CHAPTER 5: Stress and Physical and Mental Health

CHAPTER 5: Stress and Physical and Mental Health
Teaching Objectives
1. Define stress, and learn about how stress presents as a psychiatric disorder.
2. Differentiate and provide an example of a stressor, stress, and coping; describe the basic categories of
stressors, and discuss factors that increase or decrease a person's vulnerability to stress.
3. Review ways to measure life stress and discuss the importance of resilience.
4. Explain the role cortisol and other hormones play in stress reaction and why extended contact can be
problematic over the longer term.
5. Explain the interactions between the nervous system, the immune system, and behavior, and describe
psychoneuroimmunology's relationship to all three.
6. Explain what cytokines are, how they work, and why researchers are so excited about them.
7. Discuss the connection between the mind and body when it comes to health.
8. Explain why negative emotional states can impair the functioning of the immune system and the
cardiovascular system.
9. Explain the correlation between stress, depression, and the immune system functioning.
10. Review the treatment modalities for stress-related physical disorders.
11. Characterize the DSM-5 diagnosis of adjustment disorder and describe three major stressors and the
consequences that increase the risk of adjustment disorder.
12. Characterize the phenomenon of combat-related stress and of PTSD in connection with battlefield stress.
13. Summarize what is known about the major features of reactions to catastrophic events.
14. Explain the risk factors in the development of PTSD.
15. Understand PTSD from a sociocultural point of view.
16. Outline the factors that appear to influence combat-related stress problems and describe the long-term
effects of PTSD.
17. Summarize the approaches that have been used to treat or to prevent stress disorders and evaluate their
effectiveness.
18. Discuss the issue of using psychotropic medications to treat PTSD.
19. Discuss the process of psychological debriefing and the challenges faced when studying disaster victims.
20. Review the impact trauma has on one’s physical health.
21. Outline the DSM-5current diagnostic criterion for PTSD and discuss how it differs from the DSM-IV-TR
criteria.
Chapter Overview/Summary
Health psychology is the sub discipline of the field of psychology that focuses on the effects of stress and other
psychological factors in the development and maintenance of physical health problems. Behavioral medicine is an
approach to physical illness that is concerned with how psychological factors cause physical health problems. Stress
is an inevitable part of life; all situations, positive and negative, can be stressful. Stressors can be placed into one of
three categories: frustrations, conflicts, and pressures. A person’s response to stressful situations depends not only
on the severity of the stressor but also on the person’s perceptions, preexisting stress vulnerabilities, and amount of
external resources and social supports. Conflict situations can be characterized as approach-avoidance, doubleapproach, or double-avoidance. People’s stress responses can be viewed as task-oriented or defense-oriented.
Among the consequences of extreme or prolonged stress can be extensive physical and psychological problems.
When we are stressed, the autonomic nervous system responds in a variety of ways. One consequence of
stress is increased production of cortisol. High levels of this stress hormone may be beneficial in the short term but
problematic if the levels remain high over the longer term. In the immune system, specialized white blood cells
called B-cells and T-cells work together to respond to antigens such as viruses and bacteria. T-cells are assisted by
macrophages.
Copyright © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.
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Psychoneuroimmunology, an exciting and developing new field, is concerned with the interactions between
the nervous system, the immune system, and behavior. Cytokines are chemical messengers that allow the brain and
the immune system to communicate with each other. Some cytokines respond to a challenge to the immune system
by causing an inflammatory response. Other cytokines, called anti-inflammatory cytokines, dampen the response
that the immune system makes when it is challenged.
Negative emotional states, such as being under stress or having low social support, can impair the
functioning of the immune system and the cardiovascular system, leaving a person more vulnerable to disease and
infection. Damaging habits and lifestyles, such as smoking or lack of exercise, also enhance risk for physical
disease. Many physical illnesses seem to be linked to chronic negative emotions such as anger, anxiety, and
depression. Hostility is well established as an independent risk factor for CHD. The same is true of depression.
When assessing the treatment methods for stress-related disorders, you can look at serious medical
treatments as well as psychological interventions such as emotional disclosure, biofeedback, relaxation and
meditation, and cognitive-behavioral therapy. Factors such as genetic vulnerabilities and excessive autonomic
reactivity remain important in our understanding of the causes of physical diseases. They must also be a part of
treatment considerations whenever physical disease occurs, regardless of strong evidence of psychological
contributions to its development. A common factor in much psychosocially mediated physical disease is inadequacy
in an individual’s coping resources for managing stressful life circumstances. Cognitive-behavior therapy, in
particular, shows much promise in alleviating this type of health-endangering problem.
Adjustment disorders can be caused by relatively common life events, such as unemployment, loss of a
loved one through death, or marital separation or divorce. PTSD is the response to more severe trauma or
excessively stressful situations such as rape, military combat, imprisonment, being held hostage, forced relocation,
or torture.
PTSD may include such symptoms as intrusive thoughts and repetitive nightmares about the event, intense
anxiety, avoidance of stimuli associated with the trauma, negative changes in thoughts and mood, and increased
arousal manifested as chronic tension, irritability, insomnia, impaired concentration and memory, and reckless
behavior. When PTSD symptoms occur within six months of the traumatic event, the diagnosis is acute stress
disorder; if symptoms are delayed by six months or more after the traumatic event, the diagnosis is classified as
delayed PTSD, a diagnosis that is more difficult to make and that is more controversial.
Many factors contribute to breakdown under excessive stress, including the intensity or harshness of the
stressful situation, the length of the traumatic event, the person’s biological makeup and personality adjustment prior
to the stressful situation, and the ways in which the person manages once the stressful situation is over. In many
cases, symptoms remit with the removal of the stressor, especially with the help of psychotherapy. In extreme cases,
there may be residual damage or symptom-onset itself may be delayed until well after the trauma is over.
Among the most important treatments for PTSD are the following: prevention by reducing the frequency of
traumatic events; prevention of maladaptive responses to stress by preparing people in advance; stress-inoculation
training; telephone hotlines; crisis intervention; psychological debriefing; medication and cognitive-behavioral
treatments. 

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