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ABNORMAL PSYCHOLOGY
SIXTEENTH EDITION
James N. Butcher/ Jill M. Hooley/ Susan Mineka
Chapter 5
Stress and Physical and
Mental Health
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What Is Stress?
Stress
• External demands placed on
an organism
• Organism’s internal biological and
psychological responses to
such demands
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• STRESS
• (Hans Selye definition)
• Non-specific response of the body to any
demand made upon it to adapt whether
that demand produces pleasure or pain.
• Stress is extremely difficult to define. The response of
individuals to the circumstances and events (”stressors”)
that threaten them and tax their coping abilities. The
physiological and psychological response to a condition
that threatens or challenges a person and requires some
form of adaptation or adjustment.
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• EUSTRESS
• Positive stress which stimulates a person to
function properly (motivation, growth,
physical/social activity).
• DISTRESS
• Negative stress (associated with pain, anxiety,
or sorrow); may result in “psychosomatic illness.”
• The less control we have over any situation the
higher the stress.
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Stress and the DSM
Stress and DSM
• Significant component of multiple DSM
diagnostic categories
• DSM-5: Trauma- and stressor-related
disorders (PTSD, Adjustment disorder,
Acute stress disorder)
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Factors Creating Predisposition
to Stress
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“Other Stressors”
• ACCULTURATIVE STRESS: term to describe the negative
consequences of acculturation.
• We need to provide minority children (and others) with "protective
buffers." One of them is the extended family. Werner & Smith (1982)
found that the best single factor in determining whether a child can
cope with a threatening environment is a trusting relationship with an
adult (long-lasting).
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• A significant source of chronic stress is being a member of a
minority group in a majority culture even in the absence of racism,
racist attitudes or discrimination (Plummer & Slane, 1996), Troxel et
al., 2003 proposed “historical racism” experienced by members of
groups that have a history of repression, can also be a source of
stress. This might contribute to the high incidence of high blood
pressure among African Americans.
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Warning Signs of Stress
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Sore throat
Headache
Anxiety (non-specific that lasts for days)
Feelings that things go wrong
Inability to focus attention
Lack of concentration
Minor accidents.
Overeating or lack of appetite
Nausea, vomiting
Gastritis
Fatigue, boredom
Hyperventilation
Cold hands, feet
Indigestion
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Warning Signs (Continued)
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Allergies
Frequent colds/virus infections
Lower back pain, muscle tension
Sleeping disorders
Increased dependence on alcohol/drugs
Frequent urination
Strong urge to cry or run
"Lump in throat" feeling
Feeling dazed
Explosive temper (over minor issues)
Feeling unable to relax
Diarrhea or constipation, etc., etc., etc. . . . . . .
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Coping Strategies
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Two rules to deal with and reduce stress:
1)
Don’t sweat the small stuff
2)
Everything is small stuff
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Stress is an inevitable part of life that we need to learn to manage rather than
to eliminate.
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Serenity is not the absence of conflict, but the ability to cope with it.
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High achievers (vs. low achievers) recognize when they are under stress and
they immediately do something about it.
Personal factors reducing stress: Optimism, Hardiness, Religious
Involvement, Social Support (more important is perceived support–the belief
that help is available when needed, than received support–actual help
received). Exercise, good sense of humor, yoga, relaxation, meditation, etc.
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Work related stress
• Albrecht (1979) suggests that if people are to function
effectively and find satisfaction on the job, the following 9
variables must fall within their comfort zone: workload,
clarity of job description and evaluation criteria, physical
variables, job status, accountability (accountability
overload occurs when people have responsibility for the
physical/psychological well-being of others but only a
limited degree of control or accountability underload when
job perceived as meaningless), task variety, human
contact, physical challenge, mental challenge. For women
sex-specific stressors: sex discrimination, sexual
harassment, and combining work and family roles.
Consequences: absenteeism, tardiness, accidents,
substance abuse, and lower morale.
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Characteristics of Stressors
Severity
Chronicity
Key characteristics
of
stress involve:
Timing
Degree of impact
Level of expectation
Controllability
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Characteristics of Stressors
Life changes
Crises
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Perception
of benefits
Social Readjustment Rating Scale (SRRS)
• Designed to measure life changes and
susceptibility to illness or accident. Developed by
Holmes & Rahe (1967) to measure stress by
ranking different life events from most to least
stressful and assigning a point value to each
event. Therefore, the amount of stress an
individual experiences is linked to their chance of
experiencing a major health problem.
Shortcoming: SRRS assigns a point value to
each life change without taking into account how
an individual copes with that stressor or unique
circumstances. This led to the development of
Life Events and Difficulties Schedule (LEDS)
Stress and the Stress Response
• Two of body’s systems respond when
stressor is perceived:
• Sympathetic-adrenomedullary (SAM)
system: prepares us for fight/flight
• With prolonged exposure to stressors:
Hypothalamic-pituitary adrenocortical
(HPA) produces cortisol which is helpful
in emergencies (shuts off immune
system) and also with fight/flight resp.
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Figure 5.1: The Hypothalamic-PituitaryAdrenal (HPA) Axis
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Biological Costs of Stress
Allostasis
• Is process of adaptation or
achieving stability through change
• Results in wear and tear on body
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Allostatic load
• The biological cost of adapting to stress.
• Although we cannot categorically relate
specific stressors to specific medical
problems, stress is becoming a key
underlying theme in our understanding of
the development and course of virtually all
physical illness.
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The Mind-Body Connection
Psychoneuroimmunology
• Study of interaction between nervous
system and immune system
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The Mind-Body Connection
True or False?
Stress may cause overall vulnerability to
disease.
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Understanding the Immune System
Protects body from
such things as
viruses and
bacteria
Immune system
Provides
leukocytes: front
lines of defense
Communicates with
brain via cytokines
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• Immune system is like the body’s “police force,”
protecting it from such things as viruses and bacteria
• Leukocytes are the front lines of defense, and there are
two types:
• B-cells: produce antibodies to specific antigens (foreign
invaders, tumors, cancer cells)
• T-cells: Helper cells. Help destroy antigens after activation
from a microphage
• Cytokines mediate inflammatory and immune response
and send signals to the brain about infection and injury.
Also stimulate the HPA axis which creates a negative
feedback loop.
• Progression from HIV to AIDS illustrates impact of stress
on immune functioning
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Figure 5.2: Immune System Responses
to a Bacterial Infection
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Stress, Depression, and
the Immune System
Depression
• Associated with compromised immune
function beyond stressors that
precipitated depression
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Stress and Physical Health
Many psychological factors can affect relationship
between stress and health
• Optimism (contributes to better physical health)
• Also, “controllability,” increased self-esteem,
and better social support.
• Negative affect (chronic anger, hostility)
contribute to poor physical health
• Positive psychology movement
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Cardiovascular Disease
Study in this
area includes:
Hypertension
Coronary heart
disease
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Risk and
causal factors
Hypertension
Hypertension involves persisting systolic
and diastolic blood pressure
Chronic hypertension
and disease
Hypertension and
ethnicity
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Hypertension and
anger management
Figure 5.3: Defining Hypertension
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Coronary Heart Disease
How would you define coronary
heart disease?
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Certain personality
patterns are linked
Risk and Causal Factors in
Cardiovascular Disease
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Type A
Type D
• Type A: Excessive drive, hostility, impatience.
Hostility presents greatest risk for heart disease
• Type B: more relaxed, easy going
• Type D: Distressed; tendency to experience
negative emotions
• Chronic and acute stress can contribute to
cardiovascular disease
• Depression, anxiety, and social isolation are
also linked to cardiovascular disease
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Treatment of Stress-Related
Physical Disorders
Biological
interventions
Psychological
interventions
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Biological Interventions
Antidepressant
medications
Aspirin or other
anticoagulants
Lipid-lowering
medications
Surgical
procedures
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Psychological Interventions
Biofeedback
Relaxation
and
meditation
Emotional
disclosure
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Cognitivebehavior
therapy
Stress and Mental Health
Some DSM
disorders are
triggered by
exposure to stress
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Adjustment
disorder: reaction
to a common
stressor
Posttraumatic
stress disorder:
reaction to a
traumatic stressor
Stress and Mental Health
Adjustment Disorder
• Maladaptive response to common
stressor within 3 months of stressor
(divorce, death of a loved one, loss of a
job, etc)
• Symptoms disappear when stressor
ends or person adapts
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Posttraumatic Stress Disorder
Definition
Causes
Clinical description
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• PTSD: Severe psychological and physical symptoms
resulting from sudden, unexpected environmental crises
• Trauma causing PTSD varies
• If briefer (4 weeks or less), correct diagnosis may instead
be acute stress disorder
• Recurrent re-experiencing of the traumatic event through
nightmares or intrusive memories
• Avoidance of stimuli associated with the trauma and
emotional numbing
• Negative cognitions and mood including feeling detached
or excessive blaming of self or others
• Increased arousal, which may involve insomnia, the
inability to tolerate noise, and excessive response when
startled
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Prevalence of PTSD
in General Population
• Lifetime prevalence rate in the U.S. is
6.8%
• Higher rates in women (9.7%) despite
finding that men (3.6%) are more likely to
be exposed to traumatic events
What contributes to this gender
difference?
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Rates of PTSD After Traumatic Experiences
Military combat
Prisoner of war, concentration
camp, and torture experience
Traumas caused by human
intent
Accidents or natural disasters
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Causal Factors in
Posttraumatic Stress Disorder
True or false?
Not everyone exposed to a trauma will
develop PTSD!
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Causal Factors in
Posttraumatic Stress Disorder
Individual
risk factors
Nature of
trauma
Sociocultural
risk factors
Causal
factors
may
include:
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Individual Risk Factors
How many can you name?
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Being female
Low levels of social support
Neuroticism
Preexisting anxiety or depression
Family history of anxiety or depression
Substance abuse
Appraisals soon after trauma
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Individual Risk Factors
High cognitive
ability (IQ) may
lower risk of
PTSD
Biological
differences
may play a role
in likelihood of
developing
PTSD
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• Biological differences may play a role in
likelihood of developing PTSD
• Hormone levels
• Genetics
• Size of hippocampus
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Sociocultural Factors
In combat-related trauma:
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Justification for combat
Identification with combat unit
Esprit de corps
Quality of leadership
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Prevention and Treatment
of Stress Disorders
Psychological
debriefing
Prevention and
treatment of
stress disorders
Challenges in
studying crisis
victims
Trauma and
physical health
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Prevention
Advanced preparation of stressor
• Military service
• Medical procedures
• Relationship termination
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Treatment for Stress Disorders
Approaches to treatment include:
• Telephone hotlines
• Psychological first aid
• Crisis intervention
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Psychological Debriefing
Strategies for relief of PTSD
symptoms
• Critical Incident Stress Debriefing
• Medications
• Cognitive-behavioral treatments
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Challenges in
Studying Crisis Victims
Challenges
Traumatic
events cannot
be predicted
or controlled
by researchers
Variables of
interest are
difficult to
assess
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Funding can
be difficult to
obtain
Trauma and Physical Health
Relatively new
area for
physical
research
Studies indicate
that trauma is
bad for body as
well as mind
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Unresolved Issues
The motivation for studying
trauma stress
The role of advocacy for trauma
victims in trauma stress studies
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