Trauma and Stress Disorder

Stress, Coping and the anxiety response  

  • The state of stress has 2 components  

  • Stressor – event that creates demands  

  • Stress response – person’s reactions to the demands 

  • Influenced by how we judge the events and our capacity to react to them effectlively  

  • People sense that they have the ability and ressources to cope are more likely to takes stressors in stride and respond well  

  • Problem that money could solve are not real problem  

  • When we view a stressor as threatening, the natural reaction is arousal and anxious and often at play in psychological disorders 

  • People who experience a large number of stressful events are particularly vulnerable to the onset of anxiety and other psychological disorders (Diathesis-stress model)  

  • Stress also play a more central role in certain psychological stress disorders including  

  • Acute stress disorder  

  • Posttraumatic stress disorder (PTSD) 

  • Technically, DSM-5 lists these patterns within a group called “trauma- and stressor-related disorders” 

  • These disorders are triggered by traumatic stressors and 
    include symptoms such as heightened arousal, anxiety, 
    and mood disturbance, and memory difficulties 

  • The physical disorders of stress are typically called psychophysiological disorders disorder 

  • These disorders are listed in DSM-5 under 
    “psychological factors affecting medical condition” 

  • Here, significant stressors set in motion an interaction of 
    biological, psychological, and sociocultural factors to 
    help produce or worsen a physical illness. 

 

Stress and Arousal : The fight-or-flight response  

  • There are two pathways, or routes  

  • Autonomic nervous system (ANS)  

  • Hypothalamic-pituitary-adrenal (HPA)  
     

  • HPA axis  

  • Hypothalamic-pituitary-adrenal axis (also HTPA) 

  • Fight or flight response (1932) (Walter Bradford Cannon)  

  • The autonomic nervous system 

  • The second pathway is the hypothalamic- 
    pituitary-adrenal (HPA) pathway 

  • When we are faced by stressors, the hypothalamus 
    signals the pituitary gland, which stimulates the 
    adrenal cortex to release a group of corticosteroids – 
    stress hormones – into the bloodstream (e.g., 
    cortisol) 

  • The endocrine system  

  • Hypothalmus --> pituinary gland --> secretion of ACTH (adrenocoricotropic homrone) --> adrenal cortex –> corticosteroids. 

  • Pathways of arousal and fear  

 

  • People differ in  

  • Their general level of arousal and anxiety  

  • Called trait anxiety  

  • Some poeple are usually somewhat tense ; others are usually relaxed  

  • Differences appear soon after birth  

  • Their sense of which situation are threatening  

  • Called “ situation /state anxiety”  

  • Situation-based  

Trauma and stressor Related disorder  

  • During and immediately after trauma, we are temporarily aroused, anxious, and depressed  

  • For some symptoms persist well after the trauma  

  • These people may be suffering from  

  • Acute stress disorder  

  • Symptoms begin within 4 weeks of event and last for less than a month  

  • Posttraumatic stress disorder (PTSD)  

  • Symptoms may begin eother shortly after the event or months or years afterwards  

  • At least helf og all cases of acute stress disorder develop into PTSD  

  • The event usually involves actual or threatened serious injury to self or others  

  • The situation that cause these disorders would be traumatic to anyone  

  • Aside from the differences in onset and 
    duration, the symptoms of acute stress disorders 
    and PTSD are almost identical: 

  • Reexperiencing the traumatic event (flashback) 

  • Avoidance  

  • Reduce responsiveness (dissociative symptoms)  

  • Increase arousal anxiety and guilt  

  • What trigger a trauma and stressor related disorder  

  • Ratio of women to men is 2:1 

  • People with low income are twice as likely as people with higher incomes to experience one of the stress disorder  

  • Some event –  

  • combats,  

  • During and after combat  

  • As many as 29% of Vietnam combat veteran suffered acute or PTSD 

  • Another 22% has at least some stress symptoms  

  • Similar pattern is currently unfolding with veteran of Afghanistan and Iraq wars  

  • disaster  

  • Follows natural and accidental disaster  

  •  victimization  

  • Ongoing victimization and abuse in the family may also lead to stress disorders and other disorders  

  • Terrorism, torture, and stress disorder 

  • The experience of terrorism or the threat of terrorism often leads to posttraumatic stress symptoms, as does the experience of torture  

  • Why do people develop a trauma and stressor-related disorder  

  • Clearly, trauma can cause a stress disorder  

  • However, the event alone may not be the entire explanation  

  • To understand the development of these disorders, researchers have looked to the : 

  • Severity of the traumas 

  • Generally, the more severe the trauma and the more direct one’s exposure to it, the greater the likelihood of developing a stress disorder 

  • Especially risky: mutilation and severe injury (self-experienced);  

  • Witnessing the injury or death of others (modelling)  

  • Survivors' biological processes 

  • Traumatic events trigger physical changes in the brain and body that may lead to severe stress reactions and, in some cases, to stress disorders  

  • Abnormal neurotransmitter and hormone activity (norepinephrine and cortisol)  

  • Stress disorder is set it may arouse and make more damage on the hippocampus and amygdala  

  • May have some biological predisposition 

  • Personalities  

  • Some people with certain personalities and coping style are more likely to develop stress disorder  

  • Risk factors  

  • High anxiety (high trait ands state anxiety )  

  • Negative worldview  

  • Resiliency or hardiness is protective against developing stress disorder  

  • Childhood experiences 

  • Certain childhood experiences increase risk for later stress disorders  

  • An impoverished childhood  

  • Psychological disorders in the family  

  • The experience of assault, abuse, or catastrophe at an early age  

  • Being 10 years or younger when parents break up  

  • Social support systems  

  • People whose social support systems are weak are more likely to develop a stress disorder after a traumatic event  

  • How do clinician treat the trauma and stressor-related disorder  

  • 33% of PTSD cases improve within a year; the remainder may persist for years  

  • Treatment procedures vary depending on type of trauma  

  • General goals  

  • End lingering stress reaction  

  • Gain perspective on painful experience  

  • Return to constructive living  

  • Treatment  

  • Drug therapy 

  • Antianxiety and antidepressant medication are most common 

  • Behavioral exposure 

  • Reduce specific symptoms, increase overall adjustment  

  • Use exposure and relaxation training  

  • Eye movement desensitization and reprocessing (EMDR)  

  • Insight/cognitive therapy  

  • Bring out deep-seated feelings, create acceptance, lessen guilt  

  • Rap groups  

  • Facilitating trauma recovery through provision of support from individual who had experienced the same type of trauma  

  • Psychological debriefing  

  • Form of crisis intervention that has victims of trauma talk extensively about their feeling and reactions within days of the critical incident  

  • Four stage approach  

  • Normalize response to the disaster  

  • Encourage expression of anxiety, anger and frustration  

  • Teach self-help skills  

  • Provide referrals 

  • Approach has come under careful scrutiny  

  • High-risk individuals may profit form debriefing programs but that others shouldn’t receive such interventions  

  • What is the need  

  • Scientific knowledge of the interrelationships among cognitive, behavioral, biological, emotional, and social components in health and disease