Transcript Comer, Abnormal Psychology, 7th edition

Stress Disorders
Chapter 6
Slides & Handouts by Karen Clay Rhines, Ph.D.
Northampton Community College
Comer, Abnormal Psychology, 7e
Stress, Coping, and the
Anxiety Response

The state of stress has two components:

Stressor – event that creates demands

Stress response – person’s reactions to the
demands

Influenced by how we appraise 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 constructively
Comer, Abnormal Psychology, 7e
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Stress, Coping, and the
Anxiety Response

When we appraise a stressor as
threatening, the natural reaction is 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
Comer, Abnormal Psychology, 7e
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Stress, Coping, and the
Anxiety Response

Stress 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”
Comer, Abnormal Psychology, 7e
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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
Comer, Abnormal Psychology, 7e
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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
Comer, Abnormal Psychology, 7e
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Stress and Arousal:
The Fight-or-Flight Response

When 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
Comer, Abnormal Psychology, 7e
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Comer, Abnormal Psychology, 7e
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Stress and Arousal:
The Fight-or- Flight Response

The second pathway is the
hypothalamic-pituitary-adrenal (HPA)
pathway

When confronted by stressors, the
hypothalamus signals the pituitary gland,
which stimulates the adrenal cortex to
release corticosteroids – stress hormones –
into the bloodstream
Comer, Abnormal Psychology, 7e
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Comer, Abnormal Psychology, 7e
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Stress and Arousal:
The Fight-or-Flight Response

The 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…
Comer, Abnormal Psychology, 7e
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Stress and Arousal:
The Fight-or-Flight Response

People 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)
Comer, Abnormal Psychology, 7e
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The Psychological
Stress Disorders

During and immediately after trauma, we
may temporarily experience levels of
arousal, anxiety, and depression

For some, symptoms persist well after the
trauma


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)
Comer, Abnormal Psychology, 7e
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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
Comer, Abnormal Psychology, 7e
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Comer, Abnormal Psychology, 7e
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What Triggers a Psychological
Stress 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 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
Comer, Abnormal Psychology, 7e
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What Triggers a Psychological
Stress Disorder?

Combat and stress disorders

For years clinicians have recognized that
soldiers experience distress during combat



As many as 29% of Vietnam combat veterans
suffered acute or posttraumatic stress disorders



Called “shell shock” or “combat fatigue”
Post-Vietnam War clinicians discovered that soldiers
also experienced psychological distress AFTER combat
An additional 22% had some stress symptoms
10% still experiencing problems
A similar pattern is currently unfolding among
veterans of wars in Iraq and Afghanistan
Comer, Abnormal Psychology, 7e
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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

Civilian traumas have been implicated in
stress disorders at least 10 times as often as
combat traumas
Comer, Abnormal Psychology, 7e
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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
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 longlasting
One study found that 94% of rape survivors developed
an acute stress disorder within 12 days after assault
Comer, Abnormal Psychology, 7e
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What Triggers a Psychological
Stress 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
Comer, Abnormal Psychology, 7e
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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
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
Comer, Abnormal Psychology, 7e
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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

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
Comer, Abnormal Psychology, 7e
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Why Do People Develop a
Psychological Stress Disorder?

Personality factors

Some studies suggest that people with certain
personality profiles, attitudes, and coping styles
are particularly 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, Abnormal Psychology, 7e
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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
Comer, Abnormal Psychology, 7e
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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
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 early dissociative reactions
to trauma, cultural beliefs systems, and the cultural
emphasis on social relationships
Comer, Abnormal Psychology, 7e
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Why Do People Develop a
Psychological Stress 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
Comer, Abnormal Psychology, 7e
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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

Symptoms have been found to last an average of 3
years with treatment and 5½ years without
treatment

Treatment procedures vary depending on type of trauma

General goals:

End lingering stress reactions

Gain perspective on painful experiences

Return to constructive living
Comer, Abnormal Psychology, 7e
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How Do Clinicians Treat the
Psychological Stress Disorders?

Treatment for combat veterans

Drug therapy


Behavioral exposure techniques




Reduce specific symptoms, increase overall adjustment
Use flooding and relaxation training
Use eye movement desensitization and reprocessing (EMDR)
Insight therapy



Antianxiety and antidepressant medications are most
common
Bring out deep-seated feelings, create acceptance, lessen
guilt
Often use family or group therapy formats; rap groups
Usually used in combinations
Comer, Abnormal Psychology, 7e
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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 continues to call into
question its effectiveness
Comer, Abnormal Psychology, 7e
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The Physical Stress Disorders:
Psychophysiological Disorders

In 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
somatic illnesses has ancient roots, but had
few supporters before the 20th century

17th century philosopher René Descartes called
a variation on the idea mind–body dualism
Comer, Abnormal Psychology, 7e
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The Physical Stress Disorders:
Psychophysiological Disorders

About 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
Comer, Abnormal Psychology, 7e
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Comer, Abnormal Psychology, 7e
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The Physical Stress Disorders:
Psychophysiological Disorders

It 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 7
Comer, Abnormal Psychology, 7e
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Traditional Psychophysiological
Disorders

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
Comer, Abnormal Psychology, 7e
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Traditional Psychophysiological
Disorders

Ulcers



Lesions 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
Comer, Abnormal Psychology, 7e
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Traditional Psychophysiological
Disorders

Asthma

A narrowing of the body’s airways that makes breathing
difficult

Affects up to 20 million people in the U.S. each year


Causal psychosocial factors:


Most victims are children at the time of first attack
Environmental pressures, troubled family relationships,
anxiety, high dependency
Causal physiological factors:

Allergies, a slow-acting sympathetic nervous system,
weakened respiratory system
Comer, Abnormal Psychology, 7e
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Traditional Psychophysiological
Disorders

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
Comer, Abnormal Psychology, 7e
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Traditional Psychophysiological
Disorders

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
Comer, Abnormal Psychology, 7e
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Traditional Psychophysiological
Disorders

Hypertension



Chronic high blood pressure, usually producing
no 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
Comer, Abnormal Psychology, 7e
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Traditional Psychophysiological
Disorders

Coronary heart disease

Caused by blockage in 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
Comer, Abnormal Psychology, 7e
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Traditional Psychophysiological
Disorders

A number of variables contribute to
the development of
psychophysiological disorders,
including:

Biological factors

Psychological factors

Sociocultural factors
Comer, Abnormal Psychology, 7e
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Traditional Psychophysiological
Disorders

Biological 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
Comer, Abnormal Psychology, 7e
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Traditional Psychophysiological
Disorders

Psychological factors

According to many theorists, certain
needs, attitudes, emotions, or coping
styles may cause people to repeatedly
overreact to stressors – increasing their
chances of developing psychophysiological
disorders

Examples: a repressive coping style, a Type A
personality style
Comer, Abnormal Psychology, 7e
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Traditional Psychophysiological
Disorders

Sociocultural factors

Adverse social conditions may set the stage for
psychophysiological disorders

Stressors may be wide-ranging (e.g., nuclear threat,
like Three Mile Island) or local (e.g., living in a crimeridden neighborhood)

One of society’s most adverse 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
Comer, Abnormal Psychology, 7e
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Traditional Psychophysiological
Disorders

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
Comer, Abnormal Psychology, 7e
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New Psychophysiological
Disorders

Since the 1960s, researchers have
found many links between
psychosocial stress and a wide range
of physical illnesses
Comer, Abnormal Psychology, 7e
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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
Comer, Abnormal Psychology, 7e
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Comer, Abnormal Psychology, 7e
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New Psychophysiological
Disorders

Are physical illnesses related to 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
Comer, Abnormal Psychology, 7e
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New Psychophysiological
Disorders

Are physical illnesses related to 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, women and men have been
shown to react differently to certain life
changes measured by the scale
Comer, Abnormal Psychology, 7e
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New Psychophysiological
Disorders

Researchers 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
Comer, Abnormal Psychology, 7e
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New Psychophysiological
Disorders

Psychoneuroimmunology

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
Comer, Abnormal Psychology, 7e
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New Psychophysiological
Disorders

Psychoneuroimmunology

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, including
biochemical activity, behavioral changes,
personality style, and degree of social support
Comer, Abnormal Psychology, 7e
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New Psychophysiological
Disorders

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
Comer, Abnormal Psychology, 7e
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New Psychophysiological
Disorders

Psychoneuroimmunology

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 their 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
Comer, Abnormal Psychology, 7e
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New Psychophysiological
Disorders

Psychoneuroimmunology

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
Comer, Abnormal Psychology, 7e
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Psychological Treatments for
Physical 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
Comer, Abnormal Psychology, 7e
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Psychological Treatments for
Physical Disorders

The field of treatment that combines
psychological and physical
interventions to treat or prevent
medical problems is known as
behavioral medicine
Comer, Abnormal Psychology, 7e
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Psychological Treatments for
Physical Disorders

Relaxation training


People can be trained 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 chronic headaches, insomnia,
asthma, pain after surgery, certain vascular diseases,
and the undesirable effects of cancer treatments
Comer, Abnormal Psychology, 7e
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Psychological Treatments for
Physical Disorders

Biofeedback 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
from burns
Comer, Abnormal Psychology, 7e
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Psychological Treatments for
Physical Disorders

Meditation

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 treat pain, high blood
pressure, heart problems, insomnia, and asthma
Comer, Abnormal Psychology, 7e
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Psychological Treatments for
Physical Disorders

Hypnosis

Individuals undergoing hypnosis are
guided into a sleeplike, suggestible state
during which they can be directed to act in
unusual ways, to remember unusual
sensations, or to forget remembered events

With training, hypnosis can be done without a
hypnotist (self-hypnosis)
Comer, Abnormal Psychology, 7e
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Psychological Treatments for
Physical Disorders

Hypnosis

This technique seems to be particularly
helpful in the control of pain; is now used
to treat such problems as skin diseases,
asthma, insomnia, high blood pressure,
warts, and other forms of infection
Comer, Abnormal Psychology, 7e
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Psychological Treatments for
Physical Disorders

Cognitive interventions

People with physical ailments have
sometimes been taught new attitudes or
cognitive responses as part of treatment

One intervention is self-instruction training,
in which patients are taught to rid themselves
of negative self-statements and to replace
these with positive self-statements
Comer, Abnormal Psychology, 7e
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Psychological Treatments for
Physical Disorders

Insight therapy and support groups

If negative psychological symptoms (e.g.,
depression, anxiety) contribute to a
person’s physical ills, therapy to address
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
Comer, Abnormal Psychology, 7e
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Psychological Treatments for
Physical Disorders

Combination approaches

Studies have found that the various
psychological treatments for physical
problems tend to be equal in effectiveness

Psychological treatments are often of greatest
help when used in combination and with
medical treatment

With these combined approaches, today’s
practitioners are moving away from the mind–
body dualism of centuries past
Comer, Abnormal Psychology, 7e
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