Exercises — Chapter 31: Physical Health and Psychological Wellbeing

Part A: Understanding the Biopsychosocial Model

Exercise 1 — Mapping Three Levels

Choose a health condition you have personal experience with — either a past illness, an ongoing condition, or a period of significant physical stress. Map the condition across all three levels of the biopsychosocial model.

After completing the table, write 2–3 sentences about what the biological-only explanation would have missed. What changes when you include all three levels?

Exercise 2 — Biomedical vs. Biopsychosocial Case Comparison

Read both case descriptions below. For each, identify: (a) What a purely biomedical approach would focus on (b) What a biopsychosocial approach would add (c) What treatment implications differ between the two approaches

Case A: Maria, 52, has been diagnosed with Type 2 diabetes. She has been prescribed metformin, received nutritional guidelines, and scheduled for quarterly bloodwork. Her A1C remains elevated despite compliance. She lives alone, was recently laid off, and describes feeling "too exhausted to care about eating."

Case B: David, 38, presents with recurring lower back pain with no structural abnormality found on imaging. He describes the pain as worse when he's stressed at work, improving on vacation, and worsening when a conflict with his supervisor is ongoing.

Part B: Stress Physiology and Its Consequences

Exercise 3 — Tracing the HPA Axis

Fill in the cascade below, then answer the questions that follow.

Perceived threat → Hypothalamus releases _ → Pituitary gland releases _ → Adrenal cortex releases __

In acute stress, this cascade is adaptive. In chronic stress, it becomes harmful. List three specific physiological consequences of HPA axis dysregulation that are discussed in the chapter.

Exercise 4 — Allostatic Load Self-Audit

Allostatic load is the cumulative physiological cost of chronic stress. This exercise helps you estimate your current load across four categories.

Rate each item 0 (not applicable) to 3 (significant/ongoing):

Objective stressors: - Work demands consistently exceeding capacity ___ - Financial pressure or insecurity ___ - Caregiving responsibilities ___ - Relationship conflict or instability ___ - Sleep consistently under 7 hours ___

Physiological indicators (to the extent you're aware): - Frequent illness or slow recovery from illness ___ - Chronic fatigue not resolved by rest ___ - Persistent tension, headaches, or digestive symptoms ___ - Difficulty maintaining healthy weight despite reasonable habits ___ - Elevated blood pressure or cholesterol ___

Behavioral indicators: - Relying on alcohol, caffeine, or food for regulation ___ - Reduced exercise compared to what you'd prefer ___ - Neglecting medical appointments ___ - Difficulty maintaining social connections ___

Psychological indicators: - Reduced threshold for emotional reactivity ___ - Persistent low mood or anxious baseline ___ - Difficulty experiencing positive emotions ___ - Sense of helplessness about health ___

Total: ___/51

Ranges: 0–10 (low), 11–20 (moderate), 21–35 (elevated), 36+ (high — consider consultation)

Reflection: Identify the two highest-scoring items. For each, write one concrete, feasible thing you could change in the next 30 days that would reduce that specific stressor or its physiological impact.

Exercise 5 — Telomere Science and Lifestyle

The Epel-Blackburn research established that chronic psychological stress accelerates telomere shortening — a biological measure of cellular aging. Consider the following evidence:

• High caregiving stress is associated with approximately 10 years of additional cellular aging
• Meditation practice is associated with longer telomeres
• Exercise is associated with longer telomeres
• Social connection is associated with longer telomeres
• Perceived control (even without objective changes in stressors) is associated with preserved telomere length

Write a paragraph responding to this claim: "If I can't change my stressors, there's nothing I can do about the biological effects of stress." Draw specifically on the Epel-Blackburn findings to challenge or complicate this view.

Part C: Exercise and Psychological Wellbeing

Exercise 6 — Your Exercise History and Its Psychological Correlates

Think back over the past 12 months. Identify periods when you were exercising regularly (3+ times per week) and periods when you were not.

For each period, rate the following on a 1–10 scale:

Analysis questions: 1. Where do you see the largest differences? What might this suggest about which psychological functions are most responsive to exercise for you personally? 2. Did the exercise cause the better psychological state, or did the better state make exercise more likely? How would you design a small test to help disentangle the direction of causality?

Exercise 7 — Building Your Exercise Prescription

The chapter discusses evidence-based exercise for psychological wellbeing. Using the guidelines below, design a realistic starting exercise plan for yourself.

Minimum effective dose for psychological benefits: - Aerobic: 150 minutes/week moderate intensity OR 75 minutes/week vigorous - Strength: 2 sessions/week (any major muscle groups) - For acute mood benefits: even a single 20-minute walk is sufficient

Your plan:

For each barrier you identified, write one implementation intention: "When [barrier], I will [specific response]."

Exercise 8 — The BDNF Mechanism in Your Life

The chapter describes BDNF (Brain-Derived Neurotrophic Factor) as the key mechanism linking exercise to cognitive and emotional benefits — essentially brain fertilizer that supports neuroplasticity and mood regulation.

1. Before this chapter, how did you conceptualize the relationship between physical exercise and mental performance? (e.g., as separate domains, as loosely connected, as the same system)

2. The "dose" of exercise sufficient to elevate BDNF is relatively modest — a 20–30 minute aerobic session produces detectable effects. How does this specific information change (or not change) your motivation to exercise on days when you "don't have time for a full workout"?

3. Consider a domain in your life that currently requires cognitive intensity (learning, creative work, difficult conversations, decision-making). How might you strategically position even brief exercise before or during this domain to support performance?

Part D: Nutrition, the Gut-Brain Axis, and Inflammation

Exercise 9 — Diet Pattern Assessment

Researchers studying the gut-brain axis identify several dietary patterns with evidence for psychological wellbeing. Rate your typical week:

Mediterranean-pattern components: - 5+ servings of vegetables and fruit daily /7 days - Fish 2+ times per week /7 days - Legumes (beans, lentils) at least twice weekly /7 days - Olive oil as primary cooking fat /7 days - Whole grains rather than refined grains /7 days - Nuts as a regular snack /7 days - Minimal processed food (packaged snacks, fast food) ___/7 days

Anti-inflammatory additions: - Fermented foods (yogurt, kimchi, sauerkraut, kefir) /7 days - Varied plant foods (20+ different plants per week is associated with microbiome diversity) /7 days

Reflection: You are not being asked to overhaul your diet. Identify one small, sustainable change that would move your diet meaningfully in the direction of the evidence. What would that change be, and what is the smallest version of it you could start this week?

Exercise 10 — The Gut-Brain Dialogue

The enteric nervous system contains approximately 100 million neurons — more than the spinal cord. Consider the following phenomena through the gut-brain axis lens:

1. Pre-performance "butterflies": You feel nausea and stomach discomfort before a high-stakes presentation. Using the bidirectional gut-brain pathway, explain both the brain-to-gut and gut-to-brain directions of this experience.

2. "Comfort food" and mood: Why might warm, high-carbohydrate foods produce temporary mood improvement? What are the limitations of this mechanism as a long-term mood regulation strategy?

3. Post-antibiotic mood: Several studies report mood changes during and after antibiotic treatment. Using the gut-brain axis framework, propose a mechanism.

Part E: Social Connection and Physical Health

Exercise 11 — Your Social Health Inventory

The Holt-Lunstad meta-analysis established that social isolation is associated with a 50% increased risk of premature mortality — equivalent to smoking 15 cigarettes per day. Take stock of your social health:

Quantity: - How many people in your life would you call in a genuine crisis? ___ - How many people do you have face-to-face contact with in a typical week? ___ - How many people outside your household do you speak with substantively in a typical week? ___

Quality: - Rate the depth of your closest relationship (1 = surface only, 10 = genuine mutual understanding): ___ - Rate how often you feel truly understood by someone in your life (1 = rarely/never, 10 = regularly): ___ - Rate how often you feel genuine belonging (1 = rarely/never, 10 = regularly): ___

Trends: - Compared to 2 years ago, are your social connections stronger, the same, or weaker? ___ - Is the current trajectory moving toward more connection, less, or stable? ___

Reflection: Based on this inventory, is your greatest social health challenge quantity (not enough people) or quality (existing relationships lacking depth)? These require different interventions. Identify one concrete action for the appropriate challenge.

Exercise 12 — Social Baseline Theory in Practice

James Coan's social baseline theory proposes that the human nervous system evolved assuming social proximity as the default state — and that being alone is experienced by the nervous system as a form of effortful exertion. When someone is nearby and trusted, cognitive and emotional tasks genuinely cost less.

1. Think of a situation where you faced a difficult challenge alone versus one where you had a supportive person present (even if they said or did very little). Describe the difference in experience.

2. "Co-regulation" refers to the way another nervous system can help regulate your own — through proximity, touch, voice tone, or even just presence. Identify two or three people in your life who function as reliable co-regulators for you. How often are you accessing this resource?

3. The chapter notes that even imagining a supportive person reduces perceived threat. Describe how you might use this principle in a situation where a supportive person cannot physically be present.

Part F: Positive Emotions and Health

Exercise 13 — Broaden-and-Build in Your Experience

Fredrickson's broaden-and-build theory proposes that positive emotions — unlike negative emotions, which narrow attention to immediate threats — broaden awareness, expand behavioral repertoire, and over time build durable personal resources (skills, relationships, resilience, health).

Part 1: Identify your positive emotion repertoire

List the five emotions from the following set that you experience most regularly in your daily life: joy, gratitude, serenity, interest, hope, pride, amusement, inspiration, awe, love.

For each one you identified: what specific situations reliably produce it for you? What do you do during or after experiencing it?

Part 2: Building positive emotions deliberately

Choose one positive emotion you experience less frequently than you'd like. Design three concrete, specific activities that reliably produce it — activities you could actually do this week. The bar is low: even one to three minutes of genuine positive emotional experience has measurable physiological effects.

Exercise 14 — The Upward Spiral

The broaden-and-build theory predicts that positive emotions produce upward spirals: today's positive emotional states build resources that make tomorrow's positive emotional states more likely. But the spiral requires an entry point.

1. Describe a time in your life when you entered an upward spiral — when positive experiences compounded, each building on the last. What was the entry point? What kept the spiral going?

2. The downward spiral is its mirror: stress and negative emotion deplete resources, making subsequent positive experiences harder to access, increasing the probability of further negative experience. Describe a period you've experienced this.

3. Given your current allostatic load (from Exercise 4), and your current positive emotion repertoire (from Exercise 13): where is the smallest, most accessible entry point for an upward spiral in your life right now? What single small action would constitute that entry point?

Part G: Integration — Building Your Physical-Psychological Self-Care System

Exercise 15 — The Priority Cascade

The chapter proposes a prioritized sequence for physical self-care: sleep → movement → social connection → nutrition and hydration → stress reduction practices → positive emotion cultivation. This sequence reflects the research evidence for relative psychological impact.

1. For each tier of the cascade, rate your current adequacy (1 = severely lacking, 5 = well-maintained): - Sleep: ___ - Movement: ___ - Social connection: ___ - Nutrition/hydration: ___ - Stress reduction practices: ___ - Positive emotion cultivation: ___

2. Identify your lowest-rated tier. This is your highest-leverage intervention point. What is the minimum viable change you could make to this tier — something small enough that you would actually do it — that would meaningfully improve your rating in 30 days?

3. Now identify your highest-rated tier. This is an existing strength. How are you maintaining it? Is there anything from this tier's maintenance approach that could transfer to your lowest-rated tier?

Exercise 16 — Writing Your Physical-Psychological Self-Care Statement

Drawing on this chapter, write a personal statement (one page or less) that articulates:

1. Your current understanding of how your physical health and psychological wellbeing are connected — specific mechanisms that resonate for you based on your own experience

2. Your current challenge — the biopsychosocial factor (biological, psychological, or social) that most significantly limits your physical or psychological wellbeing right now

3. Your intervention logic — given the priority cascade and the evidence, what one change would have the greatest downstream impact on both your physical and psychological wellbeing?

4. Your implementation plan — what specifically, when, where, and with what support structure?

This statement is for you — not assessed, not shared unless you choose. The goal is to translate the chapter's research into a personally grounded plan.

Reflection Journal Prompts

These are not exercises with right or wrong answers. They are prompts for sustained thinking.

Prompt 1 — The Body as Context The chapter opens with the premise that psychological wellbeing does not happen in a brain suspended in a vat — it happens in a body with a gut, a circulatory system, an immune system, and a social network. Before this chapter, how integrated was your sense of your physical body and your psychological self? Has this changed?

Prompt 2 — What Are You Carrying? Allostatic load is sometimes described as "what chronic stress does to the body over time." It accumulates invisibly — at the level of cortisol rhythms, inflammatory markers, telomere length — and becomes visible only in symptoms or illness. What do you think you might be carrying that you haven't fully accounted for?

Prompt 3 — The Loneliness Question Loneliness is one of the most consequential health risks documented in contemporary research — more consequential than obesity, more consequential than many modifiable risk factors. And it is substantially stigmatized, making it difficult to acknowledge or address. How honest are you able to be with yourself about your level of social connection? What would you need to feel, believe, or have in place to increase that honesty?

Prompt 4 — Movement as Medicine The Blumenthal Duke study found that exercise was equivalent to antidepressants in treating major depression — and superior on relapse prevention. If you were told, with certainty, that 30 minutes of brisk walking three times a week would have the same effect on your mood as an antidepressant, would you do it? If not, what would actually need to change? If yes, what stops you currently?

End of Chapter 31 Exercises