Understanding Trauma and Stress Disorders: Causes and Treatment Options

1. 6 Trauma- and Stressor-Related Disorders

2. Stress Definitions • Stressors • External events or situations that place physical or psychological demands on a person • Stress • Internal psychological or physiological response to a stressor

3. Trauma- and Stressor-Related Disorders • Types of disorders covered in this chapter • Adjustment • Acute stress • Post-traumatic stress • Childhood disorders are covered in chapter 16

4. Adjustment Disorders • Difficulty coping with or adjusting to a specific life stressor • DSM-5 diagnostic criteria • Exposure to an identifiable stressor that results in onset of symptoms • Symptoms are out of proportion to the severity of the stressor • Symptoms persist no longer than six months after exposure to stressor has ended

5. Trauma- and Stressor-Related Disorders

6. Trauma-Related Disorders • Typical outcomes after exposure to traumatic incidents • Resilience • Recovery • Initial distress with symptom reduction over time • Delayed symptoms • Few initial symptoms • Increasing symptoms over time • Chronic symptoms

7. Undergraduates’ Lifetime Exposure to Traumatic Events

8. Diagnosis of Acute and Post-Traumatic Stress Disorders • Requirements for diagnosis • Exposure to traumatic event • Intrusion symptoms • Avoidance • Negative alterations in mood or cognition • Arousal and changes in reactivity • Hypervigilance

9. Traumatic Events Associated with ASD and PTSD • Combat • Sexual assaults • Violent crime or domestic violence • Sexual harassment • Natural disasters • Car accidents or work-related accidents

10. Etiology of ASD and PTSD • Factors associated with increased risk • More severe physical injuries • Stroke or injury to the head or extremities • Major burn injuries • Rape or sexual assault • Intentional trauma • Close relationship with the perpetrator of sexual assault

11. Lifetime Prevalence of Exposure to Stressors by Gender and PTSD Risk

12. Biological Dimension of ASD and PTSD • Body systems designed for homeostasis • Fear extinction • Decline in fear responses associated with the trauma • SS genotype • Two short alleles of the serotonin transporter gene • More prone to heightened anxiety reactions associated with PTSD

13. Multipath Model for Post-Traumatic Stress Disorder

14. Psychological Dimension of ASD and PTSD • Risk factors • Preexisting conditions such as anxiety and depression, hostility, and anger • Specific cognitive styles or dysfunctional thoughts • Interpret stressors in a catastrophic manner • Social dimension • Social support can diminish PTSD symptoms

15. Sociocultural Dimension of ASD and PTSD • Ethnic differences • Different exposure to previous trauma • Cultural difference in responding to stress • Women are twice as likely as men to suffer a trauma-related disorder • Female police officers less likely than civilian women to have PTSD symptoms

16. Medication Treatment for Trauma-Related Disorders • Certain antidepressants show some effect • Effective in fewer than 60 percent of individuals • Only 20-30 percent show full recovery • D-cycloserine • Mixed results • Prazosin(hypertension medication) • Propranolol (beta-blocker) • Under study; may offer little benefit

17. Psychotherapy for Trauma-Related Disorders • Prolonged exposure therapy (PE) • Involves exposure to trauma-related cues • Cognitive-behavioral therapy (CBT) • Involves identifying and challenging dysfunctional cognitions

18. Psychotherapy Methods (cont’d.) • Trauma-focused cognitive-behavioral therapy (TF-CBT) • Eye movement desensitization and reprocessing (EMDR) • Nontraditional therapy • Involves visualizing traumatic experience while following a therapist’s fingers moving side to side

19. Psychological Factors Affecting Medical Conditions • Stress • Causes a multitude of physiological, psychological, and social changes that influence health • Psychophysiological disorder • Physical disorder with a strong psychological basis or component

20. Medical Conditions Influencedby Psychological Factors • Actual tissue damage • Disease process • Physiological dysfunction • Relative contributions of physical and psychological factors vary greatly • Both medical treatment and psychotherapy may be required

21. Coronary Heart Disease • Cardiac arteries narrow • Results in complete or partial blockage of flow of blood and oxygen to heart • Some risk factors for CHD • Poor eating habits • Obesity and lack of physical activity • Hypertension • Stress • Depression

22. Atherosclerosis

23. Hypertension • Normal blood pressure • Systolic pressure lower than 120 • Diastolic pressure lower than 80 • Hypertension • Systolic pressure at or above 140 • Diastolic pressure at or above 90 • Prehypertension • Blood pressure levels higher than normal but not meeting hypertension levels

24. Types of Headaches • Migraine headaches • Result from constriction of the cranial arteries • Pressure on nearby nerves produces moderate to severe pain • Often accompanied by nausea and vomiting • Tension headaches • Stress creates a prolonged contraction of scalp and neck muscles • Results in vascular constriction and steady pain

25. Cluster Headaches • Excruciating stabbing or burning sensations located in the eye or cheek • Pain so severe that 55 percent report suicidal thoughts • Attacks have a rapid onset • 15 minutes to three hours in duration • End abruptly • Headaches preceded by aura in about 20 percent of cases

26. Asthma • Chronic inflammatory disease of the lungs • Stress or other triggers cause excessive mucus secretion • Spasms and swelling of the airways, which reduces the amount of air that can be inhaled • Symptoms range from mild to severe

27. An Asthma Attack

28. Asthma Prevalence

29. Stress and the Immune System • Stress itself does not appear to cause infections • Appears to decrease immune system’s efficiency • Results in more susceptibility to disease • Stress response involves release of hormones (such as cortisol) that impair immune functioning • Chronic stress accelerates disease progression

30. Etiological Influences on Physical Disorders • Biological dimension • Stressors can dysregulate physiological processes in the brain and body • Release of norepinephrine, epinephrine, and cortisol • Early environmental influences may produce changes in stress-response systems • Brief exposure to stressors enhances immune functioning

31. Psychological Dimension • Psychological and personality characteristics can influence health status • Positive emotions help regulate stress reactions • Negative emotions accentuate the stress response • Commitment, control, and openness to challenge associated with thriving through stressful situations

32. Social Dimension • Risk factors for adverse health outcomes • Lack of social support • Maltreatment in social relationships • Good relationships moderate the link between hostility and poor health

33. Sociocultural Dimension • Women are more likely to be impacted by stress • Due to care-giving role for children, parents, and partners • More likely to live in poverty • Exposure to racism and discrimination • Coping skills, resources, and social support mitigate vascular reactivity to racism

34. Treatment of Stress-Related Disorders • Relaxation training • Learn to relax muscles of the body under almost any circumstances • Biofeedback training • Learn to voluntarily control physiological processes in order to improve physical or mental health • Examples: heart rate, blood pressure

35. Cognitive-Behavioral Therapy • Designed to improve coping skills and manage stress • Shown to improve immune functioning in breast cancer patients • Opportunities to talk about health situation help predict adjustment to cancer • Those who did not talk reported more depressive symptoms

36. Contemporary Trends and Future Directions • Areas of research focus • How positive emotions affect stress responses • Role of psychological factors on disease progression and prevention • Examining why gender and racial differences in stress response exist

37. Review • What do we know about disorders caused by exposure to specific stressors or traumatic events? • In what ways can stress affect our physical health?