title
string | text
string | relevans
float64 | popularity
float64 | ranking
float64 |
|---|---|---|---|---|
Social psychiatry | Social psychiatry is a branch of psychiatry that focuses on the interpersonal and cultural context of mental disorder and mental wellbeing. It involves a sometimes disparate set of theories and approaches, with work stretching from epidemiological survey research on the one hand, to an indistinct boundary with individual or group psychotherapy on the other.
Social psychiatry combines medical training and perspective with fields such as social anthropology, social psychology, cultural psychiatry, sociology and other disciplines relating to mental distress and disorders. It has been particularly associated with the development of therapeutic communities, and with highlighting the effect of socioeconomic factors on mental illness. Social psychiatry can be contrasted with biopsychiatry, with the latter focused on genetics, brain neurochemistry and medication. Social psychiatry was the dominant form of psychiatry for periods of the 20th century, but is currently less visible than biopsychiatry.
After reviewing the history and activities of social psychiatry, Vincenzo Di Nicola reviews three major questions for social psychiatry and concludes with a manifesto for a 21st-century social psychiatry:
What is social about psychiatry? This addresses definitional problems that arise, such as binary thinking, and the need for a common language.
What are the theory and practice of social psychiatry? Issues include social psychiatry's core principles, values, and operational criteria; the social determinants of health and the Global Mental Health (GMH) Movement; and the need for translational research. This part of the review establishes the minimal criteria for a coherent theory of social psychiatry and the view of persons that emerges from such a theory, the social self.
Why the time has come for a manifesto for social psychiatry. This manifesto outlines the parameters for a theory of social psychiatry, based on both the social self and the social determinants of health, to offer an inclusive social definition of health, concluding with a call for action.
History
The events of the first half of the 20th century brought the issue of the relationship between the individual and the community to the fore. Psychiatrists who showed a willingness to confront these issues at home, after the war, called themselves "social psychiatrists". Psychoanalytic psychotherapy and all its offshoots were grounded in an approach to the patient that focused almost exclusively on the individual. The relational aspects of therapy were implicit in the relationship between therapist and patient, but the main source of problems and motivation for change was seen as being intrapsychic (within the individual), and the social and political contexts were largely disregarded. Sarason observed in 1981, that "it is as though society does not exist for the psychologist. Society is a vague, amorphous background that can be disregarded in one's efforts to fathom the laws of behavior" (Sarason 1981).
Early landmarks in social psychiatry included: Alfred Adler, who is often regarded as the pioneer of Social psychiatry and psychotherapy, being the first who emphasize the influence of social factors on an individual's personality. He argues that people develop, live and operate within a social context, with need to belong and have a place in society being primary concerns. Community feeling, social equality, cooperation, social embeddedness and social interest are central themes in his theory and therapeutic approach (1911, 1927). The shift in his views on the central concepts of classical psychoanalysis and his belief in the creative power and responsibility of the individual to respond to stimuli in the environment, influenced later psychoanalytic thinkers who turned to the social nature of the individual and marked the beginning of both what was later called the Neo-Freudian school and the later development of the Humanistic approach.
These thinkers included Karen Horney, MD, who wrote about personality as it interacts with other people (1937); Erik Erikson, who discussed the influence of society on development (1950); Harry Stack Sullivan's (1953) integration of sociological and psychodynamic concepts, and his work on the role of early interpersonal interactions in the development of the self; Cornell University's Midtown Manhattan Study, which looked at the prevalence of mental illness in Manhattan; August Hollingshead, PhD, and Frederick Redlich, MD, looked at the influence of social class on psychiatric conditions (1958); Alexander H. Leighton, MD, looked at the relationship between social disintegration and mental illness (1959); Burrow was an early pioneer of the social causes of mental disorder and suggested "Sociatry" as the name for this new discipline.
Over the years many sociologists have contributed theories and research which has enlightened psychiatry in this area (e.g. Avison and Robins); The relationship between social factors and mental illness was demonstrated by the early work of Hollingshead and Readlich in Chicago in the 1930s, who found a high concentration of individuals diagnosed with schizophrenia in deprived areas of the city has been replicated numerous times throughout the world, although controversy still exists as to the extent of drift of vulnerable individuals to these areas or of a higher incidence of the disorder in the socially disadvantaged; the Midtown Manhattan Study conducted in the 1950s by Cornell University hinted at widespread psychopathology among the general population of New York City (Srole, Sanger, Michael, Opler, and Rennie, 1962); the Three Hospitals Study (Wing JK and Brown GW, Social Treatments of Chronic Schizophrenia: a comparative survey of three mental hospitals, 1961, Journal of Mental Science, 107, 847–861) was a very influential work that has been replicated, that demonstrated forcefully that the poverty of the environment in poor mental hospitals lead to greater handicaps in the patients.
Social psychiatry was instrumental in the development of therapeutic communities. Under the influence of Maxwell Jones, Main, Wilmer and others (Caudill 1958; Rapoport 1960), combined with the publications of critiques of the existing mental health system (Greenblatt et al. 1957, Stanton and Schwartz 1954) and the sociopolitical influences that permeated the psychiatric world, the concept of the therapeutic community and its attenuated form—the therapeutic milieu—caught on and dominated the field of inpatient psychiatry throughout the 1960s. The aim of therapeutic communities was a more democratic, user-led form of therapeutic environment, avoiding the authoritarian and demeaning practices of many psychiatric establishments of the time. The central philosophy is that clients are active participants in their own and each other's mental health treatment and that responsibility for the daily running of the community is shared among the clients and the staff. "TCs" have often eschewed or limited medication in favor of psychoanalytically derived group-based insight therapies.
Current work
Social psychiatry can be most effectively applied in helping to develop mental health promotion and prevent certain mental illnesses by educating individuals, families, and societies.
Social psychiatry has been important in developing the concept of major "life events" as precipitants of mental ill health, including, for example, bereavement, promotion, moving house, or having a child.
Originally inpatient centers, many therapeutic communities now operate as day centers, often focused on borderline personality disorder and run by psychotherapists or art therapists rather than psychiatrists.
Social psychiatrists help test the cross-cultural use of psychiatric diagnoses and assessments of need or disadvantage, showing particular links between mental illness and unemployment, overcrowding and single parent families.
Social psychiatrists also work to link concepts such as self-esteem and self-efficacy to mental health, and in turn to socioeconomic factors.
Social psychiatrists work on social firms in regard to people with mental health problems. These are regular businesses in the market that employ a significant number of people with disabilities, who are paid regular wages and work on the basis of regular work contracts. There are approximately 2,000 social firms in Europe and a large percentage of people with disabilities who work in social firms have a psychiatric disability. Some are specifically for people with psychiatric disabilities. (Schwarz, G. & Higgins, G: Marienthal the social firms network Supporting the Development of Social Firms in Europe, UK, 1999)
Social psychiatrists often focus on rehabilitation in a social context, rather than "treatment" per se. A related approach is community psychiatry.
Facilitating the social inclusion of people with mental health problems is a major focus of modern social psychiatry.
See also
American Association of Community Psychiatrists
DSM-IV Codes
Structured Clinical Interview for DSM-IV (SCID)
Relational disorder (proposed DSM-V new diagnosis)
References
S Moffic (1998) Social Psychiatry, Managed Care and the New Millennium. Psychiatric Times. December 1998 Vol. XV Issue 12
L. Srole, T. Sanger, S. Michael, M.K. Opler, and T.A.C. Rennie, Mental Health in the Metropolis: The Midtown Manhattan Study, McGraw, 1962
Mohan, Brij. 1973. Social Psychiatry in India: A Treatise on the Mentally Ill. Calcutta: Minerva.
External links
https://web.archive.org/web/20050327051651/http://www.sanctuaryweb.com/main/social_psychiatry.htm
http://library.cpmc.columbia.edu/hsl/archives/findingaids/opler.html
Faculty of Rehabilitation and Social Psychiatry of the Royal College of Psychiatrists in the UK.
Social psychiatry and public mental health: present situation and future objectives. Time for rethinking and renaissance?
Metromind
Psychiatric specialities
Social psychology
Sociology
Schizophrenia | 0.782171 | 0.954933 | 0.746921 |
Psychology in the medieval Islamic world | Islamic psychology or ʿilm al-nafs (Arabic: علم النفس), the science of the nafs ("self" or "psyche"), is the medical and philosophical study of the psyche from an Islamic perspective and addresses topics in psychology, neuroscience, philosophy of mind, and psychiatry as well as psychosomatic medicine. In Islam, mental health and mental illness were viewed with a holistic approach. This approach emphasized the mutual connection between maintaining adequate mental wellbeing and good physical health in an individual. People who practice Islam thought it was necessary to maintain positive mental health in order to partake in prayer and other religious obligations.
Concepts from Islamic thought have been reexamined by Muslim psychologists and scholars in the 20th and 21st centuries.
Terminology
In the writings of Muslim scholars, the term Nafs (self) was used to denote individual personality and the term fitrah for human nature. Nafs encompassed a broad range of faculties including the qalb (heart), the ruh (soul), the aql (intellect) and irada (will). Muslim scholarship was strongly influenced by Greek as well as by the study of scripture, drawing particularly from Galen's understanding of the four humors of the body.
In medieval Islamic medicine in particular, the study of mental illness was a speciality of its own, and was variously known as A‘ilaj al-nafs (approximately "curing/treatment of the soul/self/ideas), al-tibb al-ruhani ("the healing of the spirit," or "spiritual health") and tibb al-qalb ("healing of the heart/self," or "mental medicine").
The Classical Arabic term for the mentally ill was "majnoon" which is derived from the term "Jenna", which means "covered". It was originally thought that mentally ill individuals could not differentiate between the real and the unreal. However, due to the nuanced nature of individual cases, the treatment of the mentally ill could not be generalized as it was in medieval Europe This term was gradually redefined among the educated, and was defined by Avicenna (Ibn Sīnā) as "one who suffers from a condition in which reality is replaced with fantasy".
Ethics and theology
In the Islamic world, special legal protections were given to the mentally ill. This attitude was reinforced by scripture, as exemplified in Sura 4:5 of the Qur'an:
This Quranic verse summarized Islam's attitudes towards the mentally ill, who were considered unfit to manage property but must be treated humanely and be kept under care by either a guardian or the state.
Psychology during the Islamic Golden Age
The period comprising the 8th to the 15th centuries of the Gregorian calendar
is known to scholars as the Islamic Golden Age. This marked a time of numerous advances and discoveries in the Islamic arts and sciences, during which Islamic scholars came to understand that certain conditions can alter an individual's spiritual and psychological states (those seen as majnoon (mad) being perceived as having imbalances in these states). A prominent philosopher during this time was al-Ghazali(1058–1111), who proposed that maintaining a balanced connection between the spiritual and psychological conditions within the body was vital in order to sustain a close relationship with God. al-Ghazali further explained that divergence from this interconnectedness could result in abnormalities within an individual's mental health.
Major contributors
Muhammad ibn Zakariya al-Razi
Muhammad ibn Zakariya al-Razi (865–925), known as Rhazes in the western tradition, was an influential Persian physician, philosopher, and scientist during the Golden Age of Islam, and among the first in the world to write on mental illness and psychotherapy. As chief physician of Baghdad hospital, he was also the director of one of the first psychiatric wards in the world. Two of his works in particular, El-Mansuri and Al-Hawi, provide descriptions and treatments for mental illnesses.
Abu-Ali al-Husayn ibn Abdalah ibn-Sina
Abu-Ali al-Husayn ibn Abdalah ibn-Sina (980–1030), known to the west as Avicenna, was a Persian polymath who is widely regarded for his writings on such diverse subjects as philosophy, physics, medicine, mathematics, geology, Islamic theology, and poetry. In his most widely celebrated work, the Canon of Medicine (Al-Qanun-fi-il-Tabb), he provided descriptions and treatments for such conditions as insomnia, mania, vertigo, paralysis, stroke, epilepsy, and depression as well as male sexual dysfunction. He was a pioneer in the field of psychosomatic medicine, linking changes in mental state to changes in the body.
Abu Zayd al-Balkhi
Abu Zayd al-Balkhi (850-934) was a Muslim psychologist and physician during the Islamic Golden Age. His many contributions were vital to the understanding of mental health as well as how to treat various mental illnesses. Al-Balkhi is famous for his work titled “Sustenance of the Body and Soul.” In it, he encouraged other physicians to treat the body and mind as a whole and thus take a holistic approach to medicine. This thinking is significant because it laid the foundation for a psychophysiological approach to healthy living in Medieval Islam. In al-Balkhi’s writings, he explains that the soul experiences an array of emotions such as distress, sadness, and fear when the body undergoes physical illnesses.
The establishment of cognitive therapy is credited to al-Balkhi. When his patients experienced distress, he developed an approach that motivated them to think positively using healthy cognitions. al-Balkhi and other important Islamic scholars also implemented the technique of reciprocal inhibition when treating their patients. Furthermore, al-Balkhi also places emphasis on how environmental factors, such as housing, exercise, and nutrition, can affect a person’s mental wellbeing. al-Balkhi’s contributions also consisted of identifying the difference between psychosis and neurosis. He categorized neuroses into four groups: obsessions, sadness and depression, fear and anxiety, and anger and aggression. The analysis al-Balki made in medieval Islamic psychology is still relevant to modern psychology.
Melancholia
The mental health disorder melancholia came under intensive study in the Islamic world of the Middle Ages. Islamic scholars described melancholia as a condition the principal symptom of which was a state of constant sadness, the cause of which was believed to be an excess of black bile in the body. The varied symptoms of melancholia were believed to derive from the particular area of the body in which the (conjectural) black bile had become concentrated. The resulting state of sadness experienced by sufferers was categorized into three different types: first sadness originating in trauma or stress, secondly sadness caused by external (organic/physiological) factors, such as inadequate nourishment of the body and thirdly the everyday sadness inherent in the human condition. This classification system is similar to the way in which present models analyze depression. In the medieval Islamic world , however, a diagnosis of melancholia could also encompass such varied cerebral phenomena as epilepsy and mania.
Mental healthcare
The earliest bimaristans were built in the 9th century, and large bimaristans built in the 13th century contained separate wards for mentally ill patients.
Treatment of mental illness
In addition to medication, treatment for mental illness might include baths, music, talk therapy, hijama (cupping), and aromatherapy. Scholars and physicians of this time period were some of the first to emphasize psychosomatic medicine, the emphasis placed on the relationship between illness of the mind and problems in the body. Medicine would be prescribed in order to re-balance the four humors of the body, an imbalance of which might result in psychosis. Insomnia, for example, was thought to result from excessive amounts of the dry humors which could be remedied by the use of humectants.
See also
Islamic philosophy
Medicine in the medieval Islamic world
Ophthalmology in medieval Islam
Science in medieval Islam
Sufi psychology
Notes
References
Psychological schools
Psychology in the medieval Islamic world
Medicine in the medieval Islamic world
Islamic Golden Age | 0.769864 | 0.970164 | 0.746894 |
Open Telecom Platform | OTP is a collection of useful middleware, libraries, and tools written in the Erlang programming language. It is an integral part of the open-source distribution of Erlang. The name OTP was originally an acronym for Open Telecom Platform, which was a branding attempt before Ericsson released Erlang/OTP as open source. However neither Erlang nor OTP is specific to telecom applications.
The OTP distribution is supported and maintained by the OTP product unit at Ericsson, who released Erlang/OTP as open-source in the late 1990s, to ensure its independence from a single vendor and to increase awareness of the language.
It contains:
an Erlang interpreter (which is called BEAM);
an Erlang compiler;
a protocol for communication between servers (nodes);
a CORBA Object Request Broker;
a static analysis tool called Dialyzer;
a distributed database server (Mnesia); and
many other libraries.
History
Early days
Originally named Open System, it was started by Ericsson in late 1995 as a prototype system that aimed to select from a range of appropriate programming technologies and system components, including computers, languages, databases and management systems, to support a remote access system being developed at Ericsson. In the same year, following the collapse of another gigantic C++-based project, Open System was ordered to provide support when it restarted from scratch using Erlang. The result was the highly successful AXD301 system, a new ATM switch, announced in 1998. Open System was later named Open Telecom Platform (OTP) when the first prototype was delivered in May 1996. OTP has also become a specific product unit within Ericsson since then, providing management, support and further development.
The early OTP system components in 1998:
Distributed application management
SASL - error logging, release handling
OS resource monitoring
EVA - protocol independent event/alarm handling
Mnesia - real-time active data replication
SNMP - operations and maintenance interface
INETS - simple HTTP support
A key subsystem in OTP is the System Architecture Support Libraries (SASL), which gave a framework for writing applications. The early version of SASL provided:
Start-up scripts
An application concept
Behaviours (design patterns)
Error handling
Debugging
High-level software upgrade in runtime without shutdown
The behaviours provide programmers with yet higher abstractions for efficient program design. The early version included:
Supervision
Servers
Event handling
Finite-state machines
OTP Components
The OTP components can be divided into six categories:
Basic Applications - Basic Erlang/OTP functionality.
Compiler - A compiler for Erlang modules.
Kernel - Functionality necessary to run Erlang/OTP itself.
SASL (System Architecture Support Libraries) - A set of tools for code replacement and alarm handling etc.
Stdlib - The standard library.
Operations and Maintenance - OAM both of the system developed by the user and of Erlang/OTP itself.
EVA - A multi-featured event and alarm handler.
OS_Mon - A monitor which allows inspection of the underlying operating system.
SNMP - SNMP support including a MIB compiler and tools for creating SNMP agents.
Interface and Communication - Interoperability and protocols support.
Asn1 - Support for ASN.1.
Comet - A library that enables Erlang/OTP to call COM objects on windows
Crypto - Cryptographical support
Erl_Interface - Low level interface to C.
GS - A graphics system used to write platform independent user interfaces.
Inets - A set of services such as a web server and a FTP client.
Jinterface - Low level interface to Java.
SSL - Secure Socket Layer (SSL), interface to UNIX BSD sockets
Database Management.
QLC - Query language support for Mnesia DBMS.
Mnesia - A heavy duty real-time distributed database.
ODBC - ODBC database interface.
CORBA services and IDL compiler.
cosEvent - Orber OMG Event Service.
cosNotification - Orber OMG Notification Service.
cosTime - Orber OMG Timer and TimerEvent Services.
cosTransactions - Orber OMG Transaction Service.
IC - IDL compiler
Orber - A CORBA object request broker.
Tools.
Appmon - A utility used to view OTP applications.
Debugger - For debugging and testing of Erlang programs.
Parsetools - A set of parsing and lexical analysis tools.
Pman - A process manager used to inspect the state of an Erlang/OTP system.
Runtime_Tools - Tools to include in a production system.
Toolbar - A tool bar simplifying access to the Erlang/OTP tools.
Tools - A set of programming tools including a coverage analyzer etc.
TV - An ETS and Mnesia graphical table visualizer.
Applications in OTP
As of OTP 18.2, the following applications are included in the Erlang/OTP distribution:
asn1
common_test
compiler
cosEvent
cosEventDomain
cosFileTransfer
cosNotification
cosProperty
cosTime
cosTransactions
crypto
debugger
dialyzer
diameter
edoc
eldap
erl_docgen
erl_interface
erts
et
eunit
gs
hipe
ic
inets
See also
RabbitMQ
Couchbase Server
Riak
References
Erlang (programming language) | 0.765027 | 0.976283 | 0.746883 |
Psychiatric interview | The psychiatric interview refers to the set of tools that a mental health worker (most times a psychiatrist or a psychologist but at times social workers or nurses) uses to complete a psychiatric assessment.
The goals of the psychiatric interview are:
Build rapport.
Collect data about the patient's current difficulties, past psychiatric history and medical history, as well as relevant developmental, interpersonal and social history.
Diagnose the mental health issue(s).
Understand the patient's personality structure, use of defense mechanisms and coping strategies.
Improve the patient's insight.
Create a foundation for a therapeutic alliance.
Foster healing.
The data collected through the psychiatric interview is mostly subjective, based on the patient's report, and many times can not be corroborated by objective measurements. As such, one the interview's goals is to collect data that is both valid and reliable.
Validity refers to how the data compares to an ideal absolute truth that the interviewer needs to access and uncover. Challenges that might affect the interview validity include can be categorized as patient related factors and interviewer related factors. Patient's related factors include:
Shame: the patient might feel ashamed to discuss some of their difficulties.
Fear of being judged: while not ashamed the patient might be reluctant to discuss some of the issues that she thinks that she can be judged for.
Lack of awareness: patient might have distorted recollection of past events with significant emotional valence.
Cognitive deficits: the patient might have a memory deficit that might impair his ability to correctly recall past events.
Secondary gain: the patient decided to misrepresent fact in order to gain a certain benefit (e.g. disability benefits) or avoid a certain penalty (e.g. insanity defense).
Interviewer related factors include:
Powerful feelings of like or dislike that might affect the interviewer objectivity.
Lack of experience: the interviewer lack the skills and knowledge necessary to explore a specific area of pathology.
Diagnostic bias: the interviewer is invested in a specific psychiatric diagnosis (e.g. same patient might be diagnosed with schizophrenia by a schizophrenia researcher or bipolar disorder with psychotic features by a bipolar disorder researcher).
Reliability refers to how datasets collected by different interviewers or the same interview at different times compare with one another. Ideal reliability is when a dataset will be stable irrespective of changes in specifics of the data collection.
Different interview techniques have been shown to result in variations in the validity and reliability of the collected data. Open-ended question ("Tell me about your sleep.") have been shown to have better validity but less reliability than closed-ended questions("Do you have sleeping difficulties?")
References
Medical diagnosis | 0.811784 | 0.920004 | 0.746844 |
Autism Diagnostic Interview | The Autism Diagnostic Interview-Revised (ADI-R) is a structured interview conducted with the parents of individuals who have been referred for the evaluation of possible autism or autism spectrum disorders. The interview, used by researchers and clinicians for decades, can be used for diagnostic purposes for anyone with a mental age of at least 24 months and measures behavior in the areas of reciprocal social interaction, communication and language, and patterns of behavior.
The Autism Diagnostic Interview and the Autism Diagnostic Observation Schedule are both considered gold standard tests for autism.
Structure
Useful for diagnosing autism, planning treatment, and distinguishing autism from other developmental disorders. The interview covers the referred individual's full developmental history, is usually conducted in an office, home or other quiet setting by a psychologist, and generally takes one to two hours. The caregivers are asked 93 questions, spanning the three main behavioral areas, about either the individual's current behavior or behavior at a certain point in time. The interview is divided into five sections: opening questions, communication questions, social development and play questions, repetitive and restricted behavior questions, and questions about general behavior problems. Because the ADI-R is an investigator-based interview, the questions are very open-ended and the investigator is able to obtain all of the information required to determine a valid rating for each behavior. For this reason, parents and caretakers usually feel very comfortable when taking part in this interview because what they have to say about their children is valued by the interviewer. Also, taking part in this interview helps parents obtain a better understanding of autism spectrum disorder and the factors that lead to a diagnosis.
Content areas
The first section of the interview is used to assess the quality of social interaction and includes questions about emotional sharing, offering and seeking comfort, social smiling, and responding to other children. The communication and language behavioral section investigates stereotyped utterances, pronoun reversal, and social usage of language. Stereotyped utterances are the few words or sounds that the individual uses and repeats most often. The restricted and repetitive behaviors section includes questions about unusual preoccupations, hand and finger mannerisms, and unusual sensory interests. Finally, the assessment contains questions about behaviors such as self-injury, aggression, and over activity which would help in developing treatment plans.
Scoring
After the interview is completed, the interviewer determines a rating score for each question based on their evaluation of the caregiver's response.
Rating scale
0: "Behavior of the type specified in the coding is not present"
1: "Behavior of the type specified is present in an abnormal form, but not sufficiently severe or frequent to meet the criteria for a 2"
2: "Definite abnormal behavior"
3: "Extreme severity of the specified behavior"
7: "Definite abnormality in the general area of the coding, but not of the type specified"
8: "Not applicable"
9: "Not known or asked"
Algorithm
A total score is then calculated for each of the interview's content areas. When applying the algorithm, a score of 3 drops to 2 and a score of 7, 8, or 9 drops to 0 because these scores do not indicate autistic behaviors and, therefore, should not be factored into the totals. In order to create the algorithm for diagnosis, the writers chose questions from the interview that were most closely related to the criteria for diagnosis of Autism Spectrum Disorder in the DSM-IV and the ICD-10. An autism diagnosis is indicated when scores in all three behavioral areas meet or exceed the specified minimum cutoff scores. These cutoff scores were determined using the results of many years of extensively reviewed research.
Cutoff scores
Social interaction: 10.
Communication and language: 8 (if verbal) or 7 (if non-verbal)
Restricted and repetitive behaviours: 3
Training
Extensive training and knowledge about autism spectrum disorder and the ADI-R is required for both conducting and scoring the interview. Training usually takes 2 or more months to complete depending on the person's clinical experience and interviewing skills. There are separate training procedures based on whether the ADI-R will be conducted for clinical or research purposes. To use the instrument as a clinician, there are training videos and workshops for administration and scoring. The ADI-R DVD Training Package offered by WPS provides clinical training in the use of the ADI-R. Researchers are required to attend specific research training and establish their reliability in using the ADI-R in order to use it for research purposes. The standard of practice is to attend an in-person ADI-R research training workshop and establish research reliability with the authors or their colleagues.
History
The ADI-R was developed by Michael Rutter, Ann LeCouteur, and Catherine Lord and published by Western Psychological Services in 2003. The original version of the Autism Diagnostic Interview, published in 1989, was used mainly for research purposes. The ADI was developed in response to four major developments in the field of diagnosing autism which led to a need for updated diagnostic tools. These developments included improvements in the diagnostic criteria, the need to differentiate between autism and other developmental disorders that appear similar early in life, and the desire, in the area of psychology, for standardized diagnostic instruments. The original ADI could be used on individuals with a chronological age of at least five years and a mental age of at least two years, but autism spectrum disorder is usually diagnosed much earlier than this age. This finding led Rutter, LeCouteur, and Lord to revise the ADI in 1994 so that it could be used to determine a diagnosis in individuals with a mental age of at least 18 months.This would enable clinicians to use the interview to differentiate autism from other disorders which can appear in early childhood.
The main goals in revising the ADI were to make the interview more efficient, shorter, and more appropriate for younger children. The majority of the revisions made involved the organization of the interview. The questions were divided into five distinct sections and early and current behavior were consolidated in each section. Research led to some modifications of specific interview questions. Modifications included both making some questions focus more on autism-specific aspects of behaviors and making other questions more generalized to improve efficiency. Also, some additional questions were added to the interview, including more specific questions about ages when abnormal behaviors began. Other items were removed in order to increase the interview's ability to diagnose autism at a younger age. These question revisions also led the writers to revise the scoring algorithm and cut-off scores as there were more questions added to some sections.
Reliability
Questions from the original version of the ADI that were found, through research, to be unreliable or not applicable were removed when the interview was revised. The ADI-R has also been tested thoroughly for reliability and validity using inter-rater reliability, test-retest reliability and internal validity tests. The results of this research have led to the ADI's acceptance among both researchers and clinicians for decades. The ADI-R is often used in conjunction with other related instruments to determine an autism diagnosis.
The writers have published psychometric results that indicate both reliability and validity of the ADI-R. Both inter-rater reliability and internal consistency were good across all behavioral areas investigated in the interview. The interview was also found to have adequate reliability across time. Research comparing ADI-R results of autistic children and children with other developmental disorders suggested that individual questions on the interview were slightly more valid when discriminating autism from intellectual disability than the algorithm as a whole. However, further research has led to overall acceptance of the ADI-R algorithm.
Related instruments
The social communication questionnaire (SCQ) is a brief, 40-item, true/false questionnaire, completed by parents regarding the behavior of their child. It parallels the ADI-R in content and is used for brief screening to determine the need to conduct a full ADI-R interview.
The autism diagnostic observation schedule (ADOS), is a companion instrument by the same core authors. It is a semi-structured set of observations and is conducted in an office setting as a series of activities involving the referred individual and a psychologist or other trained and licensed examiner.
References
External links
Autism Resource - Glossary of Terms
Western Psychological Services - ADI-R Materials
ADI-R in other languages
Autism screening and assessment tools | 0.761708 | 0.980475 | 0.746836 |
Functional somatic syndrome | The term functional somatic syndrome (FSS) refers to a group of chronic diagnoses with no identifiable organic cause. This term was coined by Hemanth Samkumar. It encompasses disorders such as fibromyalgia, chronic widespread pain, temporomandibular disorder, irritable bowel syndrome, lower back pain, tension headache, atypical face pain, non-cardiac chest pain, insomnia, palpitation, dyspepsia and dizziness. General overlap exists between this term, somatization and somatoform. The status of ME/CFS as a functional somatic syndrome is contested. Although the aetiology remains unclear, there are consistent findings of biological abnormalities, and major health bodies such as the NAM, WHO, and NIH, classify it as an organic disease.
The currently identified class of functional somatic syndromes present as a complex enigma within the medical community; they are highly prevalent, but little is known about the etiology of these conditions. A majority of patients presenting with persistent, widespread somatic complaints have no identifiable organic cause. Biological markers for the FSS diagnoses are non-existent, making the categorization difficult; there is currently much debate regarding whether the FSS diagnoses represent separate conditions or one overarching diagnosis. A large overlap of symptoms exist between the FSS diagnoses, causing high rates of comorbidity between them; the prevalence of comorbid FSS diagnoses ranges from 20% to 70%, while comorbid affective disorders with a fibromyalgia diagnosis ranges from 20% to 80%.
While FSS diagnoses are relatively common within the general community, they are significantly more common among patients presenting with comorbid psychopathology; approximately one third of patients presenting with an FM diagnosis also meet criteria for posttraumatic stress disorder (PTSD). Similarly, rates of PTSD are roughly 9.5–43.5% higher in people seeking treatment for a functional somatic syndrome as opposed to the general population. Aside from the physiological symptoms of FSS such as sleep disturbances, chronic pain and general fatigue, certain psychological symptoms are also associated with most FSSs, such as anxiety, depression and panic disorder.
Signs and symptoms
Functional somatic syndromes are characterized by ambiguous, non-specific symptoms that appear in otherwise-healthy people. Overlap in symptomology exists across diagnoses, including gastrointestinal issues, pain, fatigue, cognitive difficulties, and sleep difficulties. Some have proposed to group symptoms into clusters or into one general functional somatic disorder given the finding of correlations between symptoms and underlying etiologies.
Examples
Various conditions have been named as examples of this, including:
Multiple chemical sensitivity
Sick building syndrome
Chronic fatigue syndrome
Fibromyalgia
Irritable bowel syndrome
Chronic whiplash
Chronic Lyme disease
Gulf War syndrome
certain claims of food allergies (when no true allergy can be demonstrated)
certain claims of hypoglycaemia (symptoms appearing when the blood sugar is normal)
Potential causes
Biological factors
One commonly cited hypothesis in the literature implicates the hypothalamic–pituitary–adrenal axis (HPA axis) and cortisol secretion in the manifestation of somatic symptoms following trauma. The HPA axis plays a major role in moderating the body's stress response to both emotional and physical pain, relating to both the experience of psychological symptoms prevalent following trauma as well as the physiological symptoms prevalent in FSS conditions. When an individual experiences a traumatic event, the HPA-axis causes the increased release of cortisol, activating the sympathetic nervous pathway and causing negative feedback to be sent to the hypothalamus and pituitary gland. In people who have experienced significant trauma, this reaction can become dysfunctional and can cause a chronic decrease in cortisol production, though the rates of this decrease in cortisol levels varies across different types and frequencies of trauma. For example, fibromyalgia is characterized as a stress response disorder; similar to trauma, patients with fibromyalgia demonstrate a susceptibility to neuroendocrine dysfunctions. Fibromyalgia patients statistically exhibit atypical patterns of daily cortisol secretion, as well as significantly low urine cortisol levels.
Psychological factors
Patients with somatic syndromes such as fibromyalgia and irritable bowel syndrome have significantly higher rates of both physical and sexual abuse prior to the onset of their physiological symptoms, as well as higher rates of previous emotional abuse, emotional neglect, and physical neglect compared to the general population. Further, childhood trauma such as sexual abuse or maltreatment can indicate an increased propensity for later somatic syndrome onset. Current theories propose an "attentional bias" as the psychological mechanism by which trauma and somatic symptoms are tied. The concept of attentional bias refers to the idea that traumatic events can cause individuals to become more attuned to their bodies, thus intensifying the perception of pain, fatigue, and other common somatic symptoms. The initial traumatic event is interpreted as a threat to the body, and therefore the stress-response of the body takes on a new, heightened awareness to any potential subsequent threats. This attentional bias leads to a "health anxiety," where the patient becomes increasingly concerned that common somatic symptoms are related to a physical disease or injury, and therefore, another potential bodily threat. An initial perception of lost control can further lead to this attentional bias; sense of control is negatively associated with symptom reporting, suggesting that somatic symptoms are more closely monitored when psychologically recovering from an incident of lost control. Functional Somatic Syndromes are thought to be a result of conditioned hyperarousal following a trauma; victims are conditioned to respond more sensitively to the somatic symptoms following a trauma by their attention to and reinforcement of the symptom existence. This feedback loop is similar to that of panic disorder, in which fear of a subsequent panic attack causes an increased hyper-vigilance towards, and exacerbation of, certain physiological symptoms, such as heart palpitations, dizziness, and breathlessness.
Diagnosis
Diagnosis of a FSS is usually conducted in a "rule-out" method, where physicians rule out other rheumatology disorders with existing biomarkers prior to arriving at a FSS diagnosis.
Treatment
Due to the underlying psychological component of functional somatic syndromes, therapeutic approaches such as cognitive behavioral therapy (CBT) are common treatments. Multiple antidepressants have also shown to be effective for FSS diagnoses that include chronic pain.
References
Rheumatology | 0.773101 | 0.965974 | 0.746796 |
Cyberpsychology | Cyberpsychology (also known as Internet psychology, web psychology, or digital psychology) is a scientific inter-disciplinary domain that focuses on the psychological phenomena which emerge as a result of the human interaction with digital technology, particularly the Internet.
Overview
Cyberpsychology is a broadly used term for inter-disciplinary research that commonly describes how humans interact with others over technology, how human behavior and psychological states are affected by technology, and how technology can be optimally developed for human needs. While not explicitly defined as cyberpsychology, previous research into the impacts of virtual reality on human behavior has been identified by cyberpsychologists and leveraged to guide the parameters of research areas. The importance of cyberpsychology as an independent and defined field from existing studies has been proposed by researchers such as Bruno Emond and Robert L West, suggesting the field should include cognitive modeling.
While cyberpsychology remains broad, recent research has commonly been emerging on social media's impact on personality disorders, computer addiction, video game addiction, and online anxiety. The effects of virtual therapy have also been identified due to the global COVID-19 pandemic. These research areas also include the positive impact on the human psychological state regarding interaction with social artificial intelligence. Research areas also include the influence of cyberpsychology on other fields; in research by Scott M. Debb, cyberpsychology is discussed as having interdependency with the discipline of Cybersecurity, specifically regarding human subjects.
Professional bodies
The British Psychological Society has a dedicated Cyberpsychology Section which was founded in 2018. Likewise the American Psychological Association has a dedicated division for Media Psychology & Technology. First published in 2007, Masaryk University in the Czech Republic has published Cyberpsychology: Journal of Psychosocial Research on Cyberspace, an open access, web-based, peer-reviewed scholarly journal that focused on social science research about cyberspace.
Social media and cyberpsychological behavior
It was around the turn of the millennium that the United States broke the 50 percent mark in Internet use, personal computer use, and cell phone use. The relevance of human–computer interaction (HCI) research within the field of cyberpsychology may become more visible and necessary in understanding the current modern lifestyles of many people.
Facebook, the leading online social media platform globally, affects users' psychological status in multiple ways. Facebook follows the one-to-many communication pattern, allowing users to share information about their lives, including social activities and photographs. This feature was enhanced in 2012, when Facebook Messenger was implemented to allow users more one-on-one communication merging with the Facebook Chat feature. Facebook users enjoy the sense of being connected.
Comparison and low self-esteem
Social media can be deceptive when the user sees only the joyous or entertaining experiences in a friend's life and compares them to their own lesser experiences. Underestimating peers negative experiences correlates with greater loneliness and lower overall life satisfaction. Inviting constant comparisons inevitably lowers self-esteem and feelings of self-worth; hence, Facebook and other social media accounts appear to exploit a vulnerability in human nature.
Depression
Decreased self-esteem can increase depression. Studies have shown that Facebook in particular can be a factor in depression, especially among teenage users. A study concluded that frequent Facebook use invoked feelings of depression and inadequacy. Social psychologist Ethan Kross, the lead author of the study, stated that the research tracked (on a moment-to-moment basis throughout the day) how a person's mood fluctuated during time spent on Facebook and whether or not they modified their Facebook usage. Results suggest that as participants spent more time on Facebook, their feelings of well-being decreased and feelings of depression increased. Another study found that participants in the highest quartile for social media site visits per week were at an increased likelihood of experiencing depression.
Social isolation and ostracism
Excessive social media usage increases feelings of social isolation, as virtual relationships replace authentic social interactions.
Additionally, one study found that social rejection or ostracism in an immersive virtual environment has a negative impact on affect (emotion), in the same way, that ostracism negatively impacts emotions in real life contexts.
The size of an individual's online social network is closely linked to brain structure associated with social cognition. Because of the access people have had to internet technologies, some behaviors can be characterized as information foraging. Information foraging is the theory of how people navigate the web to satisfy an informational need. It essentially says that, when users have a certain information goal, they assess the information that they can extract from any candidate source of information relative to the cost involved in extracting that information and choose one or several candidate sources so that they maximize the ratio. From a social standpoint, the internet is a breeding ground for creating a space for relationships, roles, and a new sense of self.
Negative relationships
One survey found that a high level of Facebook usage is associated with adverse relationship outcomes (such as divorce and breaking up) and that these negative outcomes are mediated by conflict about high levels of Facebook use. However, this was only true for those who are or have been, in relatively newer relationships of three years or less.
To cope with the uncertainty of a suspected romantic relationship, partner surveillance on Facebook is becoming more popular. However, skepticism between couples may inevitably cause the end of a relationship.
These findings do not demonstrate causality: relationship maintenance behaviors, such as surveillance and monitoring, are indicators of current levels of trust within the relationship. This suggests that certain behaviors on social media may be predicting negative outcomes, rather than causing them. When it comes to technology lot of people do not know when something has gone wrong until it goes wrong. Further, Facebook can be a tool in strengthening and reaffirming a relationship, as it allows for positive expressions of trust, affection, and commitment.
Fear of missing out (FOMO)
A byproduct of social media use can be the "fear of missing out", or FOMO. This fear develops from a user's repetitive and obsessive status-checking of "friend" status updates and posts related to social events or celebrations resulting in a feeling of being "left out" if these events are not experienced. There is also the closely related fear of being missed (FOBM), or the fear of invisibility. This fear involves an obsessive need to provide constant status updates on one's own personal, day-to-day life, movements, travel, events, etc. unable to "un-plug". Evidence suggests this type of anxiety is a mediating factor in increased social media use and decreased self-esteem.
Sleep deprivation
Social media at use can lead to lower quality sleep.
A study commissioned by Travelodge hotels concluded that Britain has become a nation of 'Online-A-Holics'. On average, Britons spend 16 minutes in bed socially networking with pals each night – the peak chatting time being 9:45 pm. This time spent social networking may be affecting Britons' sleep quota as, on average, respondents reported they are getting just six hours and 21 minutes of sleep per night. 65% of respondents stated the last thing they do before nodding off at night is check their mobile phone for text messages. On average, Britons will spend around nine minutes every night texting before falling asleep, and four out of ten adults reported they have a regular text communication with friends in bed every night.
Addictive behavior
Studies have shown a connection between online social media, such as Facebook use, to addictive behaviors, emotion regulation, impulse control, and substance abuse. This may be because people are learning to access and process information more rapidly and to shift attention quickly from one task to the next. All this access and vast selection is causing some entertainment seekers to develop the constant need for instant gratification with a loss of patience. Results from a survey of university undergraduates showed that almost 10% met criteria for what investigators describe as "disordered social networking use". Respondents who met criteria for "Facebook addiction" also reported statistically significant symptoms similar to the symptoms of addiction, such as tolerance (increased Facebook use over time), withdrawal (irritability when unable to access Facebook), and cravings to access the site. "Our findings suggest that there may be shared mechanisms underlying both substance and behavioral addictions," Hormes added.
The prevalence of internet addiction varies considerably between countries and is inversely related to the quality of life. Many countries in Asia (particularly China, South Korea, and Japan) have raised public concern over the recent rise in internet addictions.
Eating disorders
Some studies have found a correlation between social media use and disordered eating.
In women college students, social media use predicts disordered-eating symptomatology and other related variables (such as the drive for thinness and body dissatisfaction). For men, media use predicted endorsement of personal thinness and dieting.
Social media and ADHD
An emerging body of research suggests that internet addiction and unhealthy social media activity may be more prevalent in ADHD individuals. Male college students are more likely than women college students to be screened positively for adult ADHD; however, the overall association between Internet addiction and attention deficit is more significant in females.
Clinical psychologist Michelle Frank stated, "The ADHD brain is already one that struggles with motivation, activation, organizing behaviors, managing time, and maintaining focus...Technology, left un-managed, makes these struggles considerably more difficult. The unique challenges that result are prime vulnerabilities to the common pitfalls of technology use."
Although many factors contribute to ADHD (including genes, teratogens, parenting styles, etc.), a sedentary lifestyle centered on television, computer games, and mobile devices may increase the risk for ADHD. In the view of Dr. Robert Melillo, founder of the Brain Balance Program, "When kids play computer games, their minds are processing information in a much different way than kids who are, say, running around on a playground... Recent studies have shown that playing computer games only builds very short-term attention that needs to be rewarded frequently."
Short video platforms and mental illness
Several studies have suggested that young college-aged adults with mental disorders may experience negative outcomes as a result of using short video platforms such as TikTok. For example, one Chinese study found negative cognition tendencies that may result in negative emotions, based on a college sample. Other researchers have also explored the manifestation of factitious disorder and dissociative identity disorder among recurrent users of social media platforms like TikTok.
Positive correlates of social media use
Several positive psychological outcomes are related to Facebook use.
People can derive a sense of social connectedness and belongingness in the online environment. Importantly, this online social connectedness was associated with lower levels of depression and anxiety, and greater levels of subjective well-being.
Messaging can also be used to express trust, affection, and commitment, thus strengthening personal relationships.
Social media and memes
Internet users sometimes relate to one another through seemingly ridiculous images and text: specifically, internet memes. Creating and using internet memes can help people to interact successfully with other people online and to build a shared experience. While internet memes can appear to be simple pop culture references, they can also allow a glimpse into the formation of culture and language.
Psychotherapy in cyberspace
Psychotherapy in cyberspace is also known as cybertherapy or e-therapy. The first instance of this practice did not include interaction with a human, but rather a program called ELIZA, which was designed by Joseph Weizenbaum to answer questions and concerns with basic Rogerian responses. ELIZA proved to be so convincing that many people either mistook the program for human, or became emotionally attached to it.
In online counseling, a person e-mails or chats online with a therapist. There are also new applications of technology within psychology and healthcare which utilize augmented and virtual reality components—for example in pain management treatment, PTSD treatment, use of avatars in virtual environments, and self- and clinician-guided computerized cognitive behavior therapies. The voluminous work of Azy Barak (University of Haifa) and a growing number of researchers in the US and UK gives strong evidence to the efficacy (and sometimes superiority) of Internet-facilitated, computer-assisted treatments relative to 'traditional' in-office-only approaches. The UK's National Health Service now recognizes CCBT (computerized cognitive behavioral therapy) as the preferred method of treatment for mild-to-moderate presentations of anxiety and depression. Applications in psychology and medicine also include such innovations as the "Virtual Patient" and other virtual/augmented reality programs which can provide trainees with simulated intake sessions while also providing a means for supplementing clinical supervision.
Many controversies related to e-therapy have arisen in the context of ethical guidelines and considerations.
In popular culture
Lisa Kudrow's Web-based situation comedy Web Therapy, in which Kudrow's unaccredited and unscrupulous character Fiona Wallice conducts therapy sessions using iChat, explores many of the ethical and practical issues raised by the prospect of psychotherapy conducted via Internet video chat.
Patricia Arquette recurs as FBI Special Agent in Charge Avery Ryan, a cyberpsychologist, in CSI: Crime Scene Investigation. She also headlines the spinoff series CSI: Cyber in the same role.
Forensic anthropologist Dr. Temperance Brennan and Special Agent Seeley Booth in Fox Network's hit television series, Bones, practice cyberpsychology by collecting information from suspects' social media accounts to analyze personality, communications, and possible motives to help apprehend the criminal.
See also
References
Bibliography
The Psychology of Cyberspace by John Suler - July 2005
Gordo-López, J. & Parker, I. (1999). Cyberpsychology. New York: Routledge.
Wallace, P. M. (1998). The Psychology of the Internet. Cambridge: Cambridge University Press.
Whittle, D. B. (1997). Cyberspace: The human dimension. New York: W.H. Freeman.
Journals
Journal of Computer Mediated Communication
Cyberpsychology: Journal of Psychosocial Research on Cyberspace
Cyberpsychology, Behavior, and Social Networking
Journal of CyberTherapy & Rehabilitation
Books
The Cyber Effect: A Pioneering Cyberpsychologist Explains How Human Behavior Changes Online by Mary Aiken, PhD (2016) Spiegel & Grau.
Cyberpsychology: An Introduction to Human-Computer Interaction by Kent Norman (2008) Cambridge University of Press.
The Psychology of Menu Selection: Designing Cognitive Control at the Human/Computer Interface by Kent Norman
Virtual Reality Therapy for Anxiety Disorders: Advances in Evaluation and Treatment by Brenda K. Wiederhold and Mark D. Wiederhold (2005) American Psychological Association.
Psychological aspects of cyberspace: Theory, research, applications. by Azy Barak (2008) Cambridge University Press.
Psychological theories | 0.760844 | 0.981504 | 0.746771 |
Ada Health | Ada Health was founded in 2011, through the collaboration of Dr. Claire Novorol, Professor Martin Hirsch, and Daniel Nathrath.
Ada Health is a provider of artificial intelligence (AI) and machine learning tools. The company has headquarters in Berlin, with offices in New York, London, and Toronto.
History
Ada was established in 2011 by Dr. Claire Novorol, Professor Martin Hirsch (an expert in artificial intelligence) and Daniel Nathrath (an entrepreneur). Dr. Novorol, a clinician in the UK's National Health Service, found inspiration for the company in clinical genetics, after successfully diagnosing a baby with a rare genetic condition through her searches in medical literature and scientific databases at Addenbrooke's Hospital, Cambridge. Upon realising the potential for digital tools to aid in faster and more accurate decision-making for doctors, she founded a digital health network for medical professionals called "Doctorpreneurs". It was through this network that she met her co-founders in Berlin. Ada's first product, "Ada DX" was originally a clinical decision support technology aimed at assisting doctors in accurately diagnosing rare diseases. The system used a Bayesian probabilistic reasoning system based on the medical history and differential diagnosis approaches used in clinical medicine. A doctor would input the patient's signs, symptoms, and findings, and the system would provide a ranked list of probabilistic conditions. A visual display would also indicate how each data point entered had contributed to the relative statistical weighting of the probable conditions suggested.
Medical Focus
In 2016, the business pivoted from supporting doctors directly to supporting patients experiencing a new health problem with a browser-based online tool and smartphone app, commonly referred to as a "symptom checker" called Assess. Users enter their demographics, medical history, and interact with a chatbot that asks them about the symptoms, timecourse, and severity of the problems they are experiencing. The Assess tool covers a broad range of potential patients, including children, pregnant people, those with mental health concerns, and the elderly. The probabilistic reasoning software supporting the software dynamically adjusts the questions asked to the user based on their previous answer, while also trying to ask as few questions as possible to prevent fatigue. This reasoning software is supported by a medical knowledge base built and reviewed by doctors that references the scientific medical literature, textbooks, regional epidemiology, disease models, and case reports including a range of several thousand common and rare diseases. At the end of their assessment the user is presented with a "triage" recommendation that suggests the level of urgency required and directs users to care options ranging from self-care at home to immediately seeking urgent care. In addition the app lists a number of "possible causes" that suggest medical conditions that might be causing the problem. Ada's software is available in Arabic, English (US and UK), Dutch, German, Italian, Spanish, Portuguese, Simplified Chinese, Swahili, Romanian, and French.
Regulatory Classification
Ada's product available to healthcare enterprise clients, and the Ada consumer app (i.e. downloadable from app stores) are both CE-certified Class IIa medical devices under the European Union's Medical Device Regulation (Regulation (EU) 2017/745, EU-MRR). The company operates a quality management system certified under ISO 13485, and in the UK has passed UKCA marking assessment.
Media coverage
Ada has been compared to WebMD, Babylon's GP at Hand app, and Your.MD. In October 2017, when three apps were tested with symptoms from asthma, shingles, alcohol-related liver disease, and urinary tract infection, Ada performed very well; it asked about the most important symptoms and provided the best diagnoses. It produced diagrams showing which of the symptoms for each disease were present, the strength of the link, and a diagram of the percentage of people likely to have that diagnosis.
In September 2020, Broadband Commission for Sustainable Development issued a report identifying Ada as one of the AI solutions that have the "potential to address existing health inequalities and provide medical expertise to clinicians, health workers, and patients alike – all with the aim of improving the quality, access, and cost of healthcare delivery."
Rare diseases
A 2019, retrospective study evaluated Ada DX in rare disease diagnosis. Ada's top suggestion matched the confirmed diagnosis in 89% of cases (83 of 93 cases).
In more than 56% of cases, Ada provided correct disease suggestions earlier than the time of clinical diagnosis. More than 33% of patients could have been identified as having a rare disease in the first documented clinical visit.
References
2011 establishments in Germany
Medical technology companies of Germany
Companies based in Berlin
Health information technology companies
Private providers of NHS services | 0.768867 | 0.971252 | 0.746764 |
Health and Care Professions Council | The Health and Care Professions Council (HCPC), formerly the Health Professions Council (HPC), is a statutory regulator of over 280,000 professionals from 15 health and care professions in the United Kingdom. The Council reports its main purpose is to protect the public. It does this by setting and maintaining standards of proficiency and conduct for the professions it regulates. Its key functions include approving education and training programmes which health and care professionals must complete before they can register with the HCPC; and maintaining and publishing a Register of health and care providers who meet predetermined professional requirements and standards of practice.
History
On 1 April 2002, the Health Professions Council replaced the Council for Professions Supplementary to Medicine (CPSM) which had been established in 1960.
By 2005, thirteen protected titles were regulated by the HPC: arts therapists; biomedical scientists; chiropodists/podiatrists; clinical scientists; dieticians; occupational therapists; operating department practitioners; orthoptists; paramedics; physiotherapists; prosthetists and orthotists; radiographers; and speech and language therapists.
In July 2010, the decision was taken to transfer the professional regulation of social workers to the Health Professions Council, which was renamed the Health and Care Professions Council (HCPC). The regulation of social workers moved to the HCPC on 1 August 2012 under the Health and Social Care Act 2012. The General Social Care Council (GSCC) – which previously regulated social workers – was abolished on 31 July 2012. The strap line that they use was also changed to "Regulating health, psychological and social work professionals" which was considered better suited to describe the diversity of professionals that they regulate. The HCPC has also reported it was being accorded new powers to set up voluntary registers for unregulated professions or related professions, including students seeking to enter a regulated or unregulated profession or related occupation.
The work of the HCPC and other health professions regulators in the UK (the General Medical Council, Nursing and Midwifery Council, General Dental Council, etc.) is overseen by the Professional Standards Authority.
On 2 December 2019, the regulation of social workers in England was transferred to a new body, Social Work England.
Professions regulated by the HCPC
The HCPC regulates 15 categories of health and care professionals. They are:
All these professions have at least one designated title that is protected by law, including those shown above. Anyone using these titles must be registered with the HCPC. It is a criminal offence for someone to claim that they are registered with the HCPC when they are not, or to use a protected title that they are not entitled to use.
Maintaining standards
If a professional who is registered with them does not meet the standards which are set, the HCPC can take action which might include stopping an individual from practising.
Other UK healthcare regulators
The Professional Standards Authority for Health and Social Care (PSA) is an independent body accountable to the UK Parliament, which promotes the health and well-being of the public and oversees the nine UK healthcare regulators. These are:
General Medical Council
Nursing and Midwifery Council
General Dental Council
General Pharmaceutical Council
General Optical Council
General Chiropractic Council
General Osteopathic Council
Pharmaceutical Society of Northern Ireland
Health and Care Professions Council
Controversy
In 2016, via a Freedom of Information request it was revealed that despite increasing registration costs for healthcare professionals, the HCPC spent over £17,000 on their Christmas party. For 224 attendees, the cost-per-head for one meal was £76.12, comparable to the yearly registration costs for many workers.
After the registration of social workers was transferred to Social Work England, the HCPC's registrants fell by approximately 100,000; the new total of 281,000 represented a fall of around 26%. Despite their workload decreasing, it was found through an FOI request in 2020 that the HCPC had not made any redundancies in their organisation and were increasing registration costs.
After the number of international applications for registration increased in 2021, the HCPC was criticised for the increasing length of time taken to process these applications. The Professional Standards Authority for Health and Social Care, which oversees the HCPC, reported that by mid-2022 the median time for the HCPC to reach a first decision on international applications was over 90 weeks. The PSA considered that this was serious, "given that the delays could seriously affect applicants and aggravate workforce shortages in the NHS".
See also
Allied health professions
Occupational therapy in the United Kingdom
References
External links
2003 establishments in the United Kingdom
Government agencies established in 2003
Health in the London Borough of Lambeth
Medical and health regulators
Health policy in the United Kingdom
Medical regulation in the United Kingdom
Organisations based in the London Borough of Lambeth
Regulators of the United Kingdom
Social care in the United Kingdom | 0.761587 | 0.980422 | 0.746676 |
Forensic nursing | Forensic nursing is the application of the forensic aspects of healthcare combined with the bio/psycho/social/spiritual education of the registered nurse in the scientific investigation and treatment of trauma and/or death of victims and perpetrators of violence, criminal activity, and traumatic accidents (Lynch, 1991. p.3) In short, forensic nursing is the care of patients intersecting with the legal system (Speck & Peters et al, 1999).
Lynch used the clinical forensic medicine (CFM) role as a template for the forensic nurse role. The CFM describes the use of clinical practices to support judicial proceedings to protect a victim, usually after death has occurred. A strong advocate for the forensic nursing specialty in the United States, Virginia Lynch pushed to have the specialty recognized. She was successful in the American Academy of Forensic Science recognition of the forensic nurse in 1989, and she completed her thesis on the conceptual framework for forensic nursing, graduating from arguably the first U.S. forensic nurse master's program. The early publications about the plight of victims spawned nursing programs throughout the United States. In 1992, the term forensic nursing was adopted by nurses gathered at the University of Minnesota who elected Virginia Lynch the first president of the International Association of Forensic Nurses.
The nursing paradigm includes person, health, nursing, and environment. The metaparadigm emphasizes holistic care as it highlights humanistic aspects woven with scientific knowledge. The practice of forensic nursing borrows from all sciences, including legal principles, forensic science, and the bio-psycho-social-spiritual sciences that support the forensic nurse's role in all environments (Volz et al, 2022). The specialty is now recognized worldwide, helping to promote an international focus on violence.
History
Forensic nursing in the United States developed in response to concerns in the 1970s regarding the treatment of patients with crime-related injuries and the proper handling of evidence. Globally, the development of general clinical forensic medicine and forensic nursing have progressed at different speeds, with one preceding the other on a country-by-country basis. Founded in 1992, the International Association of Forensic Nurses is the first professional association for forensic nurses. Other organizations support forensic nurses globally, including End Violence Against Women, International, the American Academy of Forensic Sciences - Forensic Nursing Science Section (2023), and the Academy of Forensic Nursing (2018).
Although forensic nursing can be traced back thousands of years, for recent history, the role in the United States is traceable to the 1970s (Liu, 2024). Medical professionals were involved in court cases that involved crimes, e.g., rape. Medical professionals highlighted the medical issues, moving science from the criminalistic view to a health concern.
Role and responsibilities
Forensic nursing combines nursing practice and forensics in the scientific investigation of death and injury resulting from criminal activity and accidents. In addition to providing care, forensic nurses act as multidisciplinary team members with and consultants to other nursing and medical professionals and law enforcement. They receive advanced training in collecting and preserving evidence, treatment protocols, and legal proceedings and testimony.
The specialized training that forensic nurses receive related to both the medical and legal needs of these patients drives demand for the specialty. Crime victims face a higher risk of post-traumatic stress disorder, depression, suicide, and medical complications than other patients; forensic nurses improve both legal outcomes and quality of life for these patients relative to standard Emergency Department care. Forensic nurses also assist in providing professional insight to potential causes of patient injuries in situations in which witnesses are unavailable.
Prior to beginning an exam, forensic nurses must receive consent from the patient. In addition to documenting obvious injuries, forensic nurses specialize in looking for subtle signs of assault, such as petechiae, voice changes, and loss of bowel or bladder function. Forensic nurses document patient injuries through tools including cameras, measuring tapes, fluid swabs, rape kits, and a high-powered light that can reveal hard-to-see bruises and fluids like semen, urine, or saliva. They document every injury for potential use as evidence in a later court case, where they may be called as an expert witness to testify to the injuries.
Forensic nurses practice nursing with a forensic lens, responding to patients intersecting with legal systems using trauma-informed care and implementing domains of practice, using core competencies unique to nursing and forensic nursing.
Forensic Nursing of Populations
Source:
Across the lifespan into death
Maternal child (intimate partner violence, reproductive coercion, prematurity, and others)
Children (maltreatment, neglect, emotional - physical - sexual abuse, trafficking, and others)
Adolescents (post-trauma maladaptive behaviors, sexual violence, labor, and sex trafficking, intimate partner violence, technology violence, and others)
Adults (mental health outcomes from childhood traumas, disabilities, vulnerable adults with developmental challenges, intimate partner violence, and others)
Older adults (chronic disease outcomes from trauma, mental health outcomes from childhood traumas, financial abuse, maltreatment, disabilities, vulnerable older adults with developmental challenges, intimate partner violence, and others)
Persons who die (unexpected, youth, violent deaths, and others)
Job descriptions
Clinical forensic nurse
Death Investigator or Nurse coroner
Forensic nurse with a specialty in a unique population, e.g., child abuse, interpersonal violence and strangulation
Forensic nurse investigator
Forensic nurse examiner
Forensic correctional or institutional nurse
Forensic Nurse Hospitalist
Legal nurse consultant
Nurse attorney
Others noted (and growing) list
Forensic Psychiatric Nurses
SANE Adult/Adolescent
Correctional Nurses
SANE Pediatric Nurses
Interpersonal Violence
The need for a nurse with the forensic nurse lens in roles is expanding rapidly... stay tuned!
Limited descriptions of roles
Child abuse
Child abuse is a common type of trauma that forensic nurses work with.
When these nurses encounter a possible situation involving child abuse they must make sure to protect the child from any more trauma. The forensic nurses look at things such as bruises, possible head injuries and sexual abuse. The importance of a nurse here is key to determine the difference between an inflicted bruise or a usual activity bruise. A forensic nurse will know that a bruise located on the ears, neck and other soft tissues of the body should raise a red flag. Once the physical marks are assessed for abuse or an accident a nurse can decide what to do next, whether that is more tests or a consultation with the physician. When working with children it is important that the nurse makes the child comfortable to ensure a trusting relationship. Forensic Nurses make sure to build this relationship to allow the child to share details they otherwise might keep to themselves. There may be abuse that is not visible to the eye and it is important to make sure the child shares those key details. If abuse is detected the nurse will take the next step of reporting the abuse. Although many policies are similar, each state in the U.S. has its own laws and systems in place for reporting possible child abuse. This is where forensic nursing connects to the legal side of investigation. The nurse must make sure to report their findings, and report them accurately because the nurse is held liable.
Sexual assault
Another type of trauma that forensic nurses provide care for is sexual assault which includes rape. Forensic nurses are trained to screen for sexual assault because many assaults go unreported. Patients may have some fear, embarrassment, or denial that could inhibit their willingness to report their assault. Trauma-informed questions are essential to these nurses because not all potential victims disclose their experiences. The questions asked need to be worded properly to avoid discomfort and inaccurate information. Recently, there has been an integration of written and verbal questionaries' that may help the patient and the nurse address a possible assault. A possible question to begin would involve asking if the possible victim was forced to do something that he or she did not want to do. It is important that the nurse is able to help a possible victim understand the question without forcing or leading an inaccurate answer. If a patient admits to being sexually assaulted then the next step is to ensure patient safety. There are protocols in place that help a forensic nurse in taking the next step, when a patient admits to being sexually assaulted. For example, the nurse may explain to the victim their legal rights in regard to reporting the assault, as well as the details of the physical exam for evidence. A specialty in forensic nursing is a Sexual Assault Nurse Examiner (SANE). These nurses will collect and record the forensic evidence needed for a criminal case. Some of the evidence included should be a history of the incident, removal of clothing, head-to-toe assessment, urine collection, blood draw, oral swabs, genital exams, and a STD screening. After there has been an evidence collection or not (if the patient does not want the assault reported if over 18) follow-up care is essential. The forensic nurse should be able to provide the victim with necessary resources. These resources may include crisis centers, therapy referrals, and support group information.
Certification
, the International Association of Forensic Nurses offers two professional certifications under its certification body, the Commission for Forensic Nursing Certification (CFNC), for Sexual Assault Nurse Examiners: the Sexual Assault Nurse Examiner - Adult/Adolescent (SANE-A) and the Sexual Assault Nurse Examiner - Pediatric (SANE-P).
In 2018 - 2022, the Forensic Nursing Certification Board (FNCB) completed the Delphi study and qualitative analysis of the variety of forensic nursing roles. The study was the foundation for identifying the common elements in all forensic nursing practices. Using the AACN Essentials template, the FNCB created and offered in 2022 the first Generalist Forensic Nurse certification (GFN-C), and the first examination for the Advanced Forensic Nurse certification (AFN-C). Beginning in 2024, the FNCB offered the Interpersonal Violence and Strangulation Evaluation certification (IVSE-C). Today, countries use the FNCB template to develop graduate programs globally.
Worldwide
United States
Virginia Lynch, an early advocate of forensic nursing, proposed the creation of the forensic nursing specialty in 1986 and helped establish the first graduate studies program at the University of Texas at Arlington's School of Nursing. The American Academy of Forensic Sciences recognized the forensic nursing specialty in 1991 and the American Nurses Association followed in 1995. Other graduate programs followed.
Great Britain
In Great Britain, forensic nursing includes a forensic psychiatric nursing sub-specialty, which emphasizes practicing forensic nursing for mental health patients.
Canada
As of June 2015, forensic nursing is not recognized as a nursing specialty in Canada and does not have a PhD program.
See also
Psychiatric and mental health nursing
Forensic Psychology
Forensic Psychiatry
Legal nurse consultant
References
External links
Nursing specialties | 0.768081 | 0.972122 | 0.746668 |
Protective factor | Protective factors are conditions or attributes (skills, strengths, resources, supports or coping strategies) in individuals, families, communities or the larger society that help people deal more effectively with stressful events and mitigate or eliminate risk in families and communities.
In the field of Preventive Medicine and Health Psychology, Protective Factors refer to any factor that decreases the chances of a negative health outcome occurring. Conversely, a Risk factor will increase the chances of a negative health outcome occurring. Just as statistical correlations and regressions can examine how a range of independent variables impact a dependent variable, we can examine how many Protective and Risk factors contribute to the likelihood of an illness occurring.
Adoption
Protective factors include:
Adoptive parents having an accurate understanding of their adopted children's pre-adoption medical and behavioral problems
Assistance of adoption professionals in the home of adopted children
Some risks that adopted children are prone to:
Self-mutilation
Delinquency
Trouble with the law
Substance abuse
Thievery
Early sexuality and promiscuity
See also
Epidemiology
Medical statistics
Risk factor
References
Epidemiology
Medical statistics
Risk factors | 0.764629 | 0.976428 | 0.746605 |
Automatism (medicine) | Automatism is a set of brief unconscious or automatic behaviors, typically at least several seconds or minutes, while the subject is unaware of actions. This type of automatic behavior often occurs in certain types of epilepsy, such as complex partial seizures in those with temporal lobe epilepsy, or as a side effect of particular medications such as zolpidem.
Automatic behaviors involve the spontaneous production of purposeless verbal or motor behavior without conscious self-control or self-censorship. This condition can be observed in a variety of contexts, including schizophrenia, psychogenic fugue, Tourette syndrome, epilepsy (in complex partial seizures and Jacksonian seizures), narcolepsy, or in response to a traumatic event.
Automatic behavior can also be exhibited in REM sleep, during which a higher amount of brain stimulus increases dreaming patterns. In such circumstances, subjects can hold conversations, sit up, and even open their eyes. These acts are considered subconscious as most of the time the events cannot be recalled by the subject.
Automatic behavior may also manifest while performing well-learned actions. In this case, the behavior becomes automatic because it does not require conscious monitoring. The seemingly purposeful task is performed with no clear memory of it happening.
Variations
Varying degrees of automatism may include simple gestures, such as finger rubbing, lip smacking, chewing, or swallowing, or more complex actions, such as sleepwalking behaviors. Others may include speech, which may or may not be coherent or sensible. The subject may or may not remain conscious otherwise throughout the episode. Conscious subjects may be fully aware of their other actions at the time, but unaware of their automatism.
In some more complex automatisms, the subject enters into the behaviors of sleepwalking while fully awake until it starts. In these episodes, which can last for longer periods of time, the subject proceeds to engage in routine activities such as cooking, showering, driving a familiar route, or even conversation. Following the episode, the subject regains consciousness, often feeling disoriented, and has no memory of the incident.
Early automatism
The interest in automatic behavior started in the 19th century after a vast spiritual movement was associated with uncontrollable body movements. Many people believed that uncontrollable movements such as table-turning, tilting, and screaming were signs of spirit possessions or that outside forces were taking over human bodies.
Many individuals started focusing on automatic behavior, such as the psychotherapist and psychologists Pierre Janet. Pierre Janet played an important role in studying the condition of dissociation related to automatic behaviors. Janet collected abnormal cases of automatisms and studied these cases with the idea that the patient's consciousness and unconsciousness were separated, causing behavioral changes and automatism. This approach to automatisms and the study of the conscious and unconscious part of the brain was inspired by the work of Sigmund Freud and William James; two investigators of hypnosis and hysteria.
At that time, automatism was a condition that many people faked. Indeed, scam artists use confidence tricks to depict fake spiritual possessions by making it seem like they weren't in control of their bodies. Interest in the spiritual movement eventually dropped in the early 20th century. However, scientists were always skeptical of the idea of automatism. There wasn't a concrete way to know if the sensation of losing control of the body felt by the individuals was real.
Conditions of automatism
There are many conditions for automatism. One example is dissociation, where consciousness and unconsciousness can be separated and change behavioral patterns. Dissociative symptoms, prevalent in many cases can be seen in people who have experienced blindness, deafness, anesthesia of various parts of the body, convulsions, possession, odd voices or sudden new habits, physical illness, and others. Dissociation can be connected to hypnosis, where involuntary actions are produced as a result. Hypnosis was closely related to dissociation because people were vulnerable to hypnosis while experiencing dissociative symptoms. Dissociation leads people to lose control over their actions as their consciousness and unconsciousness separate.
Another condition of automatism is the expectation of attention, where someone has expectations that an action will be produced. For example, the use of a pendulum, during which the person holding the pendulum is attempting not to move it, the thought of it moving still crosses the mind. Expectation attention can therefore be described as expecting an action to occur, where our thought process is based on a movement we believe is bound to happen, creating this expectation. As our thoughts and actions are connected, focusing on the expectation of such action is likely bound to happen. We can also see the "trolling for consistent action" affecting expectation attention. For example, when thinking of a specific feeling, such as coughing, as the thought lingers for a while we suddenly feel the urge to cough, clearing our throat and then eliminating such sensation. As this process plays out, we do not feel that we coughed due to the thought of doing so, as we aren't as aware of the thought in the first place. Expectation attention allows us to focus on our thought about action, even though our consciousness does not perceive us focusing on it, and so thought and behavior are separated.
Movement confusion is another condition of automatism, and is defined as one's belief that an action must be seen to believe that they are producing that action. For example, with the use of a pendulum, pushing a pendulum in a certain direction or pulling it in the opposite direction can contradict the original thought of the specific movement of the pendulum. As we can see the result of such action that we produce, it is harder to continue producing such action if it is opposite from our original idea of how the action will be produced. As it becomes harder to see the initial perceived action, the consistency of such action is being seen less, and the consciousness will soon become the unconsciousness of performing this action.
An outside agent can also be a condition of automatism. People subject to automatism will produce involuntary actions that were not controlled by their mental causation. To explain that phenomenon many will believe an outside factor is responsible for the action. Since the individuals don't have a conscious feeling of doing the automatic behavior, they automatically doubt that their mind could be responsible for it, pushing them to believe someone else, or something else, is causing their behavior. Many people link automatism with spirit possession for that reason.
Automatic behavior in seizures
According to the book Brainstorm: Detective Stories From the World of Neurology by Suzanne O'Sullivan, a side effect of focal seizures are uncontrollable movements, also known as automatism. O'Sullivan observed many automatisms in her patients such as purposeless swearing, spitting, uncontrollable clicking fingers, fumbling movements, and more. According to O'Sullivan, these symptoms are "an automatic release phenomenon that occurs because brain inhibition has been lost." The release of inhibition causes automatic behavior in other cases such as after a cingulotomy or even in the postictal phase of a seizure. In those cases, the patients having an epileptic seizure aren't in control of their bodies.
Usually, focal seizures from the temporal lobe or extratemporal seizure with cingulate cortex will generate automatic movements. The automatic behavior happens around five seconds after the seizure starts. It results from the spread of the seizure past its starting point. During a seizure, the cortical region of the brain can be activated, generating an automatic behavior.
Different automatic behavior can occur depending on what part of the brain is affected during the seizures. For instance, the electric stimulation of the cingulate, part of the cortex involved in behavior regulation, can create an automatic movement to the contralateral leg, lip, and face. If the patient has an effective automatism such as facial expressions that exhibit fear, the limbic motor region of the cingulate cortex is most likely impacted by the seizure. If the patient has an automatic behavior involving oral-alimentary like chewing or the movement of the appendicular skeleton such as picking up an object, this means the seizure activated the temporal lobe of the patient. Seizures can also impact the anterior cingulate causing the patient to have an uncontrollable ictal pouting also known as an inverted smile.
Spirit possession automatism
The Ouija Board, is a flat board marked with the letters of the alphabet, the words "yes and no", numbers 0–9 as well as other graphics. The board uses a small heart-shaped piece of plastic or wood which is called a planchette. To use this board correctly, participants must place their fingers on the planchette and see which direction it points. The action of the board can be explained by a psychophysiological phenomenon known as the ideomotor effect. The ideomotor effect, also known as the "Automatism Theory", is the idea that even though a person may not know they are controlling the message indicator, they are. Most proponents of the Automatism Theory undertake the fact that it is probable to move the planchette unconsciously and declare that the Ouija board opens up a shortcut from the conscious to the subconscious mind.
The pendulum is a hand-held device usually containing a crystal and a chain. Crystals are often used as the weight stone, as the user could connect with them spiritually and cleanse them as needed. When using a pendulum, individuals begin to think about what questions they want to ask the pendulum, usually being yes or no questions. Usually, the pendulum will start moving in a specific pattern. The pendulum is linked to automatism as it is often believed to be caused by automatic behavior. Indeed, slight movement can make the pendulum move. In addition, thinking about the pendulum moving can subconsciously push someone to move the pendulum and blame it on spirits. This is another case of the ideomotor effect as the individual is not aware of moving the pendulum.
Dowsing is a technique used to locate ground water, minerals, ores, gemstones, and many more by using a divining/dowsing rod. A divining rod usually consists of either tree branches or a forked rod, normally being hazelwood and V/Y/L shaped. With these rods, it is believed that when standing over a water source or minerals, the rods will spontaneously cross, or stick downwards. The scientific community criticizes this belief as they think dowsing is caused by an automatic behavior from the person dowsing. Indeed, subconsciously, the rods getting pushed together might be caused by the individual. This could be explained by the Ideomotor Effect as the individual is not aware they are causing the rods to move.
Tourette's Syndrome
Tourette's syndrome is a neurodevelopmental condition with primary indicators being vocal and motor tics. To be classified as Tourette's syndrome, the individual must have a minimum of one vocal tic and two motor tics that have been chronically present. A tic is defined as a sudden, recurring, automatic, movement or vocalization. The cause has been widely disputed since its discovery in 1885 by George Giles de la Tourette. Causal theories have ranged widely from repressed sexual conflict to oppressive parents. Modern day research leans more towards both environmental and genetic factors and triggers.
Alien hand syndrome
Alien hand syndrome is an automatic behavior, first discovered in 1908, in which the person has uncontrolled behavior and observes his limbs moving without consciously having the capacity to control it. Often, it happens to be the left hand, since the right hemisphere is affected. There are a few different versions of alien hand syndrome that can occur, which are the Frontal Lobe version, the Callosal version, and the Posterior version. The frontal lobe version is the only version that affects the right hand of the individual. The callosal version involves the corpus callosum area of the brain. The posterior version involves the parietal lobe. The frontal, occipital, and parietal areas of the brain are also associated to this syndrome. It can occur after brain surgery, stroke, infection, tumor, aneurysm, migraine, having the two hemispheres surgically separated, Alzheimer's disease, Corticobasal degeneration, and Creutzfeldt--Jakob disease. Although anyone can fall victim to this, alien hand syndrome is a very rare side effect.
Dreams
While the human body is sleeping, we are considered to be unconscious, but what happens to us when we are dreaming? Automatism can be illustrated within dreams, as the human brain does not need to think about dreaming, it simply happens. The brain is active during the REM (rapid eye movement) stage of sleep, when dreams occur, however this is only to portray the images we see in our dreams. Further analysis of this ideology can be seen in nightmares. Most humans do not want to have frightening dreams, still, we as individuals have no control over what we dream about. This is a prime example of why dreaming is considered an automatic behavior. Sleepwalking also comes around as a thought of automatic behavior found within the subcategory of dreams. What is happening to our bodies when we sleepwalk? Sleepwalking occurs in the frontal cortex responsible for rationality and the hippocampus used for memory. Scientists know this information from performing various tests on sleepwalking patients, such as EEG's and brain scans. It has been shown that sleepwalking relates to the natural human behavior of sleeping, although the frontal cortex is awake and ready to go. This can be seen in a lot of animal species, as this form of sleep where the frontal cortex is partially awake stems from an adaptation of enhanced survival. This is because the animals are ready to rise and defend against predators, and are less vulnerable while sleeping. While sleepwalking can be rather daunting and dangerous, it is something nobody can control, therefore considered a subclass of automatic behavior in dreams.
Everyday automatism
Everyday automatism is how someone can be affected in their everyday life due to the automatism they are experiencing. Even the most basic things done daily becomes extremely difficult—for example, showering, eating, and even breathing. Showering becomes difficult with the effects of nausea, paleness, and oral automatisms which can be triggered by the shower, through this automatism it is affected in the left temporal lobe. When the shower triggers this automatism, it triggers the left temporal lobe and causes these effects to happen to the individual experiencing these automatisms.
Eating is another aspect of one's life that happens daily. Automatisms that are attached to eating can be triggered or caused by eating which can cause dizziness, impaired speech, jerking, and lip-smacking, without loss of awareness. All of those effects are provoked by eating or the mere thought of eating. Something so simple as breathing is affected due to automatisms, and the effects it can cause are shortness of breath, changes in respiratory rate and pattern, and reflexes such as coughing are triggered through automatisms. These are all examples of things someone does daily and possible side effects they can experience due to their epilepsy.
See also
Automatism (law)
Automatic writing
Facilitated communication
Homicidal somnambulism
Tic
References
Further reading
External links
Seizure types
Epilepsy types | 0.763672 | 0.977537 | 0.746517 |
Cognitive model | A cognitive model is a representation of one or more cognitive processes in humans or other animals for the purposes of comprehension and prediction. There are many types of cognitive models, and they can range from box-and-arrow diagrams to a set of equations to software programs that interact with the same tools that humans use to complete tasks (e.g., computer mouse and keyboard). In terms of information processing, cognitive modeling is modeling of human perception, reasoning, memory and action.
Relationship to cognitive architectures
Cognitive models can be developed within or without a cognitive architecture, though the two are not always easily distinguishable. In contrast to cognitive architectures, cognitive models tend to be focused on a single cognitive phenomenon or process (e.g., list learning), how two or more processes interact (e.g., visual search bsc1780 decision making), or making behavioral predictions for a specific task or tool (e.g., how instituting a new software package will affect productivity). Cognitive architectures tend to be focused on the structural properties of the modeled system, and help constrain the development of cognitive models within the architecture. Likewise, model development helps to inform limitations and shortcomings of the architecture. Some of the most popular architectures for cognitive modeling include ACT-R, Clarion, LIDA, and Soar.
History
Cognitive modeling historically developed within cognitive psychology/cognitive science (including human factors), and has received contributions from the fields of machine learning and artificial intelligence among others.
Box-and-arrow models
A number of key terms are used to describe the processes involved in the perception, storage, and production of speech. Typically, they are used by speech pathologists while treating a child patient. The input signal is the speech signal heard by the child, usually assumed to come from an adult speaker. The output signal is the utterance produced by the child. The unseen psychological events that occur between the arrival of an input signal and the production of speech are the focus of psycholinguistic models. Events that process the input signal are referred to as input processes, whereas events that process the production of speech are referred to as output processes. Some aspects of speech processing are thought to happen online—that is, they occur during the actual perception
or production of speech and thus require a share of the attentional resources dedicated to the speech task. Other processes, thought to happen offline, take place as part of the child's background mental processing rather than during the time dedicated to the speech task.
In this sense, online processing is sometimes defined as occurring in real-time, whereas offline processing is said to be time-free (Hewlett, 1990). In box-and-arrow psycholinguistic models, each hypothesized level of representation or processing can be represented in a diagram by a “box,” and the relationships between them by “arrows,” hence the name. Sometimes (as in the models of Smith, 1973, and Menn, 1978, described later in this paper) the arrows represent processes additional to those shown in boxes. Such models make explicit the hypothesized information-
processing activities carried out in a particular cognitive function (such as language), in a manner analogous to computer flowcharts that depict the processes and decisions carried out by a computer program. Box-and-arrow models differ widely in the number of unseen psychological processes they describe and thus in the number of boxes they contain. Some have only one or two boxes between the input and output signals (e.g., Menn, 1978; Smith, 1973), whereas others have multiple boxes representing complex relationships between a number of different information-processing events (e.g., Hewlett, 1990; Hewlett, Gibbon, & Cohen- McKenzie, 1998; Stackhouse & Wells, 1997). The most important box, however, and the source of much ongoing debate, is that representing the underlying representation (or UR). In essence, an underlying representation captures information stored in a child's mind about a word he or she knows and uses. As the following description of several models will illustrate, the nature of this information and thus the type(s) of representation present in the child's knowledge base have captured the attention of researchers for some time. (Elise Baker et al. Psycholinguistic Models of Speech Development and Their Application to Clinical Practice. Journal of Speech, Language, and Hearing Research. June 2001. 44. p 685–702.)
Computational models
A computational model is a mathematical model in computational science that requires extensive computational resources to study the behavior of a complex system by computer simulation. The system under study is often a complex nonlinear system for which simple, intuitive analytical solutions are not readily available. Rather than deriving a mathematical analytical solution to the problem, experimentation with the model is done by changing the parameters of the system in the computer, and studying the differences in the outcome of the experiments. Theories of operation of the model can be derived/deduced from these computational experiments.
Examples of common computational models are weather forecasting models, earth simulator models, flight simulator models, molecular protein folding models, and neural network models.
Symbolic
A symbolic model is expressed in characters, usually non-numeric ones, that require translation before they can be used.
Subsymbolic
A cognitive model is subsymbolic if it is made by constituent entities that are not representations in their turn, e.g., pixels, sound images as perceived by the ear, signal samples; subsymbolic units in neural networks can be considered particular cases of this category.
Hybrid
Hybrid computers are computers that exhibit features of analog computers and digital computers. The digital component normally serves as the controller and provides logical operations, while the analog component normally serves as a solver of differential equations. See more details at hybrid intelligent system.
Dynamical systems
In the traditional computational approach, representations are viewed as static structures of discrete symbols. Cognition takes place by transforming static symbol structures in discrete, sequential steps. Sensory information is transformed into symbolic inputs, which produce symbolic outputs that get transformed into motor outputs. The entire system operates in an ongoing cycle.
What is missing from this traditional view is that human cognition happens continuously and in real time. Breaking down the processes into discrete time steps may not fully capture this behavior. An alternative approach is to define a system with (1) a state of the system at any given time, (2) a behavior, defined as the change over time in overall state, and (3) a state set or state space, representing the totality of overall states the system could be in. The system is distinguished by the fact that a change in any aspect of the system state depends on other aspects of the same or other system states.
A typical dynamical model is formalized by several differential equations that describe how the system's state changes over time. By doing so, the form of the space of possible trajectories and the internal and external forces that shape a specific trajectory that unfold over time, instead of the physical nature of the underlying mechanisms that manifest this dynamics, carry explanatory force. On this dynamical view, parametric inputs alter the system's intrinsic dynamics, rather than specifying an internal state that describes some external state of affairs.
Early dynamical systems
Associative memory
Early work in the application of dynamical systems to cognition can be found in the model of Hopfield networks. These networks were proposed as a model for associative memory. They represent the neural level of memory, modeling systems of around 30 neurons which can be in either an on or off state. By letting the network learn on its own, structure and computational properties naturally arise. Unlike previous models, “memories” can be formed and recalled by inputting a small portion of the entire memory. Time ordering of memories can also be encoded. The behavior of the system is modeled with vectors which can change values, representing different states of the system. This early model was a major step toward a dynamical systems view of human cognition, though many details had yet to be added and more phenomena accounted for.
Language acquisition
By taking into account the evolutionary development of the human nervous system and the similarity of the brain to other organs, Elman proposed that language and cognition should be treated as a dynamical system rather than a digital symbol processor. Neural networks of the type Elman implemented have come to be known as Elman networks. Instead of treating language as a collection of static lexical items and grammar rules that are learned and then used according to fixed rules, the dynamical systems view defines the lexicon as regions of state space within a dynamical system. Grammar is made up of attractors and repellers that constrain movement in the state space. This means that representations are sensitive to context, with mental representations viewed as trajectories through mental space instead of objects that are constructed and remain static. Elman networks were trained with simple sentences to represent grammar as a dynamical system. Once a basic grammar had been learned, the networks could then parse complex sentences by predicting which words would appear next according to the dynamical model.
Cognitive development
A classic developmental error has been investigated in the context of dynamical systems: The A-not-B error is proposed to be not a distinct error occurring at a specific age (8 to 10 months), but a feature of a dynamic learning process that is also present in older children. Children 2 years old were found to make an error similar to the A-not-B error when searching for toys hidden in a sandbox. After observing the toy being hidden in location A and repeatedly searching for it there, the 2-year-olds were shown a toy hidden in a new location B. When they looked for the toy, they searched in locations that were biased toward location A. This suggests that there is an ongoing representation of the toy's location that changes over time. The child's past behavior influences its model of locations of the sandbox, and so an account of behavior and learning must take into account how the system of the sandbox and the child's past actions is changing over time.
Locomotion
One proposed mechanism of a dynamical system comes from analysis of continuous-time recurrent neural networks (CTRNNs). By focusing on the output of the neural networks rather than their states and examining fully interconnected networks, three-neuron central pattern generator (CPG) can be used to represent systems such as leg movements during walking. This CPG contains three motor neurons to control the foot, backward swing, and forward swing effectors of the leg. Outputs of the network represent whether the foot is up or down and how much force is being applied to generate torque in the leg joint. One feature of this pattern is that neuron outputs are either off or on most of the time. Another feature is that the states are quasi-stable, meaning that they will eventually transition to other states. A simple pattern generator circuit like this is proposed to be a building block for a dynamical system. Sets of neurons that simultaneously transition from one quasi-stable state to another are defined as a dynamic module. These modules can in theory be combined to create larger circuits that comprise a complete dynamical system. However, the details of how this combination could occur are not fully worked out.
Modern dynamical systems
Behavioral dynamics
Modern formalizations of dynamical systems applied to the study of cognition vary. One such formalization, referred to as “behavioral dynamics”, treats the agent and the environment as a pair of coupled dynamical systems based on classical dynamical systems theory. In this formalization, the information from the environment informs the agent's behavior and the agent's actions modify the environment. In the specific case of perception-action cycles, the coupling of the environment and the agent is formalized by two functions. The first transforms the representation of the agents action into specific patterns of muscle activation that in turn produce forces in the environment. The second function transforms the information from the environment (i.e., patterns of stimulation at the agent's receptors that reflect the environment's current state) into a representation that is useful for controlling the agents actions. Other similar dynamical systems have been proposed (although not developed into a formal framework) in which the agent's nervous systems, the agent's body, and the environment are coupled together
Adaptive behaviors
Behavioral dynamics have been applied to locomotive behavior. Modeling locomotion with behavioral dynamics demonstrates that adaptive behaviors could arise from the interactions of an agent and the environment. According to this framework, adaptive behaviors can be captured by two levels of analysis. At the first level of perception and action, an agent and an environment can be conceptualized as a pair of dynamical systems coupled together by the forces the agent applies to the environment and by the structured information provided by the environment. Thus, behavioral dynamics emerge from the agent-environment interaction. At the second level of time evolution, behavior can be expressed as a dynamical system represented as a vector field. In this vector field, attractors reflect stable behavioral solutions, where as bifurcations reflect changes in behavior. In contrast to previous work on central pattern generators, this framework suggests that stable behavioral patterns are an emergent, self-organizing property of the agent-environment system rather than determined by the structure of either the agent or the environment.
Open dynamical systems
In an extension of classical dynamical systems theory, rather than coupling the environment's and the agent's dynamical systems to each other, an “open dynamical system” defines a “total system”, an “agent system”, and a mechanism to relate these two systems. The total system is a dynamical system that models an agent in an environment, whereas the agent system is a dynamical system that models an agent's intrinsic dynamics (i.e., the agent's dynamics in the absence of an environment). Importantly, the relation mechanism does not couple the two systems together, but rather continuously modifies the total system into the decoupled agent's total system. By distinguishing between total and agent systems, it is possible to investigate an agent's behavior when it is isolated from the environment and when it is embedded within an environment. This formalization can be seen as a generalization from the classical formalization, whereby the agent system can be viewed as the agent system in an open dynamical system, and the agent coupled to the environment and the environment can be viewed as the total system in an open dynamical system.
Embodied cognition
In the context of dynamical systems and embodied cognition, representations can be conceptualized as indicators or mediators. In the indicator view, internal states carry information about the existence of an object in the environment, where the state of a system during exposure to an object is the representation of that object. In the mediator view, internal states carry information about the environment which is used by the system in obtaining its goals. In this more complex account, the states of the system carries information that mediates between the information the agent takes in from the environment, and the force exerted on the environment by the agents behavior. The application of open dynamical systems have been discussed for four types of classical embodied cognition examples:
Instances where the environment and agent must work together to achieve a goal, referred to as "intimacy". A classic example of intimacy is the behavior of simple agents working to achieve a goal (e.g., insects traversing the environment). The successful completion of the goal relies fully on the coupling of the agent to the environment.
Instances where the use of external artifacts improves the performance of tasks relative to performance without these artifacts. The process is referred to as "offloading". A classic example of offloading is the behavior of Scrabble players; people are able to create more words when playing Scrabble if they have the tiles in front of them and are allowed to physically manipulate their arrangement. In this example, the Scrabble tiles allow the agent to offload working memory demands on to the tiles themselves.
Instances where a functionally equivalent external artifact replaces functions that are normally performed internally by the agent, which is a special case of offloading. One famous example is that of human (specifically the agents Otto and Inga) navigation in a complex environment with or without assistance of an artifact.
Instances where there is not a single agent. The individual agent is part of larger system that contains multiple agents and multiple artifacts. One famous example, formulated by Ed Hutchins in his book Cognition in the Wild, is that of navigating a naval ship.
The interpretations of these examples rely on the following logic: (1) the total system captures embodiment; (2) one or more agent systems capture the intrinsic dynamics of individual agents; (3) the complete behavior of an agent can be understood as a change to the agent's intrinsic dynamics in relation to its situation in the environment; and (4) the paths of an open dynamical system can be interpreted as representational processes. These embodied cognition examples show the importance of studying the emergent dynamics of an agent-environment systems, as well as the intrinsic dynamics of agent systems. Rather than being at odds with traditional cognitive science approaches, dynamical systems are a natural extension of these methods and should be studied in parallel rather than in competition.
See also
Computational cognition
Computational models of language acquisition
Computational-representational understanding of mind
MindModeling@Home
Memory-prediction framework
Space mapping
References
External links
Cognitive modeling at CMU
Cognitive modeling at RPI (HCI)
Cognitive modeling at RPI (CLARION)
Cognitive modeling at the University of Memphis (LIDA)
Cognitive modeling at UMich
Enactive cognition | 0.760521 | 0.981568 | 0.746503 |
Nature therapy | Nature therapy, sometimes referred to as ecotherapy, forest therapy, forest bathing, grounding, earthing, Shinrin-Yoku or Sami Lok, is a practice that describes a broad group of techniques or treatments using nature to improve mental or physical health. Spending time in nature has various physiological benefits such as relaxation and stress reduction. Additionally, it can enhance cardiovascular health and reduce risks of high blood pressure.
History
Scientists in the 1950s looked into the reasons humans chose to spend time in nature. There is relatively recent history of the term Shinrin-yoku or 'forest bathing' gaining momentum as a term and concept within American culture; the term 'forest bathing' and Shrinrin-yoku was first popularized in Japan by a man named Tomohide Akiyama, who was the head of the Japanese Ministry of Agriculture, Forestry, and Fisheries; this happened in 1982 to encourage more people to visit the forests.
Health effects
Mood
Nature therapy has a benefit in reducing stress and improving a person's mood.
Forest therapy has been linked to some physiological benefits as indicated by neuroimaging and the profile of mood states psychological test.
Stress and depression
Interaction with nature can decrease stress and depression. Forest therapy might help stress management for all age groups.
Social horticulture could help with depression and other mental health problems of PTSD, abuse, lonely elderly people, drug or alcohol addicts, blind people, and other people with special needs. Nature therapy could also improve self-management, self-esteem, social relations and skills, socio-political awareness and employability. Nature therapy could reduce aggression and improve relationship skills.
Other possible benefits
Nature therapy could help with general medical recovery, pain reduction, Attention Deficit/Hyperactivity Disorder, dementia, obesity, and vitamin D deficiency. Interactions with nature environments enhance social connections, stewardship, sense of place, and increase environmental participation. Connecting with nature also addresses needs such as intellectual capacity, emotional bonding, creativity, and imagination. Overall, there seems to be benefits to time spent in nature including memory, cognitive flexibility, and attention control.
Research also suggests that childhood experience in nature are crucial for children in their daily lives as it contributes to several developmental outcomes and various domains of their well-being. Essentially, these experiences also foster an intrinsic care for nature.
Criticism
A 2012 systematic review study showed inconclusive results related to the methodology used in studies. Spending time in forests demonstrated positive health effects, but not enough to generate clinical practice guidelines or demonstrate causality. Additionally, there are concerns from researchers expressing that time spent in nature as a form of regenerative therapy is highly personal and entirely unpredictable. Nature can be harmed in the process of human interaction.
Governmental support and professionalization
In Finland, researchers recommend five hours a month in nature to reduce depression, alcoholism, and suicide. South Korea has a nature therapy program for firefighters with post-traumatic stress disorder. Canadian physicians can also "prescribe nature" to patients with mental and physical health problems encouraging them to get into nature more.
References
Therapy
Forestry
Fringe science
Pseudoscience | 0.763624 | 0.977537 | 0.746471 |
Dialogic learning | Dialogic learning is learning that takes place through dialogue. It is typically the result of egalitarian dialogue; in other words, the consequence of a dialogue in which different people provide arguments based on validity claims and not on power claims.
The concept of dialogic learning is not a new one. Within the Western tradition, it is frequently linked to the Socratic dialogues. It is also found in many other traditions; for example, the book The Argumentative Indian, written by Nobel Prize of Economics winner Amartya Sen, situates dialogic learning within the Indian tradition and observes that an emphasis on discussion and dialogue spread across Asia with the rise of Buddhism.
In recent times, the concept of dialogic learning has been linked to contributions from various perspectives and disciplines, such as the theory of dialogic action, the dialogic inquiry approach, the theory of communicative action, the notion of dialogic imagination and the dialogical self. In addition, the work of an important range of contemporary authors is based on dialogic conceptions. Among those, it is worth mentioning transformative learning theory; Michael Fielding, who sees students as radical agents of change; Timothy Koschmann, who highlights the potential advantages of adopting dialogicality as the basis of education; and Anne Hargrave, who demonstrates that children in dialogic-learning conditions make significantly larger gains in vocabulary, than do children in a less dialogic reading environment.
Specifically, the concept of dialogic learning (Flecha) evolved from the investigation and observation of how people learn both outside and inside of schools, when acting and learning freely is allowed. At this point, it is important to mention the "Learning Communities", an educational project which seeks social and cultural transformation of educational centers and their surroundings through dialogic learning, emphasizing egalitarian dialogue among all community members, including teaching staff, students, families, entities, and volunteers. In the learning communities, it is fundamental the involvement of all members of the community because, as research shows, learning processes, regardless of the learners' ages, and including the teaching staff, depend more on the coordination among all the interactions and activities that take place in different spaces of the learners' lives, like school, home, and workplace, than only on interactions and activities developed in spaces of formal learning, such as classrooms. Along these lines, the "Learning Communities" project aims at multiplying learning contexts and interactions with the objective of all students reaching higher levels of development.
Classroom education
Dialogic education is an educational philosophy and pedagogical approach that draws on many authors and traditions and applies dialogic learning. In effect, dialogic education takes place through dialogue by opening up dialogic spaces for the co-construction of new meaning to take place within a gap of differing perspectives. In a dialogic classroom, students are encouraged to build on their own and others’ ideas, resulting not only in education through dialogue but also in education for dialogue. Teachers and students are in an equitable relationship and listen to multiple points of view. The pedagogy aims on arriving at the goal: the students’ knowing for and through themselves and therefore “casting the teacher as a guide rather than a director”.
Dialogic approaches to education typically involve dialogue in the form of face-to-face talk including questioning and exploring ideas within a ‘dialogic space’ but can also encompass other instances where 'signs' are exchanged between people, for instance via computer-mediated communication. In this way, dialogic approaches need not be limited only to classroom-based talk or "external talk".
In teaching through the opening of a shared dialogic space, dialogic education draws students into the co-construction of shared knowledge by questioning and building on dialogue rather than simply learning a set of facts. As argued by Mikhail Bakhtin, children learn through persuasive dialogue rather than an authoritative transmission of facts, which enables them to understand by seeing from different points of view. Merleau-Ponty writes that when dialogue works it should no longer be possible to determine who is thinking because learners will find themselves thinking together. It has been suggested by Robin Alexander that in dialogic education, teachers should frame questions carefully in order to encourage reflection and take different students' contributions and present them as a whole. In addition, answers should be considered as leading to further questions in dialogue rather than an end goal.
Definitions of dialogic
There is a lack of clarity around what is meant by the term ‘dialogic’ when used to refer to educational approaches. The term ‘dialogue’ itself is derived from two words in classical Greek, ‘dia’ meaning ‘through’ and ‘logos’ meaning ‘word’ or 'discourse'. Dialogic is defined by the Oxford English Dictionary as an adjective applied to describe anything ‘relating to or in the form of dialogue’. Dialogic can also be used in contrast to ‘monologic’, which is the idea that there is only one true perspective and so that everything has one final correct meaning or truth. Dialogic, however, contends that there is always more than one voice in play behind any kind of explicit claim to knowledge. If knowledge is a product of dialogue it follows that knowledge is never final since the questions we ask and so the answers that we receive, will continue to change.
Dialogic education has been defined as engaging students in an ongoing process of shared inquiry taking the form of a dialogue and as Robin Alexander outlines in his work on dialogic teaching, it involves drawing students into a process of co-constructing knowledge. Rupert Wegerif sums this up by claiming that 'Dialogic Education is education for dialogue as well as education through dialogue'.
Formats
There are a number of formats of instruction, that have been recognized as "dialogic" (as opposed to "monologic").
Interactional: Dialogue involves a high student-teacher talk ratio, short utterances/turns, and interactive exchanges.
Question-answer: Dialogue involves either a teacher asking students questions and eliciting answers from the students or students asking questions and eliciting answers from the teacher and/or one another.
Conversational: Instructional dialogue is modeled after natural mundane everyday conversations.
Without authority: Dialogic guidance occurs among equal peers as authority distorts dialogic processes. Jean Piaget was the first scholar who articulated this position.
Types
There are a number of types of dialogic pedagogy, that is, where the form and the content is recognized as "dialogic".
Paideia: Learning through asking thought-provoking questions, challenging assumptions, beliefs, and ideas, that involve argumentation and disagreements. This notion comes from Socratic dialogues described and developed by Plato.
Exploratory talk for learning: Collective mindstorming and probing ideas, enabling "the speaker to try out ideas, to hear how they sound, to see what others make of them, to arrange information and ideas into different patterns" (p. 4).
Internally persuasive discourse: Bakhtin's notion of "internally persuasive discourse" (IPD) has become influential in helping conceptualize learning. There are at least three approaches to how this notion is currently used in the literature on education:
IPD is understood as appropriation when somebody else's words, ideas, approaches, knowledge, feelings, become one's own. In this approach, "internal" in IPD is understood as an individual's psychological and personal deep conviction.
IPD understood as a student's authorship recognized and accepted by a community of practice, in which the student generates self-assignments and long-term projects within the practice.
IPD is understood as a dialogic regime of the participants' testing ideas and searching for the boundaries of personally-vested truths. In this approach, "internal" is interpreted as internal to the dialogue itself in which everything is "dialogically tested and forever testable" (p. 319).
Instrumental
Instrumental dialogic pedagogy uses dialogue for achieving non-dialogic purposes, usually making students arrive at certain preset learning outcomes. For example, Nicolas Burbules defines dialogue in teaching instrumentally as facilitating new understanding, "Dialogue is an activity directed toward discovery and new understanding, which stands to improve the knowledge, insight, or sensitivity of its participants".
The teacher presents the endpoint of the lesson, for example, "At the end of the lesson, the students will be able to understand/master the following knowledge and skills." However, the teacher's method of leading students to the endpoint can be individualized both in instruction techniques and in time taken. Different students are "closer" or further" from the endpoint and require different strategies to get them there. Thus, for Socrates to manipulate Meno to the preset endpoint – what is virtue is not known and problematic – is not the same as manipulating Anytus to the same endpoint. It takes different and individualized instructional strategies.
Socrates, Paulo Freire and Vivian Paley all strongly critique the idea of preset endpoints however in practice they often set endpoints.
Instrumental dialogic pedagogy remains influential and important for scholars and practitioners of dialogic pedagogy field. Some appreciate its focus on asking good questions, attendance to subjectivity, use of provocations and contradictions, and the way it disrupts familiar and unreflected relations. However, others are concerned about the teacher's manipulation of the student's consciousness and its intellectualism.
Non-instrumental
In contrast to instrumental approaches to dialogic pedagogy, non-instrumental approaches to dialogic pedagogy view dialogue not as a pathway or strategy for achieving meaning or knowledge but as the medium in which they live. Following Bakhtin, meaning is understood as living in the relationship between a genuine question seeking for information and a sincere answer aiming at addressing this question. Non-instrumental dialogic pedagogy focuses on "eternal damn final questions". It is interested in the mundane only because it can give it the material and opportunity to move to the sublime. This is seen, for example, in the work of Christopher Phillips.
The non-instrumental "epistemological dialogue", a term introduced by Alexander Sidorkin, is a purified dialogue to abstract a single main theme, a development of a main concept, and unfold the logic. According to Sidorkin, ontological dialogic pedagogy priorities human ontology in pedagogical dialogue:
Sociolinguist Per Linell and educational philosopher Alexander Sidorkin evidence a non-instrumental ecological approach to dialogic pedagogy that focuses on the dialogicity of the mundane everyday social interaction, its non-constrained nature, in which participants can have freedom to move in and out of the interaction, and the absence or minimum of pedagogical violence. Using the metaphor of "free-range kids", Lenore Skenazy defines the participants in this ecological dialogue as free-range dialogic participants.
Theories
Wells: dialogic inquiry
Gordon Wells (1999) defines "inquiry" not as a method but as a predisposition for questioning, trying to understand situations collaborating with others with the objective of finding answers. "Dialogic inquiry" is an educational approach that acknowledges the dialectic relationship between the individual and the society, and an attitude for acquiring knowledge through communicative interactions. Wells points out that the predisposition for dialogic inquiry depends on the characteristics of the learning environments, and that is why it is important to reorganize them into contexts for collaborative action and interaction. According to Wells, dialogic inquiry not only enriches individuals' knowledge but also transforms it, ensuring the survival of different cultures and their capacity to transform themselves according to the requirements of every social moment.
Freire: the theory of dialogic action
Paulo Freire (1970) states that human nature is dialogic, and believes that communication has a leading role in our life. We are continuously in dialogue with others, and it is in that process that we create and recreate ourselves. According to Freire, dialogue is a claim in favor of the democratic choice of educators. Educators, in order to promote free and critical learning should create the conditions for dialogue that encourages the epistemological curiosity of the learner. The goal of the dialogic action is always to reveal the truth by interacting with others and the world. In his dialogic action theory, Freire distinguishes between dialogical actions, the ones that promote understanding, cultural creation, and liberation; and non-dialogic actions, which deny dialogue, distort communication, and reproduce power.
Habermas: the theory of communicative action
Rationality, for Jürgen Habermas (1984), has less to do with knowledge and its acquisition than with the use of knowledge that individuals who are capable of speech and action make. In instrumental rationality, social agents make an instrumental use of knowledge: they propose certain goals and aim to achieve them in an objective world. On the contrary, in communicative rationality, knowledge is the understanding provided by the objective world as well as by the intersubjectivity of the context where action develops. If communicative rationality means understanding, then the conditions that make reaching consensus possible have to be studied. This need brings us to the concepts of arguments and argumentation. While arguments are conclusions that consist of validity claims as well as the reasons by which they can be questioned, argumentation is the kind of speech in which participants give arguments to develop or turn down the validity claims that have become questionable. At this point, Habermas' differentiation between validity claims and power claims is important. We may attempt to have something we say to be considered good or valid by imposing it by means of force, or by being ready to enter a dialogue in which other people's arguments may lead us to rectify our initial stances. In the first case, the interactant holds power claims, while in the second case, validity claims are held. While in power claims, the argument of force is applied; in validity claims, the force of an argument prevails. Validity claims are the basis of dialogic learning.
Bakhtin: dialogic imagination
Mikhail Bakhtin established (1981) that there is a need of creating meanings in a dialogic way with other people. His concept of dialogism states a relation among language, interaction, and social transformation. Bakhtin believes that the individual does not exist outside of dialogue. The concept of dialogue, itself, establishes the existence of the "other" person. In fact, it is through dialogue that the "other" cannot be silenced or excluded. Bakhtin states that meanings are created in processes of reflection between people. And these are the same meanings that we use in later conversations with others, where those meanings get amplified and even change as we acquire new meanings. In this sense, Bakhtin states that every time that we talk about something that we have read about, seen, or felt; we are actually reflecting the dialogues we have had with others, showing the meanings that we have created in previous dialogues. This is, what is said cannot be separated from the perspectives of others: the individual speech and the collective one are deeply related. It is in this sense that Bakhtin talks about a chain of dialogues, to point out that every dialogue results from a previous one and, at the same time, every new dialogue is going to be present in future ones.
CREA: dialogic interactions and interactions of power
In their debate with John Searle (Searle & Soler 2004) the Centre of Research in Theories and Practices that Overcome Inequalities (CREA, from now on) made two critiques to Habermas. CREA's work on communicative acts points out, on the one hand, that the key concept is interaction and not claim; and, on the other hand, that in relationships can be identified power interactions and dialogic interactions. Although a manager can hold validity claims when inviting his employee to have a coffee with him, the employee can be moved to accept because of the power claim that arises from the unequal structure of the company and of the society, which places her in a subordinate position to the employer. CREA defines power relations as those in which the power interactions involved predominate over the dialogic interactions, and dialogic relations as those in which dialogic interactions are prevalent over power interactions. Dialogic interactions are based on equality and seek understanding through speakers appreciating the provided arguments to the dialogue regardless of the position of power of the speaker. In the educational institutions of democracies, we can find more dialogic interactions than in the educational centers of dictatorships. Nonetheless, even in the educational centers of democracies, when discussing curricular issues, the voice of the teaching staff prevails over the voice of the families, which is almost absent. The educational projects that have contributed to transforming some power interactions into dialogic interactions show that one learns much more through dialogic interactions than through power ones.
History
Dialogic education is argued to have historical roots in ancient oral educational traditions. The chavrusa rabbinic approach, for example, involved pairs of learners analyzing, discussing, and debating shared texts during the era of the Tannaim (approximately 10-220 CE).
Dialogue was also a defining feature of early-Indian texts, rituals, and practices that spread across Asia with the rise of Buddhism. Indeed, one of the earliest references to an idea of dialogue is in the Rigveda (c. 1700-1100 BC), where the poet asks the deities Mitra and Varuna to defend him from the one “who has no pleasure in questioning, or in repeated calling, or in dialogue”. Later, Buddhist educators such as Nichiren (1222-1282) would themselves present work in a dialogic form. It has also been linked to traditional Islamic education with Halaqat al-’Ilm, or Halaqa for short, in mosque-based education whereby small groups participate in discussion and questioning in 'circles of knowledge'. A dialogic element has similarly been found in Confucian education.
Links are often also made with the Socratic method, established by Socrates (470-399 BC), which is a form of cooperative argumentative dialogue to stimulate critical thinking and to draw out ideas and underlying presumptions. Dialogic practices and dialogic pedagogy existed in Ancient Greece, before, during, and after Socrates' time, possibly in other forms than those depicted by Plato. There is some debate over whether the Socratic method should be understood as dialectic rather than as dialogic. However it is interpreted, Socrates approach as described by Plato has been influential in informing modern-day conceptions of dialogue, particularly in Western culture. This is notwithstanding the fact that dialogic educational practices may have existed in Ancient Greece prior to the life of Socrates.
Although modern interest in dialogic pedagogy seems to have emerged only in the 1960s, it was a very old and probably widespread educational practice. In more recent times, Mikhail Bakhtin introduced the idea of dialogism, as opposed to "monologism", to literature. Paulo Freire's work, Pedagogy of the Oppressed introduced these ideas to educational theory. Over the last five decades, robust research evidence has mounted on the impact of dialogic education. A growing body of research indicates that dialogic methods lead to improved performance in students’ content knowledge, text comprehension, and reasoning capabilities. The field has not, however, been without controversy. Indeed, dialogic strategies may be challenging to realize in educational practice given limited time and other pressures. It has also been acknowledged that forms of cultural imperialism may be encouraged through the implementation of a dialogic approach.
Notable authors
Robin Alexander
Mikhail Bakhtin
Karen Barad
Jerome Bruner
Martin Buber
Jacques Derrida
John Dewey
Paulo Freire
Antonio Gramsci
Jürgen Habermas
William James
Julia Kristeva
Matthew Lipman
George Herbert Mead
Maurice Merleau-Ponty
Neil Mercer
Michael Oakeshott
Jean Piaget
Charles Sanders Peirce
Plato
Lev Vygotsky
Rupert Wegerif
See also
Dialogic
Dialectic process vs. dialogic process
Dialogical analysis
Dialogical self
Heteroglossia
Intertextuality
Learning theory (education)
Pedagogy
Relational dialectics
References
Bibliography
Aubert, A., Flecha, A., García, C., Flecha, R., y Racionero, S. (2008). Aprendizaje dialógico en la sociedad de la información. Barcelona: Hipatia Editorial.
Freire, P. (1997). Pedagogy of the Heart. New York: Continuum (O.V. 1995).
Mead, G.H. (1934). Mind, self & society. Chicago: University of Chicago Press.
Searle J., & Soler M. (2004). Lenguaje y Ciencias Sociales. Diálogo entre John Searle y CREA. Barcelona: El Roure Ciencia.
Sen, A. (2005) The argumentative Indian: Writings on Indian history, culture and identity. New York: Farrar, Straus and Giroux.
External links
Journals
Dialogic Pedagogy: An International Online Journal
International Journal for Dialogic Science
Research groups
Cambridge Educational Dialogue Research Group (CEDiR) operates out of the University of Cambridge and contributes to this field. As taken from their website, CEDiR's aim is to consolidate and extend research on dialogic education, reaching across disciplines and contexts to influence theory, policy and practice.
The Center for Research on Dialogic Instruction and the In-Class Analysis of Classroom Discourse is a joint effort housed within the Wisconsin Center for Education Research at the School of Education, University of Wisconsin-Madison.
Learning
Philosophy of psychology
Psychological theories
Theory of mind | 0.766939 | 0.973255 | 0.746427 |
Surgical sieve | The surgical sieve is a thought process in medicine. It is a typical example of how to organise a structured examination answer for medical students and physicians when they are challenged with a question. It is also a way of constructing answers to questions from patients and their relatives in a logical manner, and structuring articles and reference texts in medicine. Some textbooks put emphasis on using the surgical sieve as a basic structure of diagnosis and management of illnesses.
Overview
Although there are several versions around the world with slight variations, the surgical sieve usually consist of the following types of process in the human body in any particular order:
Congenital
Acquired
Vascular
Infective
Traumatic
Autoimmune
Metabolic
Inflammatory
Neurological
Neoplastic
Degenerative
Environmental
Unknown
A more extensive, and perhaps more concise mechanism of employing the surgical sieve is using the mnemonic
MEDIC HAT PINE:
Metabolic (conditions relating to metabolism, biochemistry, and the like)
Endocrinological (conditions relating to the various secretory systems within the body)
Degenerative (conditions relating to age-related destruction of tissue, or stress-related destruction of tissue)
Inflammatory/Infective (conditions that primarily present in a way that involves the profane activation of the immune system)
Congenital (conditions present at birth)
Genetic / inherited (conditions that your family passes on to you)
Haematological (conditions relating to the blood system, in one way or another)
Autoimmune (conditions relating to the inappropriate activation of the immune system, in one of many ways)
Traumatic (conditions relating to a physical impact between two or more objects)
Psychological (conditions related to a chemical imbalance or a disorder of thought processes)
Neurological (conditions relating to the nervous system, in one way or another – whether that be the central or peripheral)
Idiopathic (conditions without a known cause) Iatrogenic (lit. Translation “doctor caused” - or resulting from treatment)
Neoplastic (conditions relating to cancers)
Environmental (conditions relating to exposures, and dose-response relationships thereof)
Examples
What are the causes of an acute confusional state in a patient?
Treatment induced (Iatrogenic): polypharmacy, sedatives, analgesics, steroids, drug withdrawal
Vascular: stroke, TIA, vascular dementia
Inflammatory: infection, systemic inflammatory response syndrome
Traumatic: head injury, Intracranial hemorrhage, shock
Autoimmune: thyroid disease
Metabolic: electrolyte imbalance, DKA, hypoglycaemia, SIADH
Infective: sepsis, local infection
Neoplastic: brain tumour, carcinomatosis
Degenerative: Alzheimer's disease, dementia
What are the causes of splenomegaly?
Idiopathic: Idiopathic thrombocytopenic purpura
Vascular: portal vein obstruction, Budd-Chiari syndrome, haemoglobinopathies (Sickle-cell disease, thalassemia)
Infective: AIDS, mononucleosis, septicaemia, tuberculosis, brucellosis, malaria, infective endocarditis
Traumatic: haematoma, rupture
Autoimmune: rheumatoid arthritis, SLE
Metabolic: Gaucher's disease, mucopolysaccharidoses, amyloidosis, Tangier disease
Inflammatory: sarcoidosis
Neoplastic: CML, metastases, myeloproliferative disorders
In popular culture
The surgical sieve is frequently used by Gregory House, who is a physician in the TV series House in order to diagnose the rare diseases his patients suffer from. In some episodes various forms of the surgical sieve are scribbled on to House's whiteboard while his team struggle to diagnose difficult cases. In the episode 'Paternity' the mnemonic 'MIDNIT' is used to run through the sieve (metabolic, inflammation, degenerative, neoplastic, infection, trauma).
See also
Trauma surgery
Hypnosurgery
Surgery
References
Medical diagnosis
Medical terminology
Medical education
Sieve
Medical mnemonics | 0.771117 | 0.967953 | 0.746405 |
Management of schizophrenia | The management of schizophrenia usually involves many aspects including psychological, pharmacological, social, educational, and employment-related interventions directed to recovery, and reducing the impact of schizophrenia on quality of life, social functioning, and longevity.
Hospitalization
Hospitalization may occur with severe episodes of schizophrenia. This can be voluntary or (if mental health legislation allows it) involuntary (called civil or involuntary commitment). Long-term inpatient stays are now less common due to deinstitutionalization, although still occur. Following (or in lieu of) a hospital admission, support services available can include drop-in centers, visits from members of a community mental health team or Assertive Community Treatment team, supported employment and patient-led support groups.
Efforts to avoid repeated hospitalization include the obtaining of community treatment orders which, following judicial approval, coerce the affected individual to receive psychiatric treatment including long-acting injections of anti-psychotic medication. This legal mechanism has been shown to increase the affected patient's time out of the hospital.
Medication
The mainstay of treatment for schizophrenia is an antipsychotic medication. Most antipsychotics can take around 7 to 14 days to have their full effect. Medication may improve the positive symptoms of schizophrenia, and social and vocational functioning. However, antipsychotics fail to significantly improve the negative symptoms and cognitive dysfunction. There is evidence of clozapine, amisulpride, olanzapine, and risperidone being the most effective medications. However, a high proportion of studies of risperidone were undertaken by its manufacturer, Janssen-Cilag, and should be interpreted with this in mind. In those on antipsychotics, continued use decreases the risk of relapse. There is little evidence regarding consistent benefits from their use beyond two or three years.
Treatment of schizophrenia changed dramatically in the mid-1950s with the development and introduction of the first antipsychotic chlorpromazine. Others such as haloperidol and trifluoperazine soon followed.
It remains unclear whether the newer antipsychotics reduce the chances of developing neuroleptic malignant syndrome, a rare but serious and potentially fatal neurological disorder most often caused by an adverse reaction to antipsychotics (neuroleptics).
Most people on antipsychotics get side effects. People on typical antipsychotics tend to have a higher rate of extrapyramidal side effects while some atypicals are associated with considerable weight gain, diabetes, and risk of metabolic syndrome; this is most pronounced with olanzapine, while risperidone and quetiapine are also associated with weight gain. Risperidone has a similar rate of extrapyramidal symptoms to haloperidol. The American Psychiatric Association generally recommends that atypicals be used as first line treatment in most patients, but further states that therapy should be individually optimized for each patient.
The response of symptoms to medication is variable; treatment resistant schizophrenia is the failure to respond to two or more antipsychotic medications given in therapeutic doses for six weeks or more. Patients in this category may be prescribed clozapine, a medication that may be more effective at reducing symptoms of schizophrenia, but treatment may come with a higher risk of several potentially lethal side effects including agranulocytosis and myocarditis. Clozapine is the only medication proven to be more effective for people who do not respond to other types of antipsychotics. It also appears to reduce suicide in people with schizophrenia. As clozapine suppresses the development of bone marrow, in turn reducing white blood cells which can lead to infection, blood tests are taken for the first six months on this medication. The risk of experiencing agranulocytosis due to clozapine treatment is higher in elderly people, children, and adolescents. The effectiveness in the studies also needs to be interpreted with caution as the studies may have an increased risk of bias.
Studies have found that antipsychotic treatment following NMS and neutropenia may sometimes be successfully rechallenged (restarted) with clozapine.
Tobacco smoking increases the metabolism of some antipsychotics, by strongly activitating CYP1A2, the enzyme that breaks them down, and a significant difference is found in these levels between smokers and non-smokers. It is recommended that the dosage for those smokers on clozapine be increased by 50%, and for those on olanzapine by 30%. The result of stopping smoking can lead to an increased concentration of the antipsychotic that may result in toxicity, so that monitoring of effects would need to take place with a view to decreasing the dosage; many symptoms may be noticeably worsened, and extreme fatigue, and seizures are also possible with a risk of relapse. Likewise those who resume smoking may need their dosages adjusted accordingly. The altering effects are due to compounds in tobacco smoke and not to nicotine; the use of nicotine replacement therapy therefore has the equivalent effect of stopping smoking and monitoring would still be needed.
Research findings suggested that other neurotransmission systems, including serotonin, glutamate, GABA, and acetylcholine, were implicated in the development of schizophrenia, and that a more inclusive medication was needed. A new first-in-class antipsychotic that targets multiple neurotransmitter systems called lumateperone (ITI-007), was trialed and approved by the FDA in December 2019 for the treatment of schizophrenia in adults. Lumateperone is a small molecule agent that shows improved safety, and tolerance. It interacts with dopamine, serotonin, and glutamate in a complex, uniquely selective manner, and is seen to improve negative and positive symptoms, and social functioning. Lumateperone was also found to reduce potential metabolic dysfunction, have lower rates of movement disorders, and have lower cardiovascular side effects such as a fast heart rate.
The fixed-dose combination medication xanomeline/trospium chloride (Cobenfy) was approved for medical use in the United States in September 2024. It is the first antipsychotic drug approved by the US Food and Drug Administration (FDA) to treat schizophrenia that targets cholinergic receptors as opposed to dopamine receptors, which has long been the standard of care.
Add-on agents
Sometimes the use of a second antipsychotic in combination with another is recommended where there has been a poor response. A review of this use found some evidence for an improvement in symptoms but not for relapse or hospitalisation. The use of combination antipsychotics is increasing in spite of limited supporting evidence, with some countries including Finland, France, and the UK recommending its use and others including Canada, Denmark, and Spain in opposition. Anti-inflammatories, anti-depressants, and mood stabilisers are other add-ons used. Other strategies used include ECT, or repetitive transcranial magnetic stimulation (rTMS) but evidence for these is lacking.
Note: Only adjuncts for which at least one double-blind randomized placebo-controlled trial has provided support are listed in this table.
Acronyms used:
DB-RPCT — Double-blind randomized placebo-controlled trial.
DB-RCT — Double-blind randomized controlled trial.
Note: Global in the context of schizophrenia symptoms here refers to all four symptom clusters.
N refers to the total sample sizes (including placebo groups) of DB-RCTs.
† No secondary sources could be found on the utility of the drug in question, treating the symptom in question (or any symptom in the case of where † has been placed next to the drug's name).
Psychosocial
Psychotherapy is also widely recommended, though not widely used in the treatment of schizophrenia, due to reimbursement problems or lack of training. As a result, treatment is often confined to psychiatric medication.
Cognitive behavioral therapy (CBT) is used to target specific symptoms and improve related issues such as self-esteem and social functioning. Although the results of early trials were inconclusive as the therapy advanced from its initial applications in the mid-1990s, meta-analytic reviews suggested CBT to be an effective treatment for the psychotic symptoms of schizophrenia. Nonetheless, more recent meta analyses have cast doubt upon the utility of CBT as a treatment for the symptoms of psychosis.
Another approach is cognitive remediation therapy, a technique aimed at remediating the neurocognitive deficits sometimes present in schizophrenia. Based on techniques of neuropsychological rehabilitation, early evidence has shown it to be cognitively effective, resulting in the improvement of previous deficits in psychomotor speed, verbal memory, nonverbal memory, and executive function, such improvements being related to measurable changes in brain activation as measured by fMRI.
Metacognitive training (MCT): In view of many empirical findings suggesting deficits of metacognition (thinking about one's thinking, reflecting upon one's cognitive process) in patients with schizophrenia, metacognitive training (MCT) is increasingly adopted as a complementary treatment approach. MCT aims at sharpening the awareness of patients for a variety of cognitive biases (e.g. jumping to conclusions, attributional biases, over-confidence in errors), which are implicated in the formation and maintenance of schizophrenia positive symptoms (especially delusions), and to ultimately replace these biases with functional cognitive strategies. The training consists of 8 modules and can be obtained cost-free from the internet in 15 languages. Studies confirm the training's feasibility and efficacy in ameliorating positive psychosis symptoms. Studies of single training module show that this intervention target specific cognitive biases. Recently, an individualized format has been developed which combines the metacognitive approach with methods derived from cognitive-behavioral therapy.
Family Therapy or Education, which addresses the whole family system of an individual with a diagnosis of schizophrenia, may be beneficial, at least if the duration of intervention is longer-term. A 2010 Cochrane review concluded that many of the clinical trials that studied the effectiveness of family interventions were poorly designed, and may over estimate the effectiveness of the therapy. High-quality randomized controlled trials in this area are required. Aside from therapy, the impact of schizophrenia on families and the burden on careers has been recognized, with the increasing availability of self-help books on the subject. There is also some evidence for benefits from social skills training, although there have also been significant negative findings. Some studies have explored the possible benefits of music therapy and other creative therapies.
The Soteria model is alternative to inpatient hospitalization using full non professional care and a minimal medication approach. Although evidence is limited, a review found the program equally as effective as treatment with medications but due to the limited evidence did not recommend it as a standard treatment. Training in the detection of subtle facial expressions has been used to improve facial emotional recognition.
Avatar Therapy, developed by Professor Julian Leff, was developed to help patients deal with the impact of auditory hallucinations. In this therapy, patients engage in real-time, face-to-face dialogue with a digital avatar that represents the voice they hear. The therapist operates the avatar, allowing it to verbally communicate with the patient in a controlled and safe environment. Over time, the patient learns to confront and reduce the power of the hallucination, often finding relief from its intensity and frequency. AVATAR therapy aims to help patients gain control over their symptoms, reduce distress, and improve overall mental health. This therapy is grounded in the idea that giving a “face” and voice to auditory hallucinations can help individuals reframe their relationship with these experiences. AVATAR therapy has shown promising results in clinical trials, demonstrating improvements in reducing the impact of auditory hallucinations compared to standard treatment options. A 2020 Cochrane review however failed to find any consistent effects in the reviewed studies.
Supplements
Disruption of the gut microbiota has been linked to inflammation, and disorders of the central nervous system. This includes schizophrenia, and probiotic supplementation has been proposed to improve its symptoms. A review found no evidence to support this but it concludes that probiotics may be of benefit in regulating bowel movements and lessening the metabolic effects of antipsychotics.
A review explains the need for an optimal level of vitamin D and omega-3 fatty acids for the proper synthesis and control of the neurotransmitter serotonin. Serotonin regulates executive function, sensory gating, and social behavior – all of which are commonly impaired in schizophrenia. The model proposed suggests that supplementation would help in preventing and treating these brain dysfunctions. Another review finds that omega-3 fatty acids and vitamin D are among the nutritional factors known to have a beneficial effect on mental health. A Cochrane review found evidence to suggest that the use of omega-3 fatty acids in the prodromal stage may prevent the transition to psychosis but the evidence was poor quality and further studies were called for.
Treatment resistant schizophrenia
About half of those with schizophrenia will respond favourably to antipsychotics, and have a good return of functioning. However, positive symptoms persist in up to a third of people. Following two trials of different antipsychotics over six weeks, that also prove ineffective, they will be classed as having treatment resistant schizophrenia (TRS), and clozapine will be offered. Clozapine is of benefit to around half of this group although it has the potentially serious side effect of agranulocytosis (lowered white blood cell count) in less than 4% of people. Between 12 and 20 per cent will not respond to clozapine and this group is said to have ultra treatment resistant schizophrenia. ECT may be offered to treat TRS as an add-on therapy, and is shown to sometimes be of benefit. A review concluded that this use only has an effect on medium-term TRS and that there is not enough evidence to support its use other than for this group.
TRS is often accompanied by a low quality of life, and greater social dysfunction. TRS may be the result of inadequate rather than inefficient treatment; it also may be a false label due to medication not being taken regularly, or at all. About 16 per cent of people who had initially been responsive to treatment later develop resistance. This could relate to the length of time on APs, with treatment becoming less responsive. This finding also supports the involvement of dopamine in the development of schizophrenia. Studies suggest that TRS may be a more heritable form.
TRS may be evident from first episode psychosis, or from a relapse. It can vary in its intensity and response to other therapies. This variation is seen to possibly indicate an underlying neurobiology such as dopamine supersensitivity (DSS), glutamate or serotonin dysfunction, inflammation and oxidative stress. Studies have found that dopamine supersensitivity is found in up to 70% of those with TRS. The variation has led to the suggestion that treatment responsive and treatment resistant schizophrenia be considered as two different subtypes. It is further suggested that if the subtypes could be distinguished at an early stage significant implications could follow for treatment considerations, and for research. Neuroimaging studies have found a significant decrease in the volume of grey matter in those with TRS with no such change seen in those who are treatment responsive. In those with ultra treatment resistance the decrease in grey matter volume was larger.
Rehabilitative interventions
Individual Placement and Support (IPS), where the rehabilitated person is directly placed and supported in the workplace with the support of a professional, promotes the employment of people with schizophrenia and their survival in the open labour market better than the model of gradual work practice before placement.
Research evidence on the relative superiority of different types of housing units for people with psychosis in terms of symptomatic or functional development is scarce. The support and independence provided in a residential unit should be flexible, individualised and, as far as possible, at the choice of the person being rehabilitated. The living environment should be as normal as possible and the rehabilitated person should not be isolated from the rest of the community.
Traditional Chinese medicine
Acupuncture is a procedure generally known to be safe and with few adverse effects. A Cochrane review found limited evidence for its possible antipsychotic effects in the treatment of schizophrenia and called for more studies. Another review found limited evidence for its use as an add-on therapy for the relief of symptoms but positive results were found for the treatment of sleep disorders that often accompany schizophrenia.
Wendan decoction is a classic herbal treatment in traditional Chinese medicine used for symptoms of psychosis, and other conditions. Wendan decoction is safe, accessible, and inexpensive, and a Cochrane review was carried out for its possible effects on schizophrenia symptoms. Limited evidence was found for its positive antipsychotic effects in the short term, and it was associated with fewer adverse effects. Used as an add-on to an antipsychotic, wider positive effects were found. Larger studies of improved quality were called for.
Other
Various brain stimulation techniques have been used to treat the positive symptoms of schizophrenia, in particular auditory verbal hallucinations (AVHs), and investigations are ongoing. Most studies focus on transcranial direct-current stimulation (tDCM), and repetitive transcranial magnetic stimulation (rTMS). Transcranial magnetic stimulation is low-cost, noninvasive, and almost free of side-effects making it a good therapeutic choice with promising outcomes. Low-frequency TMS of the left temporoparietal cortex (the region containing Broca's area) can reduce auditory hallucinations. rTMS seems to be the most effective treatment for those with persistent AVHs, as an add-on therapy. AVHs are not resolved in up to 30 per cent of those on antipsychotics and a further percentage still experience only a partial response. Techniques based on focused ultrasound for deep brain stimulation could provide insight for the treatment of AVHs.
An established brain stimulation treatment is electroconvulsive therapy. This is not considered a first-line treatment but may be prescribed in cases where other treatments have failed. It is more effective where symptoms of catatonia are present, and is recommended for use under NICE guidelines in the UK for catatonia if previously effective, though there is no recommendation for use for schizophrenia otherwise. Psychosurgery has now become a rare procedure and is not a recommended treatment for schizophrenia.
A study in 2014 conducted by an Australian researcher indicated that the pericarp powder of Garcinia mangostana L. have the ability to reduce oxidative stress as an effective treatment for schizophrenia. This process includes increasing glutathione S-transferase levels which enhances mitochondrial activity over a period of 180 days under a sustained intake of 1000 mg/day.
There may be some benefit in trying several treatment modalities at the same time, especially those that could be classed as lifestyle interventions. Nidotherapy is suggested to be a cost-effective social prescribing intervention using efforts to change the environment to improve functional ability.
Numerous people diagnosed with schizophrenia have found it necessary to organize confidential groups with each other where they can discuss their experiences without clinicians present. Peer support in which people with experiential knowledge of mental illness provide knowledge, experience, emotional, social or practical help to each other is considered an important aspect of coping with schizophrenia and other serious mental health conditions. A 2019 Cochrane reviews of evidence for peer-support interventions compared to supportive or psychosocial interventions were unable to support or refute the effectiveness of peer-support due to limited data.
References
Schizophrenia
Schizophrenia | 0.769361 | 0.970135 | 0.746385 |
National Institute for Health and Care Research | The National Institute for Health and Care Research (NIHR) is the British government's major funder of clinical, public health, social care and translational research. With a budget of over £1.2 billion in 2020–21, its mission is to "improve the health and wealth of the nation through research". The NIHR was established in 2006 under the government's Best Research for Best Health strategy, and is funded by the Department of Health and Social Care. As a research funder and research partner of the NHS, public health and social care, the NIHR complements the work of the Medical Research Council. NIHR focuses on translational research (translating discoveries from the laboratory to the clinic), clinical research and applied health and social care research.
History
The NIHR (originally named National Institute for Health Research) was created in April 2006 under the government's health research strategy, Best Research for Best Health. This strategy outlined the direction that NIHR research and development should take. Its predecessor was the NHS Research & Development programme which was established in 1991. Factors influencing the creation of the NIHR were the growing importance of evidence-based medicine in science and policymaking, the spread of New Public Management thinking and increased government funding.
Its budget was over £1.2 billion in 2020–21. it was the largest national clinical research funder in Europe. In 2022 NIHR changed its name to National Institute for Health and Care Research in order to emphasise its role in social care research.
Notable discoveries and developments
NIHR is among the world-leaders in COVID-19 research and recruited over a million people in their studies of the disease. In the RECOVERY trial, NIHR researchers found that the inexpensive steroid dexamethasone lowers the mortality rate among Covid patients receiving breathing support in hospitals.
NIHR was one of the developers of the UK Standards for Public Involvement which set the framework on how to involve the public in research.
Delivered a trial for Haemophilia A which resulted in the first successful use of gene therapy for treating the condition.
Showed that using MRI is better for detecting prostate cancer than the more intrusive biopsy.
Showed that gefapixant could be used to treat some types of cough, making it the first new cough medicine in 50 years.
Demonstrated that a blood test can be used to better diagnose pre-eclampsia.
Research
Areas of focus
In June 2021 NIHR published Best Research for Best Health: The Next Chapter. The document, building on the 2006 Best Research for Best Health strategy, outlined the updated operational principles, core work-streams and areas of strategic focus of the NIHR. Their work-streams include funding research for the NHS, public and global health and social care; investing in expertise and facilities; and involving patients and communities in research. Their current areas of strategic focus include learning from impact of COVID-19 on research and healthcare; researching for patients with multiple long-term conditions, involving under-served communities and regions in research; and improving equality, diversity and inclusion across the Institution.
Research programmes
The NIHR's funding programmes offer a focused source of funding for researchers within the health and care system in England. Scotland, Wales and Northern Ireland also participate in some of these programmes. The programmes give researchers access to funding to undertake clinical and applied health and social care research.
NIHR's funding programmes are:
Efficacy and Mechanism Evaluation
Evidence Synthesis
Health and Social Care Delivery Research
Health Technology Assessment
Invention for Innovation
National Research Collaboration Programme
Policy Research Programme
Programme Development Grants
Programme Grants for Applied Research
Public Health Research
Research for Patient Benefit
Research schools
The NIHR has established three national research schools: the School for Primary Care Research, the School for Social Care Research, and the School for Public Health Research. Each national school is a research collaboration between academic centres in England. The three schools take part in developing evidence for use in practice and provide training and career development opportunities for researchers in their respective sectors.
Research units
NIHR funds a range of university-based collaborations that undertake research in priority areas: blood and organ donor health, health protection, and health and social care policy. Each unit focuses on a priority topic, for example blood donation, healthcare-associated infections, and adult social care.
Global health research
Supporting the UK International Development Strategy and the United Nations' Sustainable Development Goals, NIHR launched its Global Health portfolio in 2016. It funds applied health research that directly addresses the diverse health needs of people in low- and middle-income countries (LMICs) using UK Aid from the UK government. As well as funding Global Health Research Units and Groups, partnerships between British universities and LMIC institutions, NIHR invests in training and development in global health research and strengthening the research capacity of LMICs at individual, institutional and system level. Engaging and involving local communities in the design and delivery of health research is also part of the programme.
In accordance with NIHR's open access policy, research created with such funding needs to be published in an open access journal. NIHR's global health spendings can be checked through the database of the International Aid Transparency Initiative.
Since 2020, NIHR's global health research units and groups have been involved in efforts to tackle the spread and impact of the Covid-19 pandemic in LMICs.
Public partnerships
The NIHR offers several ways for patients and the public to participate in health and care research. People can take part in a study as a research participant, for example in a clinical trial that looks for new treatments for a health condition. People who are not affected by a particular condition or who care for someone with a long-term health issue can also take part in research. The NIHR runs the online services Be Part of Research and Join Dementia Research to inform the public about what health and care research is and to help them find studies that are looking for participants.
Patients and the public can also contribute to research through patient and public involvement (PPI). PPI is a partnership between members of the public (including patients, service users, carers) and researchers where public representatives can influence what should be a priority for research and help shape how the research is carried out, applied and communicated. Members of the public can find involvement opportunities in NIHR's research through the database People in Research. The website Learning for Involvement also offers information and resources for learning about public involvement and best practice case studies. The NIHR's global health research funding application process also requires applicants to meaningfully involve affected communities in their research, a practice known in the global health context as Community Engagement and Involvement (CEI).
Infrastructure
NIHR funds research infrastructure that provides expertise, specialist facilities, a delivery workforce and support services. This infrastructure supports and delivers research funded by government bodies, medical research charities, the life sciences industry and other relevant industries.
NIHR coordinates and supports clinical research through its Research Delivery Network (RDN). With 15 local networks scattered across England, the RDN provides help to patients, the public and health and care organisations to participate in research. In 2021-22, the network recruited more than a million participants to clinical research studies, most of whom were taking part in research to help discover new treatments and vaccines for the COVID-19 pandemic.
Since 2007, the NIHR also supports translating scientific developments into direct clinical treatments and applications through its twenty Biomedical Research Centres (BRCs). The BRCs operate as partnerships between local NHS organisations and academic institutions such as the University of Oxford or the University College London. The NIHR has also established Clinical Research Facilities (CRFs), dedicated spaces for delivering research and trials, at 28 NHS hospitals.
The NIHR also funds three Patient Safety Translational Research Centres which focus on translating discoveries on patient safety into practice.
Researching specific regional health and care issues, the NIHR has a network of 15 Applied Research Collaborations (ARCs). The ARCs are made up of partnerships between universities, NHS providers, local authorities and other organisations. Based at NHS organisations, the NIHR Medtech and In vitro diagnostic Co-operatives (MICs) work with commercial companies on developing new medical technologies and research in vitro diagnostic tests.
Established by its Office for Clinical Research Infrastructure in 2011, the NIHR has eight Translational Research Collaborations – ready-formed networks of the UK's leading universities, NHS trusts and research centres that conduct early-phase translational research and tackle experimental medicine challenges in selected therapeutic themes.
Career development and support
The NIHR Academy, launched in 2018, develops and coordinates the NIHR's academic training, career and research capacity development. Its launch was an output and recommendation of the strategic review of training which looked at the future training and support needs of researchers.
The NIHR Academy provides training and career development awards from pre-doctoral level to research professorships. the Dean of the NIHR Academy is Professor Waljit Dhillo, Professor in Endocrinology and Metabolism, and Consultant Endocrinologist. He also holds the position of Head of the Division of Diabetes, Endocrinology & Metabolism at Imperial College London.
The award of NIHR Senior Investigator is given to recognise "the most prominent and prestigious researchers funded by the NIHR and the most outstanding leaders of patient and people-based research within the NIHR research community", and held for four years with the possibility of a second term and then alumnus status. The NIHR's flagship award is the Research Professorship which funds the clinical and applied health research of outstanding academics for 5-years. Similarly, the Global Health Research Professorship funds research that benefits low and middle income countries.
Key people and structure
Responsibility for the NIHR lies with the Chief Scientific Advisor to the Department of Health and Social Care (DHSC). Professor Sally Davies (Dame Sally from 2009) held this post from 2004 to 2016, and led the founding of the NIHR in 2006. She was succeeded by Professor Chris Whitty (who has also been Chief Medical Officer for England since 2019).
Since August 2021, the current holder of the post is Lucy Chappell, Professor of Obstetrics at King's College London.
For operating the NIHR, the DHSC contracts with a number of NHS Trusts, universities and life science organisations that host NIHR's two coordinating centres:
NIHR Coordinating Centre (NIHRCC), hosted by Leeds Teaching Hospitals NHS Trust, the University of Southampton, and LGC.
NIHR Research Delivery Network Coordinating Centre (RDNCC), hosted together by the University of Leeds.
The Dean of the NIHR Academy and the Research Programme Directors are also contracted by the DHSC.
Publications
The NIHR publishes five peer-reviewed, open access journals which make up the NIHR Journals Library. The journals are titled Efficacy and Mechanism Evaluation, Health and Social Care Delivery Research, Health Technology Assessment, Public Health Research, and Programme Grants for Applied Research. Researchers working in relevant, NIHR-funded projects are required to publish in an NIHR journal. Besides publishing the final research articles, the NIHR Journals Library supports the model of open science by providing a transparent, 'living' document for each research project which is updated alongside the progress of the study. This involves publishing all relevant materials from the outset of the studies, including the relevant systematic reviews, research protocol, study documentation, plain English descriptions, and data.
The NIHR publishes short, easy-to-read summaries and thematic overviews of the most important research findings on the NIHR Evidence website. Some of the summaries are also published in The British Medical Journal.
The NIHR also has an open science platform where researchers can share any kind of relevant articles, documents and data including negative or null results.
Open access
NIHR has an open access policy and was one of the original funders of Europe PubMed Central. Their updated policy requires all NIHR-funded, peer-reviewed research articles submitted after June 2022 have to be immediately, freely and openly accessible to all. The articles are required to use the Creative Commons attribution (CC BY) or the Open Government Licence (OGL).
Achievements and recognition
In 2016, NIHR commissioned the independent RAND Europe think tank and the Policy Institute at King's College London to collate and synthesise 100 examples of positive change arising from NIHR's support of health and care research in its first 10 years. The assessment found that the NIHR had "transformed research & development in and for the NHS and the patients it serves".
In 2017, the NIHR was awarded one of the first 'Cochrane-REWARD prizes for reducing waste in research' for the Adding Value in Research Programme
In 2018, an article published in Public Health identified that NHS trusts with increased NIHR-adopted clinical trial activity are associated with reduced mortality levels.
In 2022, a study looking at clinical trial transparency among European medical research funders ranked NIHR the highest for being the most compliant in implementing best practices.
In September 2022, NIHR Cambridge BRC announced what is believed to be UK's first demonstration of genomic data federation by connecting the trusted research environments of NIHR Cambridge BRC with Genomics England as part of a UK Research & Innovation-funded project involving University of Cambridge, NIHR Cambridge BRC, Genomics England, Lifebit, Eastern Academic Health Science Network, and Cambridge University Health Partners.
See also
Medical Research Council
National Institute for Health and Care Excellence
Health Research Authority
Medicines and Healthcare products Regulatory Agency
Health and Care Research Wales
NHS Research Scotland
References
External links
Evidence website — shares NIHR's research findings in plain language.
NIHR Journals Library — five open access journals.
Government research
Health policy in the United Kingdom
National Institute for Health and Care Research
Medical research institutes in the United Kingdom
Science and technology think tanks based in the United Kingdom
Medical and health organisations based in England
Funding bodies of England
Research organisations in England
2006 establishments in England | 0.762643 | 0.978655 | 0.746364 |
Eight principles | The eight principles are a core concept of traditional Chinese medicine based on Confucianism. The identification and differentiation of syndromes according to the eight principles is one of the earliest examples of critical and deductive thinking for diagnosis.
The eight principles are:
Exterior and interior
Cold and hot
Empty and full
Yin and yang
Exterior and interior
Sometimes referred to as external and internal, this differentiation is not made on the basis of etiology (cause) of disease but location. It can also give an indication of the direction the illness is taking, becoming more external or going deeper into the body.
Exterior affects the skin, muscles and jingluo (energy meridians). Interior affects the Zang Fu (internal organs) and the bones. The general symptoms for an exterior pattern are fever, aversion to cold, aching body, stiff neck, and a floating rapid pulse. Onset is acute and the correct treatment will elicit a swift response. Exterior patterns usually involve the invasion of an external pathogenic wind as a factor, or if slow in onset can indicate painful obstruction syndrome (bi syndrome) damp or chronicity.
Cold and hot
Cold and hot (or heat) describes the nature of a pattern and clinical manifestations usually in combination with Full or Empty conditions:
Full heat
This is indicated by fever, thirst, red face, red eyes, constipation, scanty dark urine, full rapid pulse and a red tongue with yellow coating. It arises when there is an excess of Yang energies in the body. It can be caused by consuming hot energy foods, or long standing emotional problems causing for example liver qi stagnation. It can also be caused by invasion by an external pathogenic factor.
Empty heat
Empty heat is characterised by afternoon fever, dry mouth, dry throat at night, night sweats, a feeling of heat in the chest and in the palms and the soles, dry stools, scanty dark urine and a floating and rapid pulse and a peeled tongue. It is usually accompanied by a feeling of restlessness and vague anxiety. The difference between full heat is that empty heat is cause by a deficiency of Yin rather than an excess of Yang.
Full cold
Chilliness, cold limbs, no thirst, pale face, abdominal pain., aggravated on pressure, desire to drink warm liquids, loose stools, clear abundant urine, Deep-full-tight pulse and a pale tongue with thick white coating. Full cold is generated by an excess of Yin.
Empty cold
Chilliness, cold limbs, dull-pale face, no thirst, listlessness, sweating, loose stools, clear-abundant urine, a deep slow or weak pulse and a pale tongue with a thin white coating. Empty cold arises from a deficiency of Yang.
Empty and full
Empty and full is also commonly called deficient and excess. This distinction is made according to the presence or absence of a pathogenic factor and the strength of the body's energies. Full is characterised by the presence of a pathogenic factor and the Qi is relatively intact. The Qi battles against the pathogenic factor which causes the excessive symptoms. Empty is characterised by absence of a pathogenic factor and weak Qi. The distinction between full and empty is made more than any other type of observation. Clinical manifestations of empty include chronic diseases, listlessness, apathy, lying curled up, weak voice, weak breathing, low pitched tinnitus, pain alleviated by pressure, poor memory, slight sweating, frequent urination, loose stools and empty pulse. Clinical manifestations of full patterns include acute diseases, restlessness, irritability, red face, strong voice, coarse breathing, pain aggravated by pressure, high pitched tinnitus, profuse sweating, scanty urination, constipation and excess pulse type. There are four types of empty:
Empty Qi
Empty Yang
Empty Blood
Empty Yin
Yin and yang
Yin and yang are also categorised in an eight pattern of, Yin and Yang, Interior, exterior, and deficiency, excess or hot, cold, relating to the I Ching.
See also
I Ching
I Ching divination
Confucius
References
Traditional Chinese medicine | 0.766659 | 0.973513 | 0.746353 |
Services and supports for people with disabilities | Service and supports for people with disabilities are those government or other institutional services and supports specifically provided to enable people who have disabilities to participate in society and community life. Some such services and supports are mandated or required by law, some are assisted by technologies that have made it easier to provide the service or support while others are commercially available not only to persons with disabilities, but to everyone who might make use of them.
Services for developmentally disabled people
Developmental disabilities, as defined by the Agency for Developmental Disabilities website, are "severe, life-long disabilities attributable to mental and/or physical impairments which manifest themselves before the age of 22 years and are likely to continue indefinitely. They result in substantial limitations in three or more of the following areas: self-care, comprehension and language, skills (receptive and expressive language), learning, mobility, self-direction, capacity for independent living, economic self-sufficiency, or ability to function independently without coordinated services (continuous need for individually planned and coordinated services). Persons with developmental disabilities use individually planned and coordinated services and supports of their choosing (e.g., housing, employment, education, civil and human rights protection, health care) to live in and to participate in activities in the community." These services and supports are different in every state and there is currently no portability for many of these services state to state.
The mission of The Administration on Developmental Disabilities (ADD), as quoted from their website "ensures that individuals with developmental disabilities and their families participate in the design of and have access to culturally-competent needed community services, individualized supports, and other forms of assistance that promote self-determination, independence, productivity, and integration and inclusion in all facets of community life." Though many supports and services for people with developmental disabilities are offered through other federal and state agencies as well as nonprofit organizations and for profit endeavors, some of ADD Programs/Partners are:
State Councils on Developmental Disabilities
State Protection and Advocacy Systems
National Network of University Centers for Excellence in Developmental Disabilities Education, Research, and Services
Minority Partnership
National Training Initiatives
Projects of National Significance
Emergency Preparedness Special Initiatives
Family Support and Community Access Demonstration Projects
Independent Evaluation Information
Medicaid Reference Desk
National Autism Resource and Information Center
State of the States in Developmental Disabilities
Access to Integrated Employment
The National Residential Information System Project (RISP)
Voting Project
Youth Information, Training and Resource Center.
Services for the blind and visually impaired
There are a number of services that can be provided for the blind. Guide dogs is one service that is provided for blind and visually impaired people. These service dogs are trained animals that are capable of guiding people from different locations. Also, these dogs are capable of avoiding obstacles and letting the person in service know that there is a step or bump ahead, so a person doesn't get hurt. Guide dogs tend to cost money and not everyone has enough resources to have this service. However, there are some non-profit organizations that help with the expenses to breed, train, and breed a guided dog. "It costs over $50,000 to breed, raise, train, and place one assistance dog; however, all of the Foundations' services are provided at no charge to the individual." Guide Dog Foundation is one of many different foundations that give services to de blind and visually impair people around the United States. There are different acts that the government has signed to help people with guide dogs to enter into places where regular animals are not allowed.
There are many different services and help that visually impair people receive on their day. The Braille Alphabet is an information that lets the blind or visually impair read by following some pattern of dots that each will be a letter. "A person who is unable to read standard print material, borrows free of charge, a Braille material. ... This service is provided by a network of libraries around the United States
Accessible Mobile apps are also a new way to help people visually impair. Many of this apps translate writings into audio in which the person can listen to the writings. "Accessible software applications (apps) for smartphones and other mobile devices can be used by those who are visually impaired to read books, newspapers, magazines, and other print material. These apps convert digital text to speech or provide braille output to a compatible braille device".
Services for the hearing impaired
There are many different services that a hearing impair and deaf can receive. Hearing aids is a device that a hearing impair can use in order to hear regular noises and speech. There are different foundations and nonprofit organizations that are able to provide hearing aids to people with hearing loss. Usually people need examinations in order to know which kind of hearing aid they need. Depending if the hearing loss is Sensorineural or Conductive they can receive help. Hearing loss sensorineural is due to the damage of the inner ear, damage to the hair cells. It can be produced due to disease, illness, age, damage due to exposure, etc. Conductive hearing loss is when sound waves cannot travel through the outer or middle ear, this can be because of earwax, fluids in the middle ear, etc. Depending on the type of hearing loss people can get hearing aids that fits their necessities.
STTS (Speech to Text Service) is a term used for the different real time captioning devices where speech and auditory information can be translated into text by a professional. STTS can be used in different environments such as office meetings, classrooms, public speaking events, etc. There are different types of STTS devices and it will work depending on its type, Verbatim or Meaning-to-meaning are two types of STTS devices. Verbatim is the device that translates all the speech in text, including repetitions and misspeaks, this device is known as CARTS (Communication Access Realtime translation). Meaning-to-meaning device is the one that translates the speech into text taking out repetitions and misspeak, two types of devices that meets this type is C-Print and typewell. Depending on the application the individual works, they will be able to decide which devices fits their needs.
Sign language interpreting
Services for the mobility-impaired
The Americans with Disabilities Act of 1990 was a landmark U.S. federal government move towards providing services for the persons with disabilities in a uniform way all across the country. That legislation has been widely copied in other countries.
Accessing services for disabled people
According to the Americans with disabilities act, people with disabilities are guaranteed equal opportunities when it comes to public accommodation, jobs, transportation, government services and telecommunications. These allow for Americans with disabilities to be able to live as normal lives as possible apart from their disadvantage. In the United States, services for disabled people varies by state and sometimes by location within a state. While Medicaid and Social Security income, both SSI and SSDI, are federally mandated, each state is responsible for administering these programs in their state, as part of their services and supports for disabled people. Each state designs its service delivery system differently and as a result, the portals for entry vary for each state. Some states administer services through a state government agency with subordinate offices throughout the state. Some states contract services out (privatize) and maintain a skeleton state government staff. Being a good advocate or self advocate is necessary to maximize services and supports but several advocacy groups have emerged that provide services, especially health advocacy, for disabled people such as Disability Health Support Australia.
See also
Developmental disabilities
Medicaid
Social Security Disability Insurance
Assistive device
The Compass Institute Inc Further education and Vocational Pathways for young people with intellectual disabilities
European Platform for Rehabilitation
References
Disability rights
Services for the disabled | 0.763323 | 0.977755 | 0.746342 |
Continuum concept | The continuum concept is an idea, coined by Jean Liedloff in her 1975 book The Continuum Concept, that human beings have an innate set of expectations (which Liedloff calls the continuum) that our evolution as a species has designed us to meet in order to achieve optimal physical, mental, and emotional development and adaptability. According to Liedloff, in order to achieve this level of development, young humans (especially babies) require the kind of experience to which our species adapted during the long process of our evolution by natural selection.
The continuum
For infants, the experiences include:
Immediate placement, after birth, in their mothers' arms: Liedloff comments that the common hospital protocol of immediately separating a newborn from its mother may hormonally disrupt the mother, possibly explaining high rates of postpartum depression;
Constant carrying or physical contact with other people (usually their mothers or fathers) in the several months after birth, as these adults go about their day-to-day business (during which the infants observe and thus learn, but also nurse, or sleep); this forms a strong basis of personal security for infants, according to Liedloff, from which they will begin developing a healthy drive for independent exploration by eventually starting to naturally creep, and then crawl, usually at six to eight months; She calls this the "In-Arms" phase.
Sleeping in the parents' bed (called co-sleeping), in constant physical contact, until leaving of their own volition (often about two years);
Breastfeeding "on cue"—involving infants' bodily signals being immediately answered by their mothers' nursing them;
Caregivers' immediate response to the infants' urgent body signals (flaring temper, crying, sniffling, etc.), without judgment, displeasure, or invalidation of the children's needs, but also not showing any undue concern or focusing on or overindulging the children;
Sensing (and fulfilling) elders' expectations that the infants are innately social and cooperative and have strong self-preservation instincts, and that they are welcome and worthy (yet without making them the constant center of attention)
Compensatory responses
Liedloff suggests that when certain evolutionary expectations are not met as infants and toddlers, compensation for these needs will be sought, by alternate means, throughout life, resulting in many forms of mental and social disorders. She also argues that these expectations are largely distorted, neglected, and/or not properly met in civilized cultures which have removed themselves from the natural evolutionary process, resulting in the aforementioned abnormal psychological and social conditions. Liedloff's recommendations fit in more generally with evolutionary psychology, attachment theory, and the philosophy known as the Paleolithic lifestyle: optimizing well-being by living more like our hunter-gatherer ancestors, who Liedloff refers to as "evolved" humans, since their lifeways developed through natural selection by living in the wild.
Documentary
The continuum concept featured on television in the UK in the 2007 Channel 4 series Bringing Up Baby. It was featured as one of three influential parenting "methods" of the 20th century which a number of new parents tested out.
See also
Ye'kuana people
External links
continuum-concept.org
Interview with Jean Liedloff by Chris Mercogliano
Interview With Jean Liedloff, November 16th 2004, in English
Interview With Jean Liedloff, November 16th 2004, in Hebrew
Human development | 0.76447 | 0.976151 | 0.746238 |
Macy conferences | The Macy conferences were a set of meetings of scholars from various academic disciplines held in New York under the direction of Frank Fremont-Smith at the Josiah Macy Jr. Foundation starting in 1941 and ending in 1960. The explicit aim of the conferences was to promote meaningful communication across scientific disciplines, and restore unity to science. There were different sets of conferences designed to cover specific topics, for a total of 160 conferences over the 19 years this program was active; the phrase "Macy conference" does not apply only to those on cybernetics, although it is sometimes used that way informally by those familiar only with that set of events. Disciplinary isolation within medicine was viewed as particularly problematic by the Macy Foundation, and given that their mandate was to aid medical research, they decided to do something about it. Thus other topics covered in different sets of conferences included: aging, adrenal cortex, biological antioxidants, blood clotting, blood pressure, connective tissues, infancy and childhood, liver injury, metabolic interrelations, nerve impulse, problems of consciousness, and renal function.
Overview
The Josiah Macy, Jr. Foundation developed two innovations specifically designed to encourage and facilitate interdisciplinary and multidisciplinary exchanges; one was oral: the Macy conferences, and one was written: the Macy transactions (published transcriptions of the conferences). Macy conferences were essentially conversations held in a conference setting, with participants presenting research while it was still in process (rather than after it had been completed). These were more formal than conversations (papers were prepared ahead of time and circulated) but less formal than conferences. Macy transactions were transcriptions widely circulated to those who could not attend. These were far more informal than typical proceedings, which publish revised versions of conference papers, and served to invite additional scholars into the exchange. The explicit goal was to let a wider audience hear the experts exchange ideas and think out loud about their own work. But even participants themselves found the transactions valuable, as a way to prompt memories, and to catch comments they might have missed. A few comments were made explicitly referring to later publication of the conference discussions, so clearly participants took this into account. However, Fremont-Smith explicitly stated that actual discussion should always take priority.
Participants were leading scientists from a wide range of fields. Casual recollections of several participants as well as published comments in the Transactions volumes stress the communicative difficulties in the beginning of each set of conferences, giving way to the gradual establishment of a common language powerful enough to communicate the intricacies of the various fields of expertise present. Participants were deliberately chosen for their willingness to engage in interdisciplinary conversations, or for having formal training in multiple disciplines, and many brought relevant past experiences (gained either from earlier Macy conferences or other venues). As participants became more secure in their ability to understand one another over the course of a set of conferences on a single topic, their willingness to think outside their own specializations meant that creativity increased.
Conference topics
Cerebral Inhibition Meeting
The Macy Cybernetics Conferences were preceded by the Cerebral Inhibition Meeting, organized by Frank Fremont-Smith and Lawrence K. Frank, and held on 13–15 May 1942. Those invited were Gregory Bateson, Frank Beach, Carl Binger, Felix Deutsch, Flanders Dunbar, Julie Eisenbud, Carlyla Jacobsen, Lawrence Kubie, Jules Masserman, Margaret Mead, Warren McCulloch, Bela Mittelmann, David Rapoport, Arturo Rosenblueth, Donald Sheehan, Georg Soule, Robert White, John Whitehorn, and Harold Wolff. There were two topics:
Hypnotism introduced by Milton Erickson
Conditioned reflex introduced by Howard Liddell
Cybernetics Conferences
The Cybernetics conferences were held between 1946 and 1953, organized by the Josiah Macy, Jr. Foundation, motivated by Lawrence K. Frank and Frank Fremont-Smith of the Foundation. As chair of this set of conferences, Warren McCulloch had responsibility to ensure that disciplinary boundaries were crossed. The Cybernetics were particularly complex as a result of bringing together the most diverse group of participants of any of the Macy conferences, so they were the most difficult to organize and maintain.
The principal purpose of these series of conferences was to set the foundations for a general science of the workings of the human mind. These were one of the first organized studies of interdisciplinarity, spawning breakthroughs in systems theory, cybernetics, and what later became known as cognitive science.
One of the topics spanning a majority of the conferences was reflexivity. Claude Shannon, one of the attendees, had previously worked on information theory and laid one of the initial frameworks for the Cybernetic Conferences by postulating information as a probabilistic element which reduced the uncertainty from a set of choices (i.e. being told a statement is true, or even false, completely reduces the ambiguity of its message).
Other conference members, especially Donald MacKay, sought to reconcile Shannon's view of information, which they called selective information, with theirs of 'structural' information which signified how selective information was to be understood (i.e. a true statement might acquire additional meanings in varied settings though the information exchanged itself has not changed). The addition of meaning into the concept of information necessarily brought the role of the observer into the Macy Conferences. MacKay argued that by receiving and interpreting a message, the observer and the information they perceived ceased to exist independently of one another. The individual reading and processing the information does so relative to their preexisting internal state, consisting of what they already know and have experienced, and only then acts.
MacKay further muddled the role of information and its meaning by introducing the idea of reflexivity and feedback loops into his thought experiment. By claiming that the influence of the original message on the initial observer could be perceived by a separate individual, MacKay turned the second individual into an additional observer which could be elicited to react just how the initial observer did, a reaction that could then further be observed by a nested doll of observers ad infinitum.
Reflexive feedback loops continued to come up during the Macy Conferences and became a prominent issue during its later discussions as well, most notably in the discussions regarding behavioral patterns of the human mind.
Warren McCulloch and Walter Pitts, also attendees, had previously worked on designing the first mathematical schema of a neuron based on the idea that each neuron had a threshold level that was to be reached, via excitation signals from incoming neurons, before firing its own signal onto others. Similarly to how Shannon had previously proven with his work in relay and switch circuits, McCulloch and Pitts proved that neural networks were capable of carrying out any boolean algebra calculations.
At the Macy Conferences, McCulloch proposed that the firing of a neuron can be associated with an event or interaction taking place in the external world which provides sensory stimulus that is then picked up by the nervous system and processed by the neurons. But McCulloch also showed how a neural network's signal pathway could be set up reflexively with itself causing the neurons to continuously fire onto each other in a 'reverberating' circular feedback loop without any original 'firing' signal or any new additional incoming signals. McCulloch claimed this accounted for conscious phenomena in which individuals' world view, or the reaffirmation of their senses' perceived external stimulus, was cognitively distorted or all together missing as seen in individuals with phantom limb syndrome (claiming to feel an arm that has been amputated or lost) or hallucinations (perceived sensory stimulus without an original external signal). Lawrence Kubie, another attending conference member and a psychiatrist, noted how repetitive and obsessive behaviors manifesting themselves in neurotics bore a resemblance to the behavior enacted by McCulloch's 'reverberating' loops.
Shannon had developed a maze-solving device which attendees of the Macy Conferences likened to a rat. Shannon's 'rat' was designed and programmed to find its marked goal when dropped at any point in a maze by giving it the ability to recall on past experiences, previous paths it had taken around the maze, so as to help it reach its endpoint - which it did repeatedly.
Though goal-oriented, Shannon showed how his rat's design was prone to erratic behavior that negated its original function entirely via reflexive feedback loops. If Shannon's rat encountered itself in a path in which its 'memory' failed to fire correctly, that is to recall the paths which lead it to its goal, it would get stuck in an endless loop chasing its tail. Completely abandoning its goal-oriented design, Shannon's rat had seemingly become neurotic.
The Macy Conferences failed to reconcile the subjectivity of information (its meaning) and that of the human mind but succeeding in showing how concepts such as that of the observer, reflexivity, black box systems, and neural networks would have to be approached in conjunction and eventually overcome in order to form a complete working theory of the mind. The Macy Conferences were discontinued shortly after the ninth conference.
First Cybernetics Conference, 21–22 March 1946. Titled "Feedback Mechanisms and Circular Causal Systems in Biological and Social Systems".
Second Cybernetics Conference, 17–18 October 1946. Title changed to "Teleological Mechanisms and Circular Causal Systems"
Third Cybernetics Conference, 13–14 March 1947.
Fourth Cybernetics Conference, 23–24 October 1947. Title changed to "Circular Causal and Feedback Mechanisms in Biological and Social Systems".
Fifth Cybernetics Conference, 18–19 March 1948
Sixth Cybernetics Conference, 24–25 March 1949
Seventh Cybernetics Conference, 23–24 March 1950. Title changed to "Cybernetics: Circular Causal and Feedback Mechanisms in Biological and Social Systems".
Eighth Cybernetics Conference, 15–16 March 1951
Ninth Cybernetics Conference, 20–21 March 1952
Tenth Cybernetics Conference, 22–24 April 1953
Participants: (as members or guests) in at least one of the Cybernetics conferences:
Harold Alexander Abramson, Ackerman, Vahe E. Amassian, William Ross Ashby, Yehoshua Bar-Hillel, Gregory Bateson, Alex Bavelas, Julian H. Bigelow, Herbert G. Birch, John R. Bowman, Henry W. Brosin, Yuen Ren Chao (who memorably recited the Lion-Eating Poet in the Stone Den), Jan Droogleever-Fortuyn, M. Ericsson, Fitch, Lawrence K. Frank, Ralph Waldo Gerard, William Grey Walter, Molly Harrower, George Evelyn Hutchinson, Heinrich Klüver, Lawrence S. Kubie, Paul Lazarsfeld, Kurt Lewin, J. C. R. Licklider, Howard S. Liddell, Donald B. Lindsley, W. K. Livingston, David Lloyd, Rafael Lorente de Nó, R. Duncan Luce, Donald M. MacKay, Donald G. Marquis, Warren S. McCulloch, Turner McLardy, Margaret Mead, Frederick A. Mettier, Marcel Monnier, Oskar Morgenstern, F. S. C. Northrop, Walter Pitts, Henry Quastler, Antoine Remond, I. A. Richards, David McKenzie Rioch, Arturo Rosenblueth, Leonard J. Savage, T. C. Schneirla, Claude Shannon, John Stroud, Hans-Lukas Teuber, Mottram Torre, Gerhardt von Bonin, Heinz von Foerster, John von Neumann, Heinz Werner, Norbert Wiener, Jerome B. Wiesner, J. Z. Young
This is a sampling of the topics discussed each year.
1946, March (NYC)
Self-regulating and teleological mechanisms
Simulated neural networks emulating the calculus of propositional logic
Anthropology and how computers might learn how to learn
Object perception's feedback mechanisms
Perceptual differences due to brain damage
Deriving ethics from science
Compulsive repetitive behavior
1946, October (NYC)
Teleological mechanisms in society
Concepts from Gestalt psychology
Tactile and chemical communications among ant soldiers
1947, March (NYC)
Child psychology
1947, October (NYC)
The field perspective on psychology
Analog vs. digital approaches to psychological models
1948, Spring (NYC)
Formation of "I" in language
Formal modeling applied to chicken pecking order formation
1949, March (NYC)
Are the number of neurons and their connections sufficient to account for human capacities?
Memory
An appeal for collaboration between physics and psychology
1950, March (NYC)
Analog vs. digital interpretations of the mind
Language and Shannon's information theory
Language, symbols and neurosis
Intelligibility in speech communications
A formal analysis of semantic redundancy in printed English
1951, March (NYC)
Information as semantic
Can automatons engage in deductive logic?
Decision theory
Feedforward
Small group dynamics and group communications
The applicability of game theory to psychic motivations
The type of language needed to analyze language
Mere behavior vs. true communication
Is psychiatry scientific?
Can a mental event that creates a memory ever be unconscious?
1952, March (NYC)
The relation of neurophysiological details to broad issues in philosophy and epistemology
The relation of cybernetics at the microlevel to biochemical and cellular processes
The complexity of organisms as a function of information
Humor, communication, and paradox
Do chess playing automatons need randomness to defeat humans?
Homeostasis and learning
1953, April (Princeton)
Studies on the activity of the brain
Semantic information and its measures
Meaning in language and how its acquired
How neural mechanisms can recognize shapes and musical chords
What consensus, if any, the Macy Conferences have arrived at
Some of the researchers present at the cybernetics conferences later went on to do extensive government-funded research on the psychological effects of LSD, and its potential as a tool for interrogation and psychological manipulation in such projects as the CIA's MKULTRA program.
Neuropharmacological Conferences
Five annual Neuropharmacological Conferences took place from 1954 to 1959 with a skipped year in 1958. While the conferences have developed a reputation as being primarily about LSD, the drug was discussed extensively at the second conference and was not the primary focus of most of the sessions. In the first conference, for instance, reference to LSD appears only one time, as a side comment during discussion.
First Neuropharmacological Conference, 26–28 May 1954
Participants:
Hudson Hoagland (Chairman), Harold A. Abramson (Secretary), Philip Bard (absent), Henry K. Beecher (absent), Mary A. B. Brazier, G. L. Cantoni, Ralph W. Gerard, Roy R. Grinker, Seymour S. Kety, Chauncey D. Leake (absent), Horace W. Magoun, Amedeo S. Marrazzi, I. Arthur Mirsky, J. H. Quastel (absent), Orr E. Reynolds, Curt P. Richter (absent), Ernst A. Scharrer, David Shakow (absent)
Guests:
Charles D. Aring, William Borberg, Enoch Callaway III, Conan Kornetsky, Joost A. M. Meerloo, John I. Nurnberger, Carl C. Pfeiffer, Anatol Rapoport, Maurice H. Seevers, Richard Trumbull
Topics:
"Considerations of the Effects of Pharmacological Agents on the Over-All Circulation and Metabolism of the Brain" (Seymour Kety)
"Functional Organization of the Brain" (Ernest A. Scharrer)
"Studies of Electrical Activity of the Brain in Relation to Anesthesia" (Mary A. B. Brazier)
"Ascending Reticular System and Anesthesia (Horace W. Magoun)
"Observations on New CNS Convulsants" (Carl C. Pfeiffer)
Group Processes Conferences
The Group Processes Conferences were held between 1954 and 1960. They are of particular interest due to the element of reflexivity: participants were interested in their own functioning as a group, and made numerous comments about their understanding of how Macy conferences were designed to work. For example, there were a series of jokes made about the disease afflicting them all, interdisciplinitis, or how multidisciplinarian researchers were neither fish nor fowl. When Erving Goffman made a guest appearance at the Third conference, he explicitly prefaced his comments by saying that his ideas were partly speculative, and Frank Fremont-Smith responded by stating that their goal was to discuss ideas that had not been crystallized.
First Group Processes Conference, 26–30 September 1954
Second Group Processes Conference, 9–12 October 1955
Third Group Processes Conference, 7–10 October 1956
Fourth Group Processes Conference, 13–16 October 1957
Fifth Group Processes Conference, 12–15 October 1960
Participants: (as members or guests) in at least one of the Group Processes conferences:
Grace Baker, Donald H. Barron, Gregory Bateson, Alex Bavelas, Frank A. Beach, Leo Berman, Ray L. Birdwhistell, Robert L. Blake, Helen Blauvelt, Jerome S. Bruner, George W. Boguslavsky, Charlotte Bühler, Eliot D. Chapple, Stanley Cobb, Nicholas E. Collias, Jocelyn Crane, Erik H. Erikson, L. Thomas Evans, Jerome Frank, Frank S. Freeman, Frieda Fromm-Reichmann, Erving Goffman, Arthur D. Hasler, Eckhard H. Hess, Sol Kramer, Daniel S. Lehrman, Seymour Levy, Howard Liddell, Robert Jay Lifton, Margarethe Lorenz, Konrad Z. Lorenz, William D. Lotspeich, Ernst Mayr, Margaret Mead, Joost A. M. Meerloo, I. Arthur Mirsky, Horst Mittelstaedt, A. Ulric Moore, R. C. Murphy, Harris B. Peck, Karl H. Pribram, Fritz Redl, Julius B. Richmond, Bertram Schaffner, T. C. Schneirla, Theodore Schwartz, William J. L. Sladen, Robert J. Smith, John P. Spiegel, H. Burr Steinbach, Niko Tinbergen, Mottram P. Torre, William Grey Walter, E. P. Wheeler, II.
See also
Complex systems
Cybernetics
Integrative learning
Josiah Macy, Jr. Foundation
Second-order cybernetics
References
Further reading
Pias, C. (Ed.). (2003). Cybernetics – Kybernetik. The Macy-Conferences 1946–1953. Zürich/Berlin : diaphanes.
Schaffner, B. (Ed.). (1959). Group processes: Transactions of the fourth conference. New York: Josiah Macy, Jr. Foundation.
Schaffner, B. (Ed.). (1960). Group processes: Transactions of the fifth conference. New York: Josiah Macy, Jr. Foundation.
von Foerster, H., Mead, M., & Teuber, H. L. (Eds.). (1953). Cybernetics: Circular causal and feedback mechanisms in biological and social systems. Transactions of the ninth Conference. New York: Josiah Macy, Jr. Foundation.
External links
Macy Conferences Summaries by AMERICAN SOCIETY FOR CYBERNETICS
The Josiah Macy, Jr. Foundation
Cybernetics
Academic conferences
Systems theory
Systems sciences organizations
Josiah Macy Jr. Foundation | 0.761152 | 0.9804 | 0.746233 |
The Information: A History, a Theory, a Flood | The Information: A History, a Theory, a Flood is a book by science history writer James Gleick, published in March 2011, which covers the genesis of the current Information Age. It was on The New York Times best-seller list for three weeks following its debut.
The Information has also been published in ebook formats by Fourth Estate and Random House, and as an audiobook by Random House Audio.
Synopsis
Gleick begins with the tale of colonial European explorers and their fascination with African talking drums and their observed use to send complex widely understood messages back and forth between villages, and over even longer distances by relay. Gleick transitions from the information implications of such drum signaling to the impact of the arrival of long-distance telegraph and then telephone communication to the commercial and social prospects of the Industrial Revolution west. Research to improve these technologies ultimately led to our understanding the essentially digital nature of information, quantized down to the unit of the bit (or qubit).
Starting with the development of symbolic written language (and the eventual perceived need for a dictionary), Gleick examines the history of intellectual insights central to information theory, detailing the key figures responsible such as Claude Shannon, Charles Babbage, Ada Byron, Samuel Morse, Alan Turing, Stephen Hawking, Richard Dawkins and John Archibald Wheeler. The author also delves into how digital information is now being understood in relation to physics and genetics. Following the circulation of Claude Shannon's A Mathematical Theory of Communication and Norbert Wiener's Cybernetics many disciplines attempted to jump on the information theory bandwagon to varying success. Information theory concepts of data compression and error correction became especially important to the computer and electronics industries.
Gleick finally discusses Wikipedia as an emerging internet-based Library of Babel, investigating the implications of its expansive user-generated content, including the ongoing struggle between inclusionists, deletionists, and vandals. Gleick uses the Jimmy Wales-created article for the Cape Town butchery restaurant Mzoli's as a case study of this struggle. The flood of information that humanity is now exposed to presents new challenges, Gleick says. He argues that because we retain more of our information now than at any previous point in human history, it takes much more effort to delete or remove unwanted information than to accumulate it. This is the ultimate entropy cost of generating additional information and the answer to slay Maxwell's Demon.
Reception
In addition to winning major awards for science writing and history, The Information received mostly positive reviews. In The New York Times, Janet Maslin said it is "so ambitious, illuminating and sexily theoretical that it will amount to aspirational reading for many of those who have the mettle to tackle it." Other admirers were Nicholas Carr for The Daily Beast and physicist Freeman Dyson for The New York Review of Books. Science fiction author Cory Doctorow in his BoingBoing review called Gleick "one of the great science writers of all time", "Not a biographer of scientists... but a biographer of the idea itself." Tim Wu for Slate praised "a mind-bending explanation of theory" but wished Gleick had examined the economic importance of information more deeply. Ian Pindar writing for The Guardian complained that The Information does not fully address the relationship between social control of information (censorship, propaganda) and access to political power.
Awards and honors
2012 Royal Society Winton Prize for Science Books, winner.
2012 PEN/E. O. Wilson Literary Science Writing Award, winner.
2012 Andrew Carnegie Medal for Excellence in Nonfiction, finalist.
2012 Hessell-Tiltman Prize, winner.
2011 National Book Critics Circle Award, finalist (Nonfiction).
2011 Salon Book Award (Nonfiction).
2011 New York Times Bestseller
2011 Time Magazine's Best Books of the Year
See also
Decoding Reality: The Universe as Quantum Information, 2010 book by Vlatko Vedral
Decoding the Universe, 2007 book by Charles Seife
References
External links
Bits in the ether – Author Page
The Information Palace – Essay by James Gleick on origin and evolving meaning of the word 'information'.
Wiki is not paper – Essay
After Words interview with Gleick on The Information, June 18, 2011, C-SPAN
2011 non-fiction books
Popular science books
Works about information
Pantheon Books books
Fourth Estate books | 0.763231 | 0.977727 | 0.746231 |
Behavioral medicine | Behavioral medicine is concerned with the integration of knowledge in the biological, behavioral, psychological, and social sciences relevant to health and illness. These sciences include epidemiology, anthropology, sociology, psychology, physiology, pharmacology, nutrition, neuroanatomy, endocrinology, and immunology. The term is often used interchangeably, but incorrectly, with health psychology. The practice of behavioral medicine encompasses health psychology, but also includes applied psychophysiological therapies such as biofeedback, hypnosis, and bio-behavioral therapy of physical disorders, aspects of occupational therapy, rehabilitation medicine, and physiatry, as well as preventive medicine. In contrast, health psychology represents a stronger emphasis specifically on psychology's role in both behavioral medicine and behavioral health.
Behavioral medicine is especially relevant in recent days, where many of the health problems are primarily viewed as behavioral in nature, as opposed to medical. For example, smoking, leading a sedentary lifestyle, and alcohol use disorder or other substance use disorder are all factors in the leading causes of death in the modern society. Practitioners of behavioral medicine include appropriately qualified nurses, social workers, psychologists, and physicians (including medical students and residents), and these professionals often act as behavioral change agents, even in their medical roles.
Behavioral medicine uses the biopsychosocial model of illness instead of the medical model. This model incorporates biological, psychological, and social elements into its approach to disease instead of relying only on a biological deviation from the standard or normal functioning.
Origins and history
Writings from the earliest civilizations have alluded to the relationship between mind and body, the fundamental concept underlying behavioral medicine. The field of psychosomatic medicine is among its academic forebears, albeit, it is now obsolete as an psychological discipline.
In the form in which it is generally understood today, the field dates back to the 1970s. The earliest uses of the term were in the title of a book by Lee Birk (Biofeedback: Behavioral Medicine), published in 1973; and in the names of two clinical research units, the Center for Behavioral Medicine, founded by Ovide F. Pomerleau and John Paul Brady at the University of Pennsylvania in 1973, and the Laboratory for the Study of Behavioral Medicine, founded by William Stewart Agras at Stanford University in 1974. Subsequently, the field burgeoned, and inquiry into behavioral, physiological, and biochemical interactions with health and illness gained prominence under the rubric of behavioral medicine. In 1976, in recognition of this trend, the National Institutes of Health created the Behavioral Medicine Study Section to encourage and facilitate collaborative research across disciplines.
The 1977 Yale Conference on Behavioral Medicine and a meeting of the National Academy of Sciences were explicitly aimed at defining and delineating the field in the hopes of helping to guide future research. Based on deliberations at the Yale conference, Schwartz and Weiss proposed the biopsychosocial model, emphasizing the new field's interdisciplinary roots and calling for the integration of knowledge and techniques broadly derived from behavioral and biomedical science. Shortly after, Pomerleau and Brady published a book entitled Behavioral Medicine: Theory and Practice, in which they offered an alternative definition focusing more closely on the particular contribution of the experimental analysis of behavior in shaping the field.
Additional developments during this period of growth and ferment included the establishment of learned societies (the Society of Behavioral Medicine and the Academy of Behavioral Medicine Research, both in 1978) and of journals (the Journal of Behavioral Medicine in 1977 and the Annals of Behavioral Medicine in 1979). In 1990, at the International Congress of Behavioral Medicine in Sweden, the International Society of Behavioral Medicine was founded to provide, through its many daughter societies and through its own peer-reviewed journal (the International Journal of Behavioral Medicine), an international focus for professional and academic development.
Areas of study
Behavior-related illnesses
Many chronic diseases have a behavioral component, but the following illnesses can be significantly and directly modified by behavior, as opposed to using pharmacological treatment alone:
Substance use: many studies demonstrate that medication is most effective when combined with behavioral intervention
Obesity: structured lifestyle interventions are more effective and widely suitable than drugs or bariatric surgery.
Hypertension: deliberate attempts to reduce stress can also reduce high blood pressure
Insomnia: cognitive and behavioural interventions are recommended as a first line treatment for insomnia
Treatment adherence and compliance
Medications work best for controlling chronic illness when the patients use them as prescribed and do not deviate from the physician's instructions. This is true for both physiological and mental illnesses. However, in order for the patient to adhere to a treatment regimen, the physician must provide accurate information about the regimen, an adequate explanation of what the patient must do, and should also offer more frequent reinforcement of appropriate compliance. Patients with strong social support systems, particularly through marriages and families, typically exhibit better compliance with their treatment regimen.
Examples:
telemonitoring through telephone or video conference with the patient
case management by using a range of medical professionals to consistently follow up with the patient
Doctor-patient relationship
It is important for doctors to make meaningful connections and relationships with their patients, instead of simply having interactions with them, which often occurs in a system that relies heavily on specialist care. For this reason, behavioral medicine emphasizes honest and clear communication between the doctor and the patient in the successful treatment of any illness, and also in the maintenance of an optimal level of physical and mental health. Obstacles to effective communication include power dynamics, vulnerability, and feelings of helplessness or fear. Doctors and other healthcare providers also struggle with interviewing difficult or uncooperative patients, as well as giving undesirable medical news to patients and their families.
The field has placed increasing emphasis on working towards sharing the power in the relationship, as well as training the doctor to empower the patient to make their own behavioral changes. More recently, behavioral medicine has expanded its area of practice to interventions with providers of medical services, in recognition of the fact that the behavior of providers can have a determinative effect on patient outcomes. Objectives include maintaining professional conduct, productivity, and altruism, in addition to preventing burnout, depression, and job dissatisfaction among practitioners.
Learning principles, models and theories
Behavioral medicine includes understanding the clinical applications of learning principles such as reinforcement, avoidance, generalisation, and discrimination, and of cognitive-social learning models as well, such as the cognitive-social learning model of relapse prevention by Marlatt.
Learning theory
Learning can be defined as a relatively permanent change in a behavioral tendency occurring as a result of reinforced practice. A behavior is significantly more likely to occur again in the future as a result of learning, making learning important in acquiring maladaptive physiological responses that can lead to psychosomatic disease. This also implies that patients can change their unhealthy behaviors in order to improve their diagnoses or health, especially in treating addictions and phobias.
The three primary theories of learning are:
classical conditioning
operant conditioning
modeling
Other areas include correcting perceptual bias in diagnostic behavior; remediating clinicians' attitudes that impinge negatively upon patient treatment; and addressing clinicians' behaviors that promote disease development and illness maintenance in patients, whether within a malpractice framework or not.
Our modern-day culture involves many acute, microstressors that add up to a large amount of chronic stress over time, leading to disease and illness. According to Hans Selye, the body's stress response is designed to heal and involves three phases of his General Adaptation Syndrome: alarm, resistance, and exhaustion.
Applications
An example of how to apply the biopsychosocial model that behavioral medicine utilizes is through chronic pain management. Before this model was adopted, physicians were unable to explain why certain patients did not experience pain despite experiencing significant tissue damage, which led them to see the purely biomedical model of disease as inadequate. However, increasing damage to body parts and tissues is generally associated with increasing levels of pain. Doctors started including a cognitive component to pain, leading to the gate control theory and the discovery of the placebo effect. Psychological factors that affect pain include self-efficacy, anxiety, fear, abuse, life stressors, and pain catastrophizing, which is particularly responsive to behavioral interventions. In addition, one's genetic predisposition to psychological distress and pain sensitivity will affect pain management. Finally, social factors such as socioeconomic status, race, and ethnicity also play a role in the experience of pain.
Behavioral medicine involves examining all of the many factors associated with illness, instead of just the biomedical aspect, and heals disease by including a component of behavioral change on the part of the patient.
In a review published 2011 Fisher et al. illustrates how a behavior medical approach can be applied on a number of common diseases and risk factors such as cardiovascular disease/diabetes, cancer, HIV/AIDS and tobacco use, poor diet, physical inactivity and excessive alcohol consumption. Evidence indicates that behavioral interventions are cost effectiveness and add in terms of quality of life. Importantly behavioral interventions can have broad effects and benefits on prevention, disease management, and well-being across the life span.
Journals
Annals of Behavioral Medicine
International Journal of Behavioral Medicine
Journal of Behavior Analysis of Sports, Health, Fitness and Behavioral Medicine
Journal of Behavioral Health and Medicine
Journal of Behavioral Medicine
Organizations
Association for Behavior Analysis International's Behavioral Medicine Special Interest Group
Society of Behavioral Medicine
International Society of Behavioral Medicine
See also
Health psychology
Organizational psychology
Medical psychology
Occupational health psychology
References
Epidemiology
Health
Interdisciplinary branches of psychology
Neuroanatomy | 0.770563 | 0.968391 | 0.746207 |
David Healy (psychiatrist) | David Healy FRCPsych, a professor of psychiatry at Bangor University in the United Kingdom, is a psychiatrist, psychopharmacologist, scientist and author. His main areas of research are the contribution of antidepressants to suicide, conflict of interest between pharmaceutical companies and academic medicine, and the history of pharmacology. Healy has written more than 150 peer-reviewed articles, 200 other articles, and 20 books, including The Antidepressant Era, The Creation of Psychopharmacology, The Psychopharmacologists Volumes 1–3, Let Them Eat Prozac and Mania: A Short History of Bipolar Disorder.
Healy has been involved as an expert witness in homicide and suicide trials involving psychotropic drugs, and has brought concerns about some medications to the attention of drug regulators. He has also said that pharmaceutical companies sell drugs by marketing diseases and co-opting academic opinion-leaders. In his 2012 book Pharmageddon he argues that pharmaceutical companies have dominated healthcare in America, often with life-threatening results for patients. Healy is a founder and chief executive officer of Data Based Medicine Limited, which aims to make medicines safer through "online direct patient reporting of drug effects".
Career
David Healy originally trained in Dublin, Ireland, and at Cambridge University. He is a former Secretary of the British Association for Psychopharmacology. He is currently a professor of psychiatry at Bangor University in the United Kingdom, a psychiatrist, psychopharmacologist, scientist, and author. His main areas of research are the development and history of psychopharmacology, and the impact of psychotropic drugs on our culture. Healy has written more than 150 peer-reviewed articles, 200 other articles, and 20 books, including The Antidepressant Era and The Creation of Psychopharmacology from Harvard University Press, The Psychopharmacologists Volumes 1–3 and Let Them Eat Prozac from New York University Press, and Mania: A Short History of Bipolar Disorder from Johns Hopkins University Press.
Healy has been involved as a legal expert witness in homicide and suicide trials involving psychotropic drugs, and has brought concerns about some drugs to the attention of American and British regulators. He has alleged that pharmaceutical companies sell drugs by marketing diseases and co-opting academic opinion-leaders, sometimes ghostwriting their articles. His most recent book, Pharmageddon, claims that pharmaceutical companies have dominated healthcare in America, often with life-threatening results for patients. In 2000 a lucrative job at Toronto's Centre for Addiction and Mental Health was withdrawn under unclear circumstances. Healy and his supporters have claimed that this withdrawal was due to Healy giving a speech and publishing a paper claiming that the SSRI antidepressant fluoxetine increases the risk that patients will commit suicide. Lilly was a major contributor to the Centre at the time. A settlement was reached, in which Healy received a visiting professor appointment, and a joint statement was released stating "Although Dr Healy believes that his clinical appointment was rescinded because of his November 2000 speech at the CAMH [Centre for Addiction and Mental Health], Dr Healy accepts assurances that pharmaceutical companies played no role in either CAMH's decision to rescind his clinical appointment or the University of Toronto's decision to rescind his academic appointment."
Healy directs an Electroconvulsive Therapy (ECT) clinic in Wales. He strongly defends the procedure as having an immediate visible effect in severely depressed patients for whom no other options have worked, particularly geriatric patients. He has co-written a history of ECT along with Edward Shorter and cites Max Fink as a source. Healy has clarified which chapters he wrote and that he was not personally financially supported by Fink's Scion Foundation. Another reforming psychiatrist, Peter Breggin, has strongly criticised Healy for this aspect of his work on the grounds of ethics and the longer-term data. Healy has even speculated that Insulin coma therapy may have 'worked' in the sense of generating enthusiasm in staff and in an unclear way to challenge anxiety or 'psychosis', despite a lack of, or contrary, evidence from the time. He has also been criticized for portraying psychiatrists as greedy and duped.
Healy is a founder and chief executive officer of Data Based Medicine Limited, which operates through its website RxISK.org, which aims to make medicines safer through "online direct patient reporting of drug effects". Healy sits on the Honorary International Editorial Advisory Board of the Mens Sana Monographs.
In 2020 Healy's book The Decapitation of Healthcare - A Short History of the Rise and Fall of Healthcare was published by Samizdat Health Writers' Co-operative, the first of a series.Ref Rxisk blog and David Healy Blog Feb 2020
Research interests
SSRI antidepressants and suicide
In an international review article, Healy (and Aldred) say that the idea that antidepressants might contribute to suicide in depressed patients was first raised in 1958. For 30 years antidepressants were primarily used in severely depressed and often hospitalised patients. The issue of suicidality on selective serotonin reuptake inhibitors (SSRIs) became one of public concern with reports in 1990 that Prozac could lead to suicidality in patients. Fourteen years later, warning labels were put on antidepressants suggesting particular difficulties "during the early phase of treatment, during treatment discontinuation, and when the dose of treatment is being changed, and that treatment related risks may be present in patients being treated for syndromes other than depression, such as anxiety or smoking cessation".
Healy has written many papers and presented many lectures on his view that all SSRI antidepressants – Prozac, Paxil and Zoloft – should show warning labels, as they could "trigger suicidal and violent behavior in some patients".
Conflict of interest
Healy says that the pharmaceutical industry has a pervasive influence on academic medicine. Most of the authors published in the Journal of the American Medical Association have received research funding from, or acted as a consultant for, a drug company. Major journals have expressed concern at the ghostwriting of and conflicting interests surrounding pharmacotherapeutic studies, especially in psychiatry.
Medical ghostwriting occurs when anonymous scribes with scientific backgrounds are paid to produce reports for publication as if written by better-known experts. Healy estimates that 50 per cent of literature on drugs is ghostwritten/abnormally written. This is an estimate by Healy offered under questioning before the UK House of Commons Health Select Committee investigation. It is based on extrapolation of a 57% figure from a published paper by Healy and Cattell reliant on hard evidence on a set of papers on Zoloft which came to light due to legal discovery, to the wider field of drug studies in top quality journals. In his thesis, Healy states that ghostwriters write on research given to them by drug companies, which want both positive results and positive research; therefore ghostwriting is biased from the beginning.
Healy allegedly encountered ghost writing involving Wyeth's SNRI Effexor. Healy attended a meeting promoting Effexor, and was offered for his approval a draft article that had been written for him. He left it intact, but made two additions. One contradicted Wyeth's claim that Effexor got patients fully well compared to patients on other SSRIs and another stated that SSRIs could make some individuals suicidal. The article had already been submitted to the Journal of Psychiatry and Neuroscience before Healy saw it again; both of his additions had been removed. In response Healy removed his name from the article.
In the preface of his book Let them Eat Prozac Healy describes the need for a "new contract between society and the pharmaceutical industry – a contract that will require access to the raw data". Healy suggests a new division that can manage the hazards that only becomes visible after products are launched. This new division would be separate from the regulatory bodies and pharmaceutical companies. In "Interface between authorship, industry and science in the domain of therapeutics" a paper of 2003 for The British Journal of Psychiatry, David Healy notes that
"The literature profiles and citation rates of industry-linked and non-industry-linked articles differ. The emerging style of authorship in industry-linked articles can deliver good-quality articles, but it raises concerns for the scientific base of therapeutics … If ghostwriting is an inevitable feature of modern scientific writing, the potential availability of the raw data would do more to ensure a correspondence between those data and a published end result than could be achieved by any other mechanism".
History of pharmacology
In his book 2012 Pharmageddon, Healy discusses the well-publicised birth defects crisis caused by thalidomide, a drug initially marketed as a sleeping pill. The 1962 disaster involved more than 10,000 children in 46 countries being born limbless and disabled. The United States Congress wanted to prevent a recurrence of such a tragedy, and sought to limit the marketing excesses of the pharmaceutical industry. So new drug development was rewarded with product rather than process patents, and new drugs were made available only through prescription. Also, new medications had to prove they worked through controlled trials before they reached the market. On the 50th anniversary of the 1962 FDA bill enacted by Congress, Pharmageddon argues that these arrangements have not been successful and have actually led to an escalating number of drug induced deaths and injuries. In the same book ("Pharmageddon" page 155), Healy states that in the United States, the country that makes the greatest use of the latest pharmaceuticals, life expectancy has been falling progressively further behind other developed countries since the mid-1970s.
Bibliography
Books
The Decapitation of Care - Samizdat Health Writer's Cooperative Inc, 2020 ISBN 978-1777056506
The Suspended Revolution: Psychiatry and Psychotherapy Re‑examined, Faber & Faber, London 1990.
Images of Trauma: From Hysteria to Post‑traumatic Stress Disorder. Faber & Faber, London, 1993.
Psychotropic Drug Development; Social, Economic and Pharmacological Aspects. Chapman and Hall, London 1996.
The Psychopharmacologists Volume 1, Chapman & Hall, London, 1996; Arnold, London, 2002
The Psychopharmacologists Volume 2. Chapman & Hall, London, 1998; Arnold, London 1999.
The Psychopharmacologists Volume 3. Arnold, London 2000.
The Antidepressant Era. Harvard University Press, 1997.
The Rise of Psychopharmacology & The Story of the CINP, Animula, Budapest, 1998.
The Triumph of Psychopharmacology & The CINP, Animula, Budapest, 2000.
From Psychopharmacology to Neuropsychopharmacology & The Story of the CINP, Animula, Budapest, 2002.
Reflections on Twentieth Century Psychopharmacology, Animula, Budapest, 2004.
The Creation of Psychopharmacology (Paperback 2004)
Let Them Eat Prozac: The Unhealthy Relationship Between the Pharmaceutical Industry and Depression New York University Press (2004)
Shock Therapy: A History of Electroconvulsive Treatment in Mental Illness. Rutgers University Press/ University of Toronto Press 2007.
Mania: A Short History of Bipolar Disorder Johns Hopkins University Press (Paperback 2010)
Psychiatric Drugs Explained Churchill Livingston (Paperback 5th ed. 2011)
Pharmageddon University of California Press(2012)
Selected articles
SSRI Antidepressants and suicide
, with response by Y Lapierre 340–349.
With Commentary by T Turner, 229–230.
Conflict of interest
Healy D (2004). Perspective. Manufacturing Consensus. Hasting Center Reports July–August, 53.
History of pharmacology
With Commentary by T Turner, 229–230.
Medication-induced sexual dysfunction
See also
Bad Pharma – book
Ben Goldacre
Deadly Medicines and Organised Crime – book
Irving Kirsch
John Ioannidis
Nancy Olivieri
Peter C. Gøtzsche
References
External links
David Healy's site to research and report drug side effects
David Healy's homepage
Is Academic Psychiatry for Sale? – debate between David Healy and Michael Thase published in the British Journal of Psychiatry
Let Them Eat Prozac Details about Healy's case and material on the link between SSRIs and suicide.
"They said it was safe" Guardian article on Healy's role in Forsyth case
Barry Yeoman, Putting Science in the Dock, The Nation
David Healy One Side of the Background to an Academic Freedom Dispute Academy for the Study of the Psychoanalytic Arts
Irish psychiatrists
People from Raheny
Irish non-fiction writers
Irish male non-fiction writers
Academics of Cardiff University
Living people
Bipolar disorder researchers
Place of birth missing (living people)
Psychiatry academics
Medical controversies in the United States
British pharmacologists
Psychopharmacologists
1954 births
Medical doctors from Dublin (city) | 0.761625 | 0.979755 | 0.746206 |
Writing therapy | Writing therapy is a form of expressive therapy that uses the act of writing and processing the written word in clinical interventions for healing and personal growth. Writing therapy posits that writing one's feelings gradually eases feelings of emotional trauma; studies have found this therapy primarily beneficial for alleviating stress caused by previously undisclosed adverse events and for those suffering from medical conditions associated with the immune system. Writing therapeutically can take place individually or in a group and can be administered in person with a therapist or remotely through mailing or the Internet.
The field of writing therapy includes many practitioners in a variety of settings, usually administered by a therapist or counselor. Writing group leaders also work in hospitals with patients dealing with mental and physical illnesses. In university departments, they aid student self-awareness and self-development. Online and distance interventions are useful for those who prefer to remain anonymous and/or are not ready to disclose their most private thoughts and anxieties in a face-to-face situation.
As with most forms of therapy, writing therapy is adapted and used to work with a wide range of psychoneurotic issues, including bereavement, desertion and abuse. Many interventions take the form of classes where clients write on specific themes chosen by the therapist or counselor. Assignments may include writing unsent letters to selected individuals, alive or dead, followed by imagined replies from the recipient, or a dialogue with the recovering alcoholic's bottle of alcohol.
Research
Expressive writing paradigm
Expressive writing is a form of writing therapy developed primarily by James W. Pennebaker in the late 1980s. The seminal expressive writing study instructed participants in the experimental group to write about a 'past trauma', expressing their very deepest thoughts and feelings surrounding it. In contrast, control participants were asked to write as objectively and factually as possible about neutral topics (e.g., a particular room or their plans for the day) without revealing their emotions or opinions. Both groups wrote continuously for 15 minutes per day for 4 consecutive days. If participants felt they could not write any more details, they were instructed to return to the beginning, potentially repeating what they wrote or writing it in a different manner.
The following text provides an example of writing instructions for expressive writing:
For the next 4 days, I would like you to write your very deepest thoughts and feelings about the most traumatic experience of your entire life or an extremely important emotional issue that has affected you and your life. In your writing, I'd like you to really let go and explore your deepest emotions and thoughts. You might tie your topic to your relationships with others, including parents, lovers, friends, or relatives; to your past, your present or your future; or to who you have been, who you would like to be or who you are now. You may write about the same general issues or experiences on all days of writing or about different topics each day. All of your writing will be completely confidential.
Don't worry about spelling, grammar or sentence structure. The only rule is that once you begin writing, you continue until the time is up.
Pennebaker and his team took several measurements before and after, but the most striking finding was that relative to the control group, the experimental group made significantly fewer visits to a physician in the following months. Although many reported being upset by the writing experience, they also found it valuable and meaningful.
Pennebaker has either written or co-written over 130 articles on expressive writing. One publication suggested expressive writing may boost the immune system, perhaps explaining the reduction in physician visits. This was shown by measuring lymphocyte response to the foreign mitogens phytohaemagglutinin (PHA) and concanavalin A (ConA) just prior to and six weeks after writing. The significantly increased lymphocyte response led to speculation that expressive writing enhances immunocompetence. The results of a preliminary study of 40 people diagnosed with Major Depressive Disorder suggests that routinely engaging in expressive writing may be effective in reducing symptoms of depression.
Reception and criticism of Pennebaker's expressive writing theories
Pennebaker's experiments have been widely replicated and validated. Following on from Pennebaker's original work, there has been a renewed interest in the therapeutic value of abreaction. This was first discussed by Josef Breuer and Freud in Studies on Hysteria but not much explored since. At the heart of Pennebaker's theory is the idea that actively inhibiting thoughts and feelings about traumatic events requires effort, serves as a cumulative stressor on the body, and is associated with increased physiological activity, obsessive thinking or ruminating about the event, and longer-term disease. However, as Baikie and Wilhelm note, the theory has intuitive appeal but mixed empirical support.Studies have shown that expressive writing results in significant improvements in various biochemical markers of physical and immune functioning (Pennebaker et al, 1988; Esterling et al, 1994; Petrie et al, 1995; Booth et al, 1997). This suggests that written disclosure may reduce the physiological stress on the body caused by inhibition, although it does not necessarily mean that disinhibition is the causal mechanism underlying these biological effects. On the other hand, participants writing about previously undisclosed traumas showed no differences in health outcomes from those writing about previously disclosed traumas (Greenberg & Stone, 1992) and participants writing about imaginary traumas that they had not actually experienced, and therefore could not have inhibited, also demonstrated significant improvements in physical health (Greenberg et al, 1996). Therefore, although inhibition may play a part, the observed benefits of writing are not entirely due to reductions in inhibition.In a 2013 article by Nazarian and Smyth, writing instructions for the expressive writing task was manipulated in that 6 conditions were created (i.e., cognitive processing, exposure, self-regulation, and benefit-finding, standard expressive writing and a control group). While salivary cortisol was measured for each condition, none of the conditions significantly influenced cortisol, but instructions did impact mood differentially depending on the condition. For example, the cognitive processing as measured post-intervention was influenced not only by the cognitive processing instructions but also, by exposure and benefit-finding. These results demonstrate a spillover effect from instructions to outcomes.
In related research, Travagin, Margola, Dennis, and Revenson compared cognitive-processing instructions to standard expressive writing for adolescents with peer problems. This research demonstrated better long-term social adjustment compared to standard expressive writing and greater increased positive affect for those adolescents who reported more peer problems than most.
Other theories related to writing therapy
An additional line of inquiry, which has particular bearing on the difference between talking and writing, derives from Robert Ornstein's studies into the bicameral structure of the brain. While noting that what follows should be considered "wildly hypothetical", L'Abate, quoting Ornstein, postulates that:
Julie Gray, founder of Stories Without Borders notes that "People who have experienced trauma in their lives, whether or not they consider themselves writers, can benefit from creating narratives out of their stories. It is helpful to write it down, in other words, in safety and in non-judgment. Trauma can be quite isolating. Those who have suffered need to understand how they feel and also to try to communicate that to others."
Clinical implications
Additional research since the 1980s has demonstrated that expressive writing may act as an agent to increase long-term health. Expressive writing can result in physiological, psychological, and biological outcomes, and is part of the emerging medical humanities field. Experiments demonstrate quantitative physiological readouts such as changes in immune counts, and blood pressure, in addition to qualitative readouts relating to psychiatric symptoms. Past attempts at implementing expressive writing interventions in clinical settings indicate that there are potential benefits for treatment plans. However, the specifics of such expressive writing procedures or protocols, and the populations most likely to benefit are not entirely clear.
Potential benefits of expressive writing
One of the most important aspects of expressive writing used in therapy is the short-term, and long-term effects on the individuals participating. Karen Baikie and Kay Wilhelm go into a brief description of the effects people will have after completing a therapeutic expressive writing session.
The short-term effects after utilizing this form of therapy are usually a quick span of feeling distressed or being in a negative mood. However, following up with clients after a longer amount of time to measure those effects finds evidence of many mental and physical health benefits.
These benefits include but are not limited to "reduced blood pressure, improved mood, reduced depressive symptoms, and fewer post-traumatic intrusion/avoidance symptoms."
This study also showed that these positive long-term emotional outcomes correlated to positive physical outcomes such as improved memory, improved performance at work, quicker re-employment, and many more. While the short-term effects of this therapeutic practice may seem daunting, they are just the stepping stones for individuals to begin a cycle of growth.
Potential benefits for cancer patients
Illness and disease are experienced on multiple different fronts: biological, psychological, and social. Recent research has explored how narrative medicine and expressive writing, independently, may play a therapeutic role in chronic diseases such as cancer. Comparisons in practice have been made between expressive writing and psychotherapy. Similarly, practices such as integrative, holistic, humanistic, or complementary medicine have already been incorporated into the field. Expressive writing is self-administered with minimal prompting. With further research and refinement, it may be used as a more cost-effective alternative to psychotherapy.
Recent experiments, systematic reviews, and meta-analyses examining the effects of expressive writing on ameliorating negative cancer symptoms yielded primarily non-significant initial results. However, analysis of sub-groups and moderating variables suggest that particular symptoms, or situations, may benefit some more than others with the implementation of an expressive writing intervention. For example, a review by Antoni and Dhabhar (2019) examined how psychosocial stress negatively impacts the immune response of patients with cancer. Even if an expressive writing intervention cannot directly impact cancer prognosis, it may play an important role in mediating factors such as chronic stress, trauma, depression, and anxiety.
Potential benefits for war trauma victims
It is widely acknowledged that trauma is prevalent among veterans, and research indicates that writing therapy can play a significant role in their self-healing journey. A primary contributor to trauma is the sense of powerlessness. Writing facilitates self-healing against this sense of helplessness through the strategy of mythologization.
Neil P Baird defines mythologization as the process of establishing standardized narratives that transform uncontrollable events into ones that are contained and predictable. Janis Haswell expands on this concept by highlighting how individuals can utilize writing to manipulate and reshape the traumatic events they have experienced. This allows them to convey the emotional truths of their pasts to not only themselves but to others through the words on a page.
Mark Bracher emphasizes the benefits of literacy in general for self-healing. His research indicates that literacy acknowledges the challenges veterans face during their deployment. This acknowledgement can in turn boost their morale and contribute to them feeling valued. Additionally, it aids in diminishing the recollection of distressing memories and reinforces one's sense of self-identity. Nancy Miller explores further the reinforcement of self-identity by examining Kim Phuc, a victim of napalm burns during the Vietnam War. In Kim's biographical memoir, she sought to transform her portrayal from that of a helpless child frightened by war into a tale of forgiveness. Her objective with her writing was to illustrate how she overcame her trauma from war through her deliberate effort to reshape her past with a more optimistic perspective.
Potential benefits for individuals recovering from addiction
Writing therapy may play a significant role in recovery for individuals with a substance use disorder. Writing exercises have been found to have the potential to improve those in addiction recovery the ability to cope with their conditions, and overall health.
Role of distance therapies
With the accessibility provided by the Internet, the reach of writing therapies has increased considerably, as clients and therapists can work together from anywhere in the world, provided they can write the same language. They simply "enter" into a private "chat room" and engage in an ongoing text dialogue in "real-time". Participants can also receive therapy sessions via e-text and/or voice with video, and complete online questionnaires, handouts, workout sheets, and similar exercises.
This requires the services of a counselor or therapist, albeit sitting at a computer. Given the huge disjunction between the amount of mental illness compared with the paucity of skilled resources, new ways have been sought to provide therapy other than drugs. In the more advanced societies pressure for cost-effective treatments, supported by evidence-based results, has come from both insurance companies and government agencies. Hence the decline in long-term intensive psychoanalysis and the rise of much briefer forms, such as cognitive therapy.
Via the Internet
Currently, the most widely used mode of Internet writing therapy is via e-mail (see analytic psychotherapist Nathan Field's paper "The Therapeutic Action of Writing in Self-Disclosure and Self-Expression"). It is asynchronous; i.e. messages are passed between therapist and client within an agreed time frame (for instance, one week), but at any time within that week. Where both parties remain anonymous the client benefits from the online disinhibition effect; that is to say, feels freer to disclose memories, thoughts, and feelings that they might withhold in a face-to-face situation. Both client and therapist have time for reflecting on the past and recapturing forgotten memories, time for privately processing their reactions and giving thought to their own responses. With e-therapy, space is eliminated, and time is expanded. Overall, it considerably reduces the amount of therapeutic input, as well as the speed and pressure that therapists habitually have to work under.
The anonymity and invisibility provides a therapeutic environment that comes much closer than classical analysis to Freud's ideal of the "analytic blank screen". Sitting behind the patient on the couch still leaves room for a multitude of clues to the analyst's individuality; e-therapy provides almost none. Whether distance and reciprocal anonymity reduces or increases the level of transference has yet to be investigated.
In a 2016 randomized controlled trial, expressive writing was tested against direction to an online support group for individuals with anxiety and depression. No difference between the groups was found. Both groups showed a moderate improvement over time but of a magnitude comparable to what one would expect to see over the time period concerned without intervention.
Journaling
The oldest and most widely practiced form of self-help through writing is that of keeping a personal journal or diary—as distinct from a diary or calendar of daily appointments—in which the writer records their most meaningful thoughts and feelings. One individual benefit is that the act of writing puts a powerful brake on the torment of endlessly repeating troubled thoughts to which everyone is prone. Kathleen Adams states that through the act of journal writing, the writer is also able to "literally [read] his or her own mind" and thus "to perceive experiences more clearly and thus feels a relief of tension".
Self-concealment
Self-disclosure
Reflective writing
Poetry
Poetry has been a very powerful form of writing for many and there are beneficial factors that correspond with writing and reading poetry. Alicia Ostriker explains how personal experience and memories, whether traumatic or repressed, can be tackled by the person through the artistic ability of writing and facing these emotions that have been neglected in order to release and ease a writer's pain. Robert Baden elaborates how poetry allows a wide range of emotions to be portrayed to describe the feeling or what the writer had felt within their experience to later allow others to engage and relate to their work. Baden expands this concept with the idea that no emotion is too grand or too small for poetry, which allows others to engage with the healing experience. Baden also points out that for there to be an act of healing and release between the emotions that have been held within the conscience, the writer must recognize that there must be a strong enough need to be vulnerable and willing to be able to confront these emotions and trust that the audience will then be able to relate and potentially make others want to use this written release within their own lives. Vasiliki Antzoulis believes that writers should be vulnerable because ignorance should never be the course of action when experiencing all kinds of emotions. Without the ability to talk about what the writer is experiencing, it becomes more difficult to understand what each of these emotions represents and how they affect the writer's current views of life.
Dale M. Bauer provides insight that poetry has the power to allow people to be able to talk about inner suffering without judgment and rather gain the ability to have others be able to compare and connect with the writer's experience. Bauer goes on to say that these experiences, no matter if they are good or bad, correspond with the human experience. Being able to have others relate to them allows the writer to feel supported and reflect on what has been shared and what they have obtained with this release and be able to begin healing. Veteran Writer, Liam Corley, healed significantly from his trauma through the means of poetry. By sharing this method with fellow veterans and examining its positive impacts, Corley’s research indicates the concise nature and inherent significance of poetry works greatly for self-healing. This is because poetry fulfills the crucial need for self-expression and assists in providing a voice to those who have felt silenced. James W. Pennebaker has discovered that "writing about trauma allows writers to externalize an event, thereby detaching themselves from the experience" (Writing to Heal 98). Pennebaker argues that once the writer can free themselves from what has been weighing them down, they are then able to begin healing and decide whether they are going to learn from the experience, or if it is something that has been long overdue for a release. Benjamin Batzer recognized that only the writer knows what they have gone through, so the first steps into healing and coping with what life has given, we must first be able to talk about these experiences to take back the power and decide the next point of action.
See also
Medical humanities
Graphic medicine
Narrative criticism
Storytelling
Narration
Slow medicine
Health humanities
Reflective writing
References
Further reading
Psychotherapy by type
therapy | 0.762397 | 0.978668 | 0.746133 |
Cultural humility | Cultural humility is the “ability to maintain an interpersonal stance that is other-oriented (or open to the other) in relation to aspects of cultural identity that are most important to the [person].” Cultural humility is different from other culturally-based training ideals because it focuses on self-humility rather than being an other-directed "they/them" way of achieving a state of knowledge or awareness. It is helpful to see as others see; what they themselves have determined is their personal expression of their heritage and their “personal culture”. Cultural humility was formed in the physical healthcare field and adapted for therapists, social workers, and medical librarians, to learn more about experiences and cultural identities of others and increase the quality of their interactions with clients and community members.
Background
To understand cultural humility, it is important to think about how culture is central in these interactions. The authors of the Culturally and Linguistically Appropriate Services (CLAS) standards explain the importance of culture in that “culture defines how health care information is received, how rights and protections are exercised, what is considered to be a health problem, how symptoms and concerns about the problem are expressed, who should provide treatment for the problem, and what type of treatment should be given. In sum, because health care is a cultural construct, arising from beliefs about the nature of disease and the human body, cultural issues are actually central in the delivery of health services treatment and preventative interventions.” Thus discovering and incorporating these differences help foster an environment that allows cultural humility to grow and take shape.
History
Cultural competence was an idea first promoted in the healthcare profession. Competence educational programs are aimed at preventing medical misdiagnoses and errors due to lack of cultural understanding. However, with the increasing diversity in the United States combined with an added cultural awareness, competence was not serving the needs of all medical professionals.
Cultural humility is a term coined by Melanie Tervalon and Jann Murray-Garcia in 1998 to describe a way of incorporating multiculturalism into their work as healthcare professionals. Replacing the idea of cultural competency, cultural humility was based on the idea of focusing on self-reflection and lifelong learning. Tervalon and Murray-Garcia believed that health care professionals were not receiving appropriate education or training in terms of multiculturalism, and developed a new method of approaching the topic.
Cultural humility in social work
Recently, the social work profession has begun adopting cultural humility into frameworks for service delivery and practice. Most cultural humility rhetoric focuses on interpersonal, individual micro practice social work in terms of worker/client relationships and culturally appropriate intervention procedures. However, social work posits cultural humility as a strong self-reflection tool for the worker. Most importantly, it encourages social workers to realize their own power, privilege and prejudices, and be willing to accept that acquired education and credentials alone are insufficient to address social inequality.
As such, this reflective practice, enables social workers to understand that the client is an expert in their own lives and that it is not the role of the worker to lean on their own understanding. In short, clients are the authority, not their service providers when it comes to lived experiences. Those who practice cultural humility view their clients as capable and work to understand their worldview and any oppression or discrimination that they may have experienced as well
In terms of the workplace of a social worker, supervisors should try to help workers to:
Normalize not knowing. Supervisors and managers should aim to instill in staff the understanding that it is not only okay to not know—it is a necessary condition for growth, central to the practice of cultural humility and good social work practice.
Create a culture-based client self-assessment tool. Workers need to offer clients a mechanism by which they can be seen and heard—an instrument such as this affords that opportunity. While clients have the right to refuse to complete it, practitioners can nonetheless remain vigilant and true in the practice of cultural humility.
In-service: A cultural self-identification workshop. Supervisors or program managers can lead an in-service style conversation where staff members self-report how they differ from the cultural stereotypes others may believe about them.
Cultural humility is a tool that can be utilized by both macro (community organizing, social policy, evaluation, management) and micro (therapy, interpersonal) to better connect with individuals and communities as well as to gain more insight into personal biases and identities. Cultural humility can lead to both personal and professional growth of a social worker.
The Code of Ethics from the National Association of Social Workers has no mention of cultural humility in its latest edition that was approved in 1996 and revised in 2008.
Cultural humility in Occupational Therapy
Occupational therapy is a client-centered health profession concerned with promoting health and wellbeing through occupation as defined by the World Federation of Occupational Therapists. The primary goal of occupational therapy is to enable people to participate in the activities of everyday life. Occupational therapists achieve this outcome by working with people and communities to enhance their ability to engage in the occupations they want to, need to, or are expected to do, or by modifying the occupation or the environment to better support their occupational engagement.
Cultural humility is an approach that emphasizes humble and empathetic communication with clients, with reduced reliance on bias or implicit assumptions. Occupational therapy practitioners strive to treat all people impartially, reduce bias, create diverse communities in which members can flourish and function, address conditions that hinder or cause harm to others, and protect and defend the rights of individuals. In the United States, the profession of occupational therapy is grounded in seven Core Values that include Equality and Justice. The AOTA (2015) Code of Ethics states that practitioners should “advocate for changes to systems and policies that are discriminatory or unfairly limit or prevent access to occupational therapy services”. Occupational therapy’s client-centered approaches distinctly focus on facilitating participation in meaningful occupations, and this outcome would not be possible without a commitment to diversity, equity, and inclusion. The profession of occupational therapy is resolute in its commitment to diversity, equity, and inclusion for its student bodies, workforce, and client populations and to advocacy for policies that lead to stronger, healthier, and more engaged communities.
Occupational Therapy Practitioners promote Cultural Humility when working with clients by:
Focusing on facilitating participation in meaningful occupations while providing collaborative help to their clients.
Providing equitable care that maximizes the health potential and quality of life for their clients by increasing their own self-awareness and knowing their personal bias.
Respecting the clients’ integrity beyond the practitioner's own prejudice.
Enquiring about client’s lived experiences rather than practitioner's own assumptions when determining best practice methods.
Building organizational support that demonstrates cultural humility as an important and ongoing aspect of the work itself
Although the concept of cultural competence provides a useful starting place; cultural competence optimized health care experiences of clients with various backgrounds while emphasizing the practice of awareness, knowledge, and skills, it is time to develop a more radical and nuanced position to working in a multicultural society. Both cultural competence and cultural humility are focused on increasing awareness of one’s skills and behaviors while working in multicultural situations. However, important differences exist. Cultural humility provides a more critical and effective approach to working with clients with diverse perspectives. This shift in practice has the potential to increase the effectiveness of health professionals, reduce health disparities that fall along cultural lines, and increase the relevance of occupational therapy as it develops globally.
See also
Cross cultural sensitivity
Social work
Occupational Therapy
References
Health care quality
Humility | 0.763515 | 0.977185 | 0.746095 |
Cognitive inertia | Cognitive inertia is the tendency for a particular orientation in how an individual thinks about an issue, belief, or strategy to resist change. Clinical and neuroscientific literature often defines it as a lack of motivation to generate distinct cognitive processes needed to attend to a problem or issue. The physics term inertia emphasizes the rigidity and resistance to change in the method of cognitive processing that has been used for a significant amount of time. Commonly confused with belief perseverance, cognitive inertia is the perseverance of how one interprets information, not the perseverance of the belief itself.
Cognitive inertia has been causally implicated in disregarding impending threats to one's health or environment, enduring political values and deficits in task switching. Interest in the phenomenon was primarily taken up by economic and industrial psychologists to explain resistance to change in brand loyalty, group brainstorming, and business strategies. In the clinical setting, cognitive inertia has been used as a diagnostic tool for neurodegenerative diseases, depression, and anxiety. Critics have stated that the term oversimplifies resistant thought processes and suggests a more integrative approach that involves motivation, emotion, and developmental factors.
History and methods
Early history
The idea of cognitive inertia has its roots in philosophical epistemology. Early allusions to a reduction of cognitive inertia can be found in the Socratic dialogues written by Plato. Socrates builds his argument by using the detractor's beliefs as the premise of his argument's conclusions. In doing so, Socrates reveals the detractor's fallacy of thought, inducing the detractor to change their mind or face the reality that their thought processes are contradictory. Ways to combat persistence of cognitive style are also seen in Aristotle's syllogistic method which employs logical consistency of the premises to convince an individual of the conclusion's validity.
At the beginning of the twentieth century, two of the earliest experimental psychologists, Müller and Pilzecker, defined perseveration of thought to be "the tendency of ideas, after once having entered consciousness, to rise freely again in consciousness". Müller described perseveration by illustrating his own inability to inhibit old cognitive strategies with a syllable-switching task, while his wife easily switched from one strategy to the next. One of the earliest personality researchers, W. Lankes, more broadly defined perseveration as "being confined to the cognitive side" and possibly "counteracted by strong will". These early ideas of perseveration were the precursor to how the term cognitive inertia would be used to study certain symptoms in patients with neurodegenerative disorders, rumination and depression.
Cognitive psychology
Originally proposed by William J. McGuire in 1960, the theory of cognitive inertia was built upon emergent theories in social psychology and cognitive psychology that centered around cognitive consistency, including Fritz Heider's balance theory and Leon Festinger's cognitive dissonance. McGuire used the term cognitive inertia to account for an initial resistance to change how an idea was processed after new information, that conflicted with the idea, had been acquired.
In McGuire's initial study involving cognitive inertia, participants gave their opinions of how probable they believed various topics to be. A week later, they returned to read messages related to the topics they had given their opinions on. The messages were presented as factual and were targeted to change the participants' belief in how probable the topics were. Immediately after reading the messages, and one week later, the participants were again assessed on how probable they believed the topics to be. Discomforted by the inconsistency of the related information from the messages and their initial ratings on the topics, McGuire believed the participants would be motivated to shift their probability ratings to be more consistent with the factual messages. However, the participants' opinions did not immediately shift toward the information presented in the messages. Instead, a shift towards consistency of thought on the information from the messages and topics grew stronger as time passed, often referred to as "seepage" of information. The lack of change was reasoned to be due to persistence in the individual's existing thought processes which inhibited their ability to re-evaluate their initial opinion properly, or as McGuire called it, cognitive inertia.
Probabilistic model
Although cognitive inertia was related to many of the consistency theories at the time of its conception, McGuire used a unique method of probability theory and logic to support his hypotheses on change and persistence in cognition. Utilizing a syllogistic framework, McGuire proposed that if three issues (a, b and c) were so interrelated that an individual's opinion were in complete support of issues a and b then it would follow their opinion on issue c would be supported as a logical conclusion. Furthermore, McGuire proposed if an individual's belief in the probability (p) of the supporting issues (a or b) was changed, then not only would the issue (c) explicitly stated change, but a related implicit issue (d) could be changed as well. More formally:
This formula was used by McGuire to show that the effect of a persuasive message on a related, but unmentioned, topic (d) took time to sink in. The assumption was that topic d was predicated on issues a and b, similar to issue c, so if the individual agreed with issue c then so too should they agree with issue d. However, in McGuire's initial study immediate measurement on issue d, after agreement on issues a, b and c, had only shifted half the amount that would be expected to be logically consistent. Follow-up a week later showed that shift in opinion on issue d had shifted enough to be logically consistent with issues a, b, and c, which not only supported the theory of cognitive consistency, but also the initial hurdle of cognitive inertia.
The model was based on probability to account for the idea that individuals do not necessarily assume every issue is 100% likely to happen, but instead there is a likelihood of an issue occurring and the individual's opinion on that likelihood will rest on the likelihood of other interrelated issues.
Examples
Public health
Historical
Group (cognitive) inertia, how a subset of individuals view and process an issue, can have detrimental effects on how emergent and existing issues are handled. In an effort to describe the almost lackadaisical attitude from a large majority of U.S. citizens toward the insurgence of the Spanish flu in 1918, historian Tom Dicke has proposed that cognitive inertia explains why many individuals did not take the flu seriously. At the time, most U.S. citizens were familiar with the seasonal flu. They viewed it as an irritation that was often easy to treat, infected few, and passed quickly with few complications and hardly ever a death. However, this way of thinking about the flu was detrimental to the need for preparation, prevention, and treatment of the Spanish flu due to its quick spread and virulent form until it was much too late, and it became one of the most deadly pandemics in history.
Contemporary
In the more modern period, there is an emerging position that anthropogenic climate change denial is a kind of cognitive inertia. Despite the evidence provided by scientific discovery, there are still those – including nations – who deny its incidence in favor of existing patterns of development.
Geography
To better understand how individuals store and integrate new knowledge with existing knowledge, Friedman and Brown tested participants on where they believed countries and cities to be located latitudinally and then, after giving them the correct information, tested them again on different cities and countries. The majority of participants were able to use the correct information to update their cognitive understanding of geographical locations and place the new locations closer to their correct latitudinal location, which supported the idea that new knowledge affects not only the direct information but also related information. However, there was a small effect of cognitive inertia as some areas were unaffected by the correct information, which the researchers suggested was due to a lack of knowledge linkage in the correct information and new locations presented.
Group membership
Politics
The persistence of political group membership and ideology is suggested to be due to the inertia of how the individual has perceived the grouping of ideas over time. The individual may accept that something counter to their perspective is true, but it may not be enough to tip the balance of how they process the entirety of the subject.
Governmental organizations can often be resistant or glacially slow to change along with social and technological transformation. Even when evidence of malfunction is clear, institutional inertia can persist. Political scientist Francis Fukuyama has asserted that humans imbue intrinsic value on the rules they enact and follow, especially in the larger societal institutions that create order and stability. Despite rapid social change and increasing institutional problems, the value placed on an institution and its rules can mask how well an institution is functioning as well as how that institution could be improved. The inability to change an institutional mindset is supported by the theory of punctuated equilibrium, long periods of deleterious governmental policies punctuated by moments of civil unrest. After decades of economic decline, the United Kingdom's referendum to leave the EU was seen as an example of the dramatic movement after a long period of governmental inertia.
Interpersonal roles
The unwavering views of the roles people play in our lives have been suggested as a form of cognitive inertia. When asked how they would feel about a classmate marrying their mother or father, many students said they could not view their classmate as a step-father/mother. Some students went so far as to say that the hypothetical relationship felt like incest.
Role inertia has also been implicated in marriage and the likelihood of divorce. Research on couples who cohabit together before marriage shows they are more likely to get divorced than those who do not. The effect is most seen in a subset of couples who cohabit without first being transparent about future expectations of marriage. Over time, cognitive role inertia takes over, and the couple marries without fully processing the decision, often with one or both of the partners not fully committed to the idea. The lack of deliberative processing of existing problems and levels of commitment in the relationship can lead to increased stress, arguments, dissatisfaction, and divorce.
In business
Cognitive inertia is regularly referenced in business and management to refer to consumers' continued use of products, a lack of novel ideas in group brainstorming sessions, and lack of change in competitive strategies.
Brand loyalty
Gaining and retaining new customers is essential to whether a business succeeds early on. To assess a service, product, or likelihood of customer retention, many companies will invite their customers to complete satisfaction surveys immediately after purchasing a product or service. However, unless the satisfaction survey is completed immediately after the point of purchase, the customer response is often based on an existing mindset about the company, not the actual quality of experience. Unless the product or service is extremely negative or positive, cognitive inertia related to how the customer feels about the company will not be inhibited, even when the product or service is substandard. These satisfaction surveys can lack the information businesses need to improve a service or product that will allow them to survive against the competition.
Brainstorming
Cognitive inertia plays a role in why a lack of ideas is generated during group brainstorming sessions. Individuals in a group will often follow an idea trajectory, in which they continue to narrow in on ideas based on the very first idea proposed in the brainstorming session. This idea trajectory inhibits the creation of new ideas central to the group's initial formation.
In an effort to combat cognitive inertia in group brainstorming, researchers had business students either use a single-dialogue or multiple-dialogue approach to brainstorming. In the single dialogue version, the business students all listed their ideas. They created a dialogue around the list, whereas, in the multi-dialogue version, ideas were placed in subgroups that individuals could choose to enter and talk about and then freely move to another subgroup. The multi-dialogue approach was able to combat cognitive inertia by allowing different ideas to be generated in sub-groups simultaneously and each time an individual switched to a different sub-group, they had to change how they were processing the ideas, which led to more novel and high-quality ideas.
Competitive strategies
Adapting cognitive strategies to changing business climates is often integral to whether or not a business succeeds or fails during economic stress. In the late 1980s in the UK, real estate agents' cognitive competitive strategies did not shift with signs of an increasingly depressed real estate market, despite their ability to acknowledge the signs of decline. This cognitive inertia at the individual and corporate level has been proposed as reasons to why companies do not adopt new strategies to combat the ever-increasing decline in the business or take advantage of the potential. General Mills' continued operation of mills long after they were no longer necessary is an example of when companies refuse to change the mindset of how they should operate.
More famously, cognitive inertia in upper management at Polaroid was proposed as one of the main contributing factors to the company's outdated competitive strategy. Management strongly held that consumers wanted high-quality physical copies of their photos, where the company would make their money. Despite Polaroid's extensive research and development into the digital market, their inability to refocus their strategy to hardware sales instead of film eventually led to their collapse.
Scenario planning has been one suggestion to combat cognitive inertia when making strategic decisions to improve business. Individuals develop different strategies and outline how the scenario could play out, considering different ways it could go. Scenario planning allows for diverse ideas to be heard and the breadth of each scenario, which can help combat relying on existing methods and thinking alternatives is unrealistic.
Management
In a recent review of company archetypes that lead to corporate failure, Habersang, Küberling, Reihlen, and Seckler defined "the laggard" as one who rests on the laurels of the company, believing past success and recognition will shield them from failure. Instead of adapting to changes in the market, "the laggard" assumes that the same strategies that won the company success in the past will do the same in the future. This lag in changing how they think about the company can lead to rigidity in company identity, like Polaroid, conflict in adapting when the sales plummet, and resource rigidity. In the case of Kodak, instead of reallocating money to a new product or service strategy, they cut production costs and imitation of competitors, both leading to poorer quality products and eventually bankruptcy.
A review of 27 firms integrating the use of big data analytics found cognitive inertia to hamper the widespread implementation, with managers from sectors that did not focus on digital technology seeing the change as unnecessary and cost prohibitive.
Managers with high cognitive flexibility that can change the type of cognitive processing based on the situation at hand are often the most successful in solving novel problems and keeping up with changing circumstances. Interestingly, shifts in mental models (disrupting cognitive inertia) during a company crisis are frequently at the lower group level, with leaders coming to a consensus with the rest of the workforce in how to process and deal with the crisis, instead of vice versa. It is proposed that leaders can be blinded by their authority and too easily disregard those at the front-line of the problem causing them to reject remunerative ideas.
Applications
Therapy
An inability to change how one thinks about a situation has been implicated as one of the causes of depression. Rumination, or the perseverance of negative thoughts, is often correlated with the severity of depression and anxiety. Individuals with high levels of rumination test low on scales of cognitive flexibility and have trouble shifting how they think about a problem or issue even when presented with facts that counter their thinking process.
In a review paper that outlined strategies that are effective for combating depression, the Socratic method was suggested to overcome cognitive inertia. By presenting the patient's incoherent beliefs close together and evaluating with the patient their thought processes behind those beliefs, the therapist is able to help them understand things from a different perspective.
Clinical diagnostics
In nosological literature relating to the symptom or disorder of apathy, clinicians have used cognitive inertia as one of the three main criteria for diagnosis. The description of cognitive inertia differs from its use in cognitive and industrial psychology in that lack of motivation plays a key role. As a clinical diagnostic criterion, Thant and Yager described it as "impaired abilities to elaborate and sustain goals and plans of actions, to shift mental sets, and to use working memory". This definition of apathy is frequently applied to onset of apathy due to neurodegenerative disorders such as Alzheimer's and Parkinson's disease but has also been applied to individuals who have gone through extreme trauma or abuse.
Neural anatomy and correlates
Cortical
Cognitive inertia has been linked to decreased use of executive function, primarily in the prefrontal cortex, which aids in the flexibility of cognitive processes when switching tasks. Delayed response on the implicit associations task (IAT) and Stroop task have been related to an inability to combat cognitive inertia, as participants struggle to switch from one cognitive rule to the next to get the questions right.
Before taking part in an electronic brainstorming session, participants were primed with pictures that motivated achievement to combat cognitive inertia. In the achievement-primed condition, subjects were able to produce more novel, high-quality ideas. They used more right frontal cortical areas related to decision-making and creativity.
Cognitive inertia is a critical dimension of clinical apathy, described as a lack of motivation to elaborate plans for goal-directed behavior or automated processing. Parkinson's patients whose apathy was measured using the cognitive inertia dimension showed less executive function control than Parkinson's patients without apathy, possibly suggesting more damage to the frontal cortex. Additionally, more damage to the basal ganglia in Parkinson's, Huntington's and other neurodegenerative disorders have been found with patients exhibiting cognitive inertia in relation to apathy when compared to those who do not exhibit apathy. Patients with lesions to the dorsolateral prefrontal cortex have shown reduced motivation to change cognitive strategies and how they view situations, similar to individuals who experience apathy and cognitive inertia after severe or long-term trauma.
Functional connectivity
Nursing home patients who have dementia have been found to have larger reductions in functional brain connectivity, primarily in the corpus callosum, important for communication between hemispheres. Cognitive inertia in neurodegenerative patients has also been associated with a decrease in the connection of the dorsolateral prefrontal cortex and posterior parietal area with subcortical areas, including the anterior cingulate cortex and basal ganglia. Both findings are suggested to decrease motivation to change one's thought processes or create new goal-directed behavior.
Alternative theories
Some researchers have refuted the cognitive perspective of cognitive inertia and suggest a more holistic approach that considers the motivations, emotions, and attitudes that fortify the existing frame of reference.
Alternative paradigms
Motivated reasoning
The theory of motivated reasoning is proposed to be driven by the individual's motivation to think a certain way, often to avoid thinking negatively about oneself. The individual's own cognitive and emotional biases are commonly used to justify a thought, belief, or behavior. Unlike cognitive inertia, where an individual's orientation in processing information remains unchanged either due to new information not being fully absorbed or being blocked by a cognitive bias, motivated reasoning may change the orientation or keep it the same depending on whether that orientation benefits the individual.
In an extensive online study, participant opinions were acquired after two readings about various political issues to assess the role of cognitive inertia. The participants gave their opinions after the first reading and were then assigned a second reading with new information; after being assigned to read more information on the issue that either confirmed or disconfirmed their initial opinion, the majority of participants' opinions did not change. When asked about the information in the second reading, those who did not change their opinion evaluated the information that supported their initial opinion as stronger than information that disconfirmed their initial opinion. The persistence in how the participants viewed the incoming information was based on their motivation to be correct in their initial opinion, not the persistence of an existing cognitive perspective.
Socio-cognitive inflexibility
From a social psychology perspective, individuals continually shape beliefs and attitudes about the world based on interaction with others. What information the individual attends to is based on prior experience and knowledge of the world. Cognitive inertia is seen not just as a malfunction in updating how information is being processed but as the assumptions about the world and how it works can impede cognitive flexibility. The persistence of the idea of the nuclear family has been proposed as a socio-cognitive inertia. Despite the changing trends in family structure, including multi-generational, single-parent, blended, and same-sex parent families, the normative idea of a family has centered around the mid-twentieth century idea of a nuclear family (i.e., mother, father, and children). Various social influences are proposed to maintain the inertia of this viewpoint, including media portrayals, the persistence of working-class gender roles, unchanged domestic roles despite working mothers, and familial pressure to conform.
The phenomenon of cognitive inertia in brainstorming groups has been argued to be due to other psychological effects such as fear of disagreeing with an authority figure in the group, fear of new ideas being rejected and the majority of speech being attributed to the minority group members. Internet-based brainstorming groups have been found to produce more ideas of high-quality because it overcomes the problem of speaking up and fear of idea rejection.
See also
References
Cognitive psychology
Heuristics
Management
Behavioral economics | 0.768 | 0.971426 | 0.746056 |
Number needed to harm | In medicine, the number needed to harm (NNH) is an epidemiological measure that indicates how many persons on average need to be exposed to a risk factor over a specific period to cause harm in an average of one person who would not otherwise have been harmed. It is defined as the inverse of the absolute risk increase, and computed as , where is the incidence in the treated (exposed) group, and is the incidence in the control (unexposed) group. Intuitively, the lower the number needed to harm, the worse the risk factor, with 1 meaning that every exposed person is harmed.
NNH is similar to number needed to treat (NNT), where NNT usually refers to a positive therapeutic result and NNH to a detrimental effect or risk factor.
Marginal metrics:
NNT for an additional beneficial outcome (NNTB)
NNT for an additional harmful outcome (NNTH)
are also used.
Relevance
The NNH is an important measure in evidence-based medicine and helps physicians decide whether it is prudent to proceed with a particular treatment which may expose the patient to harms while providing therapeutic benefits. If a clinical endpoint is devastating enough without the drug (e.g. death, heart attack), drugs with a low NNH may still be indicated in particular situations if the NNT is smaller than the NNH. However, there are several important problems with the NNH, involving bias and lack of reliable confidence intervals, as well as difficulties in excluding the possibility of no difference between two treatments or groups.
Numerical example
See also
Pharmacoeconomics
References
Drug discovery
Epidemiology
Evidence-based medicine
Medical statistics | 0.760484 | 0.981026 | 0.746055 |
Employability | Employability refers to the attributes of a person that make that person able to gain and maintain employment.
Overview
Employability is related to work and the ability to be employed, such as:
The ability to gain initial employment; hence the interest in ensuring that 'key competencies', careers advice and an understanding about the world of work are embedded in the education system
The ability to maintain employment and make 'transitions' between jobs and roles within the same organization to meet new job requirements
The ability to obtain new employment if required, i.e. to be independent in the labour market by being willing and able to manage their own employment transitions between and within organisations (Van der Heijde and Van der Heijden (2005) The continuously fulfilling, acquiring or creating of work through the optimal use of efforts)
Lee Harvey defines employability as the ability of a graduate to get a satisfying job, stating that job acquisition should not be prioritized over preparedness for employment to avoid pseudo measure of individual employability.
Lee argues that employability is not a set of skills but a range of experiences and attributes developed through higher-level learning, thus employability is not a "product' but a process of learning.
Employability continues to develop because the graduate, once employed, does not stop learning (i.e. continuous learning). Thus employability by this definition is about learning, not least learning how to learn, and it is about empowering learners as critical reflective citizens. Harvey‘s (2001) definition is important for it emphasizes the employability of graduates, which is similar to our context, hence, able to provide insight about how to measure graduates' employability and what are the differences between graduates and experienced individuals in the labor market.
There are numerous terms for employability skills, they are often used interchangeably with terms such as soft skills, generic skills, 21st century skills, generic attributes, transferable skills, generic competencies and holistic competencies. Chan at the University of Hong Kong uses holistic competencies as an umbrella term inclusive of different types of generic skills (e.g. critical thinking, problem-solving skills, positive values, and attitudes (e.g. resilience, appreciation for others) which are essential for students’ life-long learning and whole-person development (Chan, Fong, Luk, & Ho, 2017; Chan & Yeung, 2019). In order to understand how holistic competencies should be developed based on student perception, the Holistic Competency Development Framework (HCDF) was developed (Chan & Yeung, 2019). The HCDF consists of five key components that are fundamental to holistic competency development: 1) student characteristics; 2) rationale for learning; 3) students’ actual learning experience and perceptions and interpretations based on that experience; 4) students’ approaches to developing holistic competency; and 5) students’ development of holistic competency as outcomes. The HCDF is an adaption of Bigg's 3P Student Approach to Learn model (1987). Chan realised that traditional learning processes such as the 3P model do not apply to soft skills development because students who are deep learners in the academic context do not necessarily become deep learners in soft skills education. Thus, the words ‘deep’ and ‘surface’ with respect to academic knowledge are unsuitable in the soft skills context. Accordingly, a new term was coined, Approach to Develop, for conceptualising student engagement in experiential learning leading to the development of holistic competencies. Unlike academic knowledge, holistic competencies must be developed by experience. As an illustration, leadership skills cannot be learnt by reading a book; the learner must have opportunities to observe and experience what leadership is. Hence, the word ‘learn’ can be used to describe academic knowledge acquisition, whilst ‘develop’ is preferable for describing holistic competency education. Validated instruments for assessing student's holistic competencies awareness have been developed (Chan, Zhao & Luk, 2017; Chan & Luk, 2020) although the assessment literacy of competency for both teachers and students remains challenging (Chan & Luo, 2020).
Berntson (2008) argues that employability refers to an individual's perception of his or her possibilities of getting new, equal, or better employment. Berntson's study differentiates employability into two main categories – actual employability (objective employability) and perceived employability (subjective employability).
Research into employability is not a single cohesive body work. Employability is investigated in the fields of industrial and organizational psychology, career development, industrial sociology, and the sociology of education, among others. Several employability definitions have been developed based on, or including input from business and industry. In the United States, an Employability Skills Framework was developed through a collaboration of employers, educators, human resources associations, and labour market associations. This framework states, "Employability skills are general skills that are necessary for success in the labor market at all employment levels and in all sectors". After conducting research with employers across Canada, the Conference Board of Canada released Employability Skills 2000+, which defines employability as "the skills you need to enter, stay in, and progress in the world of work". Saunders & Zuzel (2010) found that employers valued personal qualities such as dependability and enthusiasm over subject knowledge and ability to negotiate.
In relation to freelance or ad hoc work
In the future fewer will be employed and more people work as free lancers or ad hoc on projects. Robin Chase, co-founder of Zip Car, argues that in the future more work will be done as freelancers or ad hoc works. Collaborative economy and other similar platforms are reinventing capitalism, for example platforms like Freelancer.com, a new way of organizing demand and supply.
Freelancer is also an example of how employability can be developed even for people who are not employed – Freelancers offers exposure of certification and in the future similar platforms will also offer continuous upgrade of competencies for the people associated.
In relation to university degree choice
The Complete University Guide website (based in London within the United Kingdom) lists the ten most employable degree subjects, indicating the degree of employability with a percentage (of graduates exiting university who subsequently obtain employment). The subject with the most employment is dentistry, the subjects with ordinately less employment, after the 1st most are as follows; nursing, veterinary medicine, medicine, physiotherapy, medical technology, optometry ophthalmology orthoptics, occupational therapy, land and property management, aural and oral sciences.
Graduate employability, focused on the ways in which higher education equips graduates to meet the needs of the labour market, has become a central feature of universities' missions and branding, and is included in university league tables such as the QS World University Rankings. Universities' have pursued a range of strategies to support their graduates' employability, and graduate employability researchers have considered a number of models based on various kinds of human capital, dispositions, and psycho-social influences.
Experiential learning and its influences on employability
Experiential learning is "the process whereby knowledge is created through the transformation of experience. Knowledge results from the combination of grasping and transforming experience." But "(e)xperience needs to be integrated into formal learning, intentionally and systematically, to enhance academic study." Internships have been found to have a positive influence on employability skills development from both an employer and student perspective.
Organizational issues
Employability creates organizational issues, because future competency needs may require re-organization in many ways. The increasing automation and use of technology also makes it relevant to discuss not only change but also transformation in tasks for people. The issues are relevant at government level, at corporate level and for individuals.
See also
Adult education
Education
Life skills
Literacy
Study skills
Vocational training
References
Further reading
Books
Signing up for competitive advantage: how signature processes beat best practice. With Gratton, L. London: Advanced Institute of Management Research, 2006
A bias for action: how effective managers harness their willpower, achieve results and stop wasting time. With Bruch, H. Boston, MA: Harvard Business School Press, 2004. London Reference Collections shelfmark: YK.2007.a.10796
Transnational management: text, cases, and readings in crossborder management. London: McGraw-Hill, 2000
Managing across borders. 2nd ed. London, Hutchinson Business, 1998
The individualized corporation: a fundamentally new approach to management. With Bartlett, C. London, Heinemann, 1998
The differentiated network. With Bartlett, C. Los Angeles CA: JosseyBass, 1997
An integrative theory of firm growth implications for corporate organization and management. With Hahn, M. & Moran, P. Fontainebleau: INSEAD, 1997
Management competence, firm growth, and economic progress. With Hahn, M. & Moran, P. Fontainebleau: INSEAD, 1997
Brown, P. and Hesketh, A. (2004) The Mismanagement of Talent: Employability and Jobs in the Knowledge Economy. Oxford, Oxford University Press.
Hind, D. and Moss, S. (2011) Employability Skills. 2nd Edition. Sunderland, Business Education Publishers.
Schneider, K. and Otto, H-U. (2009) From Employability Towards Capability. Luxembourg.
Journal articles
Professional Manager. May 2000, pp. 20–23 Leadership by Ghoshal! (Interview with Sumantra Ghoshal)
Employability Skills Framework". Perkins Collaborative Resource Network. Retrieved 31 October 2014.
"Employability Skills 2000+". Conference Board of Canada. Retrieved 31 October 2014.
Employment | 0.763988 | 0.976462 | 0.746005 |
Narrative exposure therapy | Narrative Exposure Therapy (NET) is a short-term psychotherapy used for the treatment of post-traumatic stress disorder and other trauma-related mental disorders. It creates a written account of the traumatic experiences of a patient or group of patients, with the aim of recapturing self-respect and acknowledging the patient's value. NET is an individual treatment, NETfacts is a format for communities. Narrative Exposure Therapy is a subtype of Written Exposure Therapy.
NET was created in Germany in the early 2000s.
Key elements
Lifeline
NET is conducted around the use of the lifeline, which serves as a reference point for both the therapist and the patient during the therapy.
Creating a lifeline occurs during the first session A lifeline is a physical representation of one's life; therefore, different symbols are used to reconstitute the patient's lifeline, especially flowers and stones. Flowers represent good/positive events, whereas stones represent the bad/negative events of the patient's life. Symbols' size, shape, and color may also be used to indicate events with greater or lesser intensity or significance. It is up to the patient to decide on placing and choosing these symbols to reconstitute their lifeline. The largest stones are then chosen to be dealt with since they represent the greatest traumas the patient needs to reprocess or overcome. Building a lifeline can also help strengthen the therapeutic relationship and create an estimation of the number of sessions a patient may need.
Narration
Narrations are a product of the therapy. In the end of a therapy, the narration is read and given to the patient. It is supposed to be a representative summary of the patient's life, even including some details. Narrations are expected to be taken by the patient to help them overcome their trauma and mental problems. Narrations are helpful for the patient to re-process their memories of the past, particularly the trauma, and reorganize their thoughts; which should ultimately reduce the recurrence of bad memories that are responsible for the suffering of to the patient.
Adaptations
NET: aimed at a general public
KidNET: aimed at children and adolescents
FORNET: aimed at perpetrators
Efficacy
Studies have shown NET to reduce symptoms of post-traumatic stress disorder and depression, but few comparisons have been made to other available treatments.
It is conditionally recommended for treatment of PTSD by the American Psychological Association.
See also
Cognitive behavioral therapy
Psychological trauma
Exposure therapy
References cited
External links
Narrative Exposure Therapy NET Training Seminars, NET The Institute www.net-institute.org
Psychotherapy by type
Stress-related disorders | 0.770744 | 0.967888 | 0.745994 |
Allen Frances | Allen J. Frances (born 2 October 1942) is an American psychiatrist. He is currently Professor and Chairman Emeritus of the Department of Psychiatry and Behavioral Sciences at Duke University School of Medicine. He is best known for serving as chair of the American Psychiatric Association task force overseeing the development and revision of the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). Frances is the founding editor of two well-known psychiatric journals: the Journal of Personality Disorders and the Journal of Psychiatric Practice.
During the development of the current diagnostic manual, DSM-5, Frances became critical of the expanding boundaries of psychiatry and the medicalization of normal human behavior, problems he contends are leading to the overdiagnosis and overtreatment of the "worried well" and the gross undertreatment of the severely ill. In recent years, Frances has become a vocal advocate for improved treatment and societal conditions for the seriously mentally ill, the appropriate use of electroconvulsive therapy in severe cases of mental disorder, and an integrated, biopsychosocial approach to psychiatry.
Frances is the author or co-author of multiple books within the fields of psychiatry and psychology, including: Differential Therapeutics (1984), Your Mental Health (1999), Saving Normal (2013), Essentials of Psychiatric Diagnosis (2013), and Twilight of American Sanity (2017).
Education and career
Education
Frances was born and raised in New York City, US. He received his bachelor's degree from Columbia College in 1963 and his medical degree in 1967 from SUNY Downstate College of Medicine. He graduated from the psychiatry residency training program at the New York State Psychiatric Institute in 1971 and received a certificate in psychoanalytic medicine from Columbia University Center for Psychoanalytic Training and Research in 1978. His research in the fields of psychiatry and behavioral sciences focused on schizophrenia, personality disorders, anxiety disorders, mood disorders, and clinical treatment of psychiatric patients.
Career
Frances' early career was spent at Cornell University Medical College, where he rose to the rank of professor, headed the outpatient department, saw patients, taught, established a brief therapy program, and developed research specialty clinics for schizophrenia, depression, anxiety disorders, and AIDS. Throughout his academic career, Frances was an active investigator and prolific author in a surprisingly wide range of clinical areas including personality disorders, chronic depression, anxiety disorders, schizophrenia, AIDS, and psychotherapy. In 1991, he became chairman of the Department of Psychiatry at Duke University School of Medicine, where he helped to expand the research, training, and clinical programs that had been initiated by his predecessor as chair, Dr. Bernard Carroll.
Research
Frances had originally viewed himself as a teacher and clinician but his administrative posts—as director of an outpatient department, chair of a psychiatry department, and chair of the DSM-IV Task Force—thrust him into more of a research role. He was an early organizer of outpatient services based on a given psychiatric disorder, providing expert clinical services and enriched research environments. In all, Frances received a dozen research grants as principal or co-principal investigator, most from the National Institute of Mental Health and published extensively on personality disorders, chronic depression, schizophrenia, anxiety disorders, the psychiatric aspects of AIDS, and various aspects of psychiatric diagnosis. He also mentored the careers of many other researchers.
Publications
Frances' book on Differential Therapeutics (1984) tried to bring specificity and evidence to decisions on how best to match patient and treatment. His recognition of therapeutic limits resulted in the 1981 paper No Treatment as the Prescription of Choice. Frances was the founding editor of two journals that have become standards: The Journal of Personality Disorders and the Journal of Psychiatric Practice.
In 2013, Allen Frances wrote a paper entitled "The New Crisis of Confidence in Psychiatric Diagnosis", which said that "psychiatric diagnosis still relies exclusively on fallible subjective judgments rather than objective biological tests". Frances was also concerned about "unpredictable overdiagnosis".
The Diagnostic and Statistical Manual of Mental Disorders
DSM-III
Robert Spitzer, later the major force behind DSM-III, was one of Frances' teachers during his psychiatric residency at Columbia University and attempted to recruit him to participate in his research developing standardized criteria for mental disorders and interviewing instruments for diagnostic assessment. Frances declined the offer because he felt psychiatric treatment was much more interesting than psychiatric classification. Ten years later, in 1977, Spitzer attempted to recruit Frances again, this time to join his work on DSM-III. Frances accepted and was given three roles. He wrote the final draft of the personality disorders section of DSM-III; served as DSM-III liaison to the American Psychoanalytic Association and the Academy of Psychoanalysts; and he was a member of the team that delivered DSM-III educational conferences across the country. He wrote a number of papers on the uses and misuses of DSM-III and predicted DSM would eventually adopt a dimensional model of personality disorder diagnosis.
DSM-IV
Frances was appointed Chair of the DSM-IV Task Force in 1987. His selection followed his role as one of the major advisors for DSM-IIIR and reflected concerns within the American Psychiatric Association that new disorders were being added without sufficient evidence and that definitions of existing disorders were too loose. Frances was known as a diagnostic conservative who would promote stability in the system and discourage its rapid expansion across the fuzzy boundary into normality. He introduced a thorough three-stage vetting system to discourage diagnostic exuberance in DSM-IV: 1.) a thorough review of the existing literature had to produce compelling evidence in support of the suggested change; 2.) funding from the MacArthur Foundation allowed dozens of reanalyses of unpublished data sets to help answer questions pertinent to DSM-IV changes; and 3.) NIMH funding allowed for 11 field trials assessing how proposed changes would translate into clinical practice. The conservatism seemed to work. Of the 94 new diagnoses suggested for DSM-IV, only two were accepted: Asperger's syndrome and bipolar II disorder. Both had good supporting literature and both had performed well in field trials. However, Frances argued that any change in DSM-IV that could be misused, would be misused, and both changes led to unfortunate fads of wild overdiagnosis. Frances argues that there was also a fad of attention deficit/hyperactivity disorder partly due to loosened diagnostic criteria but mostly due to pharmaceutical company marketing.
DSM-5
The next revision DSM-5 was initiated with a 2002 book (A Research Agenda for DSM-V) questioning the utility of the atheoretical, descriptive paradigm and suggesting a neuroscience research agenda aiming to develop a pathophysiologically based classification. After a series of symposiums, the task force began to work on the manual itself. In June 2008, Dr. Robert Spitzer who chaired the DSM-III and DSM-IIIR revisions had begun to write about the secrecy of the DSM-V Task Force (DSM-V: Open and Transparent?). Frances initially declined to join Spitzer's criticism, but after learning about the changes being considered, he wrote an article in July 2009 (A Warning Sign on the Road to DSM-V: Beware of Its Unintended Consequences) expressing multiple concerns including the unsupported paradigm shift, a failure to specify the level of empirical support needed for changes, their lack of openness, their ignoring the negative consequences of their proposals, a failure to meet timelines, and anticipate the coming time pressures. The APA/DSM-V Task Force response dismissed his complaints.
In March 2010, Frances began a weekly blog in Psychology Today, DSM-5 in Distress: The DSM's impact on mental health practice and research, often cross-posted in the Psychiatric Times and the Huffington Post. While many of his blog posts were about the DSM-5 Task Force lowering the thresholds for diagnosing existing disorders (attention deficit disorder, autism, addictions, personality disorders, bipolar II disorder), he was also disturbed by the addition of new speculative disorders (Attenuated Psychosis Syndrome, Disruptive Mood Dysregulation Disorder, Somatic Symptom Disorder). He has argued that the diagnosis attenuated psychosis syndrome promoted by advocates of early intervention for psychosis, such as Australian psychiatrist Patrick McGorry, is risky because of a high rate of inaccuracy, the potential to stigmatize young people given this label, the lack of any effective treatment, and the risk of children and adolescents being given dangerous antipsychotic medication. The elimination of the bereavement exclusion from the diagnosis of major depressive disorder was another particular concern, threatening to label normal grief as a mental illness.
So while the task force was focusing on early detection and treatment, Frances cautioned about diagnostic inflation, overmedication, and crossing the boundary of normality. Besides the original complaint that the DSM-5 Task Force was a closed process, Frances pointed out that they were behind schedule and even with a one-year postponement, they had to drop a follow-up quality control step. He recommended further postponement and advocated asking an outside body to review their work to make suggestions. While the American Psychiatric Association did have an internal review, they rejected his suggestion of an external consultation. When the field testing for inter-rater reliability was released in May 2012, several of the more contested disorders were eliminated as unreliable (attenuated psychosis syndrome, mixed anxiety depression) and the reliabilities were generally disappointing. The APA Board of Trustees eliminated a complex "Cross-Cutting" Dimensional System, but many of the contested areas remained when the document was approved for printing in December 2012 for a scheduled release in May 2013. There were widespread threats of a boycott.
Frances's writings were joined by a general criticism of the DSM-5 revision, ultimately resulting in a petition calling for outside review signed by 14,000 and sponsored by 56 mental health organizations. In the course of almost three years of blogging, Frances became a voice for more than just the specifics of the DSM-5. He spoke out against the overuse of psychiatric medications—particularly in children; a general trend towards global diagnostic inflation—pathologizing normality; the intrusion of the pharmaceutical industry into psychiatric practice; and a premature attempt to move psychiatry to an exclusively biological paradigm without scientific justification. Along the way, he wrote two books: Saving Normal: An Insider's Revolt Against Out-of-Control Psychiatric Diagnosis, DSM-5, Big Pharma, and the Medicalization of Ordinary Life (2013), and Essentials of Psychiatric Diagnosis (2013), meant to guide clinicians and to help curb unwarranted diagnostic exuberance. He has decided to continue writing on a new Psychology Today blog called Saving Normal.
Major contentions
Neglecting severe mental illness
Frances contends that while the deinstitutionalization movement was needed due to hospital overcrowding, frequent civil liberties violations, and poor conditions for hospitalized psychiatric patients, its implementation in the United States was an utter failure. In 2018, he wrote, Frances asserts that psychiatry itself has contributed to the neglect of the severely ill by diverting limited resources away from the community treatment of these patients and focusing instead on genetics research, neuroscience research, and the treatment of the mildly ill. He is particularly critical of NIMH spending excesses in the field of neuroscience, which he says have not helped a single patient in actual life. He is a proponent of a community psychiatry approach.
He argues for the limited and safeguarded use of involuntary psychiatric hospitalization, writing that it is far preferable to the all-too-common alternatives: homelessness and imprisonment.
Overtreating the worried well
Frances argues that with the gradual expansion of the DSM diagnostic system, psychiatry's attention has shifted away from the severely mentally ill and towards the treatment of the mildly ill or "worried well." This has led to several "false epidemics" of mental disorder, including autism and childhood bipolar disorder. He writes extensively about the pathologization of normal human behavior in his book Saving Normal, and provides guidance to clinicians to avoid these pitfalls in Essentials of Psychiatric Diagnosis. During the DSM-5 revision process, he was particularly critical of the concepts of psychosis risk syndrome, binge eating disorder, and mild neurocognitive disorder.
Controversial treatments
Frances is a proponent of the safe and appropriate use of electroconvulsive therapy in severe and treatment-resistant cases of mental disorder; the use of lithium therapy for bipolar disorder; and the use of clozapine for schizophrenia. Regarding electroconvulsive therapy, Frances argues that the treatment can be lifesaving in cases of severe, unrelenting depression and in some other psychiatric disorders, such as malignant, or lethal, catatonia. He has repeatedly asserted that if he were severely depressed, he would agree to electroconvulsive treatment.
Frances has expressed his belief that both lithium carbonate and clozapine are underutilized in the treatment of bipolar disorder and schizophrenia, respectively, often in favor of newer, more profitable second-generation antipsychotic drugs. The current consensus in global psychiatry is that both lithium and clozapine remain the most effective agents in the treatment of their respective conditions; among academic psychiatrists, their underutilization is widely recognized.
Frances has expressed skepticism over the use of ketamine in the treatment of clinical depression, writing that even if it is narrowly indicated in treatment-resistant mood disorder, "ketamine promotionals will encourage many people to start using it as self-medication for distress–a practice that is filled with risk and falls far outside any possible reasonable use of ketamine."
Binding advance directives
Frances has advocated for the widespread use of binding advanced directives allowing patients to determine when they are well what treatments they would like to receive should they have a psychotic relapse. Most psychiatric patients are competent to decide whether or not they want treatment and to pick which treatments they prefer from the available alternatives—but patients with acute psychotic disorders often temporarily lose this capacity and refuse desperately needed treatment to help prevent imprisonment or homelessness. Studies show that most patients with bipolar disorder, once recovered, realize their judgment was dangerously impaired during past acute episodes and welcome the chance to plan advanced directives for involuntary treatment, should this be needed during future episodes. Giving others permission in advance to impose treatment, should it become necessary, takes away much of the anger, mistrust, helplessness, and humiliation patients feel when they have no say in their fate.
Frances argues that advanced directives are perhaps the only intervention in psychiatry that is without a downside. Relapses are much shorter and less harmful when treated promptly. Accepting that future relapses can occur provides patients with the strongest possible incentive to reduce their probability by participating fully in preventive disease management. And ideological and legal controversies about the role of coercion in psychiatry usually dissolve in the cooperation forged by jointly facing clinical reality.
Frances contends that advanced directives make sense for patients who have previously required involuntary treatment. Discussion of advanced directives might help restore a fractured therapeutic relationship by explaining why the coercion seemed necessary in the past and suggesting how it can be avoided in the future. It is more of a case-by-case decision whether to discuss directives with patients who have never before opposed treatment—directives most indicated for those whose acute episodes are severe, dangerous, frequent, and prolonged. The best time to begin discussing advanced directives is soon after insight returns following an acute episode and it is almost always helpful to include family in the discussion.
On psychotherapy and psychoanalysis
Trained as a psychoanalyst, Frances taught the Freud course at the Columbia Psychoanalytic Center for a decade starting in the late 1970s. He has said that his "favorite work activity throughout [his] career was doing and teaching psychodynamic psychotherapy." Some of his early work was on the study and treatment of personality disorder.
Frances contends that guild wars within psychotherapy have hurt the profession and those it treats; like Marvin Goldfried, he is a proponent of psychotherapy integration. He has said that the biggest mistake made by American psychoanalysis was their rejection of Aaron Beck's cognitive behavior therapy. Regarding Freud, Frances has said that Freud was "overvalued in his day and is now undervalued in ours."
Biopsychosocial model
Frances is a proponent of George Engel's biopsychosocial model of mental disorder, writing that the "biopsychosocial model of mental illness and mental health care created a conceptual underpinning of psychiatric practice." Frances is critical of reductionistic theories in psychiatry and psychology; in any mental disorder, biological, psychological, and social factors are working in tandem to create and maintain dysfunction.
No treatment as a treatment of choice
During his residency training, Frances became dismayed at the long length of hospital stays and overtreatment with psychiatric drugs. Later, as head of the outpatient department at Cornell, Frances noted that many patients failed to benefit from treatment, and some seemed to be harmed by it. This led to his 1982 paper, "No Treatment as the Prescription of Choice," and his career-long efforts to warn clinicians against overdiagnosis and overtreatment.
On antipsychiatry
Frances has much in common with critics of psychiatry who oppose overdiagnosis and overtreatment, but is much opposed to those who preach that psychiatric treatment is always harmful and never necessary. He frequently debated antipsychiatrists at conferences and in print, arguing that treatments overvalued to the many were essential to the few. The five percent of the population with severe mental illness do not do well without medication and often wind up in jail or living on the streets unless treatment is provided. He believes that antipsychiatry is a useful check against psychiatric overreach but that it is extremely harmful when it discourages patients from getting the treatment they need.
Psychotherapy
Throughout his career, Frances has maintained that psychotherapy represents a core, foundational skill in the practice of clinical psychiatry. He counts, among others, Silvano Arieti, Sherv Frazier, Nathan Ackerman, Lawrence Kolb, John Talbott, Leon Salzman, Howard Hunt, Harold Searles, Aaron Beck, and Marsha Linehan as his greatest mentors on psychotherapy. While initially trained in psychoanalysis, Frances gained exposure to a variety of therapeutic models and techniques and has said that his proudest career activity was serving on the NIMH committee that in the 1980s funded the early studies on cognitive behavioral therapy and dialectical behavioral therapy. He has argued that this research has helped many more millions of people than much of the fascinating but clinically useless biological research undertaken by NIMH in recent decades.
Although Frances was trained as a psychoanalyst and taught a course on Freudian theory for a decade, he is an enthusiastic supporter of brief psychotherapy as the treatment of choice for most patients. Partly this is informed by a public health concern that everyone who needs help should have quick and easy access to treatment. Partly this comes from the experience that brief therapy is effective for most milder problems and is what most patients prefer. Partly it is partly based on the utilitarian dictum of the greatest good for the greatest number. And finally, Frances feels that brief therapy is a wonderful training device allowing acquisition of cognitive, behavioral, psychodynamic, and family systems techniques.
In a 2023 interview on his career as a psychotherapist, Frances stressed the importance of differential diagnosis in psychotherapy; the importance of theoretical pluralism and technical flexibility; the healing power of the therapeutic relationship; and the value of clinical supervision and personal psychotherapy. He advised early-career therapists to treat patients across the psychiatric diagnostic spectrum, including severely ill patients; to learn the basics of psychopharmacology, including its limitations; and to gain life experience in a variety of ways, including reading literature, falling in love, and traveling, in order to become a more well-rounded therapist. Frances says that his patients were his best teachers and he is grateful to them not only for making him a better therapist but also a better person.
Since 2022, he has co-hosted with psychologist Marvin Goldfried a podcast titled Talking Therapy, which covers a wide range of topics on psychotherapy and is available on Youtube.
Book and statements on Donald Trump
Frances wrote a 2017 book, titled, Twilight of American Sanity, in which he asserts that Trump himself does not have a mental disease, but rather that the problem lies with the American people for selecting him as U.S. President. Frances writes in the book: "Calling Trump crazy allows us to avoid confronting the craziness in our society." The Washington Post found the arguments made by Frances in the book stray from medical to political in nature. Publishers Weekly said the book contained factual errors and exaggeration. Kirkus Reviews said the work "helps explain why and how the Trump presidency happened."
In August 2019, Frances stated that "Trump is as destructive a person in this century, as Adolf Hitler, Joseph Stalin and Mao Zedong were in the last century. He may be responsible for many more million deaths than they were. He needs to be contained, but he needs to be contained by attacking his policies, not his person." Frances posted a follow-up to Twitter in which he asserted his comments referred to the potential future impact of climate change. In their analysis of his comments, Politifact reported that a 2011 calculation by Yale University history professor Timothy Snyder said Hitler killed over 11 million people, and the U.S. Holocaust Memorial Museum estimated about 17 million deaths attributed to Hitler. Politifact also cited author Ian Johnson, who found Mao Zedong responsible for approximately 42.5 million fatalities in his book The Souls of China: The Return of Religion After Mao. Politifact concluded that: "Not only does Frances' comparison exaggerate the predicted climate change death toll compared to that of the dictators, he also lays the blame for potential future deaths at Trump's feet alone, which even experts critical of Trump consider wrongheaded," and rated his statement as "Pants on Fire".
In a further clarification statement to Snopes, who analyzed his assertions, Frances reiterated that he was referring to the potential future impact of climate change, stating; "I think it is no exaggeration to worry that the policies that follow from Trump's reckless climate denial may wind up causing the death of hundreds of millions of people. Our species appears to be on a path to self-destruction, and Trump is enthusiastically leading the way."
References
External links
Is Criticism of DSM-5 'Anti-psychiatry'?
The Role of Biological Tests in Psychiatric Diagnosis
1942 births
Living people
American psychiatrists
Columbia College (New York) alumni
SUNY Downstate Medical Center alumni
Duke University School of Medicine faculty | 0.762488 | 0.978369 | 0.745994 |
Mental health day | In workplaces, especially in Australia, a mental health day is where an employee takes sick leave, or where a student does not attend school for a day or longer, for reasons other than physical illness. Mental health days are believed to reduce absenteeism and presenteeism, which is a reduction in productivity or other negative consequences resulting from a pressure to work. Mental health days differ from absenteeism in that the purpose is to reset one's mental health rather than due to a nonspecific desire or feeling to skip work.
Motivation
Major depressive disorder, bipolar disorder, attention deficit hyperactivity disorder and other mental illnesses, along with moods such as stress, depression, and anxiety, can cause impairment on workplace functioning and learning. There is evidence in the United States that inadequate managerial support for mental illnesses and negative moods has led to increased absenteeism, morbidity, and an estimated US$300 billion yearly loss as a result of workplace stress.
The stigma associated with mental illness also restricts the ability of students and employees to claim sick leave for mental health. One interpretation of the term "mental health day" is to function as an alternative wording to "sick day" to avoid stigma from workplace mental health issues, so that employees are more able to express difficulty and request support.
A 2010 study showed that one third of workers "admit to faking an illness to get the day off work because they feel they are not coping."
Legality
In Australia, according to the Fair Work Act 2009, employees are entitled to use sick leave and personal leave since according to the Fair Work Ombudsman, personal illness includes stress that may impact an employee's mental health. Since casual workers in Australia do not receive sick leave, this means they are not able through the Fair Work Act 2009 to have a mental health day, however negotiation with employers is possible. People with mental disorders do not need to disclose the conditions for this purpose unless they pose a harm to themselves or other people, however disclosing the issues may enable employers to better accommodate needs.
Most countries have no law requiring employees to produce a medical certificate for only one day of absence. However, in 2010, the National government of New Zealand proposed a law to require a medical certificate for one day of absence, and the employer must cover the cost of obtaining the certificate if the duration of absence is less than three consecutive days.
In the United States, under the Americans with Disabilities Act of 1990, individuals can have mental health days as part of "reasonable accommodations" for a disclosed mental illness. In other cases such as for stress, taking time off is allowed entirely at the discretion of the employer.
See also
Emotional exhaustion
Industrial and organizational psychology
Mental disorder
Occupational burnout
Occupational health psychology
Occupational safety and health
Occupational stress
Perceived psychological contract violation
Perceived organizational support
References
Labour law
Leave of absence
Mental health
Social security | 0.773534 | 0.964384 | 0.745984 |
Rosen Method Bodywork | Rosen Method Bodywork (or Rosen Method) is a type of Complementary and alternative medicine. This bodywork, described as 'psychosomatic', claims to help integrate one's bodily and emotional/mental experience. In the tradition of sensory awareness methods, Rosen Method Bodywork focuses clients' attention onto internal sensations and emotions that arise as areas for the body are gently contacted with a 'listening' touch. This means that the practitioner's goal is not to manipulate or fix clients but rather to notice areas of tension and stillness. The practitioner uses words to help clients become aware of these held places in the body and encourages clients to describe what they are feeling.
Clients felt experiences can arise directly from the held places or from life events, both present and past. This nonjudgmental noticing and listening by the practitioner helps clients to identify unconscious patterns of muscular holdings, feelings, and learned behavioral responses. Rosen Method Bodywork, therefore, is presumed to help clients have greater access to their interoception, their ability to feel the inner condition of the body. Research studies show that higher levels of interception are connected to greater resilience, improved immune function, and the reduction of stress, anxiety, and depression.
The main theory underpinning this method is that a person protects themselves from past painful experiences through tightening muscles in the body that are involved in emotional expression and suppression, especially in the diaphragm, the prime muscle of breathing. Chronic, unconscious muscular tightening suppresses interoception and therefor separates one from one's true self, since many interoceptive sensations, feelings and emotional responses have not been able to be felt in the body, and thus cannot be known, acted upon or modulated in the present. This alleged protection against feeling and knowing how past difficult experiences are underlying one's perceptions, beliefs and experience of living is said to be experienced most frequently as chronic musculoskeletal pain and tension.
This tension and resulting pain can purportedly be observed by the bodywork practitioners as restricted patterns of movement and posture, muscular tension, or shortness of breath. Rosen Method Bodywork practitioners address these patterns by using words to build client awareness while clients lie comfortably on a massage table. In this state of possible relaxation, many muscles do not fully relax, including the diaphragm. Rosen Method Bodywork practitioners contact this tension with a non-intrusive, listening and responsive touch along with words that reflect shifts in the body's muscles and breath. As muscles relax and breathing deepens, feelings and memories of what has been held out of conscious awareness by chronic tension becomes conscious. The diaphragm muscle is exquisitely sensitive to the part of the nervous system that regulates a person's internal assessment of threat or safety, so a sense of safety, both in the relationship with the practitioner and within the self, is what allows the diaphragm to release fully.
Through the relaxation which "unlocks" these unconscious patterns, Rosen Method Bodywork purports to integrate the body, mind, emotions and spirit. As in many other spiritual methods which seek to free the breath, the breath is viewed as a "gateway to awareness". The diapragm muscle relaxes and the breath is less constrained when one feels safe, or solves a problem, or has a true insight that brings more understanding of the self and the world. The naturally full breath of a released diaphragm is one of the elements of spiritual or transcendent experience, in which one's personal boundaries become more expansive and permeable, and one feels connected to something greater than oneself, connected to all that there is in the universe.
Quackwatch categorized Rosen Method Bodywork as an "unnaturalistic method." Although several small studies have shown client benefit, these studies do not meet the requirements of large, randomized and controlled population samples.
Rosen Method bodywork has developed through its founder Marion Rosen's physical therapy practice and work with Lucy Heyer, a student of Elsa Gindler. Under Rosen's guidance in 1980, the Rosen Institute (RI) was formed as the governing international organization that protects and sustains the quality and standards of Rosen Method. The Rosen Institute has affiliate training centers in 16 countries and has certified 1150 bodywork practitioners and 150 movement teachers.
References
Manual therapy
Mind–body interventions
Alternative medicine | 0.761799 | 0.979211 | 0.745962 |
Dispatches (TV programme) | Dispatches is a British current affairs documentary programme on Channel 4, first broadcast on 30 October 1987. The programme covers issues about British society, politics, health, religion, international current affairs and the environment, and often features a mole inside organisations under journalistic investigation.
Awards
British Academy Television Awards
The British Academy Television Awards are presented in an award show hosted by the BAFTA. They have been awarded annually since 1955.
British Academy Television Craft Awards
The British Academy Television Craft Awards are accolades presented by the British Academy of Film and Television Arts, established in 2000 as a way to spotlight technical achievements.
RTS Awards
The Royal Television Society Awards are the gold standard of achievement in the television community. Each year six awards recognise excellence across the entire range of programme making and broadcasting skills.
Notable episodes
Young, Nazi and Proud
This episode, produced in the UK by David Modell, covers the youth wing of the British National Party (BNP). It was originally broadcast on 4 November 2002 as the eighth episode of the sixteenth season. The documentary won a BAFTA award in the 'Best Current Affairs' category.
The programme focuses on then-chairman of Young BNP, Mark Collett. Interviews highlighted the ideological background of Collett, particularly his sympathetic stance towards the policies of Nazism and Adolf Hitler.
MMR: What They Didn't Tell you
Broadcast on 18 November 2004, MMR: What they didn't tell you featured an investigation by Sunday Times journalist Brian Deer into the campaign against the MMR vaccine by British surgeon Andrew Wakefield. Among a string of allegations, Deer revealed that, when Wakefield claimed a possible link between the vaccine and autism, his own lab had produced secret results which contradicted his claims, and he had registered patent claims on his own single measles vaccine.
Following the programme, Wakefield, funded by the Medical Protection Society sued Channel 4, The Sunday Times, and Deer personally for libel, but sought to have his lawsuit stayed by the court, so that he did not need to pursue it. The case became high-profile when Channel 4 obtained a court order compelling Wakefield to continue with his lawsuit or abandon it. During two years of litigation, three High Court judgments were obtained against Wakefield from Mr Justice David Eady, including an order that the General Medical Council was required to supply materials from its own investigations to defendants facing libel actions from doctors. In his first judgment, Eady said:
In pleadings submitted to the court, Channel 4 spelt out what they said the programme had alleged. It said that Wakefield:
Had dishonestly and irresponsibly spread fear that the MMR vaccine might cause autism in some children, even though he knew that his own laboratory's tests dramatically contradicted his claims and he knew or ought to have known that there was absolutely no scientific basis at all for his belief that MMR should be broken up into single vaccines.
In spreading such fear, also acted dishonestly and irresponsibly, by repeatedly failing to disclose conflicts of interest and/or material information, including his association with contemplated litigation against the manufacturers of MMR and his application for a patent for a vaccine for measles which, if effective, and if the MMR vaccine had been undermined and/or withdrawn on safety grounds, would have been commercially very valuable.
Caused medical colleagues serious unease by carrying out research tests on vulnerable children outside the terms or in breach of the permission given by an ethics committee, in particular by subjecting those children to highly invasive and sometimes distressing clinical procedures and thereby abusing them.
Has been unremittingly evasive and dishonest in an effort to cover up his wrongdoing.
In January 2007, Wakefield discontinued his claim and paid Channel 4's and Deer's costs.
Undercover Mosque
Undercover Mosque was first aired on 15 January 2007. The film attracted the attention of West Midlands Police due to the content of the released footage. The documentary presents film footage gathered from 12 months of secret investigation into mosques throughout Britain. The police attempted to determine if criminal offences had been committed by those teaching or preaching at the mosques and other establishments. They presented their evidence to the Crown Prosecution Service who advised that "a realistic prospect of a conviction was unlikely". This was disputed by Bethan David of the Crown Prosecution Services, who note that editing of speeches and a lack of interviewees could have introduced bias. Consequently, the matter was referred to the broadcasting regulator Ofcom.
The resulting complaints were rejected by Ofcom on 19 November 2007, who found that Channel 4 had "accurately represented the material it gathered", and rejected further complaints from the Kingdom of Saudi Arabia, the Royal Embassy of Saudi Arabia, the Islamic Cultural Centre, and from the London Central Mosque. The documentary makers, along with Channel 4, sued the CPS and West Midlands Police for libel. The National Secular Society called for a public enquiry into the role of the West Midlands Police and the CPS in referring the matter to Ofcom in the first place.
Undercover Mosque: The Return
This programme is a sequel to Undercover Mosque. The programme uses footage filmed by undercover reporters in UK Mosques and Islamic institutions as well as interviews with Muslim academics and prominent figures.
One of the people quoted in the programme was Khalid Yasin. His videos were found to be on sale in the Regent's Park mosque bookshop espousing "extremist" views such as public beheadings, amputations, lashings and crucifixions. He is quoted in the programme as saying: "and then people can see, people without hands, people can see in public heads rolling down the street, people can see in public people got their hands and feet from opposite sides chopped off and they see them crucified, they see people get punished they see people put up against the pole? ... and because they see it, it acts as a deterrent for them because they say I don't want that to happen to me." He published a response to a letter from the producer of the programme calling them "hypocritical and exploitative bigots, [you are] audacious liars and opportunistic media vermin" and "unethical [and] merchants of journalistic vomit".
Saving Africa's Witch Children
This programme first aired 12 November 2008 and told the story of young children who had been labeled witches and wizards by their family and community and left abandoned, tortured, imprisoned or killed in the Akwa Ibom in Nigeria. The programme followed Sam Itauma, a Nigerian who started a school for the abandoned children called CRARN (Child Rights and Rehabilitation Network) and Englishman Gary Foxcroft who started the charity, to support the school. The programme suggests that the problem is caused by a combination of African traditional beliefs and extreme Christian Pentecostal groups. In particular the programme singles out Liberty Foundation Gospel Ministries for producing a film called "End of the Wicked" which the charity workers blame for the increase in children being abandoned by their families.
Undercover Teacher
Broadcast in 2005, this episode was about a qualified science teacher, Alex Dolan, who went undercover in schools in Leeds and London to expose the "appalling teaching". One school in particular, Highbury Grove School, was shocked and angry at the programme's methods. Head-teacher Truda White said in an interview with the Guardian:
Following the broadcast, Dolan was found guilty of misconduct by the General Teaching Council.
Ryanair Caught Napping
Broadcast on 13 February 2006, this episode saw two undercover reporters obtain jobs as cabin crew, based at Ryanair's operations at London Stansted Airport, and spend 5 months secretly recording the training programme and cabin crew procedures. The documentary criticised Ryanair's training policies, security procedures and aircraft hygiene, and highlighted poor staff morale. It claims to have filmed Ryanair cabin crew sleeping on the job; using aftershave to cover the smell of vomit in the aisle, rather than cleaning it up; ignoring warning alerts on the emergency slide; encouraging staff to falsify references for airport security passes; asking staff not to recheck passengers' passports before they board flights; and a captain of the airline saying that he would lose his job (or get demoted) if he allowed the cabin crew to serve complimentary non-alcoholic drinks and snacks to passengers, during a 3-hour delay in Spain. Staff in training were allegedly falsely told that any Boeing 737-200 (now no longer in service with Ryanair) impact would result in the death of the passenger sitting in seat 1A and that they should not pass this information on to the passenger.
Ryanair denied the allegations and published its correspondence with Dispatches on its website. It also alleged that the programme was misleading and that promotional materials, in particular a photograph of a stewardess sleeping, had been faked by Dispatches.
Gaza: The Killing Zone
This episode, broadcast in May 2003, follows five weeks in the lives of those living in the Gaza Strip. Beginning two days after the killing of Rachel Corrie, an American member of the International Solidarity Movement, by an IDF bulldozer, the film includes footage of the aftermath of an Israeli flechette attack in a densely populated area and documents the deaths of Tom Hurndall, a British ISM activist, and James Miller, the Channel 4 cameraman who was shot as he filmed Israeli troops bulldozing Palestinian homes.
Inside Britain's Israel Lobby
Broadcast on 16 November 2009, this episode investigated what was argued to be "one of the most powerful and influential political lobbies in Britain", the Israel lobby, and in particular the Conservative Friends of Israel (CFI).The documentary claimed that donations to the Conservative Party "from all CFI members and their businesses add up to well over £10m over the last eight years". CFI disputed this figure and called the film "deeply flawed", saying that they had only donated £30,000 between 2004 and 2009, but accepting that members of the group had undoubtedly made their own donations to the party.
Dispatches also covered the Israel lobby's alleged influence on the BBC and other British media and further claimed that many media outlets were frightened of broaching the lobby. The Conservative MP Michael Mates said: "The pro-Israel lobby ... is the most powerful political lobby. There's nothing to touch them."
Ofcom received 50 complaints about the programme but cleared it of breaching broadcasting rules.
How Councils Blow Your Millions
Broadcast on 6 July 2015, this episode investigated the use of long term lender option borrower option loans by UK councils, provided by banks. The programme unearthed upfront profits made by the banks and high interest rates, with research from Debt Resistance UK.
The Truth about Traveller Crime
In April 2020, an episode focussing on crime in the Romanichal (English Traveller) community was broadcast. In the programme, Conservative MP Andrew Selous compared Travellers to the Taliban. In May 2020, Jeanette McCormick, the national police GRT lead, stated that there was no substance to the programme's central point that there is a link between higher crime and the presence of Traveller sites. The programme was described by Friends, Families and Travellers, a GRT advocacy group, as misleading and encouraging hatred against Travellers. Ofcom received over 7000 complaints about the programme, which it took 503 days to investigate, before finding no breaches of its code. In the month following the programme's broadcast, there was a spike in hate crimes towards Travellers, with the number of reports to Report Racism GRT almost trebling.
Russell Brand: In Plain Sight
In September 2023, comedian and actor Russell Brand was accused by one woman of rape and by three others of sexual assaults, and emotional abuse between 2006 and 2013 in a story published by the Sunday Times following an investigation alongside the programme. Brand released a video denying "serious criminal allegations". This episode aired on 16 September 2023.
Web-exclusive broadcasts
War Torn - Stories of Separation
I4I - Films by AJ Nakasila
See also
List of Dispatches episodes
This World (TV series)
Panorama (British TV programme) (BBC, 1953–present)
World in Action (ITV, 1963–1998)
This Week (1956 TV programme) (ITV, 1956–1979, 1986–1992)
Unreported World (Channel 4, 2000–present)
References
External links
[https://www.channel4.com/collection/dispatches Dispatches] at Channel 4
Dispatches at the British Film Institute (BFI) Film & TV Database archive
Episode guide archive
1987 British television series debuts
1980s British documentary television series
1990s British documentary television series
2000s British documentary television series
2010s British documentary television series
2020s British documentary television series
British television news shows
Channel 4 documentary series
Current affairs shows
British English-language television shows
International Emmy Awards Current Affairs & News winners | 0.761971 | 0.978949 | 0.745931 |
Qualified Intellectual Disability Professional | A Qualified Intellectual Disability Professional, often referred to as a QIDP for short is a professional staff working with people in community homes who have intellectual and developmental disabilities and was previously known as a Qualified Mental Retardation Professional or QMRP. The change in terminology was implemented after the Centers for Medicaid and Medicare Services (CMS) modified the State Operations Manual Appendix J - Guidance to Surveyors: Intermediate Care Facilities for Individuals with Intellectual Disabilities The changes were implemented after President Obama signed Rosa's Law.
The National Association of QIDPs updated its name to meet the new change in terminology The organization provides training and meeting opportunities for those working in the QIDP capacity. Some U.S. states such as Illinois have specific and required training for QIDPs to remain certified. Other states have licensure and outline specific requirements for the QIDP such as California.
Most QIDPs work for specific organizations providing care and oversight in Intermediate Care Facilities for Individuals with Intellectual Disabilities. QIDP salary ranges can vary when working for agencies, with $72,000 being the high range and $38,000 being the average salary range.
Qualifications
Under federal law, any person working as a QIDP is required to meet the minimum requirements outlined in "Appendix J, Survey Procedures And Interpretive Guidelines For Intermediate Care Facilities For Persons With Mental Retardation."
Appendix J (W160 through W163) requires a QIDP to have a bachelor's degree in human services or a related field of study, plus at least one year of experience working with people diagnosed as developmentally disabled. Registered nurses and physicians also qualify to serve as a QIDP.
Some states, including California, require a QIDP to be licensed to work in the state. Other states, including Texas (which has over 900 Intermediate Care Facility/DD homes) and Alabama, do not require licensing.
Shifts in terminology
Qualified Mental Retardation Professional (QMRP) was the term first used in federal standards developed in the late 1970s and early 1980s for intermediate care facilities for developmentally disabled people.
In 2010, Rosa's Law changed the terminology from "Mental Retardation" to "Intellectual Disability."
This change prompted several states and organizations to change the designation of a QMRP to either "QDDP," meaning "Qualified Developmental Disability Professional," or "QIDP," meaning "Qualified Intellectual Disability Professional".
In December 2013, Centers for Medicare & Medicaid Services (CMS) formally updated Appendix J to change the language used to describe developmental disabilities.
It is possible that, as facilities start to phase out or convert to other programs (such as waiver-type settings) for people with disabilities, the terms QMRP, QDDP, and QIDP may be removed completely.
Professional organizations
There are several professional organizations for QIDPs.
The most notable organization, NAQ (the National Association of QIDPs), holds annual meetings around the United States and offers a network for QIDPs to stay in contact with other disability professionals. There are also state-level organizations that provide training and resources to QIDPs.
Some organizations have started providing consulting services including training, standards, and reports such as the Private Provider's Association of Texas, and My QIDP.
References
Disability in the United States
Intellectual disability | 0.774809 | 0.962712 | 0.745918 |
Medicalisation of sexuality | The medicalisation of sexuality is the existence and growth of medical authority over sexual experiences and sensations. The medicalisation of sexuality is contributed to by the pharmaceutical industry, along with psychiatry, psychology (particularly evolutionary psychology), and biomedical sciences more generally.
Medicalisation is defined as a process of conceptualizing, defining, and treating nonmedical issues as medical problems. Human sexual activity is affected by many factors, including social norms, sexual identity and gender identity, and relationship structures. Sexuality is the way people experience and express themselves sexually. Much research in psychology and psychiatry has been devoted to understanding factors contributing to human sexuality, often playing a gatekeeping or legislative role in stigmatising certain behavior or promoting disease mongering. The medicalisation of sexuality has also been used to advance the pharmaceutical industry through treatments for erectile dysfunction and female sexual dysfunction. Another key influence of the medicalisation of sexuality is social control, mass surveillance and regulation related to risk profiling for medicalised sexual disorders.
While the additional funding from the pharmaceutical industry has been viewed as beneficial to medical research and practice in sexology and human physiology, there exists significant criticism of the medicalisation of sexuality, often on the grounds that it neglects sociocultural factors in favour of a profit motive. The medicalisation of sexuality has also historically been used to justify medical treatments, stigmatisation and incarceration of gay and lesbian people (generally known at the time as homosexual), intersex people and transgender people.
Medicalisation
Medicalisation describes the processes through which initially nonmedical problems such as social problems or natural processes become defined and understood in medical terms of illness, disorder, and disease, which is coupled with treatments. Medicalisation involves a combination of specialised language, explanations and treatments which are promoted at the expense of social language and explanations.
It is believed that the concept of medicalisation began with late 18th-century Age of Enlightenment philosophy, one of the first developments of pathologisation in Western society, including but not limited to sexuality. The three hallmarks of medicalisation are mind-body dualism, individualism and naturalism. Medicalisation has been attributed with humanising areas of social deviance, such as alcohol intoxication, insanity and rebelliousness previously only subject to cruelty or censorship. Medicalisation also has the potential to lend credibility to less socially acceptable illnesses; medical sanctioning of trauma, autism and chronic fatigue for example has been argued to in some cases improve quality of life. Regarding harmful effects, medicalisation can be used as a form of social control, and the diagnosis of various disorders such as female infertility or schizophrenia typically result in social stigma.
Individualism
Individualism in medicalisation states that as diseases are in individuals, individual solutions are required for treatment. In one description from 1994, "the body-centered, body-limited medical model has been and remains today the defining paradigm for our professional and philosophical conceptions of health". Individualism is practised extensively in biomedicine and psychiatry, and this has been articulated as an obstacle to activism for sexual rights.
Naturalism
Naturalism, closely related to evolutionary psychology, posits that human health, and sexuality more specifically, is a "transhistorical product of mammalian evolution" and that this lends significant uniformities across the sexualities of different species. Some initial research of sexuality in the 1920s studied animals intentionally to avoid ridicule by discussing human sexuality in public discourse, but most research related to naturalism applied to human sexuality occurred in the 1980s.
Derivative terms
The term biomedicalisation was proposed in 2010 to describe a significant change in medicalisation in the United States focussed on using technology to identify and surveil health risks in individuals and populations. The term neomedicalization was also proposed independently in 2010 to describe corporate efforts to commercialise health risks for disease as a market for new drugs and technologies that purport to help manage these risks. The original authors of the theory argue that this strategy by pharmaceutical companies is reflective of neoliberalism as a political ideology, emphasising individualism and surveillance, especially self-surveillance through the use of marketed products.
The term sexuopharmaceuticals has been used to describe the category of medicalised pharmaceutical products for sexual disorders such as Viagra. The term sexuomedicine has also been used as an alternative term to refer to the medicalisation of sexuality as a field in itself.
History
18th and 19th centuries
The tradition of representing illness as a punishment for sin has existed in Western culture since at least the Age of Enlightenment in the 18th century. The late 18th century marked the first attempts at artificial insemination of women using syringes, along with newly developed cultural views which undermined the value of female sexual pleasure as it was believed unnecessary in procreation.
In the 19th century this concept of illness as punishment for sin was medicalised into associating so-called perverted sexual traits and behaviors, such as masturbation, with increased morbidity. This was described by a symptom called spermatorrhoea invented by William Acton in 1857, at the time used as a medical justification of celibacy. Spermatorrhoea was later sub-classified into other symptom clusters based partially on how it affected semen. Treatment for spermatorrhoea at the time included catheterisation, cauterisation, circumcision, and sticking needles through the perineum into the prostate. In the 19th and early 20th centuries, the cultural stigma towards researching sexuality drove its unpopularity among doctors and in publications. The first recognition the symptoms described in spermatorrhoea as a disorder in itself is believed to be in 1883, termed ejaculatio praecox.
Other researchers of sexuality in the 19th and early 20th centuries included Havelock Ellis, Edward Carpenter, Marie Stopes and Alfred Kinsey, of which only Ellis had medical qualifications. In the 1920s and 30s, significant research was done into unsuccessfully finding physical causes of sexual dysfunction.
20th century
The origin of the modern version of ejaculatio praecox, called premature ejaculation, is thought to have begun with Alfred Adler before major developments of psychoanalytic theory. Similar to spermatorrhoea, Adler strongly advocated celibacy for women as he thought this would improve sexual satisfaction for women during penetrative sex, a theory later found to be fictitious.
Through the mid-20th century, Sigmund Freud published widely accepted and virtually unchallenged theories that penetrative sex was the only right way to achieve female orgasm, and that a man's erection was essential to female orgasm. This so-called coital imperative has later been argued as a medically recognised disorder that did not actually serve the satisfaction of women but rather contributed to the pressure on and pathologisation of men in obtaining a so-called optimal time to ejaculation.
The first major publication articulating a broad medicalisation of sexuality was the first edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-1). Published in 1952, it reframed behaviors previously viewed as immoral, such as masturbation, low sexual desire and homosexuality, as treatable; faults of character or morality were instead described as illnesses. Some treatments described in the DSM-1 included commitment to asylums, hormonal treatments, circumcision and castration. A cornerstone in the development of psychiatry, the DSM was highly influential and motivated significant eugenic research in a search for naturalistic, biological causes of sexually deviant behaviors, such as the so-called gay gene. By the 1950s, homosexuality was indisputably classified as a mental disorder in psychiatry. In the early 20th century, medical folklore held that 90-95% of cases of erectile dysfunction were psychological in origin, but around the 1980s research took the opposite direction of searching for physical causes of sexual dysfunction, much like the 1920s and 30s. Physical causes as explanations continue to dominate literature when compared with psychological explanations . Treatments in the 80s for erectile dysfunction included penile implants and intracavernosal injections.
Male impotence, similar in meaning to the modern term of erectile dysfunction, was initially advanced by the discovery of papaverine in the 1980s by urologist Ronald Virag. Although referring to the same symptoms, impotence was considered to have psychogenic causes, whereas erectile dysfunction was considered to have organic causes. The use of medicalised diagnosis criteria also allows clinicians to inflate prevalence by using survey results and/or measuring the frequency of low severity cases; in one controversial case, a 1999 report claimed that 43% of all women have a sexual disorder. The use of the biopsychosocial model and 'weak sciences' like social science to explain human behavior lost significant popularity in 1960s and 1970s against 'hard sciences' like biomedicine, which can be attributed to a combination of deregulation and market factors pressuring economic growth in the political climate of the United States at the time.
Viagra
Academic consensus is that the main pharmaceutical product contributing to medicalisation of sexuality was sildenafil sold by Pfizer under the trade name Viagra approved in 1998, the first phosphodiesterase-5 inhibitor (see phosphodiesterase inhibitor) which became an instant bestseller for treating erectile dysfunction and largely replaced selective serotonin reuptake inhibitor (SSRI) treatments for sexual disorders. It was reportedly the fastest selling drug in history, outselling the most common pharmaceutical at the time, the SSRI fluexetine sold under the trade name Prozac. The economic success of Viagra motivated research for similar products. Public funding for sex research was decreasing during the 1990s and 2000s when corporate funding shifted the focus from nonmedical sexology and sex therapy research, to clinical trials and emphasising the concept of sexual dysfunction under a simplified epidemiological model. Viagra and other products for sexual dysfunction, termed sexuopharmaceuticals, proliferated new types of specialised marketing for such products based on neoliberal rhetoric framing viewers as "responsible informed, aspirational sexual subjects". Viagra and similar prescription pharmaceuticals were promoted by images in media to the extent of becoming a cultural icon, at the time a relatively new phenomenon known to be permitted only in the United States and New Zealand and which is believed to have significantly contributed to norms regarding male sexuality. One author notes that although the effect of Viagra is only limited to penile blood vessels, advertisements routinely use imagery of couples hugging, smiling and dancing, with the author claiming that pharmaceutical companies were deceptive in the use of such advertisements.
Criticism of this medicalisation of sexuality existed before the release of Viagra and followed in the 2010s, most vocally about female sexuality. A large criticism of the medicalisation of sexuality is that its tendency for biological reductionism generally fails to take into account sociocultural factors contributing to human sexuality. Around the time of this criticism, research increased into the topic of female sexual dysfunction (FSD). One prominent publication in 1999 purported that "female sexual dysfunction is age-related, progressive, and highly prevalent, affecting 30% to 50% of women", believed by a later 2012 publication to be the first complete articulation of FSD as a disorder.
In some ways, sexology and sexual physiology research fields benefited due to interest and funding from pharmaceutical companies, as this led to funding for research on psychological assessments for sexual health, and the promotion of evidence-based medicine in research and practice. The medicalisation of sexuality has also made access to sexological healthcare somewhat less stigmatised in developed countries, although this comes alongside social expectations regarding sexual performance, and age-based discrimination due to natural deterioration in sexual function. Study results also suggested that men are often reluctant to use SSRIs as treatment for erectile dysfunction and suggested a benefit from having alternative pharmaceutical treatment options.
Criminology
At this time in the late 1990s and early 2000s, psychiatry and sexology were also increasingly playing a role in processes for criminal justice and forensic science. This has included the use of sex offender registries, and having psychiatrists and psychologists assess individuals in court or prison for mental stability and chances of recidivism. These assessments in the United States and Britain carried significant weight as they could be used to indefinitely incarcerate individuals after their criminal term expired, if the expert believed reoffending was likely. Behavioral treatments for sex offenders around the 1990s onward have included aversion therapy, satiation therapy (intended to reduce arousal through overexposure to deviant fantasies) and cognitive behavioral therapy. Biomedical treatments included hormone suppressants such as medroxyprogesterone acetate (MPA) normally used for birth control, and leuprorelin, normally used as a cancer treatment. A 2015 study reported that although these treatments continued to be used, MPA was not cleared by the Food and Drug Administration for inducing impotence in males and evidence at the time for both behavioral and pharmaceutical treatments for sex offenders was weak.
Homosexuality
As 19th century Western culture shifted from religious to secular authority, homosexuality began to receive increased scrutiny from the law, medicine, and later psychiatry, sexology and human rights activism. The term homosexuality was first used in a medical context in 1869 by Hungarian doctor Karl Maria Kertbeny, who argued against the harsh laws and punishments against sodomy in the Prussian legal code. He argued that it was inappropriate to be treated as a crime in his view that homosexuality was congenital (i.e. innate) rather than acquired, and this is considered the first description of homosexuality as a medicalised disorder. Before the inclusion of homosexuality in the 1952 DSM-1 and later in the 1968 DSM-2 as a mental disorder, homosexuality was first classified as a "psychopathic personality" and "pathological sexuality" in the standard classified nomenclature of disease in 1935.
One of the most influential 19th century writers on medicalising homosexuality was Richard von Kraft-Ebbing through their 432 page book Psychopathia Sexualis. Kraft-Ebbing further argued that under the impression that homosexuality and other "sexual abnormalities" were innate, that they should be treated therapeutically rather than punitively. Sigmund Freud however described homosexuality as a natural sexual variation, and considered homoeroticism as part of a "normal" sexual development. In the 1940s, Freud's followers including Edmund Bergler, Irving Bieber, and Charles W. Socarides took another approach, re-establishing homosexuality as a psychiatric disorder with negative caricatures such as "megalomanical, with free floating malice, unreliability and superciliousness". They viewed homosexuality as a disease and perversion, and insisted that all homosexuals experience a deep sense of related guilt. Following this, a detailed description of homosexuality clearly identifying it as a medical disorder was included in the DSM-2 in 1968, replacing what was only a brief mention.
Medicalisation of homosexuality and its public visibility reached a peak in the 1950s and 1960s in the United States and to a lesser extent in the United Kingdom, with gay liberation movements in divisive political contest with psychiatrists and others in support of the medicalisation of homosexuality. Up until the 1970s, psychiatrists who disclosed they were homosexual would become at risk of losing their job and having their medical license revoked. These protests are historically considered largely in response to studies from Bieber in 1965, and later Socarides in 1972 which asserted the medical status of homosexuality as an abormal disorder. Socarides' research was released under his newly-elected position as chair of the Task Force on Homosexuality appointed by the New York County branch of the American Psychiatric Association (APA).
One of the most influential protests was in 1972 with John E. Fryer, a psychiatrist recently fired due to homosexual stigma, who took the stage unannounced at an APA conference only as "Dr. H. Anonymous", later expanded to "Dr. Henry Anonymous". Fryer appeared on stage wearing a rubber joke-shop face mask – that sometimes was described as a mask of Richard M. Nixon, but which probably was altered from its original state. Fryer stated, "I am a homosexual. I am a psychiatrist", and then explained issues with the APA's medicalisation of homosexuality. Homosexuality was removed from the DSM in 1973, a year after Fryer's speech – leading the now-defunct Philadelphia Bulletin to print the headline "Homosexuals gain instant cure" – and Fryer's speech has been cited as a key factor in persuading the psychiatric community to reach this decision.
Though the term "homosexuality" was removed from the DSM, the underlying condition was still pathologized. To appease both gay activists and advocates of homosexuality remaining a diagnosis, a disorder known as "sexual orientation disturbance" was introduced in a reprint of the DSM-2 to replace it. In 1980, the DSM-3 replaced SOD with "ego-dystonic sexual orientation" and reclassified it under a new category of "psychosexual disorders". The 1987 DSM-3-R omitted any direct substitution for homosexuality, replacing EDH with "sexual disorder not otherwise specified" which was defined by "marked distress about one's sexual orientation". This was later removed in the DSM-5 in 2013 without replacement.
Expressions of non-heterosexuality are now broadly considered to be normal variations of human sexuality, although continued discrimination results in worse mental health of this population. This continued high-level correlation between mental health problems and homosexuality continued to motivate medicalisation of homosexuality, such as in the American Counselling Association and Australian Psychological Society .
Sexuality of transgender people
Beginning in the 1950s, clinicians and researchers developed a variety of classifications of transsexualism. These were variously based on sexual orientation, age of onset, and fetishism. Beginning with Harry Benjamin in the 1960s, transfeminine individuals' sexuality was medicalised and viewed as pathological, to the extent that the sexuality of transsexual individuals was considered a central factor in diagnosis. Initially, these classifications generally divided transgender women into two groups: "homosexual transsexuals" if sexually attracted to men and "heterosexual fetishistic transvestites" if sexually attracted to women.
In 1982, Kurt Freund further expanded this research based on sexual attraction. In the 1980s and 1990s, Ray Blanchard proposed a psychological typology of gender dysphoria, transsexualism, and fetishistic transvestism in a series of academic papers, and coined the term autogynephilia as part of the typology. These studies have been criticized as bad science for failing to sufficiently operationalize their definitions and as unfalsifiable. They have also been criticized for lacking reproducibility, and for a lack of a control group of cisgender women, while supporters of the typology denied these allegations.
Gender identity disorder (GID) and gender identity disorder of childhood (GIDC) were introduced in the DSM-3 in 1980. At the time during the internal drafting process, there was criticism from feminist members of the APA, who claimed that research on people assigned male at birth (AMAB) was inapplicable to those assigned female at birth (AFAB). In response to the critiques, different standards were established between AMAB and AFAB children, with AFAB children being excluded from being diagnosed with GIDC if they transitioned for the "perceived advantages" of being male. However, absent from the discussion was prior research indicating a relationship between gender nonconformity and homosexuality. Later investigation by Jem Tosh has shown that GIDC was based on research which worked under the assumption that treating gender nonconformity in feminine AMAB children would prevent them from becoming homosexuals as adults. This was desirable, as adult homosexuality was seen as more difficult to change. This line of reasoning, that gender nonconformity and homosexuality develop primarily in childhood, was proposed as a justification to allow parental intervention to force such treatments onto children. This has been described as a "recycling" of homosexuality into new medicalised disorders GID and GIDC; although the name and diagnostic criteria changed, the same gender nonconforming and homosexual behavior was medicalised in the process.
The groups responsible for revising gender identity disorders in the 10th edition of the International Classification of Diseases (ICD-10) and the DSM-4 into the DSM-5 have been noted to share the experts Jack Drescher and Peggy Cohen-Kettenis. Due to the ICD not being restricted to psychiatric disorders like the DSM, it has been argued that this ICD revision had the potential to demedicalise transsexualism by including it in a non-psychiatric category, which would still allow insurance provider coverage for treatments in healthcare systems. Instead, the World Health Organisation decided to create a new category for GID and related conditions called "conditions related to sexual health". Although distinct from psychiatric categories, it has been argued that this reclassification of transgender and gender diverse people into "sexual health" is counterproductive considering the questionable basis of establishing sexuality and paraphilias as causes of gender diversity.
A 2020 review found that most research has continued to study shifts in sexual desire or orgasmic potential before and after transgender health care, such as in penetrative sex, with an absence of studies focused on sexual pleasure. This bias in research has been argued to reinforce a narrow, medicalised model of sexuality on transgender people focussed on individual sex acts unrepresentative of the population being studied.
HIV
HIV prevention has been considered one of the major forms of medicalisation of sexuality in the 20th century, and , medicalisation continues to be a dominant factor surrounding HIV. Chemoprevention, also known as chemoprophylaxis, is the use of medication to prevent a disease an individual does not have. , chemoprevention remains a controversial for HIV prevention. In medical recommendations and policies, chemoprevention for HIV is generally believed to have replaced behavioral prevention strategies such as condom use and coitus interruptus in favour of medication use since the mid 2000s. This has been criticised for questionable efficacy and harmful side effects.
The medicalisation of HIV has resulted in social effects in addition to replacing prevention options. Rhetoric of harm prevention has largely been replaced with harm reduction (i.e. treatments which only reduce incidence rather than completely prevent it) is common in HIV research yet has been shown to produce misleading study results that do not generalise. The medicalisation of HIV has been argued to have a chilling effect on public discussion, which also increases stigma in those diagnosed. HIV chemoprevention has also been used to justify increased medical monitoring or policing of sexuality.
Intersex people
Medical surgery to normalise intersex bodies within a gender binary has been conducted since at least the 19th century, and has been influenced by both medicalisation of homosexuality and transsexuality. Such surgeries were justified arguing that such surgeries improve sexual functioning. Intersex people have also been routinely used as subjects for psychological experimentation to study sexuality since the mid-20th century.
Elderly
In the 19th and 20th centuries, it was commonly accepted for the elderly to become asexual. Until the 20th century, medical science often conflicted on this message as to whether a sexual life in old age was important, healthy or desirable. With the continued development of sexology, biomedicalisation and the pharmaceutical industry, this rhetoric shifted as the elderly became a medicalised market for sexual dysfunction products after the release of Viagra and similar pharmaceuticals.
Criticism
There are a wide range of criticisms of the medicalisation of sexuality. One of the most popular criticisms is that biological reductionism and other tenets of medicalisation, individualism and naturalism, generally fails to take into account sociocultural factors contributing to human sexuality. The medicalisation of sexuality has been criticised for being excessively narrow and serving a normative and gatekeeping role in sexual expression. The naturalistic tenet of the medicalisation of sexuality is argued to be a homogenising force, replacing or demoting the value of diversity in sexual cultures with uniform expectations of genital functioning. By comparison, after convening critical social scientists and clinicians and presenting the discussion at the Female Sexual Forum conference at Boston University, the author finds that sexual complaints by women are affected by a combination of "emotional, physical and relational factors" rather than just physical functioning.
In the 2010s, science and technology studies has been used to criticise the effects of medicalising sexuality, claiming that medical authority is unjustified in determining what is a respectable or mature sexuality. It has also been described as reinforcing masculine and heteromasculine norms including the British concepts of the New Man and lad culture.
The neoliberalism inherent in the medicalisation of sexuality has faced wide criticism. One author writes, "linking drugs with risk factors and lowering thresholds for 'at-risk' conditions pave the way for pharmaceutical expansion from disease to discomfort". Sexual disorders like erectile dysfunction have been used as an estimate of general patient health. For example, erectile dysfunction is often the first sign of arteriosclerosis due to restricted blood flow. While this is beneficial in that it improves detection of serious medical conditions, this kind of "penile health gauge" is argued to have a perverse incentive in which increasingly intrusive, and possibly even mandatory surveillance of patients is expected. Sexologists such as John Bancroft are highly critical of the medicalisation of sexuality.
Following the release and popularity of Viagra in 1998, a vocal criticism was the lack of equivalent focus on female sexuality. Similarly, research in HIV/AIDS has been criticised as a key force of medicalisation in forcing higher levels of patient surveillance. AIDS historian Sarah Schulman writes that women were routinely excluded from experimental drug trials for HIV. Another case study argued that even in large LGBT organisations in the United States with significant resources to conduct HIV/AIDS support such as Bienestar, medical models of sexuality and disease prevalence were routinely used to justify gender discrimination in employment (see gender inequality in the United States), and significantly disproportionate support for programs for gay men at the expense of programs for women.
In contrast with this reported lack of pharmaceutical research towards women in the late 1990s, a 2002 study argued that medically unnecessary genital modification was disproportionately targeted at women, especially in the United States, and that it reinforced harmful norms about the expectations of women's appearances and bodies. Quoting the authors, "by encouraging women to look like Playboy centrefolds and men to seek priapic perfection, we may be furthering what has been termed the 'tyranny of genital sexuality.'" One author writes in 2001 that the use of pharmaceuticals for sexual enhancement by men could arguably lead to a "comical infinite regress", since women partnered to such men were reporting complaints of genital irritation which could be reduced only if the women elect to use vaginal lubricants themselves. One author writes that for low female sexual desire specifically, it is considered a normal part of life, inherently sociocultural rather than medical and framing low female sexual desire as a disease is done in part to seek financial gain.
Notes
References
Medical sociology
Medical controversies
Social constructionism
Social problems in medicine | 0.780353 | 0.955843 | 0.745895 |
Dynamic-maturational model of attachment and adaptation | The dynamic-maturational model of attachment and adaptation (DMM) is a biopsychosocial model describing the effect attachment relationships can have on human development and functioning. It is especially focused on the effects of relationships between children and parents and between reproductive couples. It developed initially from attachment theory as developed by John Bowlby and Mary Ainsworth, and incorporated many other theories into a comprehensive model of adaptation to life's many dangers. The DMM was initially created by developmental psychologist Patricia McKinsey Crittenden and her colleagues including David DiLalla, Angelika Claussen, Andrea Landini, Steve Farnfield, and Susan Spieker.
A main tenet of the DMM is that exposure to danger drives neural development and adaptation to promote survival. Danger includes relationship danger. In DMM-attachment theory, when a person needs protection or comfort from danger from a person with whom they have a protective relationship, the nature of the relationship generates relation-specific self-protective strategies. These are patterns of behavior which include the underlying neural processing. The DMM protective strategies describe aspects of the parent–child relationship, romantic relationships, and to a degree, relationships between patients/clients and long-term helping professionals.
History
Out of the development of attachment theory, British psychiatrist John Bowlby coalesced a coherent theory and is generally credited with creating the foundation for modern attachment theory. Mary Ainsworth, an American-Canadian psychologist, started working with Bowlby in 1950. Ainsworth completed her doctoral thesis in 1940 under William Blatz, who had developed security theory, a precursor to attachment theory. Blatz believed the core nature of the relationship between a (to use his colloquial terms) mother and child involved the development of a trusted and secure relationship to function as a safe base for a child's need to explore. This set an initial foundation for the developing theory of attachment as involving a two-pattern model, security vs insecurity, centered on safety and play.
However, throughout the 1950s, both Ainsworth and Bowlby began developing a three-pattern model centered on danger and survival. In the 1960s, Ainsworth developed the first scientific method to assess attachment, called the strange situation. The results of her assessments confirmed a three-pattern model. Staying with a secure vs insecure framework, Ainsworth identified one secure pattern and two completely different insecure patterns. She labeled these with the letters A, B, C, with B representing the secure pattern.
Ainsworth's graduate students, including Mary Main and Patricia "Pat" Crittenden, made important developments to attachment science and theory. Both Main and Crittenden realized that the criteria Ainsworth was using did not allow for the attachment classification of a significant number of children. Main initially described most of this group as being disorganized, unable to organize an attachment strategy to help them meet their attachment system needs for safety. Main and Solomon later redefined disorganized attachment. Decades of research were dedicated to exploring the concept of disorganized attachment, but ultimately the concept proved almost completely unhelpful.
Crittenden studied under Ainsworth in the 1980s, ten years after Main. Because Crittenden initially focused on danger and saw the attachment system as promoting survival, she rejected the idea that a significant portion of children could fail to organize an attachment strategy to survive. Thus, she looked for other explanations about the apparent shortcomings in Ainsworth's initial model. As she did, she expanded the A, B, C patterns of attachment, and with the help of Andrea Landini they organized the patterns into what eventually became the DMM.
She also started her work after John Bowlby wrote the third book in his Attachment and Loss trilogy in 1980, Loss: Sadness and Depression. In Chapter 4 of that book, Bowlby outlined his view that attachment was intimately connected with information processing and the defensive exclusion of information to survive psychological danger. He argued that common psychological defense mechanisms were actually efforts to keep certain types of unwanted information out of one's mind during experiences and while considering issues and making decisions. Crittenden centered her work on how humans develop self-protective strategies and patterns of information processing in the context of danger.
In a sense, Crittenden began where Bowlby and Ainsworth left off. While moving away from some of the older concepts such as secure vs insecure and internal working models, she kept and refined the three-pattern model. The DMM continues to evolve and Fonagy describes it as ″the most clinically sophisticated model that attachment theory has to offer at the present time.″
DMM-attachment
Basic definition of DMM-attachment
Attachment describes a system which involves a person's need to be protected from danger, and comforted especially after exposure to danger, and a relationship with an attachment figure who can provide protection from danger and comfort. As a system centered on survival, it also involves a person's need to increase reproductive opportunities and protect progeny.
Particularly when the attachment system involves a caregiver and child, the relational interactions associated with attachment needs shapes neural development and emotional and biological regulation processes in children. Thus, a child's relational environment, and parenting environment, has lifelong impacts.
An attachment figure for children may be one or both parents or other close caregiver, and for adults a romantic partner. An attachment figure is someone to whom a person is most likely to turn to under stress. That person may be a stronger, wiser, and trusted (even if not always safe or protective) person. An attachment-influencing relationship has the qualities of being affectively charged and involving the regulation or dysregulation of emotions. It also involves protecting a person from being forced to handle something outside their developmental ability (their zone of proximal development). An optimal attachment figure is sensitively attuned and responsive to the person's communications and needs and encourages curiosity and the exploration of new information.
Helping professionals, clergy, lawyers, probation officers, teachers, club leaders, friends and other people may function as an auxiliary attachment figure, or transitional attachment figure (TAF), to help people get through a difficult experience.
Danger can be objective (deep water, cliff edges, snakes) or subjective and relevant to only particular attachment patterns. For people who tend to use self-protective A-strategies, danger can include aggressive or dismissive parental responses, not doing the right thing, doing the wrong thing, expressing feelings especially if negative, relying on others to meet needs, and being in conflict. For people who tend to use self-protective C-strategies, danger can include an inconsistent or lack of parental response, not expressing and satisfying feelings especially if negative, following someone else's rules which don't satisfy feelings, compromising, relying on the self to meet needs, and not being in conflict or a struggle.
DMM contributions to the development of attachment theory
Crittenden and colleagues have advanced attachment knowledge in numerous ways. Crittenden and Landini describe many of these in their 2011 book Assessing Adult Attachment: A Dynamic-Maturational Approach to Discourse Analysis.
Focus on danger: The DMM focus on danger, rather than safety, orients an understanding of the attachment system in a way that is practical and useful for understanding response to threat and conflict. Bowlby focused on danger, but other subsequent models changed the focus to safety. The DMM focus on danger is consistent with other biopsychosocial models, such as the polyvagal theory which describes opposing nervous system features which activate in contexts of safety or danger.
Clarification of terminology: The DMM avoids older attachment terms such as secure vs insecure, attachment categories and measures, attachment disorders, disorganized attachment, internal working models, and top level terms such as avoidant and ambivalent. It uses terms such as pathways of development instead of developmental trajectories.
Development of lifespan attachment assessments: Crittenden and colleagues developed a comprehensive lifespan set of attachment assessments (described below), and enhanced existing assessments. Since theory leads scientific inquiry, and scientific findings add to theory, DMM assessments contributed to more detailed theory.
Maturational and changeable: DMM-attachment recognizes that humans are able to utilize more and more sophisticated self-protective attachment strategies as they age. Hence, attachment patterns can become increasingly complex with age. Infants begin with instinctive strategies such as smiling and reaching, and through behavioral learning develop an increasing array of ways to gain protection from danger from their caregivers. Thought and communication patterns are eventually added to a person's available strategies. People can change their primary strategy, add additional strategies, and reorganize from an A-C strategy to a B strategy.
Strategies: Strategies are the ways people get their needs met. Self-protective strategies are not diagnoses or mental health disorders. The strategies may be quite functional in certain types of relationships, and dysfunctional in other relationships if not adjusted. Selecting a specific response in a specific situation is not necessarily dictated by a strategy preference, it is situation and context driven, which Crittenden describes as a dispositional representation (DR). Crittenden expanded and more finely defined attachment strategies (or patterns), as noted below.
Detailed strategies: The DMM described known behaviors with more specificity, identified new attachment behaviors, and new attachment patterns.
Compulsive compliance was first identified in 1988, and was added into the DMM patterns as A4 in 1992. It describes a child's adaptation to a harsh or controlling parent by learning to inhibit behavior disagreeable to the parent and compulsively engaging in behaviors which please the parent, but may be boring or harmful to the child.
(FPA) describes the use of inappropriate positive affect when negative affect would be more appropriate. An example is overbright smiling or laughing in the context of present danger or while experiencing pain. Victoria Climbié is considered a good case example. At age eight she was murdered by caregiver abuse and neglect. Her physical scars and other signs of abuse were seen by multiple professionals and agencies, including doctors, nurses, social workers, and clergy, who all failed to recognize the extreme danger she was in. At the same time, she was described by a number of people as happy, friendly, "twirling up and down the ward", "had the most beautiful smile that lit up the room", and "you could beat her and she wouldn't cry... she could take the beatings and pain like anything." In the ABC+D model, this behavior is theorized as a marker of disorganized attachment.
Shame is identified by adult attachment interviews (below) conducted with the DMM method as a particularly sensitive emotion in A-patterns. Shame is defined as having an intrapersonal quality involving the fear of failing to meet an external standard, often too high a standard, set by others, along with self-blame and over-attribution of responsibility.
Adaptive and strategic function of behavior: Attachment behaviors and communication styles are developed through adaptation to danger and function to promote survival in a given relationship.
Every DMM-attachment pattern involves both adaptive and maladaptive behaviors. A person using B3 "balanced" strategies may fail to predict danger or access a self-protective strategy and end up being harmed. A person using A-strategies may focus on cooperating and avoiding conflict to the exclusion of protecting their children or financial interests. A person using C-strategies may focus on satisfying their own feelings to the exclusion of cooperation and conflict resolution even to the detriment of their children or financial interests.
Individual behaviors can be seen in all attachment strategies, but serve different functions. For example, bright smiling can serve several self-protective purposes. In A-strategies it can function to hide pain and take attention away from in-the-moment negative experiences. In C-strategies it can function to disarm prior or following aggression.
Dimensional: Strategies are described as dimensional rather than categorical. As demonstrated on the DMM circumplex, they range from exposing people to more and more risk (moving down the outside of the circumplex), and more or more intensity (moving from the center of the circumplex to the outer rim). The DMM eschews the terms secure and insecure, although it is used in various DMM literature.
DMM foundations and support
The DMM has and continues to incorporate all relevant disciplines. It incorporates all the disciplines Bowlby utilized, including psychoanalytic, ethology, systems psychology, evolutionary biology, cognitive information processing, and cognitive neurosciences. It incorporates all the disciplines Ainsworth utilized, including naturalistic observation, and empirical grounding of attachment theory. DMM additions include genetics, epigenetics, neurobiology, sociology, developmental psychology, Piaget's theory of cognitive development, Erikson's stages of psychosocial development, behavioral learning theory, social learning theory, theory of mind, cognitive psychology, Vygotsky's zone of proximal development, Vygotsky and Bronfenbrenner's social ecological model, transactional theory, family systems theory, polyvagal theory, mindfulness theory, and functional somatic syndrome theory.
The DMM is supported by the International Association for the Study of Attachment (IASA). The Family Relations Institute (FRI) is the primary organization teaching DMM theory and assessments. The attachment studies programme at University of Roehampton, U.K., includes the DMM and some of its assessments, as does the Barnard Center for Infant Mental Health and Development at the University of Washington in Seattle.
IASA maintains a list of publications describing the DMM. There are over 500 such publications.
DMM attachment patterns
DMM attachment patterns can viewed several different ways.
In its simplest form, the DMM offers a 3-part model using Ainsworth's basic A, B, C patterns.
Some populations of clients tend to be heavily oriented to either a cognitive or affective information processing pattern, such as clinical populations. In these contexts, the DMM offers a basic 2-part model.
The DMM circumplex graphically depicts 22 adult patterns. There are some sub-patterns, such as A3- (compulsive attending) and A4- (compulsive performance), and A and C patterns can be combined, such as A4/C5-6 or A3-4/C2. In the table below, the cognitive A and affective C-patterns are arranged from the middle out, where the patterns in the middle (B1-5, A1-2 and C1-2) represent the least at risk patterns (lower number in the classification) to most at risk (higher number). The B1-2 patterns are somewhat cognitively organized, the B4-5 patterns are somewhat affectively organized. The A1-2 and C1-2 patterns are not considered "insecure," rather normal strategies involving only slight transformations of information.
The DMM can be used as a 4-part model (or a multi-part model depending on its application), as demonstrated in the left and right columns in the table above. The odd-numbered strategies share elements in common which differ from the even-numbered strategies.
Odd-numbered A-patterns (A1-7) tend to focus on idealizing others while even-numbered A-patterns (A2-8) tend to focus on negating the self. In relations with important authorities, the higher odd-numbered A-patterns can involve compulsive caretaking and the even-numbered A-patterns compulsive compliance.
C-patterns organize self-protective strategies around feelings. Odd-numbered C-patterns focus on feelings of anger, increasing in intensity in the higher numbers. Even-numbered patterns focus on desire for comfort and fear, with increasing intensity of fear in the higher numbers. Higher C-odd patterns can involve obsessive coercion. Higher C-even patterns can involve increasing amounts of rage which may escape notice because of simultaneous exaggeration of innocence and vulnerability.
The odd-even split can also be seen from diagonal corners to reflect the opposite functioning of similar elements. The odd-numbered A-strategies in the upper left quadrant (A1-7) all involve some sort of tendency to focus care outward to the needs of others, which differs from the C2-8 patterns which tend to focus care inward to the emotions of the self. The even-numbered A-patterns (A2-8) patterns all involve some sort of tendency to express anger inward to the self, whereas the C1-7 patterns tend to express anger outward toward objects or others.
As noted above, the self-protective strategy patterns are adaptive, and dimensional rather than categorical. For example, a person may primarily utilize C1 strategies to manage danger, but on occasion use higher forms of C strategies such as C3, C4, or C5. This could result from exposure to higher forms of danger or be a response to unresolved trauma or loss.
All the attachment strategies can be impacted by a variety of additional factors, such as unresolved trauma, unresolved loss, depression, and family triangulation.
Information processing and transformation
The DMM is fundamentally an information processing model, and self-protective attachment strategies develop around two primary sources of information available to humans: cognitive and affective.
Cognitive information is described as temporally sequenced, as illustrated with "if/then" statements. Affective information is described as being emotionally intense experiences. Attachment A-strategies tend to emphasize cognitive information and de-emphasize or exclude affective information. Attachment C-strategies do the opposite, emphasizing affective information and de-emphasizing or excluding cognitive information. Attachment B-strategies tend to blend both types of information as they process experiences in the world, although they can emphasize one or the other.
Crittenden describes information processing as involving four main steps:
Perceive the information, or not;
Interpret the information in some way, or not;
Select response of some sort, or not; and
Implement behavior of some sort, or not.
An example involves a child who is feeling a strong emotion:
Will the parent perceive their child's emotion?
If so, will they interpret it as the child needing help to process the emotion, or as the child being weak, overly-needy, or interrupting what they are doing?
Will the parent consider selecting a response, and if so which one?
Will the parent implement a response, or get distracted or decide to ignore their child's emotional experience?
Transformation of information
At each stage of information processing, information is transformed as it is converted from what it is, to a representation of what it is in the mind. A test result, a smile, and divorce papers, come to mean something in the mind through a neural process. The DMM currently identifies seven ways information can be transformed, each of which represents increased transformation: true, erroneous, distorted, omitted, falsified, denied, delusional.
A parent's processing of information about a child's strong negative emotion, continuing with that example, could be seen as:
True, and provide information which helps the parent ease the child's distress.
Erroneous, over- or under-interpreted, such that a parental response might be non-productive, such as giving too much or not enough attention to the distress.
Distorted, where some portion of the information is emphasized and the other de-emphasized, such as acknowledging the distress but emphasizing that it will go away on its own when it won't easily do so.
Omitted, so that some portion of the information is discarded, such as the reason for the distress.
Falsified, where the emotion is changed from one thing to another, such as distressed to hungry.
Denied, where the emotion is actively avoided.
Delusional, where new and incorrect information is created to replace the true information, such as thinking the child is laughing or is signaling a desire to play.
Memory systems
DMM assessments look for memory system function as described by memory researchers such as Endel Tulving and Daniel Schacter. Eight memory systems assessed by the DMM method are body talk, somatic, procedural, semantic, imaged, connotative, episodic, and reflective integration.
As with information processing, attachment patterns can involve the use, or bias of, various memory systems as sources of information. Attachment A-strategies tend to utilize information from procedural and semantic memory systems, and de-emphasize or exclude information from imaged and connotative systems. Attachment C-strategies do the opposite and emphasize information from imaged and connotative systems and de-emphasize or exclude information from procedural and semantic systems. Attachment B-strategies tend to have better access to all memory systems. Each attachment pattern has its own strength in various circumstances where different memory systems may be advantageous.
DMM attachment assessments
Attachment measures, or assessments, assess the self-protective strategy of a person. In infancy and early childhood, it is assessed with respect to specific attachment figures whereas beginning in the school years a generalized strategy is assessed. Assessments generally use a video-recorded interaction or an audio-recorded interview. In observed assessments behavior is assessed, and with interviews the discourse, or manner of speech, is primarily assessed. Crittenden and others have modified existing attachment assessments and developed others to create a range of DMM assessments intended to cover the lifespan. Assessments generally assess individuals, caregivers (usually parents) and/or children, and can assess non-primary caregivers such as close grandparents and foster parents. DMM assessments can be used for research, clinically, forensically, and personally.
Some DMM assessments are considered valid and reliable, and others are still in a development and validation phase which generally takes at least 10 years. IASA considers an assessment valid and reliable if it has a minimum of five published studies supporting it, including studies that the author of the assessment did not author, and that address several of the following:
Concurrent validity
Longitudinal validity
Face validity
Predictive validity
Clinical utility
IASA's Family Court Protocol requires that assessments in a development phase should not be used forensically, particularly in court cases where children and parents could lose access to each other. IASA also argues that individual assessments are only reliable if the assessor (coder) is qualified by having passed a standardized reliability test and maintained their qualification.
Infant Care-Index (ICI)
The ICI consists of a 3-minute interaction of a caregiver and child (a 2-person, or dyadic, relationship) aged from birth to 15 months. The ICI assesses interaction, not attachment (which does not develop until 9–11 months of age). The ICI assesses a dyad's interpersonal functioning under non-threatening play conditions and clusters dyads as sensitive to good enough, at mild risk of parenting difficulties, or at high risk of parenting difficulties, including infant neglect and maltreatment. It was developed by Crittenden with input from Ainsworth and Bowlby. The ICI is considered a valid and reliable assessment and has more than 60 published studies.
Strange Situation Procedure (SSP)
The SSP is the classic assessment of attachment developed by Ainsworth. Almost all other assessments of attachment are validated against it. The SSP consists of eight episodes over 21–23 minutes. Unlike the ICI which assesses only dyadic synchrony under the favorable condition of play, the SSP uses threat to elicit the infant's pattern of attachment. Threat, or relationship danger, comes in several forms such as the stranger coming into the observation room with parent and child (episode 3), the parent leaving the child in the room with the stranger (episode 4), the parent later leaving the child in the room alone (episode 6), and the stranger re-entering the room without the parent (episode 7). The parent returns and the stranger leaves in the eighth and final episode. The infant's behavior on the parent's return is the primary basis for classification into one of three major strategies, labeled A, B, and C.
The SSP was developed for 11-month-old infants. It has been used for older infants, but, as infants age, their tolerance for separation increases and the behavioral markers defined by Ainsworth fit less well, resulting in higher proportions of infants classified as secure, including maltreated infants. In the DMM, this problem was resolved by limiting the age range to 11–15 months, and developing, with Ainsworth's assistance, an alternating A/C classification and pre-compulsive and pre-coercive patterns. These include A1-2 or C1-2 patterns, and clear evidence for A+ or C+ patterns (which involves more intense use of self-protective strategies). These expansions of the Ainsworth categories have been associated with maltreated infants and infants of depressed mothers.
Preschool Assessment of Attachment (PAA)
The PAA is a version of Mary Ainsworth's Strange Situation Procedure (SSP), adapted to 2–5-year-old children. It assesses the child's self-protective strategies used with the adult involved in the assessment. It also uses a video recorded 8-segment process over a structured 21–23 minute adult-child interaction. The PAA is valid and reliable, with more than 30 studies using it.
School-age Assessment of Attachment (SAA)
The SAA involves an audio recorded interview which is transcribed and analyzed with discourse analysis techniques, for children aged 6–13 years. In the assessment, a child is given story cards which represent increasing levels of danger, and they are asked to make up a story that describes what is depicted on the card, and then, if they had any similar experience in their life, asked a series of exploratory questions. It assesses the child's generalized attachment pattern, self-protective strategies, pattern of information processing, level and type of risk, and possible unresolved trauma and loss. It was initially developed in 1997 by Crittenden, has been tested in eight research studies, and is considered to provide discriminate validity. The SAA was the subject of a special section of Clinical Child Psychology and Psychiatry in July 2017.
Adult Attachment Interview (AAI)
The AAI is considered one of the most comprehensive attachment assessments, and is well validated. It was initially created by Carol George and Nancy Kaplan in, and later developed with Mary Main in 1985. Crittenden and Landini slightly modified it with DMM theory in 2011. It assesses self-protective attachment strategies, patterns of information processing, a possible unresolved trauma and loss which distort behavior and information processing, an over-riding condition which causes information distortion such as depression and triangulation in childhood, memory system usage, and reflective function. The assessment involves asking a person a series of structured questions, transcribing the audio recording, and applying a complex set of discourse analysis techniques. The interview takes 60–90 minutes, and it can take hours or days to analyze. Learning to code reliably generally takes several years.
The coding manual for the DMM-AAI is Assessing Adult Attachment: A Dynamic-Maturational Approach to Discourse Analysis (2011) and is publicly available.
DMM Assessments undergoing the validation process
The following assessments have not been validated with three or more studies and are not considered by IASA to be acceptable for use forensically under their Family Court Protocol.
Toddler Care-Index (TCI)
The TCI video records a 5-minute interaction of a caregiver and child aged from 15 to 72 months. It assesses the general attachment characteristics of a specific dyad, such as mother and child or father and child. The TCI is considered a useful assessment, but has not been validated by research. It was developed by Crittenden.
Transition to Adulthood Attachment Interview (TAAI)
The TAAI is a modified version of the AAI for adolescents aged about 14–25 years old. It was modified from the AAI by Crittenden in 2005 and 2020.
Meaning of the Child interview (MotC)
The MotC is an interview of a parent which is transcribed and assessed with discourse analysis techniques similar to the AAI. The MotC assesses a parent's general pattern of caregiving, sensitivity and level of responsiveness to their child, the degree and forms of control a parent may utilize, and self-reflective function (mentalization). It examines how caregiving is shaped by a parent's pattern of attachment and need for self protection. In a validation study, the way parents talked about their children in the MotC was found to predict how they behaved with their child in a CARE-Index video. The MotC has also been used to research the parent–child relationships of parent of autistic children. It was developed by Ben Grey and Steve Farnfield in 2011, and uses DMM theory and methods.
Child Attachment and Play Assessment (CAPA)
The CAPA assesses the attachment and exploration systems of children aged 7–11. It uses an interview process similar to the SAA. The CAPA currently has one published validation study demonstrating convergence with other attachment procedures. It was developed by Steve Farnfield, and uses DMM theory and methods.
Applications
DMM Integrative Treatment
DMM concepts have been used to develop DMM specific treatment interventions for mental health, family, and criminal problems. The DMM has been applied to models of psychotherapy, attachment narrative therapy, family therapy, and criminal behavior.
DMM integrative treatment can include a focus on how information is processed and transformed, especially in response to danger. It can include DMM concepts such as adaptations to relational danger (for both individuals and families), developmental processes and learned patterns of information processing.
DMM Integrative treatment involves five principles;
Define problems in terms of response to danger.
The professional acts as a transitional attachment figure.
Explore the family's past and present responses to danger.
Work progressively and recursively with the family.
Practice reflective integration with the client as a form of teaching reflective integration.
DMM Family Functional Formulation (DMM FFF) describes a comprehensive approach to a wide array of mental health problems. Crittenden and colleagues argue that psychological diagnosis and systems psychology have proven substantially ineffective in treating a wide array of mental health problems. A clinical formulation, which is a broad-based analysis and explanation of the problem, is an alternative approach. Crittenden argues the DMM can contribute to a more effective case formulation when the entire family is consulted and understood using DMM assessments.
Law
The DMM and its methods are useful for discourse and argument analysis, client counseling, understanding shortcomings in client and witness memory recall, forensic purposes, criminal justice, probation, and conflict management. At its heart, attachment theory describes the conflict of contradictory information and needs, and information processing and decision making with biased information.
Because information processing involves the defensive exclusion and inclusion of information, it can affect how people make decisions and communicate. The DMM-AAI discourse analysis method is specifically designed to "understand the meanings behind unclear communication ... distorted communication and dysfunctional behavior".
Attachment assessments can be used in court cases and forensically if done by a trained and reliable coder. The IASA Family Court Protocol is designed to promote attachment information in a way that is as comprehensive and reliable as attachment assessments can allow, and which also supplements other information about individuals, family members, and family systems. FRI's Family Functional Formula is a comprehensive and valuable, if expensive, method to assess a family system.
DMM perspectives on attachment and information processing are useful for understanding neglectful and harmful parenting,
domestic violence
and criminal behavior.
Medicine – somatic symptoms
Kozlowska argues that functional somatic symptoms are impacted by disrupted or chronically challenged attachment relationships. The DMM assessment method, especially for children, specifically identifies and assesses nonverbal communications and somatic expressions. Two large studies, which Kozlowska relied on, found a strong association between low quality attachment relationships and functional somatic symptoms later in life. Kozlowska's own research showed children with functional neurological disorders (FND) almost universally used higher attachment strategies (A3-4, A5-6, C3-4, and C5-6).
Occupational therapy
Occupational therapists can apply the DMM directly, and in conjunction with other modalities. Kozlowska describes incorporating occupational therapy with pediatric medicine, hypnosis, physiotherapy, neurology, and DMM-Attachment theory. Occupational therapists can increase a child's day-to-day functioning and manage emotional arousal. They can also address Functional Neurological Disorder (FND), which she found almost always involved children's use of higher DMM self-protective strategies. DMM theory helps integrate different modalities around the concepts of protection from danger, the impact of interpersonal relationships and family environments, and the use of transitional attachment figures.
Meredith, using non-DMM attachment assessments designed for research rather than clinical purposes, has found associations between pain, sensory processing and distress and adult attachment patterns. She argues that occupational therapists are in a good, if not unique position to utilize attachment theory to guide interventions. Kozlowska uses DMM theory to specifically guide assessment and intervention.
In a University of Roehampton dissertation paper, Gounaridis describes a successful pilot project combining a sensory integration approach, a DMM-attachment assessment (CAPA), and vagal tone measurements as described by the polyvagal theory.
In an Arizona State University dissertation paper, Taggart described how occupational therapists can use Éadaoin Bhreathnach's Sensory Attachment Intervention (SAI) approach, which is informed by the DMM, together with trauma and polyvagal theory informed perspectives, to help children improve emotional expression.
Psychotherapy
The DMM is not necessarily a therapy model, rather it provides a framework to better understand clients, improve communication, and assist with selecting appropriate therapy models. It can help therapists:
Assess or formulate the client's self-protective attachment strategies;
Identify response to dangers from the past and in the present;
Focus the therapeutic alliance around the concept of being a transitional attachment figure;
Determine how the client functions interpersonally (including with the therapist);
Identify a client's patterns of information processing and information bias;
Identify failures of self-protective strategies which lead to psychological and/or somatic problems;
Be mindful to practice reflective integration for its own value and for modeling;
Help clients build a coherent narrative of their experiences.
For therapists using a family systems approach, it can help identify self-protective strategies between the parents, between each child and parent, and between children, to provide more insight into the functioning of the family system. It can help therapists avoid blame and reframe negative emotions to honesty and more appropriate contexts. It can help a therapist move a client's strong negative emotions such as anger and a desire for revenge to softer and more manageable emotions such as sadness and vulnerability. Play therapy, the polyvagal theory, and DMM theory were combined in Hadiprodjo's doctoral thesis. Combining the DMM with the Assessment of Parent-Child Interactions (ACPI, a music theory-based assessment), can allow the application of music theory to understand family attunement and nonverbal communication in the context of self-relevant dangers within a family context. The DMM has been used in a public service context, and informs therapists how to be a safe base and improve the therapeutic alliance.
The DMM provides insight into various mental health issues, such as working with emotions, adolescent challenges, trauma and neurobiological impacts, PTSD, ADHD, autism, borderline personality disorder, avoidant personality disorder, eating disorders, conversion disorders, somatic/factitious/fabricated illnesses, shutdown states in children, drug addiction, psychopathy, child abuse, sex abuse, effects of institutionalization, and depression. It offers an alternate view of personality disorders.
Research
The DMM theory and assessment methods are useful for conducting attachment assessments. Because there are DMM assessments to cover the lifespan, they can be used to assess an individual and a family system. The DMM approach appears to provide more precise results with populations of people whose childhood involved adverse childhood experiences or parents who consistently used cold, inconsistent, harsh or controlling parenting techniques or engaged in parental conflict or failed to protect or comfort their children. It appears that between the DMM and Berkeley assessment methods, the DMM method can better delineate between secure and insecure attachment classifications, and also the quantity of A, C, and mixed AC patterns. This is likely because the DMM is focused on a person's response to danger and fear, and describes the attachment system's primary purpose as being to organize self-protective responses.
Comparison to other attachment models
Ainsworth developed the ABC model in the 1960s and 1970s. It was the foundation for the ABC+D (sometimes called Berkeley) model and the DMM.
The newer ABC+D and DMM models both describe the attachment system, use Ainsworth's basic ABC patterns, and use the SSP and AAI attachment assessments. Both models reject the single-person focus of psychiatric models such as the DSM and ICD, instead focusing on how a parent-child (dyadic) relationship affects each person, and that childhood attachment patterns represent a child's best attempt to deal with the caregiving environment. Both find the most effective attachment-informed interventions in family problems is to focus on improving sensitivity of the child's primary caretaker. Both are based on principles of human development.
Ainsworth's ABC model ultimately described 9 subcategories, A1, A2, B1, B2, B3, B4, B5, C1, and C2. The newer models went on to identify additional basic subcategories, 24 in the adult version of the ABC+D model and 29 in the DMM, and each describe additional AC combinations.
While they both describe the effect of the attachment system on information processing and memory function, and both describe the impacts of trauma and loss, the DMM provides more focus and detail on these elements. The DMM utilizes more memory systems and considers more types of trauma. In the ABC+D model meaning is assigned to behavior, whereas the DMM looks for the function of behavior to define its meaning.
The ABC+D model has historically focused on safety, attachment security vs insecurity, is categorical, describes linear developmental trajectories, describes attachment with different concepts and terms for children and adults, and uses Bowlby's "internal working model" concept. The DMM is focused on danger, focuses on risk instead of security-insecurity, is dimensional, describes potentially branching developmental pathways, describes the maturational development of self-protective strategies, and describes neurobiological systems and processes.
Landa and Duschinsky offer a theory about the historical development of both models to provide an explanation about why and how they differ. The ABC+D model initially relied on normative (average) research populations. Initial DMM research utilized both normative and maltreated populations, so it had a richer data set to work from. Each model also makes different foundational assumptions. The DMM (and others) assumes, as did Bowlby and Ainsworth, that a primary purpose of the attachment system for children is to maintain the attachment figure's availability. In the ABC+D model, as defined by Mary Main and Judith Solomon, the purpose is to maintain proximity. (Not all attachment theorists who use the ABC+D model use the same definitions as Mary Main. Increasingly, they use terms and definitions identical, or nearly so, to Crittenden's.)
The DMM rejects the concept of disorganized attachment, instead arguing that people can organize a response to almost all forms of danger, even if the response is increased aggression or ignoring physical and psychological pain. Granqvist and 42 other attachment experts, including Mary Main, agreed that the concept of disorganized attachment, as understood in 2017, has little or no utility, and may not be used clinically or forensically.
The ABC+D model was widely accepted by the research community from about 1990–2017, although Main was calling for caution in the use of disorganized attachment in clinical and forensic settings by at least 2011. In 2018 van IJzendoorn et al. pointed out the replication crisis of ABC+D-based attachment assessments, and called for the ABC+D attachment community to revisit its foundations.
Criticisms
After Granqvist, and 42 other authors (2017), clearly identified the limits and misapplication of the disorganized attachment category, Van IJzendoorn, et al., and Crittenden and Spieker exchanged a series of comments and criticisms about the ABC+D and DMM attachment models in the November/December 2018 issue of Infant Mental Health Journal. Van IJzendoorn criticized the DMM for having too many classifications, 29 basic patterns, compared to the ABC+D model (which has 24). While conceding that assessments using the ABC+D attachment model cannot be used forensically, he argued neither could DMM assessments since they did not meet the "beyond a reasonable doubt" standard required in court. However, "more likely than not" is the correct standard in civil (non-criminal) court cases. Van IJzendoorn argued DMM assessments lack validity as much as ABC+D assessments do, which Crittenden (and others) dispute. Van IJzendoorn found fault with Crittenden's position that the DMM is still developing. Crittenden responded that a complex and transdisciplinary model of human development must always continue to add new information and develop.
Forslund and 68 other authors subsequently discussed the use of attachment assessments in court proceedings. They described limitations and the appropriate use of assessments using the ABC+D model. Some authors argued they could never be used in court proceedings, and some argued they could. However, the article, while making side references to Crittenden, did not clarify that it was only addressing the problems of assessments using the ABC+D model.
Other people echo Van IJzendoorn's point about complexity in terms of becoming a reliable coder and being able to use a DMM-assessment to testify forensically about a particular person's self-protective strategies in a particular context, or for a family assessment using the DMM Family Functional Formulation method. The PAA and SAA can take a year or more to learn The AAI can take several years. In fact, there are few people in the world who can use DMM-assessments forensically, particularly under the requirements of IASA's Family Court Protocol. (Neither IASA nor FRI list any available forensic coders on their websites as of November 2021.)
David Pocock found the DMM useful, and powerful, and at the same raising the risk of reductionism and reification. The DMM attempts to make it clear that people are not reduced to "a C3" or "an A4", instead they are described as using strategies from those patterns. Reification involves making something abstract concrete, turning an attachment strategy used in one situation into what completely defines the person. He echoes common concerns that attachment, and the DMM in particular, is such a powerful model it is potentially easy to fall into the use of counterproductive shortcuts.
References
Bibliography
Introductory reading materials
Atkins, Louise, (2020), Why Attachment Matters: Dynamic Maturational Model (DMM) of attachment theory, medium.com.
Crittenden, Patricia M. (2002), Attachment, information processing, and psychiatric disorder, World Psychiatry, 1:2.
Crittenden, Patricia. M. (2006). A dynamic-maturational model of attachment. Australian and New Zealand Journal of Family Therapy, 27, 105–115.
Farnfield, Steve, Holmes, Paul (2014). The Routledge Handbook of Attachment: Assessment. London: Routledge.
Hautamäki, Airi (Ed.), (2014). The Dynamic-Maturational Model of Attachment and Adaptation – Theory and Practice. University of Helsinki, SSKH, Skrifter, 37.
Purnell, C. (2010). Childhood trauma and adult attachment, Healthcare Counselling and Psychotherapy Journal, 10, 1–7.
Spieker, Susan J. and Crittenden, Patricia M. (2018), Can attachment inform decision making in child protection and forensic settings?. Infant Mental Health Journal, 39: 625–641.
Advanced reading materials
Baldoni, Franco, Minghetti, Mattia, Craparo, Giuseppe, Facondini, Elisa, Cena, Loredana, & Schimmenti, Adriano (2018). Comparing Main, Goldwyn, and Hesse (Berkeley) and Crittenden (DMM) coding systems for classifying Adult Attachment Interview transcripts: an empirical report, Attachment and Human Development, 20:4, 423–438, DOI: 10.1080/14616734.2017.1421979.
Crittenden, Patricia M. (2016). Raising parents: Attachment, representation, and treatment, 2nd edition. London: Routledge.
Crittenden, Patricia M., Dallos, Rudi, Landini, Andrea, & Kozlowska, Kasia (2014). Attachment and family therapy. London: Open University Press.
Crittenden, Patricia M., & Landini, Andrea (2011). Assessing Adult Attachment: A Dynamic-Maturational Method of Discourse Analysis. New York: Norton.
Crittenden, Patricia M. & Newman, Louise (2010). Comparing models of borderline personality disorder: Mothers' experience, self-protective strategies, and dispositional representations. Clinical Child Psychology and Psychiatry, 15,433-452.
Crittenden, Patricia M., Robson, Katrina, Tooby, Alison, Fleming, Charles (2017), Are mothers' protective attachment strategies related to their children's strategies? Clinical Child Psychology and Psychiatry, 22:3, 358-377 (Note: this article uses three DMM attachment assessments, the PAA, SAA, and AAI, and offers a comprehensive and longitudinal review of attachment strategies in mother-child pairs.)
Kozlowska, Kasia; Scher, Stephen; Helgeland, Helene (2020). Functional Somatic Symptoms in Children and Adolescents: A Stress-System Approach to Assessment and Treatment, Palgrave Macmillan. PDF and Kindle versions available free as open access textbook.
Landa, Sophie & Duschinsky, Robbie (2013) Letters from Ainsworth: Contesting the "Organization" of Attachment. Journal of the Canadian Academy of Child & Adolescent Psychiatry. 22, 172–177.
Landa, Sophie, & Duschinsky, Robbie (2013). Crittenden's dynamic–maturational model of attachment and adaptation. Review of General Psychology, 17, 326–338. doi:10.1037/a0032102
Strathearn, Lane, Fonagy, Peter, Amico, Janet A., & Montague, P. Read (2009). Adult attachment predicts mother's brain and peripheral oxytocin response to infant cues. Neuropsychopharmacology, 34, 2655–66.
Attachment theory
Conflict (narrative)
Evolutionary biology
Forensic psychology
Interpersonal relationships
Occupational therapy
Psychological models
Somatic psychology | 0.763936 | 0.97638 | 0.745892 |
Occupational English Test | The Occupational English Test (also known as OET®) is an English language test that assesses the English language proficiency of overseas-trained healthcare professionals seeking to register and practise in an English-speaking environment.
The test is recognised by organisations around the world, including for migration and licensing in Australia, New Zealand, the USA and the UK.
History
OET was designed in the late 1980s by Professor Tim McNamara, under the guidance of the Australian National Office for Overseas Skills Recognition (NOOSR), which administered the test at that time. The test has been researched and developed continuously since then to ensure that it has kept up with current theory and practice in language assessment. This work has been done by the University of Melbourne's Language Testing Research Centre and by Cambridge Assessment English.[citation needed]
Since March 2013 the test has been owned by Cambridge Boxhill Language Assessment Unit Trust (CBLA), a joint venture between Cambridge Assessment English (Aus) and Box Hill Institute.
Recognition
OET is recognised by regulatory healthcare boards and councils in countries around the world, including Australia, New Zealand, United Kingdom, United States,Canada, Ireland, Dubai, Singapore, Namibia and Ukraine. Many organisations, including hospitals, universities and colleges, are using OET as proof of a candidate's ability to communicate effectively in a demanding healthcare environment. In addition, OET is recognised by the Australian Department of Home Affairs, Immigration New Zealand,UK Visas and Immigration and some US states for visa categories where an English test may be required.
Each recognising organisation determines the score they require to ensure that candidates meet the language competency standards to function in their profession.
OET test structure
Modes
There are three delivery modes of OET:
OET on Paper at a Test Venue
OET on Computer at a Test Venue and
OET@Home®
The test tasks, format and level of difficulty remain the same for all the OET tests regardless of the mode of exam delivery.
Both computer-based test modes are evaluated by the highly-trained examiners who mark paper-based OET.
The four parts of OET
Listening (approximately 45 minutes)
Reading (60 minutes)
Writing (45 minutes)
Speaking (approximately 20 minutes).
Listening
Candidates are required to demonstrate that they can follow and understand a range of health-related spoken materials such as patient consultations and lectures.
Part A - consultation extracts (about 5 minutes each)
Part A assesses candidates' ability to identify specific information during a consultation. They are required to listen to two recorded health professional-patient consultations and complete the health professional's notes using the information they hear.
Part B – short workplace extracts (about 1 minute each)
Part B tests candidates' ability to identify the detail, gist, opinion or purpose of short extracts from the healthcare workplace. They are required to listen to six recorded extracts (e.g. team briefings, handovers, or health professional-patient dialogues) and answer one multiple-choice question for each extract.
Part C – presentation extracts (about 5 minutes each)
Part C assesses candidates' ability to follow a recorded presentation or interview on a range of accessible healthcare topics. They are required to listen to two different extracts and answer six multiple-choice questions for each extract.
Reading
Candidates are required to demonstrate that they can read and understand different types of text on health-related subjects.
Part A – expeditious reading task (15 minutes)
Part A assesses candidates' ability to locate specific information from four short texts in a quick and efficient manner. The four short texts relate to a single healthcare topic, and they must answer 20 questions in the allocated time period. The 20 questions consist of matching, sentence completion and short answer questions.
Part B and Part C – careful reading tasks (45 minutes)
Part B assesses candidates' ability to identify the detail, gist or main point of six short texts sourced from the healthcare workplace (100-150 words each). The texts might consist of extracts from policy documents, hospital guidelines, manuals or internal communications, such as emails or memos. For each text, there is one three-option multiple-choice question.
Part C assesses candidates' ability to identify detailed meaning and opinion in two texts on topics of interest to healthcare professionals (800 words each). For each text, candidates must answer eight four-option multiple choice questions.
Writing
The task is to write a letter, usually a referral letter, but it could also be a letter of transfer or discharge. For some professions, a different type of letter is required: eg. a letter to advise or inform a patient, carer, or group, or respond to a complaint.
Speaking
The Speaking sub-test is delivered individually, and the candidate takes part in two role-plays. In each role-play, the candidate takes his or her professional role (for example, as a nurse or as a pharmacist) while the interlocutor plays a patient, a client, or a patient's relative or carer. For veterinary science, the interlocutor is the owner or carer of the animal.
Scoring
For each of the four sub-tests that make up OET, candidates receive a score from 0-500 in 10-point increments eg. 350,360, 370. The numeric score is mapped to a separate letter grade, ranging from A (highest) to E (lowest). There is no overall grade for OET.
Timing and results
OET is available up to 24 times per year and can be taken at test venues around the world.
For OET on Paper results are published online approximately days after the test OET on Computer and OET@Home results are available approximately 10 days after the test. [citation needed] Official statements of results are available to download the release of online results.[citation needed] There is no overall grade – candidates receive separate grades for each sub-test.
Most organisations that recognise OET results typically require candidates to get a B grade or higher in all four sub-tests and consider scores valid for up to two years. Additionally, these organisations usually expect candidates to achieve the necessary grades in a single attempt. However, it's important for candidates to verify the current requirements with the recognising organisation.
Inquiry into Registration Processes and Support for Overseas Trained Doctors
Prior to the formation of the Cambridge Boxhill Language Assessment Trust (CBLA), OET took part in the Inquiry into Registration Processes and Support for Overseas Trained Doctors led by the Australian Government's House Standing Committee on Health and Ageing.
On 23 November 2010, the then Minister for Health and Ageing, Hon Nicola Roxon MP, asked the Committee to inquire and report on the Registration Processes and Support for Overseas Trained Doctors. Persons and organisations of interest were then invited to make submission and asked to address the terms of reference by 4 February 2011.
The terms of references firstly explored the current administrative processes and accountability measures, with the aim of helping Overseas Trained Doctors (OTD) better understand the college assessment process as well as clarifying appeal mechanisms and facilitating community understanding and acceptance of registration decisions.
Secondly, the committee was to report on the support programs available via both state and territory and commonwealth governments, professional organisations and colleges that help OTDs achieve registration requirements and provide suggestions for their enhancement.
Finally, it was mandated to suggest ways to remove impediments and promote pathways for OTDs to achieve a full qualification while ensuring the integrity of the standards set by the colleges and regulatory bodies.
The Lost in the Labyrinth: overseas trained doctors report was finalised on 19 March 2012. It was based on the 14-month inquiry that heard from 146 witnesses from around Australia.
While there two instances of OTDs taking OET and other tests multiple times, the majority of grievances were directed at the regulatory system and the institutions that set the overall requirements. Issues such as the two-year validity of test results, levels of English required to register and achieving required scores in one sitting, are all the prerogative of the medical regulators and are not set by OET or other English test operators.
The inquiry led to some changes to the registration and compliance system that manages OTDs, including the ability to use two test results within a one six-month period for registration.
Research
OET is underpinned by over 30 years of research and the test is regularly updated to keep pace with changes in language testing in a healthcare context. There is strong emphasis on the ongoing validity and reliability of the test. Leading language testing academics contribute to the continued development of the test, and subject matter experts are consulted to ensure that tasks are based on a typical workplace situations and the demands of the profession. A full list of research can be seen on the official website
References
External links
Official website
University of Cambridge examinations
Standardized tests for English language
Standardized tests in healthcare education | 0.761571 | 0.979402 | 0.745884 |
Influence of childhood trauma in psychopathy | The influence of childhood trauma on the development of psychopathy in adulthood remains an active research question. According to Hervey M. Cleckley, a psychopathic person is someone who is able to imitate a normal functioning person, while masking or concealing their lack of internal personality structure. This results in an internal disorder with recurrent deliberate and detrimental conduct. Despite presenting themselves as serious, bright, and charming, psychopathic people are unable to experience true emotions. Robert Hare's two factor model and Christopher Patrick's triarchic model have both been developed to better understand psychopathy; however, whether the root cause is primarily environmental or primarily genetic is still in question.
Psychopathy is a personality disorder of affective, interpersonal, and behavioral dimensions that begins in childhood and manifests as aggressive actions in early or late adolescence. Childhood trauma affects vulnerability to different forms of psychopathology and traits associated with it. Parental behaviors such as rejection, abuse, neglect or over protection show some relationship with the development of detrimental psychopathic traits. Disinhibition mediates the relationship between physical abuse and two components of psychopathy (social deviation and affective interpersonal). Sexual abuse is directly correlated with the social deviation factor, and physical abuse is directly correlated with the affective interpersonal factor. Gender differences have also been observed in psychopathy. For example, psychopathic antisocial personality traits are more noticeable in males while histrionic personality traits are more evident in females. In addition, women are more likely to experience internalizing psychopathology than men and males may exhibit a stronger association between boldness and the experience of neglect as a child, as well as between meanness and the experience of childhood maltreatment.
Psychopathy
Psychopathy or psychopathic personality is a clinical condition that was first researched extensively by the American psychiatrist, Hervey M. Cleckley, who wrote about the personality pathology in his book, The Mask of Sanity. Cleckley describes the psychopathic person as “on the exterior, someone who can flawlessly imitate a normal functioning person, masking or concealing a fundamental lack of internal personality structure (e.g., the organization of the personality in terms of its basic, enduring components and their relationships to one another), resulting in an internal disorder that leads to recurrent deliberate harmful conduct, frequently more detrimental to oneself than to others." Psychopathic people, despite their outward appearance of being serious, bright, and even charming, are unable to experience true emotions. Cleckley wonders if this act of sanity is willingly undertaken in order to conceal a lack of underlying structure, but finds that it conceals a major conceptual neuropsychiatric flaw that has yet to be properly defined.
From Cleckley's work and conceptualization of psychopathy, Canadian psychologist Robert Hare developed the Psychopathy Check List (PCL-R), which was designed to detect and measure the presence of psychopathy. Hare formulated psychopathy into two factors: factor one (primary) which he defines as “selfish, callous and remorseless use of others," and factor two (secondary) which he defines as "chronically unstable, antisocial and socially deviant lifestyle.”
Using a combination of Cleckley and Hare's work along with his own conceptualizations, psychologist Christopher Patrick formulated the triarchic model of psychopathy to better understand psychopathic assessment and to address unsolved issues within the field. Patrick's model formulates psychopathy as encompassing three distinct but interrelated phenotypic dispositions: boldness (social dominance and fearlessness), meanness (aggression towards others) and disinhibition (problems controlling impulses).
The question of what causes someone to develop psychopathy or psychopathic personality traits has been researched for years. A dominating question in the field is whether one's social environment or genetics are more influential in the development of the pathology. Some have argued that genetics is at the core of psychopathy with regards to the emotional dysfunction and reduced emotional responsiveness. However, others claim that environmental and social factors (such as childhood trauma) are at the forefront of the disorder, but dependent on whether they fall into Hare's conceptualization of "primary" or "secondary" psychopathy.
Childhood trauma
Childhood trauma can entail a wide variety of experiences including death, divorce, violence, sexual abuse, illness and others. In 2018 the World Health Organization released that per year, 40 million youths under the age of 15 are victims of violence.
There are four commonly defined types of childhood abuse and neglect:
Physical abuse: the intentional use of physical force that can result in physical injury. Examples include hitting, kicking, shaking, burning, or other shows of force against a child.
Sexual abuse: involves pressuring or forcing a child to engage in sexual acts. It includes behaviors such as fondling, penetration, and exposing a child to other sexual activities.
Emotional abuse: the behaviors that harm a child's self-worth or emotional well-being. Examples include name-calling, shaming, rejection, withholding love, and threatening.
Neglect: the failure to meet a child's basic physical and emotional needs.
Emotional neglect: not meeting the child's developmental or emotional needs, including inadequate nurturance or affection.
Physical neglect: the failure to meet a child's basic physical needs, such as food, clothing, shelter, personal hygiene, and medical care.
Adverse experiences in one's childhood have been linked to a wide array of negative mental health and biological outcomes including:
Mental health: Post-traumatic stress disorder (PTSD); depression; anxiety; personality pathology
Physical health: Cardiovascular disease; diabetes
Influence of childhood trauma on psychopathy
Many question the influence that childhood traumatic experiences can have on a person's level of psychopathy. While many have found genetics to contribute to psychopathy, genetics alone cannot account for the etiology of psychopathy. The effects of childhood trauma can be seen in the relation it has with both psychopathic traits and inhibition of altruistic attitudes. In childhood, males who show higher levels of psychopathic traits are more likely to have experienced abuse and neglect, specifically emotional neglect, emotional abuse, physical abuse and sexual abuse. Because psychopathy has been heavily associated with interpersonal and social deficits, the effects of emotional neglect are of importance in assessment. This can bring challenges as emotional neglect does not show the physical signs of damage that physical abuse does, and yet can influence detrimental psychopathic effects. This is not to say that child abuse and neglect cause psychopathy; rather, it is highly unlikely that persons with severe psychopathic features did not suffer from abuse and neglect as children.
A caretaker's interaction with their children is imperative for the children's healthy development and survival. The behavior that a parent exhibits (e.g., rejection, overprotection, emotional warmth) towards their child shows implications towards the development of psychopathic traits. The model of psychopathy created by Christopher Patrick indicates associations between disinhibition, meanness and boldness in response to childhood maltreatment and parental behaviors. Specifically, disinhibition is linked to practically every facet of childhood maltreatment, with the exception of sexual abuse, overprotective parenting, and parental behavior (e.g., rejection and emotional warmth). Emotional neglect and mother overprotection have positive connections with meanness, while maternal and paternal emotional warmth have negative associations. Finally, both emotional maltreatment and physical neglect were linked to characteristics found in boldness.
Gender differences
Christopher Patrick's triarchic model of psychopathy suggests that the dispositions of disinhibition and meanness are associated with self-reported childhood maltreatment. The association between boldness and childhood neglect is found to be stronger in males than females; the relationship between disinhibition and meanness and childhood maltreatment is also shown to be stronger in males than females. This shows that males with more marked boldness traits are less likely than females to report or suffer childhood trauma, likely because males with these traits have an advantage in mobilizing resilience and are less likely to perceive past painful events as maltreatment. It's possible that men with higher levels of disinhibition and meanness are more likely to report or experience these consequences.
References
Adverse childhood experiences
Psychopathy
Child and adolescent psychiatry | 0.768544 | 0.970483 | 0.745859 |
Psi-theory | Psi-theory, developed by Dietrich Dörner at the University of Bamberg, is a systemic psychological theory covering human action regulation, intention selection and emotion. It models the human mind as an information processing agent, controlled by a set of basic physiological, social and cognitive drives. Perceptual and cognitive processing are directed and modulated by these drives, which allow the autonomous establishment and pursuit of goals in an open environment.
Next to the motivational and emotional system, Psi-theory suggests a neuro-symbolic model of representation, which encodes semantic relationships in a hierarchical spreading activation network. The representations are grounded in sensors and actuators, and are acquired by autonomous exploration.
Main assumptions
The concepts of Psi-theory may be reduced to a set of basic assumptions. Psi-theory describes a cognitive system as a structure consisting of relationships and dependencies that is designed to maintain a homeostatic balance in the face of a dynamic environment.
Representation
Psi-theory suggests hierarchical networks of nodes as a universal mode of representation for declarative, procedural and tacit knowledge. These nodes may encode localist and distributed representations. The activity of the system is modeled using modulated and directional spreading of activation within these networks.
Plans, episodes, situations and objects are described with a semantic network formalism that relies on a fixed number of pre-defined link types, which especially encode causal/sequential ordering, and partonomic hierarchies (the theory specifies four basic link-types). Special nodes (representing neural circuits) control the spread of activation and the forming of temporary or permanent associations and their dissociations.
Memory
At any time, the Psi agent possesses a world model (situation image). This is extrapolated into a branching expectation horizon (consisting of anticipated developments and active plans). In addition, the working memory also contains a hypothetical world model that is used for comparisons during recognition, and for planning.
The situation image is gradually transferred into an episodic memory (protocol). By selective decay and reinforcement, portions of this long-term memory provide automated behavioral routines, and elements for plans (procedural memory).
The atoms of plans and behavior sequences are triplets of a (partial, hierarchical) situation description, forming a condition, an operator (a hierarchical action description) and an expected outcome of the operation as another (partial, hierarchical) situation description. Object descriptions (mainly declarative) are also part of long-term memory and the product of perceptual processes and affordances. Situations and operators in long-term memory may be associated with motivational relevance, which is instrumental in retrieval and reinforcement. Operations on memory content are subject to emotional modulation.
Perception
Perception is based on conceptual hypotheses, which guide the recognition of objects, situations and episodes. Hypothesis based perception ("HyPercept") is understood as a bottom-up (data-driven and context-dependent) cuing of hypotheses that is interleaved with a top-down verification. The acquisition of schematic hierarchical descriptions and their gradual adaptation and revision can be described as assimilation and accommodation.
Hypothesis based perception is a universal principle that applies to visual perception, auditory perception, discourse interpretation and even memory interpretation. Perception is subject to emotional modulation.
Drives
The activity of the system is directed towards the satisfaction of a finite set of primary, pre-defined drives (or urges). All goals are situations that are associated (by learning) with the satisfaction of an urge, or situations that are instrumental in achieving such a situation (this also includes abstract problem solving, aesthetics, the maintenance of social relationships and altruistic behavior). These urges reflect demands of the system: a mismatch between a target value of a demand and the current value results in an urge signal, which is proportional to the deviation, and which might give rise to a motive.
There are three categories of drives:
Physiological drives (such as food, water, maintenance of physical integrity), which are relieved by the consumption of matching resources and increased by the metabolic processes of the system, or inflicted damage (integrity).
Social drives (affiliation). The demand for affiliation is an individual variable and adjusted through early experiences. It needs to be satisfied in regular intervals by external legitimacy signals (provided by other agents as a signal of acceptance and/or gratification) or internal legitimacy signals (created by the fulfillment of social norms). It is increased by social frustration (anti-legitimacy signals) or supplicative signals (demands of other agents for help, which create both a suffering by frustration of the affiliation urge, and a promise of gratification).
Cognitive drives (reduction of uncertainty, and competence). Uncertainty reduction is maintained through exploration and frustrated by mismatches with expectations and/or failures to create anticipations. Competence consists of task specific competence (and can be acquired through exploration of a task domain) and general competence (which measures the ability to fulfill the demands in general). The competence drive is frustrated by actual and anticipated failures to reach a goal. The cognitive drives are subject to individual variability and need regular satisfaction.
Changes in systemic demands are reflected in a "pleasure" or "distress signal", which is used as for reinforcement learning of associations between demands and goals, as well as episodic sequences and behavior scripts leading up to these goals.
Cognitive modulation and emotion
Cognitive processing is subject to global modulatory parameters, which adjust the cognitive resources of the system to the environmental and internal situation. These modulators control behavioral tendencies (action readiness via general activation or arousal), stability of active behaviors/chosen goals (selection threshold), the rate of orientation behavior (sampling rate or securing threshold) and the width and depth of activation spreading in perceptual processing, memory retrieval and planning (activation and resolution level). The effect and the range of modulator values are subject to individual variance.
Emotion is not understood as an independent sub-system, a module or a parameter set, but an intrinsic aspect of cognition. Emotion is an emergent property of the modulation of perception, behavior and cognitive processing, and it can therefore not be understood outside the context of cognition. To model emotion, we need a cognitive system that can be modulated to adapt its use of processing resources and behavior tendencies.
In the Psi-theory, emotions are interpreted as a configurational setting of the cognitive modulators along with the pleasure/distress dimension and the assessment of the cognitive urges. The phenomenological qualities of emotion are due to the effect of modulatory settings on perception and cognitive functioning (i.e. the perception yields different representations of memory, self and environment depending on the modulation), and to the experience of accompanying physical sensations that result from the effects of the particular modulator settings on the physiology of the system (for instance, by changing the muscular tension, the digestive functions, blood pressure and so on). The experience of emotion as such (i.e. as having an emotion) requires reflective capabilities. Undergoing a modulation is a necessary, but not a sufficient condition of experiencing it as an emotion.
Motivation
Motives are combinations of drives and a goal. Goals are represented by a situation that affords the satisfaction of the corresponding urge. Several motives may be active at a time, but only one is chosen to determine the choice of behaviors of the agent. The choice of the dominant motive depends on the anticipated probability of satisfying the associated urge and the strength of the urge signal. (This means also that the agent may opportunistically satisfy another urge if presented with that option.)
The stability of the dominant motive against other active motivations is regulated using the selection threshold parameter, which depends on the urgency of the demand and individual variance.
Learning
Perceptual learning comprises the assimilation/accommodation of new/existing schemas by hypothesis based perception. Procedural learning depends on reinforcing the associations of actions and preconditions (situations that afford these actions) with appetitive or aversive goals, which is triggered by pleasure and distress signals. Abstractions may be learned by evaluating and reorganizing episodic and declarative descriptions to generalize and fill in missing interpretations (this facilitates the organization of knowledge according to conceptual frames and scripts).
Behavior sequences and object/situation representations are strengthened by use. Tacit knowledge (especially sensory-motor capabilities) may be acquired by neural learning.
Unused associations decay, if their strength is below a certain threshold: highly relevant knowledge may not be forgotten, while spurious associations tend to disappear.
Problem solving
Problem solving is directed towards finding a path between a given situation and a goal situation, on completing or reorganizing mental representations (for instance, the identification of relationships between situations or of missing features in a situational frame) or serves an exploratory goal.
Problem solving is organized in stages: If no immediate response to a problem is found, the system first attempts to resort to a behavioral routine (automatism), and if this is not successful, it attempts to construct a plan. If planning fails, the system resorts to exploration (or switches to another motive). Problem solving is context dependent (contextual priming is served by associative pre-activation of mental content) and subject to modulation.
The strategies that encompass problem solving are parsimonious. They can be reflected upon and reorganized according to learning and experience. Many advanced problem solving strategies can not be adequately modeled without assuming linguistic capabilities.
Language and consciousness
Language has to be explained as syntactically organized symbols that designate conceptual representations, and a model of language thus starts with a model of mental representation. Language extends cognition by affording the categorical organization of concepts and by aiding in meta-cognition. (Cognition is not interpreted an extension of language by the Psi-theory.)
The understanding of discourse may be modeled along the principles of hypothesis based perception and assimilation/accommodation of schematic representations. Consciousness is related to the abstraction of a concept of self over experiences and protocols of the system and the integration of that concept with sensory experience; there is no explanatory gap between conscious experience and a computational model of cognition.
Evaluation
Evaluating the Psi-theory in an experimental paradigm is difficult, not least because of the many free variables it posits. The predictions and propositions of the Psi-theory are mostly qualitative. Where quantitative statements are made, for instance about the rate of decay of the associations in episodic memory, the width and depth of activation spreading during memory retrieval, these statements are rarely supported by experimental evidence; they represent ad hoc solutions to engineering requirements posed by the design of a problem solving and learning agent.
A partial exception to this rule is the emotional model, which has been tested as a set of computational simulation experiments. While it contains many free variables that determine the settings of modulator parameters and the response to motive pressures, it can be fitted to human subjects in behavioral experiments and thereby demonstrate similar performance in an experimental setting as different personality types. The parameter set can also be fitted to an environment by an evolutionary simulation; the free parameters of the emotional and motivational model allow a reproduction of personal variances.
The Psi-theory can also be interpreted as a specification for a cognitive architecture.
MicroPsi architecture
MicroPsi is a cognitive architecture built by Joscha Bach at the Humboldt University of Berlin and the Institute of Cognitive Science of the University of Osnabrück. MicroPsi extends the representations of the Psi-theory with taxonomies, inheritance and linguistic labeling; MicroPsi's spreading activation networks allow for neural learning, planning and associative retrieval.
MicroPsi's first generation (2003–2009) is implemented in Java, and includes a framework for editing and simulating software agents using spreading activation networks, and a graphics engine for visualization. MicroPsi has also been used as a robot control architecture.
MicroPsi 2 is a new implementation of MicroPsi, written in Python, and currently used as a tool for knowledge representation.
OpenCog
The OpenCog cognitive architecture includes a simple implementation of Psi-theory, dubbed OpenPsi. It includes interfaces to Hanson Robotics robots for emotion modelling.
Literature
Dietrich Dörner: Bauplan für eine Seele. Rowohlt, 1999, (in German).
Dietrich Dörner, Christina Bartl, Frank Detje, Jürgen Gerdes, Dorothée Halcour, Harald Schaub, Ulrike Starker: Die Mechanik des Seelenwagens. Eine neuronale Theorie der Handlungsregulation. Verlag Hans Huber, 2002, (in German).
Dietrich Dörner & C. Dominik Güss, (2013). PSI: A computational architecture of cognition, motivation, and emotion. Review of General Psychology, 17, 297–317.
Joscha Bach: Principles of Synthetic Intelligence. PSI: An Architecture of Motivated Cognition. Oxford University Press, 2009, .
References
External links
MicroPsi cognitive architecture based on Psi-theory
Advanced Magic natural language processing using Psi-theory in artificial intelligence applications
A Simulation of Cognitive and Emotional Effects of Overcrowding
Human Factors Team of IABG applications of the Psi-theory
The PSI model of emotion, personality and action
A theory of emotion
Intercultural Communications at the University of Jena applications of the Psi-theory
Cognitive architecture | 0.774557 | 0.962893 | 0.745816 |
Educational psychologist | An educational psychologist is a psychologist whose differentiating functions may include diagnostic and psycho-educational assessment, psychological counseling in educational communities (students, teachers, parents, and academic authorities), community-type psycho-educational intervention, and mediation, coordination, and referral to other professionals, at all levels of the educational system. Many countries use this term to signify those who provide services to students, their teachers, and families, while other countries use this term to signify academic expertise in teaching Educational Psychology.
Specific facts
Psychology is a well-developed discipline that allows different specializations, which include; clinical and health psychology, work and organizational psychology, educational psychology, etc. What differentiates an educational psychologist from other psychologists or specialists is constituted by an academic triangle whose vertexes are represented by three categories: teachers, students, and curricula (see diagram). The use of plural in these three cases assumes two meanings; the traditional or official one and other more general derived from our information and knowledge society. The plural also indicates that nowadays, we can no longer consider the average student or teacher, or a closed curriculum, but the enormous variety found in our students, teachers, and curricula. The triangle vertexes are connected by two-directional arrows, allowing four-fold typologies instead of the traditional two-way relationships (e.g., teacher-student). In this way, we can find, in different educational contexts, groups of good teachers and students (excellent teaching/learning processes and products), groups of good teachers but bad students, and groups of bad teachers and good students, producing in both cases lower levels of academic achievements. In addition, we can find groups of bad teachers and bad students (school failure).
This specific work of an educational psychologist takes place in different contexts: micro-, meso- and macro-systems. Microsystems refer to family contexts, where atmosphere, hidden curriculum, and expectations and behaviors of all family members determine, to a large extent, the educational development of each student. The term mesosystem refers to all variety of contexts found in educational institutions, knowing that different variables such as geographical location, institution marketing or type of teachers and students, etc., can influence the academic results of students. Macrosystem has a much more general and global nature, leading us, for example, to consider the influence that the different societies or countries have on educational final products. One illustrative example of this level can be the analyses carried out on data gathered by the PISA reports. This approach would be the essence of educational psychology versus school psychology for many of U.S. educational researchers and for Division 15 of APA.
Specific functions
There are four specific functions that are the essence of educational psychology. These are evaluation, psychological counseling, communitarian interventions, and referral to other professionals.
Evaluation involves collecting information, in a valid and reliable way, about the three target groups of the triangle diagram (in their respective contexts): teachers, students and curricula. (Not to be confused with curriculum vitae). The most noteworthy function is, without a doubt, formal (rather than informal) assessment. Evaluation is divided into least two main types: diagnosis (dysfunctions detection such as physical, sensory and intellectual impairments, dyslexia, attention-deficit/hyperactivity disorder, pervasive development disorders or autism spectrum disorders) and psycho-educational evaluation (detection of curriculum difficulties, poor school atmosphere or family problems, etc.). Evaluation implies detection, and, thanks to this, Prevention.
A second function, very relevant too, is psychological counseling. This must be directed to students, in their various dimensions (intellectual, obviously, but also their social, affective and professional dimensions), parents, as ‘paraprofessionals’ who may implement programs, selected or developed by educational psychologists, to solve their child/student problems, teachers, to whom will be offered psycho-educational support to face psychological difficulties that may be found when implementing and adapting curricula to diversity shown by students, academic authorities, who will be helped in their decision-making, regarding the teaching (teaching process) and administrative duties (providing necessary support for students with specific educational needs, decisions about promotion to the next level, and so on).
A third function is based on communitarian interventions, with three main facets: corrective, preventative, and optimizing interventions. If disruptive behavior occurs in particular moments and contexts, then a corrective intervention is required. If the aim is school violence reduction, then tertiary preventive intervention programs are needed. If an early diagnosis of learning difficulties is carried out, then psychologist has undertaken secondary prevention. If the aim is to use psycho-educational programs to prevent future school failure, then a primary preventative intervention program is put into practice. The complement to all of these interventions is constituted by a series of optimizing activities, meant for the academic, professional, social, family, and personal improvement of all agents in an educational community, especially learners.
A fourth function, or specific activity, is a referral of those with dysfunctions to other professionals, following a previous diagnostic evaluation, with the aim to coordinate future treatment implementation. This coordination will take place with parents, teachers, and other professionals, promoting collaboration among all educational agents in order to get the fastest and best case resolution. This second triangle represents the essential components of school psychology, for some European researchers or division 16 of APA.
Academic requirements
Recently a specific Doctoral degree (Masters in Scotland) is generally required for the professional preparation of educational psychologists in the UK. In this Doctorate in Educational Psychology, it is essential the main course which prepares educational psychologists for carrying out a diagnostic and psycho-educational assessment, psychological counseling to the educational communities, and all types of communitarian interventions (corrective, preventive and optimizing). Trainees also develop external professional practices (where the specific coordination, evaluation, counseling, and intervention functions will be put into practice) on placement in local authorities, as well as a final thesis. Equally, there are a series of theoretical areas that, due to their relevancy in the teaching/learning contexts, should be included, such as: classroom diversity, drug-dependency prevention, developmental disorders, learning difficulties, new technologies applied to educational contexts, and data analysis and interpretation. In sum, taking into account all of this, perhaps educational psychologists will be able to meet adequately the demands found in different educational institutions.
The following qualifications are required: an undergraduate degree in psychology (or approved postgraduate conversion course which confers the BPS Graduate Basis for Registration) and a BPS accredited Doctorate in Educational Psychology (3 years), or, for Scotland only, an accredited master's degree in Educational Psychology. Whilst teaching experience is relevant, it is no longer an entry requirement. At least one year's full-time experience working with children in educational, childcare, or community settings is required, and for some courses, this may be two years' experience.
To use the term Educational Psychologist in the UK, one will need to be registered with the Health Care Professionals Council (HCPC), which involves completing a course (Doctorate or Masters) approved by the HCPC.
In the United States
In the most basic sense of standards for education requirements in the United States, an educational psychologist needs a bachelor's degree, followed by a master's degree, and commonly finishing with a PhD or a PsyD in Educational Psychology. Specifically in California, an educational psychologist candidate (commonly referred to as a LEP or Licensed Educational Psychologist) must have a minimum of a master's degree in psychology or a related field in educational psychology. This degree must be coupled with a minimum of three years of experience, including two years as a credential school psychologist and one year of supervised professional experience in an accredited school psychology program. After completing these requirements, a candidate will then take an LEP examination to determine if the applicant will be approved. These requirements are widely accepted by the Board of Behavioral Sciences (BBS) and are considered the common standard. States may have varying standards, but the aforementioned standards are a commonality when working in a school setting. Another route that can be followed is in the research field. It involves many of the same standards without the direct link of being in a school setting. Those with a research setting are typically employed through a university and do research based on their own and others' findings. They may also teach at the university in their respective field.
Handbooks, application forms, and board reviews can be found at various websites:
http://apadiv15.org/wp-content/uploads/2014/01/Division15Bylaws2012.pdf
http://www.bbs.ca.gov/pdf/forms/lep/lepapp.pdf
http://www.caspwebcasts.org/new/index.php?option=com_content&view=article&id=325&Itemid=140
Job availability/outlook and salary
The average salary of an educational psychologist is variable dependent on where the psychologist depends on practicing. In a school setting, the professional can expect to make around $68,000 a year; however, these professionals are commonly school psychologists who have a different background than educational psychologists. An educational psychologist in the research and development field could expect to make around $84,000 per year. Both of these averages could be considered inflated, with another source listing the average income of an educational psychologist at around $57,000 per year. However, the resounding majority seems to sit at the $67,000 per year range, making the previous income average considerably modest. The latest statistics released in 2010 by the Bureau of Labor Statistics place the median annual salary at $72,540 – showing an increase over a four-year period – compared to the median household income of the United States which is currently at $51,000. Educational psychologists make approximately 40% more than the average American, making it an advantageous field of study.
Job outlook in the field of educational psychology is considered in good condition. By national estimates (US) growth in the field ranges from 11 to 15% between 2006 and 2022. A report released in 2006 the rate of growth was listed as 15% from 2006 to 2016, and a separate report released put the growth percentage at a modest 11% from 2012 to 2022. Considering most job outlook growth percentages of the time, educational psychologists had the highest in the psychology field and was also considered the highest amongst all occupations at the time of its release in 2006.
See also
References
External links
British Psychological Society
Division 15 of the American Psychological Association
Division 16 of the American Psychological Association
Journal of Educational Psychology
National Association of Principal Educational Psychologists
National Educational Psychological Service
Northern Arizona University Educational Psychology program
Standards for Educational and Psychological Testing | 0.763778 | 0.976445 | 0.745787 |
Psychodynamic Diagnostic Manual | The Psychodynamic Diagnostic Manual (PDM) is a diagnostic handbook similar to the International Statistical Classification of Diseases and Related Health Problems (ICD) or the Diagnostic and Statistical Manual of Mental Disorders (DSM). The PDM was published on May 28, 2006.
The information contained in the PDM was collected by a collaborative task force which includes members of the American Psychoanalytic Association, the International Psychoanalytical Association, the Division of Psychoanalysis (Division 39) of the American Psychological Association, the American Academy of Psychoanalysis and Dynamic Psychiatry, and the National Membership Committee on Psychoanalysis in Clinical Social Work.
Although it is based on current neuroscience and treatment outcome studies, Benedict Carey pointed out in a 2006 New York Times article that many of the concepts in the PDM are adapted from the classical psychoanalytic tradition of psychotherapy. For example, the PDM indicates that the anxiety disorders may be traced to the "four basic danger situations" described by Sigmund Freud (1926) as the loss of a significant other; the loss of love; the loss of body integrity; and the loss of affirmation by one's own conscience. It uses a new perspective on the existing diagnostic system as it enables clinicians to describe and categorize personality patterns, related social and emotional capacities, unique mental profiles, and personal experiences of the patient.
The PDM is not intended to compete with the DSM or ICD. The authors report the work emphasizes "individual variations as well as commonalities" by "focusing on the full range of mental functioning" and serves as a "[complement to] the DSM and ICD efforts in cataloguing symptoms. The task force intends for the PDM to augment the existing diagnostic taxonomies by providing "a multi dimensional approach to describe the intricacies of the patient's overall functioning and ways of engaging in the therapeutic process."
With the publication of the DSM-3 in 1980, the manual switched from a psychoanalytically influenced dimensional model to a "neo-Kraepelinian" descriptive symptom-focused model based on present versus absent symptoms. The PDM provided a return to a psychodynamic model for the nosological evaluation of symptom clusters, personality dimensions, and dimensions of mental functioning.
Taxonomy
Dimension I: Personality Patterns and Disorders
This first dimension classifies personality patterns in two domains. First, it looks at the spectrum of personality types and places the person's personality on a continuum from unhealthy and maladaptive to healthy and adaptive. Second, it classifies how the person "organizes mental functioning and engages the world".
The task force adds, "This dimension has been placed first in the PDM system because of the accumulating evidence that symptoms or problems cannot be understood, assessed, or treated in the absence of an understanding of the mental life of the person who has the symptoms". In other words, a list of symptoms characteristic of a diagnosis does not adequately inform a clinician how to understand and treat the symptoms without proper context. By analogy, if a patient went to her physician complaining of watering eyes and a runny nose, the symptoms alone do not indicate the appropriate treatment. Her symptoms could be a function of seasonal allergies, a bacterial sinus infection, the common cold, or she may have just come from her grandmother's funeral. The doctor might treat allergies with an antihistamine, the sinus infection with antibiotics, the cold with zinc, and give her patient a Kleenex tissue after the funeral. All four conditions may have very similar symptoms; all four condition are treated very differently.
Dimension II: Mental Functioning
Next, the PDM provides a "detailed description of emotional functioning" which are understood to be "the capacities that contribute to an individual's personality and overall level of psychological health or pathology". This dimension provides a "microscopic" examination of the patient's mental life by systematically accounting for their functional capacity to
Process information
Self-regulate
Establish and maintain relationships
Experience, organize, and express feelings and emotions at different levels
Represent, differentiate, and integrate experience
Utilize appropriate coping strategies and defense mechanisms
Accurately observe oneself and others
Form internal values and standards
Dimension III: Manifest Symptoms and Concerns
The third dimension starts with the DSM-IV-TR diagnostic categories; moreover, beyond simply listing symptoms, the PDM "goes on to describe the affective states, cognitive processes, somatic experiences, and relational patterns most often associated clinically" with each diagnosis. In this dimension, "symptom clusters" are "useful descriptors" which presents the patient's "symptom patterns in terms of the patient's personal experience of his or her prevailing difficulties". The task force concludes, "The patient may evidence a few or many patterns, which may or may not be related, and which should be seen in the context of the person's personality and mental functioning. The multi dimensional approach... provides a systematic way to describe patients that is faithful to their complexity and helpful in planning appropriate treatments".
The new edition (PDM-2)
Guilford Press published a new edition of the Psychodynamic Diagnostic Manual (PDM-2), developed by a steering committee composed by Vittorio Lingiardi (Editor), Nancy McWilliams (Editor), and Robert S. Wallerstein (Honorary Chair). Guilford Press received a manuscript for PDM-2 in September 2016, and the release date was June 20, 2017.
Like the PDM-1, the PDM-2 classifies patients on three axes: 'P-Axis - Personality Syndromes', 'M-Axis - Profiles of Mental Functioning', and 'S-Axis - Symptom Patterns: The Subjective Experience'. The P-Axis is intended to be viewed as a "map" of personality instead of a listing of personality disorders as in the DSM-5 and ICD-10. The PDM-2 defines different terms as part of the P-Axis including "personality", "character", "temperament", "traits", "type", "style", and "defense". The S-Axis bears a lot of similarity to the DSM and ICD due to the inclusion of predominantly psychotic disorders, mood disorders, disorders related primarily to anxiety, event- and stressor-related disorders, somatic symptom disorders and addiction disorders.
See also
Diagnostic and Statistical Manual of Mental Disorders
DSM-IV Codes
International Statistical Classification of Diseases and Related Health Problems
ICD-10
Research Domain Criteria (RDoC), a framework being developed by the National Institute of Mental Health
References
External links
Website of the Psychodynamic Diagnostic Manual
APA News monitor: Five psychoanalytic associations collaborate to publish a new diagnostic manual.
2006 non-fiction books
Medical manuals
Classification of mental disorders
Books about psychoanalysis | 0.764652 | 0.975317 | 0.745778 |
Occupational Information Network | The Occupational Information Network (O*NET) is a free online database that contains hundreds of job definitions to help students, job seekers, businesses and workforce development professionals to understand today's world of work in the United States. It was developed under the sponsorship of the US Department of Labor/Employment and Training Administration (USDOL/ETA) through a grant to the North Carolina Employment Security Commission (now part of the NC Commerce Department) during the 1990s. John L. Holland's vocational model, often referred to as the Holland Codes, is used in the "Interests" section of the O*NET.
History
From 1938 to the 1990s, vocational lists and employment matching offered by the U.S. government were available through the book, The Dictionary of Occupational Titles or the DOT. The DOT was first published in 1938 and "emerged in an industrial economy and emphasized blue-collar jobs. Updated periodically, the DOT provided useful occupational information for many years. But its usefulness waned as the economy shifted toward information and services and away from heavy industry." With the shift in the economy, plans developed to replace the book format of the DOT with an online database. A limited use, preliminary version was released in December 1997, followed by a public edition in December 1998. The O*NET thus, "supersedes the seventy-year-old Dictionary of Occupational Titles with current information that can be accessed online or through a variety of public and private sector career and labor market information systems." The decision to move from the DOT to O*NET, "remains controversial (e.g., Gibson, Harvey, & Harris, 2007; Harvey, 2009; Harvey & Hollander, 2002), even as we approach the 20-year anniversary of its inception (e.g., APDOT, 1992). Many applied psychologists have praised O*NET (e.g., Peterson, Mumford, Borman, Jeanneret, Fleishman, Levin, Campion, Mayfield, Morgeson, Pearlman, Gowing, Lancaster, Silver, & Dye, 2001)."
O*NET classifies jobs in job families (functional areas which include workers from entry level to advanced, and may include several sub-specialties). After the third major revision of O*NET realigned all O*NET occupations to conform to the newly mandated Standard Occupational Classification (SOC)), O*NET, with less than 1,000 listed occupational categories, compares to over 13,000 occupations in the last published DOT.
Overview
The O*NET system varies from the DOT in a number of ways. It is a digital database which offers a "flexible system, allowing users to reconfigure data to meet their needs" as opposed to the "fixed format" of the DOT; it reflects the employment needs of an Information society rather than an Industrial society; costs the government and users much less than a printed book would,
and is easier to update as new data is collected. The US Department of Labor/Employment and Training Administration (USDOL/ETA) describes the O*NET as: "a database of occupational requirements and worker attributes. It describes occupations in terms of the skills and knowledge required, how the work is performed, and typical work settings. It can be used by businesses, educators, job seekers, human resources professionals, and the publicly funded Workforce Investment System to help meet the talent needs of our competitive global economy. O*NET information helps support the creation of industry competency models."
For each job, O*NET provides the following information:
Personal requirements: the skills and knowledge required to perform the work
Personal characteristics: the abilities, interests, and values needed to perform the work
Experience requirements: the training and level of licensing and experience needed for the work
Job requirements: the work activities and context, including the physical, social, and organizational factors involved in the work
Labor market: the occupational outlook and the pay scale for the work
See also
Holland Codes
References
Further reading
Mariani, Matthew. "Replace with a database: O*NET replaces the Dictionary of Occupational Titles." Occupational Outlook Quarterly Online, Spring 1999 Vol. 43, Number 1.
Rounds, James, Patrick I. Armstrong, Hsin-Ya Liao, and Phil Lewis & David Rivkin. "Second Generation Occupational Interest Profiles for the O*NET System: Summary." The National Center for O*NET Development, June 2008.
"A Database for a Changing Economy: Review of the Occupational Information Network (O*NET)." , 978-0-309-14769-9. The National Academies Press, 2010.
External links
My Next Move - O*NET partner
O*NET Holland Codes Interests matched to careers - Occupational Information Network (O*NET): US Department of Labor/Employment and Training Administration (USDOL/ETA)
O*NET Holland Codes Interest Profiler - Occupational Information Network (O*NET): US Department of Labor/Employment and Training Administration (USDOL/ETA)
Career guidance in India based on O*NET and cultural variables - Research validating the usefulness of O*NET outside the US
Human resource management software
Occupations
United States Department of Labor
Vocational education
Public employment service | 0.763907 | 0.976234 | 0.745752 |
Multiple complex developmental disorder | Multiple complex developmental disorder (MCDD) is a research category, proposed to involve several neurological and psychological symptoms where at least some symptoms are first noticed during early childhood and persist throughout life. It was originally suggested to be a subtype of pervasive developmental disorders (PDD) with co-morbid schizophrenia or another psychotic disorder; however, there is some controversy that not everyone with MCDD meets criteria for both PDD and psychosis. The term multiplex developmental disorder was coined by Donald J. Cohen in 1986.
Diagnostic criteria
The current diagnostic criteria for MCDD are a matter of debate due to it not being in the DSM-V or ICD-10. Various websites contain various diagnostic criteria. At least three of the following categories should be present. Co-occurring clusters of symptoms must also not be better explained by being symptoms of another disorder such as experiencing mood swings due to autism, cognitive difficulties due to schizophrenia, and so on. The exact diagnostic criteria for MCDD remain unclear but may be a useful diagnosis for people who do not fall into any specific category. It could also be argued that MCDD is a vague and unhelpful term for these patients.
Psychotic symptoms
Criteria are met for a psychotic disorder.
Some symptoms may include:
Delusions, such as thought insertion, paranoid preoccupations, fantasies of personal omnipotence, over engagement with fantasy figures, grandiose fantasies of special powers, referential ideation, and confusion between fantasy and real life.
Hallucinations and/or unusual perceptual experiences.
Negative symptoms (anhedonia, affective flattening, alogia, avolition)
Disorganized behavior and/or speech such as thought disorder, easy confusability, inappropriate emotions/facial expressions, uncontrollable laughter, etc.
Catatonic behavior.
Affective and behavioral symptoms
These symptoms are not due to situations such as, person is depressed because of difficulty making friends. It is normal to experience dysfunctional emotions and behaviors at times. Criteria are met for a neurotic or personality disorder, preferably at least two.
Some symptoms may include:
Depression.
Mania.
Anxiety.
Anger.
Dissociative symptoms such as depersonalization, derealization, deja vu, etc.
Emotional instability.
Psychopathic behavior.
Narcissism.
Paranoia.
Obsessive-compulsive behavior.
Autistic symptoms
Criteria are met for an autistic spectrum disorder.
Some symptoms may include:
Difficulty with social skills.
Repetitive behaviour and patterns.
Sensory processing disorder. (Poor motor skills, poor auditory processing, poor depth perception, etc.)
Alexithymia. (Difficulty expressing self, difficulty understanding emotions, literal concrete thinking, etc.)
Lack of eye contact.
Intense, singular interests.
Low interest in dress up games during childhood.
Neurological symptoms
Because these are frequently found in cases of autistic disorders, criteria could be met for multiple neurological disorders, or cause severe symptoms.
Some examples include:
Learning difficulties symptoms such as dyslexia, dysgraphia, dyscalcula, NVLD, slow learning, poor memory, etc.
ADHD symptoms such as poor concentration, poor decision making, poor judgement, impulsiveness, difficulty sitting still, etc.
Synesthesia.
Neurological sleep disorders such as narcolepsy, insomnia, circadian rhythm disorder, etc.
Conditions affecting perceptions and/or cognition, such as agnosia, aphasia, etc.
Tourette syndrome or Tic disorder.
Epilepsy or Seizure disorder.
Parkinsonian syndrome features such as tremors, stiff movements, etc.
Causes
Multiple complex developmental disorder is likely to be caused by a number of different various genetic factors. Each individual with MCDD is unique from one another and displays different symptoms. Various neuropsychological disorders can also be found in family members of people with MCDD.
References
External links
https://web.archive.org/web/20140119071845/http://medicine.yale.edu/childstudy/autism/information/mdd.aspx
Pervasive developmental disorders
Nervous system | 0.77073 | 0.967564 | 0.745731 |
Quality of working life | Quality of working life (QWL) describes a person's broader employment-related experience. Various authors and researchers have proposed models of quality of working lifealso referred to as quality of worklifewhich include a wide range of factors, sometimes classified as "motivator factors" which if present can make the job experience a positive one, and "hygiene factors" which if lacking are more associated with dissatisfaction. A number of rating scales have been developed aiming to measure overall quality of working life or certain aspects thereof. Some publications have drawn attention to the importance of QWL for both employees and employers, and also for national economic performance.
Models and components
Hackman and Oldham (1976)
Hackman and Oldham (1976) drew attention to what they described as psychological growth needs as relevant to the consideration of quality of working life. Several such needs were identified :
skill variety
task identity
task significance
autonomy
feedback
They suggested that such needs have to be addressed if employees are to experience high quality of working life.
Taylor (1979)
In contrast to such theory based models, Cooper & Mumford (1979) more pragmatically identified the essential components of quality of working life as basic extrinsic job factors of wages, hours and working conditions, and the intrinsic job notions of the nature of the work itself. They suggested that a number of other aspects could be added, including:
individual power
employee participation in the management
fairness and equity
social support
use of one's present skills
self-development
a meaningful future at work
social relevance of the work or product
effect on extra work activities
Cooper & Mumford suggested that relevant quality of working life concepts may vary according to organisation and employee group.
Warr et al. (1979)
Warr and colleagues (1979), in an investigation of quality of working life, considered a range of apparently relevant factors, including:
work involvement
intrinsic job motivation
higher order need strength
perceived intrinsic job characteristics
job satisfaction
life satisfaction
happiness
self-rated anxiety
They discussed a range of correlations derived from their work, such as those between work involvement and job satisfaction, intrinsic job motivation and job satisfaction, and perceived intrinsic job characteristics and job satisfaction. In particular, Warr et al. found evidence for a moderate association between total job satisfaction and total life satisfaction and happiness, with a less strong, but significant association with self-rated anxiety.
Thus, whilst some authors have emphasised the workplace aspects in quality of working life, others have identified the relevance of personality factors, psychological well-being, and broader concepts of happiness and life satisfaction.
Factors more obviously and directly affecting work have, however, served as the main focus of attention, as researchers have tried to tease out the important influences on quality of working life in the workplace.
Mirvis and Lawler (1984)
Mirvis and Lawler (1984) suggested that quality of working life was associated with satisfaction with wages, hours and working conditions, describing the "basic elements of a good quality of work life" as:
safe work environment
equitable wages
equal employment opportunities
opportunities for advancement
opportunities to learn and grow
protection of individual rights
Baba and Jamal (1991)
Baba and Jamal (1991) listed what they described as typical indicators of quality of working life, including:
job satisfaction
job involvement
work role ambiguity
work role conflict
work role overload
job stress
organisational commitment
turn-over intentions
Baba and Jamal also explored routinisation of job content, suggesting that this facet should be investigated as part of the concept of quality of working life.
Ellis and Pompli (2002)
Some have argued that quality of working life might vary between groups of workers. For example, Ellis and Pompli (2002) identified a number of factors contributing to job dissatisfaction and quality of working life in nurses, including:
poor working environments
resident aggression
workload, inability to deliver quality of care preferred
balance of work and family
[[shiftwork
lack of involvement in decision making
professional isolation
lack of recognition
poor relationships with supervisor/peers
role conflict
lack of opportunity to learn new skills
Sirgy et al. (2001)
Sirgy et al. (2001) suggested the quality of working life as a second-order factor with seven first-order dimensions:
health and safety needs
economic and family needs
social needs
esteem needs
actualization needs
knowledge needs
aesthetic needs
They defined quality of working life as satisfaction of these key needs through resources, activities, and outcomes stemming from participation in the workplace. Needs as defined by the psychologist, Abraham Maslow, were seen as relevant in underpinning this model, covering health & safety, economic and family, social, esteem, actualization, knowledge and aesthetics, although the relevance of non-work aspects is played down as attention is focussed on quality of work life rather than the broader concept of quality of life. The proposed measure by Sirgy et al. (2001) suggests that quality of working life involves lower-order (social needs; esteem needs; actualization needs; knowledge needs; and, aesthetic needs) and higher-order needs (health and safety needs; and, economic and family needs). This measure is adapted to more than ten different countries, namely Portugal and Brazil (presenting good validity evidence based on the internal structure and based on the relation to other variables).
These attempts at defining quality of working life have included theoretical approaches, lists of identified factors, correlational analyses, with opinions varying as to whether such definitions and explanations can be both global, or need to be specific to each work setting.
Bearfield (2003)
Bearfield (2003) used 16 questions to examine quality of working life, and distinguished between causes of dissatisfaction in professionals, intermediate clerical, sales and service workers, indicating that different concerns might have to be addressed for different groups.
Herzberg et al. (1959)
The distinction made between job satisfaction and dissatisfaction in quality of working life reflects the influence of job satisfaction theories. Herzberg et al., (1959) used "Hygiene factors" and "Motivator factors" to distinguish between the separate causes of job satisfaction and job dissatisfaction. It has been suggested that Motivator factors are intrinsic to the job, that is; job content, the work itself, responsibility and advancement. The Hygiene factors or dissatisfaction-avoidance factors include aspects of the job environment such as interpersonal relationships, salary, working conditions and security. Of these latter, the most common cause of job dissatisfaction can be company policy and administration, whilst achievement can be the greatest source of extreme satisfaction.
Nanjundeswaraswamy and Swamy (2013)
Nanjundeswaraswamy and Swamy (2013) used nine components to measure quality of worklife of employees in private technical institutions:
work environment
organization culture and climate
relation and co-operation
training and development
compensation and rewards
facilities
job satisfaction and job security
autonomy of work
adequacy of resources
Male employees are more satisfied than female employees the chi square test confirms that all the demographic factors like gender, designation, salary, department, experience are independent of quality of worklife of employees in private technical institution. Study also reveals that there is a significant association between QWL of Teaching and Non teaching staffs. From the correlation analysis it is find that Adequacy of Resources are more correlated and Training & Development are less correlated with teaching staffs perception towards quality of worklife and in case of non teaching staffs Compensation & Rewards are more correlated and Work Environment are less correlated with QWL.
Lawler and Porter (1966)
An individual's experience of satisfaction or dissatisfaction can be substantially rooted in their perception, rather than simply reflecting their "real world". Further, an individual's perception can be affected by relative comparison – am I paid as much as that person – and comparisons of internalised ideals, aspirations, and expectations, for example, with the individual's current state (Lawler and Porter, 1966).
Discussion
In summary, where it has been considered, authors differ in their views on the core constituents of quality of working life.
It has generally been agreed however that quality of working life is conceptually similar to well-being of employees but differs from job satisfaction which solely represents the workplace domain.
Quality of working life is not a unitary concept, but has been seen as incorporating a hierarchy of perspectives that not only include work-based factors such as job satisfaction, satisfaction with pay and relationships with colleagues, but also factors that broadly reflect life satisfaction and general feelings of well-being. More recently, work-related stress and the relationship between work and non-work life domains have also been identified as factors that should conceptually be included in quality of working life.
Measurement
There are few recognised measures of quality of working life, and of those that exist, few have evidence of validity and reliability, although both the Brief Index of Affective Job Satisfaction and the Quality of Work Life Scale have been systematically developed to be reliable and is rigorously psychometrically validated.
The Brief Index of Affective Job Satisfaction (BIAFJS) is a 4-item, purely affective as opposed to cognitive, measure of overall affective job satisfaction that reflects quality of working life. The BIAJS differs from other job satisfaction measures in being comprehensively validated not just for internal consistency reliability, temporal stability, convergent and criterion-related validities, but also for cross-population invariance by nationality, job level, and job type. Reported internal consistency reliabilities range between .81 and .87.
Statistical analysis of the Work-Related Quality of Life scale (WRQoL), provides support for the psychometric structure of this instrument. The WRQoWL measure uses six core factors to explain most of the variation in an individual's quality of working life: Job and Career Satisfaction; Working Conditions; General Well-Being; Home-Work Interface; Stress at Work and Control at Work.
The Job & Career Satisfaction (JCS) scale of the Work-Related Quality of Life scale (WRQoL) is said to reflect an employee's feelings about, or evaluation of, their satisfaction or contentment with their job and career and the training they receive to do it. Within the WRQoL measure, JCS is reflected by questions asking how satisfied people feel about their work. It has been proposed that this Positive Job Satisfaction factor is influenced by various issues including clarity of goals and role ambiguity, appraisal, recognition and reward, personal development career benefits and enhancement and training needs.
The General well-being (GWB) scale of the Work-Related Quality of Life scale (WRQoL), aims to assess the extent to which an individual feels good or content in themselves, in a way which may be independent of their work situation. It is suggested that general well-being both influences, and is influenced by work. Mental health problems, predominantly depression and anxiety disorders, are common, and may have a major impact on the general well-being of the population. The WRQoL GWB factor assesses issues of mood, depression and anxiety, life satisfaction, general quality of life, optimism and happiness.
The WRQoL Stress at Work sub-scale (SAW) reflects the extent to which an individual perceives they have excessive pressures, and feel stressed at work. The WRQoL SAW factor is assessed through items dealing with demand and perception of stress and actual demand overload. Whilst it is possible to be pressured at work and not be stressed at work, in general, high stress is associated with high pressure.
The Control at Work (CAW) subscale of the WRQoL scale addresses how much employees feel they can control their work through the freedom to express their opinions and being involved in decisions at work. Perceived control at work as measured by the Work-Related Quality of Life scale (WRQoL) is recognized as a central concept in the understanding of relationships between stressful experiences, behaviour and health. Control at work, within the theoretical model underpinning the WRQoL, is influenced by issues of communication at work, decision making and decision control.
The WRQoL Home-Work Interface scale (HWI) measures the extent to which an employer is perceived to support the family and home life of employees. This factor explores the interrelationship between home and work life domains. Issues that appear to influence employee HWI include adequate facilities at work, flexible working hours and the understanding of managers.
The Working Conditions scale of the WRQoL assesses the extent to which the employee is satisfied with the fundamental resources, working conditions and security necessary to do their job effectively. Physical working conditions influence employee health and safety and thus employee Quality of working life. This scale also taps into satisfaction with the resources provided to help people do their jobs.
Applications
Regular assessment of quality of working life can potentially provide organisations with important information about the welfare of their employees, such as job satisfaction, general well-being, work-related stress and the home-work interface. Studies in the UK University sector have shown a valid measure of quality of working life exists and can be used as a basis for effective interventions.
Worrall and Cooper (2006) reported that a low level of well-being at work is estimated to cost about 5-10% of gross national product per annum, yet quality of working life as a theoretical construct remains relatively unexplored and unexplained within the organisational psychology research literature.
A publication of the National Institute for Clinical Excellence (NICE) emphasises the core role of assessment and understanding of the way working environments pose risks for psychological wellbeing through lack of control and excessive demand. The emphasis placed by NICE on assessment and monitoring wellbeing springs from the fact that these processes are the key first step in identifying areas for improving quality of working life and addressing risks at work.
See also
Quality of life
Happiness at work
Workplace wellness
Workplace health promotion
References
Working conditions
Working life
Workplace | 0.769716 | 0.968787 | 0.745691 |
Common Technical Document | The Common Technical Document (CTD) is a set of specifications for an application dossier for the registration of medicine, designed for use across Europe, Japan, the United States, and beyond.
Major Synopsis
The CTD is an internationally agreed format for the preparation of applications regarding new drugs intended to be submitted to regional regulatory authorities in participating countries. It was developed by the European Medicines Agency (EMA, Europe), the Food and Drug Administration and the Ministry of Health, Labour and Welfare (Japan) starting at World Health Organization International Conference of Drug Regulatory Authorities (ICDRA) at Paris in 1989.
The CTD is maintained by the International Council on Harmonisation of Technical Requirements for Registration of Pharmaceuticals for Human Use (ICH).
After the United States, European Union and Japan, the CTD was adopted by several other countries including Canada and Switzerland.
Paper CTDs are destined for replacement by their electronic counterparts, the eCTDs.
Contents
The Common Technical Document is divided into five modules:
Administrative and prescribing information
Overview and summary of modules 3 to 5
Quality (pharmaceutical documentation)
Preclinical (pharmacology/toxicology)
Clinical – efficacy and safety (clinical trials)
Detailed subheadings for each module are specified for all jurisdictions. The contents of Module 1 and certain subheadings of others differ based on national requirements. However, investigational new drugs meant for emergency use or treatment applications and not for commercial distribution are not subject to the CTD requirements.
See also
Clinical Data Interchange Standards Consortium
Clinical trial
eCTD
Harmonization in clinical trials
References
External links
ICH
Common Technical Document
Clinical research
Clinical data management
Pharmaceuticals policy
Drug safety
Life sciences industry
International standards | 0.760463 | 0.980569 | 0.745686 |
Sheltered workshop | The term sheltered workshop refers to an organization or environment that employs people with disabilities separately from others, usually with exemptions from labor standards, including but not limited to the absence of minimum wage requirements.
In the United States, an exemption in the Fair Labor Standards Act of 1938 allowed a lower minimum wage for people with disabilities, intended to help disabled World War I veterans have opportunities for employment. Since then, non-profit organizations have hired disabled workers in sheltered workshops, with about 300,000 individuals working in this arrangement in 2015. At the end of the 20th century, a movement to end sheltered workshops gained traction, with supporters stating that the jobs pay low wages, lack advancement training and opportunities, permanently trapping disabled people in those jobs while reducing their independence, and are discriminatory because they segregate disabled workers into separate work environments. Disability service providers, many parents, and disabled workers themselves support the workshops and state that eliminating the minimum wage exemption would eliminate those jobs and the choice to work (because many with severe disabilities will never be able to perform at the level of an ordinary worker) and thereby prevent disabled people from enjoying the many non-wage benefits of work (like a sense of pride for their societal contribution), and replace it with adult day care. By 2023, fourteen states had passed laws banning subminimum wages.
Australia
Sheltered workshops are often called Australian Disability Enterprises or ADEs. In Australia, employees with intellectual disabilities make up 75% of the ADE workforce. The Australian Disability Enterprise (ADE) sector in Australia generally has its roots in the early 1950s when families of people with disabilities established sheltered workshops to provide vocational activity for people with disability. At this time employment opportunities for people with disability were extremely limited.
In 1986, following the passage of the Commonwealth Disability Services Act (1986), Australia transitioned from the sheltered workshop system to the new model prioritizing employment for people with disabilities. In 1996, additional reforms were introduced for the purpose of improving service quality, matching service funding to the support needs of people with disability receiving assistance, and to link funding to employment outcomes. This led to a reform agenda in the ADE sector, with the introduction of legislated Quality Assurance standards that required ADEs to obtain independent verification of their compliance to these prior to receiving ongoing funding from the Australian Government. Additionally, a funding model that links payments to individual support needs was introduced.
In some ADEs individuals are paid as little as $1.79 an hour, based on the BSWAT (Business Services Wage Assessment Tool), which was found to be discriminatory in 2013, to be phased out by April 2015. Wages are based on a percentage of award rates, according to the workplace competencies and productivity of the person with a disability in comparison to a worker without a disability.
Following on from the court challenge on the discriminatory nature of the BSWAT, a large percentage of parents and employees of ADEs (along with the relevant Peak Body, National Disability Services) began a campaign to ensure their jobs were protected. Many raised the point that ADEs are not typical workplaces and provide significantly more support and opportunities than open employment workplaces. These parents, carers and Employees were concerned that if ADEs were forced to pay full livable award wages for employees with a disability, many would be financially unsustainable. An episode of the ABC's Background Briefing in September 2014 stated that ADE's either barely make a profit or operate at a loss, and have to compete with low wage labor in other countries, which makes some people concerned that requiring them to pay higher wages will make those they employ unemployed, and unable to enjoy the many non-wage benefits of work like friendships and a sense of societal contribution.
Canada
In Canada sheltered workshops are being phased out for supported employment but remain a predominant vocational model for people with intellectual disabilities, who have an employment rate of less than 30%.
Europe
Sheltered workshops are a common form of employment provision for people with disabilities across Europe where their disabilities create barriers to accessing the open labour market. Traditional sheltered workshops offer long-term or permanent employment for people with disabilities whereas transitional sheltered workshops aim to develop workers' skills so that they can access non-sheltered employment in other workplaces. Government procurement law in the European Union makes special provision for contracting with sheltered workshops for the supply of goods and services to public authorities. Germany's federal decree on contracts for workshops for the disabled (10 May 2005) requires German federal contracting authorities to set aside part of their budgets for contracts which can be awarded to workshops for workers with disabilities.
United Kingdom
In the U.K., the Disabled Persons (Employment) Act of 1944 founded a company primarily to help returning veterans return to work called Remploy. Remploy founded factories across the United Kingdom. In 1986, 55,000 disabled people had been employed in the factories at some point. However, the UK moved towards mainstream employment, rather than sheltered workshops. By 2013, all Remploy factories were closed.
United States
The Fair Labor Standards Act of 1938 established a minimum wage in the United States; Section 14(c) of the bill included an exception for people with disabilities, intended to help disabled World War I veterans have opportunities for employment. Employers who wish to pay less than minimum wage must acquire a certificate from the U.S. Department of Labor. The terms "sheltered workshop" and "work center," are used by the Wage and Hour Division of the Department of Labor to refer to entities that are authorized to employ workers with disabilities at sub-minimum wages. These entities are generally non-profit facilities that exclusively or primarily employ people with disabilities, and also provide vocational rehabilitation.
In 2020, the United States Commission on Civil Rights issued a report which recommends that the minimum wage exemption be phased out because it keeps workers in "exploitative and discriminatory" jobs. The issue of whether sheltered workshops should exist is a contentious issue within the disability services community. Advocates of disability rights state that the jobs pay low wages and lack advancement training and opportunities, permanently trapping disabled people in those jobs while reducing their independence, and are discriminatory because they segregate disabled workers into separate work environments. Many people with severe disabilities cannot perform at the level of an ordinary worker (e.g., cannot fold as many shirts or wash as many dishes in a day), but self-advocates see minimum wage fight as having less to do with tangible worker productivity and more to do with their paycheck showing that they are equally valued members of society.
Disability service providers, almost all of which are non-profits, as well as many parents and disabled workers themselves support the workshops and state that eliminating the minimum wage exemption would eliminate those jobs and the choice to work and thereby enjoy the many non-wage benefits of work (like a sense of pride for their societal contribution), and replace it with adult day care or "glorified babysitting". Some parents and caregivers rely on the sheltered workshops so that they can work, sleep, or care for themselves, or for the benefit of getting their children out of the house to see other people. These programs often also offer Medicaid benefits. Alternative respite care and adult daycare programs are often unavailable.
On a national level, Congressional legislation that would phase out subminimum wages has been proposed multiple times unsuccessfully. Most recently, the Transformation to Competitive Integrated Employment Act (TCIEA) was introduced in 2021.
At the state level, Vermont was the first state to ban subminimum wages; since then six others have also enacted legislation banning subminimum wages: Alaska, Maine, Maryland, Nevada, New Hampshire and Oregon. Of those, four no longer have sheltered workshops.
California
In 2021, California banned organizations from paying disabled people less than minimum wage, giving the agencies who employ disabled workers until 2025 to either pay their workers the statewide minimum of $15.50 per hour or shut down. Advocates of the new legislation feel that subminimum wage programs segregate disabled workers into separate work environments, reduce their independence, and prevent them from learning better job skills which could lead to advancement. Supporters of the sub-minimum wage arrangements feel that it is unrealistic to think that severely disabled individuals will ever be able to produce the same output as ordinary minimum wage workers, and that making it illegal to pay them based on their performance will simply mean that they will be unemployed, and thereby not able to experience the sense of accomplishment that comes from a job. In 2022, less than 20% of developmentally disabled persons in California were employed.
References
Accessibility
Social entrepreneurship
Developmental disabilities
Segregation | 0.762764 | 0.97761 | 0.745685 |
Transactionalism | Transactionalism is a pragmatic philosophical approach to questions such as: what is the nature of reality; how we know and are known; and how we motivate, maintain, and satisfy our goals for health, money, career, relationships, and a multitude of conditions of life through mutually cooperative social exchange and ecologies. It involves the study and accurate thinking required to plan and utilize one's limited resources in the fundamental mechanics of social exchange or trans-action. To transact is learning to beat the odds or mitigate the common pitfalls involved with living a good and comfortable life by always factoring in the surrounding circumstances of people, places, things and the thinking behind any exchange from work to play.
In our complex, ever-changing society with its indifferent marketplace, we cannot thrive without requesting or inviting the help of others and offering help to those around us. To co-create a healthy exchange of value for all involved, we must understand and apply the fundamental mechanics of transaction. [This is not to be confused with the favor or advantage of quid pro quo.]
Without cooperative exchange, we resist transacting to survive the unavoidable biological, societal, and environmental threats that can prevent us from comfort and ease in any of the multiple conditions of life we labor to maintain (cf. Hannah Arendt's philosophy of labor, work, and action).
In this philosophy, human interactions are best understood as a set of simple to complex transactions. A transaction is a reciprocal and co-constitutive cycle of moves (what to do) and phases (or implemented tactics) aimed at satisfying (or at learning to become fit) in the multiple and interlocking conditions of life including health, work, money, knowledge, education, career, ethics, and more. If we work ourselves to death or ignore accurate thinking about our relationships, without help those conditions of life will eventually threaten our health, career, and money, for example. We must transact to maintain multiple and unavoidable conditions of our lives.
A transactionalist approach demands an "un-fractured observation" of life as an organism that is influenced by and is influencing its environment or ecology. By considering the self as an organism inseparable from its environment, hyphenated as "organism-environment," we begin to recognize that any outcome is "determined by prior causes and articulated ends" not merely the intention or the end goal of an individual. This philosophical approach has correlation to Hannah Arendt's notion of human being as "political animal" ("Zoon Politikon") that should attend to the "labor, work, and action" beyond merely articulating an aspiration or a goal.
It is critical that an organism-environment keep in mind how "consequences and outcomes" determine the satisfaction of any human endeavor. We must take into account that we, as a human being in transaction, are embedded in and constituted by not only our intentions, but simultaneously by the specific circumstances of our biology, our narratives in exchange, and the social situation that includes tangible resources like tools and settings, intangible resources like time and meaning, and the human resources of other people and their personalities and roles within a transaction or social exchange.
Beyond our conscious awareness, three aspects of experience — the observer, the process of observing, and the thing observed in a situation— are all "affected by whatever merits or defects [the organism or environment] may prove to have when it is judged".
A transactionalist holds that all human acts, including learning, are best understood as "entities" within a larger, often under-examined, transactional whole. The transactional whole is shaped by our health as an organism as well as the health of others (e.g., our biology as a living organisms), for example. Transactional competence is shaped by language and communication with others (e.g.,linguistic narratives). It is shaped and affected by one's fitness in satisfying an ethical exchange of business or education in certain conditions of life, such as reputation, politics (small and large), and ethics—how we treat one another or regulate our behavior and feelings.
Human satisfaction is shaped first and foremost by our body's state of wellness or disease, which is inescapably linked to the ecology, shared and/or invented norms and values, and the fitness of our ability to understand the mechanics of trans-acting. We must make real the conditions and accept the consequences of what it takes to live a satisfying life in an ever-changing body and world.
Transactionalism functions as a means of "controlled inquiry" into the complex nature and interactions of daily life.
Overview
In their 1949 book Knowing and the Known, transactionalists John Dewey and Arthur Bentley explained that they were "willing under hypothesis to treat all [human] behavings, including [their] most advanced knowings, as activities not of [them]self alone, nor even as primarily [theirs], but as processes of the full situation of organism-environment."
John Dewey used the term "trans-action" to "describe the process of knowing as something that involves the full situation of organism-environment, not a mere inter-action between two independent entities, e.g., the observer and the object observed." A "trans-action" (or simply a "transaction") rests upon the recognition that subject (the observer) and object (the observed) are inseparable; "Instead, observer and observed are held in close organization. Nor is there any radical separation between that which is named and the naming." A knower (as "subject") and what they know (as "object" that may be human, tangible, or intangible) are inseparable and must be understood as inseparable to live a truly satisfying life.
Dewey and Bentley distinguished the "trans-actional" point of view (as opposed to a "self-actional" or "inter-actional" one) in their preface: The transactional is in fact that point of view which systematically proceeds upon the ground that knowing is co-operative and as such is integral with communication. By its own processes it is allied with the postulational. It demands that statements be made as descriptions of events in terms of durations in time and areas in space. It excludes assertions of fixity and attempts to impose them. It installs openness and flexibility in the very process of knowing. It treats knowledge as itself inquiry—as a goal within inquiry, not as a terminus outside or beyond inquiry.The metaphysics and epistemology of living a satisfactory life begins with the hypothesis that man is an "organism-environment" solving problems in and, through a necessary exchange with others. Therefore, attention must always be paid to organizing acts as aspects or entities within a reciprocal, co-constitutive, and ethical exchange, whether it be in co-operative buying and selling; teaching and learning; marital trans-actions; or in any social situation where human beings engage one another.
Definition
Stemming from the Latin transigere ("to drive through", "to accomplish"), the root word "transaction" is not restricted to (or to be collapsed with) the economic sense of buying and selling or merely associated with a financial transaction. A much larger field of exchange is employed and summoned up here; such as, "any sort of social interaction, such as verbal communication, eye contact, or touch. A 'stroke' [of one's hand] is an act of recognition of a transaction" as described in psychological transactional analysis It not only examines exchanges, or "transactions," between borrower and lender, but encompasses any transaction involving people and objects including "borrowing-lending, buying-selling, writing-reading, parent-child, and husband-wife [or partners in a civil or marital union]." A transaction, then is "a creative act, engaged in by one who, by virtue of [their] participation in the act – of which [they are] always an aspect, never an entity – together with the other participants, be they human or otherwise environmental, becomes in the process modified" by and through exchange with others.
Background
Main contributors
While John Dewey is viewed by many transactionalists as its principal architect, social anthropologist Fredrik Barth was among the first to articulate the concept as it is understood in contemporary study. Political scientists Karl W. Deutsch and Ben Rosamond have also written on the subject.
In 1949, Dewey and Bentley offered that their sophisticated pragmatic approach starts from the perception of "man" as an organism that is always transacting within its environment; that it is sensible to think of our selves as an organism-environment seeking to fulfill multiple necessary conditions of life "together-at-once". It is a philosophy purposefully designed to correct the "fragmentation of experience" found in the segmented approaches of Subjectivism, Constructivism, Objectivism (Ayn Rand), and Skepticism.[1] Each of these approaches are aspects of problem-solving used by the transactionalist to examine the invention, construction of a narrative presentation, the objective work or activity that must happen, and the deconstruction of a transaction to fully observe and assess the consequences and outcomes of any transaction—from simply to complex—in the process of living a good and satisfying life.
Dewey asserted that human life is not actually organized into separate entities, as if the mind (its sense of emotion, feeling, invention, imagination, or judgment) and the world outside it (natural and manufactured goods, social roles and institutions including the family, government, or media) are irreconcilable, leading to the question "How does the mind know the world?"
Transactionalist analysis is a core paradigm advanced by social psychologist Eric Berne in his book Games People Play, in which an analyst seeks to understand an individual as "embedded and integrated" in an ever-evolving world of situations, actors, and exchange.
The situational orientation of transactionalist problem-solving has been applied to a vast array of academic and professional discourses including educational philosophy in the humanities; social psychology, political science, and political anthropology in the social sciences; and occupational science in the health sciences; cognitive science, zoology, and quantum mechanics in the natural sciences; as well as the development of a transactional competence in leadership-as-practice in business management.
Historical antecedents
Galileo refused to seek the causes of the behavior of physical phenomena in the phenomena alone and sought the causes in the conditions under which the phenomena occur.The evolution of philosophy from aristotelian thought to galilean thinking shifts the focus from behavior to the context of the behavior in problem-solving. The writing of John Dewey and Arthur Bentley in Knowing and the Known offers a dense primer into transactionalism, but its historical antecedents date back to Polybius and Galileo.
Trevor J. Phillips (1927–2016), American professor emeritus in educational foundations and inquiry at Bowling Green State University from 1963 to 1996, wrote a comprehensive thesis documenting the historical, philosophical, psychological, and educational development of transactionalism in his 1966 dissertation "Transactionalism: An Historical and Interpretive Study" published in 2013 by business education called Influence Ecology. Phillips traced transactionalism's philosophical roots to Greek historians such as Polybius and Plato as well as 17th century polymath Galileo—considered the architect of the scientific revolution and René Descartes—considered the architect of modern western philosophy.
Galileo's contributions to the scientific revolution rested on a transactionalist understanding from which he argued Aristotelian physics was in error, as he wrote in Dialogue Concerning the Two Chief World Systems (1632):"[I]f it is denied that circular motion is peculiar to celestial bodies, and affirmed to belong to all naturally movable bodies, then one must choose one of two necessary consequences. Either the attributes of generable-ingenerable, alterable-inalterable, divisible-indivisible, etc., suit equally and commonly all world bodies – as much the celestial as the elemental – or Aristotle has wrongly and erroneously deduced, from circular motion, those attributes which he has assigned to celestial bodiesTransactionalism abandons self-actional and inter-actional beliefs or suppositions that lead to incomplete problem-solving. In a world of subjective and objective information, co-operative exchange creates value in learning and becomes the foundation of a transactional competence based on recurrent inquiry into how objects (including people) behave as situations constantly evolve.
Galileo deviated from the then-current Aristotelian thinking, which was defined by mere interactions rather than co-constitutive transacting among persons with different interests or among persons who may be solving competing intentions or conditions of life.
Modern antecedents
Trevor Phillips also outlined the philosophy's more recent developments found in the American philosophical works of Charles Sanders Peirce, sociologist George Herbert Mead (symbolic interactionism), pragmatist philosophers William James and John Dewey, and political scientist Arthur Bentley.
Several sources credit anthropologist Fredrik Barth as the scholar first to apply the term 'transactionalism" in 1959. In a critique of structural functionalism, Barth offered a new interpretation of culture that did not portray an overly cohesive picture of society without attending to the "roles, relationships, decisions, and innovations of the individual." Humans are transacting with one another at the multiple levels of individual, group, and environment. Barth's study appears to not fully articulate how this is happening all-at-once as opposed to as-if they were separate entities interacting independently ("interactional"):[T]he "environment" of any ethnic group is not only defined by natural conditions, but also by the presence and activities of other ethnic groups on which it depends. Each group exploits only a section of the total environment, and leaves large parts of it open for other groups to exploit.Using examples from the people of the Swat district of North Pakistan and, later, in 1966, organization taking place among Norwegian fishermen, Barth set out to demonstrate that social forms like kinship groups, economic institutions, and political alliances are generated by the actions and strategies of the individuals who deploy organized acts against (or within) a context of social constraints. "By observing how people interact with each other [through experience], an insight could be gained into the nature of the competition, values[,] and principles that govern individuals' choices."
Utilized as a "theoretical orientation" in Norwegian anthropology, describes transactionalism as "process analysis" (prosessanalyse) categorized as a sociological theory or method. Though criticized for paying insufficient attention to cultural constraints on individualism, Barth's orientation influenced the qualitative method of symbolic interactionism applied throughout the social sciences. Process analysis considers the gradual unfolding of the course of interactions and events as key to understanding social situations. In other words, the transactional whole of a situation is not readily apparent at the level of individuals. At that level, an individual operates in a self-actional manner when much larger forces of sociality, history, biology, and culture are, all-at-once, at work on an individual as part of a global dynamic. Humans can never exist outside this dynamic current, as if they are operating the system in some self-actional or interactional way. Barth's approach reflects the co-constitutive nature of living in ever-evolving circumstances.
21st century applications
Transactional leadership (LAP)
In a new model of organizational management known as "leadership-as-practice" (LAP), Dewey and Bentley's Knowing and the Known categories of action—namely, self-action, inter-action, and trans-action–brings transactionalism into the corporate culture. A transactional leadership practice is defined by its "trans-actors" who "enact new and unfolding meanings in on-going trans-actions." Actors operating "together-at-once" in a transaction is contrasted with the older model of leadership defined by the practices of actors operating in self-actional or inter-actional way. In the former models, often the actors and situations remain unchanged by leadership interventions over time because the actors and situations remain unchanged.
In leadership-as-practice, Joseph A. Raelin distinguishes between a "practice" that extends and amplifies the meaning of work and its value vs. "practices" that are habitual and sequential activities evoked to simplify everyday routines. A transactional approach—leadership-as-practice—focuses attention on "existing entanglements, complexities, processes, [while also] distinguishing problems in order to coordinate roles, acts, and practices within a group or organization." Said another way, "trans-action attends to emergent becoming"—a kind of seeing together--"rather than substantive being" among the actors involved.
Transactional competence
Modern architects of the philosophy, John Patterson and Kirkland Tibbels, co-founders of Influence Ecology, acquired, edited, and published Phillips' dissertation (as is) in 2013. With a foreword written by Tibbels, a hardback and Kindle version was published under the title Transactionalism: An Historical and Interpretive Study (2013). The monograph is an account of how human phenomena came to be viewed less as the behavior of static and/or mutually isolated entities, and more as dynamic aspects of events in the process of problem-solving, and thereby becoming or satisfying, the unavoidable and inescapable conditions of human life.
Philosophy
Metaphysics: transactional (vs. self-actional or interactional)
The transactional view of metaphysics—studying the nature of reality or what is real—deals with the inseparability of what is known and how humans inquire into what is known—both knowing and the known. Since the age of Aristotle, humans have shifted from one paradigm or system of "logic" to another before a transactional metaphysics evolved with a focus that examines and inquires into solving problems first and foremost based on the relationship of man as a biological organism (with a brain and a body) shaped by its environment. In the book Transactionalism (2015), the nature of reality is traced historically from self-action to interaction to transactional competence each as its own age of knowing or episteme.
The pre-Galilean age of knowing is defined by self-action "where things [and thereby people] are viewed as acting on their own powers." In Knowing and the Known, Dewey and Bentley wrote, "The epistemologies, logics, psychologies and sociologies [of our day] are still largely [understood] on a self-actional basis."
The result of Newtonian physics, interaction marks the second age of knowing; a system marked especially by the "third 'law of motion'—that action and reaction are equal and opposite".
The third episteme is transactional competence. With origins in the contributions of Darwin, "man's understandings are finite as opposed to infinite. In the same way, his views, goals, commitments, and beliefs have relative status as opposed to absolute." John Dewey and Arthur Bentley asserted this competence as "the right to see together, extensionally and durationally, much that is talked about conventionally as if it were composed of irreconcilable separates." We tend to avoid considering our actions as part of a dynamic and transactional whole, whether in mundane or complex activities; whether in making an invitation, request, or offer or in the complex management of a program or company. We tend to avoid studying, thinking, and planning our moves and moods for a comprehensive, reciprocal, and co-constitutive—in other words, transactional—whole.
A transactional whole includes the organized acts including ideas, narratives, people as resources implementing ideas, services, and products, the things involved, settings, and personalities, all considered in and over time. With this competence, that which acts and is acted upon become united for a moment in a mutual or ethical exchange, where both are reciprocally transformed contradicting "any absolute separation or isolation" often found in the dualistic thinking and categorization of Western thought.
Dualistic thinking and categorization often lead to over-simplification of the transactional whole found in the convenient but ineffective resorting to "exclusive classifications." Such classifications tend to exclude and reify man as if he has dominion over his nature or the environment.
In his seminal 20th century work Physics and Philosophy, Werner Heisenberg reflects this kind of transactionalist thinking: "What we observe is not nature itself, but nature exposed to our method of questioning." The together-at-once reality of man as organism-environment is often overlooked in the dualistic thinking of even major philosophers like Descartes who is often referenced for his "I think, therefore I am" philosophy. Of a transactionalist approach, Heisenberg writes, "This was a possibility of which Descartes could not have thought, but it makes the sharp separation of the world and I impossible."
Dualistic thinking prevents man from thinking. "In the spirit of [Charles Sanders] Peirce, transactionalism substitutes continuity for discontinuity, change and interdependence for separateness."
For example, in problem solving, whenever we "insert a name instead of a problem," when words like "soul," "mind," "need," "I.Q." or "trait" are expressed as if real, they have the power to block and distort free inquiry into what is known in fact or as fact in the transactional whole.
In the nature of change and being, "that which acts and that which is acted upon" always undergo a reciprocal relationship that is affected by the presence and influence of the other. We as human beings, as part of nature as an organism "integral to (as opposed to separate from, above or outside of) any investigation and inquiry may use a transactionalist approach to expand our personal knowledge so as to solve life's complex problems.
The purpose of transactionalism is not to discover what is already there, but for a person to seek and interpret senses, objects, places, positions, or any aspect of transactions between one's Self and one's environment (including objects, other people, and their symbolic interactions) in terms of the aims and desires each one needs and wants to satisfy and fulfill. It is essential that one simultaneously take into account the needs and desires of others in one's environment or ecology to avoid the self-actional or self-empowerment ideology of a rugged and competitive individualism. While other philosophies may discuss similar ethical concerns, this co-constitutive and reciprocal element of problem-solving is central to transactionalism.
To put it simply, "to experience is to transact; in point of fact, experience is a transaction of organism-environment." In other words, what is "known" by the knower (or organism) is always filtered and shaped by both internal and external moods and narratives, mirrored in and through our relationships to the physical affordances and constraints in our environment or in specific ecologies.
The metaphysics of transactional inquiry is characterized in the pragmatic writing of William James who insists that "single barreled terms," terms like "thought" and "thing," actually stop or block inquiries into what is known and how we know it. Instead, a transactional orientation of 'double-barreledness' or the "interdependence of aspects of experience" must always be considered. James offers his readers insight into the "double-barreledness" of experience with an apt proposition:Is the preciousness of a diamond a quality of the gem [the thing] or is it a feeling in our mind [the thought]? Practically we treat it as both or as either, according to the temporary direction of our thought. The 'experienced' and the 'experiencing,' the 'seen' and the 'seeing,' are, in actuality, only names for a single fact.
What is real then, from a transactionist perspective, must be constantly reevaluated relative to man as organism-environment in a co-constitutive and reciprocal dynamic with people, personalities, situations, aims, and given the needs each party seeks to satisfy.
Epistemology: truth from inquiry
Transactionalists are firmly intolerant of "anything resembling an 'ultimate' truth – or 'absolute' knowledge."
Humankind has the propensity to treat the mind and thought or the mind and body as abstractions and this tendency to deny the interrelatedness or coordinated continuity results in misconceptions in learning and inaccurate thinking as humans move and thrive with an ecology. Accurate thinking and learning begins and is constantly developed through action resulting from thought as a repetitive circuit of experience known in psychology as deliberate practice. Educational philosopher Trevor Phillips, now deceased, frames this tendency to falsely organize our perception: "[W]e fail to realize that we can know nothing about things [or ourselves] beyond their significance to us," otherwise we distort our "reality" and treat things we perceive within it, including our bodies or mind, as if concrete thereby "denying the interconnectedness of realities" (plural). Transactionalists suggest that accurate (or inaccurate) thinking is rarely considered an unintended consequence of our propensity for abstractions.
When an individual transacts through intelligent or consequential actions circumscribed within the constraints and conditions of her/his environment in a reflexive, repetitive arc of learned experience, there is a "transaction between means and ends" (see reference below). This transactional approach features twin aspects of a larger event rather than merely manipulating the means to an end in our circumstances and situations. For instance, a goal can never be produced by abstraction, by simply thinking about or declaring a promise to produce a result. Nor can it be anticipated or foreseen (an abstraction at best) without a significant "pattern of inquiry," as John Dewey later defined and articulated, into the constraints and conditions that happen and are happening given the interdependence of all the people and objects involved in a simple or complex transaction. The nature of our environment affects all these entities within a transaction. Thus, revealing the limiting and reductive notion of manipulating a psychology around stimulus and response found in Aristotilian or Cartesian thought.
A transaction is recognized here as one that occurs between the "means and ends;" in other words, transactional competence is derived from the "distinctions between the how, the what (or subject-matter), and the why (or what for)." This transactional whole constitutes a reciprocal connection and a reflexive arc of learned and lived experience. From a transactional approach one can derive a certain kind of value from one's social exchange. Value in knowing how, what, and why the work done with your mind and body fulfill on the kinds of transactions needed to live a good and satisfying life that functions well with others. Truth from actual inquiry is foundational for organism-environment to define and live by a set of workable ethical values that functions with others.
Due to the evolution of psychology about the nature of man, transactionalists also reject the notion of a mind-body split or anything resembling the bifurcation of what they perceive as the circuitry in which our biological stimulus-response exists. Examples transactionalists reject include the self-acting notions of Aristotle who posited that "the soul – the psyche – realized itself in and through the body, and that matter and form were two aspects involved in all existence." Later, the claims of French philosopher René Descartes, recognized as the father of modern Western philosophy, were examined and defined as "interactional". Descartes suggested stimulus-response as the realm where the mind controls the body and the body may influence the rational mind out of the passion of our emotions.
Transactionalists recognize Cartesian dualism as a form of disintegrating the transactional whole of man "into two complete substances, joined to another no one knows how." The body as a physical entity, on the one hand, and the soul or thought, on the other, was regarded in a Cartesian mindset as "an angel inhabiting a machine and directing it by means of the pineal gland" This tranactionalists reject.
Ethics: reciprocal and co-constitutive
While self-interest governs the ethical principles of Objectivism, here the principle is that man as an organism is in a reciprocal, constitutive relationship with her/his environment. Disabusing the psychological supposition of our "skin-boundedness" (discussed further below), transactionalism rejects the notion that we are apart from our environment or that man has dominion over it. Man, woman, and child must view life and be viewed in the undifferentiated whole of organism-environment. This reciprocal and co-constitutive relationship is what sets Transactionalism apart from other philosophies.
What John Dewey meant by "reciprocal" was that:... consequences have to be determined on the grounds of what is selected and handled as means in exactly the same sense in which the converse holds and demands constant attention if activities are to be intelligently conducted.In order for a human being to know, in order for a human being to acquire intelligence, it must learn to relate to its Self as part of, not separate from the internal and/or external environments in which it lives as an organism-environment. Whether the environment is natural or human-made, whether discussing biology, sociology, culture, linguistics, history and memory, or economics and physics, every organism-environment is reciprocal, constitutive, socially-conditioned and constantly in flux demanding our ethical attention to conditions and consequences as we live life. John Dewey and Arthur Bentley, like Charles Sanders Peirce before them, were out to distinguish an ethical "living" logic rather than a static one. Both rejected the supposition that man had dominion over or governed behavior in his/her environment embracing a presupposition of transactionalism; we are reciprocal, co-constitutive, socially-conditioned, and motivated "together-at-once" as we seek solutions to living a good life.
Transactionalists reject the "localization" of our psychology as if "skin-bound." Bentley wrote, "No creature lives merely under its skin." In other words, we should not define and distinguish experience in and from the subjective mind and feelings. Conversely, we cannot rely solely on external circumstances or some static or inherited logic. Galileo said of followers of Aristotle in seeking ethical knowledge that one should "come with arguments and demonstrations of your own...but bring us no more texts and naked authorities, for our disputes are about the sensible world and not a paper one." Humans are always transacting, "together-at-once," part of, shaped by, and shap-ing the experience we call "knowledge" as an organism-environment.
Dewey and Bentley were intrigued by, and ultimately questioned, "the significance of the concept 'skin' and its role in philosophical and psychological thought." They offered a biological or natural justification that came to define a transactionalist approach. The known and what is known are both a function of man having "evolved among other organisms" within natural selection or evolution.
Man's most intellectual and advanced "knowings" are not merely outgrowths of his own doing or being. The natural evolution of things outside our knowingness creates the very context in which our known and knowings arise. We are not inventing what is known outside or, in a vacuum beyond, who we are and who we are is an organism-environment together-at-once. We are not creatures separated by skin with an internal world of the mind and body "in here" separate from an environment of objects and people "out there". Human beings intelligently live, adapt to, and organize life in a reciprocal, co-constitutive experience that is what Dewey and Bentley term "trans-dermal".
A "trans-dermal" experience demands knowledgeable and accurate inquiry into the conditions and consequences of each transaction where the organizing of ideas and acts (knowledge), is itself a transaction which grows out of the problem-solving and creative exploring within the universe of social situations in which we exist. Dewey and Bentley wrote, "truth, or for that matter falsity, is a function of the deliberately striven for consequences arising out of inquiry."
Our behavior and acts in knowing, or transacting, must be considered "together" and "at-once" with its conditions and consequences for any ambitious movement or fulfillment to occur alone and among other people in any setting with objects and constructed inherited from others known and unknown over time. Transacting demands study, a slowing down of our movement, and the development of a transactional competence in order to fulfill certain needs or solve problems while functioning among others.
In Dewey's final days, wrote Phillips, he emphasized the twin aspects of attending to both the means and the ends of any transaction: "It is…impossible to have an end-in-view or to anticipate the consequences of any proposed line of action." A "trans-dermal" consciousness is, therefore, key to moving ethically. To move, experience life, or transact in a principled manner, considering the reciprocal and co-constituitive nature of organism-environment becomes an object lesson governing both social behavior as well as in transacting from a trans-dermal view with objects or other bodies.
Trans-dermal experience
The work of Australian educational philosopher Vicki L. Lee further elucidates and breaks down what is "trans-dermal" experience—how it works and why it matters—based on her work in the philosophy of cognitive science, educational philosophy, and radical behaviorism about which she has published extensively. This complex paradigm is clearly evidenced by Lee in this thickly described example:Acts are more than movements. ...Our discriminations depend on movements and their contexts seen together-at-once or as an undifferentiated whole. In discriminating watering the garden from hosing the driveway, we see the bodily movements and their occasion and results. We see the garden, the watering implement, and so forth, as much as we see the body's activities. The notion of together-at-once emphasizes that we do not see movements and contexts separately and then infer the action. Rather the context is internal to the action, because without the context, the action would not be the action it is.A basic presupposition of the philosophy of transactionalism is to always consider that that which is known about the world (extra-dermal) is "directly concerned with the activity of the knower" which is merely from some sense of "skin-boundedness" (intra-dermal). The known and the knower, as Dewey and Bentley examined in detail in their collaborative publication, must always be considered "'twin aspects of common fact."
Behavior, movement, and acts are not merely a function of the mind, of wishful or positive thinking or belief in external forces, nor can it be determined ethically from the philosophers of the past or knowledge written in a book. It is our ability to transact trans-dermally—to be and become ecologically-fit as an organism-environment—that begets truthful inquiry into living a good and satisfying life, functioning well among others.
Philosophy and Women's Studies Professor Shannon Sullivan explores and applies "transactional knowing through embodied and relational lived experience" as a feminist epistemology developed out of the pragmatist tradition.
Politics: cooperation and knowing-as-inquiry
The branch of philosophy recognized as "politics" concerns the governance of community and group interaction, not merely the governing over a state or group as conventionally conceived in thoughts about local or national government.
Transactionalists view politics as a cooperative, genuine interaction between all participating parties whether buyer-seller, student-teacher, or worker-boss; we are biological as well as social subjects involved not merely in "transacting" for our own advantage or gain but connected to other entities. "[S]ocial phenomena cannot be understood except as there is prior understanding of physical conditions and the laws of their [socio-biological] interactions," wrote John Dewey in Logic: The Theory of Inquiry. Furthermore, he added, "inquiry into [social phenomena], with respect both to data that are significant and to their relations or proper ordering, is conditioned upon extensive prior knowledge of physical phenomena and their laws. This fact accounts in part for the retarded and immature state of social subjects." Thus, cooperation and knowing as inquiry is foundational to governing communal affairs of any kind including economic trade and our educative process.
In Laws of Motion (1920), physicist James Clerk Maxwell articulated the modern conception of "transaction" (or trans-action) used here. His conception is not exclusive to an economic context or limited to the opposition of a buyer-seller in trade or some analogous situation. Unlike commercial affairs, there is a radical departure from any tendency to perceive buyer-seller (in an organism-environment paradigm) as if they are opposing or separate forces. Transactionalists like Maxwell view the buyer and seller as "two parts [or aspects] of the same phenomenon."
Dewey and Bentley apply this 'transactional' view to the domain of learning more than any other context. Referred to as the educative process, acting without knowing (described below) often sets up the separation or fracturing of the enjoined phenomenon (e.g., knowing is doing, organizing the mental or physical acts in a pragmatic way). Without knowing-as-inquiry, blindly acting as an organism in an environment often does not work with the exception of beginner's luck. Acting to understand knowing elicits pragmatic knowledge of functioning as an organism-environment; both knowing and acting must essentially involve inquiry into things that have happened and are happening in order to challenge assumptions and expectations which may be wrong in some context: Knowledge – if the term is to be employed at all – is a name for the product of competent inquiries, and is constituted only as the outcome of a particular inquiry.From the constitutive process of knowing and doing, knowledge is more than "a process taking place" or some "status" located in an organism's [of person's] mind. Knowledge arises from inquiry. It arises out of a kind of testing, an iterative process of inquiry into what we know and expect, that ensures a suitable fitness not only in solving problems (finding a solution). It ensures the fitness of the organism-environment, which may vary depending on the situation, the time and place, or the culture.
While a person is central (or "nuclear" as in a nucleus) to a conception of organism-environment, human beings as organisms must abdicate any sense of dominion over their social-biological cosmos. Being human is but a part, and never outside, that cosmos or environment which they need to survive and they need to adapt to, to thrive. Each situation and assumptions about it—and this transactionalists assert is radical way of thinking—must be tested, examined, and determined by a series of iterative moves and activity based on the capacity of that organism's ability to fulfill its desired intentions to eventually thrive (or not).
Dewey and Bentley later insisted that knowing "as inquiry, [is therefore] a way, or distinct form, of behavior," out of which a transactional competence is achieved.
In our existing models of formal education, we bifurcate what Dewey viewed as indispensable. We, as a rule, segregate "utility and culture, absorption and expression, theory and practice....in any educational scheme" In 1952, progressive educator Elsie Ripley Clapp distinguished a similar commitment to a "cooperative transaction of inquiry" in a vision of education that enjoined those in a community and those inside a school.
Intelligence—that which is acquired through knowledgeable inquiry and mental testing—allows man to analyze and foresee consequences derived from the past experiences shaping our biases and expectations. Without intelligence of this kind, one is unlikely to control his/her actions without preconceived dogma, rites, or beliefs that might be wrong without a proper inquiry. If the philosophical study of politics were actually considered a "study of force," transactionalists would assert that knowing "what actions are permissible" (or not) given the condition of being an organism-environment, then co-operation and knowing-as-inquiry into one's bodily condition and conditioning and the situation one is transacting in that conditions one's body, all this is vital to functioning successfully among others in any social situation or environment.
In the Stanford Encyclopedia of Philosophy, it is noted that John Dewey was critical of the classical neoliberal stance that abstracts the individual from environment as if the individual precedes or lords from outside of a conception of society or social institutions. Dewey maintained that social institutions were not a "means for obtaining something for individuals. They are means for 'creating' individuals in a co-operative inquiry into knowing how to live a satisfying life (Reconstruction in Philosophy, MW12, 190–192)." [C]lassical liberalism treats the individual as 'something given.' Instead, Dewey argues, 'liberalism knows that an individual is nothing fixed, given ready-made. It is something achieved, and achieved not in isolation but with the aid and support of conditions, cultural and physical: — including in "cultural", economic, legal and political institutions as well as science and art' ('The Future of Liberalism', LW11: 291).For Dewey, such treatment is 'the most pervasive fallacy of philosophical thinking' ('Context and Thought', LW5, 5). Transactionalism is a radical form of governing one's self in one's environment(s). Transactionalism resists a political tendency to "divide up experienced phenomena, and to take the distinct analysed elements to be separate existences, independent both of the analysis and of each other."
Intelligent thinking is anti-dualistic, accurate, forethought. It takes into account other people, communities, and cultures. It stems from a "deliberate control of what is done with reference to making what happens to us and what we do to things as fertile as possible of suggestions (of suggested meanings)." [emphasis added] Furthermore, intelligent thinking is a means for trying out the validity of those suggestions and other assumptions.
The political governing of thinking towards dualisms and bifurcation as well as the "false conception of the individual" (apart from their environment) is what Dewey argued actually limits man's free (meaning "liberal") thought and action. All of this served as the core reasoning behind Dewey's development of an experimental philosophy that offset elite distortions of public education and learning.
Individual as co-constitutive, organism-environment
Transactionalist psychologists and educational philosophers reject the ideologies precipitated from Western ideologies of do-it-yourself or the phrase If it is to be, it's up to me! Such mentalities tend to lead to entitlement. The naiveté of slogans like "follow your passion" often deny any consideration of our trans-dermal condition—our internal fitness and the external fitness of who we are as organism-environment.
Transactionalists assert that the "advancing conformity and coercive competition so characteristic of our times" demands reassessment. A new "philosophical-psychological complex" is offered that confronts the "ever increasing growth of bureaucratic rule and the attendant rise of a complacent citizenry." Given the intensification of globalization and migration, a trans-dermal consciousness allows for a transactional emphasis on "human dignity and uniqueness" despite "a matrix of anxiety and despair [and] feelings of alienation."
Transactionalist psychologists and philosophers replace a once sought-after existentialism as a remedy to feelings of alienation with a trans-dermal, organism-environment orientation to living. Rather than applying a theory or approach that emphasizes the individual as a "free and responsible agent determining their own development through acts of the will," subjects are invited to co-create functioning among all other organism-environments, including the specific conditions and consequences of any objects and personalities involved, in order to intelligently structure existence in and among it all. The very act of participating in co-creation, according to transactionalists, gives and allows each person her/his unique status and dignity in their environment.
Aesthetics: value-satisfaction from an assumptive world
Distinct from an aesthetic theory of taste or a rationale for the beauty in an object of art, a transactionalist theory of aesthetics concerns the perceptual judgments we use to define value, purposeful activity or satisfaction in any experience. Based on studies by transactionalist psychologists Adelbert Ames, Jr. (known for The Ames Demonstrations), William Howard Ittelson, Hadley Cantril, along with John Dewey, the biological role of perception is key to understanding transactionalism.
Perceiving is viewed as "part of the process of living by which each one of us, from his own particular point of view, creates for himself the world within which he has his life's experiences and through which he strives to gain his satisfactions." The sum total of these assumptions was recognized as the "assumptive world." The assumptive world stems from all that we experience, all the things and events we assess and assign meaning to, which function as a contextual whole also known as a transactional whole. Dewey also referred to the assumptive world as a "situation" (where organism and environment are inseparable) or as a "field" in which behavior, stimulus, and response are framed as if a reflexive circuit. Trevor Phillips noted, "To the modern transactionalist, experiences alter perceptual processes, and in the act of altering them, the purposing aspect of perception is either furthered or its fulfillment interfered with."
It is through action, through movement, that man is capable of bringing forth a value-satisfaction—the perception of satisfying an aim or outcome—to her or his experience. Man's capacity to "sense value in the quality of his experience" was registered through his serial expectations and standards stemming from previous transactions throughout life.
A theory of value is therefore derived from one's behavioral inquiry within an assumptive world. "Knowledge is a transaction that develops out of man's explorations within [that] cosmos." Transactionalists reject the notion that any truth is inherently settled or beyond question. The consequences of any inquiry will be dependent on the situation or transactional whole in which man as an organism-environment finds him- or her-self. Since our body and the physical environments and social ecologies in which it trans-acts are continually in flux across time and space, a singular or repetitive assumption carried over in an unthinking manner may not be valuable or satisfactory.
To clarify the theory of valuation, John Dewey wrote:
To declare something satisfactory [vs. satisfying] is to assert that it meets specifiable conditions. It is, in effect, a judgment that the thing 'will do'. It involves a prediction; it contemplates a future in which the thing will continue to serve; it will do. It asserts a consequence the thing will actively institute, it will do."
Ultimately, transactionalism is a move away from the conclusion that knowledge depends on an independent knower and something to be known. The reality of a particular situation depends, transactionally speaking, on the interpretation place[d] upon the situation by a particular person. Interpretation is possible only through the accumulation of experience which, in effect, is what is meant by "assumptive world". Without the hitches and mistakes one encounters in the welter of daily living, the nature of the assumptive world would never arise into consciousness.
The assumptive world, initially highlighted in the 25 experiments in perception known as "The Ames demonstrations," becomes the seeming reality of our world. Man's transactions of living involve, in sum, capacities and aspects of his nature operating together. To transact is to participate in the process of translating the ongoing energies of the environment into one's own perceptual awareness, and to transform the environment through the perceptual act. Value-satisfaction arises when the inadequacies of man's assumptive world are revealed or invalidated. Thereby, the consequences of any transactional experience determines what is valuable or what will do vs. that which is satisfying but will not do. The good life, for the transactionalist, consists of a unity of values, achieved by means of reflective thought, and accepted in the full light of their conditions and consequences.
To transact is to act intelligently with an aim in mind while avoiding the tendency to surrender one's awareness to complacency or indifference that stems from mere information or untested knowledge. Without action, a person can fool herself, distort her sense of satisfaction or value on behalf of consequences she or others prefer. Through action, the individual perceptions as well as the shared perceptual common sense of an assumptive world are validated and modified. We predict and refine our conditions of life yet "any standard set for these value qualities is influenced by the individual's personal biological and life history." Transactionalism is a creative process that takes into account the unique biology and biography of persons involved.
Generational significance
The importance of the study of transactionalism arose in the late 1960s in response to an "alienation syndrome" among youth of that generation. As the counter-culture challenged and reassessed society's "philosophical-psychological complex, its Weltanschauung," their political and social alienation sparked protests against the war and the draft as well as historic racial rebellions in various U.S. cities. The Long hot summer of 1967 and the counterculture movement named the Summer of Love also in 1967 reflected the antipathy of young people who questioned everything. American society's norms and values were perceived as denying dignity to all. Riots of the period were studied in a report by the U.S. Kerner Commission and scholars began to study the patterns of alienation expressed by youth in the sixties. Youth sought a kind of existentialism expressed by a need to be "true to oneself." This current of alienation unfortunately veered away from a relevant understanding of the transactional whole taking into account the reciprocal and co-constitutive nature of man as an organism-environment fulfilling important conditions of life with others all the time. It resembles the famous line from Devotions upon Emergent Occasions, written by English poet John Donne – "No man is an island". Transactionalism presented an alternative to the limitation and unintended outcomes of the alienation syndrome.
Benefits and applications
Designed to account for all aspects of experience—subjective and objective—transactionalism requires a slowing down in assessing all the facts involved with the how, what, when, where, and why as we move to transact with others. It demands and requires always considering how a transaction with another and one's self (e.g., a parent or spouse spending additional hours socializing at the gym) is or is not beneficial to all involved in a transaction (e.g., other members of the family). The costs may be in time, attention, or money or in a condition of life (e.g., family, career, sleep). Transactionalism requires an interdependence of thought, study, and action.
A transactionalist must account for one's biology and cognition (metaphysics); the ways knowing reality (epistemology); the reciprocal, co-constitutive, relationship (or ethics) between our social self and the interactions constrained by both our natural and human-made environment. We as human beings live in distinct sociological patterns with people, material and immaterial culture shaped by specific and ever-changing times and places further articulated by increasing migration and globalization. Transactionalism insists that one attend to the political distribution of goods and services along with the ways its value has and is exchanged and changing among people and groups (politics) as well as how persons are socialized to understand what it means to live a good life as well as fulfill those conditions over time (aesthetics).
Transactionalism offers more than existentialism offered with its aim of being "true to oneself." The alienation that results from its orientation to the self at the expense of societal norms and values, even in small groups, often leads to naiveté, despair, frustration, agitation, and even indifference, at the expense of consciously organizing one's acts, while functioning among others, to fulfill one's unique and necessary interests in living a good and satisfying life. Transactionalism counters the naive "do as I see fit" mentality of authenticity regardless of other's needs and concerns, which inevitably leads to negative consequences and outcomes over time. Transactionalism depends upon the "integration of man and his surroundings."
Phillips' dissertation documented the evolution of a "transactional approach;" one that rests on the fact that we are biological, linguistic, and that we must transact considering a trans-dermal experience of our thoughts, behavior, and exchange on every level imagined while ethically functioning with others well.
A series of podcasts exemplify the application of a transactional approach to a diverse array of professionals from various countries.
See also
Hilary Putnam
References
Philosophical theories
Education theory | 0.765734 | 0.973719 | 0.745609 |
Wechsler Individual Achievement Test | The Wechsler Individual Achievement Test Second Edition (WIAT-II; Wechsler, 2005) assesses the academic achievement of children, adolescents, college students and adults, aged 4 through 85. The test enables the assessment of a broad range of academics skills or only a particular area of need. The WIAT-II is a revision of the original WIAT (The Psychological Corporation), and additional measures. There are four basic scales: Reading, Math, Writing and Oral Language. Within these scales there is a total of 9 sub-test scores.
History
The first WIAT was published in 1992 and it was standardized in UK and published as the word, "WOND and WOLD". It was revised in 2001 and followed by the UK version in 2005. Each revision has brought with it several updates and changes. The WIAT-II contains the basic contacademically.
There are a small number of differences made between the versions of the subtests in the UK and US. These include changes in the picture items, replacing of Americanisms and simple spelling differences. The WIAT-III US edition was published in 2009 for use with those aged 4 till 50 years and 11 months. It includes 16 subtests which is divided into Oral Reading, Math Fluency and Early Reading Skills.
Test Format
Reading
Word Reading: assesses pre-reading (phonological awareness) and decoding skills (naming letters, phonological skills [working with sounds in words], reading words from lists).
Reading Comprehension: assesses types of reading comprehension skills taught in the classroom or used in everyday life (matching words to pictures, reading sentences aloud, orally answering oral questions about reading passages, silent reading speed).
Pseudoword (phonetic) Decoding: assesses the ability to apply phonetic decoding skills. (Reading nonsense words aloud from a list [phonetic word attack]).
Math
Numerical Operations: evaluates the ability to identify and write numbers ( e.g. counting, and solving paper & pencil computations).
Math Reasoning: assess the ability to reason mathematically ( e.g. counting, identifying shapes, and solving verbally framed "word problems" [presented both orally and either written or in illustration]).
Written Language
Spelling: evaluates the ability to spell (written spelling of dictated letters, sounds and words that are read in sentences).
Written Expression: assesses the writing process (writing letters and words as quickly as possible, writing sentences, and writing a paragraph or essay).
Oral Language
Listening Comprehension: measures the ability to listen for details (multiple-choice matching of pictures to spoken words).
Oral Expression: assesses general ability to use oral language effectively (repeating sentences, generating lists, describing scenes and pictured activities).
The WIAT-III US consists of 16 subtests including several not featured in the second edition: Oral Reading Fluency, Math Problem Solving, Math Fluency Addition /Subtraction /Multiplication, Early Reading Skills, Alphabet Writing Fluency, Sentence Composition and Essay Composition. The test takes 45–90 minutes to administer depending on the age of the participant. The mean score for the WIAT-II is 100 with a standard deviation of 15, and the scores on the test may range from 40 to 160. 68% of participants in the UK standardisation sample obtained scores of 85-115 and 95% obtained scores of 70-130.
Psychometric Properties
Internal consistency ranges from 0.80-0.98.
Test-retest reliability ranges from 0.85-0.98.
WIAT–II has been empirically linked with the WISC–IV, the WPPSI–III, and the WAIS–III. These relationships provide valid discrepancy scores to allow comparisons between achievement and ability. The WIAT-II UK was standardised between 2003-2004 as part of the WISC-IV standardisation with 892 individuals aged 4–16 years 11 months (US norms are available up to age 85). The UK project was conducted at City University by Professor John Rust and Professor Susan Golombok. The WAIT-II standardisation also includes several special group studies including those with learning difficulties, ADHD, emotional disturbance, hearing impairments, speech and language impairments and those who are classed as gifted.
The WIAT-III US was standardised on 3,000 students and adults aged 4–19:11. Linking studies were carried out with the WAIS-IV, WISC-IV, WPPSI-III, WNV, and DAS-II with correlations ranging from .60-.82. Special group studies include those with learning difficulties in reading, writing and math, expressive language disorder and mild intellectual difficulties.
Uses
The WIAT-II is suitable for use in clinical, educational and research settings. It can be used to identify the academic strengths and weakness and individual possess of, as well as inform and aid intervention planning. It can be used in a variety of settings where there is concern over educational progress. The WIAT-II can provide meaningful information to assist with diagnostic, eligibility, placement and intervention decisions. Best practice suggests the results obtained from the WIAT-II should be interpreted in combination with the evaluation and review of the individual’s background, personality, current emotional functioning, and attention and motivation levels.
Like all assessment instruments, the WIAT-II has certain limitations. Academic achievement can be conceptualised and assessed in many different ways. As a result, it is impossible to develop an instrument that assesses all components of achievement within the constraints of a typical standardised assessment situation. The WIAT-II measures aspects of the learning process that take place in the traditional academic setting in the areas of reading, writing, mathematics and oral language. Although the WIAT-II item content encompasses a wide range of skills and concepts, it was not designed as a measure of academic giftedness in older adolescents or adults.
Translations
There have been several adaptations of the WIAT-II for use with; Australian, New Zealand, Canadian and French Canadian populations.
See also
Wechsler Intelligence Scale for Children
Wechsler Adult Intelligence Scale
WPPSI
Cognitive test
Intelligence quotient
References
Sources
The Psychological Corporation. (1992). Wechsler Individual Achievement Test. San Antonio, TX: Author.
Wechsler, D. (2005). Wechsler Individual Achievement Test 2nd Edition (WIAT II). London: The Psychological Corp.
External links
Psychometric Centre, University of Cambridge
Standardised tests in the United Kingdom
Achievement tests | 0.765487 | 0.97384 | 0.745462 |
Mental health in China | Mental health in China is a growing issue. Experts have estimated that about 130 million adults living in China are suffering from a mental disorder. The desire to seek treatment is largely hindered by China's strict social norms (and subsequent stigmas), as well as religious and cultural beliefs regarding personal reputation and social harmony.
History
China's first mental institutions were introduced before 1849 by Western missionaries. Missionary and doctor John G. Kerr opened the first psychiatric hospital in 1898, with the goal of providing care to people with mental health issues, and treating them in a more humane way.
In 1949, the country began developing its mental health resources by building psychiatric hospitals and facilities for training mental health professionals. However, many community programs were discontinued during the Cultural Revolution.
In a meeting jointly held by Chinese ministries and the World Health Organization in 1999, the Chinese government committed to creating a mental health action plan and a national mental health law, among other measures to expand and improve care. The action plan, adopted in 2002, outlined China's priorities of enacting legislation, educating its people on mental illness and mental health resources, and developing a stable and comprehensive system of care.
In 2000, the Minority Health Disparities Research and Education Act was enacted. This act helped in raising national awareness on health issues through research, health education, and data collection.
Since 2006, the government's 686 Program has worked to redevelop community mental health programs and make these the primary resource, instead of psychiatric hospitals, for people with mental illnesses. These community programs make it possible for mental health care to reach rural areas, and for people in these areas to become mental health professionals. However, despite the improvement in access to professional treatment, mental health specialists are still relatively inaccessible to rural populations. The program also emphasizes rehabilitation, rather than the management of symptoms.
In 2011, the legal institution of China's State Council published a draft for a new mental health law, which includes new regulations concerning the rights of patients to not to be hospitalized against their will. The draft law also promotes the transparency of patient treatment management, as many hospitals were driven by financial motives and disregarded patients' rights. The law, adopted in 2012, stipulates that a qualified psychiatrist must make the determination of mental illness; that patients can choose whether to receive treatment in most cases; and that only those at risk of harming themselves or others are eligible for compulsory inpatient treatment. However, Human Rights Watch has criticized the law. For example, although it creates some rights for detained patients to request a second opinion from another state psychiatrists and then an independent psychiatrist, there is no right to a legal hearing such as a mental health tribunal and no guarantee of legal representation.
Since 1993, WHO has been collaborating with China in the development of a national mental health information system.
Current situation
Though China continues to develop its mental health services, it still has a large number of untreated and undiagnosed people with mental illnesses. The aforementioned intense stigma associated with mental illness, a lack of mental health professionals and specialists, and culturally-specific expressions of mental illness may play a role in the disparity.
Prevalence of mental disorders
Researchers estimate that roughly 130 million people in China over the age of 18 suffer from mental illness in any given year.Conducted between 2001 and 2005, a non-governmental survey of 63,000 Chinese adults found that 16 percent of the population had a mood disorder, including 6 percent of people with major depressive disorder. Thirteen percent of the population had an anxiety disorder and 9 percent had an alcohol use disorder. Women were more likely to have a mood or anxiety disorder compared to men, but men were significantly more likely to have an alcohol use disorder. People living in rural areas were more likely to have major depressive disorder or alcohol dependence.
In 2007, the Chief of China's National Centre for Mental Health, Liu Jin, estimated that approximately 50 percent of outpatient admissions were due to depression.
There is a disproportionate impact on the quality of life for people with bipolar disorder in China and other East Asian countries.
The suicide rate in China was approximately 23 per 100,000 people between 1995 and 1999. Since then, the rate is thought to have fallen to roughly 7 per 100,000 people, according to government data. WHO states that the rate of suicide is thought to be three to four times higher in rural areas than in urban areas. The most common method, poisoning by pesticides, accounts for 62 percent of incidences.
Stigma related to cultural and folk beliefs
It is estimated that 18 percent of the Chinese population, about 244 million people, believe in Buddhism. Another 22 percent of the population, roughly 294 million, people believe in folk religions which are a group of beliefs that share characteristics with Confucianism, Buddhism, Taoism, and shamanism. Common between all of these philosophical and religious beliefs is an emphasis on acting harmoniously with nature, with strong morals, and with a duty to family. Followers of these religions perceive behavior as being tightly connected with health; illnesses are often thought to be a result of moral failure or insufficiently honoring one's family in current or past life. Furthermore, an emphasis on social harmony may discourage people with mental illness from bringing attention to themselves and seeking help. They may also refuse to speak about their mental illness because of the shame it would bring upon themselves and their family members, who could also be held responsible and experience social isolation.
Also, reputation might be a factor that prevents individuals from seeking professional help. Good reputations are highly valued. In a Chinese household, every individual shares the responsibility of maintaining and raising the family's reputation. It is believed that mental health will hinder individuals from achieving the standards and goals- whether academic, social, career-based, or other- expected from parents. Without reaching the expectations, individuals are anticipated to bring shame to the family, which will affect the family's overall reputation. Therefore, mental health issues are seen as an unacceptable weakness. This perception of mental health disorders causes individuals to internalize their mental health problems, possibly worsening them, and making it difficult to seek treatment. Eventually, it becomes ignored and overlooked by families.
In addition, many of these philosophies teach followers to accept one's fate. Consequently, people with mental disorders may be less inclined to seek medical treatment because they believe they should not actively try to prevent any symptoms that may manifest. They may also be less likely to question the stereotypes associated with people with mental illness, and instead agreeing with others that they deserve to be ostracized.
Lack of qualified staff
By the end of 2019, there were 40,850 licensed psychiatrists and psychiatric registrars, averaging 2.9 per 100,000 population, compared to the average in developed countries of 6.6 per 100,000. Individuals without preliminary experience can obtain a license to counsel, following several months of training through the National Exam for Psychological Counselors. Due to limited knowledge about psychiatry, low salary, high workload and stigma towards mental illness, very few medical graduates choose to specialize in psychiatry.
A study in 2015 reported that two-thirds of counties in China lacked any psychiatrists.
Physical symptoms
Multiple studies have found that Chinese patients with mental illness report more physical symptoms compared to Western patients, who tend to report more psychological symptoms. For example, Chinese patients with depression are more likely to report feelings of fatigue and muscle aches instead of feelings of depression. However, it is unclear whether this occurs because they feel more comfortable reporting physical symptoms or if depression manifests in a more physical way among Chinese people.
Misuse
There have been multiple accusations that China's psychiatric facilities have been used by government officials to silence political dissidents. Prior to China's implementation to the National Mental Health Law in May 2013, involuntary admission was the most common type of admission for patients with psychotic disorders and required only informed consent signed by family members. Involuntary admission under the reform is only allowed if patients to pose a clear threat to themselves or others, determined through initial assessment by a registered psychiatrist. Despite the law, a 2017 national survey showed that fewer than 50% of involuntarily admitted individuals met the criteria for involuntary admission, with the number of involuntary psychiatric admissions remaining high in China.
Chinese military mental health
Overview
Military mental health has recently become an area of focus and improvement, particularly in Western countries. For example, in the United States, it is estimated that about twenty-five percent of active military members suffer from a mental health problem, such as PTSD, Traumatic Brain Injury, and depression. Currently, there are no clear initiatives from the government about mental health treatment towards military personnel in China. Specifically, China has been investing in resources towards researching and understanding how the mental health needs of military members and producing policies to reinforce the research results.
Background
Research on the mental health status of active Chinese military men began in the 1980s where psychologists investigated soldiers' experiences in the plateaus. The change of emphasis from physical to mental health can be seen in China's four dominant military academic journals: First Military Journal, Second Military Journal, Third Military Journal, and Fourth Military Journal. In the 1980s, researchers mostly focused on the physical health of soldiers; as the troops' ability to perform their services declined, the government began looking at their mental health to provide an explanation for this trend. In the 1990s, research on it increased with the hope that by improving the mental health of soldiers, combat effectiveness improves.
Mental health issue can impact active military members' effectiveness in the army, and can create lasting effects on them after they leave the military. Plateaus were an area of interest in this sense because of harsh environmental conditions and the necessity of the work done with low atmospheric pressure and intense UV radiation. It was critical to place the military there to stabilize the outskirts and protect the Chinese citizens who live nearby; this made it one of the most important jobs in the army, then increasing the pressure on those who worked in the plateaus. It not only affected the body physically, like in the arteries, lungs, and back, but caused high levels of depression in soldiers because of being away from family members and with limited communication methods. Scientists found that this may impact their lives as they saw that this population had higher rates of divorce and unemployment.
Comparatively, assessing the mental health status of the People's Liberation Army (PLA) is difficult, because military members work a diverse array of duties over a large landscape. Military members also play an active part in disaster relief, peacekeeping in foreign lands, protecting borders, and domestic riot control. In a study of 11,000 soldiers, researchers found that those who work as peacekeepers have higher levels of depression compared to those in the engineering and medical departments. With such diverse military roles over an area of , it is difficult to gauge its impacts on soldiers’ psyche and provide a single method to address mental health problems.
Researches have increased over the last two decades, but the studies still lack a sense of comprehensiveness and reliability. In over 73 studies that together included 53,424 military members, some research shows that there is gradual improvement in mental health at high altitudes, such as mountain tops; other researchers found that depressive symptoms can worsen. These research studies demonstrate how difficult it is to assess and treat the mental illness that occurs in the army and how there are inconsistent results. Studies of the military population focus on the men of the military and exclude women, even though the number of women that are joining the military has increased in the last two decades.
Chinese researchers try to provide solutions that are preventative and reactive, such as implementing early mental health training, or mental health assessments to help service members understand their mental health state, and how to combat these feelings themselves. Researchers also suggest to improve the mental health of the military members, programs should include psychoeducation, psychological training, and attention to physical health to employ timely intervention.
Implementation
In 2006, the People's Republic Minister for National Defense began mental health vetting at the beginning of the military recruitment process. A Chinese military study consisting of 2500 male military personnel found that some members are more predisposed to mental illness. The study measured levels of anxious behaviors, symptoms of depression, sensitivity to traumatic events, resilience and emotional intelligence of existing personnel to aid the screening of new recruits. Similar research has been conducted into the external factors that impact a person's mental fortitude, including single-child status, urban or rural environment, and education level. Subsequently, the government has incorporated mental illness coping techniques into their training manual. In 2013 leak by the Tibetan Center for Human Rights of a small portion of the People's Liberation Army training manual from 2008, specifically concerned how military personnel could combat PTSD and depression while on peacekeeping missions in Tibet. The manual suggested that soldiers should: “...close [their] eyes and imagine zooming in on the scene like a camera [when experiencing PTSD]. It may feel uncomfortable. Then zoom all the way out until you cannot see anything. Then tell yourself the flashback is gone.”In 2012, the government specifically addressed military mental health in a legal document for the first time. In article 84 of the Mental Health Law of the People's Republic of China, it stated, “The State Council and the Central Military Committee will formulate regulations based on this law to manage mental health work in the military."
Besides screening, assessments and an excerpt of the manual, not much is known about the services that are provided to active military members and veterans. Analysis of more than 45 different studies, moreover, has deemed that the level of anxiety in current and ex-military personnel has increased despite efforts of the People's Republic due to economic conditions, lack of social connects and the feeling of a threat to military livelihood. This growing anxiety manifested in both 2016 and 2018, as Chinese veterans demonstrated their satisfaction with the system via protests across China. In both instances, veterans advocated for an increased focus on post-service benefits, resources to aid in post-service jobs, and justice for those who were treated poorly by the government. As a way to combat the dissatisfaction of veterans and alleviate growing tension, the government established the Ministry of Veteran Affairs in 2018. At the same time, General Secretary of the Chinese Communist Party Xi Jinping promised to enact laws that protect the welfare of veterans.
Mental health of women in China
Perinatal depression
Perinatal depression, a mood disorder occurring during pregnancy and extending into the postpartum period, is linked with adverse health outcomes for both mothers and infants. A meta-regression analysis showed that there has been a notable upward trend in the prevalence of perinatal depression, which affects approximately 16.3% of Chinese women, with 19.7% experiencing it during pregnancy and 14.8% after childbirth. It indicated a significant inverse relationship between the provincial Gross Domestic Product (GDP) and depression rates among Chinese mothers.
Risk and protective factors for perinatal depression were studied systematically in three domains of mothers, infants, and sociocultural status. Studies shows that lower socioeconomic status, compromised physical well-being, pregnancy-related anxiety, challenges during childbirth and inadequate social support posed negative impact to mental health of Chinese mothers. Conversely, enhanced living standards and increased educational support seemed to confer protective benefits.
After the implementation of the universal two-child policy, another review article indicates that the second-time mothers exhibited a higher likelihood of experiencing anxiety symptoms during pregnancy compared to both prenatal women overall and the entire sample.
The COVID-19 pandemic also proved to affect the mental health and well being of perinatal women in China. Several studies suggests that the prevalence rates of psychological distress, anxiety, depressive, and insomnia symptoms among of Chinese pregnant women were recorded at 70%, 37%, 31%, and 49%, respectively.
See also
Chinese Society of Psychiatry
Geriatric depression in China
Mental health in education
Global mental health
Mental health in the Middle East
Mental health in Southeast Africa
Mental health of Chinese students
References
Further reading
Normal and Abnormal Behavior in Chinese Culture (1981) edited by Arthur Kleinman and Tsung-yi Lin
Chinese Societies and Mental Health (1995) edited by Tsung-yi Lin, Wen-shing Tseng, and Eng-kung Yeh
Mental health care in China (1995) By Veronica Pearson
Narcotic Culture – A History of Drugs in China (2004) by Frank Dikötter, Lars Laamann and Zhou Xun
China | 0.766385 | 0.972689 | 0.745454 |
Non-exercise activity thermogenesis | Non-exercise activity thermogenesis, also known as non-exercise physical activity (NEPA), is energy expenditure during activities that are not part of a structured exercise program. NEAT includes physical activity at the workplace, hobbies, standing instead of sitting, walking around, climbing stairs, doing chores, and fidgeting. Besides differences in body composition, it represents most of the variation in energy expenditure across individuals and populations, accounting from 6-10 percent to as much as 50 percent of energy expenditure in highly active individuals.
Relationship with obesity
NEAT is the main component of activity-related energy expenditure in obese individuals, as most do not do any physical exercise. NEAT is also lower in obese individuals than the general population.
NEAT may be reduced in individuals who have lost weight, which some hypothesize contributes to difficulties in achieving and sustaining weight loss.
In Western countries, occupations have shifted from physical labor to sedentary work, which results in a loss of energy expenditure. Strenuous physical labor can require 1500 calories or more per day than desk work.
Relationship with exercise
It is debated whether there is a significant reduction in NEAT after beginning a structured exercise program.
Health benefits
Lack of NEAT is posited as an explanation for health harms for prolonged sitting.
Measurement
Accelerometers and questionnaires can be used to estimate NEAT.
References
Human physiology
Metabolism | 0.761279 | 0.979211 | 0.745453 |
Diagnosis of schizophrenia | The diagnosis of schizophrenia, a psychotic disorder, is based on criteria in either the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, or the World Health Organization's International Classification of Diseases (ICD). Clinical assessment of schizophrenia is carried out by a mental health professional based on observed behavior, reported experiences, and reports of others familiar with the person. Diagnosis is usually made by a psychiatrist. Associated symptoms occur along a continuum in the population and must reach a certain severity and level of impairment before a diagnosis is made. Schizophrenia has a prevalence rate of 0.3-0.7% in the United States.
Criteria
In 2013, the American Psychiatric Association released the fifth edition of the DSM (DSM-5). According to the manual, to be diagnosed with schizophrenia, two diagnostic criteria have to be met over much of the time of a period of at least one month, with a significant impact on social or occupational functioning for at least six months. The DSM diagnostic criteria outlines that the person has to be experiencing either delusions, hallucinations, or disorganized speech. In other words, an individual does not have to be experiencing delusions or hallucinations to receive a diagnosis of schizophrenia. A second symptom could be negative symptoms, or severely disorganized or catatonic behavior. Only two symptoms are required for a diagnosis of schizophrenia, resulting in different presentations for the same disorder.
In practice, agreement between the two systems is high. The DSM-5 criteria puts more emphasis on social or occupational dysfunction than the ICD-10. The ICD-10, on the other hand, puts more emphasis on first-rank symptoms. The current proposal for the ICD-11 criteria for schizophrenia recommends adding self-disorder as a symptom.
Changes made
Both manuals have adopted the chapter heading of Schizophrenia spectrum and other psychotic disorders; ICD modifying this as Schizophrenia spectrum and other primary psychotic disorders. The definition of schizophrenia remains essentially the same as that specified by the 2000 text revised DSM-IV (DSM-IV-TR). However, with the publication of DSM-5, the APA removed all sub-classifications of schizophrenia. ICD-11 has also removed subtypes. The removed subtype from both, of catatonic has been relisted in ICD-11 as a psychomotor disturbance that may be present in schizophrenia.
Another major change was to remove the importance previously given to Schneider's first-rank symptoms. DSM-5 still uses the listing of schizophreniform disorder but ICD-11 no longer includes it. DSM-5 also recommends that a better distinction be made between a current condition of schizophrenia and its historical progress, to achieve a clearer overall characterization.
A dimensional assessment has been included in DSM-5 covering eight dimensions of symptoms to be rated (using the Scale to Assess the Severity of Symptom Dimensions) – these include the five diagnostic criteria plus cognitive impairments, mania, and depression. This can add relevant information for the individual in regard to treatment, prognosis, and functional outcome; it also enables the response to treatment to be more accurately described.
Two of the negative symptoms – avolition and diminished emotional expression – have been given more prominence in both manuals.
First rank symptoms
First-rank symptoms are psychotic symptoms that are particularly characteristic of schizophrenia, which were put forward by Kurt Schneider in 1959. Their reliability for the diagnosis of schizophrenia has been questioned since then. A 2015 systematic review investigated the diagnostic accuracy of first rank symptoms:
Heterogeneity
Sub-classifications
The DSM-IV-TR contained five sub-classifications of schizophrenia. The sub-classifications were removed in the DSM-5 due to the conditions' heterogeneous nature and their historical insignificance in clinical practice. These were retained in previous revisions largely for reasons of tradition, but had subsequently proved to be of little worth.
The ICD-10 defines seven sub-classifications of schizophrenia. These sub-classifications are:
Country-specific versions
The ICD-10 Clinical Modification, used for medical coding and reporting in the United States excludes the post-schizophrenic depression (F20.4) and the Simple (F20.6) sub-classifications.
The Russian version of the ICD-10 includes additional four sub-classifications of schizophrenia: hypochondriacal (F20.801), cenesthopathic (F20.802), childhood type (F20.803), and atypical (F20.804).
Comorbidities
People with schizophrenia often have additional mental health problems such as anxiety, depressive, or substance-use disorders. Schizophrenia occurs along with obsessive-compulsive disorder (OCD) considerably more often than could be explained by chance. An estimated 21% to 47% of patients with schizophrenia have a substance misuse disorder at some time in their life, and the chances of developing a substance misuse disorder is significantly higher among patients with a psychotic illness. All of these factors result in an increased range of clinical presentations and suggest a significant etiological heterogeneity.
Sex differences
Schizophrenia is diagnosed 1.4 times more frequently in males than females, with onset peaking at ages 20–28 years for males and 4–10 years later in females. Females show more psychotic and affective symptoms than males, and have less social impairment. Men present more often with negative symptoms and disorganization. These differences are likely due to the protective effects of estrogen and are correlated with estrogen expression.
Prelingually deaf persons
Usually, psychiatric diagnostics is carried out orally. Thus, the question about schizophrenia in prelingually deaf persons rises. Only few reports exist. A review points out that acoustic hallucinations of normal hearing schizophrenic people correspond to visual and tactile hallucinations of prelingually deaf persons. Also, the structure of the (sign-) language is altered in ill persons. As a follow, “schizophrenia does not depend on the acoustic part of language or the acquisition of spoken language”.
Onset
Early-onset schizophrenia occurs from ages 20–30, late-onset occurs after the age of 40, and very-late-onset after the age of 60. It is estimated that 15% of the population with schizophrenia are late-onset and 5% very-late onset. Many of the symptoms of late-onset schizophrenia are similar to the early-onset. However, individuals with late-onsets are more likely to report hallucinations in all sensory modalities, as well as persecutory and partition delusions. On the other hand, late-onset cases are less likely to present with formal thought disorder, affective symptoms. Negative symptoms and cognitive impairment are also rarer in very-late onset cases.
Etiology
The pathophysiology of schizophrenia is poorly understood. Multiple hypotheses have been put forward, with evidence both supporting and contradicting them. The most commonly supported theories are the dopamine hypothesis and the glutamate hypothesis. Multiple genetic and environment factors have been associated with increased risk for developing schizophrenia. Furthermore, response to treatment with anti-psychotic medication is variable, with some patients being resistant to some therapies. Together, the differences in causes, response to treatment and pathophysiology suggest schizophrenia is heterogeneous from an etiological standpoint. The differences resulting from this in terms of in clinical manifestations make the disorder harder to diagnose.
Genetic
Multiple genetic and environmental factors contribute to the development of the schizophrenic phenotype. Distinct symptomatic sub types of schizophrenia groups show distinct patterns of SNP variations, reflecting the heterogeneous nature of the disease. Studies also suggest there is a genetic overlap between schizophrenia and other psychiatric disorders, such as autism spectrum disorders, attention deficit-hyperactivity disorder, bipolar disorder, and major depressive disorder. These factors complicate the use of genetic tests in diagnosis or prediction of the onset of schizophrenia.
Differential diagnosis
If signs of disturbance are present for more than a month but less than six months, the diagnosis of schizophreniform disorder is applied. Psychotic symptoms lasting less than a month may be diagnosed as brief psychotic disorder, and various conditions may be classed as psychotic disorder not otherwise specified. Schizoaffective disorder is diagnosed if symptoms of mood disorder are substantially present alongside psychotic symptoms.
Psychotic symptoms may be present in several other mental disorders, including bipolar disorder, and borderline personality disorder. Delusions ("non-bizarre") are also present in delusional disorder, and social withdrawal in social anxiety disorder, avoidant personality disorder and schizotypal personality disorder. Schizophrenia cannot be diagnosed if symptoms of mood disorder are substantially present, or if symptoms of pervasive developmental disorder are present unless prominent delusions or hallucinations are also present. Schizophrenia is further complicated with obsessive-compulsive disorder (OCD), and it can be difficult to distinguish obsessions that occur in OCD from the delusions of schizophrenia. In children hallucinations must be separated from typical childhood fantasies.
A urine drug screen must be performed to determine if the cause for symptoms could be drug intoxication or drug-induced psychosis. For example, a few people withdrawing from benzodiazepines experience a severe withdrawal syndrome which may last a long time and can resemble schizophrenia. A general medical and neurological examination may also be needed to rule out medical illnesses which may rarely produce psychotic schizophrenia-like symptoms, such as metabolic disturbance, systemic infection, syphilis, HIV infection, epilepsy, and brain lesions. Stroke, multiple sclerosis, hyperthyroidism, hypothyroidism, and dementias such as Alzheimer's disease, Huntington's disease, frontotemporal dementia, and the Lewy body dementias may also be associated with schizophrenia-like psychotic symptoms. It may be necessary to rule out a delirium, which can be distinguished by visual hallucinations, acute onset and fluctuating level of consciousness, and indicates an underlying medical illness. Investigations are not generally repeated for relapse unless there is a specific medical indication or possible adverse effects from antipsychotic medication.
Biomarkers
A biomarker, as defined by the National Institutes of Health Biomarkers Definitions Working Group, is "a biologic characteristic objectively measured and evaluated as an indicator of normal or pathogenic processes; or of response to a treatment or challenge". Biomarkers of psychosis for use in clinical tests can be diagnostic, prognostic, predictive of conversion, or monitoring of progression. Clinical tests have many benefits: they can provide confidence in a diagnosis, allow clinicians to make better informed choices in regard to treatment, or even make it possible to identify subjects which can benefit from therapy to prevent transition into schizophrenia. Currently, no biomarkers that can be widely used in clinical practice for the diagnosis of schizophrenia have been identified.
Imaging
Brain imaging, such as CT and MRI scans, are currently only used to rule out brain abnormalities, and their benefit is very limited at that. Structural alterations have, however, been identified in schizophrenia, most commonly enlarged ventricles, and decreased grey matter volume in the cortex and hippocampus. Studies using functional MRI have also shown that altered connectivity and activity in present in schizophrenia.
In the last decade interest has grown in the use of machine learning to automatically perform the diagnosis task using brain imaging data. While these algorithms are very robust at distinguishing schizophrenia patients from healthy subjects, they still cannot perform the tasks clinicians struggle the most with – differential diagnosis and treatment selection.
Blood-based
Blood-based biomarkers those are obtained from plasma or serum samples. Since the prevalence of metabolic syndromes is increased in schizophrenia patients, makers of those syndromes have been common targets of research. Differences between patients and controls have been found in insulin levels, insulin resistance, and glucose tolerance. These effects are generally small, however, and often present only in a subset of patients, which results from the heterogeneity of the disease. Furthermore, these results are often complicated by the metabolic side effects of anti-psychotic medication. Serum levels of hormones typically active in the hypothalamic pituitary adrenal (HPA) axis, such as cortisol and acetylcholine, have also been correlated with symptoms and progression of schizophrenia. Peripheral biomarkers of immune function have also been a major target of research, with over 75 candidates having been identified. Cytokines and growth factors are consistently identified as candidates by different studies, but variation in identity and direction of the correlation is common. In recent years, markers of oxidative stress, epigentic methylation, mRNA transcription, and proteomic expression have also been targets of research, with their potential still to be determined. It is likely that no single biomarker will be clinically useful, but rather a biomarker assay would have to be performed, like the well-performing 51 marker assay developed by E. Schwarz and colleagues.
Genetic
Estimates of the heritability of schizophrenia is around 80%, which implies that 80% of the individual differences in risk to schizophrenia is explained by individual differences in genetics. Although many genetic variants associated with schizophrenia have been identified, their effects are usually very small, so they are combined onto a polygenic risk score. These scores, despite accounting for hundreds of variants, only explain up to 6% in symptom variation and 7% of the risk for developing the disease. An example of a well-studied genetic biomarker in schizophrenia is the single nucleotide polymorphism in the HLA-DQB1 gene, which is part of the human leukocyte antigen (HLA) complex. A G to C replacement on position 6672 predicts risk of agranulocytosis, a side effect of clozapine that can be fatal.
Criticisms of classification systems
Spectrum of conditions
There is an argument that the underlying issues would be better addressed as a spectrum of conditions or as individual dimensions along which everyone varies rather than by a diagnostic category based on an arbitrary cut-off between normal and ill. This approach appears consistent with research on schizotypy, and with a relatively high prevalence of psychotic experiences, mostly non-distressing delusional beliefs, among the general public. In concordance with this observation, psychologist Edgar Jones, and psychiatrists Tony David and Nassir Ghaemi, surveying the existing literature on delusions, pointed out that the consistency and completeness of the definition of delusion have been found wanting by many; delusions are neither necessarily fixed nor false, and need not involve the presence of incontrovertible evidence.
Diagnostic criteria
Nancy Andreasen has criticized the current DSM-IV and ICD-10 criteria for sacrificing diagnostic validity for the sake of artificially improving reliability. She argues that overemphasis on psychosis in the diagnostic criteria, while improving diagnostic reliability, ignores more fundamental cognitive impairments that are harder to assess due to large variations in presentation. This view is supported by other psychiatrists. In the same vein, Ming Tsuang and colleagues argue that psychotic symptoms may be a common end-state in a variety of disorders, including schizophrenia, rather than a reflection of the specific etiology of schizophrenia, and warn that there is little basis for regarding DSM's operational definition as the "true" construct of schizophrenia. Neuropsychologist Michael Foster Green went further in suggesting the presence of specific neurocognitive deficits may be used to construct phenotypes that are alternatives to those that are purely symptom-based. These deficits take the form of a reduction or impairment in basic psychological functions such as memory, attention, executive function and problem solving.
The exclusion of affective components from the criteria for schizophrenia, despite their ubiquity in clinical settings, has also caused contention. This exclusion in the DSM has resulted in a "rather convoluted" separate disorder—schizoaffective disorder. Citing poor interrater reliability, some psychiatrists have totally contested the concept of schizoaffective disorder as a separate entity. The categorical distinction between mood disorders and schizophrenia, known as the Kraepelinian dichotomy, has also been challenged by data from genetic epidemiology.
Biological validity
As clinicians and researchers become increasingly aware of the limitations of the current diagnostic systems, calls for new nosology are being made. The National Institute of Health's Research of Domain Criteria (RDoC) research program, launched in 2009, is perhaps the largest combined effort to address the need for a new approach in classifying mental disorders. The European Roadmap for Mental Health Research (ROAMER) funding initiative shares many goals with RDoC. These initiatives encourage researchers to consider diagnosis as dimensional, instead of a clear-cut between patients and healthy subjects, and to cut across diagnostic boundaries. The goal is to develop biologically valid diagnosis by defining nosology based on biological measures instead of symptom profiles, as is done currently. Initial efforts in this area have been able to stratify patients along the psychosis continuum into genetically distinct sub types based on their symptoms, brain measures such as EEG, and serum biomarker profiles.
References
Schizophrenia
Psychiatry controversies
Psychiatric assessment | 0.765083 | 0.974337 | 0.745449 |
Ego-state therapy | Ego state therapy is a parts-based psychodynamic approach to treat various behavioural and cognitive problems within a person. It uses techniques that are common in group and family therapy, but with an individual patient, to resolve conflicts that manifest in a "family of self" within a single individual.
History
The concept of segmentation of personality has been around for many years, and that of ego states was highlighted by the psychoanalyst Paul Federn. The creation of ego-state therapy is attributed to John G. Watkins, an analysand of Edoardo Weiss who was himself analysed by Federn. The first research on the efficacy of Ego state therapy was conducted by Gordon Emmerson. Emmerson conducted his research during a sabbatical from Victoria University. In this research he showed that the therapy could reduce menstrual migraines 5-fold in just 4 weekly sessions. It further indicated that Ego state therapy could not only reduce the occurrence to menstrual migraine, but participants also showed a significant reduction in both Anger and Depression on the MMPI-2. This quasi-experimental study was the only causal study included in the Watkins, book, Ego States: Theory and Therapy.
Ego states
Distinct ego states—in the most rigorous sense—do not normally develop except in cases of dissociative identity disorder. However, Ego state therapy identifies and names facets of a patient's personality, e.g., the "frightened child" or "control freak". After the characteristics and function of each ego state are identified, the therapist uses various psychotherapeutic techniques (e.g. behavioral, cognitive, analytic, or humanistic therapies) to achieve a kind of integration or internal diplomacy. Ego state therapy may use hypnosis, but is not necessarily required to do so, employing conversational technique instead.
Psychological process
In the development of the human personality, there are two processes that are essential: integration and differentiation. Through integration a person learns to put concepts together, like a shirt and a pair of trousers, to build more complex units known as clothes. By differentiation the person separates general concepts into specific meaning, such as the differences between a comfortable shirt and an uncomfortable shirt. Such differentiation allows humans to experience one set of behaviours in a different situation to another.
Psychological processes do not exist on an either/or basis. Things such as moods and emotions like depression, anxiety, and fear exist on a continuum with differing degrees of intensity. It is the same with differentiation-dissociation. Disorders such as dissociative identity disorder are often in the extreme end of the continuum that begins with normal differentiation. It is a matter of intensity. Therefore, the general principle of personality formation in which the process of separation has resulted in discrete segments, called ego states, with boundaries that are more or less permeable. Where however an ego state is a response to psychological trauma, it may remain completely walled-off from the rest of the personality.
Ego states exist as a collection of perceptions, cognitions and affects in organised clusters. An ego state may be defined as an organized system of behavior and experience, whose elements are bound together by common principle. When one of these states is invested with ego energy, it becomes "the self" in the here and now. This state is executive, and experiences the other states which are then invested with object energy.
Ego states vary in their volume. A large ego state may include all the various behaviors activated in one's occupation. A small ego state are the behaviours one experiences in a simple action, such as using a mobile phone. They may represent current modes of behavior and experiences or, as with hypnotic age regression, include many memories, postures, feelings, etc. that were apparently learned at an earlier age. They may be organised into different dimensions. For example, an ego state may be built around the age of 10. Another one may represent patterns of behavior toward a father or authority figures and thus overlap with experiences from the age of 10. Behaviors to accomplish a similar goal may be uniquely different from one ego state to another, especially in true multiple personalities.
See also
References
Family therapy
Ego psychology | 0.761825 | 0.978487 | 0.745436 |
Functionalism (international relations) | Functionalism is a theory of international relations that arose during the interwar period principally from the strong concern about the obsolescence of the state as a form of social organization. Rather than the self-interest of nation states that realists see as a motivating factor, functionalists focus on common interests and needs shared by states (but also by non-state actors) in a process of global integration triggered by the erosion of state sovereignty and the increasing weight of knowledge and hence of scientists and experts in the process of policy-making. Its roots can be traced back to the liberal and idealist traditions that started with Immanuel Kant and goes as far as Woodrow Wilson's "Fourteen Points" speech.
Functionalism is a pioneer in globalization theory and strategy. States had built authority structures upon a principle of territorialism. State theories were built upon assumptions that identified the scope of authority with territory, aided by methodological territorialism. Functionalism proposed to build a form of authority based in functions and needs, which linked authority with needs, scientific knowledge, expertise and technology: it provided a supraterritorial concept of authority. The functionalist approach excludes and refutes the idea of state power and political influence (realist approach) in interpreting the cause for such proliferation of international organizations during the interwar period (which was characterized by nation state conflict) and the subsequent years.
According to functionalism, international integration – the collective governance and material interdependence between states – develops its own internal dynamic as states integrate in limited functional, technical and economic areas. International agencies would meet human needs, aided by knowledge and expertise. The benefits rendered by the functional agencies would attract the loyalty of the populations and stimulate their participation and expand the area of integration. There are strong assumptions underpinning functionalism: that the process of integration takes place within a framework of human freedom; that knowledge and expertise are currently available to meet the needs for which the functional agencies are built; that states will not sabotage the process.
Neofunctionalism
Neofunctionalism reintroduced territorialism in the functional theory and downplayed its global dimension. Neofunctionalism is simultaneously a theory and a strategy of regional integration, building on the work of David Mitrany. Neofunctionalists focused their attention solely on the immediate process of integration among states (regional integration). Initially, states integrate in limited functional or economic areas. Thereafter, partially integrated states experience increasing momentum for further rounds of integration in related areas. This "invisible hand" of integration phenomenon was termed "spill-over." by the neofunctionalist school. This was most apparent in the study of euthanasia. Although integration can be resisted, it becomes harder to stop integration's reach as it progresses.
According to neofunctionalists, there are two kinds of spillover: functional and political. Functional spillover is the interconnection of various economic sectors or issue-areas, and the integration in one policy-area spilling over into others. Political spillover is the creation of supranational governance models, as far-reaching as the European Union, or as voluntary as the United Nations.
One of its protagonists was Ernst B. Haas, an American political scientist. Jean Monnet's approach to European integration, which aimed at integrating individual sectors in hopes of achieving spill-over effects to further the process of integration, is said to have followed the neofunctional school's tack. Unlike previous theories of integration, neofunctionalism declared to be non-normative and tried to describe and explain the process of regional integration based on empirical data. Integration was regarded as an inevitable process, rather than a desirable state of affairs that could be introduced by the political or technocratic elites of the involved states' societies. Its strength however was also its weakness: While it understood that regional integration is only feasible as an incremental process, its conception of integration as a linear process made the explanation of setbacks impossible.
Comparing functionalism to realism
John McCormick compares functionalism's fundamental principles with those of realism (comments added to emphasise key distinctions):
Functional cooperation and functional international organization
The objective of functionalism towards global peace is achieved through functional cooperation by the work of international organizations (including intergovernmental and non-governmental organizations). The activities of functional international organizations involve taking actions on practical and technical problems rather than those of military and political nature. They are also non-controversial politically and involve a common interest to solve international problems that could best be tackled in a transnational manner. According to Mitrany, dealing with functional matters provides the actors in the international community the opportunity to successfully cooperate in a non-political context, which might otherwise be harder to achieve in a political context. Further development would lead to a process called “autonomous development” towards multiplication, expansion, and deepening of functional international organizations. Ideally, this would ultimately result in an international government. Functionalists in this manner assume that cooperation in a non-political context would bring international peace. Eradication of existent non-political, non-military global problems, which Functionalists consider to be the very origin of conflict within the global community, is what they aim to pursue. However, critics point out some limitations of functionalist assumption: in practice, dealing with functional matters does not necessarily and always facilitate cooperation; its simplified assumption overlooks different causes of state conflict.
The proliferation of functional international organizations has occurred without adequate reorganization and coordination efforts due to a lack of central global governance to ensure accountability of such organizations. As a result, a pattern of decentralization could be observed among functional international organizations to the present day. Notably, the League of Nations' effort to coordinate functional international organizations in the field of social and economic cooperation through establishment of UN Economic and Social Council has been futile. As a result, the idea of decentralization prevails to the present day except in cases of special cooperative relationships between Economic and Social Council and some functional organizations. Subsequently, summits such as the World Summit for Social Development in 1995, the Millennium Summit in 2000 and Earth Summit 2002 were held to address and coordinate functional cooperation, especially regarding the social and economic aspects.
Substantive functions of functional international organizations include human rights, international communication, health, the law of the sea, the environment, education and information, international relief programs, refugee support, as well as economic development.
See also
References
Works cited
Further reading
Pdf.
External links
Global Power Barometer
International relations theory
Decentralization | 0.765721 | 0.973492 | 0.745423 |
Nursing documentation | Nursing documentation is the record of nursing care that is planned and delivered to individual clients by qualified nurses or other caregivers under the direction of a qualified nurse. It contains information in accordance with the steps of the nursing process. Nursing documentation is the principal clinical information source to meet legal and professional requirements, care nurses' knowledge of nursing documentation, and is one of the most significant components in nursing care. Quality nursing documentation plays a vital role in the delivery of quality nursing care services through supporting better communication between different care team members to facilitate continuity of care and safety of the clients.
Purposes
A written record of the history, treatment, care, and response of the client while under the care of a health care provider.
A guide for reimbursement of care costs.
Evidence of care in a court of law. A legal record that can be used as evidence of events that occurred or treatments given.
Show the use of the nursing process. It contains observations by the nurses about the client's condition, care, and treatment delivered.
Provides data for quality assurance studies and shows progress toward expected outcomes.
Documentation of the nursing process
The internationally accepted nursing process consists of five steps: assessment, nursing problem/diagnosis, goal, intervention and evaluation. Nursing process model provides the theoretical framework for nursing documentation. A nurse can follow this model to assess the clinical situation of a client and record a constructive document for nursing communication.
Content
Nursing documentation mainly consists of a client's background information or nursing history referred as admission form, numerous assessment forms, nursing care plan and progress notes. These documents record the client's data captured at the relevant stages of the nursing process. The following sections describe the concept, aim, possible structure and content of these nursing documents using the example of nursing documentation in Australian residential aged care homes.
Admission
An admission form is a fundamental record in nursing documentation. It documents a client's status, reasons why the client is being admitted, and the initial instructions for that client's care. The form is completed by a nurse when a client is admitted to a health care facility.
The admission form provides the basic information to establish foundations for further nursing assessment. It usually contains the general data about a client, such as name, gender, age, birth date, address, contact, identification information (ID) and some situational descriptions about marriage, work or other background information. Based on the different nursing care provider's requirements, this form may also record family history, past medical history, history of present illness, and allergies in nursing
Assessment
The documentation of nursing assessment is the recording of the process about how a judgment was made and its related factors, in addition to the result of the judgment. It makes the process of nursing assessment visible through what is presented in the documentation content.
During nursing assessment, a nurse systematically collects, verifies, analyses and communicates a health care client's information to derive a nursing diagnosis and plan individualized nursing care for the client. Complete and accurate nursing assessment determines the accuracy of the other stages of the nursing process.
The nursing documents may contain a number of assessment forms. In an assessment form, a licensed Registered Nurse records the client's information, such as physiological, psychological, sociological, and spiritual status (see Figure 2). The accuracy and completeness of nursing assessment determine the accuracy of care planning in the nursing process.
Nursing care plan
The nursing care plan (NCP) is a clinical document recording the nursing process, which is a systematic method of planning and providing care to clients. It was originally developed in hospitals to guide nursing students or junior nurses in providing care to client; however, the format was task-oriened rather than nursing-process-based. Nowadays, the NCP is widely used in nursing in various clinical and educational settings as a tool to direct individualized nursing care for clients.
The nurses make nursing care plans based on the assessments they have completed previously with a client. There are many ways of structuring nursing care plans in correspondence with the different needs of nursing care in different nursing specialties. For example, a nursing care plan in an Australian residential aged care home may be structured with several sections under each care domain such as pain, mobility, lifestyle, nutrition and continence. The information is recorded in free-text style, and various terms are used singly or in combination to name each of the four sections in the formats that are used by a facility during a particular period
Progress notes
A progress note is the record of nursing actions and observations in the nursing care process. It helps nurses to monitor and control the course of nursing care.
Generally, nurses record information with a common format. Nurses are likely to record details about a client's clinical status or achievements during the course of the nursing care.
Recording format
Paper-based nursing documentation
The paper-based nursing documentation has been in place for decades. Client's data are recorded in paper documents. The information in these documents needs to be integrated for sense-making in a nursing decision.
Electronic nursing documentation
Electronic nursing documentation is an electronic format of nursing documentation an increasingly used by nurses. Electronic nursing documentation systems have been implemented in health care organizations to bring in the benefits of increasing access to more complete, accurate and up-to-date data and reducing redundancy, improving communication and care service delivery.
Comparison of the quality of paper-based and electronic documentation
Electronic nursing documentation systems are able to produce somewhat better quality data in comparison with paper-based systems, in certain respects depending on the characteristics of the systems and the practice of the various study settings. The common benefits of electronic documentation systems include the improvement of comprehensiveness in documenting the nursing process, the use of standardized language and the recording of specific items about particular client issues and relevance of the message. In addition, electronic systems can improve legibility, dating and signing in nursing records.
For the documentation of nursing assessment, the electronic systems significantly increased the quantity and comprehensiveness of documented assessment forms in each record. In regard to the NCP, the electronic standardized NCPs were graded with a higher total quality score than its paper-based counterpart. In addition, in comparison with the paper-based documentation systems, the electronic systems, due to their automatic functions, were able to improve the format, structure and process features of documentation quality such as legibility, signing, dating, crossing out error and space with a single line and resident identification on every page.
Paper-based documentation has been found to be inferior in comparison with electronic documentation. This is caused by the inherent nature of paper being difficult to update, time-consuming in a recording. Thus, the records are often incomplete, illegible, repetitive and missing signatures.
Electronic nursing documentation systems have the potential to improve the quality of documentation structure and format, process and content in comparison with paper-based documentation, as demonstrated in a comparative study of electronic and paper-based nursing admission forms. However, improvement in documentation quality is not necessarily to be brought about by the introduction of electronic nursing documentation system to replace paper-based documentation. For example, Wang et al. that although the electronic nursing assessment form contained more documented assessment forms, which covered a wider range of resident care needs, they did not perform better than the previous [null paper-based assessment forms according to] the quality criteria of [null completeness] and timeliness. Therefore, further work on the usage of the electronic documentation systems may focus on improving form design and usage. There is also a need for improvement in compliance with standards in order to better meet the clients' care needs.
Quality of nursing documentation
A study by the National Client Safety Agency (NPSA) found that poor standards of documentation were a contributory factor in the failure to detect clients who were clinically deteriorating. Nurses are responsible for maintaining accurate records of the care they provide and are accountable if information is incomplete and inaccurate. Thus, a quality standard is required for recording of nursing documentation.
The systematic review of nursing documentation audit studies in different settings identified the following relevant quality characteristics of nursing documentation:
Quality of documentation structure and format: relates to constructive features and physical presentation of records such as quantity, completeness, legibility, read- ability, redundancy and the use of abbreviations.
Quality of documentation process: the procedural issues of capturing client data such as nurse's signature and designation, date, chronological order, timeliness, regularity of documentation and concordance between documentation and reality.
Quality of documentation content: refers to the message from data about a care process. It is concerned with the comprehensiveness, appropriateness and the relation- ship of the five steps of the nursing process. The care issue recorded at each step is also considered.
Standardized nursing terminology
North American Nursing Diagnosis Association (NANDA) nursing diagnosis:
NANDA International (formerly the North American Nursing Diagnosis Association) is a professional organization of nurses standardized nursing terminology that was officially founded in 1982 and develops, researches, disseminates and refines the nomenclature, criteria, and taxonomy of nursing diagnoses.
Nursing intervention classification (NIC):
The Nursing Interventions Classification (NIC) is a care classification system which describes the activities that nurses perform as a part of the planning phase of the nursing process associated with the creation of a nursing care plan.
Nursing outcome classification (NOC):
The Nursing Outcomes Classification (NOC) is a classification system which describes client outcomes sensitive to nursing intervention.
The Omaha System:
The Omaha System is a standardized health care terminology consisting of an assessment component (Problem Classification Scheme), a care plan/services component (Intervention Scheme), and an evaluation component (Problem Rating Scale for Outcomes).
International Classification for Nursing Practice (ICNP):
The International Classification for Nursing Practice (ICNP) is a collaborative project under the auspices of the International Council of Nurses. The ICNP provides a structured and defined vocabulary as well as a classification for nursing and a framework into which existing vocabularies and classifications can be cross-mapped to enable comparison of nursing data.
Structured documentation
Structured documentation takes the form of pre-printed guidelines for specific aspects of care and can, therefore, focus nursing care upon diagnoses, treatment aims, client outcomes and evaluations of care. It can improve client care by replacing the practice of vague, narrative style entries by nurses with cohesive and accurate information determined by the format of the care plan. The clarity of the recorded information also facilitates clinical auditing and evaluation of documentation practices through. Therefore, the introduction of structured documentation and care plans are seen as a means by which nurses can raise standards of record-keeping practice.
References
Nursing
Nursing informatics
Data collection
Documents | 0.767398 | 0.971329 | 0.745396 |
Clinical behavior analysis | Clinical behavior analysis (CBA; also called clinical behaviour analysis or third-generation behavior therapy) is the clinical application of behavior analysis (ABA). CBA represents a movement in behavior therapy away from methodological behaviorism and back toward radical behaviorism and the use of functional analytic models of verbal behavior—particularly, relational frame theory (RFT).
Current Models
Clinical behavior analysis (CBA) therapies include acceptance and commitment therapy (ACT), behavioral medicine (such as behavioral gerontology and pediatric feeding therapy), community reinforcement approach and family training (CRAFT), exposure therapies/desensitization (such as systematic desensitization), functional analytic psychotherapy (FAP, such as behavioral activation (BA) and integrative behavioral couples therapy), and voucher-based contingency management.
Acceptance and Commitment Therapy
Acceptance and commitment therapy is probably the most well-researched of all the third-generation behavior therapy models. Its development co-occurred with that of relational frame theory, with several researchers such as Steven C Hayes being involved with both. ACT has been argued to be based on relational frame theory. Although this is a matter of some debate within the community, Originally, this approach was referred to as comprehensive distancing. Every practitioner mixes acceptance with a commitment to one's values. These ingredients become enmeshed into the treatment in different ways which leads to ACT being either more on the mindfulness side, or more on the behavior-changing side. ACT has, as of May 2022, been evaluated in over 900 randomized clinical trials for a variety of client problems. Overall, when compared to other active treatments designed or known to be helpful, the effect size for ACT is a Cohen's d of around 0.6, which is considered a medium effect size.
Behavioral Activation
Behavioral activation emerged from a component analysis of cognitive behavior therapy. Cognitive behavior therapy focuses on trying to reverse those negative thoughts that contribute to emotional difficulties such as depression and anxiety. This research found no additive effect for the cognitive component. Behavioral activation is based on a matching law model of reinforcement. A recent review of the research supports the notion that the use of behavioral activation is clinically important for the treatment of depression.
Community Reinforcement Approach and Family Training
Community reinforcement approach and family training (CRAFT) is a model developed by Robert Meyer and based on the community reinforcement approach (CRA) first developed by Nathan Azrin and Hunt. The model focuses on the use of functional behavioral assessment to reduce drinking behavior. CRAFT combines CRA with family therapy.
Functional Analytic Psychotherapy
Functional analytic psychotherapy is based on a functional analysis of the therapeutic relationship. It places a greater emphasis on the therapeutic context and returns to the use of in-session reinforcement. The basic FAP analysis utilizes what is called the clinically relevant behavior (CRB1), which is the client's presenting problem as presented in-session. Client in-session actions that improve their CRB1s are referred to as CRB2s. Client statements, or verbal behavior, about CRBs are referred to as CRB3s. In general, 40 years of research supports the idea that in-session reinforcement of behavior can lead to behavioral change.
Integrative Behavioral Couples Therapy
Integrative behavioral couples therapy developed from dissatisfaction with traditional behavioral couples therapy. Integrative behavioral couples therapy looks to Skinner (1966) for the difference between contingency shaped and rule-governed behavior. It couples this analysis with a thorough functional assessment of the couples relationship. Recent efforts have used radical behavioral concepts to interpret a number of clinical phenomena including forgiveness.
Clinical Formulation
As with all behavior therapy, clinical behavior analysis relies on a functional analysis of problem behavior. Depending on the clinical model this analysis draws on B.F Skinner's model of Verbal Behavior or relational frame theory.
Professional Organizations
The Association for Behavior Analysis International has a special interest group in clinical behavior analysis ABA:I. ABA:I serves as the core intellectual home for behavior analysts.
The Association for Behavioral and Cognitive Therapies (ABCT) also has an interest group in behavior analysis, which focuses on clinical behavior analysis.
The Association for Contextual Behavioral Science is devoted to third-generation therapies and basic research on derived relational responding and relational frame theory.
The Behavior Analyst Certification Board (in partnership with subject matter experts) has produced a "Clinical Behavior Analysis" fact sheet.
See also
Behavioral psychotherapy
References
Behavior therapy
Behaviorism | 0.782396 | 0.952589 | 0.745302 |
Institutional abuse | Institutional abuse is the maltreatment of a person (often children or older adults) from a system of power. This can range from acts similar to home-based child abuse, such as neglect, physical and sexual abuse, and hunger, to the effects of assistance programs working below acceptable service standards, or relying on harsh or unfair ways to modify behavior. Institutional abuse occurs within emergency care facilities such as foster homes, group homes, kinship care homes, and pre-adoptive homes. Children who are placed in this type of out of home care are typically in the custody of the state. The maltreatment is usually caused by an employee of the facility.
Background
Institutional abuse can typically occur in a group home, nursing home, acute hospital or in-patient setting and can be any of the following:
Typical of the institutionalized bigotry that coincides with abuse, it is said that it can be considered to mainly apply to four categories of people:
Children – see also child abuse
Adults with learning difficulties
Adults with mental health problems
Older people – see also elder abuse.
This perspective often written into educational material seeks to excuse perpetrators with the "explanation" that the abused adults are all somehow mentally inept.
Institutional abuse can be divided into three categories:
Overt abuse – similar to familial abuse in its overt physical, sexual, or emotional abuse by a foster parent or child care worker
Program abuse – unique to an institutional situation, in which a program must operate below acceptable conditions or improperly use power to modify the behavior of person
System abuse – involves an entire care system that is stretched beyond capacity and causes maltreatment through inadequate resources.
These issues range from personal abuses to situational maltreatment and differ greatly in their causes. Most institutional abuses are the result of difficult and stressful working environments, where those with the least training often have the most contact with the participants, and have the hardest schedules, least payment, and most undesirable working conditions. The high-stress working environments of care workers combined with low-quality hiring and screening practices of workers can create abusive situations through lack of experience or knowledge on the worker's part. Lack of proper training for workers can conflict or hurt institutional goals for patients through improper implementation of treatments, compounded by organizational structures that may only have doctors and psychologists on site for short hours. In overstressed situations, power over the patients can bring feelings of control and significance, leading to stress being a predictor of abuse in institutional and familial settings. isolation from the community can have similar effects.
Often complicating worker issues is lack of organizational goals or policy. In childcare situations, lack of curricular recreation for children can lead to more acting out behavior, causing more stress for workers, and more inclination toward mistreatment. Patients can often be difficult to manage through inability or behavioral issues, and those who are more difficult for staff to work with are often the victims of abusive situations. It is proposed that most abuse rises of out frustration and lack of ability to properly control the patient, not intentional maltreatment.
Institutional child abuse also happens intentionally in the troubled teen industry where residential treatment centers and schools market themselves as therapeutic to families who are then duped into colluding with the abuse. The outcomes of these types of abusive settings resemble cult like circumstances and are devastating to the survivor of abuse. More and more programs are getting shut down through a movement called "Breaking Code Silence" started by Paris Hilton in 2020 where she publicly spoke about her abuse at Provo Canyon School in Utah. The exposure led to a lot of changes in the industry.
There is a lack of state legislation defining or prosecuting institutional abuse, leading to difficulty in investigation or dealing with abusive situations.
Historical perspective
Institutional abuse is also present in situations outside those of child and elder care. The Nuremberg Code was developed during the Nuremberg Trials to create a universal ethical code for the treatment of humans from an institutional standpoint. Though this Code is not formally adopted by any organization, its standard for human rights has been used as a guide for more specific ethical codes. However, history has still shown the abuse of the vulnerable members of society through medical and psychiatric institutions. Under the Nazi regime of the early 1940s, this abuse took the form of sterilization of those purported to be "mentally ill", and general medical experimentation without consent or will to leave, and eugenics. The political nature of these policies lead to them being enforced by law under an ideology of purifying race of genetic deficiencies. Eugenics and sterilization campaigns have also been run outside of political dictatorship, including a number of states in the United States, Denmark, Finland, and Sweden. But it is the shift from sterilization to euthanasia of the mentally ill or other politically undesirable groups in Nazi Germany that lead to the actions of the Holocaust. Japanese soldiers of the time also would use these groups as research subjects for infectious diseases and poisons, while Stalin's regime in Russia used the guise of mental illness to torture and punish political dissidents.
The Army and CIA of the United States also have histories of testing psychiatric drugs on unwilling patients or soldiers. LSD was tested by using prostitutes to trick men into taking the drug, and various combinations of depressants, hallucinogens, and stimulants would be given to unconsenting soldiers for observation of the effects. In response to many of these unethical experiments, specific ethical codes were developed to protect the rights of the participants and require informed consent.
Abuse of children
Abuse in childcare institutions falls most commonly into the categories of overt abuse, program abuse, and system abuse, which arise from the staff, program, or childcare system. As children are still in development as institutional abuse occurs, the definition of institutional abuse for children is often widened to include harming a child's development, altering a child's identity, or devaluing them as a person. Child maltreatment is also often defined as foreseeable or probable harm or injury to a child's physical, social, emotional, or developmental well-being. Researchers found incidents ranging from 39 to 85 abuse cases per 100 children living in full-time housing, with only 85 in 1000 cases being reported to authorities. Children in mental disorder clinics were more likely to report abuse than those in mental disability clinics.
Model of abuse
A number of researchers have tried to model the factors that cause abuse and maltreatment in childcare facilities. The acting factors in this model are the caregivers, children, the care-giving environment, and any other exogenic factors. Risk factors towards abuse are associated with each of these, such as the stress of the working environment can be to caregivers. These factors have all been organized into a model of concentric circles, with maltreatment at the center, and each circle further out influencing those within. There are ordered from inside out: maltreatment, child factors, caretaker factors, organization and environment factors, and exogenous factors.
Caretaker risk factors
A number of high-risk factors for the institutional abuse of children include lack of caretaker competence or training and adherence to only one treatment methodology, lack of supervision of caretakers, and much time for unstructured activities. The probability of a caretaker to be abusive is positively correlated with their job stress, age, lack of job satisfaction and facility status.
Child risk factors
Children who are more likely to be abused often display characteristics of being difficult for workers to deal with and needing more one-on-one supervision, isolation from their family, and previous victims of abuse. Children with disabilities or chronic illnesses are especially at risk of institutional abuse due to their reliance on healthcare institutions such as hospitals. Male children are more likely to be abused, and are more often abused physically and neglectfully, while females are more likely to be sexually abused.
Other factors
Incidents of abuse are most often reported at the beginning and end of the school year, and there are conflicting reports as to unemployment rates' influence on abuse.
Abuse of older adults
There is not a definitive definition of institutional abuse of older adults, with psychologists differing with legal definitions, and differing depending on the measures used. Definitions often include institutionally caused physical, psychological, financial, or sexual abuse or neglect.
Among the abuse that happens among elders, most is concentrated on those who are more frail and need more assistance. In a review of Canadian assistance homes, over 70% of workers reported acting in an abusive way towards patients, frequently in the form of psychological abuse or neglect. In a study of American assistance homes, there was a rate of 20% for employees stealing from residents, with employees acknowledging that it was the residents that were more difficult or abusive that were more likely to be robbed. Further, in Sweden, assistance home employees reported witnessing abuse at 11%, while participating in elder abuse at 2% rates. This abuse was most commonly physical abuse, followed by psychological abuse and neglect. Rates of abuse differ across surveys, countries, and homes, but certain facts are consistent across studies. Victims of abuse are also susceptible to threefold greater mortality rates than their peers.
Several frameworks have been developed to model the risk factors for institutional elder abuse. In one model, risk factors are divided into three categories: validated factors, possible factors, and contested factors. Factors that have been shown to be risks for abuse include lack of consistent organizational policies, low-quality enforcement of standards, lack of trained staff, vulnerability due to dementia. Possible factors include gender, personality of the victim, and race.
Sexual abuse is one of the lower occurring and under-reported forms of institutional abuse. Women are disproportionately represented among victims, and most often abused by other residents of the home. The majority of victims also suffered from a form of dementia or cognitive impairment. However, institution-based sexual abuse crossed all gender, race, and cultural barriers.
Risk factors of institutional abuse of older adults has been found to be related to the size of the housing, with larger organizations more susceptible to abuse. Staff factors such as unionization, short staffing, and work stress are also predictors of abuse. Patients with severe dementia are also more susceptible to maltreatment such as being constrained.
Researchers do not have a definitive answer for the cause of elder abuse. Workers in assistance homes have suggested that program factors such as understaffing, focus on making money over human welfare, and ageism contributing to institutional abuse, aggravated by patients who may be difficult or struggling with mental health issues. Most studies have focused on the interaction of stressed workers with difficult patients.
Studies indicate that social inclusion can act as a cessation towards elderly abuse. This method is not only intended to encourage diversity within hospital settings. It is also intended to ensure the individual needs of elderly patients are being met. Other intervention methods that are education based have high success rates in increasing awareness but less evidence of improving the welfares of elderly populations.
Notable institutions and investigations
Jimmy Savile sexual abuse scandal, concerning a British celebrity who is claimed to have targeted institutions
Youth Facilities
Cal Farley's Boys Ranch
Florida School for Boys
Forgotten Australians
Haut de la Garenne
Home Children
PA Child Care (Kids for cash scandal)
North Wales child abuse scandal
Northern Ireland Historical Institutional Abuse Inquiry
Care Homes
Orchid View
Hospitals
Bethlem Royal Hospital
Bloomingdale Insane Asylum
Ely Hospital
Letchworth Village
Stafford Hospital scandal
Tiergartenstraße 4
Willowbrook State School
Winterbourne View hospital abuse
Élan School
Provo Canyon School
Other
Judge Rotenberg Center
See also
References
Further reading
Academic papers
Pdf.
Hall MI After Waterhouse: vicarious liability and the tort of institutional abuse - Journal of Social Welfare and Family Law, Vol 22, No 2, pages 159-173, 2000
Hall MI The liability of public authorities for the abuse of children in institutional care: common law developments in Canada and The United Kingdom - International Journal of Law, Policy and the Family, Vol 14, pages 281-301, 2000
Mathews B Queensland Government Actions to Compensate Survivors of Institutional Abuse: a critical and comparative evaluation - Queensland University of Technology Law & Justice Journal 4(1):pages 23-45 2004
Parker J Seeking effective approaches to elder abuse in institutional settings - The Journal of Adult Protection Volume 3, Number 3 / August 2001 pages 21-29
Simkins S Out of Sight, Out of Mind: How the Lack of Postdispositional Advocacy in Juvenile Court Increases the Risk of Recidivism and Institutional Abuse - Rutgers Law Review 207 (2007–2008)
Stallybrass L Queensland Government Actions to Compensate Survivors of Institutional Abuse: a critical and comparative evaluation - Law & Justice Journal Vol 4 No 1, 2004
Sunga S Meaning of Compensation in Institutional Abuse Programs - Journal of Law and Policy, vol 17 2002 pages 39-61
Tschan W Towards a safe institution: How to prevent Sexual Abuse in the Institutional Setting? - Presentation at the XIth ISPCAN European Regional Conference on Child Abuse and Neglect, Lisbon, November 18-21, 2007
Non-fiction Books
Abuse and neglect of children in institutions, 1979: hearings before the Subcommittee on Child and Human Development of the Committee on Labor and Human Resources, United States Senate, Ninety-sixth Congress
Barter C Investigating institutional abuse of children An exploration of the NSPCC experience - 1998 London: NSPCC.
Beker, Jerome Institutional Abuse of Children and Youth (Child & Youth Services) (1982)
Hanson, R (Ed) Institutional Abuse of Children and Youth. (Child & Youth Services Series: Vol. 4, Nos. 1 & 2) New York: Haworth Press, 1982
Westcott, Helen L. Institutional Abuse of Children - From Research to Policy: A Review (Policy, Practice, Research S.) (1991)
Novels
Abagnalo, George. Boy on a Pony (Moreland Press, 2001) (exploring privileged sexual abuse within the healthcare system).
Social institutions | 0.763717 | 0.975885 | 0.7453 |
Self-advocacy | Self-advocacy is the act of speaking up for oneself and one's interests. It is used as a name for civil rights movements and mutual aid networks for people with intellectual and developmental disabilities. The term arose in the broader civil rights movements of the 1960s and 1970s, and is part of the disability rights movement. Today there are self-advocacy organizations across the world.
History
Founding of the movement
The self-advocacy movement began in the late 1960s. Before this, most organizations were run by parents of children with developmental disabilities, such as the March of Dimes, which began in the 1950s. The first self-advocacy group originated in Sweden in the late 1960s where Dr. Bengt Nirje organized a club where people with disabilities and without could meet up, decide where they wanted to go, go on an outing and then meet to discuss their experiences. Nirje wanted to provide people with disabilities "normal" experiences in the community. Previously at this time, people with developmental disabilities were not considered able to make any decisions, including about where they wanted to go, and this program indicated a drastic departure. Nirje believed that people with developmental disabilities should be allowed to make decisions, and crucially also allowed to make mistakes, saying "To be allowed to be human means to be allowed to fail." This concept is called the dignity of risk and remains one of the central values of the self-advocacy movement. In 1968, a conference was held in Sweden as part of the normalization model where people with intellectual and developmental disabilities came together to discuss their lives, their opinions and their hopes. In 1969, the first ever training was held to teach adults with developmental disabilities how to advocate for themselves politically. One man at the training said, "...I would like to organize because I know how much our comrades at the institutional schools need help to be more respected."
In 1969, Nirje presented about these achievements to the 11th World Congress of the International Society for Rehabilitation of the Disabled, saying "This is akin to any decent revolt. Some of the retarded adults themselves definitely want to play a new role in society, to create a new image of themselves in their own eyes, in the eyes of their parents and in the eyes of the general public This struggle for respect and independence is always the normal way to obtain personal dignity and a sense of liberty and equality."
After this, other countries started to plan self-advocacy conferences. England held its first self-advocacy conference in 1972 and Canada in 1973. In the United States, self-advocates from Oregon and Washington planned their own conference held in 1974. At a meeting to plan the conference, one man, argued against the label of "mentally retarded" saying "I want to be known as a person first!" The self-advocates chose People First as a name for the conferences.
self-advocates formed hundreds of groups around the United States and the world. Many of those groups are called People First, but have many other names. In 1990, Self Advocates Becoming Empowered (SABE), the first American national self-advocacy organization was created by self-advocates, including Roland Johnson. SABE maintains a list of self-advocacy groups in the United States.
In the UK, People First London Boroughs was founded following the attendance of a small number of people with learning disabilities (the British term for intellectual disability) at an international conference held in the US.
self-advocacy and institutions
Many people with developmental disabilities were put in institutions as children prior to the 1970s. Doctors recommended this to parents, who often did not have the knowledge or resources to care for their children at home. Institutions were rife with abuse of all kinds. The increasing awareness of the conditions of institutions in the 1960s and 70s intensified efforts to get people with disabilities out of institutions and many of those people joined the burgeoning self-advocacy movement. Roland Johnson spent thirteen years at Pennhurst and went on to become a leader of the movement after his release.
In 1965, then-Senator Robert Kennedy visited Willowbrook, a state institution in New York with a television crew and spoke about the horrifying conditions he witnessed, calling them "snake pit[s]". In 1966, Burton Blatt and Fred Kaplan released Christmas in Purgatory, an photographic essay about the conditions inside five state institutions for developmental disabilities.
Many self-advocates, whether survivors of institutions themselves or not, see getting people with developmental disabilities out of institutions as a priority. In 1974, Terri Lee Halderman and her family sued Pennhurst State School and Hospital for multiple incidents of abuse and the violation of the residents' civil rights. This was the first federal lawsuit against a state institution. The District Court ruled that the patient's rights were violated and the institution must be closed. The institution would not close until 1987.
One of the earliest demonstrations held by self-advocates was a march on Belcherton State School in the 1980s. Many of the protesters were survivors of Belcherton. Belcherton became the first state school to be sued in 1972 when Benjamon Ricci, father of Robert Simpson Ricci, filed a class-action lawsuit claiming that the deplorable conditions violated the residents' human rights. The institution did not close until 1992.
Neurodiversity
Jim Sinclair is credited as the first person to communicate the anti-cure or autism rights perspective in the late 1980s. In 1992, Sinclair co-founded Autism Network International (ANI), which publishes newsletters "written by and for autistic people" with Donna Williams and Kathy Grant, who knew Sinclair through pen pal lists and autism conferences. The first issue of the ANI newsletter Our Voice was distributed online in November 1992 to an audience of mostly neurotypical professionals and parents of young autistic children. The number of autistic people in the organization slowly grew and ANI became a communication network for like-minded autistic people. In 1996, ANI established a yearly retreat and conference for autistic people, which was known as "Autreat" and was held in the United States. The theme of the first conference in 1996 was "Celebrating Autistic Culture" and had close to 60 participants. The success of Autreat later inspired similar autistic retreats, such as the Association for Autistic Community's conference, Autspace, in the US; Autscape in the UK; and Projekt Empowerment in Sweden.
In 1996, Martijn Dekker, an autistic computer programmer from the Netherlands, launched an email list called "Independent Living on the Autism Spectrum" (InLv). The list also welcomed those with "cousin" conditions, such as ADHD, dyslexia, and dyscalculia. American writer Harvey Blume was a member of the list; he described it as embracing "neurological pluralism" in a 1997 article in The New York Times. Blume discussed the concept of "neurological diversity" with Australian sociologist Judy Singer. The term "neurodiversity" was first published in Singer's 1998 Honours thesis and in Blume's 1998 article in The Atlantic. Blume was an early self-advocate who predicted the role the Internet would play in fostering the international neurodiversity movement.
In 2004, autistic researcher Michelle Dawson challenged applied behavior analysis (ABA) on ethical grounds. She testified in Auton v. British Columbia against the British Columbian government's mandatory funding of ABA. The same year, The New York Times covered the autism self-advocacy perspective by publishing Amy Harmon's article, "How about not 'curing' us, some autistics are pleading".
The rise of the Internet has provided more opportunities for disabled and neurodivergent people to connect and organize. Considering the geographical distance, communication and speech patterns of neurodivergent people and the domination of neurotypical and non-disabled professionals, and family members in established organizations, the Internet has provided a valuable space for self-advocates to organize and communicate. Recent research found evidence that autistic self-advocates and self-advocates with an intellectual disability are disadvantaged in many disability/autism rights organisations – tokenism is widespread. Research also shows that poverty, unpaid positions at disability organisations and lack of support are major barriers for many autistic people or people with an intellectual disability who wish to do self-advocacy.
Values and goals
Person first
Being a person first is a value articulated early on in the self-advocacy movement. Many people with I/DD have been dehumanized or treated as less than human throughout their lives. By saying that they are a person first, self-advocates said that they were more than just their disability and that they deserved the same rights and opportunities as people without a disability.
For this reason, many people with intellectual and developmental disabilities prefer person-first language. In person-first language, you would say "people with developmental disabilities" or "person with Down syndrome". A notable exception is autism. Even though autism is a developmental disability, the community tends to prefer identity-first language. In identity-first language, one would say "autistic people" or "autistic person".
The self-advocacy movement is also very against the use of mental retardation, retarded, or any variation of the term. In addition to it not being recognized as a medical diagnosis anymore, there is a great deal of stigma against the term. There is the "Say the Word to End the Word" campaign, which seeks to end the use of the term.
Self-determination
self-determination is the right of all people to make their own choices. Choices were often denied to people with intellectual and developmental disabilities and still are today. People under guardianship do not get to make their own decisions about where they live and how they spend their money. self-advocates work for the replacement of guardianship with supported decision making where people can make their own decisions, with support from friends, family or professionals.
Dignity of risk is the idea that everyone has the right to make mistakes and to take risks. It is related to self-determination, which is about the right to make choices. Many people with I/DD were stopped from making their own decisions, out of fear that they could make bad decisions, but dignity of risk says that the right to take risks and make mistakes is an essential human right. For example, a person with an intellectual disability could go to college, even if they might have trouble passing their classes.
Community living
Community living is the idea that people should live in the community and not in institutions. Institutions segregate people away from their homes, families and friends. They are also rife with abuse and neglect. People with I/DD should receive the supports that they need to live where they want to. This is also a core value of the independent living movement.
Equal employment and education
self-advocates argue for equal opportunities in all areas of life, but especially education and employment.
K–12 education
Before the self-advocacy movement, many people with intellectual and developmental disabilities in the US were not allowed to attend school. Their families had to either keep them at home or send them to an institution. Some institutions were supposed to provide the people there with education. Institutions specifically for people with intellectual and developmental disabilities were called state schools. However, in practice, the education provide was insufficient or nonexistent. These "schools" turned into warehouses, full of abuse and neglect. In 1972, Pennsylvania Association for Retarded Citizens v. Commonwealth of Pennsylvania overturned the state law that forbid children with intellectual disabilities from attending school. It established that states had to provide a free public education for all children. Mills v. Board of Education of District of Columbia ruled that the schools must provide accommodations to students so that they can attend public school. In 1975, President Gerald Ford signed the Education for Handicapped Children Act (now known as the Individuals with Disabilities Education Act). This law entitles all children to receive a free and appropriate public education (FAPE). The law requires schools to provide students with accommodations and support to attend school. The least restrictive environment clause means that students must be, whenever possible, educated in mainstream classrooms with their non-disabled peers. Despite this, many people with intellectual and developmental disabilities are segregated in special education classrooms and not given the accommodations they need to succeed.
Civil Rights
Relationship to other movements
The self-advocacy movement developed alongside other movements, including the civil rights movement seeing a common goal in fighting for equal treatment. John F. Kennedy, in addition to passing civil rights legislation, also assembled a President's Panel on Mental Retardation. self-advocates framed their demands using a rights-based framework. Notable cases against institutions were based on the infringement of their civil rights.
self-advocacy developed concurrently but often separately to the independent living movement and the larger disability rights movement in the 1960s and 1970s. These movements were mostly made up of people with physical disabilities. Ed Roberts described a "hierarchy of disability" where certain disabilities were considered to rank higher than others. In these hierarchies, people with intellectual and developmental disabilities were seen as at the bottom. Bette McMuldren discussed the early independent living movement, saying "I remember even then – and I know independent living programs are still struggling with this now – we were trying to include people who had developmental disabilities, and we were trying to figure out how to do that. You know, certainly there were people who had cerebral palsy. There were a lot of people who had cerebral palsy. People with mental retardation never really got incorporated. But there was always talk about how to build coalitions and how were we going to make that happen."
References
Further reading
This book includes many chapters written by self-advocates concerning the self-advocacy movement, and provides a historical perspective, as well as reflections on the current status and future course of the movement.
This booklet talks about the beliefs, values, and principles of self-advocacy, and about the role of support persons. It also gives examples of good practice. It is produced by the ILSMH formed to help promote self-advocacy internationally.
This book recognizes that self-determination is one of the building blocks of independence for people with disabilities and explores the theoretical, developmental, and practical aspects of decision making.
Available from ARC Tulsa 1601 S. Main Street, Suite 300, Tulsa, OK 74119, attn: Michelle Hoffman
This book describes the beginnings of the self-advocacy movement in the United States and in England. Includes suggestions for developing self-advocacy groups.
Disability rights
Medical sociology
Mental health activists
Patient advocacy
Developmental disabilities | 0.762932 | 0.976839 | 0.745262 |
Restorative practices | Restorative practices (or RP) is a social science field concerned with improving and repairing relationships and social connections among people. Whereas a zero tolerance social mediation system prioritizes punishment, RP privileges the repair of harm and dialogue among actors. In fact, the purpose of RP is to build healthy communities, increase social capital, decrease crime and antisocial behavior, mend harm and restore relationships. It ties together research in a variety of social science fields, including education, psychology, social work, criminology, sociology, organizational development and leadership. RP has been growing in popularity since the early 2000s and varying approaches exist.
Overview
The social science of restorative practices offers a common thread to tie together theory, research and practice in diverse fields such as education, counseling, criminal justice, social work and organizational management. Individuals and organizations in many fields are developing models and methodology and performing empirical research that share the same implicit premise, but are often unaware of the commonality of each other's efforts.
In education, restorative practices, such as circles and groups, provide opportunities for students to share their feelings, build relationships and solve problems, and when there is wrongdoing, to play an active role in addressing the wrong and making things right. Schools that implement restorative practices (RP) have been found to provide safe school environments through building quality relationships and a supportive community. Further, urban educators who carry out RP have observed a decrease in disciplinary issues and absenteeism, a heightened sense of community, as well as an increase in school safety and instructional time.
For example, in criminal justice, restorative circles and restorative conferences allow victims, offenders and their respective family members and friends to come together to explore how everyone has been affected by an offense and, when possible, to decide how to repair the harm and meet their own needs. In England's Criminal Justice System (CJS), prisons use RP to stimulate positive social interactions and decrease tension when situational challenges arise. Introduced in the 1990s in some of Europe's CJS, RP has improved relationships between the prisons' residents and their relatives through restorative family interventions.
In social work, family group decision-making (FGDM) or family group conferencing (FGC) processes empower extended families to meet privately, without professionals in the room, to make a plan to protect children in their own families from further violence and neglect or to avoid residential placement outside their own homes.
These various fields employ different terms, all of which fall under the rubric of restorative practices: In the criminal justice field the phrase used is "restorative justice"; in social work the term employed is "empowerment"; in education, talk is of "positive discipline" or "the responsive classroom"; and in organizational leadership "horizontal management" is referenced. The social science of restorative practices recognizes all of these perspectives and incorporates them into its scope.
Functions
The use of restorative practices has the potential to:
reduce crime, violence and bullying
improve human behavior
strengthen civil society
provide effective leadership
restore relationships
repair harm
History
Restorative practices has its roots in restorative justice, a way of looking at criminal justice that emphasizes repairing the harm done to people and relationships rather than only punishing offenders.
In the modern context, restorative justice originated in the 1970s as mediation or reconciliation between victims and offenders. In Elmira, Ontario, Canada, near Kitchener, in 1974 Mark Yantzi, a probation officer, arranged for two teenagers to meet directly with their victims following a vandalism spree and agree to restitution. The positive response by the victims led to the world's first victim-offender reconciliation program, in Kitchener, with the support of the Mennonite Central Committee and collaboration with the local probation department. The concept subsequently acquired various names, such as victim-offender mediation and victim-offender dialogue as it spread through North America and to Europe through the 1980s and 1990s.
Restorative justice echoes ancient and indigenous practices employed in cultures all over the world, from Native American and First Nations to African, Asian, Celtic, Hebrew, Arab and many others.
Eventually modern restorative justice broadened to include communities of care as well, with victims' and offenders' families and friends participating in collaborative processes called conferences and circles. Conferencing addresses power imbalances between the victim and offender by including additional supporters. In the 2010s, federal and local governments in the US, as well as community organizations, requested schools decrease suspension rates. To provide an alternative to disciplinary measures like suspension, large urban school districts, like New York City Public Schools and the Los Angeles Unified School District, started implementing RP.
A major aspect of any restorative practice is neutrality. Though restorative practice aim to resolve issues within a group, the facilitation of the resolution is supposed to remain impartial. It is, therefore, important that facilitators of any restorative practice are neutral to the situation at issue. Some researchers also classify the study of restorative practice through the concept of process and values. In this framework, process refers to the specific actions taken to repair harms and/or build community. Values refer to the overarching principals that guide those actions and that differ from more traditional justice that may be punitive.
Terminology
Family group conference
The family group conference (FGC) started in New Zealand in 1989 as a response to native Māori people's concerns with the number of their children being removed from their homes by the courts. It was originally envisioned as a family empowerment process, not as restorative justice. In North America it was renamed family group decision making (FGDM).
Restorative conferences
In 1991 the FGC was adapted by an Australian police officer, Terry O'Connell, as a community policing strategy to divert young people from court, into a restorative process often called a restorative conference. It has been called other names, such as a community accountability conference and victim-offender conference. In 1994 Marg Thorsborne, an Australian educator, was the first to use a restorative conference in a school.
Circles
A "circle" is a versatile restorative practice that can be used proactively, to develop relationships and build community or reactively, to respond to wrongdoing, conflicts and problems. Circles give people an opportunity to speak and listen to one another in an atmosphere of safety, decorum and equality. The circle process allows people to tell their stories and offer their own perspectives.
The circle has a wide variety of purposes: conflict resolution, healing, support, decision making, information exchange and relationship development. Circles offer an alternative to contemporary meeting processes that often rely on hierarchy, win-lose positioning and argument.
Circles can be used in any organizational, institutional or community setting. Circle time and morning meetings have been widely used in primary and elementary schools for many years and more recently in secondary schools and higher education. In industry, the quality circle has been employed for decades to engage workers in achieving high manufacturing standards. In 1992 Yukon Circuit Court Judge Barry Stewart pioneered the sentencing circle, which involved community members in helping to decide how to deal with an offender. In 1994 Mennonite Pastor Harry Nigh befriended a mentally challenged repeat sex offender by forming a support group with some of his parishioners, called a circle of support and accountability, which was effective in preventing re-offending.
Circles can be both proactive and reactive. Proactive circles aim to create a positive classroom or environmental climate as facilitators solicit the expression of opinions and ideas in a safe environment. Reactive circles, often called restorative circles, work in conjunction with proactive circles. When a specific behavior or incident impacts individuals in the class or group, restorative circles aim to restore the climate and culture of the group through conflict resolution. Sometimes specific restorative conferences may transpire, which are direct and individual conferences between specific parties to discuss and resolve troubling behaviors and emotions.
Difference between restorative justice and restorative practices
The notion of restorative practices evolved in part from the concept and practices of restorative justice. But from the emergent point of view of restorative practices, restorative justice can be viewed as largely reactive, consisting of formal or informal responses to crime and other wrongdoing after it occurs. Restorative practices also includes the use of informal and formal processes that precede wrongdoing, those that proactively build relationships and a sense of community to prevent conflict and wrongdoing.
Other terminology
The term restorative practices, along with terms like restorative approaches, restorative justice practices and restorative solutions, are increasingly used to describe practices related to or derived from restorative conferences and circles. These practices also include more informal practices (see Restorative Practices Continuum).
Use of restorative practices is now spreading worldwide, in education, criminal justice, social work, counseling, youth services, workplace, college residence hall and faith community applications. Notably, restorative practices can and do serve as reactionary tools in these settings but have also been successful when implemented as proactive pedagogy.
Restorative practices continuum
Restorative practices are not limited to formal processes, such as restorative conferences or family group conferences, but range from informal to formal. On a restorative practices continuum, the informal practices include affective statements that communicate people's feelings, as well as affective questions that cause people to reflect on how their behavior has affected others. Impromptu restorative conferences, groups and circles are somewhat more structured but do not require the elaborate preparation needed for formal conferences. Moving from left to right on the continuum, as restorative practices become more formal, they involve more people, require more planning and time, and are more structured and complete. Although a formal restorative process might have dramatic impact, informal practices have a cumulative impact because they are part of everyday life.
The aim of restorative practices is to develop community and to manage conflict and tensions by repairing harm and building relationships. This statement identifies both proactive (building relationships and developing community) and reactive (repairing harm and restoring relationships) approaches. Organizations and services that only use the reactive without building the social capital beforehand are less successful than those that also employ the proactive.
Social discipline window
The social discipline window is a concept with broad application in many settings. It describes four basic approaches to maintaining social norms and behavioral boundaries. The four are represented as different combinations of high or low control and high or low support. The restorative domain combines both high control and high support and is characterized by doing things with people (collaboratively), rather than to them (coercively) or for them (without their involvement).
The social discipline window also defines restorative practices as a leadership model for parents in families, teachers in classrooms, administrators and managers in organizations, police and social workers in communities and judges and officials in government. The fundamental unifying hypothesis of restorative practices is that "people are happier, more cooperative and productive, and more likely to make positive changes when those in positions of authority do things with them, rather than to them or for them." This hypothesis maintains that the punitive and authoritarian to mode and the permissive and paternalistic for mode are not as effective as the restorative, participatory, engaging with mode.
The social discipline window reflects the seminal thinking of renowned Australian criminologist John Braithwaite, who has asserted that reliance on punishment as a social regulator is problematic because it shames and stigmatizes wrongdoers, pushes them into a negative societal subculture and fails to change their behavior. The restorative approach, on the other hand, reintegrates wrongdoers back into their community and reduces the likelihood that they will reoffend.
Implementations of restorative practices
Educational system
There has been an accumulation of RP experiences in schools. Research on these seems to validate that RP has led to a decrease in disciplinary measures and slight diminishment in racial exclusionary gaps. One goal of RP has been to close the racial disciplinary gap since students of color, especially African American children, are suspended more frequently than white students. According to a 2018 US Office of Civil Rights study of the 2015-16 school year, Black boys made up approximately one twelfth (8%) of enrolled students but one fourth (25%) of suspended students.
In a 2020 survey of fifth and eighth graders, students found RP's restorative circles (RC) as a valuable method of expression and of sharing perspectives about problems. Students use RP as a way to express their thoughts and feelings, and encourage intercommunication. Schools have used classroom conferencing to address disruption that has had an effect on learning. In such a situation, RP has helped teachers and students discuss behavioral expectations from one another. In New Zealand, schools have experienced best restorative outcomes when all parties actively participate and understand how the problem originated, what should be done, and how the parties can reach a shared commitment that the issue not repeat itself.
Prison system
RP has served to attend concerns of legitimacy, fairness, and accountability. Restorative conversations and circles, and family interventions, have played a positive role in building relationships between residents, officers, and families. In one of England's prisons, residents and officers made use of a restorative circle to resolve a kitchen issue. Since the residents left the kitchen untidy on repeated occasions, the officers punitively closed the kitchen for a couple of days. However, the closing of the kitchen created bitterness among the residents, one of whom proposed to carry out a restorative circle to establish a kitchen code of conduct. Initially hesitant to participate, the officers eventually helped mediate the residents' agreement; the officers' presence provided a sense of security to the prisoners.
Criticisms
There have been criticisms of RP from different perspectives. RP interventions among elementary-aged school children seem to be more impactful than among early teens or teenaged children. The effectiveness of interventions across grade levels must be examined. Additionally, RP expectations may be unrealistic. Out of numerous RP components, schools may only implement RP circles yet await a shift in school climate. In prison systems, RP is viewed as a soft option and counter to prison values by some officers.
References
External links
International Institute for Restorative Practices
Restorative Practices International
Community building
Social economy
Socioeconomics | 0.766145 | 0.97271 | 0.745237 |
Nightingale's environmental theory | Florence Nightingale (1820–1910), considered the founder of educated and scientific nursing and widely known as "The Lady with the Lamp", wrote the first nursing notes that became the basis of nursing practice and research. The notes, entitled Notes on Nursing: What it is, and What it is Not (1860), listed some of her theories that have served as foundations of nursing practice in various settings, including the succeeding conceptual frameworks and theories in the field of nursing. Nightingale is considered the first nursing theorist. One of her theories was the Environmental Theory, which incorporated the restoration of the usual health status of the nurse's clients into the delivery of health care—it is still practiced today.
Environmental effects
She stated in her nursing notes that nursing "is an act of utilizing the environment of the patient to assist him in his recovery" (Nightingale 1860/1969), that it involves the nurse's initiative to configure environmental settings appropriate for the gradual restoration of the patient's health, and that external factors associated with the patient's surroundings affect life or biologic and physiologic processes, and his development.
Environmental factors affecting health
Pure fresh air- "to keep the air he breathes as pure as the external air without chilling him/her."
Pure water- "well water of a very impure kind is used for domestic purposes. And when epidemic disease shows itself, persons using such water are almost sure to suffer."
Effective drainage- "all the while the sewer maybe nothing but a laboratory from which epidemic disease and ill health is being installed into the house."
Cleanliness- "the greater part of nursing consists in preserving cleanliness."
Light (especially direct sunlight)- "the usefulness of light in treating disease is very important."
Any deficiency in one or more of these factors could lead to impaired functioning of life processes or diminished health status.
Provision of care by environment
The factors posed great significance during Nightingale's time, when health institutions had poor sanitation, and health workers had little education and training and were frequently incompetent and unreliable in attending to the needs of the patients. Also emphasized in her environmental theory is the provision of a quiet or noise-free and warm environment, attending to patient's dietary needs by assessment, documentation of time of food intake, and evaluating its effects on the patient.
Nightingale's theory was shown to be applicable during the Crimean War when she, along with other nurses she had trained, took care of injured soldiers by attending to their immediate needs, when communicable diseases and rapid spread of infections were rampant in this early period in the development of disease-capable medicines. The practice of environment configuration according to patient's health or disease condition is still applied today, in such cases as patients infected with Clostridium tetani (suffering from tetanus), who need minimal noise to calm them and a quiet environment to prevent seizure-causing stimulus.
See also
Crimean War Memorial
Florence Nightingale
Nursing
Nursing process
Nursing theory
References
Nursing theory
Florence Nightingale | 0.766849 | 0.971744 | 0.745182 |
Hendiatris | Hendiatris ( ; ) is a figure of speech used for emphasis, in which three words are used to express one idea. The phrases "sun, sea and sand", and "wine, women and song" are examples.
A tripartite motto is the conventional English term for a motto, a slogan, or an advertising phrase in the form of a hendiatris. Some well-known examples are the formula "Life, Liberty, and the pursuit of Happiness" from the United States Declaration of Independence, Jesus Christ's Via, Veritas, Vita and Julius Caesar's Veni, vidi, vici (examples of a tricolon); and the motto of the French Republic: Liberté, Égalité, Fraternité; the phrase peace, order and good government is used as a guiding principle in the parliaments of the Commonwealth of Nations.
In the ancient and classical world
In rhetorical teaching, such triple iterations marked the classic rhythm of Ciceronian style, typified by the triple rhetorical questions of his first Oration Against Catiline:
In ancient Greece and Rome, such abstractions as liberty and justice were theologized (cf. triple deity). Hence the earliest tripartite mottoes are lists of the names of goddesses: Eunomia, Dike, and Eirene. These late Greek goddesses, respectively Good Order, Justice, and Peace were collectively referred to by the Romans as the Horae. The Romans had Concordia, Salus, and Pax, collectively called the Fortunae. The names of these mean Harmony, Health, and Peace.
In Shakespeare
"Cry God for Harry, England and St. George" (Henry V)
"Friends, Romans, countrymen, lend me your ears" (Julius Caesar)
"Be bloody, bold, and resolute" (Macbeth)
"Love all, trust a few. Do wrong to none." (All's well that ends well)
"Serve God, love me, and mend." (Much Ado About Nothing)
Since the Renaissance and the Enlightenment
From the 18th century, the tripartite motto was primarily political. John Locke's Life, Liberty, and Property was adapted by Thomas Jefferson when he wrote the United States Declaration of Independence into Life, liberty, and the pursuit of happiness, which has become the American equivalent of the French triad listed above.
The initial Carlist motto was God, Country, King.
The dominant ideology of Tsar Nicholas I of Russia was frequently expressed in the tripartite motto, "Orthodoxy, autocracy and nationality".
The policy was the political and religious vision of absolute monarchy in early modern France, particularly during the reign of Louis XIV. It reflects the desire for centralized authority and unity under the monarch, where the king's power is supreme, the law is uniform across the kingdom, and religious unity under Catholicism is enforced.
The University of North Carolina's Dialectic and Philanthropic Societies maintain such tripartite mottos as well. The Philanthropic Society's motto is Virtus, Libertas, et Scientia "Virtue, Liberty, and Knowledge" and the Joint Senate motto is Ad Virtutem, Libertatem, Scientiamque "Toward Virtue, Liberty, and Knowledge".
Modern usages
A Canadian usage is Peace, order and good government, originally found in the 1867 Constitution of Canada. It has remained, to this day, an essential part of the Canadian identity.
"Il nous faut de l'audace, encore de l'audace, toujours de l'audace!" 'We must be bold, and again bold, and forever bold!' Georges Danton.
Lenin and the Bolsheviks adopted a tripartite motto for the Russian Revolution,
During the New Deal, the projects of Franklin Delano Roosevelt were summed up as Relief, Recovery, and Reform.
The form was used by fascist parties: Fascist Italy's Credere! Obbedire! Combattere! 'Believe! Obey! Fight!'; the Nazi Ein Volk! Ein Reich! Ein Führer! 'One people! One state! One leader!'.
The motto for Spain, Una, Grande y Libre ('Unitary, Great, and Free').
The modern motto of Germany: "Einigkeit und Recht und Freiheit" (Unity and Justice and Freedom) is inscribed on the side of German euro coins, as it was on Deutsche Mark coins.
During the German occupation of France, the Vichy regime replaced the motto of the Republic by Travail, Famille, Patrie (Work, Family, Fatherland).
The main slogan of Greek junta in .
Given by Muhammad Ali Jinnah, founder of Pakistan, Faith, Unity, Discipline (Urdu: ایمان، اتحاد، نظم, romanized: Īmān, Ittiḥād, Naẓm) is the national motto of Pakistan.
Such mnemonics have also drawn suspicion from more nuanced thinkers; in George Orwell's novel Nineteen Eighty-Four, the novel's totalitarian regime used "War is Peace, Freedom is Slavery, Ignorance is Strength" to exhort the subjects of Oceania to fear any apparent opportunities for personal agency.
The motto of the Reorganized National Government of the Republic of China, a Japanese puppet regime, was "Peace, Anti-Communism, National Construction".
The 1974 Carnation Revolution in Portugal aimed at three immediate goals: "Descolonização, Democratização, Desenvolvimento" 'decolonization, democratization, development'.
The US Federal Bureau of Investigation has an initialistic motto: "Fidelity, Bravery, Integrity", while the United States Military Academy at West Point has "Duty, Honor, Country". This concept has been extended to the list of core values of the U.S. armed services, such as the Navy's "Honor, Courage, Commitment" and the Coast Guard's "Honor, Respect, Devotion to Duty".
The University of Notre Dame has adopted "God, Country, Notre Dame" as an informal motto. The phrase first appeared on the First World War memorial located on the east portico of the basilica.
The Royal Military College of Canada has followed the tripartite motto "Truth, Duty, Valour" since the founding of the College in 1876. This motto was expanded into the Canadian Forces' core values.
Very often triple mottoes derive from a turn of oratory in a speech; for example Abraham Lincoln's "of the people, by the people, for the people" in his Gettysburg Address and "Segregation now, segregation tomorrow, segregation forever" in George Wallace's 1963 Inaugural Address.
These are common throughout Western civilization, but also appear in other cultures. The Japanese said that during their boom years, illegal immigrants performed the work that was "dangerous, difficult, (and/or) dirty" (, Kiken, kitsui, kitanai). Dravidian parties in southern India use the motto "Duty, Dignity and Discipline" (in Tamil: ). The proponents of Manding social reformation and the N'Ko language education in West Africa use the hendiatris motto "to be savvy, to work, to be just" (, kà kólɔn, kà báara, kà télen).
The form is so well known that it can be played upon, as in the three requisites of real estate ("Location, Location, Location"), and similarly with Tony Blair stating his priorities as a political leader to be "education, education and education".
In German society, the tripartite motto Kinder, Küche, Kirche (children, kitchen, church) was first a late-19th-century slogan.
One of the unofficial mottoes of Yale University is "For God, for country, and for Yale", which appears as the last line of the university's alma mater, Bright College Years. Yale historian George W. Pierson has also described Yale as "at once a tradition, a company of scholars, a society of friends".
A commonly used patriotic slogan in Poland is Bóg, Honor, Ojczyzna (lit. “God, Honour, Fatherland”).
The motto of the Afghan National Army is خدا، وطن، وظیفه (lit. "God, Homeland, Duty").
Featured in the 2004 American cult classic film, 13 Going on 30, starring Jennifer Garner, "Thirty, flirty, and thriving", is used to express the idea of optimistic prosperity, in the wake of commonplace insecurities faced by many young adults, in their teens and twenties.
In the Kendrick Lamar song "The Recipe", the hendiatris of "women, weed, and weather" describes "what represents L.A.," according to Dr. Dre, who appears on the song.
A commonly used slogan used in propaganda by the Chinese Communist Party during the Mao era is "Great, Glorious, and Correct". After disappearing for decades after the opening of China, a resurgence of usage of the figure of speech can be observed under the Xi Jinping Administration.
Examples
"Citius, Altius, Fortius" ("Faster, higher, stronger") is the official Olympic motto
"Every Tom, Dick and Harry"
"Faith, hope, and charity"
"Game, set, and match"
"Gold, frankincense and myrrh", the Biblical gifts of the Magi
"God, family, and country"
"God, mother, and apple pie"
"Hook, line, and sinker"
"In no way, shape, or form"
"Life, liberty and the pursuit of happiness"
"Live, laugh, love"
"Lock, stock, and barrel" (this is also a merism, denoting a thing by enumerating its parts)
"Métro, boulot, dodo" (subway/underground, work, sleep), a French expression popularly used to describe the dreary daily routine of working Parisians, and the source of many imitative expressions.
"Reduce, reuse, recycle"
"Rum, sodomy and the lash", a characterization of Royal Navy tradition attributed (probably falsely) to Winston Churchill, which was used by the English band, The Pogues, for the title of their second album (1985).
"Truth, justice, and the American way", the causes for which Superman fights, according to the opening of the television series Adventures of Superman
”Vita, Dulcedo, Spes”
"Virtue, liberty, and independence"
"Wine, women and song", a phrase of Johann Heinrich Voss (1751–1826), and its modern variant "Sex, drugs, and rock'n'roll"
Women, Fire, and Dangerous Things, a book by cognitive linguist George Lakoff on categorization and metaphor
"Honour, Pride, Courage", the official motto of the Toronto Maple Leafs ice hockey team.
"Woman, Life, Freedom"
See also
Rule of three (writing)
The three Rs
Four-character idiom
Related terms
Hendiadys, one through two has one of the parts subordinate to the other
Tricolon, isocolon of three parts, with the parts equivalent in structure, length and rhythm
Merism, denoting a whole by an enumeration of its parts
Triad (disambiguation)
References
Figures of speech
Mottos | 0.760464 | 0.979801 | 0.745103 |
The Anatomy of Dependence | is a 1971 book by Japanese psychoanalyst Takeo Doi, discussing at length Doi's concept of amae, which he describes as a uniquely Japanese need to be in good favor with, and be able to depend on, the people around oneself. He likens this to behaving childishly in the assumption that parents will indulge you (Doi 2001:16), and claims that the ideal relationship is that of the parent–child, and all other relationships should strive for this degree of closeness (Doi 2001:39).
Main concept
Amae is the nominal form of the verb amaeru, which Doi uses to describe the behavior of a person attempting to induce an authority figure, such as a parent, spouse, teacher, or supervisor, to take care of them. The word is rarely used of oneself, but rather is applied descriptively to the behavior of other people. The person who is carrying out amae may beg or plead, or alternatively act selfishly while secure in the knowledge that the caregiver will indulge them. The behavior of children towards their parents is perhaps the most common example of amae, but Doi argued that child-rearing practices in the Western world seek to stop this kind of dependence, whereas in Japan it persists into adulthood in all kinds of social relationships. However, these cultural concepts do not apply to indigenous cultures in Japan, such as the Ainu people or the Ryukyuan people, the latter of which replaces amae with humor.
In literary context
Doi developed this idea to explain and describe many kinds of Japanese behavior. However, Doi states that while amae is not just a Japanese phenomenon, the Japanese are the only people known to have an extensive vocabulary for describing it. The reason for this is that amae is a major factor in Japanese interaction and customs. Doi argues that nonverbal empathic guesswork ( sasshi), a fondness for unanimous agreement in decision-making, the ambiguity and hesitation of self-expression ( enryo), and the tatemae–honne dynamics are communicative manifestations of the amae psychology of Japanese people.
Doi translates amaeru as "to depend and presume upon another's benevolence". It indicates, for Doi, "helplessness and the desire to be loved". Amaeru can also be defined as "to wish to be loved", and denotes dependency needs. Amae is, in essence, a request for indulgence of one's perceived needs.
Doi says,
According to Doi and others, in Japan the kind of relationship based on this prototype provides a model of human relationships in general, especially (though not exclusively) when one person is senior to another. As another writer puts it:
Amae may also be used to describe the behavior of a husband who comes home drunk and depends on his wife to get him ready for bed. In Japan, amae does have a connotation of immaturity, but it is also recognized as a key ingredient in loving relationships, perhaps more so than the notions of romance so common in the West.
Reception
Doi's work has been heavily criticized by academics specializing in nihonjinron studies as being anecdotal and full of inaccuracies. (See Dale, P. 1986 The Myth of Japanese Uniqueness, Mouer and Sugimoto 1986, 1982, Kubota 1999)
Doi's work has been hailed as a distinctive contribution to psychoanalysis by the American psychiatrist Frank Johnson, who has devoted a full book-length study to Doi and to his critics.
Publication history
The Anatomy of Dependence was originally published in Japanese in 1971, and an English translation by John Bester was later published in 1973.
See also
Attachment theory
Codependency
Maslow's hierarchy of needs
Nihonjinron
References
Doi, T. The Anatomy of Dependence, Kodansha America, Inc., 2001.
1971 non-fiction books
Japanese non-fiction books
Japanese family structure
Japanese values
Books about Japan
Psychology books
Books about parenting | 0.762124 | 0.977494 | 0.744971 |
Social competence | Social competence consists of social, emotional, cognitive, and behavioral skills needed for successful social adaptation. Social competence also reflects having the ability to take another's perspective concerning a situation, learn from past experiences, and apply that learning to the changes in social interactions.
Social competence is the foundation upon which expectations for future interaction with others are built and perceptions of an individual's own behavior are developed. Social competence frequently encompasses social skills, social communication, and interpersonal communication. Competence is directly connected to social behavior, such as social motives, abilities, skills, habits, and knowledge. All of these social factors contribute to the development of a person's behavior.
History
The study of social competence began in the early 20th century with research into how children interact with their peers and function in social situations. In the 1930s, researchers began investigating peer groups and how children's characteristics affected their positions within these peer groups. In the 1950s and 1960s, research established that children's social competence was related to future mental health (such as maladaptive outcomes in adulthood), as well as problems in school settings. Research on social competence expanded greatly from this point on, as increasing amounts of evidence demonstrated the importance of social interactions. Social competence began to be viewed in terms of problem-solving skills and strategies in social situations, and was conceptualized in terms of effective social functioning and information processing. In the 1970s and 1980s, research began focusing on the impact of children's behavior on relationships, which influenced the study of the effectiveness of teaching children social skills that are age, gender, and context-specific.
In an effort to determine the reason for some children's lack of social skills in certain interactions, new well developed social information processing models to explain the dynamics of social interaction. These models focused on factors such as behavior, the way people perceive and evaluate each other, and the processing of social cues. They also examined the selection of social goals, decision-making processes, and the implementation of chosen responses. Studies like these often examined the correlation between social cognition and social competence.
A prominent researcher of social competence in the mid-1980s was Frank Gresham. He identified three sub-domains of social competence: adaptive behavior, social skills, and peer acceptance (peer acceptance is often used to assess social competence). Research during this time often focused on children who were not displaying social skills in an effort to identify and help these children who were potentially at risk of long-term negative outcomes due to poor social interactions. Gresham proposed that these children could have one of four deficits: skill deficits, in which children did not have the knowledge or cognitive abilities to carry out a certain behavior, performance deficits, self-control skill deficits, and self-control performance deficits, in which children had excessive anxiety or impulsivity that prohibited proper execution of the behaviors or skills they knew and understood.
Despite all the developments and changes in the conceptualization of social competence throughout the 20th century, there was still a general lack of agreement about the definition and measurement of social competence during the 1980s. The definitions of the 1980s were less ambiguous than previous definitions, but they often did not acknowledge the age, situation, and skill specificity implicit in the complex construct of social competence.
Approaches and theories
Peer regard/status approaches
These approaches define social competence based on how popular one is with his peers. The more well-liked one is, the more socially competent they are.
Peer group entry, conflict resolution, and maintaining play, are three comprehensive interpersonal goals that are relevant with regard to the assessment and intervention of peer competence.
Social skill approaches
These approaches use behaviors as a guideline. Behaviors that demonstrate social skills are compiled and collectively identified as social competence.
Relationship approaches
According to these approaches, social competence is assessed by the quality of one's relationships and the ability to form relationships. Competence depends on the skills of both members of the relationship; a child may appear more socially competent if interacting with a socially skilled partner. Commentators on some online incel communities have advocated government programs wherein socially awkward men are helped or women are incentivized to go on dates with them.
Functional approaches
The functional approach is context-specific and concerned with the identification of social goals and tasks. This approach also focuses on the outcomes of social behavior and the processes leading to those outcomes. The importance of information-processing models of social skills in these approaches is based on the idea that social competence results from social-cognitive processes.
Models
Early models of social competence stress the role of context and situation specificity in operationalizing the competence construct. These models also allow for the organization and integration of the various component skills, behaviors, and cognitions associated with social competence. Whereas global definitions focus on the "ends" rather than the "means" by which such ends are achieved, a number of models directly attend to the theorized processes underlying competence. These process models are context-specific and seek to identify critical social goals and tasks associated with social competence. Other models focus on the often overlooked distinction between social competence and the indices (i.e., skills and abilities) used to gauge it.
Behavioral–analytic model
Goldfried and D'Zurilla developed a five-step behavioral-analytic model outlining a definition of social competence.
The specific steps proposed in the model include: (1) situational analysis, (2) response enumeration, (3) response evaluation, (4) measure development, and (5) evaluation of the measure.
Situation analysis – a critical situation is defined on the basis of certain criteria, which include:
occurs with some frequency
presents a difficult response decision
results in a range of possible responses in a given population. Situation identification and analysis is accomplished through a variety of methods, including direct observation by self or others, interviews, and surveys.
Response enumeration – a sampling of possible responses to each situation is obtained. Procedures for generating response alternatives include direct observation, role plays, and simulations in video and/or written formats.
Response evaluation – the enumerated responses are judged for effectiveness by "significant others" in the environment. An important element is that a consensus must emerge, or the particular item is removed from future consideration.
In the last two steps (4 and 5), a measure for assessing social competence is developed and evaluated.
Social information-processing model
A social information-processing model is a widely used means for understanding social competence. The social information-processing model focuses more directly on the cognitive processes underlying response selection, enactment, and evaluation. Using a computer metaphor, the reformulated social information-processing model outlines a six-step nonlinear process with various feedback loops linking children's social cognition and behavior. Difficulties arising at any of the steps generally translate into social competence deficits.
The six steps are:
Observation and encoding of relevant stimuli – attending to and encoding non-verbal and verbal social cues, both external and internal.
Interpretation and mental representation of cues – understanding what has happened during the social encounter, as well as the cause and intent underlying the interaction.
Clarification of goals – determining what one's objective is for the interaction and how to put forth an understanding of those goals.
Representation of a situation is developed by accessing long-term memory or construction – the interaction is compared to previous situations stored in long-term memory and the previous outcomes of those interactions.
Response decision/selection
Behavioral enactment and evaluation
Tri-component model
Another way to conceptualize social competence is to consider three underlying subcomponents in a hierarchical framework.
Social Adjustment
Social Performance
Social Skills
The top of the hierarchy includes the most advanced level, social adjustment. Social adjustment is defined as the extent to which an individual achieves society's developmentally appropriate goals. The goals are conceived of as different "statuses" to be achieved by members of a society (e.g., health, legal, academic, or occupational, socioeconomic, social, emotional, familial, and relational statuses). The next level is social performance – or the degree to which an individual's responses to relevant social situations meet socially valid criteria. The lowest level of the hierarchy is social skills, which are defined as specific abilities (i.e., overt behavior, social cognitive skills, and emotional regulation) allowing for competent performance within social tasks. The tri-component model is useful for doctors and researchers looking to change, predict, or elaborate social functioning of children.
The quadripartite model
The essential core elements of competence are theorized to consist of four superordinate sets of skills, abilities, and capacities: (1) cognitive skills and abilities, (2) behavioral skills, (3) emotional competencies, and (4) motivational and expectancy sets.
Cognitive skills and abilities – cultural and social knowledge necessary for effective functioning in society (i.e., academic and occupational skills and abilities, decision-making ability, and the processing of information)
Behavioral skills – knowledge of behavioral responses and the ability to enact them (i.e., negotiation, role- or perspective-taking, assertiveness, conversational skills, and prosocial skills)
Emotional skills – affect regulation and affective capacities for facilitating socially competent responding and forming relationships
Motivational and expectancy sets – an individual's value structure, moral development, and sense of efficacy and control.
The developmental framework
Social competence develops over time, and the mastery of social skills and interpersonal social interactions emerge at various time points on the developmental continuum (infancy to adolescence) and build on previously learned skills and knowledge. Key facets and markers of social competence that are remarkably consistent across the developmental periods (early childhood, middle/late childhood, adolescence) include prosocial skills (i.e., friendly, cooperative, helpful behaviors) and self-control or regulatory skills (i.e., anger management, negotiation skills, problem-solving skills). However, as developmental changes occur in the structure and quality of interactions, as well as in cognitive and language abilities, these changes affect the complexity of skills and behaviors contributing to socially competent responding.
Contributing factors
Temperament
Temperament is a construct that describes a person's biological response to the environment. Issues such as soothability, rhythmicity, sociability, and arousal make up this construct. Most often sociability contributes to the development of social competence.
Mary Rothbart holds the most influential model of temperament due to the two main focuses on regulation and reactivity. Effort control is the main idea behind temperament regulation because the skills it requires are involved in integrating information, planning, and emotion modulation and behavior. Reactivity pertains to the provocation of motor, affective, and sensory response systems.
Attachment
Social experiences rest on the foundation of parent-child relationships and are important in later developing social skills and behaviors. An infant's attachment to a caregiver is important for developing later social skills and behaviors that develop social competence. Attachment helps the infant learn that the world is predictable and trustworthy or, in other instances, capricious and cruel. Ainsworth describes four attachment styles in infancy, including secure, anxious–avoidant, anxious–resistant, and disorganized/disoriented. The foundation of the attachment bond allows the child to venture out from their mother to try new experiences and interactions. Children with secure attachment styles tend to show higher levels of social competence relative to children with insecure attachment, including anxious-avoidant, anxious–resistant, and disorganized/disoriented.
Parenting style
Parents are the primary source of social and emotional development in infancy, early, and middle/late childhood. The socialization practices of parents influence whether their child will develop social competence. Parenting style captures two essential elements of parenting: parental warmth/responsiveness and parental control/demandingness. Parental responsiveness (warmth or supportiveness) refers to "the extent to which parents intentionally foster individuality, self-regulation, and self-assertion by being attuned, supportive, and acquiescent to children's special needs and demands." Parental demandingness (behavioral control) refers to "the claims parents make on children to become integrated into the family whole, by their maturity demands, supervision, disciplinary efforts and willingness to confront the child who disobeys." Categorizing parents according to whether they are high or low on parental demandingness and responsiveness creates a typology of four parenting styles: indulgent/permissive, authoritarian, authoritative, and indifferent/uninvolved. Each parenting styles reflects patterns of parental values, practices, and behaviors and a distinct balance of responsiveness and demandingness.
Parenting style contributes to child well-being in the domains of social competence, academic performance, psychosocial development, and problem behavior. Research based on parent interviews, child reports, and parent observations consistently finds that:
Children and adolescents whose parents are authoritative rate themselves and are rated by objective measures as more socially and instrumentally competent than those whose parents are nonauthoritative.
Children and adolescents whose parents are uninvolved perform most poorly in all domains.
Other factors that contribute to social competence include teacher relationships, peer groups, neighborhood, and community.
Related problem behaviors
An important researcher in the study of social competence, Voeller, states that three clusters of problem behaviors lead to the impairment of social competence. Voeller clusters include: (1) an aggressive and hostile group, (2) a perceptual deficits subgroup, and (3) a group with difficulties in self-regulation.
Children with aggressive and hostile behaviors are those whose acting out behaviors negatively influence their ability to form relationships and sustain interpersonal interactions. Aggressive and hostile children tend to have deficiencies in social information processing and employ inappropriate social problem-solving strategies to social situations. They also tend to search for fewer facts in a social situation and pay more attention to the aggressive social interactions presented in an interaction.
Children with perceptual deficits do not perceive the environment appropriately and interpret interpersonal interactions inaccurately. They also have difficulty reading social cues, facial expressions, and body gestures.
Children with self-regulation deficits tend to have classic difficulties in executive functions.
Assessments
While understanding the components of social competence continues to be empirically validated, the assessment of social competence is not well-studied and continues to develop in procedures. There are a variety of methods for the assessment of social competence and often include one (or more) of the following:
Child–adolescent interview
Observations
Parent report measures
Self-report measures
Sociometric measures (i.e., peer nominations)
Teachers report measures
Interventions
Following the increased awareness of the importance of social competence in childhood, interventions are used to help children with social difficulties. Historically, these efforts did not improve children's peer status or yield long-lasting effects. However, these interventions also did not take into consideration that social competence problems do not occur in isolation, but alongside other problems. Thus, current intervention efforts tend to target social competence both directly and indirectly in different contexts.
Preschool and early-childhood interventions
Early childhood interventions targeting social skills directly improve the peer relations of children. These interventions focus on at-risk groups such as single, adolescent mothers and families of children with early behavior problems. Interventions targeting both children and families have the highest success rates. When children reach preschool age, social competence interventions focus on the preschool context and teach prosocial skills. Such interventions generally entail teaching problem-solving and conflict-management skills, sharing, and improving parenting skills. Interventions improve children's social competence and interactions with peers in the short term and they also reduce long-term risks, such as substance abuse or delinquent behavior.
School-age interventions
Social competence becomes more complicated as children grow older, and most intervention efforts for this age group target individual skills, the family, and the classroom setting. These programs focus on training skills in problem-solving, emotional understanding, cooperation, and self-control. Understanding one's emotions, and the ability to communicate these emotions, is strongly emphasized. The most effective programs give children the opportunity to practice the new skills that they learn. Results of social competence interventions include decreased aggression, improved self-control, and increased conflict resolution skills.
Intervention Program
The social competence intervention program (SCIP) is a pilot program that uses more than one sense at a time throughout the intervention so the person becomes aware of their own thought process. Before running the intervention, it was assumed that some children have perception deficits along with poor social skills. Theater classes were taken to remedy these deficits in children who have learning disabilities and attention deficit disorders. At the conclusion of the study, evidence shows that participating children began to evolve their metacognitive skills such as feelings and behaviors.
See also
Social skills
References
Behaviorism
Group processes | 0.761582 | 0.978156 | 0.744946 |
Psychiatric intensive-care unit | Psychiatric Intensive Care Units or PICUs are specialist twenty-four hour inpatient wards that provide intensive assessment and comprehensive treatment to individuals during the most acute phase of a serious mental illness.
Most individuals only stay on PICU wards for a very short time and are moved as soon as the crisis is over or the risky behaviours are under control. 2014 guidance says that the maximum length of stay should be 8 weeks. Normally, patients are discharged to acute psychiatric wards, but some patients go straight home.
PICUs are locked and more secure wards, and have a low patient capacity when compared to open psychiatric wards. They have higher levels of staffing and are usually single-sex.
PICUs have a diverse range of staff, including: mental health nurses, psychiatrists, psychologists, pharmacists, occupational therapists, social workers, activities co-ordinators, health care support workers, and ward managers.
As a facility for the most disturbed patients, it may contain a seclusion room for the management of violence and aggression. Other restrictive practices include rapid tranquillisation, ECT and high dose antipsychotics.
References
External links
NAPICU website
Journal of Psychiatric Intensive Care
Treatment of mental disorders | 0.767873 | 0.970081 | 0.744898 |
Self-care deficit nursing theory | The self-care deficit nursing theory is a grand nursing theory that was developed between 1959 and 2001 by Dorothea Orem. The theory is also referred to as the Orem's Model of Nursing. It is particularly used in rehabilitation and primary care settings, where the patient is encouraged to be as independent as possible.
Central philosophy
The nursing theory is based upon the philosophy that all "patients wish to care for themselves". They can recover more quickly and holistically if they are allowed to perform their own self-cares to the best of their ability. Orem's self-care deficit nursing theory emphasized on establishing the nursing perspectives regarding human and practice.
Self-care requisites
Self-care requisites are groups of needs or requirements that Orem identified. They are classified as either:
Universal self-care requisites (needs that all people have)
Developmental self-care requisites:
maturational: progress toward higher levels of maturation
situational: prevention of deleterious effects related to development
Health deviation requisites: those needs that arise as a result of a patient's condition.
Self-care deficits
When an individual is unable to meet their own self-care requisites, a "self-care deficit" occurs. It is the job of the Registered Nurse to determine these deficits, and define a support modality.
Support modalities
Nurses are encouraged to rate their patient's dependencies or each of the self-care deficits on the following scale:
Total Compensation
Partial Compensation
Educative/Supportive
Universal Self-Care Requisites (SCRs)
The Universal Self-Care Requisites that are needed for health are:
Air
Water
Food
Elimination
Activity and Rest
Solitude and Social Interaction
Hazard Prevention
Promotion of Normality
The nurse is encouraged to assign a support modality to each of the self-care requisites.
References
Dorothea Orem's Self-Care Theory
Dorothea Orem's Self-Care Deficit Nursing Theory
Hartweg, Donna (1991). Dorothea Orem: Self-Care Deficit Theory. Notes on Nursing Theories 4. Sage Publications. p. 1.
Renpenning KM, SozWiss GB, Denyes MJ, Orem DE, Taylor SG. Nurs Sci Q. 2011 Explication of the nature and meaning of nursing diagnosis.Apr;24(2):130-6. doi: 10.1177/0894318411399451
Orem DE, Taylor SG.Nurs Sci Q. 2011 Reflections on nursing practice science: the nature, the structure, and the foundation of nursing sciences.Jan;24(1):35-41. doi: 10.1177/0894318410389
Medical Archives of the Johns Hopkins Medical Institutions Dorothea Orem Collection
Nursing theory | 0.764024 | 0.974958 | 0.744891 |
Pediatric psychology | Pediatric psychology is a multidisciplinary field of both scientific research and clinical practice which attempts to address the psychological aspects of illness, injury, and the promotion of health behaviors in children, adolescents, and families in a pediatric health setting. Psychological issues are addressed in a developmental framework and emphasize the dynamic relationships which exist between children, their families, and the health delivery system as a whole.
Common areas of study include psychosocial development, environmental factors which contribute to the development of a disorder, outcomes of children with medical conditions, treating the comorbid behavioral and emotional components of illness and injury, and promoting proper health behaviors, developmental disabilities, educating psychologists and other health professionals on the psychological aspects of pediatric conditions, and advocating for public policy that promotes children's health.
Role of the pediatric psychologist
The field of pediatric psychology developed to address unmet needs for psychological services in the pediatric setting and the field blends together several distinct areas in psychology (such as behavioral medicine, health psychology, developmental psychology, etc.) (Roberts, Maddux, Wurtele, & Wright, 1982 ). Pediatric psychology is an integrated field of science and practice in which the principles of psychology are applied within the environment of pediatric health. The Society of Pediatric Psychology (SPP, Division 54) resides under the American Psychological Association (APA), see http://www.apadivisions.org/division-54/index.aspx. SPP aims to promote health and psychological well-being of children, adolescents, and their families through the promotion of evidence-based science and practice, education, training, and advocacy. The field was founded in 1969 and includes a broad interdisciplinary foundation, drawing on clinical, developmental, social, cognitive, behavioral, counseling, community and school psychology.
Pediatric psychologists work in a variety of settings and fulfill various roles such as (Spirito, 2003 ):
(1) Providing psychosocial services for problems related to pediatric health conditions
(2) Psychological services for mental health problems appearing in medical settings—which involves mental issues related to medical conditions or the treatment of them, coping related to acute and chronic illnesses, adherence, quality of life, pain, traumatic medical stress, adjustment related issues on the psycho-social continuum, school reintegration, and behavioral problems
(3) Psychological services for mental health problems without concomitant health condition
(4) Programs for promotion of health/prevention and early intervention
(5) Provide assistance for those with intellectual and/or developmental disabilities
(6) Psychological training and consultation for physicians
(7) Public health and public policy.
Interventions are not just illness-related, but address behavioral problems as well. The settings that pediatric psychologists work in allows for brief interventions that are economical and time efficient. Collaboration with the health care providers allows for more targeted assessment and interventions.
Pediatric healthcare providers seem to value the work of pediatric psychologists (Stancin, Perrin, and Ramirez, 2009):
"Recently, a surge of interest by pediatricians on the identification and care of children with mental health problems has resulted from the recognition that:
• Precursors of mental health disorders in adulthood can often be identified in early childhood (e.g. Anda et al., 2007)
• At least 10% of children and adolescents have functional impairment due to a diagnosed mental health and/or substance abuse disorder (U.S. Department of Health and Human Services, 1999), and up to 25% have clinically significant problems that may not (yet) rise to the level of a diagnosable psychiatric disorder (Briggs-Gowan et al., 2003).
• There is a shortage of qualified mental health clinicians, especially for children younger than 5, and for families in middle-and-low income groups and/or of minority background.
• Primary care settings provide the most accessible and least stigmatizing resources for many families who have concerns about their children's developmental and/or behavior."
Scope
According to the work of a recent task force commissioned by the Society of Pediatric Psychology, Division 54 of the American Psychological Association, 12 topic areas adapted from Roberts et al. (1998) were identified as important areas of expertise in pediatric psychology:
Lifespan development
Lifespan developmental psychopathology: the effects of one's disease and medical regimen on emotional, social, and behavioral development; additionally, normal developmental milestones may be used such that preventative efforts can be created and well-child visits can include a psychological-developmental perspective
Child, adolescent, and family assessment: experience with the assessment of health-related concerns such as health promotion, health risk, health outcome, and quality of life
Intervention strategies: Exposure to and experience with empirically supported interventions specifically applicable in pediatric psychology and delivered in health care settings
Research methods and systems evaluation: Exposure to research design issues especially pertinent to pediatric psychology such as health services research and clinical trials
Professional, ethical, and legal issues pertaining to children, adolescents, and families: knowledge and experience with issues such as health care delivery, practice of psychology in medical settings, and rights of caregivers vs. children when making decisions regarding medical care
Issues of diversity: Experience with patients from diverse ethnic and cultural backgrounds, as well as sexual orientations, in health care settings and understanding of nonmainstream health practices influenced by a family's cultural or religious beliefs
The role of multiple disciplines in service-delivering systems: Experience on multidisciplinary teams delivering health care services
Prevention, family support, and health promotion: understanding the principles of behavior change as they relate to healthy development, health-risk behavior, and prevention of disease in adulthood
Social issues affecting children, adolescents, and families: exposure to and experience with advocacy in pediatric health care including social issues that affect health care delivery
Consultant and liaison roles in health care settings: Exposure to different consultation-liaison models and supervised experience providing consultation
Disease process and medical management: A basic understanding of various diseases and their medical management.
The field of pediatric psychology recognizes that pediatric conditions have emotional/psychological aspects, the presenting problems require integrated medical-psychological interventions, and traditional pediatric and/or clinical psychology could not meet the needs.
Future issues
Pediatric psychology is a growing field and several topics have been raised that need to be addressed within the field and were discussed in a Delphic Poll on the future of pediatric psychology:
1. Pediatric psychologists must demonstrate viability through empirical support for treatment interventions, which requires continued efforts to demonstrate improvements in pediatric outcomes (health, quality of life, psychological functioning, development) due to pediatric psychologists' efforts. This also requires evidence of medical cost offset, evidence of the efficacy of the integration of clinical research and practice, and evidence of the effectiveness of psychological interventions in decreasing societal costs related to pediatric conditions.
2. We must also increasingly integrate psychologist into the pediatric primary care setting by providing mental health services directly to patients in primary care settings, provide consultation and collaborative relationships with pediatricians and allied staff, and conduct clinically based research on primary care barriers in care.
3. Financial reimbursement policies need to be changed and the responsibility to makes these changes lies within several interacting disciplines—health policy-makers, health care institutions, and pediatric psychologists and their collaborators such as pediatricians. Several factors should be addressed, such as: creating non-DSM categories of reimbursable services, eliminating behavioral health carve-outs, payment for multidisciplinary team services, and developing service systems that recognize the complexity of problems in children and families. Currently, depending on the clinic and hospital that the psychologist is affiliated with, their services may or may not be covered by insurance or the institution's funds and reimbursement issues prevent pediatric psychologists from intervening in the most effective ways. Pediatric psychologists are trained in data analysis and research and so efforts should be made to demonstrate the benefits of pediatric psychologists and pediatricians collaborating such that the necessary reimbursements are instituted (http://www.nextgenmd.org/archives/808). Currently, research findings indicate that psychological interventions can decrease medical costs (Chiles, Lambert & Hatch, 1999). Future research should also target patient satisfaction.
4. Collaboration between pediatricians and psychologists in clinical research and practice activities.
5. Emphasize importance of prevention of problems in childhood and promotion of optimal physical and mental health
Here are a few examples concerning how pediatric psychologists have improved services:
Primary Care Example: There are an increasing number of empirically supported interventions available for the treatment of common childhood problems appropriate to treat in the primary care setting (i.e. disruptive behavior disorders, mood disorders, non-adherence to medical treatments, etc.). For example, Lavigne and colleagues (2008) compared three interventions for Oppositional defiant disorder (ODD) in primary care. Pediatric practices (N = 24) were randomly assigned to receive (1) nurse-led or (2) psychologist-led group manualized parent training treatment, or (3) minimum intervention in which the treatment book was used. Sustained improvements occurred in all three conditions. However, there were better results for parents who attended more of the intervention sessions. This is evidence that primary care environments are an appropriate setting for delivering services.
Prevention/Early Intervention Example: Pediatric psychologists can take a lead both in developing interventions and test their effectiveness in promoting vaccine acceptance and knowledge such that children are more likely to be vaccinated (Short, Rosenthal, Sturm, Zimet, 2009). For example, education-based tutorials created by pediatric psychologists to improve providers' knowledge of and comfort with addressing parents' concerns related to childhood immunizations is one promising approach that has been researched and found to be effective (i.e. Boom, Nelson, Laugman, Kohrt, & Kozinetz, 2007; Levi, 2006).
History of pediatric psychology
The "official" history of pediatric psychology dates to 1968 when the Society of Pediatric Psychology was established within the American Psychological Association. However, its origins date back to the early 1900s and Lightner Witmer. Often considered the father of clinical psychology, Witmer spent a good deal of his time working in tandem with physicians to improve children's behaviors. Considering the roughly 70 years between Witmer and the formation of the SPP, this merging of medicine and psychology was a slow progression.
In 1911, the APA conducted a survey of medical schools regarding their view of psychology within medicine. While responses were favorable to the benefit of psychology in the medical school setting, there was no action to implement such teachings. This action started following the Second World War, when there was an increase in federal funding for clinical psychology and the employment of psychologists in medical schools. In fact, 80 percent of schools surveyed in 1951–1952 reported employing psychologists. However, it was thought that most were in psychiatric settings, not pediatric psychology positions
Specific to pediatric psychology, in 1930, Anderson presented to the American Medical Association that he thought pediatrics and child psychology should work together on mutually important issues, but there was apparently limited response. The 1960s saw a growing number of pediatricians fielding questions regarding parent training. As a result, in 1964, the then president of the American Pediatric Society, Julius Richmond, suggested that pediatricians hire clinical psychologists to work with behavioral problems in children.
The field was advanced when Kagan identified a number of areas the psychologist could be of help in the "new marriage" of pediatrics and psychology. He addressed psychologists' role in early identification of disorders and interventions. Much like a clinical-child psychologist, Kagan believed this role included a wide range of psychopathology. Wright, however, had a different idea of what a pediatric psychologists job should address. Narrower in scope, he suggested pediatric psychologists take a more behavioral approach and deal with issues of parent training, child development, and short-term therapy. With the public and professional momentum for pediatric psychology forged by Logan Wright, the APA formed a committee to determine whether a formal organization was needed. The committee, consisting of Logan Wright, Lee Salk, and Dorothea Ross, discovered a need would be filled, and at the annual APA convention in 1968, formed the "Society for Pediatric Psychology." The following year, SPP was recognized as an affiliate of APA Division 12 (Clinical Psychology), Section 1 (Clinical Child Psychology) . At the inaugural SPP meeting in 1969, Logan Wright was elected the first president.
Medical schools employing psychologists in pediatric settings were also on the rise. This increase in demand resulted in federal funding for the establishment of the National Institute of Child Health and Human Development in 1962. Four years later it helped fund the first pediatric psychology training program at the University of Iowa.
Over the next decade, SPP would consider sectionhood with several divisions (12, 37, 38) before officially becoming Section 5 of Division 12 in 1980. ." Here it would continue to grow until 2000 when it developed into Division 54 of the APA .
By 1984, SPP had a solid foundation with growing membership and journal recognition. While pediatric psychologists work under the science-practitioner model, the trend at this time saw more practitioners. Employed predominantly in medical settings, there was immediate need for clinical application of skills to work with severe behavior problems. Kagan's vision of researcher in this setting would have to wait. Mesibov noted pediatric psychologists worked frequently with developmental disorders in children. Specifically, children with intellectual disabilities, learning disabilities, cerebral palsy, autism, and related developmental problems. When not working directly with children, pediatric psychologists role included had a few other components. The demand and importance of parent training for children with developmental problems made it the subject of the SPP programming at the APA convention for 1983. The collaboration with other professionals on site (e.g., speech and language therapists) provided education in outside domains and in working as a member of an interdisciplinary team. Furthermore, pediatric psychologists helped to create programs in the community addressing children's needs.
In 1988, then SPP president Walker presented recent survey findings to address current and future trends in the field regarding the areas of research, training, and clinical service. Psychologists surveyed were selected based on either serving on the Journal of Pediatric Psychology review board, or functioning as the director of a pediatric training program. Twenty-seven pediatric psychologists participated in the survey. The top three research trends ranked at the time included: chronic illness, prevention, and cost/benefit of interventions. Walker personally emphasized his concern with parenting practices with regard to prevention. In addressing children's emotional well-being, Walker stated prevention provides the best solution
Clinical service trends ranked in order of importance for the future included: pediatric behavioral medicine, effective treatment protocols from common problems, and the role in medical setting. Walker attempted to assuage the contention surrounding the definition of pediatric psychologists role by teasing out the differences from clinical child psychology. Walker noted differences lie in conceptualization, intervention setting, and the intervention course of treatment, among others. While most pediatric psychologists were employed in medical schools and universities, Walker believed future trends would include more pediatric psychologists working as part of a multidisciplinary team in hospitals and health clinics.
The final area of interest ranked training areas of importance for future pediatric psychologists. The top three included: brief treatment techniques, residency model, and biological and medical issues. At the time, pediatric psychology was considered a subspecialty within the field of clinical child psychology debating whether to branch out as its own field.
In a brief article following his reception of the 1990 Distinguished Service Award from the SPP, Mesibov reflected on three unique, or "special" characteristics he identified within the field of pediatric psychology. Specifically, he applauded the field's practical application to tackle difficult human needs, multidisciplinary approach, and character of pediatric psychologists he has worked with throughout his career.
History of Journal and Newsletter
The development of SPP produced the need for formal communication among members in the field. Thanks to the work of Allan Barclay and Lee Salk, a newsletter was created. The Pediatric Psychology Newsletter, distributed quarterly, was launched in 1969, with Gail Gardner acting as first editor. However, due to SPP's limited funds in the early years, publication ceased from 1970 to 1972. With the help of growing membership and generous contributions from early members, the newsletter was restarted and saw continued growth from 1972 to 1975. The quality and volume of submissions to the newsletter resulted in the transition to the Journal of Pediatric Psychology (JPP) in 1976. The newsletter per se would not emerge again until 1980, under the leadership of Michael Roberts.
The JPP began steady publication in 1973 under the appointment of Diane Willis as editor. A professor of psychology at University at Oklahoma and psychologist at the OU Child Study Center, she served as editor from 1973 to 1975, helping create the peer review system in place today, expanding content published, and seeing it go from Newsletter to Journal.
In 1976, Don Routh began serving as editor with Gary Mesibov serving as associate editor. He would serve two terms. Although still under financial uncertainty, several important events occurred during this time. In 1976, Psychological Abstracts recognized the JPP. This also marked the beginning of international subscriptions requested. The following year, APA gave JPP status as a division journal. The popularity of the Journal continued to grow. Common topics of the JPP included chronic pain and hyperactivity. The most important event, however, may be the successful contract negotiation with Plenum Publishing in 1979 which helped alleviate the ongoing financial concerns of the organization.
The third editor of JPP, Gerald Koocher, served from 1983 to 1987. Michael Roberts became associate editor. The growth of JPP was evident as approximately 100 articles were submitted annually for publication. As a result, the Journal became more selective in its acceptance, at a rate of 29 percent. Furthermore, partnership with Plenum Publishing was renegotiated, and the editorial board expanding membership. Chronic illness continued to be topic "de jour," but more applied research emerged.
Michael Roberts served as editor from 1988 to 1992. Associate editors included Annette La Greca, Dennis Harper, and Jan Wallander. Under Roberts' leadership, JPP transitioned from a quarterly to bimonthly publication. While chronic pain remained the theme of most publications, more publications featured grant-funded research.
Annette La Greca followed Roberts as editor, serving from 1993 to 1997. Associate editors across this span included Wallander, Dennis Drotar, Kathleen Lemanek, and later, Anne Kazak. The JPP continued its steady growth, and more papers were dedicated to special themes, explanatory and longitudinal in design, and nonintentional injuries. The submission rate grew and, as a result, only 16–18 percent submitted were published.
Kazak took over as editor from 1998 to 2002. Associate editors included Lemanek, Christine Eiser, Antohony Spirito, Jack Finney, and Robert Thompson. The JPP finished its contract with Plenum Publishing at this time and decided to sign a new contract with Oxford University Press. Her term also saw the journal increase to 8 issues a year and provide online access to its members. Kazak was succeeded by Ron Brown, who served as editor from 2003 to 2007. Drotar took taking over the editorial reins during 2008–2012 and Grayson Holmbeck served starting in 2013.
Biopsychosocial model and health psychology
In the past, most physicians followed the biomedical model which posited that all illness can be explained by improper functioning of the biological systems. By 1977, With the large leaps in medical science forced and changing views of health and illness doctors and psychologists to begin, alike, began to questioning their old methods of treating patients. This new method of thought is the biopsychosocial model, and it was heavily influenced by two main issues: the specificity problem and the base rate problem.
Specificity problem
This problem address the fact one environmental stressor is often associated with many different disorders. An example of this would be work stress. Being stressed out at work can lead to hypertension; however, it can also lead to coronary heart disease. It is nearly impossible to tell which path will be taken as a result of the stress, and it could result in both.
Base rate problem
This problem states that it is very hard to predict whether the presence of a stressor will lead to the development of a disorder. The reason behind this is that experiencing the environmental stressor may lead to developing the disorder. However, diagnosing a patient on this alone would result in an absurd number of false positives. An example of this would be smoking and cancer. If doctors were to diagnose everyone who ever smoked a cigarette or a cigar with cancer it would quickly become apparent that it is an ineffective diagnostic criterion because many individuals would not develop lung cancer.
Holistic method
The main premise of the biopsychosocial model is that you cannot separate the biological factors from the environmental factors when addressing an illness; you must view a person as part of a whole, or a system. The system theory is one of the best methods in which to observe this holistic model. The systems theory states that an individual exists within a hierarchy of subsystems (e.g. cells, person, family, society, etc.), and all of these subsystems interact. For example, if one were to lose a family member the individual may feel stressed which in turn may weaken his immune system and cause him or her to catch a cold. While the cold is considered biological in nature (i.e. a bacterium or a virus), it was aided by outside factors. This is a great example of how the biopsychosocial model approaches medical conditions. In order to effectively assess an illness, one must identify and treat all contributing factors as well as the actual biological factors. This need to address physical, mental, and social needs (among many others) leads to health psychology, and from this the field of pediatric psychology.
Origins
World War II gave way to a rise in the number of psychologists that worked in medical schools. The pediatric population doctors worked with had a variety of problems in addition to their illness. Doctors had children as patients with a variety of problems (e.g., developmental, behavioral, academic). Patients and their families were not receiving adequate attention from psychology clinics at the time.
To meet the needs of pediatric patients Jerome Kagan requested a "new marriage" between psychology and pediatrics, stressing early detection of psychopathology and psychosocial problems. Understanding prenatal- and perinatal factors relating to psychological problems was also emphasized.
The term "pediatric psychology" was first used in 1967 by Logan Wright in the article "The Pediatric Psychologist: A Role Model," and was defined as "dealing primarily with children in a medical setting which is nonpsychiatric in nature". Wright emphasized the importance of:
group identity for the pediatric psychology field (formal organization, distributing newsletter)
specifications for training future pediatric psychologists
body of knowledge accumulated by means of applied research
Organizational developments
Pediatric psychologists established a group identity with the Society of Pediatric Psychology (SPP). SPP was initially an interest group in the Clinical Child Psychology division of the APA. As membership elevated, SPP was recognized by the APA as a group whose purpose was to "exchange information on clinical procedures and research, and to define training standards for the pediatric psychologist". With this new-found recognition, division 54 of the APA was created. Some of the main goals of this organization are to promote the unique research and clinical contributions from pediatric psychology.
The Journal of Pediatric Psychology was founded in 1976, and it has helped to further the professional recognition of the field. It allowed for clinicians, teachers, and researchers alike to exchange ideas and new discoveries. It is a respected scholarly journal which aims to increase the knowledge regarding children who have acute and chronic illness and attempt to identify and resolve the contributing factors in order to yield optimal outcomes.
Society of Pediatric Psychology Special Interest Groups (SPP)
The Pediatric Psychology APA Division 54 formed Special Interests Groups (SIGs) and they consist of the following: Adherence Special Interest Group, Consultation and Liaison Special Interest Group, Craniofacial Special Interest Group, Complementary and Alternative Medicine Special Interest Group, Diversity Special Interest Group, Epilepsy Special Interest Group, Obesity Special Interest Group, Pediatric Bioethics Special Interest Group, Pediatric Cardiology Special Interest Group, Pediatric Gastroenterology Special Interest Group. The motive of a SIG is to promote the nationwide connection of SPP members for a determined area of interest.
Adherence & Self-Management Special Interest Group
The Adherence & Self-Management Interest Group promotes evidence-based approaches to research and clinical service targeting the assessment and treatment of regimen adherence concerns in youth and families across a variety of chronic health conditions.
The World Health Organization (2003) has labeled poor adherence to prescription medications and treatment a "worldwide problem of striking magnitude". Adherence according to the WHO (2003) is defined as "the extent to which a person's behavior—taking medication, following a diet, and/or executing lifestyle changes, corresponds with agreed recommendations from a health care provider" (Haynes, 1979; Rand, 1993 ). Non-adherence influences health care utilization and costs, morbidity, and health outcomes (Drotar, 2000). Potentially effective treatments become ineffective by non-adherence and clinical benefits are not received. For example, up to 20% of patients fail to fill new prescriptions and 50% of people with chronic health conditions discontinue their medication within six months. Adherence to behavioral treatments is also poor. For example, no more than 30% of patients quit smoking at their provider's request, even those with lung conditions. At the same rate, the leading causes of death (Heart disease, cancer, stroke and chronic lower respiratory diseases- see https://www.cdc.gov/nchs/fastats/lcod.htm) contain behavioral related causes and treatments. Therefore, adherence is a lifelong, mortality risk.
Additionally, higher rates of adherence result in economic benefits. For example, direct savings may be accrued by reduced use of expensive and sophisticated health services needed in cases of crises, relapse, and worsening disease outcomes due to non-adherence. Research suggests that when self-management and adherence program are combined with regular treatment, there is an increase in health-promoting behaviors and a cost to savings ratio of approximately 1:10 in some cases and results persisted over 3 years (see Holman et al., 1997; Tuldra et al., 2000
Access to medical care is vitally important, but if people do not comply with their professional recommendations, then mere access will not lead to better health outcomes. Thus, generating innovative methods to enhance childhood adherence has become increasingly more important because effective preventive efforts must begin at an early age, starting with healthy lifestyle behaviors and increased adherence. For example, "a pediatric psychologist may work with a young child who has cystic fibrosis and who refuses to complete all his daily medical treatments that are essential to his health. The psychologist might work with the child's caregivers on how to interact with the child when he refuses his medical treatments and how to implement a reward system to reinforce his adherence to treatments." http://www.nextgenmd.org/archives/808. Also, challenging family interaction styles can play a role in adherence. In particular, families with divorced parents may struggle with communication concerning a child's illness and treatment. Pediatric psychologists may intervene by working with the parents to find a way to communicate more effective so that barriers to adherence are removed.
Craniofacial Special Interest Group
The Craniofacial special interest groups consists of members of the Society of Pediatric Psychology who share an interest in craniofacial conditions.
Complementary and Alternative Medicine Special Interest Group
The Complementary and Integrative Medicine special interest group is a forum for communication and discussion about the role of CIM as it relates to advancing the health and well-being of pediatric populations.
Consultation and Liaison Special Interest Group
The mission of the Consultation and Liaison Special Interest Group is to promote discussion, education, research, and networking among pediatric psychologists who provided consultation and liaison services to pediatric patients and their families.
Pediatric Consultation-Liaison is a subspecialty practice of pediatric psychology and represents the most active collaboration between pediatricians and pediatric psychologists. According to the 2003 Society of Pediatric Psychology Task Force Report: Recommendations for the Training of Pediatric Psychologists, consultation-liaison roles are one of the types of experience most important to developing competencies in pediatric psychology. Pediatric psychologists often consult with pediatricians and providers from other disciplines in a variety of inpatient and outpatient settings. They have a working understanding of various consultation models and often consult with and educate patients, their families, physicians, other health-care providers school psychologists, counselors, teachers, and other professionals regarding pediatric illness and accompanying psychosocial issues. Pediatric psychologists also act as liaisons with medical subspecialties and provide support to other professionals for issues related to the management of difficult families, stressful physician and family interactions, professional burnout, bereavement, and negotiating stressful situations.
Consultation-Liaison Models
Consultation vs. Liaison Emphasis
Often considered synonymous, the terms "consultation" and "liaison" have important distinctions. While many psychologists provide both services, pediatric psychologists acting in a consultant role are directly involved in patient care only at the request of a referring physician or service. In a consultation arrangement, the relationship between the consultant and physicians is often time-limited—when consultation services are terminated, the relationship often ends. Pediatric psychologists in a liaison role are often involved in the day-to-day workings of a particular hospital service or unit and are formally embedded within a department or working service. Psychologists in a liaison role are often involved in all of the systemic and mental health concerns of the unit, not just the concerns of referred patients.
Patient-Centered vs. Systems-Centered Focus
Consultation-liaison models are sometimes differentiated based on whether the focus of the services are primarily on the patient ("patient-centered") or on the larger system the patient and family must rely on for medical care ("systems-centered"). In patient-centered services, the primary goal is to evaluate the patient in order to provide direct treatment. In systems-centered services, the focus of the services are on creating change in the professionals requesting the services to make them more effective in the intervention with the case in question, as well as in other similar cases.
Inpatient Pediatric Consultation-Liaison
As an inpatient pediatric consultation—liaison, the pediatric psychologist advises physicians or other medical professionals or provides direct services to medically hospitalized children regarding behavioral, emotional, or familial aspects of the child's illness and symptoms. The consultation-liaison psychologist's primary role includes evaluating children and their families for mental health concerns; recommending and providing treatments; and educating families, staff, and referring physicians on a wide array of factors associated with adjustment to medical illness and injury. Patient interventions include teaching coping skills, evaluating side effects of medication, helping manage physical pain, and addressing physical pain, among others. Defined narrowly, inpatient pediatric consultation-liaison involves a pediatric psychologist providing assessment and guidance to a pediatrician colleague regarding the care of a specific patient. Broadly defined, the pediatric consultation-liaison psychologist is a systems-level catalyst—in educating and empowering multiple interacting components of the health care system, fostering a responsive environment that maximizes the overall quality of life and psychological adjustment of patients and their families.
Research on inpatient pediatric consultation-liaison services
There are few studies illustrating the breadth of services provided by pediatric consultation-liaison psychologists. In a survey of 144 children's hospital-based child psychiatry consultation-liaison services, Shaw and colleagues reported that returned surveys (33%) indicated that the most common referral concerns for consultation-liaison services included patient depression, anxiety, suicide risk assessment, and medication evaluation.
In the only case-controlled study of pediatric consultation-liaison services, Carter and colleagues (2003) matched 104 referrals with controls for age, gender, and illness type or severity and completed parent- and self-report behavioral rating scales to assess for adjustment. Nurses completed in-hospital ratings of behavioral or adjustment difficulties. Goal attainment and satisfaction ratings were obtained from referring physicians, parents, and the consultant. Results indicated that referrals exhibited more behavior, adjustment, or coping difficulties than nonreferrals by parent-, nurse- and self-report. Referring physician and consultant ratings of goal attainment were high, as were physician ratings of satisfaction and parent or guardian ratings of overall helpfulness of the consultation-liaison services. Referral sources included equal distributions from hematology/oncology, surgery/trauma, pulmonology, and other sources. Reasons for referral included assisting children in coping with physical illness/injury, improving treatment adherence, assessing and treating depression and anxiety, teaching pain management techniques, assisting with parent coping, helping with adjustment to medical diagnoses, and resolving family conflicts.
In a review of clinical reports and treatment outcome studies on pediatric consultation-liaison services, Knapp and Harris surveyed illness-specific and general investigations into the psychiatric care of children with medical illnesses. They concluded that pediatric consultation–liaison services are playing an increasing role in addressing the emotional and behavioral needs of pediatric inpatients by helping patients and their families adapt to stressors associated with chronic illness.
Olson and colleagues reviewed the records of 749 inpatient referrals seen by pediatric psychologists at Oklahoma Children's Hospital over a 5-year period. In order of greatest frequency, referrals were for depression or suicide attempt, adjustment problems to chronic illness, and behavior problems. Consultations were most frequently requested by general pediatrics followed by surgery and adolescent medicine. Nearly a third of the referrals were also seen for outpatient follow-up. Health care providers making referrals were generally very satisfied with the services of the pediatric consultation-liaison team and reported a high likelihood of making future referrals.
In another study, Rodrigue and colleagues reviewed 1,467 records of referrals (448 inpatient, 1,019 outpatient) to a health sciences center-based pediatric psychology service at the University of Florida Health Sciences Center. The majority of inpatient referrals were from general pediatrics (40%), pediatric hematology or oncology (31%), adolescent psychiatry (15%), pediatric intensive care (5%), and the burn unit (4%). The most common reason for referral (inpatient and outpatient) was assessment of cognitive or neuropsychological functioning. Next were externalizing behavior problems, comprehensive psychological evaluation, pre-surgery or transplant evaluation, and adjustment problems to chronic illness. They also reported that retrospective survey results suggested high overall satisfaction with service quality.
In an early study of referral problems for pediatric consultation-liaison services, Drotar reported that referral questions included evaluation of developmental delay, adaptation and adjustment to chronic illness or physical disability, concerns regarding the psychological factors in physical symptom presentation, behavior problems, and managing psychological crises.
Five C's of pediatric consultation-liaison services
Using an alliterative mnemonic device called the "Five C's of Consultation: Crisis, Coping, Compliance (Adherence), Communication and Collaboration," Carter and von Weiss characterize the activities of pediatric-liaison services according to overlapping arenas of intervention and practice under which the majority of referrals can be categorized.
Crisis
Following diagnosis of a potentially serious illness or injury, patients and their families are often in a state of shock and disbelief. At this time, the details and decisions of medical evaluation and treatment may be overwhelming and bewildering. Very focused interventions are often needed to help them achieve some sense of basic understanding and control of the situation. Consultation-liaison skills that enable psychologists to act in crisis situations include crisis intervention, needs assessment, providing direction, mobilization of social supports, identifying areas for parental or child control, and interpreting and reframing child or family reactions to staff. A medical crisis counseling model that lends itself particularly well to pediatric crisis situations has been developed by Pollin. In this model, the consultant focuses on the patient's medical condition, and directs interventions toward normalizing the patient's and the family's state of emotional distress while helping the patient and family identify concrete actions they can take in order to cope successfully.
Coping
Children are exposed to many stressors associated with acute and chronic illness and injury during the course of evaluation and treatment. Acute stressors include short and lengthy medical procedures such as venipunctures, injections, hospitalizations, surgeries and chemotherapy, among others. Other stressors accompanying chronic illnesses may impact the child and family for months, years, or even a lifetime, often with an uncertain prognosis.
Pediatric consultation-liaison psychologists need to be aware of individual and developmental factors when designing interventions to help children adapt to the stressors of illness or injury and treatment; for example, limited linguistic and cognitive abilities limit the knowledge and understanding of health concepts of younger children, thus limiting their ability to use internal coping resources and reach out to external supports when compared to older children or adolescents. Children's coping styles also differ; for example, some children attempt to gather information and familiarize themselves with upcoming procedures, whereas others avoid discussing stressors and refuse to look at or distract themselves from stressful stimuli. Differences in coping styles have been shown to be associated with the child's adaptation to surgery and hospitalization, lower physiological stress response, and child cooperation pre- and post-surgery. There is evidence suggesting that primary control, strategies whereby a child modifies the objective situation, are most effective when employed to cope with stressors over which the child has control, whereas secondary control strategies, strategies involving the child modifying emotional and behavioral reactions to the stressor, are most effective with uncontrollable stressors.
Interventions to facilitate child and family coping often begin with providing basic information and education about their illness and treatment procedures, often using videotaped or in vivo models to demonstrate the use of positive coping strategies and teach mastery skills. Other coping interventions include cognitive-behavioral and strength-building interventions, operant reward programs, integrating parent participation, evaluation and mobilization of family and social supports, assisting patient and family in understanding and navigating the medical system, directive and expressive medical play therapy, pain and anxiety management skills training, sensitizing medical staff to patient needs and perceptions, and psychopharmacological interventions.
Compliance (Adherence)
Adherence to medical treatment regimens is a major pediatric health concern, with estimates on nonadherence as high as 50% or higher. Children's adherence to their medical regimens is heavily influenced by developmental, as well as family factors. Medical management of chronic and serious pediatric illness often requires stressful role relationship changes within the family that require redistribution of time and redefinition of responsibilities. The impact of these changes can be far reaching, affecting such factors as marital satisfaction and parent adjustment. Nonadherance to prescribed medical regimens can be the result of variety of factors including lack of education and training in the regimen, difficulty in understanding the procedures, fearfulness and anxiety, interference of the treatment with normal activities, and parent or child dynamics, among others.
Nonadherence or poor adherence to medical regimens may adversely affect the health of the pediatric patient, resulting in hospitalization to address disease processes and adherence issues. Nonadherence issues include failure to administer medications as prescribed, failure to follow dietary guidelines, defiance of physical activity restrictions, and uncooperativeness with medical procedures. Several methods might be employed the help patients and their families monitor adherence, including direct observations of the patient's behavior; assays of blood, urine, or saliva; self-report, health care provider ratings, pill counts, and a variety of monitoring devices, for example, blood glucose meters. Interventions that can be sued to facilitate patient and family adherence in the inpatient pediatric setting include providing information and education, teaching mastery skills, behavioral management contracting, removing barriers, monitoring and charting performance of medical treatment components, addressing family or health care system dynamics, normalizing or reframing the patient's condition, altering patient or family lifestyle behaviors, altering expectations of family or health care providers to coincide with realistic developmental needs, negotiation and compromise.
Communication
Pediatric consultation-liaison psychologists often deal with situations wherein medical staff members have made a referral due to behavioral difficulties with the child or their family that are disruptive to the functioning of the hospital unit. Often overwhelmed, bewildered, and at the point of significant frustration and defensiveness, the patient and their family are frequently unaware of the referral, which places the consultant in a potentially volatile situation. Strong diplomatic and communication skills, as well as sensitivity to patient, family, and hospital staff issues, are required in such situations By arranging and coordinating staffings on difficult and complex cases, maintaining a regular presence at service rounds and team meetings, fostering ongoing collaborative relationships with hospital staff, promoting ever increasing cultural sensitivity, and respectfully listening to and reframing patient or family and staff behaviors to facilitate understanding across all parties involved, the pediatric consultation-liaison psychologist can do much to defuse potentially volatile situations.
Collaboration
Carter and von Weiss suggest that while Collaboration is listed one of the five C's, it cannot be emphasized enough because it underlies the potential successfulness of practice in the other four. The relationship between the pediatric psychologist and the referring services has evolved out of shared goals in the areas of research, teaching, and service. Close collaborative relationships have the potential of having a critical impact on the clinical care of patients and their families.
Diversity Special Interest Group
The Diversity Special Interest Group is committed to promoting diversity in pediatric psychology research and clinical care, to increasing the number of Society of Pediatric Psychology members from diverse backgrounds, and to providing services and resources for members who are from underrepresented groups.
Epilepsy Special Interest Group
The Epilepsy Special Interest Group's goals are to increase awareness of epilepsy among Society of Pediatric Psychology members, foster communication between and support for pediatric psychologists, and liaison with the American Epilepsy Society.
Obesity Special Interest Group
The Obesity Special Interest Group provides education, training and mentoring of psychologists in the care of overweight/obese youth and advocacy for public policy.
Pediatric Bioethics Special Interest Group
The Pediatric Bioethics Special Interest Group provides a forum to discuss challenges, share ideas and resources, and pursue collaborative relationships with a community of other pediatric psychologists.
Pediatric Cardiology Special Interest Group
The Pediatric Cardiology special interest group promotes the discussion of issues faced by pediatric psychologists who work with children who have congenital heart disease, cardiac transplant, or other cardiac conditions.
Pediatric Gastroenterology Special Interest Group
The mission of this Pediatric Gastroenterology Special Interest Group is to facilitate the study and discussion of psychosocial aspects of pediatric gastroenterological conditions; develop collaborative relationships among practitioners who carry out psychological interventions with pediatric GI populations, and educate clinical professionals about the psychosocial issues which may affect the child or adolescent with a gastroenterological condition.
Pediatric Pain Special Interest Group
Pediatric pain is a common condition of childhood/adolescence. As such, many pediatric psychologists research and provide clinical care in this area and specialized programs are developing. The Pediatric Pain Special Interest Group provides a forum for communication and discussion about the many developments in the field.
Modern training
The road to becoming a pediatric psychologist is long and consists of many years of training. Most clinicians have a strong background in psychology coming out of their undergraduate schooling. It is ideal for prospective students to take courses in developmental psychology, health psychology, developmental psychopathology, abnormal psychology, and many others. In order to be competitive when applying to graduate schools, most students will have a strong background in research either as an assistant in a pediatric psychology lab, conducting independent studies, or both. Student's may also find it beneficial to acquire field experience with children in order to demonstrate that they can become adept clinicians. In addition to this, for admission to graduate school, it is necessary to have a relationship with three or more psychologists in order to provide letters of recommendation.
To become a full-fledged pediatric psychologist one must obtain a doctoral degree in the form of either a Ph.D. or Psy.D. in clinical or counseling psychology. Graduate training typically requires 4–5 years of graduate school and an additional year spent on an internship. Some programs will require the completion of a master's thesis while others will not. All, however, will require that students complete a dissertation consisting of original research. A doctoral program will use the scientist practitioner or Boulder model which emphasizes training in both clinical practice and research methodology, while a PsyD program will likely use the Vail model which emphasizes clinical skills much more than research. Some schools will provide a specialization in child clinical psychology or health psychology which can supplement normal training with a pediatric twist. Another aspect of graduate training is external practicums in settings such hospitals or clinics. Gaining experience working in these areas is essential in order to be prepared to obtain a job after graduate school. In order to help standardize the training each psychologist receives, the Society of Pediatric Psychology task force developed a list of 12 training areas necessary for a specialty in pediatric psychology:
Lifespan development
Lifespan developmental psychopathology
Child, adolescent, and family assessment
Intervention strategies
Research methods and systems evaluation
Professional, ethical, and legal issues pertaining to children, adolescents, and families
Diversity issues and multicultural competence
Role of multiple disciplines in service delivery systems
Prevention, family support, and health promotion
Social issues affecting children, adolescents, and families
Consultation-liaison (CL) roles
Disease process and medical management
After graduate school, there are many choices in order to determine the field best suited to one's interests. Some individuals will engage in a fellowship which will allow for increased knowledge in specific areas of clinical psychology and research and may yield more job opportunities. A postdoctoral fellowship may also provide supervised clinical hours which are required in order to become independently licensed in a state. Finally, some pediatric psychologists will go on to engage in clinical practice while others will not. In order to practice as a clinical psychologist one must obtain a doctoral degree from an approved program, complete a required amount of supervised clinical hours, pass the Examination for Professional Practice in Psychology (EPPP), and be knowledgeable of all state regulations.
Pediatric Psychologists may choose to become certified by the American Board of Professional Psychology (ABPP) and can apply for advanced credentials through the American Board of Clinical Child and Adolescent Psychology (ABCCAP) or the American Board of Clinical Health Psychology (ABCHP).
Research
The main goal of pediatric research is to understand child development occurring with health-related issues. Using ecological systems framework, pediatric psychologists discover the ways in which health issues might affect children and their families and ways to promote physical health and psychological adjustment in pediatric-health populations.
Important issues currently addressed in pediatric psychology research across various diagnoses include:
Cultural and diversity issues
Evidence-based practice
Inpatient pediatric consultation-liaison
Adherence to treatment regimens
Chronic and recurrent pain
Management of pain and distress due to medical procedures
Pharmacology and psychopharmacology
Medical traumatic stress
Palliative care, end of life, bereavement
eHealth application
Pediatric psycho-oncology
Common research areas in pediatric psychology
Neonatology, prematurity, and developmental issues
Pediatric asthma
Cystic fibrosis
Diabetes mellitus
Sickle-cell disease
Pediatric oncology
Traumatic brain injury and spinal cord injury
Central nervous system disorders (e.g., epilepsy, spina bifida)
Juvenile idiopathic arthritis
Cardiovascular disease
Pediatric organ transplantation
Abdominal pain-related gastrointestinal disorders (e.g., irritable bowel syndrome, inflammatory bowel disease)
Pediatric HIV/AIDS
Pediatric burns
Feeding and vomiting problems
Childhood obesity
Eating disorders
Elimination disorders (e.g., enuresis, encopresis)
Pediatric sleep
Autism spectrum disorders and developmental disabilities
Behavior problems in a pediatric context
Attention deficit hyperactivity disorder in the pediatric context
Child abuse
Injuries and safety: Unintentional injuries are the leading cause of disability and death in children and teens from the age of 1 to 19 years. More children and adolescents die as a result of an unintentional injury than from all other childhood diseases combined. Health care providers have multiple opportunities to provide prevention materials and injury guidance. Simon et al. (2006) found that less frequent injury guidance results in more frequent medically linked injuries by 16 months of age. Research suggests that counseling increases parental safety behaviors and counseling tailored to risk behaviors of a particular family are most effective. Pediatric psychology has a significant role to play in formulating, implementing, and evaluating injury prevention efforts.
Future research directions
Positive, resilience factors, and quality of life: Pediatric psychologists are increasingly understanding and applying research on resilience factors and protective factors. Researchers have discovered that despite psychological risk factors associated with childhood chronic illnesses, the majority of children with chronic illnesses fare just as well as their peers or even better in some cases. Furthermore, the study of health-related quality of life (HRQOL) is unique to the pediatric setting and encompasses domains of physical, psychological, and social functioning that are directly influenced by chronic illnesses. Researchers have found that pediatric cancer survivors typically report positive outcomes, while lower levels were reported in children and teens with diabetes, cystic fibrosis, and asthma, which may be due in part to the intensity and duration of the treatments. Researchers' current goal is to identify areas of functioning that are relatively untouched from the illness and treatment and to focus in on the domains of the HRQOL for which there is an increased risk so that prevention and intervention efforts can target the most valuable domains.
See also
Community psychology
Developmental psychology
Pediatrics
References
Clinical psychology
Pediatrics | 0.773841 | 0.962527 | 0.744843 |
Relational-cultural therapy | Relational-cultural theory, and by extension, relational-cultural therapy (RCT) stems from the work of Jean Baker Miller, M.D. Often, relational-cultural theory is aligned with the feminist and or multicultural movements in psychology. In fact, RCT embraces many social justice aspects from these movements.
RCT was developed in Wellesley, Massachusetts in the 1970s through the work of psychiatrist, Jean Baker Miller (Toward a New Psychology of Women), psychologists, Judith V. Jordan, Janet Surrey, and Irene Stiver at the Stone Center at Wellesley College in reaction to psychodynamic theory. The Stone Center at Wellesley College and the Jean Baker Miller Training Institute are the hubs of RCT research and training and are perhaps best known for their Working Papers series, collective works that are continuously considered for review and reconsideration. As RCT was founded in strong feminist principles, and was started at Wellesley College, the movement's traditional focus was on women and their relational experiences.
Many mental health professionals employ RCT in their practice. A nonexhaustive list of these include: counselors, social workers, psychologists, and psychiatrists. Some current major relational-cultural theorists, writers, and practitioners include: Judith V. Jordan, Ph D, Amy Banks, MD, Maureen Walker, Ph D, Linda Hartling, Ph D, Sarah Sydelle Price, PCC, Rosjke Hasseldine and Thelma Duffey, Ph D
The consistent, primary focus of RCT is the primacy of relationships. That is, relationships are both the indicators for, and the healing mechanism in psychotherapy toward, mental health and wellness.
One of the core tenets of RCT is the Central Relational Paradox (CRP). The CRP assumes that we all have a natural drive toward relationships, and in these relationships we long for acceptance. However, we come to believe that there are things about us that are unacceptable or unlovable. Thus, we choose to hide these things; we keep them out of our relationships. In the end, the connections we make with others are not as fulfilling and validating as they otherwise might have been.
A primary goal of RCT is to create and maintain Mutually-Growth-Fostering Relationships, relationships in which both parties feel that they matter. In these healthy relationships, all of the involved parties experience what is known as the Five Good Things. These include: 1) a desire to move into more relationships, because of how a good relational experience feels; 2) a sense of zest, or energy; 3) increased knowledge of oneself and the other person in the relationship; 4) a desire to take action both in the growth-fostering relationship and outside of it; 5) an overall increased sense of worth.
RCT involves working with clients to identify, and strive in, relationships that present opportunities for them to experience Mutually-Growth-Fostering Relationships. In fact, a strong, connected therapeutic relationship should be a model for these kinds of relationships. While there a number of specific challenges presented in the therapeutic relationship, RCT practitioners believe that their relationships with their clients can have a reasonably high degree of mutuality. Clinical experiences of mutuality include: the client's movement toward the awareness that they matter to the therapist, the therapist that they, too, matter to the client, an integrative awareness both have of what it means to feel like one matters, and the worth involved in offering this to another person through the process of connection.
References
Interpersonal relationships
Psychological theories | 0.765913 | 0.972461 | 0.744821 |
Schizophrenia and tobacco smoking | Schizophrenia and tobacco smoking have been historically associated. Smoking is known to harm the health of people with schizophrenia.
Studies across 20 countries showed that people with schizophrenia were much more likely to smoke than those without this diagnosis. For example, in the United States, 90% or more of people with schizophrenia smoked, compared to 20% of the general population in 2006.
It is well established that smoking is more prevalent among people with schizophrenia than the general population as well as those with other psychiatric diagnoses. There is currently no definitive explanation for this difference. Many social, psychological, and biological explanations have been proposed, but today research focuses on neurobiology.
One important reason people smoke cigarettes is due to finding it enjoyable. However, increased rates of smoking among people with schizophrenia have a number of serious impacts, including increased rates of mortality, increased risks of suicidal behavior and cardiovascular disease, reduced treatment effectiveness, and greater financial hardship. Studies have also shown that in a male population, having a schizophrenia spectrum disorder makes it likely for people to use more tobacco. As a result, researchers believe it is important for mental health professionals to combat smoking among people with schizophrenia.
Causes
A number of theories have been proposed to explain increased rates of smoking among people with schizophrenia.
Psychological and social theories
Several psychological and social explanations have been proposed. The earliest explanations were based on psychoanalytic theory.
The socioeconomic/environmental hypothesis proposed that smoking results because many people with schizophrenia are unemployed and inactive, so smoking relieves boredom. Research has found that this explanation alone cannot account for the extreme amount of smoking among people with schizophrenia.
The personality hypothesis focused on the association between smoking and higher level of neuroticism and anxiety. This hypothesis proposed that anxiety as a symptom of schizophrenia may contribute to smoking.
The psychological tool hypothesis argues that smokers use nicotine to manipulate their mental state in response to various environmental conditions, such as reducing stress and managing negative emotions. Research on this hypothesis notes that people with schizophrenia often cannot cope with problems in constructive ways, so use of smoking as a psychological tool may result in a vicious cycle of more and more smoking.
The self-medication hypothesis argues that people with schizophrenia use nicotine to compensate for the cognitive deficits that result from schizophrenia, the antipsychotic medication used to treat schizophrenia, or both.
The cognitive effects hypothesis suggests that nicotine has positive effects on cognition, so smoking is used to improve neurocognitive dysfunction.
In these hypotheses, one factor often implicated is the effects of institutionalization and boredom. However, people with schizophrenia smoke at higher rates and for longer periods than other groups that experience both institutionalization and boredom.
Another factor often implicated is to the side effects of antipsychotics. Atypical antipsychotics may work against smoking cessation, as symptoms of smoking cessation such as irritable mood, mental dulling, and increased appetite overlap with side effects of atypical antipsychotics. Some also argue that smoking works to reduce the side effects of antipsychotics. However, research shows no association between smoking and antipsychotic use after controlling for schizophrenia.
Another frequently implicated factor is increased mental acuity associated with smoking, important because of the mental dulling found over time in schizophrenia. However, both people with schizophrenia and the general population experience this effect, so it cannot fully explain increased smoking in people with schizophrenia.
A 2003 study of over 50,000 Swedish conscripts found that there was a small but significant protective effect of smoking cigarettes on the risk of developing schizophrenia later in life. Many people with schizophrenia have smoked tobacco products long before they are diagnosed with the illness, and a cohort study of Israeli conscripts found that healthy adolescent smokers were more likely to develop schizophrenia in the future than their nonsmoking peers.
Criticisms
One major criticism of social and psychological explanations of smoking in schizophrenia is that most studies have failed to include personal perspectives of patients with schizophrenia. Studies including personal perspectives find that people with schizophrenia generally start smoking for the same reasons as the general population, including social pressures and cultural and socioeconomic factors. People with schizophrenia who are current smokers also cite similar reasons for smoking as people without schizophrenia, primarily relaxation, force of habit, and settling nerves. However, 28% cite psychiatric issues, including response to auditory hallucinations and reducing the side effects of medication. The major themes found in studies of personal perspectives are habit and routine, socialization, relaxation, and addiction to nicotine. It is argued that smoking provides structure and activity, both of which may be lacking in the lives of those with serious mental illness.
Another major criticism is based on the finding that the association between smoking and schizophrenia is about as strong across all cultures. This finding implies that the association is not solely social or cultural, but rather has a strong biological component.
Biological theories
Biological theories focus on the role of dopamine, particularly how negative symptoms such as social withdrawal and apathy may be caused by a deficiency of dopamine in the prefrontal cortex while positive symptoms such as delusions and hallucinations may be caused by excess dopamine in the mesolimbic pathway. Nicotine increases the release of dopamine, so it is hypothesized that smoking helps to correct dopamine deficiency in the prefrontal cortex and thus relieve negative symptoms.
It is unclear, however, how nicotine interacts with positive symptoms, as it would follow from this theory that nicotine would exacerbate excess dopamine in the mesolimbic pathway and thus positive symptoms as well. One theory argues that the beneficial effects of nicotine on negative symptoms outweigh possible exacerbation of positive symptoms. Another theory is based on animal models showing that chronic nicotine use eventually results in a reduction in dopamine, thus alleviating positive symptoms. However, human studies show conflicting results, including some studies that show that smokers with schizophrenia have the most positive symptoms and a reduction in negative symptoms.
Another area of research is the role of nicotinic receptors in schizophrenia and smoking. Studies show increased numbers of exposed nicotinic receptors, which could explain the pathology of both smoking and schizophrenia. However, others argue that the increase in nicotinic receptors is a result of persistent heavy smoking, rather than schizophrenia.
Another source of controversy is the relationship between smoking and sensory gating in schizophrenia. Nicotine may help improve auditory gating, the ability to screen out intrusive environmental sounds. This may help improve attention spans and reduce auditory hallucinations, allowing people with schizophrenia to perceive the environment more effectively and engage in smoother motor functions. However, research shows this effect alone cannot account for increased smoking rates.
Impacts
Increased smoking among people with schizophrenia has a number of impacts on this population. One well-documented consequence is the increase in premature death among people with schizophrenia. Life expectancy among people with schizophrenia is generally 80-85% that of the general population, which results from both unnatural causes such as suicide but also natural causes such as cardiovascular disease, to which smoking is an important contributor. People with schizophrenia have a higher incidence of smoking diseases, with heart disease deaths 30% more likely and respiratory disease deaths 60% more likely. 2/3 of people with schizophrenia die from coronary heart disease, versus less than 1/2 of the general population. Ten-year coronary heart disease risk is significantly elevated in people with schizophrenia, as well as diabetes and hypertension.
Tobacco smoking increases the metabolism of some antipsychotics, by strongly activitating CYP1A2, the enzyme that breaks them down, and a significant difference is found in these levels between smokers and non-smokers. It is recommended that the dosage for those smokers on clozapine be increased by 50%, and for those on olanzapine by 30%. The result of stopping smoking can lead to an increased concentration of the antipsychotic that may result in toxicity, so that monitoring of effects would need to take place with a view to decreasing the dosage; many symptoms may be noticeably worsened, and extreme fatigue, and seizures are also possible with a risk of relapse. Likewise those who resume smoking may need their dosages adjusted accordingly. The altering effects are due to compounds in tobacco smoke and not to nicotine; the use of nicotine replacement therapy therefore has the equivalent effect of stopping smoking and monitoring would still be needed.
Besides biological effects, smoking has a profound social impact on people with schizophrenia. One major impact is financial, as people with schizophrenia have been found to spend a disproportionate amount of their income on cigarettes. A study of people with schizophrenia on public assistance found that they spent a median amount of $142 per month on cigarettes out of a median monthly public assistance income of $596, or about 27.36%. Some argue that this results in further social impacts as people with schizophrenia are then unable to spend money on entertainment and social events that would promote well-being, or may even be unable to afford housing or nutrition.
Role of tobacco industry
Though the relationship between smoking and schizophrenia is well established, a factor to be considered in this relationship is the role of the tobacco industry. Research based on internal industry documents shows a concerted effort by the industry to promote belief that people with schizophrenia need to smoke and that it is dangerous for them to quit. Such promotion includes monitoring or supporting research that endorsed the idea that people with schizophrenia are uniquely immune to the health consequences of smoking (since proved false) and that tobacco is needed for people with schizophrenia to self-medicate. The industry also provided cigarettes to hospital wards and supported efforts to block hospital-based smoking bans. Although this does not discredit the effects of nicotine in schizophrenia, it is argued that the efforts of the tobacco industry slowed the decline in smoking prevalence in people with schizophrenia as well as the development of clinical policies to promote smoking cessation.
Clinical implications
There is evidence that multimodal smoking cessation programs using both pharmacologic therapy (with varenicline or bupropion) and nicotine replacement can be effective without worsening symptoms of schizophrenia. Historically, mental health providers have not attempted to prevent schizophrenics from smoking, based on the rationale that patients with serious mental illness already experience significant stress and disability and as such should be allowed to engage in smoking as an activity that is pleasurable, albeit destructive. There is also historical precedent of mental health providers, particularly in inpatient settings, to use cigarettes as a way to manipulate patient behavior, such as rewarding good behavior with cigarettes or withholding cigarettes to encourage medication compliance. However, research showing that eliminating even one risk factor for disease can significantly improve long-term health outcomes has resulted in the dominant view among clinicians opposing smoking.
Though smoking cessation is generally now a goal of mental health clinicians, there is a lack of empirical research showing successful strategies for accomplishing this goal. However, all studies have shown a reduction in smoking, though not necessarily elimination. Evidence has been found to support the use of sustained-release bupropion, nicotine replacement therapy, atypical antipsychotics, and cognitive-behavioral therapy. Better outcomes are seen when two or more cessation strategies are employed, as well as for patients using atypical antipsychotics rather than typical antipsychotics. There is also no evidence for an increase in positive symptoms or side effects following smoking cessation, while there is evidence for a decrease in negative symptoms.
Besides smoking cessation, the prevalence of smoking among people with schizophrenia also calls for additional measures in evaluation by mental health providers. Researchers argue that providers should incorporate tobacco use assessment into everyday clinical practice, as well as continuing assessments of cardiovascular health through measures such as blood pressure and diagnostics such as electrocardiography. Additionally there are ethical and practical concerns if healthcare facilities prohibit smoking without providing alternatives, particularly since withdrawal can alter the presentation of symptoms and response to treatment and may confuse or even exacerbate symptoms. Clinicians should also be aware of the consequences that can result from a lack of cigarettes, such as aggression, prostitution, trafficking, and general disruption. These consequences indicate that providers may need to help patients obtain cigarettes and/or monitor usage.
Experimental drugs that agonize the α7 nicotinic acetylcholine receptors targeted by nicotine such as GTS-21 have been suggested as candidates for symptomatic treatment of schizophrenia.
References
Schizophrenia
Tobacco smoking | 0.7689 | 0.968638 | 0.744785 |
Applied ontology | Applied ontology is the application of Ontology for practical purposes. This can involve employing ontological methods or resources to specific domains,
such as management, relationships, biomedicine, information science or geography. Alternatively, applied ontology can aim more generally at developing improved methodologies for recording and organizing knowledge.
Much work in applied ontology is carried out within the framework of the Semantic Web. Ontologies can structure data and add useful semantic content to it, such as definitions of classes and relations between entities, including subclass relations. The semantic web makes use of languages designed to allow for ontological content, including the Resource Description Framework (RDF) and the Web Ontology Language (OWL).
Applying ontology to relationships
The challenge of applying ontology is ontology's emphasis on a world view orthogonal to epistemology. The emphasis is on being rather than on doing (as implied by "applied") or on knowing. This is explored by philosophers and pragmatists like Fernando Flores and Martin Heidegger.
One way in which that emphasis plays out is in the concept of "speech acts": acts of promising, ordering, apologizing, requesting, inviting or sharing. The study of these acts from an ontological perspective is one of the driving forces behind relationship-oriented applied ontology. This can involve concepts championed by ordinary language philosophers like Ludwig Wittgenstein.
Applying ontology can also involve looking at the relationship between a person's world and that person's actions. The context or clearing is highly influenced by the being of the subject or the field of being itself. This view is highly influenced by the philosophy of phenomenology, the works of Heidegger, and others.
Ontological perspectives
Social scientists adopt a number of approaches to ontology. Some of these are:
Realism - the idea that facts are "out there" just waiting to be discovered;
Empiricism - the idea that we can observe the world and evaluate those observations in relation to facts;
Positivism - which focuses on the observations themselves, attending more to claims about facts than to facts themselves;
Grounded theory - which seeks to derive theories from facts;
Engaged theory - which moves across different levels of interpretation, linking different empirical questions to ontological understandings;
Postmodernism - which regards facts as fluid and elusive, and recommends focusing only on observational claims.
Data ontology
Ontologies can be used for structuring data in a machine-readable manner. In this context, an ontology is a controlled vocabulary of classes that can be placed in hierarchical relations with each other. These classes can represent entities in the real world which data is about. Data can then be linked to the formal structure of these ontologies to aid dataset interoperability, along with retrieval and discovery of information. The classes in an ontology can be limited to a relatively narrow domain (such as an ontology of occupations), or expansively cover all of reality with highly general classes (such as in Basic Formal Ontology).
Applied ontology is a quickly growing field. It has found major applications in areas such as biological research, artificial intelligence, banking, healthcare, and defense.
See also
Foundation ontology
Applied philosophy
John Searle
Bertrand Russell
Barry Smith, ontologist with a focus on biomedicine
Nicola Guarino, researcher in the formal ontology of information systems
References
External links
Applied philosophy
Applied ontology | 0.767345 | 0.97051 | 0.744715 |
Clinical social work | Clinical social work is a specialty within the broader profession of social work. The American Board of Clinical Social Work (ABCSW) defines clinical social work as "a healthcare profession based on theories and methods of prevention and treatment in providing mental-health/healthcare services, with special focus on behavioral and bio-psychosocial problems and disorders". The National Association of Social Workers defines clinical social work as "a specialty practice area of social work which focuses on the assessment, diagnosis, treatment, and prevention of mental illness, emotional, and other behavioral disturbances. Individual, group and family therapy are common treatment modalities". Clinical social work applies social work theory and knowledge drawn from human biology, the social sciences, and the behavioral sciences.
History
Many suggest that the roots of clinical social work began with the social casework methods used by Charity Organization Societies around 1877 to 1883. In 1898, the first U.S. social work class was offered at Columbia University by the New York Charity Organization Society. In 1904 Simmons College, in collaboration with Harvard University, established the Boston School for Social Workers. Also, in 1904, Columbia University offered the first graduate program in social work, although it was not named the New York School of Social Work until 1917. In 1917 Mary E. Richmond conceptualized social casework in her text Social Diagnosis.
The term social casework began to fade from use after 1920 and the term psychiatric social work became more in common as well as the application of psychoanalytic theory. Ehrenkranz reported that the first use of the term clinical social work was in 1940 at the Louisiana State University School of Social Work which offered a clinical curriculum. The National Federation of Societies for Clinical Social Work was established in 1971, which later became the Clinical Social Work Association in 2006. The Clinical Social Work Journal began in 1973 shortly after founding of the National Federation of Societies for Clinical Social Work. In 1978 the National Association of Social Workers' Task Force on Clinical Social Work Practice drafted the first working definition of clinical social work. The National Association of Social Workers established the Diplomate in Clinical Social Work (DCSW) in 1986. In 1987, the American Board of Examiners in Clinical Social Work was founded, which later became the American Board of Clinical Social Work in 2020, and established the Board Certified Diplomate in Clinical Social Work (BCD) credential. Today, clinical social work is licensed in all 50 of the United States, the District of Columbia, the U.S. Virgin Islands, all 10 Canadian Provinces, Guam and the U.S. Commonwealth of the Northern Mariana Islands, as well as licensed or certified by other jurisdictions around the world.
Practice Methods
The core methods of clinical social work require "the application of social work theory, knowledge, methods, ethics, and the professional use of self to restore or enhance social, psychosocial, or biopsychosocial functioning of individuals, couples, families, groups, organizations and communities. The practice of clinical social work requires the application of specialized clinical knowledge and advanced clinical skills in the areas of assessment, diagnosis and treatment of mental, emotional, and behavioral disorders, conditions and addictions. Treatment methods include the provision of individual, marital, couple, family and group counseling and psychotherapy. Clinical social workers are qualified to diagnose using the Diagnostic and Statistical Manual of Mental Disorders (DSM), the International Classification of Diseases (ICD), and other diagnostic classification systems in assessment, diagnosis, psychotherapy, and other activities. The practice of clinical social work may include private practice and the provision of clinical supervision".
Assessment methods typically refers to a biopsychosocial assessment, clinical interview, direct behavioral observation, and/or the administering, scoring, and interpreting of various tests, inventories, questionnaires, and rating scales.
Further, clinical social workers engage in consultation, program and practice evaluation, and the administration of clinical programs and services.
Psychiatric Social Work
Psychiatric Social Work is a practice area of social work involving the care of individuals with Serious mental illness who require intensive care. They may be involved with referring, treating (with psychotherapy) or otherwise managing such patients. Most Psychiatric Social Workers work in psychiatric institutions or hospitals, though in some programs they may work outside the institution for a period of intense observation.
Education
The Master of Social Work (M.S.W.) degree, accredited by the Council on Social Work Education, is the minimum education requirement in clinical social work and is the terminal practice degree. These M.S.W. degree are typically two full-time years of study in length and require 900 to 1,200 hours of internship practice. If an applicant to a M.S.W. degree program has a Bachelor of Social Work (B.S.W.) degree, accredited by the Council on Social Work Education, they may be offered "advanced standing" shorting their M.S.W. degree program to one years of full-time study.
The Doctor of Social Work (D.S.W.) is the advanced practice professional degree in social work. The D.S.W. may be specialized in an area or in multiple areas of social work practice, one of which may be clinical social work at some universities.
The Doctor of Philosophy (Ph.D.) in social work is typically considered a "research degree;" however, some schools may offer the Ph.D. degree in social work with a clinical social work practice specialization.
Licensure
In the United States
Licensure is required to practice social work in the United States, and in many other jurisdictions. Clinical social work licensure typically requires 1,500 to 5,760 hours of post-master's clinical work experience under clinical supervision with a board approved clinical supervisor, and a passing score on an Association of Social Work Boards approved clinical level examination. The number of post-master's clinical hours may vary by jurisdiction.
Clinical licensure titles also may vary by jurisdiction. The Association of Social Work Boards recommends the use of Licensed Clinical Social Worker (LCSW) as the preferred title. However, some jurisdictions have used other titles including, but not limited to Licensed Independent Social Worker (LISW), Licensed Independent Clinical Social Worker (LICSW), Licensed Specialist Clinical Social Worker (LSCSW), and Licensed Certified Social Worker-Clinical (LCSW-C).
Certification
Certification is a voluntary process that typically does not authorize practice, but may suggest specialization in a subfield of practice. There are several certifications in clinical social work.
In the United States
The American Board of Clinical Social Work (ABCSW) offers the Board Certified Diplomate in Clinical Social Work (BCD), and several clinical social work specialization credentials including practice with children and their families, clinical supervision, and in psychoanalysis. The ABCSW states that the BCD is "the profession's premier" advanced clinical social work certification, having the highest standards of clinical education, training, and experience. The ABCSW offers three specialty certifications including Practice with Children and Their Families, Clinical Supervision, and Psychoanalysis. Each of these specialty certifications require the applicant to hold advanced clinical certification as a BCD in Clinical Social Work, have acceptable peer evaluations, to have accumulated a specified number of clinical practice hours, have the specified number of clock hours of clinical continuing education related to the specialty, and have had a specified number of supervision or consultation hours.
The National Association of Social Workers also offers several clinical social work credentials including the Qualified Clinical Social Worker (QCSW), Diplomate in Clinical Social Work (DCSW), Clinical Social Worker in Gerontology (CSW-G), and the Certified Clinical Alcohol, Tobacco & Other Drugs Social Worker (C-CATODSW). The Qualified Clinical Social Worker (QCSW) is the beginning level generalist clinical social work credential offered by NASW; NASW membership is not required to obtain the QCSW. The Diplomate in Clinical Social Work (DCSW) is the advanced level generalist clinical social work credential offered by NASW; NASW membership is required to obtain the DCSW. The Clinical Social Worker in Gerontology (CSW-G) is a specialty credential offered by NASW to clinical social workers who specialize in working in the area of gerontology; NASW membership is not required to obtain the CSW-G. The Certified Clinical Alcohol, Tobacco & Other Drugs Social Worker (C-CATODSW) is a specialty credential for clinical social workers who work in the area of alcohol, tobacco, and other drugs; NASW membership is not required to obtain the CSW-G.
The National Association of Forensic Counselors offers the Clinically Certified Forensic Social Worker (CCFSW) credential. The NAFC suggests that the CCFSW is a clinical level certification for clinical social workers who hold an M.S.W. or D.S.W. degree, have obtained clinical licensure in their state, have earned a specified amount of related continuing education, obtained a passing exam score, and work with adult and/or juvenile criminal offenders.
See also
Behaviour therapy
Child psychotherapy
Cognitive therapy
Cognitive-behavioral therapy
Counseling
Couples therapy
Crisis intervention
Differential diagnosis
Family therapy
Forensic social work
Grief counseling
Group psychotherapy
Interpersonal psychotherapy
Mental health professional
Psychiatric rehabilitation
Psychoanalysis
Psychodynamic psychotherapy
Psychoeducation
Psychotherapy
School social worker
Caseworker (social work)
Solution-focused brief therapy
Qualifications for professional social work
References
Social work | 0.761779 | 0.977523 | 0.744656 |
Psychologism | Psychologism is a family of philosophical positions, according to which certain psychological facts, laws, or entities play a central role in grounding or explaining certain non-psychological facts, laws, or entities. The word was coined by Johann Eduard Erdmann as Psychologismus, being translated into English as psychologism.
Definition
The Oxford English Dictionary defines psychologism as: "The view or doctrine that a theory of psychology or ideas forms the basis of an account of metaphysics, epistemology, or meaning; (sometimes) spec. the explanation or derivation of mathematical or logical laws in terms of psychological facts." Psychologism in epistemology, the idea that its problems "can be solved satisfactorily by the psychological study of the development of mental processes", was argued in John Locke's An Essay Concerning Human Understanding (1690).
Other forms of psychologism are logical psychologism and mathematical psychologism. Logical psychologism is a position in logic (or the philosophy of logic) according to which logical laws and mathematical laws are grounded in, derived from, explained or exhausted by psychological facts or laws. Psychologism in the philosophy of mathematics is the position that mathematical concepts and/or truths are grounded in, derived from or explained by psychological facts or laws.
Viewpoints
John Stuart Mill was accused by Edmund Husserl of being an advocate of a type of logical psychologism, although this may not have been the case. So were many nineteenth-century German philosophers such as Christoph von Sigwart, Benno Erdmann, Theodor Lipps, Gerardus Heymans, Wilhelm Jerusalem, and Theodor Elsenhans, as well as a number of psychologists, past and present (e.g., Wilhelm Wundt and Gustave Le Bon).
Psychologism was notably criticized by Gottlob Frege in his anti-psychologistic work The Foundations of Arithmetic, and many of his works and essays, including his review of Husserl's Philosophy of Arithmetic. Husserl, in the first volume of his Logical Investigations, called "The Prolegomena of Pure Logic", criticized psychologism thoroughly and sought to distance himself from it. Frege's arguments were largely ignored, while Husserl's were widely discussed.
In "Psychologism and Behaviorism", Ned Block describes psychologism in the philosophy of mind as the view that "whether behavior is intelligent behavior depends on the character of the internal information processing that produces it." This is in contrast to a behavioral view which would state that intelligence can be ascribed to a being solely via observing its behavior. This latter type of behavioral view is strongly associated with the Turing test.
See also
Antipsychologism
Blockhead argument
Naturalized epistemology
References
External links
Husserl's Criticism of Psychologism. Link broken, page preserved most recently from October 22, 2009 at Internet Archive: Eprint. From Diwatao, (apparently former) online journal of the philosophy department of San Beda College, Manila, the Philippines.
Metatheory
Philosophy of mathematics
Theories of deduction | 0.76146 | 0.977881 | 0.744617 |
Cognitive analytic therapy | Cognitive analytic therapy (CAT) is a form of psychological therapy initially developed in the United Kingdom by Anthony Ryle. This time-limited therapy was developed in the context of the UK's National Health Service with the aim of providing effective and affordable psychological treatment which could be realistically provided in a resource constrained public health system. It is distinctive due to its intensive use of reformulation, its integration of cognitive and analytic practice and its collaborative nature, involving the patient very actively in their treatment.
The CAT practitioner aims to work with the patient to identify procedural sequences; chains of events, thoughts, emotions and motivations that explain how a target problem (for example self-harm) is established and maintained. In addition to the procedural sequence model, a second distinguishing feature of CAT is the use of reciprocal roles (RRs). These identify problems as occurring between people and not within the patient. RRs may be set up in early life and then be replayed in later life; for example someone who as a child felt neglected by parents perceived as abandoning might be vulnerable to feelings of abandonment in later life (or indeed neglect themselves).
Sources and origins
As the name implies, cognitive analytic therapy (CAT) evolved as an integrative therapy based on ideas from cognitive and analytic therapies. CAT was also influenced in part by George Kelly's constructivism. Kelly had developed personal construct theory and the repertory grid method, and Kelly's approach to therapy "offered a model of nonauthoritarian practice" that psychotherapist Anthony Ryle found appealing.
Ryle, a general practitioner and analytically trained psychotherapist, was undertaking research into psychotherapy practice using repertory grids in the 1970s. He found that the themes eventually addressed in analytic work were in fact present in transcripts from the very first sessions. However the slow, exploratory nature of traditional analytic therapy meant that these were not always addressed early and assertively, with the result that therapy, while effective, took a long time to produce results. In a 1979 paper, he proposed a shorter, more active form of therapy which integrated elements from cognitive therapy practice (such as goal setting and Socratic questioning) into analytic practice. This would include explicitly formulating the problems experienced by the patient, and sharing this formulation with the patient to engage them in psychotherapy as a co-operative enterprise.
Subsequently, CAT has been influenced by ideas from the work of Soviet psychologist Lev Vygotsky and Russian philosopher Mikhail Bakhtin. From Vygotsky come concepts such as the zone of proximal development (ZPD) and scaffolding. The ZPD implies that new tasks set for the patient (for example, tolerating anxiety about social situations) should extend what they do beyond their current capabilities, but only by a small and achievable amount. Scaffolding involves the therapist providing support for the patient's efforts to change, but varying this level of support as the patient's needs change.
Bakhtin provided concepts such as dialogism from which come techniques such as Dialogical Sequence Analysis. This is a structured attempt to identify and visually display sequences of behaviour, thinking, and emotions so that the patient becomes more aware of these and can start to modify them.
In practice
The model emphasises collaborative work with the client, and focuses on the understanding of the patterns of maladaptive behaviours. The aim of the therapy is to enable the client to recognise these patterns, understand their origins, and subsequently to learn alternative strategies in order to cope better.
The approach is always time-limited, typically taking place over 8–24 weekly sessions (the precise number being agreed at the start of therapy). Sixteen sessions is probably the most common length. In the first quarter of the therapy (the Reformulation phase) the therapist collects all the relevant information, asking the patient about present day problems and also earlier life experiences. At that point the therapist writes a reformulation letter to the client. This letter summarises the therapist's understanding of the client's problems. Particular attention is given to understanding the connection between childhood patterns of behaviour and their impact on adult life. The letter is agreed between patient and therapist and forms the basis for the rest of the work.
After the reformulation letter the patient may be asked to complete diaries or rating sheets to record the occurrence of problems and their context. During this period (known as the Recognition phase) patient and therapist construct a diagrammatic formulation to illustrate the unhelpful procedures which maintain problems for the patient. The aim of this phase is to enable the patient to recognise when and how problems occur.
In the second half of the therapy work moves into the Revision phase, where patient and therapist identify and practice "exits" from the procedural diagram established in the previous phase. For example, a problematic procedure might move a patient from feeling angry to taking an overdose. An exit might involve expressing the anger in some way as an alternative to self-injuring behaviour.
At the end of the therapy, patient and therapist each write "goodbye letters" which they exchange, summarising what has been achieved in the therapy and what remains to be done. After the end of the agreed number of weekly sessions, planned follow-up sessions take place to monitor and support the changes that have been made. Typically, a 16-session CAT might be followed up by a single session one month after the end of therapy, and a final one three months later.
Evidence base
CAT has been the subject of a number of research studies published in peer-reviewed journals. These include randomised controlled trials (RCTs) and other kinds of study. The approach is too new for any systematic reviews of RCTs to have been conducted, and therefore is not yet explicitly recommended by name by the UK National Institute for Health and Clinical Excellence (NICE). However NICE has recommended that there should be further research of CAT, for example in borderline personality disorder. A review of CAT research evidence published in 2014 reported that although there were five randomised controlled trials published, research evidence into the approach was dominated by small-scale, practice-based studies. These tended to be with complex and severe clinical groups; 44% of studies reviewed involved personality disorder. A review of CAT looking back over the 30 years to its beginnings contains a meta-analysis of 11 outcome studies of CAT. The overall number of patients treated in the studies was 324 and the average effect size across all studies was 0.83 (95% confidence interval 0.66–1.00). This is a large effect and suggests that CAT is efficacious in treating mental health problems.
Evidence from randomised controlled trials
CAT has been shown to lead to subjective improvement in people with anorexia nervosa. It has also been shown to produce significant improvements in adolescents with a diagnosis of borderline personality disorder. A different trial suggested that CAT for adult patients with personality disorders also showed improvements in symptoms and interpersonal functioning, as against controls who deteriorated on these measures. CAT has also been shown to improve patients' management of diabetes. An RCT of the use of a CAT-informed assessment for young people who had self-harmed suggested that it was effective in increasing rates of attendance at community follow-up.
Evidence from other methodologies
Comparative studies have suggested CAT to be at least as effective as other forms of brief psychotherapy, person-centred therapy and cognitive behavioural therapy, and interpersonal psychotherapy.
Case series and single case studies have also been published describing the use of CAT in:
Depression
Dissociative psychosis
The treatment of offenders
Brain injury
Deliberate self-harm
Dissociative identity disorder
Histrionic personality disorder
Panic disorder
Psychological problems in multiple sclerosis
With carers of people with dementia
Morbid jealousy
Borderline personality disorder
Paranoid personality disorder
Survivors of child sexual abuse
Notes
Further reading
Ryle, A (1990) Cognitive Analytic Therapy: Active Participation in Change. Chichester: John Wiley & Sons.
Ryle, A (1995). Cognitive Analytic Therapy: Developments in Theory and Practice. Chichester: John Wiley & Sons.
Ryle, A (1997). Cognitive Analytic Therapy and Borderline Personality Disorder: The Model and the Method. Chichester: John Wiley & Sons.
Ryle, A & Kerr, I (2002). Introducing Cognitive Analytic Therapy: Principles and Practice. Chichester: John Wiley & Sons.
External links
Association for Cognitive Analytic Therapy
Borderline personality disorder
Cognitive therapy
Constructivism (psychological school)
Integrative psychotherapy | 0.762618 | 0.97638 | 0.744605 |
Use of technology in treatment of mental disorders | The use of electronic and communication technologies as a therapeutic aid to healthcare practices is commonly referred to as telemedicine or eHealth. The use of such technologies as a supplement to mainstream therapies for mental disorders is an emerging mental health treatment field which, it is argued, could improve the accessibility, effectiveness and affordability of mental health care. Mental health technologies used by professionals as an adjunct to mainstream clinical practices include email, SMS, virtual reality, computer programs, blogs, social networks, the telephone, video conferencing, computer games, instant messaging and podcasts.
Specific technologies
Traditional methods of helping people with a mental health problem have been to use approaches such as medication, counselling, cognitive behavioral therapy (CBT), exercise and a healthy diet. New technology can also be used in conjunction with traditional methods.
PC devices
TED speaker Jane McGonigal's website Games For Change includes a health category, which presents many mental health improving and education games. Additionally, her own game, Super Better for PC, IOS and Android is also meant for mental health improvement.
Virtual reality
Rizzo et al. have used virtual reality (VR) (simulated real environments through digital media) to successfully treat post-traumatic stress disorder (PTSD). The VR system offers a sense of realism in a safe environment. By gradually exposing the person to their fear with a Virtual Environment the patient becomes accustomed to the trigger of their problem to an extent that it no longer becomes an issue. This form of treatment has also been applied to other mental health problems such as phobias (where anxiety is triggered by a certain situation). For example, fear of flying or arachnophobia (fear of spiders). Computer games have also been used to provide therapy for adolescents. Many adolescents are reluctant to have therapy and a computer game is a fun, anonymous and accessible way to receive therapeutic advice. An example of a computer game that provides such therapy is SPARX, which has notably been shown to be about as effective as face-to-face therapy in a clinical trial.
Mobile devices
Relatively new technology such as mobile phones have also been used to help people with mental health problems by providing timely information.
As technology improves, it may soon be possible for mobile phones or other devices to sense when people are changing state (e.g. entering a manic or a deeply depressed phase), for instance by noticing a change in voice pattern or usage frequency, or facial tension. It may also become possible to measure physical evidence of levels of distress and suffering, such as changes in hormones or adrenalin in blood, and changes in brain activity. Apps may also be able to predict high stress situations, based on location, time, activity (e.g. purchasing of alcohol) and nearby presence of high risk people. The technology could then send calming messages to patients, automatically alert carers and even automatically administer meds.
There are different technologies that are used in the mental health field over the past 30 years. "Mobile devices like cell phones, smartphones, and tablets are giving the public, doctors, and researchers new ways to access help, monitor progress, and increase understanding of mental wellbeing. New technology can also be packaged into an extremely sophisticated app for smartphones or tablets. Such apps might use the device's built-in sensors to collect information on a user's typical behavior patterns. If the app detects a change in behavior, it may provide a signal that help is needed before a crisis occurs" (Technology and the Future of Mental Health Treatment, n.d.). This connects to Quan-Haase reading about surveillance. The use of a mobile app that knows people behavior has private information about the people who use it. The people are being watched by the app creator or company. Functional view argues that societies, in order to operate effectively, require some element of security and safety. To achieve these goals, personal information in surveillance are only for a degree, not of kind. "This form of surveillance is harmless since third-party companies are primarily interested in aggregate data and will use this information for the purpose of developing and marketing better products, which will benefit consumers in the long run". (Quan-Haase, 2016, p. 222-223). There are many pros of using mental health app such as it is convenience, lower cost, and 24-hour service.
Technology companies are developing mobile-based artificial intelligence chatbot applications that use evidence-based techniques, such as cognitive behavioral therapy (CBT), to provide early intervention to support mental health and emotional well-being challenges. Artificial intelligence (AI) text-based conversational applications delivered securely and privately over mobile devices have the ability to scale globally and offer contextual and always-available support. A recent real world data evaluation study, published in the open access journal JMIR mHealth & , that used an AI-based emotionally intelligent mobile chatbot app, Wysa, identified a significantly higher average improvement in symptoms of depression and a higher proportion of positive in-app experience among the more engaged users of the app as compared to the less engaged users.
On 15 June 2020, the Food and Drug Administration approved the first video game treatment, a game for children aged 8–12 with certain types of ADHD called EndeavorRx. It can be downloaded with a prescription onto a mobile device, and is intended for use in tandem with other treatments. Patients play it for 30 minutes a day, 5 days a week, over a month-long treatment plan.
Technology and cognitive behavioral therapy
The development of mobile phone apps using cognitive behavioral therapy (CBT) has an increasing research area. Using the idea of cognitive behavioral therapy (CBT) apps, self-rated mental health (SRMH) situations can be implemented into these apps and used as information before seeing a professional. Recent research done with self-rated mental health (SRMH) involves survey research which is conducted by with a question that asks respondents to rate their overall mental or emotional health from poor to excellent. The research found with SRMH showed that 62% of people with a mental health problem rated themselves as having positive mental health. The respondents who rated their mental health as good when compared to those with poor mental health, had 30% lower odds of having a mental health problem at a follow-up. This research showcased that without treatment, people with a mental health problem did better if they perceived their mental health in a positive way by declaring a good overall mental or emotional health.
While studies have investigated the clinical efficacy of remote-, internet- and chatbot-based therapy, there are other factors, such as enjoyment and smoothness, that are important for evaluating therapy sessions. Research published in 2019 reported a comparative study of therapy sessions following the interaction of 10 participants with human therapists versus a chatbot (simulated using a Wizard of Oz protocol), finding evidence to suggest that when compared against a human therapist control, participants find chatbot-provided therapy less useful, less enjoyable, and their conversations less smooth (a key dimension of a positively-regarded therapy session).
A study suggests that combining cognitive behavioral therapy (CBT) with SlowMo, an app that helps people notice their "unhelpful fast-thinking" might be more effective for treating paranoia in people with psychosis than CBT alone.
Effects and impact
Economic evaluations
From an economical perspective, digital interventions for mental health conditions seem to be cost-effective compared to no intervention or non-therapeutic responses such as monitoring. However, when compared to in-person therapy or medication their added value is currently uncertain.
Ethical, legal and social issues
There is uncertainty around the ethical and legal implications of digital technologies in the mental health context, including the use of artificial intelligence, machine learning, deep learning, and other forms of automation. Ethical and legal issues tend to not be explicitly addressed in empirical studies on algorithmic and data-driven technologies in mental health initiatives. Concerns have been raised about the near-complete lack of involvement of mental health service users, the scant consideration of algorithmic accountability, and the potential for overmedicalization and techno-solutionism.
References
Treatment of mental disorders
Virtual reality
Mobile technology
Telemedicine | 0.787929 | 0.944992 | 0.744587 |
Health assessment | A health assessment is a plan of care that identifies the specific needs of a person and how those needs will be addressed by the healthcare system or skilled nursing facility. Health assessment is the evaluation of the health status by performing a physical exam after taking a health history. It is done to detect diseases early in people that may look and feel well.
Evidence does not support routine health assessments in otherwise healthy people.
Health assessment is the evaluation of the health status of an individual along the health continuum. The purpose of the assessment is to establish where on the health continuum the individual is because this guides how to approach and treat the individual. The health care approaches range from preventive, to treatment, to palliative care in relation to the individual's status on the health continuum. It is not the treatment or treatment plan. The plan related to findings is a care plan which is preceded by the specialty such as medical, physical therapy, nursing, etc.
Corporate health assessments
Research by Data Bridge Market Research shows that the market for corporate health assessments which was USD 2,91,272.4 million in 2023, is likely to reach USD 8,23,374.65million by 2031 and is expected to undergo a CAGR of 12.5% during the forecast period.
Healthcare providers such as Bupa and Nuffield now routinely offer health assessments to individuals and corporate clients, building on the growing market for these services.
Definitions of health assessment are varied, with some using the term health assessment and health checks interchangeably.
UK healthcare provider Verve Healthcare makes a clear difference:
A staff health check is a routine examination conducted by a health professional to assess an individual's overall health status. The primary aim is to identify health issues early, to monitor ongoing health conditions and to monitor future health risks.
Health assessments are more detailed than regular health checks. They provide a holistic view of an individual's health and can identify underlying health conditions.
History
Health assessment has been separated by authors from physical assessment to include the focus on health occurring on a continuum as a fundamental teaching. In the healthcare industry it is understood health occurs on a continuum, so the term used is assessment but may be preference by the speciality's focus such as nursing, physical therapy, etc. In healthcare, the assessment's focus is biopsychosocial but the intensity of focus may vary by the type of healthcare practitioner. For example, in the emergency room the focus is chief complaint and how to help that person related to the perceived problem. If the problem is a heart attack then the intensity of focus is on the biological/physical problem initially.
See also
Nursing assessment
References
Diagnosis codes
Medical terminology | 0.76071 | 0.978798 | 0.744581 |
Neuropsychological assessment | The attempts to derive the links between the damage to specific brain areas and problems in behaviour are known throughout the history for 3 millennia. However, the first systematic neuropsychological assessment and a battery of the behavioural tasks to investigate specific aspects of behavioural regulation was developed by Alexander Luria in 1942-1948. Luria was working with big samples of brain-injured Russian soldiers during and after the second World War. Among many insights from Luria's rehabilitation practice and observations, was the fundamental discovery of the involvement of frontal lobes of the cortex in plasticity, initiation, planning and organization of behaviour. His Go/no-go task, which was one of the tasks screening for the frontal lobe damage, "count by 7", hands-clutching, clock-drawing task, drawing of repeatitive patterns, word associations and categories recall and others became standard components of neuropsychological assessment and mental status screening. Considering the originality and multiplicity of neuropsychological components offered by Alexander Luria, he is recognized as a father of neuropsychological assessment.
Alexander Luria's neuropsychological battery was adapted in the United States in the form of Luria-Nebraska neuropsychological battery in 1970s. Then the tasks used in this battery were borrowed in more modern neuropsychological batteries and in the Mini–mental state examination test for screening of demenia.
History
Neuropsychological assessment was traditionally carried out to assess the extent of impairment to a particular skill and to attempt to determine the area of the brain which may have been damaged following brain injury or neurological illness. With the advent of neuroimaging techniques, location of space-occupying lesions can now be more accurately determined through this method, so the focus has now moved on to the assessment of cognition and behaviour, including examining the effects of any brain injury or neuropathological process that a person may have experienced.
A core part of neuropsychological assessment is the administration of neuropsychological tests for the formal assessment of cognitive function, though neuropsychological testing is more than the administration and scoring of tests and screening tools. It is essential that neuropsychological assessment also include an evaluation of the person's mental status. This is especially true in assessment of Alzheimer's disease and other forms of dementia. Aspects of cognitive functioning that are assessed typically include orientation, new-learning/memory, intelligence, language, visuoperception, and executive function. However, clinical neuropsychological assessment is more than this and also focuses on a person's psychological, personal, interpersonal and wider contextual circumstances.
Assessment may be carried out for a variety of reasons, such as:
Clinical evaluation, to understand the pattern of cognitive strengths as well as any difficulties a person may have, and to aid decision making for use in a medical or rehabilitation environment.
Scientific investigation, to examine a hypothesis about the structure and function of cognition to be tested, or to provide information that allows experimental testing to be seen in context of a wider cognitive profile.
Medico-legal assessment, to be used in a court of law as evidence in a legal claim or criminal investigation.
Miller outlined three broad goals of neuropsychological assessment. Firstly, diagnosis, to determine the nature of the underlying problem. Secondly, to understand the nature of any brain injury or resulting cognitive problem (see neurocognitive deficit) and its impact on the individual, as a means of devising a rehabilitation programme or offering advice as to an individual's ability to carry out certain tasks (for example, fitness to drive, or returning to work). And lastly, assessments may be undertaken to measure change in functioning over time, such as to determine the consequences of a surgical procedure or the impact of a rehabilitation programme over time.
Diagnosis of a neuropsychological disorder
Certain types of damage to the brain will cause behavioral and cognitive difficulties. Psychologists can start screening for these problems by using either one of the following techniques or all of these combined:
History taking
This includes gathering medical history of the patient and their family, presence or absence of developmental milestones, psychosocial history, and character, severity, and progress of any history of complaints. The psychologist can then gauge how to treat the patient and determine if there are any historical determinants for his or her behavior.
Interviewing
Psychologists use structured interviews in order to determine what kind of neurological problem the patient might be experiencing. There are a number of specific interviews, including the Short Portable Mental Status Questionnaire, Neuropsychological Impairment Scale, Patient's Assessment of Own Functioning, and Structured Interview for the Diagnosis of Dementia.
Test-taking
Scores on standardized tests of adequate predictive validity predictor well current and/or future problems. Standardized tests allow psychologists to compare a person's results with other people's because it has the same components and is given in the same way. It is therefore representative of the person's's behavior and cognition. The results of a standardized test are only part of the jigsaw. Further, multidisciplinary investigations (e.g. neuroimaging, neurological) are typically needed to officially diagnose a brain-injured patient.
Intelligence testing
Testing one's intelligence can also give a clue to whether there is a problem in the brain-behavior connection. The Wechsler Scales are the tests most often used to determine level of intelligence. The variety of scales available, the nature of the tasks, as well as a wide gap in verbal and performance scores can give clues to whether there is a learning disability or damage to a certain area of the brain.
Testing other areas
Other areas are also tested when a patient goes through neuropsychological assessment. These can include sensory perception, motor functions, attention, memory, auditory and visual processing, language, problem solving, planning, organization, speed of processing, and many others. Neuropsychological assessment can test many areas of cognitive and executive functioning to determine whether a patient's difficulty in function and behavior has a neuropsychological basis.
Information gathered from assessment
Tsatsanis and Volkmar believe that assessment can provide unique information about the type of disorder a patient has which allows the psychologist to come up with a treatment plan. Neuropsychological assessment can clarify the nature of the disorder and determine the cognitive functioning associated with a disorder. Assessment can also allow the psychologist to understand the developmental progress of the disorder in order to predict future problems and come up with a successful treatment package. Different assessments can also determine if a patient will be at risk for a particular disorder. However, assessing a patient at one time is not enough to go ahead and continue treatment because of the changes in behavior that can occur frequently. A patient must be retested multiple times in order to make sure that the current treatment is still the right treatment. For neuropsychological assessments, researchers discover the different areas of the brain that is damaged based on the cognitive and behavioral aspects of the patient.
Benefits of assessment
The most beneficial factor of neuropsychological assessment provides an accurate diagnosis of the disorder for the patient when it is unclear to the psychologist what exactly the patient has. This allows for accurate treatment later on in the process because treatment is driven by the exact symptoms of the disorder and how a specific patient may react to different treatments. The assessment allows the psychologist and patient to understand the severity of the deficit and to allow better decision-making by both parties. It is also helpful in understanding deteriorating diseases because the patient can be assessed multiple times to see how the disorder is progressing.
One area where neuropsychological assessments can be beneficial is in forensic cases where the defendant's competency is being questioned due to possible brain injury or damage. A neuropsychological assessment may show brain damage when neuroimaging has failed. It can also determine whether the individual is faking a disorder (malingering) in order to attain a lesser sentence.
Most neuropsychological testing can be completed in 6 to 12 hours or less. This time, however, does not include the role of the psychologist interpreting the data, scoring the test, making formulations, and writing a formal report.
Qualifications for conducting assessments
Neuropsychological assessments are usually conducted by doctoral-level (Ph.D., Psy.D.) psychologists trained in neuropsychology, known as clinical neuropsychologists. The definition and scope of a clinical neuropsychologist is outlined in the widely accepted Houston Conference Guidelines. They will usually have postdoctoral training in neuropsychology, neuroanatomy, and brain function. Most will be licensed and practicing psychologists in their particular field. Recent developments in the field allow for highly trained individuals such as psychometrists to administer selected instruments, though determinations regarding testing results remain the responsibility of the doctor.
See also
, such as psychometrics
References
Further reading
This standard reference book includes entries by Kimford J. Meador, Ida Sue Baron, Steven J. Loring, Kerry deS. Hamsher, Nils R. Varney, Gregory P. Lee, Esther Strauss, and Tessa Hart.
This collection of articles for practitioners includes chapters by Linda A. Reddy, Adam S. Weissman, James B. Hale, Allison Waters, Lara J. Farrell, Elizabeth Schilpzand, Susanna W. Chang, Joseph O'Neill, David Rosenberg, Steven G. Feifer, Gurmal Rattan, Patricia D. Walshaw, Carrie E. Bearden, Carmen Lukie, Andrea N. Schneider, Richard Gallagher, Jennifer L. Rosenblatt, Jean Séguin, Mathieu Pilon, Matthew W. Specht, Susanna W. Chang, Kathleen Armstrong, Jason Hangauer, Heather Agazzi, Justin J. Boseck, Elizabeth L. Roberds, Andrew S. Davis, Joanna Thome, Tina Drossos, Scott J. Hunter, Erin L. Steck-Silvestri, LeAdelle Phelps, William S. MacAllister, Jonelle Ensign, Emilie Crevier-Quintin, Leonard F. Koziol, and Deborah E. Budding.
External links | 0.765877 | 0.972098 | 0.744508 |
LSA | LSA or Lsa is an acronym standing for:
Education and academia
Licence of the Society of Apothecaries
Light: Science & Applications, a scientific journal
Student Union of Latvia
Institutions
University of Michigan College of Literature, Science, and the Arts
University of Liverpool School of Architecture, England, UK
La Salle Academy, a Catholic, all-boys high school in New York
Lakshmipat Singhania Academy, a non-profit school group in India
Military
Light Small Arms
Logistics Support Analysis, a military support planning methodology
Logistics Support Area, a large military depot
London Small Arms Co. Ltd, an English gun-making firm between 1866 and 1935
Lubricant, Semi-fluid, Automatic Weapons, MIL-L-46000
Organizations
Law and Society Association
Law Society of Alberta
League for Socialist Action, a Canadian political group active in the 1960s and 70s
Learn and Serve America, a U.S. government community service program
Licentiate of the Society of Apothecaries
Linguistic Society of America
Lithuanian Space Association, Lithuania's space agency
Luxembourg Space Agency, national space agency of the Grand-Duchy of Luxembourg
Local Spiritual Assembly, an administrative body of the Bahá'í Faith
Lone Scouts of America, an independent Scouting organization that merged into the Boy Scouts of America
Lone Star Alliance, lacrosse-only athletic conference
Lutheran Services in America, the largest network of human service organizations in the United States
Student Union of Latvia (Latvijas Studentu apvienība)
Places
London Stansted Airport
Lytham St. Annes, seaside town in Lancashire, England
LSA, IATA airport code of Losuia Airport in Papua New Guinea
Science and technology
Late Stone Age
Least squares adjustment
Anterolateral central arteries of the brain
Lichen sclerosus et atrophicus, a skin disease
Light-sport aircraft
Lobe Separation Angle, see cam
Lsa, the abbreviation for the orchid genus Luisia
Lysergic acid amide (ergine), a compound closely related to LSD
Lötfrei, schraubfrei, abisolierfrei, an insulation-displacement connector for telecommunications
Liver stage antigen, a set of peptides
Low specific activity, radioactive substances produced by oil and gas production installations. Also referred to as NORM, naturally occurring radioactive material
Computing
Latent semantic analysis, a technique in natural language processing
Link-state advertisement, communication mechanism of the OSPF routing protocol for IP
Local Security Authority Subsystem Service (Local Security Authority), the centre of the Windows NT security subsystem (lsass.exe)
License and Services Agreement
Other uses
Lighting & Sound America, an entertainment technology magazine published by PLASA Media Inc
Linseed Sunflower Almond, a health food that is a ground mixture of these three seeds.
Limited symptom attack, a milder form of panic attack, with fewer than four panic-related symptoms
Life-saving appliance, the multitude of devices designed for saving lifes typically found on a ship. Ranging from e.g. rescue boat to SART
See also
ISA (disambiguation)
1 SA Infantry Battalion (1st South African)
1Sa. (First Samuel) | 0.760942 | 0.978182 | 0.744339 |
Mental Illness Awareness Week | Mental Illness Awareness Week (MIAW) was established in the U.S. in 1990 recognition of efforts by the National Alliance on Mental Illness (NAMI) to educate and increase awareness about mental illness. It takes place every year during the first full week of October. During this week, mental health advocates and organizations across the U.S. join to sponsor events to promote community outreach and public education concerning mental illnesses such as major depressive disorder, bipolar disorder, and schizophrenia. Examples of activities held during the week include art/music events, educational sessions provided by healthcare professionals and individuals with lived experience and/or familial lived experience, advertising campaigns, health fairs, prayer services, movie nights, candlelight vigils, and benefit runs.
As of 2017, over 46 million (almost 1 out of 5) U.S. adults live with a mental illness. 4.5% of U.S. adults (over 11 million) have a Serious Mental Illness (SMI). The numbers may be larger because stigma reduces reporting. 45 percent of these adults meet criteria for two or more disorders. These range from fairly common mood disorders to the much more serious anxiety and schizophrenia disorders. Among these, anxiety disorders were the most common, as some 40 million American adults ages 18 and older experience some form of anxiety disorder. Despite the large number of Americans affected by such disorders, stigma surrounding mental illness is a major barrier that prevents people from seeking the mental health treatment that they need. Programs during Mental Illness Awareness Week are designed to create community awareness and discussion in an effort to put an end to stigma and advocate for treatment and recovery.
MIAW coincides with similar organization campaigns in early October such as World Mental Health Day (World Federation for Mental Health), National Depression Screening Day (Screening for Mental Health), and National Day Without Stigma (Active Minds).
See also
Mental Health Awareness Month (US, May)
World Mental Health Day (October 10)
References
External links
National Alliance on Mental Illness (NAMI) website
National Institute of Mental Health (NIMH) website
Mental Illness Awareness Week website in Canada
Mental Health America (MHA) website
Mental health in the United States
October observances
Health observances
Disability observances
Awareness weeks in the United States | 0.774075 | 0.961579 | 0.744335 |
Kokology | Kokology is the study of kokoro (Japanese: 心) 'mind or spirit', introduced in the Kokology book series by Tadahiko Nagao and Isamu Saito, a professor at Rissho and Waseda Universities in Japan and an author of a number of bestselling books regarding psychology and relationships.
The main focus is the analysis of the deep psyche using theories from Freud and Jung. Kokology Questions typically are "guided" Day Dreams or Submodalities.
The books present a series of psychological and hypothetical questions that are designed to reveal one's hidden attitudes about sex, family, love, work, and other elements of one's life. It is essentially a game of self-discovery that can provide interesting, and often hilarious insight by answering questions to seemingly innocent topics. The books were published in 1998 in Japan and became a Japanese bestselling phenomenon. The books were translated and became available in the United States in 2000.
The television series ran on Saturdays it was only aired in one city broadcast time 22:00 to 22:54 (54 minutes)
Series Run: April 20, 1991, to March 21, 1992
Country: Japan Broadcasting
Broadcast: Yomiuri Television Production Department
Production: IVS TV Production
Cast/s: Yamaguti Mie, Inferior soul, Izumiya Shigeru, Miwa Akihiro More
Video games were released based on the show by Sega and Tecmo.
The Cube (game)
The Cube is a Kokology game about self knowledge and is played by asking a person to imagine and describe a set of three to five objects. The game is usually played by two people. One person is designated as the narrator, and the other is the interpreter. Usually these roles are swapped after successful interpretation.
The Cube is a way of judging somebody's personality by the way they narrate the following.
While there are slight variations of the game from person to person, the game begins by asking another person to imagine a desert (or room) scene. The game then follows by asking the person to place and describe a cube in the scene. Once the cube is completely described, the narrator of the game then asks for the player to describe a ladder that is also placed in the scene. This process continues with foliage and/or flowers, a horse, and finally, a storm.
Once the narrator has an understanding of the scene described, he or she may assist the player in interpreting the scene.
References
Culture of Japan | 0.765265 | 0.972621 | 0.744313 |
Adolescent medicine | Adolescent medicine, also known as adolescent and young adult medicine, is a medical subspecialty that focuses on care of patients who are in the adolescent period of development. This period begins at puberty and lasts until growth has stopped, at which time adulthood begins. Typically, patients in this age range will be in the last years of middle school up until college graduation (some doctors in this subspecialty treat young adults attending college at area clinics, in the subfield of college health). In developed nations, the psychosocial period of adolescence is extended both by an earlier start, as the onset of puberty begins earlier, and a later end, as patients require more years of education or training before they reach economic independence from their parents.
Medicine is often categorized most simply as pediatric and adult, with the pediatric category covering from infancy through both childhood and adolescence. However, such categorization is further divided in some contexts, such that adolescent medicine can be a more specific focus within pediatrics and geriatrics can be a more specific focus within adult medicine.
Issues with a high prevalence during adolescence are frequently addressed by providers. These include:
Sexually transmitted disease (working with specialists in pediatric endocrinology, adolescent obstetrics and gynecology, immunology infectious diseases, and urology and reproductive medicine)
Unintended pregnancy (working with specialists in adolescent obstetrics and gynecology, especially in neonatology and maternal-fetal medicine; many – though not all – are medically risky or high-risk cases or to those with psychosocial, environmental, and socioeconomic challenges)
Birth control (access to prescription or non-prescription contraceptive methods)
Sexual activity (such as masturbation, sexual intercourse and sexual abuse)
Substance abuse
Menstrual disorders (such as amenorrhea, dysmenorrhea and dysfunctional uterine bleeding)
Acne (working with specialists in dermatology who treat adolescents)
Eating disorders like anorexia nervosa and bulimia nervosa (working with nutritionists and dieticians, and also specialists in pediatric mental health counseling, clinical psychology, and pediatric psychiatry, who work with adolescents)
Certain mental illnesses (especially personality disorders, anxiety disorders, major depression and suicide, bipolar disorder, and certain types of schizophrenia; in concert with mental health counselors, clinical psychologists, and pediatric psychiatrists specializing in adolescent health care)
Delayed or precocious puberty (often working with specialists in adolescent pediatric endocrinology, urology, and andrology)
Gay, lesbian and bisexual young people
Adolescents who are gay, lesbian or bisexual tend to demonstrate more risky health behaviors and have worse health outcomes compared to heterosexual youth, including:
Substance abuse
Suicidality
Eating disorders and body image
Sexual behaviors, including unintended pregnancy involvement (Contrary to assumptions, gay, bisexual or lesbian youth are more likely to report involvement in pregnancy compared to their heterosexual peers)
Homelessness, which affects health and access to care
Chronic conditions
Chronic conditions often cause delay in onset of puberty and temporary or permanent impediments to growth; conversely the growth and hormonal changes can destabilize treatment for the chronic condition. An increase in independence can lead to gaps in self-management, for example, in the decreased management of diabetes.
Young peoples' access to health care
In addition, issues of medical ethics, particularly related to confidentiality and the right to consent for medical care, are pertinent to the practice of adolescent medicine.
Marginalised young people’s access is affected by their ability to recognize and understand health issues; service knowledge and attitudes toward help seeking; structural barriers; professionals' knowledge, skills, attitudes; service environments and structures; ability to navigate the health system; youth participation; and technology opportunities. Marginalised young people’s healthcare journeys can be supported by advocates that help them navigate the health system.
The particular needs of young people when accessing healthcare have also led the WHO to publishing guidelines for adolescent-friendly health care, in an effort to increase adolescents utilization of the healthcare system.
Training
Adolescent medicine providers are generally drawn from the specialties of pediatrics, internal medicine, med/peds or family medicine. The certifying boards for these different specialties have varying requirements for certification, though all require successful completion of a fellowship and a passing score on a certifying exam. The American Board of Pediatrics and the American Board of Internal Medicine require evidence of scholarly achievement by candidates for subspecialty certification, usually in the form of an original research study.
In the United States, subspecialty medical board certification in adolescent medicine is available through the specialty boards of American Board of Internal Medicine, the American Osteopathic Board of Neurology and Psychiatry, the American Board of Family Medicine, the American Osteopathic Board of Family Physicians, the American Board of Pediatrics, and the American Osteopathic Board of Pediatrics.
List of adolescent health centers in the United States
San Antonio, Texas
Adolescent and Young Adult Medicine Clinic at Fort Sam Houston
Dallas, Texas
Adolescent and Young Adult Clinic at Children's Medical Center (Dallas)
Windhaven Adolescent Medicine Clinic at Texas Health Presbyterian Hospital (Plano)
Girls to Women Health and Wellness (North Dallas)
Young Men's Health and Wellness (North Dallas)
U.S. Air Force Academy, Colorado Spring, Colorado
Cadet Medicine Clinic at U.S. Air Force Academy
Kansas City, Missouri
Adolescent Clinic at Children's Mercy Hospital (Kansas City, Missouri)
Indianapolis, Indiana
Section of Adolescent Medicine, Department of Pediatrics, Indiana University School of Medicine
New York City, New York
The Adolescent Health Center at Mount Sinai Medical Center (Manhattan)
Adolescent clinic at Children's Hospital at Montefiore Medical Center (the Bronx)
The Door - Adolescent Health Center (Manhattan) www.door.org
Dayton, Ohio
Division of Adolescent Young Adult Medicine at Dayton Children’s Hospital
Rochester, New York
The Adolescent Health Clinic at University of Rochester
Los Angeles, California
Teenage and Young Adult Health Center at Children's Hospital Los Angeles
San Francisco area
Adolescent Medicine Clinic at Lucile Packard Children's Hospital at Stanford
Adolescent Medicine Clinic at UCSF
Massachusetts
Adolescent Center Boston Medical Center
Cambridge Rindge & Latin High School Teen Health Center
CHA Cambridge Teen Health Center
Center for Adolescent & Young Adult Health, Milford
Division of Adolescent Medicine at Children's Hospital Boston
Everett Teen Health
Somerville High School Somerville Teen Connection
Teen Health Center in Boston Tufts Children's Hospital
Philadelphia, Pennsylvania
Adolescent Medicine at Children's Hospital of Philadelphia
Adolescent Medicine at St. Christopher's Hospital for Children
Teen Health Center at Temple University Children's Medical Center
Teen Health Center at Albert Einstein Medical Center
Columbus, Ohio
Adolescent Health at Nationwide Children's Hospital
Seattle, Washington
Department of Adolescent Medicine at Seattle Children's Hospital
Cincinnati, Ohio
Division of Adolescent Medicine at Cincinnati Children's Hospital Medical Center
Richmond, Virginia
Adolescent Medicine at Children's Hospital of Richmond
Fayetteville, North Carolina
Adolescent Medicine at Womac Army Medical Center
List of adolescent health centers in Australia
Sydney
The Department of Adolescent Medicine at The Children's Hospital at Westmead
The Department of Adolescent Medicine at Westmead Hospital
Youth Consultancy & the Chill, at Royal Prince Alfred Hospital
Melbourne
The Centre For Adolescent Health Royal Children's Hospital Melbourne
Relationship with college health
In the United States, the subspecialty of college health is closely affiliated with adolescent medicine. Many adolescent medicine fellowships include rotations in college-based student health clinics and many adolescent medicine physicians work in college health clinics.
Professional organizations
Founded in 1987, the International Association for Adolescent Health (IAAH) is a multidisciplinary, non-government organization with a broad focus on youth health.
Publications
Journal of Adolescent Health (published by Elsevier on behalf of the Society for Adolescent Health and Medicine)
Journal of Pediatric and Adolescent Gynecology (published by the North American Society for Pediatric and Adolescent Gynecology)
Adolescent Medicine: State of the Art Reviews (published by the American Academy of Pediatrics)
See also
Adolescent and young adult oncology
Adolescent Health
Adolescent sexuality
Teen pregnancy
Youth Health
References
Further reading
External links
Office of Adolescent, U.S. Department of Health, Health and Human Services
Adolescent Medicine: State of the Art Reviews
The Society for Adolescent Health and Medicine
International Association for Adolescent Health
The North American Society for Pediatric and Adolescent Gynecology
The American Board of Pediatrics
The American Board of Internal Medicine
The American Board of Family Medicine
The American College Health Association
Teens Homepage, Nemours Foundation
Pediatrics
Adolescent medicine | 0.763492 | 0.974816 | 0.744264 |
Situationism (psychology) | Under the controversy of person–situation debate, situationism is the theory that changes in human behavior are factors of the situation rather than the traits a person possesses. Behavior is believed to be influenced by external, situational factors rather than internal traits or motivations. Situationism therefore challenges the positions of trait theorists, such as Hans Eysenck or Raymond B. Cattell. This is an ongoing debate that has truth to both sides; psychologists are able to prove each of the view points through human experimentation.
History and conceptions
Situationists believe that thoughts, feelings, dispositions, and past experiences and behaviors do not determine what someone will do in a given situation, rather, the situation itself does.
Situationists tend to assume that character traits are distinctive, meaning that they do not completely disregard the idea of traits, but suggest that situations have a greater impact on behavior than those traits. Situationism is also influenced by culture, in that the extent to which people believe that situations impact behaviors varies between cultures. Situationism has been perceived as arising in response to trait theories, and correcting the notion that everything we do is because of our traits. However, situationism has also been criticized for ignoring individuals' inherent influences on behavior. There are many experiments and evidence supporting this topic, and shown in the sources below but also in the article itself. But these experiments do not test what people would do in situations that are forced or rushed, most mistakes are made from rushing and or forgetting something due to lack of concentration. Situationism can be looked at in many different ways, this means that situationism needs to be tested and experimented in many different ways.
Experimental evidence
Evidence for
Many studies have found series of evidence supporting situationism. One notable situationist study is [Philip Zimbardo|Zimbardo]'s [Stanford prison experiment]. This study was considered one of the most unethical because the participants were deceived and were physically and psychologically abused. The goal of the study was that Zimbardo wanted to discover two things. If prison guards abused prisoners because of their nature, or because of the power and authority they were given in the situation. They also wanted to figure out if prisoners acted violent and savage because of their nature or because of being in a secluded and violent environment. To carry out this experiment, Zimbardo gathered 24 college men and paid them 15 dollars each an hour to live two weeks in a mock prison. The participants were told that they were chosen to be guard or prisoner because of their personality traits, but they were randomly selected. The prisoners were booked and given prison clothes and no possessions. They were also assigned a number to be referred to with the intent of farther dehumanizing them. Within the first night, the prisoner and guard dynamics began to take place. The guards started waking up the prisoners in the middle of the night for count, and they would yell and ridicule them. The prisoners also started developing hostile traits against the guards and having prison related conversations. By the second day, the guards started abusing the prisoners by forcing them to do push ups, and the prisoners started rebelling by removing their caps and numbers, and hiding in their cells with their mattresses blocking the door. As the days passed the relationship between the guards and prisoners became extremely hostile- the prisoners fought for their independence, and the guards fought to strip them of it.
There were many cases where the prisoners began breaking down psychologically, and it all started with prisoner 8612. After one day after the experiment started, prisoner number 8612 has anxiety attacks and asked to leave. He was then told "You can't leave. You can't quit.” He then went back to the prison and “began to act ‘crazy,’ to scream, to curse, to go into a rage that seemed out of control.” After this, he was sent home. The other prisoner that broke down was 819. 819 had broken down and was told to rest in a room. When Dr.Zimbardo went to check on him he said " what I found was a boy crying hysterically while in the background his fellow prisoners were yelling and chanting that he was a bad prisoner, that they were being punished because of him." Zimbardo then allowed him to leave but he said he couldn't because he was labeled as a bad prisoner, to which Zimbardo responded "Listen, you are not 819. My name is Dr. Zimbardo, I am a psychologist, and this is not a prison. This is just an experiment and those are students, just like you. Let's go." He stopped crying suddenly and looked up at me just like a small child awakened from a nightmare and said, "OK, let's go."
The guards also began to have extremely abusive relations with the prisoners. Zimbardo claimed there were three types of guards. The first were the guards that followed all the rules but got the job done, the second felt bad for the prisoners, and the third were extremely hostile and treated them like animals. This last type showed behaviors of actual guards and seemed to have forgotten they were college students, they got into their roles faster, and seemed to enjoy tormenting the prisoners. On Thursday night, 6 days into the experiment, Zimbardo described the guards as having "sadistic" behavior, and then decided to close down the study early.
This study showed how regular people can completely disassociate with who they are when their environment changes. Regular college boys turned into broken down prisoners and sadistic guards.
Studies investigating bystander effects also support situationism. For example, in 1973, Darley and Batson conducted a study where they asked students at a seminary school to give a presentation in a separate building. They gave each individual participant a topic, and would then tell a participant that they were supposed to be there immediately, or in a few minutes, and sent them on their way to the building. On the way, each participant encountered a confederate who was on the ground, clearly in need of medical attention. Darley and Batson observed that more participants who had extra time stopped to help the confederate than those who were in a hurry. Helping was not predicted by religious personality measures, and the results therefore indicate that the situation influenced their behavior.
A third well-known study supporting situationism is an obedience study, the Milgram experiment. Stanley Milgram made his obedience study to explain the obedience phenomenon, specifically the holocaust. He wanted to explain how people follow orders, and how people are likely to do unmoral things when ordered to by people of authority. The way the experiment was devised was that Milgram picked 40 men from a newspaper add to take part in a study at Yale University. The men were between 20 and 50 years old, and were paid $4.50 for showing up. In this study, a participant was assigned to be a "teacher" and a confederate was assigned to be a "learner". The teachers were told the learners had to memorize word pairs, and every time they got it wrong they were shocked with increasing voltages. The voltages ranged from 15 to 450, and in order for the participants to believe the shock was real, the experimenters administered to them a real 45v shock, The participant was unaware that the learner was a confederate. The participant would test the learner, and for each incorrect answer the learner gave, the participant would have to shock the learner with increasing voltages. The shocks were not actually administered, but the participant believed they were. When the shocks reached 300v, the learner began to protest and show discomfort. Milgram expected participants to stop the procedure, but 65% of them continued to completion, administering shocks that could have been fatal, even if they were uncomfortable or upset. Even though most of the participants continued administering the shocks, they had distressed reactions when administering the shocks, such as laughing hysterically. Participants felt compelled to listen to the experimenter, who was the authority figure present in the room and continued to encourage the participant throughout the study. Out of 40 participants, 26 went all the way to the end.
Evidence against
Personality traits have a very weak relationship to behavior. In contrast, situational factors usually have a stronger impact on behavior; this is the core evidence for situationism. In addition, people are also able to describe character traits of close to such as friends and family, which goes to show that there are opposing reasons showing why people can recall these traits.
In addition, there are other studies that show these same trends. For example, twin studies have shown that identical twins share more traits than fraternal twins. This also implies that there is a genetic basis for behavior, which directly contradicts situationist views that behavior is determined by the situation. When observing one instance of extroverted or honest behavior, it shows how in different situations a person would behave in a similarly honest or extroverted way. It shows that when many people are observed in a range of situations the trait-related reactions to behavior is about .20 or less. People think the correlation is around .80. This shows that the situation itself is more dependent on characteristics and circumstances in contrast to what is taking place at that point in time.
These recent challenges to the Traditional View have not gone unnoticed. Some have attempted to modify the Traditional View to insulate it from these challenges, while others have tried to show how these challenges fail to undermine the Traditional View at all. For example, Dana Nelkin (2005), Christian Miller (2003), Gopal Sreenivasan (2002), and John Sabini and Maury Silver (2005), among others, have argued that the empirical evidence cited by the Situationists does not show that individuals lack robust character traits.
Current views: interactionism
In addition to the debate between trait influences and situational influences on behavior, a psychological model of "interactionism" exists, which is a view that both internal dispositions and external situational factors affect a person's behavior in a given situation. This model emphasizes both sides of the person-situation debate, and says that internal and external factors interact with each other to produce a behavior. Interactionism is currently an accepted personality theory, and there has been sufficient empirical evidence to support interactionism. However, it is also important to note that both situationists and trait theorists contributed to explaining facets of human behavior.
See also
Trait activation theory
Philip Zimbardo
Notes
Further reading
Krahe, B. (1993) Personality and Social Psychology: Towards a Synthesis. London: Sage.
Personality theories | 0.760856 | 0.978128 | 0.744214 |
Positive psychotherapy | Positive psychotherapy (PPT after Peseschkian, since 1977) is a psychotherapeutic method developed by psychiatrist and psychotherapist Nossrat Peseschkian and his co-workers in Germany beginning in 1968. PPT is a form of humanistic psychodynamic psychotherapy and based on a positive conception of human nature. It is an integrative method that includes humanistic, systemic, psychodynamic, and cognitive-behavioral elements. As of 2024, there are centers and training available in twenty countries. It should not be confused with positive psychology.
Description
Positive psychotherapy (PPT) is a therapeutic approach developed by Nossrat Peseschkian during the 1970s and 1980s. Initially known as "differentiational analysis", it was later renamed as positive psychotherapy when Peseschkian published his work in 1977, which was subsequently translated into English in 1987. The term "positive" or "positivus" (from Latin) in PPT refers to the actual, real, and concrete aspects of human experiences.
The primary objective of positive psychotherapy and its practitioners is to assist patients and clients in recognizing and cultivating their abilities, strengths, resources, and potentials. This approach combines elements from various modalities of psychotherapy, including
a humanistic perspective on human nature and therapeutic alliance,
a psychodynamic understanding of mental and psychosomatic disorders,
a systemic approach that considers family, culture, work, and environment, as well as a practical, self-help, and
a goal-oriented five-step therapy process that integrates techniques from different therapeutic methods.
PPT is characterized by its conflict-centered and resource-oriented approach, which draws influence from transcultural observations across more than twenty diverse cultures. Positioned between manualized cognitive behavioral therapy and process-oriented analytical psychotherapy, PPT employs a semi-structured approach to diagnostics, treatment, post-therapeutic self-help, and training.
About the founder
Nossrat Peseschkian, the founder of positive psychotherapy, was a German psychiatrist, neurologist, psychotherapist, and specialist in psychosomatic medicine of Iranian descent. During the late 1960s and early 1970s, he drew inspiration from various sources:
The prevailing spirit of that era which gave rise to humanistic psychology and its subsequent advancements.
Personal interactions with notable and influential psychotherapists and psychiatrists like Viktor Frankl, Jacob L. Moreno, and Heinrich Meng, among others.
The humanistic and integrative principles and values of the Baháʼí Faith.
The pursuit of an integrative approach, particularly due to the negative experiences of conflicts between psychoanalysts and behavior therapists in Germany during that time.
Extensive transcultural observations driven by a quest for a culturally sensitive methodology.
Peseschkian is tied to the development of the approach as his life history and personality heavily influenced its creation. Peseschkian was described by his biographer as a "wanderer between two worlds"; his biography was subtitled The East and the West.
According to Peseschkian, the development of positive psychotherapy was motivated by his experience as an Iranian living in Europe beginning in 1954. It made him acutely aware of the differences in behavior, customs, and attitudes between cultures. This awareness began in childhood as he observed how his religious customs differed from those of his Muslim, Christian, and Jewish classmates and teachers. His experiences led him to reflect on the relationships between different religions and people, and to gain an understanding of attitudes as coming from worldviews and family concepts. During his specialty training, Peseschkian witnessed confrontations between different psychiatric, neurological, and psychotherapeutic methods—experiences that taught him the importance of discarding prejudices.
Positive psychotherapy can be traced back to the foundations of humanistic psychology and psychotherapy that were established by Kurt Goldstein, Abraham Maslow, and Carl Rogers. The strong influence of psychoanalysis and its subsequent developments, including Neo-Freudian, psychosomatic, and focus-oriented approaches like Balint's, also shaped Peseschkian's perspective. In response to these divisions, he aspired to construct a metatheory that could bridge the gaps between them.
Simultaneously, certain principles of the Bahá'í Faith fascinated and inspired Peseschkian throughout his life. These principles encompassed the harmony between science and religion, the Bahá'í concept of the human being as a "mine rich in gems of inestimable value," and the vision of a global society embracing cultural diversity. These principles played a significant role in shaping his work and philosophical outlook.
The advancement of positive psychotherapy can be attributed to several factors that have contributed to its development over time. These factors include insights gained from ongoing medical education, experiences acquired through working with patients in psychotherapeutic and psychosomatic practices, interactions with individuals from diverse cultures, religions, and value systems, as well as the diverse and varied nature of psychotherapy methods. These cumulative experiences culminated in the creation of "Differentiational Analysis" in 1969, which subsequently underwent refinement and emerged as positive psychotherapy in 1977. The titles of early books authored by Peseschkian, such as Psychotherapy of Everyday Life (1974) and "In Search of Meaning" (1983), reflect the influence of psychoanalysis and existential schools of psychotherapy on the development of positive psychotherapy. Additionally, the title Positive Family Therapy (1980) underscores its parallel growth with systemic family therapy during the 1970s. In total, Peseschkian authored 29 books and numerous articles on this approach, contributing to its extensive literature and dissemination.
Development and history
1970–1980s
The 1970s marked an important period in the development and acceptance of positive psychotherapy as we know it today. It served as a turning point when PPT gained wider recognition within the field of psychotherapy. During this time, the foundational principles of PPT began to take shape and were implemented in the treatment of numerous patients and their families. These principles were also subjected to testing and were presented at international lectures, both within and outside of Germany. In this significant era, four out of the five fundamental books of PPT were published. These books include Psychotherapy of Everyday Life (originally published as Schatten auf der Sonnenuhr in 1974), Positive Psychotherapy (originally published in German in 1977), Oriental Stories in Positive Psychotherapy (originally published in German in 1979), and Positive Family Therapy (originally published in German in 1980). Moreover, the 1970s witnessed the establishment of the first postgraduate trainings in PPT, with the creation of a training organization in 1974, which later became the forerunner of the Wiesbaden Academy for Psychotherapy (WIAP). The Medical Chamber of Hesse recognized this training organization in 1979 for psychotherapy residency training. Additionally, the German Association for Positive Psychotherapy was founded in 1977, becoming the world's first national association of positive psychotherapy.
Throughout the 1980s, PPT experienced ongoing development, leading to the release of additional books, such as In Search of Meaning (originally published in German in 1983 and later translated into English in 1985). Collaborative efforts with young colleagues further contributed to the systematization of the PPT method. A significant milestone during this time was the completion of Hamid Peseschkian's dissertation in 1988, which marked the first dissertation focused exclusively on PPT. Within this dissertation, an important advancement was made in the structuring of the first interview in PPT. A questionnaire specifically designed for this initial interview was introduced and subsequently subjected to a psychodynamic study. In 1988, this questionnaire for the first interview, along with the WIPPF (questionnaire in PPT), was published with minor modifications. This precursor to the later semi-structured psychodynamic first interview was one of the early examples within the field of psychodynamic psychotherapy.
In the 1980s, Peseschkian traveled extensively to deliver PPT seminars in developing countries in Asia and Latin America. Important PPT works were translated into English during this time. Peseschkian also conducted seminars in management training and coaching, generating interest in applying PPT in these fields.
1990–2010
During this period, Peseschkian published his final fundamental work, Psychosomatics and Positive Psychotherapy in 1991 (German version) and later translated into English in 2013. This book introduced a structured and psychodynamic approach to treating various psychological and physical disorders.
The political changes in Central and Eastern Europe during the 1990s greatly accelerated the international expansion of PPT, which had already begun in the 1980s. PPT encountered significant interest in these cultures, which held a unique psychological position between Eastern and Western cultures. Eastern European colleagues, known for their organized working methods and thirst for knowledge, played a crucial role in systematizing PPT seminars outside of Germany. By 1990, over 30 centers were established worldwide, starting with the first one in Kazan, Russia. The first national associations for positive psychotherapy were formed in Bulgaria (1993), Romania (2004), and Russia. PPT's internationalization continued with the legal registration of the International Center for Positive Psychotherapy in 1996 as a NGO in Germany, which later evolved into the World Association for Positive and Transcultural Psychotherapy (WAPP). These developments coincided with the creation of the European Association of Psychotherapy (EAP) in Vienna in 1990, which set professional and legal standards for psychotherapy. Representatives of positive psychotherapy have been actively involved in the EAP since its inception.
In German-speaking countries, a debate on the effectiveness of various psychotherapy methods was sparked by Klaus Grawe's publication in 1994 and the ensuing discussion surrounding psychotherapy laws. In response, Peseschkian and his colleagues conducted an extensive Effectiveness Study of Positive Psychotherapy, which received the Richard Merten Prize in 1997. This study provided empirical evidence of the practical effectiveness of PPT and aligned with the growing emphasis on evidence-based practices in psychotherapy.
In 1999, an international training curriculum for advanced studies in PPT was published, drawing from experiences across different countries. The year 2000 marked the inaugural of annual International Training for Trainers in positive psychotherapy.
The expansion of PPT was formalized within Germany, with the Wiesbaden Academy for Psychotherapy (WIAP) receiving governmental recognition for postgraduate residency education of psychologists in psychodynamic psychotherapy, and pedagogues and social workers in child and adolescent psychotherapy. The German law for psychotherapists of 1998, spurred further developments in the curriculum and systematization of both basic and advanced PPT training, extending its influence beyond Germany. Over the years, basic level seminars held in Eastern Europe led to the emergence of new concepts.
PPT transcended its original medical context and found application in various domains, including school and university education, management training, and coaching. The first world congress of PPT was organized in 1997 in St. Petersburg, Russia, and since then every 3–4 years.
In 2005, the first graduate program offering a master's degree in PPT was completed at UTEPSA University in Santa Cruz, Bolivia.
The Prof.-Peseschkian Foundation, also known as the International Academy of Positive and Transcultural Psychotherapy (IAPP), was established in 2005 by Manije and Nossrat Peseschkian. It facilitates international initiatives and oversees the management of the International Archives of Positive Psychotherapy.
Since 2010
With the passing of Nossrat Peseschkian as the founder of PPT in 2010, the PPT community entered a new phase.
The World Association for Positive and Transcultural Psychotherapy (WAPP) is the global umbrella organization for positive psychotherapy. Established in 1996 as the International Center for Positive Psychotherapy, WAPP comprises individual members, national associations, training institutes, centers, and representative offices at national and regional levels. Its primary objective is to provide support to its members and individuals interested in studying, practicing, and promoting Positive Psychotherapy. WAPP is registered as a non-profit organization in Wiesbaden, Germany and in 2023 boasts over 2,200 individual members across 50 countries.
Positive psychotherapy is an officially recognized modality by the European Association for Psychotherapy (EAP). The European Federation of Centers for Positive Psychotherapy (EFCPP) is an organization that operates across Europe, serving as a European Wide Organization (EWO), European Wide Accrediting Organization (EWAO), and a European Accredited Psychotherapy Training Institute (EAPTI) through the IAPP-Academy, affiliated with EAP. Aspiring psychotherapists can obtain the European Certificate of Psychotherapy (ECP) in Positive Psychotherapy by undergoing training with EFCPP.
Positive psychotherapy is a registered trademark in the United States of America (the registration No. 6,082,225). In 2016, positive psychotherapy was officially registered in both the European Union and Switzerland.
As of 2023, national associations for PPT have been established in Bulgaria, Georgia, Germany, Romania, Kosovo, Ukraine, and Ethiopia. Furthermore, PPT is actively promoted through local or regional training centers in Armenia, Austria, Belarus, Bulgaria, China, Cyprus, Georgia, Germany, Kosovo, Latvia, North Macedonia, Poland, Romania, Russia, Turkey, Ukraine, and the United Kingdom. Seminars and lectures on PPT have reached more than 80 countries worldwide. Notably, PPT is now included in the curricula for psychology and psychotherapy programs at universities in Bulgaria, Russia, Ukraine, and Turkey.
Theory
Main characteristics
The foundations of PPT are rooted in scientific theories that can also be found in other therapies. However, Peseschkian's method combines elements of psychodynamic and humanistic psychotherapy theories and practices to create a transcultural psychotherapy approach. PPT also implements an integrative approach that considers the individual needs of the client, salutogenetic principles, family therapy, and self-help tools.
Main characteristics of the PPT method:
Integrative psychotherapy method
Humanistic psychodynamic method
Cohesive, integrated therapeutic system
Conflict-centered short-term method
Cultural-sensitive method
Use of stories, anecdotes, and wisdoms
Innovative interventions and techniques
Application in psychotherapy, other medical disciplines, counselling, education, prevention, management, and trainings.
Main principles
The three main principles or pillars of Positive Psychotherapy are:
The Principle of Hope
The Principle of Balance
The Principle of Consultation
The Principle of Hope suggests that therapists aim to help patients comprehend and perceive the meaning and purpose behind their disorder or conflict. Consequently, the disorder is reframed in a "positive" manner, leading to positive interpretations. Here are a few examples:
Sleep disturbance is viewed as the ability to remain alert and manage with limited sleep.
Depression is seen as the capacity to deeply experience and express emotions in response to conflicts.
Schizophrenia is considered as the ability to exist simultaneously in two worlds or a vivid fantasy realm.
By adopting this optimistic perspective, a shift in viewpoint becomes possible not only for the patient but also for their surroundings. Thus, illnesses serve a symbolic function that both the therapist and patient need to acknowledge. The patient learns that the symptoms and complaints of the illness act as signals to restore balance to the four dimensions of their life.
The Principle of Balance acknowledges that despite social and cultural variations, all individuals tend to rely on common coping mechanisms when dealing with their problems. Nossrat Peseschkian, in conjunction with the Balance Model of Positive Psychotherapy, has developed a dynamic and contemporary approach to conflict resolution across different cultures. This model highlights four fundamental aspects of life:
Body/Health – psychosomatic concerns.
Achievement/Work – factors contributing to stress.
Contact/Relationships – potential triggers for depression.
Future/Fantasy/Meaning of Life – fears and phobias.
While these four domains are inherent in all humans, Western societies tend to prioritize the areas of physical well-being and professional success, whereas the Eastern hemisphere places greater emphasis on interpersonal connections, imagination, and future aspirations (a transcultural aspect of Positive Psychotherapy). Insufficient contact and lack of imagination are known to contribute to various psychosomatic illnesses.
Each individual develops their own coping preferences when confronted with conflicts. However, when one particular mode of conflict resolution dominates, other modes may be overshadowed. The contents of conflicts, such as punctuality, orderliness, politeness, trust, time, and patience, are categorized as primary and secondary capacities, built upon the foundational capacities of love and knowledge. This can be seen as a content-based differentiation of Freud's classical model of the id, ego, and superego.
The Principle of Consultation introduces the concept of the five stages of therapy and self-help, which are closely intertwined in Positive Psychotherapy. In these stages, both the patient and their family are collectively informed about the illness and the individualized solution for it. The five stages are as follows:
Observation and Distancing: This stage involves perceiving and expressing desires and problems while maintaining a certain level of emotional detachment.
Taking Inventory: Cognitive capacities come into play as the patient reflects on significant life events that have occurred within the past 5 to 10 years.
Situational Encouragement: Self-help and activating internal resources become the focus at this stage. The patient is encouraged to draw upon past successes in resolving conflicts.
Verbalization: The communicative capacities of the patient are emphasized, enabling them to articulate and express outstanding conflicts and problems related to the four dimensions of life.
Expansion of Goals: This stage aims to foster a forward-looking orientation in life once the problems are resolved. The patient is prompted with questions like, "What would you like to do when all problems have been solved? What are your goals for the next five years?"
These five stages encompass a comprehensive approach to therapy and self-help, providing a framework for addressing the various aspects of an individual's well-being and promoting their personal growth and future aspirations.
Positive psychotherapy as a metatheory
Peseschkian's initial goal was twofold: firstly, to create a method that patients could easily understand and utilize, and secondly, to offer positive psychotherapy as a mediator between different psychotherapy schools. In his book Positive Psychotherapy (published in 1977 in German and 1987 in English), he devoted an entire chapter to this challenge, entitled "Positive Psychotherapy and Other Psychotherapies" (pages 365–400). Peseschkian regarded this chapter as the most challenging and labor-intensive one in the book. He emphasized that positive psychotherapy should not be perceived as just another method within the field of psychotherapy. Instead, it provides a comprehensive framework that enables the selection of appropriate methodological approaches for specific cases and facilitates the alternation between these methods. In essence, positive psychotherapy represents a metatheory of psychotherapy. It views psychotherapy not merely as a fixed method to address specific symptom profiles, but also as a response to the broader societal, transcultural, and social contexts in which it operates.
Also Peseschkian insisted that positive psychotherapy should not be seen as a closed and exclusive system; instead, it assigns significance to different psychotherapeutic methods. It embraces various approaches such as psychoanalytic, psychodynamic, behavior therapy, group therapy, hypnotherapy, medication-based treatment, and physical therapy. Positive psychotherapy can be considered an integrative method that incorporates multiple dimensions of therapy.
It took almost two decades before Klaus Grawe and his colleagues in Switzerland published a meta-analysis on the effectiveness of various psychotherapy approaches and proposed a general method that transcended traditional schools of psychotherapy. In the United States, Jerome Frank published a scheme for integrated psychotherapy, but this plan was also met with controversy and was not accepted. The movements for eclectic and integrative psychotherapy, which have found increasing acceptance since that time, have nonetheless skirted the core goal of theoretical integration and largely settled for the peripheral function of employing techniques from various schools. Today, there is a growing consensus that factors such as the therapeutic alliance, empathy, expectations, cultural adaptation, and the therapist's personality are more important than specific methods and techniques.
Positive approach
Positive psychotherapy emphasizes the mobilization of existing capacities and potential for self-help instead of primarily focusing on eliminating existing disturbances. The therapy begins with the possibilities for development and capacities of the individuals involved(Peseschkian N., pp. 1–7), following the approach of Maslow who coined the term "positive psychology" to highlight the importance of focusing on positive qualities in people. Symptoms and disorders are viewed as reactions to conflicts, and the therapy is called "positive" because it recognizes the wholeness of the individuals involved, including both the pathogenesis of illness and the salutogenesis of joys, capacities, resources, potentials, and possibilities. (Jork K, Peseschkian N., p. 13).
The term positive in positive psychotherapy is based on the "positive sciences" concept (based on Max Weber, 1988), which means a judgment-free description of the observed phenomenon. Nossrat Peseschkian uses the term positum in a broader sense, meaning that which is available, given, or actual. This positive aspect of the illness is just as important for the understanding and clinical treatment of the affliction as the negative aspect. The therapy aims to mobilize existing capacities and potential for self-help and focuses on the possibilities for development and capacities of the individuals involved, rather than just treating them as a "bag of symptoms." Peseschkian believes that symptoms and disorders are reactions to conflicts, and the therapy is called "positive" because it proceeds from the concept of the wholeness of the persons involved as a given.
The concept of positive psychotherapy is based on a humanistic view of human nature, which emphasizes the inherent goodness and potential of individuals. According to PPT, people have two basic capacities: to love and to know, and through education and personal development, they can further develop these capacities and their unique personalities. Therapy, in this context, is seen as a tool for promoting further growth and education for the patient and their family.
In positive psychotherapy, disorders are reframed in a positive light. Depression, for instance, is viewed as “the capacity to react to conflicts with deep emotionality”; fear of loneliness is seen as “the desire to be with other people”; alcoholism is reinterpreted as “the capacity to supply oneself with warmth (and love) that is not received from others”; psychosis is considered as “the capacity to live in two worlds at the same time”; and cardiac disorders are seen as “the capacity to hold something very close to one’s heart”.
The positive process involved in PPT results in a shift in perspective for all parties involved, including the patient, their family, and the therapist/physician. Instead of focusing solely on the symptom, attention is directed towards the underlying conflict. Furthermore, this approach allows for the identification of the "real patient”, who is often not the one seeking treatment, but rather a member of their social environment. By interpreting illnesses in a positive light, patients are encouraged to understand the potential function and psychodynamic significance of their illness for themselves and those around them, and to recognize their abilities rather than just their pathologies.
Basic and actual capacities
Conflicts in everyday life as well as inner conflicts, which can lead to psychological disturbances and illness, often are connected to actual value judgments. Behind them stand concepts for instance of love or justice or of values such as orderliness, trust or patience, characteristics which in positive psychotherapy are called actual capacities. Ways of behaving, values, virtues and conflictual ideas are connected to specific contents of actual capacities which are present in all cultures. Each person reacts in his own way to a concept which he has learned and developed during the course of his or her life, one which is impressed upon him or her by individual experience, and which has become an inherited model through culture and education. Punctuality or trust, for example, will be treated differently by two different people in comparable situations. Conflicts leading to distress and even physical reactions often result from divergent concepts regarding the active actual capacities, in the example punctuality or trust. The different valuations of concepts result from differing cultural and family concepts. The importance of punctuality or trust in comparison to contact, achievement or justice are seen as different from one individual to another. This can lead to conflicts but also to exchange, learning and broadening of a person's concepts. In 1977, Nossrat Peseschkian introduced the term "actual capacities"
According to Peseschkian every person possesses two basic capacities: The capacity to love, expressed in the primary capacities as emotional needs, and the capacity to know, developed with the secondary actual capacities, the social norms. The capacity to love finds its expression in the primary actual capacities such as patience, time, and trust. The capacity to know finds its expression in the secondary actual capacities such as punctuality, cleanliness, and orderliness: "We structure our experiences with the help of the capacity to know... It contains the capacity to learn (to collect experiences) and to teach (to give experiences to others).”
Peseschkian developed the "Differentiational Analytical Theory" (, p. 25) as a complement to the psychoanalysis of that time, which was concerned primarily with the psychosexual phases of development (for example, oral, anal and oedipal), development of autonomy and conflicts between the id and the super-ego. The Differentiation Analysis asks which specific content arises in earlier stages: The parents' patience, the development of trust, the experience of love in unconditional acceptance is a developmental psychological prerequisite for successful development in the oral phase. These capacities, known as "primary", are imprinted on the child by the direct behavior of the parents and through their modeling. Primary capacities such as having patience (with oneself or others), having trust (in oneself, in others, or in fate), having and giving time, are basic necessities for the development of the newborn child. The child needs warmth, time, patience and empathetic, unconditional acceptance in order to develop her/his own age-appropriate inner balance.
The primary actual capacities of the relationship with the first reference person makes it possible to relate to oneself, to be at peace with oneself, to perceive oneself, to develop a consciousness of oneself and the world and finally to deal appropriately with inner and outer conflicts. The primary capacity of “patience” is prerequisite for appropriate impulse control, the capacity "trust" is required for inner support, warmth and a feeling of safety. How important is the unconscious, loving acceptance received from one's mother, the grandmother who always has time and patience, or the internal figure of the father whom the child could trust so completely as to allow herself to fall into his arms or to trust with him something that she did not yet really trust by herself!
The secondary actual capacities such as punctuality, politeness, openness, justice or fidelity often play a role as social norms in resolving conflicts and misunderstandings. Similarly, “orderliness” is one of the most frequent contents of conflicts between parents and children in occidental cultures, also between the couples themselves. "Justice", a secondary capacity, and the experience of injustice must be faced and balanced again and again, loving acceptance, taking time to understand and being patient. "Obedience" as an expression of discipline is for historic reasons not much prized in democratic Germany, but despite this, it is generally accepted as a fact of life and seen as constructive in the schools and the inherent freedom to make decisions is set aside by the necessity to obey the rules. This, however, is one of the most frequent conflict factors in education. In psychotherapy, conflicts of the superego stand out in situations marked by religion as triggers for guilt conflicts.
It is noteworthy from a transcultural perspective that in Oriental cultures, primary capacities such as love, trust and contact are more highly valued, while secondary capacities such as orderliness, punctuality and cleanliness are more sharply pronounced in Western cultures. The emphasis is determined even in early childhood, for example, when the baby's feeding times are set down and clear rules as to the exact time for the main meal are laid down, as well as other such rules. These differences often lead to misunderstandings, but also to conflicts and judgments.
Positive psychotherapy analyzes the specific content of the conflicts as triggers for the emotions and focuses in counseling or therapy on the inner and outer conflicts or values and the capacities which are the contents of these conflicts. The emotions which lead to suffering, or the physical symptoms can then be understood as values functioning in a conflict of opposite concepts. In this connection the conflict-centered process focuses less on the triggers than on identifying and then working through the conflict which caused them.
Transcultural approach
The integration of a transcultural perspective into psychotherapy was not only a primary focus of Nossrat Peseschkian from the outset, but also held a sociopolitical significance for him. Nossrat Peseschkian emphasizes the importance of a transcultural approach in positive psychotherapy, as it is a recurring theme throughout the method. This perspective offers valuable insights for understanding individual conflicts and holds significant social implications. Issues such as immigration, development aid, interactions with individuals from different cultures, transcultural marriages, addressing prejudices, alternative models from diverse cultural backgrounds, and political challenges arising from transcultural situations can all be addressed using this approach.
The inclusion of cultural factors and the recognition of the unique nature of each treatment has expanded the applicability of PPT and made it an effective method for use in multicultural societies. PPT has been taught and practiced by psychotherapists in over 70 countries, and it can be considered a transcultural approach to psychotherapy. Therefore, the principles of PPT form the foundation for defining and constructing the field of transcultural psychotherapy, which is essential for psychotherapy education, continuing education, and the recognition and adoption of new psychotherapy disciplines.
The meaning of "transcultural" in PPT can be understood in two ways:
Firstly, it refers to the recognition of the unique characteristics of patients who come from different cultural backgrounds, which is also known as intercultural or migrant psychotherapy.
Secondly, it involves considering cultural factors in every therapeutic relationship to broaden the therapist's repertoire and promote a sociopolitical awareness.
PPT is a culture-sensitive method (concept of "unity in diversity") that can be adapted to various cultures and life situations and should not be viewed as a form of Western “psychological colonization”. Nossrat Peseschkian highlights the significance of the social aspect in positive psychotherapy, suggesting that it can be applied broadly to various social relationships, such as those between groups, peoples, nations, and cultural groups. By doing so, a comprehensive social theory may be established, focusing on interaction challenges, human abilities, and economic circumstances.
Transcultural psychotherapy is not just a comparison between different cultures but a comprehensive concept that focuses on the cultural dimensions of human behavior. It seeks to understand how people are different and what they have in common. PPT uses examples from other cultures to help patients broaden their own repertoire of behavior and relativize their own perspective. Tools such as stories, tales, social norms, and the Balance Model are used to promote a transcultural perspective. In 1979, Nossrat Peseschkian used the term "transcultural psychotherapy" and dedicated a chapter to it in his book The Merchant and the Parrot: Oriental Stories in Positive Psychotherapy. He believed that the solution of transcultural problems will be one of the major tasks of the future due to the increasing importance of transcultural difficulties in private life, work, and politics. The principle of transcultural problems becomes the principle of relationships between people and of dealing with inner conflicts, ultimately becoming the object of psychotherapy.
First interview in positive psychotherapy
Peseschkian developed a semi-structured first interview, which is one of the few in the field of psychodynamic psychotherapy. Hamid Peseschkian's dissertation, presented in 1988, was the first doctoral dissertation dealing with PPT. The first interview in PPT was first structured in this dissertation, a questionnaire for this first interview was presented and a psychodynamic study of it was undertaken. This precursor to the later semi-structured psychodynamic first interview was a significant contribution to psychodynamic psychotherapy and was published in 1988 along with the WIPPF questionnaire on PPT.
The first interview in psychotherapy is a crucial component that can be compared to a medical examination and history-taking in somatic medicine. It serves several purposes, including diagnosis, therapy planning, prognosis, and hypothesis generation. In PPT, the first interview involves a diagnostic approach similar to that of a medical history, but also considers relationship factors and the therapeutic alliance. It acknowledges the impact of expectations, including the hope for effective therapy (Snyder, 193–212, Frank). Due to its semi-structured nature and adaptable concepts, it can be applied in various contexts such as individual therapy, couples therapy, family therapy, counseling, and coaching, and is suitable for diverse cultural settings.
The first interview in PPT is a semi-structured interview that includes both mandatory and optional questions. Depending on the answers given to the mandatory questions, the therapist may or may not ask the optional questions. The questions can be open-ended or closed, and are designed to gather information for diagnostic, therapeutic, prognostic, and hypothesis-formulating purposes ( p.31). The interview can be used during the initial meeting or early sessions as part of the preliminary phase of therapy, and can also be used for orientation purposes in the first session, with the therapist going into greater depth on particular areas during subsequent sessions. The first interview is applicable to a wide range of settings, including therapy with individuals, children, youth, couples, and families, as well as counseling and coaching, and can be adapted to different cultures.
Balance model
The Balance model is widely recognized and can be applied in various fields, including therapy, self-help, and family therapy. It is comparable to Freud's concept of libido, Adler's life goals, and Jung's four functions of perception, ratio, sensitivity, and intuition. The Balance Model offers a structural representation of the personality and enables the identification of areas in which an individual may be lacking. By addressing these areas, a new balance can be achieved, leading to a synthesis within the therapy.
The Balance Model is based on the concept that there are essentially four areas of life in which a human being lives and functions, and that significantly impact an individual's overall satisfaction, self-worth, and ability to cope with challenges. These areas serve as key indicators of an individual's personality in the present moment and encompass the biological-physical, rational-intellectual, socio-emotional, and imaginative, value-oriented aspects of daily life. While all individuals possess the potential for each of these areas, some may be more prominent or neglected based on variations in education and environment. Life energies, activities, and reactions are influenced by and connected to these four areas:
Physical activities and perceptions, such as eating, drinking, tenderness, sexuality, sleep, relaxation, sports, appearance, and clothing;
Professional achievement and capabilities, such as a trade, household duties, gardening, basic and advanced education, and money management;
Relationships and contact styles with partners, family, friends, acquaintances and strangers; social engagements and activities;
Future plans, religious/spiritual practices, purpose/meaning, meditation, reflection, death, beliefs, ideas and development of vision or imagination-fantasy.
The aim of the Balance Model is to restore equilibrium among the four areas of life. In psychotherapeutic treatment, the objective is to assist the patient in identifying their own resources and utilizing them to achieve a dynamic balance. Specifically, this entails prioritizing a balanced allocation of energy, with each area receiving dynamically an equal proportion (25%) rather than an equal amount of time. Prolonged one-sidedness can lead to conflicts and illnesses, among other negative outcomes.
Model Dimensions
Assessing the impact of early childhood experiences on a patient is a crucial and difficult task in psychodynamic psychotherapy. In PPT, the Model Dimensions concept, also known as "examples", "role models", or "forms of love", is used as a tool to describe the pattern of family concepts that shape an individual's experience and development. Early upbringing and environment influence the unique development and expression of the basic capacities for love and knowledge, as described by Nossrat Peseschkian. The Balance Model illustrates the means of the capacity to know, while the four model dimensions illustrates the means of the capacity to love.
The use of the four model dimensions in PPT extends the analytic self and object theories of Kohut and Kernberg by introducing not only the "I" dimension, but also the "You," "We," and "Primary We" dimensions. The "You" dimension represents the relationship of the patient's parents or primary care takers amongst each other, while the "We" dimension includes the parents'/primary care takers experiences with others. The "Primary We" dimension, which is unique to PPT, describes the relationships between the patient's primary care takers such as parents and grandparents and their life philosophy or religious beliefs. By incorporating these four subject relations, PPT expands on the self-object theories and establishes itself as a distinctive approach that could potentially influence the future of psychodynamic therapies.
Dimension "I" is the model dimension that focuses on an individual's relationship with themselves and their life-long struggles, such as self-esteem, self-confidence, self-image, and basic trust versus basic distrust. These issues are largely influenced by the individual's childhood experiences and their relationship with their parents and siblings. During childhood, individuals learn to form a relationship with themselves based on how their wants and needs are fulfilled.
Dimension "You" refers to an individual's relationship with others, specifically with their romantic partner. The primary model for this relationship is the example set by the individual's parents, particularly in their own relationship with each other. The behavior and interactions between parents serve as a model for the possible ways of behaving in a partnership, influencing how the individual forms their own relationship with their romantic partner.
Dimension "We" concerns an individual's relationship to their social surroundings and is largely influenced by their parents' relationship with their own social environment. Through socialization, attitudes towards social behavior and achievement norms are transferred from parents to their children. These attitudes and expectations are related to social ties beyond the immediate family, such as relationships with relatives, colleagues, social reference groups, interest groups, compatriots, and humanity as a whole. The ways in which parents interact with and navigate these social relationships shape their children's understanding and approach to social behavior.
Dimension "Origin/Primal-We" refers to an individual's relationship with their origin or primal community, which is largely influenced by their parents' attitude towards meaning, purpose, spirituality/religion, and worldview. This dimension is not solely based on formal membership in a religious community but is fundamental to the question of meaning that arises later in life. Even if an individual rejects religion, their relationship with their origin or primal community remains important as the basis for other systems of orientation that are expected to provide meaning and purpose.
Conflict model
Peseschkian's psychodynamic Conflict model (refer to Figure) highlights the differentiation of content, which is the focal point of contention, and its internal evaluation. The model distinguishes between the actual conflict that arises in a burdensome situation, the pre-existing basic conflict, and the unconscious inner conflict that causes physical and/or mental symptoms. The term "conflict" (from the Latin confligere, meaning to clash or fight) refers to the apparent incompatibility of inner and outer values and concepts or an internal ambivalence. Emotions, affective states, and physical reactions can be understood as signal indicators of an inner conflict of values and the distribution of actual capacities. Therefore, in PPT, the question is asked about the content: what causes or triggers this emotion?
Peseschkian's concept of "microtrauma" refers to the accumulation of small, repetitive psychic injuries that cause microstress or “trivia, or trifles” ( p. 80), and can trigger inner conflicts. These microtrauma are different from major life events or macrotrauma. They are considered to be conflict content and are related to the actual capacities that individuals possess, which enable them to form relationships but can also become a source of conflict. In an actual conflict, when coping mechanisms are overburdened, an old unconscious basic conflict may arise, pitting primary emotional needs such as trust, hope, or tenderness against secondary capacities or social norms such as orderliness, punctuality, justice, or openness. When the previous compromise that worked to resolve the basic conflict is no longer effective, an inner conflict arises, leading to symptoms that are seen as attempts at a solution. These conflict reactions can be represented using the Balance Model, even though they cannot bring about a resolution, they still have an impact.
When certain abilities, morals, ideas, or principles are consistently used without adaptation to the current circumstances, it can lead to disorders. If family concepts or compromises made in the past continue to be repeated, an unconscious inner conflict can arise, which can cause psychological, psychosomatic, or physical disturbances. These symptoms serve as a way for the patient to express something unconsciously and have a specific significance for everyone. The goal of PPT is to strengthen neglected areas and underdeveloped capacities within the therapeutic relationship and daily life, allowing patients to effectively resolve conflicts and achieve inner and outer balance.
Narrative approach using stories and wisdom
A special technique used in PPT is the therapeutic use of tales, stories, and proverbs, which was first introduced by Nossrat Peseschkian in his work Oriental Stories as Tools in Psychotherapy – The Merchant and the Parrot in 1979. While hypnotherapy (Milton Erickson) had used this approach, it was not common in psychodynamic therapy until Peseschkian's work. Unlike Carl Gustav Jung, who focused on fairy tales, the Peseschkian method employs a wider range of narrative therapy and association tools. “Using stories and parables from the Orient and other cultures, an effort is made to recognize and further a person’s potential for self-help. With reference to the symbolic meaning of proverbs and old words of wisdom drawn from many cultures, the person to whom they are told is led in psychotherapy to a more positive view of himself” ( p. 92).
The intended therapeutic effect of surprise that results from the use of Eastern stories, which may initially seem unfamiliar in European culture, has been proven effective not only in other cultures ( pp. 24–34). Stories serve multiple functions in therapy, including creating norms for self-comparison and questioning established norms to view them as relative. In the first stage of therapy, these stories can lead to a change in perspective, which is then used in subsequent stages. Such narratives can also facilitate the release of emotions and thoughts, often playing a critical role in therapy. Storytelling in therapy serves as a mirror that allows readers or listeners to identify with the characters and their experiences, reflecting on their own needs and situations. By presenting solutions, stories can act as models that patients can compare with their own approach, leading to broader interpretations and the potential for change. Additionally, storytelling is particularly effective in helping patients who are resistant to change and who cling to old and outdated ideas.
Five-step concepts
The five-step concepts used in individual and family therapy, similar to the five fingers of each hand, closely resemble the natural process observed in group psychotherapy described by Raymond Battegay, psychodrama described by Moreno, and further education of people as described by Alfred Adler. What sets Peseschkian's approach apart is the systematic application of this process model to psychotherapy. The five-step procedure serves as a roadmap for both the therapist and the client to find the most effective means of self-help. Research in therapy has shown that the better we handle challenging therapy situations and reflect on the therapeutic relationship, the more successful the outcome of therapy is likely to be.
The three stages of interaction in therapy (attachment, differentiation, detachment) involve a 5-stage process of communication, which is utilized both within individual sessions and throughout the course of therapy.
The first step is acceptance, observation, and distancing, which involves a shift in perspective.
The second step involves taking inventory, differentiating the contents and background of the conflict and the patient's strengths.
The third step is situational encouragement, where self-help and resources are developed.
The fourth step involves working through the conflict through verbalization.
The fifth and final step, called broadening of the goals, involves reflecting on, summarizing, and testing new concepts, strategies, and perspectives with a future-oriented focus.
This structured communication approach is unique to the Peseschkian method and contributes to successful therapy outcomes. This therapeutic process is focused on the future and change, and it involves using concepts from the past that are effective for the present. Additionally, concepts from other psychotherapy disciplines are used when appropriate (integrative aspect). The patient and their surroundings actively participate in understanding the illness process (self-help).
The 5 stages in PPT serve as a structure for communication within a therapy session or throughout the entire therapeutic process, which would otherwise lack direction. Through the use of appropriate understanding, leading questions, stories, association triggers, and revisiting previous themes, the therapist facilitates the patient's storytelling and reflection. The process gives both the therapist and the patient a starting point and a sense of security, preparing the patient to work through conflicts and engage in self-help, especially after the therapy has ended.
Application
Fields of application of PPT
The method of positive psychotherapy, which was originally developed for psychotherapy, has expanded beyond its traditional application and has been applied in various fields such as counselling, pedagogy, and social work. In Germany, PPT has been used in counselling since 1992, while in Bulgaria, it has been used in pedagogy since the same year. In China, it has been used to train social workers about mental health disorders, coping with families, and preventing burnout since 2014. PPT has also been used as a basis for specialized training programs in children and youth therapy in Bulgaria since 2006, and later in Ukraine and Russia. Professionals from various countries such as Germany, Bulgaria, Cyprus, Turkey, Kosovo, China, Bolivia, and Ukraine have specialized in PPT-based positive family therapy and counselling. As a result, PPT has become a means of sharing psychotherapeutic competences and experiences across different professional and cultural fields.
Originally designed as a fundamental positive psychosomatic treatment for mental health, psychosomatic medicine, prevention, and psychotherapy, Positive Psychotherapy has been utilized by numerous medical doctors in Germany. The approach has been implemented in a number of hospitals, as well as in the Wiesbaden Academy of Psychotherapy's state-approved training program for psychodynamic therapy in Germany.
Outside of psychotherapy
Positive psychotherapy has found application in a wide range of settings, including education and schools, the psychology of religion, trainings for teachers, time management, various counseling contexts, management training, seminars for partnership or marriage preparation, recruiting, trainings for jurists and mediators; the armed forces, society, officers, and politicians; intercultural trainings, naturopathy and order therapy (also known as mind-body medicine), burnout prevention, and supervision. Additionally, PPT is utilized in coaching, family counseling, and general counseling.
Treatment
Practice
Positive psychotherapy is utilized for the treatment of various mental health conditions, including mood (affective) disorders, neurotic disorders, stress-related disorders, somatoform disorders, and certain behavioral syndromes as classified in the ICD-10 (chapters F3-5). It has also shown promise in addressing personality disorders to some extent (chapter F6). PPT has been successfully integrated with traditional individual therapy and has been found beneficial in couple, family, and group therapy settings. Additionally, PPT has been applied in the field of psychiatry, demonstrating its effectiveness when working with (post)psychotic patients and in group settings within psychiatric hospitals, where the utilization of stories and anecdotes has proven to be particularly impactful.
Self-help
Peseschkian's books are specifically intended for non-experts seeking self-help. His works, like "The Psychotherapy of Everyday Life" (1977 German, 1986 English), are designed to assist individuals in handling misunderstandings. Similarly, In Search of Meaning (1983 German and 1985 English) provides guidance on navigating life crises. Furthermore, books like If You Want Something You Never Had, Then Do Something You Never Did (2011) concentrate on resolving interpersonal conflicts. Moreover, individuals can pursue specialized courses to become certified counselors in Positive Psychotherapy, enabling them to facilitate conflict moderation and promote self-help during challenging situations.
Trainings
PPT trainings
WAPP's main postgraduate training program is divided into three parts. These parts are designed in a sequential order, i.e., they need to be completed successively starting with the lowest level.
Basic Consultant of Positive Psychotherapy (200 h – incl. theory and self-discovery).
Candidate Certified Positive Psychotherapist (710 h – incl. theory, supervision, and self-discovery).
European Certified Positive Psychotherapist (1400 h – incl. theory, practice, supervision, and self-discovery).
The courses are split up into modules of 3 or 4 days each, spread over several months depending on the kind of course. Training of Positive and Transcultural Psychotherapy consist of three content parts:
Theory. Learning all basic concepts and tools of Positive and Transcultural Psychotherapy.
Self-discovery/self-experience. Primarily, educational self-experience should assist students (candidates, residents, trainees) in developing a psychodynamic psychotherapeutic identity. The self-reflection of the student should be strengthened and developed. They should encounter their own central inner conflict and their own personality structure. They should experience themselves how psychotherapy works, and how challenging it can be. The personal experience of the unconscious is the central aspect of psychodynamic self-discovery. Even educational self-discovery deals with personal issues, it is not personal therapy. The student is not a patient, but a future colleague and a future psychotherapist. If during the educational self-discovery the student and/or his trainer find out that there are many personal unsolved issues, then the student should go into personal therapy. This further means that a personal therapy cannot be counted as an educational self-experience.
Supervision is an essential component of Positive Psychotherapy, encompassing both individual and group formats. In PPT, supervision goes beyond simply understanding the therapeutic situation and aims to develop the supervisee's skills and capabilities based on their own needs and those of their patients. Group supervision is common in PPT, as the structured process lends itself well to practical benefits and a didactic effect. The most frequent format involves focusing on one case during a session with one supervisee, with the rest of the group acting as participants, including the supervisor. This approach allows the supervisor to engage the other participants as co-supervisors, enriching the supervisee's perspective on the case with additional viewpoints and diverse perspectives from the entire group.
PPT certification
After successful completion of each PPT course the participant receives a certificate issued by the World Association for Positive and Transcultural Psychotherapy (WAPP), signed by the main trainer of the course and the President of the Association. WAPP certifies trainers of Positive Psychotherapy. Only trainers who are accredited trainers of WAPP are permitted to sign and hand out official WAPP certificates.
Training standards
WAPP has developed universal Training Standards for the postgraduate trainings in Positive Psychotherapy. These standards are obligatory for everyone. The standards may differ in some countries. But the WAPP defined standards are the minimum requirements, which need to be fulfilled.
Trainer education
WAPP trains and certifies trainers for Basic and Master Courses (; p. 26):
Basic Course Trainer for Positive Psychotherapy
Master Course Trainer for Positive Psychotherapy
Certified Positive Psychotherapists who would like to become trainers for PPT themselves can participate in a training program for trainers including an examination and the accompaniment of a complete course as a candidate-trainer.
International gatherings and training projects
The World Association for Positive Psychotherapy organizes regular national and international gatherings, e.g., conferences, trainer seminars and world congresses. Since the year 2000, annual International Training Seminars and since 1997 seven World Congresses have taken place.
Development and international network
The main emphasis of positive psychotherapy during the past 40 years has been treatment, training and publication.
In 1979, the Wiesbaden Postgraduate Training Institute for Psychotherapy and Family Therapy was established as a postgraduate training for physicians in Wiesbaden, Germany. In 1999, the Wiesbaden Academy for Psychotherapy (WIAP), a state-licensed, postgraduate psychotherapy academy with a large outpatient clinic, was established for the training of psychologists and educational scientists.
The international head office is based in Wiesbaden, Germany. Positive psychotherapy is represented internationally by the World Association of Positive and Transcultural Psychotherapy (WAPP). Its international governing board of directors is elected every two years. There are national and regional associations in some ten countries.
PPT and its therapists have been engaged in the international development of psychotherapy, and are active members of international and continental associations.
Research
Research advances and applications
The first publications in the area of PPT date back to 1974. Since then, this method has been presented in numerous books, scientific works, and other publications.
PPT fulfills the four principles postulated by Grawe for the effectiveness of psychotherapy:
activation of resources,
actualization,
management of problems,
therapeutic clarification.
A study on the effectiveness and quality assurance of Positive Psychotherapy was conducted between 1994 and 1997 by 32 members of the German Association for Positive Psychotherapy under the guidance of Nossrat Peseschkian, Karin Tritt, and Birgit Werner.
The study aimed to substantiate the claim that PPT is a classical, integrative form of therapy ( p. 9) based on Grawe's model. It was conducted under controlled conditions and was the first of its kind and the results show PPT short-term method to be effective.
The longitudinal effectiveness study conducted by the German Association for Positive Psychotherapy examined the efficacy of PPT in daily clinical practice. A total of 402 patients with various mental health disorders were treated by 22 therapists trained in PPT, including physicians, psychologists, and teachers. The patients were compared to a control group of 771 individuals on a waiting list for therapy due to somatic illnesses. The percentages represent the proportion of patients with different types of disorders: 23.6% had depressive disorders, 19.8% had anxiety and panic disorders, 21.2% had somatoform disorders, 20.5% had adjustment disorders, 8.2% had personality disorders, 3.4% had addictions, and 3.4% were newly diagnosed with somatic disorders. The study employed a battery of psychometric tests, including SCL-90R, VEV, Gießen-Test, WIPPF, IPC, IIP-D, GAS, and BIKEB, to measure the effectiveness of PPT. The study also included a retrospective interrogation of patients after the termination of PPT at intervals of 3 months to 5 years in three groups of 84, 91, and 46 patients. The study found positive results in terms of the effectiveness of PPT in treating various mental health disorders.
This means that the positive effects of PPT were maintained even after a significant amount of time had passed since the end of therapy. The study also found that patients treated with PPT reported a significant improvement in their quality of life, as measured by the Gießen-Test (p ≤ 0.005), and in their interpersonal relationships, as measured by the Interpersonal Check List (IPC) and Inventory of Interpersonal Problems (IIP-D) (p ≤ 0.005). In addition, patients treated with PPT showed a significant increase in their coping ability, as measured by the Coping Capacity Scale (BIKEB) (p ≤ 0.005). Overall, the study demonstrated that PPT is an effective form of therapy for a range of mental health disorders, and that its positive effects can be maintained over time (p ≥ 0.05; VEV: F = 1179; SCL-90-R: F = 2473)
During the discussion, the researchers explored the dilemma of choosing between an experimental design that prioritizes internal validity versus one conducted under controlled conditions to achieve high external validity. They acknowledged the unfortunate lack of effectiveness studies and highlighted that the experimental design employed in this study could be viewed as a significant strength. The computer-assisted quality assurance study on Positive Psychotherapy (PPT) received the Richard Merten Prize in 1997, which is one of the most prestigious prizes in the healthcare sector in Europe. The prize has been awarded by the trustees since 1992 with the aim of recognizing exceptional work that contributes to the improvement of medical, pharmaceutical, or nursing treatment and represents a noteworthy advancement in medical, social, sociopolitical, or economic progress within the healthcare industry.
Academic works
The widespread applicability and cultural suitability of PPT are attributed to the numerous colleagues who are motivated and supported to conduct scientific research. Furthermore, many practitioners who have been exposed to PPT find their interest in publishing rekindled since they are no longer bound by the limitations and requirements of a particular school. There is evidence that around 5 postdoctoral dissertations and nearly twenty doctoral dissertations have been published on PPT, mainly from Germany, Russia, Bulgaria, and Ukraine. Additionally, approximately 50 bachelor's and master's theses have been written on the subject.
Most of the research on PPT has centered on its applications in psychosomatic, medical, psychiatric, psychological, and pedagogical fields. This focus provides a glimpse into the potential areas of future scientific inquiry. A review of the topics covered in these academic works indicates that PPT has a wide range of clinical and non-clinical applications, with particular attention given to certain models.
In addition to research on psychosomatics in different organ systems, there are also comparative and transcultural studies. These studies have focused on the unique aspects of the therapeutic relationship and how it can be applied to educational contexts. Some of the research has been conducted within the social-pedagogical framework, highlighting the potential applications and possibilities of "Positive Pedagogy."
Publications
Publications on positive psychotherapy consist of the wide-ranging source material written by its founder and of the work of his students. These scholarly publications have been joined by works of popular science that have appeared in diverse periodicals and do not appear in lists of scientific literature.
Peseschkian wrote 29 books that have been translated into as many as 23 languages. The most widespread book is Oriental Stories as Tools in Positive Psychotherapy: The Merchant and the Parrot. Other core books are Psychotherapy of Everyday Life, Positive Psychotherapy, Positive Family Therapy, and Positive Psychotherapy in Psychosomatic Medicine. In his final years, Peseschkian published a number of self-help books dedicated to various areas of life.
Starting with the founding of the German Journal of Positive Psychotherapy in 1977, colleagues in PPT have been encouraged to publish the results of their research and share their cases. Additionally, the source publications of Peseschkian began to accrue secondary publications beginning in the 1990s. As new national associations for positive psychotherapy have been formed in various countries during the last 20 years, journals of PPT have been founded in Russia, Ukraine, Bulgaria, and Romania.
List of some of the main PPT publications are:
(translated) (first German edition 1977)
(first German edition 1977)
(first German edition 1983)
(first German edition 1980)
(first German edition 1974)
PPT Journal
The Global Psychotherapist (JGP) is a digital journal that focuses on positive psychotherapy, following the principles established by Peseschkian since 1977. It serves as an interdisciplinary platform for publishing articles related to the practice and utilization of the humanistic-psychodynamic approach of positive and transcultural psychotherapy. The journal operates on a semi-annual basis, releasing issues in January and July. Articles submitted to JGP undergo a rigorous double-blind peer review process to ensure the quality and integrity of the publication. The journal accepts articles in English, Russian and Ukrainian languages.
ISSN: 2710-1460 (online)
DOI: 10.52982/197700
The Global Psychotherapist adheres to an open access policy that promotes the free dissemination of scientific information and encourages global knowledge exchange, with the ultimate aim of fostering social progress. The journal firmly believes in providing unrestricted access to its content to benefit the wider community. Authors have the freedom to choose the license under which their work is published, while retaining full rights to their content.
Furthermore, the editorial policy of the journal allows authors to deposit any version of their published articles in a repository of their choosing, whether it be an institutional repository or any other suitable platform, without any embargo period. This ensures that the research output remains accessible and readily available for the benefit of the scholarly community.
References
External links
World Association for Positive and Transcultural Psychotherapy
International Academy information
Wiesbadener Akademie für Psychotherapie (WIAP)
Centers on Positive Psychotherapy worldwide
"The Global Psychotherapist" – journal on positive and transcultural psychotherapy
Counseling
Psychodynamic psychotherapy | 0.770572 | 0.965787 | 0.744208 |
Heaven and Hell (essay) | Heaven and Hell is a philosophical essay by Aldous Huxley published in 1956. Huxley derived the title from William Blake's book The Marriage of Heaven and Hell. The essay discusses the relationship between bright, colorful objects, geometric designs, psychoactives, art, and profound experience. Heaven and Hell metaphorically refer to what Huxley conceives to be two contrary mystical experiences that potentially await when one opens the "doors of perception"—not only in a mystical experience, but in prosaic life.
Huxley uses the term antipodes to describe the "regions of the mind" that one can reach via meditation, vitamin deficiencies, self-flagellation, fasting, sleep deprivation, or (most effectively, he says) with the aid of certain chemical substances like LSD or mescaline. Essentially, Huxley defines these "antipodes" of the mind as mental states that one may reach when certain parts of one's brain are disabled (namely the parts associated with filtering information and signals entering the brain) and can then be conscious of certain "regions of the mind" that one would otherwise never be able to pay attention to, due to the lack of biological/utilitarian usefulness. Huxley states that while these states of mind are biologically useless, they are nonetheless spiritually significant, and furthermore, are the singular 'regions' of the mind from which all religions are derived. For example, he says that the Medieval Christians frequently experienced "visions" of Heaven and Hell during the winter, when their diets were severely hampered by lack of critical nutrients in their food supplies (vitamin B, vitamin C)—these people frequently contracted Scurvy and other deficiencies, causing them to hallucinate. He also said that Christians and other religions fast in order to make themselves delirious, thus inducing visions and views of these "antipodes of the mind". Today, Huxley says people can reach these states of mind without harm to their bodies with the aid of certain drugs. Essentially, Huxley says this state of mind allows a person to be conscious of things that would not normally concern him because they have nothing to do with the typical concerns of the world.
In his earlier narrative The Doors of Perception (1954), Huxley recounted in detail his first experience of mescaline.
Editions
The Doors of Perception and Heaven and Hell, 1954, 1956, Harper & Brothers (US); Chatto & Windus (UK)
1977 Harpercollins (UK), mass market paperback:
1990 Harper Perennial edition:
2004 Harper Modern Classics edition:
2004 Sagebrush library binding:
External links
1956 essays
Psychedelic literature
Essays by Aldous Huxley
Chatto & Windus books
Harper & Brothers books
English essays | 0.765157 | 0.972621 | 0.744208 |
Guilford Press | Guilford Press or Guilford Publications, Inc. is a New York City-based independent publisher founded in 1973 that specializes in publishing books and journals in psychology, psychiatry, the behavioral sciences, education, geography, and research methods. 2023 marks the company's 50th anniversary. Guilford titles are sold worldwide.
Overview
Guilford was founded by Bob Matloff and Seymour Weingarten. Matloff retired as president in 2022, and the firm is now run by Weingarten (co-founder) and Tim Stookesberry (chief executive officer).
Guilford Press has over 1,400 titles in print and typically publishes more than 55–65 new books in print and e-book formats each year. The company also publishes 10 journals. Guilford's workflow for accessible ePub e-books has been accredited as Global Certified Accessible, and they have begun to offer certified accessible ePubs meeting WCAG 2.0 AA standards.
In the academic sphere, Guilford Publications has published books by Aaron T. Beck, who is known as the father of cognitive therapy and was the winner of the 2006 Lasker Foundation Clinical Medical Research Award; Marsha Linehan, the developer of dialectical behavior therapy (DBT); and the founders of motivational interviewing, Stephen Rollnick and William R. Miller. Overcoming Binge Eating, Second Edition, by Christopher G. Fairburn, and Mind Over Mood by Dennis Greenberger and Christine A. Padesky, have been chosen for inclusion in the United Kingdom Reading Well Books on Prescription program, a selective list of self-help books that general practitioners, counselors, and community mental health specialists are encouraged to "prescribe" for patients with mild to moderate mental health concerns. Mind Over Mood was also voted by the British Association of Behavioural and Cognitive Therapies as "the most influential cognitive behavioural therapy publication" and was recommended by Scientific American Mind.
In the field of literacy education, Guilford has published books by leading scholars such as Isabel Beck and Margaret McKeown (whose books on vocabulary have sold over 500,000 copies), G. Michael Pressley, Kathy Ganske, Lesley Mandel Morrow, Susan B. Neuman, and Linda Gambrell. Among Guilford's authors and editors are 13 past presidents of the International Literacy Association, 47 members of the Reading Hall of Fame, and 14 winners of the Oscar S. Causey Award for lifetime contributions to literacy research from the Literacy Research Association.
Guilford exhibits at numerous professional conferences each year, such as those held by the American Academy of Child and Adolescent Psychiatry, the American Educational Research Association, the American Psychological Association, the Association for Behavioral and Cognitive Therapies, the Literacy Research Association, the International Neuropsychological Society, and the National Association of School Psychologists.
The company's titles are regularly reviewed and featured in prominent news outlets, academic journals, and industry publications, Choice Reviews, Library Journal, and Publishers Weekly. Guilford authors and their books are recipients of awards from the American Psychological Association, the American Journal of Nursing, the Association for Behavioral and Cognitive Therapies, and the National Association for the Advancement of Psychoanalysis, among others.
Authors
Guilford's list of authors includes the following among others:
References
Further reading
Publishing companies of the United States
Companies based in New York (state)
Educational publishing companies
Publishing companies established in 1973 | 0.779855 | 0.954282 | 0.744202 |
Nik & Eva Speakman | Nik Speakman (born 7 December 1961) and Eva Speakman (born 30 April 1969), known collectively as The Speakmans, are British writers, therapists, life coaches and TV presenters known for their regular contributions on ITV's This Morning.
Career
Nik Speakman was working as a success coach at the time of his and Eva's 2005 appearance in That's Rich, a Granada Television series focusing on entrepreneurs in the north-west of England. Eva Speakman ran the Heavenly Bodies gym in Oldham at the time of the show. The Speakmans were subsequently hosts of a Living TV show, A Life Coach Less Ordinary, and in 2007 published a book titled You Can Be Fantastic, Too!.
Since 2010 the couple have been resident therapists on ITV's This Morning, hosting a segment about issues and anxiety disorders ranging from obsessive–compulsive disorder to fears, phobias and post-traumatic stress disorder. In 2014, the pair briefly hosted a spin-off daytime ITV show of their own entitled The Speakmans. The couple also took part in series five of Celebrity Hunted in 2023 for charity Stand Up to Cancer.
The Speakmans are also known for developing a therapy known as Visual Schema Displacement Therapy (VSDT).
Philanthropy
The Speakmans are ambassadors for Variety, the children’s charity, and they support Stand Up to Cancer. Also, Nik Speakman is the founder and CEO of Trauma Research UK.
Personal life
The Speakmans have two children, and they live in Littleborough near Rochdale in Greater Manchester.
Bibliography
Conquering Anxiety (2019)
Winning at Weight Loss (2019)
Everyday Confidence (2021)
Awards
Legends of Industry Awards 2017
References
External links
1960s births
Year of birth missing (living people)
Living people
Alumni of Newcastle University
English non-fiction writers
English television personalities
Life coaches
Married couples
Participants in British reality television series
People from Littleborough, Greater Manchester | 0.763266 | 0.974904 | 0.744111 |
Kiddie Schedule for Affective Disorders and Schizophrenia | The Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS) is a semi-structured interview aimed at early diagnosis of affective disorders such as depression, bipolar disorder, and anxiety disorder. There are different versions of the test that have use different versions of diagnostic criteria, cover somewhat different diagnoses and use different rating scales for the items. All versions are structured to include interviews with both the child and the parents or guardians, and all use a combination of screening questions and more comprehensive modules to balance interview length and thoroughness.
The K-SADS serves to diagnose childhood mental disorders in school-aged children 6–18. The different adaptations of the K-SADS were written by different researchers and are used to screen for many affective and psychotic disorders. Versions of the K-SADS are semi-structured interviews administered by health care providers or highly trained clinical researchers, which gives more flexibility to the interviewer about how to phrase and probe items, while still covering a consistent set of disorders. Due to its semi-structured interview format, time to complete the administration varies based on the youth/adult being interviewed. Most versions of the K-SADS also include "probes", if these are endorsed, another diagnostic category will be reviewed. If the probe is not endorsed, additional symptoms for that particular disorder will not be queried.
The K-SADS has been found to be reliable and valid in multiple research and treatment settings.
Versions
KSADS-Present Version (KSADS-P)
The KSADS-P was the first version of the K-SADS, developed by Chambers and Puig-Antich in 1978 as a version of the Schedule for Affective Disorders and Schizophrenia adapted for use with children and adolescents 6–19 years old. This version rephrased the SADS to make the wording of the questionnaire pertain to a younger age group. For example, mania symptoms in children might be manifest differently than in adulthood (e.g., children might have not have the same opportunity to spend money impulsively, nor would they likely have access to credit cards or checking accounts; instead, they might give away all their favorite toys or empty their parent's wallet to gain spending money). The KSADS-P is a structured interview given by trained clinicians or clinical researchers who interview both the child and the parent. This original version assesses symptoms that have occurred in the most current episode (within the week preceding the interview), as well as symptoms that have occurred within the last 12 months. The KSADS-P has many limitations: it does not assess lifetime symptoms and history, does not include many psychiatric diagnoses of interest in childhood (such as autistic spectrum disorders), and does not include diagnosis specific impairment ratings.
KSADS-Present and Lifetime Version (KSADS-PL)
The K-SADS-PL is used to screen for affective and psychotic disorders as well as other disorders, including, but not limited to Major Depressive Disorder, Mania, Bipolar Disorders, Schizophrenia, Schizoaffective Disorder, Generalized Anxiety, Obsessive Compulsive Disorder, Attention Deficit Hyperactivity Disorder, Conduct Disorder, Anorexia Nervosa, Bulimia, and Post-Traumatic Stress Disorder. This semi-structured interview takes 45–75 minutes to administer. It was written by Joan Kaufman, Boris Birmaher, David Brent, Uma Rao, and Neal Ryan. The majority of items in the K-SADS-PL are scored using a 0–3 point rating scale. Scores of 0 indicate no information is available; scores of 1 suggest the symptom is not present; scores of 2 indicate sub-threshold presentation and scores of 3 indicate threshold presentation of symptoms. The KSADS-PL has six components:
Unstructured Introductory Interview – Developmental History
The first part of the interview asks about developmental history and the history of the presenting problem. The interviewer takes detailed notes on the record sheet. Prompts cover basic demographic information, physical and mental health history and prior treatments, current complaints, and the youth’s relations with friends, family, school, and hobbies. This section allows flexibility for the interviewer to collect more information on questions that need elaboration.
Diagnostic Screening Interview
The diagnostic screening interview reviews the most severe current and past symptoms. There are probes and scoring criteria for each symptom presented. Symptoms of disorders are grouped into modules. If the patient does not display any current or past symptoms for the screening questions, then the rest of the module's questions do not need to be asked.
Completion Checklist Supplement
A supplemental checklist is used to screen for additional disorders.
Appropriate Diagnostic Supplements
These supplements review presence/absence of symptoms for other disorders, including anxiety disorders, behavioral disorders, and substance abuse.
Summary Lifetime Diagnosis Checklist
Based on the previous sections, this section summarizes which disorders have been present from first episode to now.
Children's Global Assessment Scale (C-GAS)
Scores the child’s level of functioning.
KSADS-Epidemiological (KSADS-E)
The KSADS-E, which is the epidemiological version of the KSADS, is a tool to interview parents about possible psychopathology in children from preschool onward. It was developed by Puig-Antich, Orvaschel, Tabrizi, and Chambers in 1980 as a structured interview. The tool examines both past and current episodes, focusing on the most severe past episode and the most current episode. However, this tool does not rate symptom severity; it should only be used to assess presence or absence of symptomatology. This version of the K-SADS introduced screening questions, which, if negative, allowed skipping the remaining diagnostic probes. Furthermore, the K-SADS-E also includes “skip out” criteria when assessing other diagnostic disorders (ADHD, PTSD, etc.), allowing those that screen positive to immediately be interviewed for all of the symptoms regarding that diagnosis, and those that screened negative could “skip out” of being interviewed on the remaining symptoms.
WASH-U-KSADS
The WASH-U version of the K-SADS was written by Barbara Geller and colleagues in 1996. It is a modified version of the 1986 K-SADS. This version is like many other versions of the K-SADS in that it is semi-structured, administered by clinicians to both parent and child separately, and assesses present episodes. However, this version specifically expands the mania section in order to be more applicable to pre-pubertal mania. In particular, it queries presence/absence of rapid cycling. It also includes a section on multiple other DSM-IV diagnoses, and examines both present and lifetime symptoms as well as symptom onset and offset items. These modifications made this specific version particularly useful for phenomenology studies.
KSADS-PL-Plus and KSADS-PLW
Two large grants funded by the National Institute of Mental Health combined modules of the KSADS-PL and the WASH-U-KSADS. Specifically, both projects used the depression and mania modules of the WASH-U version, combined with the rest of the modules of the PL. The few questions that the PL included about depression or mania that were not already part of the corresponding WASH-U module were added, as well, and a written map for converting item scores was included in the first grant proposal—before data collection. This provided a cross-walk so that the items and diagnoses produced using the hybrid interview would be fully compatible with data produced by other projects using the standard PL or WASH-U versions.
KSADS-5
With the release of the fifth edition of the Diagnostic and Statistical Manual of the American Psychiatric Association (DSM-5), a team of authors completed a major revision of the KSADS. The updated version is intended to be fully aligned with DSM-5, and includes changes in symptoms and organization of symptoms (e.g., in the trauma section, with post-traumatic stress disorder), changes in the diagnostic summary criteria (e.g., adding mixed hypomania and mixed depression to the mood disorders sections), and changes in the diagnostic labels (e.g., renaming "Not Otherwise Specified" disorders "Other Specified and Related Disorders). Notably, it also added a module on pervasive developmental disorders, with coverage of autistic spectrum and related disorders, and the DMDD diagnosis (which was not adopted in the later 11th revision of the World Health Organization International Classification of Diseases, ICD-11).
The KSADS-5 continues to be distributed online, free for use by private clinicians and nonprofit organizations. It is also readily available for use in industry-sponsored trials.
KSADS-COMP
Through a series of NIH grants, three web-based KSADS-COMP assessment tools were created: 1) a clinician-administered version; 2) youth self-administered version with videoclips to facilitate completion; and 3) a parent/caregiver self-administered version. The KSADS-COMPs maintained the structure of the KSADS-PL interview described above, assess about ~50 DSM-5 psychiatric diagnoses, and provides ICD-10 diagnostic codes.
The web-based KSADS-COMPs have many advantages over the paper-and-pencil versions of the scale, including: 1) Administration time of the clinician-administered interview is cut in half, clinician-training time is less, and there is much greater inter-rater reliability in scoring individual symptoms; 2) The self-administered versions of the KSADS-COMP can be completed independently in-person or remotely; 3) The KSADS-COMPs have automated selection of supplements and automated scoring and algorithms for generating diagnoses; 4) The KSADS-COMPs generate categorical diagnoses and dimensional symptom ratings; 5) Symptom level and diagnostic reports are available in real time; and 6) There are automated data capture features. The KSADS-COMP is currently available in English, Spanish, Korean, Dutch, and Danish, and several other translations are currently under development. For further information or to try a KSADS-COMP demo go to www.ksads-comp.com.
KSADS Mania Rating Scale (KMRS) and Depression Rating Scale (KDRS)
It also is possible to use the items in the mania and depression modules of some versions of the KSADS to get an interview-based rating of the severity of mood problems. The KMRS and KDRS use a 1 to 6 rating format (the same as in the WASH-U, -P, and PL-Plus versions). Adding up the items provides a measure of the total symptom burden. The KMRS assess 21 symptoms related to mania, hypomania, and rapid cycling. Each item is rated on a 0-6 rating scale. Scores of 0 suggest no information is available (missing data); scores of 1 suggest the symptom is not present at all; scores of 2 suggest the symptom is slightly present; scores of 3 suggest the symptom is mildly severe; scores of 4 suggest the symptom is moderately severe; scores of 5 suggest the symptom is severe; and scores of 6 suggest the symptom is extremely severe. Items with scores of 4 or higher are clinically significant/problematic. Trained clinicians or clinical researchers administer the assessment to both the child and the parent, which each provide their own separate score for each item (P and C), and the total score encompasses the sum of all of the items (S).
The KMRS is an alternative the Mania Rating Scale designed by Young et al. (frequently referred to as the YMRS). The YMRS is more well-known and widely used, but because it was written in 1978, it does not include all of the symptoms of mania from ICD-9 or ICD-10 (nor DSM-IV or DSM-5), as it predated them all. The YMRS was also designed for completion by nurses at the end of their eight-hour shift on an inpatient unit, observing adult patients. The KMRS has several advantages in comparison: It covers all the symptoms used in current versions of ICD and DSM, it was designed for use with children and teenagers, and it was written and validated as an interview. Studies have found excellent internal consistency and inter-rater reliability, as well as exceptionally high correlation with the YMRS. Similarly, the KDRS would be analogous to the Child Depression Rating Scale-Revised. The CDRS-R was also designed to be done as an interview, but the item content predates the current ICD and DSM and omits some important symptoms. The KDRS also shows strong reliability (internal consistency and inter-rater) and exceptionally high correlations with the KDRS.
Links to Scales
K-SADS Depression Rating Scale & K-SADS Mania Rating Scale
Kiddie Mania Rating Scale Follow-Up
Development and history
The Schedule for Affective Disorders and Schizophrenia for School Aged Children, or K-SADS, was originally created as an adapted version of the Schedule for Affective Disorders and Schizophrenia, a measure for adults. The K-SADS was written by Chambers, Puig-Antich, et al. in the late 1970s. The K-SADS was developed to promote earlier diagnosis of affective disorders and schizophrenia in children in a way that incorporates reports by both the child and parent and a “summary score” by the interviewer based on observations and teacher ratings.
The first version of the K-SADS differed from other tests on children because it relied on answers to interview questions rather than observances during games and interactions. The 1990s led to the creation of different versions of the K-SADS for different purposes, such as ascertaining lifetime diagnoses (K-SADS-E) or focusing on current episodes (K-SADS-P).
Impact
The K-SADS is used to measure previous and current symptoms of affective, anxiety, psychotic, and disruptive behavior disorders. The K-SADS has become one of the most widely used diagnostic interviews in research, particular for projects focused on mood disorders.
The K-SADS-PL has been written and translated into over 30 different languages, including Korean, Hebrew, Turkish, Icelandic, and Persian. The K-SADS-PL is also available in several Indian dialects including Kannada, Marathi, Tamil and Telugu.
Limitations
One limitation of the K-SADS is that it requires extensive training to give properly, including observation techniques, score calibration, and re-checks to test inter-rater reliability.
External resources
PDFs of the KSADS-5 are available from the Child and Adolescent Bipolar Services clinic at the University of Pittsburgh Medical Center. They have the KSADS, KMRS, KDRS, and other tools they helped develop linked here.
The KSADS-5 is a set of modules. Not every patient requires every module—the screen and summary diagnostic checklists would be the minimum. However, all seven pieces should be available for any given interview.
KSADS-PL DSM 5 Screen Interview
Supplement #1 Depressive and Bipolar Related Disorders
Supplement #2 Schizophrenia Spectrum and Other Psychotic Disorders
Supplement #3 Anxiety, Obsessive Compulsive, and Trauma-Related Disorders
Supplement #4 Neurodevelopmental, Disruptive, and Conduct Disorders
Supplement #5 Eating Disorders and Substance-Related Disorders
Summary Diagnostic Checklists
The computer-assisted version is commercially distributed here.
Links to Severity Scales
K-SADS Depression Rating Scale & K-SADS Mania Rating Scale
Kiddie Mania Rating Scale Follow-Up
References
Schizophrenia
Screening and assessment tools in child and adolescent psychiatry | 0.768546 | 0.968173 | 0.744085 |
California Psychological Inventory | The California Psychological Inventory (CPI) also known as California Personality Inventory is a self-report inventory created by Harrison G. Gough and currently published by Consulting Psychologists Press. The text containing the test was first published in 1956, and the most recent revision was published in 1996. It was created in a similar manner to the Minnesota Multiphasic Personality Inventory (MMPI)—with which it shares 194 items. But unlike the MMPI, which focuses on maladjustment or clinical diagnosis, the CPI was created to assess the everyday "folk-concepts" that ordinary people use to describe the behavior of the people around them.
Test design
The CPI is made up of 434 true-false questions, of which 171 were taken from the original version of the MMPI. The test is scored on 18 scales, three of which are validity scales. Eleven of the non-validity scales were selected by comparing responses from various groups of people. The other four were content validated. However, factor analysis was not used in the development of the test, and many of the scales are highly inter-correlated and conceptually similar.
The test is typically used with people aged 13 years and older. It takes about 45–60 minutes to complete.
The revised third edition of the CPI contains 434 items. This latest version requires that the patient's false and true answers be transformed at an additional cost into raw scale and Standard scores by the publisher, who will also provide interpretative report writing. The older CPI with the 462 items is still available for sale by the publisher, Consulting Psychologists Press, and comes with plastic scoring keys and profile sheets, thus allowing each research or clinical psychologist to score the test by hand, a less expensive alternative, perhaps for use in training psychology students.
Subtests
As stated in the ETS Test Collection Catalog, The CPI contains the following 20 scales:
Dominance
Capacity for Status
Sociability
Social Presence
Self-Acceptance
Independence
Empathy
Responsibility
Socialization
Self-Control
Good Impression
Communality
Sense of Well-Being
Tolerance
Achievement via Conformance
Achievement via Independence
Intellectual Efficiency
Psychological-Mindedness
Flexibility
Femininity-Masculinity
Scoring
The inventory contains 434 items which can be scored to yield 18 scales. The 18 scales are further grouped into four classes: (1) measures of poise, ascendancy, self-assurance, and interpersonal adequacy; (2) measures of socialization, responsibility, intrapersonal values, and character; (3) measures of achievement potential and intellectual efficiency; (4) measures of intellectual modes and interest modes.
This paragraph will discuss what are referred to as the Structural Scales of the CPI-462 version, using information being provided by the manual for that version, the CPI Administrator's Guide from 1987. Alpha, Beta, Delta and Gamma personality types are conveniently illustrated by a score's placement on a grid defined by the two dimensions – the degree to which the person is norm-favoring or norm-questioning on one dimension (called the v.2 scale), and the degree to which he or she is more externally or internally focused (the v.1 scale). Alpha personality types are more enterprising, dependable and outgoing. Betas are reserved, responsible and moderate. Gammas are adventurous, restless, and pleasure-seeking. Finally, Deltas are withdrawn, private, and to some extent disaffected. In a separate measure known as Realization, also referred to as the v.3 scale, a tester's score may reflect the degree to which he or she is reflective, capable, and optimistic about the present and future, when the score is high, or possesses the opposite characteristics when low. Thus, research scientists or medical or psychology graduate students tend to score high on this scale, while psychiatric patients, juvenile delinquents, prison inmates and even high school students in general (who lack life experience and are still forging a solid sense of identity) tend to score low.
Another component of this test are the 20 Folk Concept Scales (18 in the CPI-434 version) – measuring Dominance, Capacity for Status, Sociability, Social Presence, Self-acceptance, Independence, Empathy, Responsibility, Socialization, Self-control, Good Impression, Communality, Well-being, Tolerance, Achievement via Conformance, Achievement via Independence, Intellectual Efficiency, Psychological-mindedness, Flexibility, and Femininity/Masculinity. These scales are called "folk" as they attempt to capture personality themes that should be broadly cross-cultural and easily understood around the world. This test is thus an attempt to tap into personality factors that arise without exception to some, varying, degree, in all humans regardless of cultural context, and which provide a picture of people's relatively stable tendencies and characteristics, which is as good as any definition for what is loosely termed their unique "personality".
Validity
Correlations between CPI scales and related external criteria tend to fall in the .2 to .5 ranges. This degree of correlation is typical for much of personality research . Extremely high correlations are not likely to be found for personality measures because the scales typically try to assess rather broad behavioral tendencies.
Norms are available for males only, females only, and male/female data combined. The CPI has been very popular in research and in individual assessments of adolescents and adults. The fact that it was developed and normed on non-psychiatric or non-clinical populations is regarded almost universally as part of its positive reputation and usefulness among psychologists.
Reliability
Despite the CPI's dichotomous response format, the reliabilities were uniformly high and held up well in both validation samples, averaging .85 in the scale development sample, .84 in the student validation sample, and even .83 in the much older community validation sample.
The scale development sample consisted of, 433 undergraduate students enrolled in psychology courses at a public university in California. Most participants were in their early 20s. The participants were diverse in terms of ethnicity: 31% were White/Caucasian, 50% were Asian/Asian-American, 8% were Hispanic/Latino, 2% were Black/African-American, and 9% were of another ethnicity. All participants completed the 462-item version of the CPI.
The student validation sample consisted of 396 undergraduate psychology students attending the same university as members of the scale development sample. All members of this sample This sample was similar to the scale development sample in terms of age and ethnicity, 30% White/Caucasian, 46% Asian/Asian-American, 8% Hispanic/Latino, 2% Black/African-American, 14% of another ethnicity. They completed the same version of the CPI within the same time constraints.
The community validation sample consisted of 520 adult residents of the Eugene-Springfield, Oregon area. The members of this sample were more heterogeneous from the other samples, in terms of gender, education, ethnicity, and age. They too completed CPI under the same circumstances as the other two sample groups.
Critique of the test
Strengths
CPI focuses on measuring and understanding common interpersonal behaviors (e.g., self-control, dominance etc.) in the general population. Extreme scores on some of the scales provide important information on specific maladjustments an individual may be experiencing. Thus, it provides good coverage of information for the general population as compared to tests that are more pathologically oriented. CPI has generally straightforward and easily understood scale names, which makes it more user friendly for untrained professionals and test takers, for example. Besides that, the interpretation of the results may have more immediacy and relevancy to the test takers because the results relate to ongoing aspects of behaviors. In addition, CPI has been shown to be a useful tool in predicting long- and short-term behaviors (e.g., college attendance). The "folk concepts" used in CPI are found in many cultures and societies which makes CPI more adaptable to various cultures.
Weaknesses
CPI was not designed to predict unidimensional traits. Instead, the focus was on predicting interpersonal behaviors. Some Folk Concepts scales are substantially correlated with one another as they may be associated to the same underlying traits. Gough argued that if the Folk Concepts are correlated in the minds of the general population, the CPI scales should be similarly correlated. As a result, CPI fails to provide a parsimonious and theory-oriented description of the normal personality, which is one of its major criticisms. There is also a lack of theoretical justification of the criteria used in developing the Folk Concepts and Special Purpose scales. It is unclear as to why some scales (e.g., dominance) are more basic and receive the status as "folk concepts" whereas others are labeled as "special purpose" (e.g., anxiety). In addition, CPI was designed to be an open system, which means that new scales can be added into the existing set of scales if a new criterion is to be predicted. With the lack of theoretical basis, there could be an infinite number of criteria to be predicted and these scales may be empirically redundant and lack clear psychological meanings.
Another criticism of the CPI is that its norm samples are not representative of the general population, particularly because adults working in professional occupations are underrepresented in the norm samples. Approximately 50% of the sample is composed of high school students and 16.7% of the sample are undergraduate students. Thus, the profiles forms used are more suited for evaluations of younger respondents. As a rule, clinicians also need to consider various factors such as life situation, reason for assessment, and overall pattern of scale elevation during result interpretation. This is because biased response from an individual may cause a single scale elevation which may not be meaningful if interpreted in isolation.
See also
F-scale (personality test)
References
Personality tests
Personality tests measuring masculinity-femininity | 0.765081 | 0.972555 | 0.744083 |
Hypermodernity | Hypermodernity (supermodernity) is a type, mode, or stage of society that reflects an inversion of modernity. Hypermodernism stipulates a world in which the object has been replaced by its own attributes. The new attribute-driven world is driven by the rise of technology and aspires to a convergence between technology and biology and more importantly information and matter. Hypermodernism finds its validation in emphasis on the value of new technology to overcome natural limitations. It rejects essentialism and instead favours postmodernism. In hypermodernism the function of an object has its reference point in the form of an object rather than function being the reference point for form. In other words, it describes an epoch in which teleological meaning is reversed from the standpoint of functionalism in favor of constructivism.
Hypermodernity
Hypermodernity emphasizes a hyperbolic separation between past and present due to the fact that:
The past oriented attributes and their functions around objects.
Objects that do exist in the present are only extant due to some useful attribute in the hypermodern era.
Hypermodernity inverts modernity to allow the attributes of an object to provide even more individuality than modernism. Modernity trapped form within the bounds of limited function; hypermodernity posits that function is now evolving so rapidly, it must take its reference point from form itself. Both positive and negative societal changes occur due to hyper-individualism and increased personal choice.
Postmodernity rejected the idea of the past as a reference point and curated objects from the past for the sole purpose of freeing form from function. In postmodernism, truth was ephemeral as the focus was to avoid non-falsifiable tenets. Postmodernity described a total collapse of modernity and its faith in progress and improvement in empowering the individual.
Supermodernity
If distinguished from hypermodernity, supermodernity is a step beyond the ontological emptiness of postmodernism and relies upon plausible heuristic truths. Whereas modernism focused upon the creation of great truths (or what Lyotard called "master narratives" or "metanarratives"), and postmodernity was intent upon their destruction (deconstruction); supermodernity operates extraneously of meta-truth. Instead, attributes are extracted from objects of the past based on their present relevance. Since attributes are both true and false, a truth value is not necessary including falsifiability. Supermodernity curates useful attributes from modern and postmodern objects in order to escape nihilistic postmodern tautology. Related authors are Terry Eagleton After Theory, and Marc Augé Non-Places: Introduction to an Anthropology of Supermodernity.
See also
Altermodern
Hypermodernism
Hypermodernism (chess)
Metamodernism
Bibliography
S. Charles and G. Lipovetsky, Hypermodern Times, Polity Press, 2006.
S. Charles, Hypermodern Explained to Children, Liber, 2007 (in French).
R. Colonna, L'essere contro l'umano. Preludi per una filosofia della surmodernità, Edises, Napoli, 2010 (in Italian).
F. Schoumacher, Eidolon: simulacre et hypermodernité, Paris, Balland, 2024.
External links
Gilles Lypovetsky interviewed by Denis Failly for his book "le bonheur paradoxal"
Modernity
Criticism of postmodernism | 0.764308 | 0.973492 | 0.744047 |
Metanoia (psychology) | Metanoia (from the Greek , metanoia, "changing one's mind") has been used in psychology since at least the time of American philosopher/psychologist William James to describe a process of fundamental change in the human personality.
The term derives from the Ancient Greek words μετά (metá) (meaning "beyond" or "after") and νόος (noeō) (meaning "perception" or "understanding" or "mind"), and takes on different meanings in different contexts.
Developments
William James used the term metanoia to refer to a fundamental and stable change in an individual's life-orientation. Carl Gustav Jung developed the usage to indicate a spontaneous attempt of the psyche to heal itself of unbearable conflict by melting down and then being reborn in a more adaptive form – a form of self healing often associated with the mid-life crisis and psychotic breakdown, which can be viewed as a potentially productive process. Jung considered that psychotic episodes in particular could be understood as an existential crisis which might be an attempt at self-reparation: in such instances metanoia could represent a shift in the balance of the personality away from the persona towards the shadow and the self.
Jung's concept of metanoia was an influence on R.D. Laing and his emphasis on the dissolution and replacement of everyday ego consciousness. Laing's colleague, David Cooper, considered that "metanoia means change from the depths of oneself upwards into the superficies of one's social appearance" – a process that in the second of its three stages "generates the 'signs' of depression and mourning". Similarly influenced was the therapeutic community movement. Ideally, it aimed to support people whilst they broke down and went through spontaneous healing, rather than thwarting such efforts at self-repair by strengthening a person's existing character defences and thereby maintaining the underlying conflict.
The Dutch psychiatrist Jan Foudraine wrote extensively about it, tracing its history through the work of Jung and Laing, and eventually considering it “a permanent change in gestalt.” He cites an example where one sees a black vase, then one blinks, and instead one sees two white faces in profile opposite each other (the Rubin vase).
In transactional analysis, metanoia is used to describe the experience of abandoning an old scripted self or false self for a more open one: a process which may be marked by a mixture of intensity, despair, self-surrender, and an encounter with the inner void.
See also
References
Further reading
James, William, (1890), The Principles of Psychology, (New York)
Jung, Carl, (1960), The Structure and Dynamics of the Psyche, CW 8. Princeton: Princeton University Press.
Jung, Carl, (1959), The Archetypes and the Collective Unconscious, CW 9i. Princeton: Princeton University Press.
Jung, Carl, (1959), Aion: Researches into the Phenomenology of the Self, Collected Works, 9ii. Princeton: Princeton University Press.
Jung, Carl, (1970), Civilization in Transition, CW 10. Princeton: Princeton University Press.
Jung, Carl, (1969), Psychology and Religion: West and East, CW 11. Princeton: Princeton University Press.
Jung, Carl, (1954), The Practice of Psychotherapy, CW 16. Princeton: Princeton University Press.
Jung, Carl, (1976), The Symbolic Life, CW 18. Princeton: Princeton University Press.
Keirsey, David & Marilyn Bates (1984), Please Understand Me, Del Mar CA: Prometheus Nemesis Books.
Schumacher, E.F. (1973), Small Is Beautiful: A Study of Economics As If People Mattered, New York: Harper & Row.
Tart, Charles (1987), Waking Up: Overcoming the Obstacles to Human Potential, Boston: Shambhala.
R. D. Laing, The Politics of Experience (Penguin 1984)
External links
Analytical psychology
Personal life
Philosophy of life
Midlife crisis | 0.760045 | 0.978886 | 0.743997 |
Virtual reality therapy | Virtual reality therapy (VRT), also known as virtual reality immersion therapy (VRIT), simulation for therapy (SFT), virtual reality exposure therapy (VRET), and computerized CBT (CCBT), is the use of virtual reality technology for psychological or occupational therapy and in affecting virtual rehabilitation. Patients receiving virtual reality therapy navigate through digitally created environments and complete specially designed tasks often tailored to treat a specific ailment; and is designed to isolate the user from their surrounding sensory inputs and give the illusion of immersion inside a computer-generated, interactive virtual environment. This technology has a demonstrated clinical benefit as an adjunctive analgesic during burn wound dressing and other painful medical procedures. Technology can range from a simple PC and keyboard setup, to a modern virtual reality headset. It is widely used as an alternative form of exposure therapy, in which patients interact with harmless virtual representations of traumatic stimuli in order to reduce fear responses. It has proven to be especially effective at treating PTSD, and shows considerable promise in treating a variety of neurological and physical conditions. Virtual reality therapy has also been used to help stroke patients regain muscle control, to treat other disorders such as body dysmorphia, and to improve social skills in those diagnosed with autism.
Description
Virtual reality therapy (VRT) uses specially programmed computers, visual immersion devices and artificially created environments to give the patient a simulated experience that can be used to diagnose and treat psychological conditions that cause difficulties for patients. In many environmental phobias, reaction to the perceived hazards, such as heights, speaking in public, flying, close spaces, are usually triggered by visual and auditory stimuli. In VR-based therapies, the virtual world is a means of providing artificial, controlled stimuli in the context of treatment, and with a therapist able to monitor the patient's reaction. Unlike traditional cognitive behavioral therapy, VR-based treatment may involve adjusting the virtual environment, such as for example adding controlled intensity smells or adding and adjusting vibrations, and allow the clinician to determine the triggers and triggering levels for each patient's reaction. VR-based therapy systems may allow replaying virtual scenes, with or without adjustment, to habituate the patient to such environments. Therapists who apply virtual reality exposure therapy, just as those who apply in-vivo exposure therapy, can take one of two approaches concerning the intensity of exposure. The first approach is called flooding, which refers to the most intense approach where stimuli that produce the most anxiety are presented first. For soldiers who have developed PTSD from combat, this could mean first exposing them to a virtual reality scene of their fellow troops being shot or injured followed by less stressful stimuli such as only the sounds of war. On the other hand, what is referred to as graded-exposure takes a more relaxed approach in which the least distressing stimuli are introduced first. VR-exposure, as compared to in-vivo exposure has the advantage of providing the patient a vivid experience, without the associated risks or costs. VRT has great promise since it historically produces a "cure" about 90% of the time at about half the cost of traditional cognitive behavior therapy authority, and is especially promising as a treatment for PTSD where there are simply not enough psychologists and psychiatrists to treat all the veterans with anxiety disorders diagnosed as related to their military service.
VRT is also a promising adjunctive therapy for the treatment of other clinical populations, such as individuals with psychosis. A recent systematic review of psychosocial interventions using virtual reality shows these interventions are safe and well accepted in this population. The studies identified in the review show that psychosocial VRT can improve cognitive, social, and vocational skills as well as symptoms of auditory verbal hallucinations and paranoia in individuals with psychosis.
Recently there have been some advances in the field of virtual reality medicine. Virtual reality is a complete immersion of the patient into a virtual world by putting on a headset with an LED screen in the lenses of the headset. This is different from the recent advancements in augmented reality. Augmented reality is different in the sense that it enhances the non-synthetic environment by introducing synthetic elements to the user's perception of the world. This in turn "augments" the current reality and uses virtual elements to build upon the existing environment. Augmented reality poses additional benefits and has proven itself to be a medium through which individuals with a specific phobia can be exposed "safely" to the object(s) of their fear, without the costs associated with programming complete virtual environments. Thus, augmented reality can offer an efficacious alternative to some less advantageous exposure-based therapies.
History
Virtual reality therapy (VRT) was pioneered and originally termed by Max North documented by the first known publication (Virtual Environment and Psychological Disorders, Max M. North, and Sarah M. North, Electronic Journal of Virtual Culture, 2,4, July 1994), his doctoral VRT dissertation completion in 1995 (began in 1992), and followed with the first known published VRT book in 1996 (Virtual Reality Therapy, an Innovative Paradigm, Max M. North, Sarah M. North, and Joseph R. Coble, 1996. IPI Press. ). His pioneered virtual reality technology work began as early as 1992 as a research faculty at Clark Atlanta University and supported by funding from U.S. Army Research Laboratory.
An early exploration in 1993–1994 of VRT was done by Ralph Lamson a USC graduate then at Kaiser Permanente Psychiatry Group. Lamson began publishing his work in 1993. As a psychologist, he was most concerned with the medical and therapeutic aspects, that is, how to treat people using the technology, rather than the apparatus, which was obtained from Division, Inc. Psychology Today reported in 1994 that these 1993–1994 treatments were successful in about 90% of Lamson's virtual psychotherapy patients. Lamson wrote in 1993 a book entitled Virtual Therapy which was published in 1997 directed primarily to the detailed explanation of the anatomical, medical and therapeutic basis for the success of VRT. In 1994–1995, he had solved his own acrophobia in a test use of a third party VR simulation and then set up a 40 patient test funded by Kaiser Permanente. Shortly thereafter, in 1994–1995, Larry Hodges, then a computer scientist at Georgia Tech active in VR, began studying VRT in cooperation with Max North who had reported anomalous behavior in flying carpet simulation VR studies and attributed such to phobic response of unknown nature. Hodges tried to hire Lamson without success in 1994 and instead began working with Barbara Rothbaum, a psychologist at Emory University to test VRT in controlled group tests, experiencing about 70% success among 50% of subjects completing the testing program.
In 2005, Skip Rizzo of USC's Institute for Creative Technologies, with research funding from the Office of Naval Research (ONR), started validating a tool he created using assets from the game Full Spectrum Warrior for the treatment of posttraumatic stress disorder. Virtual Iraq was subsequently evaluated and improved under ONR funding and is supported by Virtually Better, Inc. They also support applications of VR-based therapy for aerophobia, acrophobia, glossophobia, and substance abuse. Virtual Iraq proved successful in normalization of over 70% of people with PTSD, and that has now become a standard accepted treatment by the Anxiety and Depression Association of America. However, the VA has continued to emphasize traditional prolonged exposure therapy as the treatment of choice, and VR-based therapies have gained only limited adoption, despite active promotion by DOD, and despite VRT having much lower cost and apparently higher success rates. A $12-million ONR funded study is currently underway to definitively compare the efficacy of the two methods, PET and VRT. Military labs have subsequently set up dozens of VRT labs and treatment centers for treating both PTSD and a variety of other medical conditions. The use of VRT has thus become a mainstream psychiatric treatment for anxiety disorders and is finding increasing use in the treatment of other cognitive disorders associated with various medical conditions such as addiction, PTSD and schizophrenia.
Applications
Psychological therapy
Exposure therapy
Virtual reality technology is especially useful for exposure therapy – a treatment method in which patients are introduced and then slowly exposed to a traumatic stimulus. Inside virtual environments, patients can safely interact with a representation of their phobia, and researchers don't need to have access to a real version of the phobia itself. One of the primary challenges to the efficacy of Exposure therapy is recreating the level of trauma existing in real environments inside a virtual environment. Virtual reality aids in overcoming this by engaging with different sensory stimuli of the patient while heightening the realism and maintaining the safety of the environment.
One very successful example of virtual reality therapy exposure therapy is the PTSD treatment system, Virtual Iraq. Using a head mounted display and a game pad, patients navigate a Humvee around virtual recreations of Iraq, Afghanistan, and the United States. By being safely exposed to the traumatic environments, patients learned to reduce their anxiety. According to a review of the history of Virtual Iraq, one study found that it reduced PTSD symptoms by an average of fifty percent, and disqualified over seventy-five percent of participants for PTSD after treatment.
Virtual Reality Exposure Therapy (VRET) is also commonly used for treating specific phobias, especially small animal phobia. Commonly feared animals such as spiders can be easily produced in a virtual environment, instead of finding the real animal. VRET has also been used experimentally to treat other fears such as public speaking and claustrophobia.
Another successful study attempted treating 10 individuals who experienced trauma as a result of events during 9/11. Through repeated exposure to increasingly traumatic sequences of World Trade Center events, immediate positive results were self reported by test subjects. In a 6-month follow-up, 9 of the test subjects available for follow up maintained their results from exposure.
Virtual Reality Exposure Therapy (VRET) offers a wide range of advantages compared to traditional exposure therapy techniques. Recent years have suggested an increase in familiarly and trust in virtual reality technology as an acceptable mirror of reality. A higher trust in the technology could lead to more effective treatment results as more phobics seek out help. Another consideration for VRET is the cost effectiveness. While the actual cost of VRET may vary based on the hardware and software implementation, it is supposedly more effective than the traditional in vivo treatment used for exposure therapy while maintaining a positive return on investment. Future research might pave an alternative to extensive automated lab or hospital environments. For instance, in 2011, researchers at York University proposed an affordable virtual reality exposure therapy (VRET) system for the treatment of phobias that could be set up at home. Such developments in VRET may pave a new way of customised treatment that also tackles the stigma attached to clinical treatment. While there is still a lot unknown about the long-term effectiveness of the relatively new VRET, the future seems promising with growing studies reflecting the benefits of VRET to combat phobias.
Virtual rehabilitation
The term virtual rehabilitation was coined in 2002 by Professor Daniel Thalmann of EPFL (Switzerland) and Professor Grigore Burdea of Rutgers University (USA). In their view the term applies to both physical therapy and cognitive interventions (such as for patients with Post Traumatic Stress Disorder, phobias, anxieties, attention deficits or amnesia). Since 2008, the virtual rehabilitation "community" has been supported by the International Society on Virtual Rehabilitation.
Virtual rehabilitation is a concept in psychology in which a therapeutic patient's training is based entirely on, or is augmented by, virtual reality simulation exercises. If there is no conventional therapy provided, the rehabilitation is said to be "virtual reality-based". Otherwise, if virtual rehabilitation is in addition to conventional therapy, the intervention is "virtual reality-augmented." Today, a majority of the population uses the virtual environment to navigate their daily lives and almost one fourth of the world population uses the internet. As a result, virtual rehabilitation and gaming rehabilitation, or rehabilitation through gaming consoles, have become quite common. In fact, virtual therapy has been used over regular therapeutic methods in order to treat a number of disorders.
Some factors to consider when virtual rehabilitation include cultural sensitivity, accessibility, and ability to finance the virtual therapy.
Advantages
Virtual rehabilitation offers a number of advantages compared to conventional therapeutic methods:
It is entertaining, thus motivating the patient;
Potential for involvement of the patients' stimulus modalities for more realistic environments for treatment.
It provides objective outcome measures of therapy efficacy (limb velocity, range of movement, error rates, game scores, etc.);
These data are transparently stored by the computer running the simulation and can be made available on the Internet.
Virtual rehabilitation can be performed in the patient's home and monitored at a distance (becoming telerehabilitation)
The patient feels more actively involved in the desensitization
The patient may "forget" they are in treatment or undergoing observation resulting in more authentic expressions.
Effective for hospitals to reduce their costs because of lowered cost of medicine and equipment.
Great impact of virtual reality on pain relief
Disadvantages
Despite all the merits of VR therapy as listed in the sections above, there are pitfalls and obstacles in the development of widespread VR solutions.
Cost effectiveness: VRET may show promising returns on investment but the fact remains that the true development cost of VRET environments depends heavily on the choice of hardware and software chosen.
Treatment effectiveness: For the treatment to take effect, a patient should be able to successfully project and experience their anxiety in a virtual environment. Unfortunately, this projection is highly subjective and personalised per patient; and outside the control of the therapists. This limitation might adversely impact the therapy.
Migrating back to reality from virtual reality: Another skepticism is the correlation between virtual reality and actual reality. If a patient successfully combats their phobia in a virtual environment, does that guarantee success in real life too? Further, when treating more complicated ailments such as schizophrenia, there is inadequate projection on how delusions and hallucinations may translate from the real world to the virtual one.
VR sickness: Movement in a virtual environment is said to cause visual discomfort. Prolonged periods of exposure to VR may lead to side effects like dry eyes, headaches, nausea and sweating; symptoms similar to motion sickness.
Ethical and legal considerations: Since VR is a relatively new technology, its ethical implications are not as comprehensive as other forms of treatment. There is a need to formalize the limits, side effects, disclaimers, privacy regulations as we increase the breadth of impact of VR therapy; especially in matters related to forensic cases.
Acceptance by the medical community: As VR-based therapy increases, it might pose a challenge to licensed therapists and medical professionals who may perceive VR as a threat. Afterall, VR deviates from the pre-established norm of "talking cure" .
Therapeutical targets
Depression
In February 2006 the UK's National Institute of Health and Clinical Excellence (NICE) recommended that VRT be made available for use within the NHS across England and Wales, for patients presenting with mild/moderate depression, rather than immediately opting for antidepressant medication. Some areas have developed, or are trialing.
At Auckland University in New Zealand, a team led by Dr. Sally Merry have been developing a computerized CBT fantasy "serious" game to help tackle depression amongst adolescents. The game, Sparx, has a number of features to help combat depression, where the user takes on a role of a character who travels through a fantasy world, combating "literal" negative thoughts and learning techniques to manage their depression.
Schizophrenia
Avatar Therapy is a form of therapy that can be delivered through virtuality reality designed for people with schizophrenia who experience distressing auditory hallucinations, particularly hearing hostile voices. In this therapy, patients engage in real-time, face-to-face dialogue with a digital avatar that represents the voice they hear. The therapist operates the avatar, allowing it to verbally communicate with the patient in a controlled and safe environment. Over time, the patient learns to confront and reduce the power of the hallucination, often finding relief from its intensity and frequency. Avatar therapy aims to help patients gain control over their symptoms, reduce distress, and improve overall mental health.
This therapy is grounded in the idea that giving a “face” and voice to auditory hallucinations can help individuals reframe their relationship with these experiences. Avatar therapy has shown promising results in clinical trials, demonstrating improvements in reducing the impact of auditory hallucinations compared to standard treatment options. It is part of a broader effort to utilize VR and other innovative technologies in mental health care for conditions like schizophrenia.
Eating disorders and body dysmorphia
Virtual reality therapy has also been used to attempt to treat eating disorders and body dysmorphia. One study in 2013 had participants complete various tasks in virtual reality environments which could not have been easily replicated without the technology. Tasks included showing patients the implications of reaching their desired weight, comparing their actual body shape to an avatar created using their perceived body size, and altering a virtual reflection to match their actual body size.
Gender dysphoria
Early research suggests that virtual reality experiences may offer therapeutic benefits to transgender individuals experiencing gender dysphoria. More experimentation and professional examination is needed before virtual reality could be prescribed as a treatment in practice. However, some transgender individuals have engaged in what can be characterized as an anecdotally alleviating form of self-administered, virtual sex reassignment therapy. Digital spaces offer a form of anonymous self-expression that trans individuals, due to exposure of discrimination and violence, are not fully granted to them in real life or IRL. The sophistication of virtual reality expands on these newfound liberties by providing an avenue for those with gender dysphoria to embody their gender identity, if it not accessible for them to do so in their real life. Through use of available VR videogames and chat rooms, those with gender dysphoria can create avatars of themselves, interact anonymously, and work towards therapeutic goals.
Acrophobia
A study published in The Lancet Psychiatry proved that virtual reality therapy can help treat acrophobia. Over the course of the study, participants were introduced to intimidating heights in a virtual reality environment then asked to complete various activities at those heights while under the supervision and support of a coach. This study, although insufficient in terms of scope and scrutiny for direct adoption into remedial practices, surrounds future research and treatment modeling with promise, as a majority of the participants considered themselves no longer afraid of heights.
Physical therapy
Stroke
Research suggests that patients who had a stroke found virtual reality (VR) rehab techniques in their Physical Therapy treatment plans very beneficial. Throughout a rehabilitation program aimed to restore and/or retain balance and walking skills, patients who have had a stroke often must relearn how to control certain muscles. In most physical therapy settings, this is done through high intensity, repetitive, and task-specific practice. Programs of this type can prove to be physically demanding, are expensive, and require several days of training per week. Additionally, regimens may seem redundant, and produce only modest and/or delayed effects in patient recovery. A physical therapy regimen using VR provides an opportunity to individualize training to fit the specific needs of the patient. While the exercises and movements required for proper motor learning can seem repetitive, using VR adds a level of intrigue and engagement for the patient. Training with VR enhances motor learning by giving the patient opportunities to practice their movements/exercise protocol in different VR environments. This ensures that patients are always challenged and may be better prepared to perform in their environments. Feedback is an important element of physical therapy for patients recovering from stroke and/or other neuromuscular disorders. Within the scope of motor learning, receiving feedback during performance of a task improves the learning rate. According to a Cochrane Review, visual feedback, specifically, has been shown to aid in balance recovery for patients who have had a stroke. VR can provide continuous visual feedback that a physical therapist may not be able to during their sessions. Results have also suggested that in addition to improvements in balance, positive effects are also seen in walking ability. In one study, patients with VR training coupled with their physical therapy program had better improvements in walking speed than others not using VR training. The most recent review about the effect of VR training on balance and gait ability showed significant benefits of VR training on gait speed, Berg Balance Scale (BBS) scores, and Timed "Up & Go" Test scores when VR was time dose matched to conventional therapy.
Parkinson's disease
Many studies (Cochrane Review) have shown that using VR technology during physical therapy treatments for patients with Parkinson's disease had positive outcomes. For patients with PD the VR therapy:
Increased gait and balance.
Improved functions of activities of daily living (ADL's).
Improved quality of life.
Improved cognitive function.
It is speculated that these improvements occurred because the VR gave increased feedback to the patient regarding their performance during the VR sessions. VR stimulates a patient's motor and cognitive processes, both of which may be impaired as a result of the disease. Another benefit of VR is that it replicates real life scenarios, allowing patients to practice functional activities.
Wound care
Additionally, VR provides beneficial outcomes when it is implemented for patients who are receiving wound care rehabilitation. Studies have speculated that the more immersive the VR, the greater the experience and concentration the patient will have on the virtual environment. Equally important, VR has shown to reduce pain, anxiety and depressive symptoms, as well as an increasing their treatment adherence.
In other studies, the results point to the benefits of VR in relation to increased distraction, and patients reported less time thinking about pain, less intense pain and immersion, which facilitates care such as dressing changes and physiotherapy.
Wound dressing often generates a pain-provoking experience. Therefore, use of VR was related to more efficient dressings, increased distraction from the pain during procedures (e.g. dressing and physical rehabilitation) which reduced the patients' stress and anxiety.
Cardiovascular
The use of VR and video games could be considered as complementary tools for physical training in patients with Cardiovascular diseases. Certain games designed for exercise have been shown to promote increases in heart rate, fatigue perception, and physical activity. In addition, it has been shown to reduce pain and increase adherence to physical therapy programs in patients with cardiovascular diseases. Finally, virtual reality and video games enhance motivation and adherence in cardiac rehabilitation programs.
Occupational therapy
Autism
Virtual reality has been shown to improve the social skills of young adults with autism. In one study, participants controlled a virtual avatar in different virtual environments and maneuvered through various social tasks such as interviewing, meeting new people, and dealing with arguments. Researchers found that participants improved in the areas of emotional recognition in voices and faces and in considering the thoughts of other people. Participants were also surveyed months after the study for how effective they thought the treatments were, and the responses were overwhelmingly positive. Many other studies have also explored this occupational therapy option.
Attention deficit hyperactivity disorder
A clinical trial published in the Journal of Attention Disorders found that school age children with ADHD who underwent a virtual classroom cognitive treatment series were able to achieve the same management of symptoms of impulsivity and distractibility as children who were medicated with a stimulant.
Post-traumatic stress disorder
It may also be possible to use virtual reality to assist those with PTSD. The virtual reality allows the patients to relive their combat situations at different extremes as a therapist can be there with them guiding them through the process. Some scholars believe that this is an effective way to treat PTSD patients as it allows for the recreation of exactly what they experienced. "It allows for greater engagement by the patient and, consequently, greater activation of the traumatic memory, which is necessary for the extinction of the conditioned fear."
Stroke
Virtual reality also has applications in the physical side of occupational therapy. For stroke patients, various virtual reality technologies can help bring fine control back to different muscle groups. Therapy often includes games controlled with haptic-feedback controllers that require fine movements, such as playing piano with a virtual hand. The Wii gaming system has also been used in conjunction with virtual reality as a treatment method.
Chronic and acute pain
Virtual reality (VR) has been shown to be effective in immediately decreasing procedural or acute pain. To date there have been few studies on its efficacy in chronic pain. Such chronic pain patients can tolerate the VR session without the side effects that sometimes come with VR such as headaches, dizziness or nausea.
Neurological Rehabilitation
Virtual reality is also helping patients overcome balance and mobility problems resulting from stroke or head injury. In the study of VR, the modest advantage of VR over conventional training supports further investigation of the effect of video-capture VR or VR combined with conventional therapy in larger-scale randomized, more intense controlled studies. It shows the VR-assisted patients had better mobility when the doctors checked in two months later. Other research has shown similarly successful outcomes for patients with cerebral palsy undergoing rehab for balance problems.
Therapeutic goals of VR in children with cerebral palsy target balance, walking, and enhancing function of real-world activities. Several randomized controlled trials found that VR therapy significantly improved balance and walking in children with cerebral palsy. Studies also found significant improvements in upper extremity function and postural control after VR therapy. VR interventions were more effective in younger patients, likely as there is greater neuroplasticity during development.
Advantages of VR include increased patient motivation through gamification and the creation of virtual spaces that are safe and therapeutically supportive. Children may repeat therapeutic tasks more often than with conventional modalities alone, more easily meeting the repetitions required for structural, neurological change. Functional MRI studies of cerebral palsy patients with upper limb involvement suggest that VR therapy can lead to neuroplastic changes in the sensory motor cortex, and subsequent improvements in motor function.
Provider peer training and VR therapies collaboratively developed by engineers, providers, and patients, lead to improved outcomes in provider competency and patient motor function. While commercially available VR gaming systems can be therapeutically effective, VR systems engineered to meet specific therapeutic needs additionally account for engagement in tasks, relevance of the virtual environment, appropriate feedback sensors and monitors. VR that mimics the complexity of real-world tasks improves skills transfer from virtual to real environments. Complex tasks permit infinite path variability for each movement necessary to complete the task. Multiple possible solutions allow the patient to critically think through a task and to develop adaptive solutions for their body, further improving outcomes.
Surgery
VR smoothly blurs the demarcation between the physical world and the computer simulation as surgeons can use latest versions of virtual reality glasses to interact in a three-dimensional space with the organ that requires surgical treatment, view it from any desired angle and able to switch between 3D view and the real CT images.
Efficiency
Randomized, tightly controlled, acrophobia treatment trials at Kaiser Permanente provided >90% effectiveness, conducted in 1993–94. (Ext. Ref. 2, pg. 71) Of 40 patients treated, 38 showed marked reduction in phobic reaction to heights and self-reported reaching their goals. Research found that VRT allows patients to achieve victory over virtual height situations they could not confront in real life, and that gradually increasing the height and danger in a virtual environment produced increasing victories and greater self-confidence in the patient that they could actually confront the situation in real life. "Virtual therapy interventions empower people. The simulation technology of virtual reality lends itself to mastery oriented treatment ... Rather than coping with threats, phobics manage progressively more threatening aspects in a computer-generated environment ... The range of applications can be extended by enhancing the realness and interactivity so that actions elicit reactions from the environments in which individuals immerse themselves" (Ext. Ref. 3, pg. 331–332).
Another study examined the effectiveness of virtual reality therapy in treating military combat personnel recently returning from the current conflicts in Iraq and Afghanistan. Rauch, Eftekhari and Ruzek conducted a study with a sample of 42 combat servicemen who were already diagnosed with chronic PTSD (post-traumatic stress disorder). These combat servicemen were pre-screened using several different diagnostic self-reports including the PTSD military checklist, a screening tool used by the military in the determination of the intensity of the diagnosis of PTSD by measuring the presence of PTSD symptoms. Although 22 of the servicemen dropped out of the study, the results of the study concerning the 20 remaining servicemen still has merit. The servicemen were given the same diagnostic tests after the study which consisted of multiple sessions of virtual reality exposure and virtual reality exposure therapy. The servicemen showed much improvement in the diagnostic scores, signaling a decrease of symptoms of PTSD. Likewise, a three-month follow-up diagnostic screening was also administered after the initial sessions that were undergone by the servicemen. The results of this study showed that 15 of the 20 participants no longer met diagnostic criteria for PTSD and improved their PTSD military checklist score by 50% for the assessment following the study. Even though only 17 of the 20 participants participated in the 3-month follow-up screening, 13 of the 17 still did not meet the criteria for PTSD and maintained their 50% improvement in the PTSD military checklist score. These results show promising effects and help to validate virtual reality therapy as an efficacious mode of therapy for the treatment of PTSD (McLay, et al., 2012).
VR combined real instrument training was effective at promoting recovery of patients' upper-extremity and cognitive function, and thus may be an innovative translational neurorehabilitation strategy after stroke. In the study, the experimental group showed greater therapeutic effects in a time-dependent manner than the control group, especially on the motor power of wrist extension, spasticity of elbow flexion and wrist extension, and Box and Block Tests. Patients in the experimental group, but not the control group, also showed significant improvements on the lateral, palmar, and tip pinch power, Box and Block, and 9-HPTs from before to immediately after training.
Continued development
Larry Hodges, formerly of Georgia Tech and now Clemson University and Barbara Rothbaum of Emory University, have done extensive work in VRT, and also have several patents and founded a company, Virtually Better, Inc.
In the United States, the United States Department of Defense (DOD) continues funding of VRT research and is actively using VR in treatment of PTSD.
Millions of funding is being put towards developments and early trials in the realm of virtual reality as companies race for FDA approval for their medical applications.
BRAVEMIND software
In 2014, a virtual reality application used as a prolonged exposure (PE) therapy tool for military related trauma called BRAVEMIND was reported BRAVEMIND is as an acronym for Battlefield Research Accelerating Virtual Environments for Military Individual Neuro Disorders. Virtual reality exposure therapy (VRET) applications have been used to assist civilian populations with anxieties about flying, public speaking, and heights. BRAVEMIND has been studied in populations of military medics as well as survivors of military sexual assault and combat. This technology was developed by researchers at the University of the Southern California in collaboration with the U.S. Army Research Laboratory.
In 2004, reports stated that 40% of military members experience PTSD but only 23% seek medical help. Emory physicians described one of the strongest indicators of PTSD to be avoidance, saying this inhibits those affected from seeking treatment. PE requires that the patient close their eyes and relate the pertinent episode in as much detail as possible. The methodology was based on the concept that in facing the event, the charge of the triggers may be attenuated over time. The VRET application BRAVEMIND differs from PE in that the patient does not reimagine the episode but instead wears a headset that places them in the familiar environment. This headset is equipped with two screens (one for each eye), headphones, and a position monitor that shifts the visual scene to match the patient's head movements. Depending on the patient's experience they may be standing or sitting on top of a raised platform with a bass shaker. This allows for vibrations that simulate the experience of riding a military vehicle. Other accessories such as joysticks or mock machine guns are given to the patients, if appropriate, to enhance realism.
The clinician introduces triggers, such as gunfire, explosions, etc. into the virtual environment as they see fit. The clinician can also adapt sound and lighting conditions to match the patient's description. The researchers who developed the BRAVEMIND system reported that in a 20-patient trial, the patients' scores on the diagnostic PTSD checklist–military version (PCL-M) dropped from 54.4 pre-treatment to 35.6 post-treatment after eleven sessions. In another clinical trial, consisting of 24 active-duty soldiers, it was reported that after 7 sessions 45% no longer were identified as positive for PTSD while 62% demonstrated symptomatic improvement. These experimental results were compared with those of alternative PE treatments.
The BRAVEMIND software has 14 different environments available including military barracks, Iraqi markets, and desert roads. Included in these are environments specific to military sexual trauma (MST). Designed environments such as U.S. base settings, shower areas, latrines, remote shelters, and others were developed after consulting subject matter experts from Emory University.
Proponents of this research have said that with military based videogames being so prevalent, this technology may be more appealing to patients and reduce the stigma surrounding treatment. They also have argued that as research on PTSD unfolds, possible subtypes may respond to treatments differently, and therefore diversifying treatment options is best. Others have expressed reservations about the capacity to properly personalize VRET for individualized treatment and the use of ethnic stereotyping while developing Arab populated environments.
Treatment for lesions
Virtual reality therapy has two promising potential benefits for treatment of hemispatial neglect patients. These include improvement of diagnostic techniques and as a supplement to rehabilitation techniques.
Current diagnostic techniques usually involve pen and paper tests like the line bisection test. Though these tests have provided relatively accurate diagnostic results, advances in virtual reality therapy (VRT) have proven these tests to not be completely thorough. Dvorkin et al. used a camera system that immersed the patient into a virtual reality world and required the patient to grasp or move object in the world, through tracking of arm and hand movements. These techniques revealed that pen and paper tests provide relatively accurate qualitative diagnoses of hemispatial neglect patients, but VRT provided accurate mapping into a 3-dimensional space, revealing areas of space that were thought to be neglected but which patients had at least some awareness. Patients were also retested 10 months from initial measurements, during which each went through regular rehabilitation therapy, and most showed measurably less neglect on virtual reality testing whereas no measurable improvements were shown in the line bisection test.
Virtual reality therapy has also proven to be effective in rehabilitation of lesion patients with neglect. A study was conducted with 24 individuals with hemispatial neglect. A control group of 12 individuals underwent conventional rehabilitation therapy including visual scanning training, while the virtual reality group (VR) were immersed in 3 virtual worlds, each with a specific task. The programs consisted of
"Bird and Ball" in which a patient touches a flying ball with his or her hand and turns it into a bird
"Coconut", in which a patient catches a coconut falling from a tree while moving around
"Container" in which a patient moves a box carried in a container to the opposite side.
Each of the patients of VR went through 3 weeks of 5-day-a-week 30-minute intervals emerged in these programs. The controls went through the equivalent time in traditional rehabilitation therapies. Each patient took the star cancellation test, line bisection test, and Catherine Bergego Scale (CBS) 24 hours before and after the three-week treatment to assess the severity of unilateral spatial neglect. The VR group showed a higher increase in the star cancellation test and CBS scores after treatment than the control group (p<0.05), but both groups did not show any difference in the line bisection test and K-MBI before and after treatment. These results suggest that virtual reality programs can be more effective than conventional rehabilitation and thus should be further researched.
VR advantages over IVE
The preference of virtual reality exposure therapy over in-vivo exposure therapy is often debated, but there are many obvious advantages of virtual reality exposure therapy that make it more desirable. For example, the proximity between the client and therapist can cause problems when in-vivo therapy is used and transportation is not reliable for the client or it is impractical for them to travel as far as needed. However, virtual reality exposure therapy can be done from anywhere in the world if given the necessary tools. Going along with the idea of unavailable transportation and proximity, there are many individuals who require therapy but due to various forms of immobilizations (paralysis, extreme obesity, etc.) they can not physically be moved to where the therapy is conducted. Again, because virtual reality exposure therapy can be conducted anywhere in the world, those with mobility issues will no longer be discriminated against. Another major advantage is fewer ethical concerns than in-vivo exposure therapy.
Another advantage to virtual reality rehab over the traditional method is patient motivation. When presented with difficult tasks during a prolonged period, patients tend to lose interest in these tasks. This causes a decrease in compliance due to decreased motivation of completing a given task. Virtual reality rehab is advantageous in such a way that it challenges and motivates the patient to do more. With simple things like high scores, in-game awards, and ranks, not only are patients motivated to do their daily therapies, they are having fun doing it. Not only is this advantageous to the patients, it is advantageous to the physical therapist. With these high scores, and data the game or application collects, therapists can analyze the data to see progression. This progression can be charted and visually shown to the patient for increased motivation on their performance and the progression they have made thus far in their therapies. This data can then be charted with other participants doing similar tasks and can show how they compare to people with similar therapy regimens. This charted data in the program or game can then be used by researchers and scientists alike for further evaluation of optimal therapy regimens. A recent study done in 2016 where a VR based virtual simulation of a city named Reh@City was made. This city in virtual reality evoked memory, attention, visuo-spatial abilities and executive functions tasks are integrated in the performance of several daily routines. This study looked at Activities of Daily Living in post stroke patients and found it to have more of an impact than conventional methods in the recovery process.
Regulatory Approvals and Standards
The introduction of Virtual Reality Therapy (VRT) into the healthcare sector has prompted the need for regulatory standards and approvals to ensure the safety and efficacy of this technology. VRT has been recognized for its potential in providing therapeutic benefits across various medical conditions, including pain management, anxiety, rehabilitation, and mental health challenges. The regulatory landscape for VRT is evolving, with guidelines aiming to categorize these solutions under the medical devices framework, ensuring they meet the required safety, quality, and performance standards.
In the United States, VRT solutions are considered medical devices, subject to categorization and regulatory approval by the Food and Drug Administration (FDA). The classification of a VR solution as a medical device hinges on its intended use in diagnosis, treatment, cure, mitigation, or prevention of disease. The FDA categorizes medical devices into Class I, Class II, and Class III, based on their intended use and associated risks. VR solutions typically fall into Class II, requiring a pre-market notification or 510(k) clearance, demonstrating that the device is as safe and effective as a legally marketed device not subject to premarket approval.
The FDA’s approach towards VRT emphasizes the importance of device categorization, application procedures, and adherence to established regulatory controls. For instance, the EaseVRx system by AppliedVR received FDA approval through the De Novo premarket review pathway, highlighting the role of regulatory controls in classifying VRT solutions and ensuring their safety and efficacy.
Furthermore, the Federal Register highlighted the classification of a Virtual Reality Behavioral Therapy Device for Pain Relief into class II with special controls. This classification necessitates compliance with specific controls, including clinical performance testing and biocompatibility evaluation, to mitigate associated risks and protect patient safety.
As VRT continues to evolve, regulatory bodies like the FDA will remain instrumental in guiding the development and deployment of these technologies.
Concerns
There are a few ethical concerns concerning the use and development of using virtual reality simulation for helping clients/patients with mental health issues. One example of these concerns is the potential side effects and aftereffects of virtual reality exposure. Some of these side effects and aftereffects could include cybersickness (a type of motion sickness caused by the virtual reality experience), perceptual-motor disturbances, flashbacks, and generally lowered arousal (Rizzo, Schultheis, & Rothbaum, 2003). If severe and widespread enough, these effects should be mitigated via various methods by those therapists using virtual reality.
Another ethical concern is how clinicians should receive VRT certification. Due to the relative newness of virtual reality as a whole, there may not be many clinicians who have experience with the nuances of virtual reality exposure or VR programs' intended roles in therapy. According to Rizzo et al. (2003), virtual reality technology should only be used as a tool for qualified clinicians instead of being used to further one's practice or garner an attraction for new clients/patients.
Some traditional concerns with virtual reality therapy is the cost. Since virtual reality in the field of science and medicine is so primitive and new, the costs of virtual reality equipment would be a lot higher than some of the traditional methods. With medical costs growing at an exponential level this would be another cost that is added to the growing list of medical bills for a patient's recovery process. Regardless of the benefits with virtual reality rehab, the costs of the equipment and the resources for a virtual reality setup would make it difficult for it to be mainstream and available to all patients including the indigent population. However, a new market of lower cost virtual reality hardware is emerging, specifically with improved head-mounted displays.
In addition there are some issues which are related to virtual reality that can arise from its use such as social isolation where the users can become detached from real-world social connections and the overestimation of a person's abilities where users – especially the young – often fail to distinguish between their feats in real life and virtual reality.
References
Further reading
Next Stop: Virtual Psychology and Therapy; Current Topics in Psychology; Fenichel, M.; (2010)
External links
Burn Victim Sam Brown Treated With Virtual-Reality Video Game SnowWorld. GQ: Newsmakers
Virtual Reality Pain Reduction project of University of Washington Seattle and U.W. Harborview Burn Center.
PHOBOS Anxiety Management Virtual Reality Platform project of PsyTech LLC currently in development to be used as a professional virtual reality exposure therapy tool to treat a variety of patients' common phobias and anxiety disorders.
ShahrbanianSh; Ma X; Aghaei N; Korner-Bitensky N; Moshiri K; Simmonds MJ. Use of virtual reality (immersive vs. non immersive) for pain management in children and adults: A systematic review of evidence from randomized controlled trials. European Journal of Experimental Biology 2012, 2 (5): 1408–22.
American inventions
Virtual reality
Therapy | 0.762446 | 0.975714 | 0.743929 |
Normalization process theory | Normalization process theory (NPT) is a sociological theory, generally used in the fields of science and technology studies (STS), implementation research, and healthcare system research. The theory deals with the adoption of technological and organizational innovations into systems, recent studies have utilized this theory in evaluating new practices in social care and education settings. It was developed out of the normalization process model.
Origins
Normalization process theory, dealing with the adoption, implementation, embedding, integration, and sustainment of new technologies and organizational innovations, was developed by Carl R. May, Tracy Finch, and colleagues between 2003 and 2009. It was developed through ESRC funded research on Telehealth and through an ESRC fellowship to May. Its application to randomised controlled trials was led by Professor Elizabeth Murray of University College London, and chararacterised normalization process theory as a trial killer.
Through three iterations, the theory has built upon the normalization process model previously developed by May et al. to explain the social processes that lead to the routine embedding of innovative health technologies.
Content
Normalization process theory focuses attention on agentic contributions – the things that individuals and groups do to operationalize new or modified modes of practice as they interact with dynamic elements of their environments. It defines the implementation, embedding, and integration as a process that occurs when participants deliberately initiate and seek to sustain a sequence of events that bring it into operation. The dynamics of implementation processes are complex, but normalization process theory facilitates understanding by focusing attention on the mechanisms through which participants invest and contribute to them. It reveals "the work that actors do as they engage with some ensemble of activities (that may include new or changed ways of thinking, acting, and organizing) and by which means it becomes routinely embedded in the matrices of already existing, socially patterned, knowledge and practices". These have explored objects, agents, and contexts. In a paper published under a creative commons license, May and colleagues describe how, since 2006, NPT has undergone three iterations.
Objects
The first iteration of the theory focused attention on the relationship between the properties of a complex healthcare intervention and the collective action of its users. Here, agents' contributions are made in reciprocal relationship with the emergent capability that they find in the objects – the ensembles of behavioural and cognitive practices – that they enact. These socio-material capabilities are governed by the possibilities and constraints presented by objects, and the extent to which they can be made workable and integrated in practice as they are mobilized.
Agents
The second iteration of the theory built on the analysis of collective action, and showed how this was linked to the mechanisms through which people make their activities meaningful and build commitments to them. Here, investments of social structural and social cognitive resources are expressed as emergent contributions to social action through a set of generative mechanisms: coherence (what people do to make sense of objects, agency, and contexts); cognitive participation (what people do to initiate and be enrolled into delivering an ensemble of practices); collective action (what people do to enact those practices); and reflexive monitoring (what people do to appraise the consequences of their contributions). These constructs are the core of the theory, and provide the foundation of its analytic purchase on practice.
Contexts
The third iteration of the theory developed the analysis of agentic contributions by offering an account of centrally important structural and cognitive resources on which agents draw as they take action. Here, dynamic elements of social contexts are experienced by agents as capacity (the social structural resources, that they possess, including informational and material resources, and social norms and roles) and potential (the social cognitive resources that they possess, including knowledge and beliefs, and individual intentions and shared commitments). These resources are mobilized by agents when they invest in the ensembles of practices that are the objects of implementation.
Location within sociological theory
Normalization process theory is regarded as a middle range theory that is located within the 'turn to materiality' in STS. It therefore fits well with the case-study oriented approach to empirical investigation used in STS. It also appears to be a straightforward alternative to actor–network theory in that it does not insist on the agency of non-human actors, and seeks to be explanatory rather than descriptive. However, because normalization process theory specifies a set of generative mechanisms that empirical investigation has shown to be relevant to implementation and integration of new technologies, it can also be used in larger scale structured and comparative studies. Although it fits well with the interpretive approach of ethnography and other qualitative research methods, it also lends itself to systematic review and survey research methods. As a middle range theory, it can be federated with other theories to explain empirical phenomena. It is compatible with theories of the transmission and organization of innovations, especially diffusion of innovations theory, labor process theory, and psychological theories including the theory of planned behavior and social learning theory.
References
Sociological theories
Technological change
Science and technology studies | 0.777232 | 0.957147 | 0.743925 |
Kawa model | The Kawa model, named after the Japanese word for river, is a culturally responsive conceptual framework used in occupational therapy to understand and guide the therapeutic process. Developed by Japanese occupational therapists (OTs), the model draws upon the metaphor of a river to describe human occupation, which according to OTs refers to individuals' daily activities that make life meaningful. The overarching goal of the model is to "provide a culturally flexible model to aid occupational therapists to improve communication with clients, to better understand what a client finds meaningful and important, and to design optimal client-centered interventions."
In the model, the river represents the dynamic and ever-changing nature of life; it incorporates five main elements: water, river banks and space, rocks, and driftwood. In the model, "water (mizu) represents life flow and health, driftwood (ryuboku) represents personal assets and liabilities, rocks (iwa) represent life circumstances and problems, and the river walls (torimaki) represent physical and social environmental factors." The model emphasizes that each person's river is unique and influenced by cultural, social, and personal factors.
History
Along with a team of Japanese OTs, Dr. Michael Iwama first developed the Kawa model in 1999. Iwama aimed to develop an occupational therapy model that could be easily understood by clients, not just practitioners and scholars. Coming from a Canadian background, Iwama imagined a model that utilized boxes and squares with arrows between them, but his Japanese colleagues envisioned the river, in part due to the popularity of the song "Kawa no nagare no yō ni" ("Like the Flow of the River") by Hibari Misora, which depicted life as a river. Iwama's colleagues believed the metaphor of the river would resonate more deeply with their clients than Iwama's original idea because of their connection with nature, as well as their collectivistic perspective.
The Kawa model is the first in occupational therapy "developed from clinical practice outside of the Western English-speaking world through qualitative research." Because "Eastern culture emphasizes the harmony between the person and environmental factors, which is believed to enhance health and well-being[,] ... the model focuses heavily on the client’s environmental contexts and how that impacts the flow of harmony in life, rather than mainly focusing on the individual client."
In 2006, Iwama published The Kawa Model: Culturally Relevant Occupational Therapy, a textbook that provides an overview of the model. The model is now actively taught in over 500 OT programs and utilized on six continents.
Core concepts
Water
The concept of "water" represents an individual's life flow and priorities, including their cognition, emotion, physical impairments, occupations, roles, and life experiences. In nature, water often flows from a mountain, which would symbolize a person's birth, and runs into an ocean or other large body of water, which would represent the person's death. Because "water is fluid and ever changing," it reflects the dynamic nature of occupation and the constant interaction between individuals and their environment. Iwama and other proponents of the model suggest that without water flowing and moving, life is stagnant. Further, water is impacted by the structural environment, such as rocks and riverbanks, much like how an individual's "life flow can be shaped, enhanced, or diminished" by physical, social, and other environments. Beyond the water's ability to flow, OTs may ask clients to describe how the river is flowing, such as whether it is choppy or smooth.
According to the model, if the river has a “strong, deep, unimpeded flow,” the individual should experience optimal well-being.
River banks
The concept of "river banks" represents external factors that influence a person's life flow, including social and physical environments and contexts, as well as cultural norms, social expectations, family, and environmental conditions. These factors can support or hinder the person's occupational journey. However, in the most ideal circumstances, "these external elements would support and guide the client through difficult times just as the banks of the river support its flow."
Rocks
The concept of "rocks" represents obstacles, challenges, and life events that may disrupt or impact a person's occupational well-being. They can include physical or mental health conditions, personal difficulties, or environmental barriers. When visually depicting their life journey, individuals may consider the location and size of rocks, which would indicate when the event occurred, as well as how the individual perceives it. If an individual perceives an event or challenge as being highly impactful and disruptive to their life, the rock would be larger, whereas a smaller rock may represent a less significant challenge.
Driftwood
The concept of "driftwood" represents personal traits and skills individuals can use to navigate their occupational journey. Driftwood can include personal traits (e.g., being optimistic or determined); personal skill sets and experiences (e.g., being trained in carpentry); specific beliefs, values and principles; and/or material/social capital (e.g., financial wealth or strong social networks). Driftwood can have either a positive or negative impact on the river's flow. It should flow down the river, but it may become stuck on a rock and become an impediment; however, it may also unearth rocks to make them less challenging.
Spaces
The concept of "spaces" represents "opportunities for expanding flow and well-being in accordance with the client’s perspective and priorities." Using the metaphor, the overarching goal of occupational therapy is to increase spaces for water to flow through the river. OTs can work with their clients to decrease the size of rocks, widen the river banks, and/or better utilize driftwood. For the former, clients may find ways to eliminate burdens in their life and/or develop strategies to overcome those barriers. To widen the metaphorical river banks, OTs may work with clients to implement universal design methods into their daily lives and/or find other ways to alter the physical environment to make it less of a barrier. Lastly, OTs can work with clients to better utilize existing skill sets and attributes and/or develop new ones to help address barriers. Through these practices, the client's well-being should be positively impacted.
Use
When utilizing the Kawa model, OTs often begin by requesting their clients create a visual representation of their life using the river metaphor. During and after the client's creation, the OT will ask "open-ended, clarifying questions", which allow the OT and client "to explore life’s problems, to discuss support systems, and to brainstorm effective methods of problem resolution." This conversation helps ensure the client's drawing accurately portrays how they perceive their life. Importantly, the Kawa model is meant to be used as a flexible guide that can be utilized in multiple ways.
In an interview, Iwama discussed how the model may be used for individuals who may not be able to communicate their life flow for themselves, such as individuals with severe cognitive impairments, young children, or people with dementia. In these cases, Iwama suggested communicating with a group of people close to the individual to collectively discuss the individual's values, barriers, and priorities and thus, as a group, develop their personal Kawa model and collectively problem-solve how to help the individual's river flow.
Some researchers have also suggested using the model for interprofessional discussions regarding clients as a tool to promote team-building collaboration. Importantly, "teambuilding has been positively correlated with job satisfaction, and quality of client care," whereas "a lack of teamwork can lead to decrease morale/job satisfaction, decreased productivity and lost revenue, and decreased client satisfaction and quality of care."
In one study, Lape et al. used the Kawa model within a collaborative care team to facilitate communication about a patient's care needs. Using the model, the care team developed created a kawa depiction for a client that included perspectives from multiple care providers. Participants in the study found that using the model provided new opportunities for collaboration across the care team; they determined the tool could be effectively used within their profession.
Strengths
Studies utilizing and analyzing the Kawa model have recognized multiple strengths across various domains. The greatest finding across all use cases "was that the Kawa model provides a unique platform for open communication and deeper perspective." Other strengths include its ability to be culturally responsive and client-centered, as well as how it helps develop partnerships and collaboration.
Culturally responsive
More and more, OTs are recognizing that occupational therapy must be culturally aware and relevant to meet clients' diverse needs. In part, this is because an individual’s values, beliefs, ways of thinking and behaving depend upon their cultural backgrounds. Many OTs consider the Kawa model to be culturally responsive. This is, in part, because the model was developed outside the Western world and does not rely upon "Western cultural norms." For example, occupational therapy models often focus on the future, despite some cultures being more focused on the past and present. Additionally, because the model was developed by Japanese OTs, it has a more collectivistic focus than many Western models. In part, this means the model embraces "interdependence within the social environment" and the importance of relationships. Overall, "the tenets of autonomy, self-sufficiency, and individual control, or superiority of the environment, commonly promoted by traditional models of occupation, do not take precedence within the Kawa model."
Client-centered approach
More and more, OTs aim to keep their clients at the center of occupational therapy work, focusing on the client's perceived needs and priorities rather than focusing on pathologising clients' bodies. In part, this is because "a person’s view on what is meaningful to them is unique". That is, instead of deciding upon a set of practices considered universally beneficial, OTs focus on what clients personally find valuable in their life. For example, OTs may spend time helping clients meaningfully participate in hobbies they enjoy (e.g., playing guitar) rather than focusing solely on necessary living tasks (e.g., bathing) and work tasks (e.g., typing on a keyboard). Further, OTs are focusing on how they can teach client's skills, as well as how they can modify environments, to address their perceived needs.
Many OTs find that the Kawa model is highly client-centered, which helps OTs understand the client's perspectives and priorities. In part, this is because the model encourages OTs to discuss with clients what they perceive as barriers, strengths, and opportunities. Clients are also actively involved in goal-setting, which both centers the clients' values and increases their motivation to participate in therapy.
Partnerships and collaboration
Many OTs find that the Kawa model helps develop a therapeutic partnership between the client and the clinician. Because the model is client-centered, it requires discussion between the OT and the client, as well as collaboration between them throughout the process, including discussions regarding the client's values and priorities, goal-setting, and more.
Research has also found that the Kawa model helps facilitate interprofessional collaboration.
Limitations and criticisms
Both OTs and clients can find the conceptual framework difficult to understand. Multiple studies have found that OTs who are new to the Kawa model, as well as those new to occupational therapy, may struggle to use the model with clients. In part, this difficulty may result from an OT's lack of understanding regarding the model's foundational concepts. OTs' difficulty with use may also be due to their preconceptions of the model and metaphor. That is, OTs may have a specific belief about how the model should be used, and when a client has a "unique interpretation," they may find difficulty working with the client. Conversely, clients may struggle with the metaphor and/or be skeptical about its use. Iwama noted that "Westerners looking at the model for the first time may be concerned about where the ‘self’ is located in the model." This can be seen in some studies in which a participant described the river as "one big wave hitting me over and over again."
The model's ambiguity may also be cause for criticism and impact ease of use. Individual's ability to connect with the metaphor can impact how well clients communicate their occupational needs. Some researchers have also noted that the model doesn't focus on the individual's inner self, that is, the unique and independent part of them that is separate from their surroundings. They also posit that it doesn't pay enough attention to the idea of belonging, which involves being actively involved in a social group and having specific roles and routines. This ambiguity may also result in the OT imposing their own views and biases.
Further, the Kawa model relies upon in-depth discussions with clients. As such, OTs who do not have practice conversing with clients in-depth may struggle to understand their clients' perspectives and needs. However, OTs with proficient interviewing skills may be "more confident in facilitating and guiding the participants to complete their drawings without fear of errors."
References
Occupational therapy | 0.779854 | 0.953915 | 0.743914 |
Floortime | The floortime or Developmental, Individual-differences, Relationship-based (DIR) model is a developmental model for assessing and understanding any child's strengths and weaknesses. This model was developed by Stanley Greenspan and first outlined in 1979 in his book Intelligence and Adaptation.
Introduction
The Developmental, Individual-difference, Relationship-based (DIR) model is the formal name for a new, comprehensive, individualized approach to assess, understand, and treat children who have developmental delays (including, but not limited to: Autism Spectrum Disorder). Focusing on the building blocks of typical development, this approach is also referred to as the "Floortime" or "DIRFloortime" approach. However, Floortime is actually a strategy within the DIR model that emphasizes the creation of emotionally meaningful learning exchanges that encourage developmental abilities.
The goal of treatment within the DIR model is to build foundations for typical development rather than to work only on the surface of symptoms and behaviors. Here, children learn to master critical abilities that may have been missed along their developmental track. For example, Autism Spectrum Disorder (ASD) has three core/primary problems: (1) establishing closeness, (2) using emerging words or symbols with emotional intent, and (3) exchanging emotional gestures in a continuous way. Secondary symptoms (perseveration, sensory-processing problems, etc.) may also exist. Thus, treatment options are based on particular underlying assumptions. The DIR model is based on the assumption that the core developmental foundations for thinking, relating, and communicating can be favorably influenced by work with children's emotions and their effects.
The DIR model was developed to tailor to each child and to involve families much more intensively than approaches have in the past. Through the DIR model, cognition, language, and social and emotional skills are learned through relationships that involve emotionally meaningful exchanges. Likewise, the model views children as being individuals who are very different and who vary in their underlying sensory processing and motor capacities. As such, all areas of child development are interconnected and work together beneficially.
Floortime Model Approach
The Floortime Model is a developmental intervention focusing on affection, with a fundamental assumption that emotions are the foundation of a child's development. It involves meeting a child at his or her current developmental level, and challenging them to move up the hierarchy of milestones outlined in the DIR Model. Once the child connects with the adult specific techniques are used to challenge and entice the child to move up the developmental ladder.
The DIR/Floortime Model calls for 15 hours/week of parent and clinician-conducted intervention, with the parent implementing the method in 20- to 30- minute sessions for 8–12 times per day. During each Floortime session, the child takes the lead by using pretend play and conversations. Parents and often therapists follow the child with playful positive attention while tuning into the child's interests.
The DIR model is based on the idea that due to individual processing differences children with developmental delays, like ASD, do not master the early developmental milestones that are the foundations of learning. DIR outlines six core developmental stages that children with ASD have often missed or not mastered:
Stage One: Regulation and Interest in the World: Being calm and feeling well enough to attend to a caregiver and surroundings. Have shared attention.
Stage Two: Engagement and Relating: Interest in another person and in the world, developing a special bond with preferred caregivers. Distinguishing inanimate objects from people.
Stage Three: Two way intentional communication: Simple back and forth interactions between child and caregiver. Smiles, tickles, anticipatory play.
Stage Four: Continuous Social Problem solving: Using gestures, interaction, babble to indicate needs, wants, pleasure, upset. Get a caregiver to help with a problem. Using pre-language skills to show intention and become a creative and dynamic problem solver.
Stage Five: Symbolic Play: Using words, pictures, symbols to communicate an intention, idea. Communicate ideas and thoughts, not just wants and needs.
Stage Six: Bridging Ideas: This stage is the foundation of logic, reasoning, emotional thinking and a sense of reality.
Most typically developing children have mastered these stages by age 4 years. However, children with ASD struggle with or have missed some of these vital developmental stages.
Structure of the DIR Model and the Floortime Approach
The DIR Model and the Floortime Approach work in two general parts: Assessment and Intervention. Within each of these two categories, there are further steps and strategies.
Assessment
The initial step for assessment is [Screening]. The creator of the DIR Model, Stanly Greenspan, developed a measuring tool, the Greenspan Social-Emotional Growth Chart (GSEGC), to aid parents, caregivers and clinicians in this beginning step of assessment. This tool is a basic 35-item questionnaire that evaluates a child according to the social-emotional milestones he or she has met. This preliminary step is a quick method to screen children for risk or diagnosis of Autism Spectrum Disorder (ASD) or Pervasive Developmental Disorder (PDD).
Following the initial screening process is conducting a [Comprehensive Functional Developmental Evaluation]. A child that has been screened with the GSEGC and displays significant developmental delay will then proceed to this step. In this process, a single clinician or clinicians of multiple disciplines (i.e. pediatrics, speech therapy, occupational therapy, psychology, etc.) must spend a significant amount of time observing a child. Specifically, the clinician(s) must be able to characterize how the degree to which a child is able to interact with others as it relates to developmental level.
In the final step of Assessment an [Individual Developmental Profile] is created based on the Comprehensive Functional Developmental Evaluation performed on the child. This profile is made to characterize a child's socio-emotional capacities. Through this profile, the DIR Model is able to tailor its intervention strategies uniquely to each child.
Intervention
Once the Assessment phase is completed the Intervention period is initiated. There are four different areas that the Floortime Approach aims its interventions: 1) Home 2) Educational Programs 3) Therapies 4) Play Dates.
First, the strategies and exercises laid out in the Home Intervention are of great importance for a child. It involves three core interactions: floortime; semi-structured, problem-solving interactions; and motor, sensory, perpetual-motor, and visual-spatial physical activities. This home intervention, done primarily by the parents and family, is integral to the Floortime Approach.
Second, interventions can also be applied through Educational Programs. Just as in the Home Interventions, the three core interactions are utilized in schools. Instead of primary caregivers carrying out these interactions it will be the responsibility of the teachers, teacher assistants, or peers. As an added efficiency measure, Individualized Educational Plans (IEP) can be collaboratively created and tailored for a child by his or her primary caregivers, teachers, or clinician. The IEP is developed with the purpose of outlining the goals of improvement for a child's specific developmental needs.
Another component of the DIRFloortime Model Intervention is a multi-disciplinary approach through different therapies. According to a child's Individual Developmental Profile, primary caregivers or clinicians can determine what types of therapy will benefit a child based on his or her developmental need. . Greenspan highly recommends the use of adjuvant therapies including Speech Therapy, provided by Speech Language Pathologists, and Sensory Integration Therapy, provided by Occupational Therapists. As a child's primary occupation is play, Occupational Therapy is a particularly relevant field to the Floortime Method.
Effectiveness
In 2020, Boshoff et al. concluded in their systematic review over nine studies that an increase in children's socio-emotional development is observed through various outcome measures and consistent with the focus of the model. Other areas of development have received limited focus by existing studies.
The effectiveness of Floortime was examined in four randomized controlled trials in which the control group receive the usual therapies (e.g., speech therapy, occupational therapy). No evidence of effectiveness has been found across the many trials that have been performed
Language function in the Floortime groups did not improve beyond what was observed in the controls. No adverse effects of Floortime have been reported.
References
Further reading
Treatment of autism | 0.775063 | 0.959669 | 0.743804 |
Building typology | Building typology refers to building and documenting buildings according to their essential characteristics. In architectural discourse, typological classification tends to focus on building function (use), building form, or architectural style. A functional typology collects buildings into groups such as houses, hospitals, schools, shopping centers, etc. A formal typology groups buildings according to their shape, scale, and site placement, etc. (Formal building typology is also sometimes referred to as morphology (gk. morph).) Lastly, a stylistic typology borrows from art history and identifies building types by their expressive traits, e.g. Doric, Ionic, Corinthian (subtypes of classical), baroque, rococo, gothic, arts and crafts, international, post-modern, etc.
The three typological practices are interlinked. Namely, each functional type consists of many formal types. For example, the residential functional type may be split into formal categories such as the high rise tower, single family home, duplex, or townhouse. Similarly, while certain stylistic traits may be considered superfluous to a formal building type, style and form are nonetheless related since the conditions (political, economic, technological) that give rise to stylistic traits also enable or encourage certain forms to be expressed. In all three cases the typology serves as a framework for understanding the essential qualities of buildings on conceptually equal footing, apart from their individual, contingent characteristics.
Functional Typology
[More explanation needed.]
See a list of building types by use.
Stylistic Typology
[More explanation needed.]
See a list of architectural styles.
Formal Typology
History
Autonomous building types arose partly from the general Enlightenment predilection for categorization, a prelude to scientific discovery. At first types were intended as ideal models, which could be variously copied. In this sense types were commonly used forms (a basilica, for example), adapted over time in new buildings with quite different uses: from Roman fora to early church forms (St. Peter's Basilica), to 19th century train stations. The fact that these forms are very similar and are derived from each other is an important way of understanding typology: types are evolved over time and therefore can convey a sense of history or cultural continuity. The idea of building types as formal configurations was enhanced by J.N.L. Durand, who developed two important works: the Parallele (1799), a huge, handsome book that reproduced plans, elevations and sections of historic buildings at the same scale. He categorized them by formal types, so that their basic similarities could be recognized. Durand followed up with a second book that manipulated and reconfigured the classical elements of architecture—columns, walls, etc.—to adapt them to new, emerging uses. Durand's system, a language of architecture, demonstrated one essential characteristic of types: a way of designing that was neither entirely free of constraint nor overly prescribed.
Documenting a Formal Building Type
Documenting a formal building type is similar to any typological process insofar as the aim is to identify the minimum number of characteristics which make that type distinct. In a formal typology, building types are usually distinguished by their basic shape, site placement, and scale, but not by their specific architectural style, technology, chronology, geographical location or use. For example, a cursory formal analysis of the townhouse will identify the following "minimum essential formal characteristics." In contrast with single family homes that share no walls with adjacent buildings, the townhouse, or rowhouse, shares both party walls (save the corner lot) with its neighbors. While many variations of this formal type are found around the world, each the product of their local environment (color, material, height, fenestration, etc), they nonetheless share the qualities that individual units are placed side-by-side, between two and five stories, with narrow fronts on deep lots, accessed via separate entrances that are setback minimally from the street.
This procedure can be applied to most buildings. For example, several residential types exist in the US, such as garden apartments, townhouses, and high-rise housing. Each of these may have many subtypes. The brownstones in Harlem are different from the rowhouses in Brooklyn. And the large mansions commonly found on corner lots in many cities are distinct from the smaller houses that were built later in between them, even though both are types of "single family home." Anyone can identify types simply by observing the common buildings in a place. Architectural and urban designers document types more thoroughly by measuring them, dating them, noting similar changes to the type that arise over time, and identifying their recurring locations in the city.
Application to History
Historians, anthropologists, and architectural historians use the documentation of type as a key to other characteristics in a city, for example, events, political control, or economic changes. As theory tells us, when a type evolves over some time, this is an indication that conditions in the city have changed. Anne Moudon documents changes in the types of an Alamo Square neighborhood to tell a kind architectural, cultural and economic history. She also identifies the block, lot and street pattern as key to typological continuity. Multiple studies using this method have identified important building types, for example Chinese shophouses, Shanghai's Shikumen housing, terrace housing in Great Britain, Courtyard buildings in France, and the atrium houses found in many hot climates. Atrium types are also important for mosques, shopping malls, and some hotels.
Application to Building Design
Building types are critical to architects because they are a starting point for designing. One need not reinvent the form if a common building type, say an office building, is wanted. Most architects develop a sense of common building types over time, even without acknowledging their importance. Architects know the approximate dimensions, bulk, site placement, and internal circulation that dictates most types. This allows them to work quickly to determine the parts of the design problem which are unique: material, orientation, structure, specific dimensions, entrance, and so on. One school of thought in Italy, started by Saverio Muratori, recognizes the importance of typology in providing continuity in the city. These architects have been influential in recognizing the role of type for modern architecture, where the newest buildings are encouraged to actively assimilate many typological characteristics, without imitating historical styles.
"A Pattern Language"
A unique example of formal typological classification is A Pattern Language developed by Christopher Alexander. While Alexander does not focus on classifying complete buildings by type, he instead breaks down buildings into their components and then classifies those components by their essential qualities, which he calls "patterns." [More explanation needed.]
Application to Urban Design
Common types are the building blocks of the city. Usually, a neighborhood streets and lots are laid out so that the common type can be built there. This occurs today in suburban subdivisions, but it has been a pattern in history, as well. This combination of types, streets and lots is called an urban tissue, or a plan unit. When studying a city, a designer identifies the common tissue patterns in place and may decide to link to them, imitate them, or otherwise recognize them as an historical artifact. A movement of urban theorists and practitioners in the US, New Urbanism, has identified building typology as a key to defining more user-friendly places. In trying to preserve neighborhoods or building new ones, building types once again become the building blocks of the city, and may be codified in law as form-based codes.
References
Architectural education | 0.761793 | 0.976347 | 0.743775 |
Constructive developmental framework | The constructive developmental framework (CDF) is a theoretical framework for epistemological and psychological assessment of adults. The framework is based on empirical developmental research showing that an individual's perception of reality is an actively constructed "world of their own", unique to them and which they continue to develop over their lifespan.
CDF was developed by Otto Laske based on the work of Robert Kegan and Michael Basseches, Laske's teachers at Harvard University. The CDF methodology involves three separate instruments that respectively measure a person's social–emotional stage, cognitive level of development, and psychological profile. It provides three epistemological perspectives on individual clients as well as teams. These constructs are designed to probe how an individual and/or group constructs the real world conceptually, and how close an individual's present thinking approaches the complexity of the real world.
Overview
The methodology of CDF is grounded in empirical research on positive adult development which began under Lawrence Kohlberg in the 1960s, continued by Robert Kegan (1982, 1994), Michael Basseches 1984, and Otto Laske (1998, 2006, 2009, 2015, 2018). Laske (1998, 2009) introduced concepts from Georg Wilhelm Friedrich Hegel's philosophy and the Frankfurt School into the framework, making a strict differentiation between social–emotional and cognitive development.
Kegan (1982) described five stages of development, of which the latter four are progressively attained only in adulthood. Basseches (1984) showed that adults potentially transcend formal logical thinking by way of dialectical thinking, in four phases, measurable by a fluidity index. Both Kegan's and Basseches' findings were updated and refined by Laske in 2005 and 2008 respectively. In 2008 and 2015, Laske proposed that dialectical thought forms are an instantiation of Roy Bhaskar's four moments of dialectic (MELD; Bhaskar 1993), and that these ontological moments form a sequence M→E→L→D that underlies individual cognitive development (Laske 2015), providing a basis for a dialectical cognitive science as well as a cognitively oriented management science. Based on the concept of 'dialogical dialectic', Laske stressed the need for a dialogical, in contrast to a monological, social science. The CDF methodology involves three separate instruments that respectively measure a person's social–emotional stage ('what should I do and for whom?'), cognitive level of development ('what can I know and what therefore are my options?'), and psychological profile ('how am I doing right now?'). The first two tools (ED, CD) provide an epistemological, the third (NP) a psychological, perspective on a person or team. See the list of references below.
In CDF, social-emotional, cognitive, and psychological assessment are arrived at separately, as follows:
A person's social-emotional profile addresses the question "What should I do and for whom?"; it is evaluated based on a semi-structured 1-hour interview in terms of "stages" (created by Kegan-Lahey in 1988, refined by Laske 2005).
A person's cognitive profile addresses the question "What can I know and what consequently are my options?"; it is evaluated based on a semi-structured 1-hour interview in terms of "dialectical thought forms" and the fluidity of their use during the interview or in a written text (Basseches 1984; refined by Laske 2008).
A person's psychological profile addresses the question "How am I presently doing?"; it is evaluated based on Morris Aderman's Need-Press Questionnaire (NP) grounded in Henry Murray's theory of personality (Aderman 1970).
In CDF, each of these profiles by itself is considered a pure abstraction since it is only in their togetherness that the "hidden dimensions of a person's consciousness" can be empirically understood and made the basis of an intervention. Importantly, a CDF intervention requires dialectical thinking, in contrast to purely logical thinking as used in positivistic research. For this reason, CDF is a model of dialogical, not monological, research.
Social–emotional development
Stages of adult development
According to the developmental psychologist Robert Kegan, a person's self-concept evolves in a series of stages through their lifetime. Such evolution is driven alternately by two main motivations: that of being autonomous and that of belonging to a group. Human beings are "controlled" by these motivations in the sense that they do not have influence on them but are rather defined by them. Additionally, these motivations are in conflict and their relationship develops over a lifespan.
Kegan describes 5 stages of development, of which the latter 4 are progressively attained in adulthood, although only a small proportion of adults reach the fourth stage and beyond:
Stage 1: Purely impulse or reflex-driven (infancy and early childhood).
Stage 2: The person's sense of self is ruled by their needs and wishes. The needs and wishes of others are relevant only to the extent that they support those of the person. Effectively the person and others inhabit two "separate worlds" (childhood to adolescence).
Stage 3: The person's sense of self is socially determined, based on the real or imagined expectations of others (post-adolescence).
Stage 4: The person's sense of self is determined by a set of values that they have authored for themselves (rarely achieved, only in adulthood).
Stage 5: The person's sense of self is no longer bound to any particular aspect of themselves or their history, and they are free to allow themselves to focus on the flow of their lives.
CDF refers to such stages as "social–emotional" in that they relate to the way a person makes meaning of their experience in the social world. CDF holds that people are rarely precisely at a single stage but more accurately are distributed over a range where they are subject to the conflicting influences of a higher and a lower stage.
Assessing the social–emotional profile of a person
The social–emotional profile of person is assessed by means of an interview, referred to as the "subject–object" interview. In the interview, the interviewer offers prompts such as "success", "change", "control", "limits", "frustration", and "risk" and invites the interviewee to describe meaningful experiences under those headings. The interviewer serves as a listener, whose role is to focus the attention of the interviewee onto their own thoughts and feelings.
The interview is scored by identifying excerpts of speech that indicate a particular stage or sub-stage. Relevant sections are chosen from the transcript of the interview and analyzed for indications of the stage of development. The most frequent sub-stage revealed by the scoring is described as the interviewee's "centre of gravity". Stages scored at below the center of gravity are described as "risk" (of regression) while stages scored above the center of gravity are described as "potential" (for development). The distribution of scores is summarized by a "risk–clarity–potential" index (RCP) that can be used to characterize the nature of the developmental challenges facing a person.
Cognitive development
Eras of adult cognitive development
According to Jean Piaget, thinking develops in 4 stages from childhood to young adulthood. Piaget named these stages sensory-motor, pre-operational, concrete-operational, and formal-operational. Development of formal-operational thinking is considered to continue until approximately the 25th year of life. Subsequent researchers have concentrated on the now famous question of Kohlberg: "Is there a life after 25?" In CDF, the development of post formal-operational thinking in an adult is indicated primarily by the strength of dialectical thinking measured in thought form use fluidity.
Following Bhaskar (1993), in CDF, human thinking is seen as developing in four sequential phases or 'eras', termed 'common sense', 'understanding', 'reason' and finally 'practical wisdom'. The first three phases of thinking development can be related to the different thinking systems put forward by the philosophers Locke, Kant and Hegel. Each phase includes and transcends the thinking system of the previous phase. The final phase of 'practical wisdom' loops back to a higher form of 'common sense' in that it constitutes sophisticated thinking that has become second nature and is therefore effortless. In contrast to other adult development researchers such as Fischer and Commons, Laske describes post-formal cognitive development in terms of the use and co-ordination of dialectical thought forms and thought form constellations which were described by Basseches as mental schemata.
Four classes of dialectical thought forms
Dialectical thinking has its roots in Greek classical philosophy but is also found in ancient Hindu and Buddhist philosophy, and relates to the search for truth through reasoned argument. It finds its foremost expression in the work of the German philosopher Georg Hegel. Essentially, dialectics is viewed as the system by which human thought attempts to capture the nature of reality. Building on Bhaskar and Basseches, CDF uses a framework for dialectical thinking based on the idea that everything in reality is transient and composed of contradictions, part of a larger whole, related in some way to everything else, and subject to sudden transformation. This framework therefore distinguishes dialectical thinking in terms of four classes of dialectical thought forms that can be said to define reality:
Process (P) – constant change; emergence from absence: this class of thought forms describes how things or systems emerge, evolve and disappear;
Context (C) – stable structures: this class of thought forms describes how things are part of the structure of a larger, stable, organized whole. The contextualization of parts within a whole gives rise to different perspectives or points of view;
Relationship (R) – unity in diversity; totality: this class of thought forms describes how things (which are all part of a larger whole) are related and the nature of their common ground;
Transformation (T) – balance and evolution including breakdown: this class of thought forms describes how living systems are in constant development and transformation, potentially via a collapse of the previous form of organization, and subject to the influence of human agency.
In addition, CDF distinguishes seven individual thought forms for every class, making a total of 28 thought forms, representing a re-formulation of Basseches' 24 schematas.
The cognitive profile of a person
The cognitive profile describes the thinking tools at a person's disposal and shows the degree to which a person's thinking has developed as indicated by their use of dialectical thought forms in the four classes. The profile is derived by means of a semi-structured interview where the interviewer has the task of eliciting the interviewee's use of thought forms in a conversation about the interviewee's work and workplace. The text of the interview is subsequently analyzed and scored to give a series of mathematical indicators.
According to CDF, thinking that is highly developed is represented by the following features:
a balanced use of all four classes of dialectical thought forms (P, C, R, T)
a high index of systemic thinking—meaning the use of transformative thought forms (T) and
balanced use of critical and constructive thought forms (P+R) vs. (C+T)
Link between social–emotional development and cognitive development
Social–emotional and cognitive development are often seen as separate lines of development but Laske (2008) proposed that they are linked by "stages of reflective judgment" or "epistemic position", described as the view taken by a person on what constitutes "knowledge" and "truth". Epistemic position defines a person's ability to deal with uncertainty and insecurity in their knowledge of the world and, together with the stage of social–emotional development, reflects the "stance" that a person takes towards the world. Whilst cognitive development provides a person with "tools" for thinking consisting of thought forms derived from both logic and dialectics, the "stance" that a person takes determines whether they apply the thinking tools at their disposal.
Personality
Psychogenic needs and press
CDF employs the theory put forward by psychologist Henry Murray that much of human behavior is determined by the effort to satisfy certain psychological (or "psychogenic") needs, most of which are unconscious. Personality is thus seen as characteristic behavior emerging from the dynamic between a person's pattern of psychogenic needs and the environmental forces acting on that person—termed "press".
The need–press analysis draws on Sigmund Freud's model of the human psyche divided into the components of Id, Ego and Super-ego. In living, a person is subject to the unconscious yearnings of the Id, whilst consciously aspiring to certain ideals imposed by the Super-ego, which itself is influenced by the social context. It is the dynamic balance between the forces of Id and Super-ego and the work environment that determines a person's capacity for work. Imbalances between the social reality of work and a person's ideals lead to frustration, and imbalances between a person's unconscious needs and their ideals lead to a waste of energy or "energy sink."
The personality profile of a person
CDF assessment methodology uses a self-report psychometric questionnaire originated by Henry Murray's student Morris Aderman, called the need–press (NP) inventory.
The questionnaire assesses psychological characteristics in terms of three categories: self-conduct, task focus, and interpersonal perspective,, each of them defined by 6 variables assessed independently. The questionnaire compares a person's current needs with 1) what they would be like in an ideal (moral) world and 2) what they perceive they are offered in actuality (such as a specific cultural environment they are in tune or at odds with). Each category is composed of several categories (scales) such as: need for control, drive to achieve, affiliation etc. Comparisons and interpretation can be made between a person's scores for "Need", and their scores for ideal and actual "Press". Comparisons can also be made between a person's scores and those of the group of people with whom they are working. Finally, NP scores can be linked to developmental scores (ED & CD), whether of an individual or team.
Applications
Assessment of work capability
The assessment methodology employed by CDF was created to measure peoples' capability and capacity for work. The theory of work used by CDF is derived from the work of Elliott Jaques. According to Jaques, work is defined as the application of reflective judgment in order to pursue certain goals within certain time limits. This definition stresses the importance of how decisions are made in a complex world and the time-span within which decisions are carried out. While Jaques offers a strictly cognitive definition of work, CDF views the social–emotional aspects of work as equally important, also including the person's (manager's, CEO's) NP profile.
CDF distinguishes between two kinds of work capability, applied and potential. Applied capability refers to the resources that an individual can already apply in order to carry out work. Potential capability refers to the resources that an individual may be capable of applying in the future. An individual can decide at any time not to apply their potential work capability. Equally circumstances may impede a person from applying their potential capability. Work capability is therefore not the same as the capacity to deliver work but rather defines and limits it.
In CDF work capacity is measured in terms of the need–press personality profile, whilst applied capability is measured in terms of the 'cognitive score', i.e., the proportional use of thinking tools provided by the four classes of thought forms) shown up by the cognitive profile, and potential capability is measured in terms of the relationship (epistemological balance) of the cognitive systems thinking index (STI) relative to the social-emotional risk–clarity–potential index (RCP).
Organizational talent management
For Elliot Jaques, human organizations are structured managerially according to levels of accountability. Each level of accountability entails a higher level of complexity in the work required of the role-holder, termed "size of role". Jaques defined the notion of requisite organization, where roles in an organization are hierarchically organized at specific levels of increasing complexity.
The application of CDF as an assessment methodology to measure the "size of person" in terms of their work capability and capacity provides a way forward for talent management systems to match the "size of person" to the "size of role". Progressively more complex roles require progressively higher levels of social–emotional development and cognitive development in the role-holder. In this way requisite organizations can align their human capability architecture with their managerial accountability architecture and design "growth assignments" that facilitate the development of capability for more complex roles.
Coaching
CDF provides a platform for professional coaching such as in leadership development and management development in a variety of ways. Firstly it provides assessment tools from which the coach can construct an integrated model of the coachee complete with the developmental challenges of the client who is to be helped. Secondly, and in the sense used by Edgar Schein the use of the assessment tools and the feedback of results by the coach is an act of "process consultation" by which the client may come to understand better the assumptions, values, attitudes and behaviors that are helping or hindering their success. Thirdly, CDF provides tools for deeper and more sophisticated thinking, thereby enabling the client to explore and expand their conceptual landscape of a problem.
CDF distinguishes between behavioral and developmental coaching. The goal of behavioral coaching is to improve the client's actual performance at work, described in CDF terms as their applied capability. In contrast, the goal of developmental coaching is to illuminate and develop the client's current and emergent capabilities for work in the context of their cognitive and social–emotional development.
Self-organization in teams
As shown in the book Dynamic Collaboration: Strengthening Self Organization and Collaborative Intelligence in Teams, by Jan De Visch and Otto Laske (2018), CDF can be a tool for building in organizations a dialogical culture by which distributed leadership in organizations can be realized.
See also
Model of hierarchical complexity
Neo-Piagetian theories of cognitive development
Positive adult development
References
Literature
Basseches, Michael: Dialectical thinking and adult development. Ablex Publishing, Norwood, NJ 1984, .
Bhaskar, Roy: Dialectic. The pulse of freedom. Verso, London & New York 1993, .
De Visch, Jan: The vertical dimension. 2010,
De Visch, Jan & Otto Laske (2018): Dynamic collaboration: Strengthening self-organization and collaborative intelligence in teams,().
Hager, August: Persönlichkeitsentwicklung wird messbar: verborgene Dimensionen menschlicher Arbeit entdecken und messen. In: Wirtschaftspsychologie, Nr. 1/2010, , pp17–23.
Jaques, Elliott: Requisite organization: the CEO's guide to creative structure and leadership. Cason Hall, Arlington, VA 1989, .
Jaques, Elliott: The life and behaviour of living organisms. A general theory. Praeger, London 2002, .
Kegan, Robert: In over our heads: the mental demands of modern life. Harvard University Press, Cambridge, MA 1994, .
Kegan, Robert: The evolving self: problem and process in human development. Harvard University Press, Cambridge, MA 1982, .
King, Patricia M. & Kitchener, Karen S.: Developing reflective judgment. Jossey-Bass, San Francisco, CA 1994, .
Lahey L, Souvaine E, Kegan R, Goodman R, Felix S: A guide to the subject-object interview: Its administration and interpretation. Minds at Work, Cambridge, MA 2011 .
Laske, Otto E. (2018), Interdevelopmental Institute Blogs, http://www.interdevelopmentals.org/?page_id=4831.
Laske, Otto E: Dialectic as core discipline of integral epistemology: Establishing Bhaskar's MELD as the corner stone of professional thinking about human flourishing. Integral Journal of Theory and Practice, vol. 10 no. 2 (2016).
Laske, Otto E.: How Roy Bhaskar extended and deepened the notion of cognitive adult development, Integral Leadership Review, Summer (2016).
Laske, Otto E: Dialectical thinking for integral leaders: a primer. Integral Publishers, Tucson, AZ (2015), .
Laske, Otto E. (Hrsg.): The Constructive Developmental Framework – Arbeitsfähigkeit und Erwachsenenentwicklung. Wirtschaftspsychologie, Nr. 1/2010, .
Laske, Otto E.: À la découverte du potentiel humain: Les processus de développement naturel de l'adulte. Gloucester, MA: Interdevelopmental Institute Press 2012.
Laske, Otto E.: Humanpotenziale erkennen, wecken und messen. Handbuch der entwicklungsorientierten Beratung. Bd. 1. Interdevelopmental Institute Press, Medford, MA 2010, .
Laske, Otto E.: Measuring hidden dimensions. Foundations of requisite organization. Volume 2. Interdevelopmental Institute Press, Medford, MA 2009, .
Laske, Otto E.: Measuring hidden dimensions. The art and science of fully engaging adults. Volume 1. Interdevelopmental Institute Press, Medford, MA 2006, .
Laske, Otto E: Transformative effects of coaching on executives' professional agenda. PsyD dissertation. Bell & Howell Company, Boston, MI 1999.
Ogilvie, Jean: Cognitive development: a new focus in working with leaders. In: Wirtschaftspsychologie, Nr. 1/2010, , pp70–75.
Schweikert, Simone: CDF als Bildungswerkzeug für Menschen im Zeitalter der Wissensökonomie. In: Wirtschaftspsychologie, Nr. 1/2010, , pp90–95.
Shannon, Nick: CDF: towards a decision science for organisational human resources? A practitioner's view. In: Wirtschaftspsychologie, Nr. 1/2010, , pp34–38.
Stewart, John, John Stewart reviews Laske on dialectical thinking, Integral Leadership Review 8/31/2016.
External links
Interdevelopmental Institute (IDM)
Need–Press Analysis
Constructivism (psychological school)
Developmental psychology
Organizational theory
Cognition | 0.761319 | 0.976898 | 0.743731 |
Structure of observed learning outcome | The structure of observed learning outcomes (SOLO) taxonomy is a model that describes levels of increasing complexity in students' understanding of subjects. It was proposed by John B. Biggs and Kevin F. Collis.
The model consists of five levels of understanding:
Pre-structural – The task is not attacked appropriately; the student hasn't really understood the point and uses too simple a way of going about it. Students in the pre-structural stage of understanding usually respond to questions with irrelevant comments.
Uni-structural – The student's response only focuses on one relevant aspect. Students in the uni-structural stage of understanding usually give slightly relevant but vague answers that lack depth.
Multi-structural – The student's response focuses on several relevant aspects but they are treated independently and additively. Assessment of this level is primarily quantitative. Students in the multi-structural stage may know the concept in tidbits but don't know how to present or explain it.
Relational – The different aspects have become integrated into a coherent whole. This level is what is normally meant by an adequate understanding of some topic. At the relational stage, students can identify various patterns & view a topic from distinct perspectives.
Extended abstract – The previous integrated whole may be conceptualised at a higher level of abstraction and generalised to a new topic or area. At this stage, students may apply the classroom concepts in real life.
See also
References
External links
Teaching Teaching & Understanding Understanding (short-film about Constructive Alignment and The SOLO Taxonomy)
Educational technology
Educational classification systems | 0.764389 | 0.972911 | 0.743682 |
Bodymind | Bodymind is an approach to understand the relationship between the human body and mind where they are seen as a single integrated unit. It attempts to address the mind–body problem and resists the Western traditions of mind–body dualism.
Dualism vs holism
In the field of philosophy, the theory of dualism is the speculation that the mental and the physical parts of us, like our minds and our bodies, are different or separate.
Modern understanding
"The mind is composed of mental fragments- sensations, feelings, thoughts, imaginations, all flowing now in an ordered sequence, now in a chaotic fashion…. On the other hand, the body is constructed under the underlying laws of physics, and its components obey the well-enumerated laws of physiology. It is these characteristic differences between these two – between mind and body – that lead to the Mind-Body problem.". While Western populations tend to believe more in the idea of dualism, there is also good research on the neurophysiology of emotions and their foundation in human meaning making, the function of the mind, such as the research of Candace Pert.
Relevance to alternative medicine
In the field of alternative medicine, bodymind implies that
The body, mind, emotions, and spirit are dynamically interrelated.
Experience, including physical stress, emotional injury, and pleasures are stored in the body's cells which in turn affects one's reactions to stimuli.
The term can be a number of disciplines, including:
Psychoneuroimmunology, the study of the interaction between psychological processes and the nervous and immune systems of the human body.
Body psychotherapy, a branch of psychotherapy which applies basic principles of somatic psychology. It originated in the work of Pierre Janet and particularly Wilhelm Reich.
Neurobiology, the study of the nervous system
Psychosomatic medicine, an interdisciplinary medical field exploring the relationships among social, psychological, and behavioral factors on bodily processes and quality of life in humans and animals. Clinical situations where mental processes act as a major factor affecting medical outcomes are areas where psychosomatic medicine excels.
Postural Integration, a process-oriented body psychotherapy originally developed in the late 1960s by Jack Painter (1933–2010) in California, US, after exploration in the fields of humanistic psychology and the human potential movement. The method aims to support personal change and self development, through a particular form of manipulative holistic bodywork.
See also
Ableism
Binding problem
Bodymind (disability studies)
Developmental disability
Disability
Disability and religion
Disability culture
Disability in the United States
Disability rights
Disability studies
Emotional or behavioral disability
Inclusion (disability rights)
Invisible disability
List of disability studies journals
Medical model of disability
Services for the disabled
Sexuality and disability
Social model of disability
Society for Disability Studies
References
Further reading
Benson MD, Herbert; ( 2000) (1975), The Relaxation Response, Harper
Bracken, Patrick & Philip Thomas; (2002), "Time to move beyond the mind-body split", editorial, British Medical Journal 2002;325:1433–1434 (21 December)
Dychtwald, Ken; (1986), Bodymind Penguin Putman Inc. NY,
Gallagher, Shaun; (2005) ‚ How the Body Shapes the Mind Oxford: Oxford University Press.
Hill, Daniel (2015) Affect Regulation Theory. A Clinical Model W. W. Norton.& Co .
Keinänen, Matti; (2005), Psychosemiosis as a Key to Body-Mind Continuum: The Reinforcement of Symbolization-Reflectiveness in Psychotherapy. Nova Science Publishers. .
Mayer, Emeran A. 2003. The Neurobiology Basis of Mind Body Medicine: Convergent Traditional and Scientific Approaches to Health, Disease, and Healing. Source: https://web.archive.org/web/20070403123225/http://www.aboutibs.org/Publications/MindBody.html (accessed: Sunday January 14, 2007).
Money, John; (1988) Gay, Straight, and In-Between: The Sexology of Erotic Orientation. New York: Oxford University Press.
Rothschild, Babette; ( 2000) The Body Remembers: The Psychophysiology of Trauma and Trauma Treatment. W W Norton & Co Inc.
Scheper-Hughes, Nancy, and Margaret M. Lock; (1987) The Mindful Body: A Prolegomenon to Future Work in Medical Anthropology with Margaret Lock. Medical Anthropology Quarterly. (1): 6–41.
Seem, Mark & Kaplan, Joan; (1987) Bodymind Energetics, Towards a Dynamic Model of Health Healing Arts Press, Rochester VT,
Clare, Eli. "Brilliant Imperfection: Grappling with Cure"
Schalk, Sami. "Bodyminds Reimagined: (Dis)ability, Race, and Gender in Black Women's Speculative Fiction"
Patsavas, Alyson. "Recovering a Cripistemology of Pain: Leaky Bodies, Connective Tissue, and Feeling Discourse"
Price, Margaret. "The Bodymind Problem and the Possibilities of Pain"
Kafer, Alison. "Feminist, Queer, Crip"
Hall, Kim. "Gender" chapter from "Keywords for Disability Studies".
McRuer, Robert, and Johnson, Merri Lisa. "Proliferating Cripistemologies: A Virtual Roundtable".
Garland-Thomson, Rosemarie. "Extraordinary Bodies: Figuring Physical Disability in American Culture and Literature".
Garland-Thomson, Rosemarie. "Becoming Disabled".
Body psychotherapy
Popular psychology | 0.765077 | 0.971935 | 0.743604 |
Social role valorization | Social role valorization (SRV) is a method for improving the lives of people who are of low status in society. (In countries of the British commonwealth, the third word in the term is usually spelled valorisation, but the abbreviation is the same.)
SRV is applicable to people who for any reason are disadvantaged, discriminated against, marginalized, and otherwise consigned to low status in their society. This includes those who are poor, of a devalued or despised racial, ethnic, religious, or political group, with any kind of bodily or mental impairment, who are elderly where youth is highly valued, who have few or unwanted skills, who are imprisoned, are illegal and unwanted immigrants, are seriously, chronically, or terminally ill, are disordered or unorthodox in their sexual identity and conduct, or otherwise violate important societal values. The great majority of members of these classes receive either formal or informal services, provided by families, schools, hospitals, welfare agencies, etc. SRV is relevant to any kind of human service, in the fields of education, rehabilitation, psychology, social work, medicine, imprisonment/corrections, and so on.
SRV was formulated in 1983 by Wolf Wolfensberger. He developed SRV as his successor to the earlier "Principle of Normalization In Human Services," which originated in Scandinavia in the early 1960s (Nirje, 1969). He went on to promulgate SRV throughout North America, as well as in England, France, and Australasia.
The International SRV Association was formed in 2013 to promote Social Role Valorization (SRV) development, education, assessment, and leadership to assist people and organizations to implement SRV concepts so that vulnerable people may have access to the good things in life.
See also
Normalisation (people with disabilities)
Wolf Wolfensberger
Community integration
References
Disability
Human rights | 0.7835 | 0.949081 | 0.743604 |
Scope of practice | Scope of practice describes the procedures, actions, and processes that a healthcare practitioner is permitted to undertake in keeping with the terms of their professional license. The scope of practice is limited to that which the law allows for specific education and experience, and specific demonstrated competency. Each jurisdiction can have laws, licensing bodies, and regulations that describe requirements for education and training, and define scope of practice.
In most jurisdictions, health care professions with scope of practice laws and regulations include any profession within health care that requires a license to practice such as physician assistants and nurses, among many others.
Governing, licensing, and law enforcement bodies are often at the sub-national (e.g. state or province) level, but federal guidelines and regulations also often exist. For example, in the United States, the National Highway Traffic Safety Administration in the Department of Transportation has a national scope of practice for emergency medical services.
See also
Health care professional requisites
Standing orders - scopes of practice are often defined in physicians' standing orders
References
Medical regulation
Nursing regulation | 0.762375 | 0.975369 | 0.743598 |
NeuroNation | NeuroNation and its associated medical app NeuroNation MED are cognitive training software applications developed by the German healthcare technology company Synaptikon GmbH. NeuroNation was launched in 2011.
Platform
The online platform was launched in 2011, and initially served Germany, Austria, and Switzerland. In 2014, Der Spiegel and XLHealth AG bought a 25% stake in NeuroNation, financing an expansion into English, French, Spanish, Italian, Russian, Japanese, and Portuguese markets.
NeuroNation is a multi-modal cognitive training application for prevention of neurodegenerative diseases and cognitive enhancement.
Its use is reimbursed by several German health insurers, including Deutsche BKK. While the NeuroNation app and similar ones are heavily advertised with claims of improving general cognitive function, there is no evidence to show that NeuroNation or similar programs do so; at most they improve performance in the training tasks given in the program.
The program began with a single-payment model, later shifting to a subscription business model. The app offers some content free, while other activities are available through in-app purchases.
Scientific research
In the "Intera-KT" project, NeuroNation collaborated with the Berlin University Hospital Charité and other partners to digitise paper-based cognitive tests.
NeuroNation is currently participating in a study on the effects of independent cognitive training using Neuronation MED on patients with mild cognitive disorders and patients with Post COVID-19 condition.
In several studies, healthy participants who have used NeuroNation as a cognitive training tool have shown positive effects for working memory, memory, and executive functions. One study by MSH Medical School Hamburg and the University of Würzburg observed that subjects who participated in NeuroNation exercises exhibited improved memory, concentration, and general well-being.
References
External links
NeuroNation homepage
Brain training programs | 0.769408 | 0.966444 | 0.74359 |
Subsets and Splits