Stress and Trauma Exam 4
Limitations with self-report measures for coping
1) cant determine directionality 2) confound measures of distress and coping
How to do PMR
1. Tension 2. relax
Prolonged Exposure
10-15 90min sessions; imaginal exposure (client repeatedly and vividly describes the trauma in present tense to therapist; learns that the memories themselves are not dangerous); in-vivo exposure (confronting feared people, places, objects in real life)
Which of the following is NOT one of the emotion regulation strategies associated with more distress in the Aldao et al. (2010) meta-analysis? a. drinking b. suppression c. rumination d. avoidance
A
The two most recommended treatments for PTSD are a. EMDR and CPT b. medications and PE c. PE and CPT d. PE and EMDR
C
More childhood trauma is associated with
less perceived control and less effective coping with daily stressors
Acceptance, problem-solving, and reappraisal associated with
less psychopathology
Effectiveness of PMR
lots of evidence of efficacy in improving mental health especially anxiety and insomnia (and stress)
CBT interventions had ______ to ______ effects on mental health and productivity
medium to very large
Cognitive coping
mental strategies and self-talk (cognitive reappraisal, rumination)
Top two sources of stress
money and work
decreases in reactivity to thoughts and emotions was the
most consistent and strongest mediator of the relations between mindfulness and changes in mental health outcomes
Behavioral coping
taking (or avoiding) action (problem solving, problem avoidance)
Secondary interventions
teach skills for coping with stress (stress management programs, CBT, relaxation, meditation) *most common
Why doesn't debriefing help?
- Early emotional processing of trauma might interfere with the natural processing of the event - might lead people to bypass their normal sources of support - could increase awareness of normal manifestations of distress with unintended results
Criteria for Acute Stress Disorder
- Exposure to actual or threatened death, serious injury, or sexual violation - at least 9+ from any 5 categories - Duration of 3 days to 1 month after trauma exposure - Clinically sig distress or impairment (prevalence 15%) - Those with ASD more likely to develop PTSD
Methodological issues in coping research
- Individualistic focus - retrospective reports - studies ignore context of coping - use of checklists
How to solve problems with coping research
- Longitudinal studies - Physiological measures - experimental studies
Experimental studies for coping
- Participants brought to lab, engage in stressful task or go through an emotion induction - Instructed to use particular emotion regulation strategy - Greater experimental control but less realistic
Interventions for immediate and acute trauma symptoms
- Psychological debriefing in immediate post-trauma period is not recommended - psychological first aid without emotional processing is recommended in immediate period - CBT interventions are effective in preventing PTSD with acute symptoms (ASD)
PTSD treatments and their efficacy
- Psychotherapy more effective than medications - 2 best est. treatments are PE and CPT - EMDR is effective but controversial
These factors may obscure the relations between "adaptive" coping and distress
- Some items are confounded with distress - only need to cope if you are distressed - different strategies are sometimes combined into one category
Describe two methodological problems in coping research, why they are a problem, and research illustrating a potential solution to the problem
- Use of checklists; may miss important strategies; narrative approaches that ask people to describe in their own words - Individualistic focus; ignores how other people in their lives cope or how they may cope together; dyadic studies, examine both partners coping
5 factor mindfulness questionnaire subscales
- observing - describing - acting with awareness - nonjudging - nonreactivity
Types of work stress interventions
- primary interventions - secondary interventions - tertiary interventions
5 categories of coping
- problem solving - support seeking - avoidance - distraction - positive reappraisal/cognitive restructuring
Gender differences and coping
- women do engage in more rumination than men - women tend to use most coping strategies more than men, including problem solving and positive self-talk - women tend to appraise events are more stressful - most robust finding is that women are more likely to seek emotional support
Recovery Process: immediate phase
0-48hrs post trauma; many report significant distress during this period (debriefing)
Recovery Phase: chronic phase
1 month onward; 10% develop PTSD
Mindfulness-based stress reduction (MBSR)
8-week group workshop taught by certified trainers; weekly group meetings, homework, and instruction in 3 formal techniques: mindfulness meditation, body scanning, hatha yoga
Mindfulness
Ability to direct and sustain one's attention to the present moment in an accepting and nonjudgmental way; experiencing the present moment with compassion and openness, reduces tendency to avoid (which we know is generally unhelpful)
Which of the following statements about mindfulness is most accurate? a. as a new therapy, it has not received much research attention b. many studies support its efficacy c. awareness is the most effective component d. it was development by Albert Ellis
B
Avoiding emotions associated with a stressor is an example of which type(s) of coping strategy? a. problem focused strategy b. avoidance based strategy c. emotion focused strategy d. approach based strategy
B and C
Treatment elements common to PE and CPT and to theories of the development of PTSD
Behavioral strategies designed to decrease avoidance (exposure); cognitive strategies (identifying and changing maladaptive thoughts that contribute to distress)
Psychological debriefing... a. is recommended for treating acute trauma symptoms b. is recommended for treating immediate trauma symptoms c. is not recommended for treating immediate trauma symptoms d. is effective for preventing PTSD
C
Eye movement desensitization and reprocessing
Clients describe trauma memory while moving eyes back and forth following therapist's finger; eye movements are proposed to facilitate info processing and integration; controversial
Coping Definition
Cognitive and behavioral efforts to manage the internal and external demands of situations that are appraised as stressful
Psychological first aid IS recommended in the immediate aftermath
Components - protecting from further harm - opportunity to talk without pressure - active listening - compassion - addressing and acknowledging concerns - discussing coping strategies - social support - offer to return to talk - referral
Which of the following is NOT a methodological problem in coping research? a. coping studies tend to ignore the context of the stressor b. coping studies tend to focus only on an individuals coping strategy c. coping measures are often completed retrospectively d. coping measures are too long to be completed daily
D
which of the following is not one of the main dimensions of coping strategies? a. emotion focused b. avoidant c. approach d. support seeking
D
Cognitive Techniques
Detecting and changing distorted thinking
Cognitive Processing Therapy
Developed for rape-related PTSD - Focuses more on changing thoughts and interpretations of the event (self blame and overgeneralization) - Also involves exposure (write detailed account of the trauma and read it daily)
Problem Focused coping
Efforts to solve or change the stressor itself (problem solving)
Use of checklists
May miss important strategies - solution: narrative studies
Progressive Muscle Relaxation
PMR is systematic tensing and relaxing of muscle groups
Two most recognized PTSD treatments
Prolonged exposure and cognitive processing therapy
psychological debriefing
Single session; within a few hours or days after trauma; includes psychoeducation about stress reactions and emotional processing of event; goal is to prevent PTSD; widely used in 90s-2000s
Tend and befriend theory
Under conditions of threat, tending to offspring and affiliating with others are common responses in humans. These responses may be particularly characteristic of women. Women's responses to threat would have evolved to protect themselves and their offspring
Recovery Process: acute phase
a few days to 1month post-trauma; distress diminishes greatly for most people during this phase
Approach coping
active efforts to do something about the stressor or its emotional consequences (problem solving or seeking support)
Cognitive behavioral interventions ___ ________ in preventing PTSD in those with ASD
are effective
Why people use different coping strategies: Childhood trauma
associated with lower perceived control over stressors and more avoidant coping
Coping strategies that have medium to large associations with increased psychopathology
avoidance, rumination, and suppression
Problem focused avoidance
avoiding dealing with the stressor/problem
Avoidant coping
avoiding or withdrawing from the stressor or thoughts about it (not thinking about it; withdrawing from others)
emotion focused avoidance
avoiding the emotions associated with the stressor
Mindfulness is ______ than no treatment and ______ to evidence based therapies like CBT
better; equal
Individualistic focus
ignores how other people in their lives cope or how they might cope together - solution: dyadic studies
Why people use different coping strategies: personality
coping strategies are personality-congruent (extraversion associated with support seeking; relations are stronger with retrospective coping measures)
PTSD symptoms _______ more if you do nothing if you provide debriefing
decrease
Bad coping strategies especially bad for...
depression and anxiety
Emotion focused approach
directly trying to deal with the emotions associated with the stressor
Problem focused approach
directly trying to solve the problem/stressor
Studies ignore context of coping
efficacy of coping strategies depends on nature of stressor - solution: examine situation-strategy fit
Emotion Focused coping
efforts to reduce or manage the distress from the stressor (seeking emotional support)
Avoiding problems, ruminating about problems, suppressing thoughts and feelings is associated with
poorer mental and physical health in correlational, longitudinal, and experimental studies.
Retrospective Reports
problems with recall; dont capture dynamic nature of coping - solution: daily dairy coping studies
Process model of emotion regulation
process by which people influence which emotions they have, when they have them, and how they experience and express these emotions
Rumination may ________ activation of the negative emotional response to stress and the corresponding physiological response, including ________ levels of cortisol
prolong; increased
What treatment is most effective for PTSD?
psychotherapy had bigger effects than medications on PTSD (CBT, EMDR, psycodynamic)
Small correlations between ______ and ________ and physical health
reappraisal and problem solving
Stress interventions ______ distress for college students
reduce
Primary interventions
reduce the sources of stress at work (job redesign); positive effects on perceived job control, quality of feedback, well-being; no effects on performance, psychological contract fulfillment
How might mindfulness work?
reperceiving: standing back and taking a more objective view of your emotions; changing one's relationships with thoughts rather than the thoughts themselves (i am depressed vs. these depressive thoughts are not me"
Personality traits are most strongly related to
retrospective measures of coping
CBT
situation (what triggers the problem) -> thoughts (what goes through my head) -> emotions (how do I feel?) -> behavior (what do I do?) -> physical reactions (how does my body react?) ->
Positive reappraisal, acceptance, problem solving, and positive religious coping generally have ______ relations with distress and poorer physical health in correlational studies
small
Relations between personality and coping are ______ to ________ but can add up over many stressors
small to moderate
Tertiary Interventions
treat health conditions (employee assistance programs)
Why people use different coping strategies: Gender differences
women tend to use most coping strategies more than men, perhaps because they tend to appraise events as more stressful. Most robust finding is that women are more likely to seek emotional support than are men, consistent with gender roles and perhaps evolution