EXCI 233 Quiz 1 PDF

Lecture 1 Slides 3,4,5: know the concepts on these slides (**make sure you view these slides in "presentation" mode so that you are viewing all of the information on the slides) Slide 6: no need to memorize numbers or the different categories; rather understand the concept of the illness-wellness co...

Lecture 1 Slides 3,4,5: know the concepts on these slides (**make sure you view these slides in "presentation" mode so that you are viewing all of the information on the slides) Slide 6: no need to memorize numbers or the different categories; rather understand the concept of the illness-wellness continuum. Slide 9 – you don’t need to memorize the wheel of social determinants of health but be able to recognize these as social determinants if provided in a multiple choice question. Slide 11 – you don’t need to memorize the SDG’s, but understand what the overall objective of the SDG’s is. Be able to recognize the SDG’s if given in a question (it will be obvious; I won’t try to trick you) Slide 3​ WHO defines health as: ​“a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity (illness).”​ ​ “Health” is the goal we strive to achieve for optimal function and state of being for body, mind, and spirit. ​ Slide 4​ WHO defines wellness as:​ “a positive approach to living” and encompasses “the optimal state of health of individuals and groups”​ ​ Wellness is the lifelong, daily process of conscious (and unconscious) choices and actions, not only for self, but also for community and the planet.​ ​ The Dimensions of Wellness model: 8 mutually interdependent elements of personal wellness that influence our wellness, quality of life and longevity Slide 5 Slide 6 The Illness-Wellness Continuum is a concept that shows the relationship between the treatment paradigm and the wellness paradigm. It suggests that wellbeing is more than just the absence of illness, but also includes mental and emotional health. The continuum ranges from a state of poor health on the left to a state of optimal health and wellbeing on the right Slide 9 Slide 11 Lecture 2 Know info on Slides 4-8. Slide 9: understand that within the gut-brain axis, that the gut bacteria "communicate" with the nervous system and immune system, which in turn, sends signals to the brain that impacts our thoughts, mood and behaviour (we will learn more about this later in the semester). Slide 11: What is the "take home" message from Dr. Maté on stress and the immune system? Slide 14: define communicable vs. chronic illness and recognize which illnesses fall into which category (animate this slide to reveal information). Slide 16-17: what is cardiometabolic health? What is the diagnostic criteria for metabolic syndrome? Slides 18-19: recognize difference between T1 and T2 diabetes; difference between Alzheimer's and dementia. Slide 23: understand the hierarchy from low to high strength of scientific evidence. 1. How many nerves are present in the gastrointestinal (GI) tract?===== 100 million Slides 4-8​ ​ Prefrontal cortex: higher executive function, reasoning, attention – slow response to impulse inhibition ​ Limbic system: lower order emotional processing, impulsive – acts quickly in response to emotion​ Within the limbic system is the Amygdala: fight-flight-freeze-appease response – e.g. fear, sadness, anger, physical `aggression, withdrawing (stress response)​ ​ Lizard brain – brainstem and cerebellum​ Mammalian brain – limbic system ​ Human brain - cortex ​ ​ The “Amygdala Hijack”​ When faced with stress, there is a “back-and-forth” battle between the prefrontal cortex and the “primitive” default system for emotion (the limbic system / amygdala). When the amygdala wins, we retreat into “fight-flight-freeze-appease” with fear/sadness/anger/aggression/anxiety/panic/avoid/shutdown/become numb/people please/co-dependency. In this state, there is limited connection with the prefrontal cortex. At this point, reasoning and communication is a challenge. ​ ​ It’s important to note that the amygdala hijack is a *normal* and autonomic process – it is an evolutionary adaptation to save us in fight-or-flight. It is necessary for survival, but not always for day-to-day interactions. The good news is that we do have the capacity to override the amygdala response with the prefrontal cortex. We can control our body response with our mind control. This is done through conscious awareness and behaviour-cognitive techniques. Mindfulness strategies and professional therapy is effective in helping us navigate our emotional responses to stress. ​ ​ Think of your brain as your ”central command centre”. The brain controls all of our body systems: immune system, endocrine (hormone), cardiovascular, respiratory, digestive, reproductive, etc. Everything we feel, observe, sense and feel (both consciously but also subconsciously) is transmitted through the entire nervous system. Your response to stress and/or trauma (brain fog, irritability, anxiety, depression, GI issues, sleep disorders….) is based in physiology. ​ ​ From an evolutionary perspective, nervous system regulation by the ”central command centre” has two modes: either “fight-or-flight” or “rest and digest”. This we cannot change. Therefore, whenever the brain is processing our environment, it will function in one of two ways: to be at rest (parasympathetic nervous system) or in flight-flight-freeze-appease (sympathetic nervous system). Vagus nerves – group of nerves involved in the parasympathetic nervous system. Vagus nerves stimulate digestion, slow heart rate and respiration, decrease blood pressure, moderate immune system and inflammatory response. It is the “rest and digest” nervous system pathway. The HPA Axis (see next slide) prepares us for action (sympathetic nervous system). Both modes are beneficial to our homeostasis (internal balance). However, it’s when we perceive/experience a chronic amount of stress that we end up in chronic “fight-or-flight overdrive” that can lead to mental, physical and emotional dysfunction. ​ ​ Sometimes (well, let’s face it: many times) the stress is unavoidable, and we need to employ strategies to protect our health. While this is not a cure-all to chronic stress, employing strategies to ”hack” the nervous system can decrease SNS activity and increase PNS activity. ​ TBD later in the semester. ​ The hypothalamus is essential in homeostasis (balance/regulation) of the body’s vital functions including temperature, blood pressure, mood, hunger and thirst, sex drive and sleep. It acts as a “thermostat” to regulate these processes in response to signals from the brain and peripheral cells. It is an essential link between the nervous and endocrine systems.​ ​ Cortisol is a steroid hormone produced by the adrenal glands (found on top of the kidneys) and released in response to stress. While cortisol does have a “beneficial” role in the body (e.g. regulation of blood pressure, mobilization of glucose for metabolism, decreasing inflammation), chronically high levels of cortisol in the body gives rise to health issues. This is a simplified overview of the link between stress and chronic disease. While there are many other hormonal regulatory systems in the body, the HPA axis is highlighted here because of its central role in the body’s stress response. It affects the *entire body* and its control systems: namely cognition/emotion, immune system (immunity and inflammation), metabolism and digestion. ​ ​ When stress of any type (social, emotional, physical, environmental, etc) is perceived and internalized, the HPA axis transmits the stress response to the entire body – cells, organs, body systems – via nerve impulse, neurotransmitter (EP, NE) and endocrine (cortisol) response. ​ ​ We need cortisol for our everyday function (it is beneficial for us when blood levels are “normal” range). It helps with focus, stamina and is involved in metabolic processes of the body. The issue is that chronically high levels of cortisol can lead to dysregulation or “dis-ease” autoimmune, cardiovascular, intestinal, muscular…​ ​ *** It’s important to note there is genetic/epigenetic pre-disposition to disease, and the interactions of genetics, lifestyle and environment is complex​ ​ ​ Why does stress show up in the digestive system? ​ Enteric nervous system: division of the autonomic nervous system (meaning automatic, without thinking) that is a ”web” of 200-600 MILLION nerve endings embedded into the digestive tract from the lower part of the esophagus to the rectum. Often called our “second brain”, it communicates back-and-forth between the GI tract and the brain. The enteric nervous system controls motility (contractions and movement of food), release of neurotransmitters and hormones, sensation of pain, and cross-talk with the brain’s perception of environment (emotions, stress) therefore our thoughts and emotions can impact how the GI tract functions and feels AND VISE VERSA – THE HEALTH OF OUR GUT CAN IMPACT OUR EMOTIONS, THOUGHTS, BEHAVIOURS, OVERALL HEALTH​ ​ Digestive issues related to stress: acid reflux, gallstones, ulcers, nausea, appetite suppression, indigestion, intestinal/bowel pain, bloating, constipation, diarrhea, diverticulitis, IBS (irritable bowel syndrome, IBD (inflammatory bowel disease: Chrone’s Disease, ulcerative colitis)​ ​ *** It is important to differentiate between stress-related GI issues and signs/symptoms of serious health issues (e.g. colorectal cancer, celiac disease). Always consult with a medical professional regarding on-going health issues. Slide 9 What makes up the communication of the MICROBIOTA GUT-BRAIN AXIS?​ The communication is two-way or back-and-forth, known as cross-communication.​ Note: we will be discussing this pathway in more detail later in the semester.​ *nervous system: HPA axis, enteric nervous system and neurotransmitters, vagus nerve, brain​ *endocrine system and hormones​ *circulatory system​ *immune system​ *gut bacteria, parasites, fungi, signalling proteins​ ​ As you can see, the system is VERY complex. Throw in genetics and environmental factors, and you can why this is a fascinating, albeit challenging, field of research in health and wellness ​ Slide 11 Chronic stress can lead to immune system dysregulation. In this illustration, one of the immune cells, called the T-cell, becomes “confused”, and instead of protecting the nerve cells of the body, it attacks and breaks them down. This, in simplistic terms, is known as autoimmune disease. Several autoimmune diseases are identified. ​ ​ *** It’s important to note there is genetic/epigenetic pre-disposition to disease, and the interactions of genetics, lifestyle and environment is complex.​ ​ Slide 14 Communicable vs non- communicable ( chronic disease) Communicable: you can spread it (STI’s, covid). Can lead to chronic health complications, but usally acute Non-communicable: you cannot spread it, last for more than 1 year and requires medical care and impacts quiality of life. It is multi-factorial: genetics, lifestyle, environment, age gender. It can be things such as type 2 diabetes and cancer Slide 16-17 Which body organs encompass cardiometabolic health? ​ ​ What are the health indicators of cardiometabolic disease? ​ ​ blood pressure​ ​ blood lipid levels (LDL, HDL and triglycerides)​ ​ blood glucose and insulin response​ ​ body fat distribution​ ​ immune/ inflammation markers​ ​ kidney and liver enzymes…​ ​ Blood lipid levels = cholesterol (HDL and LDL), triglycerides​ ​ HDL: high-density lipoprotein – “good” cholesterol – want this to be higher​ LDL: low-density lipoprotein – “bad” cholesterol – want this to be lower​ triglycerides: type of fat cell in the blood; higher levels are unfavorable ​ ​ cardiometabolic disease: systemic inflammation, heart attack, stroke, diabetes, liver and kidney disease (also certain cancers, dementia) Research indicates that almost 20% or 1 in 5 adult Canadians has MetS (Metabolic Syndrome)​ This number jumps to 40% in those 65 and older​ Slide 18-19 Slide 23 Lecture 3 Slide 5: know information on this slide about unconscious bias. Slide 7: recognize different types of privilege. Slide 8, 9, 10: understand the concept of intersectionality and be able to recognize communities that are marginalized, and types of “isms”. Slides 11, 12, 14, 15,16: what are the take-home messages/themes from these data? Slide 13: what is calling out/calling in? Slide 17: how is emotional suppression in boys linked to societal issues we see today? What are three areas in society that boys and men are currently facing challenges? Slide 19: understand the concept of compassion. Slide 22: What is DEIB? Slide 5 halo bias: making assumptions on a person, company, country, etc based on one perceived “good” quality e.g. someone well-dressed is honest​ horn bias: making assumption based on a perceived “negative” trait e.g. someone casually dressed is not honest​ Slide 7 Slides 8, 9, 10 Kimberlé Crenshaw is a pioneering scholar and writer on civil rights, critical race theory, Black feminist legal theory, and race, racism and the law. Over 30 years ago, Kimberlé Crenshaw coined the term “intersectionality” in her scholar paper as a way to help explain the oppression of African-American women. She is a professor at Columbia Law school and the UCLA School of Law.​ the interconnected nature of social categorizations such as race, class, and gender as they apply to a given individual or group, regarded as creating overlapping and interdependent systems of discrimination or disadvantage: critical race theory: “a set of ideas holding that racial bias is inherent in many parts of western society, especially in its legal and social institutions, on the basis of their having been primarily designed for and implemented by white people” Oxford definition​ ​ Slides 11, 12, 14, 15, 16 secularism: separation of religion from the “state” (e.g. no religion within public institutions) ​ ​ What is Bill 21? Bill 21 is a secular law passed in Quebec in 2019. It bans government public employees (e.g. school teachers, police officers, judges) or basically any civil servants in a position of authority, from wearing religious symbols (e.g. hijabs, kippas, crucifixes, turbans) at work.​ ​ When Bill 21 was adopted, the government said it would "permit a harmonious transition toward secularism" for Quebec. In other words, separating the state (government) from religious institution, as a means to limit discrimination in the name of religion. ​ ​ But instead, does Bill 21 reinforce pre-existing prejudice? ​ Joint study between Concordia and McGill University shows it does Slides 17 Research indicates that boys and men are facing challenges in these 3 areas:​ 1. Education​ 2.​ Employment and earning power​ 3.​ Family units and fatherhood Over the last 1-2 generations, there have been significant societal shifts that have deeply impacted the health and well-being of our boys and men. Changes in traditional gender roles, economic pressures, lack of support within education systems, the rise of digital culture, and evolving expectations around masculinity have created both challenges and opportunities. While progress has been made in some areas, such as increased awareness of mental health, many boys and men continue to navigate a complex landscape that can affect their physical, emotional, and psychological well-being. These shifts have reshaped what it means to grow up male in today’s world, often leading to feelings of uncertainty, isolation, and confusion. It’s important for us to reflect, how as an individual and as a community, how these changes influence the overall health and happiness of boys and men in contemporary society and how we can support them.​ ​ To be clear, this does not cast a shadow over the progress and rights of girls and women. It is not a binary battle, one gender versus the other. It is about supporting all people, and that both gender experience their unique challenges within society. ​ ​ Research-based, empirically supported information on the contemporary challenges and solutions for our boys and men. ​ ​ Slide 19 Sympathy: to acknowledge someone’s distress (and may provide support), without truly understanding their feelings (no lived experience)​ Empathy: to understand how someone is feeling (perhaps through lived experience); to hold space for them without trying to dismiss their feelings ​ Compassion: to take action in relieving suffering through action, “I want to help”​ ​ Slide 22​ Lecture 4 Slide 6: why are diagnosis rates for mental health disorders higher in women (vs men?) Slides 7 – 15: know social/cultural determinants that contribute to poor mental health; populations disproportionally impacted; social programs that can improve mental health of a population. Slide 16 (social stigma – be able to recognize a social stigma statement). Slides 17-19: what changes happen within the nervous system and the brain in response to chronic stress? Slide 22: recognize signs and symptoms of anxiety, depression. Slide 24: What is the number someone can call or text for suicide prevention and crisis support? Slide 26: 5 actions steps for helping someone experiencing an emotional crisis. Slide 6 Some mental health diagnoses are more common in women than men. This could be due to both biological and environmental factors. Further, bias and stigma could be at play. Some mental disorders are only experienced by women, due to differences in hormones and reproduction. Slides 7-15 Mental health as it relates to dimensions of health and wellness will be integrated into class discussion over the course of the semester. For example:​  ​ intergenerational trauma ​ ​ substance use​ ​ climate change​ ​ gut health and diet​ ​ physical activity​ ​ sleep​ ​ sexuality​ ​ access to medical care​ ​ Are there any sociocultural issues that are “new” to your generation, ones that generations before you didn’t face?​ Do you feel your generation has it “easier” or “harder” than previous generations? Why/why not?​ ​ WHO declares isolation and loneliness a global public health concern​ https://www.theguardian.com/global-development/2023/nov/16/who-declares-loneliness-a-gl obal-public-health-concern​ - an international task force was formed to address this imperative social issue​ - The WHO estimates that 5-15% of adolescents are lonely, and believes these figures are underestimated​ - loneliness is older adults significantly increases risk for dementia, heart disease​ - US surgeon general Vivek Murthy, estimated isolation/loneliness equates to smoking 15 cigarettes/d​ ​ The data on anxiety disorder are statistics published in 2022 as a part of the Canadian Community Health Survey. Quintile 1 has the lowest income while Quintile 5 has the highest income. What are the trends that you observe in this graph?​ ​ Poverty intersects with so many determinants of mental health: access to services, secure housing, food security, education/knowledge, cultural/social stigma and systemic discrimination (e.g. what if I am male, POC, identify as transgender and with low income? How could their access to healthcare services and overall treatment within the healthcare field and community be different than that for a cis white female with high income?​ ​ Recall from Lecture 1 the sustainable well-being: People, Planet, and Profit. Economic justice is essential to the health of our communities and planet. ​ Socio-economic parity = lower rates of mental health disorders = healthy, thriving and connected society​ ​ It is estimated that in 2021, $80 billion of tax payers money was spent on Canadian healthcare and social support systems related to mental health disorders. A disability is any condition (mental or physical) that impacts day-to-day quality of life (e.g. completing tasks, learning, moving, social interactions). ​ Disabilities can be related to a condition from birth (e.g. cystic fibrosis, blindness), an injury (e.g. concussion, loss of a limb), chronic illness (e.g. diabetes, autoimmune disease) or neuro-development (e.g. autism, ADHD)​ ​ 25-40% of the homeless population are 2SLGBTQ despite making up ~10% of the Canadian population https://cmha.ca/brochure/fast-facts-about-mental-illness/​ ​ Answer the following questions:​  ​ What’s the difference between “mental health” and ”mental illness”?​ ​ What factors contribute to the development of a mental health condition?​ ​ What environmental factors impact mental health?​ ​ What systemic inequalities can further increase risk and severity of mental health and illness?​ ​ What is the age by which symptoms of mental illness present in most individuals?​ ​ By the age of 40, what percentage of the Canadian population will have experienced a mental health condition?​ ​ What was the estimated economic cost of mental health care in Canada for 2021? ​ ​ ​ Slides 17-19 We can’t escape our evolutionary biology!​ ​ During a stressful event, the limbic system (the part of our brain responsible for survival) goes into overdrive. ​ The amygdala will increase in size, and the number of neural connections also increase. ​ ​ Conversely, the pre-frontal cortex (rational, higher thinking part of our brain) is ”dialed down”. ​ Research demonstrates the that pre-frontal cortex will decrease in size. ​ Furthermore, there is a decrease in neural connection between the pre-frontal cortex and amygdala, where there is poor communication between these two areas of the brain. ​ ​ Furthermore, there is a decrease in size and neural activity of the hippocampus, which helps to “dial down” the stress response​ ​ Consequently, the brain is in “amygdala hijack” mode, where people are more reactive/impulsive/reclusive/etc ​ Other outcomes may include: poorer concentration and memory retention, avoidance of social situations, risk-taking behaviours, sleep disturbance, aggression​ ​ This neurobiology is present in mental health conditions such as anxiety and depression Answer the following:​ stress can affect brain _________________________​ ​ Which stress hormone negatively impacts brain​ function?​ ​ chronic stress can impair ____________________​ ​ changes in brain structure include ____________​ ​ Slide 24 Slide 26 ​ isten actively: Give them your full attention when they talk. Avoid interrupting or giving unsolicited advice. Sometimes, just being heard can provide a lot of comfort. ​ Offer practical help: Ask if there’s anything specific you can do to help.... ​ Respect their space: While it’s important to be available, respect their need for space.... ​ Follow up: A crisis can last longer than a single conversation.... Lecture 5 General tips: - If you *added* slides while making lecture notes, make sure you are referring to the slide numbers of the originally posted lectures! Otherwise, my notes below will not correspond properly. - Any statistics (e.g. 30% of people…. 3.2x more likely …) you do NOT need to know. HOWEVER, understand RELATIVE comparisons (e.g. as income increases, risk of suffering from mental health issues decreases…over age of 65, sleep duration decreases) - The numbers you DO need to know: o Lecture 2: number of nerves in the GI tract, o Lecture 6: sleep recommendations # hour/night for adults; number of hours it takes for coffee to be metabolized in the body; for sleep/circadian clock: recommendations for daily morning sun exposure; window from ___pm to ___am to avoid exposure to light; ideal room temperature for sleep - For the SDL (self-directed learning) material: you can expect questions but it will be general concept. - Any slides that contain resources (e.g. books, mental health resources) are not examinable. This is typically stated in the "notes" section of the powerpoints - If you notice any errors with the slide numbers to study, please let me know! For the quiz, know the following (if I didn’t list the slide, you don’t need to worry about it). Lecture 1 Slides 3,4,5: know the concepts on these slides (**make sure you view these slides in "presentation" mode so that you are viewing all of the information on the slides) Slide 6: no need to memorize numbers or the different categories; rather understand the concept of the illness-wellness continuum. Slide 9 – you don’t need to memorize the wheel of social determinants of health but be able to recognize these as social determinants if provided in a multiple choice question. Slide 11 – you don’t need to memorize the SDG’s, but understand what the overall objective of the SDG’s is. Be able to recognize the SDG’s if given in a question (it will be obvious; I won’t try to trick you) Lecture 2 Know info on Slides 4-8. Slide 9: understand that within the gut-brain axis, that the gut bacteria "communicate" with the nervous system and immune system, which in turn, sends signals to the brain that impacts our thoughts, mood and behaviour (we will learn more about this later in the semester). Slide 11: What is the "take home" message from Dr. Maté on stress and the immune system? Slide 14: define communicable vs. chronic illness and recognize which illnesses fall into which category (animate this slide to reveal information). Slide 16-17: what is cardiometabolic health? What is the diagnostic criteria for metabolic syndrome? Slides 18-19: recognize difference between T1 and T2 diabetes; difference between Alzheimer's and dementia. Slide 23: understand the hierarchy from low to high strength of scientific evidence. Lecture 3 Slide 5: know information on this slide about unconscious bias. Slide 7: recognize different types of privilege. Slide 8, 9, 10: understand the concept of intersectionality and be able to recognize communities that are marginalized, and types of “isms”. Slides 11, 12, 14, 15,16: what are the take-home messages/themes from these data? Slide 13: what is calling out/calling in? Slide 17: how is emotional suppression in boys linked to societal issues we see today? What are three areas in society that boys and men are currently facing challenges? Slide 19: understand the concept of compassion. Slide 22: What is DEIB? Lecture 4 Slide 6: why are diagnosis rates for mental health disorders higher in women (vs men?) Slides 7 – 15: know social/cultural determinants that contribute to poor mental health; populations disproportionally impacted; social programs that can improve mental health of a population. Slide 16 (social stigma – be able to recognize a social stigma statement). Slides 17-19: what changes happen within the nervous system and the brain in response to chronic stress? Slide 22: recognize signs and symptoms of anxiety, depression. Slide 24: What is the number someone can call or text for suicide prevention and crisis support? Slide 26: 5 actions steps for helping someone experiencing an emotional crisis. Lecture 5 Know concepts/info on Slides 7, 8, 12, 14, 15. Slides 17-18: signs/symptoms of stress v.s. burnout? Professions at higher-risk for burnout? Slide 19: how can internalized stress impact the body? Slide 24: Be able to answer the questions on the slides about the neurotransmitters. Slide 25: understand how breath control helps with nervous system/ stress response regulation. Slide 26: understand the concept of neuroplasticity. Slide 27: benefits of meditation. Slide 31: What is the take home message from the data presented on this slide? Slide 32: Answer the questions in the blue oval about the stress buffering hypothesis. Slide 34: Know that, in a professionally supervised and controlled setting, and in combination with talk therapy, medicinal use of MDMA (ecstasy) has been effective in the treatment of PTSD. HOWEVER, at this time, the FDA has not formally approved it for clinical use. Slides 36-42 SDL - know this information. Slides 7, 8, 12, 14, 15 What is the scientific name for our inner voice? Inner speech or subvocalization Our inner voice is important in helping us: ​ Keep verbal information active in our head; allows us to plan, prepare ​ Maintain focus ​ Narrate our lives – how our experiences shape our identity How can excessive inner voice “chatter” negatively affect us? ​ Lose focus/concentration  ​ Create friction in relationships ​ Displaced emotions ​ Reliving/repeating a narrative keeps us in stress mode → affects chronic health: inflammation, CVD, cancer What is one strategy to help us gain control over our verbal chatter? ​ Creating psychological distance: you control your thoughts and not the other way around Everyone will have unique needs for strategies for control over chatter: movement, breathing, art, nature… The study (2012) analysed the responses of over 32,000 participants, aged 18 – 85 years, who completed the BBC’s `Stress Test’ University of Liverpool ​ Outcome: traumatic life events aren’t the biggest cause of anxiety and depression, but how a person thinks about these events determines the level of stress they experience.​ Dwelling, or “ruminating” on the negative event was related to level of anxiety and depression. ​ Those who can reframe thoughts, practice self-compassion are more resilient ​ ​ As hypothesised, a family history of mental health difficulties, social deprivation, and traumatic or abusive life-experiences all strongly predicted higher levels of anxiety and depression. However, these relationships were strongly mediated by psychological processes; specifically rumination, self-blame and lack of adaptive mental coping strategies.​ ​ Self-compassion: the process of turning compassion inwards​ Sense of purpose can change several times over lifespan according to world views, life stages (adolescent, adult, senior) and life events (lived experience at work or with family, life crises/event…)​ Resilience: there are many definitions. Taken from these: it is successful adaptation to challenging life experiences; “springing off” of adversity to a higher point than before the hardship https://www.apa.org/ed/precollege/topss/daily-life-resilience.pdf​ ​ Building resilience and ability to thrive within self and community. Think of life as a trampoline – as you are falling down and the trampoline is being stretched out, what is going to support you, to spring you back up again? What are your self-supports (i.e. with internal processing, lifestyle behaviours)? What are your community supports? ​ ​ We will discuss resilience during lectures on childhood and adolescent health​ ​ Resilience strategies such as:​ ​ Connecting deeper with sense of cultural identity​ ​ Nurturing self-compassion, positive affirmations​ ​ Discovery and expression through art, culture, creativity​  ​ Establishing strong connections with community​ ​ Spiritual practice​ ​ Self-care​ ​ Cognitive behavioural therapy to assert control over thoughts, perceptions, actions​ ​ Lifestyle behavior change​ ​ At a community level: built-in support systems (e.g. urban policies with transportation; access to education; etc) Slides 17-18 Important to note that with burnout, while there are physical signs/symptoms, will manifest primarily as psychological symptoms​ ​ Stress is an adaptive response to any kind of adverse circumstance. ​ Burnout occurs due to continuous exposure to stress, leading to mental, physical and emotional exhaustion. It is a health disorder. ​ Slide 19 Women are 80% more likely than men to present with an autoimmune disease​ - related to emotional suppression, emotional burden (e.g. caregiver), people pleasing, never good enough​ ​ There are other emotional profiles and that are linked to chronic disease such as cancer. Read the book by Dr. Maté When the Body Says No​ ​ Slide 24 Dopamine THE REWARD CHEMICAL enhances feelings of pleasure and reward, enhances motivation. It increases attention, improves cognitive executive function, and stimulates creativity​ Oxytocin THE LOVE HORMONE (that functions as a NT in the brain) has a physiological anti-stress effect: decreases blood pressure and cortisol; regulates emotional response and promotes social bonding, trust, empathy​ Serotonin MOOD STABILIZER “HAPPY NEUROTRANSMITTER” influencing learning, memory, happiness as well as regulating sleep​ Endorphins THE PAIN RELIEVER AND PLEASURE reduces sensation of pain, enhance mood, self-esteem, pleasure, reduce risk of anxiety/depression ​ ​ There is another neurotransmitter of interest: GABA. Closely linked to diet quality/gut health. It will be discussed later in the semester​ ​ Note: Morphine, fentanyl, and other opioid drugs work on the same pain receptors involved in your brain's endorphin system. When you take opioids, your brain releases more dopamine. (Extended use of opioids can decrease body’s production of dopamine levels, leading to chronically low dopamine levels)​ Slide 16 controlled breathing (breath holds, longer exhale, less # breaths/min)​ ​ “dials up” the “rest and digest” ​ ​ “dials down” the “fight and flight” his also applies to meditation and yoga – these mindfulness-based practices are “bottom up” therapies to “reset” the circuitry, to inhibit neural input from the HPA axis (the stress response, SNS) and increase neural input from the vagus nervous system (the rest and digest, PNS)​ ​ A great place to start is the 4-7-8 breathing technique. There are many other techniques you can explores​ Slide 31 Slide 26 CBT – cognitive behaviour therapy. Cognitive techniques to reshape thought patterns and behaviours ​ ​ These images are visual examples of how meditation ”trains the brain” and changes its neurocircuitry and firing to benefit mental health and well-being.​ ​ In the treatment of anxiety (top image) or pain (bottom image), regular practice of meditation “turns down” the areas of the brain that perceive anxiety or pain, and “turn up” the areas associated with calmness. ​ ​ Your mind is like a muscle – through CBT and mind-body activities like meditation, you can ”train your brain”​ ​ You can “strengthen your mind muscle” and change brain neural activity ​  ​ We can ”dial in” and strengthen connections to areas of the brain associated with higher learning, memory and relaxation (e.g. pre-frontal cortex, hippocampus) and “dial down” connections to areas responsible for pain, stress response (e.g. amygdala)​ ​ ​ Slide 32 Stress-buffering hypothesis: reducing the activity of the stress-mediated neurobiological systems: ie. HPA axis, limbic system​ ​ social support figures (e.g. parents) provide a “buffering” support in our processing with defense reactions and to fear​ ​ From an evolutionary perspective, we used to travel around in tribal groups (on average around 150 people). When surrounded by support of this “tribe” our brains said, “phew, we are safe in numbers to threats. I can remain calm, I have others around me for support in case of fight-or-flight. The stress response / HPA axis isn’t activated (or if it is activated, the amplification isn’t high)​ ​ ​ ​ Slide 34 The FDA voted to NOT approve MDMA as a recognized therapy in the clinical treatment of PTSD, despite the fact that, in the Phase 3 clinical trial for MDMA, approximately 2 out of 3 people who received three sessions of MDMA and talk therapy no longer qualified for a PTSD diagnosis (a positive outcome that is almost 2x higher than that from other existing medications). Researchers and clinicians are outraged and will continue to advocate for its use.​ Lecture 6 Slide 5 - be able to answer the question Slides 6-9 understand all the concepts on these slides: circadian clock and what it controls; factors that can help to regulate or dysregulate the clock (e.g. nutrition, exercise, etc); sleep-wake cycle, stages of sleep, benefits of deep sleep to the body and brain Slide 10 – don’t need to know the stats, but understand what social determinants can impact sleep Slides 12-14 - importance of sleep - in this case REM sleep - to the brain Slides 16-17 - recognizing what chronic diseases are linked to circadian dysregulation (also understanding it can be bidrectional e.g. poor sleep can increase risk of depression; depression can decrease quality of sleep) Slides 18-19 know the information presented on this slide, in relation to how late-night light exposure can impact health Slide 20 – you don’t need to memorize anything from this slide; just know that poor sleep is linked to memory loss and progression of Alzheimer's Slide 21, 25, 26, 27, 28 - nutrition factors and impact on sleep; also how sleep Slides 21, 23-27 - know this information Slide 28 – recognize foods to avoid before bed; know that gut health is linked to sleep, and that a plant-based, pre- and probiotic diet supports sleep. All other information you do *not need to know from this slide Slides 29-35 - know this information Slide 36 - be able to define what CBT-i. You don't need to know the components of it According to sleep recommendations, how many hours per night should adults get?====7-9 How long does it take for caffeine (from coffee) to be metabolized in the body? ====5-7 What is the ideal room temperature for sleep? 15-19 Slide 5 The two lifestyle factors that appear to have the biggest impact on regulating our circadian rhythm (24-hour sleep-wake cycle) are: 1.​ Light exposure – Natural sunlight in the morning and minimizing blue light exposure at night help regulate melatonin production and maintain a stable sleep-wake cycle. 2.​ Consistent sleep schedule – Going to bed and waking up at the same time every day, even on weekends, helps reinforce the body's internal clock. Other factors like meal timing, physical activity, and caffeine consumption also play a role, but light exposure and sleep consistency are the most influential. Slides 6-9 ​ Communication between our circadian clock and body systems is bidirectional – for example, the circadian clock will send signals to the cardiovascular system for sleep (e.g. heart rate will slow, blood will decrease). Similarly neural feedback from our cardiovascular system to our internal clock can either support or disrupt the sleep-wake cycle. ​ ​ Besides light exposure first thing in the morning (and dim light at night), regular physical activity is a key player in regulating our sleep-wake cycle. After a workout session, signals are sent back to the circadian clock telling us that we need to get a good night’s rest, so that all the body systems (cardiovascular, muscle, nervous, immune, hormone) can sufficiently repair/recover from the exercise. So when people say sleep better when they are active, that’s why! (the exception is intense exercise late at night, right before sleep – this can impair sleep.)​ ​ Observe the 24-hr hormone cycles for melatonin and cortisol. Assuming an ”ideal” sleep from 10pm-6am (8hr), note when they peak, and when they are at their lowest​ - cortisol in the am is required for performance: energy, stamina, concentration​ - melatonin, known as the sleep hormone signals our body systems (nervous system, endocrine, cardiovascular, digestion, reproductive) for sleep, repair and regeneration. ​ ​ Fullness and satiety hormones affect our circadian rhythm. Emerging research indicates that timing of meals can affect this internal clock. Eating late in the evening may contribute to dysregulation of sleep. Conversely, sleep deprivation can affect our appetite regulatory hormones, contributing to cravings and overeating. Why is it important to be outdoors and have at least 15min of natural sunlight before 10am everyday? ​ https://www.webmd.com/sleep-disorders/features/morning-light-better-sleep​ ​ sensory cells in the eye’s retina tells your brain to stop making the sleep hormone melatonin​ ​ natual light sensed by the eye will also send signals to the brain’s circadian rhythm “master centre”, instructing the body to increase melatonin levels about 14 hours later (an increase in melatonin will tell our body that it’s time to go to sleep)​ ​ Morning light stimulates the production of cortisol, which can help with attention, performance, stamina (we do need cortisol for this)​ ​ Studies show that morning light may also affect the hormones leptin (the satiating hormone) and ghrelin (the hunger hormone) in ways that promote a healthy body weight.​ ​ exposure to natural sunlight increases the release of serotonin in the brain – that’s our ”mood stabilizer” , happy neurotransmitter non-REM : stages 1-4 increasing depth of sleep​ stage 1-2 decrease HR, body temp, and brain activity, “lighter sleep”​ stages 3-4 deeper sleep; recharging of immune system; overhaul of CV system, ​ ​ REM sleep​ during which we dream, increase in brain wave activity, integration and consolidation of information, emotional processing, problems solving we are “paralysed” during this sleep phase why?​ ​ cycle back-and-forth between REM and non-REM, this cycles approximately every 90min-120min (4-5 cycles depending on sleep duration)​ ​ Ratio of REM to Non-REM changes throughout the night​ For the first half of the night, non-REM sleep dominates, specifically stages 3&4​ For the 2nd half of the night, REM sleep dominates ​ ​ sleep spindles: bursts of brain activity during namely Stage 2 sleep, a part of memory consolidation and cortical development​ Slide 10 Women 35-64 tend to sleep longer than men, and on average and different studies suggest it’s 10-28min more/night (this a generalization; some women might need more sleep; some women don’t need additional sleep). ​ Women spend more time in the deep phase (3/4) of sleep. Possible reasons?​ -Physical and emotional stress of menstruation, pregnancy and menopause require --> body needs more deep sleep for repair/ system recovery​ -women are typically the caregivers extra emotional/physical labour of family. May need extra deep sleep for body/mind recovery​ ​ Gender differences in sleep disruption​ - women are disproportionally impacted by anxiety and chronic pain, both of which disrupt sleep (women are more likely to be diagnosed with a sleep disorder but this could be partly due to the fact that more women seek help)​ - Lower iron and fluctuating estrogen levels can disrupt sleep in women​ ​ Slides 12-14 NREM: Stages 3&4 deep sleep: less brain activity, slow delta waves; “cleaning” and repair of the brain, preparing it for the REM stage​ REM: high brain activity, fast beta waves. Dreaming phase of sleep. Memory consolidation, learning, emotional regulation, problem solving, creativity.​ ​ Brain reprocessing happens during REM. There is more REM taking place during the second-half of the sleep cycle. So if we cut our sleep cycle short (e.g. get 6 hr instead of 8hr of sleep), we are missing out valuable REM sleep. This impacts our brain potential. ​ ​ With respect to emotional regulation:​ full-night sleep – good connection between the amygdala and prefrontal cortex good regulation of emotion; ​ sleep-deprived – impaired connection prefrontal cortex with amygdala (which is on overdrive, hyperstimulated when sleep-deprived); therefore poor emotional processing and regulation​ ​ 1.​ Need sleep before learning, otherwise the memory circuits will be impaired, can’t effectively lay down new memory from the learning opportunity​ 2.​ ​ 2.​ Need sleep after learning to help with memory consolidation into short- and long-term memory. Two processes that happen:​ ​ - file transfer collected by the hippocampus and relayed to the cortex to be stored​ ​ -replay to strengthen waking memories (happens in faster motion than real time!) ​ ​ ​ 3.​ Integration and association – interconnects memories, widening your perspective and understanding ​ ​ SRI – sleep regularity index consistent sleep-wake times ​ ​ 2017 study – observed 61 college students for 31 days​ The findings for the graph on the right, from the 2017 study demonstrate that irregular sleep-wake cycle in college students is associated with delayed circadian rhythms and lower academic performance. ​ ​ The same correlations have been demonstrated for athletic performance.​ Better sleep quantity and regularity = better skill acquisition, improvement in athletic parameters (e.g. strength, speed, running time). Decreased risk injury.​ Slides 16-17 Chronic sleep deprivation (defined as curtailed sleep for > 3months)​ Low-grade inflammation: low levels of cellular inflammation that can increase risk of chronic disease: e.g. heart disease, diabetes. We will be talking about this in more detail later in the semester​ ​ Sleep apnea: breath stops and restarts while sleeping​ Restless leg syndrome: uncomfortable sensation in the leg that creates the urge to move the leg. It can feel like crawling, tingling, pulling beneath the skin​ ​ The relationship between sleep and disease can be bidirectional (e.g. the pain makes it more difficult to fall asleep, which increases sleep deprivation, which then increases fatigue and perception of pain…) Exposure to artificial light at night (ALAN) disrupts circadian time structure and significantly increases risk for several diseases, including cancer, diabetes, cardiovascular risks, obesity, and mood disorders. In fact, shift work is classified as a “probable carcinogen to humans” as it involves circadian disorganization.​ Slides 18-19 10 PM to 4 AM magic time Light exposure during this time can decrease the brain neurotransmitter dopamine (reward, motivation), therefore having a pro-depressive effect in the mind. Avoiding artificial light, especially blue light from screens, during this window helps maintain healthy dopamine levels, supports melatonin production, and improves sleep qualit Main outcomes from a large population study with over 86,000 subjects (Oct 2023):​ ​ Exposure to light at night can increase a person’s risk for mental health conditions: depression, anxiety, bipolar disorder, self-harm, PTSD severity as well as self-harm.​ ​ Independent of evening light exposure, daytime light exposure significantly reduces risk for these conditions e.g. risk for depression was reduced by 20%!​ ​ Listen here for the results from a study comparing the effectively of light therapy v.s. Prozac in the treatment of depression: https://www.instagram.com/reel/C3GGYY3rilK​ ​ “Avoiding light at night and seeking light during the day may be a simple and effective, non-pharmacological means of broadly improving mental health.” Burns et al, 2023​ ​ Over 85,000 subjects, cross-sectional study looking at light exposure, sleep, physical activity and mental health​ adjusted for many factors such as sociodemographics, physical activity, sleep quality, and cardiometabolic health​ examined independent relationship of light exposure to mental health​ Slides 21, 25, 26, 27, 28 ​ In brief, sleep deprivation impairs the balance of, and body response to, hormones that regulate appetite ​ ​ ​ ​ Sleep deprivation can:​ ​ Increase in appetite stimulating hormones​  ​ Increase craving for sweet, salty and fatty foods​ ​ Blunt response to fullness hormones – promote overeating​ ​ Promote weight gain, dependent and independent of overeating​ T or F: Everyone has the same biological response to caffeine.​ ➡ False – Caffeine metabolism varies based on genetics, age, liver function, and habitual consumption. Some people are fast metabolizers, while others experience prolonged effects. Caffeine is classified as a stimulant (specifically a central nervous system stimulant). T or F: It takes the body 4-6 hours to metabolize all of the caffeine consumed.​ ➡ False – Caffeine has a half-life of about 4-6 hours, meaning that only half of the caffeine is metabolized in that time. It can take 10+ hours for it to fully leave the body. T or F: “I drink Red Bull at night and it doesn’t affect my sleep.”​ ➡ False – Even if someone doesn't feel the effects, caffeine can still disrupt sleep quality, reduce deep sleep, and delay melatonin production. Some people are less sensitive, but caffeine still affects brain activity related to rest. What are 3 ways in which alcohol can impact sleep?​ 1.​ Sedative – it will downregulate the cortex; we feel sleepy but it’s not actually sleep, it’s nervous system suppressive​ 2.​ Activates the “fight-or-flight” system throughout sleep cycle – waking us up (even though we don’t remember it)​ 3.​ Blocks REM sleep (dream sleep) --> therefore impairs what?​ Reason to limit late-night snacks/meals:​ ​ It can cause us to stay up later, throwing us off our natural circadian rhythm​ ​ Eating food 15min daily. Why? UV light from the sun is the strongest regulator of our circadian rhythm. UV rays sensed by our retina sends signals to the brain to: ”press pause” on melatonin production and signal the circadian clock to “press play” about 14hr later. ​ ood sleep hygiene​ 2.​ Before bedtime, we need darkness to stimulate release of the hormone melatonin. Avoid any screens >90min before bed. Turn down ambient light 2-3hr before bed (mimics sun set).​  3.​ Consistent sleep and wake times. Sleep regularity maintains the circadian rhythm, maintains sleep quantity and quality. ​ 4.​ Evening ritual to wind down 20-60min before bedtime. Completely unplug from technology, choose a relaxing activity that helps you disconnect from daily stressors such as reading, journaling, listening to relaxing music.​ 5.​ Avoid caffeine ~10hr before scheduled bedtime. Limit/avoid alcohol intake several hours before bed.​ 6.​ Avoid late-night eating. This can throw circadian rhythms off-balance. It can also cause indigestion/acid reflux (difficulty falling or staying asleep)​ 7.​ Reduce the room temperature (ideal is 18C) – core body temp needs to drop 1C to initiate and stay asleep​ 8.​ Make the room as dark and as quiet as possible. Any source of light (e.g. from under blinds, alarm clock) can disrupt sleep. Sound machines may help drown out street noise that wakes us.​ 9.​ Avoid late-evening exercise – this can disrupt the circadian clock. Post-exercise adrenaline will also impair ability to fall and stay asleep. ​ 10.​Can’t sleep? Move to a different location after 25min of non-sleep. The brain associates the bed as a trigger of wakefulness. Return to bed when you feel sleep so the brain associates the bed with sleep.​ CBT-i === cognitive behabviour therapy for insomnia: BT-I (Cognitive Behavioral Therapy for Insomnia) is a structured, evidence-based therapy designed to treat chronic insomnia by addressing the thoughts, behaviors, and habits that disrupt sleep. It is considered the first-line treatment for insomnia and is often more effective than medication in the long term.