
Anxiety
Fear
Anger
Depression
Unconscious Ego Defense Mechanism

INDICATORS OF STRESS:
PSYCHOLOGIC
ANXIETY state of
mental UNEASINESS,
apprehension, dread or
a feeling of
hopelessness related to
an impending or
anticipated
UNIDENTIFIED
THREAT to self or
significant relationships.

INDICATORS OF STRESS:
PSYCHOLOGIC
LEVELS OF
ANXIETY
MILD
MODERATE
SEVERE
PANIC

MILD ANXIETY
best anxiety
ALERTNESS, MOTIVATION and
ATTENTIVENESS.
It produces a SLIGHT AROUSAL STATE that
enhances perception, learning and productive
activities.
Mild Anxiety often motivates people to make
changes or to engage in goal directed activity.
Ex: It helps students to focus on studying for an
examination.

MILD ANXIETY
ALERT, AWAKE, ALIVE
M Mild restlessness
I Increased
Questioning
Increased alertness
and arousal
L Less sleep =
SLEEPLESSNESS
D D The client uses
learning to adapt

MODERATE ANXIETY
Increases the arousal state to a point where the person
expresses feelings of tension, nervousness or concern.
Attention is focused on a particular aspect of a situation than
on peripheral activities.
FOCUSED ON IMMEDIATE CONCERN!
Ex: Nurse who is giving pre op instructions to a client who is
anxious about the upcoming surgery. As the nurse is teaching,
the clients attention wanders but the nurse can regain the
clients attention and direct him or her back to the task at hand.

MODERATE ANXIETY
M Mild Gastric Symptom: Butterflies in the
stomach
O vOice tremors & pitch changes, facial
twitching, shakiness
D Decreased perception: narrowed attention
E Elevated Heart Rate [SLIGHT!]
R Respiratory Rate slightly increase
A Able to focus but has selective inattention
T The learning is impaired
E E Encreased Increased muscle tension

MODERATE ANXIETY

SEVERE ANXIETY
Consumes most of the persons energies and
requires intervention.
A person with severe anxiety has trouble
thinking and reasoning.
Person unable to focus on whats
happeningfocuses on one specific detail of
the situation generating the anxiety.

SEVERE ANXIETY
S - Severely impaired learning
E - Easily distracted, inability to concentrate
V - Vital Signs : Inc. RR = Hyperventilation
Inc. HR = Tachycardia
E - Expression: fearful facial expression
R - Reduced perceptual field
E - Encreased Increased motor activity &
inability to relax
D - Dizziness
H - Headache
N - Nausea

PANIC
Overpowering
Frightening level of anxiety causing the
person to lose control
Less frequently experienced than other levels
of anxiety

PANIC
P - Poor motor coordination (trembling)
P - Perception distorted or exaggerated
P - Paresthesia, Palpitations
P - Peeling Feeling of Impending doom
A - Agitation, unpredictable response
N - Not able to learn or function
I - Increased motor activity
C - Communication may not be
understandable, Choking, Chest Pain

PANIC

Working with ANXIOUS
CLIENTS
Nurses will encounter anxious clients and
families in a wide variety of situations such
as:
Prior to surgery
Emergency Room Departments
ICU
Offices and clinics

Working with ANXIOUS
CLIENTS
First and foremost,
the nurse must:
ASSESS the clients
anxiety level
Because that will
determine what
nursing interventions
are likely to be
effective.

Nursing Intervention: MILD
ANXIETY
No direct intervention.
People with mild anxiety can learn and
solve problems and are even eager for
information.
TEACHING can be VERY EFFECTIVE!

Nursing Intervention:
MODERATE ANXIETY
The nurse must be certain that the client
is following what the nurse is saying.
Speak in SHORT, SIMPLE sentence.
The nurse may need to redirect the client
back to the topic if the client goes on
unrelated topic.

Nursing Intervention:
SEVERE ANXIETY
Nurses goal must be to lower the persons
anxiety level to moderate or mild.
Talking to the client in a low, calm and
soothing voice can help.
Nurses should be directive: SIT

Nursing Intervention: PANIC
o Persons SAFETYis the primary concern.
o He or she cannot perceive potential harm and
may have no capacity for rational thought.

Review
Anxiety level that can help motivate
learning and produce personal growth:
a. Mild c. Severe
b. Moderate d. Panic

Review
In this level of anxiety, the individual is
focus only on immediate concerns.
a. mild c. severe
b. Moderate d. panic

FEAR
An emotion of feeling of APPREHENSION
aroused by impending or seeming danger,
pain or other perceived threat.
Fear maybe in response to something that
has already occurred, immediate or current
threat or in response to something the
person believes will happen.
The object of fear may or may not be based
on reality.
SOURCE IS IDENTIFIABLE!

ANXIETY and FEAR
ANXIETY
Source: Not Identifiable
Related to the FUTURE
Vague
FEAR
Source: Identifiable
Related to the PRESENT
Definite

ANGER
ANGERis an emotional
state consisting of a
subjective feeling of
animosity or STRONG
DISPLEASURE.
ANIMOSITY:
Suggests anger, INTENSE
ILL WILL that threaten to hurt
or destroy

ANGER
Anger can be expressed in a non alienating
Verbal manner; it is then considered
a POSITIVE EMOTION and a sign of emotional
maturity because growth & beneficial.
Interactions result from it.

ANGER
Different manner of anger
expression:
1. Verbal expression-constructive
expression of anger
2. Hostility-mark by harmful behavior;
deep seated dislike
3. Aggression-unprovoked attack
4. Violence-exertion of physical force to
injure or abuse

Depression
- an extreme feeling of sadness and despair
Dizziness
Emptiness / feeling of being alone
Physical signs (loss of wt., headache)
Reduce sexual desire
Eating disorders / loss of appetite
Sleep disturbances / insomnia
Social withdrawal / sadness
Irritability / Inability to concentrate
Originates from overwhelming stressful
event
Numbness

Review
An emotion without specific object.
a. Anxiety
b. Fear
c. Anger
d. Depression

Review
An extreme feeling of displeasure.
a. Anxiety
b. Fear
c. Anger
d. Depression

UNCONSCIOUS DEFENSE
MECHANISM
Mental mechanisms that develops as the
personality attempts to defend itself
(Sigmund Freud)
DEFENSE MECHANISMS are the
UNCONSCIOUS MIND working to protect
the person from ANXIETY.

UNCONSCIOUS DEFENSE
MECHANISM
COMPENSATION
COMPENSATE
- Covering up
weakness by
emphasizing a more
desirable trait or
overachievement in a
more comfortable
area.

UNCONSCIOUS DEFENSE
MECHANISM
DENIAL DENY
- An attempt to screen
or ignore unacceptable
realities by REFUSING
to acknowledge.

UNCONSCIOUS DEFENSE
MECHANISM
DISPLACEMENT
DISPLACE
- Transferring or
discharging of
emotional reactions
from one person to
another object.
- Ex: Husband and wife
are fighting, husband
hits the door instead
of his wife.

UNCONSCIOUS DEFENSE
MECHANISM
IDENTIFICATION
IDENTIFY or IDOLIZE
- An attempt to manage anxiety
by imitating the behavior of
someone feared or
respected.
- Ex: Nursing student becomes
a critical care nurse because
this is the specialty of an
instructor he admires.

UNCONSCIOUS DEFENSE
MECHANISM
INTELLECTUALIZATION
INTELLECT
- An emotional response that normally
would ACCOMPANY an uncomfortable
or PAINFUL EXPERIENCE is evaded
by the use of rational explanations.
- Ex: PAIN over parents sudden death is
reduced by saying, He wouldnt have
wanted to live with a disability.

UNCONSCIOUS DEFENSE
MECHANISM
INTROJECTION
severe form of
IDENTIFICATION
Allows for the acceptance
of others norms & values
into oneself even when
contrary to ones
previous assumptions.
- A person who dislikes
guns become an avid
hunter, just like his friend .

UNCONSCIOUS DEFENSE
MECHANISM
MINIMIZATION
MINIMIZE
- Not acknowledging
the significance of
ones behavior
- Ex: Dont believe
everything my wife
tells you, I wasnt so
drunk that I could
drive.

UNCONSCIOUS DEFENSE
MECHANISM
PROJECTION
PROJECTION
- blaming others.
- Ex: A mother is told
her child must repeat a
grade school and she
blames this on the
teachers poor
instructions.

UNCONSCIOUS DEFENSE
MECHANISM
RATIONALIZATION
RATIONALIZE
- Justifications of certain
behaviors by faulty logic.
- Ex: A mother spanks her
toddler too hard and says it
was all right because she
couldnt feel it through the
diapers anyway.

UNCONSCIOUS DEFENSE
MECHANISM
REACTION
FORMATION
plastic
- A mechanism that causes
people to act exactly
opposite to the way they
feel.
- Ex: Person who despises
his boss tells everyone what
a great boss he is.

UNCONSCIOUS DEFENSE
MECHANISM
REGRESSION
moving back to an
earlier stage of
growth and
development.
- Ex: An adult who is
overwhelmed with
depression begin
thumb sucking.

UNCONSCIOUS DEFENSE
MECHANISM
REPRESSION
unconscious mechanism by
which threatening thoughts,
feelings and desires are kept
from becoming conscious.
- UNCONSCIOUS
PORGETTING Forgetting
- Ex: Woman has no memory
before age 7 when has no
memory before age 7 when she
was removed from abusive
parents.

UNCONSCIOUS DEFENSE
MECHANISM
SUBLIMATION
displacement of
energy associated with
more primitive SEXUAL
or AGGRESSIVE
desires into socially
acceptable activities.
- Ex: A man with
excessive sexual drives
joined a painting
contest.

UNCONSCIOUS DEFENSE
MECHANISM
SUBSTITUTION
SUBSTITUTE
- Replacing the desired
object with one that is
more readily
available.

UNCONSCIOUS DEFENSE
MECHANISM
UNDOING UNDO
- Exhibiting acceptable
behavior to make up for or
negate unacceptable
behavior.
- Ex: Person who cheats on
his wife brings a bouquet of
flowers.

Review
A physically unattractive adolescent
becomes an expert dancer. What defense
mechanism is manifested by this
individual?
a. Denial c. Displacement
b. Compensation d. Repression

Review
A woman is abandoned by her fiance;
quickly finds another man about whom she
develops the same feelings.
a. Reaction formation
b. Sublimation
c. Substitution
d. Undoing

Review
A salesman is angry at his superior but
suppresses his anger; later, on return to his
home, he punishes one of his children for
misbehavior that would usually be tolerated
or ignored.
a. Denial c. Displacement
b. Compensation d. Repression

Review
A psychiatric client told his nurse, Im not a
drug addict.

Review
A student who failed the his math subject
blames his teacher for not teaching the
lesson well.
A rock band member wears the same
earrings as his favorite rock icon.

Review
A person with strong antisocial impulses
leads a crusade against violence.
A client experiencing extreme cold positioned
his body like a fetus wherein the extremities
are fully flexed.

Cognitive Indicators
thinking responses to stress
Problem Solving
Structuring
Self-control
Suppression
Fantasy

Cognitive Indicators
PROBLEM SOLVING
involves THINKING through the
threatening situation, USING
SPECIFIC STEPS to arrive at a
SOLUTION.
Assess situation / problem
Analyzes
Define
Choose Alternative
Carries out the selected alternative
Evaluates
EX: Nursing Process

Cognitive Indicators
STRUCTURING
- MANIPULATION of the
situation so that
THREATENING EVENT
may NOT occur.
- Ex. Nurses use close-
ended questions in
conducting interview with
the client.

Cognitive Indicators
SELF CONTROL
(DISCIPLINE)
assuming a manner of
being in control with the
situation.
Ex. I dont need your
help, I can handle the
situation.

Cognitive Indicators
SUPPRESSION
- consciously
putting a thought
out of mind
- Ex. I wont deal
with that today, Ill
do it tomorrow.

Cognitive Indicators
FANTASY or DAY
DREAMING
- Unfulfilled wishes and
desires are imagined as
fulfilled.
- Ex. I know I can pass the
exams, stated by the
student without doing any
effort to review his lessons.

Cognitive Indicators
PRAYER
- identification, description
of the problem,
suggestion of solution
then reaching out for
help and support.

Verbal and Motor
Manifestations
Crying feelings of pain, joy, sadness are released.
Verbal abuse release mechanism toward non living
objects and stress producing events.
Laughing anxiety reducing response that leads to
constructive problem solving.
Screaming / Shouting response to fear or intense
frustration and anger.
Hitting and Kicking spontaneous response to physical
threats.
Holding and touching responses to joyful, painful or
sad events.