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UNIT 4, Consciousness - Coggle Diagram

- - - - Circadian rhythms
        
        biological processes, regulated by internal mechanisms, that coordinate the timing of activity of body systems over a 24-hour period
      - Ultradian rhythms
        
        biological processes that coordinate the timing of activity of body systems in less than 24 hours
      - Suprachiasmatic Nucleus
        
        part of the brain’s hypothalamus, which functions as the master body clock (internally regulating sleep wake cycle)
    - - light
        
        The suprachiasmatic nucleus is sensitive to light
        
        circadian rhythm is so closely connected to day and night
        
        main zeitgeber
        
        melatonin
        
        high levels = increase drive for sleep
        
        low levels = decreases drive for sleep
        
        induces drowsiness
        
        drive for sleep
        
        hormone
      - external cues
        
        exercise
        social activity
        eating patterns
        shift work
        temperature
      - PROCESS
        
        zeitgeber natural/artificial light
        
        suprachiasmatic nucleus (SCN), in hypothalamus
        
        message to the Pineal Gland
        
        inhibitory signal in day light or high level of light
        
        inhibit or release melatonin
        
        induces drowsiness, decreasing brain cell activity
        
        Excitatory signals in low level of light or darkness
      - influences the suprachiasmatic nucleus (SCN), in hypothalamus
      - serotonin
        
        Your brain also needs serotonin to make melatonin (a hormone that regulates your sleep-wake cycle)
        
        Serotonin is involved in wakefulness, sleep onset, and preventing REM sleep
        
        Low levels of serotonin can lead to insomnia
  - - - There are different techniques for measuring sleep based on objective physiological changes in the activity of the body, observations and subjective reports
      - records:
        
        the onset of sleep
        
        sleep duration
        
        sleep quality
        
        awakenings during sleep
        
        any body movements
        
        wake-up time
      - techniques:
        
        Electroencephalography (EEG)
        
        activity of the brain
        
        brain waves
        
        BATD fish - acronym
        
        BETA – high frequency, low amplitude (REM sleep and wakefulness)
        
        ALPHA – medium frequency, medium amplitude (NREM N1)
        
        THETA – low frequency, high amplitude (NREM N2)
        
        DELTA – lowest frequency, highest amplitude (NREM N3)
        
        frequency: speed
        
        activity per sec The frequency of a brain wave indicates the speed of the brain waves or how much activity is occurring every second
        
        Slower tired, relaxed or asleep
        
        Faster awake and alert
        
        amplitude: strength
        
        The amplitude of a brain wave indicates the intensity or strength of the brain wave, or how many neurons are firing together at the same time
        
        high P low T similar task Higher peaks and lower troughs indicate more synchronised brain activity from multiple neurons working on a similar task (such as sleep)
        
        low P and T different tasks Lower peaks and troughs indicate groups of neurons are working on different tasks (such as driving a car)
        
        Electrodes are attached to a person’s scalp or through a cap or headset
        
        identify a particular stage or abnormal brain activity that differs from what would usually be expected
        
        a general pattern across the four brain wave types is as frequency of a brain wave decreases, the amplitude increases
        
        BRAIN
        
        Electroencephalography (EEG)
        
        A technique that detects, amplifies and records the electrical (D.A.R.E) activity of the muscles controlling the eyes
        
        Electrodes are attached to the surface of the skin around the sides of each eye
        
        An EOG may be used during a sleep study to determine the onset of sleep as well as when the stages and types of sleep occur
        
        As you drift into deeper sleep, your eye movement decreases and slows down, and when you experience REM sleep, your eye movement increases deep, decrease movement/REM, increase movement
        
        EYE MUSCLES
        
        Electromyography (EMG)
        
        A technique that detects, amplifies and records the electrical (D.A.R.E) activity of the skeletal muscles
        
        Electrodes are attached to the surface of the skin, typically around the jaw and sometimes the legs or other body parts
        
        May be used during a sleep study to measure muscle tension which can indicate the stages and type of sleep the person is experiencing
        
        In general, more muscle tension indicates greater alertness
        
        SKELETAL MUSCLES
        
        D.A.R.E = detects, amplifies, records, electrical
        
        Sleep Diaries
        
        A subjective, self-report tool used by a person to track their own sleep and wake patterns
        
        Aim to identify any patterns or habits that cause sleep trouble and provide the sleep specialist with a personal and subjective account of the quantity and quality of sleep being experienced
        
        In a sleep diary, a person can record both qualitative and quantitative data
      - Video Monitoring
        
        During a sleep study, video monitoring is used to collect qualitative visual and audio information about a person’s sleep
        
        Video monitoring is used alongside others EEGs, EOGs and EMGs
        
        It can validate the data collected by these devices to show exactly what activity is occurring while a person is asleep, such as their:
        
        sleeping positions
        
        specific movements
        
        sleep talking
        
        teeth grinding
        
        laboured breathing
  - - - Partial Sleep Deprivation
      - Total Sleep Deprivation
      - Inadequate sleep in either quantity or quality
      - Sleep deprivation effects disappear after one night of uninterrupted sleep
      - Effects of Partial Sleep Deprivation
        
        Affective – amplified emotional responses
        
        AMPLIFIED EMOTIONAL RESPONSES
        
        Mood swings, Increase in negative emotions, Irritability, Reduced motivation, Easily bored, Inability to cope with stress
        
        Behavioural – actions
        
        IMPAIRED ACTIONS & REACTIONS
        
        Difficulty completing routine tasks
        Reduced ability to assess risk and to perform fine motor tasks
        
        Mircosleeps
        
        During the day the body can react with brief periods of sleep
        
        Short, few seconds, with eyes open, appear awake
        
        EEG - first stages of NREM
        
        Cognitive – thought processes
        
        DISRUPTION OF THINKING
        
        Memory lapses, Low attention and concentration, Difficulty thinking logically, Reduced creativity, Distorted perceptions, Slowed reaction time, Reduced spatial awareness
        
        WHY
        
        Performance on complex intellectual tasks are less impaired
        
        Ability to follow simple routines impacted
        
        Tasks that are low-level/boring are impacted due to motivation rather than ability
      - Effects of Total Sleep Deprivation
        
        Same effect as those of partial SD but MAGNIFIED
        
        Temporary sleep deprivation psychosis (major disruption of mental and emotional functioning brought on by lack of sleep)
        
        Psychologically
        
        Paranoid
        
        Depressed
        
        Hallucinations
        
        Little impairment on interesting or complex tasks
        
        Physically
        
        Psychomotor impairments similar to alcohol induced state
        
        24 hour no sleep = BAC of 0.10
        
        SAME AS PARTIAL BUT MAGNIFIED
    - - Sleep deprivation
        
        Negative moods increase
        
        Hostile, argumentative and angry
        
        Vulnerability to stress
      - BAC
        
        Emotions and mood exaggerated and intensified
        
        Fluctuate and little control
    - - Sleep deprivation
        
        Reaction time on tests is slower
        
        Slower movements
      - BAC
        
        Slower
        
        Less control over movements
        
        Reactions further deteriorate, balance and vision decline
        
        Impaired coordination (more likely to fall)
    - - sleep deprivation
        
        Working Memory
        
        Attention
        
        Executive functions (planning and problem-solving)
        
        LTM (declarative )and reduced levels of activity in the medial Temporal lobe (hippocampus)
        
        Simple and routine tasks seem more difficult
        
        Complex tasks less affected but still difficult
      - BAC
        
        Various aspects impaired
        
        Inability to solve or make decisions
        
        Not able to concentrate on multifaceted aspects
    - - Significant relationship between fatigue and levels of BAC and impaired performance (Dawson and Reid 1997)
      - Found that performance on a variety of cognitive tasks
      - 17hrs of sleep deprivation = decreased levels of performance equivalent to BAC of 0.05 17hrs = 0.05 BAC
      - 24hr of full sleep deprivation = decreased levels of performance equivalent to BAC 0.10 24hrs = 0.10 BAC
  - - - Mismatch between an individual’s sleep–wake pattern (internal) and the pattern that is desired or required (external)
        Mismatch of internal and external patterns
        Demonstrates the importance of synchronization of sleep-wake cycle
      - Endogenous (internal)
        
        Age related sleep wake shifts
        Biological mechanisms (melatonin)
      - Zietgebers (external)
        
        Influence of work/school
        Shift work
      - Delayed Sleep Phase Syndrome
        DSPS
        
        a delay (sleep later 2 hrs or more) in the timing of sleep onset and awakening, compared with the timing that is desired
        
        Treatment
        
        Exposure to BLT in the early morning can help reset the sleep–wake cycle by reducing melatonin release earlier in the morning, and promoting melatonin release earlier in evening. This advances sleepiness (brings it forward)
        
        BLT early morning
        
        reset sleep-wake cycle
        
        reduce melatonin release in early morning
        
        promotes melatonin release in early evening
      - Advanced Sleep Phase Disorder ASPD
        
        an advance (sleep begins 2 hours earlier) in the timing of sleep onset and awakening compared to the timing that is desired
        
        Treatment
        
        Exposure to BLT in the early evening results in later melatonin release, therefore delaying sleepiness until a more appropriate later time of the evening
        
        BLT early evening
        
        later melatonin release
        
        delays sleepiness until appropriate time
      - must refer to both falling asleep 2hrs late/early AND waking up 2 hrs later/earlier (because the circadian rhythm (sleep / wake cycle) is misaligned
      - Treatment: Bright Light Therapy
        
        Exposure to artificial lights for specific and regular amounts of time
        
        Stronger / intense light
        
        Resync sleep-wake cycle with normal external day-night cycle
        
        The light will inhibit melatonin (SCN/pineal gland) and promote serotonin, increasing wakefulness and positive mood
        
        Can have negative side effects including headaches and nausea
        
        MUST
        
        Right time of day
        
        Right light intensity
        
        Right amount of time
    - - Night-time
        
        Difficulty falling asleep
        
        Difficulty maintaining sleep for desired time
        
        Waking frequently
      - Daytime
        
        Lethargy (lack of energy and motivation)
        
        Difficulty following schedules
        
        Difficulty learning and accessing memory
        
        Decreased emotional control
    - - During adolescence the sleep-wake cycle shifts towards the evening
      - Results in difficulty going to sleep (increased sleep onset), waking up (incorrect sleep cycle at end of sleep episode) and insufficient sleep quantity
      - Delayed sleep onset: leads to sleep deprivation/sleep debt (sleep that is owed and needs to be made up because requirements have not been met)
      - Cause: during adolescence the release of melatonin is delayed for up to 2 hours
      - sleep onset
        
        A shift forward in sleep onset by about 1 to 2 hours (phase delay) difficulty falling asleep
        
        Body clock wants to go to sleep later
        
        Doesn’t match the sleep time required by the external environment
      - wakefulness
        
        A shift forward in wakefulness by 1 to 2 hours and thus difficulty waking
        
        Body clock wanting to sleep in
        
        Mismatch with early wake time required by the external environment (going to school)
      - body clock doesn't line up with external environment
      - BioPsychoSocial Factors
        
        Biological factors
        
        Delay in the release of melatonin by 1 to 2 hours
        
        Psychological factors
        
        Adolescents like to exert independence, by deciding to stay up late, when to sleep etc
        
        Believe early sleep times are associated with childhood
        
        Poor attitude to good sleep hygiene
        
        Social factors
        
        Increased demands on their time for socialising
        
        increased use of technology and the light emitted from these devices
      - Bright Light Therapy
        
        aims to regaling rhythm
        
        Avoidance of bright light (especially blue light) in the evening
        
        Increasing light exposure in the morning
        
        Social changes/improving sleep hygiene
    - - Shift work: start late evening, end daytime, early in the morning (2 am)
      - Against normal body clock
      - Difficulty sleeping through the day (results in poor quality/quantity sleep)
      - Typical effects
        
        Reduced sleep quality
        
        Avg. 1 – 4 hours less sleep
        
        Accumulation of sleep debt
        
        No continuity
        
        Reduced alertness
        
        Unstable/irregular sleep-wake cycle
      - Treatment
        
        Circadian rhythm needs to be delayed/advanced to realign
        
        Promote wakefulness at night (treat ASPD) BLT administered in the afternoon, to promote earlier onset of sleep (treat DSPS), BTL administered at noon (12pm)
        
        Bright light Therapy (BLT) required while working (during the night) in order to supress the release of melatonin (depends on the shift work)
  - - - The total amount of sleep decreases.
      - The amount of N3 sleep decreases, replaced mostly by N2 sleep.
      - Sleep efficiency reduces (the percentage of the time in bed that is spent asleep).
    - - Newborn 0-3months
        
        14-17hr
        
        50/50
      - Infant 4-11months
        
        12-16hr
        
        30/60
      - toddler 1-2yr
        
        11-14hr
        
        25/70
        
        biggest change in REM sleep amount
      - preschooler 3-5yr
        
        10-13hr
        
        25/75
      - school aged 6-13yr
        
        9-11hr
        
        20/80
      - adolescent 12-17yr
        
        8-10hr
        
        20/80
        
        circadian phase delay occurs 2hr based shift (later)
      - young adult 18-25yr
        
        7-9hr
        
        20/80
        
        shift to a circadian phase advance occurs (earlier)
      - adult 26-64yr
        
        7-9hr
        
        20/80
        
        Awakenings during sleep increase from here
      - older adult 65yr+
        
        7-8hr
        
        18/80
      - hours of sleep
      - REM/NREM %
      - 20/80% generally
  - - - sleep-related behaviours and environmental conditions that are beneficial for sleep (and knowing how they interact with internal mechanisms)
      - ENVIROMENTAL changes to promote sleep
        
        avoid devices and caffeine before bed
        
        wind-down routine
        
        avoid ‘watching the clock’
        
        minimise light and noise
        
        cool temperature
        
        comfortable bedding
        
        Zeitgebers are environmental cues that can synchronise (or misalign) the body’s circadian rhythm.
        
        light
        
        daylight - primary zeitgeber
        
        Blue Light
        
        Exposure at the wrong times reduce the quality and quantity of sleep
        
        inhibits melatonin
        
        consistent exposure to light at appropriate times can help reinforce a regular sleep–wake cycle
        
        at appropriate times, can keep a person alert while improving performance and mood, thereby overall wellbeing
        
        needs to be an appropriately timed
        
        light directly influences the release of melatonin by the pineal gland
        
        Temperature
        
        Body temperature is a marker to the sleep–wake cycle (circadian Rhythm).
        
        Body temperature operates as a circadian rhythm.
        
        decreasing body temperature
        
        sleep onset when temperature greatest rate of decline
        
        begins to decrease in the early evening
        
        Body temp is highest, when melatonin is lowest, vica versa.
        
        link between the neural pathways promoting NREM sleep and the neural pathways for body cooling
        
        cool room (18 degrees) + warm bedding (28 – 30 degrees) promote sleep
        
        Eating and Drinking Patterns
        
        Peripheral body clocks
        
        receive daily resetting signals from the suprachiasmatic nucleus
        
        exist in almost all other body tissues
        
        influenced by other zeitgebers, particularly the timing of meals
        
        SCN suprachiasmatic nucleus’ maintains the 24-hour cycle for food= energy, metabolism, insulin
        
        routine
        
        SCN + peripheral clocks = synchronised = consistent, appropriate sleep–wake cycle
        
        consume food during the active, daylight phase of the 24-hour cycle
        
        alter the timing amount and composition of their meals to the inactive, dark phase of the 24-hour cycle
        
        This influences the peripheral clock timing and leads to an uncoupling of the peripheral clocks from the suprachiasmatic nucleus
        
        timing/amount/ now misaligned with the routine light–dark cycle of the day
- - - - -
        
        non-specific
        
        +
        
        fluxuates
        
        nondefinitive
      - Mentally Healthy:
        Generally positive state/ mental wellbeing,
        ability to cope with and manage life’s challenges
        working productively
        striving to fulfil one’s goals and potential
        connection to others/community.
        
        Characteristics
        
        Multi-dimensional, holistic framework
        
        High levels of functioning
        
        High levels of social and emotional wellbeing
        
        Resilience to life stressors
      - Mental Health Problem
        Adversely affects the way a person thinks, feels and/or behaves typically to a lesser extent/shorter duration than a mental disorder.
        
        Affective (emotions) – deal adversely with negative emotions (e.g. worry, anxious, irritable)
        
        Behaviours (actions) – reduced motivation, mild social withdrawal
        
        Cognitive (thoughts) – difficulty making big decisions and concentrating especially in difficult situations (e.g. school or work)
      - Mental Disorder:
        A mental health state
        combination of thoughts, feelings and behaviors
        usually associated with significant personal distress
        impair the ability to function effectively in everyday life
        
        Affective (emotions) – significant emotional distress
        
        Behaviours (actions) – inability to function effectively in everyday life (e.g. chores, school, work, social situations). Actions are inappropriate
        
        Cognitive (thoughts) – low level of cognitive functioning (e.g. making decisions, with perception of events, reasoning and logical thinking, concentration / attention)
        
        Distinguishable by two factors in comparison to mental disorder – severity (how much) and/or duration (amount of time).
      - High vs Low Levels of Functioning
        
        high levels
        
        If someone is considered as having high levels of functioning – their behaviour is said to be ADAPTIVE
        
        Actions that enable a person to effectively carry out their usual tasks
        
        Adaptive – involves actions that enable a person to effectively carry out their usual everyday tasks
        
        low levels
        
        If someone is considered as having low levels of functioning – their behaviour is said to be MALADAPTIVE
        
        Actions that disrupt or impair everyday functioning
        
        Maladaptive – interferes with a persons ability to carry out usual tasks
      - HERS
        
        High functioning
        
        emotional
        
        resilience
        
        social wellbeing
      - CHECK DURATIONS!!
      - KEY IDEAS
        
        Mental wellbeing
        
        Functioning
        
        high or low
        
        Social and emotional wellbeing
        
        ability to have satisfying relationships and interactions with others
        
        Resilience
        
        ability to cope with uncertainty/change
        
        adapt well to life stressors and restore positive functioning
        
        It means 'bouncing back’ from adversity or difficult experiences that are stressors and restoring positive functioning
    - - Internal and External Factors
        
        affect and are affected by one another
        
        internal
        
        Influences that originate inside or within a person (psychological or biological)
        
        biological
        
        Neurotransmitter GABA dysfunction
        
        Long term potentiation LTP
        
        Psychological
        
        Catastrophic thinking (future)
        
        Memory bias (past)
        
        external
        
        Influences that originate outside a person (social)
        
        Social
        
        Specific environmental triggers
        
        Stigma around seeking treatment
      - KEY IDEAS
        
        Mental Wellbeing for ATSI people
        
        Body, mind and emotions
        
        family and kinship, community
        
        culture, country, spirituality and ancestors
        
        Social and Emotional Wellbeing (SEWB) Framework
        
        multidimensional and holistic
        
        elements
      - BSP framework
        
        factors
        
        various factors (multidimensional)
        
        Factors combine and interact to influence an individual's mental health
        
        reflects a holistic view of health
        
        Three domains are equally important
        
        main ideas
        
        3 main influences - biological, social, psychological
        
        multidimensional
        
        internet and influence
        
        holistic
        
        -/+
        
        +
        
        considers BSP
        
        -
        
        non-specific
      - SEWB framework
        
        remember all 7 domains
        
        domains
        
        body
        
        mind and emotions
        
        family and kinship
        
        community
        
        culture
        
        Country
        
        spirituality and ancestors
        
        main ideas
        
        multidimensional
        
        7 domains
        
        3 determinants - social, historical, political
        
        holistic
        
        interconnected
        
        cannot be considered in isolation
        
        influenced by the community's social, emotional, cultural wellbeing
        
        community based
        
        influenced by social, historical and political determinants
        
        entwined with the past injustices associated with colonisation
        
        healing is collective and relational
        
        +/-
        
        +
        
        can be applied broadly
        
        -
        
        doesn't account for biological
        
        must be educated in ASTI culture to use SEWB
        
        inseparable domains
      - comparing frameworks
        
        SEWB
        
        specific to ASTI community
        
        7 domains / 3 determinates
        
        detail around specifics domains
        
        greater emphasis on external
        
        collective and relational - community based
        
        BOTH
        
        multidimensional
        
        holistic
        
        internal and external influences
        
        BSP
        
        universal
        
        3 non-specific categories
        
        greater emphasis on internal
    - - areas on continuum
        
        Stress – a state of physiological and psychological arousal produced by internal or external stressors that are perceived by the individual as challenging or exceeding their ability or resources to cope
        
        Anxiety – state of physiological arousal and is associated with feelings of apprehension, worry or uneasiness that something wrong or unpleasant is about to happen FUTURE BASED
        
        Phobia – persistent, intense, excessive and irrational fear (disproportionate to actual risk) of a particular object or situation
      - comparing areas
        
        Anxiety
        
        Stress
        
        Phobias
        
        Neurotransmitter GABA dysfunction
        
        Long term potentiation
        
        Catastrophic thinking (future)
        
        Memory bias (past)
        
        Specific environmental triggers
        
        Stigma around seeking treatment
        
        ALL
  - - - relative influences of BPS factors that contribute to the development of specific phobia
        
        BPS model
        
        Proposes that health and illness outcomes are a result of the interaction of contributing biological, psychological (both internal) and social (external) factors
        
        Interactive nature
        
        Holistic understanding of diagnosis
      - GABA dysfunction, LTP (biological)
      - behavioural models, precipitation CC, perpetuation OC, cognitive biases - memory, catastrophic thinking (psychological)
      - specific environmental triggers, stigma treatment (social)
    - - 4 Ps
        
        Predisposing
        
        Increase susceptibility
        Conception or early life events
        GABA
        
        Precipitating
        
        Increase susceptibility and contribute to occurrence
        Trigger onset of phobia (occur before)
        CC
        Specific enviromental triggers
        
        Perpetuating
        
        Prolong the course of the disorder and inhibit recovery
        OC
        Stigma
        LTP
        
        Protective
        
        Prevent occurrence or re-occurrence
        Positive effect on health
        Promoting wellbeing
    - - biological
        
        GABA
        
        Normal GABA: inhibitory neurotransmitter, calming effect on nervous system
        
        GABA Dysfunction: significantly low levels
        
        Insufficient amounts result in a rise in anxiety due to raised arousal levels that are not mediated
        
        Can cause overthinking and leads to easily triggered F/F/F response
        
        LTP Long Term Potentiation
        
        Fear is a learnt response
        
        When a stimulus is frequently triggers a response (fear response) a synpatic connection will strengthen as time progresses due to stimulation
        
        Exposure to the fear stimulus will strengthen the memory pathway, enables them to transmit information at faster rate and more efficiently causing responses to intensify over time.
      - Psychological
        
        Behavioural Models
        
        Classical conditioning CC
        
        Establish phobia
        
        Precipitating
        
        NS is associated with a UCS that elicits a fear response, becoming a CS
        
        Activation of amygdala due to fear response results in stronger association between stimulus and fear.
        
        Operant conditioning OC
        
        Maintain phobia
        
        Perpetuating
        
        The phobic stimulus (antecedent) is repeatedly followed by a fear reaction (consequence)
        
        Cognitive models
        
        Cogntive bias
        
        Belief and expectation that the phobic stimulus poses a danger
        
        Perceived threat is overestimated
        
        Exaggerates fear response
        
        Memory bias
        
        Fear-inducing aspect of original memory dominates any other non-frightening experience
        
        Catastrophic
        thinking
        
        Negative thoughts are combined and amplified out of proportion
        
        Dwell on likelihood that event/phobic encounter will reoccur
        
        underestimates their coping capacity
      - Social
        
        Specific Environmental Triggers
        
        Development of a specific phobia after one single experience that is negative
        
        Stigma Around Seeking Treatment
        
        Real (observable comments or actions from others) or perceived (individuals thoughts that others think they are weak for their illness/phobia is silly or embarrasing)
        
        Negative label that can led to being ashamed and therefore avoiding professional help
    - - Biological
        
        Short acting benzodiazepine agents (GABA agonists)
        
        Agonists
        
        stimulate production, increasing its overall levels
        
        mimic the role of a neurotransmitter
        
        Benzodiazepine agonists
        
        assist with the physiological symptoms of phobias (FFF)
        
        enhance the role of GABA
        
        change the structure of the receptor site on the post-synaptic neuron
        
        to be more receptive to GABA transmission / activity, less likely to fire
        
        Side-effects
        
        reduced alertness
        
        reduced abilities dependent on alertness
        
        can be addictive
        
        can lower inhibition / increase impulsivity / take risks when mixed with alcohol
        
        Does not address mental or behavioural elements of phobia (short term effectiveness)
        
        Breathing retraining
        
        Correcting breathing habits to help reduce anxiety.
        
        Controlled Breathing - Breathing exercises that slow down breathing rate
        
        deep breaths through nose and out through mouth
        
        to control fast / irregular and shallow breaths associated with anxiety
        
        reduce physiological arousal (FFF) associated with fear response
        
        help the individual to have some control over autonomic functions - sympathetic nervous system
      - Psychological
        
        Cognitive Behavioural Therapy (CBT)
        
        therapy program that combines thought (cognitive) and actions (behaviour) based interventions that promote recovery.
        
        Behaviours (actions)
        
        adaptive actions / behaviours
        
        promote recovery or prevention - not avoiding / promoting safe contact with phobic stimulus.
        
        Can include breathing retraining, exercise, encouraging rewarding activities, not encouraging avoidance
        
        Thoughts (cognitive)
        
        identify cognitive distortions/ maladaptive thoughts
        
        and challenge them with evidence-based research / testing / objective evaluation / education component
        
        Can be researching phobic stimulus or learning about avoidance behaviour (to become self-aware of illness)
        
        Systematic Desensitisation
        
        Systematic (step by step/controlled) Desensitisation (fear reducing)
        
        behaviour therapy
        
        (can be used separately or as part of CBT program – the behaviour part)
        
        involves replacing an anxiety response with a relaxation response when individual encounters phobic stimulus
        
        Process of unlearning the connection between anxiety and phobic stimulus
        
        Step one – teach relaxation technique to decrease physiological symptoms e.g. breathing retaining
        
        Step two – break down anxiety arousing object or stimulus from most to least anxiety inducing – known as fear hierarchy (between 10 – 15 stages)
        
        Step three – gradual pairing with items on list and breathing retraining until relaxation is achieved (counter-conditioning e.g. reverse classical conditioning fear learnt response ). No advancement is made until relaxation is achieved at previous stage
      - Social
        
        Psychoeducation for families/supporters
        
        Challenging unrealistic or anxious thoughts
        
        Encourage individual to think rationally
        
        challenge thoughts that contribute to anxiety
        
        Not encouraging avoidance behaviours
        
        Avoidance behaviours (strengthened by negative reinforcement) perpetuate phobias
        
        Encourage individual to face what is feared
        
        short term relief from avoidance doesn’t solve the problem
        
        Provision and explanation of information about phobias
- - - - Sleep–wake cycle – 24hr sleep/wake cycle (8/16)
      - circadian rhythm (24-hour internal body clock)
      - Sleep episode – total sleep time (e.g. 8 hours asleep)
      - Sleep cycle – 5 cycles approximately 90 minutes two types of sleep: REM and NREM sleep
      - Hypnogram - Displays patterns of a sleep episode,
        adults 5 sleep cycles
        REM and NREM sleep
      - non-rapid eye movement (NREM) sleep
        
        A type of sleep characterised by progressive decline in physiological activity
        
        It is thought that our body is repairing during NREM sleep
        
        NREM sleep consists of 3 stages and takes up around 80% of a sleep episode in people of school age and older
        
        STAGES
        
        NREM Stage 1 (N1) – a transitional phase between wakefulness and sleep. It is considered to be light sleep and physiological responses begin to slow down
        
        *easy to wake from N1
        
        NREM Stage 2 (N2) – also considered light sleep during which physiological responses continue to slow down. It is the stage of sleep that is experienced the most throughout a sleep episode
        
        *moderately able to wake up from N2
        
        NREM Stage 3 (N3) – considered deep sleep, during which physiological responses are at their slowest. N3 is experienced more in the first half of the night, and it may not be experienced at all in the last one or two sleep cycles of a typical night
        
        difficult to wake (deepest sleep) from N3
      - rapid eye movement (REM) sleep
        
        During REM sleep, your eyes make quick darting movements behind closed eyelids and your physiological activity increases
        
        REM takes up around 20% of a sleep episode in people of school age and older
        
        During REM sleep, brain activity resembles wakefulness, heart rate and breathing rate increase. Voluntary muscles are seemingly paralysed
        
        The most vivid and memorable dreams occur during REM sleep
        
        end of each sleep cycle
        
        It is thought that our mind is repairing during REM sleep
        
        get longer and closer together as night progresses