Basic Statistics for the Behavioral Sciences
Chapter Six
Stress Disorders
*
Stress Disorders
Stressor:
External event or situation that places a physical or psychological demand on a person
Range from chronic i
itation to acute an traumatic events
Stress:
Internal psychological or physiological response to a stresso
*
Stress Disorders (cont’d.)
Figure 6-2 Five Leading Causes of Stress in America
Source: American Psychological Association (2010)
*
Acute and Posttraumatic Stress Disorders
Both begin with a normative reaction (“fight or flight”) that occurs when an individual faces some type of dange
Fear response remains even though original basis for fear is no longer present
*
Acute and Posttraumatic Stress Disorders (cont’d.)
Acute stress disorder (ASD):
Anxiety and dissociative symptoms that occur within one month after exposure to a traumatic stresso
Posttraumatic stress disorder (PTSD):
Anxiety, dissociative, and other symptoms that last for more than one month and that occur as a result of exposure to extreme trauma
*
Diagnosis of ASD and PTSD
DSM-V criteria:
Direct or indirect exposure to stresso
Intrusive symptoms and intense physiological reactivity associated with traumatic event
Persistent evasion of stimuli related to trauma
Alterations in cognitions and mood associated with event and inability to experience positive emotions
Heightened autonomic arousal or reactivity
*
Diagnosis of ASD and PTSD (cont’d.)
Differ in duration:
ASD lasts three days to one month
PTSD lasts longer than a month
An individual is likely to receive initial diagnosis of ASD and then PTSD if symptoms persist longer than a month
*
Etiology of ASD and PTSD
Figure 6-1 Multipath Model for PTSD The dimensions interact with one another and combine in different ways to result in PTSD.
*
Etiology of ASD and PTSD (cont’d.)
Factors associated with increased risk:
Higher magnitude stressors
More severe physical injuries
Multiple stressors
Rape and sexual assault
Individual characteristics
Perceptions of event
Specific vulnerabilities
*
Etiology of ASD and PTSD (cont’d.)
Biological dimension:
Sensitized autonomic system:
Nervous system has become highly reactive to fear and stress
PTSD is not a biologically normative stress response, but one in which neural and biological systems demonstrate increased reactivity resulting in hypersensitivity
Diminished ability to inhibit or extinguish conditioned fea
*
Etiology of ASD and PTSD (cont’d.)
Biological dimension:
Role of the amygdala and medial prefrontal cortex
Epinephrine and cortisol
One third of risk for PTSD due to genetics
Individuals with specific biological vulnerabilities predisposed to developing PTSD.
*
Etiology of ASD and PTSD (cont’d.)
Psychological dimension:
Specific psychological vulnerabilities have been identified, but precise role varies
Dysfunctional cognitions regarding oneself or environment
Positive cognitive styles reduce risk of PTSD
Preexisting conditions such as trait anxiety and depression found to be risk factors
*
Etiology of ASD and PTSD (cont’d.)
Social dimension:
Poor or inadequate support during childhood and adulthood
Social isolation
Lack of social support after trauma may be most important facto
Above average cognitive skills as protective factors
*
Etiology of ASD and PTSD (cont’d.)
Sociocultural dimension:
Recent immigrants and refugees from countries where there was civil conflict show elevated rates of stress disorders
Ethnic differences
Women are twice as likely as men to suffer stress disorde
*
Treatment of ASD and PTSD
Biological:
SSRI antidepressants
Psychological:
Psychotherapy focus on extinguishing fear or to co
ect dysfunctional cognitions
Exposure to cues associated with trauma
*
Psychological Factors Affecting Medical Conditions
Medical evidence suggests attitudes and emotional states have impact on physical well-being
Psychophysiological disorder:
Physical disorder that has a strong psychological basis or component
*
Psychological Factors Affecting Medical Conditions (cont’d.)
DSM-V criteria:
Medical condition is present
Psychological or behavioral factors are adversely influencing the medical condition in one of the following ways
Close temporal relationship between condition and psychological factors
Psychological factors interfere with treatment
Psychological factors cause additional health risk
Psychological factors influence physiology
*
Psychophysiological Disorders
Characteristics:
Actual tissue damage, a disease process, or physiological dysfunction
Medical treatment and psychotherapy usually required
Physical and psychological factors vary greatly
*
Psychophysiological Disorders (cont’d.)
Coronary heart disease:
The na
owing of cardiac arteries, resulting in restriction of partial blockage of flow of blood and oxygen to heart
Psychosocial risk factors
Depression
Perceived stress
Difficult life events
*
Psychophysiological Disorders (cont’d.)
Hypertension:
Chronic condition characterized by blood pressure of 140 over 90 or highe
Found in 28% of US adult population
Stressors impact blood pressure
*
Psychophysiological Disorders (cont’d.)
Migraine, tension, and cluster headaches:
Migraine headaches:
Moderate to severe pain resulting from constriction of the cranial arteries followed by dilation of cere
al blood vessels
Tension headaches:
Produced by prolonged contraction of scalp and neck muscles, resulting in vascular constriction and steady pain
*
Psychophysiological Disorders (cont’d.)
Migraine, tension, and cluster headaches:
Cluster headaches:
Excruciating sta
ing or burning sensations located in the eye or cheek
*
Psychophysiological Disorders (cont’d.)
Asthma:
Chronic inflammatory disease of the airways in the lungs, in which the airways become constricted, making it difficult to empty the lungs and therefore reducing the amount of air that can be inhaled
*
Psychophysiological Disorders (cont’d.)
Stress and the immune system:
Stress itself does not appear to cause infections, but it may decrease immune system’s efficiency thereby making one more susceptible to disease
Part of stress response involves release of several neurohormones that can impair immune functioning
*
Psychophysiological Disorders (cont’d.)
Exposure to chronic stress appears to increase vulnerability to infection and accelerates progression of disease by decreasing immunity
Connection between stress and naturally occu
ing cancer has yet to be demonstrated
*
Etiology of Psychophysiological Disorders
Figure 6-9 Multipath Mode for Psychophysiological Disorders The dimensions interact with one another and combine in different ways to result in a specific psychophysiological disorder.
*
Etiology of Psychophysiological Disorders (cont’d.)
Biological dimension:
Stressors can dysregulate HPA axis and sympathetic nervous system through release of neurohormones (e.g., norepinephrine, catecholamines, and cortisol)
Changes in
ain structure and in the stress-responsive neurobiological systems due to environmental influences
Genetic influences
*
Etiology of Psychophysiological Disorders (cont’d.)
Psychological dimension:
Psychological and personality characteristics can mediate effects of exposure to stressors
Positive affect: optimism, happiness, joy, and contentment
Hardiness: commitment, control, and challenge
Personal control and perception of control
Positive emotions: optimism
Negative emotional states can elevate risk: depression, hostility, anxiety, and cynicism
*
Etiology of Psychophysiological Disorders (cont’d.)
Social dimension:
Childhood adversities linked to adult onset headaches
Divorce, separation, and a
asive marital relations all linked to negative health changes
Strong and positive social network linked to positive health
High quality relationships linked to reduced physiological reactivity to stress
*
Etiology of Psychophysiological Disorders (cont’d.)
Sociocultural dimension:
Conflicts with societal standards
Discrimination and exposure to racism
Cultural expectations
Cultural changes
Women more likely to be impacted by stress due to care-giving role
*
Treatment of Psychophysiological Disorders
Relaxation training:
Learn to relax muscles of the body in almost any circumstances
Biofeedback training:
Learn voluntary control of specific physiological function of interest (e.g., heart rate, blood pressure)
*
Treatment of Disorders (cont’d.)
Cognitive-behavioral intervention:
Anger management
Social-cognitive processing programs to help find validation and meaning
Improve coping skills and manage stress
*
Future Directions in Research
Must consider biological, psychological, social, and sociocultural dimensions
Areas of interest:
Biology of stress
Psychological characteristics
Social networks
Sociocultural factors
*
Basic Statistics for the Behavioral Sciences
Chapter Six
Stress Disorders
*
Stress Disorders
Stressor:
External event or situation that places a physical or psychological demand on a person
Range from chronic i
itation to acute an traumatic events
Stress:
Internal psychological or physiological response to a stresso
*
Stress Disorders (cont’d.)
Figure 6-2 Five Leading Causes of Stress in America
Source: American Psychological Association (2010)
*
Acute and Posttraumatic Stress Disorders
Both begin with a normative reaction (“fight or flight”) that occurs when an individual faces some type of dange
Fear response remains even though original basis for fear is no longer present
*
Acute and Posttraumatic Stress Disorders (cont’d.)
Acute stress disorder (ASD):
Anxiety and dissociative symptoms that occur within one month after exposure to a traumatic stresso
Posttraumatic stress disorder (PTSD):
Anxiety, dissociative, and other symptoms that last for more than one month and that occur as a result of exposure to extreme trauma
*
Diagnosis of ASD and PTSD
DSM-V criteria:
Direct or indirect exposure to stresso
Intrusive symptoms and intense physiological reactivity associated with traumatic event
Persistent evasion of stimuli related to trauma
Alterations in cognitions and mood associated with event and inability to experience positive emotions
Heightened autonomic arousal or reactivity
*
Diagnosis of ASD and PTSD (cont’d.)
Differ in duration:
ASD lasts three days to one month
PTSD lasts longer than a month
An individual is likely to receive initial diagnosis of ASD and then PTSD if symptoms persist longer than a month
*
Etiology of ASD and PTSD
Figure 6-1 Multipath Model for PTSD The dimensions interact with one another and combine in different ways to result in PTSD.
*
Etiology of ASD and PTSD (cont’d.)
Factors associated with increased risk:
Higher magnitude stressors
More severe physical injuries
Multiple stressors
Rape and sexual assault
Individual characteristics
Perceptions of event
Specific vulnerabilities
*
Etiology of ASD and PTSD (cont’d.)
Biological dimension:
Sensitized autonomic system:
Nervous system has become highly reactive to fear and stress
PTSD is not a biologically normative stress response, but one in which neural and biological systems demonstrate increased reactivity resulting in hypersensitivity
Diminished ability to inhibit or extinguish conditioned fea
*
Etiology of ASD and PTSD (cont’d.)
Biological dimension:
Role of the amygdala and medial prefrontal cortex
Epinephrine and cortisol
One third of risk for PTSD due to genetics
Individuals with specific biological vulnerabilities predisposed to developing PTSD.
*
Etiology of ASD and PTSD (cont’d.)
Psychological dimension:
Specific psychological vulnerabilities have been identified, but precise role varies
Dysfunctional cognitions regarding oneself or environment
Positive cognitive styles reduce risk of PTSD
Preexisting conditions such as trait anxiety and depression found to be risk factors
*
Etiology of ASD and PTSD (cont’d.)
Social dimension:
Poor or inadequate support during childhood and adulthood
Social isolation
Lack of social support after trauma may be most important facto
Above average cognitive skills as protective factors
*
Etiology of ASD and PTSD (cont’d.)
Sociocultural dimension:
Recent immigrants and refugees from countries where there was civil conflict show elevated rates of stress disorders
Ethnic differences
Women are twice as likely as men to suffer stress disorde
*
Treatment of ASD and PTSD
Biological:
SSRI antidepressants
Psychological:
Psychotherapy focus on extinguishing fear or to co
ect dysfunctional cognitions
Exposure to cues associated with trauma
*
Psychological Factors Affecting Medical Conditions
Medical evidence suggests attitudes and emotional states have impact on physical well-being
Psychophysiological disorder:
Physical disorder that has a strong psychological basis or component
*
Psychological Factors Affecting Medical Conditions (cont’d.)
DSM-V criteria:
Medical condition is present
Psychological or behavioral factors are adversely influencing the medical condition in one of the following ways
Close temporal relationship between condition and psychological factors
Psychological factors interfere with treatment
Psychological factors cause additional health risk
Psychological factors influence physiology
*
Psychophysiological Disorders
Characteristics:
Actual tissue damage, a disease process,