Saturday, January 25, 2020

Cognitive Behavioural Therapy: Theory and Applications

Cognitive Behavioural Therapy: Theory and Applications Cognitive Behavioural Therapy Assessment Introduction Definition of Cognitive behavioural Therapy The term Cognitive behavioural therapy (CBT) covers a number of techniques of spoken interactive therapy which are considered useful in helping people solve life problems such as anxiety, depression, post-traumatic stress disorder (PTSD) and various addictive problems. (Beck A T 2005) Basic theoretical principles Cognitive behavioural therapy has arisen as a hybrid therapy combining the elements of cognitive therapy, which was originally conceived and developed to assist in changing dysfunctional beliefs, thoughts, attitudes, and expectations, and behavioural therapy (which is referred to as behaviourism) which was originally developed to change how people acted in response to various stimuli. Influential authorities such as Beck suggested that how one thinks about a situation determines how one acts and our actions determine how one thinks and feels. (Beck A T et al. 1979). This therapy endeavours to change elements of thinking (cognition) and behaviour together in order to achieve its beneficial effect on feelings. The therapy is based on an assumption that feelings and behaviour patterns such as anxiety and avoidance behaviours are related to the development of maladaptive beliefs and their related thought processes in an individual. Therapy is based on a series of collaborative interactions between the patient and the therapist in conjunction with specific cognitive and behavioural techniques such as Socratic dialogue, monitoring of beliefs, activity monitoring and scheduling, analysing advantages and disadvantages of avoidance, graded exposure assignments, behavioural experiments and role-play. The exact form of the therapy will depend on the presentation of the patient and the professional expertise of the therapist. (Hobbis I C A et al. 2005) Brief overview of the evidence base to support CBT There are two basic issues here. In order to define the evidence base for Cognitive behavioural therapy, one has to define the condition for which it is said to be efficacious. In the context of this essay, one can specifically consider Cognitive behavioural therapy in the area of anxiety treatment. A good place to start is the study by Stanley (Stanley M A et al. 2003). This was a small retrospective study which Cognitive behavioural therapy was contrasted with â€Å"usual care† and demonstrated a clear statistically significant advantage in the Cognitive behavioural therapy group on a broad battery of anxiety measurement tools. This correlates well with other findings from larger studies (viz Wetherell J L et al. 2005) and the meta analysis by Pinquart (Pinquart M et al. 2007) Principles and practices of CBT assessment Role and purpose of CBT assessment process related to relevant theory described previously. Describe the different stages of CBT assessment process. There are a number of different assessment models. For an illustrative example one can use the Williams Garland model (Williams C et al. 2002). This model uses five discrete areas of assessment which are described as:- Area 1: Situation, relationships and practical problems For example, Debts, housing or other difficulties. Patients may have problems in relationships with family, friends, colleagues, etc. Life events such as deaths, redundancy, divorce, court appearances may all be relevant. Area 2: Altered thinking An exploration of the typical characteristics of dysfunctional thinking that are commonly found in anxiety and depressive states, for example patients may display an ability to overlook their strengths and become very self-critical. Patients will often unhelpfully dwell on past, current or future problems; they put a negative slant on things, using a negative mental filter that focuses only on their difficulties and failures. They can catastrophise events and will typically mind-read and second-guess that others think badly of them, rarely checking whether this is true. (after Whitfield G et al. 2003) Area 3: Altered emotions There are a number of altered emotional states commonly found in anxiety states which can include feelings of anxiety, stress, worry, fear, panic and being ‘hassled’. Guilt, anger and irritability are common as are shame and embarrassment. Area 4: Altered physical symptoms There is a wide variety of symptoms commonly found in anxiety related conditions and these can include restlessness and an inability to relax, feeling of tension, shakiness or unsteadiness when standing, insomnia, palpitations and feelings of depersonalisation. Area 5: Altered behaviour In anxiety states one of the commonest symptoms is avoidance behaviour which can usually be elicited by asking the question ‘What things have you stopped doing since you started feeling anxious?’ Define and describe role and purpose of formulation in CBT assessment There are two major reasons for this type of assessment. Firstly it serves as a guide for the practitioner to determine the impact of the anxiety (or depression) on the patient’s overall subjective experience and thereby define goals and targets. Secondly it is helpful for the patient. The Five areas assessment model is easily grasped and understood by patients and thereby allows for an understanding of the effects that their anxiety state has on them. Often the act of writing down their symptoms under the headings allows for a degree of emotional distance which allows a patient the ability to examine their symptoms more objectively. Discuss the role and purpose of measurement in CBT model including psychometric and ideographic measures and problem and target statements Include relevant references and appendices (e.g. examples of measures) The academic determination of the evidence base for Cognitive behavioural therapy is ultimately based on studies that have measured the degree of response to the intervention. To this end there are a number of tools available for measurement. A comparatively new tool that has been described in the literature is the Questionnaire on Control Expectancies in Psychotherapy, (Jennings S 2008) which quantifies the degree to which responsibility for change is shared between therapist and patient. Other older tools include the state trait anxiety inventory, the graphic anxiety scale, the hospital anxiety and depression scale, and the anxiety-defining characteristics tool (Chuldham C M et al. 2008) Engagement issues Engagement with the patient can be a complex matter. A brief overview of the literature on the subject suggests that studies that have shown a poor patient response to Cognitive behavioural therapy have identified one of the causes to be inadequate expectancies of the patient specifically regarding the responsibility and the mechanisms of therapeutic change. Responsibility can be assigned to the therapist rather than the patient. In this respect, assessing control beliefs specific to the context of the psychotheraputic approach and specifically linking them to the expected therapy outcome can help highlight this specific aspect. References Beck A T (2005) The Current State of Cognitive Therapy: A 40 Year Retrospective Arch Gen Psychiatry, September 1, 2005; 62 (9) : 953 959. Beck A T, Rush A J, Shaw B F, Emery G : (1979) Cognitive Therapy of Depression. New York, Guilford, 1979 Chuldham C M. Cunningham G, Hiscock M, Luscombe P (2008) Assessment of anxiety in hospital patients Journal of Advanced Nursing Vol 22 Issue 1 Pg 87 93 208 Hobbis I C A, Sutton S (2005) Are Techniques Used in Cognitive Behaviour Therapy Applicable to Behaviour Change Interventions Based on the Theory of Planned Behaviour? Journal of Health Psychology, Vol. 10, No. 1, 7 18 (2005) Jennings S (2008) Perceived responsibility for change as an outcome predictor in Cognitive behavioural therapy. British Journal of Clinical Psychology, Volume 47, Number 3, September 2008 , pp. 281 293(13) Pinquart M, Duberstein P R (2007) Treatment of Anxiety Disorders in Older Adults: A Meta-analytic Comparison of Behavioral and Pharmacological Interventions. Am J Geriatr Psychiatry, August 1, 2007; 15 (8) : 639 651. Stanley M A, Hopko D R, Diefenbach G J, Bourland S L, Rodriguez H, Wagener P, (2003) Cognitive–Behavior Therapy for Late-Life Generalized Anxiety Disorder in Primary Care Preliminary Findings Am J Geriatr Psychiatry 11 : 92 96, February 2003 Wetherell J L, Gatz M, Craske M G : (2005) Treatment of generalized anxiety disorder in older adults. J Geriatr Psychiatry Neurol, June 1, 2005; 18 (2) : 72 82. Whitfield G, Williams C (2003) The evidence base for cognitive-behavioural therapy in depression: delivery in busy clinical settings. Advan. Psychiatr. Treat., January 1, 2003; 9 (1) : 21 30. Williams C, Garland A (2002) A cognitive–behavioural therapy assessment model for use in everyday clinical practice. Advances in Psychiatric Treatment (2002) 8 : 172 179 ################################################################ 26.08.2008 Word count 1,439 PDG

Friday, January 17, 2020

Life of Bob Marley

Gabrielle Coelho ENC 1101 Informative Essay Bob Marley â€Å"Who are you to judge the life I live, I know I'm not perfect and I don't live to be, but before you point fingers make sure your hands are clean†, one of my favorite Bob Marley quotes; I know it by heart. This quote is perfect to me because I know I'm not perfect and I don't allow anybody to judge my lifestyle or decisions especially if they have or made the same or worse decisions. I grew up listening to Bob Marley's music because of my dad. Nobody loves reggae or Bob Marley more than my dad.So ever since I've been little I've had a love for Bob Marley. Bob Marley, born Robert Nesta Marley, is a singer, song writer and musician. He was the most widely known reggae performer and was a great aid in spreading Jamaican music and the Rastafari movement. Marley first began his career as the lead singer of the music band â€Å"Bob Marley and the Wailers†, making songs such as â€Å"I Shot the Sheriff† and â⠂¬Å"Get Up Stand Up† which are still known today. The Wailers later broke up while each of the members continued to pursue solo careers.Marley later had his first international hit, outside of Jamaica â€Å"No Woman No Cry†. Marley was also very much involved with the social and political issues going on in Jamaica. He held rallies and free concerts, which some turned violent where Marley was shot, but fully recovered after. Bob Marley had many children; two from is wife Rita Anderson, two adopted from Rita's previous relationship and several others from different women, according to the Bob Marley official website. Bob also has many grandchild, a few I personally know myself from middle school.Most of Marley's children and grandchildren reside in Miami now. Bob Marley continued to make the best lyrical and influential reggae music, with songs like â€Å"One Love†, â€Å"Jamming† and â€Å"Redemption Song†. In July 1977, Marley discovered a type of melanoma under his toe, which was a symptom of already existing cancer. Doctors told Marley that he should get his toe amputated, but refused because of his religious beliefs. Despite his illness Marley continued on with his world tour up until his final show in at the Stanley theater in Pittsburg.Marley became very ill and the cancer spread through out his body. After fighting the cancer for eight months without success Marley died on the morning of May 11, 1981, in the Cedars of Lebanon hospital in Miami. All in all, Bob Marley introduced the world to the mystic power of reggae. His influential music is loved by everybody all over the world. His music was educational, lyrical and very positive. Bob Marley always stood up for what he believed him which is why I adore him too. Marley is still very popular after his death and his legacy still lives on today.

Thursday, January 9, 2020

Health Care Spending in the United States - 1163 Words

Health Care Spending in the United States HCS440/Economics: The Financing of Health Care November 25, 2011 Jeannie Major Health Care Spending In the early 1930’s, the Blue Cross/Blue Shield Organization led consumers to hospitalization and medical coverage under their own charter for everyone who sought coverage for one prepaid fee. Years later, other insurance companies, such as Kaiser Permanente began to offer coverage to consumers within their geographic boundary. However, health care spending is on the rise. Over the last couple of decades the expenditures have risen from 724.0 billion dollars in 1990 to 2,486.3 billion in 2009(US census, 2011). Today, we are a nation with Health Care Reform signed into law by President Obama†¦show more content†¦Likewise, there will be an increase in waiver forms as employees will have the opportunity to â€Å"waive† their right to partake in healthcare benefits from the employer. Medical claims activity will rise due to an increased number of consumers covered with no pre-existing condition exclusion for those who are age 19 and younger. When services are pro vided for consumers beyond the age 19 for a pre-existing condition, there could be an increase in consumer appeals to the health carrier. There are two additional attractions to the healthcare reform. One is the anticipated reduction of cost to consumers by eliminating annual or lifetime maximums for services. This reform will not affect ancillary plans such as dental, vision, hearing and prescription drug plans for adult coverage. The other attraction is that there will always be consumer coverage. An employer would provide a temporary insurance plan to bridge the gap for retired employees who are over the age of 55, without retiree medical coverage and not Medicare eligible. Employers would receive 80 percent of claims that are between $15,000 to $90,000 to help reduce plan costs (AARP, 2010). The catch for the employer is to apply, document claims, and implement the program thatShow MoreRelatedNational Health Care Spending in the United States1828 Words   |  8 PagesRunning head: NATIONAL HEALTH CARE SPENDING IN THE UNITED STATES National Health Care Spending in the United States Bill Obert HCS/440 June 3rd, 2012 University of Phoenix National Health Care Spending in the United States When the United States first began keeping statistical; data on national health expenditures in 1960, the population of the time was estimated at a mere 186 million people, with a national health care cost of approximately $27 billionRead MoreHealth Care Spending1686 Words   |  7 PagesHealth Care Spending HCS 440 Health Care Spending Health care spending in the United States is a key contributor to the countrys economy. The health care industry provides employment as well as providing services that bring healthier lifestyles, better productivity, and a longer life. 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Wednesday, January 1, 2020

The Benefits of Community-Based Alternatives to Incarceration

As crime and arrest rates continue to climb, prisons across the nation, and even the world are beginning to experience immense overcrowding, placing a burden on both the prison personnel and inmate population. Nevertheless, this scenario is nothing unusual for anyone who has either worked some time for served some time in almost any prison. With most prison staff members suffering from high levels of stress from the unbearable workloads placed upon them, work conditions are starting to be considered near impossible, which is completely unacceptable. However, it’s to be expected if you work in a prison. So, what does the correctional department do to address this issue? Surely, officials aren’t apprehending a lesser amount of individuals†¦show more content†¦Even today, offenders are being placed behind bars with multiple inmates confined to a single cell. Why is this? Should jails be constructed larger to adhere to these escalating needs for space, or should th e corrections department reanalyze the types of offenders they’re putting behind bars? Needless to say, jails and prisons just simply do not have the space to construct new cells, nor do they have the budget to pull a project like that off. With crime rates increasing or remaining consistent, prison vacancy is becoming scarce. However, within the walls of most prisons, stress is beginning build and tempers are flaring. To ward off the stress overcrowding may cause for both inmates and prison personnel, community-based programs, such as probation, parole, and even community service for low-risk offenders may do corrections a favor by cutting down on prison populations and making some more leg room. Moreover, this maneuver provides generous benefits for the community as well. Inmates may be required to clean the neighborhood, pick up trash and recycle as part of their obligation to their sentence. With this being said, utilizing the community as a place to rehabilitate low-risk offenders will drastically lessen the mental and physical burden on other inmates and prison staff by decreasing overcrowding, as well as put forth an effort to strengthen theShow MoreRelatedMale And Female Sentencing : A Look Into Alternative Sentencing1274 Words   |  6 PagesFemale V Male Sentencing A Look into Alternative Sentencing Ritchey, Christian American Military University Author Note This paper was prepared for CRMJ201. Abstract With incarceration rates rising and jail and prison populations at an all-time high, alternative sentencing is being used more often with non-violent offenders. This paper looks at male and female incarceration rates, the use of alternative programs for sentencing between the two and the effectiveness of such programs. 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In reviewing mass incarceration there is often criticism of simple warehousing of human beings who are convicted of crimes. If it is a violent crime there is a need to safeguard society from future criminal acts of a person who is convicted of the most heinous offenses. I willRead MoreExpanding Funding For Alternatives For Incarceration Essay1589 Words   |  7 PagesExpanding Funding for Alternatives to Incarceration Many individuals in prison have mental health and addiction problems. The only way they can be helped is by our system offering lower-cost alternatives to incarceration to address the problem which led them to criminal activity. Studies have indicated that only 10% or fewer inmates received mental health care while incarcerated which in turn is costly and ineffective. 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It is agreed that violent offenders should be in maximum security facilities, however establishing alternatives to prison for non-violent offenders have become a necessity (e.g. DMI, Project HOPE, The 24/7 sobriety project). Due to the overcrowding and budget issues, methods have been devised to increaseRead MoreThe Incarceration Rate Of The United States1543 Words   |  7 PagesAlternatives to Mass Incarceration Once upon a time, Americans could proudly say that America was the land of freedom and opportunity. As the Pledge of Allegiance states, â€Å"One nation under God, Indivisible, with liberty and justice for all.† However, under the current criminal justice system, more and more people lose their liberties because of the crimes they have committed. According to Roy Walmsley, a consultant of the United Nations and Associate of the International Center for prison studiesRead MoreJuvenile Justice And Juvenile Delinquency1675 Words   |  7 Pagesbehavior changes to courts. (Mulligan 2009) We do justice to the youth offenders by understanding the history of Juvenile Justice restorative programs, the alternatives to incarceration, and how to help them amend their actions and behavior. The history of Juvenile Justice went from incarceration with adults to reform back to incarceration in separate facilities and similar rights as adult offenders. The need for Juvenile Justice came from the need to reform juveniles instead of incarcerating withRead MoreThe Effects Of Incarceration On The Correctional System Essay1629 Words   |  7 PagesPositive Alternatives to Incarceration It has been said â€Å"bad company corrupts good morals†. Parents sometimes use this phrase in hopes of keeping their children from hanging out with the wrong crowd. The prison system is no different. Locking up people in jail should be a consequence that most want to avoid thus decreasing the crime rate. In 1976, William Nagel found that incarceration did not stop criminals from committing crimes. In fact, if overcrowded prisons are increasing with more people beingRead MoreQuavyon Green . Professor Irwin . English 1113 . 2/19/2017 .987 Words   |  4 PagesCivil war started. She offers her perspective on the mass incarceration of African American men  in the US. Taking shots  at all she holds responsible for the  issues.  She explores the social and systematic influence of racial stereotypes and  policies that support  incarceration of minorities. She  explains that minorities  are  discriminated against legally for their whole   lives. By  being denie d employment, housing, education, and  public benefits. Unable to overcome said obstacles most will eventually return