COM 315 Module Two Jou

COM 315 Module Two Journal Relational Maintenance Habits
Guidelines and Rubric
Overview: Analyze your relational maintenance habits. Pick one
person with whom you are currently maintaining a relationship
and have communicated with
multiple times via technology in the past 48 hours. Look at the
past 48 hours of communication you have had with that person.
Journals are private between the
student and the instructor. Activities are graded individually.
In your journal:

person (e.g., instant messaging, microblogging, text messaging,
Facebook, email, etc.)
assurances, openness, networks, shared tasks) you used each
time you communicated
Example: “Hey! What are you up to tomorrow? Do you want to
hang out?” -- Text message: strategy is assurances (focused on
future commitment to
relationship)
In your journal, respond to the following questions:
maintain this relationship?
Try for the next 24 hours to use different communication
technology and strategies other than the ones you already do.
For example, if you noticed all you do is
text this person, pick up the phone and call him or her, or send a
Facebook message or email. If you are always being positive
and talking about assurances, try
being more open and see how this impacts your relationship. In
your journal, note the changes you made.
In your journal, respond to the following questions:
when you changed communication technology
and tried additional strategies?

the person is long-distance or geographically close?
t if the relationship were a different type—romantic,
friend, family, coworker?
Guidelines for Submission: Submit the assignment as a Word
document with double spacing, 12-point Times New Roman
font, and one-inch margins.
Rubric
Critical Elements Exemplary (100%) Proficient (85%) Needs
Improvement (55%) Not Evident (0%) Value
Factual Assignment Assignment reflects a detailed
accounting of technologies and
strategies used
Assignment reflects a solid
accounting of technologies and
strategies used
Assignment includes only
general statements subject to
interpretation

Descriptions are vague to the
point where it is difficult to
ascertain the technologies and
strategies used
30
Analysis Meets “Proficient” criteria and
draws conclusions about what
the student's patterns mean
and how they should change
Analysis questions are fully
answered and reflect a serious
effort to examine the student's
use of communication
technologies and strategies
Answers to one or more
questions reflect a superficial
effort to examine student's
communication patterns
Answers reflect a failure to
examine and questions
student's use of communication
technologies and strategies
60
Articulation Submission is free of errors
related to citations, grammar,
spelling, syntax, and
organization and is presented in
a professional and easy-to-read
format

Submission has no major errors
spelling, syntax, or organization
Submission has major errors
that negatively impact
readability and articulation of
main ideas
Submission has critical errors
that prevent understanding of
ideas
10
Total 100%
COM 315 Module Two Journal Relational Maintenance Habits
Guidelines and Rubric Rubric
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LIHeadingsRule NameStatusDescriptionAppropriate
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Depressive and Bipolar Disorders and Suicide: Features and
Epidemiology
Depressive and Bipolar Disorders and Suicide: Causes and
Prevention
Depressive and Bipolar Disorders and Suicide: Assessment and
Treatment
Normal Mood Changes and Depression and Mania: What Are
They?
Stigma Associated with Depressive and Bipolar Disorders
Depressive and bipolar disorders are sometimes referred to
collectively as mood disorders because they involve extreme
emotional states of sadness or euphoria.
Causes and
Prevention
Assessment
and Treatment
Features and
Epidemiology
Normal Mood Changes and Depression and Mania: What Are
They?
Sadness
Depression
Happiness
Euphoria

Mania
For most people, sadness is a natural reaction to unfortunate
events that happen in their lives. However, for other people,
sadness
or a sense of hopelessness can become so intense that harming
oneself or committing suicide seems like the only way to stop
the pain. These symptoms refer to depression.
Sadness is an emotion or mood, and its natural opposite is
happiness.
Other people sometimes experience an intense state of
happiness called euphoria. Mania is at the far end of the
happiness and euphoria continuum.
Causes and
Prevention
Assessment
and Treatment
Features and
Epidemiology
Major Depressive Episode
People with depression are often sad and isolated from others.
A major depressive episode is a period of two weeks or more
during which a person experiences a sad or empty mood,

changes in appetite, weight, and sleep; concentration
difficulties, fatigue, sense of worthlessness, and suicidal
thoughts or attempts.
DSM-5: Major Depressive Disorder (Part 1)
Causes and
Prevention
Assessment
and Treatment
Features and
Epidemiology
DSM-5: Major Depressive Disorder (Part 2)
Causes and
Prevention
Assessment
and Treatment
Features and
Epidemiology
Causes and
Prevention

Assessment
and Treatment
Emotions
Cognitions
Behaviors
Normal
Good mood.
Thoughts about what one has to do that day.
Thoughts about how to plan and organize the day.
Rising from bed, getting ready for the day,
and going to school or work.
Mild
Moderate
Depression – Less Severe
Depression – More Severe
Mild discomfort about the day, feeling
a bit irritable or down.
Thoughts about the difficulties of the day.

Concern that something will go wrong.
Taking a little longer than usual to rise from bed.
Slightly less concentration at school or work.
Feeling upset and sad, perhaps
becoming a bit teary-eyed.
Dwelling on the negative aspects of the day, such
as a couple of mistakes on a test or a cold shoulder
from a coworker.
Coming home to slump into bed without eating dinner.
Tossing and turning in bed, unable to sleep.
Some difficulty concentrating.
Intense sadness and frequent crying. Daily feelings
of “heaviness” and emptiness.
Thoughts about one’s personal deficiencies, strong
pessimism about the future, and thoughts about
harming oneself (with little intent to do so).
Inability to rise from bed many days, skipping
classes at school, and withdrawing from
contact with others.
Extreme sadness, very frequent crying, and
feelings of emptiness and loss. Strong sense
of hopelessness.
Thoughts about suicide, funerals, and
instructions to others in case of one’s death.
Strong intent to harm oneself.
Complete inability to interact with others or even
leave the house. Great changes in appetite and
weight. Suicide attempt or completion.
Continuum of Sadness and Depression
Features and
Epidemiology
Major Depressive Disorder

Major depressive disorder usually involves several major
depressive episodes separated by periods of at least 2 months of
normal mood, although it can be diagnosed upon the first major
depressive episode.
DSM-5: Premenstrual Dysphoric Disorder (Part 1)
Causes and
Prevention
Assessment
and Treatment
Features and
Epidemiology
DSM-5: Premenstrual Dysphoric Disorder (Part 2)
Causes and
Prevention
Assessment
and Treatment
Features and
Epidemiology
Focus on College Students: Depression

Causes and
Prevention
Assessment
and Treatment
Features and
Epidemiology
Focus on College Students: Depression (cont’d.)
Causes and
Prevention
Assessment
and Treatment
Features and
Epidemiology
DSM-5: Persistent Depressive Disorder (Dysthymia) (Part 1)
Causes and
Prevention
Assessment
and Treatment
Features and
Epidemiology

DSM-5: Persistent Depressive Disorder (Dysthymia) (Part 2)
Causes and
Prevention
Assessment
and Treatment
Features and
Epidemiology
Causes and
Prevention
Assessment
and Treatment
Cycle of Major Depressive Disorder
Cycle of Persistent Depressive Disorder (Dysthymia)
Features and
Epidemiology
Persistent Depressive Disorder (Dysthymia)
Persistent depressive disorder is a chronic feeling of depression

for at least 2 years. As you can see in these graphs, persistent
depressive disorder (also known as dysthymia) involves lower
grade symptoms than major depressive disorder, and often is
chronic—these symptoms last two years or longer.
Double depression occurs when a patient with dysthymia
experiences a major depressive episode.
DSM-5: Disruptive Mood Dysregulation Disorder (Part 1)
Causes and
Prevention
Assessment
and Treatment
Features and
Epidemiology
DSM-5: Disruptive Mood Dysregulation Disorder (Part 2)
Causes and
Prevention
Assessment
and Treatment
Features and
Epidemiology

DSM-5: Manic Episode
Causes and
Prevention
Assessment
and Treatment
Features and
Epidemiology
DSM-5: Hypomanic Episode (Part 1)
Causes and
Prevention
Assessment
and Treatment
Features and
Epidemiology
DSM-5: Hypomanic Episode (Part 2)
Causes and
Prevention
Assessment
and Treatment

Features and
Epidemiology
Causes and
Prevention
Assessment
and Treatment
Symptoms of a Manic Episode
Distractibility
Increase in goal-directed activity
Excessive involvement in activities with high potential for
painful consequences
Inflated self-esteem or grandiosity
Decreased need for sleep, such as feeling rested after only 3
hours of sleep
More talkative than usual or pressure to keep talking
Subjective experience that one’s thoughts are racing, or flight
of ideas
Features and
Epidemiology
Manic and Hypomanic Episodes
A manic episode is a period of uncontrollable euphoria and
potentially self-destructive behavior. Hypomanic episodes are
similar to manic episodes but with less impaired functioning.
DSM-5: Bipolar I Disorder

Causes and
Prevention
Assessment
and Treatment
Features and
Epidemiology
Causes and
Prevention
Assessment
and Treatment
Features and
Epidemiology
Bipolar I Disorder
Bipolar I disorder involves one or more manic episodes in a
person, as represented in this graph of mood state over time.
DSM-5: Bipolar II Disorder
Causes and
Prevention

Assessment
and Treatment
Features and
Epidemiology
Causes and
Prevention
Assessment
and Treatment
Features and
Epidemiology
Bipolar II Disorder
Bipolar II disorder refers to hypomanic episodes that alternate
with major depressive episodes. Notice in this graph how the
manic mood states are less intense in bipolar II as compared to
bipolar I, but the depressive states are equally intense.
DSM-5: Cyclothymic Disorder
Causes and
Prevention
Assessment
and Treatment

Features and
Epidemiology
Causes and
Prevention
Assessment
and Treatment
Features and
Epidemiology
Cyclothymic Disorder
Cyclothymic disorder does not involve full-blown episodes of
depression, mania or hypomania, but refers to general symptoms
of hypomania and depression that cycle back and forth over a
period of two years or more.
Causes and
Prevention
Assessment
and Treatment
Features and
Epidemiology
Suicide

Suicide is commonly seen in people with depressive and bipolar
disorders. Suicide also occurs in people with other mental
disorders or no mental disorder.
Suicidality can be viewed along a spectrum ranging from
thoughts of suicide (suicidal ideation), to suicidal behavior
(self-destructive behavior, not necessarily with the intent to
die), to suicide attempt to completion.
Features and
Epidemiology
Causes and
Prevention
Assessment
and Treatment
Epidemiology of Depressive and Bipolar Disorders
Women are more likely to have a first episode of depression,
longer episodes of depression, and more recurrent episodes of
depression than men.
Bipolar I and cyclothymic disorders seem equally present in
men and women and among people of different cultures.
Mood disorders are common in the general population and often
occur with anxiety-related, personality, eating, and substance
use disorders.

Features and
Epidemiology
Causes and
Prevention
Assessment
and Treatment
Epidemiology of Suicide
An estimated 800,000 lives are lost due to suicide worldwide
each year. Although women attempt suicide more frequently
than men, men are far more likely to complete suicide than
women.
As you can see here, suicide rates do vary substantially across
cultures, with the highest rates in Eastern Europe, lower rates in
the United States, Taiwan, Korea, Japan, China, and
Canada. The lowest rates are in the Latin American and Muslim
countries. Within the U.S., African Americans, Asian/Pacific
Islanders, and Hispanics tend to have the lowest rates of
suicide.
Causes and
Prevention
Assessment
and Treatment

Features and
Epidemiology
Stigma Associated with Depressive and Bipolar Disorders
People with these disorders may experience substantial stigma
Programs to combat stigma can be effective
Education is a powerful antidote to stigma
Lasalvia and colleagues (2013) surveyed hundreds of people
worldwide with depression. Most (79 percent) reported some
form of discrimination in at least one domain.
According to Griffiths and colleagues (2014), perceived stigma
was reduced significantly for participants who reviewed online
educational materials about aspects of depression as compared
to the study control group who did not review the online
materials.
Features and
Epidemiology
Causes and
Prevention
Assessment
and Treatment
Biological Risk Factors for Depressive and Bipolar Disorders
and Suicide

Biological risk factors for mood disorders include genetics,
neurochemical and hormonal differences, sleep deficiencies, and
brain changes.
The images comparing the brain of a control participant (top)
with the brain of a clinically depressed person (bottom)
illustrate the lower activity (less yellow coloring) of the cortex
and other areas in the brain of someone who is depressed.
The cortex in general will show less activity in a person with
major depression compared to a person without this disorder,
and depressed patients show higher than normal cortisol levels
hormonally.
Depression and bipolar disorders are associated with disruptio n
to REM sleep and less slow-wave sleep.
Features and
Epidemiology
Causes and
Prevention
Assessment
and Treatment
Environmental Risk Factors
Stressful life events such as caring for two young children while
working
full time can help trigger depressive or bipolar disorders.
Environmental risk factors for mood disorders include stressful
life events and cognitive, interpersonal, and family factors.

Cultural and evolutionary factors may also be influential.
Features and
Epidemiology
Causes and
Prevention
Assessment
and Treatment
Features and
Epidemiology
Assessment
and Treatment
Biological vulnerabilities/early predispositions: Genetic
contributions, neurochemical and hormonal changes, brain
changes
Early family problems: Poor attachment, disengaged parents,
expressed emotion, modeling of parental depression
Stressful life events: Family conflict, alienation from
others, academic and other challenges
Cognitive-stress and behavioral vulnerabilities: Sense of
learned helplessness and hopelessness, intense negative
emotions and arousal, escape-oriented behavior, lack of social

support
Possible mood disorder
Causes of Depressive and Bipolar Disorders and Suicide
Evidence indicates that mood disorders result from a
combination of (1) early biological vulnerability and (2)
psychological vulnerability that develops out of environmental
factors related to ability to cope, think rationally, and develop
competent social and academic skills. This image shows one
developmental pathway for depression that integrates both the
biological and psychological vulnerabilities that result in
development of a depressive disorder.
Features and
Epidemiology
Causes and
Prevention
Assessment
and Treatment
Features and
Epidemiology
Assessment
and Treatment
Prevention of Depressive and Bipolar Disorders and Suicide
Resourceful Adolescent Program-Adolescents (RAP-A) teaches:
Declaring existing strengths; managing stress
Modifying negative and irrational thoughts
Solving problems efficiently
Developing and using social support networks

Enhancing social skill and recognizing other perspectives
Preventing mood disorders involves building one’s ability to
control situations that might lead to depression. This may
involve helping people declare their strengths, manage stress,
change unrealistic thoughts, solve problems, develop
friendships, reduce conflict, enhance social skills, and maintain
prescribed medication. For example, the Resourceful
Adolescent Program-Adolescents (RAP-A) involves an 11-
session group approach that teaches skills as listed here.
Features and
Epidemiology
Causes and
Prevention
Assessment
and Treatment
Features and
Epidemiology
Assessment
and Treatment
Interviews and Clinician Ratings
Primary methods to assess people with mood disorders include
interviews, self-report questionnaires, self-monitoring,
observations from others, and physiological measurement. Here
is one item from a rating scale a therapist might use when

interviewing a client known as the Hamilton Rating Scale for
Depression.
Features and
Epidemiology
Causes and
Prevention
Assessment
and Treatment
Features and
Epidemiology
Assessment
and Treatment
Self-Report Questionnaires
The interview remains a dominant psychological approach for
assessing people with bipolar-related disorders. However, some
measures assess self-reported symptoms of mania and
hypomania.
Features and
Epidemiology
Causes and
Prevention
Assessment
and Treatment
Features and

Epidemiology
Assessment
and Treatment
Self-Monitoring and Observations from Others
Self: monitor and log symptoms on a daily basis
Others: record more obvious mood symptoms, such as
grandiosity
People with depressive and bipolar disorders can monitor and
log their own symptoms on a daily basis.
A clinician who know a client well can also record more
obvious mood symptoms, such as the grandiosity in the belief
that one can fly.
.
Features and
Epidemiology
Causes and
Prevention
Assessment
and Treatment
Features and
Epidemiology
Assessment
and Treatment
Adrenal gland
Pituitary gland

Dexamethasone
Cortisol
ACTH
Copyright © Cengage Learning
Laboratory Assessment
Laboratory assessments for mood disorders include the
dexamethasone test (DST), where people are injected with a
corticosteroid to determine whether cortisol levels decline over
time or remain high. In normal controls, cortisol levels from
DST tend to decline over time, but not in people with
depression.
Features and
Epidemiology
Causes and
Prevention
Assessment
and Treatment
Features and
Epidemiology
Assessment
and Treatment
Elderly
Unmarried
White
Male

Living alone
Assess sociodemographic risk factors
“How are things going in your marriage, in your family,
at home, at work?”
(Cover health, financial, marital, family, legal, and occupational
factors)
“Have you experienced sad, blue, or empty feelings
and at least two of the following in the past two weeks?”
Trouble falling or staying asleep
Feeling tired or having little energy
Poor appetite or overeating
Little interest or pleasure in doing things
Feeling bad about yourself
Trouble concentrating
Feeling fidgety, restless, or unable to sit still
“Have you felt nervous, anxious, or on edge?”
“Have you had anxiety or panic attacks recently?”
Ask about stressors
Screen for depression and associated anxiety or agitation
“Have you ever felt you should cut down
on your drinking?”
“Have people annoyed you by criticizing your drinking?”
“Have you ever felt bad or guilty about your drinking?”
“Have you ever had a drink first thing in the morning
to steady your nerves or get rid of a hangover?”
Yes to two or more means probable alcohol abuse.
Screen for alcohol abuse

“Have you had thoughts about death, or about killing yourself?”
If yes, ask:
“Do you have a plan for how you would do this?”
“Are there means available (e.g., a gun and bullets or poison)?”
“Have you actually rehearsed or practiced how you would kill
yourself?”
“Do you tend to be impulsive?”
“How strong is your intent to do this?”
“Can you resist the impulse to do this?”
“Have you heard voices telling you to hurt or kill yourself?”
Ask about previous attempts, especially the degree of intent.
Ask about suicide of family members.
Assess risk of suicide
Assessment of Suicide
Assessing risk of suicide is critical in mood disorders and often
focuses on recent symptoms of depression or anxiety and
substance use, detail of suicide plan, access to weapons, and
support from others.
Features and
Epidemiology
Causes and
Prevention
Assessment
and Treatment
Features and
Epidemiology
Assessment
and Treatment

Biological Treatment of Depressive and Bipolar Disorders and
Suicide
Repetitive transcranial magnetic stimulation (rTMS) is a
treatment for
people with depression.
Biological treatment of mood disorders includes selective
serotonin reuptake inhibitors (SSRIs), tricyclics, monoamine
oxidase inhibitors (MAOIs), and mood-stabilizing drugs.
Electroconvulsive therapy (ECT) involves deliberately inducing
a brain seizure to improve very severe depression. Repetitive
transcranial magnetic stimulation (rTMS), pictured here,
involves placing an electromagnetic coil on a person’s scalp and
introducing a current to relieve mood disorder symptoms.
Light therapy is often used for people with seasonal affective
disorder.
Features and
Epidemiology
Causes and
Prevention
Assessment
and Treatment
Features and
Epidemiology
Assessment
and Treatment
Psychological Treatments

Marital therapy is an effective treatment for depression,
especially in
women.
Psychological treatments are quite effective for mild and
moderate mood problems.
Psychological treatment of mood disorders includes behavioral
approaches to increase activity and reinforcement from others
for prosocial behavior. Cognitive therapy is also a main staple
for mood disorders. Mindfulness is a relatively new therapy to
help people understand and accept their symptoms but still live
a normal life and may be linked to mindfulness.
Interpersonal and marital and family therapists concentrate on
improving a person’s relationships with others to alleviate
symptoms of mood disorders.
Features and
Epidemiology
Causes and
Prevention
Assessment
and Treatment
Features and
Epidemiology
Assessment
and Treatment
What If I Am Sad or Have a Depressive or Bipolar Disorder?

The answers to some basic questions (Table 7.16) may help you
decide if you wish further assessment or even treatment for a
possible depressive or bipolar disorder.
Features and
Epidemiology
Causes and
Prevention
Assessment
and Treatment
Features and
Epidemiology
Assessment
and Treatment
Long-Term Outcome
Improved long-term outcome with:
Early treatment
Persistent medication use
Fewer comorbid diagnoses
Good support from family and others
Long-term outcome for people with mood disorders is best when
they receive early treatment, remain on medication, have fewer
comorbid diagnoses, and experience good support from others.
Chapter Reflections
What would you say to a friend who might be very sad or

euphoric and who might be considering suicide?
What separates “normal” from “abnormal” mood?
How might friends help those with severe mood changes?
43
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