This pilot study compared the effectiveness of mindfulness and psychoeducation treatments for combat-related PTSD delivered via telehealth. 33 veterans were randomly assigned to 8 weeks of either mindfulness training based on MBSR or psychoeducation. Both treatments consisted of 2 in-person sessions followed by 6 phone sessions. Results showed that telehealth is a feasible delivery method for PTSD treatment. Veterans tolerated and were satisfied with the mindfulness intervention, which temporarily reduced PTSD symptoms, though not enough to sustain long-term effects. Participation in either treatment was associated with reduced PTSD symptoms post-treatment, with mindfulness showing somewhat greater reduction, though psychoeducation may still provide clinical benefit for PTSD when delivered via telehealth.
Running head VETERANS PTSD CAUSES, TREATMENTS, AND SUPPORT SYSTEM.docxrtodd599
Running head: VETERANS PTSD CAUSES, TREATMENTS, AND SUPPORT SYSTEMS 1
VETERANS PTSD CAUSES, TREATMENTS, AND SUPPORT SYSTEMS 3
Veterans PTSD Causes, Treatments, and Support systems
Yoan Collado
Carlos Albizu University
Veterans PTSD Causes, Treatments, and Support systems
Evaluations on Post Traumatic Stress Disorder (PTSD) among veterans is imperative for a positive health outcome. The evaluations and analysis of the results ensure that barriers to treatment are addressed and have access to the available support systems. Studies carried out have depicted the successes of the treatments and support programs in the health systems to veterans. Modifications on the systems have also been recommended to combat and control PTSD. Alternative approaches such as computerized systems, natural treatment methods, and home-based systems are also essential in providing a holistic approach in PTSD treatments. Treatment methods success ensures that veterans do not fall victim to depression, which can result in chronic diseases. This can be as a result of negative health behaviors and lifestyles. Understanding the consequences of PTSD among veterans will ensure that approaches utilized offer not only treatment methods but also offer support systems for general wellbeing.
The first source focuses on the treatment and success of three-week outpatient program by “evaluating patterns and predictors of symptom change during a three-week intensive outpatient treatment for veterans with PTSD.” The study is evidence-based on statistics drawn from the program and modifications for optimal success rates. 191 veterans were the participants in the research comprising of a daily group and individual Cognitive Processing Therapy (Zalta et al., 2018). The data was analyzed from the sample cohorts in accordance with military and demographic characteristics. Measures in the study involved treatment engagement as well as comparison of pre-treatment and post-treatment changes (Zalta et al., 2018). The results showed progress in the evaluation of predictors and patterns in treatment changes. Procedures utilized involved group sessions with daily activities for the development of the treatment program. Self-report metrics were also applied in the procedures as control groups were challenging in the study. Modified and intensive outpatient (IOP) treatment to veterans showed high success levels in the program (Zalta et al., 2018).
The second source examines a new treatment in exploring the feasibility of computerized, placebo-controlled, and home-based executive function training (EFT) on psychological and neuropsychological functions. The source titled “Computer-based executive function training for combat veterans with PTSD” shows trials in assessing feasibility and predictors output. The study shows how the functions can be useful in brain activation combating PTSD in veterans. Symptoms experienced after treatment on PTSD cases are stimulated through neural and c.
Running head VETERANS PTSD CAUSES, TREATMENTS, AND SUPPORT SYSTEM.docxjenkinsmandie
The document discusses research on PTSD causes, treatments, and support systems for veterans. It summarizes five research studies that evaluate PTSD among veterans. The studies examine predictors of symptom change during intensive outpatient treatment, the feasibility of computerized executive function training, nature-based therapy as an alternative treatment, screening and treatment of moral injury, and the relationship between PTSD, depression, and health behaviors. The document concludes that understanding PTSD symptoms and integrating both medical and conventional interventions can improve treatment effectiveness for veterans. Evaluating different treatment approaches is important to ensure consistency in care and program modifications.
Benchmarking the Effectiveness of Psychotherapy Treatment for .docxikirkton
Benchmarking the Effectiveness of Psychotherapy Treatment for Adult
Depression in a Managed Care Environment: A Preliminary Study
Takuya Minami
University of Utah
Bruce E. Wampold and Ronald C. Serlin
University of Wisconsin–Madison
Eric G. Hamilton
PacifiCare Behavioral Health
George S. (Jeb) Brown
Center for Clinical Informatics
John C. Kircher
University of Utah
This preliminary study evaluated the effectiveness of psychotherapy treatment for adult clinical depres-
sion provided in a natural setting by benchmarking the clinical outcomes in a managed care environment
against effect size estimates observed in published clinical trials. Overall results suggest that effect size
estimates of effectiveness in a managed care context were comparable to effect size estimates of efficacy
observed in clinical trials. Relative to the 1-tailed 95th-percentile critical effect size estimates, effec-
tiveness of treatment provided in this setting was observed to be between 80% (patients with comorbidity
and without antidepressants) and 112% (patients without comorbidity concurrently on antidepressants) as
compared to the benchmarks. Because the nature of the treatments delivered in the managed care
environment were unknown, it was not possible to make conclusions about treatments. However, while
replications are warranted, concerns that psychotherapy delivered in a naturalistic setting is inferior to
treatments delivered in clinical trials appear unjustified.
Keywords: benchmarking, effectiveness, managed care, clinical trials, depression
More than a decade has passed since estimating the effect of
psychotherapy as it is delivered in natural settings was identified as
a critical issue in psychotherapy research (e.g., Barlow, 1981;
Cohen, 1965; Luborsky, 1972; Seligman, 1995; Strupp, 1989;
Weisz, Donenberg, Han, & Weiss, 1995). Although the benefits of
psychotherapy have been investigated in laboratory environments
with randomized clinical trials (RCTs) and found to be substantial
as early as the late 1970s (Smith & Glass, 1977; also Smith, Glass,
& Miller, 1980), surprisingly little is known about the effects of
psychotherapy in natural settings. The dichotomy of laboratory and
natural settings was emphasized by Seligman (1995), who discrim-
inated between efficacy, which is now used to denote the effects of
psychotherapy in RCTs, and effectiveness, which is used to denote
the effects of psychotherapy in clinical practice.
The few studies that have investigated effectiveness over the
years have provided mixed results, attributed in part to a variety of
methodologies used to investigate effectiveness because of diffi-
culty in using a randomized control group design in natural set-
tings. Notably, three methods have been used to estimate the
effects of psychotherapy in natural settings: clinical representa-
tiveness, direct comparison, and benchmarking. Clinical represen-
tativeness studies, including some of the analyses conducted by
Smith et al ...
13 hours ago
Charlene Ricketts
Week 5- Discussion
COLLAPSE
Top of Form
Discussion: Posttraumatic Stress Disorder (PTSD)
Posttraumatic Stress Disorder (PTSD) is known as a mental health condition or a psychiatric disorder that occurs in people who witnessed or experienced a traumatic event in which physical harm occurred or was threatened (Bisson, Cosgrove, Lewis, & Roberts, 2015). According to Lancaster et al. (2016), PTSD creates long-lasting consequences of traumatic ordeals that creates intense fear, feeling of guilt, helplessness, persistent sadness due to sudden death of loved one, natural disaster, major accident, war or combat, physical assault, rape, terrorist attacks. According to Pai et al. (2017), DSM-5 diagnostic criteria related to PSTD includes flashbacks of the trauma, nightmares, intense distress, panicking, lack of sleep or self-disturbance, self-destructive behavior, aggressive behavior, reduce interest, avoidance or avoiding distress memories, emotionally numb and increase the use of alcohol and drugs. In the case study of Thomson Family, William Thompson is a 38 years old African American who is the younger brother of henry. William is a military person and was involved in an Iraq war veteran who recently starts living with her brother in Pasadena, California (Laureate Education, 2012a). Both his brother and wife argue that William is suffering from PTSD but William does not accept this thing and show the symptoms of avoidance when someone tries to talk to him about that. William starts living with his brother when he was unable to pay his mortgage and now working on jeopardy due to his PTSD and alcoholic concerns. The behavior of William that aligns with the DSM-5 diagnostic criteria of PTSD includes avoidance, war veteran, alcoholic concerns, concentration issues on working due to which he was unable to pay the mortgage due to joblessness, working in jeopardy due to PTSD concerns and his brother also admits that William is suffering from PTSD.
Psychotropic Medications
Selective serotonin reuptake inhibitors (SSRIs) are the only FDA-approved drugs that are used in the treatment of PTSD (Ipser & Stein, 2012). In PTSD treatment sertraline antidepressants such as Zoloft, Pfizer and Paroxetine antidepressant HCl such as Paxil are recommended in the medication process. SSRIs work by helping to create a balance between certain chemicals such as neurotransmitter serotonin levels in the brain (Feduccia, et al., 2019). This chemical balance in the brain helps in regulating mood, improving sleep disturbance, improving appetite and decreasing other symptoms. According to Alexander (2012), the first-line treatment method for PTSD includes the use of Fluoxetine (Prozac) which helps in improving the energy level, restoring daily interest, decrease fear, unwanted thought, improve concentration and reduce panic attacks.
In the case of PTSD along with first-line treatment process different therapeutic approaches are also adopted for the .
CONVENTIONAL AND UNCINVENTIONAL TREATMENT 1
Conventional and Unconventional Treatment Methods of PTSD:
Which is Better at Decreasing Symptoms of PTSD?
Your Name
San Francisco State University
CONVENTIONAL AND UNCONVENTIONAL TREATMENTS 2
Conventional and Unconventional Treatment Methods of PTSD: Which is Better at
Decreasing Symptoms of PTSD?
Post-traumatic stress disorder (PTSD) is a mental health disorder that is typically
followed after one has experienced or directly witness a traumatic event (Mayo Clinic, 2018).
Symptoms of PTSD may be present a month after the event or sometimes may even take longer
to appear, it is vital that one seeks help to treat and reduce these symptoms of PTSD as they can
and will impede on one’s day-to-day functioning (Mayo Clinic, 2018). Symptoms of PTSD
include but are not limited to, having flashbacks of the traumatic event, avoiding any stimuli
(people, places or things) that remind one of the event, feelings of hopelessness towards the self,
and detachment from the real world and being in a constant state of arousal (Mayo Clinic, 2018).
Every person is susceptible to developing symptoms of PTSD, however, many of those
who have served in the military have been diagnosed with PTSD (National Veterans Foundation,
2015; U.S. Department of Veterans Affairs, 2018). According to the U.S. Department of
Veterans Affairs (2018), about 30% of Vietnam veterans have been diagnosed with PTSD in
their lifetime. The cause of their diagnoses are a result of combat or missions that expose them to
horrific and life-threatening events (U.S. Department of Veterans Affairs, 2018).
Having symptoms of PTSD as a result of fighting wars, being in battle and/or
experiencing life in deployment can take a serious toll on the veteran. It is imperative that
veterans be given and seek out treatments for their symptoms of PTSD. However, what kinds of
treatments should veterans choose to receive? With the abundance of treatment methods to
choose from, it is important to determine which is most effective in treating symptoms of PTSD
in the future. This paper will explore specifically whether conventional treatment methods are
better than unconventional treatment methods to treat for PTSD symptoms. Treatment methods
CONVENTIONAL AND UNCONVENTIONAL TREATMENTS 3
like cognitive-behavior therapy and exposure therapy, or cognitive-exposure therapy will be
considered conventional treatment methods as these forms of treatment of PTSD have been used
for a long time by mental health practitioners. On the contrary, unconventional treatment
methods include using the internet to conduct therapy sessions, virtual reality (VR) simulations
and even creative arts to help treat PTSD symptoms.
Literature Review
Treatment Types for PTSD
Tarrier, Liversidge & Gregg (2006) list and analyzed t ...
Research Paper Assignment – Waste Management Purpose .docxverad6
Research Paper Assignment – Waste Management
Purpose: This assignment supports the following objective for the course: define waste
management and the strategies for achieving it.
Key Dates: The topic for your research paper is one that you can begin work on immediately.
While the final paper is not due until the end of the term, it is recommended from a time
management standpoint that you start early.
Key due dates are:
Detailed outline, including key conclusions, due by the end of Week 6.
Final report, containing all the elements below, due by the end of Week 8.
[Note an appendix is optional; it is not required for the paper to be complete.]
Research Topic: Should container deposit laws (bottle bills) be expanded to include
noncarbonated drinks?
Format: The paper must be submitted as a Word document using the APA format and
headings. It should be 1500 to 2500 words in length, written in 12 point font and double
spaced. For full credit it must contain each of the following elements:
Title Page.
Body of Paper - Based on your research:
o Briefly describe the history of container deposit laws.
o Describe how container deposit laws work.
o Explain why proponents believe bottle laws should be updated to include bottled
water, sports drinks, teas, and other noncarbonated beverages.
o Explain the position of those that oppose changing the law.
Conclusions (minimum 2 paragraphs): Based on the above state and defend your
position on whether states should expand their container deposit laws to include
noncarbonated beverages.
Bibliography: Include at least three sources not in the weekly reading assignments that
you used in this paper. (Wikipedia is not an acceptable source.)
Appendices (optional): Include appropriate charts, graphs, or other documents for extra
credit. (Note: Appendices do not count as part of the overall length requirement).
Psychological Services
Treatment Choice Among Veterans With PTSD Symptoms
and Substance-Related Problems: Examining the Role of
Preparatory Treatments in Trauma-Focused Therapy
Laura D. Wiedeman, Susan M. Hannan, Kelly P. Maieritsch, Cendrine Robinson, and Gregory
Bartoszek
Online First Publication, November 26, 2018. http://dx.doi.org/10.1037/ser0000313
CITATION
Wiedeman, L. D., Hannan, S. M., Maieritsch, K. P., Robinson, C., & Bartoszek, G. (2018, November
26). Treatment Choice Among Veterans With PTSD Symptoms and Substance-Related Problems:
Examining the Role of Preparatory Treatments in Trauma-Focused Therapy. Psychological
Services. Advance online publication. http://dx.doi.org/10.1037/ser0000313
Treatment Choice Among Veterans With PTSD Symptoms and Substance-
Related Problems: Examining the Role of Preparatory Treatments in
Trauma-Focused Therapy
Laura D. Wiedeman
Edward Hines Jr. Veterans Affairs Hospital, Hines, Illinois, and
Veterans Affairs Northern California Health Care System,
Martinez, Califor.
The Impact of Ethnicity on Anti-depressant TherapyThe Case .docxrtodd33
The Impact of Ethnicity on Anti-depressant Therapy
The Case: The man whose antidepressant stopped working.
Gathering information on physical assessment is essential in the management and treatment of the patient’s conditions like depression. The participation of a family is vital in the overall treatment of a person who has a mental disorder.
The three questions necessary to ask the patient with depression are: “How do you feel about being retired?” ; “Can you tell me about your family?”; and “ Are you having thoughts of harming yourself?” The first question will explore the extent of financial demand on the patient and will assess the feeling of guilt regarding financial constraints related to his chronic disease. The importance of financial challenge appeared as the primary stressor on the study on chronic disease and depression (Chan & Corvin, 2016). The second question determines how family relations affect the patient’s condition, whether he has a sound support system. The third question explores the patient's plan for himself.
The patient’s wife in the scenario is his support person. Family and social interactions appeared crucial to coping strategy even without resolution on the problem (Chan & Corvin, 2016). The following questions are necessary to determine how supportive is the patient’s wife: “Do you keep track of your husband’s medication regimen?” ; “ What are the things that you and your husband like to do?”; and “How do you feel about your husband’s illness?”
The first question determines the wife’s involvement in patient care and whether the patient is compliant with his schedules of medication. The second question explore the things that both patient and wife enjoy. The third question assesses how the patient’s wife handles his husband’s illness. The wife can be a husband’s caregiver, and such a job involves managing the patient’s treatment, side effects, and symptoms, which providing such care can be emotionally difficult (Nik Jaafar et al., 2014). Greater caregiver burden is associated with older adults with long-standing depressive manifestations (Marshe et al., 2017).
Physical Examination and Diagnostic Tests
Physical assessment on the patient’s head, thyroid, and nervous system is an appropriate action to rule out other causes of depression. Current studies affirmed a significant correlation between thyroid hormone imbalance in patients with MDD (Shen et al., 2019). The result of a physical examination will enable the provider to treat any condition that might have contributed to the patient’s depression. The patient may also benefit from HAM-D6 or melancholia sub-scale. The HAM-D6 is a focused version of the Hamilton Depression Rating Scale (HAM-D), an outcome measure in MDD (Dunlop et al., 2019). The test result helps identify the effect of an antidepressant (Dunlop et al., 2019). The result is beneficial and helpful in medication decision management.
Three Differential Diagnosis
The three differential diagn.
Running head VETERANS PTSD CAUSES, TREATMENTS, AND SUPPORT SYSTEM.docxrtodd599
Running head: VETERANS PTSD CAUSES, TREATMENTS, AND SUPPORT SYSTEMS 1
VETERANS PTSD CAUSES, TREATMENTS, AND SUPPORT SYSTEMS 3
Veterans PTSD Causes, Treatments, and Support systems
Yoan Collado
Carlos Albizu University
Veterans PTSD Causes, Treatments, and Support systems
Evaluations on Post Traumatic Stress Disorder (PTSD) among veterans is imperative for a positive health outcome. The evaluations and analysis of the results ensure that barriers to treatment are addressed and have access to the available support systems. Studies carried out have depicted the successes of the treatments and support programs in the health systems to veterans. Modifications on the systems have also been recommended to combat and control PTSD. Alternative approaches such as computerized systems, natural treatment methods, and home-based systems are also essential in providing a holistic approach in PTSD treatments. Treatment methods success ensures that veterans do not fall victim to depression, which can result in chronic diseases. This can be as a result of negative health behaviors and lifestyles. Understanding the consequences of PTSD among veterans will ensure that approaches utilized offer not only treatment methods but also offer support systems for general wellbeing.
The first source focuses on the treatment and success of three-week outpatient program by “evaluating patterns and predictors of symptom change during a three-week intensive outpatient treatment for veterans with PTSD.” The study is evidence-based on statistics drawn from the program and modifications for optimal success rates. 191 veterans were the participants in the research comprising of a daily group and individual Cognitive Processing Therapy (Zalta et al., 2018). The data was analyzed from the sample cohorts in accordance with military and demographic characteristics. Measures in the study involved treatment engagement as well as comparison of pre-treatment and post-treatment changes (Zalta et al., 2018). The results showed progress in the evaluation of predictors and patterns in treatment changes. Procedures utilized involved group sessions with daily activities for the development of the treatment program. Self-report metrics were also applied in the procedures as control groups were challenging in the study. Modified and intensive outpatient (IOP) treatment to veterans showed high success levels in the program (Zalta et al., 2018).
The second source examines a new treatment in exploring the feasibility of computerized, placebo-controlled, and home-based executive function training (EFT) on psychological and neuropsychological functions. The source titled “Computer-based executive function training for combat veterans with PTSD” shows trials in assessing feasibility and predictors output. The study shows how the functions can be useful in brain activation combating PTSD in veterans. Symptoms experienced after treatment on PTSD cases are stimulated through neural and c.
Running head VETERANS PTSD CAUSES, TREATMENTS, AND SUPPORT SYSTEM.docxjenkinsmandie
The document discusses research on PTSD causes, treatments, and support systems for veterans. It summarizes five research studies that evaluate PTSD among veterans. The studies examine predictors of symptom change during intensive outpatient treatment, the feasibility of computerized executive function training, nature-based therapy as an alternative treatment, screening and treatment of moral injury, and the relationship between PTSD, depression, and health behaviors. The document concludes that understanding PTSD symptoms and integrating both medical and conventional interventions can improve treatment effectiveness for veterans. Evaluating different treatment approaches is important to ensure consistency in care and program modifications.
Benchmarking the Effectiveness of Psychotherapy Treatment for .docxikirkton
Benchmarking the Effectiveness of Psychotherapy Treatment for Adult
Depression in a Managed Care Environment: A Preliminary Study
Takuya Minami
University of Utah
Bruce E. Wampold and Ronald C. Serlin
University of Wisconsin–Madison
Eric G. Hamilton
PacifiCare Behavioral Health
George S. (Jeb) Brown
Center for Clinical Informatics
John C. Kircher
University of Utah
This preliminary study evaluated the effectiveness of psychotherapy treatment for adult clinical depres-
sion provided in a natural setting by benchmarking the clinical outcomes in a managed care environment
against effect size estimates observed in published clinical trials. Overall results suggest that effect size
estimates of effectiveness in a managed care context were comparable to effect size estimates of efficacy
observed in clinical trials. Relative to the 1-tailed 95th-percentile critical effect size estimates, effec-
tiveness of treatment provided in this setting was observed to be between 80% (patients with comorbidity
and without antidepressants) and 112% (patients without comorbidity concurrently on antidepressants) as
compared to the benchmarks. Because the nature of the treatments delivered in the managed care
environment were unknown, it was not possible to make conclusions about treatments. However, while
replications are warranted, concerns that psychotherapy delivered in a naturalistic setting is inferior to
treatments delivered in clinical trials appear unjustified.
Keywords: benchmarking, effectiveness, managed care, clinical trials, depression
More than a decade has passed since estimating the effect of
psychotherapy as it is delivered in natural settings was identified as
a critical issue in psychotherapy research (e.g., Barlow, 1981;
Cohen, 1965; Luborsky, 1972; Seligman, 1995; Strupp, 1989;
Weisz, Donenberg, Han, & Weiss, 1995). Although the benefits of
psychotherapy have been investigated in laboratory environments
with randomized clinical trials (RCTs) and found to be substantial
as early as the late 1970s (Smith & Glass, 1977; also Smith, Glass,
& Miller, 1980), surprisingly little is known about the effects of
psychotherapy in natural settings. The dichotomy of laboratory and
natural settings was emphasized by Seligman (1995), who discrim-
inated between efficacy, which is now used to denote the effects of
psychotherapy in RCTs, and effectiveness, which is used to denote
the effects of psychotherapy in clinical practice.
The few studies that have investigated effectiveness over the
years have provided mixed results, attributed in part to a variety of
methodologies used to investigate effectiveness because of diffi-
culty in using a randomized control group design in natural set-
tings. Notably, three methods have been used to estimate the
effects of psychotherapy in natural settings: clinical representa-
tiveness, direct comparison, and benchmarking. Clinical represen-
tativeness studies, including some of the analyses conducted by
Smith et al ...
13 hours ago
Charlene Ricketts
Week 5- Discussion
COLLAPSE
Top of Form
Discussion: Posttraumatic Stress Disorder (PTSD)
Posttraumatic Stress Disorder (PTSD) is known as a mental health condition or a psychiatric disorder that occurs in people who witnessed or experienced a traumatic event in which physical harm occurred or was threatened (Bisson, Cosgrove, Lewis, & Roberts, 2015). According to Lancaster et al. (2016), PTSD creates long-lasting consequences of traumatic ordeals that creates intense fear, feeling of guilt, helplessness, persistent sadness due to sudden death of loved one, natural disaster, major accident, war or combat, physical assault, rape, terrorist attacks. According to Pai et al. (2017), DSM-5 diagnostic criteria related to PSTD includes flashbacks of the trauma, nightmares, intense distress, panicking, lack of sleep or self-disturbance, self-destructive behavior, aggressive behavior, reduce interest, avoidance or avoiding distress memories, emotionally numb and increase the use of alcohol and drugs. In the case study of Thomson Family, William Thompson is a 38 years old African American who is the younger brother of henry. William is a military person and was involved in an Iraq war veteran who recently starts living with her brother in Pasadena, California (Laureate Education, 2012a). Both his brother and wife argue that William is suffering from PTSD but William does not accept this thing and show the symptoms of avoidance when someone tries to talk to him about that. William starts living with his brother when he was unable to pay his mortgage and now working on jeopardy due to his PTSD and alcoholic concerns. The behavior of William that aligns with the DSM-5 diagnostic criteria of PTSD includes avoidance, war veteran, alcoholic concerns, concentration issues on working due to which he was unable to pay the mortgage due to joblessness, working in jeopardy due to PTSD concerns and his brother also admits that William is suffering from PTSD.
Psychotropic Medications
Selective serotonin reuptake inhibitors (SSRIs) are the only FDA-approved drugs that are used in the treatment of PTSD (Ipser & Stein, 2012). In PTSD treatment sertraline antidepressants such as Zoloft, Pfizer and Paroxetine antidepressant HCl such as Paxil are recommended in the medication process. SSRIs work by helping to create a balance between certain chemicals such as neurotransmitter serotonin levels in the brain (Feduccia, et al., 2019). This chemical balance in the brain helps in regulating mood, improving sleep disturbance, improving appetite and decreasing other symptoms. According to Alexander (2012), the first-line treatment method for PTSD includes the use of Fluoxetine (Prozac) which helps in improving the energy level, restoring daily interest, decrease fear, unwanted thought, improve concentration and reduce panic attacks.
In the case of PTSD along with first-line treatment process different therapeutic approaches are also adopted for the .
CONVENTIONAL AND UNCINVENTIONAL TREATMENT 1
Conventional and Unconventional Treatment Methods of PTSD:
Which is Better at Decreasing Symptoms of PTSD?
Your Name
San Francisco State University
CONVENTIONAL AND UNCONVENTIONAL TREATMENTS 2
Conventional and Unconventional Treatment Methods of PTSD: Which is Better at
Decreasing Symptoms of PTSD?
Post-traumatic stress disorder (PTSD) is a mental health disorder that is typically
followed after one has experienced or directly witness a traumatic event (Mayo Clinic, 2018).
Symptoms of PTSD may be present a month after the event or sometimes may even take longer
to appear, it is vital that one seeks help to treat and reduce these symptoms of PTSD as they can
and will impede on one’s day-to-day functioning (Mayo Clinic, 2018). Symptoms of PTSD
include but are not limited to, having flashbacks of the traumatic event, avoiding any stimuli
(people, places or things) that remind one of the event, feelings of hopelessness towards the self,
and detachment from the real world and being in a constant state of arousal (Mayo Clinic, 2018).
Every person is susceptible to developing symptoms of PTSD, however, many of those
who have served in the military have been diagnosed with PTSD (National Veterans Foundation,
2015; U.S. Department of Veterans Affairs, 2018). According to the U.S. Department of
Veterans Affairs (2018), about 30% of Vietnam veterans have been diagnosed with PTSD in
their lifetime. The cause of their diagnoses are a result of combat or missions that expose them to
horrific and life-threatening events (U.S. Department of Veterans Affairs, 2018).
Having symptoms of PTSD as a result of fighting wars, being in battle and/or
experiencing life in deployment can take a serious toll on the veteran. It is imperative that
veterans be given and seek out treatments for their symptoms of PTSD. However, what kinds of
treatments should veterans choose to receive? With the abundance of treatment methods to
choose from, it is important to determine which is most effective in treating symptoms of PTSD
in the future. This paper will explore specifically whether conventional treatment methods are
better than unconventional treatment methods to treat for PTSD symptoms. Treatment methods
CONVENTIONAL AND UNCONVENTIONAL TREATMENTS 3
like cognitive-behavior therapy and exposure therapy, or cognitive-exposure therapy will be
considered conventional treatment methods as these forms of treatment of PTSD have been used
for a long time by mental health practitioners. On the contrary, unconventional treatment
methods include using the internet to conduct therapy sessions, virtual reality (VR) simulations
and even creative arts to help treat PTSD symptoms.
Literature Review
Treatment Types for PTSD
Tarrier, Liversidge & Gregg (2006) list and analyzed t ...
Research Paper Assignment – Waste Management Purpose .docxverad6
Research Paper Assignment – Waste Management
Purpose: This assignment supports the following objective for the course: define waste
management and the strategies for achieving it.
Key Dates: The topic for your research paper is one that you can begin work on immediately.
While the final paper is not due until the end of the term, it is recommended from a time
management standpoint that you start early.
Key due dates are:
Detailed outline, including key conclusions, due by the end of Week 6.
Final report, containing all the elements below, due by the end of Week 8.
[Note an appendix is optional; it is not required for the paper to be complete.]
Research Topic: Should container deposit laws (bottle bills) be expanded to include
noncarbonated drinks?
Format: The paper must be submitted as a Word document using the APA format and
headings. It should be 1500 to 2500 words in length, written in 12 point font and double
spaced. For full credit it must contain each of the following elements:
Title Page.
Body of Paper - Based on your research:
o Briefly describe the history of container deposit laws.
o Describe how container deposit laws work.
o Explain why proponents believe bottle laws should be updated to include bottled
water, sports drinks, teas, and other noncarbonated beverages.
o Explain the position of those that oppose changing the law.
Conclusions (minimum 2 paragraphs): Based on the above state and defend your
position on whether states should expand their container deposit laws to include
noncarbonated beverages.
Bibliography: Include at least three sources not in the weekly reading assignments that
you used in this paper. (Wikipedia is not an acceptable source.)
Appendices (optional): Include appropriate charts, graphs, or other documents for extra
credit. (Note: Appendices do not count as part of the overall length requirement).
Psychological Services
Treatment Choice Among Veterans With PTSD Symptoms
and Substance-Related Problems: Examining the Role of
Preparatory Treatments in Trauma-Focused Therapy
Laura D. Wiedeman, Susan M. Hannan, Kelly P. Maieritsch, Cendrine Robinson, and Gregory
Bartoszek
Online First Publication, November 26, 2018. http://dx.doi.org/10.1037/ser0000313
CITATION
Wiedeman, L. D., Hannan, S. M., Maieritsch, K. P., Robinson, C., & Bartoszek, G. (2018, November
26). Treatment Choice Among Veterans With PTSD Symptoms and Substance-Related Problems:
Examining the Role of Preparatory Treatments in Trauma-Focused Therapy. Psychological
Services. Advance online publication. http://dx.doi.org/10.1037/ser0000313
Treatment Choice Among Veterans With PTSD Symptoms and Substance-
Related Problems: Examining the Role of Preparatory Treatments in
Trauma-Focused Therapy
Laura D. Wiedeman
Edward Hines Jr. Veterans Affairs Hospital, Hines, Illinois, and
Veterans Affairs Northern California Health Care System,
Martinez, Califor.
The Impact of Ethnicity on Anti-depressant TherapyThe Case .docxrtodd33
The Impact of Ethnicity on Anti-depressant Therapy
The Case: The man whose antidepressant stopped working.
Gathering information on physical assessment is essential in the management and treatment of the patient’s conditions like depression. The participation of a family is vital in the overall treatment of a person who has a mental disorder.
The three questions necessary to ask the patient with depression are: “How do you feel about being retired?” ; “Can you tell me about your family?”; and “ Are you having thoughts of harming yourself?” The first question will explore the extent of financial demand on the patient and will assess the feeling of guilt regarding financial constraints related to his chronic disease. The importance of financial challenge appeared as the primary stressor on the study on chronic disease and depression (Chan & Corvin, 2016). The second question determines how family relations affect the patient’s condition, whether he has a sound support system. The third question explores the patient's plan for himself.
The patient’s wife in the scenario is his support person. Family and social interactions appeared crucial to coping strategy even without resolution on the problem (Chan & Corvin, 2016). The following questions are necessary to determine how supportive is the patient’s wife: “Do you keep track of your husband’s medication regimen?” ; “ What are the things that you and your husband like to do?”; and “How do you feel about your husband’s illness?”
The first question determines the wife’s involvement in patient care and whether the patient is compliant with his schedules of medication. The second question explore the things that both patient and wife enjoy. The third question assesses how the patient’s wife handles his husband’s illness. The wife can be a husband’s caregiver, and such a job involves managing the patient’s treatment, side effects, and symptoms, which providing such care can be emotionally difficult (Nik Jaafar et al., 2014). Greater caregiver burden is associated with older adults with long-standing depressive manifestations (Marshe et al., 2017).
Physical Examination and Diagnostic Tests
Physical assessment on the patient’s head, thyroid, and nervous system is an appropriate action to rule out other causes of depression. Current studies affirmed a significant correlation between thyroid hormone imbalance in patients with MDD (Shen et al., 2019). The result of a physical examination will enable the provider to treat any condition that might have contributed to the patient’s depression. The patient may also benefit from HAM-D6 or melancholia sub-scale. The HAM-D6 is a focused version of the Hamilton Depression Rating Scale (HAM-D), an outcome measure in MDD (Dunlop et al., 2019). The test result helps identify the effect of an antidepressant (Dunlop et al., 2019). The result is beneficial and helpful in medication decision management.
Three Differential Diagnosis
The three differential diagn.
I need a response to this assignment2 references zero plagia.docxsamirapdcosden
I need a response to this assignment
2 references
zero plagiarism
Does psychotherapy have a biological basis?
In a word, yes. Psychotherapy has a solid basis in biological processes. Changes in thought processes can be linked to changes in the structure or function of neural activity (Stahl, 2013). Numerous imaging and functional scanning studies demonstrate that psychotherapy changes how the brain functions, and these changes can be demonstrated on a biological level. A few of these studies are highlighted here to illustrate the point.
A systematic review by Zantvoord, Diehle, & Lindauer (2013) identified 16 studies that examined brain imaging with PTSD patients receiving trauma-processing therapies including TF-CBT and EMDR. The studies reviewed showed various biological factors at play including increased activity in the mid-prefrontal cortex and decreased activity in the amygdala following TF-CBT (Zantvoord, Diehle, & Lindauer, 2013). Furthermore, Lindauer et al. (2008) showed that following TF-CBT, the neural circuitry of working memory in the dorsolateral prefrontal cortex showed decreased activity. Disturbances in this brain region appears to play a part in the development and maintenance of PTSD (Lindauer et al, 2008).
Too many studies demonstrate the biological basis of therapy to give a solid accounting of this evidence. Thome et al (2016) compared the use of psychotherapy versus pharmacology to help reduce anxiety in reconsolidation phases of traumatic memories. The reality that both therapy and pharmacologic agents can produce similar results demonstrates that therapy has a biological component. Even (traditionally) less structured forms of therapy such as psychodynamic therapy has been shown through brain imaging to change the structure and function of neural pathways (Abbass, Nowoweiski, Bernier, Tarzwell, & Beutel, 2014).
The summation of evidence that psychotherapy can alter the chemistry, structure, and function of the brain makes it clear that psychotherapeutic interventions are an important aspect of effective treatment for mental disorders.
Explain how culture, religion, and socioeconomics might influence one’s perspective of the value of psychotherapy treatments.
Culture, religion, and socioeconomic status are active influences in people’s lives, so these factors will inherently have influence on the choices people are willing to consider. Some cultures may believe more in therapy than in pharmacology, as may certain religious groups. Some religious groups may shun all forms of mental health intervention believing that these illnesses reflect a lack of faith or misunderstanding of how to bring life into balance.
All three of these specific factors have systemic impacts that can influence a patient’s willingness to engage in psychotherapy, and this can limit the potential gains from therapy if the patient is hesitant to participate (.
The document discusses challenges faced by US veterans, including physical disabilities and mental health issues like post-traumatic stress disorder (PTSD). It reviews research on effective PTSD therapies like mindfulness-based stress reduction, exposure therapy, and an integrated approach combining behavioral activation and exposure techniques. However, it notes high unemployment among veterans and few programs addressing both therapy and vocational needs. The proposed program integrates group therapy based on the Veterans Transition Program model with a vocational component to help veterans transition to civilian life by addressing PTSD symptoms and employment. It outlines program details, limitations, and potential funding sources.
Somatic Experiencing: Reduction of Depression and Anxiety in Homeless Adults ...Michael Changaris
This is a brief 7 page version of dissertation presented for completion of doctorate. The study found some implications for reduction of symptoms of depression and anxiety in homeless adults. Limitations are number of sessions attended (1.33 average), population heterogeneity and small sample size.
Psychosocial interventions for fatigue during cancer treatment with palliativ...Maja Miljanović
Psychosocial interventions aim to reduce fatigue in cancer patients receiving palliative treatment through changing cognitions, emotions, behaviors, and social interactions. Such interventions include cognitive behavioral therapy, coping skills training, mindfulness, and psychoeducation. They teach patients to change thoughts, actions, or feelings related to symptoms. While psychosocial interventions show promise for managing cancer-related fatigue, it remains unclear if they are effective for patients receiving palliative cancer treatment specifically. This review will evaluate evidence from randomized controlled trials on the effectiveness of psychosocial interventions for reducing fatigue in patients with incurable cancer receiving palliative cancer treatment.
A Naturalistic Study Of Dissociative Identity Disorder And Dissociative Disor...Sara Alvarez
This study aimed to describe community treatment of dissociative disorders and determine if it is as effective as treatment for related conditions like PTSD. Analyses found that patients later in treatment engaged in less self-harm, had fewer hospitalizations, and higher functioning than early patients. Later patients also reported lower dissociation, PTSD, and distress symptoms than early patients. The effectiveness was comparable to treatments for chronic PTSD and depression with borderline personality disorder. This suggests extended dissociative disorder treatment may be beneficial.
717JRRDJRRD Volume 49, Number 5, 2012Pages 717–728Coup.docxsleeperharwell
717
JRRDJRRD Volume 49, Number 5, 2012Pages 717–728
Couple/family therapy for posttraumatic stress disorder: Review to
facilitate interpretation of VA/DOD Clinical Practice Guideline
Candice M. Monson, PhD;1–2* Alexandra Macdonald, PhD;3 Amy Brown-Bowers1
1Ryerson University, Toronto, Ontario, Canada; 2Department of Veterans Affairs (VA) National Center for PTSD,
Women’s Health Sciences Division, Boston, MA; 3VA National Center for PTSD, Behavioral Science Division, and
Boston University School of Medicine, Boston, MA
Abstract—A well-documented association exists among Vet-
erans’ posttraumatic stress disorder (PTSD) symptoms, family
relationship problems, and mental health problems in partners
and children of Veterans. This article reviews the recommenda-
tions regarding couple/family therapy offered in the newest
version of the Department of Veterans Affairs (VA)/Depart-
ment of Defense (DOD) VA/DOD Clinical Practice Guideline
for Management of Post-Traumatic Stress. We then provide a
heuristic for clinicians, researchers, and policy makers to con-
sider when incorporating couple/family interventions into Vet-
erans’ mental health services. The range of research that has
been conducted on couple/family therapy for Veterans with
PTSD is reviewed using this heuristic, and suggestions for
clinical practice are offered.
Key words: caregiver burden, clinical practice guidelines,
cognitive-behavioral therapy, couple/family therapy, emotion-
ally focused couple therapy, mental health, PTSD, rehabilita-
tion, strategic approach therapy, Veterans.
INTRODUCTION
To their credit and our benefit, Veterans and their fami-
lies have been the predominant contributors to our knowl-
edge about the role of posttraumatic stress disorder (PTSD)
symptoms in family functioning and vice versa. This
research documents a clear and convincing association
between PTSD symptoms and a range of family problems
(see Monson et al. [1] for review). In addition, Veterans’
PTSD symptoms have been associated with a myriad of
individual mental health problems in spouses and children
(see Renshaw et al. [2] for review). Yet, research on couple/
family therapies for Veterans with PTSD has lagged behind
individual psychotherapy treatment outcome efforts. This is
in spite of research showing that Veterans desire greater
family involvement in their treatment (e.g., Batten et al. [3])
and the presence of significant mental health problems in
Veterans’ loved ones who may individually profit from
family therapy. In addition, treatments for PTSD do not
necessarily improve couple and family functioning (e.g.,
Abbreviations: BCT = behavioral couple therapy, BFT =
behavioral family therapy, CBCT = cognitive-behavioral con-
joint therapy, CPG = Clinical Practice Guideline, CSO = con-
cerned significant other, DOD = Department of Defense, DTE =
directed therapeutic exposure, EFCT for Trauma = emotionally
focused couple therapy for trauma, LMC = lifestyl.
The document discusses the history and current state of evidence-based practices in children's mental health. It notes that while research has identified hundreds of evidence-based therapies and interventions, many children still have unmet mental health needs. It summarizes the levels of evidence for different psychosocial and pharmacological treatments, as well as home- and community-based services. However, it states that significant challenges remain in implementing evidence-based practices into real-world mental health systems and services.
PSYCHIATRIC SERVICES ps.psychiatryonline.org September 201.docxpotmanandrea
PSYCHIATRIC SERVICES � ps.psychiatryonline.org � September 2012 Vol. 63 No. 9 885555
Soldiers returning from combatoften face a postdeployment pe-riod in which there is an in-
creased risk of readjustment stres-
sors, such as problems with family,
marriage, or employment. This peri-
od can also be marked by the onset of
posttraumatic stress disorder (PTSD).
Coping with the additional burden of
PTSD likely complicates soldiers’
ability to cope during the readjust-
ment period. Accordingly, research
has documented a relationship be-
tween PTSD and greater readjust-
ment stress among soldiers serving in
recent conflicts (1) or in previous
ones (2,3).
Many soldiers with a mental health
need do not seek care within the first
year of their readjustment period. An
estimated 23%–44% of returning sol-
diers with PTSD or other mental
health problems receive treatment
within the first year (4,5). Linking re-
turning soldiers who have PTSD with
treatment is a national priority be-
cause effective treatments for PTSD
are available (6,7) and PTSD suffer-
ers who seek treatment experience
symptom relief more quickly than
those who do not (8). Therefore, re-
search is needed to better understand
the process by which returning sol-
diers with PTSD seek treatment.
Readjustment stressors may be a
key motivator for treatment seeking.
Veterans returning from Operation
Enduring Freedom or Operation Iraqi
Freedom (OIF) often seek help for fi-
nancial, occupational, and other read-
justment concerns. A qualitative
study suggested that returning sol-
diers are most likely to seek mental
health treatment when problems
emerge within family and occupa-
tional roles (9). Accordingly, one
study showed that combat veterans
seeking care from the U.S. Depart-
ment of Veterans Affairs (VA) ex-
pressed most interest for services re-
lated to veterans’ benefits (83%) and
schooling, employment, or job train-
ing (80%) (1). Also, at least one study
Readjustment Stressors and Early Mental
Health Treatment Seeking by Returning
National Guard Soldiers With PTSD
AAlleejjaannddrroo IInntteerriiaann,, PPhh..DD..
AAnnnnaa KKlliinnee,, PPhh..DD..
LLaannoorraa CCaallllaahhaann,, MM..SS..
MMiikkllooss LLoossoonncczzyy,, MM..DD..,, PPhh..DD..
Dr. Interian, Dr. Kline, and Dr. Losonczy are affiliated with the Department of Psychia-
try, UMDNJ–Robert Wood Johnson Medical School, 671 Hoes Lane, D306, Piscataway,
NJ 08854-5635 (e-mail: [email protected]). They are also with the Veterans Af-
fairs New Jersey Healthcare System, Mental Health and Behavioral Sciences, Lyons, New
Jersey. Ms. Callahan is with the Bloustein Center for Survey Research, Rutgers Univer-
sity, Piscataway.
Objectives: Readjustment stressors are commonly encountered by vet-
erans returning from combat operations and may help motivate treat-
ment seeking for posttraumatic stress disorder (PTSD). The study ex-
amined rates of readjustment stressors (marital, family, and employ-
ment) and their relationshi ...
Respond to at least two colleagues by explaining how they could use .docxcarlstromcurtis
Respond to at least two colleagues by explaining how they could use strategies to advocate for a client with a somatic symptom disorder given the reasons for advocacy they described.
Colleague 1: Brooke
Somatic symptom disorders are mental disorders that manifest with physical symptoms that are not always clear to explain with medical diagnosis (APA, 2013). One specific example of such a disorder is the Illness Anxiety Disorder (F45.21). This disorder is diagnosed when there is a pervasive and impacting preoccupation with having a serious medical condition in circumstances when no predisposition or existing symptomatology indicate there should be medical concern (APA, 2013). The diagnosed individual will exhibit heightened anxiety regarding their perceived condition. Furthermore, the diagnosis is classified as either “care-seeking type,” whereby the individual frequently seeks out medical guidance from professionals or “care-avoidant type: whereby the individual avoids medical care despite their ongoing concerns (APA, 2013).
This can present a unique challenge for guiding professionals, as the client is potentially in need of both medical and mental health care. Therefore, a biopsychosocial assessment is recommended to gain the most thorough, comprehensive picture of the client and their current set of circumstances. This multi aspect evaluation serves to understand the biological, or physical, contributors to the individual’s somatic diagnosis, while also delving into their perceptions and beliefs (psychological) and their social environment and experiences. When this information is gathered from these varied perspectives, intervention can be designed to target specific areas of need, with the understanding that medical care may be required, concurrently, with mental health support (Dimsdale, Patel, Xin and Kleinman, 2007).
Because of the complexity of such diagnoses, a multidisciplinary approach is deemed most effective when working with such clients. Because of the psychological involvement in this disorder, psychotherapy aimed at modifying existing thought patterns would be considered sound practice (Kirmayer and Sartorius, 2007). To expand, cognitive behavioral therapy (CBT) can be applied, increasing the client's awareness of their current thought patterns, possible triggers and strategies to combat negative thinking. Additionally, the prescription of medication to address the co-occurring anxiety or other resulting physical symptoms would be provided by a medical professional, such as a psychiatrist. This approach, widely accepted, allows for the client’s case to be viewed through different lenses.
While there is certainly significant validity in approaching such cases through a multidisciplinary team, the professionals required to ensure this effective intervention all have to be “on board.” This may require advocacy on the part of a social worker to convey the importance of employing this approach. It can b ...
The document summarizes a study that assessed the validity of using the PHQ-2 and PHQ-9 questionnaires to screen for and diagnose depression in a rural area of Chiapas, Mexico. The study found that:
1) Confirmatory factor analysis suggested the 1-factor structure of the PHQ-9 fit the data reasonably well.
2) The PHQ-9 showed good internal consistency and validity, with participants diagnosed with depression having lower quality of life scores.
3) Using the PHQ-9 as the standard, the optimal cutoff for the PHQ-2 to screen for depression was a score of 3, with a sensitivity of 80% and specificity of 86.8%.
This document reviews different treatments for bipolar disorder, including medications and psychotherapy. It finds that lithium is the first-line pharmacological treatment for managing mania, while medications like carbamazepine and valproate are also effective. Family-focused therapy and psychoeducation are beneficial as they help patients and families manage the disorder. Cognitive behavioral therapy teaches skills to detect mood changes and prevent relapses. The best treatment combination includes lithium medication alongside family-focused therapy and psychoeducation.
This document provides a literature review on the effectiveness of Mindfulness-Based Cognitive Therapy (MBCT) for patients with Bipolar Disorder (BD). It summarizes that while MBCT was not originally intended for BD patients, studies have found it can help reduce comorbid anxiety and depression for BD patients. Specifically, MBCT teaches skills to increase self-awareness of mood changes and manage distressing thoughts and emotions. However, the evidence is mixed, and more research is still needed comparing MBCT's effectiveness for different types of BD. Overall, MBCT shows promise as a supplemental treatment but its benefits for BD have not been conclusively determined.
Running head PSYCHOLOGY1PSYCHOLOGY5Empirical res.docxSUBHI7
Running head: PSYCHOLOGY
1
PSYCHOLOGY
5
Empirical research on the prevalence of PTSD on servicemen and veterans from combat
Developments in combat zone medicine infer more aggrieved servicemen and veterans are surviving their injuries; though, numerous injuries are not as noticeable such as missing appendages and other bodily wounds, explicitly distressing cognitive damages and post-traumatic stress writhed by both soldiers and citizens in the way of relatives and friends. The frequency of these injuries can be, and still are, not clear-cut. Moreover, the categorizations of these injuries have transformed over the course of time, touching on the way in which the sum of the aggrieved is tallied over and above the interventions presented (Angkaw et.al, 2015). An editorial in The Economist on March 2013 centered on the upsurge in the figure of war veterans pursuing medical assistance as a result of post-traumatic stress symptoms. The rise was realized amongst the newly repatriated officers, albeit similarly among elderly veterans of prior wars, and had resulted to a surge in America`s disabled former soldiers count by nearly 45% from the year 2000. A lot of empirical research reinforces the assertion made in the Economist piece, and investigation correspondingly demonstrates the long-term overheads will be a reality for many nations involved in the cross-border wars (Beckham et.al, 2014). Internationally, a rise in number of war veterans looking for assistance for psychological signs that are every so often well-matched with PTSD disorder explicate that the number of troupers affected with PTSD in the year 2013 will grow to over 300,000 persons in the United States. A similar predisposition is noticed in other nation state, and a recent research from Europe (particularly United Kingdom) pronounces late onset indications among servicemen. Our test hypothesis will appraise the prevalence and frequency of PTSD in servicemen and veteran from the warzone. From the prevalence then apt interventions can be devised to help assist all those who served and are affected with disorder.
How is PTSD perceived in a health perspective?
PTSD is a mental disorder, which is described and defined in the ensuing two classifications; the International Classification of Diseases (ICD-10) established by the World Health Organization (WHO), together with the Diagnostic and Statistical Manual of Mental Disorders (DMMD) instigated by the American Psychiatric Association (DSM-5). The analytical measures in the two classifications are articulated somewhat differently, but overall they are seen as alike. The analytical criteria consist of the following: experiencing a traumatic situation or event, short or long lasting, in which the person is exposed to fears of loss of life, grim harm or sexual abuse. The exposure is a due to circumstances with unswervingly involves the distressing event or observes the traumatic happening personally (Angkaw et.al, 2015). The social-b ...
Over 35% of veterans receiving VA care have been diagnosed with a mental health condition such as PTSD, depression, or substance abuse disorder. Veterans are at high risk for these issues due to the difficulties of adjusting to civilian life after deployment. The proposed community program would provide an integrated treatment approach including individual, group, and family therapy using trauma-informed models like Seeking Safety that address PTSD and substance abuse together. Case management services would also be provided to help veterans with life tasks like employment, housing, and medication management to support recovery.
Culture, religion, and socioeconomic status can influence one's perspective on the value of psychotherapy in several ways. Some cultures or religious groups may favor therapy over medication or reject mental health treatment altogether. Socioeconomic factors are also closely tied to health literacy and willingness to engage in therapy. For treatment to be effective, therapists must account for how these systemic influences shape a client's lived experience and willingness to participate in the therapeutic process.
Working with veterans suffering from mental health problemsWellcome Collection
The document discusses working with veterans suffering from mental health problems. It notes that mental health issues in veterans can arise from pre-service vulnerabilities, military life, and adjusting to civilian life. Common mental health problems in veterans include depression, anxiety, PTSD, alcohol and drug issues, and personality problems. Combat Stress is the largest mental health charity in the UK for veterans, providing clinical outreach services and bespoke inpatient programs to address veterans' complex biopsychosocial needs. Treatment involves assessment, stabilization, trauma-focused therapies, and rehabilitation. Major challenges include complex trauma, co-occurring substance use, forensic cases, and the needs of aging and in-service family populations.
This randomized clinical trial compared the effectiveness of mindfulness-based stress reduction (MBSR), cognitive behavioral therapy (CBT), and usual care for treating chronic low back pain. 342 adults with chronic low back pain were randomly assigned to receive MBSR, CBT, or usual care. At 26 weeks, participants receiving MBSR or CBT reported significantly greater improvement in back pain and functional limitations compared to usual care. There were no significant differences in outcomes between MBSR and CBT. These findings suggest that MBSR may be an effective treatment option for chronic low back pain.
Horticultural Therapy as a Complementary Treatment for Post Traumatic Stress Disorder
`
For more information, Please see websites below:
`
Organic Edible Schoolyards & Gardening with Children =
http://scribd.com/doc/239851214 ~
`
Double Food Production from your School Garden with Organic Tech =
http://scribd.com/doc/239851079 ~
`
Free School Gardening Art Posters =
http://scribd.com/doc/239851159 ~
`
Increase Food Production with Companion Planting in your School Garden =
http://scribd.com/doc/239851159 ~
`
Healthy Foods Dramatically Improves Student Academic Success =
http://scribd.com/doc/239851348 ~
`
City Chickens for your Organic School Garden =
http://scribd.com/doc/239850440 ~
`
Simple Square Foot Gardening for Schools - Teacher Guide =
http://scribd.com/doc/239851110 ~
Investigation of Horticultural Therapy as a Complementary Treatment for Post Traumatic Stress Disorder
`
For more information, Please see websites below:
`
Organic Edible Schoolyards & Gardening with Children
http://scribd.com/doc/239851214
`
Double Food Production from your School Garden with Organic Tech
http://scribd.com/doc/239851079
`
Free School Gardening Art Posters
http://scribd.com/doc/239851159`
`
Increase Food Production with Companion Planting in your School Garden
http://scribd.com/doc/239851159
`
Healthy Foods Dramatically Improves Student Academic Success
http://scribd.com/doc/239851348
`
City Chickens for your Organic School Garden
http://scribd.com/doc/239850440
`
Simple Square Foot Gardening for Schools - Teacher Guide
http://scribd.com/doc/239851110
CompetencyAnalyze ethical and legal dilemmas that healthcare wor.docxannette228280
Competency
Analyze ethical and legal dilemmas that healthcare workers may encounter in the medical field.
Instructions
You have recently been promoted to Health Services Manager at Three Mountains Regional Hospital, a small hospital located in a mid-size city in the Midwest. Three Mountains is a general medical and surgical facility with 400 beds. Last year there were approximately 62,000 emergency visits and 15,000 admissions. More than 6,000 outpatient and 10,000 inpatient surgeries were performed.
An important aspect of the provider/patient relationship pertains to open communication and trust. Patients want to know that their doctors and the support staff associated with their care understand their wishes and will abide by them. Ideally, these conversations happen well before an emergency or procedure takes place; however, often times this information is missing from a patient's file. As part of Three Mountains' initiative to build trust with their patients, an increased emphasis has been placed on obtaining living wills from the patient as part of the intake process to ensure that the healthcare team has written directives of the patient's wishes in case of incapacitation. You will be creating a living will for a patient and provide educational information as to why the patient should fill it out during the admission process before a procedure.
Introduction:
Explain the definition of a living will and its key components. This section will provide an educational overview of the document for the patient.
Living Will Template:
Create a living will that can serve as a template to the patients. This should cover the basic treatment issues such as resuscitation, feeding tubes, ventilation, organ and tissue donations, etc. Provide instructions in the template that can be easily altered, depending on each patient's wishes.
Summary:
In this section, you will discuss the importance of this document and encourage patients to complete it. Address how this document ensures that a patient's wishes are known and followed by the healthcare team.
NOTE
- APA formatting and proper grammar, punctuation, and form required.
.
CompetencyAnalyze how human resource standards and practices.docxannette228280
Competency
Analyze how human resource standards and practices within the healthcare field support organizational mission, visions, and values.
Scenario
Wynn Regional Medical Center (WRMC) is the premier hospital in your area. The hospital has been in your city for over 100 years. Over the past decade, the hospital has been losing money for various reasons, though primarily due to uncompensated care. You were recently hired as the Vice President for Human Resources at WRMC, and part of your responsibilities include presenting historical information to participants of the new employee orientation.
Instructions
Create a PowerPoint presentation detailing the changing nature of the healthcare workforce. The presentation should contain speaker notes for each slide or voiceover narration. The presentation should address the following topics and questions:
Historical information on the changing healthcare workforce
How have legislation and policies changed in the past decade?
How have patient demographics changed in the past decade (baby boomers, generation X, millennials, ethnicities)?
How have patient centric approaches changed in the past decade (use of the Internet and social media to gather health information)?
Challenges associated with the changing healthcare workforce
What are some of the challenges associated with the policy and legislative changes?
What are some challenges associated with demographic changes?
What are some of the challenges associated with patients “researching” their own health instead of going to the doctor?
Current state of healthcare
What have been some of the improvements to the healthcare system over the last decade?
Resources
This
link
has information for creating a PowerPoint presentation.
Here is a
link
to information about adding speaker notes.
Here is a
link
to information about creating a voiceover narration using Screencast-O-Matic.
GRADING RUBRICS:
1.Clear and thorough explanation of the history of the changing healthcare workforce. Includes comprehensive descriptions with multiple supporting examples for each of the SUB-BULLET POINTS.
2. Clear and thorough discussion of the challenges associated with the changing healthcare workforce. Includes comprehensive descriptions with multiple supporting examples for each of the SUB-BULLET POINTS.
3. Comprehensive analysis of the current state of healthcare.
Includes a clear and thorough assessment of improvements to the healthcare system over the last decade and supports assertions with multiple supporting examples.
.
More Related Content
Similar to Comparing Mindfulness and Psychoeducation Treatments forComb.docx
I need a response to this assignment2 references zero plagia.docxsamirapdcosden
I need a response to this assignment
2 references
zero plagiarism
Does psychotherapy have a biological basis?
In a word, yes. Psychotherapy has a solid basis in biological processes. Changes in thought processes can be linked to changes in the structure or function of neural activity (Stahl, 2013). Numerous imaging and functional scanning studies demonstrate that psychotherapy changes how the brain functions, and these changes can be demonstrated on a biological level. A few of these studies are highlighted here to illustrate the point.
A systematic review by Zantvoord, Diehle, & Lindauer (2013) identified 16 studies that examined brain imaging with PTSD patients receiving trauma-processing therapies including TF-CBT and EMDR. The studies reviewed showed various biological factors at play including increased activity in the mid-prefrontal cortex and decreased activity in the amygdala following TF-CBT (Zantvoord, Diehle, & Lindauer, 2013). Furthermore, Lindauer et al. (2008) showed that following TF-CBT, the neural circuitry of working memory in the dorsolateral prefrontal cortex showed decreased activity. Disturbances in this brain region appears to play a part in the development and maintenance of PTSD (Lindauer et al, 2008).
Too many studies demonstrate the biological basis of therapy to give a solid accounting of this evidence. Thome et al (2016) compared the use of psychotherapy versus pharmacology to help reduce anxiety in reconsolidation phases of traumatic memories. The reality that both therapy and pharmacologic agents can produce similar results demonstrates that therapy has a biological component. Even (traditionally) less structured forms of therapy such as psychodynamic therapy has been shown through brain imaging to change the structure and function of neural pathways (Abbass, Nowoweiski, Bernier, Tarzwell, & Beutel, 2014).
The summation of evidence that psychotherapy can alter the chemistry, structure, and function of the brain makes it clear that psychotherapeutic interventions are an important aspect of effective treatment for mental disorders.
Explain how culture, religion, and socioeconomics might influence one’s perspective of the value of psychotherapy treatments.
Culture, religion, and socioeconomic status are active influences in people’s lives, so these factors will inherently have influence on the choices people are willing to consider. Some cultures may believe more in therapy than in pharmacology, as may certain religious groups. Some religious groups may shun all forms of mental health intervention believing that these illnesses reflect a lack of faith or misunderstanding of how to bring life into balance.
All three of these specific factors have systemic impacts that can influence a patient’s willingness to engage in psychotherapy, and this can limit the potential gains from therapy if the patient is hesitant to participate (.
The document discusses challenges faced by US veterans, including physical disabilities and mental health issues like post-traumatic stress disorder (PTSD). It reviews research on effective PTSD therapies like mindfulness-based stress reduction, exposure therapy, and an integrated approach combining behavioral activation and exposure techniques. However, it notes high unemployment among veterans and few programs addressing both therapy and vocational needs. The proposed program integrates group therapy based on the Veterans Transition Program model with a vocational component to help veterans transition to civilian life by addressing PTSD symptoms and employment. It outlines program details, limitations, and potential funding sources.
Somatic Experiencing: Reduction of Depression and Anxiety in Homeless Adults ...Michael Changaris
This is a brief 7 page version of dissertation presented for completion of doctorate. The study found some implications for reduction of symptoms of depression and anxiety in homeless adults. Limitations are number of sessions attended (1.33 average), population heterogeneity and small sample size.
Psychosocial interventions for fatigue during cancer treatment with palliativ...Maja Miljanović
Psychosocial interventions aim to reduce fatigue in cancer patients receiving palliative treatment through changing cognitions, emotions, behaviors, and social interactions. Such interventions include cognitive behavioral therapy, coping skills training, mindfulness, and psychoeducation. They teach patients to change thoughts, actions, or feelings related to symptoms. While psychosocial interventions show promise for managing cancer-related fatigue, it remains unclear if they are effective for patients receiving palliative cancer treatment specifically. This review will evaluate evidence from randomized controlled trials on the effectiveness of psychosocial interventions for reducing fatigue in patients with incurable cancer receiving palliative cancer treatment.
A Naturalistic Study Of Dissociative Identity Disorder And Dissociative Disor...Sara Alvarez
This study aimed to describe community treatment of dissociative disorders and determine if it is as effective as treatment for related conditions like PTSD. Analyses found that patients later in treatment engaged in less self-harm, had fewer hospitalizations, and higher functioning than early patients. Later patients also reported lower dissociation, PTSD, and distress symptoms than early patients. The effectiveness was comparable to treatments for chronic PTSD and depression with borderline personality disorder. This suggests extended dissociative disorder treatment may be beneficial.
717JRRDJRRD Volume 49, Number 5, 2012Pages 717–728Coup.docxsleeperharwell
717
JRRDJRRD Volume 49, Number 5, 2012Pages 717–728
Couple/family therapy for posttraumatic stress disorder: Review to
facilitate interpretation of VA/DOD Clinical Practice Guideline
Candice M. Monson, PhD;1–2* Alexandra Macdonald, PhD;3 Amy Brown-Bowers1
1Ryerson University, Toronto, Ontario, Canada; 2Department of Veterans Affairs (VA) National Center for PTSD,
Women’s Health Sciences Division, Boston, MA; 3VA National Center for PTSD, Behavioral Science Division, and
Boston University School of Medicine, Boston, MA
Abstract—A well-documented association exists among Vet-
erans’ posttraumatic stress disorder (PTSD) symptoms, family
relationship problems, and mental health problems in partners
and children of Veterans. This article reviews the recommenda-
tions regarding couple/family therapy offered in the newest
version of the Department of Veterans Affairs (VA)/Depart-
ment of Defense (DOD) VA/DOD Clinical Practice Guideline
for Management of Post-Traumatic Stress. We then provide a
heuristic for clinicians, researchers, and policy makers to con-
sider when incorporating couple/family interventions into Vet-
erans’ mental health services. The range of research that has
been conducted on couple/family therapy for Veterans with
PTSD is reviewed using this heuristic, and suggestions for
clinical practice are offered.
Key words: caregiver burden, clinical practice guidelines,
cognitive-behavioral therapy, couple/family therapy, emotion-
ally focused couple therapy, mental health, PTSD, rehabilita-
tion, strategic approach therapy, Veterans.
INTRODUCTION
To their credit and our benefit, Veterans and their fami-
lies have been the predominant contributors to our knowl-
edge about the role of posttraumatic stress disorder (PTSD)
symptoms in family functioning and vice versa. This
research documents a clear and convincing association
between PTSD symptoms and a range of family problems
(see Monson et al. [1] for review). In addition, Veterans’
PTSD symptoms have been associated with a myriad of
individual mental health problems in spouses and children
(see Renshaw et al. [2] for review). Yet, research on couple/
family therapies for Veterans with PTSD has lagged behind
individual psychotherapy treatment outcome efforts. This is
in spite of research showing that Veterans desire greater
family involvement in their treatment (e.g., Batten et al. [3])
and the presence of significant mental health problems in
Veterans’ loved ones who may individually profit from
family therapy. In addition, treatments for PTSD do not
necessarily improve couple and family functioning (e.g.,
Abbreviations: BCT = behavioral couple therapy, BFT =
behavioral family therapy, CBCT = cognitive-behavioral con-
joint therapy, CPG = Clinical Practice Guideline, CSO = con-
cerned significant other, DOD = Department of Defense, DTE =
directed therapeutic exposure, EFCT for Trauma = emotionally
focused couple therapy for trauma, LMC = lifestyl.
The document discusses the history and current state of evidence-based practices in children's mental health. It notes that while research has identified hundreds of evidence-based therapies and interventions, many children still have unmet mental health needs. It summarizes the levels of evidence for different psychosocial and pharmacological treatments, as well as home- and community-based services. However, it states that significant challenges remain in implementing evidence-based practices into real-world mental health systems and services.
PSYCHIATRIC SERVICES ps.psychiatryonline.org September 201.docxpotmanandrea
PSYCHIATRIC SERVICES � ps.psychiatryonline.org � September 2012 Vol. 63 No. 9 885555
Soldiers returning from combatoften face a postdeployment pe-riod in which there is an in-
creased risk of readjustment stres-
sors, such as problems with family,
marriage, or employment. This peri-
od can also be marked by the onset of
posttraumatic stress disorder (PTSD).
Coping with the additional burden of
PTSD likely complicates soldiers’
ability to cope during the readjust-
ment period. Accordingly, research
has documented a relationship be-
tween PTSD and greater readjust-
ment stress among soldiers serving in
recent conflicts (1) or in previous
ones (2,3).
Many soldiers with a mental health
need do not seek care within the first
year of their readjustment period. An
estimated 23%–44% of returning sol-
diers with PTSD or other mental
health problems receive treatment
within the first year (4,5). Linking re-
turning soldiers who have PTSD with
treatment is a national priority be-
cause effective treatments for PTSD
are available (6,7) and PTSD suffer-
ers who seek treatment experience
symptom relief more quickly than
those who do not (8). Therefore, re-
search is needed to better understand
the process by which returning sol-
diers with PTSD seek treatment.
Readjustment stressors may be a
key motivator for treatment seeking.
Veterans returning from Operation
Enduring Freedom or Operation Iraqi
Freedom (OIF) often seek help for fi-
nancial, occupational, and other read-
justment concerns. A qualitative
study suggested that returning sol-
diers are most likely to seek mental
health treatment when problems
emerge within family and occupa-
tional roles (9). Accordingly, one
study showed that combat veterans
seeking care from the U.S. Depart-
ment of Veterans Affairs (VA) ex-
pressed most interest for services re-
lated to veterans’ benefits (83%) and
schooling, employment, or job train-
ing (80%) (1). Also, at least one study
Readjustment Stressors and Early Mental
Health Treatment Seeking by Returning
National Guard Soldiers With PTSD
AAlleejjaannddrroo IInntteerriiaann,, PPhh..DD..
AAnnnnaa KKlliinnee,, PPhh..DD..
LLaannoorraa CCaallllaahhaann,, MM..SS..
MMiikkllooss LLoossoonncczzyy,, MM..DD..,, PPhh..DD..
Dr. Interian, Dr. Kline, and Dr. Losonczy are affiliated with the Department of Psychia-
try, UMDNJ–Robert Wood Johnson Medical School, 671 Hoes Lane, D306, Piscataway,
NJ 08854-5635 (e-mail: [email protected]). They are also with the Veterans Af-
fairs New Jersey Healthcare System, Mental Health and Behavioral Sciences, Lyons, New
Jersey. Ms. Callahan is with the Bloustein Center for Survey Research, Rutgers Univer-
sity, Piscataway.
Objectives: Readjustment stressors are commonly encountered by vet-
erans returning from combat operations and may help motivate treat-
ment seeking for posttraumatic stress disorder (PTSD). The study ex-
amined rates of readjustment stressors (marital, family, and employ-
ment) and their relationshi ...
Respond to at least two colleagues by explaining how they could use .docxcarlstromcurtis
Respond to at least two colleagues by explaining how they could use strategies to advocate for a client with a somatic symptom disorder given the reasons for advocacy they described.
Colleague 1: Brooke
Somatic symptom disorders are mental disorders that manifest with physical symptoms that are not always clear to explain with medical diagnosis (APA, 2013). One specific example of such a disorder is the Illness Anxiety Disorder (F45.21). This disorder is diagnosed when there is a pervasive and impacting preoccupation with having a serious medical condition in circumstances when no predisposition or existing symptomatology indicate there should be medical concern (APA, 2013). The diagnosed individual will exhibit heightened anxiety regarding their perceived condition. Furthermore, the diagnosis is classified as either “care-seeking type,” whereby the individual frequently seeks out medical guidance from professionals or “care-avoidant type: whereby the individual avoids medical care despite their ongoing concerns (APA, 2013).
This can present a unique challenge for guiding professionals, as the client is potentially in need of both medical and mental health care. Therefore, a biopsychosocial assessment is recommended to gain the most thorough, comprehensive picture of the client and their current set of circumstances. This multi aspect evaluation serves to understand the biological, or physical, contributors to the individual’s somatic diagnosis, while also delving into their perceptions and beliefs (psychological) and their social environment and experiences. When this information is gathered from these varied perspectives, intervention can be designed to target specific areas of need, with the understanding that medical care may be required, concurrently, with mental health support (Dimsdale, Patel, Xin and Kleinman, 2007).
Because of the complexity of such diagnoses, a multidisciplinary approach is deemed most effective when working with such clients. Because of the psychological involvement in this disorder, psychotherapy aimed at modifying existing thought patterns would be considered sound practice (Kirmayer and Sartorius, 2007). To expand, cognitive behavioral therapy (CBT) can be applied, increasing the client's awareness of their current thought patterns, possible triggers and strategies to combat negative thinking. Additionally, the prescription of medication to address the co-occurring anxiety or other resulting physical symptoms would be provided by a medical professional, such as a psychiatrist. This approach, widely accepted, allows for the client’s case to be viewed through different lenses.
While there is certainly significant validity in approaching such cases through a multidisciplinary team, the professionals required to ensure this effective intervention all have to be “on board.” This may require advocacy on the part of a social worker to convey the importance of employing this approach. It can b ...
The document summarizes a study that assessed the validity of using the PHQ-2 and PHQ-9 questionnaires to screen for and diagnose depression in a rural area of Chiapas, Mexico. The study found that:
1) Confirmatory factor analysis suggested the 1-factor structure of the PHQ-9 fit the data reasonably well.
2) The PHQ-9 showed good internal consistency and validity, with participants diagnosed with depression having lower quality of life scores.
3) Using the PHQ-9 as the standard, the optimal cutoff for the PHQ-2 to screen for depression was a score of 3, with a sensitivity of 80% and specificity of 86.8%.
This document reviews different treatments for bipolar disorder, including medications and psychotherapy. It finds that lithium is the first-line pharmacological treatment for managing mania, while medications like carbamazepine and valproate are also effective. Family-focused therapy and psychoeducation are beneficial as they help patients and families manage the disorder. Cognitive behavioral therapy teaches skills to detect mood changes and prevent relapses. The best treatment combination includes lithium medication alongside family-focused therapy and psychoeducation.
This document provides a literature review on the effectiveness of Mindfulness-Based Cognitive Therapy (MBCT) for patients with Bipolar Disorder (BD). It summarizes that while MBCT was not originally intended for BD patients, studies have found it can help reduce comorbid anxiety and depression for BD patients. Specifically, MBCT teaches skills to increase self-awareness of mood changes and manage distressing thoughts and emotions. However, the evidence is mixed, and more research is still needed comparing MBCT's effectiveness for different types of BD. Overall, MBCT shows promise as a supplemental treatment but its benefits for BD have not been conclusively determined.
Running head PSYCHOLOGY1PSYCHOLOGY5Empirical res.docxSUBHI7
Running head: PSYCHOLOGY
1
PSYCHOLOGY
5
Empirical research on the prevalence of PTSD on servicemen and veterans from combat
Developments in combat zone medicine infer more aggrieved servicemen and veterans are surviving their injuries; though, numerous injuries are not as noticeable such as missing appendages and other bodily wounds, explicitly distressing cognitive damages and post-traumatic stress writhed by both soldiers and citizens in the way of relatives and friends. The frequency of these injuries can be, and still are, not clear-cut. Moreover, the categorizations of these injuries have transformed over the course of time, touching on the way in which the sum of the aggrieved is tallied over and above the interventions presented (Angkaw et.al, 2015). An editorial in The Economist on March 2013 centered on the upsurge in the figure of war veterans pursuing medical assistance as a result of post-traumatic stress symptoms. The rise was realized amongst the newly repatriated officers, albeit similarly among elderly veterans of prior wars, and had resulted to a surge in America`s disabled former soldiers count by nearly 45% from the year 2000. A lot of empirical research reinforces the assertion made in the Economist piece, and investigation correspondingly demonstrates the long-term overheads will be a reality for many nations involved in the cross-border wars (Beckham et.al, 2014). Internationally, a rise in number of war veterans looking for assistance for psychological signs that are every so often well-matched with PTSD disorder explicate that the number of troupers affected with PTSD in the year 2013 will grow to over 300,000 persons in the United States. A similar predisposition is noticed in other nation state, and a recent research from Europe (particularly United Kingdom) pronounces late onset indications among servicemen. Our test hypothesis will appraise the prevalence and frequency of PTSD in servicemen and veteran from the warzone. From the prevalence then apt interventions can be devised to help assist all those who served and are affected with disorder.
How is PTSD perceived in a health perspective?
PTSD is a mental disorder, which is described and defined in the ensuing two classifications; the International Classification of Diseases (ICD-10) established by the World Health Organization (WHO), together with the Diagnostic and Statistical Manual of Mental Disorders (DMMD) instigated by the American Psychiatric Association (DSM-5). The analytical measures in the two classifications are articulated somewhat differently, but overall they are seen as alike. The analytical criteria consist of the following: experiencing a traumatic situation or event, short or long lasting, in which the person is exposed to fears of loss of life, grim harm or sexual abuse. The exposure is a due to circumstances with unswervingly involves the distressing event or observes the traumatic happening personally (Angkaw et.al, 2015). The social-b ...
Over 35% of veterans receiving VA care have been diagnosed with a mental health condition such as PTSD, depression, or substance abuse disorder. Veterans are at high risk for these issues due to the difficulties of adjusting to civilian life after deployment. The proposed community program would provide an integrated treatment approach including individual, group, and family therapy using trauma-informed models like Seeking Safety that address PTSD and substance abuse together. Case management services would also be provided to help veterans with life tasks like employment, housing, and medication management to support recovery.
Culture, religion, and socioeconomic status can influence one's perspective on the value of psychotherapy in several ways. Some cultures or religious groups may favor therapy over medication or reject mental health treatment altogether. Socioeconomic factors are also closely tied to health literacy and willingness to engage in therapy. For treatment to be effective, therapists must account for how these systemic influences shape a client's lived experience and willingness to participate in the therapeutic process.
Working with veterans suffering from mental health problemsWellcome Collection
The document discusses working with veterans suffering from mental health problems. It notes that mental health issues in veterans can arise from pre-service vulnerabilities, military life, and adjusting to civilian life. Common mental health problems in veterans include depression, anxiety, PTSD, alcohol and drug issues, and personality problems. Combat Stress is the largest mental health charity in the UK for veterans, providing clinical outreach services and bespoke inpatient programs to address veterans' complex biopsychosocial needs. Treatment involves assessment, stabilization, trauma-focused therapies, and rehabilitation. Major challenges include complex trauma, co-occurring substance use, forensic cases, and the needs of aging and in-service family populations.
This randomized clinical trial compared the effectiveness of mindfulness-based stress reduction (MBSR), cognitive behavioral therapy (CBT), and usual care for treating chronic low back pain. 342 adults with chronic low back pain were randomly assigned to receive MBSR, CBT, or usual care. At 26 weeks, participants receiving MBSR or CBT reported significantly greater improvement in back pain and functional limitations compared to usual care. There were no significant differences in outcomes between MBSR and CBT. These findings suggest that MBSR may be an effective treatment option for chronic low back pain.
Horticultural Therapy as a Complementary Treatment for Post Traumatic Stress Disorder
`
For more information, Please see websites below:
`
Organic Edible Schoolyards & Gardening with Children =
http://scribd.com/doc/239851214 ~
`
Double Food Production from your School Garden with Organic Tech =
http://scribd.com/doc/239851079 ~
`
Free School Gardening Art Posters =
http://scribd.com/doc/239851159 ~
`
Increase Food Production with Companion Planting in your School Garden =
http://scribd.com/doc/239851159 ~
`
Healthy Foods Dramatically Improves Student Academic Success =
http://scribd.com/doc/239851348 ~
`
City Chickens for your Organic School Garden =
http://scribd.com/doc/239850440 ~
`
Simple Square Foot Gardening for Schools - Teacher Guide =
http://scribd.com/doc/239851110 ~
Investigation of Horticultural Therapy as a Complementary Treatment for Post Traumatic Stress Disorder
`
For more information, Please see websites below:
`
Organic Edible Schoolyards & Gardening with Children
http://scribd.com/doc/239851214
`
Double Food Production from your School Garden with Organic Tech
http://scribd.com/doc/239851079
`
Free School Gardening Art Posters
http://scribd.com/doc/239851159`
`
Increase Food Production with Companion Planting in your School Garden
http://scribd.com/doc/239851159
`
Healthy Foods Dramatically Improves Student Academic Success
http://scribd.com/doc/239851348
`
City Chickens for your Organic School Garden
http://scribd.com/doc/239850440
`
Simple Square Foot Gardening for Schools - Teacher Guide
http://scribd.com/doc/239851110
Similar to Comparing Mindfulness and Psychoeducation Treatments forComb.docx (20)
CompetencyAnalyze ethical and legal dilemmas that healthcare wor.docxannette228280
Competency
Analyze ethical and legal dilemmas that healthcare workers may encounter in the medical field.
Instructions
You have recently been promoted to Health Services Manager at Three Mountains Regional Hospital, a small hospital located in a mid-size city in the Midwest. Three Mountains is a general medical and surgical facility with 400 beds. Last year there were approximately 62,000 emergency visits and 15,000 admissions. More than 6,000 outpatient and 10,000 inpatient surgeries were performed.
An important aspect of the provider/patient relationship pertains to open communication and trust. Patients want to know that their doctors and the support staff associated with their care understand their wishes and will abide by them. Ideally, these conversations happen well before an emergency or procedure takes place; however, often times this information is missing from a patient's file. As part of Three Mountains' initiative to build trust with their patients, an increased emphasis has been placed on obtaining living wills from the patient as part of the intake process to ensure that the healthcare team has written directives of the patient's wishes in case of incapacitation. You will be creating a living will for a patient and provide educational information as to why the patient should fill it out during the admission process before a procedure.
Introduction:
Explain the definition of a living will and its key components. This section will provide an educational overview of the document for the patient.
Living Will Template:
Create a living will that can serve as a template to the patients. This should cover the basic treatment issues such as resuscitation, feeding tubes, ventilation, organ and tissue donations, etc. Provide instructions in the template that can be easily altered, depending on each patient's wishes.
Summary:
In this section, you will discuss the importance of this document and encourage patients to complete it. Address how this document ensures that a patient's wishes are known and followed by the healthcare team.
NOTE
- APA formatting and proper grammar, punctuation, and form required.
.
CompetencyAnalyze how human resource standards and practices.docxannette228280
Competency
Analyze how human resource standards and practices within the healthcare field support organizational mission, visions, and values.
Scenario
Wynn Regional Medical Center (WRMC) is the premier hospital in your area. The hospital has been in your city for over 100 years. Over the past decade, the hospital has been losing money for various reasons, though primarily due to uncompensated care. You were recently hired as the Vice President for Human Resources at WRMC, and part of your responsibilities include presenting historical information to participants of the new employee orientation.
Instructions
Create a PowerPoint presentation detailing the changing nature of the healthcare workforce. The presentation should contain speaker notes for each slide or voiceover narration. The presentation should address the following topics and questions:
Historical information on the changing healthcare workforce
How have legislation and policies changed in the past decade?
How have patient demographics changed in the past decade (baby boomers, generation X, millennials, ethnicities)?
How have patient centric approaches changed in the past decade (use of the Internet and social media to gather health information)?
Challenges associated with the changing healthcare workforce
What are some of the challenges associated with the policy and legislative changes?
What are some challenges associated with demographic changes?
What are some of the challenges associated with patients “researching” their own health instead of going to the doctor?
Current state of healthcare
What have been some of the improvements to the healthcare system over the last decade?
Resources
This
link
has information for creating a PowerPoint presentation.
Here is a
link
to information about adding speaker notes.
Here is a
link
to information about creating a voiceover narration using Screencast-O-Matic.
GRADING RUBRICS:
1.Clear and thorough explanation of the history of the changing healthcare workforce. Includes comprehensive descriptions with multiple supporting examples for each of the SUB-BULLET POINTS.
2. Clear and thorough discussion of the challenges associated with the changing healthcare workforce. Includes comprehensive descriptions with multiple supporting examples for each of the SUB-BULLET POINTS.
3. Comprehensive analysis of the current state of healthcare.
Includes a clear and thorough assessment of improvements to the healthcare system over the last decade and supports assertions with multiple supporting examples.
.
CompetencyAnalyze financial statements to assess performance.docxannette228280
Competency
Analyze financial statements to assess performance and to ensure organizational improvement and long-term viability
.
Scenario
In an ongoing effort to explore the feasibility of expanding services into rural areas of the state, leadership at Memorial Hospital has determined that conducting a review of its financial condition will be essential to ensuring the organization’s ability to successfully achieve its expansion goals.
Instructions
The CFO has provided you with a copy of the organization’s
financial statements
. This information will be critical in evaluating the organization’s financial capacity to support the proposed expansion of services into the rural areas of the state.
You are asked to review these financial statements (which include the Income Statement, Statement of Cash Flows, and the Balance Sheet) and prepare an executive summary outlining the financial strength of the organization and evidence to support the expansion. Your executive summary should include the following:
An overview of the issue.
A review of critical financial ratios (Liquidity, Solvency, Profitability, and Efficiency) based on financial statements.
Inferences of forecasts, estimates, interpretations, and conclusions based on the key ratios.
Provide a recommendation based on ration analysis.
Resources
This
link
has information for creating an executive summary.
Grading Rubric:
1.
Comprehensive identification of summary of the issue. Includes multiple examples or supporting details.
2. Clear and thorough review of critical financial ratios--Liquidity, Solvency, Profitability, and Efficiency--based on financial statements. Includes multiple examples or supporting details per topic.
3. Clear and thorough inferences of forecasts, estimates, interpretations, and conclusions based on the key ratios. Includes multiple examples or supporting details per topic.
4. Comprehensive recommendation, based on ration analysis. Includes multiple examples or supporting details.
.
CompetencyAnalyze ethical and legal dilemmas that healthcare.docxannette228280
Competency
Analyze ethical and legal dilemmas that healthcare workers may encounter in the medical field.
Instructions
You have recently been promoted to Health Services Manager at Three Mountains Regional Hospital, a small hospital located in a mid-size city in the Midwest. Three Mountains is a general medical and surgical facility with 400 beds. Last year there were approximately 62,000 emergency visits and 15,000 admissions. More than 6,000 outpatient and 10,000 inpatient surgeries were performed.
An important aspect of the provider/patient relationship pertains to open communication and trust. Patients want to know that their doctors and the support staff associated with their care understand their wishes and will abide by them. Ideally, these conversations happen well before an emergency or procedure takes place; however, often times this information is missing from a patient's file. As part of Three Mountains' initiative to build trust with their patients, an increased emphasis has been placed on obtaining living wills from the patient as part of the intake process to ensure that the healthcare team has written directives of the patient's wishes in case of incapacitation. You will be creating a living will for a patient and provide educational information as to why the patient should fill it out during the admission process before a procedure.
Introduction:
Explain the definition of a living will and its key components. This section will provide an educational overview of the document for the patient.
Living Will Template:
Create a living will that can serve as a template to the patients. This should cover the basic treatment issues such as resuscitation, feeding tubes, ventilation, organ and tissue donations, etc. Provide instructions in the template that can be easily altered, depending on each patient's wishes.
Summary:
In this section, you will discuss the importance of this document and encourage patients to complete it. Address how this document ensures that a patient's wishes are known and followed by the healthcare team.
NOTE
- APA formatting and proper grammar, punctuation, and form required. APA help is available
here.
.
Competency Checklist and Professional Development Resources .docxannette228280
Competency Checklist and Professional Development Resources
An important and yet often overlooked function of leadership in an early childhood program is the ability to positively influence the people in the program. For this group assignment, consider the characteristics of a leader who can support and lead teachers in reflective teaching. This type of self-reflection is the first step to understanding how a supervisor supports teachers to accomplish their goals through mentoring. For this assignment, your group will need to address the following two components:
Part 1
: Consider the following question as your group completes the competency checklist below: What might be evidence that a teacher leader possesses the competence to also be a mentor? You are encouraged to evenly divide the competencies among your group, so that each member contributes to providing brief examples of interactions while highlighting the characteristic(s) that demonstrates each competency. While this portion can be completed independently, you should then collaborate to ensure that each group member provides feedback before submitting the full collaborative document.
Competency Checklist
Competency
Describe an example of a teacher-leader with children (when acting as a teacher)
Describe an example of a teacher-leader with adults (when acting as a supervisor)
Listens well, does not interrupt, and respects the pace of the other person
Is able to wait for others to discover solutions, form own ideas, and reflect
Asks questions that encourage details
Is aware of and comfortable with his or her feelings and the emotions of others
Is responsive to others
Guides, nurtures, supports, and empathizes
Integrates emotion and intellect
Fosters reflection or wondering by others
Is aware of how others’ reactions affect a process of dialogue and reflection, including sensitivity to bias and cultural context
Is willing to have consistent and predictable meeting times and places
Is flexible and available
Is able to form trusting relationships
Part 2:
Professional Development Resources Document
–Early childhood programs have numerous curriculum options which may contribute to a need to support teachers and staff in a curriculum context they are not familiar with. Therefore, as we prepare to support protégés, we can refer to the National Association of the Education of Young Children core standards for professional development, to promote the use of best practices. These six core standards, briefly describe what early childhood professionals should know and be able to do. After reading each of the
NAEYC Standards for Early Childhood Professional Preparation Programs (Links to an external site.)
, focus on the first four standards:
STANDARD 1.
PROMOTING CHILD DEVELOPMENT AND LEARNING
STANDARD 2.
BUILDING FAMILY AND COMMUNITY RELATIONSHIPS
STANDARD 3.
OBSERVING, DOCUMENTING, AND ASSESSING TO SUPPORT YOUNG CHILDREN AND FAMILIES
STANDARD 4.
US.
Competency 6 Enagage with Communities and Organizations (3 hrs) (1 .docxannette228280
Competency 6: Enagage with Communities and Organizations (3 hrs) (1 to 2 Pages)
Behavior: use empathy, reflection, and interpersonal skills to effectively engage diverse clients and constituencies.
For this assignment, you are to explore how your community is addressing the needs of its citizens during the CoVID 19 situation. Explore how you can consult and connect with community leaders and organizations to be a part of solutions in your community. Provide a detailed account of your exploration of community needs, as well as how you participated at the community level to address the needs of your community.
.
Competency 2 Examine the organizational behavior within busines.docxannette228280
Competency 2: Examine the organizational behavior within business systems
Provide the name of the corporation you will be using as the basis for this project.
Provide the organization’s purpose or mission statement.
Describe the organization's industry.
Provide the name and position of the person interviewed during this portion of the assignment (indicate as much pertinent information (e.g., length of service with company, previous roles in the company, educational background, etc.).
Provide the list of interview questions you asked the manager/executive.
Indicate which two - three of the following concepts from this competency that you intend to evaluate the organization/team on and describe the company’s/team’s current situation with each topic you’ve selected:
Motivational theories
Psychological contract
Job design
Use of evaluation, feedback and rewards
Misbehavior
Individual or organizational stress
Provide citations in APA format for any references
.
CompetenciesEvaluate the challenges and benefits of employ.docxannette228280
Competencies
Evaluate the challenges and benefits of employing a diverse workforce.
Design a plan for conducting business and managing employees in a global society.
Critique the actions of organizations as they integrate diverse perspectives into their cultures.
Evaluate the role of identity, diverse segments, and cultural backgrounds within organizations.
Attribute different cultural perspectives to current social-cultural dimensions.
Analyze the importance of managing a diverse workforce.
Scenario Information
Your company has been nominated for a national diversity award associated with your efforts and dedication to diversity initiatives in the workplace and their impact on the organization and community. You have been asked to summarize your efforts for the year in a slide presentation for the diversity committee who selects the winner. Be sure to include details of the changes you made in your organization and the impact the changes made.
Instructions
As part of your nomination, you have been asked to create a slide presentation including a voice recording for your entry (Voice Recording not needed). Remember your audience when giving your presentation and include the following slides:
Title slide
Highlighting the importance of workplace diversity
Discussing the points that were included in your diversity plan
Describing how culture and inclusion impact your organization
Providing examples of how diverse workgroups work together in the workplace
Gives examples of strategies used to incorporate Hofstede's cultural dimensions in a global workforce
Provides best practices for managers associated with managing a diverse, global workforce
Conclusion slide that includes a summary of why you should win this award
Any additional, relevant information
References
.
CompetenciesDescribe the supply chain management principle.docxannette228280
Competencies
Describe the supply chain management principles through the flow of information, materials, services, and resources.
Analyze the external and internal drivers that influence supply chain principles.
Evaluate supply chain management operational best practices.
Compare the nature of logistics operations and services in both international and domestic contexts.
Apply strategic supply chain management to logistics systems.
Analyze different software systems and technology strategies used in supply chain management.
Scenario
You have just been promoted to Senior Analyst at Mitchell Consulting, a firm that specializes in providing managerial expertise in supply chain management. After completing many assignments under the supervision of a Senior Analyst, your role now allows you to make selections for clients. You are assigned a new client, Scent
Solution
s. Your new manager, Partner Ronda Anderson, has directed you to work on this case and provide analysis and options to resolve the problems directly to the client.
Scent
.
CompetenciesABCDF1.1 Create oral, written, or visual .docxannette228280
Competencies
A
B
C
D
F
1.1: Create oral, written, or visual communications appropriate to the audience, purpose, and context.
4 points
Key Criteria: Tailors communication to purpose, context, and target audience. Clearly articulates the thesis and purpose, and supports the thesis and purpose with authentic and appropriate evidence. Provides smooth transitions and leaves no awkward gaps from point to point. Shows coherent progress from the introduction to the conclusion with no unnecessary sections.
3 points
Key Criteria: Tailors communication to purpose, context, and target audience. Articulates the thesis and purpose, and supports the thesis and purpose with authentic and appropriate evidence. Generally provides smooth transitions and leaves few awkward gaps from point to point. Shows identifiable progress from the introduction to the conclusion with no unnecessary sections.
2 points
Key Criteria: Considers the purpose, context, and target audience. Articulates the thesis and purpose, and shows some evidence supporting both. Some transitions are not smooth, and there are occasional gaps or awkward connections from point to point. There is a sense of progress from the introduction through the conclusion, but the organization may not be completely clear.
1 point
Key Criteria: Does not tailor communication well in terms of purpose, context, and target audience. Provides a weak thesis, unclear purpose, and little or no evidence to support points. Transitions may be rough or nonexistent, and there are significant gaps or connections between points that leave sections incomprehensible. Progress from the introduction through the conclusion is difficult to decipher, and there may be some material that is unrelated to thesis and purpose.
0 points
Key Criteria: Does not tailor communication in terms of purpose, context, and target audience. Lacks a good thesis and has little or no evidence to support a thesis. Transitions are rough or nonexistent, and there are few discernable connections from point to point. There is no identifiable progress from the introduction through the conclusion, and/or there is substantial material that is unrelated to thesis and purpose.
1.2: Communicate using appropriate writing conventions, including spelling, grammar, mechanics, word choice, and format.
4 points
Uses a format that is highly appropriate to the writing task and carefully tailors the style and tone to the specific audience. Aligns both the writing style and grammar usage to standards appropriate to the task.
3 points
Uses a format that is appropriate to the writing task and tailors the style and tone to the specific audience. Aligns both the writing style and grammar usage to standards appropriate to the task.
2 points
Generally has a clear purpose, but there may be a gap between the format used and the writing task. Fails to fully align the style and tone to the audience, or fails to fully define the audience for the writing task. Has some style or grammar.
COMPETENCIES734.3.4 Healthcare Utilization and Finance.docxannette228280
COMPETENCIES
734.3.4
:
Healthcare Utilization and Finance
The graduate analyzes financial implications related to healthcare delivery, reimbursement, access, and national initiatives.
INTRODUCTION
It is essential that nurses understand the issues related to healthcare financing, including local, state, and national healthcare policies and initiatives that affect healthcare delivery. As a patient advocate, the professional nurse is in a position to work with patients and families to access available resources to meet their healthcare needs.
REQUIREMENTS
Your submission must be your original work. No more than a combined total of 30% of the submission and no more than a 10% match to any one individual source can be directly quoted or closely paraphrased from sources, even if cited correctly. An originality report is provided when you submit your task that can be used as a guide.
You must use the rubric to direct the creation of your submission because it provides detailed criteria that will be used to evaluate your work. Each requirement below may be evaluated by more than one rubric aspect. The rubric aspect titles may contain hyperlinks to relevant portions of the course.
A. Compare the U.S. healthcare system with the healthcare system of Great Britain, Japan, Germany, or Switzerland, by doing the following:
1. Identify
one
country from the following list whose healthcare system you will compare to the U.S. healthcare system: Great Britain, Japan, Germany, or Switzerland.
2. Compare access between the
two
healthcare systems for children, people who are unemployed, and people who are retired.
a. Discuss coverage for medications in the two healthcare systems.
b. Determine the requirements to get a referral to see a specialist in the two healthcare systems.
c. Discuss coverage for preexisting conditions in the two healthcare systems.
3. Explain
two
financial implications for patients with regard to the healthcare delivery differences between the two countries (i.e.; how are the patients financially impacted).
B. Acknowledge sources, using in-text citations and references, for content that is quoted, paraphrased, or summarized.
C. Demonstrate professional communication in the content and presentation of your submission.
File Restrictions
File name may contain only letters, numbers, spaces, and these symbols: ! - _ . * ' ( )
File size limit: 200 MB
File types allowed: doc, docx, rtf, xls, xlsx, ppt, pptx, odt, pdf, txt, qt, mov, mpg, avi, mp3, wav, mp4, wma, flv, asf, mpeg, wmv, m4v, svg, tif, tiff, jpeg, jpg, gif, png, zip, rar, tar, 7z
RUBRIC
A1:COUNTRY TO COMPARE
NOT EVIDENT
A country for comparison is not identified.
APPROACHING COMPETENCE
The identified country for comparison is not from the given list.
COMPETENT
The identified country for comparison is from the given list.
A2:ACCESS
NOT EVIDENT
A comparison of healthcare system access is not provided.
APPROACHING COMPETENCE
The comparison does not acc.
Competencies and KnowledgeWhat competencies were you able to dev.docxannette228280
Competencies and Knowledge
What competencies were you able to develop in researching and writing the course Comprehensive Project? How did you leverage knowledge gained in the assignments (Units 1–4) in completing the Comprehensive Project? How will these competencies and knowledge support your career advancement in management
.
Competencies and KnowledgeThis assignment has 2 partsWhat.docxannette228280
Competencies and Knowledge
This assignment has 2 parts:
What competencies were you able to develop in researching and writing the course Comprehensive Project? How did you leverage knowledge gained in the intellipath assignments (Units 1- 4) in completing the Comprehensive Project? How will these competencies and knowledge support your career advancement in management?
Discuss the similarities and differences between shareholder wealth maximization and stakeholder wealth maximization.
.
Competencies and KnowledgeThis assignment has 2 parts.docxannette228280
Competencies and Knowledge
This assignment has 2 parts:
What competencies were you able to develop in researching and writing the course Comprehensive Project? How did you leverage knowledge gained in the intellipath assignments (Units 1- 4) in completing the Comprehensive Project? How will these competencies and knowledge support your career advancement in management?
Discuss the similarities and differences between shareholder wealth maximization and stakeholder wealth maximization.
.
Competences, Learning Theories and MOOCsRecent Developments.docxannette228280
Competences, Learning Theories and MOOCs:
Recent Developments in Lifelong Learning
Karl Steffens
Introduction
We think of our societies as ‘knowledge societies’ in which lifelong learning is
becoming increasingly important. Lifelong learning refers to the idea that people
not only learn in schools and universities, but also in non-formal and informal
ways during their lifespan.The concepts of lifelong learning and lifelong education
began to enter the discourse on educational policies in the late 1960s (Tuijnman
& Boström, 2002). However, these are related, but distinct concepts. As Lee (2014,
p. 472) notes ‘the terminological change (from lifelong education, continuing
education and adult education, to lifelong learning) reflects a conceptual departure
from the idea of organised educational provision to that of a more individualised
pursuit of learning’.
One of the first important documents on lifelong learning was the report of the
International Commission on the Development of Education to UNESCO in
1972, titled ‘Learning to be. The world of education today and tomorrow’. In his
introductory letter to the Director-General of UNESCO, the chairman of the
Commission, Edgar Faure, stated that the work of the Commission was based on
four assumptions (see Elfert pp. and Carneiro pp. in this issue). The first was
related to the idea that there was an international community which was united by
common aspirations and the second was the belief in democracy and in education
as its keystones. The third was ‘that the aim of development is the complete
fulfilment of man, in all the richness of his personality, the complexity of his forms
of expression and his various commitments — as individual, member of a family
and of a community, citizen and producer, inventor of techniques and creative
dreamer’. The last assumption was that ‘only an over-all, lifelong education can
produce the kind of complete man, the need for whom is increasing with the
continually more stringent constraints tearing the individual asunder’ (Faure,
1972, p. vi).
Following the Faure Report, the UNESCO Institute for Education, which
was founded in Germany in 1951, started to focus on lifelong learning and
subsequently became the UNESCO Institute for Lifelong Learning (UIL, http://
uil.unesco.org/home/). It was under its leadership that a formal model of lifelong
education was developed and published in the book ‘Towards a System of Life-
long Education’ (Cropley, 1980). The concept of lifelong learning also became
manifest in the ‘Education for All’ (EFA) agenda that was launched at the World
Conference on Education for All which took place in Jomtien (Thailand) in
1990 (Inter-Agency Commission, 1990). Ten years later, at the World Education
Forum in Dakar (Senegal) in 2000, the Dakar Framework for Action was
designed ‘to enable all individuals to realize their right to learn and to fulfil their
responsibility to contribute to the development of their society’ (UNESCO,
2000, p..
Compensation, Benefits, Reward & Recognition Plan for V..docxannette228280
Compensation, Benefits, Reward & Recognition Plan for V.P. Operations
Learning Team B
HRM 595
December 19, 2017
Rosalie M. Lopez
Running head: COMPENSATION, BENEFITS, REWARD & RECOGNITION PLAN
1
COMPENSATION, BENEFITS, REWARD & RECOGNITION PLAN
2
Compensation, Benefits, Reward & Recognition Plan for V.P. Operations
Introduction
Base Salary Range
For the position of VP of Operations, the National Average Salary is $122,624. In San Francisco, the average is higher and placed at $155,946. This amount is 16% higher than the National Average (Payscale, 2016). The reason for this increase is because of experience and geography. These are the two prime factors that impact the pay scale. Another major factor is the employer. Most employers base their decision to hire an individual on the experience they bring with them. Of course, with more experience, higher pay is required. With our company cutting cost a less experienced individual would be the best fit for the position.
Standard Employee Benefit
In many cases, your employee benefits could be the turning point for a prospective employee. This benefit is a vital portion of any employee packet. These valuable benefits are used as a blanket of security in the case of any sickness, injury, unemployment, old age, or death (Gomez-Mejia, Balkin & Cardy, 2015, p. 362). There is a significant difference between incentives and benefits: benefits are financial and nonfinancial compensations that are indirect to the employee. To have a competitive strategy Blossoms Up! must align their profits with the compensation package that has been already put in place. This action will help provide flexibility to the amount and the benefits available (Gomez-Mejia et al., 2015).
There are also some benefits that most companies are legally obligated to provide. Three benefits are required regardless of the number of employees that the company has. These interests involve social security, workers compensation, and unemployment insurance (Gomez-Mejia et al., 2015). Other laws must be adhered to when dealing with a certain number of individuals. When a company has 50 or more employee they must have the Family and Medical Leave Act in place and since its induction in 2015 the Affordable Care Act for Health Insurance for companies with 20 or more employees. For the health insurance to be considered standard medical, vision and dental plans must be made available to the business. These programs that must be regarded as being under the Health Maintenance Organization (HMO) or a Preferred Provider Organization (PPO) (Gomez-Mejia et al., 2015).
There are some voluntary benefits that we can include. We are already looking into adding a pension package using the Defined Contribution Plan as well as the 401(K) plan (Gomez-Mejia et al., 2015). Life insurance is another excellent benefit that could be added to the package as well as short-term and long-term disability insurance. Adding Vacation and PTO, and Holiday pay is .
Compete the following tablesTheoryKey figuresKey concepts o.docxannette228280
Compete the following tables:
Theory
Key figures
Key concepts of personality formation
Explanation of the disordered personality
Scientific credibility
Comprehensiveness
Applicability
Attachment
Complete the following...200-300 words..
Is Freud's theory a viable theory for this century?
Provide reasons for
your
view.
.
Compensation PhilosophyEvaluate the current compensation phi.docxannette228280
Compensation Philosophy
Evaluate the current compensation philosophy for your organization or an organization of your choosing (from a third-person perspective). Write a three-to-five page paper (not including the title and reference pages). Your paper should be written in a scholarly third-person tone; it should be in APA format. In addition to the introduction and conclusion, your paper should address the following:
Evaluate the organization’s current compensation philosophy and propose ways to enhance or revamp the current compensation philosophy to meet the changing needs of the organization and its employees.
Examine key factors within the internal and external environment including the mission and strategic focus of the organization, as well as the financial and cultural aspects of your organization (i.e., they cannot have a compensation philosophy where they “lead” the market if the organization does not have the financial resources) that should influence this philosophy. The proposed philosophy itself should be no more than a short paragraph.
Identify the key factors that should contribute to the organization’s development based on your proposed organizational philosophy.
Remember to write from a third-person perspective. Do not include wording like “my company’s philosophy is …” Instead include wording like “XYZ Company Name’s philosophy is …” Remember to write about the company and the company’s philosophy; do not refer to you or your connection to the company.
In addition to the text, cite at least two scholarly references to support your discussion.
Carefully review the
Grading Rubric (Links to an external site.)
for the criteria that will be used to evaluate your assignment.
Grading Rubric:
Total Possible Score
: 7.00
Evaluates the Organization’s Current Compensation Philosophy and Proposes Ways to Enhance or Revamp the Current Compensation Philosophy Organization and Its Employees
Total: 2.00
Distinguished - Accurately and thoroughly evaluates the organization’s current compensation philosophy and propose ways to enhance or revamp the current compensation philosophy to meet the changing needs of the organization and its employees.
Proficient - Accurately evaluates the organization’s current compensation philosophy and propose ways to enhance or revamp the current compensation philosophy to meet the changing needs of the organization and its employees. Minor details are missing.
Basic - Evaluates the organization’s current compensation philosophy and propose ways to enhance or revamp the current compensation philosophy to meet the changing needs of the organization and its employees. Relevant details are missing and/or inaccurate.
Below Expectations - Attempts to evaluate the organization’s current compensation philosophy and propose ways to enhance or revamp the current compensation philosophy to meet the changing needs of the organization and its employees; however, significant details are missing .
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.
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!"
Chapter wise All Notes of First year Basic Civil Engineering.pptxDenish Jangid
Chapter wise All Notes of First year Basic Civil Engineering
Syllabus
Chapter-1
Introduction to objective, scope and outcome the subject
Chapter 2
Introduction: Scope and Specialization of Civil Engineering, Role of civil Engineer in Society, Impact of infrastructural development on economy of country.
Chapter 3
Surveying: Object Principles & Types of Surveying; Site Plans, Plans & Maps; Scales & Unit of different Measurements.
Linear Measurements: Instruments used. Linear Measurement by Tape, Ranging out Survey Lines and overcoming Obstructions; Measurements on sloping ground; Tape corrections, conventional symbols. Angular Measurements: Instruments used; Introduction to Compass Surveying, Bearings and Longitude & Latitude of a Line, Introduction to total station.
Levelling: Instrument used Object of levelling, Methods of levelling in brief, and Contour maps.
Chapter 4
Buildings: Selection of site for Buildings, Layout of Building Plan, Types of buildings, Plinth area, carpet area, floor space index, Introduction to building byelaws, concept of sun light & ventilation. Components of Buildings & their functions, Basic concept of R.C.C., Introduction to types of foundation
Chapter 5
Transportation: Introduction to Transportation Engineering; Traffic and Road Safety: Types and Characteristics of Various Modes of Transportation; Various Road Traffic Signs, Causes of Accidents and Road Safety Measures.
Chapter 6
Environmental Engineering: Environmental Pollution, Environmental Acts and Regulations, Functional Concepts of Ecology, Basics of Species, Biodiversity, Ecosystem, Hydrological Cycle; Chemical Cycles: Carbon, Nitrogen & Phosphorus; Energy Flow in Ecosystems.
Water Pollution: Water Quality standards, Introduction to Treatment & Disposal of Waste Water. Reuse and Saving of Water, Rain Water Harvesting. Solid Waste Management: Classification of Solid Waste, Collection, Transportation and Disposal of Solid. Recycling of Solid Waste: Energy Recovery, Sanitary Landfill, On-Site Sanitation. Air & Noise Pollution: Primary and Secondary air pollutants, Harmful effects of Air Pollution, Control of Air Pollution. . Noise Pollution Harmful Effects of noise pollution, control of noise pollution, Global warming & Climate Change, Ozone depletion, Greenhouse effect
Text Books:
1. Palancharmy, Basic Civil Engineering, McGraw Hill publishers.
2. Satheesh Gopi, Basic Civil Engineering, Pearson Publishers.
3. Ketki Rangwala Dalal, Essentials of Civil Engineering, Charotar Publishing House.
4. BCP, Surveying volume 1
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
Communicating effectively and consistently with students can help them feel at ease during their learning experience and provide the instructor with a communication trail to track the course's progress. This workshop will take you through constructing an engaging course container to facilitate effective communication.
Strategies for Effective Upskilling is a presentation by Chinwendu Peace in a Your Skill Boost Masterclass organisation by the Excellence Foundation for South Sudan on 08th and 09th June 2024 from 1 PM to 3 PM on each day.
Beyond Degrees - Empowering the Workforce in the Context of Skills-First.pptxEduSkills OECD
Iván Bornacelly, Policy Analyst at the OECD Centre for Skills, OECD, presents at the webinar 'Tackling job market gaps with a skills-first approach' on 12 June 2024
How to Setup Warehouse & Location in Odoo 17 InventoryCeline George
In this slide, we'll explore how to set up warehouses and locations in Odoo 17 Inventory. This will help us manage our stock effectively, track inventory levels, and streamline warehouse operations.
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.
Comparing Mindfulness and Psychoeducation Treatments forComb.docx
1. Comparing Mindfulness and Psychoeducation Treatments for
Combat-Related PTSD Using a Telehealth Approach
Barbara L. Niles
National Center for Posttraumatic Stress Disorder (PTSD) and
Veterans Administration (VA) Boston Healthcare System,
Boston, Massachusetts, and Boston University
Julie Klunk–Gillis and Donna J. Ryngala
National Center for PTSD and VA Boston Healthcare System,
Boston, Massachusetts
Amy K. Silberbogen
VA Boston Healthcare System, Boston, Massachusetts, and
Boston University
Amy Paysnick
National Center for PTSD and VA Boston Healthcare System,
Boston, Massachusetts
Erika J. Wolf
National Center for PTSD and VA Boston Healthcare System,
Boston,
Massachusetts, and Boston University
This pilot study examined two telehealth interventions to
address symptoms of combat-related posttrau-
2. matic stress disorder (PTSD) in veterans. Thirty-three male
combat veterans were randomly assigned to
one of two telehealth treatment conditions: mindfulness or
psychoeducation. In both conditions, partic-
ipants completed 8 weeks of telehealth treatment (two sessions
in person followed by six sessions over
the telephone) and three assessments (pretreatment,
posttreatment, and 6-week follow-up). The mind-
fulness treatment was based on the tenets of mindfulness-based
stress reduction and the psychoeducation
manual was based on commonly used psychoeducation materials
for PTSD. Results for the 24 partici-
pants who completed all assessments indicate that: (1)
Telehealth appears to be a feasible mode for
delivery of PTSD treatment for veterans; (2) Veterans with
PTSD are able to tolerate and report high
satisfaction with a brief mindfulness intervention; (3)
Participation in the mindfulness intervention is
associated with a temporary reduction in PTSD symptoms; and
(4) A brief mindfulness treatment may
not be of adequate intensity to sustain effects on PTSD
symptoms.
Keywords: PTSD, mindfulness, Telehealth
The ongoing wars in Iraq and Afghanistan have intensified the
need for effective psychological interventions to assist veterans
returning from war. In addition to the nearly half million
veterans
from Operation Enduring Freedom and Operation Iraqi Freedom
(OEF/OIF) estimated to have posttraumatic stress disorder
(PTSD), a substantial portion of the five million other Veterans
Health Administration (VHA) patients also suffer from PTSD
related to military experiences (VHA Office of Public Health,
2009). Military-related PTSD is associated with psychosocial
3. and
health ailments that severely impact veterans and tax the VHA
system and society at large. Veterans with chronic PTSD
manifest
myriad impairments in functioning, such as problems in family
relationships (Riggs, Byrne, Weathers, & Litz, 1998),
unemploy-
ment and income disparities (Sanderson & Andrews, 2006;
Savoca
& Rosenheck, 2000), and increased morbidity (O’Toole, Catts,
Outram, Pierse, & Cockburn, 2009) and mortality (Boscarino,
2006).
Although evidence-based treatments for PTSD offer relief for
many sufferers (Foa, Keane, Friedman, & Cohen, 2009), many
service members with PTSD diagnoses do not seek mental
health
treatment (Hoge et al., 2004). A proportion of individuals who
do
seek treatment for PTSD either drop out or are not substantially
helped by it (Chard, Schumm, Owens, & Cottingham, 2010;
Gar-
cia, Kelley, Rentz, & Lee, 2011; Schottenbauer, Glass, Arnkoff,
Tendick, & Gray, 2008). Emerging evidence suggests that OEF/
OIF veterans may be difficult to engage and likely to drop out
This article was published Online First November 14, 2011.
Barbara L. Niles, National Center for PTSD–Behavioral Science
Division,
and VA Boston Healthcare System and Boston University
School of Medicine,
Boston, Massachusetts; Julie Klunk-Gillis and Donna J.
Ryngala, National
Center for PTSD–Behavioral Science Division, and VA Boston
Healthcare
4. System, Boston, Massachusetts; Amy K. Silberbogen, VA
Boston Healthcare
System and Boston University School of Medicine, Boston,
Massachusetts;
Amy Paysnick, National Center for PTSD–Behavioral Science
Division, and
VA Boston Healthcare System, Boston, Massachusetts; Erika J.
Wolf, Na-
tional Center for PTSD–Behavioral Science Division, and VA
Boston Health-
care System and Boston University School of Medicine, Boston,
Massachusetts.
This research was supported by grant 1 EA-0000043 from the
Samueli
Institute for Information Biology and by funding from the
National Center for
PTSD, Behavioral Sciences Division, VA Boston Healthcare
System.
Correspondence concerning this article should be addressed to
Barbara L.
Niles, PhD, National Center for PTSD–Behavioral Science
Division, VA
Boston Health Care System, 150 South Huntington Avenue
(116-B-2), Bos-
ton, MA 02130. E-mail: [email protected]
Psychological Trauma: Theory, Research, Practice, and Policy
In the public domain
2012, Vol. 4, No. 5, 538 –547 DOI: 10.1037/a0026161
538
(Erbes, Curry, & Leskela, 2009). It is critical to find innovative
5. ways to address barriers to treatment and new ways to reduce
symptoms. The current study examines a novel mode of
treatment
delivery—telehealth—and evaluates the efficacy of two treat-
ments—mindfulness and psychoeducation—that have the
potential
to address the symptoms of PTSD.
Telehealth
The use of telecommunications technologies to provide or en-
hance health care has become increasingly popular. Therapy ad-
ministered over the telephone has gained attention as mobile
telephones have become commonplace, are easy to use, and pri-
vate (Mohr, Vella, Hart, Heckman, & Simon, 2008). Telephone
therapy addresses two important barriers to treatment: inconve-
nience and privacy. Telephone calls can be easily scheduled at
convenient times to accommodate busy schedules. Because ses-
sions are not held in a clinic, they bypass the perceived stigma
associated with mental health care. Furthermore, telephone
inter-
ventions are less costly than face-to-face visits, as the financial
and
time costs of travel are eliminated.
Challenges associated with telephone mental health treatment
have also been identified. Building rapport may be more
difficult,
and there is the potential for both therapist and client to be
distracted by their environments (Haas, Benedict, & Kobos,
1996).
It is important that safety and ethical issues (e.g., assisting a
suicidal client) may be more challenging when the therapist is
geographically distant from the client (Haas et al., 1996). None-
theless, studies investigating efficacy and client satisfaction of
telehealth interventions have been quite promising. A recent
6. meta-
analysis of telephone-delivered psychotherapy for depression
in-
dicates that it significantly reduces symptoms, with dropout
rates
below 10% (Mohr et al., 2008).
Studies evaluating telehealth treatments to address PTSD are
scant, but findings suggest that telehealth treatments for PTSD
can
be as effective as those delivered in person. No differences in
efficacy, dropout rates, or attendance were detected between
cognitive– behavioral therapy (CBT) delivered over the phone
and
CBT delivered in person for veterans with combat-related PTSD
(Frueh et al., 2007). In a trial comparing videoteleconferencing
versus in-person modalities of anger-management group therapy
for veterans with PTSD, no significant differences were found
on
measures of attrition, adherence, satisfaction, treatment expec-
tancy, or measures of anger difficulties (Morland et al., 2010).
A
study of prolonged exposure therapy delivered via one-to-one
videoconference demonstrated feasibility and high acceptability
for this modality and resulted in significant decreases in self-
reported PTSD and depression (Tuerk, Yoder, Ruggiero, Gros,
&
Acierno, 2010). Thus, there is great potential for the use of
telehealth technologies in the treatment of PTSD.
Mindfulness
Mindfulness, frequently defined as a focused attention on pres-
ent experiences without judgment (Kabat–Zinn, 1994), has re-
ceived increasing attention in the clinical treatment literature.
One
7. of the most popular and well-researched mindfulness
interventions
is mindfulness-based stress reduction (MBSR; Kabat–Zinn,
1990),
an 8-week group treatment that introduces a meditative practice
and cultivates present awareness of mental processes and
physical
states. MBSR has demonstrated efficacy in ameliorating a wide
range of medical and mental health diagnoses (see Baer, 2003;
Grossman, Niemann, Schmidt, & Walach, 2004).
The use of MBSR as a stand-alone treatment for PTSD has not
been thoroughly investigated, though Santorelli and Kabat–Zinn
(2009) do not recommend the MBSR program as a first-step
treatment, due to concerns that clients may lack skills to
tolerate
difficult emotions. However, one recent pilot study evaluated
the
impact of MBSR on symptoms of PTSD and depression among
adult survivors of childhood trauma in concurrent
psychotherapy
(Kimbrough, Magyari, Langenberg, Chesney, & Berman, 2010).
Although this trial lacked a control or comparison condition,
results showed significant reductions in depression and PTSD
symptoms at posttreatment that were largely sustained at the
follow-up assessment 4 months later.
Mindfulness skills are key components of some empirically
validated treatments for conditions that frequently co-occur
with
PTSD, such as depression (Segal, Williams, & Teasdale, 2002),
borderline personality disorder (Linehan, 1993), and
generalized
anxiety disorder (Roemer & Orsillo, 2007), suggesting that
mind-
8. fulness may augment other therapies. A recent meta-analysis
also
demonstrated robust effects of mindfulness-based therapy on
de-
pression and anxiety symptoms in clinical samples (Hoffman,
Sawyer, Witt, & Oh, 2010).
Despite the encouraging research on mindfulness for psycho-
logical disorders, the extant research suffers from
methodological
flaws, such as a lack of control groups, small sample sizes,
inadequate adherence monitoring, failure to determine clinical
significance, and absence of follow-up assessment. Recent com-
mentaries (e.g., Davidson, 2010) have called for empirically
sound
research to address these methodological issues in order to
deter-
mine whether mindfulness interventions can be efficacious in
treating psychological problems, such as PTSD.
Psychoeducation
Education about PTSD has been recommended as a treatment or
component of treatment for persistent PTSD (Foa et al., 1999).
The
goals of psychoeducation are to increase one’s understanding of
stress reactions, readjustment difficulties, and recovery, as well
as
to normalize experiences, and assist in the early identification
of
symptoms that may reflect the development or exacerbation of a
mental disorder. Even though most empirically validated treat-
ments for PTSD begin with psychoeducation (e.g., Foa & Roth-
baum, 1998; Resick & Schnicke, 1993), there has been little
evaluation of its efficacy.
9. Current Study
In this pilot study, we examined two telehealth interventions—
mindfulness and psychoeducation—to address symptoms of
combat-related PTSD in veterans using a randomized
experimental
design. A combination of two face-to-face sessions, followed by
six telephone sessions was used in both treatments provided.
Primary variables of interest were feasibility and client
satisfaction
with the telehealth approach and the content of the two
therapies.
We hypothesized that both treatments would be associated with
reduced symptoms of PTSD at posttreatment and 6-week follow-
539COMPARING MINDFULNESS AND
PSYCHOEDUCATION
up, with greater and more clinically significant reductions ex-
pected for the mindfulness condition.
Method
Participants
Participants were 33 male veterans recruited through: (1) flyers
posted throughout Veterans Administration (VA) Boston Health
care System; (2) clinician referrals; and (3) an electronic
partici-
pant recruitment database. Inclusion criteria were: documented
military service in a war zone or peace-keeping theater, a
current
diagnosis of PTSD (as determined by structured interview), and
access to a telephone. Exclusion criteria were: severe organicity
10. or
active psychosis, an unstable regimen of psychiatric medication
over the last 2 months, psychiatric hospitalization in the last 2
months, or symptoms consistent with a diagnosis of alcohol or
drug dependence within the past 3 months. The Addiction
Severity
Index (McLellan, Luborsky, Woody, & O’Brien, 1980) and the
substance abuse module of the Structured Clinical Interview for
the Diagnostic and Statistical Manual for Mental Disorders 4th
edition (DSM–IV) Axis I Disorders (SCID-SA; First, Spitzer,
Gibbon, & Williams, 2002) were used to assess current
substance
use problems as part of the study screen to determine
participant
eligibility (see below). Substance abuse was not an exclusion
criterion.
Sixty-eight veterans completed a telephone screening, 41 com-
pleted an initial assessment, and 33 met eligibility criteria and
enrolled in the study. See Figure 1 for the study flowchart.
All participants were male, between the ages of 23 and 66
(mean
[M]age � 52.0; standard deviation [SD] � 13.0), were exposed
to
trauma in either warzone or peacekeeping theaters, and met full
criteria for PTSD as measured by the Clinician-Administered
PTSD Scale (CAPS; Blake et al., 1990, see below). Regarding
era
of military service, 30% (n � 10) were veterans of Operation
Iraqi
Freedom (OIF), 64% (n � 21) had served in Vietnam, and 6%
(n � 2) had served during peace-keeping missions (e.g.,
Bosnia).
Additionally, 76% of the sample (n � 25) identified as White,
11. not
Hispanic, 15% (n � 5) Black, not Hispanic, 6% (n � 2) White,
Hispanic, and 3% (n � 1) as “other.”
Participants were not required to discontinue ongoing treatment
with other mental health providers during the study. Use of and
changes in psychiatric medication were assessed through review
of
VA medical records (for participants receiving mental health
care
through the VA, n � 27) or by self report (for participants
receiving psychiatric care from other providers, n � 6). Most
participants (67%, n � 21) were taking prescribed psychiatric
medication when they entered the study.
Involvement in ongoing psychotherapy was also assessed by
review of medical records. Most of the participants who
completed
treatment (66%, n � 15 of 27) had one or more individual
sessions
with a mental health provider in addition to the treatment
provided
Figure 1. Flowchart for participant completion rates.
540 NILES ET AL.
by the study, and PTSD was the focus of at least one session for
33% (n � 9 of 27). Per medical record notes, 8 participants
(30%)
completed 4 or more individual sessions during the 8 weeks in
which the study treatment was ongoing, and the average number
of
sessions for those in individual treatment was 5.5 (range � 1 to
12. 12).
Measures
The Clinician Administered PTSD Scale (CAPS; Blake et
al., 1990). Considered the “gold-standard” for PTSD assess-
ment, the CAPS is a 30-item structured interview that assesses
all
DSM–IV diagnostic criteria for PTSD. The scale yields a
dichot-
omous diagnosis and a continuous score of clinician—rated fre-
quency and intensity for each symptom rated on 5-point scales.
Symptom severity is determined by summing frequency and in-
tensity scores. We employed the commonly used “Frequency
�1/Intensity �2” scoring rule to determine thresholds for each
symptom. The CAPS has repeatedly demonstrated strong and
robust psychometric properties with excellent test–retest
reliability
(r � .89 –1.00; Weathers, Ruscio, & Keane, 1999), interrater
reliability (r � .92 for total severity; Weathers et al., 1999), and
concurrent validity (r � .91 with the Mississippi Scale for
Combat-Related PTSD; Weathers et al., 1999). The internal
con-
sistency for this measure in the current study was high: Time 1
� � .90, Time 2 � � .93.
The PTSD Checklist–Military Version (PCL-M; Weathers,
Litz, Herman, Huska & Keane, 1993). The PCL-M is a
self-report measure consisting of 17 items that parallel the
DSM–IV PTSD criteria. Respondents indicate on a 5-point scale
how much they have been bothered in the last month by
particular
symptoms that are related to stressful military experiences. The
PCL has been shown to have excellent test–retest reliability (r
�
.96; Weathers et al., 1993) and concurrent validity as compared
13. with structured clinical interviews for PTSD (r � .79 to 0.93;
Blanchard, Jones–Alexander, Buckley, & Forneris, 1996). The
internal consistency for this measure in the current study was
high:
Time 1 � � .89, Time 2 � � .95, Time 3 � � .91.
The Participant Satisfaction Questionnaire (PSQ). The
PSQ is a self-report questionnaire developed for the current
study
to gather information about participants’ levels of satisfaction
with
the interventions. Responses using a 5-point scale are summed
and
averaged to derive an overall satisfaction score. Psychometric
properties of this scale have not been established.
Procedure
Clinicians. Two female clinicians with PhDs in clinical psy-
chology served as therapists. Both served as therapists for both
conditions, were regular practitioners of mindfulness
meditation,
and had received training in assessment and treatment of PTSD
in
veterans at the National Center for PTSD, Behavioral Science
Division, VA Boston Healthcare System. Each participant was
assigned to one of the two clinicians to complete the initial
assessment and the treatment.
Informed consent. The institutional review board-approved
informed consent form was reviewed with the participant, and
the
participant’s signature was obtained at the outset of the first
visit.
Assessments. The CAPS and Addiction Severity Index were
14. administered to participants at the baseline (Time 1)
assessment. If
a participant screened positive on the Addiction Severity Index,
the
SCID-SA was administered, and those who met criteria for sub-
stance dependence were screened out. Self-report measures were
administered and therapy sessions were scheduled with the
clini-
cian who conducted the assessment. Dr. Niles then informed the
therapist of the group assignment that had been determined by a
random numbers generator. A stratified randomization
procedure
was used to balance the number of OEF/OIF veterans in each
condition. Clinicians and participants were blind to treatment
condition until after the first assessment had been completed.
The posttreatment (Time 2) assessment included the same mea-
sures as the initial assessment with one additional measure, the
PSQ. In order to reduce participant and therapist demand bias,
posttreatment assessments were not completed by the
participant’s
therapist, but by the other study clinician or principal
investigator.
Participants were compensated $40 for the pre- and
posttreatment
assessments.
The 6-week follow-up (Time 3) assessment was identical to the
posttreatment assessment, with three exceptions: the PSQ was
not
readministered due to redundancy, the CAPS was not readminis-
tered in an effort to reduce participant burden, and participants
were compensated $30.
Treatment. At the first session for both treatment conditions,
15. participants were provided with a handbook (specific to
treatment
condition) comprised of two- to three-page readings for each
week
of treatment. The handbooks for both treatment conditions were
developed to meet the needs of a veteran population (e.g., text
was
in a large and easy-to-read font, written at an eighth grade
level).
In addition to providing content, the two 45-min in-person
sessions
were used to establish rapport. The six weekly telephone
sessions
reviewed information presented in the manuals. The eighth
session
was used to review the previous seven sessions and address ter-
mination issues. Telephone sessions were approximately 20 min
in
length.
Mindfulness. The Mindfulness Handbook was developed in
collaboration with the codirector of Professional Training at the
Center for Mindfulness in Medicine, Health Care, and Society at
the University of Massachusetts Medical School. It
complemented
the information covered during the sessions and provided educa-
tion about these mindfulness topics: defining mindfulness,
notic-
ing sensations, noticing thoughts and emotions, beginner’s
mind,
choice, patience, continuing to practice. During the two initial
in-person sessions, participants were led through two
experiential
exercises. Participants were given portable CD players and CDs
with 5- to 15-min guided mindfulness exercises to practice the
mindfulness skills outside of sessions. Participants were asked
16. to
keep track of their practice using monitoring sheets provided,
and
to report this each week. A few minutes of each session were
spent
focusing on any difficulties participants may have encountered
with the practice.
Psychoeducation. The PTSD Education Handbook, based on
content from an introductory psychoeducation group developed
at
the National Center for PTSD, complemented the information
covered in the initial two sessions and provided additional
educa-
tion on a variety of topics: trust, safety and self-care, effects of
trauma, relationships and trauma, coping and healing, change,
and
moving forward. The treatment was focused on educating
partic-
ipants about how PTSD may affect their lives (e.g., avoidance
may
take the form of social isolation, workaholism, substance
abuse).
541COMPARING MINDFULNESS AND
PSYCHOEDUCATION
Participants were encouraged to reflect on how symptoms may
be
impacting their day-to-day lives and suggestions for positive
cop-
ing were offered (e.g., listening to music, physical exercise) but
no
specific techniques for coping, such as relaxation exercises or
17. behavioral activation, were delivered.
Treatment adherence. At each telephone session, partici-
pants in both groups were asked to report the percentage of
assigned readings they completed. Participants in the
mindfulness
condition were also asked to keep a log of the CD track numbers
and the amount of unguided practice they engaged in each day
during the 8-week treatment. Time spent in mindfulness practice
during the 6-week follow-up period was not assessed.
To ensure therapist compliance with treatment delivery, thera-
pists completed a checklist of the major points to be covered at
each session. Each therapist met weekly with the principal
inves-
tigator for supervision regarding the cases. In addition, the
thera-
pists and investigators met weekly as a team to review session
progress and to problem solve difficulties with the protocols or
participant responses. The consultant from the Center for Mind-
fulness joined team meetings via telephone to provide guidance
regarding the mindfulness treatment.
Data Analysis
Univariate analyses were performed with a t test or chi-square
test. Repeated measures analyses of variance (RM-ANOVAs)
were used to examine differences between the two conditions
across all three time points. The type of intervention
(mindfulness
vs. psychoeducation) was the between-subjects factor and time
was the within-subjects factor. The RM-ANOVAs were then
sep-
arated by group and post hoc tests were used to determine
signif-
icance between specific cells.
18. Results
Completion, Compliance, and Satisfaction
Of the 33 veterans who were randomized, 27 (82%) completed
the 8-week intervention and posttreatment (Time 2) assessment
and 24 (72%) completed the 6-week follow-up (Time 3) assess-
ment (See Figure 1).
Treatment and posttreatment assessment completion rates did
not differ significantly between conditions: 76% for the
mindful-
ness condition and 87% for the psychoeducation condition,
�2(1,
N � 33) � .674, p � .412. Reasons for dropping out were:
moved
away (n � 2), terminated after being frequently unavailable for
telephone sessions (n � 2), experienced a manic episode and
dropped out of all VA treatment (n � 1), and no reason
provided
(n � 1). OIF veterans had similar treatment completion rates
(80.0%) as veterans from other eras, 82.6%; �2(1, N � 33) �
.032,
p � 1.00. Three participants who completed the Time 2 assess-
ment declined the follow-up (Time 3) assessment. There was no
significant difference between groups for completion of the
Time
3 assessment, �2(1, N � 27) � .081, p � .776. For both groups,
no adverse reactions to treatment were reported during the treat-
ment or follow-up periods.
Baseline scores on most demographics (race, ethnicity, educa-
tion level, employment status, meditation experience) and
outcome
measures did not differ between the nine dropouts and the 24
19. completers. Although OIF veterans did not differ from others on
the completion of the Time 2 assessment, a chi-square test indi-
cated a trend for OIF veterans to be more likely to drop out of
the
study before the follow up assessment. Half (50%) of the OIF
veterans dropped out by the Time 3 assessment, as compared
with
17% of the other veterans, �2(1, N � 33) � 3.74, p � .053. A
follow-up t test showed that veterans who dropped out were
significantly younger (Mage � 42.22, SD � 10.59) than the vet-
erans who completed, Mage � 55.25, SD � 15.48, t(31) � 2.56,
p � .016.
Participants who completed the interventions were very com-
pliant: 89% reported that they completed an average of at least
75% of the readings, while 63% reported completing all
readings
in their entirety. In the mindfulness condition, compliance with
mindfulness practice was surprisingly high: participants
reported
practicing over 2 hours per week on average (M � 137, SD �
91,
range � 41 to 307 min), even though the total amount of
practice
time assigned in the study ranged from only 20 –50 min per
week.
They also reported practicing an average of over 5 days per
week,
and 69% reported practicing both with and without the help of
the
guided exercises on CDs.
All participants who completed the study reported high satis-
faction ratings on the PSQ. There were no differences in
satisfac-
20. tion ratings between groups, with 88% of completing
participants
reporting that the intervention was “convenient” and 81%
report-
ing they “would recommend the intervention to other
individuals.”
The remaining participants reported being neutral on both of
these
statements; none reported dissatisfaction.
Pretreatment Group Differences
No differences were found between the two intervention groups
on demographic variables (age, race, ethnicity, education level,
employment status, era of service, meditation experience).
Despite
randomization, however, PTSD symptoms for the mindfulness
group were less severe at baseline. For the 24 participants who
completed all three assessments, scores on the PCL-M were sig-
nificantly lower, t(22) � �2.18, p � .040. The repeated-
measures
analyses reported below compare the two groups on their
relative
changes in symptoms over time; due to the small sample size,
however, no additional statistical procedure was used to control
for
the unequal baseline scores in symptoms.
Posttreatment and Follow-Up Group Differences
Evaluation of CAPS scores in the 27 participants who com-
pleted treatment and the Time 2 assessment revealed a main
effect
of condition, F(1, 25) � 7.21, p � .013, �p
2 � .224, no main effect
21. of time, F(1, 25) � 3.27, p � .083, �p
2 � .116, and a significant
Condition � Time interaction, F(1, 25) � 5.62, p � .026, �p
2 �
.183. We examined this interaction within condition and found
that
for the mindfulness group, mean scores dropped significantly
from
60.92 (SD � 19.25) at Time 1 to 47.46 (SD � 18.29) at Time 2,
F(1, 12) � 12.11, p � .005, �p
2 � .502, while for the psychoedu-
cation group, there was no significant change in mean symptoms
over time, F(1, 13) � .094, p � .765, �p
2 � .007 (see Table 1).
For the self-report PCL-M, PTSD changes at Time 2 were
similar to those found using the interview-based CAPS. For the
26
participants with valid scores, there was a main effect of
condition,
542 NILES ET AL.
F(1, 24) � 14.86, p � .001, �p
2 � .382, a main effect of time, F(1,
24) � 8.23, p � .008, �p
2 � .255, and a significant Condition �
Time interaction, F(1, 24) � 10.44, p � .004, �p
22. 2 � .303. We
examined this interaction within condition and found that for
the
mindfulness group, mean PCL-M scores dropped significantly
from 52.31 (SD � 11.88) at Time 1 to 41.92 (SD � 11.27) at
Time
2, F(1, 12) � 15.03, p � .002, �p
2 � .556, while for the psychoe-
ducation group, there was no significant change in mean
symptoms
over time, F(1, 12) � .086, p � .775, �p
2 � .007 (see Table 1).
At Time 3 (6-week follow-up), PTSD symptoms were assessed
only with the PCL-M. For the 24 participants who completed all
three assessments, on PCL-M scores there was a main effect of
condition, F(1, 22) � 10.60, p � .004, �p
2 � .325, no main effect
of Time, F(1, 22) � 1.41, p � .248, �p
2 � .060, and a significant
quadratic Condition � Time interaction effect, F(1, 22) �
16.15,
p � .001, �p
2 � .423. We examined this interaction within condi-
tion and found that for the mindfulness group, mean PCL-M
scores
had a quadratic change from 52.75 (SD � 12.30) at Time 1 to
42.75 (SD � 11.35) at Time 2 to 50.75 (SD � 12.27) at Time 3,
F(1, 12) � 14.98, p � .003, �p
23. 2 � .577, while for the psychoedu-
cation group, there was no significant linear or quadratic change
over time, F(1, 11) � 1.89, p � .196, �p
2 � .147 (quadratic).
Follow-up t tests on the mindfulness group indicate a significant
drop in PCL-M scores from Times 1 to 2, t(11) � 3.47, p �
.005,
a significant increase from Times 2 to 3, t(11) � �3.57, p �
.004,
but no significant difference between Time 1 and Time 3, t(11)
�
0.89, p � .391 (see Figure 2).
We examined whether clinically significant changes pre to post
treatment for individuals were distributed equally between the
two
groups. We first calculated whether or not there was a clinically
significant change for each individual using criteria reported by
Monson et al. (2008): 20 point changes on the CAPS, 10 point
changes on the PCL-M. Participants were then categorized into
three groups: clinically significant improvement, no change
(i.e.,
change only within the a priori specified amount), or clinically
significant worsening of symptoms. For the CAPS, a chi-square
analysis indicated a trend toward significant difference between
the two groups. In the mindfulness condition, 5 of 13 (38.5%)
participants had a clinically significant improvement and the re-
mainder had no significant change. By contrast, in the psychoe-
ducation condition, 1 of 14 (7.1%) had a clinically significant
improvement, 10 (71.4%) had no change, and 3 (21.4%) had
worsening of symptoms, �2(2, N � 27) � 5.86, p � .053. For
the
PCL-M the outcomes were similar. In the mindfulness
condition,
24. 7 of 13 (53.8%) participants had a clinically significant
improve-
ment and the remainder had no significant change. In the
psychoe-
ducation condition, 1 of 13 (7.7%) had a clinically significant
improvement, 11 (84.6%) had no change, and 1 (7.7%) had
wors-
ening of symptoms, �2(2, N � 26) � 6.97, p � .031.
No significant differences between groups were found for vari-
ables representing concurrent psychotherapy. Five participants
(15.2%) had a change in psychiatric medication; two of these
dropped out of the study and three completed. The three com-
pleters were all in the mindfulness condition and were
prescribed
additional medication during the 14-week study (two during the
intervention and 1 during the follow-up). One of these three
exhibited a clinically significant improvement in PTSD
symptoms
between Times 1 and 2 as measured by the CAPS and the PCL-
M
and two did not show clinically significant change on either
measure. To address concerns that medication change for the
individual who improved was responsible for the overall group
change between Times 1 and 2, we eliminated this participant
and
re-ran the ANOVAS. The pattern of results was unchanged from
that reported above. (Details available from Dr. Niles).
For the mindfulness group, a significant dose-response correla-
tion was found between total practice time and pre- to posttreat-
ment symptom change in the expected direction (more practice
was associated with better outcome) for CAPS scores, r(10) �
�.66, p � .02, 2-tailed, but not for PCL-M scores, r(10) � .01,
p � .97.
25. Discussion
This study indicates that it is feasible to deliver telehealth
treatments for PTSD, as over 80% of the participants completed
Figure 2. Change in PCL-M scores at posttreatment and follow-
up as-
sessment.
Table 1
Means and Standard Deviations for Outcome Measures
Measure Assessment
M (SD)
Mindfulness Psychoeducation
CAPSa Time 1 60.92 (19.25) 72.50 (19.66)
Time 2 47.46 (18.29) 74.00 (22.95)
Time 3 — —
PCL-M Time 1 52.75 (12.29) 63.08 (10.85)
Time 2 42.75 (11.35) 64.42 (10.84)
Time 3 50.75 (12.27) 61.33 (11.39)
Note. CAPS � Clinician Administered PTSD Scale; PCL-M �
PTSD
Checklist–Military Version.
a CAPS data were collected only at Times 1 and 2 (n � 27);
PCL-M was
collected at Times 1, 2, and 3 (n � 24).
543COMPARING MINDFULNESS AND
PSYCHOEDUCATION
26. the 8-week intervention and over 70% completed the follow-up
assessment. These rates of completion are comparable to those
reported in a VA PTSD clinic (Erbes et al., 2009) and to rates
reported for most randomized trials of treatments for PTSD
(Schottenbauer et al., 2008). This study detected no differences
between OIF veterans and other veterans in completion of treat-
ment, a finding in contrast with that of Erbes et al. (2009) who
found that twice as many OEF/OIF veterans dropped out of
treat-
ment than did Vietnam veterans. However, three of the eight
OIF
veterans who completed treatment dropped out during the 6-
week
follow-up period. As a result, completion rates for follow-up
assessment (Time 3) indicate that the veterans from current con-
flicts were substantially (with a trend toward significantly)
more
likely to drop out and that those who dropped out were signifi-
cantly younger than those who completed. These findings
suggest
that the telehealth format may equally engage younger and older
veterans in treatment, but that the younger veterans from
current
conflicts are not as likely to complete follow-up assessments.
The
veterans who finished the interventions were very compliant
with
the treatment, completing all the telephone calls and most of the
weekly homework assignments. Participants also reported very
high rates of satisfaction with the mode of delivery, a
combination
of two in-person sessions and six telephone sessions.
The findings of this study support evidence from other recent
27. studies (Frueh et al., 2007; Morland et al., 2010; Tuerk et al.,
2010)
indicating that telehealth modalities are feasible to deliver and
are
associated with high satisfaction rates in the treatment of PTSD
for
veterans. Telehealth interventions may be especially important
for
clients who have difficulty attending appointments due to health
constraints or travel from rural locations. However, even for
phys-
ically healthy individuals in an urban environment, the conve-
nience offered by a telephone intervention may encourage
greater
participation in treatment.
Regarding compliance with a mindfulness intervention in a
veteran PTSD population, participants in the mindfulness condi-
tion completed more of the homework assignments than antici-
pated, engaging in guided or sitting meditation over 2 hours per
week on average, substantially more than requested by the
proto-
col. The veterans who chose to participate in this investigation
may
have been particularly interested in mindfulness and meditation,
and may have been more compliant with homework than other
veterans seeking treatment for PTSD. Nonetheless, this finding
is
especially notable given concerns that mindfulness meditation
may
not be appropriate for individuals with PTSD because intense
focus on the present moment could trigger an exacerbation of
symptoms or dissociative reaction. In the current study, no
adverse
reactions to the mindfulness treatment were reported and
satisfac-
28. tion ratings were high. Thus, this study demonstrates that some
veterans with PTSD can engage in mindfulness meditation.
The current study provides preliminary evidence that participa-
tion in a brief mindfulness intervention may temporarily reduce
symptoms of PTSD more than the psychoeducation intervention.
Scores on both self-report and clinician-administered measures
of
PTSD dropped significantly in the mindfulness group between
Times1 and 2. The effect sizes were large, accounting for at
least
half of the variance in the scores on both measures. Over 50%
of
those in the mindfulness treatment achieved a clinically
significant
change in PTSD symptoms as measured by self-report. Given
the
brevity of the intervention, it is encouraging that the impact on
symptoms was clinically significant for a substantial proportion
of
participants. However, it is important to note that the mean
scores
on the PTSD measures indicate that even after a reduction in
symptoms, substantial PTSD symptoms remained.
The return to baseline on self-report PTSD measures at Time 3
for the mindfulness group indicates that positive effects
associated
with this brief treatment were not enduring and may reflect the
ebb
and flow of PTSD over time. Continued mindfulness practice
has
been found to be necessary for a continued positive effect (Car-
mody & Baer, 2008). Participants may have stopped practicing
or
29. reduced meditation time after the intervention ended. Practice
time
during the 6-week follow-up period was not measured, so we
cannot provide evidence to support this theory. However, the
correlation between practice time and change in PTSD
symptoms
as measured by the CAPS at Time 2 was significant. Thus, it
seems
very plausible that reduction of mindfulness practice is
associated
with the rise in PTSD symptoms.
The psychoeducation intervention did not appear to impact
PTSD symptoms; pre- to posttreatment mean scores on PTSD
measures were not significantly different and the majority of
participants showed no clinically significant change. One expla-
nation for this might be that additional education about PTSD
symptoms is not beneficial for those who have already received
it,
as most participants in this study had been in treatment and
educated about PTSD symptoms before. A few veterans in this
study evidenced a clinically significant worsening of symptoms
which may indicate that psychoeducation can be harmful for
some
individuals. However, a more likely explanation may be that
education about the symptoms of PTSD causes more awareness
of
symptoms and can thus increase reports of symptoms. For exam-
ple, psychoeducation may allow participants to notice trauma
cues,
the distress associated with the cues, and the subsequent
avoidant
responses. Alternatively, a desire to attain or maintain service-
connected compensation for PTSD may cause veterans to report
more symptoms and distress (e.g., Frueh et al., 2003), although
this
30. would be true for both conditions. Thus, despite findings that
PTSD symptoms increased slightly following the
psychoeducation
intervention, we concur with previous suggestions that psychoe-
ducation is likely helpful for traumatized individuals who are
new
to treatment (e.g., Foa & Rothbaum, 1998; Resick & Schnicke,
1993) and recommend it as an early component of treatment for
PTSD.
The small sample size for this pilot study limits the conclusions
that can be drawn. First, in terms of data analysis, participants
who
dropped out of treatment did not complete Time 2 or Time 3
assessments and the small sample precluded use of maximum-
likelihood based methods of addressing missing data at these
time
points. Intention-to-treat analyses therefore were not possible
for
this study. Thus, it must be assumed that the missing data is not
missing at random and may be biased. As this is a pilot investi-
gation, differences detected between the mindfulness and
psychoe-
ducation conditions can only be considered suggestive and
future
formal clinical trials with appropriate intention-to-treat and
miss-
ing data procedures are needed to examine whether these differ-
ences are replicable. Second, the risk of type one error was
elevated because we used several repeated-measures ANOVAs.
In
order to balance the risks of type one and type two error,
follow-up
tests were performed only after the initial omnibus F tests indi-
cated significant differences. Third, participants in the
psychoedu-
31. 544 NILES ET AL.
cation group evidenced greater PTSD symptoms, indicating that
randomization along these dimensions was not successful; a
larger
sample size would likely have produced more balanced groups.
Because the mindfulness group had less severe PTSD symptoms,
it is not possible to know if this intervention would produce
similar
results in a sample with greater symptom severity. However, it
is
notable that treatment effects were detected in the mindfulness
group despite the lower initial scores on the PTSD measures,
suggesting a robust effect. Fourth, even though the number of
people taking psychiatric medications was balanced across
groups,
all three participants with medication changes were in the mind-
fulness group and one of the three evidenced a clinically
signifi-
cant improvement in symptoms. A larger sample would allow
inclusion of medication change as a covariate. Finally, the small
sample precluded use of regression analyses to identify
mediators
and moderators of treatment outcomes.
There are also aspects of study design that indicate these
results should be interpreted with caution. (1) Veterans in VA
treatment for combat-related PTSD are a select group and these
results may not apply to other veteran, military, or PTSD
populations. The majority of the veterans in this study were in
concurrent VA treatment. Given that VA populations have
shown lower response rates to PTSD treatments than nonveter-
ans (Bradley, Greene, Russ, Dutra, & Westen, 2005; Friedman,
32. Marmar, Baker, Sikes, & Farfel, 2007), it is notable that the
mindfulness condition was associated with symptom reduction.
(2) The assessors for the Time 2 and Time 3 assessments were
not blind to condition and may have been biased in the admin-
istration of the CAPS at Time 2. However, the self-report PCL
findings at Times 1 and 2 were very similar to the CAPS
findings, indicating consistency across methods of assessment.
(3) The study therapists delivered both treatments and were not
randomly assigned to condition; this raises concerns about
potential bias regarding delivery of treatment (Luborsky, Bar-
rett, Antonuccio, Shoenberger, & Stricker, 2006). They were
both mindfulness practitioners and thus may have favored the
mindfulness treatment, which may have unduly inflated the
superiority of the mindfulness intervention. However, they both
also regularly delivered psychoeducation to veterans with
PTSD. (4) Although checklists were used to assess therapist
adherence to the treatment protocol, adherence was not evalu-
ated by independent reviewers via recordings. Thus, the thera-
pists may have deviated from the protocol at times. (5) The
study design did not allow a comparison between the novel
aspects of the treatments (telehealth mode of delivery, mind-
fulness as a treatment for PTSD) and available empirically
supported treatments for PTSD.
Overall the findings from this study of veterans with combat-
related PTSD provide preliminary support for the feasibility of
(1)
a telehealth mode of delivery and (2) an intervention promoting
mindfulness. The mindfulness intervention was associated with
a
reduction in PTSD symptoms at posttreatment, and this
investiga-
tion contributes to the literature suggesting that mindfulness
train-
ing may be useful in the treatment of PTSD (e.g., Follette &
Vijay,
33. 2009; Kimbrough et al., 2010). The brief treatment was not ade-
quate to sustain changes and may need to be extended in length
or
intensity or paired with other treatments to have lasting effects.
The mechanisms by which mindfulness can impact PTSD symp-
tomatology should be explored in future studies. For example,
the
arousal symptoms of PTSD have been shown to be important in
“driving” the other PTSD symptoms (Schell, Marshall, &
Jaycox,
2004) and decrements in arousal associated with mindfulness
practice may account for changes in symptoms. Mindfulness
prac-
tice also encourages cognitive flexibility and cultivation of non-
judgmental acceptance of thoughts and feelings, even those that
are distressing. This may serve as exposure to trauma-related
cognitions and emotions and may be effective in a manner
similar
to the way that exposure-based treatments are hypothesized to
reduce symptoms.
Mindfulness meditation has shown promise in treating many
disorders and the current study suggests that its use in the
treatment of PTSD merits further investigation. This study also
highlights that mindfulness can be delivered through a tele-
health format, a more flexible alternative to traditional face-to-
face treatment. Future treatment trials should evaluate the use
of
mindfulness for PTSD using intention-to-treat analyses with
larger samples, clinician-administered outcome measures ad-
ministered by blind assessors, and evaluation of therapist ad-
herence to protocol. Comparing current evidence-based treat-
ments for PTSD with mindfulness interventions alone and with
mindfulness interventions combined with evidence-based treat-
34. ments will be important in determining whether mindfulness
can enhance current efficacious treatments for PTSD. In addi-
tion, future studies should evaluate different modalities of
mindfulness treatment delivery, such as group, face-to-face
individual, telehealth with no face-to-face, or Internet-based
treatment. To provide optimal patient care, it is critical to
consider novel approaches that may complement and extend
current therapies for PTSD.
References
Baer, R. A. (2003). Mindfulness training as a clinical
intervention: A
conceptual and empirical review. Clinical Psychology: Science
and
Practice, 10, 125–143. doi:10.1093/clipsy.bpg015
Blake, D. D., Weathers, F. W., Nagy, L. M., Kaloupek, D. G.,
Klaaumin-
zer, G. Charney, D. S., & Keane, T. M. (1990). A clinician
rating scale
for assessing current and lifetime PTSD: The CAPS-1. Behavior
Ther-
apist, 13, 187–188.
Blanchard, E. B., Jones–Alexander, J., Buckley, T. C., &
Forneris, C. A.
(1996). Psychometric properties of the PTSD checklist (PCL).
Behav-
iour Research and Therapy, 34, 669 – 673. doi:10.1016/0005-
7967(96)00033-2
Boscarino, J. A. (2006). Posttraumatic stress disorder among
U.S. army
veterans 30 years after military service. Annals of
Epidemiology, 16,
35. 248 –256. doi:10.1016/j.annepidem.2005.03.009
Bradley, R., Greene, J., Russ, E., Dutra, L., & Westen, D.
(2005). A
multidimensional meta-analysis of psychotherapy for PTSD.
The Amer-
ican Journal of Psychiatry, 162, 214 –227. doi:10.1176/appi.ajp
.162.2.214
Carmody, J., & Baer, R. (2008). Relationships between
mindfulness prac-
tice and levels of mindfulness, medical and psychological
symptoms and
well-being in a mindfulness-based stress reduction program.
Journal of
Behavioral Medicine, 31, 23–33. doi:10.1007/s10865-007-9130-
7
Chard, K. M., Schumm, J. A., Owens, G. P., & Cottingham, S.
M. (2010).
A comparison of OEF and OIF veterans and Vietnam veterans
receiving
cognitive processing therapy. Journal of Traumatic Stress, 23,
25–32.
doi:10.1002/jts.20500
Davidson, R. J. (2010). Empirical explorations of mindfulness:
Conceptual
and methodological conundrums. Emotion, 10, 8 –11.
doi:10.1037/
a0018480
545COMPARING MINDFULNESS AND
PSYCHOEDUCATION
36. Erbes, C. R., Curry, K. T., & Leskela, J. (2009). Treatment
presentation
and adherence of Iraq/Afghanistan era veterans in outpatient
care for
posttraumatic stress disorder. Psychological Services, 6, 175–
183. doi:
10.1037/a0016662
First, M. B., Spitzer, R. L., Gibbon, M., & Williams, J. B. W.
(2002).
Structured clinical interview for DSM–IV–TR axis I disorders-
patient
ed. (SCID-I/P, 11/2002 revision). New York, NY: New York
State
Psychiatric Institute.
Foa, E. B., Davidson, J. R. T., Frances, A. Culpepper, L., Ross,
R., & Ross,
D. (Eds.). (1999). The expert consensus guideline series:
Treatment of
posttraumatic stress disorder. Journal of Clinical Psychiatry, 60,
4 –76.
Foa, E. B., Keane, T. M., Friedman, M. J., & Cohen, J. A.
(Eds.). (2009).
Effective treatments for PTSD. New York, NY: Guilford Press.
Foa, E. B., & Rothbaum, B. O. (1998). Treating the trauma of
rape:
Cognitive-behavioral therapy for PTSD. New York, NY:
Guilford Press.
Follette, V. M., & Vijay, A. (2009). Mindfulness for trauma and
posttrau-
matic stress disorder. In F. Didonna (Ed.), Clinical handbook of
37. mind-
fulness (pp. 299 –317). New York, NY: Springer Science �
Business
Media.
Friedman, M. J., Marmar, C. R., Baker, D. G., Sikes, C. R., &
Farfel, G. M.
(2007). Randomized, double-blind comparison of sertraline and
placebo
for posttraumatic stress disorder in a Department of Veterans
Affairs
setting. Journal of Clinical Psychiatry, 68, 711–720.
doi:10.4088/
JCP.v68n0508
Frueh, B. C., Elhai, J. D., Gold, P. B., Monnier, J., Magruder,
K. M.,
Keane, T. M., & Arana, G. W. (2003). Disability compensation
seeking
among veterans evaluated for posttraumatic stress disorder.
Psychiatric
Services, 54, 84 –91. doi:10.1176/appi.ps.54.1.84
Frueh, B. C., Monnier, J., Yim, E., Grubaugh, A. L., Hamner,
M. B., &
Knapp, R. G. (2007). A randomized trial of telepsychiatry for
post-
traumatic stress disorder. Journal of Telemedicine and Telecare,
13,
142–147. doi:10.1258/135763307780677604
Garcia, H. A., Kelley, L. P., Rentz, T. O., & Lee, S. (2011).
Pretreatment
predictors of dropout from cognitive behavioral therapy for
PTSD in
Iraq and Afghanistan war veterans. Psychological Services, 8,
38. 1–11.
doi:10.1037/a0022705
Grossman, P., Niemann, L., Schmidt, S., & Walach, H. (2004).
Mindfulness-based stress reduction and health benefits: A meta-
analysis.
Journal of Psychosomatic Research, 57, 35– 43.
doi:10.1016/S0022-
3999(03)00573-7
Haas, L. J., Benedict, J. G., & Kobos, J. C. (1996).
Psychotherapy by
telephone: Risks and benefits for psychologists and consumers.
Profes-
sional Psychology: Research and Practice, 27, 154 –160.
doi:10.1037/
0735-7028.27.2.154
Hoffman, S. G., Sawyer, A. T., Witt, A. A., & Oh, D. (2010).
The effect
of mindfulness-based therapy on anxiety and depression: A
meta-
analytic review. Journal of Consulting and Clinical Psychology,
78,
169 –183. doi:10.1037/a0018555
Hoge, C. W., Castro, C. A., Messer, S. C., Cotting, D. I.,
Koffman, R. L.,
& McGurk, D. (2004). Combat duty in Iraq and Afghanistan,
mental
health problems, and barriers to care. The New England Journal
of
Medicine, 351, 13–22. doi:10.1056/NEJMoa040603
Kabat–Zinn, J. (1990). Full catastrophe living: Using the
wisdom of your
39. body and mind to face stress, pain and illness. New York, NY:
Dela-
corte.
Kabat–Zinn, J. (1994). Wherever you go, there you are:
Mindfulness
meditation in everyday life. New York, NY: Hyperion.
Kimbrough, E., Magyari, T., Langenberg, P., Chesney, M., &
Berman, B.
(2010). Mindfulness intervention for child abuse survivors.
Journal of
Clinical Psychology, 66, 17–33. doi:10.1002/jclp.20624
Linehan, M. M. (1993). Skills training manual for treating
borderline
personality disorder. New York, NY: Guilford Press.
Luborsky, L. B., Barrett, M. S., Antonuccio, D. O.,
Shoenberger, D., &
Stricker, G. (2006). What else materially influences what is
represented
and published as evidence? In J. C. Norcross, L. E. Beutler, &
R. F.
Levant (Eds.), Evidence-based practices in mental health:
Debate and
dialogue on the fundamental questions (pp. 257–298).
Washington, DC:
American Psychological Association. doi:10.1037/11265-000
McLellan, T. A., Luborsky, L., Woody, G. E., & O’Brien, C. P.
(1980). An
improved diagnostic evaluation instrument for substance abuse
patients,
the Addiction Severity Index. Journal of Nervous and Mental
40. Disease,
168, 26 –33. doi:10.1097/00005053-198001000-00006
Mohr, D. C., Vella, L., Hart, S., Heckman, T., & Simon, G.
(2008). The
effect of telephone-administered psychotherapy on symptoms of
depres-
sion and attrition: A meta-analysis. Clinical Psychology:
Science and
Practice, 15, 243–253. doi:10.1111/j.1468-2850.2008.00134.x
Monson, C. M., Gradus, J. L., Young-Xu, Y., Schnurr, P. P.,
Price, J. L.,
& Schumm, J. A. (2008). Change in posttraumatic stress
disorder symp-
toms: Do clinicians and patients agree? Psychological
Assessment, 20,
131–138. doi:10.1037/1040-3590.20.2.131
Morland, L. A., Greene, C. J., Rosen, C. S., Foy, D., Reilly, P.,
Shore, J.,
. . . Frueh, B. C. (2010). Telemedicine for anger management
therapy in
a rural population of combat veterans with posttraumatic stress
disorder:
A randomized noninferiority trial. Journal of Clinical
Psychiatry. Ad-
vance online publication. Retrieved from:
http://www.ncbi.nlm.nih.gov/
pubmed/20122374.
O’Toole, B. I., Catts, S. V., Outram, S., Pierse, K. R., &
Cockburn, J.
(2009). The physical and mental health of Australian Vietnam
veterans
3 decades after the war and its relation to military service,
41. combat and
post-traumatic stress disorder. American Journal of
Epidemiology, 170,
318 –330. doi:10.1093/aje/kwp146
Resick, P. A., & Schnicke, M. K. (1993). Cognitive processing
therapy for
rape victims: A treatment manual. Thousand Oaks, CA: Sage.
Riggs, D. S., Byrne, C. A., Weathers, F. W., & Litz, B. T.
(1998). The
quality of intimate relationships of male Vietnam veterans:
Problems
associated with posttraumatic stress disorder. Journal of
Traumatic
Stress, 11, 87–102. doi:10.1023/A:1024409200155
Roemer, L., & Orsillo, S. M. (2007). An open trial of an
acceptance-based
behavior therapy for generalized anxiety disorder. Behavior
Therapy, 38,
72– 85. doi:10.1016/j.beth.2006.04.004
Sanderson, K., & Andrews, G. (2006). Common mental
disorders in the
workforce. Recent findings from descriptive and social
epidemiology.
Canadian Journal of Psychiatry, 51, 63–75.
Santorelli, S. F., & Kabat–Zinn, J. (2009). Mindfulness-based
stress re-
duction professional training resource manual: Integrating
mindfulness
meditation into medicine and health care. Worcester, MA:
Center for
Mindfulness in Medicine, Health Care, and Society.
42. Savoca, E., & Rosenheck, R. (2000). The civilian labor market
experiences
of Vietnam-era veterans: The influence of psychiatric disorders.
Journal
of Mental Health Policy and Economics, 3, 199 –207.
doi:10.1002/
mhp.102
Schell, T. L., Marshall, G. N., & Jaycox, L. H. (2004). All
symptoms are
not created equal: The prominent role of hyperarousal in the
natural
course of posttraumatic psychological distress. Journal of
Abnormal
Psychology, 113, 189 –197. doi:10.1037/0021-843X.113.2.189
Schottenbauer, M. A., Glass, C. R., Arnkoff, D. B., Tendick, V.,
& Gray,
S. H. (2008). Nonresponse and dropout rates in outcome studies
on
PTSD: Review and metholodological consideration. Psychiatry,
71,
134 –168. doi:10.1521/psyc.2008.71.2.134
Segal, Z. V., Williams, J. M. G., & Teasdale, J. D. (2002).
Mindfulness-
based cognitive therapy for depression: A new approach to
preventing
relapse. New York, NY: Guilford Press.
Tuerk, P. W., Yoder, M., Ruggiero, K. J., Gros, D. F., &
Acierno, R.
(2010). A pilot study of prolonged exposure therapy for
posttraumatic
stress disorder delivered via telehealth technology. Journal of
43. Traumatic
Stress, 23, 116 –123. doi:10.1002/jts.20494
VHA Office of Public Health and Environmental Hazards.
(2009). July
2009 analysis of VA health care utilization among US global
war on
546 NILES ET AL.
terrorism (GWOT) veterans: Operation Enduring
Freedom/Operation
Iraqi Freedom. Washington, DC: Author.
Weathers, F. W., Litz, B. T., Herman, D. S., Huska, J. A., &
Keane, T. M.
(1993, October). The PTSD checklist (PCL): Reliability,
validity, and
diagnostic utility. Paper presented at the meeting of the
International
Society of Traumatic Stress Studies, San Antonio, TX.
Weathers, F. W., Ruscio, A. M., & Keane, T. M. (1999).
Psychometric
properties of nine scoring rules for the Clinician-Administered
PTSD
Scale (CAPS). Psychological Assessment, 11, 124 –133.
doi:10.1037/
1040-3590.11.2.124
Received July 16, 2010
Revision received September 2, 2011
44. Accepted September 10, 2011 �
547COMPARING MINDFULNESS AND
PSYCHOEDUCATION
1
Paper Title
Student Name
Professor Name
Course Title
Date
Delete this text and compose an Introduction Paragraph that
tells your reader what your paper is going to be about and
creates interest about your paper. This paragraph might also
provide some background information that the reader needs to
know about to fully understand your paper.
Description of Brand
Delete this text and answer the first question in this Written
Assignment, “Identify and describe the brand. Description of
their previous image as a brand.” Be sure to clearly describe
the brand, the product or service that they offer, and how the
general public viewed the company before the time of the
rebrand.
45. Reason for Rebranding
Delete this text and answer the second question in this Written
Assignment, “Identify the reason for the rebranding. Why was
the company trying to bring about change?” Clearly explain
why the company chose to rebrand. What was the thing that
they were trying to change? Why was this change needed?
Support your answers through examples. Use research to
support your answer.
Overview of the Rebranding
Delete this text and answer the third question in this Written
Assignment, “Thoroughly describe the rebanding that the
company went through. Focus on at least three areas of change
for the rebranding; i.e. logo, product line, packaging, slogan,
advertising, endorsements, etc.” Clearly identity at least three
areas that the company changed or modified in their rebranding
efforts. Describe how those areas were changed and how
changing these area helped to reach the goal of the rebranding.
Compare the
Success of the Rebranding
Delete this text and answer the fourth question in this Written
Assignment, “Do you think the rebranding was successful?
Explain why or why not.” Explain and validate if you feel the
rebranding was a success or not. Use your own opinion based
on what you have learned in MKT100 so far, as well as data
collected through research to validate whether the rebrand was a
success. You might want to look for facts such as sales data,
grown of the business, etc. to validate the success of the
rebrand. Make sure to list citations for facts found during
research.
Conclusion
Delete this text and compose a Conclusion Paragraph that
briefly summarizes your paper and emphasizes the key points
you want your reader to take away from reading your paper.
References
Iacobucci, D. (2014). MM4: Marketing Management. Mason,
46. OH: South-Western Cengage Learning.
Delete this. List all other references used in your paper. List
references using APA format. Citations should also be listed
within the text to show which references facts were taken from.
1
Theory Into Practice: Four Social Work Case Studies
In this course, you select one of the following four case studies
and use it throughout
the entire course. By doing this, you will have the opportunity
to see how different
theories guide your view of a client and that client’s presenting
problem. Each time you
return to the same case, you use a different theory, and your
perspective of the problem
changes—which then changes how you ask assessment questions
and how you
intervene.
These case studies are based on the video- and web-based case
studies you encounter
in the MSW program.
Table of Contents
Tiffani Bradley
48. sexual exploitation and human trafficking. Tiffani has been
provided room and board
in the residential treatment facility for the past 3 months.
Tiffani describes herself as
heterosexual.
Presenting Problem: Tiffani has a history of running away. She
has been arrested on
three occasions for prostitution in the last 2 years. Tiffani has
recently been court
ordered to reside in a group home with counseling. She has a
continued desire to be
reunited with her pimp, Donald. After 3 months at Teens First,
Tiffani said that she
had a strong desire to see her sister and her mother. She had not
seen either of
them in over 2 years and missed them very much. Tiffani is
confused about the path
to follow. She is not sure if she wants to return to her family
and sibling or go back to
Donald.
Family Dynamics: Tiffani indicates that her family worked well
together until 8 years
ago. She reports that around the age of 8, she remembered being
awakened by
music and laughter in the early hours of the morning. When she
went downstairs to
investigate, she saw her parents and her Uncle Nate passing a
pipe back and forth
between them. She remembered asking them what they were
doing and her mother
49. saying, “adult things” and putting her back in bed. Tiffani
remembers this happening
on several occasions. Tiffani also recalls significant changes in
the home's
appearance. The home, which was never fancy, was always neat
and tidy. During
this time, however, dust would gather around the house, dishes
would pile up in the
sink, dirt would remain on the floor, and clothes would go for
long periods of time
without being washed. Tiffani began cleaning her own clothes
and making meals for
herself and her sister. Often there was not enough food to feed
everyone, and Tiffani
and her sister would go to bed hungry. Tiffani believed she was
responsible for
helping her mom so that her mom did not get so overwhelmed.
She thought that if
she took care of the home and her sister, maybe that would help
mom return to the
person she was before.
Sometimes Tiffani and her sister would come downstairs in the
morning to find empty
beer cans and liquor bottles on the kitchen table along with a
crack pipe. Her parents
would be in the bedroom, and Tiffani and her sister would leave
the house and go to
school by themselves. The music and noise downstairs
continued for the next 6
years, which escalated to screams and shouting and sounds of
people fighting.
Tiffani remembers her mom one morning yelling at her dad to
“get up and go to
work.” Tiffani and Diana saw their dad come out of the
50. bedroom and slap their mom
so hard she was knocked down. Dad then went back into the
bedroom. Tiffani
3
remembers thinking that her mom was not doing what she was
supposed to do in the
house, which is what probably angered her dad.
Shondra and Robert have been separated for a little over a year
and have started
dating other people. Diana currently resides with her mother
and Anthony, 31 years
old, who is her mother’s new boyfriend.
Educational History: Tiffani attends school at the group home,
taking general
education classes for her general education development (GED)
credential. Diana
attends Town Middle School and is in the 8th grade.
Employment History: Tiffani reports that her father was
employed as a welding
apprentice and was waiting for the opportunity to join the
union. Eight years ago, he
was laid off due to financial constraints at the company. He
would pick up odd jobs
for the next 8 years but never had steady work after that. Her
mother works as a
51. home health aide. Her work is part-time, and she has been
unable to secure full-time
work.
Social History: Over the past 2 years, Tiffani has had limited
contact with her family
members and has not been attending school. Tiffani did contact
her sister Diana a
few times over the 2-year period and stated that she missed her
very much. Tiffani
views Donald as her “husband” (although they were never
married) and her only
friend. Previously, Donald sold Tiffani to a pimp, “John T.”
Tiffani reports that she was
very upset Donald did this and that she wants to be reunited
with him, missing him
very much. Tiffani indicates that she knows she can be a better
“wife” to him. She
has tried to make contact with him by sending messages through
other people, as
John T. did not allow her access to a phone. It appears that over
the last 2 years,
Tiffani has had neither outside support nor interactions with
anyone beyond Donald,
John T., and some other young women who were prostituting.
Mental Health History: On many occasions Tiffani recalls that
when her mother was
not around, Uncle Nate would ask her to sit on his lap. Her
father would sometimes
ask her to show them the dance that she had learned at school.
When she danced,
52. her father and Nate would laugh and offer her pocket change.
Sometimes, their
friend Jimmy joined them. One night, Tiffani was awakened by
her uncle Nate and his
friend Jimmy. Her parents were apparently out, and they were
the only adults in the
home. They asked her if she wanted to come downstairs and
show them the new
dances she learned at school. Once downstairs Nate and Jimmy
put some music on
and started to dance. They asked Tiffani to start dancing with
them, which she did.
While they were dancing, Jimmy spilled some beer on her. Nate
said she had to go to
the bathroom to clean up. Nate, Jimmy, and Tiffani all went to
the bathroom. Nate
asked Tiffani to take her clothes off and get in the bath. Tiffani
hesitated to do this,
but Nate insisted it was OK since he and Jimmy were family.
Tiffani eventually
relented and began to wash up. Nate would tell her that she
missed a spot and would
scrub the area with his hands. Incidents like this continued to
occur with increasing
levels of molestation each time.
4
The last time it happened, when Tiffani was 14, she
pretended to be willing to dance
for them, but when she got downstairs, she ran out the front
door of the house. Tiffani
53. vividly remembers the fear she felt the nights Nate and Jimmy
touched her, and she
was convinced they would have raped her if she stayed in the
house.
About halfway down the block, a car stopped. The man
introduced himself as Donald,
and he indicated that he would take care of her and keep her
safe when these things
happened. He then offered to be her boyfriend and took Tiffani
to his apartment.
Donald insisted Tiffani drink beer. When Tiffani was drunk,
Donald began kissing her,
and they had sex. Tiffani was also afraid that if she did not have
sex, Donald would
not let her stay— she had nowhere else to go. For the next 3
days, Donald brought
her food and beer and had sex with her several more times.
Donald told Tiffani that
she was not allowed to do anything without his permission. This
included watching
TV, going to the bathroom, taking a shower, and eating and
drinking. A few weeks
later, Donald bought Tiffani a dress, explaining to her that she
was going to “find a
date” and get men to pay her to have sex. When Tiffani said she
did not want to do
that, Donald hit her several times. Donald explained that if she
didn’t do it, he would
get her sister Diana and make her do it instead. Out of fear for
her sister, Tiffani
relented and did what Donald told her to do. She thought at this
point her only
purpose in life was to be a sex object, listen, and obey—and
54. then she would be able
to keep the relationships and love she so desired.
Legal History: Tiffani has been arrested three times for
prostitution. Right before the
most recent charge, a new state policy was enacted to protect
youth 16 years and
younger from prosecution and jail time for prostitution. The
Safe Harbor for Exploited
Children Act allows the state to define Tiffani as a sexually
exploited youth, and
therefore the state will not imprison her for prostitution. She
was mandated to
services at the Teens First agency, unlike her prior arrests when
she had been sent
to detention.
Alcohol and Drug Use History: Tiffani’s parents were social
drinkers until about 8
years ago. At that time Uncle Nate introduced them to crack
cocaine. Tiffani reports
using alcohol when Donald wanted her to since she wanted to
please him, and she
thought this was the way she would be a good “wife.” She
denies any other drug use.
Medical History: During intake, it was noted that Tiffani had
multiple bruises and burn
marks on her legs and arms. She reported that Donald had
slapped her when he felt
55. she did not behave and that John T. burned her with cigarettes.
She had realized that
she did some things that would make them mad, and she tried
her hardest to keep
them pleased even though she did not want to be with John T.
Tiffani has been
treated for several sexually transmitted infections (STIs) at
local clinics and is
currently on an antibiotic for a kidney infection. Although she
was given condoms by
Donald and John T. for her “dates,” there were several “Johns”
who refused to use
them.
5
Strengths: Tiffani is resilient in learning how to survive the
negative relationships she
has been involved with. She has as sense of protection for her
sister and will sacrifice
herself to keep her sister safe.
Robert Bradley: father, 38 years old
Shondra Bradley: mother, 33 years old
Nate Bradley: uncle, 36 years old
Tiffani Bradley: daughter, 16 years old
Diana Bradley: daughter, 13 years old
Donald: Tiffani’s self-described husband and her former pimp
Anthony: Shondra’s live-in partner, 31 years old
John T.: Tiffani’s most recent pimp
56. 6
Paula Cortez
Identifying Data: Paula Cortez is a 43-year-old Catholic
Hispanic female residing in New
York City, NY. Paula was born in Colombia. When she was 17
years old, Paula left
Colombia and moved to New York where she met David, who
later became her
husband. Paula and David have one son, Miguel, 20 years old.
They divorced after 5
years of marriage. Paula has a five-year-old daughter, Maria,
from a different
relationship.
Presenting Problem: Paula has multiple medical issues, and
there is concern about
whether she will be able to continue to care for her youngest
child, Maria. Paula has
been overwhelmed, especially since she again stopped taking
her medication. Paula is
also concerned about the wellness of Maria.
Family Dynamics: Paula comes from a moderately well-to-do
family. Paula reports
suffering physical and emotional abuse at the hands of both her
57. parents, eventually
fleeing to New York to get away from the abuse. Paula comes
from an authoritarian
family where her role was to be “seen and not heard.” Paula
states that she did not feel
valued by any of her family members and reports never
receiving the attention she
needed. As a teenager, she realized she felt “not good enough”
in her family system,
which led to her leaving for New York and looking for
“someone to love me.” Her
parents still reside in Colombia with Paula’s two siblings.
Paula met David when she sought to purchase drugs. They
married when Paula was 18
years old. The couple divorced after 5 years of marriage. Paula
raised Miguel, mostly by
herself, until he was 8 years old, at which time she was forced
to relinquish custody due
to her medical condition. Paula maintains a relationship with
her son, Miguel, and her
ex-husband, David. Miguel takes part in caring for his half-
sister, Maria.
Paula does believe her job as a mother is to take care of Maria
but is finding that more
and more challenging with her physical illnesses.
Employment History: Paula worked for a clothing designer, but
she realized that her true
passion was painting. She has a collection of more than 100
drawings and paintings,
58. many of which track the course of her personal and emotional
journey. Paula held a full-
time job for a number of years before her health prevented her
from working. She is
now unemployed and receives Supplemental Security Disability
Insurance (SSD) and
Medicaid. Miguel does his best to help his mom but only works
part time at a local
supermarket delivering groceries.
Paula currently uses federal and state services. Paula
successfully applied for WIC, the
federal Supplemental Nutrition Program for Women, Infants,
and Children. Given
Paula’s low income, health, and Medicaid status, Paula is able
to receive in-home
childcare assistance through New York’s public assistance
program.
7
Social History: Paula is bilingual, fluent in both Spanish and
English. Although Paula
identifies as Catholic, she does not consider religion to be a big
part of her life. Paula
lives with her daughter in an apartment in Queens, NY. Paula is
socially isolated as she
has limited contact with her family in Colombia and lacks a
peer network of any kind in
her neighborhood.
59. Five (5) years ago Paula met a man (Jesus) at a flower shop.
They spoke several times.
He would visit her at her apartment to have sex. Since they had
an active sex life, Paula
thought he was a “stand-up guy” and really liked him. She
believed he would take care
of her. Soon everything changed. Paula began to suspect that he
was using drugs,
because he had started to become controlling and demanding.
He showed up at her
apartment at all times of the night demanding to be let in. He
called her relentlessly, and
when she did not pick up the phone, he left her mean and
threatening messages. Paula
was fearful for her safety and thought her past behavior with
drugs and sex brought on
bad relationships with men and that she did not deserve better.
After a couple of
months, Paula realized she was pregnant. Jesus stated he did not
want anything to do
with the “kid” and stopped coming over, but he continued to
contact and threaten Paula
by phone. Paula has no contact with Jesus at this point in time
due to a restraining
order.
Mental Health History: Paula was diagnosed with bipolar
disorder. She experiences
periods of mania lasting for a couple of weeks then goes into a
depressive state for
months when not properly medicated. Paula has a tendency
toward paranoia. Paula
60. has a history of not complying with her psychiatric medication
treatment because she
does not like the way it makes her feel. She often discontinues
it without telling her
psychiatrist. Paula has had multiple psychiatric hospitalizations
but has remained out of
the hospital for the past 5 years. Paula accepts her bipolar
diagnosis but demonstrates
limited insight into the relationship between her symptoms and
her medication.
Paula reports that when she was pregnant, she was fearful for
her safety due to the
baby’s father’s anger about the pregnancy. Jesus’ relentless
phone calls and voicemails
rattled Paula. She believed she had nowhere to turn. At that
time, she became scared,
slept poorly, and her paranoia increased significantly. After
completing a suicide
assessment 5 years ago, it was noted that Paula was
decompensating quickly and was
at risk of harming herself and/or her baby. Paula was
involuntarily admitted to the
psychiatric unit of the hospital. Paula remained on the unit for 2
weeks.
Educational History: Paula completed high school in Colombia.
Paula had hoped to
attend the Fashion Institute of Technology (FIT) in New York
City, but getting divorced,
then raising Miguel on her own interfered with her plans.
Miguel attends college full time
in New York City.
61. Medical History: Paula was diagnosed as HIV positive 15 years
ago. Paula acquired
AIDS three years later when she was diagnosed with a severe
brain infection and a T-
cell count of less than 200. Paula’s brain infection left her
completely paralyzed on the
right side. She lost function in her right arm and hand as well as
the ability to walk. After
8
a long stay in an acute care hospital in New York City, Paula
was transferred to a skilled
nursing facility (SNF) where she thought she would die. After
being in the skilled nursing
facility for more than a year, Paula regained the ability to walk,
although she does so
with a severe limp. She also regained some function in her right
arm. Her right hand
(her dominant hand) remains semi-paralyzed and limp. Over the
course of several
years, Paula taught herself to paint with her left hand and was
able to return to her
beloved art.
Paula began treatment for her HIV/AIDS with highly active
antiretroviral therapy
(HAART). Since she ran away from the family home, married
and divorced a drug user,
then was in an abusive relationship, Paula thought she deserved
62. what she got in life.
She responded well to HAART and her HIV/AIDS was well
controlled. In addition to her
HIV/AIDS disease, Paula is diagnosed with Hepatitis C (Hep
C). While this condition
was controlled, it has reached a point where Paula’s doctor is
recommending she begin
a new treatment. Paula also has significant circulatory
problems, which cause her
severe pain in her lower extremities. She uses prescribed
narcotic pain medication to
control her symptoms. Paula’s circulatory problems have also
led to chronic ulcers on
her feet that will not heal. Treatment for her foot ulcers
demands frequent visits to a
wound care clinic. Paula’s pain paired with the foot ulcers make
it difficult for her to
ambulate and leave her home. Paula has a tendency not to
comply with her medical
treatment. She often disregards instructions from her doctors
and resorts to holistic
treatments like treating her ulcers with chamomile tea. When
she stops her treatment,
she deteriorates quickly.
Maria was born HIV negative and received the appropriate
HAART treatment after birth.
She spent a week in the neonatal intensive care unit as she had
to detox from the
effects of the pain medication Paula took throughout her
pregnancy.
Legal History: Previously, Paula used the AIDS Law Project, a
not-for-profit organization
63. that helps individuals with HIV address legal issues, such as
those related to the child’s
father . At that time, Paula filed a police report in response to
Jesus' escalating threats
and successfully got a restraining order. Once the order was
served, the phone calls
and visits stopped, and Paula regained a temporary sense of
control over her life.
Paula completed the appropriate permanency planning
paperwork with the assistance
of the organization The Family Center. She named Miguel as
her daughter’s guardian
should something happen to her.
Alcohol and Drug Use History: Paula became an intravenous
drug user (IVDU), using
cocaine and heroin, at age 17. David was one of Paula’s “drug
buddies” and suppliers.
Paula continued to use drugs in the United States for several
years; however, she
stopped when she got pregnant with Miguel. David continued to
use drugs, which led to
the failure of their marriage.
Strengths: Paula has shown her resilience over the years. She
has artistic skills and has
found a way to utilize them. Paula has the foresight to seek
social services to help her
64. 9
and her children survive. Paula has no legal involvement. She
has the ability to bounce
back from her many physical and health challenges to continue
to care for her child and
maintain her household.
David Cortez: father, 46 years old
Paula Cortez: mother, 43 years old
Miguel Cortez: son, 20 years old
Jesus (unknown): Maria’s father, 44 years old
Maria Cortez: daughter, 5 years old
10
Jake Levy
Identifying Data: Jake Levy is a 31-year-old, married, Jewish
Caucasian male. Jake’s
wife, Sheri, is 28 years old. They have two sons, Myles (10) and
Levi (8). The family
resides in a two-bedroom condominium in a middle-class
neighborhood in Rockville,
MD. They have been married for 10 years.
65. Presenting Problem: Jake, an Iraq War veteran, came to the
Veterans Affairs Health
Care Center (VA) for services because his wife has threatened
to leave him if he
does not get help. She is particularly concerned about his
drinking and lack of
involvement in their sons’ lives. She told him his drinking has
gotten out of control
and is making him mean and distant. Jake reports that he and his
wife have been
fighting a lot and that he drinks to take the edge off and to help
him sleep. Jake
expresses fear of losing his job and his family if he does not get
help. Jake identifies
as the primary provider for his family and believes that this is
his responsibility as a
husband and father. Jake realizes he may be putting that in
jeopardy because of his
drinking. He says he has never seen Sheri so angry before, and
he saw she was at
her limit with him and his behaviors.
Family Dynamics: Jake was born in Alabama to a Caucasian,
Eurocentric family
system. He reports his time growing up to have been within a
“normal” family system.
However, he states that he was never emotionally close to either
parent and viewed
himself as fairly independent from a young age. His dad had
previously been in the
military and was raised with the understanding that his duty is
to support his country.
His family displayed traditional roles, with his dad supporting
66. the family after he was
discharged from military service. Jake was raised to believe that
real men do not
show weakness and must be the head of the household.
Jake’s parents are deceased, and he has a sister who lives
outside London. He and
his sister are not very close but do talk twice a year. Sheri is an
only child, and
although her mother lives in the area, she offers little support.
Her mother never
approved of Sheri marrying Jake and thinks Sheri needs to deal
with their problems
on her own. Jake reports that he has not been engaged with his
sons at all since his
return from Iraq, and he keeps to himself when he is at home.
Employment History: Jake is employed as a human resources
assistant for the
military. Jake works in an office with civilians and military
personnel and mostly gets
along with people in the office. Jake is having difficulty getting
up in the morning to go
to work, which increases the stress between Sheri and himself.
Shari is a special
education teacher in a local elementary school. Jake thinks it is
his responsibility to
provide for his family and is having stress over what is
happening to him at home and
work. He thinks he is failing as a provider.
Social History: Jake and Sheri identify as Jewish and attend a
67. local synagogue on
major holidays. Jake tends to keep to himself and says he
sometimes feels
pressured to be more communicative and social. Jake believes
he is socially inept
11
and not able to develop friendships. The couple has some
friends, since Shari gets
involved with the parents in their sons’ school. However,
because of Jake’s recent
behaviors, they have become socially isolated. He is very
worried that Sheri will leave
him due to the isolation.
Mental Health History: Jake reports that since his return to
civilian life 10 months ago,
he has difficulty sleeping, frequent heart palpitations, and
moodiness. Jake had seen
Dr. Zoe, a psychiatrist at the VA, who diagnosed him with post-
traumatic stress
disorder (PTSD). Dr. Zoe prescribed Paxil to help reduce his
symptoms of anxiety
and depression and suggested that he also begin counseling.
Jake says that he does
not really understand what PTSD is but thought it meant that a
person who had it was
“going crazy,” which at times he thought was happening to him.
He expresses
concern that he will never feel “normal” again and says that
68. when he drinks alcohol,
his symptoms and the intensity of his emotions ease. Jake
describes that he
sometimes thinks he is back in Iraq, which makes him feel
uneasy and watchful. He
hates the experience and tries to numb it. He has difficulty
sleeping and is irritable, so
he isolates himself and soothes this with drinking. He talks
about always feeling
“ready to go.” He says he is exhausted from being always alert
and looking for
potential problems around him. Every sound seems to startle
him. He shares that he
often thinks about what happened “over there” but tries to push
it out of his mind.
Nighttime is the worst, as he has terrible recurring nightmares
of one particular event.
He says he wakes up shaking and sweating most nights. He adds
that drinking is the
one thing that seems to give him a little relief.
Educational History: Sheri has a bachelor’s degree in special
education from a local
college. Jake has a high school diploma but wanted to attend
college upon his return
from the military.
Military History: Jake is an Iraqi War veteran. He enlisted in
the Marines at 21 years
old when he and Shari got married due to Sheri being pregnant.
The family was
stationed in several states prior to Jake being deployed to Iraq.
69. Jake left the service
10 months ago. Sheri and Jake had used military housing since
his marriage, making
it easier to support the family. On military bases, there was a lot
of social support and
both Jake and Sheri took full advantage of the social systems
available to them
during that time.
Medical History: Jake is physically fit, but an injury he
sustained in combat sometimes
limits his ability to use his left hand. Jake reports sometimes
feeling inadequate
because of the reduction in the use of his hand and tries to push
through because he
worries how the injury will impact his responsibilities as a
provider, husband, and
father. Jake considers himself resilient enough to overcome this
disadvantage and
“be able to do the things I need to do.” Sheri is in good physical
condition and has
recently found out that she is pregnant with their third child.
Legal History: Jake and Sheri deny having criminal histories.
12
Alcohol and Drug Use History: As teenagers, Jake and Sheri
used marijuana and
drank. Both deny current use of marijuana but report they still
70. drink. Sheri drinks
socially and has one or two drinks over the weekend. Jake
reports that he has four to
five drinks in the evenings during the week and eight to ten
drinks on Saturdays and
Sundays. Jake spends his evenings on the couch drinking beer
and watching TV or
playing video games. Shari reports that Jake drinks more than
he realizes, doubling
what Jake has reported.
Strengths: Jake is cognizant of his limitations and has worked
on overcoming his
physical challenges. Jake is resilient. Jake did not have any
disciplinary actions taken
against him in the military. He is dedicated to his wife and
family.
Jake Levy: father, 31 years old
Sheri Levy: mother, 28 years old
Myles Levy: son, 10 years old
Levi Levy: son, 8 years old
13
Helen Petrakis
Identifying Data: Helen Petrakis is a 52-year-old, Caucasian
female of Greek descent
71. living in a four-bedroom house in Tarpon Springs, FL. Her
family consists of her
husband, John (60), son, Alec (27), daughter, Dmitra (23), and
daughter Althima (18).
John and Helen have been married for 30 years. They married in
the Greek Orthodox
Church and attend services weekly.
Presenting Problem: Helen reports feeling overwhelmed and
“blue.” She was referred
by a close friend who thought Helen would benefit from having
a person who would
listen. Although she is uncomfortable talking about her life with
a stranger, Helen
says that she decided to come for therapy because she worries
about burdening
friends with her troubles. John has been expressing his
displeasure with meals at
home, as Helen has been cooking less often and brings home
takeout. Helen thinks
she is inadequate as a wife. She states that she feels defeated;
she describes an
incident in which her son, Alec, expressed disappointment in
her because she could
not provide him with clean laundry. Helen reports feeling
overwhelmed by her
responsibilities and believes she can’t handle being a wife,
mother, and caretaker
any longer.
Family Dynamics: Helen describes her marriage as typical of a
traditional Greek
72. family. John, the breadwinner in the family, is successful in the
souvenir shop in
town. Helen voices a great deal of pride in her children. Dmitra
is described as smart,
beautiful, and hardworking. Althima is described as adorable
and reliable. Helen
shops, cooks, and cleans for the family, and John sees to yard
care and maintaining
the family’s cars. Helen believes the children are too busy to be
expected to help
around the house, knowing that is her role as wife and mother.
John and Helen
choose not to take money from their children for any room or
board. The Petrakis
family holds strong family bonds within a large and supportive
Greek community.
Helen is the primary caretaker for Magda (John’s 81-year-old
widowed mother), who
lives in an apartment 30 minutes away. Until recently, Magda
was self-sufficient,
coming for weekly family dinners and driving herself shopping
and to church. Six
months ago, she fell and broke her hip and was also recently
diagnosed with early
signs of dementia. Helen and John hired a reliable and trusted
woman temporarily to
check in on Magda a couple of days each week. Helen would go
and see Magda on
the other days, sometimes twice in one day, depending on
Magda’s needs. Helen
would go food shopping for Magda, clean her home, pay her
bills, and keep track of
Magda’s medications. Since Helen thought she was unable to
continue caretaking for
73. both Magda and her husband and kids, she wanted the helper to
come in more often,
but John said they could not afford it. The money they now pay
to the helper is
coming out of the couple’s vacation savings. Caring for Magda
makes Helen think
she is failing as a wife and mother because she no longer has
time to spend with her
husband and children.
14
Helen spoke to her husband, John (the family decision maker),
and they agreed to
have Alec (their son) move in with Magda (his grandmother) to
help relieve Helen’s
burden and stress. John decided to pay Alec the money typically
given to Magda’s
helper. This has not decreased the burden on Helen since she
had to be at the
apartment at least once daily to intervene with emergencies that
Alec is unable to
manage independently. Helen’s anxiety has increased since she
noted some of
Magda’s medications were missing, the cash box was empty,
Magda’s checkbook
had missing checks, and jewelry from Greece, which had been
in the family for
generations, was also gone.
Helen comes from a close-knit Greek Orthodox family where
74. women are responsible
for maintaining the family system and making life easier for
their husbands and
children. She was raised in the community where she currently
resides. Both her
parents were born in Greece and came to the United States after
their marriage to
start a family and give them a better life. Helen has a younger
brother and a younger
sister. She was responsible for raising her siblings since both
her parents worked in a
fishery they owned. Helen feared her parents’ disappointment if
she did not help
raise her siblings. Helen was very attached to her parents and
still mourns their loss.
She idolized her mother and empathized with the struggles her
mother endured
raising her own family. Helen reports having that same fear of
disappointment with
her husband and children.
Employment History: Helen has worked part time at a hospital
in the billing
department since graduating from high school. John Petrakis
owns a Greek souvenir
shop in town and earns the larger portion of the family income.
Alec is currently
unemployed, which Helen attributes to the poor economy.
Dmitra works as a sales
consultant for a major department store in the mall. Althima is
an honors student at a
local college and earns spending money as a hostess in a family
friend’s restaurant.
During town events, Dmitra and Althima help in the souvenir
75. shop when they can.
Social History: The Petrakis family live in a community
centered on the activities of the
Greek Orthodox Church. Helen has used her faith to help her
through the more
difficult challenges of not believing she is performing her “job”
as a wife and mother.
Helen reports that her children are religious but do not regularly
go to church
because they are very busy. Helen has stopped going shopping
and out to eat with
friends because she can no longer find the time since she
became a caretaker for
Magda.
Mental Health History: Helen consistently appears well
groomed. She speaks clearly
and in moderate tones and seems to have linear thought
progression—her memory
seems intact. She claims no history of drug or alcohol abuse,
and she does not
identify a history of trauma. More recently, Helen is
overwhelmed by thinking she is
inadequate. She stopped socializing and finds no activity
enjoyable. In some
situations in her life, she is feeling powerless.
76. 15
Educational History: Helen and John both have high school
diplomas. Helen is proud
of her children knowing she was the one responsible in helping
them with their
homework. Alec graduated high school and chose not to attend
college. Dmitra
attempted college but decided that was not the direction she
wanted. Althima is an
honors student at a local college.
Medical History: Helen has chronic back pain from an old
injury, which she manages
with acetaminophen as needed. Helen reports having periods of
tightness in her
chest and a feeling that her heart was racing along with trouble
breathing and
thinking that she might pass out. One time, John brought her to
the emergency room.
The hospital ran tests but found no conclusive organic reason to
explain Helen’s
symptoms. She continues to experience shortness of breath,
usually in the morning
when she is getting ready to begin her day. She says she has
trouble staying asleep,
waking two to four times each night, and she feels tired during
the day. Working is
hard because she is more forgetful than she has ever been.
Helen says that she
feels like her body is one big tired knot.
Legal History: The only member of the Petrakis family that has
77. legal involvement is
Alec. He was arrested about 2 years ago for possession of
marijuana. He was
required to attend an inpatient rehabilitation program (which he
completed) and was
sentenced to 2 years’ probation. Helen was devastated,
believing John would be
disappointed in her for not raising Alec properly.
Alcohol and Drug Use History: Helen has no history of drug use
and only drinks at
community celebrations. Alec has struggled with drugs and
alcohol since he was a
teen. Helen wants to believe Alec is maintaining his sobriety
and gives him the
benefit of the doubt. Alec is currently on 2 years’ probation for
possession and has
recently completed an inpatient rehabilitation program. Helen
feels responsible for his
addiction and wonders what she did wrong as a mother.
Strengths: Helen has a high school diploma and has been
successful at raising her
family. She has developed a social support system, not only in
the community but
also within her faith at the Greek Orthodox Church. Helen is
committed to her family
system and their success. Helen does have the ability to
multitask, taking care of her
immediate family as well as fulfilling her obligation to her
mother-in-law. Even under
78. the current stressful circumstances, Helen is assuming and
carrying out her
responsibilities.
John Petrakis: father, 60 years old
Helen Petrakis: mother, 52 years old
Alec Petrakis: son, 27 years old
Dmitra Petrakis: daughter, 23 years old
Althima Petrakis: daughter, 18 years old
Magda Petrakis: John’s mother, 81 years old