Week 6 - Mental Health Flashcards
SAD - Sad, Anxiety, Depression
About Depression
- Impacts all facets of health
Depression exists on continuum
depression can be…
- major public health concern, over 264 million suffer worldwide
- leading cause of morbidity worldwide
- physical concerns (e.g., heart disease, diabetes mellitus, asthma, arthritis)
- mental concerns (e.g., anxiety, stress)
-From episodes of unhappiness that effect most people from time to time, to persistent low mood and inability to find enjoyment
-Depression can be either acute or chronic depending on the severity and duration of symptoms
- not all forms reach clinical
SAD - Sad, Anxiety, Depression
Depression continued
Depression is characterized by one or more of the following symptoms
Diagnosed with DSM-V, Clinical diagnosis
- Sustained feelings of sadness
- Feelings of guilt or worthlessness
- Disturbances in appetite
- Disturbances in sleep patterns
- Fatigue or lack of energy
- Difficulty concentrating
- Loss of interest in all or most activities
- Problems with memory
- Thoughts of self-harm/suicide
- 5+ symptoms including depressed mood, loss of interest/pleasure lasting for at least 2 weeks
Causes of depression
impact of…
measurement
- Both biological and environmental factors interact
- Neurotransmitter function interacts with an individual’s stress responses
- factors like coping skills, heredity and social support play influence
Environment!
-Self-report measures in research
- BDI – Beck Depression Inventory
- CES-D – Centre for Epidemiological Studies-Depression
- Zung Self-Rating Depression Scale
- POMS – Profile of Mood States
- PHQ-9 – Patient Health Questionnaire
Depression treatment
Pharmacological
Psychological
– E.g., medication
* Side effects
* Cost
* Stigma
– E.g., cognitive behavioural therapy
* Duration and intensity
* Cost
* Stigma
Exercise for depression
Exercise as a tool
- natural treatment, is as effective as some drugs
- many studies supporting, can decrease depression
- Preventative
- Treatment
Evidence for exercise as a preventative effects
- association between inactivity
and depression across age spectrum
People who are less active or sedentary at greater risk for depression than people who are more active
- Physical activity offers defense against depressive symptoms
- Regular physical activity is useful for preventive mental health problems
exercise vs traditional treatments
Exercise shown to be as effective as therapies and in some instances medication
Exercise is both cost-effective and can improve other aspects of physical health and mental health
- Exercise in with psychotherapy and/or medicine yielded the best results
- Combined approach when necessary
-Aids in prevention of other physical maladies
* It is WHOLE BODY!
Exercise Versus ‘Traditional’ Treatments
Exercise prescription for depression - evidence based
Mode
Intervention length
Frequency
Intensity
Duration
-Does not matter
- at least 10 weeks
- 3-5 times per week
-Aerobic 50-85% HR max, Resistance 80% of 1RM better than 20% of 1RM
- Sessions 30-60 mins; greatest benefit at 45-60 mins
Consensus statement
- Exercise has protective effect against symptoms of depression
- Protective effects of exercise seem to increase with greater levels of physical activity
- Exercise associated with decreasing levels of mild to moderate depression
- Exercise may be adjunct to the professional treatment of severe depression
- Optimal types and/or amounts of physical activity remain unknown
Mechanisms of change
- Anthropological hypothesis
- Endorphin hypothesis
- Monoamine hypothesis
- Mastery hypothesis
- Social interaction hypothesis
Anthropological hypothesis
- we are born to move
Endorphin hypothesis
During stress (e.g., exercise) body produces endorphins
* Endorphins = body’s natural painkillers
- Hypothesis
- Endorphins released during exercise → exercise feeling good → reduced depression
- Reality
- More research required!
Monoamine hypothesis
Explain effects of exercise on depression via alteration in neurotransmitters
- Neurotransmitters implicated in regulation of emotion
- Exercise can increase rate at which neurotransmitters produced, released and processed
- Much of the evidence for these models based on animal research
Mastery and social hypothesis
Psychology is only one part of it…
Mastery
Social interaction
- build self-efficacy, feel better about oneself, may help to reduce depression -Increase control over environment
-building social connections battles symptoms of depression
-Can see benefits of exercise even if done alone
what is stress
- What we experience when we face challenges in our lives
Stressors (challenges) can be:
* External or Internal
* Distress (negative) or Eustress (positive)
Primary appraisal- assessing stressor as important and if demanding
Secondary appraisal- assessing resources to deal with stressor can lead to revision of primary appraisal
key points of stress
People self-report feeling less stress following exercise or physically active in general
Seems likely exercise useful in reducing stress response
-Reduced risk of disease and disability associated with stress
Defining anxiety - disrupts thought processes, behavior, and alters physiological functioning
* Diagnosed with DSM-V, same as depression
Anxiety is more then increased arousal
- When anxiety affects processes to such an extent that normal behavior is disrupted, it becomes clinical
-“Clinical” anxiety distinguished from
“normal” anxiety on basis of number/ intensity of symptoms
- Perceptions over threat disproportionate to actual threat
- Cognitive and behavioural actions undertaken to avoid symptoms of anxiety
- Anxiety usually experienced far longer than arousal lasts
- Anxiety can occur in absence of actual threat; even perceived threat can result in anxiety
Anxiety prevelance
16-18% prevalence rate for diagnosable anxiety disorder in US adult population
Symptomology - Anxiety can be manifested both psychologically and physiologically and is characterized by
one or more of the following:
Of those individuals diagnosed:
* 22.8% serious
* 33.7% moderate
* 43.5% mild
-Unpleasant feelings (emotions)
* Bodily symptoms
* Changes in cognition
* Changes in behavior
* Vigilance
* Treatment: same as depression – meds, therapy…limitations!
Measurement
State anxiety - short
Trait anxiety - apart of you, longer
Psychological measures
Physiological measures
Transient emotional state characterized by feelings heightened autonomic nervous system activity
* Assess before and after single bout of exercise
- General predisposition to respond with anxiety across many situations
- Assess before and after chronic exercise program
- Self-report inventories (STAI, POMS-T)
- Physiological measures
- Blood Pressure and Heart rate (ECG)
- Muscle tension (EMG)
- Sweaty palms (GSR)
- Neurocognitive (EEG, fMRI)
- Neuroendocrine (salivary assays)
Treatment - Physical Activity
Exercise now examined as potential tool in prevention and treatment of
anxiety
- Regular exercise habits associated with low symptom scores
- Low-fit and highly anxious people may have most to gain from exercise
- Moderate exercise sufficient to decrease anxiety
- Exercise has been shown to be as effective as other known anxiety-reducing treatments
Defining emotional well being
all emotions and moods are under affect
- affect
- well being
- moods
-emotion
- A more general “valenced” (like or dislike) response
- Does not require thought processes to precede it
- A greater amount of positive affect than negative affect
- Favourable thoughts such as satisfaction with life
- Subjective states that have a cognitive basis
- Can enhance or interfere with behavior
- An immediate response to a specific stimulus that requires some level of cognitive input
-Usually short term, more intense and variable than moods
Exercise specific measures
- Exercise-induced Feeling Inventory (EFI)
- Subjective Exercise Experiences Scale (SEES)
- Physical Activity Affect Scale (PAAS)
- Feeling Scale (FS)
Limitations: None have shown to be any more sensitive to exercise stimuli or better capture the exercise context than general well-being measures
Temporal Dynamic of Affective responses
- Majority of literature has studied affective responses before and after exercise
- Affect during exercise distinct from affective change before and after exercise. Partially intensity-based
- If person does not feel well during exercise, even if they feel better afterwards, they are less inclined to continue the activity
- Post-exercise positive feelings may not “override” negative feelings during exercise
Dose response for positive impact
-Threshold of intensity and duration must be reached before significant changes in affect can be realized
- Also suggested affect benefit maximized by exercising regularly for a
specific length of time - Moderate amounts of exercise usually energy exerciser
- Positive affect tends to increase pre-post exercise following exercise
intensities that are not exhaustive
-Recommend exercise for 20-30 minutes duration and intensities in
moderate range (70% aerobic capacity) to achieve positive psychological
changes
HIIT training good or bad
Negative Psychological effects of exercise
-Following high intensity exercise, negative affective states may be increased, and positive affective states decreased, particularly in less
fit individuals
- But for more fit, improved positive effect
-overtraining
- staleness syndrome, negative mental health and poor performance
- exercise dependance syndrome
Signs of exercise dependance
Tolerance
Withdrawl
Intention effects
Loss of control
- Need for increased amount of exercise to achieve desired effect
- Diminished effect with same amount of exercise
- Withdrawal symptoms when exercise missed –e.g., tension
- Exercise often lasts longer than originally intended
- Persistent desire and/or unsuccessful effort to control exercise (unable)
