chapter 4: stress-related disorder
STRESS #Demand
- a demand made on an organism to adapt or
adjust
- can have profound effects on our physical and
emotional health
STRESSOR
- a source of stress
HANS SELYE
- he took the word stress and used it to describe
the difficulties and strains experienced by living
organisms as they struggled to cope with and
adapt to changing environmental conditions
- he also noted stress could occur in both
positive and negative situations
DISTRESS
- bad stress
- has the potential to do more damage than
positive stress
EUSTRESS
- good/positive stress
- making a person more productive
CRISIS
- term used to refer to times when a stressful
situation threatens to exceed or exceeds the
adaptive capacities of a person or a group
HEALTH PSYCHOLOGY
- field concerned with the effects of stress and
other psychological factors in the development
and maintenance of physical problems
- subspecialty within behavioral medicine
BEHAVIORAL MEDICINE
- an approach to physical illness concerned with
psychological factors that may predispose an
individual to medical problems
HEALTH PSYCHOLOGIST
- a psychologist who studies the
interrelationships between psychological
factors, such as stress, and physical health
- the field is called medical psychology
- in practice, it focuses on patient’s mental and
emotional reactions and ability to cope to an
illness or recovery from an illness
4 TYPES OF HEALTH PSYCHOLOGY:
1.) CLINICAL HEALTH PSYCHOLOGY
#ChangeBadHabits
#OvercomeLifestyleProblems
- is an area of health psychology that focuses on
treating individuals
- professional pursuing this, often focus on how
an individual’s lifestyle and behavior might
affect his overall health
- clinical health psychologist will also usually
work with individuals to help change bad habits
or overcome lifestyle problems that may be
affecting their physical health
2.) COMMUNITY HEALTH PSYCHOLOGY
#SameWithEpidemiology #Prevalence&Cause
- focuses on the health of the community as a
whole
- individuals pursuing this, will typically study
the prevalence of diseases and certain
communities and what might cause them
3.) OCCUPATIONAL HEALTH PSYCHOLOGY
#SameWithIOPsychologist #RestructurePolicies
#GiveCounseling
- focuses on the individual’s job and his overall
state of health
- occupational health psychologist or people
who are working on this area might work with
companies and businesses to help create
happier and healthier employees
- this might involve restructuring workplace
policies or counseling individual employees
4.) PUBLIC HEALTH PSYCHOLOGY
- concerned with public and government health
policies and programs
- this type of professionals might work with low
income individuals, influence governments
health policies or help organize public health
campaigns
CHILDREN
- this group of people is particularly vulnerable
to severe stressors such as war and terrorism
PSYCHOLOGICAL SOURCES OF STRESS MAY
ADVERSELY AFFECT OUR HEALTH
- abnormal amounts of stress can lead to
increased risk or to various types of physical
illnesses
such as digestive disorders and
heart/cardiovascular disease, also to increase
risk to other psychological problems such as
depression and anxiety
- stress is implicated in a wide range of physical
and psychological problems; also increased
irritability and anger while physical symptoms
include fatigue
DIATHESIS-STRESS MODEL #Vulnerable
- shows the role stress can play in triggering the
onset of mental disorders in vulnerable people
is explicitly acknowledged in this model
PSYCHONEUROIMMUNOLOGY
- studies relationships between psychological
factors, especially stress, and the workings of
the immune system
- would investigate a person’s psychological
symptoms, physical symptoms and immune
system functioning
- ex. if a person say Rico is always sick and had
frequent visits to a medical doctor to treat his
cold, a psychoneuroimmunologist would
investigate the reasoning of his repetitive colds
on a psychological level
- conclusion on Rico’s repetitive colds, may
include that his tress levels may be high and
thus decreasing his immune system functioning
ENDOCRINE SYSTEM
- the system of ductless glands that secrete
hormones directly into the bloodstream
2 DISTINCT SYSTEMS ARE INVOLVE IN STRESS
REPONSE:
1.) SYMPATHETIC-ADRENOMEDULLARY (SAM)
SYSTEM #PrepareFightOrFlightReponse
- is designed to mobilize resources and prepare
for a fight-or-flight response- the stress
response begins to hypothalamus
2.) HYPOTHALAMUS-PITUITARY-ADRENAL - second system involved in the stress response
(HPA) SYSTEM - prolonged stress leads to secretion of the
adrenal hormone cortisol, which elevates blood
sugar and increases metabolism
- these changes help the body sustain prolonged
activity but at the expense of decreased
immune system activity

SEVERAL ENDOCRINE GLANDS ARE INVOLVED IN THE RESPONSE TO STRESS:

HYPOTHALAMUS
- the stress response begins in the - hypothalamus releases a hormone called
hypothalamus corticotrophin-releasing hormone or CRH
- stimulates the sympathetic nervous
system/SNS CORTICOTROPHIN-RELEASING HORMONE
- causes the inner portion of the adrenal glands - this hormone stimulates the pituitary gland
(the adrenal medulla) to secrete adrenaline
(epinephrine) * PITUITARY GLAND
and noradrenaline (as these circulate through - pituitary then secretes adrenocorticotrophic
the blood, they cause an increase in heart rate hormone
(familiar to all of us; they also get the body to
metabolize glucose more rapidly)
 WHY CORTISOL DOES NOT SHUT OFF?
- IL-1 (example of proinflammatory cytokine)
and other cytokines can stimulate the HPA axis
- if the stressor remains, the HPA axis stays
active and cortisol release continues. Although
short-term cortisol production is highly
adaptive, a chronically overactive HPA axis, with
high levels of circulating cortisol, may be
problematic
ACTH
- resulting increase in cortisol sets off a negative
- stimulates the adrenal glands which are
feedback loop that is designed to prevent an
located above the kidneys
excessive or exaggerated immune or
- Its key function is to stimulate the adrenal
inflammatory response
cortex to produce and release of glucocorticoids
- if this feedback system fails and is either too
or cortisol from the cortex (outer part) of the
sensitive or not sensitive enough, serious
adrenal gland
disorders such as cancer, infection, or
- when stress persists, the body rarely pumps
autoimmune diseases can develop
out stress hormones and mobilizes other
- because the brain is also involved in this
systems which can overtime can tax the body’s
feedback loop, emotional factors and
resource and impair health leading to physical
psychosocial stresses may tilt in the balance of
and psychological symptoms
in the feedback loop

STRESS HORMONES PRODUCED BY ADRENAL

ALLOSTATIC LOAD
GLANDS HELP BODY PREPARE FOR IMPENDING
- biological cost of adapting to stress
THREAT OR STRESSOR
- when we are relaxed and not experiencing
stress, our allostatic load is low
WHY HORMONAL IMBALANCE LEADS TO
- when we are stressed and feeling pressured,
ABNORMAL BEHAVIOR?
our allostatic load will be higher
- cortisol is a good hormone since it prepares
the body for fight and flight
IMMUNE SYSTEM #DefenseAgainstDisease
- it also inhibits the innate immune response
- word immune comes from the Latin immunis,
called immunosuppression; that means if an
which means “exempt”
injury does occur, the body’s inflammatory
- the body’s system of defense against disease,
response to it is delayed (escape is priority over
virus, and bacteria
healing)
- If it is too weak, it cannot function effectively,
- but the downside of cortisol is if the cortisol
and the body succumbs to damage from
response is not shut off, cortisol can damage
invading viruses and bacteria
brain cells specifically the hippocampus
- if the immune system is too strong and
unselective, it can turn on the body’s own
healthy cells that causes of lupus and
rheumatoid arthritis
- it regulates the body’s inflammatory response
(occurs when tissues are injured by bacteria,
trauma, toxins, heat, or any other cause) to
infection
- psychological stressors can dampen/make less
strong the response of the immune system
- under stress, the immune system is less
capable of toning down the inflammatory
response, leading to persistent inflammation,
health issues, and contribute to the
development of many psychological disorders
including cardiovascular disease, asthma, and
arthritis
WHITE BLOOD CELLS
- front line of defense in the immune system
- these leukocytes (or lymphocytes) are
produced in the bone marrow and then stored
in various places throughout the body, such as
the spleen and the lymph nodes
2 IMPORTANT TYPES OF LEUKOCYTES:
1.) B-CELL #AlwaysAlertCell
- because it matures in the bone marrow
- produces specific antibodies that
are different in structure from T-cells
- when a B-cell recognizes an antigen, it begins
to divide and to produce antibodies that
circulate in the blood are designed to respond
to specific antigens; this process is facilitated by
cytokines that are released by the T-cells
- production of antibodies takes 5 days or more;
however, the response of the immune system
will be much more rapid if the antigen ever
appears in the future because the immune
system has a memory of the invader
ANTIGENS #GaSurangSurangSaLife
- the word is a contraction of antibody
generator are foreign bodies such as viruses and
bacteria
- as well as internal invaders such as tumors and
cancer cells
2.) T-CELL
- the second important type of leukocytes
- named because it matures in the thymus,
which is an important endocrine gland (which
produces hormones)
- circulate through the blood and lymph systems
in an inactive form
- each T-cell has receptors on its surface that
recognize one specific type of antigen; however,
the T-cells are unable to recognize antigens by
themselves
- they just become activated when immune cells
called macrophages (means big eater) detect
antigens and start to engulf and digest them
- to activate the T-cells, the macrophages
release a chemical known as interleukin-1, then
the T-cells can begin to destroy antigens
— WHEN THE IMMUNE SYSTEM IS STIMULATED,
B-CELLS AND T-CELLS BECOME ACTIVATED AND
MULTIPLY RAPIDLY, MOUNTING VARIOUS
FORMS OF COUNTERATTACK
— THE PROTECTIVE ACTIVITY OF THE B- AND T-
CELLS IS SUPPORTED AND REINFORCED BY
OTHER SPECIALIZED COMPONENTS OF THE
SYSTEM, MOST NOTABLY NATURAL KILLER
CELLS, MACROPHAGES, AND GRANULOCYTES
(type of white blood cell that has small granules.
These granules contain proteins, the
granulocytes specifically the neutrophils, help
the body fight bacterial infections)
CYTOKINES (chemical that is release by
macrophages) #ChemicalMessenger
- an important component of the immune
system response
- small protein molecules that serve as chemical
messengers and allow immune cells to
communicate with each other; and also send
signal to the brain, the reason why immune
system regarded as almost sensory organ
- play an important role in mediating the
inflammatory and immune response
- interleukin 1, a chemical that was released by
macrophages is a cytokine
- another cytokine is interferon, which is given
to patients with cancer, multiple sclerosis, and
hepatitis C
2 MAIN CATEGORIES OF CYTOKINES:
1.) PROINFLAMMATORY CYTOKINES
#IncreaseImmuneResponse
- such as interleukin-1 (IL-1), IL-6, or tumor
necrosis factor help us deal with challenges to
our immune system by augmenting/increasing
the immune response
2.) ANTI-INFLAMMATORY CYTOKINES
#DecreaseResponse
- such as IL-4, IL-10, and IL-13 decrease or
dampen the response that the immune system
makes
- sometimes they accomplish this by blocking
the synthesis of other cytokines
-  immunoregulatory molecules that control the
proinflammatory cytokine response since strong
level of immune system can destroy the healthy
cells
— HAVING A STRONG SOCIAL SUPPORT MAY
HELP MODERATE OR BUFFER THE HARMFUL
EFFECTS OF STRESS
— WRITING ABOUT STRESS & TRAUMA AS A
COPING RESPONSE
- expressing our emotions in writing is a positive
coping response that can have beneficial
psychological and physical effects since
expressive writing can reduce psychological and
physical symptoms
- writing about stressful situation may reduce
the burden on the autonomic nervous system
which if left in tension can weaken the
effectiveness of the immune system (since ANS
is the system that regulates our heart rate,
breathing etc., so letting it not chill and be
burden, can weaken the capability of immune
system to defend your body on inflammation,
SO YOU MUST WRITE IT DOWN BECAUSE IT
SEEMS TO BE A GRADUAL EXPOSURE!)
— IN A STUDY, IT SHOWED THAT THE NUMBER
OF SUICIDES INCREASED IN THE MONTHS AFTER
9/11 ATTACKS (twin tower got attacked)
- although most people expose to traumatic
events such as 9/11 people but they do not
develop PTSD, many do experience symptoms
associated with the disorder such as difficulties
on concentrating and high levels of arousal
— PEOPLE HAVE VARIED RESPONSE TO
TRAUMATIC STRESS SINCE OTHER PEOPLE HAVE
PROTECTIVE FACTORS SUCH AS COPING
STRATEGIES OR RESILIENCE; OTHER HAVE
POSITIVE FEELINGS LIKE LOVE AND GRATITUDE
THAT APPEAR TO HAVE HELPED BUFFER THE
EFFECTS OF STRESS
— STRESSFUL EXPERIENCES MAY ALSO CREATE
A SELF-PERPETUATING CYCLE (negative and not
part of protective factors) BY CHANGING HOW
WE THINK ABOUT, OR APPRAISE, THE THINGS
THAT HAPPEN TO US
-  is something that has the power to continue
indefinitely
- example: if you’re feeling depressed or anxious
already, you may perceive a friend’s canceling a
movie date as an indication that she doesn’t
want to spend time with you
— BOTTLED-UP EMOTIONS MAY PUT A BURDEN
ON AUTONOMIC NERVOUS SYSTEM AND
WEAKEN IMMUNE SYSTEM
PROTECTIVE FACTORS #Modify
#LessAdverseConsequences #Resist
- are influences that modify a person’s response
to environmental stressors, making it less likely
that the person will experience the adverse
consequences of the stressors
- not necessarily positive experiences since
sometimes exposure to stressful experiences
that are dealt with successfully can promote a
sense of self-confidence or self-esteem and
thereby serve as a protective factor
- one important protective factor in childhood is
having a family environment in which at least
one parent is warm and supportive, allowing the
development of a good attachment relationship
between the child and parent that can protect
against the harmful effects of an abusive parent
- sometimes, protective factors have nothing to
do with experiences at all but are simply some
quality or attribute of a person include an
easygoing temperament, high self-esteem, high
intelligence, and school achievement
- it does not give other benefits aside from
helping to resist the effects of risk factors
- most often, but not always, lead to
resilience
RESILIENCE #Adapt #FunctionWell
#FewSymptoms
- healthy psychological and physical functioning
after a potentially traumatic event
- it is not rare and is in fact the most common
reaction following loss or trauma
- the ability to adapt successfully, function well
and experience very few symptoms after
experiencing very difficult circumstances or
after experiencing a potentially traumatic event
or stress
- an example is the child who perseveres and
does well in school despite his or her parent’s
drug addiction or physical abuse
- child’s fundamental systems of adaptation
such as intelligence and cognitive development,
ability to self-regulate, motivation to achieve
mastery, effective parenting, and well-
functioning neurobiological systems for
handling stress are operating normally, then
most threatening circumstances will have
minimal impact on him or her
- also, other factors that increase resilience
include being male, being older, being well
educated, and having more economic resources
is also beneficial
COPING STRATEGIES
- efforts to deal with stress
STRESS TOLERANCE #WithstandStress
#WithoutSeriouslyImpaired
- refers to a person’s ability to withstand
stress without becoming seriously impaired
STYLES OF COPING/ 2 WAYS OF FOCUS IN
WHICH PEOPLE REACT TO STRESSFUL
EVENTS:
1.) EMOTION-FOCUSED COPING #Adler
- a coping style that involves reducing the
impact of a stressor through denial, avoidance,
and wish-fulfillment fantasies
- denying the problem altogether, pretending
the problem does not exist or withdrawing from
the problem entirely
- downfall: it does not get rid of the stressor,
meaning the stress can persist
2.) PROBLEM-FOCUSED COPING #Confront
#ChangeSituationOrModifyAction
- a coping style that involves confronting a
stressor directly
- people examine the stressful situations or
stimuli and try to change the situation or modify
their actions to render the stress less harmful
GENERAL ADAPTION SYNDROME/GAS
#3StagesResponse
- to describe biological stress pattern to
prolonged or excessive stress
- the body’s three-stage response to states of
prolonged or excessive stress
>> RESISTANCE STAGE #Self-healing
-body tries to renew spent energy and repair
damage
>> EXHAUSTION STAGE
- resources are depleted and ability to resist is
gone since we convert all of our glycogen to
glucose; and spent all the glucose to energy for
running, etc.

THREE STAGES RESPONSE:

>> ALARM REACTION
#PrepareBody&StressHormones #FightOrFlight
- mobilizes and prepares body for challenges or — OUR BODIES RESPOND TO SIMILAR MANNER,
stress TO MANY KINDS OF UNPLEASANT STRESSORS
- earlier in 1929, Walter Cannon termed this as - whether the source of stress is an invasion of
fight-or-flight reaction microscopic disease organisms, a divorce, or
- during this, the adrenal glands which are aftermath of other traumatic events
controlled by the pituitary gland in the brain
pump out corticotrophin and stress hormones — BEFORE, THE STRESS RESPONSE SYSTEM WAS
that help mobilize the body’s defense ACTIVATED FOR A SHORT PERIOD OF TIME
- but today, in a modern generation, our stress
STRESS-RELATED CHANGES IN BODY ASSOCIATED response system can be activated for a long
WITH THE ALARM REACTION period of time due to the increase demands of
Corticosteroids are Blood shifts from the
life and increase/prolonged stressors.
released internal organs to the
skeletal muscles STRESS & LIFE CHANGES
Epinephrine and Digestion is inhibited
STRESS
norepinephrine are
- illness connection studied by quantifying life
released
Heart rate, respiration Sugar is released by the stress in terms of life changes

rate, and blood pressure liver - life changes are sources of stress because they

(medulla) increase impose and force us to adjust; this include both

Muscles tense Blood-clotting (an positive events such as getting married, and
important process that negative events such as death of a loved one
prevents excessive - people who experience greater number of life
bleeding when changes are more likely to suffer from
a blood vessel is injured psychological and physical problems
ability is increased
ACCULTURATIVE STRESS #Pressure #Demands
#PrimarySourceOfStress
- pressure from demands to adapt to a host or
mainstream culture
- a primary source of stress imposed on
immigrant groups, or on native groups living in
the larger mainstream culture
- associated with poorer psychological
functioning
TWO GENERAL THEORIES:
- attempt to understand the adjustment of
immigrants to their host culture
>> MELTING POT THEORY #Adapting
#AdjustingToTheLivingStandard
- suggest that the immigrants experiencing
stress can decrease that stress by adjusting to
the living standards of the host culture such as
people from Mexico that come from the U.S,
changing and adapting to their language
- changing or living with another country can
decrease levels of stress if they learn to speak
english fluently as well as adopting the values
and customs associated with theory
>> BICULTURAL THEORY
- adapting + sense of ethnic identity = decrease
level of stress
- suggest that immigrants experiencing stress
can decrease the stress by adapting to the ways
of the host culture combined with a sense of
ethnic identity
- they are able to maintain their ethnic identity
and traditional values by learning to adapt to
the language and customs of the host culture
SENSE OF ETHNIC IDENTITY (such as learning
their language) IS CORRELATED WITH BETTER
PSYCHOLOGICAL FUNCTIONING (unlike with
acculturative stress that is link with poor
psychological functioning)
CULTURAL SHIFTS AND PSYCHOLOGICAL
ADJUSTMENT IS COMPLEX
- because it has shown that the higher the
acculturation (individual adopts cultural
environment of new culture) status is, there is a
greater chance in which someone may develop
psychological problems such as:
> increased risk of heavy drinking among
women
> increased risk of smoking and sexual
intercourse among adolescents
> increased risk of disturbed eating behaviors
PSYCHOLOGICAL FACTORS THAT MODERATE
STRESS
• Individual differences in response to stress
affect coping
- meaning ascribed to stressful event
contributes to individual reaction (cognitive
model)
- example: major life event such as pregnancy
interpreted as a positive or negative stressor
depending on a couple’s desire for and
confidence in ability to care for child
- someone may find it and interpret it as
stressful but other people find it extremely
stressful
- ex. you may find calculus easy and not stressful
at all but the other students are having hard
time and were really stress
SELF-EFFICACY EXPECTANCIES
#ExpectionInAbility
#ManageStress&SenseOfControl
- expectations in our ability to cope with
challenges, perform behaviors successfully, and
produce positive change in our lives
- this allows us to manage stress, cope to illness
related to stress, and cope with different life
challenges
- better able to deal with stressors when we feel
confident in our ability to cope with challenge
- increased self-efficacy associated with
decreased levels of stress hormones since self-
efficacy acts to decrease people's potential for
experiencing negative stress feelings by
increasing their sense of being in control of the
situations they encounter
PSYCHOLOGICAL HARDINESS #3Cs
#3Approaches
- a cluster of stress-buffering traits characterized
by commitment, challenge, and control that
may help people manage stress
- example: business executives who resisted
illness despite heavy burdens of stress were
investigated; 3 traits were found to be
correlated with psychological hardiness
THREE KEY TRAITS:
>> COMMITMENT #FullyInvolve
- is being fully involved in the tasks and
situations of the employees
- ex. business executives need to believe in what
they are doing
>> CHALLENGE #AdaptToChange
- needed to be able to adapt to change in
normal routines
>> CONTROL OVER THEIR LIVES #Useful
- ex. executives needed to feel useful to the
team and tax rather than powerless and non-
influential
PSYCHOLOGICALLY HARDY PEOPLE APPEAR TO
COPE MORE EFFECTIVELY WITH STRESS BY
ADOPTING AND HAVING MORE ACTIVE
APPROACH TO THE TASKS AND SITUATIONS
THEY PLACE THEMSELVES IN, PROBLEM-
SOLVING APPROACHES AND BY PERCEIVING
THEMSELVES AS CHOOSING HIGH-STRESS
SITUATIONS
- understanding that you chose to put yourself
in a stressful situation helps with coping in the
stressful situations since you are already aware
what challenge and situation you are in
- you are aware that you had control over the
situation
OPTIMISM #ExpectGoodThingsInFuture
- has also been shown a positive impact on the
ability to cope with stress
- positive outlook and tendency to expect good
things in the future
- ex. if people in a community help with one
another to cope with stress (such as aftermath
of disaster) disregarding their race, ethnicity,
beliefs etc.
- linked to better physical and emotional well-
being such as lower rates of heart disease and
better immunological functioning; and also,
better self-care, more physical activity,
avoidance of harmful substances, healthier body
weight
THE BEST PREDICTOR OF BEHAVIOR IS PAST
BEHAVIOR
STRESS AND PHYSICAL HEALTH with the ability to cope with stressful situations,

- how you view problems and cope with and live longer

challenges, and even your temperament, may

directly affect your underlying physical health CARDIOVASCULAR DISEASE/ CVD

- ex. a research study conducted and explored - is the leading cause of death

the physical aspects/health of participants by - it is the umbrella term for all heart diseases

asking to be forgiving and unforgiving. but not all heart diseases are cardiovascular

participants who were ask to be forgiving on disease since this only focuses on the problem

their imagination, report more feelings of of heart/cardio and blood vessels

empathy and forgiveness; but participants who - is a general term for conditions affecting

were imagining the unforgiving moments, the heart or blood vessels; it's usually associated

reported that they felt more negative, angry, with a build-up of fatty deposits inside the

sad, aroused, and out of control; they also arteries (atherosclerosis) and an

showed greater tension in their brows; their increased risk of blood clot (that can lead to

heart rates went up, their blood pressures heart disease or stroke)

increased, and their skin conductance

(electrodermal response or sweating of skin)

POSITIVE PSYCHOLOGY #PositiveAttributes

#SupportSystem #HumorGratitudeCompassion
#PositiveTraitsEffectsOnCognition&Behavior
- a growing contemporary movement within
psychology that focuses on the positive
attributes of human behavior
- a school of psychology focuses on human traits CARDIOVASCULAR CASE STUDY:

and resources such as humor, gratitude, and

compassion that might have direct implications
for our physical and mental well-being
- ex. how can happiness, optimism, love and etc.
have an effect on cognition and behavior
- another aspect that is studying in positive
psychology how a support system affects the
behavior and cognition
- it has been shown that people with broad
system and social relationship such as having a
spouse or close family members, close friends,
and belonging to social organization, all help

WHAT HAPPENS TO OUR HEART WHEN WE ARE
EXPERIENCINGG STRESS?
- the blood vessels supplying our internal organs
constrict (become narrower/limited) and blood
flows in greater quantity to the muscles of the
trunk and limbs – this shows poor blood
circulation
- when this happens, the heart must work
harder, so it beats faster and as it beats faster,
our pulse quickens and blood pressure increases
HYPERTENSION
- having a persisting/continue systolic blood
pressure of 140 or more and a diastolic blood
pressure (also known as between-beat
pressure) of 90 or higher
- more men than women suffer from high blood
pressure, however, after about age 50, the
prevalence of hypertension is greater in women
and is probably due to menopausal
- is an insidious and dangerous disorder since
the person who has it may have no symptoms
until its consequences show up as medical
complications
- it increases the risk of coronary heart disease
and stroke; and a causal factor of kidney failure,
blindness, and number of other serious physical
ailments
ESSENTIAL HYPERTENSION
- a hypertension that has no specific physical
cause
HYPERTENSION BEGINS WHEN A PERSON HAS A
BIOLOGICAL TENDENCY TOWARD HIGH
CARDIOVASCULAR REACTIVITY TO STRESS
- not being able to express anger in a
constructive way (e.g., by expressing why one
feels angry and trying to reach an understanding
by engaging in open communication with the
person one is angry with) may also increase a
person’s risk for hypertension
- higher levels of stress from such factors as
inner-city living, economic disadvantage,
exposure to violence, and race-based
discrimination may play a key role in this
CORONARY HEART DISEASE/ CHD
#SevereChestPain
- is a potentially lethal blockage of the arteries
that supply blood to the heart muscle also
known as myocardium
- If the muscles of the heart are not getting
enough oxygenated blood, the person may
experience severe chest pain also known as
angina pectoris
MYOCARDIAL INFARCTION #Myocardium
#PermanentDamageToHeart
- also known as heart attack
- this results from a blockage in a section of the
coronary arterial system/ blockage in the
myocardium
- because the heart muscle is being deprived of
oxygen, tissue may die, permanently damaging
the heart
- if this is extensive, the person may not survive
PERSONALITY ATTEMPTS TO EXPLORE THE
PSYCHOLOGICAL CONTRIBUTION TO THE
DEVELOPMENT OF CHD
TYPE A BEHAVIOR #Choleric #LeaderAtittude
- is characterized by excessive competitive drive,
extreme commitment to work, impatience or
time urgency, and hostility (including anger,
contempt, scorn, cynicism, and mistrust)
- choleric people have this kind of personality
- type A personality was associated with a
twofold increase in coronary artery disease and
an eightfold increased risk of recurrent
myocardial infarction over the course of the
follow-up
HOSTILITY
- the component of Type A personality that is
most closely correlated to coronary artery
deterioration
TYPE D BEHAVIOR #Distress #Insecure #Anxious
- distressed
- have a tendency to experience negative
emotions and also to feel insecure and anxious
PEOPLE WITH HEART DISEASE ARE
APPROXIMATELY THREE TIMES MORE LIKELY
THAN HEALTHY PEOPLE TO BE DEPRESSED
- depression also appears to be a risk factor for
the development of CHD
WHY ARE DEPRESSION AND HEART DISEASE SO
CLOSELY LINKED?
- stress is thought to activate the immune
system, triggering the production of
proinflammatory cytokines such as IL-1, IL-6,
and tumor necrosis factor by the white blood
cells
- long-term exposure to these proinflammatory
cytokines is thought to lead to changes in the
brain that manifest themselves as symptoms of
depression
- proinflammatory cytokines also trigger the
growth of plaques (fatty deposits that is made
by cholesterol and other fatty substances that
build up in your arteries is called
atherosclerosis) in the blood vessels as well as
making it more likely that those plaques will
rupture and cause a heart attack
- the link between heart disease or myocardial
infarction and depression is due to inflammation
and the presence of inflammatory cytokines
TRAUMA AND STRESSOR RELATED DISORDERS
- adjustment disorder, acute disorder, and PTSD
are part of this new diagnostic category
- this is because the experience of major stress
is central to the development of all of these
conditions
ADJUSTMENT DISORDER #CommonStressor
#StressBeginWithin3Months
- a psychological response to a common stressor
(e.g., divorce, death of a loved one, loss of a job)
that results in clinically significant behavioral or
emotional symptoms
- it could a single stressor or multiple stressors
that people might experience severe stress that
exceeds their coping resources
- it could lead to significant impairment in social,
occupational, or other important area of
functioning, or by states of emotional distress
that exceed those normally induced by the
stressor
- for the diagnosis to be given, symptoms must
begin within 3 months of the onset of the
stressor, must experience more distress than
would be expected given the circumstances or
be unable to function as usual
- the person’s symptoms lessen or disappear
when the stressor ends or when the person
learns to adapt to the stressor
- in cases where the symptoms continue beyond
6 months, the diagnosis is usually changed to
some other mental disorder
- estimates indicate that between 5% and 20%
of people seeking outpatient mental health care
present with an adjustment disorder
ADJUSTMENT DISORDER CAUSED BY
UNEMPLOYMENT
-
unemployment is an especially severe problem
for young minority males, many of whom live in
a permanent economic depression with few job
prospects
- managing the stress associated with
unemployment requires great coping strength,
especially for people who have previously
earned an adequate living however,
unemployment can have serious long-term
effects
- if it is prolonged, it increases the risk of suicide
309.0 / F43.21 Adjustment Disorders with
depressed mood
309.24 / F43.22 Adjustment Disorders with
anxiety 309.28 / F43.23 Adjustment Disorders
with mixed anxiety and depressed mood
309.3 / F43.24 Adjustment Disorders with
disturbance of conduct
309.4 / F43.25 Adjustment Disorders with mixed
disturbance of emotions and conduct
SPECIFIC TYPES OF ADJUSTMENT DISORDER

POSTTRAUMATIC STRESS
DISORDER/309.81/F43.10
CRITERIA FOR POSTTRAUMATIC STRESS DISORDER
CLINICAL DESCRIPTION states such as shame or anger, or distorted
- in PTSD a traumatic event is thought to cause a blame of oneself or others
pathological memory/mental problem that is at
the center of the characteristic clinical 4. AROUSAL AND REACTIVITY/CRITERIA E
symptoms associated with the disorder - hypervigilance, excessive response when
- these memories are often brief fragments of startled, aggression, and reckless behavior
the experience and often concern events that
happened just before the moment with the
largest emotional impact

IN DSM-5, THE CLINICAL SYMPTOMS OF PTSD

ARE GROUPED INTO FOUR MAIN AREAS.:
1. INTRUSION/CRITERIA B
- recurrent reexperiencing of the traumatic
event through nightmares, intrusive images,
and physiological reactivity to reminders of the
trauma

2. AVOIDANCE/ CRITERIA C
- avoidance of thoughts, feelings or reminders
of the trauma

3. NEGATIVE COGNITIONS AND

MOOD/CRITERIA D PTSD CASE STUDY:
- this includes such symptoms as feelings of
detachment as well as negative emotional
 - traumatic stressors include combat, rape,
being confined in a concentration camp, and
experiencing a natural disaster such as a
tsunami, earthquake, or tornado

- stress symptoms are very common in the

immediate aftermath of a traumatic event,
however, for most people, these symptoms
decrease with time because natural recovery
with time is therefore a common pattern

ANOTHER PTSD CASE STUDY:

PTSD AND DIATHESIS
- certain preexisting vulnerabilities also play an
important role

PREVALENCE OF PTSD IN THE GENERAL

POPULATION
- studies show that men are much more likely to
be exposed to traumatic events and some
suggested that women are more likely to be
exposed to certain kinds of traumatic
experiences, such as rape, that may be
inherently more traumatic
- but based on lifetime prevalence, women still
show higher rates of PTSD and tend to have
more severe symptoms

RATES OF PTSD AFTER TRAUMATIC

EXPERIENCES with because they can destroy the sense of

- traumatic events that result from human safety

intent such as rape are more likely to cause

PTSD than are traumatic events such as
accidents and natural disasters that are not
personal in nature since traumatic events
involving humans who do terrible things are
perhaps even more difficult to come to terms
- ex. at 4 months, rates of PTSD were much
higher in the terrorist attack survivors than in
those who had survived the car accidents
- another is the higher rates of direct exposure
of people to the traumatic events such as rescue
workers

SHELL SHOCK #TraumaticReactions

- term coined by British pathologist, Col.
Frederick Mott for the traumatic reactions to
combat conditions during WWI

PTSD MORE CASE STUDIES:

6 KEY FACTORS USED TO DETERMINE HOW

SERIOUS A STRESSOR IS COMPARED TO OTHERS:
- the severity of the stressor
- its chronicity (how long it lasts)
- its timing
- how closely it affects our own lives
- how expected it is
- how controllable it is

CAUSAL FACTORS IN POSTTRAUMATIC STRESS

DISORDER
- first, the very notion of PTSD makes it explicit
that PTSD is caused by experiencing trauma
specially when are directly experiencing it
- second concern is that, if some people are
more likely to develop PTSD in the face of
severe stress than other people are, might this
not lead to double victimization, with victims of
trauma also being stigmatized and being blamed
for the troubles that they have
RISK FACTORS
- a variable that increases the likelihood of a
specific (and usually negative) outcome
occurring at a later time
ANOTHER FACTORS THAT RESULT IN
DEVELOPING PTSD
1.) INDIVIDUAL RISK FACTORS
- not everyone will develop a PTSD since some is
at risk for experiencing trauma and risk for PTSD
given that there has been exposure to trauma
- risk factors that increase the likelihood of
being exposed to trauma include being male,
having less than a college education, having
conduct problems in childhood, having a family
history of psychiatric disorder, and scoring high
on measures of extraversion and neuroticism
- also, being female is a risk factor, having lower
levels of social support, having preexisting
problems with depression, anxiety, and
substance abuse
2.) BIOLOGICAL FACTORS #Cortisol
#GeneEnvironment #5httlpr #Hippocampus
- people with this disorder would have high
levels of stress hormones such as cortisol and
show an exaggerated cortisol response. Women
have higher baseline cortisol than men
- levels of cortisol tend to be lower in people
with PTSD who have experienced physical or
sexual abuse. In other words, the type of
trauma may be an important factor
- another is gene–environment interactions
since people who had the high-risk (s/s)
genotype of the serotonin-transporter gene
(people who have short forms of gene or allele
more likely to develop depression than people
with 2 long alleles) were at especially high risk
for the development of PTSD if they also had
high natural disaster exposure and low social
support; having those genes makes a bad
situation worse
- hippocampus which is involved in memory and
responsive to stress, seems to be reduced in size
in people with PTSD
- good cognitive ability or a higher IQ may be
protective against experiencing trauma and
developing PTSD because children who had
average or below average IQ scores were at
similar risk for PTSD because a person with
more intellectual; might be better at creating
some meaning from their traumatic experiences
and translate them into a personal narrative of
some kind
3.) SOCIOCULTURAL FACTORS #Minority
#UnsupportiveEnvironment
- being a member of a minority group seems to
place people at higher risk for developing PTSD
- negative and unsupportive social environment
can also increase vulnerability to posttraumatic
stress
4.) LONG-TERM EFFECTS OF POSTTRAUMATIC
STRESS
ACUTE STRESS DISORDER
- a person who had a symptom of stress within 2
days until before 4 weeks will be diagnose with
this (since it will be diagnose with PTSD when it
is the 4th week)
- is a diagnostic category that can be used when
symptoms develop shortly after experiencing a
traumatic event and last for at least 2 days
- existence of this diagnosis means that people
with symptoms do not have to wait a whole
month to be
diagnosed with PTSD can receive treatment as
soon as they experience symptoms
- studies showed that people who develop an
acute stress disorder shortly after traumatic
event are indeed at increased risk of developing
PTSD
OF COURSE, PTSD IS NOT THE ONLY DISORDER
THAT CAN DEVELOP AFTER A TRAUMATIC
EXPERIENCE
- since the most common other factors are
depression and generalized anxiety disorder
- depression is the higher comorbid of PTSD
PREVENTION AND TREATMENT OF STRESS
DISORDERS
>> PREVENTION
- one way to prevent ptsd is to reduce the
frequency of traumatic events, by this to
happen, we should prevent maladaptive
responses to stress by preparing people in
advance and providing them with information
and coping skills
- adequate training and preparation for extreme
stressors may also help soldiers, firefighters,
and others for whom exposure to traumatic
events is highly likely
COGNITIVE BEHAVIOR THERAPY
- has been shown to be an effective intervention
for headache as well as for other types of pain
COGNITIVE-BEHAVIORAL TECHNIQUES
- help people manage potentially stressful
situations or difficult events
- one strategy of this is stress-inoculation
training
STRESS-INOCULATION TRAINING #prepare
#ChangeThingsTheySayToThemselves
- prepares people to tolerate an anticipated
threat by changing the things they say to
themselves before or during a stressful event
- the disadvantage of this is it might be
impossible when the real disaster comes since it
is unpredictable and uncontrollable
BIOFEEDBACK PROCEDURES
- these aim to make patients more aware of
such things as their heart rate, level of muscle
tension, or blood pressure
- over time patients become more consciously
aware of their internal responses and able to
modify them/make minor changes when
necessary
- can be helpful in treating headaches
RELAXATION TECHNIQUES
- can help with hypertension, tension headaches
MEDITATION
- daily practice of this, may be helpful in
reducing blood pressure
 - a single session of behavioral therapy will not
TREATMENT FOR STRESS DISORDERS
- people who have symptoms from traumatic
experience could be healed even without any
professional help

1. TELEPHONE HOTLINES 
- national and local telephone hotlines provide
help for people under severe stress and for
people who are suicidal
- there are specific hotlines for victims of rape totally heal the person but they will receive

and sexual assault and for runaways who need knowledge and learn skills that will help them

help and this hotline were mostly staffed by gain better control over their lives in the

volunteers ensuing weeks and months

- how skilled and knowledgeable the volunteer

is playing an important role in how satisfied
users are with the hotline; most positive 3. PSYCHOLOGICAL DEBRIEFING

outcomes come when helpers show empathy #EmotionalSupport #Talk

and respect for callers - approaches are designed to help and speed up
the healing process in people who have

2. CRISIS INTERVENTION experienced disasters or been exposed to other

- emerged in response to especially stressful traumatic situations

situations, be the disasters or family situations - traumatized victims are provided with

that have become intolerable emotional support and encouraged to talk

about their experiences during the crisis

SHORT-TERM CRISIS THERAPY/CRISIS- - discussion is usually quite structured, and

ORIENTED THERAPY #FocusOnMainProblem common reactions to the trauma are

#Detailed #Knowledge&SkillsToControlSelves normalized; some believe that this form of

- a brief duration that focuses on the individual counseling should be mandated for disaster

functioning after the trauma (without changing victims in order to prevent PTSD

the personality before the trauma), thus, - although those who experience the debriefing

focuses only on the immediate problem with sessions often report satisfaction with the

which an individual or family is having difficulty; procedure and with the organization’s desire to

the immediate crisis not remaking the provide assistance, no well-controlled study has

personality of the person shown that it reduces symptoms of PTSD since

- therapist is usually very active, helping to that people who facilitate this are non-mental

clarify the problem, suggesting plans of action, health professional

providing reassurance, and otherwise providing

needed information and support CRITICAL INCIDENT STRESS DEBRIEFING/CISD
- a single session of CISD lasts between 3 and 4
hours and is conducted in a group format,
usually 2 to 10 days after a critical incident or
trauma
4. MEDICATIONS
- persons experiencing traumatic situations
usually report intense feelings of anxiety or
depression, numbing, intrusive thoughts, and
sleep disturbance
- several medications can be used to provide
relief for intense PTSD symptoms such as
antidepressant to alleviate the PTSD symptoms
such as depression, intrusion, and avoidance;
and also, antipsychotic medications (those
medications used to treat schizophrenia) but
there are still doubt on the effectiveness of this
5. COGNITIVE-BEHAVIORAL TREATMENTS  understanding and a caring therapist since some
- one of the examples of this is the prolonged
exposure
PROLONGED EXPOSURE THERAPY/VIRTUAL
REALITY EXPOSURE THERAPY
- behaviorally oriented treatment strategy that
is now being used for PTSD
- an effective therapy since this procedure also
involves repeated or extended exposure, either
in vivo or in the imagination, to feared (but
objectively harmless) stimuli that the patient is
avoiding because of trauma-related fear
- client is asked to vividly recount the traumatic
event over and over until there is a decrease in
his or her emotional responses
- can also be supplemented by other behavioral
techniques such as relaxation training to
manage anxiety because of traumatic events
- involves persuading clients to confront the
traumatic memories they fear, the therapeutic
relationship may be of great importance in this
kind of clinical intervention
- it is important that the therapist provides a
safe, warm, and supportive environment that
can facilitate clinical change; also capable of
other patients have trust issues
6. COGNITIVE THERAPY FOR PTSD
- designed to modify excessively negative
appraisals of the trauma or its consequences,
decrease the threat that patients experience
when they have memories of the traumatic
event, and remove problematic cognitive and
behavioral strategies