Stress, Coping, and the Anxiety Response

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

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 Autonomic Nervous System

The Endocrine System

Pathways of Arousal and Fear

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?

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?

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

Psychological Factors Affecting Medical Condition

Psychological Factors Affecting Medical Condition

Traditional Psychophysiological Disorders

Traditional Psychophysiological Disorders

Traditional Psychophysiological Disorders

Traditional Psychophysiological Disorders

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

Traditional Psychophysiological Disorders

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

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

Psychoneuroimmunology

Psychoneuroimmunology

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

Psychological Treatments for Physical Disorders

Psychological Treatments for Physical Disorders

Psychological Treatments for Physical Disorders

Psychological Treatments for Physical Disorders

Psychological Treatments for Physical Disorders

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