CH 5 Stress Flashcards
What is PE
Prolonged Exposure Therapy, a PTSD treatment
Who coined the term “stress”?
Hans Selye
Define “stress”
External demands placed on an organism lead to the organism’s internal biological and physiological responses
How is stress involved with the DSM and how has this changed over time?
Stress is a component of multiple DSM diagnostic categories
DSM-4 and before: Classified under anxiety disorders
DSM-5: PTSD, Acute stress disorder, and Adjustment disorder are in their own category (trauma and stressor-related disorders)
List the Trauma- and Stressor-related disorders classified in the DSM-5
PTSD, Acute Stress Disorder, Adjustment Disorder
List characteristics of stressors (factors in the intensity of stress)
Severity
Chronicity
Timing
Degree of impact
Level of expectation
Controllability
Age
Social support available
Isolation
What factors are linked to high resilience?
Being older
High income
More life experience
Higher education
Positive life outlook
Self-confidence
Ability to focus on the present
Allostatic load
Biological cost of adapting to stress
High allostatic load = _____(high/low) stress
high
What are some physical illnesses associated with high levels of stress?
(9 answers)
Heart disease
stroke
asthma
diabetes
obesity
GI issues
Cancer
Alzheimer’s disease
High blood pressure
Sympathetic adrenomedullary system SAM (What it does & Pathway)
The body’s response to short-term stressors
Fight or flight
- The hypothalamus stimulates the sympathetic nervous system
- Inner portion of adrenal glands secrete adrenaline (epinephrine) and noradrenaline (norepinephrine)
- These circulate in the blood and lead to an increase in heart rate & glucose metabolization
Hypothalamus-pituitary-adrenal system HPA
(What it does & Pathway)
- The hypothalamus releases corticotropin-releasing hormone
- The pituitary gland is stimulated and releases the adrenocorticotropic hormone
- The adrenal cortex is stimulated to release cortisol
The hypothalamus releases _______, which causes the pituitary gland to release _______, which causes the adrenal glands to release _______.
corticotropin-releasing hormone
adrenocorticotropic hormone
cortisol
Leukocytes
White blood cells involved in immune protection
FIRST LINE OF DEFENSE
T Cells
Leukocytes
Recognizes specific antigens when activated
B Cells
Leukocytes
Produce antibodies that respond to specific antigens
Cortisol
Human stress hormone released by adrenal glands
Immune System
Protects body from viruses and bacteria
Provides leukocytes, the front line of defense
Communicates with brain via cytokines
Stress is linked to immune system _______ (improvement, suppression)
suppression
What 2 personality types are associated with high stress and increased risk for heart disease?
Type A
Type D
Type A behavior pattern
Hostile, committed to work, impatient, competitive
Type D behavior pattern
Distressed personality type
Experience mostly negative emotions, insecurity, anxiety
Forgiveness is linked with _______(increased/decreased) stress.
decreased
What is the goal of biological interventions in chronically stressed patients?
Lower cholesterol or reduce risk of blood clots
What are some biological interventions for chronically stressed patients?
Surgeries, lipid-lowering medications, aspirin or other anticoagulants, antidepressants
What are some psychological interventions for chronically stressed clients?
Emotional disclosure (journaling), biofeedback, relaxation and meditation, CBT
Biofeedback
The technique of gaining greater awareness of the physiological functions of one’s own body
Uses electronic or other instruments
Goal: being able to manipulate the body’s systems at will
What is the difference between Adjustment Disorder and PTSD?
AD: Common Stressor, mild symptoms
PTSD: Traumatic stressor, severe symptoms
Adjustment Disorder
(Common causes, typical timeline, and general definition)
One of the mildest DSM diagnoses
A common stressor leads to a psychological response
Within 3 months of the stressor
Symptoms disappear when the stressor ends OR the person adapts
Common causes: unemployment, death of loved one, moving, divorce
Posttraumatic Stress Disorder
(Common causes and clinical description)
Trauma and stressor-related disorder
Common causes: Combat, rape, concentration camp, natural disaster
Clinical Description: Trauma memory inexperienced involuntarily with same emotional force for at LEAST 1 month
DSM-5 Criteria for PTSD
(Criteria A-E)
1 month or longer
A. Stressor (1 required)
1. A person is exposed to death, serious injury, or sexual violence (actual or threatened) in the following ways: direct exposure, witnessing, learning that a close person was exposed to the trauma
2. Indirect exposure to aversive details of the trauma (first responders, medics)
B. Intrusion symptoms (1 required)
Unwanted upsetting memories
Nightmares
Flashbacks
Emotional distress
Physical reactivity
MUST BE PERSISTENT
C. Avoidance (1 required)
Trauma-related thoughts or feelings
Trauma-related external reminders
D. Negative alterations in cognitions & mood (begin or worsen AFTER trauma)
(2 required)
Inability to recall key features of the trauma
Overly negative thoughts & assumptions about oneself or the world
Exaggerated blame of self/others for causing trauma
Negative affect
Anhedonia
Feeling isolated
Difficulty experiencing positive affect
E. Alterations in arousal and reactivity (2 required)
Irritability or aggression
Risky or destructive behavior
Hypervigilance
Heightened startle reaction
Difficulty concentrating
Difficulty sleeping
Describe the prevalence of PTSD
Trauma is more common in men and PTSD diagnoses are more common in women
6.8% lifetime prevalence
Why is PTSD difficult to diagnose?
Comorbidity with other conditions
(Depression, substance abuse)
Acute Stress Disorder
Symptoms develop shortly after traumatic event and last for AT LEAST 2 days
Can receive treatment immediately
Diagnosis CAN change to PTSD if symptoms persist (1 month or longer)
Biological factors in PTSD
(Gender, genetics, brain)
Gender: Higher baseline cortisol levels in females with PTSD (women are more likely to experience chronic stress)
Genetics: 5-HTTLPR
Brain: Reduced size of hippocampus
Which gene is associated with trauma exposure and low levels of social support?
5-HTTLPR
5-HTTLPER
Gene associated with trauma exposure and low levels of social support
Sociocultural risk factors for PTSD include _______.
Minority group
Negative and unsupportive social environment
Less than a college education
Poverty
PTSD Prevention
Reduce exposure to traumatic events
Advanced preparation (ex. proper military training)
PTSD Treatment
Hotlines, crisis intervention, psychological debriefing, medications, CBTs
What medications are used to treat PTSD?
SSRIs (Prozac, Paxil, and Effexor)
Golden treatments for PTSD
- Prolonged Exposure PE
- Cognitive Processing Therapy CPT
- Eye Movement Desensitization and Reprocessing EMDR
Prolonged Exposure PE
PTSD Treatment involves building up exposure to stressors over 9-12 90-minute sessions through use of imaginal and in vivo exposure
