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Sleep cycle
The typical sleep cycle moves from stages 1-2-3-4-3-2-REM. The sleep
cycle repeats every 90 minutes, with one exception. After the first
cycle, REM replaces stage 1. As the night progresses, deep sleep
(stage 3 and 4) decreases and REM increases. We need a balance of
REM and non-REM sleep to feel rested in the morning. If the sleep cycle
is disrupted, the quality of sleep is disrupted. We would then feel tired
in the morning, even if we slept the necessary eight hours.
The sleep cycle can be influenced by:
age- babies spend more time in REM sleep than older children and
adults
stress- increases REM sleep
depressants (ie., alcohol, cough syrup, medication for some mental
illnesses)- decreases both REM and non-REM sleep
sleeping pills- decreases REM (you get the quantity, not the quality of
sleep needed)
sleep deprivations- experience a REM rebound; once you do get to
sleep, you will quickly pass through non-REM sleep and spend most of
the night in REM sleep - you will still feel tired when you wake up
because the quality of sleep is still disrupted
Therefore, one could understand that since stress, depressants and sleeping pills disrupt
quality of sleep, a person experiencing or using any of these factors could feel sleepy
during wakeful periods.
Sleep problems
Insomnia- difficulty attaining or maintaining sleep - this problem is the
most diagnosed sleep disorder - treatments include sleeping pills (fast
and effective, yet can cause addiction, imbalance of sleep cycle
{decreases REM}, and rebound of insomnia when no longer taking the
sleeping pills), behavioral techniques (slower to treat but does not
create addiction, insomnia rebound, or decrease of REM) - behavioral
techniques include:
• go to bed only when sleepy
• do nothing else in the bedroom besides sleep (associate the bed
with rest instead of stress of doing homework, excitement of the
television program, exercise or sex)
• if you cannot get to sleep within 20 minutes, get up and do an
activity that will make you sleepy- (read, watch tv, knit, crochet,
go for a ride {you, of course, are not the driver} - do not exercise
at this time)
• exercise before noon
• proper diet (decrease caffeine, sugar, fat and alcohol)
• establish a regular schedule (if you get up at 7:00 am and go to
bed at 11:00pm during the weekdays, you should follow this
schedule as best you can on the weekends - if you stay up until
2:00am on Friday, try to get up by 8:00 - 8:30 on Saturday - do
not sleep until noon - this late morning sleeping will catch up to
you on Sunday night when you want to go to bed by 11:00pm)
• do not nap
Narcolepsy- sudden bouts of REM sleep during wakefulness - A person
could be awake and then suddenly fall asleep. This person will skip
non-REM sleep and enter right into REM sleep during this episode.
Narcoleptic attacks may be brought on by stress or strong emotional
situations. This person will often feel tired during the day and may be
mis-diagnosed. Medication can be used to treat the symptoms.
Sleep apnea - episodes of not breathing while asleep - This individual may also feel tired
during the day. Individuals who snore and "snort" while sleeping should be checked for
apnea. The snorting may be an indication that the person is grasping for breath or just
beginning to breath again. The severity of the problem varies from person to person.
Treatments include surgery and/or receiving oxygen through a mask while sleeping.
Night terrors - bouts or neurological panic attacks while asleep - This person may
appear to wake up screaming or swinging at objects or people. This individual is still
asleep. He most likely will not remember the episode upon wakening. Night terrors are
most diagnosed in young children and adolescents. Most people outgrow these
symptoms. Some theorists believe that night terrors are related to elevated stress levels.
Night terrors are not bad dreams; most people do not remember a dream during the
episode (if they remember the episode at all).
Somnambulism - sleep walking - Sleep walking can be dangerous if the person starts
playing with the steak knives or decides to take a walk outside. Most sleepwalking is
harmless. Special locks or bells may need to be placed on doors or kitchen draws. You
can safely wake up a sleep walker (although the person may be extremely disoriented,
therefore may swing at you). If the person is engaging in a harmless activity, you can let
the person go or guide her back to her bedroom. If the person is going outside, you
should seriously consider waking (from a distance) this person.
Dreams
Everyone dreams, even though a person may not remember the
dreams. An average person (sleeping eight hours) will experience a
vivid dream state four – five times per night. We dream in color,
although color is the first part of our dreams that we forget. Our
dreams are easier to recall right after the dream. For example, you
wake up in the middle of the night to go to the bathroom and you are
remembering the dream that you just had; in the morning you may not
remember that dream. We spend more time in REM closer to morning,
so we are more likely to remember the dreams that we had later in our
sleep period.
Dream content
Three most common themes of reported dreams include:
• falling
• being chased or attacked
• trying but failing to accomplish something
Two-thirds of reported dreams involve fear, sadness and anger. Aggression is more
common than friendliness (2:1) in our dreams.
Which theory best explains why we dream? Psychologists do not know. Much evidence
exists to support both the biological and cognitive theories, however many theorists and
practitioners believe the psychoanalytic theory. The answer may be that a combination of
all three theories best explain why we dream.
Hypnosis
This chapter addresses sensation and perception. We will talk about the type of
information that gets into our system and then how we interpret that information.
Sensation is the conversion of energy from the environment into a pattern of response by
the nervous system. Sensation includes the registration of information or the raw data
that we receive.
Perception involves making sense of or interpreting the information brought in from the
environment through the senses. Light rays striking your eyes or sound waves striking
your ears would be sensation. When you say such things as "I see my roommate" or "I
hear the bell ringing" you are expressing your perception of what those sensations mean.
Newborn abilities
From birth, infants' senses all operate to some degree and the sensory
capabilities develop rapidly over the first years of life.
TOUCH - infants' sensitivity to touch and pain increases during the first
5 days after birth. Many parents suffer as they watch their babies in
pain when going through such procedures as circumcision and heel
lancing (used to obtain blood samples). Doctors had shied away from
giving anesthesia because of a persistent belief that the neonate does
not feel pain and because of the known effects of the drugs. New
evidence differs, showing that when going through these procedures,
infants cry more, have higher heart rates and blood pressure, and
sweat more during the procedure. Infants will also pull their legs away
(more persistent than natural reflex) from the pin prick of the heel
lancing.
PRACTICAL CONSIDERATIONS:
1. changes in some neonatal surgical procedures and concern for safe
levels of pain medication;
2. reconsideration for routine circumcision
Development of touch - Haptic perception (exploring by touch)
increases during infancy, especially after fine motor (use of small
muscles) skills develop. Infants increase use of their fingers to explore
the world.
I. Sensitivity. One of the most striking aspects about our sensory modalities is that they
are extremely sensitive at detecting changes in the environment. The most common way
to assess the sensitivity of a sensory modality is to determine the minimum magnitude of
a stimulus that can be reliably discriminated from no stimulus at all - for ie., the weakest
light that can be reliably discriminated from darkness.
Touch - The wing of a fly falling on your cheek from a distance of one centimeter.
Sensory differences. There are many factors that could influence a person's sensory
sensitivity.
1. Individual differences. Within the human species there are receptor differences across
individuals. Some people have greater sensitivity to taste, some have difficulty hearing
sounds at particular frequencies, and some have problems distinguishing among different
colors.
3. Situational factors. Even within the same person, receptor sensitivity differs from time
to time. For example, suppose you attend a concert in which the music is very loud.
Immediately after the concert, you may have trouble hearing what your friends are saying
and have to increase the volume of your radio for the sound level to seem normal.
4. Sensory adaptation. Another way in which receptor sensitivity can change is called
sensory adaptation. For example, you move to a new home where you find that the
water has a bad taste because it contains certain minerals or chemicals. Yet after a short
time you no longer notice the bad taste. You might perceive a horrible smell as you enter
a friend's house, yet find that after a short stay the smell seems to disappear. Sensory
adaptation is a loss of sensitivity that usually occurs at the receptor level in all sensory
systems when stimuli are unchanging.
Sensory adaptation is generally a useful process, and we are often grateful that our senses
act in this way. Nevertheless, when adapted, our receptors can be less sensitive to certain
stimuli, so that we might not be able to hear sounds or taste certain foods that we could
perceive when our receptors were in a more normal state of operation. Responsitivity
may also decrease at the neural level due to repeated stimulation. This repeated process is
called habituation. It differs from adaptation in that responsiveness can suddenly
reappear if the stimulation level is increase or decreased (dishabituation).
Two important variables that one must consider when determining thresholds or a
person's sensitivity are:
1. person characteristics;
PERCEPTUAL ORGANIZATION
How do we interpret or organize our sensations? The two main approaches used to study
this question include:
1. feature detection approach- in which scientists believe that there are cortical cells that
are specifically responsive to certain features of a stimulus (horizontal, vertical, diagonal,
etc.). Ultimately, the stimuli are represented by a combination of these elements. They are
basic building blocks of what we perceive. Other researchers believe that this approach is
too simplistic.
2. The second approach is the Gestalt approach. Early in 1900's, a group of psychologists
became interested with how the mind organizes sensations into perceptions. Given a
cluster of sensations, the human perceiver organizes them into a gestalt, a German word
meaning a "form" or a "whole". The Gestalt psychologists provided many compelling
demonstrations of this ability. Gestalt psychologists are fond of saying that the whole
may differ from the sum of its parts. There is far more to perception than meets the
senses. An example of this is the PHI PHENOMENON, the illusion of movement
created by the presentation of visual stimuli in rapid succession. We don't perceive the
individual lights, rather the form in movement (IE., neon signs). Gestalt psychologists
describe the principles by which we organize our sensations into perceptions. Our brains
do more than just register information about the world. Perception is not just opening a
shutter and letting a picture print itself on the brain. We always filter sensory information
and construct perceptions in ways that make sense to us.
Form perception.
1. Figure/ground: To begin perception of form, we must first perceive any object, called
the figure, as distinct from its surroundings, called the ground. Among all the voices that
you hear at a party, the one you attend to becomes the figure. All other voices are part of
the ground. When you read the test, the words are the figure whereas the white paper is
the ground. The figure-ground relationship continually reverses - but we always
organize the stimulus into a figure against ground.
2. Grouping. Having discriminated figure from ground, we must then organize the figure
into a meaningful form. Some basic features of a scene, such as color, movement, and
light-dark contrast are processed instantly and automatically. To bring order and form to
these basic sensations, our minds follow certain rules for grouping stimuli together. These
rules, identified by the Gestalt psychologists, illustrate their idea that the perceived whole
differs from the mere sum of its parts.
a. proximity - we group nearby figures together (86 trees are seen as woods, whereas 3
trees are seen as 3 trees)
c. closure - if a figure has gaps, we complete it, filling in the gaps to create a complete
whole object
The grouping principles usually help us perceive reality, but sometimes they lead us
astray. Examples of these principles can be found on the resources page for this chapter.
Interactive links provide better demonstrations of the principles.
DEPTH PERCEPTION
Depth perception. From the two-dimensional images that fall on our retinas, we somehow
organize three-dimensional perceptions. The ability to see objects in three dimensions,
called depth perception, allows us to estimate their distance from us. At a glance, we
estimate the distance of an oncoming car or the height of a cliff.
How do we transform two-dimensional retinal images into three- dimensional
perceptions? Some of the cues that we use require both eyes (binocular cues). Other cues
are available to each eye separately (monocular cues).
Binocular cues.
1. Retinal disparity. Because our eyes are about 2 and 1/2 inches apart, our retinas receive
slightly different images of our world. When the brain compares these two images, their
retinal disparity (difference between two images) provides an important cue to distance.
When your finger is directly in front of your nose, your retinas receive quite different
views. At greater distance - say, when you hold your finger at arm's length - the disparity
is smaller. The creators of 3-D movies and viewmasters simulate retinal disparity by
photographing a scene with two cameras placed a few inches apart. When viewed
through spectacles or a device that allows the left eye to see only the image from the left
camera and the right eye the image from the right camera, the 3-D effect mimics normal
retinal disparity.
2. Convergence. This is a muscular cue that indicates the extent to which the eyes turn
inward when we look at an object. By noting the angle of convergence, the brain
determines whether you are focusing just past your nose, or on a printed paper, or on the
person across the room.
Monocular cues. We depend on binocular cues more for close distances, while we rely
on monocular cues for greater distances.
1. Relative size. If we assume that two objects are similar in size, we perceive the one that
casts the smaller image on the retina as farther away.
4. Relative height. We perceive objects higher in our field of vision as farther away. This
may contribute to the illusion that vertical dimensions are longer than identical horizontal
dimensions (things appear taller than wider).
5. Relative brightness. Nearby objects reflect more light to our eyes. Thus, given two
identical objects, the dimmer one seems farther away. Artists use these monocular cues to
convey depth on canvas.
Both monocular and binocular cues are manipulated to produce optical illusions. An
optical illusion occurs when there is a discrepancy between the appearance of a visual
stimulus and its reality. Interactive exercises/videos for optical illusions and depth
perception are found under the resource link for this chapter.
Subliminal Perception
Subliminal perception is the claim that a stimulus that we do not consciously attend to
can influence our behavior. Research supports that the messages/pictures prime our
perceptions. In other words, the subliminal messages prepare us to see or interpret a
particular image or message.
1. Changes in behavior; the subliminal message seems to impact our mental processing
and judgments, but the primed thought does not necessarily change our behavior.
3. Influences of subliminal tapes. Should I use subliminal tapes while I sleep to improve
my memory? Does this process actually improve memory? A study was conducted in
which subjects were divided into two groups: self-esteem group and memory group.
During the research procedure, subjects in the self-esteem group were told that while they
slept, they would listen to self-esteem enhancing tapes; the memory group was told that
they were listening to memory enhancing tapes. In reality, the self-esteem group listened
to the memory tapes and the memory group listened to the self-esteem tapes. In the end,
the group that was told that they were listening to the self-esteem tapes but actually
listened to the memory tapes improved on self-esteem measures. Those who were told
that they were listening to the memory tapes improved on memory measures. The
subliminal messages on the tape did not impact their behavior; instead the directions or
what the subjects believed that they were listening to impacted their performance. The
findings of this study suggest a placebo effect - subjects' expecations, not the independent
variable, changed performance.
Effects that have been reported in other subliminal studies appear to be due to
uncontrolled random variables or the placebo effect.
Chapter 11
STRESS AND HEALTH
A new subfield of health psychology assumes that illness results
from the interaction of our biological, psychological, and social
systems. Basically, anything putting a demand on or challenge to our
body is considered stress. We then can distinguish between two types
of stress:
eustress- pleasant, desirable stress (getting married, graduating,
getting a new job)
distress - unpleasant, unwanted stress (getting divorced, being in an
accident, being stood up by a date)
Regardless of whether the stress is eustress or distress, the effects on the body are the
same.
According to some researchers, there are major sources of stress that should be
considered:
1. Frustration- occurs when a goal is blocked. For example, You may
be working on a paper that is due today - guests come over
unexpectedly, the telephone is ringing off of the hook, etc. Most
frustrations are short-lived and relatively insignificant. However, some
frustrations can create a significant amount of stress. ie., high
expectations and unrealistic goals
2. Conflict - occurs when two or more differing motivations compete
for expression.
One source of stress comes from everyday conflicts we face between
our different motives. Least stressful are the approach-
approach conflicts, in which two attractive but incompatible goals
pull at us - to go to sporting event or out for pizza, watch one of two
goods television shows on tv - of the three kinds of conflict, the
approach-approach tends to be less stressful.
Other times, we face an avoidance-avoidance conflict between two
undesirable alternatives. Your mother and father have both set you up
on a blind date with one of their co-worker's children. You do not want
to go on either date, but your parents are forcing you to be nice and go
on one date. Do you go on the blind date set up by your mother or
father?
In times of approach-avoidance conflict, we feel simultaneously
attracted and repelled. Some things you may adore about a person you
are dating, other things you dislike. Do you continue dating this
person? Stress multiplies when we face several approach-avoidance
conflicts simultaneously.
3. Change - anything that results in a readjustment of one's life - this
can be both positive (wedding, new job, entering college) and negative
(death of someone close, divorce, etc.) - little evidence to say that
change is destined to result in stress - the theory states that the more
change a person experiences in a one year period, the more likely
he/she will get sick (example stress assessment included in
powerpoint)
4. Pressure- compelling influence or constraining force - expectations
that we act/behave in a certain way - to always be nice, to teach your
children to behave properly in all situations, to study well to get an A,
etc
5. Personality types- person's individual response to stress; one way
to address personality is to determine if the person may be Type A or
Type B
Type A personality style includes characteristics such as competitive,
highly motivated, unable to relax, concerned with time, angered easily,
aggressive
Type B personality style includes characteristics such as being easy
going, relaxed, understanding, and able to enjoy leisure time
Type A personalities:
• Have more stress
• Maintain stress for longer periods of time
• Are two times more likely to have a heart attacks, if they have strong
emotional responses to stressors
6. Hardiness - reaction to environment with commitment (stay with it
for the long haul), control (having power over the situation) and
challenge (this is an obstacle to overcome); if we are low in hardiness,
we are more likely to experience negative consequences in reaction to
stress.
8. Acculturative stress- Stress resulting from contact between two cultural groups
Assimilation - assuming identity/practices of the mainstream culture
Integration - maintain personal cultural identity while moving into new
mainstream culture
Separation - separating oneself from mainstream culture
Marginalization - rejected by both mainstream and personal cultures
Regardless of which of these four types of acculturative stress occurs, a person can have
great difficulty adjusting to a new culture.
headaches
neck, shoulder and back pain
change in sleeping habits
change in eating habits
loss of interest in pleasurable activities
loss of sex drive
gastrointestinal problems (ie.,heartburn, gas, constipation, diarrhea,
ulcers)
heart problems
breathing problems (ie., exaggerate symptoms of asthma)
increase risk of illness (ie., germ magnet for colds and flus)
increased risk for accidents
inability to concentrate
memory difficulties
decrease effectiveness of other medical therapies (ie., for cancer)
This list represents a small sample of the possible influences of stress on a human being.
Each person will react to stressor in different ways.
Coping strategies
These four issues are important issues that are addressed differently
by various developmental theories. Each development theory
approaches these issues from a slightly different viewpoint. However,
these issues are not clear cut, nor are there definite answers to the
questions that the issues bring.
FIRST PERIOD OF DEVELOPMENT
Three stages of prenatal development
1. Zygote (Germinal)
• first two weeks after conception
• implantation of zygote (fertilized egg) on uterine wall
• doctors believe that 1/5 of all pregnancies are spontaneously aborted at this time
- an egg would be fertilized but would not attach to the uterine wall; instead the
zygote is discharged without the woman even knowing that she was pregnant
2. Embryo
• 3rd to 8th week after conception
• structures (nose, feet, fingers), organs (heart, lungs, kidneys), and systems
(reproductive, circulatory, digestive) begin to develop
• outside influences (teratogens) can harm embryo
A few examples of teratogens include:
Alcohol - infant can be born with fetal alcohol syndrome (enlarged
forehead, small physical stature, mental retardation)
3. Fetus
• 9th through 40th week after conception
• growth and refinement of structures and systems
• outside influences (teratogens) can still harm fetus
Full term birth is usually between 37 - 42 weeks gestation.
Hearing
Taste
• early months prefer sweet tastes, later in first year prefer salty tastes
Smell
• differentiates between smells, and like adults, prefer pleasant smells
Touch
• sensitive to pain - contrary to past beliefs, babies can intensely feel pain
during circumcisms, surgeries, heal lancings, etc.
Often you will find that the affective behavior of the infant will
determine the response by the parent and vice versa. For example, if
you have a parent who is stressed, always uptight, etc. as the main
caregiver, the baby is likely to be fussy, tense in posture and react in a
negative fashion.
Conversely, consider the colicky baby. This baby is always fussy with
little hope of calming the child when in this state. Parents might
respond to this fussiness by becoming tense, stressed, and at the end
of their ropes. Thus parent and child have a reciprocal relationship.
TEMPERAMENT
• Activity level
• Rhythmicity or regularity of biological processes
• Approach or withdrawal (how a person initially responds to a new stimulus, like
a new toy, food, or person)
• Adaptability
• Threshold of responsiveness (how much stimulation is needed to evoke a
response)
• Intensity of reaction (how energetically a person responds)
• Quality of mood (whether a person's behavior is predominantly pleasant, joyful,
or friendly; or unpleasant, unhappy, and unfriendly)
• Distractability - how easily an irrelevant stimulus can alter or interfere with a
person's behavior
• Attention span and persistence - how long a person pursues an activity and
continues in the face of obstacles.
THREE PATTERNS OF TEMPERAMENT. Almost 2/3rds of the children
studied fit into one of three categories:
Easy (40 percent of sample) - this baby is generally happy, rhythmic in
biological functioning, and accepting of new experiences;
Many children (35 %) of the NYLS did not fit neatly into any of the three
groups. A baby may have regular eating and sleeping habits, yet be
fearful of strangers. Some children may be easy on some days but not
others. A children may be slow-to-warm-up to new foods but adapt
very quickly to new babysitters. Not all children are going to fit neatly
into one of the three groups.
The goodness of fit between parent and child, the degree to which
parents feel comfortable with the child they have, is also important
because it affects parents' feelings toward their children. Thus
energetic, active parents may become impatient with a slow-moving,
not-a-care-in-the-world child, while more easy going parents might
welcome such a personality.
One of the most important things that a parent can do is accept the
child's temperament style and the behavior that coincides, instead of
trying to cast the child into a mold of the parent's design. Do not try to
make the child something that the child is not. Recognition of inborn
temperament style relieves parents of some heavy emotional baggage.
When parents understand that a child acts a certain way not of
willingness, laziness, or stupidity but because of inborn temperament,
they are less likely to feel guilty, anxious, or hostile, or to act rigid or
impatient. They can help the child use the temperament style as a
strength instead of a weakness.
ATTACHMENT
Goldberg reviewed the literature and found that the sensitive period
may not be so important. In one well controlled study in which mothers
and neonates were carefully observed for a nine-day period, the
advantages of early contact steadily declined over the nine days. By
the ninth day after birth, early contact mothers were no more
affectionate or responsive toward their infants than mothers who had
no skin-to-skin contact with their babies for several hours after birth.
The delayed mothers showed a significant increase in the
responsiveness over the nine day period suggesting that the
hours immediately after birth are not so critical.
Most adoptive parents are quite satisfied with and will develop close
emotional ties to the adopted children, even though they have rarely
had any contact with the child during the neonatal period. The
likelihood that a mother and her infant will become securely attached
is just as high with adoptive families as in non-adoptive families.
The research tells us that parents can become highly involved with
their infants during the first few hours if they are permitted to touch,
hold, cuddle, and play with their babies. As a result many parents have
altered their routine practices to encourage these practices. However,
it appears that this early contact is neither crucial nor
sufficient for the development of strong parent-to-infant or
infant-to-parent attachments. Stable attachments between infants
and caregivers are not formed in a matter of minutes, days, or hours;
they build rather slowly from social interactions that take place over
many weeks and months. There is no reason for parents who have not
had early skin-to-skin contact with their infant to assume that they will
have problems establishing a warm and loving relationship with the
child.
Cognitive development
PIAGETIAN THEORY
Piaget stressed that children are ACTIVE and CURIOUS explorers who
constantly encounter objects and ideas that aren't understood. These
imbalances between what is known and what is experienced
(information that is not understood) would prompt the child to make
mental adjustments that would enable the child to cope with puzzling
new experiences and thereby restore cognitive equilibrium.
He described the child as a constructivist: if children are to know
something, they must construct that knowledge themselves. The child
acts on novel objects and events and thereby gains some
understanding of their essential features. The child's constructive
reality will depend on the knowledge available to him at that time. The
more immature the child's cognitive system, the more limited his
interpretation of an environmental event.
Piaget believed that children learn to imitate during this stage. Infants
progressively learn to imitate simple behaviors (make faces) to
complex behaviors (picking up toys).
Research has shown that not all individuals make it to the formal
operations stage.
3-6 years INITIATIVE VS. GUILT Children in this stage are developing
cognitively and physically at an enormous rate. Parents who give their
children freedom in doing activities are allowing the children to develop
initiative. Parents who curtail this freedom are giving children a sense
of themselves as nuisances and inept intruders in an adult world.
Rather than actively and confidently shaping their own behaviors, such
children become passive recipients of whatever the environment
brings. Successful resolution of this crisis requires a balance: the child
must retain a sense of initiative and yet learn not to infringe on the
rights, privileges, or goals of others. Family is key social agent.
65 years to death EGO INTEGRITY VS. DESPAIR Older adults will look
back on life, viewing it as either a meaningful, productive, and happy
experience or a major disappointment full of unfulfilled promises and
unrealized goals. One will either achieve a sense of acceptance of
one's own life, allowing the acceptance of death, or else fall into
despair. One's life experiences will determine the outcome of this final
life crisis.
independence
Adulthood
Early
Middle
• productive in society
• possible mid-life crisis (rare occurrence; equally likely to be experienced
by men and women)
• children leaving home - most parents are not upset when the last child
leaves home, rather marital satisfaction is likely to increase
• menopause (ceasation of menstration)
• becoming grandparents
Late