- examines the relationship between psychological behavior and physical health

-Deals with psychology’s contributions to the diagnosis, treatment, and prevention of psychological components of physical problems

-things on Axis 4 that start to cause physical and psychological problems

Stress is the body’s non-specific response to any demand made on it.

Any adjustment demand that creates a state of tension or threat and that requires change or adaptation.

The adjustive demands placed on an organism (a.k.a. stressors)

The organism’s internal biological and psychological responses to such demands

Stress is a by-product of poor or inadequate coping and the perceived ability to cope with the situation.

Both eustress (positive stress) and distress (negative stress) tax a person’s coping skills

-Neustress- neutral stress that comes and goes like watching the news

Stress is how we perceive it

• The nature of the stressor
• How important is the stressor to you? How close is it to your goals?  More important= more stress
• The experience of crisis
• When the situation exceeds our coping skills. When we no longer feel like we have control
• Life changes
• Life changes do not happen often. Can be bad if they do.
• A person’s perception of the stressor
• Perception: can we control it? Can we adjust and still be happy?
• The individual’s stress tolerance
• Sometimes we can handle more stress
• A lack of external resources
• and social supports
• Sometimes we can handle more stress
  A person who is lacking in friends and family will not be able to handle stress as well as someone who has a lot of social support

The sympathetic portion of the autonomic nervous system is activated during stress.

(Sympathetic and Parasympathetic exist)

Increased heart rate, muscle tension, blood pressure – fight or flight symptoms appear

Release of cortisol – stress hormone

These physiological changes use up energy and can be sustained for only a period of time.

Prolonged stressor exposure leads to exhaustion and death.

GAS- developed by hans Selie in 1926

People in the early phases of disease experience the same symptoms

3 Phases:

Alarm- Body mobilizes energy to defend against stressor.

Resistance- Arousal declines somewhat.  People may develop diseases of adaptation.

- The body trying to work over time and we ignore it

Exhaustion- Energy becomes depleted.  Ability to resist stressors may collapse.

 -when the long term resistance has finally given up . Life sustaining mechanism start slowing down and organs break down. Leads to burnout.

- the study of interaction between the nervous system and the immune system

- in the immune system specialized white blood cells respond to the antigens such as viruses and bacteria

- stress can weaken the immune system

can cause heart problems and cancer

Hypertension (high blood pressure) is more common among

In younger adults greater in men, after age 50 greater in women. after menopause high blood pressure is greater in women 

People who do not use anger constructively

- if not used constructively it will come out in different ways

- anger is not a primary emotion, it is fueled by fear

Influenced by the following factors:

Depression & Anxiety- frustration

Social Isolation & Lack of  Social Support

Chronic  Stress

Four Main Personality Types

• Take things slower
• Use positive self talk
• Read books for enjoyment
• Leave your computer at home
• Avoid rushing meals
• Enjoy activities
• Develop relaxing interests
• Set realistic daily goals

Type B Characteristics

Socializer, extrovert, party person, love the spotlight and crave it. Love to be part of the group

High energy . Like excitement. Very supportive of their friends and family

Actors, 

Very important for type B people to be liked

 Type C Characteristics

The seekers, detail people

Thrive on details and being accurate

Very serious natured people, very neat and precise and calculated

They like life in a logical order

Accountants, cpas and engineers

Very reserved not risk takers. Need all the facts before they can make a decision

Type D Characteristics

People stick to a routine. Lower executives. No change Not risk takers. Prefer to have a standard set of guidelines. Motivated by security and benefits. Have a very high compassion level.

Punctual and consistent. They have balance

Secretaries, They can be boring. Prefer to be followers not leaders

Coping:  Managing stress in some effective way.  Homeostasis- acheiving equilibrium between mind and body

Self-efficacy-mhow effective you are in your environment and coping

Psychological hardiness- People with an Internal locus of control who can handle stress

Commitment, Openness to Challenge, Internal Locus of Control & Positive Attitude 

Optimism

Task-oriented  vs Defense-oriented- Task oriented people are better at dealing with stress , Defense people rely too much on emotion. 

Stress is easier to deal with when you remove emotion

• Relaxation minimizes the impact of the stress exposure.
• Exercise leads to physical fitness and good health.
• Reduces likelihood of illness
• Reduces negative impact of stress

Adjustment disorder

Response to a common stressor is maladaptive

Occurs within 3 months of stressor

Axis 1 disorder- after three months you should start to adapt. See this in clinical therapy 

Response to a common stressor

Unemployment, bereavement, separation or divorce , general life changes

This is Axis 4 stuff that makes axis 1 come alive

Helps to get people out and about volunteering joining groups etc.

PTSD is an anxiety disorder following exposure to a horrifying event.

Associated with severe symptoms:

Flashbacks:  Persistently re-experiencing the traumatic event through memories, dreams, thoughts.

Persistently avoiding stimuli and events associated with the trauma.

Chronic tension, irritability, and insomnia/nightmares

*Impaired concentration and memory

Feelings of depression

Reduced responsiveness

Increased arousal, anxiety & guilt

PTSD- normal reaction to a horrifying event. Rape, war etc

Acute Stress disorder- Within 4 weeks of the stressor. Symptoms- DE realization life happens like a movie

If symptoms continue to occur after 4 weeks it is called PTSD and people start having flashbacks

Plays havoc with their memory

dual Diagnoses and is usually paired with Depression

Half of all US adults will experience a traumatic event, but only 7.8% will develop PTSD 

Rates are lower in national populations with fewer disasters and lower crime

PTSD is twice as prevalent in women as in males

PTSD can occur with other disorders

Common in soldiers especially ones involved in abusive violence

Prisoners of war 

Victimization and Sexual Assault

Terrorism

• Psychotropic medications- SSRI's lower anxiety like wellbutrin
• EMDR- Eye movement desensitization and reprocessing fairly new. Moving the eyes back and forth using you finger while you are reliving the situation. Associated stimuli of the memory has been inadequately processed. When it is in an isolated place in your brain. 
• Individual & Family Therapy
• Group Therapy-PTSD people do better in group therapy and so do wife beaters due to their fragile egos. PTSD – finding out other people are dealing with it. 
• Stress Inoculation Training-Getting people ready and putting them through maneuvers so that they don’t freak out when something happens. 

Burnout develops slowly over time

Examples: loss of energy, mental and physical fatique

Increased irritability and proneness to anger

development of stress related disorders like headaches backaches, depression

changes in ones feelings toward work

loss of satisfaction

feeling like your commitment to the work is not there due to lack of energy

Health and energy are key aspects to minimize the damage produced by stress.

Positive beliefs & belief in personal control.  

Social support (network of friends and family) reduces stress impact.

Relaxation Training

Meditation

Hypnosis

Humor!

People who are ill and in the hospital who have visitors get better faster than those who don't

Anxiety Disorders 

Feelings of impending doom or disaster from an unknown.

Symptoms: sweating, muscular tension, and increased HR and BP

fear and anxiety response patterns

Fear and/or panic is a basic emotion that involves activation of the “fight-or-flight” response in the sympathetic nervous system. 

- marked by a minute long episode of intense dreadin which a person experiences intense dread, chest pain, choking, or other frightening sensation

can last anywhere from  few minutes to a few hours

has no apparent trigger and can come on suddenly

a feeling of apprehension about possible danger

 It is more oriented to the future and more diffuse than fear

It has cognitive/ subjective and physciological and behavioral components

Biological vulnerability- glass is half empty, irritable, driven, heritable contribution to negative effect

Specific Psychological vulnerability- hypochondriac non clinical panic. belief that physical sensations are dangerous

Generalized psychological vulnerability-  sense that events are uncontrollable or unpredictable,  lack of self confidence, low self esteem, inability to cope

have unrealistic or irrational fears or anxieties of disabling intensity as their most obvious manifestation

anxiety is inappropriate to the circumstances

unable to control anxiety

1. phobic disorders of the specific type
2. Phobic disorders of the social type
3. panic disorders with agoraphobia
4. panic disorder without agoraphobia
5. generalized anxiety disorder
6. OCD
7. PTSD

Unrealistic fear of some specific object activity or situation that presents little to no danger

- people remain comfortale as long as tehy avoid the object or situation

3 phobias of categories:

1. Specific phobia
2. social phobia
3. panic disorder with or without agoraphobia

16% of women and 7% of men suffer from phobias at one point in their life

phobias- a fear of a specific object or situation

-blood, spiders, etc

age of onset for different phobias varies widely

exposure therapy is  most commonly used

flooding and systemic desensitization

- participiant modeling

-combining cognitive techniques with exposure based therapy

involves disabling fears of one or more discrete social situations in which a person believes they are exposed to scrutiny and negative evaluation by others

evolutionary perspective

Treatments: exposure therapy

behavior and cognitive therapy training

medications

social skills training

Panic Disorder- characterized by unexpected panic attacks that appear to come out of the blue

accompanied with intense anxiety abotu having another one

agoraphobia- fear of being in a place  where escape is impossible

more prevalent in women than in men

50% of panic disorder people have additional diagnoses

3.5%- 4.7% of people have panic disorder at some point in their lives

Panic disorder has a mild heritable component

There are also several areas in the brain implicated in panic attacks

Anxiety about future attacks- limbic system

avoidance- hyppocampus

panic attacks- abnormal activity in the amygdala

cognitive theoryof panic

peceived control and anxiety sensitivity

biases leading to maintenance of panic

-tranquilizers and antidepressents

- cognitive behavioral treatments

extended version of panic disorder

may experience multiple episodes that may occur frequently or for a long duration

may have trouble sleeping, tense irritable

-Chronic or excessive worry about events or activities

-twice as common in women as men

- often co occurs with other axis one disorders - commorbidity

psychoanalytic viewpoint

role of unpredictable and uncontrollable events

content of anxious thoughts

function of worry

cognitive biases for threatening information

biological causal factors

- gentetic factors

functionary deficiency of GABA

neurobiological differences between anxiety and panic

defined by the occurance of unwanted and intrusive obsessive or distressing images

usuall accompanied by compulsive behavior that neutralize the obsessive thoughts or images

prevent some dreaded event or situation

these images differe from worries . Involve dirt or death etc

psychoanalytic viewpoint-

Behavioral viewpoint-effects of attempting to opress obsessive thoughts

biological link

In mood disorders, disturbances of mood are intense and persistent enough to be clearly maladaptive

severe mania

hypomania

normal

mild to moderate depression

severe depression

The two key moods involved are mania and depression

In unipolar disorders the person experiences only severe depression

In bipolar disorders the

person experiences both

manic and depressive

episodes

The lifetime prevalence of unipolar disorder is

13% for males

21% for females

The lifetime prevalence for bipolar disorder ranges from 0.4–1.6%

The diagnostic criteria for major depressive disorder require

That the person exhibit more symptoms than are required for dysthymia

5 symptoms of depression, lasting for 2 weeks or more.  

Subtypes of major depression include

Major depressive episode with melancholic features

Severe major depressive episode with psychotic features

Major depressive episode with atypical features

Major Depressive Disorder – intense depressed mood, reduced interest or pleasure in activities, and loss of energy for a min. of 2 weeks.

Seasonal Affective Disorder – seasonal depression that recurs usually during the winter months (usually in northern latitudes)

Treatment – UV lamps

The presence of at least 5 of the following symptoms during the same 2 week period

1. Depressed mood most for the day

Markedly diminished interest or pleasure in almost all activates

Significant weight loss or weight gain 

Insomnia or hypersomina nearly every day

Psychomotor agitation or retardation

Fatigue or loss of energy

Feelings of worthlessness or excessive guilt

Reduced ability to think or concentrate

Recurrent thoughts of death or suicide

2.  Significant distress or impairment

Stressful life events are linked to depression

Diathesis-stress models propose that some people have vulnerability factors that may increase the risk for depression

Family studies and twin studies suggest a moderate genetic contribution

Altered neurotransmitter activity in several systems is clearly associated with major depression

Hormones cortisol & melatonin may also play a role

Disruptions of the following may also play a role:

Sleep

Exposure to sunlight

Freud believed that depression was anger turned inward

Beck proposed a cognitive model of depression

The reformulated helplessness theory proposes that a pessimistic attributional style is a diathesis for depression

The hopelessness theory proposes that a pessimistic attributional style and one or more negative life events will not produce depression unless one first experiences a state of hopelessness

External vs. Internal Locus of Control revisited

Bipolar I & Bipolar II

Bipolar disorders are distinguished from unipolar disorders by the presence of manic or hypomanic symptoms

Some people are subject to cyclical mood swings less severe than those of bipolar disorder; these are symptoms of cyclothymia

Bipolar manic episodes

Manic Episode

Period of abnormal, expansive, or irritable mood lasting at least one week

Persistence of at least 3 of the following

Inflated self esteem or grandiosity

Decreased need of sleep

More talkativeness than usual or pressure to keep talking

Flight of ideas or racing thoughts

Distractibility increase in activity or psychomotor agitation

Excessive involvement in pleasurable activities that have a high potential for painful consequences

Significant distress or impairment

The presence of a hypomanic or major depressive episode

If currently in a major depressive episode, history of a hypomanic episode. If currently in a hypomanic episode, history of a major depressive episode.

No history of a manic episode

Significant distress or impairment

There is a greater genetic contribution to bipolar disorder than to unipolar disorder

Norepinephrine, serotonin, and dopamine all appear to be involved in regulating our mood states

Psychosocial causal factors include

Stressful life events

Manic reactions maybe 

an extreme defense 

against or reaction to 

depression

Psychotherapy

Cognitive-behavioral therapy

Interpersonal therapy

Family and marital therapy

Antidepressant, mood-stabilizing, and antipsychotic drugs are all used in the treatment of unipolar and bipolar disorders

ECT

Nobody likes me  Even people who like me     occasionally get mad at me

I’m a moron I’m smart, even if I do make       mistakes now and then

I’m worthless I’m a good person

My jokes are bad It’s not my fault that theclass has no sense of humor.

Used to be called Manic-Depressive Disorder

Two extremes: 

Mania and  Depression

Affects 1-2% of the population

Peak vulnerability (20-29.)

High Self-Esteem

Euphoria

High Energy

No Sleep

Extravagant Plans

Optimism

Hyperactive

Rapid Talking

Impaired Judgment

Excessive Gambling

Excessive Spending

Sexually Reckless

Excessive Drug and Alcohol Use

Most people enjoy their periods of mania becausetraists are seen as attractive and they are creative

The risk of suicide is a significant factor in all types of depression

Suicide ranks among the top ten leading causes of death in most Western countries

Suicide attempts are most common in people between 25 and 44 years old

Completed suicides are most common in the elderly (65 and older)

Women are more likely to attempt suicide, but men are more likely to complete suicide

Some people do not really wish to die but instead want to communicate a dramatic message concerning their distress

Research has clearly disproved the tragic belief that those who threaten to take their lives seldom do so

People who talk about suicide are unlikely to commit suicide

People who threaten suicide are only seeking attention.

Talking about suicide with a depressed person may prompt the person to attempt it.

Suicides usually do not warn others

Suicidal persons are fully committed to dying

Men and women are equally likely to commit suicide

Only depressed people commit suicide

Thinking about suicide is rare

Major risk factors

Drug or alcohol abuse

A prior suicide attempt

Depression or other mood d/o

Feelings of hopelessness, lack of coping skills

Severe anxiety, panic attacks

Family history of suicidal behavior

Shame, failure or rejection

Linked to biochemical factors