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Stress, Coping, and the Anxiety Response. 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 • 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
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”
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
The Physical Stress Disorders: Psychophysiological Disorders • In addition to affecting psychological functioning, stress can also have great impact on physical functioning
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
Traditional Psychophysiological Disorders • A number of variables contribute to the development of psychophysiological disorders, including: • Biological factors • Psychological factors • Sociocultural factors
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
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
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
Psychological Treatments for Physical Disorders • Behavioral medicine - the field of treatment that combines psychological and physical interventions to treat or prevent medical problems
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