A Clinical Guide to the Treatment of the Human Stress Response

481 Pages·2002·9.172 MB·English

by  George S. Everly Jr., Jeffrey M. Lating (auth.)

A Clinical Guide to the
Treatment of the
Human Stress Response
Second Edition
The Plenum Series on Stress and Coping
Series Editor:
Donald Meichenbaum, University of Waterloo, Waterloo, Ontario, Canada
Current Volumes in the Series:
BEYOND TRAUMA
Cultural and Societal Dynamics
Edited by Rolf J. Kleber, Charles R. Figley, and Berthold P. R. Gersons
A CLINICAL GUIDE TO THE TREATMENT OF THE HUMAN STRESS
RESPONSE
Second Edition
George S. Everly, Jr. and Jeffrey M. Lating
CREATING A COMPREHENSIVE TRAUMA CENTER
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Edited by Ellen Gerrity, Terence M. Keane, and Farris Tuma
PSYCHOTRAUMATOLOGY
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STRESS, CULTURE, AND COMMUNITY
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Edited by John R. Freedy and Stevan E. Hobfoll
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A Clinical Guide to the
Treatment of the
Human Stress Response
Second Edition
George S. Everly, Jr.
Loyola College in Maryland and
The Johns Hopkins University
Baltimore, Maryland
and
Jeffrey M. Lating
Loyola College in Maryland
Baltimore, Maryland
KLUWER ACADEMIC PUBLISHERS
NEW YORK,BOSTON, DORDRECHT, LONDON, MOSCOW
eBookISBN: 0-306-47800-5
Print ISBN: 0-306-46620-1
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To Marideth Rose Everly and to George S. Everly, Sr.,
both of whom have taught me some of the most important
lessons in life that I have ever learned
GSE
To Austin and Jenna, I am so grateful for the immense love,
joy, and balance you have brought to my life.
JML
Preface to the Second Edition
Over a decade has passed since the first edition of this critically acclaimed
volume was published. Much is new, but much has remainedthesame. The
reader will find that the primary efferent biological mechanisms of the stress
response are largely the same as described in 1989. This underscores the bril-
liance of Selye, Cannon, Mason, Gellhorn, and Levi as they sought to eluci-
date the anatomical and physiological constituents of human stress. New
information has been generated regarding the microanatomy, biochemistry,
and genetic aspects of the human stress response. Furthermore, the anatomy
and physiology of posttraumatic stress has been more thoroughly elucidated.
The important role of cognitive processes in the determination of subse-
quent stress arousal remains underscored and has been empirically validated
by subsequent research (Smith, Everly, & Johns, 1992, 1993). The “rediscov-
ery” of the importance of positive psychology and optimism is consistent
with our earlier etiological emphasis upon the cognitive–affective domain in
the overall phenomenology of human stress.
But there have been even more dramatic changes in the field of
human stress since our first edition was published. Since then, we have dis-
covered that the stress response can affect virtually every cell in the human
body, not only by virtue of direct neural, neuroendocrine, and endocrine
mechanisms, but also by the more recent realization that psychological
processes, through stress response mechanisms, can dramatically affect the
human immune system, and as a result, one’s vulnerability to autoimmune
and communicable diseases. We have included a special chapter on the
immune system to update and emphasize this important phenomenon.
Since the first edition was published, interest in posttraumatic stress
has dramatically increased. School shootings, mass disasters, “airline rage,”
“road rage,” violence in the workplace, and of course terrorism in the wake
of September 11, have emerged as important stress-related issues. To
vii
viii PREFACE TO THE SECOND EDITION
respond to this interest, we have not only revised and expanded our chap-
ter on posttraumatic stress, but we have also included a new chapter on cri-
sis intervention as an empirically validated intervention for the mitigation
of dysfunctional and disabling posttraumatic stress reactions.
Numerous clinical innovations have emerged since the first edition
was published. Interventions such as Eye Movement Desensitization and
Reprocessing (EMDR), Critical Incident Stress Debriefing (CISD), Crisis
Management Briefings in response to mass disasters and terrorism, and
Critical Incident Stress Management (CISM) have generated interest and
programmatic utilization. Therefore, we have included a special section on
innovations in clinical practice.
Since the first edition was published, a new interest in spirituality and
religion as stress management tools has emerged. Spirituality, religion, and
faith appear to exert generally positive effects upon health. In response, we
have included a new chapter on these topics.
Dramatically new information has emerged in the area of dietary
factors and stress. Dietary sympathomimetics, antioxidants, and cholesterol
are all topics addressed in a new chapter on diet and stress.
Since the first edition was published, psychopharmacological inter-
vention in the human stress response has significantly changed. The advent
of selective serotonergic reuptake inhibitors (SSRIs) and increasedutiliza-
tion of anticonvulsant medications has expanded the basic pharmacopeia
for the treatment of human stress.
Finally, new perspectives and research have emerged relevant to topics in
our original edition, necessitating an updated presentation of those topics.
We believe that these additions, along with our efforts to update pre-
viously addressed topics, will make this textbook useful to students, prac-
titioners, and faculty in the fields of psychology, psychiatry, medicine,
nursing, social work, public health, business administration, and even pub-
lic safety and emergency services. We hope that these updates will once
again make this volume the standard textbook for the understanding and
treatment of the human stress response.
GEORGES.EVERLY,JR.
JEFFREYM.LATING
Acknowledgments
George S. Everly, Jr. wishes to thank the following individuals for their con-
tributions, either direct or indirect, to the creation of this second edition:
Theodore Millon, Ph.D., D.Sc., for his continued mentorship, Bertram
Brown, M.D., M.P.H., for his support and guidance in international affairs,
Jeffrey T. Mitchell, Ph.D., for his friendship and support over the last
decade, but most of all, he thanks his family.
Jeffrey M. Lating wishes to thank Wayne Campbell, M.D., for his
expertise and early review of the chapter on psychoneuroimmunology, and
Stephen Bono, Ph.D. for his guidance, friendship, and support. Thanks
also to Amos Zeichner, Ph.D., Don Wilmes, Ph.D., Lee McCabe, Ph.D.
and Jennifer Haythornthwaite, Ph.D. for their continued mentorship. He
would also like to thank his wife, Kathy Niager, Ph.D., whose patience and
tolerance enables him to stay focused on his work.
Finally, both authors would like to thank Melvin Gravitz, Ph.D.,
Roger Page, Ph.D., Jason Noel, Pharm.D., Judy Curtis, Pharm.D. and
Kristy Kelly, B.A. for their scholarly contributions. They are also indebted
to Kristy Kelly, Jan Warrington, Psy.D., Thomas Winston Thorpe, Doris
Manner, Nina Morrison, Phyllis Grupp, KristyBurroughs, Mike D’Imperio,
and Joanne Newbert for their editorial and production assistance in the
development of the text, Dan Vaught and Steve Beck for their artistic con-
tributions, and Eliot Werner, Sharon Panulla, Herman Makler, and Donald
Meichenbaum, Ph.D., for their useful suggestions.
ix
Contents
I: THE NATURE OF HUMAN STRESS
1. The Concept of Stress 3
Stress, Behavior, and Health 3
Defining Stress 6
Ten Key Concepts in the Study of Stress 7
Plan of the Book 14
2. The Anatomy and Physiology of the
Human Stress Response 15
Neurological Foundations 16
Neural Transmission 16
Basic Neuroanatomy 18
A Systems Model of the Human Stress Response 23
Stressor Events 25
Cognitive-Affective Domain 26
Neurological Triggering Mechanisms 28
The Stress Response 29
The Stress Response: A Summary 40
Target-Organ Activation 42
Coping 44
Summary 46
xi
xii CONTENTS
3. The Link from Stress Arousal to Disease 49
Selye’s “General Adaptation Syndrome” 50
Lachman’s Model 51
Sternbach’s Model 52
Kraus and Raab’s “Hypokinetic Disease” Model 53
Schwartz’s “Disregulation” Model 54
Conflict Theory of Psychosomatic Disease 55
Everly and Benson’s “Disorders of Arousal” Model 56
Summary 60
4. Stress-Related Disease: A Review 63
Gastrointestinal Disorders 63
Gastrointestinal Physiology 64
Peptic Ulcers 65
Ulcerative Colitis 66
Irritable Bowel Syndrome 66
Esophageal Reflux 67
Cardiovascular Disorders 67
Cardiovascular Physiology 68
Essential Hypertension 70
Vasospastic Phenomena 71
Myocardial Ischemia and Coronary Artery Disease 72
Respiratory Disorders 73
Allergy 73
Bronchial Asthma 73
Hyperventilation 73
Musculoskeletal Disorders 74
Skin Disorders 74
Psychological Manifestations of the Stress Response 75
Summary 77
5. Psychoneuroimmunology 79
Immune System 80
Innate Immunity 80
Acquired Immunity 81
Cell-Mediated Processes 82
Humoral Responses 83