Investigates effects of stress and other psychological factors on physical factors.

Concerned w/ sleep, diet, smoking... coping strategies

To Change phsychological issues, change physical issues

Hans Seyle came up with the GAS theory: Alarm, resistance, Exhaustion

1. Body mobilizes to confront a therat by triggering sympathetic nervous system activity.

2. The organism makes efforts to cope with the threat, by fighting it or fleeing from it.

3. Ocurs if the organism is unable to fight or flee from the threat and depletes physiological resources while trying to do so.

1. Central Nervous System

2. Peripheral Nervous System

   A. Somatic

   B. Automatic

      I. Sympathetic

      I. Parasympathetic

Direct Effeccts Model (DEM)

Interactive Model (IM)

Indirect Effects Model (IEM)

Psychological factors (stress, personality styles):

   -> Leads body to physiological response

   -> Leads to disease leads to illness/disease

Phsycological factors ply part but depends on if body is predisposed to disease:

   -> Physiological changes

   -> Disease

Psychological factors influence:

   -> Health related behaviors (smoking, sleep)

   -> Disease

Due to another mental disorder

Sleep disorder due to a general medical condition

Substance induced sleep disorder

Primary sleep disorder

Primary insomnia

Primary hypersomnia

Narcolepsy

Breathing related sleep disorder

Circadian rhythm sleep disorder

Irresistible attacks of refreshing sleep that occur daily over at least three months, plus either cataplxy or recurrent intrusions of elements of REM sleep

Sleep disruption, leading to excessive sleepiness or insomnia, that is due to a sleep related breathing condition such as apnea

Sleep disruption leading to excessive sleepiness or insomnia that is due to a mismatch between the sleep wake schedule requred by a person's environmet and his or her circadian sleep wake pattern

Nightmare disorder

Sleep terror disorder

Sleep Walking disorder

Repeated awakenings wih detailed recall of extended and rextremely frightenening dreams, usually involving threats to survival, security, or self esteem, on awakening, person is alert and oriented

Repeated abrupt awakenings beginning with a panicky scream; intense fear and signs of autonomic arousal; amnesia for the episode and relative unresponsiveness to comfort

Repeated episodes of rising from bed during sleep and walking about; wakened only with much difficulty; amnesia for the episode; no impairment of mental activity or behavior

1. Relaxation methods

   A. Diet

   B. Breathing/Meditation

   C. Look at substance use

2. Sleep restriction therapy

   A. A Restricts amount of time insomniacs can sleep each night, eventually lengthen

Treatments for Sleep Disorders

COGNITIVE-BEHAVIOR THERAPIES

Stimulus Control Therapy

1. Bed when sleepy

2. Only sleep/sex in bedroom

3. Go to another room after 15 minutes and don't return until sleepy

4. Out of bed at some time each morning

5. No naps

1. Pessimism

   -> Perceive more events an uncontrollable and stressful

   -> Chronic physiological arousal-> Impaired health

2. Pessimism

   -> Unhealthy behavior

   -> Impaired health

Type A:

1. Time Urgency

2. Easily aroused hostility

3. Competitiveness

4. Heart disease Twice that of Type B

TYPE B:

1. Not constantly in a hurry

2. Can relax without feeling guilty

3. Nost easily hostile

4. Not overly competitive

5. Half that of Type A

Intervention Guided Master Techniques

Reducion of Catastrophizing Cognitions

Biofeedback

Time Management

Provide explicit information on how to engage in positive behaviors and opportunities to practice these behaviors in challenging situations.

Interventions designed to promote healthy behaviors

Provide basic education about illness to reduce concern; help the person engage in positive coping.

Reduce concerns as illness

Teach the person to reduce obligations, prioritize and schedule important activities, break tasks up, reward self.

Learn to say no.

Three categories:

1. Reexperiencing of the traumatic event; Relive in nightmares, memories.

2. Emotional numbing; They want nothing to do with it.

3. Hyperviligance and chronic arousal; Constantly on guard like something will happen to you.

      *May experience "Survival Guilt". Social support is HUGE.

1. DISASTERS: Tornadoes, floods, etc.

2. COMMON TRAUMATIC EVENTS: Car accidents, sudden deaths of loved ones.

3. COMBAT AND WAR-RELATED TRAUMAS: Combat fatigue syndrom, "Shell Shock".

4. ABUSE: Physical, emotional, sexual.

Sociocultural Factors, Psychological factors, and Biological factors

What mental health was like prior to even can determine if likely to get PTSD.

Sociocultural factors:

1. Severity, duration, proximity of trauma

2. Social support

Psychological factors:

1. Personal assumptions

2. Distress (Before traumas)

3. Coping styles

Biological factors

1. Physiological hyperactivity

2. Genetics

1. Cognitive Behavioral therapy

2. Stress Managements

3. Biological therapies

4. Sociocultural Approaches

Systematic desensitization is used to extinguish fear reactions to memories; cognitive techniques are used to challenge irrational thoughts.

Thought stopping technique: Yell "NO!" when having thought.

Eye Movement Desensization and Reprocessing: For trama survivors experience series of movement, follow with eyes. Lateral eye movement helps with trauma.

1. Exposing the client to what they fear in order to extinguish that fear.

2. Challenging distorted cognition.

3. Helping reduce stress in daily lives.

4. Improving coping capacity.

Similar to PTSD, but occurs within one month of stressor, and lasts four weeks or less

Dissociative symptoms are prominent

At high risk of developing PTSD W/in 1 month develope ASD if lasts PTSD

Consists of emotional and behavioral symptoms (depressive symptoms, anxiety symptoms, and/or antisocial behaviors) that arise within three months of the onset of a stressor

Differs from PTSD and ASD in several ways

People prone to panic attacks:

(1) pay very close attention to their bodily sensations,

(2) misinterpret these sensations, and

(3) engage in snowballing, catastrophizing thinking.

• Animal type Natural environment type
• Situational type
• Blood-injection-injury type
• *Fear of specific objects, places or situations

Physiological: Goosebumps emerge

Muscles tense

Heart rate increases

Respiration accelerates

Respiration deepens

Spleen contracts P

eripheral blood vessels dilate

Liver releases carbohydrates

Bronchioles widen

Pupils dilate

Perspiration increases

Adrenaline is secreted

Stomach acid is inhibited S

alivation decreases

Bladder relaxes

Escape

Avoidance

Aggression

Freezing

Decreased appetitive responding Increased aversive responding

I. Recurrent and unexpected panic attacks

    1. Length of time between attacks varies

II. Fear of future attacks, fears consequence of having an attack, and/or change in behavior in response to the attacks

1. Classically conditioned

2. Can learn fears through social learning

3. Prepared Classical Conditioning: evolutionary fears

1. Heredity may play a role in that increased anxiety may be, in part, genetic (biological predisposition)

2. Agoraphobia has the most significant hereditary component, particularly for women

• 1. Presence of obsessions and/or compulsions
• 2. Person recognizes obsessions/compulsions as excessive or unreasonable
• 3. Content of obsession not restricted to another disorder (food and Eating Disorder)

• 1. Recurrent and persistent thoughts, impulses, or images that are experienced intrusive and inappropriate and that cause anxiety or distress
• 2. Thoughts, impulses, or images that are not simply excessive worries about real life problems
• 3. Thoughts, impulses or images that the person attempts to ignore or suppress or to neutralize with some other thought or action
• 4. Obsessive thoughts, impulses or images that the person recognizes are a product of his or her own mind

• 1. Repetitive behaviors (such as hand washing, ordering, checking) or mental acts (such as praying, counting, repeating words silently) that the person feels driven to perform in response to an obsession or according to rules that must be applied rigidly
• 2. Behaviors or mental acts that are aimed at preventing or reducing distress or preventing some dreaded event or situation; however, these behaviors or mental acts are not connected in a realistic way with what they should prevent
•  *If they don't engage in ritual, tragedy will strike

• 1. BIOLOGICAL: Tricyclics and SSRIs have been helpful to many b/c they increase levels of serotonin
• 2. CBT: Exposure w/ response prevention is the treatment of choice. ->Will engage in obsession in front of you.  
• *Best treatment seems to be a combination of the two approaches

• Unipolar- Only depression
• Bipolar- Depression and mania

Poor concentration and attention, indecisiveness, poor self-esteem, hopelessness, suicidal thoughts, delusions and hallucinations with depressing themes, sense of worthlessness or guilt

SYMPTOMS OF DEPRESSION

Physiological and Behavioral

Symptoms of Depression

Emotional

Subtypes of Major Depression

(and the Depressive Phase of Bipolar Disorder)

Depression with Melancholic Features

Depression with Psychotic Features

Depression with Catatonic Features

Depression with Atypical Features

Depression with Postpartum Onset

Depression with Seasonal Patterns- SAD

Inability to experience joy/pleasure

Significant anorexia/weight loss

guilt

Distinct depressed mood

Mornings are worse

Seeking, hearing, feeling things that are not real (hallucination)

    *Only when depressed

Delusion: Basis of belief with no basis in reality

Muscular rejection

Catalepsy- postal regitiancy and mental stuper

Can be opposite- excessive motor activity, sever speech disturbances

Positive respnses to same events

Significant weight gain

    -> Appetite increase

Hypersomnia

Heavy feelings in arms/legs,

Long standing pattern to sensitivity/rejection

Depression with Postpartum Onset

MDE within 4 weeks of giving birth

Depression with Seasonal Patterns

SAD

2 years have experiences with the same episode with same season

Degrees of Depression

(Diagnosis)

Severity

   Must say w/ or w/out psychotic features.

   Based on number, severity of symptoms, and how it impairs daily lief

Single Episode vs. Recurrent

Partial Remission vs. Full Remission

   Full: Symptom free for 2 months

   Partial: 2 ways

      Same symptom present but meet full criteria

      No long have significant symptom but period has been less than 2 months

Chronic

   Full blown depression for 2 years

Major Depression

vs.

Dysthymic Disorder

Major Depression:

   1. 5 or more symptoms including sadness or loss of interest or pleasure

   2. At least 2 weeks in duration

Dysthymic Disorder

   1. 3 or more symptoms including depressed mood

   2. At least 2 years in duration

   3. Low level of depression, but chronic

2 major types:

   Bipolar 1- At least 1 full blown manic episode

   Bipolar 2- Hypomanic episode, no full blown mania, milder mania and depression

Cyclothymic Disorder: Same as Dysthemia but for Bipolar

Rapid Cylcing: 4 mood episodes in 1 month

Gentetic Theory

Neurotransmitter Theories

Neurophysiological Abnormaltives

   Altered brain wave activities

Neuroendocrine Abnormalitites

   Hyperactivity in fight/flight, but slow to turn to normal

Lewinsohn's theory

   Reduction in positive reinforcments and up in aversive events

Learned helplessness thoery

   Lose motivation, unable to control events that are controlable

Selligan's theory

   People lack control, they believe that they're helpless, go into depression

Aaron Beck's theory

   Negative cognitive triad

   Consists of self, world, and future and negative beliefs about all, goes into depression

   Depressed people have tendency to attribute events to internal, stable, and global factors

Reformulated learned helpless ness theory

Ruminative response styles theory

Cohort effect

   People born in 1 historical period at different risk than people born in another historical period

Social status

   Lower social status, higher rates of depression/mood disorders

Cross-cultural differences

   Less industrialized less depression

Psychological Treaments for Depression

Behavioral

Cognitive-Behavioral

Psychodynamic

 Increase positive reinforcers and decrease aversive events by teaching the person new skills for managing interpersonal situations and the environment

 –Challenge distorted thinking and help the person learn more adaptive ways of thinking and new behavioral skills

3 Steps