 Non-specific response of the body to

MODULE 9| TRAUMA AND STRESS-RELATED any demand for change.

DISORDERS
I. THE NATURE OF STRESS
 needs, or lack of resources.
 Internal response to a situation that is
hard to manage.
A. SHORT-TERM EFFECTS OF STRESS
 A set of emotional, physical, and
cognitive reactions to changes,
demands, threats, unmet
C. LONG-TERM EFFECTS OF STRESS
1. PHYSICAL EFFECTS (Increased levels of
CORTISOL)

1. ACTIVATION OF THE SYMPATHETIC  Brain atrophy

NERVOUS SYSTEM  Compromised immune system
 Weight loss or weight gain
o Muscle tension  Increased blood pressure
o Increased heart rate  Aches and pains
o Increased blood pressure  Palpitations
o Stomach tension
o Edginess 2. EMOTIONAL EFFECTS
o Cold and clammy hands
 Apathy
2. ACTIVATION OF THE PARASYMPATHETIC  Anxiety
NERVOUS SYSTEM  Depression
 Loss of confidence
o Muscle relaxation  Irritability
o Normal heart rate  Apprehension
o Normal blood pressure  Oversensitivity
o Relaxed stomach
o Composed mood 3. COGNITIVE EFFECTS
o Hands are warm and dry
 Worrying
B. TYPES OF STRESS  Pessimism
 Impaired judgment
1. EUSTRESS (POSITIVE STRESS)  Inability to concentrate
 Suspiciousness
o Promotes growth and
 Delusions and hallucinations
accomplishment
 Suicidal ideation
o Increases learning, motivation,
development, creativity, and 4. BEHAVIORAL EFFECTS
satisfaction
 Disturbance of sleep and eating
2. DISTRESS (NEGATIVE STRESS) patterns
 Withdrawal and isolation
o Feels unpleasant
 Excessive use of cigarettes, substances,
o Causes anxiety or concern
alcohol, and drugs
o Interferes with goal-directed
 Loss of interest in activities
behavior
 Neglect of personal hygiene
D. SOURCES OF STRESS
1. EXTERNAL SOURCES
 Family
 Relationships
 School
 Environmental Stresses
 Chemical and nutritional stress
 Hormonal factors
 Daily hassles
 Major life events
2. INTERNAL SOURCES
o Lifestyle
o Negative self-talk
o Stressful Personality
 Perfectionism
 Pessimist
 Superman personality
E. GENERAL ADAPTATION SYNDROME
(SELYE, 1976)
 A common biological response pattern
to prolonged or excessive stress.
 The GAS model suggests that our
bodies under stress are like clocks with
alarm systems that do not shut off until
their energy is perilously depleted.
1. ALARM REACTION
 Mobilizes the body to prepare for
challenges or stress
 1st line of defense against a threatening
stressor
 The body reacts with a complex,
integrated response involving the
activation of the SNS, which increases
bodily arousal and triggers the release
of stress hormones by the endocrine
system.
 The adrenal glands (controlled by the
pituitary gland) pump out cortical
steroids and stress hormones that help
mobilize the body’s defenses.
FIGHT OR FLIGHT RESPONSE (W. CANNON,
1929)
 Helped our early ancestors cope with
the many perils they faced.
 The reaction may have been provoked
by the sights of a predator or by a
rustling sound in the undergrowth.
 Sensitive alarm reactions increased their
chances of survival; once a threat was
eliminated, the body reinstated a lower
level of arousal. It did not remain for
long in a state of heightened arousal
after the immediate danger was past.
2. RESISTANCE OR ADAPTATION STAGE
 High levels of response by the SNS and
Endocrine System
 The body tries to renew spent energy
and repair damage.
3. EXHAUSTION STAGE
 When stressors continue or new ones
appear.
 The dominance of the Parasympathetic
NS
 Heart and Respiration rates decelerate
F. PSYCHOLOGICAL FACTORS THAT
MODERATE STRESS
1. STYLES OF COPING (Lazarus & Folkman,
1984)
a. EMOTION-FOCUSED COPING
 People take measures that immediately
reduce the impact of the stressor.
 Denying the existence of the stressor or
withdrawal from the situation.
 Not eliminate the stressor or develop
better ways to manage it.
 EXAMPLE: USE OF WISH-FULFILLMENT
FANTASIES
o Ruminating about what might have
been had an illness or stressor not
occurred and longing for better
times.
o Offers a person no means of coping
with life’s difficulties other than an
imaginary escape.
o Linked to poor adjustment in coping
with serious illness or stress.
b. PROBLEM-FOCUSED COPING
 Examine stressors and try to change or
modify their own reactions to render the
stressors less harmful.
 Involves strategies that address the
sources of stress, such as seeking
information about the illness through
self-study and medical consultation.
2. SELF-EFFICACY EXPECTANCIES (Bandura,
1986, 2006)
 Expectations regarding our abilities to
cope with the challenges we face, to
perform certain behaviors skillfully, and
to produce positive changes in our lives.
 Serves as a buffer to stress; we are
better able to manage stress, including
the stress of coping with illness, when
we feel confident (have higher self-
efficacy) in our ability to cope
effectively with the challenges we face.
 High self-efficacy expectancies appear
to be associated with lower secretion of
stress hormones, epinephrine, and
norepinephrine; people who believe
they can cope with their problems are
less likely to feel nervous.
3. PSYCHOLOGICAL HARDINESS (Kobasa,
1979)
 A cluster of traits that may help people
manage stress.
➢ KEY TRAITS OF PSYCHOLOGICAL
HARDINESS:
 COMMITMENT
o Rather than feeling alienated from
the tasks and situations, hardy
individuals engage themselves fully
in their tasks and believe in what
they were doing.
 CHALLENGE
o Hardy individuals believed change
was the normal state of things, not
sterile sameness, or stability for the
sake of stability.
 CONTROL OVER THEIR LIVES
o Hardy individuals believed and
acted as though they were
effectual rather than powerless in
controlling the rewards and
punishments of life.
 Internal locus of control (Rotter, 1966)
➢ PSYCHOLOGICALLY HARDY PEOPLE
 Appear to cope more effectively with
stress by using more active, problem-
solving approaches.
 Report fewer physical symptoms and
less depression in the face of stress than
nonhardy people.
 Hardy people are better able to handle
stress because they perceive
themselves as choosing their stress-
creating situations. They perceive the
stressors they face as making life more
interesting and challenging, not as
simply burdening them with additional
pressures.
 A sense of control is a key factor in
psychological hardiness.
4. OPTIMISM (Seligman)
 Evidence shows that more optimistic
people tend to have better
cardiovascular health and
immunological functioning.
 Optimists tend to take better care of
themselves than pessimists, such as
engaging in more physical activity,
avoiding harmful substances such as
tobacco, and maintaining healthier
body weight.
5. SOCIAL SUPPORT
 People with a broad network of social
relationships, such as having a spouse,
having close family members and
friends, and belonging to social
organization, not only show greater
resistance to fending off the common
cold but also tend to live longer lives
than people with narrower social
networks.
 Having a diverse social network may
provide a wider range of social support
that helps protect the body’s immune
system by serving as a buffer against
stress.
II. ADJUSTMENT DISORDER
 A maladaptive reaction to a distressing
life event or stressor that develops
within 3 MONTHS of onset of the stressor.
The stressful event may be either a
traumatic experience, such as a natural
disaster or motor vehicle accident with
serious injury, or a non-traumatic life
event, such as the breakup of a
romantic relationship or starting college.
 Significant impairment in SOCIAL,
OCCUPATIONAL, and other IMPORTANT
AREAS OF FUNCTIONING, such as
academic work, or by marked
emotional distress exceeding what
would normally be expected in coping
with the stressor.
DIAGNOSIS:
 Stress reaction must not be sufficient to
meet the diagnostic criteria for other
clinical syndromes such as traumatic
stress disorders, anxiety, or mood
disorders.
 If adjustment disorder lasts for more
than 6 months after the stressor has
been removed, the diagnosis can be
changed.
 The maladaptive reaction may be
resolved if the stressor is removed, or the
individual learns to cope with it.
III. TRAUMATIC STRESS DISORDERS
A. TRAUMA
 The response to a deeply distressing or
disturbing event overwhelms an
individual’s ability to cope, causes
feelings of helplessness, diminishes their
sense of self and the ability to feel the
full range of emotions and experiences.
➢ COMMON RESPONSES & SYMPTOMS OF
TRAUMA
1. EMOTIONAL SYMPTOMS:
1. Sadness
2. Anger
3. Denial
4. Fear
5. Shame
2. BEHAVIORAL SYMPTOMS:
1. Nightmares
2. Insomnia
3. Difficulty with relationships
4. Emotional outbursts
3. PHYSICAL SYMPTOMS:
1. Nausea and vomiting
2. Altered sleep patterns
3. Changes in appetite
4. Headaches
5. Gastrointestinal problems
B. TRAUMATIC STRESS DISORDERS
 Focus on how people cope with
disaster and traumatic experiences.
 Exposure to trauma can make it difficult
for anyone to adjust.
 Maladaptive patterns of behavior in
response to trauma that involved
marked personal distress or significant
impairment in functioning.
1. ACUTE STRESS DISORDER
 A maladaptive pattern of behavior for
a period of 3 days to one month
following exposure to a traumatic
event.
 Traumatic Event involves exposure to:
1. Actual or threatened death
2. A serious accident
3. A sexual violation
 Source of Trauma:
o Direct exposure to trauma
o Witnessing other people
experiencing the trauma
o Learning about a violent or
accidental traumatic event
experienced by a close friend or
family member
 Feel like they are “in a daze” or that the
world seems like a dreamlike or unreal
place.
 Occur in response to battlefield trauma
or exposure to natural or technological
disasters
 Walk around “in a fog” for days or
weeks afterward
 Be bothered by intrusive images,
flashbacks, or dreams of the disaster.
 Relive the experience as though it were
happening again
 Symptoms vary:
o Disturbing, intrusive memories or
dreams about the trauma
o Flashbacks: Re-experiencing the
trauma
o Dissociation: Feeling of unreality or
detachment
o Avoidance of external reminders of
the trauma
o Problems sleeping
o Irritable or aggressive behavior
o Exaggerated startle response to
sudden noises
2. POSTTRAUMATIC STRESS DISORDER
 The prolonged maladaptive reaction
lasts longer than one month after the
traumatic experience.
 Similar symptom profile as ASD but is
persistent for months, years, or
decades.
 May not develop until many months or
years after the traumatic event.
 SOURCES OF TRAUMA:
o Direct exposure to trauma involving
actual or threatened death
o Serious physical injury or sexual
violation
o Witnessing people experiencing
trauma
o Learning that a close friend or family
member has experienced an
 accidental or violent traumatic
event.
VULNERABILITY TO PTSD:
 The more direct the exposure, the
greater the likelihood of developing
PTSD.
 Men have more traumatic experiences
however women are more likely to
develop PTSD.
 BIOLOGICAL FACTORS: Smaller
amygdala size
 PERSONALITY FACTORS:
o History of childhood sexual abuse,
lack of social support, and limited
coping skills.
o History of childhood sexual abuse,
lack of social support, and limited
coping skills.
o Low levels of SELF-EFFICACY.
o High levels of HOSTILITY.
3. REACTIVE ATTACHMENT DISORDER
4. DISINHIBITED SOCIAL ENGAGEMENT
DISORDER
IV. THEORETICAL PERSPECTIVE: BEHAVIORAL
MODEL
1. CLASSICAL CONDITIONING
 UNCONDITIONED STIMULUS: Traumatic
Experience
 CONDITIONED STIMULI: Sight, smell, or
sound
 CONDITIONED RESPONSE: Anxiety
 Cues that reactivate negative arousal
or anxiety are associated with thoughts,
memories, or even dream images of the
trauma; hearing someone talking about
the trauma; or visiting the scene of the
trauma.
2. OPERANT CONDITIONING
 Negative Reinforcement of Avoidant
Behavior due to relief from anxiety.
 By avoiding trauma-related cues, a
person also avoids opportunities to
overcome the underlying fear.
3. EXTINCTION OF CONDITIONED ANXIETY
 Occur when the person encounters the
conditioned stimuli (the cures
associated with the trauma) in the
absence of any troubling
unconditioned stimuli.
V. TREATMENT APPROACHES
1. ANTIDEPRESSANTS
 SSRI’s: Sertraline (Zoloft) or Paroxetine
(Paxil)
 Reduce anxiety components of PTSD
2. COGNITIVE-BEHAVIORAL THERAPY
 The gradual re-experience of anxiety
associated with the traumatic event in
a safe setting thereby
allowing EXTINCTION to take its course.
 The patient may be encouraged to
repeatedly talk about the traumatic
experience, re-experience the
emotional aspects of the trauma in
imagination, view related slides or films,
or visit the scene of the traumatic
event.
 Survivors of serious motor vehicle
crashes who have avoided driving
since the accident might be instructed
 to make short driving trips around the
neighborhood (Gray & Acierno, 2002),
they may also be asked to repeatedly
describe the incident and the
emotional reactions they experienced.
 Combat-related PTSD, exposure-based
homework assignments might include
visiting way memorials or viewing war
movies.
 Evidence shows that supplementing
exposure with cognitive restructuring
(challenging and replacing distorted
thoughts or beliefs with rational
alternatives) can enhance treatment
gains.

3. PROLONGED EXPOSURE

 The person repeatedly re-experiences

the traumatic event in imagination
during treatment sessions or directly
confronts situations linked to trauma in
real life without seeking escape from
anxiety.

 For rape survivors, prolonged exposure

may take the form of repeatedly
recounting the horrifying ordeal within a
supportive therapeutic setting.

4. TRAINING IN STRESS MANAGEMENT SKILLS

 Self-Relaxation
 Improve the client’s ability to cope with
the troubling symptoms of PTSD i.e.,
heightened arousal and the desire to
run away from trauma-related stimuli

5. TRAINING IN ANGER MANAGEMENT