Stress & PTSD Flashcards by Amie Hayes

Stress

A real or interpreted threat to the physiological or psychological integrity of an individual
Results in physiological and/or behavioural responses
We all perceive stress differently

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Hooke’s law

Wear & tear of everyday life

How long until the spring snaps

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Cannon(1932): homeostasis, fight or flight

Homeostasis; biological self-regulation, enables an organism to adapt to life’s demands, we’re built to prepare to fight or flight

Stressor; stimulus resulting in imbalance threatening homeostasis

Stress response; response of an organism to maintain or re-establish homeostasis

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General adaptation syndrome; Selye (1956)

3 stage model of chronic stress

1) alarm; immediate response
2) resistance; bodies ability to cope with higher level of stress
3) exhaustion; need a break from stress or exhaustion occurs, rush if developing other conditions, reduced immune system

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Cognitive effects of stress

Loss of concentration
Memory loss
Reduced decision-making ability

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Behavioural effects of stress

Over eating
Under eating 
Reduced work performance
Reduced time management 
Arguments

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Physiological effects of stress

Increased heart rate
Increased blood pressure
Increased galvanic skin response

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Emotional effects of stress

Anxiety
Anger
Low motivation
Increased jealously/insecurity

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Sympathetic-adrenal-medulla (SAM) axis

Sympathetic nervous system
Immediate stress response/fight or flight

Norepinephrine (in brain)
Epinephrine (in blood)

Generates more energy, conserving every, more blood & oxygen to brain, heart & muscles, decreased blood loss after injury

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Hypothalamic-pituitary-adrenal (HPA) axis

Hormone mediated
Slower response
1) stress
2) corticotropin releasing hormone
3) adrenocorticotropin hormone
4) cortisol
Negative feedback loop
Short term release of cortisol is protective
Adaptive long term release can lead to immunosuppression, CVD & hypertension
Early life stress can lead to high cortisol releasing hormone & altered cortisol

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Measuring acute stress

High salivary amylase

High norepinephrine in blood

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Measuring chronic stress

Diurnal (daily) curve of cortisol response
Cortisol awakening response; natural rise in morning, prepares people for day
Altered in mental health disorders

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Life events as stressors

Stress exposure significantly associated with depression
Increased cortisol awakening response in men who have experienced early life stress compared to men who have not
Still an effect even if no MH disorder
If experienced trauma; higher CAR
low parental care; increased CAR
CAR higher in patients with psychosis

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Ways to measure life events as stressors

Social readjustment rating scale; Holmes & Rae (1967)

College life inventory (Renner & Macklin, 1998); gives value to different events

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Childhood trauma/adversity

Frequent in people with psychosis
Increase in the likelihood of developing psychotic symptoms in adulthood if having experienced childhood adversity
Childhood adversity associated with the severity of symptoms & cause of schizophrenia
Has an effect on cognition (memory, executive functioning, cognitive performance)

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Importance of appraisal

Lazarus; influential stress theorist & researcher
Perceived stressors
Transactional model
Appraisal; 15 core relational themes
Some stressors can be positive if we believe we can cope

Risk factors

neuroticism
external locus of control
type A personality (exaggerated sense of time urgency, competitive, hostility & drive, linked to 2x increased risk of CHD, type D personality?

Protective factors

Conscientious 
Extra version 
C+E= resilience 
Openness to experience 
Agreeableness 
Dispositional optimism
Internal locus of control

Influence of stress on mental health

Yerkes-Dodson law; optimal stress=high performance

Higher sense of control, more likely to experience stress as excitement rather than depression or anxiety

Salutogenic model

Anyonvosky, medical sociologist
Health is on a continuum defined by how a person manages stress
Generalised resistance resources, conprehensibility, manageability , meaningfulness & sense of coherence (confidence that environment is predictable & that things will work out)

Erickson & Lindstrom (2005)

Reviewed 458 publications of salutogenic model

Found that sense of coherence promoted resilience & positive health

Van der Hal-van Raalte et al (2008)

203 holocaust survivors

Strong sense of coherence protects from PTSD even in old age compared to survivors with weak SOC

Trauma & stress-related disorders

Separate in DSM-5 from anxiety disorders
Major diagnostic category is PTSD
primary precipitating cause is traumatic experience
Can be diagnosed even if you have just witnessed an event

PTSD

Intrusive symptoms e.g. disturbing dreams
Avoidance responding
Negative changes in cognition & mood
Increased arousal & reactivity
Symptoms began at event or after & lasted for at least 1 month

Acute stress disorder

Similar to PTSD much shorter duration Begins within 3 days-1 month after event Lasts for 3 days-1 month Prescribe of PTSD? Actually a disorder?

Effects of military service on mental health; Hoge et al (2004)

``` 2530 studied before Iraq deployment 1709 studied after return PTSD before; 9.4% PTSD after; 18% Demographics of pp were similar to those of the general, deployed non-officer pop in Iraq ```

PTSD triggers

``` Rape; 90% chance Torture; 70-90% chance Prisoners of war; <50% Flood & earthquake survivors; 20-25% Motor vehicle accident victims; 15% Overall US prevelance rate; 1% ```

Conditioning theory

symptoms associated with PTSD due to classical conditioning Trauma (UCS) associated with other cues (CS) Conditioned fear response does not extinguish due to avoidance responses

Conditioning theory doesn’t explain;

Individual nature of responses to trauma | Range if symptoms specific to PTSD e.g. dissociative experiences & flashbacks

Why only some people?

Pre-existing personality factors Possible genetic disposition Key appears to be the fear reaction to the experience

Biological factors

30% heritability Genetically wired heightened startle response & endocrine system response Reduced hippocampul volume Vebtrimedial frontal cortex; amygdala circuitry

Other factors

Tendency to take responsibility for the traumatic event & the misfortunes of others involved in the event Developmental factors Family history of PTSD Existing high levels of anxiety or pre-existing psychological disorder Low IQ, link to coping strategies? Types of experiences reported at time of event

Mental defeat

Individual vulnerability in increased in those who see themselves as a victim Loss of individual autonomy All info about trauma is processed negatively & person views themselves as unacceptable to act effectively Perceived lack of control prevents processing of the memory

Avoidance & dissociation

Avoidance coping more likely to lead to PTSD Dissisociation as an avoidant strategy; dissociation used to allow person to detach & distance themselves from the trauma Individuals who show dissociative symptoms at the time of trauma more likely to develop PTSD

Emotional processing theory

Information processing model 1) Representation of memory becomes strongly associated with other contextual details due to intense nature of trauma 2) leads to formation of representations & associations in memory different to those formed from everyday experience 3) previous assumptions about how safe the world is leads to a sensitisation in terms of the threshold to display fear response People with fixed ideas of self & world prior to trauma more susceptible to PTSD

Dual representation theory; Brewin (1996)

Trauma memories are represented in a more fundamentally distinct way Re-experiencing arises when trauma memories become dissociated from the ordinary memory system Recovery involves transforming them into ordinary or narrative memories

Memory model

Verbally accessible memories (VAM) vs situationally accessible memories (SAM)

Verbally accessible memories

Memories consciously processed at time of trauma Contain info before, during & after traumatic event; temporal context is encoded Can be deliberately retrieved Integrates with personal context comprising past, present & future Hippocampus involvement

Situationally accessible memories

Perceptual processing (sights, sounds, touch) Stores info about bodily response Memories difficult to communicate to others Responsible for flashbacks Amygdala involvement Triggered involuntarily by situational reminders