Psychology · Study Guide

Exam 7 Study Guide

This guide covers the last two chapters. First you will follow stress from the moment it starts to the toll it takes on the body. Then you will learn how people cope and stay well. After that, you will learn how clinicians decide what counts as a disorder, the main families of disorders, and the treatments that help. Work one chapter at a time. Read "What to know." Then cover the right side of each table and rebuild it from memory. Say the sequences out loud. Finish each chapter with its self-test. The cram sheet at the end holds every name, number, and step in one place.

Chapter 13 Chapter 14 Cram sheet Read Chapter 13 Read Chapter 14

What this guide covers

Chapter 13 · stressors and appraisal, fight-or-flight, Selye's three stages, the SAM and HPA axes, allostatic load, stress and the heart and immune system, coping, social support, happiness, and resilience.
Chapter 14 · the four Ds, the DSM-5-TR, anxiety disorders, OCD, PTSD, depression, bipolar disorder, schizophrenia, the diathesis-stress model, the four schools of therapy, medications, and the therapeutic alliance.

A note before you start. Chapter 14 teaches how clinicians think about disorders. It is not a checklist for diagnosing yourself or people you know. Only a trained professional, after a full assessment, can make a diagnosis. If you or someone you know is having a hard time, talking to a counselor or doctor is a strong first step. In the U.S., you can call or text 988 at any hour to reach the Suicide and Crisis Lifeline.

Chapter 13Stress, Health & Coping

The big ideas

Stress is a process, not a thing. It has three parts. A stressor is the demand, like an exam or a traffic jam. The stress response is what happens inside you, like a racing heart. Between them sits your appraisal, your judgment of the event. That middle part is why the same event can crush one person and fire up another.

Richard Lazarus split appraisal into two steps. In primary appraisal, you ask, "Does this matter? Is it a threat, a challenge, or nothing?" In secondary appraisal, you ask, "Can I cope? What do I have to work with?" Stress flares when the demand looks big and your resources look small. Hans Selye's word for good stress is eustress. The harmful kind is distress.

Stressors come in sizes. Cataclysmic events hit many people at once. Significant life changes are personal, like a death or a move. Holmes and Rahe scored these on the Social Readjustment Rating Scale. Daily hassles are small but pile up. Ambient stressors are steady background noise, like crowding.

When appraisal says "threat," the body acts fast. Walter Cannon called this the fight-or-flight response. The sympathetic nervous system fires. The adrenal medulla releases adrenaline (epinephrine) in seconds. This fast path is the SAM axis. A slower path, the HPA axis, runs from the hypothalamus to the pituitary to the adrenal cortex. It releases cortisol, the main stress hormone.

Hans Selye found a three-stage pattern for long stress, the general adaptation syndrome. First comes alarm, then resistance, then exhaustion. Cortisol helps in short bursts. When it stays high for months, it wears the body down. That built-up wear is called allostatic load.

Chronic stress harms the heart and the immune system. The Type A link to heart disease, from Friedman and Rosenman, did not hold up overall. The part that does predict heart risk is hostility. Psychoneuroimmunology studies how stress weakens immunity. Kiecolt-Glaser found slower wound healing in stressed caregivers. Cohen found that stressed people caught more colds.

Coping comes in two main kinds. Problem-focused coping changes the stressor. Emotion-focused coping manages your feelings. Match the tool to the situation. If you can change it, solve it. If you can't, work on your response. Avoidance, such as denial or numbing with alcohol, backfires. Social support is one of the strongest shields of all.

Positive psychology studies what helps people flourish. Seligman's PERMA lists the parts. We drift back toward a partly inherited happiness set point, which is called hedonic adaptation. What we choose to do, our intentional activity, is the part we can act on. Resilience is common and can be built. Kobasa's hardiness rests on commitment, control, and challenge.

Lock these in

Stressor = the demand. Stress response = your reaction. Stress = the whole process, with appraisal in the middle.
Primary appraisal: "Is it a threat?" Secondary appraisal: "Can I cope?"
Cannon = fight-or-flight. Selye = general adaptation syndrome. Do not swap them.
SAM axis is fast and releases adrenaline. HPA axis is slow and releases cortisol.
GAS order: alarm, resistance, exhaustion. Remember ARE.
Hostility, not busyness, is the harmful part of Type A.
Problem-focused for what you can change. Emotion-focused for what you can't.
Hardiness: commitment, control, challenge. PERMA: positive emotion, engagement, relationships, meaning, accomplishment.

Appraisal, drawn

Figure 13.1. Primary appraisal decides whether the event matters. Secondary appraisal weighs your resources. Adding resources, or reappraising the event, can turn a threat into a challenge.

The two stress pathways, drawn

Figure 13.2. The SAM axis gives the fight-or-flight jolt. The HPA axis keeps the body coping, and it is the path that does damage when stress becomes chronic.

Selye's curve, drawn

Figure 13.3. If the stressor ends during alarm or resistance, the body recovers. Only stress that never lets up reaches exhaustion.

The tables worth memorizing

Kind of stressor	What it is	Example
Cataclysmic	Sudden, large, hits many people at once	Earthquake, war, pandemic
Significant life change	A big personal change that takes readjusting	A death, divorce, job loss, new baby
Daily hassle	Small; harmful when they pile up	Lost keys, traffic, a rude email
Ambient	Steady, low-level background condition	Noise, crowding, a long commute

Person	Known for	One-line memory hook
Walter Cannon	Fight-or-flight response	Cannon fires fast
Hans Selye	General adaptation syndrome; eustress	Alarm, resistance, exhaustion (ARE)
Richard Lazarus	Primary and secondary appraisal; coping with Folkman	Stress is in the judgment
Holmes and Rahe	Social Readjustment Rating Scale	Scored life changes
Friedman and Rosenman	Type A personality	Hostility is the harmful part
Janice Kiecolt-Glaser	Slow wound healing in caregivers	Stress slows repair
Sheldon Cohen	Stress and catching colds	Stress lowers the drawbridge
Robert Sapolsky	Why Zebras Don't Get Ulcers	Our alarm keeps ringing
Martin Seligman	Positive psychology, PERMA, learned helplessness	From fixing illness to flourishing
Barbara Fredrickson	Broaden-and-build theory	Good feelings build resources
Suzanne Kobasa	Hardiness	Three C's
Ann Masten	Resilience as "ordinary magic"	Resilience is common

Feature	Problem-focused coping	Emotion-focused coping
Aims at	The stressor itself	Your feelings about it
Best when	You can change the situation	You cannot change the situation
Examples	Study plan, asking for an extension, fixing the problem	Reappraisal, exercise, meditation, talking to a friend
Risk if overused	Wasted effort on what cannot change	Sliding into avoidance

Sequences, in order

Say these out loud until they come without thinking.

HPA axis: hypothalamus releases CRH, pituitary releases ACTH, adrenal cortex releases cortisol.
GAS: alarm (shock, then the surge), resistance (coping at a cost), exhaustion (reserves run out).
Appraisal: event, primary appraisal, secondary appraisal, then challenge or threat.

How to reason through the question types

Worked example · name the appraisal

"Before her driving test, Tia thinks, 'I've practiced a lot and my uncle helped me. I can do this.' Which appraisal is this?"

Step 1 · find the question she is askingShe is not asking whether the test matters. She already knows it does.

Step 2 · look for resourcesPractice and her uncle's help are resources. Weighing resources is secondary appraisal.

Step 3 · name the outcomeShe judges her resources enough, so this is a challenge. It should feel like eustress.

Worked example · pick the coping style

"A storm cancels Omar's flight home for a family event. Which coping fits best?"

Step 1 · ask the key questionCan Omar change this? He can't stop the storm, but he can look for another flight.

Step 2 · split the stressorThe rebooking part is controllable, so problem-focused coping fits it. The missed-event part may not be, so emotion-focused coping fits that.

Step 3 · check for the trapSkipping all action and drinking to forget would be avoidance. That is not a good answer.

Worked example · place the GAS stage

"Three months into a hard new job, Lee still gets everything done but feels drained and snaps at friends. Which stage?"

Step 1 · check how longMonths, not minutes, so this is past the alarm stage.

Step 2 · check if he is still copingHe is still getting things done. Exhaustion means coping has failed, so he is not there yet.

Step 3 · answerResistance: coping, but at a cost.

Traps people fall into

Swapping Cannon and Selye. Cannon is fight-or-flight. Selye is the three-stage GAS.
Mixing up the two appraisals. Primary is "Does it matter?" Secondary is "Can I cope?"
Thinking cortisol is always bad. It helps in short bursts. The harm comes when it stays high.
Saying Type A causes heart disease. The overall pattern did not replicate. Hostility is the part that holds up.
Thinking stress gives you a cold. The germ does. Stress lowers your defenses so the germ can take hold.
Calling emotion-focused coping weak. For things you can't change, it is the wiser choice.
Calling avoidance a kind of emotion-focused coping. Avoidance leaves the problem in place and makes stress last.
Quoting the old happiness pie chart. Its authors withdrew it. No percentage split should be quoted.

Chapter 13 self-test · ten items

1. What is the difference between a stressor and the stress response?

The stressor is the demand. The stress response is your reaction to it. Stress is the whole process, including your appraisal in between.

2. Name Lazarus's two appraisals and the question each one asks.

Primary: "Does this matter, and is it a threat or a challenge?" Secondary: "Can I cope?" Stress flares when the demand looks bigger than your resources.

3. Who described the fight-or-flight response, and which hormone drives it?

Walter Cannon. Adrenaline (epinephrine). The adrenal medulla releases it within seconds through the SAM axis.

4. List the three stages of the GAS in order.

Alarm, resistance, exhaustion. Hans Selye described them. Remember ARE.

5. Trace the HPA axis.

Hypothalamus (CRH), pituitary (ACTH), adrenal cortex (cortisol). It is the slow, long-lasting arm of the stress response.

6. What is allostatic load?

The built-up wear and tear from a stress response that keeps turning on. It links chronic stress to diseases of the heart, immune system, and brain.

7. Which part of the Type A pattern predicts heart disease?

Hostility: chronic anger, cynicism, and mistrust. The overall Type A pattern did not replicate in later large studies.

8. What did Cohen's cold virus studies show?

People with more chronic stress were more likely to catch a cold after the same exposure. This is a core finding of psychoneuroimmunology.

9. A friend's pet has died. Which coping style fits best, and why?

Emotion-focused coping, because the loss cannot be changed. Talking with someone, grieving, and reappraising help. Problem-focused coping has nothing to fix here.

10. Name the three C's of hardiness.

Commitment, control, and challenge. Suzanne Kobasa described them as a resilient attitude toward stress.

Chapter 14Psychological Disorders & Therapy

The big ideas

Almost every symptom of a disorder is something we all feel in small doses. So what makes it a disorder? Clinicians weigh the four Ds. Dysfunction means it gets in the way of daily life. Distress means real suffering. Deviance means it is far from the culture's norms. Danger means risk to self or others. No single D is enough, and dysfunction counts most. Jerome Wakefield calls a disorder a harmful dysfunction.

The shared rulebook in the U.S. is the DSM-5-TR (2022), from the American Psychiatric Association. The World Health Organization's version is the ICD-11. The DSM is strong on reliability, meaning clinicians agree. Its validity, whether the labels match real separate conditions, is still debated. Labels can help and hurt. Comorbidity, having two disorders at once, is very common. We say "a person with schizophrenia," because a diagnosis is something a person has, not who they are.

Fear answers a threat that is here now. Anxiety looks ahead. Anxiety disorders are the most common group. They include generalized anxiety disorder (six months or more of worry), panic disorder (sudden attacks and dread of the next one), specific phobias, and social anxiety disorder. Agoraphobia is its own diagnosis. Seligman's biological preparedness explains why snakes scare us more than cars.

DSM-5 gave OCD and PTSD their own chapters. OCD pairs obsessions, unwanted thoughts, with compulsions, rituals done to ease the dread. The brief relief keeps the loop going. PTSD follows trauma. Its four symptom groups are intrusion, avoidance, negative changes in mood and thinking, and hyperarousal, lasting more than a month. Most people who face trauma do not get PTSD. The diathesis-stress model explains why: a vulnerability has to meet enough stress.

Major depressive disorder needs at least two weeks of low mood or anhedonia, plus other symptoms. Bipolar I needs at least one manic episode, lasting a week or more. Bipolar II pairs depression with milder hypomania. The biopsychosocial model says biology, thinking, and life stress all play a part. Beck's negative cognitive triad is about dark views of self, world, and future.

Schizophrenia is a psychotic disorder. Positive symptoms add experiences, like hallucinations and delusions. Negative symptoms take things away, like emotion and drive. It is not "split personality." The dopamine hypothesis links positive symptoms to too much dopamine activity.

Therapy comes in four main schools. Psychodynamic therapy (Freud) seeks insight into the unconscious. Humanistic therapy (Rogers) heals through acceptance and empathy. Behavioral therapy (Wolpe, Skinner) unlearns problem habits. Cognitive therapy (Beck, Ellis) fixes thinking errors. CBT joins the last two. Biomedical therapy uses medication, ECT, and TMS. Across all schools, the therapeutic alliance predicts who gets better.

Lock these in

Four Ds: dysfunction, distress, deviance, danger. Dysfunction counts most.
DSM-5-TR (2022) is the U.S. manual. ICD-11 is the world system.
Reliability is the DSM's strength. Validity is its open problem.
OCD: obsession, then compulsion, then brief relief, and the loop tightens.
PTSD: intrusion, avoidance, negative mood and thinking, hyperarousal, for over a month.
Depression: two weeks. Mania: one week. Hypomania: four days. GAD: six months.
Positive symptoms add. Negative symptoms take away. Neither means good or bad.
SSRIs act on serotonin. Antipsychotics block dopamine. Benzodiazepines boost GABA. Lithium steadies bipolar disorder.

The OCD loop, drawn

Figure 14.1. The compulsion works for a moment, and that is the problem. Treatment cuts the link at the gold X, between rising anxiety and the ritual.

Mood over time, drawn

Figure 14.2. A manic or hypomanic episode is what separates bipolar disorder from depression alone. Bipolar I needs full mania. Bipolar II never reaches it.

The diathesis-stress model, drawn

Figure 14.3. The stressor is the same for all three people. Vulnerability decides who is near the line. Protective factors decide where the line sits.

The tables worth memorizing

Disorder	DSM-5-TR family	Core feature	Time rule
Generalized anxiety	Anxiety	Hard-to-control worry about many things	6 months
Panic disorder	Anxiety	Sudden attacks plus dread of the next one	1 month of worry after attacks
OCD	Obsessive-compulsive and related	Obsessions plus compulsions	Takes over 1 hour a day or causes real distress
PTSD	Trauma- and stressor-related	Intrusion, avoidance, mood change, hyperarousal	More than 1 month
Major depression	Depressive	Low mood or anhedonia plus other symptoms	2 weeks
Bipolar I	Bipolar and related	At least one manic episode	Mania 1 week
Schizophrenia	Schizophrenia spectrum	Positive and negative symptoms	6 months, 1 month active

School	Founder(s)	Core idea	Signature technique
Psychodynamic	Freud	Symptoms grow from unconscious conflict	Free association, dream analysis, transference
Humanistic	Rogers, Maslow	People grow when accepted	Unconditional positive regard, active listening
Behavioral	Wolpe, Skinner	Problems are learned and can be unlearned	Systematic desensitization, exposure, token economy
Cognitive	Beck, Ellis	Thoughts drive feelings	Testing thinking errors; the ABC model

Drug class	Example	Mainly treats	Acts on	Watch for
SSRI	Fluoxetine (Prozac)	Depression, anxiety, OCD	Serotonin reuptake	Takes weeks to work
Benzodiazepine	Diazepam	Short-term anxiety	GABA	Dependence
Antipsychotic	Haloperidol; clozapine	Schizophrenia, psychosis	Dopamine D2	Movement problems; weight gain with atypicals
Mood stabilizer	Lithium	Bipolar disorder	Several systems	Needs blood tests

Sequences, in order

Systematic desensitization: learn deep relaxation, build a fear ladder from mild to worst, then climb it one calm step at a time.
Ellis's ABC: Activating event, then Belief about it, then emotional Consequence. Change B to change C.
The OCD loop: obsession, anxiety, compulsion, brief relief, and back to a stronger obsession.

How to reason through the question types

Worked example · weigh the four Ds

"Jun collects antique clocks and has 300 of them. He loves them, keeps a clean home, and has many friends in a clock club. Is this a disorder?"

Step 1 · check each DDeviance: yes, it is unusual. Distress: no. Dysfunction: no. Danger: no.

Step 2 · weigh themOnly deviance is present. Dysfunction, the most important D, is missing.

Step 3 · answerNot a disorder. Being different is not the same as being ill.

Worked example · sort anxiety, OCD, and PTSD

"Since a fire in her building, Ava wakes from nightmares about smoke and avoids the street where it happened. Which family?"

Step 1 · look for a traumaYes, a fire. That points to the trauma family.

Step 2 · look for the PTSD groupsNightmares are intrusion. Avoiding the street is avoidance.

Step 3 · check the clockIf it lasts more than a month, the pattern fits PTSD. A clinician would confirm with a full assessment.

Worked example · match the therapy

"A therapist asks a client to write down the thought 'I'm a total failure' and list the evidence for and against it. Which school?"

Step 1 · find the targetThe target is a thought, not a habit, a feeling about the past, or the relationship.

Step 2 · name the methodTesting a thought against evidence is cognitive restructuring.

Step 3 · answerCognitive therapy (Beck), part of CBT.

Traps people fall into

Calling anything unusual a disorder. Deviance alone is not enough. Look for dysfunction.
Thinking people with disorders are usually dangerous. Danger is uncommon. They are more often victims of violence than causes.
Filing OCD and PTSD under anxiety disorders. Since DSM-5, each has its own chapter.
Saying schizophrenia means split personality. It means a split from reality. Many identities is dissociative identity disorder.
Reading "positive symptom" as a good thing. Positive means added, like hallucinations. Negative means taken away.
Saying bipolar I requires depression. It requires mania. Depression is common but not required.
Thinking depression is just "a chemical imbalance." Biology, thought patterns, and stress all play a part.
Citing Rosenhan as solid proof. Later work found serious flaws. Treat it as a warning story.
Using this chapter to diagnose yourself or friends. Diagnosis takes a trained professional and a full assessment.

Chapter 14 self-test · ten items

1. Name the four Ds. Which one counts most?

Dysfunction, distress, deviance, and danger. Dysfunction counts most. They are weighed together and in context.

2. What is the difference between reliability and validity in diagnosis?

Reliability means clinicians agree. Validity means the categories match real, separate conditions. The DSM is strong on the first and still debated on the second.

3. How is fear different from anxiety?

Fear answers a present threat. Anxiety looks ahead to a future one. Both are normal in small amounts.

4. Why do compulsions make OCD stronger over time?

The brief relief rewards the ritual. So treatment helps people face the fear without doing the ritual.

5. Name the four symptom groups of PTSD.

Intrusion, avoidance, negative changes in mood and thinking, and hyperarousal. They must last more than a month after a trauma.

6. What does the diathesis-stress model say?

A disorder develops when a built-in vulnerability meets enough stress. It explains why the same trauma affects people differently.

7. What sets bipolar disorder apart from major depression?

A history of mania (bipolar I) or hypomania (bipolar II). Depression alone, with no highs, is unipolar.

8. Give one positive and one negative symptom of schizophrenia.

Positive: hallucinations or delusions. Negative: flat affect or avolition. Positive adds experiences. Negative takes things away.

9. Which school of therapy uses unconditional positive regard, and who founded it?

Humanistic (client-centered) therapy, founded by Carl Rogers. The therapist also offers empathy and genuineness.

10. What is the dodo bird verdict, and what factor helps explain it?

Different therapies give broadly similar results. The therapeutic alliance helps explain it. The bond of trust predicts improvement in every kind of therapy. The verdict is debated, since some methods work better for certain problems.

Cram sheetEverything in one place

Names and numbers

Item	Fact
DSM-5-TR	American Psychiatric Association, 2022
ICD-11	World Health Organization, used worldwide
Adults with a mental disorder in a year	About 1 in 5
Major depression	5 or more of 9 symptoms, at least 2 weeks; about twice as common in women
Manic episode / hypomania	At least 1 week / at least 4 days
Generalized anxiety disorder	At least 6 months
PTSD	Symptoms for more than 1 month
Schizophrenia	6 months with 1 month of active symptoms; identical twin risk about 33 to 50%
Type A study	About twice the heart disease rate in Friedman and Rosenman's own group; did not replicate overall
Heritability of well-being	About 30 to 40%
Smith and Glass	Average treated person better off than about 80% of untreated people
Crisis line (U.S.)	Call or text 988

Definitions worth having word-perfect

Term	Say it like this
Stress	The process of noticing and responding to events judged as threatening or challenging
Eustress	Good stress from a challenge you feel able to meet
Primary appraisal	"Is this a threat, a challenge, or nothing?"
Secondary appraisal	"Do I have what it takes to cope?"
Allostatic load	Built-up wear and tear from a stress response that keeps turning on
Psychoneuroimmunology	How the mind, nervous system, and immune system affect each other
Buffering hypothesis	Social support cushions the impact of stressors
Hedonic adaptation	Drifting back to a usual happiness level after good or bad events
Resilience	The ability to adapt and bounce back
Harmful dysfunction	An inner system failing at its job in a way that causes real harm
Comorbidity	Two or more disorders at the same time
Anhedonia	Loss of pleasure in things once enjoyed
Delusion	A fixed false belief held despite evidence
Hallucination	A sensory experience with nothing outside causing it
Diathesis-stress model	Vulnerability plus enough stress leads to a disorder
Transference	Aiming feelings about important people at the therapist
Unconditional positive regard	Accepting a client without judgment
Therapeutic alliance	The bond of trust and shared goals between client and therapist

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