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Stem Cell Therapy: A Possible Cure for Amyotrophic Lateral Sclerosis?

INTRODUCTION

Imagine yourself at the peak of adulthood, running, swimming, enjoying all aspects of life to the fullest, and being diagnosed with a fatal disease. Like a bird that soars the skies and gets shot down, that is the feeling that a person diagnosed with Amyotrophic Lateral Sclerosis must feel because to date, it is practically a death sentence. Amyotrophic Lateral Sclerosis (ALS) is a neurodegenerative disease that progressively affects motor neurons causing the loss of almost all voluntary movement. First described by Jean-Martin Charcot, ALS became known in the United States as Lou Gehrig’s disease in honor of the great baseball player who developed the disease in the 1930s. Two of my personal heroes, the Nobel Prize winning astrophysicist Stephen Hawking and guitar virtuoso Jason Becker, suffer from the disease and despite the nearly complete paralysis of their arms, legs and the muscles necessary for speech, there is no cognitive impairment, allowing them to still excel in their respective fields. Knowing these facts, it was inspirational for me to see these individuals persevere and triumph in the face of adversity and I started reading about ALS. Being a biotechnology student researching in a neuroscience laboratory, it is of interest to investigate the causes of neuronal disease and when I found out that ALS was incurable with no determined cause, I really reflected on the matter and saw the applications of biotechnology, cell culture and stem cell research in finding the causes and a cure. Novel stem cell therapies are currently being tested and developed for amyotrophic lateral sclerosis presenting a possible cure for this horrible disease and I wanted to find out if these treatments are in fact capable of curing ALS.

In this reading process, I learned that ALS is generally fatal within 1–5 years with a prevalence of 2–3 per 100,000 people. The causes of almost all occurrences of the disease remain unknown, where between 5–10% of cases the disease is inherited in a dominant manner and an astonishing 90–95% of instances, there is no apparent genetic linkage. Both forms show progressive muscle weakness, atrophy and spasticity, each of which reflects the degeneration and death of upper or lower motor neurons in the brain and spinal cord. Weakening of the respiratory muscles and diaphragm is generally the fatal occurrence. To date, several theories have been proposed where one or more of these mechanisms may interact and lead to motor neuron death. The mechanisms of neuronal death in ALS include defective glutamate metabolism, free radical injury, mitochondrial dysfunction, gene defects, apoptosis, autoimmune dysfunction, and viral infections. These proposed mechanisms have provided targets for drug treatments, but to date there is no effective treatment against ALS. Is stem cell treatment a good candidate for curing ALSThis is a question I wanted to answer and a more profound research allowed me to do this.

In this research I found out that stem cells are biological cells that are found in all multicellular organisms and have the ability to divide through mitosis and differentiate into diverse cell types. In humans, there are two types of stem cells: adult stem cells, found in various tissues, and embryonic stem cells, isolated from the inner cell mass of blastocysts. Also from the different classes in biotechnology I have taken, it was showed that stem cells can now be artificially grown and transformed into specialized cell types with characteristics consistent with cells of various tissues. In recent times, researchers have used various types of stem cells to develop an effective treatment against ALS including: autologous, allogeneic, adult, fetal, mesenchymal, umbilical cord blood, hematopoietic and amniotic. Autologous stem cells are found in most adult tissues, such as bone, skin and blood, and which are also present in placentas and umbilical cords. I think that the therapy using autologous stem cells is a good candidate because of the potential to differentiate into specialized cells and shows no risk of rejection by the patient. Letizia Mazzini and colleagues (2003) injected autologous bone marrow derived stem cells into the spinal cord of seven ALS patients and reported that the procedure had a reasonable margin of clinical safety. Also in 2008, John T. Dimos successfully generated induced pluripotent stem cells from an 82-year-old woman with familial ALS and differentiated them to motor neurons. Another type of cells used is allogeneic stem cells that are derived from a healthy donor and transplanted into the patient. In contrast to using autologous cells, using these donated cells show a risk of rejection and in my opinion, is a liability treating ALS patients. Another type currently tested for ALS is mesenchymal stem cells. These are of particular interest because they have the capacity to differentiate into a variety of tissues, including fat, cartilage, bone, tendon, ligaments, muscle, skin and nerve cells. One advent of these stem cells is that they can be obtained and propagated in culture for long periods of time without losing their capabilities to self-renew and differentiate. This is another example of a type of stem cell that can be used in ALS patients without the risk of rejection. Cheng Zhang and colleges (2009) successfully made multiple transplantations of human marrow stem cells through the central nervous system improving motor performance and prolonging the life of superoxide dismutase (SOD1) transgenic mice. SOD1 is a gene that encodes for the enzyme superoxide dismutase involved in the protection of cells against free radical injury. Also Albert Clement and colleagues (2003) showed that in SOD1G93A chimeric mice, motorneuron degeneration requires damage from mutant SOD1 acting in non-neuronal cells. Wild-type nonneuronal cells could delay degeneration and extend survival of mutant-expressing motorneurons. Hematopoietic stem cells are adult cells obtained from a patient’s own blood, are frequently used to treat life threatening and are now being clinically tested for treatment of ALS. These are cells that can be isolated from the blood or bone marrow and differentiated into a variety of specialized cells. This procedure also yields greater numbers and better quality cells for transplantation. More recent research by Dr. Hector R. Martinez (2009), where he transplanted autologous CD133+ stem cells into the frontal motor cortex in ALS patients, clearly revealed the capability for therapy. This is one of the most promising because it was demonstrated that is a safe and well-tolerated procedure. Embryonic stem cells are totipotent cells capable of differentiating into any type of cells, including motor neurons, one target for curing ALS. These cells are obtained from embryos that are 4 to 5 days old. Thanks to the versatility of these cells for regenerating or repairing diseased or injured tissue in human beings they hold great promises. The downside of this is that these cells must be guided into becoming the needed cell type because if there is a dormant cancer tumor somewhere in the body, an embryonic stem cell is just as likely to energize that cancer if it is not properly guided through the differentiation process. An alternative I found for this is using amniotic fluid. The use of this fluid produces multi-potent stem cells that are extremely active and not tumorigenic. Research at this time is in the earliest of stages and is not considered a replacement for human embryonic stem cell research, but I think it holds great promises because they can differentiate and not produce cancer.

The other aspect of the treatment process with stem cells for amyotrophic lateral sclerosis is the transplantation. For ALS patients, the objective is to replace and repair damaged and deceased neurons in the brain and spinal cord. These are painful and dangerous surgical procedures that require careful scrutiny because of the fragility of ALS patients. Because of respiration difficulties, heavy sedation could prove fatal and this is a challenge for health professionals because minimally invasive clinical and surgical procedures need to be used for the safety of the patient. Adult and fetal stem cells have been transplanted into the brain in clinical trials of ALS and other conditions for some time now. Surprisingly, this type of brain surgery can be performed with a minimum use of sedation. Current clinical trials utilize peripheral blood-derived hematopoietic stem cells and incorporate minimally invasive brain surgery in the attempt to repair or replace damaged neurons to manage the symptoms of ALS, with impressive results to date. A problem with brain transplantations is the obstacle of the blood brain barrier (BBB). The BBB protects the brain from invasion and delivering cells to the brain is a challenge, but research with a mouse model for ALS done by Zhang (2009) demonstrated how this obstacle can be bypassed. Another method is to transplant cells derived from the spinal cords of human fetuses into the lumbar part of the spinal cord of ALS patients. This is a risky procedure because ALS patients are extremely fragile and to me is not as safe as transplantation to the brain. The problem is that to reach the lower motor neurons one has to transplant as close as possible to the spinal area. Other methods involve intravenous and intramuscular stem cell injections appear promising only when used in conjunction with other forms of delivery, but in my opinion, brain and spinal cord injection of stem cells are the best way to deliver treatment and with the invention of new medical instruments, the room for complications diminishes.

All the scientific data points to stem cells as capable of slowing the progression of amyotrophic lateral sclerosis, but none have proven it can cure it. The biochemical evidence to date clearly indicates that the process of motor neuron degeneration in ALS is complex and not clearly elucidated. Genetic understanding of familial ALS is relatively well advanced, but less so in sporadic disease. The advent of technology and the falling costs of genotyping will enable researchers to reveal the genetic roots of ALS. Given the fact that 90 % of ALS cases are sporadic, much work is needed to find the missing link between familial and sporadic ALS. The use of mice models for ALS is extremely important in finding therapies because it mimics the disease and provides a template for human therapy. As showed by Ripps (1995), a mouse model for ALS was produced and proved that the gene characteristics of the disease are present. Mice models are great for testing, but the problem is that to prove stem cells are effective on humans with ALS one has to test it on actual patients. Currently the Food and Drug Administration (FDA) approved tests with stem cells on humans with ALS, but they are in the early stages of trials with no definitive results. Also the retrieval and use of human embryonic stem cells has been under the radar of ethical groups for years. Their argument stands on the fact that to obtain the cells one has to kill a living undeveloped human being. This raises ethical problems and government approval can be tedious because of the public pressure involving this matter. Stem cell research is an emerging field with lots of applications and the pursuit of novel therapeutic methods on diseases like ALS is just becoming apparent. I think that stem cell therapy could hold the key in curing ALS, but more extensive research is necessary. With my experience in neuroprotection and biotechnology, I hope in the future to contribute in the search for a cure for ALS not for personal gain, but for all those people in the world living with this condition who never gave up hope.

References

Amyotrophic lateral sclerosis and other motor neuron diseases. (2010, August). Retrieved from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001708/.

Clement, A.M. (2003). Wild-type nonneuronal cells extend survival of SOD1 mutant motor neurons in ALS mice. Science, 302, 113-117. Retrieved from http://www.sciencemag.org/content /302/5642/113.full.pdf

Dimos, J.T. (2008). Induced pluripotent stem cells generated from patients with ALS can be differentiated into motor neurons. Science, 321, 1218-1221. Retrieved from Error! Hyperlink reference not valid.

Martinez, H.R., Gonzalez, M.T., Moreno, J.E., Caro, E., Gutierrez, E., & Segura, J.J. (2009). Stem-cell transplantation into the frontal motor cortex in amyotrophic lateral sclerosis patients. Cytotherapy, 11(1), 26-34. doi: 10.1080/14653240802644651

Mazzini, L., Fagioli, F., Boccaletti, R., Mareschi, K., Oliveri, G., Oliveri, C., … Madon, E. (2003). Stem cell therapy in amyotrophic lateral sclerosis: a methodological approach in humans. Amyotrophic Lateral Sclerosis & Other Motor Neuron Disorders, 4(3), 158-162. doi: 10.1080 /14660820310014653

Ripps, M.E. (1995). Transgenic mice expressing an altered murine superoxide dismutase gene provide an animal model of amyotrophic lateral sclerosis. Genetics, 92, 689-693. Retrieved from Error! Hyperlink reference not valid.

Zhang, C., Zhou, C., Teng, J., Zhau, R., & Song, Y. (2009). Multiple administrations of human marrowstromal cells through cerebrospinal fluid prolong survival in a transgenic mouse model of amyotrophic lateral sclerosis. Cytotherapy, 11(3), 299-306. doi: 10.1080/14653240902806986

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Psychological Interventions for children and adolescents who have experienced war-related trauma: An argument for Narrative Exposure Therapy

Abstract
Introduction

Children and adolescents who have experienced severe losses and multiple traumatic events over long periods of time, as a result of war and organised violence, may experience many mental health difficulties, including post-traumatic stress disorder (PTSD), depression and anxiety. Increasingly clinicians are being asked to provide interventions for young refugees; however, evidence-based guidance remains scarce.Narrative Exposure Therapy is a short-term therapy which has been adapted for children and adolescents who have PTSD symptoms as a result of these traumatic experiences. This review investigates the impact of war-related trauma amongst children and adolescents and the current available literature on psychological interventions for this group. Emerging evidence suggests that Narrative Exposure Therapy is an effective treatment for children and adolescents who have been traumatized by conflict, even in settings that remain unstable and volatile.

Key Words: Refugee, children, adolescents, treatment, psychological interventions, post-traumatic-stress disorder, trauma, war.

Psychological Interventions for children and adolescents who have experienced war-related trauma: An argument for Narrative Exposure Therapy

Civilian populations have been increasingly targeted in recent wars, with victims comprising of an increasing number of children and adolescents whose lives have been disrupted by organised violence (United Nations High Commissioner for Refugees [UNHCR], 2004). United Nations Children’s Fund (UNICEF) has estimated that 80% of the victims in modern wars are women and children.According to UNICEF (1995), during the prior decade, over 300,000 children had been forcibly recruited to serve as soldiers, more than 2 million children were killed in war activities; 4-6 million were injured or left with a physical disability, more than 1 million were orphaned, and 12 million were left homeless. Supporting this assertion, The World Bank reports that the mortality rate of children under the age of five years has increased by 11% as a consequence of war (Collier et al. 2003).

In response to violence, many people are forced to flee their countries in search of safety. UNHCR (2009) recently stated that some 43.3 million people worldwide were forcibly displaced due to conflict and persecution, the highest number since the mid-1990s. UNHCR (2009) also reports that 43% of its population of concern are children under the age of 18. According to government statistics, an estimated 103,080 individuals applied for asylum in the United Kingdom in 2002. Of these applicants 6200 were unaccompanied children, aged 17 and under (UNHCR, 2004). Figures such as these demonstrate that there are a considerable number of young refugees living in the UK.

Children and adolescents are directly affected by violence aimed at them and their families. They are also indirectly affected by the distress caused to their families and they may be internally displaced or find themselves crossing borders as asylum seekers. Their experiences during and immediately after war means they are unlikely to develop in a safe, secure, and predictable environment, putting their mental health put at risk. It remains a challenge to develop appropriate guidelines and interventions for the treatment of traumatic stress in child survivors of organized violence and war.

This novel review is intended to be of benefit to clinicians and researchers working with children and adolescents who have experienced war-related trauma as it will summarise and critique the current state of the evidence base for interventions and suggest directions for future research.

Traumatic Experiences and Child Mental Health

Recent investigations from various war zones all over the world confirm that many survivors of organized violence and war develop long-term physical and emotional problems (Neuner at al., 2006; Schaal & Elbert, 2006). Trauma-related mental health difficulties are conceptualized as posttraumatic stress disorder (PTSD).PTSD is characterised by exposure to an extremely stressful or catastrophic event or situation followed by three core symptoms. The first of these symptoms is the re-experiencing of intrusive vivid memories of the trauma, e.g., through images or dreams of the event or re-enactment of the traumatic events through play in young children. However, these images and sensations are typically incomplete and disjointed. The reliving of these memories is reflected in a distortion in the sense of time such that the traumatic events seem to be happening in the present rather than belonging to the past (Brewin & Holmes, 2003). Secondly, the persistent avoidance of stimuli associated with the trauma with numbing of general responsiveness, derealisation and depersonalisation. The final symptom is hyper-arousal with increased vigilance and disturbed sleep (World Health Organisation, 1992). The requirements of DSM IV criteria for the diagnosis of PTSD in children are that children must exhibit at least one re-experiencing symptom, three avoidance or numbing symptoms and two increased arousal symptoms (American Psychiatric Association, 1994). From the age of 8–10 years, following traumatic events, children display reactions closely similar to those observed in adults. Below 8 years of age, and in particular below the age of 5 years, there is less agreement as to the range and severity of the reactions. Scheeringa et al., (1995) have suggested an alternative set of criteria for the diagnosis of PTSD in children, which places more emphasis on regressive behaviours and new fears, but these have yet to be fully validated.

Substantial evidence supports the cross-cultural validity of PTSD with post traumatic symptoms having been found following exposure to war and organised violence in children and adolescents from many different parts of the world, including Rwanda (Neugebauer et al., 2009), Somalia (Onyut et al., 2005), Sri Lanka (Catani et al., 2008) and Bosnia (Papageorgiou et al., 2000). The nature of trauma seems to be an important factor in the emergence of PTSD. As in adult literature, human made intentional abuse seems to be more traumatic for children and adolescents than natural disasters. Between 17 – 25% of children exposed to severe trauma, such as natural disasters, suffer from PTSD, whereas among victims of interpersonal trauma such as sexual abuse the rate is considerably higher, ranging from 40 to 58% (Punamaki, 2008). In parts of the world where war and organized violence exist such as Palestine, the PTSD prevalence has been documented to be 20–25% among children (Thabet et al., 2002).

The type of traumatic exposure also seems to be important. Personal exposure to severe violence and losses, such as the murder of a family member or witnessing someone being injured or tortured can result in prevalence as high as 69% (Elbedour et al., 2007). Research has revealed levels of PTSD of 75% among African children in Sudan (Morgos et al., 2008) and Rwandan orphans (Schaal & Elbert, 2006). There is also a high prevalence rate of PTSD in young refugees who have recently arrived in resettlement countries (Lustig et al., 2004). According to Hodes (2000), an estimated 40% of young refugees in Britain may have psychiatric disorders, including PTSD, depression and anxiety. It is therefore, a reality that significantly increased demands may be made of the NHS, both in primary and secondary child and adolescent mental health services following traumatic events.

The consequences of exposure to military violence are highly devastating and affect all levels of society from individuals, to families, school and communities. In a study of Palestinian children and adolescents living in the Gaza Strip, it was found that, approximately one-half (48.5%) of the participants reported the death of a family member, 15.7% had witnessed the demolition of homes and 7.91% the injury of a friend. Approximately one-third (34.1%) of participants indicated that the painful event cited had directly involved them (Elbedour et al., 2007). The disappearance of a family member also seems to be a risk factor. Researchers have found that individuals experience a high level of distress due to the uncertainty regarding death and the subsequent inability to grieve fully (Quirk & Casco, 1994). Concerning the individual themselves, pre-existing individual vulnerability, such as conduct problems or chronic physical illness, places refugee children at greater risk of developing mental health difficulties, whilst having the ability to respond to new situations and positive self-esteem seems to be a protective factor (Almqvist & Broberg, 1999).

In addition, excessive fears and internalizing and externalizing symptoms are common consequences of traumatic events (Yule, 2000). Among Middle Eastern refugee children and adolescents anxiety manifested itself most frequently by increasingly dependent behaviour, e.g. clinging to the parents and expressing fear of being left alone and fear of sleeping in darkness (Montgomery & Foldspang, 2005). Sleep disturbances were also prevalent in a third of these children. A high co-morbidity between PTSD and depressive symptoms has been found among children exposed to military violence and war trauma (Elbedour et al., 2007). A survey by Schaal and Elbert (2006) in children orphaned by the Rwandan genocide showed that, a decade later, almost half of the examined orphans suffered from chronic PTSD and co-morbid depression. Some research is available on war and military violence increasing children’s aggressive behaviour. A follow-up study among Bosnian children showed that war trauma in preschool age predicted aggression in adolescents, due to difficulties in emotional regulation and impulse control (Kerestes, 2006). A study among Israeli children who had witnessed a terrorist attack showed an increased level of aggressive behaviour (Greenbaum, 2005). There is also some evidence to suggest that adolescent refugees may be at increased risk of psychosis (Tolmac & Hodes, 2004).

If effective therapy is not received, the long-term effects of life-threatening, traumatic events in childhood can be devastating. These studies suggest that many children and adolescents, who have been traumatised by war, continue to suffer from distressing symptoms long after the trauma is over.

Traumatic Experiences and Cognitive, Emotional and Social Development

Traumatic events have been found to have particularly negative impacts on cognitive, emotional and social development, which place traumatized children at increased risk for subsequent psychopathology (Maughan & Cicchetti, 2002).

Researchers have found that it is impaired problem-solving skills and the biased and narrowed memory and attention processes that are the central issues in the negative consequences of trauma (Feeny et al., 2004). Trauma has been found to have a negative impact on verbal functioning and prefrontal executive skills in adults (Dickie et al., 2008). In support of this, research has determined that adolescents with PTSD had significantly lower scores on discrete measures of verbal intelligence in comparison to non-traumatized controls (Saigh et al., 2006). Punamaki et al., (2007) found that among Palestinian children, exposure to severe losses and home destruction was associated with impaired cognitive capacity for attention and concentration which also predicted increased PTSD and depression in adolescence.There is some research to suggest that when PTSD accompanies trauma, brain structures essential to long-term memory formation (e.g., the hippocampus) have been altered (Bremner et al., 2003) and that memory performance is poor in general even on measures of everyday memory (Moradi et al., 1999). Children who have been maltreated in Western countries have been found to show biased and poor recollection, especially of narrative episodes (Howe et al., 2004). The cognitive functions that trauma seems to impair are those that have been found be particularly important in protecting children’s mental health. It is the verbal, narrative and episodic memory which are important in successfully integrating traumatic experiences.

The family frequently acts as a safeguard against post-traumatic stress.Unfortunately, poor parental mental health is associated with psychological distress in war traumatised and refugee children (Qouta, Punamaki, & Sarraj, 2005). Maternal mental distress in particular, is a significant mediator of their children’s mental health in times of conflict (Smith, Perrin, Yule, & Rabe-Hesketh, 2001). Supportive parenting styles were also found to predict low levels of emotional distress and PTSD symptoms among children despite war related trauma (Thabet et al., 2008). Exposure to war trauma has been found to negatively affect family functioning. Research has suggested conflicting and withdrawn relationships in traumatized veteran families due to overburdening and inability of the members to share their experiences (Orcutt et al., 2003). In Palestinian families exposed to war trauma, children experienced their parents as controlling and rejecting (Punamaki et al., 2006).

Social support is an important protective factor against the development of PTSD following a traumatic event (Brewin, Andrews, & Valentine, 2000). However, research has suggested that refugee children had less social support from friends than non-refugee children (Howard & Hodes, 2000). War trauma also has a detrimental effect on peer relationships. Paardekooper et al., (1999) demonstrated that Sudanese children who had been exposed to civil war were less satisfied with their peers than children had not experienced such trauma.

Theories of PTSD and its application across cultures

The official recognition of posttraumatic stress disorder (PTSD) in the DSM-III (American Psychiatric Association [APA], 1980) has prompted what is now a very considerable body of research into the psychology, biology, epidemiology, and treatment of the condition. In a review by Brewin & Holmes (2003) three main theories of PTSD were identified as having the most explanatory power for the current empirical findings and observed clinical symptoms in patients. These are emotional processing theory (Foa & Rathbaum, 1998), dual representation theory (Brewin, Dalgleish, & Joseph, 1996) and Ehlers and Clark’s cognitive model (Ehlers, Clark, Hackmann, McManus, & Fennell, 2005). There are several similarities between the models which all stress the importance of maladaptive processing of traumatic events. They also explain how a fragmented autobiographical memory, lacking in contextual information, results in a skewed sense of current threat, as the traumatic event is indistinguishable from the present context. However, whilst these models account for PTSD resulting from single event trauma, the relevance for complex PTSD that can follow multiple stresses over prolonged periods of time is less clear (Green et al., 2000). Children and adolescents who have fled from war regions often report a number of extremely stressful experiences such as physical and psychological torture, shelling, sexual violence, and other atrocities. Some authors have questioned whether contemporary notions of trauma, and especially a focus on the category of PTSD, are adequate in assessing the effects of such experiences (Silove, 1996, 1999). The category of PTSD may not fully capture the complex nature of the psychological responses that arise out of such human rights violations (Silove, 1996).

It has also been argued that PTSD itself is an unhelpful diagnosis which may not be culturally relevant to those who have experienced trauma associated with war and organised violence (Summerfield, 2001). It has been suggested that it is not ethical to apply western, biomedical classification to different cultures because it results in normal responses to abnormal situations being interpreted as abnormal states (Summerfield, 2000). The use of psychiatric diagnoses has been criticised as an inappropriate form of labelling that doesn’t consider the huge range of losses that have been suffered (Summerfield, 2001). Many children and adolescents who are affected by war are unable to safely escape their countries, instead moving to nearby regions that are often equally affected by military violence. In addition, many of these children are also living in poverty and suffering from malnourishment. These living conditions question the applicability of psychotherapeutic treatment approaches that have been developed for western PTSD populations. Maslow’s hierarchy of needs (Maslow, 1943), for instance, claims that treatment for psychological problems can’t be addressed as long as the basic needs of nutrition and safety remain unmet. It is also unclear how many refugees suffering from PTSD actually seek and accept aid.

However, the core PTSD symptom clusters have been found repeatedly in children and adolescents, across cultures, and following a wide variety of traumatic events (Barrett & Ollendick, 2004). It is a certainty that children and adolescents who have witnessed military violence will experience emotional reactions, as would anyone in such a situation. Therefore, one of the benefits of the conceptualisation of psychological models of PTSD has been the development of successful psychological treatments.

Psychological Interventions for Children and Adolescents Traumatised by War

Policy and Research Recommendations

When the diagnosis of PTSD was first formulated (APA, 1980) it was initially believed that it would not be relevant to children and adolescents. However, it is now accepted that children and adolescents can develop PTSD following traumatic events (National Institute for Clinical Excellence, 2005). A phased model of intervention has been described by Herman (1997) and this is supported by the NICE guidelines (2005) as an appropriate way of working with traumatised individuals who are still living in situations of threat. It consists of three phases; establishing safety and trust, followed by trauma-focused therapy and finally reintegration and rehabilitation. This approach is suggested to be of particular benefit when working with asylum seekers because emotional states are so greatly influenced by asylum status. However, as there is a lack of trial evidence to support this model, it reflects a purely pragmatic approach.

The NICE guidelines (2005) state that conclusions about the effectiveness of psychological interventions for children and adolescents with PTSD are drawn from other areas, principally work on PTSD with sexually abused children and psychological interventions for adults. They suggest that considerable caution is required in drawing conclusions, particularly when drawing on results from research done with adults. However, even with the limited psychological trials available, NICE recommend that ‘trauma-focused cognitive behavioural therapy (TFCBT) should be offered to children with severe post-traumatic symptoms or with severe PTSD in the first month after the traumatic event’ (NICE, 2005, p. 123). The NICE guidelines report that no other psychological intervention has yet established a comparable evidence base to TFCBT, but other interventions such as Eye Movement Desensitisation and Reprocessing (EMDR) show promise.

Interventions for adults with PTSD are well studied in victims of traumatic events who live in Western societies. A large number of studies have shown that cognitive behavioural therapy (CBT) is effective in treating PTSD with those who experienced sexual assault (Foa et al., 1999) as well as those recovering from physical assault or accidents (Tarrier et al., 1999). Trauma-focused psychological interventions are generally effective for the treatment of PTSD in adults but only a limited evidence base exists for children and young people (Cohen et al., 2000). In addition, much of the evidence is drawn from work with children who have developed PTSD as a result of childhood sexual abuse (Ramchandani & Jones, 2003) and therefore the evidence base for interventions for PTSD arising from other traumas is weaker. The knowledge about the treatment of PTSD in populations of civilians who have been affected by war is even more limited. The NICE guidelines refer to the very little clinical research has been conducted on how to adequately support and treat these groups. The high number of survivors of military violence previously reported supports the notion that psychosocial services in refugee camps need guidelines on how to assist traumatised individuals in war-affected societies. There are also many problems with generalising the results of randomised control trials of psychological treatments for PTSD. One of the main difficulties is that not all PTSD sufferers are able to attend treatment in the usual clinical settings. The NICE guidelines (2005) do make reference to treatment innovations that may help deliver effective interventions to PTSD sufferers in remote locations. Narrative Exposure Therapy (NET) is highlighted and described as ‘encouraging’ (NICE ,2005, p. 62). Support for NET includes studies in traumatised communities affected by disaster (Basoglu et al., 2003, 2005) and studies in non-Western societies (Neuner et al., 2004).

Research assessing the efficacy of psychotherapy treatment for children and adolescents diagnosed with PTSD is generally underrepresented in the empirical literature. Since the inclusion of PTSD in the DSM-III, the majority of Randomised Control Trials (RCT’s) treating children with PTSD have focused on the use of variations of cognitive behavioural therapy including TFCBT. In 2007 an expert panel presented written evidence to the House of Commons relating to the general problems in implementing NICE guidelines in mental health (Barkham, 2007). NICE guidelines classify RCT evidence as the highest level of evidence (termed grade A), and the structured nature of a CBT approach ‘fits’ with an RCT design, however, there are other effective psychological therapies which are being overlooked because they do not have RCT evidence to support them. This issue relates to the lack of funding for other psychological therapies which does not necessarily equate to a lack of effectiveness, and as government initiatives increasingly rely on treatments tested only by RCTs, patient choice becomes restricted. NICE admits that the provision of psychological services for suffers of PTSD varies hugely across the UK and that some people may have to go through many steps before they can obtain referral to a treatment service, as well possibly facing unreasonably long delays (NICE, 2007). The guidelines emphasize a need for the NHS to develop a pathway of care that offers prompt, evidence-based services in local communities, supported by specialist services for individuals with more complex problems.

Research Evaluating Psychological Interventions

This review will now turn to a discussion of research studies that have attempted to evaluate interventions for children and adolescents who have experienced war-related trauma. A search of the literature was conducted; the search terms ‘PTSD’ and ‘war-trauma’ were used with ‘children’, ‘adolescents’ and ‘psychological interventions’. This review does not have the scope to systematically review the research studies evaluating the range of interventions that can be used with children and adolescents experiencing PTSD symptoms. The following section will therefore focus primarily on interventions that have been carried out with children and adolescents who have experienced war-related trauma. However, as mentioned previously, RCT evidence in the area of war trauma and refugees remains scarce. It has been suggested that the lack of research studies in this area is because this population are more difficult to treat (Bisson et al. 2007), possibly because of the severe and often multiple traumatic incidents occurring in war contexts (Silove, 1999).

Cognitive behavioural interventions are the most studied for treating PTSD in children and among the trauma therapies (Saxe, MacDonald & Ellis, 2007). CBT interventions for PTSD are based on learning and information-processing theories (Smith, Perrin, & Yule, 1999). According to learning theory, the traumatic event becomes an unconditioned stimulus which is triggered by non-traumatic stimuli (reminders), resulting in intense feelings or reactions such as fear, panic, dread and helplessness. Information-processing theory proposes that cognitions influence behaviour and so changing cognitions can also lead to subsequent changes in behaviour and affect. Cognitive behavioural interventions with children generally draw on both of these theories by relying on the use of behavioural techniques, as well as considering the cognitive interpretations and attributions about events made by children. Most CBT protocols include a variety of specific components. These range from psycho-education work, problem-solving strategies and skills teaching to behaviourally based exposure methods (creating a new narrative of the traumatic event) or cognitive techniques aimed at modifying distorted cognitions. Foa, Keane, and Friedman (2000) reviewed eight different CBT interventions for PTSD in young people with the aim of discovering with element was the most effective. These interventions included: exposure therapy, systematic desensitization, stress inoculation training, cognitive processing therapy, cognitive therapy, assertiveness training, biofeedback and relaxation training, and combination approaches. They reported that for cognitive therapy there was ‘initial evidence’, whereas for exposure ‘no other treatment component has such strong evidence for its efficacy’ (Foa, Keane, & Friedman, 2000, p.52). Other researchers have also suggested that ‘some form of exposure to trauma-related stimuli’ is required to bring about ‘effective emotional processing of the event’ (Barrett & Ollendick, 2004, p. 228).

The Ehlers and Clark (2000) cognitive model of PTSD has been successfully used with refugee children and this is described in two case vignettes (Vickers, 2005).This model differs from previous ‘conditioning’ models of PTSD in that it has cognitions and the personal meaning of events at its core. Graded exposure to aspects of the trauma and triggers of unwanted re-experiencing of the event are conducted alongside cognitive techniques that promote the search for a new meaning. It provides a clear framework for changing the dysfunctional beliefs the sufferer holds about the meaning of the trauma for them. This model has been described as s a useful way to explain the symptoms of PTSD in young people who are also refugees (Vickers, 2005). However, one of the young people in this case study dropped out of treatment before the course had finished and the author agrees with Yule (2004), who argued that, although CBT has an important place in helping young refugees, attention also needs to be given to other social and psychosocial interventions as well.

A controlled study (n = 26) evaluated the effectiveness of a school-based group intervention for children who had experienced war-related trauma (Ehntholt, Smith, & Yule, 2005). The treatment group (n = 15) received six sessions of group CBT, while the control group (n = 11) were placed on a waiting list. Children in the CBT group showed a statistically significant decrease in PTSD symptoms, whereas the children on the waiting list did not show any improvement over the same period. Based on a manual (Smith et al., 2000), this school based intervention focused on psycho-education, normalising reactions to trauma and developing coping strategies. Within the sessions children also engaged in trauma-focused exposure therapy using dual attention techniques. However, follow-up data, which were only available for eight of the children, suggest the improvements in the CBT group were not maintained at two-month follow-up. It is possible that the six session treatment is too brief when delivered in a group format. The researchers also highlight the difficulty of implementing exposure in a group session and suggest that graded exposure programmes could have been encouraged for children who had more idiosyncratic forms of avoidance (Ehntholt, Smith, & Yule, 2005).

Eye Movement Desensitization and Reprocessing (EMDR) is a fairly recently discovered treatment that uses bilateral stimulation when processing traumatic memories in individuals with PTSD (Shapiro, 1995). It was initially used for treating adults with PTSD, however over recent years an adapted protocol with age appropriate modifications has been suggested for use with children (e.g., Alder-Tapia & Settle, 2008). There is no well established theory that explains the way EMDR works. However, according to Shapiro (2007), who founded the method, EMDR is guided by the adaptive information processing model. When a traumatic or distressing experience occurs, it may overwhelm usual ways of coping and the memory of the event is inadequately processed with the memory subsequently being stored in an isolated memory network. This theory suggests EMDR works directly with memory networks and enhances information processing by forging associations between the distressing memory and more adaptive information contained in other memory networks. It is thought that the distressing memory is transformed when new connections are made with more positive and realistic information resulting in a neutralization of the traumatic memories. Once neutralized, the traumatic memory becomes available to the normal information processing in the brain leading to the normal healing process and a decrease in the post-traumatic stress symptoms (Shapiro, 2007). Exposure to the memories of the traumatic event is a central feature of both EMDR and TFCBT, and it has been suggested that the therapies that did not focus on the trauma itself but instead focused on past or present problems were not as effective in reducing PTSD (Rodenburg et al., 2009). Although the eye movements are integral to the basic procedure (Shapiro, 1995), some researchers have argued that they are not necessary and that EMDR is best understood as an exposure technique (Davidson & Parker, 2001).

To date there has been only one study conducted using EMDR with children and adolescents who have experienced trauma in the context of war and organised violence. A case study series (n = 13) reports significant improvements in both PTSD and depression symptoms following the use of EMDR in a psychodynamic context (Oras, Cancela de Ezpeleta, & Ahmad, 2004). However, due to the small sample size, lack of a control group and the mixture of psychotherapeutic methods with EMDR, these findings should be interpreted with caution.

A further therapy, testimony psychotherapy was developed specifically for adults who have suffered multiple traumas over a prolonged period of time. Testimonial psychotherapy is distinguished from other approaches, by its basis in the social and political aspects of trauma. Testimonials involve the retelling of an individuals account to a therapist who documents the narrative, and, through a joint process of reviewing it, a written document is produced which may be used for documentary or political purposes. The testimonial process also allows the victim to gain some distance from the event, and to focus on different aspects of the story, such as the individual’s personal resources that led to survival (Lustig, Weine, Saxe & Beardslee, 2004).

The written testimonial serves a particularly important function with refugees from countries where psychotherapy may be uncommon or even stigmatizing (Lustig, Weine, Saxe, & Beardslee, 2004). The written document alters the focus of the therapy to political, not clinical and is therefore more culturally acceptable. Testimonial psychotherapy is likely most suitable within cultures that acknowledge the oral tradition of storytelling, and a belief in the possibility of changing the future, whereas cultures that believe one’s fate is predetermined would be much less likely to embrace testimonials (Weine, Kulenovic, Pavkovic, & Gibbons, 1998). Testimonial psychotherapy has been found to be effective in a case series study with adult Bosnian refugees (n = 20), who all showed improvement in depressive symptoms and PTSD symptoms at post-treatment, as well as at two and six month follow-up (Weine, Kulenovic, Pavkovic, & Gibbons, 1998). However, results of this study should be interpreted cautiously, because there was no control group, and PTSD symptoms among refugees can improve over time without treatment. Testimonial psychotherapy has also been described as being effective in three case studies of Sudanese refuges (Lustig, Weine, Saxe & Beardslee, 2004). However, it is impossible to determine the efficacy of testimonial psychotherapy in this study as they did not assess the individuals for symptoms of PTSD before and after giving testimony. Also, the success of testimonial psychotherapy relies heavily upon the cultural acceptability of sharing personal stories, which cannot be universally presumed (Lee, 1988).

Narrative Exposure Therapy as a new model for treating PTSD

Theoretical background

Narrative Exposure Therapy (NET) is a new approach that has been devised specifically for the victims of military violence, incorporating elements of testimonial psychotherapy with cognitive behavioural techniques and theory (Schauer, Neuner, & Elbert, 2005). It was developed as a short-term treatment, originally devised to be used in refugee camps in emergency settings; it has now been trialled with asylum seekers and refugees in western countries (Ruf et al., 2010). NET is based on the assumptions of cognitive behavioural exposure therapy but using an adapted narrative approach to exposure. It relies on principles of habituation of fear networks and how they can be activated in the brain (Foa & Rathbaum, 1998). It also draws on the theoretical understanding of both autobiographical memory (Conway, 2001) and the framework it provides in understanding intrusive symptoms (Ehlers & Clark, 2000).

In the development of NET, a distinction was made between declarative and non-declarative memory. These memory systems differ in the retrieval of information: declarative memory is retrieved deliberately and accessed verbally, whereas non-declarative memory is activated automatically by environmental cues (Squire, 1994).

The declarative part of episodic memory has been termed “autobiographical memory” (Conway & Pleydell-Pearce, 2000) and is the primary base for the narration of events, as well as being the main resource for the retrieval of information about one’s life. To allow rapid access of information, autobiographical memory is stored at different levels of organization. At the top of the organization is information relating to ‘lifetime periods’ that have identifiable beginnings and endings (Neuner & Catini, et al., 2008), such as where a person lived or their occupation over a certain period. The next level is the memory for general events, which can be divided into repeated events (e.g. the journey into work) and specific events (e.g. the first day at a new job).

The non-declarative part of episodic memory contains sensory information, as well as cognitive and emotional perceptions (Brewin et al., 1996). The retrieval of sensory information is fundamentally different from the retrieval of autobiographic information. The contextual facts stored in auto biographic memory are retrieved as verbally accessible knowledge, whereas, the retrieval of sensory information is perceived as an experience of the information itself. For traumatic events, sensory perceptual representations are known as ‘fear networks’ (Lang, 1993). The associations between items within these fear networks are extremely strong, so that when an individual later comes across one external or internal stimulus within the fear network, it results in activation of the entire network. Flashbacks in PTSD are thought to occur when the whole fear network is activated (Neuner & Catini, et al., 2008). The fear network can be activated easily, because many environmental cues resemble the items in the fear structure. This activation is experienced as an intrusive sensory, emotional and physiological re-experiencing of the traumatic event, which is the primary symptom in PTSD. As a result, the traumatized individual learns to prevent the activation of the fear structure by avoiding cues that remind them of the trauma. This avoidance includes both internal and external cues and eventually the individual acquires a pattern of avoidance behaviour. In addition, the lack of contextual information means that the person maintains a sense of current threat when the memory is activated (Neuner, Catani, et al., 2008) and the autobiographical memory is disrupted. This disruption in autobiographical memory means that the individual is unlikely to be able to provide a consistent chronological account of events, which explains how repeated or multiple events are more likely to result in severe psychological disturbance. As fear networks increase and become more readily activated through repeated experiences, intrusive memories are accompanied by the sensation of current and continued threat, even thought the event might have happened years ago (Elbert et al., 2006).

Several studies have shown that traumatic memory differs significantly from everyday memory (Brewin, 2007). The content of traumatic memory is dominated by sensory elements and is highly distressing and repetitive, as well as narrations being more fragmented (Harvey & Bryant, 1999). Furthermore, it has been shown that disorganization of the narration and a dominance of sensory elements in the trauma memory immediately after the event predicts the development of chronic PTSD (Jones et al., 2007).

In NET the traumatic events are worked through with the client in sequential order to integrate thoughts, feelings and body reactions associated with the traumatic events within the autobiographic memory (Schauer et al., 2005). The individual learns that the fear triggered by thoughts about the past events can be overcome by talking in detail about what has happened, hence, in stopping to avoid thoughts about the trauma. In NET the life history of the client with all trauma events is written up in the narration and at the end of therapy handed over to the client (Neuner & Catini, et al., 2008).

Implications for treatment

In line with the previously discussed theory of PTSD, one of the aims of NET is to construct a consistent autobiographical representation of the traumatic event. This representation helps the individual to realise that the activity of the fear structure is just a memory and therefore the sense of current threat is reduced. Initial theories of exposure therapy (Foa & Rothbaum, 1998) were based on fear extinction but more recently, research has supported the importance of constructing autobiographical knowledge (Neuner, Catani, et al., 2008). It has also been demonstrated that traumatized individuals who mange to construct a coherent narration of the event during exposure therapy benefit most from treatment (Foa, Molnar, & Cashman, 1995), suggesting that whilst habituation to the memory of the traumatic event is crucial, constructing a meaningful narrative of the event is also important in assisting recovery (Neuner & Catani, et al., 2008).

Consequently, NET aims to construct a consistent autobiographical representation of traumatic events within the context of a narrative of the individual’s whole life. Previous exposure therapies for PTSD tend to target the worst traumatic event, however, as NET has been developed for individuals who have experienced war trauma, they are likely to have experienced multiple traumatic events, making it impossible to identify one event as ‘worse’ (Catini et al., 2009). Instead of a using single event as a target for therapy, the aim is to narrate all stressful life events in chronological order from birth to the present day.

Research Evaluating Narrative Exposure Therapy for Children and Adolescents

With encouraging finding from NET studies in adults, a version of this therapy has been adapted for use with children and adolescents (KIDNET). It has been demonstrated that children and adolescents who have experienced war-related trauma are at risk of developing moderate to severe PTSD (Catani, Jacob, Schauer,

Kohila, & Neuner, 2008; Catani, Schauer, et al., 2009; Schaal et al., 2009; Yule, 2000). In addition to the debilitating and distressing effects of PTSD, individuals may also experience impairment in social and educational functioning and cognitive development (Elbert et al., 2009).

In contrast to the adult version, KIDNET involves play and visual instruction to help children to elaborate on their experiences, for example, during the life-line exercise, a rope is used to represent the child’s lifeline, with flowers being used to mark positive experiences and stones to mark negative and traumatic experiences (Schauer et al., 2003). Children are also encouraged to extend their narrative beyond the present so that it describes their hopes and wishes for the future. To date there have been four published studies investigating the use of KIDNET (Catani, Kohiladevy, et al., 2009; Onyut et al., 2005; Ruf, Schauer, et al., 2010; Schauer et al., 2004), and all but one were conducted in low and middle income settings.

In a case study, KIDNET was used with a thirteen year old Somali refugee, Mohammed, who presented in the severe range for PTSD (Schauer et al., 2004). Mohammed had suffered multiple traumatic events. In the course of one year, he had experienced multiple traumas, including; being shot at and wounded; seeing dead bodies floating in the water; being beaten in the face with a gun; witnessing the rape of his best friend; a village raid; a car accident, where he was sat in the passenger seat and witnessed the driver being shot in the head and killed. Mohammed attended a psycho-educational session before receiving four sessions of KIDNET, each lasting 60-90 minutes. The post-test revealed that Mohammed’s symptoms had reduced to a level below the diagnostic threshold for PTSD. Avoidance intrusive symptoms had also disappeared almost completely. His symptoms of hyper arousal were still present occasionally, but they no longer interfered with his functioning to the extent that he felt he was out of control. The results of this case study suggest that it is possible that well-established knowledge about the efficacy of exposure techniques for the treatment of PTSD (Foa, 2000) may be applied to child refugee populations, even when living in unstable conditions. In contrast to a variety of other cognitive behavioural approaches, KIDNET is shorter and the procedure is more pragmatic. This makes the method especially suitable in war and disaster areas.

In a pilot study of KIDNET, in an African refugee settlement, six Somali refugees aged 13–17 years were treated (Onyut et al., 2005). All of the children were assessed for depression and PTSD and attended a psycho-educational session before receiving four to six sessions of KIDNET, each lasting 1-2 hours. All children accepted the offer of KIDNET and completed the full course of treatment. Pre- and post-tests were conducted measuring depression and PTSD and all patients were followed up at nine months. Prior to treatment all children had moderate to severe scores for PTSD, and four children presented with clinically significant depression.

A reduction in PTSD scores was evident at post-hoc and after nine months, four of the six children no longer met the criteria for PTSD. Two of the children still fulfilled PTSD criteria, but now at borderline levels and with a reduction in functional impairment. None of the children met the criteria for clinically significant depression at the post-test or the nine months follow-up. However, this study has several methodological limitations, including a small sample size and the lack of a control group. In addition, the researchers cannot be sure that improvement in symptoms is attributed solely to treatment as it may also be caused by spontaneous remission. Nevertheless, given the data available, on the high prevalence of PTSD in the Somali refugee population (Onyut et al., 2004), it seems unlikely that spontaneous remission could have occurred at this rate.

In a Sri Lankan study of KIDNET, children who had been traumatized by Tsunami and war, was conducted. This study was carried out in response to an initial needs assessment for children affected by the tsunami, which found a 45% prevalence rate of PTSD in the part of the country affected by the tsunami. The study included six sessions of KIDNET compared with six sessions of meditation and relaxation in 31 children (aged 8–14) who had been diagnosed with PTSD (Catani, Kohiladevy, et al., 2009). Both treatments consisted of six sessions lasting 60-90 minutes. To rule out a possible therapist effect, each therapist provided the same number of treatments in both conditions. The meditation protocol involved relaxation exercises, encouraging the child to be mindful of their experiences with the aim of helping them control their fear without re-exposure to the traumatic event. It was developed by local counsellors and had high cultural validity. Results showed that in both treatments, PTSD symptoms were reduced after one month post-test with no significant difference between treatments. Improvements were maintained at the six month follow-up where 81% of the children who were treated with KIDNET and 71% of children treated with meditation no longer met diagnostic criteria for PTSD. In addition to the reduction of PTSD, improvements were also shown in psychosocial functioning, including in social relationships and everyday tasks. The major limitation of this study is that the lack of a control group, however, because of the high level of need for trauma interventions among the population, the decision not to include a non-treated group was made because of ethical concerns (Catani, Kohiladevy, et al., 2009). Furthermore, if diagnostic interviews had been conducted several months after treatment, it could have provided more insight into therapy effects, as previous studies using NET with adults have shown that PTSD reduction at one year follow-up is more evident than effects at three to four month post-tests (Neuner et al., 2004: Schaal et al., 2008).

One trail of KIDNET has been carried out on refugee children living in Germany (Ruf, Schauer, et al., 2010). In this trial, 26 children aged between 7–16 years with PTSD were randomly allocated to either the KIDNET group (n = 13) or to a wait list control group (n = 13). The two groups (KIDNET vs. waiting list) did not differ significantly in terms of traumatic events experienced and all the children have lived under the threat of potential deportation to their home country. Children in the KIDNET group received 7-10 sessions on a weekly basis. Only one child dropped out of the treatment but requested to restart therapy after 2 years, as his suffering had continued. Results from this trial showed that KIDNET effectively reduced PTSD across all three symptom clusters (intrusions, avoidance and hyperarousal) between pre- and post-test, whereas the waiting list control group showed no improvement. These results were maintained at both 6 month and 12 month follow-up. Given the unstable status of the families as asylum seekers and the background of highly traumatic experiences, the success of KIDNET is substantial both in terms of clinical symptoms and mental functioning. It is clear that the treatment itself was highly accepted by the children, due to the low drop-out rate. In addition, as the treated group consisted of children from five different ethnic groups, it would seem to suggest that KIDNET is an approach which is suitable for children of different backgrounds. Limitations of the study include the relatively small sample size and the lack of an active control group, which means it is impossible to state explicitly that the improvement in the KIDNET group is due to the specific treatment approach and not as result of the attention and empathic understanding children had received.

However, the sustainable clinical effects, compared to treatment attempts reported in the literature suggest that it is possible to effectively treat refugee children suffering from PTSD even while the children and their families are still living in refugee centres.

Conclusions

This review has highlighted the multiple traumatic events and severe losses that children and adolescents from war-affected regions are frequently subjected to. Although many of these young people are extremely resilient, some will undeniably develop mental health difficulties. Clinicians should be aware that even though PTSD is frequently diagnosed, it often co-exists with a range of other mental health difficulties, such as anxiety, depression and grief. The promising results obtained for KIDNET suggest that co-morbid difficulties and functional problems may also be improved with this therapy. Researchers have highlighted the importance of continuing to develop and improve existing treatments as well as to be innovative in creating new treatments to reduce drop out rates and treatment failures (Cukor, Spitalnick, Difede, Rizzo, & Rothbaum, 2009). The dropout rates of trials of KIDNET have been consistently low and it has been demonstrated to be effective in a number of different settings and in both high and lower income countries. In addition, the efficacy of KIDNET in reducing PTSD symptoms in diverse populations demonstrates the transferability of the intervention across cultures and adds further evidence to suggest the importance of exposure to traumatic memories in reducing PTSD symptoms.

This review, thus suggests that KIDNET should be further explored for the psychological rehabilitation of children and adolescents who have experienced war-related trauma, irrespective of their particular background and history.

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Categories
Free Essays

This study aims to measure the lung function between 1st year sports therapy university students

Introduction

This study aims to measure the lung function between 1st year sports therapy university students. This is appropriate to assess the level of severity of lung diseases such as asthma or cystic fibrosis and identify characteristics when diagnosing other participants. The study tests both static and dynamic lung volumes by measuring the volume of air expired from the lungs as well as the power of which it is expired. These are measured by a Spirometer machine, which calculates the volume of the lungs forced vital capacity (FVC), which is the maximum volume of air, expired after one maximum inspiration. Also forced expiratory volume (FEV1) showing the percentage of FVC expelled over the time in seconds of which the measurement is made. Lastly by calculating the final measurement of the forced expiratory volume to forced vital capacity ratio (FEV1/FVC) we can see the expiatory power to resistance of airflow within the lungs, allowing to show signs of the lungs percentage ability to forcibly expel air within the lungs.

This study could be seen to look into the physical fitness and ability of the lungs and other pulmonary factors to perform. With the use of the participants we can see the different levels of fitness between subjects and assess other factors, which could contribute to the outcome of the study. The test itself can be described as a random sampling test, subjects were previously assigned you groups that vary in gender and physical fitness. It is conducted by subjects in a seated position on a bench firstly testing FVC values by forcibly expelling as much air as possible, in one rapid expiration after one inspiration into the spirometer. Secondly by forcibly expelling as much air as possible for as long as possible to calculate the FEV1 value. Finally to show an entire resistance to airflow a FEV1/FVC can be calculated. Averages will be taken of each group and higher values can be seen to show a more powerful and resourceful lung function between Subjects. Other variables and factors considered within the tests are the subject’s height, gender and illnesses or conditions to show any outliers or considerable variances between groups. With these in mind the results will be assessed to show the level of performance within the groups and how these could be affected.

Results

SUBJECT

Group

INITIALS

Gender

HeightFVCFEV1FEV1/FVCNOTES
1

A

1012133

M

167

5.2

4.8

92.31

FVC
2

A

0907562

F

171

4.8

4.25

88.54

Group A3.96

3

A

1028114

M

182

6.6

5.95

90.15

Group B3.7475

4

A

HH

M

170

3.75

3.15

84.00

Group C4.91714286

5

A

0906679

M

171

5.25

4.62

88.00

Group D4.81111111

6

A

1027186

M

178

5.9

5.5

93.22

Group E4.77136364

7

A

1005219

M

171

4.28

3.98

92.99

8

A

1012960

F

160

2.93

2.3

78.50

FEV1
9

A

0919586

F

167

4.01

3.43

85.54

Group A3.38384615

10

A

1003480

F

164

4.45

3.84

86.29

Group B3.246

11

E

JT

M

178.5

#DIV/0!

Group C4.26571429

12

E

AO

F

168

4.1

3.64

88.78

Group D4.1

13

E

DF

F

176

3.01

2.54

84.39

Group E4.12318182

14

E

AD

F

167.5

3.47

3.19

91.93

SMO
15

E

ER

F

163

3.19

2.81

88.09

SMOFVC AV4.44643678

16

E

BG

F

167

4.04

3.53

87.38

SMOFEV1 AV3.8291954

17

E

BH

M

173

5.57

4.77

85.64

18

E

SS

M

179

5.54

4.63

83.57

19

E

JE

M

185

6.13

5.01

81.73

20

E

JS

M

178

5.33

4.68

87.80

21

E

SH

M

174

4.81

4.42

91.89

22

E

FR

M

172

5.6

4.6

82.14

23

E

OS

M

172

5.4

4.6

85.19

24

E

MO

M

179.4

5.34

4.71

88.20

25

E

GN

M

172

4.7

4.3

91.49

26

E

MONZ

M

177

4.45

3.78

84.94

27

E

TREVOR

M

177

3.88

3.21

82.73

28

E

ALI

M

168

5.23

4.7

89.87

29

E

JOR

M

174

5.88

4.74

80.61

30

D

CH

M

175

4.49

4.01

89.31

31

D

HB

F

164

#DIV/0!

32

D

RM

M

175

4.55

3.86

84.84

33

D

AS

M

172

4.3

4.11

95.58

34

D

KC

M

183

4.2

3.91

93.10

35

D

CO

F

168

4.12

3.7

89.81

36

D

SL

F

168

4.38

3.2

73.06

37

D

JT

F

154

3.4

2.9

85.29

38

D

CP

F

164

3.67

3

81.74

39

D

TM

F

168.5

3.6

3.03

84.17

40

D

AL

M

180.5

4.55

3.83

84.18

41

D

JA

M

178.2

4

3.37

84.25

42

D

CTK

M

176

4.78

4.18

87.45

43

D

AB

M

179.9

4.62

4.07

88.10

44

D

SB

M

176

2.8

2.25

80.36

45

C

1014315

F

172

5.65

5

88.50

46

C

1012212

M

191

6.65

6.2

93.23

47

C

1014640

F

156

3.7

3.55

95.95

48

C

1012633

M

167

3.3

2

60.61

49

C

1016163

M

182

5.6

5.05

90.18

50

C

1013151

M

176

5.2

4.4

84.62

51

C

1011941

M

181

5.95

5.4

90.76

52

C

1022773

M

186

6.2

3.4

54.84

53

C

1011809

M

170

4.51

4.1

90.91

54

C

F

M

3.47

3.19

91.93

55

C

S

M

167

3.87

3.81

98.45

56

C

L

F

156.5

3.65

3.12

85.48

57

B

JRS

M

181

4.95

4.12

83.23

58

B

L Dennis

M

183

4.8

4.28

89.17

59

B

1023169

M

186

3.7

3.65

98.65

60

B

RWJ

M

177

3.15

3.02

95.87

SMO
61

B

JM

M

168.3

6

5.25

87.50

62

B

MH

F

161.3

4

3.6

90.00

63

B

AB

M

161.3

5.05

4.33

85.74

64

B

BU

M

101.8

5.4

4.6

85.19

65

B

JW

M

179.1

5.4

4.6

85.19

66

B

NC

M

169.1

4.32

3.26

75.46

67

B

EH

M

187

5.32

3.88

72.93

68

B

1009373

F

174

3.65

2.92

80.00

69

B

CM

M

176.7

5.11

4.24

82.97

70

B

JR

M

176

5.05

4.45

88.12

71

B

EK

M

171

5.05

4.28

84.75

72

B

RB

F

165

4.6

4.29

93.26

SMO
73

B

1007117

F

155

3.9

3.5

89.74

74

B

1017573

M

174

4.8

4.5

93.75

75

B

1027814

M

180

4.3

2.89

67.21

Chest inf
76

E

1010245

F

164

2.01

1.25

62.19

77

E

1027206

F

155

2.38

2.26

94.96

Asthma
78

E

1006974

M

176

2.73

2.7

98.90

79

E

1015301

M

176

3.3

3.28

99.39

SMO
80

D

1007703

M

184

5.81

5.07

87.26

81

B

1020415

F

160

2.76

2.15

77.90

Asthma
82

D

1010931

M

1.89

4.52

3.81

84.29

83

D

1026768

F

160

3.64

3.25

89.29

84

C

1012648

F

167

3.71

3.09

83.29

85

A

1027299

M

182

5.32

4.63

87.03

86

A

1003819

F

176

2.47

2.41

97.57

87

B

1005235

F

161

3.43

2.77

80.76

88

C

1013209

F

3.33

2.96

88.89

89

A

1002116

F

4.83

3.53

73.08

(Figure 1) Raw data Collected within the study, outlining the contained variables and data collected.

One-Sample Statistics

N

Mean

Std. Deviation

Std. Error Mean

Group A13

4.5992

1.14036

.31628

(Figure 2.0) One sample T-Test comparing group A’s FVC results to the rest of the year.

One-Sample Test

Test Value = 4.446436782

t

df

Sig. (2-tailed)

Mean Difference

95% Confidence Interval of the Difference

Lower

Upper

Group A.483

12

.638

.15279

-.5363

.8419

(Figure 2.1) One sample T-Test comparing group A’s FVC results to the rest of the year.

One-Sample Statistics

N

Mean

Std. Deviation

Std. Error Mean

Group B21

4.5114

.84415

.18421

(Figure 2.2) One sample T-Test comparing group B’s FVC results to the rest of the year.

One-Sample Test

Test Value = 4.446436782

t

df

Sig. (2-tailed)

Mean Difference

95% Confidence Interval of the Difference

Lower

Upper

VAR00001.353

20

.728

.06499

-.3193

.4492

(Figure 2.3) One sample T-Test comparing group B’s FVC results to the rest of the year.

One-Sample Statistics

N

Mean

Std. Deviation

Std. Error Mean

Group C14

4.6279

1.19814

.32022

(Figure 2.4) One sample T-Test comparing group C’s FVC results to the rest of the year.

One-Sample Test

Test Value = 4.446436782

t

df

Sig. (2-tailed)

Mean Difference

95% Confidence Interval of the Difference

Lower

Upper

Group C.567

13

.581

.18142

-.5104

.8732

(Figure 2.5) One sample T-Test comparing group C’s FVC results to the rest of the year.

One-Sample Statistics

N

Mean

Std. Deviation

Std. Error Mean

Group D17

4.2018

.66987

.16247

(Figure 2.6) One sample T-Test comparing group D’s FVC results to the rest of the year.

One-Sample Test

Test Value = 4.446436782

t

df

Sig. (2-tailed)

Mean Difference

95% Confidence Interval of the Difference

Lower

Upper

Group D-1.506

16

.152

-.24467

-.5891

.0997

(Figure 2.7) One sample T-Test comparing group D’s FVC results to the rest of the year.

One-Sample Statistics

N

Mean

Std. Deviation

Std. Error Mean

Group E22

4.3677

1.22493

.26116

(Figure 2.8) One sample T-Test comparing group E’s FVC results to the rest of the year.

One-Sample Test

Test Value = 4.446436782

t

df

Sig. (2-tailed)

Mean Difference

95% Confidence Interval of the Difference

Lower

Upper

Group E-.301

21

.766

-.07871

-.6218

.4644

(Figure 2.9) One sample T-Test comparing group E’s FVC results to the rest of the year.

One-Sample Statistics

N

Mean

Std. Deviation

Std. Error Mean

Group A13

4.0300

1.08923

.30210

(Figure 3.0) One sample T-Test comparing group A’s FEV1 results to the rest of the year.

One-Sample Test

Test Value = 3.829195402

t

df

Sig. (2-tailed)

Mean Difference

95% Confidence Interval of the Difference

Lower

Upper

Group A.665

12

.519

.20080

-.4574

.8590

(Figure 3.1) One sample T-Test comparing group A’s FEV1 results to the rest of the year.

One-Sample Statistics

N

Mean

Std. Deviation

Std. Error Mean

Group B21

3.8371

.77423

.16895

(Figure 3.2) One sample T-Test comparing group B’s FEV1 results to the rest of the year.

One-Sample Test

Test Value = 3.829195402

t

df

Sig. (2-tailed)

Mean Difference

95% Confidence Interval of the Difference

Lower

Upper

Group B.047

20

.963

.00795

-.3445

.3604

(Figure 3.3) One sample T-Test comparing group B’s FEV1 results to the rest of the year.

One-Sample Statistics

N

Mean

Std. Deviation

Std. Error Mean

Group C14

3.9479

1.14264

.30538

(Figure 3.4) One sample T-Test comparing group C’s FEV1 results to the rest of the year.

One-Sample Test

Test Value = 3.829195402

t

df

Sig. (2-tailed)

Mean Difference

95% Confidence Interval of the Difference

Lower

Upper

Group C.389

13

.704

.11866

-.5411

.7784

(Figure 3.5) One sample T-Test comparing group C’s FEV1 results to the rest of the year.

One-Sample Statistics

N

Mean

Std. Deviation

Std. Error Mean

Group D17

3.6206

.64917

.15745

(Figure 3.6) One sample T-Test comparing group D’s FEV1 results to the rest of the year.

One-Sample Test

Test Value = 3.829195402

t

df

Sig. (2-tailed)

Mean Difference

95% Confidence Interval of the Difference

Lower

Upper

Group D-1.325

16

.204

-.20861

-.5424

.1252

(Figure 3.7) One sample T-Test comparing group D’s FEV1 results to the rest of the year.

One-Sample Statistics

N

Mean

Std. Deviation

Std. Error Mean

Group E22

3.7886

1.02453

.21843

(Figure 3.8) One sample T-Test comparing group E’s FEV1 results to the rest of the year.

One-Sample Test

Test Value = 3.829195402

t

df

Sig. (2-tailed)

Mean Difference

95% Confidence Interval of the Difference

Lower

Upper

Group E-.186

21

.854

-.04056

-.4948

.4137

(Figure 3.9) One sample T-Test comparing group E’s FEV1 results to the rest of the year.

Test of Homogeneity of Variances

VAR00002
Levene Statistic

df1

df2

Sig.

3.835

4

82

.007

(Figure 4.0) One way ANOVA comparing FVC of each group.

ANOVA

VAR00002
Sum of Squares

df

Mean Square

F

Sig.

Between Groups2.007

4

.502

.472

.756

Within Groups87.208

82

1.064

Total89.215

86

(Figure 4.1) One way ANOVA comparing FVC of each group.

Multiple Comparisons

Dependent Variable:VAR00002
(I) VAR00001(J) VAR00001Mean Difference (I-J)

Std. Error

Sig.

95% Confidence Interval

Lower Bound

Upper Bound

BonferroniAB.08780

.36394

1.000

-.9622

1.1378

C-.02863

.39721

1.000

-1.1746

1.1173

D.39747

.37996

1.000

-.6987

1.4936

E.23150

.36076

1.000

-.8093

1.2723

BA-.08780

.36394

1.000

-1.1378

.9622

C-.11643

.35582

1.000

-1.1430

.9101

D.30966

.33646

1.000

-.6610

1.2803

E.14370

.31462

1.000

-.7640

1.0514

CA.02863

.39721

1.000

-1.1173

1.1746

B.11643

.35582

1.000

-.9101

1.1430

D.42609

.37219

1.000

-.6477

1.4998

E.26013

.35257

1.000

-.7570

1.2773

DA-.39747

.37996

1.000

-1.4936

.6987

B-.30966

.33646

1.000

-1.2803

.6610

C-.42609

.37219

1.000

-1.4998

.6477

E-.16596

.33302

1.000

-1.1267

.7948

EA-.23150

.36076

1.000

-1.2723

.8093

B-.14370

.31462

1.000

-1.0514

.7640

C-.26013

.35257

1.000

-1.2773

.7570

D.16596

.33302

1.000

-.7948

1.1267

Dunnett T3AB.08780

.36601

1.000

-1.0511

1.2268

C-.02863

.45008

1.000

-1.4006

1.3433

D.39747

.35557

.940

-.7214

1.5164

E.23150

.41016

1.000

-1.0115

1.4745

BA-.08780

.36601

1.000

-1.2268

1.0511

C-.11643

.36942

1.000

-1.2582

1.0254

D.30966

.24562

.893

-.4197

1.0391

E.14370

.31959

1.000

-.8033

1.0907

CA.02863

.45008

1.000

-1.3433

1.4006

B.11643

.36942

1.000

-1.0254

1.2582

D.42609

.35907

.917

-.6951

1.5473

E.26013

.41321

.999

-.9869

1.5071

DA-.39747

.35557

.940

-1.5164

.7214

B-.30966

.24562

.893

-1.0391

.4197

C-.42609

.35907

.917

-1.5473

.6951

E-.16596

.30757

1.000

-1.0829

.7510

EA-.23150

.41016

1.000

-1.4745

1.0115

B-.14370

.31959

1.000

-1.0907

.8033

C-.26013

.41321

.999

-1.5071

.9869

D.16596

.30757

1.000

-.7510

1.0829

(Figure 4.2) One way ANOVA comparing FVC of each group.

Test of Homogeneity of Variances

VAR00002
Levene Statistic

df1

df2

Sig.

1.485

4

82

.214

(Figure 5.0) One way ANOVA comparing FEV1/FVC of each group.

ANOVA

VAR00002
Sum of Squares

df

Mean Square

F

Sig.

Between Groups63.338

4

15.834

.243

.913

Within Groups5343.195

82

65.161

Total5406.532

86

(Figure 5.1) One way ANOVA comparing FEV1/FVC of each group.

Multiple Comparisons

Dependent Variable:VAR00002
(I) VAR00001(J) VAR00001Mean Difference (I-J)

Std. Error

Sig.

95% Confidence Interval

Lower Bound

Upper Bound

BonferroniAB2.36465

2.84873

1.000

-5.8539

10.5832

C1.93275

3.10914

1.000

-7.0370

10.9025

D1.47376

2.97412

1.000

-7.1065

10.0540

E.57801

2.82387

1.000

-7.5688

8.7248

BA-2.36465

2.84873

1.000

-10.5832

5.8539

C-.43190

2.78518

1.000

-8.4671

7.6033

D-.89090

2.63361

1.000

-8.4888

6.7070

E-1.78665

2.46267

1.000

-8.8914

5.3181

CA-1.93275

3.10914

1.000

-10.9025

7.0370

B.43190

2.78518

1.000

-7.6033

8.4671

D-.45899

2.91330

1.000

-8.8638

7.9458

E-1.35474

2.75975

1.000

-9.3165

6.6071

DA-1.47376

2.97412

1.000

-10.0540

7.1065

B.89090

2.63361

1.000

-6.7070

8.4888

C.45899

2.91330

1.000

-7.9458

8.8638

E-.89575

2.60669

1.000

-8.4160

6.6245

EA-.57801

2.82387

1.000

-8.7248

7.5688

B1.78665

2.46267

1.000

-5.3181

8.8914

C1.35474

2.75975

1.000

-6.6071

9.3165

D.89575

2.60669

1.000

-6.6245

8.4160

Dunnett T3AB2.36465

2.45780

.979

-5.0407

9.7700

C1.93275

3.80046

1.000

-9.9166

13.7821

D1.47376

2.18161

.998

-5.2430

8.1905

E.57801

2.41005

1.000

-6.6911

7.8471

BA-2.36465

2.45780

.979

-9.7700

5.0407

C-.43190

3.74733

1.000

-12.1297

11.2659

D-.89090

2.08768

1.000

-7.1028

5.3210

E-1.78665

2.32536

.996

-8.6439

5.0706

CA-1.93275

3.80046

1.000

-13.7821

9.9166

B.43190

3.74733

1.000

-11.2659

12.1297

D-.45899

3.57227

1.000

-11.8337

10.9157

E-1.35474

3.71619

1.000

-12.9882

10.2787

DA-1.47376

2.18161

.998

-8.1905

5.2430

B.89090

2.08768

1.000

-5.3210

7.1028

C.45899

3.57227

1.000

-10.9157

11.8337

E-.89575

2.03125

1.000

-6.9231

5.1316

EA-.57801

2.41005

1.000

-7.8471

6.6911

B1.78665

2.32536

.996

-5.0706

8.6439

C1.35474

3.71619

1.000

-10.2787

12.9882

D.89575

2.03125

1.000

-5.1316

6.9231

(Figure 5.3) One way ANOVA comparing FEV1/FVC of each group.

(Figure 6.0) Graph containing the correlation between Height and FVC results.

Group Statistics

GenderN

Mean

Std. Deviation

Std. Error Mean

FVCFemales30

3.6960

.77678

.14182

Males57

4.8414

.90564

.11995

(Figure 7.0) Independent samples text comparing FVC results between males and females.

Independent Samples Test

Levene’s Test for Equality of Variances

t-test for Equality of Means

95% Confidence Interval of the Difference

F

Sig.

t

df

Sig. (2-tailed)

Mean Difference

Std. Error Difference

Lower

Upper

FVCEqual variances assumed1.665

.200

-5.878

85

.000

-1.14540

.19485

-1.53281

-.75800

Equal variances not assumed-6.166

67.457

.000

-1.14540

.18575

-1.51611

-.77470

(Figure 7.1) Independent samples text comparing FVC results between males and females.

Discussion

After conducting the study there is much to discuss. Raw data (figure 1) from the tests indicate that some participant did not fill in the required data needed. This can be down to competence of conducting the procedure or observer error asking the question whether this is entirely valid. Furthermore a correct procedure must be outlined and overlooked so that each group performs the same method. Some subjects may have stood up and some may have sat down, possibly causing the results to differ. (Townsend, 1984; Allen et al. 1985) have shown that FVC is affected by body position, 1-2% lower by sitting rather than standing and 7-8% lower supine than to standing.

Taking these into account the results could not be described as entirely valid or reliable. As the study looks into identifying and discussing results between student groups we can see how they performed compared to normal values. The subjects appear to deliver between the normal values of 4-5L in males and 3-4L in females for FVC (figure 7.0) this appears to show a significant result meaning males have a higher FVC than females with group C performing the best on average (figure 2.4). (Figure 4.0) shows that the statistic of FVC between the groups has a significance of .007 meaning there is a small difference between them however (figure 4.1) states that the difference is not significant. This essentially shows that although there is an apparent difference between the groups this can be seen as not having an effect on the study. (Figure 3.0) shows that Group A has the highest average FEV1 meaning they have the most power of expiration of air. (Figures 5.0 – 5.1) state that there is no significant difference between the values of all the groups with each subject showing results near to the value of 85% this could be seen to have a normal result.

With such an apparent loosely based study it is important to consider certain group or subject variances, which can effect the study. Identifying these can create a more reliable and valid study as well as identify further ideas for research. The FVC method is highly effort dependant and has poor reliability as it is measured upon volume of air as well as a less reliable observed rate of exertion. Certain people may not want to exert the entire force needed due to anxiety or other factors such as illness or conditions. (Eston. R. et al. 2009) shows us that although there is no difference between FVC values for healthy people and asthmatics there is a considerable change in dynamic FEV1 values with asthmatics having a much larger decrease in performance from the FVC value. This could be mainly attributed to the fact that asthmatics have difficulty breathing out and therefore exerting a larger force of air from their lungs for a long time could be harder. With this in mind it could be advised that a screening process becomes more prominent before the test it taken these can identify, illnesses, conditions, injuries and even a physical activity questionnaire to see whether more active subject have better results. Any hidden values could the research and discovering more about the subject can help to answer more questions. Height comparisons (figure 6.0) show there is no relationship between the subjects height and FVC value, however it is hard to follow this when it not clear of whether the sitting or standing method has been used. (Ferris et al 1971; Cotes 1979) show that sitting height provides less variability in lung function than standing height, this could show that (figure 6.0) with its varied results show that subjects were standing. (Becklake 1968) explains that there are many other factors that effect lung function results, some of which are not identified within this study. Gender amounts to a change in 30%, body size 22%, age 8% and ethnicity 10% most of which can be identified through a survey.

This study may be described as having no significant purpose without the inclusion of further factors detailed by (Becklake 1968). With these included it could be seen to show a purpose and significance with vision to elaborate upon affecting factors however currently this shows a significant variety of results between subject groups.

References

Becklake,M.R. (1986) Concepts of normality applied to measurement of lung function. American Journal of Medicine; 80: 1158-64.

Eston, R. Et al. (2009) Kinanthropometry and Exercise Physiology Laboratory Manual: Tests, Procedures and Data, Volume 2: Physiology. 3rd ed. Oxon, Routledge.

Ferris, B et al (1971) correlation of anthropometry and simple tests of pulmonary function. Archives of environmental health; 22: 672-6.

McArdle,W.D. et al (2006) Essentials of Exercise Physiology. 3rd ed. Philadelphia, Lippincott Williams & Wilkins

Townsend, M.C (1984) Spirometric forced expiratory volumes measured in the standing versus sitting posture. American Review of Respiratory Disease; 130:123-4.

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Free Essays

Comparing Person-based Therapy and Cognitive Behavioural Therapy

Abstract

This paper presents a comparison of two therapeutic concepts, person-centred approach and cognitive behavioural therapy in terms of the role of counsellor and client. It specifically describes the role of the client and counsellor and then compares them accordingly. The paper will also discuss the strengths and limitations of the two approaches in order to differentiate them better.

Introduction

Both person-centred therapy and cognitive behavioural therapy provide support and help to patients by addressing individual matters. Both practices share the common therapeutic goal of welfare improvement. The necessity of an integrated approach to person-centred therapy and cognitive behavioural therapy has called for numerous researches to investigate the roles of the different parties (Moon, 2006). In the comparison of the two therapeutic concepts in terms of the role of counsellor and client, there is a clear difference that is well defined in the subsequent discussions. In person-centred, the patient is the expert on himself and finds his or her own way, while in CBT the counsellor is the expert and leads the patient (Branaman, 2001). The approaches also have strengths and limitations that are discusses comprehensively.

Therapeutic relationship
The role of the client and the counsellor

In terms of the therapeutic relationship, it is critical to make sure that the result of the therapy is effective and desirable. In relation to these two approaches of counselling, the therapeutic relationships are different from each another. In each approach, the therapist and the client have different roles to play in the processes. Therapeutic relationship in the cognitive behavioural therapy resembles that between a student and his or her teacher (Burkitt, 2008). The role of the counsellor is to provide therapeutic instructions and recommendations to the client who listens and then does exactly as they are told by the therapist. In this kind of relationship, the therapist uses directive structures in directing clients on the changes in behaviour. In this instance, the therapist acts as the point of focus since they impact much on the client’s cognitive and behavioural changes (Branaman, 2001). However, for the purposes of desirable and effective outcomes, collaboration is emphasised in the process of the therapy.

The therapist employs Socratic dialogue, which is essential in supporting clients in tenets like the identification of assumptions, values and norms that have affected the emotional and psychological functionality. It involves a disciplined questioning or probing that can be used in the pursuing of thought in various directions and for several purposes, which include exploration of complex ideas (Timulak, 2005). The therapist in this approach questions the client to find out the reality of things, to open up matters together with problems, to reveal presumptions and beliefs and to find out what they know and what they do not know, as well as following out rational meanings of thought and managing the discussion (Burkitt, 2008). The technique is important in the relationship between the client and the therapist because it is disciplined, methodical and normally focuses on critical principles, matters and problems. In addition to this, the client is encouraged by the therapist to change these assumptions and identify an unconventional concept for the present and future living (Timulak, 2005). The therapist, in this instance, assists in the promotion of the adoption of remedial learning skills. The client, in this kind of association is always presented with new insights in relation to the matters they are experiencing and thus chooses the most effective and efficient ways of acquiring change.

The cognitive behavioural therapy employs the methods that are aimed at individual counselling. It employs the Socratic Method that comprises of numerous questions to be responded to by the client. Counsellors employ various techniques of behaviour, emotion and cognition; different techniques are tailored to fit individual clients (Wetherell et al 2001). Nevertheless, the client is also given chance to ask the therapist some questions. The approach utilises the aspect of homework or coursework that encourages the patients to practice the skills acquired. Therefore, cognitive behavioural therapy’s major technique is the ABC one, which employs the Socratic concept.

On the other hand, the therapeutic relationship in the person-centred therapy is very different from the cognitive behavioural therapy. Here, the relationship between the therapist and the client is critical because the therapy focuses on the client as they turn to be the point of focus of the therapy. As a result of this, the therapist has to make sure that there is maintenance of respect, empathy and honesty towards the client (Timulak, 2005). Communication is also important in this approach particularly between the counsellor and the client. The relationship should be equal since it important in enabling change in the client.

The client centred therapy approach utilises the attitudes of the therapist as the main technique. The therapist’s attitude towards the patient determines the result of the whole process. The approach makes use of the aspects of listening and hearing and clarification of feelings and ideas (Timulak, 2005). This approach does not employ the methods that encompass directive aspects. In this therapy, there is nothing like questioning or probing, which are commonly seen or done in the cognitive behavioural therapy.

Strengths of cognitive behavioural therapy

Of all the known psychological therapies, cognitive behavioural therapy is the most clinically researched and examined and is generally considered as one of the most effective means of dealing with anxiety (Wetherell et al 2001). The approach is affordable and the overall procedure of treatment can last for as few as six sessions of one hour each for minor cases of anxiety, though normally in the area of 10-20 sessions. It has more appeal or attraction in the sense that it is exclusively natural and different from medication, there are no harms or side effects. The therapy is most commonly provided as a face-to-face remedy between the counsellor and patient but there is more evidence to demonstrate that its principles can be used in several other frameworks (Denscombe, 2007). For instance, interactive computerized cognitive behavioural therapy is on the rise, however, it can be given in groups or in the self-help books. These alternatives are very appealing to people that find the practicalities or ideas of frequent meetings with a counsellor not suiting them. CBT is an approach that is highly structured and involves the patient and the counsellor collaborating on the objectives of treatment that are specific, quantifiable, time-limited, attainable and actual or real. The patient is motivated to break down the behaviours, feelings and thoughts that confine them in an undesirable cycle and they get to learn strategies and skills that can be used in the daily life for the purposes of helping them cope better (Burkitt, 2008).

Weaknesses of cognitive behavioural therapy

There are some problems with cognitive behavioural therapy that make it undesirable and unsuitable for some individuals. The concept might not be effective for individuals with mental health problems that are more complex or for those that have difficulties in learning. The major focus of the concept is usually about the patient and their capacity to change their behaviours. Some individuals feel like this is a focus that is too narrow, and disregards too many significant matters such as family, histories of self and extensive emotional issues (Moon, 2006). There is no scope within the concept for individual examination and exploration of emotions, or even of looking at the challenging issues from different angles or perspectives. For these matters to be dealt with in a proper manner, a patient would have to turn to another method, probably along the lines of the psychodynamic counselling.

In order to fully gain from the cognitive behavioural therapy, the client has to make sure that they give a substantial level of commitment and dedication as well as participation. Those who argue against the therapy claim that since it only deals with the present issues, and focuses on issues that are very specific, it does not adequately address the probable causes of the mental health problems like a child who is not happy (Furedi, 2004).

Sceptics of the concept claim that just by an individual being told that their perceptions of the world do not correctly reflect the reality by the concept’s counsellor are not enough to change the cognition of a patient. A criticism that is more salient for some patients might be that the counsellor initially may accomplish something of a specialist role, in the sense that they offer expertise or experience that is problem solving in the cognitive psychology (Palmer, 2001). Some individuals might also feel that the counsellor can be playing a leading role in their probing and somehow commanding in terms of their suggestions. Patients who are okay with self-examination, who readily employ the scientific approach for the exploration of their personal therapy and who put confidence in the basic theoretical method of cognitive therapy, might find the concept an important one (Gillon, 2007). However, patients that appear to be less easy or contented with any of these, or even whose suffering is of a more common interpersonal nature, to an extent that it cannot be in a position of easily being framed as an interplay or interaction between behaviours, thoughts and emotions within a particular environment might find this kind of therapy useful to them and their conditions. Cognitive behavioural therapy has always proved to be helpful to the people that suffer from serious conditions, such as depression, uneasiness, fear or obsessive compulsive and panic (Denscombe, 2007).

Strengths of person-centred therapy

The concept of the approach is that the patient is the best professional or expert on themselves and has the best position of helping themselves. Its strengths include the fact that the patient is the one guiding the experience whereas the therapist reflects on what the patient is doing or saying and can paraphrase the ideas together with practices (Giddens, 2001). The therapist does not judge the patient as being right or wrong. The objective of the person-centred therapy is improving the trust of the patient in themselves and their self-confidence. It also helps them in becoming more able to live in the period, and letting go of the emotions that are unproductive and negative, such as guilt regarding the past events that are difficult to change (Branaman, 2001).

Weaknesses of person-centred therapy

The fact that the approach is client-led is one of its biggest weaknesses since it is up to the patient to be in a position of processing information and making rational decisions for their personal well-being. In case the client is not capable of doing this as required by the concept, the cornerstone of a therapist not making judgments about the information provided or processed by the client can turn out to be counterproductive to the patient’s welfare (Robb et al, 2004).

The approach requires creation of an extended and honest relationship with a counsellor (Bolton, 2001). The advocates of this therapy would claim that the counsellor could work faster, if that is their wish. However, if they are less than one hundred per cent committed to working via their issues, the required duration of the treatment can seriously exceed or surpass the money and time of the patient. Still the counsellors would cite that unlike cognitive behavioural therapy, the major focus of the treatment or approach is about ‘being in the period’ and the concerns of today, instead of upon long-ago past excavation (Branaman, 2001).

Conclusion

In the discussions above, it is apparent that these two therapies have different approaches to treating patients of the same and different problems. Both of them focus on the conscious mind, the current issues and problems that the patients might have. Both of them have a positive perception of the nature of human beings and perceive the person as not essentially being an outcome of their past experiences, but recognise that they are capable of determining their individual futures. Both approaches try to improve the welfare of patients by way of a collaborative therapeutic relationship, which allows and enhances health adaptation techniques in patients that are having psychological pain and distress in their lives. The biggest differences in the two approaches include the fact that the relationship between clients and therapists differ. The role of the counsellor in cognitive behavioural therapy is to provide therapeutic instructions and recommendations to the client who listens and then exactly does as they are told, while in the person-centred therapy, the relationship between the therapist and the client is critical because it on the client as they turn to be the point of focus.

References

Bolton, G. (2001). Reflective Practice: Writing and Professional Development. London: Sage.

Giddens, A. (2001). Sociology (4th Ed). Cambridge: Polity (Classic Text).

Gillon, E. (2007). Person-Centred Counselling Psychology. London: Sage.

Branaman, A. (2001). Self and Society. Oxford: Blackwell.

Burkitt, I. (2008). Social Selves: Theories of Self and Society. London: Sage.

Denscombe, M. (2007). The Good Research Guide. (3rd Ed). Maidenhead: Open University Press.

Furedi, F. (2004). Therapy culture. London: Routledge.

Moon, J. A. (2006). Learning Journals. London: Routledge.

Palmer, S. (ed.) (2001). Multicultural Counselling: A Reader. London: Sage.

Robb, M. et al (eds) (2004). Communication, Relationships and Care; A Reader. London: Routledge

Timulak R. (2005). Research in Psychotherapy and Counselling. London: Sage.

Wetherell, M., Taylor, T., Yates, S. J. ( eds) (2001). Discourse Theory and Practice: A Reader. London: Sage.

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Free Essays

Nutrition/Diet Therapy Project

Health is an important aspect for the people as this manifests as the foundation of their lives and welfare. Ideally, good health can be maintained through adhering to a strict discipline and a physically nurturing lifestyle. Having proper nutrition, adequate rest, regular exercise and avoidance from vices can lead to a healthy personal development bringing forth longer with a pleasant condition.

Among the three approaches to a healthy living, the aspect of diet and nutrition commonly manifests as the most influential factor as this can significantly affect the general development of the physical body. Healthy body condition can be maintained through adhering through a proper diet even the prevention and resistance to many health ailments such as heart diseases. Indeed, heart diseases are serious problems which must be given sufficient attention as they are mostly life-threatening. One common approach for reducing treatment ad prevention of heart diseases is adhering to a proper diet and nutrition therapy.

Nutrition is mainly taken through eating and drinking. The body extracts the needed vitamins and minerals from the food and water taken in to properly maintain the basic processes vital for a healthy living. In the aspect of treating or preventing heart diseases, the value of the foods taken in terms of vitamins and minerals play much significance.

Naturally, the origin of heart disease also has other factors such as hereditary as determined from the history of the family lineage. For cases wherein a person indeed has history of heart disease cases running down his or her family, the value of the dietary nutrition can have preventive effects to the probability of the development of heart ailments for the said individual.

To further elaborate the significance of the said health recommendation, an actual study health study will be implemented wherein the author of this paper will establish a personal dietary recommendation in relation to his health information. As this author has determined, a significance percentage of heart disease has to be considered, as the problem is present in the family history. As gathered through intrinsic research, the risk factor is associated with the case of the subject’s father dying from a heart attack, which is likely due to high cholesterol level similar to the case of the subject’s grandfather.

Considering the present health status of the subject, there is still no sign of heart disease symptoms and the cholesterol is still regular within the normal level. From these informations, it can be ruled that heart disease in terms of hereditary and congenital nature however, a consideration for precaution is still necessary. Thus, this dietary recommendation project will be significantly focused on the development of preventive approach and maintenance of healthy condition.

In preventing heart disease ailments, it is important to consider the nutritional value of the diet being taken by the subject. In this project, three particular diet elements are highly recommended namely:

emphasize on fruits, vegetables, whole-grains, and fat-free or low-fat milk and milk products
inclusion of lean meats, poultry, fish, beans, eggs and nuts on the regular diet and
reduction in saturated fats, cholesterol, sodium and, added sugars.

A strict adhesion to these three diet factors is important in the aspect of preventing health ailments as their nutritional benefits are incremental thus aiding the proper development of the body. The health values gain from this diet works mainly in two ways namely first through promoting the development of the body’s health and natural defenses, and second through reducing the likely diet causes of heart problems. It must be noted that cases of high cholesterol level are present in the family background and the likely contributor to the development of the heart problem of the subject’s father, thus, it must this diet recommendation project wishes to emphasize the elimination of this factor.

This health diet project has also considered the said factor through eliminating the food sources of cholesterol. Reduction of cholesterol is addressed through eliminating saturated fats on the diet and focusing more on fruits, vegetables, grains, wheat, and other. Indeed, this diet recommendation eliminates the risk factor determined from family history and promotes the development of a healthy lifestyle for the subject.

To better realize the effect of the recommendations of the mentioned diet project, it is also important to adhere to a healthy lifestyle particularly regular exercise and sufficient rest. In this project, an emphasis on cardiovascular exercises on a regular basis is recommended namely the basic jogging, simple stretching, and brisk walking. This form of exercises develops the capacity and healthy condition of the circulatory system particularly the heart, lung, and blood vessels. In addition, these exercises also promote proper waste removal from the body through perspiration and the maintenance of the cholesterol level.

These exercises must be done at maximum of thrice a week for maintenance purposes. As additional recommendations, exercise done with mechanical assistance such as treadmill and tension bikes is also recommended but not necessary as these will require additional expense for the project. Having sufficient rest periods is also important in this health project. Insufficient rest can reduce the capacity and health of the muscles in the body and this effect has detrimental consequences mainly on the heart organ. Thus, to maintain the benefits from the food recommendations and exercise, proper rest periods ranging within 8 to 10 hours must also be given consideration.

In general, this diet recommendation project is not solely focused on heart diseases as the benefits in this program can also address other health problems. It is a general emphasis on this program to develop a strong and healthy body for its subject through maintaining a proper healthy lifestyle.

By adhering to a nutritious and healthy diet, a regular exercise, and adequate sleep program, the subject can easily improve his or her physical well-being and natural defenses, enabling the subject to prevent numerous health problems particularly heart diseases. Indeed, in the approach of preventing health problems, the primary approach for this aspect is to develop a strong body through a healthy lifestyle throughout his or her life.

Bibliography

Lee, Dennis & Stoppler, Melissa Conrad (2007). Disease Prevention Through Diet and Nutrition. MedicineNet, Inc. http://www.medicinenet.com/prevention/article.htm. September 7, 2007.

Medical Update (1993). Take heart – and save it, too! (preventing heart disease with healthy diet). Benjamin Franklin Literary & Medical Society, Inc. Vol 17, Page 2.

Mirkin, Gabe (2003).The Healthy Heart Miracle: Your Roadmap to Lifelong Health. Collins Publication. 1st Edition. ISBN-10: 0060196807

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Use of Prayer and Scripture in Cognitive-Behavioral Therapy

Use of Prayer and Scripture in Cognitive-Behavioral Therapy: A Journal Article Beatrice St. Surin Liberty University COUN-506 September 23, 2012 Abstract According to the article Use of Prayer and Scripture in Cognitive-Behavioral Therapy, published in the Journal of Psychology and Christianity in 2007, Siang-Yang Tan talked about how prayer and scripture can be incorporated into the practice of cognitive-behavioral therapy (CBT).

Lately, in the field of CBT, there have been an increased on a suggestive awareness regarding a two-component model that involves self-regulation of attention in order to preserved on instant knowledge, centers on present circumstances, and implements an orientation to the acceptance of a person’s situation. Tan demonstrated that this model of CBT can be combined with prayer and scriptural truth to bring long-term benefit to clients.

He mentioned a study by Hayes, Luoma, Bond, Masuda and Lillis (2006) that defined an ancient method of behavior therapy that was divided into three generational actions and involved a gradual transition from traditional behavior therapy and CBT to a collection of views and approaches like Acceptance and Commitment Therapy (ACT) (Tan, 2007, p. 101). Tan referred to a self-developed biblical model to this approach that consists of an 8-part process. These processes consist of emphasizing agape love, the necessity to cultivate a sincere and open relationship with the client.

While they ease the process of settling with past unresolved issues they also help with discovering spiritual meaning; by means of scriptural truth to stimulate behavior change; depend on the Holy Spirit’s ministering; concentrating on the main goal and stick to techniques that are biblical. The discussion of ongoing research before generated irrefutable statements about the advantage of CBT (Tan, 2007, p. 102). Tan also addressed the use of implicit and explicit integration in therapeutic situations.

He vowed that the choice of either an implicit or an explicit method should be decided first and foremost by the necessities of the client, and that the Holy Spirit should be relied upon for guidance (Tan, 200, pp. 102-103). According to the article, Tan however, did not emphasize to take for granted that all clients will be comfortable with the inclusion of prayer and scripture in the CBT process. He stated that this approach may not be suitable with more severely distressed or psychotic clients (Tan, 2007, p. 104).

A complete intake interview will obviously reveal whether the client is open to this method or whether this technique is appropriate. Tan stressed that this type of approach is very beneficial to clients who are experiencing depression, anxiety and anger issues, as well as those struggling with addictions. One method, developed by Tan in 1992, is a 7-step inner healing prayer. This method is a form of communication between the Counselor and the client to concentrate more on Christ than upon the hurt or childhood trauma they have experienced.

It is really good that Tan also described actual interaction between client and counselor (Tan, 2007, p. 105). Tan indicated that the appropriate and ethical use of Scripture and prayer in CBT can be a significant help to Christian’s clients who completely believe the Bible to be the inspired Word of God and their definitive authority in life (Tan, 2007, p. 108). He also expressed how the use of Scripture can enhance cognitive restructuring.

Although, this technique of combining prayer and scripture with CBT appeared to be a very good approach, Tan cautioned the readers that there are some clients who will not accept it, even though several empirical studies have shown its benefits. It is evident to see how the author is addressing an approach to therapy that has in the past been overlooked by many typical practitioners. The combination of CBT with prayer and scripture obviously provides most clients with durable, maintenance-free resolution.

Since we are created by God (Genesis 1:27), in my opinion, it makes perfect sense to go to him when something is broken and need repairing. As Christians, we understand that absolute truth comes only from the Scriptures and that God alone is truth. In the beginning was the Word, and the Word was with God, and the Word was God (John 1:1). I believe Christian counselors should, therefore, make positive use of what God has given them in their attempts to reconstruct an individual’s thought rocesses. Subsequently we all have bad thinking sometimes and are in need to reframe the mind. For instance, according to the word, Jesus died for all of our sins (John 3:16, 1 John 2: 1-2), but after we accepted Jesus Christ in our lives, most of us struggled with self- forgiveness. We can only count on the Holy Spirit to change our thoughts and reveal the truth through the Scriptures to replace all the lies and misconceptions, we formulated from old traumatic experiences.

The knowledge I accrued from this article are similar to what I went through myself last year around this time; but, I would say I found it very encouraging that experimental studies are beginning to demonstrate the benefits of incorporating prayer and scripture into CBT, and that the scientific community is beginning to take notice. After reading this article, I was inspired to look for more information on this subject, and see what others are doing in this area to help people who profoundly brokenhearted.

It’s acknowledged that in CBT a therapist with the best intentions can convince a client to reason differently about themselves and to change their views about their history. Although, after I observed a family member fell into a deep depression after she lost of her husband, got better with Therapy then lost it completely when her mother passed away. It is apparent that at any particular time in a client’s life one day, something dramatic can happen and all the work accomplished can be undone by another disturbing event that can cause the client to regress to the previous defective thinking.

I would say, I truly believe until a client is set free by the Lord Jesus Christ, the giver of life (Genesis 2:7); they will never be completely free. Application As a Christian who had to face my own demons in life, I could say before July 2011 I never used the principles of the inner healing prayer. It was not until I was strike by a very rare illness that was destroying me mentally and physically, no doctor or specialist knew what was wrong with me when part of the sickness was visible physically. All tests ran was very good but no one new or could explain why I was so sick.

It wasn’t until a friend of mine took me to his Co-Pastor at a new Church, and the pastor and his wife are both professional Christian counselors. They used that approach for me and I found it to be a very effective approach. Although, I have to say that I truly believed God did a miracle for me due to the fact that I was not only healed mentally, but also physically. I will definitely use this method when I complete my degree and begin helping people. Furthermore, I plan to use this approach with references to the Scriptures, as the Lord guides me for all my clients who will be open to this method.

Even though, right now I am working as an accountant, my line of work does not involve any counseling or helping people but I have many of my tax clients, business clients, Church brothers, sisters and friends with various problems. Many are depressed, suffer from gender confusion, childhood traumas and addiction issues. I believe with the help God, this extra education and with support from my husband and children, I will incorporate prayer and scripture with CBT in my ministry at my church and in my community. My approach with my clients will be to always begin a session with prayer.

Then a complete intake interview, follow with encouraging the client to reflect and retrieve the memories that have been the most traumatic if it is a new client. I will help the client to develop a warm and open relationship with me, make he/she feels safe and that it is okay to accept the truth of what happened, and recognize the hurts and dishonesties associate with the memories. As the client re-live the events of what took place in the past, I will pray silently and call upon the Holy Spirit to take control, to give me discernment and reveal the truth to me about the memories.

I will then encourage the client to tell me what he/she is feeling and discern from the answers what book of the Bible can be helpful according to the Word of God. I will also tell the client to do a confession prayer to ask God for forgiveness and help to forgive anyone that was not easy to forgive. This will then be followed by giving the client some homework that might include a 3 day of fast while asking God to reveal more memories. I will ask them to write down anything else that God reveals during the fast after the previous session.

After the client has obtained truth from the Lord regarding the painful event, we will then re-visit that place and see how the client feels about the memory and how he/she relates to the new experience. From there I will ask the Holy Spirit to guide me to what to do next. I will encourage prayer, reading the scriptures, meditation on the word and anything that transpires before the next session. I will end the session by asking the client to pray and thank God for revealing the truth.

The use of prayer and scripture in combination with CBT seems to be a very effective technique to help clients make sense of their difficulties. I believe this approach can be the best medicine for a long-term change and freedom from memories who are affecting people’s lives. References Dake Annotated Reference Bible. Tan, S. -Y. (2007). Use of prayer and scripture in cognitive-behavioral therapy. Journal of Psychology and Christianity, 16(2), p. 101-111.

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Massage Therapy

Annotated Bibliography and Critique: Massage Therapy September 19th, 2012 Introduction The alternative therapy I chose to research was Massage therapy. The Oxford Dictionary of Psychology defines massage therapy as “manual manipulation of soft tissue to promote physical and mental health and well-being. Forms of massage therapy can be traced back to ancient Chinese, Egyptian, Greek, Roman, Hindu, and Japanese civilizations” (“massage therapy”, 2008).

I chose to do this topic for my annotated bibliography because I am interested in learning more about the benefits of massage and to understand ways of healing pain and discomfort through touch and manual manipulation. I believe that massage therapy is not only helpful in the relief of pain and discomfort but also helps in the emotional maintenance of romantic relationships. Article One Ho, Y. , Lee, R. , Chow, C. , & Pang, M. (2010). Impact of massage therapy on motor outcomes in very low-birthweight infants: Randomized controlled pilot study.

Pediatricsinternational, 52, 378-385. The purpose of this randomized trial was to “investigate the efficacy of massage therapy on stable preterm VLBW infants in promoting motor development, weight gain, and earlier discharge from the hospital” (Ho et al. , 2010, p. 378). Ho et al. suggest that “it is generally accepted that infants at 32 weeks gestational age and beyond may benefit from massage therapy” (Ho et al. , 2010, p. 378). This was a randomized controlled intervention pilot trial that studied infants whose gestational age was between 25 and 34 weeks with VLBW.

Two types of massage interventions were performed on separate groups of infants for 15 minutes in duration. One intervention being 5 minutes of massage therapy with tactile stimulation in the first and third phases and physical activity phase in the second phase and the other therapy (sham treatment) consisted of gentle still touch producing no indentation in the skin. Each treatment was done an hour after feedings. Daily caloric intake was recorded as well as bodyweight before intervention, at 36 weeks PCA, and after intervention.

The results of this study were shown to be that out of the 24 infants that were involved, the “infants with poor initial motor performance had significantly more improvement in motor outcomes and shorter length of hospital stay following massage therapy than sham treatment” (Ho et al. , 2010, p. 381) Article One Critique Strengths of this article were the thorough explanation of the therapies done with the infants. This allows for easy replication of the study should anyone try and implement these types of massage therapies in hospital NICU’s.

This article also outlined implications for future research suggesting that a large sample size would be beneficial for another study to have more accurate results. The author’s use and interpretation of the evidence lead to the same conclusion as was given in the conclusion. Appropriate methods to gather evidence was used and measurements were done at appropriate growth stages. I believe that the results of this study were congruent with what the conclusion stated in the end.

Shortcomings of this article are stated within the article saying that “the effect of massage on preterm infants’ motor developmental outcomes thus remains uncertain, and a study with a more rigorous study design is warranted” (Ho et al. , 2010, p. 378). Excluding certain infants from the study I believe was also a short coming in this article. They limited infants that had maternal drug addictions, congenital abnormalities, and genetic disorders. This was a limitation to this study because it didn’t allow for results to show if massage therapy could benefit these types of conditions in newborns.

Limiting infants such as ones with congenital abnormalities may have allowed the results to show better growth in the overall group. For future studies infants with conditions such as congenital abnormalities or maternal drug addiction could be included as a third subgroup for testing of massage therapy to see if the benefits of this alternative therapy aids in their growth and development. Article Two Munk, N. , Kruger, T. , & Zanjani, F. (2011). Massage therapy usage and reported health in older adults.

The Journal of Alternative and Complimentary Medicine, 17(7), 609- 616. A randomized study was done to examine the impact of massage therapy in older adults with persistent pain compared to persistent pain clients who have not sought out the use of alternative therapies such as massage therapy. This article suggests that “high rates of persistent and acute pain have been reported by users of complementary and alternative medicine (CAM) including recipients of massage therapy (MT), with pain being the primary reason some adults utilize CAM treatments” (Munk et al. 2011, p. 609). Participants of this study were 60 – 92years from Lexington, Kentucky either from 500 randomly selected Feyette County voters or from surveys given out at massage therapy clinics. Surveys and questions were dispersed to each participant and answers were recorded. The results of this study were “mean annual income and years of education were significantly higher for those who utilized MT in the past year compared to those who did not indicate MT usage in the past year” (Munk et al. , 2011, p. 611).

Furthermore, “participants who utilized MT in the past year had significantly higher incomes, more years of education, and greater cumulative CAM usage than those who did not report massage usage” (Munk et al. , 2011, p. 612). Article Two Critique The strengths of this article were that it suggested future studies to look into things such as policy change that would help with older adults being able to afford massage therapy or be covered under their benefits. Another strength of this article was that it lists its limitations, allowing future studies to build off of the limitations they had and continue with the study.

Shortcomings of this article were that it didn’t talk much about the positives that older adults experience from massage therapy. I would have found it more beneficial to understand how older adults benefited from massage therapy in regards to their persistent pain. Another shortcoming of this article, as stated on page 609, is that “due to the limited existence of evidence-based studies, the benefits of MT are not well understood for older adults, especially in regards to pain” (Munk et al. , 2011, p. 609).

As well, a wider variety of patients could be used to see how different types of people or conditions could benefit from massage therapy. This article was limited to only the Kentucky population rather than a wider variety of people. With this study being centered around a survey and data analysis I feel that surveys could have been sent out worldwide to get a better understanding of massage therapy and its benefits on a wide variety of conditions. More shortcomings were that there was no real measure of pain or how long it lasted for in the participants.

This makes me wonder about the authors’ conclusion of massage therapy being “associated with self-report of less limitation due to physical or emotional issues” (Munk et al. , 2011, p. 614). The last short coming of this article was that there was no actual controlled massage therapy taking place, rather it was just assumed through self reports that massage therapy aided in the management of persistent pain. Article Three Sefton, J. , Yarar, C. , Berry, J. , & Pascoe, D. (2010). Therapeutic massage of the neck and shoulders produces changes in peripheral blood flow when assessed with dynamic infrared thermography.

The Journal of Alternative and Complimentary Medicine, 16(7), 723-732. The objective of this repeated-measures crossover experimental design study was to “determine the effect of therapeutic massage on peripheral blood flow (Yarar et al. , 2010, p. 723). It is suggested that “MT may improve circulation to damaged or painful tissues, and thereby improve the delivery of metabolic fuels and gas in addition to accelerated waste removal”( Yarar et al. , 2010, p. 724). “Thus, massage treatment may improve tissue function and potentiate tissue repair by removing barriers to healing processes” (Yarar et al. 2010, p. 724). 17 volunteers were chosen for this study. “Using a blinded, randomized crossover design, each subject completed the control (C), light touch (LT) and massage (MT) conditions on 3 separate days, at least 1 week apart” (Yarar et al. , 2010, p. 724). The participants were then scanned by dynamic infrared thermography (DIRT) and anterior, posterior and lateral thermal images were taken. “The key finding of this investigation was that the MT condition produced significantly higher skin temperatures when compared to the control condition in five zones” (Yarar et al. , 2010, p. 27). “Importantly, significant changes were found in zones 9 and 13, areas adjacent to the massaged areas that did not receive massage treatment” (Yarar et al. , 2010, p. 727-728). “These results suggest that a 20-minute MT protocol can increase skin temperature and peripheral blood perfusion to both the areas receiving massage treatment as well as areas adjacent to the treatment” (Yarar et al. , 2010, p. 728). “The second key finding in this investigation was that the LT condition did not differ significantly from the C condition” (Yarar et al. , 2010, p. 728). Article Three Critique

The strengths and shortcomings of this article were that it was, to me, very difficult to read with the abbreviations throughout. There was only one method used for measuring the temperature of the skin following massage treatment after a few different methods were mentioned in the beginning. The strengths were that it outlined the changes in every zone after treatment, making it clear what areas benefited from treatment. Much time was taken into the discussion part to better understand the results that came of this study. The graphs on pages 729 and 730 are a great way of showing readers the different affects each treatment had on the zones.

The use of DIRT to measure the surface temperature without touching the skin was beneficial to this study because it does not require direct touch to the skin. This allows for accurate results because contact with the skin could possibly increase temperature readings. However, I think further study into other methods of taking temperature could have been done to have more options and a wider variety of results. Different variety of massage therapies, such as relaxation massage versus deep tissue massage, could bring about different results as well. Perhaps with deep tissue massage arterial blood flow would be encouraged throughout the body.

The final shortcoming of this article I thought to be the small sample size of 17 participants. However, results were rather accurate due to each participant experiencing each of the 3 treatment types. Application to health care I believe these articles are all applicable to health care because each one is related to a type of condition or illness that could benefit from massage therapy. Low birth weight infants are born every day and finding an alternative therapy to helping with growth and development would help in reducing medical costs and helps in shortening hospital stays for the families affected.

Aging adults are often affected by persistent pain from ware on their bones and joints. As an alternative of using harsh prescription medications, massage therapy would help with medical costs as well as lessen the complications and undesirable side effects that come with taking pills all the time. And lastly, massage therapy being used to help with peripheral blood flow to areas that may have little to no circulation can help with lessoning the chance of DVTs, decrease medical costs and improve healing time. Conclusion

In conclusion, massage therapy is effective in helping low birth weight babies with gaining weight and having shorter hospital stays as well as improvement in management of persistent pain and increase in peripheral blood flow. More studies could be done in regards to other positive effects that massage therapy has such as, mental and emotional health and well being. The articles reviewed in this annotated bibliography showed that very low-birth weight infants can benefit from massage in regards to promoting motor development and weight gain.

Massage therapy in older adults experiencing persistent pain, according to self reported findings, improves limitation due to physical or emotional issues. And therapeutic massage helps with increased surface temperature aiding in peripheral blood flow. References Ho, Y. , Lee, R. , Chow, C. , & Pang, M. (2010). Impact of massage therapy on motor outcomes in very low-birthweight infants: Randomized controlled pilot study. Pediatrics international, 52, 378-385. Massage therapy. (2008). In A. Colman (Ed. ), A Dictionary of Psychology (3rd ed. ). Retrieved from http://library. troyal. ca:2139/view/10. 1093/acref/9780199534067. 001. 0001/acref- 9780199534067-e-9168? rskey=9C7gUq&result=1&q=massage%20therapy Munk, N. , Kruger, T. , & Zanjani, F. (2011). Massage therapy usage and reported health in older adults. The Journal of Alternative and Complimentary Medicine, 17(7), 609-616. Sefton, J. , Yarar, C. , Berry, J. , & Pascoe, D. (2010). Therapeutic massage of the neck and shoulders produces changes in peripheral blood flow when assessed with dynamic infrared thermography. The Journal of Alternative and Complimentary Medicine, 16(7), 723-732.

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Occupational Therapy vs Physical Therapy

Many people might question the relationship between occupational therapy and physical therapy. Some think the professions are the same or that the terms are the same; there are a few different therapies for people who have been faced with a stroke, a disability, or any injury that has caused physical restrictions. The methods and techniques used in these therapies can overlap with each other, but both occupational therapy and physical therapy covers all aspects of the patient’s health including their physical, psychological, and mental state. Occupational therapists and physical therapists are similar when it comes to training.

The fields of occupational and physical therapy usually involve the training of patients and improving the abilities of their motor functions. Occupational therapists and physical therapists share certain areas such as body awareness, strength and endurance, classroom positioning and adaptations, and sensory motor skills. They both involve accessing the medical history of the patients as well as evaluating their current performances, setting therapeutic goals, developing a plan, and applying a treatment that enables the patient to function better.

After an illness, serious injury, or surgery, you may recover slowly. One may need to regain their strength, relearn lost skills or find new ways of doing things they once did. The process is called rehabilitation. Rehabilitation often focuses on occupational therapy to help the patients with their daily activities. Physical therapy is needed to help their fitness, mobility, and strength. One example of how a similar activity might be used in occupational therapy versus physical therapy is where the patient might be asked to work on a crossword puzzle or another activity.

In occupational therapy, the OT would be watching to see how well the patient is able to understand and spot the words among other letters, and the patient’s capacity to hold the pencil steadily and circle the word. In the physical therapy setting, the PT might have the patient stand up at the table if he/she usually sits in a wheelchair and maintain his/her balance while circling the words. For this certain activity the gross motor controls would be more of the focus.

There are also some differences between Occupational therapy and Physical therapy that may make each therapy distinctive from each other. Occupational therapy mainly focuses on evaluating and improving the patient’s functional abilities. The OT does not directly treat a person’s injury but they do help the patient gain back their freedom and their ability to accomplish their daily activities. The occupational therapists main purpose is to improve life skills and most of the time involves adaptive equipment.

On the other hand, physical therapy is focused on treating the patient’s injuries itself and helping prevent further injuries. The PT will make a diagnosis and treat the physical source of the problem like the structures and injured tissues. A physical therapist studies mostly over the musculoskeletal system and the anatomy. Occupational therapists receive extra training in oral and hand skill interventions and physical therapists obtain more training in the postural development and gross motor.

The common and easy dividing line is, occupational therapists work with the patient’s body from the waist up, and physical therapists work with the patient’s body from the waist down. Although occupational and physical therapy uses different methods when treating the patients, the number one goal for both professions is the same: they both solve the function of maintaining the fitness and overall health of the individual. Both of the professions make every effort to cover all the aspects of the human health such as; mental, physical, and psychological.

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Terminal Illness Impact on Family Functioning and Bowenian Therapy

Terminal Illness Impact on Family Functioning and Bowenian Therapy Abstract This paper will discuss the adjustments that accompany terminal illness within a family setting. The methods that are applied in the theory of choice will be explored as to whether the treatment is appropriate for this type of tragedy. The compatibility of this theory and this issue will be explored when dealing with the family unit. Terminal Illness Impact and Bowenian Therapy A family is two or more people who consider themselves family and who assume obligations, functions, and responsibilities generally essential to healthy family life. (Barker, 1999. p. 55). Families create patterns that are passed on from grandparents to parents and from parents to children. These become the traditions and part of the value systems that are instilled in the lives of all that are involved. Murray Bowen developed his views of theory pertaining to family systems theory. His view is a theory of human behavior that views the family as an emotional unit and uses systems thinking to describe the complex interactions in the unit. (www. thebowencenter. org/pages/theory. html). His perspective of the family as a whole having an impact on each individual family member was also shared by many of his colleagues.

The objective was to work with the family to understand that unresolved conflict with our original families is the most important unfinished business of our lives. He started out working with mother and child, and then he added fathers to the equation. (Nicholas & Schwartz. 2009, p. 138). The interactions between family members generate how a crisis is handled. If a family is close knit, it may be a considered a sign of weakness to let outsiders know how they are feeling or if there is a problem within the family.

Generation to generation brings an aspect to the next generation about how a matter such as terminal illness is handled. The emotional interdependence presumably evolved to promote the cohesiveness and cooperation families require to protect, shelter, and feed their members. (www. thebowencenter. org/pages/theory. html). Older family members such as great grandparents may come from an era that believed in privacy or the cultures may consider this type of problem a bad omen. This is not necessarily a bad thing, but maybe not a good one either. Stress causes may reactions in many different ways.

According to Bowen, the family is viewed as an emotional unit and uses system thinking to describe the complex interactions in the unit. (www. thebowencenter. org/pages/theory. html). A family has a specific purpose for everyone included. It gives a sense of familiar, a sense of completeness, and a sense of belonging. Attachment to the family member that is sick is ultimate for the entire family. The bond sometimes becomes more of an issue than the actual stress of the patient having a terminal illness. Terminal illness and death, however, would appear to be the ultimate way to resolve the attachment bond. Clair, 2000, p. 512). Terminal illness is an infection or disease which is considered ultimately fatal or incurable. It can go undetected, patients cannot afford proper care, or the illness is virulent enough that it will resist medical intervention. (www. wisegeek. com/what-is-a-terminal-illness. htm). Terminal illness impacts the entire family. The family consists of more than just parents and children. Grandmothers, grandfathers, aunts, and uncles make up family as well. There are people who become part of a family through interactions throughout people’s lives.

Friends can be just as much a part of the family as the biological members. Some people have better relationships with outside people than those who are born to them. Some parts of the family may not fit as well as others because even though a family is considered a functioning unit, all parts do not always work. When there is anxiety or stress within the family, the individual members show how they can function on their own. Differentiation of self from the family of origin is defined as the ability to function autonomously as an individual without being emotionally dependent upon or attached to the family process. Murdock & Gore, 2004, p. 319). Behind closed doors families have an order of rank. There is an order that an individual serves in the community, but the family is the most important role someone can have. The individual that has the strongest backbone so to speak is usually the person higher up the rank chain. This person is usually the tradition carrier. This is usually the one who has the ability to keep the family functioning in time of stress. The responsibility that accompanies being a family member may be more than some people can handle.

When a serious illness is an issue that families deals with every day, somehow there will be problems. If there is an imbalance between togetherness and separation forces in the family system, anxiety is experienced within the individual. (Ecke, Chope, & Emmelkamp. (2006), p. 84). Stress is any influence that interferes with the normal functioning of an organism and produces some internal strain or tension. (Barker, 2003. p. 420). Discovering that a tragedy of this type is a problem within any family is not a good thing, yet sometimes it takes a crisis to fix what is wrong.

Stress contributes to the way an individual’s life will function. When a family is going through a traumatic event, the functioning of the individual is not what is thought about. The fact that someone that is loved is going through a hard time is a major factor. It is not a time to think about other members of the family, it is centered on the person who is sick. Most families put the differences aside so that the issue at hand can be dealt with. Bowen viewed that the two forces: togetherness and individuality centered on the two counterbalancing each other. (Nichols & Schwartz. 009. P. 140). If a family member has an unresolved issue of some sort with other family members, then how can it be expected for the family to function in a time of distress? Resolving an emotional attachment to the family is what this theory says must take place in order for the functioning to work. As adults we are expected to fulfill certain roles and positions. As productive aspects of the community as well as within the family as a participating member, this must be accomplished. It reflects back to the upbringing and the culture that a person comes from.

When a family is not able to function as a whole unit, stress can be a good thing because it gives the family a common goal in which to work towards fixing together. Terminal illness can be a surprise as well as an expected occurrence. It can cause strain on a family emotionally, financially, and physically. Dealing with grief and loss, may make the family feel as if they are on a roller coaster ride. The ability of a family’s survival is a part of the foundation on which the family is built. Illness can last for short periods of time as well as for extended periods.

Every member of a family handles situations differently. According to Kubler-Ross, grief has stages that a person goes through. Denial, anger, bargaining, depression, and acceptance is the order in which a person is suppose to grieve, but it may not necessarily work out that way. (Zastraw & Kirst-Ashman, 2007. p. 566). Some stages may be skipped or some may not be gone through at all. The ability to pass from one stage to the next is how the family system functions is an aspect of Bowen’s theory. In Bowen’s theory, the stress response expands beyond the individual to include the family.

He theorized that if a family functions under the strain of stress then the individual could function. The family as a unit revolves around the fact that each member of the family plays an important role. If one of the members can not pull their weight, then the entire family could suffer. If one person is not able to accept and handle what is thrown out when dealing with an issue such as terminal illness then the entire family system could suffer. The way a family works is dependent on how its members can work together as a single functioning unit. Families create alliances in many ways.

Sometimes in families parents are each others’ support while the children usually stick together. Usually alliances are formed as well as the normal array. Children gravitate to the grandparents or to a favorite aunt or uncle as well as other relatives. The family figures out how to make the family work by the way the alliances are formed. The way problems are handled can easily be passed from generation to generation. Culture plays a part in how families deal with issues within the family. Children are affected more often during this type of situation in the family.

The adults feel that the children should be protected at all cost. Grieving is a normal process of life as well as being a part of the family circle. Grief is the multifaceted response to death and losses of all kinds, including psychological, emotional, social, and physical reactions according to Waldrop. (Waldrop, 2007, p. 198). Telling a child that a parent or grandparent has a sickness that may take them away is somewhat difficult to do. If a child is not an appropriate age to understand the concept of what a terminal illness is, then they cannot grieve properly.

This is a part of the family system that has a breakdown. The children not understanding and being able to cope and function as individuals in the system gives the theory some weight. Even adults who do not come to terms with the severity of the stress of dealing with a terminal illness will cause extra stress for the family. People who are not biological member of a family can still be family members. Doctors, nurses, and other caregivers become a part of the family because of the relationship that is build when they come into ontact with the family. As an individual tries to demonstrate the capability of growing and becoming a productive part of society, the way a family creates bonds is essential to that goal. As people interact relationships from all walks will make paths become intertwined. Some of these relationships become as strong as relationships that come from within the family and just as important. Bowen believed that a family functions as a unit if the individuals in the family system can function on their own.

His theory is to help the individual and the entire family is helped. When a serious crisis comes along and the family members must deal with the emotional, psychological, and even the physical aspects, the ability to put small things aside to look at the overall picture comes into play. It is shown that families work only as well as the members in the family work. Different theorists have used the initial framework of family systems as the basis for their ideas and it has been shown many times that as a system the family works whether functional or dysfunctional.

This theory of Bowen has shown that in order for the family to function in a crisis the individual family members must be able to work together to form the unit. It takes every member doing his or her part. Taking care of individual needs in order to build and maintain healthy relationships is a must. The family does operate as a unit running on the mind, body, and soul of each and every member. It is critical that each member be able to interact and function with the other members. Murray Bowen had the conception that the unit that makes a family can function as a whole if the members can work together.

It is a must that a family needs all of the members in order to create the bound of togetherness that is required to perform completely. There are other theories that would also fit this issue of terminal illness, but Bowen’s Theory also fits that illness and it shows that family members have an impact on a family while dealing with a serious problem. Family means many things to many people. It requires work regardless of the situation that a family is in. The acceptance of loving your family is part of the bond that will not allow a family to stray away from one another even though there will be struggles.

The perception that a family is only functioning if all are participating is not always true. The fact that members can allow themselves to see, give, and say that love is in their hearts and minds, makes a family a wonderful place to be. The theory of Bowen’s and his colleagues helped to create ways for families and their members to have an available resource of treatment. It is good to know that there are options out there that are beneficial to families and their members. References Barker, R. L. (ED). (2003). The Social work dictionary (5th ed. ) Baltimore, MD: NASW Press.

Clair, M. St. , (2000). An unfortunate family: terminal illness and the altering of the attachment Bond. American Journal of Psychotherapy, 54 (4), 512 -518. Davis, B. D. , Cowley, S. , & Ryland, R. (1996). The effects of terminal illness on patients and careers. Journal of Advanced Nursing, 23, 512 – 520. Ecke van, Y. , Chope, R. C. , & Emmelkamp, P. M. (2006), Bowlby and Bowen: attachment theory and family therapy. Counseling and Clinical Psychology Journal, 3(2), 81-108. Fraser, B. , McKay, L. , & Pease, L. , (2010). Interview with Michael Kerr.

Australian and New Zealand Journal of Family Therapy, 31(1), 100 – 109. Klever, P. (2005). Multigenerational stress and nuclear family functioning. Contemporary Family Therapy, 27 (2), 233 – 250. Murdock, N. , & Gore, P. (2004). Stress, coping, and differentiation of self: a test of Bowen Theory. Contemporary Family Therapy, 26 (3), 319 – 335. Nichols, M. , & Schartz, R. , (2009). The essentials of family therapy, 4/e. Boston: Allyn & Bacon. Waldrop, D. , (2007). Caregiver grief in terminal illness and bereavement: a mixed-methods Study.

Health and Social Work, 12 (4), 197 -206. Wright, J. , (2009). Self-soothing – a recursive intrapsychic and relational process: the Contribution of the Bowen Theory to the process of self-soothing. Australian and New Zealand Journal of Family Therapy, 30 (1), 49 – 41. www. thebowencenter. org/pages/theory. html retrieved on October 16, 2011 at 4:30p. m. www. wisegeek. com/what-is-a-terminal-illness. htm retrieved on November 1, 2011 at 1:15 a. m. Zastrow, C. , & Kirst-Ashman, K. (Ed). (2007). Understanding human behavior and the social Environment (7th ed. ) Belmont, California: Brooks/Cole.

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Radiation Therapy

1. What concepts in the chapter are illustrated in this case? What ethical issues are raised by radiation technology? Basic concepts that are covered in this case are responsibility, accountability and liability. Ethical issues that are raised by radiation technology is when scientist is finding ways to use radiation therapy to destroy cancerous cells while making sure that healthy cells are not being harmed. An incident occurred where Mr. Jerome-Parks “experienced deafness and near-blindness, ulcers in his mouth and throat, persistent nausea, and severe pain. (Laudon, 2012, p. 131). Organizations did not take the time to properly train doctors and medical technicians therefore incidents like Jerome-Parks happens. The machines that are used to ‘cure’ patients are not being appropriately updated and watch carefully. In this case study we can see that the technicians are not being fully responsible and being careless, and doctors that are not getting the full training for operating the machine. 2. What management, organization and technology factors that was responsible for the problems detailed in this case?

The management, organization and technology factors were responsible for the problems detailed in this case because they failed to provide extensive training for doctors, technicians, and machine operations as well as insufficient staffs. They should have thought of creating a mandatory checklist for employees each time the machine was being used. The lack of knowledge on the machines, the lack of reporting these incidents for future references instead the doctors and technicians do not troubleshoot the problem unless it is serious and by that time the patient(s) is already injured.

The machines were not well designed, there was software glitch and “the complexity of new Linear accelerator technology has not been accompanied by with appropriate updates in software” (Laudon, 2012, p. 132). 3. Do you feel that any of the groups involved with this issue (hospital administrators, technicians, medical equipment, and software manufacturers) should accept the majority of the blame for these incidents? I feel as if they are all responsible for this issue because if the medical equipment, software manufacturer and technicians were the first people who would be experiencing the machine.

The software manufacturer designed the software so they should have known if there was any error that was missed during the trial and error stage. If there was they should’ve continued with more research until the software was nearly perfect because it is what operated the entire machine. The software was the main source of machine to operate because those software engineers were hired for a reason and they had responsibility in executing the errors and debugging them. This also would go on to the medical equipment and technicians because these technicians should already have knowledge on what is right and what is wrong.

Technicians are the one that tries out the machine at the hospital first they are the one that have the main knowledge on how these machines should be operating. All these three should be responsible for this issue since they are part in creating the machine and testing it out. 4. How would a central reporting agency that gathered data on radiation-related accidents help reduce the number of radiation therapy errors in the future? Having a central reporting agency that gathered data of radiation-related accidents could prevent future overdoses, misadministration, and deaths or near deaths.

These data can train future and present doctors from doing these incidents, allows the agency to monitor the use of the machine and especially creates a safety environment. If these accidents were to occur more than once than the managers are the MIS could take in the machines for a more detailed examination, changing the policy and procedures. Also reporting the radiation therapy errors can used to teach future doctors, technicians, medical operators about it so they would not make the same mistake again. At the same time this can save many lives that was once put into danger due to the lack of knowledge, carelessness, and laziness. . If you were in charge of designing electronic software for a linear accelerator, what are some features you would include? Are there any features you would avoid? If I were in charge of designing electronic software for a linear accelerator some features I would include: a check list that is embedded within the machine ensuring that everything goes smoothly, a safety button which allows the machine to alert the doctor or technicians that something went wrong and will automatically shut down if the machine seems to malfunction that can do harm to a patient.

Making sure that the software is doing its job in saving people’s lives, the software will go through multiple of examination until it is working at its potential. Every time the system seems to malfunction it will be sent back to the manufacturing for fixing. I would avoid what happened to those patients that died because of the manufacturer’s error. Anything that was at fault will be avoided and things will be done properly and precisely to ensure every part of the machine is working. Work Cited Laudon, Kenneth and Laudon, Jane. (2012). Management Information Systems: Managing the digital film (5th ed. ). Pearson Education Canada.

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Cognitive Therapy Case Conceptualization

The client: Elena Elena is an adolescent female, coming to the therapy process demonstrating through actions and words a great deal of anxiety and overall apathy for her situation. Elena is a smart, socially engaged Mexican American attending public high school. She opens the session with presenting problems regarding conflict over what she might do after high school. Preliminary conceptualization from a cognitive perspective Overall, there is an obvious feeling of disempowered regarding her right and or ability to make life decisions.

She comes from a close-knit family, though some of her siblings have moved away to seek out goals beyond those that they may feel their parents are putting upon them. She has recently begun to disengage academically and socially as she feels the urgency of choosing to adhere to family tradition or to go out on her own, like her peers. Though she says she has not yet made a decision, know that cognition mediates affect and behavior (Friedburg 101).

From this perspective a therapist might conclude that her recent apathy toward academics and isolating herself from her peers show that she indeed is letting the thoughts of “I must listen to my parents” drive her life perspective. It is promising from a cognitive standpoint, that she shows some jealousy toward her boyfriend and others: Perhaps the anger when discussing her family dynamics and recent history is most telling that Elena could benefit from Beck’s Socratic dialogue.

The pluralistic views that come from her own identity within her biculturalism are strongly embedded, and the therapist demonstrated this by demonstrating lots of open questions. Letting Elena focus on herself as an individual rather than a Mexican-American could lead to meaningful exploration and collaborative cognitive change to help Elena feel more empowered.

When counseling adolescents from a cognitive perspective the counselor must remember that under any circumstances this may be the first time that these clients might see their actions and behaviors, and question the beliefs that may have become embedded during childhood. Elena obviously needs a relatively short-term look into these feelings due to her grades slipping and applying for colleges, if she so chooses. Asking a client “what is going through your mind right now” (Murdock 337) is one of the base approaches to beginning to help the client recognize their individual thought patterns.

This is a question that is difficult for many adults, and though adolescents in general can be more open to change, Elena’s worldview as a bicultural young woman is overpowering any other automatic thoughts that she might have; it is culturally appropriate for a young Mexican American to disregard her own thoughts and needs for the good of the family—which Elena does in fact voice (Rochlen 2009). As an observer to this case scenario, the challenge, due to age and culture, seems very difficult. The video demonstrates this strong schema Elena has developed that exudes this overwhelming disempowerment.

I believe this schema of overall disempowerment is deeply embedded and will be difficult to challenge through cognitive therapy. Additionally, Mexican culture tends to see the counselor as “expert” and the collaborative aspect of cognitive therapy may prove to be at the least uncomfortable for Elena, if not ineffective. Elena may continue to rely on others’ to make decisions for her, to give her an unconditional guarantee (Corey 107), if this base belief cannot be penetrated due to adherence to cultural tradition, fear of change, or if Elena is unable to begin to identify these automatic thoughts. Possible cognitive strategies

In general, Latino Americans traditionally have strong family bonds and honor generational wisdom (Sue 377) Through the current political venue of the United States and popular culture, Mexican-Americans may fall prey to stereotypes and inherently feel a disconnect or poor self-image: American beliefs certainly account for this inner struggle Elena is feeling. Because this is pervasive and overarching in American culture where to begin with Elena in imperative. There is a lot behind these feelings, and as an adolescent who is struggling the counselor should take these omnipresent cultural truths into consideration.

It is promising to me that Elena is already speaking about her siblings: I see this as an open door for initiating questions that challenge Elena’s view of herself as a young Mexican American. I would certainly recognize Elena’s frustration and give lots of positive regard as she speaks about her presenting problem. Cognitively, I would go back to Elena’s conversation regarding the varying paths her siblings have chosen. I would respectfully move through this aspect of cognitive therapy so as to not threaten Elena’s loyalty to her family.

Since Beck’s model is based on a leading rather than a more confrontational approach, I would use this to my advantage to allow her to explore her emotions about her siblings and their life choices. I see this as an aspect of Elena’s life experience that may allow Elena to begin to explore self-identity outside of the effects of biculturalism. Keeping the central focus of thought exploration on how she might challenge her beliefs about her life choices through reflecting on her siblings’ life choices may be a safe way to allow Elena to begin connecting the deeper thoughts behind her ability to make life choices.

From a cognitive perspective and the lens of cultural identity, my goal for Elena would be for her to begin understanding that many are facing overwhelming decisions within their own cultural context. At some point everyone must decide to respect family wishes or go out on her own. Elena would be challenged to explore the beliefs she holds regarding herself as a Mexican American; she could begin to see how the complex construct is not a means to an end. Helping Elena expose automatic thoughts and change subsequent behaviors could serve to identify the struggle she will face as a bicultural woman in America today.

Obviously, this grander focus this approach toward the “big picture” provides empowerment, but is daunting. Collaboratively, it would be ideal to praise Elena for exploring her identity on a grander scale. At this point, I would encourage Elena to do some homework: Her recent social isolation undermines her support system and exploration of self-identity. Many of her friends to do not sound as if they are struggling as bicultural adolescents: Meeting with a Latino cultural group on her local college campus would be an ideal way to allow her to feel empowered as well as supported.

I am sure that many others have faced this kind of multicultural dilemma in their formative years, and have come up with myriad life choices. Though I can help Elena begin to understand and possibly question her core beliefs that drive her behaviors, she will need safe and pertinent ways to explore them. Elena is a very intelligent young lady, and I do think from our observation that she inherently knows that as well.

Finding places and people with whom she can identify will empower her—not pressuring her into making a decision about her next step in life; with a goal toward hearing other stories of biculturalism in America and give her a comfortable place to explore her wishes for her own future and how she might find congruency between her choices and her heritage. I am certain that once her belief of what it means to be Mexican-American is challenged in some authentic way, she will begin to explore her automatic thoughts about cultural identity.

My hope in working with Elena from a cognitive perspective is that she will begin to see her own identity and realize how her own thoughts had created a situation that most certainly is not the only possible scenario for her path in life. Relevant multicultural considerations From the perspective of a bilingual educator and a culturally aware individual, I was ultimately unable to separate Elena’s biculturalism from the cognitive approaches and questioning that I would practice with Elena.

Though this aspect of Elena’s life situation appears hopeless to her now, I believe through finding authentic ways to identify with successful, independent Mexican-Americans she might begin to expose the prevailing automatic thoughts leading her to these isolating, dichotomous conclusions. The last relevant multicultural aspect that I have not addressed is it would be imperative that I find an opportunity to speak with Elena’s family, and connect them with other families who are raising children in a bicultural environment.

This is ideal because Latino families need opportunities to be involved in the community and support one another in myriad ways. non-productive cognitive approaches Note how at the beginning of this integrated discourse regarding Elena’s pull toward family tradition and sense of loss for her dreams of going to college I was careful to note which door felt safe and respectful to collaboratively open with Elena.

Siblings, cousins, aunts and uncles may “stay out of family business” such as the pressure from her mother, but it would be culturally insensitive for me to have Elena challenge her thoughts and risking her attaching them to family ties. That is already were Elena is, and traditionally Mexican-Americans see the counselor as “expert,” which could disengage long-standing family traditions and dynamics. I am convinced that approaching Elena through questions about herself, her riends, her academic life, and family would have made her feel that cognition is knowable and accessible, which is an underlying foundation of Beck’s theory. If a counselor were to solely base their approach, without multicultural considerations, on cognitive therapy with Elena as an individual it could serve to not allow herself to fully feel her human emotions, nor to bring awareness that change is central to the human process.

I do not think asking Elena to explain how her beliefs construct her reality without first finding meaningful ways for her to relate to others outside of herself could she effect any change at all. Cognitive therapy, through the lens of multiculturalism, must always consider the bigger picture of what their life perspective really is: If challenged directly about her mother Elena may have only further solidified her commitment to fail at school to have a concrete reason to obey her parents.

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Nitric Oxide Therapy in infants with pulmonary hypertension

The benefits of nitrogen oxide (NO) therapy as used in the treatment of infants with persistent pulmonary hypertension (PPHN) can be best appreciated if the reader is familiar with the pathophysiology of PPHN and the previous methods used in treating the disease. The function of NO has evolved in the minds of the scientific community from being a mere noxious gas emitted by vehicles to a wonder compound in the field of medicine. In the area of pulmonology, its vasodilatory effect in the blood vessels is now being used to assist PPHN patients in rerouting blood flow in infants whose blood circulation fails to shift from fetal to normal circulation.

Such nature of the compound, being the main ingredient in NO therapy allows for a less invasive procedure which in effect reduces risks of complications during and after treatments, expected in previous treatment methods. This reduced risks account for the relatively more cost-effective character of NO therapy as a treatment method in PPHN patients.

There is not much use for the lungs during the fetal life. At such stage, the function of the lungs is carried out by the placenta through the umbilical cord. Fetal life is characterized by a high pulmonary vascular resistance (PVR) with pulmonary blood flow being restricted to a less than 10% lung-directed cardiac output. Blood vessels that connect the heart and the lungs are constricted, sending the circulating blood back to the heart through the ductus arteriosus, a blood vessel that functions only in fetuses. In other words, the lungs in the fetal stage are bypassed.

At birth, when the lungs finally assume the function of gas exchange, the PVR decreases, allowing for an increase in pulmonary blood flow. The blood vessel that is previously constricted, favoring blood flow to the ductus arteriosus is now relaxed, simultaneously with the permanent closure of the ductus arteriosus. This happens as the lungs become ventilated and the alveolar oxygen tension is increased.

Persistent Pulmonary Hypertansion occurs when at birth, the lung circulation fails to achieve the normal drop in PVR, preventing the transition from fetal to newborn circulation. This failure results in the continuous functioning of the ductus arteriosus which impairs the flow of blood from the heart to the lungs and limits the amount of oxygen that can be picked up by the blood to be delivered to the different parts of the body. The blood that flows back to the heart remains in an unoxygenated state which could lead to the development of refractory hypoxemia, respiratory distress and acidosis.

It is only in 1987 when nitric oxide (NO) was recognized as a key endothelial-derived vasodilator molecule. From then, research has been expanded to establish the role of NO throughout the body, and to discover its therapeutic potential.  To appreciate the effects of NO in alleviating pulmonary hypertension, it is important to gain understanding of its chemistry and mechanism of action.

Nitric Oxide is a gaseous compound that rapidly diffuses across membranes and has a single unpaired electron. This explains its high reactivity, especially to Hemoglobin (Hb) in the blood. This nature of the compound accounts for its noted biological significance. It has been discovered to function as stimulant in the release of hormones; as neurotransmitter; a significant participant in the magnification of synaptic actions and learning processes; and an inhibitor in platelet aggregation, which makes it a marvel in the field of cardiology. In the field of pulmonology, nitric oxide is valued for its vasodilatory effect in the blood vessels.

This effect can be explained by the mechanism involving the compound’s diffusion from the vascular endothelial cells to the subjacent smooth muscles of the pulmonary vessels. From here, NO activates the enzyme guanylate cyclase to change conformation to promote smooth muscle relaxation by converting GTP to cGMP.  This vasodilatory effect signals the mechanism to modulate blood flow and vascular tone.

Given the mechanism of action, it is easy to surmise how NO can be utilized as a therapeutic agent in the management of blood-vessel-related diseases such as those related to the heart (hypertension), the reproductive system(erectile dysfunction) and in this case, the lungs (Persistent Pulmonary Hypertension in infants (PPHN)).

Before NO, treatments used in infant PPHN are hyperventilation, continuous infusion of alkali, tube vasodilation and vasodilator drugs. A study on the effects of these various treatments was done by Ellington, Jr., et. al., (2001) showing no specific therapy clearly associated with the reduction in mortality in infants. In determining whether therapies were equivalent, the study showed that hyperventilation reduced the risk of extracorporeal membrane oxygenation (ECMO) with no oxygen increase at 28 days, while alkali infusion increased the use of ECMO as well as an increase in the use of oxygen at 28 days (Ellington, Jr., et. al., 2001). ECMO is a highly invasive procedure that requires major surgery, performed in serious cases of PPHN when patients fail to respond to treatments.

It is only after post-lab studies were able to identify the role of NO-cGMP signaling in the regulation of lung circulation that NO therapy was developed for PPHN (Channick, R., et. al., 1994). Like previous treatment methods, NO therapy improves oxygenation as well as reduces the risk of ECMO in infants with PPHN (Oliveira, et. al., 2000). But because nitric oxide is capable of acting on its own upon inhalation to relax the blood vessels and improve circulation, it is considered as a less invasive procedure in the management of infants with PPHN compared to the previous treatments mentioned in the preceding paragraphs.

The efficiency of the treatment procedure can be determined by observing its effect on the patient’s ventilation and blood flow, which is a determinant of the efficiency of transpulmonary oxygenation and partial pressure of oxygen in the systemic arterial blood (Ichinose, et. al., 2004). NO therapy enhances the mechanism by which blood flow is redistributed toward regions in the lungs with better ventilation and higher intra-alveolar partial pressure of oxygen (Ichinose, et. al., 2004).

Other treatments used in the management of PPHN such as tube ventilation, alkalosis and intravenous vasodilators were shown to be effective in ameliorating pulmonary hypertension in some infants, but in many instances, it does not, as ECMO almost always becomes a necessity in saving the life of the infants (Ichinose, et. al., 2004). A type of hyperventilation has been proven not to increase the risk of ECMO, but unlike NO-therapy (Ellington, Jr., et. al., 2001), it is invasive as to require a tube inserted inside the infant’s trachea.

In patients with moderate PPHN, there is an improvement in arterial p a O 2, reduced necessity of ventilator support and low risk of progression to severe PPHN (Sadiq, et. al., 2003) and this, without the risk of increasing the incidence of adverse outcomes when the age of 1 year is reached (Clark, et. al. 2003). Inhaled NO is able to rapidly increase the arterial oxygen tension and increase the blood flow in the lungs without causing systemic hypotension (Roberts, 1992; Kinsella, 1992). No apparent increase in morbidity has been shown after one year of treatment with NO (Aparna and Hoskote, 2008). For high-risk infants with PPHN, inhaled NO has been found to lessen the risk of pulmonary hypertensive crisis (PHTC) after congenital heart surgery (Miller, et. al. 2000).

Studies on the role of NO in the management of PPHM show that while it is therapeutic, it also prevents the occurrence of chronic lung disease which affects morbidity. Vascular cell proliferation and pulmonary vascular disease have been shown to decrease with NO in the newborn (Roberts, et. al., 1995). In addition, while NO treatment can be more costly, it is the most cost-effective among other methods because of the reduced need for ECMO (Angus, et. al. 2003). For these reasons, it is understandable why NO therapy seems to have taken over in the area of PPHN treatment.

References

Angus DC, Clermont G, Watson RS, et al. (2003). Cost-effectiveness of inhaled nitric oxide in the treatment of neonatal respiratory failure in the United States. Pediatrics. 112, 1351–1360.

Aparna U., Hoskote, MD., et. al. (2008). Airway function in infants treated with inhaled nitric oxide for persistent pulmonary hypertension. Pediatr Pulmonol. 43, 224-235.

Channick R, Hoch R, Newhart J, et al. (1994). Improvement in pulmonary hypertension and hypoxemia during nitric oxide inhalation in a patient with end-stage pulmonary fibrosis. Am J Respir Crit Care Med. 149, 811-814

Clark, RH., Huckaby, JL., et. al. (2003). Low-Dose Nitric Oxide Therapy for Persistent Pulmonary Hypertension: 1-Year Follow-up. Journal of Perinatology. 23, 300.

 Ellington Jr, Marty, O’Reilly, et. al. (2001). Child Health Status, Neurodevelopmental Outcome, and Parental Satisfaction in a Randomized, Controlled Trial of Nitric Oxide for Persistent Pulmonary Hypertension of the Newborn. Pediatrics,107.

Ichinose F, Roberts JD, et.al. (2004). A Selective Pulmonary Vasodilator: Current Uses and Therapeutic Potential. Circulation. 109, 3106-3111.
Kinsella JP, Neish SR, Shaffer E, et al. (1992). Low-dose inhalation nitric oxide in persistent pulmonary hypertension of the newborn. Lancet.  340, 819–820.

Miller O, Tang SW, et. al. (2000) Inhaled nitric oxide and prevention of pulmonary hypertension after congenital heart surgery: A randomised double-blind study. The Lancet. 356: 9240, 1464.

Oliveira cac, et. al. (2000). Inhaled Nitric oxide in the management of persistent pulmonary hypertension of the newborn: a meta-analysis. Rev. Hosp. Clin. Fac. Med. S., 55 (4): 145-154, 2000

Roberts JD Jr, Polaner DM, Lang P, et al. (1992). Inhaled nitric oxide in persistent pulmonary hypertension of the newborn. Lancet. 340, 818–819.

Roberts JD Jr, Roberts CT, Jones RC, et al. (1995). Continuous nitric oxide inhalation reduces pulmonary arterial structural changes, right ventricular hypertrophy, and growth retardation in the hypoxic newborn rat. Circ Res. 76, 215-222.

 Sadiq HF, Mantych G, et. al. (2003). Inhaled Nitric Oxide in the Treatment of Moderate Persistent Pulmonary Hypertension of the Newborn: A Randomized Controlled, Multicenter Trial. Journal of Perinatology.  23, (2).98

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Benefits of Animal Assisted Therapy

Angelica Carlos English 4 19 March 2012 Benefits of Animal Assisted Therapy Throughout human history, “animals have occupied a central position in theories concerning the ontology and treatment of sickness and disease” (Serpell 16). Animals have played a major role in the lives of humans in ways that have affected our entire being and survival. Countless amounts of people, animals, and time have been put into bringing AAT all over the world; as a result, five other countries have adopted this form of therapy.

The volunteers and workers of Animal Assisted Therapy have pushed to bring an exciting new therapy to children and adults all around. Animal-assisted therapy (AAT) is a familiar method of treatment and rehabilitation in many diseases and conditions, where the animal becomes an important “behavioral facilitator”, causing improvements in the behavior and health of the patient. “Numerous authors and medical professionals point to its importance and in particular that the positive feedback between the patient, the animal, and the therapist reduces many symptoms, and improves the quality of life” (Yeh 2005).

The history of Animal Assisted Therapy can be traced back to the 9th Century. It is a goal-oriented intervention in which an animal that meets the criteria becomes an integral part of the treatment process for patients. The benefits of Animal Assisted Therapy far outweigh the risks, and should be used and recognized as an effective form of therapy. AAT in a natural environment brings about the encounter between a patient and an animal, which elevates the motivation and strength of the individual. The therapist-animal-patient trio establishes such mechanisms which increase the level of communication. It enhances motivation, the driving force that heals” (Journal of Psychology 44). The patient learns to experience himself/herself in relation to others, and to better perceive truth and reality. Pressure from school can exacerbate medical and psychological pathologies in kids. “The use of Animal Assisted Therapy and Animal Assisted Activities maybe [a] useful tool which could be offered in school counseling” (Chandler 2000). If AAT is offered in schools, it could bring in students who are too scared and embarrassed to talk about their problems. The presence of an animal can facilitate a trust-bonding relationship between therapist and client” (Chandler 2000). The bond between client and therapist is essential because without a connection no progress will be made in the recovery of the patient/client. Additionally, “Animal Assisted Therapy interactions are goal directed, individualized to the patient and has documented progress” (Bloomquist). The purpose of AAT is to develop checkpoints and make a patient’s recovery fast and fun. With the goals in mind, it is easier to track a patient’s progress.

Animals keep the patient in check; “positive psychological and psychosocial [and physiological] benefits have been linked to the presence of animals. Reductions in blood pressure, heart rates, and stress levels, as well as increases in emotional well-being and social interaction are benefits from the human- animal bond “(Jorgenson 1997). Animals become more aware of possible problems and act as caretaker. “Animals can be aware of internal states, and so they can alert individuals of impending seizures [and any other health emergencies]” (Granger).

We accept animals as potential healers and major contributors to our health, happiness, wellness, and vitality. The effectiveness of AAT “has gained wide spread support and application over the past few decades” (Connor 2000). The therapy involves special training for the animals to work with patients. The Delta Society defines Animal Assisted Therapy as a targeted intervention in which an animal complying with specific criteria represents an integral part of the therapeutic process. Animal Assisted Therapy has physical, mental, educational and motivational effects on the participants. From the physical point of view, the therapy improves the fine motoric abilities, the use of the wheel-chair, and the maintenance of equilibrium when standing. ”(Zasloff 1994) Certain animals can improve the development of motor skills that the patient is missing. “In the mental health area, it improves attention, concentration, and self-esteem reduces anxiety and loneliness, improves verbal interaction, and develops recreation and leisure abilities. ”(Zasloff 1994) AAT promotes cognitive development in a patient, which is an important for normal societal function. “Educationally, it improves vocabulary, as ell as long and short term memory. Motivationally, the presence of an animal increases the desire for joining in group and social activities, and improves interaction with others. It is applied both in groups and individually” (Zasloff 1994). The use of various animals is not uncommon in animal-assisted therapy: dogs, cats, birds, horses, dolphins, rabbits, lizards, and other small animals. However, dogs are the most frequently used animals because of their training and sociability skills. “Many times children will tell things to an animal that they feel uncomfortable telling to an adult or therapist” (Bloomquist).

Animals give off a relaxing feeling and allow the child to feel more comfortable and open. The child will be more trustworthy of the animal and can talk about anything without feeling judged. Every human has a story to share, and the animal is just easier to share it with. People in hospitals all share one hope, and that is for a fast recovery through any means necessary. “In some hospitals, canine-visitations are enabled for patients afflicted with chronic diseases, including the participation of medical staff, animal owners and veterinarians” (Lefebvre 2006).

Animal visitation boosts morale in nursing homes, hospitals, psychiatric wards and even prisons. The faces of these people become lit up when the animals comes to visit. Almost instantly the participants forget where they are and the pain they are in. “Dogs and owners are familiarized with hospital rules, which require mandatory documentation on the dogs in terms of vaccinations, and the control of behavior and temperament. Trainers [receive] advice and instruction on how to conduct a therapy group” (Barker 1998). When a dog comes for a visitation, all rules and regulations are set into place to conduct a safe therapy session.

Even though dogs are the preferred animal for hospital visitations, “cats are often used for therapeutic purposes, as are birds. Some authors discovered that group meetings held in premises with caged birds have better patient attendance, more involved participation, and better results compared to the appropriate control group who stayed in premises without birds”(Barker 1998). Bigger animals, like dogs, can be intimidating to patients, so smaller animals are used as alternatives to elevate the amount of people who come to the sessions and participate.

In horse-assisted therapy observations are made on the effects on the neuromuscular system of the patient caused by the mechanical influence of the horse walk. Specific to the horse therapy is that the patient continuously receives impulses from the horse walk, which lead to a relaxed perception of the body, equilibrium, and coordination of movement. “Humans and horses walk very similarly, when a person is sitting on top of a walking horse, the body goes through the same movements as if he/she was walking by him/herself. ” (Beiry 437).

Children with motor skill issues can participate in equestrian therapy to develop an identical walking sensation. The similarity between the two is astonishing. This is particularly significant in motoric deficiencies caused by hereditary lesions, such as cerebral paralysis in children. The very process of fitting the horse with saddle and harness, and acceleration in riding, improve the coordination of arms and shoulders, and sharpen the perception of one’s body and one’s self, which leads to improved strengthening of independence and resolve. All of this leads to better communication in the family, and improved work skills and quality of life “(Yeh 2005). Comparatively, “Hippotherapy has been used successfully with one-sided paralysis and other problems with asymmetry” (Beiry 352) Hippotherapy is another term for equestrian therapy and has worked wonders on patients who suffer through paralysis. “Benefits of Hippotherapy include increase in flexibility, balance, and arm and leg strength. ” (Beiry 352-54). The development progress is one-hundred percent in terms that children and adults developed fine tuned motor skills that were otherwise non-existent.

Development of leg and arm strength is seen in people who participate in Hippotherapy the patient develops the strength and confidence to walk on their own. Equally, “in the presence of a horse, there are other influences on the patient, such as visual, auditory, olfactory, and tactile. The warmth of the horse and the touch during grooming act positively on the patient. Such therapeutic meetings are practiced 2 to 3 times per week” (Yeh 2005). It has been observed that during horse riding, the rider experiences a unique interaction with the animal with which he shares a relationship and space.

A communication is therefore established, resulting in gratification and motivation, which in turn alleviates pathologies. In the same fashion, “animal visitation and therapy in critical care helps motivates patients by reminding them that there is life outside the walls to which in time, they’ll return”(Connor 40). AAT allows for people to develop an outgoing/positive outlook on life, despite the fact that they are confined. “Critical care nurses use AAT to relieve patients stress during [procedures]” (Connor 52).

Certain procedures that a patient must endure cause an immense amount of pain, but with the animal there, a patient can focus on the animal and ignore the pain almost completely. In a unique way “AAT reduces anxiety levels of institutionalized patients” (Connor). Institutionalized patients are often if not always in a constant fear, but with an animal present during their therapy session, the patient can relax and worry less. With an animal there patients develop a “willingness to be involved” (Connor). Patients become more eager to participate. They know that participating will allow them to pet the animal.

In turn, patients will develop an eagerness to participate in society. Florence Nightingale, founder of modern nursing, once wrote “A small animal is often an excellent companion for the sick. ” Animals will never leave a person because of a disease or a disability. No matter the situation, an animal will say by your side. “Animals serve to buffer and normalize an aging person’s sense of social isolation” (Journal of Psychology). Never does an animal pass judgment on someone, nor reject someone for being different. Animals only provide unconditional love to all young and old.

Because patients can become lonely, bored in hospitals, so the animal visitations are something to look forward to. “AAT provides patients with entertainment and social interaction” (Abdill 8). Patients can have fun while experiencing the beneficial parts of the therapy. It brings entertainment to people in hospitals, homes, and even prisons. “Animals smooth all kinds of social interactions” (Abdill 79) Patients who go through AAT learn how to interact with other people. The more people who work with an AAT animal, the easier it is to talk to others.

Although AAT has been acknowledged by many medical professionals, some still doubt the validity of Animal Assisted Therapy. Some families tend to stay away from AAT because of the cost. “AAT cost three-thousand to five-thousand dollars” (Baxter). Cost should not be the one thing that prevents a person from partaking in AAT. Most facilities offer free sessions to any person who wants to get involved in AAT. Skeptics will also say that AAT is not an effective form of therapy. “AAT is for a purely recreational purpose” (Baxter) The therapy allows for development in physical and cognitive function.

To further their point, people who oppose the use of AAT mention the danger it brings to the animals as well as the patients. The danger they see with the animals is aimed at DAT or Dolphin Assisted Therapy. “Removing dolphins from the wild results in separation from their families” (Baxter). Also stated is that DAT often results in the “deaths and/or injuries of many dolphins” (Baxter). Experts have acknowledged the separation a dolphin can feel, so they put those dolphins in tanks with other dolphins so they could form their own family. Only a small amount of dolphins die while participating in DAT.

The dolphins are given one-hundred and ten percent of attention and care. Furthermore, AAT employees “[limit] the time an animal is ‘on duty’ and keep the animal safe from accidents and/or aggressive behavior”(Granger 230). Safety of both patient and animal is the top priority during each therapy session. Rules and regulations are set in place for safer sessions and visits that are both fun and productive. In addition, opponents will say that AAT may be “physically hazardous to the body”, and there have been “multiple reports of children injured” (Baxter). On rare occasions children are injured, but at the fault of the AAT supervisors.

Very rarely is the fault placed on the animal. However, “patients and animals participating in these programs require special care in order to avoid transmission of infectious diseases associated with pets, hypersensitivity and accidents during their visits” (Jofre 2005). To prevent accidents, animals are thoroughly screened and tested before being approved for training to become an AAT service animal. There are many different roles an animal plays in someone’s life. A person who is living with a disability can have their day brightened up by the touch of an animal. Animals can become the very thing you need.

They adapt to the persons needs. “Animals can sooth the emotionally distressed and relieve physical pain” (Graham). These service animals can make a person healthier and happier just by being by their side. One will never feel alone when beside and animal; “animals provide a valuable relationship that serves such functions as companionship, tactile stimulation, safety and nonjudgmental emotional support” (Graham 50). “Many individuals will thrive from the positive attention they will receive from a companion animal” (Graham). Individuals feel loved and adored by the animal which in turn makes the person strive to be a better person.

The feeling of pride from an animal can feel a whole in somebody who is empty inside. “Animals are tools for therapy because they can make people feel safe and loved when they have been deprived of social interaction or hurt by other people” (Granger). People who are denied from emotions are more reserved. Animals can bring the trust back to a person who has no real reason to trust anyone. When an animal is brought into a room, the faces of everyone present glows. The benefits of AAT are so great that some believe in animals more than they do doctors. Animals are windows to our souls and they understand people better than some doctors do.

It is as though animals know exactly what people need when they need it most. It is obvious that animals bring so much into the lives of the people who need most. AAT has advanced a great deal in the last years. Beginning in the days of the Romans, people have relied on animals for a number of things such as, farming, transportation, hunting and lastly, companionship. In the twenty first century, people are still relying on animals for mental and physical healing, even though modern medicine has come so far. The medical field has and continues to grow with leaps and yet the four legged furry friend is still needed and wanted above all else.

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Free Essays

Nitric oxide therapy

There is not much use for the lungs during the fetal life. At such stage, the function of the lungs is carried out by the placenta through the umbilical cord. Fetal life is characterized by a high pulmonary vascular resistance (PVR) with pulmonary blood flow being restricted to a less than 10% lung-directed cardiac output. Blood vessels that connect the heart and the lungs are constricted, sending the circulating blood back to the heart through the ductus arteriosus, a blood vessel that functions only in fetuses. In other words, the lungs in the fetal stage are bypassed.

At birth, when the lungs finally assume the function of gas exchange, the PVR decreases, allowing for an increase in pulmonary blood flow. The blood vessel that is previously constricted, favoring blood flow to the ductus arteriosus is now relaxed, simultaneously with the permanent closure of the ductus arteriosus. This happens as the lungs become ventilated and the alveolar oxygen tension is increased.

Persistent Pulmonary Hypertansion occurs when at birth, the lung circulation fails to achieve the normal drop in PVR, preventing the transition from fetal to newborn circulation. This failure results in the continuous functioning of the ductus arteriosus which impairs the flow of blood from the heart to the lungs and limits the amount of oxygen that can be picked up by the blood to be delivered to the different parts of the body. The blood that flows back to the heart remains in an unoxygenated state which could lead to the development of refractory hypoxemia, respiratory distress and acidosis.

It is only in 1987 when nitric oxide (NO) was recognized as a key endothelial-derived vasodilator molecule. From then, research has been expanded to establish the role of NO throughout the body, and to discover its therapeutic potential.  To appreciate the effects of NO in alleviating pulmonary hypertension, it is important to gain understanding of its chemistry and mechanism of action.

Nitric Oxide is a gaseous compound that rapidly diffuses across membranes and has a single unpaired electron. This explains its high reactivity, especially to Hemoglobin (Hb) in the blood. This nature of the compound accounts for its noted biological significance. It has been discovered to function as stimulant in the release of hormones; as neurotransmitter; a significant participant in the magnification of synaptic actions and learning processes; and an inhibitor in platelet aggregation, which makes it a marvel in the field of cardiology.

In the field of pulmonology, nitric oxide is valued for its vasodilatory effect in the blood vessels. This effect can be explained by the mechanism involving the compound’s diffusion from the vascular endothelial cells to the subjacent smooth muscles of the pulmonary vessels. From here, NO activates the enzyme guanylate cyclase to change conformation to promote smooth muscle relaxation by converting GTP to cGMP.  This vasodilatory effect signals the mechanism to modulate blood flow and vascular tone.

Given the mechanism of action, it is easy to surmise how NO can be utilized as a therapeutic agent in the management of blood-vessel-related diseases such as those related to the heart (hypertension), the reproductive system(erectile dysfunction) and in this case, the lungs (Persistent Pulmonary Hypertension in infants (PPHN)).

Before NO, treatments used in infant PPHN are hyperventilation, continuous infusion of alkali, tube vasodilation and vasodilator drugs. A study on the effects of these various treatments was done by Ellington, Jr., et. al., (2001) showing no specific therapy clearly associated with the reduction in mortality in infants. In determining whether therapies were equivalent, the study showed that hyperventilation reduced the risk of extracorporeal membrane oxygenation (ECMO) with no oxygen increase at 28 days, while alkali infusion increased the use of ECMO as well as an increase in the use of oxygen at 28 days (Ellington, Jr., et. al., 2001). ECMO is a highly invasive procedure that requires major surgery, performed in serious cases of PPHN when patients fail to respond to treatments.

It is only after post-lab studies were able to identify the role of NO-cGMP signaling in the regulation of lung circulation that NO therapy was developed for PPHN (Channick, R., et. al., 1994). Like previous treatment methods, NO therapy improves oxygenation as well as reduces the risk of ECMO in infants with PPHN (Oliveira, et. al., 2000). But because nitric oxide is capable of acting on its own upon inhalation to relax the blood vessels and improve circulation, it is considered as a less invasive procedure in the management of infants with PPHN compared to the previous treatments mentioned in the preceding paragraphs.

The efficiency of the treatment procedure can be determined by observing its effect on the patient’s ventilation and blood flow, which is a determinant of the efficiency of transpulmonary oxygenation and partial pressure of oxygen in the systemic arterial blood (Ichinose, et. al., 2004). NO therapy enhances the mechanism by which blood flow is redistributed toward regions in the lungs with better ventilation and higher intra-alveolar partial pressure of oxygen (Ichinose, et. al., 2004).

Other treatments used in the management of PPHN such as tube ventilation, alkalosis and intravenous vasodilators were shown to be effective in ameliorating pulmonary hypertension in some infants, but in many instances, it does not, as ECMO almost always becomes a necessity in saving the life of the infants (Ichinose, et. al., 2004). A type of hyperventilation has been proven not to increase the risk of ECMO, but unlike NO-therapy (Ellington, Jr., et. al., 2001), it is invasive as to require a tube inserted inside the infant’s trachea.

In patients with moderate PPHN, there is an improvement in arterial p a O 2, reduced necessity of ventilator support and low risk of progression to severe PPHN (Sadiq, et. al., 2003) and this, without the risk of increasing the incidence of adverse outcomes when the age of 1 year is reached (Clark, et. al. 2003). Inhaled NO is able to rapidly increase the arterial oxygen tension and increase the blood flow in the lungs without causing systemic hypotension (Roberts, 1992; Kinsella, 1992). No apparent increase in morbidity has been shown after one year of treatment with NO (Aparna and Hoskote, 2008). For high-risk infants with PPHN, inhaled NO has been found to lessen the risk of pulmonary hypertensive crisis (PHTC) after congenital heart surgery (Miller, et. al. 2000).

Studies on the role of NO in the management of PPHM show that while it is therapeutic, it also prevents the occurrence of chronic lung disease which affects morbidity. Vascular cell proliferation and pulmonary vascular disease have been shown to decrease with NO in the newborn (Roberts, et. al., 1995). In addition, while NO treatment can be more costly, it is the most cost-effective among other methods because of the reduced need for ECMO (Angus, et. al. 2003). For these reasons, it is understandable why NO therapy seems to have taken over in the area of PPHN treatment.

References

Angus DC, Clermont G, Watson RS, et al. (2003). Cost-effectiveness of inhaled nitric oxide in the treatment of neonatal respiratory failure in the United States. Pediatrics. 112, 1351–1360.

Aparna U., Hoskote, MD., et. al. (2008). Airway function in infants treated with inhaled nitric oxide for persistent pulmonary hypertension. Pediatr Pulmonol. 43, 224-235.

Channick R, Hoch R, Newhart J, et al. (1994). Improvement in pulmonary hypertension and hypoxemia during nitric oxide inhalation in a patient with end-stage pulmonary fibrosis. Am J Respir Crit Care Med. 149, 811-814

Clark, RH., Huckaby, JL., et. al. (2003). Low-Dose Nitric Oxide Therapy for Persistent Pulmonary Hypertension: 1-Year Follow-up. Journal of Perinatology. 23, 300.

Ellington Jr, Marty, O’Reilly, et. al. (2001). Child Health Status, Neurodevelopmental Outcome, and Parental Satisfaction in a Randomized, Controlled Trial of Nitric Oxide for Persistent Pulmonary Hypertension of the Newborn. Pediatrics,107.

Ichinose F, Roberts JD, et.al. (2004). A Selective Pulmonary Vasodilator: Current Uses and Therapeutic Potential. Circulation. 109, 3106-3111.
Kinsella JP, Neish SR, Shaffer E, et al. (1992). Low-dose inhalation nitric oxide in persistent pulmonary hypertension of the newborn. Lancet.  340, 819–820.

Miller O, Tang SW, et. al. (2000) Inhaled nitric oxide and prevention of pulmonary hypertension after congenital heart surgery: A randomised double-blind study. The Lancet. 356: 9240, 1464.

Oliveira cac, et. al. (2000). Inhaled Nitric oxide in the management of persistent pulmonary hypertension of the newborn: a meta-analysis. Rev. Hosp. Clin. Fac. Med. S., 55 (4): 145-154, 2000

Roberts JD Jr, Polaner DM, Lang P, et al. (1992). Inhaled nitric oxide in persistent pulmonary hypertension of the newborn. Lancet. 340, 818–819.

Roberts JD Jr, Roberts CT, Jones RC, et al. (1995). Continuous nitric oxide inhalation reduces pulmonary arterial structural changes, right ventricular hypertrophy, and growth retardation in the hypoxic newborn rat. Circ Res. 76, 215-222.

Sadiq HF, Mantych G, et. al. (2003). Inhaled Nitric Oxide in the Treatment of Moderate Persistent Pulmonary Hypertension of the Newborn: A Randomized Controlled, Multicenter Trial. Journal of Perinatology.  23, (2).98

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Free Essays

Hippotherapy

Plan of the project: 1) What is hippotherapy? 2) Analysis of the organization 3) SWOT analysis 4) Target Audience 5) Objectives PR campaign 6) Task of PR campaign 7) Plan of the PR program 8) Work plan of preparation for the conference “Hippotherapy-riding to health” 9) Information for controllable mass media 10) Information for non-controllable mass media 11) Budget 12) Press kit: * Press release * Information about organization * Biography of the CEO * List of quotations * Logo * Questionnaire for journalists

What is hippotherapy? About hippotherapy known since the time of Hippocrates. He claimed that the wounded and the sick get better faster if they ride on horseback, and melancholic part with their dark thoughts. In the middle of the XVIII century the encyclopedist Denis Diderot, in his treatise: “About riding and what it means to maintain health and to find it again”, wrote: “Among the exercise the first place belongs to ride. It can be used to treat many diseases, but may also prevent them befores they appear. Hippotherapy is a comprehensive and multi-method of rehabilitation, a form of physiotherapy (physical therapy), where tools for rehabilitation are the horse, the process of riding and exercising that a person does during riding. While riding all the major muscle groups of the body receive a work out. This occurs at a reflex level, because sitting on the horse, moving along with it, the person instinctively tries to keep the balance not to fall off the horse, and thus encourages the active work of both healthy and affected muscles, without noticing it.

Hippotherapy is the only type of treatment when the patient may not understand that he is treated, riding and communication with the horse becomes a game. Psychogenic factor increases the ability to adapt to reality. For a person with a mental disorder, the position on a horse becomes winning – “I above, but they below”. All the fundamental principles of psychotherapy – a unity of place and characters, the unity of time and unity of action – stay complied. Hippotherapy is effective in: • Cerebral palsy. • Orthopedic syndromes. • Disorders of the musculoskeletal system that result from paralysis and other lesions of the central nervous system. Lesions of the senses – blindness, deafness. • Disorders of posture, scoliosis • Malformations of the limbs. • Various forms of intellectual disability resulting from organic or genetic diseases. • Down syndrome. • Violations of the psycho-emotional sphere: * Autism * Neuroses * Mental retardation * Schizophrenia * Emotional disorders * Social maladjustment * Syndrome of hyperactivity * The state of anxiety The process of riding improves blood circulation and breathing, it involves the work of almost all the muscles and tendons, ligaments and joints of the body.

This is particularly important for autistic people, who cannot be motor-active without stimulation from the outside – not counting their stereotypical movements. The horseback riding includes training of overall coordination, maintaining balance and responsiveness. It trains senses and a deep sensitivity. Through the senses different stimuli are taken and accumulated. The horse becomes a link between the inner world of the person and the surrounding reality. Communion of human and horse is a full chain of communicative feedback between person and the outside world, which allows a person to perceive reality more wholly.

Analysis of the organization: Hippotherapy center SPIRIT was established in 2010 in Kiev, by a group of enthusiasts with the support of Children’s Psychological Center. The center has eight experts: three hostlers and 5 hippotherapy specialists. It is located in the city of Kiev. The center has its own space: the manege – ?? 900 m? , 200 m? stable, cafe 35 m? and public spaces of 30 m?. In the property of hippotherapy center SPIRIT there are ten horses. An average weekly visits of the center 50 people. The cost of training is 40 UAH. An annual income from services of the organization is 96,000 UAH.

An annual income from conferences and seminars is 250,000 UAH. Expenditure on the horses and the activities of the center is 600 000 UAH. The difference between the revenue and expenditure of the budget is covered by the Center of State Support, donations from individuals and charitable organizations, including «American Hippotherapy Association». To date, the HC SPIRIT has an opportunity to conduct 90 classes per week and is planning in two years to expand the area of ?? the base in half and increase the number of horses to 15. SWOT analysis Strengths

Enthusiasm, love of horses, the desire to help people, professional knowledge and experience in the field of hippotherapy, specialists in medicine, such as: rehabilitation, neurology, psychotherapy and psychology. Existence of its own space in Kiev and trained horses. The support of the Children’s Psychological Center. Weaknesses Material and technical infrastructure is not powerful enough to meet the demand for the services of the organization. Opportunities Prepared strong scientific base on a global level. The growing interest to hippotherapy of the target audience.

The development of social orientation in sport, community and government organizations. Growth of financial capacity of the target audience through the creation and development of relevant charities, philanthropy and government support in recent years. Threats Unstable economic situation, the high cost of maintenance of horses (feeding, treatment, ammunition), high rates for advertising. Target Audience The target audiences for PR action are parents of children with specific diseases at whose treatment the hippotherapy is aimed.

The scientific community is interested in the exchange of information in the study of hippotherapy. Ukrainian and international governmental and non-governmental organizations that are related to the specific theme. Objectives PR campaign At this stage, the Organization aims to increase attendance in half and increase organizational effectiveness for the treatment of profile diseases, which, in turn, increase the interest in the work of the HC SPIRIT of the Ukrainian and international governmental and charitable organizations and increase their funding in the center.

This will enhance the material and technical base of the center and go to the free form of treatment for patients. Also, the expansion of international recognition will help the exchange of scientific information and enhance the effectiveness of treatment. Task of PR campaign Improve the knowledge about the HC SPIRIT of potential customers, Ukrainian and international governmental and charitable organizations. Enhance the image of the center as an open, social-oriented organization with professional, scientific approach to work and the desire to develop.

Plan of the PR program: 09:00 – 09:30 Registration of Journalists Meeting with the guests near the Hotel “MIR”, departure to the HC SPIRIT 09:30 – 10:00 Opening. Speeches by the President of the Equestrian Federation of Ukraine A. Onishchenko and the Deputy Head of the department of Reform and Development of medicine N. Hobzey. 10:00 – 11:00 A scientific conference on “Hippotherapy in the treatment of cerebral palsy. ” Speakers: Professor A. Denisenko (Ukraine), neurologist, Professor D. Tsverava (Georgia) 11:00 – 12:00 Coffee Break 2:00 – 13:30 A scientific conference on “Hippotherapy in diseases of the musculoskeletal system” Speakers: Professor M. Rukhadze (Georgia), Professor Naomi Robert (USA) 13:30 – 14:00 Lunch 14:00 – 14:30 Reception of children from Rehabilitation Center 14:30 – 16:00 Master Class. Hold by prof. Naomi Robert and prof. D. Tsverava. The program includes: practical lessons with children demonstrating different methods of hippotherapy in cerebral palsy, scoliosis, osteochondrosis 16:00 – 16:30 Departure of children to rehabilitation center.

Coffee break 16:30 – 17:00 Communication with visitors. Questions and answers 17:00 Departure of guests from HC SPIRIT to the Hotel “MIR” End of program. Information for controllable mass media: For “Horses” & “What’s On” Magazines: “Hippotherapy – riding to health” – the slogan of charity event for children with disabilities. Nowadays it is great to hear about different kinds of charity events that are going on in all parts of the world. We are not an exception, being heard in Ukraine.

A charity event is going to take place in Kiev, organized by volunteers and Hippotherapy center SPIRIT. It is an event for children with mental disabilities from rehabilitation center. Do we hear about hippotherapy every day? It is a form of physical, occupational and speech therapy in which a therapist uses the characteristic movements of a horse to provide carefully graded motor and sensory input. Hippotherapy is also used in speech and language pathology. This method uses a horse to accomplish traditional speech, language, cognitive, and swallowing goals.

Using hippotherapy, appropriate sensory processing strategies have been integrated into the treatment to facilitate successful communication. So, basically we can help the children without them even noticing it. The charity event is taking place on 6 April 2013. Children are transported from the rehabilitation center right to the HC SPIRIT. The parents are also invited to receive more information about the therapy. Professors and doctors prepare speeches about what is hippotherapy and how it can be used as a treatment for the child.

The event is sponsored by the following organizations: the Equestrian Federation, Hippotherapy center SPIRIT, the Ministry of Labor and Social Policy of Ukraine, the Ministry of Health of Ukraine, Children’s Psychological Center and American Hippotherapy Association. Information for non-controllable mass media: An event devoted to hippotherapy, which helps children with mental disabilities from Kiev rehabilitation center, is going to take place on the 6th of April 2013 in HC SPIRIT. Sponsors, doctors and professors, parents and children, as well as authorities are going to be present at this event.

The main goal is to attract the society’s attention to children with disabilities and to inform guests about advantages of hippotherapy. The project is sponsored and supported by: the Equestrian Federation, Hippotherapy center SPIRIT, the Ministry of Labor and Social Policy of Ukraine, the Ministry of Health of Ukraine, Children’s Psychological Center and American Hippotherapy Association. Budget 1. Coffee-break Program| Number of participants| Coffee-break menu| Quantity| Price per unit UAH| Total priceUAH| Price to payUAH| Source of financing| Coffee- break 1| 50? Coffee| 100 | 5 | 500| 4250| American Hippotherapy Association| | | Tea| 100| 5 | 500| | | | | Cookies| 10| 15 | 150| | | | | Sandwiches| 150| 10 | 1500| | | | | Server| 2| 300| 600| | | | | Transportation| | 500| 500| | | | | Other| | 500| 500| | | Coffee-break 2| 50? | Coffee| 100 | 5 | 500| 2750| American Hippotherapy Association| | | Tea| 100| 5 | 500| | | | | Cookies| 10| 15 | 150| | | | | Sandwiches| 150| 10 | 1500| | | Lunch| 50? | Coffee| 100| 5| 500| 2820| HC SPIRIT| | | Tea| 100| 5| 500| | | | | Set lunch| 52| 35| 1820| | | 5 doctors, 5 officials, 10 journalists, 10 personnel, 20 clients, 10 others 2. Transportation Transport| Number of people| Route| Price UAH| Total price UAH| Source of financing| Minibus for children| 10| Rehabilitation center – HC SPIRITHC SPIRIT – Rehabilitation center| 600| 1200| Ministry of Labor and Social Policy| Minibus for guests (doctors and specialists)| 5| Hotel – HC SPIRITHC SPIRIT – Hotel| 600| 600| Ministry of Health| 3. Hotel | Number of people| Number of nights| Price per night UAH| Total Price| Source of financing| Guests (doctors and specialists)| 5| 2| 500| 5000| Ministry of Health| . Presents for children Type of present| Number of presents| Price per unit UAH| Total price UAH| Source of financing| Assorted candies| 50 packages| 40| 2000| American Hippotherapy Association| Books for painting| 50| 40| 2000| | 5. Mass-media Type of mass-media| Type of service| Number of advertisement| Price UAH| Total price UAH| Source of financing| Magazine “Zdorovie”| Order a special article| One page + three photo| 2000| 2800| Children’s Psychological Center| Web-site zdorovbud. com. a| Placing an article| | 800| | | Photograph | | | 500| 500| Equestrian Federation| 6. Advertisement materials Type of advertisement| Type of work| Number of materials| Price UAH| Total price UAH| Source of financing| Prospect, press release? | Layout, printing| 100| 1200| 1200| HC SPIRIT| Prospect of the conference showing sponsors? | Layout, printing| 300| 1500| 1500| Equestrian Federation| Brochure with materials about hippotherapy? | Layout, printing| 100| 2500| 2500| Ministry of Health| Internet banner? | Creating, placement on websites zdorovbud. om. uamedical. us | | 800| 800| HC SPIRIT| ? Distributed four months before the conference to the media, charitable organizations, social organizations, in order to find sponsors. ? Distributed three months before the conference in the profile of medical institutions and doctors. ? Issued after the conference to all interested and distributed to the profile Medical Institutions. ? Placed a month before the conference on websites: zdorovbud. com. ua, medical. us and Equestrian Federation site. 7. Medical and Police support

Department| Type of service| Price UAH| Total price UAH| Source of financing| Medical| Emergency brigade on duty| 1500| 3000| Ministry of Health| Police| Escort of the bus with children| 1500| | | Total expenditures Organization| Expenditures UAH| HC SPIRIT| 4,820| Ministry of Health| 11,100| Equestrian Federation| 2,000| Children’s Psychological Center| 2,800| Ministry of Labor and Social Policy| 1,200| American Hippotherapy Association| 11,000| Total| 32,920| Press kit Press release Horse as doctor and friend for your children. Hippo therapy- new way of treating children with disabilities. Hippotherapy-riding to health” is the slogan of the charity event which is taking place on 6 April, 2013 in Hippotherapy center SPIRIT. The main goal is to inform parents and doctors about the advantages of such treatment. The event attracts society’s attention to children with disabilities. Its aim is to attract more financial help from government, business people and charity organizations. At the beginning the President of the Equestrian Federation of Ukraine A. Onishchenko and the Deputy Head of the department of Reform and Development of medicine N.

Hobzey will present speeches about the importance of such events. The topics of the conference are “Hippotherapy in the treatment of cerebral palsy” and “Hippotherapy in diseases of the musculoskeletal system”. Among the special guests neurologist Professor A. Denisenko (Ukraine), Professor D. Tsverava (Georgia), Professor M. Rukhadze (Georgia), Professor Naomi Robert (USA). Expected number of guests is around 50. The program with horses for children includes practical lessons demonstrating different methods of hippotherapy in cerebral palsy, scoliosis, osteochondrosis.

The project is financed by Equestrian Federation, Hippo therapy center SPIRIT, Ministry of Labor and Social Policy of Ukraine, Ministry of Health of Ukraine, Children’s Psychological Center and American Hippotherapy Association. Contact information: Hippotherapy center SPIRIT Phones: 099-155-24-54, 096-295-95-45, 093-401-36-94 e-mail: spirit. [email protected] com Information about organization The idea of the project was developed by three students of the International Christian University-Kiev. Hippo therapy center SPIRIT was pleased to help in organizing this event on their part.

That’s why the project has a form of charity event. Center SPIRIT was founded in 2010 in Kiev by a group of enthusiasts with the support of the Children’s Psychiatric Center. Experts of the center hold higher education degrees and have been trained on the course “Hippotherapy for children’s diseases” abroad. At the center work professional psychologists, rehabilitation specialists, neurologist. Horses are specifically purchased for use in hippotherapy and are trained by professional athletes. We care about safety. Classes are held with the participation of three people: the ringleader, hippotherapist and assistant to hippotherapist.

Biography of the CEO Director of the Hippotherapy center Spirit, Anna Burago, established the center in 2010. Prior to that, she took a course “Rehabilitation of patients with limited ability” at Medics’ Retraining Facility of People’s Friendship University of Russia. She is a specialist in rehabilitation. In May 2010 she completed a course in “Ridetherapy in Children’s Diseases” and got a qualification of instuctor of hippotherapy at Tbilisi Medical Academy. Every year the center organizes special events regarding hippotherapy. List of quotations

A parent says about the results of therapy: “The biggest change for Maxim has been the area of speech. Before the hippotherapy, he could say only a few words clearly and would attempt speech only if it was modeled for him. After only four sessions, Maxim speaks about 20 words clearly and is making approximations of several more, sometimes spontaneously. Something extraordinary happens to Maxim when he is up on that horse. The feeling of the rhythm of the horse walking seems to be helping Maxim’s brain organize what it needs to make speech happen. ” Professor M.

Rukhadze tells about the difference of hippotherapy from clinics: “Hippotherapy takes the patient out of the traditional clinical setting and places them into a more relaxed, yet stimulating atmosphere in order to help them meet their functional goals. Patients are in a natural environment, which may help integrate their needs into everyday life experiences. Children, who are sensitive to being “different”, do not consider the riding environment to be a clinic. ” Logo Questionnaire for journalists 1. Name and last name 2. Company 3. Phone number 4. E-mail

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Radiotherapy – One World Essay

What are the Benefits and Drawbacks of Radiotherapy? Cancer is one of our planets most concerning illnesses at this time. It is the uncontrollable growth and forming of malignant tumours. In 2007, it was said to cause about 13% of all human deaths worldwide (Kleinsmith, Lewis J. M. D). Some cancers may be cured and this depends on certain variables such as the type of cancer, where the cancer is, and how early it has been detected. One method of treatment for cancer is Radiation therapy (Radiotherapy). This is the medical use of ionizing radiation to control or kill these malignant cells.

However, there is doubt among society about the use of radiotherapy. This is mainly because some long-term side effects include the growth of scar tissue, infertility and damage to other areas of the body, depending on the location of the radiation treatment. Another major reason for doubting this treatment is because in some cases, people may also develop a secondary cancer as a result of exposure to radiation. Therefore this is a global issue and in the following essay, the social and economic factors involved in this topic will be discussed. Radiation therapy is commonly applied to the cancerous tumor because of its ability to control cell growth. Ionizing radiation works by damaging the DNA of exposed tissue leading to cellular death. To spare normal tissues (such as skin or organs which radiation must pass through to treat the tumor), shaped radiation beams are aimed from several angles of exposure to intersect at the tumor, providing a much larger absorbed dose there than in the surrounding, healthy tissue. ” (Cancer Research U. K. ). There are two main types of radiotherapy, internal and external.

The one being discussed in this topic will be external radiotherapy because it is most related to the electromagnetic spectrum, while the other is based more on placing radioactive material inside patients. External radiotherapy uses radiation aimed at a cancer from a machine to destroy the cancer cells. The types of radiation used include high energy X-ray beams, cobalt irradiation or particle beams, such as protons or electrons. The most common types of external radiotherapy, use photon beams (either as x-rays or gamma rays).

A machine called a linear accelerator focuses high-energy X-rays or other high-energy beams (gamma rays) at the cancer. It is concentrated so that the radiation destroys the cancer cells and not the healthy cells around them. Although, healthy cells may be damaged, the cancer cells will take most of the damage and the healthy cells should be strong enough to repair themselves afterwards. “The linear accelerator uses microwave technology (similar to that used for radar) to accelerate electrons in a part of the accelerator called the “wave guide,” then allows these electrons to collide with a heavy metal target.

As a result of the collisions, high-energy x-rays are produced from the target. These high energy x-rays are shaped as they exit the machine to conform to the shape of the patient’s tumor and the customized beam is directed to the patient’s tumor. The beam may be shaped either by blocks that are placed in the head of the machine or by a multi-leaf collimator that is incorporated into the head of the machine. The patient lies on a moveable treatment couch and lasers are used to make sure the patient is in the proper position.

The treatment couch can move in many directions including up, down, right, left, in and out. The beam comes out of a part of the accelerator called a gantry, which can be rotated around the patient. Radiation can be delivered to the tumor from any angle by rotating the gantry and moving the treatment couch. ” (Radiological Society of North America, Inc. ) There are numerous advantages to having radiotherapy in comparison to other treatments to cancer. Using linear accelerators is more efficient than using ring-type accelerators. This is because; linear accelerators can generate and maintain stronger light rays.

This is crucial so that the cancer can be completely destroyed and so that the blasts are concentrated enough to not overly damage the healthy cells surrounding the cancerous ones. The other main advantage of using radiotherapy over other cancer treatments is because it is a focused treatment. Other treatments such as chemotherapy affect the entire body. Therefore, radiotherapy has fewer adverse effects on the rest of the body compared to other treatments. Radiotherapy also has several disadvantages and limitations. Firstly, this treatment can only be used if the cancer has been diagnosed at an early stage.

Once the cancer has spread over several areas, this treatment cannot be used. Also, the linear accelerators require large power supplies, increasing the construction and maintenance expense of the machines. Radiation therapy delivers cancer-killing doses of radiation at the tumor site, the National Cancer Institute explains, but doesn’t travel throughout the body to destroy cancer cells that have spread as chemotherapy treatment can do. Therefore, radiotherapy cannot be used after the cancer has spread to a certain degree. As mentioned, some people may also develop a secondary cancer as a result of exposure to radiation.

There are numerous social factors that question the use of radiotherapy to treat cancer. A major social concern is developing secondary cancer as a result to the treatment. Though possible, this is a very rare situation. Developing a secondary cancer is more likely when being treated with chemotherapy or sometimes internal radiotherapy. Unfortunately, many are unaware of these facts and therefore they refuse to take these treatments. However, this therapy (along with chemotherapy) has been a revolutionary breakthrough in medicine.

Radiotherapy, as mentioned before, would act as an alternative to chemotherapy for patients who have been diagnosed with a cancer in its early stages. Referring to one of the main advantages, this is a very beneficial treatment as it limits exposure to radioactivity, and out of the different treatments, it has the least probability of causing a secondary cancer. Also, because of its accuracy, we have been able to completely irradiate cancerous cells while barley harming the surrounding ones. There are also several economic factors that account to us using radiotherapy.

Firstly, there are major costs for the maintenance of machines such as the linear accelerator, which is crucial for radiotherapy. Because of these expenses, not all hospitals have these equipment and also not many patients can afford to get this treatment. This too is a major limitation of using radiotherapy. However, these machines also benefit the economy as it provides better healthcare (In those hospitals and for patients who can afford it), it also creates more jobs. This is because there must be technicians to fix these machines whenever they are broken, and as said before, they are very high maintenance.

For that reason, there must be regular check-ups on how the systems are running. Especially when considering these machines if run improperly, and at an overdose, can cause cancer. Therefore, this opens more job opportunities. Referring back to the availability of resources such as radiotherapy much depend on location. Unfortunately, people in Ghana do not have the same access to treatments such as radiotherapy to those in the Netherlands. This is mainly to do with the two countries different economical stand points. Most resident of MEDC’s have the chance of receiving such treatments, while many others do not.

Also, seeing as how cancer is a growing problem which caused 13% deaths worldwide in 2007, it is clear that radiotherapy is a viable treatment which should be considered over the globe, so that other people have accessibility to these treatments. This will not only save more lives in the future, but also increase economy due to the reasons stated previously. Throughout this essay, radiotherapy has been discussed. Radiotherapy is a treatment for cancer, by which powerful x-rays are blasted into cancerous tumors, to destroy them, eliminating the cancer.

Though presented with possible side-effects, as well as being expensive, radiotherapy is a viable choice for a treatment to an early caught cancer. This is an example of how science (using x-rays) and technology (creating equipment such as linear accelerators) can work together to create a possible solution for globe issues such as cancer. Two factors affecting the use of radiotherapy has also been discussed, and in conclusion, one can say that radiotherapy is not without limitation; however it can be considered one of the best treatments for early caught cancer.

Bibliography * “About External Radiotherapy. ” : Cancer Research UK : CancerHelp UK. Cancer Research UK, n. d. Web. 12 Nov. 2012. ;http://www. cancerresearchuk. org/cancer-help/about-cancer/treatment/radiotherapy/external/about-external-radiotherapy;. * “Advantages & Disadvantages of Radiation Therapy. ” LIVESTRONG. COM. LIVESTRONG, n. d. Web. 12 Nov. 2012. ;http://www. livestrong. com/article/513783-advantages-disadvantages-of-

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Nature Based Therapy

Introduction Nature based therapy is not a new concept, our well – being and association with nature is part of the never-ending human quest of who were are and just where is our place in this vast environment which surrounds us. In order to better grasp the topic of nature based therapy or ecotherapy, studies consulted were those pertaining to our connection with nature and our wellbeing. Just how does nature connectedness affect our experiencing of a good life is the subject of the first paper reviewed, by Howell, J. A. , Dopko, R. L. , Passmore, H. , Buro, K. (2011).

The second paper by Jordan & Marshall (2010) describes a the changes to the traditional therapy frame in a the uncertain environment of the outdoors. In taking therapy outside, we work with nature as one of the variables in the therapeutic relationship. The integrative, often experiential approach of nature- based therapy or ecotherapy, is gaining rapid ground in the field of counselling and psychotherapy. My final research paper aims at looking further into this growing field and how it can help those suffering from anxiety, burnout and depression. Article Review A Howell, J. A. , Dopko,R. L. Passmore, H. , Buro, K. (2011). Nature connectedness: Associations with well- being and mindfulness. Personality and Individual Differences, 51 (2), 166-171. Howell, Dopko, Passmore and Buro (2011) delve deeply into the question of our connectedness with nature and how it can be measured as a reflection of our mental well- being. The authors, all from the Grant MacEwen University in Edmonton Alberta conducted two empirical studies evidencing this association with data demonstrating that connection to nature may be more beneficial to our emotional and social well- being that previously realized.

Drawing from the Biophilia hypothesis argued by Harvard evolutionary biologist E. O Wilson in 1984, that human beings have an instinctive, emotional and genetic need to be in contact with nature, Howell et al. , thus hypothesize that “higher levels of nature connectedness would be associated with higher levels of well-being and with greater mindfulness. ” Many studies have been conducted on the subject with various results. Howell et al. , describe a study conducted by Mayer and Franz in 2004 which showed a “significant correlation between trait nature connectedness and life satisfaction” (p. 66). They are careful to define the word trait and provide a seemingly through review of the qualitative variables in current literature, discussing the changes in definition of well- being by various theorists (Nisbert, Zelenski and Murphy, 2011). The team from Alberta builds upon current research by probing further into the question of the “whether trait nature connectedness was associated with feeling well … and with functioning well … as well as the relations among nature connectedness and a second index of positive mental health, mindfulness” (p. 67). Howell et al. , review a large amount of research, define terminology and uncover new holes in the theories, they then go on to pose the hypotheses: “are higher levels of nature connectedness associated both with higher levels of well being and with greater mindfulness? ” Methodology Howell et al. , conducted two studies using quantitative methods. In the first study, data was collected from 452 university students, primarily female, with “81. 1% identifying Canada as their country of birth” (p. 167).

Using a variety of questionnaires including Mayer and Franz (2004) 14- item Connectedness to Nature Scale, Keyes’ (2005) 40- item, measure of well being and Brown ; Ryan’s (2003) Mindful Attention Awareness Scale (MASS). In order to ensure objectivity of results, Howell et al. , balanced these scales by using Paulhus’s (1994) Balanced Inventory of Desirable Responding which serves to filter out “unintentionally inflated self-descriptions and impression management” (p 168). In the second study 275 students participated, all students of similar age and demographic as thefirst study.

Howell et al. , used a few of the same questionnaires adding the Allo-Inclusive Identity Scale (Leary, Tipsord ; Tate, 2008) as well as the Philadelphia Mindfulness Scale (PMS) (Cardaciotto, Herbert, Forman, Moitra, Farrow, 2008). In an attempt to provide consistency and validity to the results, Howell et al. , provide succinct definitions and examples for some of the questions on these scales in order that the reader better understand the subtle differences in the descriptive statistics of the variables.

Results Variables such as connectedness to nature, nature relatedness, allo inclusive identity, emotional well being, psychological well being, social well being, MAAS, PMS awareness and PMS acceptance showed correlations between nature connectedness and well being. Descriptive statistics were measured and then correlated among variables using confirmatory factor analysis (CFA). Howell et al. , also provided models with hypothesized correlations between nature connectedness, well -being and mindfulness.

In the first study “associations between nature connectedness and well- being and between well- being and mindfulness were significant; however, the association between nature connectedness and mindfulness was not” (p. 168). In the second study , correlations were significant with respect to psychological and social and emotional well being and with the added test scores added to the soup, nature connectedness was found to be significantly correlated to mindfulness. Discussion Howell et al. are satisfied with their consistent findings and that most results of their two studies support their hypothesis and suggest that ” nature connectedness is associated with the extent to which people are flourishing in their private, personal lives” (p. 170). Howell et al. do admit that some of the findings were inconsistent with their hypothesis and that future research could examine “moderators and mediators of the relationship between nature connectedness and mental health” (p. 170).

They go onto discuss future research possibilities and challenges, including how nature could be incorporated into other activities to produce maximum therapeutic results. Howell et al. , produced convincing research into the relationship between connectedness to nature and well being. They took into account multiple scales of affect in order to collect their results and carefully described their differences and their impact on the final results. I feel their downfall is in their sample size and demographic and suspect results may be different depending on age and culture.

Perhaps new rating scales would need to be developed in order to reflect these differences. Essentially, nature can benefit us all and regardless of the outcome being present within a natural environment will help you learn to experience the moment and perhaps even a renewed vitality in life. Article Review B Jordan, M. , ; Marshall, H. , (2010). Taking counselling and psychotherapy outside: Destruction or enrichment of the therapeutic frame? European Journal of Psychotherapy and Counselling, 12 (4), 345-359

We all know that nature can help us feel better, but just how can we take a traditional therapeutic frame outdoors? What would be the challenges and what is the potential of this upcoming field of ecotherapy? Ecotherapy represents “a new form of psychotherapy that acknowledges the vital role of nature and addresses the human nature relationship” (p. 354) Martin Jordan and Hayley Marshall use relational therapy concepts in order to investigate mutuality and asymmetry and how they may be experienced differently in the great outdoors.

Both Jordan ;Marshall are practicing registered psychotherapists and by using their own experiences, they explore both the successes and challenges to the traditional framework of a therapeutic session. Jordan ; Marshall address many fundamental questions including how confidentiality would be addressed in public settings and how timing or the therapeutic session is affected by practicing counselling and psychotherapy outside. They believe that the challenges to the traditional framework could be sorted out between client and therapist and in fact become part of the process .

A flexible contract could be drawn up, one open to change. Jordan ; Marshall are careful to provide several definitions of a therapeutic frame, from eh uber- conservative “Psychotherapy should be carried out in a soundproof consulting room, in a private office in a professional building” (Langs 1982), to “being seen as a transgression or a dual relationship for the therapist” (Zur 2001). But there are others who believe that the therapeutic boundary should be a dynamic process (Hermansson, 1997) or that the flexibility in the frame is an opportunity for “deepening the therapeutic work and relationship” (Bridges, 1999).

Jordan ; Marshall seem to be covering all bases with their own summary of a therapeutic boundaries,” Working outdoors can throw new light on these traditionally more fixed ideas concerning boundaries and invite an increasingly flexible perspective on issues concerning power and mutuality within the therapeutic relationship” (p. 347). They examine the changes in client therapist relationships and how mutuality must not be equated with equality in terms of the therapeutic relationship. Jordan ; Marshall are not prescribing a recipe for therapy outdoors nor are they saying therapy is better outdoors.

Their goal with this paper is to present their experiential findings and observations regarding the challenges various forms of outdoor therapy impart on the traditional therapeutic frame as well as on the relationship between therapist and client. Methodology The qualitative method devised to learn more about the impacts of taking the therapeutic frame outdoors was simple. Jordan ; Marshall began to hold sessions outdoors with their existing clients. They used two types of interactions outdoors: 1. taking the traditional therapeutic frame of one hour into ‘ nearby nature’ and 2. aking clients on excursions where the frame is extended to over a weekend or more. Relational theory concepts were used in order to better understand how the traditional frame of psychotherapy elements such as “confidentiality and timing of therapeutic work, weather, containment and power dynamics” (p. 347), would be challenged by unpredictable natural environment. The variables of mutuality and asymmetry were also studied in terms of the expanding boundaries in the client – therapist relationship. One case study (in two parts) is presented in order to better grasp the challenges and potential of nature – based therapy.

Results Jordan ; Marshall found many potential challenges in taking the therapeutic frame outdoors. In particular, they found that the boundaries between client and therapist, could become challenged. The outdoors provided a neutral environment which fostered mutuality but maintaining some asymmetry in the relationship could be difficult. In taking this frame outdoors, Jordan ; Marshall also found that the structure of the frame itself may need to be reshaped and become more flexible; perhaps the frame becomes an open process, rather than an ultimate set of rules.

They also found that sometimes the unpredictability of the environment created more anxiety, both in the client and the therapist and that the establishment of a therapeutic container or the ‘building of a home in nature’ (Berger, 2006) was successful in overcoming some of these obstacles. Discussion The purpose of Jordan ; Marshall’s paper was to provide information on the potential and challenges of taking traditional therapy practice outdoors. Jordan & Marshall consulted a vast reference list including one of the founders of nature- based therapy, Ronen Berger and this provided interesting insight into this emerging field.

At times the paper felt disorganized and the case presentation split in two halves was confusing. Results were scattered throughout the paper and the methodology was vague and seemingly structureless. Nevertheless, Jordan & Marshall got to the gist of the subject and were honest with their results, reporting their own struggles with mutuality and asymmetry when taking clients outside of the traditional hour long frame; “both clients and therapists can experience a blurring of the boundaries between what is therapy and what is social space” (p357).

Jordan & Marshall did not however, provide much data as to how many clients they had seen and under what circumstances. Their observations are keen and easily related to when thinking about the traditional therapeutic frame, nevertheless a concrete chart or model, using the relational as well as other theories or approaches, would have been welcome and interesting. Conclusion

Overall I found both these articles fascinating and extremely pertinent to my final research paper. Simply being present within a natural environment can help us feel better. Perhaps when taking therapy outdoors and as nature becomes a dynamic third in the therapeutic relationship, the traditional frame will come alive with an emergent creativity and mindfulness nudging us all towards our own true nature.

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Outline and Evaluate One Biological Therapy for Schizophrenia

The main form of biological therapy for schizophrenia is drug therapy. Some drugs are more effective at reducing the positive symptoms such as delusions and hallucination than negative symptoms such as lack of motivation and social withdrawal. There are two main categories of drugs, neuroleptic drugs and atypical drugs. Neuroleptic drugs such as Prolixin are conventional drugs that reduce psychotic symptoms but produce some of the symptoms of neurological diseases. These drugs block the activity of the neurotransmitter dopamine within 48 hours and their effect on dopamine are believed to be very important in therapy.

However it takes several weeks of drug therapy before schizophrenic symptoms show substantial reduction. These drugs are more effective in reducing positive symptoms than negative symptoms. This is supported by Birchwood and Jackson 2001 whose conclusion was the same. These drugs appear to be a more effective treatment for schizophrenia than any of the other approaches used alone. (Comer 2001) Researches have shown that patients can get independent to drugs which means they might not be able to stop taking them otherwise they might have to face serious problems. Neuroleptic drugs also have side effects.

Windgassen 1992 found 50% of patients with schizophrenia who take neuroleptic drugs reported grogginess or sedation, 18% reported problems with concentration, and 16% had blurred vision. In addition many patients developed symptoms closely resembling those of Parkinson’s disease such as muscle rigidity, tremors and foot shuffling. Also it was found that more than 20% of patients who take neuroleptic drugs for over a year develop the symptoms of tardive dyskinesia. These symptoms include involuntary sucking and chewing and writhing movements of the mouth or face.

Atypical antipsychotic drugs (such as clozapine) also combat positive symptoms of schizophrenia but there are claims that they also have beneficial effects on negative symptoms as well. These antipsychotics also act on the dopamine system but are thought to block serotonin receptors in the brain as well. They help by only temporarily occupying the dopamine receptors and then rapidly dissociating to allow normal dopamine transmission. Atypical drugs have several advantages over neuroleptic drugs. Firstly they have fewer side effects than neuroleptic drugs.

Secondly they benefit 85% of patients with schizophrenia, compared with 65% given neuroleptic drugs. However, the atypical drugs can produce serious side effects. For example, schizophrenic patients who take clozapine have a 1-2% risk of developing agranulocytosis. This involves reduction in white blood cells, and the condition can be life threatening. Although the use of antipsychotic drugs is crucial in the treatment of schizophrenia, many people do not experience the benefits they offer, normally due to their side effects.

As a result, additional psychological treatments are used. The cognitive behavioural therapy (CBT) follows the assumption that people often have distorted beliefs which influence their behaviour in maladaptive ways. In this therapy, patients are encouraged to trace back the origins of their symptoms in order to get a better idea of how the symptoms might have developed. As well as this, they are also encouraged to evaluate the content of their delusions to consider ways in which they might test the validity of their faulty beliefs.

Next the patients would be given behavioural assignments with the aim of improving their general level of functioning. The learning of maladaptive responses to life’s problems is often the result of distorted thinking by the schizophrenic. Researches over time suggest that CBT has a significant effect on improving the symptoms of patients with schizophrenia, however the majority of studies of the effectiveness of CBT have used schizophrenics who are also taking antipsychotic drugs. This leaves the question, how much of the improvement is due to CBT alone?

Also, CBT for schizophrenia works by trying to generate less distressing explanations of psychotic experiences, rather than trying to eliminate them completely. The negative symptoms shown by a schizophrenic may well serve a useful function for the person and so can be understood as safety behaviours and could cause potential damage. Lastly, it has been found that CBT doesn’t actually work for all Schizophrenics, Kingdon and Kirschen found that many patients were not deemed suitable for CBT because psychiatrists believed that they would not fully engage with the therapy.

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Forgiveness Therapy on Depression, Anxiety and Posttraumatic

Gayle and Robert (2006) explain the different studies on the effect of forgiveness therapy. The article discuses about 35% of women are facing emotional abuse from a spouse or romantic partner. “Women often demonstrate negative psychological outcomes long after this abuse. ” (O’Leary, 1999).

Follingstad, Rutledge, Berg, Hause, and Polek (1990) and Sackett and Sanders (1999) have stated some of the categories that took effect after one’s been abuse psychological thru critizing, ridiculing, jealous control, purposeful ignoring, threats of abandonment, threats of harm and damage to personal property which causes and have strong negative impact of emotional abuse than physical abuse.

Enright and Reed has underlined the consequences of those psychological problems which are depression, anxiety, and posttraumatic stress disorder, low self-esteem, learned helplessness, and an ongoing debilitating resentment of the abuser. The treatment uses to heal those women is ‘Forgiveness Therapy’which uses as a problem solving respond to severe wrong doing. FT also found out these psychological emotional abuse can affect those women decision making. There are two unique challenges for recovery that Sackett & Saunders, 1999 have found.

First “Learned Helpness” which defines that those women turn out to blame themselves for the abuse relationship. And “Accusatory Suffering” (Seagult & Seagult 1991) entails maintaining resentment and victim stauts. “ the assumption in accusatory suffering is that healing the wounds of the abuse will somehow let the penetrator off the hook. ” FT also focusing on decreasing and helping the resentful feeling toward the abusing partner and assist them to recover and develop good will.

The study used 20 participant abused women who has been abused and has been divorced or permantly separate with their partner for a more or at least 2 years. Among those participants are different races, ethnicity that has some or college degrees with no or full time career jobs. Participants have been tested by using the screening checklist by using the Psychological abuse survey, the Enright forgiveness inventory, Coopersmith self-esteem inventory, State-Trait Inventory, Beck Depression inventory, Environmental Mastery Scale Reed instrument, the PTSS checklists, and Story measure.

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Occupational Therapy Philosophy

* ————————————————- Occupational Therapy: Integrating Art and Science * ————————————————- * ————————————————- What is occupational therapy? How does one define the profession and validate its worth in the medical field? Since its conception as an established health care profession, occupational therapy’s philosophy has been defined, redefined, and refined.

In their writings esteemed Occupational Therapists Mary Reilly and Susan Peloquin offer their own critical and revisionary ideas of occupational therapy’s worth, the basic need it fulfills, and its service to the healthcare profession. Both women ask their peers to refine what is uniquely inherent about occupational therapy and by doing so validate the profession’s contribution in serving the needs of man (Reilly, 1963; Peloquin,2002). * ————————————————-

In her 1962 Eleanor Clarke Slagle address entitled, “Occupational Therapy Can Be One Of The Great Ideas of 20th Century Medicine” Mary Reilly (1962) challenges her fellow colleagues to critically define Occupational Therapy’s value within the medical field. She initiates this critique by first asking the provocative question, “Is Occupational Therapy a sufficiently vital and unique service for medicine to support and society to reward” (Reilly,1962, p. 3)?

Reilly suggests it is precisely these critical questions and line of discourse that we as practitioners need to be embracing to maintain our unique and vital contribution to the healthcare realm. * ————————————————- Drawing inspiration from Occupational therapy’s earliest visions Suzanne M. Peloquin also seeks to engage her audience by asking to consider and reflect upon a different but equally important component that makes occupational therapy unique and vital to the health of man.

Quoting Ora Ruggles,an early contributor to the field of occupational therapy, Peloquin writes, “It is not enough to give a patient something to do with his hands. You must reach for the heart as well as the hands. It’s the heart that really does the healing” (Peloquin,2002). Through the use of visual imagery and storytelling Peloquin calls our attention to the profession’s earliest founders and their visionary beliefs. Peloquin eloquently reminds us of the healing power of the heart and the vital aspect of caring that is inherent and necessary in our profession. ————————————————- Furthermore, Peloquin maintains that when we undertake an integrative approach employing both “competency and caring” in healing we solidify our value as a profession (Peloquin 2012). She demonstrates this when she writes, “Three constructs deeply rooted in our profession’s culture and integral to its central character are well-presented in the early vision: integration, occupation, and caring”(Peloquin,1962,p. 525).

In contrast, Reilly engages her audience by putting forth a mandate that charges the practitioners of occupational therapy to validate the profession by inviting and seeking critical appraisal. “ When a professional organization as a whole accepts criticism as the dominating mode of thought, then indeed, theorizing flourishes and the intellectual atmosphere of their gatherings, is characterized by sweeping controversies. In this atmosphere of controversy, progress becomes somewhat assured” (Reilly, 1962, p. 3). * ————————————————-

In addition to engaging in critical debate Reilly believes that in order to establish credibility and worth, Occupational Therapy must strive to identify and define “the vital need of man which we serve and the manner in which we serve it”(Reilly p. 3). In this academic and investigative tone, Reilly delivers her lecture in a clear and orderly fashion. Her writing is concise and articulate as she methodically introduces an hypothesis in which postulates “That man, through the use of his hands, as they are energized by mind and will, can influence the state of his own health” (Reilly,1962,p. ). She formulates this theory and tests it by drawing upon a multi-discipline approach to research (Reilly, 1962). She charges her colleagues with the mandate to define man’s basic need for occupation in a scientific researchable manner and atmosphere. It is not enough to draw upon multiple disciplines such as the social sciences, biology, and neurophysiology, Reilly suggests we must also observe the anthropological , social, and biological study of occupation through “phylogenetic and ontogenetic” lenses Reilly,1962,p. 10) . Through this study of occupation and the therapeutic meaning of work Reilly defines a unique aspect of occupational therapy: “the profound understanding of the nature of work” (Reilly,1962,p. 9). Her thesis in this thought provoking address, her take home message, is so powerful that Peloquin describes Reilly’s hypothesis of human occupation as “one of the profession’s best visionary statements”(Peloquin,1962,p. 518). * ————————————————-

In contrast to Mary Reilly’s urging to attain a scientific understanding of man’s basic need for occupation, Peloquin’s reminiscent recalling of early visions of occupational therapy’s goals and unique attributes highlights the profession philosophy of meaningful and purposeful work in a client-centered modality of care. Incorporating the art of caring in our treatment paired with the extensive wealth of knowledge gleaned across multiple disciplines enables us as practitioners to guide the patient toward the occupation of living or as Peloquin puts it “allow us to see individuals occupying their lives” and “living well” (Peloquin,2002,p. 24). * ————————————————- Reilly also strongly embraces an integrated approach and outlines the importance of maintaining a individual or client-centered approach when assigning treatment. Her abhorrence of formulaic activity groups prescribed as therapy used in psychiatric settings in the 1960’s is detailed best when she writes, “activity programs so designed, tend to depersonalize,institutionalize and, in general, debase human nature” (Reilly,1962,p. 12). * ————————————————-

In their vastly different writings, different in style, in delivery and different in focus, these women have a common concern, passion, and desire for the preservation of occupational therapy. Mary Reilly aims to mark the profession as vital by focusing our attention to the distinctive quality that occupational therapy holds: the unique speciality of defining the value of“work” to man. (Reilly, 1962). It is this concept and the critical engagement from which great ideas such as this stems, are necessary in ensuring a professional organization’s existence in these dynamic and emanding times. Suzanne Peloquin also believes that occupational therapy’s attributes are unique and standout from others in the healthcare field. The uniqueness that Peloquin refers to and asks her readers to preserve and incorporate in our practice is the founding member’s early vision of caring and empathy. She writes, “To see hearts engaged is to see personal actualization, an occupational link with identity, a making of meaning.

The depiction transcends more limited visions of activity or productivity and allow us to see individuals occupying their lives”(Peloquin,1962,p524). * ————————————————- In an attempt to integrate Peloquin’s vision and Reilly’s hypothesis I refer to Peloquin’s remark, “Occupational therapy is not about balancing at some midpoint between two dimensions of practice, with either heart or hands getting about half of a practitioner’s attention; it is about reaching for both” (Peloquin,1962,p. 522).

Reilly collaborates this sentiment writing, “And more than all this, it implies that man, through the use of his hands, can creatively deploy his thinking, feelings and purpose to make himself at home in the world and to make the world his home” (Reilly,1962,p. 2). It is precisely this distinctive blending of visionary statements and scientific exploration that lends occupational its unique * ————————————————- vitality and credibility. Leaders in the field such as Peloquin, and Reilly inspire, shape and preserve the richness and dignity of the important dynamic nature of our field.

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Solution Focused Therapy

Social Work Department Faculty of Humanities University of Johannesburg Student Surname| Le Roux| Student Initials| C| Student First Name| Charlene| Student Number| 201170104| Assignment Title| Practice Model| Date of Submission| 15 March 2013| Course Title| B Social work| Lecturers Name| Prof. Adrian Van Breda| Course Code| SW2A11| Plagiarism Declaration| I, Charlene Le Roux 201170104, declare that this assignment is my own original work. Where secondary material has been used (either from a printed source or from the internet), this has been carefully acknowledged and referenced in accordance with departmental requirements.

I understand what plagiarism is and aware of the department’s policy in this regard. | Name| Charlene Le Roux| Signature| | Index Page 1. 2. 3. 4. 5. 5. 15. 25. 35. 45. 55. 65. 767. 8. | Introduction History of Solution Focused TherapyUnderlying theoryKey principlesApplication to the PCPEngagementAssessmentPlanningImplementingEvaluationTerminationFollow-upCritical reflectionConclusionReference list| Page 334-55-66-116-77-88991010-11111213| 1. Introduction I have chosen to do the Solution focused therapy practice model (Hereafter referred to as SFT).

I chose this model because I was interested in finding out more about how to use one’s own resources and strengths to empower oneself. My hardest issue with counseling is learning how to teach clients how to use their own resources instead of supplying it myself and also encouraging clients to come up with their own solutions and just giving them advice and my opinion. SFT discusses the different techniques one can use to ensure they are empowering their clients and not doing everything for them. 2. History The two founding theorists for SFT are Insoo Kim Berg and Steve De Shazer.

Together they adapted existing theories to mold into a theory of their own. They strongly believed that true positive change lies within the client themselves and not in the relationship between the client and worker. Berg was the cofounder of a center in Milwaukee in 1978 whose intention was to launch the mental research institute and it used Brief Family therapy. This was an organization that made no profit and was used to serve the needs of people in surrounding areas and people and families that were poor or living in poverty (O’Connell, 2005).

Four years later this became the home of SFT (Lee, 2011). De Shazer later worked in the center and was thoroughly trained in brief family therapy. According to Milton Erikson, brief therapy models were hugely influenced by the strengths perspective and social constructivism. The strengths perspective is about using one’s own strengths, assets and resources to come up for solutions that are best suited for them and their problem rather than simply providing everything for one’s client.

It goes with the famous saying “Give a man a fish and he will eat for a day, but teach him how to fish and he will eat for a lifetime”. Berg and De Shazer developed this model by listening to and using the feedback of their clients. They created this model by observing therapy sessions to observe the techniques and skills the therapist used, by listening to the feedback of their clients about what was or was not working for them and by observing the progress of their own clients (Lee, 2011). 3. Underlying theory of practice model Social constructivism strongly influences SFT (O ‘Connell, 2005).

This perspective states that human beings create their own reality through different linguistic means. In other words, we create our own realities through conversations and by our own view of the truth so therefore each person has a different meaning that has been created which in turn means that there is no ‘objective truth’ that is true in any situation. This all implies that each person’s problems are constructed by the way in which they talk. As a result of each person having their own linguistic style, there is no fixed meaning attached to a problem or a solution.

In order for a person to see their created reality from another perspective, the therapist or practitioners main goal is to change the language the client uses. Practitioners encourage clients to use solution talk as opposed to problem talk. One thing that stands out from the social constructivist perspective is that the clients perception and experiences have main priority. This theory also takes into account the context in which the client lives and emphasizes that people do not exist in social isolation but rather are products of the interactions that surround them.

The relationship between the practitioner and the client is of utmost importance in this perspective because it is within this relationship that a new style of language can be created for the client to build new realities. The systems theory is another perspective that influences solution focused therapy. The systems theory expects a practitioner to look at all the systems surrounding an individual so that the best interventions can be used. To understand the systems theory fully there are some terms that are the most important (Kirst-Ashman & Hull, 2006).

Every individual is viewed as the product of interactions between different micro systems in that individuals life and practitioners look at their clients as a person-in-environment where they are constantly interacting with the various systems around them. These systems function reciprocally and change in one system means there will be change in another. The systems approach is also dynamic. It is ever changing and evolving from one particular view to another yet maintains a relatively stable homeostasis. All systems are interrelated.

The systems theory basically states that because no two client systems are alike, no two solutions will be alike either and therefore every problem needs a unique and suitable intervention (Kirst-Ashman & Hull, 2006). Lastly, the strengths perspective has had an influence on SFT. The main view of the strengths perspective is that every individual, family or community has already got strengths, resources and assets that should be used in intervention strategies and it is the responsibility of the practitioner to uncover these different strengths.

The strength perspective doesn’t see hard times such as traumatic experiences, struggles and sicknesses as demotivating experiences but rather as opportunities and challenges that can be overcome and in the end be used to the benefit of the client even if it is just a lesson that was learned. A worker should never limit their clients capacities and capabilities but rather believe in their goals and dreams and help them achieve it in any way that they can and another important aspect to remember here is that their goals and dreams can only be achieved if the client and worker work together to achieve these.

One last thing that is important for people to know about the strengths perspective is that it believes that every environment also has strengths and that the client should always look for help in their own environments rather than other environments. 4. Key principles As seen above and as previously mentioned, SFT was founded by bringing many different theories together. In this section the main principles of SFT will be discussed. First and foremost, it is set on the notion that if something is not broken there is no need to fix it (O ‘Connell, 2005).

In other words, workers should not look for problems where there are none. If a situation is working for a client the worker shouldn’t try fix it even if it is different to the way the worker thinks it should be working. This is a theory that believes in the strengths of clients and the fact that people are resilient and can bounce back from traumatic experiences with the right support and resources. It draws on the importance of people to emerge as stronger people after the traumas by relying on their own resources and coping methods that they themselves have learned (Van Breda, 2011).

If the client’s way of solving a problem is working then the worker should encourage the client to do it more often and if a resolution is not working then there is no point in continuing to try it so the worker should encourage the client to stop that way and try to find another way of dealing with the problem. It should be kept as simple as possible so as not to confuse the client but rather to encourage them to find new and improved solutions to dealing with individual problems. This process of therapy should not be drawn out longer than necessary and should be to the point with as little intervention from the therapist as possible.

This theory believes that one change ultimately brings about another change until all the required change has been achieved. Therefore, this theory does not seek to make big changes but rather a chain of smaller changes. Another reason why smaller changes are encourages is because it helps the client feel less intimidated as they would feel by implementing one big change at one time. As always with positive change, a worker needs to recognize it and praise the client for the change they themselves have implemented.

Since language is such an important aspect in this theory, the worker should never assume that there is only one possible solution to a problem but the worker should be open-minded and should try using many different paths to try and find a suitable solution. Since this theory focuses on solutions rather than problems, the worker should not spend time analyzing the problems but should jump into finding solutions that will work for that specific client and their circumstances (Malherbe & Greef, 2005). . Application to the PCP The planned change process is a set of stages that a social worker can follow and the stages overlap and flows into one another (Kirst-Ashman & Hull, 2006). 5. 1Engagement “Engagement is when a social worker begins to establish communication and a relationship with other but also addressing the problem” (Kirst-Ashman & Hull, 2009, p. 34). Engagement starts from the very first interaction a worker has with a client.

The main goal of engagement is to build rapport by using different skills such as acceptance and warmth. It is very important that the worker does not judge their client at any stage and shows acceptance as acceptance is a necessary tool for change. Part of engagement in SFT is for the worker to help the change process along from the very beginning. Change needs to be spoken about and visualized. In the engagement stage it is important for rules and expectations to be set and this can be done by a means of contracting.

Contracting is when the client and the worker discuss the roles, norms and expectations for sessions and this is where the boundaries are set for the client-worker relationship (Kirst-Ashman & hull, 2006) Contracting also helps establish roles between the client and the worker which is important in the formal relationship so that boundaries can be set in place. Firstly, the worker needs to enquire about the “pre-session change”. Pre-session change is that happened in the clients life that pushed them to make the appointment in the first place.

The worker can do this by asking questions like “Tell me more about why you are here today” or “What made you seek help? ”. Giving compliments to the client eases their anxiety and affirms the belief that positive regard increases the chance of change for people (Rasheed, Rasheed & Marley, 2011). 5. 2 Assessment “Assessment is differential, individualized and accurate identification and evaluation of problems, people and situations and of their interrelations to serve as a sound basis for differential helping interventions” (Siporin as cited in Kirst-Ashman & Hull, 2009, p. 34).

Assessment is usually when the worker assesses what the problems are that the client is facing but because SFT focuses on solutions the worker needs to change problem talk into solution talk and already start thinking about possible solutions to the problem. A worker using SFT needs to pay attention to detail and listen to the clients carefully during the assessment stage. Once the worker has heard the clients issues they need to respond empathically as this helps create empowerment for the client as well as lets the client know that the worker is paying attention and understanding the clients’ point of view.

There are many different types of questions that should be used in the assessment stage of SFT. The miracle question is the first. The answer to this type of question is usually on the path of the fitted solution. This type of question helps the client vision their preferred future. These questions are asked to find out about the clients story, strengths and resources and their own expectations for the solution. This type of question would be something like “Imagine you were sleeping tonight and a miracle happens that solves the problem you came to speak to me about.

When you wake up in the morning, what would be the change that would make you realize something must have happened to solve your problem? ” a client could possibly reply with answers similar to this, “my children weren’t moody and crying, my husband and I were smiling and organized. We left on time for work and when we came home we had food on our plates and the children were playing. ” Another type of question is an exception question. This type of question helps the worker to get an idea of the good times in a client’s life. It helps the client remember that there were times when they knew what to do nd how to do it in order for them to function normally. Helping a client remember times when they were managing better gives them hope that they can do it again. A worker would ask this question “can you think of a time in the past month, year or ever that you did not have this problem? What were you doing differently during those times that helped prevent the problem then? ” (De Shazer as cited in Lee, 2011). Coping questions are also important questions when assessing and planning for implementation. This question is useful for clients who feel completely helpless because it can give ideas to solutions that could help serve their problems.

This type of question helps the worker get to know more about the clients coping strategies. A coping question would be something along the lines of “wow, how have you managed to carry on during all of these hard times? ” Lastly, scaling questions can be used. These questions can be used during the evaluation stage as well. This question helps the client track their own progress which helps them identify where they are at (Lee, 2011). This is a question that asks the clients to choose a number between 1 and 10 to determine their progress.

A worker would ask a question like “from a scale of 1 to 10, 10 being the best, how are you feeling now compared to when we started? ” (Nichols & Schwartz, 2008). 5. 3 Planning “Planning specifies what should be done” (Kirst-Ashman & Hull, 2009, p. 370. Planning in this theory goes hand in hand with assessment because in assessment the worker will not spend too much time focused on the problem but rather on already finding possible solutions. It is also important to remember that changes should be planned as small rather than one big change. 5. 4 Implementation Implementation is the actual doing of the plan. The Client and worker follow their plan to achieve their goals. Progress during implementation must be constantly monitored and assessed. Sometimes, new issues, situations and conditions require the plan to be changed” (Kirst-Ashman & Hull, 2009, p. 40). The most important aspect to the implementation is the changes need to small so as to not overwhelm the client with major changes. When a small change is achieved, it leaves the client feeling empowered and motivated to start change in another dimension of their lives.

It gives the client courage to try for new and bigger changes (Lee, 2011). The above mentioned questions can also be asked to stimulate change (Macdonald, 2011), therefore intervention starts during the assessment stage. Intervention by the worker should be limited ensuring that the changes will be as a result of the clients new ways of doing things while at the same time making sure the client gets a sense of independence rather than relying on the worker to do all the work. 5. 5 Evaluation “Each goal is evaluated in terms of the extent to which it has been achieved.

The decision must be made about whether the case must be terminated or reassessed to establish new goals” (Kirst-Ashman & Hull, 2009, p. 41). Evaluation in SFT basically combines all the above mentioned techniques. The worker uses the questions to find out how much change and progress has been made. Once the worker realizes what those changes are he or she points these out and celebrates together with the client for making these changes (Macdonald, 2011). The miracle question is used to monitor the progress and to keep the client in a positive frame of mind in order for them to continue progressing to their full potential.

It is important for the worker and client to reflect to evaluate what has been improved and how. Evaluation in SFT does not necessarily only occur after implementation. The worker also evaluates the client at the beginning of every session to see what changes have been made and how the client is progressing. 5. 6 Termination “The worker/client relationship must eventually come to an end. Termination in Generalist Practice involves specific skills and techniques” (Kirst-Ashman & Hull, 2009, p. 41). Termination begins from the very beginning in order to prepare clients for the ending of sessions.

SFT is meant to be brief and not carry on for long periods of time. The worker needs to keep reminding the client that the therapy will not be long and the client should have the goals of finding new solutions quicker than in other types of therapy. In the last session, the client is asked to describe in detail what changes they experienced so the change can be maintained and the worker should point out what worked and what did not work in the clients’ progress. One way of knowing when a client is ready for termination is by asking them a scaling question (Macdonald, 2011).

This is when a client answer from a scale of 1 to 10, 10 being the best level of functioning. If a client’s answer is 7 or higher then the client is ready to terminate. These types of questions can be “What would you rate your level of functioning as on a scale from 1 to 10, 10 being the best? ” or “Consider that when we started you were on a level 3 scale of functioning, what would you rate your level as now between 1 and 10? ”. It is important to remember that terminating with an open door policy is of benefit to this client.

This means that even though the sessions are over, you let the client know they are always welcome back should they encounter any other problems but the worker can also encourage the client to come visit in a few months to let the worker know how everything is going. this makes the client feel important and valuable and is a positive way to terminate. 5. 7 Follow-up Although not a stage of the planned change process I do think it is important for a social worker to follow up with their clients to ensure that everything is still going alright.

Following-up with a client also empowers them in a way because it makes them feel like they are still cared for and worried about and not like they were just forgotten by the social worker. Following up can be done in many different ways. A worker can request that the client comes back for one last session just to follow-up and ensure that everything is okay. It can also be done telephonically or via e-mail. If a client does not respond to the email or does not come in for the session it is the responsibility of the worker to find out what the reason is just to make sure the client is still on track. . Critical reflection There are some concerns surrounding SFT. One of the concerns is that it is so focused on solutions that it does not focus on curing the root cause of the problems. A therapist using this model could say that the deep rooted cause was in fact also just a form of the clients’ distortion of reality. This therapy also relies too much on the client. In some cases people may not understand that what they want is not what they need and clients sometimes need a counselor to give them a new view point to look at their situation from.

For example a married couple may sometimes not know what it is they need and a worker can step in to give some ideas for solutions they can try instead of relying on the client to recognize what it is they really need. I would use this practice model if I could change a few things. I would focus more on the way a client is feeling about their problems because sometimes all somebody needs is someone to listen to their problems and not just think of solutions. Sometimes it is important to try and understand a client in a bit more of an informal way rather than strictly professional.

It is important though to remember boundaries and that a client may never be friend with a worker as there may then be conflict of interest. Although there are holes in this model, there are also things I really like about SFT. It is good to focus on the positive things rather than continuously analyzing the negative to get to a solution. Focusing on a solution puts the client in the future and motivates them to get to that level of functioning. It is a model that can help clients succeed a lot quicker than other models.

I also like the fact that SFT has specific types of questions that are direct because other models can sometimes take a long time just to assess the problem leaving the client feeling like there has been no progress over a period of time because the worker has just been assessing. With SFT the client will start to see changes quite soon and will feel empowered just by the questions that they will be asked. 7. Conclusion I like the idea of SFT because it focuses on strengths and it has always fascinated me to know how a client can use their own strengths.

After researching this practice model I understand a lot more about how I can recognize what a client’s strengths are and how they can be used for solutions. It is a therapy that is direct and results can be seen soon after the first session. This therapy promotes the empowerment of people and is easy to follow in order to empower one’s own clients. It is a widely used therapy and has a high success rate. I am glad I have learned about this model because I can now apply it to my practice this year.

Instead of focusing on my clients weaknesses (low self-esteem) we can focus on building confidence and not on what has caused the low self-esteem. This is great because often speaking about the causes can be re-traumatizing to the client when all they want to do is more forward instead of focus on the past. 8. Reference List Kirst-Ashman, K. K. , & Hull, G. H. (2009). Understanding Generalist Practice (5thed. ). Belmont, CA: Brooks/Cole, Cengage Learning. Lee, M. Y. (2011). Solution-focused theory. In F. J. turner (Ed. ), Social work treatment: Interlocking theoretical approaches (5th ed. pp. 460-476). New York: Oxford University Press. Macdonald, A. (2011). Solution focused therapy. In R. Nelson-Jones (Ed. ), Theory and practice of counselling and therapy (5th ed. , pp. 371-391). Los Angeles, CA: Sage. Nichols, M. P. , & Schwartz, R. C. (2008). Family therapy: concepts and methods (8th ed. ). Boston, MA: Pearson. O’Connell. B. (2005). Solution focused therapy (2nd ed. ). London: Sage Publications ltd. Rasheed, J. M. , Rasheed, M. N. , & Marley, J. A. (2011). Family therapy: models and techniques. Los Angeles, CA: Sage.

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Guided Imagery Child Play Therapy

DEFINITION Guided imagery therapy is a cognitive-behavioral technique in which a child is guided in imagining a relaxing scene or series of experiences. RATIONALE Guided Imagery is similar to hypnosis and various relaxation strategies. Guided Imagery lies somewhere in the middle of a continuum consisting of standard relaxation techniques on one end of the spectrum and hypnosis on the other. As used by the author, guided imagery involves the child engaged in some sort of focused relaxation exercise followed by the use of visual imagery for the purpose of either direct or indirect problem-solving with the child.

Guided Imagery brings two primary benefits to the play-therapy process. First, it can be used to help children gain a sense of mastery over both their bodies and their feelings, and secondarily, it can be used to augment generalization of other gains made in the play therapy by allowing children to use their imaginations to create hypothetical life situations in the play room so as to practice their newly acquired skills with the support of the therapist. Guided Imagery is thus really an elaborate form of role playing.

While conventional role playing can be very effective, it is the use of Guided Imagery to augment mastery that is the focus of this discussion. DESCRIPTION Guided Imagery can be introduced at any point in the play therapy process. The child must be able to follow simple sequential directions and must be willing to relax in session. The ultimate goal is to provide the child with an increased sense of mastery, but the initial process requires that the child relinquish some control to the therapist, as the therapist will need to teach the child the techniques.

There are a number of ways the therapist may introduce the process to the child — younger children often respond to the idea of taking an imaginary trip, while older children often like the idea of personal mastery, including the concept of self-hypnosis. However Guided Imagery is introduced, the therapist begins by teaching the child a basic relaxation strategy. If the child is willing, it is useful to have him or her lie down or sit in a recliner for the early training; alternatively, sitting in a beanbag chair works well.

Progressive deep muscle relaxation is probably the most effective way of preparing the child for guided imagery. Is this approach to relaxation the child is asked to focus on one muscle group at a time while working to achieve maximum relaxation of that area of the body. Groups of muscles are added in sequence with the goal of achieving total body relaxation. Younger children may have difficulty with progressive deep muscle relaxation because it is such a passive process. For them a sequence of contract-relax instructions that take them through all of the major muscle groups is usually more effective.

For example the child might be told to curl his toes then relax them, push his knees together then relax, tighten his stomach muscles and relax, and so on. Each muscle group is contracted and relaxed several times in a slow sequential progression. While deep relaxation facilitates the guided imagery process it is not necessary; simply getting the child to focus and follow directions is sufficient. Note that the child should be encouraged to achieve relaxation with his/her eyes open. This will make easier for the child to access the effects of the imagery later, in situations where full relaxation is not possible.

Once even minimal relaxation has been achieved, Guided Imagery can be introduced. The imagery used needs to be tailored to the child’s needs, experiences, and developmental levels. This is best illustrated through a case example. Imagery techniques have been combined with a wide range of behavioral and cognitive procedures and treatment methods of some psychotherapeutic approaches, including behavior modification, cognitive processing therapy, rational emotive therapy, multimodal therapy, and hypnotherapy.

Combinations of treatment methods among these approaches lead to the following general uses of imagery: ? antifuture shock imagery (preparing for a feared future event) ? positive imagery (using pleasant scenes for relaxation training) ? aversive imagery (using an unpleasant image to help eliminate or reduce undesirable behavior) ? associated imagery (using imagery to track unpleasant feelings) ? coping imagery (using images to rehearse to reach a behavioral goal or manage a situation ? step-up” technique (exaggerating a feared situation and using imagery to cope with it) An assessment of the child and their problems is an essential part of treatment, both at the beginning of therapy and throughout the entire process. This is to ensure that the therapist has sufficient understanding of the child’s situation and diagnosis of the problem(s). The assessment generally covers a variety of areas, such as developmental history (including family, education, and social relationships), past traumatic experiences, medical and psychiatric treatments, and goals.

HEALTHY IMAGERY The University of Michigan Comprehensive Cancer Center reports that clinicians often use guided imagery to help people (including children) deal with cancer. Guided Imagery can help children with cancer or other illnesses cope with the pain and the stress they may experience. To help a child through this Guided Imagery exercise, tell him or her to sit comfortably or lie down and close his or her eyes. Then ask the child to tell you their idea of the color of sickness and the color of healthiness. He or she might choose black for sickness and yellow for healthiness.

Ask the child to visualize the black color in the area of the sickness, and then ask them to visualize the yellow color calmly filling the body, destroying all areas of black. Encourage the child to feel the warmth of the yellow color and the happiness that it brings. This can be done by the parent of a child when they are in a doctor’s office awaiting tests, when the child is feeling hopeless and when they just need a boost of encouragement. Read more: http://www. livestrong. com/article/137127-guided-imagery-exercises-children/#ix zz293qwHEFg APPLICATIONS

Michael was 8 years old when he was brought to play therapy for anxiety-related behaviors. There had been many changes in his life and neither of his parents had been particularly able to address his needs because of their own distress. While play therapy focused on helping identify Michael’s basic needs and factors that were preventing him from getting his needs met, Guided Imagery was introduced to help him achieve symptom-mastery, thereby helping to reduce some portion of his anxiety. One problem area was that Michael was having distressing nightmares that were interfering with his ability to get a full night’s sleep.

Because of his age, a contract-relax procedure was used to initiate relaxation. Although the therapist wanted Michael to practice his Guided Imagery while lying on the floor using a pillow and a blanket, Michael found this setup too anxiety-provoking, he associated sleep with having nightmares. For this reason, Michael was initially trained while he sat in a bean bag chair and later moved to a pretend bed. In a interview with Michael it was determined that one of the images he found very relaxing was swimming in a lake (so long as the water was clear enough that he could see the bottom and ensure there were no creatures lying in wait. Once he was relaxed, the therapist guided him through imagining lying in very shallow water by the side of a lake. The image of water was strengthened by making it multisensory. Michael was asked to imagine that the sand he was lying on was warm and very soft and that it felt and sounded like the shifting of the beans in the bean bag chair. Then he was asked to imagine the water as being quite warm as it flowed over his body. He was told to picture a bright blue sky with puffy white clouds and to hear the sound of very gently waves as they moved past his ears.

The ebb and flow of the waves was then synchronized to his breathing so that the waves came up as he breathed in and flowed out as he exhaled. Michael enjoyed the image very much and was more than willing to practice it at home. The therapist instructed Michael to begin by practicing in the morning after he woke up so as to reduce his anxiety about possibly of falling asleep during the exercise. In session, the therapist helped Michael learn to use the image as a way of regaining control when anxious material was discussed.

If Michael became anxious in session, the therapist would cue him to begin “breathing with the waves” in a slow and measured pace. As Michael reported achieving a more relaxed state, he and the therapist began to introduce images from his nightmares into the process. At first Michael was told to remain lying in the lake and to practice seeing some of the monsters from his dreams in the clouds overhead. Since these were clouds, not monsters, there were not particularly threatening. Later the monsters were brought to life and Michael engaged in many mastery fantasies. He would have his own monsters rise up out of the lake to protect him.

He would become a knight with magic power. Or he would tell a joke and the monsters would laugh until they literally broke into pieces. At this time, the therapist began having Michael use the imagery when he woke up from a nightmare during the night as a way of soothing himself. As Michael reported more success he was encouraged to use the imagery prior to going to sleep at night to create dreams that would not be frightening. In essence, Michael scripted his dreams and took control over the expression of his anxiety. As can be seen in the above, it is important for the relaxation process and imagery to come under the child’s control.

The therapist attempts to move from the role of instructor, to simply cuing the start of the process, and finally to a role where he or she is simply reinforcing and helping to focus the use of the process outside of the session. If the child does not gain control of the process, it is unlikely that they will be able to use it outside of session, and they will remain dependent on the therapist. It should be also apparent that the process, at least in this case, also contained elements of cognitive-behavioral therapy and systematic desensitization.

As stated in the introduction, Guided Imagery effectively enhances the therapeutic process. In this case, as intense as his nightmares were, it took Michael only a few weeks to first reduce and then virtually eliminate them. Once he experienced mastery, rapid gains ad generalization followed. This same process was used to help him master some other anxiety-related symptoms and enhance his school performance. SUPPLIES NEEDED The supplies needed for Guided Imagery are items that can help in the relaxation of muscles and visualization of the image(s) of the therapy. Some examples of useful supplies would be: pillows ? blankets ? bean bag chairs ? a bed ? relaxing music (a variety) ? picture books (variety) RESOURCES http://www. minddisorders. com/Flu-Inv/Guided-imagery-therapy. html Books: – Kaduson, Schaefer. 101 Favorite Play Therapy Techniques/Guided Imagery – Crowley, R. Cartoon Magic: How to Help Children Discover Their Rainbows Within. 1989 REFERENCES – Jacobson, E (1938) Progressive Relaxation: A Physiological and Clinical Investigation of Muscular States and Their Significance in Psychology and Medical Practice, 2nd ed. Chicago: University of Chicago. – O’Connor, K.