1. health and fitness
2. disorders
3. mental disorder
4. panic and anxiety

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Contact hours 2
Word count: 8740
[OT info- go live date for OT: 4-25-08]
Target Audience For occupational therapists and assistants providing services for adults in the
continuum of health care.
Learning Level Introductory
Focus is on increasing understanding and competent application of the subject matter.
Content Focus
Category 1—Domain of OT: Client Factors
Category 3—Professional Issues: Contemporary Issues and Trends
Hi Dennis: I do not know who wrote the OT information printed above or its current relevance,
however I believe this course should be listed on all of our course lists, including nursing,
nursing case management, physical therapy, occupational therapy, paramedics, emergency
medical technicians, and first responders. Of course, on these other sites, these OT specifications
should not appear.
[summary]
This course presents characteristics and functions of emotions; the neurology of emotions,
management of primary emotions, and how caregivers can use emotional intelligence to
communicate more effectively.
Emotions as a Healthcare Concern
Persis Mary Hamilton, RN, CNS, MS, EdD
COURSE OBJECTIVES: To provide information to healthcare providers about human
emotions, their neurology, definition, functions, management, and how caregivers can use
emotional intelligence to communicate more effectively.
LEARNING OBJECTIVES
Upon completion of this course, you will be able to:
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Identify characteristics of emotions.
Describe the limbic system of the brain.
Define emotions and their overall function.
State the unique function of each of the primary emotions.
Explain the management of each primary emotion.
Discuss the capacities and skills to gain emotional intelligence.
What stirs our souls when we watch a glorious sunrise, depresses our mood when we suffer loss,
enflames our passion when we see injustice, or sickens us when we see repulsive behavior?
Emotions do. But what are emotions? Where do they come from? How did we learn them or
were they inborn? Are they the product of thought or of something else? Can we control them or
are they uncontrollable? How do emotions influence our choices and decisions?
For centuries, prophets, poets, and philosophers have posed these questions, and for an equally
long time gurus have offered convoluted explanations based on beliefs and conjectures. Modern-
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day psychologists and neurologists ask the same questions but have begun to use scientific
research to understand the origins and functions of emotions. Though recent studies reveal
something about the anatomy and physiology of emotions, scholars have yet to agree on a single,
comprehensive theory to explain the capacity of living creatures to experience and express this
enigmatic thing we call an emotion (de Sousa, 2007).
This course addresses these issues, describes the generally accepted characteristics of emotions,
identifies neurologic structures and functions involved in emotional responses, offers a distinct
model to explain the purpose and nature of the emotions, and suggests practical strategies
healthcare professionals can use to help individuals manage emotions.
[H1] CHARACTERISTICS OF EMOTIONS
Though scholars hold different views regarding a philosophical theory of emotions and the
capacity to experience and express emotions, they agree on the following nine characteristics:
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Emotions are conscious phenomena—that is, people are aware of them.
Emotions are more consistently demonstrated than other conscious states, such as fatigue.
Emotions vary in several dimensions, such as intensity, type, and range.
Emotions are reputed to be antagonists of objective, rational thought.
Emotions play an indispensable role in determining the quality of life.
Emotions contribute significantly when we define priorities in our lives.
Emotions play a crucial role in the regulation of social life.
Emotions protect us from excessively narrow rational thought.
Emotions hold a central place in moral education and moral life. (de Sousa, 2010)
1. Which of the following is not a characteristic of emotions? B
a. Emotions hold a central place in the teaching of ethical behavior.
b. Emotions are unconscious, in that people are not aware of them.
c. Emotions vary in several dimensions, such as intensity, type, and range.
d. Emotions protect us from excessively narrow rational thought.
[H1] THE LIMBIC SYSTEM
Dennis: I wish we could place a picture of the limpic system right here. Do you know how to do
that? These are many illustrations on the web via google, but I do not know how to access them.
In the long ago past, Susanna did this for the editor who preceded you, but I don’t know if she is
available to do that anymore. Persis
Neurologists have found that emotions are produced by a complex organization of the brain
called the limbic system. “Limbic” comes from the Latin word limbus, meaning “edge” or
“border,” though its major structures are located in the center of the brain. The limbic system is
the area of the brain that becomes active when humans experience an emotion from a past or
present event. The system influences the formation of memory and integration of emotional
states with physical sensations (Bruce & Neary, 1995) (Mosby’s Dictionary (2009). The
following structures and functions of the cerebral cortex and subcortex of the brain are a part of
the limbic system:
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Amygdala: signals the cortex about stimuli that regard fear and rewards
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Central nucleus of the amygdala: contains links to key brainstem areas that control
autonomic functions
Hippocampus: participates in the formation of long-term memories; it includes the
parahippocampal gyrus, which plays a role in the formation of spatial memory
Cingulate gyrus: regulates heart rate, blood pressure, and cognitive and attentional
processing
Fornicate gyrus: encompasses the cingulate, hippocampus, and parahippocampal gyrus
Hypothalamus: regulates the autonomic nervous system by hormone production, affecting
blood pressure, heart rate, hunger, thirst, sexual arousal, and the sleep-wake cycle
Mammillary body: participates in the formation of memory
Nucleus accumbens: participates in feelings of reward, pleasure, and addiction
Orbitofrontal cortex: takes a vital part in decision making
Thalamus: acts as the “relay station” to the cerebral cortex
Pituitary gland: produces thyrotropin and adrenocorticotropin, activating the thyroid and
adrenal systems (Bruce & Neary, 1995) (Mosby’s Dictionary (2009).
Using perceptions and thoughts, the structures of the brain’s limbic system store and retrieve
information from memory, generate emotions, and provide feedback about appropriate social
behavior. However, identifying and naming these structures is just the beginning. We need to
know much more in order to understand emotions. Specifically, we need to define what we mean
by emotions, then, we need to learn their functions, numbers, qualities, intensities, and
combinations. Most important, we need to learn how to manage our emotions.
2. The body system that stores and retrieves information from memory, generates emotions, and
gives feedback about appropriate social behavior is the: C
a. Lymphatic system.
b. Sensory system.
c. Limbic system.
d. Endocrine system.
[H1] WHAT ARE EMOTIONS?
[H2] Definition of an Emotion
Though there are as many definitions of an emotion as there are theorists, the one articulated by
Robert Plutchik and his fellow researchers at Albert Einstein College of Medicine in New York
City continues to be widely accepted, builds on a broad base of research, and describes the steps
of an exceedingly complex entity. These investigators define an emotion as:
[EXT]
[An emotion is] a complex sequence of events having elements of cognitive appraisal,
feelings, impulses to action, and overt behavior, all of which are designed to deal with a
stimulus that triggers the chain in the first place and serves an adaptive function for
survival. (Plutchik, 2002)
[end EXT]
3. An emotion is defined as a: D
a. Stimulus that triggers a strong feeling.
b. Behavior that results from an feeling.
c. Thought that makes people upset.
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d. Sequence of events with an adaptive function.
4. The overall purpose or function of all emotions is: B
a. Reproduction of the species.
b. Survival of the species.
c. Rejection of harmful circumstances.
d. Exploration of the environment for safety.
[H2] Primary Emotions
Plutchik (2002) identified eight primary emotions—four positive and four negative—in regard to
the pleasure or displeasure they bring to the individual:
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Positive emotions: acceptance (trust, love), anticipation (hope), joy (happiness), and
surprise (astonishment)
Negative emotions: anger (wrath), fear (horror), disgust (revulsion), and sadness
(sorrow)
5. Plutchik’s primary emotions include all but one of the following. Select the one that is not a
primary emotion. D
a. Acceptance
b. Fear
c. Surprise
d. Distrust
[H2] Functions of Emotions
Lazarus affirmed that emotions have a useful purpose (function) and that purpose is to help the
individual survive (1991). Eight such functions of emotions have been identified:
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Destruction of the enemy = anger
Protection from harm = fear
Reintegration to wholeness again = sadness/loss
Rejection of whatever may be harmful = disgust
Reproduction of the species = joy/happiness
Incorporation of sustenance = acceptance/trust/love
Exploration of the environment for safety = anticipation/hope
Orientation to an unexpected and possibly dangerous event = surprise/astonishment
6. The function of acceptance is: D
a. Reproduction.
b. Surprise.
c. Anticipation.
d. Incorporation.
7. The function of fear is: C
a. Orientation.
b. Destruction.
c. Protection.
d. Reintegration.
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An emotion is a chain reaction beginning with a stimulus event, followed by cognition
(appraisal), then feeling, then impulse to act, and finally action. All of this occurs to increase the
likelihood of survival. An individual:
[NL]
1. Perceives a stimulus (hears, sees, smells, tastes, touches)
2. Appraises cognitively (thinks)
3. Experiences feelings (feels)
4. Has an impulse to action (considers or prepares for action)
5. Behaves (takes action)
These steps are illustrated as follows:
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Stimulus event: A burglar enters a store, wearing a mask and carrying a gun. He approaches
the clerk and says “This is a stick-up! Hand over your cash!”
Perception: The clerk sees the mask and gun and hears what the burglar says.
Cognition: The clerk thinks “This man is dangerous. He could hurt me.”
Feelings: The clerk feels intense fear.
Impulses to action: The clerk wants to escape. Her heart beats rapidly. Epinephrine from the
adrenal gland floods her body by way of the circulatory system. She remembers the
emergency button under the counter.
Action: The clerk presses the emergency button, hoping help will come soon, then opens the
cash drawer.
Function: The emotion of fear serves a survival function, mobilizing the body to protect
itself.
Table 1 shows this chain reaction for each emotion.
TABLE 1
EMOTIONS AS CHAIN REACTIONS
Stimulus event
Denial of need or
want
Threat from
enemy
Loss of loved
one, self, others
Sickening food
or behavior
Introduction of a
potential mate
Unfamiliar,
shocking event
Event with an
unknown future
Beneficial act of
caring/kindness
[table footnote]
Cognition
Confrontation
with denier
Danger
Feeling
Anger (fury)
Isolation,
loneliness
Nastiness,
harmfulness
Attraction,
interest
Need to quickly
appraise situation
Challenge
Sadness (grief)
Affiliation with
nurturing other
Fear (fright)
Disgust
(revulsion)
Joy (happiness)
Surprise
(astonishment)
Anticipation
(hope)
Acceptance
(love, trust)
Behavior
Lash out, attack,
destroy
Run/escape
Function
Destruction
Cry for help,
comfort
Expel, vomit,
turn from, vomit
Sexual signaling
Reintegration
Stop: take in new
information
Mental mapping
Orientation
Protection
Rejection
Reproduction
Anticipation
Holding, feeding, Incorporation
grooming
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Source: Adapted from Plutchik, 2002.
[end table 1]
[H2] Degrees of Intensity
In addition to their positive or negative polarity, emotions vary in degree of intensity, from mild
to intense, as follows:
[coding note: arrows]
annoyance → anger → rage
boredom → disgust → loathing
pensiveness → sadness → grief
apprehension → fear → terror
distraction → surprise → amazement
pleasure → joy → ecstasy
hopefulness → anticipation → vigilance
toleration → acceptance → adoration
[H2] Combinations of Emotions
In addition to intensity, emotions often combine to form more complex emotions, such as:
Disappointment
Jealousy
Remorse or guilt
Contempt or blame
Shame
Submissiveness
Awe
Love and trust
Optimism
=
=
=
=
=
=
=
=
=
Sadness, surprise
Sadness, anger, fear
Sadness, disgust
Disgust, anger
Fear, disgust
Fear, acceptance
Fear, amazement
Joy, acceptance
Anticipation, joy
Although emotions may be called positive or negative, in themselves they are neither good nor
bad. Even so, the behavior people exhibit and the action they take when they experience
emotions may be harmful or helpful to themselves or others. For example, unmodulated joy may
become mania, uncontrolled anger may beget violence and cruelty, unresolved sadness may lead
to depression and suicide, and unfocused or inappropriate fear may become anxiety, phobia, and
paranoia (Hamilton, 2008). For this reason, to live a balanced life people must learn to manage
their emotions, accepting their reality but controlling the actions they take.
[H1] MANAGEMENT OF EMOTIONS
Emotions play a powerful role in the lives of individuals. Consider the capacity of anger to
destroy, fear to protect, acceptance to nurture, disgust to repel, sorrow to enervate, hope to
challenge, surprise to amaze, and joy to cheer! By understanding and managing these powerful
capacities, people can achieve extraordinary personal goals or create great personal tragedy. We
will look at each primary emotion, its definition, the stimulus events that produce it, thoughts
people have as a result of an emotion, feelings they experience, the function of each emotion, its
manifestations, behaviors, and strategies for management.
[H2] Anger
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Definition: Anger is an emotion that is designed to eliminate an obstacle to the satisfaction of an
important need, such as striking down a barrier, defeating an opponent, or carrying out symbolic
acts of destruction such as cursing or belittling another person.
Stimulus event: Anger occurs when people realize someone or something is blocking the
fulfillment of a need, desire, or value.
Thoughts (cognitions): Individuals think of ways they can eliminate the barrier to their desire.
Feelings relative to intensity: People feel annoyed, frustrated, angry, and intense rage.
Aim or function: The function of anger is to eliminate or destroy an obstacle or overcome a
barrier to a desire.
Manifestations of anger: Grimacing, muscle tension, sympathetic nervous response.
Behaviors/actions: Physical assault, verbal assault, and passive-aggressive statements and or
actions.
[H3] STRATEGIES FOR MANAGING ANGER
[NL/BL]
1. Cognitive. Ask yourself: What is the obstacle? How powerful is it? Should I fight, take
flight, or compromise? The rational-emotive approach of Albert Ellis suggests that before
individuals act they should carefully consider the emotion-triggering event, examine their
belief about the event, and consider the consequences of various actions they might take
(1985). The so-called ABCDE’s of the rational-emotive approach is:
A:
B:
C.
D.
E.
Identify the activating event.
Identify your belief about the event and the emotion related to the event.
Consider the consequences.
Discuss/debate various courses of action.
Examine the effect of your action (Ellis & Bernard, 1985).
For example:
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Activating event: The driver of another automobile in the shopping mall rushes
past Sam, taking the last remaining parking space.
Belief: Sam believes he deserves the space; he got there first and the other driver
cheated him out of something that was rightfully his. He is angry.
Consequences: Sam considers how he can make the driver of the other vehicle relinquish
the parking space.
Discussion/debate: Sam debates whether he should bump the offending vehicle, scream
insults at the driver, or wait patiently for another parking space.
Effect: Sam examines the effect of each possible action. He concludes that it is best to let
go of his anger and wait for another parking space.
2. Behavioral. Research studies show that “letting it all out” escalates anger rather than
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decreasing it; therefore such action is not recommended (Travis, 1989). A more
effective
strategy uses a behavioral-cognitive strategy—wait, cognate, officiate—as demonstrated
in the following example.
Example:
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When the driver of the other car rushes past Sam and takes the parking space, Sam waits,
then cognates, thinks through his options, then officiates. He decides that confrontation
may lead to harm for himself or his automobile. Sam takes a deep breath, looks away
from the offending driver, shrugs his shoulders, and lets go of his anger.
8. Research studies indicate that the “letting it all out” strategy to manage anger is: A
a. Not recommended because it merely escalates anger.
b. Exceptionally effective with prisoner populations.
c. More useful with educated individuals.
d. Especially effective with adolescent children.
3. Chemical. When individuals are unable to use cognitive or behavioral strategies to
manage anger, physicians may prescribed anti-anxiety (anxiolytic), psychotropic, or
sedatives.
4. Management of anger in patients. People who are ill, in pain, and experiencing
exceptional stress are more likely to experience anger than those who are well and
comfortable. It is no surprise, then, that healthcare professionals often encounter angry,
hostile people.
Here are some suggestions for response to verbal expressions of anger:
o Lower the volume of your voice and slow its pace.
o Acknowledge the person’s anger, thereby demonstrate respect.
o Ask what the person wants or needs and what is preventing him from obtaining it.
o Restate the problem until you have clearly identified it.
o Offer to seek a solution or to find someone who can do so.
o Demonstrate accurate empathy and genuineness.
Here are some suggestions for response to aggressive physical behavior:
o Call for help
o Protect yourself and others from harm. Remember, safety comes first.
o Maintain access to a door or other avenue of escape.
o Use calm verbal interactions as described above.
o Express your willingness to listen with genuineness and accurate empathy.
[H2] Fear
Definition: Fear is a strong emotion intended to avoid harm and protect individuals. It is the
opposite of anger; its purpose is to escape danger.
Stimulus event: Fear occurs when people perceive a threat of harm to themselves, their loved
ones, or their property.
Thoughts (cognitions): Individuals believe they and/or their property are in danger.
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Feelings: People feel frightened, upset, and anxious.
Aim or function: The function of fear is to protect individuals and help them escape dangerous
or harmful forces.
Manifestation of fear: Adrenal system floods the body with epinephrine and stress hormones;
as a consequence, the heart races, blood pressure rises, breathing quickens, the liver releases
glucose, digestion stops, skin chills, and blood diverts to muscles.
Behaviors/actions: Individuals take defensive action (fight, flight, or withdrawal).
[H3] STRATEGIES FOR MANAGING FEAR
[NL/BL]
1. Cognitive. Ask yourself: Who is the enemy? How much threat is there? What will duce the
threat? Use the rational-emotive ABCDE approach:
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Activating event: When Mary was 6 years old a large, overly friendly sheep dog ran up to
her, pushing her over, and frightening her. Now 26 years of age, Mary has a panic attack
whenever she sees or hears a dog barking. She is afraid to go out in public.
Belief: Mary believes all dogs are dangerous, no matter what breed or training.
Consequences: Mary is terrified by dogs of any size, number, breed, or training. Her fear
limits her personal freedom and she does not want to be a prisoner in her own home.
Rationally, Mary knows all dogs are not dangerous, but her fear persists.
Discussion/debate: Mary decides to seek professional help to overcome her unrealistic fear
(phobia). She seeks desensitizing therapy in which she is gradually exposed to the object of
her fear.
Effect: Desensitization therapy helps Mary reduce her fear of dogs to manageable levels. In
addition, she learns to avoid places where off-leash dogs roam free.
9. A therapy in which people are exposed to increasing contact with the feared object, person, or
situation is called: C
a. Rational-emotive
B. Consequential
C. Desensitization
D. Activation
2. Behavioral. Relaxation exercises and creation of a safe environment.
3. Chemical. Anxiolytic drugs may be prescribed.
4. Management of fear and anxiety in patients. Often patients are unfamiliar and fearful of
hospitals and what goes on there. They may have seen gruesome pictures, heard or read horrific
stories, or experienced painful procedures in hospitals. They know they are not in control of their
person or property in a hospital and consequently, are afraid. Healthcare professionals can help
reduce fear in patients by:
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Explaining and describing in advance planned test, treatments, or procedures.
Speaking and behaving respectfully toward patients.
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Reduce stress-producing stimuli, such as sights, sounds, or extreme room temperatures.
Identify yourself and others who are working with the patient.
Stay with patients or provide some means for them to call for help.
Give accurate empathy, unconditional positive regard, nonpossessive warmth, and
genuineness.
[H2] Sadness
Definition: Sadness is an emotion associated with the loss of someone or something of value to
a person. It is the opposite emotion of joy and signals a cry for help. The accompanying mild to
moderate depression provides a time of healing.
Stimulus events: Occasions when individuals suffer loss or damage to valued things or people.
Thoughts (cognitions): People who are sad realize they are deprived of the lost person or object.
Feelings: Individuals feel pensive, sorrowful, alone, numb, and mild to moderate depression.
Aim or function: The function of sadness is to provide a time of healing and reintegration.
Manifestations of sadness: Withdrawal, depression, hopelessness, and reduced creativity.
Behaviors/actions: Crying, tearfulness, lose of appetite, and avoidance of others.
[H3] STRATEGIES FOR MANAGING SADNESS
[NL/BL]
1. Cognitive. Acknowledge the loss, large or small. When loss is large and grief profound, give
yourself time for “grief work.” At first, this may be 30 to 60 minutes, two or three times a day.
During this time, give yourself permission to weep and experience the loss. After each grieving
period, close that chapter of grief and return to normal activities of daily living. Gradually,
reduce the number and extent of planned grieving sessions until you no longer feel the need for
those sessions. If the experience of loss suddenly returns, allow yourself to do some more grief
work. Some losses are so great, they last a life-time. Use the ABCDE rational-emotive approach:
10. “Grief work” means: B
a. Working for a counseling agency.
b. Repeatedly experiencing a loss, then letting go of the grief.
c. Consciously avoiding any thought of loss.
d. Dissociation from uncomfortable or frightening situations.
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Activating event. Jane’s husband of 51 years died after a brief illness. Until his death they
had shared everything, reared three children, and never been apart except for brief
periods.
Belief. Jane is overwhelmed by her loss. She does not believe she can live without her
husband. Everything in her life seems surreal.
Consequences. Jane withdraws from all her normal social contacts and becomes more
and more depressed. She walks around in a daze of confusion and pain.
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Discussion/debate. The hospice worker who attended her husband suggested Jane join
a grief support group sponsored by the hospice agency. Jane was hesitant to expose her
feelings to strangers but her daughter urged her to attend. Finally, Jane agreed to go to at
least one meeting.
Effect. Jane was welcomed by the group and received comfort and support from its
members. She learns about grief work and decides to continue attending until she no
longer feels the need.
2. Behavioral. Participate in a support group and share grief with sympathetic others. Perform
grief work by repeatedly experiencing grief and sorrow and then letting go of sadness.
3. Chemical. Antidepressants may be prescribed for chronic depression.
4. Management of sadness in patients. When patients suffer loss, healthcare professionals need
to give empathy, genuineness, and nonpossessive warmth. If appropriate, explain grief work, and
suggest counseling and participation in support groups.
[H2] Disgust
Definition: Disgust is an emotion that arises from contact with something that is repulsive—
physically, mentally, or morally. Disgust triggers rejection of an offensive object, idea, or person
and is the opposite of acceptance.
Stimulus event: People contact something that is physically, socially, or morally abhorrent to
them, such as spoiled food, foul odors, sexual promiscuity, and drunkenness.
Thoughts (cognitions): The repulsive object or person is sickening and repugnant.
Feelings: Contempt, rejection, and repulsion.
Aim or function: The function of disgust is to reject whatever is spoiled, foul, or offensive.
Manifestations of disgust: Avoidance, disassociation, and expulsion.
Behaviors/actions: Verbally or physically turning away or condemning a rejected object.
[H3] STRATEGIES FOR MANAGING DISGUST
[NL/BL]
1. Cognitive. Identify the disgusting object, idea, or person. Evaluate your judgments. Use
ABCDE rational-emotive approach:
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Actuating event. One month ago Sue, an RN and single mom, took a job in a surgeon’s
office. Carol, the office manager, adjusted Sue’s work hours to meet her childcare needs.
Soon after Sue began to work she noticed that Carol had many personal traits that
disgusted her. The woman was annoyingly opinionated, and furthermore, she smacked
her lips while eating, burped loudly, and expelled flatus without apology.
Belief. Sue thought Carol was unprofessional, rude, and disgusting.
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
Consequences. Because of her feelings about Carol, Sue avoided her as much as
possible, but this was difficult in the small office. Sue felt antipathy toward Carol but she
did not want to quit her job.
Discussion/debate. Sue decided to talks to Joyce, the other RN in the office. Joyce
sympathized with Sue but said she believed Carol’s behavior was due to low self-esteem
coupled with lack of social skills. Joyce suggested that Sue attempt to accept Carol as she
is and suggested that when Carol did something commendable, Sue should praise her.
Effect. Sue decided to look at Carol, not as a disgusting slob, but as a needy person with
uncouth social manners. Eventually, Sue was able to accept Carol as a person, even
though she could not accept her behavior.
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2. Behavioral. Sue looked for opportunities to bolster Carol’s self-esteem. The strategy seemed
to help both Sue and Carol.
3. Chemical. Medications to reduce disgust are not available.
4. Management of disgust in patients. When patients confide to a healthcare worker that they
are disgusted with someone, individual, television personality, or athlete, the person:
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Listens closely to what patients see as the activating event.
Ask patients to identify, if possible, beliefs behind their feeling of disgust.
If appropriate, discuss the consequences of this belief.
Show respect for patients, allowing them to evaluate effects of their rejection.
11. The purpose or function of disgust is: D
a. Acceptance
b. Anticipation
c. Orientation
d. Rejection
[H2] Joy (Happiness)
Definition: Joy is a transient emotion of pleasure, enthusiasm, action, and attainment of
objectives. It is the opposite of sadness and loss. Many theorists liken joy to sexual excitement,
creative activity, energy, and innovation.
Stimulus event: These are times when people experience fulfillment, inspiration, and sexual
attraction.
Cognition (thoughts): Individuals experience self-actualization, recognition, and achievement.
Feelings: Energy, elation, sexuality, and pride in accomplishments.
Aim or function: The function of joy is reproduction, fulfillment, and self-actualization.
Manifestations of joy: Enthusiasm, creativity, energetic enterprise, and sexuality.
Behaviors/actions: Sexual activities, dancing, singing, talking, inventing, and creating.
[H3] STRATEGIES FOR MANAGING JOY
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[NL/BL]
1. Cognitive. Recognize, acknowledge, and enjoy an expansive outlook on life and good
energy level. Use the ABCDE approach:
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Activating event. Ann woke up early; it was a beautiful morning and she felt wonderful.
The night before she had a date with Tom, a senior at the liberal arts college where she
was a junior, majoring in art. They had gone to Funny Girl, the spring musical. The
words of one of the songs kept running through her head. The Fannie Brice character
“liked the feeling going through her, down her spine” (Styne & Merrill, 1964). Like that
song, Ann felt energetic, enthusiastic, and full of joy.
Belief. The future looked bright. She loved being with Tom and was quite sure he felt the
same about her. She was doing well in all her courses and was pleased with her current
project, a stylized metal sculpture of an athlete.
Consequences. Because of her joyful state of mind, Ann didn’t get annoyed with her
roommate, even when she found dirty dishes in the sink of their tiny kitchen. Instead,
Ann hummed the tune from Funny Girl and cleaned up the mess.
Discussion/debate. Because she felt so good, Ann was tempted to take the day off, go
shopping at the mall, go for a hike, and maybe ask Tom if he’d like to join her. Instead,
Ann decides to use her energy to work on a project for her sculpture class.
Effect. Even though Ann’s joyful elation lessened as the day progressed, her feeling of
satisfaction continued as she worked on her project. Had her joy increased to a state of
mania, Ann’s judgment would have been impaired and she would not have been able to
focus her energy productively.
2. Behavioral. Individuals channel their energy productively, modifying their behavior through
reason.
3. Chemical. When needed for hypomania or manic behavior, mood-stabilizing drugs may be
necessary.
4. Management of joy in patients. It is important for healthcare professionals to monitor the
mood of patients, noting whether they seem inappropriately elated and hyperactive or extremely
withdrawn and depressed. In either case, the caregiver can enter into a conversation with such
individuals about how they are feeling. When mania or depression is observed, it should be noted
and reported to the attending physician.
12. The extremes of behavior reflecting joy are: A
a. Mania and depression.
b. Hope and hopelessness.
c. Identification and repulsion.
d. Love and hate.
[H2] Acceptance (Love)
Definition: Acceptance is the opposite of disgust and rejection. It is the emotion of
incorporation and nurturance, It involves accepting a beneficial stimulus from the outside world,
as in eating, grooming, mating, parenting, or affiliation with members of one’s social group
(Plutchik, 1980).
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Stimulus event: These are time of nurturance, when people identify with others and care for
others as they do themselves.
Cognition (thoughts): Individual acknowledges and recognizes others, both to give and receive.
Feelings: People feel positive regard for others.
Aim or function: The function of acceptance is to confirm inclusion, assimilation, and merger—
ultimately, for the survival of the species.
Manifestations of acceptance: Embracing, recognizing, including, nurturing, eating,
befriending.
[H3] STRATEGIES FOR MANAGING ACCEPTANCE
[NL/BL]
1. Cognitive. Recognize feelings of positive regard and identification with another person or
object and then use the ABCDEF approach:





Activating event: Amy gave birth to her third child, a boy she named Paul. This was the
first boy in three generations on her side of the family and she was thrilled. Even so, Amy
had difficulty bonding with the baby. He seemed like a stranger to her, a toy, something
apart, not an extension of herself, as the girls had seemed. Amy decided not to breastfeed
the baby and went back to work when he was 7 weeks old, happy to find a babysitter to
care for him. One day Paul became acutely ill with a high fever and was admitted to the
hospital. Amy took time off from work to stay with him. Day and night she held him, fed
him, and watched over him until he was well enough to come home. During that time
Amy’s attachment with her son changed. She began to identify with her little boy and to
feel an attachment to him.
Belief: Amy came to accept her baby boy as never before. Indeed, he became as dear to
her as her own life.
Consequences: As a result of her experience of watching over and caring for her son,
Amy was able to accept and embraced all three of her children as never before.
Discussion/debate: Before his illness, Amy had not bonded with her baby boy as she had
with her girls. She needed to lose her discomfort with this helpless male infant and to
identify with him as her own beloved child.
Effect: By recognizing her boy as unique, yet precious extensions of herself and her
husband, Amy became a better parent to all three of her children.
2. Behavioral. Accepting people as they are, not as you want them to be, is made possible by
empathetic listening, genuineness, and identifying with them as fellow humans.
3. Chemical. Acceptance of others nurtures both those who do the accepting and those who are
accepted. For this reason, medications are not necessary.
4. Management of acceptance in patients. Because postpartum hospital stays are short,
evaluation of bonding is difficult to quantify. However, if a mother wants to hold her baby,
examine its tiny body, breastfeed, and spend time in an eye-to-eye, face-to-face (en face)
15
position, attachment probably is occurring. If not, the nurse or other professional may want to
encourage activities that will foster bonding. In pediatric units, nurturance by parents may be
indicated by their behavior toward their child and by their very presence with the child.
[H2] Anticipation
Definition: Anticipation is the emotion of investigation, exploration, and hope. It is the opposite
of unexpected shock, astonishment, or surprise. When individuals anticipate and investigate
circumstances, they are not caught off guard and are able to cope effectively with challenges to
their survival (Plutchik, 2002).
Stimulus event: People experience anticipation when they are in unfamiliar territory and feel the
need to explore and investigate a situation. These are times of excitement and challenge.
Cognition (thoughts): Individuals think about potential goals and consequence; they investigate,
explore, and anticipate end results.
Feelings: Anticipation is a feeling of hope and excitement, as well as slight fear and dread.
Aim and function: The function of anticipation is exploration, mental mapping, and
investigation about likely outcomes.
Manifestations of anticipation: Alertness, excitement, curiosity.
[H3] STRATEGIES FOR MANAGING ANTICIPATION (HOPE)
[NL/BL]
1. Cognitive. Become aware of feelings, consider future possibilities. Use the ABCDE
approach:





Activating event. Rich has an opportunity to buy some potentially valuable stock at
below market price in a company with a solid earnings history. The seller has to raise
money in a hurry and is willing to sell at a loss.
Belief. Rich believes he is getting a good deal and is quite sure he will profit.
Consequences. Rich decides to buy the stock and arranges to borrow the money.
Discussion/debate. Rich investigates the company, finds that the books look good. He
decides to go ahead with the purchase.
Effect. Even though Rich thoroughly investigates the company, he knows there is some
risk; nonetheless, he anticipates a handsome profit.
2. Behavioral. Use relaxation measures to guard against or reduce anxiety, such as deep
breathing, physical exercise, and meditation.
3. Chemical. Anxiolytic medications may be prescribed if an individual becomes excessively
anxious.
4. Management of anticipation in patients. When patients seek medical help, they may
anticipate the worst or the best outcome. In either case, they can be taught relaxation measures to
reduce anxiety.
16
[H2] Surprise (Shock, Astonishment)
Definition: The opposite of anticipation, surprise is an emotion of sudden shock, a response to
new and unfamiliar stimuli, positive or negative. When startled, individuals must stop what they
are doing, quickly reorient themselves, and take in information about the unexpected incident.
When the stimulus has been evaluated, surprise usually changes quickly to another emotion, such
as fear when a stimulus turns out to be dangerous, or joy if it turns out to be favorable.
Stimulus event: Something unexpected occurs or an unfamiliar person or animal intrudes in the
environment.
13. Surprise is an emotion about: D
a. Anger.
b. Fear.
c. Anticipation.
d. Sudden shock.
Thoughts (cognition): When such an unexpected event occurs, individuals tell themselves to
exercise caution and evaluate the stimulus.
Feelings: Startle, shock, astonishment, arousal.
Aims and function: The function of surprise is orientation, to allow people to pause and
evaluate the environment.
Manifestations (behaviors): Startle reaction, alertness, shock.
[H3] STRATEGIES FOR MANAGING SURPRISE
[NL/BL]
1. Cognitive. Become aware of feelings, consider what may happen next. Use the ABCDE
approach:
[coding: note smaller font for P.M.]



Activating event. Peggy, an LVN in a skilled nursing facility, was administering the
evening medication from the medicine cart. She was at the end of a long, dimly lit
hallway. Shortly after 9 P.M., a man came out of an empty room. He looked up and down
the corridor, walked slowly toward her, showed a gun, and said, “Don’t say a word! Put
all the narcotics in this bag. Do it now!” Peggy saw the gun and for about 10 seconds she
froze in shock.
Belief: During the period of shock, Peggy evaluated the situation. She was in danger and
needed help. Was anyone nearby?
Consequences. The period of shock gave her enough time to remember what the facility
had taught her in an in-service class: Safety comes first! Loss of narcotics is nothing
compared to loss of life.
17


Discussion/debate. Peggy fumbled, trying to open the locked narcotics drawer. The
man moved closer, repeatedly poking the gun in her side. Her hands were shaking. It was
difficult to think.
Effect. Peggy delayed as long as she dared. Just as she pulled open the drawer, a staff
member came out of a nearby room. Peggy dropped on her knees to the floor beside the
cart and called her coworker’s name. When the robber saw another person, he darted
toward a nearby door.
2. Behavioral. Maintain control, take a deep breath, and exercise your best judgment whether the
shock and surprise turns to joy or fear.
3. Chemical. Because the emotion of surprise lasts for such a brief time, medications are not an
option.
4. Management of surprise in patients. Because of the brevity of surprise, the greater concern
becomes the emotion that follows. For example, immediately after a physician tells a man he has
a fatal disease, the patient experience shock and surprise. He may simply decide to deny the
reality of the diagnosis or may immediately experience fear, anger, or some other emotion. Thus,
it is especially important to give individuals nonpossessive warmth, accurate empathy,
genuineness, and unconditional positive regard (Rogers, 1961; Carkhoff, 1977).
[H1] EMOTIONAL INTELLIGENCE (EI)
In 1995, Goldman published Emotional Intelligence, a text that posited that emotional
intelligence is different than cognitive intelligence. Since that time, investigators have found that
although emotional intelligence is different, it provides an important balance to rational thinking.
Segal and others has identified special abilities of emotional intelligence and have noted that
these capacities and skills can be learned and applied in every arena of life. These abilities are
especially important for health care providers. She defined emotional intelligence as follows:
Emotional intelligence (EI) is the ability to identify, use, understand, and manage emotions in
positive and constructive ways, recognizing your own emotional state and the emotional states of
others and engaging with others in ways that draw people to you (Segal, 2010).
[H2] Capacities of Emotional Intelligence
Emotional intelligence consists of at least four special capacities:
 Self-awareness: The ability to recognize your own emotions and know how they affect
your thoughts and actions.
 Self-management: The ability to control impulsive feelings and actions, manage emotions
in healthy ways, adapt to changing circumstances, take initiative, and follow through on
commitments.
 Awareness & empathy for others: The ability to understand the needs and concerns of
others, “walk in someone else’s shoes,” recognize emotional cues, feel comfortable
socially, and recognize the power dynamics within a group of people.
 Relationship management: The ability to develop and maintain positive relationships,
inspire and influence others, communicate clearly, work well in a team, and manage
conflict.
[H2] Skills to Gain Emotional Intelligence Capacities
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Indeed, all four of the capacities of EI are needed by health care providers, but they are not
inborn, they must be learned. The specific skills needed to gain EI capacities are the ability to:
1. Quickly reduce stress.
2. Recognize and manage your own emotions.
3. Connect with others, using nonverbal communication.
4. Use humor and play to deal with challenges.
5. Resolve conflicts positively and with confidence (Segal, 2010).
[H3] Stress Reduction
The first vital skill to learn is to notice when you are stressed and how to calm yourself so that
you can stay balanced, focused, and in control. This is necessary because when people are
overwhelmed by stress, their ability to think rationally is compromised. One simple method to
reduce stress is the one-minute relaxation exercise, as follows:




Find a quiet, separate space and if possible, sit down.
Close your eyes, take a deep breath; allow your mind to “space out” and body to relax.
Remain in that blessed moment of calm for a full minute as you let go of stress.
Take a deep breath of renewed energy, open your eyes, and go about your work.
[H3] Managements of Emotions
The second key skill of emotional intelligence is to become aware of your own emotions as
described earlier in this chapter. To do this:
 Notice if you are experiencing physical sensations, such as in your stomach or chest.
 Identify specific emotion you are experiencing, such as anger or fear.
 Note whether you are acting out an emotion so that your behavior is obvious to others.
 Consider whether your emotions are affecting your decisions.
[H3] Non-verbal Communication
The third key skill of emotional intelligence is connecting with others by means of non-verbal
communication. This wordless form of communication is emotion-driven. It asks the question,
“Are you listening?” and Do you understand and care?” (Segal, 2010). To enhance your skill in
recognizing nonverbal communication, pay attention to:
 Eye contact
 Facial expression
 Posture and gestures
 Tone of voice and timing of expression
 Touch or response to touch
[H3] Humor and Play
The fourth key skill of emotional intelligence is using humor and play to deal with challenges.
Research has found that laughter reduces stress and elevates mood. To enhance your skill in
dealing with setbacks and difficulties with humor and play:
 Take hardships as they come along; view them from a can-do perspective.
 Smooth over differences with gentle humor and a lighter touch.
 Relax and allow yourself and others to be reenergized.
19

Become more creative; look at things from a new perspective.
[H3] Conflict Resolution
The fifth key skill of emotional intelligence is the ability to resolve conflicts in a positive, trustbuilding way. Conflict resolution uses the first four skills. Having learned how to manage stress,
stay present and aware, communicate nonverbally, and use humor and play, you are better
equipped to handle emotionally charged situations and defuse conflicts before they escalate. To
enhance your skill in conflict resolutions:
 Stay focused in the present
 Choose your arguments
 Protect yourself, but forgive and let go of the urge to punish
 Disengage from conflicts that cannot be resolved (Segal, 2010).
14. Emotional intelligence means that individuals have developed: B
a. Knowledge so that they can diagnose psychiatric disorders when they see them.
b. Self-awareness, self-management, empathy, and relationship management capacities.
c. Insight into the personal problems of other people.
d. The inborn ability to experience a full range of emotions, especially anger and fear.
Indeed, emotional intelligence is needed by caregivers everywhere. Happily, its development is
within the grasp of everyone.
REFERENCES
Bruce LL, Neary TJ. (1995). The limbic system of tetrapods: A comparative analysis of cortical
and amygdalar populations. Brain Behavioral Evolution 46(4–5):224–34. PMID 8564465.
Retrieved February 1, 2008 from http://encyclopedia.thefreedictionary.com/Limbic+System.
Carkhoff RR. (1977) The Art of Helping, 2nd ed. Amherst, MA: Human Resource Development
Press.
de Sousa R. (2010). Emotion. The Stanford Encyclopedia of Philosophy. Retrieved March 10,
2011 from http://plato.stanford.edu/archives/2011/entries/emotion/.
Ellis A, Bernard ME. (1985). What is rational emotive therapy (RET)? In A. Ellis and M.E.
Bernard (Eds.), Clinical Applications of Rational-Emotive Therapy. Monterey, CA:
Brooks/Cole.
Goleman D. (1995). Emotional Intelligence: Why It Matters More Than IQ. New York: Bantam.
Johnson S. (2003, March). The brain + emotions, 1: fear. Discover Magazine, 31–40.
Hamilton PM. (2008). Posttraumatic stress disorder (PTSD). Wild Iris Medical Education.
Retrieved March 1, 2008 from http://www.wildirismedical.com.
Lazarus RS. (1991). Emotion and Adaptation. New York: Oxford University Press.
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____ (2009). Mosby’s Dictionary of Medicine, Nursing & Health Professions, 8 ed., St.Louis
Mo: Mosby Elsevier.
th
Plutchik R. (1991). The Emotions: Facts, Theories, and a New Model, rev. ed. Lanham, MD:
University Press of America.
Plutchik R. (2002). Emotions and Life: Perspectives from Psychology, Biology, and Evolution,
Washington, DC: American Psychological Association.
Rogers C. (1961). On Becoming a Person. New York: Norton.
Travis C. (1989). Anger, The Misunderstood Emotion. New York: Touchstone.
Segal J. (2010). Emotional Intelligence (EQ). Five Key Skills for Raising Your Emotional
Intelligence. HELPGUIDE.org. Retrieved March 16, 2011 from
http://helpguide.org/mental/eq5_raising_emotional_intelligence.htm.
OUTLINE OF COURSE
[H1] Learning Objectives
[H1] Characteristics of Emotions
[H1] The Limpic System
[H1] What are Emotions?
[H2] Definition of an Emotion
[H2] Primary Emotions
[H2] Functions of Emotions
[H2] Degrees of Intensity
[H2] Combinations of Emotions
[H1] Management of Emotions
[H2] Anger
[H3] Strategies for Managing Anger
[H2] Fear
[H3] Strategies for Managing Fear
[H2] Sadness
[H3] Strategies for Managing Sadness
[H2] Disgust
[H3] Strategies for Managing Disgust
[H2] Joy
[H3] Strategies for Managing Joy
[H2] Acceptance (Love)
[H3] Strategies for Managing Acceptance
[H2] Anticipation
[H3] Strategies for Managing Anticipation
[H2] Surprise (Shock, Astonishment)
[H3] Strategies for Managing Surprise
[H1] Emotional Intelligence
[H2] Capacities of Emotional Intelligence
[H2] Skill to Gain Emotional Intelligence Capacities
[H3] Stress Reduction
[H3] Management of Emotions
[H3] Non-verbal Communications
[H3] Humor and Play
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[H3] Conflict Resolution
[H1] References