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Transcript
Slides & Handouts by Karen Clay Rhines, Ph.D.
Seton Hall University
Chapter 6
Stress Disorders
Comer, Fundamentals of
Abnormal Psychology, 3e
1
Stress, Coping, and the Anxiety
Response
• The state of stress has two components:
– Stressor: event creating demands
– Stress response: reactions to the demands
• Influenced by how we appraise (a) the event, and
(b) 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
Comer, Fundamentals of
Abnormal Psychology, 3e
2
Stress, Coping, and the Anxiety
Response
• When we appraise a stressor as threatening, the
natural reaction is fear
– Fear is a “package” of physical, emotional, and
cognitive responses
• Stress reactions, and the fear they produce, are
often at play in psychological disorders
– People who experience a large number of stressful
events are particularly vulnerable to the onset of
GAD, social phobia, panic disorder, and OCD, as well
as other psychological problems
Comer, Fundamentals of
Abnormal Psychology, 3e
3
Stress, Coping, and the Anxiety
Response
• Stress also plays a more central role in certain
psychological disorders, including:
– Acute stress disorder
– Posttraumatic stress disorder
– Technically, DSM-IV-TR lists these patterns as anxiety
disorders
• …as well as certain physical disorders called
psychophysiological disorders
– These disorders are listed in the DSM-IV-TR under
“psychological factors affecting medical condition”
Comer, Fundamentals of
Abnormal Psychology, 3e
4
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 the
body’s other organs
– Contains two systems: sympathetic and parasympathetic
• Endocrine system
– A network of glands throughout the body that release
hormones
Comer, Fundamentals of
Abnormal Psychology, 3e
5
Stress and Arousal:
The Fight-or-Flight Response
• When confronting a dangerous situation,
the hypothalamus first activates the
sympathetic nervous system, which
stimulates key organs either directly or
indirectly
• When the perceived danger passes, the
parasympathetic nervous system helps
return bodily systems to normal
Comer, Fundamentals of
Abnormal Psychology, 3e
6
Stress and Arousal:
The Fight-or-Flight Response
• The reactions displayed by these two
pathways are referred to as the fight-orflight response
• People differ in their particular patterns of
autonomic and endocrine functioning and
therefore also in their particular ways of
experiencing arousal and fear…
Comer, Fundamentals of
Abnormal Psychology, 3e
7
Stress and Arousal:
The Fight-or-Flight Response
• People differ in:
– Their general level of anxiety
• Called “trait anxiety”
• Some people are usually somewhat tense; others
are usually relaxed
• Differences appear soon after birth
– Their sense of threat
• Called “state anxiety”
• Situation-based (example: fear of flying)
Comer, Fundamentals of
Abnormal Psychology, 3e
8
The Psychological Stress
Disorders
• During and immediately after trauma, many
people become highly anxious and depressed
– For some, feelings persist well after the trauma
• These people may be experiencing:
– Acute stress disorder
– Posttraumatic stress disorder (PTSD)
– The precipitating event usually involves actual or
threatened serious injury to self or others
• Occurs following an event which would be traumatic to
anyone (unlike other anxiety disorders)
Comer, Fundamentals of
Abnormal Psychology, 3e
9
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 can begin at any time following the
event but must last for longer than one month
– May develop from acute stress disorder
Comer, Fundamentals of
Abnormal Psychology, 3e
10
Comer, Fundamentals of
Abnormal Psychology, 3e
11
What Triggers a Psychological
Stress Disorder?
• Can occur at any age and affect all aspects of
life
• ~4% of U.S. population affected each year
• ~7% of U.S. population affected sometime
during life
• Approximately 2/3 seek treatment at some point
• Ratio of women to men is 2:1
– After trauma, 20% of women and 8% of men develop
disorders
– Some events – including combat, disasters, abuse,
and victimization – are more likely to cause disorders
than others
Comer, Fundamentals of
12
Abnormal Psychology, 3e
What Triggers a Psychological
Stress Disorder?
• Combat and stress disorders
– It has long been recognized that soldiers experience
distress during combat
• Called “shell shock,” “combat fatigue”
• Post-Vietnam War clinicians discovered that soldiers also
experienced psychological distress after combat
– ~30% of Vietnam combat veterans suffered acute or
posttraumatic stress disorders
• An additional 22% had some stress symptoms
• 10% still experiencing problems
Comer, Fundamentals of
Abnormal Psychology, 3e
13
What Triggers a Psychological
Stress Disorder?
• Disasters and stress disorders
– Acute or posttraumatic stress disorders may
also follow natural and accidental disasters
• Civilian traumas have been implicated in stress
disorders at least 10 times as often as combat
trauma
• Types of disasters include traffic accidents,
weather, earthquakes, and airplane crashes
Comer, Fundamentals of
Abnormal Psychology, 3e
14
What Triggers a Psychological
Stress Disorder?
• Victimization and stress disorders
– People who have been abused, victimized, or
terrorized often experience lingering stress symptoms
– Common victimization is sexual assault/rape
• ~1 in 7 women is raped at some time during her life
• Psychological impact is immediate and may be long-lasting
• One study found that 94% of rape survivors developed an
acute stress disorder within 12 days after assault
Comer, Fundamentals of
Abnormal Psychology, 3e
15
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, possibly, stress
disorders
• Some research suggests abnormal NT and
hormone activity (especially norepinephrine and
cortisol)
– There may be a biological/genetic predisposition to such
reactions
• Evidence suggests that other biological changes
and damage may also occur as a stress disorder
sets in
Comer, Fundamentals of
Abnormal Psychology, 3e
16
Why Do People Develop a
Psychological Stress Disorder?
• Personality factors
– Some studies suggest that people with certain
personality profiles, attitudes, and coping styles are
more likely to develop stress disorders
• Risk factors include:
– Preexisting high anxiety
– A history of psychological problems
– Negative worldview
– A set of positive attitudes (called resiliency or
hardiness) is protective against developing stress
disorders
Comer, Fundamentals of
Abnormal Psychology, 3e
17
Why Do People Develop a
Psychological Stress Disorder?
• Negative childhood experiences
– A wave of studies has 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
Comer, Fundamentals of
Abnormal Psychology, 3e
18
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
negative event
• Severity of the trauma
– 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
Comer, Fundamentals of
Abnormal Psychology, 3e
19
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
– Relief workers themselves may become overwhelmed
– Research on this type of intervention has called into question its
effectiveness
Comer, Fundamentals of
Abnormal Psychology, 3e
20