Diagnostic and Statistical Manual of Insomnia Disorder

Overview

Assignment	Due Date	Format	Grading Percent
Post Your Introduction	Day 1	Discussion	1
Resource Evaluation Discussion Board: Biopsychosocial Evaluation of Psychological Disorder	Day 3 (1st Post)	Discussion	5
Health Psychology & Body Organ Systems Quiz	Day 6	Quiz	5
Promoting Health Behavior Change	Day 7	Assignment	10

Learning Outcomes

This week students will:

Evaluate shared decision aids as utilized in health promotion and mental health services through the use of the Health Belief (HBM) and Transtheoretical (TTM) Models for behavior change.
Identify body systems, their functions, and associated pathologic correlates.
Discuss a mental health diagnosis using the biopsychosocial perspective.

Introduction

Welcome to Week One of PSY361! Our study of health psychology begins with a general discussion of the evolution of this discipline and some of the theoretical biopsychosocial models used by researchers and professionals in this field. We will then identify the body systems, their functions. We will examine how they are involved in maintaining health and how they are affected by disease, with selected examples of acute and chronic disease states

Required Resources

Required Text

Sarafino, E.P., & Smith, T.W. (2016). Health psychology: Biopsychosocial interactions (9th ed.). Retrieved from https://vitalsource.com
1. Chapter 1: Overview of Psychology and Health
2. Chapter 2: The Body’s Physical Systems

Articles

Immunization Action Coalition. (2013). Summary of recommendations for child/teen immunization (Links to an external site.) [PDF]. Retrieved from http://www.immunize.org/nslt.d/n55/recs_child.pdf
- This resource provides standard and catch-up vaccinations for children and teenagers as well as including contraindications and precautions parents should take with each vaccine.
National Learning Consortium (2013) Shared Decision Making Fact Sheet (Links to an external site.). Retrieved from https://www.healthit.gov/sites/default/files/nlc_s…
- This article This article discusses shared decision making as a best practice in healthcare delivery. Concepts in shared decision making (SDM) are discussed. In addition, links to resources such as decision aids (DA) are provided. Will assist with completion of the Week One discussion.
U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. (2012). Basics and common questions: Why immunize? (Links to an external site.) Retrieved from http://www.cdc.gov/vaccines/vac-gen/why.htm
- This resource provides an overview of the benefits of immunization. An historical description of advances in vaccine technology and eradication of diseases, as well as projections of potential issues if vaccination were to be discontinued.
U.S. Department of Health and Human Services, National Cancer Institute. (2005) Theory at a glance: A guide for health promotion practice (Links to an external site.) [PDF]. Retrieved from http://www.sbccimplementationkits.org/demandrmnch/…
- This article provides an overview of various biospychosocial health models. These include the Health Belief Model (HBM) and the Transtheoretical Model (TTM) of behavior change.
University of Rhode Island Cancer Prevention Research Center. (2016). Transtheoretical Model: Detailed overview (Links to an external site.). Retrieved from http://web.uri.edu/cprc/detailed-overview/
- This article provides an overview of the biopsychosocial healthcare model called the Transtheoretical Model (TTM) of behavior change, a theory that describes stages of intentional behavior change. An historical overview is provided, with a discussion of original theorists and later modifications to the theory. Stages of behavior change are described, with examples from healthcare delivery, especially health promotion interventions. As noted on the webpage, this resource is taken from a previously published article on smoking cessation and stress management published in Homeostasis (1998).

Book

American Psychiatric Association. (2013). The Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Washington, D.C.: American Psychiatric Publishing.

This is the manual of psychiatric diagnostic criteria used by mental health professionals. You will be reading Section II: Diagnostic Criteria and Codes, and choosing one of the disorders by clicking on the links for each category in this section until you find a condition of particular interest. Click on each of the categories to see the disorders contained in that category and click on any disorder to see information describing the disorder, its diagnostic criteria, code for insurance billing, and additional background information. To access the DSM-5 from the Ashford University Library:

Log into the Ashford Library
Click on “Find Articles & More”
Click on “Databases by Subject”
Click on “Psychology”
Click on “DSM-5 Library”
Click on “DSM-5™”
aClick on “Section II”

Websites

Centers for Disease Control and Prevention. (2012). Basics and common questions: Why immunize? For parents (Links to an external site.). Retrieved from http://www.cdc.gov/vaccines/vac-gen/why.htm
- This resource provides an overview of the benefits of immunization. An historical description of advances in vaccine technology and eradication of diseases, as well as projections of potential issues if vaccination were to be discontinued.
Centers for Disease Control and Prevention. (2013). Immunization schedules for adults in easy-to-read formats (Links to an external site.). Retrieved from http://www.cdc.gov/vaccines/schedules/easy-to-read…
- Most of the resources at this website are examples of passive decision aids. The healthcare consumer or provider can utilize this resource to determine recommended vaccinations by age (in adulthood), with additional information for specific vaccines on the schedule.
Centers for Disease Control and Prevention. (2013). Immunization schedules for infants and children in easy-to-read formats (Links to an external site.). Retrieved from http://www.cdc.gov/vaccines/schedules/easy-to-read…
- Most of the resources at this website are examples of passive decision aids. The healthcare consumer or provider can utilize this resource to determine recommended vaccinations by age (in childhood), with additional information for specific vaccines on the schedule.
Centers for Disease Control and Prevention. (2013). Immunization schedules for preteens and teens in easy-to-read formats (Links to an external site.). Retrieved from http://www.cdc.gov/vaccines/schedules/easy-to-read…
- Most of the resources at this website are examples of passive decision aids. The healthcare consumer or provider can utilize this resource to determine recommended vaccinations by age (in adolescence), with additional information for specific vaccines on the schedule.
Centers for Disease Control and Prevention. (2013). Instant childhood immunization schedule (Links to an external site.). Retrieved from http://www2a.cdc.gov/nip/kidstuff/newscheduler_le/
- This resource provides an example of an interactive decision aid (DA) in healthcare delivery for health promotion. The scheduler allows an individual to determine the recommended immunizations based on age and sex (in childhood).
Immunization Action Coalition. (2014). Summary of recommendations for child/teen immunization (Age birth through 18 years) (Links to an external site.) [PDF]. Retrieved from http://www.immunize.org/catg.d/p2010.pdf
- This resource is an example of a passive decision aid. The healthcare consumer or provider can utilize this resource to determine recommended vaccinations by age (in childhood), with additional information for specific vaccines on the schedule.
Centers for Disease Control and Prevention. (2012). Vaccines & preventable diseases: Vaccines: the basics (Links to an external site.). Retrieved from https://www.cdc.gov/vaccines/vpd/vpd-vac-basics.ht…
- This resource provides information on how vaccines interact with the body’s immune system to provide protection against specific infectious diseases that are known as “vaccine-preventable illnesses.” Most of the resource is a list of informational web links to sites that provide more in-depth information regarding specific vaccines, recommended immunizations by age, and consumer information sheets.

Recommended Resource

Multimedia

National Center for Health Marketing (producer). (2009). Have you heard? (Links to an external site.) [Video file] Retrieved from http://www.cdc.gov/cdctv/diseaseandconditions/vacc…

This video presents information on Meningococcal disease and provides scenario based information on how to prevent meningitis through vaccination. PSY 361 Week 1 Overview:While the course is in session, there will be Announcements in the online course to remind you of our current subject content and reading, discussion board activities, assignments, and other important or relevant information. Please be sure to click on all the links in the Course Home area and please look at my WEEK 1 ANNOUNCEMENT which summarizes our activities & the assignments for this week. As always, email with ANY questions or concerns.Topics and Learning Activities This Week:

Evaluate shared decision aids as utilized in health promotion and mental health services through the use of the Health Belief (HBM) and Transtheoretical (TTM) Models for behavior change.
Identify body systems, their functions, and associated pathologic correlates.
Discuss a mental health diagnosis using the biopsychosocial perspective.

Week 1 and Text Chapter 1: Definitions of health:Definitions and perspectives on the concepts of health, wellness, and illness/disease, psychology topics in health/wellness/illness/disease. Note that health is NOT simply an absence of disease. See the World Health Organization (WHO) definition, adopted in 1948: http://www.who.int/about/definition/en/print.html (Links to an external site.).Research concepts: There is information in the text on psychology research. To elaborate a bit more on these concepts:Correlational Research: what is the difference between causality & association? People often insist that experts tell us what “causes” an event or condition to occur. To determine “association” between variables, correlational research is done. However, this type of research can only indicate that there is (or isn’t) a relationship between the variables – not causality. One story that helped me: “When you see a fire, firefighters are always there – does this mean that firefighters cause fires?” (of course they do NOT cause them – but firefighters are associated with fires)(see link at end of guidance).Clinical Research: we are trying to come closer to the answer of “causality.” This usually takes years of painstaking, well designed research trials by many investigators. Today, most practitioners in the healthcare fields will require such research to make clinical decisions; this is called Evidence Based Practice (EBP). We are expected to know how to “grade” the clinical research (strength of taxonomy) and interpret data from randomized clinical trials (RCTs)(see links at end of guidance). Regarding RCTs:

Used to test an intervention (drug, lifestyle, surgery, etc.) and determine how an outcome is matched to the intervention
Used to determine risk factors associated with the development of disease
Requires matched cohorts of patients – matched as closely as possible by age, sex, clinical condition, lifestyle, possibly race/ethnicity, etc.
Requires the use of placebo to test on one cohort and active drug (or other intervention) on the other cohort
Usually it is “double-blind” (neither the investigator nor the subject knows if they are receiving a placebo or an active drug/intervention)
Usually it is “double-dummy” (midway through the experiment, the placebo and active cohorts are switched)
Clinicians expect that results obtained by properly “powered” (enough subjects to be able to perform statistical analysis on the results)

The biopsychosocial model: The biopsychosocial model had two main authors – Roy Grinker (1954) and George Engel (1977). Probably, Engel is more recognized in the USA as the “father” of this theory and approach to psychology. In this paradigm (a paradigm is a way of thinking about something) we give equal importance to three aspects of health care: the biological, psychological, and social.This paradigm probably opened the door to evidence-based practice in psychology and psychiatry, as well as emphasizing the integration of psychopharmacology into care for neuropsychiatric conditions. In addition, patient preferences and beliefs are also incorporated into management choices. Thus, when thinking of medical topics, it is not just the diagnosis and management or cure of illness, but also how the patient views its value and the impact on desired functional capacity. This approach has been used to discuss many topics – everything from pain management, irritable bowel syndrome, and emergency department care. For instance, in managing pain, it is not just the biological aspects (cause, location, intensity of pain) but also psychological (emotional distress, health beliefs) and social (functional impact).Health Behaviors and Behavior Change:Note that health behaviors are choices made by the individual or communities, and the study of motivations and beliefs that underlie these choices is part of health psychology. We can focus on health behavior change using the biopsychosocial model; various theories are used to explain behavior change. We’ll focus on the Health Belief Model (HBM) and the Transtheoretical Model (TTM) of behavior change. Using these models, we can analyze individual health choices in preventive care as well as management of illness and disease states. In Week 1, our use of these models will concentrate on utilizing an important part of health promotion and disease prevention – obtaining immunizations (vaccinations).Health Belief Model (HBM):The HBM contains three main concepts – readiness to act, cues to action, and self-efficacy. Within readiness to act, four components are included: perceived threat or benefit, describing them as susceptibility, severity, benefits and barriers. Cues to action describe strategies that activate readiness. Self-efficacy involves one’s confidence in being able to be successful in an action or endeavor. This model can be applied to both acute and chronic illness as well as health promotion (preventive care). There are limitations to this model, but it is very widely used.

Concept	Definition	Application
Perceived Susceptibility	One’s opinion of chances of getting a condition	Define population(s) at risk, risk levels; personalize risk based on a person’s features or behavior; heighten perceived susceptibility if too low.
Perceived Severity	One’s opinion of how serious a condition and its consequences are	Specify consequences of the risk and the condition
Perceived Benefits	One’s belief in the efficacy of the advised action to reduce risk or seriousness of impact	Define action to take; how, where, when; clarify the positive effects to be expected.
Perceived Barriers	One’s opinion of the tangible and psychological costs of the advised action	Identify and reduce barriers through reassurance, incentives, assistance.
Cues to Action	Strategies to activate “readiness”	Provide how-to information, promote awareness, reminders.
Self-Efficacy	Confidence in one’s ability to take action	Provide training, guidance in performing action.

Modified from: National Institutes of Health. (2005) “Theory at a Glance: A Guide for Health Promotion Practice” NIH number 05-3896. Retrieved from http://www.sneb.org/2014/Theory%20at%20a%20Glance.pdf (Links to an external site.)Transtheoretical Model (TTM) of Behavior Change (Stages of Change Model)The TTM is also called the “Stages of Change” model – since it describes individuals moving through specific stages of change: precontemplation, contemplation, preparation, action, and maintenance. Some descriptions of this model also include an additional final stage called termination, but this is not usually included in health-related behaviors. One focus of the TTM is to describe interventional strategies that can influence the movement from one stage to the next. The goal is to achieve maintenance. Much research has been done regarding this model, and was originally applied by Prochaska to smoking cessation interventions. In smoking cessation, research has identified the amount of time typically spent in the different stages. The information below is taken from one of your instructor’s publications on this topic (see reference list at end of this guidance):

Precontemplation: currently smoking, will not consider quitting within the next six months
Contemplation: currently smoking, will consider quitting with in the next six months
Preparation: currently smoking, change is imminent, may even start some action (e.g., “cutting down” on cigarettes)
Action: not smoking, high rate of relapse in this stage (needs more support)
Maintenance: not smoking, greater confidence, less relapse risk, may help others to make the same change (quitting smoking)

Let’s talk more about immunization (vaccines) as a health promotion practice:“THE PARABLE OF THE PEBBLES”:A man was out walking in the desert when a voice said to him, “Pick up some pebbles and put them in your pocket, and tomorrow you will be both happy and sad.”The man obeyed. He stooped down and picked up a handful of pebbles and put them in his pocket. The next morning he reached into his pocket and found diamonds and rubies and emeralds. And he was both happy and sad. Happy he had taken some – sad that he hadn’t taken more.And so it is with education…maybe vaccination? The more the better?What are vaccines?Vaccines are biological substances that interact with the person’s immune system to produce an immune response identical to that produced by the natural infection.Vaccines can prevent the debilitating and, in some cases, fatal effects of infectious diseases. Vaccines help to eliminate the illness and disability of polio, measles, and rubella. However, the organisms that cause these diseases have not disappeared. Rather, they have receded and will reemerge if the vaccination coverage drops. The serious health burden of vaccine-preventable diseases (VPDs) is evident from the measles resurgence of 1989 to 1991, resulting in more than 55,000 cases, 11,000 hospitalizations, 120 deaths, and $100 million in direct medical care costs.Vaccines protect more than the vaccinated individual. They also protect society. When vaccination levels in a community are high, the few who cannot be vaccinated—such as young children and persons with contraindications to vaccination—often are indirectly protected because of group immunity (in other words, they live among vaccinated persons who may offer protection from exposure to disease).Vaccines provide significant cost benefits. Three childhood vaccines—diphtheria, tetanus toxoids, and acellular pertussis vaccine (DTaP); measles, mumps, and rubella vaccine (MMR); and Haemophilus influenzae type b (Hib) vaccine—result in substantial direct medical savings for each dollar spent to vaccinate children against these diseases. Varicella vaccine saves roughly 90 cents in direct medical costs for every dollar invested. Consideration of indirect savings—prevention of work loss by parents to care for ill children and prevention of death and therefore lost earnings from disability—shows that vaccines routinely recommended for children are highly cost saving. Savings range from $24 for every dollar spent on DTaP to $2 for the more recently approved Hib vaccine.How vaccines got their start:

People noticed that milkmaids who contracted cowpox from cows seemed immune to smallpox
In 1796 Dr. Edward Jenner inoculated (injected) cowpox into a healthy child, who became ill with cowpox – after that, the boy was immune to smallpox
- VACCA means “cow” in Latin – that is how “VACCINE” got its name
- or, some people say that “vaccine” comes from the Latin word for smallpox (vaccinia)
Smallpox eradication:
- smallpox was eliminated from the entire world in 1977 – why we no longer need to vaccinate against it
- the only place smallpox exists in the world is in laboratories for scientific investigation
Near-eradication of other illnesses worldwide:
- poliomyelitis (polio) is ALMOST eradicated worldwide
Some vaccine-preventable diseases: anthrax, cervical cancer (Human Papilloma virus, HPV), diphtheria, hepatitis A, hepatitis B, haemophilus influenza type b, human papillomavirus, influenza, Japanese encephalitis, Lyme disease, measles (rubeola), meningococcal meningitis, monkey pox, mumps, pertussis, pneumococcal pneumonia, polio, rabies, rotavirus, rubella, shingles, smallpox, tetanus, typhoid, tuberculosis, varicella, yellow fever

Week 1 and Text Chapter 2: We usually take a “systems” approach to how the body works. What this means is that we organize physiological body functions into “systems” in which life processes are maintained by the different organ systems (nervous, endocrine, digestive, respiratory, cardiovascular, immune). These organ systems are integrated so that they work together to maintain the body’s health – this is the overall “physiology” of the body. Alterations in function cause of disease or illness, and the study of such aberrations is called “pathophysiology.” Thus, we might think of health and illness as a balancing act. The healthy body monitors for movement away from health, and implements changes to restore health should this occur. These changes are usually referred to as “compensatory” changes. Another concept in this area is that of homeostasis – this is the maintenance of normalcy in terms of health status and organ function.

Additional Resources:American Academy of Family Practice. (2007). SORT: The strength-of-recommendation taxonomy (Links to an external site.). Retrieved from: http://www.aafp.org/dam/AAFP/documents/journals/af…Cherry, K. (2016, May 11). Correlational studies: A

Diagnostic and Statistical Manual of Insomnia Disorder