Comprehensive Stress and PTSD: Definitions, Systems, and Treatments

What is stress?

Challenges to physical or emotional well-being that exceed coping resources; stressors are external demands, stress is the effect they create.

Eustress:

Moderate stress that can be beneficial (personal growth, learning new skills)

Distress:

Harmful stress that can damage physical or mental health.

What are coping strategies?

Efforts used to manage stress, which can be adaptive or maladaptive.

When does a crisis occur in response to stress?

When distress exceeds a person's coping capacity.

What key characteristics of stressors affect coping?

Severity, chronicity, timing, impact on life, predictability, and controllability

what is resilience?

he most common reaction to stress/trauma; ability to recover from stress.

Factors associated with resilience?

Older age, higher education, economic resources, optimistic outlook, self-confidence.

What is allostatic load?

Biological "cost" of adapting to stress.

Sympathetic-adrenomedullary (SAM) system:

Fight-or-flight activation

Hypothalamus-pituitary-adrenal (HPA) system:

Releases cortisol for prolonged stress response.

What does cortisol do?

Prepares the body for fight-or-flight; elevates blood sugar; sustains prolonged activity but suppresses immunity.

What is psychoneuroimmunology?

Study of interactions between the nervous system and the immune system.

how does stress affect the immune system?

Can cause stress-induced immunosuppression, impairing immune function and healing.

What are lymphocytes?

White blood cells crucial for adaptive immunity

B-Cells:

Mature in bone marrow.

T-Cells:

Mature in thymus.

Antigens:

unique markers on pathogens or tumors.

Antibodies:

Immune system "nametags" to recognize and fight antigens

What are cytokines?

Chemical messengers of the immune system

Proinflammatory (IL-1, IL-6, TNF):

Promote inflammation; essential for healing

Anti-inflammatory (IL-4, IL-10, IL-13):

Reduce immune response.

How does chronic stress affect inflammation?

Impairs immune regulation, increases chronic inflammation, increasing risk for diabetes, heart disease, asthma, osteoporosis.

How does stress affect aging?

Shortens telomeres, leading to premature aging; exercise can buffer effects.

Type A:

Competitive, impatient, hostile (hostility most predictive)

Type D:

distressed, anxious, socially inhibited.

How does depression affect physical health?

linked to immune disruption, shorter telomeres, higher risk of heart disease; mind-body connection is bi-directional.

How does anxiety affect health?

Phobic anxiety is linked to higher risk of sudden cardiac death.

How does social support impact health?

Emotional support reduces risk and improves outcomes in coronary heart disease.

Which positive emotions benefit health?

Humor, gratitude, kindness, compassion, and forgiveness—buffer against stress effects.

What is emotion regulation?

ability to manage emotions; poor regulation (e.g., anger) increases heart problems

What biological interventions help stress-related physical disorders?

Treating depression with SSRIs reduces cardiac events.

Emotional disclosure:

Writing about problems can improve health.

Biofeedback:

Awareness of physiological responses to control stress.

Relaxation & meditation:

Reduce blood pressure, tension headaches.

Cognitive-Behavioral Therapy (CBT)

Effective for pain, headaches, and arthritis.

What is Adjustment Disorder?

Maladjustment to a major stressor within 3 months; symptoms disappear when stressor ends or adaptation occurs.

What is a traumatic event per DSM-5?

Exposure to actual/threatened death, serious injury, or sexual violence:

Direct experience

Witnessing in person

Learning of a loved one's sudden death

Repeated/extreme exposure to details (e.g., first responders)

What is PTSD?

Persistent posttraumatic stress reactions lasting 1+ month causing significant life impairment.

Intrusion:

1+ (flashbacks, nightmares, trauma reminders)

Avoidance:

1+ (avoid thoughts/places/people)

Negative alterations in cognition & mood:

2+ (guilt, detachment, inability to feel happiness, dissociative amnesia)

Arousal/reactivity:

2+ (hypervigilance, startle, aggression, sleep/concentration problems)

What is Acute Stress Disorder?

PTSD-like symptoms lasting 3+ days but <1 month; may evolve into PTSD if persistent.

What are risk factors for PTSD? Individual

Past trauma, personality, coping skills

What are risk factors for PTSD? Biological

Sex, genetics (5HTTLPR), hippocampal size

What are risk factors for PTSD? Sociocultural

Minority status, socioeconomic inequalities, unsupportive environment

PTSD prevalence in the U.S.?

Lifetime prevalence ~6.8%; higher rates in women.

How can PTSD be prevented?

Reduce exposure to trauma, psychological preparedness, stress-inoculation training.

Treatment approaches for PTSD?

Hotlines & crisis intervention

Psychological debriefing

Medications: SSRIs, SNRIs

Cognitive-behavioral therapies

cognitive-behavioral therapies: Prolonged explosure

cognitive-behavioral therapies: EMDR

cognitive-behavioral therapies:

Prolonged exposure, EMDR, Cognitive Processing Therapy

What is the cognitive difference between fear and anxiety?

Fear: "I am in danger right now!"Anxiety: "Something terrible might happen in the future."

What is the physiological difference between fear and anxiety?

Fear: Increased heart rate, sweating, fight/flight/freeze, panic.Anxiety: Tension, chronic arousal, somatic complaints.

what is the behavioral difference between fear and anxiety?

Fear: Escape or eliminate threat.Anxiety: Avoidance, worrying.

What is a panic attack?

Sudden rush of intense fear/discomfort peaking within minutes, with 4+ physical or psychological symptoms.

Name some common panic attack symptoms.

Heart rate increase, sweating, shortness of breath, nausea, dizziness, numbness, dissociation, fear.

Name 5 core features shared by anxiety disorders.

: Unrealistic fears, distress/impairment, insight varies, high comorbidity, biological/psychological/sociocultural risk factors

Name 3 biological factors common to anxiety disorders.

Weak to moderate genetic influence, limbic system involvement, neurotransmitters (GABA, norepinephrine, serotonin).

Name 3 psychological factors common to anxiety disorders.

Neuroticism, perceived helplessness, intolerance of uncertainty, anxiety sensitivity, distress intolerance

What behavioral factor maintains anxiety?

Avoidance or escape behaviors, safety behaviors, reinforced through negative reinforcement.

Name evidence-based treatments for anxiety disorders.

Behavioral therapy (exposure), CBT (cognitive restructuring + exposure), medications (anxiolytics for immediate relief, antidepressants for long-term effects).

What defines a specific phobia?

strong, persistent (6+ months) fear/distress recognized as excessive, triggered by a specific object or situation

What is the cardinal feature of specific phobias?

Avoidance of or escape from the feared stimulus.

Name the DSM-5 subtypes of specific phobias.

Animal, natural environment, blood-injection-injury, situational, other.

What is the primary treatment for specific phobias?

exposure therapy.

What types of social situations trigger SAD?

Performance (public speaking), nonperformance (being observed), social interactions (conversations), generalized (both).

What early-life factor predicts SAD in middle childhood?

Behavioral inhibition in pediatric children.

Lifetime prevalence and gender ratio for SAD?

~12%; more common in females.

evidence-based treatment for SAD?

CBT and/or antidepressants.

What defines panic disorder?

Recurrent unexpected panic attacks, persistent worry about attacks, and/or maladaptive behaviors to avoid attacks.

What is the "panic circle"?

: Interoceptive/exteroceptive avoidance, safety behaviors, and attributions that maintain panic.

How is agoraphobia defined?

Fear of places/situations where escape might be difficult or help unavailable.

Treatments for panic disorder and agoraphobia?

Exposure therapy, CBT, medications.

What defines GAD?

Chronic, excessive worry about multiple life domains for ≥6 months, with ≥3 associated symptoms (1 in children).

List the 6 DSM-5 symptoms of GAD.

Restlessness, fatigue, impaired concentration, irritability, muscle tension, sleep disturbance.

Typical psychological features of GAD?

Future-oriented rumination, low tolerance of uncertainty, cognitive avoidance, checking, reassurance-seeking, procrastination.

Gender prevalence for GAD?

Females > males.

Evidence-based treatment for GAD?

CBT and/or antidepressants.

Name neurotransmitters implicated in anxiety disorders.

GABA, norepinephrine, serotonin.

How do cultural perspectives affect anxiety expression?

Anxiety disorders manifest differently across cultures (e.g., Taijin kyofusho in Japan, Koro in China).