Summary of Personality and Clinical Health Psychology PDF

Summary clinical, personality and health psychology Chapter 1 looking at abnormality Whether certain behavior is seen as abnormal depends on the context, Cultural Relativism, no universal standard for abnormality. Four dimensions of abnormality - Dysfunction – behaviors, thoughts, or feelings interf...

Summary clinical, personality and health psychology Chapter 1 looking at abnormality Whether certain behavior is seen as abnormal depends on the context, Cultural Relativism, no universal standard for abnormality. Four dimensions of abnormality - Dysfunction – behaviors, thoughts, or feelings interfere with person’s ability to function in daily life (person is unable to work or visit other people) - Distress – Negative feelings of the individual with a disorder (fear of contamination → excessive hand washing) - Deviance – nonconformity to (cultural) norms (washing hands 50 times) - Danger – behaviors or feelings that are potentially harmful Different people with the same disorder act differently Cultural norms – cultures have strong norms for what is acceptable behavior for men vs women. Throughout history, three types of theories have formed about the cause of abnormal behavior - biological theories – compare abnormal behavior with physical illnesses (defects in body) - supernatural theories – view abnormality as the result of sins, curses and possession - psychological theories – attributed abnormality to traumatic events In prehistoric times people had a concept about abnormal behavior. Then they thought it was caused by evil spirits. They made the body unfit for spirits to live in, for example trephination (drilling holes into skull) In ancient China medicine was based on balancing yin and yang. When negative and positive forces are out of balance, someone could become ill. In Egypt disorders in women were attributed to a walking uterus. The Greek adopted this theory and called it hysteria. According to Hippocrates, the body consisted of four basic fluids (humors): blood, mucus, yellow bile, black bile. He stated that all diseases were caused by the imbalance ot these fluids. In the middle ages, people believed in supernatural powers. They attributed mental disorders to physiological causes or traumas. Psychic epidemic – large groups of people participate in unusual behavior that seems to have a psychological cause. (dance frenzies) Tarantism – people develop sudden acute pain believed to be caused by a tarantula bite. Around the 11th or 12th century regular hospitals began to offer facilities for mentally ill patients, they were there usually against their will, under inhumane conditions. In 1774 the madhouses act was implemented in England to regulate the mental asylums’ conditions. This involved legal framework that required all madhouses to have a license for keeping patients and were inspected each year. (only applied to paying patients → rich) In the 18th and 19th centuries the mental hygiene movement started (Philippe Pinel). Rest and relaxation in a serene environment were needed to heal. (fight for moral treatment). Because of Dorothea Dix laws were implemented and more than 30 mental health clinics were set up. Biological perspectives People believed mental disorders could be explained by physiological processes in the body. Emil Kraepelin developed system to classify symptoms into disorders. Psychoanalytic perspective Franz Anton Mesmer. He believed that the human body contained kind of magnetic fluid that had to remain in a certain pattern to stay healthy. Used Mesmerism to heal his patients, using powerful magnetic force. We now call this state (trans) Hypnosis. Jean Charcot said hysteria was result of brain degeneration, but Bernheim and Liebault convinced him and they did hypnosis. Sigmund Freud thought much of life remains hidden from the consciousness and takes place in the unconsciousness. Worked together with Josef Breuer. Made method to let people talk about problems under hypnosis, where they reached a point where they could let go of all emotions, later called Catharsis. Psychoanalysis: study of the unconscious. Behaviorism – study of the impact of reinforcement and punishments on behavior. Classical conditioning – Ivan Pavlov studied this with salivation in dogs. Thorndike and Skinner studied operant conditioning. Learning with punishment and reinforcement. Self-efficacy beliefs – beliefs a person has about ability to control functioning and events that affect their lives. In 1960, the Patients’ rights movement emerged. This process is called deinstitutionalization. Halfway houses – offered a protected life in a community Chapter 2 Theories and treatment of abnormality Three general approaches to understanding psychological disorders: Sociocultural approach – disorders as result of environmental conditions and cultural norms Biological approach – disorders as result of abnormal genes or neurobiological dysfunction Psychological approach – disorders as result of thinking processes, personality styles, and conditioning. Biopsychosocial approach – takes risk factors from all three different approaches. Diathesis-stress model – people have certain vulnerability for disorders (diathesis → risk factor) only combined with stress these factors come together and create disorder. Biological approaches - Brain disfunction Three major parts of brain: Hindbrain (crucial for basic life functions, breathing, reflexes), midbrain (relay sensory information and control movement, responses to reward), Forebrain (complex thought processes). - Biochemical imbalances Neurotransmitters – act as messengers of impulses between neurons in nervous system. Dendrites receive impulses, passed onto next neuron by axon. Between neurons is small gap, Synaptic gap. Neurotransmitters are released into this gap, they bind to receptors of dendrites. Famous neurotransmitters: - Serotonin – plays important role in mental health (emotions and impulses) - Dopamine – important in experiencing rewards - Norepinephrine – has stimulating effect. If shortage, depressive feelings can develop - GABA – linked to feelings of anxiety Endocrine system: system of glands that produce hormones. Hormone transports information through body via bloodstream and influences mood, energy, and stress. Most important gland is pituitary gland. HPA axis – major neuroendocrine system that controls reactions to stress and regulates many body processes, including immune system, mood, emotions, sexuality, energy storage. Behavioral genetics – study of genetics of personality and abnormality. Polygenetic processes – for a disorder to develop, several mutations are needed. Most biological treatments involve drugs. Antipsychotic drugs help reduce the symptoms of psychosis. SSRIs help keep serotonin levels high. SNRIs target both serotonin and norepinephrine. MAOIs block reuptake of serotonin and norepinephrine. Lithium – stabilizes mood and is therefore often used in bipolar disorder. Side effects: nausea, blurred vision, diarrhea, tremors and twitches. Anticonvulsants – used in treatment of mania, and have fewer side effects Antianxiety drugs – reduce symptom of anxiety ECT has beneficial effect on depression. Side effects: confusion and memory loss. rTMS, patients are exposed to magnetic impulses that stimulate certain brain areas. Deep brain stimulation, electrodes are inserted into brain and then impulses are given. Vagus nerve stimulation form of deep brain stimulation that targets vagus nerve. Psychosurgery – last resort, rarely used, don’t know which regions of brain specifically cause symptoms. Medication does not work for everyone, and there are often unpleasant side effects. Psychological approaches Behavioral approaches classical conditioning and operant conditioning (law of effect). Mowrer’s two-factor model suggests that combinations of classical and operant conditioning explain persistence of fears. Social learning – learning from each other. Modeling – learn by imitating people Observational learning – observing rewards/punishments others receive, behaving accordingly. Behavioral theories focus on rewards and punishments that sustain undesirable behavior. Systematic desensitization therapy – patients learn relaxation techniques and ranks fears. Cognitive approaches cognitions (thoughts/beliefs) influence our behavior and emotions. Cognitive therapies focus on removing irrational and/or negative thoughts often combined with behavioral therapy: cognitive behavioral therapy (CBT) Psychodynamic approaches assume all behavior, thoughts and emotions are influenced by unconscious processes. Repression – suppressing traumatic experiences. Catharsis – release of emotions. Freud thought that two drives motivate people: Sexual and aggressive drive. Libido arises in the id – maximum pleasure and minimum pain (instant rewards) ego – strives for same goal but within rules of society superego – rules for performing behavior are stored. (thinking ahead, doing the smart thing) Freud divides child’s development into psychosexual phases 1. Oral – stimulation of mouth 2. Anal – stimulation of anus 3. Phallic – focus on genitals 4. Latent – developing social skills 5. Genital – sexual lust arises again in puberty Psychodynamic therapies – make clients aware of their coping strategies. Free association – client talks about everything that comes to mind, therapist finds pattern Transference – patient’s way of reacting is influenced by a trauma from early childhood. Interpersonal Therapy (IPT) – looks at relationships the patient has had throughout his life. Humanistic approaches Take the view that people naturally tend to be, and do, good. It is not the development of your best self, but the high expectations of society that create obstacles. Main goal of humanistic therapy is to help patients discover their abilities through self- exploration. reflection – therapist gives feedback, but no further interpretation. Family systems approaches See the family as a complex interpersonal system with its hierarchy and rules. according to this theory, if a member of the family has psychological problems, it is caused by the malfunctioning of the family system. inflexible family – offers resistance to outside world and changes within the family enmeshed family – members are too involved in each other’s lives disengaging family – opposite of enmeshed family. Family systems therapy assumes individuals problems to be rooted in the family. behavioral family systems therapy focuses on family communication and problem-solving. Third-wave approaches Dialectical behavior therapy – focuses on the difficulties in managing negative emotions and controlling impulsive behaviors. Acceptance and commitment therapy assumes that experiential avoidance is at the core of many mental health problems. The focus is on building acceptance, which is seen as the key Sociocultural approaches Focus on whole of society. Consequences of war, hunger, or natural disasters. Cross-cultural issues in treatment – it is better if therapist is from same culture. Primary prevention – aims to prevent development of disorder before they have started Secondary prevention – detect disorder as early as possible and then inhibit further development. Tertiary prevention – people who already have a disorder do not relapse and live as normal as possible. Chapter 3 Assessing and diagnosing abnormality Before diagnosing, assessment takes place. All information about symptoms are examined. Validity – degree to which a test measures what it is supposed to measure - Face validity – items seem to measure what test intends to measure - Content validity – test measures all important aspects of phenomenon - Convergence validity – test has same outcome as other tests that measure same construct - Predictive validity – test accurately predicts how someone later acts, thinks, or feels - Construct validity – test only measures what it is supposed to measure, nothing else Reliability – criterion of how consistently a test measures what it is supposed to measure - Test-retest reliability – consistency of results of a test over time - Alternate form reliability – different versions of same test have similar results - Internal reliability – people answer similarly among different parts of same test - Interrater (interjudge) reliability – different raters come to same conclusion Standardization – prevents extraneous factors from influencing a person’s response Assessment tools Clinical interview – face-to-face conversation (may or may not be structured) Mental status exam – organize information collected during interview In unstructured interview, the clinician simply collects five types of information: appearance and behavior, thought processes, mood and affect, intellectual functioning, orientation in time and place (sensorium) Symptom questionnaires – quick way to determine person’s symptoms Personality inventory – questionnaire that measures how people usually think, feel, behave. Behavioral observation – disadvantage – people may change behavior Self-monitoring – entails person to keep track of their behavior. Intelligence test – provide picture of person’s intellectual strengths and weaknesses Neuropsychological tests – detecting specific cognitive deficits such as memory problems. Brain-imaging techniques – CT, PET, SPECT, MRI Psychophysiological tests – detect changes in brain and nervous system that reflect emotional and psychological changes Projective tests – inkblot test, thematic apperception test. Challenges in assessment: resistance in providing information Difficult for small children to describe or distinguish feelings. Children talk about physical pain rather than emotional pain they feel or only show it non-verbally. This case you can use parents, however they are also not always accurate. Language differences and cultural differences can cause problems. DSM as classification system (usa). ICD (Europe, rest of world) Comorbidity – being diagnosed with more disorders. Chapter 4 Mood disorders and suicide Unipolar disorders (only depression), bipolar disorders (depression and mania) Symptoms of depression: depressed mood, loss of interest (anhedonia), changes in sleep, appetite, activity level, physical restlessness (psychomotor agitation) or slowness (psychomotor retardation), etc. Two categories of unipolar depression: Major depressive disorder (MDD) – depression that lasts longer than two weeks and shows severe symptoms - depressed mood or loss of interest in usual activities - presence of at least five of the following symptoms: o weight loss/gain o insomnia/hypersomnia o motor retardation/agitation o fatigue, energy loss o guilt, worthlessness o concentration issues o suicidal thoughts o symptoms interfere with everyday functioning o single episode vs. recurrent episodes Persistent depressive disorder (dysthymia) – is less severe but more chronic than MDD. Person has depressed mood for most of the day, for more days than not, for at least 2 years. - Presence of two or more of the following symptoms: o Poor appetite o Insomnia or hypersomnia o Low energy and fatigue o Low self-esteem o Poor concentration o Hopelessness - Never without symptoms of depression for longer than two months - High risk for comorbid disorders, especially substance abuse, anxiety disorders and eating disorders. Subtypes of depression - Depression with anxious distress - Depression with mixed features – manic symptoms, but not fully bipolar disorder - Depression with melancholic feature – physiological symptoms are mainly present - Depression with psychotic features - Depression with catatonic features - Depression with atypical features - Seasonal affective disorder – at least 2 years of experiencing and recovering from MDD as seasons change - Depression with peripartum onset – depression during pregnancy or after birth - Premenstrual dysphoric disorder – increase in distress during premenstrual phase - Depression due to another medical condition - Substance/medication-induced depression – depression that occurs after intake or stop of use of licit or illicit drug Prevalence of MDD 3-16%. Young adults between 18-29 most likely. Lowest rates in people above 65. Women are more likely to talk about symptoms and reach out for help. Comorbidity is high Children often show irritability instead of sadness. Prevalence 2.5% in children, 8% in adolescents. Genetic factors play a role. Serotonin transporter gene may play a role. A disfunction affects the stability of an individual’s mood. Depression that starts early in life is more genetically based than other forms of depression. The neurotransmitters that play a role are the monoamines norepinephrine, serotonin and to lesser extent dopamine. Structural and functional brain abnormalities involved in depression: - Prefrontal cortex: involved in attention, working memory, problem solving. Reduced activity and reduction in volume of grey matter are found - Anterior cingulate: involved in stress, emotional expression, social behavior. Different levels are found. - Hippocampus: involved in memory and fear-related learning. With depression, smaller volume and metabolic activity is found. - Amygdala: enlarged and increased activity - Hormones. Difficulty switching off the HPA axis. Results in chronic activation of stress response. Behavioral theories suggest that life stress leads to depression by reducing the number of positive enhancers in a person’s life. Learned helplessness theory – experiencing unpredictable and uncontrollable stressors leads to depression most quickly. Three main cognitive theories about depression: 1.depressed people possess negative cognitive triad: negative views of self, world and future. This results in person ignoring good events and exaggerating negative events. 2. reformulated learned helplessness theory: onset of depression depends on someone’s evaluation of situation. Explain negative events by internal reasons 3. ruminative response styles theory – rumination about negative events causes and perpetuates depression. Rumination: repeatedly thinking and focusing on negative events Interpersonal theories focus on complex interpersonal relationships of depressed people. Sociocultural theories suggest that the risk of depression has increased because of rapid changes in social values, disintegration of family unit, and unrealistically high expectations that are put on individuals. (cohort effect) Bipolar disorder is characterized by alternating periods of mania and depression. Diagnosis of mania requires elevated, expansive, of irritable mood for at least one week and three of following symptoms:  - Inflated self-esteem or grandiosity - Decreased need for sleep - Being more talkative than usual or a pressure to keep talking - Flight of ideas or subjective experience that thoughts are racing - Distractibility - Increased goal-directed activity or psychomotor agitation - Excessive involvement in activities that have a high potential for painful consequences Different types of bipolar disorder: - Bipolar I disorder: manic episodes alternating with depressive episodes - Bipolar II disorder: severe episodes of depression, but manic episodes are milder (hypomania →same symptoms, but does not interfere with daily life, not associated with hallucinations and delusions) - Cyclothymic disorder: less severe but more chronic form of bipolar disorder, at least 2 years - Rapid cycling bipolar disorder: 4 or more cycles within one year. Difficult to diagnose in children. Disruptive mood dysregulation disorder: diagnosis for young person, who shows severe temper outburst, out of proportion in intensity and duration Prevalence of bipolar I is 0.6% and bipolar II is 0.4%, no gender difference. Most people develop in late teens or young adulthood. Goes hand in hand with creativity. Abnormal functioning in amygdala, prefrontal cortex Increased activity in striatum in basal ganglia → sensitive to reward signals Monoamine neurotransmitters are involved in depression and bipolar disorder Dysregulation of dopamine system results in extreme search for reward during mania, lack of attention during depression. Psychosocial theories: more sensitive to rewards Biological treatments: - SSRIs: most commonly used to treat depression. Positive effects on the side effects of depression: anxiety, eating disorders and impulsivity. Negative side effects - SNRIs: affect level of serotonin and norepinephrine in brain. Better at preventing relapse than SSRIs - Bupropion: norepinephrine-dopamine reuptake inhibitor. - Tricyclic antidepressants: now used less, dangerous side effects, fatal with overdose - Monoamine oxidase inhibitors (MAOIs) decreasing action of enzyme MAO People with bipolar disorder can take antidepressants to relieve depressive symptoms, but mood stabilizer is needed to prevent escalating into mania: Lithium, anticonvulsants, atypical antipsychotics Other biological treatments: ECT, rTMS, VNS, DBS, Light therapy Behavioral therapy focuses on increasing positive experiences and reducing aversive experiences in a person’s life. Cognitive behavioral therapy has 2 goals: change negative, hopeless thought patterns of someone with depression, and to solve concrete problems and develop better coping skills Interpersonal therapy focuses on four types of problems: 1.Grieving loss of loved one (not always from death) 2. Interpersonal role disputes (e.g. between parents and adolescents) 3. Role transitions (difficulties in adapting to new roles) 4. Deficits in interpersonal skills Interpersonal and social rhythm therapy combines interpersonal therapy techniques with behavioral therapy techniques. Family focused therapy focuses on reducing interpersonal stress within client’s family. Psychotherapy and drug treatment are equally effective, combination most effective. Suicide one of leading causes of death: death by injury, poisoning, and suffocation with evidence of self-inflicted with intention of dying. Complete suicide (death), suicide attempt, suicidal thoughts. More attempts in women, more deaths in men. Non-suicidal self-injury (NSSI) injuring yourself without intent to die. Prevalence 13-35%. This increases risk of later suicide attempts Three types of suicide: 1.Selfish suicide: people who feel alone, misunderstood, empty and abandoned 2. Anomic suicide: people who feel disorientation due to change 3. Altruistic suicide: people who think they are helping the world by dying Suicide cluster – when two or more suicides occur close together in time or space Suicide contagion: if friend or celebrity commits suicide Crisis intervention programs: e.g. suicide hotlines or walk-in clinics Chapter 5 Anxiety, obsessive-compulsive, trauma, and stressor-related disorders Fight or flight response. Physiological changes result from activation of two systems controlled by hypothalamus: autonomic nervous system, adrenal-cortical system. When we perceive threat, hypothalamus first activates sympathetic division of autonomic nervous system. Cortical is released. Anxiety is future-oriented apprehension, tension, or sense of dread, while fear is an immediate emotional response to danger or perceived threat Fear becomes dysfunctional when: - Unrealistic and excessive - Persist after threat has passed - Lead to dangerous behavior or impairment Post-traumatic stress disorder (PTSD) result of experiencing trauma. Trauma is event in which a person is exposed to actual or threatened death, serious injury, or sexual violation. 7% of adults will have PTSD at some point. Women at greater risk For diagnosis, 4 symptoms are required: - Repeated reexperiencing of traumatic event (flashbacks, nightmares) - Persistent avoidance of situations, thoughts or memories associated with trauma - Negative changes in thought and mood associated with event - Hypervigilance band chronic arousal (irritability, sleep disturbance) Related disorders: - Acute stress disorder: same symptoms, but occur and disappear earlier. - Adaptation disorder: when person experiences emotional and behavioral symptoms within three months of stressor, but does not meet criteria for PTSD Traumas leading to PTSD: natural disasters, Human-made disasters (war, abuse) Environmental, social factors: duration and severity of trauma influence reaction, type of trauma determines risk, available social support is predictor Psychological factors: people with anxiety, problems in social life, develop PTSD faster. Destructive and evasive coping styles (drinking, self-isolation) lead to PTSD faster. Dissociation during or after trauma is strong indication for development. Previous trauma (childhood abuse) heightens chance of development. Women develop more quickly Brain of people with PTSD reacts differently to emotions and memory. Difficulty turning off fight-or-flight response. Reduced hippocampus volume. Lower cortisol levels Classical and operant conditioning play role. Avoidance behavior is reinforced. Psychotherapy focuses on exposing to extinguish fears. Cognitive behavioral therapy most chosen for anxiety disorders. Based on classical and operant conditioning. Systematic desensitization. Hierarchy of anxiety-related situations. Goal is habituation Stress-inoculation therapy. Person learns skills to deal with problems from PTSD Drugs used are SSRIs and to lesser extent, benzodiazepines. Specific phobias are unreasonable or irrational fears for specific objects or situations (animal type, natural environment, situational type (lifts), blood-injection-injury type) Disproportionate to actual danger. Diagnoses also include avoidance. Confrontation can cause panic attacks. Lifetime prevalence is 13% Agoraphobia – fear of places from which you cannot escape or get help in case of panic attack. Also involves embarrassment when others see their symptoms Two-factor theory by Mowrer states that classical conditioning creates phobia, operant conditioning maintains it. Biological theories state that general tendency for anxiety may be partly due to genetics Behavioral therapy focuses on exposure to dreaded object, so that fear can be extinguished - Systematic desensitization: make ranking of feared situations. Start least scary - Modeling: therapist does it first, then client - Flooding: extreme form, exposed to fear until it has completely disappeared For people with blood phobia, there is applied tension technique, increases blood pressure and heart rate, so someone does not faint. Cognitive behavioral therapy focuses on identifying and challenging negative thoughts that occur during fear. Benzodiazepines are used to reduce anxiety, but do not solve phobia. Social anxiety disorder – people are afraid to be judged by others and to ridicule themselves. So worried that their whole live becomes focused on avoiding social encounters. 3 groups: - Fear of public speaking - Fear of different social situations - Generalized social anxiety Prevalence in America is 12%, internationally 1-7%. Affects more women Often associated with mood disorders, other anxiety disorders, avoidant personality disorder SSRIs and SNRIs often used, but relapse is common when patient stops medication Cognitive behavioral therapy, exposing clients to social situations, roleplaying, homework, relaxation techniques. Aim is to identify irrational, dysfunctional cognitions Mindfulness-based interventions can also be helpful. Panic disorder panic attacks occur very frequently and often without trigger. Constantly worry about having panic attack, and therefore change their behavior. Panic attack short period of intense fear. Heritability between 43-48% Fight or flight response poorly regulated, possibly due to dysregulation of neurotransmitters Deregulation of norepinephrine systems in locus cereleus in brain stem is linked to panic disorder Anxiety sensitivity is belief that physical symptoms have harmful consequences. Higher interoceptive awareness: more aware of physical signs that may announce panic attack, these signs become conditioned stimuli that later independently can trigger a panic attack, this process is known as interoceptive conditioning Conditioned avoidance response – starting to avoid situations Biological treatment in form of drugs: tricyclic antidepressants reduce panic attacks. SSRIs and SNRIs also effective, fewer unpleasant side effects. Cognitive behavioral therapy focuses on confronting situations that cause fear and panic General anxiety disorder (GAD) constant, continuous anxiety, which isn’t specific to any one event or situation. Intrusive and causes stress Goes hand in hand with physical symptoms such as muscle tension, sleep problems. Emotional and cognitive factors: people tend to experience more intense negative emotions. Focused on danger, both consciously and unconsciously. Heightened activity of sympathetic nervous system and greater reactivity to emotional stimuli in amygdala. Abnormalities in GABA neurotransmitter system. Cognitive behavioral therapy focuses on challenging negative catastrophic thoughts and developing coping strategies Biological treatment uses benzodiazepines, short term relief from anxiety symptoms, nasty side effects. Tricyclic antidepressants, as well as SSRIs and SNRIs work better Separation anxiety disorder – associated with childhood. Infants become anxious and upset if separated from caregivers. Occurs in about 4-10% of children. Equally common in boys and girls Biological factors include family history of anxiety and depression. Controlling, intrusive parents contribute Cognitive behavioral therapy involves increasing number and duration of periods in which children are separated Drug treatments include antidepressants, anti-anxiety drugs, stimulants, antihistamines, SSRIs Selective mutism – failure to speak in certain social situations. Prevalence between 0.03-0.79% Obsessive compulsive disorder (OCD) – anxiety disorder in which people have frightening obsessive thoughts that they can alleviate or eliminate by engaging in compulsive behavior Obsession – uncontrollable, recurring thought, image, or idea which causes stress Compulsion – repetitive behavior or mental act that the person must engage in to make the fear disappear or avert danger. Biological theories suggest that there is a circuit in the brain that is responsible for motor behavior, cognition, and emotion Biological treatments include antidepressants, SSRIs, and atypical antipsychotics. Hoarding – collecting everything you own, including waste material Prevalence around 2-5% Hair-pulling disorder – pulling out hair, resulting in hair loss, automatic pulling Skin-picking disorder – recurrently picking at one’s own skin Body dysmorphic disorder – excessive preoccupation with part of person’s body. Patient believes it is defective. Chapter 15 Health Psychology Allostasis is adaptation of body to respond to stress more efficiently. If stressor is chronic, uncontrollable, and unpredictable, can cause allostatic load → condition in which body is severely damaged due to chronic arousal. Health psychology is the study of how biological, psychological, and social/environmental factors interact to influence health. Pessimistic ideas cause extra stress and deprive them of motivation to live healthy life. Optimistic ideas give positive results Coping strategy – the way a person deals with stress Women usually have larger social network Asian cultures more reluctant to seek social support and share feelings The innate immune system – reacts quickly and non-specifically to microorganisms The specific immune system – reacts slower but only reacts to specific invaders Coronary heart disease – can occur when afferent blood vessels that go toward the heart are narrowed by plaques or inflammation, atherosclerosis CHD is linked to type A behavior pattern: often in hurry, hostile, competitive, time pressure Depression and CHD are often comorbid Guided mastery techniques provide people with information on maintaining healthy life Internet-based health interventions People who sleep less than 6 hours per night have 70% higher mortality rate Sleep deprivation leads to weakened immune system, increased risk of various diseases Four differing depths of sleep First phase → alpha waves Phase two spindles Phase three, four, delta waves The fifth phase is rapid eye movement (REM), dreaming takes place During 8 hour sleep, you go through around 4 or 5 cycles. Insomnia – chronic difficulty in falling asleep or staying asleep. Major stressors often cause Hypersomnolence disorders, excessive sleepiness Narcolepsy, sleep attacks, where you suddenly fall asleep. Cataplexy – attack in which muscle tension suddenly disappears. On awakening often sleep paralysis Central sleep apnea – person does not breathe for up to 20 seconds Sleep-related hyperventilation – episodes of decreased breathing Obstructive sleep apnea hypopnea syndrome – episodes of abnormally shallow breathing or a low respiratory rate. Stopped airflow, due to narrow airway. CPAP machine can help Circadian rhythm sleep-wake disorders types: - Delayed sleep phase type: goes to bed late and gets up late - Advanced sleep phase type: goes to bed and awakes, two or more hours earlier than desired - Irregular sleep-wake type: sleeps in fragments, divided in at least three periods over 24 hours - Non-24-hour type: has free-running sleep-wake cycle that is not related to light-dark cycle of day - Shift work type: occurs when people work irregular shifts that disrupt sleep schedule Disorders of arousal – recurrent episodes of incomplete awakening from sleep. Elements of wakefulness and non-REMsleep are mixed Three types: sleep terror disorder, sleepwalking disorder, confusional disorder. REM sleep behavior disorder – waking up during REM sleep and then engaging in complex and often dangerous or violent behaviors. Nightmare disorder – nightmares that are frequent and cause distress Restless leg syndrome- creeping, crawling, tingling, and itching sensations in legs that keep person from sleeping. Chapter 9 Psychoanalytic approaches to personality Psychoanalysis was developed by Sigmund Freud psychic energy refers to source of motivation and energy within person instincts are strong innate forces that provide energy in psychic system two instincts: - Libido: life instinct, all need-satisfying, life-sustaining, pleasure-oriented urges - Thanatos: death instinct, any urge to destroy, harm, or aggress against others or self According to Freud’s model, the human mind consists of three parts: Conscious mind, preconscious mind, unconscious mind Freud said, nothing happens by chance or by accident, he states little accidents are expressions of the motivated unconscious. Freud proposed three components of personality: - Id, selfish, impulsive, pleasure-loving, operates from pleasure principle, immediate gratification. (not studying, because you don’t feel like it). Primary process thinking - Ego, constrains id to reality. Acts according to reality principle. Secondary process thinking - Superego, responsible for upholding social values and ideals (studying, because that is smart) Three parts are in constant interaction Three types of anxiety: - Objective anxiety: fear that occurs in response to real external threat - Neurotic anxiety: when there is conflict between id and ego - Moral anxiety: when there is conflict between ego and superego, people often punish themselves, have low self-esteem, feel worthless Defense mechanisms efforts to defend oneself from anxiety, which the ego uses to cope with threats and defend against the danger they pose. Defense mechanisms serve 2 functions: - Protect the ego - Minimize anxiety and distress Repression is process of preventing unacceptable thoughts, feelings, or urges from entering awareness. People engaging in denial insist that things are not the way they seem. Displacement, where a threatening or unacceptable impulse is channeled or redirected from original source to a non-threatening target. E.g. channeling anger from boss on husband. Rationalization – reduces anxiety bt generating acceptable explanation for outcomes that might otherwise appear socially acceptable. After getting bad grade, saying it was unclear. Projection, sometimes in others we see the traits and desires we find most upsetting in ourselves. We can hate them instead of hating ourselves. False consensus effect, tendency many people must assume that others are similar to them Sublimation – channeling unacceptable sexual or aggressive instincts into socially desired activities. (becoming lawyer) Psychosexual stage theory of Freud 1st stage: oral stage 2nd stage: anal stage 3th stage: phallic stage oedipal complex: desire for boys to have his mother all to himself castration anxiety: boys’ fear of losing penis because of rivalry with father penis envy: little girls envy father for penis Elektra complex: girl wishes to have father all to herself 4th stage: latency stage 5th stage: genital stage Free association: relaxing and letting your mind wander, therapist finds pattern Dream analysis, manifest content is what dream actually contains, latent contents, what the elements of the dream represent. Dreams serve three functions: - Wish-fulfillment and gratification of desires - Allowing person to release unconscious tension - Dreams are guardian of sleep Projective therapy, what a person sees in ambiguous figure, such as inkblot, reflects personality (Rorschach test→ look at 10 inkblots) Insight refers to intense emotional experience that accompanies the release of repressed material Resistance, patient may unconsciously set up obstacles to progress such as forgetting appointments. Transference, patient begins reacting the analyst as if they were an important figure from patient’s own life. Chapter 8 schizophrenia spectrum and other psychotic disorders A psychosis is a period in which a person cannot tell the difference between what is real and what is not. Within US 1-2% of people develop schizophrenia. Global prevalence 0.5-2% 5 domains of symptoms: - Delusions - Hallucinations - Disorganized thought and speech - Disorganized or catatonic behavior - Negative symptoms Delusions – false beliefs or ideas. Thoughts that are contrary to reality. Constantly looking for evidence to support delusions, want to convince others. Persecutory delusions – paranoid delusions (being watched or tormented) Delusions of reference – believe random events or comments by others are directed at them Grandiose delusions – beliefs one has superpowers, wealth, inflated worth Delusions of thought insertion – beliefs one’s thoughts are being controlled by outside forces Delusions of being controlled – beliefs thoughts, feelings and behaviors are controlled or imposed by an external force Thought broadcasting – beliefs thoughts are being broadcast from one’s mind for others to hear Thought withdrawal – belief thoughts have been removed from minds by another person or object Delusions of guilt or sin – false beliefs that one has committed a terrible act or is responsible for terrible event Somatic delusions – content pertains to bodily functioning, bodily sensation, or physical appearance Hallucinations – false or inaccurate perceptions that affect senses Auditory verbal hallucinations – most commonly, perceived as voices. Content often negative. Person may speak back to voices Visual hallucinations – seeing things Tactile hallucinations – perception that something is happening outside person’s body Somatic hallucinations – perception that something is happening inside body Olfactory hallucinations – detect smells that are not present Gustatory hallucinations – occur in oral cavity in absence of food or beverage Disorganized thought and speech – formal thought disorder - Loose associations/derailment – people jump from one subject to another, without logical connection - Illogicality – individuals say sentences that are not logical - Tangentiality – wandering train of thought and lack of focus on conversation topic - Incoherence – totally incoherent stories that do not make sense. Often goes hand in hand with creating new words. Disorganized or catatonic behavior – people react unpredictably and with agitation, perhaps in response to hallucinations or delusions Catatonia – disorganized behavior that reflects noticeable psychomotor dysfunction that may involve decreased or peculiar motor activity which can range from unresponsiveness to agitation. Can involve lack of response to instructions, showing bizarre posture, mutism In catatonic excitement the patient suddenly displays purposeless and excessive motor activity for no apparent reason. Negative symptoms – loss of certain qualities of person - Restricted affect – reduction or absence of emotional expression in schizophrenia patients - Anhedonia – loss of ability to experience pleasure - Avolition – inability to initiate or persist at common, goal-directed activities - Asociality/social withdrawal – avoliation may be expressed as asociality – lack of desire to interact with people - Alogia – reduction of speech People with schizophrenia often show deficits in basic cognitive processes, including attention, memory, and processing speed. Also deficits in working memory, ability to hold information in memory and manipulate it. First it was called dementia praecox Kreapelin introduced label schizophrenia Prodromal symptoms are symptoms that are present before person enters acute phase of schizophrenia. Residual symptoms are symptoms that occur after acute episode. Lifetime prevalence between 0.25 and 0.7% Typically emerges during late teens. Typically peak around 40, then symptoms go down. Life expectancy about 20 years shorter. About 5-10% commit suicide. Fewer than 1 in 7 recover Specific content of delusions can differ across cultures Other psychotic disorders: - Schizoaffective disorder – mix of schizophrenia and mood disorder. Meet criteria of depressive or manic episode - Schizophreniform disorder – when patients’ symptoms only last for one to six months - Brief psychotic disorder – shows sudden onset of psychotic symptoms that merely last between one day and one month - Delusional disorder – delusions that last at least one month - Schizotypal personality disorder – lifelong pattern of oddities in self-concept, relation to others, and thinking and behavior, maintain grasp on reality - Undifferentiated schizophrenia – fitting into two or more types of schizophrenia - Residual schizophrenia – mild version, person has experienced acute period of schizophrenia, but now shows no prominent positive symptoms - Shared psychotic disorder – when someone develops delusion after contact with someone with same delusion Genetics may account for up to 80% of risk-factor Brain features: - Reductions in gray and white matter - Enlarged ventricles - Prefrontal cortex is less active and smaller - Hippocampus looks and works differently Serious birth and prenatal problems are common Perinatal hypoxia – severe oxygen deficiency just before, during or after birth → risk factor Virus infections during birth → risk factor Dopamine plays big role → more dopamine receptors, excess of dopamine in mesolimbic system. Interaction between serotonin and dopamine may be critical Abnormal levels of GABA and glutamate Social drift is theory that people drift downward in social hierarchy Stress can cause new episode Trauma, urbanization, immigration are major stressors Mothers used to be seen as source of the disorder Phenothiazines can reduce agitation, hallucinations, and delusions, block dopamine receptor Clozapine, agranulocytosis, risperidone, antidepressants, and mood stabilizers Electroconvulsive therapy is often also extremely effective. Negative symptoms often remain with drugs, so therapy is needed. Cognitive interventions – recognizing people’s attitudes and helping them Family therapy – educating family Family therapy in combination with medication is more effective in preventing relapse Chapter 9 Personality disorders Personality is defined as enduring patterns of perceiving, feeling, thinking about, and relating to oneself and the environment Five-factor model: Openness to experience, Conscientiousness, Extraversion, Agreeable- ness, Neuroticism (OCEAN) DSM-5 includes 2 models of personality disorders - Categorical model, defines 10 personality disorders in terms of distinct criteria - Dimensional model, views personality disorders as extreme and maladaptive variants of typical personality traits Three clusters of personality disorders: - Cluster A: Odd eccentric, have characteristics of schizophrenia, but without people having lost contact with reality - Cluster B: Dramatic-emotional, are characterized by manipulative, volatile, and indif- ferent social relationships, and impulsive behavior - Cluster C: Anxious-fearful, Characterized by low self-confidence and difficulties in re- lationships due to anxiety Cluster A Paranoid Personality Disorder: persistent distrust and suspiciousness of others such that their motives are interpreted as malevolent. Often preoccupied with concerns about being victimized or mistreated Strong predictor of aggressive behavior Symptoms can intensify under stress Prevalence between 0.7-5.1%. more common in families of people with schizophrenia Cognitive therapy focuses on self-efficacy. Therapist must be calm, respectful and extremely straightforward. Schizoid personality disorder: lack of desire to build interpersonal relationships and restricted range of emotional expression in interactions with others. Receive little, if any, pleasure from social interactions Correlation between SPD and commitment in violent crimes and alcohol abuse Prevalence of 0.8-1.7% Highly treatment resistant disorder. Therapy may be experienced as stressful rather than helpful Schizotypal personality disorder: few close relationships, trouble understanding behavior of others. Eccentric behaviors, disturbance of thought and affect are similar to schizophrenia, but course and symptom development not consistent. Like SPD and PPD: Socially isolated, restricted range of emotions, uncomfortable in social situations. But STPD also cognitive and perceptual distortions and odd and eccentric behav- iors Four categories:  - Paranoia and suspiciousness - Ideas of reference (random events are seen as meaningful) - Magical thinking - Illusions similar to hallucinations Tend to have speech that is vague, inconclusive, divergent or overdetailed. In interactions with others, may have inappropriate or odd emotional responses or no emotional response at all. Severity not as great as in schizophrenia and retain contact with reality Prevalence of 3.9%. more common in men. Heredity of.81 Same drugs used to treat schizophrenia, but lower doses Cluster B Antisocial Personality Disorder – chronic antisocial behavior. Barrier to forming positive relationships. Characterized by superficial charm, grotesque self-image, rapid boredom, pathological lying, manipulation, and lack of repentance. Poor social relationships, low impulse control and frustration tolerance. They lie, are unreliable, do not see consequences of actions and do not experience feelings of guilt. Impulsive behavior More common in men Treatment is difficult because people feel they don’t need it Borderline personality disorder – instability in mood, self-concept, and interpersonal relationships. Goes hand in hand with tendency of impulsive, self-harming behavior. Feeling on top of world to having thoughts of suicide and self-harm within hours Affects social relationships, might lead to reduced social learning. Relationships can go from despising to idealizing without good reason. Often worry about abandonment and cling to new acquaintances to fill internal void. More than 70-75% have participated in self-harm. Suicide rates between 8-10% Prevalence 1.7% More diagnosed in women Heritability of 55%, genetic overlap with bipolar, major depression and schizophrenia Splitting is characteristic of seeing things black and white (perfect or bad) Amygdala and hippocampus are smaller in volume Dialectical behavioral therapy focuses on helping clients gain more realistic and positive sense of self. Histrionic personality disorder – rapid mood changes and intense, unstable relationships. Commonly described as dramatic, excitable, erratic or volatile. Show self-destructiveness, angry disruptions in interpersonal relationships and chronic feel- ing of inner emptiness. Behave in ways to draw attention Crave the spotlight and feel underappreciated. Pursue others’ attention Overly trusting and easily influenced by others. Tend to consider relationships closer than they are in reality Prevalence of 1.8%. mor common among women Threaten with suicide or self-harm to get attention Narcissistic personality disorder – see themselves as superior and seek confirmation and recognition for it. See dependence as weakness Lack empathy. Dwell on belief others should admire them Prevalence of 4-7.7%. higher likelihood of men High rates of substance abuse, mood disorders, anxiety disorders Either grandiose or vulnerable Cluster c Avoidant personality disorder – excessive avoidance of interpersonal interactions which are fueled by feelings of personal inadequacy and fears of criticism and rejection Symptoms similar to social anxiety disorder, but people with APD have more severe anxiety in social situations and do not want to connect with others, while people with SAD want to connect, but do not dare to Low self-esteem, extremely anxious about being criticized by others and thus avoid interactions in which there is a possibility of being criticized. Seek isolated jobs, nervous in social interactions, hypersensitive to signs of rejection Crave relationships, but feel unworthy and isolate themselves Prevalence 1.5-2.5%. higher likelihood of women Cognitive theories suggest disorder results from development of dysfunctional beliefs about being worthless, which originate from rejection early in life. Dependent personality disorder – excessive and pathological need to be taken care of by others → clinging behaviors and fear of separation. Worry about displeasing others Heavily rely on others for advice and reassurance, don’t take initiatives for themselves Prevalence of 0.78%. more diagnosed in women Goes hand in hand with depression and separation anxiety, triggered by interpersonal con- flict or relationship disruption. Heritability of.81 Psychodynamic treatment focuses on insight into early experiences with caretakers that have led to their dependent behavior Nondirective and humanistic therapies focus on fostering autonomy and self-confidence Cognitive-behavioral therapy aims at increasing assertiveness and decreasing anxiety Obsessive-compulsive personality disorder – similar to OCD, but difference that people with OCD focus on specific compulsions and obsessions, while PD experience these obsessive, compelling feelings in more general way. Rigid, emotionally controlled, and rarely spontaneous. Seem grim and strict, tensely in control of emotions Perfectionism, stubbornness, workaholism Difficulty appreciating others or tolerating their quirks, and are rigidly bound to rules. Often stubborn and may force others to follow strict standards of performance Chapter 6 Dissociative disorders (and somatic symptoms comes later) Dissociation is a phenomenon in which different parts of person’s identity, memory, perception, motor control, or consciousness split off from one another. Fatigue and stress are most common causes Dissociative disorder is characterized by development of multiple separate personalities or memory loss of a portion of a person’s life Three categories of symptoms - Loss of continuity in subjective experience - inability to access information or control mental functions that are normally amenable to such control or access - sense of experiential disconnectedness, including distorted perceptions about self or environment dissociative identity disorder (DID) – person has multiple identities, alters, in one body. Every personality has own way of behaving, looking at, and interpreting the world. They take turns taking control. Often associated with self-harm or self-destructive behavior. Often have emotional and social problems. Show many symptoms of PTSD. Often voices in head. Majority adult women. Prevalence of 1-6%. Most people also diagnosed with personality disorder Several common alters: - child: take role of victim, so host can escape - big brother/sister: protection - persecutor: dangerous, self-harming behavior - Protector: controls switching, passive observer, does not front Trauma model suggests that DID is result of coping strategies Often after childhood trauma, especially sexual abuse. Socio-cognitive model states that alters can be created by patient to explain events that happen in their lives. Treatment focuses on integrating alters into coherent personality Dissociative amnesia – periods of amnesia, but do not take on new personalities. Large gaps in memory and knowledge Organic amnesia: caused by brain damage, accidents, or surgery Psychogenic amnesia: in absence of organic causes and probably caused by psychological factors Anterograde amnesia: inability to store new memories, often has organic cause Retrograde amnesia: inability to retrieve old memories, can have both organic and psychological cause Korsakoff’s syndrome: related disorder, in which there is more global amnesia because of severe alcohol abuse Dissociative fugue: rare phenomenon in which someone leaves after severe stress or trauma, starts new life, and takes on new identity. After period, their consciousness suddenly returns, they do not understand where they are, what they are doing, and they return to their old identity and life, forgetting everything about their fugue. Psychotherapy aims to help patients recall and understand trauma that caused dissociation Depersonalization/derealization disorder Depersonalization is characterized by regular episodes in which a person feels detached from their own body or mental processes, as if being outside observer, with this disorder it occurs often that it interferes with daily life. Often diagnosed in people with history of child abuse Derealization is feeling of being detached from environment e.g. person may feel as if the world has become vague, dreamlike, less real, or non-existent. Chapter 11 traits and trait taxonomies People are described by character traits, which refer to relatively stable and consistent characteristics. character traits are reasonably stable over time and somewhat consistent over situations two basic definitions of traits: - Traits as internal causal properties: traits are internal because person carries them from situation to situation, and causal because these traits influence or explain person’s behavior. Traits exist, even if no behavior is observed - Traits as purely descriptive summaries: character traits are used to describe ongoing patterns in a person's behavior. Not assumed traits are internal or cause, because behavior can also be influenced by social situation. Personality coherence – manifestation of personality traits shifts with age Traits – typical behaviors that a person displays over long periods of time. Traits are relatively insensitive to situational contexts States – can vary across time and situations and can therefore be regarded as within-subject variations of behavior. E.g. emotions Act frequency approach (illustration of descriptive summary formulation)– assumption that traits are categories of acts. In this approach behaviors are clustered in group, umbrella term becomes descriptive summary Three key elements: - Act nomination: procedure to determine which acts belong in which category - Prototypical judgement: determining which acts are most central for their category - Recording of act performance: gathering information about actual act performance in people’s daily lives Three ways in which most important character traits are identified: - Lexical approach: all important individual differences in traits are encoded within natural language. Terms that best express it are used most often o Synonym frequency (if many synonyms →more important), cross-cultural uni- versality (word used in different languages →more important) - Statistical approach: starts with many personality words, large number of people rate themselves. Then use statistical procedure to identify clusters of items o Goal is to identify major dimensions of personality map o Factor analysis most common procedure - Theoretical approach: identification of most important traits based on theory that de- termines which variables are important. Starts with a theory Personality taxonomy is hierarchical arrangement of character traits Eysenck’s model of personality – 3 super traits (highly heritable): Psychoticism, Extraversion, Neuroticism-emotional stability (PEN) Limitations include that PEN are not the only traits that are shown to be heritable, and he did not include all important traits Cattell’s taxonomy: 16 personality factor system. Used self-report data to extract sixteen personality factors. Nobody could replicate, probably because of faults of Cattell. Wiggins circumplex – axes of love and status - Adjacency – how close traits are to each other - Bipolarity – how opposite/negatively correlated traits are - Orthogonality – unrelatedness of traits Five-factor model – OCEAN (openness, conscientiousness, extraversion, agreeableness, neuroticism) Most common way to measure the 5 traits with sentences is the NEO-PI-R (neuroticism-ex- traversion-openness personality inventory – revised) Social attention is important part of extraversion High agreeableness associated with withdrawal from social conflicts High conscientiousness perform well in school and work High neuroticism have more unstable relationships, poorer physical and mental health High on openness harder to focus on one thing, more open towards extramarital affairs Chapter 12 genetics and personality Process of mixing up pieces of chromosomes is called recombination. 22 pairs of chromosomes. Chromosome consists of DNA. DNA strands in combinations of A→T and G→C Genes are specific sequences of nucleotides. Different versions of the same gene are called alleles The way human genes get decoded is more variable than in other species Genetic junk – non-coding DNA, still useful Behavioral genetics attempts to determine the degree to which individual differences in personality are caused by genetic and environmental differences Eugenics – design the future of the human species (create master race?), but recent research shows environment plays big role Percentage of variance – fact that individuals vary Heritability – statistic that refers to portion of observed variance in group of individuals that can be accounted for by genetic variance. - Phenotypic variance – observed individual differences - Genotypic variance – individual differences in total collection of genes possessed - Environmentality – proportion of phenotypic variance that is not attributable to genetic variance Heritability cannot be applied to single individual. Refers to differences in population Heritability is not constant, but changes over time Selective breeding – mating species with specific characteristics Family studies correlate degree of genetic relatedness among family members with degree of personality similarity Twin studies – identical twins should be more similar than fraternal twins (fraternal twins share about 50% of genes and identical twins almost 100%) Equal environment assumption – environments of identical twins are not more similar than environments of fraternal twins Adoption studies – if high correlation between adoptive child and parent, then strong evidence for environmental influences. If higher correlation between adopt away child and biological parent, then heritability Assumption of representativeness – assumes that children, birth parents, and adoptive parents are representative of population Selective placement – when adopted children are placed with adoptive parents who are similar to their birth parents, this rarely happens Combination of twin and adoption studies most powerful Most personality traits are moderate to highly heritable Smoking explained by 44% genetic influences. Heritability of 0.53. Alcoholism shows heritability of 0.50 or greater Heritability for homosexuality ranges from 30-70% Homosexual vs heterosexual show differences in hypothalamus Gender identity disorder (GID) 62% heritable - Cross-gender identification that is strong persists over time - Persistent psychological discomfort with one’s biological sex - The disturbance must not be concurrent with a physical intersex condition - The disturbance must cause clinically significant distress or impairments Molecular genetics aim to identify the specific genes associated with personality traits This kind of research is called candidate gene association studies Most frequent examined gene is called DRD4, which codes for the protein, dopamine. Those with long repeat version of DRD4 score high on novelty seeking Genotype-environment interaction – differential response of individuals with different genotypes to the same environments. E.g. extraversion-introversion (individuals with differ- ent genotypes respond differently to same environment) Genotype-environment correlation – differential exposure of individuals with different genotypes to different environments - Passive genotype-environment correlation – when parents provide both genes and environment, but children do nothing to obtain that environment - Reactive genotype-environment correlation – when parents or others respond to children differently, depending on child’s genotypes (cuddlers vs. non-cuddlers) - Active genotype-environment correlation – when person with particular genotype creates or seeks out particular environment These genotype-environment correlations can be positive or negative, environment can encourage or discourage expression of genetic disposition. Subjectively feeling lonely has bigger negative impact. Not everyone that is lonely feels lonely. Chapter 3 Health behaviors Health promotion is general philosophy that states that health or well-being is personal and collective achievement Health behavior is behavior that is carries out to improve or maintain health. Primary prevention – learning good habits, unlearning bad ones. Behavior change techniques are used to unlearn bad habits Several factors determine whether a person has good or bad health habits: - Demographic factors: higher educated people who experience little stress and have lot of social support generally have better health behavior - Age: in childhood, health habits typically good, decline in adolescence, then get better in adulthood - Cultural values: different cultures experience different behaviors as positive - Self-monitoring/personal control: health locus of control determines extent to which people view themselves in control of their health - Social influence: influence from social environment can both positively and negatively influence health behavior - Personal goals and values: when a person has recently focused on setting personal goals, they will show better health habits - Perceived symptoms: bad habits often have pleasant symptoms, for example, smoking is relaxing, makes it difficult to unlearn - Access to the health care delivery system: good prevention measures and advice from doctors can promote healthy behavior - Cognitive factors: reduced knowledge and intelligence can help maintain false assumptions Emotions may lead to perpetuate unhealthy behaviors. unhealthy behaviors are often pleasurable, addictive, automatic and resistant to change. Health habits are barely related to each other. Are also unstable Habits differ because 1) are controlled by different factors and 2) different factors may control the same health behavior for different people. 3) over time, the causes of health behavior can also change Habits are strongly influenced by early socialization, especially the influence of parents as both teachers and role models. Middle school is important time for learning several health-related behaviors Treating people with increased risk has many advantages, When large part of population is at risk, public interventions can be given. Health promotion also focuses on remaining socially engaged Differences between ethnic groups, men and women in terms of vulnerability to health risks Educational appeals – people will change health behaviors if they receive sufficiently good information Communication colorful and interesting, communicator must be expert, messages short, clear, direct Fear appeals – approach that assumes if people are afraid a certain habit is harmful, they want to change it. Fear can also increase defensiveness Messages with negative approach often turns out to work with behaviors that have uncertain outcomes, and the positive approach with behaviors that have certain outcomes Whether person practices health behavior depends on two factors: - Whether person perceives personal health threat - Whether person believes that particular health practice will be effective in reducing threat Important predictor of health behavior is self-efficacy – belief on individual to have the ability to perform a certain behavior. According to Bandura’s social learning/cognitive theory, the link between a person and their behavior is moderated by self-efficacy beliefs Theory of planned behavior – attempts to make direct link between health attitudes and behavior. According to this theory health behavior is direct result of behavioral intention. Attitude-change interventions may provide informational base for altering habits, but not always the impetus to take action. Self-regulation – people can control their own actions, emotions, and thoughts Self-determination theory states that for behavioral change it is necessary to have the autonomous motivation and perceived competence Autonomous motivation means that someone acts of their own free will and sincerely wants to change something. Activity in medial prefrontal cortex, posterior cingulate cortex, reflects behavioral intentions Cognitive behavioral therapy for behavior change Stimulus control – removal of stimuli Self-control – gaining control over causes and consequences of target behavior Self-reinforcement – systematically rewarding oneself to strengthen or decrease certain behavior Cognitive restructuring – people are trained to recognize and influence internal monologues Contingency contracting–forming contract with other person, specifies rewards, punishments Abstinence violation effect – person who has stopped certain behavior, after one relapse, im- mediately feels that the whole behavioral change has been ruined Precontemplation: people are not yet aware of their wrong behavior and therefore have no intention of changing it Contemplation: people become aware of their problem and feel that something needs to be done about it, but do not actively engage in change Preparation: intention to start behavioral change arises Action: a lot of time and energy is put into changing the problem behavior Maintenance: after behavior has changed, it must be maintained, efforts being made Perceived barriers – aspects of ones life that interfere with practicing good health behaviors (unsafe environment, lack of health insurance) Social engineering is adaptation of environment to facilitate people in engaging in certain health behavior. Often done on broader level Chapter 18 health-promoting behaviors Aerobic exercise – involves stimulating heart and lungs, thus improving oxygen use in body Exercise also has positive impact on psychological health, can improve mood, etc. Exercise used as treatment for depression Setting should be accessible and not too far away, not too expensive Accidents most common causes of death, workplace accidents, motorcycle and automobile Vaccinations and screenings → early detection, avoidance Sun safety practices to prevent skin cancer Sleep is vital to health, can decrease risk of infectious diseases, depression, poor response to vaccines and chronic disorders Chapter 5 health-compromising behaviors Health-compromising behaviors – behaviors that undermine or harm current or future health Peer influence: being influenced by peers, wanting to be liked by others Craving – what someone experiences when they have a huge desire for a drug You get withdrawal symptoms when you stop using a drug Obesity – excessive accumulation of body fat. Obese people are often excluded from society, have low self-esteem, and receive judgement Socio-economic status plays role, unhealthy food is cheaper. In high socio-economic levels thinness is more valued Obesity more common in low socio-economic levels Depression and weight also linked, high neuroticism, extraversion, impulsivity as well Yo-yo effect – repeated cycles of losing and regaining weight Stress influences eating differently in different persons Cognitive behavioral therapies are effective Eating disorders also problem Alcoholism third leading cause of preventable death Leads to high blood pressure, stroke, cancer, etc. Substance dependence, or addiction, when person that repeatedly self-administers a substance, resulting in tolerance, withdrawal and compulsive behavior Genes play role in alcoholism. Stress causes people to start drinking Half of all alcoholics stop drinking by themselves. Especially common when someone gets older First phase of treatment is detoxification Drunk driving major cause of death Smoking causes cancer, cardiovascular diseases Thin people who smoke are at elevated risk of dying Smoking is related to depression and anxiety Genes that regulate dopamine functioning are implicated in smoking Smokers often less health-conscious, less educated, less intelligent, from lower social class Nicotine replacement therapy, way to prevent withdrawal symptoms Chapter 12 eating disorders Eating disorders are characterized by preoccupation with weight-concerns and eating behav- ior that is out of control Many people migrate between these disorders, meeting criteria of different disorders at different times Other specified feeding or eating disorder – individuals that show behaviors and concerns characteristics of one or more of the eating disorders without meeting the full criteria Anorexia nervosa – people that starve themselves, resulting in abnormally low body weight, people are still convinced they need to lose more weight, have distorted body image Higher rates of suicide than general population Dramatic weight loss is associated with serious medical consequences Amenorrhea – for girls to stop having menstrual periods Rituals around food 2 different types of anorexia: - Restricting type: eat none, to little - Binge/purge type: episodes of binging alternating with vomiting or use of laxatives Lifetime prevalence 0.9% adult women, 0.3% adolescent girls, 0.3% among men Usually begins in adolescence or young adulthood Bulimia nervosa – eating above average amounts of food in short time, without having control over it, then doing compensatory behavior to prevent weight gain. Compensatory behavior could be: vomiting, laxative use, fasting, excessive exercise Do not tend to show gross distortions in body images Men more likely to want to gain muscly image, rather than thinness Imbalance of electrolytes can lead to heart disease, but still less dangerous than anorexia Difference with anorexia binge/purge type is that bulimia is normal/above weight Binge-eating disorder – eating large amount of foods, without compensatory behavior, results in excessive weight gain, obesity Often in response to stress and to feelings of anxiety or depression Impact approximately 1-2.6% of general population Other specified feeding or eating diorders: - Partial syndrome eating disorders – symptoms, but not meet full criteria - Atypical anorexia nervosa – symptoms of anorexia, but still normal weight - Bulimia nervosa of low frequency and/or limited duration – less than once a week/and or for less than three months - Night eating disorder – regularly eating excessive amounts of food during night If BMI of 30 of higher, then obesity Weight loss drugs suppress appetite, but have nasty side effects Eating disorders run in families. Heritability for anorexia 48-74%. Heritability binge eating disorder 41% Hypothalamus – plays important role in regulating eating behaviors People with anorexia show lowered functioning in hypothalamus and abnormalities in levels of dopamine and serotonin, but unclear whether cause or consequence of low weight Many people with bulimia show abnormalities in systems regulating neurotransmitter serotonin, this leads to appetite for carbohydrates, which results in binge eating Sociocultural and psychological factors Great social pressure to be thin, ideals of beauty, social media influences this People with eating disorder tend to have dichotomous thinking style (judging things as all good or all bad) Cognitive factors – feel the need to have perfect body, concerned about opinion of others Two subtypes of depressive feelings with eating disorder: - Dieting subtype – greatly concerned about body shape and size and will do everything they can to lose weight - Depressive subtype – unhappy with body, but plagued by feelings of depression and low self-esteem and often eat to quell these feelings. Suffer from greater social and psychological consequences Authoritarian parenting styles associated with problematic eating behaviors Quality of family relationships, poor communication linked to development of ED AN often occurs in ‘’good girls’’ who strive to be ideal daughter Difficult to heal from eating disorder Cognitive-behavioral therapy AN– patient is confronted with incorrect self-image and rewards for weight gain are agreed upon. Relaxation techniques to help reduce anxiety Other approaches: interpersonal therapy, supportive-expressive psychodynamic therapy, be- havioral therapy Only medicine for bulimia are SSRIs like fluoxetine Chapter 6 somatic symptom (and dissociative disorders, already in summary) Difficulty in diagnosing somatic symptom disorders is possibility that individual has real physical disorder that is difficult to detect or diagnose Pseudocyesis – woman presents signs of pregnancy, but there is not fetus Somatic symptom disorder – have one or more distressing physical symptoms and spend great deal of time and energy thinking about these symptoms and seeking medical care for them When they experience a symptom, they often assume the worst and may insist on medical procedures that are unnecessary Prevalence is 5-7% More females Illness anxiety disorder – worry that they have or will develop illness, but do not necessarily experience severe physical symptoms If there is physical sign, they misinterpret as sign of serious issue Formerly called hypochondriasis, people with this disorder have no physical illness, but are preoccupied with belief that a severe illness is present Core feature is cycle of worry and reassurance-seeking behaviors Patients often consult with multiple physicians for same medical problem and believe their previous doctor missed something People are not faking symptoms or pretending to get attention People with SSD and IAD may be prone to periods of depression and anxiety Changes in symptoms mirror emotional well-being: when depressed or anxious, more symptoms Cognitive factors play role → people have dysfunctional beliefs about illness, tend to misin- terpret any physical change in themselves as sign for concern Association between abuse and severity of somatic symptoms Psychodynamic therapies – focus on providing insight into connections between emotions and physical symptoms by helping people recall events and memories that may have triggered their symptoms Behavioral therapies – attempt to determine the reinforcements individuals receive for their symptoms and health complaints and to eliminate these reinforcements while increasing positive rewards for healthy behavior Cognitive therapies – help people to interpret physical symptoms appropriately Conversion disorder – functional neurological symptom disorder. Neurological symptoms that cannot be explained by neurological disease or other medical condition Diagnostic criteria require at least one symptom of altered motor or sensory function that is not deu to neurobiological or medical conditions One dramatic symptom is glove anesthesia, lose all feeling in one hand Typically involves one specific symptom Impact of traumatic experience is associated with this disorder Can be difficult to treat because they do not believe there is anything wrong with them psychologically Psychoanalytic treatment focuses on expression of painful emotions and memories, and insight into the relationship between these and conversion symptoms Cognitive-behavioral treatment focuses on relieving person’s anxiety centered on initial trauma Factitious disorder – imposed on self, when a person deliberately fakes an illness specifically to gain medical attention in order to become a patient Fabricate or exaggerate symptoms Not the same as malingering – fake symptoms in order to avoid unwanted situation Factitious disorder imposed on another – when individuals falsify an illness in another person Chapter 7 physiological approaches to personality Brain damage can lead to changes in personality One of most common symptoms is reduced ability to control impulses, probably caused by injury to frontal lobes People where brain damage has changed personality are often impulsive and have lot of mood swings Phineas Gage, well-known brain injury patient, iron rod went through his head Electrodes are usually made to make measurements, glued to skin, nowadays they can use telemetry – wireless electrodes Electrodermal activity – 2 electrodes are placed in palm of hand, low voltage is applied to one, then measures how much electricity is present on second electrode The more sweat the better the electrical conduction Cardiovascular activity includes heart and adjacent blood vessels Brain activity another physiological measure, EEG, fMRI Eysenck developed the Eysenck personality questionnaire Eysenck claimed introverts have higher activity in ascending reticular activating system, therefore try to reduce activity, while extroverts seek the stimulation Gray made the reinforcement sensitivity theory – there are two systems in the brain that de- termine personality: behavioral inhibition system (BIS) and behavioral activation system (BAS). Bis is linked to fear and BAS to impulsivity Sensation seeking is another dimension of personality with physiological basis, tendency to seek thrilling activities MAO plays role, neurotransmitter Pathological gambling disorder, score higher on impulsiveness and sensation seeking Dopamine associated with pleasure, serotonin with depression and anxiety disorders Norepinephrine responsible for activating sympathetic nervous system in fight-or-flight Tridimensional personality disorder – how certain amounts of neurotransmitters express themselves in the personality Type 4 dopamine receptor gene (DRD4) is associated with increased levels of sensation seeking Morningness-eveningness, circadian rhythms Morningness-eveningness questionnaire Chapter 13 emotion and personality Emotions consist of four characteristics - Subjective feelings - Bodily changes - Cognitions - Action tendencies Emotional state – transitory emotion that depends more on situation than on person (get angry because they were treated unfair) Emotional trait – stable emotional pattern that is characteristic of person, which persists over variety of situations and stable over time Categorical vs dimensional approach to emotion Categorical approach – small number of primary emotions that in different combinations are responsible for wide variety of emotions Disgust, sadness, joy, surprise, anger, fear Dimensional approach – using statistical techniques to identify basic dimensions of large set of data about emotional items Dimensions: pleasantness to unpleasantness, high to low activation/arousal Dimensional approach looks more at how people experience the emotion, categorical approach looks more at characteristics of different emotions Content is specific kind of emotion someone experiences Greatest positive emotion is happiness Two approaches to happiness - Based on judgement that your life is fulfilling - Happiness is presence of more positive emotions than negative ones Positive psychology is based on presence of factors that enable people to flourish and grow People who score high on neuroticism have enormous reaction to negative stimuli Neuroticism is positively associated with crying Eysenck’s biological theory suggests that neuroticism is caused by an easily activated limbic system Anterior cingulate is deep brain structure Hostility – is tendency to respond to frustrations with anger and aggression Style – is the way a person experiences the emotion, the form Affect intensity – is description of persons who either score high or low on emotional style Affect intensity can be measured with affect intensity measure (AIM) Chapter 18 stress, coping, adjustment, and health Health psychology is field of research that looks at relationship between mind and body Stress is subjected feeling that results from uncontrollable or threatening events - Interaction model: personality dertermines person’s coping response to stressful events, this coping response leads to physiological arousal. limitation of model was that researchers could not determine stable coping responses that were (mal-)adaptive - Transactional model: more complex model of interaction model. Personality has three possible effects, can influence exposure to event, how someone interprets event, influence the coping style not event itself, but its interpretation causes the stress - Health behavior model: personality influences link between stress and illness - Predisposition model: personality and disease are expression of underlying predisposition - Illness behavior model: illness behavior is behavior people perform when they think they are sick Stressor is event that causes stress Three characteristics: - Are extreme - Produce conflicting tendencies - Are uncontrollable Generalized adaptation syndrome (GAS) occurs when stressors are chronic, consists of three phases - Alarm phase, fight-or-flight response is activated - Resistance phase, body uses reserves to fight stressor - Depletion phase, no more reserves, person can no longer fight the stress and be- comes prone to illness and disease Stress is often caused by major life events Daily hassles are another source of stress Different kinds of stress: - Acute stress: sudden demand that must be met - Episodic acute stress: occurs when episode of acute stress occurs repeatedly - Traumatic stress: massive amount of acute stress that can have lifelong effects - chronic stress: stressor does not stop, can lead to serious chronic diseases it also matters how people look at stressful events. Stress is subjective reaction to event - primary appraisal: to perceive the event as a threat to your personal goals - secondary appraisal: conclude that you cannot cope with the demands of this event coping strategies attributional style – how a person explains the causes of bad events. Three dimensions: - external vs internal - unstable vs stable - specific vs global attributional style questionnaire (ASQ), content analysis of verbatim explanations (CAVE) pessimist attributes negative events to internal, stable, and global causes optimist attributes negative events to external, unstable, and specific causes dispositional optimism expect that there will be many positive and few negative events in future self-efficacy – belief you have behavior needed to create certain outcome optimistic bias – underestimation of risk types of coping mechanisms effective in generating positive emotions: - positive reappraisal, focus on good that is happening or has happened - problem-focused coping, uses thoughts and behaviors to solve underlying problem causing stress - creating positive events, entails escaping stress for a while by doing something positive optimism is good predictor for good health emotional inhibition – suppression of emotions, linked to experiencing control of emotions is accomplished by part of frontal lobe disclosure – telling others about private aspect of yourself, can feel as relief can help you reinterpret events and attach other importance to them hostility, link between type A personality and cardiovascular disease, hostile people get an- gry very quickly and react strongly to small frustrations