comerfund9e_lectureslides_ch05.pptx

Dis s of Trauma and Stress
Chapter 5
Fundamentals of Abnormal Psychology
RONALD J. COMER | JONATHAN S. COMER| ninth edition

Stress and Arousal (part 1)
Components of stress
Stressor
Event that creates demands
Causes fear when viewed as threatening
Stress response
Person’s reactions to demands
Extraordinary stress and trauma
Can play a central role in certain psychological dis s

Fear is a “package” of responses that are physical, emotional, and cognitive.
People who experience a large number of stressful events are particularly vulnerable to the onset of anxiety and other psychological dis s.

_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Stress and Arousal (part 2)
Stress and psychological dis s
Acute stress dis
Posttraumatic stress dis (PTSD)
DSM-5 lists these as “trauma and stressor-related dis s”
Stress and physical (psychophysiological) dis s
DSM-5 lists these under “psychological factors affecting medical condition”

Stress and Arousal: The Fight-or-Flight Response (part 1)
Features of arousal and fear are set in the hypothalamus
Two important systems are activated
Autonomic nervous system (ANS)
An extensive network of nerve fibers that connect the central nervous system (the brain and spinal cord) to all other organs of the body
Endocrine system
A network of glands throughout the body that release hormones

_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

The Autonomic Nervous System (ANS)

When the sympathetic division of the ANS is activated, it stimulates some organs and inhibits others. The result is a state of general arousal. In contrast, activation of the parasympathetic division leads to an overall calming effect.
Sympathetic nervous system: The nerve fibers of the autonomic nervous system that quicken the heartbeat and produce other changes experienced as arousal.
Parasympathetic nervous system: The nerve fibers of the autonomic nervous system that help return bodily processes to normal.
_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Stress and Arousal: The Fight-or-Flight Response (part 2)
Two pathways by which ANS and the endocrine system produce arousal and fear reactions
Sympathetic nervous system pathway
Hypothalamic-pituitary-adrenal pathway

The Endocrine System: The HPA Pathway
When we face a dangerous situation, the hypothalamus first excites the sympathetic nervous system, which stimulates key organs either directly or indirectly.
When the perceived danger passes, the parasympathetic nervous system helps return body processes to normal.
The reactions on display in these two pathways are collectively referred to as the fight-or-flight response.
Each person has a particular pattern of autonomic and endocrine functioning and, therefore, a particular way of experiencing arousal and fear.
Hypothalamic-pituitary-adrenal pathway: The hypothalamus signals the pituitary gland, which stimulates the adrenal cortex to release corticosteroids (stress hormones) into the bloodstream.

_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Acute and Posttraumatic Stress Dis s (part 1)
Acute stress dis
Symptoms begin within four weeks of event and last for less than one month
Posttraumatic stress dis (PTSD)
Symptoms may begin either shortly after event, or months or years afterward
As many as 80 percent of all cases of acute stress dis develop into PTSD

Lingering impact More than four decades after the Vietnam War, over a quarter million veterans of that war are still suffering from PTSD. Until his death in 2016, one such veteran was King Charsa Bakari Kamau. He is seen here playing the piano at a mall in Denver, Colorado, an avocation that he considered to be his best therapy.
During and immediately after trauma, we may temporarily experience levels of arousal, anxiety, and depression. For some, symptoms persist well after the trauma. These people may be suffering from:
Acute stress dis
Posttraumatic stress dis (PTSD)
The precipitating event usually involves actual or threatened serious injury to self or others. The situations that cause these dis s would be traumatic to anyone (unlike other anxiety dis s).

_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Acute and Posttraumatic Stress Dis s (part 2)
Aside from differences in onset and duration, symptoms of acute stress dis s and PTSD are almost identical
Increased arousal, anxiety, and guilt
Reexperiencing the traumatic event
Avoidance
Reduced responsiveness and dissociation

_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Acute and Posttraumatic Stress Dis s (part 3)
Checklist
A person is exposed to a traumatic event—death or threatened death, severe injury, or sexual violation
A person experiences at least one of the following intrusive symptoms:
Repeated, uncontrolled, and distressing memories
Repeated and upsetting trauma-linked dreams
Dissociative experiences such as flashbacks
Significant upset when exposed to trauma-linked cues
Pronounced physical reactions when reminded of the event(s)

Acute and Posttraumatic Stress Dis s (part 4)
Checklist (continued)
The person continually avoids trauma-linked stimuli
The person experiences negative changes in trauma-linked cognitions and moods, such as being unable to remember key features of the event(s) or experiencing repeated negative emotions
The person displays conspicuous changes in arousal or reactivity, such as excessive alertness, extreme startle responses, or sleep disturbances
The person experiences significant distress or impairment, with symptoms lasting more than a month

Acute and Posttraumatic Stress Dis s
(part 5)
Can occur at any age and affect all aspects of life
Affect at least 3.5 percent of people in the United States each year
More common among women (2:1) and people with low incomes
Two-thirds of affected people seek treatment at some point
More likely to be caused by some event—combat, disasters, abuse, and victimization

Approximately 7 to 9 percent of people in the United States are affected sometime during their lifetime.
After trauma, approximately 20 percent of women and 8 percent of men develop dis s.

_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Acute and Posttraumatic Stress Dis s (part 6)
Triggers
Combat
Disasters and accidents
Victimization
Sexual assault and rape
Terrorism
Torture

Combat and stress dis s are called “shell shock” or “combat fatigue.”
Post–Vietnam War clinicians discovered that soldiers also experienced psychological distress after combat.
As many as 29 percent of Vietnam combat veterans suffered acute or posttraumatic stress dis s.
An additional 22 percent had some stress symptoms.
Some 10 percent are still experiencing problems.
A similar pattern is currently unfolding among 2.7 million veterans of wars in Afghanistan and Iraq.

Acute or posttraumatic stress dis s may also follow natural and accidental disasters.
Types of disasters include earthquakes, floods, tornadoes, fires, airplane crashes, and serious car accidents.
Because they occur more often, civilian traumas have been implicated in stress dis s at least 10 times as often as combat traumas.

Victimization and stress dis s:
People who have been abused or victimized often experience lingering stress symptoms.
Research suggests that more than one-third of all victims of physical or sexual assault develop PTSD.

Terrorism and torture:
The experience of terrorism or the threat of terrorism often leads to posttraumatic stress symptoms, as does the experience of torture.

_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Acute and Posttraumatic Stress Dis s (part 7)
Why do people develop acute and posttraumatic stress dis s?
Biological factors
Childhood experiences
Personal styles
Social support systems
Severity and nature of the traumas
Let’s take a look at each of these.

_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Acute and Posttraumatic Stress Dis s (part 8)
Why do people develop acute and posttraumatic stress dis s?
Biological factors
Brain–body stress pathways
Brain’s stress circuit
Inherited predisposition
Childhood experiences
Chronic neglect or abuse
Poverty
Parental separation or divorce
Catastrophe
Family members with psychological dis s

Some research suggests abnormal neurotransmitter and hormone activity (especially norepinephrine and cortisol).
Once a stress dis sets in, further biochemical arousal and damage may also occur (especially in the hippocampus and amygdala).
There may be a biological/genetic predisposition to such reactions.

Researchers have found that certain childhood experiences increase risk for later stress dis s.
Risk factors:
An impoverished childhood
Psychological dis s in the family
The experience of assault, abuse, or catastrophe at an early age
Being younger than 10 years old when parents separated or divorced

_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Acute and Posttraumatic Stress Dis s (part 9)
Why do people develop acute and posttraumatic stress dis s?
Personal styles
Preexisting high anxiety and negative worldview versus resiliency and positive attitudes
Social support systems
Weak family and social support systems

Some studies suggest that people with certain personalities, attitudes, and coping styles are particularly likely to develop stress dis s.
Risk factors:
Preexisting high anxiety
Negative worldview
A set of positive attitudes (called resiliency or hardiness) is protective against developing stress dis s.

_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Acute and Posttraumatic Stress Dis s (part 10)
Why do people develop acute and posttraumatic stress dis s?
Severity and nature of the trauma
More severe or prolonged trauma
More direct exposure to trauma
Intentionally inflicted trauma
Mutilation, severe physical injury, or sexual assault

_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Acute and Posttraumatic Stress Dis s (part 11)
Why do people develop acute and posttraumatic stress dis s?
Developmental psychopathology perspective
Timing of stressors and traumas over developmental course and
Inherited or acquired biological predisposition for overreactivity in brain–body stress pathways and dysfunction in brain stress circuit
Principles of multifinality and equifinality

_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Acute and Posttraumatic Stress Dis s (part 12)
How do clinicians treat acute and posttraumatic stress dis s?
About half of all cases of PTSD improve within 6 months; the remainder may persist for years
Treatment procedures vary depending on the type of trauma
General goals
End lingering stress reactions
Gain perspective on painful experiences
Return to constructive living

Acute and Posttraumatic Stress Dis s (part 13)
How do clinicians treat acute and posttraumatic stress dis s?
Combat veterans
Antidepressant drugs
Cognitive-behavioral therapy
Cognitive processing therapy
Mindfulness-based techniques
Exposure techniques; prolonged exposure
Eye movement desensitization and reprocessing (EMDR)
Couple or family therapy
Group therapy
Combination of some of the above

_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

MindTech: Virtual Reality Therapy: Better Than the Real Thing?
Exposure-based treatment is the best intervention for people with PTSD
Earlier treatment: In vivo exposure more effective than covert exposure
Today: Virtual reality exposure now standard in PTSD treatment
Virtual reality therapy is becoming more common in treatment of other anxiety dis s and phobias

“Virtual” exposure: Back to a battle scene in Iraq
Exposure-based therapy may be the single most helpful intervention for people with PTSD.
In virtual reality therapy, clients use wraparound goggles and joysticks to navigate their way through a computer-generated military convoy, battle, or bomb attack in a landscape that looks like Iraq or Afghanistan.

_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Acute and Posttraumatic Stress Dis s (part 14)
How do clinicians treat acute and posttraumatic stress dis s?
Couple or family therapy
Counseling for spouses and children
Group therapy
Rap groups
Individual counseling
Combination of some of the above

_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Acute and Posttraumatic Stress Dis s (part 15)
How do clinicians treat acute and posttraumatic stress dis s?
Psychological debriefing (critical incident stress debriefing)
Crisis intervention in which victims of trauma talk extensively about their feelings and reactions within days of the critical incident
Unsupported in research

_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Dissociative Dis s (part 1)
Group of dis s triggered by traumatic events
When such changes in memory lack a clear physical cause, they are called “dissociative” dis s
One part of the person’s memory typically seems to be dissociated, or separated, from the rest

The key to our identity—the sense of who we are and where we fit in our environment—is memory.
Our recall of past experiences helps us to react to present events and guides us in making decisions about the future.
People sometimes experience a major disruption of their memory:
They may not remember new information.
They may not remember old information.
Dissociative symptoms are often found in cases of acute or posttraumatic stress dis s.
When such symptoms occur as part of a stress dis , they do not necessarily indicate a dissociative dis (a pattern in which dissociative symptoms dominate).

_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Dissociative Dis s (part 2)
Kinds of dissociative dis s
Dissociative amnesia
Dissociative fugue
Dissociative identity dis (multiple personality dis )
Subpersonalities
Alternate personalities

Managing without memory Andy Wray developed dissociative amnesia after witnessing several horrific deaths in his work as a policeman. His dis is marked by continuous forgetting. Every few days, many of his new memories disappear, leaving him unable to recognize friends, relatives, and events in any detail. To help him get on with his life, he uses countless notebooks and reminder cards like the ones he is looking at here.

_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Dissociative Dis s (part 3)
Dissociative amnesia
Inability to recall important information, usually of an upsetting nature, about one’s life
Memory loss much more extensive than normal forgetting and is not caused by physical factors
Often the amnesia episode is directly triggered by a specific upsetting event

Dissociative Dis s (part 4)
Checklist
Dissociative amnesia
Person cannot recall important life-related information, typically traumatic or stressful information. The memory problem is more than simple forgetting.
Leads to significant distress or impairment
Symptoms are not caused by a substance or medical condition
Dissociative identity dis
Person experiences a disruption to his or her identity, as reflected by at least two separate personality states or experiences of possession
Person repeatedly experiences memory gaps regarding daily events, key personal information, or traumatic events, beyond ordinary forgetting
Leads to significant distress or impairment
Symptoms are not caused by a substance or medical condition

Information from APA, 2013.
_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Dissociative Dis s (part 5)
Dissociative amnesia
Localized: Most common type; loss of all memory of events occurring within a limited period
Selective: Loss of memory for some, but not all, events occurring within a period
Generalized: Loss of memory beginning with an event, but extending back in time; may lose sense of identity; may fail to recognize family and friends
Continuous: Forgetting continues into the future; quite rare in cases of dissociative amnesia

All forms of the dis are similar in that the amnesia interferes mostly with a person’s memory.
Memory for abstract or encyclopedic information usually remains intact.
Clinicians do not known how common dissociative amnesia is, but many cases seem to begin with serious threats to health and safety.

…