3.3.5. Stress & emotional wellness

Separation anxiety disorder

A person with separation anxiety disorder is excessively fearful or anxious about separation from those with whom he or she is attached. The feeling is beyond what is appropriate for the person's age, persists (at least four weeks in children and six months in adults) and causes problems functioning. A person with separation anxiety disorder may be persistently worried about losing the person closest to him or her, may be reluctant or refuse to go out or sleep away from home or without that person, or may experience nightmares about separation. Physical symptoms of distress often develop in childhood, but symptoms can carry though adulthood.

Social anxiety disorder

A person with social anxiety disorder has significant anxiety and discomfort about being embarrassed, humiliated, rejected or looked down on in social interactions. People with this disorder will try to avoid the situation or endure it with great anxiety. Common examples are extreme fear of public speaking, meeting new people or eating/drinking in public. The fear or anxiety causes problems with daily functioning and lasts at least six months.

Phobias, specific phobias

A specific phobia is excessive and persistent fear of a specific object, situation or activity that is generally not harmful. Patients know their fear is excessive, but they can't overcome it. These fears cause such distress that some people go to extreme lengths to avoid what they fear. Examples are fear of flying or fear of spiders.

Neighborhood and Built Environment social determinant

Access to Foods that Support Healthy Eating Patterns Crime and Violence Environmental Conditions Quality of Housing

Health and Health Care social determinant

Access to Health Care Access to Primary Care Health Literacy

Agoraphobia

Agoraphobia is the fear of being in situations where escape may be difficult or embarrassing, or help might not be available in the event of panic symptoms. The fear is out of proportion to the actual situation and lasts generally six months or more and causes problems in functioning. A person with agoraphobia experiences this fear in two or more of the following situations: Using public transportation Being in open spaces Being in enclosed places Standing in line or being in a crowd Being outside the home alone The individual actively avoids the situation, requires a companion or endures with intense fear or anxiety. Untreated agoraphobia can become so serious that a person may be unable to leave the house. A person can only be diagnosed with agoraphobia if the fear is intensely upsetting, or if it significantly interferes with normal daily activities.

Anxiety disorders

Anxiety is a normal reaction to stress and can be beneficial in some situations. It can alert us to dangers and help us prepare and pay attention. Anxiety disorders differ from normal feelings of nervousness or anxiousness, and involve excessive fear or anxiety. Anxiety disorders are the most common of mental disorders and affect nearly 30% of adults at some point in their lives. But anxiety disorders are treatable and a number of effective treatments are available. Treatment helps most people lead normal productive lives.

Relaxation techniques

Autogenic Training Biofeedback-Assisted Relaxation Deep Breathing or Breathing Exercises Guided Imagery Progressive Relaxation Self-Hypnosis

Examples of social determinants of health include

Availability of resources to meet daily needs (e.g., safe housing and local food markets) Access to educational, economic, and job opportunities Access to health care services Quality of education and job training Availability of community-based resources in support of community living and opportunities for recreational and leisure-time activities Transportation options Public safety Social support Social norms and attitudes (e.g., discrimination, racism, and distrust of government) Exposure to crime, violence, and social disorder (e.g., presence of trash and lack of cooperation in a community) Socioeconomic conditions (e.g., concentrated poverty and the stressful conditions that accompany it) Residential segregation Language/Literacy Access to mass media and emerging technologies (e.g., cell phones, the Internet, and social media) Culture

Treatment of depression

Before a diagnosis or treatment, a health professional should conduct a thorough diagnostic evaluation, including an interview and a physical examination. In some cases, a blood test might be done to make sure the depression is not due to a medical condition like a thyroid problem or a vitamin deficiency (reversing the medical cause would alleviate the depression-like symptoms). The evaluation will identify specific symptoms and explore medical and family histories as well as cultural and environmental factors with the goal of arriving at a diagnosis and planning a course of action. Medications Psychotherapy ECT

Risk factors for depression

Biochemistry: Differences in certain chemicals in the brain may contribute to symptoms of depression. Genetics: Depression can run in families. For example, if one identical twin has depression, the other has a 70 percent chance of having the illness sometime in life. Personality: People with low self-esteem, who are easily overwhelmed by stress, or who are generally pessimistic appear to be more likely to experience depression. Environmental factors: Continuous exposure to violence, neglect, abuse or poverty may make some people more vulnerable to depression.

Biofeedback-Assisted Relaxation

Biofeedback techniques measure body functions and give you information about them so that you can learn to control them. Biofeedback-assisted relaxation uses electronic devices to teach you to produce changes in your body that are associated with relaxation, such as reduced muscle tension.

Social and Community Context social determinant

Civic Participation Discrimination Incarceration Social Cohesion

What is depression?

Depression (major depressive disorder) is a common and serious medical illness that negatively affects how you feel, the way you think and how you act. Fortunately, it is also treatable. Depression causes feelings of sadness and/or a loss of interest in activities you once enjoyed. It can lead to a variety of emotional and physical problems and can decrease your ability to function at work and at home. Symptoms must last at least two weeks and must represent a change in your previous level of functioning for a diagnosis of depression. Also, medical conditions (e.g., thyroid problems, a brain tumor or vitamin deficiency) can mimic symptoms of depression so it is important to rule out general medical causes. Depression affects an estimated one in 15 adults (6.7%) in any given year. And one in six people (16.6%) will experience depression at some time in their life. Depression can occur at any time, but on average, first appears during the late teens to mid-20s. Women are more likely than men to experience depression. Some studies show that one-third of women will experience a major depressive episode in their lifetime. There is a high degree of heritability (approximately 40%) when first-degree relatives (parents/children/siblings) have depression

Symptoms of panic disorder

During an attack several of these symptoms occur in combination: Palpitations, pounding heart or rapid heart rate Sweating Trembling or shaking Feeling of shortness of breath or smothering sensations Chest pain Feeling dizzy, light-headed or faint Feeling of choking Numbness or tingling Chills or hot flashes Nausea or abdominal pains Feeling detached Fear of losing control Fear of dying

Education Social determinant

Early Childhood Education and Development Enrollment in Higher Education High School Graduation Language and Literacy

signs of mental health problems

Eating or sleeping too much or too little Pulling away from people and usual activities Having low or no energy Feeling numb or like nothing matters Having unexplained aches and pains Feeling helpless or hopeless Smoking, drinking, or using drugs more than usual Feeling unusually confused, forgetful, on edge, angry, upset, worried, or scared Yelling or fighting with family and friends Experiencing severe mood swings that cause problems in relationships Having persistent thoughts and memories you can't get out of your head Hearing voices or believing things that are not true Thinking of harming yourself or others Inability to perform daily tasks like taking care of your kids or getting to work or school

These five key areas (determinants) include: (healthy 2020)

Economic Stability Education Social and Community Context Health and Health Care Neighborhood and Built Environment

Economic Stability Social determinant

Employment Food Insecurity Housing Instability Poverty

Depression symptoms can vary from mild to severe and can include

Feeling sad or having a depressed mood Loss of interest or pleasure in activities once enjoyed Changes in appetite — weight loss or gain unrelated to dieting Trouble sleeping or sleeping too much Loss of energy or increased fatigue Increase in purposeless physical activity (e.g., inability to sit still, pacing, handwringing) or slowed movements or speech (these actions must be severe enough to be observable by others) Feeling worthless or guilty Difficulty thinking, concentrating or making decisions Thoughts of death or suicide

Guided imagery

For this technique, people are taught to focus on pleasant images to replace negative or stressful feelings. Guided imagery may be self-directed or led by a practitioner or a recording.

Types of anxiety disorder

Generalized Anxiety Disorder Panic Disorder Phobias, Specific Phobia Agoraphobia Social Anxiety Disorder (previously called social phobia) Separation Anxiety Disorder

generalized anxiety disorder

Generalized anxiety disorder involves persistent and excessive worry that interferes with daily activities. This ongoing worry and tension may be accompanied by physical symptoms, such as restlessness, feeling on edge or easily fatigued, difficulty concentrating, muscle tension or problems sleeping. Often the worries focus on everyday things such as job responsibilities, family health or minor matters such as chores, car repairs, or appointments.

Ways to maintain positive mental health include:

Getting professional help if you need it Connecting with others Staying positive Getting physically active Helping others Getting enough sleep Developing coping skills

Meditation and the brain

In a 2012 study, researchers compared brain images from 50 adults who meditate and 50 adults who don't meditate. Results suggested that people who practiced meditation for many years have more folds in the outer layer of the brain. This process (called gyrification) may increase the brain's ability to process information. A 2013 review of three studies suggests that meditation may slow, stall, or even reverse changes that take place in the brain due to normal aging. Results from a 2012 NCCIH-funded study suggest that meditation can affect activity in the amygdala (a part of the brain involved in processing emotions), and that different types of meditation can affect the amygdala differently even when the person is not meditating. Research about meditation's ability to reduce pain has produced mixed results. However, in some studies scientists suggest that meditation activates certain areas of the brain in response to pain.

Autogenic training

In autogenic training, you learn to concentrate on the physical sensations of warmth, heaviness, and relaxation in different parts of your body. a relaxation technique that involves a sensation of heaviness, warmth, and tingling in the limbs

Self-hypnosis

In self-hypnosis programs, people are taught to produce the relaxation response when prompted by a phrase or nonverbal cue (called a "suggestion").

Stress management

Maintaining a healthy social support network Engaging in regular physical exercise Getting an adequate amount of sleep each night

How much do we know about meditation?

Many studies have been conducted to look at how meditation may be helpful for a variety of conditions, such as high blood pressure, certain psychological disorders, and pain. A number of studies also have helped researchers learn how meditation might work and how it affects the brain.

What the Science Says About Safety and Side Effects of Meditation

Meditation is generally considered to be safe for healthy people. People with physical limitations may not be able to participate in certain meditative practices involving movement. People with physical health conditions should speak with their health care providers before starting a meditative practice, and make their meditation instructor aware of their condition. There have been rare reports that meditation could cause or worsen symptoms in people with certain psychiatric problems like anxiety and depression. People with existing mental health conditions should speak with their health care providers before starting a meditative practice, and make their meditation instructor aware of their condition.

What do we know about the safety of meditation?

Meditation is generally considered to be safe for healthy people. However, people with physical limitations may not be able to participate in certain meditative practices involving movement.

What is mental health

Mental health includes our emotional, psychological, and social well-being. It affects how we think, feel, and act. It also helps determine how we handle stress, relate to others, and make choices. Mental health is important at every stage of life, from childhood and adolescence through adulthood. Over the course of your life, if you experience mental health problems, your thinking, mood, and behavior could be affected. Many factors contribute to mental health problems, including: Biological factors, such as genes or brain chemistry Life experiences, such as trauma or abuse Family history of mental health problems

Stress effects on the body

Musculoskeletal - muscles tense up Respiratory - breathe harder/rapid breathing Cardiovascular - increase in heart rate/stronger contractions of the heart muscle, blood vessels dilate (increased blood pressure) Endocrine - adrenals produce cortisol and epinephrine, liver produces glucose Gastrointestinal - heartburn, nausea, pain, vomiting, ulcers, diarrhea, constipation Nervous - "fight or flight" response. Drains the body. Male reproductive - testosterone/sperm production, impotence, erectile dysfunction. Female reproductive - Absent/irregular menstrual cycles, worse PMS symptoms, worse menopause symptoms, reduced sexual desire.

Examples of physical determinants of health include:

Natural environment, such as green space (e.g., trees and grass) or weather (e.g., climate change) Built environment, such as buildings, sidewalks, bike lanes, and roads Worksites, schools, and recreational settings Housing and community design Exposure to toxic substances and other physical hazards Physical barriers, especially for people with disabilities Aesthetic elements (e.g., good lighting, trees, and benches)

Positive mental health allows people to

Realize their full potential Cope with the stresses of life Work productively Make meaningful contributions to their communities

What do we know about the safety of relaxation techniques?

Relaxation techniques are generally considered safe for healthy people, although there have been a few reports of negative experiences such as increased anxiety. People with serious physical or mental health problems should discuss relaxation techniques with their health care providers.

What do we know about the effectiveness of relaxation techniques?

Relaxation techniques may be helpful in managing a variety of health conditions, including anxiety associated with illnesses or medical procedures, insomnia, labor pain, chemotherapy-induced nausea, and temporomandibular joint dysfunction. Psychological therapies, which may include relaxation techniques, can help manage chronic headaches and other types of chronic pain in children and adolescents. Relaxation techniques have also been studied for other conditions, but either they haven't been shown to be useful, research results have been inconsistent, or the evidence is limited.

Mechanisms of influence on social relationships and health behaviors

Social Support - (includes instrumental (e.g., help with tasks), informational (e.g., advice), and emotional (e.g., a sense that one is loved, cared for, and listened to) support, with most studies focusing on emotional support) Stress - (Stress is a central dimension of the negative side of social ties . Stress refers to life disruptions (e.g., discrete events such as divorce) and chronic strains (e.g., ongoing conflict in relationships) that challenge individuals' coping capacities) Social and personal control - (Social ties may provide direct control by regulating and facilitating healthier behaviors or indirect control by instilling norms (e.g., responsibility) conducive to healthier behavior) Symbolic meaning - (symbolic meaning of social ties and health habits helps to explain why they are linked. For example, studies on adolescents often point to the meaning attached to peer groups (e.g., what's cool) when explaining the influence of peers on substance use. Similarly, advertisers try to shape norms and meanings of health habits, such as smoking, to sell products) Mental Health - (social ties provide support that enhances psychological well-being as well as stress that contributes to psychological distress, which, in turn, is associated with increased physiological arousal (e.g., heart rate, stress hormones) that elicits behavioral coping responses and with greater propensities for unhealthy behavior in general)

Social Relationships and Health Behavior Across Life Course

Sociological theory and research point to the importance of social relationships in affecting health behavior. This work tends to focus on specific stages of the life course, with a division between research on childhood/adolescent and adult populations. Yet recent advances demonstrate that early life course experiences shape health outcomes well into adulthood. We synthesize disparate bodies of research on social ties and health behavior throughout the life course, with attention to explaining how various social ties influence health behaviors at different life stages and how these processes accumulate and reverberate throughout the life course.

What do we know about the effectiveness of meditation?

Some research suggests that practicing meditation may reduce blood pressure, symptoms of irritable bowel syndrome, anxiety and depression, and insomnia. Evidence about its effectiveness for pain and as a smoking-cessation treatment is uncertain.

Risk factors for anxiety disorders

The causes of anxiety disorders are currently unknown but likely involve a combination of factors including genetic, environmental, psychological and developmental. Anxiety disorders can run in families, suggesting that a combination of genes and environmental stresses can produce the disorders.

Risk factors for panic disorders

The causes of anxiety disorders are currently unknown but likely involve a combination of factors including genetic, environmental, psychological and developmental. Anxiety disorders can run in families, suggesting that a combination of genes and environmental stresses can produce the disorders.

Panic disorder

The core symptom of panic disorder is recurrent panic attacks, an overwhelming combination of physical and psychological distress. Because symptoms are so severe, many people who experience a panic attack may believe they are having a heart attack or other life-threatening illness and may go to a hospital ER. Panic attacks may be expected, such as a response to a feared object, or unexpected, apparently occurring for no reason. The mean age for onset of panic disorder is 22-23. Panic attacks may occur with other mental disorders such as depression or PTSD.

Diagnosis of panic disorders

The first step is to see your doctor to make sure there is no physical problem causing the symptoms. If an anxiety disorder is diagnosed, a mental health professional can work with you on the best treatment. Unfortunately, many people with anxiety disorders don't seek help. They don't realize that they have an illness that has effective treatments.'

Deep breathing or breathing exercises

This technique involves focusing on taking slow, deep, even breaths.

Progressive relaxation

This technique, also called Jacobson relaxation or progressive muscle relaxation, involves tightening and relaxing various muscle groups. Progressive relaxation is often combined with guided imagery and breathing exercises.

Emerging Strategies To Address Social Determinants of Health

Use of Health Impact Assessments to review needed, proposed, and existing social policies for their likely impact on health Application of a "health in all policies" strategy, which introduces improved health for all and the closing of health gaps as goals to be shared across all areas of government

What is meditation

a mental procedure that focuses attention on an external object or on a sense of awareness Meditation is a mind and body practice that has a long history of use for increasing calmness and physical relaxation, improving psychological balance, coping with illness, and enhancing overall health and well-being

Types of meditation

a quiet location with as few distractions as possible; a specific, comfortable posture (sitting, lying down, walking, or in other positions); a focus of attention (a specially chosen word or set of words, an object, or the sensations of the breath); and an open attitude (letting distractions come and go naturally without judging them).

DIfferences between sadness/grief/bereavement and depression

in grief, painful feelings come in waves, often intermixed with positive memories of the deceased. In major depression, mood and/or interest (pleasure) are decreased for most of two weeks. In grief, self-esteem is usually maintained. In major depression, feelings of worthlessness and self-loathing are common. In grief, thoughts of death may surface when thinking of or fantasizing about "joining" the deceased loved one. In major depression, thoughts are focused on ending one's life due to feeling worthless or undeserving of living or being unable to cope with the pain of depression.

Treatment of panic disorders

psychotherapy, or "talk therapy," and medications. These treatments can be given alone or in combination. Cognitive behavior therapy (CBT), a type of talk therapy, can help a person learn a different way of thinking, reacting and behaving to help feel less anxious. Medications will not cure anxiety disorders, but can give significant relief from symptoms. The most commonly used medications are anti-anxiety medications (generally prescribed only for a short period of time) and antidepressants. Beta-blockers, used for heart conditions, are sometimes used to control physical symptoms of anxiety.

Common stress reactions to traumatic event

• Disbelief and shock • Feeling sad, frustrated, helpless, and numb • Fear and anxiety about the future • Feeling guilty • Anger, tension, and irritability • Difficulty concentrating and making decisions • Crying • Reduced interest in usual activities • Wanting to be alone • No desire for food or loss of appetite • Sleeping too much or too little • Nightmares or bad memories • Reoccurring thoughts of the event • Headaches, back pains, and stomach problems • Increased heart rate and difficulty breathing • Increased smoking or use of alcohol or drugs

Ways to Cope with Stress After a Traumatic Event

• Follow a normal routine as much as possible. Wake up and go to sleep at your usual times. Eat meals at regular times. Continue to go to work and school and do activities with friends and family. • Take care of yourself. Do healthy activities, like eating well-balanced meals, getting plenty of rest, and exercising—even a short walk can clear your head and give you energy. If you are having trouble sleeping, do not drink caffeine or alcohol before going to bed and do not watch TV or use your cell phone or computer in bed. Avoid other things that can hurt you, like smoking, drinking alcohol, or using drugs. • Talk about your feelings and accept help. Feeling stress after a traumatic event is normal. Talking to someone about how you are doing and receiving support can make you feel better. Others who have shared your experience may also be struggling and giving them support can also help you. • Turn it off and take a break. Staying up-to-date about a traumatic event can keep you informed, but pictures and stories on television, in newspapers, and on the Internet can increase or bring back your stress. Schedule information breaks. If you are feeling upset when getting the news, turn it off and focus on something you enjoy. • Get out and help others. Volunteer or contribute to your community in other ways. This community support can be connected to the disaster-related needs or to anything else that you care

Signs that More Help May Be Needed after traumatic event

• Having symptoms of stress, like feeling sad or depressed, for more than two weeks • Not being able to take care of yourself or family • Not being able to do your job or go to school because of your stress • Alcohol or drug use • Thinking about suicide