- Contains neurobiological, cognitive, and behavioral approaches
- Explains methods for examining sleep and affect
- Summarizes research on sleep and specific affect states
- Translates research for clinical use in treating disorders
Sleep and Affect: Assessment, Theory, and Clinical Implications synthesizes affective neuroscience research as it relates to sleep psychology and medicine. Evidence is provided that normal sleep plays an emotional regulatory role in healthy humans. The book investigates interactions of sleep with both negative and positive emotions, along with their clinical implications. Sleep research is discussed from a neurobiological, cognitive, and behavioral approach. Sleep and emotions are explored across the spectrum of mental health from normal mood and sleep to the pathological extremes. The book, additionally, offers researchers a guide to methods and research design for studying sleep and affect. This book will be of use to sleep researchers, affective neuroscientists, and clinical psychologists in order to better understand the impact of emotion on sleep as well as the effect of sleep on physical and mental well-being. Contains neurobiological, cognitive, and behavioral approaches Explains methods for examining sleep and affect Summarizes research on sleep and specific affect states Translates research for clinical use in treating disorders
Front Cover 1
Sleep and Affect: Assessment, Theory, and Clinical Implications 4
Copyright 5
Contents 6
Foreword: Interrelationships between Sleep and Affect 14
References 22
Preface 28
Acknowledgements 30
Contributors 32
Part 1: Definitions 36
Chapter 1: Neurophysiology of Sleep and Circadian Rhythms 38
Overview 39
Wakefulness 40
NREM Sleep 44
REM Sleep 46
Circadian Rhythms 48
Sleep Deprivation 50
References 53
Chapter 2: Human Emotions: A Conceptual Overview 58
Foundations of Affect and Emotion 58
A Consensus Definition of “Emotions,” as Seen Through the Lens of the Animal Model 59
Emotion Science: Selected Milestones 60
Views Based on Introspection and Observation 60
The Emergence of Cognitive Approaches and Animal Models of Emotion 61
The Contributions of Psychophysiology and Human Neuroscience 63
Current Definitions and Theoretical Approaches 64
The Data of Emotion: Empirical Approaches 68
Challenge with Affective Stimuli 69
Emotional Imagery 70
Classical Conditioning 71
The Role of “Regulation” in Emotion Research 72
Conclusions and Elements of a Comprehensive Approach for the Study of Emotion 74
References 75
Chapter 3: Sleep, Emotions, and Emotion Regulation: An Overview 80
Sleep, Emotions, and Emotion Regulation: An Overview 80
Emotions and Emotion Regulation 81
Sleep and its Impact on Affect and Affect Regulation 82
Affect and its Impact on Sleep 85
Affect Regulation and its Impact on Sleep 88
Sleep and Affect: Bidirectional Relations 89
Discussion 91
References 94
Part 2 : Methods 98
Chapter 4: Methodology for the Assessment of Sleep 100
Part 1: Objective Diagnostic Measures of Sleep 104
Part 2: Subjective Diagnostic Measures of Sleep 111
Part 3: Research-Focused Measures of Sleep 115
Summary 119
Acknowledgments 119
References 119
Chapter 5: The Elicitation and Assessment of Emotional Responding 126
Primary Perspectives 127
Emotion Elicitation: Laboratory Methods 127
Visual Stimuli 127
International Affective Picture System 127
Word Stimuli Timuli: Affective Norms for English Words 128
Word Stimuli: The “Emotional” Stroop Task 128
Olfactory Stimuli 129
Auditory Stimuli 129
Script-Driven Imagery 129
International Affective Digital Sounds 130
Musical Scores 130
Biological Stimuli 131
Hyperventilation 131
Carbon Dioxide-Enriched Biological Challenge 132
Pharmacological Agents 133
Blended Stimuli 133
Stressful Film Paradigm 133
Virtual Reality 134
Laboratory Methods: Developmental Considerations 134
Laboratory Methods: Additional Considerations 137
Trajectories of Emotional Experience 138
Selection of Assessment Time Point 138
Selection of Assessment Strategy 139
Physiological Assessment 139
Self-Report Assessment 140
fMRI Assessment 141
Behavioral Assessment 142
Developmental Considerations in Assessment 142
Elicitation Method and Assessment Strategy Considerations 143
Matching Method to Emotion 143
The Impact of Sleep on Both Emotion Elicitation and Assessment 144
Conclusions 145
References 146
Chapter 6: Methodological Considerations When Integrating Experimental Manipulations of Sleep and Emotion 154
Emotion Elicitation 155
Visual Stimuli 155
Photographs 155
Film Clips 156
Behavioral Tasks 157
Directed Emotional Expressions 157
Anger Inductions 158
Stressors 158
Measurement of Emotional Responses 160
Subjective/Self-Report Measures 160
Visual Stimuli 161
Mood States 161
Behavioral Tasks 162
Psychophysiological Measurement 162
Pupillometry 162
Saliva Assays 163
Cardiovascular Measures 164
Facial Displays 164
Electromyography 165
Human Scoring 165
Automated Computer Scoring 166
Neural Responses to Emotional Stimuli 166
Special Considerations when Designing Experimental Studies of Sleep and Affect 167
Environment 167
Types of Sleep Manipulations 168
Research Designs 169
Conclusion 170
References 171
Part 3: Evidence Regarding Sleep and Specific Types of Affect 174
Section 1: Sleep and Negative Affect 176
Chapter 7: The Interrelations Between Sleep and Fear/Anxiety: Implications for Behavioral Treatment 178
Background and Definition of Key Concepts 178
Fear/Anxiety Is Associated with Sleep Disturbances 180
Summary 181
Sleep Disturbance Is Associated with Elevations in Fear/Anxiety 182
Summary 183
Fear/Anxiety Is Associated with Sleep Disturbance 184
Summary 184
Theoretical Models 185
Diathesis-Stress Model 185
Stimulus Control Model 185
Cognitive Model 186
Neurocognitive Model 186
Neurobiological Model 187
Summary 187
Proposed Mechanisms of Action 187
Neurobiological 187
Cognitive-Behavioral 188
Bedtime Arousal 188
Appraisal of the Stressor 188
Coping Style 189
Summary 189
Implications for Intervention 189
Animal Models 189
Clinical Interventions 190
Conclusions and Future Directions 192
References 192
Chapter 8: Nightmares and the Mood Regulatory Functions of Sleep 198
Nightmares and the Mood Regulatory Functions of Sleep 198
REM Properties 199
The NREM-REM Cycle 199
The Tonic Component of REM 199
The Phasic Component of REM Sleep 199
Brain Activation and REM 200
REM and Nightmares 200
Phenomenology of Nightmares 201
Syndrome of Recurring Nightmares 201
Sleep Disorders with Nightmares 201
REM Behavior Disorder 201
N2 NREM Nightmares 203
Nightmares Associated with Narcolepsy 203
Mood Disturbances, Depression, and Nightmares 203
Nightmares and PTSD 205
Theories of the Nightmare 205
Freud on Nightmares 205
Fisher on Nightmares 206
Hartmann on Nightmares 206
Nielsen and Levin on Nightmares 206
A Diathesis-Stress Model of Nightmares 207
Theory and Treatment Strategies 207
Recent Findings/Current Research 209
Future Directions 210
References 210
Chapter 9: Isolated Sleep Paralysis and Affect 216
Isolated Sleep Paralysis and Affect 216
Vignette 217
Diagnostic Criteria 219
Prevalence Rates 220
Associated Comorbidities 220
Sleep Paralysis and Affect 221
Cultural and Historical Contexts 221
Phenomenology and Specific Features of ISP and Their Relations to Fear 223
The Clear Sensorium in ISP and Appraisal of Episodes 227
Nonfearful Affect and Sleep Paralysis 229
Clinical Impairment as a Result of Sleep Paralysis 229
Conclusions 230
References 230
Chapter 10: Sleep and Repetitive Thought: The Role of Rumination and Worry in Sleep Disturbance 236
Sleep and Repetitive Thought: The Role of Rumination and Worry in Sleep Disturbance 236
Worry: Phenomenology and Assessment 237
Worry and Sleep 238
Rumination: Phenomenology and Assessment 241
Rumination and Sleep 243
Rumination and Worry: Common and Distinguishing Features 245
Rumination, Worry, and Sleep: Theoretical Models 247
Rumination, Worry, and Sleep: Treatment Implications 250
Rumination, Worry, and Sleep: Other Clinical Implications 251
Conclusion 253
References 253
Chapter 11: Sleep, Sadness, and Depression 262
Sleep, Sadness, and Depression 262
How Sleep Impacts Sadness or Depression 263
How Poor and Insufficient Sleep Impact a Future Depressive Episode 264
The Impact of Poor Sleep on Next-Day Depressed Mood in Nondepressed Samples 265
The Impact of Sleep Deprivation on Mood During a Depressive Episode 266
The Impact of Poor Sleep on the Severity of Depression 267
The Impact of Poor Sleep on the Course of Depression Treatment 268
The Impact of Sadness or Depression on Sleep 269
Subjective Sleep Symptoms in Depression 269
Objective Sleep Abnormalities in Depression 269
How Sadness and Depression Impact Future Sleep Disorders 271
How Mood Impacts Next-Day Sleep 273
Summary and Implications for Future Research 274
References 276
Chapter 12: The Interrelations Between Sleep, Anger, and Loss of Aggression Control 282
Introduction 282
Aspects of Sleep, Anger, and Aggression 283
Correlational Studies Showing the Relationship Between Sleep and Anger 284
Nonaggressive Populations 284
Aggressive Populations 286
What is the Causal Direction? 287
Is Sleep Loss a Potential Risk Factor for Anger and Aggressive Behavior? 287
Human Studies 289
Animal Studies 290
Summary 292
Do Aggressive Tendencies and Actions Cause Poor Sleep? 292
Human Studies 292
Animal Studies 293
Summary 294
Possible Neurobiological Mechanisms Underlying the Relationship Between Sleep and Aggression 294
A Central Role for The Prefrontal Cortex (PFC) 294
Involvement of the Hypothalamic-Pituitary-Adrenal (HPA) Axis System 296
Serotonin 298
Groups at Risk 298
Clinical Implications 299
Conclusions and Future Directions 300
References 301
Section 2: Sleep and Positive Affect 308
Chapter 13: Positive Affect as Resilience and Vulnerability in Sleep 310
Positive Affect as Promotive Influence and Resilience 311
Promotive Effects 311
Trait Positive Affect 311
Daily Positive Affect 313
Discrete Emotions 313
Protective Effects 316
Mechanisms 316
Summary 317
Positive Affect as Risk and Vulnerability 317
Mood Disorders and Sleep 317
Anxiety and Depression 317
Bipolar Disorder 319
Mechanisms 319
Summary 320
Conclusions 320
References 322
Chapter 14: Sleep and Biological Rhythms in Mania 328
Mania as an Activation Switch Dysfunction 328
Motor Activation, Deregulation of Energy Levels, and the Experience of a Decreased Need for Sleep 328
The Typical Cyclic Nature of Mania Symptoms 330
Sleep and Circadian Disturbances in Mania-Related Illnesses 333
Bipolar Disorder 333
Adolescence and Early-Onset Bipolar Disorder 335
Cyclothymia 336
Obsessive-Compulsive Symptoms 336
Attention Deficit Hyperactivity Disorder 337
The Impact of Sleep Disturbances on Affective Regulation, Executive Functions, and Risk-Taking Behavior 338
Affective Regulation 338
Cognition 339
Therapeutic Implications 340
Sleep and Circadian Disturbances as Predictors of Manic Episodes 340
Sleep- and Circadian-Based Interventions for the Management of Mania Symptoms 341
Conclusion 344
References 344
Chapter 15: Physical Activity, Sleep, and Biobehavioral Synergies for Health 356
Exercise and Sleep: Overview of Primary Findings 357
Temporal Exercise-Sleep Relationships 358
Exercise Modalities and Sleep 359
Putative Biological Mechanisms of Exercise Effects on Sleep 360
Exercise and Obstructive Sleep Apnea 362
Exercise and Restless Leg Syndrome 363
Sedentary Behavior and Sleep 363
Synergies Among Sleep, Sedentary Behavior, and Exercise 364
A 24-h Approach to Chronic Disease Prevention 365
Summary 367
References 367
Chapter 16: Mindfulness, Affect, and Sleep: Current Perspectives and Future Directions 374
Mindfulness, Affect, and Sleep: Current Perspectives and Future Directions 374
Mindfulness-Based Interventions 375
Evidence for the Efficacy of MBIs on Sleep 377
Study Characteristics 377
Outcome Measures for Sleep 389
Comparison Conditions 391
Theoretical Models Of The Relationship Of Mindfulness To Sleep And Affect? 393
Cognitive Models 394
Neurobiological Models 395
Future Directions and Implications 397
References 399
Section 3: Evidence Regarding Sleep and Affect Among Special Populations 410
Chapter 17: Pain and Sleep 412
Pain and Sleep 412
Methodological Issues 413
Association of Disturbed Sleep and Pain 414
Acute Pain Conditions 414
Chronic Pain Conditions 415
Headache 415
Musculoskeletal Pain 416
Rheumatoid Arthritis 416
Fibromyalgia 417
Neuropathic Pain 418
Experimental Sleep Manipulations and Pain Sensitivity 419
Nonspecific Sleep Deprivation 419
Total Deprivation 419
Reduced Nighttime Sleep Period 419
Sleep Fragmentation 420
Sleep-Stage Deprivation 420
Slow-Wave-Sleep Deprivation 420
REM-Sleep Deprivation 421
Mechanisms Underlying the Sleep-Pain Nexus 421
Sleep Loss or Sleepiness and Cytokines 421
Cytokine Activation and Pain 422
Modulators of the Sleep-Pain Nexus: Mood and Cognitive Processes 422
Pharmacological and Behavioral Treatment of Sleep and Pain 424
Behavioral 424
Pharmacologic 425
Chronic Pain of Various Etiologies 425
Summary 427
References 427
Chapter 18: The Impact of Sleep on Emotion in Typically Developing Children 434
Associations Among Key Aspects of Sleep Regulation, Emotion, and Mood 435
Sleep Regulation 435
Homeostatic Sleep Process and Emotional Processes 436
Homeostatic Sleep Process and Emotional Reactivity 436
Homeostatic Sleep Process and Emotional Regulation 439
Circadian Sleep Process and Mood 441
Circadian Tendencies and Socioemotional Adjustment 442
Neural Sleep Regulation and its Associations with Affect 443
Developmental Considerations Related to the Interplay Between Sleep and Affect 443
Developmental Changes Related to Sleep and Affect 443
Overlapping Brain Mechanisms 445
Implications for Abnormal Development 445
Directionality and the Contributions of Additional Factors 447
Summary 448
References 449
Chapter 19: Sleep and Adolescents 456
Sleep and Adolescents 456
Changes in Normal Sleep 457
Conceptual Models 459
Sleep for Restoration 459
Link Between Arousal and Sleep 460
Sleep Difficulties—The Three-P Model 461
Current State of the Research 461
Bidirectional Associations Between Sleep and Mood or Emotion 461
Bidirectional Associations Among Sleep, Affect, and Behavior 462
Bidirectional Associations Among Sleep, Affect, and Cognition (Including Learning and Memory Consolidation) 463
Bidirectional Associations Among Sleep, Affect, and Health 464
Technology Use 464
Clinical Studies of Disordered Sleep in Adolescents 465
Discussion of the Impact of Sleep on Adolescent Well-Being and Prevention 467
Clinical Implications 467
Public Health Implications 468
Future Directions for Research 469
References 469
Chapter 20: The Relationship Between Sleep and Emotion Among the Elderly 476
Emotion Regulation in Aging: The “Paradox of Well-Being” 477
Decline in Emotional Processing with Aging 479
Age-Related Sleep Modifications 481
Are Age-Related Sleep Modifications Linked to Emotion Regulation in Aging? 483
References 486
Part 4: Future Directions 496
Chapter 21: Sleep and Affect: An Integrative Synthesis and Future Directions 498
The Complex Interplay of Sleep and Affect 499
Sleep Problems Influence Affect 499
Negative Affect 499
Positive Affect 500
Summary 500
Affect Influences Sleep 500
Negative Affect 501
Positive Affect 501
Summary 501
Conclusions and Future Directions 502
Factors Implicated in Links Between Sleep and Affect 502
Predisposing Factors 502
Causal Links 505
Factors that Influence Links Between Sleep and Affect 506
Developmental Stage 506
Diagnostic Status 506
Conclusions and Future Directions 507
Clinical Implications 508
Assessment of Sleep and Affect 508
Objective Versus Self-report 508
Interventions Targeting Sleep to Improve Affect 509
Interventions Targeting Affect to Improve Sleep 510
Combined Interventions for Sleep and Affect 511
Conclusions and Future Directions 512
General Conclusions 512
References 513
Index 520
Foreword: Interrelationships between Sleep and Affect
Edward Pace-Schott, Harvard Medical School and Massachusetts General Hospital, Boston, MA, USA
Sleep and Affect: Assessment, Theory, and Clinical Implications provides the first comprehensive review of the emerging synthesis between the affective neurosciences and sleep psychology and medicine. Researchers frequently hypothesize that normal sleep helps regulate emotions in healthy humans (e.g., Cartwright, Luten, Young, Mercer, & Bears, 1998; Dahl & Lewin, 2002; Deliens, Gilson, & Peigneux, 2014; Germain, Buysse, & Nofzinger, 2008; Goldstein & Walker, 2014; Kramer, 1993; Levin & Nielsen, 2007; Soffer-Dudek, Sadeh, Dahl, & Rosenblat-Stein, 2011; Walker, 2009; Walker & van der Helm, 2009). The bulk of the empirical evidence supporting this assertion has emerged only recently, however, and it represents a dynamic and expanding field of inquiry brought together in this volume. After introducing key concepts and methodologies in each field, the book discusses the interactions between sleep and the full complement of negative and positive emotions, while explaining the clinical implications of those interactions. Some relationships between sleep and emotion have been widely studied, especially in the context of mood and anxiety disorders, whereas researchers are only beginning to examine others, such as the possible link between sleep quality and anger. Once we have considered the more general interactions between sleep and emotion, we explore how these interactions manifest in special populations such as children and adolescents, among whom sleep problems may presage and even contribute to later psychiatric disorders. Importantly, this volume deals with sleep and emotion across the spectrum of mental health from the normal covariance of mood and sleep to the pathological extremes.
People often take for granted the fact that sleep profoundly affects one’s emotional state. In most cases, a good night of sleep improves mood, along with other subjective experiences of mind-body health such as restedness and stamina. In fact, the absence of such benefits can be associated with symptoms of sleep or psychiatric disorders, referred to as nonrestorative sleep or anxious awakenings. As a tried and true adage of folk psychology, the individual expects to be a different person after a good night’s sleep. So, what takes place across sleep in healthy individuals to produce such a reliable change? In part, improved mood is expected to result from sleep based on Borbely’s two-process model (Borbely, 1982) in which sleep propensity results from an interaction between circadian and sleep-homeostatic factors. For example, circadian rhythms, such as the preawakening rise in cortisol (Kalsbeek et al., 2012) and the cortisol awakening response (Federenko et al., 2004), are believed to prepare us for the challenges of the new day, and these processes could promote a sense of vigor upon awakening. Similarly, having slept away homeostatic sleep pressure and reduced levels of endogenous somnogens, such as adenosine (Porkka-Heiskanen & Kalinchuk, 2011), in the central nervous system (CNS), one might expect to experience improved mood, which can be further boosted by the adenosine-receptor antagonist, caffeine (Fisone, Borgkvist, & Usiello, 2004). An abrupt change in the forebrain’s neuromodulatory milieu also coincides with abundant REM sleep late in the sleep period, during which monoamines, such as serotonin, are at their nadir, ending when the individual wakes, at which time they return to high levels (Pace-Schott & Hobson, 2002). Such state-dependent changes are undoubtedly important for producing a mild morning euphoria (with notable exceptions being many adolescents and evening chronotypes!). Other nightly changes promote enduring aspects of emotional health regardless of waking mood, however. Such changes have now become long-overdue subjects of many scientific investigations, such as those addressing the sleep-dependent consolidation of emotional memories, and this volume provides the first systematic compendium of their findings.
These new investigations into sleep and emotion are increasingly necessary, given the well-documented trend toward voluntary curtailment of sleep in Western societies, a trend that may be broadly problematic for physical, mental, and, especially, emotional health. From the 1950s to the first decade of this century, average sleep duration in adults has decreased from over 8 to under 7 h per night (Van Cauter, Knutson, Leproult, & Spiegel, 2005). Recent research has shown that many physiological systems are negatively influenced by insufficient sleep (Van Cauter et al., 2007). For example, sleep deprivation is associated with endocrine abnormalities such as elevated evening cortisol (Leproult, Copinschi, Buxton, & Van Cauter, 1997), immunological abnormalities such as increased inflammatory markers (Mullington, Haack, Toth, Serrador, & Meier-Ewert, 2009; Pejovic et al., 2013), and heightened risk of cardiovascular disease (Solarz, Mullington, & Meier-Ewert, 2012). Similarly, sleep deprivation is associated with metabolic abnormalities contributing to obesity, insulin resistance, and, ultimately, type II diabetes (Knutson, Spiegel, Penev, & Van Cauter, 2007). Sleep disorders such as obstructive sleep apnea and insomnia are linked to hypertension (Fernandez-Mendoza et al., 2012; Palagini et al., 2013) and elevated sympathetic nervous system activity (Zhong et al., 2005). Notably, many of these physiological abnormalities can be reversed by naps or recovery sleep (Pejovic et al., 2013; Vgontzas et al., 2007). Although emotional state is intimately linked to physiological homeostasis in both the peripheral nervous system and CNS (Craig, 2002; Damasio, 2003), the effect of insufficient sleep on physiological aspects of normal emotional regulation has only begun to attract inquiry.
CNS function and cognition are similarly impacted by insufficient sleep. Loss of vigilance, especially at unfavorable circadian periods for maintenance of wakefulness, leads to a large number of automobile, public transportation, and industrial accidents (Garbarino, Nobili, Beelke, De Carli, & Ferrillo, 2001). In the elderly, sleep disturbances may be a risk factor for incident cognitive impairment (Blackwell et al., 2011). Cognitive skills such as working memory, short-term memory, and logical reasoning are especially disrupted by sleep deprivation (Chee & Chuah, 2008). Such functions rely on the prefrontal regions of the brain and include executive processes such as decision-making and behavioral inhibition (Chee & Chuah, 2008; Drummond, Paulus, & Tapert, 2006; Killgore, Balkin, & Wesensten, 2006). These prefrontal areas include the major loci of emotion regulation (Ochsner & Gross, 2005; Schiller & Delgado, 2010). Thus, sleep loss also impacts cognitive processes for which emotional information is essential, such as moral reasoning (Killgore et al., 2007), emotional intelligence (Killgore et al., 2008), and affect-guided decision-making (Killgore et al., 2006).
The following brief overview of some recent findings on sleep and emotion will whet the reader’s appetite for the extensive treatment provided later in the book. Many of these studies have used total sleep deprivation (TSD) and sleep restriction protocols. TSD can reportedly impair recognition of facial emotion (van der Helm, Gujar, & Walker, 2010), and sleep restriction slows the expression of facial emotions (Schwarz et al., 2013). Similarly, even mild sleep restriction can impair emotional regulation in children (Gruber, Cassoff, Frenette, Wiebe, & Carrier, 2012), and normal variation in sleep quality can affect an individual’s high-level ability to reappraise negative stimuli in normal adults (Mauss, Troy, & Lebourgeois, 2013). Functional neuroimaging studies have shown distinct effects of TSD on the neural circuits involved in emotion regulation (Gujar, Yoo, Hu, & Walker, 2011; Yoo, Gujar, Hu, Jolesz, & Walker, 2007). Following TSD, activation is reduced in regions, such as the ventromedial prefrontal cortex (vmPFC), that inhibit expression of negative emotion (Thomas et al., 2000; Yoo et al., 2007) but increased in the amygdala in response to emotional stimuli (Yoo et al., 2007). Moreover, sleep deprivation disrupts the functional connectivity between the vmPFC and the amygdala (Yoo et al., 2007). A recent fMRI study has further shown that the sleep debt accrued by prolonged sleep restriction can produce a similar hyperresponsivity of the amygdala, while reducing its functional connectivity with the vmPFC (Motomura et al., 2013).
Unlike normal emotion regulation, psychopathology appears to be strongly linked to the sleep disturbances that are ubiquitous in affective and anxiety disorders (Ford & Cooper-Patrick, 2001; Harvey, 2008, 2011; Kobayashi, Boarts, & Delahanty, 2007; Mellman, 2006, 2008; Peterson & Benca, 2006; Riemann, Berger, & Voderholzer, 2001). Among the anxiety disorders, poor sleep quality (e.g., low efficiency, prolonged onset latency) is common in posttraumatic...
| Erscheint lt. Verlag | 1.2.2015 |
|---|---|
| Sprache | englisch |
| Themenwelt | Geisteswissenschaften ► Psychologie ► Allgemeine Psychologie |
| Geisteswissenschaften ► Psychologie ► Klinische Psychologie | |
| Geisteswissenschaften ► Psychologie ► Verhaltenstherapie | |
| Medizin / Pharmazie ► Gesundheitsfachberufe | |
| Medizin / Pharmazie ► Medizinische Fachgebiete | |
| Naturwissenschaften ► Biologie ► Humanbiologie | |
| Naturwissenschaften ► Biologie ► Zoologie | |
| ISBN-10 | 0-12-417200-8 / 0124172008 |
| ISBN-13 | 978-0-12-417200-5 / 9780124172005 |
| Haben Sie eine Frage zum Produkt? |
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