ReviewEffects of appraisal and coping on the neuroendocrine response to extreme stress
Introduction
In the general population 5–6% of men and 10–12% of women suffer from PTSD at some point in their lives, making it the fourth most common psychiatric disorder (Breslau et al., 1991, Resnick et al., 1993, Kessler et al., 1995). In patients with PTSD, studies have shown alterations in brain structures and functions, dysregulation in the neuroendocrine system, psychophysiological abnormalities as well as increased somatic symptoms and illnesses. Although 50–60% of individuals experience a traumatic event in their life, only a minority develops PTSD, depression or other psychiatric or physical disorders (Kessler et al., 1995). It is yet unclear why some people show extreme psychobiological dysregulation due to traumatic events whereas others do not, or why people develop different types of psychopathology.
Our hypothesis is that individual differences in the specific appraisal of the traumatic event and in subsequent coping behavior are crucial in determining outcome. In the stress literature cognitive theories do identify appraisal and coping as critical mediators of stressful person–environment relations and their psychobiological outcomes (Lazarus, 1996, Olff et al., 1993, Ursin and Olff, 1993, McEwen, 1998, Biondi and Picardi, 1999, Olff, 1999, Ursin and Eriksen, 2004). However, these effects have rarely been established in the context of extreme or traumatic stressors (Spaccarelli, 1994, Aldwin and Yancura, 2004).
In the trauma literature there is evidence for the fact that the development of PTSD is associated with specific appraisals (McNally, 2003, Ehlers et al., 1998) and coping styles (Aldwin and Yancura, 2004). It has also been shown that peritraumatic dissociation and specific acute physiological reactions to extreme stressors are implicated in the development of posttraumatic stress disorder (PTSD) or depression (Bryant, 2003, Shalev et al., 1998a, Shalev et al., 1998b, Shalev et al., 2000). However, there is very little information on how appraisal and coping affect the neuroendocrine responses to trauma. In the present paper the focus is on this latter issue. First, the neuroendocrine response to normal and traumatic stress will be described. Secondly, the (traumatic) stress literature will be reviewed with regard to associations between stress appraisals and neuroendocrine responses to stressors. Subsequently, findings concerning relationships between different types of coping and neuroendocrine data are described. Finally, these findings will be integrated in a model of the psychobiology of traumatic stress-coping in adults.
Section snippets
The neuroendocrine stress response
Two neuroendocrine response systems have been described for specific stress-coping patterns. In the event the subject has to ‘fight or flight’ or has to put an effort to control the situation, adrenergic mechanisms in both central nervous system (CNS) and the peripheral sympathetic nervous system (SNS) are activated. These systems respond with in seconds to threats to homeostasis with the release of neurotransmitters (catecholamines) in the adrenergic system. This sympathetic stress response
Stress-coping
Cognitive appraisal refers to the perception, interpretation and evaluation of the stressor. It is the first step in a cascade of responses, as shown in the stress model in Fig. 1 adapted from Olff (1999). After the appraisal phase the emotional, behavioral and physiological responses are determined by the subject's specific coping and defense strategies. Defensive coping will by definition affect the appraisal of the stressor. The distorted perception of reality serves to keep the threatening
Cognitive appraisal and neuroendocrine responses
The appraisal process, reflecting the person's subjective perception, interpretation and evaluation of the event, is the crucial first step in the cascade eventually leading to symptoms (Frazier et al., 2002). For instance, negative appraisals of stressors lead to the release of cortisol and increase the vulnerability to depression (Buchanan et al., 1999). Given that cortisol is not released until the situation is perceived as noxious, the cognitive ability to evaluate events is the key in the
Coping and neuroendocrine responses
After the appraisal phase, the choice of coping strategies through which individuals either attempt to change the stressful reality or to regulate their emotional reactions codetermines whether an experience is associated with severe symptoms or recovery (Lazarus, 1996). In stress research it is well known that how individuals cope with problems does have an effect on their physiology (Biondi and Picardi, 1999, Aldwin and Yancura, 2004), and subsequently on stress-related mental and physical
A conceptual model
Evidence does suggest that acute extreme stress and chronic severe stress are associated with the onset of stress-related disorders, possibly through their effects on neuroendocrine stress systems. More generally, whether a particular response to extreme threats is adaptive or maladaptive is a function of numerous factors of which the environment of the individual is of great importance. Normal adaptive responses to extreme stress can under certain psycho-sociocultural conditions become
Future research directions
First of all, it should be mentioned that research findings on coping are difficult to draw together due to the wide variety of different operational definitions of coping that have been employed (Skinner et al., 2003). Consensus about how to conceptualize or measure ways of coping would be very helpful in future research concerning links between coping to adaptive processes. Furthermore, trauma research should include measures of new facets of the coping process being discussed in the broader
Concluding remarks
Acknowledging the important implication of appraisal and coping for interventions designed to alleviate posttraumatic stress (Saakvine et al., 1998, Ehlers and Clark, 2000), because these variables are more amenable to change than neuroendocrine response, further research among trauma victims focusing on these variables is warranted. That cognitive appraisal and coping may represent important targets for trauma treatments, has been indicated by a randomized controlled study of effects of
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