Chapter 5 Handouts

Chapter 5 Handouts - 0. 2. 3. 4. 5. 1. 2. Chapter 5...

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Unformatted text preview: 0. 2. 3. 4. 5. 1. 2. Chapter 5 Handouts Chapter 5 Handouts Stress, Coping, and the Anxiety Response The state of stress has two components: 0. ______________: event creating demands 1. ______________: reactions to the demands 0. Influenced by how we appraise (a) __________, and (b) ________________________________ 0. People who sense that they have the ability and resources to cope are more likely to take stressors in stride Stress, Coping, and the Anxiety Response When we appraise a stressor as threatening, the natural reaction is fear 1. Fear is a “package” of physical, emotional, and cognitive responses Stress reactions, and the fear they produce, are often at play in psychological disorders 2. 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 Stress, Coping, and the Anxiety Response Stress also plays a more central role in certain psychological disorders, including: 3. Acute stress disorder 4. Posttraumatic stress disorder 5. Technically, DSM­IV­TR lists these patterns as anxiety disorders …as well as certain physical disorders called psychophysiological disorders 6. These disorders are listed in the DSM­IV under “psychological factors affecting medical condition” Stress and Arousal: The Fight­or­Flight Response The features of arousal and fear are set in motion by the hypothalamus 6. Two important systems are activated: 7. ________________________________________ 1. An extensive network of nerve fibers that connect the central nervous system (the brain and spinal cord) to the body’s other organs 2. Contains two systems: sympathetic and parasympathetic 8. ________________________________________ 3. A network of glands throughout the body that release hormones Stress and Arousal: The Fight­or­Flight Response There are two pathways by which the ANS and the endocrine systems produce arousal and fear reactions: 7. Sympathetic nervous system 8. Hypothalamic­pituitary­adrenal pathway Stress and Arousal: Stress and Arousal: The Fight­or­Flight Response 3. When confronting a dangerous situation, the hypothalamus first activates the ____________________, which stimulates key organs either directly or indirectly 4. When the perceived danger passes, the ___________________________________ helps return bodily systems to normal Stress and Arousal: The Fight­or­Flight Response 5. The second pathway is the ______________ ____________________________________ 9. 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 Stress and Arousal: The Fight­or­Flight Response 6. The reactions displayed by these two pathways are referred to as the fight­or­flight response 7. People differ in their particular patterns of autonomic and endocrine functioning and therefore also in their particular ways of experiencing arousal and fear… Stress and Arousal: The Fight­or­Flight Response 8. People differ in: 10. Their general level of anxiety 9. Called “___________________” 10. Some people are usually somewhat tense; others are usually relaxed 11. Differences appear soon after birth 11. Their sense of threat 12. Called “___________________” 13. Situation­based (example: fear of flying) The Psychological Stress Disorders 12. During and immediately after trauma, many people become highly anxious and depressed 14. For some, feelings persist well after the trauma 4. These people may be experiencing: 5. Acute stress disorder 6. Posttraumatic stress disorder (PTSD) 15. The precipitating event usually involves actual or threatened serious injury to self or others 7. ____________________________________________________ (unlike other anxiety disorders) The Psychological Stress Disorders 9. Acute stress disorder 13. Symptoms begin within four weeks of event and last for less than one month 10. Posttraumatic stress disorder (PTSD) 10. 14. Symptoms can begin at any time following the event but must last for longer than one month 15. May develop from acute stress disorder The Psychological Stress Disorders 11. Symptoms of the two disorders include: 16. Re­experiencing the traumatic event 17. Avoidance 18. Reduced responsiveness 19. Increased arousal, anxiety, and guilt What Triggers a Psychological Stress Disorder? 16. Can occur at any age and affect all aspects of life 17. ~4% of U.S. population affected each year 18. ~7% of U.S. population affected sometime during life 19. Around 2/3 seek treatment at some point 20. Ratio of women to men is 2:1 8. After trauma, 20% of women and 8% of men develop disorders 21. Some events – including combat, disasters, abuse, and victimization – are more likely to cause disorders than others What Triggers a Psychological Stress Disorder? 20. Combat and stress disorders 22. It has long been recognized that soldiers experience distress during combat 9. Called “shell shock,” “combat fatigue” 10. Post­Vietnam War clinicians discovered that soldiers also experienced psychological distress after combat 23. ~______% of Vietnam combat veterans suffered acute or posttraumatic stress disorders 11. An additional 22% had some stress symptoms 12. 10% still experiencing problems What Triggers a Psychological Stress Disorder? 12. Disasters and stress disorders 21. Acute or posttraumatic stress disorders may also follow natural and accidental disasters 24. Civilian traumas have been implicated in stress disorders at least 10 times as often as combat trauma 25. Types of disasters include traffic accidents, weather, earthquakes, and airplane crashes What Triggers a Psychological Stress Disorder? 22. Victimization and stress disorders 26. People who have been abused, victimized, or terrorized often experience lingering stress symptoms 27. Common victimization is ___________________ 13. ~_________ women is raped at some time during her life 14. Psychological impact is immediate and may be long­lasting 14. 15. One study found that 94% of rape survivors developed an acute stress disorder within 12 days after assault What Triggers a Psychological Stress Disorder? 13. Victimization and stress disorders 0. Ongoing victimization and abuse in the family may also lead to stress disorders 1. The experience of terrorism or the threat of terrorism often leads to posttraumatic stress symptoms Why Do People Develop a Psychological Stress Disorder? 14. Clearly, extraordinary trauma can cause a stress disorder 23. _______________________________________ 15. 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 Why Do People Develop a Psychological Stress Disorder? 16. Biological and genetic factors 24. Traumatic events trigger physical changes in the brain and body that may lead to severe stress reactions, and, possibly, stress disorders 28. Some research suggests abnormal NT and hormone activity (especially norepinephrine and cortisol) 16. _______________________________________________ 29. Evidence suggests that other biological changes and damage may also occur as a stress disorder sets in Why Do People Develop a Psychological Stress Disorder? 25. Personality factors 30. Some studies suggest that people with certain personality profiles, attitudes, and coping styles are more likely to develop stress disorders 17. Risk factors include 0. Preexisting high anxiety 1. A history of psychological problems 2. Negative worldview 31. A set of positive attitudes (called resiliency or hardiness) is protective against developing stress disorders Why Do People Develop a Psychological Stress Disorder? 26. Negative childhood experiences 32. A wave of studies has found that certain childhood experiences increase risk for later stress disorders 33. Risk factors include: 18. An impoverished childhood 19. Psychological disorders in the family 20. The experience of assault, abuse, or catastrophe at an early age 21. Being younger than 10 years old when parents separated or divorced 21. Why Do People Develop a Psychological Stress Disorder? 27. Social support 34. People whose social support systems are weak are more likely to develop a stress disorder after a negative event 28. Severity of the trauma 29. The more severe the trauma and the more direct one’s exposure to it, the greater the likelihood of developing a stress disorder 35. Especially risky: mutilation and severe injury; witnessing the injury or death of others How Do Clinicians Treat the Psychological Stress Disorders? 17. Symptoms have been found to last an average of 3 years with treatment and 5½ years without treatment 30. Treatment type varies depending on type of trauma 31. General goals: 36. ____________________________________ 37. Gain perspective on traumatic experience 38. ____________________________________ How Do Clinicians Treat the Psychological Stress Disorders? 39. Treatment for combat veterans 22. ________________________________ 3. Antianxiety and antidepressant medications are most common 23. ________________________________ 4. Reduce specific symptoms, increase overall adjustment 5. Use flooding and relaxation training 6. Use eye movement desensitization and reprocessing (EMDR) 24. ________________________________ 7. Bring out deep­seated feelings, create acceptance, lessen guilt 8. Often use family or group therapy formats; rap groups 25. ________________________________ How Do Clinicians Treat the Psychological Stress Disorders? 40. Psychological debriefing 26. A form of crisis intervention that has victims of trauma talk extensively about their feelings and reactions within days of the critical incident 27. Four­stage approach: 9. Normalize responses to the disaster 10. Encourage expressions of anxiety, anger, and frustration 11. Teach self­help skills 12. Provide referrals 28. Relief workers themselves may become overwhelmed 29. Research on this type of intervention has called into question its effectiveness The Physical Stress Disorders: Psychophysiological Disorders The Physical Stress Disorders: Psychophysiological Disorders 18. In addition to affecting psychological functioning, stress can also have an enormous impact on physical functioning 19. The idea that stress and related psychosocial factors may contribute to physical illnesses has ancient roots – René Descartes called a variation on this idea _________________ The Physical Stress Disorders: Psychophysiological Disorders 20. About 80 years ago, clinicians first identified a group of physical illnesses that seemed to result from an interaction of psychosocial and physical factors 21. Early versions of the DSM labeled these illnesses psychophysiological, or psychosomatic, disorders 32. DSM­IV­TR calls them psychological factors affecting medical condition The Physical Stress Disorders: Psychophysiological Disorders 22. It is important to note that these psychophysiological disorders bring about ___________________________________ 33. They are different from “apparent” physical illnesses like factitious disorders or somatoform disorders, which are discussed in Chapter 6 Traditional Psychophysiological Disorders 23. 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 24. Recent research has shown that many other physical illnesses may be caused by an _____________________________________ Traditional Psychophysiological Disorders 34. ________________ 41. Lesions in the wall of the stomach that result in burning sensations or pain, vomiting, and stomach bleeding 42. Affect up to 20 million people at some point in their lives 43. Causal psychosocial factors: 30. Environmental stress, anger, anxiety, dependent personality style 44. Causal physiological factors: 31. Bacterial infection Traditional Psychophysiological Disorders 35. _________________ 45. A narrowing of the body’s airways that makes breathing difficult 46. Affects up to 20 million people in the U.S. each year 32. Most victims are children at the time of first attack 47. Causal psychosocial factors: 13. Environmental pressures, troubled family relationships, anxiety, high dependency 33. Causal physiological factors: 14. Allergies, a slow­acting sympathetic nervous system, weakened respiratory system Traditional Psychophysiological Disorders 25. ___________________ 25. 36. Difficulty falling asleep or maintaining sleep 37. Affects 35% of people in the U.S. each year 38. Causal psychosocial factors: 48. High anxiety or depression 39. Causal physiological factors: 49. Overactive arousal system, certain medical ailments Traditional Psychophysiological Disorders 40. __________________________ 50. Tension headaches affect 40 million Americans each year 51. Migraine headaches affect 23 million Americans each year 52. Causal psychosocial factors: 34. Environmental pressures; general feelings of helplessness, anger, anxiety, depression 53. Causal physiological factors: 35. Abnormal serotonin activity, vascular problems, muscle weakness Traditional Psychophysiological Disorders 41. ________________________ 54. Chronic high blood pressure, usually producing no overt symptoms 55. Affects 65 million Americans each year 56. Causal psychosocial factors: 36. Constant stress, constant environmental danger, general feelings of anger or depression 57. Causal physiological factors: 37. 10% caused by physiological factors alone 38. Obesity, smoking, poor kidney function, high proportion of collagen rather than elastic tissue in an individual’s blood vessels Traditional Psychophysiological Disorders 58. ___________________________ 39. Caused by a blocking of the coronary arteries 40. Includes angina pectoris (chest pain), coronary occlusion (complete blockage of a coronary artery, and myocardial infarction (heart attack) 41. Leading cause of death in men older than 35 years and women older than 40 years in the U.S. 42. Causal psychosocial factors: 15. Job stress, high levels of anger or depression 43. Causal physiological factors: 16. High level of cholesterol, obesity, hypertension, the effects of smoking, lack of exercise Traditional Psychophysiological Disorders 26. A number of factors contribute to the development of psychophysiological disorders, including: 42. Sociocultural factors 42. 43. Psychological factors 44. Biological variables Traditional Psychophysiological Disorders 27. Sociocultural factors 45. Stressful demands placed on people by their culture may ______________________ for psychophysiological disorders 59. Examples include poverty, violence, and nuclear threat (such as Three Mile Island) Traditional Psychophysiological Disorders 28. Psychological factors 46. 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 60. Examples: a repressive coping style, Type A personality style Traditional Psychophysiological Disorders 29. Biological factors 47. Defects in the autonomic nervous system (ANS) are believed to contribute to the development of psychophysiological disorders 48. Other more specific biological problems may also contribute 61. For example, a weak gastrointestinal system may create a predisposition to develop ulcers Traditional Psychophysiological Disorders 49. Clearly, sociocultural, psychological, and biological variables combine to produce psychophysiological disorders 50. Although once thought to be unusual, the interaction of psychosocial and physical factors is now considered the rule of bodily function, not the exception 51. In recent years, more and more illnesses have been placed in this category New Psychophysiological Disorders 30. Since the 1960s, researchers have found many links between psychosocial stress and a range of physical illnesses New Psychophysiological Disorders 31. Are physical illnesses related to stress? 52. The development of the Social Adjustment Rating Scale in 1967 enabled researchers to examine the relationship between life stress and the onset of illness New Psychophysiological Disorders 32. Are physical illnesses related to stress? 53. Using the Social Adjustment Rating Scale, __________________________________________________________ 54. Overall, the greater the amount of life stress, the greater the likelihood of illness 62. Researchers have even found a relationship between traumatic stress and death New Psychophysiological Disorders New Psychophysiological Disorders 33. Are physical illnesses related to stress? 55. One key weakness of the Social Adjustment Rating Scale is that it fails to take into account the particular stress reactions of specific populations 63. For example, women and men have been shown to react differently to certain life changes measured by the scale; college students face different stresses, etc. New Psychophysiological Disorders 34. Researchers have increasingly looked to the body’s immune system as the key to the relationship between stress and infection 35. This area of study is called psychoneuroimmunology New Psychophysiological Disorders 36. Psychoneuroimmunology 56. 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 64. Among the most important cells in this system are the lymphocytes 44. Lymphocytes are white blood cells that circulate through the blood system and attack the invaders 45. Lymphocytes include helper T­cells, natural killer T­cells, and B­cells New Psychophysiological Disorders 37. Psychoneuroimmunology 57. Researchers now believe that stress can interfere with the activity of lymphocytes, slowing them down and ______________________________ _______________________________________ 58. 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 New Psychophysiological Disorders 38. Psychoneuroimmunology 59. Biochemical activity 65. Stress leads to increased activity of the sympathetic nervous system, including a release of norepinephrine 66. In addition to supporting nervous system activity, this chemical also appears to slow down the functioning of the immune system 67. Similarly, the body’s endocrine glands reduce immune system functioning during periods of prolonged stress through the release of corticosteroids New Psychophysiological Disorders 60. Psychoneuroimmunology 68. Behavioral changes 46. 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 69. Personality style 47. An individual’s personality style, including their level of optimism, constructive 47. coping strategies, and resilience, plays a role in determining how much the immune system is slowed down by stress New Psychophysiological Disorders 39. Psychoneuroimmunology 61. Social support 70. Level of social support appears to play a role in immune system functioning 48. 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 49. Studies have shown that social support and affiliation with others may actually speed up recovery from illness or surgery Psychological Treatments for Physical Disorders 40. As clinicians have discovered that psychosocial factors may contribute to physical disorders, they have applied psychological treatment to more and more medical problems 62. The most common of these interventions are relaxation training, biofeedback training, meditation, hypnosis, cognitive interventions, insight therapy, and support groups Psychological Treatments for Physical Disorders 41. The field of treatment that combines psychological and physical interventions to treat or prevent medical problems is known as __________________________ Psychological Treatments for Physical Disorders 63. Relaxation training 71. People can be trained to relax their muscles at will, a process that sometimes reduces feelings of anxiety 72. Relaxation training can be of help in preventing or treating medical illnesses that are related to stress 50. Often used in conjunction with medication in the treatment of high blood pressure 51. Often used alone to treat chronic headaches, insomnia, and asthma Psychological Treatments for Physical Disorders 42. Biofeedback training 64. Patients given biofeedback training are connected to machinery that gives them continuous readings about their involuntary bodily activities 73. This procedure has been used successfully to treat pain from muscle tension, headaches, and muscular disabilities caused by stroke or accident 74. Some biofeedback training has been effective in the treatment of asthma, irregular heartbeat, migraine headaches, and high blood pressure Psychological Treatments for Physical Disorders 43. Meditation 65. Although meditation has been practiced since ancient times, Western clinicians have only recently become aware of its effectiveness in relieving physical distress 66. Meditation involves turning one’s concentration inward and changing one’s level of consciousness 44. Hypnosis 67. 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 76. With training, hypnosis can be done without a hypnotist (self­hypnosis) Psychological Treatments for Physical Disorders 45. Hypnosis 68. This technique is now used as an aid to psychotherapy and to treat medical conditions, including asthma, insomnia, high blood pressure, and infection Psychological Treatments for Physical Disorders 46. Cognitive interventions 69. People with physical ailments have sometimes been taught new attitudes or cognitive responses as part of treatment 77. One intervention is self­instruction training, in which patients are taught to rid themselves of negative self­statements and to replace these with positive self­ statements 78. This technique has been used in pain management, headaches, ulcers, and back disorders Psychological Treatments for Physical Disorders 47. Insight therapy and support groups 70. 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 71. These techniques have been used to treat a variety of illnesses including asthma, cancer, headache, and arthritis Psychological Treatments for Physical Disorders 48. Combination approaches 72. Studies have found that the various psychological treatments for physical problems tend to __________________________________ 79. Psychological treatments are often most effective when used in combination and with medical treatment 80. With these combined approaches, today’s practitioners are moving away from the mind­body dualism of centuries past 75. Meditation has been used to treat pain, high blood pressure, heart problems, 75. insomnia, and asthma Psychological Treatments for Physical Disorders ...
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