PSY707 Week 5 Students PDF

WEEK 5 Dr. AJ Fiocco PSY707 Housekeeping Submit Unpleasant Events Calendar tomorrow. This week: Practicing Gratitude Term Paper Have you selected a topic yet? Ensure to read the term paper guidelines Check syllabus for deadlines, including Outline Deadline...

WEEK 5 Dr. AJ Fiocco PSY707 Housekeeping Submit Unpleasant Events Calendar tomorrow. This week: Practicing Gratitude Term Paper Have you selected a topic yet? Ensure to read the term paper guidelines Check syllabus for deadlines, including Outline Deadline 2  Week 5 Objectives ► Discuss the Association between Stress and Psychological Health ►Anxiety ►Depression ►Anger 3 “I am an old man and have known a great many troubles, but most of them never happened” ~ Mark Twain 4 5  Anxiety ► Fear: the emotion we experience in response to concrete danger ► Anxiety: complex feelings of uneasiness to possible impending threats ► Both related to fight-or-flight response ► Exposure to a traumatic event increases risk of developing an anxiety disorder; anxiety disorder may also be secondary to a chronic illness (e.g., chronic pain or IBS) ► If anxiety is excessive and disabling and there is lack of a physical cause, a person may have an anxiety disorder 6  ► Anxiety Disorders: ► Generalized Anxiety Disorder (GAD) ► Panic Disorder Anxiety ► Phobic Disorder ► Obsessive Compulsive Disorder (OCD) ► Post-traumatic Stress Disorder (PTSD) 7 Anxiety: GAD ► Excessive uncontrollable anxiety and worry ► Symptoms: fatigue, muscle tension, restlessness, irritability, sleep disturbances, concentration problems ► Common co-morbidity with depression ► Women > Men; Onset often begins in childhood or adolescence ► Symptoms exacerbated by stress and can wax and wane throughout a person’s life 8 Anxiety: Panic Disorder Characterized by repeated and unexpected panic attacks along with worry about future attacks Symptoms of panic attack are similar to having a heart attack and include chest pains, rapid heartbeat, shortness of breath, dizziness, etc. Panicked person has intense fear; anxiety Image: https://www.verywellhealth.com/panic-disorder-7967767 sensitivity; interoceptive sensitivity (overwhelmed by feelings that are a part of the body's day-to-day functioning) 9 Anxiety: Phobia ► An unreasonable or excessive fear of an object, situation, or activity ► Three broad categories: ► Agoraphobia: fearful of a public place or being outside of the home to the extent that a panic attack or extreme embarrassment is possible ► Social phobia: a fear of social activity, especially of being scrutinized and embarrassed ► Specific phobias: exaggerated fear of specific objects/situations not covered by the other two 10  Anxiety and the Brain Increased activation of amygdala and decreased activation of prefrontal cortex (PFC) while viewing negative stimuli (e.g., fearful faces) The ability of PFC to decrease activation of amygdala is not present in persons with anxiety disorder High levels of anxiety correlate with increased activation of amygdala and decreased ventral anterior cingulate cortex (vACC) activation Image: Arnsten, 2015 11 Anxiety: OCD ► Obsessions: Recurrent and persistent thoughts, urges or images that are experienced, at some time during the disturbance, as intrusive, unwanted, and that in most individuals cause marked anxiety or distress ► Compulsions: ritualistic repetitive behaviors or mental acts that are designed to neutralize anxiety and negative affect ► Decreased inhibitory control, evidenced by increased impulsivity and compulsivity (van Velzen et al., 2014) ► Impairment in goal-directed behaviour leading to overreliance on maladaptive, habitual behaviours and contributing to the formation of compulsions. 12  OCD and the Brain ► Dysregulation of the cortico-basal ganglia- thalamo-cortical (CBGTC) loop has been conceptualized in symptom provocation in OCD patients = connects the cortex with the basal ganglia and the thalamus Hyperactivity of the dorsal anterior cingulate cortex (dACC) results in overestimation of threat and creates a disbalance between habit formation and goal-directed networks, resulting in impaired goal-directed behaviour Van de Veerdonk et al., 2023 13 Stress and OCD 25–67% of OCD patients report significant life events (a majority of which are stressful) in relation to the onset of their OCD Persons who retrospectively report exposure to traumatic events in childhood are 5-9 times more likely to meet criteria for OCD in adulthood than those without a trauma history Longitudinal study found that high school and middle school students who reported stressful life events were 21% more likely to go on to meet criteria for OCD 12 months later when compared to students who reported no such events Excessive stress can: Result in atrophy of the frontal cortices and caudate nucleus (of basal ganglia), which impairs goal-directed behaviours (moving from goal directed control to habitual behaviour control) Executive dysfunction is key factor in OCD (rather than emotion dysregulation) 14  Anxiety: PTSD ► A reaction to traumatic stressors that results in: ► Specification of trauma: actual ► Reliving the event or threatened death, serious ►Flashbacks, Reactivity to reminders injury, or sexual violence ► Repeated upsetting memories, Nightmares ► Avoidance ► Situations may include: ► Emotional numbing, Detached, Repression ► Fire,flood, ice storm, war, ► Avoiding places that remind of event car accident ► Arousal ► Assault, domestic abuse, ► Poor concentration rape ► Exaggerated Startle, Hypervigilance ► Irritable ► Not everyone will develop PTSD ► Note: PTSD includes emotions of guilt, shame and anger, moving beyond the fear/anxiety spectrum 15 Proximity Matters Marcy Borders (aka: “Dust Lady) 16 PTSD and the Brain Neuroendocrinology and the brain: ►Increased activation of amygdala and decreased activation of PFC to fearful faces ►Atrophy of hippocampus … Chicken or Egg? 17 PTSD and the Brain Gilbertson et al. 2002: Hippocampal volume and PTSD in patient and unexposed twin pair Monozygotic twins Vietnam Era Twin Registry 17 PTSD twin pairs 23 non-PTSD twin pairs 18 PTSD and Blunted Cortisol Response (Hypocortisolemia) Martinson et al., PNE, 2016 19  PTSD and Cortisol: Complexity of PTSD ► N=60 WTC survivors ► Cortisol responsivity to 7-months post event WTC recollection ► Symptom severity: ► PTSD+MDD: 28.58 ► PTSD: 19.69 ► Control: 7.45 Cortisol before and after recollection Dekel et al, 2017 20 PTSD and Offsprings’ Cortisol? Epigenetic Effects on HPA Activity Blunted cortisol as a Marker of vulnerability? Offspring of mother with PTSD and mothers w/out PTSD Exposure to stressor Controlled for traumatic event history, anxiety symptoms, depression and maternal depression Danielson et al., PNE, 2015 21  Anxiety & Co: Treatment ► Pharmacological: ►SSRI’s (serotonin), anxiolytics (GABA), ► Propranolol (PTSD) ► Behavioral: ► Preventive: Integrate the strategies that work best into daily routine: ► Exposure therapy: ► Behavioral activation therapy: prevention of ► Reduce use of stimulants avoidance behaviors ► Engage in aerobic exercise ► systematic desensitization: systematic exposure to feared events/stimuli in a ► Meditate controlled manner ► Using deep breathing/relaxation exercises ► Response prevention: person prevents compulsion when confronted with feared ► Accept anxiety as natural stimulus (OCD) ► Challenge anxiety-generating belief ► CBT: system/thoughts ► designed to challenge dysfunctional thoughts, assumptions, and beliefs ► Confront your fears 22 23 Depression ► Major Depressive Disorder (MDD) ► Unremitting depression ► Bipolar Disorder (BD) ► Cyclical period of mania and depression ► One of the most common mental health disorders in Canada ► 8% Canadian will experience depression at some point ► Incidence is approx. 20-26% for women; 8-12% in men Canadian Chronic Disease Surveillance System, 2016 ► 2:1 female to male ratio 24 Depression ► Person experiences at least one major depressive episode that lasts two weeks or more ► Hopelessness and helplessness ► Worthlessness, self-hate, guilt ► Agitation/ irritability ► Weight loss ► Concentration ► Fatigue/lack of energy ► Isolation/withdrawal ► Anhedonia ► Sleep ► Suicidal thoughts 25 Depression ► Diathesis-Stress Model of Depression: stress leads to depression in vulnerable individuals ► Biological stress reactivity as a mechanism? Gotlib et al 2008 26 Depression and the Brain ► Hippocampus Smaller volume, minimized neurogenesis Glucocorticoid Cascade Hypothesis: Excessive secretion of GC cross the blood brain barrier and impose neurotoxic effects on the HC over time ► Amygdala ⮚ 50-70% increased blood flow & metabolism in amygdala ⮚ amygdala activity correlated with severity symptoms ⮚ Faulty amygdala-PFC coupling ► (Subgenual) Anterior Cingulate Cortex Smaller volume in MDD In healthy adults: 5HT s allele carriers had 25% reduction in sgACC volume. increased activity in depressed patients 27 Liu et al. 2017 Depression and HPA Activity Meta-analysis in children and adolescents (Lopez-Duran et al., 2009) 17 publications on DEX and basal HPA functioning; 3 on reactivity Dexamethasone Test: Greater CORT (non-suppression) following DEX among MDD vs control Basal Cortisol: Higher basal CORT among MDD vs control Stress Reactivity: Higher post-stress CORT in MDD (variations in this findings, k=1 suggests blunted) 28 Depression: Treatment ► Lifestyle behaviors: ► Exercise, nutrition, social engagement, stress management ► Pharmacological treatments: ► Most common now are SSRIs (BUT! Not all depression is created equal!) ► Therapy treatments: ► Behavior therapy: motivate depressed person to be active and engaged in rewarding activities ► Interpersonal psychotherapy: help depressed persons identify and deal effectively with interpersonal issues that concern their depression ► CBT: focuses on changing dysfunctional thoughts ► Mindfulness Based Cognitive Therapy (MBCT) (remittance/relapse prevention) 29 Depression: Treatment 30 31 Anger ► Anger primes us to fight as in the fight-or-flight response ► Anxiety can supersede or accompany anger ► Several reasons for feeling anger: a demeaning offense, frustration, competitiveness, need to control/dominate All of these reasons are based on perception 32 Anger ► “Anger-in” is anger directed towards the self, “anger-out” is directed to someone else ► moderate expression can be good ► Anger-hostilitycorrelated with negative health outcomes 33  Anger ► Intermittent explosive disorder (IED): a psychiatric disorder characterized by episodes of extreme anger and acting out through assaults or property damage ► Can produce negative health outcomes, weaken relationships, etc. ► People who experience anger tend to rely on projection as a defense mechanism ► Chronic anger is over-stimulating 34  Anger Management ► Effective approaches to managing anger: ► Catharsis theory: if anger is not expressed, it ► Take responsibility will build up until a person “explodes” ► Use humor ► Social psychology studies show this increases anger, ► Examine intentions not decreases it ► Use deep breathing ► Practice deep relaxation exercises ► Alternative approach is stress inoculation: ► Take a time-out builds coping strategies to use in stressful ► Challenge anger-building situations cognitions ► Group treatments rely on cognitive approaches, ► Empathize relaxation training, and social skills training ► Be assertive (avoid passive ►Related to interpersonal stress and effective aggressive behavior) communication style ► Practice forgiveness 35 "Life is 10% what happens to us, and 90% how we react to it." ~Charles Swindoll 36