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Chapter 5

Chapter 5.odt Abnormal Psych

12 Pages

Course Code
PSYC 3390
Mary Manson

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Chapter 5 Pgs 150 – 156 What is Stress? -Stress can refer to both: 1) adjustive demands placed on organism (stressors) 2) the organism’s internal biological and psychological responses to such demands -Stressor = adjustive demands -Stress = effects stressors create within organism, a by-product of poor or inadequate coping -Coping strategy = efforts to deal with stress -according to Hans Selye (pioneering stress researcher), stress broken down into: -eustress (positive stress) – like the stress during a wedding -distress (negative stress) – like the stress during a funeral -both tax a person’s resources/coping skills, but distress has more potential to do damage -in DSM-IV-TR, diagnostician can specify on Axis IV the specific psychosocial stressors facing a person -Axis IV scale particularly useful in relation to 3 Axis I categories: adjustment disorder, acute stress disorder, PTSD Categories of Stressors 1) frustrations -internal and external obstacles lead to frustration -prejudice, discrimination, unfulfillment in job, death of loved one is common environmental frustrations -physical handicaps, loneliness, guilt, inadequate self-control are frustrations based on personal limitations -difficult to cope with b/c often lead to self-devaluation and feeling incompetent 2) conflicts -stress often from simultaneous occurrence of 2 or more incompatible needs/motives (requirement of one precludes satisfaction of others) -classified as approach-avoidance, double-approach, and double- avoidance types -Approach –avoidance conflicts: involve strong tendency to approach and avoid the same goal -ex: Mary offered appealing job in her company that she’s had her eye on for several years but her ex-husband with whom she’s been having great difficulty with also works there. She is concerned the atmosphere will be unbearable -Double-approach conflicts : involve choosing between 2 or more desirable goals, may cause more eustress than distress but the stress is still real and the choice difficult, in each case person gives up something -ex: Choosing between two graduate programs (one that is more prestigious, and one that is less prestigious but has his exact specialization) -Double-avoidance conflicts: choices are between undesirable alternatives (neither choice will bring satisfaction so that task is to decide which is less disagreeable – the least stressful) -ex: Jenny’s mom sends airline ticket to her for family outing that she doesn’t want to go to, she considers lying that she’s busy (which she finds distasteful) or attending (which she doesn’t want to do either) 3) pressures -pressures to achieve specific goals or behave in certain ways can result in stress -originate from external (like pressure to make good grades as parents demand) and internal sources (pressure to make good grades because they want to get into graduate school) -occupational demands can be highly stressful -any situation can involve elements of all three categories of stress -we usually confront a continuously changing pattern of interrelated and sometimes contradictory demands Factors predisposing a person to stress -severity of stress is gauged by degree to which disrupts functioning Nature of the stressor -stressors involving important aspects of person’s life (like death of loved one, divorce, job loss), tend to be highly stressful -longer the stressor operates, the more severe it’s effects -stressors have cumulative effect (the “one last straw” effect on a precipitating stressor) -chronic, long lasting stressors that act on person’s life center -encountering several stressors at same time also makes difference – results in more severe stress than if they had occurred separately -symptoms of stress intensify when person more closely involved in immediately traumatic situation The Experience of Crisis -crisis: times when a stressful situation approaches or exceeds the adaptive capacities of a person or group -a traumatic crisis overwhelms a person’s ability to cope, whereas lesser stressors don’t necessarily overwhelm the person -crisis can impair person’s ability to cope, or they may emerge from crisis better adjusted than before -crisis intervention (providing psychological help in times of severe and special stress) is widely used Life Changes -life changes place new demands on us and therefore might be stressful -the faster the changes the greater the stress -scale that measures life stress in terms of life change units (LCU): the more stressful the event, the more LCUs assigned to it -death of a spouse rates 100 LCUs, divorce rates 73 LCUs, vacation rates 13 LCUs -Holmes and colleagues found that people w/LCU score of 300 or more for recent months are at significant risk for getting major illness within next 2 yrs -Impact of Event Scale – measures person’s reaction to stressful situation by first identifying the stressor and then posing series of questions to determine sort of stress-related symptoms that the person is experiencing -criticism of life event scale assessment focus on items selected for scales, subjectivity of scoring, failure to take into account relevance of items for population studied, reliance on subjects’ memory of events -most problematic criticism is that they serve only as general indicator of distress and don’t provide useful info about specific types of disorders -Life Event and Difficulty Schedule by Brown and Harris and Brown and Moran – semistructured interview that places life event rating variables in clearly defined context in order to increase interrater reliability (can assess the meaning of the event to the individual more directly) Person’s Perception of the Stressor -different reactions people have to environmental events are due in part to the way they perceive (appraise) the situation -same event interpreted differently by diff people (some are scared of being on stage, some love it) -Lazarus and Folkman say people make 2 appraisals of events: is this a threat? And can I cope? -a person who appraises event as threatening and is concerned will be unable to deal w/stressor is likely to experience anxiety -some theorists have pointed out that trauma always leaves person transformed in some way and that one natural outcome of stress process is adaptation and growth -to perceive some benefit in adapting to the consequence of a disaster depends in part on nature of disaster Individual’s Stress Tolerance -ppl who don’t handle changing life circumstances well may be vulnerable to frustration and pressure -children particularly vulnerable to severe stressors like natural disasters, war, terrorism -stress tolerance refers to person’s ability to withstand stress without being seriously impaired -stress tolerance due to combination of genetic factors and environmental experiences -early traumatic experiences can leave person vulnerable to (or well equipped to handle) certain stressors Lack of External Resources and Social Supports -positive social and family relationships can moderate effects of stress on a person -those who have closer network of friends tend to have reduced vulnerability to depression when experience extreme stress -lack of external supports can make a stressor more potent and weaken capacity to cope with it -a person may be adversely affected by family members who experience problems -level of tension for family members can be increased if one member experiences extreme difficulty like chronic or life threatening illness or psychiatric disability Coping with Stress -any stress reaction reflects interplay of inner strategies and outer conditions (some more influential than others) -some people create stress for themselves rather than coping -stressful situations can be related to or intensified by a person’s beliefs or interpretations -there are 3 interacting levels pertaining to principles of coping with stress: 1) biological level (immunological defences and damage-repair mechanisms) 2) psychological and interpersonal level (learned coping patterns and self defences, and support from family/friends) 3) sociocultural level (group resources like labor unions, religious organizations, law enforcement agencies) -failure of coping on any of these 3 levels can increase vulnerability on other levels -in coping w/stress, a person is confronted w/2 challenges: meeting the requirements of the stressor, and protecting himself/herself from psychosocial or physical damage and disorganization -these challenges can be met in the following 2 general ways: 1)Task-oriented coping: making changes in one’s self, one’s surroundings, or both -action may be overt (like showing more affection to spouse) or covert (lowing one’s level of aspiration) -action may involve retreating from problem, attacking it directly, or trying to find workable compromise 2) Defence-oriented coping: behavior directed primarily at protecting oneself from hurt and disorganization rather than resolving the situation -typically forsake more productive task-oriented action in favor of maintaining integrity of self -two types of defence-oriented coping are: responses like crying/mourning (psychological damage-repair mechanisms), and denial/repression (ego- defence/self-defence mechanisms) -ego-defence mechanisms are considered maladaptive when become the predominant means of coping with stressors and are applied in excess -Greve and Strobl (2004) view adaptation to stressors in terms of 3 modes of adaptation: 1) defensive – reject the problem/threat 2)proactive – attempts to cope with stress by modifying situation (like task-oriented) 3) accommodative - re-evaluates the situation and adapts to changed circumstances by modifying goals/searching for more positive ways of responding to crisis -the only successful coping reaction is the one that stabilizes or increases well being Pg. 160 - 182 Adjustment Disorder: Reactions to Common Life Stressors -a person whose response to common stressor (marriage, divorce, childbirth, loss job) is maladaptive and occurs within 3 months of stressor can be said to have adjustment disorder -maladaptive reaction is if unable to function as usual or if reaction is excessive -maladjustment lessens or disappears when stressor subsides, or they learn to adapt to stressor -if symptoms go beyond 6 month, DSM-IV-TR recommends diagnosis changed to a mental disorder -in DSM-IV-TR, no separate category exists for stress disorders, rather, acute stress disorder and PTSD are categorized under the anxiety disorders -what pushes a normal reaction into category of adjustment disorder is inability to function as usual -adjustment disorder is probably least stigmatizing and mildest diagnosis therapist can give client Adjustment disorder caused by unemployment -managing stress associated with unemployment requires great coping strength, especially for those who have previously earned adequate living -unemployment especially important problem in some population subgroups -impact of chronic unemployment on person’s self-concept, sense of worth, and feelings of belongingness is shattering, especially in an affluent society Adjustment Disorder caused by bereavement -sudden, unexpected death of loved one accounts for about 1/3 of all PTSD cases seen in a community -often first response is disbelief, then sadness, grief, despair -some people don’t go through typical grieving process, perhaps due to defensive coping styles, or because they may be expected to be stoical about their feelings -other may have exaggerated or prolonged depression after grieving should’ve ended -normal grieving process typically about a year and may include negative health effects like high blood pressure, changes in eating habits, and withdrawal from formerly enjoyable activities Adjustment disorder caused by divorce or separation -marital disruption is a major source of vulnerability to psychopathology: people recently divorced or separated are overrepresented among people with psychological problems -problems involve: explaining the failure to family/friends, loss of valuable friendships that accompany the rupture, economic uncertainty and hardship, problem of custody when children involved -after separation or divorce, new problems emerge: adjustment to single life, friends and assets have to be divided, new friendships need to be made, new romantic relationships, new strength to adapt/cope (divorce may motivate task-oriented coping response of seeking counseling) Posttraumatic Stress Disorder: reactions to catastrophic events -Symptoms of PTSD may include: -traumatic event re-experienced via intrusive thoughts or nightmares -avoid stimuli associated w/trauma (like cars, if were in car crash) -experience chronic tension or irritability, insomnia, inability to tolerate noise -impaired concentration or memory -inability to experience positive emotions (emotional numbing), distance and alienation from others Prevalence of PTSD in general population -7-12% of Canadian and US adults affected by PTSD at some point in lives -2/3 of Canadians and US experience some traumatic event (but only 7-12% develop PTSD) -lack of social support/various vulnerability factors place traumatized people at risk of PTSD -10-20% of Canadian armed forces, especially those in places like Afghanistan, have developed PTSD -risk of developing PTSD is higher for those living in war-torn countries and those engaging in hazardous activities/occupations -men more likely to be exposed to trauma, but women more likely to develop PTSD -women more likely to experience sexual assault (a particularly potent stressor for causing PTSD) -PTSD often follows chronic course, but frequency and severity of symptoms fluctuate over time -media reports of a person’s trauma (like description of criminal assault) may exacerbate PTSD symptoms -sexual harassment may exacerbate PTSD symptoms in those previously sexually assaulted -PTSD commonly co-occurs w/other psychiatric disorders, a
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