PSYC 018 Well-being quiz 1

Major depressive episode

• Depressed mood most of day

• Markedly diminished interest in pleasure

• decreased/increased appetite for most of day

• Insomnia/hypersomnia

• Psychomotor agitation or retardation

  • Speed up or slowed movement 

• Fatigue or loss of energy

• Feelings of worthlessness or excessive/inexplicable guilt

• Diminished ability to think

• Recurrent thoughts of death or suicidal ideation/suicidal attempt

social anxiety

• Marked fear or anxiety about 1 or more social situations in which individual is exposed to possible scrutiny

  • Individual fears that they will act in a way or show anxiety symptoms that will be negatively evaluated

  • SS almost always provokes fear/anxiety

  • SS are avoided or endured with intense fear/anxiety

Generalized anxiety disorder

• Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months about a number of events/activities

• Person finds it difficult to control worry

• Anxiety and worry are associated with 3 or more of the following:

well being

what we want more of vs what we want less of

Study on age of onset and cumulative risk of mental disorders

• From 29 diff countries

• Coded gender based on appearances

• Women are more likely than men to be diagnosed with a disorder

• Median cumulative incidence around 20ish

•  On average, psychological disorders are most likely to have their first onset from adolescence to adulthood

  • Large risk period

• Major depressive disorder

  • Women more likely than men to be diagnosed

• Takeaways

  • Common (affecting 50% during our lifetime)

    • All of us are affected directly or indirectly

  • Many difficulties have their first onset in adolescence and young adulthood

anxiety

• Fear and excessive worrying 

avoidance in anxiety

• Increased avoidance = increased anxiety

• Positive reinforcement 

  • Creates sense of relief 

  • Avoid -> reduced anxiety (reward)

cognitive behavioral model anxiety

• Link between thoughts, behaviors, and emotions

  • Triangle that all connects

  • Fear (emotion) that something ball will happen (thoughts) causes avoidance (behaviors)

What to do when fear and anxiety are out of proportion to the real threat

• Helps to face fear even though we are afraid

• Feelings are temporary, treat it like background noise

CBT (cognitive behavioral therapy)

• Externalize worry

• Become aware of and correct thinking mistakes/biases

• Exposure

  • Flooding 

  • Gradual

• Skills based approach

• Widely researched

• Effective treatment for many common difficulties

• Helps prevent relapse or reoccurrence

• Prevention

• Depression

  • Challenge beliefs / and behavioral withdrawal

Connection to Hadit readings (elephant and rider)

• anxiety/avoidance

  • Elephant’s reaction

• Externalizing worry

  • Recognizing that’s the elephant

• Becoming aware of thinking mistaking and correcting them

  • Helping rider understand what is going on and have more influence

• Exposure 

  • Training elephant

• Divisions

  • Mind vs body

  • Left vs right

  • New vs old

  • Controlled vs automatic

• Negativity bias

negativity bias

• Reacting more strongly to negative things then positive ones

• Wired that amygdala has first response

  • Connects to fight/flight system

  • Evolutionarily adaptive to be vigilant for negative; to avoid; withdraw; etc.

• Makes us vulnerable to depression, anxiety, etc.

continuum of care triangle

• top/smallest: treatment (most specific and intensive)

• Middle: targeted

• Bottom/largest: universal prevention and well being promotion

Depression treatments

• CBT

• Third wave therapies

• Family therapy

• Interpersonal psychotherapy

• Medication

Albee: founder of community psychology (believed social factors are the major cause of mental illness)

• Most psychological/psychiatric treatment = bailing (hopeless in making a difference on population level)

• Disorder affect many people

• Therapy is helpful

  • BUT most do not receive treatment 

  • Not enough therapists to go around 

• Social factors affect risk and outcomes

• Formula

  • Incidence = organic factors + stress / coping skills + self worth + social supports

Kazdin paper (children's access to psychological treatment)

• >=20% of children meet criteria for a DSM 5 disorder

• 60-80% of children in need do not receive services 

  • 17% remain in treatment 

types of intervention

• Treatment (smallest)

• Targeted prevention (middle)

• Universal prevention and well-being promotion (largest)

how to tell if intervention is helpful

• Signs of happiness, decrease in avoidance, experiment to see results

• Need a control and comparison group 

  • Hard to find control (can’t stop group from receiving treatment)

  • Compare to usual/standard care

• Test against control/comparison group

  • Randomized controlled trial (RCT)

• No intervention control, usual care control, evidence based treatment control

• Immediate benefits

• Longer term benefits (least commonly examined)

• Evaluate real world conditions (real-world providers)

• Acceptability

  • Do the people who participate like the treatment 

• Feasibility 

• Reach

Penn Resiliency Program (CB prevention)

• Group program

• Ages 10-15

• Delivered by teachers and counselors

• 18-24 hours of content

• Typically twelve 90-minute sessions, modular

• Plus practice skills outside of group

• Teaches CB and social problem-solving skills 

  • Before age of 15 (when most clinical rates of depression starts increasing)

Cognitive skills taught in Penn Resilency program

• Link between thoughts and feelings/behaviors

  • ABC model

  • identifying thinking styles (negative self talk)

  • identifying downward spirals

  • challenging negative self talk

ABC model

• A - Adversity 

  • Didn’t get selected for choir (negative event/circumstance)

• B - Beliefs 

  • I have a terrible voice, I will never be good.

• C - Consequences

  • Feel sad and quit singing (feelings/behaviors)

• Identify thinking styles

• Identify self-talk, especially maladaptive thinking styles

  • Pessimism

  • Perfectionism

  • Entity (fixed) mindset

    • “I am not good at math and I will never be good”

identifying downward spirals

• Self-fulfilling prophecies

• Consequences of negative beliefs causes one to withdraw, then causes friends to not spend as much time with them

challenging negative self-talk

• Flexibility: consider alternatives

• Accuracy: examine evidence

Summary of PRP studies

• 20+ controlled studies diverse samples

• Findings

  • Benefits through 12 month follow up

  • Significantly reduced pessimism and increased hope/optimism

  • Reduced depression symptoms 

  • A few studies have shown improvement in 

    • Anxiety symptoms

    • Behavior 

Depression prevention programs for teens

• Cognitive behavioral therapy

• Interpersonal therapy 

Preventing depression in pregnancy and postpartum (Assigned reading)

• Mothers and babies course (MB)

  • CBT skills

    • Cognitive skills

    • Actions 

      • Behavioral activation (pleasant events)

      • Increasing helpful activities

      • Healthy management of reality

  • Attachment relationship focus

    • Increase social connections and contacts

    • Decrease harmful interactions

  • Attention to culture

    • Original work with low-income Mexican-American women, Central American immigrant women, and african american women

  • Adaptability and reach

    • In person as well as online and app based

  • Effectiveness

    • Reduced incidence of major depressive disorder (MDD)

    • Reduce depressive symptoms relative to control

    • Benefits in several other studies 

    • Now considered evidence based practice

      • Implication: should be covered by health insurance 

therapeutic lifestyle changes examples

• sleep

• exercise

• nutrition and diet

• nature

what is a TLC

therapeutic lifestyle change

Walsh (2011). Therapeutic Lifestyle Changes (TLCs)

• Advantages of TLCs

  • Affordability 

  • Reach/accessibility

  • Less/no side effects

  • Stigma free

  • Some benefit in multiple ways

• Why is it hard to implement?

  • Preference for unhealthy decisions/choices (e.g. high sugars, etc.)

  • Social, cultural, and media pressures for unhealthy choices

  • Idea that intervention has to come from outside

  • Desire for a quick fix

  • Context (socio-economic factors)

• Russel Foster, Matthew Walker: Why We Sleep

• Restoration

  • Toxins in brian are swept out

  • Constantly sleep deprived (toxins build up) and is a risk factor for Alzheimer's 

• Energy conservation (probably unlikely)

• Processing information and memory consolidation

Consequences of sleep deprivation

• Fatigue

• Difficulty paying attention

• Stress

•  Depression 

• Lower immune functioning 

• Substance abuse 

• Auto accidents 

getting good sleep

• At least an 8 hour window

• Regular schedule

• Make bedroom a haven for sleep

  • Dark 

  • Slightly cool

• Turn off screens

• Limit caffeine after lunch

• Get some exercise during the day

school start times study (SSTs)

• In 2018, 83% of public high schools started before 8:30 am

• 10% started before 7:30 am

• Many students wake up before/around 6am

• When schools start later

  • Teens get more sleep

  • Less sleepiness in high school youth, falling asleep in class

  • Reduced absences and tardiness

  • Mental health improves

  • Less likely to drop out

  • Teens prefer change

  • Benefits for teachers

    • Increased sleep and sleep quality

    • More alert 

    • Less tired

exercise and links between depression

• LOWER DEPRESSION

• Release of endorphins, serotonin, norepinephrine, dopamine

• Promotes neurogenesis

• Reduces bodies inflammatory response, including neuro-inflammatory response

• Interrupts negative self-talk and rumination

• Sense of competence / empowerment

• Social connection community

Duke university study on exercise - blumenthal

• Participants randomized to aerobic exercise, anti-depressions, exercise +medication

• Results:

  • Exercise works as well as medication

  • Medication response was faster in first two weeks

  • After 16 weeks all groups doing equally well

  • 60-68% were no longer clinically depressed 

• Implications

  • Exercise could be a viable alternative or supplement to medication

  • Use medication for more server cases of depressions

Benefits of healthy habits and lifestyle (Study by Zhao et al.)

• Longitudinal study

• Habits that predicted lower risk for depression

  • Better sleep  (7-9 hours)

  • Exercise

  • Healthy eating 

  • Limit alcohol

  • Don’t smoke

  • Limit sedentary time

  • Spending time with people we like 

• Lower risk even among people with high genetic risk

• Habits (combined) predicted better scores on biomarkers

  • Triglycerides - risk for heart disease

  • C-reactive protein - response to inflammation

Behavior change: developing and sustaining healthy behaviors RIDER

• Controlled processing 

• Kahneman’s system 2

•  A small part of our thinking 

• Effortful, rational, deliberate thought

• Problem-solving 

Behavior change: developing and sustaining healthy behaviors ELEPHANT

• Automatic processing

• Kahneman’s system 1

• Most of our thinking 

• Like-o-meter

• Negativity bias

• Avoids new experiences

• How to develop and sustain healthy habits (rider and elephant)

• Rider develops plan

• Rider trains elephant

  • Motivates

  • Makes behavior easy

  • Repetition, practice

  • Rewards

• Goal is to make behaviors more automatic

• Elephant is a social creature

  • Engaging on TLCs with others

  • Support, engagement, motivation

• Difficult periods

  • Starting a new habit

  • Resuming TLC after lapse

  • Takes extra work from the rider

  • Increase rewards, cues, etc.

  • Challenge all or none (perfectionist thinking)

Carol Dweck Helplessness research

• Children’s response to difficult academic tasks, think aloud or describe thoughts

  • Students who focused on effort and a change in behavior did better than students who thought they couldn’t change their behavior

fixed mindset

• Intelligence is fixed or stable quality

• You have a certain amt that is stable throughout life

• Intelligence is determined at birth or very early in life

• Goal: just get by

growth mindset

• Intelligence is a quality that changes

• Intelligence increases with learning as we develop new knowledge and skills 

• Brain is like a muscle 

  • Gets stronger with effort

• Goal: learning 

Teachers theories of intelligence (rattan et al. 2012)

• entity theory

• incremental theory

entity theory

• fixed

• More likely to:

  • Attribute low grade to low intelligence

  • Use comfort reassurance (ex. “Its okay not everyone can be good at math)

incremental theory

• growth

• More likely to:

  • Attribute low grade to lack of effort

  • Provide feedback about strategy

Praise for intelligence (Mueller and dweck 1998)

• Experimenter feedback - all told had done well

  • Ability praise

  • Effort praise

  • Control

• Then given questionnaire (performance vs learning goals)

  • What puzzles do you want

    • Easy, so i dont get many wrong 

    • Ones im good at, so ill look smart

    • Problems that ill learn from if it I get it wrong

• Children given intelligence praise did much worse after given hard puzzle

• Children given effort praise did much better after given hard puzzle 

• Students given intelligence praise lied more than other children when told to tell their performance scores to another student 

National experiment reveals where a growth mindset improves achievement (Yeager)

• Looked at students with low GPA 

• Gave some growth mindset intervention 

  • Brief, 2 online sessions

  • Brain like muscles: grow stronger with exercise

• Results

  • Compared to control, GMI

    • Reduced fixed mindset 

    • Increased next term GPA

  • Worked best in lower achieving schools and where school norms support growth mindset

• Do growth mindset interventions impact students academic achievement … (Macnamara)

• Meta-analysis 1

  • Overall:

    • Significant by small effect on achievement 

• Meta-analysis 2

  • Overal:

    • No significant effect on mindset

    • 24 studies no effect, 25 positive effect

Single session growth mindset intervention for adolescent anxiety and depression (Schleider)

• Mindset intervention vs control

•  Results 

  • Mindset intervention reduced depressive symptoms relative to control

• (burnette et al.) meta-analysis of growth mindset interventions

• Looking at effects of mindset intervention

• Results

  • Significant benefits for: growth mindset, mastery behaviors, achievements, mental health, social functioning 

  • High fidelity (intervention protocol followed well)

    • Benefits: achievement, mental health

Selgiman

• positive psychology

• PERMA model of wellbeing

PERMA model of well being

• Positive emotions

• Engagement

• Relationships

• Meaning 

• Accomplishment/Achievement

Positive psychology

• Focuses on qualities and processes that promote flourishing in individuals, groups, institutions, and communities

Happiness (Nozick)

• pleasure

  • immediate pleasure

  • pleasure over a lifetime

    • limits

      • enjoyment that isn’t pleasurable

• happiness

  • mood

  • feeling that life is good now

  • satisfied w/ your life as a whole

Mood quadrant

• pleasantnes x-axis

• energy y-axis

• Q1: contentment

• Q2: joy

• Q3: anger/fear

• Q4: sadness

Broaden and build theory

• positive emotions:

  • Often viewed as a consequence of flourishing, of things going well in our lives, but …

  • May actually promote flourishing 

  • Broaden focus

  • More general tendencies to act

  • Survival value has been less clear 

• Negative emotions

  • Narrow our focus

  • Quick, specific, decisive action

  • Often clear survival value 

Effects of positive emotions on cognition: (Fredrickson 2001)

• Expanded attention

• Openness 

• Creativity

• Flexibility

• Resiliency

• synthetic / integrative thinking

• Perspective: seeing the bigger picture 

• Positive emotions lead to positive upward spirals 

  • Positive emotions -> interest and engagement -> effort -> achievement and success ->

The Nun Study (Danner, SNowdon, Friesen, 2001)

• Study of aging

• Studied 180 catholic nuns

• Raters quantified amount of positive emotions evident in the nun’s journal in response to early adulthood

  • Compared to longevity (how long they lived)

• Results

  • Positive emotions expressed in young adulthood predicted longevity

    • Lowest PE : 86.6 mean age

    • Highest PE: 93.5 mean age

  • Nuns who expressed positive emotions lived longer