Unit 5

Health Psychology Overview

  • Health Psychology: Branch of psychology focusing on how physical health interacts with behaviors, thoughts, and feelings.

  • Explores the psychological impact of illness, and how behavior influences health outcomes.

Stress

Definition of Stress

  • Stress: A feeling of being challenged or endangered by a situation.

  • Can stem from major life events (e.g., death, marriage) or daily hassles (e.g., traffic, deadlines).

  • Stressors: Events or stimuli that cause stress.

Subjectivity of Stress

  • Stress is largely perception-based.

  • The same event may be stressful to one person but motivating or neutral to another.

  • Appraisal: The individual’s interpretation of an event determines its level of stress.


Types of Stress

1. Transient Stressors

  • Short-term, temporary.

  • Example: Argument with a friend, being late.

2. Chronic Stressors

  • Ongoing, long-term.

  • Example: Job dissatisfaction, chronic illness.

  • Chronic stress can negatively affect physical and mental health.


Stress Appraisal Theory (Richard Lazarus)

  1. Primary Appraisal: Is the situation threatening, challenging, or benign?

  2. Secondary Appraisal: Do I have the resources to cope with it?

  • If coping resources are insufficient, stress increases.

  • If resources are sufficient, stress is reduced.


General Adaptation Syndrome (Hans Selye)

1. Alarm Stage

  • Sympathetic nervous system activates (“fight or flight”).

  • Hormones (e.g., corticosterone) are released.

  • Body prepares for immediate action.

2. Resistance Stage

  • Parasympathetic nervous system attempts to bring body back to balance.

  • Body remains on high alert; resources begin to be used up.

  • This stage is adaptive for short-term stress, but harmful if prolonged.

3. Exhaustion Stage

  • Body’s resources are depleted.

  • Tissue damage, reduced immunity, increased illness risk.

  • Chronic stress leads to long-term health issues (e.g., cardiovascular disease, immune suppression).


Physiological Response to Stress

  • Governed by the autonomic nervous system.

    • Sympathetic: Activates “fight or flight”.

    • Parasympathetic: Attempts recovery and relaxation.

  • Chronic stress keeps the body in sympathetic mode, exhausting energy and resources.


Behavioral Responses to Stress

Type A Personality

  • Traits:

    • Competitive

    • Time-urgent

    • Hostile or angry

  • Quick and aggressive stress responses.

  • More likely to experience heart disease, but also more likely to survive cardiac episodes due to being proactive.

Type B Personality

  • Traits:

    • Relaxed

    • Less time-focused

    • Easygoing

  • Slower stress response, generally healthier under stress.


Gender Differences in Stress Response

Tend and Befriend Theory

  • Suggests humans, especially females, tend to:

    • Care for offspring (“tend”)

    • Seek social support (“befriend”) when under threat.

  • Contrasts with traditional fight-or-flight theory, which is more aligned with male responses.


Coping Mechanisms

1. Problem-Focused Coping

  • Addresses the source of the stress directly.

  • Example: Studying for an exam you’re worried about.

2. Emotion-Focused Coping

  • Focuses on managing emotions rather than the problem.

  • Useful when the stressor is uncontrollable.

  • Examples:

    • Deep breathing

    • Meditation

    • Talking it out

    • Taking medication


Meditation and Mindfulness

Meditation

  • Practices that train attention and awareness.

  • Techniques:

    • Focused (e.g., on breathing)

    • Open monitoring (e.g., awareness of surroundings)

  • Reduces stress, pain, anxiety, and improves attention.

Mindfulness-Based Stress Reduction (MBSR)

  • A structured clinical program combining:

    • Meditation

    • Mindfulness

    • Breath awareness

    • Gentle movement

  • Effective in treating chronic stress and emotional disorders.

Brain Wave Effects

  • Alpha and theta waves increase during and after meditation.

  • More experienced meditators show greater, more sustained changes.

POSITIVE PSYCHOLOGY

Definition

  • A newer field of psychology focused on strengths, well-being, and thriving—both for individuals and communities.

  • Founded by Martin Seligman, who also researched learned helplessness.

  • Builds on humanistic psychology, especially the goal of helping people reach their full potential.

Core Concepts

  • Cultivation of Positive Emotions: Focus on joy, gratitude, hope, and compassion.

  • Resilience: The ability to bounce back and grow from adversity.

  • Gratitude Practices: Shown to improve subjective well-being and happiness.

Signature Strengths (Ryan Niemec)

  • Six broad categories of strengths:

    1. Wisdom

    2. Courage

    3. Humanity

    4. Justice

    5. Temperance

    6. Transcendence

  • Using your signature strengths contributes to personal happiness and life satisfaction.

Post-Traumatic Growth

  • Research shows some individuals grow stronger or find new meaning after trauma.

  • Involves personal development through adversity.


PSYCHOLOGICAL DISORDERS

What Defines Disordered Behavior?

  1. Statistically Unusual: Rare or uncommon in the general population.

  2. Maladaptive: Interferes with daily life or function.

  3. Socially Abnormal: Considered unacceptable by societal norms.

  4. Cognitive/Perceptual Dysfunction: Involves thinking errors or distorted perceptions.

All four criteria are generally needed to define behavior as “disordered.”


Diagnosis of Psychopathology

DSM-5 (Diagnostic and Statistical Manual of Mental Disorders)

  • American Psychiatric Association’s tool for diagnosing and classifying disorders.

  • Includes consideration of physical and social factors.

ICD (International Classification of Diseases)

  • Used globally (by the WHO) to diagnose mental disorders.


Theories of Psychopathology

1. Psychoanalytic (Freud)

  • Cause: Unconscious conflicts, often from childhood.

  • Behavior is driven by repressed impulses and unresolved inner conflicts.

  • Treatment focuses on uncovering and resolving intrapsychic conflict.

2. Humanistic

  • Cause: Lack of unconditional positive regard, low self-esteem, failure to reach self-actualization.

  • Emphasizes self-acceptance and social support.

  • Treatment involves client-centered therapy and building self-worth.

3. Cognitive

  • Cause: Faulty, illogical, or distorted thinking.

  • Leads to misinterpretation of events and maladaptive emotions or behavior.

  • Treatment: Cognitive restructuring, CBT (Cognitive Behavioral Therapy).

4. Behavioral

  • Cause: Behavior is learned through reinforcement or association.

  • Disordered behaviors are habits formed through conditioning.

  • Treatment: Behavioral therapy, exposure, desensitization, reconditioning.

5. Biological

  • Cause: Brain abnormalities, chemical imbalances, genetics.

  • Popular in the U.S.

  • Focus on medication, brain scans, neurotransmitter research.

6. Sociocultural

  • Cause: Social and cultural factors, including poverty, discrimination, and cultural expectations.

  • Society defines what is "normal" or "abnormal."

7. Biopsychosocial

  • A holistic approach combining:

    • Biological (e.g., brain structure)

    • Psychological (e.g., cognition, emotion)

    • Social (e.g., environment, culture)

8. Diathesis-Stress Model

  • Psychological disorders result from a predisposition (genetic/biological vulnerability) triggered by environmental stress.


Causal Factors in Disorders

  • Predisposing Causes: Long-term vulnerabilities (genetic or environmental).

  • Precipitating Causes: Immediate stressors or triggers.

  • Maintaining Causes: Ongoing factors that keep the disorder going.

Summary Table of Theoretical Causes

Perspective

Cause of Disorder

Psychoanalytic

Childhood trauma, unconscious conflict between id & superego

Humanistic

Low self-esteem, lack of acceptance or social support

Cognitive

Faulty thinking and cognitive distortions

Behavioral

Learned behaviors, reinforcement of maladaptive actions

Biological

Brain structure/function, neurotransmitters, genetics

Sociocultural

Cultural norms, environment, social expectations

Biopsychosocial

Interaction of biological, psychological, and social influences

Diathesis-Stress

Underlying vulnerability + environmental stress = disorder


NEURODEVELOPMENTAL DISORDERS

Overview

  • Involve abnormal brain development, typically showing symptoms early in life.

  • Causes: Genetic factors, prenatal trauma, or brain damage during/soon after birth.

  • Range: From specific learning issues to global impairments (e.g., social skills or intelligence).


1. Autism Spectrum Disorder (ASD)

  • Manifests early in childhood.

  • Core symptoms:

    • Social communication deficits (verbal & nonverbal):

      • Difficulty with social cues, eye contact, and conversations.

    • Restrictive/repetitive behaviors:

      • Repeated routines or movements.

      • Difficulty coping with or accepting change.

  • Wide spectrum: Symptoms range from mild to severe.

  • Note: Asperger's Disorder is now part of the ASD spectrum—term no longer used.


2. Attention-Deficit Hyperactivity Disorder (ADHD)

  • Characterized by inattention and/or hyperactivity-impulsivity.

  • Interferes with functioning at school, work, home, and in relationships.

  • Diagnosis requirement: Some symptoms must be present before age 12.

  • Everyone can be distracted at times, but ADHD symptoms are persistent and impairing.


3. Other Neurodevelopmental Disorders

  • Communication Disorders:

    • Language Disorder

    • Speech Sound Disorder

    • Fluency Disorder (Stuttering)

  • Motor Disorders:

    • Developmental Coordination Disorder

    • Stereotypic Movement Disorder

    • Tic Disorders

  • Specific Learning Disorders:

    • Difficulty with reading, writing, or math that is not due to intellectual disability.


SCHIZOPHRENIA SPECTRUM & OTHER PSYCHOTIC DISORDERS

Key Features

  • Disorders affecting thought, perception, emotion, and behavior.

  • NOT the same as Dissociative Identity Disorder (formerly Multiple Personality Disorder).

  • Includes schizophrenia and related psychotic conditions.


Positive Symptoms (additions to normal experience)

  1. Delusions: False beliefs not grounded in reality (e.g., thinking you’re a famous figure or being watched by spies).

  2. Hallucinations: False sensory experiences (e.g., hearing voices, seeing things that aren’t there).

  3. Disorganized Thinking/Speech:

    • Jumping from topic to topic.

    • Giving irrelevant or nonsensical answers.

    • "Word salad": Speech that is jumbled and incoherent.

Schizophrenia Spectrum Disorders

Cognitive Symptoms

  • Disorganized thinking, poor attention, impaired decision making.

  • Caused by brain changes:

    • Structural: Enlarged ventricles.

    • Functional: Low frontal lobe activity (seen in PET/fMRI).

Symptom Types

  • Positive Symptoms (additions):

    • Delusions, hallucinations, disorganized speech.

  • Negative Symptoms (losses):

    • Flat affect, lack of motivation, reduced speech.

    • Catatonia: Can be positive (excessive movement) or negative (lack of movement).

Causes

  • Unknown, but likely due to:

    • Genetic predisposition.

    • Environmental stressors (e.g., viruses, trauma).

    • Brain structure/function abnormalities.


Depressive Disorders

Major Depressive Disorder (MDD)

  • 5+ of these symptoms for 2 weeks or more:

    • Depressed mood, anhedonia (loss of interest), weight change, sleep disturbance, suicidal ideation, fatigue, worthlessness, psychomotor changes, poor concentration.

Persistent Depressive Disorder (PDD)

  • Less severe but chronic (2+ years).

  • Similar symptoms to MDD but with lower intensity and longer duration.

Causes

  • Biological, genetic, cognitive, behavioral, sociocultural factors.

Treatments

  • CBT and antidepressants are common.


Bipolar & Related Disorders

Bipolar I

  • Full manic episodes + major depressive episodes.

  • Mania may include delusions and risky behavior.

Bipolar II

  • Hypomania (milder mania) + major depression.

Mania Symptoms

  • Rapid speech, elevated mood, less need for sleep, grandiosity.

Causes & Treatment

  • Same multifactorial causes as depression.

  • Treated with mood stabilizers and psychotherapy.


Anxiety Disorders

General Concepts

  • Fear = present threat; anxiety = future threat.

  • Physical symptoms: muscle tension, restlessness, irritability, sleep issues, poor focus.

Types

  1. Generalized Anxiety Disorder (GAD): Constant worry + arousal.

  2. Panic Disorder: Recurrent, intense panic attacks + fear of recurrence.

  3. Phobias: Irrational fears (e.g., snakes, heights).

    • Agoraphobia: Fear of situations where escape is hard.

  4. Social Anxiety Disorder: Fear of social judgment.

    • Taijin kyofusho: Japanese disorder—fear of offending others with appearance or behavior.

  5. Ataque de nervios: Panic-related cultural syndrome in Caribbean/Iberian populations.

Causes

  • Behavioral (learned fears), cognitive (maladaptive thinking), biological factors.


Obsessive-Compulsive & Related Disorders

Key Distinction

  • Obsessions = intrusive thoughts.

  • Compulsions = repetitive behaviors or mental acts to reduce anxiety.

OCD

  • Time-consuming, distressing obsessions and compulsions (e.g., handwashing, checking).

Related Disorders

  • Body Dysmorphic Disorder: Obsession with appearance flaws.

  • Hoarding Disorder: Difficulty discarding items.

  • Trichotillomania: Hair-pulling.

  • Excoriation: Skin-picking.

Causes

  • Similar to anxiety:

    • Maladaptive thinking, learned behavior, biological/genetic factors.

Dissociative Disorders

Key Feature: Disruption of consciousness, identity, memory, or perception, often following trauma.

  • Derealization: Feeling the world is not real.

  • Depersonalization: Feeling detached from oneself.

  • Dissociative Amnesia: Inability to recall personal info, beyond normal forgetting.

    • May include fugue state: wandering, unexpected travel, confused identity.

  • Dissociative Identity Disorder (DID):

    • Formerly multiple personality disorder.

    • Presence of two or more distinct identities.

    • Often involves lost time and childhood trauma.


Trauma- and Stressor-Related Disorders

Key Feature: Follows a traumatic or stressful event.

  • Post-Traumatic Stress Disorder (PTSD):

    • Symptoms:

      • Intrusive thoughts, flashbacks, nightmares.

      • Avoidance of reminders.

      • Emotional numbing, detachment.

      • Sleep problems, irritability, reduced interest in life.

    • Impairs functioning and alters perception of reality.


Feeding and Eating Disorders

Anorexia Nervosa:

  • Restriction of food intake.

  • Fear of weight gain and distorted body image.

  • Can lead to serious health problems.

Bulimia Nervosa:

  • Binge eating followed by purging (vomiting, laxatives, over-exercising).

  • Involves shame and distorted self-image.

Binge-Eating Disorder:

  • Bingeing without purging.

  • Includes loss of control, can occur at any weight.

  • Tied to biological, psychological, and cultural factors.


Personality Disorders

Key Features:

  • Long-lasting, inflexible patterns of behavior.

  • Starts in adolescence or adulthood.

  • Causes impairment or distress.

  • Children cannot be diagnosed due to ongoing development.

Three Clusters (Three W’s):


Cluster A – Weird (Odd/Eccentric)

  1. Paranoid PD:

    • Distrust and suspicion of others.

  2. Schizoid PD:

    • Detachment from social relationships, flat affect.

  3. Schizotypal PD:

    • Odd beliefs, magical thinking, eccentric behavior/speech.


Cluster B – Wild (Dramatic/Erratic)

  1. Antisocial PD:

    • Violation of others’ rights, lying, manipulation, no remorse.

  2. Borderline PD:

    • Instability in relationships and self-image.

    • Fear of abandonment, impulsivity, emotional extremes.

  3. Histrionic PD:

    • Excessive attention-seeking, emotional overreaction.

  4. Narcissistic PD:

    • Grandiosity, lack of empathy, need for admiration.


Cluster C – Worried (Anxious/Fearful)

  1. Avoidant PD:

    • Social inhibition, feelings of inadequacy, fear of criticism.

  2. Dependent PD:

    • Clingy, fears separation, indecisive, submissive.

  3. Obsessive-Compulsive PD (OCPD):

    • Preoccupation with order, control, perfectionism.

    • Unlike OCD, symptoms are not intrusive—seen as rational by the person.

In Addition

We have only given an overview and selection of the disorders listed in the DSM-S.

Other disorders include the following: elimination disorders; sleep-wake disorders; sexual dysfunctions; gender dysphoria; disruptive, impulse-control, and conduct disorders; substance-related and addictive disorders; neurocognitive disorders; paraphilic disorders; and others.

Study Tip

It can seem quite daunting to know all of the disorders listed in the DSM-5. Focus on the ones highlighted in this chapter. More and more in modern times, famous people have been open about their diagnoses and their struggles with some of these conditions. If you are aware of such individuals, it may be helpful to link these disorders with real-world people as a way to remember the associated symptoms.

Overview of Treatment Approaches

  • Modern treatment often combines psychotherapy and medication.

  • Effective treatment depends on cultural sensitivity and a strong therapeutic alliance.

  • Historically:

    • 1800s: Push for humane care.

    • 1900s: Rise of psychoanalysis, institutionalization, and psychosurgery (e.g., lobotomy).

    • Today: Outpatient care, focus on ethical conduct.


Insight Therapies

1. Psychoanalysis (Freud)

  • Goal: Gain insight into unconscious conflicts.

  • Techniques:

    • Free association: say whatever comes to mind.

    • Dream analysis: explore symbolic meaning.

  • Resistance: Patient avoids uncovering painful unconscious material.

  • Transference: Patient projects feelings onto therapist.

  • Countertransference: Therapist projects feelings onto patient (to be avoided).


2. Humanistic Therapy (Carl Rogers)

  • Focus on conscious experience and present reality.

  • Client-centered therapy:

    • Therapist provides:

      • Genuineness (authenticity),

      • Unconditional positive regard (nonjudgmental support),

      • Empathic understanding (seeing through the client’s eyes).

  • Goal: Self-actualization.

3. Gestalt Therapy (Fritz Perls)

  • Integrates mind and body awareness.

  • Focus on personal responsibility.

  • Clients may act out conflicts to process them consciously.


Cognitive Therapies

1. Cognitive Therapy (Aaron Beck)

  • Focus: Change maladaptive schemas and cognitive distortions.

  • Example: Negative cognitive triad in depression:

    • Negative view of self, world, and future.

  • Common distortions:

    • Arbitrary inference: Conclusions without evidence.

    • Dichotomous thinking: All-or-nothing thinking.

2. Rational-Emotive Behavior Therapy (REBT) (Albert Ellis)

  • Belief: Emotions come from irrational self-statements.

  • Goal: Directly challenge and change irrational beliefs.

  • Example irrational thoughts:

    • “I must be perfect.”

    • “Others’ opinions define my worth.”

3. Dialectical Behavior Therapy (DBT)

  • Combines CBT, mindfulness, emotional regulation, and distress tolerance.

  • Originally developed for suicidal or borderline patients.

Study Tip

As mentioned previously, these different treatment approaches are linked to the different theories of personality development described in Unit 4.

See whether you can identify how the therapy has a logical connection to the underlying theory. For example, in psychoanalysis, techniques like free association and dream analysis are designed to afford access to the patient's unconscious mind. This makes sense, since the unconscious mind is a central aspect of Freud's theory.

Behavioral Therapy

Focus: Change behavior directly (not uncover deep causes). Short-term, structured, and goal-oriented.

Key Techniques:

  1. Counterconditioning
    Replace maladaptive response with a healthy one.

    • Aversion therapy: Pair unwanted behavior with negative stimulus (e.g., Antabuse + alcohol).

    • Systematic desensitization (Joseph Wolpe):

      • Create anxiety hierarchy.

      • Pair increasing anxiety-inducing situations with relaxation techniques.

  2. Flooding

    • Immediate exposure to fear-inducing stimulus without escape.

    • Goal: Extinction through realization of no harm.

  3. Implosion

    • Like flooding, but uses imagined stimuli.

  4. Operant Conditioning

    • Behavioral contracting: Therapist and client set behavioral goals and rewards.

  5. Modeling (Bandura)

    • Learn through observation and imitation of appropriate behaviors.

  6. Applied Behavioral Analysis (ABA)

    • Especially effective for autism; uses reinforcement principles.

  7. Biofeedback

    • Learn to control physiological responses (e.g., heart rate, muscle tension).

    • Often used for anxiety, ADHD, chronic pain.


Modes of Therapy

  • Group Therapy

    • Lower cost, peer interaction, group support.

    • Used in substance abuse treatment.

  • Twelve-Step Programs

    • Peer-run, not professionally led.

    • Focus on spirituality + shared experiences (e.g., AA).

  • Family/Couples Therapy

    • Treats family as a system.

    • Helps resolve relational conflict and improve communication.


Alternative Therapies

  • Biofeedback – for anxiety, pain, ADHD.

  • EMDR (Eye Movement Desensitization and Reprocessing) – PTSD.

  • Light Therapy – seasonal affective disorder (SAD).

  • Therapeutic Touch – alternative healing (limited scientific support).


Biological Therapies

Psychopharmacology – Use of medications.

  1. Antipsychotics

    • Treat schizophrenia by blocking dopamine.

    • First-gen: Thorazine, Haldol – high side effects (e.g., tardive dyskinesia).

    • Second-gen (atypical): Risperidone, Clozapine, Abilify – fewer motor side effects.

  2. Antidepressants

    • MAO Inhibitors: Block breakdown of serotonin/norepinephrine (diet restrictions).

    • Tricyclics: Increase serotonin/norepinephrine.

    • SSRIs (e.g., Prozac): Block reuptake of serotonin – fewer side effects.

    • SNRIs (e.g., Cymbalta) and Atypical (e.g., Wellbutrin) also common.

  3. Anxiolytics (Anti-Anxiety Drugs)

    • Depress CNS; reduce anxiety and insomnia.

    • Benzodiazepines: Xanax, Valium.

    • Barbiturates: Rarely used due to risk of overdose and addiction.

  4. Mood Stabilizers

    • Lithium carbonate – treats bipolar disorder (mechanism unknown).


Invasive Biological Treatments

  1. Electroconvulsive Therapy (ECT)

    • Used for treatment-resistant depression.

    • Risk: memory loss.

  2. Transcranial Magnetic Stimulation (TMS)

    • Magnetic pulses stimulate neural activity.

    • Effective for some with depression.

  3. Psychosurgery

    • Rare and controversial (e.g., prefrontal lobotomy – now obsolete).