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PSY240H5 (135)
Chapter 5


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Ayesha Khan

PSY240 CHAPTER 5 – STRESS AND ADJUSTMENT DISORDERS WHAT IS STRESS? Stress – refer both to adjustive demands placed on an organism and to the organism’s internal biological and psychological responses to such demands Refer to adjustive demands as stressors, effects they create within an organism as stress, and efforts to deal with them as coping strategies Stress – by-product of poor or inadequate coping Stress can be broken down into: Eustress – positive stress Distress – negative stress Both types tax a person’s resources and coping skills, but distress potential to do more damage Axis I categories - Adjustment disorder, acute stress disorder, and posttraumatic stress disorder – involves patterns of psychological and behavioural disturbances that occur in response to identifiable stressors Differences: severity of disturbances, and nature of stressors and time frame which disorders occur - Stressors can be identified as causal factors and specific on Axis IV Categories of Stressors Adjustive demands (stressors) stem from sources that fall into three basic categories: [closely related] 1 – frustrations, 2 – conflicts, 3 – pressures Frustrations Can be difficult for a person to cope with because they often lead to self-devaluation, making person feel that they have failed in some way or is somehow incompetent Conflicts Stress results from two or more incompatible needs or motives, may be classified as approach- avoidance, double-approach, and double-avoidance types Pressures To achieve specific goals or to behave in particular ways, pressures force us to speed up, redouble our effort, or change direction of goal-oriented behaviour, which can tax our coping resources or lead to maladaptive behaviour  Given stressor may involve elements of all three categories  Usually confront a continuously changing pattern of interrelated, sometimes contradictory demands Table 5.1 – Classification of Conflict Situations Approach-avoidance conflicts – involve strong tendencies to approach and to avoid the same goal Double-approach conflicts – involve choosing between two or more desirable goals Double-avoidance conflicts – involves choices are between undesirable alternatives, task to decide which course of action will be least stressful Factors Predisposing a Person to Stress  Severity of stress gauged by degree to which it disrupts functioning  Actual degree of disruption that occurs or threatens to occur depends on several factors (listed below)  Everyone faces unique pattern of adjustive demands because of how people perceive and interpret similar situations differently and no two people face exactly same pattern of stressors Nature of Stressor - Longer stressor operates, more severe its effects - Appear to have cumulative effect - Sometimes key stressors in person’s life centre on continuing difficult life situation, these stressors considered chronic PSY240 CHAPTER 5 – STRESS AND ADJUSTMENT DISORDERS - Symptoms of stress intensify when person is closely involved in immediately traumatic situation The Experience of Crisis Crisis – refers to time when a stressful situation approaches or exceeds the adaptive capacities of a person or group Distinguish from stress: traumatic situation or crisis overwhelms a person’s ability to cope, whereas lesser stressors do not necessarily overwhelm the person Crisis intervention has been widely used to provide psychological help in times of severe/special stress Life Changes Place new demands on us, so may be stressful, the faster the changes the greater the stress - Psychosocial environment can play significant role in causing disorders or precipitating their onset (even in strongly biological disorders) Social Readjustment Scale – objective method for measuring cumulative stress to which a person has been exposed over a period of time, measures life stress in terms of life change units (LCU) so the more stressful the event, the more LCUs assigned to it, found that people with scores of 300 or more for recent months were at significant risk for getting major illness within next two years Impact of Event Scale – measures person’s reaction to stressful situation by identifying stressor, and posing series of questions to determine sorts of stress-related symptoms that person is experiencing Limitation: serve only as general indicator of distress and do not provide useful information about specific types of disorders, but evidence supports stressfulness of life changes Life Event and Difficulty Schedule – involves semistructured interview that places life event rating variables in clearly defined context in order to increase interrater reliability, makes it possible to assess meaning of event to individual more directly A Person’s Perception of the Stressor Different reactions that people have to environmental events due partially to how they perceive (appraise) the situation, people make two kinds of appraisals; primary appraisal (“Is this a threat?”) and secondary appraisal (“Can I cope?”) - New adjustive demands that have not been anticipated (no ready-made coping strategies) will place person under severe stress - Knowing what to expect adds predictability to the situation, which reduces stress and anxiety - Trauma always leaves the person transformed in some way and one natural outcome of the stress process is adaptation and growth - Individuals’ ability to perceive some benefit in adaptive to consequences of disaster depended on nature of disaster Individual’s Stress Tolerance Stress tolerance – person’s ability to withstand stress without becoming seriously impaired - People vary in overall vulnerability to stressors - Stress due to a combination of genetic factors and environmental experiences - Person may have failed to learn effective adaptive strategies for certain kinds of stressors Lack of External Resources and Social Supports Evidence suggests that positive social and family relationships can moderate effects of stress on person Lack of external supports can make given stressor more potent and weaken person’s capacity to cope with it - Person whose spouse is experiencing psychological disturbance likely to experience more stress than one who spouse is psychologically better adjusted Stress of illness is compounded by loss of support Coping with Stress Sometimes, inner factors *person’s frame of reference, motives, competencies, or stress tolerance] play dominant role in determining their coping strategies PSY240 CHAPTER 5 – STRESS AND ADJUSTMENT DISORDERS Some people create stress for themselves rather than coping, stressful situations can be related to person’s beliefs or interpretations Three interacting levels: 1 – on biological level [immunological defences and damage-repair mechanisms], 2 – on psychological and interpersonal level [learned coping patterns, self-defences, and support from family and friends], 3 – on sociocultural level [group resources]  Failure of coping on any of these levels may increase person’s vulnerability on other levels Coping with stress, person confronted with two challenges: 1 – meeting requirements of stressor, 2 – protecting themselves from psychological or physical damage or disorganization, challenges can be met in following two general ways: Task-oriented coping Task-oriented response – may involve making changes in one’s self, one’s surroundings, or both Action may involve retreating from problem, attacking directly, or trying to find workable compromise Defence-oriented coping Defence-oriented response – behaviour is directed primarily at protecting oneself from hurt and disorganization rather than resolving the situation Two types of responses – 1) psychological damage-repair mechanisms [crying, repetitive talking, mourning], 2) ego-defence or self-defence mechanisms [denial, repression – relieve tension and anxiety and protect person from hurt and devaluation], protect self 1) by denying, distorting, or restricting person’s experience, 2) reducing emotional or self-involvement, and/or 3) counteracting threat or damage  Ego-defence mechanisms considered maladaptive when they become primary means of coping with stressors and applied in excess View adaptation to stressors in three modes: defensive, proactive, and accommodative Defensive-responding – responding efforts attempt to reject problem/threat Proactive approach – [like task-oriented] individual attempts to cope with stress by modifying situation Accommodative efforts – person re-evaluates situation and adapts to changed circumstances by modifying goals and searching for more positive ways of responding to the crisis  Only successful coping reaction is one that stabilizes or increases well-being THE EFFECTS OF SEVERE STRESS Personality or psychological decompensation- when stressors sustained or severe, there is a lowering of adaptive functioning  Severe stress can exact a high cost in terms of lowered efficiency, depletion of adaptive resources, wear and tear on biological system, and sometimes in death Using resources to meet one severe stress, an organism may suffer a lowering of tolerance for other stressors, coping resources are limited Homeostasis – balanced state in which an organism finds itself when basic biological needs are met  When organism is stressed, thrown out of homeostatic balance Allostasis – process of adaptation or achieving stability through change Example – to meet demands of stressor, organism mobilize bodily resources via action of adrenaline, and under prolonged stress, bodily resources activated on continuing basis so they fail to shut down when not needed Allostatic load – frequent mobilization of these resources [systems] under stress, results in wear and tear of body Prolonged stress may lead to 1) Pathological overreponsiveness to stressors – “last straw” response 2) Pathological insensitivity to stressors – loss of hope or extreme apathy in “stressed out” people PSY240 CHAPTER 5 – STRESS AND ADJUSTMENT DISORDERS Biological Effects of Stress Model that helps explain course of biological decompensation under excessive stress: general adaptation syndrome – found that body’s reaction sustained and excessive stress typically occurs in three major phases: 1 – alarm reaction *body’s defensive forces are “called to arms” by activation of autonomic nervous system, shows initial lowered resistance to stress or shock], 2 – stage of resistance [biological adaptation is at maximal level in terms of bodily resources used, defensive reaction in attempt to adapt to stress], and 3 – exhaustion [bodily resources depleted, and organisms loses its ability to resist and further exposure to stress can lead to illness or death, collapse of adaptation ] Stress and Sympathetic Nervous System SNS discharges adrenaline to prepare organism for “fight or flight” response as follows: 1 – heart rate and blood flow [blood pressure] to large muscles increase to provide organisms with capability of reacting to physical threats, 2 – pupils dilate so more light enters the eye, 3 – skin constricts to limit blood loss in event of injury, 4 – blood sugar increases to provide more ready energy  Stress response activated for long periods, harder to shut off organism’s natural response, and return back to homeostasis  Any employment of stress response inflicts degree of wear and tear on system [even after it is gone] Neurotransmitters when SNS activated: norepinephrine, epinephrine, and dopamine - Studies have compared levels of these substances in patients undergoing severe stress and in control samples - Another way: “challenge” study – research subject [trauma victim] exposed to external stimuli resembling original trauma, and researcher records individual’s biological response - Research shows that stressful situations can have significant impact on cardiovascular system Stress and the Immune System - Stress can act through hypothalamic-pituitary-adrenal glands to produce serious endocrine imbalance that takes major toll on person’s immune system - Hypothalamus releases hormones that stimulate pituitary to release other hormones that regulate many bodily functions - Stress operates through hypothalamic-pituitary-adrenal system - Suppression of immune system under chronic stress can have health consequences - Psychoneuroimmunology – focuses on effects of stressors on the immune system - Immune system protects us against autoimmune diseases and maintains balance of cells that maximize our survival Psychological Effects of Long-Term Stress 1) Alarm and mobilization – person’s resources for coping with trauma are altered and mobilized, emotional arousal, increased tension, heightened sensitivity, greater alertness, and determined efforts at self-control, person attempts to undertake coping measures [task-oriented, defence- oriented, or combination], symptoms of maladjustment may appear [continuous anxiety, tension, gastrointestinal upset or other bodily diseases, and lowered efficiency – signs that mobilization of adaptive resources is inadequate] 2) Resistance –person able to find some means of dealing with trauma and maintain some adjustment to life, indications of strains may exist, person may become rigid and cling to previously developed defences rather than re-evaluate traumatic situation and work out more adaptive coping patterns 3) Exhaustion – person’s adaptive resources depleted, and coping patterns called forth in stage of resistance begin to fail, individual’s ability to deal with continuing stress is lowered and may employ exaggerated and inappropriate defence mechanisms, hallucinations and delusions begin PSY240 CHAPTER 5 – STRESS AND ADJUSTMENT DISORDERS ADJUSTMENT DISORDER: REACTIONS TO COMMON LIFE STRESSORS Adjustment disorder – person whose response to common stressor is maladaptive and occurs within three months of stressor maladjustment lessens or disappears when 1) stressor has subsided, or 2) individual learns to adapt to the stressor If order exceeds 6 months, DSM-IV-TR recommends diagnosis changed to some other mental disorder  Reality of adjustment disorders is that they don’t always adhere to a time schedule Question: What would be considered a normal response to a stressor? Answer: DSM-IV-TR has no category for stress disorders, classified under anxiety disorders [PTSD, acute stress disorder] Adjustment Disorder Caused by Unemployment Requires great coping strength, can affect person’s self-concept, sense of worth, and feeling of belongingness Adjustment Disorder Caused by Bereavement Accounts for 1/3 of PTSD cases in a community First reaction – disbelief, then begin to realize significance of death, feelings of sadness, grief, and despair overwhelm us Grief – natural process that allows survivors to mourn their loss and free themselves for life without departed person Pathological reactions to death more likely to occur in people who have history of emotional problems, or who harbour great deal of resentment and hostility towards the deceased and experience guilt, usually depressed and suffering from major depression Adjustment Disorder Caused by Divorce or Separation Factors make divorce or separation unpleasant and stressful: Acknowledgement of failure in relationship, necessity of explaining failure to family and friends, loss of valuable friendships that accompany rupture, economic uncertainties and hardships that both parents experience, when children are involved [problem of custody], adjustment to single life, new romantic relationships may require personal change, new strength to adapt and copy needed, and divorce may motivate task-oriented coping response of seeking counseling POSTTRAUMATIC STRESS DISORDER: REACTIONS TO CATASTROPHIC EVENTS Symptoms include – persistently re-experiencing traumatic event, persistently avoiding stimuli associated with trauma, chronic tension, irritability, and insomnia, impaired concentration and memory, feelings of depression or emotional numbing [unable to experience positive emotions] Prevalence of PTSD in the General Population 7-12% Canadian and U.S. adults affected by PTSD at some point in their lives More than 2/3 of people experience some traumatic event in their lives in Canada and U.S. PTSD develops in a minority of traumatized individuals Lack of social support and various vulnerability factors place traumatized people at risk for PTSD Risk of being traumatized and developing PTSD higher for people living in war-torn countries and for those engaging in hazardous activities or occupations Men more likely to be exposed to trauma, women more likely to develop PTSD  Gender difference in prevalence of PSTD may reflect differences in nature of traumatic stressors Sexual assault is particularly potent stressor for causing PT
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