Midterm #2 PSYC 3604 A Flashcards
What is a stressor?
Any event that triggers coping adjustment
What is strain?
The physical and emotional wear and tear reaction of a person attempting to cope with a stressor
What is stress?
The process by which we perceive and respond to events (stress)
Three Research Focuses
- The environment
- Reaction to stress
- Stress as a process that includes stressors and strains, but includes relationship between person and the environment (coping)
The environment:
Stress as a stimulus (stressors)
Reaction to stress:
Stress as a response (distress)
When we sense danger, what is there an increase in?
Adrenaline, heart rate, breathing, blood pressure, cortisol, etc
When we sense danger, what is there a decrease in?
Reduced blood flow to the kidneys, skin and gut that are not immediately needed
What is the role of the endocrine system during stress?
The hypothalamus orders the pituitary to secrete adrenocorticotrophic hormone (ACTH) which is taken up by the adrenal glands
What do the adrenal glands do?
Mediates most of our physiological responses to stress. Also releases cortisol, epinephrine and norepinephrine
What are the two parts of the Adrenal Glands?
- Adrenal Medulla
- Adrenal Cortex
What does the adrenal medulla do?
Fast acting, secretes epinephrine, and norepinephrine
What does the adrenal cortex do?
Delayed response that restores body to homeostasis
What does cortisol influence?
Immune function, metabolism, heart rate, blood to muscles, memory
Sympathetic Nervous System (adrenal medulla) increases
Heart rate, respiration, perspiration, blood to muscles, metabolism, mental activity
Explain General Adaptation Syndrome
Perceived stressor –> Alarm Reaction (fight or flight) –> Resistance (arousal high as the body tries to defend and adapt) –> Exhaustion (limited physical resources; resistance decreases; death)
What are the 5 biological theories of psychophysiological disorders?
- Somatic-Weakness Theory
- Specific-Reaction Theory
- Prolonged Exposure to Stress Hormones
- Stress and the Immune System
- Stress as a transaction
Somatic weakness theory
Weakness in a specific body organ (ex. congenitally weak respiratory system might predispose the individual to asthma)
Specific reaction theory
Individual response to stress is idiosyncratic
Prolonged Exposure to Stress Hormones
Activation of CNS and HPA axis
Stress and the Immune System
Stress impacts the ANS, hormone levels, and brain activity
Stress as a transaction
The circumstance in which transactions lead a person to perceive a discrepancy between the physical or psychological demands of a situation and the resources of his or her biological, psychological, or social systems
Explain the transactional model?
First, encounter a potentially stressful event or situation. Followed by two cognitive appraisals (primary & secondary).
What is the primary appraisal?
Is this event positive, neutral or negative: and if negative, how bad?
What is the secondary appraisal?
Do I have resources or skills to handle the event/demand?
If yes… Problem focused coping: Moderate stress.
If no… Emotion focused coping: High stress.
What are the psychological aspects of stress?
Stress can affect our cognitive performances (vicious cycle of rumination and worrying) as well as our emotions (fear and anxiety)
What is cognitive vulnerability?
A person’s perception of himself as subject to internal or external dangers over which his control is lacking or is insufficient to afford him a sense of safety.
*In clinical syndromes, the sense of vulnerability is magnified by certain dysfunctional cognitive processes
Stress arises or is augmented by faulty or irrational ways of thinking. What are 3 dysfunctional cognitive processes?
Catastrophizing, Overgeneralizing, and Selective abstraction
Give an example of catastrophizing
“It is the end of the world if I get turned down when I ask for a date”
Give an example of overgeneralizing
“I didn’t get a good grade on this test, I can’t get anything right”
What is selective abstraction?
Only seeing specific details of the situation (e.g., seeing the negatives but missing the positive details).
How do we measure stress physiologically?
Galvanic Skin Response: measure of the skins resistance to electricity
Glass and Singer / Driskel et al.
Social facilitation (good stress)
What is social facilitation?
Any increment of individual activity resulting from the presence of another individual
What is the social readjustment rating scale?
Life’s most stressful events in one chart. 100 = most stressful
What are the top 5 most stressful life events?
- Death of a spouse
- Divorce
- Marital separation
- Jail term
- Death of close family member
What is acute stress? + an example
Sudden, typically short-lived threatening event (e.g., robbery, giving a speech)
What is chronic stress? + an example
Ongoing, environmental demand (e.g., marital conflict, work stress)
What are daily hassles? Add some examples
Experiences and conditions of daily living that have been appraised as salient and harmful or threatening. Ex. concerns about weight, home maintenance, too many things to do, etc
What are daily uplifts? Add some examples
Experiences and conditions of daily living that have been appraised as salient and positive or favorable. Ex.completing a task, feeling healthy, relating well to friends
What are the 3 types of job stress?
- Work overload
- Role overload
- Burnout
What is work overload?
Work too long and too hard
What is role overload?
Balance several different jobs at once
What is burnout?
Physical and psychological exhaustion
Types of environmental stress?
Natural disasters, accidents, terrorism, and war
How does stress affect health?
Physiological Effects, Unhealthy Habits and Poor Coping, Health Behavior
What are the physiological effects of stress?
Hormones, decreased immunity, and increased blood pressure
What are unhealthy habits and poor coping from stress?
Increased smoking, drugs, alcohol and decreased sleep and nutrition
What is the health behavior effect from stress?
Decreased compliance, delay in care seeking
How many people die from heart disease in Canada?
Heart disease is the second leading cause of death in Canada, accounting for 1 in 5 deaths
What is essential hypertension?
Hypertension without identified biological cause
What else is essential hypertension known by?
Primary hypertension or the silent killer (as it may go undetected for years)
What is coronary heart disease (CHD)?
The narrowing of blood vessels supplying O2 and blood to heart
What are the two diseases involving heart and blood circulation system that are adversely affected by stress?
- BP (high blood pressure)
- CHD (coronary heart disease)
How do genetics relate to BP?
Little success in identifying specific genes
How does biology relate to BP?
Heightened cardiovascular reactivity in response to exposure to stressors
How does psychology relate to BP?
Acute stress such as anger episodes and physical exertion can trigger myocardial infarction
How does chronic stress affect BP?
Activates immune system and contributes to inflammation, which, in turn, produces coronary heart disease
Risk Factors for BP
Excessive weight
Central obesity
Lack of regular physical activity
Heavy alcohol use
Inadequate diet
Poor coping response to chronic stress
Low socio-economic status
Low birth weight
etc
Risk Factors for CHD
Age
Sex (males at greater risk)
Smoking
Elevated BP
Elevated serum cholesterol
Increased size of left ventricle
Obesity
etc
What are the two psychological diatheses (predispositions)?
Type A behavior pattern and type D (distressed) personality
Explain Type A behavior pattern
An intense and competitive drive for achievement and advancement, exaggerated sense of urgency, aggressiveness and hostility toward others
Explain type D (distressed) personality
Negative affectivity + social inhibition, including the inhibition of anger, anxiety, and depression
What are 4 therapies for psychophysiological disorders?
Treating hypertension through decreasing CHD risk factors, drugs can be used to decrease cholesterol levels, biofeedback, and cardiac rehabilitation.
Effectiveness of biofeedback?
Only modest empirical support
What is cardiac rehabilitation?
Support and counseling aimed at decreasing stress.
What are the concerns about barriers to access programs for Cardiac Rehabilitation?
Lack of physician referral, long travel time and distance to available rehab
What are 3 trauma and sterssor-related disorders?
Adjustment disorder, acute stress disorder, posttraumatic stress disorder
Diagnostic Criteria of Adjustment Disorder
A. The development of emotional or behavioral symptoms in response to an identifiable stressor(s) occurring within 3 months of the onset of the stressor
B. These symptoms or behaviors are clinically significant, as evidenced by one or both of the following:
1. 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 symptoms severity and presentation
2. Significant impairment in social, occupational, or other important areas of functioning
C. The stress-related disturbance does not meet criteria for another mental disorder and is not merely an exacerbation of a preexisting mental disorder
D. The symptoms do not represent normal bereavement
E. Once the stressor or its consequences have terminated, the symptoms do not persist for more than an additional 6 months
Diagnostic Criteria of Acute Stress Disorder
A. Exposure to actual or threatened death, serious injury, or sexual violation in one (or more) of the following ways:
- Directly experiencing the traumatic event
- Witnessing, in person, the event as it occurred to others
- Learning that the event occurred to a close family member or friend (violent or accidental)
- Experiencing repeated or extreme exposure to aversive details of the traumatic event (not through media unless work related)
B. Presence of nine or more symptoms from any of the five categories: intrusion, negative mood, dissociation, avoidance, and arousal, beginning or worsening after the traumatic event occurred
C. Duration of the disturbance is 3 days to 1 month after trauma exposure (typically begin immediately after the trauma)
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, or another medical condition and is not better explained by brief psychotic disorder
Intrusion Symptoms:
- Recurrent, involuntary, and intrusive distressing memories of the traumatic event (in children - repetitive play with themes of event)
- Recurrent distressing dreams in which the content/affect of the dream are related to the event (children - frightening dreams without recognizable content)
- Dissociative reactions (e.g., flashbacks) in which the individual feels or acts as if the event was recurring (occur on a continuum)
- Intense of prolonged psychological distress or marked physiological reactions in response to internal or external cues that symbolize or resemble an aspect of the traumatic events
Negative Mood:
Persistent inability to experience positive emotions
Dissociative Symptoms:
- An altered sense of the reality of one’s surroundings or oneself
- Inability to remember an important aspect of the traumatic events (typically due to dissociative amnesia and not other factors)
Avoidance Symptoms:
- Efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic event
- Efforts to avoid external reminders (people, places, activites, etc) that arouse distressing memories, thoughts, or feelings about closely associated with the traumatic events
Arousal Symptoms:
- Sleep disturbance
- Irritable behavior and angry outbursts (with little or no provocation), typically expressed as verbal or physical aggression toward people or objects
- Hypervigilance
- Problems with concentration
- Exaggerated startle response
Diagnostic Criteria of Posttraumatic Stress Disorder
A. Exposure to actual or threatened death, serious injury, or sexual violation in one (or more) of the following ways:
- Directly experiencing the traumatic event
- Witnessing, in person, the event as it occurred to others
- Learning that the event occurred to a close family member or friend (violent or accidental)
- Experiencing repeated or extreme exposure to aversive details of the traumatic event (not through media unless work related)
B. Presence of one or more intrusion symptoms
C. Persistent avoidance of stimuli associated with the traumatic event beginning after the traumatic event occurred
D. Negative alterations in cognitions and mood associated with the traumatic event, beginning or worsening after the traumatic event occurred
E. Marked alterations in arousal and reactivity associated with the traumatic event, beginning or worsening after the traumatic event occurred
F. Duration of disturbance is more than 1 month
G. The disturbance causes clinically significant distress or impairment in social, occupational or other important areas of functioning
H. Disturbance is not attributable to the physiological effects of substance or other medical disorder
Negative alterations in cognitions evidenced by two or more of the following:
- Inability to remember an important aspect of the event
- Persistent and exaggerated negative beliefs or expectations about oneself, others or the world (e.g., “No one can be trusted”, “I am bad”
- Persistent, distorted cognitions about the cause or consequences of the traumatic event that lead the individual to blame them self or others
- Persistent negative emotional state
- Markedly diminished interest or participation in significant activities
- Feelings of detachment or estrangement from others
- Persistent inability to experience positive emotions
PTSD specify if…
With dissociative symptoms or with delayed expression
PTSD with dissociative symptoms:
- Depersonalization: persistent or recurrent experiences of feeling detached from and as if one were an outside observer of, one’s mental processes or body
- Derealization: persistent or recurrent experiences of unreality of surroundings
PTSD 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)
Risk Factors of PTSD
Exposure to trauma
Severity of trauma
Gender (more females)
Perceived threat to life
Family history of psychiatric disorders
Pre-existing psychiatric disorders
Early separation from parents
Previous exposure to traumas
Dissociative symptoms at time of trauma
Trying to push memories of trauma out of one’s mind
Tendency to take personal responsibility for failures
Coping with stress by focusing on emotions (“I wish I could change how I feel”)
Attachment style (insecure attachment style)
Psychological theories of PTSD
PTSD arises from a classical conditioning of fear avoidances being built up, and they are negatively reinforced by the reduction of fear that comes from not being in the presence of the CS
Cognitive theories of PTSD
Hallmark feature being constant involuntary recollection of the traumatic event. There is a robust association between PTSD and memory impairment and this tendency is stronger for verbal memory than visual memory
Biological theories of PTSD - MZ co-twin control design… Abnormalities common to both twins:
Smaller hippocampal volume, large cavum septum pellucidum, more neurological soft signs, lower general intellectual ability, and poorer performance in the specific cognitive abilities of executive function, attention, declarative memory, and processing of contextual cues
Biological theories of PTSD - MZ co-twin control design… Abnormalities in twin with PTSD that are not present in identical co-twin:
Psychophysiological responding, higher resting anterior cingulate metabolism, event- related potential abnormalities associated with attentional processes, recall intrusions, and possibly some types of chronic pain
Lifetime prevalence of AN
Women: 0.9%
Men: 0.3%
Lifetime prevalence of BN
Women: 1.5%
Men: 0.5%
Lifetime prevalence of BED
Women: 3.5%
Men: 2.0%
BED vs BN prevalence
Similar in terms of age of onset (late teen years to early 20s) but it was slightly earlier for those with BN. BN also distinguished by having a longer persistence (6.5 years vs 4.3 years)
Stats Canada Facts Eating Disorders
0.5% of Canadians 15 years or older reported an eating disorder in the preceding 12 months
Women more likely than men to report an eating disorder
1.5% of women aged 15 to 24 reported they had an eating disorder
1.7% of Canadians met 12 month criteria for an eating attitude problem
Hospitalization rates are highest among young women in the 15 to 24 age range. However rates are high among those aged to 10 to 14
EDs during COVID-19
Diagnostic incidence was 15.3% higher in 2020 with a steady increase solely in females between 10-19 years old. Primarily anorexia nervosa
Pathways through which COVID increased ED risk & symptoms
Increased risk (media exposure, social isolation, negative affect, disruption to daily activities) and Lower protective capacity and access to care (social support, emotional regulation, access to treatment and care)
When did EDs first appear in the DSM
1980
What were the categories in ED in DSM-IV?
AN and BN formed distinct categories
Eating Disorder - Not Otherwise Specified (EDNOS)
How are ED portrayed in DSM-5?
BED is distinct category.
Removed EDNOS and replaced it with more specific categories
Unspecified Feeding Or Eating Disorder
Can be used for any condition that causes clinically significant distress or impairment but does not meet diagnostic thresholds
Can be used when there is insufficient information (ex. hospital emergency room situations)
Other specified feeding or eating disorder
Applies to atypical, mixed, or subthreshold conditions
What is night eating syndrome?
A repetitive tendency to wake up and eat during the night and then get quite upset about it
What is purging disorder?
Form of bulimia that involves self induced vomiting or laxative use at least once a week for a minimum of six months in the absence of binge eating
Why is the term Anorexia Nervosa a misnomer?
Because most patients do not lose their appetite or interest in food - they become preoccupied with food
Essential features of Anorexia Nervosa:
Individual refuses to maintain a minimally normal body weight, is intensely afraid of gaining weight, and exhibits a significant disturbance in the perception of the shape or size of their body
Diagnostic Criteria of AN:
A. Restriction of energy intake relative to requirements, leading to significantly low body weight (less than minimally normal than that minimally expected)
B. Intense fear of gaining weight or of becoming fat, or persistent behavior that interferes with weight gain, even though at a significantly low weight
C. DIsturbance in the way in which one’s body weight or shape is experienced, undie influence of body on self evaluation, or persistent lack of recognition of the seriousness of the current low body weight