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ABNORMAL PSYCHOLOGY SIXTEENTH EDITION James N. Butcher/ Jill M. Hooley/ Susan Mineka Chapter 5 Stress and Physical and Mental Health © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. What Is Stress? Stress • External demands placed on an organism • Organism’s internal biological and psychological responses to such demands © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. • 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. © 2013 Pearson Education, Inc. All rights reserved. • 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. © 2013 Pearson Education, Inc. All rights reserved. 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) © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. Factors Creating Predisposition to Stress © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. “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). • • 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. © 2013 Pearson Education, Inc. All rights reserved. Warning Signs of Stress • • • • • • • • • • • • • • 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 © 2013 Pearson Education, Inc. All rights reserved. Warning Signs (Continued) • • • • • • • • • • • • 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. . . . . . . © 2013 Pearson Education, Inc. All rights reserved. Coping Strategies • • • Two rules to deal with and reduce stress: 1) Don’t sweat the small stuff 2) Everything is small stuff • Stress is an inevitable part of life that we need to learn to manage rather than to eliminate. • • • Serenity is not the absence of conflict, but the ability to cope with it. • • 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. © 2013 Pearson Education, Inc. All rights reserved. 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. © 2013 Pearson Education, Inc. All rights reserved. Characteristics of Stressors Severity Chronicity Key characteristics of stress involve: Timing Degree of impact Level of expectation Controllability © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. Characteristics of Stressors Life changes Crises © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. 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. © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. Figure 5.1: The Hypothalamic-PituitaryAdrenal (HPA) Axis © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. Biological Costs of Stress Allostasis • Is process of adaptation or achieving stability through change • Results in wear and tear on body © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. 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. © 2013 Pearson Education, Inc. All rights reserved. The Mind-Body Connection Psychoneuroimmunology • Study of interaction between nervous system and immune system © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. The Mind-Body Connection True or False? Stress may cause overall vulnerability to disease. © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. 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 © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. • 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 © 2013 Pearson Education, Inc. All rights reserved. Figure 5.2: Immune System Responses to a Bacterial Infection © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. Stress, Depression, and the Immune System Depression • Associated with compromised immune function beyond stressors that precipitated depression © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. 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 © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. Cardiovascular Disease Study in this area includes: Hypertension Coronary heart disease © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. Risk and causal factors Hypertension Hypertension involves persisting systolic and diastolic blood pressure Chronic hypertension and disease Hypertension and ethnicity © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. Hypertension and anger management Figure 5.3: Defining Hypertension © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. Coronary Heart Disease How would you define coronary heart disease? © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. Certain personality patterns are linked Risk and Causal Factors in Cardiovascular Disease © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. 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 © 2013 Pearson Education, Inc. All rights reserved. Treatment of Stress-Related Physical Disorders Biological interventions Psychological interventions © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. Biological Interventions Antidepressant medications Aspirin or other anticoagulants Lipid-lowering medications Surgical procedures © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. Psychological Interventions Biofeedback Relaxation and meditation Emotional disclosure © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. Cognitivebehavior therapy Stress and Mental Health Some DSM disorders are triggered by exposure to stress © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. 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 © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. Posttraumatic Stress Disorder Definition Causes Clinical description © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. • 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 © 2013 Pearson Education, Inc. All rights reserved. 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? © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. 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 © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. Causal Factors in Posttraumatic Stress Disorder True or false? Not everyone exposed to a trauma will develop PTSD! © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. Causal Factors in Posttraumatic Stress Disorder Individual risk factors Nature of trauma Sociocultural risk factors Causal factors may include: © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. Individual Risk Factors How many can you name? © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. • • • • • • • Being female Low levels of social support Neuroticism Preexisting anxiety or depression Family history of anxiety or depression Substance abuse Appraisals soon after trauma © 2013 Pearson Education, Inc. All rights reserved. Individual Risk Factors High cognitive ability (IQ) may lower risk of PTSD Biological differences may play a role in likelihood of developing PTSD © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. • Biological differences may play a role in likelihood of developing PTSD • Hormone levels • Genetics • Size of hippocampus © 2013 Pearson Education, Inc. All rights reserved. Sociocultural Factors In combat-related trauma: • • • • Justification for combat Identification with combat unit Esprit de corps Quality of leadership © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. Prevention and Treatment of Stress Disorders Psychological debriefing Prevention and treatment of stress disorders Challenges in studying crisis victims Trauma and physical health © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. Prevention Advanced preparation of stressor • Military service • Medical procedures • Relationship termination © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. Treatment for Stress Disorders Approaches to treatment include: • Telephone hotlines • Psychological first aid • Crisis intervention © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. Psychological Debriefing Strategies for relief of PTSD symptoms • Critical Incident Stress Debriefing • Medications • Cognitive-behavioral treatments © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. Challenges in Studying Crisis Victims Challenges Traumatic events cannot be predicted or controlled by researchers Variables of interest are difficult to assess © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. 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 © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. Unresolved Issues The motivation for studying trauma stress The role of advocacy for trauma victims in trauma stress studies © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.