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Stress Disorders. Chapter 6. Stress, Coping, and the Anxiety Response. The state of stress has two components: Stressor – event that creates demands Stress response – person’s reactions to the demands

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Stress Disorders

Chapter 6


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Stress, Coping, and the Anxiety Response

  • The state of stress has two components:

    • Stressor – event that creates demands

    • Stress response – person’s reactions to the demands

      • Influenced by how we appraise both the event and our capacity to react to the event effectively

        • People who sense that they have the ability and resources to cope are more likely to take stressors in stride and respond constructively

Comer, Abnormal Psychology, 7e


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Stress, Coping, and the Anxiety Response

  • When we appraise a stressor as threatening, the natural reaction is fear

    • Fear is a “package” of responses that are physical, emotional, and cognitive

  • Stress reactions, and the fear they produce, are 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

Comer, Abnormal Psychology, 7e


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Stress, Coping, and the Anxiety Response

  • Stress also plays a more central role in certain psychological disorders, including:

    • Acute stress disorder

    • Posttraumatic stress disorder (PTSD)

    • Technically, DSM-IV-TR lists these patterns as anxiety disorders

  • …as well as certain physical disorders, called psychophysiological disorders

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

Comer, Abnormal Psychology, 7e


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Stress and Arousal: The Fight-or-Flight Response

  • The features of arousal and fear are set in motion by the hypothalamus

    • Two important systems are activated:

      • Autonomic nervous system (ANS)

        • An extensive network of nerve fibers that connect the central nervous system (the brain and spinal cord) to all other organs of the body

      • Endocrine system

        • A network of glands throughout the body that release hormones

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Stress and Arousal: The Fight-or-Flight Response

  • There are two pathways, or routes, by which the ANS and the endocrine system produce arousal and fear reactions:

    • Sympathetic nervous system pathway

    • Hypothalamic-pituitary-adrenal pathway

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Stress and Arousal: The Fight-or-Flight Response

  • When we face a dangerous situation, the hypothalamus first excites the sympathetic nervous system, which stimulates key organs either directly or indirectly

  • When the perceived danger passes, the parasympathetic nervous system helps return body processes to normal

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Stress and Arousal: The Fight-or- Flight Response

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

    • When confronted by stressors, the hypothalamus signals the pituitary gland, which stimulates the adrenal cortex to release corticosteroids – stress hormones – into the bloodstream

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Stress and Arousal: The Fight-or-Flight Response

  • The reactions on display in these two pathways are collectively referred to as the fight-or-flight response

  • Each person has a particular pattern of autonomic and endocrine functioning and so a particular way of experiencing arousal and fear…

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Stress and Arousal: The Fight-or-Flight Response

  • People differ in:

    • Their general level of arousal and anxiety

      • Called “trait anxiety”

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

      • Differences appear soon after birth

    • Their sense of which situations are threatening

      • Called “state anxiety”

      • Situation-based (example: fear of flying)

Comer, Abnormal Psychology, 7e


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The Psychological Stress Disorders

  • During and immediately after trauma, we may temporarily experience levels of arousal, anxiety, and depression

    • For some, symptoms persist well after the trauma

      • These people may be suffering from:

        • Acute stress disorder

        • Posttraumatic stress disorder (PTSD)

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

      • The situations that cause these disorders would be traumatic to anyone (unlike other anxiety disorders)

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The Psychological Stress Disorders

  • Acute stress disorder

    • Symptoms begin within four weeks of event and last for less than one month

  • Posttraumatic stress disorder (PTSD)

    • Symptoms may begin either shortly after the event, or months or years afterward

      • As many as 80% of all cases of acute stress disorder develop into PTSD

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What Triggers a Psychological Stress Disorder?

  • Can occur at any age and affect all aspects of life

  • At least 3.5% of people in the U.S. are affected each year

  • 7–9% of people in the U.S. are affected sometime during their lifetime

  • Around two-thirds seek treatment at some point

  • Ratio of women to men is 2:1

    • After trauma, around 20% of women and 8% of men develop disorders

  • Some events –including combat, disasters, abuse, and victimization – are more likely to cause disorders than others

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What Triggers a Psychological Stress Disorder?

  • Combat and stress disorders

    • For years clinicians have recognized that soldiers experience distress during combat

      • Called “shell shock” or “combat fatigue”

      • Post-Vietnam War clinicians discovered that soldiers also experienced psychological distress AFTER combat

    • As many as 29% of Vietnam combat veterans suffered acute or posttraumatic stress disorders

      • An additional 22% had some stress symptoms

      • 10% still experiencing problems

    • A similar pattern is currently unfolding among veterans of wars in Iraq and Afghanistan

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What Triggers a Psychological Stress Disorder?

  • Disasters and stress disorders

    • Acute or posttraumatic stress disorders may also follow natural and accidental disasters

      • Types of disasters include earthquakes, floods, tornadoes, fires, airplane crashes, and serious car accidents

      • Civilian traumas have been implicated in stress disorders at least 10 times as often as combat traumas

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What Triggers a Psychological Stress Disorder?

  • Victimization and stress disorders

    • People who have been abused or victimized often experience lingering stress symptoms

      • Research suggests that more than one-third of all victims of physical or sexual assault develop PTSD

    • A common form of victimization is sexual assault/rape

      • Around 1 in 6 women is raped at some time during her life

      • Psychological impact is immediate and may be long-lasting

      • One study found that 94% of rape survivors developed an acute stress disorder within 12 days after assault

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What Triggers a Psychological Stress Disorder?

  • Victimization and stress disorders

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

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

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Why Do People Develop a Psychological Stress Disorder?

  • Clearly, extraordinary 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:

    • Survivors’ biological processes

    • Personalities

    • Childhood experiences

    • Social support systems/cultural backgrounds

    • Severity of the traumas

Comer, Abnormal Psychology, 7e


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Why Do People Develop a Psychological Stress Disorder?

  • Biological and genetic factors

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

      • Some research suggests abnormal neurotransmitter and hormone activity (especially norepinephrine and cortisol)

      • Evidence suggests that other biological changes and damage may also occur (especially in the hippocampus and amygdala) as a stress disorder sets in

      • There may be a biological/genetic predisposition to such reactions

Comer, Abnormal Psychology, 7e


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Why Do People Develop a Psychological Stress Disorder?

  • Personality factors

    • Some studies suggest that people with certain personality profiles, attitudes, and coping styles are particularly likely to develop stress disorders

      • Risk factors include:

        • Preexisting high anxiety

        • A history of psychological problems

        • Negative worldview

    • A set of positive attitudes (called resiliency or hardiness) is protective against developing stress disorders

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Why Do People Develop a Psychological Stress Disorder?

  • Childhood experiences

    • Researchers have found that certain childhood experiences increase risk for later stress disorders

    • Risk factors include:

      • An impoverished childhood

      • Psychological disorders in the family

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

      • Being younger than 10 years old when parents separated or divorced

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Why Do People Develop a Psychological Stress Disorder?

  • Social support

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

  • Multicultural factors

    • A careful look at research literature suggests that there may be important cultural differences in the occurrence of PTSD

      • It seems that Hispanic Americans might be more vulnerable to PTSD than other racial or ethnic groups

        • Possible explanations include early dissociative reactions to trauma, cultural beliefs systems, and the cultural emphasis on social relationships

Comer, Abnormal Psychology, 7e


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Why Do People Develop a Psychological Stress Disorder?

  • Severity of the trauma

    • 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; witnessing the injury or death of others

Comer, Abnormal Psychology, 7e


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How Do Clinicians Treat the Psychological Stress Disorders?

  • About half of all cases of PTSD improve within 6 months; the remainder may persist for years

  • Symptoms have been found to last an average of 3 years with treatment and 5½ years without treatment

    • Treatment procedures vary depending on type of trauma

    • General goals:

      • End lingering stress reactions

      • Gain perspective on painful experiences

      • Return to constructive living

Comer, Abnormal Psychology, 7e


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How Do Clinicians Treat the Psychological Stress Disorders?

  • Treatment for combat veterans

    • Drug therapy

      • Antianxiety and antidepressant medications are most common

    • Behavioral exposure techniques

      • Reduce specific symptoms, increase overall adjustment

      • Use flooding and relaxation training

      • Use eye movement desensitization and reprocessing (EMDR)

    • Insight therapy

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

      • Often use family or group therapy formats; rap groups

    • Usually used in combinations

Comer, Abnormal Psychology, 7e


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How Do Clinicians Treat the Psychological Stress Disorders?

  • Psychological debriefing

    • A form of crisis intervention that has victims of trauma talk extensively about their feelings and reactions within days of the critical incident

      • Four-stage approach:

        • Normalize responses to the disaster

        • Encourage expressions of anxiety, anger, and frustration

        • Teach self-help skills

        • Provide referrals

    • Relief workers themselves may become overwhelmed

    • Research on this type of intervention continues to call into question its effectiveness

Comer, Abnormal Psychology, 7e


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The Physical Stress Disorders: Psychophysiological Disorders

  • In addition to affecting psychological functioning, stress can also have an enormous impact on physical functioning

  • The idea that stress and related psychosocial factors may contribute to somatic illnesses has ancient roots, but had few supporters before the 20th century

    • 17th century philosopher René Descartes called a variation on the idea mind–body dualism

Comer, Abnormal Psychology, 7e


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The Physical Stress Disorders: Psychophysiological Disorders

  • About 80 years ago, clinicians first identified a group of physical illnesses that seemed to result from an interaction of biological, psychological, and sociocultural factors

  • Early versions of the DSM labeled these illnesses psychophysiological, or psychosomatic, disorders

    • DSM-IV-TR calls them psychological factors affecting medical condition

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The Physical Stress Disorders: Psychophysiological Disorders

  • It is important to recognize that these psychophysiological disorders bring about actual physical damage

    • They are different from “apparent” physical illnesses like factitious disorders or somatoform disorders, which will be discussed in Chapter 7

Comer, Abnormal Psychology, 7e


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Traditional Psychophysiological Disorders

  • Before the 1970s, the best known and most common of the psychophysiological disorders were ulcers, asthma, insomnia, chronic headaches, high blood pressure, and coronary heart disease

  • Recent research has shown that many other physical illnesses may be caused by an interaction of psychosocial and physical factors

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Traditional Psychophysiological Disorders

  • Ulcers

    • Lesions in the wall of the stomach that result in burning sensations or pain, vomiting, and stomach bleeding

    • Experienced by 20 million people at some point in their lives

    • Causal psychosocial factors:

      • Environmental pressure, anger, anxiety, dependent personality style

    • Causal physiological factors:

      • Bacterial infection

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Traditional Psychophysiological Disorders

  • Asthma

    • A narrowing of the body’s airways that makes breathing difficult

    • Affects up to 20 million people in the U.S. each year

      • Most victims are children at the time of first attack

    • Causal psychosocial factors:

      • Environmental pressures, troubled family relationships, anxiety, high dependency

    • Causal physiological factors:

      • Allergies, a slow-acting sympathetic nervous system, weakened respiratory system

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Traditional Psychophysiological Disorders

  • Insomnia

    • Difficulty falling asleep or maintaining sleep

    • Affects 35% of people in the U.S. each year

    • Causal psychosocial factors:

      • High levels of anxiety or depression

    • Causal physiological factors:

      • Overactive arousal system, certain medical ailments

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Traditional Psychophysiological Disorders

  • Chronic headaches

    • Frequent intense aches of the head or neck that are not caused by another physical disorder

      • Tension headaches affect 40 million Americans each year

      • Migraine headaches affect 23 million Americans each year

    • Causal psychosocial factors:

      • Environmental pressures; general feelings of helplessness, anger, anxiety, depression

    • Causal physiological factors:

      • Abnormal serotonin activity, vascular problems, muscle weakness

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Traditional Psychophysiological Disorders

  • Hypertension

    • Chronic high blood pressure, usually producing no outward symptoms

    • Affects 65 million Americans each year

    • Causal psychosocial factors:

      • Constant stress, environmental danger, general feelings of anger or depression

    • Causal physiological factors:

      • 10% caused by physiological factors alone

      • Obesity, smoking, poor kidney function, high proportion of collagen (rather than elastic) tissue in an individual’s blood vessels

Comer, Abnormal Psychology, 7e


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Traditional Psychophysiological Disorders

  • Coronary heart disease

    • Caused by blockage in the coronary arteries

    • Includes angina pectoris (chest pain), coronary occlusion (complete blockage of a coronary artery), and myocardial infarction (heart attack)

    • Leading cause of death in men older than 35 years and women older than 40 years in the U.S.

    • Causal psychosocial factors:

      • Job stress, high levels of anger or depression

    • Causal physiological factors:

      • High level of cholesterol, obesity, hypertension, the effects of smoking, lack of exercise

Comer, Abnormal Psychology, 7e


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Traditional Psychophysiological Disorders

  • A number of variables contribute to the development of psychophysiological disorders, including:

    • Biological factors

    • Psychological factors

    • Sociocultural factors

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Traditional Psychophysiological Disorders

  • Biological factors

    • Defects in the autonomic nervous system (ANS) are believed to contribute to the development of psychophysiological disorders

    • Other more specific biological problems may also contribute

      • For example, a weak gastrointestinal system may create a predisposition to developing ulcers

Comer, Abnormal Psychology, 7e


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Traditional Psychophysiological Disorders

  • Psychological factors

    • According to many theorists, certain needs, attitudes, emotions, or coping styles may cause people to repeatedly overreact to stressors – increasing their chances of developing psychophysiological disorders

      • Examples: a repressive coping style, a Type A personality style

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Traditional Psychophysiological Disorders

  • Sociocultural factors

    • Adverse social conditions may set the stage for psychophysiological disorders

      • Stressors may be wide-ranging (e.g., nuclear threat, like Three Mile Island) or local (e.g., living in a crime-ridden neighborhood)

      • One of society’s most adverse social conditions is poverty

      • Research also reveals that belonging to an ethnic or cultural minority group increases the risk of developing these disorders and other health problems

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Traditional Psychophysiological Disorders

  • Clearly, biological, psychological, and sociocultural variables combine to produce psychophysiological disorders

  • In fact, the interaction of psychosocial and physical factors is now considered the rule of bodily function, not the exception

  • In recent years, more and more illnesses have been added to the list of psychophysiological disorders

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New Psychophysiological Disorders

  • Since the 1960s, researchers have found many links between psychosocial stress and a wide range of physical illnesses

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New Psychophysiological Disorders

  • Are physical illnesses related to stress?

    • The development of the Social Adjustment Rating Scale in 1967 enabled researchers to examine the relationship between life stress and the onset of illness

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New Psychophysiological Disorders

  • Are physical illnesses related to stress?

    • Using the Social Adjustment Rating Scale, studies have linked stressors of various kinds to a wide range of physical conditions

    • Overall, the greater the amount of life stress, the greater the likelihood of illness

      • Researchers have even found a relationship between traumatic stress and death

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New Psychophysiological Disorders

  • Are physical illnesses related to stress?

    • One shortcoming of the Social Adjustment Rating Scale is that it does not take into consideration the particular stress reactions within specific populations

      • For example, women and men have been shown to react differently to certain life changes measured by the scale

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New Psychophysiological Disorders

  • Researchers have increasingly looked to the body’s immune system as the key to the relationship between stress and infection

  • This area of study is called psychoneuroimmunology

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New Psychophysiological Disorders

  • Psychoneuroimmunology

    • The immune system is the body’s network of activities and cells that identify and destroy antigens (foreign invaders, such as bacteria) and cancer cells

      • Among the most important cells in this system are the lymphocytes

        • Lymphocytes are white blood cells that circulate through the lymph system and the bloodstream, attacking invaders

        • Lymphocytes include helper T-cells, natural killer T-cells, and B-cells

Comer, Abnormal Psychology, 7e


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New Psychophysiological Disorders

  • Psychoneuroimmunology

    • Researchers now believe that stress can interfere with the activity of lymphocytes, slowing them down and increasing a person’s susceptibility to viral and bacterial infections

    • Several factors influence whether stress will result in a slowdown of the system, including biochemical activity, behavioral changes, personality style, and degree of social support

Comer, Abnormal Psychology, 7e


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New Psychophysiological Disorders

  • Psychoneuroimmunology

    • Biochemical activity

      • Stress leads to increased activity of the sympathetic nervous system, including a release of norepinephrine

      • In addition to supporting nervous system activity, this chemical also appears to slow down the functioning of the immune system

      • Similarly, the body’s endocrine glands reduce immune system functioning during periods of prolonged stress through the release of corticosteroids

Comer, Abnormal Psychology, 7e


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New Psychophysiological Disorders

  • Psychoneuroimmunology

    • Behavioral changes

      • Stress may set in motion a series of behavioral changes – poor sleep patterns, poor eating, lack of exercise, increase in smoking and/or drinking – that indirectly affect the immune system

    • Personality style

      • An individual’s personality style (including their level of optimism, constructive coping strategies, and resilience) may also play a role in determining how much the immune system is slowed down by stress

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New Psychophysiological Disorders

  • Psychoneuroimmunology

    • Social support

      • People who have few social supports and feel lonely seem to display poorer immune functioning in the face of stress than people who do not feel lonely

      • Studies have found that social support and affiliation with others may actually protect people from stress, poor immune system functioning, and subsequent illness, and can help speed up recovery from illness or surgery

Comer, Abnormal Psychology, 7e


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Psychological Treatments for Physical Disorders

  • As clinicians have discovered that stress and related psychosocial factors may contribute to physical disorders, they have applied psychological treatment to more and more medical problems

    • The most common of these interventions are relaxation training, biofeedback training, meditation, hypnosis, cognitive interventions, insight therapy, and support groups

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Psychological Treatments for Physical Disorders

  • The field of treatment that combines psychological and physical interventions to treat or prevent medical problems is known as behavioral medicine

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Psychological Treatments for Physical Disorders

  • Relaxation training

    • People can be trained to relax their muscles at will, a process that sometimes reduces feelings of anxiety

    • Relaxation training can be of help in preventing or treating medical illnesses that are related to stress

      • Often used in conjunction with medication in the treatment of high blood pressure

      • Often used alone to treat chronic headaches, insomnia, asthma, pain after surgery, certain vascular diseases, and the undesirable effects of cancer treatments

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Psychological Treatments for Physical Disorders

  • Biofeedback training

    • Patients given biofeedback training are connected to machinery that gives them continuous readings about their involuntary bodily activities

      • This procedure has been used successfully to treat headaches and muscular disabilities caused by stroke or accident

      • Some biofeedback training has been effective in the treatment of asthma, irregular heartbeat, migraine headaches, high blood pressure, stuttering, and pain from burns

Comer, Abnormal Psychology, 7e


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Psychological Treatments for Physical Disorders

  • Meditation

    • Although meditation has been practiced since ancient times, Western health care professionals have only recently become aware of its effectiveness

    • Meditation is a technique of turning one’s concentration inward and achieving a slightly changed state of consciousness

      • Meditation has been used to treat pain, high blood pressure, heart problems, insomnia, and asthma

Comer, Abnormal Psychology, 7e


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Psychological Treatments for Physical Disorders

  • Hypnosis

    • Individuals undergoing hypnosis are guided into a sleeplike, suggestible state during which they can be directed to act in unusual ways, to remember unusual sensations, or to forget remembered events

      • With training, hypnosis can be done without a hypnotist (self-hypnosis)

Comer, Abnormal Psychology, 7e


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Psychological Treatments for Physical Disorders

  • Hypnosis

    • This technique seems to be particularly helpful in the control of pain; is now used to treat such problems as skin diseases, asthma, insomnia, high blood pressure, warts, and other forms of infection

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Psychological Treatments for Physical Disorders

  • Cognitive interventions

    • People with physical ailments have sometimes been taught new attitudes or cognitive responses as part of treatment

      • One intervention is self-instruction training, in which patients are taught to rid themselves of negative self-statements and to replace these with positive self-statements

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Psychological Treatments for Physical Disorders

  • Insight therapy and support groups

    • If negative psychological symptoms (e.g., depression, anxiety) contribute to a person’s physical ills, therapy to address these emotions should help reduce the ills

    • These techniques have been used to treat a variety of illnesses including HIV, asthma, cancer, headache, and arthritis

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Psychological Treatments for Physical Disorders

  • Combination approaches

    • Studies have found that the various psychological treatments for physical problems tend to be equal in effectiveness

      • Psychological treatments are often of greatest help when used in combination and with medical treatment

      • With these combined approaches, today’s practitioners are moving away from the mind–body dualism of centuries past

Comer, Abnormal Psychology, 7e


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