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An Invitation to Health (Brief Edition) 10e Dianne Hales (Instructor Manual (Lecture Notes Only) All Chapters, 100% Original Verified, A+ Grade)

1 The Power of Now Learning Objectives After studying this chapter in the text, the student should be able to: 1.1

Define health and wellness.

1.2

Outline the dimensions of health.

1.3

Assess the current health status of Americans.

1.4

Discuss health disparities based on gender and race.

1.5

Evaluate the health behaviors of undergraduates.

1.6

Describe the impact of habits formed in college on future health.

1.7

Explain the influences on behavior that support or impede healthy change.

1.8

Identify the stages of change.

Chapter Summary This chapter shows you how to make healthy choices and thus how to live more fully, more happily, and more healthfully. This is an offer that you literally cannot afford to refuse. Your life may depend on it, starting now.

Lecture Outline I.

Health and Wellness A. What It Means 1. Health means being sound in body, mind, and spirit. 2. The World Health Organization defines health as “not merely the absence of disease or infirmity,” but “a state of complete physical, mental, and social well-being.” 3. Health has many dimensions: physical, psychological, spiritual, social, intellectual, and environmental.

© 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use.

4. Wellness can be defined as purposeful, enjoyable living or, more specifically, a deliberate lifestyle choice characterized by personal responsibility and optimal enhancement of physical, mental, and spiritual health. B. The Dimensions of Health 1. Physical Health a. According to a contemporary medical dictionary, health is “an optimal state of physical, mental, and social well-being, not merely the absence of disease or infirmity.” b. Health is not a static state, but a process that depends on the decisions we make and the behaviors we practice every day. c. We must feed our bodies nutritiously, exercise them regularly, avoid harmful behaviors and substances, watch out for early signs of sickness, and protect ourselves from accidents. 2. Psychological Health a. Psychological health refers to both our emotional and mental states. b. It involves awareness and acceptance of a wide range of feelings in oneself and others, as well as the ability to express emotions, to function independently, and to cope with the challenges of daily stressors. 3. Spiritual Health a. Spiritually healthy individuals identify their own basic purpose in life; learn how to experience love, joy, peace, and fulfillment; and help themselves and others achieve their full potential. 4. Social Health a. Social health refers to the ability to interact effectively with other people and the social environment, to develop satisfying interpersonal relationships, and to fulfill social roles. b. Health educators are placing greater emphasis on social health in its broadest sense as they expand the traditional individualistic concept of health to include the complex interrelationships between one person’s health and the health of the community and environment. c. This change in perspective has given rise to a new emphasis on health promotion, which educators define as “any planned combination of educational, political, regulatory, and organizational supports for actions and conditions of living conducive to the health of individuals, groups, or communities.”

5. Intellectual Health a. Intellectual health refers to your ability to think and learn from life experience, your openness to new ideas, and your capacity to question and evaluate information. 6. Occupational and Financial Health a. College provides the opportunity for you to choose and prepare for a career that is consistent with your personal values and beliefs and to learn how to manage your money and safeguard your financial wellbeing. b. Health educators have expanded the traditional individualistic concept of health to include the complex interrelationships between one person’s health and the health of the community and environment. i. This change in perspective has given rise to a new emphasis on health promotion, which educators define as “any planned combination of educational, political, regulatory, and organizational supports for actions and conditions of living conducive to the health of individuals, groups, or communities.” II.

Health in America A. Overview 1. According to a recent national survey of more than 4,700 people, 97.3 percent get a failing grade in healthy lifestyle habits. 2. For the minority who do adapt these health guidelines, the payoff includes a lower risk of many health problems, including type 2 diabetes, heart disease, and cancer. B. Healthy People 2020 1. Eliminate preventable disease, disability, injury, and premature death. 2. Achieve health equity, eliminate disparities, and improve the health of all groups. 3. Create social and physical environments that promote good health for all. 4. Promote healthy development and healthy behaviors across every stage of life. C. Health Disparities 1. Despite great improvements in the overall health of the nation, Americans who are members of racial and ethnic groups are more likely than whites to suffer poor health and die prematurely. a. Genetic variations, environmental influences, and specific health behaviors contribute to health disparities, but poverty may be a more significant factor.

2. Why Race Matters i. Black Americans lose substantially more years of potential life to homicide and diabetes ii. About one in three Hispanics has prediabetes iii. Caucasians are prone to osteoporosis (progressive weakening of bone tissue); cystic fibrosis; skin cancer; and phenylketonuria (PKU), a metabolic disorder that can lead to cognitive impairment iv. Native Americans, including those indigenous to Alaska, are more likely to die young than the population as a whole, primarily as a result of accidental injuries, cirrhosis of the liver, homicide, pneumonia, and complications of diabetes. v. The suicide rate among American Indians and Alaska Natives is 50 percent higher than the national rate. The rates of co-occurring mental illness and substance abuse (especially alcohol abuse) are also higher among Native American youth and adults. b. Cancer i. Overall, black Americans are more likely to develop cancer than persons of other racial or ethnic groups. ii. Although blacks continue to have higher cancer death rates than whites, the disparity has narrowed for all cancers combined in men and women and for lung and prostate cancers in men. iii. However, the racial gap in death rates has widened for breast cancer in women and remained level for colorectal cancer in men. c. Cardiovascular Disease i. Heart disease and stroke are the leading causes of death for all racial and ethnic groups in the United States, but rates of death from these diseases are higher among African American adults than among white adults. ii. African Americans also have higher rates of high blood pressure (hypertension), develop this problem earlier in life, suffer more severe hypertension, and have higher rates of stroke. d. Diabetes i. American Indians and Alaska Natives, African Americans, and Hispanics are twice as likely to be diagnosed with diabetes compared with non-Hispanic whites. e. Infant Mortality i. African American, American Indian, and Puerto Rican infants have higher death rates than white infants.

f. Mental Health i. American Indians and Alaska Natives suffer disproportionately from depression and substance abuse. ii. The prevalence of dementia varies significantly among Americans of different racial and ethnic groups, with the highest rates among blacks and American Indians/Alaskan Natives. g. Infectious Disease i. Asian Americans and Pacific Islanders have much higher rates of hepatitis B. ii. Black teenagers and young adults become infected with hepatitis B three to four times more often than those who are white. h. HIV and Sexually Transmitted Infections i. African Americans and Hispanics account for about two-thirds of adult AIDS cases and more than 80 percent of pediatric AIDS cases. 3. Sex, Gender, and Health a. Medical scientists define sex as a classification, generally as male or female, according to the reproductive organs and functions that derive from the chromosomal complement. b. Gender refers to a person’s self-representation as a male or female or how that person is responded to by social institutions on the basis of the individual’s gender presentation. c. Sex and gender may have a greater impact than any other variable on how our bodies function, on how long we live, and the symptoms, course, and treatment of the diseases that strike us. d. Among the reasons that may contribute to the health and longevity gap between the sexes are: i. Biological factors ii. Social factors iii. Behavioral factors iv. Health habits e. Sexual orientation can also affect health. III. Health on Campus A. Overview 1. As one of an estimated 21 million college students in the United States, you are part of a remarkably diverse group. 2. Although most undergraduates are “traditional” age (between 18 and 24 years old), more than ever before are over the age of 25. © 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use.

3. Today’s college students are both similar to and different from previous generations in many ways. B. College and Health 1. Although the words “college health” often appear together, they are, in fact, two different things that profoundly influence each other. Healthier students get better grades and are more likely to graduate. a. A college education boosts health status, income, and community engagement later in life. b. Yet the transition from high school to college is considered an at-risk period for health and healthy behaviors. 2. Although healthier than their peers who are not attending college, undergraduates have significant health issues that can affect their overall well-being and ability to perform well in an academic environment. C. How Healthy Are Today’s Students? 1. In the American College Health Association’s National College Health Assessment (ACHA-NCHA) survey, more than 8 in 10 undergraduates (fewer than in previous years) rated their health as good, very good, or excellent. 2. Yet the habits of young Americans often aren’t healthy. 3. Colleges and universities have tried various interventions to improve students’ health choices and habits. a. In a meta-analysis of 41 studies, most conducted in the United States, 34 yielded significant improvements in one of several key outcomes. D. Why “Now” Matters 1. The choices you make today have an immediate impact on how you feel as well as long-term consequences. E. Student Health Norms 1. Psychologists use the term norm, or social norm, to refer to a behavior or an attitude that a particular group expects, values, and enforces. a. Norms influence a wide variety of human activities, including health habits. b. However, perceptions of social norms are often inaccurate. c. Undergraduates are particularly likely to misjudge what their peers are and aren’t doing, especially regarding smoking, drinking, and other drug use. F. The Promise of Prevention 1. Many chronic problems begin early in life. 2. Two out of every three deaths and one in three hospitalizations in the United States could be prevented by changes in six main risk factors: © 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use.

tobacco use, alcohol abuse, accidents, high blood pressure, obesity, and gaps in screening and primary health care. G. Protecting Yourself 1. Immunizations 2. Prevent STIs and unwanted pregnancies H. Understanding Risky Behavior 1. Today’s students face different and potentially deadlier risks than undergraduates did a generation or two ago. 2. The problem is not that students who engage in risky behavior feel invulnerable or do not know the danger. a. Young people, according to recent research, actually overestimate the risk of some outcomes. b. However, they also overestimate the benefit of immediate pleasure when, for instance, engaging in unsafe sex, and they underestimate the negative consequences, such as an STI. IV. Making Healthy Changes A. Understanding Health Behavior 1. Predisposing Factors a. Predisposing factors include knowledge, attitudes, beliefs, values, and perceptions. b. Researchers report that people are most likely to change health behavior if they hold three beliefs: i. Susceptibility ii. Severity iii. Benefits 2. Enabling Factors a. Enabling factors include skills, resources, accessible facilities, and physical and mental capacities. 3. Reinforcing Factors a. Reinforcing factors may be praise from family and friends, rewards from teachers and parents, or encouragement and recognition for meeting a goal. V. How and Why People Change A. Overview 1. Change can simply happen, but can also be intentional. a. In intentional change, a person consciously, deliberately sets out either to change a negative behavior, such as chronic procrastination, or to initiate a healthy behavior, such as daily exercise. © 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use.

2. For decades psychologists have studied how people intentionally change and have developed various models that reveal the anatomy of change. a. In the moral model, you take responsibility for a problem (such as smoking) and its solution; success depends on adequate motivation. b. In the enlightenment model, you submit to strict discipline to correct a problem; this is the approach used in Alcoholics Anonymous. c. The behavioral model involves rewarding yourself when you make positive changes. d. The medical model sees the behavior as caused by forces beyond your control (a genetic predisposition to being overweight, for example) and employs an expert to provide advice or treatment. B. The Health Belief Model 1. According to this model, people will take a health-related action if they: a. Feel susceptible to a possible negative consequence b. Perceive the consequence as serious or dangerous c. Think that a particular action will reduce or eliminate the threat d. Feel that they can take the necessary action without difficulty or negative consequences e. Believe that they can successfully do what’s necessary C. Self-Determination Theory 1. This approach focuses on whether an individual lacks motivation, is externally motivated, or is intrinsically motivated. D. Motivational Interviewing 1. Health professionals, counselors, and coaches use motivational interviewing to inspire individuals, regardless of their enthusiasm for change, to move toward improvements that could make their lives better. E. Self-Affirmation Theory 1. According to self-affirmation theory, thinking about core personal values, important personal strengths, or valued relationships can provide reassurance and reinforce self-worth. a. Repeating an affirmation is one of the fastest ways to restructure thought patterns, develop new pathways in the brain, and make individuals less defensive about changing health behaviors. F. Transtheoretical Model 1. Their transtheoretical model focuses on universal aspects of an individual’s decision-making process rather than on social or biological influences on behavior. 2. The key components of the transtheoretical model of change include stages of change, processes of change, and self-efficacy. © 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use.

a. Stages of Change i. Precontemplation ii. Contemplation iii. Preparation iv. Action v. Maintenance vi. Termination b. Processes of Change i. Consciousness-Raising ii. Social Liberation iii. Emotional Arousal iv. Self-Reevaluation v. Commitment vi. Rewards vii. Countering viii. Environmental Control ix. Helping Relationships 3. Self-Efficacy and Locus of Control a. Self-efficacy is the belief in your ability to change and to reach a goal. b. Locus of control is the sense of being in control of your life.

Discussion Questions •

Discuss with students which dimension of health is most prominent in their lives. Why? Which are they least concerned with? Ask students what they could do in order to incorporate all components into their lives? What are some of the obvious differences between those who do incorporate all of these aspects into their lives and those who only concentrate on one or two components?

•

Ask students to take a quick inventory of their own and their immediate family’s health status. Using the statistics found in the text, compare their inventory to the different health risks for their racial and ethnic group. Ask students what factors they believe contribute to the differences in health status that various racial and ethnic groups face. How might religion affect the health of a culture? Ask students which family health problems may “run in the family” and if they have concerns about eventually getting these illnesses?

•

What challenges do ethnicity, race, religion, gender, and sexual orientation bring to the health-care system? What actions can government, universities, hospitals, and other health-care facilities and individuals take to address these differences? What factors in the health-care system might keep various individuals from keeping up with their health?

•

Ask students how they have handled their newfound freedom since attending college or leaving home for the first time. How have their parents handled and reacted to it? How does the sense of independence affect their health? Are there any additional health challenges that they face?

•

Ask students to identify their most common health problems. Do students have similar health problems? Why or why not? Ask students to generate a list of ways to prevent these health problems?

Answers to Global Health Watch 1. b 2. c 3. surgery rates

Classroom Activities Activity #1: Meet Your Classmates Purpose: 1.

To meet your classmates and learn to appreciate the differences we all share.

To learn how to appreciate nonverbal communication.

Time: Ten to fifteen minutes of class.

Introduction: Introduce the disparities in health and how often we overlook our differences. Elaborate on the following communication facts: 1. Seven percent of communication is the result of the verbal message: words. 2. Thirty-five percent of communication is the result of verbal cues: volume, pitch, etc. 3. Fifty-eight percent of communication is the result of nonverbal cues.

Method: 1.

Go to an area in which students can easily move around.

Divide the class into two or three teams.

Have students stand in a straight line.

Give students a topic (most siblings, most pets, most operations, height, weight, age, foot size).

Have students line up accordingly (most to least, least to most).

Keep track of time to see which group lines up first (and then compare times after they are not allowed to speak).

To add a twist, don’t let students talk while trying to line up.

Repeat many times, so the students get a chance to be in a different location each time.

Discussion: 1.

Discuss with the students how they felt when they could not talk. What did they rely on to communicate? a. How did some communicate? Were there different styles? b. Is nonverbal communication as effective as verbal communication? Explain.

Discuss whether anyone was always in the same place in line. Discuss these differences.

How might these differences reflect how we treat ourselves? Our lifestyle behaviors?

Activity #2: The Dimensions of Health Purpose: 1.

To introduce and investigate the dimensions of health and how various individuals perceive these dimensions.

To analyze human behavior in the context of physical, psychological, social, intellectual, environmental, and spiritual health.

To enable students to meet their classmates.

Time: One class period.

Method: 1.

Form a circle in the room.

Instruct each student to introduce himself or herself and identify a dimension of health that represents their lifestyle by acting it out.

Discussion: 1.

Discuss the various ways that people perceived the dimensions not only from the person acting out the dimension but also from the audience.

Activity #3: Family Health History Purpose: 1.

To investigate your family health history.

To analyze how current health practices along with family health history can determine future health.

Time: One class period.

Method: 1.

Have students first create a family tree that includes parents, siblings, grandparents, aunts, and uncles. Students should also list close relatives who may be deceased.

After creating the family tree, students should list the health concerns or illnesses that any family member has experienced.

Discussion: 1.

How many relatives in their family tree have health concerns?

Discuss how those health conditions may play a role in the student’s life in terms of their own health.

Discuss strategies for behavior change or preventive measures each student can take to possibly avoid the same health concerns.

Activity #4: Goal Setting for a Healthy Change Purpose: To establish one or more goals that you would like to strive toward throughout the semester.

Time: Half of a class period.

Method: 1.

Have each student choose one lifestyle change that they would like to work on or improve during the semester.

Have the student determine what stage of change they feel they are currently in: precontemplation, contemplation, preparation, or action. (They will not be in the maintenance or the termination stage if they are working to improve a health behavior.)

Based on their stage of change, have the students refer to the chart on page 17 in the text and identify which of the nine processes in the transtheoretical model they can use to help them move to the next stage of change.

Have the student come up with one idea that they will use for each of the processes they identified.

Discussion: 1. Discuss the likelihood that the student will implement the ideas they thought of for the processes of change. If the likelihood is not good, ask why. Have the students reassess their goal, the stage of change they are in and the ideas for each process of change. If the likelihood is good, create an assignment or discussion to follow up on their progress.

References, Readings, and Resources American College Health Association. American College Health Association-National College Health Assessment II: Reference Group Executive Summary Fall 2015 (Hanover, MD: American College Health Association, 2016). Centers for Disease Control and Prevention. National Vital Statistics Report 64, no. 2 (February 16, 2016). United States Life Tables, 2009. Falk, Emily B., et al. “Self-Affirmation Alters the Brain’s Response to Health Messages and Subsequent Behavior Change.” Proceedings of the National Academy of Sciences 112, no. 7 (2015): 1977–82. doi: 10.1073/pnas.1500247112. McNamara, Robert S., et al. “Motivational Interviewing Intervention with College Student Tobacco Users: Providers’ Beliefs and Behaviors.” Journal of American College Health 63, no. 4 (2015): 286–90. doi: 10.1080/07448481.2014.1003376. Montanaro, E. A., & Bryan, A. D. “Comparing Theory- Based Condom Interventions: Health Belief Model versus Theory of Planned Behavior.” Health Psychology 33, no. 10 (2014): 1251–60. doi: http://dx.doi. org/10.1037/a0033969. National Center for Health Statistics. Health, United States, 2015: With Special Feature on Racial and Ethnic Health Disparities (Hyattsville, MD: Author, 2016). Racial and Ethnic Health Disparities.

Films and Videos A Simple Way to Break a Bad Habit (Psychiatrist Judson Brewer studies the relationship between mindfulness and habits. Learn more about the mechanism of habit development and discover a simple but profound tactic that might help you beat your next urge to smoke, snack, or check a text while driving.) Judson Brewer: A Simple Way to Break a Bad Habit Achieve a Healthy Lifestyle (“What we do, and what we put into our bodies, has a direct impact on the way we feel.” To prove the point, Rick, a health enthusiast, is contrasted with his friend Tina, a nightclubbing, smoking, convenience-food junkie.) Films Media Group 132 West 31st Street, 16th Floor © 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use.

New York, NY 10001 P: 800.322.8755 F: 800.678.3633 E: Films Media Group Homeostasis (This program introduces students to the phenomenon of homeostasis, illustrating its crucial importance and how it works inside the body.) Films Media Group 132 West 31st Street, 16th Floor New York, NY 10001 P: 800.322.8755 F: 800.678.3633 E: Films Media Group Nutrition Starts Here (Join Chef Marshall O’Brien as he shares nutritious food choices and healthy eating strategies in Nutrition Starts Here: Smart Eating on a Budget.) Films Media Group 132 West 31st Street, 16th Floor New York, NY 10001 P: 800.322.8755 F: 800.678.3633 E: Films Media Group Our Cultures Are Our Source of Health (Renowned Hollywood actor and Cherokee tribal member, Wes Studi, explains how American Indians and Alaska Natives are twice as likely to have diagnosed diabetes as non-Hispanic whites.) Centers for Disease Control and Prevention Our Cultures Are Our Source of Health Outbreak (This film tells the vivid, inside story of how and why the Ebola outbreak in West Africa wasn’t stopped before it was too late, drawing on revelatory and candid admissions of failure from key government and public health officials.) Films Media Group 132 West 31st Street, 16th Floor New York, NY 10001 © 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use.

P: 800.322.8755 F: 800.678.3633 E: Films Media Group

Internet Resources Centers for Disease Control and Prevention Provides a wide variety of information and is a gateway to specific CDC agencies. Centers for Disease Control and Prevention Go Ask Alice Sponsored by Columbia University, this site offers questions and answers as well as an interactive service on a wide variety of health-related topics. Go Ask Alice Healthways “World Faces Shortage in Purpose Well-Being” Healthy People 2020 “Healthy People 2020” Healthy People provides science-based, 10-year national objectives for improving the health of all Americans. health.gov – Healthy People Centers for Disease Control and Prevention – Healthy People National Institutes of Health A governmental organization that supplies data and resources on a wide variety of health issues. National Institutes of Health National Patient Safety Foundation and Partnership for Clear Health Communication The Partnership for Clear Health Communication is a coalition of national organizations that are working together to promote awareness and solutions around the issue of low health literacy and its effect on health outcomes. Ask Me 3: Good Questions for Your Good Health Office of Minority Health The Office of Minority Health was created in 1986 as one of the most significant outcomes of the Heckler Report and was reauthorized by the Affordable Care Act (ACA) in 2010. The mission of the Office of Minority Health is to improve the health of © 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use.

racial and ethnic minority populations through the development of health policies and programs that will eliminate health disparities. Office of Minority Health Home Page Office on Women’s Health The Office on Women’s Health provides national leadership and coordination to improve the health of women and girls through policy, education, and model programs. Womenshealth.gov U.S. National Library of Medicine This excellent governmental website features information on a variety of medical conditions; current health topics; research projects; directories of doctors, hospitals, and other health-care providers; as well as access to other online medical resources such as Medline. U.S. National Library of Medicine

Key Terms enabling factors

protection

health

reinforcing factors

health belief model (HBM)

self-efficacy

health promotion

social norm

locus of control

transtheoretical model

predisposing factors

wellness

prevention

2 Your Psychological and Spiritual WellBeing Learning Objectives After studying this chapter in the text, the student should be able to: 2.1

Identify the components of psychological health.

2.2

Discuss the ways in which positive psychology enhances quality of life.

2.3

Review the relationship of sleep and health.

2.4

Describe the key factors related to depressive disorders, their symptoms, and treatments.

2.5

Summarize four categories of anxiety disorders.

2.6

Outline the patterns of attempting or committing suicide among Americans.

2.7

List treatment options available for mental disorders.

Chapter Summary Psychological health can make the difference between facing a challenge with optimism and confidence or feeling overwhelmed by expectations and responsibilities.

Lecture Outline I.

Emotional and Mental Health A. Psychological health encompasses both our emotional and our mental states—that is, our feelings and our thoughts. B. Emotional health generally refers to feelings and moods. C. Characteristics of emotionally healthy persons, identified in an analysis of major studies of emotional wellness, include the following: 1. Determination and effort to be healthy

2. 3. 4. 5. 6. 7. 8.

Flexibility and adaptability to a variety of circumstances Development of a sense of meaning and affirmation of life An understanding that the self is not the center of the universe Compassion for others The ability to be unselfish in serving or relating to others Increased depth and satisfaction in intimate relationships A sense of control over the mind and body that enables the person to make health-enhancing choices and decisions D. Mental health describes our ability to perceive reality as it is, to respond to its challenges, and to develop rational strategies for living. E. The characteristics of mental health include: 1. The ability to function and carry out responsibilities 2. The ability to form relationships 3. Realistic perceptions of the motivations of others 4. Rational, logical thought processes 5. The ability to adapt to change and to cope with adversity F. Culture helps to define psychological health. In our diverse society, many cultural influences affect Americans’ sense of who they are, where they came from, and what they believe. II.

The Lessons of Positive Psychology A. Overview 1. Positive psychology is defined as “the scientific study of ordinary human strengths and virtues.” 2. The three major areas of positive psychology are the study of positive emotions, such as hope and trust; positive traits, such as wisdom and courage; and positive institutions, such as strong families and democracy. B. Develop Self-Compassion: a healthy form of self-acceptance and a way of conceptualizing our favorable and unfavorable attitudes about ourselves and others. Three components of self-compassion are: 1. Treating oneself kindly in the face of perceived inadequacy by engaging in self-soothing and positive self-talk 2. Recognizing that such discomfort is an unavoidable part of the human experience—this recognition of “common humanity” promotes a sense of connection to others even in the face of isolation and disappointment 3. Facing painful thoughts without avoiding or exaggerating them and managing disappointment and frustration by quelling self-pity and melodrama

C. Boost Emotional Intelligence: “EQ” (for emotional quotient) is the ability to monitor and use emotions to guide thinking and actions. D. Meet Your Needs. According to Maslow, human needs are the motivating factors in personality development. 1. First, we must satisfy our basic physiological needs, such as those for food, shelter, and sleep. 2. Only then can we pursue fulfillment of our higher needs—for safety and security, love and affection, and self-esteem. 3. Few reach the state of self-actualization, in which one functions at the highest possible level and derives the greatest possible satisfaction from life. E. Boost Self-Esteem 1. Self-esteem is belief or pride in ourselves; it gives us confidence to dare to attempt to achieve at school or work, and to reach out to others to form friendships and close relationships. 2. Self-esteem is based on what you believe about yourself. It is not something you are born with; it develops over time. 3. One of the most useful techniques for bolstering self-esteem and achieving your goals is developing the habit of positive thinking and talking. F. Pursue Happiness 1. Psychological research has identified three major factors that contribute to a sense of well-being: your happiness set-point, life circumstances such as income or marital status, and thoughts, behaviors, beliefs, and goal-based activities. 2. Education, intelligence, gender, and race do not matter much for happiness. 3. Recent research suggests that happiness comes from: a. Focusing on time rather than focusing on money b. Spending time and money on others rather than oneself c. Spending time and money to acquire experiences rather than possessions G. Become Optimistic 1. Mental health professionals define optimism as the “extent to which individuals expect favorable outcomes to occur.” 2. Studies have established “significant relationships” between optimism and cardiovascular health, stroke risk, immune function, cancer prognoses, physical symptoms, pain, and mortality rates. 3. In terms of health, optimists not only expect good outcomes—but take steps to increase this likelihood. © 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use.

H. Manage Your Moods 1. A mood is a more sustained emotional state that colors our view of the world for hours or days. 2. The most effective way to banish a sad or bad mood is by changing what caused it in the first place. III. Spiritual Health A. Overview 1. Spiritual health refers to a breath of life and involves our ability to identify our purpose in life and to experience the fulfillment of achieving our full potential. 2. Spirituality is a belief in what some call a higher power, in someone or something that transcends the boundaries of self. 3. Religiosity refers to various spiritual practices. B. Spirituality and Physical Health 1. A growing body of scientific evidence indicates that faith and spirituality can enhance health—and perhaps even extend life. 2. Church attendance may account for an additional two to three years of life (by comparison, exercise may add 3–5 extra years). 3. Prayer and other religious experiences, including meditation, may actually change the brain for the better. C. Deepen Your Spiritual Intelligence 1. Spiritual intelligence is the capacity to sense, understand, and tap into the highest parts of ourselves, others, and the world around us. 2. Spiritual intelligence, unlike spirituality, does not center on the worship of an external God, but the discovery of wisdom within. D. Clarify Your Values 1. Values are the criteria by which you evaluate things, people, events, and yourself; they represent what’s most important to you. 2. When you confront a situation in which you must choose different paths or behaviors, follow these steps: a. Carefully consider the consequences of each choice. b. Choose freely from among all of the options. c. Publicly affirm your values by sharing them with others. d. Act out your values. E. Enrich Your Spiritual Life 1. Whatever role religion plays in your life, you have the capacity for deep, meaningful spiritual experiences that can add great meaning to everyday existence. © 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use.

a. Sit quietly. b. Start small. c. Step outside. d. Use activity to tune into your spirit. e. Ask questions of yourself. f. Trust your spirit. g. Develop a spiritual practice. F. Consider the Power of Prayer 1. Prayer is the most commonly used form of complementary and alternative medicine. G. Cultivate Gratitude 1. A grateful spirit brightens mood, boosts energy, and infuses daily living with a sense of glad abundance. 2. Feelings of gratitude are associated with better mood, improved sleep, less fatigue, less inflammation, and lower risk of heart failure. H. Forgive 1. When you forgive, you let go of all the anger and pain that have been demanding your time and wasting your energy. 2. When you forgive, you reclaim your power to choose. 3. Forgiveness based interventions have resulted in greater self-esteem and hopefulness, positive emotions toward others, less depression and anxiety, and improved resistance to drug use. IV. Sleep and Health A. Overview 1. About 35 percent of U.S. adults sleep less than 7 hours a night, which puts them at risk of obesity, type 2 diabetes, high blood pressure, heart disease, stroke, mental distress, and death. B. Student Night Life 1. In recent research, about two-thirds of students reported poor sleep quality; the average number of hours slept reported by participants was 6.68, with a range of 1–11 hours. 2. In the American College Health Association–National College Health Assessment (ACHA-NCHA) survey, about one in five college students said that sleep difficulties have affected their academic performance, ranking behind stress and anxiety. 3. Alcohol compounds many sleep problems. 4. Female students generally have poorer sleep patterns than males and suffer more consequences as a result. © 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use.

5. On average college students go to bed 1–2 hours later and sleep 1–1.6 hours less than students of a generation ago. C. Sleep’s Impact on Health 1. Nighttime sleep affects your daytime well-being in the following areas: a. Learning and memory b. Metabolism and weight c. Safety d. Mood/quality of life e. Immunity f. Mental disorders g. Major diseases and death D. How Much Sleep Do You Need? 1. To figure out your sleep needs, keep your wake-up time the same every morning and vary your bedtime. See how you feel throughout the day. E. Treating Sleep Disorders 1. About 6–10 percent of adults suffer from insomnia, difficulty initiating or maintaining sleep, or early-morning waking with inability to return to sleep that leads to fatigue, poor cognitive function, mood disturbance, distress, or impaired personal functioning. 2. In its recent guidelines, the American College of Physicians recommends cognitive-behavioral therapy (CBT) as first-line therapy for chronic insomnia. 3. If CBT fails, medications may be considered, including a. Over-the-counter medications b. Dietary supplements c. Prescription medications V.

Understanding Mental Health A. Overview 1. Mentally healthy individuals value themselves, perceive reality as it is, accept their limitations and possibilities, carry out their responsibilities, establish and maintain close relationships, pursue work that suits their talent and training, and feel a sense of fulfillment that makes the efforts of daily living worthwhile. B. What Is a Mental Disorder? 1. Psychiatrists define a mental disorder as a clinically significant behavioral or psychological syndrome or pattern that is associated with present distress or disability or with a significantly increased risk of suffering death, pain, disability, or an important loss of freedom.

C. Mental Health on Campus 1. There have been increases in the numbers of students seeking psychological services and in the severity of problems they report, such as drug use, alcohol abuse, sexual assaults, self-injury, and suicide. 2. According to the ACHA-NCHA survey, about one in four undergraduates has been diagnosed or treated for a mental disorder. 3. Risk factors for significant mental health impairment include a. History of a mental disorder b. Ongoing psychiatric issues c. Breakup d. Financial pressures e. Discrimination f. Increased risk of other disorders g. Minority status 4. Psychological and emotional problems can affect every aspect of a student’s life, including physical health, overall satisfaction, and relationships. a. In the ACHA-NCHA’s national survey, 24 percent of students reported that anxiety had impaired their ability to learn and earn higher grades; 15 percent said that depression had affected their academic performance. b. The impact of mental health problems extends beyond an individual student to roommates, friends, classmates, family, and instructors. VI. Depressive Disorders A. Overview 1. Depression, the world’s most common mental ailment, affects more than 13 million adults in the United States every year and costs billions of dollars for treatment and lost productivity and lives. B. Depression in Students 1. An estimated 15–40 percent of college-age men and women may develop depression, but the number may be rising. 2. Three key contributors to depression in college students are stress, too little sleep, and academic and athletic pressures. C. Gender and Depression 1. Female Depression a. Depression is twice as common in women as men. i. However, this gender gap decreases or disappears in studies of men and women in similar socioeconomic situations. © 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use.

b. Brain chemistry and sex hormones may play a role. c. The DSM-5 classifies premenstrual dysphoric disorder (PDD), which is not the same as pre-menstrual syndrome (PMS), as a depressive disorder. i. In the final week before onset of menstruation, an estimated 1.8–5.8 percent of women experience the characteristic symptoms of PDD: 2. Male Depression a. More than 6 million men in the United States—1 in every 14—suffer from this insidious disorder, many without recognizing what’s wrong. b. Experts describe male depression as an “under” disease: underdiscussed, underrecognized, underdiagnosed, and undertreated. c. Genes may make some men more vulnerable to depression, but chronic stress of any sort plays a major role. D. Major Depressive Disorder 1. An estimated 20–30 percent of college students may develop a major depressive disorder, which can simply be defined as sadness that does not end. 2. The characteristics of depression include: a. Feeling depressed b. Loss of interest c. Eating more or less d. Having trouble sleeping e. Feeling slowed down or feeling restless f. Lacking energy g. Feeling helpless, hopeless, and worthless h. Having difficulty thinking or concentrating i. Having persistent thoughts of death or suicide E. Treating Depression 1. The most recent guidelines for treating depression call for an individualized approach tailored to each patient’s symptoms. 2. Medication has become the most common approach, while fewer patients receive psychotherapy, possibly because of limited insurance coverage. 3. A combination of psychotherapy and medication is considered the most effective approach for most patients. F. Bipolar Disorder 1. Known as manic depression in the past, bipolar disorder consists of mood swings, changes in thinking, changes in behavior, and changes in physical condition.

2. Bipolar and related disorders affect approximately 4 percent of the population. 3. Professional therapy is essential in treating bipolar disorders. VII. Anxiety Disorders A. Overview 1. Anxiety disorders, which affect an estimated 10–15 percent of psychiatric patients, are more common than depression (diagnosed in 7–10 percent of patients). B. Specific Phobia 1. Phobias—the most prevalent type of anxiety disorder—are out-of-theordinary, irrational, intense, persistent fears of certain objects or situations. 2. Although various medications have been tried, the best approach is behavioral therapy, which consists of gradual, systematic exposure to the feared object (a process called systematic desensitization). C. Panic Attacks and Panic Disorder 1. Panic attacks often involve one or more of the following: a racing heart, light-headedness or dizziness, rapid breathing, hyperventilation, tingling and numbness in parts of the body, and the sense that something horrible is about to happen. 2. Panic disorder develops when attacks recur or apprehension about them becomes so intense that individuals cannot function normally. 3. The two primary treatments for panic disorder are cognitive-behavioral therapy (CBT), which teaches specific strategies for coping with symptoms such as rapid breathing, and medication. D. Generalized Anxiety Disorder 1. About 10 million adults in the United States suffer from a generalized anxiety disorder (GAD), excessive or unrealistic apprehension that causes physical symptoms, such as restlessness, fatigue, and muscle tension that lasts for 6 months or longer. E. Obsessive–Compulsive Disorder 1. An estimated 1.9–3.3 percent of Americans have an obsessive–compulsive disorder (OCD). Some of these individuals suffer only from an obsession, a recurring idea, thought, or image that they realize, at least initially, is senseless. 2. The most common obsession are: a. Repetitive thoughts that usually involve harm and danger b. Contamination (e.g., becoming infected by shaking hands) © 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use.

c. Doubt (e.g., wondering whether one has performed some act, such as having hurt someone in a traffic accident) 3. Compulsion: a repetitive behavior performed according to certain rules or in a stereotyped fashion. The most common compulsions are: a. Handwashing b. Cleaning c. Repeating words silently d. Counting e. Checking (e.g., making sure dozens of times that a door is locked) VIII. Other Common Disorders A. Attention-Deficit/Hyperactivity Disorder 1. Attention-Deficit/Hyperactivity Disorder (ADHD) is the most common mental disorder in childhood. 2. An estimated 5.9–7.1 percent of children and adolescents suffer from ADHD. 3. About 5 percent of adults have ADHD. 4. The characteristic symptoms of ADHD are: a. Inattention b. Hyperactivity c. Impulsivity 5. ADHD on Campus 6. An estimated 2–8 percent of young adult college students report clinically significant ADHD symptoms. 7. The normal challenges of college—navigating the complexities of scheduling, planning courses, and honing study skills—may be especially daunting for these students, who may find it hard to concentrate, read, make decisions, complete complex projects, and meet deadlines. 8. The medications used for this disorder include stimulants (such as Ritalin), which improve behavior and cognition for about 70 percent of adolescents with ADHD. 9. Undergraduates with ADHD are at higher risk of becoming smokers, abusing alcohol and drugs, and having automobile accidents. B. Autism Spectrum Disorder 1. Autism, a complex neurodevelopmental disability that causes social and communication impairments, is a “spectrum” disorder that includes several disorders with similar features. 2. According to recent estimates from the CDC, about 1 in 68 children has autism spectrum disorder (ASD). © 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use.

3. There is no scientific evidence that any part of a vaccine or combination of vaccines causes autism, nor is there proof that any material used to produce the vaccine, such as thimerosal, a mercury-containing preservative, plays a role in causing autism. 4. Symptoms, which include repetitive patterns of thoughts and behavior and inability to communicate verbally, usually start before age 3 and can create delays or problems in many different skills that develop from infancy to adulthood. 5. Autism Spectrum Disorder on Campus: a. Increasing numbers of adolescents and young adults diagnosed with ASD—an estimated 2 percent of all undergraduates with disabilities— are entering colleges and universities. b. Although many have the cognitive ability to succeed academically, a high percentage of ASD-diagnosed undergraduates do not complete their postsecondary programs. C. Schizophrenia 1. Schizophrenia is one of the most debilitating mental disorders, which profoundly impairs in individual’s sense of reality. 2. Symptoms: a. Hallucinations b. Delusions c. Disorganized thinking d. Talking in rambling or incoherent ways e. Making odd or purposeless movements or not moving at all f. Repeating others’ words or mimicking their gestures g. Showing few, if any, feelings; responding with inappropriate emotions h. Lacking will or motivation to complete a task or accomplish something i. Functioning at a much lower level than in the past at work, in interpersonal relations, or in taking care of themselves 3. Schizophrenia, which affects 0.3–0.7 percent of the world’s population, is one of the leading causes of disability among young adults. 4. For the vast majority of individuals with schizophrenia, antipsychotic drugs are the foundation of treatment. D. Nonsuicidal Self-Injury 1. Deliberately harming oneself may take any form of damage to the body: cutting, burning, stabbing, hitting, and excessive rubbing. 2. The intent is not to take one’s life but to obtain relief from painful feelings or thoughts.

IX. Suicide Suicide is not in itself a psychiatric disorder, but it is often the tragic consequence of emotional and psychological problems. At all ages, men commit suicide three to four times more frequently than women, but women attempt suicide much more often than men. A. Overview 1. Suicide is the third leading cause of death among 10- to 24-year-olds in the United States. 2. Long considered a threat to younger and older Americans, suicide has increased significantly among middle-aged men and women. B. Suicide on Campus 1. More than 1,100 college students take their own lives every year; many more—an estimated 1.2 percent of undergraduates—attempt to do so. C. Factors That Lead to Suicide 1. Suicidal behavior disorders 2. Mental disorders 3. Substance abuse 4. Hopelessness 5. Combat stress 6. Family history 7. Physical illness 8. Brain chemistry 9. Access to guns 10. Other factors a. Individuals who kill themselves often have gone through more major life crises—job changes, births, financial reversals, divorce, retirement—in the previous six months, compared with others. X.

Overcoming Problems of the Mind A. Overview 1. At any given time, about 25 percent of men, women, and children meet the criteria for a mental disorder, yet 70 percent of those in need of psychological help never receive it. B. Where to Turn for Help 1. About 10 percent of students seek care from a mental health counseling center on campus. 2. Your health education instructor can tell you about general and mental health counseling available on campus.

3. Within the community, you may be able to get help through the city or county health department and neighborhood health centers as well as local hospitals. C. Types of Therapy 1. Psychotherapy refers to any type of counseling based on the exchange of words in the context of the unique relationship that develops between a mental health professional and a person seeking help. 2. Brief Psychotherapies a. Short-term treatments typically focus on a central issue and typically conclude in less than 6 months or 24 sessions. 3. Psychodynamic Psychotherapy a. This therapy takes into account the role of early experiences and unconscious influences in actively shaping behavior. 4. Cognitive-Behavioral Therapy (CBT) a. CBT focuses on inappropriate and inaccurate thoughts or beliefs to help individuals break out of a distorted way of thinking. 5. Behavioral Therapy a. The goal is to substitute healthier ways of behaving for maladaptive patterns used in the past. 6. Interpersonal Therapy (IPT) a. IPT focuses on relationships in order to help individuals deal with unrecognized feelings and needs and improve their communication skills. D. Other Treatment Options 1. Psychiatric Drugs 2. Thanks to the development of more precise and effective psychiatric drugs (medications that regulate a person’s mental, emotional, and physical functions to facilitate normal functioning), success rates for treating many common and disabling disorders—depression, panic disorder, schizophrenia, and others—have soared. 3. Alternative Mind-Mood Products a. Some “natural” products, such as herbs and enzymes, claim to have psychological effects. i. However, they have not undergone rigorous scientific testing. b. Daily meditation might help relieve anxiety and depression.

Discussion Questions •

Discuss the concept of psychological health as it relates to the other five dimensions of health. Can psychological health be separate and distinct from the other components without affecting them? How so? How do the other dimensions affect one’s psychological health?

•

Ask students what it means to love and accept themselves. Can one accept and love another without first loving oneself? How? Why? How does this relate to Maslow’s hierarchy of thinking?

•

Ask students what emotional intelligence means to them. Discuss the benefits of possessing emotional intelligence. What role does an individual’s EQ play in their everyday life or career? Ask them which they would rather have, a high IQ or a high EQ? Why or why not?

•

Ask students what factors contribute to happiness. Compare these characteristics to those cited for contributing to good psychological health. Ask students to make a list of the things that make them happy. Do they think of the things on the list when they make choices or decisions that may or may not affect their happiness? Why? How come?

•

Discuss the concept of sleep deprivation as discussed in the text. Ask for volunteers who have experienced it to share their symptoms or experiences. Ask others to share the strategies and rituals they use in order to reduce sleep deprivation and maximize restful sleep. How might they improve their sleep rituals? Why is it important at this point in their lives to get enough sleep?

•

Provide a definition for mental well-being and for mental illness. Have students brainstorm characteristics and symptoms for each. Also work through the stereotypes of mental illness and attempt to explain how “normal” people can become so overwhelmed by “life” that depression or other illnesses occur.

•

Compare and contrast the everyday blues to depressive disorder. What characteristics differentiate the two? When might one seek professional counseling? How and where can they get it? What is available on campus? How might one afford such counseling? Describe the free services available and who to contact.

•

After reviewing the statistics related to suicide among the young, ask students why they believe this occurs. Note their responses on the chalkboard. Ask them to examine what society, families, and individuals can do to help prevent suicide.

•

Ask students how they might go about finding a mental health therapist. What questions might they ask in order to ascertain qualifications and experiences? (Have

them note that a similar list can be used to select any type of health practitioner). Formulate and share with them a list of low or no-cost counseling services available on your campus and within the community. Discuss the differences in psychiatrists, psychologists, and social workers. Also explain how some psychologists are trained in special areas. •

Discuss the number of psychiatric drugs that are out there and the differences between them. How do students view these types of drugs? How many students support Tom Cruise’s belief that they are not needed to treat depression? Why or why not?

•

Discuss suicide, including the major causes of suicide. Discuss the differences between males and females in terms of suicide risk.

Classroom Activities Activity #1: Abraham Maslow’s Hierarchy of Needs Purpose: To assist students in identifying their own potential.

Time: This activity will take 10–15 minutes.

Introduction: Introduce to students how not reaching our fullest potential can impact our health.

Method: 1.

Introduce to students Maslow’s Hierarchy of Needs and review the various levels within this model.

Have students make their own pyramid and have them write a brief statement about how they have reached each level or not reached a particular level.

Discussion: 1.

Ask students to identify areas that they are meeting.

Ask students to identify areas that they are not meeting.

How do they feel meeting or not meeting a particular area that has influenced their life?

Are there areas in life for which students believe that meeting each “step” isn’t necessary to achieve the next level? Why or why not?

Ask students to identify someone they believe has reached the self-actualization level. Why?

Activity #2: Enhancing Self-Esteem Purpose: To improve self-esteem.

Time: This activity will take 10–15 minutes.

Introduction: Enhancing self-esteem and personal well-being is a lifelong process.

Method: 1.

Have students ask themselves the following questions: a. How do I feel about my life in general—positively or negatively? b. Do I constantly send myself negative messages? c. What is one area of my life that I would like to improve upon?

Write two positive affirmations that you will repeat to yourself whenever you feel those negative or self-defeating thoughts begin to enter your mind.

Discussion: 1.

What factors have contributed to your feelings about your life in general, whether they are positive or negative?

Will your positive affirmations help derail any negative observations you have of yourself?

What role does self-esteem play in the ability to set and establish goals?

Activity #3: Self-Analysis: Depression Purpose: To increase awareness of signs of depression.

Time: This activity will take one-half to a whole class period with possible out of class research.

Introduction: Improving the ability to recognize the signs and symptoms of depression and to develop healthy strategies for coping with depression.

Method: 1.

Have students ask themselves the following questions: a. Do I have low self-esteem or feelings of inadequacy? b. Do I feel hopeless? c. Do I feel guilty? d. Do I have low energy and have feelings of fatigue? e. Am I having difficulty making decisions? f. Am I having difficulty enjoying pleasurable activities?

If students answered yes to any of those questions, then they should recognize that they could be suffering from depression.

Discussion: 1.

Ask students to reflect on how they feel about this experience? Were they surprised by the results?

Does this experience open their eyes to taking more time to work on their mental health and well-being?

If they are dealing with depression, what resources will they seek for help?

What resources are available on campus for students dealing with depression?

Activity #4: Self-Analysis: Sleep Purpose: To assess your daily sleep habits and to determine if you are getting an adequate amount of rest for optimal health.

Time: One week.

Method: 1.

Students should keep a sleep journal for 1 week. Students should keep track of the amount of time they sleep each day, the time at which they are sleeping, and how they felt upon waking each day.

At the end of 1 week, students should ask themselves the following questions: a. Do I wake up each day feeling well rested? b. Do I go to sleep at a different time each day? c. Am I taking a nap every day? d. Do I have to take medications or drink alcohol to go to sleep?

Discussion: 1.

Discuss the behavioral patterns that impact the amount of sleep students get on a daily basis.

Ask students if they have a clearer picture of their sleep habits and how they might be influencing their physical health.

Discuss the steps that students can take to improve their sleep habits.

References, Readings, and Resources Abbeduto, L., et al. “Neurodevelopmental Disorders.” In Textbook of Psychiatry, 6th ed., edited by Hales, R. E., et al. (Washington, DC: American Psychiatric Publishing, 2014). American College Health Association. American College Health Association-National College Health Assessment II: Reference Group Executive Summary Fall 2015 (Hanover, MD: American College Health Association, 2016). American Psychiatric Association. Understanding Mental Disorders (Washington, DC: American Psychiatric Association, 2015). Baio, J. “Prevalence of Autism Spectrum Disorder among Children Aged 8 Years. Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2010.” MMWR Surveillance Summaries 2, no. 63 (2014): 1–21. Dougherty, D. D., et al. “Obsessive Compulsive and Related Disorders.” In Textbook of Psychiatry, 6th ed., edited by Hales, R. E., et al. (Washington, DC: American Psychiatric Publishing, 2014). Ketter, T. A., and K. D. Chang. “Bipolar and Related Disorders.” In Textbook of Psychiatry, 6th ed., edited by Hales, R. E., et al. (Washington, DC: American Psychiatric Publishing, 2014). Liu, Y., et al. “Prevalence of Healthy Sleep Duration among Adults—United States, 2014.” Morbidity and Mortality Weekly Report 65, no. 6 (2016): 137–41. doi: 10.15585/mmwr.mm6506a1. Lucette, Aurelie, et al. “Spirituality and Religiousness Are Associated with Fewer Depressive Symptoms in Individuals with Medical Conditions.” Psychosomatics (2016). doi: 10.1016/j.psym.2016.03.005. Lyubominsky, S. The Myths of Happiness (New York: Penguin, 2013). Peach, Hannah, Jane F. Gaultney, and David D. Gray. “Sleep Hygiene and Sleep Quality as Predictors of Positive and Negative Dimensions of Mental Health in College Students.” Cogent Psychology 3, no. 1 (2016): 1168768. doi: 10.1080/23311908.2016.1168768.

Phillips, L., et al. “Eating Disorders and Spirituality in College Students.” Journal of Psychosocial Nursing and Mental Health Services 53, no. 1 (2015), 30–7. doi: 10.3928/02793695-20141201-01. Roberto, P. M., et al. “How Your Bank Balance Buys Happiness: The Importance of ‘Cash on Hand’ to Life Satisfaction.” Emotion (2016). doi: http://dx.doi.org/10.1037/emo0000184. Shatkin, J. P., and U. Diamond. “Psychiatry’s Next Generation: Teaching College Students about Mental Health.” Academic Psychiatry (2015). doi: 10.1007/s40596-0150305-1. Stein, M. B., et al. “Anxiety Disorders.” In Textbook of Psychiatry, 6th ed., edited by Hales, R. E., et al. (Washington, DC: American Psychiatric Publishing, 2014). Stroup, T. S., et al. “Schizophrenia Spectrum and Other Psychotic Disorders.” In Textbook of Psychiatry, 6th ed., edited by R. E. Hales, et al. (Washington, DC: American Psychiatric Publishing, 2014). Sontag-Padilla, Lisa, et al. “Factors Affecting Mental Health Service Utilization among California Public College and University Students.” Psychiatric Services (2016). doi: 10.1176/appi.ps.201500307.

Films and Videos A Beautiful Mind (The story of John Nash, Nobel Prize Winner who suffered from schizophrenia.) Available at most video stores. ADHD Rush Hour (This program speaks with students diagnosed with ADHD and to nearly a dozen medical and academic experts about its identification and treatment.) Films Media Group 132 West 31st Street, 16th Floor New York, NY 10001 P: 800.322.8755 F: 800.678.3633 E: Films Media Group Anxiety Disorders (Humans, like many animals, possess a fine-tuned sense of danger. In truly hazardous situations, our awareness of threats is highly beneficial—but in 21st-century society it can become a constant state of mind, severely limiting a person’s ability to function.) Films Media Group 132 West 31st Street, 16th Floor New York, NY 10001 P: 800.322.8755 F: 800.678.3633 E: Films Media Group Autism Spectrum Disorders (This three-part series presents the diagnosis evolution of autism, describes diagnostic mechanisms, and discusses specific treatment modalities.) Films Media Group 132 West 31st Street, 16th Floor New York, NY 10001 P: 800.322.8755 F: 800.678.3633 E: Films Media Group BLOW-UPS AND RAGES: Learning to Manage Your Anger

(Anger is a natural response to many of life’s most troubling situations, but all too often explosions of teen anger can be harmful and hurtful. Hostility and anger can devastate a teen’s life, destroy relationships, cloud effective thinking, impact school performance, affect physical health, and ruin future career plans.) Human Relations Media 800-431-2050 41 Kensico Drive Mt. Kisco, NY 10549 E: Human Relations Media Cut-Up Kids: The Epidemic of Self-Harm (For reasons still being explored, a growing number of children, teenagers, and young adults regularly and willfully cut, burn, and otherwise harm their own bodies. This film follows three young people as they confront the violence they have inflicted upon themselves.) Films Media Group 132 West 31st Street, 16th Floor New York, NY 10001 P: 800.322.8755 F: 800.678.3633 E: Films Media Group Dark Days: Shedding Light on Depression (Even as ignorance about depression leads to social stigmas and alienation, many people with depression do not realize what ails them and therefore do not seek treatment in the first place. This program examines in detail what depression is, its various symptoms, and the options available for coping with or even curing it.) Films Media Group 132 West 31st Street, 16th Floor New York, NY 10001 P: 800.322.8755 F: 800.678.3633 E: Films Media Group Girl Interrupted (Excellent movie about a young woman who is in a mental institution and the friendship and relationships endured.) Check your local video store.

Myths about Madness: Challenging Stigma and Changing Attitudes (Exposes myths surrounding afflictions of the mind and challenges discrimination against the mentally ill.) Films Media Group 132 West 31st Street, 16th Floor New York, NY 10001 P: 800.322.8755 F: 800.678.3633 E: Films Media Group Schizophrenia (This three-part series takes a thorough look at schizophrenia, with discussions of the disorder’s etiology, its effects on the daily life of patients and their families, and the various impacts of deinstitutionalization.) Films Media Group 132 West 31st Street, 16th Floor New York, NY 10001 P: 800.322.8755 F: 800.678.3633 E: Films Media Group There’s No 3G in Heaven: Addressing Teen Suicide (This important program tells the story of an Australian community that, after a string of teen suicides, held a public meeting to allow the victims’ loved ones to share their experiences and discuss ways to prevent such tragedies in the future.) Films Media Group 132 West 31st Street, 16th Floor New York, NY 10001 P: 800.322.8755 F: 800.678.3633 E: Films Media Group

Internet Resources American Association of Suicidology The American Association of Suicidology is an education and resource organization. American Association of Suicidology

Anxiety and Depression Association of American (ADAA) Gives information, resources, and referrals related to anxiety disorders. Anxiety and Depression Association of American American Foundation for Suicide Prevention Research, facts, survivor support, and more. Suicide Awareness Voices of Education American Psychiatric Association Provides information about a wide variety of mental health problems as well as psychiatric medications. American Psychiatric Association American Psychological Association Provides information on a wide variety of mental health topics. American Psychological Association Authentic Happiness The Authentic Happiness website is a University of Pennsylvania website developed by the Positive Psychology Center, which is directed by Martin Seligman. Authentic Happiness Website Brain & Behavior Research Foundation This association is dedicated to funding scientific research on brain and behavior disorders. Brain & Behavior Research Foundation Depression and Bipolar Support Alliance The mission of this website is to improve the lives of people living with mood disorders. Depression and Bipolar Support Alliance Depression Screen.org The mission of this website is to educate people about clinical depression, offer a confidential way for people to get screened for symptoms of the illness, and guide people toward appropriate professional help if necessary. DepressionScreen.org

Mental Health America Mental Health America (MHA)—founded in 1909—is the nation’s leading communitybased nonprofit dedicated to helping Americans achieve wellness by living mentally healthier lives. Mental Health America National Association for Self-Esteem The purpose of this organization is to fully integrate self-esteem into the fabric of American society so that every individual, no matter what their age or background, experiences personal worth and happiness. National Association for Self-Esteem National Center for PTSD To advance the clinical care and social welfare of America’s veterans through research, education, and training in the science, diagnosis, and treatment of PTSD and stressrelated disorders. This website is provided as an educational resource concerning PTSD and other enduring consequences of traumatic stress. PTSD: National Center for PTSD National Institute of Mental Health Working to improve mental health through biomedical research on mind, brain, and behavior. National Institute of Mental Health National Sleep Foundation This site features information on sleep disorders; healthy sleep, support, and advocacy; and online resources on sleep. National Sleep Foundation International OCD Foundation Organization of researchers and clinicians pioneering the world’s foremost innovative and aggressive efforts to find a cure for OCD. International OCD Foundation happier Learn about the evidence-based pursuit and practice of happiness. happier Home Page

Schizophrenia and Related Disorders Alliance of America Schizophrenia and Related Disorders Alliance of America promotes improvement in the lives of people with schizophrenia-related illnesses and their families by providing support, hope, and awareness so that early diagnosis, treatment, and community services increase recovery. Schizophrenia and Related Disorders Alliance of America Suicide: Read this First A collection of suicide resources. Metanoia – Suicide... Read This First World Federation for Mental Health An international, non-profit organization established in 1948 to advance, among all peoples and nations, the prevention of mental and emotional disorders, the proper treatment and care of those with such disorders, and the promotion of mental health. World Federation for Mental Health World Health Organization Part of the WHO’s website on mental health. World Health Organization – Mental Health

Key Terms antidepressant

interpersonal therapy (IPT)

anxiety disorders

major depressive disorder

attention deficit/hyperactivity disorder (ADHD)

mental disorder

autism spectrum disorder

mood

behavioral therapy

obsessive-compulsive disorder (OCD)

bipolar disorder

mental health

optimism

cognitive therapy

panic attacks

culture

panic disorder

emotional health

phobias

emotional intelligence

psychiatric drugs

generalized anxiety disorder (GAD)

psychodynamic

psychotherapy

spiritual health

schizophrenia

spiritual intelligence

self-actualization

spirituality

self-compassion

values

self-esteem

Answers to Global Health Watch 1. a 2. b 3. inflammatory

3 Stress Management Learning Objectives After studying this chapter in the text, the student should be able to: 3.1

Outline the types of stress and the effects of stress on people.

3.2

Identify stressors commonly reported by different groups across the United States.

3.3

Summarize the incidence, symptoms, and treatment of the stress disorders associated with traumatic life events.

3.4

Outline the ways in which the body responds to stress.

3.5

Describe how stress can affect a person’s heart, immune system, gastrointestinal system, and susceptibility to cancer.

3.6

Explain psychological responses to stress.

3.7

Discuss practical techniques of stress management.

3.8

Summarize how time management can help prevent stress.

Chapter Summary This chapter helps students learn to anticipate stressful events, manage day-to-day hassles, prevent stress overload, and find alternatives to running endlessly on a treadmill of alarm, panic, and exhaustion.

Lecture Outline I.

What Is Stress? A. Overview 1. Hans Selye, a pioneer in studying physiological responses to challenge, defined stress as “the non-specific response of the body to any demand made upon it.”

B. Eustress, Distress, and Neustress 1. Eustress refers to the positive stress in our lives. a. Eustress challenges us to grow, adapt, and find creative solutions in our lives. 2. Distress refers to the negative effects of stress that can deplete or even destroy life energy. 3. Some experts have introduced another category: “neustress” for neutral stressors that do not affect us immediately or directly but that may trigger anxiety, sadness, fear, and other stressful feelings. C. Stress and the Dimensions of Health 1. From a holistic perspective, stress can have an impact on every dimension of well-being. a. Physical—Stress triggers molecular changes within your body that affect your heart, muscles, immune system, bones, blood vessels, skin, lungs, gastrointestinal tract, and reproductive organs. b. Psychological—Chronic stress affects thoughts and feelings; however, positive emotions and attitudes can buffer the ill effects of stress and enhance satisfaction and genuine happiness. c. Spiritual—Stress can sidetrack us from achieving our full potential; but our spirit, when nurtured, can help resist and recover from stress. d. Social—Your relationships with your family, friends, coworkers, and loved ones affect and are affected by the stress in your life. e. Intellectual—Even mild stressors can interfere with your brain’s functioning. f. Occupational—Most undergraduates (about 70 percent) are employed, with 20 percent working full time year-round. They are more likely to feel overwhelmed and report greater anxiety and stress than students without jobs. g. Environmental—External forces such as pollution, noise, natural disasters, exposure to toxic chemicals, and threats to your safety can cause or intensify the stress in your life. 2. Types of Stressors a. Acute time-limited stressors: situations that cause feelings of anxiety, such as having to speak in public or work out a math problem while under pressure. b. Brief naturalistic stressors: more serious challenges (e.g., taking the SAT or meeting a deadline for a project). c. Life change events: include planned and predictable occurrences, such as graduation or marriage, as well as unexpected ones, such as the loss © 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use.

of a home in a fire or flood. The death of a partner or parent ranks high on the list. d. Chronic stressors: ongoing demands caused by life changing circumstances, such as permanent disability from an accident or caring for a parent with dementia. e. Distant stressors: traumatic experiences that occurred long ago, such as child abuse or combat, which have an emotional and psychological impact. II.

Stress in America A. Overview 1. Every year the American Psychological Association (APA) asks men and women across the country to rank their stress level on a scale of 1 (little or no stress) to 10 (a great deal of stress). a. In its most recent Stress in America survey, the average stress level was 5.1, significantly higher than the 3.8 Americans see as a healthy stress rating. B. Stress on Campus 1. In the American College Health Association National College Health Assessment survey, about 85 percent—75 percent of men and 90 percent of women—reported feeling overwhelmed by all they had to do at some point in the past 12 months. C. Stress and Student Health 1. Students say they react to stress in various ways: a. Physiologically b. Emotionally c. Behaviorally d. Cognitively 2. Stress on students include the following documented effects: a. Difficulty paying attention and concentrating. b. Poor or inadequate sleep c. Lack of exercise d. Increased consumption of junk food e. Greater risk of anxiety and depression f. Lessened life satisfaction 3. Gender Differences a. More female than male students reported feeling hopeless, overwhelmed, or exhausted (but not from physical activity). b. Neither gender necessarily handles stress better.

4. Students under Age 25 a. The stage of life between the ages of 18 and 25 is termed “emerging adulthood.” b. During this potentially risky transition period, young men and women of every racial and ethnic group are more likely to engage in behaviors that can increase stress and imperil health. 5. Students over Age 25 a. The number of older undergraduates is skyrocketing, with an estimated increase of 21 percent from 2005 to 2016. b. Many of these students, often parents with full- or part-time jobs, find themselves playing multiple roles and facing multiple stressors. c. Veterans may be processing their experiences in distant and dangerous lands. d. Family typically emerges as the greatest source of both stress and support for women returning to school. D. Minority Students 1. Minority stress refers to negative experiences in the campus environment that students perceive to be linked to the social, physical, or cultural attributes characteristic of their racial or ethnic group. 2. Among the forms of minority stress are: a. University social climate stress b. Intergroup stress c. Discrimination stress d. Within-group stress e. Achievement stress f. Acculturative stress 3. While many minority students say that overt racism is rare and relatively easy to deal with, subtle racial expressions—sometimes termed microaggressions—may undermine their academic confidence and their ability to bond with the university. 4. Researchers have identified three common types of microaggressions: a. Microassaults—conscious and intentional actions or slurs b. Microinsults—verbal and nonverbal communications that subtly convey rudeness and insensitivity and demean a person’s racial heritage or identity c. Microinvalidation—communications that subtly exclude, negate, or nullify the thoughts, feelings, or experiential reality of a person of color

5. Entering Freshmen a. The first year of college is the most stressful for all undergraduates, even when they begin with positive expectations and attitudes. b. First-generation college students encounter more difficulties with social adjustment and lack of social support that adds to their stress levels. 6. Test Stress a. For some students, test anxiety provokes a marked elevation in blood pressure. b. The students most susceptible to exam stress are those who believe they’ll do poorly and who see tests as extremely threatening. c. Negative thoughts often become a self-fulfilling prophecy. d. You can overcome test stress by knowing—even mastering—the subject and by controlling the way you think about and talk to yourself about tests. III. Other Stressors A. Financial Stress 1. Money ranks second only to academics as a source of stress for college students. 2. Although money cannot buy happiness, it does buffer the ill effects of stress. B. Occupational Stress 1. About half of undergraduates have jobs, which helps make ends meet but can create other difficulties. 2. High job strain is defined as high psychological demands combined with low control or decision-making ability over one’s job. C. Burnout 1. Burnout is a state of physical, emotional, and mental exhaustion brought on by constant or repeated emotional pressure. D. Illness and Disability 1. A common source of stress for college students is learning disabilities, which may affect 1 out of every 10 Americans. IV. Traumatic Life Events A. Overview 1. According to epidemiological studies, about 60 percent of men and 50 percent of women experience at least one potentially traumatic event—natural or human caused, large scale or small—during the course of their lives. © 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use.

B. Acute Stress Disorder 1. In acute stress disorder, disabling symptoms occur within 3 days to a month after exposure to a traumatic event. 2. Symptoms of acute stress disorder may include: a. Recurrent, involuntary, and intrusive distressing memories of the trauma b. Recurrent distressing dreams related to the trauma c. Dissociative reactions, such as flashbacks, in which an individual feels that the traumatic event is recurring d. Persistent inability to experience happiness, satisfaction, or other positive emotions e. Altered sense of the reality of one’s surroundings or oneself, such as time slowing down f. Inability to remember an important aspect of the traumatic event g. Efforts to avoid distressing memories, thoughts, or feelings related to the trauma h. Efforts to avoid reminders, such as certain people, places, activities, objects, or situations, which arouse distressing feelings or thoughts i. Sleep disturbances, including difficulty falling or staying asleep and restless sleep j. Irritable behavior and angry outbursts k. Hypervigilance l. Problems with concentration m. Intensified startle response 3. Acute distress disorder causes significant distress and interferes with a person’s ability to work, study, relate to others, and maintain usual routine and social activities. C. Posttraumatic Stress Disorder 1. In the past, posttraumatic stress disorder (PTSD) was viewed as a psychological response to out-of-the-ordinary stressors, such as captivity or combat. a. However, other experiences can also forever change the way people view themselves and their world. 2. An estimated 9 percent of all college students suffer from PTSD. 3. Symptoms of PTSD, which usually begin within the first 3 months after a trauma, include: a. Recurrent, involuntary, and intrusive distressing memories of the traumatic event b. Recurrent distressing dreams related to the trauma © 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use.

5. 6. 7.

c. Persistent avoidance of external reminders and distressing memories of the trauma d. Persistent feelings of guilt, shame, anger, horror, fear, or other negative emotions e. Hypervigilance and other changes in arousal and alertness Individuals with PTSD may require different types of help at different stages. a. Behavioral, cognitive, and psychodynamic therapy, sometimes along with psychiatric medication, can help individuals suffering with PTSD. b. Mind–body practices, such as exercise, mindfulness, meditation, and deep breathing, also have proven effective. Without recognition and treatment, PTSD can last for decades, with symptoms intensifying during periods of stress. When identified and treated, more than half of affected persons achieve complete recovery. Mental health professionals have found that no single approach to treatment works for all trauma victims.

Inside Stress A. The stress response refers to a cascade of internal changes that mobilize the body’s resources for action. B. General Adaptation Syndrome (GAS) 1. In his GAS model of the stress response, Hans Selye postulated that our bodies continually strive to maintain a stable and consistent physiological state, called homeostasis. 2. When a stressor disrupts this state, it triggers a nonspecific physiological response, consisting of three distinct stages: a. Alarm—As it becomes aware of a stressor, the body mobilizes various systems for action. b. Resistance—If the stress continues, the body draws on its internal resources to try to sustain homeostasis, but this requires greater and greater effort. c. Exhaustion—If stress continues long enough, normal functioning becomes impossible. Even a small amount of additional stress at this point can lead to a breakdown.

VI.

Coping with Stress A. Fight or Flight 1. Physiologist Walter Cannon, another pioneer in stress research, dubbed the complex, near-instantaneous sequence of internal changes that kicks in when you confront any potential danger the “fight-or-flight” response. 2. In interpersonal situations, individuals “fight” by arguing, opposing, demanding, criticizing, accusing, insisting, or refusing. a. Alternatively, they may take flight—literally by physically removing themselves or by withdrawing, not talking, dissociating, changing the topic, or otherwise “checking out.” B. Freezing 1. More recently, scientists have identified an acute stress response that may precede fight or flight: freezing, a survival mechanism that stems from some of the oldest circuits within the brain. C. Submission 1. If unable to flee from or fight off a predator, animals may become immobile in the hope that their attacker will lose interest. 2. Submission occurs when no other option seems possible. D. Challenge Response Model 1. Unlike a threat response, which rewires the brain to heighten a sense of danger, a challenge response strengthens connections between the parts of the brain that suppress fear and enhance learning and positive motivation. 2. In various studies of people in high-stakes situations, the challenge response consistently predicted better performance under pressure than fight or flight or than the absence of any stress response. E. Tend-and-Befriend Model 1. The classic threat response that prepares us for fight or flight can make people angry, defensive, aggressive, or withdrawn. a. But some individuals respond differently under pressure and become more caring, compassionate, and cooperative. b. The reason, according to the tend-and-befriend model, is that an urge to forge social connections under stress may be, like fight or flight, an essential survival instinct, especially for the females of a species. 2. The very acts of connecting and caring for others enable individuals to overcome feelings of powerlessness and hopelessness by inducing increases in several key brain chemicals, including oxytocin, serotonin, and dopamine.

F. Transactional or Cognitive-Relational Model 1. The transactional or cognitive-relational model, developed by psychologist Richard Lazarus, is a framework for evaluating the processes of coping with stressful events. 2. According to this model, stress stems from an interaction or “transaction” between a person and a stress-inducing trigger. 3. Lazarus identified four stages in this process: a. Primary appraisal—individual judges the severity of a threat; if not perceived as dangerous, no stress develops b. Secondary appraisal—if the situation is perceived as threatening, individual assesses whether they have the power and resources to act c. Coping stage—individual does whatever they can to deal with the challenge d. Reappraisal—individual evaluates whether the original stressor has been eliminated or whether they need to try again or use a different approach G. Yerkes-Dodson Law 1. Increasing stress can boost performance—but only up to a certain point. VII. The Impact of Stress A. Overview 1. While stress alone doesn’t cause disease, it triggers molecular changes throughout the body that make us more susceptible to many illnesses. B. Stress and the Heart 1. The links between stress, behavior, and the heart are complex. a. One way in which stress increases the risk of heart attack and other cardiovascular problems is by pushing people toward bad habits. C. Stress and Immunity 1. Acute time-limited stressors, the type that produce a fight-or-flight response, prompt the immune system to ready itself for the possibility of infections resulting from bites, punctures, or other wounds. 2. Long-term or chronic stress creates excessive wear and tear, and the system breaks down. 3. The longer the stress, the more the immune system shifts from potentially adaptive changes to potentially harmful ones. 4. Traumatic stress can impair immunity for as long as a year. D. Stress and the Gastrointestinal System 1. The “brain–gut axis” links the brain with the organs involved in digesting food. © 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use.

2. Stress can: a. Decrease saliva so your mouth becomes dry (a frequent occurrence when under the stress of speaking in public) b. Cause contractions in the esophagus that interfere with swallowing c. Increase the amount of hydrochloric acid in the stomach d. Constrict blood vessels in the digestive tract e. Alter the rhythmic movements of the small and large intestines necessary for the transport of food (leading to diarrhea if too fast or constipation if too slow) f. Contribute to or exacerbate GERD (gastroesophageal reflux disease) g. Lead to blockage of the bile and pancreatic ducts h. Increase the risk of pancreatitis (inflammation of the pancreas), ulcerative colitis, and irritable bowel syndrome 3. For many years stress alone was blamed for causing stomach ulcers, but scientists have discovered that a bacterium, Helicobacter pylori, infects the digestive system and sets the stage for ulcers. 4. Stress may increase susceptibility by reducing the protective gastric mucus that lines the stomach so ulcers develop more readily. 5. Stress directly affects what researchers call our “drive to eat.” 6. Even if they don’t consume more calories, some people, perhaps especially sensitive to cortisol, put on “belly,” or visceral, fat when stressed. E. Stress and Cancer 1. Among the latest findings from psycho-oncology, the field that combines medical and psychological approaches to cancer, are: a. Stress-related abnormalities in cortisol, inflammation, and the sympathetic nervous system can affect cancer growth. b. Stressful life experiences and depression are associated with poorer survival and greater mortality from various types of cancer, including breast, lung, and head and neck tumors. c. Psychosocial support and improved coping skills help even terminally ill patients to live better at the end of life—and in some cases to live longer as well. F. Other Stress Symptoms 1. The first signs of stress include muscle tightness, tension headaches, backaches, upset stomach, and sleep disruptions (caused by stress-altered brain-wave activity). 2. Stress is also closely linked to skin conditions.

VIII. Managing Stress A. Overview 1. Various approaches, including online stress management interventions, have proven effective in reducing perceived stress and symptoms of anxiety, depression, and stress. B. Journaling 1. College students that wrote in their journals about traumatic events felt much better afterward than those who wrote about superficial topics. C. Exercise 1. Regular physical activity can relieve stress, boost energy, lift mood, and keep stress under control. D. Routes to Relaxation 1. Relaxation is the physical and mental state opposite that of stress. 2. Relaxation techniques may alter brain chemistry such as increasing the levels of pleasure-inducing chemicals in the brain. a. Progressive relaxation works by intentionally increasing and then decreasing tension in the muscles. b. Visualization or guided imagery involves creating mental pictures that calm you down and focus your mind. c. Biofeedback is a method of obtaining information about some physiological activity occurring in the body. E. Meditation and Mindfulness 1. Meditation activates the sections of the brain in charge of the autonomic nervous system. 2. Meditation may be particularly helpful for people dealing with stressrelated medical conditions. 3. There is no right way to meditate. 4. Mindfulness is “an awareness that emerges by paying attention deliberately in the present to an experience as it happens moment by moment.” 5. Psychological benefits of mindfulness include greater self-compassion and decreased absent-mindedness, difficulty regulating emotions, fear of emotion, worry, and anger. 6. Mindfulness benefits individuals suffering from chronic pain, fibromyalgia, cancer, anxiety disorders, depression, and the stresses of everything from prison life to medical school. F. Yoga 1. Yoga is defined as a union of mind, body, and spirit.

2. Yoga eases conditions such as lower-back pain, migraine, asthma, and hypertension and has been proven to reduce anxiety and cortisol levels in those with moderate levels of stress. 3. Yoga may lower harmful compounds associated with stress that increase inflammation. G. Resilience 1. Adversity—whether in the form of a traumatic event or chronic stress— has different effects on individuals. 2. Various factors that enable individuals to thrive in the face of adversity include: a. An optimistic attitude b. Self-efficacy c. Stress inoculation d. Secure personal relationships e. Spirituality or religiosity IX. Stress Prevention: Taking Control of Your Time Symptoms of poor time management include rushing, chronic inability to make choices or decisions, fatigue or listlessness, constantly missed deadlines, not enough time for rest or personal relationships, and a sense of being overwhelmed by demands and details. A. Overview 1. Although you may struggle to cram all that you need and want to do into your allotted 24 hours each day, you can take control of how you use the time you have. 2. One of the hard lessons of being on your own is that your choices and your actions have consequences. B. Time Management 1. Schedule your time. 2. Develop a game plan. 3. Identify time robbers. 4. Make the most of classes. 5. Develop an efficient study style. 6. Focus on the task at hand. 7. Turn elephants into hors d’oeuvres. 8. Keep your workspace in order. C. Overcoming Procrastination 1. In various studies, 30–60 percent of undergraduates have reported postponing academic tasks, such as studying for exams, writing papers, © 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use.

and reading weekly assignments, so often that their performance and grades have suffered. 2. The three most common types of procrastination are putting off unpleasant things, putting off difficult tasks, and putting off tough decisions. 3. To overcome procrastination: do what you like least first; build time into your schedule for interruptions, unforeseen problems, and unexpected events; establish ground rules for meeting your own needs; and learn to “Just do it.”

Discussion Questions •

A somewhat surprising observation for some students is that positive lifestyle changes can contribute to stress. Give examples of positive stressors (e.g., marriage, moving, acquisition of an automobile). Ask the class to name other positive changes and events that can contribute to stress. What are some negative stressors that affect them? How do our bodies react to the differences between these two stressors? Is there a difference?

•

Ask students why they, as a group, are prone to stress. Have them list ways in which their campus helps to alleviate stress. As a result of the students’ brainstorming, you may wish to compose a list of campus-based programs and services available to students and distribute it to the class.

•

Though many people seem to be working more and enjoying it less, the text states that “work is not hazardous to health.” Discuss why this might be true in light of the students’ work-related experiences. What steps can they take to reduce these hazards? What steps can they take to prevent such hazards?

•

Discuss strategies for coping with stress. Ask students to share their means of coping. Are there any ways by which coping with stress can indeed contribute to additional stress?

Classroom Activities Activity #1: Journal Writing Purpose: To teach students the benefits of writing in journals to alleviate stress.

Time: The initial session may take the entire period, but future sessions may only need to be 15–20 minutes.

Introduction: Journal writing is an excellent resource for stress management. Through the use of journals, one can release emotions onto paper and then review it at a later time to better understand oneself and how to handle future stressful situations better.

Method: 1.

Tell students to bring a new notebook or a journal that they are currently using to the next class meeting.

Explain the advantages of keeping a journal and the ability to release stress through journal writing.

Ask students to spread out across the room (or go outside if the weather is nice); make sure they are comfortable with their surroundings.

Then select a topic for them to write about, such as: who am I, how is my day going, favorite places in the world, how I feel today, what makes me angry, people I admire, what makes me happy, and what makes me sad.

Explain to the students that you will never see their work, that it is only for them, and that they should not show it to anyone.

Spend some time describing how you personally like to write in your journal and offer suggestions to them (e.g., I like to write in my journal at the end of the day, out on my porch, with a little soft or classical music in the background). Explain to them that you will assign them a topic to write on and that they should discover what is comfortable for them.

Though your students will not be turning in their work, have them write a paper about their journal writing experiences at the end of the semester.

Tell the students that for the remainder of the class they may write in their journals. For the initial session, it is a good idea to have them write about who they are. They can address their journal as if writing a letter or as in a class assignment (whatever they are comfortable doing). Remind them that they should just write whatever is on their mind and not pay attention to grammar or spelling. Just write, write, and write!

At the conclusion of class, ask students how they felt about writing in a journal and then discuss the benefits of writing in it as a stress reliever and as a record of their life.

10. Assign the next topic to be written. Topic ideas: • Who is my best friend? How would I describe him or her? • What do I like about the place I live? Dislike? • What music do I like to listen to? Why? • Draw my favorite place. • Who are my parents? What do I admire most about them? • What was my scariest moment? • What do I like about school? Why am I here? What do I dislike about school? • Who are my favorite teachers? Why? • Where would I go in the world if I could? • What do I think about dying? • What was the saddest day of my life? • What was the happiest day of my life?

Discussion: 1.

After the first few times writing, ask students for feedback on how they felt about writing about their thoughts.

After several weeks of assigning the journaling activity, ask students how many are continuing to use the journaling activity as a stress reliever.

Activity #2: Identifying Stress Purpose: To identify the stressors in our lives.

Time: A week outside of class, and half a class period for discussion.

Introduction: Discuss with students the various forms of stress and how it affects all of our lives.

Method: 1.

Inform students to bring a new notebook or a journal that they are currently using to the next class meeting.

Ask students to keep a stress management journal, so they can record their everyday stressors as well as the actions they take to relieve such stress.

Students will record their stressors for a week and then meet as a class to discuss their stressors.

Discussion: 1.

When did your stressors occur? Were they always at the same time of day? a. How might you modify these factors or eliminate some of your stress?

Did you notice during the week whether you started preparing to avoid these stressors?

How might you adjust your schedule, so these stressors are lessened in your everyday life?

To become better acquainted with your stress and how you handle it, you may want to try the following: a. Identify several of your personal health concerns (e.g., a concern that you drink or smoke too much). Share one of these concerns with a classmate. Ask for suggestions on making a lasting behavior change. Now reverse roles and offer suggestions to help your classmate with their personal health concern. b. Visit the university counseling center to discuss test anxiety and the measures

that can be taken to help students defuse exam stress. Prepare a handout for the class that summarizes suggestions for reducing test anxiety. c. Interview an older relative, friend, or neighbor and find out from this person the types of stressors they experienced when they were your age. Write about these stressful experiences and compare ways they are similar to and different from your experiences.

Activity #3: Time Management Purpose: To teach students the importance of managing time and prioritizing.

Time: One-half hour to an hour.

Introduction: Introduce students to time management and the benefits of improving an individual’s organizational skills.

Method: 1.

Have students use a daily schedule with one-half hour or 15-minute intervals to plan a normal day.

Have students make a “to-do list” for one “normal” day. You can have them do a whole week after they get the hang of it, if you wish.

Ask students to look at their list and then list the top 5–10 items they need to do (e.g., #1 take exam, #2 mail bills, #3 put air in tires, and so forth).

Next, have them look at their list and identify whether there are similar items (e.g., pick up stamps, mail bills, go grocery shopping, go workout). Similar items could be near each other in location, or they may need to be completed in the same time block (e.g., take exam at 8:00 am and drop off paper by 10:00 am). Once students have “blocked” their items, have them assess whether there are any that should change in priority as to when to be completed?

Now looking at their daily schedule, can they reorganize it, so they manage their time more efficiently?

Discussion: 1.

Did you find that you spent more time than you expected? Why? Can you use it to your advantage? How? Will you? Why or why not? What typically keeps us from using such an easy method of stress management?

What things do you think really eat up your time? Can these be corrected? Do they need to be?

How do you feel about scheduling “you time” or time for yourself? Is this important? Why or why not? Have any of you done this and had a positive experience? Would you share?

Activity #4: Stress and College Life Purpose: To identify the stress specifically experienced by college students.

Time: One-half hour to an hour.

Introduction: Discuss with students the various stressors specifically linked to being a college student.

Method: 1.

Students should write down their top three college-related stressors.

For each stressor listed, students should then list two specific healthy strategies for managing the stressor.

Discussion: 1.

Were these strategies new to you, or were they ideas from the past that you had just never put into place?

Will these three stressors remain constant during your college career or are they likely to change over time? If so, will you be able to develop healthy strategies for dealing with future stressors?

Activity #5: Time Management Purpose: To help students understand where their time is spent and how to be more efficient in using it.

Time: One to two days outside of class.

Method: 1.

Assign students to keep a time log for 1–2 days.

In their time log they will account for each hour of the day and what they did that hour.

At the end of each day, review the time log. Identify productive time, transition time, and wasted time. Add up the total amount of time in each area.

Identify strategies to reduce wasted time.

Discussion: 1.

2. 3.

Have students review their time logs. Discuss the amount of wasted time. When did this time occur? Why does wasted time occur? Were students surprised that so much time was spent in between productive activities? To what extent do things like procrastination, distraction, and not planning the day contribute to the loss of productive time? Discuss ways to improve time management and reducing wasted time. Include strategies and processes previously discussed in the Transtheoretical Model. Include a follow-up assignment to see if using these strategies has improved their time management.

References, Readings, and Resources American College Health Association. American College Health Association–National College Health Assessment II: Reference Group Executive Summary Fall 2015 (Hanover, MD: American College Health Association, 2016). American Psychological Association. Stress in America, February 2016. Stress in America Press Room. Benson, H. (1975) The Relaxation Response. New York: HarperCollins. Benson, H. and Proctor, W. (2003) The Breakout Principle. New York: Scribner. Cannon, W. (1932) The Wisdom of the Body. New York: W.W. Norton. Seaward, B. (2005) Managing Stress, Third Edition. Sudbury: Jones and Bartlett Publishers. Selye, H. (1976) The Stress of Life, New York: McGraw Hill. Stoddard, F. J., et al. “Trauma- and Stressor-Related Disorders.” In Textbook of Psychiatry (6th ed.), edited by Hales, R. E., et al. (Washington, DC: American Psychiatric Publishing, 2014). Ursano, Robert et al. “Posttraumatic Stress Disorder: Neurobiology, Psychology, and Public Health,” Psychiatric Times, Vol. 25, No. 3, Mar. 2008, pp. 16–20.

Films and Videos Anger Management (Comedy about managing anger, with Adam Sandler.) Available at most video stores. Planes, Trains, and Automobiles (Video about two gentlemen trying to make it home for the holidays.) Available at most video stores.

Seriously Stressed (In this program, an immunologist, a psychiatrist, and a mental skills coach lay bare the symptoms of chronic stress, the negative impact on the body of continual exposure to adrenalin and cortisol, and biological and psychological factors that influence vulnerability to overstressing.) Films Media Group 132 West 31st Street, 16th Floor New York, NY 10001 P: 800.322.8755 F: 800.678.3633 E: Films Media Group Stress (Stress and techniques to handle it are the focus of this video.) Growth Associates 190l East First Street, P.O. Box 467 Newton, KS 67114 Stress Management: How To Cope (Explores the stress management methods used by various professionals.) NIMCO, Inc. P.O. Box 9 102 Highway 81 North Calhoun, KY 42327-0009 P: 270-273-5000 • 800-962-6662 E: NIMCO Stress Test: Brain Games (Through a series of interactive games and experiments, you'll discover how stress works and how to handle it better.) Films Media Group 132 West 31st Street, 16th Floor New York, NY 10001 P: 800.322.8755 F: 800.678.3633 E: Films Media Group

Stress: The Good, the Bad, and the Healthy (One-third of all teens feel some negative stress on a daily basis. But not all stress is bad. Real teens talk about the types of situations that cause them to become too stressed.) Human Relations Media 800-431-2050 41 Kensico Drive Mt. Kisco, NY 10549 E: Human Relations Media Stressed Out: Stress Management 101 (This program describes different forms of stress (acute, episodic, and chronic) and explains how important it is for young people to learn effective techniques for coping with stressful situations.) Human Relations Media 800-431-2050 41 Kensico Drive Mt. Kisco, NY 10549 E: Human Relations Media Struggling with Stress (Struggling with Stress uses a documentary format to follow a group of ethnically and socioeconomically diverse teenagers through their normal everyday lives and exposes the challenges they face in managing stress.) Human Relations Media 800-431-2050 41 Kensico Drive Mt. Kisco, NY 10549 E: Human Relations Media Taking Control: Strategies for Coping with Stress (A student’s first step to dealing constructively with stress is understanding it: what it is, how it works, and why it’s such a powerful force in a teenager’s life.) Films Media Group 132 West 31st Street, 16th Floor New York, NY 10001 P: 800.322.8755 F: 800.678.3633 E: Films Media Group

Time Management (Compared to high school, where the day is structured down to the minute, college is a blank do-it-yourself calendar. Over the course of this program, viewers will learn to sidestep common time-management errors and plan out their semesters so they can take control of their time and enjoy a healthy work/life balance.) Films Media Group 132 West 31st Street, 16th Floor New York, NY 10001 P: 800.322.8755 F: 800.678.3633 E: Films Media Group Unresolved Anger (Sparks fly when we look at the hurt and rage that has victimized us in the past. Working with this program will ultimately bring release from the bondage that creates the want to abuse one's self in the first place.) NIMCO, Inc. P.O. Box 9 102 Highway 81 North Calhoun, KY 42327-0009 P: 270-273-5000 • 800-962-6662 E: NIMCO

Internet Resources American College Health Association American College Health Association–National College Health Assessment web summary. National College Health Assessment American Psychological Association Information available on stress management and psychological disorders. American Psychological Association International Society for Traumatic Stress Studies Scientific research information on traumatic stress. International Society for Traumatic Stress Studies

American Academy of Experts in Traumatic Stress The American Academy of Experts in Traumatic Stress is a multidisciplinary network of professionals who are committed to the advancement of intervention for survivors of trauma. American Academy of Experts in Traumatic Stress The American Institute of Stress Website dedicated to improving the understanding of the role stress plays in health and illness. The American Institute of Stress

Key Terms biofeedback

microinvalidations

burnout

mindfulness

defense mechanisms

neustress

distress

posttraumatic stress disorder (PTSD)

eustress

progressive relaxation

holistic

stress

homeostasis

stress response

meditation

stressor

microaggression

tend and befriend

microassaults

visualization, or guided imagery

microinsults

Answers to Global Health Watch 1. a 2. b 3. structure

4 Social Health Learning Objectives After studying this chapter in the text, the student should be able to: 4.1

Explain the meaning of the term social health, using examples.

4.2

Outline various ways of communicating.

4.3

Examine how relationships contribute to the social health of individuals.

4.4

Evaluate the impact of modern technology on communicating.

4.5

Identify current trends in dating among young people.

4.6

Explain the significance of love to an individual’s well-being.

4.7

Summarize the impact of dysfunctional relationships.

4.8

Describe the trends, factors, and forms of long-term partnering in America.

4.9

Summarize the changes that have taken place in the American household over time.

Chapter Summary This chapter discusses the social needs we all share, the ways some of us respond to those needs, healthy and unhealthy relationships, and the possibilities that exist for coming together from our solitude to warm ourselves in each other’s glow.

Lecture Outline I.

The Social Dimension of Health A. Social health refers to the ability to interact effectively with other people and with the social environment, to develop satisfying interpersonal relationships, and to fulfill social roles. B. Supportive relationships buffer us from stress, distress, and disease. C. Social support refers to the ways in which we provide information or assistance, show affection, comfort, and confide in others.