Stress, Coping, and the Anxiety Response

2. Stress, Coping, and the Anxiety Response

3. 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

4. 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”

5. 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

6. 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

7. The Autonomic Nervous System

8. The Endocrine System

9. Pathways of Arousal and Fear

10. 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

12. 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

13. What Triggers a Psychological Stress Disorder?

14. What Triggers a Psychological Stress Disorder? • Combat and stress disorders • Called “shell shock” or “combat fatigue” • Post-Vietnam War clinicians discovered that soldiers also experienced psychological distress after combat • As many as 29% of Vietnam combat veterans suffered acute or posttraumatic stress disorders • 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

15. 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

16. 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

17. 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

18. 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

19. 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

20. 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

21. 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

22. 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

23. 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

24. 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

25. How Do Clinicians Treat the Psychological Stress Disorders?

26. 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

27. The Physical Stress Disorders: Psychophysiological Disorders • In addition to affecting psychological functioning, stress can also have great impact on physical functioning

28. 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

29. Psychological Factors Affecting Medical Condition

30. Psychological Factors Affecting Medical Condition

31. Traditional Psychophysiological Disorders

32. Traditional Psychophysiological Disorders

33. Traditional Psychophysiological Disorders

34. Traditional Psychophysiological Disorders • A number of variables contribute to the development of psychophysiological disorders, including: • Biological factors • Psychological factors • Sociocultural factors

35. Traditional Psychophysiological Disorders

36. 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

37. 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

39. Psychoneuroimmunology

40. 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 T-cells, and B-cells

41. Psychoneuroimmunology

42. Psychoneuroimmunology

43. Psychological Treatments for Physical Disorders • Behavioral medicine - the field of treatment that combines psychological and physical interventions to treat or prevent medical problems

44. Psychological Treatments for Physical Disorders

45. Psychological Treatments for Physical Disorders

46. Psychological Treatments for Physical Disorders

47. Psychological Treatments for Physical Disorders

48. Psychological Treatments for Physical Disorders

49. Psychological Treatments for Physical Disorders

50. 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