NUR3535C Module 1

NUR3535C | Module 1 | Mental Health, Mental Illness, Stress Response

Mental health

• The successful adaptation to stressors from the internal or external environment, evidenced by thoughts, feelings, and behaviors that are age-appropriate and congruent w/ local and cultural norms.

• Provides people w/ the capacity for rational thinking, communication, skills, learning, emotional growth, resilience, and self-esteem.

• State of well-being in which individuals reach their own potential, cope w/ the normal stresses of life, work productively, and contribute to the community (as defined by the WHO)

Mental illness

• Maladaptive responses to stressors from the internal or external environmental, evidenced by thoughts, feelings, and behaviors that are incongruent w/ the local and cultural norms and interfere w/ the individual’s social, occupational, or physical functioning

• Significant dysfunction in mental functioning r/t developmental, biological, and physiological disturbances

• Definition shaped by the prevailing culture and societal values, reflecting changes in cultural norms, social expectations, and political climates

Mental health

Mental health-mental illness continuum

• Adequate to high-level functioning

• Stress and discomfort of daily life does not result in impairments in daily functioning

Emotional problems

Mental health-mental illness continuum

• Mild to moderate discomfort and distress

• Mild impairment in functioning (e.g. insomnia, lack of concentration, loss of appetite)

• Temporary

Mental illness

Mental health-mental illness continuum

• Altered thinking, mood, and behavior (e.g. depression, anxiety, schizophrenia)

• Chronic or long-term impairments that range from moderate to disabling

Resilience

Ability and capacity to secure resources needed to support well-being, including regulating one’s own emotions and overcoming negative, self-defeating thoughts.

Fight-or-flight

Stress response in which body prepares for a situation an individual perceives as a threat to survival → increased BP, HR, RR, and cardiac output

Alarm (acute stress) stage

General adaptation syndrome (GAS)

• Initial, brief and adaptive response (fight or flight)

• Activates SNS 

• Immune response negatively affects body’s ability to produce protective factors 

• Activates HPA axis to stay on alert

Resistance (adaptation) stage

General adaptation syndrome (GAS)

• Sustained and optimal resistance to the stressor

• Recovery, repair, and renewal may occur 

• Use of valuable resources and reduction in defenses and adaptive energy

Exhaustion stage

General adaptation syndrome (GAS)

• Resources are depleted

• Stress becomes chronic 

• Sustained physical responses to stress promote susceptibility to many diseases (e.g. anxiety disorders, major depressive disorder, sleep disorders, digestive problems, heart disease, weight gain) 

Distress

Negative, draining energy (e.g. death, financial overload, school/work demands) → anxiety, depression confusion, helplessness, hopelessness, and fatigue

Eustress

Normal physiological positive energy (e.g. vacation, birth, new job, favorite sport) → motivates individuals and results in feelings of happiness, hopefulness, and purposeful movement

Stress

Any psychological or physical stimuli/event that triggers an individual’s adaptive physiological and psychological response

Adaptive

Response that occurs when behavior maintains the integrity of the individual

Maladaptive

Response that occurs when one’s physical or behavioral response to any change in their internal/external environment results in disruption of one’s integrity or in persistent disequilibrium, considered to be negative or unhealthy

Precipitating event

Stimulus perceived as a stressor

Cognitive appraisal

Individual’s perception of a precipitating event

Primary appraisal

The initial evaluation of a situation to determine its significance (e.g. irrelevant, benign) and whether it poses a threat or challenge, harm or loss

Secondary appraisal

The process of evaluating resources and options available to cope with a perceived threat or challenge after the primary appraisal. Coping strategies determine the quality of the individual’s adaptation response to stress.

Relaxation techniques

The following are examples of…

Biofeedback, deep breathing exercises, guided imagery, progressive relaxation, meditation, mindfulness, physical exercises, cognitive reframing (restructuring), journaling, humor

Anxiety

Major, primary psychological response pattern to stress, accompanied by various thoughts, feelings, and behaviors (e.g. uncertainty, hopelessness)

Adaptation

_________ is determined by the extent to which the thoughts, feelings, and behaviors interfere w/ a individual’s functioning. Anxiety becomes problematic when the individual is unable to prevent their response from escalating to a level that interfere w/ their ability to meet basic needs.

Mild

Peplau’s four levels of anxiety: Seldom a problem.

• Individuals employ various coping mechanisms to deal w/ stress (e.g. sleeping, yawning, fidgeting, finger tapping) 

• Adaptive and can provide motivation for survival

Moderate

Peplau’s four levels of anxiety: Perceptual field diminishes, selective inattention.

• Ability to think clearly is hampered, but learning and problem solving can still take place 

• Ego defense mechanisms – become maladaptive when the defense mechanism interferes w/ ability to deal w/ reality as it is presented, w/ interpersonal relations or w/ occupational performance

Severe

Peplau’s four levels of anxiety: Perceptual field is so diminished that concentration centers on one detail only or on many extraneous/scattered details.

• Learning and problem solving are not possible

• Unresolved → risk for development of physiological disturbances

• Unresolved repressed severe anxiety → psychoneurotic patterns of behavior

Panic

Peplau’s four levels of anxiety: The most intense state where the individual is not capable of processing what is happening in the environment and may lose contact w/ reality (psychosis).

• Psychosis: significant thought disturbance in which reality testing is impaired → delusions, hallucinations, disorganized, speech, catatonic behavior

• Physical behavior becomes erratic, uncoordinated, and impulsive

Defense mechanisms

Automatic coping styles that protect people from anxiety and enable them to maintain their self-image (biological and psychological therapy) by blocking feelings, conflicts, and memories. Used either consciously or unconsciously.

Altruism

Defense mechanisms: Unconscious motivation to feel caring and concerns for others and act for the well-being of others

Compensation

Defense mechanisms: Counterbalance perceived deficiencies by emphasizing strength

Conversion

Defense mechanisms: Unconscious transformation of anxiety into a physical symptom w/ no organic cause

Denial

Defense mechanisms: Escaping unpleasant, anxiety-causing thoughts, feelings, wishes, or needs by consciously ignoring their existence

Displacement

Defense mechanisms: Transference of emotions assoc. w/ a particular person, object, or situation to another nonthreatening person, object, or situation

Dissociation

Defense mechanisms: Disruption on consciousness, memory, identity, or perception of the environment that results in compartmentalizing uncomfortable or unpleasant aspects of oneself

Identification

Defense mechanisms: Attributing to oneself the characteristics of another person or group either consciously or unconsciously

Intellectualization

Defense mechanisms: Events are analyzed based on remote, cold facts and w/o passion, rather than incorporating feeling and emotion into the processing

Introjection

Defense mechanisms: A person unconsciously adopts the qualities, attitudes, values, or behaviors of someone else to manage anxiety, fear, or loss

Isolation

Defense mechanisms: Mentally separating painful or threatening thoughts and feelings from the rest of one’s consciousness, preventing emotional overwhelm

Projection

Defense mechanisms: Unconscious rejection of emotionally unacceptable features and attributing them to others

Rationalization

Defense mechanisms: Justifying illogical or unreasonable ideas, actions, or feelings by developing acceptable explanations that satisfy the teller and the listener

Reaction formation

Defense mechanisms: Unacceptable feelings or behaviors are controlled and kept out of awareness by developing the opposite emotion or behavior

Regression

Defense mechanisms: Reverting to an earlier, more primitive and childlike pattern of behavior that may or may not have been exhibited previously

Repression

Defense mechanisms: Unconscious exclusion of unpleasant or unwanted experiences, emotions, or ideas from conscious awareness

Splitting

Defense mechanisms: Inability to integrate the positive and negative qualities of oneself or others into a cohesive image

Sublimation

Defense mechanisms: Unconscious process of transforming negative impulses into less damaging and even productive impulses

Suppression

Defense mechanisms: Conscious decision to delay addressing a disturbing situation or feeling

Undoing

Defense mechanisms: A person makes up for a regrettable act or communication