Mental and Physical Health Notes

Mental and Physical Health

This unit focuses on psychological disorders, their treatment, and the concept of psychological health. Clinical psychologists play a crucial role in defining, diagnosing, and recommending treatments for these disorders. The content is primarily found in chapters on psychological disorders and treatment within AP Psychology textbooks.

Health Psychology

Learning Objectives

  • Understand stress and its effects.
  • Explore positive psychology.

Key Terms

  • Eustress: Positive stress.
  • Distress: Negative stress.
  • Stressors: Life events causing stress.
  • General Adaptation Syndrome (GAS): General response to stressful events.
    • Alarm Reaction: Initial response to stress, activating the sympathetic nervous system.
    • Resistance: Body's attempt to sustain readiness, potentially depleting resources.
    • Exhaustion: Physiological state returns to normal, vulnerability to disease increases.
  • Hypertension: High blood pressure.
  • Immune Suppression: Decreased ability of the body to fight off infection.
  • Tend-and-Befriend Theory: Managing stress through self-care and social connections.
  • Emotion-Focused Coping: Stress management techniques, like meditation.
  • Positive Psychology: Focus on human flourishing.
  • Happiness: Overall sense of well-being.
  • Subjective Well-Being: Satisfaction with one's life overall.
  • Virtues: Character strengths.
    • Wisdom: Using information creatively and retaining curiosity.
    • Courage: Includes persistence and integrity.
    • Humanity: Kindness and interest in others.
    • Justice: Striving to be socially responsible.
    • Temperance: Moderation and self-control.
    • Transcendence: Valuing connection with the world.
  • Well-Being: Perception of effective functioning.
  • Gratitude: Thankfulness, associated with increased well-being.
  • Resilience: Ability to adapt effectively to trauma.
  • Post-Traumatic Growth: Constructing meaningful experiences after trauma.

Overview

Psychological factors significantly impact physical and mental health. Psychologists aim to understand how to promote healthy lifestyles, stress management, emotional growth, and mental illness treatment.

Stress

Stress is intimately connected to emotion and can be positive (eustress) or negative (distress). Stress can refer to life events (stressors) or reactions to environmental changes (stress reactions). Studies focus on describing stress reactions and identifying influencing factors.

Measuring Stress

Thomas Holmes and Richard Rahe developed the Social Readjustment Rating Scale (SRRS), which measures stress using Life Change Units (LCUs). Changes like selling a home or changing jobs are assigned different LCU values.

SRRS = \sum LCUs

Major life changes increase SRRS scores; high scores correlate with increased likelihood of stress-related diseases. Newer measures consider individual perceptions of stress and differentiate between pleasant and unpleasant stresses, showing an even higher correlation with disease.

General Adaptation Syndrome

Hans Selye's GAS outlines the consistent pattern of response to stressful events. The GAS includes:

  • Alarm Reaction: Heart rate increases, blood is diverted to muscles.
  • Resistance: Body remains physiologically ready, hormone release maintains readiness.
  • Exhaustion: Parasympathetic nervous system normalizes physiological state; vulnerability to disease increases, potentially causing physical diseases like ulcers and heart conditions, and emotional difficulties like depression. Prolonged stress can lead to hypertension and immune suppression due to decreased white blood cell production.

Managing Stress

  • Tend-and-Befriend Theory: Managing stress by tending to self-care needs and the needs of friends/family, promoting meaningful social connections.
  • Emotion-Focused Coping: Using techniques like meditation, mindfulness, and breathing exercises, sometimes combined with medication.

Perceived Control

Lack of control over events exacerbates the harmful effects of stress. Studies show that rats with control over electric shocks are less likely to develop ulcers. Patients with control over morphine flow report better pain control. Control over events reduces stress; perceived lack of control increases it.

Positive Psychology

Positive psychology emerged in the 1990s, shifting the focus from human weakness to human flourishing. It shares an optimistic view with humanistic psychology, supporting theories with empirical evidence.

Subjective Well-Being

Subjective well-being is a sense of satisfaction with one’s life overall.

Virtues

Positive psychology explores character strengths or virtues linked to life satisfaction and achievement. Six core virtues are universally valued:

  • Wisdom: Creative use of information, open-mindedness, and curiosity.
  • Courage: Persistence, integrity, and bravery.
  • Humanity: Appreciation, kindness, and interest in others.
  • Justice: Social responsibility and striving for a better world.
  • Temperance: Moderation and self-control.
  • Transcendence: Seeing beyond oneself and valuing connections with the world.

Well-Being and Gratitude

Well-being refers to the perceived effectiveness of functioning in personal life and group roles. Gratitude is linked to increases in happiness and life satisfaction, which can be cultivated through gratitude journals.

Resilience and Post-Traumatic Growth

Resilience is the ability to adapt to trauma and extreme stress. Some individuals even experience post-traumatic growth, constructing meaningful experiences from trauma. Positive psychologists focus on how people can flourish even in difficult situations, promoting post-traumatic growth.

Psychological Disorders

Overview

Psychological disorders manifest in behavior and thoughts, encompassing common problems like depression and substance abuse, as well as rarer disorders like bipolar disorder and schizophrenia.

Defining Psychological Disorders

Defining psychological disorders involves considering dysfunction, distress, and deviance. For example, agoraphobia leads to dysfunction, depression causes distress, and having visions (in the US) is considered deviant.

  • Dysfunction: Impairment in daily functioning.
  • Distress: Suffering experienced by the individual or others.
  • Deviance: Behavior differing from the norm.

The term "insane" is a legal, not medical term, used to differentiate between those responsible for their crimes and those not fully responsible due to psychological disorders. Defendants may plead not guilty by reason of insanity (NGRI).

Psychologists utilize the International Classification of Mental Disorders (ICD) by the World Health Organization (WHO) and the Diagnostic and Statistical Manual of Mental Disorders (DSM) by the American Psychiatric Association to diagnose disorders. The DSM-5 contains symptoms of psychological disorders but does not delve into etiologies or treatments, as psychological perspectives differ.

Etiological perspectives include:

  • Psychodynamic: Unconscious conflicts from adverse childhood experiences (ACES).
  • Behavioral: History of reinforcement.
  • Cognitive: Maladaptive learned associations.
  • Humanistic: Feelings, self-esteem, and self-concept.
  • Sociocultural: Social ills like racism and sexism.
  • Biomedical: Biological factors like hormonal or neurotransmitter imbalances.

The biopsychosocial view suggests disorders arise from biological, psychological, and social factors. The diathesis-stress model proposes environmental stressors trigger biological predispositions. Eclectic psychologists use ideas from multiple perspectives.

Disorder = Biological \, Predisposition + Environmental \, Stressors

Categories of Disorders

The DSM-5 lists numerous disorders, including:

Neurodevelopmental Disorders:

  • Autism Spectrum Disorder: Deficits in social interaction, sensory hypersensitivity, repetitive behaviors.
  • Attention-Deficit/Hyperactivity Disorder (ADHD): Difficulties paying attention or sitting still, diagnosed more in boys.

Critics suggest overdiagnosis in boys due to more active behavior.

Neurocognitive Disorders:

  • Alzheimer's Disease: A form of dementia involving deterioration of cognitive abilities, especially memory.

The DSM-5 includes diagnostic criteria for major and mild forms of neurocognitive disorders.

Anxiety Disorders:

Characterized by anxiety. These include:

  • Specific Phobia: Intense, unwarranted fear of a situation or object (e.g., arachnophobia).
  • Agoraphobia: Fear of open, public spaces.
  • Social Anxiety Disorder: Fear of public embarrassment.
  • Taijin Kyofusho: Social anxiety specific to Japanese culture, involving concern over one's body being displeasing to others.
  • Generalized Anxiety Disorder (GAD): Constant, low-level anxiety.
  • Panic Disorder: Acute episodes of intense anxiety, with possible anticipation anxiety. Similar symptoms are labeled as ataque de nervios in Caribbean cultures.
Theories About the Cause of Anxiety Disorders
  • Psychodynamic: Unresolved, unconscious conflicts.
  • Behavioral: Learned fear responses through classical conditioning, operant conditioning, or cognitive learning.
  • Cognitive: Dysfunctional ways of thinking and/or specific irrational thoughts.

Somatic Symptom and Related Disorders

Somatic symptom disorders involve psychological problems manifesting through physiological symptoms without identifiable physical cause e.g., conversion disorder (paralysis, blindness).

Theories About the Cause of Somatic Symptom Disorders
  • Psychodynamic: Outward manifestations of unresolved unconscious conflicts.
  • Behavioral: Reinforcement of the symptomatic behavior.

Dissociative Disorders

Involve disruption in conscious processes, creating a break from memories and thoughts; including:

  • Dissociative Amnesia: Inability to remember things without physiological basis.
  • Dissociative Identity Disorder (DID): Multiple personalities, often stemming from childhood trauma.
Theories About the Cause of Dissociative Disorders
  • Psychodynamic: Repression of traumatic events leading to split in consciousness.
  • Behavioral: Rewarding of not thinking about trauma.

Depressive Disorders

Mood or affective disorders involving extreme or inappropriate emotions including:

  • Major Depressive Disorder: Prolonged unhappiness (over two weeks) with symptoms like loss of appetite, fatigue, and feelings of worthlessness.
  • Persistent Depressive Disorder: Long-lasting but less severe depression.
  • Seasonal Affective Disorder (SAD): Depression during specific times of the year, often treated with light therapy.
Theories About the Cause of Depressive Disorders

  • Psychodynamic: Anger directed inward or overly punitive superego.

  • Learning: Reinforcement through attention or sympathy.

  • Cognitive: Unreasonably negative ideas about self, world, and future (cognitive triad). Pessimistic attributional styles contribute to depression.

    • Internal vs. External: Cause of the failure being assigned to oneself or outside factors.
    • Global vs. Specific: Effect of the failure being related to all situations or specific ones.
    • Stable vs. Unstable: Permanence of the failure lasting forever or being temporary.

  • Learned Helplessness: Prior experiences leading to a view of oneself as unable to control future events, resulting in passivity and depression. (Martin Seligman's experiment demonstrated this).

  • Biological Factors: Low serotonin levels linked to major depression; bipolar disorder associated with more receptors for acetylcholine. Family history suggests genetic component.

Bipolar and Related Disorders

Involve both depressed and manic episodes. People experiencing manic episodes exhibit high energy and engage in risky behavior. Types include:

  • Bipolar I Disorder: Involves at least one episode of mania.
  • Bipolar II Disorder: Involves at least one episode of hypomania (less extreme mania).

Schizophrenia Spectrum Disorders

Severe and debilitating disorders characterized by disordered thinking, delusions, hallucinations, disorganized speech, and/or disorganized motor behavior.

  • Delusions: Beliefs with no basis in reality including delusions of persecution and delusions of grandeur.
  • Hallucinations: Perceptions without sensory stimulation.
  • Odd language use (neologisms, clang associations leading to word salad)
  • Inappropriate affect (laughing at bad news, flat affect: no emotional response).
  • Catatonia: Motor problems including immobility of strange posture with waxy flexibility.
Symptoms

Symptoms are categorized into:

  • Positive symptoms: Excesses in behavior, thought, or mood
  • Negative Symptoms: Deficits such as flat affect or catatonic stupor.
Theories About the Cause of Schizophrenic Disorders
  • Dopamine Hypothesis: High levels of dopamine associated with schizophrenia. Antipsychotic drugs lower dopamine levels. Parkinson’s drug L-Dopa (increases dopamine) can cause schizophrenic-like symptoms.
  • Biological Basis: Enlarged brain ventricles, brain asymmetries, and genetic predisposition are associated with schizophrenia.
    • Incidence in general population: 1 in 100.
    • Incidence among identical twins: Nearly 1 in 2 when a co-twin is schizophrenic.
  • Double Binds: Conflicting messages may lead to distorted thinking.

Personality Disorders

Maladaptive ways of behavior manifesting in early adulthood and divided into clusters:

  • Cluster A: Suspicious or eccentric (paranoid, schizoid, schizotypal personality disorders).
  • Cluster B: Impulsive, dramatic, erratic (antisocial, histrionic, narcissistic, borderline personality disorders).
  • Cluster C: Anxious (avoidant, dependent, obsessive-compulsive personality disorders).

Obsessive-Compulsive and Related Disorders

  • Obsessive-Compulsive Disorder (OCD): Persistent, unwanted thoughts (obsessions) causing the need to engage in particular actions (compulsions).
  • Hoarding Disorder: Difficulty discarding possessions leading to clutter and distress.
  • Post-Traumatic Stress Disorder (PTSD): Flashbacks or nightmares following troubling events leading to anxiety.

Paraphilic Disorders

Psychosexual disorders involving sexual attraction to unusual objects, people, or activities (e.g., pedophilia, zoophilia, fetishism, voyeurism, masochism, sadism); more common in men.

Feeding and Eating Disorders

Include anorexia nervosa, bulimia, and binge-eating disorder. Anorexia nervosa includes being at significantly low weight and an intense fear of food. Bulimia has binge-purge cycle without significant loss of weight. Binge-eating involves eating very large quantities of food in a short time with feelings of loss of control.

Substance-Related and Addictive Disorders

Diagnosed when substance use or behaviors like gambling negatively affect a person’s life.

A Cautionary Note

Diagnostic labels can be incorrect and outlast their usefulness.

The Advantages and Disadvantages of Diagnostic Labels

David Rosenhan's 1978 study demonstrated issues with diagnostic labels. Researchers feigned hearing voices and were admitted to mental hospitals, diagnosed with schizophrenia. Their behavior was interpreted as a sign of the disorder. This study questions the lasting impacts of diagnosis, the role of the environment, and quality institutional care.

Treatment of Psychological Disorders

Overview

Beliefs about effective treatment are grounded in ideas about the causes of problems. Psychotherapeutic models and biomedical perspectives offer diverging approaches to care.

Types of Therapy

Psychotherapies (except behavioral treatments) largely consist of talking with a professional. Psychologists with biomedical orientation assert the need for somatic (drug) treatments. Psychotherapies are delivered to clients, and somatic treatments are administered to patients.

Psychodynamic Therapy

Evolved from Sigmund Freud's psychoanalytic approach. Focuses on identifying the underlying, unconscious causes of problems, and avoids treating only the symptoms.

  • Hypnosis: Altered state of consciousness for recovering repressed memories.
  • Free Association: Saying whatever comes to mind without thinking.
  • Dream Interpretation: Analyzing latent content (hidden meaning) of dreams.

These techniques rely on the therapist's interpretations of the patient resistance (objections) is seen as a sign the therapist is nearing the problem's source. Transference is the strong feelings developed toward therapists, which allows them to explore the source of the problems. Psychodynamic and humanistic therapies are referred to as insight therapies.

Humanistic Therapies

Focus on helping people understand and accept themselves and strive to self-actualize, based on the belief that people are innately good and possess free will, leading support and goal recognition to self-fulfillment.

  • Person-Centered Therapy: Developed by Carl Rogers, focuses on providing unconditional positive regard.
  • Active Listening: Mirroring back feelings to clarify for the client.
  • Gestalt Therapy: Developed by Fritz Perls, emphasizes integrating thoughts, feelings, and actions.
  • Existential Therapies: Help clients achieve subjectively meaningful perception of lives.

Behavioral Therapies

Based on learning principles (classical conditioning, operant conditioning, and modeling).

  • Applied Behavior Analysis (ABA): Reinforcement systems to teach life skills.
  • Counterconditioning: Replacing unpleasant conditioned response with a pleasant one.
  • Systematic Desensitization: Developed by Joseph Wolpe.
    1. Teaching client to relax
    2. Constructing an anxiety or fear hierarchy.
      This method may employ either in vivo desensitization (confronting feared objects), or covert desensitization (imagining feared objects). The client is asked to engage in behaviors the client fears step by step until no more anxiety is felt.
  • Flooding: Addressing the most frightening scenario first.
  • Modeling: Learning by observing and imitating others.
  • Aversive Therapy: Pairing unpleasant stimulus with habit to break.
  • Token Economy: Reinforcing desired behaviors with tokens exchangeable for rewards.

Cognitive Therapies

Concentrating on changing unhealthy thought patterns and cognitive restructuring challenging such patterns. Cognitive therapy is combative as therapists challenge thinking patterns.

  • Attributional Styles:
    Internal, global, and permanent attributions are seen as negative, whereas external, specific, and temporary attributions are seen as more favorable
  • Cognitive Therapy: Created by Aaron Beck.
    Employs cognitive triads and has a client engage in pursuing success as well as identifying and challenging irrational ideas causing unhappiness.

Cognitive Behavioral Therapies

Combining both cognitive and behavioral techniques.

  • Rational Emotive Behavior Therapy (REBT): developed by Albert Ellis, exposes and confronts dysfunctional thoughts by showing the client that failure is rare and not a big deal in essence. Employs homework assignments in which clients are tasked with engaging in their fears, demonstrating no cataclysmic event as a result.

Group Therapy

Involving groups of people instead of one on one client therapist interactions. Family therapy is a common form of group therapy. Self-help groups such as Alcoholics Anonymous (AA) are a form of group therapy that does not involve a therapist.

Somatic Therapies

Psychologists with a biomedical model orientation advocate somatic therapies involving bodily changes. Types of Somatic therapies range from Drug to Physical intervention.

  • Drug Therapy: Use of psychoactive medications to treat certain problems, though can be limited if patient cannot express self coherently. Schizophrenia is treated using antipsychotic drugs which block receptor sites for dopamine. Mood disorders often respond to chemotherapy, and tricyclic antidepressants, monoamine oxidase (MAO) inhibitors, and serotonin selective reuptake inhibitor drugs or SSRIs commonly are used for unipolar depression. Bipolar disorder is typically treated through Lithium. Anxiety is generally treated with drugs such as Barbiturates and Benzodiazepines that reduce the activity of the central nervous system.
  • Biofeedback: Teaches patient recognition and control over physiological responses (breathing, heart rate, or even brain activity (neurofeedback)) without medication.
  • Transcranial Magnetic Stimulation (TMS): Employs magnets to alter brain activity; typically used in treatment of depression.
  • Electroconvulsive Therapy (ECT): Electric current passes through brain. Can be bilateral and unilateral types. Bilateral is seen as most effective. This runs current through one hemisphere. Results in short loss of consciousness, mostly used for severe cases after other solutions have failed. This is typically seen as changing blood flow patterns.
  • Psychosurgery: Purposeful destruction to brain to alter a person and is typically used as a last resort type treatment. Most common early psychosurgery was prefrontal lobotomy. This involved cutting neurons leading to frontal lobe, but reduced functioning to a vegetative state.

Eclectic Therapies

Many therapies combine many orientations and therapeutic techniques to arrive at some solution. This can entail cognitive behavior that mixes cognitive and behavioral therapies, sometimes also involving talk therapy that understand cognitions in regards to certain behaviors. Cognitive and somatic therapies are two therapy types that also see the mixing of drug therapy with cognitive talk therapy.

Kinds of Therapists

  • Psychiatrists: Medical doctors, and are permitted to prescribe medication in all US states. Typically are trained less in the realm of psychotherapy.
  • Clinical psychologists: Earn doctoral degrees involving study, internship, and oversight. Typically deal problems that are severe and go beyond every day family/work issues.