35 - Stress, Chronic Stress and Traumatic Stress Flashcards

1
Q

Describe the level of stress that allows the highest level of functioning

A
  • Normative stress or “just a little stress”

- This is motivational and helpful for performance

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2
Q

What are the other levels of stress?

A

High level stress

  • Inhibits functioning
  • Does NOT improve performance

Traumatic stress

  • Terror
  • Does NOT improve performance
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3
Q

Describe an acute stressor

A
  • You go from baseline to acute stress

- After the acute stress response, you go through a period of recovery then go back to baseline

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4
Q

Describe a chronic stressor

A
  • Stressor continues over time
  • There is an alteration in the psychophysiology
  • There is NO period of recovery or baseline, you are constantly under stress

Growing up in an abusive house or serving as a soldier in Afghanistan

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5
Q

Define stress

A

a disruption of the body’s normal balance

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6
Q

Define stress response

A

the body’s attempt at regaining homeostasis

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7
Q

What did Hans Selye label environmental challenges or “stress”?

A

The body’s stress response is unrelated to the type of stressor (key = whatever the individual views as a threat)

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8
Q

What are the three stages of the adaptation response?

A

The three stages of the adaptation response are:

  • Alarm – the body’s natural initial response
  • Resistance – mobilization of defenses
  • Exhaustion – response to prolonged stress
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9
Q

What does prolonged or chronic stress cause?

A

Prolonged (chronic) stress can cause disease, “diseases of adaptation”

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10
Q

Define homeostasis

A

the collective processes that maintain an internal equilibrium

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11
Q

Define stress

A

the presence of significant physiological or psychological threat resulting in acute or persistent strain on the body’s compensatory systems

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12
Q

Define allostasis

A

the activity that is required for the individual to “maintain stability through change, i.e., to adapt.”

Laying on the floor takes no energy to balance, but doing yoga takes a lot of energy to balance

Allostasis is the PROCESS of maintaining hoeostasis by ACTIVE means

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13
Q

What is the allostatic load?

A

Cost of maintaining homeostasis to the body and brain –> physiological wear and tear

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14
Q

What are the two branches of the ANS?

A
  • Sympathetics

- Parasympathetics

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15
Q

Describe what stress does to the sympathetic nervous system

A

When you’re stressed, the sympathetics are the first thing that are activated

  • Fight or flight response
  • Increased HR, BP, SV, bronchial dilation, metabolism, circulation to brain, muscle, heart
  • Decreased circulation to stomach, skin, kidney, reproductive organs
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16
Q

Describe what stress does to the parasympathetic nervous system

A
  • Aroused in states of rest and relaxation but ALSO the FREEZE response
  • If you have been a victim of abuse, the freeze response may have been the best choice, so now when you’re under stress, you feel as if you can’t move, you”freeze”
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17
Q

What are the two major sources of stress?

A
  • Outside environment (physiological/biological)

- Inside our mind (psychological)

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18
Q

Describe the outside environment as a source of stress

A

Bottom up physiological response

  • Signals from the body’s sensory system progress through the spinal cord to reach the brainstem, followed by the hypothalamus and limbic system that evoke reflex responses to maintain homeostasis
  • Higher brain centers shape appropriate emotional & behavioral responses
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19
Q

Describe inside our minds as a source of stress

A

Top down response
- Top-down response mechanisms originate as thoughts or learned reactions and behaviors in the higher cognitive centers in the brain

If you’ve been raped before, and you hear foot steps behind out, your stress reaction is more so from your psychological state than the actual stressor

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20
Q

What do you need to know about chronic stress?

A

Chronic stress is NEUROTOXIC ***

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21
Q

What neurotransmitters cause neurotoxicity when exposed to chronic stress

A
  • Adrenalin

- Cortisol

22
Q

Describe adrenalin as a neurotoxin

A
  • Increases the encoding of implicit memory blocks

- Strengthens the synaptic connections

23
Q

Describe cortisol as a neurotoxin

A
  • Kills existing neurons & destroys synapses in the hippocampus
  • Especially vulnerable during developmental period
  • Results in impaired integration of memory
24
Q

What are the effects of chronic cortisol release?

A
  • Impaired memory
  • Suppressed immune system
  • Weakened muscles
  • Increased blood pressure
  • Hardening of arteries
  • Inflammation
  • Colitis
  • Loss of libido
  • Adult onset diabetes
25
Q

What are the implications of chronic stress?

A
  • The need to adjust to early life stressors increases allostatic load
  • This physiological cost accumulates over time across multiple systems
  • These systems become dysregulated resulting in multiple physical & emotional symptoms
26
Q

What are the effects of chronic stress on children?

A
  • Avoidant coping
  • Overly aggressive responses to stressors that cannot be avoided
  • Coping styles that develop are ineffective in reducing stress
27
Q

Describe the “powerfully destructive cycle” of chronic toxic stress and trauma

A
  • Increased allostatic load
  • Leads to biological embedding (neural encoding)
  • This results in chronic behavioral problems and/or medical conditions
  • There are implications for academic and vocational achievement and expanding disparity
  • This causes more chronic toxic stress and/or trauma
28
Q

What is the definition of trauma?

A

“Individual trauma results from an event, series of events, or set of circumstances that is experienced by an individual as physically or emotionally harmful or threatening and that has lasting adverse effects on the individual’s functioning and physical, social, emotional, or spiritual well-being.”

The three Es:

  • Event
  • Experienced
  • Effects
29
Q

What are the intervening variables for trauma?

A
  • Genetic vulnerability – individual susceptibility
  • Intensity of trauma
  • Frequency & duration (acute, short, chronic)
  • Developmental level
  • Effects of previous stressors
  • Subjective assessment of coping ability
  • Availability of external support & resources
  • Attached meanings & implications
30
Q

Describe the factors that effect how an individual handles trauma in relation to developmental level

A
  • Cognitive & emotional development
  • Sense of self
  • Strength and adaptiveness of defenses
31
Q

Describe the factors that effect how an individual handles trauma in relation to the attached meanings and implications of the trauma

A
  • Conscious meanings
  • Unconscious or symbolic meanings
  • Associations to previous stressors
  • Cultural implications
32
Q

What is impersonal trauma?

A
  • Disasters (natural and human related)

- Accidents (can be related to human action/inaction)

33
Q

What is personal trauma? What are the types?

A

HUMAN initiated
- Can be intentional or unintentional

Attachment trauma
- Family, partner or significant other person is abusive

Interpersonal trauma
- Acquaintance or stranger is abusive

Self-directed
- Self harm and suicide

Systemic
- Social, political, economic, religious, spiritual, ethnic, genoside, war

34
Q

What are the characteristics of the worst traumas?

A
  • Repetitive (chronic)
  • Human initiated (especially when intentional and by a caretaker)
  • The normal fight/flight response is not possible (you’re trying to get away, but you’re trapped)
  • Lack of emotional support following the trauma
35
Q

Describe attachment trauma

A

Abuse, violence and neglect in the family are the leading causes of physical and psychological injuries

The key here is IN THE FAMILY

36
Q

Describe the system of studying child maltreatment

A

Adverse Childhood Experiences (ACEs)

  • Childhood experience leads to disrupted neurodevelopment
  • There is social, emotional and cognitive impairment
  • The child adopts health-risk behaviors (eating, alcohol, drugs, etc.)
  • Disease, obesity and social problems result
  • The overall result is EARLY DEATH in this group
37
Q

Describe the statistics of abuse in children

A
  • One million children suffer physical and sexual abuse each year in the US
  • Cost of child abuse & neglect in 2007 = $103.9 billion
  • Combined mental health care, social services, medical care and police services – per incident of childhood abuse = $4379.
  • 1 in 10 children are exposed to intrafamilial violence
38
Q

What has the CDC said about childhood trauma?

** KNOW THIS ***

A

Childhood trauma is “the” most significant public health issue in the US (CDC)

39
Q

Describe the prevalence of different childhood abuse

A

Grew up in a household with…

  • Substance abuse (27%)
  • Divorce (23%)
  • Physical abuse (28%)
  • Sexual abuse (21%)
40
Q

What are the characteristics of child abuse coping

A
  • ACEs come in groups
  • Produce behaviors that if sustained create chronic illness and disease
  • Many of these behaviors are actually adaptive ways to cope with the initial ACE
  • We will find avenues in our environment to help us adapt
  • Examples: Smoking – nicotine helps with anxiety and depression
  • Cumulative ACEs increase the clinical complexity of individual cases (# of lifetime DSM dxs increases)
41
Q

Is all mental health related childhood trauma?

A

NO

If someone has depression, anxiety, suicide, etc. it does NOT mean they had a bad childhood, but if they did have a traumatic childhood, the rates went WAY up

42
Q

What is much more common in adults with a history of childhood trauma?

A

Smoking and COPD

43
Q

What is the important take home message?

A

Trauma is NOT destiny

  • You can grow up in a very traumatic childhood and you can get better
  • The most helpful thing is relationships
  • Can be a psychotherapist or can be a great life partner that is always supportive and present
  • Can be a church group or close group of friends
44
Q

Describe the principles of “trauma informed care”

A

“A program, organization, or system that is trauma-informed realizes the widespread impact of trauma and understands potential paths for healing; recognizes the signs and symptoms of trauma in staff, clients, and others involved with the system; and responds by fully integrating knowledge about trauma into policies, procedures, practices, and settings.”

The three Rs ***

  • Realize
  • Recognize
  • Respond
45
Q

What are the key elements of trauma informed care?

A

Three pillars of trauma informed care

  • Safety
  • Connection
  • Management of emotions
46
Q

What current behaviors have roots in learned ways of coping with earlier life experiences

A

Compassion for

  • A person’s history of adverse experiences
  • Undeserved consequences of those experiences that affect all dimensions of life
  • Sensitivity to culture
47
Q

What does trauma informed care do?

A

Encourages autonomy, agency and self-efficacy

48
Q

What are the outcomes of children and youth that are involved in trauma informed care?

A

Reduced

  • Behavioral & emotional problems
  • Trauma symptoms
  • Substance use problems

Improved

  • Behavioral & emotional skills
  • Functioning in school & community
  • Ability to build relationships
49
Q

What is the application of this in medical settings?

A

Help the pt stay in control

  • Clarify boundaries of relationship
  • Respectfully & thoroughly explain procedures
    • -> What will be done
    • -> What it might feel like
    • -> Why it is necessary
  • Inform before touching
  • Respect the patient’s signal to stop
  • Patient may need to re-ground herself
50
Q

Describe the effect of interpersonal relationships

A

“The crucial fact of life is this: we are hurt by other persons, we are made sick through our relationships with other persons. We are also cured through other persons. The healing process is a process of relationships…”