Stress Disorders

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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 appraisal of
• (a) Event
• (b) Our capacity to react to the event effectivel

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Stress, Coping, and the Anxiety Response

• Plays a more central role in certain
  psychological disorders, including
• Acute stress disorder
• Posttraumatic stress disorder
• as well as certain physical disorders called
  psychophysiological disorders

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The Psychological Stress Disorders

• Two Psychological Stress Disorders
• Acute stress disorder
• Posttraumatic stress disorder (PTSD)
• 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
• Disasters
• Can be natural and accidental
• Victimization
• Commonsexual victimization/rape
• 1 in 7 women is raped at some time during her
  life
• Ongoing victimization and abuse
• Experience or Threat of Terrorism

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Why Do People Develop a Psychological Stress
Disorder?

• Biological and genetic factors
• Physical changes
• NT and hormone activity
• Biological/genetic predisposition
• Personality factors
• Risk factors include preexisting high anxiety,
  history of psychological problems, negative
  worldview
• Resiliency
• Negative Childhood Experiences
• Include impoverished childhood, psychological
  disorders in family, negative experience
  (assault, abuse, or catastrophe) at early age,
  lt10 yrs. when parents divorce/separate
• Social Support
• Severity of the Trauma

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How Do Clinicians Treat the Psychological Stress
Disorders?

• Symptoms have been found to last an average of 3
  years with treatment and 5½ years without
  treatment
• Treatment type varies depending on type of trauma
• General goals
• End lingering stress reactions
• Gain perspective on traumatic experience
• Return to constructive living

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The Physical Stress Disorders Psychophysiological
Disorders

• It is important to note that these
  psychophysiological disorders bring about actual
  physical damage
• Best known and most common of the
  psychophysiological disorders were ulcers,
  asthma, insomnia, chronic headaches, high blood
  pressure, and coronary heart disease
• Recent research has shown that many other
  physical illnesses may be caused by an
  interaction of psychosocial and physical factors

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Traditional Psychophysiological Disorders

• Ulcers
• Lesions in the wall of the stomach that result in
  burning sensations or pain, vomiting, and stomach
  bleeding
• Affect up to 20 million people at some point in
  their lives
• Causal psychosocial factors
• Environmental stress, anger, anxiety, dependent
  personality style
• Causal physiological factors
• Bacterial infection

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Traditional Psychophysiological Disorders

• Asthma
• A narrowing of the bodys airways that makes
  breathing difficult
• Affects up to 20 million people in the U.S. each
  year
• Most victims are children at the time of first
  attack
• Causal psychosocial factors
• Environmental pressures, troubled family
  relationships, anxiety, high dependency
• Causal physiological factors
• Allergies, a slow-acting sympathetic nervous
  system, weakened respiratory system

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Traditional Psychophysiological Disorders

• Insomnia
• Difficulty falling asleep or maintaining sleep
• Affects 35 of people in the U.S. each year
• Causal psychosocial factors
• High anxiety or depression
• Causal physiological factors
• Overactive arousal system, certain medical
  ailments

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Traditional Psychophysiological Disorders

• Chronic headaches
• Tension headaches affect 40 million Americans
  each year
• Migraine headaches affect 23 million Americans
  each year
• Causal psychosocial factors
• Environmental pressures general feelings of
  helplessness, anger, anxiety, depression
• Causal physiological factors
• Abnormal serotonin activity, vascular problems,
  muscle weakness

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Traditional Psychophysiological Disorders

• Hypertension
• Chronic high blood pressure, usually producing no
  overt symptoms
• Affects 65 million Americans each year
• Causal psychosocial factors
• Constant stress, constant environmental danger,
  general feelings of anger or depression
• Causal physiological factors
• 10 caused by physiological factors alone
• Obesity, smoking, poor kidney function, high
  proportion of collagen rather than elastic tissue
  in an individuals blood vessels

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Traditional Psychophysiological Disorders

• Coronary heart disease
• Caused by a blocking of the coronary arteries
• Includes angina pectoris (chest pain), coronary
  occlusion (complete blockage of a coronary
  artery), and myocardial infarction (heart attack)
• Leading cause of death in men older than 35 years
  and women older than 40 years in the U.S.
• Causal psychosocial factors
• Job stress, high levels of anger or depression
• Causal physiological factors
• High level of cholesterol, obesity, hypertension,
  the effects of smoking, lack of exercise

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Traditional Psychophysiological Disorders

• A number of factors contribute to the development
  of psychophysiological disorders, including
• Sociocultural factors
• Psychological factors
• Biological variables

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Traditional Psychophysiological Disorders

• Sociocultural factors
• Stressful demands placed on people by their
  culture may set the stage for psychophysiological
  disorders
• Examples include poverty, violence, and nuclear
  threat (such as Three Mile Island)

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Traditional Psychophysiological Disorders

• Psychological factors
• According to many theorists, certain needs,
  attitudes, emotions, or coping styles may cause
  people to repeatedly overreact to stressors,
  thereby increasing their likelihood of developing
  psychophysiological disorders
• Examples a repressive coping style, Type A
  personality style

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Traditional Psychophysiological Disorders

• Biological factors
• Defects in the autonomic nervous system (ANS) are
  believed to contribute to the development of
  psychophysiological disorders
• Other more specific biological problems may also
  contribute
• For example, a weak gastrointestinal system may
  create a predisposition to developing ulcers

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Traditional Psychophysiological Disorders

• Clearly, sociocultural, psychological, and
  biological variables combine to produce
  psychophysiological disorders
• Although once thought to be unusual, the
  interaction of psychosocial and physical factors
  is now considered the rule of bodily function,
  not the exception
• In recent years, more and more illnesses have
  been placed in this category

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New Psychophysiological Disorders

• Since the 1960s, researchers have found many
  links between psychosocial stress and a range of
  physical illnesses

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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

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New Psychophysiological Disorders

• Are physical illnesses related to stress?
• Using the Social Adjustment Rating Scale, studies
  have consistently linked stresses of various
  kinds to a wide range of physical conditions
• Overall, the greater the amount of life stress,
  the greater the likelihood of illness
• Researchers have even found a relationship
  between traumatic stress and death

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New Psychophysiological Disorders

• Are physical illnesses related to stress?
• One key weakness of the Social Adjustment Rating
  Scale is that it fails to take into account the
  particular stress reactions of specific
  populations
• For example, women and men have been shown to
  react differently to certain life changes
  measured by the scale

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New Psychophysiological Disorders

• Researchers have increasingly looked to the
  bodys immune system as the key to the
  relationship between stress and infection
• This area of study is called psychoneuroimmunology

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New Psychophysiological Disorders

• Psychoneuroimmunology
• The immune system is the bodys network of
  activities and cells that identify and destroy
  antigens (foreign invaders, such as bacteria) and
  cancer cells
• Among the most important cells in this system are
  the lymphocytes
• Lymphocytes are white blood cells that circulate
  through the blood system and attack the invaders
• Lymphocytes include helper T-cells, natural
  killer T-cells, and B-cells

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New Psychophysiological Disorders

• Psychoneuroimmunology
• Researchers now believe that stress can interfere
  with the activity of lymphocytes, slowing them
  down and increasing a persons susceptibility to
  viral and bacterial infections
• Several factors influence whether stress will
  result in a slowdown of the system, including
  biochemical activity, behavioral changes,
  personality style, and degree of social support

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New Psychophysiological Disorders

• Psychoneuroimmunology
• Biochemical activity
• Stress leads to increased activity of the
  sympathetic nervous system, including a release
  of norepinephrine
• In addition to supporting nervous system
  activity, this chemical also appears to slow down
  the functioning of the immune system
• Similarly, the bodys endocrine glands reduce
  immune system functioning during periods of
  prolonged stress through the release of
  corticosteroids

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New Psychophysiological Disorders

• Psychoneuroimmunology
• Behavioral changes
• Stress may set into motion a series of behavioral
  changes poor sleep patterns, poor eating, lack
  of exercise, increase in smoking and/or drinking
  that indirectly affect the immune system
• Personality style
• An individuals personality style, including
  their level of optimism, constructive coping
  strategies, and resilience, plays a role in
  determining how much the immune system is slowed
  down by stress

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New Psychophysiological Disorders

• Psychoneuroimmunology
• Social support
• Level of social support appears to play a role in
  immune system functioning
• People who have few social supports and feel
  lonely seem to display poorer immune functioning
  in the face of stress than people who do not feel
  lonely
• Studies have shown that social support and
  affiliation with others may actually speed up
  recovery from illness or surgery

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Psychological Treatments for Physical Disorders

• As clinicians have discovered that psychosocial
  factors may contribute to physical disorders,
  they have applied psychological treatment to more
  and more medical problems
• The most common of these interventions are
  relaxation training, biofeedback training,
  meditation, hypnosis, cognitive interventions,
  insight therapy, and support groups

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Psychological Treatments for Physical Disorders

• The field of treatment that combines
  psychological and physical interventions to treat
  or prevent medical problems is known as
  behavioral medicine

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Psychological Treatments for Physical Disorders

• Relaxation training
• People can be trained to relax their muscles at
  will, a process that sometimes reduces feelings
  of anxiety
• Relaxation training can be of help in preventing
  or treating medical illnesses that are related to
  stress
• Often used in conjunction with medication in the
  treatment of high blood pressure
• Often used alone to treat chronic headaches,
  insomnia, and asthma

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Psychological Treatments for Physical Disorders

• Biofeedback training
• Patients given biofeedback training are connected
  to machinery that gives them continuous readings
  about their involuntary bodily activities
• This procedure has been used successfully to
  treat pain from muscle tension, headaches, and
  muscular disabilities caused by stroke or
  accident
• Some biofeedback training has been effective in
  the treatment of asthma, irregular heartbeat,
  migraine headaches, and high blood pressure

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Psychological Treatments for Physical Disorders

• Meditation
• Although meditation has been practiced since
  ancient times, Western clinicians have only
  recently become aware of its effectiveness in
  relieving physical distress
• Meditation involves turning ones concentration
  inward and changing ones level of consciousness
• Meditation has been used to treat pain, high
  blood pressure, heart problems, insomnia, and
  asthma

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Psychological Treatments for Physical Disorders

• Hypnosis
• Individuals undergoing hypnosis are guided into a
  sleeplike, suggestible state during which they
  can be directed to act in unusual ways, to
  remember unusual sensations, or to forget
  remembered events
• With training, hypnosis can be done without a
  hypnotist (self-hypnosis)

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Psychological Treatments for Physical Disorders

• Hypnosis
• This technique is now used as an aid to
  psychotherapy and to treat medical conditions,
  including asthma, insomnia, high blood pressure,
  and infection

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Psychological Treatments for Physical Disorders

• Cognitive interventions
• People with physical ailments have sometimes been
  taught new attitudes or cognitive responses as
  part of treatment
• One intervention is self-instruction training, in
  which patients are taught to rid themselves of
  negative self-statements and to replace these
  with positive self-statements
• This technique has been used in pain management,
  headaches, ulcers, and back disorders

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Psychological Treatments for Physical Disorders

• Insight therapy and support groups
• If negative psychological symptoms (e.g.,
  depression, anxiety) contribute to a persons
  physical ills, therapy to address these emotions
  should help reduce the ills
• These techniques have been used to treat a
  variety of illnesses including asthma, cancer,
  headache, and arthritis

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Psychological Treatments for Physical Disorders

• Combination approaches
• Studies have found that the various psychological
  treatments for physical problems tend to be equal
  in effectiveness
• Psychological treatments are often most effective
  when used in combination and with medical
  treatment
• With these combined approaches, todays
  practitioners are moving away from the mind-body
  dualism of centuries past