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Download Comer, Abnormal Psychology, 8th edition
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Stress, Coping, and the Anxiety Response The state of stress has two components: Stress response – person's reactions to the demands Stressor – event that creates demands • Influenced by how we judge both the event and our capacity to react to the event effectively • People who sense that they have the ability and resources to cope are more likely to take stressors in stride and respond well Stress, Coping, and the Anxiety Response When we view a stressor as threatening, the natural reaction is arousal and fear Stress reactions, and the fear they produce, are often at play in psychological disorders Stress, Coping, and the Anxiety Response Stress and psychological disorders Acute stress disorder Posttraumatic stress disorder (PTSD) The DSM-5 lists these as “trauma and stressor-related disorders” Stress and physical (psychophysiological) disorders These disorders are listed in the DSM-5 under “psychological factors affecting medical condition” Stress and Arousal: The Fight-or-Flight Response The features of arousal and fear are set in motion by the hypothalamus Two important systems are activated: Autonomic nervous system (ANS) An extensive network of nerve fibers that connect the central nervous system (the brain and spinal cord) to all other organs of the body Endocrine system A network of glands throughout the body that release hormones Stress and Arousal: The Fight-or-Flight Response There are two pathways, or routes, by which the ANS and the endocrine system produce arousal and fear reactions: Sympathetic nervous system pathway Hypothalamic-pituitary-adrenal pathway Hypothalamus signals the pituitary gland, which stimulates the adrenal cortex to release corticosteroids – stress hormones – into the bloodstream The Autonomic Nervous System The Endocrine System Pathways of Arousal and Fear The Psychological Stress Disorders Acute stress disorder Symptoms begin within four weeks of event and last for less than one month Posttraumatic stress disorder (PTSD) Symptoms may begin either shortly after the event, or months or years afterward As many as 80% of all cases of acute stress disorder develop into PTSD The Psychological Stress Disorders Aside from the differences in onset and duration, the symptoms of acute stress disorders and PTSD are almost identical: Reexperiencing the traumatic event Avoidance Reduced responsiveness Increased arousal, anxiety, and guilt What Triggers a Psychological Stress Disorder? What Triggers a Psychological Stress Disorder? Combat and stress disorders As many as 29% of Vietnam combat veterans suffered acute or posttraumatic stress disorders Called “shell shock” or “combat fatigue” Post-Vietnam War clinicians discovered that soldiers also experienced psychological distress after combat An additional 22% had some stress symptoms 10% still experiencing problems A similar pattern is currently unfolding among veterans of wars in Afghanistan and Iraq What Triggers a Psychological Stress Disorder? Disasters and stress disorders Acute or posttraumatic stress disorders may also follow natural and accidental disasters Types of disasters include earthquakes, floods, tornadoes, fires, airplane crashes, and serious car accidents Because they occur more often, civilian traumas have been implicated in stress disorders at least 10 times as often as combat traumas What Triggers a Psychological Stress Disorder? Victimization and stress disorders People who have been abused or victimized often experience lingering stress symptoms Research suggests that more than one-third of all victims of physical or sexual assault develop PTSD Terrorism and torture The experience of terrorism or the threat of terrorism often leads to posttraumatic stress symptoms, as does the experience of torture Why Do People Develop a Psychological Stress Disorder? Clearly, extraordinary trauma can cause a stress disorder However, the event alone may not be the entire explanation Why Do People Develop a Psychological Stress Disorder? Biological and genetic factors Traumatic events trigger physical changes in the brain and body that may lead to severe stress reactions and, in some cases, to stress disorders Why Do People Develop a Psychological Stress Disorder? Personality factors Some studies suggest that people with certain personalities, attitudes, and coping styles are particularly likely to develop stress disorders Risk factors include: Preexisting high anxiety Negative worldview A set of positive attitudes (called resiliency or hardiness) is protective against developing stress disorders Why Do People Develop a Psychological Stress Disorder? Childhood experiences Researchers have found that certain childhood experiences increase risk for later stress disorders Risk factors include: An impoverished childhood Psychological disorders in the family The experience of assault, abuse, or catastrophe at an early age Being younger than 10 years old when parents separated or divorced Why Do People Develop a Psychological Stress Disorder? Social support People whose social support systems are weak are more likely to develop a stress disorder after a traumatic event Why Do People Develop a Psychological Stress Disorder? Multicultural factors There is a growing suspicion among clinical researchers that the rates of PTSD may differ among ethnic groups in the US It seems that Hispanic Americans might be more vulnerable to PTSD than other cultural groups Possible explanations include cultural beliefs systems about trauma and the cultural emphasis on social relationships and social support Why Do People Develop a Psychological Stress Disorder? Severity of the trauma Generally, the more severe the trauma and the more direct one's exposure to it, the greater the likelihood of developing a stress disorder Especially risky: Mutilation and severe injury; witnessing the injury or death of others How Do Clinicians Treat the Psychological Stress Disorders? About half of all cases of PTSD improve within 6 months; the remainder may persist for years Treatment procedures vary depending on type of trauma General goals: End lingering stress reactions Gain perspective on painful experiences Return to constructive living Treatment for combat veterans How Do Clinicians Treat the Psychological Stress Disorders? Drug therapy Antianxiety and antidepressant medications are most common Reduce specific symptoms, increase overall adjustment Behavioral exposure techniques Use flooding and relaxation training Use eye movement desensitization and reprocessing (EMDR) Insight therapy Often use couple, family, or group therapy formats; rap groups Bring out deep-seated feelings, create acceptance, lessen guilt How Do Clinicians Treat the Psychological Stress Disorders? Psychological debriefing A form of crisis intervention that has victims of trauma talk extensively about their feelings and reactions within days of the critical incident Four-stage approach: Normalize responses to the disaster Encourage expressions of anxiety, anger, and frustration Teach self-help skills Provide referrals The Physical Stress Disorders: Psychophysiological Disorders In addition to affecting psychological functioning, stress can also have great impact on physical functioning The Physical Stress Disorders: Psychophysiological Disorders Psychophysiological (psychosomatic) disorders: disorders in which biological, psychological, and sociocultural factors interact to cause or worsen a physical illness. Early versions of the DSM labeled these illnesses psychophysiological, or psychosomatic, disorders DSM-5 also labels them as psychological factors affecting medical condition Psychological Factors Affecting Medical Condition 1. The presence of a general medical condition. 2. Psychological factors adversely affecting the general medical condition in one of the following ways: • (a) Influencing the course of the general medical condition. • (b) Interfering with the treatment of the general medical condition. • (c) Posing additional health risks. • (d) Stress-related physiological responses precipitating or exacerbating the general medical condition. Psychological Factors Affecting Medical Condition Traditional Psychophysiological Disorders Ulcers Asthma • Lesions in the wall of the stomach that result in burning sensations or pain, vomiting, and stomach bleeding • Experienced by over 25 million people at some point in their lives • Causal psychosocial factors: • Environmental pressures, intense feelings of anger or anxiety • Bacterial infection • A narrowing of the body's airways that makes breathing difficult • Affects up to 25 million people in the U.S. each year • Causal psychosocial factors: • Environmental pressures or anxiety • Allergies, a slow-acting sympathetic nervous system, weakened respiratory system Traditional Psychophysiological Disorders Insomnia • Difficulty falling asleep or maintaining sleep • Affects 10% of people in the U.S. each year • Causal psychosocial factors: • High levels of anxiety or depression • Overactive arousal system, certain medical ailments Chronic headaches • Frequent intense aches of the head or neck that are not caused by another physical disorder • Tension headaches affect 45 million Americans each year • Migraine headaches affect 23 million Americans each year • Causal psychosocial factors: • Environmental pressures; general feelings of helplessness, anger, anxiety, depression • Abnormal serotonin activity, vascular problems, muscle weakness Traditional Psychophysiological Disorders Hypertension Coronary heart disease • Chronic high blood pressure, usually producing few outward symptoms • Affects 75 million Americans each year • Causal psychosocial factors: • Constant stress, environmental danger, general feelings of anger or depression • 10% caused by physiological factors alone • Obesity, smoking, poor kidney function, high proportion of collagen (rather than elastic) tissue in an individual's blood vessels • Caused by blockage in the coronary arteries • The term refers to several problems, including myocardial infarction (heart attack) • Nearly 18 million people in the US suffer from some form of coronary heart disease • It is the leading cause of death in men older than 35 years and women older than 40 • Causal psychosocial factors: • Job stress, high levels of anger or depression • High level of cholesterol, obesity, hypertension, the effects of smoking, lack of exercise Traditional Psychophysiological Disorders A number of variables contribute to the development of psychophysiological disorders, including: Biological factors Psychological factors Sociocultural factors Needs, attitudes, emotions, or coping styles may cause people to overreact repeatedly to stressors – increasing their chances of developing psychophysiological disorders Sociocultural factors Defects in the autonomic nervous system (ANS) are believed to contribute to the development of psychophysiological disorders Other more specific biological problems may also contribute Psychological factors Biological factors Traditional Psychophysiological Disorders Adverse social conditions may set the stage for psychophysiological disorders New Psychophysiological Disorders Since the 1960s, researchers have found many links between psychosocial stress and a wide range of physical illnesses In recent years, more and more illnesses have been added to the list of psychophysiological disorders New Psychophysiological Disorders Are physical illnesses related to stress? The development of the Social Adjustment Rating Scale in 1967 enabled researchers to examine the relationship between life stress and the onset of illness Using the Social Adjustment Rating Scale, studies have linked stressors of various kinds to a wide range of physical conditions Overall, the greater the amount of life stress, the greater the likelihood of illness Social Adjustment Rating Scale does not take into consideration the particular stress reactions within specific populations Psychoneuroimmunology Psychoneuroimmunology - the relationship between stress and infection Psychoneuroimmunology The immune system identifies and destroys antigens (foreign invaders, such as bacteria) and cancer cells Lymphocytes - white blood cells that circulate through the lymph system and the bloodstream, attacking invaders Helper T-cells, natural killer Tcells, and B-cells Psychoneuroimmunology Biochemical activity • Stress leads to increased activity by the sympathetic nervous system, including a release of norepinephrine • Endocrine glands reduce immune system functioning during periods of prolonged stress through the release of corticosteroids Behavioral changes • Stress may set in motion a series of behavioral changes – poor sleep patterns, poor eating, lack of exercise, increase in smoking and/or drinking – that indirectly affect the immune system Psychoneuroimmunology Personality style • An individual's personality style (including their level of optimism, constructive coping strategies, and resilience) experience better immune system functioning and are better prepared to fight off illness Social support • People who have less social support and feel lonely seem to display poorer immune functioning when stressed than people who do not feel lonely • Studies have found that social support and affiliation with others may actually protect people from stress, poor immune system functioning, and subsequent illness, and can help speed up recovery from illness or surgery Psychological Treatments for Physical Disorders Behavioral medicine - the field of treatment that combines psychological and physical interventions to treat or prevent medical problems Psychological Treatments for Physical Disorders Relaxation training Relaxation training can help prevent or treat medical illnesses that are related to stress People can be trained to relax their muscles at will, a process that sometimes reduces feelings of anxiety • Often used in conjunction with medication in the treatment of high blood pressure • Often used alone to treat chronic headaches, insomnia, asthma, pain after surgery, certain vascular diseases, and the undesirable effects of cancer treatments Psychological Treatments for Physical Disorders Biofeedback Patients given biofeedback training are connected to machinery that gives them continuous readings about their involuntary bodily activities • Somewhat helpful in the treatment of anxiety disorders, this procedure has been used successfully to treat headaches and muscular disabilities caused by stroke or accident • Some biofeedback training has been effective in the treatment of heartbeat irregularities, asthma, migraine headaches, high blood pressure, stuttering, and pain Psychological Treatments for Physical Disorders Meditation Meditation is a technique of turning one's concentration inward and achieving a slightly changed state of consciousness Although meditation has been practiced since ancient times, Western health care professionals have only recently become • Meditation has been used to aware of its effectiveness in manage pain, treat high blood pressure, heart problems, relieving physical distress insomnia, and asthma Psychological Treatments for Physical Disorders Hypnosis Individuals who undergo hypnosis are guided into a sleeplike, suggestible state during which they can be directed to act in unusual ways, to remember unusual sensations, or to forget remembered events • With training, hypnosis can be done without a hypnotist (self-hypnosis) Psychological Treatments for Physical Disorders Cognitive interventions People with physical ailments have sometimes been taught new attitudes or cognitive responses as part of treatment • One intervention is stress inoculation training, in which patients are taught to rid themselves of negative selfstatements and to replace these with coping selfstatements Psychological Treatments for Physical Disorders Emotion expression and support groups If negative psychological symptoms (e.g., depression, anxiety) contribute to a person's physical ills, intervention to reduce these emotions should help reduce the ills These techniques have been used to treat a variety of illnesses including HIV, asthma, cancer, headache, and arthritis Psychological Treatments for Physical Disorders Combination approaches Studies have found that the various psychological interventions for physical problems tend to be equal in effectiveness Psychological treatments are often of greatest help when they are combined and used with medical treatment
