Final 1001 Lecture Notes + Readings PDF

Chapter 1: taking charge of your health - Readings 1) Core Concepts in Health: Chapter 1 (pp. 1-39) 2) Belluz, J. (2012). Good science vs. bad science. Macleans.ca Health: - overall condition of a person's body or mind and to the presence or absence of illness or injury - Can...

Chapter 1: taking charge of your health - Readings 1) Core Concepts in Health: Chapter 1 (pp. 1-39) 2) Belluz, J. (2012). Good science vs. bad science. Macleans.ca Health: - overall condition of a person's body or mind and to the presence or absence of illness or injury - Can be determined or influenced by factors beyond your control, like genes, age, health care system and care received in childhood Wellness: - optimal health and vitality- to living life to its fullest ○ Determined by the decisions you make about how you live Social Determinants of Health: Income and income distribution - Finances shape overall living conditions, affecting psychological functioning and health-related behaviors - More equal distribution of income among a population is a strong predictor of better overall health of a society. Education - People with higher education tend to be healthier than those with lower educational attainment. Unemployment and job security - Being without a job often leads to material and social deprivation, psychological stress, and unhealthy coping behaviors; insecure employment is associated with high levels of stress, body pains, and risk of injury. Employment and working conditions - People tend to spend a substantial amount of time at work, making the physical, emotional, and other influences imposed by a work setting important contributors to health. Early childhood development - Early childhood experiences have strong immediate and longer lasting biological, psychological, and social impacts on health. Food insecurity - People who are unable to have an adequate diet in terms of quality or quantity are at high risk for inadequate nutritional intake. Housing - Poor quality housing and homelessness increase the risk for many health problems, including those associated with overcrowding, unclean water, and lack of a safe shelter. Social exclusion - Individuals or groups who are denied the opportunity to participate fully in Canadian life are less likely to have access to social, cultural, and economic resources, all of which impact health. Social safety net and network - There are a range of benefits, programs, and supports that protect citizens during various life changes that can affect their health. Health services - High-quality health care services are considered both a social determinant of health and a basic human right. Indigenous status - The health of Indigenous peoples in Canada is inextricably tied up with their history of colonization. This has taken the form of disregard for land claims of Métis people, relocation of Inuit communities, and the establishment of residential schools. The result has been adverse health outcomes. Gender - Men, women, and transex individuals are at higher risk for different adverse health outcomes, due to discrimination, social exclusion, and society-influenced gender roles. Race - Canadians of visible minority groups experience a range of adverse living circumstances that threaten their health. Because our country prides itself on being a multicultural society, these adverse circumstances also threaten the overall health and well-being of Canadian society. Disability - While disability tends to be related to physical and mental functions, it is important to consider whether society is willing to provide persons with disabilities with support and opportunities necessary to participate in Canadian life. Dimensions of wellness: 1. Physical wellness  - includes not just your body’s overall condition and the absence of disease but also your fitness level and your ability to care for yourself. - The higher your fitness level, the higher your level of physical wellness will be 2. Emotional wellness - reflects your ability to understand and deal with your feelings - involves attending to your own thoughts and feelings, monitoring your reactions, and identifying obstacles to emotional stability. 3. Intellectual wellness - constantly challenging the mind; An active mind is essential to wellness because it detects problems, finds solutions, and directs behavior 4. Interpersonal wellness - defined by your ability to develop and maintain satisfying and supportive relationships. ○ requires participating in and contributing to your community and to society. 5. Spiritual wellness - to possess a set of guiding beliefs, principles, or values that give meaning and purpose to your life, especially in difficult times. 6. Environmental wellness - defined by the livability of your surroundings - To improve your environmental wellness, you can learn about and protect yourself against hazards in your surroundings and work to make your world a cleaner and safer place. 7. Cultural wellness 8. Occupational wellness ○ refers to the level of happiness and fulfillment you gain through your work. 9. Financial wellness ○ A person’s economic situation is a key factor in overall well-being. Infectious diseases: Diseases that can spread from person to person; caused by microorganisms, such as bacteria and viruses. Chronic diseases: Diseases that develop and continue over a long period, such as heart disease or cancer. Lifestyle choices: Conscious behaviors that can increase or decrease a person’s risk of disease or injury, such as eating a healthy diet, smoking, exercising, and others. Life Expectancy and Major Health Threats Early-to-mid 1900’s - Life expectancy: 58.8 years (Male) 60.6 years (Female) - Health Threats = infectious diseases (e.g. cholera, tuberculosis, pneumonia) - Spread due to lack of clean water, poor sewage removal, crowding, unsanitary food, preparation, etc. - Growing trade between countries moved diseases from one to the other - Sources of infectious diseases soon discovered - Became easier to control the spread of disease, public health became important - Adoption of vaccinations and development of antibiotics, Western society controls the major causes of morbidity and mortality ▪ Morbidity – illness or disease ▪ Mortality – death - People began to expect that modern medicine could conquer any illness - In some ways, this belief holds true today In Canada: - Life expectancy (2007-2009): 78.8 years (Males) 83.3 (Females) (Avg. 81.1 years) ▪ Health threats – chronic diseases (cancer, heart disease, stroke) ▪ Some risk factors fall within the realm of a person’s “lifestyle” ▪ Life expectancy in Canada is among the highest in the world ▪ Most health regions with higher life expectancy are in and west of Ontario ▪ Life Expectancy increases as: Unemployment decreases Level of education increases Concentration of immigrants increases (arrive healthy, with own traditional lifestyles, avoiding the negative aspects of Canadian health styles, go through immigration screening, eventually their positive impact lowers as they adapt the Canadian way) The Integrated Pan-Canadian Healthy Living Strategy: goal: address the diseases’ common, preventable risk factors - physical inactivity - unhealthy diet - tobacco use +underlying conditions in society that contribute to them - Income - Employment - Education - geographic isolation - social exclusion two initiatives focused on making  1. the prevention of disease, disability and injury, and health promotion priorities 2. decreasing the prevalence of childhood obesity. Diversity: - Stereotyping: talking about people as groups rather than as individuals. - Overgeneralizing: ignoring the extensive biological and cultural diversity that exists among peoples who are grouped together. Sex and Gender: Sex: - biological and physiological characteristics that define men, women and intersex people - characteristics are related to chromosomes and their effects on reproductive organs and the functioning of the body. Gender: - roles, behaviors, activities, and attributes that a given society considers appropriate for men and women. - A person’s gender and gender identity are rooted in biology and physiology, and can be shaped by experience and environment—including how society responds to individuals based on their sex. Cultural differences: - health-related differences that are acquired as patterns of behavior through daily interactions with families, communities, and society Genetic predisposition: - A person can have a genetic predisposition for a disease, for example, but won’t actually develop the disease itself unless certain lifestyle factors are present, such as stress or a poor diet. Health differences in gender: 1. Life expectancy: - Women- live 4x longer but have higher rates of disabling health problems - Men- shorter life but lower health problem rate 2. Height and weight: - Women- shorter on average, higher obesity rate - Men- taller on average 3. Skills and fluencies: - Women- score better on tests of fluency, speech production, motor skills, visual and working memory  - Men- score better on tests of visual-spatial ability 4. Heart attacks: - Women- experience heart attacks about ten years later than men, suffer from atypical or silent heart attacks - Men- experience heart attacks earlier 5. Stroke: - Women- more likely to have and die from one, more likely to recover language ability - Men- less likely, but likely to suffer permanent loss of language ability 6. Immune response: - Women- stronger, less susceptible to infection, likely to develop autoimmune diseases (lupus) - Men- weaker 7. Smoking: - Women- Lower rates but higher risk of lung cancer - Men- higher rates 8. Alcohol: - Women- become more intoxicated - Men- become less intoxicated, alcoholism 9. Stress: - Women- react with tend-and-befriend - Men- react with aggression or hostility, stress-related disorders 10. Depression: - Women- more likely, higher risk of suicide - Men- lower rate, less likely of suicide 11. Headaches: - Women- migraine and chronic tension - Men- cluster headaches 12. STI's: - Women- more likely - Men- less likely Income and Education: Higher poverty rate + less education = worse health - Higher rates of infant mortality, traumatic injury, violent death and many diseases (heart disease, diabetes, tuberculosis, HIV, and cancers) ○ Likely to eat poorly, overweight, smoke, drink, use drugs Disability: - People with disabilities have activity limitations, need assistance, or perceive themselves as having a dis- ability. - about 14 percent of Canadians aged 15 years and older, as well as a third of  Canadian seniors, have some level of disability People with disabilities are more likely to be inactive and overweight. They also report more days of depression than people without disabilities. Geographic location: About one in five Canadians currently lives in a rural area—a place with fewer than 1000 residents and with less than 400 people per square kilometer. People living in rural areas have higher death rates and are less likely to be physically active, to use seat belts, or to obtain screening tests for preventive health care than are their urban counterparts. They are less likely to finish high school, have less access to timely emergency services, and have much higher rates of some diseases and injury‐related death than people living in urban areas Sexual Orientation: The 3 percent of Canadians aged 18 to 59 years who identify themselves as gay, lesbian, or bisexual make up a diverse community with varied health concerns. found them to be more likely to engage in risky behaviours, such as unsafe sex and drug use; they are also more likely to be depressed and to attempt suicide. HIV/AIDS is a major concern for gay men, and gay men and lesbians may have higher rates of substance abuse, depression, and suicide. Factors that influence wellness: 1. Health habits: - Heart disease is associated with smoking, stress, hostile and suspicious attitudes, a poor diet, and a sedentary way of life - Regular exercise can help prevent heart disease, high blood pressure, diabetes, osteoporosis, and depression, and may reduce the risk of colon cancer, stroke, and back injury. - A balanced and varied diet helps prevent many chronic diseases. 2. Heredity and Family History: Your genome consists of the complete set of genetic material in your cells; it contains about 25 000 genes, half from each of your parents. Genes control the production of proteins that serve both as the structural mate- rial for your body and as the regulators of all your body’s chemical reactions and metabolic processes. Errors in our genes are responsible for about 3500 clearly hereditary conditions, including sickle‐cell disease and cystic fibrosis. Altered genes also play a part  in heart disease, cancer, stroke, diabetes, and many other common conditions. 3. Environment: Your environment includes not only the air you breathe and the water you drink, but also substances and conditions in your home, workplace, and community. 4. Access to health care: Adequate health care helps improve both quality and quantity of life through preventive care and the treatment of disease. For example, vaccinations prevent many dangerous infections, and screening tests help identify key risk factors and diseases in their early, treatable stages 5. Reaching wellness through lifestyle management: behavior change: ○ A lifestyle-management process that involves cultivating healthy behaviours and working to overcome unhealthy ones. target behaviour: ○ An isolated behaviour selected as the subject of a behaviour change program. self-efficacy: ○ The belief in your ability to take action and perform a specific task. locus of control: - The figurative place a person designates as the source of responsibility for the events in his or her life. - People who believe they are in control of their own lives are said to have an internal locus of control. - Those who believe that factors beyond their control determine the course of their lives are said to have an external locus of control. **For lifestyle management, an internal locus of control is an advantage because it reinforces motivation and commitment. **An external locus of control can sabotage efforts to change behavior. For example: if you believe that you are destined to die from breast cancer because your mother died from the disease, you may view breast self‐exams and regular check‐ups as a waste of time. In contrast, if you believe that you can take action to reduce your risk of breast cancer in spite of hereditary factors, you will be motivated to follow guidelines for early detection of the disease. Visualization and self-talk: - One of the best ways to boost your confidence and self‐efficacy is to  visualize yourself successfully engaging in a new, healthier behavior. Role models and other supportive individuals: - Social support can make a big difference in your level of motivation and your chances of success. - Perhaps you know people who have reached the goal you are striving for; they could be role models or mentors for you, providing information and support for your efforts. - Gain strength from their experiences, and tell yourself, “If they can do it, so can I.” Identify and overcome barriers to change: - Don’t let past failures at behavior change discourage you; they can be a great source of information you can use to boost your chances of future success. Make a list of the problems and challenges you faced in any previous behavior change attempts; to this, add the short‐ term costs of behavior change that you identified in your analysis of the pros and cons of change. Once you have listed these key barriers to change, develop a practical plan for overcoming each one. 6. Enhancing your readiness to change: Stage 1: Precontemplation: - you think you have no problem and don’t intend to change your behavior. - To move forward in this stage, try raising your awareness. - Research the importance of exercise, for example. - Seek social support. Friends and family members can help you identify target behaviors (e.g., fitting in exercise into your time schedule or encouraging you while you work out). Other resources might include exercise classes or stress management workshops offered by your school. Stage 2: Contemplation: - You now know you have a problem and within six months intend to do something about it, such as invite a friend to work out with you. Stage 3: Preparation: - You plan to take action within a month or may already have begun to make small changes in your behavior. Stage 4: Action: - You outwardly modify your behavior and your environment. Stage 5: Maintenance: - You have maintained your new, healthier lifestyle for at least six months by working out and riding your bike. Lapses have occurred, but you have been successful in quickly re‐establishing the desired behavior. - The maintenance stage can last months or years. Stage 6: Termination: - you may reach the sixth and final stage of termination. At this stage, you have exited the cycle of change and are no longer tempted to lapse back into your old behavior. You have a new self‐image and total control with regard to your target behavior. SMART Goals: - Goals = challenging, have trouble making steady processes and will be more likely to give up altogether 1. Specific: avoid vague goals 2. Measurable: recognize progress easier to track if goals are quantifiable 3. Attainable: set goals within your physical limits 4. Realistic: manage expectations 5. Time frame specific: give yourself a reasonable amount of time to reach your goals Chapter 2: psychological health Readings: - Chapter 2: 40-81+ lecture notes Psychological Health (mental health): - Contributes to every dimension of wellness - Difficult to maintain emotional, social, or physical wellness of not psychologically healthy - Broad concept, difficult to define - Capacity to think, feel and behave in ways that contribute to ability to enjoy life and manage challenges - Supported or sabotaged by variety of factors (dietary choices, sleep patterns, relationship issues) - Good psychological health → positive sense of emotional+spiritual wellbeing and values fairness, culture, dignity and interpersonal connections - Freedom from disorders, one factor in psychological wellness Maslow's Hierarchy of Needs: Positive definition: Psychological health as the presence of wellness → more ambitious outlook that encourages us to fulfil our own potential Abraham moslow described ideal mental health in book “ toward a psychology of being” - According to moslow, people have a hierarchy of needs listed in order of  decreasing importance… 1. Physiological needs ○ Food and water, Shelter, Sleep, Exercise, sex 2. Safety ○ safe surroundings, protection by others, knows to avoid risks 3. Being loved ○ Loved, loving, connected 4. Maintaining self‐esteem ○ as a person, as a doer, in relationships 5. Self‐actualization - Maslow conclusions based off of study group of visibly successful people who seemed to have lived/be living their lives to the fullest - He said people achieve self-actualization: they has fulfilled a good measure of their human potential self-actualization: ○ The highest level of growth in Maslow’s hierarchy. Certain qualities of self actualized individuals: 1. Realism: - Realistic - They know the difference between what is real and what they want - can cope with the world as it exists without demanding that it be different; they know what they can and cannot change. 2. Acceptance: - Psychologically healthy people accept themselves as they are - Self‐acceptance requires a positive self‐concept: (The ideas, feelings, and perceptions people have about themselves); also called self-image, or self‐image: - a positive but realistic perception of yourself - Similarly, psychological health requires an appropriately high but realistic level of self‐esteem(The ideas, feelings, and perceptions people have about themselves; also called self-image). - People with healthy self‐esteem value them- selves as people; they feel good about themselves and are likely to live up to their positive self‐image and enjoy successes that in turn reinforce these good feelings. - Self‐acceptance also means being tolerant of your own imperfections, an ability that makes it easier to accept the imperfections of others. 3. Autonomy: - Psychologically healthy people are autonomous: they can direct themselves and act independently of their social environment - Autonomy is more than physical independence; it is social, emotional, and  intellectual independence as well. - Autonomous people are inner‐directed, finding guidance from within, from their own rules and values. They have an internal locus of control and a high level of self‐efficacy. - other‐directed people often act only in response to what they feel as external pressure from others. 4. Authenticity: - Autonomous people are not afraid to be themselves; sometimes, their capacity for being real may give them a certain childlike quality. - They respond in a genuine, spontaneous way to whatever happens, without pretence or self‐consciousness. - Such people do not worry about being judged by others just for being themselves. This quality of genuineness is sometimes called authenticity. 5. Capacity for intimacy: - Healthy people can be physically and emotionally intimate - They are able to share their feelings and thoughts without fear of rejection - A psychologically healthy person is open to the pleasure of physical contact and the satisfaction of being close to others—but without being afraid of the risks involved in intimacy, such as the risk of getting hurt. 6. Creativity: - Psychologically healthy people continually look at the world with renewed appreciation. - Such appreciation can inform a person’s creativity, which helps explain why so many mentally healthy people are creative. - They may not be great poets or painters, but they live their everyday lives in creative ways. - Creative people seem to see more and to be open to new experiences; they don’t fear the unknown or avoid uncertainty. 20 Positive psychology: Martin seligman and mihaly csikzentminhalti - 2 positive psychological pioneers - Major gains in prevention of psychological pathologies and damage were gained mainly from a perspective centred on systematically supporting, nourishing and building competency in an individual - Strength based approach - What makes life fulfilling and enjoyable are important concepts of + psychology - seligman : 3 types of happiness, each linked w + emotion and appear to deepen as a person experiences latter ones: pleasure  gratifications Embodiment of strengths and virtues Experiencing meaning and purpose - Indiv can experience happiness via 3 dimensions: 1. Pleasant life: - Dedicated to thinking constructively about past - Achieving optimism - Hope for future - Minimizing - emotions 2. Good life: - Cultivating and actively using personal virtues + strengths (wisdom and knowledge, kindness and humanity, courage and spirituality) bring forth authentic happiness and to live in the moment 3. Meaningful life: - Using personal virtues in service to others - Investing to create deeper meanings of life What psychological health is NOT: - Psychological health is not the same as psychological normality. - Being mentally normal simply means being close to average. ○ Normality: The psychological characteristics attributed to the majority of people in a population at a given time. - Freedom from disorders is only one aspect of psychological wellness. - Other aspects include our ability to enjoy life, manage challenges, and a positive sense of emotional and spiritual well-being. Further, we can’t say people have a mental illness or are mentally healthy based solely on the presence or absence of symptoms. Finally, we cannot judge psychological health from the way people look. - All too often, a person who seems to be okay and even happy suddenly takes his or her own life. Growing up psychologically: Psychologist Erik Erikson proposed that development proceeds through a series of eight stages that extend throughout life. ○ Each stage is characterized by a major crisis or turning point—a time of increased vulnerability as well as increased potential for psychological growth - On average: 275 people attempt sucide in canada each day - 11 canadians die by sucide today (2022) More than 5 million people in canada reported that needed help for their mental health in the previous year (2019) Growing up psychologically - Response to life’s challenges influence development of personality and identity Erikson’s stages of development: Erik erikson (psychologist) : - development proceeds thru a series of 8 stages that extend throughout life - Each stage characterised by major crisis or turning point (time increases vulnerability as well as increased potential for psychological growth) ❖ Birth - 1 year → trust vs mistrust → primary caregiver → being fed + comforted, developing trust that others will respond to your needs ❖ 1-3 years→ autonomy vs shame and self doubt → parents → in toilet training, exploration, learning self control ❖ 3-6 years → initiative vs guilt → family → playing talking, developing conscience ❖ 6-12→ industry vs inferiority → community → school, playing w peers ❖ Adolescence → identity vs identity confusion → peers → developing stable sense of who you are ❖ Young adulthood → intimacy vs isolation → close friends, sex partners → learning to live and share intimacy with others ❖ Middle adulthood → generativity vs self absorption → work associates, children, community → doing thing for others, parenting and civic activities ❖ Older adulthood → integrity vs despair → society → affirming the value of life and its ideals Developing an Adult Identity: A primary task beginning in adolescence is the development of an adult identity: a unified sense of self, characterized by attitudes, beliefs, and ways of acting that are genuinely your own. - People with adult identities know who they are, what they are capable of, what roles they play, and their place among their peers. - Identity crisis: internal confusion about who you are - Identity reflects a lifelong process, and it changes as a person develops new relationships and roles.  Developing Values: Erikson assigned his last two stages, generativity versus self‐absorption and integrity versus despair, to middle adulthood and older adulthood Values: - criteria for judging what is good and bad - they underlie our moral decisions and behaviour - The first morality of the young child is to consider good to mean what brings immediate and tangible rewards, and bad, whatever results in punishment. Living according to values means: ○ Considering your options carefully before making a choice; ○ Choosing between options without succumbing to outside pressures that oppose your values; and ○ Making a choice and acting on it rather than doing nothing. Striving for Spiritual Wellness: - associated with greater coping skills and higher levels of overall wellness - It is a very personal wellness component, and it can be developed in many ways 1. Social support: - Attending religious services or participating in volunteer organizations helps people feel that they are part of a community with similar values and promotes social connectedness and caring. 2. Healthy habits: Some of the paths to spiritual wellness may encourage healthy behaviours, such as eating a vegetarian diet or consuming less meat and alcohol, and may discourage harmful habits, such as smoking. 3. Positive attitude: Spirituality can give people a sense of meaning and purpose in life, and these qualities create a more positive attitude in people, which in turn helps them cope with life’s challenges. 4. Moments of relaxation: Spiritual practices, such as prayer, meditation, and immersion in artistic activities, can reduce stress by eliciting the relaxation response. Self-Esteem: - regarding yourself, which includes all aspects of your identity, as good, competent, and worthy of love. - It is a critical component of wellness. Self-Concept: - begins in childhood, based on experiences both within the family and outside it.  - If they feel rejected or neglected by their parents, they may fail to develop feelings of self‐ worth. - They may grow to have a negative concept of themselves. - Another component of self‐concept is integration. An integrated self‐concept is one that you have made for yourself—not someone else’s image of you or a mask that doesn’t quite fit. - A further aspect of self‐concept is stability. Stability depends on the integration of the self and its freedom from contradictions. - People who have received mixed messages about themselves from parents and friends may have contradictory self‐images, which defy integration and make them vulnerable to shifting levels of self‐esteem. - At times they regard themselves as entirely good, capable, and lovable—an ideal self—and at other times they see themselves as entirely bad, incompetent, and unworthy of love. Challenges to self-esteem: - The worst reaction is to develop a lasting negative self‐concept in which you feel bad, unloved, and ineffective—in other words, to become demoralized. - Instead of coping, the demoralized person gives up, reinforcing the negative self‐concept and setting in motion a cycle of bad self‐concept and failure. - In people who are genetically predisposed to depression By contrast, people who are demoralized tend to use all‐or‐nothing thinking. - They overgeneralize from negative events. - They overlook the positive and jump to negative conclusions, minimizing their own successes and magnifying the successes of others. - They take responsibility for unfortunate situations that are not their fault, and then jump to more negative conclusions and more unfounded overgeneralizations. Cognitive distortions: - Patterns of negative thinking that make events seem worse than they are. Being less defensive: Defence mechanisms: mental devices for coping with conflict or anxiety Many psychologists believe that pessimism is not just a symptom of everyday depression, but an import- ant root cause as well. - Pessimists not only expect repeated failure and rejection but also accept it as deserved. - Pessimists do not see themselves as capable of success, and they irrationally dismiss any evidence of their own accomplishments. Maintaining honest communication: - Some people know what they want others to do but don’t state it clearly because they fear denial of the request, which they interpret as personal rejection. - Such people might benefit from assertiveness training: learning to insist on their rights and to bargain for what they want.  - Assertiveness includes being able to say no or yes depending on the situation. Dealing with anger: At the other extreme are people whose anger is explosive or misdirected—a condition called intermittent explosive disorder (IED). - IED is often accompanied by depression or another disorder. - Explosive anger or rage, like a child’s tantrum, renders individuals temporarily unable to think straight or to act in their own best interest. - During an IED episode, a person may lash out uncontrollably, hurting someone else or destroying property. - Anyone who expresses anger this way should seek professional help. Anxiety Disorders: Anxiety: - another word for fear, especially a feeling of fear that is not in response to any definite threat. Simple Phobia: (specific phobia) - a fear of something definite, such as lightning or a particular animal or location. - 5% of children, 16% adolescents and 13% of all canadians will have specific phobia in lifetime. - Simple phobias are believed to result from a combination of biological factors and life events. Social Phobia: - The 8 to 13 percent of Canadians with social phobia fear humiliation or embarrassment while being observed by others. Panic Disorder: - experience sudden unexpected surges in anxiety, accompanied by other symptoms, such as rapid and strong heartbeat, shortness of breath, loss of physical equilibrium, and a feeling of losing mental control. - About 2 percent of Canadians experience a panic disorder in a given year, and 4 percent will experience it at some point in their lifetime. - The fears and avoidance may spread to a large variety of situations until a person is virtually housebound, a condition called agoraphobia. - People with panic disorder can often function normally in feared situations  if someone they trust accompanies them. Generalized anxiety disorder (GAD): - by excessive, uncontrollable worry about all kinds of things and anxiety in many situations. - experienced by about 8.7 percent of Canadians (ages 15 and older). - This diagnosis is given to people whose worries have taken on a life of their own, pushing out other thoughts and refusing banishment by any effort of will. - Worrying about ordinary concerns (will i be able to pass next fridays exams) - Always nervous → depressed Obsessive-Compulsive Disorder: - An anxiety disorder characterized by uncontrollable, recurring thoughts and the performing of irrational rituals - Diagnosis given to about 1 percent of Canadians who may have obsessions or compulsions or both. - Obsessions are recurrent, unwanted thoughts or impulses. - Unlike the worries of GAD, they are not ordinary concerns but improbable fears, such as of suddenly committing an antisocial act or of having been contaminated by germs. - Compulsions are repetitive, difficult‐to‐resist actions that are usually associated with obsessions. - A common compulsion is handwashing, which is typically associated with an obsessive fear of contamination by dirt. Behavioural Addictions: - such as gambling, shopping, or sexual activity, the role of compulsion is small but significant. - People experience intense urges to engage in the behaviour, which can create anxiety. - The urge intensifies until they carry out the behaviour repeatedly, after which they usually feel relief and elation. - As with substance addictions, the behaviour may have negative consequences, but the individual keeps returning to it in spite of them. - The behaviour is both maladaptive and persistent. Post-Traumatic Stress Disorder: - reacting to severely traumatic events (events that produce a sense of terror and helplessness), such as physical violence to themselves or loved ones.  - Trauma occurs in personal assaults (rape, military combat), natural disasters (floods, hurricanes), and tragedies (fires and airplane or car crashes). - Just under 10 percent of Canadians are estimated to have had PTSD at some point during their lifetime. - Symptoms include re‐experiencing the trauma in dreams and in intrusive memories, trying to avoid anything associated with the trauma, and numbing of feelings. ○ Hyperarousal, sleep disturbances, and other symptoms of anxiety and depression also commonly occur. - Such symptoms can last months or even years. - PTSD symptoms often decrease substantially within three months, and about half of individuals recover fully within six months Mood Disorders: Mood disorder: - An emotional disturbance that is intense and persistent enough to affect normal function; - two common types of mood disorders… 1. Depression 2. bipolar disorder. Depression: - loss of interest, sadness, hopelessness, loss of appetite, disturbed sleep, and othe physical symptoms. - depression affects about 11 percent of Canadians (ages 15 and older) at some point during their lifetime. - Women are nearly twice as likely as their male counter- parts to experience depression, at 14.1 percent compared to 8.5 percent, respectively. Various symptoms: ○ A feeling of sadness and hopelessness ○ Loss of pleasure in doing usual activities ○ Poor appetite and weight loss ○ Insomnia or disturbed sleep ○ Restlessness or, alternatively, fatigue ○ Thoughts of worthlessness and guilt ○ Trouble concentrating or making decisions ○ Thoughts of death or suicide a diagnosis of dysthymic disorder may be applied to people who experience persistent symptoms of mild or moderate depression for two years or  longer. Treating depression: - antidepressant → affect key neurotransmitter in brain (serotonin) - Electroconvulsive therapy (ECT) is effective for severe depression when other approaches, including medications and other electronic therapies, such as magnetic stimulation, have failed. - In ECT, an epileptic‐ like seizure is induced by an electrical impulse transmitted through electrodes placed on the head. Mania and Bipolar Disorder: Mania: - A mood disorder characterized by excessive elation, irritability, talkativeness, inflated self-esteem, and expansiveness. ○ A less common feature of mood disorders, are restless, have a lot of energy, need little sleep, and often talk non‐stop. They may devote themselves to fantastic projects and spend more money than they can afford. Bipolar disorder: - A mood disorder characterized by alternating periods of depression and mania. - Bipolar disorder affects men and women equally. ○ Tranquilizers are used to treat individual manic episodes, while special drugs taken daily, such as the salt lithium carbonate, can prevent future mood swings. ○ Anticonvulsants (drugs used to prevent epileptic seizures) are also prescribed to stabilize moods; examples are Tegretol (carbamazepine) and Lamictal (lamotrigine). - Warning Signs of Suicide: The expression of the wish to be dead or the revealing of contemplated methods Increasing social withdrawal and isolation A sudden, inexplicable lightening of mood (which can mean the person has decided to commit suicide) Certain risk factors increase the likelihood of suicide: A history of previous attempts A suicide by a family member or friend  Readily available means, such as guns or pills A history of substance abuse or eating disorders Serious medical problems AAS developed a mnemonic to remember suicidal warning signs: IS PATH WARM: Seasonal affective disorder (SAD): - A mood disorder characterized by seasonal depression, usually occurring in winter, when there is less daylight. Light therapy may work by extending the perceived length of the day and thus convincing the brain that it is summertime even during the winter months. Mood Disorders Society of Canada estimates that 15 percent of Canadians experience the winter blues, and 2 to 3 percent experience symptoms severe enough to be diagnosed as SAD. SAD is more common among people who live at higher latitudes, which receive fewer hours of light in winter. Schizophrenia: - involves a disturbance in thinking and in perceiving reality. - this disorder is not rare; in fact, 1 percent of Canadians have schizophrenia, and the lifetime risk is 3 percent. - 56% in men - 44% in women - 30% occurs ages 20-34 years old - Schizophrenia is likely caused by a combination of genes and environmental factors that occur during pregnancy and development. ○ For example, children born to a parent with schizophrenia have higher rates of schizophrenia, as do children with prenatal exposure to certain infections or medications. - Characteristics: disorganized thoughts, inappropriate thoughts, delusions, auditory hallucinations - Deteriorating social and work functioning Models of Human Nature and Therapeutic Change:  - 4 diff perspectives (biological, behav, cog, psychodynamic) - Each perspective has diff human nature and their therapeutic approaches 1) The Biological Model: - emphasizes that the mind’s activity depends entirely on an organic structure, the brain, whose composition is genetically determined. - The activity of neurons, mediated by complex chemical reactions, gives rise to our most complex thoughts, our most ardent desires, and our most pathological behaviour Pharmacological Therapy: - A list of some of the popular medications currently used for treating psychological disorders follows. - All require a prescription from a psychiatrist or other medical doctor. - All have been evaluated as being safe and more effective than a placebo. - As with all pharmacological therapies, these drugs may cause side effects. Placebo: A chemically inactive substance that a patient believes is an effective medical therapy for his or her condition. - To help evaluate a therapy, medical researchers compare the effects of a particular therapy with the effects of a placebo. - The placebo effect occurs when a patient responds to a placebo as if it were an active drug. Antidepressants: - selective serotonin reuptake inhibitors (SSRIs) because of one of their actions. - This group includes fluoxetine (Prozac), paroxetine (Paxil), …… - Another group is called cyclics, or tricyclics after their chemical structure; it includes amitriptyline (Elavil), maprotiline ….. - Nardil (phenelzine) and tranylcypromine (Parnate) are monoamine oxidase inhibitors (MAOI). - There are numerous others antidepressants that do not fit into these groups - Surprisingly, some of these antidepressants are as effective in treating panic disorder and certain kinds of chronic anxiety as they are in treating depression. - They may also alleviate the symptoms of OCD. Mood stabilizers: - Lithium divalproex, valproic acid or valproate, and carbamazepine lamotrigine are different types of mood stabilizers. - Many drugs that were first developed as anticonvulsants to treat epilepsy also act as mood stabilizers. - although they are usually only given in addition to other medications. They are taken to bring stability and calm to areas of the brain that have become overstimulated and overactive, or to prevent this state from developing. Antipsychotics: Older antipsychotics include chlorpromazine (once marketed as Largactil), Newer antipsychotics (sometimes called atypical) are risperidone (Risperdal) - These drugs reduce hallucinations and disordered thinking in people with schizophrenia, bipolar disorder, and delirium, and they have a calming effect on agitated patients. Anxiolytics (antianxiety agents) and hypnotics (sleeping pills): - One of the largest and most prescribed classes of anxiolytics is the benzodiazepines, a group of drugs that includes clonazepam (Rivotril), alprazolam (Xanax) - Benzodiazepines enhance the activity of the neurotransmitter GABA—a chemical in the brain that helps you to feel calm. - Their effect also produces drowsiness, making it easier to fall asleep and to sleep through the night. Stimulants: - Ritalin (methylphenidate) and Dexedrine (dextroamphetamine) are most commonly used for attention deficit hyperactivity disorder (ADHD) in children and less often in adults. - Amphetamine and dextroamphetamine (Adderall) and Lisdexamfetamine dimesylate (Vyvanse) are also stimulants, - which act to increase the level of the central nervous system. ○ ADHD: A disorder characterized by persistent, pervasive problems with inattention or hyperactivity, or both, to a degree that is considered inappropriate for a person’s developmental stage and that causes significant difficulties in school, work, or relationships. Anti‐dementia drugs: - Dementia is an impairment in memory and thinking that occurs almost exclusively in older adults. - The most common type is Alzheimer’s disease (see Chapter 17). - Some peo- ple with this problem are now prescribed reminyl, rivastigmine (Exelon), aricept, or memantine hydrochloride (Ebixa). The Behavioural Model: The behavioural model focuses on what people do—their overt behaviour—rather than on brain structures and chemistry or on thoughts and consciousness.  - This model regards psychological problems as maladaptive behaviours or bad habits. - When and how a person learned the maladaptive behaviour is less important than what makes it continue. Behaviourists analyze behaviour in terms of stimulus, response, and reinforcement. - The essence of behaviour therapy is to discover what reinforcements keep an undesirable behaviour going and then to try to alter those reinforcements. To change their behaviour, fearful people are taught to practice exposure—to deliberately and repeatedly enter the feared situation and remain in it until their fear begins to abate. The Psychodynamic Model: - Also emphasizes thoughts. - Proponents of this model, however, do not believe thoughts can be changed directly because they are fed by other unconscious ideas and impulses. - Symptoms are not isolated pieces of behaviour, but rather are the result of a complex set of desires and emotions hidden by active defense mechanisms - In psychodynamic therapy, patients speak as freely as possible in front of the therapist and try to understand the basis of their feelings toward the therapist and others. - Through this process, patients gain insights that allow them to overcome their maladaptive behaviour. Psychodynamic therapies → criticised as ineffective + endless Cognitive model: - Emphasises effect of ideas on behaviour and feeling - Resulted in complicated attitudes, expectations, and motives rather tgan from simple immediate reinforcements A Combined Approach: Cognitive-Behavioural Therapy - Typically emphasize exposure as well as changing problematic patterns of thinking - Typically involve 10 individual or groups sessions with therapist plus homework - Has been shown to produce significant improvements - Has been combined with drug therapy for depression, anxiety disorders, and schizophrenia  SUMMARY - Psychological health encompases more than a single particular state of normality. - Crucial parts of psychological wellness include developing an adult identity, establishing intimate relationships, and developing values and purpose in life/ - A sense of self esteem develops during childhood as a result of giving and receiving love and learning to accomplish goals. Chapter 3) STRESS Readings: pg 82-118 What is stress? - Refers to 2 diff things 1. Situations that trigger physical and emotional reactions 2. Reactions themselves (Stress response) Situations (triggers/ stressor) + reactions (our response) = Stress (state) - Stressor: any physical or psychological event or condition that produces stress - Stress response: the physical and emotional changes associated with stress Physical Responses to Stressors: - Two systems in your body control for your physical response to stressors: 1. nervous system 2. endocrine system. - your body is primed to respond quickly and appropriately in times of danger 1. Nervous System: - consists of the brain, spinal cord, and nerves. - Some of nervous system in voluntary and some is involuntary Autonomic nervous system: 1. Parasympathetic division: - Activated when relaxed - It aids in digesting food, storing energy, and promoting growth. 2. Sympathetic division: - Activated during arousal, including exercise - there is an emergency, such as severe pain, anger, or fear. - Neurotransmitter norepinephrine/noradrenaline: released onto specific tissues to increase their function during increased activity; when released by the brain, causes arousal (increased attention, awareness, and alertness) - to exert their actions on nearly every organ, sweat gland, blood vessel, and muscle to enable your body to handle an emergency - Commands body to stop storing energy and use it to respond to crisis 2. Endocrine System: - During stress, the sympathetic nervous system triggers the endocrine system. - This system of glands, tissues, and cells helps control body functions by releasing hormones and other chemical messengers into the bloodstream to influence metabolism and other body processes. - These chemicals act on a variety of targets throughout the body. - Along with the nervous system, the endocrine system prepares the body to respond to a stressor. The two systems together: - Chemical messages and actions of sympathetic nerves cause the release of key hormones, including cortisol and epinephrine. Hormones trigger changes: ○ Heart and respiration rates accelerate to speed oxygen through the body. ○ Hearing and vision become more acute. ○ The liver releases extra sugar into the bloodstream to boost energy. ○ Perspiration increases to cool the skin. ○ The brain releases endorphins—chemicals that can inhibit or block sensations of pain—in case you are injured. Fight-or-flight reaction: - A defence reaction that prepares an individual for conflict or escape by triggering hormonal, cardiovascular, metabolic, and other changes The Return to Homeostasis:  - Once a stressful situation ends, the parasympathetic division of your autonomic nervous system takes command and halts the stress response. - It restores homeostasis, a state in which blood pressure, heart rate, hormone levels, and other vital functions are maintained within a narrow range of normal. Emotional and Behavioural Responses to Stressors: - Your cognitive (mental) appraisal of a potential stressor strongly influences how you view stressors. - Two factors that can reduce the magnitude of the stress response are successful prediction and the perception of control. Effective and Ineffective Responses: Behavioural responses to stressors— - controlled by the somatic nervous system, which manages our conscious actions—are entirely under our control Effective behavioural responses: - such as talking, laughing, exercising, meditating, learning time‐management skills, and becoming more assertive Ineffective behavioural responses to stressors include overeating, expressing hostility, and using tobacco, alcohol, or other drugs. Personality and Stress: - the sum of cognitive, behavioural, and emotional tendencies, clearly affects how people perceive and react to stressors - Personality types: 1. Type A: - People with type A personality are described as ultracompetitive, controlling, impatient, aggressive, and even hostile.  - Type A people have a higher perceived stress level and more problems coping with stress. - They react explosively to stressors and are upset by events that others would consider only annoyances. Studies indicate that certain characteristics of the type A pattern—anger, cynicism, and hostility—increase the risk of heart disease. 2. Type B: The type B personality is relaxed and contemplative. - Type B people are less frustrated by daily events and more tolerant of the behaviour of others. 3. Type C: The type C personality is characterized by anger suppression, difficulty expressing emotions, feelings of hopelessness and despair, and an exaggerated response to minor stressors. - This heightened response may impair immune functions. 4. Type D: The type D, or distressed, personality is a new personality construct. - People with this pattern have a joint tendency to feel (but not express) negative emotions and avoid social contact with others. - They tend to be gloomy, socially inept, and anxious worriers, a combination that puts them at risk for heart problems. Researchers have also looked for personality traits that enable people to deal more successfully with stress. - One such trait is hardiness, a particular form of optimism. - View potential stressors as challenges and opportunities for growth and learning - They see fewer situations as stressful and react less intensely to stress - Committed to their activities, have a sense of inner purpose and an inner locus of control, and feel at least partly in control of their lives. Resilience: - social and academic success in at‐risk populations, such as people from low‐income families and those with mental or physical disabilities. - emotional intelligence and violence prevention. - tend to set goals and face adversity through individual effort. There are three basic types of resilience: 1. Non‐reactive resilience, in which a person does not react to a stressor 2. Homeostatic resilience, in which a person may react strongly but returns to baseline functioning quickly 3. Positive growth resilience, in which a person learns and grows from the stress experience Gender: Gender roles - (what we are expected to do) affects our stress; ex: males are “supposed” to cry in public and that could be stressful for them - women are more likely to balance multiple roles - 64% of women make all the family decisions about health care - Men tend to feel like they need to be in charge at all times; which may impair their relationships and make them feel like it's their responsibility to support the family - Women are more likely to report more high work stress, and tend to cope with stress in unhealthy ways Levels of testosterone make men have higher blood pressure increasing their chance for heart failure. - Amygdala is sensitive to testosterone and that is why men are more likely to to find a situation stressful ○ Women have higher levels of oxytocin (mood regulator) and are more likely to seek support The Stress Experience as a Whole: Stress management strategies: ○ Building greater social support through meaningful relationships ○ Participating in and contributing to your family and community in productive ways ○ Setting higher expectations for yourself but with clear boundaries and fair, consistent expectations ○ Building life skills, such as decision‐making, effective communication, and conflict management ○ Avoiding the urge to control the outcome of every situation ○ Knowing your own limits and limitations ○ Trusting others Stress and Health: 21% of Canadians report most days as quite bit or extremely stressfull (ages 12 and older) - Stress can increase vulnerability General Adaptation Syndromes (GAS) Universal and predictable response pattern to all stressors The stress triggered by a pleasant stressor is called eustress Stress brought on by an unpleasant stressor is called distress. Stages: 1. Alarm: fight or flight feeling, most susceptible to disease or injury 2. Resistance: body develops new level of homeostasis  3. Exhaustion: if the stressor persists, your body runs out of energy to keep up; can be life threatening - Gas model still viewed as key conceptual contribution to understanding of stress - Some aspects stoll outdated Allostatic Load: Long term wear and tear of body High allosteric load could be due to frequent stressor, poor adaptation to common stressor, inability to shut down stress response Linked with - heart disease - Obesity - reduced brain + immune function When allosteric load exceeds your ability to cope, you are more likely to get sick Psychoneuroimmunology: - Stress and disease study - interactions among the… 1. nervous system 2. the endocrine system 3. immune system. Immune system: - flexible and is capable of substantial change without compromising health - Increased levels of cortisol is linked to decrease number of immune system cells called lymphocytes - Neuropeptides translate stressful emotions into biochemical events, providing a physical link between immune systems and emotions acute stress: - white blood cell moves into skin and enhance immune response Personal trauma: - no immune affect Chronic stress: - negative affect on all aspects of immune system - Prolonged secretion of cortisol and may accelerate disease and inflammation - Mood, personality, and behavior and immune system are all intertwines Links between stress and specific conditions: Short term:  - Cold - stiff neck Long term: - accelerating aging - heart disease - high blood pressure - impaired immune system Cardiovascular Disease: - heart rate increases and blood cells constrict, blood cells - become damaged and covered in fat - If your stressed you have elevated cholesterol which increases inflammation - Stress‐induced increases in inflammatory messenger molecules are also linked to elevated levels of homocysteine and C‐reactive protein (CRP), two compounds that appear to be markers for CVD risk. - Stress‐related depression and anger are associated with elevated homocysteine levels, and job‐related - exhaustion is linked to high CRP levels in some people. - Elevated CRP levels have also been implicated in insulin resistance and the development of diabetes, which is in turn a risk factor for CVD. - Clearly, stress reduction can improve cardiovascular health. Psychological problems: - stress activates PKC which influences the brain's frontal cortex. - If there is too much PKC, which leads to bad judgments, can’t focus, and can’t think clearly. - Can also contribute to depression, panic attacks, anxiety, etc. - The brain’s plasticity has the ability to physically change its structure and function in response to experience. (allows brain to be altered by stress) ○ Acute stress can alter learning ○ Moderate stress enhances ability to learn ○ Effects of stress are apparent in hippocampus, which involves learning and memory Other health problems: - Digestion problems - Headaches/ migraines - Cancer - Asthma - Insomnia - Fatigue  - Menstrual irregulation - Loss of interest in previously enjoyed activities Tension headaches” - 46 - 76 % dull steady pain both sides of head Migraines: - 8.3 % canadians reported diagnosis of migraine, lasts 20 min Cluster headaches: - Severe headaches intense pain around one eye - Clusters of 1-3 headaches per day - Mainly male+histiry of family members - No cure / but # if treatment Common Sources of Stress Major life changes Daily Hassles Post-secondary Stressors - Academic stress - Interpersonal stress - Time pressures - Financial concerns - Worries about the future Job-related stressors - Burnout: a state of physical, mental and emotional exhaustion Social Stressors - Real social networks - Virtual social networks Environmental Stressors - Natural disasters - acts of violence - Industrial accidents Internal stressors - We pressure ourselves to reach goals and continually evaluate our progress and performance.; unrealistic expectations Managing Stress: ○ Shore up your support system. ○ Improve your communication skills. ○ Be nurturing and kind to others. ○ Develop healthy exercise, eating, and sleeping habits. ○ Learn to identify and moderate individual stressors and develop your resilience.  Social Support Communication Kindness Exercise Nutrition Sleep ; improves mood, fosters feelings of com- petence and self‐worth, enhances mental functioning, and supports emotional functioning. Chapter 3: Response to Stressors These stress responses include: ▪ Physical changes ▪ Emotional and behavioural responses Physical Responses: 1. Endocrine System: The system of glands tissues and cells that help control body functions by releasing hormones and other chemical messengers into the bloodstream Helps prepare the body to respond to a stressor 2. Nervous System: Autonomic Nervous System – part of the nervous system that is not under conscious supervision, consists of two divisions Autonomic Nervous System o Physical Responses to Stressors Nervous + Endocrine o Brain Detects Threat: Neurochemical message sent to the Hypothalamus→releases chemicals→ Pituitary Gland→ releases adrenocorticotropic hormone into bloodstream - ACTH → adrenal glands→ release cortisol other key hormones into the bloodstream Simultaneously: ▪ Sympathetic nerves instruct adrenal glands to release hormone epinephrine (adrenaline) which triggers several body changes (i.e. acute hearing and vision, increased heart rate, increased perspiration, etc) The nervous system + endocrine system = fight or flight reaction (Sir Walter Cannon) o Physical changes vary in intensity but the same physical reactions occur in response to both positive and negative stressors Homeostasis o A state in which blood pressure, heart rate, hormone levels, and other vital functions are maintained within a narrow range of normal o Once a stressful situation ends, the parasympathetic division of the ANS initiates adjustments necessary to restore homeostasis Fight or Flight Reaction in Modern Day Life o A survival mechanism that is part of our biological heritage o Not often necessary - many stressors we encounter do not require a physical reaction o Prepares the body for physical action regardless of whether it is an appropriate response Tend-and-Befriend o In addition to fight or flight, humans may respond to stress with social and nurturing behaviours o Especially characteristic of females, female response to stress evolved to protect self and offspring o May depend on underlying biological mechanisms (i.e. hormone oxytocin) Stress and Disease o The General Adaption Syndrome (GAS) ▪ Developed by Hans Selye (1936) ▪ Stressors can be pleasant = Eustress ▪ Stressors can be unpleasant = Distress ▪ Sequence of physical response is the same for oth ▪ Three Stages of Reaction 1. Alarm (initial stressor): -includes fight or flight response -body is prepared to deal with crisis, more susceptible to disease -symptoms include: headaches, indigestion, anxiety, disrupted sleep and eating  2. Resistance (or adaption stage) (Continued Stress) -new level of homeostasis achieved -resistance to disease is enhanced -individuals can cope with normal life and added stress 3. Exhaustion (Prolonged exposure to stress) -considerable amount of resources utilized in previous stages -result = physiological exhaustion and low resistance to disease -symptoms = distorted perceptions and disorganized thinking ▪ Criticisms: assigns a limited role to psychological factors, assumes that responses to stress are uniform, Beliefs are a cornerstone of the field of stress and they are not factored in o Allostatic Load ▪ Long term wear and tear of the stress response ▪ Long term exposure to stress hormones linked with health problems ▪ Dependent on many factors (i.e. genetics, life experience, emotional/behavioural responses to stressors, etc) ▪ High allostatic load linked with heart disease, hypertension, obesity, lowers brain and immune system functioning o Psychoneuroimmunology ▪ The study of the interactions among psychological processes and the nervous/immune systems ▪ Stress impairs the immune system thereby affecting health ▪ Acute stress (5-100 mins) → enhancement of immune response ▪ Chronic stress (long term) → negative effects on immunity ▪ Additional research needed with humans o Short Term Stress ▪ Colds and other infections ▪ Headaches ▪ stiff neck ▪ stomach ache ▪ allergies ▪ etc o Long term ▪ Cardiovascular disease ▪ High blood pressure ▪ Impaired immune function ▪ Type 2 diabetes ▪ Cancer ▪ Psychological problems The Dalai Lama o Joined scientists to discuss how stress affects health o Suggested that stress in life leads to negative emotions such as fear, jealousy, anger which can turn into violence  o Believes world peace begins with inner peace, tolerance and compassion o “To understand meaningful dialogue first you must understand others’ interests and you must respect them as your brothers and sisters and also consider them as a part of yourself” Week 7/chapter 4: weight management and obesity Reading: pg 119-165 Successful weight management requires the long-term coordination of many aspects of a wellness lifestyle, including proper nutrition, adequate physical activity and stress management - 36 % of adults have been self reported obesity (bmi) - 12-17 years old, 23% → overweight / obese - 42% gained weight unintentionally during covid 19 Body Composition: divided into: 1. fat-free mass (i.e. non-fat tissues, bones, muscle, organ tissues, connective tissues, etc.) 2. body fat 3 types of body fat: 1. subcutaneous fat: - the fat just beneath the skin; critical for normal body functioning - protection against diseases - when storage capacity is exceeded, fat starts to accumulate 2. visceral fat: the fat inside the abdominal wall and around the internal organs - an excess leads to a greater risk of heart disease, insulin resistance, and metabolic syndrome 3. ectopic fat: the fat located on or within organs, such as the liver, heart, and brain - increases the risk for metabolic syndrome, heart disease, and stroke - one kg of body fat = 7000 calories - Extra 22 calories a day → 1 kg increase in a year percent body fat - % of total body weight that is composed of fat Energy Balance - Healthy fat-to-fat mass ratio→ maintaining energy balance - Take in food/calories→ body uses for vital functions→ digest to fuel phsycial activities  - Energy in=energy out to maintain current weight - + energy → take in more than needed (excess) - - energy → take in less than needed (burn more) the Canadian environment has caused the energy balance to tip to the positive side due to large portion sizes, high-fat, high-calorie foods and easily available and inexpensive foods Evaluating Body Weight and Body Composition overweight - body weight that falls above the recommended range for good health obesity - the condition of having an excess of nonessential body fat; having a body mass index of 30 or greater Or having a percent body weight greater than about - 25% for men - 33% for women 1. Height-Weight Charts o range of ideal or recommended body weights associated with the lowest mortality for people of a particular sex, age, and height o can be highly inaccurate for some people o provide only an indirect measure of body fat 2. Body Mass Index (BMI) - a measure of relative body weight that makes height into account and is highly correlated with more direct measures of body fat; calculated by dividing total body weight (in kilograms) by the square of height in metres o fairly accurate measure of the health risks of body weight for average people o does not distinguish between fat weight and non-fat weight o inaccurate for short people ( criteria for eating disorder) ▪ 18.5-24.9 = healthy weight ▪ above 25 = overweight ▪ 25-29.99 = pre-obese ▪ 30-34.99 = obese class I ▪ 35-39.99 = obese class II ▪ above 40 = obese class III 3. Body Composition Analysis: determine percent body fat i. Hydrostatic Weighing & Bod Pod - person is submerged and weighed underwater - % body fat can be calculated from body density to compared to that of water Bod Pod: - computerised pressure sensors determine the amount of air displaced by a person’s body in a chamber ii. Skinfold measurements : - measures thickness of fat under the skin - Measurements taken several sites of body plugged in formulas that calculate body fat % - Accuracy dependent on expertise iii. Circumference measures - Waist to hip ratio determine abdominal obesity to predict health risk Waist: - Greater than 40 inch (men) - Greater than 35 inch (women) Increased chronic diseases Hip: - M: 0.94 - F: 0.82 iv. Electrical Impedance Analysis - electrodes are attached to the body and an electrical current is transmitted from electrode to electrode - electrical conduction favours the path of fat-free tissues over fat tissues v. Scanning Procedures : - computed tomography (CT) - magnetic resonance imaging (MRI) - dual-energy X-ray absorptiometry (DEXA) - Very accurate vi. Smart scales - Cellular connected scales - Easy to use - Enhance awareness of body fat composition - Not relatively accurate Excess Body Fat and Wellness obesity reduces life expectancy by 10-20 years unhealthy cholesterol and triglyceride levels, impaired heart function, death from CVD, hypertension, cancer, impaired immune function, skin problems, etc. increased risk of diabetes as the body weight increases, risk for development of these diseases increases depends on other factors such as blood pressure, tobacco use, fat distribution weight loss is recommended for people who BMI places them in the obese category and for those who are overweight and have 2 or more major risk factors for disease Body Fat Distribution men and postmenopausal women tend to store fat in the upper regions of the body (i.e. abdominal area) premenopausal women tend to store fat in their hips, thighs and buttocks excess fat in the abdominal area increases the risk for high blood pressure, diabetes, CVD, stroke, etc. - appears that abdominal fat is more easily mobilised and sent into the bloodstream waist circumference can be a measure of abdominal obesity o can increase the risk for health problems even in those with healthy BMIs abdominal obesity and any two other risk factors associated with cardiovascular health put an individual at risk for metabolic syndrome, diabetes, and heart disease Obesity canada: 1 in ten premature deaths canadians age 20-64 attribute to obesity - Excess body → diabetes mellitus (distructbition between normal metabolism) - Pancreas unable to secrete insulin to regulate bp, buildup of glucose in bloodstream - Kidney failure, nerve damage, circulation problems …. - People w obesity 7-39 times more likely to develop type ii diabetes body image - the mental representation a person holds about his or her body at any given moment in time, consisting of perceptions, images, thoughts, attitudes, and emotions about the body - a negative body image is associated with dissatisfaction of your body in general or a specific area Problems Associated with Very Low Levels of Fat less than 8-12% for women and less than 3-5% for men linked with immune, reproductive and circulatory disorders, fatigue, etc. female athlete triad – a condition consisting of three interrelated disorders 1. abnormal eating patterns and excessive exercising 2. followed by lack of menstrual periods (amenorrhea) 3. decreased bone density (premature osteoporosis) prolonged amenorrhea can lead to significant eroding of bone density Factors Contributing to Excess Body Fat 1. Genetic Factors o nutrigenomics: study of how nutrients interact and how genetic variations can cause people to respond differently to nutrients in food o genes influence body size and shape, body fat distribution, and metabolic rate  o have a greater tendency to be obese if parents are obese ▪ expression of tendency is determined by environmental factors 2. Physiological Factors i. Metabolism resting metabolic rate (RMR) – the energy required to maintain vital body function, including respiration, heart rate, body temperature, and blood pressure, while the body is at rest o heredity and behaviour affect metabolic rate o muscle is more metabolically active than fat higher RMR = burns more calories at rest o RMR is somewhat proportional to weight o exercise has a positive effect on metabolism ii. Hormones o hormonal changes during puberty, pregnancy, and menopause can contribute to the amount of fat accumulation o leptin → hormone linked with obesity - secreted by fat cells and is carried to the brain to let it know how big or small the body’s fat stores are - brain can regulate appetite and metabolic rate accordingly iii. Fat Cells o when existing fat cells are filled, the body makes more, thereby increasing its ability to store fat o if a person loses weight, it is unclear whether the number of fat cells can be decreased or just the fat cell content o the more visceral and ectopic fat you have, the greater your chances of developing health issues ***subcutaneous fat carries little or no health risk*** o gynoid obesity = excess subcutaneous fat in hips, thighs, buttocks (pear shape) o android obesity = excess visceral and ectopic fat in the upper body (apples shape) 3. Lifestyle Factors o increased eating, decreased physical activity o consuming more high-fat, high-sugar, high calorie foods, processed foods, going out to eat more o 60% of the incidence of overweight can be linked to excessive television viewing 4. Psychosocial Factors o using food as a means of coping with stress and negative emotions o eating is a distraction for feelings of loneliness, anger, boredom, anxiety, etc. o combats low self-esteem levels, low moods and low energy levels o prevalence of obesity goes down as income level goes up o food is an integral part of social gatherings and celebrations linked to culture and family Physical activity and sedentariness  - Levels of canadians declining of activity - 15% of 5-17 yo children meeting canada's 24 hour movement guidelines since before covid began - Decreased further after covid - 60% of incident of overweight → excessive television viewing - Over 90% of food and beverage products viewed online are by teens /children → unhealthy Sleep: - Short sleep→ increased BMI + abdominal obesity - Increased snacking Adopting a Healthy Lifestyle most weight problems are lifestyle problems slow weight gain is a major cause of obesity critical to adopt a healthy lifestyle in early adulthood Diet and Eating Habits diet = daily food choices dieting = some form of food restriction finding an adequate energy balance Total calories: portions of packaged foods and restaurant foods have increased in size but are underestimated in terms of the amount of food we eat people also commonly eat much more of the foods they perceive as being healthy but in the process consume far more calories than they need energy density = the number of calories per gram of food o foods with low energy density have more volume and bulk but less calories (i.e. fruits, vegetables, whole grains) o high energy density foods include cookies, crackers, meats, etc. ▪ important to limit the amount of high energy density foods and be mindful of foods labelled “fat-free” or “sugar free” as they may still have a high caloric content eating several small meals a day vs large infrequent meals o avoid skipping meals = leads to excessive hunger o eating more during the day than in the evening Thinking and Emotions people who have weight problems indicates that low self-esteem and negative emotions accompany self talk can be either self-deprecating or positively motivating depending on beliefs and attitudes having unrealistic images in one’s mind promotes negative emotions Coping Strategies overeating is a strategy used to alleviate loneliness, boredom, etc. Some turn to alcohol, smoking or gambling Approaches to Overcoming a Weight Problem Doing it Yourself o weight loss is a slow process, rapid water loss at the beginning then slows down o maintaining weight is a bigger challenge Diet Books and Fad Diets o fad diets are promoted as quick and easy weight loss, but the weight is easily regained o elimination of entire food groups do not meet a person’s nutrient requirements o avoid books that: ▪ eliminate or isolate loan food groups ▪ claims to be “scientific” ▪ use gimmicks ▪ promise quick weight loss ▪ promote supplements instead of food ▪ advocate diets with fewer than 1800 & 1500 kcal for men and women respectively ▪ state it is healthy to lose more than one kilogram a week Dietary Supplements and Diet Aids o canned diet drinks, powders and food bars are designed to achieve weight loss by substituting daily food intake ▪ result in short-term weight loss that is regained o herbal supplements pose a risk to human health as little is known about them ▪ ingredients are not labelled properly Weight Loss Programs o Non-commercial Weight Loss Programs ▪ provide group support ▪ do not promote any particular diet ▪ recommend seeking professional advice ▪ generally free o Commercial Weight Loss Programs ▪ provide group support, nutrition education, physical activity recommendations and behaviour modification advice ▪ safe-weight loss programs include: - recommend diets that are safe and include all food groups - promote slow and steady weight loss (0.25-1 kg/week) - physician evaluation and monitoring if a person is planning to lose more than 10 kg or is on any medications - weight maintenance after weight loss - provide information about all fees and costs (i.e. for supplements, prepackaged foods)  o Online Weight Loss Programs ▪ self-help and group support through group chats, bulletin boards, and e-newsletters o Clinical Weight Loss Programs ▪ medically supervised clinical programs are usually located in hospital or other medical settings Prescription Drugs o for a medicine to cause weight loss, it must reduce energy consumption, increase energy expenditure or interfere with energy absorption o often are appetite suppressants that reduce feelings of hunger or increase feelings of fullness ▪ increase levels of serotonin and catecholamine o many people regain the weight they’ve lost after being off the drug o side effects o recommended for those who have been unable to lose weight with non drug options and who have a BMI higher than 30 (or higher than 27 if two or more additional risk factors present) Surgery o Roux-en-Y Gastric Bypass ▪ the stomach is separated into two pouches, one large and one small ▪ a Y segment of the stomach pouch restricts food intake, and the bypass of the lower stomach and part of the small intestine results in the absorption of fewer calories ▪ could cause fat intolerance, nutritional deficiencies, dumping syndrome, etc. o Vertical Banded Gastroplasty ▪ a small gastric pouch is created in the upper part of the stomach by applying a double row of staples that elongates the esophagus ▪ small pouch empties into the remaining stomach through an outlet that is restricted with a band ▪ controls the gastric emptying of food and the volume of food eaten - gastric banding surgery was significantly more effective in reducing weight and improving quality of life than nonsurgical methods - key is to have adequate follow up and stay motivated to change lifestyle behaviours Liposuction ▪ cosmetic procedure that removes localized fat deposits ▪ does not improve health Body Image - Perceptions, images, thoughts, attitudes and emotions - - body image = dissatisfaction with body Body dysmorphic disorder (BDD) - overly concerned with physical appearance, often focusing on slight flaws that are not obvious to others - Affects 350000 canadians  - low self-esteem - can lead to depression, social phobia, and suicide, ocd Muscle dysmorphia - athletes seem themselves as small and out shape despite being very muscular Eating Disorders - a serious disturbance in eating patterns or eating-related behaviour, characterised by a negative body image and concerns about body weight or body fat - usually caused by a dissatisfaction with body image and body weight o i.e. perfectionist beliefs, unreasonable demands for self-control, excessive self-criticism - dissatisfaction with body weight leads to dysfunctional attitudes about eating, such as fear of fat and preoccupation of with food, problematic eating behaviours heredity plays a role in eating disorders o expressed by the environment (i.e. family life, cultural messages, friends,) young people see themselves as lacking control in their lives and are at high risk for developing eating disorders Anorexia Nervosa – an eating disorder characterised by a refusal to maintain body weight at a minimally healthy level and an intense fear of gaining weight or becoming fat; self-starvation introverted, emotionally reserved and socially insecure critical of themselves and their accomplishments hide or hoard food without eating it stop menstruating, develop low blood pressure and heart rate intolerant to cold, and develop fine body hair on dry skin when body fat is gone, body turns to muscles for proteins. purging – the use of vomiting, laxatives, excessive exercise, restrictive dieting, enemas, diuretics, or diet pills to compensate for food that has been eaten and that a person fears will produce weight gain bulimia nervosa – an eating disorder characterized by recurrent episodes of binge eating and purging – overeating and then using compensatory behaviours, such as vomiting, laxatives, and excessive exercise, to prevent weight gain difficult to recognize, because sufferers usually maintain a normal weight, may have weight fluctuations (5 to 10 kg) during a binge, a person consumes thousands of calories, followed by an attempt to get rid of the food by a purging episode appear to eat normally, but are not comfortable around food binges are secretive and nightmarish, all feelings are blocked out  feel disgusted and ashamed after a binge episode vomit erodes tooth enamel, damage to kidneys and liver, esophageal bleeding, menstrual problems depression binge-eating disorder – an eating disorder characterised by binge eating and a lack of control over eating behaviour in general uncontrollable eating, followed by feelings of guilt and shame eating more rapidly than normal, eating uncomfortably full, eating when not hungry, preferring to eat alone food is a means of coping with stress, conflict or emotions can begin in childhood if food is taught as a reward almost always obese, and have risk factors associated with obesity Borderline Disordered Eating people with borderline eating have some symptoms of eating disorders but do not meet the full diagnostic criteria for anorexia, bulimia or binge eating disorder i.e. excessive dieting, occasional bingeing or purging, inability to control food Treating Eating Disorders Anorexia o restoring body weight o addressing psychological issues Bulimia/Binge-eating disorder o stabilizing eating patterns o identifying and changing the patterns of thinking that led to disordered eating o improving coping skills medical professionals aid, family & group support, prescribed drugs LECTURE NOTES: 1. Examine the definitions, prevalence, and measurement of overweight and obesity 2. Explore the concepts of weight-related stigma, bias, and discrimination 3. Explore childhood obesity as a complex, multifactorial disease 4. Examine health and lifestyle interventions for children with obesity v C.H.A.M.P. v C.H.A.M.P. Families PEOPLE-FIRST LANGUAGE - The standard for respectfully addressing people with chronic disease, rather than labelling them by their illness - Important in ↓ bias and stigma associated with obesity - *Not a one-size fits all solution à some prefer identity-first language (some want identity ( core component) PREVALENCE - 54% of adults in Canada report that they live with overweight - 18% report that they live with obesity - Estimated that 70% of males and nearly 50% of females in Canada will be classified as having overweight or obesity What is obesity video: - Abnormal or excess body fat that impairs health - Lifelong disease - Canadian medicine association → chronic disease August 2020: canadian adult obesity guidelines - released by obesity canada and badiactirc association describe obesity → complex chronic disease if impairs health and not by body fat - Clinical test asses health not size - Only when threatens health - Treatable - Chronic disease CANADIAN CLINICAL PRACTICE GUIDELINES - Improving people's health only on weight loss Dr. Ian Patton (Obesity Canada) - Guest Lecture Video Obesity canada: - Stands at the forefront of obesity management in canada - Lead a way with evidence informed resources , comprehensive guidelines, commitment improving lives on canadians - Innovation, research, education and advocacy sets critical; public health issue - BMI: limited, more than size and weight - Right def: Chronic disease Obesity pathogenesis - Complex biological, psychological and environmental factors - Body weight meticulously regulated by brain - Obesity influenced by social and physical environment where we live in Three pillars of obesity management that support nutrition and activity 1. Psychological intervention 2. Pharmacological therapy (med) 3. Bariatric surgery - Nutrition therapy - Physical activity NOT pillars but support treatment pathway Work bias and discrimination: school,work… - 64% elementary school students face obesity with higher chances of being bullied - 54% adults with obesity report stigma from coworkers - 64% adults w ob bias from healthcare - 72% images w 77% stigmatise people w obesity Shaming individuals : harmful and ineffective LESSON OUTCOME; #2 Explore the concepts of weight-related stigma, bias, and discrimination Obesity: Popular Media Images Canadian medical health association: - stigma : a negative stereotype Unfair beliefs video : - Bias: Personal beliefs - Stigma: social stereotypes - Weight Based discrim: when we act on both personal and stigma HBO Documentary: The Weight of the Nation: Stigma - The Human Cost of Obesity - 18+ % children rn = obese - Problem w society LESSON OUTCOME #3 Explore childhood obesity as a complex, multifactorial disease CHILDHOOD OBESITY - A serious global health concern - In Canada, overweight and obesity have steadily increased among children - 1 in 3 (31.4%) children and youth in overweight or obese categories (11.7%), - compared to 1 in 4 (23.3%) in 1978/79 - Almost 1 in 7 classified in obese category - Linked to insulin resistance, type 2 diabetes, discrimination, ↓ social well-being - Tracks to adulthood à important to intervene during childhood LESSON OUTCOME #4 Examine health and lifestyle interventions for children with obesity HEALTH INTERVENTION : “A health intervention is an act performed for, with, or on behalf of a person or population - whose purpose is to: 1. Assess 2. Improve 3. Maintai 4. Promote modify health, functioning, or health conditions. THE CHILDREN’S HEALTH AND ACTIVITY MODIFICATION PROGRAM (“C.H.A.M.P.”) - A Lifestyle Intervention for Children with Obesity Project description: - Community- and family-based program for children with obesity and their families - 2-year pilot project funded by The Lawson Foundation (2008-2010) Community partnerships: - Canadian Centre for Activity & Aging - YMCA of Western Ontario - Middlesex-London Health Unit - Children’s Hospital of Western Ontario - Family Service Thames Valley - Thames Valley Family Practice Research Network - London Anti-Bullying Coalition - Western Campus Community Police Service - Field Trip Partners - London Knights Hockey - CCH Secondary School ü UWO Football ü Superstore Cooking School GENERAL PURPOSE - To develop, implement, and assess the effectiveness of a 4-week lifestyle intervention for children with obesity and their families SPECIFIC OBJECTIVES - To increase physical activity behaviour during and after the intervention - To improve physiological and psychological outcomes, as well as dietary patterns and self-efficacy PARTICIPANT RECRUITMENT Physician referrals Newspaper articles and ads Radio interviews and ads Television interviews Posters displayed in community settings Project description - Participants - Year 1 (2008) - 15 children (8 females, 7 males), ages 8-14 - Year 2 (2009) - 25 children (12 females, 13 males), ages 10-12 - Body Mass Index (BMI) > 95th percentile for age and sex Intervention - 4-week group-based lifestyle intervention (August 2008 & 2009) - Monday – Friday 9am-4pm (children) - Saturday family sessions 10am-2pm (guardians) - Monthly post-intervention support – “Booster Sessions” - $200 - Bus given Program details - Week 1: Sports Week - Week 2: Healthy Eating Around the Clock - Week 3: Olympic Week - Week 4: Adventure Week ★ We strive to incorporate daily: Aerobic activities ★ Resistance-training activities ★ Sports or fitness-based activities ★ Nutrition sessions ★ Educational sessions RESEARCH COMPONENTS 1) Initial Meeting (Western University) Letter of Information, Assent, Consent Demographic questionnaire Quality of Life (PedsQL 4.0)—child and parent reports  Acticals (worn for 7 days) (measure before mid and after 6-12 months later) DXA Scan (body composition info body fat %, lean mass) more infor that bmi 2) Bloodwork and Physical Assessment (Children’s Hospital) - Fasting bloodwork (glucose, insulin, lipid panel) - Physical Assessment (medical clearance) 3) Phone Conversation with C.H.A.M.P. Dietitian - child’s Self-Efficacy Towards Healthy Living Questionnaire 4) First Day of C.H.A.M.P. - Physical Activity Questionnaire for Children (PAQ-C) - Fitness testing (Cooper 12 minute walk test) 5) Mid-C.H.A.M.P. Assessments - Weekly fidelity checks (children/guardians) - Cohesion/perceptions of belongingness 6) Focus Group Interviews - Conducted after the 4-week program - Separate focus groups for children and parents were conducted to explore and discuss the perceived impact of C.H.A.M.P. RESULTS: SELECTED CHILD OUTCOMES 1. Significant ↑ in physical activity self-efficacy (6 months) (Burke et al., 2015) 2. Significant ↑ in muscle mass and ↓ in body fat percentage (post-intervention) 3. Significant ↑ in children’s self-reported physical (6 months), social (6 months), and emotional (12 months) quality of life (Burke et al., 2015) 4. Significant ↑ in parents’ perceptions of their child’s physical (12 months), social (12 months), and emotional (12 months) quality of life (Burke et al., 2015) 5. Positive perceptions from parents (Pearson et al., 2013) and children (Pearson et al., 2012) RESULTS: PARENTAL INVOLVEMENT 1. Mean child (91%) vs. parent (69%) attendance - Some parents expressed a desire for more involvement in the program (e.g., “…There should be a C.H.A.M.P camp for parents!”) CHAMP FAMILIES - A Parent-Focused Lifestyle Intervention for Children with Obesity Parental Roles and Influences Parents are critical partners in childhood obesity treatments for several reasons: - Primary decision makers abo