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Stress DisordersStress Stressor: an event that creates a demand on our bodies Stress response: Sympathetic Nervous System activated▪ Fight or Flight! HPA axis activated▪ Releases cortisol, a stress hormoneTraumatic stress: involves actual or threatened death or serious injury to self or others Creates intense feelings of fear, helplessness, or horrorTraumatic Stress and Stress Disorders During and immediately after a trauma, we may temporarily experience levels of arousal, anxiety, and depression For some, symptoms persist well after the trauma  The situations that cause these disorders would be traumatic to anyone (unlike other anxiety disorders)Posttraumatic Stress Disorder (PTSD) Criteria for disorder: Having experienced, witnessed, or been confronted by a traumatic stressor The person’s reaction to this stressor consist of intense fear, horror, and helplessness.Symptom Clusters of PTSD: Re-experiencing Reliving the traumatic event Intrusive thoughts Dreams or nightmares Intense distressSymptom Clusters of PTSD: Emotional Numbing/Detachment  Avoiding thoughts, feelings, or conversations Avoiding activities, places, or people Trouble recalling aspects of event Loss of interest  Feelings of detachment Restriction of feelings Future feels bleakSymptom Clusters of PTSD: Hypervigilance/Chronic Arousal  Sleep difficulties Irritability Difficulty concentrating Hypervigilance Exaggerated startle responseMore criteria for disorder: Symptoms occur for at least 1 month after stressor Disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning  Acute Stress Disorder Traumatic event (like PTSD) Symptoms begin within 4 weeks, last less than 1 month Dissociative symptoms: depersonalization, derealization, or dissociative amnesia Epidemiology of Stress Disorders Avg. age of onset: late teens and early 20s Lifetime prevalence of PTSD in the general population is 7-9% Twice as common in women compared to men (post-trauma, 20% of women and 8% of men)  High comorbidity with depression, other anxiety disorders, substance abuseFactors contributing to PTSD and ASD Question: How is classical conditioning related to the development of PTSD? “Intensity” of conditioned relationship will depend on a number of variables that may differ among various individuals. Biological Biological consequences of a stress disorder that may perpetuate symptoms: Abnormal levels of cortisol and norepinephrine Dysfunctional activity of the amygdala and hippocampusPersonality More likely to develop a stress disorder if person…  Feels a lack of control over negative events Is less able to find positive outcomes from an unpleasant situation (find the “silver lining”) Personal HistoryFamily HistoryChildhood ExperiencePre-trauma history of Anxiety Disorder, Depression or other psychiatric symptomsCurrent ageTrauma-Specific Reactions Intensity of perceived danger Losing touch with reality during traumaPost-trauma characteristicsSocial support Social environment that produces shame, guilt, stigma or self-hatredTreatments for Stress Disorders General goals End lingering stress reactions Gain perspective on painful experiences Return to constructive livingCognitive Processing Therapy (CPT)Components of CPT Education Processing the trauma Impact Statement Written Account Stuck points  Discovering and Modifying negative thoughtsProlonged Exposure (PE)Components of PE:1. Psychoeducation2. Relaxation3. In vivo exposure4. Imaginal Exposure Eye-Movement Desensitization & Reprocessing (EMDR) Clients move eyes in a saccadic manner while flooding mind with images of stimuli they avoid Controversy over mechanism (and efficacy)Early Intervention in PTSD Critical Incident Stress Debriefing ▪ Victims encouraged to talk extensively (e.g. 3-4 hours) about the trauma soon after it occurs Is it effective?▪ Expert Guidelines for Psychotherapy for PTSDConclusions For some people, traumatic situations can prompt the occurrence of a stress disorder, in the short-term (ASD) or long-term (PTSD). A number of individual differences are important in predicting who will suffer from PTSD Some treatments for these disorders have been shown to be effective (ex: PE, CPT), whereas some treatments for these disorders have been questioned for their efficacy or the mechanisms by which they see their effects


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OSU PSYCH 3331 - Stress Disorders

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