Chapter 17: Trauma and stress are related disorders, crisis and response to disaster Flashcards
The evolution of the concept of stress
From the Latin word meaning to draw tight. It was used to denote force pressure or strain. The earliest 20th century had a shift away from the view of the body as machine.
Stress as a physiological response
Stress as a response to changing environment conditions. Homeostasis with used to describe the body’s ability to maintain stable internal Environment. Environmental changes are perceived as threats to the personal integrity or safety and signal a compensatory response mediated by the sympathic branch of the autonomic nervous system. Strong emotions like fear and anger or fundamental to the stress response. Leader dubbed the fight or flight response. The General adaption syndrome theory differentiate stress which is a nonspecific response of the body to any demand placed on it, from stressors which are events that initiate the response. Stressors can be physical like infection, physiological like trauma, or social like lack of social support, and can be short or long term. First is the alarm reaction stage during which all body systems respond in a coordinated effort to mediate the stressor, then stage of resistance were efforts to adopt continue then stage of exhaustion where the individuals resources deplete and exhaustion or death in ensue.
Criticism included that many norepinephrine responses are not general but very specific. That stressors do not necessarily produce the same response in every individual. That a stressor for one person may not be a stressor for another.
The evolution of stress, stress as a stimulus
Researchers became interested in the physiological and emotional aspects of stress. Life changes or events where the stimuli, i.e. stressors, that evoked the stress response. Explored associations between significant life events such as marriage birth divorce and death, and stress.
Major problem is that stress provoking stimuli can be identified only in retrospect. It does not take into consideration the meaning the individual assigned to an item, individual coping abilities, or the implication of chronic or recurrent events.
The evolution of stress, stress as a person environment transaction
Stress is the appraisal of an event (the subjective evaluation of an event or situation) that is critical to the stress experience. Stress resulted from a perceived in balance between individuals resources and the demands placed on them. Depends on how a stressor is appraised in relation to the persons resources for coping with it. It is neither an environmental stimulus, a characteristic of the person, nor response, but a relationship between demands and the power to deal with them without unreasonable or destructive costs.
The evolution of stress, cognitive appraisal
Cognitive appraisal describes the process by which individuals examined the demands and constraints of a situation in relation to their own personal and network resources. Two levels primary where individuals evaluate the situation and determine whether they are in danger or under threat. If yes they go to the secondary appraisal where the individual considers the options for dealing with the situation. Stress is the perception of threat or harm (1st appraisal) for which an individual has no effective response. (2nd appraisal)
New understandings of the stress and the stress response
Concept of stress criticized for his lack of Percision and specificity. Stress is probably best thought of as a generic, non-technical term, analogous to disease or to addiction.
Allostasis
Means maintaining stability through change. It reflects the notion that different environmental circumstances or conditions require different set points. Example ideal blood pressure is different when asleep versus exercising. Allostatic load Refers to the cumulative negative effects on the body of continuously having to adapt to changing environmental conditions and psychosocial challenges. It is the sum total of the where in tear on the body that accumulates from the constant effort required to maintain normal body rhythms in the face of changing environmental conditions, the challenges of life and adverse psychological consequences of harmful lifestyle choices such as inactivity alcohol and smoking
New views on responses to stress
The freeze hide response
The tendency to produce a passive response to stress. Natural selection supports the development of different traits of pipe preserving genes for high aggression in hawks and low aggression in doves within a population and between and across genders within the species
Tend and befriend
Males and females respond differently to stress. Females exhibit tend and befriend. It has advantages and reflects the inclination of females towards affiliation, cooperation and caretaking. Tending involves nurturant activities designed to protect the south and offspring that promotes safety and reduce his distress. Befriending is the creation and maintenance of social networks that may aid in this process. Involves oxytocin which has a role in a range of social behaviours such as social memory, attachment, bonding, trust and aggression
Physiologic stress responses
Dangerous situation triggers an automatic total body response where the brain receives inputs and coordinates physiologic and behavioural responses that enhance survival. Begins in the central nervous system but involves all body systems. Hypothalamus is responsible for maintaining internal environment and initiating the body stress response. Hypothalamus activates the sympathic branch of the ANS which stimulates the adrenal medulla to secrete catecholamines and mediates vigilance arousal activation and mobilization. Also secretes corticotropin releasing hormone to signal the interior Pituitary gland To release adrenocorticotropic hormone into the systemic circulation which stimulates the adrenal cortex to secrete cortisol. Hypothalamus excites locus coeruleus in the brain stem to increase norepinephrine in the CNS. Hypothalamus also synthesizes a VP/ADH which increases blood pressure by causing Vasco construction. If the stressor It’s prolonged the body must make long term metabolic adjustments that ensure a sufficient supply of energy. Cortisol is essential to sustain the stress response since it mobilizes lipid stores and skeletal protein for energy. Short term stressors use glucose and skeletal muscle stores
Social support and stress
Social support
Social support is resources provided to us by others. It moderates the adverse effects of stress. Two categories. Functional support is the quality of the relationship and the degree to which an individual believes that help is available. Structural support is the quantitative characteristics of a social support network such as size and number of interconnections. Not all interpersonal interactions are supportive and someone can have a large complex social network but little social support. Dissupport derives from the observation that some relationships can be harmful stressful and damaging to an individual‘s self-esteem.
social network
A social network can be a resource which in Hanses the ability to cope with change and influence the course of illness. Contacts are Categorized into three levels. Level 16 to 12 people with whom the person has intimate contact. Level 230 to 40 people whom the person sees regularly. Level III the several hundred people with whom an individual has direct contact but incidental contact in the course of his or her day-to-day life. And ideal network is dense and interconnected. Intensity is the degree or closeness of a relationship. Intense relationships can restrict a persons opportunity to act interact with other network members but without Intense relationships people lack intimacy. Reciprocity is the extent to which there is a balanced give-and-take in a relationship. Members must provide and receive support aid services and information from each other
Emotional response to stress
There’s still a debate between emotion and cognition and which one is primary that gives rise to the other. Emotion is defined as a complex organized psychological reaction consisting of cognitive appraisals, action impulses and patterned somatic reactions. 15 basic emotions, each of which is elicited in response to a particular perception of what a situation or an event means to an individual. Example anxiety is typically associated with the perception of a non-specific threat or some uncertainty.
Coping
Is an individuals constantly changing cognitive and behavioural efforts to manage specific external or internal demands that are appraised as taxing or exceeding the individuals resources. It has three principles. 1 it continuously changes over the course of an encounter, 2 it must be assessed independently of its outcomes, 3 it consists of what an individual thinks and does in response to the perceived demands of a situation. It reflects an individual’s continued reappraisal of the person environment relationship in light of changing conditions. If people see their efforts as ineffective they can feel helpless and overwhelmed. Positive coping leads to adoption. The inability to cope leads to maladaption and contributes to Ill health.
Two general approaches to coping. Problem focussed coping maybe inner or outer directed. Outer directed strategies attempt to illuminate or alter a situation or another’s behaviour well inner directed strategies in at altering one’s own beliefs attitudes skills and resources. Emotion focussed coping six to manage a persons emotional distress through exercise prayer meditation expressing emotion and talking to friends.
Coping involves continuous reevaluation or reappraisal. Reappraisal incorporates feedback about the effects of coping and allows for continual processing of new information.
Stress and illness
Stressors such as isolation, crowding, exposure to predators, electrical shock can increase morbidity and mortality from tumours and infections. Acute exam stress is linked to reduction in natural killer cells and increased activation of latent viruses. Long-term caregivers can have a reduced immune function.
The stress diathesis model proposes that pre-existing genetic, biologic and psychological vulnerabilities interact with negative or stressful life events to cause illness. Predicts an inverse relationship between vulnerability and stress. The more vulnerable the individual the smaller the stressor required to cause illness. There is a high genetic component to nervousness, emotionality, neuroticism and being high strong.
Trauma and stress related disorders
Modern psychiatry did not officially recognize extreme stress until 1980 when PTSD appeared in the DSM. 14 years later acute stress disorder was added. In the latest version these were removed from the list of anxietyDisorders and placed in a new category called trauma and stress are related disorders. A traumatic stress or is considered to be any event or events that may cause or threatened death, serious injury, or sexual violence to an individual, a close family member, or a close friend.
Acute Stress Disorder
ASD diagnosis is when an individual has experienced, personally or through witnessing others experiences, a severe threat in which life or injury is or appears to be at stake. This must’ve been continue to affect the individuals mental health status.
Post traumatic stress disorder
PTSD is diagnosed if an individual experiences or witnesses unauthentic, severe threat of death or injury to self or others and this experience then affects the individuals mental health in specific ways. Reliving the Traumatic Experience through intrusive thoughts, avoidance of memories of trauma and inability to concentrate, altered arousal levels, negative effects on sleep. The most common types of threats related to PTSD include witnessing the killing or injury of others and being in a life-threatening accident. Factors that predict the development of PTSD include being female, type and severity of the trauma, past trauma, availability of support at the time of the stressful event. Females have less exposure than males to war like trauma but greater experience of sexual assault. Children especially those under 10 or less likely to experience PTSD after trauma than our adults. Treatments for PTSD include cognitive behavioural therapy, psychotherapy, Eye movement desensitization and repossessing EMDR, and medication
Intergenerational transmission of stress, trauma and resilience
The process by which the effects of trauma and stress experienced in one generation can be transmitted to the subsequent generations. Adverse experiences in childhood may influence the risk for various health and social outcomes in offspring. Experiences of parents are linked with the way children appraise certain situations, how the appraise stressful experiences and their ability to contend with these stressors. These individuals may be at increased risk of further stressor encounters, increased psychological and neural chemical reactivity to stressors and the promotion of poor mental and physical health outcomes.
These events do not occur in isolation since there are indirect factors that might contribute such as sociocultural environment, physical environment, historical influences and government policies. These factors may result in an impaired ability to provide an adequate early childhood environment which might result in the Recapitulation of the events that occurred in the preceding generation.
Collective trauma and historical trauma
Significant collective experiences and outcomes can arise when a whole group of people encounter a traumatizing or adverse experience. Collective trauma refers to instances in which a significant portion of any given social group, based on political racial religious cultural or other factors, are collectively exposed to our Trumatic event. Can be random such as a single natural disaster or purposely conducted by one group to another. Community level changes in the aftermath of trauma include erosion of basic trust, collective silence, deterioration in social norms, morals and values and poor leader ship.
Historical trauma highlights the process by which the consequences of multiple collectively experienced adversities experienced by group overtime maybe calmative and be carried forward to subsequent generations if they outweigh contextual and group level resilience factors. Historical trauma has been suggested and shown to be a contributing factor in relation to the high prevalence of certain psychosocial issues faced by first nations. Those with a parent or grandparent who attended residential schools were at greater risk for psychological distress and suicide attempts.
Responses to collective and historical trauma
Collective approaches will often have the most benefit from a public health perspective when resources are limited. Community level mental health and psychosocial support interventions have been shown to help communities affected by disasters. Community-based approaches let interventions reach a larger target population and take preventative and promotional activities. Individuals and families can recover and cope when communities become functional, activating healing mechanisms. Approaches that were useful include creating public awareness, training of grassroot workers, encouraging traditional practises and rituals, promoting positive family and community relationships, rehabilitating and networking with other organizations.
Definitions
Collective trauma occurs when a traumatic event is experienced by significant portion of a given social group, it can have long-term consequences for the social group beyond its additive effect on individuals such as social norms, dynamics, functioning and structure of the group may be modified
Historical trauma is the process by which a social group is affected by the consequences of multiple collectively experienced adversities across time that way group resiliency factors, become cumulative, and are carried forward to subsequent generations that the trauma may be considered as part of a single trajectory.
Trauma informed care
Is an approach to all clients that is based on knowledge of trauma and its affects with policies and practises incorporating principles of safety, choice and control as well as compassion, collaboration and trustworthiness. Implicit discrimination such as bias, attitudes and beliefs can influence provider behaviour in healthcare settings. There is a growing attention to the need for cultural competence in trauma informed healthcare. We also need cultural safety and cultural humility. Cultural humility is an active and continual engagement in a process of self critique, reflection, acknowledgment, rectification of in balance of power and respectful community partnership in the provision of care. Cultural safety is an examination of colonial, interpersonal and professional power relationships reflected through racism and discrimination.
