Transcript Chapter 6
Slides & Handouts by Karen Clay Rhines, Ph.D.
Seton Hall University
Chapter 6
Stress Disorders
Comer, Abnormal Psychology, 6e – Chapter 6
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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
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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 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
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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
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”
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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 the body’s other
organs
Contains two systems: sympathetic and parasympathetic
Endocrine system
A network of glands throughout the body that release hormones
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Stress and Arousal:
The Fight-or-Flight Response
There are two pathways by which the ANS and
the endocrine systems produce arousal and fear
reactions:
Sympathetic nervous system
Hypothalamic-pituitary-adrenal pathway
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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
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Stress and Arousal:
The Fight-or- Flight Response
The second pathway is the hypothalamicpituitary-adrenal (HPA) pathway
When confronted by stressors, the hypothalamus
sends a message to the pituitary gland, which signals
the adrenal cortex to release corticosteroids – the
stress hormones – into the bloodstream
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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…
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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)
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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)
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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 can begin at any time following the event
but must last for longer than one month
May develop from acute stress disorder
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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
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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
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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
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
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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
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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
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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 why only some people develop
stress disorders, researchers have looked to the
survivors’ biological processes, personalities,
childhood experiences, and social support
systems, and to the severity of the trauma itself
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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, 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
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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 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
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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
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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 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
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How Do Clinicians Treat the
Psychological Stress Disorders?
Symptoms have been found to last an average of
3 years with treatment and 5½ years without
treatment
Treatment type varies depending on type of trauma
General goals:
End lingering stress reactions
Gain perspective on traumatic experience
Return to constructive living
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How Do Clinicians Treat the
Psychological Stress Disorders?
Treatment for combat veterans
Drug therapy
Antianxiety and antidepressant medications are most common
Behavioral exposure therapy
Reduce specific symptoms, increase overall adjustment
Use flooding and relaxation training
Use eye movement desensitization and reprocessing (EMDR)
Insight therapy
Bring out deep-seated feelings, create acceptance, lessen guilt
Often use family or group therapy formats; rap groups
Usually used in combinations
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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 has called into question its
effectiveness
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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 – René Descartes called a variation
on this idea mind-body dualism
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The Physical Stress Disorders:
Psychophysiological Disorders
About 75 years ago, clinicians first identified a
group of physical illnesses that seemed to result
from an interaction of psychosocial and physical
factors
Early versions of the DSM labeled these
illnesses psychophysiological, or psychosomatic,
disorders
DSM-IV-TR calls them psychological factors
affecting medical condition
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The Physical Stress Disorders:
Psychophysiological Disorders
It is important to note 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
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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
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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
Affect up to 20 million people at some point in their lives
Causal psychosocial factors:
Environmental stress, anger, anxiety, dependent personality style
Causal physiological factors:
Bacterial infection
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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
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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 anxiety or depression
Causal physiological factors:
Overactive arousal system, certain medical ailments
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Traditional Psychophysiological
Disorders
Chronic headaches
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
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Traditional Psychophysiological
Disorders
Hypertension
Chronic high blood pressure, usually producing no overt
symptoms
Affects 65 million Americans each year
Causal psychosocial factors:
Constant stress, constant 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
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Traditional Psychophysiological
Disorders
Coronary heart disease
Caused by a blocking of 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
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Traditional Psychophysiological
Disorders
A number of factors contribute to the
development of psychophysiological disorders,
including:
Sociocultural factors
Psychological factors
Biological variables
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Traditional Psychophysiological
Disorders
Sociocultural factors
Stressful demands placed on people by their culture
may set the stage for psychophysiological disorders
Examples include poverty, violence, and nuclear threat
(such as Three Mile Island)
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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, thereby increasing
their likelihood of developing psychophysiological
disorders
Examples: a repressive coping style, Type A personality
style
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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
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Traditional Psychophysiological
Disorders
Clearly, sociocultural, psychological, and biological
variables combine to produce psychophysiological
disorders
Although once thought to be unusual, 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
placed in this category
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New Psychophysiological
Disorders
Since the 1960s, researchers have found many
links between psychosocial stress and a range of
physical illnesses
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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
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New Psychophysiological
Disorders
Are physical illnesses related to stress?
Using the Social Adjustment Rating Scale, studies
have consistently linked stresses 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
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New Psychophysiological
Disorders
Are physical illnesses related to stress?
One key weakness of the Social Adjustment Rating
Scale is that it fails to take into account the particular
stress reactions of specific populations
For example, women and men have been shown to react
differently to certain life changes measured by the scale
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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
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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
blood system and attack the invaders
Lymphocytes include helper T-cells, natural killer T-cells, and Bcells
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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
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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
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New Psychophysiological
Disorders
Psychoneuroimmunology
Behavioral changes
Stress may set into 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, plays a role in
determining how much the immune system is slowed down by stress
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New Psychophysiological
Disorders
Psychoneuroimmunology
Social support
Level of social support appears to play a role in immune
system functioning
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 shown that social support and affiliation with others
may actually speed up recovery from illness or surgery
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Psychological Treatments for
Physical Disorders
As clinicians have discovered that 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
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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
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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, and asthma
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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 pain
from muscle tension, headaches, and muscular disabilities
caused by stroke or accident
Some biofeedback training has been effective in the
treatment of asthma, irregular heartbeat, migraine
headaches, and high blood pressure
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Psychological Treatments for
Physical Disorders
Meditation
Although meditation has been practiced since
ancient times, Western clinicians have only recently
become aware of its effectiveness in relieving
physical distress
Meditation involves turning one’s concentration
inward and changing one’s level of consciousness
Meditation has been used to treat pain, high blood
pressure, heart problems, insomnia, and asthma
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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)
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Psychological Treatments for
Physical Disorders
Hypnosis
This technique is now used as an aid to
psychotherapy and to treat medical conditions,
including asthma, insomnia, high blood pressure,
and infection
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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 selfstatements and to replace these with positive selfstatements
This technique has been used in pain management,
headaches, ulcers, and back disorders
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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 asthma, cancer, headache, and
arthritis
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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 most effective 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
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