Download Stress and Physical and Mental Health

Stress and Physical and
Mental Health
Chapter 5
Introduction
Daily stress causes
negative
consequences on
physical and mental
health. Sometimes,
even leisure activities
can be stressful.
Introduction
A loss of the Superbowl
in the city of the team
that lost has an
increase in heart
attacks and death
over the next two
weeks.
Introduction
How are you affected
by stress?
How does it affect you
physically?
Introduction
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Health psychology – is concerned with
the effects of stress and other
psychological factors in the
development and maintenance of
physical problems.
Behavioral medicine – this field is
concerned with psychological factors
that may predispose an individual to
medical problems. Stressful life events,
certain personality traits, coping styles,
and a lack of social support are
included in these factors. This field also
addresses the effects of stress on the
physical body, including the immune,
endocrine, gastrointestinal, and
cardiovascular systems.
Introduction
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The role that stress can play in
triggering the onset of mental
disorders in vulnerable people
is explicitly acknowledged in
the diathesis-model.
Exposure to extreme and
traumatic stress may
overwhelm coping
mechanisms of otherwise
apparently healthy people,
leading to mental disorders
such as post-traumatic stress
disorder (PTSD).
What is stress?
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Many personal and
environmental obstacles get
into the way of our lives. We
may be rejected by
someone we love. We may
not have enough money.
These are all obstacles
within people's lives.
When we experience or
perceive challenges to our
physical and emotional wellbeing that exceed our
coping resources, this is
generally referred to as
stress.
What is stress?
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Stressors – external demands
Stress – the effects stress creates
within the organism
Coping strategies – the efforts to deal
with stress
All situations that require adjustment
can be considered stressful. The word
stress used to be used by engineers.
Hans Selye (a Canadian physician
and endocrinologist) used the word to
describe the difficulties and strains
experienced by living organisms as
they struggled to cope with and adapt
to changing environments.
What is stress?
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Selye's work provided the
foundation for current stress
research.
Selye also stated that stress
could occur in negative as
well as positive situations.
Both types of stress can tax
a person's resources and
coping skills, although bad
stress (distress) typically
has the potential to do more
damage. Stress can come in
the form of continuous force
and not always happens in
one moment bursts.
Stress and the DSM
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The relationship between
stress and psychopathology
is so important that stress is
recognized in diagnostic
formulations.
This is definitely noted in
PTSD. The old DSM used to
look at acute stress
disorders and chronic stress
disorders. These disorders
involve patterns of
psychological and
behavioral disturbances that
occur in response to
identifiable stressors.
Factors Predisposing a Person to
Stress
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Everyone has stress and different
people interpret that stress
differently. No two people have the
exact same stressors in their lives.
Some people will develop longterm problems given stress.
Children are very vulnerable to the
stressors of war and terrorism.
Adolescents are vulnerable to
parents that are depressed.
Those with higher levels of
optimism, greater psychological
control and mastery, increased,
self-esteem, and better social
support tend to do better with
additional stress.
Factors Predisposing a Person to
Stress
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There is a gene that can predispose that a
person will become depressed trying to face
life's stress.
The amount of stress that we are exposed to
early in life may also determine whether or not
we are able to deal with stress. Each stressor
could make us more vulnerable to future
stress.
Animals that have experienced a stressful time
tend to produce more stress creating hormone
called cortisol.
Stress tolerance – refers to a person's ability to
withstand stress without becoming seriously
impaired. Stress can change how we think
about what happens to us. Those with
depression tend to have a more negative
experience with negative events.
Characteristics of Stressors
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Human beings definitely know
which stressors are more
dangerous than others. The
key to stressors is: 1) the
severity of the stressor, 2) how
long it lasts, 3) its timing, 4)
how closely it affects our own
lives, and 5) how controllable it
is.
The death of a loved one, a
divorce, a job loss, a serious
illness, or negative social
exchanges – tend to be
extremely stressful for people.
Stressors have cumulative
effects.
Characteristics of Stressors
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Encountering many stressors at the
same time is very difficult. The
more closely involved the individual
is given the stressful situation, the
more it will impact them.
Events that are unpredictable and
unanticipated and will cause severe
stress. Given realistic expectations
about the event will help the
person. Those that know what is
going to happen are generally less
anxiety-ridden about the event.
With a bad stressor, there is no
way to avoid or run away from
severe situations.
The Experience of Crisis
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Most of us experience
occasional periods of acute
stress (sudden and intense)
stress. The term crisis – is
when a stressful situation
threatens to exceed or
exceeds the adaptive
capacities of a person or a
group.
Crisis is not usually helped by
coping mechanisms. A
traumatic situation overwhelms
a person's ability to cope with
the event.
Measuring Life Stress
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Even being promoted in a job brings
new demands to a person, which
means stress. This stress can bring
problems to those with bipolar
disorder or others disorders that do
not deal well with change.
An LED (Life Event and Difficulty
Schedule) is an interview-based
survey that looks at acute and
chronic forms of stress and comes
with a manual. It can take into
account a person's unique life
circumstances. Interviews take more
time and money to administer, but
they are more reliable given the
research than other methods.
Resilience
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After going through a traumatic
experience, some people do quite well
in the following weeks and months.
This kind of healthy psychological and
physical functioning after the event are
called resilience. There is no single
factor that improves resilience. This is
linked to resources and different
characteristics.
Being male, older, and being welleducated tends to give individuals
more resilience. Having more
economic resources is also important.
Economics plays a huge role in this.
Resilience
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Those individuals that can stay
positive or look at the positive
aspects of the situation tend to
deal much better with
situations.
Trying to find meaning,
constantly going over the
situation, and being negative
about it does not tend to bring
about positive aspects.
Those that tend to be overly
positive and see themselves as
better than what they might be,
tend to do much better in
traumas.
Stress and the Stress Response
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The sympathetic adrenomedullary (SAM) system – is designed to
mobilize resources and prepare for the fight-or-flight response.
The stress response begins in the hypothalamus, which stimulates the
sympathetic nervous system (SNS). This causes the inner portions of
the adrenal glands to secrete epinephrine and non-epinephrine. These
cause an increase in heart rate. The body metabolizes glucose more
rapidly.
The second system is called the hypothalamus-pituitary-adrenal (HPA)
system. This releases a hormone called “corticotrophin-releasing
hormone”. This stimulates the pituitary gland. The pituitary then
secretes adrenocorticotrophic hormone (ACTH). This tells the adrenal
cortex to produce stress hormones called glucocorticoids. This stress
hormone is called cortisol. This is a good hormone to have in an
emergency. It inhabits the body's immune system, which means the
inflammatory response is delayed. This means escape has priority over
healing. This is why cortisol injections are made to reduce inflammation
in damaged joints.
Stress and the Stress Response
There is a downside to cortisol,
though. If the cortisol is not shut
off, it can cause brain cell
damage, especially in the
hippocampus.
At every level, stress is bad for
your brain. The brain has no
receptors to detect cortisol.
The Biological Cost of Stress
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The biological cause of adapting to
stress is called the allostatic load.
When we are stressed and feeling
pressured, our allostatic load is high.
Stress is becoming the underlining
theme in virtually all physical
illnesses.
Daily stressors are also important to
note such as commuting, unexpected
work deadlines, or even computer
problems can cause stress. When a
virus enters the body and the person
has stress, it is thought that the
body's immune system will be
lessened and not be able to fight off
the virus.
The Mind Body Connection
Psychoneuroimmunology – is the study
of the interaction of the immune
system and the nervous system. The
nervous system and the immune
system communicate on a regular
basis.
The immune system is also influenced by
the brain as the immune system also
influenced the brain. A person's
behavior and psychological state
definitely impact the immune system.
Glucocorticoids can cause stressinduced immunosuppression. This can
be adaptive (escape first, heal later).
Long-term stress can create problems
for the future.
Understanding the Immune System
The word “immune” comes from the
Latin word “immunis”, which means
“exempt”. The immune system
protects the body from such things
as viruses and bacteria. If the
immune system is too strong and
unselective, it can turn on the body's
own healthy cells.
If the immune system is too weak, it
cannot function effectively and the
body gets hit by viruses and
bacteria.
Lupus and Rheumatoid Arthritis are
examples of autoimmune diseases
where the immune system attacks
the person.
Understanding the Immune System
The front line of defense within the immune system is
the white blood cells. These are called the
leukocytes (or lymphocytes), which are produced
in the bone marrow and then stored in various
places in the body including the spleen and the
lymph nodes.
There are two types of leukocytes – 1) B-Cells – (in
bone marrow) produces specific antibodies that
are supposed to respond to different antigens.
Antigen – are foreign bodies such as viruses and
bacteria, as well as internal invaders such as
tumors and cancer cells.
2) T-cell – (which matures in the thymus, which is
important to the endocrine gland), and is
stimulated when the immune system signals an
attack. They multiple rapidly along with B Cells to
counterattack.
Understanding the Immune System
T-Cells circulate through the blood and
lymph systems in an inactive form.
Each T-Cell has a receptor on its
surface that recognizes one specific
type of antigen.
The T-Cells become activated when
immune cells called macrophages
detect antigens and start to engulf
and digest them. To activate the TCells, the macrophages release a
chemical known as interleukin-1.
Interleukins are a class of chemicals
called cytokines.
Cytokines – are chemical messengers
that appear to be crucially important
to health.
Understanding the Immune System
B-Cells – are much different in
structure than the T-Cells.
When a B-Cell recognizes an
antigen, it begins to divide and
to produce antibodies that
circulate in the blood. This
process is facilitated by
cytokines that are released by
the T-cells. If the antigen ever
appears in the future, it will be
attacked sooner because there
is a memory of it.
Stress, Depression, and the Immune
System
Stress slows the healing of
wounds by as much as 24-40%.
This is because stress is linked
to suppression of the immune
system. Sleep deprivation,
marathon running, space flight,
and being a caregiver, or the
death of a spouse are linked to
immunosuppression.
There is a small amount of
evidence that laughter can be
associated with enhanced
immune functioning. The
immune system can go back to
normal once the stress is gone.
Stress, Depression, and the Immune
System
Depression is associated with a
compromised immune system.
Chronic stress and depression may
trigger the production of
proinflammatory cytokines such as
interleukin-6.
One study showed that women that
were caring for family members with
Alheimer's disorder had higher levels
of IL-6. Age of the woman did not
seem to matter.
Treatment with antidepressants can
lower this level. Those that went to
church seemed to have lower levels
of IL-6.
Cardiovascular Disease
Cardiovascular disease
is the leading cause
of death within the
United States. The
impact of stress on
the heart is well
researched.
Hypertension
When we are stressed, the blood
vessels supplying our internal
organs constrict (become more
narrow) and blood flows in
greater quantity to the muscles of
the trunk and limbs. When this
happens, the heart must work
harder.
When the pulse quickens, the blood
pressure increases. When the
pressure decreases, the blood
pressure goes back to normal.
If there is emotional strain, high
blood pressure may be a problem
through the life.
Hypertension
Ideally, blood pressure should be below
120/80. The first number is the
systolic pressure when the heart
contracts. The second is the diastolic
or between-beat pressure.
The definition of hypertension is having
a persisting blood pressure of 140 or
more and a diastolic of 90 or more.
Blood pressure increases as we age. In
younger adults, more young men
suffer from high blood pressure. After
the age of 50, hypertension is greater
in women. Menopause amplifies the
stiffness of the arteries. Sustained
hypertension affects about 28% of the
population in the U.S.
Hypertension
Essential hypertension – having no
specific cause for the disorder.
Hypertension is an insidious disorder
and very dangerous. The person
that has it may not know it until
medical complications come up.
Hypertension increases the risk of
coronary heart disease and stroke.
There are theories that not being able
to express anger in certain ways or
trying to communicate with
someone that is often angry, might
also bring about cardiovascular
problems.
Hypertension and African Americans
African Americans have much higher
hypertension levels than do European
Americans (40% versus 27%). Their
death rate is also three times higher.
This is not just in the U.S., but
throughout the world.
High blood pressure in young people is
also alarming. 10% of African
American men 18-21 years of age
have hypertension as compared to 12% in other groups. This could be
because of the environment that some
young Blacks live in. Exercise is also
an issue with women and men
because sometimes the neighborhood
is not okay or safe to walk through.
Hypertension and African Americans
Fast food may also be a potential reason why
more African Americans have hypertension.
African American retain sodium at higher
rates than do other groups. This results in
fluid retention and endocrine changes and
that in turn changes blood pressure.
Renin (an enzyme produced in the kidneys) is
linked to blood pressure and is also
processed differently by African Americans.
Studies also suggest that nitric oxide (a
dissolved gas that is crucial for the
functioning of blood vessels and blood cells)
is produced in lower levels in the blood
vessels of African Americans and may be
destroyed quite easily.
Coronary Heart Disease
The heart is a pump made of muscle.
Coronary heart disease (CHD) is a
potentially lethal blockage of the arteries
that supply blood to the heart muscle, or
myocardium. If the muscles of the heart
are not getting enough oxygenated
blood, the person may experience chest
pains. This is a sign that oxygen is not
getting to the heart and that this organ is
being overworked.
An even more severe problem is
myocardial infarction. This means there
is a blockage in a section of the coronary
arterial system. Because the heart
muscle is deprived of oxygen, tissue
may die, permanently damaging the
heart. If the damage is extremely
extensive the person may not survive.
Coronary Heart Disease
In many instances of cardiac
arrest, the victim might not have
had any history of CHD or
symptoms. There is a silent
CHD. This generally happens
when plague adheres to arterial
walls and it breaks loose and
heads into a smaller vessel,
blocking it.
Every year, more than 900,000
people in the United States
experience a myocardial
infarction.
Risk and Causal Factors in
Cardiovascular Disease
Stress increases the risk of having a heart
attack. Death from CHD rise after an
earthquake in an area.
Those that have stress in their job and have
little control over the decision making are
at risk of a heart attack. For workers,
most heart attacks occur on Monday.
Smokers are also more at risk for CHD.
Getting asked to give a speech can
increase the risks.
Mental stress is known to raise systolic
blood pressure and can cause elevation
given epinephrine. Mental stress can
reduce the oxygen within the heart
muscle.
Personality
The Type A behavioral pattern – is characterized
having an obsessive competitive drive, extreme
commitment to work, impatience or time urgency,
and hostility. Type A personality has been linked
to a 2-fold increase in coronary arterial disease
and an 8-fold increase in continued CHD. It is
specifically the hostility portion of the Type A
personality that is directly linked to coronary heart
disease.
Type D personality (the “distressed” personality”) - is
a person that has a tendency to experience
negative emotions and to feel anxious and
insecure. Men that had this personality trait were
more likely to have a fatal heart attack within 5
years as compared to those that did not have this
personality. These individuals tend to have more
problems after surgery.
Depression
People with heart disease are
three times more likely to have
depression. Depression is more
likely to be found with these
individuals than with others that
have major health problems.
Those that have a heart attack
that also have depression are
more likely to die within the next
five years than those that do
not have it.
Depression may also be a risk
factor in developing CHD.
Anxiety
There is a link between phobic
anxiety and an increased risk of
sudden cardiac death. Sudden
cardiac death is six times
higher in the men with the
highest levels of anxiety.
Social Isolation and Lack of Social
Support
Monkeys that are caged alone
have four times more
atherosclerosis (blockage of the
arteries of the heart) than do
monkeys that are caged with
other monkeys.
People that consider themselves
to have a small network of
social support are at a higher
risk of CHD. If an individual has
already had a heart attack and
now lives alone...the chance of
that person having a heart
attack is three times more likely
within the next 5 years.
The Importance of Emotional
Regulation
Given this information, would it be beneficial to attempt to
regulate your own emotions? Yes!
Those individuals that have the least control over their emotions
were the ones that seemed to be at the most risk of developing
heart problems.
Self-regulation skills are important in order to stay healthy.
Treatment of Stress Related
Physical Disorders
For those individuals that already have serious disease, they may have to
have medical intervention or take pills so that their blood does not clot as
regularly.
Because of the link of depression with CHD, it is very important to treat
depression early. Most people with depression go untreated.
Physicians also fail to treat depression in their CHD patients. They tend to
think it is a normal reaction to a medical scare. Thousands of lives could
be saved by providing antidepressants to those that have had cardiac
problems. In this case, cognitive behavioral therapy alone does not
reduce the risk of future cardiac arrests.
Psychological Interventions
Talking about or writing about one's
feelings does seem to be an
effective way of coping with
problems within one's life.
In a group of RA sufferers, those that
wrote about their feelings toward
the disease had less physical
dysfunction than others. For those
that are asked to write emotional
disclosures, there is an initial
distress, but show improvement
with their medical follow-ups. This
may help because they are
“blowing off steam”. It may also
help people to rethink their
problems.
Biofeedback
Biofeedback is a way to make
patients aware of their blood
pressure, level of muscle
tension, or heart rate. This
means hooking the person to a
machine that tells them when
they are relaxing and when
those items are going back up.
This machine is especially useful
for people that have
headaches. After 11 sessions,
people are much more aware of
how to relax and slow down
these biological activities.
Relaxation and Meditation
Researchers have studied various
relaxation techniques in regards
to stress. The results have
been encouraging. Relaxation
techniques have helped with
hypertension. It can also help
those that suffer from tension
headaches.
Daily meditation can also reduce
blood pressure pretty
significantly. The difficult part is
getting someone to do this.
Cognitive-Behavioral Therapy
CBT has been an important
intervention for those that suffer
from chronic headaches.
Children with recurrent stomach
pains were helped with family
therapy and not one-to-one
therapy. CBT has also been
used for RA patients.
Those that receive CBT tend to
have better physical, social,
and psychological functioning.
Sometimes, just slowing down life
helps to make things better.
Psychological Reactions to Stress
Adjustment Disorder
Adjustment disorder – is a psychological response to a common stressor (divorce, death,
the loss of a loved one, etc.) that results in clinically significant behavioral or emotional
symptoms. It can be one stressor such as going away to college or two stressors –
divorce and starting a new job.
Someone that is experiencing a level of stress that they do not have coping strategies for
may have an adjustment disorder. Symptoms must begin within three months of the
stressor. The person must experience more stress than what is normal given other
people in the same situation. The person's symptoms disappear when they adjust to
the stressor. Adjustment disorder must be changed to some other mental illness if it
goes beyond 6 months. A label of adjustment disorder is one of the mildest labels one
can be given.
Adjustment Disorder because of
Unemployment
Since the recent recession, millions of Americans have been dealing with
chronic unemployment.
Unemployment reached a peak in 2010 in January at 10.6%. In almost
every community, there are people who have been at jobs for years that
were let go. They may also be facing the end of their unemployment
compensation.
Unemployment is especially difficult for young minority males, many of
whom live in a permanent economic depression with few job prospects.
Rates of unemployment for blacks are twice as high as compared to
whites. Suicide can become more of a risk the longer someone is out of
work. Children that live in families where one parent is unemployed is
very difficult.
Adjustment Disorder caused by
Divorce or Separation
The deterioration of a relationship or a
divorce is extremely stressful and many
seek psychological treatment.
Divorce can be difficult because people
feel that they have failed at something.
Another difficulty is explaining why the
relationship ended to families and
friends. There is generally a loss of
friendships. There also tend to be
economic problems. When children are
involved, there tend to be court-battles,
custody issues, living and visit
arrangements, etc. Adjustment to single
life may be difficult as it may become
lonely. New friendships need to be
made. Many seek counseling when they
are going through a divorce.
Post-Traumatic Stress Disorder
(PTSD)
Generally, PTSD is seen as an anxiety disorder. This is
because the disease has aspects of apprehension
and fear. Major stress is the characteristic that
brings about the development of PTSD.
PTSD first entered the DSM in 1980. At the time,
psychologists and psychiatrists were noticing that
there were many veterans who were permanently
emotionally scarred and could not return to normal
life, especially after Vietnam.
In the past PTSD was viewed as a normal response to
an abnormal stressor. Traumatic stressors may
include: combat, rape, being confined to a
concentration camp, and experiencing a natural
disaster. Symptoms of the stress of experiencing
these traumas will usually reduce over time. About
95% of women that have been raped show
symptoms of PTSD within two weeks of the assault.
After 3 months, this had dropped to 45.9%.
Acute Stress Disorder
When symptoms develop shortly
after the trauma and last for at
least two days, this is known as
Acute Stress Disorder. This
means that the person does not
have to wait a whole month
(like those with PTSD) to get
help. If the symptoms do stay
for over a month, the label can
be changed to PTSD. Early
intervention is key in these
scenarios. Other psychological
disorders can exist with these
disorders.
Clinical Description
In PTSD, there is a psychological memory
that is at the center of the characteristic
clinical symptoms. These memories
are brief fragments of the experience
and often concern events that
happened just before the moment with
the largest emotional impact. The main
features of PTSD include:
1) Recurrent reexperiencing of the
traumatic event through nightmares or
intrusive memories.
2) Avoidance of stimuli associated with
the trauma and emotional numbing.
3) Increased arousal, which may involve
insomnia, the inability to tolerate noise,
and an excessive response if startled.
Prevalence of PTSD within the
General Population
The lifetime prevalence rate of
PTSD within the U.S. Is 6.8%.
PTSD is higher in women than
in men. 9.7% of women and
3.6% of men will develop this
disorder. Sex differences could
be the reason why there is such
a difference (rape).
Rates of PTSD after Traumatic
Experiences
There are many types of events that could
cause PTSD. For example, there are about
900 earthquakes a year. There are also
tsunamis, hurricanes, tornadoes, and
floods. Traumatic events that are brought
about by humans (like rape) tend to be
more traumatic than those that are brought
by the weather or the Earth.
Humans that do horrible things are very hard
to understand. These can destroy human
being's sense of safety. PTSD is higher if
the person was directly exposed to the
trauma or not. This can range from 30-40%
of the individuals that are exposed. Rescue
workers can even come back with PTSD
from trying to help in a situation.
The Trauma of Military Combat
In a combat situation where the
continual threat of injury or
death and repeated narrow
escapes, a person's ordinary
coping skills are relatively
useless.
Combat brings a constant fear,
unpredictability, many
uncontrollable circumstances,
and unnecessary killing. There
are also separations from loved
ones, reductions in personal
freedoms, sleep deprivation,
and harsh climate conditions,
and increased risk of disease.
The Trauma of Military Combat
For many that have been in war,
the trauma can last months or
years afterward. After WWI,
psychological trauma was
called, “shell shock” and it was
thought that organic conditions
produced by minute brain
hemorrhages. Only a small
percentage of these cases had
physical injury, though.
During WWII, traumatic reactions
were known as operational
fatigue and war neurosis. After
WWII, combat exhaustion was
the greatest single cause of the
loss of personnel.
Iraq and Afghanistan
Over 2 million members of the Armed
Forces have been deployed to Iraq
and Afghanistan. The military have
had to live under dangerous
conditions and severe threat. 92% of
soldiers said that they had been
ambushed or have seen combat.
86% said they know someone that
was killed or seriously injured.
Mental health is now a major
concern with our soldiers.
21.8% have now been diagnosed with
PTSD and 17.4% have been
diagnosed with depression. This may
be because some units have been
called upon 3-4 times to go to war.
Iraq and Afghanistan
In 2006, media questioned
whether or not military
psychiatrists were sending unfit
persons into the war. The
Department of Defense did not
get enough psychological help
for those soldiers that did come
back. There are also soldiers
that have multiple checking
behaviors.
There has been a greater rate of
soldier suicide as well. From
2005-2009, more than 1100
members of the Armed Forces
committed suicide. That is 1
suicide every 36 hours. Most
were self-inflicted gun wounds.
Prisoners of War and Holocaust
Survivors
One of the most traumatic events that a
soldier can be put through is being a
prisoner of war. About 40% of American
prisoners in Japanese POW camps
during WWII died during their
imprisonment.
Many survivors of Nazi concentration camps
sustained residual organic and
psychological damage, along with
lowered stress of any kind. The
symptoms that they experienced
included: anxiety, insomnia, headaches,
irritability, depression, nightmares,
impaired sexual potency, and diarrhea.
The camps had inadequate nutrition and
serious infectious diseases.
Prisoners of War and Holocaust
Survivors
Even when prisoners of war did
not show much psychological
damage, they still showed little
resistance to physical illness,
dependence on drugs and
alcohol, low frustration
tolerance, and irritability.
½ of all POW's met the criteria for
PTSD. The death rate of these
individuals is higher even after
release.
One of the worst things to live
through is torture put upon you
by another human being.
Causal Factors of Post-Traumatic
Stress Disorder
Not everyone that is exposed to a traumatic event will develop PTSD.
There is a close relationship between the total number of people
killed and wounded and the number of psychiatric casualties in
war. Those who viewed killing or were responsible for killing had
higher rates of PTSD.
Individual Risk Factors
Certain occupations (a soldier, a
firefighter, etc.) carry more risk
of a person developing PTSD
from seeing or being involved in
some sort of trauma.
Being male, having less college
education, having had conduct
disorder in childhood, having a
family history of psychiatric
disorders, and scoring high on
tests of neuroticism put
individuals at a higher risk of
PTSD.
Black Americans are more at-risk
for PTSD than are White
Americans.
Individual Risk Factors
Good cognitive abilities tend to put
individuals at a lower risk for PTSD.
People with higher cortisol levels do not
seem to be at a higher risk for PTSD.
Individuals that are predisposed to
depression (within the genes) might
be vulnerable to an increased risk of
PTSD.
The hippocampus seems to be smaller
in the brain of individuals with PTSD.
This portion of the brain is involved
with memory. The brain abnormalities
found with PTSD are also found with
depression so it is hard to know what
is affecting the PTSD.
Sociocultural Factors with PTSD
Being a member of a minority group seems to put people at-risk for PTSD.
Having an unsupported social environment also increases the risk of PTSD.
If an individual is a soldier, whether or not they are at-risk of PTSD depended
upon whether they understood why they were going to war and putting
their own life on the line. Combat stress control teams provide counseling
to troops at war. There are also “safe” areas where troops can have air
conditioning, regular mail delivery and good food. Access to the Internet
has definitely made a difference in troop morale.
Long-Term Effects of PostTraumatic Stress
Some soldiers that seemed to do
well during deployment and
abroad are now developing
PTSD at home. Devastating
feelings of guilt seem to go
along with killing other people
as well as surviving when
friends did not (survivor's guilt).
Delayed onset PTSD is very rare,
though. These are more
common with Vietnam Vets.
Prevention and Treatment of Stress
Disorders
One way to prevent PTSD is to reduce the
number of traumatic events in a person's
life. Changes in the law might help this.
Preparing people in advance for disaster and
teaching coping skills might also help
prevent stress disorders.
When a traumatic event occurs, police tend
to deal with it much better than volunteers
or civilians.
Stress-inoculation training – prepares people
to tolerate an anticipated threat by
changing the things people say to
themselves before and after a stressful
situation. It is almost impossible to be
prepared psychologically for any type of
trauma.
Treatment for Stress Disorders
Most people that experience a
stressful situation will
experience symptoms, but then
be able to recover on their own
without any professional help.
National and local telephone
hotlines help people who are
under severe stress and are
potentially suicidal. There are
specific hotlines for rape and/or
sexual assault or for runaways
that need help. Many of these
hotlines are staffed by
volunteers. When empathy and
respect are shown to all callers,
the situations tend to get better.
Crisis Intervention
Crisis intervention has evolved in
response to especially stressful
situations or family situations that have
become intolerable.
Crisis intervention focuses on the
immediate problem in which the
individual or family is having issues.
The therapist tends to be concerned
about the problems that may have an
emotional nature.
The therapist tends to be very active in
defining the problem, suggesting plans
of action, providing reassurance, and
providing needed information and
assurance. People will quickly gain
skills to help them deal with their
issues.
Psychological Debriefing
These debriefings are designed to
help speed up the healing
process in people who have
experienced disasters or
traumatic events.
Traumatized individuals are asked
to talk about their feelings and
are provided emotional support.
The discussion is quite
structured and common
reactions are normalized. Some
people believe this form of
counseling should be mandated
for disaster victims in order to
prevent PTSD.
Psychological Debriefing
One form of psychological
debriefing is Critical Incident
Stress Debriefing (CISD). A
single session of CISD lasts
between 3-4 hours and is
conducted in a group format. It
usually takes place 2-10 days
after the traumatic event.
Psychological debriefing is quite
controversial. Scholars show
there is no clinical
effectiveness. Most people
report that they are satisfied
with the debriefing and are glad
that someone is trying to
provide assistance. The U.S.
Military is now using this.
Medications
People experiencing trauma
usually report intense feelings
of anxiety or depression,
numbing, intrusive thoughts,
and sleep disturbance.
Antidepressants are usually
helpful at reducing PTSD
symptoms of depression,
intrusion, and avoidance. Antipsychotic medication is often
used.
Cognitive-Behavioral Treatments
Prolonged exposure – the patient
is asked to vividly recount the
traumatic event over and over
until there is a decrease in his
or her emotional responses.
Sometimes, the imagination is
used to bring the person to their
fear.
Relaxation training might also be
used. The therapeutic
relationship in these situations
has to be very high with rapport
and trust. It is very important
that therapist also provide a
safe and comforting
environment.
Cognitive-Behavioral Treatments
Prolonged exposure is an effective
treatment for PTSD. Prolonged
exposure has a very high
dropout rate, though.
Challenges in Studying Disaster
Victims
It is next to impossible to have an ideal,
well-controlled, and well-funded
experiment set up “awaiting a
disaster”.
It is very difficult to get researchers that
are ready to jump to study disaster
and disaster victims.
Therapy sessions are often conducted in
noisy, makeshift locations such as
crew lounges, hallways, and gate
areas. Funding has to be used
immediately and not for long-term
research.
A history of trauma also predicts
mortality.