Unit 2 Flashcards
Chapters 5-7 and 9-10
stress
a perception that environmental demands overwhelm one’s personal resources available to deal with them
how to respond constructively to stress:
- changing perceptions
- reducing, reframing, or renegotiation demands
- increasing personal resources to meet demands
- deploying personal resources more effectively
characteristics of stressful events
- uncontrollable
- unpredictable
- change/challenge capabilities or self concepts
the body’s response to stress
- must turn on, then turn off the stress response
- active sympathetic nervous system, then activate the parasympathetic nervous system to restore homeostasis
- problems if homeostatic balance is not properly restored or stress response stays active long term
Hans Seyle General Adaptation Syndrome
- series of physiological changes in response to stressful events
- alarm stage: initial symptoms the body experiences when under stress (fight-or-flight)
- resistance stage: body enters recovery phase but is still on high alert for a period of time
- exhaustion stage: result of prolonged or chronic stress; signs included fatigue, burnout, depression, anxiety, decreased stress tolerance
gender differences with stress
- “authoritarian control” originally identified, male subjects used (fight-or-flight)
- “tend and befriend” response often characteristic of females; theory that humans rely on taking care of young ones and connecting with others during stressful situations
hypothalamic-pituitary-adrenal pathway
hypothalamus –> pituitary gland –> secretion of ACTH –> adrenal cortex –> corticosteroids
what happens in the brain in the face of stress?
- sensory input (see, hear, etc)
- amygdala: threat detected
- activated hypothalamus
- initiates the “fight-or-flight” response
sympathetic nervous system pathway response to stress
- nerve fibers of the autonomic nervous system that quicken the heartbeat and produce other changes experienced as arousal
- nerves can stimulate the body directly or indirectly, by stimulating the adrenal glands to release epinephrine and norepinephrine
emotional brain response to stress
- sensory information goes to the thalamus
- immediate response initiated via the fast path (thalamus to amygdala to response)
- longer pathway activates follow-up response (thalamus to visual cortex to amygdala to response)
DSM-5 criteria for diagnosing PTSD
- post traumatic stress is a normal reaction to an abnormal event
- the person has been exposed to a traumatic event in which they experienced, witnessed, or were confronted with an event involving actual or threatened death or serious injury, or a threat to the physical integrity of oneself or others
symptom categories of PTSD
- re-experiencing the trauma
- avoidance of things relating to the trauma
- reduced responsiveness (detached, dissociation, derealization)
- increased arousal, negative emotions, and reactivity
prevalence of PTSD
- 61% or men and 51% of women experience at least one traumatic event in their lifetime
- about 4% of the population, aged 18-54 will experience symptoms of PTSD in a given year (5.2 million people)
- lifetime rates: 10% for women and 5% for men
history of PTSD
- Da Costa’s Syndrome/Soldier’s Heart
- Combat Fatigue/War Neuroses
- Myers’ ‘Shell Shock’
- Freud’s Hysteria
- Rape trauma syndrome
- Battered woman syndrome
- DSM-III Ptsd
- acute stress disorder: symptoms begin soon and last less than a month
- PTSD: onset and duration of symptoms variable
additional problems of PTSD
- attention and memory issues
- functional impairment (occupational conflicts, aggression, divorce, legal altercations, difficulties parenting)
course of PTSD
- onset: within 3 months or not until years later
- duration: varies, some people recover within 6 months while others suffer much longer
- pattern: periods of acute symptoms followed by remissions, some experience severe and unremitting symptoms, variable
associated comorbid disorders with PTSD
- major depressive episodes
- alcohol/drug abuse/addiction/dependence
- simple and social phobias (more in women)
- conduct disorders (more in men)
- in children: anxiety disorders and acting-out
PTSD symptoms in children
- generalized fears
- sleep disturbances
- posttraumatic play and reenactment
- lose an acquired developmental skill
- omen formation
post-trauma variables for PTSD
- rate of physical recovery
- social support
- involvement in work and social activities
pre-trauma variables for PTSD
- poor coping skills
- pre-existing mental-health problems
- poor social support
trauma-related variables for PTSD
- amount of physical injury
- potential life-threat
- loss of significant others
treatment for PTSD
- varies depending on type of trauma
- general clinical goals: end lingering stress reactions, gain perspective on painful experiences, and return to constructive living
process goals for PTSD treatment
- exposing the client to what they fear in order to extinguish that fear
- challenging distorted cognitions
- helping reduce stress in daily lives
- improving coping capacity
biological and genetics variables for PTSD
- abnormal levels of cortisol and norepinephrine
- system remains unstable, triggering symptoms, possible brain damage
- vulnerability may be passed on genetically
basic recommendations for PTSD treatment
- immediate aftermath: reestablish routines, find support network, avoid major life decisions
drug therapy for PTSD
antianxiety and antidepressant medications
behavioral exposure techniques for PTSD
- prolonged exposure using in vivo exposure or imaginal exposure
- reduce specific symptoms, increase overall adjustment
- flooding and relaxation training
- eye movement desensitization and reprocessing (EMDR)
insight therapy for PTSD
- client centered type of talk therapy that can help you better understand yourself better
- bring out deep-seating feelings, create acceptance, lessen guilt
- often use family or group therapy formats; “rap groups”
cognitive processing therapy for PTSD
guides the individual to identify ways that the trauma has impacted different areas of their life and to identify and change ways of thinking that are disrupting daily functioning
additional treatment options for PTSD
- psychological debriefing
- psychosocial rehabilitation
- inpatient treatment
- hypnosis
- marital and family therapy
- creative therapies
dissociation
- an involuntary disruption of the normal integration of consciousness, memory, identity, or perception
- aspects of an individual’s identity, memories, and consciousness become split off from one another
- Freudian idea is that by “walling off” traume as not part of the self, dissociations serve as a protective function
dissociative identity disorder
there are separate, multiple personalities in the same individual
symptoms of dissociative amnesia
- loss of memory due to psychological rather than physiological causes
- the memory loss is usually confined to personal information only
dissociative amniesia
the person loses memory of important personal facts, including personal identity, for no apparent organic cause
symptoms of dissociative fugue
person suddenly moves away from home assumes an entirely new identity, with no memory of previous identity
etiology of dissociative amnesia
- typically occurs following traumatic events
- may involve motivated forgetting of events, to poor storage of information during events due to overarousal, or to avoidance of emotions experience during an event
treatment of dissociative amnesia
help the individual remember traumatic events and accept them
dissociative fugue
- the person moves away and assumes a new identity, with amnesia for the previous identity
- DSM 5 not defines dissociative fugue as a subcategory of dissociative amnesia
etiology of dissociative fugue
fugue states usually occur in response to some stressor, but because they are extremely rare, little is known
treatment of dissociative fugue
psychotherapy to help the person identify the stressors leading to the fugue state and learn better coping skills
depersonalization-derealization disorder
- frequent episodes where individual feels detached from his or her mental state or body, or from the outside world
- individuals may show inhibitory responses to negative emotional information
- lower activity in sensory areas and less cortical thickness found in those with depersonalization disorder
treatment for depersonalization disorder
general principles are to help the person regain their memory, help the person find out what stress precipitated the disorder and work through it, and improve coping skills with training
symptoms of dissociative identity disorder (multiple personality disorder)
- presence of two or more separate personalities or identities in the same individual
- these personalities may have different ways of speaking and relating to others and may even have different ages, genders, and physiological responses
etiology of identity disorder
- alters may be created by people under conditions of extreme stress, often child abuse
- self-hypnosis may be involved
- some evidence it runs in families
treatment for identity disorder
- long-term psychotherapy and use of hypnosis to discover functions of the personalities and to assist in “integration”
- antidepressants and antianxiety drugs may be used
differences in alters (identity disorder)
- identifying features (age, gender)
- abilities and preferences (vision, personality, musical ability)
- physiological responses (allergies, brain imaging)
- “host”, “precursor”, other functional types
what causes are proposed for dissociative and identity disorders?
- almost all patients have histories of severe child abuse
- most are also highly suggestible
- DID is believed to represent a mechanism to escape from impact of trauma
- closely related to PTSD
psychodynamic approach to dissociative and identity disorders
- massive repression
- self-hypnosis: hypnotic amnesia of trauma
- treatment: focus is on reintegration of identities, hypnotic techniques used
cognitive-behavioral approach to dissociative and identity disorders
- state dependent learning, based on level of arousal
- extremes of normal memory functions
- treatment: identify and neutralize the cues/triggers that provoke memories of trauma and dissociation, apply cognitive therapy techniques
mood disorder
involves persistent feelings of sadness or periods of feeling overly happy or fluctuations from extreme sadness to extreme happieness
unipolar depression
experiencing only depression
bipolar disorder (main depression)
cycle between period of depression periods of mania
diagnostic note to causes of bipolar depression
- reactive (exogenous) depression is response to external stressors
- endogenous depression arises dependent of external stressors
- hard to distinguish, important to include both internal and external assessments in diagnosis
symptoms of depression
- emotional: sadness, anhedonia
- physiological/behavioral: sleep disturbances, psychomotor retardation, fatigue and loss of energy, catatonia
- cognitive: poor concentration, difficulty making decisions, feelings of being worthless/hopeless, delusions and hallucinations with depressing themes, suicidal thoughts
how common is depression?
- 17% of americans experience an acute episode at some point in their life
- 6% experience chronic depression
- highest levels of depression are aged 15-21
- lowest levels of depression are aged 55-70
- women are about twice as likely as men top experience symptoms
persistent depressive disorder (chronic)
with major depressive episodes and dysthymic syndrome, 3 or more symptoms including depressed mood, lasting at least two years