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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