Exam Notes: Intro to Health Psychology PDF

Intro to Health Psychology can result from a genetic disease, acquired conditions such as HIV-infection, or the use of an ‘problem’ is not some characteristic of the target. This is about power dy...

Intro to Health Psychology Definition of Health:WHO 1946: ‘the state of complete physical, social and spiritual well-being, not simply the absence of illness’.WHO definition overlooks the psychological, cultural and economic aspects of health. Health is a state of well-being that involves satisfaction of physical, cultural, psychosocial, economic, and spiritual needs. It is not merely the absence of illness. Psychological processes and social context play a crucial role in influencing well-being. The term ‘psychosocial’ is often used to describe human behaviour and experience as an influence on well-being. Social inequalities and poverty are also strongly associated with health outcomes and warrant explicit inclusion in any definition. Maslows 1943 heirarchy of needs: Physiological, Safety, Love/Belonging, Esteem, Self-actualization- morality, creativity, spontaneity, problem solving, lack of prjuidice, acceptance of facts --A person is healthy if all of their needs are satisfied. Three biological systems of relevance to health psychology are the nervous system (NS), the endocrine system (ES) and the immune system (IS). These three systems communicate within the body using electrical and chemical signals. They activate and de-activate tissues, organs and muscles to control and regulate the body, the emotions and the mind. The principal objective of the three systems is to preserve homeostasis. Homeostasis refers to the ability of an organism to maintain the internal environment of the body within limits that allow it to survive. Negative loop: counteracts a change, bringing the value of a parameter back towards its set point. Eg Maintaining body temperature. Positive loop: increases change away from set point. When there is a problem in the feedback system? E.g. Type 1 diabetes Homeostasis and allostasis: One of the principal goals of health psychology is to understand the links between subjective well-being and health. Homeostasis-Physiology in Psychology important. Allostasis can be defined as the active process of maintaining/re-establishing homeostasis, when one defines homeostasis as those aspects of physiology (pH, oxygen tension, body temperature for homeotherms) that maintain life. In that context, allostasis refers to the ability of the body to produce hormones (such as cortisol, adrenalin) and other mediators (e.g. cytokines, parasympathetic activity) that help an animal adapt to a new situation/challenge. Allostasis means “achieving stability through change”; it was introduced by Sterling and Eyer (1988). Claude Bernard, 1974 --The stability of the internal environment is the condition for the free and independent life. The most efficient regulation is anticipatory, relying upon experience or learning from past events: A key process involved in allostasis is therefore prediction. Predictive regulation means that the system can be efficient. E.g. greater oxygen requirement in the muscles during a fight or flight situation Allostatic load: the ’wear and tear’ on the body. It reflects the cumulative effect of experiences in daily life and includes the physiological consequences of the resulting health-damaging behaviours (e.g. poor sleep, lack of exercise, unhealthy diet). It explains why an inherently adaptive process can lead to disease. Allostatic load cause: exposure to frequent stressors that may determine a status of chronic stress and repeated physiological arousal; lack of adaptation to repeated stressors; inability to shut off the stress response after a stressor is terminated; allostatic response not sufficient to deal with the stressor.The nervous system:neurones and glial cells. Glial cells provide support and nutrition, maintain local homeostasis, produce myelin, and participate in signal transmission. Microglial cells are highly plastic and act as macrophage('big eater') defence of CNS.This constant system of microglial surveillance protects the brain against any microbe invaders, demyelination, trauma and cancerous or defective cells (Lieff, 2013). Synapses and neurotransmission. One major form of communication in the NS uses 60 neurotransmitters across a 'synapse: serotonin, dopamine, glutamate, glycine, histamine and adenosine. Neuromodulators do not propagate nerve impulses, but instead affect the synthesis, breakdown, or reabsorption (reuptake) of neurotransmitters Neuromodulation occurs when a neurone uses a chemical to regulate diverse populations of neurones. Neuromodulators are secreted by a small group of neurons and diffused through large areas of the NS, instead of into a synaptic gap, affecting multiple neurones at the same time.Organisation: CNSbrain and spinal cord. Peripheral NScranial & spinal nerves, to the motor (effector) division of the NS. Communication back to the CNS is conducted by the sensory (afferent) division. Two branches of the efferent division: The autonomic nervous system (ANS): cardiac muscles, smooth muscles and glands. The somatic nervous system:skeletal muscular actions (speech and behaviour). The somatic nervous system: Is the organism’s apparatus for responding to the external environment. The somatic nerves enable us to respond to these stimuli by moving through our environment, taking action, and speakingpredict and actively adjust to the external environment. The autonomic nervous system (ANS): Maintains homeostasis in digestion, respiration, blood circulation, excretion, and the secretion of hormones. The ANS is divided into two subsystems: the sympathetic and parasympathetic systems. The sympathetic nervous system (SNS): When the organism faces a major stressor the SNS prepare 'fight-or flight'--dilates the bronchi and the pupils, accelerates heart rate and respiration, and and arterial blood pressure, but reduces digestive activity. Neurotransmitters associated: epinephrine and norepinephrine. The parasympathetic nervous system (PNS): Causes a general slowdown in the body’s functions in order to conserve energy. PNS augments only digestive functions and sexual appetite. Neurotransmitter: acetylcholine. The endocrine system: ductless glands of the body & hormones. Hormones act as "messengers" via blood to cells. ES maintains physiological homeostasis: Cellular metabolism, reproduction, sexual development, sugar and mineral homeostasis, heart rate, and operates 24/7. Regulates the circadian rhythm and sleep/waking cycle with a variety of hormone releases. The secretion of some hormones increases during sleep (e.g., growth hormone, prolactin, and luteinizing hormone), while the secretion of other hormones is inhibited (e.g., thyroid stimulating hormone and cortisol). Endocrine dysfunction has been linked to sleep disturbances such as insomnia (Institute of Medicine, 2006). The immune system: Its main role is to protect the body from harm—has 2 parts:innate IS & adaptive IS. Both change as people get older. The Innate IS: First line of defence: It is made up of barriers and cells that keep harmful germs from entering the body- skin, the cough reflex, mucous membranes, and stomach acid. If germs pass through these physical barriers, they encounter a second line of innate defence, specialized cells that alert the body. The Adaptive IS (third line of defence): More complex than the innate IS and includes the thymus, spleen, tonsils, bone marrow, circulatory system, and lymphatic system- together produce, store, and transport specific types of cells and substances to combat health threats. The immune system: inflammation: Inflammatory responses take precedence over normal body metabolism with the objective of restoring normality as quickly as possible. Disorders of the IS can result in autoimmune diseases, inflammatory diseases and cancer. Immunodeficiency: is when the IS is less active than normal and recurring and life-threatening infections can occur. Immunodeficiency weight blamed for everything – complaints not taken seriously.Mensinger et al (2018) Fat people and healthcare access: ↑ BMI  ↑ experienced and internalised weight stigma  ↑body-related shame/ guilt  ↑ healthcare stress  ↑ healthcare avoidance. Reduced service utilisation, especially for preventive care: Less likely to undergo age-appropriate screenings for breast, cervical, and colorectal cancer. Increased use of emergency resources. Avoidance of healthcare  later diagnosis/treatment.Fat people and treatment: antibiotics-Underdosing increases risk of tx failure and may promote antimicrobial resistance. Cancer-- ~ 40% ‘obese’ cancer patients do not receive correct dose chemotherapy. Fatal misdiagnosis: Class I misdiagnosis. Case Study: Irmtraud Eichler: 60-year old woman, Rapid weight gain, Trouble breathing. Diagnosis: diabetes + lack of activity. Prescription: anti- obesity pills. A second opinion Lost 40 kg, Doing well. Ellen Maud Bennett (d. 2018)-- dying wish was that women of size make her death matter by advocating strongly for their health and not accepting that fat is the only relevant health issue. Genetics and heritability In 1905, the study of meiosis revealed that sex is based on chromosomes.A genome is any organism’s complete set of DNA, including all of its genes. The human genome is not uniform, and it is not static.Genotype vs phenotype--The genotype is the part of the genetic makeup e.g. eye colour, general intelligence and personality traits. The phenotype is the set of observable characteristics of an individual resulting from the interaction of the genotype with the environment. Nature:To build a human brain, and the mind it supports, all you need is information included in the genes of the individual. Nurture: A human brain, and the mind it supports, is built from the structure of the external world. Heritability and twin studies: Polderman et al. (2015) reported a meta-analysis of twin correlations. Across all traits the reported heritability was 49% indicating an almost exactly equal contribution of genes and environment. Nurture and nature were independent and equal contributors to individual differences in traits.The epigenetic landscape proposed by Conrad Waddington (1905-1975)--Deviation from the normal path early in development – at a decision point --Perturbation later on in development. Epi is a Greek prefix that means “above” or “upon”. Epi-genetics can be translated into “above genes. Epigenetics is the influence of experience on genes. Epigenetics comes from the notion that knowledge about genetic characteristics is insufficient to predict the diversity of phenotypic outcomes during development. Epigenetics- It’s not just about what genes you have, it’s about what your genes are doing (genetic regulation). Inheritance system: genetics vs. epigenetics. The inheritance of traits in genetics occurs as a result of rare genetic mutations which involves DNA mutation but selection is slow in making adaptations to the constantly changing environment. The soft inheritance system of epigenetics, on the other hand, is able to adapt to fluctuations in the environment such as changes in nutrition, stress and toxins (Wei, Schatten and Sun, 2015). Genetic inheritance involves the transmission of traits through DNA. Traits like eye color, blood type, and inherited diseases are largely influenced by genetic inheritance. Epigenetic inheritance involves changes in gene expression without altering the DNA sequence. It can impact traits like susceptibility to obesity, addiction tendencies, and responses to stress. Epigenetic changes include DNA methylation and histone modification both of which regulate gene expression without altering the linear sequence of DNA. Epigenetics – DNA methylation: DNA methylation acts by ‘turning genes off.. Epigenetics and inheritance: At every point in development and at every level of the neural system, the capacity to adapt is essential to the functional viability of the organism. Developmental plasticity: phenomenon by which one genotype can give rise to a range of different physiological or morphological states in response to different environmental conditions during development (West-Eberhard, 1989). Nutritional status, exposure to toxins and drugs, and the experiences of interacting with varied environments and stress can all modify an individual’s epigenome.‘Intergenerational transmission’ occurs when enduring epigenetic changes in parental biological systems in response to maternal exposure are transmitted to the offspring. Epigenetic changes occurring in the fetus can be passed on to later generations, affecting children, grandchildren, and their descendants (though conclusive evidence is lacking). Teratogens: environmental agents that may cause developmental deviations in the foetus, Maternal smoking during pregnancy: Increased hyperactivity (Melchior et al., 2015), Conduct disorder (Talati et al., 2017), Asthma (Hu et al., 1997), Changes to DNA methylation in the placenta, fetal cord, and pulmonary function during childhood (Shorey-Kendrick et al., 2017),Maternal alcohol consumption during pregnancy:, Alcohol exposure during pregnancy results in impaired growth, stillbirth, and fetal alcohol spectrum disorder. Maternal smoking & alcohol during pregnancy – Avon Longitudinal Study of Parents and Children (ALSPAC): Changes to DNA methylation in the cord blood of infants at birth. These epigenetic changes are critical intermediary between prenatal environment and subsequent substance abuse risk in adolescence (Cecil et al., 2016). Ultrasound observations of subtle movements: a pilot study comparing foetuses of smoking and nonsmoking mothers (Reissland et al., 2015, Acta Paediatrica): Illustrative 4D scan frames of a 32‐week‐old foetus of a smoking and nonsmoking mother- 10‐second period of observation. Increased DNA methylation of a gene that encodes for an enzyme that inactivates stress hormones elevated exposure of the fetus to stress hormones cause preterm birth, suboptimal neurobehavioral profiles, and emotional dysregulation (Field et al., 2006 for a review). Rubella- Blindness; deafness; heart defects; brain damage. Marijuana- Irritability; nervousness; tremors. Cocaine- Decreased height; low birth weight; respiratory problems; learning difficulties; seizures. Alcohol- FAS (intellectually impaired, delayed growth, facial malformation); learning difficulties; smaller than normal head size. Nicotine- Miscarriage; low birth weight; stillbirth; short stature; learning disabilities. Caffeine- Miscarriage; low birth weight. Radiation- Higher incidence of cancers; physical deformities. Klengel and Binder (2015) Stress early life adversities activate the stress hormone system and may epigenetically program the system toward a lifelong alteration of the hormonal response to even minor stressors. Early life development: Early environmental experience --Differences in the size of children’s vocabulary first appear at 18 months of age, based on whether they were born into a family with high education and income or low education and income (Hart and Risley, 1995). Adverse living circumstances in first 24-36 months- developmental delay. Risk Factors:Poverty, Caregiver mental illness, Child maltreatment, Single parenthood, Low maternal education-cumulative impact. Maltreated children who are exposed up to 6 additional risks face a 90-100% delays in their cognitive, language, or emotional development (Barth et al., 2008). Adults who recall having 7 or 8 serious adverse experiences in childhood are 3 times more likely to have cardiovascular disease as an adult (Dong et al., 2004). Protective factors:Parenting support:Parenting programmes increased scores on measures of: psychosocial, motor and child cognitive development. Adequate nutrition: Malnutrition-micronutrient supplementation improves academic performance among children 5–16 years of age. Attachment and bonding: Secure attachment forms with a caregiver who provides security, safety, affection, and comfort- 'Kangaroo Mother Care'. Prevention of child maltreatment: in first 24 months of life-more behavioural problem. Programmes (e.g., Nurse Maternal depressive symptoms are associated with behavioral and emotional problems in their children. The adverse effects of a mother in poorer mental health on a child’s behavioral and emotional problems are substantially reduced when a father reports better mental health. When both the father and mother report poorer mental health, the influence on a child’s behavioral problems is strong, particularly for boys. Health promotion is any event, process or activity that facilitates the protection or improvement of the health status of individuals, groups, communities or populations. The objective is to prolong life and to improve quality of life, that is, to prevent or reduce the effects of impaired physical and/or mental health in those individuals who are directly (e.g., patients) or indirectly (e.g., carers) affected. While early models focused primarily on disease prevention (as influenced by the biomedical model), more recent models are influenced by the biopsychosocial model, which takes into account the psychological and social determinants of health. Creating favourable social conditions, Reducing inequalities and ensuring equal opportunities, Coordinating with people from all walks of life. Improving Perinatal Maternal Mental Health Starts With Addressing Structural Inequities (Shuffrey et al., 2022): Removing Obstacles to Perinatal Mental Health Treatment: women with low income and racial and ethnic minority women, who report higher rates of postpartum depression, are less likely to receive treatment.Improve policies including guaranteed medical coverage for 1 year postpartum, enforcement of mental health parity, etc. Increasing Perinatal Support Through Paid Leave and Affordable Childcare: Black and Hispanic mothers are less likely to have access to time off or be financially able to take time off after childbirth compared with White mothers. Paid leave to all working mothers could lead to reductions in sociodemographic disparities in maternal and child health. Expanding the international conversation with fathers’ mental health: toward an era of inclusion in perinatal research and practice (Fisher et al., 2021)-lack of access to effective evidence-based treatments and other appropriate services, the available treatments are not tailored to the father experience, barriers world-wide to fathers receiving treatment: (1) recognition of mental health problems by men, (2) men identifying and seeking professional support, (3) access to perinatal psychiatric clinics that accept fathers, and (4) access to psychiatric services that effectively assess and treat paternal perinatal mental health, and retain fathers in treatment. Key areas to support father perinatal mental health (1) intervention research, (2) clinical training, (3) national policy, and (4) the inclusion of fathers in the focus of the International Society for Perinatal Mental Health. Family Interventions: About 70% of adults with a mental disorder are parents and one in five children lives with a parent with psychopathology but.There is a lack of evidence-based tailored interventions for parents. Most interventions aimed specifically at parenting practices are not designed to accommodate adult psychopathology. There are only a few models of integrated services that attend to both parents’ and children’s mental health. There is the need for integrative theoretical models and treatment options that specifically target adult clients who are parents and that target psychopathology simultaneously in both parents and children. Parent psychopathology Biological transmission/ Parenting quality/ stressors Children wellbeing / risk of psychopathology. Factors: Maternal health during pregnancy, Genetic risk (heritability), Exposure to stressors, Parenting quality. Children wellbeing / emotional and behavioural problems Parenting quality Presence and severity of parent psychopathology.Factors: Greater parental stress, Time and financial pressure/strain, Negative emotions. Intergenerational transmission of psychopathology: (a) the extent of risk for the development of psychopathology in offspring of parents with psychopathology, and (b) the extent to which those risks are specific to parental psychopathology or to related risks (e.g., marital conflict). Having a parent with psychopathology is associated with offspring risk of psychopathology, but there is limited evidence that parent and child will have the same disorder. Adult psychopathology and co-occurring conditions (unemployment, poverty, family instability), Both parents with psychopathology, Elevated risk of child psychopathology May emerge early or later in development. Parenthood as a protective factor for adult psychopathology. Integrated Treatments targeting simultaneously parents and children; effective at improving the symptoms of both mothers and their children and at improving parenting quality. Preventive Interventions decrease the risk of onset of new disorders in offspring by 40%. Interventions targeting parenting behavior (Gonzales & Jones, 2016: Parent training, Parental self- efficacy, decrease of depressive symptoms / stress. More engagement with child, Reinforcement of positive parent-child interaction, Improvement on child behaviour Everett et al., 2021 Information, Communication Patient-Centered Approach: A patient-centered approach emphasizes empathy and understanding patients' needs, values, and preferences- involve patients actively in decision-making and treatment discussions, known as Shared Decision-Making (SDT). Charles et al. (1999)key elements of SDT, including physicians and patients engaging in decision-making, expressing treatment preferences, and jointly agreeing on treatment decisions--shift from a doctor-centric to a collaborative model. However, barriers to SDT, Pollard, Bansback, and Bryan (2015), include the time required, appropriateness of clinical scenarios, and patients' ability or willingness to participate. Therapeutic Alliance:positive between physicians and patientsactive listening, empathy, and open communication. Pourhabib et al. (2016)-- greater interaction with healthcare practitioners is associated with less patient worry and increased referrals for cardiovascular rehabilitation. Technology and the Internet: The advent of e-health and m-health has transformed patient engagement. E-health - digital technology for health promotion, m-health- mobile applications and wearable devices. Patients--active consumers of health information, technology. glucose monitors, enables patients to make informed decisions about their health based on real-time data. Online Interventions: target various health behaviors such as smoking, alcohol consumption, diet, physical activity, and chronic diseases. Often use combo of strategies like tailored feedback, weekly emails, and self-assessment. Their impact can vary, with smoking cessation showing less positive outcomes than other behaviors (de la Vega et al., 2018). Adherence to Chronic Disease Management: SMS, video messaging, phone applications, and wireless devices, enhance adherence to chronic disease management. A meta-analysis by Hamine et al. (2015) indicates that short message services (SMS) are commonly used and effective in improving adherence and clinical outcomes. Patient Promotion: Cognitive Behavioral Therapy (CBT) for fibromyalgia is promoted through mHealth apps like the one developed by de la Vega et al. (2018). aim to increase access to CBT for patients dealing with chronic conditions, potential of technology in patient promotion. Message Framing: Message framing, person is awake, it increases, increases the trauma, in the sense intrusions and distress both decreased when sleeping and, but while being awake both intrusion and distress increased Psychotherapy and sleep: Reconsolidation: information which is encoded into our hippocampus, which is the labile memory trace or short-term memory. Then during sleep, it gets consolidated into long-term memory, which is in neocortex. What psychotherapy does is that they take the long-term memory from the neocortex and bring it back to hippocampus, then consolidate and modulate it into something else that is a reconsolidation. So, psychotherapy and sleep reactivate and change aggressive memories. Those memories which we are not fond of, new behavior is adapted and corresponding. Preexisting memories are updated. That is how sleep and psychotherapy is related. Brain plague and Alzheimer's beta, Beta amyeloid is a peptide, which is a protein. It's normal functions are still unknown, but it is known beta. It accumulates in the brain and is linked to the cell death, which is also called brain plaque. The more beta amyloid you have, the more cell death of the brain happens. So, it is more related with Alzheimer's disease where cell death is more evident. So biomarker of Alzheimer's disease is beta amyloid. In positron emission tomography, that is PET scan. They measured beta myeloid accumulation. What it showed is that high lower amount of sleep, you get higher beta Amy myeloid accumulation according to the sleep efficiency predicts the beta amyloid deposition after several years. According to Winer etal 2020 which means the less efficient your sleep is, more beta amyloid deposition are seen. According to Wang and Holzman, 2020 sleep flushes out this beta amyloid. So sleep is critical for our mental health as well as physical that is brain health. Immune system is equal to a cognitive system. It means, for example, you receive vaccination antigen, is injected and the antigen is taken up by antigen presenting cells or a PC. And this a PC or antigen presenting cells interacts with the T cells in the lymph node and then formed the informed t-cells is produced and they respond to the infections. They are ready to respond to the infections. So taking up the antigen by the antigen presenting cells is encoding. And the T-cells interaction with a PC is retention or consolidation. And informed T cells ready to respond is retrieval, which is equal to cognitive system. And this lymph node where the PC interact with t-cells is the immunological synapse. And the informed t-cells ready to respond is the immunological memory. So that when an infection comes in, they remembers the antigen they have taken up and they fight against it. By Lanke et al in 2003 and 2011, even one night of sleep deprivation reduces immune function. So, one night's sleep is also important, which means that immune response correlate with slow wave sleep or SWS immune function is mediated by sleep. What happens is that sleep, that is slow wave sleep enhances the cytokine protection which is signaling molecules of immune system that antigen has come. And then it also enhances cell migration. That is a PC interaction towards the T-cell in lymph node migration happens, and then sleep also enhances cell proliferation. Where more t cells who are ready is produced. this happens via unique hormonal constellation mediated by SWS, which is increases aldosterone growth hormone and prolactin, and decreases the cortisol, which is the stress hormone. And all of these are linked to the immune function. Sleep and immunity has a bidirectional relationship. Sleep helps immunity and immunity also affects the sleep. Sleep supports the immune function, and also inflammation drives sleep. When your body is infected, when you fall sick you want to have more sleep. One method is to enhancing sleep or slow wave sleep is hypnosis. Hypnotic suggestion to sleep deeper is very helpful. One study conducted is 13 minute study where the subject is asked to come to the lab. They are asked to lie down and they were allowed to hear a hypnotic suggestion, like a fishes diving deeper and deeper into the ocean. They were asked to allow to take a nap for 77 minutes. And then they measured the SWS growth hormone and prolactin. It showed that the people who heard the hypnosis suggestion had deeper SW sleep, and they have more growth hormones and prolactin compared to the control group. This conducted by Besedovski. Circadian rhythms and sleep disruptions. Circadian rhythms are physical, mental and behavioral changes for 24 hour cycle. So they're regulated by circadian clocks found within our body near all tissues and organs. The main clock is suprachiasmastic nucleus and main Zeitgeber the sun which is closer to hypothalamus, about hypothalamus. Sleep regulation: Two process model : circadian rhythms regulate our inner sleep clock ie process where the one cycle starts from 7PM to next day, 7 PM. That is a circadian rhythm which is process C. And then the process interacts with sleep pressure. Sleep pressure (Process S) is the pressure that build up during the day when you are not sleeping. And when you go to sleep, the sleep pressure comes down. So when you take nap, also the sleep pressure decreases and comes down and in it again, goes up and then again come down when you sleep. Three historical caused by sleepiness are Titanic, Exxon Valdez oil spill, and Cherno. All these three things happened because people didn't go to Social jet lag, sleep deprivation driven by social obligations. Example, work and friends, which known as social clock. Berg Etal 2019 did a, a study on people asking how much they sleep on days and work days. It is found out that more than 85% of people do not have enough sleep during their weekdays, during their free days, and they have social jet lag. This increases the social jet the caffeine alcohol metabolic disorders, obesity type two diabetes, and then cardiovascular Circadian rhythm and sleep disruptions are becoming a pandemic. Addictive Behaviours: International Classification of Disease (ICD-10) A maladaptive pattern of substance use, leading to significant impairment or distress, as manifested by three or more of the following occurring month period: Withdrawal symptoms, Tolerance (e.g., increase of doses required for an original effect)Strong desire or sense of compulsion to take substance, Difficulties in controlling onset, or levels of substance-taking, Neglect of alternative pleasures & responsibilities, Persisting despite evidence of harmful consequences. Diagnostic and statistical manual of mental disorders (DSM-5): A problematic pattern of substance use, leading to significant impairment or distress, as manifested by two or more of the following occurring within a 12-month period: Impaired control more of a substance or longer than intended, Wanted to limit/stop using but not being able to, Social impairment : Failure to fulfil duties in social roles, Continue using despite substance-related problems, Giving up activities because of substance use. Risky use: Using in situations where using is dangerous to oneself or others, Continue using despite substance-related mental or physical problems. Pharmacology criteria: Tolerance, Withdrawal. Theories of Addiction: 1.Opponent process theory of motivation: Two opposing processes Process A: Tolerance (positive), Process B: Withdrawal (negative) Repeated use changes Allostatic state (shift in homeostatic point). 2.Incentive-sensitization model: can result from a genetic disease, acquired conditions such as HIV-infection, or the use of an ‘problem’ is not some characteristic of the target. This is about power dynamics. Labelling ->Stereotyping immunosuppressive medication. Autoimmunity: results from a hyperactive IS attacking normal tissues ->Separation -Us and them  Dehumanisation. Creates rationale for devaluing, rejecting, excluding ‘them. as if they were foreign organisms. Common autoimmune diseases include rheumatoid arthritis and diabetes This cause Status Loss Discrimination -- Individual & Structural. Labelling and stereotyping – cultural mellitus type 1. and historical context. Structural  impaired quality of life through multiple pathways, Unequal access to resources (interpersonal, intrapersonal, structural barriers, Cultural truism, Modified labelling theory- Research Methodology -Link and colleagues' (1989) modified labeling theory assumes that during socialization, an individual forms belief about how mental illness is treated. Stereotype threat, Interchangeable and mutually When is measurement taken: Cross-sectional: Measurement is taken at one time point. Longitudinal: reinforcing. Life outcomes throughout life course. Use of power- Stigma entirely dependent on social, Measurement is taken at more than one time point. Do we interfere? Yes → Experimental No → economic, political power. Mediators linking stigma to health: Hatzenbuehler et al., 2013 –Stigma - Observational. Kind of data collection: Numeric → Quantitative Non-numeric → Qualitative Both → >Availability of resources Social relationships Psychological and behavioural responses, Stress-- Mixed methods. Causation in Cross-sectional and Longitudinal Data: Cross-sectional data can only Population health.1. Availability of resources: Stigma  Socioeconomic status (SES)  unequal show associations, not causation. Longitudinal data may establish causation if a control group is access to resourses: 2. Social isolation: Stigma associated with ↑ social isolation ↓ health outcomes, present. Advantages of Qualitative Research: Gives participants a voice. Provides greater depth and Fears of rejection and negative evaluation (often with good reason), Visible and invisible stigmatised understanding. Complimentary to quantitative research. Valued by employers, especially in industry settings. Can be enjoyable for researchers. The 10 Fundamentals of Qualitative Research: Qualitative statuses, Concealable stigmas; disclosure, Again, social support  better health outcomes. 3. research is about meaning, not numbers. It doesn't aim to test hypotheses or generate replicable results. It Psychological and behavioural responses to stigma: ↓ Psychological resources--Maladaptive emotional doesn't provide one single answer. It treat context as important. Qualitative approaches can be regulation (e.g., rumination); Maladaptive behavioural responses (e.g., avoidant coping styles, substance experiential or critical. It is underpinned by ontological assumptions (Ontological positions mean what use); Self-stigmatisation (see IWS).4. Stress: Stress response evolved to deal with acute stressors-- type of reality do u view, and it can be realism, critical realism or relativism), It is underpinned by Dissipates on termination of stressor; Chronic stress  repeated/ongoing physiological arousal; Allostatic epistemological assumptions (Epistemological positions can be positivism, contextualism or load = “wear and tear” on the body; Cumulative effect of experiences in daily life constructionism). It involves a qualitative methodology. It uses various types of data- One-to-one Allostatic load:cascading relationships, beginning early in life, between environmental factors and genetic interviews, Focus groups, Diaries, Qualitative (questions on) surveys. It values subjectivity (our own predispositions that lead to large individual differences in susceptibility to stress and, in some cases, to experiences, perspectives, and values, which influence how we see the world )and reflexivity (process of disease(McEwen & Stellar, 1993). Types of stress:Biological – illness, pollution, etc; Economic – critically reflecting on knowledge we’ve produced as researchers. Positionality statement- what are opportunity, hardship; Social – structural, interpersonal, intrapersonal. Social stress: Social stress has your beliefs, culture, gender, what you feel about the topic, stating my views based on my position. negative impact on health--Perceived racial discrimination or mistreatment associated with increased risk Ontological Assumptions: Realism: realism means there’s only one objective reality and we understand of coronary events, breast cancer, HTN, respiratory illnesses, glucose intolerance, high waist every aspect of it, for example, “the max word count of this assignment is 2000 words” there’s nothing unclear. Relativism: There are multiple constructions of reality, each valid(Relativism is like circumference (RR 2–6). Stress response associated with hypertension, heart disease, T2DM, subjectivity, you can think that this assignment is easy while others can find it difficult, both are correct hypercholesterolaemia--HPA, cortisol and other glucocorticoids; Increase risk of obesity, and visceral to the person who said it). Epistemological Assumptions: Positivism: Like an archaeologist, truth exists obesity in particular. Microaggressions: Sue et al. 2007: Brief and commonplace verbal, behavioral, or independently and can be discovered (Positivism refers to facts are waiting to be discovered, e.g., environmental indignities, whether intentional or unintentional that communicate hostile, derogatory, or through an experiment, we discovered that a result is statistically significant because the p value is less negative insults to a target person or group”. Microaggressions in practice: Targets usually a group that than 0.05) Constructionist: Like an artisan, truth is created through inquiry and context is not the majority—Race, Sexual orientation, Nationality, Religion; But not necessarily about numbers-- (Constructionism refers to knowledge/ idea that is created by how we view it, e.g., gender roles). Black people in apartheid South Africa, Fat people in modern Western society, Women; More about Ontology and Epistemology Implications for Methodology: Realism aligns with quantitative methods. structural societal inequality. Hostile environments: Overt prejudice & discrimination; microaggressions; Critical realism recognizes an imperfect understanding of a single objective reality. Benefits of internalised stigma. Anticipated/feared stigma  heightened arousal, hypervigilance, anxiety, Thematic Analysis Extremely flexible and appropriate for any qualitative data. Themes can be data- ambulatory blood pressure. Exposure to hostile environments and perceived discrimination (racism, driven(inductive) or theory-driven(deductive) or both. Analysis can be experiential (semantic coding; homophobia, sexism etc.)  increased risk of: Hypertension, heart disease, diabetes, some cancers, takes words at face-value) or critical (latent coding; digs deeper for meaning). Three main approaches: Worse psychological health, Unhelpful coping behaviours, Poorer obstetric outcomes (e.g. pre-term birth, Coding reliability (Multiple researchers code data using a previously developed codebook to reach low birth weight, etc.). Quasi-experimental studies: 1)Islamophobia and birth outcomes: California shared consensus; descriptive; may include quant summary) active immune Codebook approaches (Use structured codebook but recognise interpretative nature of data coding; less birth certificate data:6 months after 9/11 versus 6 months before. Women with Arabic names had poorer focus on inter-rater reliability), Reflexive approaches (Highlights researcher’s active role in knowledge birth outcomes-- Low birth weight, very-low birth weight, pre-term births; No other racial, ethnic, or production. Coding process is unstructured, organic (can evolve and change along the way), and nationality group differences. 2)Same-sex marriage legislation: Hatzenbuehler et al, subjective. Steps in Thematic Analysis: Familiarize with the data, Code the data, Generate initial 2012:Massachusetts first state to legalise same-sex marriage (2003):12 months before and after, Gay and themes. Review themes. Define and name themes. Write it up. Coding Process: Semantic coding: Takes bisexual men experienced ↓ physical/mental health problems, e.g. 14% ↓ depression, 18% ↓ hypertension, words at face value, experiential, and descriptive. Latent coding: Digs deeper for meaning, critical, and 15% ↓ healthcare usage. Hatzenbuehler et al, 2010: Conversely, in 2004, 16 states banned same-sex interpretive. What is the theme- An idea or concept that captures and summarises the core point of a marriage:Between two waves NESARC cohort (2001 and 2005), LGB adults: 37% ↑ mood disorders, 42% coherent and meaningful pattern in the data. Codes = concise labels (bricks; one idea) Themes = Self- ↑ alcohol use disorders, 248% ↑ GAD, No change in heteronormative in same states, or LGB adults in explanatory sentences that represent a central organising concept Looking to identify a number of themes other states. 3)Mass-media fat shaming: Ravary et al., 2019: Project Implicit website – Implicit that capture the most salient patterns in the data to answer your RQ. Identifying a Theme: Review codes Assocation Test, Identified 20 celebrity “fat-shaming” media events, 2004–2016, Women who completed and collated data to identify potential themes. Cluster similar codes to find central organizing concepts. Weight IAT within 2 weeks before/after event, N = 93,239. Spike in implicit anti-fat attitudes; higher with Themes should be coherent, distinctive, and relate to the research question, distinctive from each other, ↑ notoriety; No change in implicit racial attitudes; Cultural feedback  change in cultural attitudes. work together, and importantly relate to the RQ. Summary: Stigma as a fundamental cause of health inequality--Multiple pathways, multiple risk The impact of prejudice and inequality on health outcomes factors; throughout life course: Direct effects of: Experienced/internalised/structural/symbolic stigma on physical/mental health, health behaviours, coping strategies, social support etc.Indirect effects: Social and economic conditions and their effects on people’s lives determine: Risk of illness, Actions Disparities (education, employment, healthcare etc)  SES  health. Generally applicable across taken to prevent them becoming ill, Treatment of illness when it occurs. Macro-social influences on stigmatised identities--weight stigma is not equally distributed in the population. It intersects with several health (and other life outcomes)--Macro-social = large-scale social, economic, political and cultural other marginalised identities, including race, class, and gender, resulting in layered compound forms of forces that influence the life course of masses of people simultaneously. Social determinants of health: oppression--worsened over the last 10 years or so, at the same time as attitudes towards many other increases perspiration The circumstances in which people are born, grow up, live, work and age and the systems put in place to stigmatised groups improving. For example, women experience more weight stigma than men, and at deal with illness. These shaped by forces: economics, social policies, and politics—WHO. lower BMI. Stigma in Public Policy: Pomeranz, 2008: Public policy is reflection of cultural mores of Neoliberalism: Political ideology involving reducing state oversight and control; opening of markets; its time, Discrimination vs “socially undesirable” groups  societal/government neglect health issues in individual autonomy- Capitalism & Globalisation. Individuals and markets will interact to optimise these groups, Also provides scapegoats, Perpetuates and reinforces stigma and health inequities, Trigger personal wellbeing. Reality:↑ Income inequality, ↑ Poverty, ↑ Health inequalities. Healthism (Crawford, warning for next slides. Slavery abolished in 1865; 1880s: Jim Crow laws – enforced segregation 1980, 2006) Health is a moral good, + neoliberal policies re taxation, benefits etc. Micro-social influences Richmond, Va: 38% population but 57% deaths from tuberculosis. Didn’t allocate resources; mayor on health (and other life outcomes)--Micro-social = factors specific to the person that work at the warned against “indiscriminate employment of negroes in our households. “The Negro Health Problem”. individual or local level. Much health psychology, health promotion, and health policy is targeted at Blamed teach “good character, good habits, and skill”i.e., victim blaming and education to teach personal the individual level: Education campaigns, Cajoling, Nudge theory (changing the default to make the responsibility. HIV/AIDS and ‘obesity. ”correct” choice easier). Marks et al., 2021: What individuals can do to change their lives is not simply a Case Study: Weight Stigma: Weight sigma is intersectionalWhat’s more, the burden of weight stigma matter of personal choice – such changes are constrained politically, economically, and culturally. Macro is not equally distributed in the population. It intersects with several other marginalised identities, including > Micro. Example for micro-social effects: UK Chief Medical Officer ten health tips. Some things can race, class, and gender, resulting in layered compound forms of oppression. Women experience more be improved (at least a bit): Whitehall II cohort (since 1985)—Death rates Vs employment grades weight stigma than men, and at lower BMI. Pearl & Puhl (2018). Weight bias internalization and over 25 yr period.Over 10,000 civil servants--Demands vs control  ill health. Buffers (moderators): health: Internalised weight stigma (IWS): Self-directed anti-fat attitudes and self-devaluation, Related Social support, Effort-reward balance, Job security, Organisational stability. Inequity in power interacts to but distinct from self-esteem, body image, and general anti-fat bias, Women  Men (c.f., experienced across four main dimensions – political, economic, social, and cultural – together constituting a weight stigma, women > men). Experience Stigma->Internalised stigma->Health & Behavioural outcomes. continuum along which groups are, to varying degrees, excluded or included. Health equity depends Correlates of experienced and internalised weight stigma: Health: Reduced Health related quality of vitally on the empowerment of individuals to challenge and change the unfair and steeply graded life, Mental health~60% ↑ mortality risk. Behavioural: Eating behaviour,Avoid exercise, Social isolation, distribution of social resources to which everyone has equal claims and rights. – WHO. Semantic Avoidant coping strategies, Avoidance of healthcare. Weight stigma in health care professionals: definitions: Stigma = a mark or label signifying membership of a devalued group. Prejudice = negative Physicians: Strong implicit and explicit anti-fat bias.NursesIn one study:31% would prefer not to care attitudes and beliefs towards a devalued group. Discrimination = unequal or unfair treatment based on for obese patients, 24% agreed that obese patients “repulsed” them, 12% would prefer not to touch obese membership of group.. A practical definition of stigma in operation (Link & Phelan, 2001): The patients. The patient experience-- Aphramor (2012). Inappropriate comments, treated disrespectfully, Family Partnership) characterised by intensive visits by professional home visitors and beginning stable over the ante- and post-natal periods.The origins of clinical or high, sub-clinical maternal symptoms prenatally. of depression and anxiety may extend even further into the preconception period. The strongest predictor of post-natal depression is depression in pregnancy. 87% of pregnancies with reported onset of depressive symptoms during pregnancy had a preconception history of mental health problems. Similarly, Parental Health 83% of pregnancies with post-partum depression had a preconception history of mental health problems (Kee et al., 2021). Fisher et al., 2021- The transition to parenthood is a life-changing experience that can Becoming Parents:Results in strain, reduced marital quality and decline in relationship satisfaction. also impact fathers’ mental health and the health of the family. Depression occurs in 8–10% of men Factors psychological adjustment of parents and be a predictor of postnatal depressed mood: Conflicts between the first trimester of pregnancy and the first year postpartum (highest rate occurring 3 to 6 months related to finances, Strength of partner relationship, Length of parental leave, The couple’s physical post- partum). Depressive symptoms can extend through the first 5 years of fatherhood.. Paternal Mental Health: Parental depression: Change in hormones, Stress of having a new baby in the household, relationships can also be affected in the TTP. Experience of pregnancy and childbirth - Changes in body Adjusting to new roles, attachment developing problems, feeling excluded from mom-child bonding, lack image, mismatch of desire, less time to parenting -Changes in sexual relationships. Quantitative TTP research focuses on changes in factors such as relationship satisfaction, relationship quality, and patterns of role model, lack of social support, maternal depression. Stressors:Personal - role change, contextual- of interaction within couples. Qualitative research provides an understanding of the lived experience of the low SES, Biological- sleep disruption, interparental- change in the relationship. Social- impact on othe TTP, e.g. intimacy, gender, fatherhood, etc. The systemic review of 12 qualitative papers by Delicate et relationship, Financial-child care. Interrelatedness of parental mental health:Vallotton et al., 2016 - A al., 2018 identified 6 themes; Adjustment Phase- Focus on the baby. Development of co-parenting, parent’s mental health status influences not only their own parenting, but also their partner’s mental health relationship positive impact on the couple, Focus on the Baby – Parents feel unprepared to changes in the and parenting. Some research suggests that when one parent experiences a mental health issue, the other relationship, Communication- Reduced but effective communication as a tool to navigate adjustments to may compensate or buffer the child from negative consequences; other studies find no evidence of parenthood...disagreements not always negative, Intimacy- Long-term impairment of the frequency and buffering. Parents with a partner experiencing a mental health issue are more likely to suffer mental health quality of sexual relations but some report otherwise also, Strain on the Relationship-can be short term, issues themselves; and parents experiencing depression may increase their partners’ stress levels. Parental and Strengthened Relationships-coiples find new affinity through parenting. influences on child dev.- The most fundamental promotive experiences in the early years of life come Qualitative paper: Stavdal, M. N., Skjævestad, M. L. L., & Dahl, B. (2019). First-time parents’ from nurturing care and protection received from parents, family and community, which have lifelong experiences of proximity and intimacy after childbirrth. Couple dissatisfaction during TTP + Negative benefits including improved health and wellbeing, and increased ability to learn and earn. Negetive effects changes in relationships with friends and/or extended family = Psychological distress. Hughes et al. (2020) on children: Parents strained relationship dynamics, Parents Mental Health Problems, Low SES;. E.g. longitudinal study of first-time mothers& fathers to assess across-parent similarities and contrasts in the mothers’ exposure to intimate partner violence is associated to their children’s cortisol reactivity and buffering effects of different sources of social support on the psychological impact of becoming a parent. asthma problems (Bair-Merritt et al., 2015). Parenting attitudes also affect child development E.g. child >400 expectant parents (4 time points of assessments: 1 month prior childbirth, 4-, 14- and 24-months)- neglect and abuse activate biosocial processes that impact health, but “even mild exposure to a risky family Saliva sample at prenatal stage (cortisol level)-completed questionnaires on depression, anxiety, general in early life can shift the developmental trajectory toward a proinflammatory phenotype” (Gershoff et al., health, perceived social support, perceived social standing (education, income and employment), perceived 2018). Intergenerational transmission: Intergenerational transmission’ occurs when enduring epigenetic couple conflict, and the ‘Who Does What Questionnaire’ each time. Results: Mothers: Higher initial levels changes in parental biological systems in response to maternal exposure are transmitted to the offspring. of psychological distress- stable over time; Elevated prenatal cortisol associated with higher self-reported Parents can model behaviours, and children can learn to react to their environments in a manner similar to prenatal distress; Friendship support was associated with maternal trajectories. Fathers: Levels of their parents. Phenotypic changes can also occur as a consequence of child rearing and offspring can also psychological distress increased with time; Family support associated with paternal trajectories. Couple experience parental trauma vicariously or by imagining traumas that they know their parents experienced conflict was associated with higher initial level of psychological distress in both mothers and fathers. A from parents’ stories. Stress effects that are inherited via an ‘intergenerational transmission’ mode are mothers brain - Pregnancy leads to long-lasting changes in human brain structure - Hoekzema et al., reflected in offspring biological changes, including neuroendocrine, epigenetic and neuroanatomical 2017. Grey matter volume changes across pregnancy - the brain undergoes maturation/specialization of changes. the neural network subserving social cognition. Gestational adaptation (evolutionary perspective). Mother’s ability to comment on baby’s mental state. Parent-infant attachment. Infant’s social cognitive Promoting Parent-child Health development. Matrescence: A time when the brain and body prepare for the transition to motherhood. Orchard et al., 2023 Early motherhood and cognition: Self-reported cognitive decline, e.g. impaired Parent Child interactions: Better emotional regulation, Few behavioural problems, Lower levels of memory, concentration, and absentmindedness. Objective evidence of memory decline during pregnancy aggression. Maternal sensitivity: “the mother’s ability to perceive and accurately interpret the signals but not postpartum. Cognitive renormalization trajectory (even improvements) in late pregnancy and post and communications implicit in infant behaviour, and given this understanding, to respond to them partum. Neuroplasticity in the maternal brain, e.g. the hippocampus (memory) shows dramatic appropriately and promptly” (Ainsworth et al., 1971). Attachment theory (e.g., Ainsworth et al., 1978) restructuring across the peripartum period. Biological factors, i.e. hormonal fluctuations not linked to has traditionally focused on the construct of maternal sensitivity as a main precursor of child secure cognitive performance. Psychosocial factors can be associated to cognitive decrement, e.g. emotional attachment. Mother-child dyadic synchrony during interaction plays an important mediating role adjustment, new stressors and worries. Environmental factors, e.g. increased responsibilities and cognitive between maternal sensitivity and infant-mother attachment, and is critical for the development of infants’ load, also might contribute to decline in memory or concentration. Parents live in an enriched ability to regulate their internal states. Synchronized positive affect is essential for the development of environment, i.e. housing conditions that involve enhanced sensory, cognitive, motor, or social stimulation. Animal research shows that enriched environments stimulate brain processes such as self- regulation (Feldman, 2003; 2007). Dyads ability to share and communicate emotions + caregivers synaptogenesis and complex dendritic branching, and may provide a protective effect against brain empathic understanding of the infants affective state = Infants emotional regulation. How effectively ageing. Reproductive experience confers neural and cognitive benefits similar to an environmental infants communicate their needs can significantly influence caregivers’ response to their cues. Flippetti: enrichment, suggesting that maternal experience may be stimulating and protective for brain health. Parents Allostatic balance: Babies are responsible for whether and how effectively their needs (i.e. changes in develop mechanisms for maintaining their cognitive abilities to adapt to the cognitive challenges of the internal states) are perceived and signaled. Caregivers are responsible for correctly interpreting the cues, postpartum period, i.e. increase in executive functioning. Mothers show superior executive function and and responding appropriately and promptly to them. Disrupted interaction: Infant characteristics, attention 3 years following birth. Mothers may also show neural compensation, where brain networks are Caregivers mental health, their behaviour, Combo. Associations between infants’ behavioral and activated in different ways, or additional neural mechanisms are recruited to support behavior. A fathers physiological profiles (neurobehavioral organization, social withdrawal behavior, and endocrine reactivity brain: Birth of a Father: Fathering in the First 1,000 Days Bakermans-Kranenburg et al., 2019 A to stress) and quality of mother-infant interactions: Extroverted infants had higher neurobehavioral Biobehavioral Model of Emergent Fatherhood:Sociocultural factors--Paid paternity leave:increasing organization, showed lower social withdrawal, and expressed more positive interactions behaviors. Under- opportunities for paternal caregiving but still many individual differences (countries, personal aroused infants had lower reactivity to stress and their mothers were the more sensitive, happy and with circumstances). Couples use more maternal leave:breastfeeding; income differences between men and more energy. Withdrawn infants had lower neurobehavioral organization, higher response to stress and women; social expectations of mothers as primary caregivers; mothers may be (unconsciously) reluctant to delegate caregiving responsibilities. Fathers spend less than half as much time in one-on-one poor performance in interactions. Their mothers expressed less optimal behaviors and more depressive interaction with their children as mothers. This relates to to connectivity between parenting-related symptoms. Depressed mothers have longer latencies in terms of maternal responsivity towards the infant, brain areas in fathers. Paternal behaviour: Prenatal--Influence on the environment; Protection of the indicating a lack of synchrony during interactions (Cohn et al., 1990). Depressive symptoms in the first 4 partner Couvade syndrome. Postnatal- Establishing an attachment relationship with the infant. Higher months postpartum are predictive of bonding impairments in the first 14 months of life (Moehler et al., levels of paternal sensitivity predict good child outcomes. Fathers’ mental health: Paternal perinatal 2006). Depressive symptoms at 6 months are associated with both lower maternal structuring and depression influences the father–child relationship and is related to less optimal relationships between decreased infant involvement in interaction observed at 8 months (Hakanen et al., 2019). Parental mind- couples as well as to maternal depression (Paul- son et al., 2016), doubling the risk for unfavourable child mindedness: caregiver’s tendency to attribute mental states to their young children (emotions, preferences, outcomes. Paternal hormones: Prenatal: Testosterone and estradiol decline in men, and men with greater motives and goals) and to interpret behavior as resulting from these mental states (Meins, 1997). declines were found to be more involved in childcare after birth; Enhanced sensitivity to vasopressin McMahon and Bernier, 2017: Mind-minded parents are more likely to act as if infant’s vocalizations promotes attention to baby-related signals. Postnatal: Fathers with lower basal testosterone levels tend to are an attempt to communicate; engage in appropriate talk with their infant commenting on what the infant engage in higher-quality parenting. But testosterone may also prepare fathers for caregiving; e.g., exposure may be feeling/thinking. A review of studies on parental mind-mindedness report: associations between to cry stimuli increases fathers’ testosterone levels. Oxytocin increases over the first 6 months of appropriate mind-related comments during interaction and parental sensitivity and associations between fatherhood. Cortisol levels increase in response to infant crying, and decrease when they hold their appropriate mind-related comments during interaction and attachment security. Impact on brain newborn or interact with their toddler Paternal neural networks: Structural changes-Changes in grey matter volume between 2–4 weeks and development: Higher quality maternal behaviour during mother–infant interactions at 5 months predicts 12– 16 weeks after child birth (Kim et al., 2014). Prenatal neural responses: Protective neural higher EEG power up to 24 months of age (Bernier et al., 2016). Higher maternal mechanisms in place when viewing videos of an infant in danger and asked to imagine the infant were their Accessibility/Availability and greater maternal positivity during mother–infant interactions at 1 year of own vs someone else’s.Postnatal Neural responses:Activation of the amygdala in primary caregiving age were found to be predictive of smaller right amygdala volume and smaller bilateral hippocampal fathers similar to mothers when watching themselves interacting with baby. More activity than women in volumes at 10 years (Bernier et al., 2019). Early mother- infant interaction Infant development the right inferior frontal gyrus when exposed to infants’. Maternal mental health:Meaney 2018: The Shared pleasure (parent and child sharing positive affect in synchrony) in early mother–infant interaction incidence of peripartum depression (onset of symptoms during pregnancy and for up to 4 weeks at 2 months was related to later child emotional and behavioural symptoms at 2 years of age, i.e., shorter postpartum) developed countries b/w 10 and 12%, with markedly higher rates in low- and middle-income shared pleasure moments were associated with higher infant internalizing and externalizing problems. countries. Impact of subclinical symptom levels of depression; women with high, sub-clinical levels are as Shared pleasure was also found to be a protective factor in the presence of parental psychopathology, i.e. affected in terms of psychosocial function and parenting as are those with clinical levels of depressive children with longer shared pleasure moments were more protected against family mental health symptoms. Mothers with clinical and high- subclinical levels of depressive symptoms-40% of the problems.(Mäntymaa et al., 2006). population in developed countries. Kee et al., 2021 - Depressive and anxiety symptom levels are largely emphasizing gains or losses, influences health behaviors. Gain-framed messages focus on the benefits of to traumatic stress develop PTSD. But this depends on the type of stressor. Children who witness parental action, while loss-framed messages highlight the costs of inaction. Studies by Rothman and Salovey homicide. A 100% children exposed to school shooting. 77 % urban youths exposed to community (1997) suggest that the persuasiveness of gain or loss framing depends on the type of behavior promoted, violence- 35 %. Predictors of PTSD clustering can cause clustering of family history, psychopathology with gain frames being more effective for health-affirming behaviors and loss frames for illness-detecting and exposure to prior traumatic stressor, psychological difficulties. All these can cause. PTSD. Other behaviors. Health Literacy: Health literacy, defined by WHO as the ability to access, understand, appraise, predictors of developing PTSD are perceived life threat, peritraumatic dissociation, peritraumatic and use health information, has three levels: functional, interactive, and critical. It extends beyond emotions, family history, psychopathology, prior trauma, all adds onto some PTSD. Perceived support negates it reduces the chances of getting PTSD. Post-traumatic growth. Experience of positive change traditional literacy skills to include social skills, communication approaches, and access to health care as a result of struggle with a highly challenging life crisis associated with increased appreciation for life, (HLS-EU Consortium, 2012). Low health literacy is associated with poor health outcomes (Paasche-Orlow more meaningful interpersonal relationships, increased sense of personal strength, changed priorities, et al., 2007). Barriers to Health Literacy: Certain populations, such as Latin Americans in the US, face richer existential and spiritual life. The process of PTG, major life crisis challengeA person's barriers to health literacy, impacting vaccination rates for HPV. Vamos et al. (2022) identified micro-level understanding of the worldThen growth phase, cognitive rebuilding that takes into account the changed barriers like low health literacy, meso-level barriers including poor patient-provider communication, and reality of one's life after trauma, beliefs or assumptions of the world. Crisis happens It questions the macro-level barriers related to public perceptions and attitudes.Promoting Health Literacy and benevolence, predictability and controllability of the world  beliefs or assumptions about the Empowerment: Projects like the Health Literacy Project -improve health literacy through adult education world struggle with new reality-Distresscognitive rebuilding- Life after trauma. That is the growth centers. Schultz and Nakamoto (2013) caution that health literacy and empowerment are distinct phase develops schemas that are resistant to being shattered. Determinants of PTG. Personal concepts. They argue that interventions should address both aspects to avoid dependency or uninformed characteristics, openness to experience. Extraversion managing distressing emotions, manage distress to self-management. allow constructive cognitive processing, producing schema change, support and disclosure. Others offer perspectives that can be integrated into the schema. Change, stress, stressor and health can stress cause Stress, Coping & Health. physical health. Stress can lead to heavy smoking, heavy drinking. Lack of exercise, which lead to physical health illness can personality buffer against effects of stress. So stress personalities, contentness, Stress among patients: Healthcare practitioners often met patients presenting with physical and self-efficacy, hardiness, which can also leads to illness. Stress can lead to coronary heart disease. psychological symptoms of stress. Different perspectives of stress: Stress can be stimulus based, stressful life response based, feeling stressed, interaction, coping with stress, stimulus based or focus on workplace Sleep or environmental stressor. Response based are focus on physiological responses to stress, interactional coping with stress, focus on coping and resources, Stimulus based perspective: Social Readjustment Human sleep approximately around eight hours per day. Horses 2.9 hours, goat, 5.3 hours. There are Rating scale, SRRC by Holmes and Rahe 1967: Life events are scored and ranked according to the three types of sleep. Monophasic, biphasic, polyphasic. Diurnal, Crepescular, nocturnal, metaturnal. Sleep amount of stress they induce. The nature of the event dictates the magnitude of the stress response architecture recurring state, suspended sensory and motor activity, characterized by total or partial undesirable. Uncontrollable events require more readjustment and cause greater stress. Death of spouses unconsciousness, decreased ability to react to stimuli, easily reversible. Measuring sleep. Subjective scored 100. Divorces- 73, marital separation. 65. Present term 63. Christmas 12 minor low violations. 11. questionnaires are used one such questionnaire, Karolinska sleepiness scale, measurement goes from 1, The Contamination hypothesis: Some life events may actually be stress-related outcomes like change in 2, 9, 1-extremely alert, 3- alert, 5-neither alert nor sleepy, 7- sleepy, but not difficulty staying awake. 9- sleeping pattern, change in eating habits. This can cause health outcomes. Hassles and uplift scale: Kanner extremely sleepy fighting sleep. SFA questionnaire - measures, sleep quality, whether you are well rested etal 1981. Focus on relatively minor events. Hassles that are irritating, frustrating, distressing demands. or not. Mental balance using more than 20 questions that measure time. Going to bed at what time you fall Uplifts positive experiences. Hassles are losing things,Traffic jams, Uplifts- goodnight, goodnight's. Rest. asleep, do you, wake up during night? How to quantify sleep. One method is actigraphy, which is a Hearing good news. Hassles and uplifts better predict psychological symptoms than life events. Score wristband, tied to your hand, which measures the awake and sleep. Polysomnography is the gold standard Hassles may mediate the association between life events and health outcomes. Life events may also to measure sleep: ectroencephalogram, electrooculogram, electromyogram. Stages: Sleep has five disrupt coping process like housekeeping, repairing the car, finding companionship, making your own stages. 1) wake 2)N1/ transitional sleep 3) N2/light sleep 4) N3/ deep slow wave sleep -SWS, 5) Rapid meals, handling finances. All these things are hassles, which can, become the association between the life eye movement-REM. The whole night 5-6 cycles of these five stages of sleep each having 90 minutes events like divorce, which have a health outcome uplifts in SRRC. Any change, regardless of balance and cycle. REM sleep is characterized by rapid eye moment. That is how differentiate wake and REM Sleep. coping ability is potentially damaging to health. However, positive emotional experiences can buffer Elderly has more of they have very less REM sleep. They keep on waking up at night. 9-year-old child against stress disorders. Lazarus etal 1980 example. Breathers, sustainers, restores - breather breaks has more. SWS sleep. Sleep latency is the time from light switch off time to go to the transitional sleep. from regulate stressful encounters. Sustainers sustain coping activity. Restores replenish depleted WASO means wake after sleep- how awake you feel after sleeping, uh, in the middle of the night. it is resources. Response-based perspective, General adaptation syndrome: Hans Selye first alarm found from 5 to 85 years of age. The WASO increases REM sleep. SWS considerably reduced. Non REM reaction. Body defenses are mobilized. Resistance stage body adapts to the stressor. Exhaustion, stage and REM sleep is reduced. Sleep duration and mortality are very close related. Sleeping less than six hours body's capacity. Resistance is depleted. Disease adaptation happens in the resistance stage. Abnormal or too much more than 10 hours. Increase risk ratio for mortality. Sleep disorders and problems: physiology, example, ulcers, cardiovascular diseases resulting from a long-term resistance. This is an Insomnia can't sleep at night. Hypersomnia sleeping more at night, narcolepsy, sudden sleep attacks. example of pituitary-adrenocortical system. Psychosomatic medicine:, Franz, Alexander- fight or Parasomnia sleep walking. Nightmares, you get nightmares. REM sleep behavior disorder dreams acted flight. Temporary and biologically adapted changes. Chronic stress -Overactivation of the sympathetic out. Sleep paralysis You wake up from the sleep and then you feel paralyzed. You can't move and feels branch of the autonomic nervous system. Autonomic nervous system has sympathetic and parasympathetic like a diminish sitting on your chest. Sleep problems in mental disorders, 20 to 40 percentage of psychiatric nervous system, sympathetic as fight or flight. Chronic stress, continuous activation of sympathetic branch patients suffer from sleep problems. They can be predictors or symptoms of a mental disorder. Often. Sleep and relaxation- parasynthetic. problems persist after treatment for effective disorder, alcohol addiction, dementia, schizophrenia, So chronic stress. HP axis activationhigh cortisol levels, hypercortisolism greater intraabdominal fat, insomnia is very prominent. Alcohol addiction, insomnia is not much prominent. REM sleep, larger waist circumferenceType two diabetes disinhibition happens. hypersomnia is also seen in some cases not always. PTSD is related with emotional Interaction perspective interaction models, LAZARRE and folkman. 1984. Primary appraisal: regulation. PTSD sleep related symptoms: nightmares, insomnia, hypnogogic and hypnopompic Evaluation of the stressor. Threat or no threat. Secondary appraisal: Identifying coping options and hallucinations. Hypnogogic: while falling asleep, you have hallucination. Hypnopompic hallucination: resources. Coping strategies are active coping, planning, positive reframing humor, active coping. during waking up, you have hallucinations. Then frequent awakenings with somatic anxiety symptoms. Example. I have been concentrating my efforts on doing something about the situation I am in, or I have That is strong body symptoms- reduced deep sleep, reduced REM sleep and REM fragmentation been taking action to try to make the situation better. Planning example, I have been trying to come with a happens. strategy about what to do, or I have been thinking hard about what steps to take. Positive reframing. I have Sleep and memory consolidation Sleep problems can cause memory or cognitive impairment. Theories been trying to see it in a different light to make it seem more positive. I have been looking for something of memory consolidation, Active system consolidation: the newly encoded information in the good in what is happening. Humor, I have been making jokes about it. They're asking that question. hippocampus is replayed and thereby strengthening memory traces in the neocortex. Synaptic Flowchart Model of stress Cox 1978: So actual capability and actual demand leads to perceived capability homeostasis/downscaling: encoding during wakefulness potentiates synapsis synapses are downscaled and perceived demand. That leads to cognitive appraisal, which leads to imbalance is equal to stress during subsequent sleep leading to an elimination of weak and survival of strong connections. Mental relationship response, which has a cognitive defense and behavioral behavioral response. Cognitive defense leads to health problems can cause sleep problems and sleep problems can cause mental health. 90% of depressed cognitive appraisal again, behavioral response leads to actual demand. The valued resources are objects patients have difficulties falling asleep, Frequent nocturnal arousals early morning awakening, the feeling like property, natural resources, personal characteristics, perspectives of self, energies, time, money, of sadness, anxiety, or guilt make it difficult to sleep because of the mental health problems. And mental information. All these resources need stability. When we need resource stability, it leads to stress, which health problems are associated with physical symptoms, which can impair sleep. Example, pain, poor cause depression and anxiety. Again, coping strategies. Problem solving skills is a positive coping sleep can be a side effect of psychiatric medication also. Sleep loss can lead to changes in mood, emotional strategy. It can add to distress. Avoidance behavior is a negative part. It can also add to distress. Distress reactivity and cognition. Depression, anxiety and mood swings can be sign. A side effect of can lead to depression and anxiety. Deep water, horizontal drilling. RIG explosion. The explosion pharmaceutical sleep aids, sleep loss can impair stress Regulation. Sleep is important for emotional occurred in the Gulf of Mexico in April 20th, 2010. Largest marine oil spill in the world and largest regulation. Emotional regulation is an important part in PTSD. Emotional regulation. Emotional environmental disaster in United States history, relatively untested chemical dispersements were released. memories are composed of core memory and an effective tone. Effective tone means the emotional blanket Subsequent reports of depression, anxiety, and post-traumatic stress symptoms among the residents of the that surrounds the memory. In the core, there is memory. The REM sleep reduces the effective tone and costal communities seen COR model and coping with a disaster. Physical, psychological, social until the memory of an emotional memory remains, that is the regulation of emotion. So the protective relationships, environmental,  resource stability adds to distress. Distress can go in both ways. mechanism of sleep helps us to not have intrusive thoughts while sleeping. Way to measure how Constructive coping and avoidant coping. Constructive coping can also leads to suicide proce and emotional memories are regulated by our sleep. One method is Analogue trauma task- subjects shown a avoidant coping, and also leads to suicide. Post-traumatic stress disorder, PTSD. A specific stress traumatic or neutral movie followed by sleep or awake. they are asked to collect intrusion diary with response in persons exposed to extreme stressors. Example, disaster war abuse. PTSD emerged as a term distress rating for 2-7 days. The study showed that for neutral movie sleep and awake doesn't make much in the study of US soldiers returning from Vietnam War. Symptoms include distress, insomnia, nightmares, of a difference. But in trauma movie while when the person is asleep, it reduced the trauma. But when the flashbacks, problems with memory concentration, risk of developing PTSD. 10 -30 % of persons exposed Wanting‘ does not equal ‚Liking‘. Liking: Enjoying the pleasurable effect. Wanting: Process transforming perception by increasing attractiveness of substances (incentive salience). Liking most likely decreases. Susceptible individuals become hypersensitive (sensitized) upon regular substance use. Neurophysiology of Addiction, Circuits of addiction: Reward-associated behaviour relies on an interplay between reward, memory, motivation and memory-related networks. In a non-addicted brain, control is sufficient to inhibit certain behaviour. An addicted brain enhanced value of drug in reward, memory and motivation overcomes inhibitory control. Addiction is a consequence of pathological learning and memory. The Mesocorticolimbic pathway: Main circuit for reward & addiction Four main areas : Ventral tegmental area (VTA): reward regulation, Nucleus accumbens: reward-action interface, Amygdala: emotional regulation, (Pre-)frontal lobe: executive control. Neurotransmitter: Dopamine: Increases upon reward exposure, Proportional to reward value. Impact of substances: Substances change glutamatergic (excitatory) & GABA-ergic (inhibitory) activity Different substances have different targets/effects. stages of the addiction cycle: Stage1:Binge/intoxication: Positive reinforcement by substance, Reward mediated by dopamine, Associative learning of context (drug) cues. Stage 2: Withdrawal/negative effect: Negative emotional state (involving amygdala) induces stress & anxiety Decrease in endogenous opioids. Negative reinforcement: substance seeking to avoid withdrawal. Stage 3: Preoccupation/anticipation: High vulnerability to relapse after prolonged abstinence, Drug-associated cues can elicit „craving“, Disrupted PFC function (loss of control). Interim conclusion: Addiction an increasing risk factor causing health issues. Addiction emerges from Mesocorticolimbic circuits responsible for reward. Dopamine activity is the central neurotransmitter of addiction. Neurofunctional effects of substances Physical and psychological addiction are two distinct phenomena: Physical addiction: Acute effects, Chronic consequences. Psychological addiction: Delay discounting, Addiction Delay discounting Goal-directed action. Attentional/approach bias. Acute effects of Addiction Dopamine release: Substance use causes acute increase in dopamine levels, Can be measured with PET, Concentrations correlate with„high“ experience. Natural rewards vs. substances: Two distinct differences between biological stimuli (e.g., food) and substances. Substances elicit a stronger and longer dopamine release than natural rewards. Repeated use (on a short time scale) shows no tolerance for substances; natural rewards are blunted.Chronic consequences of Addiction: Dopamine receptors: Intravenous injection of methamphetamine, Observe availability of dopamine receptors as proxy for DA release, Controls show decrease in DA receptors, but addicts do not, Chronic use decreases dopamine release, Change in dopamine receptors correlates with craving. Prediction Error: However substances boost dopamine regardless of anticipation or not. Impaired prediction error: no correction of behaviour or evaluation of reward value Alternative rewards: Participants were asked to indicate their motivation for a reward (money vs. cigarettes) via button presses. Occasional (OS) vs. dependent smokers (DS). OS show more motivation for money, while DS show no difference in motivation for either reward. Structural change: Brain atrophy: reduction of brain volume in PFC, hippocampus, amygdala, cerebellum, only partly reversible. Heavy drinkers are more at risk of brain shrinkage. Psychological/Behavioural effects: Marshmallow Test Delay discounting: Systematic decrease in the subjective value of a reinforcer as a function of delay to delivery.Biassed decision making or impulsive choices are typical in substance use disorder. Examined by binary choice between a small immediate vs. large delayed reward. Higher discounting rate, i.e., a preference for immediate reward, in alcohol use disorder. Goal-directed action vs. Habits: Goal-directed control: Deliberate regulation of behaviour, Resisting to stay out late, Exercising regularly, Linked to compulsivity. Goal-directed behaviour in Alcoholics: Probabilistic patterns can be learned. Strategies for choices emerge. Chronic alcohol use impairs goal-directed behaviour. Cue Reactivity: Physiological, Craving, Arousal (heart rate), Behavioural bias, Attentional bias, Approach bias. Attentional Bias: Incentive-sensitisation theory suggests drug related stimuli become salient Do smokers attend to smoking-related stimuli?, Visual dot probe task, Slow reaction in smokers, attention drawn to addiction-related stimuli. Approach Bias: Does saliency of drug-related stimuli affect motor responses?, Depending on orientation avoid or approach, Does saliency of drug-related stimuli affect motor responses? Approach tendency: The higher approach tendency the faster approaching than avoiding. Alcohol-dependent subjects show stronger approach tendencies for alcohol cues. Approach tendency: The higher approach tendency the faster approaching than avoiding Approach tendency (approach tendency correlates with craving). Aversive conditioning & smoking: Treating smoking during sleep. Olfactory aversive conditioning: Unpleasant odours (ammonium sulphide or rotten fish) combined with cigarette odour vs. clean air during sleep. sleep on time. is also their free lag because of problems etc. within a 12- termination substance use : Using Craving. social

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