respon psikologis terhadap stress

RESPON PSIKOLOGIS TERHADAP STRESSDiyan Yuli Wijayanti

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Program Studi Ilmu Keperawatan Universitas Diponegoro

Psychologic Responses

Anxiety Fear Anger Depression Defense mechanisms: compensation,

denial, displacement, identification, intellectualization, introjection, minimization, projection, rationalization, reaction formation, regression, repression, sublimation, substitution, undoing.

Anxiety

Gelisah Apprehension Dread Firasat Tidak berdaya

Can be experienced at the conscious, subconscious, or unconscious level

Anxiety

Berbeda dengan fear :

Anxiety Fear

Sumber tidak teridentifikasi Sumber teridentifikasi

Berhubungan dengan “future” Sekarang

Tidak jelas Jelas

Result of psychological or emotional conflict

Result of a discrete physical or psychologic entity

Level cemasVidebeck (2008)

1. Cemas ringana. Respons fisik

Ketegangan otot ringan Sadar akan lingkungan Rileks atau sedikit gelisah Penuh perhatian Rajin


b. Respon kognitif Lapang persepsi luas Terlihat tenang, percaya diri Perasaan gagal sedikit Waspada dan memperhatikan

banyak hal Mempertimbangkan informasi Tingkat pembelajaran optimal

Level cemas Videbeck (2008)

c. Respons emosional Perilaku otomatis Sedikit tidak sadar Aktivitas menyendiri Terstimulasi Tenang


2. Cemas sedanga. Respon fisik :

Ketegangan otot sedang Tanda-tanda vital meningkat Pupil dilatasi, mulai berkeringat Sering mondar-mandir, memukul tangan Suara berubah : bergetar, nada suara

tinggi Kewaspadaan dan ketegangan

menigkat- Sering berkemih, sakit kepala, pola tidur

berubah, nyeri punggung


b. Respons kognitif Lapang persepsi menurun Tidak perhatian secara selektif Fokus terhadap stimulus

meningkat Rentang perhatian menurun Penyelesaian masalah menurun Pembelajaran terjadi dengan

memfokuskan


c. Respons emosional Tidak nyaman Mudah tersinggung Kepercayaan diri goyah Tidak sabar Gembira


3. Cemas berata. Respons fisik

Ketegangan otot berat Hiperventilasi Kontak mata buruk Pengeluaran keringat meningkat Bicara cepat, nada suara tinggi Tindakan tanpa tujuan dan serampangan Rahang menegang, mengertakan gigi Mondar-mandir, berteriak Meremas tangan, gemetar


b. Respons kognitif Lapang persepsi terbatas Proses berpikir terpecah-pecah Sulit berpikir Penyelesaian masalah buruk Tidak mampu mempertimbangkan

informasi Hanya memerhatikan ancaman Preokupasi dengan pikiran sendiri Egosentris


c. Respons emosional Sangat cemas Agitasi Takut Bingung Merasa tidak adekuat Menarik diri Penyangkalan Ingin bebas


4. Panik a. Respons fisik

Flight, fight, atau freeze Ketegangan otot sangat berat Agitasi motorik kasar Pupil dilatasi Tanda-tanda vital meningkat kemudian

menurun Tidak dapat tidur Hormon stress dan neurotransmiter

berkurang Wajah menyeringai, mulut ternganga


b. Respons kognitif Persepsi sangat sempit Pikiran tidak logis, terganggu Kepribadian kacau Tidak dapat menyelesaikan masalah Fokus pada pikiran sendiri Tidak rasional Sulit memahami stimulus eksternal Halusinasi, waham, ilusi mungkin

terjadi


c. Respon emosional Merasa terbebani Merasa tidak mampu, tidak

berdaya Lepas kendali Mengamuk, putus asa Marah, sangat takut Mengharapkan hasil yang buruk Kaget, takut Lelah

Fear

Respon terhadap sesuatu yang sudah ada atau jelas.Contoh :

The beginning nursing student may be fearful in anticipation of the first experience in a client setting. The student may fear that the client will not want to be cared for by the student or that the student might harm the client

Anger

Subjective feeling of animosity Can be expressed in a non alienating

verbal manner – positive emotion and sign of emotional maturity

Do the verbal communication than – constructive

Depression

Negative Extreme feeling of sadness, despair, dejection,

lack of worth, emptiness Tanda dan gejala berbeda antara individu satu

dengan yang lain Emotional symptom: tiredness, sadness,

emptiness, numbness Behavior sign: irritability, inability to

concentrate, difficulty making decision, loss of sexual desire, crying, sleep disturbance, social withdrawal

Physical sign: loss of appetite, weight loss, constipation, headache, dizziness

Defense mechanisms

Unconscious Psychologic adaptive mechanisms/

mental mechanisms to defend, establish compromises among conflicting impulses, allay inner tension

Protect person from anxiety – precursors to conscious cognitive coping mechanisms – solve problem

Defense mechanisms

Defense mechanism

Examples Use/purpose

Compensation: Covering up weaknesses by emphasizing a more desirable trait or by overachievement in amore comfortable area

A high school student too small to play football becomes the star long-distance runner for the track team

Allow a person to overcome weakness and achieve sucess

Denial:An attempt to screen or ignore unacceptable realities by refusing to acknowledge them

A woman, though told her father has metastatic cancer, continues to plan a family reunion 18 months in advance

Temporarily isolated a person from the full impact of a traumatic situation

Defense mechanisms

Defense mechanism


Displacement:The transferring or discharging of emotional reaction from one object or person to another object or person

A husband and wife are fighting, and the husband becomes so angry he hits a door instead of his wife

Allows for feelings to be expresses through or to less dangerous objects or people

Identification:An attempt to manage anxiety by imitating the behavior of someone feared or respected

A new graduate suddenly left in charge emulates her faculty role model

Helps a person avoid self-devaluation

Defense mechanisms

Defense mechanism Examples Use/purpose

Intellectualization:A mechanism by which an emotional response that normally would accompany an uncomfortable or painful incident is evaded by the use of rational explanation that remove from the incident any personal significance and feeling

The pain over a parent’s sudden death is reduced by saying, “he wouldn’t have wanted to live with a disability”

Protect a person from pain and traumatic events

Defense mechanisms

Defense mechanism


Minimization:Not acknowledging the significance of one’s behavior

A person says, “Don’t believe everything my wife tells you. I wasn’t so drunk I couldn’t drive”.

Allows a person to decrease responsibility for own behavior.

Projection:A process in which blame attached to others or the environment for unacceptable desires, thoughts, shortcomings, and mistakes

A mother is told her child must repeat a grade in school, and she blames this on the teacher’s poor instruction. A husband forgets to pay a bill and blames his wife for not giving it to him earlier

Allows a person o deny the existence of shortcomings and mistakes; protect self image

Defense mechanisms


Rationalization: Justification of certain behavior by faulty logic and ascribing motives that are socially acceptable but did not in fact inspire the behavior

A mother spanks her toddler too hard and says it was all right because he couldn’t feel it through the diapers anyway

Helps a person cope with the inability to meet goals or certain standards.

Introjection:A form of identification that allows for the acceptance of others’ norms and value into oneself, even when contrary to one’s previous assumptions

A 7-year-old tells his little sister, “Don’t talk to strangers”. He has introjected this value from the instructions of parents and teacher

Help a person avoid social retaliation and punishment; particulary important for the child’s development of superego

Defense mechanisms

Defense mechanism


Reaction formation:A mechanism that causes people to act exactly opposite to the way they feel

An executive resent his bosses for calling in a consulting firm to make recommendation for change in his department but verbalizes complete support of the idea and is exceedingly polite and cooperative

Aids in reinforcing repression by allowing feelings to be acted out in a more acceptable way.

Regression:Resorting to an earlier, more comfortable level of functioning that is characteristically less demanding and responsible

An adult throws a temper tantrum when he does not get his own way. A critically ill client allows the nurse to bathe and feed him

Allows a person to return to appoint in development when nurturing and dependency were needed and accepted with comfort

Defense mechanisms


Sublimation:Displacement of energy associated with more primitive sexual or aggressive drives into socially acceptable activities

A person with excessive sexual drives invests psychic energy into a well-defined religious value system

Protect a person from behaving in irrational, impulsive ways

Substitution:The replacement of a highly valued, unacceptable, or unavailable object by a less valuable, acceptable, or available object.

A woman wants to marry a man exactly like her dead father and settles for someone who looks a little bit like him

Helps a person achieve goals and minimize frustration and disappointment

Defense mechanisms


Undoing:An action or words designed to cancel some disapproved thoughts, impulses, or act in which the person relieves guilt by making reparation

A father spanks his child and the next evening brings home a present for him.

Allow a person to appease guilty feelings and atone for mistakes

Repression:An unconscious mechanism by which threatening thoughts, feelings, and desires are kept from becoming conscious; the present material is denied entry into consiousness

A teenager, seeing his best friend killed in a car accident, becomes amnesic about the circumstances surrounding the accident

Protect a person from a traumatic experience until he or she has the resources to cope.

Common coping mechanisms grouped by developmental appropriateness

Age Coping mechanisms

0-5 Delusional projection

Denial

Distortion

3-15 Projection

Fantasy

Somatization

Acting out

Passive-aggressive behavior

Common coping mechanisms grouped by developmental appropriateness

Age Coping mechanisms

3-adulthhood IntellectualizationRepressionDisplacementReaction formationDissociation

12-adulthhood AltruismHumorSuppressionAnticipation Sublimation

respon psikologis terhadap stress

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