Chapter 6

1. Slides & Handouts by Karen Clay Rhines, Ph.D. Seton Hall University Chapter 6 Stress Disorders Comer, Fundamentals of Abnormal Psychology, 3e

2. 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 how we appraise (a) the event, and (b) 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 Comer, Fundamentals of Abnormal Psychology, 3e

3. Stress, Coping, and the Anxiety Response • When we appraise a stressor as threatening, the natural reaction is fear • Fear is a “package” of physical, emotional, and cognitive responses • 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 GAD, social phobia, panic disorder, and OCD, as well as other psychological problems Comer, Fundamentals of Abnormal Psychology, 3e

4. Stress, Coping, and the Anxiety Response • Stress also plays a more central role in certain psychological disorders, including: • Acute stress disorder • Posttraumatic stress disorder • 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” Comer, Fundamentals of Abnormal Psychology, 3e

5. 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 the body’s other organs • Contains two systems: sympathetic and parasympathetic • Endocrine system • A network of glands throughout the body that release hormones Comer, Fundamentals of Abnormal Psychology, 3e

6. Stress and Arousal: The Fight-or-Flight Response • When confronting a dangerous situation, the hypothalamus first activates the sympathetic nervous system, which stimulates key organs either directly or indirectly • When the perceived danger passes, the parasympathetic nervous system helps return bodily systems to normal Comer, Fundamentals of Abnormal Psychology, 3e

7. Stress and Arousal: The Fight-or-Flight Response • The reactions displayed by these two pathways are referred to as the fight-or-flight response • People differ in their particular patterns of autonomic and endocrine functioning and therefore also in their particular ways of experiencing arousal and fear… Comer, Fundamentals of Abnormal Psychology, 3e

8. Stress and Arousal: The Fight-or-Flight Response • People differ in: • Their general level of anxiety • Called “trait anxiety” • Some people are usually somewhat tense; others are usually relaxed • Differences appear soon after birth • Their sense of threat • Called “state anxiety” • Situation-based (example: fear of flying) Comer, Fundamentals of Abnormal Psychology, 3e

9. The Psychological Stress Disorders • During and immediately after trauma, many people become highly anxious and depressed • For some, feelings persist well after the trauma • These people may be experiencing: • Acute stress disorder • Posttraumatic stress disorder (PTSD) • The 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) Comer, Fundamentals of Abnormal Psychology, 3e

10. 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 Comer, Fundamentals of Abnormal Psychology, 3e

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12. 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 2:1 • 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 Comer, Fundamentals of Abnormal Psychology, 3e

13. What Triggers a Psychological Stress Disorder? • Combat and stress disorders • It has long been recognized that soldiers experience distress during combat • Called “shell shock,” “combat fatigue” • Post-Vietnam War clinicians discovered that soldiers also experienced psychological distress after combat • ~30% of Vietnam combat veterans suffered acute or posttraumatic stress disorders • An additional 22% had some stress symptoms • 10% still experiencing problems Comer, Fundamentals of Abnormal Psychology, 3e

14. What Triggers a Psychological Stress Disorder? • Disasters and stress disorders • Acute or posttraumatic stress disorders may also follow natural and accidental disasters • Civilian traumas have been implicated in stress disorders at least 10 times as often as combat trauma • Types of disasters include traffic accidents, weather, earthquakes, and airplane crashes Comer, Fundamentals of Abnormal Psychology, 3e

15. What Triggers a Psychological Stress Disorder? • Victimization and stress disorders • People who have been abused, victimized, or terrorized often experience lingering stress symptoms • Common victimization is sexual assault/rape • ~1 in 7 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 Comer, Fundamentals of Abnormal Psychology, 3e

16. 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, possibly, stress disorders • Some research suggests abnormal NT and hormone activity (especially norepinephrine and cortisol) • There may be a biological/genetic predisposition to such reactions • Evidence suggests that other biological changes and damage may also occur as a stress disorder sets in Comer, Fundamentals of Abnormal Psychology, 3e

17. Why Do People Develop a Psychological Stress Disorder? • Personality factors • Some studies suggest that people with certain personality profiles, attitudes, and coping styles are more likely to develop stress disorders • Risk factors include: • Preexisting high anxiety • A history of psychological problems • Negative worldview • A set of positive attitudes (called resiliency or hardiness) is protective against developing stress disorders Comer, Fundamentals of Abnormal Psychology, 3e

18. Why Do People Develop a Psychological Stress Disorder? • Negative childhood experiences • A wave of studies has 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 Comer, Fundamentals of Abnormal Psychology, 3e

19. 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 negative event • 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 Comer, Fundamentals of Abnormal Psychology, 3e

20. 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 • Relief workers themselves may become overwhelmed • Research on this type of intervention has called into question its effectiveness Comer, Fundamentals of Abnormal Psychology, 3e