Unit 5

Mental and Physical Health: the one-page sheet

5.1 Introduction to Health Psychology

Health psychology studies how stress and behavior affect physical health. Stress depends on how we appraise stressors: eustress motivates, distress harms. Daily hassles and adverse childhood experiences are linked to poorer health. Under threat, the sympathetic nervous system drives fight-flight-freeze, and people may also tend and befriend. With a long stressor, the general adaptation syndrome moves from alarm to resistance to exhaustion, when illness becomes more likely. Problem-focused coping changes the stressor; emotion-focused coping manages the feelings.

Health psychology studies how psychological and social factors affect physical health. Stress is how we appraise and respond to stressors; eustress feels like a challenge, distress like harm.
Stressors include catastrophes, major life changes, daily hassles and adverse childhood experiences, which are linked to poorer later health (a correlation).
The general adaptation syndrome: alarm, resistance, exhaustion. Fast responses: fight-flight-freeze (sympathetic) and tend-and-befriend (protect and seek support).
Problem-focused coping changes the stressor; emotion-focused coping manages feelings. Match the strategy to how controllable the stressor is.

the sympathetic nervous system triggers fight-flight-freeze, or people tend and befriend the body moves from alarm to resistance, keeping arousal and stress hormones high reserves run down (exhaustion) and the person becomes more vulnerable to illness the stress response is smaller and shorter

health psychology: The field that studies how psychological, behavioral and social factors, such as stress, habits and support from others, affect physical health and illness.
stress: The process by which we appraise and respond to events (stressors) that we see as threatening or challenging. Our response depends partly on how we interpret the event and our ability to handle it.
stressor: An event or condition that triggers stress, from catastrophes and major life changes to daily hassles.
eustress: Positive stress, felt as a motivating challenge, such as the excitement of starting a new job.
distress (stress): Distress: negative stress that feels overwhelming or harmful; when intense or long-lasting it is linked to poorer health.
daily hassles: Small, everyday stressors, such as traffic, lost keys or a noisy roommate, that can add up and affect health.
general adaptation syndrome: The general adaptation syndrome, described by Hans Selye: the body's response to a continuing stressor in three stages. Alarm (shock, then sympathetic arousal), resistance (the body copes with arousal kept high) and exhaustion (reserves run down and vulnerability to illness rises).
fight-flight-freeze response: The fight-flight-freeze response: the fast, automatic reaction to a threat, driven by the sympathetic nervous system, that prepares the body to fight, run or go still.
tend-and-befriend response: The tend-and-befriend response: under stress, protecting and caring for others (tend) and seeking social support (befriend). First described in women by Shelley Taylor and linked to oxytocin.
coping: Efforts to manage stress, either by changing the stressor or by managing the reaction to it.
problem-focused coping: Problem-focused coping: dealing with stress by acting directly on the stressor, such as making a study plan for a hard test. Works best when the stressor can be changed.
emotion-focused coping: Emotion-focused coping: dealing with stress by managing the emotional reaction, such as talking with friends or exercising. Fits best when the stressor cannot be changed.

5.2 Positive Psychology

Positive psychology scientifically studies what helps people thrive. Subjective well-being is a person's own judgment of life satisfaction and feelings. Resilience, bouncing back after adversity, is common; posttraumatic growth is positive change after a struggle with trauma. Gratitude practices and using signature strengths show small benefits. Character strengths are grouped into six virtues: wisdom, courage, humanity, justice, temperance and transcendence.

Positive psychology is the scientific study of well-being and of the strengths and conditions that help people and communities thrive.
Subjective well-being is a person's own rating of life satisfaction plus the balance of pleasant and unpleasant feelings.
Resilience is bouncing back after adversity, and it is common. Posttraumatic growth is positive change after a struggle with trauma; it can occur alongside distress.
Gratitude and signature strengths are studied practices and traits. Strengths fall into six virtue categories: wisdom, courage, humanity, justice, temperance, transcendence.

they report somewhat higher subjective well-being, though effects are small most show resilience, adapting and returning to their earlier functioning they report posttraumatic growth: new priorities, closer relationships or a sense of strength

positive psychology: The scientific study of human flourishing: well-being, positive emotions, character strengths and the conditions that help people and communities thrive. Martin Seligman helped found it.
subjective well-being: A person's own judgment of their happiness: how satisfied they are with life, plus the balance of pleasant over unpleasant feelings. Measured by self-report.
resilience: The ability to adapt well and bounce back after adversity, trauma or stress, returning to one's earlier level of functioning. Research finds it is common.
gratitude: Noticing and appreciating the good things in life and the people responsible for them. Gratitude exercises, such as writing down good things, show small gains in well-being.
signature strengths: The few character strengths a person shows most often and that feel most central to who they are, such as curiosity or kindness.
character virtues: Six broad categories of character strengths found across many cultures and traditions: wisdom, courage, humanity, justice, temperance and transcendence.
posttraumatic growth: Posttraumatic growth: positive psychological change, such as new priorities, closer relationships or a sense of personal strength, after struggling with a highly challenging event. It can occur alongside distress.

5.3 Explaining and Classifying Psychological Disorders

A psychological disorder is a pattern of thinking, feeling or behaving that is unusual for its cultural setting and causes distress or dysfunction. Clinicians classify disorders with the DSM-5-TR or the ICD. Each psychological perspective explains disorders in its own way, and the biopsychosocial and diathesis-stress models combine causes: a vulnerability plus enough stress.

A psychological disorder involves deviation (unusual for the person's culture), plus distress (suffering) or dysfunction (it gets in the way of life). Unusual alone is not a disorder.
The DSM-5-TR (American Psychiatric Association) and the ICD (World Health Organization) classify disorders by their symptoms and how long they last.
Each perspective offers an explanation: biological, behavioral, cognitive, psychodynamic, humanistic, evolutionary and sociocultural. Match the explanation to the perspective.
The biopsychosocial model combines body, mind and social world; the diathesis-stress model says vulnerability plus stress; the eclectic approach draws on several perspectives.

deviation is present, but that alone is not a disorder distress or dysfunction is present, and a clinician considers a diagnosis the pattern is classified as a specific disorder, or not the disorder appears, as the diathesis-stress model predicts

psychological disorder: A pattern of thoughts, feelings or behaviors that is unusual for the person's culture (deviation) and causes significant suffering (distress) or gets in the way of daily life (dysfunction).
Diagnostic and Statistical Manual of Mental Disorders: The Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association. The current edition, the DSM-5-TR (2022), lists each disorder with its symptoms and how long they must last.
International Classification of Diseases: The International Classification of Diseases, published by the World Health Organization. It codes all health conditions, physical and psychological, and is used around the world.
eclectic approach: Using ideas and methods from several psychological perspectives, chosen to fit the person, instead of relying on one perspective.
biopsychosocial model: A model that explains a disorder as the product of biological factors (genes, brain chemistry), psychological factors (thoughts, learning, emotions) and social factors (relationships, culture, conditions) acting together.
diathesis-stress model: A model in which a disorder appears when a vulnerability (the diathesis, such as genes or early experiences) meets enough stress. Neither alone is usually enough.

5.4 Selection of Categories of Psychological Disorders

The DSM-5-TR groups disorders by their core features. Depressive and bipolar disorders differ by whether mania or hypomania occurs. Schizophrenia involves positive and negative symptoms and is not dissociative identity disorder. Anxiety disorders center on fear and worry; OCD, PTSD, the dissociative disorders, the eating disorders and the three clusters of personality disorders each have their own categories. Learn the core feature and the time rule for each.

Mood: major depressive disorder (two weeks or more), persistent depressive disorder (two years or more); bipolar I needs a manic episode, bipolar II hypomania plus major depression.
Schizophrenia is a break from reality: positive symptoms add (hallucinations, delusions); negative symptoms take away (emotion, speech, motivation). It is not a "split personality."
Anxiety disorders (phobia, agoraphobia, panic, social anxiety, generalized anxiety) are separate from OCD and hoarding, from PTSD, and from the dissociative disorders, including DID.
Personality disorders are lasting, rigid patterns in three clusters: A odd, B dramatic, C anxious. Eating disorders: anorexia (low weight), bulimia (binge and compensate).

they compare it with the DSM-5-TR criteria: which symptoms, how many and for how long the pattern points to a depressive or a bipolar disorder it points to an anxiety, obsessive-compulsive or trauma-related disorder it points to schizophrenia spectrum or to a dissociative disorder, two very different things

neurodevelopmental disorders: Disorders that begin in early development and affect how the brain grows and functions, such as ADHD and autism spectrum disorder.
attention-deficit/hyperactivity disorder: A neurodevelopmental disorder: a lasting pattern of inattention and/or hyperactivity and impulsivity that begins in childhood and appears in two or more settings, such as home and school.
autism spectrum disorder: A neurodevelopmental disorder with differences in social communication and interaction plus restricted, repetitive behaviors or interests, present from early childhood; "spectrum" means support needs vary widely.
schizophrenia: A disorder in the schizophrenia spectrum marked by a break from reality: two or more of delusions, hallucinations, disorganized speech, disorganized behavior and negative symptoms (at least one of them delusions, hallucinations or disorganized speech) for much of a month, with signs lasting at least six months.
delusion: A firmly held false belief that does not change in the face of clear evidence, such as believing one is being watched or controlled.
hallucination: A false perception, such as hearing a voice that no one else hears, without an outside stimulus.
positive symptoms: Symptoms of schizophrenia that add experiences or behaviors: hallucinations, delusions and disorganized speech or behavior.
negative symptoms: Symptoms of schizophrenia that reduce or remove normal functions: flat emotional expression, little speech, low motivation and social withdrawal.
dopamine hypothesis: The idea that too much dopamine activity in some brain pathways contributes to the positive symptoms of schizophrenia. It explains part of the disorder, not all of it.
major depressive disorder: A depressive disorder: one or more major depressive episodes, each with at least five symptoms (including low mood or loss of interest) on most days for at least two weeks.
persistent depressive disorder: A depressive disorder: a depressed mood on most days for at least two years in adults (one year in children and teens), often milder than a major depressive episode.
bipolar disorder: Disorders with periods of abnormally high mood and energy. Bipolar I requires at least one manic episode (a week or more of severe high mood); bipolar II requires a hypomanic episode (milder, four days or more) and a major depressive episode.
anxiety disorder: Disorders marked by excessive fear or worry and avoidance that cause distress or get in the way of life, such as specific phobia, panic disorder and generalized anxiety disorder.
specific phobia: Intense, lasting fear of a particular object or situation, such as heights or spiders, out of proportion to the real danger, usually with avoidance.
agoraphobia: Fear and avoidance of situations where escape might be hard or help unavailable, such as crowds, public transportation or lines.
panic disorder: Repeated, unexpected panic attacks (sudden surges of intense fear with symptoms such as a pounding heart) followed by ongoing worry about more attacks.
social anxiety disorder: Intense fear of social situations in which one might be watched or judged, with fear of embarrassment and avoidance.
generalized anxiety disorder: Excessive, hard-to-control worry about many things on most days for at least six months, with symptoms such as tension, fatigue and poor sleep.
culture-bound syndrome: A pattern of distress shaped by a particular culture (the DSM-5-TR calls them cultural concepts of distress), such as ataque de nervios in Latin American cultures and taijin kyofusho in Japan.
obsessive-compulsive disorder: Obsessive-compulsive disorder: unwanted, intrusive thoughts or urges (obsessions) and repeated behaviors or mental acts done to reduce the anxiety they cause (compulsions), taking up much time or causing distress.
hoarding disorder: Persistent difficulty discarding possessions, whatever their value, because of a felt need to save them, leading to clutter that blocks living spaces.
dissociative disorders: Disorders involving a disruption of memory, identity or awareness, such as dissociative amnesia (memory loss for personal, often stressful, information), sometimes with fugue (travel or wandering).
dissociative identity disorder: Dissociative identity disorder: two or more distinct identity states with recurrent gaps in memory. It is not schizophrenia; researchers still debate the roles of trauma and social influence in its causes.
posttraumatic stress disorder: Posttraumatic stress disorder: after a traumatic event, more than a month of intrusive memories, avoidance, negative changes in thoughts and mood, and heightened arousal.
anorexia nervosa: An eating disorder: restricting food so that body weight becomes significantly low, with an intense fear of gaining weight and a distorted view of one's body.
bulimia nervosa: An eating disorder: repeated episodes of binge eating followed by behaviors to make up for them, such as vomiting or fasting, often at an average body weight.
personality disorders: A lasting, inflexible pattern of thinking, feeling and relating to others that differs from cultural expectations, begins by adolescence or early adulthood, and causes distress or dysfunction.
Cluster A personality disorders: Odd or eccentric personality disorders: paranoid (distrust), schizoid (detachment from relationships) and schizotypal (odd beliefs and discomfort in close relationships).
Cluster B personality disorders: Dramatic, emotional or erratic personality disorders: antisocial (disregard for others' rights), histrionic (attention seeking), narcissistic (grandiosity) and borderline (unstable emotions and relationships).
Cluster C personality disorders: Anxious or fearful personality disorders: avoidant (fear of rejection), dependent (need to be cared for) and obsessive-compulsive personality disorder (perfectionism and control).

5.5 Treatment of Psychological Disorders

Each approach to therapy targets a different cause: psychodynamic therapy seeks insight into unconscious conflicts, humanistic therapy offers acceptance, behavioral therapy changes learned responses, cognitive therapy changes thoughts, and CBT combines the two. Biomedical treatments change brain chemistry or activity. Good care is evidence-based, built on a strong therapeutic alliance and cultural humility, and guided by ethics such as informed consent and confidentiality.

Match technique to approach: free association and dream interpretation (psychodynamic); active listening with unconditional positive regard (humanistic); cognitive restructuring, REBT (cognitive); CBT, DBT (cognitive-behavioral).
Behavioral: exposure and systematic desensitization reduce fear, aversion therapy pairs a habit with discomfort, token economies reward behavior, biofeedback trains body control.
Medications: antidepressants (often SSRIs), anti-anxiety drugs (GABA, risk of dependence), lithium (bipolar), antipsychotics (block dopamine; risk of tardive dyskinesia). Also ECT, TMS, rare psychosurgery.
Judge treatments by evidence. Hypnosis helps pain and anxiety but does not recover memories; the lobotomy is history, not treatment.

its therapy targets that cause: conflicts, thoughts, learning, growth or brain chemistry the treatment earns a place in evidence-based practice, or not the client gets a treatment matched to them clients can trust the process, which strengthens the alliance

evidence-based practice: Choosing treatment by combining the best available research (often meta-analyses of many studies) with clinical expertise and the client's characteristics, culture and preferences.
therapeutic alliance: The bond of trust between a therapist and a client, with agreement on goals and on how to work toward them; a strong alliance predicts better outcomes across many therapies.
cultural humility: An ongoing attitude of learning from each client about their culture and recognizing the limits of one's own perspective.
deinstitutionalization: The shift, starting in the 1950s, from long stays in large psychiatric hospitals to care in the community; underfunded community services left many people without enough care.
free association: A psychodynamic technique in which the client says whatever comes to mind, so that patterns pointing to unconscious conflicts can emerge.
dream interpretation: A psychodynamic technique in which the therapist and client look for hidden meaning in the client's dreams.
cognitive therapy: Therapy that helps people notice, test and change distorted or unhelpful thoughts (cognitive restructuring), on the idea that thoughts shape feelings and behavior.
cognitive triad: Negative thinking about oneself, the world and the future, a pattern that cognitive therapy targets in depression.
cognitive-behavioral therapy: Cognitive-behavioral therapy: changing unhelpful thoughts and behaviors together, with practice between sessions. It has strong research support for depression and anxiety.
dialectical behavior therapy: Dialectical behavior therapy: a form of CBT that balances acceptance with change and teaches mindfulness, distress tolerance, emotion regulation and relationship skills, often for people with intense emotions and self-harm.
rational emotive behavior therapy: Rational emotive behavior therapy: a cognitive therapy that directly disputes irrational beliefs, such as "I must succeed at everything," and replaces them with realistic ones.
behavior therapy: Therapy that applies classical and operant conditioning to change problem behaviors directly; applied behavior analysis is one form.
systematic desensitization: A behavioral technique that pairs relaxation with a step-by-step list of feared situations, from least to most frightening, to countercondition the fear.
exposure therapy: A behavioral treatment in which a person faces a feared object or situation, in real life or in imagination, until the fear fades because the feared harm does not happen.
aversion therapy: A behavioral technique that pairs an unwanted behavior, such as drinking alcohol, with an unpleasant stimulus so that the behavior comes to trigger discomfort.
token economy: An operant technique in which people earn tokens (secondary reinforcers) for target behaviors and trade them for rewards.
biofeedback: A technique that shows a person live information about a body process, such as muscle tension or heart rate, so they can learn to control it.
person-centered therapy: A humanistic therapy in which the therapist offers genuineness, empathy and unconditional positive regard, and the client leads the sessions.
active listening: Listening with full attention, then restating and clarifying what the client said and felt, a key skill in person-centered therapy.
group therapy: Therapy with several clients, or a whole family, together; people learn they are not alone, practice new ways of relating, and in family therapy change patterns in the family system.
hypnosis: A social interaction in which one person suggests changes in perceptions, feelings or behavior to another. It can help with pain and anxiety, but it does not recover accurate memories.
antidepressant: Medication for depression and several anxiety disorders; the most common kind, SSRIs, are selective serotonin reuptake inhibitors. Effects usually build over several weeks.
anti-anxiety medication: Medication that reduces anxiety, such as drugs that increase the calming effect of GABA; they act quickly but can lead to tolerance and dependence.
lithium: A mood stabilizer used for bipolar disorder that makes manic and depressive episodes less likely; it needs blood tests because its safe dose range is narrow.
antipsychotic: Medication for schizophrenia and other psychotic symptoms that blocks dopamine receptors (a dopamine antagonist), reducing positive symptoms such as hallucinations.
tardive dyskinesia: Involuntary, repeated movements of the face, lips and tongue that can develop after long-term use of antipsychotic medication, especially older ones.
psychosurgery: Surgery that removes or destroys brain tissue to change behavior or relieve symptoms; today it is very rare and used only when other treatments fail.
lobotomy: A former psychosurgery, used mainly in the 1940s and 1950s, that cut connections to the prefrontal cortex; it often left people withdrawn and impaired and is no longer performed.
transcranial magnetic stimulation: Transcranial magnetic stimulation: magnetic pulses from a coil on the scalp stimulate targeted brain areas, used mainly for depression that has not responded to medication.
electroconvulsive therapy: Electroconvulsive therapy: a brief electric current causes a short seizure under anesthesia, used mainly for severe depression that has not responded to other treatments; short-term memory loss is a common side effect.