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Chapter5 - Chapter 5 Chapter 5 Stress and Physical and...

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Unformatted text preview: Chapter 5 Chapter 5 Stress and Physical and Mental Health (Part I) 0. Stress 1. Responses to stress Comment on stress in our lives 2. The reality of higher stress in our lives 0. 1. 2. 3. 4. 5. 6. 7. Since 9/11 concern with terrorism World instability The economy in trouble Loss of jobs and homes Uncertain future Increased work demands Rapid social change Instant communication Comment on stress in our lives 3. Life is stressful 8. We all face demands and adjustments 9. At any time we can be overwhelmed and develop psychological problems 10. Breakdown can be sudden (crisis) or slow (bad job) 11. Usually we recover after stress is past 12. However, effects can go on long afterward 0. E.g. increased vulnerability (physically/psychologically) Relationship between stress and Relationship between stress and psychopathology 4. Empirical evidence indicating stress contributes to increased probability of physical and psychological problems 5. Noted on axis IV of DSM 6. Disorders directly due to stress: adjustment and PTSD 7. Disorders facilitated by stress: mood, anxiety, schizophrenia, etc. What Is Stress? (Process) 8. Stress refers to both 13. The adjustive demands placed on an organism (a.k.a. stressors) (sources) 14. The organism’s internal biological and psychological responses to such demands 9. Stress is a by­product of poor or inadequate coping (mediator) 10.Both eustress (positive stress) and distress (negative stress) tax a person’s coping skills Categories of Stressors (Sources) 15. Frustrations can be caused by a wide range of 15. obstacles 1. May be external or internal (e.g. prejudice, physical handicaps, limited ability) 16. Conflicts result from the simultaneous occurrence of two or more needs or motives 2. (approach ­ approach; avoidance ­ avoidance) 17. Pressures force us to speed up or change the direction of goal­oriented behavior OSHA’s concern with stress in the work place (Sources) 11.Overload (quantitative and qualitative) 12.Inadequate rewards 13.Lack of autonomy 14.Conflict 15.Applicable to UGA? Factors Predisposing a Person to Stress (Mediators) Biological Effects of Stress (Responses) 16.Extreme or prolonged stress can bring about extensive physical and psychological problems 3. E.g. child repeatedly abused 4. Reduction in ability to adapt and deal with world 18. Stress can affect the sympathetic nervous and endocrine systems 19. Stress can affect the immune system 20. General effects of stress over time 20. Biological Effects of Stress (Responses) 17.Sympathetic­adreno­medullary (SAM) system 21. Mobilizes resources and prepares for a flight or fight response 22. Hypothalamus stimulates sympathetic nervous system causing adrenal medulla to secrete adrenaline resulting in an increase in heart rate and the metabolizing of glucose Biological Effects of Stress (Responses) 18.Hypothalamic­pituitary adrenocortical (HPA) system 23. Hypothalamus stimulates pituitary gland which secretes adrenocorticotropic hormone (ACTH) resulting in production of cortisol by adrenal cortex 24. Cortisol prepares body for flight or fight 5. Also inhibits immune response 0. (escape has priority over healing) 6. Will damage brain cells if not shut off Biological Effects of Stress (Responses) 19.Homeostasis – a “balanced” state when basic biological needs are being met (stress = imbalance) 20.Allostasis – 20. The process of adaptation or achieving stability through change 21.Allostatic load results in wear and tear on the body (greater load, lower adaptability) Biological Effects of Stress (Responses) 22.In the immune system, specialized white blood cells (B­cells and T­cells) respond to antigens such as viruses and bacteria 25. T cells are activated by cytokines released by macrophages 26. T cells and macrophages destroy antigens 23.These cells are assisted by 27. Natural killer cells: 7. Granulocytes and Macrophages Biological Effects of Stress (Responses) 24.Cytokines are chemical messengers that allow the brain and the immune system to communicate with each other 8. Protein molecules (immune system hormones) 25.Cytokines can either 28. challenge the immune system by causing an inflammatory response 29. dampen the response that the immune system makes when it is challenged Biological Effects of Stress (Responses) 26.Cytokines send information about injury and 26. infection to the brain 30. Brain influences immune system 27.Cytokines also stimulate HPA axis 31. Increases cortisol which suppresses immune responses 28.Thus interaction between brain and immune system (two­way effect) Biological Effects of Stress (Responses) 29.Stress can suppress immune responses (immunosuppression) . 30.Stress can increase immune responsiveness 31.Summary: chronic stress throws the immune system out of balance in ways that can compromise health Psychological Factors in Health and Disease 32.Psychoneuroimmunology is concerned with the interactions between 32. The nervous & immune systems 33. AND 34. Behavior & psychological states that influence immune functioning Biological Effects of Stress: General Adaptation Syndrome Biological Effects of Stress: Biological Effects of Stress: General Adaptation Syndrome 33.Alarm and mobilization (Phase 1) 35. Body's defenses begun by ANS 9. Autonomic arousal, higher vigilance, coping 34.Resistance (Phase 2) 36. Maximum use of body resources 10. Use of task oriented or defense oriented coping 35.Exhaustion (Phase 3) 37. Body's resources are depleted 11. Loss of ability to resist ­ can lead to illness or death Biological Effects of Stress (Responses) 36.Biological decompensation appears to involve the following biological responses: 38. Sympathetic nervous system 12. Fight or flight 39. Cardiovascular system 40. 41. 42. 43. 13. heart attacks, hypertension Muscular­skeletal system Gastrointestinal system Endocrine system Immune system (cancer) Biological Effects of Stress (Responses) 37.The effects of severe stress include: 44. 45. 46. 47. Lowered efficiency Depletion of adaptive resources Wear and tear on the biological systems Severe personality and physical deterioration 48. Death 48. The Biopsychosocial Model of Health Previously, disease was main cause of death (germs) Now, main causes of death: cardiovascular & cancer – related to stress Often, psychosocial causes Behavioral Medicine and Health Psychology 38.Behavioral medicine, an interdisciplinary field, focuses on the role that psychological factors play in the occurrence, maintenance, and prevention of medical problems 49. Takes into account psychological and social contributions to physical disorders 50. Provides a tool for conceptualizing and treating health problems Behavioral Medicine and Health Psychology 39.Health psychology deals with psychology’s contributions to the diagnosis, treatment, and prevention of psychological components of physical problems 51. Specialty within behavioral medicine – looking for psychological factors 14. E.g. predisposing factors, role of stress, psychological processes, compliance with medical advice Lifestyle Factors in Health and Illness Lifestyle Factors in Health and Illness 40.Lifestyles that contribute to stress 41.Habits or behavior patterns under our own control (e.g. smoking) 42.Related to leading causes of death 52. Coronary heart disease 53. Automobile accidents 54. Alcohol related deaths Lifestyle Patterns of Coping 43.Levels: biological, psychological, socio­cultural 44.Tasks: 55. Meet demands of stressor 56. Protect self from damage 45.Three styles: 57. 1.Proactive (task oriented) 58. 2.Defensive (defense mechanisms) 59. 3. Accommodating (reinterpreting situation) Task­oriented Style of Coping 46.1. A task­oriented (proactive) response involves 0. Making changes in one’s self, one’s surrounding, or both 1. Overt or covert action 2. Retreating, attacking, or compromising Defense­oriented Style of Coping 47.2. A defense­oriented (self­protective) response 47. may involve 60. Psychological damage repair mechanisms (e.g., crying, repetitive talking, and mourning) 61. Ego­defense mechanisms (e.g., denial, repression) 15. Designed to relieve tension and anxiety 16. Maladaptive when used extensively Accommodation­oriented Style of Coping 48.3. An accommodating­oriented response involves 62. Reinterpreting the situation 17. (the glass is half full instead of half empty) 18. Looking for the good that comes from things 63. “Working around” the problem and taking a different approach Health and Attitudes in Coping 49.Hopeless and helpless attitudes can have devastating effects on organic functioning 64. E.g. accelerates progression of atherosclerosis 50.Negative affect and anxiety appear to increase our susceptibility to certain health problems 65. E.g. depression and immune functioning 66. E.g. anger and anxiety and heart disease Health and Attitudes in Coping 51.Optimism appears to 67. Serve as a buffer against disease 68. Accelerate recovery 69. Potentially prevent a person from seeking necessary medical treatment 52.Positive affectivity (compassion, gratitude, humor, 52. spirituality, laughter) 70. Improve and increase immune functioning 71. Importance of positive psychology Stress and Physical and Mental Health (Part II) 53.Cardiovascular disease 72. Psycho­physiological disorders 54.Adjustment disorders 55.PTSD – post­traumatic stress disorders Psychophysiological Disorders 56.Psychophysiological disorders (formerly referred to as psychosomatic disorders) are disorders in which psychological factors are thought to play a role 73. Real medical conditions with real symptoms that involve psychological factors (not somatoform) 74. E.g. ulcers, headaches, asthma, cardiovascular disease, hypertension Cardiovascular Disease: Prevalence 57.Leading cause of death in U.S. 58.Hypertension (high blood pressure) 75. 76. 77. 50 million in U.S. Increases with age Is more common among 19. African Americans (possibly due to sociocultural factors 19. or diet) 20. People who do not use anger constructively Cardiovascular Disease: Description 59.Both genetics and stress contribute 78. Genetic predisposition toward higher cardiovascular reactivity 79. Stress compounds effect (e.g. anger) 60.Essential hypertension 80. Makes coronary heart disease and stroke more likely ­ contributing to blocking arteries and congestive heart failure Cardiovascular Disease: Process 61.Stress and hypertension 81. Stress causes blood vessels to visceral organs to constrict making the heart work harder 21. Results in the heart to beat faster and blood pressure to rise 82. Ideal blood pressure is 120 (diastolic) over 80 (systolic) Cardiovascular Disease: Outcome 62.Coronary heart disease (CHD) is a potentially lethal blockage of the arteries that supply blood to the heart muscle, or myocardium 83. Myocardial infarction: blockage of artery 84. Angina pectoris: chest pain due to low oxygen 85. Disturbance of pumping action 85. 86. Eventual outcome: death General Causal Factors in CHD & Physical Illness: Overview 63.In general, CHD & other physical illness are influenced by the following: 87. 88. 89. 90. 91. 1. Genetic and biological factors 2. Depression & anxiety 3. Personality 4. Social support & learning 5. Socio­cultural factors General Causal Factors in CHD & Physical Illness (1) 64.1. Certain biological/physiological factors must be a part of treatment considerations including 92. 93. 94. Genetic vulnerabilities Excessive autonomic reactivity Possible organ weaknesses General Causal Factors in CHD & Physical Illness (2) 65.2a. Depression 95. increased risk (5 times) 66.2b. Anxiety 96. risk for sudden cardiac death 67.(Likely third variable: stress) General Causal Factors in CHD & Physical General Causal Factors in CHD & Physical Illness (3a) 68.3a. Personality 97. Type A vs. type B 22. Type A – two fold increase in coronary heart disease 23. Type A – eight fold increase in myocardial infarction 24. Critical dimension: hostility (anger, contempt, scorn, cynicism, mistrust) 98. Type D – negative emotions, insecurity, anxiety 25. Higher risk for cancer Type A Behavior Pattern and Coronary Heart Disease General Causal Factors in CHD & Physical Illness (3b) 69.3b. Personality factors also include other characteristics (weakly but significantly correlated) 26. Disease prone personality – negativity 27. Disease resistant personality ­ positive General Causal Factors in CHD & Physical Illness (4) 99. 4a. Social support 28. Poor – marital unhappiness, loss of spouse – linked to illness 29. Good – lower blood pressure, better immune functioning 100. 4b. Classical/operant conditioning of the autonomic nervous system 30. E.g. staying at home from school every time upset 30. stomach – learn chronic indigestion General Causal Factors in CHD & Physical Illness (5) 70.5. Sociocultural factors include: 101. The fact that fewer cases of gastrointestinal and cardiovascular diseases occur in nonindustrialized society 102. A relationship between conditions that boost life stress and disease and physical and mental problems 31. Industrialization – illness CHD Treatments & Outcomes I 71.Biological measures for the treatment of CHD include 103. Surgery 104. Anticoagulants: e.g.. Aspirin 105. Anxiolytic (antianxiety) medications: e.g. xanax 106. SSRIs CHD Treatments & Outcomes II 72.Psychosocial measures for treatment of CHD include 107. 108. 109. Traditional psychotherapy 32. Emotional disclosure – (blowing off steam) Biofeedback Behavior therapy 33. Alter lifestyle behavior (smoking) 110. 110. Cognitive­behavior therapy: lowering stress CHD Treatment & Outcomes III 73.Sociocultural measures for treatment of CHD include 111. Focus on prevention 112. Efforts to alter the lifestyle behaviors of groups thought to be at risk 113. 114. 34. E.g. high school students ­ smoking Media persuasion Laws (such as anti­smoking laws) Problematic Psychological Reactions to Stress 74.Adjustment disorders: reactions to common life stressors 75.Post­traumatic stress disorders: reactions to catastrophic events 115. 116. Rape Military combat Adjustment disorder: Reactions to Common Life Stressors 76.A person is said to have an adjustment disorder if the person’s response to a common stressor 117. Is maladaptive (unable to function normally) 118. Occurs within 3 months of the stressor (and reaction lessons when stressor subsides) 77.Stressors that typically cause adjustment disorder include: 119. 119. Unemployment, bereavement, divorce Post­Traumatic Stress Disorder: Reactions to Catastrophic Events ­ Causes 78.Severe psychological and physical symptoms can result from sudden unexpected environmental crises 79.Plane crashes, automobile accidents, explosions, fires, earth quakes, tornados, sexual assaults, combat, physical assaults Post­Traumatic Stress Disorder: Reactions to Catastrophic Events ­ Symptoms 80.These severe symptoms can include 120. Persistently re­experiencing the traumatic event (intrusive, recurring thoughts) 121. Persistently avoiding stimuli associated with the trauma 122. Chronic tension, irritability, and insomnia 123. Impaired concentration and memory 124. Feelings of depression, apprehension, anxiety 125. Avoiding social interactions PTSD in the General Population ­ Prevalence 81.Half of all US adults will experience a traumatic 81. event, but only less than 10% will develop PTSD 82.Rates are lower in national populations with fewer disasters and lower crime 83.PTSD is twice as prevalent in women as in males 84.PTSD can occur with other disorders Acute Stress Disorder and PTSD 85.Acute stress disorder 126. Occurs within 4 weeks of a traumatic event 127. Lasts for a minimum of 2 days and a maximum of 4 weeks 86.If the symptoms last longer, the appropriate diagnosis is PTSD (symptoms must last at least a month) 128. 129. Acute PTSD (w/in 6 months) Delayed PTSD (after 6 months) Disaster Syndrome and PTSD 87.Initial response after trauma 130. 131. 132. Shock stage (stunned) Suggestible stage (passive) Recovery stage (appropriate responses) If poor recovery – PTSD can develop 35. (night mares, feeling overwhelmed) 36. (complicated by after effects of trauma – for example, injury) The Trauma of Rape and PTSD The Trauma of Rape and PTSD 88.Rape is the most common cause of post­traumatic stress disorder in women 89.Coping with rape involves several stages: 133. 1. Anticipatory phase (which begins before the rape) (may be denial) 134. 2. Impact phase (which occurs during the rape) (fear, paralysis, lack of coping) 135. 3. Post­traumatic recoil phase (which begins immediately after the rape) (guilt) 136. 4. Reconstitution phase (from leaving the emergency room until months later) The Trauma of Rape: Moderating Factors 90.Whether a rape victim will experience serious psychological problems depends to a large extent on her 137. 138. Past coping skills Level of psychological functioning 91.Some research suggests that women who disclose rape tend to have more positive and fewer negative reactions The Trauma of Rape: Effects 92.Physical disturbances (poor health) 93.Emotional problems (anxiety, depression) 94.Self concept issues (self­blame) 95.Cognitive difficulties (attention, concentration) 96.Behavioral problems (withdrawal) 97.Social distress (distrust, fears) 97. The Trauma of Military Combat and PTSD: History 98.WW I: “shell shock” 99.WW II: “war neurosis” 100. 101. 102. 139. (greatest single cause of loss of personnel) Korean conflict: “combat fatigue” Vietnam conflict: “ combat exhaustion” Iraq: “post­traumatic stress disorder” The Trauma of Military Combat: Prevalence 103. Post­traumatic stress disorder is quite common in soldiers especially 140. Soldiers involved in abusive violence 141. Soldiers involved in graves registration 142. Prisoners of war The Trauma of Military Combat: Effects 143. Physical effects: higher vulnerability to illness 144. Psychological effects: anxiety, depression, low frustration tolerance, insomnia, nightmares, anger control difficulties, attentional difficulties 145. Behavioral effects: drug and alcohol use 146. Social effects: withdrawal, conflict 147. Effects can last a life­time if not treated Other Causes of PTSD 104. Other causes of post­traumatic stress 104. disorder include 148. 149. 150. 151. 152. Exposure to war and combat (civilians) Imprisonment (50% of POWs) Forced migration (lower self­esteem) Being held hostage Torture (very high rate of PTSD) Causal factors in PTSD & other stress disorders 105. Features of the trauma: intensity, duration, extent and nature, control, anticipation 106. Features of the person: temperament, prior adjustment, immaturity, family history, coping style, guilt 107. Features of the post trauma environment: social support, acceptance of goals, group identification, other stressors Prevention of PTSD 108. Attempts to prepare a person in advance of a stressor has met with success in the military 109. This approach is now being used with people facing events such as major surgery and the breakup of a relationship Prevention of PTSD 110. Stress inoculation training ­ develop realistic and adaptive attitude 153. 153. 154. 155. Provide information about stressors Develop self­statements regarding coping Practice coping with stressful situation 111. Limited to situation where stressful situation is anticipated (e.g. surgery, combat, police/fire) Treatment of PTSD: Importance 112. Fortunately, majority of persons facing crisis or severe stress do not suffer seriously disruptive problems 156. Typically effects of crisis or stress dissipate over time after stress or crisis has passed 113. Unfortunately, some do experience PTSD and most persons who do suffer from PTSD do not seek help Treatment of PTSD: Immediate 114. Approaches to treatment include 157. 158. Telephone hotlines Short­term crisis intervention 37. Both above approaches: focus on immediate problem, clarify problem; suggest plan; provide reassurance; mobilize support Treatment of PTSD: Long­term 115. Approaches to treatment include 159. 160. Debriefing sessions 38. Provided for both victims as well as for disaster workers (opportunity to 'unwind') Psychotropic medications 39. Antidepressants (deal only with symptoms) 161. 161. Direct exposure therapy 40. For delayed PTSD; exposure techniques for reducing symptoms of PTSD Issue of Medication 116. The use of psychotropic medications could have unwelcome consequences including 162. 163. Suppression of natural warning signs Future reliance on medication End of Chapter 5 ...
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