1
Instructions for Coming of
Age in Mississippi
Due Sunday, April 25th, 2021
Late papers will be penalized. Failure to turn in this assignment will result in
the automatic failure of the class.
Anne Moody’s Coming of Age in Mississippi is an autobiographical presentation of
her life and experiences in the segregationist South during the middle third of the
20th Century. Although Moody was intensively involved in the civil rights
movement of the 1950’s and 1960’s, the real value of her autobiography is that she
describes what it was like to grow up in Mississippi long before she became a civil
rights activist.
Your book essay for Coming of Age in Mississippi should explore and discuss the
following topics and questions:
1. Begin with a brief overview of the book: in general, what is it about, who wrote
it, etc.
2. Moody’s decision to become engaged in the political activism central to the
Civil Rights Movement was a result of her experiences at both work and play
growing up in Mississippi. What kinds of incidents from her life led Moody to
become politically active in the movement? For example, what does she notice
about how she is treated as a black person in Southern white society?
3. Women played an important role in Moody’s life. Using examples from her
autobiography, discuss what Moody learned about race, class and sexual
orientation from the women around her. Who were the most important women in
her life? Discuss each and explain why that person was so important.
4. Moody was a participant and observer of some of the most important historical
events of the 1950’s and 1960’s. How did she view and describe these events – for
example, the murder of Emmitt Till, the sit-in protests, the voter registration drive
in Mississippi, Ku Klux Klan activities and the assassination of Medgar Evars and
2
others? In general, what do her descriptions tell you about the struggle for civil
rights?
5. What did you think of this book? Did you like it/ not like it? Explain why.
Writing Instructions:
1. Use the above questions/topics as your paper outline and answer them in the
order they are presented.
2. Use some common sense in how much you write on each topic. The general
overview of the book, for example, can be covered in one relatively brief
paragraph. Other topics may require more extensive coverage. The main body of
your paper should focus on topics 2-4. You should explore those thoroughly and
back up any general comments with specific details that illustrate and support
them. Topics 1 and 5 should be about a paragraph in length.
3. Although I don’t grade in terms of the length of the paper, under most
circumstances I would expect a paper somewhere within the range of 4-5 pages.
As a general rule, it’s better to write more than less.
4. The paper must be typed using a standard word processing program, double-
spaced using norm ...
Learn How to Write a Truly Impressive Scholarship Essay!. Scholarship Essay Writing Guide [+Examples] | Pro Essay Help. Impressive Sample Scholarship Essays Based Financial Need ~ Thatsnotus. How To Write A Scholarship Essay - Bright Writers. 011 Why Do You Deserve This Scholarship Essay Example ~ Thatsnotus. What Should I Write My Scholarship Essay About - Sample Scholarship Essays. Scholarship Essay - 20+ Examples, Format, Pdf | Examples. Scholarship Essay Examples - 10+ in PDF | Examples. College Essay: Essay for scholarship sample. Best Scholarship Essay Examples (Winning Tips). Scholarship Essay Sample. The best college scholarship essay writing service by vatoxekiw - Issuu. FREE 7+ Sample Scholarship Essay Templates in PDF | MS Word. How to Write a Scholarship Essay: Valuable Tips from Experts. Sample Scholarship Essay Why I Deserve | The Document Template. Free Scholarship Essay Example - doc | 41KB | 6 Page(s). FREE 9+ Scholarship Essay Samples in MS Word | PDF.
PLEASE READ THE ASSIGNMENT BEFORE TAKING IT ON. WIILLING TO PAY FOR.docxsarantatersall
This document provides instructions for students to complete multiple assignments. It requests that students read assignments fully before taking them on and offers to pay for entire classes completed, not just individual assignments. It emphasizes following the rubric, including citations in papers, and using proper APA format. Students are to analyze television characters using Horney's coping strategies and complete two case assignments analyzing Freud/Jung's theories and Erikson's stages of development. They are also to discuss environmental factors using Skinner's perspective and complete a Myers-Briggs personality test with analysis.
Literature ReviewsPlanning and Writing Them1You’ve.docxsmile790243
Literature Reviews
Planning and Writing Them
1
You’ve done the hard part!
You did your secondary research with your annotated bibliography
Now, take that research and compile it into a cohesive, useful narrative that explains the “conversation” around the topic you’re going to be looking into
2
What is a lit review?
Lit reviews usually are at the beginnings of research articles
Summarize the “conversation” on the subject and establish why your study is important
Look at Zakreski article, Greene article – see in the beginning of their articles, they summarize and explain what others have had to say about the topic
Your annotated bib should easily transition into what will be the first part of your paper, the literature review.
Duggar has lots of citations; 16 in her bib. She talks about lots of different ideas here to lay the groundwork for what she is going to do
Greene has fewer, but has more to say about them
3
Three functions of a lit review
Your literature review will become the first part of your research paper. Thus, it should do three things:
Include a short introduction that defines or identifies the general topic, issue, or area of concern, thus providing an appropriate context for reviewing the literature (this is called establishing a territory)
Synthesize other research on the topic, explaining what is known about it
Conclude by stating what is missing, what is controversial, what is not yet known, or what needs to be resolved in the discussion. This will provide the transition later to your own study and your research questions (this is called “establishing a niche”)
4
How do I write it?
Your literature review should synthesize all the information from your annotated bibliography
You can organize the information chronologically
You can organize the information by topic
by least-most recent studies or vice versa; clump everything by what was found, what
5
How do I write it, con’t
Your lit review should have an intro, body, and conclusion
This is not true of ALL lit reviews, but it is a good general rule to follow
The intro will serve at the intro to your paper
The body will establish the “conversation”
The conclusion will serve to transition your paper into a discussion of your study
The body can (and probably should) have multiple paragraphs, based on how you’ve organized it
6
About the conclusion
In the conclusion, you want to establish why your study is important
You need to somehow point out a gap in the knowledge, a question you have about other research, or a counter-point you want to raise
If you can’t prove that your study authentically adds to the conversation, then you really shouldn’t be doing the research
Leads to your methods section
7
Example lit reviews
See the link on Isidore on the “Info on Lit Reviews” page, “Example Lit Review”
From York College in New York – web.York.cuny.edu/~washton/student/Org-Behavior/lit_rev_eg.pdf
Also see https://owl.english.purdue.edu/owl/res ...
ENGL1304 – Dr. Salome – Fall 2016Major Writing Project #1 Gradin.docxSALU18
ENGL1304 – Dr. Salome – Fall 2016
Major Writing Project #1 Grading Rubric
Evaluation and Analysis of Two Sources
GRADING CRITERIA
POSSIBLE POINTS
POINTS RECEIVED/COMMENTS
Introduction Section:
· Purpose (Introduces two sources to include author names and title of text, along with the subject matter.)
· Claim/Thesis/Main Idea from Authors (Provide the main claim or thesis statement of each author.)
· Analysis Parameters (What methods of analysis will you use to analyze the sources? Explain what criteria are used in your paper.)
15
Analysis Section:
· Provide at least three characteristics by which to analyze each text (i.e., Ethos, Pathos, Logos or Style, Tone, Sentence Structure, Toulmin Model, etc.)
· Compare and contrast elements of each text/author arguments (What are the similarities? How are they different?)
· Provide specific examples from each text in order to support your comments (quotes with in-text citations)
· The details should be thorough and logical
30
Conclusion Section:
· States the major inferences that can be drawn from the analysis.
· It is based entirely on previously stated information.
· It does not introduce new material or evidence to support your analysis.
15
Works Cited and In-Text Citations:
· There must be at least two sources on the same topic of your overall project
· Works cited page contains each source used in the in-text citations.
· There are at least three in-text citations from each source used throughout the analysis.
10
Format and Organization:
· MLA style formatting is used throughout the paper, including works cited page and in-text citations
· Effective use of headings and subheadings throughout
· 11- or 12-point font size for main body of writing (Arial, Calibri, Cambria, or Times Roman font type)
· Paragraphs of approximately five to seven sentences
· Standard 1” margins
· Ragged right justification
15
Writing Style and Mechanics:
· The tone is appropriate for the audience and the purpose.
· Sentences are complete, clear, concise, well- constructed, and varied.
· Rules of grammar, usage, spelling, and punctuation are followed.
15
TOTAL
100
Points Earned: /100
Type: Individual Project
Unit: Default
Due Date: Mon, 10/10/16
Deliverable Length: 2 - 3 pages
Ethical Dilemmas: Read the following scenarios and answer the questions listed at the end of each scenario.
Situation 1
A rich businessman’s daughter, Patty, had the best of everything all her life. Her future
would have included college, a good marriage to a successful young man, and a life of
comparative luxury—except that she was kidnapped by a small band of radical extremists
who sought to overthrow the government by terror, intimidation, and robbery. After being
raped, beaten, and locked in a small, dark closet for many days, continually taunted and threatened, she was told that she must participate with the terrorist gang in a bank robbery;
otherwise, she and her family would be killed. During the course of the r ...
SOCW 60 and 61 response to students and professorSOCW 60week.docxwhitneyleman54422
This document discusses how violence is portrayed in video games. It notes that while many games involve killing large numbers of anonymous enemies, this type of violence can become boring. Two games from 2013, The Last of Us and BioShock Infinite, are compared. The Last of Us uses violence purposefully to further the story and leave the characters emotionally scarred, while the violence in BioShock Infinite feels gratuitous and does little to further the plot or character development. The document argues that personal, specific violence like torture is difficult for games to portray in a meaningful way.
INCA Survey InformationINCA is an acronym for intercultural comp.docxbradburgess22840
The document provides information about the INCA intercultural competency assessment survey. The purpose of the survey is to examine a person's intercultural awareness in three key areas: openness, knowledge, and adaptability. It addresses communicative awareness, respect for others, and empathy. After completing the survey, participants receive a cultural awareness level for respect of others and determine their levels for communicative awareness and empathy. The document also includes directions for a presentation assignment analyzing critical incidents related to cultural orientations and themes.
Summary Of Special Education Terminology, Concepts, And...Tara Smith
According to the document, autism is defined as a complex developmental disability that affects a person's ability to communicate and interact with others. It typically appears during the first three years of life and is a spectrum disorder that affects individuals differently and to varying degrees. An intellectual disability is defined as significantly subaverage intellectual functioning existing concurrently with deficits in adaptive behavior manifested during development. A hearing impairment is defined as an impairment in hearing, whether permanent or fluctuating, that adversely affects a child's educational performance.
Running head: RESEARCH PROPOSAL1
RESEARCH PROPOSAL5
Research Proposal
Jamie Bass
Composition II Comment by Spencer Ellsworth: Actually Comment by Jamie Bass:
ENG102 A02
Instructor: Ellsworth
February 16, 2016
WORKING THESIS
Suicide has negatively affected the society, and unless there are mitigation strategies to curb this menace, it will continue to take the lives of many people in the society.Comment by Spencer Ellsworth: This is a good subject, but the thesis needs a little work. “Mitigation” is really generalized. Maybe more like “early intervention and general support are needed to help
EXPLANATION
Suicide is the act of human beings voluntarily taking their lives. Research has shown that it has always been caused by a sense of despair or hopelessness. All these issues may be induced by mental illness which may include Bipolar disorder or even depression. Suicide has been traumatizing and shameful to the bereaved families and many people in the society have always viewed it as a cowardice cowardly way of taking one’s life. Many suicidal persons have been haunted by their thoughts. I in many cases this is depicted as a very personal process (Goldsmith, Pellmar, Kleinman & Bunney, 2002).Comment by Spencer Ellsworh: Citations for this. Also, maybe consider that it is often an outgrowth of chronic disease or chronic pain.
In this paper, it is very much possible to look at what suicide is and the risk factors associated with suicide. It is also recommended in the research paper to dwell on mental disorder and substance abuse as risk factors that contribute to suicide as well as medical conditions and psychosocial states. The media and how it depicts suicide is also very important to research on as well as the rational suicide is a controversial statement in this topic. We will have the chance to look at the suicide methods and pathophysiology which is very important to note. After all these, prevention will be a key topic to note which involves screening for mental illness. It will also be possible to research on epidemiology, social and culture based on legislation and religious views and all about philosophy, advocacy, locations and some notable cases of suicide.Comment by Spencer Ellsworh: Fairly awkward sentence.Comment by Spencer Ellsworh: To make a good argumentation paper, you’ll have to focus on where intervention is failing right now, and how intervention can work more effectively. It’ll make for a great paper, but it’ll involve some legwork with current practices and funding of mental health intervention by federal and state governments.
SUB POINTS
Many people in the society are very much scared of taking away their lives and they are actually left to wonder how one can voluntarily manage to be suicidal. Some may be caused by illnesses with some visible symptoms and various ways to mitigate this act is by careful observation of these people. People in high risk of committing suicide often have mood disorders and .
Learn How to Write a Truly Impressive Scholarship Essay!. Scholarship Essay Writing Guide [+Examples] | Pro Essay Help. Impressive Sample Scholarship Essays Based Financial Need ~ Thatsnotus. How To Write A Scholarship Essay - Bright Writers. 011 Why Do You Deserve This Scholarship Essay Example ~ Thatsnotus. What Should I Write My Scholarship Essay About - Sample Scholarship Essays. Scholarship Essay - 20+ Examples, Format, Pdf | Examples. Scholarship Essay Examples - 10+ in PDF | Examples. College Essay: Essay for scholarship sample. Best Scholarship Essay Examples (Winning Tips). Scholarship Essay Sample. The best college scholarship essay writing service by vatoxekiw - Issuu. FREE 7+ Sample Scholarship Essay Templates in PDF | MS Word. How to Write a Scholarship Essay: Valuable Tips from Experts. Sample Scholarship Essay Why I Deserve | The Document Template. Free Scholarship Essay Example - doc | 41KB | 6 Page(s). FREE 9+ Scholarship Essay Samples in MS Word | PDF.
PLEASE READ THE ASSIGNMENT BEFORE TAKING IT ON. WIILLING TO PAY FOR.docxsarantatersall
This document provides instructions for students to complete multiple assignments. It requests that students read assignments fully before taking them on and offers to pay for entire classes completed, not just individual assignments. It emphasizes following the rubric, including citations in papers, and using proper APA format. Students are to analyze television characters using Horney's coping strategies and complete two case assignments analyzing Freud/Jung's theories and Erikson's stages of development. They are also to discuss environmental factors using Skinner's perspective and complete a Myers-Briggs personality test with analysis.
Literature ReviewsPlanning and Writing Them1You’ve.docxsmile790243
Literature Reviews
Planning and Writing Them
1
You’ve done the hard part!
You did your secondary research with your annotated bibliography
Now, take that research and compile it into a cohesive, useful narrative that explains the “conversation” around the topic you’re going to be looking into
2
What is a lit review?
Lit reviews usually are at the beginnings of research articles
Summarize the “conversation” on the subject and establish why your study is important
Look at Zakreski article, Greene article – see in the beginning of their articles, they summarize and explain what others have had to say about the topic
Your annotated bib should easily transition into what will be the first part of your paper, the literature review.
Duggar has lots of citations; 16 in her bib. She talks about lots of different ideas here to lay the groundwork for what she is going to do
Greene has fewer, but has more to say about them
3
Three functions of a lit review
Your literature review will become the first part of your research paper. Thus, it should do three things:
Include a short introduction that defines or identifies the general topic, issue, or area of concern, thus providing an appropriate context for reviewing the literature (this is called establishing a territory)
Synthesize other research on the topic, explaining what is known about it
Conclude by stating what is missing, what is controversial, what is not yet known, or what needs to be resolved in the discussion. This will provide the transition later to your own study and your research questions (this is called “establishing a niche”)
4
How do I write it?
Your literature review should synthesize all the information from your annotated bibliography
You can organize the information chronologically
You can organize the information by topic
by least-most recent studies or vice versa; clump everything by what was found, what
5
How do I write it, con’t
Your lit review should have an intro, body, and conclusion
This is not true of ALL lit reviews, but it is a good general rule to follow
The intro will serve at the intro to your paper
The body will establish the “conversation”
The conclusion will serve to transition your paper into a discussion of your study
The body can (and probably should) have multiple paragraphs, based on how you’ve organized it
6
About the conclusion
In the conclusion, you want to establish why your study is important
You need to somehow point out a gap in the knowledge, a question you have about other research, or a counter-point you want to raise
If you can’t prove that your study authentically adds to the conversation, then you really shouldn’t be doing the research
Leads to your methods section
7
Example lit reviews
See the link on Isidore on the “Info on Lit Reviews” page, “Example Lit Review”
From York College in New York – web.York.cuny.edu/~washton/student/Org-Behavior/lit_rev_eg.pdf
Also see https://owl.english.purdue.edu/owl/res ...
ENGL1304 – Dr. Salome – Fall 2016Major Writing Project #1 Gradin.docxSALU18
ENGL1304 – Dr. Salome – Fall 2016
Major Writing Project #1 Grading Rubric
Evaluation and Analysis of Two Sources
GRADING CRITERIA
POSSIBLE POINTS
POINTS RECEIVED/COMMENTS
Introduction Section:
· Purpose (Introduces two sources to include author names and title of text, along with the subject matter.)
· Claim/Thesis/Main Idea from Authors (Provide the main claim or thesis statement of each author.)
· Analysis Parameters (What methods of analysis will you use to analyze the sources? Explain what criteria are used in your paper.)
15
Analysis Section:
· Provide at least three characteristics by which to analyze each text (i.e., Ethos, Pathos, Logos or Style, Tone, Sentence Structure, Toulmin Model, etc.)
· Compare and contrast elements of each text/author arguments (What are the similarities? How are they different?)
· Provide specific examples from each text in order to support your comments (quotes with in-text citations)
· The details should be thorough and logical
30
Conclusion Section:
· States the major inferences that can be drawn from the analysis.
· It is based entirely on previously stated information.
· It does not introduce new material or evidence to support your analysis.
15
Works Cited and In-Text Citations:
· There must be at least two sources on the same topic of your overall project
· Works cited page contains each source used in the in-text citations.
· There are at least three in-text citations from each source used throughout the analysis.
10
Format and Organization:
· MLA style formatting is used throughout the paper, including works cited page and in-text citations
· Effective use of headings and subheadings throughout
· 11- or 12-point font size for main body of writing (Arial, Calibri, Cambria, or Times Roman font type)
· Paragraphs of approximately five to seven sentences
· Standard 1” margins
· Ragged right justification
15
Writing Style and Mechanics:
· The tone is appropriate for the audience and the purpose.
· Sentences are complete, clear, concise, well- constructed, and varied.
· Rules of grammar, usage, spelling, and punctuation are followed.
15
TOTAL
100
Points Earned: /100
Type: Individual Project
Unit: Default
Due Date: Mon, 10/10/16
Deliverable Length: 2 - 3 pages
Ethical Dilemmas: Read the following scenarios and answer the questions listed at the end of each scenario.
Situation 1
A rich businessman’s daughter, Patty, had the best of everything all her life. Her future
would have included college, a good marriage to a successful young man, and a life of
comparative luxury—except that she was kidnapped by a small band of radical extremists
who sought to overthrow the government by terror, intimidation, and robbery. After being
raped, beaten, and locked in a small, dark closet for many days, continually taunted and threatened, she was told that she must participate with the terrorist gang in a bank robbery;
otherwise, she and her family would be killed. During the course of the r ...
SOCW 60 and 61 response to students and professorSOCW 60week.docxwhitneyleman54422
This document discusses how violence is portrayed in video games. It notes that while many games involve killing large numbers of anonymous enemies, this type of violence can become boring. Two games from 2013, The Last of Us and BioShock Infinite, are compared. The Last of Us uses violence purposefully to further the story and leave the characters emotionally scarred, while the violence in BioShock Infinite feels gratuitous and does little to further the plot or character development. The document argues that personal, specific violence like torture is difficult for games to portray in a meaningful way.
INCA Survey InformationINCA is an acronym for intercultural comp.docxbradburgess22840
The document provides information about the INCA intercultural competency assessment survey. The purpose of the survey is to examine a person's intercultural awareness in three key areas: openness, knowledge, and adaptability. It addresses communicative awareness, respect for others, and empathy. After completing the survey, participants receive a cultural awareness level for respect of others and determine their levels for communicative awareness and empathy. The document also includes directions for a presentation assignment analyzing critical incidents related to cultural orientations and themes.
Summary Of Special Education Terminology, Concepts, And...Tara Smith
According to the document, autism is defined as a complex developmental disability that affects a person's ability to communicate and interact with others. It typically appears during the first three years of life and is a spectrum disorder that affects individuals differently and to varying degrees. An intellectual disability is defined as significantly subaverage intellectual functioning existing concurrently with deficits in adaptive behavior manifested during development. A hearing impairment is defined as an impairment in hearing, whether permanent or fluctuating, that adversely affects a child's educational performance.
Running head: RESEARCH PROPOSAL1
RESEARCH PROPOSAL5
Research Proposal
Jamie Bass
Composition II Comment by Spencer Ellsworth: Actually Comment by Jamie Bass:
ENG102 A02
Instructor: Ellsworth
February 16, 2016
WORKING THESIS
Suicide has negatively affected the society, and unless there are mitigation strategies to curb this menace, it will continue to take the lives of many people in the society.Comment by Spencer Ellsworth: This is a good subject, but the thesis needs a little work. “Mitigation” is really generalized. Maybe more like “early intervention and general support are needed to help
EXPLANATION
Suicide is the act of human beings voluntarily taking their lives. Research has shown that it has always been caused by a sense of despair or hopelessness. All these issues may be induced by mental illness which may include Bipolar disorder or even depression. Suicide has been traumatizing and shameful to the bereaved families and many people in the society have always viewed it as a cowardice cowardly way of taking one’s life. Many suicidal persons have been haunted by their thoughts. I in many cases this is depicted as a very personal process (Goldsmith, Pellmar, Kleinman & Bunney, 2002).Comment by Spencer Ellsworh: Citations for this. Also, maybe consider that it is often an outgrowth of chronic disease or chronic pain.
In this paper, it is very much possible to look at what suicide is and the risk factors associated with suicide. It is also recommended in the research paper to dwell on mental disorder and substance abuse as risk factors that contribute to suicide as well as medical conditions and psychosocial states. The media and how it depicts suicide is also very important to research on as well as the rational suicide is a controversial statement in this topic. We will have the chance to look at the suicide methods and pathophysiology which is very important to note. After all these, prevention will be a key topic to note which involves screening for mental illness. It will also be possible to research on epidemiology, social and culture based on legislation and religious views and all about philosophy, advocacy, locations and some notable cases of suicide.Comment by Spencer Ellsworh: Fairly awkward sentence.Comment by Spencer Ellsworh: To make a good argumentation paper, you’ll have to focus on where intervention is failing right now, and how intervention can work more effectively. It’ll make for a great paper, but it’ll involve some legwork with current practices and funding of mental health intervention by federal and state governments.
SUB POINTS
Many people in the society are very much scared of taking away their lives and they are actually left to wonder how one can voluntarily manage to be suicidal. Some may be caused by illnesses with some visible symptoms and various ways to mitigate this act is by careful observation of these people. People in high risk of committing suicide often have mood disorders and .
This is a 100,000 word, 200 page, longitudinal, retrospective and prospective account of my experience with bipolar disorder and some other mental health problems over 70 years: from October 1943 to October 2013. This account is a personal, clinical, and idiosyncratic study of what some life-study students call a chaos narrative. This study focuses on an aspect of my life involving several mental health issues, but mainly bipolar 1 disorder. This account is now in its 13th edition. In my retirement, the years from 2001 to 2013, I have revised the account each year up-dating the content (i) as new information about the mental health issues I deal with are added to the science, and (ii) as I continue to deal with these mental health issues as I head to the age of 70 in 2014.
SWAD#4Watch the you tube video below and write at least a 300 wo.docxmattinsonjanel
SWAD#4
Watch the you tube video below and write at least a 300 word reflection regarding Sexuality and Older Adults. Did you learn any new information? What tips does Dr. Sewell have for communicating with older adults about sexuality and intimacy?
Sexuality and aging-research by Dan Sewell
https://www.youtube.com/watch?v=fJHiUzHZP80
Running head: SHORT TITLE OF PAPER
3
Full Title of Paper
Student Name
PSY2010 Abnormal Psychology
Abstract
The abstract is on a page of its own after the title page. It is a brief summary of the content of your paper (typically 50-150 words but no more than 200). It is not indented and the word abstract at the top of the page is not bold since it is not a heading within the paper.
Full Title of Paper
This is the first page of the body of your paper. The full title of your paper is repeated at the top of the page. Like with the abstract, the title at the top of the page is not bold since it is not considered a heading within the paper. You will see below that headings within the paper are in bold and follow the heading styles required by the Publication Manual of the American Psychological Association (6th ed.; American Psychological Association, 2009).
This first section of your paper is the introduction of your paper. This introduction is one page in length at a minimum. It is not labeled separately. It introduces the topic of your paper and the points you intend to make. Why is this topic important to psychology? This section also introduces how your paper will be organized, such as stating that you will review the historical background of the topic and then follow it with an overview of related current trends and discussion.
Literature Review
This is the beginning of your literature review. Keep in mind, the literature review is not just a summary of each individual article. It is also a critical analysis of your topic supported by information you learned when reading the background literature. Your APA formatted citations for the sources of the information you are discussing is your indication of the literature reviewed.
Subheading 1 Example
Depending on your topic, you may find it necessary to use subheadings within sections of your document. For example, if you are comparing and contrasting the different theories or treatments for the disorders based on the articles you reviewed.
Subheading 2 Example
Only use subheadings if you have more than one area you want to distinguish as a sub-section. Otherwise, leave them out and simply use separate paragraphs.
Discussion and Conclusions (1-2 pages minimum)
This section of your paper is where you discuss your opinions about the topic you have been covering (backed by the information you have learned and citations for that information). What are the similarities and differences between what you learned in reviewing the literature and what you previously knew about the topic? What is the quality of the research you found on this topic? Did you find ...
Long-Term Care TodayDemographics and epidemiological transitions.docxSHIVA101531
Long-Term Care Today
Demographics and epidemiological transitions result in dramatic changes in the health needs of individuals throughout the globe. In recent times, there has been increase in the prevalence of long-term disability in the population—causing increasing need for long-term care services. In addition, the present developing world is experiencing an increase in the demand for long-term care services at a cost much lower than industrialized countries.
Prepare a report in a 3- to 4-page Microsoft Word document comparing the US long-term care system with the long-term care system of a developing country. Research Scholarly Library and the Internet to find relevant content.
Include the following information in your report:
· What are the chronic illness trends of each country?
· What is the incidence and prevalence of elderly consumers of long-term care in the United States as compared to your chosen developing country?
· How does each country expect these numbers to change in the next ten years?
· What are the main characteristics of the elderly population in both the countries? Is there any difference in the long-term health care needs of consumers in both the countries? Provide a rationale for your answer.
· Who are the institutional and non institutional caregivers in both the countries? Support your answer with relevant examples. Explain the factors that affect care giving in each country.
· Is there any difference in the status of quality of care of the elderly consumers in the United States as compared to the developing country?
· Is there any difference in the health care cost provided in the United States as compared to the developing country? Define any social support that may exist to cover health care in both countries.
Support your responses with examples.
Cite any sources in APA format.
15 INTERVIEW QUESTIONS
1. How do you feel about yourself? She cross that one
2. What are your experiences on your everyday interactions with the normal members of the society?
3. What are your everyday experiences with the deaf colleagues in the society?
4. What are your experiences with your family members?
5. How do you relate to your wife? (Married male adults) OR, how do you relate to your husband? (married female adults?)
6. need Q
7. How often do you interact with the members of the society that are not deaf?
8. How do you communicate with members of the society who do not know sign language?
9. What do you do if you encounter an individual who does not know how to communicate in sign language?
10. What was your experience when you were young?
11. How did you feel when you were with your peers when you were little?
12. How did you feel when your peers could not understand your situation when you were little?
13. What was your experience in your family during young age?
14. In case you were discriminated by your peers, how did you feel?
15. Do you remember any one time when you felt low self-esteem due to the treatment that you ...
Attachment, Antisocial, And Antisocial BehaviorDiane Allen
Secure early attachments help develop empathy and emotional regulation, promoting prosocial behavior. Those lacking these skills display antisocial behavior like disrespecting others' rights. Antisocial behavior in adolescents can predict later adjustment issues and criminality. While some defiance is normal in teens, consistent antisocial behavior signals a disorder requiring treatment.
· 22 sub Diagnostic Case ReportsThere, you will see twchestnutkaitlyn
· 2:2 sub
: Diagnostic Case Reports
There, you will see twelve different disorders listed. For this module, view the following disorders:
· Borderline Personality Disorder
· Substance Use
After clicking a disorder, click the Diagnostic Overview tab in the left column. This will cover the major diagnostic features of the disorder. After that, click the
DSM-5
Features tab. You can then go though the Case History, Interview, and Treatment sections on the website. Finally, in the Assessment section, you can complete an optional multiple-choice quiz. You have to write a case report for each case study. You should use the format provided on the web page. There is a sample report that you can also view by clicking the link in the upper-right corner.
The format for the sample report is as follows:
Your Name
Instructor's Name
Class/Section Number
Background
· Outline the major symptoms of this disorder.
· Briefly outline the client's background (age, race, occupations, etc.).
· Describe any factors in the client's background that might predispose him or her to this disorder.
Observations
· Describe any symptoms that you have observed that support the diagnosis. You can include direct quotes or behaviors that you may have observed.
· Describe any symptoms or behaviors that are inconsistent with the diagnosis.
· Provide any information that you have about the development of this disorder.
Diagnosis
· Did you observe any evidence of general medical conditions that might contribute to the development of this disorder?
· Did you observe any evidence of psychosocial and environmental problems that might contribute to this disorder?
· As per your observations, what is the client's overall level of safety regarding the potential harm to self or others (suicidality or homicidality)?
· What cross-cultural issues, if any, affect the differential diagnosis?
Therapeutic Intervention
· In your opinion, what are the appropriate short-term goals of this intervention?
· In your opinion, what are the appropriate long-term goals of this intervention?
· Which therapeutic strategy seems the most appropriate in this case? Why?
· Which therapeutic modality seems the most appropriate in this case? Why?
Described the major symptoms of each disorder, outlined each person's background, and described any factors in the person's background that might predispose him or her to their disorder.
20
Described any symptoms that were observed that support each diagnosis and any symptoms or behaviors that are inconsistent with each diagnosis and provided relevant information from the case history about the development of each disorder
20
Described any evidence of psychosocial or medical issues that might have contributed to each disorder, identified any safety concerns regarding suicidality or homicidality, and discussed any cross-cultural issues affecting the differential diagnosis.
20
Discussed appropriate short-term and long-term goals of each i ...
This paper will discuss serial killers and identify a research pro.docxherthalearmont
This paper will discuss serial killers and identify a research problem in regard to the topic. Generally, a serial killer can be defined as a person who has murdered three or more people within a time range of more than a month with some significant emotional cooling periods in between the events. Furthermore, this has to be in service of abnormal psychological gratification. However, over the years, various professionals such as mental health experts and law enforcement investigators have been trying to study serial killers in vain since they have never reached a consensus in regard to the issue in question. Therefore, the problem to be addressed by this study is that there is not enough information about the life of the serial killers before the killings started (Abe, 2017). Comment by EasyTiger: Try to form a concise problem statement that has it’s own paragraphs apart from the rest of the sections or in a section of its own. The problem statement should have a maximum of 500 words.
Understanding serial killers
Generally, from the studies, it is clear that the motivations for serial killers are quite complex and therefore, only an intensive psychological analysis on the individuals can help in providing some significant insight. This might include how and why the individuals in question became serial killers. Information from the analysis can then be used in preventing cases of serial killings in future. For example, since the various incidences of serial killing are known to have a number of similar features, these similarities can be used to identify a killer who is actively killing and, hence, prevent any other cases of homicide in the future. However, the problem is that many relevant authorities or rather bodies that are supposed to deal with cases of serial killing lack this vital information that might be instead used to curb any further homicidal incidents. However, in a bid to understand them, there are some areas that need to be discussed in detail that include: the motivations involved in serial killings, the psychological, and neurodevelopment disorders (Ioana, 2017).
Psychological Disorders
As much as the research into serial killers might still be in its infancy, current evidence indicates that psychological disorders play a significant role. This can be well understood by looking into the motivations of serial killers. Evidence shows that some of the motivations involved in serial killing include the need for perfection or power or the fear of rejection. As a result, a majority is usually much afraid of rejection and is usually also very insecure. They also avoid close or painful relationships. This is the reasons many of them are usually reported to having sex with their victims or even their corpses to reduce the chances of being rejected. Furthermore, they tend to prolong the suffering of their victims, especially when killing with the main aim of creating a sense of power over the victims. In addition, they also hold on ...
Running head RESEARCH PROPOSAL10RESEARCH PROPOSAL 8.docxtoltonkendal
Running head: RESEARCH PROPOSAL 10
RESEARCH PROPOSAL 8
Research Proposal
Jamie Bass
Argosy University
March 3, 2016
ABSTRACT
Suicide is experienced in all parts of parts of the world. Even though it has been argued that suicide is common amongst the elderly in the society, it is worth noting that even children as young as 13 years old have committed suicide. The myths and misconceptions surrounding suicidal individuals are inherently different from one culture to another. For instance, in some cultures it is believed that suicidal individuals are possessed by demons. Other cultures attribute suicide to generational curses whereas other cultures attribute suicide to such factors as depression and other mental disorders. The purpose of the proposed research is to establish the risk factors of suicide and realize possible strategies which if undertaken can help to counteract suicide and hence its adverse effects in the society. In this proposal are the points to be addressed in the course of the research. It is anticipated that there will be objections to the factors to be established and hence part of this proposal are possible objections and how each of the possible objections will be addressed. The research will use secondary sources of information and hence part of this proposal is an annotated bibliography of the sources that will be utilized in course of the research. Comment by Spencer Ellsworth: This is good, but could you state it more as a piece of argumentation? Like “This paper argues that early intervention can prevent suicide if done correctly.”
WORKING THESIS
Suicide has negatively affected the society, and unless there are mitigation strategies to curb this menace, it will continue to take the lives of many people in the society.
EXPLANATION
Suicide is the act of human beings voluntarily taking their lives. Research has shown that it has always been caused by a sense of despair or hopelessness. All these issues may be induced by mental illness which may include Bipolar disorder or even depression. Suicide has been traumatizing and shameful to the bereaved families and many people in the society have always viewed it as a cowardice way of taking one’s life. Many suicidal persons have been haunted by their thoughts in many cases this is depicted as a very personal process (Goldsmith, Pellmar, Kleinman & Bunney, 2002).
In this paper, it is very much possible to look at what suicide is and the risk factors associated with suicide. A study conducted in Sweden consisting of 271 men aged 15 years and above revealed that mental disorder is a major suicide risk factor. It is thus recommended that the research paper will dwell on mental disorder and substance abuse as risk factors that contribute to suicide as well as medical conditions and psychosocial states. Harris & Barraclough (2009) also established a causal relationship between mental disorder and suicide a factor that further makes the proposed research ...
Based on the authors’ own clinical experiences, these seventee.docxjasoninnes20
Based on the authors’ own clinical experiences, these seventeen comprehensive
case histories reflect the most common psychological disorders. Rich in detail, inte-
grated in approach, and fully updated for the DSM-5, each case describes patient
symptoms and history, the formulation and implementation of a treatment plan,
and results. Each case also includes the perspective of a family member or friend.
This unique viewpoint emphasizes the impact of psychological disorders on those
closest to the patient as well as the importance of considering sociocultural factors
in diagnosis and treatment. Each case study concludes with assessment questions
that help students check their understanding of the symptoms, diagnosis, and
treatment of the disorder exhibited by the patient. Three additional cases provide
opportunities for students to identify disorders and suggest appropriate therapies.
Diagnostic information and treatment strategies for the patients in these “You
Decide” cases are provided in appendices for students to check their assessments.
About the Authors
Ethan E. Gorenstein is clinical director of the Behavioral Medicine Program at
Columbia-Presbyterian Medical Center and a professor of clinical psychology in
the department of psychiatry at Columbia University. He is also the author of The
Science of Mental Illness (Academic Press). He has an active clinical practice de-
voted to the use of evidence-based psychological treatment methods for problems
of both children and adults.
Ronald J. Comer is a professor in the psychology department at Princeton Univer-
sity and director of clinical psychology studies. He is also chair of the university’s
Institutional Review Board. A clinical psychologist, he is the author of the text-
books Abnormal Psychology and Fundamentals of Abnormal Psychology (Worth
Publishers), Psychology Around Us (John Wiley and Sons Publishers), and producer
of numerous educational videos on subjects ranging from abnormal psychology to
introductory psychology and neuroscience.
For complete information on our books, electronic materials, and faculty and
student resources, visit us at www.worthpublishers.com
C A S E S T U D I E S I N
ABNORMAL PSYCHOLOGY
E t h a n E . G o r e n s t e i n a n d R o n a l d J . C o m e r
S E C O N D E D I T I O N
CASE STUDIES IN ABNORMAL PSYCHOLOGY
S E C O N D
E D I T I O N
W O R T H
Gorenstein
■ Com
er
C A S E S T U D I E S I N
ABNORMAL PSYCHOLOGY
E t h a n E . G o r e n s t e i n a n d R o n a l d J . C o m e r
S E C O N D E D I T I O N
Cover image: Gary Waters/Illustration Source
7.5 × 9.125 SPINE: 0.688 FLAPS: 0
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Case Studies in
Abnormal Psychology
SeCond edition
Ethan E. Gorenstein
Behavioral Medicine Program
Columbia-Presbyterian Medical Center
Ronald J. Comer
Princeton University
WoRtH PUBLiSHeRS
Macmillan education
Vice President, Editing, Design, and Media ...
Alcoholism and its effects on society Free Essay Example. The Abuse of Alcohol - Free Essay Example | PapersOwl.com. ≫ An In Depth Look At Alcoholism Free Essay Sample on Samploon.com. Alcohol:What You Should Know - Sample Essay. Cause and effects of alcohol essays. Persuasive Essay: Teens and Alcohol Abuse. Fearsome Alcoholism Cause And Effect Essay ~ Thatsnotus. Academic Text.docx | Alcoholism | Essays.
Extra Credit Opportunity for Spring 2019Students of Abnormal Psy.docxmecklenburgstrelitzh
This document provides information about an extra credit opportunity for students in an Abnormal Psychology course. Students can earn up to 10 extra credit points by writing a paper analyzing a fictional or historical character and diagnosing them with a mental illness using criteria from the DSM-5. The paper must be at least two pages, single spaced, and include examples from the chosen text to support the diagnosis as well as a discussion of potential causes and treatment approaches for the illness. The deadline to submit papers is April 16, 2019.
CLASS ASSIGNMENTS (Choose OneWriting Project, Discussion Grou.docxbartholomeocoombs
CLASS ASSIGNMENTS (Choose One:
Writing Project, Discussion Group or Couple Enrichment):
Option #1:
WRITING
PROJECT
(Choose 1 out of the following 7 Topics)
:
Paper
heading
should include:
Student Name;
Student ID #;
and Section 001.
Pages must be:
typed and double-spaced:
12 point font;
1” margins.
It should be a minimum of 6 pages and is due on
March 30th
.
HARD COPY ONLY.
Choose 1 of the following 7 topics. Your paper should be divided into 2 sections.
Section 1: (2 -3 pages)
- “What Do You Think” - asks
you
to reflect and discuss the topic area.
Section 2: (3-4 pages)
– “What Does Research Tell Us” – asks you to discuss
your review
of the
literature, with appropriate references and bibliography, on the topic area.
PLEASE use the following headings within your paper:
Section 1: What Do You Think?
Section 2: What Does Research Tell Us?
1.
TOPIC 1
·
Section 1: What Do You Think?
:
Do you think that sex or violence on television influences how promiscuous or violent our society becomes? Do you think the sexual stereotypes in commercials and advertisements shape our attitudes toward gender relations? How do you think you have been influenced by the media?
·
Section 2: What Does Research Tell Us?
:
Discuss what research has revealed regarding the impact of sexually violent and degrading media on the attitudes and behaviors of men and women. What effect, if any, does this “exposure” have on intimate relationships?
2.
TOPIC 2
·
Section 1: What Do You Think?
:
Describe your ideal marriage/cohabitating partner and their characteristics (e.g. appearance, personality, and occupation). What circumstances or conflicts (if any) would lead you to consider a separation or divorce (e.g. infidelity, refusal to have children, disease, or cross-dressing)?
·
Section 2: What Does Research Tell Us?
:
After a review of the literature, discuss the factors that determine with whom we fall in love; and the principle factors involved in keeping a relationship strong.
3.
TOPIC 3
·
Section 1: What Do You Think?
:
Imagine that you have always been attracted emotionally and sexually to your own sex and that your family has rather traditional religious and conservative views. Would you tell your family about your attraction? If you were to disclose your sexual orientation to your family, how would you do it? What do you think their response would be?
·
Section 2: What Does Research Tell Us?
:
From your research, what are the steps that people can take to communicate to others about their sexual orientation? What is the process of “coming out”? Briefly discuss the social and psychological effects on people who are unable to disclose their sexual orientation or introduce a lifetime partner to family and friends.
4.
TOPIC 4:
·
Section 1: What Do You Think?
:
Both men and women may sometimes give unclear signals about whether they are willing to engage in sexual contact when they are in a potent.
Experiences of schizophrenia are not homogeneous; there is wide.docxrhetttrevannion
Experiences of schizophrenia are not homogeneous; there is wide variety in onset, course of illness, and combinations of symptoms. Social workers need to be able to understand the different manifestations and pathways of the illness to plan interventions. Social work services play a key role in stabilizing crises, supporting family coping, and influencing overall quality of life and outcomes of individuals with schizophrenia. In this Assignment, you practice applying this necessary individualization.
To prepare:
In the Learning Resources, focus on the associated features, development, and course of the illnesses in the schizophrenia spectrum. Also focus on descriptions of the disorder and the way it develops for different individuals.
Choose two articles from the list in the Learning Resources that apply to treatment support and interventions for the schizophrenia spectrum. Access the Walden Library and research additional peer-reviewed articles.
By Day 7
Submit
a 3- to 4-page paper, supported by at least 3–4 scholarly resources (including both required and additional resources), in which you address the following:
Compare Saks’s and McGough’s experiences with schizophrenia, specifically referencing the positive and negative symptoms they each experienced.
Explain how you would use the Clinician Rated Dimensions of Psychosis Symptom Severity measure and the WHODAS to help confirm your diagnosis.
Identify in what ways their cases are typical or atypical of the illness in terms of onset, associated features, development, and course. Support your response with references to scholarly resources.
Explain how you would plan treatment and individualize it for these two individuals. Support your response with references to scholarly resources. In your explanation, consider the following questions:
What are the long-term challenges for someone living with the illness?
What social, family, vocational, and medical supports are needed for long-term stabilization?
How might treatment look similar or different for Saks and McGough, given they have the same diagnosis?
Briefly explain how race/ethnicity, gender, sexual orientation, socioeconomic status, religion, or other identity characteristics may influence an individual’s experience with schizophrenia. in the black community
Morrison, J. (2014).
Diagnosis made easier
(2nd ed.). New York, NY: Guilford Press.
Chapter 5, “Coping with Uncertainty” (pp. 43–56)
Chapter 13, “Diagnosing Psychosis” (pp. 185–215)
American Psychiatric Association. (2013o). Schizophrenia spectrum and other psychotic disorders. In
Diagnostic and statistical manual of mental disorders
(5th ed.). Arlington, VA: Author. doi:10.1176/appi.books.9780890425596.dsm02
Note:
You will access this e-book chapter from the Walden Library databases.
American Psychiatric Association. (2013b). Assessment measures. In
Diagnostic and statistical manual of mental disorders
(5t.
INTERCULTURAL RESEARCH AND ANALYSIS PROJECTWritten Report. The .docxnormanibarber20063
INTERCULTURAL RESEARCH AND ANALYSIS PROJECT
Written Report. The written report (7-8 pages and References) should consist of an introduction, in which the general context is explained and a rationale is provided for the importance of the topic, and the following sections: (a) description of the situation and the context in which it is embedded; (b) 4 page literature review; and (c) analysis of the situation and conclusion. Include a reference page prepared in either APA or MLA format, and attach an appendix with copies of materials (e.g., specific news articles) that help explain the context.
Paper Structure Guidelines
You may use headings (e.g., Introduction, Body, Conclusion) for the main parts of your paper. Also, use “I” in this paper where appropriate.
1. Introduction
a. Provide background information about the issue/case/incident/situation that led you to work on this research project
b. State your Research Question
c. State your position on the issue and preview what you will discuss in the paper
2. Body
a. Provide a summary of each of the articles/sources you located. Think carefully about how you order these summaries.
b. Discuss how these sources inform you about the situation/case/issue your investigated; how they help you in answering your research question.
3. Conclusion
a. State what you have learned about the situation/issue/case based on the research you did.
4. Do not forget to mention how this research relates to what you have been learning in CAS 471 this semester.
5. References
6. Appendix (only if applicable). If you investigated a specific incident/case/situation discussed in the media, include a link or attach a copy of the news article.
Grading Rubric:
Content (80 pts)
Introduction (14 pts)
Body: Review of research studies/articles/sources (36 pts)
Body: Summary and discussion of findings (20 points)
Conclusion (10 pts)
Organization & overall format (5 pts)
Grammar, punctuation, spelling (5 pts)
In-text documentation (5 pts)
Reference page (end-of-text list of references) (5 pts)
Running head ANNOTATED BIBLIOGRAPHY 1
ANNOTATED BIBLIOGRAPHY 4
Annotated Bibliography
Gordon Lu (Guo)
ICC 471
Dixon, J., Durrheim, K., & Tredoux, C. (2005). Beyond the optimal contact strategy: a reality check for the contact hypothesis. American Psychologist, 60(7), 697.
Dovidio, J. F., Kawakami, K., & Gaertner, S. L. (2002). Implicit and explicit prejudice and interracial interaction. Journal of personality and social psychology, 82(1), 62.
In this article, the authors discuss the contact theory that argues that contact between people between diverse groups normally assists in reducing the intergroup prejudice, but only in ideal conditions. The authors continue to criticize some research practices have been dominant in this field including the prioritization of the research of relations between rarefied circumstances. They also critic.
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1. IntroversionScore 11 pts.4 - 22 pts.Feedback Some peopMartineMccracken314
1. Introversion
Score : 11 pts.
4 - 22 pts.
Feedback: Some people thrive in teleworking arrangements, whereas others discover that it is neither a satisfying nor productive work environment for them. This scale assesses three personal dispositions that are identified in the literature as characteristics of effective teleworkers: (a) high company alignment, (b) low social needs at work and (c) independent initiative.
Company alignment
Company alignment estimates the extent to which you follow company procedures and have values congruent with company values. The greater the alignment, the more likely that you can abide by company practices while working alone and with direct supervision. While some deviation from company practices may be appropriate, teleworkers need to agree with company values and provide work that is consistent with company expectations most of the time. Scores on this scale range from 4 to 20.
Extroversion
Score: 17 pts.
4 - 22 pts.
Feedback: Low individualism
Individualism refers to the extent that you value independence and personal uniqueness. Highly individualist people value personal freedom, self-sufficiency, control over their own lives, and appreciation of their unique qualities that distinguish them from others.
However, keep in mind that the average level of individualism is higher in some cultures (such as Australia) than in others.
2. Total score: 8 pts.
RANGE BASED FEEDBACK:
6-12 pts.
Feedback: Low work centrality
People with high work centrality define themselves mainly by their work roles and view non-work roles as much less significant. Consequently, people with a high work centrality score likely have lower complexity in their self-concept. This can be a concern because if something goes wrong with their work role, their non-work roles are not of sufficient value to maintain a positive self-evaluation. At the same time, work dominates our work lives, so those with very low scores would be more of the exception than the rule in most societies. Scores range from 6 to 36 with higher scores indicating higher work centrality. The norms in the following table are based on a large sample of Canadian employees (average score was 20.7). However, work centrality norms vary from one group to the next. For example, the average score in a sample of Canadian nurses was around 17 (translated to the scale range used here).
3. Total score: 32 pts.
RANGE BASED FEEDBACK:
28-32 pts.
Feedback: High need for social approval
The need for social approval scale estimates the extent to which you are motivated to seek favourable evaluation from others. Founded on the drive to bond, the need for social approval is a secondary need, because people vary in this need based on their self-concept, values, personality and possibly social norms. This scale ranges from 0 to 32. How high or low is your need for social approval? The ideal would be to compare your score with the collective results of other students in your class. Otherwi ...
1. International financial investors are moving funds from Talona MartineMccracken314
1. International financial investors are moving funds from Talona to other countries. This depreciation is causing even more disenchantment with this Talona's currency. Describe the affects will this have on the supply and demand curves for this currency on the foreign exchange markets?
2. Using a supply and demand diagram, demonstrate how a negative externality leads to market inefficiency. How might the government help to eliminate this inefficiency?
3. Briefly discuss the shortcomings of environmental command-and-control regulations.
4. Some data that at first might seem puzzling: The share of GDP devoted to investment was similar for the United States and South Korea from 1960-1991. However, during these same years South Korea had a 6 percent growth rate of average annual income per person, while the United States had only a 2 percent growth rate. If the saving rates were the same, why were the growth rates so different?
5. “Block Imports—Save Jobs for Some Americans, Lose a Roughly Equal Number of Jobs for Other Americans, and Also Pay High Prices.” Discuss this statement within the context of protectionism.
6. Steve and Craig have been shipwrecked on a deserted island in the South Pacific. Their economic activity consists of either gathering pineapples or fishing. We know Steve can catch four fish in one hour or harvest two baskets of pineapples. In the same time Craig can reel in two fish or harvest two baskets of pineapples.
Assume Craig and Steve both operate on straight-line production possibilities curves. What is Steve's opportunity cost of producing a basket of pineapples? Of a producing a fish? What is Craig's opportunity cost of producing a basket of pineapples? Of a producing a fish?
7. Provide examples of market-oriented environmental policies.
Running head: SC PLAN 1
SC PLAN 4
SC PLAN
Student’s Name
Institution Affiliation
SC PLAN
1. Describe the actions you will take to increase your net cash flows in the near future.
The first step is to reduce living expenditures. It is critical to lessen the amount spent on living expenses and other variables and save for future use. I will have to prevent luxuries such as vacation costs or keep them in check to avoid spending a hefty amount on them. I should check the option to cook for myself and avoid buying food. Also, I will choose a destination I can drive myself to save on rental car expenditures and airfare. I will have a detailed budget indicating the amount required for savings, debt repayment, and investment that will assist only to spend the money on essential expenditures. Further, the savings can help to start a business and become self-employed in the distant future.
I would have to look for a job that pays well or engage in a robust salary negotiation. The right time to negotiate for salary is during a performance review, compensation meeting, or job promotion (Bellon, Cookson, Gilje, & Heimer, 2020). I will ensure that I expand my education and technic ...
1. Interventionstreatment· The viral pinkeye does not need any MartineMccracken314
1. Interventions/treatment
· The viral pinkeye does not need any medication
· The bacterial pinkeye is treated with ointment or eye droplets
2. Possible nursing diagnosis
· Checking the specific infection affecting the eye
· Identifying burning eyes
· Increased anxiety with red eyes
3. Sign and symptoms
· Eye irritation
· Eye tearing
· Eye redness
· Eye discomfort
4. Nursing Interventions
· Putting some droplets in the kid’s eye
· Using a antibiotic ointment
· Administering ibuprofen to the kid
5. Risk factors
· Allergies
· A women having an STD during pregnancy
· Exposing the child to areas with lots of bacteria
6. Pathophysiology
The infected eye shows through an inflammation that is swollen and red. The conjunctiva shows and this is the clear membrane seen in the part where the eye is white. It remains this way if not treated for a while before it ends with medication administered or just ends naturally.
7. Complications
· A scaring in the child’s eye if the conjunctivitis is caused by allergic reactions
· It can aggravate to cause different conditions such as meningitis
8. Diagnostic Procedure
· Administering the medicine using eye droplets
· Rubbing the eye area with the ointment
...
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Similar to 1 Instructions for Coming of Age in Mississippi
This is a 100,000 word, 200 page, longitudinal, retrospective and prospective account of my experience with bipolar disorder and some other mental health problems over 70 years: from October 1943 to October 2013. This account is a personal, clinical, and idiosyncratic study of what some life-study students call a chaos narrative. This study focuses on an aspect of my life involving several mental health issues, but mainly bipolar 1 disorder. This account is now in its 13th edition. In my retirement, the years from 2001 to 2013, I have revised the account each year up-dating the content (i) as new information about the mental health issues I deal with are added to the science, and (ii) as I continue to deal with these mental health issues as I head to the age of 70 in 2014.
SWAD#4Watch the you tube video below and write at least a 300 wo.docxmattinsonjanel
SWAD#4
Watch the you tube video below and write at least a 300 word reflection regarding Sexuality and Older Adults. Did you learn any new information? What tips does Dr. Sewell have for communicating with older adults about sexuality and intimacy?
Sexuality and aging-research by Dan Sewell
https://www.youtube.com/watch?v=fJHiUzHZP80
Running head: SHORT TITLE OF PAPER
3
Full Title of Paper
Student Name
PSY2010 Abnormal Psychology
Abstract
The abstract is on a page of its own after the title page. It is a brief summary of the content of your paper (typically 50-150 words but no more than 200). It is not indented and the word abstract at the top of the page is not bold since it is not a heading within the paper.
Full Title of Paper
This is the first page of the body of your paper. The full title of your paper is repeated at the top of the page. Like with the abstract, the title at the top of the page is not bold since it is not considered a heading within the paper. You will see below that headings within the paper are in bold and follow the heading styles required by the Publication Manual of the American Psychological Association (6th ed.; American Psychological Association, 2009).
This first section of your paper is the introduction of your paper. This introduction is one page in length at a minimum. It is not labeled separately. It introduces the topic of your paper and the points you intend to make. Why is this topic important to psychology? This section also introduces how your paper will be organized, such as stating that you will review the historical background of the topic and then follow it with an overview of related current trends and discussion.
Literature Review
This is the beginning of your literature review. Keep in mind, the literature review is not just a summary of each individual article. It is also a critical analysis of your topic supported by information you learned when reading the background literature. Your APA formatted citations for the sources of the information you are discussing is your indication of the literature reviewed.
Subheading 1 Example
Depending on your topic, you may find it necessary to use subheadings within sections of your document. For example, if you are comparing and contrasting the different theories or treatments for the disorders based on the articles you reviewed.
Subheading 2 Example
Only use subheadings if you have more than one area you want to distinguish as a sub-section. Otherwise, leave them out and simply use separate paragraphs.
Discussion and Conclusions (1-2 pages minimum)
This section of your paper is where you discuss your opinions about the topic you have been covering (backed by the information you have learned and citations for that information). What are the similarities and differences between what you learned in reviewing the literature and what you previously knew about the topic? What is the quality of the research you found on this topic? Did you find ...
Long-Term Care TodayDemographics and epidemiological transitions.docxSHIVA101531
Long-Term Care Today
Demographics and epidemiological transitions result in dramatic changes in the health needs of individuals throughout the globe. In recent times, there has been increase in the prevalence of long-term disability in the population—causing increasing need for long-term care services. In addition, the present developing world is experiencing an increase in the demand for long-term care services at a cost much lower than industrialized countries.
Prepare a report in a 3- to 4-page Microsoft Word document comparing the US long-term care system with the long-term care system of a developing country. Research Scholarly Library and the Internet to find relevant content.
Include the following information in your report:
· What are the chronic illness trends of each country?
· What is the incidence and prevalence of elderly consumers of long-term care in the United States as compared to your chosen developing country?
· How does each country expect these numbers to change in the next ten years?
· What are the main characteristics of the elderly population in both the countries? Is there any difference in the long-term health care needs of consumers in both the countries? Provide a rationale for your answer.
· Who are the institutional and non institutional caregivers in both the countries? Support your answer with relevant examples. Explain the factors that affect care giving in each country.
· Is there any difference in the status of quality of care of the elderly consumers in the United States as compared to the developing country?
· Is there any difference in the health care cost provided in the United States as compared to the developing country? Define any social support that may exist to cover health care in both countries.
Support your responses with examples.
Cite any sources in APA format.
15 INTERVIEW QUESTIONS
1. How do you feel about yourself? She cross that one
2. What are your experiences on your everyday interactions with the normal members of the society?
3. What are your everyday experiences with the deaf colleagues in the society?
4. What are your experiences with your family members?
5. How do you relate to your wife? (Married male adults) OR, how do you relate to your husband? (married female adults?)
6. need Q
7. How often do you interact with the members of the society that are not deaf?
8. How do you communicate with members of the society who do not know sign language?
9. What do you do if you encounter an individual who does not know how to communicate in sign language?
10. What was your experience when you were young?
11. How did you feel when you were with your peers when you were little?
12. How did you feel when your peers could not understand your situation when you were little?
13. What was your experience in your family during young age?
14. In case you were discriminated by your peers, how did you feel?
15. Do you remember any one time when you felt low self-esteem due to the treatment that you ...
Attachment, Antisocial, And Antisocial BehaviorDiane Allen
Secure early attachments help develop empathy and emotional regulation, promoting prosocial behavior. Those lacking these skills display antisocial behavior like disrespecting others' rights. Antisocial behavior in adolescents can predict later adjustment issues and criminality. While some defiance is normal in teens, consistent antisocial behavior signals a disorder requiring treatment.
· 22 sub Diagnostic Case ReportsThere, you will see twchestnutkaitlyn
· 2:2 sub
: Diagnostic Case Reports
There, you will see twelve different disorders listed. For this module, view the following disorders:
· Borderline Personality Disorder
· Substance Use
After clicking a disorder, click the Diagnostic Overview tab in the left column. This will cover the major diagnostic features of the disorder. After that, click the
DSM-5
Features tab. You can then go though the Case History, Interview, and Treatment sections on the website. Finally, in the Assessment section, you can complete an optional multiple-choice quiz. You have to write a case report for each case study. You should use the format provided on the web page. There is a sample report that you can also view by clicking the link in the upper-right corner.
The format for the sample report is as follows:
Your Name
Instructor's Name
Class/Section Number
Background
· Outline the major symptoms of this disorder.
· Briefly outline the client's background (age, race, occupations, etc.).
· Describe any factors in the client's background that might predispose him or her to this disorder.
Observations
· Describe any symptoms that you have observed that support the diagnosis. You can include direct quotes or behaviors that you may have observed.
· Describe any symptoms or behaviors that are inconsistent with the diagnosis.
· Provide any information that you have about the development of this disorder.
Diagnosis
· Did you observe any evidence of general medical conditions that might contribute to the development of this disorder?
· Did you observe any evidence of psychosocial and environmental problems that might contribute to this disorder?
· As per your observations, what is the client's overall level of safety regarding the potential harm to self or others (suicidality or homicidality)?
· What cross-cultural issues, if any, affect the differential diagnosis?
Therapeutic Intervention
· In your opinion, what are the appropriate short-term goals of this intervention?
· In your opinion, what are the appropriate long-term goals of this intervention?
· Which therapeutic strategy seems the most appropriate in this case? Why?
· Which therapeutic modality seems the most appropriate in this case? Why?
Described the major symptoms of each disorder, outlined each person's background, and described any factors in the person's background that might predispose him or her to their disorder.
20
Described any symptoms that were observed that support each diagnosis and any symptoms or behaviors that are inconsistent with each diagnosis and provided relevant information from the case history about the development of each disorder
20
Described any evidence of psychosocial or medical issues that might have contributed to each disorder, identified any safety concerns regarding suicidality or homicidality, and discussed any cross-cultural issues affecting the differential diagnosis.
20
Discussed appropriate short-term and long-term goals of each i ...
This paper will discuss serial killers and identify a research pro.docxherthalearmont
This paper will discuss serial killers and identify a research problem in regard to the topic. Generally, a serial killer can be defined as a person who has murdered three or more people within a time range of more than a month with some significant emotional cooling periods in between the events. Furthermore, this has to be in service of abnormal psychological gratification. However, over the years, various professionals such as mental health experts and law enforcement investigators have been trying to study serial killers in vain since they have never reached a consensus in regard to the issue in question. Therefore, the problem to be addressed by this study is that there is not enough information about the life of the serial killers before the killings started (Abe, 2017). Comment by EasyTiger: Try to form a concise problem statement that has it’s own paragraphs apart from the rest of the sections or in a section of its own. The problem statement should have a maximum of 500 words.
Understanding serial killers
Generally, from the studies, it is clear that the motivations for serial killers are quite complex and therefore, only an intensive psychological analysis on the individuals can help in providing some significant insight. This might include how and why the individuals in question became serial killers. Information from the analysis can then be used in preventing cases of serial killings in future. For example, since the various incidences of serial killing are known to have a number of similar features, these similarities can be used to identify a killer who is actively killing and, hence, prevent any other cases of homicide in the future. However, the problem is that many relevant authorities or rather bodies that are supposed to deal with cases of serial killing lack this vital information that might be instead used to curb any further homicidal incidents. However, in a bid to understand them, there are some areas that need to be discussed in detail that include: the motivations involved in serial killings, the psychological, and neurodevelopment disorders (Ioana, 2017).
Psychological Disorders
As much as the research into serial killers might still be in its infancy, current evidence indicates that psychological disorders play a significant role. This can be well understood by looking into the motivations of serial killers. Evidence shows that some of the motivations involved in serial killing include the need for perfection or power or the fear of rejection. As a result, a majority is usually much afraid of rejection and is usually also very insecure. They also avoid close or painful relationships. This is the reasons many of them are usually reported to having sex with their victims or even their corpses to reduce the chances of being rejected. Furthermore, they tend to prolong the suffering of their victims, especially when killing with the main aim of creating a sense of power over the victims. In addition, they also hold on ...
Running head RESEARCH PROPOSAL10RESEARCH PROPOSAL 8.docxtoltonkendal
Running head: RESEARCH PROPOSAL 10
RESEARCH PROPOSAL 8
Research Proposal
Jamie Bass
Argosy University
March 3, 2016
ABSTRACT
Suicide is experienced in all parts of parts of the world. Even though it has been argued that suicide is common amongst the elderly in the society, it is worth noting that even children as young as 13 years old have committed suicide. The myths and misconceptions surrounding suicidal individuals are inherently different from one culture to another. For instance, in some cultures it is believed that suicidal individuals are possessed by demons. Other cultures attribute suicide to generational curses whereas other cultures attribute suicide to such factors as depression and other mental disorders. The purpose of the proposed research is to establish the risk factors of suicide and realize possible strategies which if undertaken can help to counteract suicide and hence its adverse effects in the society. In this proposal are the points to be addressed in the course of the research. It is anticipated that there will be objections to the factors to be established and hence part of this proposal are possible objections and how each of the possible objections will be addressed. The research will use secondary sources of information and hence part of this proposal is an annotated bibliography of the sources that will be utilized in course of the research. Comment by Spencer Ellsworth: This is good, but could you state it more as a piece of argumentation? Like “This paper argues that early intervention can prevent suicide if done correctly.”
WORKING THESIS
Suicide has negatively affected the society, and unless there are mitigation strategies to curb this menace, it will continue to take the lives of many people in the society.
EXPLANATION
Suicide is the act of human beings voluntarily taking their lives. Research has shown that it has always been caused by a sense of despair or hopelessness. All these issues may be induced by mental illness which may include Bipolar disorder or even depression. Suicide has been traumatizing and shameful to the bereaved families and many people in the society have always viewed it as a cowardice way of taking one’s life. Many suicidal persons have been haunted by their thoughts in many cases this is depicted as a very personal process (Goldsmith, Pellmar, Kleinman & Bunney, 2002).
In this paper, it is very much possible to look at what suicide is and the risk factors associated with suicide. A study conducted in Sweden consisting of 271 men aged 15 years and above revealed that mental disorder is a major suicide risk factor. It is thus recommended that the research paper will dwell on mental disorder and substance abuse as risk factors that contribute to suicide as well as medical conditions and psychosocial states. Harris & Barraclough (2009) also established a causal relationship between mental disorder and suicide a factor that further makes the proposed research ...
Based on the authors’ own clinical experiences, these seventee.docxjasoninnes20
Based on the authors’ own clinical experiences, these seventeen comprehensive
case histories reflect the most common psychological disorders. Rich in detail, inte-
grated in approach, and fully updated for the DSM-5, each case describes patient
symptoms and history, the formulation and implementation of a treatment plan,
and results. Each case also includes the perspective of a family member or friend.
This unique viewpoint emphasizes the impact of psychological disorders on those
closest to the patient as well as the importance of considering sociocultural factors
in diagnosis and treatment. Each case study concludes with assessment questions
that help students check their understanding of the symptoms, diagnosis, and
treatment of the disorder exhibited by the patient. Three additional cases provide
opportunities for students to identify disorders and suggest appropriate therapies.
Diagnostic information and treatment strategies for the patients in these “You
Decide” cases are provided in appendices for students to check their assessments.
About the Authors
Ethan E. Gorenstein is clinical director of the Behavioral Medicine Program at
Columbia-Presbyterian Medical Center and a professor of clinical psychology in
the department of psychiatry at Columbia University. He is also the author of The
Science of Mental Illness (Academic Press). He has an active clinical practice de-
voted to the use of evidence-based psychological treatment methods for problems
of both children and adults.
Ronald J. Comer is a professor in the psychology department at Princeton Univer-
sity and director of clinical psychology studies. He is also chair of the university’s
Institutional Review Board. A clinical psychologist, he is the author of the text-
books Abnormal Psychology and Fundamentals of Abnormal Psychology (Worth
Publishers), Psychology Around Us (John Wiley and Sons Publishers), and producer
of numerous educational videos on subjects ranging from abnormal psychology to
introductory psychology and neuroscience.
For complete information on our books, electronic materials, and faculty and
student resources, visit us at www.worthpublishers.com
C A S E S T U D I E S I N
ABNORMAL PSYCHOLOGY
E t h a n E . G o r e n s t e i n a n d R o n a l d J . C o m e r
S E C O N D E D I T I O N
CASE STUDIES IN ABNORMAL PSYCHOLOGY
S E C O N D
E D I T I O N
W O R T H
Gorenstein
■ Com
er
C A S E S T U D I E S I N
ABNORMAL PSYCHOLOGY
E t h a n E . G o r e n s t e i n a n d R o n a l d J . C o m e r
S E C O N D E D I T I O N
Cover image: Gary Waters/Illustration Source
7.5 × 9.125 SPINE: 0.688 FLAPS: 0
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Case Studies in
Abnormal Psychology
SeCond edition
Ethan E. Gorenstein
Behavioral Medicine Program
Columbia-Presbyterian Medical Center
Ronald J. Comer
Princeton University
WoRtH PUBLiSHeRS
Macmillan education
Vice President, Editing, Design, and Media ...
Alcoholism and its effects on society Free Essay Example. The Abuse of Alcohol - Free Essay Example | PapersOwl.com. ≫ An In Depth Look At Alcoholism Free Essay Sample on Samploon.com. Alcohol:What You Should Know - Sample Essay. Cause and effects of alcohol essays. Persuasive Essay: Teens and Alcohol Abuse. Fearsome Alcoholism Cause And Effect Essay ~ Thatsnotus. Academic Text.docx | Alcoholism | Essays.
Extra Credit Opportunity for Spring 2019Students of Abnormal Psy.docxmecklenburgstrelitzh
This document provides information about an extra credit opportunity for students in an Abnormal Psychology course. Students can earn up to 10 extra credit points by writing a paper analyzing a fictional or historical character and diagnosing them with a mental illness using criteria from the DSM-5. The paper must be at least two pages, single spaced, and include examples from the chosen text to support the diagnosis as well as a discussion of potential causes and treatment approaches for the illness. The deadline to submit papers is April 16, 2019.
CLASS ASSIGNMENTS (Choose OneWriting Project, Discussion Grou.docxbartholomeocoombs
CLASS ASSIGNMENTS (Choose One:
Writing Project, Discussion Group or Couple Enrichment):
Option #1:
WRITING
PROJECT
(Choose 1 out of the following 7 Topics)
:
Paper
heading
should include:
Student Name;
Student ID #;
and Section 001.
Pages must be:
typed and double-spaced:
12 point font;
1” margins.
It should be a minimum of 6 pages and is due on
March 30th
.
HARD COPY ONLY.
Choose 1 of the following 7 topics. Your paper should be divided into 2 sections.
Section 1: (2 -3 pages)
- “What Do You Think” - asks
you
to reflect and discuss the topic area.
Section 2: (3-4 pages)
– “What Does Research Tell Us” – asks you to discuss
your review
of the
literature, with appropriate references and bibliography, on the topic area.
PLEASE use the following headings within your paper:
Section 1: What Do You Think?
Section 2: What Does Research Tell Us?
1.
TOPIC 1
·
Section 1: What Do You Think?
:
Do you think that sex or violence on television influences how promiscuous or violent our society becomes? Do you think the sexual stereotypes in commercials and advertisements shape our attitudes toward gender relations? How do you think you have been influenced by the media?
·
Section 2: What Does Research Tell Us?
:
Discuss what research has revealed regarding the impact of sexually violent and degrading media on the attitudes and behaviors of men and women. What effect, if any, does this “exposure” have on intimate relationships?
2.
TOPIC 2
·
Section 1: What Do You Think?
:
Describe your ideal marriage/cohabitating partner and their characteristics (e.g. appearance, personality, and occupation). What circumstances or conflicts (if any) would lead you to consider a separation or divorce (e.g. infidelity, refusal to have children, disease, or cross-dressing)?
·
Section 2: What Does Research Tell Us?
:
After a review of the literature, discuss the factors that determine with whom we fall in love; and the principle factors involved in keeping a relationship strong.
3.
TOPIC 3
·
Section 1: What Do You Think?
:
Imagine that you have always been attracted emotionally and sexually to your own sex and that your family has rather traditional religious and conservative views. Would you tell your family about your attraction? If you were to disclose your sexual orientation to your family, how would you do it? What do you think their response would be?
·
Section 2: What Does Research Tell Us?
:
From your research, what are the steps that people can take to communicate to others about their sexual orientation? What is the process of “coming out”? Briefly discuss the social and psychological effects on people who are unable to disclose their sexual orientation or introduce a lifetime partner to family and friends.
4.
TOPIC 4:
·
Section 1: What Do You Think?
:
Both men and women may sometimes give unclear signals about whether they are willing to engage in sexual contact when they are in a potent.
Experiences of schizophrenia are not homogeneous; there is wide.docxrhetttrevannion
Experiences of schizophrenia are not homogeneous; there is wide variety in onset, course of illness, and combinations of symptoms. Social workers need to be able to understand the different manifestations and pathways of the illness to plan interventions. Social work services play a key role in stabilizing crises, supporting family coping, and influencing overall quality of life and outcomes of individuals with schizophrenia. In this Assignment, you practice applying this necessary individualization.
To prepare:
In the Learning Resources, focus on the associated features, development, and course of the illnesses in the schizophrenia spectrum. Also focus on descriptions of the disorder and the way it develops for different individuals.
Choose two articles from the list in the Learning Resources that apply to treatment support and interventions for the schizophrenia spectrum. Access the Walden Library and research additional peer-reviewed articles.
By Day 7
Submit
a 3- to 4-page paper, supported by at least 3–4 scholarly resources (including both required and additional resources), in which you address the following:
Compare Saks’s and McGough’s experiences with schizophrenia, specifically referencing the positive and negative symptoms they each experienced.
Explain how you would use the Clinician Rated Dimensions of Psychosis Symptom Severity measure and the WHODAS to help confirm your diagnosis.
Identify in what ways their cases are typical or atypical of the illness in terms of onset, associated features, development, and course. Support your response with references to scholarly resources.
Explain how you would plan treatment and individualize it for these two individuals. Support your response with references to scholarly resources. In your explanation, consider the following questions:
What are the long-term challenges for someone living with the illness?
What social, family, vocational, and medical supports are needed for long-term stabilization?
How might treatment look similar or different for Saks and McGough, given they have the same diagnosis?
Briefly explain how race/ethnicity, gender, sexual orientation, socioeconomic status, religion, or other identity characteristics may influence an individual’s experience with schizophrenia. in the black community
Morrison, J. (2014).
Diagnosis made easier
(2nd ed.). New York, NY: Guilford Press.
Chapter 5, “Coping with Uncertainty” (pp. 43–56)
Chapter 13, “Diagnosing Psychosis” (pp. 185–215)
American Psychiatric Association. (2013o). Schizophrenia spectrum and other psychotic disorders. In
Diagnostic and statistical manual of mental disorders
(5th ed.). Arlington, VA: Author. doi:10.1176/appi.books.9780890425596.dsm02
Note:
You will access this e-book chapter from the Walden Library databases.
American Psychiatric Association. (2013b). Assessment measures. In
Diagnostic and statistical manual of mental disorders
(5t.
INTERCULTURAL RESEARCH AND ANALYSIS PROJECTWritten Report. The .docxnormanibarber20063
INTERCULTURAL RESEARCH AND ANALYSIS PROJECT
Written Report. The written report (7-8 pages and References) should consist of an introduction, in which the general context is explained and a rationale is provided for the importance of the topic, and the following sections: (a) description of the situation and the context in which it is embedded; (b) 4 page literature review; and (c) analysis of the situation and conclusion. Include a reference page prepared in either APA or MLA format, and attach an appendix with copies of materials (e.g., specific news articles) that help explain the context.
Paper Structure Guidelines
You may use headings (e.g., Introduction, Body, Conclusion) for the main parts of your paper. Also, use “I” in this paper where appropriate.
1. Introduction
a. Provide background information about the issue/case/incident/situation that led you to work on this research project
b. State your Research Question
c. State your position on the issue and preview what you will discuss in the paper
2. Body
a. Provide a summary of each of the articles/sources you located. Think carefully about how you order these summaries.
b. Discuss how these sources inform you about the situation/case/issue your investigated; how they help you in answering your research question.
3. Conclusion
a. State what you have learned about the situation/issue/case based on the research you did.
4. Do not forget to mention how this research relates to what you have been learning in CAS 471 this semester.
5. References
6. Appendix (only if applicable). If you investigated a specific incident/case/situation discussed in the media, include a link or attach a copy of the news article.
Grading Rubric:
Content (80 pts)
Introduction (14 pts)
Body: Review of research studies/articles/sources (36 pts)
Body: Summary and discussion of findings (20 points)
Conclusion (10 pts)
Organization & overall format (5 pts)
Grammar, punctuation, spelling (5 pts)
In-text documentation (5 pts)
Reference page (end-of-text list of references) (5 pts)
Running head ANNOTATED BIBLIOGRAPHY 1
ANNOTATED BIBLIOGRAPHY 4
Annotated Bibliography
Gordon Lu (Guo)
ICC 471
Dixon, J., Durrheim, K., & Tredoux, C. (2005). Beyond the optimal contact strategy: a reality check for the contact hypothesis. American Psychologist, 60(7), 697.
Dovidio, J. F., Kawakami, K., & Gaertner, S. L. (2002). Implicit and explicit prejudice and interracial interaction. Journal of personality and social psychology, 82(1), 62.
In this article, the authors discuss the contact theory that argues that contact between people between diverse groups normally assists in reducing the intergroup prejudice, but only in ideal conditions. The authors continue to criticize some research practices have been dominant in this field including the prioritization of the research of relations between rarefied circumstances. They also critic.
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Similar to 1 Instructions for Coming of Age in Mississippi (18)
1. IntroversionScore 11 pts.4 - 22 pts.Feedback Some peopMartineMccracken314
1. Introversion
Score : 11 pts.
4 - 22 pts.
Feedback: Some people thrive in teleworking arrangements, whereas others discover that it is neither a satisfying nor productive work environment for them. This scale assesses three personal dispositions that are identified in the literature as characteristics of effective teleworkers: (a) high company alignment, (b) low social needs at work and (c) independent initiative.
Company alignment
Company alignment estimates the extent to which you follow company procedures and have values congruent with company values. The greater the alignment, the more likely that you can abide by company practices while working alone and with direct supervision. While some deviation from company practices may be appropriate, teleworkers need to agree with company values and provide work that is consistent with company expectations most of the time. Scores on this scale range from 4 to 20.
Extroversion
Score: 17 pts.
4 - 22 pts.
Feedback: Low individualism
Individualism refers to the extent that you value independence and personal uniqueness. Highly individualist people value personal freedom, self-sufficiency, control over their own lives, and appreciation of their unique qualities that distinguish them from others.
However, keep in mind that the average level of individualism is higher in some cultures (such as Australia) than in others.
2. Total score: 8 pts.
RANGE BASED FEEDBACK:
6-12 pts.
Feedback: Low work centrality
People with high work centrality define themselves mainly by their work roles and view non-work roles as much less significant. Consequently, people with a high work centrality score likely have lower complexity in their self-concept. This can be a concern because if something goes wrong with their work role, their non-work roles are not of sufficient value to maintain a positive self-evaluation. At the same time, work dominates our work lives, so those with very low scores would be more of the exception than the rule in most societies. Scores range from 6 to 36 with higher scores indicating higher work centrality. The norms in the following table are based on a large sample of Canadian employees (average score was 20.7). However, work centrality norms vary from one group to the next. For example, the average score in a sample of Canadian nurses was around 17 (translated to the scale range used here).
3. Total score: 32 pts.
RANGE BASED FEEDBACK:
28-32 pts.
Feedback: High need for social approval
The need for social approval scale estimates the extent to which you are motivated to seek favourable evaluation from others. Founded on the drive to bond, the need for social approval is a secondary need, because people vary in this need based on their self-concept, values, personality and possibly social norms. This scale ranges from 0 to 32. How high or low is your need for social approval? The ideal would be to compare your score with the collective results of other students in your class. Otherwi ...
1. International financial investors are moving funds from Talona MartineMccracken314
1. International financial investors are moving funds from Talona to other countries. This depreciation is causing even more disenchantment with this Talona's currency. Describe the affects will this have on the supply and demand curves for this currency on the foreign exchange markets?
2. Using a supply and demand diagram, demonstrate how a negative externality leads to market inefficiency. How might the government help to eliminate this inefficiency?
3. Briefly discuss the shortcomings of environmental command-and-control regulations.
4. Some data that at first might seem puzzling: The share of GDP devoted to investment was similar for the United States and South Korea from 1960-1991. However, during these same years South Korea had a 6 percent growth rate of average annual income per person, while the United States had only a 2 percent growth rate. If the saving rates were the same, why were the growth rates so different?
5. “Block Imports—Save Jobs for Some Americans, Lose a Roughly Equal Number of Jobs for Other Americans, and Also Pay High Prices.” Discuss this statement within the context of protectionism.
6. Steve and Craig have been shipwrecked on a deserted island in the South Pacific. Their economic activity consists of either gathering pineapples or fishing. We know Steve can catch four fish in one hour or harvest two baskets of pineapples. In the same time Craig can reel in two fish or harvest two baskets of pineapples.
Assume Craig and Steve both operate on straight-line production possibilities curves. What is Steve's opportunity cost of producing a basket of pineapples? Of a producing a fish? What is Craig's opportunity cost of producing a basket of pineapples? Of a producing a fish?
7. Provide examples of market-oriented environmental policies.
Running head: SC PLAN 1
SC PLAN 4
SC PLAN
Student’s Name
Institution Affiliation
SC PLAN
1. Describe the actions you will take to increase your net cash flows in the near future.
The first step is to reduce living expenditures. It is critical to lessen the amount spent on living expenses and other variables and save for future use. I will have to prevent luxuries such as vacation costs or keep them in check to avoid spending a hefty amount on them. I should check the option to cook for myself and avoid buying food. Also, I will choose a destination I can drive myself to save on rental car expenditures and airfare. I will have a detailed budget indicating the amount required for savings, debt repayment, and investment that will assist only to spend the money on essential expenditures. Further, the savings can help to start a business and become self-employed in the distant future.
I would have to look for a job that pays well or engage in a robust salary negotiation. The right time to negotiate for salary is during a performance review, compensation meeting, or job promotion (Bellon, Cookson, Gilje, & Heimer, 2020). I will ensure that I expand my education and technic ...
1. Interventionstreatment· The viral pinkeye does not need any MartineMccracken314
1. Interventions/treatment
· The viral pinkeye does not need any medication
· The bacterial pinkeye is treated with ointment or eye droplets
2. Possible nursing diagnosis
· Checking the specific infection affecting the eye
· Identifying burning eyes
· Increased anxiety with red eyes
3. Sign and symptoms
· Eye irritation
· Eye tearing
· Eye redness
· Eye discomfort
4. Nursing Interventions
· Putting some droplets in the kid’s eye
· Using a antibiotic ointment
· Administering ibuprofen to the kid
5. Risk factors
· Allergies
· A women having an STD during pregnancy
· Exposing the child to areas with lots of bacteria
6. Pathophysiology
The infected eye shows through an inflammation that is swollen and red. The conjunctiva shows and this is the clear membrane seen in the part where the eye is white. It remains this way if not treated for a while before it ends with medication administered or just ends naturally.
7. Complications
· A scaring in the child’s eye if the conjunctivitis is caused by allergic reactions
· It can aggravate to cause different conditions such as meningitis
8. Diagnostic Procedure
· Administering the medicine using eye droplets
· Rubbing the eye area with the ointment
...
1. Introduction and background information about solvatochromism uMartineMccracken314
1. Introduction and background information about solvatochromism using Reichardt’s dye? (400-500 words)
2. Discuss the properties of Reichardt’s dye that cause it to change its wavelength of maximum absorbance in the presence of solvents of differing polarities.
3. Discuss solvatochromism. Are there other dyes which exhibit this effect?
4. Would it be possible to use the wavelength of maximum absorbance in the presence of Reichardt’s dye to determine the water content of acetone solutions?
...
1. Integrity, the basic principle of healthcare leadership.ContaMartineMccracken314
1. Integrity, the basic principle of healthcare leadership.
Contains unread posts
Mateo Alba posted May 12, 2021 10:04 PM
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Integrity of any organization regardless whether it is in healthcare or business or government is paramount. Because of integrity comes trust. Having trust in a healthcare organization is nonnegotiable. It is the foundation of a world-class organization. Executives who ignore ethics run the risk of personal and corporate liability in today’s increasingly tough legal environment (Lynn S. Paine, 1994, Managing for Organizational Integrity, pp. 2-21)
First, the healthcare organization. The healthcare organization is the head or the governing body. It is charged of day-to-day functions, establish policies, guidance, business process, safety, security and all the administrative duties. Integrity is and must be the cornerstone of any healthcare organization. Without it, no clinicians or workers that would knowingly work for an organization that they cannot trust or feel safe. And most importantly, if the patients do not have trust in the organization, they will avoid that facility at all cost.
Second, the clinicians. The clinicians are what makes the organization or facility function. Whether they are the providers, nurses or staff it is important that they have the integrity to always do what is right not only for the healthcare team or the organization, but most specially for the patient. It starts with the clinical leaders building trust to their subordinate staff by having the integrity and values of what a leader should be. Once that is established, then it permeates throughout the entire team. Thereby improving the healthcare delivery.
Lastly, and the most important is the patient. At the center of the entire system needs to be the patient. Once the patient recognizes the integrity or values of the healthcare organization and the clinicians delivering healthcare, patient trust is established. The patient satisfaction also increases. According to Cowing, Davino-Ramaya, Ramaya, Szmerekovsky, 2009, pp.72, “if patients are satisfied with clinician-patient interactions, they are likely to be more compliant with their treatment plan, to understand their role in the recovery process, and to follow through with the recommended treatment”. Having integrity or values in the healthcare delivery is the basic principle of healthcare leadership.
Cowing, M., Davino-Ramaya, C. M., Ramaya, K., & Szmerekovsky, J. (2009). Health care delivery performance: service, outcomes, and resource stewardship. The Permanente Journal, 13(4), 72–78. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2911834/
Lynn S. Paine, 1994, Managing for Organizational Integrity. Harvard business review, 2-21. Retrieved from Managing for Organizational Integrity (hbr.org)
2. Medical Delivery Influences
Contains unread posts
Robert Breeden posted May 12, 2021 9:44 AM
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Hello,
The influence within the medical community is so important and ...
1. Information organized and placed in a logical sequence (10 poMartineMccracken314
1.
Information organized and placed in a logical sequence (10 points)
Points Awarded
2.
Demonstrated knowledge of ethical dilemma presented by:
2a. Summarized the situation (10)
2b. Explained the ethical dilemma (5)
2c. Solved the problem as a professional RN (15)
3.
Responses supported with specific ANA Codes
(20)
4.
Visual aids professional, visually interesting
& aided in understanding material; proper grammar/spelling/punctuation-no more than 2 errors in presentation(10)
5.
Maintained eye contact of audience (10)
6.
Voice clear & audible (10)
7.
Encouraged class participation (5)
8.
Reference slide that includes references in APA
format (5)
Total points possible = 100
NSG 100
Case Study in-class Presentations Assignment
1): Moral Courage with a Dying Patient
Mr. T. is an 82-year-old widower who has been a patient on your unit several times over the past 5 years. His CHF, COPD, and diabetes have taken a toll on his body. He now needs oxygen 24 hours a day and still has dyspnea and tachycardia at rest. On admission, his ejection fraction is less than 20%, EKG shows a QRS interval of greater than 0.13 seconds, and his functional class is IV on NYHA assessment.
He has remained symptomatic despite maximum medical management with a vasodilator and diuretics. He tells you, "This is my last trip; I am glad I have made peace with my family and God. Nurse, I am ready to die." You ask about an advance directive and he tells you his son knows that he wants no heroics, but they just have never gotten around to filling out the form. When the son arrives, you suggest that he speak with the social worker to complete the advance directive and he agrees reluctantly. You page the physician to discuss DNR status with the son. Unfortunately, Mr. T. experiences cardiac arrest before the discussion occurs and you watch helplessly as members of the Code Blue Team perform resuscitation. Mr. T. is now on a ventilator and the son has dissolved into tears with cries of, "Do not let him die!"
2): Moral Courage to Confront Bullying
Melissa started on the unit as a new graduate 5 weeks ago. She is still in orientation and has a good relationship with her preceptor. The preceptor has been assigned consistently to Melissa for most of the last 4 weeks, but due to family emergency has not been available in the last week. Melissa has been told that she will be precepted by a different nurse for the remainder of her orientation. The new preceptor has not been welcoming, supportive, or focused on the educational goals of the orientation. In fact, this new preceptor has voiced to all who will listen her feelings about the incompetence of new BSN graduates. The crisis occurs when Melissa fails to recognize a patient's confusion as a result of an adverse medication effect. The preceptor berates Melissa in the nurses' station, makes sarcastic comments in shift report abou ...
1. In our grant application, we included the following interventioMartineMccracken314
1. In our grant application, we included the following interventions as our evidence-based programs: Family Therapy (to promote family acceptance and support, a key factor for overall health outcomes for this population), Motivational Interviewing (to address higher co-occurrence of substance use concerns), Trauma-Focused Treatment (including EMDR Therapy and TF-CBT, to address higher rates of complex trauma including from systemic oppression), and CBT (a gold standard treatment modality, but adapted to meet the needs of our client population by incorporating elements of
Solution
s-Focused or Narrative approaches to make it more strengths-based).
For questions 2-4, you would need to do some of your own research in the literature on these treatment modalities and determine for yourself if there were best practices that should be incorporated into the plan used at the agency.
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
Cultural Competency: A Key to Effective Future Social Work With Racially and Ethnically Diverse E...
Min, Jong Won
Families in Society; Jul-Sep 2005; 86, 3; ProQuest One Academic
pg. 347
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Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
...
1. I believe that the protagonist is Nel because she is the one thMartineMccracken314
1. I believe that the protagonist is Nel because she is the one that goes through different changes throughout the book. I also think she is the protagonist because most people can relate to her more. Nel was done wrong by Sula and her husband Jude Green. Sula did the one thing that a best friend should never do and, that is sleep with your best friend's husband. Even though Sula did a terrible thing Nel still cares about her best friend because she goes and visits her when she is sick even after all the pain she caused her. Nel is also deeply saddened when she visits Sulas grave. That is not the only thing that happened to Nel. Nel not only had to deal with the affair but also accepted her guilt in Chicken Little's drowning. But in the end, Nel realized she enjoyed watching him drown.
Everything changed when Sula came back to Nels life. Nel was happy before. She was happy with her family and her husband, but when Sula came back that all changed. After the affair and Sulas death, Nel was alone. Nel became a single mother and, she no longer has a good relationship with another man.
2. I believe that although the title of the story is Sula, the main protaginist of the story is Nel. Nel is kept until the end of the story and Sulay passes away and exit's the story. I think in this pivitol moment is when the author wanted to make Nel the main character. Nel contained her emotion until towards the end of the story when she has a conversation with Eva, Nel nervously comments "Who told you all these lies? Miss Peace? Who told you? Why are you telling lies on me?" I believe the author wanted us to feel the anxiousness and wonder that Nel found out that somebody finally knew about the little boy being thrown. I believe this admission of guilt to Eva brings closure to Nel. Nel was trying to hide her emotions the entire time and it wasn't after being confronted that she broke down about it and visited Sulay's grave. Nel even stated "I don't know. No." when asked whether somebody saw the boy being thrown into the river. This shows that Nel was not sure at all in the moment it happened whether somebody knew. Nel wanted to not think about what happen forever and try to mute the situation but Eva bringing it up, made Nel feel terrible about what happened which is why she ended up visting Sulay's grave. I think muting herself from knowing the little boy was thrown was still not a 'good' way to look at it, from her end. She wanted to believe a lie by just pretending it never happened. It wasn't after someone brought up the situation to her that her feelings change.
3. Although the novel is titled Sula, the real protagonist is Nel because she is the one who is transformed by the end. Sula and Nel were very great friends and were very dedicated to each other. But they were also very different. Nel was known as the more mature and "good person" while Sula is more impulsive. "Nel is the product of a family that believes deeply in social conventions, hers is a st ...
1. If the profit from the sale of x units of a product is P = MartineMccracken314
The document provides 11 math word problems related to profit, costs, revenue, supply and demand functions, and other economics topics. Students are asked to solve the problems by finding break-even points, maximum or minimum values, equilibrium quantities and prices, and other values. The problems cover concepts like profit maximization, optimal production levels, and using equations to model economic relationships.
1. How does CO2 and other greenhouse gases promote global warminMartineMccracken314
1. How does CO2 and other greenhouse gases promote global warming? Discuss your opinion on the use of geoengineering measures to mitigate the effects of global warming.
Your response should be at least 250 words in length.
2. How does CO2 and other greenhouse gases promote global warming? Discuss your opinion on the use of geoengineering measures to mitigate the effects of global warming.
Your response should be at least 250 words in length.
Raw DataNamePayResponsibilitiesSupervisionGenderDepartmentRudolph211MaleAccountingOlga211FemaleAccountingInstructionsErnest211MaleAccountingEmily211FemaleAccountingThe sheet labeled "Raw Data" lists 366 employees and their rating (1-5) of their satisfaction with their Pay, Responsibilities, and Supervision. A rating of 5 is the highest satisfaction.Bobby211MaleAccountingRaw Data also includes the Gender and Department for each employee.Benjamin211MaleAccountingBeatrice211FemaleAccountingInsert a new column in EKeith211MaleAccountingLabel this new column "Overall Satisfaction Rating"Hilda211FemaleAccountingFor each employee, compute the Overall Satisfaction Rating as the Average of Pay, Responsibilities, and Supervision.Leslie311MaleAccountingFormat Overall Satisfaction Rating to one decimal place.Curtis311MaleAccountingAlice311FemaleAccountingOn a New sheet titled Results, create a Pivot Chart & Pivot TableSophie311FemaleAccountingAssign Gender to Columns, Department to rows, and Pay to Values. Change the value field setting from Sum to Average if necessary.Sally311FemaleAccountingSort the departments in descending order of satisfaction.Melvin311MaleAccountingCreate a title for the chart, which includes your last namePearl411FemaleAccountingBe sure your chart includes a legend for male & female employees, change male color to blue and female to orangeJohnny411MaleAccountingBe sure to include axis titlesEunice411FemaleAccountingFormat the vertical axis for a max of 5 and major tick marks at 1 and one decimal place.Opal212FemaleAccountingJulia212FemaleAccountingCreate a new sheet titled "Graphs".Jimmie212MaleAccountingCopy & Paste as Picture your graph of Pay SatisfactionEsther212FemaleAccountingAlbert212MaleAccountingAlter your Pivot chart/table to display Responsibilities Satisfaction. Change titles as needed.Mike212MaleAccountingPaste this chart on the Graphs sheetMarion212MaleAccountingJosephine212FemaleAccountingAlter your Pivot chart/table to display Supervision Satisfaction. Change titles as needed.Ida212FemaleAccountingPaste this chart on the Graphs sheetGerald212MaleAccountingCaroline212FemaleAccountingAlter your Pivot chart/table to display Overall Satisfaction. Change titles as needed.Alberta212FemaleAccountingPaste this chart on the Graphs sheetLeroy312MaleAccountingLeave Results sheet with the Pivot Table & Chart displaying the Overall Satisfaction.Anita312FemaleAccountingMildred412FemaleAccountingBeulah412FemaleAccountingAda412FemaleAccountingClayton212MaleAccountingWayne312MaleA ...
1. How do you think communication and the role of training addressMartineMccracken314
1. How do you think communication and the role of training address performance gaps or training needs as it relates to how Adults learn?
2. There are many ways – or methods – available to gather data during a need’s assessment. Each one has advantages and disadvantages. What is important is to select the appropriate method based on your business problem. The most common methods for data gathering are:
· Document reviews or Extant Data Analysis – reviewing existing material like process maps, procedure guides, previous training material, etc.,
· Needs Assessment
· Interviews
· Focus groups
· Surveys
· Questionnaires
· Direct Observations
· Testing
· Subject Matter Expert Analysis
Select one of these data gathering methods to discuss and share what you see as the advantages and disadvantages associated with using the selected method.
1. Team teaching
In team teaching, both teachers are in the room at the same time but take turns teaching the whole class. Team teaching is sometimes called “tag team teaching.” You and your co-teacher teacher are a bit like co-presenters at a conference or the Oscars. You don’t necessarily plan who takes which part of the lesson, and when one of you makes a point, the other can jump in and elaborate if needed.
Team teaching can make you feel vulnerable. It asks you to step outside of your comfort zone and allow another teacher to see how you approach a classroom full of students. However, it also gives you the opportunity to learn about and improve your teaching skills by having a partner who can provide feedback and — in some cases — mentorship.
In team teaching, as well as the five other co-teaching models below, a teacher team may be made up of two general education teachers, two special education teachers, or one of each. Or, in some cases, it may be a teacher and a paraprofessional working together. Some IEPs specify that a student’s teaching team needs to include a general education teacher and a special education teacher.
Here’s what you need to know about the team teaching method:
What it looks like in the classroom
Both teachers teach at the front of the room and move about to check in with students (as needed).
Benefits
· Provides both teachers with an active instructional role
· Introduces students to complementary teaching styles and personalities
· Allows for lessons to be presented by two different people with different teaching styles
· Models multiple ways of presenting and engaging with information
· Models for students what a successful collaborative working relationship can look like
· Provides more opportunities to pursue teachable moments that may arise
Challenges
· Takes time and trust for teachers to build a working relationship that values each teacher equally in the classroom
· Necessitates a lot of planning time and coordination of schedules
· Requires teachers to have equal involvement not just in planning, but also in grading, which means assignments need to be evaluated ...
1. How brain meets its requirement for its energy in terms of wellMartineMccracken314
1. How brain meets its requirement for its energy in terms of well-fed and during starvation or fasting?
2. Explain the utilization of different sources of energy in muscle during anaerobic and aerobic conditions of high physical activity and resting?
3. Why and how adipose tissue and kidney are significant for fuel metabolism?
4. Explain in detail why liver is significant for metabolism of mammals and how does it coordinate the different metabolic pathways essential for organism?
5. Explain the Cori cycle and glucose-alanine cycle for interorgan fuel metabolism?
...
1. Give an introduction to contemporary Chinese art (Talk a littleMartineMccracken314
1. Give an introduction to contemporary Chinese art (Talk a little bit about some of the major changes in Chinese art)
2. Read the article that is provided. Do some research on the artist, Xu Bing. According to the article, give some background information about Xu Bing, and investigate the body of work.
3. Select one piece of his artwork to write about. It could be a traditional work of art, such as drawing, painting, or sculpture, or something more experimental like performance art, body art, or installation art.
4. Write a 3-page analysis of the artwork you select. The paper should have a short introduction and conclusion, but the body should focus on your analysis of the artwork. Some of the questions that you might want to work through in the paper include: Why is the work important? In what ways does it challenge the viewer? Is there an allegorical meaning to the work? How is it in dialogue with Western art traditions or earlier Chinese art traditions? Does it engage with Chinese history? Etc.
5. Be sure to include an image of the work you select into the paper, and the paper must be grammatically correct.
...
1. For this reaction essay is a brief written reaction to the readMartineMccracken314
1. For this reaction essay is a brief written reaction to the readings. It may be somewhat informal (and I would encourage you to be personal), but it must be well-written and well-organized. It must not be more than 2 pages, use 12-point font, single-spaced, at least 1" margins. You will react to the results of this systematic review article on Telemedicine " Effectiveness of Telemedicine A Systematic Review of Reviews.pdf
Focus on the results of the synthesis only, react to the authors' conclusions- do you agree or disagree with their synthesis? Discuss your opinion, are there faults in their conclusions?
Telemedicine is increasingly being suggested as an alternative for an in-person visit, especially with emergent diseases that call for person-to-person distancing. What are the potential concerns with this suggestion? What are in the authors' synthesis and conclusions underscore the limitations of this suggestion?
2. The next day a representative from Bristol Myers Squibb visits your office and tells you that Plavix® (clopidogrel) decreases cardiovascular events by 8.7% compared to aspirin. That sure sounds good to you, as you have many elderly patients at risk of heart attacks and strokes and many are already on aspirin. The brochure quotes the CAPRIE study, and you decide to investigate this further. A review of the 1996 article reveals that study patients on Plavix® experienced cardiovascular events 9.78% of the time compared to 10.64% of the time with aspirin. Plavix® was approved by the FDA based on this one study. Cost of Plavix/day=$6.50. Cost of aspirin/day = $1.33
• What was the NNT?
• How much does Plavix® cost monthly?
• What meaning do these values have for this problem?
• Be sure to include your actual calculations/math
i n t e r n a t i o n a l j o u r n a l o f m e d i c a l i n f o r m a t i c s 7 9 ( 2 0 1 0 ) 736–771
j o u r n a l h o m e p a g e : w w w . i n t l . e l s e v i e r h e a l t h . c o m / j o u r n a l s / i j m i
Effectiveness of telemedicine: A systematic review of
reviews
Anne G. Ekeland a,∗, Alison Bowes b, Signe Flottorp c,d
a Norwegian Centre for Integrated Care and Telemedicine, University Hospital of North Norway, P.O. Box 6060, N-9038 Tromsø, Norway
b Department of Applied Social Science, University of Stirling, Scotland, UK
c Norwegian Knowledge Centre for the Health Services, Oslo, Norway
d Department of Public Health and Primary Health Care, University of Bergen, Norway
a r t i c l e i n f o
Article history:
Received 23 April 2010
Received in revised form
11 July 2010
Accepted 29 August 2010
Keywords:
Telemedicine
Telecare
Systematic review
Effectiveness
Outcome
a b s t r a c t
Objectives: To conduct a review of reviews on the impacts and costs of telemedicine services.
Methods: A review of systematic reviews of telemedicine interventions was conducted. Inter-
ventions included all e-health interventions, information and communication technologies
for communication ...
1. Find something to negotiate in your personal or professional liMartineMccracken314
1. Find something to negotiate in your personal or professional life. Examples include: redistribution of household chores, a personal or professional purchase, a contract at work, asking for a raise, booking a vacation, hiring a contractor, etc. The deal does not have to be implemented for the purposes of this class (e.g. you can finalize the price for something you’re thinking of buying without following through on the purchase right now). The scenario you choose should be significant enough to allow you to do substantial research and detail for your paper. Submit a five page paper (minimum), double spaces, utilizing proper grammar and spelling, which summarizes the following:
1. Your Preparation – Describe the process you used and results of your preparation. You should also discuss your strategies, targets, and negotiating plan. Make sure you do your research, working on both your BATNA and the other party’s. (Consider newspapers, bookstores, libraries, the internet, and personal calls and visits as possible sources of information). This is the most important step, so being thorough is critical.
1. The Negotiating Process – Describe what happened in the negotiation itself. List he sequence of events and how you reacted/adjusted to the other party’s position. What was the negotiation style of the other party? What “tricks” did they try? How did you react? Were there any other influencing factors (e.g. cultural differences, misperceptions, emotion, etc.)?
1. The Outcome – What was the outcome and how did you feel about it? What worked well? What would you have done differently? Do you feel the result you arrived at was better than it would have been if you hadn’t taken the class? Why/Why not?
Your understanding of the appropriate preparation and process steps to take in negotiating this deal is more important than the final outcome.
Be sure to cite your sources, and include copies of necessary quotes/documentation.
1.
Find something to negotiate in your personal or professional life. Examples include:
redistributi
on of household chores, a personal or professional purchase, a contract at work,
asking for a raise, booking a vacation, hiring a contractor, etc. The deal does not have to be
implemented for the purposes of this class (e.g. you can finalize the price for
something you’re
thinking of buying without following through on the purchase right now). The scenario you
choose should be significant enough to allow you to do substantial research and detail for your
paper. Submit a five page paper (minimum), double
spaces, utilizing proper grammar and
spelling, which summarizes the following:
2.
Your Preparation
–
Describe the process you us
ed and results of your preparation. You should
also discuss your strategies, targets, and negotiating plan. Make sure you do your research,
working on both your BATNA and the other party’s. (Consider newspapers, bookstores, libraries,
the internet, and p
ers ...
1. FAMILYMy 57 year old mother died after a short illness MartineMccracken314
1. FAMILY
My 57 year old mother died after a short illness last June. She was a wonderful mother and my 66 year old father
adored her. They had been married for 38 years. He is finding it extremely difficult to cope without her. To make
matters worse, he retired just two months before she died and is at a loss to fill his days.
He is disorganized and has not established any pattern in his life. I invite him for meals and outings, but he is
detached and depressed. He doesn’t seem to be part of the world any more. I am terribly worried about him. How
long will he be like this? I am 34 and have small children. I thought being with the children would help him, but it’s
as though he doesn’t see or know them. He just sits and stares into space for much of the day. He seems locked
into his grief.
2. FAMILY
One of our 17 year old son’s best friends took his life several months ago. Our son didn’t say much at the time, but
he was very shaken. Since then he has gradually “retired” into himself. He stays in his room most of the time
listening to rock music.
He is unemployed and no longer sees his former schoolmates. We are very worried about him. How do we get him
out of himself? He has always been a quiet guy but his present behavior is beyond “quiet.” We have two other
children, girls aged 13 and 10, but our son now just ignores them.
3. FAMILY - rural
Ken is a 67 year old farmer who lives with his wife Margaret. Ken and Margaret had hoped to retire late in their 60s
and move to the west coast to be closer to their children, reluctantly selling the family property that has been
struggling financially. They have limited investment funds set aside to support their retirement and have been told
it is unlikely that they would be successful in selling their farm. Ken also suffers chronic back pain from a previous
farm injury. A neighbor has become concerned about Ken’s ability to cope with his property, and has visited Ken
and Margaret a number of times due to problems with his stock and pasture management. Margaret believes the
farm is “too much for them now,” but feels she can’t talk to Ken about this. Ken has become withdrawn and
refuses to discuss the issue. He talks about there being “no way out of this,” and that it “might as well be over.” He
sees his physician infrequently, having difficulty traveling the 60 miles to the nearby town.
4. FAMILY - rural
Jason is 34 years old and lives with his wife Jenny and their two children (8 and 3 years old). After completing a
mechanical trade apprenticeship in Boston, he has returned home with plans to build his future as a farmer. He has
become increasingly irritable and frustrated with what he believes is his failure to “get on top of things” on the
farm, and they are struggling to manage financially.
Jason is drinking heavily, mostly at home, but still drives his car into town. Jenny is angry and worried about this.
She is feeling isolated, having few friends in the area, and relying on Jas ...
1. Explain the four characteristics of B-DNA structure DifferentiMartineMccracken314
1. Explain the four characteristics of B-DNA structure? Differentiate between the A-DNA and Z-DNA structural features?
2. Describe the supercoiled DNA with its properties and how naturally occurring DNA under wound?
3. What are topoisomerases? Explain the two types of topoisomerases with their mechanism of action?
4. Explain the three interactions that are required to stabilize nucleic acids? How DNA denatures and renatures?
5. What are ribozymes and explain their properties?
Case 20 Restructuring
General Electric
The appointment of Larry Culp as the chairman and CEO of the General Electric
Company (GE) on October 1st, 2018 was a clear indication of the seriousness of the
problems that had engulfed the company. Culp, the former CEO of the highly-successful
conglomerate, Danaher Corporation, had been appointed a GE director only six months
previously and was the first outsider to lead GE—every one of GE’s previous CEOs had
been a career manager at the company. On the same day as Culp’s appointment, GE
abandoned its earning guidance for the year and announced a $23 billion accounting
charge arising from a write-down of goodwill at its troubled electrical power division.1
Culp’s predecessor, John Flannery had been CEO for a mere 14 months—a sharp
contrast to GE’s two previous CEOs: Jeff Immelt (16 years) and Jack Welch (20 years).
Flannery’s tenure at GE has coincided with of the company’s most difficult periods in its
entire 126-year history. In November 2017, amidst deteriorating financial performance,
Flannery announced a halving of GE’s quarterly dividend, the proposed sale of its
lighting and locomotive units—two of GE’s oldest businesses—and the elimination of
12,000 jobs in the power division.
In 2018, the situation worsened. In January, GE announced that it would be paying
$15 bn. to cover liabilities at insurance companies it had sold 12 years previously. In
February, GE confirmed suspicions over its dubious accounting practices by restating its
revenues and earnings for the previous two years, while also announcing the likelihood
of legal claims arising from its its subprime mortgage lending over a decade earlier.
The outcome was a precipitous fall in GE’s share price (see Figure 1) that culminated
in GE’s dismissal from the Dow Jones Industrial Average (DJIA). Until June 2018, GE
was the sole surviving member of the DJIA when it was created in 1896.
The crisis at GE presented the board with two central questions. First, should GE
be broken up? Second, if GE was to continue as a widely-diversified company, how
should it be managed?
As a diversified corporation that extended from jet engines, to oil and gas equipment,
to healthcare products, to financial services, GE was an anomaly. For three decades, con-
glomerates—diversified companies comprising unrelated or loosely related businesses—
had been deeply unfashionable. CEOs, Jack Welch and Jeff Immelt, had claimed that,
by virtue of its integrated m ...
1. examine three of the upstream impacts of mining. Which of theseMartineMccracken314
1. examine three of the upstream impacts of mining. Which of these do you think would be most difficult to estimate in a life cycle assessment?
Your response should be at least 250 words in length.
2. Discuss the pollutants that are emitted during the operation stage of a life cycle assessment for a fossil fuel source.
Your response should be at least 250 words in length
Body Ritual among the Nacirema
H O R A C E M I N E R
University of Michigan
HE anthropologist has become so familiar with the diversity of ways iq T which different peoples behave in similar situations that he is not a p t to.
be surprised by even the most exotic customs. I n fact, if all of thelogically
possible combinations of behavior have not been found somewhere in the
world, he is a p t to suspect that they must be present in some yet undescribed
tribe. This point has, in fact, been expressed with respect to clan organization
by Murdock (1949: 7 1 ) . I n this light, the magical beliefs and practices of the
Nacirema present such unusual aspects that i t seems desirable t o describe
them a s an example of the extremes to which human behavior can go.
Professor Linton first brought the ritual of the Nacirema to the attention
of anthropologists twenty years ago (1936:326), but the culture of this people
is still very poorly understood. They are a North American group living in the
territory between the Canadian Cree, the Yaqui and Tarahumare of Mexico,
and the Carib and Arawak of the Antilles. Little is known of their origin, al-
though tradition states that they came from the east. According to Nacirema
mythology, their nation was originated by a culture hero, Notgnihsaw, who is
otherwise known for two great feats of strength-the throwing of a piece of
wampum across the river Pa-To-Mac and the chopping down of a cherry tree
in which the Spirit of Truth resided.
Nacirema culture is characterized by a highly developed market economy
which has evolved in a rich natural habitat. While much of the people’s time
is devoted to economic pursuits, a large part of the fruits of these labors and a
considerable portion of the day are spent in ritual activity. The focus of this
activity is the human body, the appearance and health of which loom a s a
dominant concern in the ethos of the people. While such a concern is certainly
not unusual, its ceremonial aspects and associated philosophy are unique.
The fundamental belief underlying the whole system appears to be that the
human body is ugly and that its natural tendency is t o debility and disease.
Incarcerated in such a body, man’s only hope is to avert these characteristics
through the use of the powerful influences of ritual and ceremony. Every house-
hold has one or more shrines devoted to this purpose. The more powerful in-
dividuals in the society have several shrines in their houses and, in fact, the
opulence of a house is often referred to in terms of the num ...
1. Examine Hofstedes model of national culture. Are all four dimeMartineMccracken314
1. Examine Hofstede's model of national culture. Are all four dimensions still important in today's society as it relates to the success of the multinational manager? Why, or why not? Which do you think is the least important as it relates to multinational management? Why?
2. More companies are seeking to fill multinational management positions due to the influx of business growth abroad. If you were offered and accepted a position as a multinational manager, what would you do to personally prepare for the culture of a different country? Where would you seek information? What overall responsibilities would you expect of the job? How do you think the managerial responsibilities would be different from those you would face in the United States?
3. Multinational managers encounter many levels of culture. Which of the culture levels do you think might be the most difficult to manage? Why? Share an example. Which culture level do you think might be the easiest to understand? Why? Give an example of this.
4. In your own words, what is your perception of free trade? Think about the advantages of free trade; what are two benefits that result from free trade? There is also a downside to free trade; what are two disadvantages resulting from free trade? Provide reasoning for your choices.
5. What are the three major economic systems that nations utilize, and what is the role of each? How does each affect and influence individuals, multinational managers, and corporations?
6. How would you define ethical convergence? What are the four basic reasons for ethical convergence? Which might be the most difficult for multinational companies to follow, and why?
7. Describe the four major world religions. What are the impacts of each religion type on an economic environment? What do you think makes religion a concern in societies?
8. If you were a multinational manager, and you encountered an ethical dilemma within the multinational company, what heuristic questions would you use to decide between ethical relativism and ethical universalism? Of the different heuristic questions, which one do you think is most important? Explain your reasoning.
1
Week Two Instructor’s Notes
PHIL 1103 Summer
This week you will be learning in detail about the four different moral perspectives that
we will use to analyze moral questions.
Notice two things right at the start. First, because normative ethics is our main focus this
term, we are not going to attempt to settle the question of whether any moral perspective at all
could be correct or known to be correct—that is a task for metaethics. Our task in this second
week is to learn in some detail about four different kinds of consideration or value that often
seem relevant when we try to decide what is morally right or wrong in particular cases, namely:
(1) Respect for the rights and autonomy of the persons involved
(2) Increasing the overall well-being of the most individuals possible
(3) Asking wha ...
How to Manage Your Lost Opportunities in Odoo 17 CRMCeline George
Odoo 17 CRM allows us to track why we lose sales opportunities with "Lost Reasons." This helps analyze our sales process and identify areas for improvement. Here's how to configure lost reasons in Odoo 17 CRM
LAND USE LAND COVER AND NDVI OF MIRZAPUR DISTRICT, UPRAHUL
This Dissertation explores the particular circumstances of Mirzapur, a region located in the
core of India. Mirzapur, with its varied terrains and abundant biodiversity, offers an optimal
environment for investigating the changes in vegetation cover dynamics. Our study utilizes
advanced technologies such as GIS (Geographic Information Systems) and Remote sensing to
analyze the transformations that have taken place over the course of a decade.
The complex relationship between human activities and the environment has been the focus
of extensive research and worry. As the global community grapples with swift urbanization,
population expansion, and economic progress, the effects on natural ecosystems are becoming
more evident. A crucial element of this impact is the alteration of vegetation cover, which plays a
significant role in maintaining the ecological equilibrium of our planet.Land serves as the foundation for all human activities and provides the necessary materials for
these activities. As the most crucial natural resource, its utilization by humans results in different
'Land uses,' which are determined by both human activities and the physical characteristics of the
land.
The utilization of land is impacted by human needs and environmental factors. In countries
like India, rapid population growth and the emphasis on extensive resource exploitation can lead
to significant land degradation, adversely affecting the region's land cover.
Therefore, human intervention has significantly influenced land use patterns over many
centuries, evolving its structure over time and space. In the present era, these changes have
accelerated due to factors such as agriculture and urbanization. Information regarding land use and
cover is essential for various planning and management tasks related to the Earth's surface,
providing crucial environmental data for scientific, resource management, policy purposes, and
diverse human activities.
Accurate understanding of land use and cover is imperative for the development planning
of any area. Consequently, a wide range of professionals, including earth system scientists, land
and water managers, and urban planners, are interested in obtaining data on land use and cover
changes, conversion trends, and other related patterns. The spatial dimensions of land use and
cover support policymakers and scientists in making well-informed decisions, as alterations in
these patterns indicate shifts in economic and social conditions. Monitoring such changes with the
help of Advanced technologies like Remote Sensing and Geographic Information Systems is
crucial for coordinated efforts across different administrative levels. Advanced technologies like
Remote Sensing and Geographic Information Systems
9
Changes in vegetation cover refer to variations in the distribution, composition, and overall
structure of plant communities across different temporal and spatial scales. These changes can
occur natural.
How to Make a Field Mandatory in Odoo 17Celine George
In Odoo, making a field required can be done through both Python code and XML views. When you set the required attribute to True in Python code, it makes the field required across all views where it's used. Conversely, when you set the required attribute in XML views, it makes the field required only in the context of that particular view.
ISO/IEC 27001, ISO/IEC 42001, and GDPR: Best Practices for Implementation and...PECB
Denis is a dynamic and results-driven Chief Information Officer (CIO) with a distinguished career spanning information systems analysis and technical project management. With a proven track record of spearheading the design and delivery of cutting-edge Information Management solutions, he has consistently elevated business operations, streamlined reporting functions, and maximized process efficiency.
Certified as an ISO/IEC 27001: Information Security Management Systems (ISMS) Lead Implementer, Data Protection Officer, and Cyber Risks Analyst, Denis brings a heightened focus on data security, privacy, and cyber resilience to every endeavor.
His expertise extends across a diverse spectrum of reporting, database, and web development applications, underpinned by an exceptional grasp of data storage and virtualization technologies. His proficiency in application testing, database administration, and data cleansing ensures seamless execution of complex projects.
What sets Denis apart is his comprehensive understanding of Business and Systems Analysis technologies, honed through involvement in all phases of the Software Development Lifecycle (SDLC). From meticulous requirements gathering to precise analysis, innovative design, rigorous development, thorough testing, and successful implementation, he has consistently delivered exceptional results.
Throughout his career, he has taken on multifaceted roles, from leading technical project management teams to owning solutions that drive operational excellence. His conscientious and proactive approach is unwavering, whether he is working independently or collaboratively within a team. His ability to connect with colleagues on a personal level underscores his commitment to fostering a harmonious and productive workplace environment.
Date: May 29, 2024
Tags: Information Security, ISO/IEC 27001, ISO/IEC 42001, Artificial Intelligence, GDPR
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Training: ISO/IEC 27001 Information Security Management System - EN | PECB
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Walmart Business+ and Spark Good for Nonprofits.pdfTechSoup
"Learn about all the ways Walmart supports nonprofit organizations.
You will hear from Liz Willett, the Head of Nonprofits, and hear about what Walmart is doing to help nonprofits, including Walmart Business and Spark Good. Walmart Business+ is a new offer for nonprofits that offers discounts and also streamlines nonprofits order and expense tracking, saving time and money.
The webinar may also give some examples on how nonprofits can best leverage Walmart Business+.
The event will cover the following::
Walmart Business + (https://business.walmart.com/plus) is a new shopping experience for nonprofits, schools, and local business customers that connects an exclusive online shopping experience to stores. Benefits include free delivery and shipping, a 'Spend Analytics” feature, special discounts, deals and tax-exempt shopping.
Special TechSoup offer for a free 180 days membership, and up to $150 in discounts on eligible orders.
Spark Good (walmart.com/sparkgood) is a charitable platform that enables nonprofits to receive donations directly from customers and associates.
Answers about how you can do more with Walmart!"
हिंदी वर्णमाला पीपीटी, hindi alphabet PPT presentation, hindi varnamala PPT, Hindi Varnamala pdf, हिंदी स्वर, हिंदी व्यंजन, sikhiye hindi varnmala, dr. mulla adam ali, hindi language and literature, hindi alphabet with drawing, hindi alphabet pdf, hindi varnamala for childrens, hindi language, hindi varnamala practice for kids, https://www.drmullaadamali.com
A review of the growth of the Israel Genealogy Research Association Database Collection for the last 12 months. Our collection is now passed the 3 million mark and still growing. See which archives have contributed the most. See the different types of records we have, and which years have had records added. You can also see what we have for the future.
This slide is special for master students (MIBS & MIFB) in UUM. Also useful for readers who are interested in the topic of contemporary Islamic banking.
How to Add Chatter in the odoo 17 ERP ModuleCeline George
In Odoo, the chatter is like a chat tool that helps you work together on records. You can leave notes and track things, making it easier to talk with your team and partners. Inside chatter, all communication history, activity, and changes will be displayed.
বাংলাদেশের অর্থনৈতিক সমীক্ষা ২০২৪ [Bangladesh Economic Review 2024 Bangla.pdf] কম্পিউটার , ট্যাব ও স্মার্ট ফোন ভার্সন সহ সম্পূর্ণ বাংলা ই-বুক বা pdf বই " সুচিপত্র ...বুকমার্ক মেনু 🔖 ও হাইপার লিংক মেনু 📝👆 যুক্ত ..
আমাদের সবার জন্য খুব খুব গুরুত্বপূর্ণ একটি বই ..বিসিএস, ব্যাংক, ইউনিভার্সিটি ভর্তি ও যে কোন প্রতিযোগিতা মূলক পরীক্ষার জন্য এর খুব ইম্পরট্যান্ট একটি বিষয় ...তাছাড়া বাংলাদেশের সাম্প্রতিক যে কোন ডাটা বা তথ্য এই বইতে পাবেন ...
তাই একজন নাগরিক হিসাবে এই তথ্য গুলো আপনার জানা প্রয়োজন ...।
বিসিএস ও ব্যাংক এর লিখিত পরীক্ষা ...+এছাড়া মাধ্যমিক ও উচ্চমাধ্যমিকের স্টুডেন্টদের জন্য অনেক কাজে আসবে ...
Leveraging Generative AI to Drive Nonprofit InnovationTechSoup
In this webinar, participants learned how to utilize Generative AI to streamline operations and elevate member engagement. Amazon Web Service experts provided a customer specific use cases and dived into low/no-code tools that are quick and easy to deploy through Amazon Web Service (AWS.)
1. 1
Instructions for Coming of
Age in Mississippi
Due Sunday, April 25th, 2021
Late papers will be penalized. Failure to turn in this
assignment will result in
the automatic failure of the class.
Anne Moody’s Coming of Age in Mississippi is an
autobiographical presentation of
her life and experiences in the segregationist South during the
middle third of the
20th Century. Although Moody was intensively involved in the
civil rights
movement of the 1950’s and 1960’s, the real value of her
autobiography is that she
describes what it was like to grow up in Mississippi long before
she became a civil
rights activist.
2. Your book essay for Coming of Age in Mississippi should
explore and discuss the
following topics and questions:
1. Begin with a brief overview of the book: in general, what is
it about, who wrote
it, etc.
2. Moody’s decision to become engaged in the political activism
central to the
Civil Rights Movement was a result of her experiences at both
work and play
growing up in Mississippi. What kinds of incidents from her
life led Moody to
become politically active in the movement? For example, what
does she notice
about how she is treated as a black person in Southern white
society?
3. Women played an important role in Moody’s life. Using
examples from her
autobiography, discuss what Moody learned about race, class
and sexual
3. orientation from the women around her. Who were the most
important women in
her life? Discuss each and explain why that person was so
important.
4. Moody was a participant and observer of some of the most
important historical
events of the 1950’s and 1960’s. How did she view and describe
these events – for
example, the murder of Emmitt Till, the sit-in protests, the
voter registration drive
in Mississippi, Ku Klux Klan activities and the assassination of
Medgar Evars and
2
others? In general, what do her descriptions tell you about the
struggle for civil
rights?
5. What did you think of this book? Did you like it/ not like it?
Explain why.
Writing Instructions:
4. 1. Use the above questions/topics as your paper outline and
answer them in the
order they are presented.
2. Use some common sense in how much you write on each
topic. The general
overview of the book, for example, can be covered in one
relatively brief
paragraph. Other topics may require more extensive coverage.
The main body of
your paper should focus on topics 2-4. You should explore
those thoroughly and
back up any general comments with specific details that
illustrate and support
them. Topics 1 and 5 should be about a paragraph in length.
3. Although I don’t grade in terms of the length of the paper,
under most
circumstances I would expect a paper somewhere within the
range of 4-5 pages.
As a general rule, it’s better to write more than less.
4. The paper must be typed using a standard word processing
program, double-
5. spaced using normal- sized fonts (11 or 12) and margins.
5. The best grades will go to papers that have discussed each
topic/question
completely, are well-organized and well-written and follow
directions. Points will
be deducted for excessive grammatical and/or typographical
errors so be sure
that you proofread before turning it in.
6. Be careful about plagiarism. If you quote anything from this
book, use
quotation marks and cite the page number. If you use other
sources, identify
those sources and use quotation marks and page numbers as
appropriate.
Failure to do this could result in a grade of 0 for the assignment
or, in serious
cases, failure of the course.
7. Make and keep a copy of your paper.
3
6. 8. You don’t need a separate title page, but on the first page of
this paper you
should put your name and the author and title of the book.
9. All Papers must include citations and a Works Cited page.
Please use this
format when citing: (Bell, p.27). Every citation must be placed
either at the
end of the sentence cited or at the end of the paragraph
containing the
citation. I require that you have a minimum of five (5) citations
within your
paper but keep in mind that more would be better. A Works
Cited page must
be included on a separate sheet at the end of your paper. Please
use the Out
of this Furnace book as your only reference material! This
means that you
will have only one reference work cited in the Works Cited
page! The Works
Cited page should contain the name of the book cited as well as
the author(s)
name, publication date, number of pages, etc., and that is all!
7. 10. Papers are due on Sunday, April 25th, 2021. Failure to turn
in this paper
will result in failure of the course.
If you need help with any aspect of this assignment, don’t
hesitate to contact me.
I’ll be happy to clarify the topics and show you how to find the
required
information. I’m also willing to look at early drafts of your
paper provided you get
them to me at least five days for the due date.
ARTICLE
Comorbid personality disorders and their impact on severe
dissociative
experiences in Mexican patients with borderline personality
disorder
Andr�es Rodr�ıguez-Delgadoa, Ana Fres�anb, Edgar
Mirandaa, Eduardo Garza-Villarrealb,c, Ruth Alcal�a-Lozanob,
X�ochitl Duque-Alarc�ond, Thania Balduccie and Iv�an
Arango de Montisa
8. aCl�ınica de Trastorno L�ımite de la Personalidad, Instituto
Nacional de Psiquiatr�ıa Ram�on de la Fuente Mu~n�ız,
Mexico City, Mexico;
bSubdirecci�on de Investigaciones Cl�ınicas, Instituto
Nacional de Psiquiatr�ıa Ram�on de la Fuente Mu~n�ız,
Mexico City, Mexico; cCenter of
Functionally Integrative Neuroscience, University of Aarhus,
Aarhus, Denmark; dCl�ınica de Especialidades en
Neuropsiquiatr�ıa, Instituto de
Seguridad y Servicios Sociales de Los Trabajadores Del Estado
(ISSSTE), Mexico City, Mexico; eFacultad de Medicina,
Universidad Nacional
Aut�onoma de M�exico, Mexico City, Mexico
ABSTRACT
Objective: To identify personality disorders comorbid with
borderline personality disorder (BPD) that
may confer greater risk for the presence of severe dissociative
experiences.
Method: Three hundred and one outpatients with a primary
diagnosis of BPD were evaluated using
the Structured Clinical Interview for DSM-IV Axis II
personality disorders, the Borderline Evaluation of
Severity Over Time (BEST) and the Dissociative Experiences
Scale (DES).
Results: The most frequent personality disorders comorbid to
BPD were paranoid (83.2%, n ¼ 263)
and depressive (81.3%, n ¼ 257). The mean BEST and DES
total score were 43.3 (SD ¼ 11.4, range
15–69) and 28.6 (SD ¼ 19.8, range 0–98), respectively. We
categorized the sample into patients with
and without severe dissociative experiences (41% were
positive). A logistic regression model revealed
that Schizotypal, Obsessive-compulsive and Antisocial
personality disorders conferred greater risk for
the presence of severe dissociative experiences.
9. Discussion: Our results suggest that a large proportion of
patients with BPD present a high rate of
severe dissociative experiences and that some clinical factors
such as personality comorbidity confer
greater risk for severe dissociation, which is related to greater
dysfunction and suffering, as well as a
worse progression of the BPD.
ARTICLE HISTORY
Received 19 March 2019
Revised 12 August 2019
Accepted 17 August 2019
KEYWORDS
Comorbid personality
disorders; dissociation;
borderline personality
disorder; personality
disorders; dissociative
experiences
1. Introduction
Borderline personality disorder (BPD) is a psychiatric condition
characterized by affective instability, impulsivity, chaotic inter -
personal relationships, and identity disturbances which cause
alterations in multiple functioning areas [1]. BPD is considered
a common disorder that affects from 0.5% to 5.9% of the gen-
eral population [2], and is more commonly present in women;
however, this evidence has not been consistent [3]. In clinical
populations, BPD is the most common personality disorder
(PD), with a prevalence of 10% in psychiatric outpatie nts and
from 15% to 25% in inpatients [4,5]. About 80% of patients
with BPD have a co-occurring PD [6]. The most frequent PDs
reported in patients with BPD are as follows: (1) from cluster
A,
10. paranoid PD has been reported in 30–38%; (2) from cluster B,
histrionic and antisocial PD have been reported in 15–25% and
in 13–19%, respectively; and (3) from cluster C, dependent and
avoidant PD in 30–50% and in 20–40%, respectively [2,7,8].
About two thirds of BPD patients report dissociative expe-
riences such as unbidden intrusions into awareness and
behavior with accompanying losses of continuity in
subjective experience (e.g. absorption, identity confusion,
depersonalization and derealization), and/or an inability to
access information or to control mental functions that nor-
mally are controlled (e.g. amnesia) [1,9–11]. The level of dis-
sociation is significantly higher in BPD patients than in
healthy controls, general psychiatric patients and patients
with another PD. In fact, only patients with dissociative disor-
ders (DD) present higher rates of dissociative symptoms than
BPD patients [12,13]. It has been suggested that the phe-
nomenon of dissociation within BPD seems to constitute a
continuum of severity [11]. Using the Dissociative
Experiences Scale (DES), Zanarini et al. [12,14] described BPD
inpatients with low, moderate and severe dissociation. The
presence of severe dissociation in BPD patients has been cor -
related with more self-reported traumatic experiences, post-
traumatic symptoms, behavioral disturbances, and self-
injurious behavior, as well as lower adaptive functioning,
including higher frequency and duration of inpatient treat-
ments, as well as lower age of inpatient admission [10,15].
PD and comorbid dissociative experiences may worsen
the emotional and behavioral manifestation during the
CONTACT Iv�an Arango de Montis [email protected] Cl�ınica
de Trastorno L�ımite de la Personalidad, Instituto Nacional de
Psiquiatr�ıa Ram�on de la
Fuente Mu~n�ız, Mexico City 14370, Mexico
11. This article has been republished with minor changes. These
changes do not impact the academic content of the article.
� 2019 The Nordic Psychiatric Association
NORDIC JOURNAL OF PSYCHIATRY
2019, VOL. 73, NO. 8, 509–514
https://doi.org/10.1080/08039488.2019.1658127
http://crossmark.crossref.org/dialog/?doi=10.1080/08039488.20
19.1658127&domain=pdf&date_stamp=2019-09-25
https://doi.org/10.1080/08039488.2019.1658127
http://www.tandfonline.com
course of BPD, thus hindering treatments and functional
reintegration of these patients to daily life. It is therefore,
necessary to increase our knowledge about how PD comor-
bidity may affect the overt manifestation of severe dissocia-
tive experience (SDE) in this population. The aim of the
present study was to identify the most important comorbid
PDs and to determine if these are predictors of SDE in
patients with BPD.
2. Material and methods
2.1. Participants
This was a retrospective design with the use of the institu-
tional clinical databases. We included the demographic and
clinical data from all male and female patients between 18
and 65 years of age who entered the BPD Clinic at the
Instituto Nacional de Psiquiatr�ıa Ram�on de la Fuente
Mu~n�ız
(INPRF), located in Mexico City, between October 2015 and
February 2018, and who had the confirmed diagnosis of BPD
according to the Diagnostic and Statistical Manual of Mental
12. Disorders IV-TR (DSM-IV-TR) [16]. Patients with diagnoses of
psychotic disorders, bipolar disorder, active eating disorder
or substance dependence (except nicotine dependence)
were excluded. This study was conducted according to the
Declaration of Helsinki and was approved by ethics and
research committee of the INPRF (INPDSCEC-02-20.1). All
patients gave their oral and written consent for the use of
their data for research purposes.
2.2. Measurement instruments and procedure
Patients who met the criteria for admission to the BPD Clinic
were evaluated according to the Clinic’s protocol, which
includes obtaining general demographic data and a clinical
evaluation through an interview conducted by a psychiatrist
at the Clinic. This evaluation was complemented with the
administration of several scales and questionnaires. We used
the Clinical Interview for DSM-IV Axis II Personality Disorders
self-report screening questionnaire (SCID-II-PQ) to explore all
PDs. The SCID-II-PQ has 119 items with affirmative or nega-
tive answers for determination of whether a feature of any
PD is present. Different cutoff points have been suggested to
determine the diagnosis of a PD [17]. The overall PD diagno-
sis agreement reported with the use of the SCID-II-PQ vs. the
SCID II interview is adequate, with overall K of agreement of
0.75 [18]. For BPD diagnosis, we used both the SCID-II-PQ
and the SCID II interview, while only the SCID-II-PQ was used
for the remaining PDs, and were considered as present
according to the cutoff scores proposed [17]. The overall
severity of BPD symptoms in the 30 days prior to the inter-
view was evaluated with the Borderline Evaluation of
Severity Over Time (BEST) scale, a self-report instrument of
15 items rated on a 5-point Likert scale [19]. The score of
item 5, ‘Feeling paranoid or like you are losing touch with real -
ity’, which is a dissociation symptom included in the scale,
was removed from statistical analysis to avoid criterion con-
13. tamination. The DES, which consists of 28 self-report items
evaluated on a visual analog scale from 0 to 100, was used
to assess the presence and severity of dissociative experien-
ces [20]. We used a score of 30 or more as an indicator of
SDE, following Zanarini et al. [12,14]. This score was used to
divide the sample between those with and without SDE.
2.3. Statistical analysis
Demographic and clinical characteristics were described with
frequencies and percentages for categorical variables, and
means and standard deviations (SD) for continuous variables.
The comparisons between patients with and without SDE
were done using chi-square tests (x2) for categorical variables
and with independent sample t-tests for continu-
ous variables.
Variables where significant differences arose in the com-
parative analyses were included in a logistic regression ana-
lysis to determine the risk conferred by demographic
variables and the presence of comorbid PD in the presenta-
tion of SDE. The Aikake Information Criterion (AIC) was deter -
mined to identify which of the models best approximated
the data of the present sample. The level of statistical signifi -
cance was set at p � 0.05.
3. Results
A total of 316 patients with BPD were included in the study,
of which 85.8% (n ¼ 271) were female with an average age
of 29.7 years (SD ¼ 10.5, range 17–62). A large percentage of
patients had completed their high-school studies (48.4%,
n ¼ 153), followed by those with a bachelor’s degree (32.6%,
n ¼ 103). Twelve patients did not complete the BEST scale;
therefore, we reported the data obtained from 304 patients,
14. whose average score was 43.3 points (SD ¼ 11.4, range
15–69) indicative of moderate symptom severity. Likewise, 14
patients did not complete the DES scale; thus, the average
severity score of the dissociative experiences of the remain-
ing 301 patients in the sample was of 28.6 points (SD ¼ 19.8,
range 0–98). Using the cutoff point of 30, 41.9% (n ¼ 126) of
the patients were classified with SDE.
The most frequent comorbid PDs were paranoid PD
(83.2%, n ¼ 263) and depressive (81.3%, n ¼ 257), while those
with the lowest presentation were schizotypal (25.6%, n ¼ 81)
and antisocial (37.0%, n ¼ 117). The comparisons of demo-
graphic characteristics and comorbidity with PDs among
patients with and without SDE are displayed in Table 1. Both
groups were similar in terms of sex, age and level of educa-
tion. BPD patients with schizoid, schizotypal, antisocial,
obsessive-compulsive, and passive-aggressive comorbidities
presented SDE more often. In addition, patients with SDE
reported greater severity of BPD symptoms.
Five comorbid PDs and the total score of the BEST scale
were included in an initial logistic regression model. After
adjustments, the final logistic regression equation correctly
classified 67.0% of the cases and was significant for the pre -
sent sample according to the Hosmer and Lemeshow statis-
tical value (p ¼ 0.84). As shown in Table 2, the main
predictors of SDE were schizotypal PD, obsessive-compulsive
510 A. RODR�IGUEZ-DELGADO ET AL.
PD, antisocial PD and more severe BPD symptomatology.
This model was adequate according to the reduction
observed in the AIC values.
15. 4. Discussion
We observed a high rate of PD comorbidity, confirming that
BPD as a unique personality diagnosis is infrequent. In this
study, we found paranoid, depressive and passive-aggressive
PDs were the most common comorbidities in patients with
main diagnosis of BPD, and antisocial and schizotypal PD
were the least common ones. This finding contrasts with
other studies where schizotypal, narcissistic and dependent
were the most frequent PDs comorbid with BPD [21]. We
found rates of PD comorbidity higher than others reported
in the literature, which could be explained by the fact that
we used a self-report questionnaire to establish comorbidity.
Methodological factors such as the kind of instrument used
for assessment may inflate diagnosis estimates, and self-
report questionnaires are more prone to this bias [22]. In this
respect, the SCID-II-PQ presents an overrating of 19%, and
therefore, our results should be interpreted with caution [18].
We observed antisocial PD comorbidity as one of the less
common PD comorbidities, which could be the result of a
selection bias. Perhaps some patients with BPD and intense
antisocial symptoms are not sent to the clinic because they
are diagnosed with an antisocial PD as main diagnosis.
However, antisocial PD was present in 37% of the sample,
which represents a higher rate compared to other investiga-
tions that report ranges between 13% and 19% [2,7]. As
stated before, this could be a result of the use of a self-
report measure, but it also suggests the possibility that we
were dealing with a group of patients with severe
psychopathology.
The mean DES total score in our study (28.6) is higher
than means reported in other studies where BPD patients
presented a mean DES score from 17.8 to 27.4 [23] but lower
than other studies (44.4 total score) where 64% of the BPD
16. sample met criteria for an additional diagnosis of DD [24].
More than 40% of our patients presented SDE, which repre-
sents a higher percentage than the ones reported in other
studies. For example, Zanarini et al. [12,14] found that 26%
of a sample of inpatients with diagnosis of BPD presented
SDE. This is interesting since our sample were outpatients
and SDE has been correlated with higher stress and poorer
functioning, features associated with the clinical presentation
of inpatients [9]. One possible explanation could be that
Zanarini et al. [12,14] used an instrument based on DSM-III-R,
a diagnostic system that did not include item 9 about transi -
ent, stress-related dissociative symptoms, which was added to
the diagnostic criteria for BPD in the DSM-IV. Perhaps a sig-
nificant proportion of our sample could present a DD comor -
bid with BPD and not only intense dissociative experiences
[16,25]. However, BPD criterion 9 in the DSM-IV and DSM-5
mentions that dissociative symptoms are generally of insuffi -
cient severity or duration to warrant an additional diagnosis.
For some authors, this is an unspecific rule for deciding
when dissociative symptoms represent a separate DD diag-
nosis or can be considered as a BPD criterion [1,11,16].
Table 1. Demographic and clinical characteristics between
patients with and without severe dissociative experiences
(SDE).
Totala Without SDE n ¼ 175 With SDE n ¼ 126 Statistics
Demographic n %
Sex - Women 257 85.4 148 84.6 109 86.5 Fisher ¼ 0.74
Education - High-school 145 48.2 84 48.0 61 48.4 Fisher ¼ 1.00
Personality disorder n %
Avoidant 229 76.1 129 73.7 100 79.4 Fisher ¼ 0.27
Dependent 124 41.2 65 37.1 59 46.8 Fisher ¼ 0.09
Obsessive-compulsive 236 78.4 125 71.4 111 88.1 Fisher ¼
17. 0.001
Passive-aggressive 241 80.1 129 73.7 112 88.9 Fisher ¼ 0.001
Depressive 249 82.7 139 79.4 110 87.3 Fisher ¼ 0.08
Paranoid 250 83.1 139 79.4 111 88.1 Fisher ¼ 0.06
Schizotypal 79 26.2 27 15.4 52 41.3 Fisher < 0.001
Schizoid 189 62.8 99 56.6 90 71.4 Fisher ¼ 0.01
Histrionic 144 47.8 80 45.7 64 50.8 Fisher ¼ 0.41
Narcissistic 205 68.1 112 64.0 93 73.8 Fisher ¼ 0.08
Antisocial 113 37.5 51 29.1 62 49.2 Fisher < 0.001
Mean SD
Age 29.7 10.5 30.4 10.6 28.2 9.7 t ¼ 1.7, p ¼ .07
BEST scaleb 41.7 11.1 40.0 10.8 44.0 11.1 t ¼ –3.1, p ¼ .002
an ¼ 301 patients completed the DES.
bTotal score without item 5 ‘Feeling paranoid or like you are
losing touch with reality’.
Table 2. Logistic regression models for the prediction of severe
dissociative
experience (SDE) in BPD patients.
b OR 95% C.I. p
Initial model: AIC value 357.33
Higher BEST scoring 0.01 1.01 0.99–1.04 0.11
Schizoid PD 0.41 1.51 0.88–2.62 0.13
Passive-Aggressive PD 0.47 1.60 0.77–3.29 0.20
Antisocial PD 0.60 1.83 1.08–3.10 0.02
Obsessive-compulsive PD 0.79 2.22 1.12–4.39 0.02
Schizotypal PD 1.20 3.32 1.85–5.96 <0.001
Final model: AIC value 302.96
Higher BEST scoring 0.02 1.02 1.01–1.04 0.04
Antisocial PD 0.64 1.91 1.13–3.20 0.01
Obsessive-compulsive PD 0.92 2.52 1.29–4.91 0.007
Schizotypal PD 1.24 3.48 1.96–6.18 <0.001
18. NORDIC JOURNAL OF PSYCHIATRY 511
We found that higher severity of borderline personality
symptoms increases the risk for SDE (OR ¼ 1.02). This is con-
sistent with D’Ambrosio and Vacca [26], who reported that
the presence of BPD, regardless of trauma antecedent or per -
sonality comorbidity, increases the risk for dissociative symp-
tom 4.41 times, which suggests that BPD syndrome itself
represents a risk factor for the occurrence of dissociative
phenomena [12,14]. Contrary to D’Ambrosio and Vacca [26],
we found that PD comorbidity is an important predictor of
SDE. Antisocial (OR ¼ 1.91), obsessive-compulsive (OR ¼
2.52)
and schizotypal (OR ¼ 3.48) PDs were the most important
predictors of SDE in patients with main diagnosis of BPD.
Consistent with others’ reports, we found that one PD of
each cluster predicts SDE. For example, it has been reported
that any type of PD confers a higher risk for dissociation;
cluster B PDs had the highest risk (OR ¼ 7.23), followed by
cluster A PDs (OR ¼ 4.39) and finally, cluster C PDs
(OR ¼ 3.47) [27]. Specifically, Semiz et al. [28] investigated
the
association between antisocial PD and dissociative symptoms
in a sample of Turkish recruits, observing a mean of 32.6
(SD ± 22) in the DES, which represents a similar score to
those observed in individuals with a BPD diagnosis. Also,
there is evidence that the level of dissociation that occurs in
individuals with schizotypal PD is similar to that observed in
those with a BPD diagnosis [29]. In fact, some investigations
have shown an association between schizotypal personality
traits and dissociative symptoms, suggesting that both con-
structs could be a manifestation of a superordinate trait,
openness to experience [11,30]; however, other studies have
19. shown that this personality factor is not related to the level
of dissociation [31]. Interestingly, we found that obsessive-
compulsive PD predicts SDE, a finding not observed in other
studies [26]. Nevertheless, it is important to keep in mind
that information about dissociation and PDs other than BPD
is scarce, and most studies of dissociation and BPD do not
explore the effect of the PD comorbidities or use different
instruments to assess dissociative experience, and therefore,
our results are difficult to extrapolate.
The Five-Factor Model (FFM) is a dimensional model for the
assessment of the general structure of personality [32]. This
model divides personality into five domains or factors: neuroti -
cism, extraversion, openness to experience, agreeableness and
conscientiousness. All of them include various facets related to
specific traits. There is evidence that all DSM-5 PDs can be
understood as maladaptive variants of the general personality
structure described through the FFM [33]. Studies conducted
to assess the relationship between the FFM and dissoci ation
have shown that neuroticism, highly associated with border-
line and schizotypal PDs, predicts dissociation [31,34,35]. This
could explain why we observed that high severity of border -
line symptoms and schizotypal PD comorbidity predicted SDE
in our study. The dimension of extraversion, related to anti -
social PD, and conscientiousness, a characteristic factor
observed in obsessive-compulsive PD, have been shown to be
negatively correlated with dissociative symptoms in several
studies [31,35]. However, we observed that both PDs’ comor-
bidities predict SDE. These findings could suggest that traits of
extraversion and conscientiousness predict dissociation when
they occur in patients who also present traits of neuroticism or
that neuroticism has a stronger relationship with the presence
of dissociation than other FFM domains. Other PDs such as
narcissistic and histrionic have also been found to be related
to extraversion, and one might expect that comorbidity with
20. these PDs would also predict SDEs, as is the case of patients
with antisocial PD comorbidity; however, this was not the case.
Similarly, the avoidant and dependent PDs have been related
to high levels of neuroticism, as well as schizotypal PD, and
they also did not predict SDE. Future studies in BPD patients,
taking into account comorbidity and the FFM model, including
the specific facets of each domain, could offer more specific
information about why PDs related to the same FFM domain
present a different risk for dissociation.
4.1. Limitations
Some study limitations should be noted. One of the main limi -
tations in this study is the use of a self-report instrument to
establish the presence of PDs other than BPD, which possibly
caused an overrating. Other investigations could be conducted
using more reliable diagnostic methods. The DES scale is an
adequate self-report questionnaire to assess severity of dis-
sociation; however, it explores only the psychological compo-
nent of the phenomenon [36]. A complete exploration of
dissociation could include a somatoform dimension and, in
this sense, our approach towards the dissociative phenom-
enon could be partial. We did not explore some Axis I disor -
ders with potential impact on the results. Patients with DD
and posttraumatic stress disorder presents high levels of dis-
sociation, and both disorders present high comorbidity with
BPD. Therefore, exploring these comorbidities would have
been important for results interpretation. Similarly, previous
research has found dissociative experiences in BPD patients to
be positively correlated with higher co-occurrence of alcohol
abuse and traumatic events during childhood; that connection
was also not explored in the present study. Despite these limi -
tations, our study provides further evidence regarding the
complexity and heterogeneity of the dissociative phenomenon
presented in BPD, increasing knowledge about the clinical fac-
tors, such as PD comorbidity, that confer greater risk for
21. dissociation.
4.2. Conclusions
SDE are associated with severe dysfunctio n and suffering, as
well as a worse clinical course and prognosis in patients with
BPD. Comorbidity with other PDs may represent additional
prognostic factors for BPD patients that is necessary to identify
during daily clinical consultation. Future research should
include the evaluation of BPD from a broader perspective. In
addition to the assessment of BPD symptoms and functional
impairment, the impact of comorbidity with other disorders,
including PDs, should be closely monitored. The above should
not only increase our knowledge about BPD but also may
increase the possibility of carrying out early interventions and
make more specific treatment decisions for these patients
based on research results, improving their prognosis in terms
512 A. RODR�IGUEZ-DELGADO ET AL.
of symptom severity, global functioning, quality of life and
well-being.
Disclosure statement
No potential conflict of interest was reported by the authors.
Notes on contributors
Andr�es Rodriguez Delgado: Child and adolescent psychiatrist
of the
Borderline Personality Disorder Clinic at the National Institute
of
Psychiatry Ram�on de la Fuente Mu~niz in Mexico City.
22. Ana Fres�an: PhD in Psychology and health from the Faculty of
Psychology of the National Autonomous University (UNAM).
Currently
head of the Laboratory of Clinical Epidemiology at the National
Institute
of Psychiatry Ram�on de la Fuente Mu~niz. Member of the
National
Research System (SNI) level III of CONACYT. Her research
focuses on
stigma, psychopathology assessment and violence.
Edgar Miranda: Clinical psychologist with a Master in
Cognitive
Behavioral Therapy (CBT). Researcher in Dialectical
Behavioral Therapy
(DBT) in Borderline Personality Disorder (BPD) and Post
Traumatic Stress
Disorder (PTSD). Clinical Psychotherapist at the National
Institute of
Psychiatry Ram�on de la Fuente Mu~niz in Mexico City.
Eduardo Garza-Villarreal: PhD in Medicine (Neuroscience)
from the
Center of Functionally Integrative Neuroscience of the
University of
Aarhus, Denmark. Assistant Professor at the National
Laboratory of
Magnetic Resonance Imaging (LANIREM), Institute of
neurobiology,
National Autonomous University of Mexico(UNAM),
Quer�etaro,M�exico.
Member of the National Research System (SNI) level I of
CONACYT. His
work focuses on the study of neuropsychiatric disorders in
humans and
23. animal models using neuroimaging.
Ruth Alcal�a-Lozano: Psychiatrist with a Master degree in
Medical
Sciences from the Faculty of Medicine of the National
Autonomous
University (UNAM) and current PhD student at UNAM. Clinical
researcher
in the Laboratory of Clinical Epidemiology at the National
Institute of
Psychiatry Ram�on de la Fuent Mu~niz.
X�ochitl Duque-Alarc�on: Clincial psychiatrist and PhD in
Medical Sciences
from the Faculty of Medicine of the National Autonomous
University in
M�exico (UNAM). Researcher at the Neuropsychiatry Specialty
Clinic at
the Instituto de Seguridad y Servicio Sociales de los
Trabajadores del
Estado (ISSSTE) in M�exico City.
Thania Balducci: Psychiatrist with a Master degree in Medical
Sciences
from the Faculty of Medicine of the National Autonomous
University of
Mexico (UNAM). Current PhD student at UNAM, attending a
research
residency at the Research Institute for Neurosciences and
healthy
Ageing at the University of Groningen, Netherlands.
Iv�an Arango de Montis: Clinical Psychiatrist. Master in
Medial Science by
the National Autonomous University of M�exico (UNAM).
Coordinator of
24. the Borderline Personality Disorder Clinic at the National
Institute
of Psychiatry Ram�on de la Fuente Mu~niz, M�exico City
(INPRF). Member
of the National Research System (SNI) level I of CONACYT.
His work
focuses on the study of development, parenting and
psychopathology
factors associated with personality disorders.
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AbstractIntroductionMaterial and
methodsParticipantsMeasurement instruments and
procedureStatistical
analysisResultsDiscussionLimitationsConclusionsDisclosure
statementNotes on contributorsReferences
Journal of Traumatic Stress
February 2019, 32, 156–166
An Online Educational Program for Individuals With
Dissociative
Disorders and Their Clinicians: 1-Year and 2-Year Follow-Up
Bethany L. Brand,1 Hugo J. Schielke,2 Karen T. Putnam,3
Frank W. Putnam,3 Richard J. Loewenstein,4
Amie Myrick,5 Ellen K. K. Jepsen,6 Willemien Langeland,7
Kathy Steele,8 Catherine C. Classen,9
and Ruth A. Lanius10
1Department of Psychology, Towson University, Towson,
Maryland, USA
2California Department of State Hospitals, Napa, California,
USA
3The Department of Psychiatry, University of North Carolina
31. School of Medicine at Chapel Hill, Chapel Hill, North Carolina,
USA
4Sheppard Pratt Health System and University of Maryland
School of Medicine, Baltimore, Maryland, USA
5Family and Children’s Services, Bel Air, Maryland
6Modum Bad Psychiatric Center, Vikersund, Norway
7Bascous, France
8Atlanta, Georgia
9University of California San Francisco and Zuckerberg San
Francisco General Hospital, San Francisco, California, USA
10Western University, London, Ontario, Canada
Individuals with dissociative disorders (DDs) are
underrecognized, underserved, and often severely
psychiatrically ill, characterized by
marked dissociative and posttraumatic stress disorder (PTSD)
symptoms with significant disability. Patients with DD have
high rates of
nonsuicidal self-injury (NSSI) and suicide attempts. Despite
this, there is a dearth of training about DDs. We report the
outcome of a
web-based psychoeducational intervention for an international
sample of 111 patients diagnosed with dissociative identity
disorder (DID)
or other complex DDs. The Treatment of Patients with
Dissociative Disorders Network (TOP DD Network) program
was designed to
investigate whether, over the course of a web-based
psychoeducational program, DD patients would exhibit
improved functioning and
decreased symptoms, including among patients typically
excluded from treatment studies for safety reasons. Using video,
32. written, and
behavioral practice exercises, the TOP DD Network program
provided therapists and patients with education about DDs as
well as skills
for improving emotion regulation, managing safety issues, and
decreasing symptoms. Participation was associated with
reductions in
dissociation and PTSD symptoms, improved emotion regulation,
and higher adaptive capacities, with overall sample |d|s = 0.44–
0.90, as
well as reduced NSSI. The improvements in NSSI among the
most self-injurious patients were particularly striking. Although
all patient
groups showed significant improvements, individuals with
higher levels of dissociation demonstrated greater and faster
improvement
compared to those lower in dissociation |d|s = 0.54–1.04 vs. |d|s
= 0.24–0.75, respectively. These findings support dissemination
of DD
treatment training and initiation of treatment studies with
randomized controlled designs.
Dissociative disorders (DDs) have a reported lifetime preva -
lence of 9–18% in international general population studies,
Some data from this paper were presented at an invited Master
Clinician
presentation at the 33rd Annual Meeting of the International
Society for the
Study of Traumatic Stress in Chicago, Illinois, November 8,
2017.
Correspondence concerning this article should be addressed to
Dr. Bethany
Brand, Towson University, Psychology Department, Towson,
Maryland,
34. http://creativecommons.org/licenses/by-nc/4.0/
http://creativecommons.org/licenses/by-nc/4.0/
Online Intervention for Dissociative Disorders 157
is also associated with higher rates of childhood trauma than
any other diagnostic group (Spiegel et al., 2011). Patients with
DD have high rates of comorbid posttraumatic stress disorder
(PTSD), major depressive disorder, somatic symptom disorder,
and substance use disorders as well as high rates of nonsuicidal
self-injury (NSSI) and suicide attempts (Foote, Smolin, Neft,
& Lipschitz, 2008; Webermann, Myrick, Taylor, Chasson,
& Brand, 2015). Patients with DD also have higher rates of
suicide attempts than individuals with borderline personality
disorder, PTSD, or substance abuse disorders but do not have
a comorbid DD (Foote et al., 2008). Dissociative disorders are
also associated with a high level of impairment. For example,
in a representative sample of New York citizens, DD patients’
average impairment scores were 50% higher than those of
patients with other psychiatric disorders, with DID individuals
demonstrating the highest level of impairment (Johnson,
Cohen, Kasena, & Brook, 2006). The severity and chronicity of
DD patients’ symptoms usually necessitate frequent treatment
at more restrictive levels of care (Mueller-Pfeiffer et al., 2012),
which is associated with significant health care costs.
However, effective treatment for DDs has been shown to
reduce patient suffering and health care costs (Brand et al.,
2013; Lloyd, 2016; Myrick, Webermann, Langeland, Putnam,
& Brand, 2017). Meta-analyses of eight open trials of DD treat-
ment yielded an average effect size of d = 0.71 for decreased
dissociation, anxiety, depression, somatoform symptoms, sub-
stance use, and general distress (Brand, Classen, McNary, &
Zaveri, 2009). A study of DD patients found cross-sectional and
longitudinal reductions in inpatient and outpatient costs, as re-
35. ported by patients and therapists, which suggests that DD treat-
ment may be associated with reduced costs over time (Myrick
et al., 2017).
A prospective, longitudinal study of 280 DD patients and
292 clinicians from six continents found that, over the course
of 30 months of individual treatment, patients showed signifi -
cant decreases in depression, PTSD, distress, dissociation, sui-
cide attempts, NSSI, hospitalizations, drug use, physical pain,
and treatment costs (Brand, Classen, Lanius et al., 2009; Brand
et al., 2013; Myrick et al., 2017). A Norwegian inpatient study
(Jepsen, Langeland, Sexton & Heir, 2014) discovered that for
DD patients, a generic trauma-focused treatment without at-
tention to dissociation failed to reduce amnesia or dissociative
identity alteration although depression and general psychiatric
symptoms improved. Jepsen and colleagues (2014) concluded
that unless a dissociation-specific treatment is provided, disso-
ciative symptoms associated with DDs are unlikely to improve.
Studies of individuals with PTSD, both with and without bor-
derline personality disorder, have found that higher dissociation
levels predict poor response to standard treatments, such as
eye movement desensitization and reprocessing (EMDR) and
dialectical behavior therapy (DBT; Bae, Kim, & Park, 2016;
Kleindienst et al., 2011). Despite these data, most psychiatric
and psychology textbooks fail to present empirical research
about DDs, or they provide inaccurate or sensationalized in-
formation about diagnosis and treatment of DDs (Loewenstein
et al., 2017; Wilgus, Packer, Lile-King, Miller-Perrin, & Brand,
2016).
Expert consensus treatment guidelines are available for DID
in children and adults (International Society for the Study of
Trauma and Dissociation [ISSTD], 2004, 2011). These guide-
lines recommend a phasic treatment model that, consistent with
a survey of international DD experts (Brand et al., 2012), em-
36. phasizes patient safety and stabilization. Due to the severity and
complexity of DD symptoms and impairment, the first stage ex-
plicitly focuses on safety and stabilization; DD patients often
decompensate if there is a premature attempt to process trau-
matic memories before behavioral stabilization and acquisition
of emotion and symptom management skills (ISSTD et al.,
2011). The symptoms of these chronic complex DDs have been
conceptualized as reflective of emotional dysregulati on related
to trauma (Brand & Lanius, 2014), and emotional dysregulation
and posttraumatic stress have been found to predict increased
dissociation and tension reduction actions (Briere, Hodges, &
Godbout, 2010). Conceptualizing NSSI and suicidal behav-
iors as attempts at self-regulation, Stage 1 treatment is recom-
mended to utilize a multimodal, present-centered approach that
emphasizes psychoeducation and cognitive-behavioral inter-
ventions while conceptualizing relationship dynamics through
psychodynamic and attachment theories (Brand, 2001). Patients
are taught healthy coping skills to manage dysregulation, in-
cluding grounding to reduce dissociation; emotion regulation
skills to replace reliance on unhealthy behaviors (e.g., NSSI,
substance abuse) to reduce overwhelming emotions; contain-
ment of intrusive PTSD symptoms; and methods for managing
unsafe behaviors. When patients demonstrate improved aware-
ness and tolerance of emotions, decreased dissociation, mastery
of basic symptom management skills, and improved safety,
they may (optionally) progress to Stage 2, which adds carefully
paced processing of trauma memories. A survey of 36 interna-
tional experts (Brand et al., 2012) indicated that experts remain
attentive to safety and stability until the third phase of
treatment.
In Stage 3, patients are able to devote more energy to increas -
ing social and occupational activities and may completely or
partially integrate self-states (Loewenstein et al., 2017).
Despite these guidelines, accessing specialized trauma
treatment can be difficult or impossible for many pa-
37. tients with DDs, partially due to the fact that few clini -
cians report having any training in the diagnosis and treat-
ment of dissociation and DDs (Brand et al., 2014, 2016).
Internet-based interventions, by contrast, are easy to access
(Bolton & Dorstyn, 2015; Litz, Engel, Bryant, & Papa, 2007),
and Internet-based interventions aimed at treating symptoms
of depression, anxiety, and PTSD have been associated with
medium-to-large effect sizes (Bolton & Dorstyn, 2015). Unfor-
tunately, DD patients are typically excluded from most Internet-
and non-Internet-based PTSD treatment studies due to typical
exclusion criteria, including high dissociation scores, active
substance abuse, NSSI, suicidality, psychosis, lack of social
support, and/or high levels of stressors, among others (Bolton
& Dorstyn, 2015; Klein et al., 2010; Knaevelsrud & Maercker,
Journal of Traumatic Stress DOI 10.1002/jts. Published on
behalf of the International Society for Traumatic Stress Studies.
158 Brand et al.
2007; Litz et al., 2007). Internet-based DD-focused interven-
tions have not yet been investigated; however, in a study of
Internet-based cognitive behavior therapy (CBT) interventions
for PTSD that excluded highly dissociative individuals, the au-
thors did find that dissociation scores significantly decreased
during the intervention (Klein et al., 2010).
For the present study, we designed an Internet-based program
for early-stage DD patients and their therapists that focused
on stabilization, safety, and management of DD and PTSD
symptoms in an effort to determine whether psychoeducation
consistent with ISSTD treatment guidelines and expert recom-
mendations would be associated with decreased symptoms and
improved functioning. The TOP DD Network program’s psy-
38. choeducational intervention is an online, password-protected
program consisting of 45 short (i.e., 5–15-min) educational
videos, 40 of which are paired with structured writing and be-
havioral practice exercises that assist patients in cognitively
and behaviorally applying the video’s educational content. In
this report, we present 2-year outcomes, including changes in
adaptive capacities, emotion regulation, PTSD and dissociative
symptoms, NSSI, suicide attempts, and hospitalizations.
Method
Participants
Patient-therapist dyads were recruited through announce-
ments on mental health professional listservs and by contacting
therapists who had participated in the naturalistic TOP DD
study. Interested therapists were instructed to invite one patient
who had been diagnosed with DID, DD not otherwise specified
(DDNOS), or other specified DD (OSDD) to participate in the
study. The DDNOS diagnosis is specific to the fourth edition
(text revision) of the Diagnostic and Statistical Manual of Men-
tal Disorders (DSM-IV-TR; American Psychiatric Association
[APA], 2000), and the OSDD is specific to the fifth edition of
the DSM (DSM-5; APA, 2013). At the time of the study, clini-
cians were still shifting from DSM-IV-TR to DSM-5; thus,
either
clinical diagnosis was permitted. Patient exclusion criteria were
as follows: being younger than 18 years of age, unable to read
English, and/or not having access to the Internet. Therapist ex-
clusion criteria were: not having an interested/eligible patient,
not being able to read English, and/or not having Internet
access.
We did not exclude patients with comorbid disorders, current
suicidality, NSSI, substance abuse, psychosocial stressors, in-
stability, or isolation. Participants were not compensated. As
this study is still in progress, dyads included in the presented
39. analyses (N = 111) are a subset of those who will be ultimately
enrolled. Participants were included in these analyses if they
completed a baseline survey and a progress survey at either the
12-month or 24-month time points. We compared baseline data
of individuals who were not included in the presented analyses
with those included and found no differences in demographics
or measures at entry into the program. Participants in this in-
ternational sample were mostly female (88.3%) and Caucasian
(86.5%); see Table 1 and Supplementary Table S1 for additional
patient demographic information.
Therapists and patients accessed password-protected web-
sites to complete informed consents and surveys and access ed-
ucational videos, journaling, and behavioral practice exercises.
Surveys were identified by code numbers. The study received
Institutional Review Board approval from Towson University
(Towson, MD). The consent materials explained that partici-
pant pairs could discontinue at any time, but if the therapist
discontinued, the patient would be unenrolled to ensure suffi -
cient patient support during the intervention.
Procedure
Therapists and patients completed a screening survey; if both
members met inclusion criteria, they were emailed a URL to
an initial survey (baseline), followed by an e-mail that pro-
vided access to the psychoeducational program and links to
surveys every 6 months for 2 years. The educational materials
were developed based on the research team’s decades of ex-
perience working with DD patients in inpatient and outpatient
settings, drawing on the results of a survey of experts (Brand
et al., 2012), the ISSTD treatment guidelines, and findings that
DD therapists and their patients could benefit from increased
emphasis on trauma symptom management techniques (e.g.,
Myrick, Chasson, Lanius, Leventhal, & Brand, 2015). See the
40. online Supplementary Materials for additional information re-
garding the theoretical and empirical foundations of the pro-
gram’s content.
A team of three authors (Brand, Schielke, & Lanius) wrote
the video transcripts and outlined the journaling and behavioral
exercises. These were then reviewed by members of the TOP
DD team and DD patient and consumer advocates involved in
public educational efforts. None of the patient or consumer re-
viewers were in treatment with research team members. The
45 final 5–15-min videos were filmed with the first author as
spokesperson. Participants could watch the videos, read the
video transcripts, and access the exercises as often as they
found useful. To allow patients time to make meaningful use
of the journaling and behavioral exercises, access to the next
set of materials was delayed 1 week from the time of access-
ing the previous week’s materials. Although patients and their
therapists were required to participate together in the TOP DD
program, we suggested that participants watch the videos and
complete assignments outside of therapy to protect session time
for individualized work.
The psychoeducational materials addressed the impact of
trauma, including symptoms of PTSD, complex trauma re-
actions, and DDs; symptom and emotion management tech-
niques; and the nature and functions of NSSI, suicidal, and
risky
behaviors (henceforth referred to collectively as “unsafe” or
“unhealthy” behaviors) among traumatized people. We empha-
sized that although unsafe behaviors frequently represent at-
tempts to self-regulate painful affects and intrusive memories,
they fail to resolve the underlying emotional and trauma-based
Journal of Traumatic Stress DOI 10.1002/jts. Published on
behalf of the International Society for Traumatic Stress Studies.
41. Online Intervention for Dissociative Disorders 159
Table 1
Patient Demographics and Characteristics at Intake
Variable High DES Group Low DES Group
M SD M SD ta df
Age at intake (years) 43.1 9.73 41.98 11.23 0.55 108
% n % n χ2a df
Gender
Female 89.0 63 87.5 35 0.73 2
Male 9.9 7 12.0 5
Transgender 1.4 1 0.0 0
Race/ethnicity
Caucasian 83.1 59 92.5 37 0.23 4
Latino or Hispanic 5.6 4 0.0 0
Asian 2.8 2 0.0 0
Black 1.4 1 2.5 1
Other 7.0 5 5.0 2
Treatment stage
Stabilization and safety 39.4 28 32.5 13 5.70 4
Between safety and processing 47.9 34 50.0 20
Processing trauma 12.7 9 10.0 4
Between processing trauma and reconnection 0.0 0 5.0 2
Reconnection and integration 0.0 0 2.5 1
DD diagnosisb
DID (DSM-IV-TR, DSM-5) 76.5 52 53.9 21 6.23 3
42. DDNOS (DSM-IV-TR) 20.6 14 41.0 16
OSDD (DSM-5) 2.9 2 5.0 2
Note. DES = Dissociative Experiences Scale; DID =
dissociative identity disorder; DDNOS = dissociative disorder
not otherwise specified; OSDD = other specified
dissociative disorder; DSM-IV-TR = Diagnostic and Statistical
Manual of Mental Disorders (4th ed., text rev.); DSM-5 =
Diagnostic and Statistical Manual of Mental
Disorders (5th ed.).
at or chi-square tests used to examine differences between
groups. bDiagnosis data missing for four participants (high DES
group, n = 3; low DES group, n = 1).
symptoms that perpetuate their distress. Throughout the pro-
gram, self-compassion and acceptance of emotions were em-
phasized, and, for DID patients, healthy collaboration among
self-states (note that the DSM-5 uses the term “personality
states.” We prefer the term “self-states” as more conceptually
and clinically accurate in terms of DID phenomenology and
subjective experience). The content of the program is elabo-
rated in the Supplementary Materials.
Measures
Dissociative experiences. The Dissociative Experiences
Scale II (DES; Carlson & Putnam, 1993) is a 28-item self-
report measure of dissociative experiences. Each item presents
11 Likert scale response options ranging from 0% (never) to
100% (always). Higher average scores indicate a higher level
of dissociation, with a possible score of 0 to 100. The DES
cut point of 30 or above is based on a receiver operating
characteristic (ROC) curve of 1,051 subjects in nine psychi -
atric disorder categories from seven centers (Carlson et al.,
1993). Discriminant analysis has indicated that using a cutoff
43. score of 30 screens for DID with 76% sensitivity and speci -
ficity, and 85% specificity in a more representative subsample
(Carlson et al., 1993). The DES has demonstrated good internal
consistency (mean Cronbach’s α across 16 studies = .93) and
convergent validity (r = .67 overall; see paper for methodology
comparing rs with 8 different measures across 26 studies), and
test–retest reliability ranging from .78 to .93 over 4–8 weeks
(6 studies; van IJzendoorn & Schuengel, 1996). In this study,
Cronbach’s alpha was .96 at each time point.
Emotion regulation. The Difficulties in Emotion Regula-
tion Scale (DERS; Gratz & Roemer, 2004) is a 36-item self-
report measure of nonacceptance of emotional responses, dif-
ficulties engaging in goal-directed behavior, impulse control
difficulties, lack of emotional awareness, limited access to emo-
tion regulation strategies, and lack of emotional clarity. Items
are rated on a 5-point Likert scale of 1 (almost never, 0–10%) to
5 (almost always, 91–100%); scores can range from 36 to 180,
with higher scores indicating greater dysregulation. The DERS
has demonstrated good internal consistency (Cronbach’s α =
.93) and test–retest reliability (ρI = .88, p < .01) and adequate
Journal of Traumatic Stress DOI 10.1002/jts. Published on
behalf of the International Society for Traumatic Stress Studies.
160 Brand et al.
subscale test–retest reliability and well as construct and predic-
tive validity (Gratz & Roemer, 2004). Cronbach’s alpha values
ranged from .94 to .96 in the current sample.
Posttraumatic stress symptoms. The Posttraumatic
Stress Checklist—Civilian Form (PCL-C; Weathers, Litz,
Huska, & Keane, 1994) is a 17-item self-report measure of
44. DSM-IV-TR PTSD symptoms in the past month. Items are rated
on a 5-point Likert scale that ranges from 1 (not at all) to 5 (ex-
tremely). Scores can range from 17 to 85; higher scores indicate
a higher level of distress (Weathers & Ford, 1996). The PCL-
C has demonstrated high overall diagnostic efficiency (90%;
Blanchard, Jones-Alexander, Buckley, & Forneris, 1996) and
strong test–retest reliability (.96 in a 2–3 day interval; Weathers
et al., 1994). Cronbach’s alpha values ranged from .88 to .92 in
the current sample.
Treatment progress. The Progress in Treatment Ques-
tionnaire, patient version (PITQ-p; Schielke, Brand, & Marsic,
2017) is a self-report measure that assesses ability to manage
emotions, symptoms, relationships, safety, and well-being over
the prior 7 days. The PITQ-p consists of 32 expert-identified
items, 6 of which (items 27–32) are only completed by
patients who report experiencing dissociative self-states
(DSS). Responses are rated on an 11-point Likert scale with
options ranging from 0% (never true) to 100% (always true).
Responses are added and then averaged (using either 26 or 32
items, depending on whether the patient has DSS). Possible
scores range from 0 to 100; higher scores indicate better
adaptive functioning. The PITQ-p has demonstrated evidence
of good internal consistency (Cronbach’s α = .92) and
adequate convergent validity with measures of emotion-related
functioning (DERS; r = −.67), PTSD (PCL-C; r = −.47),
and dissociation (DES; r = −.42), as well as correlations in
expected directions with NSSI (r = −.34) and psychological
(r = .64) and social (r = .28) quality of life (Schielke et al.,
2017). In the current sample, Cronbach’s alpha values ranged
from .92 to .96 for patients with DSS and from .91 to .96 for
patients without DSS.
The Progress in Treatment Questionnaire, therapist version
(PITQ-t; Schielke et al., 2017) is a therapist-completed measure
of dissociative patients’ ability to manage emotions, symptoms,
45. relationships, safety, and well-being over the prior 6 months.
The 29-item instrument assesses the percentage of time pa-
tients have demonstrated expert-identified adaptive behaviors
and includes 6 items (items 24–29) that the therapist completes
only for their patients with DSS. Responses are rated on an
11-point Likert scale with options ranging from 0% (never)
to 100% (always), with higher average scores indicative of
better adaptive functioning; possible scores range from 0 to
100. The PITQ-t has demonstrated good internal consistency
(Cronbach’s α = .91) and adequate convergent validity with
measures of emotion-related functioning (DERS; r = −.35),
PTSD (PCL-C; r = −.41), and dissociation (DES; r = −.29),
as well as correlations in expected directions with NSSI
(r = −.37) and psychological (r = .45) and social (r = .22)
quality of life (Schielke et al., 2017). In the current sample,
Cronbach’s alpha values ranged from .92 to .95 for patients
with DSS and from .89 to .94 for patients without DSS.
Clinical data. Therapists reported on patients’ demograph-
ics, DD diagnosis, and stage of treatment. They also indicated
the level of NSSI, suicide attempts, and hospitalizations over
the prior 6 months.
Data Analysis
Based on prior research that has indicated differences in
therapeutic response related to severity of dissociation (e.g.,
Bae et al., 2016), we divided the sample into low dissocia-
tion (DES scores less than 30; n = 40) and high dissociation
(DES scores of 30 or more; n = 71) groups using the ROC-
derived cut point of 30 (Carlson et al., 1993). We calculated
distributions and descriptive statistics; when normality was vi-
olated, dependent variables were analyzed with nonparametric
methods.
46. The data were analyzed in two tiers. First, Cohen’s d effect
sizes were calculated using paired data to examine change in the
observed variables post- and midintervention. Confidence in-
tervals accounting for correlated paired data were constructed,
and Cohen’s (1988) traditional cut points were used to inter -
pret the effect sizes as small (0.20), medium (0.50), or large
(0.80).
We then ran a series of mixed models using SAS
(Version 9.3). First, we examined whether time involved in the
study was a significant predictor of change in the observed vari -
ables. Next, a series of 2 × 3 repeated measures models exam-
ined the linear within-subject effects over time and the between-
subject effects of the high and low DES groups. Smaller Akaike
information criterion (AIC) and -2 log-likelihood values in-
dicated that an unstructured covariance matrix demonstrated
the best model fit. Clinically relevant covariates (includi ng fe-
male/male gender, age, native English-speaking country, how
long the subject had been diagnosed with a DD, and treatment
stage) were then included to evaluate how much variance they
accounted for in the dependent variable, and significant covari -
ates were included in the final models (countries in the native
English-speaking category included the United States, Canada,
United Kingdom, Australia and New Zealand. Non-English
native language countries included Belgium, Israel, Norway,
Spain, Sweden, and India). It should be noted that the SAS
MIXED procedure accommodates missing data. Mixed models
apply an iterative estimation of the restricted or residual max-
imum likelihood (REML) method instead of the basic least-
squares method of general linear models. The REML method
utilizes all available data and estimates the parameter for each
subject. Bonferroni post hoc comparisons were constructed for
significant interactions and main effects. Additional informa-
tion on the overall sample, effect sizes, and model analyses can
be found in the online Supplementary Materials.
47. Journal of Traumatic Stress DOI 10.1002/jts. Published on
behalf of the International Society for Traumatic Stress Studies.
Online Intervention for Dissociative Disorders 161
Table 2
Means and Standard Deviations for Continuous Outcome
Measures: High and Low Dissociation (DES) Groups
High Dissociation Low Dissociation
Baseline Year 1 Year 2 Baseline Year 1 Year 2
(n = 71) (n = 50) (n = 51) (n = 40) (n = 26) (n = 27)
Reporter and Scale M SD M SD M SD M SD M SD M SD
Patient
PITQ-p 41.54 14.56 49.15 15.69 58.57 19.53 51.24 11.43 55.28
17.43 62.40 13.40
DERS 125.66 21.69 113.16 23.86 100.04 26.34 107.35 16.11
104.46 20.65 91.15 19.29
PCL-C 65.42 8.97 59.46 10.55 54.14 13.37 52.60 9.56 50.12
13.67 47.15 12.14
DES 50.89 14.31 44.50 18.64 37.82 18.36 18.21 7.57 18.34
13.42 15.67 7.32
Therapist
PITQ-t 48.39 12.49 53.53 13.48 54.77 14.07 53.64 12.48 57.37
14.62 59.15 17.29
Note. DES = Dissociative Experiences Scale; PCL-C =
Posttraumatic Stress Checklist–Civilian; DERS = Difficulties in
Emotion Regulation Scale; PITQ-p = Progress
in Treatment Questionnaire–patient; PITQ-t = Progress in
48. Treatment Questionnaire–therapist.
Results
Patient demographics and characteristics at intake are
presented in Table 1. Table 2 provides the means and standard
deviations for the low and high dissociation groups at baseline,
Year 1, and Year 2. Table 3 reports the postintervention (Year
2)
and midintervention (Year 1) effect sizes for the overall sample
and both DES groups and demonstrates postintervention
improvements in each group on each measure. Supplementary
Table S4 contains the parsimonious model summaries for
significant main effects, covariates, and Time × DES group
interactions.
Changes in Adaptive Capacities, Emotion Regulation,
and Symptoms
At study completion, overall sample effect sizes indicated
large improvements in adaptive capacities (as indicated by
PITQ-p scores; |d| = 0.86), and emotion regulation (as indi-
cated by DERS scores; d = 0.90); medium improvements in
PTSD symptoms (as indicated by PCL-C scores; d = 0.65);
and slightly smaller improvements in dissociation (as indi -
cated by DES scores; d = 0.48). The high dissociation group
demonstrated the greatest improvements, with large improve-
ments in adaptive capacities (|d| = 0.94), emotion regulation
(d = 1.04), PTSD symptoms (d = 0.93), and dissociation (d =
0.81). The low DES group demonstrated medium-approaching-
strong improvements in postintervention adaptive capacities
(|d| = 0.75) and emotion regulation (d = .74), and small im-
provements in PTSD symptoms (d = 0.32) and dissociation
(d = 0.24).
At the study’s halfway mark, overall sample effect sizes
49. indicated small improvements in adaptive capacities (|d| =
0.47), emotion regulation (d = 0.36), PTSD symptoms (d =
0.41), and dissociation (d = 0.22). The high dissociation group
again demonstrated the greatest improvements, with medium
improvements in adaptive capacities (|d| = 0.53), emotion reg-
ulation (d = 0.54), and PTSD symptoms (d = 0.61), and the
strongest improvements in dissociation of the three groups at
this time point (d = 0.45). The low DES group demonstrated
small improvements in midintervention adaptive capacities
(|d| = 0.39), emotion regulation (d = 0.26), and PTSD symp-
toms, (d = 0.20). Dissociation was unchanged for the low DES
group midintervention (d = 0.08).
Therapist-Reported Adaptive Capacities
Therapist-reported adaptive capacities (as measured using
the PITQ-t) increased in the overall sample and both groups at
Year 2 compared to baseline, with a medium effect size for the
high DES group (|d| = 0.54) and small effect sizes for the over -
all and low DES groups (|d|s = 0.44 and 0.30, respectively).
There were no DES group main effects, only time effects,
F(2, 102) = 10.56, p < .001. Bonferroni post hoc comparisons
showed improvements for the overall group from baseline to
Year 1, p = .003, and Year 2, p < .001. Finally, therapist ratings
of patients’ adaptive capacities covaried with treatment stage,
F(1, 102) = 5.66, p = .019.
Interactions, Covariates, and Post Hoc Comparisons
for Patient Ratings
We identified interactions between DES group and time in
relation to the DERS, F(2, 107) = 3.95, p = .022, and PCL-C,
F(2, 104) = 4.10, p = .019. The high DES group demonstrated
higher DERS and PCL-C scores at baseline and steeper reduc-
tion slopes compared to the low DES group.
50. Years diagnosed with a DD was weakly associated with PCL-
C reductions, F(1, 104) = 3.98, p = .049, with lower scores
found among those who had been diagnosed longer. Scores on
the DERS covaried with gender, F(1, 107) = 5.86, p = .017,
as did PITQ-p scores, F(1, 105) = 4.71, p = .032: Female
Journal of Traumatic Stress DOI 10.1002/jts. Published on
behalf of the International Society for Traumatic Stress Studies.
162 Brand et al.
Table 3
Effect Size Comparisons and Patient Measures for the Overall
Sample and High and Low Dissociation (DES) Groups
Postintervention Midintervention
(Year 2) (Year 1)
d 95% CI d 95% CI
PITQ-pa
Overall sample −0.86 [−1.10, −0.60] −0.47 [−0.67, −0.27]
High DES group −0.94 [−1.25, −0.62] −0.53 [−0.77, −0.29]
Low DES group −0.75 [−1.19, −0.31] −0.39 [−0.77, 0.00]
DERS
Overall sample 0.90 [0.65, 1.14] 0.36 [0.21, 0.62]
High DES group 1.04 [0.72, 1.36] 0.54 [0.23, 0.77]
Low DES group 0.74 [0.29, 1.18] 0.26 [−0.05, 0.56]
PCL-C
Overall sample 0.65 [0.44, 0.86] 0.41 [0.21, 0.60]
51. High DES group 0.93 [0.62, 1.23] 0.61 [0.33, 0.89]
Low DES group 0.32 [0.02, 0.61] 0.20 [−0.16, 0.56]
DES
Overall sample 0.48 [0.31, 0.65] 0.22 [0.07, 0.37]
High DES group 0.81 [0.53, 1.09] 0.45 [0.19, 0.70]
Low DES group 0.24 [−0.06, 0.53] −0.08 [−0.46, 0.29]
PITQ-ta
Overall sample −0.44 [−0.77, −0.09] −0.31 [−0.50, 0.−13]
High DES group −0.54 [−0.80, −0.27] −0.38 [−0.65, −0.10]
Low DES group −0.30 [−0.72, 0.13] −0.25 [−0.50, 0.01]
Notes. PITQ-p = Progress in Treatment Questionnaire–patient;
DERS = Difficulties in Emotion Regulation Scale; PCL-C =
Posttraumatic Stress Checklist–Civilian;
DES = Dissociative Experiences Scale; PITQ-t = Progress in
Treatment Questionnaire–therapist.
aHigher scores are better for the PITQ-t and PITQ-p; for these
measures, a negative effect size reflects improvement.
participants demonstrated higher DERS scores (M = 121.20
for female vs. M = 105.09 for male participants) and lower
PITQ-p scores (M = 43.82 for female vs. M = 53.69 for male
patients) at baseline.
Main effect post hoc comparisons indicated differences be-
tween the high and low DES groups at all three time points;
Bonferroni post hoc comparisons showed higher PCL-C scores
for the high DES compared to the low DES group at baseline,
p < .001; Year 1, p < .001; and Year 2, p = .026. The high DES
group demonstrated significant improvement at post-2-year in-
tervention, p < .001, and at the mid-1-year intervention, p <
.001. Post hoc PITQ-p comparisons indicated that the low DES
group had higher average scores (M = 56.49) than the high
52. DES group (M = 49.63), p = .016. Patient-reported PITQ-p
scores correlated with therapist-reported PITQ-t scores, r = .49,
p < .001.
Changes in Safety and Hospitalization
In our sample, NSSI events were not normally distributed
(M = 20.61; SD = 37.08; Mdn = 6; range: 0–150). Thera-
pist reports of patients’ NSSI events in the past 6 months had
maximum values of 150 events at baseline, decreasing to max-
imum counts of 10 at Years 1 and 2. For the 67 subjects with
reported NSSI events, therapists reported patients engaged in
NSSI an average of 13.75 times in the 6 months prior to intake;
this rate dropped to 1.96 times and 1.74 times by Years 1 and
2, respectively. More than half of the patients who engaged in
NSSI (68.60%, n = 46) decreased NSSI events over 2 years;
25.40% (n = 17) reported an increase in NSSI from baseline.
The remaining 6% (n = 4) had no change in NSSI (n = 2),
increased then decreased (n = 1), or decreased then increased
(n = 1) over the three time intervals. Wilcoxon signed rank
tests examined the hypothesis that median differences between
baseline to Year 1, Year 1 to Year 2, and baseline to Year 2
were equal for the high and low DES groups. The high DES
group had a median count of two NSSI events at baseline and
decreased at Year 1, z = 2.65, p = .008, and Year 2, z = 4.00,
p < .001. The median number of NSSI events for the low DES
group was 1. This decreased significantly by Year 1, z = 2.35,
p = .018. Year 2 reductions (z = 1.69, p = .086) did not meet
the p < .05 significance criteria. There were no differences in
the high and low DES groups’ NSSI between Years 1 and 2.
At study completion, patients’ average number of suicide
attempts in the prior 6 months was lower than at intake (intake
M = 0.39, SD = 1.54 vs. M = 0.17; SD = 0.80 at year 2).
Patients required an average of 22.27 days of hospitalization
53. Journal of Traumatic Stress DOI 10.1002/jts. Published on
behalf of the International Society for Traumatic Stress Studies.
Online Intervention for Dissociative Disorders 163
in the 6 months prior to engaging in the study and 11.50 days
of hospitalization 2 years later. Although the change in suicide
attempts and days hospitalized were in the direction suggesting
that the intervention was beneficial, they were not statistically
significant.
Discussion
This study examined the effectiveness of a web-based
psychoeducation program designed to assist therapists of
and patients with complex DDs, an underserved and severely
symptomatic population. Participation in the TOP DD Network
program was associated with reductions in dissociation and
PTSD symptoms, improved emotion regulation, and higher
adaptive capacities (i.e., PITQ scores). As indicated by effect
size, the overall sample demonstrated large improvements in
emotion regulation and patient-reported adaptive capacities,
medium-sized improvements in PTSD symptoms, and small
improvements in dissociation. Notably, however, patients with
higher initial DES scores demonstrated the strongest and most
consistent improvements. By Year 2, patients who entered the
study with high dissociation demonstrated large improvements
in emotion regulation, PTSD symptoms, dissociation, and
patient-reported adaptive capacities. Patients with lower initial
levels of dissociation also benefited at Year 2 relative to intake
and demonstrated medium changes in emotion regulation and
patient-reported adaptive capacities as well as small reductions
in PTSD and dissociation symptoms. In addition, despite the
54. chronicity and severity of NSSI in our sample, there were sig-
nificant overall reductions in therapist-reported patient NSSI.
Therapists’ (PITQ-t) and patients’ (PITQ-p) reports of im-
provements in adaptive capacities were directionally consistent,
but differed in effect size. As is the case in therapeutic alliance
(including among DD individuals; Cronin, Brand, & Mattanah,
2014), patients’ reports of their adaptive capacities demon-
strated stronger associations with other outcomes than did those
of their therapists. Differences in reports of adaptive capacities
may be because therapists’ and patients’ measures referred to
different time frames (i.e., 6 months vs. 1 week) and/or
patients’
greater awareness of their daily experience and capacities. Ther -
apists’ ratings of their patients’ adaptive capacities were found
to covary with their assessment of patient’s treatment stage,
which suggests that higher PITQ-t scores are associated with
later stages of treatment. Female patients demonstrated higher
levels of emotional dysregulation and lower adaptive capacities
at baseline. Results did not covary with age or native language
of the participant’s country, which suggests that the psychoedu-
cation program had a similar impact regardless of age or native
language.
This program was designed to facilitate symptom manage-
ment and patient stabilization, targeting unsafe behaviors as
well as the symptoms and emotions that contribute to them. We
were generally successful in recruiting patients who were in
the early stabilization stages of treatment; 85% of the partici -
pants were judged by their therapists to be working on symptom
management and stabilization at intake. We received feedback
from patients and therapists that the educational materials were
relevant, clear, and useful for patients struggling with safety
and symptom stabilization (see the Supplementary Materials
for examples of specific feedback; analysis of qualitative and
quantitative patient feedback is forthcoming).
55. Improving DD patients’ capacity for emotion regulation is
foundational for their recovery (Brand et al., 2012; ISSTD et
al.,
2011), as increased capacity for emotion regulation enables DD
patients to tolerate painful emotions, thereby reducing their re-
liance on NSSI, other unsafe behaviors, and dissociation to
manage overwhelming emotions related to traumatic intrusions
and compartmentalized self-states. Consistent with this view,
we found that significant improvements in emotion regulation
were accompanied by improvements in PTSD symptoms, dis-
sociation, and NSSI.
As expected for DD patients in early treatment, our sample
had high levels of NSSI that would have resulted in most of
these
patients being excluded from typical treatment studies. Even
the most chronically self-injuring patients appeared to benefit.
For example, the therapists of the three patients who had the
highest reported NSSI at intake (self-injuring approximately
100, 125, and 150 times in the last 6 months) reported their
patients’ NSSI had decreased considerably by the end of the
program (self-injuring 0, 10, and 10 times, respectively, in the
last 6 months). This is a crucial finding, as highly self-injurious
patients are largely excluded from treatment studies yet are
often the most challenging to treat (Brand, 2001).
At the beginning of the study, therapists reported that their
patients averaged .39 suicide attempts in the prior 6 months (SD
= 1.54) and required an average of 22.27 days of hospitalization
compared to a mean of 0.17 attempts and 11.50 days of hos-
pitalization 2 years later. The reduction in suicide attempts is
important given the high suicidality among DD patients, which
often necessitates intensive intervention and is likely associ-
ated with impairment (Brand et al., 2013, Foote et al., 2008).
It is possible that these changes in patients’ safety may reflect
56. underlying improvements in emotion regulation, which was a
target of this program. These are promising findings for im-
proved management of safety in this severely and chronically
self-injuring group of patients.
Despite improvements, most patients continued to report
levels of symptoms that implied need for further treatment.
This is consistent with treatment outcome data for evidence-
based PTSD treatments: A review of randomized controlled
trials (RCTs) for military PTSD found that two-thirds of
the patients who received treatment still met criteria for
PTSD after treatment, despite those studies’ exclusion of
patients with the severe symptoms and comorbidities common
in the current sample (Steenkamp, Litz, Hoge, & Marmar,
2015). This highlights the significance of the current study’s
findings: Participation in the TOP DD Network program was
associated with significant benefits among highly self-injuring,
Journal of Traumatic Stress DOI 10.1002/jts. Published on
behalf of the International Society for Traumatic Stress Studies.
164 Brand et al.
chronically ill, severely symptomatic DD patients, a popul ation
rarely targeted or included in treatment studies.
Compared to participants with lower levels of dissocia-
tion, the most highly dissociative among our DD patients
demonstrated the greatest improvements. The high dissocia-
tion group began with higher levels of symptoms, more dif-
ficulties with emotion regulation, and lower levels of adap-
tive capacities, yet they demonstrated faster and greater
improvement than the low dissociation group. These data show
that treatment that includes emphasis on providing psychoedu-
57. cation and stabilization-focused adaptive self-regulation skills
can result in meaningful improvements in quality of life for
even the most symptomatic and self-injurious DD patients. Al-
though it is possible that regression to the mean contributed to
these changes, these data also suggest that, although the pro-
gram was associated with benefits for all DD patients, it may be
especially beneficial to those with high levels of dissociation.
The strengths of the study included a large international sam-
ple, inclusion of all DD patients regardless of symptom
severity,
use of therapist and patient reports, and a standardized inter -
vention using a prospective, longitudinal design. The TOP DD
Network program was developed with input and feedback from
DD patients and expert DD clinicians in collaboration with
researchers (see the Supplementary Materials for additional in-
formation about the program’s content).
Several design issues constrain our interpretations. Thera-
pists may have shown a selection bias and invited patients who
were especially motivated for treatment, and the sample pop-
ulation consisted predominantly of female Caucasian patients.
Thus, these results may not generalize to all outpatients with
complex DDs. The patients received clinical diagnoses of DD
by their therapists rather than by using validated diagnostic
instruments such as the Structured Clinical Interview for Disso-
ciative Disorders–Revised (Steinberg, 1994). It is possible that
use of these measures would have led us to exclude some partic-
ipants. For example, given the relatively low DES scores in the
low DES group, some of these individuals may have other dis-
orders, such as the dissociative subtype of PTSD or borderline
personality disorder with relatively high levels of dissociation,
rather than a DD. Our study design did not permit assessment
of regression to the mean, expectancy bias, changes due to
individual therapy or medications, or other possible causes
for observed changes. We cannot definitively make causal
58. inferences without a comparison group. However, the strength
and breadth of the outcome data are consistent with benefit
of the program itself, particularly for commonly refractory
symptoms such as NSSI. Finally, other than what the program
itself provided, we did not control for therapists’ training. De-
spite the likely heterogeneity of therapists’ training, we found
a wide range of improvements, suggesting that the program
may be beneficial to DD patients regardless of their therapists’
training.
Future work should examine whether there are symptom re-
ductions and/or cost savings for patients who participate in this
program beyond those that have been found for individual DD
therapy alone. Future work could also investigate whether pa-
tients’ and therapists’ knowledge about managing safety and
symptoms increased over time, whether patients’ use of symp-
tom management skills increased over time, whether there is
a dose-effect relationship between patients’ involvement with
program materials and outcomes, and whether or how prein-
tervention therapist training contributes to patient participants’
progress. Patient and therapist feedback is informing the next
iteration of the TOP DD Network program, which will be stud-
ied as part of a randomized controlled trial.
Future studies should strive to increase representation of
groups underrepresented in the current study. In addition, some
study participants indicated they had already stabilized safety
and thus found the focus on safety unhelpful and dropped out
of the study. Future stabilization programs should screen for
early stage patients.
In view of the high costs associated with DD treatment, both
in terms of burden of disease and costs to the healthcare system,
it is exciting that this relatively inexpensive online program was
shown to be associated with significant improvements for the
59. most symptomatic DD patients. It is particularly encouraging
that these improvements were found in a sample that included
patients irrespective of safety issues, comorbid conditions, and
symptom severity, suggesting a broad applicability of this in-
tervention. Finally, the prospective, longitudinal data presented
here further underscore that DD patients can be meaningfully
helped when treated with the phasic trauma treatment model
exemplified by the ISSTD Treatment Guidelines and expert
consensus.
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