Post on 29-Jun-2020
Neuroscience 3403: Stress and Mental Health
Fall, 2018
Monday & Wednesday
10:05 – 11:25
Room C164 Loeb
Instructor: H. Anisman
Office: Room 5306 Health Science Bldg
Phone: 520-2600 X2699
Email: hymie_anisman@carleton.ca
Office Hours Instructor will be available for one hour after class or by appointment. The teaching assistants
will be available during their office hours, or by appointment. They are also available via email.
Text book: The book for the course is ‘An Introduction to Stress and Health’ by H. Anisman.
The bookstore carries it, but never seems to order enough copies. Amazon carries it and delivers
on short notice. However, they, too, may run out, so it’s probably best not to dilly-dally.
Grades: Final grade will be based on a midterm test (20%), a final exam (50%) and a major
essay (30%).
The midterm test will take place just prior to midterm break, and the final exam will take place
during the exam schedule.
If you miss the midterm, then your Final exam will count for 70%. The specifics of this will be
discussed in class.
Should you miss the midterm test, please don’t bring a note from your doctor (this wastes the
doctor’s time, your time, and money from the medical system).
The major essay is due on the last day of classes (NOT the last day of the exam schedule).
Exams: Mix of multiple choice and short answer questions (half page mini-essay).
Academic Accommodation
You may need special arrangements to meet your academic obligations during the term. For an
accommodation request the processes are as follows:
Pregnancy obligation: write to me with any requests for academic accommodation during the
first two weeks of class, or as soon as possible after the need for accommodation is known to
exist. For more details see the Student Guide
Religious obligation: write to me with any requests for academic accommodation during the
first two weeks of class, or as soon as possible after the need for accommodation is known to
exist. For more details see the Student Guide
Academic Accommodations for Students with Disabilities: The Paul Menton Centre for
Students with Disabilities (PMC) provides services to students with Learning Disabilities (LD),
psychiatric/mental health disabilities, Attention Deficit Hyperactivity Disorder (ADHD), Autism
Spectrum Disorders (ASD), chronic medical conditions, and impairments in mobility, hearing,
and vision. If you have a disability requiring academic accommodations in this course, please
contact PMC at 613-520-6608 or pmc@carleton.ca for a formal evaluation. If you are already
registered with the PMC, contact your PMC coordinator to send me your Letter of
Accommodation at the beginning of the term, and no later than two weeks before the first in-
class scheduled test or exam requiring accommodation (if applicable). After requesting
accommodation from PMC, meet with me to ensure accommodation arrangements are made.
Please consult the PMC website for the deadline to request accommodations for the formally-
scheduled exam (if applicable).
Plagiarism. Plagiarism, including copying and handing in for credit someone else's work or the
same work that you have submitted for academic credit in other courses, is a serious instructional
offense that will not be tolerated. Please refer to the section on instructional offenses in the
Undergraduate Calendar for additional information. A case of plagiarism will be referred to the
Chair of the Department and to the Office of the Dean of Science. The instructor will not deal
with the matter directly. The University has clear processes for how to deal with students who
are suspected of plagiarism.
Course description and course goals
The goals of this course are to illustrate that stressful events can act to increase vulnerability to a variety
of illnesses, and to undermine the effectiveness of treatments for these conditions. The mechanisms
responsible for these outcomes will be explored, including psychosocial and neurobiological processes.
Ultimately, the development of illnesses involves numerous processes, as does resilience in the face of
illness, and a (w)holistic approach will be used to explain what leads to illness and what leads to
recovery.
Neurobiological
changes
Inflammatory
alterations
Microbial
influences
Specific
genes Illness
symptoms
Neurotrophin
variations
Treatment approach
Early
experiences Appraisal &
coping Individual &
cultural factors
factors
The course will be divided into three modules:
The first will deal primarily with human issues in stress research, outlining the processes that
appear to be most important with respect to stress-related illnesses.
The second module will focus on biochemical and pharmacological issues, and will deal with
physiological coping processes. This section will obviously require that you have some appreciation of
physiological processes (although it is not an official prerequisite of the course - it couldn’t hurt to have
a good base).
The final module will deal with illnesses related to stress and therapeutic approaches to their
treatment.
Essay: Pick a health issue. Any health issue, but preferably one that you are interested in (e.g., a
type of heart disease or an autoimmune disorder, a form of cancer or diabetes, whatever illness
you’re interested in). This is the hard part; if the illness is too broad, it can cause you problems
(e.g., don’t work on ‘heart disease”, instead work on one type of heart disease or one type of
cancer, and even then that might be too broad). If you’re uncertain, ask instructor after any class.
Write a 10 page (double spaced) paper on this illness describing
a. The characteristics of the illness and its prevalence (1 page)
b. The etiology of the illness. How does it come about and what factors lead to its
occurrence? (1.5 pages)
c. Presumed mechanisms. This is the main part of the essay and should include the
contribution of developmental and psychosocial factors, genetic contribution, hormonal,
immune, neurotransmitter or other factors involved. (5-6 pages)
d. Summary (1.5-2 pages) that provides an overall perspective of the issues, including your
own assessment of the state of the field.
Table of Contents
Chapter 1 THE NATURE OF STRESSORS Some basic definitions and concepts
Factors influencing the stress response
Individual differences: a key to the analysis of stressor effects
Measuring stressors
Major Life events
Daily hassles versus major life events
Stressor interview and diaries
Characterizing stressors
Types of stressors
Psychogenic stressors
Neurogenic stressors
Systemic stressors
Characteristics of the stressor
Severity
Controllability
Stressor predictability, uncertainty, ambiguity and black swans
Chronicity
Allostatic overload
Vulnerability and resilience related to the organism and to previous experiences
Genetic factors
Approaches in humans
Appoaches in animals
Endophenoptypic analyses
Individualized (precision) medicine
Personality and individual difference factors
Age
Early postnatal experiences
Re-programming of biological functions
Prenatal experiences
Transitional periods
Older age
Sex
Previous experience and sensitization
Stress Generation
Chapter 2. APPRAISALS, COPING AND WELL-BEING
Appraisals and Coping skills Appraisals of stressors
Primary and secondary appraisals
Secondary appraisals and control dimensions
Appraisals, decision making, and thinking Fast and Slow
Appraisals and misappraisals
Appraisals, decision making and irrational thinking
Appraisals and personality factors
Appraisals in relation to learning, memory, automaticity and habit
Emotional responses
Distinguishing between emotions
Stress-related emotions
Emotional Intelligence
Coping with stressors
The stress-appraisal-coping triad
How to cope
Assessing Appraisals and Coping
Coping as a profile of responses
Finding meaning and personal growth
Forgiveness
Social support
Social support as a buffer
Social support in relation to identity
Unsupportive interaction
Social rejection
The use of the internet as a social support coping mechanism
The items below (in yellow) may or might not be included in depth, but will be considered
at various points within the course. If you’re interested, you can read more about this in
‘Stress and your health: From vulnerability to resilience’ by H. Anisman (2015) or “Health
Psychology” by H. Anisman (2016).
Modest stressful events in everyday life
Day-to -day hassles
Dealing with hassles
Major physical illnesses
Basic considerations related to illness
Appraising and coping with major illness
Psychological resilience in the face of illness
Personal control, decision making and trust
Trust in the medical system
Social support and unsupportive interactions in the face of illness
Survival in relation to mood changes associated with illness
Adjustment to chronic illnesses
Finding meaning
Stress associated with caregiving
Initial responses to sickness in a close relative
Hardships of caregiving
Care of the caregiver
Loss and grief
The grieving process
Complicated grief
Coping with loss
Separation and Divorce
Alternatives and alternative others
Trust
Collateral damage
Workplace stress
Status within the workplace
Job strain
Absenteeism/Presenteeism
Social support and unsupport in the workplace
Bullying in the workplace
The corporate psychopath
Burnout
Trust in the workplace
Unemployment
Time management and juggling
A guide to dealing with workplace stress
Discrimination and stigmatization
Blatant discrimination and microaggression
Social identity
Coping with discrimination
Chapter 3. HORMONAL CHANGES ASSOCIATED WITH STRESSORS
The Biological Stress response
The hypothalamic pituitary adrenal (HPA) axis
Cortisol/corticosterone response to an acute stressor
What cortisol (corticosterone) does for us
Mineralocorticoids
Chronic stressors
Early life events influence the corticosterone response
Stressor-induced glucocorticoid effects in humans
Cortisol changes associated with laboratory based stressors
Previous experiences influence cortisol changes elicited by laboratory challenges
The morning cortisol response in relation to stressful experiences
Corticotropin releasing hormone (CRH)
Stressor effects on CRH functioning
Fear and anxiety
CRH receptors
Stress, energy balances and eating to cope
Leptin, Insulin, Bombesin, Neuropeptide Y, and Ghrelin involvement in eating processes
Leptin, Insulin, Bombesin Neuropeptide Y, and Ghrelin involvement in stress processes
Prolactin
Estrogen and Testosterone
Stress responses in males and females
Stress and reproduction
Oxytocin
A prosocial hormone
Moderation of the stress response
Chapter 4. NEUROTRANSMITTER PROCESSES PROMOTED BY STRESSORS
Neuronal and glial processes in relation to challenges
Glial cells
Neurons
Neurotransmitter changes elicited by stressors
Biogenic amines: acute stressor effects
Amine receptor changes associated with stressors
Characteristics of stressors influence amine changes
Asymmetrical neuronal changes elicited by stressors
Impact of chronic stressors: adaptation and allostatic overload
Acetylcholine (ACh)
γ-Aminobutyric acid (GABA)
The GABAA receptor
GABA-related changes elicited by stressors
Interactions of GABA and other neurobiological factors
Cannabinoids
Growth factors
Brain-derived neurotrophic factor (BDNF)
BDNF variations associated with early life experiences
Basic fibroblast growth factor (bFGF or FGF-2)
Glial cell line-derived neurotrophic factor (GDNF)
Conclusions regarding growth factors
Sensitized neuronal responses
The past influences the future
Cross-sensitization: drugs and stress are a bad mix
Chapter 5. IMMUNOLOGICAL EFFECTS OF STRESSORS
What the immune system is supposed to do
The immune system (a very brief primer)
Components of the immune system
Macrophages and microglia
Lymphocytes: T and B cells
Natural Killer cells.
Antibodies and antigens
Changes of immune competence
Immune-hormone interactions
Glucorticoids and other hormones
Interactions between the Immune System and the Brain
Stress, central processes and immunological alterations: Animal studies
Strong and weak stressors
Acute vs chronic challenges
Stressor effects on immune functioning in humans
Stressors and cytokine changes
Th1 and Th2 Derived Cytokines
Impact of stressors on pro-inflammatory cytokines (IL-1, IL-6, and TNF- Impact of stressors on inhibitory cytokines
Sensitization
Chapter 6. STRESS IMMUNITY AND DISEASE
Immunity and Disease
Infectious Illness
Stressor effects on infectious illness
Autoimmune disorders
Multiple sclerosis (MS)
Characteristics of the illness
Impact of stressors
Lupus erythematosus
Characteristics of the illness
Impact of stressors
Arthritis
Characteristics of the illness
Impact of stressors
Cancer
The cancer process
Implication for cancer treatment
Stress associate with cancer
Cancer associated with stress
Stress and its implication for cancer treatment
Concluding comments
Chapter 7. HEART DISEASE
Diseases of the heart
The heart’s typical response to a stressor
Psychosocial factors associated with heart disease
Stressful experiences influence heart disease
Acute laboratory stressor effects
Socioeconomic status (SES)
Depressive illness in relation to heart disease
Gender differences in heart disease and stressor responses
Social support resources
Personality factors in relation to heart disease Type A personality, hostility and aggression
Type D personality
Physiological stress responses that affect heart disease
Sympathetic nervous system hyper-responsivity
Stress-related coagulation
Brain influences on cardiac functioning and disease
Inflammatory processes in heart disease
Toll like receptors in relation to cardiac illness
Cytokines and stressors
The course and source of chronic inflammatory effects
Adipocity and cytokines in relation to heart disease
C-reactive protein
Implications for treatment
Concluding remarks
Chapter 8. DEPRESSIVE DISORDERS
What is depression?
Diagnosing depression
Depressive subtypes
Illness comorbidity
Theoretical Constructs related to Depressive Illness
Cognitive theories
Hopelessness
Brain perspective of hopelessness
Helplessness
Individual difference factors related to attributional style
An alternative to helplessness theory: Perspectives based on neurochemical changes
Cross-situational effects of uncontrollable stressors
Depression – What’s it good for anyways
Neurochemical perspectives
Basic perspectives and difficulties
Determining biological substrates of mental illness
Monoamine Variations Associated with Depression
Serotonin Variations
5-HT receptors in humans: Imaging, binding and postmortem analyses.
The 5-HT transporter
Genetic engineering and behavioral impairments.
Genetic links between serotonin functioning and depression.
Corticotropin Releasing Hormone (CRH)
HPA polymorphisms related to major depression disorder
CRH-AVP interactions.
Pharmacological studies.
γ-aminobuytric acid (GABA)
Growth Factors in Depression
Brain Derived Neurotrophic Factor (BDNF)
BDNF polymorphism
Links between early life events, SNPs and depression
Fibroblast growth factor-2
Inflammatory Processes Associated with MDD
Cytokines in the brain
Promotion of depression in animal models
Promotion of depression in humans
Cytokines associated with depression under basal and challenge conditions
Depression associated with immunotherapy: the case of IFN-a
Cytokine and stressor interactions
Poststroke depression
Treatments of depression based on inflammatory processes
Concluding Comments
Chapter 9. ANXIETY DISORDERS
Subtypes of anxiety
Generalized anxiety disorder (GAD)
Biological factors and treatment of GAD
Panic Disorder
Behavioral and cognitive views of panic disorder
Biological factors related to Panic Disorder
Treatment of Panic Disorder
Phobias
Phobia subtypes
Treatment of phobias
Obsessive-compulsive disorder
Biological factors related to OCD
Treatment of OCD
Posttraumatic stress disorder (PTSD)
Vulnerability and resilience
Neuroanatomical underpinnings of PTSD
PTSD as a disturbance of memory processes
PTSD in relation to nonassociative processes
Biochemical determinants of PTSD
Norepinephrine and serotonin
CRH and corticoids
GABA and NPY
Sensitized responses and epigenetic factors in relation to PTSD
Treatment of PTSD
A broad caveat concerning temporal changes of PTSD
Concluding comments
Chapter 10. ADDICTION
What is addiction?
Stress in relation to the addiction process
Multiple stress-related causative factors
Changes during the course of illness
Theoretical views on addiction
Reward and aversion
Dopamine and reward processes
Addiction in relation to dopamine changes associated with stressors
Epigenetic factors related to dopamine neurons
Sensitization in relation to addiction
Corticotropin hormone in relation to stress and addiction
CRH in relation to other transmitters
An opponent process perspective
Different drugs, but only some common addiction processes
A different perspective on addiction: eating related peptides
Opposing effects of stress and eating systems
Self medicating: Drugs and eating as coping mechanisms
An integrated perspective
Treatment for Addictions
Concluding comments
Chapter 11: TRANSMISSION OF TRAUMA ACROSS GENERATIONS
A voyage across generations
Intergenerational effects of trauma
Psychological and physical sequelae in relation to the Shoa
The case of Aboriginal Peoples in Canada
Impact of trauma on later responses to challenges
Persistent negative influence of early life stressors
Passage of poor appraisal and coping methods
Transmission of trauma from parent to child
Early life stressors influence biological processes
Impact of postnatal insults
Impact of prenatal insults
Studies of prenatal stress in humans
Biological correlates of prenatal stress in humans
Studies of prenatal stress in animal: focus on CRH and corticosterone changes
Studies of prenatal stress in animals: monoamines and growth factors
Influence of prenatal infection in animals and humans
Prenatal infection and schizophrenia
Gender-dependent effects of prenatal stressors
A brief interlude and recapitulation
Epigenetic Changes
Intergenerational transmission
Epigenetic modification of multiple biological processes
Epigenetic changes in rodents related to maternal behaviors
Epigenetic changes associated with stressors in humans
Collective and historic trauma
Concluding comments
Chapter 12. STRESS BUSTING: TREATMENT STRATEGIES
Relaxation training
Progressive muscle relaxation
Cognitive behavioral therapy (CBT)
Behavioral and biological changes
Cognitive distortions
Therapeutic Change & Cognitive Therapy
Meditation
Mindfulness
The fundamentals of mindfulness
MBSR and MBCT
Neurobiological correlates of mindfulness
The default mode network
The Third Wave of Behavioral Therapies
Acceptance and Commitment Therapy
Pharmacotherapy
The placebo response
Anxiety and depression: Responses to drug treatments
Preliminary caveats
Selecting the right treatment
Limitations regarding drug treatments
Antidepressant Agents Selective serotonin reuptake inhibitors (SSRIs)
Serotonin-norepinephrine reuptake inhibitors(SNRIs)
Norepinephrine-dopamine reuptake inhibitors
Norepinephrine and specific serotonin antidepressants (NaSSAs)
NMDA antagonists
Monoamine oxidase inhibitors (MAOIs)
Antianxiety agents
Benzodiazepines
Azapirones
Norepinephrine -blockers
Herbal (naturopathic) treatments
Concluding remarks