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Sunday, March 24

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Sunday, March 10

  1. page home edited ... Contemporary Health Issues Open Courseware Winter 2013 Fall 2012 Developed by Judy Baker…
    Contemporary Health Issues
    Open Courseware
    Winter 2013Fall 2012
    Developed by Judy Baker, Ph.D., Dean of Foothill Global Access at Foothill College
    This compilation is licensed under CC-BY-SA.
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  3. page home edited ... Contemporary Health Issues Open Courseware Fall 2012 Winter 2013 Developed by Judy Baker…
    Contemporary Health Issues
    Open Courseware
    Fall 2012Winter 2013
    Developed by Judy Baker, Ph.D., Dean of Foothill Global Access at Foothill College
    This compilation is licensed under CC-BY-SA.
    (view changes)

Sunday, October 21

  1. page Module 10 edited Lesson 1: Psychoneuroimmunology and Stress Science of Psychoneuroimmunology Source: Science of…

    Lesson 1: Psychoneuroimmunology and Stress
    Science of Psychoneuroimmunology
    Source: Science of Psychoneuroimmunology, NCBI, NLM, NIH,
    Psychoneuroimmunology is defined as the examination of the interactions among psychological, behavioral, and social factors with immunological and neuroendocrine outcomes. It is now well established that psychological factors, especially chronic stress, can lead to impairments in immune system functioning in both the young and older adults. In several studies of older adults, those who are providing care for a relative with dementia report high levels of stress and exhibit significant impairments in immune system functioning when compared with noncaregivers. Stress-induced changes in the immune system may affect a number of outcomes, including slowing the wound healing process and increasing susceptibility to infections.
    What is stress?
    Source: Stress and Your Health,
    Stress is a feeling you get when faced with a challenge. In small doses, stress can be good for you because it makes you more alert and gives you a burst of energy. For instance, if you start to cross the street and see a car about to run you over, that jolt you feel helps you to jump out of the way before you get hit. But feeling stressed for a long time can take a toll on your mental and physical health. Even though it may seem hard to find ways to de-stress with all the things you have to do, it's important to find those ways. Your health depends on it.
    Chronic Stress
    Source: Chronic Stress, NLM, NIH, Medline Plus
    We all have stress sometimes. For some people, it happens before having to speak in public. For other people, it might be before a first date. What causes stress for you may not be stressful for someone else. Sometimes stress is helpful - it can encourage you to meet a deadline or get things done. But long-term stress can increase the risk of diseases like depression, heart disease and a variety of other problems. A stress-related illness called post-traumatic stress disorder (PTSD) develops after an event like war, physical or sexual assault, or a natural disaster.
    If you have chronic stress, the best way to deal with it is to take care of the underlying problem. Counseling can help you find ways to relax and calm down. Medicines may also help.
    How Stress Affects your Health and What You Can Do About It
    Source: Fact Sheet on Stress, NIMH, NIH,
    Stress — just the word may be enough to set your nerves on edge. Everyone feels stressed from time to time. Some people may cope with stress more effectively or recover from stressful events quicker than others. It's important to know your limits when it comes to stress to avoid more serious health effects.
    Stress can be defined as the brain's response to any demand. Many things can trigger this response, including change. Changes can be positive or negative, as well as real or perceived. They may be recurring, short-term, or long-term and may include things like commuting to and from school or work every day, traveling for a yearly vacation, or moving to another home. Changes can be mild and relatively harmless, such as winning a race, watching a scary movie, or riding a rollercoaster. Some changes are major, such as marriage or divorce, serious illness, or a car accident. Other changes are extreme, such as exposure to violence, and can lead to traumatic stress reactions.
    How does stress affect the body?
    Not all stress is bad. All animals have a stress response, which can be life-saving in some situations. The nerve chemicals and hormones released during such stressful times, prepares the animal to face a threat or flee to safety. When you face a dangerous situation, your pulse quickens, you breathe faster, your muscles tense, your brain uses more oxygen and increases activity—all functions aimed at survival. In the short term, it can even boost the immune system.
    However, with chronic stress, those same nerve chemicals that are life-saving in short bursts can suppress functions that aren't needed for immediate survival. Your immunity is lowered and your digestive, excretory, and reproductive systems stop working normally. Once the threat has passed, other body systems act to restore normal functioning. Problems occur if the stress response goes on too long, such as when the source of stress is constant, or if the response continues after the danger has subsided.
    How does stress affect your overall health?
    There are at least three different types of stress, all of which carry physical and mental health risks:
    Routine stress related to the pressures of work, family and other daily responsibilities.
    Stress brought about by a sudden negative change, such as losing a job, divorce, or illness.
    Traumatic stress, experienced in an event like a major accident, war, assault, or a natural disaster where one may be seriously hurt or in danger of being killed.
    The body responds to each type of stress in similar ways. Different people may feel it in different ways. For example, some people experience mainly digestive symptoms, while others may have headaches, sleeplessness, depressed mood, anger and irritability. People under chronic stress are prone to more frequent and severe viral infections, such as the flu or common cold, and vaccines, such as the flu shot, are less effective for them.
    Of all the types of stress, changes in health from routine stress may be hardest to notice at first. Because the source of stress tends to be more constant than in cases of acute or traumatic stress, the body gets no clear signal to return to normal functioning. Over time, continued strain on your body from routine stress may lead to serious health problems, such as heart disease, high blood pressure, diabetes, depression, anxiety disorder, and other illnesses.
    Stress and Stressors
    Source: Stress and Stressors, York School AP Psychology Textbook, CC-BY-NC-SA,
    Even though there is little consensus among psychologists about the exact definition of stress, mainstream scientists define stress as the process by which we perceive and cope environmental factors that are appraised as threatening or challenging by our brains. Those factors, known as stressors, could be either physical or psychological in natural. A stressor can be the presence of flood after a storm or nervousness about SATs. According to the theory of Richard Lazarus, a psychologist from UC Berkeley, there are three types of stressors (also known as stimuli): major cataclysmic changes that affect large numbers of persons; major changes affecting one or several persons; and daily hassles. (Lazarus, 1984)
    The first type of stressors may refer to phenomena that are outside anyone’s control. Like natural disasters, wars or uprooting and relocation, they are universally stressful. The stressors themselves could be ephemeral, but the physical and psychological aftermath is long-term. The second category of stressors happen to relatively few people or to individuals. These are events out of the individual’s control, like the death of loved ones, a robbery, or the process of taking exams. The daily hassles are little things that distress or irritate: a quarrel with parents, a losing sports game or too much homework.
    The above listed stressors all seem to have negative effects and impacts to our life, however, stressors can be positive as well. According to Hans Selye, the father of stress study, there are two types of stress: eustress and distress. Eustress refers to stress that actually allows the body to function as well or better than it does while unstressed.
    Learning Activity 1.1:
    Go to Stress Assessment to rate your own stress level.
    Were the results what you expected? Why or why not?
    Lesson 2: Dynamics and Sources of Stress
    Stress and the Brain
    Source: Psychology/Genetic Interplay, CC-BY-SA,
    Stress has many definitions, but according to Richard Lazarus, stress is a state of anxiety produced when events and responsibilities exceed one’s coping abilities. In this way, stress relies not only on environmental factors, but on cognitive appraisals of these factors (Myers, 2004). The cerebral cortex perceives the stressor, the hypothalamus stimulates the pituitary gland to release epinephrine and norepinephrine. This in turn stimulates the adrenal glands to release the hormone cortisol (Myers, 2004). Stress affects many other areas of the body, such as the amygdala, which produces a fear response. It seems to hardwire the brain differently. Middle-aged rats that had undergone early life stress had abnormal brain-cell activity and memory loss (Brunson et. al., 2005).
    The sources of stress are numerous: from catastrophes such as Hurricane Katrina, significant life changes, poverty and inequality, to daily hassles like traffic tie-ups and demanding jobs (Myer, 2004). Especially in urban and overcrowded environments, psychologists see links between everyday stressors and hypertension, and unhealthy behaviors such as lack of sleep and alcoholism (Lazarus & Folkman, 1984). In fact, the leading causes of death today in America are linked to lifestyle and stress. According United Nations Security Council, about half of the world’s children grow up in extremely stressful environments (poverty, violence, war, abuse), which means that these children may have impaired cognitive abilities later on in life.
    According to research by Janet Rodin, the less perceived control of a situation, the greater the stress. The elderly that lived in nursing homes, were lonely, and had to be fed, dressed, and changed, felt significantly more stress and had shorter lifespans than their independent, active counterparts.
    Females seem to be more susceptible to stress and depression. After experiencing traumatic events, females are twice as likely as men to develop Post Traumatic Stress Disorder, where humans develop maladaptive behaviors such as avoidance, reduced responsiveness and guilt (Myers, 2004).
    However, mindful exercise, such as Tai Chi, meditation, and aerobic exercise decrease stress response and promote overall well-being (Sandlund and Norlander, 2000). In a University of Wisconsin study, participants who did meditative exercises showed more electrical activity in the left side of the frontal lobe, indicating that they had a lower anxiety and a more positive emotional state (Davidson, 2003). Meditation, yoga, and other relaxation exercises also assist in autonomic reflexes. This is called conscious control. Through these practices, it is possible to gain control over the sphincter muscles in the anus and bladder. Yoga has been shown to help control heart rate, blood pressure, and other autonomic functions. These are learned behaviors - they involve the formation of new pathways in the brain.
    Researchers have also found the correlation between a social support network of close friends and family and less physiological stress effects (Brown and Harris, 1978). Stress Inoculation Training and Hardiness Training are cognitive behavioral techniques that work to improve stress resistance through analyzing stressors, teaching coping techniques, and changing behavior so that the patient feels more assertive and in control (Kobasa, 1986). Drugs, such as beta-blockers, which reduce stress arousal, anxiolytic drugs, such as minor tranquilizers, and anti-depressant drugs, which treat severe anxiety, can also be used to combat stress.
    What are the most common causes of stress?
    Source: Stress and Your Health Fact Sheet,
    Stress happens when people feel like they don’t have the tools to manage all of the demands in their lives. Stress can be short-term or long-term. Missing the bus or arguing with your spouse or partner can cause short-term stress. Money problems or trouble at work can cause long-term stress. Even happy events, like having a baby or getting married can cause stress. Some of the most common stressful life events include:
    Death of a spouse
    Death of a close family member
    Losing your job
    Major personal illness or injury
    Marital separation
    Spending time in jail
    What are some common signs of stress?
    Everyone responds to stress a little differently. Your symptoms may be different from someone else’s. Here are some of the signs to look for:
    Not eating or eating too much
    Feeling like you have no control
    Needing to have too much control
    Lack of energy
    Lack of focus
    Trouble getting things done
    Poor self-esteem
    Short temper
    Upset stomach
    Back pain
    General aches and pains
    These symptoms may also be signs of depression or anxiety, which can be caused by long-term stress.
    Do women react to stress differently than men?
    One recent survey found that women were more likely to experience physical symptoms of stress than men. But we don’t have enough proof to say that this applies to all women. We do know that women often cope with stress in different ways than men. Women “tend and befriend,” taking care of those closest to them, but also drawing support from friends and family. Men are more likely to have the “fight or flight” response. They cope by “escaping” into a relaxing activity or other distraction.
    Can stress affect my health?
    The body responds to stress by releasing stress hormones. These hormones make blood pressure, heart rate, and blood sugar levels go up. Long-term stress can help cause a variety of health problems, including:
    Mental health disorders, like depression and anxiety
    Heart disease
    High blood pressure
    Abnormal heart beats
    Menstrual problems
    Acne and other skin problems
    Does stress cause ulcers? NO
    Source: H-Pylori, NIDDK, NIH,
    A bacterium called Helicobacter pylori (H. pylori) is a major cause of peptic ulcers. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen, are another common cause. Rarely, cancerous or noncancerous tumors in the stomach, duodenum, or pancreas cause ulcers.
    Peptic ulcers are NOT caused by stress or eating spicy food, but both can make ulcer symptoms worse. Smoking and drinking alcohol also can worsen ulcers and prevent healing.
    What is post-traumatic stress disorder (PTSD)?
    Source: Stress and Your Health Fact Sheet,
    Post-traumatic stress disorder (PTSD) is a type of anxiety disorder that can occur after living through or seeing a dangerous event. It can also occur after a sudden traumatic event. This can include:
    Being a victim of or seeing violence
    Being a victim of sexual or physical abuse or assault
    The death or serious illness of a loved one
    Fighting in a war
    A severe car crash or a plane crash
    Hurricanes, tornadoes, and fires
    You can start having PTSD symptoms right after the event. Or symptoms can develop months or even years later. Symptoms may include:
    Flashbacks, or feeling like the event is happening again
    Staying away from places and things that remind you of what happened
    Being irritable, angry, or jumpy
    Feeling strong guilt, depression, or worry
    Trouble sleeping
    Feeling numb
    Having trouble remembering the event
    Women are 2 to 3 times more likely to develop PTSD than men. Also, people with ongoing stress in their lives are more likely to develop PTSD after a dangerous event.
    Fight or Flight Response
    Source: Stress Response, York School AP Psychology Textbook, CC-BY-SA-NC,
    When we experience excessive stress, either from internal worry or external circumstance, a bodily reaction called the "fight-or-flight" response will be triggered. Harvard physiologist Walter Cannon originally defined it. The response system represents the genetic impulse to protect ourselves from bodily harm, but also can result in negative health effects. According to Cannon’s theory, during stress-response processes, the sympathetic nervous system increases the heart rate and releases chemicals to prepare our body to either fight or flee. When the fight-or-flight response system get activated, it tends to perceive everything in the environment as a potential threat to survival.
    In modern life, we do not get the option of "flight" very often. We have to deal with those stressors all the time and find a solution. When you need to take an SAT test, there is no way for you to avoid it; sitting in the test room for five hours is the only choice. Lacking the "flight" option in stress-response process leads to higher stress levels in modern society.
    Learning Activity 2.1:
    Watch one of these two videos about the "flight-or-fight" Response -
    Physical Response to Stress (01:59)
    Fight or Flight Response and take the ungraded quiz.
    Stress and Health
    Source: Stress and Health, Bob Riesenberg, Whatcom Community College and Washington Online, Washington State Colleges, CC-BY.
    Exercise builds stronger bodies only if we push ourselves beyond our regular level of strength and endurance. Progressing in your intellectual skills occurs only by going beyond your adaptation level for the complexity and amount of knowledge you must acquire. Stress as "challenge" enhances physical and emotional well-being. Mountain climbers want risk and challenge, but they want the type that they feel they can master and mostly control. They don't want to be perfectly in control because then the challenge would not be so great. They want to be on the edge between in-control and having to use every degree of skill, concentration, and problem solving to succeed. The same is true of race car drivers, downhill skiers, chess players, musicians, and artists.
    These activities have been described by Csikszentmihalyi as inducing the experience of "flow" that totally captures the attention, makes it very easy to continue, and very hard to stop. There are many other activities and professions that produce "flow", but the essence of the experience is to be on the edge of challenge and failure with the perception that your own efforts will make the difference between good and bad outcomes. In these conditions stress builds healthier bodies and higher well-being. People who experience "flow" frequently report high degrees of satisfaction in life.
    Stress is in the eye of the beholder
    The process by which we influence the emotion we experience in a situation by the interpretation or cognitions we select in the experience is described by Lazarus's theory of appraisal as influencing our stress experience. This theory may be beneficial to our understanding of the differences between individual's stress levels. The theory's main points are:
    When we experience a situation or event we first determine if it is a threat, a challenge, or is neutral.
    We then assess our inventory of resources to cope with the event. If we do not perceive we are adequate to the task, we must be able to withdraw or we will feel trapped in a situation with aversive consequences coming. That induces distress and all the physiological processes that harm our health. If we perceive that we have the resources to successfully cope with the situation, we feel challenged and optimistic. Note that challenge and optimism are related to enhanced health and sense of well-being.
    This second stage of appraisal impacts the first stage in a loop process. If we at first perceive a threat but then realize we can handle it, it reduces the distress and may even create a perception of challenge. If at first we perceive a challenge but then realize that we don't have what it takes to be successful, we may begin to experience distress as we see the aversive outcome of failure looming ahead. Depending on the meaning of the outcome to us, the distress may be mild or severe. If the situation is always hanging over us and we always feeling inadequate to it and anxious about negative outcomes, we are always under distress. Our health and well-being take a beating in that scenario.
    Next we must select from our repertoire of coping resources. There are two types of coping resources:
    palliative (emotion-focused)
    Instrumental coping solves the problem and removes the stressor form our experience as in working out a conflict with someone to reduce the distress or by getting a better job to reduce financial pressures.
    Palliative coping alters our physiological reactions to stress that will not go away and cannot be escaped. These include relaxation skills, reinterpretation of the meaning or effects of the stressor, acceptance of the situation, or optimism about future improvements in the situation. Palliative skills would include relaxing in the traffic jam even though you have an important appointment that is being missed. You realize you cannot do anything about it, so you may as well relax because anger and tension will not make the cars move any faster, but it will hurt you, so you choose to relax instead.
    As we go to our repertoire of coping skills to select one or more, we may become more optimistic of success and reappraise the situation in the first step. It may become less threatening and hence less distressful. We could find that our coping resources will be less adequate than we initially thought and we would become more threatened now. Even a challenge might be converted into a threat as in traveling to a another country for the first time and finding your credit cards are missing and you have no money for anything and no way to get any.
    This interactive appraisal and coping process is at the heart of the impact of stress on us. If we interpret a situation as stressful, it has the stress-related effects on us. If we have few coping sources, more situations will be perceived as distressing. If we have many coping resources, more situations will be perceived as challenging or at least neutral.
    As I am driving down the road and have a flat tire, I could be annoyed at the trouble it causes or highly threatened by the memory of Bill Cosby's son's murder a few years ago as he changed his tire. If I don't know how to change a tire and it is night time, I may feel very threatened as I perceive helplessness and vulnerability to someone's attacking me. If I assure myself that this is unlikely and I do know how to change a tire, I may decide that I will get this done in ten minutes and be on the road safely. But then I find that my spare tire is flat. Now I feel threatened for sure. But if I have a good spare, have a good flashlight, have a handgun and the skill to use it, and have changed many tires, I may only feel annoyed at the hassle and not feel threatened (many instrumental skills). I may have none of these things but have a cell phone and a close friend who will quickly be here to solve the problem for me (social support). My distress is much less then.
    These factual situations are part of the appraisal and coping process. Perception is also critically important. If I have little confidence in myself to handle a flat tire even though I have been taught how to do it and have the tire, I may feel more threatened. If I have the cell phone but don't believe I should bother anybody to come here, or don't believe they would want to help me, the facts do not determine my reaction as much as my perception of the facts determines it.
    A second example of the role of coping skills and perception could involve getting started in this course. If you are a computer whiz and have taken several college courses including online courses before, you got started with little problem. Learning to use Etudes, to take online quizzes probably did not cause much distress. But if you were new to using the Internet, had never taken an online course, and had low self-confidence, you may have been quite distressed. Same situation, different coping resources. Some of our community colleges go to great effort to be sure new online students have the knowledge and coping skills to begin a course with little stress.
    Now add pure perception. If you perceive college as a supportive environment that will find a way to assist you to get through as long as you put forth the effort, and perceive instructors as willing to be flexible when circumstances are beyond all of our control, like getting started on the three programs we use and getting books late, you may be hassled but not threatened about failing the course because of these factors. But if you see colleges and instructors as money-hungry and deliberately placing obstacles in your path to cause you to fail and drop out, you have been very distressed when you had these difficulties as you would see no support or flexibility to allow you to adapt to the new situation and have the time to catch up. You might even feel quite angry at this new ploy to get your tuition and frustrate you into quitting. The reality of the college and instructor's intent make no difference in your initial perception and resultant choices. It is your perception of reality that determines what you will do.
    The appraisal and coping process underlies the statement that "stress is in the eye of the beholder." Any event of situation may be perceived differently by different individuals due to past experience with it, learned skills, personality traits like Type A and optimism, and the amount of distress being experienced already. Social support may be instrumental in helping cope with problem as in coming to help with the flat tire, or being eager to listen and be supportive with your sharing your experiences. Both reduce the distress levels.
    Learning Activity 2.2:
    Find out if life events are adding up to stress and illness in your life.
    Complete the Holmes and Rahe Stress Scale (Social Readjustment Rating Scale).
    Did your score surprise you? What can you doabout it?
    Lesson 3: General Adaptation Syndrome
    Selye's Concept of General Adaptation Syndrome
    Source: //Psychology: An Introduction// by Russ Dewey, 2007, CC-BY-NC-ND,
    Hans Selye (1907-1982) started the modern era of research into something called stress. In 1950, Selye addressed the American Psychological Association convention. He described a theory of stress-induced responses that become the standard model of stress, the one people usually refer to (or criticize) in academic journal articles about stress.
    How did Selye discover the stress response?
    Selye's discovery of the stress response was an accident. He was doing research on the effect of hormone injections in rats. Initially he thought he detected a harmful effect from the hormones, because many of the rats became sick after receiving the injections. But when Selye used a control group of rats, injected only with a neutral solution containing no hormones, he observed that they became sick, too.
    As it turned out, the rats responded more profoundly to the trauma of being injected than they did to the hormones. The experience of being handled and injected led to high levels of sympathetic nervous system arousal and arousal and eventually to health problems such as ulcers. (Note that stress was not found to directly cause ulcers by Selye.) Selye coined the term "stressor" to label a stimulus that had this effect.
    What is a stressor for rats? For lab assistants?
    The immediate response to stress is the release of adrenaline into the blood plasma (the liquid part of the bloodstream). "Mild stressors such as opening a cage door or handling a rat produces an eightfold increase in plasma epinephrine [adrenaline] concentrations" (Axelrod and Reisine, 1984). The sentence is ambiguous; does the rat or the human experience the eightfold increase in adrenaline? In this case, it is the rat which is having its adrenaline (plasma epinephrine) measured. However, many lab assistants probably experience a burst of adrenaline, too, when handling a rat for the first time.
    What were the three stages of Selye's General Adaptation Syndrome?
    Selye proposed a three-stage pattern of response to stress that he called the General Adaptation Syndrome (GAS) . He proposed that when the organism first encountered stress, in the form of novelty or threat, it responded with an alarm reaction. This is followed by a recovery or resistance stage during which the organism repairs itself and stores energy. If the stress-causing events continue, exhaustion sets in. This third stage is what became known popularly as burn-out. Classic symptoms of burn-out include loss of drive, emotional flatness, and (in humans) dulling of responsiveness to the needs of others.
    Hans Selye’s Study of Stress Response
    Source: York School AP Psychology Textbook, CC-BY-SA-NC,
    In 1934, Hans Selye at McGill University discovered a new type of hormone. He gave rats daily injections of ovarian extract and found that the rats had enlarged adrenals and shrunken spleens, thymus, lymph nodes, and intestinal ulcers. “Multiple organs in the body generate this hormone, and thus he announced that it is a nonspecific response of body to noxious agents. (Evan-Martin, 2007)
    In 1936, Selye defined these series of symptoms in the experiments with the rats as the General Adaptation Syndrome, which consists of three stages: the alarm stage, the resistance stage, and the exhaustion stage (Evan-Martin, 2007). The alarm stage is similar to the fight-to-flight response, and the body mobilizes resources to react to the incoming noxious agent. The resistance forces will be built up when the noxious challenge is detected as continuing. The exhaustion stage will cause death if the body is unable to overcome the threat.
    For example, your mom told you that you are going to take the SAT next month. The first reaction is shock, starting complaints and feelings of stress, which represent the beginning of the first stage. In the resistance stage, you will try your best to do practice tests, reviewing vocabulary, studying any type of study aids that are available. Finally, you will feel like you are doomed to fail this test and feel desperate, feel constantly anxious, have difficulty falling asleep and waking up in the morning. The exhaustion of this stage will have deleterious effects on your health by depleting your body resources which are crucial for the maintenance of normal functions. Your immune system will be exhausted and function will be impaired. Also, the decomposition which is a functional deterioration of body may happen as the exhaustion stage extends. Selye believed that one becomes sick at that point because stored hormones secrete during the stress response are depleted (Sapolsky, 1998).
    Distress may be destructive to health
    Source: Bob Riesenberg, Whatcom Community College and Washington Online, Washington State Colleges, CC-BY
    Hans Selye’s research that led to the concept of the General Adaptation Syndrome (GAS) demonstrated that stress that is perceived as a threat (distress) may be debilitating if it is continuous. But even “flow” could go on too long and the person would need a break. But "flow" only develops in activities that are freely engaged in. Negative stress, or distress, is often part of activities that we perceive we cannot escape. Our bodies and minds seem to have evolved to cope well with sudden and brief stressors, such as escaping attack by a predator. We do not seem to be designed to handle chronic stress even if it is mild, like driving in heavy traffic. Our society has created many conditions that produce chronic stress and are associated with stress related illnesses. We have time pressures, work pressures, relationship pressures, crowding, noise, crime, to many things to do in too little time, achievement pressures, and even education-related pressures in this course. It is this detrimental effect of ongoing stress that underlies the GAS and the concepts of stress-induced health problems.
    Learning Activity 3.1:
    Watch the video titled Stressed by Stress and take the ungraded quiz.
    Source: //Psychology: An Introduction// by Russ Dewey, CC-BY -NC-ND , 2007,
    What was Selye's concept of eustress?
    What type of stressors produced harmful stress reactions?
    Hans Selye originally defined stress as the body's response to challenges. He was dismayed by the implication that all challenging events in life were unhealthy and undesirable. Stress was not always bad, he pointed out. Sometimes a challenge is a good thing. Indeed, one could argue that nothing useful in life can be accomplished without some degree of stress.
    "Good stress," Selye pointed out, is "the spice of life." To combat the notion that all stress was bad, Selye developed the idea of eustress, which is a person's ideal stress level. Selye proposed that different people needed different levels of challenge or stimulation (stress) in their lives. Some people ("turtles") need low levels of stress. Others ("racehorses") thrive on challenges.
    In the long run, the popular conception of stress as something bad proved to be more durable and accurate than Selye's notion of stress as a challenge to the system. In other words, the word stress continues to mean something bad (not something challenging) to most people. That seems to make the most sense, because psychologists found that only unpleasant stressors produced the harmful stress reaction identified by Selye (corticosteroid secretion). Challenges were not harmful in themselves. A person could be a busy executive or engage in strenuous exercise without experiencing negative stress-related symptoms, as long as the person enjoyed the challenge.
    Lesson 4: Burn Out
    Burnout and Stress Related Illness
    Source: A new definition of burnout syndrome based on Farber's proposal by Jesus Montero-Maria Javier García-Campayo, Domingo M Mera and Yolanda L del Hoyo, Journal of Occupational Medicine and Toxicology 2009, 4:31 doi:10.1186/1745-6673-4-31, CC-BY,
    Burnout syndrome is considered an important work-related illness in welfare societies. It was through observations by Freudenberger inside a detoxification clinic in the mid 1960s that the first scientific descriptions came to light of staff affected by this disorder. It was only in the 1980s that evaluation criteria for the syndrome became available, through the design of a standard measurement instrument, the Maslach Burnout Inventory or MBI.
    Burnout is a psychosocial syndrome. It involves feelings of emotional exhaustion, depersonalization and diminished personal accomplishment at work. Emotional exhaustion is a situation where, owing to lack of energy, workers perceive they are no longer able to participate on an emotional level. Depersonalization entails the development of negative attitudes and feelings towards persons for whom work is done, to the point where they are blamed for the subject's own problems. Diminished personal accomplishment is a tendency in professionals to negatively value their own capacity to carry out tasks and to interact with persons for whom they are performed, and feeling unhappy or dissatisfied with the results obtained.
    The MBI questionnaire has been adapted for application not only to human services professions but to all types of occupations in general. An updated definition of burnout, constructed using the latest version of the MBI, is that proposed by Maslach et al. In their description it is "a prolonged response to chronic emotional and interpersonal stressors on the job, and is defined by the three dimensions of exhaustion, cynicism, and inefficiency." Exhaustion is the feeling of not being able to offer any more of oneself at an emotional level; cynicism is contemplated as a distant attitude towards work, the people being served by it and among colleagues; ineffectiveness is the feeling of not performing tasks adequately and of being incompetent at work.
    Burnout is generally considered a response by a person to chronic work-related stress in an attempt to adapt or protect oneself from it. From a transactional approach, stress is defined as "the result of a relationship with the environment that the person appraises as significant for his or her well-being and in which the demands tax or exceed available coping resources." This is the case because a life event is not what produces stress; rather, it is caused by the appraisal the affected person makes of it. According to Lazarus and Folkman, coping is "cognitive and behavioral efforts to manage specific internal and/or external demands that are appraised as taxing or exceeding the resources of the person." A person will be psychologically vulnerable to a determined situation if he or she does not possess sufficient coping resources to handle it adequately, and if at the same time, he or she places considerable importance on the threat implicit in the consequences of this inadequate handling. From this perspective, burnout syndrome may be seen as a progressively-developed process resulting from the use of the relatively ineffective coping strategies with which professionals try to protect themselves from work-related stress.
    Burnout has also been described as an experience where the worker is aware of considerable discrepancy between his or her efforts and the results, between the invested efforts and the rewards obtained at work. This phenomenological analysis framework is introduced into the subjective experience of those affected, and the conclusion is reached that the burnout process is triggered when the worker feels that his or her efforts are disproportionate to the gratification achieved, and consequently is no longer able to justify or cope with further investment of effort. Burnout syndrome may be seen as the continuous perception that efforts made to carry out tasks are not effective, because expected gratitude, recognition or success at work are not being achieved.
    Learning Activity 4.1:
    Take the Burn Out Self-Test
    This tool can help you check yourself for burnout. It helps you look at the way you feel about your job and your experiences at work, so that you can get a feel for whether you are at risk of burnout.
    Source: MindTools,

    Lesson 5: Managing Stress
    How can I help handle my stress?
    Schedule regular times for healthy and relaxing activities.
    Explore stress coping programs, which may incorporate meditation, yoga, tai chi, or other gentle exercises.
    Activity 5.1: Watch
    a few
    Overview of Stress and Stress Management (03:01)
    Does the "stress industry" make the problems seem worse than they are?
    Patients suffering from depression may experience alleviation by talking with a sympathetic professional.
    Stress Management Strategies (02:10)
    daily schedules.
    Cognitive Strategies for Stress Management (02:44)
    Is stress really all in the mind? Counseling works for people who may not respond to medicine. Stress inoculation prepares people for stressful situations.
    Optional: WhatWhat Is Resilience?
    Source: Resilience, Substance Abuse and Mental Health Services Administration (SAMHSA) Resilience and Stress Management Resource Collection,
    Resilience is the ability to:
    What Is Individual or Personal Resilience?
    Individual resilience is a person's ability to positively cope after failures, setbacks, and losses. Developing resilience is a personal journey. Individuals do not react the same way to traumatic or stressful life events. An approach to building resilience that works for one person might not work for another. People use varying strategies to build their resilience. Because resilience can be learned, it can be strengthened. Personal resilience is related to many factors including individual health and well-being, individual aspects, life history and experience, and social support.
    and Well-Being


    History and Experience

    These are factors with which a person is born.
    Protective Factors Enhancing Resilience
    Facilitators of Resilience
    Individual Resilience
    The ability for an individual to cope with adversity and change
    Faith Community
    Organizational Resilience
    The ability for a business or industry, including its employees, to cope with adversity and change
    Proactive employees
    Employee assistance programs
    Other businesses
    Community Resilience
    The ability for an individual and the collective community to respond to adversity and change.
    Simon, J., Murphy, J., & Smith, S. (2008). Building resilience: Appreciate the little things in life. British Journal of Social Work, 38, 218–235.
    Wilson, S., & Ferch, S. (2005). Enhancing resilience in the workplace through the practice of caring relationships. Organization Development Journal, 23(4), 45–60.
    Optional: CopingCoping With Stress
    Source: Coping with Stress, CDC,
    After experiencing an event that is especially frightening—including personal or environmental disasters, or being threatened with an assault—people sometimes have a strong and lingering reaction to stress. Getting the right care and support can put problems in perspective and help stressful feelings and symptoms subside.
    Difficulty concentrating
    Feeling emotional and nervous or having trouble sleeping and eating can all be normal reactions to stress. Getting the right care and support can put problems in perspective and help stressful feelings and symptoms subside in a few days or weeks.
    Hereere are some
    Avoid drugs and alcohol. Drugs and alcohol may seem to help with the stress temporarily; in the long run they create additional problems that compound the stress you are already feeling.
    Find support. Ask for help from a parent, friend, counselor, doctor, or pastor. Talk with them about the stress you feel and problems you face.
    Feeling nervous or on edge
    Feeling irritable or crying easily
    Iff you or
    Keep in mind that returning to the way you felt before the event may take some time. Helping and healing can begin at the time of the event but may need to continue over a period of time. If problems continue or you have trouble managing your feelings, talk to a psychologist, social worker, or professional counselor.
    Contemporary Health Issues
    (view changes)
  2. page Module 11 edited Emotional Module 11: Emotional Health, and Abnormal Behavior – Week 11 Content: This Modul…

    EmotionalModule 11: Emotional Health, and Abnormal Behavior – Week 11
    This Module contains 6 Lessons:
    Students will be able to identify and distinguish between various forms of mental illness.
    Personality Users Guide by Dr Daniel Nettle, The Open University, CC-BY-NC-SA
    Mental Illness in the Population, NIH
    Attitudes Toward Mental Illness, Centers for Disease Control and Prevention
    Information about Mental Illness and the Brain, NIH
    SAMHSA's Resource Center to Promote Acceptance, Dignity and Social Inclusion Associated with Mental Health, SAMHSA
    What is borderline personality disorder? NIMH, NIH
    Sherwin Nuland on electroshock therapy | Video on
    JD Schramm: Break the silence for suicide attempt survivors
    Suicide and Self-harm, NLM, NIH, Medline Plus
    NIH, Medline Plus
    Lesson 1: Personality

    Personality: A User Guide
    Source: Dr Daniel Nettle, The Open University, Creative Commons Attribution-NonCommercial-ShareAlike 2.0 License,
    Another key dimension is extraversion or positive emotionality (E). This is commonly used to mean sociability, but to psychologists it means something broader. The mind also contains systems for identifying rewarding things in the environment – food, comfort, mates, kin – and seeking them out. It is thought that brain circuits using the chemical dopamine function to make these positively rewarding stimuli ‘attention grabbing’ (you know the attention grabbing potential of a piece of chocolate cake or a nice looking person). Now these systems seem to be a little more responsive in some people than others.
    High E scorers, not surprisingly, go out more, talk more, want to be famous more, have more sexual partners, and drink and take more drugs than low E scorers. Low E scorers are often more content with relatively quiet, self-contained jobs or hobbies whose rewards maybe longer coming. Extraverts generally describe themselves as happier than introverts, though there is a significant group of happy introverts who have strong, self-contained interests and vocations.
    Agreeableness, Neuroticism). The OCEAN system is the subject of an online study that we are currently carrying out here at The Open University.
    People often ask what is the optimum personality profile to have. There is no simple answer to this question. It is certainly true that some extremes carry some risks. Low agreeableness is associated with violence, whilst high neuroticism is associated with the risk of depression and anxiety. However, all the systems whose operation is reflected in personality differences are there for a reason. Anxiety and fear are good things to have (at least a little), because the world actually is full of dangerous things. There is evidence that at least some high N scorers do well at college because they strive hard to avoid failure, and people who get convicted of traffic offenses may be less neurotic than those who do not (and therefore, presumably, less fearful to the danger of getting caught).
    The balance between the different systems is probably all. If you are an extreme introvert, you might want to challenge yourself to experience the rewards of greater spontaneity and exchange; if you are an extreme extravert, you might want to teach yourself to undertake a long and lonely project that will ultimately be very rewarding. As human beings, we have the unique ability to look in at our personality from the outside and decide what we want to do with it.
    Dedicated to Public Domain 2012, National Institutes of Health
    Information about Mental Illness and the Brain
    Source: NIH,
    Defining Mental Illness
    We can all be “sad” or “blue” at times in our lives. We have all seen movies about the madman and his crime spree, with the underlying cause of mental illness. We sometimes even make jokes about people being crazy or nuts, even though we know that we shouldn’t. We have all had some exposure to mental illness, but do we really understand it or know what it is? Many of our preconceptions are incorrect. A mental illness can be defined as a health condition that changes a person’s thinking, feelings, or behavior (or all three) and that causes the person distress and difficulty in functioning. As with many diseases, mental illness is severe in some cases and mild in others. Individuals who have a mental illness don’t necessarily look like they are sick, especially if their illness is mild. Other individuals may show more explicit symptoms such as confusion, agitation, or withdrawal.
    Disturbances of perception and thought process fall into a broad category of symptoms referred to as psychosis. The threshold for determining whether thought is impaired varies somewhat with the cultural context. Like anxiety, psychotic symptoms may occur in a wide variety of mental disorders. They are most characteristically associated with schizophrenia, but psychotic symptoms can also occur in severe mood disorders. One of the most common groups of symptoms that result from disordered processing and interpretation of sensory information are the hallucinations.
    Hallucinations are said to occur when an individual experiences a sensory impression that has no basis in reality. This impression could involve any of the sensory modalities. Thus hallucinations may be auditory, olfactory, gustatory, kinesthetic, tactile, or visual. For example, auditory hallucinations frequently involve the impression that one is hearing a voice. In each case, the sensory impression is falsely experienced as real. A more complex group of symptoms resulting from disordered interpretation of information consists of delusions. A delusion is a false belief that an individual holds despite evidence to the contrary. A common example is paranoia, in which a person has delusional beliefs that others are trying to harm him or her. Attempts to persuade the person that these beliefs are unfounded typically fail and may even result in the further entrenchment of the beliefs. Hallucinations and delusions are among the most commonly observed psychotic symptoms.
    manic depressive illnessillness.
    Mental Illness in the Population
    Source: NIH,
    Most scientists believe that mental illnesses result from problems with the communication between neurons in the brain (neurotransmission). For example, the level of the neurotransmitter serotonin is lower in individuals who have depression. This finding led to the development of certain medications for the illness. Selective serotonin reuptake inhibitors (SSRIs) work by reducing the amount of serotonin that is taken back into the presynaptic neuron. This leads to an increase in the amount of serotonin available in the synaptic space for binding to the receptor on the postsynaptic neuron. Changes in other neurotransmitters (in addition to serotonin) may occur in depression, thus adding to the complexity of the cause underlying the disease. Scientists believe that there may be disruptions in the neurotransmitters dopamine, glutamate, and norepinephrine in individuals who have schizophrenia. One indication that dopamine might be an important neurotransmitter in schizophrenia comes from the observation that cocaine addicts sometimes show symptoms similar to schizophrenia. Cocaine acts on dopamine-containing neurons in the brain to increase the amount of dopamine in the synapse.
    Risk Factors for Mental Illnesses
    to violence.
    Treating Mental Illnesses
    At this time, most mental illnesses cannot be cured, but they can usually be treated effectively to minimize the symptoms and allow the individual to function in work, school, or social environments. To begin treatment, an individual needs to see a qualified mental health professional. The first thing that the doctor or other mental health professional will do is speak with the individual to find out more about his or her symptoms, how long the symptoms have lasted, and how the person’s life is being affected. The physician will also do a physical examination to determine whether there are other health problems. For example, some symptoms (such as emotional swings) can be caused by neurological or hormonal problems associated with chronic illnesses such as heart disease, or they can be a side effect of certain medications. After the individual’s overall health is evaluated and the condition diagnosed, the doctor will develop a treatment plan. Treatment can involve both medications and psychotherapy, depending on the disease and its severity.
    Major mood disorders are depression, bipolar disorder, and dysthymic disorder. Like anxiety, depression might seem like something that everyone experiences at some point, and it is true that most people feel sad or “blue” at times in their lives. A true depressive episode, however, is more than just feeling sad for a short period. It is a long-term, debilitating illness that usually needs treatment to cure. And bipolar disorder is characterized by dramatic shifts in energy and mood, often affecting the individual’s ability to carry out day-to-day tasks. Bipolar disorder used to be called manic depression because of the way that people would swing between manic and depressive episodes.Depending on what definition is used, there is some overlap between mood disorders and personality disorders, which affect nine percent of Americans yearly. The American Psychological Association publishes the Diagnostic and Statistical Manual on Mental Disorders (DSM), and their definition of personality disorders is changing in the fifth edition, which is being revised in 2011 and 2012. In the DSM-IV, personality disorders represent “an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the culture of the individual who exhibits it” (National Institute of Mental Health). In other words, personality disorders cause people to behave in ways that are seen as abnormal to society but seem normal to them. The DSM-V proposes broadening this definition by offering five broad personality trait domains to describe personality disorders, some related to the level or type of their disconnect with society. As their application evolves, we will see how their definitions help scholars across disciplines understand the intersection of health issues and how they are defined by social institutions and cultural norms.
    Mental Health).

    Learning Activity:
    Is ADHD a valid diagnosis and disease? Some think it is not. This article discusses this history of the issue:
    The Americans with Disabilities Act requires that access be provided to everyone. Disability refers to a reduction in one’s ability to perform everyday tasks. The World Health Organization makes a distinction between the various terms used to describe handicaps that’s important to the sociological perspective. They use the term impairment to describe the physical limitations, while reserving the term disability to refer to the social limitation.
    Before the passage of the Americans with Disabilities Act (ADA) in 1990, Americans with disabilities were often excluded from opportunities and social institutions many of us take for granted. This occurred not only through employment and other kinds of discrimination, but through casual acceptance by most Americans of a world designed for the convenience of the able-bodied. Imagine being in a wheelchair and trying to use a sidewalk without the benefit of wheelchair accessible curbs. Imagine as a blind person trying to access information without the widespread availability of Braille. Imagine having limited motor control and being faced with a difficult-to-grasp round door handle. Issues like these are what the ADA tries to address. Ramps on sidewalks, Braille instructions, and more accessible door levers are all accommodations to help people with disabilities.
    Statistics 2011).
    What are the most commonly diagnosed mental disorders in the United States?
    ADHD Mood disorders Autism spectrum disorders Anxiety disordersAnswerD
    Stigma and Illness
    Stigma has been defined as an attribute that is deeply discrediting. This stigmatized trait sets the bearer apart from the rest of society, bringing with it feelings of shame and isolation. Often, when a person with a stigmatized trait is unable to perform an action because of the condition, other people view the person as the problem rather than viewing the condition as the problem. More recent definitions of stigma focus on the results of stigma—the prejudice, avoidance, rejection and discrimination directed at people believed to have an illness, disorder or other trait perceived to be undesirable. Stigma causes needless suffering, potentially causing a person to deny symptoms, delay treatment and refrain from daily activities. Stigma can exclude people from access to housing, employment, insurance, and appropriate medical care. Thus, stigma can interfere with prevention efforts, and examining and combating stigma is a public health priority.
    found that -
    78% of adults with mental health symptoms and 89% of adults without such symptoms agreed that treatment can help persons with mental illness lead normal lives.
    57% of adults without mental health symptoms believed that people are caring and sympathetic to persons with mental illness.
    Source: Challenging Stereotypes: An Action Guide, Substance Abuse and Mental Health Services Administration,
    Recovery from mental illness is a complex process. As with all serious illness, the well-being of recovering individuals is affected by the attitudes that surround them. Despite increasing sensitivity about most disabilities, mental illness all too often remains a target for ridicule and misrepresentation in advertising, entertainment, and the mainstream media.
    dire fate.” The
    portrayal of
    together with
    the misuse of
    Increasingly, the media are doing better work; at times, their efforts are excellent. Diana Ross’s moving and realistic portrayal of schizophrenia in Out of Darkness, an ABC television drama, was praised by mental health activists. “Good" characters with mental illness are appearing from time to time in prime-time television entertainment. In an outstanding documentary for Dateline NBC, John Hockenberry followed for two years the uneven course of recovery of a young man with schizophrenia.
    San Diego Union-Tribune’saccountUnion-Tribune’s account of pro
    Learning Activity 3.1: Take action to reduce stigma about mental illness.
    You can promote fair, accurate, and balanced portrayals of mental illness in the media. Your voice does make a difference. Whether you handwrite it, type it, or e-mail it, it’s your passion and knowledge that persuade, that get your letters read (and published), and that change hearts and minds.
    In addition to the well-established treatments described above, some parents and therapists have tried a variety of nutritional interventions to treat ADHD. A few studies have found that some children benefit from such treatments. Nevertheless, no well-established nutritional interventions have consistently been shown to be effective for treating ADHD.
    What is autism?
    Source: NINDS, NIH,
    Autism spectrum disorder (ASD) is a range of complex neurodevelopment disorders, characterized by social impairments, communication difficulties, and restricted, repetitive, and stereotyped patterns of behavior. Autistic disorder, sometimes called autism or classical ASD, is the most severe form of ASD, while other conditions along the spectrum include a milder form known as Asperger syndrome, and childhood disintegrative disorder and pervasive developmental disorder not otherwise specified (usually referred to as PDD-NOS). Although ASD varies significantly in character and severity, it occurs in all ethnic and socioeconomic groups and affects every age group. Experts estimate that six children out of every 1,000 will have an ASD. Males are four times more likely to have an ASD than females.
    There is wide racial and ethnic variation in drug metabolism. This is due to genetic variations in drug-metabolizing enzymes (which are responsible for breaking down drugs in the liver). These genetic variations alter the activity of several drug-metabolizing enzymes. Each drug-metabolizing enzyme normally breaks down not just one type of pharmacotherapy, but usually several types. Since most of the ethnic variation comes in the form of inactivation or reduction in activity in the enzymes, the result is higher amounts of medication in the blood, triggering untoward side effects.
    For example, 33 percent of African Americans and 37 percent of Asians are slow metabolizers of several antipsychotic medications and antidepressants (such as tricyclic antidepressants and selective serotonin reuptake inhibitors). This awareness should lead to more cautious prescribing practices, which usually entail starting patients at lower doses in the beginning of treatment. Unfortunately, just the opposite typically had been the case with African American patients and antipsychotic drugs. Clinicians in psychiatric emergency services prescribed more oral doses and more injections of antipsychotic medications to African American patients. These are the kinds of experiences that likely contribute to the mistrust of mental health services reported among African Americans.
    ethnic minorities.
    The term “Latino(a)” refers to all persons of Mexican, Puerto Rican, Cuban, or other Central and South American or Spanish origin.
    Acculturation refers to the “social distance” separating members of an ethnic or racial group from the wider society in areas of beliefs and values and primary group relations (work, social clubs, family, friends). Greater acculturation thus reflects greater adoption of mainstream beliefs and practices and entry into primary group relations.
    Review for Module 11 Quiz
    Licensed under Creative Commons 2012, Judy Baker
    You can take the Module 11 Quiz anytime between 8 am and 11 pm on Friday.
    You will have 15 minutes to complete the Quiz.
    You can use your readings and notes while you take the quiz but you cannot get help from anyone else.
    The Module 11 Quiz has 10 multiple-choice questions which are worth 3 points each.
    You can view your quiz score by clicking on the Gradebook on Monday.
    To prepare for this quiz, be familiar with the following:
    dimensions of personality
    obsessive-compulsive disorder
    warning signs of mental illness
    mental illness diagnosis
    causes of mental illness
    panic disorder
    borderline personality disorder
    social phobia
    panic disorder
    Anxiety Disorders
    Dedicated to Public Domain 2012, National Institutes of Mental Health

    Anxiety Disorders
    Source: Anxiety Disorders, National Institutes of Mental Health, (PDF version), citations.
    Other common rituals are a need to repeatedly check things, touch things (especially in a particular sequence), or count things. Some common obsessions include having frequent thoughts of violence and harming loved ones, persistently thinking about performing sexual acts the person dislikes, or having thoughts that are prohibited by religious beliefs. People with OCD may also be preoccupied with order and symmetry, have difficulty throwing things out (so they accumulate), or hoard unneeded items.
    Healthy people also have rituals, such as checking to see if the stove is off several times before leaving the house. The difference is that people with OCD perform their rituals even though doing so interferes with daily life and they find the repetition distressing. Although most adults with OCD recognize that what they are doing is senseless, some adults and most children may not realize that their behavior is out of the ordinary.
    run in families.3families.
    The course
    to calm themselves.4,5themselves.
    OCD usually responds well to treatment with certain medications and/or exposure-based psychotherapy, in which people face situations that cause fear or anxiety and become less sensitive (desensitized) to them. NIMH is supporting research into new treatment approaches for people whose OCD does not respond well to the usual therapies. These approaches include combination and augmentation (add-on) treatments, as well as modern techniques such as deep brain stimulation.
    Post-Traumatic Stress Disorder
    Most people with PTSD repeatedly relive the trauma in their thoughts during the day and in nightmares when they sleep. These are called flashbacks. Flashbacks may consist of images, sounds, smells, or feelings, and are often triggered by ordinary occurrences, such as a door slamming or a car backfiring on the street. A person having a flashback may lose touch with reality and believe that the traumatic incident is happening all over again.
    Not every traumatized person develops full-blown or even minor PTSD. Symptoms usually begin within 3 months of the incident but occasionally emerge years afterward. They must last more than a month to be considered PTSD. The course of the illness varies. Some people recover within 6 months, while others have symptoms that last much longer. In some people, the condition becomes chronic.
    age, including childhood.7childhood. Women are
    other anxiety disorders.4disorders.
    Certain kinds of medication and certain kinds of psychotherapy usually treat the symptoms of PTSD very effectively.
    Social Phobia (Social Anxiety Disorder)
    Social phobia can be limited to one situation (such as talking to people, eating or drinking, or writing on a blackboard in front of others) or may be so broad (such as in generalized social phobia) that the person experiences anxiety around almost anyone other than the family.
    Physical symptoms that often accompany social phobia include blushing, profuse sweating, trembling, nausea, and difficulty talking. When these symptoms occur, people with social phobia feel as though all eyes are focused on them.
    self-medicate their anxiety.4,5anxiety.
    Social phobia can be successfully treated with certain kinds of psychotherapy or medications.
    Specific Phobias
    “I’m scared to death of flying, and I never do it anymore. I used to start dreading a plane trip a month before I was due to leave. It was an awful feeling when that airplane door closed and I felt trapped. My heart would pound, and I would sweat bullets. When the airplane would start to ascend, it just reinforced the feeling that I couldn’t get out. When I think about flying, I picture myself losing control, freaking out, and climbing the walls, but of course I never did that. I’m not afraid of crashing or hitting turbulence. It’s just that feeling of being trapped. Whenever I’ve thought about changing jobs, I’ve had to think, ‘Would I be under pressure to fly?’ These days I only go places where I can drive or take a train. My friends always point out that I couldn’t get off a train traveling at high speeds either, so why don’t trains bother me? I just tell them it isn’t a rational fear.”
    A specific phobia is an intense, irrational fear of something that poses little or no actual danger. Some of the more common specific phobias are centered around closed-in places, heights, escalators, tunnels, highway driving, water, flying, dogs, and injuries involving blood. Such phobias aren’t just extreme fear; they are irrational fear of a particular thing. You may be able to ski the world’s tallest mountains with ease but be unable to go above the 5th floor of an office building. While adults with phobias realize that these fears are irrational, they often find that facing, or even thinking about facing, the feared object or situation brings on a panic attack or severe anxiety.
    run in families.11families.
    If the feared situation or feared object is easy to avoid, people with specific phobias may not seek help; but if avoidance interferes with their careers or their personal lives, it can become disabling and treatment is usually pursued.
    Specific phobias respond very well to carefully targeted psychotherapy.
    “I’d have terrible sleeping problems. There were times I’d wake up wired in the middle of the night. I had trouble concentrating, even reading the newspaper or a novel. Sometimes I’d feel a little lightheaded. My heart would race or pound. And that would make me worry more. I was always imagining things were worse than they really were. When I got a stomachache, I’d think it was an ulcer.”
    People with generalized anxiety disorder (GAD) go through the day filled with exaggerated worry and tension, even though there is little or nothing to provoke it. They anticipate disaster and are overly concerned about health issues, money, family problems, or difficulties at work. Sometimes just the thought of getting through the day produces anxiety.
    least 6 months.13months. People with
    When their anxiety level is mild, people with GAD can function socially and hold down a job. Although they don’t avoid certain situations as a result of their disorder, people with GAD can have difficulty carrying out the simplest daily activities if their anxiety is severe.
    women as men.2men. The disorder
    role in GAD.13GAD.
    Other anxiety
    or substance abuse2,4abuse often accompany
    Treatment of Anxiety Disorders
    psychotherapy, or both.14both. Treatment choices
    People with anxiety disorders who have already received treatment should tell their current doctor about that treatment in detail. If they received medication, they should tell their doctor what medication was used, what the dosage was at the beginning of treatment, whether the dosage was increased or decreased while they were under treatment, what side effects occurred, and whether the treatment helped them become less anxious. If they received psychotherapy, they should describe the type of therapy, how often they attended sessions, and whether the therapy was useful.
    Often people believe that they have “failed” at treatment or that the treatment didn’t work for them when, in fact, it was not given for an adequate length of time or was administered incorrectly. Sometimes people must try several different treatments or combinations of treatment before they find the one that works for them.
    Stress management techniques and meditation can help people with anxiety disorders calm themselves and may enhance the effects of therapy. There is preliminary evidence that aerobic exercise may have a calming effect. Since caffeine, certain illicit drugs, and even some over-the-counter cold medications can aggravate the symptoms of anxiety disorders, they should be avoided. Check with your physician or pharmacist before taking any additional medications.
    The family is very important in the recovery of a person with an anxiety disorder. Ideally, the family should be supportive but not help perpetuate their loved one’s symptoms. Family members should not trivialize the disorder or demand improvement without treatment. If your family is doing either of these things, you may want to show them this booklet so they can become educated allies and help you succeed in therapy.
    Dedicated to Public Domain 2012, National Institutes of Health

    Source: NIH,
    biological dysfunction.
    Depression, or depressive disorders, is a leading cause of disability in the United States as well as worldwide. It affects an estimated 9.5 percent of American adults in a given year. Nearly twice as many women as men have depression. Epidemiological studies have reported that up to 2.5 percent of children and 8.3 percent of adolescents in the United States suffer from depression.
    The symptoms of depression
    disorder (manic-depression).

    some of
    or suicide.
    When people have depression, their lives are affected severely: they have trouble performing at work or school, and they aren’t interested in normal family and social activities. In adults, an untreated major depressive episode lasts an average of nine months. At least half of the people who experience an episode of major depression will have another episode of depression at some point.
    Dysthymia is less severe than major depressive disorder, but it is more chronic. In dysthymia, a depressed mood along with at least two other symptoms of depression persist for at least two years in adults, or one year in children or adolescents. These symptoms may not be as disabling, but they do keep affected people from functioning well or feeling good. Dysthymia often begins in childhood, adolescence, or early adulthood. On average, untreated dysthymia lasts four years in children and adolescents.
    painful consequences.
    While in a manic phase, adolescents may engage in risky or reckless behaviors such as fast driving and unsafe sex. Bipolar disorder frequently begins during adolescence or young adulthood. Adults with bipolar disorder often have clearly defined episodes of mania and depression, with periods of mania every two to four years. Children and adolescents with bipolar disorder, however, may cycle rapidly between depression and mania many times within a day. Bipolar disorder in youths may be difficult to distinguish from other mental illnesses because the symptoms often overlap with those of other mental illnesses such as ADHD, conduct disorder, or oppositional defiant disorder.
    The causes of depression (depressive disorders)
    natural disaster.
    Treating depression
    A variety of antidepressant medications and psychotherapies are used to treat depression. The most effective treatment for most people is a combination of medication and psychotherapy. Many of us are aware that medications are available to treat depressive disorders—we see the ads on television and in magazines. Up to 70 percent of people with depression can be treated effectively with medication.
    A few years ago, the herbal supplement St. John’s wort received great attention in the media as an over-the-counter treatment for mild to moderate depression. However, many of the claims did not have good scientific evidence to back them up. The effectiveness and safety of St. John’s wort remain uncertain, and its use is generally not recommended.
    Coping with depression
    go away.

    strategies that
    friends help.

    Activity 2.1:
    Watch this video: Sherwin Nuland on electroshock therapy | Video on
    Surgeon and author Sherwin Nuland discusses the development of electroshock therapy as a cure for severe, life-threatening depression -- including his own.
    Dedicated to Public Domain 2012, National Institutes of Health

    Source: NIH,
    Treating schizophrenia
    There is no cure for schizophrenia; however, effective treatments that make the illness manageable for most affected people are available. The optimal treatment includes antipsychotic medication combined with a variety of psychotherapeutic interventions. Since the 1950s, doctors have used antipsychotic drugs, such as chlorpromazine and haloperidol, to relieve the hallucinations and delusions typical of schizophrenia. Recently, newer (also called atypical) antipsychotic drugs such as risperidone and clozapine have proven to be more effective. Early and sustained treatment that includes antipsychotic medication is important for long-term improvement of the course of the disease. Patients who discontinue medication are likely to experience a relapse of their illness. People who manage schizophrenia best combine medication with psychosocial rehabilitation (life-skills training). Therapies that combine family and community support, education, and behavioral and cognitive skills to address specific challenges help schizophrenic patients improve their functioning and the quality of their lives.
    Dedicated to Public Domain 2012, National Institutes of Health
    Ask your doctor when and how the medication should be stopped.
    Some drugs can't be stopped abruptly but must be tapered off slowly under a doctor's supervision. Work with your doctor to determine which medication is right for you and what dosage is best. Be aware that some medications are effective only if they are taken regularly and that symptoms may come back if the medication is stopped.
    Personality Disorders
    Dedicated to Public Domain 2012, National Institutes of Health

    Personality Disorders
    Source: Medline Plus
    Having stress-related paranoid thoughts or severe dissociative symptoms, such as feeling cut off from oneself, observing oneself from outside the body, or losing touch with reality.
    Seemingly mundane events may trigger symptoms. For example, people with borderline personality disorder may feel angry and distressed over minor separations — such as vacations, business trips, or sudden changes of plans —from people to whom they feel close. Studies show that people with this disorder may see anger in an emotionally neutral face and have a stronger reaction to words with negative meanings than people who do not have the disorder.
    Contemporary Health Issues
    Open Courseware
    This compilation is openly licensed under Creative Commons Attribution-ShareAlike by Judy Baker, September 2012.
    Feel free to use, reuse, customize, or share in accordance with the open license conditions of each source.
    If you believe that any of these materials infringe your copyright, please send me a notice requesting that the material be removed.
    Send notices with respect to this site to bakerjudy <at>
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  3. page Module 10 edited ... Support systems are important. to relieve stress. Meditation and Health ... Prevention, ht…
    Support systems are important. to relieve stress.
    Meditation and Health
    Many people practice meditation for a number of health-related purposes. A 2007 national government survey found that 9.4% of respondents had used meditation in the past 12 months.
    What is meditation?
    A focus of attention. Focusing one's attention is usually a part of meditation. For example, the meditator may focus on a mantra (a specially chosen word or set of words), an object, or the sensations of the breath.
    Having an open attitude during meditation means letting distractions come and go naturally without judging them.
    my health?
    It is not fully known what changes occur in the body during meditation; whether they influence health; and, if so, how. Research is under way to find out more about meditation's effects, how it works, and diseases and conditions for which it may be most helpful.
    The National Center for Complementary and Alternative Medicine (NCCAM) is the federal government's lead agency for scientific research on complementary and alternative medicine (CAM). Some recent NCCAM-supported studies have been investigating meditation for relieving stress in caregivers for elderly patients with dementia and for relieving asthma symptoms.
    Learning Activity 5.2: Watch this short video about Meditation.
    Relaxation Techniques
    Relaxation techniques include a number of practices such as progressive relaxation, guided imagery, biofeedback, self-hypnosis, and deep breathing exercises. The goal is similar in all: to consciously produce the body’s natural relaxation response, characterized by slower breathing, lower blood pressure, and a feeling of calm and well-being.
    Relaxation techniques (also called relaxation response techniques) may be used by some to release tension and to counteract the ill effects of stress. Relaxation techniques are also used to induce sleep, reduce pain, and calm emotions. This fact sheet provides a general overview of relaxation techniques and suggests sources for additional information.
    Optional: What Is Resilience?
    Resilience is the ability to:
    Bounce back
    If you or someone you know experiences any of these feelings after a traumatic event, get support from your family, friends co-workers, and others who offer support. Talk with others about your feelings and take care of yourself by sticking to your normal routine. Avoid using alcohol and drugs. Staying active, helping other people, or volunteering in your community can also help you feel better.
    Keep in mind that returning to the way you felt before the event may take some time. Helping and healing can begin at the time of the event but may need to continue over a period of time. If problems continue or you have trouble managing your feelings, talk to a psychologist, social worker, or professional counselor.
    Contemporary Health Issues
    Open Courseware
    This compilation is openly licensed under Creative Commons Attribution-ShareAlike by Judy Baker, September 2012.
    Feel free to use, reuse, customize, or share in accordance with the open license conditions of each source.
    If you believe that any of these materials infringe your copyright, please send me a notice requesting that the material be removed.
    Send notices with respect to this site to bakerjudy <at>
    {} CC BY SA

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  5. page Module 09 edited ... and Death - Week 9 Content: This Module contains 7 Lessons: ... Source: http://health…

    and Death - Week 9
    This Module contains 7 Lessons:
    Arthritis, osteoporosis, and chronic back conditions all have major effects on quality of life, the ability to work, and basic activities of daily living.
    physically active.
    Osteoporosis is a disease marked by reduced bone strength leading to an increased risk of fractures (broken bones). Chronic back pain (CBP) is common, costly, and potentially disabling.
    Why Are Arthritis, Osteoporosis, and Chronic Back Conditions Important?
    Finding better ways to manage dementia when other chronic conditions are present.
    Understanding the influence of lifestyle factors on a person’s risk of cognitive decline and dementia.
    it? Why?
    Spend it all on a specific condition?
    Which condition?
    Source:Advance Directives Might Curb Cost of End-of-Life Care by Serena Gordon, Health News,//
    End-of-life care is often a controversial subject, and when policymakers are looking for ways to control Medicare costs, such care typically comes up in the discussion. That's not surprising, because end-of-life care accounted for more than one-quarter of Medicare spending last year, according to background information in the study. One concern is that this spending may be largely earmarked for aggressive care that's not necessarily what the patient might have wanted.
    such procedures.
    Advance Directives
    Source: NIH, Medline, //
    later on.

    living will
    address, including
    The use of dialysis and breathing machines
    If you want to be resuscitated if breathing or heartbeat stops
    Tube feeding
    Organ or tissue donation
    do so.
    Optional Learning Activity: Watch this vieo about advance care planning (3:38 minutes).
    Have YOU made your health care wishes known to someone?
    Optional: Advance Care Planning for Health Professionals
    Advance Care Planning for Health Professionals
    Contemporary Health Issues
    Open Courseware
    This compilation is openly licensed under Creative Commons Attribution-ShareAlike by Judy Baker, September 2012.
    Feel free to use, reuse, customize, or share in accordance with the open license conditions of each source.
    If you believe that any of these materials infringe your copyright, please send me a notice requesting that the material be removed.
    Send notices with respect to this site to bakerjudy <at>
    {} CC BY SA

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