The battle against peace-keeping frustrations: psychiatrists and psychologists in the Dutch army.
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History, 20th Century↗
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Thwarting of behaviour in different contexts and the gakel-call in the laying hen.
Earlier studies have shown that thwarting of feeding behaviour in the laying hen is expressed through a specific vocalisation, the gakel-call. The first aim of this study was to investigate whether the effect of deprivation per se on the occurrence of gakel-calls can be distinguished from the effect of the additional frustration. Frustration is defined as the state of an animal that results from nonreward in the expectancy of reward. The second aim was to investigate whether the occurrence of gakel-calls is restricted to a food context or whether it can be regarded as an expression of frustration in general. For this purpose, 20 hens were deprived of food, water and dustbath. After deprivation at a fixed time, a cue was given and the hens were rewarded with access to food, water or dust during a 15-min session on 4 consecutive days. On the fifth day, they were thwarted in the associated behaviours by blocking the access to these commodities, after the hens had been presented the signal that previously preceded the reward. We then recorded behaviours that might reflect the state of frustration in three 15-min periods. The period "Pre-Frustration" started 15 min before "Frustration". This, in turn, was followed by the period "Post-frustration" in which the hens were rewarded again. Nesting behaviour was thwarted by blocking the access to the nest (Frustration) after a hen had reached the last stage of its prelaying behaviour.In the food, water and dustbath context, deprivation elicited gakel-calls. The additional frustration resulted in a higher number of gakel-calls in all contexts except the food context. However, together with the findings of previous experiments, the results of this study suggest that frustration, in general, is expressed through the gakel-call. Frustration in the nest context elicited more gakel-calls than the other contexts. This latter finding is discussed in the light of the occurrence of the gakel-call under natural circumstances.
Journal Article↗
Communication boards in critical care: patients' views.
BACKGROUND: Some patients receiving mechanical ventilation experience an intensified need to communicate while their ability to do so is compromised as the endotracheal tube prevents speech. Although the use of a communication board to enhance communication with such patients has been suggested, few descriptive or empirical studies have addressed the content and format of these devices or of patients' perspectives on decreasing frustration with communication. OBJECTIVES: The objectives of this study were: (1) to identify the perceived level of frustration of patients receiving mechanical ventilation while they attempt to communicate; (2) to determine patients' perceived level of frustration if a communication board had been used; and (3) to describe patients' perceptions of the appropriate content and format of a communication board. METHODS: Twenty-nine critically ill patients who were extubated within the past 72 hours were included in this descriptive study. Subjects participated in a 20- to 60-minute audiotaped interview consisting of questions about their perceived level of frustration when communicating with and without a communication board and their thoughts about the appropriate content and format of a board. Transcripts were analyzed by questions for meaning and overall themes. RESULTS: Sixty-two percent (n = 18) of patients reported a high level of frustration in communicating their needs while receiving mechanical ventilation. Patients judged that their perceived level of frustration in communicating their needs would have been significantly lower (P < .001) if a communication board had been offered (29.8%) than if not (75.8%). Most patients (69%; n = 20) perceived that a communication board would have been helpful, and they also identified specific characteristics and content for a communication board. A communication board may be an effective intervention for decreasing patients' frustration and facilitating communication. CONCLUSIONS: Most patients receiving mechanical ventilation experienced a moderate to a high level of frustration when communicating their needs. In this study, a communication board, if used patiently during mechanical ventilation, has been shown to alleviate frustration with communication. Patients have specific ideas about what terms and ideograms are useful for a communication board. Further research is needed to test the effects of a communication board and other methods of facilitating communication on outcomes such as satisfaction and anxiety of patients, adequate and appropriate management of pain, and length of mechanical ventilation time and hospital stay.
Adolescent↗
Patients' reports of health care practitioner interventions that are related to communication during mechanical ventilation.
BACKGROUND: The literature supports nursing interventions to maximize communication in mechanically ventilated patients, yet limited research exists on patients' perceptions of the helpfulness of health care practitioner interventions to enhance communication. In addition, the level of frustration experienced by these patients has not been reported. Thus, further research is necessary to examine patients' perspectives of the helpfulness of health care practitioner interventions that enhance communication of the mechanically ventilated patient. OBJECTIVES: This study describes the level of frustration experienced by mechanically ventilated patients and ascertains the helpfulness of methods used by health care practitioners to meet the communication needs of the mechanically ventilated patient. METHODS: A total of 29 critically ill patients, extubated within the last 72 hours, were included in this descriptive study using qualitative and quantitative methods. Subjects participated in an average 30-minute audiotaped interview session consisting of questions pertinent to their perceived level of frustration in communicating and the interventions practitioners used to meet their communication needs. Transcripts were analyzed by question and for overall themes. RESULTS: It was found that 62% of patients (n = 18) reported a high level of frustration in communicating their needs while being mechanically ventilated. There was no significant difference between the duration of intubation and the level of frustration (Spearman r =.109, P =.573) or between the diagnosis and the level of frustration (P =.932). Patients who received anxiolytics (n = 23, 79% of the sample) had a lower level of frustration (mean 3.26) than those who did not receive anxiolytics (n = 6, 21% of the sample, mean 4.33). This difference trended toward significance (P =.084). Patients cited health care practitioner behaviors, characteristics, and attributes that both facilitated communication (kind, informative, and physically present at the bedside) and impeded their ability to communicate (mechanical, inattentive, and "absent" from the bedside). Patients reported problems and stresses associated with communication difficulties that can be alleviated by the health care practitioner. CONCLUSIONS: Mechanically ventilated patients experience a high level of frustration when communicating their needs, and health care providers have a significant impact on the mechanically ventilated patient's experience. Further research is needed to explore and measure methods of facilitating communication that increase patient satisfaction, reduce patient anxiety, and obtain optimal pain management.
Anti-Anxiety Agents↗
"Difficult patients" as family physicians perceive them.
The physician patient relationship is an important part of medical care. This study examined events that can jeopardize that relationship, i.e., patients' behaviors and attributes that physicians find frustrating. Data were collected from practicing family physicians (N-34) using a 32 item questionnaire developed by the author. Items were drawn from previous research on the behaviors of difficult patients and checked for relevance by two family physicians before the study began. Coefficient alpha was 92. Participants were predominantly male physicians who had been in practice for an average of 18 years. They were asked to indicate if they found specific patients' characteristics frustrating or annoying by using a 9 point scale with endpoints of "not at all frustrating or annoying" (1) and "very frustrating or annoying" (9). The physicians rated half of the listed patients' attributes as at least moderately frustrating (mean rating > 61. Over 80% of the physicians were frustrated by patients who expected to "cure," brought up new symptoms at the last moment, appeared to be malingering or refused to take responsibility for their health. They were least frustrated by disease related conditions such as degenerative or chronic illnesses. The physicians' ratings were unrelated to their years of experience. Results are discussed in relation to changing disease patterns which have occurred in this country over the last half century.
Adult↗
Sex differences in negative emotional responses to chronic pain.
We proposed a sequential model of pain processing with pain intensity as stage 1, pain unpleasantness as stage 2, pain-related emotions (depression, anxiety, frustration, anger, fear) as stage 3, and overt behavioral expression of pain as stage 4. We tested hypotheses about relationships between sex and the first 3 stages of pain processing by conducting simultaneous regression analysis using LISREL-8 with data collected from 967 women and 680 men with chronic pain. We found the following results: (1) women reported higher pain-related frustration and fear; (2) frustration related most highly to pain intensity among women, as compared with anxiety and depression among men; (3) depression and frustration related most highly to usual and highest pain unpleasantness among women, as compared with frustration among men; and (4) contrary to expectations, pain-related emotions were more strongly related to pain for men. Consistent with the sequential model of pain processing, emotional response to pain was more closely related to pain unpleasantness than to pain intensity across sex. Anxiety and frustration were the emotions most highly related to pain. The current results highlight sex differences in the experience of chronic pain and the importance of assessing a range of emotions in patients with pain.
Journal Article↗
Behavioral and physiological responses of dairy goats to food thwarting.
Eight Nubian dairy goat does in one experiment, and eight Alpine dairy goat does in a second experiment, were randomly allotted to food-thwarted or fed groups in a crossover experimental design. Food thwarting was hypothesized to produce an emotional state analogous to frustration. After a 1-week training period during which the goats of both breeds were conditioned to being simultaneously fed in adjacent feeding stalls, frustration was induced in half the goats by feeding only alternate does. Focal animal behavior was recorded for the initial five min after feeding frustration commenced. Blood samples were collected via a jugular cannula before, during and after frustration was induced for thyroxine (T4), triiodothyronine (T3), cortisol, norepinephrine (NOR), and epinephrine (EPI) determinations. Food thwarting was characterized by increased plasma concentrations of NOR, and increased incidences of pawing, head movements, mouthing of objects, behaviors directed toward neighboring does being fed, and rearing (p less than 0.01). When data were pooled across experiments, breed had a strong influence on cortisol (p less than 0.05), with Nubian does having higher concentrations regardless of treatment. Concentrations of hormones were not significantly correlated with behaviors. These findings suggest that frustration may elicit a discharge of NOR but not EPI.
Animals↗
An emotional component analysis of chronic pain.
The present study sought to determine the relative contribution of frustration, fear, anger and anxiety, to the unpleasantness and depression pain patients experience. Sixty-nine women and 74 men, with an average age of 47 years, were included. Patients underwent psychological evaluation which included use of the Minnesota Multiphasic Personality Inventory (MMPI), Beck Depression Inventory (BDI), and 7 visual analog scales (VAS) measuring degree of emotional unpleasantness, pain intensity, anxiety, frustration, fear, anger and depression. Test-retest reliability coefficients were significant for the negative feeling VAS yielding an average reliability coefficient of 0.82. Analyses relating the negative feeling state VAS to pain unpleasantness and depression indices from the MMPI (scale 2) and BDI (sum score) yielded significant canonical correlations. Multiple regression was used to clarify the relationships between negative feeling VAS, pain-related unpleasantness, and indices of depression. After statistically controlling for intensity of pain, anxiety and frustration predicted unpleasantness. Regression analyses indicate that anger is an important concomitant of the depression that pain patients experience. The results suggest that anger and frustration are critical concomitants of the pain experience. Treatment techniques specifically targeting anger and frustration in these patients may prove efficacious.
Adult↗
Contextual determinants of anger and other negative expressions in young infants.
Two experiments examined how different frustration contexts affect the instrumental and emotional responses of 4- to 5-month-old infants. Three different frustrating contexts were investigated: loss of stimulation (extinction), reduction in contingent stimulation (partial reinforcement), and loss of stimulus control (noncontingency). In both experiments, changes in arm activity and facial expressions of anger and sadness coded according to the Maximally Discriminative Facial Movement Coding System (MAX) were the measures of frustration. Both experiments showed that (a) arm responses increased when the contingent stimulus was lost or reduced but decreased when control of the stimulus was lost under noncontingency, (b) MAX-coded anger, but not MAX-coded sad or blends of anger and sad, was associated with frustration, and (c) the pattern of anger and arm responses varied with the frustration context. When contingent stimulation was lost or reduced, both anger and arm responses increased, but when expected control was lost under noncontingency, arm responses decreased while anger increased.
Anger↗
Aggression during competition: effects of age, sex, and amount and type of provocation.
Three experiments were designed to examine the expression of instrumental and hostile aggression by 6- to 10-year-old children during a competitive game. The rate at which a child pressed a button which allegedly interfered with his opponent's progress on the task was the measure of instrumental aggression. Pressing a second button presumably caused one's opponent to hear an aversive noise and served as the measure of hostile aggression. The task was designed in an attempt to isolate (a) frustration from attack as the instigator of aggression and (b) instrumental from hostile aggression as the desired outcome. In all three experiments the measures of instrumental and hostile aggression were generally highly correlated except under provocation conditions during which the number of attacks exceeded the number of frustrations. This suggested that the task was successful in tapping two different classes of aggressive responding. In Experiment 1 older children (N = 161 males and females) expressed more of both instrumental and hostile aggression than did younger children, and males were more aggressive than females on both measures. However, neither measure of aggression varied as a function of level of provocation. This finding was discrepant from the authors' previous research which had focused solely on instrumental aggression. Apparently, the introduction of attack and the opportunity for hostile responding changed the experimental situation. In order to focus more directly on this issue, Experiments 2 (N = 60 males) and 3 (N = 56 males) used various combinations of attack and frustration with 9- and 10-year-old males. Attack, prior to frustration, elicited the greatest amount of hostile aggression. Frustration, with no attack, resulted in the highest level of instrumental aggression. The complex relationship between these sources of provocation and instrumental and hostile aggression was discussed.
Age Factors↗
Aggression: its relation to desire and self-interest.
Aggression continues to be a problematic, ill-defined concept for most contemporary analysts. Questions about the nature and origin of aggression remain unanswered. On the one hand, aggression is conceived of as an instinctual drive; on the other, it is thought to originate as an instrument of reaction to external sources of frustration and environmental failures to meet developmental needs. Aggression has also been dichotomized as either the benign activity of assertiveness, or the darker destructive force of hostility, believed by many to arise from separate motivational systems. There is a problem with the view of aggression as largely an ad hoc reaction to deprivation or other environmental shortcomings leading to disappointment and frustration. This view understates the importance of the original expansive demands for pleasurable satisfaction made by the individual upon the environment. Desire itself seems to be responsible for an inward vulnerability to external sources of disappointment and frustration, so that what is not desired cannot be effectively frustrated. Though the prototypical object of aggression is taken to be an external source of frustration, danger, and narcissistic injury, the mobilization of aggression more accurately reflects a susceptibility to the disturbing pressure of psychic stimuli that are the inner desire for satisfaction. Aggression contributes its force to various constructive or destructive purposes, from love to mastery to vengeance. Its most immediate aims, primarily narcissistic, are not concerned with the needs of others. Aggression also makes important contributions to maintaining psychic equilibrium, to the psychic organization's stake in instinctual gratification, to ego function, and to superego operation.
Aggression↗
[Concept of external reality in Freud's works].
Three main functions of external reality (E.R.) relative to the subjecto may be mentioned. a) it is a source of stimulae that promote the structuring of te psychic apparatus. In this sense, E.F. is the place where this apparatus is charged and where it is discharged (specific action). b) it is a vehicle of gratification or frustration of necessity (Anaké). The satisfaction of necessity is gratifying, the lackof it is frustrating. c) it is the instance that heals or makes a person ill acording to its possibility of gratifying or frustrating the subject respectively. If we first take point a), we can examine the relationship between E.R. and internal (psychic) reality along the process of internalization of normal and pathologic experience. The author thinks Freud considers frustration as structuring of the psychic apparatus as long as it does not satisfy the person's needs or opposes the accomplishment of his desire. This complels the subject to recognize the existence of the external object. Also, whenfacing the external object the subject discovers his own self. Coinciding with this reognitions he tries to defend himself against it. In normal circustances the image of the external world is built by means of successive projections and introjections. The more sane the subject, the more faithfully and without distortions will he incorporate the external images. To be structuring, the frustrations must be encountered in adequate dose. If it is excessive there will be a distortion of the image due not only to projection but also to the defusion of instincts (defusion that takes place in the process of introjection of external figures). These distorted images of the external world coexist with various fantsies. But these fantasies are also marked by E.R. Even when the individual history of a subject does not give accont of this reality, there is a "filogenetic endowment" of fantasies that always recognize an external origin: they are the prehistoric fantasies. This hypothesis of the original fantasies is similar, in respect to their ontogenetic origin, to the innate ideas of Descartes and it is coherent with Freud's empirical point of view of those fantasies being perceptions in a filogenetic past. In this way Freud tries to give account both of the idealistic and the empiricist points of view about perception. If in genetic matters the interaction with the external world is primordial, in epigenetic matters Freud goes away from empericism of perception to propose the hypothesis of an internal reality, that differs from empericism of perception to propose the hypothesis of an internal reality, that differs from external material reality. But even in the psychotic process, in which the psychological reality is far apart from E.R., the former gets influenced by the latter...
Dreams↗
Personality adjustment of children and adolescents with hypopituitarism.
Sixteen children and adolescents with extreme short stature secondary to hypopituitarism were compared to a matched group of physically healthy peers on a variety of psychological tests assessing general adjustment, body image, sex role development, sex-related fantasy, and reactions to frustration. With the exception of their reactions to frustrations, the psychological adjustment of children with hypopituitarism compared favorably with that of normal children. Children with hypopituitarism typically perceived less adaptive, mature solutions to frustrating situations than did peers of average stature. Anticipatory guidance for children with extreme short stature might help facilitate more adaptive responses to the difficult and inevitable frustrations imposed by short stature. Evaluations of intervention directed toward the enhancement of coping skills and life adjustment of children with small stature due to hypopituitarism is seen as a focus for future research with this population.
Adaptation, Psychological↗
Patients' noncompliance and how doctors manage this.
The purpose of this study was to examine doctors' behavior towards patients' noncompliance and to explain it within the framework of frustration theory. Two groups of physicians participated. The first group of 30 was selected from a larger group, based on tape-recordings of patients' visits where obvious examples of noncompliance were found. The 63 physicians forming the second group were interviewed to discover their attitude/behavior towards noncompliance. The tactics observed in the first study group and reported by the second group were then analysed according to the same system of categories. In the second group RPFS (Rosenzweig Picture-Frustration Study) was also applied to find determinants of the doctors' behavior. In general, 11 different tactics were identified but only five were applied by more than 10% of doctors from either group. These were: medical threat (most frequently used in both groups) carrying the doctor's point in an indulgent atmosphere, authoritarian tactics, medical information, withdrawal. There were no significant differences between the groups as to the tactics used (i.e. no differences between observed and reported behavior), on the contrary, a positive correlation was found. The doctors applied certain tactics of doubtful effectiveness which might worsen the patient's emotional state or harm him as a person. On the other hand, many valuable techniques of proved efficacy were not used. When the doctors' tactics were interpreted within the framework of frustration theory as task-oriented or ego-defensive, it was found that in both groups the ego-defensive tactics predominated. The kind of tactics adopted towards noncompliance was strongly determined by the attitude towards frustration measured by RPFS (Kendall Q coefficient = 0.92).(ABSTRACT TRUNCATED AT 250 WORDS)
Defense Mechanisms↗
Infants' responses to arm restraint at 2 and 6 months: a longitudinal study.
This study examined the continuity, stability, and change of infants' responses to a frustrating event (i.e., arm restraint) between 2 and 6 months in terms of both negative reactivity and its regulation. Fifty-two healthy, full-term infants and their mothers participated in an arm restraint procedure. Infant behaviors were observed and coded at 3-s intervals. The results showed that infants' reactivity to frustration and their ability to regulate such reactivity significantly changed in level over time. Individual differences in frustration reactivity were stable across the two ages; two regulatory behaviors (i.e., orientation to mother and avoidance) could be observed in the same percentage of babies at both 2 and 6 months. At 6 months, several significant associations between frustration reactivity and infant regulatory behaviors emerged. These findings suggest that the arm restraint procedure may be usefully employed to study individual differences in infants as young as 2 months of age.
Attention↗
Frustation and learned helplessness.
This article reports the transfer of learned helplessness from one aversive motivator, shock to another, frustration. In experiment 1, animals were trained to approach food in a runway and concomitantly exposed to either escapable, inescapable, or no shock in a different situation. Extinction was conducted in the runway, and subsequently the animals were tested for hurdle-jump escape from the frustrating goal box. Inescapably shocked rats failed to learn to hurdle-jump, whereas escapably or nonshocked animals learned the frustration escape response. Experiment 2 replicated the basic finidngs of Experiment 1 and showed transfer of learned helplessness from shock to frustration when no running response had been first acquired in the runway.
Animals↗
Reactivity and regulation in children prenatally exposed to cocaine.
Children prenatally exposed to cocaine may be at elevated risk for adjustment problems in early development because of greater reactivity and reduced regulation during challenging tasks. Few studies have examined whether cocaine-exposed children show such difficulties during the preschool years, a period marked by increased social and cognitive demands and by rapid changes in reactivity and regulation. The authors addressed this question by examining frustration reactivity and regulation of behavior during a problem-solving task in cocaine-exposed and -unexposed preschoolers. Participants were 174 4.5-year-olds (M age = 4.55 years, SD = 0.09). Frustration reactivity was measured as latency to show frustration and number of disruptive behaviors, whereas regulation was measured as latency to approach and attempt the problem-solving task and number of problem-solving behaviors. Results indicated that cocaine-exposed children took longer to attempt the problem-solving task but that cocaine-exposed boys showed the most difficulties: They were quicker to express frustration and were more disruptive. Effect sizes were relatively small, suggesting both resilience and vulnerabilities.
Adaptation, Psychological↗
Adrenocortical and heterophil/lymphocyte responses to challenge in hens showing short or long tonic immobility reactions.
1. Adult White Leghorn hens showing short or long tonic immobility reactions were classified as low-fear (LF) or high-fear (HF) responders, respectively. Following cannulation, their adrenocortical responsiveness to ACTH administration and the effects of chronic frustration induced by thwarting of feeding on plasma corticosterone concentrations and heterophil/lymphocyte (H/L) ratios were measured at regular intervals. 2. ACTH injection elicited significant and similar mean increases in circulating corticosterone concentrations in both the LF and HF groups. 3. Absolute H/L ratios were higher in HF than in LF hens after cannulation, although both groups showed similar proportional increases from pre-operation ratios. 4. Plasma corticosterone concentrations and H/L ratios were significantly increased at 20 h and 44 h respectively after the frustration of feeding regime began. Thus, adrenocortical activation preceded increases in H/L ratios but, whereas the elevated plasma corticosterone concentrations found after 20 h remained virtually constant thereafter, H/L ratios rose progressively throughout the 68 h frustration period. 5. There were no significant differences between groups in their plasma corticosterone and H/L responses to frustration. However, a consistent trend towards greater adrenocortical activation was observed in the HF than in the LF hens.
Adrenal Cortex↗