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