Quiz — Chapter 31: Physical Health and Psychological Wellbeing

Instructions

25 multiple-choice questions covering the core concepts of Chapter 31. Each question has one best answer. After completing the quiz, check your answers against the key at the end and review the explanation for any you missed.

1. The biopsychosocial model, introduced by George Engel in 1977, proposed that health and illness are:

a) Primarily determined by biological factors, with psychological factors as secondary influences b) Determined by the interaction of biological, psychological, and social factors simultaneously c) Best understood at the molecular and genetic level, with psychosocial factors as confounds d) A function of social conditions, with biological factors as largely downstream consequences

2. The HPA axis (hypothalamic-pituitary-adrenal axis) is most accurately described as:

a) The pathway through which exercise increases brain-derived neurotrophic factor (BDNF) b) The neuroendocrine stress response system releasing cortisol and related hormones c) The gut-brain communication pathway via the vagus nerve d) The circadian timing system governing sleep-wake cycles

3. Research in psychoneuroimmunology (PNI) has established that chronic psychological stress:

a) Has no direct effect on immune function because the nervous and immune systems are anatomically separate b) Temporarily enhances immune function through cortisol's anti-inflammatory effects c) Suppresses immune function through sustained HPA axis activation and inflammatory dysregulation d) Primarily affects the immune system through behavioral pathways (poor sleep, poor diet) rather than direct neurological mechanisms

4. Telomere length, studied extensively by Epel and Blackburn (Nobel Prize, 2009), is relevant to health psychology because:

a) Telomeres control the production of BDNF, connecting exercise to cognitive function b) Telomere shortening is a biological marker of cellular aging that is accelerated by chronic psychological stress c) Telomere length determines chronotype, explaining why some people are more resilient to sleep deprivation d) Long telomeres are associated with increased risk of autoimmune disorders

5. Blumenthal and colleagues' Duke study (1999/2007) compared exercise, antidepressants, and their combination for treating major depression. Which finding was most significant for health psychology?

a) Antidepressants produced faster symptom improvement than exercise in the initial 16 weeks b) Exercise produced equivalent remission rates to antidepressants, and lower relapse rates at 10-month follow-up c) The combination of exercise and antidepressants was twice as effective as either alone d) Exercise was effective only for mild depression, while antidepressants were required for moderate-to-severe cases

6. BDNF (Brain-Derived Neurotrophic Factor) is described in the chapter as "brain fertilizer" because it:

a) Increases the production of serotonin, which directly elevates mood b) Reduces cortisol levels by inhibiting the HPA axis c) Supports neuroplasticity, neurogenesis, and mood regulation — all elevated by aerobic exercise d) Converts excess blood glucose into neural energy, explaining post-exercise cognitive improvements

7. The effect size (Cohen's d ≈ 0.8) reported for exercise and depression in meta-analytic reviews is best classified as:

a) Small — sufficient to warrant exercise as a supplementary intervention but not a primary treatment b) Medium — equivalent to most common pharmacological antidepressants c) Large — among the most robust findings in health psychology research d) Very small — suggesting exercise is primarily useful through placebo mechanisms

8. The enteric nervous system (ENS) contains approximately how many neurons, and what does this quantity suggest?

a) 1,000 neurons — enough for basic reflex arcs but not complex information processing b) 100,000 neurons — comparable to a small cortical region c) 100 million neurons — more than the spinal cord, capable of substantial independent processing d) 10 billion neurons — comparable to the entire cortex, making the gut essentially a "second brain" of equal complexity

9. The SMILES trial (2017), which compared dietary intervention to social support for depression, found:

a) Social support produced superior outcomes to dietary change for all depression severity levels b) Neither dietary change nor social support was sufficient for clinical depression without pharmacotherapy c) A Mediterranean-style dietary intervention produced significantly greater depression improvement than social support d) Dietary intervention was effective only for depression with inflammatory biomarkers, not standard depression

10. The gut-brain axis communicates via multiple pathways. Which pathway carries information from the gut to the brain, and is most relevant to the emotional and psychological effects of gut microbiome composition?

a) The HPA axis — cortisol produced in the gut travels to the brain via the bloodstream b) The vagus nerve — approximately 80–90% of vagal fibers carry information from gut to brain (afferent direction) c) The blood-brain barrier — gut-produced neurotransmitters cross directly into cerebrospinal fluid d) The spinal cord — gut signals are processed in dorsal horn before ascending to cortex

11. Gate control theory (Melzack and Wall, 1965) proposed that pain perception is:

a) A direct, linear translation of tissue damage — more damage always equals more pain b) Modulated by a gating mechanism in the spinal cord that can be influenced by psychological factors c) Primarily a learned response, with no necessary relationship to tissue physiology d) Located in the amygdala, explaining why emotional state correlates with pain experience

12. Central sensitization, relevant to understanding chronic pain, refers to:

a) The tendency for pain to sensitize the central nervous system over time, amplifying pain signals independent of tissue damage b) The mechanism by which spinal cord injury produces phantom pain c) The neurological pathway linking acute pain to depression in chronic illness populations d) The adaptive process by which pain tolerance increases with repeated exposure

13. Holt-Lunstad's 2010 meta-analysis of 148 studies found that social isolation is associated with:

a) A 20% increase in premature mortality risk b) A 50% increase in premature mortality risk — equivalent to smoking 15 cigarettes per day c) A 100% increase in premature mortality risk — the single largest modifiable risk factor studied d) A 30% increase in premature mortality risk, similar to physical inactivity

14. Social baseline theory (James Coan) proposes that the human nervous system:

a) Functions optimally in isolation, because social stimulation creates cognitive load b) Evolved assuming social proximity as a default state, making aloneness neurologically costly c) Regulates threat responses primarily through internal mechanisms, with social support as a secondary buffer d) Is calibrated for small family groups and experiences stress in both isolation and large social groups

15. Research on social connection demonstrates that perceived social support produces neurobiological effects. Which of the following is most directly supported by the evidence?

a) Higher social support is associated with higher cortisol reactivity, because social relationships are inherently stressful b) Social support primarily reduces illness through behavioral pathways (e.g., reminders to take medication) rather than direct physiological mechanisms c) Perceived social support dampens HPA axis reactivity to threat, reduces inflammatory markers, and improves immune function d) The effects of social support are equivalent for in-person contact and digital communication

16. Fredrickson's broaden-and-build theory proposes that positive emotions, unlike negative emotions:

a) Have no evolutionary function and are therefore byproducts of cognitive appraisal systems b) Narrow attention like negative emotions, but produce pleasant rather than threatening mental content c) Broaden attention and behavioral repertoire, and over time build durable personal resources d) Are primarily useful for signaling social status and attracting cooperation from others

17. The "upward spiral" concept in positive psychology refers to:

a) The tendency for positive emotions to increase motivation, which increases achievement, which increases self-esteem in a reinforcing cycle b) The compounding dynamic in which positive emotional states build resources that make subsequent positive states more likely c) The clinical phenomenon in which depressed patients improve rapidly once they reach a tipping point of positive experience d) The social contagion of positive emotions through networks, following the same pattern as Christakis/Fowler's obesity research

18. Allostatic load is best understood as:

a) The acute physiological response to a specific stressor, measured in cortisol and adrenaline levels b) The cumulative physiological cost of chronic stress across multiple biological systems c) The ratio of perceived stress to objective stressor severity — a measure of psychological resilience d) The long-term capacity to maintain emotional equilibrium under stress

19. The "positivity resonance" concept, developed by Fredrickson, refers to:

a) The tendency for people to rate ambiguous events more positively when in a good mood b) Micro-moments of shared positive emotional experience between people, associated with mutual care and physiological synchrony c) The amplification of positive emotions through social media, compared to in-person experience d) The emotional attunement between therapist and client that predicts therapeutic outcome

20. Research on the dose-response relationship between exercise and psychological wellbeing suggests:

a) More is always better — the mental health benefits of exercise increase linearly with duration and intensity b) The minimum effective dose is quite modest — even a single 20–30 minute moderate session produces acute benefits c) High-intensity exercise (above 75% VO2 max) is required for significant mood effects, while moderate exercise has minimal impact d) The psychological benefits of exercise are primarily driven by the social component, not the physical activity itself

21. Which of the following best describes the evidence base for the relationship between nutrition and mental health?

a) Specific nutrients (omega-3s, B vitamins, zinc) have large, well-established effects on mood when supplemented individually b) Dietary pattern (e.g., Mediterranean-style, anti-inflammatory) shows more consistent associations with mental health than individual nutrients c) The relationship between diet and mental health is entirely mediated by weight — it is weight, not dietary composition, that matters d) The evidence is too preliminary to draw clinical implications, and nutritional advice should await larger RCTs

22. The Epel-Blackburn research on stress and telomere length found that one group of caregivers — mothers of chronically ill children — had telomere length suggesting accelerated cellular aging of approximately:

a) Two years b) Five years c) Ten years d) Twenty years

23. When the chapter discusses "physical self-care as psychological infrastructure," it is making which of the following arguments?

a) Psychological wellbeing is primarily determined by physical health, making exercise and nutrition more important than therapy b) Physical self-care practices are instrumentally valuable to psychological functioning, not separate from or secondary to it c) Psychological treatment should always be preceded by physical health optimization, because therapy is ineffective when physical health is compromised d) Physical self-care is most important for preventing illness, while psychological practices are most important for treating existing conditions

24. The chapter's priority cascade for physical-psychological self-care places sleep at the top. Which of the following best justifies this priority?

a) Sleep deprivation is the most reversible condition — improving sleep produces the fastest visible results b) Sleep affects all other self-care behaviors (motivation to exercise, food choices, stress reactivity, social engagement), making it the highest-leverage intervention c) Sleep disorders are more common than nutritional deficiencies or social isolation, making sleep the most prevalent target d) Sleep is easiest to change through behavioral intervention, with the lowest barrier to improvement

25. Which of the following integrates multiple mechanisms from the chapter into a single explanatory pathway?

a) Chronic social isolation → HPA axis hyperactivation → immune suppression → increased inflammatory cytokines → depression → reduced motivation to exercise → further isolation → allostatic load accumulation b) Poor nutrition → BDNF reduction → cognitive decline → increased work errors → job stress → sleep disruption → HPA axis activation c) Both A and B represent plausible multi-mechanism pathways consistent with the chapter's content d) Neither A nor B is well-supported — the mechanisms discussed in the chapter are independent and do not form cascades

Short-Answer Extensions

Choose two of the following for deeper engagement:

Extension 1: The chapter argues that the mind-body distinction — treating psychological and physical health as separate domains — is scientifically obsolete and practically harmful. Construct the strongest possible argument for this claim, drawing on at least three distinct mechanisms from the chapter.

Extension 2: A friend tells you: "I've been really stressed at work for about two years. I sleep okay, I eat decently, but I just feel like my body and brain aren't working as well as they used to." Using the concepts of allostatic load, HPA axis dysregulation, and the priority cascade from the chapter, explain what might be happening and what you would suggest.

Extension 3: Loneliness is described in the chapter as one of the most significant public health risks of the 21st century — yet it is highly stigmatized, making acknowledgment and intervention difficult. Why might the biological mechanisms discussed in the chapter be useful for destigmatizing loneliness, and how would you use them in a conversation with someone who dismisses loneliness as "a lifestyle choice"?

Answer Key