UNDERSTANDING PSYCHOPATHOLOGY

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UNDERSTANDING PSYCHOPATHOLOGY

• Psychology and Physical Health

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OVERVIEW

• Definition of stress
• Measurement of stress
• Discrimination-- a sociocultural risk factor
• Improving health through changing modifier
  variables

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WAYS OF THINKING ABOUT STRESS

• Hans Selye, MD (1926) Stress is the
  non-specific response of the body to any demand
  placed upon it. Stress is not even necessarily
  bad for you it is also the spice of
  life. Stress is an abstraction it has no
  independent existence.

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WAYS OF THINKING ABOUT STRESSORS STRESS

• Mind Tools (www.mindtools.com) Stress
  is anything that stimulates and increases your
  alertness (stimulus). Major sources Survival
  (fight or flight) Self-generated worry, anxious
  behavior Living or working environment Long-ter
  m fatigue and overwork.

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WAYS OF THINKING ABOUT STRESSORS STRESS

• Janice Wheeler (www.amican.com)
• Even a vacation in Bermuda only lasts a
  few days when you get back. The single biggest
  reason for stress is incomplete cycles of
  action.It is not what you got done that stresses
  you, its what you DIDNT get done!

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WAYS OF THINKING ABOUT STRESS

• Lyle Miller and Alma Dell Smith
• The road to burnout is paved with good
  intentions and unrealistic expectations,
  proceeding by stages that blend into each other
  smoothly and imperceptibly the
  honeymoon-awakening-brownout- full scale
  burnout-phoenix

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DEFINITION OF STRESS

• Lazarus Demand on a system in context whereby
  the demand exceeds the systems resources
• Key elements of a stressful event
• overload (harm or threat of harm)
• unpredictability
• uncontrollability

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EXAMPLE RISK FOR CORONARY HEART DISEASE BY JOB
CHARACTERISTICS OF DEMAND AND CONTROL (LATITUDE)
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STRESS ISSUES TO CONSIDER

• Objective versus subjective demand
• Acute versus chronic
• Domino effect
• Cause versus consequence

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STRESS BURNOUT SIGNALS

• Fatigue, deep sighs
• Negative emotions frustrated, angry,
  dissatisfied, anxious, depressed gt often
• Lower performance clockwatching
• Substance abuse

• Health problems sleep, eating, colds ,
  headaches, BP up
• Interpersonal conflicts
• Deadline driven
• Isolation, cynicism
• Sense of failure, guilt
• Overwhelmed

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BURNOUT

• A possible response to prolonged stress
• Particularly likely to occur when an individual
  experiences a loss of satisfaction previously
  experienced or anticipated from the work situation

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WAYS OF THINKING ABOUT BURNOUT

• Mark Gorkin, LCSW (www.stressdoc.com) Bur
  nout is less a sign of failure and more that you
  gave yourself away Burnout is not for
  wimps. A lot of other folks would have jumped
  ship much earlier.

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BURNOUT

• Doing too much/expecting too much
• Nourishing/protecting too little
• Mismatch between job demands and nature of worker

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BURNOUT

• Blame the person?
• Character flaws
• Behavior problems
• Limitations
• Weaknesses
• Competing interests
• Poor motivation

• Blame the system?
• Leadership flaws
• Management problems
• Limitations
• Weaknesses
• Competing interests
• Poor motivation

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SOURCES OF STRESS

• Traumatic events
• Major life events
• Chronic difficulties
• Daily hassles
• Conflicts

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SOURCES OF STRESS

• Traumatic events
• outside the range of usual experience
• Major life events
• major life changes that disrupt usual activity
• Chronic difficulties
• problems that require more or less continuous
  adjustments

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SOURCES OF STRESS

• Daily hassles
• minor demands individuals face daily
• Conflicts
• situations where one must chose between
  incompatible courses of action

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STRESS TUNE-UP

• Assessment of current level of stress
• --objective exposure
• History of trauma
• PTSD Module, SCID
• Experience of major life events, past year
• Recent Life Changes Questionnaire (Holmes Rahe)

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STRESS TUNE-UP

• Assessment of current level of stress, subjective
  experience
• Perceived stress is the degree to which
  respondents perceive their life situations to be
  stressful, i.e., unpredictable, uncontrollable,
  overloading.
• Life Experience Survey (Sarason et al., 1978)
• Perceived Stress Scale (Cohen et al., 1983)

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PERCEIVED STRESS SCALE (1 never to 5 very
often)

• In the last month, how often have you.
• been upset because of something that happened
  unexpectedly?
• felt that you were unable to control the
  important things in your life?
• dealt successfully with irritating life hassles?
• Felt that you were effectively coping with
  important changes that were occurring in your
  life? (reverse)

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STRESS TUNE-UP (objective exposure)

• Daily hassles
• Daily Hassles Scale (Lazarus Folkman, 1989)
• Experience of chronic difficulties
• various stress inventories include questions
  about chronic difficulties

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STRESS TUNE-UP THE ROLE OF CULTURE

• Experience of racism
• Denigration of individuals because of their
  phenotypic characteristics or ethnic affiliation
  (Clark et al., 1999, p.805)
• Racism involves harmful and degrading beliefs
  and actions expressed and implemented by both
  institutions and individuals. (Gee, 2002, p.
  615)

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STRESS TUNE-UP THE ROLE OF CULTURE

• Acculturative stress
• Immigration
• Navigating the expectations of two cultures
• Generational differences in beliefs and values in
  immigrant families

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STRESS TUNE-UP THE ROLE OF CULTURE

• Experience of racism
• no standard measure available for objective
  measurement
• several perceived racism scales have been
  developed (e.g., Schedule of Racist Events,
  Landrine Klonoff, 1996)
• Acculturative stress
• several measures debate about definition of
  acculturation

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CLARKS MODEL OF THE RELATIONSHIP BETWEEN RACISM
AND POOR HEALTH
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ASSESSMENT OF MODIFIER VARIABLES

• Biological factors
• Psychological factors
• Social factors
• Cultural factors

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STRESS -- HEALTH LINKMODIFIER VARIABLES

• Biological factors
• General health
• Predisposition (e.g., blood pressure reactivity
  to stress)

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STRESS -- HEALTH LINKMODIFIER VARIABLES

• Psychological factors
• Coping/resourcefulness/problem solving ability
• Defense mechanisms
• Perception of control
• Personality traits (e.g.,Type A hardiness)

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STRESS -- HEALTH LINKMODIFIER VARIABLES

• Social factors
• Social support
• Cultural factors
• Cultural beliefs and attitudes cultural practices

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COPING

• Cognitive and behavioral efforts to manage a
  situation that one appraises as stressful.
  (Lazarus, 1990)
• What characterizes successful coping?

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Workplace Sources of Stress

• Overload
• Lack of control
• Insufficient reward, recognition
• Breakdown of community
• Lack of fairness
• Values conflict

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Ideal Workplace

• Safe and healthy
• Flexible schedules
• Fulfill potential, employee input
• Intrinsically rewarding work
• Fair compensation
• Human values, collegiality
• Excellent products, services

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TEAMS

• Working group characterized by high energy
  directed toward accomplishing an organizations
  goals
• Teams are necessary when tasks cannot be achieved
  by individuals working in isolation
• Team work results in product/process beyond the
  capabilities of individual members

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EFFECTIVE TEAMS

• Effective leadership
• Role clarity
• Clarity of procedures
• Open climate
• Membership mix
• Inter-group relations

• Commitment
• Cohesion
• Constructive criticism
• High creativity
• Achievement motivation

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INEFFECTIVE TEAMS

• Aggregation
• Internal Conflict
• Scapegoating
• Reactivity
• Indecision Inertia
• Task incompletion
• Meeting aversion
• Dishonesty

• Turnover
• Performance decline
• Authoritarianism
• Helplessness
• Asynchrony
• Incidents Accidents
• Hints Allegations
• Formality

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WAYS OF COPING

• Problem-focused engagement
• problem solving cognitive restructuring
• Problem-focused disengagement
• problem avoidance wishful thinking
• Emotion-focused engagement
• seeking social contact expressing emotions
• Emotion-focused disengagement
• social withdrawal self-criticism

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COPING WITH STRESS AND BURN-OUT

• Self-advocacy
• Getting help
• Making and taking time
• Reconciling work and home
• Working and staying healthy
• Doing good and having fun

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CHANGING HABITS

• Start with glimmers of awareness
• Form links between awareness behavior
• Brainstorm alternatives
• Chart course and time frame
• Acknowledge shifts in time, sequence
• Reward near misses
• Fine tune memory and action