Stress Health And Well Being Thriving in the 21st Century 1st Edition by Rick Harrington – Test Bank

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INSTANT DOWNLOAD COMPLETE TEST BANK WITH ANSWERS

 

Stress Health and Well Being Thriving in the 21st Century 1st Edition by Rick Harrington – Test Bank

 

Sample  Questions

 

Chapter 3: Stress and the Nervous System

 

MULTIPLE CHOICE

 

  1. The ____ is responsible for many of the vegetative functions of the body (e.g., heartbeat, respiration, etc.) and consists of the medulla oblongata, which sits directly above the spinal cord, the pons, which sits above the medulla, and the midbrain, which lies rostral (toward the head end) to the pons.
a. cerebellum c. autonomic nervous system
b. parasympathetic branch d. brain stem

 

 

ANS:  D                    PTS:   1                    REF:   Central Nervous System

 

  1. The ____ transmits information regarding the body’s movement from the cerebral hemisphere to the region of the brain that fine tunes and coordinates motor movement, the cerebellum.
a. midbrain c. pons
b. medulla d. substantia nigra

 

 

ANS:  C                    PTS:   1                    REF:   Central Nervous System

 

  1. The ____ of the brain stem controls and coordinates many sensory and motor activities such as the auditory and visual systems as well as voluntary movement.
a. midbrain c. substantia nigra
b. medulla d. neurosubstrate

 

 

ANS:  A                    PTS:   1                    REF:   Central Nervous System

 

  1. The ____ in the brain stem’s midbrain transmits important information to the basal ganglia that is necessary for regulating voluntary motor movement.
a. neurosubstrate c. pons
b. substantia nigra d. dopamine

 

 

ANS:  B                    PTS:   1                    REF:   Central Nervous System

 

  1. The diencephalon region of the brain lies above (rostral) the midbrain and contains the brain structures called the ____ and the ____.
a. thalamus, hyperthalamus c. cortex, neocortex
b. thalamus, hypothalamus d. thalamus, mesencephalon

 

 

ANS:  B                    PTS:   1                    REF:   Central Nervous System

 

  1. The ____-layered neocortex is the highest center of the brain. The word cortex literally means bark and refers to the outside covering of an anatomical structure.
a. three c. five
b. four d. six

 

 

ANS:  D                    PTS:   1                    REF:   Central Nervous System

 

  1. A small cluster of norepinephrine synthesizing cell bodies called the ____ residing in the dorsal brain stem region of the reticular formation (RF) plays an important role in vigilance and arousal and is part of an ascending arousal pathway system that keeps the thalamus and cortex active in receiving and transmitting sensory information.
a. locus cortex c. locus diencephalons
b. limbic ceruleus d. locus ceruleus

 

 

ANS:  D                    PTS:   1                    REF:   Central Nervous System

 

  1. The ____ of the limbic system appears to play a major role in our emotional control system because of its extensive connections with the thalamus and its connections with other parts of the limbic system, including the amygdala and hypothalamus; it has been referred to as the “neurological hub of our affective control system.”
a. anterior cingulate c. locus ceruleus
b. interior cingulate d. locus cingulate

 

 

ANS:  A                    PTS:   1                    REF:   Central Nervous System

 

  1. The ____ nervous system innervates the body’s viscera generally through using both pre-ganglionic neurons (those that exit the spinal cord) and post-ganglionic neurons (those that are stimulated by the pre-ganglionic neurons).
a. central c. somatic
b. peripheral d. autonomic

 

 

ANS:  B                    PTS:   1                    REF:   The Peripheral Nervous System

 

  1. All pre-ganglionic neurons use ____ as their neurotransmitter as do the post-ganglionic neurons of the parasympathetic branch.
a. dopamine c. acetylcholine
b. epinephrine d. norepinephrine

 

 

ANS:  C                    PTS:   1                    REF:   The Peripheral Nervous System

 

  1. The viscera consists of ____.
a. the organs, the ducts and glands, the vagus nerve, and the blood vessels
b. the organs, the ducts and glands, and the smooth muscles (non-striated muscles of the organs and blood vessels)
c. the organs, the ducts and glands, the smooth muscles (non-striated muscles of the organs and blood vessels), and the blood vessels
d. the smooth muscles (non-striated muscles of the organs and blood vessels), the vagus nerve, and the blood vessels

 

 

ANS:  C                    PTS:   1                    REF:   The Peripheral Nervous System

 

  1. The parasympathetic branch supports the ____ state, and the sympathetic branch supports the ____ state.
a. energy mobilization and expenditure, basal energy conservation and restoration
b. basal energy mobilization and restoration, energy conservation and expenditure
c. energy conservation and restoration, basal energy mobilization and expenditure
d. basal energy conservation and restoration, energy mobilization and expenditure

 

 

ANS:  D                    PTS:   1                    REF:   The Peripheral Nervous System

 

  1. The ____ are cone-shaped glands that sit atop the kidneys.
a. medulla c. adrenal cortices
b. adrenals d. adrenal medulla

 

 

ANS:  B                    PTS:   1                    REF:   The Sympathetic-Adrenal Medulla Axis

 

  1. Each adrenal consists of an outer covering, the ____, and an inner core called the ____.
a. pre-ganglionic fibers, paraventricular nucleus
b. sympathetic-adrenal medulla axis (SAM), sympathetic-adrenal cortex axis (SAM)
c. adrenal cortex, adrenal medulla
d. adrenal medulla, adrenal cortex

 

 

ANS:  C                    PTS:   1                    REF:   The Sympathetic-Adrenal Medulla Axis

 

  1. Epinephrine helps to stimulate the release of ____ into the blood stream from ____ stores in the liver and muscles and through a process called ____ converts non-carbohydrate energy stores into glucose for use by the skeletal muscles.
a. glutamate, glutogen, glutogenesis c. sucrose, sucrose, sucrogenesis
b. glycogen, glucose, gluconeogenesis d. glucose, glycogen, gluconeogenesis

 

 

ANS:  D                    PTS:   1                    REF:   The Sympathetic-Adrenal Medulla Axis

 

  1. The paraventricular nucleus of the hypothalamus responds to stressors in part by synthesizing and secreting peptide messengers called releasing factors that are released into the pituitary portal system of the ____.
a. anterior pituitary c. posterior pituitary
b. pituitary gland d. the hypothalamic-pituitary-adrenal axis

 

 

ANS:  A                    PTS:   1                    REF:   The Hypothalamic-Pituitary-Adrenal Axis

 

  1. Most cells in the body depend on ____, a thyroid gland hormone, to regulate their metabolic rate; ____ is a strong hormone that can, with time and sufficient concentration levels, double basal metabolic rate.
a. glucogen c. thyroxine
b. cortisol d. thyrosine

 

 

ANS:  C                    PTS:   1                    REF:   The Thyroxine Axis

 

  1. What could account for some of the memory problems associated with PTSD such as experiencing recurring distressing memories of the trauma or flashbacks (e.g., feelings of reliving the trauma), exaggerated psychological and physiological responses to stimuli that symbolize or have similar characteristics to the traumatic stressors, and difficulties recalling significant aspects of the traumatic event?
a. hyporesponsive hippocampus c. hyperresponsive hippocampus
b. hyporesponsive amygdala d. hyporesponsive amygdala

 

 

ANS:  A                    PTS:   1                    REF:   Traumatic Stress and the Brain

 

  1. ____ refer to unrealistic positive beliefs, may give a person a greater sense of control to cope with the negative impact of a trauma and may be adaptive in the short-term but not result in actual growth. They may help a person cope by thinking that change and growth have occurred when they have not.
a. Accommodating delusions c. Positive delusions
b. Accommodating illusions d. Positive illusions

 

 

ANS:  D                    PTS:   1                    REF:   Posttraumatic Growth

 

  1. There is considerable evidence that the ____ system of the brain functions abnormally for many people with PTSD.
a. sympathetic c. autonomic
b. parasympathetic d. limbic

 

 

ANS:  D                    PTS:   1                    REF:   Traumatic Stress and the Brain

 

 

 

 

 

SHORT ANSWER

 

  1. Describe the components of the central nervous system.

 

ANS:

The central nervous system can be divided into the spinal cord and four major regions of the brain: the brain stem, the cerebellum, the diencephalon (i.e., the “between brain”), and the cerebral hemispheres. Of these neurosubstrate areas, the brain stem can be divided into the medulla, pons, and midbrain (i.e., mesencephalon). The diencephalon is subdivided into the thalamus and the hypothalamus. And the cerebral hemispheres, the largest area of the brain, are divided into the neocortex (otherwise known as the cerebral cortex, the convoluted gray outer covering of the brain) and its underlying white matter and the deeper structures of the basal ganglia, the amygdala, and the hippocampus.

 

PTS:   1                    REF:   Central Nervous System

 

  1. What is the function of the medulla?

 

ANS:

The medulla of the brain stem contains vital life support centers that control autonomic processes such as heart rate, blood pressure, respiration, and digestion. This was the area of the brain responsible for increasing your heart rate, stroke volume, and blood pressure after you heard a bang at your window and perceived it as a potential threat.

 

PTS:   1                    REF:   Central Nervous System

 

  1. What role does dopamine play in the brain’s activities? Where in the brain is it found?

 

ANS:

This midbrain area is unique in that it contains three of the brain’s four major dopaminergic tracts. Its use of dopamine as a neurotransmitter contrasts with the more typical central nervous system use of the neurotransmitter norepinephrine. Dopamine in the brain is important for regulating motor movement. Also, dopamine is noteworthy because it is one of the “feel good” neurotransmitters of the brain that can elevate mood states and combat the effects of stress.

 

PTS:   1                    REF:   Central Nervous System

 

  1. What does the thalamus do?

 

ANS:

The thalamus is an important sensory relay station that gates information from the sense organs (excluding olfactory) to the neocortex, the higher cortical regions of the brain associated with consciousness. When the thalamus opens the gate by increasing the signal to noise ratio or in other words by amplifying the signal to make it stand out against background noise, signal sensory information reaches conscious awareness in the higher center of the brain called the neocortex.

 

PTS:   1                    REF:   Central Nervous System

 

  1. Describe the anatomy of the two cerebral hemispheres.

 

ANS:

The two cerebral hemispheres connected by the corpus callosum (i.e., white matter in the center area that connects the two hemispheres and allows them to communicate with each other) consist of the neocortex otherwise known as the cerebral cortex and the white matter beneath it as well as the basal ganglia, the amygdala, and the hippocampus.

 

PTS:   1                    REF:   Central Nervous System

 

  1. What is a sensory projection system?

 

ANS:

Each sensory system has a specific end point in the neocortex. The circuit from a sense organ moving through the thalamus to its specific region of the neocortex is called the sensory projection system for that sense. For example, from the ears through the auditory nucleus of the thalamus to the auditory projection area of the neocortex is the tract of the sensory projection system for hearing. The thalamus has a distinct nucleus for hearing, for vision, for taste, the muscle senses, and for the skin senses that each relay its respective sensory information to its sensory projection target in the neocortex. Also, it is through the thalamus and its pain projection system to the neocortex that we experience the sensation of pain.

 

PTS:   1                    REF:   The Nervous System

 

  1. What is the reticular formation (RF)?

 

ANS:

The reticular formation (RF) consists of a bundle of approximately 90 separate nuclei that run like a cord through the middle of the brain stem upwards into the diencephalon.  This network of neurons forms both ascending and descending pathways relaying important sensory and motor information between the brain and body. Sensory information from the periphery is relayed in the brain’s ascending pathway through the RF into the thalamus where it is gated to determine if it will be passed on to the neocortex as part of the sensory projection system.  It is through the RF that the hypothalamus sends descending signals to the brain stem and the viscera to activate the autonomically mediated fight-or-flight response. The RF was also involved in rousing you from your slumber when you heard the loud noise at your window.

 

PTS:   1                    REF:   Central Nervous System

 

  1. Describe the limbic system.

 

ANS:

The limbic system was first proposed by James Papez in 1937 and later extended by Paul MacLean as the brain’s neural circuit for emotion. The system includes interconnected phylogenically primitive nuclei and parts of the neocortex that form a circle (a border or limbus) around the inner core of the brain. These structures include the hippocampus, the thalamus, parts of the hypothalamus, the amygdala, the pre-frontal cortex, and other structures such as the cingulated gurus.

 

PTS:   1                    REF:   Central Nervous System

 

  1. What are the targets of the autonomic nervous system’s motor neurons?

 

ANS:

The targets of the autonomic nervous system’s motor neurons include the smooth muscle cells as well as the cardiac muscle (heart muscle) and pacemaker cells (the specialized heart cells that create the heart’s rhythms and therefore regulate its pace of contraction).

 

PTS:   1                    REF:   The Peripheral Nervous System

 

 

 

  1. What happens when the sympathetic branch becomes active during the fight-or-flight response?

 

ANS:

Sympathetic branch activation during the fight-or-flight response results in increased dilation of the pupils for maximal visual access to threatening stimuli. Interestingly, our eyes also dilate when we see pleasurable stimuli, like potential mates, perhaps to also maximize visual access, though for obviously different reasons. The lungs experience bronchial dilation to maximize oxygen input into the bloodstream. The heart rate and stroke volume (the amount of blood ejected during the heart’s contraction) increase while the blood vessels constrict which has the net effect of cranking up the body’s blood pressure to move blood more rapidly through the system so that it can more quickly oxygenate and fuel the brain and large muscles of the body.

 

PTS:   1                    REF:   The Peripheral Nervous System

 

  1. Describe the functions of the endocrine system and how this process differs from direct neural stimulation.

 

ANS:

The endocrine system is a system of organs and glands that secrete hormones into our blood stream that act as biochemical messengers to their respective target cells and organs. Upon reaching these targets, these hormonal messengers regulate activity of the cells they affect. Since the process requires the circulatory system to deliver the message to target cells, it is much slower than the almost instantaneous direct neural transmission to the target organs. However, once hormones reach their targets, their overall effect is sustained until these molecules are metabolized by the body. Whereas direct neural stimulation can be likened to the speed and shorter duration of a sprinter, hormonal action can be likened to the slower but longer term endurance of a long-distance runner. Each has its advantages and disadvantages. During the fight-or-flight response the endocrine system and the sympathetic nervous system work as somewhat redundant systems to synergistically achieve a common outcome.

 

PTS:   1                    REF:   Stress and the Endocrine System

 

  1. What is the sympathetic-adrenal medulla axis (SAM)?

 

ANS:

The primary command center for the endocrine’s stress response is in the hypothalamus, and one of its primary target organs is the adrenal gland. By transmitting signals through the brain stem’s nucleus of the solitary tract into pre-ganglionic fibers of the sympathetic nervous system directly to the adrenal medulla, the paraventricular nucleus of the hypothalamus has a strong influence over this region of the adrenals. This sympathetic-adrenal medulla axis (SAM) forms one of the primary systems of the fight-or-flight response.

 

PTS:   1                    REF:   The Sympathetic-Adrenal Medulla Axis

 

  1. Briefly describe the structure of the pituitary gland.

 

ANS:

The pituitary gland is the pea-sized master gland at the base of the brain. Like the adrenal gland, it is a structure with two glandular regions with separate functions. It is divided into an anterior and a posterior region rather than an inner and outer region as the adrenal gland is.

 

PTS:   1                    REF:   The Hypothalamic-Pituitary-Adrenal Axis

 

 

  1. What is beta-endorphin and what is its function?

 

ANS:

Beta-endorphin is a natural opiate that has strong analgesic (pain relieving) properties. In an imminent life threatening struggle with a predator or competitor, pain from acute injury could debilitate a person and prevent that person from escaping the threat. Therefore, it is more adaptive for a person’s survival to have systems that temporarily inhibit pain until the person is safe from imminent threat. Beta-endorphin serves this purpose.

 

PTS:   1                    REF:   The Hypothalamic-Pituitary-Adrenal Axis

 

  1. What are glucocorticoids?

 

ANS:

Adrenocorticotropic hormone (ACTH) stimulates the adrenal cortex to release glucocorticoids that play an important role in the fight-or-flight response. Glucocorticoids are a family of steroid compounds that were so named because of their effect of raising glucose levels in the bloodstream. The primary glucocorticoid secreted by the adrenal cortex is cortisol.

 

PTS:   1                    REF:   The Hypothalamic-Pituitary-Adrenal Axis

 

  1. What effects do high levels of thyroxine have on stress and on the body?

 

ANS:

High levels of thyroxine can produce feelings of nervousness or anxiety, insomnia, increased heart rate, increased respiration leading to a sensation of shortness of breath, excessive sweating, diarrhea (due to increased gastric secretions and motility), and feelings of tiredness. The hormone can also amplify the effects of epinephrine, causing persons to experience more intense stress reactions to acute stressors than their normal reactions. Given its longevity and staying power relative to the majority of other stress-related hormones, the effects of thyroxine may explain why some individuals under chronic stress have difficulty returning to baseline levels once they leave a stressful environment. For example, some people have difficulty relaxing even during a one or two week vacation.

 

PTS:   1                    REF:   The Thyroxine Axis

 

  1. How is thyroxine released in the thyroxine axis?

 

ANS:

Like the SAM and HPA axis, the action for the thyroxine axis begins with the hypothalamus. The paraventricular nucleus of the hypothalamus responds to the demands on our systems to increase metabolism by releasing a polypeptide messenger releasing factor into the portal system of the anterior pituitary. This biochemical messenger prompts the anterior pituitary to release a compound called thyroid stimulating hormone (TSH). TSH then travels through the blood stream to the thyroid gland, a gland shaped like a butterfly that sits just below the larynx (the Adams apple is a good outer reference point for the larynx), prompting the release of thyroxine.

 

PTS:   1                    REF:   The Thyroxine Axis

 

 

 

 

 

 

 

  1. What are traumatic stressors?

 

ANS:

Traumatic stressors are events such as combat, natural or human-made disasters, violent assault, sexual assault, kidnapping, torture, serious or life- threatening accidents, a life-threatening diagnosis, a close friend or relative dying suddenly and unexpectedly, being held captive perhaps as a POW or in a concentration camp, or other highly distressing experiences that can result in feelings of terror, extreme fright, or helplessness. As is the case with all stressors, a person’s reaction to severe stressors is individualistic and subjective, in part, because each person appraises the stressors through the lens of his or her own belief system or world view.

 

PTS:   1                    REF:   Traumatic Stress and the Brain

 

  1. What is post-traumatic stress disorder (PTSD)?

 

ANS:

Unfortunately for some, the reaction to traumatic stressors may result in the development of a post-traumatic stress disorder (PTSD). PTSD is characterized by a number of symptoms including persistently re-experiencing the traumatic event, avoiding stimuli correlated with the traumatic event, experiencing a general response numbing, and having persistent increased arousal. The duration of the overall symptom pattern lasts at least a month, and there is distress or impairment in one or more primary areas of functioning.

 

PTS:   1                    REF:   Traumatic Stress and the Brain

 

  1. What is posttraumatic growth?

 

ANS:

Not everyone suffers from PTSD or other impairments in ability to function following trauma and only a minority develop PTSD. Some may even have transcendent experiences or find meaning in suffering. In the days following the experience of psychological trauma, individuals may have at minimum subclinical symptoms or brief reactive symptoms (less intense or temporary symptoms than would be associated with PTSD), though they may have no long-term resulting functional impairment. In time, a certain percentage of people exposed to traumatic events ultimately experience positive changes. These individuals are said to have experienced posttraumatic growth.

 

PTS:   1                    REF:   Posttraumatic Growth

 

ESSAY

 

  1. Describe the role(s) of the hypothalamus and in what context it operates.

 

ANS:

The hypothalamus of the diencephalon consists of powerful nuclei that regulate, control, or are involved with most of the body’s central and autonomic nervous system activities during the fight-or-flight reaction. This center for the fight-or-flight reaction became activated once you became consciously aware of the potential threat of the bang sound.

 

The hypothalamus exerts direct control over fight-or-flight activities during stress through influencing the brain stem to activate sympathetic responses of the viscera and indirect control through its connection to the master gland, the pituitary, to stimulate the endocrine system to facilitate a wide range of fight-or-flight responses. The hypothalamus is responsive to the neocortical command centers, including those involved with cognitions and emotional states, such as the frontal cortex (the outer covering of the brain behind the forehead). The primary emotional arousal states of fear linked to flight and anger linked to fight are strongly associated with the hypothalamus. Electrical stimulation of the posterior (back) region of the hypothalamus produces arousal like when you awakened from sleep after hearing the bang whereas stimulation of the anterior (front) region and the adjacent basal forebrain region produces sleep.

 

PTS:   1                    REF:   Central Nervous System

 

  1. What is the function of the amygdala? How does its function relate to stress and memories?

 

ANS:

The amygdala of the cerebral hemispheres however is important to our understanding of our physiological and emotional responses to stress. It is part of the limbic system that will be discussed later and is made of about 10 nuclei that are involved in mediating emotional responses, particularly fear and anxiety. How do we know this? We know this because people who have had their amygdala electrically stimulated report these emotional states. It is also involved in the social recognition of the fear state in the faces of others. Lesions of this area due to disease impair this emotion recognition ability. The amygdala also seems to participate in the process of storing memories about which stimuli should be approached and which to avoid. It seems to be involved in assessing threat stimuli and in emotional memory formation. Further, the amygdala participates in the process of classically conditioned fear responses where we learn to associate particular stimuli with fear or anxiety.

 

PTS:   1                    REF:   Central Nervous System

 

  1. Explain how the hippocampus and amygdala work together, using specific examples.

 

ANS:

The hippocampus, named after the Greek word for seahorse because of its long curved shape structure, has a more direct role in the memory process and is involved in encoding long term memories of events that can be consciously discussed termed declarative memories. It seems to have only an indirect role in the sensation and experience of emotion. The hippocampus appears to work with the amygdala in the fear conditioning process by encoding context while the amygdala adds the emotion. Thus, seeing a poisonous snake behind glass in a zoo is a context that is not as frightening as seeing that same snake a few feet ahead of you on a hiking trail. It is the hippocampus that helps the amygdala put the threat significance of the snake in its proper situational context so that your amygdala adds fear to the experience of the snake on the trail but not to the experience of the snake in the zoo. Likewise, it is the hippocampus that helped you determine if the bang sound was dangerous enough to signal your amygdala to activate your fear emotions. Memories encoded by your hippocampus of your neighbor’s Siamese tomcat previously banging against your window late at night as it jumped up onto your outside window ledge enabled you to eventually put the bang in a non-threatening context and resume your slumber.

 

PTS:   1                    REF:   Central Nervous System

 

 

 

 

 

 

  1. Describe the peripheral nervous system including its subsystems and their basic functions.

 

ANS:

The peripheral nervous system is comprised of both the somatic nervous system and the autonomic nervous system. The somatic nervous system innervates the skeletal muscles (striated muscles), the skin, and the sense organs. This bidirectional neural network transmits information from the brain to the periphery (the outer regions) and vice versa. The neural pathways that send signals from the brain to the periphery are called efferent and those that send signals from the periphery to the brain are called afferent.

 

In the somatic nervous system efferent pathways carry messages from the motor areas of the neocortex to the striated (red colored) muscles to facilitate voluntary motor movement.  Afferent pathways carry sensory information from the sense receptors to the sensory areas of the neocortex through the sensory projection systems. During the fight-or-flight response the brain sends messages through the efferent neurons to the striated muscles to tense in preparation for physical action.

 

PTS:   1                    REF:   The Peripheral Nervous System

 

  1. Describe the function of the parasympathetic branch of the autonomic system and how it works in conjunction with the sympathetic branch.

 

ANS:

The parasympathetic branch of the autonomic system is generally associated with the state of relaxation, and after a stressful encounter its activation serves to damp down the fight-or-flight response. As noted previously, the neurons of this system have their effect on their visceral targets through the use of the neurotransmitter acetylcholine. Most tissues of the viscera are innervated by both branches of the system. There are some exceptions; for example, the blood vessels and the adrenal medulla receive only sympathetic branch neurons.

 

Though it is common to think that only the sympathetic branch excites the organs (e.g., heart rate increase), that is a misconception. For example, it is the parasympathetic branch and not the sympathetic branch that excites the gastrointestinal system. The reason that some components of the viscera are excited by the sympathetic branch and others by the parasympathetic branch has to do with how the body’s systems deal with threats to its survival. During normal resting non-stress periods it is more adaptive for the body to ingest food when needed, digest it, and store its energy. Without doing this, the body will not survive. However, during acute stress periods when there is imminent threat to survival, it is more adaptive to avoid ingesting food, stop digesting food previously ingested, and start mobilizing and expending energy. That is, to activate the fight-or-flight response.

 

PTS:   1                    REF:   The Peripheral Nervous System

 

 

 

 

 

 

 

 

 

 

 

 

 

 

  1. Explain the effects of epinephrine on the cardiovascular system in detail. What system within the body do epinephrine injections mimic?

 

ANS:

Epinephrine has a marked effect on the cardiovascular system causing both an increase in heart rate and stroke volume as well as constriction of some blood vessels (the arterioles of the skin and abdominal viscera) and dilation of others (the arterioles of the skeletal muscles). The net effect is to shunt blood away from the outer periphery and digestive system and into the brain and large skeletal muscles. It also dilates the bronchi of the lungs to increase oxygen intake into the blood stream. Epinephrine helps to stimulate the release of glucose (i.e., sugar) into the blood stream from glycogen (long chains of glucose) stores in the liver and muscles and through a process called gluconeogenesis converts non-carbohydrate energy stores into glucose for use by the skeletal muscles. The net effect is an increase in the body’s metabolic rate (the amount of energy expended by the body). In general, the hormone epinephrine has the same effect as the sympathetic nervous system on its target organs. For example, epinephrine injections given to treat severe allergic reactions can produce sympathetic pattern side effects such as a racing heart, nausea, sweating, tremors, headaches, and feelings of anxiety.

 

PTS:   1                    REF:   The Sympathetic-Adrenal Medulla Axis

 

  1. Discuss the differences between the effects of norepinephrine and epinephrine on the body’s systems.

 

ANS:

Norepinephrine has much the same effect as epinephrine on the body’s systems. However, norepinephrine is released by the adrenal medulla in smaller amounts than epinephrine. The ratio of release is 1 to 5 of norepinephrine to epinephrine though this ratio may change under different conditions. The effects of the circulating hormone norepinephrine last up to 10 times longer than the release of the neurotransmitter norepinephrine on the target cells by the sympathetic post-ganglionic fibers. There is some research to indicate that epinephrine plays a much greater role in mental stressors such as mental arithmetic, and norepinephrine plays a greater role in physical stressors such as physical exercise. Also, epinephrine appears to be most closely associated with the emotional state of fear and norepinephrine with anger. Although both epinephrine and norepinephrine have similar effects on the heart, the effect is greater with epinephrine. Epinephrine also produces 5 to 10 times the acceleration of the body’s metabolic rate than norepinephrine and is capable of more than doubling the body’s normal rate.

 

PTS:   1                    REF:   The Sympathetic-Adrenal Medulla Axis

 

  1. Cortisol is an important steroid with many roles. Describe some of these roles and how it carries them out.

 

ANS:

The primary glucocorticoid secreted by the adrenal cortex is cortisol (known also as hydrocortisone) which accounts for over 95% of the effects on the body of this class of steroids. Cortisol is needed by cells for normal cellular function. Like epinephrine, it affects metabolism through the process of gluconeogenesis. It also somewhat reduces glucose use at the cellular level. The combined effect of gluconeogenesis and reduced cellular use of glucose is to increase the overall glucose concentration in the bloodstream.

 

Cortisol also promotes the liberation of fatty acids from fat stores in a process known as lipolysis for use as a fuel source and increases concentrations of blood amino acids (protein building blocks) in the bloodstream so they can be converted into glucose by the liver for muscle energy. This important steroid readies stress responses by increasing catecholamine synthesis at the neuronal level and by the adrenal medulla. It can sharpen memory functions of the hippocampus and increase sensitivity of the thalamus to sensory inputs. In addition, cortisol reduces inflammation and plays a role through a negative feedback loop in regulating central nervous system excesses. Along with psychological stressors, physical stressors such as intense heat and cold, surgical operations, and the experience of disease states will all increase cortisol levels.

 

PTS:   1                    REF:   The Hypothalamic-Pituitary-Adrenal Axis

 

  1. How does a traumatic stressor affect one’s world view? Give an example from your own life or from someone else’s you know well.

 

ANS:

An encounter with traumatic stressors often poses a serious challenge to one’s world view. A person’s world view is a collection of assumptions and beliefs about oneself, others, and the world. Tedeschi and Calhoun liken an encounter with a traumatic stressor to an encounter with an earthquake in which “a psychologically seismic event can severely shake, threaten, or reduce to rubble many of the schematic structures that have guided understanding, decision making, and meaningfulness.” Assumptions regarding safety and security are likely to be seriously disturbed or undermined and may result in a shattering or shakeup of a survivor’s pre-trauma world view. How a person adapts to these challenges determines how transient or chronic the trauma reactions and symptoms may be.

 

PTS:   1                    REF:   Traumatic Stress and the Brain

 

  1. Imagine you are a survivor of a major natural disaster that killed many people and nearly took your own life. Now image that this event was a transcendental experience for you, resulting in personal posttraumatic growth. Describe what changes you might experience in your daily life. How would you be different?

 

ANS:

Posttraumatic growth is usually reported by trauma survivors who experience it as having three interrelated themes: (1) relationships are strengthened or enhanced, (2) self views become more positive, and (3) world views or life philosophies are changed in positive directions. For example, survivors may feel more compassion, altruism, and gratitude toward friends and family. They may have a greater sense of resiliency and personal strength along with a greater acceptance of their personal limitations. In addition, they may view life and their world with a greater sense of appreciation. In general posttraumatic growth seems to be associated with a perception that one has experienced a high level of threat or harm and has been able to exert some control over the traumatic events or outcomes.

 

Posttraumatic growth does not appear to be a mere polar opposite of PTSD, but is rather a product of successful adaptation to trauma that may emerge independently from any point on the stress reaction continuum. Some describe the experience as having been given a second chance. There may be greater mindfulness of everyday experiences that had previously been taken for granted. Relationships and opportunities may be valued more highly. Individuals may report greater clarity of purpose, meaning, or direction in life.

 

PTS:   1                    REF:   Posttraumatic Growth

Chapter 7: Anxiety, Anger, and Depression

 

MULTIPLE CHOICE

 

  1. ____ involves mentally recycling concerns—it is the process of repeating our thoughts associated with anxiety.
a. Anger c. Worry
b. Fear d. Rage

 

 

ANS:  C                    PTS:   1                    REF:   Anxiety

 

  1. People with ____ may experience symptoms such as fatigue, muscle tension, restlessness, irritability, sleep disturbances, or difficulty concentrating. Depression may also be present.
a. GAD c. PTSD
b. panic disorder d. obsessive-compulsive disorder

 

 

ANS:  A                    PTS:   1                    REF:   Generalized Anxiety Disorder (GAD)

 

  1. ____ is characterized by repeated and unexpected panic attacks along with worry and concern about reoccurrence of attacks.
a. Obsessive-compulsive disorder c. PTSD
b. Panic disorder d. GAD

 

 

ANS:  B                    PTS:   1                    REF:   Panic Disorder

 

  1. People with a high level of interoceptive sensitivity, especially if they are acutely aware of heartbeat activity, are more likely to experience ____.
a. anxiety and anxiety disorders c. panic disorder
b. obsessive-compulsive disorder d. phobias

 

 

ANS:  A                    PTS:   1                    REF:   Panic Disorder

 

  1. A person diagnosed with ____ has an unreasonable or excessive fear of a particular object, situation, or activity.
a. GAD c. panic disorder
b. phobia d. PTSD

 

 

ANS:  B                    PTS:   1                    REF:   Phobias

 

  1. Persons with ____ are fearful of being in a public place or outside the home to the extent that it might be difficult for them to leave without embarrassment or to get help should they have a panic attack.
a. nyctophobia c. social phobia
b. astrophobia d. agoraphobia

 

 

ANS:  D                    PTS:   1                    REF:   Phobias

 

  1. ____ is a reaction to traumatic stressors (death-or injury-related stressors that evoke helplessness, extreme fear, or horror) that results in reexperiencing the traumatic event, avoiding stimuli correlated with the event, experiencing general response numbing, and having persistent increased arousal.
a. PTSD c. Obsessive-compulsive disorder
b. GAD d. Panic disorder

 

 

ANS:  A                    PTS:   1                    REF:   Posttraumatic Stress Disorder (PTSD)

 

  1. ____ has a high frequency of comorbidity (i.e., co-occurrence) with other anxiety disorders, major depressive disorder, and alcohol use disorders—calling some to question whether it is really a distinct syndrome.
a. PTSD c. Obsessive-compulsive disorder
b. Panic disorder d. Social phobia

 

 

ANS:  A                    PTS:   1                    REF:   Posttraumatic Stress Disorder (PTSD)

 

  1. ____ boost(s) serotonin levels in the brain which then often results in lowered anxiety and depression levels.
a. Norepinephrine c. SSRIs
b. GABA d. Dopamine

 

 

ANS:  C                    PTS:   1                    REF:   Treatments for Anxiety Disorders

 

  1. ____ is an inhibitory neurotransmitter that reduces neuronal excitation.
a. Dopamine c. Norepinephrine
b. Endorphin d. GABA

 

 

ANS:  D                    PTS:   1                    REF:   Treatments for Anxiety Disorders

 

  1. ____ are occasionally used to reduce organ system responses to anxiety. For those with a high level of interoceptive sensitivity, this class of medications may bring relief in certain situations.
a. SSRIs c. Anxiolytics
b. Beta blockers d. Benzodiazepines

 

 

ANS:  B                    PTS:   1                    REF:   Treatments for Anxiety Disorders

 

  1. Meta-analytic studies report that exposure therapy is the most effective treatment for ____ when combined “with relaxation training and/or breathing retraining techniques.”
a. panic disorder c. phobias
b. GAD d. obsessive-compulsive disorder

 

 

ANS:  A                    PTS:   1                    REF:   Treatments for Anxiety Disorders

 

  1. Meta-analytic studies report that exposure therapy is the most effective treatment for ____ when combined with response prevention.
a. panic disorder c. GAD
b. obsessive-compulsive disorder d. phobias

 

 

ANS:  B                    PTS:   1                    REF:   Treatments for Anxiety Disorders

 

  1. Meta-analytic studies report that exposure therapy is the most effective treatment for ____, with in vivo exposure being more effective than imaginal exposure or virtual reality exposure.
a. obsessive-compulsive disorder c. specific phobias
b. PTSD d. GAD

 

 

ANS:  C                    PTS:   1                    REF:   Treatments for Anxiety Disorders

 

  1. ____ therapy may well be positioned to become the next wave, the “third wave,” behind cognitive therapy (the second wave), and behavior therapy (the first wave) in the treatment of anxiety disorders.
a. Mindfulness-based c. Exposure
b. Interpersonal d. Cognitive behavioral

 

 

ANS:  A                    PTS:   1                    REF:   Treatments for Anxiety Disorders

 

  1. ____ resets baseline arousal to its normal level so that it takes a lot more stimulation to reach the physiological red zone.
a. Engaging in aerobic exercise c. Accepting anxiety as natural
b. Focusing attention outwards d. Reducing stimulants

 

 

ANS:  D                    PTS:   1                    REF:   Anxiety Management

 

  1. Chronically angry people often lean excessively on the defense mechanism of ____ and will critically find flaws and weaknesses in others that are really just outward manifestations of disowned elements of their own personality.
a. projective identification c. projection
b. acting out d. somatization

 

 

ANS:  C                    PTS:   1                    REF:   Anger

 

  1. According to ____, if anger is not expressed, it builds like steam in a locomotive’s steam engine until it explodes.
a. hydraulic model c. diathesis-stress model
b. catharsis theory d. positive mental health models

 

 

ANS:  B                    PTS:   1                    REF:   Anger Management

 

  1. The ____ refer(s) to a tendency among depressed people to view in a negative light (1) the self (e.g., “I am worthless”), (2) the world (“This situation is impossible”), and (3) the future (“I’ll never be successful”).
a. maladaptive attitudes c. automatic negative thoughts
b. errors of thinking d. negative cognitive triad

 

 

ANS:  D                    PTS:   1                    REF:   Depression

 

  1. ____ such as “If I do not perform as well as others, it means that I am an inferior human being” or “My value as a person depends greatly on what others think of me” are well-springs for automatic negative thoughts.
a. Negative cognitive thoughts c. Maladaptive cognitive thoughts
b. Maladaptive attitudes d. Errors of thinking

 

 

ANS:  B                    PTS:   1                    REF:   Depression

 

SHORT ANSWER

 

  1. Describe the medical student syndrome.

 

ANS:

Be aware that there is a phenomenon known as the medical student syndrome where medical students tend to see symptoms in themselves of various diseases they are studying.

 

PTS:   1                    REF:   Anxiety

 

  1. GAD is more commonly diagnosed in women than men. What is the most prominent cause for this gender difference?

 

ANS:

Gender differences like these are found in many of the anxiety disorders and could be due to multiple causes, the most prominent being that there is greater social approval for females than males to experience and express anxiety-related emotions.

 

PTS:   1                    REF:   Generalized Anxiety Disorder (GAD)

 

  1. Describe interoceptive sensitivity

 

ANS:

Interoceptive sensitivity is a conscious awareness of internal physiological activity.

 

PTS:   1                    REF:   Panic Disorder

 

  1. Describe the experience of a first panic attack. How common is it to mistake the first panic attack with a heart attack?

 

ANS:

During a first panic attack, it is not uncommon for people to mistakenly believe they are having a heart attack, since symptoms such as a pounding heart, palpitations, rapid heart rate, chest pain, sweating, shortness of breath, numbness, tingling, or dizziness are common to both conditions.

 

PTS:   1                    REF:   Panic Disorder

 

  1. Is there a gender difference in the diagnosis of panic disorder? What is the age of onset?

 

ANS:

Panic disorder, more common in women than men, has an age of onset typically occurring in late adolescence or, less commonly, in the mid-30s.

 

PTS:   1                    REF:   Panic Disorder

 

  1. A person diagnosed with an obsessive-compulsive disorder has recurrent obsessions or compulsions. What do obsessions refer to? Compulsions? Provide examples of common obsessions and compulsions.

 

ANS:

A person diagnosed with an obsessive-compulsive disorder has recurrent obsessions or compulsions. Obsessions refer to thoughts, images, or impulses that are intrusive or inappropriate enough to cause a marked elevation of anxiety whereas compulsions refer to behaviors or mental acts that are ritualistic and designed to lower anxiety. Common obsessions include anxiety themes concerning contamination, order, doubts, or aggressive or sexual imagery—normal worries about everyday problems do not qualify. Common compulsions include repetitive behaviors such as hand washing, checking, or ordering of objects, or mental acts such as counting, praying, or silently repeating words.

 

PTS:   1                    REF:   Obsessive-Compulsive Disorder

 

  1. Is there a gender difference in the diagnosis of obsessive-compulsive disorder? At what age range is it likely to begin for females? For males?

 

ANS:

Obsessive-compulsive disorder is more likely to begin during the age range of 6 to 15 years for females and from ages 20 to 29 years for males, with the disorder being equally common for males and females (total incidence probably less than 2% of the population).

 

PTS:   1                    REF:   Obsessive-Compulsive Disorder

 

  1. The first line of drug treatment today for most forms of anxiety disorders is the SSRIs. Why?

 

ANS:

The first line of drug treatment today for most forms of anxiety disorders is the SSRIs since they can be taken daily on a long-term basis with overall better results and fewer complications than other medications. They also reduce any depression symptoms that may accompany anxiety disorders.

 

PTS:   1                    REF:   Treatments for Anxiety Disorders

 

  1. For obsessive-compulsive disorder, response prevention is added to the exposure therapy. Describe response prevention.

 

ANS:

Response prevention refers to the practice of the person engaging in planned prevention of compulsive behaviors when he or she is exposed to the feared event or stimulus. Thus, the person with obsessive-compulsive disorder not only undergoes the process of habituation of fear or anxiety through exposure, but when he or she does not act upon the compulsive urge, through using response prevention, he or she also learns to recognize that a ritual is not necessary to prevent feared outcomes (e.g., the home will not burn down because the stove was not repeatedly checked).

 

PTS:   1                    REF:   Treatments for Anxiety Disorders

 

  1. Describe cognitive behavioral therapy.

 

ANS:

Cognitive behavioral therapy (one variation is called cognitive restructuring) is a short-term (generally 12 or 16 sessions in versions that use manuals to standardize the process) cognitively oriented therapeutic approach designed to challenge dysfunctional automatic thoughts, assumptions, and beliefs that sustain a particular disorder and to replace them with healthier realistic thinking patterns.

 

PTS:   1                    REF:   Treatments for Anxiety Disorders

 

  1. What is the first step for someone with debilitating chronic anxiety? The next recommended step?

 

ANS:

Consulting a physician to rule out any organic causes of anxiety should be the first step for someone with debilitating chronic anxiety. If physical causes are ruled out, the next recommended step would be to consult an appropriate mental health professional for treatment.

 

PTS:   1                    REF:   Anxiety Management

 

  1. Deep abdominal breathing is the preferred method for anxiety reduction. Describe this technique of breathing.

 

ANS:

During abdominal breathing, the first part of the breath is drawn into the lower part of the lungs which results in the abdomen expanding. The remaining breath is drawn into the upper part of the lungs which results in the chest expanding.

 

PTS:   1                    REF:   Anxiety Management

 

  1. What is righteous anger?

 

 

 

ANS:

Righteous anger is an empowering form of anger in which a person expresses indignation, outrage, and moral superiority over another. This form of anger is sometimes a cover for feelings of vulnerability.

 

PTS:   1                    REF:   Anger

 

  1. What are the benefits of anger?

 

ANS:

In fact, anger has its benefits in that it can signal a person that there are problems that need to be addressed. It can also energize individuals to take action and to make constructive changes. In relationships, anger can signify that tensions are running high and feelings need to be assertively communicated to lower frictions and address issues.

 

PTS:   1                    REF:   Anger

 

  1. What is passive-aggressive behavior? Provide an example.

 

ANS:

Passive-aggressive behavior is a form of passive resistance to others through procrastination, excuse-making, obstructionism, or poor or destructive performance of tasks where the person engaging in the behavior does not take responsibility for his or her actions or inactions. For example, a teen who reluctantly agrees to a parents’ request to wash the family’s dishes, procrastinates, and then “accidentally” breaks a few dishes when finally washing them is engaged in passive-aggressive behavior to avoid having to do the dishes in the future.

 

PTS:   1                    REF:   Anger Management

 

  1. Define ruminative thinking.

 

ANS:

Ruminative thinking is a repetitive form of thinking in which one repeatedly and in an abstract-evaluative way ponders about oneself, and about the possible causes, meaning, and implications of one’s sad and depressed feelings.

 

PTS:   1                    REF:   Depression

 

  1. What is interpersonal psychotherapy? How many sessions does this therapy entail? What is the primary focus of the treatment?

 

ANS:

Interpersonal psychotherapy for depression includes helping depressed persons recognize and deal effectively with interpersonal issues that concern their depression. The therapy generally entails around 16 sessions. As Craighead et al. (2007, p. 298) note, “the primary problem areas targeted include unresolved grief, interpersonal disputes, role transitions, and interpersonal deficits (e.g., social isolation).” Thus, as in behavioral social skills training, the social context of the disorder is addressed as a focus of treatment—in this case, the primary focus.

 

PTS:   1                    REF:   Depression

 

  1. Define errors of thinking.

 

ANS:

Errors of thinking refer to cognitive processing styles that are distorted, biased, or illogical.

 

PTS:   1                    REF:   Depression

 

  1. List at least four types of thinking errors.

 

ANS:

Beck identifies a number of thinking errors including (1) arbitrary inference (drawing conclusions without supportive evidence), (2) selective abstraction (focusing on a detail that ignores the more important big picture), (3) overgeneralization (drawing sweeping conclusions based on limited information), (4)  dichotomous thinking (thinking in black or white terms rather than shades of gray), (5) magnification and minimization (exaggerating small events or trivializing big events), and (6) personalization (taking responsibility for events that are not under one’s control).

 

PTS:   1                    REF:   Depression

 

  1. How does engaging in aerobic exercise work as a strategy for dealing with depression?

 

ANS:

There is considerable evidence that engaging in aerobic exercise will boost the “feel good” chemicals in your brain and also reduce anxiety that often accompanies depressed moods. Being on a regular exercise routine can also be used as a preventative strategy for reducing the likelihood or frequency of future depressed moods. In fact, depressed moods can be motivators to strengthen your desire to also implement other healthy lifestyle strategies such as healthy eating and using stress management.

 

PTS:   1                    REF:   Dealing with Depression

 

ESSAY

 

  1. Differentiate anxiety from fear.

 

ANS:

Generally speaking, fear is the emotion we feel when there is concrete danger, such as the feeling of fright you have when suddenly encountering a growling large muscular dog in your flower bed. There is a very real possibility that you could receive some unwanted tooth marks on your leg as that scenario unfolds. So your fear is well founded.

 

On the other hand, anxiety involves more complex and diffuse feelings of uneasiness related to possible impending threats. Anxiety is very future oriented and can capture more abstract threats than fear (e.g., the anxiety of losing face in front of an audience).  We often use words like nervous, apprehensive, and uneasy to capture the anxiety emotions. Worry involves mentally recycling concerns—it is the process of repeating our thoughts associated with anxiety.

 

PTS:   1                    REF:   Anxiety

 

 

 

 

 

 

 

 

 

 

  1. Describe existential anxiety. Provide examples. What events may trigger existential anxiety?

 

ANS:

Besides everyday anxiety, we can feel existential anxiety, a form of anxiety associated with awareness of ultimate concerns such as death, meaning, freedom, and isolation (Yalom, 1980). These concerns capture the essence of existence and embody the cosmic questions such as “What happens after death?” “What is the meaning of life?” “Why do we exist?” “How much freedom do we really have?” “What is loneliness and why do we experience it?” Certain events such as the death of a loved one, a diagnosis of a serious illness, separation or divorce, difficult choices that have long lasting life consequences (educational, career, or romantic commitments, etc.), traumatic events that evoke a crisis of meaning, midlife or other lifespan transitional passages, and so forth, may trigger existential anxiety.

 

PTS:   1                    REF:   Anxiety

 

  1. What are specific phobias? Provide examples. Are there gender differences in the diagnosis of specific phobias? How common are specific phobias?

 

ANS:

Specific phobias are intense and exaggerated fears of specific objects or situations other than public places or social contexts covered by the other phobia categories. Examples of common specific phobias include fear of particular animals, storms or heights, seeing blood or receiving an injection, flying or driving, or fear of choking to name a few. Specific phobia is more common in women than men by a ratio of 2 to 1 (American Psychiatric Association, 2000). This disorder is considered to be one of the most common of the anxiety disorders (lifetime prevalence estimate is 12.5%; Kessler et al., 2005).

 

PTS:   1                    REF:   Phobias

 

  1. What is the most effective behavioral approach in treating anxiety disorders? Describe this type of therapy.

 

ANS:

 

The behavioral approach that is most effective in treating anxiety disorders is exposure therapy, a form of therapy in which the person in treatment systematically confronts the feared event or stimulus in a safe and controlled environment. Exposure may be through one’s imagination (imaginal exposure such as systematic desensitization), reality (in vivo), or virtual reality. In addition to working with the therapist during sessions, individuals receiving exposure therapy will usually engage in homework between sessions (e.g., confronting fearful situations) without the therapist being present to generalize the positive effects outside of the therapeutic setting. The reduction of anxiety or fear symptoms is believed to occur through a classically conditioned process of extinction and habituation. The fear or anxiety response that is linked to the stimulus gradually diminishes over 8 to 12 sessions (a standard length of treatment).

 

PTS:   1                    REF:   Treatments for Anxiety Disorders

 

  1. Describe intermittent explosive disorder (IED). What health conditions are people diagnosed with IED at a greater risk of developing?

 

 

 

 

 

ANS:

Intermittent explosive disorder (IED) is a psychiatric disorder characterized by episodes of extreme anger and acting out the anger through assaults or the destruction of property. A person with this disorder has “spells” or “attacks” and often feels remorseful afterwards. A recent study found that people diagnosed with IED are at greater risk for developing a number of adverse health conditions such as CHD, stroke, hypertension, diabetes, back or neck pain, headaches, chronic pain, arthritis, and ulcers (McCloskey, Kleabir, Berman, Chen, & Coccaro, 2010).

 

PTS:   1                    REF:   Anger

 

  1. What reasons account for the ineffectiveness of the catharsis strategy?

 

ANS:

There is a large body of social psychology research showing that catharsis activity is not only ineffective in reducing anger, but it actually increases rather than decreases hostility and aggression (see Aronson, Wison, & Akert, 2010, pp. 374-378, for a discussion). For example, Aronson et al. (2010, p. 375) note that “verbal acts of aggression are followed by further attacks.” The reason catharsis does not work is because it hardens thoughts and attitudes that foster blame and derogation of the target of anger. This then leads to self-justification for harboring angry feelings. Such self-justification can lead to acting on the angry feelings in an aggressive way. The unintended effect of catharsis is to add more steam to the steam engine, causing it to overheat and go off the tracks.

 

PTS:   1                    REF:   Anger Management

 

  1. Describe a person with a major depressive disorder.

 

ANS:

A person with a major depressive disorder has at least one major depressive episode that lasts 2 weeks or more “during which there is either depressed mood or the loss of interest or pleasure in nearly all activities” (American Psychiatric Association, 2000). Almost everybody experiences occasional episodes of mild depression or the blues. However, a person with a major depressive episode experiences depressed moods that stretch throughout the day almost every day for at least 2 weeks. Besides depressed mood or loss of interest in pleasurable activities, symptoms of this form of clinical depression include most, but not necessarily all, of the following: almost daily insomnia or hypersomnia (sleeping too much), significant weight loss (not due to dieting) or gain, excessive daily fatigue, feelings of worthlessness or inappropriate guilt, poor concentration, or recurrent suicidal thoughts. As you can see, this is significantly more severe than the blues.

 

PTS:   1                    REF:   Depression

 

  1. What are the vulnerability factors for depression?

 

ANS:

As we discussed in Chapter 5, individuals with severe or chronic medical conditions (e.g., myocardial infarction) are more likely to experience depression and some of these persons will develop major depression disorder (estimates range from 20% to 25%) (American Psychological Association, 2000). Low self-esteem is also a vulnerability factor for depression. As Brown (1998, p. 234) remarks, “low self-esteem puts people at risk for developing depression when a negative life event occurs.” Orth, Robins, and Meir (2009) concluded, based on assessments of data collected from three longitudinal studies that even under low stress conditions low self-esteem is a vulnerability factor to depression.

 

Engaging in ruminative thinking about one’s depression, defined as “a repetitive form of thinking, in which one repeatedly and in an abstract-evaluative way ponders about oneself, and about the possible causes, meaning, and implications of one’s sad and depressed feelings” is also a vulnerability factor for prolonging and deepening depressed moods as well as predicting “the maintenance of clinical depression and the onset of new episodes of depression” (Raes, 2010, p. 758).

 

PTS:   1                    REF:   Depression

 

  1. Discuss the four phases of Beck’s cognitive-behavioral approach to treating depression.

 

ANS:

Beck’s cognitive-behavioral approach to treating depression involves four phases that typically unfold in less than 20 sessions. In the first phase, behavioral treatment approaches are applied that are designed to encourage participants to become more active. By the second stage, individuals begin the process of learning about and recording their automatic thoughts. The therapist challenges the accuracy of their distorted thoughts and assists them in learning the process of self-challenge. By the third phase, through the assistance of their therapist, individuals learn to identify their negative thinking patterns and biases (i.e., errors of thinking). Finally, in the fourth phase, the therapist helps participants challenge and change maladaptive attitudes that underlie their automatic negative thoughts.

 

PTS:   1                    REF:   Depression

 

  1. Describe the positive psychology approach that Maddux suggests should replace the illness ideology approach (e.g., the DSM).

 

ANS:

Instead of using the illness ideology approach, Maddux suggests using a positive psychology approach such as using character strengths to define mental health. He points to the Values in Action (VIA) classification system as a good example (Peterson & Park, 2009; Peterson & Seligman, 2004). Character strengths for the VIA system were derived from philosophy, psychology, psychiatry, and youth development as well as virtue catalogs from historical figures (e.g., Benjamin Franklin). Christopher Peterson and Martin Seligman, the originators of the system, discovered 24 strengths for the VIA that they grouped into the six categories of (1) Wisdom and Knowledge, (2) Courage, (3) Humanity, (4) Justice, (5) Temperance, and (6) Transcendence.

 

PTS:   1                    REF:   Positive Mental Health

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