Stress

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Stress

• 2.6.2007

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What is stress?Definitions

• Stress (stress response)
• Distress
• Eustress
• Stressor
• Physical
• Psychological
• Coping Strategies

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What is stress?Acute Stress

• Discrete, immediate event
• Results in a short-term activation of stress
  response
• Allows for focused attention, energy, and
  enhanced immune system activity

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What is stress?Stress Response
Stress
Hypothalamus
Pituitary Gland
Catecholamines / Cortisol
Adrenal Cortex

• Catecholamines
• Cortisol

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What is stress ?Problems with the stress response

• Problems with the stress response arise when the
  catecholamines and cortisol do not reach
  homeostasis
• Homeostasis
• Allostasis

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What is stress?Seyles General Adaptation
Syndrome
ALARM
RESISTANCE
EXHAUSTION

• Alarm
• Resistance
• Exhaustion

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What is stress?Chronic/Repeated Stress

• Problems with the stress response are associated
  with
• Physical problems
• Psychological problems
• Cognitive problems
• Behavior problems

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Some Questions

• Is stress always bad?
• What makes stress worse?
• Will two people experience the same amount of
  stress if exposed to the same stressor?

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Answers - Is stress always bad? Yerkes-Dodson Law
High
PERFORMANCE
Low
High
Low
STRESS LEVEL
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Answer - What makes stress worse?

• Nature of the stressor
• Importance
• Duration
• Cumulative effect
• Multiplicity
• Imminence
• Ambiguity
• Surprise
• Inability to cope with the stressor
• Lack of resources to deal with stressor
  (biological, psychological, interpersonal, etc.)
• Chronic stress can lower our ability to resist
  and/or cope with stressors

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Answer - Will two people experience the same
amount of stress if exposed to the same stressor?

• Stress Tolerance (Resilience)
• Perception of Stressor

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Coping

• How do you cope with stress?
• How do your friends cope with stress?
• Do certain coping mechanisms tend to help more
  than others?

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Coping

• Two goals
• Meet the requirements of the stressor
• Protect the self from physical and psychological
  damage
• Levels of Coping
• Biological
• Sociocultural
• Interpersonal
• Psychological

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CopingBiological Resources

• Immune system protects against disease
• Damage-repair systems fix-it for worn down
  muscles and organs
• What you can do to help!
• Diet
• Exercise
• Sleep

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Coping Sociocultural Resources

• Religious organizations
• Labor unions
• Law enforcement agencies
• Schools
• Shelters
• Political organizations
• Community organizations (e.g. PTA, Newcomer
  groups, etc.)

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CopingInterpersonal Resources

• Family
• Friends
• Teams, organizations, etc.
• Athletic teams
• Musical groups
• Multicultural groups

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CopingInterpersonal Resources
High
HEART RATE
Low
Weekday (High Stress)
Weekend (Low Stress)
People with high social support
People with low social support

• For nurses and accountants, high social support
  buffered the effects of stress in times of high
  stress

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CopingPsychological Resources

• Defense-Oriented Coping (Maladaptive Coping)
• Learned coping patterns
• Ego-defenses
• Adaptive Coping
• Optimism
• Self-esteem, self-efficacy
• Locus of control
• Self-complexity
• Self-talk
• Relaxation

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CopingDefense-oriented coping

• Defense-oriented coping
• Responses protect the self from hurt and
  disorganization often directed at things/people
  that are not the stressor
• Common types of responses
• Have the potential to be maladaptive if they are
  used to the extreme or if they are the only
  coping strategies used
• External Locus of Control

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CopingTask-oriented coping

• Task-oriented coping
• Responses change aspects of life often directed
  at the stressor
• Common types of responses
• Typically more productive
• Internal Locus of Control
• Using coping mechanisms before stress gets out of
  hand (VIDEO)

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Psychological ResourcesLocus of Control

• A persons belief in who/what has control over
  his life
• Internal Locus of Control
• External Locus of Control

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Psychological ResourcesSelf-Complexity

• Self-complexity
• High self-complexity buffers the effects of
  stress, depression, and illness by containing the
  negative effects of a stressor so that the entire
  self is not affected
• High Self Complexity Low Self-Complexity

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Psychological ResourcesSelf-talk

• Self-talk the things we say to ourselves
• Negative, inaccurate self-talk can contribute to
  stress
• Positive, accurate self-talk can reduce our
  stress
• I must get an A on this Extremely high levels
• test because if I dont, of stress and
  anxiety
• Im a failure
• I would like to get an A, but Some stress and
  anxiety,
• I dont NEED to get an A. If I but
  significantly less than
• dont get an A, that DOESNT before
• mean I am a stupid person

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Psychological ResourcesRelaxation

• What do you do to relax?
• Diaphragm breathing
• Mediatation, Mindfulness
• Yoga, Tai Chi, Qi Gong
• Moderate exercise
• Hobbies
• Massage, Acupressure

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Stress Scale

• Holmes and Rahe Social Readjustment Scale (1976)
• What do you notice about the scale?
• What is good about it?
• What is bad about it?
• If you were to make a Social Readjustment Scale
  for College Students, what would you include?
  What events would be the most stressful? What
  events would be the least stressful?

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Adjustment/Stress Disorders

• Adjustment Disorder
• Acute Stress Disorder
• Posttraumatic Stress Disorder
• These are actually categorized with the Anxiety
  Disorders in the DSM-IV-TR

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Adjustment Disorder

• Mildest diagnosis a therapist can give to a
  client
• Diagnosis is given if response to a common
  stressor is maladaptive
• Person is unable to function as usual
• Reaction is considered excessive
• If symptoms last longer than 6 months, diagnosis
  will change

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Adjustment DisorderCriteria

• The development of emotional or behavioral
  symptoms in response to a stressor within 3
  months of the onset of the stressor
• The symptoms are clinically significant, as
  evidenced by one of the following
• Marked distress in excess of what would be
  expected
• Significant impairment in functioning
• The symptoms do not meet criteria for another
  disorder
• The symptoms do not represent simple bereavement
• Once the stressor is gone, the symptoms do not
  persist longer than 6 months

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Adjustment Disorder Considerations

• Prevalence
• Gender
• Age of onset
• Course
• Associated w/
• Culture

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Adjustment DisorderCommon Causes

• Marriage/Divorce/Childbirth
• Loss of job/Retirement/Promotion
• Disabling medical condition
• Change of residence
• Bereavement

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Acute Stress Disorder

• Reaction to a catastrophic stressor rather than a
  common stressor
• Major disasters (natural or man-made)
• Assault/Rape
• Experience of war
• Threat of bodily harm or death
• Occurs within 2 days and 4 weeks of the trauma
• If symptoms last longer, the diagnosis changes

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Acute Stress Disorder

• A. The person has been exposed to a traumatic
  event in which both of the following were
  present
• The person experienced, witnessed, or was
  confronted with an event(s) that involved actual
  or threatened death, serious injury, or a threat
  the physical integrity of self or others
• The persons response involved fear,
  helplessness, or horror
• B. Either while experiencing or after
  experiencing the event, the individual has 3 or
  more of the following dissociative symptoms
• Sense of numbing, detachment, or absence of
  emotional responsiveness
• Reduction in awareness of his/her surroundings
• Derealization
• Depersonalization
• Dissociative amnesia

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Acute Stress Disorder

• C. The traumatic events are persistently
  reexperienced in at least one of the following
  ways thoughts, dreams, illusions, flashbacks,
  etc.
• D. Marked avoidance of stimuli that arouse
  recollections of the trauma
• E. Marked symptoms of anxiety or increased
  arousal
• F. There is clinically significant distress or
  impairment in functioning
• G. The disturbance lasts for a minimum of 2 days
  and a maximum of 4 weeks and occurs
  within 4 weeks of the event
• H. Not due to a GMC or substance

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Facts about Acute Stress Disorder

• Prevalence
• Gender
• Age of Onset
• Course
• Associated w/

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Posttraumatic Stress Disorder

• Reaction to a catastrophic stressor rather than a
  common stressor
• Major disasters (natural or man-made)
• Assault/Rape
• Experience of war
• Threat of bodily harm or death
• Diagnosis given if symptoms last longer than 4
  weeks
• Originally only applied to victims of war and
  disaster
• Was first recognized in 1980 in DSM-III

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Posttraumatic Stress Disorder

• A. The person has been exposed to a traumatic
  event in which both of the following were
  present
• The person experienced, witnessed, or was
  confronted with an event or events that involved
  actual or threatened death or serious injury, or
  a threat to the physical integrity of self or
  others
• The persons response involved intense fear,
  helplessness, or horror. (NOTE in children,
  this may be expressed instead by disorganized or
  agitated behavior)

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Posttraumatic Stress Disorder

• B. The traumatic event is persistently
  re-experienced in one (or more ) or the following
  ways
• 1. Recurrent and intrusive distressing
  recollections of the event, including images,
  thoughts, or perceptions
• 2. Recurrent distressing dreams of the event or
  acting/feeling as if the event were recurring
• 3. Intense psychological distress at exposure to
  internal or external cues that symbolize or
  resemble an aspect of the traumatic event
• 4. Psychological reactivity on exposure to
  internal or external cues that symbolize or
  resemble an aspect of the trauma

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Posttraumatic Stress Disorder

• C. Persistent avoidance of stimuli associated
  with the trauma and numbing of general
  responsiveness (not present before the trauma),
  as indicated by three or more of the following
• 1. Efforts to avoid thoughts, feelings, or
  conversations associated with the trauma
• 2. Efforts to avoid activities, places, or
  people that arouse recollections of the trauma
• 3. Inability to recall an important aspect of
  the trauma
• 4. Markedly diminished interest or participation
  in significant activities
• 5. Feelings of detachment or estrangement from
  others
• 6. Restricted range of affect (e.g. inability to
  have loving feelings)
• 7. Sense of a foreshortened future (e.g. no
  expectations of career, marriage, children, or
  normal life span)

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Posttraumatic Stress Disorder

• D. Persistent symptoms of increased arousal that
  were not present before the trauma, as indicated
  by two or more of the following
• 1. Difficulty falling or staying asleep
• 2. Irritability or outbursts of anger
• 3. Difficulty concentrating
• 4. Exaggerated startled response
• E. The duration of the disturbance is more than 1
  month
• F. The disturbance causes clinically significant
  distress or impairment in functioning

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Stress Disorders

• Major Symptoms
• Symptoms in Children
• Abuse gt Natural disasters
• Cant always show horror
• Agitation (e.g. difficulty sleeping,
  irritability, anger, exaggerated startle
  response)
• Disorganized behavior (e.g. destroying toys)
• Nightmares, often times frightening dreams
  without recognizable content
• Play reenacting the trauma or repetitive play
  in which themes from the trauma are expressed

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Facts about PTSD

• Prevalence
• Gender
• Age of Onset
• Course

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Posttraumatic Stress DisorderRates vary among
trauma victims

• 25 Female crime victims (non-rape)
• 48 Female adult rape victims
• 20 Vietnam combat veterans
• 46 Holocaust survivors (not all in concentration
  camps)
• 53 of WWII Korean War prisoners of war
• 26 Witnesses at mass shooting
• 31 Child sexual abuse victims
• 3 Breast cancer survivors
• 18 Bus accident victims
• X of Iraq war veterans????

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Posttraumatic Stress DisorderCausal Factors

• Combination of personality variables and level of
  stress but at high enough levels of stress,
  almost everyone will develop symptoms (think back
  to diathesis-stress models)
• Conditioned fear appears to be a key causal
  factor (think back to Classical Conditioning)
• Prompt treatment can prevent conditioned fear
  from becoming resistant to change

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Trauma of Rape

• 20 of female college students report having
  experienced it
• Stranger rape vs. Acquaintance rape
• Stranger rape
• Acquaintance rape
• Reactions of loved ones
• Parents
• Significant other

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Trauma of Rape

• Five major problems following rape
• Physical problems
• Emotional problems
• Cognitive problems
• Interpersonal problems
• Atypical problems
• Long-term effects depend on coping skills,
  resiliency, and level of psychological
  functioning
• Many victims postpone seeking help
• Disclosure tends to have more positive than
  negative effects

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Child Physical, Emotional, Sexual Abuse

• Factors that influence the development of PTSD

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Trauma of Military Combat

• Results from general combat situation
• Symptoms vary depending on
• Civilians living in war zones also at risk
• X of Iraq war veterans???

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Prisoners of War/Holocaust Survivors

• Almost 40 of American prisoners in Japanese POW
  camps during WWI died
• An even greater percentage of prisoners in Nazi
  concentration camps died in WWII
• Survivors showed the following symptoms
• Physical symptoms
• Psychological symptoms
• Behavioral symptoms
• 50 of POWs met PTSD criteria in the year
  following their release
• 1/3 met PTSD criteria 40-50 years later

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Other Traumatic Experiences

• Forced migration
• Victims of torture

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Preventing Stress Disorders

• Stress-Inoculation training when facing a known
  traumatic event (eg. combat, cancer treatment,
  etc.)
• 1st Stage
• 2nd Stage
• 3rd Stage
• Cant prepare for most traumatic situations
• Unpredictable
• Uncontrollable

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Treating Stress Disorders

• Short-term crisis therapy face-to-face
  discussion with a therapist can reduce PTSD
  symptoms
• Postdisaster debriefing sessions
• Exposure therapy with a therapist
• Relaxation training
• Assertiveness training
• Psychotropic medications