Abnorm psych lecture pwrpt. ch05 spg. 2011

1Slides & Handouts by Karen Clay Rhines, Ph.D.Northampton Community College

Fundamentals of Abnormal Psychology, 6eRonald Comer

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Stress DisordersStress DisordersChapter 5

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Stress, Coping, and the Stress, Coping, and the Anxiety ResponseAnxiety ResponseThe state of stress has two

components:◦ Stressor – event that creates demands

◦ Stress response – person’s reactions to the demands Influenced by how we judge both the event and

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 and respond well

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Stress, Coping, and the Stress, Coping, and the Anxiety ResponseAnxiety Response

When we appraise a stressor as threatening, the natural reaction is arousal and fear◦ Fear is a “package” of responses that are physical,

emotional, and cognitive

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 anxiety and other psychological disorders

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Stress, Coping, and the Stress, Coping, and the Anxiety ResponseAnxiety ResponseStress also plays a more central role in

certain psychological disorders, including:◦ Acute stress disorder

◦ Posttraumatic stress disorder (PTSD)

◦ 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: Stress and Arousal: The Fight-or-Flight ResponseThe Fight-or-Flight ResponseThe 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: Stress and Arousal: The Fight-or-Flight ResponseThe Fight-or-Flight ResponseThere 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

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Stress and Arousal: Stress and Arousal: The Fight-or-Flight ResponseThe Fight-or-Flight ResponseWhen we face a dangerous

situation, the hypothalamus first excites the sympathetic nervous system, which stimulates key organs either directly or indirectly

When the perceived danger passes, the parasympathetic nervous system helps return body processes to normal

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Stress and Arousal: Stress and Arousal: The Fight-or- Flight ResponseThe Fight-or- Flight ResponseThe second pathway is the

hypothalamic-pituitary-adrenal (HPA) pathway◦When faced by stressors, the

hypothalamus signals the pituitary gland, which stimulates the adrenal cortex to release corticosteroids – stress hormones – into the bloodstream

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Stress and Arousal: Stress and Arousal: The Fight-or-Flight ResponseThe Fight-or-Flight ResponseThe reactions on display in these

two pathways are collectively referred to as the fight-or-flight response

Each person has a particular pattern of autonomic and endocrine functioning and so a particular way of experiencing arousal and fear…

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Stress and Arousal: Stress and Arousal: The Fight-or-Flight ResponseThe Fight-or-Flight ResponsePeople differ in:

◦Their general level of arousal and anxiety Called “trait anxiety”

Some people are usually somewhat tense; others are usually relaxed

Differences appear soon after birth

◦Their sense of which situations are threatening Called “state anxiety”

Situation-based (example: fear of flying)

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The Psychological Stress The Psychological Stress DisordersDisordersDuring and immediately after stressful

situations, we may temporarily experience levels of arousal, anxiety, and depression◦ For some, symptoms persist well after the

situation ends These people may be suffering from:

Acute stress disorder

Posttraumatic stress disorder (PTSD)

◦ The precipitating event usually involves actual or threatened serious injury to self or others The situations that cause these disorders would

be traumatic to anyone (unlike other anxiety disorders)

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The Psychological Stress The Psychological Stress DisordersDisorders

Acute stress disorder◦Symptoms begin within four weeks of

event and last for less than one monthPosttraumatic stress disorder

(PTSD)◦Symptoms may begin either shortly

after the event, or months or years afterward

◦Symptoms continue longer than one month As many as 80% of all cases of acute

stress disorder develop into PTSD

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The Psychological Stress The Psychological Stress DisordersDisordersSymptoms of Acute and

Posttraumatic Stress Disorders:◦Reexperiencing the traumatic event

◦Avoidance

◦Reduced responsiveness

◦Increased arousal, anxiety, and guilt

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What Triggers a What Triggers a Psychological Stress Psychological Stress Disorder?Disorder? Can occur at any age and affect all aspects of

life At least 3.5% of people in the U.S. are affected

each year 7–9% of people in the U.S. are affected

sometime during their lifetime Around two-thirds seek treatment at some point Ratio of women to men is 2:1

◦ After serious trauma, around 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 What Triggers a Psychological Stress Psychological Stress Disorder?Disorder?

Combat and stress disorders◦ For years clinicians have recognized that soldiers

develop severe anxiety and depression during combat 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 veterans suffered acute or posttraumatic stress disorders An additional 22% experienced at least some stress

symptoms 10% still experiencing problems

◦ A similar pattern is currently unfolding among veterans of wars in Iraq and Afghanistan

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Disasters and stress disorders◦Acute and 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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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

◦ A common form of victimization is sexual assault/rape Around 1 in 6 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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What Triggers a What Triggers a Psychological Stress Psychological Stress Disorder?Disorder?Victimization and stress disorders

◦Ongoing victimization and abuse in the family may also lead to stress disorders

◦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 Why Do People Develop a Psychological Stress Psychological Stress Disorder?Disorder? Clearly, extraordinary trauma can cause a stress

disorder◦ However, the event alone may not be the entire

explanation To understand the development of these

disorders, researchers have looked to the: ◦ Survivors’ biological processes

◦ Personalities

◦ Childhood experiences

◦ Social support systems

◦ Cultural backgrounds

◦ Severity of the traumas

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Why Do People Develop a Why Do People Develop a Psychological Stress Psychological Stress Disorder?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 Some research suggests abnormal

neurotransmitter and hormone activity (especially norepinephrine and cortisol)

Evidence suggests that other biological changes and damage may also occur (especially in the hippocampus and amygdala) as a stress disorder sets in

There may be a biological/genetic predisposition to such reactions

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Why Do People Develop a Why Do People Develop a Psychological Stress Psychological Stress Disorder?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 Why Do People Develop a Psychological Stress Psychological Stress Disorder?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 Why Do People Develop a Psychological Stress Psychological Stress Disorder?Disorder?Social support

◦ People whose social and family support systems are weak are more likely to develop a stress disorder after a traumatic event

Multicultural factors◦ A careful look at research literature

suggests that there may be important cultural differences in the occurrence of PTSD It seems that Hispanic Americans might be more

vulnerable to PTSD than other racial or ethnic groups Possible explanations include cultural beliefs systems,

and the cultural emphasis on social relationships

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Why Do People Develop a Why Do People Develop a Psychological Stress Psychological Stress Disorder?Disorder?Severity of the trauma

◦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 How Do Clinicians Treat the Psychological Stress Psychological Stress Disorders?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 How Do Clinicians Treat the Psychological Stress Psychological Stress Disorders?Disorders? Treatment for combat veterans

◦ Drug therapy Antianxiety and antidepressant medications are most common

◦ Behavioral exposure techniques Reduce specific symptoms, increase overall adjustment

Use flooding and relaxation training

Use eye movement desensitization and reprocessing (EMDR)

◦ Insight therapy Bring out deep-seated feelings, create acceptance, lessen guilt

Often use family or group therapy formats; rap groups

◦ Usually used in combinations

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How Do Clinicians Treat the How Do Clinicians Treat the Psychological Stress Psychological Stress Disorders?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 continues to call into question its effectiveness

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The Physical Stress The Physical Stress Disorders: Disorders: Psychophysiological Psychophysiological DisordersDisordersIn addition to affecting

psychological functioning, stress can also have an enormous impact on physical functioning

The idea that stress and related psychosocial factors may contribute to physical illnesses has ancient roots, but had few supporters before the 20th century

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The Physical Stress The Physical Stress Disorders: Disorders: Psychophysiological Psychophysiological DisordersDisordersAbout 80 years ago, clinicians first

identified a group of physical illnesses that seemed to result from an interaction of biological, psychological, and sociocultural factors

Early versions of the DSM labeled these illnesses psychophysiological, or psychosomatic, disorders◦DSM-IV-TR calls them psychological

factors affecting medical condition

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The Physical Stress The Physical Stress Disorders: Disorders: Psychophysiological Psychophysiological DisordersDisordersIt is important to recognize that

these psychophysiological disorders bring about actual physical damage◦They are different from “apparent”

physical illnesses like factitious disorders or somatoform disorders, which will be discussed in Chapter 6

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Traditional Traditional Psychophysiological Psychophysiological DisordersDisorders

Before the 1970s, the 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 Traditional Psychophysiological Psychophysiological DisordersDisordersUlcers

◦ Lesions (holes) in the wall of the stomach that result in burning sensations or pain, vomiting, and stomach bleeding

◦ Experienced by 20 million people at some point in their lives

◦ Causal psychosocial factors: Environmental pressure, anger, anxiety,

dependent personality style

◦ Causal physiological factors: Bacterial infection

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Traditional Traditional Psychophysiological Psychophysiological DisordersDisordersAsthma

◦ A periodic narrowing of the body’s 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, anxiety

◦ Causal physiological factors: Allergies, a slow-acting sympathetic nervous

system, weakened respiratory system

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Insomnia◦Difficulty falling asleep or maintaining

sleep

◦Affects 35% of people in the U.S. each year

◦Causal psychosocial factors: High levels of anxiety or depression

◦Causal physiological factors: Overactive arousal system, certain medical

ailments

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Chronic headaches ◦ Frequent intense aches of the head or neck

that are not caused by another physical disorder 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 Traditional Psychophysiological Psychophysiological DisordersDisordersHypertension

◦ Chronic high blood pressure, usually producing few outward symptoms

◦ Affects 65 million Americans each year ◦ Causal psychosocial factors:

Constant stress, 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 individual’s blood vessels

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Traditional Traditional Psychophysiological Psychophysiological DisordersDisorders Coronary heart disease

◦ Caused by blockage 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 Traditional Psychophysiological Psychophysiological DisordersDisordersA number of variables contribute

to the development of psychophysiological disorders, including:◦Biological factors

◦Psychological factors

◦Sociocultural factors

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Traditional Traditional Psychophysiological Psychophysiological DisordersDisordersBiological 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 Traditional Psychophysiological Psychophysiological DisordersDisordersPsychological factors

◦According to many theorists, certain needs, attitudes, emotions, or coping styles may cause people to overreact repeatedly to stressors – increasing their chances of developing psychophysiological disorders Examples: a repressive coping style, a

Type A personality style

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Traditional Traditional Psychophysiological Psychophysiological DisordersDisordersSociocultural factors

◦Adverse social conditions may set the stage for psychophysiological disorders One of society’s most negative social

conditions is poverty

Research also reveals that belonging to an ethnic or cultural minority group increases the risk of developing these disorders and other health problems

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New Psychophysiological New Psychophysiological DisordersDisorders

Clearly, biological, psychological, and sociocultural variables combine to produce psychophysiological disorders

In fact, 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 added to the list of psychophysiological disorders

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New Psychophysiological New Psychophysiological DisordersDisordersSince the 1960s, researchers

have found many links between psychosocial stress and a wide range of physical illnesses

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New Psychophysiological New Psychophysiological DisordersDisordersAre 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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stress?◦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 Researchers have even found a

relationship between traumatic stress and death

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stress?◦One shortcoming of the Social

Adjustment Rating Scale is that it does not take into consideration the particular stress reactions within specific populations For example, African Americans and

white Americans have been shown to react differently to certain life changes measured by the scale; college students face different stresses, etc.

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New Psychophysiological New Psychophysiological DisordersDisordersResearchers have increasingly

looked to the body’s 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 New Psychophysiological DisordersDisordersPsychoneuroimmunology

◦The immune system is the body’s 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 lymph system and the bloodstream, attacking invaders

Lymphocytes include helper T-cells, natural killer T-cells, and B-cells

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◦Researchers now believe that stress can interfere with the activity of lymphocytes, slowing them down and increasing a person’s susceptibility to viral and bacterial infections

◦Several factors influence whether stress will result in a slowdown of the system…

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New Psychophysiological New Psychophysiological DisordersDisorders

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 body’s endocrine glands reduce immune system functioning during periods of prolonged stress through the release of corticosteroids

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◦Behavioral changes Stress may set in 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 individual’s personality style (including

level of optimism, constructive coping strategies, and resilience) may also play a role in determining how much the immune system is slowed down by stress

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◦Social support 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 found that social support and affiliation with others may actually protect people from stress, poor immune system functioning, and subsequent illness, and can help speed up recovery from illness or surgery

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Psychological Treatments for Psychological Treatments for Physical DisordersPhysical Disorders

As clinicians have discovered that stress and related 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 Psychological Treatments for Physical DisordersPhysical DisordersThe 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 Psychological Treatments for Physical DisordersPhysical DisordersRelaxation training

◦People can be taught 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 headaches,

insomnia, asthma, diabetes, pain after surgery, certain vascular diseases, and the undesirable effects of cancer treatments

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Psychological Treatments for Psychological Treatments for Physical DisordersPhysical DisordersBiofeedback 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 headaches and muscular disabilities caused by stroke or accident

Some biofeedback training has been effective in the treatment of asthma, irregular heartbeat, migraine headaches, high blood pressure, stuttering, and pain

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Psychological Treatments for Psychological Treatments for Physical DisordersPhysical DisordersMeditation

◦Although meditation has been practiced since ancient times, Western health care professionals have only recently become aware of its effectiveness

◦Meditation is a technique of turning one’s concentration inward and achieving a slightly changed state of consciousness Meditation has been used to help manage

pain, treat high blood pressure, heart problems, insomnia, and asthma, skin disorders, diabetes, and even viral infections

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Psychological Treatments for Psychological Treatments for Physical DisordersPhysical DisordersHypnosis

◦Individuals undergoing hypnosis are guided into a sleeplike, suggestible state during which they can be directed to act in unusual ways, experience unusual sensations, remember seemingly forgotten events, or to forget remembered events With training, hypnosis can be done

without a hypnotist (self-hypnosis)

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Psychological Treatments for Psychological Treatments for Physical DisordersPhysical DisordersHypnosis

◦This technique is now used as an aid to psychotherapy and seems to be particularly helpful in the control of pain

◦It also is now used to treat such problems as skin diseases, asthma, insomnia, high blood pressure, warts, and other forms of infection

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Psychological Treatments for Psychological Treatments for Physical DisordersPhysical DisordersCognitive interventions

◦People with physical ailments have sometimes been taught new attitudes or cognitive responses as part of treatment One intervention is self-instruction

training which has helped patients cope with severe pain Patients are taught to rid themselves of

negative self-statements and to replace these with positive self-statements

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Psychological Treatments for Psychological Treatments for Physical DisordersPhysical DisordersInsight therapy and support

groups ◦If negative psychological symptoms

(e.g., depression, anxiety) contribute to a person’s physical ills, therapy to reduce these emotions should help reduce the ills

◦These techniques have been used to treat a variety of illnesses including HIV, asthma, cancer, headache, and arthritis

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Psychological Treatments for Psychological Treatments for Physical DisordersPhysical DisordersCombination approaches

◦Studies have found that the various psychological treatments for physical problems tend to be equal in effectiveness Psychological interventions are often of

greatest help when used in combination and with medical treatment

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Abnorm psych lecture pwrpt. ch05 spg. 2011