COMPLETE PSYCHOLOGY Presentation kmtc notes

PSYCHOLOGY

Module outcomes By the end of this module, the learner should; Apply concepts of psychology in managing clients/patients Integrate theories of personality development with provision of nursing care Identify and manage patients with deviations in growth & development.

Course Outline Concepts of psychology Definition of terms Historical Background Scope of psychology Theories of personality development Human behavior and social interactions Learning and memory Classical conditioning Instrumental conditioning 3

Course outline ct’ Observational cognitive avoidance and learning Motivation Types of personalities Stress and coping Crisis and crisis intervention Mental defense mechanisms Psychology in relation to nursing Stages of growth and development Application of theories of personality development in growth and development

CONCEPTS OF PSYCHOLOGY Welcome

What is Psychology?

Definition of Terms PSYCHOLOGY -The scientific study of human behavior and mental or cognitive processes. The scientific study of human mind including its structure and functioning, usually observed in behavior. BEHAVIOUR Any activity of an organism that is capable of being observed in response to its environment. Behaviour includes all of our outward or overt actions and reactions, such as verbal and facial expressions and movements. 7

MENTAL PROCESSES Refer to all the internal and covert activity of our mind such as thinking, feeling and remembering. NOTE: The word Psychology has its origin from two Greek words ‘ Psyche ’ and ‘ Logos ’, ‘psyche’ means ‘ soul ’ and ‘logos’ means ‘ study ’. Thus literally, Psychology means ‘the study of soul’ or ‘science of soul’.

CHARACTER An evaluation of an individual`s personality against some set standards within the society focusing on morals and ethics. 9

Cont’d… ATTITUDE A tendency to respond positively or negatively to either a person, object or situation (an organism’s response to stimuli). INTELLIGENCE The ability to learn abstracts, which include learning of vocabularies, numbers, concepts, reasoning, making judgment and problem solving skills. 10

SCHOOLS OF PSYCHOLOGY The main schools of psychology are; Structuralism Functionalism Gestalt Behaviorism Psychoanalysis Humanism cognitivism.

1. STRUCTURALISM Structuralism is widely regarded as the first school of thought in psychology. This outlook focused on breaking down mental processes that is imagination, thoughts, memory into the most basic components. Major thinkers associated with structuralism include Wilhelm Wundt and Edward Titchener.

2. FUNCTIONALISM Functionalism was heavily influenced by the work of William James It focused on the mind's functions and adaptations. Instead of focusing on the mental processes themselves, functionalist thinkers were interested in the role that these processes play.

3. GESTALT Some thinkers associated with the Gestalt school of thought included Max Wertheimer, Wolfgang Köhler, and Kurt Koffka . Instead of breaking down thoughts and behavior to their smallest elements, the gestalt psychologists believed that you must look at the whole of experience. According to Gestalt thinkers, the whole is greater than the sum of its parts, a philosophy known as holism .

4. BEHAVIORISM Behaviorism became a dominant school of thought during the 1950s. It was based upon the work of thinkers such as John B. Watson , Ivan Pavlov , and B. F. Skinner . Behaviorism suggests that all behavior can be explained by environmental causes rather than by internal forces.

Behaviorism is focused on observable behavior . Examples of behavioral theories that emerged during this time include: 1. Classical conditioning by Ivan Pavlov 2. Operant conditioning by B.F Skinner

Give me a dozen healthy infants, well-formed, and my own specified world to bring them up in and I'll guarantee to take any one at random and train him to become any type of specialist I might select--doctor, lawyer, artist, merchant-chief, and, yes, even beggarman and thief, regardless of his talents, penchants, tendencies, abilities, vocations, and race of his ancestors. ( BY J.B WATSON)

5.PSYCHOANALYSIS Psychoanalysis is a school of psychology founded by Sigmund Freud . This school of thought emphasized the influence of the unconscious mind on behavior. Other major psychoanalytic thinkers included Anna Freud , Erik Erikson .

6. HUMANISTIC The development of this school of thought in psychology was heavily influenced by the work of humanistic thinkers such as Abraham Maslow , Carl Rogers . While early schools of thought were primarily centered on abnormal human behavior, humanistic psychology differed considerably in its emphasis on helping people achieve and fulfill their potential.

Humanistic psychology instead focused on topics such as: Becoming a fully functioning person Individual free will: The capacity that individuals have to make choices, select courses of action, and control their own lives

Hierarchy of needs Peak experiences : Moments of pure joy that play an important part in the reaching self-actualization . Self-actualization : A state of reaching one's full potential

7. Cognitive psychology Cognitive psychology is the school of psychology that studies mental processes, including how people think, perceive, remember and learn.

Historical Background The development of psychology can broadly be traced into four periods: Ancient Greek period, Pre-modern period, Modern period and Current status 28

Ancient Greek period: Some of the key contributors were: Socrates who was interested in studying the reincarnation of soul (embodiment in fresh). Soul or mind was considered as the representation of individuals. Plato , a bright student of Socrates expanded Socrates concepts in philosophy about life and soul . 29

Pre-modern Period: It was during 1800's that Wilhelm Wundt established first psychology laboratory in Leipzig, Germany. He defined psychology as a science of consciousness or conscious experience. He proposed the Theory called structuralism . 30

Modern period: Behaviorists ( J.B Wastson , Ivan pavlov and B.F. skinner ) proposed that psychology should study the visible behavior which can be objectively felt and seen. Hence they defined psychology as the science of behavior. They however only focused on observable behaviors and ignored the role of mental processes. Also, they undermined the role of unconscious mind and heredity in behavior. 31

Current Definition: The modern day psychology is defined as the science of behavior and mental processes. This definition comprises these things: psychology is science , it studies behavior and it studies mental process. 32

Aim of studying Psychology To find out why people act as they do To give us a better understanding (insight) of our own attitudes and reactions. 33

The BRANCHES Of Psychology

BRANCHES of Psychology: The field of psychology can be understood by various subfields of psychology making an attempt in meeting the goals of psychology.

1. Physiological Psychology: In the most fundamental sense, human beings are biological organisms. Physiological functions and the structure of our body work together to influence our behaviour .

2. Developmental Psychology Here the studies are with respect to how people grow and change throughout their life from prenatal stages, through childhood, adulthood and old age.

3. PERSONALITY PSYCHOLOGY This branch helps to explain both consistency and change in a person’s behaviour over time, from birth till they die through the influence of parents, siblings, playmates, school, society and culture. It also studies the individual traits that differentiate the behaviour of one person from that of another person.

4. CLINICAL PSYCHOLOGY It deals with the assessment and intervention of abnormal behaviour . As some observe and believe that psychological disorders arise from a person’s unresolved conflicts and unconscious motives, others maintain that some of these patterns are merely learned responses, which can be unlearned with training Still others are contend with the knowledge of thinking that there are biological basis to certain psychological disorders, especially the more serious ones.

5. COUNSELLING PSYCHOLOGY Counselling psychologists advise students on effective study habits Provide help concerned with mild problems of social nature and strengthen healthy lifestyle, economical and emotional adjustments. They also do marriage and family counselling, provide strategies to improve family relations.

6. EDUCATIONAL PSYCHOLOGY Educational psychologists are concerned with all the concepts of education. This includes the study of motivation, intelligence, personality, use of rewards and punishments, size of the class, expectations, the personality traits and the effectiveness of the teacher, the student-teacher relationship, the attitudes, etc.

7. SOCIAL PSYCHOLOGY This studies the effect of society on the way people think, behave and act. Our behaviour is not only the result of just our personality and predisposition. Social and environmental factors affect the way we think, say and do. Social psychologists conduct experiments to determine the effects of various groups, group pressures and influence on behaviour .

8. Environmental Psychology It focuses on the relationships between people and their physical and social surroundings. For example; the noise pollution and its harmful effects and the influence of overcrowding upon lifestyle, etc.

9. Sports and Exercise Psychology: It studies the role of motivation in sport, social aspects of sport.

10. Cognitive Psychology: It studies thinking, memory, language, development, perception, imagery and other mental processes in order to peep into the higher human mental functions like insight, creativity and problem-solving.

Note: Psychiatry - branch of medicine that deals with emotional and behavioral disorders. A psychiatrist can prescribe medicine and is considered a medical doctor (M.D.), NOT a psychologist.

Why study personality? It helps the health workers such as nurses and clinicians to understand themselves, each other and their patients. It determines success and failure in the medical field, ability to make friends and to adapt to different working conditions. It influences the way one copes with pain, illness and crises. It helps the health worker to understand why patients react differently to a similar situation 52

PRACTICE QUESTIONS 1. Define the following schools of psychology stating the names of theorist who influenced them (5 marks) Pschoanalysis Behaviourism Humanistic State the three levels of the mind by Sigmund Freud (3 marks) Define the following branches of psychology (3 marks) Developmental psychology Personality psychology Cognitive psychology

PERSONALITY Definition: - The unique characteristics each person develops in the course of his life. The sum total of a person His/her psychological and physiological characteristics that make him/her a unique individual. E.g. behavior, conduct, temperament (mental attitude), intellect. 57

Personality Trait A tendency to behave in a consistent manner in various situations. Knowledge that a person possesses a particular trait makes prediction of her behavior possible e.g. patience, honesty, perseverance, bad temper, etc. 58

Factors Influencing Personality 1. Heredity Studies have proved that individuals inherit certain characteristics of personality from their parents, e.g. general appearance, reaction tendencies (alertness, dull etc.) 59

2. Environment Many environmental factors determine the personality of an individual. 3. Social-cultural factors In most societies the male is supposed to be aggressive, strong, not cry aimlessly and endure a lot of pain and on the other hand girls are expected to be submissive and polite. 60

4. Learning Plays a major role in moulding and influencing one`s personality throughout life, beginning from infancy. 61

Characteristics of personality Personality is something which is unique in each individual. Personality refers particularly to persistent qualities of an individual. Personality represents a dynamic orientation of organism to environment. Personality is greatly influenced by social interactions.

TYPES OF PERSONALITY There are quite a number of types of personality: Extrovert Introvert Ambivert 63

1. EXTROVERT Extroverts are often described as talkative, sociable, action-oriented, enthusiastic, friendly, and out-going. On the negative side, they are sometimes described as attention-seeking, easily distracted, and unable to spend time alone. Extroverts are also more likely to engage in risk-taking behaviors, including risky health behaviors.

CHARACTERISTICS OF EXTROVERTS Enjoys being at the center of attention Enjoys group work Feels isolated by too much time spent alone Likes to communicate by talking

Likes to talk about thoughts and feelings Looks to others and outside sources for ideas and inspiration Tends to act first before thinking

2. INTROVERTS An introvert is often thought of as a quiet, reserved, and thoughtful individual. They don’t seek out special attention or social engagements, as these events can leave introverts feeling exhausted and drained.

INTROVERTS 1. Prefer time to yourself The idea of being home alone is thrilling, not taxing. Introverts often enjoy reading, gardening, crafting, writing, gaming, watching movies, or doing any other activity that’s performed alone .

2. Are drained by social interactions While extroverts would not dare miss a Friday night out with friends, introverts know when they’ve maxed out and need to refuel their batteries. That’s not to say all introverts will flake out of parties — they can and do enjoy them as much as any extrovert — but at the end of a long night, introverts need to escape to recharge and reset.

3. Prefer working alone If a group project feels overwhelming or loathsome, you may be an introvert. Introverts often work best when they work alone. The isolation allows introverts to focus deeply and produce high-quality work.

4. Have close circle of friends Don’t mistake an introvert’s small circle of friends as a sign that they can’t make friends or don’t like to socialize. In fact, they enjoy talking with people and getting to know others. They also prefer the solitude of a small circle of friends. High-quality relationships are a key to happiness for introverts.

3. AMBIVERTS An ambivert is someone who falls in the middle of the introvert/extrovert continuum. Ambiverts have a blend of traits from both introverts and extroverts, as well as their own unique strengths.

CHARACTERISTICS OF AMBIVERTS 1. They don’t shy away from attention, but it depends on the context. 2. E njoy being at a crowd, party, or group event for hours… and then suddenly their energy is gone. 3. P refer meaningful talk Like extroverts, the y enjoy conversation — but, like introverts, you hate small talk. (You can do it, you just find it a little less than sincere.)

4. They are very reserved in some situations Present a very different persona to co-workers and casual acquaintances than they do to close friends. 5. T akes alone time in small doses understand that you need and enjoy it, but one night to yourself is usually plenty. An entire weekend alone would leave you restless and wondering what you’re missing.

6. (usually) think before you speak You don’t have a problem putting your thoughts into words, like many introverts do. However, you’ll often wait to hear what others say first before you speak up. 7. Tend to “balance out” the people around you. If someone’s a talker, you’ll be quieter and listen. If they’re quieter, you’ll talk more.

THEORIES OF PERSONALITY DEVELOPMENT

Psychosexual Theory By Sigmund Freud 78

5 Stages of Development Freud argued that human beings develop through series of five psychosexual stages . These stages try to express the sexual energy (libido) and aggressiveness in various forms in each stage. He further argued that deprivation or overindulgence of these energy leads to a scenario he referred to as fixation .

1. Oral Stage (0 – 18months) In this stage, pleasure is achieved through stimulation of the mouth e.g. thumb sucking, suckling etc. Primary conflict: weaning. If fixation occurs, the individual would have dependency or aggression. Oral fixation can result in problems in eating, drinking, smoking , pen/nail biting, gum chewing, abusive.

2. Anal Stage( 1½-3yrs ) 83 Pleasure is achieved from holding and expelling faeces i.e. bladder and bowel movements. Conflict occurs regarding toilet training. Praise and reward for using the toilet at the appropriate time encourage positive outcomes and help children feel capable and productive.

Cont’d… 85 If punishment, ridicule or shame for accidents is used then it can result in the anal expulsive personality (lack of self control, generally messy, stubborn, wasteful or destructive) If parents are too strict or begin toilet training too early, anal-retentive personality develops in which individual is stringent, orderly, rigid, obsessive and perfectionist.

3. Phallic Stage (3 – 6yrs) 89 Primary focus is on genitals, hence, is characterized by sex and gender identification. Oedipus complex for boys and Electra complex for girls. Fear of castration-known as castration anxiety; Girls develop penis envy. Fixation: sexual deviances (overindulging or avoidance, weak or confused sexual identity.

4. Latent Stage (6 – 12yrs) 91 In this stage, sexual impulses are repressed. Individuals in this stage develop social friendship and socialism characterized by group formation and fierce group loyalties. Boys cling together and shun girls and girls despise boys. The child identify peers, and is occupied by school work and play.

Cont’d… 92 The child becomes creative and industrious and will explore his talents and be ready to tackle his problems for solutions. If unsuccessful, because the parents were not supportive and challenging, the child becomes scared and timid and will hate competition, he will not try anything because he knows he is a failure .

5. Genital Stage(12 and above) This is the adolescent stage. Gratification is obtained from actual genital stimulation hence there is development of intimate /romantic friendship with the opposite gender. Identifies with an adult they want to emulate from the previous stages and start behaving like those adults. 93

Cont’d… They tend to resent commands, disagree with parents, want independence and behave like mature adults. Lack of support and understanding leads to rebellion, run away (truancy) from the family, join gangs where they start abusing drugs, present antisocial behavior and will never be what or who they are expected to be i.e. role diffusion. 94

Structure of Personality According to Sigmund Freud, personality is composed of 3 (three) major systems: The Id The Ego and The Superego 96

The Id Also known as the “pleasure principle”. Forms the original system of personality and is present at birth. It is basically unconscious and has no knowledge of the outside world. The id is the most primitive and is driven by impulses. “ I want it” It demands immediate gratification of the needs because it is not governed by law of reason and logic. 97

The Ego Also called the rational self or the “reality principle,” It delays the satisfaction of a need until an appropriate time, place, or object is available. It mediates between the id and the super ego. 98

It develops as from the age of 2 years in the anal stage when the child starts meeting social demands like toilet training, discipline, holding on without demanding immediate gratification. It involves logic, thinking, reasoning and finding solutions to problems or in contact with reality. 99

The Superego This is the last system of personality to develop. Also known as the moral principle It contains values, legal, moral regulations, and social expectations (moral principle) It originates from the child`s assimilation of his parents` standards regarding what is good or bad and sinful. 100

It begins with the resolution of the Oedipus/Electra Complex at age 5 – 6 years and is referred to as the Sociological component of the personality. Its main function is to oppose the id 101

PRACTICE QUESTIONS Explain the structure of personality by Sigmund Freud (6 marks) Explain the word Fixation as used by Sigmund Freud (3 marks) Discuss the five stages of psychosexual theory (5 marks) Explain five (5) factors that influence personality (10 marks)

Psychosocial Theory By Erick Erickson 104

105 According to Erickson, identity is very personal and develops from our heritage and history. Course of development is determined by the interaction of the body, mind and cultural influences. The world gets bigger as we go along and failure is cumulative.

8 Stages of Development 1.Trust versus mistrust 2.Autonomy versus shame/doubt 3.Initiative versus guilt 4.Industry versus inferiority 5.Identity versus role confusion 6.Intimacy versus isolation 7.Generativity versus stagnation 8.Ego integrity versus despair 106

Stages of pschosocial development by Erik erickson Erikson was a developmental psychologist who specialized in child psychoanalysis and was best known for his theory of psychosocial development. According to Erikson, a person passes through eight developmental stages that build on each other. At each stage we face a crisis. By resolving the crisis, we develop psychological strengths or character traits that help us become confident and healthy people.

Stage 1: Trust vs. mistrust(0-18 months) This is attained during infancy. The approximate age at which the individual goes through this stage is 0 - 18 months. Trust is developed when the mother breastfeeds the infant as well as meeting other needs of the infant such as changing wet diapers.

By providing these basic needs, you teach them that they can depend on you. This builds within them the psychological strength of trust. Feeling secure and safe, your infant will be ready to experience the world. Children whose needs aren’t met will look at the world with anxiety, fear, and mistrust.

Stage 2: Autonomy vs. shame and doubt(18 months-3 years) At this stage, the toddler starts to assert their independence. They realize that they can do some things by themselves — and they insist on those things. By this stage, the toddler has food preferences. So let them choose their own snacks. Or let them choose which shirt they want to wear. Toilet training also starts at this stage. Learning to control their bodily functions gives them a feeling of independence or autonomy.

Children who come through this stage with flying colors will believe in themselves and feel secure in their abilities. Children who aren’t given the chance to be independent (within the limits you set) will battle with feelings of inadequacy and self-doubt, according to Erikson.

Stage 3: Initiative vs. guilt(3-5 years) These are the preschool years. If the child is placed in an environment where he/she can explore, make decisions, and initiate activities, they have achieved initiative. As the child interacts socially and plays with others, they learn that they can take the initiative and control what happens. A child should be encouraged; to plan, achieve goals, and take responsibility by making sure they have plenty of opportunities to interact with others.

Let them explore the world within the limits you set up Take them to visit older adults and give out chocolates. Set up playdates for them with their peers.

At this stage they ask endless questions. This stage is about much more than just calling the shots. Through both interacting with others socially and through play, your child develops self-confidence and learns to enjoy having a sense of purpose.

However, if parents are controlling or don’t support their child when they make decisions, the child may not be equipped to take the initiative, may lack ambition, and could be filled with guilt. Overpowering feelings of guilt can prevent a child from interacting with others and deter their creativity.

Stage 4: Industry vs. inferiority(5-12 years) At this stage, they may start comparing themselves to others . If they decide that they’re doing well scholastically, on the sports field, at the arts, or socially, the child will develop feelings of pride and accomplishment. If a child struggles in one area, look for another area in which they can shine.

When the child succeeds, they’ll feel industrious and believe they can set goals and reach them. However, if children have repeated negative experiences at home or feel that society is too demanding, they may develop feelings of inferiority.

Stage 5: Identity vs. role confusion(12-18 years) At this psychosocial development stage, your child faces the challenge of developing a sense of self . They form their identity by examining their beliefs, goals, and values. The encouragement and reinforcement given to a child are vital to shaping their personal identity. In addition, children experiences and social interactions mold their behavior and ideals.

Adolescents who successfully weather this crisis will come away with a strong sense of identity. They’ll be able to uphold these values despite the challenges that they’ll face in the future. But when adolescents don’t search for their identity, they may not develop a strong sense of self and won’t have a clear picture of their future and they end up developing role confusion.

Stage 6: Intimacy vs. isolation(18-40 years) This is the time to invest in commitment to others. The psychosocial challenge now — according to Erikson — is to build long-term loving relationships that feel safe. When people complete this stage successfully, they come away with safe relationships filled with commitment and love.

People who didn’t manage to complete the previous stage successfully and don’t have a strong sense of identity are generally unable to build committed relationships, according to this theory. Lacking the security and warmth of a loving relationship, they’re more likely to experience loneliness and depression.

Stage 7: Generativity vs. stagnation(40-65 years) This seventh stage is characterized by a need to give to others. On the home front, this means raising your children. It can also mean contributing to community charities and events that better society. On the work front, people strive to do well and to be productive.

People who complete this stage successfully have the satisfaction of knowing that you’re needed. They feel that they’re contributing to their families and community and work place. Without the positive feedback in these areas, though, people may experience stagnation.

Frustrated that they’re unable to raise a family, succeed at work, or contribute to society, they may feel disconnected. They may not feel motivated to invest in personal growth or in productivity.

Stage 8: Integrity vs. despair(over 65 years) This is the stage of reflection. During late adulthood, when the pace of life slows down, people look back on their lives to assess what they’ve achieved. People who are proud of what they’ve done experience genuine satisfaction.

However, people who didn’t complete the previous stages may have feelings of loss and regret. If they see their lives as unproductive, they become dissatisfied and depressed. People often alternate between feelings of satisfaction and regret. Looking back on life to get a sense of closure can help to face death without fear.

MASLOW’S HIERACHY OF NEEDS

MCQS Which stage of psychosocial development takes place during the preschool years? Industry vs. Inferiority Initiative vs. Guilt Autonomy vs. Shame and Doubt Trust vs. Mistrust

QUESTION 2 The psycho-social theory has how many stages? A. 5 B. 8 C. 9 D. None of the above

Question 3 Which is an example of the autonomy versus shame and doubt stage? A teenager trying out new fashions and hairstyles A preschooler insisting on picking out her own clothes, no matter how mismatched they are A middle-schooler completing a challenging math assignment All of the above

QUESTION 4 Erik Erickson stage that relate to normal psychosocial development in adolescence is Identity vs role confusion Initiative vs guilt Industry vs inferiority Ego integrity vs despair

HUMANISTIC THEORY MASLOW’S HIEARARCHY OF NEEDS Abraham Maslow

Introduction Maslow's hierarchy of needs is a theory in psychology proposed by Abraham Maslow in 1943. Maslow's hierarchy of needs is often portrayed in the shape of a pyramid with the largest, most fundamental needs at the bottom and the need for self-actualization at the top. In other words, the crux of the theory is that individuals’ most basic needs must be met before they become motivated to achieve higher level needs

Abraham Maslow arranged human needs into a hierarchy starting from the most basic to less basic needs He emphasized on two things: Capacity of human growth/self actualization Individual’s desire to satisfy variety of needs He developed a hierarchy of needs known as Maslow’s hierarchy of needs. 136

137

Maslow’s hierarchy of needs.

Physiological Needs Physiological needs are considered the main physical requirements for human survival. This means that Physiological needs are universal human needs. These are basic needs for survival – Air, food, water, elimination, sleep, rest, clothing, shelter, sex etc. 139

Safety and Security needs When physiological needs are satisfied, concern for safety and security from harm, both physical and psychological emerges. The normal adult is able to protect himself, is safe and usually does not feel endangered. These include job security, health, and safe environments.

Safety and Security needs include: Personal security Emotional security Financial security Health and well-being Job security Safety needs against accidents/illness and their adverse impacts

Love and belonging needs Every person desires companionship and acceptance from others. Man as a social animal hates isolation. He needs a family and friends who care.

According to Maslow, humans need to feel a sense of belonging and acceptance among social groups, regardless of whether these groups are large or small Social Belonging needs include: Friendships Intimacy Family

Self Esteem / Respect /Image / Concept Esteem needs are ego needs or status needs. People develop a concern with getting recognition, status, importance, and respect from others. This is conveyed by the recognition, time, attention and thoughtfulness we give to each other as a unique personality, worthy and dignified. 144

Self Actualization Is self fulfillment or attainment of one`s potential. This is a rarely reached level of needs. Many others are either materially or psychologically deprived and are only able to meet the lower level of needs 145

It calls for creativity, hard work and determination to venture ahead. "What a man can be, he must be. " This quotation forms the basis of the perceived need for self-actualization. Maslow describes this level as the desire to accomplish everything that one can, to become the most that one can be.

Self-actualization can include: Mate Acquisition Parenting Utilizing Abilities Utilizing Talents Pursuing a goal Seeking Happiness

Maslow’s dimensions of motives 148 Physical Dimension of motives The basic physiological needs The safety and security needs Social Dimension of motives Belonging and social activity Esteem and status in the society Psychic Dimension of motives Self actualization and fulfillment(self development).

Conflicts of motives 149 Motivational conflicts always concern an individual’s conflict within himself: Approach-Approach Approach-Avoidance Avoidance-Avoidance

1. APPROACH APPROACH CONFLICT

APPROACH-AVOIDANCE CONFLICT

AVOIDANCE AVOIDANCE CONFLICT

EGO DEFENSE MECHANISMS BY SIGMUND FREUD AND ANNA FREUD

INTRODUCTION The ego defense mechanisms are used as a means of dealing with anxiety situations. Ego defense mechanisms deny or distort reality while operating on an unconscious level.

When using ego defense mechanisms infrequently, they serve an adaptive value in reducing stress. However, if used frequently, this use becomes pathological, and individuals develop a style of avoiding reality.

1) Repression Repression serves to remove painful thoughts, memories, or feelings from conscious awareness by excluding painful experiences or unacceptable impulses. This painful experiences are pushed into the unconscious level. E.g. Traumatic events, such as sexual abuse, that occur in the first 5 years of life are likely to be repressed and to be unconscious

2) Denial of reality We protect ourselves from some unpleasant reality by simply refusing to face or accept it . Example: It is obvious that an alcohol addiction is creating serious problems in my life, but I deny it because I don’t want to give up the perceived benefits that I get from drinking.

E.g. when an individual hears that a loved one has died in a car accident, she may deny that it really happened or that the person is really dead.

3. Reaction formation A way of avoiding an unacceptable impulse is to act in the opposite extreme. By acting in a way that is opposite to disturbing desires, individuals do not have to deal with the resulting anxiety. For example, a woman who hates her husband may act with excessive love and devotion so that she will not have to deal with a possible threat to her marriage that could come from dislike of her husband.

Example: The young boy who hates his older brother for his accomplishments, praise and attention may transform this hatred into aggressive love and praise. This makes his behavior socially acceptable but the underlying hatred remains.

5. Projection Placing one’s failures, unacceptable feelings or thoughts on others. In order to guard against unfavorable self-evaluations, motives that are found personally unacceptable will be attributed to others.

For example; Example: An unfaithful husband accuses his wife of cheating when the truth is that he is the one cheating on her.

6. Displacement Redirection of hostile feelings to people or objects less dangerous than those that initially aroused the emotion. E.g. if a child is attacked by a larger child, she may not feel safe in attacking that child and will not reduce her anxiety by doing so. Instead, she may pick a fight with a smaller child

For example Example: A teen girl’s anger at her boyfriend, which she is afraid to express to him, may be displaced later in an angry outburst towards her little brother

7. Sublimation Sublimation is the modification of a drive (usually sexual or aggressive) into acceptable social behavior. A common form of sublimation is participating in athletic activities or being an active spectator. Running, tackling, or yelling may be appropriate in some sports but not in most other situations.

8. Rationalization Attempt to justify and provide logical reasons and explanations for one’s failures or shortcomings. They make excuses to lessen their anxiety and soften the disappointment. E.g. An individual who does poorly on an examination may say that he is not smart enough, that there is not enough time to study, or that the examination was unfair.

9. Regression This is a retreat to earlier developmental periods to escape the anxiety of a situation. When faced with stress, individuals may use previously appropriate but now immature behaviors.

9. Identification Increasing one’s feeling of worth by identifying one’s self with a person, group, or institution perceived as desirable. We lose our own identity in the process, and fuse our identity with the other person or entity

Example: A teen boy, feeling like he doesn’t belong anywhere and unsure of his worth and identity, joins a gang. The gang accepts him and gives him a sense of power, meaning and belonging, but requires him to abide by a code of behavior that diminishes his freedom and safety.

10. Intellectualization This is dealing with emotional issues indirectly through abstract thoughts rather than dealing with them directly. E.g. a person whose spouse has just asked for a divorce may wish to dwell on issues related to the purpose of life rather than deal with hurt and pain.

Example: An individual who, when told that she has a life threatening disease, focuses exclusively on the statistical percentages of recovery and is unable to cope with her fears and sadness.

11. FANTASY This is a normal and acceptable behavior, and can be positive in many ways, such as providing a motivation to achieve. However, one must realize that fantasy and reality are two separate entities, and that fantasizing will neither resolve conflict nor bring about self-improvement. One must actively pursue the goals of fantasies in order for them to become reality. Fantasy becomes unhealthy when it is used to avoid important real experience and development.

LEARNING THEORIES

Question 1 Which defense mechanism involves reverting to earlier behaviors? A. Displacement B. Denial C. Regression D. Suppression

Question 2 Which defense mechanism involves an outright refusal to admit or recognize that something has occurred or is currently occurring? A. Displacement B. Denial C. Rationalization D. Regression

Question 3 Which defense mechanism involves taking out frustrations on people or objects that are less threatening? A. Displacement B. Denial C. Rationalization D. Regression

QUESTION 4 What are defense mechanisms ? A. Conscious responses that protect people from anxiety B. Unconscious responses that protect people from anxiety C. Conscious responses that cause anxiety D. Unconscious responses that cause anxiety

QUESTION 5 Which defense mechanism involves converting unacceptable impulses into more acceptable outlets? A. Displacement B. Denial C. Sublimation D. Regression

QUESTION 6 Which defense mechanism involves taking your own unacceptable qualities or feelings and ascribing them to other people? A. Projection B. Intellectualization C. Rationalization D. Reaction Formation

QUESTION 7 Which defense mechanism involves replacing an unwanted impulse with its opposite? A. Displacement B. Denial C. Reaction Formation D. Suppression

QUESTION 8 Which defense mechanism involves reverting to earlier behaviors? A. Displacement B. Denial C. Regression D. Suppression

LEARNING 190

Definitions: 191 Learning Relatively permanent change in knowledge or behavior resulting from repeated experiences. Reflex Is an inborn, involuntary response to a specific kind of stimulus, as in limb-withdrawal reflex (withdrawing your hand after touching a hot plate)

Types of Learning Psychomotor Learning: acquisition of physical skills, coordination of muscles and body parts. Cognitive Learning: ability to think, form ideas and concepts, synthesis, analyze and evaluate issues logically and creatively. Affective Learning: involves emotions, values, feelings and attitudes of an individual. 192

Learning Theories Classical Conditioning by Ivan Pavlov Operant Conditioning by B.F. Skinner Cognitive Learning by Jean Piaget Social Learning by Albert Bandura 193

1. Classical conditioning by Ivan Pavlov

Introduction Classical conditioning (also known as Pavlovian or respondent conditioning) is learning through association and was discovered by Pavlov, a Russian physiologist. In simple terms, two stimuli are linked together to produce a new learned response in a person or animal.

Principles of classical conditioning 1. Neutral Stimulus In classical conditioning, a neutral stimulus (NS) is a stimulus that initially does not evoke a response until it is paired with the unconditioned stimulus. For example, in Pavlov’s experiment the bell was the neutral stimulus, and only produced a response when it was paired with food.

2. Unconditioned Stimulus In classical conditioning, the unconditioned stimulus is a feature of the environment that causes a natural and automatic unconditioned response. In pavlov's study the unconditioned stimulus was food.

3. Unconditioned Response In classical conditioning, an unconditioned response is an unlearned response that occurs automatically when the unconditioned stimulus is presented. Pavlov showed the existence of the unconditioned response by presenting a dog with a bowl of food and the measuring its salivary secretions.

4. Conditioned Stimulus In classical conditioning, the conditioned stimulus (CS) is a substitute stimulus that triggers the same response in an organism as an unconditioned stimulus. For example, Pavlov’s dog learned to salivate at the sound of a bell.

5. Conditioned Response In classical conditioning, the conditioned response (CR) is the response produced when the conditioned stimulus (bell) is produced. In Ivan Pavlov's experiments in classical conditioning, the dog's salivation was the conditioned response to the sound of a bell.

6. Acquisition In the initial period of learning, acquisition describes when an organism learns to connect a neutral stimulus and an unconditioned stimulus.

7. Extinction In psychology, extinction refers to gradual weakening of a conditioned response by breaking the association between the conditioned and the unconditioned stimuli. For example, when the bell was repeatedly rang and no food presented Pavlov’s dog gradually stopped salivating at the sound of the bell.

8. Spontaneous Recovery Spontaneous Recovery is a phenomenon of Pavlovian conditioning that refers to the return of a conditioned response (in a weaker form) after a period of time following extinction. For example, when Pavlov waited a few days after extinguishing the conditioned response, and then rang the bell once more and presented the food, the dog salivated again.

9. Generalization In psychology, generalization is the tendency to respond in the same way to stimuli that are similar but not identical to the conditioned stimulus. For example, in Pavlov's experiment, if a dog is conditioned to salivate to the sound of a bell, it may later salivate to a higher pitched bell

10. Discrimination In classical conditioning, discrimination is a process through which individuals learn to differentiate among similar stimuli and respond appropriately to each one. For example, eventually Pavlov’s dog learns the difference between the sound of the 2 bells and no longer salivates at the sound of the non-food bell

Stages of classical conditioning There are three stages of classical conditioning; Stage 1: Before conditioning Stage 2: During conditioning Stage 3 :after conditioning

Stage 1: Before conditioning In this stage, the unconditioned stimulus (UCS) produces an unconditioned response (UCR) in an organism. In basic terms, this means that a stimulus in the environment has produced a behavior / response which is unlearned (i.e., unconditioned) and therefore is a natural response which has not been taught. In this respect, no new behavior has been learned yet.

This stage also involves another stimulus which has no effect on a person and is called the neutral stimulus (NS). The NS could be a person, object, place, etc. The neutral stimulus in classical conditioning does not produce a response until it is paired with the unconditioned stimulus.

Stage 2: During conditioning During this stage, a stimulus which produces no response (i.e., neutral) is associated with the unconditioned stimulus at which point it now becomes known as the conditioned stimulus (CS). For classical conditioning to be effective, the conditioned stimulus should occur before the unconditioned stimulus. Thus, the conditioned stimulus acts as a type of signal or cue for the unconditioned stimulus.

Stage 3: After conditioning Now the conditioned stimulus (CS) has been associated with the unconditioned stimulus (UCS) to create a new conditioned response (CR).

Classical conditioning examples 1. Pavlov's Dogs The most famous example of classical conditioning was Ivan Pavlov's experiment with dogs, who salivated in response to a bell tone. Pavlov showed that when a bell was sounded each time the dog was fed, the dog learned to associate the sound with the presentation of the food.

2. Fear response Watson & Rayner (1920) were the first psychologists to apply the principles of classical conditioning to human behavior by looking at how this learning process may explain the development of phobias. They did this in what is now considered to be one of the most ethically dubious experiments ever conducted – the case of Little Albert.

The case of little albert Albert B.’s mother was a wet nurse in a children’s hospital. Albert was described as ‘healthy from birth’ and ‘on the whole stolid and unemotional’. When he was about nine months old, his reactions to various stimuli (including burning newspapers, white rat and a hammer striking a four-foot steel bar just behind his head) were tested. Only the last of these frightened him, so this was designated the unconditioned stimulus (UCS) and fear the unconditioned response (UCR). The other stimuli were neutral because they did not produce fear.

When Albert was just over eleven months old, the rat and the UCS were presented together: as Albert reached out to stroke the animal, Watson struck the bar behind his head. This occurred seven times in total over the next seven weeks. By this time the rat, the conditioned stimulus (CS), on its own frightened Albert, and fear was now a conditioned response (CR). The CR transferred spontaneously to the rabbit, the dog and other stimuli that had been previously neutral. Five days after conditioning, the CR produced by the rat persisted. After ten days it was ‘much less marked’, but it was still evident a month later

Critical evaluation Classical conditioning emphasizes the importance of learning from the environment, and supports nurture over nature. However, it is limiting to describe behavior solely in terms of either nature or nurture, and attempts to do this underestimate the complexity of human behavior. It is more likely that behavior is due to an interaction between nature (biology) and nurture (environment).

OPERANT CONDITIONING BY B.F SKINNER

INTRODUCTION Operant conditioning is also known as instrumental conditioning I t is a theory of learning where behavior is influenced by its consequences . Behavior that is reinforced (rewarded) will likely be repeated, and behavior that is punished will occur less frequently.

Skinner is regarded as the father of Operant Conditioning, but his work was based on Thorndike’s (1898) law of effect . According to this principle, behavior that is followed by pleasant consequences is likely to be repeated, and behavior followed by unpleasant consequences is less likely to be repeated.

Skinner introduced a new term into the Law of Effect – Reinforcement. Behavior that is reinforced tends to be repeated (i.e., strengthened); behavior that is not reinforced tends to die out or be extinguished (i.e., weakened). Skinner (1948) studied operant conditioning by conducting experiments using animals which he placed in a “ Skinner Box

3 MAJOR PRINCIPLES IN OPERANT CONDITIONING

1. Positive reinforcement Positive reinforcement is a term described by B. F. Skinner in his theory of operant conditioning. In positive reinforcement, a response or behavior is strengthened by rewards, leading to the repetition of desired behavior. The reward is a reinforcing stimulus.

2. Negative reinforcement Negative reinforcement is the termination of an unpleasant state following a response.

This is known as negative reinforcement because it is the removal of an adverse stimulus which is ‘rewarding’ to the animal or person. Negative reinforcement strengthens behavior because it stops or removes an unpleasant experience .

Skinner showed how negative reinforcement worked by placing a rat in his Skinner box and then subjecting it to an unpleasant electric current which caused it some discomfort. As the rat moved about the box it would accidentally knock the lever. Immediately it did so the electric current would be switched off.

The rats quickly learned to go straight to the lever after a few times of being put in the box. The consequence of escaping the electric current ensured that they would repeat the action again and again.

3. Punishment Punishment is the opposite of reinforcement since it is designed to weaken or eliminate a response rather than increase it. It is an aversive event that decreases the behavior that it follows.

Like reinforcement, punishment can work either by directly applying an unpleasant stimulus like a shock after a response or by removing a potentially rewarding stimulus, for instance, deducting someone’s pocket money to punish undesirable behavior.

Question 1 When the conditioned stimulus is no longer paired with the unconditioned stimulus, what occurs? A. Extinction B. Generalization C. Discrimination D. Nothing

Question 2 In Pavlov’s experiment, ___ is considered an unconditioned stimuli A. Meat powder B. Bell C. Food D. Salivation

Question 3 The unconditioned stimulus: A. Means that behavior always gets rewarded B. Is an interval amount of time that passes before the behavior is rewarded. C. Assumes that behavior is observable and can be correlated with other observable events. D. Naturally occurs and causes a natural unconditioned response.

Questions Differentiate between positive reinforcement and negative reinforcement (2 marks) Explain three (3) types of learning (6 marks) Define the following terms (3 marks) Neutral conditioning Generalization Discrimination

COGNITIVE THEORY BY JEAN PIAGET

Cognitive theory by Jean Piaget Piaget's stage theory describes the cognitive development of children . Cognitive development involves changes in cognitive process and abilities. In Piaget's view, early cognitive development involves processes based upon actions and later progresses to changes in mental operations.

Piaget proposed that intelligence grows and develops through a series of stages. Older children think more quickly than younger children.

After observing children closely, Piaget proposed that cognition developed through distinct stages from birth through the end of adolescence. By “stages” he meant a sequence of thinking patterns with four key features: The stages always happen in the same order. No stage is ever skipped. Each stage is a significant transformation of the stage before it. Each later stage incorporated the earlier stages into itself.

Jean Piaget's theory of cognitive development suggests that children move through four different stages of learning. His theory focuses not only on understanding how children acquire knowledge, but also on understanding the nature of intelligence. Piaget's stages are: Sensorimotor stage : Birth to 2 years Preoperational stage : Ages 2 to 7 Concrete operational stage : Ages 7 to 11 Formal operational stage : Ages 12 and up

1.Sensorimotor stage(0-2 years) During this earliest stage of cognitive development, infants and toddlers acquire knowledge through sensory experiences and manipulating objects. A child's entire experience at the earliest period of this stage occurs through basic reflexes, senses, and motor responses.

Characteristics of sensorimotor stage Know the world through movements and sensations Learn about the world through basic actions such as sucking, grasping, looking, and listening Learn that things continue to exist even when they cannot be seen ( object permanence ) Realize that they are separate beings from the people and objects around them Realize that their actions can cause things to happen in the world around them

The cognitive development that occurs during this period takes place over a relatively short time and involves a great deal of growth. Children not only learn how to perform physical actions such as crawling and walking; they also learn a great deal about language from the people with whom they interact. According to Piaget, these actions allow children to learn about the world and are crucial to their early cognitive development.

2. The pre-operational stage(2-7 years) The emergence of language is one of the major hallmarks of the preoperational stage of development. At this stage, kids learn through pretend play but still struggle with logic and taking the point of view of other people. They also often struggle with understanding the concept of conservation. For example, a researcher might take a lump of clay, divide it into two equal pieces, and then give a child the choice between two pieces of clay to play with. One piece of clay is rolled into a compact ball while the other is smashed into a flat pancake shape. Because the flat shape looks larger, the preoperational child will likely choose that piece, even though the two pieces are exactly the same size.

Major characteristics of pre-operational stage Begin to think symbolically and learn to use words and pictures to represent objects Tend to be egocentric and struggle to see things from the perspective of others Getting better with language and thinking.

3. The concrete-operational stage(7-11 years) While children are still very real and literal in their thinking at this point in development, they become much more adept at using logic. The egocentrism of the previous stage begins to disappear as kids become better at thinking about how other people might view a situation.

Characteristics of concrete operational stage Begin to think logically about real events Begin to understand the concept of conservation; that the amount of liquid in a short, wide cup is equal to that in a tall, skinny glass, for example Thinking becomes more logical and organized Begin using inductive logic, or reasoning from specific information to a general principle

4. The formal operational stage(12 years and above) The final stage of Piaget's theory involves an increase in logic, the ability to use deductive reasoning, and an understanding of abstract ideas. At this point, adolescents and young adults become capable of seeing multiple potential solutions to problems and think more scientifically about the world around them.

Characteristics of formal operational stage Begins to think abstractly and reason about hypothetical problems Begins to think more about moral, philosophical, ethical, social, and political issues that require theoretical and abstract reasoning Begins to use deductive logic, or reasoning from a general principle to specific information

SOCIAL LEARNING THEORY BY ALBERT BANDURA

Social Learning Theory Albert Bandura Considers how individuals learn through observing the behavior of others. i.e. most human behavior is learnt observationally through modeling. This theory proposes that people learn by imitating the behavior of other people. Other terms used are role modelling and identification. 265

INTRODUCTION Social learning theory suggests that social behavior is learned by observing and imitating the behavior of others. Psychologist Albert Bandura developed the social learning as an alternative to the earlier work of fellow psychologist B.F. Skinner, known for his influence on behaviorism. While behavioral psychology focuses on how the environment and reinforcement affect behavior, Bandura put forth that individuals can learn behavior through observation.

BOBO DOLL EXPERIMENT Bobo doll experiment , groundbreaking study on aggression led by psychologist Albert Bandura that demonstrated that children are able to learn through the observation of adult behaviour . The experiment was executed via a team of researchers who physically and verbally abused an inflatable doll in front of preschool-age children, which led the children to later mimic the behaviour of the adults by attacking the doll in the same fashion.

Principles that help determine whether a new behavior is acquired: Attention: The degree to which we notice the behavior. A behavior must grab our attention before it can be imitated. Considering the number of behaviors we observe and do not imitate daily indicates attention is crucial in whether a behavior influences imitation.

2. Retention: How well we remember the behavior. We cannot perform the behavior if we do not remember the behavior. So, while a behavior may be noticed, unless a memory is formed, the observer will not perform the behavior. And, because social learning is not immediate, retention is vital to behavior modeling.

3. Reproduction: The ability to perform the behavior. This is the ability to reproduce a behavior we observe. It influences our decision about whether to try performing the behavior. Even when we wish to imitate an observed behavior, we are limited by our physical abilities.

4. Motivation: The will to emulate the behavior. It involves learning through observing the consequences of actions for other people, rather than through direct experience.

Assumptions of social learning theory People learn through observation. Learners can acquire new behavior and knowledge by merely observing a model. Reinforcement and punishment have indirect effects on behavior and learning. People form expectations about the potential consequences of future responses based on how current responses are reinforced or punished.

3. Learning does not necessarily lead to change. Just because a person learns something does not mean they will have a change in behavior.

Social learning theory examples Social learning theory examples in everyday life are common, with one of the most evident being the behaviors of children, as they imitate family members, friends, famous figures and even television characters. If a child perceives there is a meaningful reward for such behavior, they will perform it at some point. Social media presents plenty of social learning examples with people imitating others whether acting a movie scene, copying dance moves from a music video.

MEMORY The process by which information acquired is encoded, stored and retrieved when needed. 275

Memory refers to those processes involved in the acquisition of information, its subsequent retrieval and use. Memory process can be divided into three main components: Registration Retention Recall and recognition

Memory ct’ Memory plays an important part in learning. Learning implies retaining of facts. If nothing is stored from previous experience, then no learning can take place Thinking and reasoning are also done with remembered facts

Types of memory The following are types of memory: Immediate or short-term memory: for events that have occurred within the past 30 seconds Recent memory: for events over the past few hours or days Recent past memory: this refers to information retained over the pest few months. Remote memory: refers to the ability to remember events that have occurred in the distant past.

Information Processing 279 Encoding allows information from the outside world to be sensed in the form of chemical and physical stimuli. Storage involves information maintenance over short periods of time. Retrieval : Stored information must be located and returned to the consciousness. - Memory enables people to recall the who, what, when, where, how and why in everyday life.

Interference 280 Interference is a memory phenomenon in which some memories interfere with the retrieval of other memories. Interference can hamper memorization and retrieval: Retroactive interference : when learning new information makes it harder to recall old information and Proactive interference : where prior learning disrupts recall of new information. However, there are situations when old information can facilitate learning of new information ( positive transfer )

Factors Influencing Memory Loss Attention Organization of content Age Health and emotional status Association developed Intelligence Value of content Study and rehearsal skills Environment Level of information processing Methods of learning/teaching 281

Improving the Memory 282 Healthy eating(balanced diet) Physical fitness(exercises) Stress reduction measures Memory exercises improves cognitive function and brain efficiency e.g. brain teasers and verbal memory training techniques Adequate sleep.

STRUCTURE AND FUNCTIONS OF THE MIND According to Freud, the mind is divided into three levels of existence or consciousness: 283

The Conscious Level This is a small part which forms 1/6 th of the total size of the mind, regarded as the sense organ of attention. It functions only when the individual is awake. This first level is responsible for – rational thinking, good judgment, correct perception of the environment, emotions and establishment of personal relationships. 284

Subconscious Level Forms 1/6 th of the total size of the mind. It is accessible to both the conscious and the unconscious levels of the mind. Acts as a censor (filter) of all information stored in the unconscious level reaching the conscious, to store all information and experiences from the conscious mind for memory, and to select which experiences should be repressed into the unconscious mind (never to be remembered). 285

Unconscious Level Comprises 2/3 rd of the entire mind. It contains all repressed ideas, psychological experiences, information and emotions. Information stored at this level of the mind cannot reach the conscious level unless through psychoanalysis. The information from this level can reach the conscious level through – a dream but in a distorted way, slip of the tongue, unexplained behavioral responses, jokes or lapses of memory. 286

STRESS Definition Stress is a state of severe physiological and psychological response to harmful or potentially harmful circumstances. It is a state of severe physiological and psychological tension or It can be also defined as a non-specific response of the body to any demand. A stressor is a stimulus which causes stress e.g. bereavement, divorce or a critical event such as robbery or the demand of life One’s responses to stress are influenced by: personality (our strength), the burden/type of stressor, subjective interpretation of the stressors. 287

Causes of stress Stressors can be sudden, overwhelming or cumulative. Examples include: Life crises e.g. accidents, death of spouse or divorce. Transitions e.g. divorce, bereavement and retirement. Catastrophes-natural and otherwise e.g. earthquakes and floods. Daily hassles, little things in life that go wrong. Frustration and conflicts. Uncertainty, doubt and inability to predict the future 288

Responses to Stress Stressors and to some extent stress are normal and at times are necessary for one to achieve certain goals in life. It becomes abnormal if they produce signs and symptoms that become the problem. Individuals can be helped to cope with or minimize life stressors and still lead a relatively normal lives with health education and support systems. 289

Physiological responses : The body prepares itself either to fight or for flight. All the body’s reactions to stress affect health. Prolonged stress may cause high BP, ulcers 290

Psychological responses : The individual may display self-destructive lifestyles & risk-taking behaviors such as drug abuse, suicidal gestures and self neglect. Aggressiveness due to frustration Anxiety Depression Inhibited sexual drive Spiritual signs and symptoms of excessive stress may include doubts about one’s faith, loss of self confidence or loss of purpose. 291

Stress in Patients is caused by: Admission to hospital Operation Sharing a ward with strangers Use of bedpans Injections and Being done tests/investigations. 292

Signs and symptoms of stress On the body Headache Muscle tension or pain Chest pain Fatigue Change in sex drive Stomach upset Sleep problems 293

On the mood Anxiety i.e. tension Restlessness Lack of motivation , focus, or concentration Irritability or anger Sadness or depression Frustration 294

On behaviour Overeating or under eating Anger outbursts Drug or alcohol abuse Social withdrawal 295

Stress Coping Mechanisms: 296 Confronting the stressor Avoiding situations that may cause stress Change your stressors e.g. take a break, switch job Maintain a reasonable work and personal schedule Engage in a Physical activity

Meditation, relaxation techniques e.g. slow music Discussing situations with a spouse / close friend/priest or Praying/going to church Taking a bath or shower Laughing or crying Seeking counseling.

ANXIETY Anxiety A vague sense of fear, dread, uneasiness Phobia A pathologically strong fear attached to objects or situations which in themselves are harmless. Anxiety may progress to panic and interfere with mental and social functioning(Neurotic breakdown). 298

Degrees of Anxiety Mild anxiety Motivates the person to be more physically and mentally alert. Panic states Very high levels of anxiety that incapacitate an individual. 299

CONFLICT AND ADJUSTMENT Welcome

Conflict Is the simultaneous arousal of more incompatible motives, resulting in unpleasant emotions, such as anxiety or anger. It’s a pair of goals that cannot be attained.

Types of conflict Approach-approach conflict There are two favourable goals, and to attain one means that the other goal must be given up. E.g. Mohamed is attracted to 2 beautiful girls but he only has to choose one.

Avoidance-avoidance conflict Both alternatives are unpleasant and yet one has to choose either. E.g. a patient has an abdominal tumour , which causes unbearable pain and discomfort. Alternatively, surgery, which has very little success rate is the only available remedy, yet the patient needs to be relieved of the pain. It becomes naturally difficult for the patient to choose either of these two.

Approach-avoidance conflict This occurs when fulfilling a motive which will have both pleasant and unpleasant consequences. E.g. a young male doctor is torn between getting married or not. Being married is attractive and socially fulfilling, but it also means added responsibilities and restrictions.

Coping strategies PROBLEM FOCUSED: DEFINE THE PROBLEM GATHER INFORMATION ANALYZE INFORMATION DEVELOP SOLUTIONS MAKE A DECISION IMPLEMENT THE DECISION EVALUATE THE SOLUTION

2. EMOTION FOCUSED: These are used when the problem is uncontrollable. They are two types: A) Behavioural strategies Exercising Using alcohol or other drugs Venting anger Seeking emotional support from friends

b) Cognitive strategies: Temporarily setting aside thoughts about the problem Changing the meaning of the situation Other coping strategies: Isolating oneself Thinking about how badly one feels Worrying Repetitively thinking about how bad things are Engaging in a pleasant activity like going to parties

CRISIS AND CRISIS MANAGEMENT Crisis is an internal experience of confusion and anxiety to the degree that formerly successful coping mechanisms fail us and ineffective decisions and behaviors take their place. As a result, the person in crisis may feel confused, vulnerable, anxious, afraid, angry, guilty, hopeless and helpless. 308

Characteristics of a Crisis Occurs in all individuals at some point It is precipitated by specific identifiable events. Crises are personal by nature. A crisis situation contains the potential for psychological growth or deterioration. 309

Types of Crises Maturational/Developmental crisis Situational/dispositional crisis Adventitious(accidental) crisis Crises of anticipated life transitions 310

1. MATURATIONAL CRISIS Maturational crises occur when a person is unable to cope with the natural process of development. Maturational crises usually occur at times of transition, such as when the first child is born, when a child reaches adolescence, and when the head-of-the- household retires.

2. SITUATIONAL CRISIS Situational Crisis is the result of the unexpected trauma such as losses, illness or displacement. Because of the unexpected shock, one typically experiences these events as more stressful.

3. ADVENTITIOUS CRISIS Adventitious crises have been called events of disaster. They are rare, unexpected happenings that are not part of everyday life and may result from: Natural disasters, such as floods, fires, and earthquakes

Crisis Intervention Aims To restore person to pre- crisis level of functioning and order. 314

Phases of crisis intervention Assessment -identify precipitating event -assess patient's perception of event -assess available coping skills and resources -assess patient's level of anxiety as well as suicidal or homicidal potential 315

Analysis and planning - organize assessment data - analyze the data, i.e. identify facts, formulate alternatives - explore options to resolve the problem i.e. advantages and disadvantages of each option - decide on the best steps to achieve the solution 316

Implementation change the patient's physical situation by; Put the desired plan into action 317

Evaluation - determine effectiveness of implementations by observing behavioral outcomes and comparing them with goals. - refer patient for additional help if outcomes differ from the planned ones. 318

MOTIVATION

INTRODUCTION Motivation is a state of mind, filled with energy and enthusiasm, which drives a person to work in a certain way to achieve desired goals. Motivation is a force that pushes people to work with a high level of commitment and focus, even if things are going against them.

1. Humanistic theory By Abraham Maslow. Maslow reasoned that human motivations are organized in a hierarchy of needs. He stated that the lower needs in the hierarchy must be partly fulfilled before those at the next level can assume importance. If they are not, then the organism remains preoccupied with them until the needs are met.

2. DRIVE REDUCTION THEORY Introduced by psychologists Clark Hull Drive Theory posits that a homeostatic disturbance , such as hunger or thirst, creates a physiological need, which in turn creates a psychological drive to reduce or satisfy that need. Essentially, it's this drive or desire that propels us to action, serving as our 'inner engine' of motivation.

3. INCENTIVE THEORY Incentive Theory, which posits that behavior is primarily driven by the desire for rewards. This theory, deeply rooted in the work of B.F. Skinner and his ideas on operant conditioning , introduces the concept of positive reinforcement . In essence, the theory suggests that we are like sailors drawn to the lighthouse of rewards, adjusting our course to reach them.

Incentive Theory focuses on the power of external rewards or incentives to shape behavior, thus labeling it as an external factor . While Drive Theory emphasizes the internal 'engine' of motivation, Incentive Theory highlights how external factors can steer our actions.

4. SELF DETERMINATION THEORY Developed by psychologists Ryan and Deci .

It posits that we are driven by three fundamental psychological needs: Autonomy (the desire to control our own life) Competence (the need to master tasks and learn different skills) Relatedness (the desire to interact, be connected to, and care for others). SDT suggests that satisfying these needs is crucial for optimal functioning, personal growth, job satisfaction , and overall wellness .

5. ACHIEVEMENT MOTIVATION THEORY Achievement Motivation Theory , often referred to as the Three Needs Theory or acquired-needs theory . Developed by psychologist David McClelland T his theory adds another dimension to our understanding of motivation, painting a vivid picture of how our innate desire for; Achievement Affiliation , Power shape our behaviors.

McClelland's theory suggests that these three needs are not inborn but are acquired over time through our experiences. These needs then influence our personal goals , motivated behaviors , and our pattern of behavior over time.

The need for Achievement, for instance, can drive individuals to pursue growth opportunities , set challenging goals, and take calculated risks. The need for Affiliation fosters a desire for harmonious relationships and social acceptance, while the need for Power can manifest as a desire to influence others or to make a significant impact on one's environment.

6. EXPECTANCY THEORY The Expectancy Theory , developed by Victor Vroom. Expectancy theory suggests that our actions are directed towards paths that offer the greatest potential rewards and chances of success. Expectancy Theory proposes that our behaviors aren't just driven by our needs, but also by our perceptions of the likelihood of satisfying those needs.

Expectancy Theory is a cognitive theory that focuses on three key components: Expectancy, Instrumentality Valence. Expectancy is the belief that increased effort will lead to increased performance Instrumentality is the belief that if one does perform, they will receive a desired outcome, Valence is the value that the individual places on the rewards.

7. COGNITIVE DISSONANCE THEORY The Cognitive Dissonance Theory , developed by Leon Festinger, provides yet another angle to our understanding of motivation. This theory posits that we have an desire to ensure consistency between our beliefs, values, and actions. When inconsistency (or dissonance) is experienced, we feel a state of tension and are motivated to reduce this discomfort.

The theory focuses on the internal conflict and discomfort that arises when our actions don't align with our beliefs or values. This theory suggests that to resolve this dissonance, we might change our beliefs, alter our actions, or even reduce the importance of the beliefs/values that are in conflict.

For example; For instance, if someone values health but smokes cigarettes, they might experience cognitive dissonance. To alleviate this tension, they might quit smoking (change behavior), convince themselves that smoking isn't that harmful (change beliefs), or downplay the importance of health (reduce importance of conflicting belief).

Psychology related To health care workers

PATIENT`S REACTION TO HOSPITALIZATION Every patient reacts differently to illness and hospitalization due to-; Age Experience in life Nature of illness Support given by significant others. The health care worker has to assess the patient`s reaction, respond and support him as an individual. 344

Cont’d… AIMS OF THE HEALTH CARE WORKER Understanding the patient Accepting the patient as he is Assessing the patient to identify the coping mechanisms in terms of the illness and hospitalization Assisting the patient to use their resources to cope with the illness and hospitalization Establishing health care worker– Patient Relationship 345

HEALTH CARE WORKER – PATIENT RELATIONSHIP Is a relationship established between the health care worker and the patient with the aim of identifying patient`s needs / problems and together work out a solution. 346

Phases of health care worker – Patient Relationship 1. Introductory Phase This is the initial contact between the health care worker and the patient. Basically they’re strangers i.e. the patient who is in need of help or assistance to solve his problems and the health care worker who has professional knowledge and willingness to assist. It is centered on mutual attempts to know each other and work with each other. 347

2. Working Phase In this phase the patient is supposed to have accepted and trusted the health care worker as a dependable person. It consists of therapeutic actions that will help the patient towards recovery. The health care worker works on the patient`s problems and together with the patient find solutions. It may take a long or short time depending on the patient`s rate of recovery and nature of illness. 348

3. Termination Phase The health care worker attempts to gradually bring the relationship to an end with the patient`s recovery through helping him develop independence and self reliance towards the management of his own health. It can be traumatic to the patient and the health care worker if not well handled due to mutual information they have shared together. Hence the health care worker must maintain and practice her ethics and encourage the pt to use their own resources to keep healthy. 349

HUMAN GROWTH AND DEVELOPMENT

What is Growth Growth can be defined as the development of a person in age, height, weight, habits, etc. In biology, growth is considered as an increase in the size of an organ or cell.

What is development D evelopment is defined as the growth process wherein a person changes in relation to physical, environmental, and social factors. In terms of children, the development of a child depends upon several factors like physical, nutritional, genetic, and environmental

FACTORS THAT INFLUENCE HUMAN GROWTH AND DEVELOPMENT 1. Heredity: Heredity and genes certainly play an important role in the transmission of physical characteristics from parents to off-springs. Different characteristics of growth and development like intelligence, aptitudes, body structure, height, weight, color of hair and eyes are highly influenced by heredity.

2. SEX Sex is a very important factor which influences human growth and development. There is lot of difference in growth and development between girls and boys. Physical growth of girls in teens is faster than boys. Overall the body structure and growth of girls are different from boys.

3. SOCIO-ECONOMIC Socioeconomic factors definitely have some affect. It has been seen that the children from different socioeconomic levels vary in average body size at all ages. The upper level families being always more advanced. The most important reasons behind this are better nutrition, better facilities, regular meals, sleep, and exercise.

4. NUTRITIONAL Growth is directly related with nutrition. The human body requires an adequate supply of calories for its normal growth and this need of requirements vary with the phase of development.

5. POLLUTION Indoor pollution or the pollution from housing conditions can result in ill health which can negatively impact human growth and development. For example, lead exposure from deteriorated lead-based paint in older housing can be very harmful. Lead is very harmful for children as it simply gets immersed into the growing bodies of children and obstructs with the normal development of brain and other organs and systems.

6. RACE Racial factors also influence height, weight, color, features, and body constitution of a human being. The body growth and development differences show a relationship with varied cultural groups. For example a child of black race will be black, their height, their hair and eye color, facial structure are all governed by the same race.

We have two stages of human development Prenatal Development Postnatal development

1. Prenatal development Germinal Embryonic Foetal

2. Postnatal development Infancy and Toddlerhood Early Childhood Middle Childhood Adolescence Early Adulthood Middle Adulthood Late Adulthood

1. Prenatal development Conception occurs and development begins. There are three stages of prenatal development: germinal, embryonic, and fetal periods. The influences of nature (e.g., genetics) and nurture (e.g., nutrition and teratogens, which are environmental factors during pregnancy that can lead to birth defects) are evident.

2. Postnatal development Infancy and Toddlerhood Early Childhood Middle Childhood Adolescence Early Adulthood Middle Adulthood Late Adulthood

1. INFANCY AND TODDLEHOOD (0-2years) The first year and a half to two years of life are ones of dramatic growth and change. A newborn, with many involuntary reflexes and a keen sense of hearing but poor vision, is transformed into a walking, talking toddler within a relatively short period of time. Caregivers similarly transform their roles from those who manage feeding and sleep schedules to constantly moving guides and safety inspectors for mobile, energetic children.

Brain development happens at a remarkable rate, as does physical growth and language development. Interactions with primary caregivers (and others) undergo changes influenced by possible separation anxiety and the development of attachment styles. Social and cultural issues center around breastfeeding or formula-feeding, sleeping in cribs or in the bed with parents, toilet training, and whether or not to get vaccinations.

2. EARLY CHILDHOOD(2-6 years) Early childhood is also referred to as the preschool years. As a preschooler, the child is busy learning language (with amazing growth in vocabulary), is gaining a sense of self and greater independence, and is beginning to learn the workings of the physical world.

A toddler’s fierce determination to do something may give way to a four-year-old’s sense of guilt for doing something that brings the disapproval of others.

3. LATE CHILDHOOD(6-12 years) Now the world becomes one of learning and testing new academic skills and assessing one’s abilities and accomplishments by making comparisons between self and others. Schools participate in this process by comparing students and making these comparisons public through team sports, test scores, and other forms of recognition.

The brain reaches its adult size around age seven, but it continues to develop. Growth rates slow down and children are able to refine their motor skills at this point in life. Children also begin to learn about social relationships beyond the family through interaction with friends and fellow students; same-sex friendships are particularly salient during this period.

4. ADOLESCENCE (12-18 years) Adolescence is a period of dramatic physical change marked by an overall physical growth spurt and sexual maturation, known as puberty; timing may vary by gender, cohort, and culture. It is also a time of cognitive change as the adolescent begins to think of new possibilities and to consider abstract concepts such as love, fear, and freedom. Ironically, adolescents have a sense of invincibility that puts them at greater risk of dying from accidents or contracting sexually transmitted infections that can have lifelong consequences.

A major developmental task during adolescence involves establishing one’s own identity. Teens typically struggle to become more independent from their parents. Peers become more important, as teens strive for a sense of belonging and acceptance; mixed-sex peer groups become more common. New roles and responsibilities are explored, which may involve dating, driving, taking on a part-time job, and planning for future academics.

EARLY ADULTHOOD (18-39 years) Late teens, twenties, and thirties are often thought of as early adulthood. It is a time when we are at our physiological peak but are most at risk for involvement in violent crimes and substance abuse. It is a time of focusing on the future and putting a lot of energy into making choices that will help one earn the status of a full adult in the eyes of others.

Love and work are the primary concerns at this stage of life. In recent decades, it has been noted (in the U.S. and other developed countries) that young adults are taking longer to “grow up.” They are waiting longer to move out of their parents’ homes, finish their formal education, take on work/careers, get married, and have children. One psychologist, Jeffrey Arnett, has proposed that there is a new stage of development after adolescence and before early adulthood, called “emerging adulthood,” from 18 to 25 (or even 29) when individuals are still exploring their identities and don’t quite feel like adults yet.

MIDDLE ADULTHOOD (40 -65 years) The late thirties (or age 40) through the mid-60s are referred to as middle adulthood. This is a period in which physiological aging that began earlier becomes more noticeable and a period at which many people are at their peak of productivity in love and work. It may be a period of gaining expertise in certain fields and being able to understand problems and find solutions with greater efficiency than before.

It can also be a time of becoming more realistic about possibilities in life; of recognizing the difference between what is possible and what is likely. Referred to as the sandwich generation, middle-aged adults may be in the middle of taking care of their children and also taking care of their aging parents. While caring about others and the future, middle-aged adults may also be questioning their own mortality, goals, and commitments, though not necessarily experiencing a “mid-life crisis.”

LATE ADULTHOOD Late adulthood covers a wide age range with a lot of variation, so it is helpful to divide it into categories such as the “young old” (65-74 years old), “old old ” (75-84 years old), and “oldest old” (85+ years old). The young old are similar to middle-aged adults; possibly still working, married, relatively healthy, and active.

The old old (75- 85 years) have some health problems and challenges with daily living activities . The oldest old (85 years +) are often frail and in need of long term care. However, many factors are involved and a better way to appreciate the diversity of older adults is to go beyond chronological age and examine whether a person is experiencing optimal aging , normal aging (in which the changes are similar to most of those of the same age), or impaired aging (referring to someone who has more physical challenge and disease than others of the same age).

Stages of death by Kubler Ross 1969

STAGE 1: DENIAL It is very difficult for any individual to face the fact that death is to be faced soon. The most common reaction is to isolate oneself until defences are achieved. Denial permits hope to exist but most patients are ready to accept the fact that they are dying but families continue to express denial. 385

STAGE 2: Anger : The person experiences anger with the person asking the question; why me? The patient is difficult to nurse as nothing seems to please him or her. The person wants to express their outrage and helplessness. After expressing their anger they move on. 386

STAGE 3: BARGAINING T hird phase of dying when the person attempts to negotiate and trade. It usually involves a deal with God; the physician or the nurse. E.g. If I can live long enough to attend my son’s wedding I will be ready to die. If possible patients should be granted their request. 387

STAGE 4 : DEPRESSION T he patient is now aware that death is inevitable. Defense mechanism are no longer effective. Sadness and anguish are felt and expressed. The patient may organize to gain support from loved one’s and nurses. The resolution leads to final stage.

STAGE 5: Acceptance : It’s a time of relative peace. The patient wants to review the past and think about the unknown future. Patient may not talk a lot about but he/she wants other people nearby. With pain relieve the person accepts death and wants to be comforted by having significant others nearby. 389

NURSING INTERVENTION To give maximum help to the dying by examining the nurse’s own feeling about death. Patient is an individual and should be treated with respect and dignity regardless of background or condition. Social values may affect reaction to the dying person e.g. age, attractiveness, socio-economic status, former accomplishment. These may affect whether the person is cared for or abandoned while dying. 390

Nurses usually become the most important link with life for the dying person. The nurse provides physical comfort and emotional support. It is an emotional stress to the nurse assigned to people who are dying and these need to share their feelings and reactions with others to obtain support. 391

Bill of rights for a dying person I have a right to be treated as a living human being until I die I have a right to maintain a sense of hopefulness, however changing its focus may be. I have the right to be cared for by those who can maintain a sense of hopefulness, however changing this may be. I have a right to express my feelings and emotions and my approaching death in my own way. I have a right to participate in decision concerning my care. 393

I have a right to expect continuing medical and nursing attention even though “cure” goals must be changed to comfort goals. I have a right not to die alone. I have a right to be free from pain. I have a right to have my questions answered honestly. I have a right not to be deceived I have the right to die in peace and with dignity 394

I have the right to retain my individuality and not to be judged by my decision, which may be contrary to the believes of others. I have the right to discuss and enlarge my religious and spiritual experience, regardless of what they mean to others. I have the right to expect that the sanctity of the human body will be respected after death. I have the right to be cared for by caring, sensitive and knowledgeable people who will attempt to understand my needs and will be able to gain some satisfaction in helping me face my death. 395

BE BETTER HEALTH CARE PROVIDERS Questions?

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