Download Mind-Body Connection Emotions, Stress, Anxiety

PSYCHOLOGY FOR
MIDWIVES
MIND-BODY CONNECTION: EMOTIONS, STRESS,
ANXIETY, COPING AND MENTAL ILLNESS
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MIND-BODY CONNECTION
THE EXPERIENCE OF EMOTION INTRINSICALLY TIED TO PHYSIOLOGICAL
AROUSAL (THROUGH THE AUTONOMIC NERVOUS SYSTEM)
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REVIEW: WHAT IS STRESS?
• Stressors: events we perceive as endangering our
physical or psychological well being
• Stress: process of experiencing these events and
responding to them
• Negative and positive change can be stressful
• Negative events larger impact
• Most pervasive – threats to self-esteem
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REVIEW --UNDERSTANDING STRESS:
EFFECTS OF STRESS
• Stress and the HPA Axis:
• Prolonged elevation of cortisol is related
to:
• increased depression, memory
problems, etc.
• impairment of the immune system,
which leaves the body vulnerable to
disease.
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PERFORMANCE AND
AROUSAL
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WHAT IS EMOTION?
• Emotion: subjective feeling
including arousal, cognitions, and
expressions
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PLUTCHIK’S WHEEL OF EMOTIONS
Negative and forceful
Anger
Annoyance
Contempt
Disgust
Irritation
Negative and not in
control
Anxiety
Embarrassment
Fear
Helplessness
Powerlessness
Worry
Quiet positive
Calm
Content
Relaxed
Relieved
Serene
Negative thoughts
Doubt
Envy
Frustration
Guilt
Shame
Negative and passive
Boredom
Despair
Disappointment
Hurt
Sadness
Agitation
Stress
Shock
Tension
Reactive
Interest
Politeness
Surprised
Positive and lively
Amusement
Delight
Elation
Excitement
Happiness
Joy
Pleasure
Caring
Affection
Empathy
Friendliness
Love
Positive thoughts
Courage
Hope
Pride
Satisfaction
Trust
CULTURE, EVOLUTION, AND EMOTION
• Cultural similarities and differences:
7 to10 culturally universal emotions,
but each culture has its own display
rules governing how, when, and
where to express emotions
• Role of evolution:
strong biological, evolutionary basis
for emotional expression and
decoding
THREE COMPONENTS OF EMOTION
1. Physiological--arousal comes
from brain (particularly
the limbic system)
and autonomic
nervous system
(ANS)
PHYSIOLOGICAL COMPONENT AND THE ANS
THREE COMPONENTS OF EMOTION
2. Cognitive--thoughts, values and
expectations
3. Behavioral--expressions,
gestures, and body positions
FACIAL FEEDBACK
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MIND-BODY CONNECTION
THE EXPERIENCE OF EMOTION INTRINSICALLY TIED TO PHYSIOLOGICAL
AROUSAL (THROUGH THE AUTONOMIC NERVOUS SYSTEM)
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SPHINCTER LAW, GASKIN
• Connection between the functioning of sphincters
and safety, comfort, and trust
• The autonomic nervous system and HPA axis when
activated may cause both negative emotions and
closure of sphincters
• What emotions are associated with safety, comfort
and trust?
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FOSTERING POSITIVE
EMOTIONS
DURING PREGNANCY, DURING LABOR, POSTPARTUM
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NORMATIVE ANTENATAL EMOTIONS
• Research suggest the majority of women enter
pregnancy in the ‘normal’ range of psychological
functioning
• However, women with pre-pregnancy
psychological distress may have more difficult
pregnancies
• Women are diagnosed more frequently with depression,
anxiety disorders, eating disorders, some personality
disorders than men
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NORMATIVE REACTIONS TO
PREGNANCY
• Pleasure, elation
• Dismay,
disappointment
• Ambivalence,
apathy
• Emotional instability
• Heightened feelings
of femininity
• Sense of attachment
to fetus or partner
• Stress and anxiety
• Increased need for
knowledge (or
feelings of not
knowing ‘enough’)
• Altered body image
• Somatic complaints
• Decreased sex drive
• Increased
vulnerability
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NORMATIVE ADJUSTMENT
THROUGHOUT PREGNANCY
• Research suggest the majority of women
maintain the ‘normal’ range of psychological
functioning throughout pregnancy
• Mood changes are sometimes thought to be
associated with social factors more than biological
factors
• Common (and more consistent across women)
psychological changes throughout pregnancy:
• Decrease in sex drive
• Feeling less understood by partner (usually men)
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SOCIAL FACTORS ASSOCIATED WITH
MOOD CHANGES IN PREGNANCY
• Body image concerns
• Feeling like one will be an adequate
mother
• Lack of social support
• Financial and economic problems
• Experiencing abuse
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Fostering Positive Emotions to
Reduce the Activation of HPAAxis and Sympathetic Nervous
System
• and to bring joy to land . . .
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MIND-BODY CONNECTION: STRESS,
ANXIETY, COPING, & MENTAL ILLNESS
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PSYCHOLOGICAL DISTRESS & WHY
MATERNAL MENTAL HEALTH MATTERS
• Adverse consequences for mother and child if
mental illness is untreated
• Relapse and recurrence are associated with
pregnancy and postpartum
• There are risk factors to depression and anxiety, so
prevention is possible!
• Talk therapy is highly effective for non-psychotic
disorders
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ANXIETY
• Very common
• Can disrupt functioning and
cause distress
• Abnormal anxiety – 4 types of symptoms
• Physiological : bodily reactions such as the fight
or flight
• Emotional: primarily fear and watchfulness
• Cognitive: unrealistic worries that something
bad will happen
• Behavioral: avoid situations because of fear
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ADAPTIVE VS. MALADAPTIVE ANXIETY
• Adaptive:
• Concerns are realistic
• In proportion to the threat
• Fear subsides when threat ends
• Maladaptive:
• Concerns are unrealistic
• objects of fears unlikely to come about or not harmful
• Out of proportion to the threat
• Fear continues when threat ends – anticipatory
anxiety
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ANXIETY DISORDERS
2nd most common group of disorders
–
–
Highly prevalent
 6-15% of population
2 Key/Core Concepts for Anxiety Disorders
•
Frequent & Intense…
1 - anxiety, worry, and apprehension &
2 - avoidance, rituals, or repetitive thoughts
to protect from experience of anxiety
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FORMS OF DEPRESSION
•
•
•
•
•
Major depression
5 symptoms for at
at least 2 weeks
Interfere w/ functioning
Dysthymic disorder
Less severe, more chronic than major
depression
• 2 symptoms for at least 2 years
• Never without depression for more
than a 2-month period
•
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DSM CRITERIA FOR DIAGNOSIS - MDE
• Five or more (one must be depressed mood, one
must be loss of interest or pleasure), For 2 weeks
• Depressed mood everyday, most of the day (kids/teens may
appear irritable)
• Loss of interest (anhedonia)
• Significant weight changes
• Insomnia or hypersomnia
• Fatigue
• Psychomotor agitation / retardation
• Feelings of worthlessness
• Difficulty concentrating
• Thoughts of death/suicide (without a specific plan or attempt)
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ANXIETY & DEPRESSION IN
PREGNANCY
• Considered mild to moderate psychological distress
• Relatively common
• prevalence 20%
• incidence10 – 15%
• Research suggests likely cause is social stressors,
change, lack of support
• Respond very well to talk therapy & Good prognosis
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THREE DSM RECOGNIZED TYPES OF
EATING DISORDERS
• Anorexia nervosa
• Pursuit of thinness that leads to self-starvation
• Bulimia nervosa
• Cycle of bingeing followed by extreme behaviors to prevent
weight gain, such as purging
• Eating Disorder – Not Otherwise Specified
• Most common diagnosis for eating disorders
DIAGNOSIS OF ANOREXIA NERVOSA
• (1) Refusal to maintain a body weight that is healthy
and normal
• Weight is 15% below minimum healthy weight for height and
age
• Not everyone who is of a low weight is anorexic
Underweight
Normal weight
Overweight
DIAGNOSIS OF ANOREXIA NERVOSA
• (2) Intense fear of gaining weight or becoming fat,
even if underweight
• Fear usually worsens as weight drops
• (3) Distorted images of own body
• Self-evaluations hinge on weight and control over eating
• (4) Amenorrhea: loss of menstrual periods
• Video of anorexia
• Rituals surrounding food
• Often take over person’s life
• Two Subtypes - Restricting & Binge-Eating/Purging
TWO SUBTYPES
Restricting Type
• Refuse to eat
• Can go for days without
eating
• Eat small amount of food
each day
• Pressures from others?
• To stay alive?
• Likely to deny they have
a problem
• Mistrust others who tell
them there’s a problem
Binge/Purge Type
• Different from bulimia:
continues to be at least 15%
below healthy weight
• Often develop amenorrhea
• Purges even with a small
amount of food
• Unstable moods and poor
• impulse control
• High rates of alcohol and
•
drug abuse, and
•
self-mutilation
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BULIMIA NERVOSA
• Uncontrolled eating (bingeing) followed by behaviors
to prevent weight gain
• Binge: eating an abnormally large amount of food in
a discrete time period
• Critical component: no control
• Average binge – 1,500 calories
• 1/3 contain only 600 calories
• < 1/3 over 2,000 calories
• Behaviors to control weight gain: vomiting, laxatives,
fasting, excessive exercise
BULIMIA NERVOSA
• Self-evaluations influenced by weight
• Thin = good person
• Usually no major distortions in body images, but still
constantly dissatisfied
• No weight criteria
• Vomiting usually discovered by family, roommates,
and friends
• Begins to rot teeth
SUBTYPES OF BULIMIA NERVOSA
Purging type:
• self-induced vomiting
or purging medications
Nonpurging type:
• excessive exercise or
fasting
• Easy to hide bulimia if
part of a group that
values exercise
ANOREXIA FACTS
• 1% of people (90-95% female)
• More likely in White women than Black
• Usually begins between ages 15-19
• Half recover within 10 yrs of treatment
• Health problems
•
•
•
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Death rates 5-8% - most deadly psychological disorder!!!
HR slowing, irregularities, and failure
Expansion and rupturing of the stomach
Kidney damage and weak immune system
BULIMIA FACTS
• 0.5 – 3% of US population
• 10% of women report some symptoms
• Much more common in women and European Americans
• Common in adolescents and young adults
• Study: 15% of college women admitted to having
engaged in purging behaviors
• Onset usually between 15-29
• Medical complications
• Imbalance in body’s electrolytes can lead to heart failure
• Deterioration of the esophagus
• Tooth erosion
• Difficulty/inability to have a bowel movement without help
of laxatives
• Chronic condition – years of symptoms
• 1/3 still have it after 5 years
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HOW COMMON IN PREGNANT
WOMEN?
• UK study: 1 in 50
• Other samples 15 – 20% of pregnant women have
eating disorders
• Up to 80% of pregnant women have disordered
eating
• Some women have symptom reduction during
pregnancy and other have symptom increases!
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SEVERE PSYCHOLOGICAL
DISTRESS
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BIPOLAR DISORDERS
 What is Mania?
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
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Grandiose self-esteem
Flight of ideas, racing thoughts
Elevated or irritable mood
Decreased need for sleep
Excessively talkative
Impulsive behaviors (e.g., business, sex, etc.)
Grand plans and goals
Must show elevated mood at least once/wk
 Hypomania: mild mania (no psychotic features, no
marked impairment in functioning)
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BIPOLAR DISORDERS
Prevalence = 1.6% of females
Bipolar I Disorder = manic episode





Note that depression is not required,
but often occurs
Manic episode lasts > 1 week
and gets attention
Can be shorter than one week if obvious
Bipolar II Disorder = hypomanic episode
+ depression



Less severe kind of mania,
good for productivity
Major Depressive Disorder is required
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BIPOLAR DISORDERS
Cyclothymic Disorder
•
•
•
•
•
•
•
•
Prevalence = 1%
Less severe
Chronic kind of bipolar disorder
Hypomania + depression (but not MDD)
for > 2 years
Onset in 20s
You feel creative, productive, at top of game
Others think you’re irritable and moody
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PREVALENCE OF BIPOLAR
DISORDER
 90% w/ bipolar have multiple episodes
 Usually long episodes, not a matter of days
 Rapid-cycling bipolar disorder: 4 or more cycles of mania
and depression within 1 year
 1-2% of US will have least one episode
 Men and women equally likely
 No differences among ethnic groups
 Usually first onset by early adulthood
 Often abuse substances
 Impaired control of the disorder and willingness to take
medications
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DSM-IV CRITERIA FOR SCHIZOPHRENIA
A. Core symptoms: >2 of the following, for at least a 1month
1. Delusions
2. Hallucinations
3. Disorganized Speech
4. Grossly disorganized or Catatonic behavior
5. Negative symptoms
B. Impairment in Social/Occupational Functioning
C. Time frame: at least 6 months duration
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PSYCHOTIC DISTURBANCES IN
PREGNANCY
1. Non-medicated, stable but at-risk
•
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Previous episode of schizophrenia or bipolar (>2 years ago)
but in residual phase now
About 50% risk of recurrence postpartum, less risk during
pregnancy
2. Medicated, stable, at-risk
•
•
Previous episode of schizophrenia or bipolar but in residual phase
now due to medication
Higher risk of recurrence during pregnancy and postpartum
3. Chronic, unstable, high-risk
•
May be actively psychotic, poor medication adherence or
effectiveness
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SCREENING TOOLS AND
WARNING SIGNS
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FOSTERING POSITIVE COPING
• Reducing negative coping styles
• Rumination, denial/cognitive avoidance, emotional
discharge
• Increasing self-efficacy
• Empowering someone to believe they have the
ability to succeed
• Modeling (with support)
• Trying to modify stress response (deep breathing &
though changing)
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COPING:
attempt to manage stress in
some effective way
•
Two major approaches:
1. Emotion-focused
(changing one's
perception of stressful
situations)
2. Problem-focused (using
problem-solving strategies
to decrease or eliminate
the source of stress)
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COPING RESOURCES
1. Health and
Exercise
2. Control (Internal
vs. External)
3. Positive Beliefs
4. Social Skills
5. Social Support
6. Material
Resources
7. Relaxation
8. Sense of Humor