Stress

and
psychiatry
 Learning Objectives
 At the end of the presentation, student should
able to
1. Categorize the biological perspectives
intricately involved in stress
2. Justify the effect of the stress on the psyche
3. Explain coping mechanisms
4. Label Psychopathology development
secondary to stress
 The term ‘stress’ was coined by Hans Seyle. He
invoked the adreno cortical system as the crucial
responder to stressful situation.

 Stress is a term like, neurosis or hysteria, ripe

with years of reference, conveying both
information and vagueness.
 Physiological responses to stressors-

Much is known about the physiological response

to acute stress but less is known about the
response to chronic stress.
a) Neurotransmitter response to stress-
Stressors activate non adrenergic system &cause
release of catecholamines from the autonomic
nervous system & serotonergic system as
evidenced by increased serotonin turnover. Stress
also increases dopaminergic neurotransmission.
b) Endocrine responses to stress- In response to
stress, CRF is released from hypothalamus into the
hypophysial-pituitary-portal system. CRF acts at
anterior pitutiary, release ACTH, it acts at the adrenal
cortex & release glucocorticoids.It increases
cardiovascular activity, inhibit growth reproduction &
immunity
c) Immune responses to stress-
Stress inhibits the immune functioning by
glucocorticoids Stress can also cause immune
activation by releasing epinephrine, norepinephrine,
interleukin-1 & interleukin-6.
 Treatment
A) If the picture is primarily one of anxiety or
insomnia-pharmacotherapy can be helpful.
B) When major psychiatric conditions such as
depression or psychosis are present, the most
appropriate medications are those for the
Axis-1 diagnosis.
This intervention, in association with
supportive psychotherapy is extremely
effective in crisis intervention.
 Cognitive behavioral approaches to stress
management:
Used to help individuals better manage their
responses to stressful life events. Cognitive
appraisals about stressful events & the coping
efforts related to these appraisals play a major role
in determining stress responding.
 1) To help individuals become more aware of
their own cognitive appraisals of stressful
events.
 2)To educate individuals about how their
appraisals of stressful events can influence
negative emotional & behavioral responses & to
help them re-conceptualize their abilities to alter
these appraisals.
 3)To teach individuals how to develop &
maintain the use of a variety of effective
cognitive & behavioral stress management skills.
 Stress management training
5 skills form the core of almost all stress
management program.
 1)Self observation
 2)Cognitive-restructuring
 3)Relaxation training
 4)Time management
 5)problem solving
 1) Stress observation:-
Patients keep a daily record of their behavior.
Entries are made in 3 columns- antecedents,
behaviors, consequences.
 In the antecedent column-pts. record a specific
environmental event that they perceived as
stressful.
 In the behavior column-pts. record their
cognitive & behavioral reactions to the stressful
event.
 In the consequences column-pts. record the
outcomes resulting from their behavior in this
particular situation.
 Self observation is effective because-
 1) It makes individuals aware of the behaviors
they usually fail to notice.
 2) It helps individuals see how their cognitive-
behavioral responses are linked to situational
antecedents & consequences.
 3) It makes individuals aware of how they might
change their behavior more effectively to
manage stress.
 2) Cognitive restructuring

 A) To help participants become aware of &

change their maladaptive thoughts, beliefs,&
expectations
 B) To monitor and analyze dysfunctional
thoughts as dysfunctional thoughts can be linked
to a negative emotion.
 C) To challenge and change cognitive distortions.
Participants are provided with a list of key
questions that can be applied to their own
negative thoughts.
They select 1 or 2 questions to identify underlying
problem Finally ,participants develop rationale
response that represents a more accurate and
helpful cognitive response.
3. relaxation training:
It can be very helpful in managing stress. When
individuals are allowed to relax, muscle tension
is reduced, able to think more rationally and
restructure negative cognitions when faced with
stressful events.
 Jacobson relaxation training (traditional)-
The pt. is instructed to focus on sensations that
occur when tensing a single muscle group , then
to release the tension & study physical
sensations.
It is effective but requires substantial
time commitment.
4) Time management-
It is designed to enhance awareness of current pattern
of time use.
A) Person is asked to maintain record of daily
activities, list important areas, to calculate the time
spend in these activities & ask about the time he
would like to spend in these activities.
Then accordingly make changes.
B) It is designed to help individuals set their priorities.
 All activities divide into 4 groups:
I. Urgent-Important
II. Urgent-Not important
III. Not urgent-Not important
IV. Not urgent-Important
C) Goal setting- Individual is asked to identify,
analyze a goal & to ensure that it is reasonable,
specific, & meaningful, then to reconfirm a time
frame. Successful completion is rewarding,
failure may be due to that the goal was set high
or person lacks the skills necessary to achieve
the goal.
 5) Problem solving-
Introduced in the later stages. Basic steps:
A) Problem identification-
One tries to identify the key problematic aspects
of a stressful event, such as problematic
behavior, thoughts, feelings & physiological
responses.
e.g. dealing with the aftermath of hurricane may
be perceived as stressful.
B) Generating alternatives-
Brainstorming is used to generate alternative
problem solutions.
Rules of brainstorming:
o Individual offers as many as solution as he can.
o No criticism is allowed.
o Attempt to mix & match solutions in creative
ways.
C) Evaluating the alternatives & selecting the best
solution-
A participant can be asked to rate the likelihood
that each solution will have a positive outcome.
Typically one solution stands out as the best &
most important.
D) Implementing the solution-
Participants try to apply the best solution in the
problem situation & then review their progress
with therapist.
 SUMMARY
1. Biological perspectives intricately involved in
stress
2. Effect of the stress on the psyche
3. Coping mechanisms
4. Psychopathology development secondary to
stress
Thank you
 Bibliography
 Friedman MJ, Charney DS, Deutch AY, eds.
Neurobiological and Clinical Consequences of Stress:
From Normal Adaptation to Post-Traumatic Stress
Disorder. Hagerstown, MD: LippincottRaven; 1995.
 Gil KM, Ross SL, Keefe FJ. Behavioral treatment of
chronic pain: Four pain management protocols. In:
France RD, Krishnan KRR, eds. Chronic Pain.
Washington, D.C.: American Psychiatric Press; 1988.
 Goldfried MR, Davison GC. Clinical Behavior Therapy.
New York: Holt, Rinehart, & Winston; 1976.