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

Chapter 13. NAVIGATING STIGMA AND SEEKING HELP

Stigma related to mental illness

Shame and anger

Can stigmatizing attitudes be altered?

Responses to stressors and social support

Trust in the health system.

Turning to the internet.

Concluding remarks