Comer, Abnormal Psychology, 8th edition

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Stress, Coping, and the Anxiety Response
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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

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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

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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 all other organs of the body
• Endocrine system
• A network of glands throughout the body that
  release hormones

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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

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The Autonomic Nervous System
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The Endocrine System
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Pathways of Arousal and Fear
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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 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

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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

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What Triggers a Psychological Stress Disorder?
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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

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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
• 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

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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

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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

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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, in some cases, to stress disorders

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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

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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

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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
  traumatic event

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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

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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

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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

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How Do Clinicians Treat the Psychological Stress
Disorders?
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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

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The Physical Stress Disorders Psychophysiological
Disorders

• In addition to affecting psychological
  functioning, stress can also have great impact on
  physical functioning

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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

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Psychological Factors Affecting Medical Condition
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Psychological Factors Affecting Medical Condition
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Traditional Psychophysiological Disorders
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Traditional Psychophysiological Disorders
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Traditional Psychophysiological Disorders
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Traditional Psychophysiological Disorders

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

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Traditional Psychophysiological Disorders
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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

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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
• 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

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Psychoneuroimmunology
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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

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Psychoneuroimmunology
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Psychoneuroimmunology
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Psychological Treatments for Physical Disorders

• Behavioral medicine - the field of treatment that
  combines psychological and physical interventions
  to treat or prevent medical problems

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Psychological Treatments for Physical Disorders
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Psychological Treatments for Physical Disorders
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Psychological Treatments for Physical Disorders
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Psychological Treatments for Physical Disorders
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Psychological Treatments for Physical Disorders
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Psychological Treatments for Physical Disorders
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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