Chapter Four Flashcards
Stress-Related Disorders
Health psychologists
Psychologists who study interrelationships between psychological factors, including stress, and physical health
Stress
Refers to pressures or demands placed on organisms to adapt or adjust
Stressor
A source of stress
Stress and the Endocrine System
Occasional stress doesn’t impact thee system much
Prolonged stress has the MOST impact
Prolonged activation of the ANS can damage our immune and cardiovascular systems
Psychoneuroimmunology
Studies relationships between psychological factors, especially stress, and the workings of the immune system
Americans report feeling fatigued, achey (head), a loss of appetite, etc when stressed
Endocrine system
The body’s system of glands that release secretions directly into the bloodstream
Hormones
Immune system
The body’s system of defense against disease
Leukocytes - white blood cells - immune system’s foot soldiers
Antigens
Invading pathogens
Antibodies
Specialized proteins that lock into position on an antigen, marking it for destruction by specialized “killer” lymphocytes that act like commandos on search and destroy missions
General adaptation syndrome (GAS)
Describes a common biological pattern of response to prolonged or excessive stress
Triune Brain Theory (Maclean)
Neo-Cortex:
Mammalian Brain or Limbic System:
Reptilian Brain:
Neo-Cortex:
Regulatory abilities, cognitive and executive functioning
Uses verbal language and analytic reasoning
SHUT DOWN! Analyzes, problem-solves, learns from experience
Mammalian Brain or Limbic System:
Emotional and somatosensory memory, attachment
Speakers the language of emotion
Amygdala as the fire alarm and emotional memory center
Reptilian Brain:
Autonomic arousal, instinctive responses
Speaks language of sensation and impulse
Controls our instinctive responses and functions
4 F’s
fight
flight
freeze
fawn
fight
When your body feels that it is in danger and believes you can overpower the threat, you’ll respond in fight mode
Your brain releases signals to your body, preparing it for the physical demands of fighting
Sympathetic
flight
If your body believes you cannot overcome the danger but can avoid it by running away, you’ll respond ini flight mode
A surge of hormones, like adrenaline, give your body the stamina to run from danger longer than you typically could
Sympathetic
freeze
This stress response causes you to feel stuck in place
This response happens when your body doesn’t think doesn’t think you can fight or flight
Parasympathetic
fawn
The fawn response is your body’s emotional reaction that involves becoming highly agreeable to the person abusing you
General Adaptation Syndrome
alarm reaction
resistance stage
exhaustion stage
Alarm reaction
Resources arise to confront a stressor
Perception of an immediate stressor triggers this
Mobilizes the body to prepare for challenge or stress
Resistance stage
Remains high and attempts to adapt
Adaptation stage
Body trees to renew spent energy and repair damage
Exhaustion stage
Resources depleted – parasympathetic dominance
Exhaust bodily resources
Characterized by dominance of the parasympathetic branch of the ANS
stats
People who experience a greater number of life changes are more likely to suffer from psychological and physical health problems than those with fewer life events
Acculturative stress
Pressure that results from the demands placed on immigrant groups, indigenous peoples, and ethnic minorities to adjust to life in the mainstream culture
Effects:
1. Increased risk of heavy drinking among women
2. Increased risk of smoking and sexual intercourse among adolescents
3. Increased risk of disturbed eating behaviors
Melting pot theory
Acculturation helps people adjust
Bicultural theory (salad bowl)
Adjustment is marked by combining and identifying with traditional and host cultures
Emotion focused coping
Immediately reduce the impact of the stressor (denial, withdrawing, wish fulfillment fantasies)
Styles of coping
emotion focused coping
problem focused coping
Problem focused coping
Examine the stressors and modify reactions to render them less harmful
Self efficacy expectancies
If someone thinks they can get through something, they are going to be able to do so better than someone who doesn;t think that
Psychological hardiness
A cluster or traits that may help people manage stress
commitment; challenge; control
optimism, social support, etc
commitment
full on, full go
challenge
change is normal
control
control of self and life
Positive psychology
The belief that psychology should focus more of its efforts on the positive aspects of the human experiences, rather than just the deficit side of the human equation, such as problems of emotional disorders, drug abuse, and violence
adjustment disorder
→ Maladaptive reactions to identified stressors
→ characterized by emotional reactions greater than normally expected given the circumstances
→ impairment in functioning
adjustment disorder
specify whether:
- With depressed mood
-Low mood, tearfulness, or feelings of hopelessness are predominant - With anxiety
-Nervousness, worry, jitteriness, or separation anxiety is predominant - With mixed anxiety and depressed mood
-A combination of depression and anxiety is predominant - With disturbance of conduct
-Disturbance of conduct is predominant - With mixed disturbance of emotions and conduct
-Both emotional symptoms (depression/anxiety) and a disturbance of conduct are predominant - Unspecified
-For maladaptive reaction that are not classifiable as one of the specific subtypes of adjustment disorder - Acute
-This specifier can be used to indicate persistence of symptoms for less than 6 months - Persistent (chronic)
-This specifier can be used to indicate persistence of symptoms for 6 months or longer. By definition, symptoms cannot persist for more than 6 months after the termination of the stressor or its consequences. The persistent specifere therefore applies when the duration of the disturbance is longer than 6 months in response to a chronic stressor or to a stressor that has enduring consequences
adjustment disorder DSM criteria
A. The development of emotional or behavioral symptoms in responses to an identifiable stressor(s) occurring within 3 months of the onset of the stressor(s)
B. These symptoms behaviors are clinically significant, as evidenced by one or both of the following:
a. Marked distress that is out of proportion to the severity or intensity of the stressor, taking into account the external context and the cultural factors that might influence symptom severity and presentation
b. Significant impairment in social, occupational, or other important areas of functioning
C. The stress-related disturbance does not meet the criteria for another mental disorder and is not merely an exacerbation of a preexisting mental disorder
D. The symptoms do not represent normal bereavement and are not better explained by prolonged grief disorder
E. Once the stressor or its consequences have terminated, the symptoms do not persist for more than an additional 6 months
Defining Trauma
“Psychological trauma is the unique individual experience of an event, a series of events, or a set of enduring conditions, in which:
- The individual’s ability to integrate his or her emotional experience is overwhelmed and/or
- The individual experiences (subjectively) a threat to life, bodily integrity, or sanity.”
What is traumatic depends on our own vulnerability
What is traumatic for one may not be traumatic for another
Because children are so dependent on their caretakers for survival and safety, they are vulnerable to traumatization by:
Frightened or frightening parenting
Exposure to domestic violence, witnessing violence
Parental fighting
Words of fighting/violence
Threatening words and behavior
Secondary effects of parental PTSD
Holocaust survivor and their adult children
Accidents, medical crises, surgery, invasive procedures
Death of a parent or parent figure
PTSD DSM criteria
Exposure to actual or threatened death, serious injury, or sexual violence in one (or more) of the following ways:
- Directly experiencing the traumatic event(s)
- Witnessing, in person, the event(s) as it occurred to others
- Learning that the event(s) occurred to a close family member or close friend
- In cases of actual or threatened death of a family member or friend, the event(s) must have been violent or accidental - Experiencing repeated or extreme exposure too aversive details of the traumatic event(s)
- Eg. first responders, police officers, etc
- Note this does not apply to exposure through media, tv, movies or pictures, unless this exposure is work related
- Eg. first responders, police officers, etc
Avoidance Symptoms
Avoidance of or efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s)
Avoidance of or efforts to avoid external reminders (people, places, conversations, activities, objects, situations) that arouse distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s)
Intrusion Symptoms
- Recurrent, involuntary, and intrusive distressing memories of the traumatic event(s)
- In children, repetitive play may occur in which themes or aspects of the traumatic event(s) are expressed - Recurrent distressing dreams in which the content and/or affect of the dream are related to the event(s)
- In children, there may be frightening dreams without recognizable content -
Dissociative reactions (flashbacks) in which the individual feels or acts as if the traumatic event(s) were recurring
- Such reactions may occur on a continuum, with the most extreme expression being a complete loss of awareness of present surroundings
- In children, trauma-specific reenactment may occur in play - Intense or prolonged psychological distress or marked physiological reactions in response to internal or external cues that symbolize or resemble an aspect of the traumatic event(s)
- Marked psychological reactions to internal or external cues that symbolize or resemble an aspect of the traumatic event(s)
- Only in PTSD
Negative Mood Symptoms
-
Inability to remember an important aspect of the traumatic event(s)
- Typically due to dissociative amnesia and not to other factors such as head injury, alcohol, or drugs -
Persistent and exaggerated negative beliefs or expectations about oneself, others, or the world
- (e.g., “I am bad,” “no one can be trusted,” “the world is completely dangerous”) - Persistent, distorted cognitions about the cause or consequences of the traumatic event(s) that lead the individual to blame himself/herself or others
- Persistent negative emotional state
- Fear, horror, anger, guilt, or shame - Markedly diminished interest or participation in significant activities
- Feelings of detachment or estrangement from others
- Persistent inability to experience positive emotions
- Inability to experience happiness, satisfaction, or loving feelings - e.g.
- Only one required in Adjustment Dx
Arousal Symptoms
- Irritable behavior and angry outbursts (with little or no provocation) typically expressed as verbal or physical aggression toward people or objects
- Reckless or self-destructive behavior
- Hypervigilance
- Exaggerated startle response
- Problems with concentration
-
Sleep disturbance
- E.g., difficulty falling or staying asleep or restless sleep
Acute Stress Disorder DSM Criteria
A. Exposure to actual or threatened death, serious injury, or sexual violence in one or more categories
B. Presence of nine (or more) of the symptoms from any of the five categories of intrusion, negative mood, dissociation, avoidance, and arousal, beginning or worsening after the traumatic event(s) occurred
C. Duration of the disturbance (symptoms in Criterion B) is 3 days to 1 month after trauma exposure
- Note: symptoms typically begin immediately after the trauma, but persistence for at least 3 days and up to a month is needed to meet disorder criteria
D. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning
E. The disturbance is not attributable to the physiological effects of a substance (e.g., medication or alcohol) or another medical condition (e.g., mild traumatic brain injury) and is not better explained by brief psychotic disorder
Posttraumatic Stress Disorder DSM Criteria
A. Exposure to actual or threatened death, serious injury, or sexual violence in one or more categories
B. One or more of the intrusion symptoms
C. One or both of the avoidance symptoms
D. Two or more of the negative mood symptoms
E. Two or more of the arousal symptoms
F. Duration is more than one month
G. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning
H. The disturbance is not attributable to the physiological effects of a substance (e.g., medication, alcohol) or another medical condition
specify whether PTSD
With dissociative symptoms:
The individual’s symptom meet the criteria for posttraumatic stress disorder, and in addition, in response to the stressor, the individual experiences persistent or recurrent symptoms of either of the following:
—— A. Depersonalization
- Persistent or recurrent experiences of feeling detached from, and as if one were an outside observer of, one’s mental processes or body (e.g., feeling as though one were in a dream; feeling a sense of unreality of self or body or of time moving slowly)
——- B. Derealization
- Persistent or recurrent experiences of unreality of surroundings (e.g., the world around the individual is experienced as unreal, dreamlike, distant, or distorted)
- To use this subtype, the dissociative symptoms must not be attributable to the physiological effects of a substance (e.g., blackouts, behavior during alcohol intoxication) or another medical condition (e.g., complex partial seizures)
Specify if:
With delayed expression: if the full diagnostic criteria are not met until at least 6 months after the event (although the onset and expression of some symptoms may be immediate)
Consolidation and retrieval of a clear event memory is comprised
Activity in the hippocampus is inhibited under threat, and the frontal cortex fails to witness the experience
The unprocessed “raw data” is encoded in the amygdala
Feeling memories, sensory memories, muscle memories, autonomic memories provide the record of what happened divorced from a narrative that could explain them
Traumatic memories are encoded primarily as bodily and emotional feelings without words or pictures detached from the event
Since the amygdala is the brain’s”smoke detector”, the result is sensation to even subtle reminders of the traumatic event
Complex Trauma
Occurs when traumatic experiences were invoked by attachment figures, exhibiting one’s social engagement system from being a source of safety
What happens when ‘the bear’ is your caregiver?
Theoretical Underpinnings
polyvagal theory (ANS)
learning theory (conditioning)
Polyvagal theory (ANS)
neurocognitive/memory storage
Learning theory (conditioning)
Traumatic experience as the unconditioned stimuli paired with neural senses (conditioned stimulus)
Avoidance behaviors can be negatively reinforced as they result in relief from anxiety
Treatment Approaches
Attachment/co-regulation work
CBT
Sensorimotor psychotherapy/limbic system therapy
EMDR
“Bottom up” vs top down”
Herman, 1992
Safety and stabilization
Coming to terms with traumatic memory
Integration and meaning making
