Chapter 5 Stress and Adjustment Disorders Stressors - environmental obstacles that place demands on us and lead to stress. Stress – the organism’s response to a stressor, the result of inadequate coping. Coping strategies – ways of dealing with stressors Eustress – stress caused by positive experiences [e.g., a wedding, or a promotion]. Distress – stress caused by “negative” events [e.g., losing one’s job]. Both eustress and distress tax resources and coping abilities but DISTRESS is potentially more harmful. Three types of stressors:  Frustrations, occur when progress towards a goal is impeded or blocked by some obstacle.  Conflicts, we are drawn to or repelled from two or more incompatible needs, goals, or motives.  Pressures, force us to speed up, intensify effort, or change direction of our behavior. Types of conflicts – John Dollard and Neal Miller described three primary types of conflicts.  Approach-avoidance - one goal both attracts and repels us. (e.g., asking for a date could lead to a date OR rejection)  Double-approach - we are equally attracted to two pleasant goals (e.g., having to choose between a hot dog OR a hamburger)  Double avoidance - we are equally repelled by two unpleasant goals (e.g., toothache getting worse OR going to the dentist). Stress tolerance – ability to withstand stress without becoming seriously impaired. Task Oriented Response - involves changing self or situation to eliminate the stress. Defense Oriented Response - behavior is directed at protecting the self and avoiding pain as opposed to solving the problem and eliminating the stress. Decompensation (psychological) – a serious breakdown in adaptive functioning. Hans Selye’s General Adaptation Syndrome (GAS) – consists of three phases. The pattern forms an “inverted U function.” Resistance is greatest during "PHASE 2."  Alarm reaction - the body's defenses are activated and mobilized.  Resistance - stress resistance is greatest during this phase  exhaustion - bodily resources are exhausted "Wear and Tear Theory" - Selye found that each successive stressor leaves a permanent scar. We recover from stress but never to the pre-stress level of functioning. Psychoneuroimmunology – new field that focuses on how long term stress suppresses functioning of the immune system, making us more vulnerable to serious disease. For example, stress activates the "HPA axis" (involving the hypothalamus, pituitary gland, and adrenal gland) resulting in harmful hormonal imbalances. Adjustment disorder – least stigmatizing of the DSM categories. Often assigned by therapists for insurance purposes. If symptoms last more than 6 months, diagnosis should be changed to another disorder. It is assumed that the symptoms will disappear or lessen once  the stressor is no longer present or  the person learns to adapt to the stressor. “Anxiety Disorders Section” – both PTSD and Acute Stress Disorder are classified within the “Anxiety Disorders” section of DSM. Post-Traumatic Stress Disorder – requires an event generally “outside” the normal range of human experience. More specifically, it would involve having witnessed or experienced actual or threatened death or serious injury and having experienced intense fear, helplessness, or horror. Symptoms must be present for 4 weeks. Many researchers think in terms of three types of PTSD:  Combat-related - e.g., military and police  Crime victim - e.g., victims of rape, mugging, childhood abuse, etc.  Disaster victim - e.g., accidents and natural disasters Acute Stress Disorder – like PTSD but symptoms need be present only for 2 days and no longer than 4 weeks. If symptoms last longer than four weeks, diagnosis is changed to PTSD. The symptoms are similar to those of PTSD. PTSD symptoms: (1 and 2 are the "hallmark" symptoms of PTSD)  Re-experiencing - intrusive thoughts, nightmares, or flashbacks (dissociation).  Reactivity to, and avoidance of, trauma-related stimuli.  Social withdrawal and restriction of affect  Hypervigilence, easily startled, irritability.  Various symptoms of “increased physiological arousal” and anxiety.  Impaired concentration and inability to focus attention  Depression, though not a criterion for PTSD, is an often associated feature. Rape: Stranger rape - the victim is likely to experience intense fear of physical harm and/or death Acquaintance rape - victims are especially likely to  be reluctant to seek help or talk to anyone  feel betrayed by the rapist  feel “guilty” in that they may have contributed in some way Social relationships - suffer greatly. The victim may withdraw, especially from intimate relationships. Combat-related PTSD - in earlier wars this was called operational fatigue, combat fatigue combat exhaustion, battle fatigue, etc. Vietnam War – The term Combat-related PTSD most often refers to Vietnam veterans. This pattern differs in that symptoms seemed to develop later, after the soldiers had returned home. Causal factors in combat related PTSD:  Personality traits (e.g., immaturity) may make one more vulnerable to stress.  Soldiers with histories of personality instability prior to combat were more likely to were more likely to break down under the stress of combat (Merbaum & Hefez, 1976)  Acceptance of war goals and identification with the unit ("esprit de corps"), and quality of leadership can improve adjustment to combat and reduce PTSD risk.  Returning to an unaccepting environment (as with the Vietnam war) can lead to increased symptoms (esp. anger). Treatment: Short Term Crisis Therapy - focuses on helping the client see the situation clearly, form a plan, identify resources, obtain support, and move foward. Direct Therapeutic Exposure (DTE) – is a often used behavioral treatment which involves repeated exposure to trauma-related stimuli in hopes that the conditioned fear responses will “extinguish.” Medications – a wide variety are used (antidepressant, anti-anxiety, and others). Long term supporting therapy – is often used (e.g., through the V. A. system). Delayed onset PTSD – Has been increasingly accepted in recent years, due largely to the public being more familiar with, and more accepting of, the diagnosis (e.g., related to childhood abuse) (not in book). Legal issues in PTSD – some have concern over the abuse of PTSD as a legal defense, (esp. in the case of sex offenders and other violent criminals) but these concerns are largely unfounded. Few cases are won on these grounds (not in book).
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