Slides & Handouts by Karen Clay Rhines, Ph.D. Seton Hall

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Chapter 6
Slides Handouts by Karen Clay Rhines,
Ph.D. Seton Hall University

• Stress Disorders

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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

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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

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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

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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 bodys other organs
• Contains two systems sympathetic and
  parasympathetic
• Endocrine system
• A network of glands throughout the body that
  release hormones

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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

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Stress and Arousal The Fight-or-Flight Response

• The reactions displayed by these two pathways are
  referred to as the fight-or-flight response
• People differ in their particular patterns of
  autonomic and endocrine functioning and therefore
  also in their particular ways of experiencing
  arousal and fear

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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)

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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)

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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

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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 21
• 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

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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

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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

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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

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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

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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

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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

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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
  ones 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

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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