Chapter 5 Flashcards
1
Q
Health psychology
A
Concerned with effects of stress and other psychological factors in development and maintenance of physical problems. Subspecialty with behavioural medicine
2
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Behavioural medicine approach
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Concerned with psychological factors that may predispose individuals to medical problems
3
Q
What is stress?
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Psychological condition that results when we experience or perceive challenges to physical or emotional well being that exceed our coping resources and abilities. Is an interactive and dynamic construct because it reflects interaction between organism and environment
4
Q
Stress vs stressors vs coping strategies
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Stressors: external demands
Stress: effects stressors create within organism
Coping strategies: efforts to deal with stress
5
Q
Good stress and bad stress
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Both types of stress can tax persons resources. Bad stress (distress) typically has potential to do more damage
6
Q
Stress and DSM
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Stress is recognized in diagnostic formulations, notably in ptsd. Ptsd used to be classed as anxiety disorder, but DSM 5 created new class of disorders called trauma and stressors related disorders, now ptsd is classed there. This category also includes adjustment disorder and acute stress disorder. Disorders involve patterns of psychological and behavioural disturbances
7
Q
Why do some people experience problems when under stress?
A
May be linked to coping skills and presence or absence of particular resources. Children are more sensitive to war and terrorism, adolescents with depressed parents are more sensitive to stressful events
8
Q
Individual characteristics that improve persons ability to handle stress
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Higher levels of optimism, greater psychological control or mastery, increased self esteem, better social support. Differences in coping styles may be linked to underlying genetic differences
9
Q
Stress and genetics
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Genetic makeup can render us more or less stress sensitive. Research determined that particular form of particular gene (5HTTLPR gene) was linked to how likely person was to become depressed when faced with stress (having 2 short forms of gene and experiencing 4 or more stressful life events, especially interpersonal events)
10
Q
Cumulative stress
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Amount of stress faced earlier in life may also make more sensitive to stress later in, showing it may be cumulative
11
Q
Stress tolerance
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Refers to persons ability to withstand stress without becoming seriously impaired
12
Q
Stressful experiences as self perpetuating cycle
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Stressful experiences may create self perpetuating cycle by changing how we think about things that happen to us. People with history of depression tend to experience negative events as more stressful than other people
13
Q
Key factors involved in stressors (6)
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- Severity ofstressor
- It’s chronicity
- It’s timing
- How closely it affects our own lives
- How expected it is
- How controllable it is
14
Q
Which stressors are more stressful?
A
Stressors that involve important aspects of persons life; stressors that last a long time; encountering a number of stressors at same time; when someone is more immediately involved in traumatic situation; events that are unpredictable and unanticipated (study: patients who underwent major surgery were less anxious when they were given realistic expectations about outcomes); events that are uncontrollable
15
Q
Crisis
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Term used to refer to times when stressful situation threatens to exceed or exceeds adaptive capacities of person or group. Often especially stressful because stressors are so potent that coping techniques we typically use do not work
16
Q
Stress vs crisis
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Traumatic situation or crisis overwhelmed persons ability to cope, whereas stress does not necessarily overwhelm person
17
Q
Social adjustment rating scale
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Self report checklist of fairly common stressful life experiences to measure life stress. Limitations of check list method later led to development of interview based approaches
18
Q
Life events and difficulties schedule (LEDS)
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Interview based approach to measure life stress. Includes extensive manual that provides rule for rating both acute and chronic forms of stress. Allows raters to consider context in which life event occurs and take into account unique life circumstances (ex pregnancy in married woman vs teenager). Although more time consuming and costly than checklist, it’s also more reliable and preferred for research
19
Q
Resilience
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When, after experiencing potentially traumatic event, some people function well and experience very few symptoms. Resilience is not rare- it is most common reaction following loss or trauma
20
Q
Why are some people more resilient than others?
A
No single factor predicts resilience, is linked to variety of different characteristics. Factors that increase resilience: Being male; being older; being well educated; having more economic resources; being a positive person ( being negative is associated with doing less well after traumatic event); people who are very self confident. When social class is controlled for, race and ethnicity are not predictive of reduced resilience.
21
Q
Allostatic load
A
Biological cost of adapting to stress. When relaxed and not experiencing stress, allostatic load is low, when we are stressed and feeling pressured, it is higher. Stress has become key underlying theme in understanding of development and course of all physical illness
22
Q
Stress And illness
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Stress can exacerbate/aggravate symptoms in people with illness (MS, migraines, allergies, arthritis). Also increased susceptibility to catching a cold and increases risk of heart attack (ex death from coronary heart disease rise in days after major earthquake). Everyday stress (working, giving short speech) can also elevate risk for heart disease. Interesting to note that most heart attacks occur on Mondays in people who work
23
Q
Stress response
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When faced with threat of perceived stressor, body undergoes cascade of biological changes. There are 2 systems in stress response:
Sympathetic-adrenomedullary (SAM) system and
Hypothalamus-pituitary-adrenal system
24
Q
Sympathetic-adrenomedullary (SAM) system
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Response begins in hypothalamus, which stimulates sympathetic nervous system, which causes inner portion of adrenal glands (adrenal medulla) to secrete adrenaline and noradrenaline. These hormones cause increase in heart rate and cause body to metabolize glucose faster.
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Hypothalamus-pituitary-adrenal (HPA) system
Hypothalamus releases hormone called corticotropin-releasing hormone (CRH) which stimulates pituitary gland. Pituitary secrets adrenocorticotropic hormone (ACTH) which induces adrenal cortex (outer portion of adrenal gland) to produce stress hormones glucocorticoids. (In humans, this is cortisol)
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Cortisol
Prepares body for fight or flight and inhibits innate immune response (so bodies inflammatory response to injury is delayed). Escape has priority over healing, and tissue repair is secondary to staying alive.
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Downside to cortisol
If not shut off, can damage brain cells, especially hippocampus. It may even stunt growth. When brain receptors detect cortisol, they send feedback message that is designed to dampen activity of glands involved in stress response. But if stressor remains, HPA axis stays active and cortisol release continues. If HPA axis is chronically active, this could be problematic
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Psychneuroimmunology
Study of interactions between nervous system and immune system. Brain and immune system influences each other. Status of immune system also influences current mental states and behavioural dispositions by affecting blood levels of circulating neurochemicals, which modify brain states.
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Immunosuppression
Can be caused by glucocorticoids because of stress. Longer term stress creates problems for immune system
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Immune system
Protects body from viruses and bacteria. If it is too weak, it can’t function effectively and body succumbs to damage from imaging viruses and bacteria. If it is too strong and unselective, it can turn on body’s own healthy cells leading to autoimmune diseases
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White blood cells
Leukocytes or lymphocytes. Produced in bone marrow and stored throughout body, are first line of defence.
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Leukocytes
2 types: B-cell, and T-cells. When stimulated, b-cells and t-cells becomes activated and multiply rapidly, mounting various forms of counterattack
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B-cells
Matures in bone marrow, produces specific antibodies that are designed to respond to specific antigens. When recognizes antigen, it begins to divide and produce antibodies that circulate in blood. This is facilitated by cytokines released by t-cells. Production of antibodies takes 5 days or more. But response of immune system will be much more rapid id antigen appears in future because immune system had memory of invader
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Antigens
Foreign bodies such as viruses and bacteria and internal invaders such as tumour and cancer.
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T-cells
Matures in thymus, which is important endocrine gland. Circulate throughout body and lymph systems in inactive form. Has receptors on surface that recognize one specific type of antigen, but are unable to recognize antigens by themselves. Become activated when macrophages detect antigens abs start to engulf and digest them. To activate t-cells, macrophages release chemical called interleukin-1
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Cytokines
Small protein molecules, important component of immune system. Serve as chemical messengers and allow immune cells to communicate with each other. In addition to communicating with immune system, also influences the brain. Brain and body work together to coordinate response to sickness. When unwell, feel tired and have little appetite. This is result of effects of cytokines. Causing us to rest into better.
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Influences between brain and immune system
Brain is influenced by products of immune system. Brain can also influence immune processes. Chronic problems at level of immune system may lead to behavioural changes or psychiatric problems
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Categories of cytokines
Proinflammatory cytokines and anti inflammatory cytokines
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Proinflammatory cytokines
Ex interleukin-1, tumour necrosis factor. Help us deal with challenges to immune system by augmenting immune response. Process is disrupted under conditions of stress, which effects healing of wounds (cytokines are still present, but at much lower levels)
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Anti inflammatory cytokines
Decrease or dampen response that immune system makes. Sometimes accomplish this by blocking synthesis of other cytokines
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Chronic stress and inflammation
Inflammation is increased in people who are under prolonged stress because long term stress seems to interfere with body’s ability to turn off cytokine production
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Cytokines and cortisol
Cortisol is supposed to regulate (turn off) cytokine production. Cytokine production sets of negative feedback loop that is designed to prevent an excessive or exaggerated immune or inflammatory response. Chronic stress seems to impair body’s ability to respond to signals that will terminate immune system reactivity, resulting in inflammation
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Why is chronic inflammation bad?
Chronic inflation is a risk factor for: cardiovascular disease, type 2 diabetes, asthma, osteoporosis, rheumatoid arthritis etc. Reason why doctors test for presence of C-reactive protein, a molecule produced by liver in response to stress hormone, when assessing persons risk for heart disease
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Stress in Alzheimer’s caregiver’s vs relocation
Correlational study found that there was higher stress in women who were caring for Alzheimer’s patients than in women anticipating stress of relocation. Age was no factor in this study
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Stress and discrimination
Discrimination is a form of chronic stress, there are elevated levels of CRP in African Americans
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Correlational research
Researchers observe or assesses characteristics of different groups, learning much about them without manipulating conditions to which they are exposed
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Traumatic stressors experienced during childhood seem to increase risk of…
Premature death in later life. In a study, People who had reported 6+ adverse events during childhood died much earlier than would be expected. Top two leading causes of death were heart disease/stroke and cancer
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Why might stress in childhood cause premature death?
Early life stress may have biological consequences that advance aging, making more likely that people die earlier from kinds of diseases that are associated with increased age. Telomeres might be part of answer
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Telomeres
Protective end parts of chromosomes. Shorten with age. Stress shortens length of telomeres. Stress hormone cortisol can reduce activity of telomerase, enzyme that maintains telomeres (also learning that drinking too much sugar sweetened soda might shorten telomeres). Pessimism accelerates rate of telomere shortening. Meditation may promote telomerase activity. Exercise seems to act as buffer against bad effects
50
Personality: type A behaviour pattern
Characterized by excessive competitive drive, extreme commitment to work, impatience and time urgency, and hostility. Type A personality associated with increased risk for coronary artery disease and heart attack. Hostility component of type A personality that is most closely related with coronary artery deterioration
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Type D personality type
“Distressed”. Tendency to experience negative emotions and also feel insecure and anxious. Men with CHD who scored high on measures of chronic emotional distress were more likely to have fatal and non fatal heart attacks. People with higher scores of negative affective component of type D personality are at increased risk of having more problems after cardiac surgery
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CHD
Coronary heart disease
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Depression and immune function
Depression is associated with decreased immune function , partially independent of specific situations or events that provoked depression, ie state of being depressed adds something beyond negative effects of stressors precipitating depressed mood.
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Depression and heart disease
Depression also factor in heart disease. Depression is more common in people with heart disease than in people with other serious diseases. Also heart attack patients with high levels of depressive symptoms after heart attack are more likely to die within 5 years. Anhedonia may be predictive of increased mortality after heart attack
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Anhedonia
Symptom of depression characterized by profound loss of interest or pleasure
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Depression appears to be a __________ for __________ CHD
Risk factor
Developing
Link between depression and future heart problems remained even when other potential confounding variables such as lifestyle were taken into account
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Risk factor
Variable that increases likelihood of specific (and usually negative) outcome occurring at later time
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Why are depression and heart disease so closely linked?
Example of mind body connection. Depression may interact with stress to further enhance inflammatory responses naturally triggered by stress exposure. Proinflammatory cytokines also trigger growth of plaques in blood vessels and making it more likely that those plaques with rupture and case heart attack. Ie link between heart disease and depression is due to inflammation and presence of inflammatory cytokines
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Depression and telomeres
People who are depressed have shorter telomeres than never depressed people, even after controlling for other health and life variables. In study, reduction of telomere length was equivalent to 4-6 years of accelerated aging. Dose-response relationship: more chronic and severe depression, shorter telomeres were, though this is just correlational
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Anxiety and CHD
Relationship between anxiety and increased risk for sudden cardiac death. Sudden cardiac death was six times higher in men with the highest levels of anxiety. Women with anxiety also have a higher risk of sudden cardiac death
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Social factors and CHD
Lonely people are at increased risk of developing heart disease. Loneliness is not the same as social support or depression and it is not related to any measures of persons social network size. This was only found in women, there was no association between loneliness and heart disease was found in men.
For people who already have CHD, people who report lower levels of emotional support were more likely to have another heart attack. Death is also more likely within 5 years if person is unmarried or had no one to confide in. Quality of marriage predicts 4 year survival rate in patients with congestive heart failure
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Health and positive emotions
People who have tendency to brood about wrongs that other people have done to them may be harming themselves with increased negative consequences for heart disease and immune function
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Positive psychology
Focuses on human traits and resources such as humour, gratitude, and compassion that might have direct implications for physical and mental well being. In study, when people asked to be forgiving, participants reported more feelings of empathy and forgiveness, but when unforgiving, reported felt more negative, angry, sad, out of control and greater tension in brows, increased heart rates and blood pressures. These negative subjects were unable to relax even after activity was over.
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How can bring forgiving benefit you?
People who are more forgiving have fewer symptoms of physical and mental health problems. Acts as buffer against side effects on mental health (no similar association found for physical health). Bring more forgiving predicts having fewer health symptoms, but having fewer health symptoms does not predict being more forgiving
65
Is it beneficial to regulate one’s emotions?
Research suggests that yes. People who were least able to control anger developed more heart problems during next 10-15 years. People with best emotional regulation skills were least likely to develop cardiac disease
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Do physicians treat depression in CHD patients?
Physicians often fail to treat depression in CHD patients, dismissing it as understandable consequence of having had life threatening medical scare. Many lives can be saved by giving anti depressant meds to patients who have suffered heart attack and are depressed. Patients treated as such are less likely to die or have another heart attack than patients who were not. Treatment with CBT was not associated with reduced mortality in patients, though CBT did help alleviate depression
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Psychological interventions to help ourselves stay healthy in face of stress
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Developing effective emotions regulation skills
Emotional disclosure
Biofeedback
Relaxation and meditation
Cognitive behaviour therapy
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Emotional disclosure
Opening up and writing expressively about life problems is effective therapy for people with illnesses and may speed up wound healing (this is important as wound healing slows down as we age, so could be used as intervention). Also provides benefit for people diagnosed with autoimmune disorder. Does not seem to help with sleep problems, depression or overall quality of life in cancer patients, and may get in way of emotional recovery during marital separation. In studies, patients often experience increases in emotional distress during writing phase and then show improvement over follow up
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Why does emotional disclosure provide benefits?
Not clear. Possible reasons:
Emotional catharsis
Writing gives people opportunity to rethink problems or reduce how threatening problems seem (reframing)
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What are risks of expressive writing?
Could lead to rumination. Expressive writing too soon after upsetting life event may make things worse
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What is Biofeedback
Aim to make patients more aware of things such as heart rate, blood pressure, muscle tension. Done by connecting patients to monitoring equipment and providing cue to patient when they are successful at making desired response. Over times, patients become better able to recognize and modify internal responses
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What is biofeedback helpful at treating?
Conditions such as headaches. Treatment effects seem to be stable over time. Especially helpful for children and adolescents
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Relaxation and meditation
Evidence suggests that relaxation techniques can help patients with essential hypertension and can help patients who experience tension headaches (though biofeedback is better for headaches and best results combine the two). Daily practice in transcendental meditation may be helpful at reducing blood pressure
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Cognitive behaviour therapy
Effective intervention for headaches and other types of pain. CBT oriented family therapy successful in alleviating children’s complaints of recurrent abdominal pain. Can also be used for arthritis, where patients show better physical, social and psychological functioning with CBT
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3 disorders that are precipitated by stress
Adjustment disorder, acute stress disorder, PTSD
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Adjustment disorder
Psychological response to common stressor (ex divorce, loss of job) that results in clinically significant behavioural or emotional symptoms. Stressor can be single event or involve multiple stressors. For diagnosis, symptoms must begin within 3 months of onset of stressor and person must experience more distress than would be expected given circumstances or be unable to function as usual. Persons symptoms lessen or disorder when stressor ends out when person adapts. When cases last more than 6 months, diagnosis changes to some other mental disorder. Least stigmatizing and mildest diagnosis therapist can give client
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Health effects of unemployment
Unemployment can have serious long term effects. If unemployment is prolonged, it can increase risk of suicide. When children live in families where parents has lost job, they are 15% more likely to have repeat grade at school
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What is post traumatic stress disorder?
In DSM, it’s grouped with other disorders in new diagnostic category called trauma and stressor related disorders (this category also contains adjustment disorder and acute stress disorder).
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First diagnosis of PTSD
Psychiatry began to realize that many veterans were emotionally scarred and unable to return to normal civilian life after Vietnam.
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Why was there opposition to include PTSD in DSM?
Including a disorder that had clear and explicit cause (trauma) was inconsistent with atheoretical nature of DSM
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Why was PTSD eventually included in DSM?
Consensus emerged that any extreme, terrifying, and stressful events that was life threatening and outside ordinary bounds of everyday experience could lead to psychological symptoms similar to those experienced by Vietnam veterans. At time of its entry to DSM, PTSD was viewed as normal response to abnormal stressor
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Traumatic event stress symptoms
stress symptoms are very common in immediate aftermath of traumatic event, but for most people, these symptoms decrease over time. Naturally recovery with time is therefore common pattern. In PTSD, stress symptoms fail to abate
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What happens in PTSD with stress symptoms?
Memory of traumatic event gets established and results in traumatic event being reexperienced involuntarily and with same emotional force that characterized original experience
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Changes to diagnostic criteria of PTSD
First, diagnostic criteria required exposure to traumatic event that was outside range of usual human experience and would cause significant distress. Emphasis was in nature of stressor and not emotional response of victim.
Then range of experiences broadened and required that intense fear, helplessness or horror was required in response. Change in emphasis from characteristics of stressor to experience of victim -PTSD was pathological response to extreme form of stress.
Then diagnostic criteria was tightened. Traumatic event must be experienced by person directly (includes witnessing event) and does not include through electronic media. Removal of requirement that person must respond in certain way (because this made it more likely that women receive diagnosis)
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What was result of broadening range of experiences to diagnosis PTSD?
Vast majority of people would qualify for diagnosis of PTSD and females were much more likely to report that they had an emotional response to a traumatic event, so PTSD was more likely to be reported in women than men. This led to tightening of criteria for DSM 5
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Acute stress disorder
Diagnostic category that can be used when symptoms develop shortly after experiencing traumatic event and lasts for at least 2 days. This is so people don’t have to wait for a month to be diagnosed with PTSD and can receive treatment right away. If symptoms persist, diagnosis can be changed to PTSD later. Acute stress disorder leads to increased risk for PTSD
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Most common disorders to experience after traumatic experience (3)
Depression
Generalized anxiety disorder
PTSD
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In PTSD a traumatic event is thought to cause…
A pathological memory that is at center of characteristics of disorder. These memories are brief fragments of experience and typically concern events that happened just before moment with largest emotional impact
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Clinical symptoms of PTSD are grouped into 4 main areas
1. Intrusion
2. Avoidance
3. Negative alterations in cognitions and mood
4. Arousal and reactivity
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PTSD symptoms: Intrusion
Recurrent reexperiencing of traumatic event through nightmares, intrusive images, and psychological reactivity to reminders of trauma. Ruminative thoughts about trauma do not reflect intrusion in DSM 5 (they do in DSM IV).
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PTSD symptoms: avoidance
Efforts to avoid thoughts, feelings, or reminders of trauma
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PTSD symptoms: negative alterations in cognitions and mood
Includes such symptoms as feelings of detachment and negative emotional states such as shame or anger, or distorted blame of oneself or others
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PTSD symptoms: arousal and reactivity
Hypervigilance, excessive response when startled, aggression and reckless behaviour
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Criteria for PTSD
1. Exposure to actual or threatened death, serious injury, or sexual violence
2. Presence of intrusion symptoms associated with traumatic event, beginning after traumatic event occurred
3. Persistent avoidance of stimuli associated with traumatic event beginning after traumatic event occurred
4. Negative alterations in cognitions and mood associated with traumatic event, beginning or worsening after traumatic event occurred
5. Marked alterations in arousal and reactivity associated with traumatic event, beginning or worsening after traumatic event occurred
6. Duration of disturbance is more than one month
7. Disturbance causes clinically significant distress or impairment in social, occupational or other areas
8. Disturbance is not attributable to physiological effects of a substance or another medical condition
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Prevalence of PTSD in general population
Lifetime Prevalence overall is 6.8%, but is actually higher in women, so 9.7% for women and 3.6% for men
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Why is there a Difference in prevalence of PTSD in men and women?
Suggested that difference reflects fact that women are more likely to be exposed to certain kinds of traumatic experiences such as rape, that may be more traumatic. However, even when that is controlled for, women still show more severe symptoms, suggesting there are differences between men and women that may determine risk of developing PTSD
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Rates of PTSD after traumatic experiences
Rates of PTSD throughout world tend to be lower in areas where people experience fewer natural disasters. Rates of PTSD seem to differ according to type of trauma that is experienced. Traumatic events that result from human intent (ex rape) are more likely to result in PTSD than events that are not personal (ex comparing rates of PTSD in people who experienced car accident’s vs people who experienced terrorism, PTSD was higher in people who experienced terrorism).
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Why are human caused traumatic events more likely to result in PTSD?
Perhaps it is more difficult to come to terms with because they can restore sense of safety were often assume comes with being a member of rule abiding and lawful social group
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Factors that are important in developing PTSD
1. Is the event personal/human caused or impersonal
2. Degree of direct exposure to traumatic event (PTSD is higher in people who experienced event than for ex rescue workers, though rescue workers are still at risk for developing PTSD)
3. Differences in rates of PTSD across different studies may sometimes be linked to way in which PTSD is defined and manner in which it is assessed. Estimates based on questionnaires tend to be higher than those based on interviews
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Why are there overestimates when questionnaires are used for PTSD?
Misunderstanding meaning of items on questionnaire, presence of symptoms that causes little impairment in functioning, including if symptoms that began at times other than during after traumatic event
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Trauma of military combat
Persons ordinary coping methods are useless in combat situation. Many people involved in war experience psychological problems afterwards. WWI, term was called shell shock, thought it was caused by minute brain hemorrhages, but later realized it was usually caused by psychological shocks and fatigue. WWII, was called operational fatigue and war neuroses, and later combat fatigue or combat exhaustion. These terms were lacking because implied that physical exhaustion played more important role than in actuality
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“ forward psychiatry” in WWII
Actual incidence of combat exhaustion in WWII unknown because many soldiers received supportive therapy at battalion aid stations and were returned to combat within few hours (forward psychiatry). Was not effective at returning soldiers with shell shock to combat but improved mood and adjustment allowed them to be reassigned to non-combat roles, resulting in less manpower losses overall. WWII, combat exhaustion was greatest single cause of loss of personnel
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Mental health in soldiers deployed to Iraq and Afghanistan
Rates of PTSD similar to rates is PTSD from Vietnam war and gulf war, but less than uk veterans from Iraq and Afghanistan. Rates of depression, aggression and problems with post deployment alcohol misuse also elevated. PTSD rate is higher in military personnel deployed into combat role vs support role. Rates were higher in army and marine personnel vs navy and airforce. Clinicians also seeing veterans with compulsive checking behaviour
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Soldier suicide
Serious issue military is trying to cope with. Most result from self inflicted gunshot wounds.
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Why is studying causal risk factors in PTSD a controversial area?
1. Notion of PTSD makes it explicit that it is caused by experiencing trauma, so why do we need to look further?
2. If some people are more likely to develop PTSD in face of severe stress than others, might this lead to double victimization, with victims of trauma being stigmatized and being blamed for troubles they have?
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Why is it necessary to study risk factors of PTSD?
Some people may be more vulnerable to developing PTSD than others. To prevent and better treat this disorder we need to understand more about the factors that are involved in its development.
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What 2 things do we need to keep in mind when it comes to risk for PTSD?
There is a risk for experiencing trauma and there is also risk for PTSD given that there has been exposure to trauma
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What are risk factors that increase the likelihood of being exposed to trauma?
Being male, having less than a college education, having had conduct problems in childhood, having a family history of psychiatric disorder, and scoring high on measures of extroversion and neuroticism. rates of exposure to traumatic events are also higher for black Americans than they are for white Americans
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Given that someone has been exposed to a traumatic event, what factors increase risk for developing PTSD?
Higher levels of neuroticism, having pre-existing problems with depression and anxiety, and having a family history of depression, anxiety, and substance abuse
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What have studies shown as a way to decrease risk of developing PTSD post deployment?
Importance of mental health screening prior to deployment and the need to provide additional resources and support for soldiers who may be most vulnerable
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Social support and PTSD
Low levels of Social Ssupportport have also been noted as a risk factor for developing PTSD. However social support is typically assessed after people have developed PTSD so it is difficult to separate cars from consequence.
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Future thoughts about traumatic eventsand developing PTSD
Evidence suggests that people who have disturbing thoughts or images about traumatic events that could happen in the future may be at higher risk of developing PTSD later
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Predicting PTSD in soldiers
The measure of pre-traumatic stress that the soldiers completed before deployment predicted their level of PTSD symptoms both during and after their service in Afghanistan, even after such factors as combat exposure and baseline PTSD symptoms were accounted for. This highlights the importance of mental imagery, suggesting that pre-and post traumatic stress reactions might have much in common
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What are factors that are protective and buffer against PTSD?
Good cognitive ability. In a study when children had IQ scores above 115 they were less likely to have experienced a traumatic event by age 17 and if they had been exposed to trauma they were at lower risk for developing PTSD. This suggests that having a higher IQ may be protective against experiencing trauma and developing PTSD. Children with average or below average IQ scores were at similar risk for PTSD
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Why might hire pre-trauma cognitive abilities provide protection against PTSD?
Individuals with more intellectual resources might be better able to create some meaning from their traumatic experiences and translate them into a personal narrative of some kind. People with hire cognitive abilities are more naturally able to incorporate there a traumatic experiences into their life narratives in ways that are ultimately adaptive and emotionally protective.
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PTSD and cortisol
When exposed to stress, People with PTSD do seem to show an exaggerated cortisol response. However baseline levels of cortisol are often very similar in people with PTSD when they are compared to those of a healthy controls. However women with PTSD do seem to have higher levels of baseline cortisol than women without PTSD. This is not the case for men. Also levels of cortisol tend to be lower in people with PTSD who have experienced physical or sexual abuse; the type of trauma may be an important factor
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Gene environment interactions and PTSD
The gene 5HTTLPR seems to be a risk factor for the development of PTSD. In a study people who had a high risk genotype of this serotonin transporter gene were at especially high risk for the development of PTSD if they also had other risk factors. These people were also more likely to develop depression. People with this genotype may be especially susceptible to the effects of traumatic stress particularly if they also have low levels of social support
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Why are people with the 5HTTLPR serotonin transporter gene at a higher risk for PTSD?
Soldiers with two short alleles of this gene were more likely to develop a bias toward looking longer at fearful stimuli after they had been deployed to Iraq versus before deployment. this suggests that people with this form of the serotonin transporter gene may be especially sensitive to certain environmental experiences such as Warzone stress and that one consequence of this is that they become more attentive to negative stimuli. The interaction between genes and environmental experiences may prime the attentional system to develop cognitive biases toward negative stimuli. This may be adaptive in combat settings but can contribute to development of psychopathology later.
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Brains of people with PTSD
The hippocampus seems to be reduced in size in people with PTSD. This area is involved in memory and is known to be responsive to stress. in a study it was suggested that small hippocampal volume may be a vulnerability factor for developing PTSD in people who are exposed to trauma. There is also a possibility that trauma reduces the size of the hippocampus to some extent. Therefore Reduced hippocampal size could be both a risk factor for PTSD and also be a consequence of trauma exposure.
The problem is that many brain abnormalities associated with PTSD are also found in people with depression. PTSD and depression are highly comorbid and it is hard for researchers to be sure which brain abnormalities are specific to PTSD and to depression
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Sociocultural factors in developing PTSD
Being a member of a minority group seems to place people at higher risk for developing PTSD. Being more educated and having a higher annual income are factors associated with lower rates of PTSD overall. Returning to a negative and unsupportive social environment can also increase vulnerability to post traumatic stress. socio cultural variables also appear to play a role in determining a persons adjustment to combat. Important factors include justification for the combat and how clear and acceptable the wars goals are to the person whose life is being put in harms way. Identification with the combat unit and the quality of leader ship also make a difference.
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What does the military do to help reduce psychological casualties
Interventions that promote morale and encourage cohesion have proved effective at reducing psychological casualties during deployment. Strategically placed combat stress control teams deploy as soon as is practical after combat engagements to provide timely counselling to troops. To improve morale, the military makes an effort to provide breaks from long engagements by providing safe zones that include such improvements as air conditioning, regular mail delivery, and good food. One of the most effective morale builders has been availability of the Internet.
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Delayed version of PTSD
Less well defined and more difficult to diagnose. These cases are exceedingly rare. Some authorities have questioned whether a delayed reaction should be diagnosed as PTSD at all, and some would categorize such a reaction as another type of disorder. Also troubling are findings that show that some men seeking treatment for a combat related PTSD had not been in the military at all. The wide publicity given to delayed PTSD and the potential for receiving service connected disability payments may be a factor.
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Prevention of PTSD
One way to prevent PTSD is to reduce the frequency of traumatic events. Ways to do this could be to lessen the access that children have to firearms, or changes in the law and social policy. it may be possible to prevent maladaptive responses to stress by preparing people in advance and providing them with information and coping skills. Studies are consistent that this may have benefits. The use of cognitive behavioural techniques to help people manage potentially stressful situation or difficult events has been widely explored, called stress inoculation training.
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Stress inoculation training
Prepares people to tolerate an anticipated threat by changing the things they say to themselves before or during a stressful event. It is a cognitive behavioural technique to help people manage stressful situations or events.
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Tetris and PTSD
A study exposed participants to graphic film footage. After the footage some participants play the Tetris while others sat quietly. The people who played Tetris reported significantly fewer involuntary flashbacks. this implies that playing Tetris after the traumatic experience may disrupt the consolidation of traumatic visual memories. however simply being distracted after viewing the traumatic film does not reduce the frequency of later flashbacks. This supports the possibility that simple visuospatial tasks such as Tetris might have promise as a cognitive vaccine if they can be administered early enough. Importantly people who played Tetris were still able to recall as many details from the film as people in the control group, showing that their factual memories of the film remained intact.
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Treatment for stress disorders
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With time and the help of friends and family it is quite typical for traumatized people to recover naturally. There are several other treatments for stress disorders:
Telephone hotlines
Crisis intervention
Psychological debriefing
Medications
Cognitive behavioural treatments
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Telephone hotlines entreating stress disorders
National and local telephone hotlines provide help for people under severe stress and for people who are suicidal. Many of these hotlines are staffed by volunteers. However skilled and knowledgable the volunteer is plays a role in how satisfied users are with the hotline. The most positive outcomes are seen when helpers show empathy and respect for callers
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Crisis intervention in treating stress disorders
Crisis intervention has emerged in response to especially stressful situations. Short term crisis therapy is of brief duration and focusses on immediate problems with which an individual or family is having difficulty. Therapists are concerned with problems of an emotional nature. Assumption is that individual was functioning well psychologically before trauma. Therapist is usually very active, helping to clarify problem, suggesting plans of action, providing reassurance and other information and support. This treatment has been shown to lower fears and provide increased sense of control; people receive knowledge and learn skills that will help them gain better control over their lives.
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Psychological debriefing entreating stress disorders
Psychological debriefing approaches are designed to help and speed up the healing process in people who have experienced disasters for being exposed to trauma situations. Victims are provided with emotional support and encouraged to talk about their experiences during the crisis. The discussion is structured and common reactions to the trauma are normalized. Some believe this form of counselling should be mandated for disaster victims. One form of psychological debriefing is critical incident stress debriefing. Psychological debriefing is currently quite controversial
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Critical incident stress debriefing
A form of psychological debriefing, a single session lasts between three and four hours and is conducted in a group format, usually 2 to 10 days after a critical incident or trauma
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Why is psychological debriefing controversial?
Reviews of literature have failed to support the clinical effectiveness of the approach. Although those who experienced the debriefing sessions often report satisfaction with the procedure and the organizations desire to provide assistance, no well controlled study has shown that it reduces symptoms of PTSD or hastens recovery in civilians.
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What is the most appropriate crisis intervention method?
Most beneficial interventions are those that focus explicitly on the needs of the individual and time their approaches accordingly. Survivors should follow their own natural inclination and talk or not talk with the people they want to talk to you. Therapists should take their lead from the trauma survivor, engaging in active listening, being supportive, but not directing or pushing for more information than the survivor wishes to provide. Caring, kindness, and common sense can go along way to helping trauma survivors along the path to healing
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Medication’s in treating stress disorders
To help with the problems of persons experiencing traumatic situations, patients are often traded with antidepressants. Sometimes antipsychotic medications are also used. Evidence for the effectiveness of these medication is slim. Anti-depressants provide modest benefits compared to placebo. But there is a little evidence that most other medication‘s provide significant benefits
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Cognitive behavioural treatment in treating stress disorders
One behaviourally oriented treatment strategy used for PTSD is prolonged exposure.
Another treatment for PTSD is based on a cognitive model of the disorder. It is thought that PTSD becomes persistent when people who have experienced trauma make excessively negative and idiosyncratic appraisals of what has happened to them in a way that creates a sense of serious current threat. Cognitive therapy for PTSD is designed to modify excessively negative appraisals of the trauma or its consequences, decrease the threat that patients experience when they have memories of the Trumatic event, and remove problematic cognitive and behavioural strategies. Evidence suggests this treatment approach is very effective and the dropout rate is very low.
Another treatment development that seems to be well received by clients is virtual reality exposure therapy as well as expressive writing
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Prolonged exposure treatment and PTSD
Patient is asked to vividly recount the traumatic event over and over until there is a decrease in their emotional responses. Prolonged exposure can also be supplemented by other behavioural techniques such as relaxation training. The therapeutic relationship is a great importance in this kind of intervention. The client has to trust the therapist. The therapist needs to provide a safe, warm, and supportive environment that can facilitate clinical change. Prolonged exposure is an effective treatment for PTSD. In studies it leads to a reduction of symptoms and a decrease in the number of people meeting diagnostic criteria for PTSD
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A problem with prolonged exposure therapy
Prolonged exposure therapy tends to have a higher drop out rate than other approaches. This is because it is difficult for people with PTSD to be exposed to their traumatic memories. As well, a concern is how long the treatment effects last. The effects of prolonged exposure treatment or less robust than expected
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Trauma and physical health
What role does psychological trauma play in our physical well-being? Findings suggest that psychological trauma plays a large role in our physical well-being. Traumatic events are not only bad for the mind, they also damage the body. The mechanisms for this are still being explored, but these findings highlight the role that stress and trauma play in both physical health and psychological well-being
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Virtual reality exposure treatment for PTSD in military personnel
This treatment uses computer simulations and virtual reality to provide a form of exposure therapy. These programs can be customized to reflect the individual soldiers traumatic experience as closely as possible. Treatment is typically short term, consisting of 4-6 90 minute individual sessions. The first session is devoted to obtaining sufficient details of the trauma to make the virtual reality experience as realistic as possible. As the therapy progresses, new cues may be added to the program to provide further exposure experiences. Early reports suggest that virtual reality exposure treatment is associated with substantial decreases in PTSD symptoms and improvements in overall functioning. The treatment is also well received by soldiers and preferred over traditional talk therapy.
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Why is the study of trauma so contentious?
In the past the idea that there could be individual risk factors for PTSD was a taboo topic. The reason for this was because it was viewed as blaming the victim. There were also concerns that the study of vulnerability factors might provide the government with an excuse to deny treatment and benefits to veterans. Individual scientists in this area are still subjected to attacks when they present findings that some in the trauma field do not want to hear.
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Hans Selye
A physician and endocrinologist who coined the term stress. He used it to describe the difficulties and strains experience by living organisms as they struggle to cope with and adapt to changing environmental conditions. His work provided the foundation for current stress research. He also noted that stress can occur in a negative and positive situation‘s.
