Chapter 2 Psychological Perspective Personality structure and development: Explanation of human behavior can be divided into three paradigms: (biomedical, psychological & sociological models) I. Biomedical model: proposes that abnormal behavior is a consequence of brain and CNS pathology. 1- Nervous system disorders. 2- Structural changes to the brain. 3- Endocrine or gland dysfunction. 4- Genetic transmission of mental illness Psychiatric and Mental Health Nursing

II. psychological models: A. Psychoanalytic theory: proposes that personality progresses through four stages: oral, anal, phallic and latent stage. Behavior is driven by unconscious processes, and influenced by childhood conflicts. Mental illness is seen as a consequence of fixation at any stage or un resolved conflict between Id, Ego & Super ego Psychiatric and Mental Health Nursing 2

B. Behavioral psychology: View that Behaviors are learned depending on whether they are rewarded or not (classical conditioning ,operant conditioning and modeling by imitation). C. Cognitive psychology: Behavior is a result of the interplay of external events (stimuli and reinforcements), and internal events (one's perceptions and thoughts about oneself, and the world), e.g. depressed person will choose information that maintains a sad perspective Psychiatric and Mental Health Nursing 3

D. Humanistic psychology: focuses on the development of a concept of self and the striving of the individual to achieve personal goals. Explain that human behavior is motivated by a drive for self-actualization. Psychiatric and Mental Health Nursing

III. Sociological models: * Examine social factors for their influence on the behavior. Social factors include: Age: the elderly are more likely to suffer from depression Gender: suicide rate for men is higher than for women. Psychiatric and Mental Health Nursing

Socioeconomic status: poverty is associated with poorer physical and mental health outcomes Marital status: depression and alcohol problems are 2-3 times more prevalent in people who have never married or divorced, than among people who are married . Psychiatric and Mental Health Nursing

DEFFENSE MECHANISMS Definition: psychoanalytical term for coping mechanisms: Unconscious processes used by ego the reduce anxiety and conflict by modifying, or rejecting reality: Mental health can be adversely effected by defense mechanisms: Distort personality. Dominate behavior Disturb adjustment with others. Psychiatric and Mental Health Nursing

DEFFENSE MECHANISMS… cont. May serve other purposes in addition to primary purpose; protect self. Characteristics: - Operate primarily on unconscious level. - Part of normal ego maintenance. - When defense cease to be effective, psychoses may result. - Client may not be able to control defense mechanisms even when conscious of them. Psychiatric and Mental Health Nursing

DEFFENSE MECHANISMS… cont. Commonly used defense mechanisms: 1- Displacement: when feelings distorted, separated from original object, transferred toward less threatening object example: man angry with boss, takes it out on wife at home. 2- Denial: anxiety-including aspects of reality are rejected. - Example: not accepting death of loved one or serious disease as cancer has occurred. Psychiatric and Mental Health Nursing

DEFFENSE MECHANISMS… cont. 3- Regression: person adopts behavior patterns characteristic of an earlier development stage. Examples: hospitalized adult regresses under stress of cancer diagnosis. A. toilet-trained child who becomes incontinent following the birth of a sibling. Psychiatric and Mental Health Nursing

DEFFENSE MECHANISMS… cont. 4- Projection: attributing undesirable feelings, to other person when it become unacceptable to oneself - Example: man who hates boss tells everyone that boss hates him. 5- Rationalization: unacceptable responses are justified with logical reasons. - Example: girl fails math test, blames English teacher who gave assignment at the same time. Psychiatric and Mental Health Nursing

DEFFENSE MECHANISMS… cont. 6- Sublimation: substituting socially acceptable behavior for unacceptable impulses. Examples: aggressive impulses are transformed into sport, or art. 7- Reaction formation: hiding true feelings from self; and development of a personality trait opposite of the original unconscious or repressed trait. - Example: child angry at mother over affection shown new baby, shows extra affection to baby. Psychiatric and Mental Health Nursing

DEFFENSE MECHANISMS… cont. 8- Repression: unacceptable impulses/ feelings unconsciously kept away from awareness. Example: woman forgets date of sister's birthday because she has always hated her. Memories of sexual abuse in childhood are barred from consciousness. Psychiatric and Mental Health Nursing

DEFFENSE MECHANISMS… cont. 9- Suppression: unwanted feelings consciously kept out of awareness - Example: student failing high school refuse counseling, says he will make an appointment next week. 10- Identification: behaviors of someone admired are imitated until become actual part of individual. - Example: young boy dresses like his favorite sport hero Psychiatric and Mental Health Nursing

Coping Defined as “process of using constantly changing cognitive and behavioral efforts to manage specific external and/or internal demands that exceeding the resources of the person”. People experiencing poor mental health use less effective strategies than those with better mental health. - Example: people suffering from depression use ineffective coping patterns than people not having depression. Psychiatric and Mental Health Nursing

Types of coping strategies: 2 1- Problem focused: E.g. confrontation, seeking for social support, and planed problem solving. 2- Emotion focused: Efforts to regulate the emotional consequences of the situation e.g. distancing, positive reappraisal, escape & avoidance (wishful thinking, drinking drugs or alcohol, and overeating). Psychiatric and Mental Health Nursing

People suffering from depression relied on avoidant coping styles, such as ‘trying to avoid think about what happened. *Avoidant coping linked to poor adaptation. * Cognitive coping (problem focused) has been associated with positive adaptation Psychiatric and Mental Health Nursing

Difference between defense mechanisms &coping strategies   Defense Mechanisms Coping Strategies 1- Operating Unconsciously Consciously 2- Dealing With internal conflict to reduce anxiety To manage external and internal demands. 3- Uses Used subjectively and can't be trained Can be trained and focused on by therapist 4- Nature Many becomes pathologically if it's used repeatedly More mature and adaptive 5- Example Displacement Problem focused coping Psychiatric and Mental Health Nursing