Is he mentally ill?

Beck—inductive—seek negative beliefs

Social problem solving; skills training, assertion training

Efficacy

• Less research on Ellis’ model—what is there says that it does not work as well as Beck’s approach.
• Combined use of cog and beh is routine these days.

Generally depends

• Generally depends

• 1) therapist’s impression of change
• 2) client’s report of change
• 3) reports from clients family or friends
• 4) pre and post scores on tests
• 5) changes in overt behaviors

• Would change occur anyway? After 40 sessions, 75 % have improved; 50 % show significant change after 21 sessions

• Can therapy be harmful? 5-10% deteriorate in tx. BPD and OCD show the most negative outcomes.

What is stress?

• What is stress?

• When environmental or social threats place demands on people

• How we react depends on:

• Nature and timing of stressor
• Psy characteristics and social situation
• Biochemical variables

• Types of stress: eustress and distress

• Frustrations—when strivings are thwarted

• Conflicts—two incompatible needs or choices

• 1) Approach-avoidance—a mixed blessing
• 2) Approach-approach
• 3) Avoidance-avoidance

The nature of the stressor

• The nature of the stressor

• Chronic or short term
• # of stressors at once
• Length of the ordeal
• Personal involvement

• Persons’ perception and tolerance of stress

• Perception of threat
• Stress tolerance—ability to withstand stress without becoming seriously impaired—risk factors

• External resources and social supports

• Life changes—Holmes and Rahe (1967)—Social Readjustment Rating Scale

• Horowitz et al 1979—those with scores of over 300 were at increased risk for major illness in next two years

• All of these factors can build upon one another and make stress worse

Begins in hypothalamus

• Begins in hypothalamus
• Stimulates sympathetic nervous system
• Causes adrenal glands to secrete adrenaline and noradrenaline.
• This causes an increase in heart rate and increased rate of glucose metabolization
• Hypothalamus also causes the release of corticotrophin-releasing hormone (CRH), which stimulates pituitary gland.
• Pituitary then secretes adrenocorticotrophic hormone (ACTH) which causes adrenal cortex to produce stress hormone cortisol.
• Cortisol prepares body for fight or flight.

Allostatic load—biological cost of adapting to stress

• Allostatic load—biological cost of adapting to stress

• Hans Selye (1936) General Adaptation Syndrome (GAS)

• 1) First stage—alarm reaction—fight or flight—autonomic nervous system activates
• 2) If stressor ends, ANS calms down. If it persists or new ones are added, alarm is followed by a stage of resistance.
• 3) If stressors continue, state of exhaustion begins as a result of long-term resistance. Physical signs: indigestion, loss of wt., insomnia, fatigue. Psychological signs: violence, delusions, stupor. May result in death.

Experiencing alarm—heightened vigilance and concentration; dizziness, light-headedness, shakiness

• Experiencing alarm—heightened vigilance and concentration; dizziness, light-headedness, shakiness

• Prolonged stress—release of stress hormones can cause chronically high b.p., damage muscle tissues and inhibit healing after injury

• Innate immunity—1st line of defense; skin, mucus membranes

• Specific immunity—acquired rather than innate

• Detection
• Destruction
• Once battle is over, suppressor T cells call a halt, if not, body turns on itself.

• Short term—stress can boost immune system

• Long term—decrease in immunological strength; can effect some parts and not others

Types of coping:

• Types of coping:

• Problem-focused: Change the stressor itself
• Cognitive reappraisal: Change how you think about the stressor
• Emotion-focused: Change emotional responses
• Social support: Direct and buffering effects

• Effects: No best way—best to be flexible in type and timing of strategy.

• Men: more often active, problem-focused
• Women: Distraction, venting, social support

• Pennebaker’s work

Sleep disorders

• Sleep disorders

• Adjustment disorders

• PTSD and Acute Stress Dis.

• Dissociative and somatoform disorders

• Psy factors affecting a medical condition

Coronary Heart Disease—more than 500,000 deaths per year

• Coronary Heart Disease—more than 500,000 deaths per year

• Main cause is atherosclerosis
• Results of CHD include: Angina pectoris and Myocardial infarction
• Risk factors: men, older people, high bp, parental history of heart problems, cigarettes, high levels of bad cholesterol
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