Abnormal notes week 6
Abnormal notes week 6 PSYC 3560
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This 8 page Class Notes was uploaded by Ashlyn Masters on Friday February 26, 2016. The Class Notes belongs to PSYC 3560 at Auburn University taught by Dr. Fix in Spring 2016. Since its upload, it has received 24 views. For similar materials see Abnormal Psychology in Psychlogy at Auburn University.
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Date Created: 02/26/16
Stress and Physical and Mental Health 2/23/16 What is stress? • iClicker question: Humans experience “fight or flight” stress response multiple times per day • Why care about physical health? o Mind-Body connection § Some psychological processes can produce physical conditions, illnesses § Some physical conditions have no biological basis § Some psychological processes can reduce immune functioning, contribute to illness § Some behaviors can maintain, spread illness • Influences of Stress o Historically, most cases of illness and death were related to injury or infection o Today, most cases are related to chronic health problems (many of these conditions are influenced by stressful lifestyles) • Definition of stress: demands placed on an organism; biological and psychological responses to demands o Stress is a byproduct of inadequate coping o Positive (eustress) vs. negative (distress) § Positive examples: graduating, going on a date you’re excited about, planning something with friends § Negative examples: getting up early, dealing with traffic, lots of tests Physical Effects of Stress • Normal response to one stressor: epinephrine/adrenaline kicks in (epinephrine lasts 15-20 minutes or so) o Sympathetic nervous system o Unnecessary systems shut down (digestive, reproductive) o After half an hour or so, the epinephrine wears off and the systems begin to regulate again o Appetite increases during this phase o Cortisol kicks in to regulate your body again • In humans, we have many little stressors in a small period of time and this causes a build up of cortisol because there isn’t enough time for the cortisol to wear off before the next stressor kicks in • Short term effects o Increased § Heart rate, blood pressure, blood glucose, breathing rate, inflammation o Decreased § Digestion, immune responsiveness, sexual function, psychosocial functioning • Long term effects o Increased § Fat storage, cardiovascular disease, metabolic diseases, autoimmune disorders, digestive disorders, sexual dysfunction, mental illness o Decreased § Hunger regulation, psychosocial functioning, stress response regulation • iClicker question: does stress cause ulcers? Answer: necessary but not sufficient • The immune system o There is a link between stress and suppression of the immune system § People heal more slowly when stressed § Depression associated with decreased immune functioning • Major stressors can lead to PTSD o Natural disasters o Abuse/sexual assault o Combat and war-related traumatic events o Common traumatic events Stress and social hierarchies • Social status found to be highly correlated with health outcomes o First discovered in primates o Whitehall studies in England § Found job ranking predicted health outcomes • CEO most healthy • VPs slightly less healthy than above • Middle managers less healthy than above • Lowest ranking workers had worst health o Social ranking strongly predicts health Factors influencing reactions to stress • Predisposing factors o Negative interpretations of events o Poor coping skills o Lack of resources o Early life stress o Social disadvantage • Resilience/protective factors o Optimism o Self-esteem o Social support o Identity Summary • How we appraise a stressor will affect how stressful it is o Characteristics of the stressor o Predispositions, diathesis • Stress can impact not only mental health, by physical health as well • Prevention and stress management is key to avoiding more serious problems Posttraumatic Stress Disorder: A Focus on Combat Trauma 2/25/16 Acronyms • PTSD: posttraumatic stress disorder • OEF: operation enduring freedom • OIF: operation Iraqi freedom • DoD: department of defense • VA: Veterans affairs • SM: service member Evolution of the Name • Nostalgia • Homesickness • Ester Roto (“to be broken” en Espanol) • Soldier’s Heart/Irritable/Da Costa Syndrome • Railway Spine • Shell Shock (WWI) • Combat Exhaustion/Fatigue (WWII and the Korean War) • Stress Response Syndrome (DSM-I and Vietnam) • First called PTSD in 1980 with the publication of the DSM-III • Combat operational stress injury (reaction) DSM-5 PTSD Criteria A. Stressor Criterion B. Intrusion C. Avoidance D. Cognition and Mood Alterations E. Arousal and Reactivity F. Time Criterion G. Functional Impairment or Distress Criterion A: Traumatic Event • Exposure to actual or threatened death, serious injury, or sexual violence in one (or more) of the following ways: o Directly experiencing the traumatic event o Witnessing, in person, the event(s) as it occurred to others o Learning that the traumatic event(s) occurred to a close family member or close friend (must be violent or accidental) o Experiencing repeated or extreme exposure to aversive details of the traumatic event(s) (e.g., first responders, police officers) Characteristics of Traumatic Events • Individuals exposed o Intentional § War § Assault § Robbery § Rape • Communities/populations exposed o Human made § War § Industrial accident § Plane crash § Toxic spill o Natural § Hurricane § Earthquake § Tornado Type of Trauma Influences PTSD Rates • Natural disasters and accidents are the most common types of traumas experienced o Lowest rates of PTSD • Combat and rape are the least common types of traumas experienced o Highest rates of PTSD o (Kessler, 1995) Criterion B: Intrusion • Intrusive, distressing recollections • Distressing dreams • Flashbacks (or dissociations) • Psychological distress to reminders • Marked physiological reactions to reminders • Need 1 Criterion C: Avoidance • Avoidance of internal reminders o Memories o Thoughts o Feelings • Avoidance of external reminders o People o Places o Conversations o Activities o Objects o Situations • Need 1 Criterion D: Negative Alterations in Cognition and Mood • Traumatic amnesia • Persistent negative beliefs and expectations • Persistent distorted blame • Persistent negative emotional state • Diminished interest • Detachment or estrangement • Persistent inability to have positive emotions • Need 2 Criterion E: Arousal • Irritable behavior and angry outbursts • Reckless or self-destructive behavior • Hypervigilance • Exaggerated startle response • Concentration difficulties • Sleep difficulties • Need 2 General Information • Lifetime prevalence of 6.4% • 6.6% have sub-threshold (partial) PTSD • Rates are higher in women (8.4%) than in men (4.1%) • Comorbidity is common PTSD and Health-Related Problems • Individuals diagnosed with PTSD have more severe: o General health symptoms and medical conditions o Pain symptoms o Cardio-respiratory symptoms o Gastrointestinal symptoms Military-Specific Information • PTSD Prevalence o Vietnam Veterans study: ~30% o Adjusted Vietnam Veterans study: ~17% o More recent estimates: 23% • Most common diagnoses for returning OEF/OIF SMs Multiple Deployments and Mental Health • The more deployments, the more mental health problems • Being deployed >1 time increases your chances of developing PTSD by 70% Risk Factors for PTSD due to Combat • Peritraumatic dissociation • Perceived life threat • Perceived lack of support • Prior trauma • Family of origin psychopathology • Prior emotional problems Battle-mind vs. PTSD • Adaptive skills for deployment o Buddies o Accountability o Targeted Aggression o Tactile Awareness o Lethally Armed o Emotional Control o Mission OPSEC o Individual Responsibility o Non-Defensive Driving o Discipline and Ordering • Maladaptive skills for reintegration o Dispersion of units o Controlling o Inappropriate Aggression o Hypervigilance o “Locked and Loaded” o Anger/Detachment o Secretiveness o Guilt o Aggressive Driving o Conflict Need for Uniformed Clinical Psychologists • High rates of PTSD, depression, and suicide • Increased risk of exposure to criterion A stressors • Diathesis-stress model • Detainee practices • Assessment History of Uniformed Clinical Psychologists • Active duty began in 1948 in the Army • Deployments began during the Korean War • Approximately 400 active duty clinical psychologists today PTSD Assessment in the DoD and VA • PTSD Checklist for DSM-5 (PCL-5) o Screens for PTSD o Make a provisional diagnosis o Monitor symptoms before, during, and after treatment o Self-report o 20 items (0-80) o Score of 50=preliminary PTSD diagnosis • Clinician-Administered PTSD Scale (CAPS-5) o 30 items o Structured interview o 45-60 minutes to administer o Used to diagnose PTSD Reasons Returning Military Personnel Do Not Seek Treatment • Medications have significant side effects • Treatment could negatively affect their career • Treatment could cause denial of security clearance • Family and friends are more helpful than mental health providers • Co-workers may lose confidence in their ability Evidence-Based Treatments for PTSD • Trauma-Focused Psychotherapies o Exposure-based therapies § Prolonged Exposure Therapy o Cognitive-based therapies § Cognitive Processing Therapy § Cognitive Restructuring o Eye Movement Desensitization Reprocessing (EDMR) • Stress Inoculation Training (anxiety management) • Medications o Selective Serotonin Reuptake Inhibitors (SSRIs) o Serotonin Norepinephrine Reuptake Inhibitors (SNRIs) o Prazosin Treatment Implications • Proximity: as close to front lines as possible • Immediacy: as quickly as possible • Expectancy: SM will return to duty as soon as possible U.S. Army’s Ready and Resilient Campaign Comprehensive Soldier and Family Fitness Master Resilience Training • Self-awareness • Self-regulation • Optimism • Mental Agility • Strength of Character • Connection Technical Report #4 • BCTs with MRTs received higher scores on: o Optimism o Adaptability o Coping o Friendship • BCTs with MRTs had lower rates of mental illness and substance abuse diagnoses Hunt the Good Stuff • Each day think of 3 good things in your life o Can be big or small o Important of not o Daily occurrence or not • Reflect on: o Why/how it occurred o How to make it occur more often Posttraumatic Growth • Appreciation for life • Relationships • Personal strength • Changed priorities • Spirituality Career Opportunities • Civilian o Uniformed Services University o VA Employee o Military Contractor o Center for Deployment Employee • Military o Health Professions Scholarship Program o Uniformed Services University o Military Internship o Direct Accession
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