Understanding Stress and its Effects

• Stress is experiencing events that are perceived as endangering one’s wellbeing.
• Stressors are the events that cause stress.
• Stress responses are people’s reactions to stressors.
• Stress reaction is adaptive for fight or flight responses.
• Stress reaction is maladaptive when a stressor is chronic or uncontrollable.
• Stress can have both direct and indirect effects on health.
• Stressful events include major changes affecting large numbers of people, major changes in the life of an individual, and daily hassles.
• Stressful events can be acute or chronic.

Types of Stressful Events

• Traumatic events.
• Uncontrollable events.
• Unpredictable events.
• Major changes in life circumstances.
• Internal conflicts.

Psychological Reactions to Stress

• Anxiety.
• Anger and aggression.
• Apathy and depression.
• Cognitive impairment.

Physiological Reactions to Stress

• Increased metabolic rate.
• Increased heart rate.
• Dilation of pupils.
• Higher blood pressure.
• Increased breathing rate.
• Tensing of muscles.
• Secretion of endorphins and ACTH.
• Release of extra sugar from the liver.

Anxiety

• Anxiety is the most common response to a stressor.
• People who live through events beyond the normal range of human suffering sometimes develop PTSD.

PTSD

• PTSD follows a traumatic event.
• PTSD involves deep detachment from everyday life (numbness).
• PTSD involves repeated reliving of the trauma.
• PTSD involves sleep disturbances, difficulty concentrating, and over-alertness (hyperarousal).
• PTSD involves avoidance of everything that reminds one of the trauma.
• Survivor guilt is feeling guilty about surviving a trauma when others did not.

PTSD Epidemiology

• The lifetime incidence of PTSD is estimated to be 9 to 15 percent.
• The lifetime prevalence of PTSD is estimated to be about 8 percent of the general population.
• An additional 5 to 15 percent may experience subclinical forms of PTSD.
• Among high-risk groups who experienced traumatic events, the lifetime prevalence rates range from 5 to 75 percent.
• The lifetime prevalence ranges from about 10 to 12 percent among women and 5 to 6 percent among men.
• PTSD is most prevalent in young adults because they tend to be more exposed to precipitating situations.
• Children can also have PTSD.
• A higher proportion of women go on to develop PTSD.
• Historically, men's trauma was usually combat experience, and women's trauma was most commonly assault or rape.
• PTSD is most likely to occur in those who are single, divorced, widowed, socially withdrawn, or of low socioeconomic level.
• The most important risk factors for PTSD are the severity, duration, and proximity of a person's exposure to the actual trauma.
• A familial pattern seems to exist for PTSD.
• First-degree biological relatives of persons with a history of depression have an increased risk for developing PTSD following a traumatic event.

PTSD Comorbidity

• Comorbidity rates are high among patients with PTSD, with about two thirds having at least two other disorders.
• Common comorbid conditions include depressive disorders, substance-related disorders, other anxiety disorders, and bipolar disorders.
• Comorbid disorders make persons more vulnerable to developing PTSD.

Predisposing Vulnerability Factors in PTSD

• Presence of childhood trauma.
• Borderline, paranoid, dependent, or antisocial personality disorder traits.
• Inadequate family or peer support system.
• Being female.
• Genetic vulnerability to psychiatric illness.
• Recent stressful life changes.
• Perception of an external locus of control rather than an internal one.
• Recent excessive alcohol intake.

PTSD Biological Factors

• Data have supported hypotheses that the noradrenergic and endogenous opiate systems, as well as the HPA axis, are hyperactive in at least some patients with PTSD.
• Other major biological findings are increased activity and responsiveness of the autonomic nervous system.
• Evidenced by elevated heart rates and blood pressure readings and by abnormal sleep architecture.
• Some researchers have suggested a similarity between PTSD and major depressive disorder and panic disorder.

Anger & Aggression

• Frustration – aggression hypothesis.
• Direct aggression.
• Displaced aggression.

Apathy & Depression

• The theory of learned helplessness (Seligman, 1975).

Cognitive Impairment

• Cognitive impairment involves difficulty in concentration, difficulty to organize thoughts logically, and easy distractibility which may lead to deterioration in task performance.
• Cognitive impairment comes from high level of emotional arousal which interferes with processing of information, and distracting thoughts that go through head when facing a stressor.

Physiological Reaction

• The fight-or-flight response is the body’s mobilization to attack or flee from a threatening situation.
• The hypothalamus is called the brain’s stress center.
• The hypothalamus has dual action of activation of the sympathetic division of the autonomic nervous system, and activation of the adrenal-cortical system which signals the pituitary to secrete ACTH the body’s major stress hormone.
• ACTH stimulates adrenal cortex which secrete cortisol and stimulate other endocrine glands to release about 30 hormones.

The General Adaptation Syndrome

• Hans Selye (1978).
• General adaptation syndrome is a set of responses that is displayed by all organisms in response to stress.
• It has three phases: alarm, resistance, and exhaustion.
• Alarm is when the body mobilizes to confront a threat by triggering sympathetic nervous system activity.
• Resistance is when the organism attempts to cope with the threat by fleeting it or fighting it.
• Exhaustion occurs if the organism is unable to flee from or fight the threat and depletes its physiological resources in attempting to do so.

How Stress Affects Health

• Emotional stress plays an important role in more than half of all medical problems.
• Chronic stress can lead to physical disorders such as ulcers, high blood pressure, and heart disease.
• Stress impairs the immune system.
• Psycho-physiological (psychosomatic) disorders are physical disorders in which emotions are believed to play a central role.
• Examples of psycho-physiological disorders include asthma, hypertension, ulcers, colitis, and rheumatoid arthritis.

Health-Related Behaviors

• Certain health-related behaviors can greatly increase our susceptibility to illness:
• Smoking.
• High-fat diet.
• No exercise.
• Excessive alcohol consumption.
• Unhealthy sexual behavior.
• Most of diseases people die from are heavily influenced by health-related behaviors.
• When we are stressed, we may be less likely to engage in healthy behaviors.