Psyc 3560 (abnormal psyc) exam 2 study guide
Psyc 3560 (abnormal psyc) exam 2 study guide PSYC 3560
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This 19 page Study Guide was uploaded by Kennedy Finister on Saturday June 4, 2016. The Study Guide belongs to PSYC 3560 at Auburn University taught by Dr. Fix in Spring 2016. Since its upload, it has received 45 views. For similar materials see Abnormal Psychology in Psychlogy at Auburn University.
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Date Created: 06/04/16
Ch 6 – Panic, Anxiety, Obsessions, and Their Disorders Fear vs. Anxiety Fear basic emotion shared by all animals involves activation of the “fight or flight” response of autonomic nervous system cognitive/subjective “omg I’m going to die” physiological heart rate increase, release of adrenaline behavioral response, whatever it takes to stay alive panic attack fear response in the absence of actual threats Anxiety Complex blend of unpleasant emotion and cognitions More oriented to the future and more diffuse than fear Cognitive/subjunctive “What if I embarrass myself?” physiological some adrenaline but not as much as fear response behavioral plan to avoid the situation, or having a plan of action if situation does arise anxiety can be adaptive problem occurs when it is excessive What defines something as an anxiety disorder? Out of proportion to dangers truly faced Severe enough to cause distress and or impairment Fear response exists even when stimulus is not present o Hyperventilating, nauseous Specific Phobia What is it (including subtypes) o Specific Phobia Characterized by a strong and persistent fear triggered by the presence of a specific object or situation plus avoidance of that object or situation o Subtypes Animal Dogs, birds, snakes and spiders are very common Natural environment Hurricane, lightning, floods Blood injection injury Blood pressure drops and person faints Seeing blood or an injury, receiving an injection Situational Fear of flying, tunnels, elevators, bridges Other Choking, throwing up Gender/Age of onset Gender ratio (varies) o most animal type cases are women (9095%) o 2:1 (women:men) ratio for blood injection injury age of onset o animal and blood injection types = early childhood o other= indolence or early adulthood Psychological Causes (including evolutionary perspective) behaviorism/learning o classical conditioning fear response can readily be conditioned to previously neutral stimuli when these stimuli are paired with traumatic or painful events phobic fears generalize to other, similar objects or situations o observational learning watching a phobic person behaving fearfully with his or her phobic object can be distressing to the observer and can result in fear being transmitted from one person to another thru vicarious or observational classical conditioning media can also play a role in this o individual differences in life experience some life experiences may serve as risk factors and make certain people more vulnerable to phobias than others and other experiences may serve as protective factors for the development of phobias a person who has had good experiences with potentially phobic stimulus, such as a girl playing with her dog, is likely to be immunized from later acquiring a fear of dogs even if she has a traumatic encounter evolutionary preparedness o evolutionary history has affected which stimuli we are most likely to come to fear. Primates and humans seem to be evolutionarily prepared to rapidly associate certain objects such as snakes, spiders, water, enclosed spaces with frightening or unpleasant events o prepared fears are not inborn or innate but rather are easily acquired or especially resistant to extinction Biological Causes genetic and temperamental variables affect the speed and strength of conditioning of fear o depending on their genetic make up or their temperament and personality, people are more or less likely to acquire fears and phobias modest genetic contribution o example monozygotic twins were more likely to share animal phobias and situational phobias than were dizygotic twins Treatment exposure therapy o behavioral technique o best treatment option o involves controlled exposure to the stimuli or situations that elicit phobic fear clients are gradually placed symbolically or increasingly under “reallife” conditions in those situations they find the most frightening o flooding one prolonged session example 56 hour session with a snake, push thru all stages at once Medications o Not very effective, can interfere with exposure Social Anxiety Disorder What is it (including subtype) o Characterized by disabling fears of one or more specific social situations (public speaking, urinating in a public bathroom, or eating or writing in public) o Person may fear that they may be exposed to the scrutiny and potential negative evaluation of others or that they may act in an embarrassing/humiliating manner o Subtypes Performance situations such as public speaking Nonperformance situations such as eating in public Gender/Age of onset o More common in women than men (3:1 to 2:1) o Typically begin during early or middle adolescence or certainly by early adulthood Psychological Causes (including evolutionary perspectives) o Behavioral o Direct and observational learning Social trauma not fitting in, bullying, etc o Cognitive biases o Uncontrollable, unpredictability Being exposed to uncontrollable and unpredictable stressful events such as parental separation and divorce, family conflict, or sexual abuse Perceptions of uncontrollability and unpredictability often lead to submissive and unassertive behavior which is characteristic of socially anxious or phobic people People with social phobia have a diminished sense of personal control over events in their lives o Misperceive ambiguous stimuli (neutral faces) o People with social phobias tend to expect that other people will reject or negatively evaluate them which leads to a sense of vulnerability when they are around people who might pose Biological Causes o Genetic and temperamental factors o Behavioral inhibitions share characteristics with both neuroticism and introversion Example infants who are easily distressed by unfamiliar stimuli and who are shy and avoidant are more likely to become fearful during childhood and by adolescence show increased risk of developing social phobia o Modest genetic contribution About 30% of the variance in the liability to social phobia is due to genetic factors Even larger proportion of variance in who develops social phobia is due to nonshared environmental factors which is consistent with a strong role for learning Treatment o Exposure therapy o Cognitive restructuring o Therapists attempts to help client with social phobia identify their underlying negative autonomic thoughts (“ive got nothing to say” or “ no one is interested in me”). Then they help change these inner thoughts and beliefs thru logical reanalysis (challenge the autonomic thoughts. Look for evidence for and against such a thought). Then they reframe thoughts to be less biased and more accurate. o Medication o Antidepressants SSRIs [serotonin reuptake inhibitors] (example Paxil) Fairly effective but not long term Panic Disorder & Agoraphobia What is a panic attack? o Abrupt surge of intense fear or intense discomfort that reaches a peak within minutes during which time 4 or more of the following symptoms occur o Palpitations, high heart rate o Sweating o Trembling or shaking o Sensations of shortness of breath o Feelings of choking o Chest pain or discomfort o Nausea or abdominal distress o Feeling dizzy, unsteady, light headed or faint o Chills or heat sensations o Paresthesias (numbness or tingling) o Derealization (feelings of unreality) or depersonalization (being attached from oneself) o Fear of losing control o Fear of dying What is Panic Disorder and Agoraphobia o Panic Disorder o Recurrent panic attacks that “come from out of the blue” AND fears of having additional panic attacks o Agoraphobia o Anxiety about being in places from which escape might be difficult/embarrassing or in which help may not be available in the event of a panic attack Gender/Age of onset o 2:1 (female:male) o due to sociocultural reasons it is more acceptable for women who experience panic to avoid the situations they fear and need a trusted companion to accompany them when they enter feared situations. Men who experience panic are more prone to “tough it out: because societal expectations & their more assertive instrumental approach to life o Often starts late teenage years, early adulthood Biological Causal Factors o May result from biochemical abnormalities in the brain as well as abnormal activity as well as abnormal activity of neurotransmitters norepinephrine and serotonin o Panic attacks arise primarily from the amygdala Psychological Causal factors o Cognitive theory o Disorder may develop in people who are prone to making catastrophic misinterpretations of their bodily sensations, a tendency that may be related to preexisting high levels of anxiety sensitivity o Anxiety sensitivity o A traitlike belief that certain bodily symptoms may have harmful consequences o Example “when I notice that my heart is racing, I worry that I might have a heart attack” o Perceived Control o If the person feels like they’re in control they have less attack/symptoms o Safety behaviors o Example a person who has 34 attacks a week for 20 years; each time believing they’re having a heart attack yet they never do. One would think that this catastrophic thought would diminish but evidence shows that it doesn’t because people with this disorder engage in safety behaviors such as carrying around a bottle of pills to pop before or during a panic attack. Then mistakenly tend to attribute the lack of catastrophe to their having engaged in the safety behavior rather than panic attacks don’t lead to heart attacks o Cognitive biases that maintain panic o The way people perceive what’s going on will determine whether the symptoms heighten or subside Treatment o Medications o Benzodiazepine (Xanax, Klonopin) Pros Quick acting, useful in acute situations of intense panic or anxiety Cons Can become dependent Side effects such as drowsiness, sedation, impaired cognitive and motor performance o Antidepressants (tricyclic & SSRIs) Pros Do not create dependence Can alleviate any comorbid depressive symptoms or disorders Cons Takes about 4 weeks before the have beneficial effects Not useful in acute situations o CognitiveBehavioral o Exposure therapy Interoceptive deliberate exposure to feared internal sensations people are asked to engage in various exercises that bring on various internal sensations and to stick with those sensations until they subside, thereby allowing habituation of their fears of these sensations o Cognitive restructuring Teach people to look at evidence for what their thoughts are Generalized Anxiety Disorder What is it? o Anxiety and worry about many different aspects of life (including minor events) becomes chronic, excessive and unreasonable Gender/Age of onset o Twice as common in women than men (2:1) o Age of onset varies but often develops in older adults Psychological Causal Factors o People may have a history of experiencing many important events in their lives as unpredictable or uncontrollable o Role of worry o Worrying is good. Superstitious avoidance of catastrophe “worrying makes it less likely that the feared event will occur” Avoidance of deeper emotion topics “worrying about most of the things I worry about is a way to distract myself from worrying about even more emotional things, things that I don’t want to think about Coping and preparation “Worrying about predictive negative events helps me to prepare for its occurrence” o Actually increases the sense of danger and anxiety o Cognitive biases for threat o People seem to have danger schemas about their inability to cope with strange and dangerous situations that promote worries focused on possible future threats Biological Causal Factors o Functional deficiency in the neurotransmitter GABA, which is involved in inhibiting anxiety in stressful situations, the limbic system is the area most involved o CRH hormone Treatment o Medications o Benzodiazepines May relieve physical symptoms but not cognitive ones o Antidepressants Help cognitive symptoms o Cognitive Behavioral Treatment o Muscle relaxation o Cognitive restructuring Aimed at reducing distorted cognitions and information processing biases, as well as reducing catastrophizing about minor events Obsessive Compulsive Disorder What is it (what are obsessions? what are compulsions?) o Obsessions o Involve persistent & recurrent intrusive thoughts, images, or impulses that are experienced as disturbing, inappropriate and uncontrollable o People actively try to resist, suppress, or neutralize them with some other thought/action o Compulsions o Involve either overt repetitive behaviors that are performed as lengthy rituals (such as hand washing, checking, organizing things over and over) may also involve more covert mental rituals such as counting, paying or saying words over and over to themselves. o Performed with the goal of preventing or reducing distress or preventing some dreaded event or situation. Gender/Age of onset o 1.4:1 ratio (woman:man) o late adolescence/early adulthood Psychological Causes o Mowrer’s two process theory of avoidance learning o Neutral stimuli becomes associated with frightening thoughts or experiences thru classical conditioning and come to elicit anxiety Example touching a doorknob or shaking hands can lead to the scary idea of contamination. Once having made this association the person may discover that anxiety produced by those stimuli can be reduced by handwashing o Once learned, such avoidance responses are extremely resistant to extinction. Any stressors that raise anxiety levels can lead to a heightened frequency of avoidance that responses in animals or compulsive rituals in humans o Cognitive Factors o Thought suppression Attempting to suppress unwanted thoughts actually increases thoughts later o Appraisals of responsibility for intrusive thoughts Simply having a thought about doing something is morally equivalent to actually having done it. Or that thinking about committing a sin increases chances of actually doing so May motivate compulsive behaviors o Cognitive behaviors/distortions People with OCD are drawn to disturbing material relevant to their obsessive concerns. Also have difficulty blocking out negative, irrelevant input or distracting information so they may attempt to suppress negative thoughts stimulated by this info. Have low confidence in their memory ability which ma contribute to their repeating of ritualistic behaviors over and over again Biological Causes o Evidence from twin studies reveals a moderately high concordance rate for monozygotic twins and a lower rate for dizygotic twins o Neurotransmitter abnormalities Treatment o Behavioral and cognitive behavioral o Exposure and response prevention OCD clients develop a hierarchy of upsetting stimuli and rate them on a scale from 1100 according to their capacity to evoke anxiety, distress, or disgust. Then theyre asked to expose themselves repeatedly to the stimuli that will provoke their obsession. Following each exposure they are asked not to engage in the rituals they would normally do to reduce the anxiety/distress. Preventing the rituals is essential so that they can see that If they allow enough time to pass the anxiety created by the obsession will dissipate naturally down to atleast 4050 on the 100 scale even if it takes hours. Very intense on clients, high drop out rates Studies suggest 5070% reduction in symptoms 75% maintain gains long term o Medication o Medications that affect serotonin systems (SSRIs) Minor improvements in symptoms but many nonresponders When discounted symptom relapse is high Body Dysmorphic Disorder What is it (including associated features) o Obsession with some perceived or imagined flaw or flaws in their appearance to the point that they firmly believe they are disfigured or ugly o Associated features o Typically focused on a specific body part o Compulsive checking behaviors common o Avoidance of activities o Reassurance seeking o Comparing self to others obsessively o Engagement in activities to cover up perceived flaw Excessive grooming, makeup , etc Gender/Age of onset o Men=women o Age of onset usually adolescence Causal factors o Personality predisposition (neuroticism) o Differences in visual processing of faces o Sociocultural context o Cognitive style o Biased attention and interpretation of information relating to attractiveness Treatment o High doses of antidepressants o Cognitive behavioral therapy o Focus on distorted perceptions, exposure and response prevention Example: wear something that highlights their perceived flaw rather than hides it prevent checking responses (looking in the mirror) Ch 7 Mood Disorders What are mood disorders? o Disorders in which extreme variation in mood either high (mania) or low (depression) are the predominate feature. Although some variation in mood are normal, for some people the extremity of moods in either direction becomes seriously maladaptive even to the extent of suicide Types of moods o Mania o Often characterized by intense and unrealistic feeling of excitement & euphoria o Depression o Usually involves feelings of extraordinary sadness and dejection Major Depressive Disorder What is it? Persistent down or depressed mood occurring more days than not o Intense and episodic Emotional, physiological/behavioral, and cognitive symptoms Emotional o Sad mood o Anhedonia (numb) Physiological/Behavioral o Apetite change o Sleep disturbance o Psychomotor disturbance o Fatigue Cognitive o Inappropriate guilt/feeling worthless o Concentration difficulty/indecisiveness o Thoughts of suicide/death Recurrent vs. single episode MDD Single o First or initial episode Recurrent o Preceded by one or more previous episodes Course of Major Depressive Disorder Depression episodes are often timelimited o 69 months on average Likelihood of reoccurrence increases as the number of MDEs increase Gender/Age of onset 2:1 (female:male) adolescence and adulthood 1:1 during childhood What is Persistent Depressive Disorder? When people have mild depressed mood, some meet full criteria MDE the whole time. Person must have a persistently depressed mood for most of the day for more days than not for 2 years (1 year for children/adolescence) o Intermittent normal mood occur very briefly & never more than 2 months Unipolar Mood Disorders Biological Causal Factors Genetic influences o 23x more prevalent among biological relatives Neurochemical o Monoamine theory (serotonin, norepinephrine drive all) o Dopamine (linked to anhedonia & low positive affect) Hormonal o Stress response (cortisol) Neurophysiological Factors o Right Pre Frontal Cortex (negative emotions) versus left PFC (approach, positive emotions Biological Rhythms o Sleep More REM, less deep sleep Could be vulnerability factor o Sunlight/Seasons Seasonal affect disorder Usually atypical features (increased sleep, increased appetite) Psychological Causal Factors Stressful life events o Independent Unrelated to own behavior Examples being an elite athlete and having a career or season ending injury. Or finding out you have HIV/AIDS when you’ve been with only your spouse the last 10 years, you’ve been getting cheated on or they kept that from you o Dependent Partly generated by own behavior Example abusing substances, ruining interpersonal relationships Stronger Role o Personality Neuroticism Sadness, guilt, anxiety Low Positive Affectivity Affectivity = emotional expression/experience Unenthusiastic, flat, boring Treatments Other biological o Electroconvulsive Therapy (ECT) a procedure, done under general anesthesia, in which small electric currents are passed through the brain, intentionally triggering a brief seizure. seems to cause changes in brain chemistry that can quickly reverse symptoms of certain mental illnesses. For Severe depression, nonresponders o Transcranial Magnetic Stimulation Pulsating magnetic fields stimulating certain regions in the cortex (5 days per week for 26 weeks Mixed findings o Bright Light Therapy Originally used for seasonal affective disorder Effective for depression and seasonal affective disorder Supposed to uplift people’s spirits and make them happier Psychotherapy o Cognitive Behavioral Therapy 1012 sessions focus on the here and now identify dysfunctional thoughts and challenge them as effective as medications, and better at preventing relapses and recurrences o Behavioral Activation Refers to increasing activities and interactions Very effective, maybe as effective as CBT o Interpersonal Therapy Identify and change maladaptive interaction patterns with others As effective as medication and CBT but still early in the research Bipolar Disorders Manic episode An overly joyful or overexcited state Hypomania Same as manic except its atleast 4 days, noticeable by other, but not severe enough to cause marked impairment in functioning Be able to differentiate between Bipolar I, Bipolar II, and Cyclothymic Disorder Bipolar I o Presence of one or more manic episodes o Clinically significant distress or impairment o History of MDE is not required Bipolar II o Presence or history of one or more depressive episodes o Presence or history of one or more hypomanic episodes o No history of manic episode o Clinically significant distress/impairment Cyclothymic o A less serious version of full blown bipolar disorder because it lacks certain extreme symptoms and psychotic features such as delusions an the marked impairment caused by fullblown manic or major depressive episodes Gender/Age of onset 1:1 late adolescence – early adulthood average 22 Characteristics of manic episodes (duration, etc) a condition in which a person shows markedly elevated euphoric, or expansive mood, often interrupted by occasional outbursts of intense irritability or even violence that lasts for at least a week. At least 3 out of 7 other designated symptoms must also occur Differences between Major Depressive Disorder and Bipolar Disorders Manic episodes o Tend to be much shorter in bipolar disorder than depressive episodes Depressive Episodes o Bipolar tend to be more severe than unipolar depression and often have: Greater mood lability More psychotic features More substance abuse Greater psychomotor retardation Overall episodes shorter than MDD but more episodes during lifetime o Rapid cycling: 34 episodes within a year Biological and Psychological Causal Factors Biological o Genetic Factor One of the most heritable disorders No single gene responsible o Neurochemical Factors Elevated norepinephrine and dopamingergic activity o Hormonal Factors Elevated cortisol levels during depressive moods Thyroid hormone can precipitate manic episodes o Biological Rhythms Disruptions in sleep patterns can trigger manic episodes Seasonal patterns also common Psychological o Similar to unipolar disorders Stressful life events Personality and cognitive variables o Interpersonal processes very important Dysfunctional family interactions often linked to onset of manic episodes Treatments Meds o Mood stabilizers: Lithium Anticonvulsants (example Depakote) Effective but not as effective ideation o Antidepressants SSRIs Antidepressants TRIGGER manic episodes Electroconvulsive Therapy (ECT) o Has been shown to help with manic episodes CBT o Good for depressive symptoms not as effective for manic episodes Interpersonal and social rhythm therapy o Taught how to recognize the effect of interpersonal events on their social and circadian rhythms and to regularize these rhythms o Recognize theyre about to have a manic episode Suicidal behavior How common is ideation, suicide attempts, & suicide? Ideation thoughts about suicide without physically harming oneself o 1/3 of general population in lifetime thinks about suicide attempts non fatal injury that is selfinflicted with at least some degree of intent to die 900,000 attempts each year suicide self inflicted death o 38000 people die each year o 11 in 100,000 people die each year Who has the highest rates, gender differences older adults +65 women are 3x as likely to attempt suicide but men are more successful o women use cleaner methods like drug ingestion. o Men use more lethal methods like gunshots Interpersonalpsychological theory of Suicide Suicide desire Acquired Capability: Thwarted Perceived Belongingness: Belongingness: Fearlessness about death, “I don’t belong, I’m not “I’m a drain on other heightened pain tolerance people, my family would accepted High risk vs. universal prevention be better off without me 68% of people who die by suicide were not seen by a mental health professional in the year before death highest suicide risk are people right out of a depressive episode when they have the energy 2 general prevention strategies o high risk focus efforts just on people who are already known to be at risk o universal prevent onset of disease/condition in everyone Chapter 5 Stress and Physical and Mental Health Why should we care about stress and physical health? When you let your stress get the best of you, you put yourself at risk of developing a range of illnesses – from the common cold to severe heart disease What is stress? Distress and eustress? Stress o When challenges to our physical or emotional well being exceed our coping abilities or resources o Can result from positive or negative situations o Takes a toll on our physical and psychological wellbeing Distress o Negative stress associated with pain, anxiety, sorrow Eustress o Positive stress What predisposes people to stress? The way people perceive and interpret stressors People with depressed parents will be more sensitive to stressful events Persons personality o Higher levels of optimism, greater psychological control or mastery, increased selfesteem, and better social support 5HTTLPR gene o linked to how likely it was that people would become depressed in the face of life stress o 2 short forms of the gene (ss genotype) were likely to develop depression than people with two long forms (ll genotype) persons stress tolerance o a person’s ability to withstand stress without becoming seriously impaired Characteristics of stressors the severity of the stressor its chronicity (how long it lasts) its timing how closely it affects our own lives how expected it is how controllable it is What is the HPA system? HypothalamusPituitaryadrenal system o Involved in stress response o Hypothalamus and pituitary gland send messages to the adrenal gland which releases a stress hormone that feeds back on the hypothalamus Stress' effect on physical health Negative emotional states impair the functioning of the immune & cardiovascular system leaving a person more vulnerable to disease, infection and problems such as hypertension and cardiovascular disease Treatment of stressrelated physical disorders Biological Interventions o Antidepressants (SSRIs) o Surgery (if patients have Coronary Heart Disease for example) Psychological Interventions o Emotional Disclosure “opening up” and writing expressively about life problems in a systematic way seems to be an effective therapy for many people how does this provide clinical benefits? Patients are given the opportunity to blow off steam Writing gives people an opportunity to rethink their problems o Biofeedback Procedures aim to make patients more aware of such things as their heart rate, level of muscle tension or blood pressure Done by connecting patient to monitoring equipment and then providing a cue (like an audible tone) to the patient when he or she is successful at desired response (like lowering blood pressure or decreasing tension in facial muscles). Over time, patients become more consciously aware of their internal responses and able to modify them when necessary Helpful in treating conditions like headaches Effects tend to be stable over time o Relaxation and Meditation Relaxation helps patients with essential hypertension help patients who suffer from tension headaches Medication Helpful in reducing blood pressure o Cognitive Behavior Therapy Effective intervention for headaches and other pain Helpful for patients suffering from arthritis Slow down and enjoy life Adjustment Disorder What is it? A psychological response to a common stressor (example divorce, death, loss of job) that results in clinically significant behavioral/emotional symptoms Different types (qualifiers) of adjustment disorders Marked distress in excess of what would be expected from the stressor Significant impairment in functioning Doesn’t meet criteria for another mental disorder Isn’t simply bereavement PostTraumatic Stress Disorder What is it and what are the main types of symptoms? Disorder that occurs following an extreme traumatic event in which a person re experiences the event, avoids reminders of the trauma and exhibits persistent increased arousal Symptoms o Intrusive memories o Recurrent & distressing dreams about the event o Evidence of stimuli associated with the trauma o Negative cognitions o impaired memory about aspects of the traumatic event o increased arousal or reactivity Prevalence, gender, comorbidity, age of onset Prevalence/Gender o In the US 6.8% o Higher in women than men, (9.7% of women and 3.6% of men will develop this disorder) Men are more likely to be exposed to traumatic events Women are more likely to certain kinds of events like rape that may be inherently more traumatic Comorbidity o Depression, alcohol/substance abuse, panic disorder, anxiety disorders Age of onset o Varies can happen at any age, just depends on traumatic events and when they occur in a person’s life Treatment Trauma focused psychotherapies o Exposure based therapies Prolonged exposure therapy o Cognitive based therapies Cognitive processing therapy Cognitive restructuring o Eye movement desensitization processing (EMDR) Stress Inoculation training (anxiety management) Medications o Selective serotonin reuptake (SSRIs) o Serotonin Norepinephrine reuptake inhibitors (SNRIs) o Prazosin Different therapeutic techniques include o Learning about the effects of trauma o Relaxation and anger management skills o Tips for better sleep , diet, and exercise habits o Help people identify and deal with guilt, shame, and other feelings about the event o Therapy often helps people visit places and be around people that are reminders of the trauma What is posttraumatic growth? Refers to a set of positive changes which occur as a result of coping with a traumatic event o Relationships are enhanced in some way People describe that the come to value with friends and family more. Feel an increased sense of compassion for other and longing more intimate relationships o Appreciation for life o Personal strength o Change priorities o Spirituality
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