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Chapter Six.doc

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Chapter Six Overview • How stress affects us psychologically and physiologically • Psychological and social factors that change how we come with stress • Interventions to help people who have been exposed to considerable stress • Two diagnosable disorders: acute stress disorder and post-traumatic stress disorder Introduction • Stress: experiencing events (stressors) that we perceive as endangering our physical or psychological well-being; reactions called stress responses • Uncontrollable: any negative event perceived as more stressful if it is uncontrollable o Galvanic skin response (GSR): drop in electrical resistance of skin; index of arousal; used to measure levels of anxiety in experiments • Unpredictability: can make some events especially stressful; warnings preferred as may allow people to prepare themselves to reduce impact o Safety signal hypothesis: with unpredictable events, people feel like they can never relax, because events may occur at any time; remain anxious constantly • Change: requirement of numerous readjustments (even a positive change) can be perceived as stressful; challenges self-concept and limits of capabilities Physiological responses to stress • Body mobilization: liver releases extra glucose to fuel muscles; hormones released to stimulate conversion of fats/proteins to sugar; body’s metabolism increases in preparation for expending energy on physical action; heart rate, blood pressure and breathing rate increase and muscles tense; less essential activities (digestion) curtailed; endorphins secreted; more red blood cells released to carry oxygen; changes result from activation of two systems • Autonomic nervous system: sympathetic division of this system important in stress response; controlled by hypothalamus; • Adrenal-cortical system: hormone releasing system; controlled by hypothalamus • Fight or flight response: physiological responses developed through evolution to fight a threat or flee from it; feedback loop to regulate level of arousal; chronic arousal can be damaging to body o Initiated by hypothalamus, which stimulates sympathetic division of ANS, which acts on smooth muscles and internal organs to produce bodily changes (increased heart rate, elevated blood pressure, etc) o Hypothalamus also releases corticotrophin release factor (CRF), which triggers the pituitary gland to release adrenocorticotropic hormone (ACTH) o ACTH stimulates adrenal glands to release about 30 other hormones, the major one being cortisol, which play roles in body’s adjustment to emergency circumstances o Hormones eventually signal hippocampus to turn off physiological cascade when threatening stimulus has passed • General adaptation syndrome: Hans Selye; body reacts in three phases to stressor; repeated or prolonged exhaustion is responsible for wide array of physiological disorders o Alarm: body mobilized to confront a threat by triggering sympathetic nervous system activity o Resistance: organism makes efforts to cope with threat by fighting or fleeing o Exhaustion: organism unable to fight or flee from threat and depletes physical resources while doing so • Tend and befriend: gender differences in responses to stressful circumstances; rather than attempting to fight or flee from aggressor, females join social groups to reduce vulnerability and gain resources and focus on caring for offspring • Health psychology: inspired by Selye’s work; investigates effects of stress and other psychological factors on physical illness; concerned with roles of personality factors, coping styles, stressful events and health related behaviours; study whether changing psychology can influence course of physical disease; three models of relationship o Direct effects model: psychological factors (ex: stressful experiences or personality characteristics) directly cause changes in physiology of body, which in turn cause/exacerbate disease; ex: stress-induced eating behaviour o Interactive model: psychological factors must interact with a pre-existing biological vulnerability to the disease in order for the disease to be developed o Indirect effects model: psychological factors affect disease largely by influencing whether people engage in health promoting behaviours; diets, smoking, exercise can influence health related behaviour that causes vulnerability • Coronary heart disease: occurs when blood vessels that supply the heart muscles are narrowed or closed by the gradual build-up of plaque (hard, fatty substance), blocking the flow of oxygen and nutrients to the heart; can lead to angina pectoris (pain across chest and arm); when oxygen in the heart is completely blocked, it can cause a myocardial infarction (heart attack); leading cause of death and chronic illness in Canada (36% of all deaths); people in chronically stressed environments at increased risk • Hypertension: high blood pressure; condition in which supply of blood through the vessels is excessive, putting pressure on vessel walls; chronic HBP can cause hardening of arterial walls and deterioration of cell tissue, leading to CHD, kidney failure and stroke; approx. 22% of Canadians have this; more chronically stressful circumstances increase chances of getting hypertension; ethnic differences (more African-Americans in US); genetics plays some role in predisposition (10% of all cases) • Immune system: protects the body from disease causing microorganisms; affects our susceptibility to infections, diseases, allergies, cancers and autoimmune disorders; common events (exams, storms) linked to deficits; affected by negative interpersonal events; perceptions of control related to progression of diseases like cancer and AIDS o Psychoneuroimmunology: study of effects of psychological factors on functioning of immune system; some of the bio-chemicals released as part of flight/fight response may suppress immune system o Lymphocytes: cells of immune system that attack viruses; suppressed in animals that have been exposed to stressors (especially uncontrollable ones)  T-cells: lymphocytes that secrete chemicals that kill harmful cells; multiply more strongly when shock can be controlled Sleep and health • Current sleep statistics: 20% of Canadian population suffers from common insomnia; average night’s sleep time declined by 20% over past century; dangers of auto accidents, fatigued workers, family dysfunction; most young adults sleep 7.5 hours or less per day; middle aged adults get <7 hours; rotating shift workers or jobs with long periods of activity are chronically sleep deprived and accumulate sleep debt • Sleep deprivation: impairs immune system; 70% higher mortality rate and higher rates of illness; cognitive impairments (logical reasoning, verbal processing, decision making); irritability, emotional instability and perceptual distortions; sleep helps us feel more in control (can cope better with stress) • Sleep disorders: four general types recognized by DSM-IV-TR o Related to another mental disorder: directly attributable to psychological disorders like depression and anxiety o Due to a general medical condition: result from physiological effects of a medical condition, like neurological illnesses (Parkinson’s), endocrine conditions and pulmonary diseases o Substance-induced: due to use of substances including prescription medication (such as those that control hypertension or cardiac arrhythmias) and non prescription substances (ex: alcohol and caffeine) o Primary sleep disorders: further subdivided into dyssomnias and parasomnias; condition must not be due to general medical condition/substance abuse and must cause significant impairment in functioning to be diagnosed • Dyssomnias: abnormalities in amount, timing or quality of sleep o Primary insomnia: difficulty initiating or maintaining sleep, or non- restorative sleep, for at least 1 month; cycle as stress from not being able to sleep makes you less able to sleep; arousal conditioned to surroundings; occasional problems very common (50% of adults report it sometime in life); chronic in 20% of population; most reliably effective medications are benzodiazepines and zolpidem (Ambien); CBT interventions highly effective and longer lasting (though take longer to begin working than drugs)  Stimulus control therapy: set of instructions designed to curtail behaviours that might interfere with sleep and regulate sleep-wake schedules (ex: don’t nap during the day; don’t work in bedroom)  Sleep restriction therapy: initially restricts amount of time insomniacs can try to sleep in the night; once sleep is more efficient, they can spend more time in bed till they reach greatest total amount of sleep while maintaining efficiency; relaxation techniques o Hypersomnia: excessive sleepiness for at least one month, as evidenced by either prolonged sleep episodes or daytime sleep episodes that occur almost daily; wake up un-refreshed o Narcolepsy: irresistible attacks of refreshing sleep that occur daily over at least three months plus either episodes of sudden loss of muscle tone (cataplexy) or recurrent intrusions of elements of REM sleep (intense dreamlike imagery and sense of paralysis); <0.05% of population have it o Breathing related: sleep disruption leading to excessive sleepiness or insomnia due to a sleep related breathing condition  Sleep apnea: repeated episodes of airway obstruction during sleep; snore loudly, go silent, do not breathe and then gasp for air; most common in overweight, middle-aged men and children with enlarged tonsils; 10% of population o Circadian rhythm: sleep disruption leading to excessive sleepiness or insomnia due to a mismatch between sleep-wake schedule required by environment and circadian sleep-wake pattern • Parasomnias: abnormal behaviour and physiological events occurring during sleep; typically quite rare though occasional problems with symptoms common o Nightmare disorder: repeated awakenings with detailed recall of extended and frightening dreams, usually involving threats to survival, security or self-esteem; on awakening, person is alert and oriented o Sleep terror disorder: repeated abrupt awakenings beginning with a panicky scream; intense fear and signs of autonomic arousal; relative unresponsiveness to the efforts of others to comfort the person; no detailed dream is recalled; amnesia for the episode o Sleepwalking disorder: related episodes of rising from the bed during sleep and walking about; while sleepwalking, the person has a blank, staring face, is relatively unresponsive to others, and can be awakened only with great difficulty; on awakening, person has amnesia for the episode; within several minutes after waking, there s no impairment of mental activity or behaviour, although there may initially be a short period of confusion and disorientation Personalit
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