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Mokom 1
Case study on Cognitive Dissonance psychological phenomena
Comment by Windows User: Good for you for selecting a
less popular subject
Abstract
The human mind enables us to perceive and understand things
differently, our perception on things is highly influenced by our
psychological stability. A phenomenon is therefore anything
that is perceived to exist, it may be natural phenomena such as
force of gravity, biological processes, visual phenomena such as
peripheral drift, social phenomena such as social or economic
networking and then psychological phenomena which is the
focus of this research paper. Comment by Windows User: FYI
the abstract is generally a summary of the paper. This paragraph
provides more of an introduction. Not a big deal but for the
future it may be better to write the abstract after you have
prepared your paper and then in just a few sentences summarize
the main points or a ‘boiled down’ version of the case
Introduction;
What is a psychological phenomenon? Moving around at work
places, home and even at school you may realize that people
behave differently at different moments, sometimes these
behavior may be as a result of the prevailing environmental,
social, and economic factor, it is relatively correct to say that
most of human behavior is influence by psychological factors
such as depression. Through your observation, you will realize
that you get results that are reliably in an empirical systematic
manner. Therefore, a psychological phenomenon is generated
through human behavior and how human responds to influences
around him. Comment by Windows User: These behaviors or
this behavior Comment by Windows User: Reliable
Comment by Ed Schultze: How a human Comment by
Windows User: how humans respond to influence or perhaps
how humans are influenced Comment by Windows User: it
seems the intent of this opening paragraph is to introduce the
idea that underneath most behavior our motives and forces
including psychological forces. This could be clearer
Cognitive Dissonance is a psychological phenomenon that
occurs when one experiences a conflict of attitude, behavior, or
beliefs. Someone’s behavior determines hi/her cognition
creating a cognition dissonance. This is a state of having
inconsistent thoughts, believes or attitude as relating to
behavior decisions and attitude change. Sometime clinical
psychotherapy sessions don’t make complete use of the
researches that have been formulated on trial/ tests concerning
psychology that are available. This case study paper aims at
providing both sociological, philosophical, and psychological
understanding of this phenomena, how it affects the affected
individuals and trying to provide a scientific approach and
medical approach of assisting the individual either to
completely recover and how to leave with the situation.
Comment by Windows User: good Comment by Windows
User: his/her Comment by Windows User: Not necessarily. (1)
Behavior or action may result in a cognition, a thought, and (2)
some behaviors may result in cognitive dissonance Comment by
Windows User: do not Comment by Windows User: this
sentence is unclear Comment by Windows User: monitor
agreement this paper aims… and tries (as opposed to trying)
Comment by Windows User: unclear
This case study paper explores, the key indicators that of
cognitive dissonance, how the condition affects the affected
individuals and psychotherapy measures that can be employed
to assist the affected individuals. This paper is a representation
of a month case study that I carried out on one of my relative
who for some time has been experiencing intra-personal
conflicts. For many years he was addicted to smoking and
excessive drinking habits, after efforts to keep him in a
rehabilitation center for nine months, the habit seemed to have
changed and he seemed to be a changed person who was ready
to be incorporated back to his job that he lost as a result of his
excessive drinking habits. After reading this article the reader
will be able to understand what Cognitive Dissonance really is
and how one can understand/ know if he is facing such a
psychological phenomenon and how he/can go about controlling
the situation. Comment by Windows User: Relatives and 2. I
am impressed that you spent a month on this Good for you. I
hope this is not your real cousin as we discussed in class You
get a lot of credit for this Comment by Windows User:
Caps not needed here Comment by Windows User: write
gender neutral he or she consistently Comment by Windows
User: Comment by Windows User:
Background
To some extent, psychological phenomena have been at the core
of psychological disorders, such as depressions, and these
disorders have been among the factors that lead to interpersonal
conflicts as a result of misunderstanding between the affected
individuals and the people around them who may not be aware
of such phenomena, these factors have somehow played a role
in the rising cases of people committing suicides when the
affected individuals feel that the people around them and those
that are close to them don’t understand them. A good example is
when someone who has had a bad criminal record reforms but
later the aspect of his past criminal life starts coming back to
him creating a conflict situation within him as to whether he
should just assume what people will say and get back to his old
ways, or strive to maintain his new ways of life, if there is no
one around to encourage such an individual in his new ways, he
may face a state of depression given that he may opt that in
order to in the state of his new life, he should start drinking or
smoking to help him control the urge. Comment by Windows
User: can be seen as Comment by Windows User: run on
sentence 111 words break it down
Case study situation.
When he was released from a rehabilitation center, my cousin
seemed like he had completely recovered from his drinking and
smoking habits, but for the past few months he has been
experiencing personal dis-satisfaction with everything he does
and wants, to level of even avoiding being seen at some hours
of the day or even talking to people directly. The paper is a
result of a one-month case study on cognitive dissonance and its
effects. Comment by Windows User: dissatisfaction not
hyphenated Comment by Windows User: do not use
absolutes. There are almost always exceptions qualify your
statements Comment by Ed Schultze: is this personal
dissatisfaction and avoidance the product of withdrawal, anxiety
and/or cognitive dissonance? How could you tease each of these
out?
Methodology
Observation; for a start I had to take a close observation on
every move made by the persona under study to try and his
physical behaviors and how he was relating with everyone and
everything around him. Keen observation helps in providing the
first hand information about anything. Comment by Windows
User: good sentence short and sweet, clear and strong
Spending time with the person of interest; spending time with
the person of interest provided a good avenue to understand his
thinking and how he reacted to the factors in the environment
around him. Spending time with the person under study gave me
a good time to create a more close relationship with him with
the aims of building great trust between us. Spending more time
together also gave him a chance to ask me questions on how
people viewed him when he was in the rehabilitation center and
how people view him today now that he recently came out the
center and he is struggling to get back on track and gain
something constructive out of his life. Comment by Windows
User: great basis for a case study. I hope you are disguising the
subject’s identity
Interviewing; this was carried out in a psychotherapy manner
and at set time and on specific days. This aimed at finding out
how he was viewing things psychologically and physically,
wanted to find out whether the current environment outside the
rehabilitation institution was helping him keep up and maintain
his new habit or was the environment challenging for him to
keep maintaining a sober mind from alcoholism and smoking
habits. Comment by Windows User: do you mean there was a
structure to your interviews and data gathering? A regular time
and routine?
Evaluation and review of paste case study articles on cognitive
dissonance; the articles helped in providing key information on
the expected results of the case study, guidelines on other steps
to take to ensure effective and positive results from the study.
Comment by Windows User: past Comment by Windows
User: excellent
Results and findings.
Close observations showed that my person of interest was
experiencing frequent aspects of anxiety, high tempers and a
sense of being almost angry at everything around him, factors
that made him to hind from people so that he can smoke and
drink with notion of relaxing his mind and feel relived from
himself. The observation enabled me to understand that my
cousin was having a big problem fighting the temptations of
smoking and drinking, he was having problems on deciding
whether he should be open and share what he was experiencing
with his parents and the people around him. Comment by
Windows User: hide Comment by Windows User: how
much could the anxiety, frustration and anger be attributed to
(1) psychological withdrawal, usually follows physical
withdrawal, (2) adjustment re-adjustment inpatient to outpatient
to step down (3) what replaces the addictive
substance/process??? (4) what about you? How do you factor in
your involvement. What biases, feelings, thinking and reactions
are stirred up just due to your presence/involvement much less
study of him?? How could you measure this???
Spending time with the person under study gave us a good time
to create an aspect of openness to each other something that
enabled him to be open with me, through this I found out the
fact was the urge of him smoking always came upon him
whenever he was alone and thought of his past life. Spending
time at the rehabilitation facility even though it helped him stop
his habits, the situation of him being away from his parents and
siblings made an aspects of hatred towards his parents, he
always felt that they took him there because they never liked
him and not that they wanted to correct him and make him a
better person, the stay at the facility had helped him change
from the habit of drinking and smoking, but somehow affected
his emotions and created two different personas in him, one
person that seemed changed and wanted to start and wanted to
have a new life, and at the same time another person who had a
high degree of hatred towards his own parents and especially
his dad. And given that he never wanted to show his dad, he
still viewed smoking and drinking as a way that can help him
control his emotions. Comment by Windows User:
Addiction, nicotine besides strong physical addiction there is
considerable learning (think classical conditioning) going on
over all the years he has been smoking. Feelings are glued to
certain behaviors that revolve around smoking. If he smoked for
20 years that can constitute some strong gluing- superglue
Comment by Windows User: Run on sentence 126 words
Comment by Windows User: So he was admitted with
resentment and doubt regarding his parents true feelings
towards him ( get rid of him, look down their noses at him get
him needed help. These conflicting thoughts connected to some
focused and intense feelings towards his father. At the same
time this conflict may also connect to his identity and comfort
with a transformation becoming a ‘straight’ version of himself.
You could really explore this in some depth what this might
mean to him at various levels. If he believes his parents did not
act out of caring could he then believe a transformation on his
part- going straight was ‘caving’ and conforming to others
version of him which can also equate to devaluing oneself
Given that the time we spent together created a sense trust
between us, the interview sessions were not hard to handle even
though the feedbacks and reactions were the same as those that I
noted whenever we hanged out. Comment by Windows
User: This seems very important. No matter how you set this up
and no matter how you intended to balance out being his friend
and cousin and also a ‘researcher’ the relationship between the
two of you was changing. Can you think about this and then
how this might have effected him?
Data
The figure below is a representation of the process of cognitive
dissonance.
From the above diagram we realize that inconsistency in
attitude, thoughts and behavior are the key factor that lead to a
state of dissonance which in turn leads to unpleasant arousal or
results. The diagram suggests that these effects can be reduced
by creating environment that will help in removing these
inconsistencies in thoughts, attitude and behavior. Comment by
Windows User: I love the chart!!!!! Comment by Windows
User: Most times after dissonance is exposed and anxiety comes
along as fuel then a change occurs in thinking, actions and/or
feelings.
Discussion
What are the effects of prolonged cognitive dissonance?
From the above study, I found that cognitive dissonance
provides a clear picture of someone’s intrinsic desire for
consistency a situation that may psychological discomfort,
therefore there is need to create measures that will help avoid
situations that may lead to this psychological phenomenon.
Generally, people have the character of describing how the
world is and how it works and not understanding how it works
creates an aspect of cognitive dissonance. The theory of
cognitive dissonance provides several dimensions most those
based on region aspects or virtues. Religion virtues play a key
role in giving explanations and directions to follow in life. An
aspect that enables us to be consistent in our thoughts, attitude
and behavior towards the natural phenomena and the nature of
science. Therefore, if we don’t understand this phenomena, we
will be in a state of cognitive dissonance. From my case study I
can say that given that the person under study never got that
love he expected to get when he came out of the correction
facility from the people close to him, his attitude towards them
and any other person that seemed hostile to him, grew towards a
negative direction and something that also affected his thoughts
and behavior, making him believe that the best way to remain in
a good state of mind is hiding so that he can drink and smoke.
And after smoking he would remain angry and annoyed at
everyone and everything around him. Given that neither of his
parents cared to listen to him so that they can understand what
was happening to him, he preferred spending time alone.
Creating a conducive environment would really help in avoiding
this phenomenon and make him live a normal life with everyone
and even motivate him to completely transform into a new
person that he aspired to be after getting from the rehabilitation
facility. Comment by Ed Schultze: May produce psychological
discomfort Comment by Ed Schultze: So one response might
be to avoid exposure to experiences that can potentially activate
cognitive dissonance. Is this the primary response to cognitive
dissonance?? Comment by Ed Schultze: Religion?? Or
religious aspects?? Comment by Windows User: Religious
virtues Comment by Ed Schultze: Incomplete sentence
Comment by Ed Schultze: Do not use contractions in
formal academic papers
Sigmund Freud describes cognitive dissonance as an experience
of something that is known to a person not entirely new or
strange something he called in Germany as “uncanny” crates a
paradox situation to the person experiencing it and it may
sometime lead to outright rejection of that which is morally and
ethically right since the situations makes the person not think
critically and rationalize factors around him/her.
Originally and under normally circumstances, emotional
response is influenced by the neuroscientific literature in
understanding cognitive dissonance as a physical phenomenon.
Basing our understanding on motivational directions model
which states that the mind should regulate and individual’s
response to their own anger and if the prevailing circumstances
are not changed by either the individual himself/herself or those
around them, their motivation to control their anger and other
emotions may not develop. The fact is frequent cases of
cognitive dissonance re-arises the previous emotional aspects
that ought to be controlled by the rationalization criteria and if
rationalization does not take place, and the emotion controlled
effectively by the person, then the previous character may grow
and take better of him/her and lead to mood control
complications such as depression, anxiety, or post-traumatic
stress disorders. Comment by Ed Schultze: An individual’s
Comment by Ed Schultze: Run on sentence
Effects of cognitive dissonance at work places.
Cognitive dissonance is not a phenomenon that affects people
only at homes or at schools but also at work place and it is a
key reason professional stress where by one will find it hard
supporting the daily programs of the company and in an
organization, in areas such as risk management, human resource
departments given that these are some of the key areas in a
company or an organization where staffs may be coerced
towards handling and tolerating, supporting and executing daily
obligations. Work places require great ethical traits therefore is
fundamental to emphasize the importance of these traits .never
the less it comes out that even though people are faced with
stressful situations at work places, they are still able to carry
out their duties as per the regulations of the company or the
organizations they are working for, the following factors
influence this aspects;
1. Positional respect; this is where they do things because the
information to them has been passed from a position higher than
their positions.
2. Normalization; this refers to a state in intrinsic justification
i.e. When someone feels that something is not pleasant to
him/her, but he/she has to do it since its part of the job and
others are doing it. Comment by Ed Schultze: Spell out in
other words in essence however For example may be better
3. Emotional trading; this is where an employee is forced to
think of the future benefits of his/her obedience to those in a
higher office.
The above factors are just a sample of personal justification
techniques that when is forced to follow when faced with an
actual choice situation at a work place. This means that
sometime people try to convince themselves to take a hard
choice even if it is against their inner notions and believes or
even if they are not in the mood to do it, a state that creates
intrinsic conflict. It is within the human nature to avoid getting
into conflicts, arguments and confrontations with their bosses at
places of work but it is also good for those in managerial
offices to understand this factor for them to treat their staff in
accordance with good work ethical norms to avoid a situation
where staff are forced to struggle fighting with personal
conflicts and conflicts with the management at the same time. It
is always good to create a working environment that will enable
the employees to deliver their work mandates effectively
despite the personal problems that they may be facing at any
given moment. Comment by Ed Schultze: Did you mean
bekiefs?
If the cognitive dissonance remain unsolved or unattended to,
they may lead to the falling problems at work place; increased
cases of absenteeism, withdrawal and disengagement, high level
of reduced performance by staff, negative and unethical
behavior at work that include; intentional efforts by staff to
block and disrupt daily activities of the company or
organization something that may cause negative impacts to the
company, malicious compliance, cases of aggression and
sabotage. On the other when the cognitive dissonance issues are
addressed the following will be achieved at work places; high
staff turnover, improved health impacts and work place stress
control.
From the above scenarios, we get that even though people may
not understand the impacts that cognitive dissonance has to the
affected people, a lot has to be reviewed in regard to depression
cases and suicidal cases that arise daily in different parts of the
country from homes to schools and even at work places, as
much at this phenomenon seems like a factor that can be dealt
with and solved in a simple manner, the truth is understanding
this phenomenon may be challenging given that it is a brain
related issue that to a high degree requires psychiatric expertise
to evaluate and create control measures. Apart from affecting
individuals as personal levels, cognitive dissonance also has
negative effects on the person’s ability to learn and
understanding; in a case study carried out by emerald insight, it
become clear that psychological discomfort creates state that
prevents people from gaining and learning new concepts in the
process of transformation over a given timeframe. Even though
productive HR habits may help in controlling an individual’s
inconsistent attitude and unpleasant psychological states and
improve their learning work behavior. This therefore means that
in constructing and control organizational learning needs basic
transformation in the manner in which we think and reason,
behave, relate with other during the process, the effective HR
practices can assist in avoiding dissonance and this involves
learning behavior in the work place. Comment by Ed
Schultze: Spell out
Conclusion, implications and reaction
Understanding cognitive resonance has to be though a
psychological approach and given that this is complication of
the human mind, and when identified psychological measures
have to be put in place to facilitate effective treating and
control of the affected individual. And in order to reduce this
phenomenon, the following three criteria need to be considered;
1. Change of behavior, this refer to doing away with old/
current personal character of an individual, this helps in
reducing the cognitive dissonance phenomenon.
2. Change of personal beliefs; our minds are constantly filtering
out conflicting data to support our beliefs. So, a person who
smokes may look for, and believe, scientific research that says
smoking does not necessarily cause cancer. That way, when
they continue their behavior, they experience less dissonance.
3. Justify your beliefs and behavior. A good example of this is a
person who spends money frivolously. They might convince
themselves that throwing their money away is ok, saying things
such as “you can’t take it with you.” Another example is when a
person who engages in risky behavior says “you’ve got to live
every day to the fullest. You never know when it will be your
last” in an attempt to rationalize their risky behavior.
References
Beauvois, J. L., Joule, R. V., 1996. A radical dissonance theory.
London: Taylor and Francis.
Cooper, J. (2007). Cognitive dissonance: 50 years of a classic
theory. London: Sage Publications.
Festinger, L. (1957). A Theory of Cognitive Dissonance.
California: Stanford University Press.
Harmon-Jones, E., Mills, J., Cognitive Dissonance: Perspectives
on a Pivotal Theory in Social
Hull, A.M. (2002). Neuroimaging findings in post-traumatic
stress disorder. The British Journal of Psychiatry 181: 102-10.
R. A. Wicklund, J. W. Brehm. (1976). Perspectives on
Cognitive Dissonance.
Harmon-Jones, E., Mills, J., Cognitive Dissonance:
Perspectives on a Pivotal Theory in Social Psychology.
American Psychological Association, Washington, DC, pp. 71–
99.
0-10 points 10 minimum word count
0-5 points 3 Grammar, spelling and word usage
0-5 points 3 Thematic development and clarity
0-5 points 5 Clearly connects focus of case study to
course material
0-5 points 5 Connects Theory, Research and Practice
0-10 points 10 Demonstrates a thoughtful understanding
and explanation of a psychological phenomena
0-5 points 4 Effectively uses the case study format to
communicate the above
0-5 points 5 Insightful and meaningful conclusions
0-50 points 45 Total
Very interesting. You are the first person to focus on a
cognitive dissonance. As mentioned, I do hope this is fabricated
subject (re your cousin).
Cognitive dissonance essentially explains the force or drive
associated to contradiction between one’s beliefs, thoughts and
actions. This force can cause significant anxiety and can be a
good force in driving change. In your paper you point to many
contradictions and ‘disconnects’(e.g., (a) maintain new
behaviors and identity or return to substance use, this may be
compounded by negative feelings and thoughts towards his
parents (hating them or appreciating them); (b) the fantasy of
how the real world might treat and view him and the reality of
new experiences (c) options at discharge: tolerate the distrust he
may have for some key family members or go back to hiding
and secrets which contradicts a path to sobriety) Each of these
and more can cause considerable tension and anxiety. Following
the theory of cognitive dissonance this anxiety should push a
change in either the thinking, belief or behavior. It could push
him either way. This makes this a great area for critical thinking
and exploration. Since anxiety seems very related to substance
use, cognitive dissonance can provide support for a
psychodynamic explanation for addiction.
You extend your critical thinking by noting that cognitive
dissonance can be a significant factor for many at work
This is a very good paper and demonstrates some excellent
critical thinking.
Please address the writing. It was difficult to get to these points
and appreciate the depth and creativity that you have provided.
The writing needs to be clearer.
Case 3.2
A Shift for Lieutenant Colonel Adams
Lt. Col. John Adams was an aeronautical engineer in the Air
Force who was recognized as an accomplished officer; he rose
quickly through the ranks of lieutenant, captain, and major. In
addition, he successfully completed a number of professional
development courses in the Air Force and received a master’s
degree in engineering. In the earlier part of his service, his
career assignments required overseeing 15- to 20-person shifts
that were responsible for routine maintenance schedules for
squadron and base aircraft. As he progressed in rank, he moved
to engineering projects, which were supported by small
technical staffs.
Based on his strong performance, Major Adams was promoted
to lieutenant colonel earlier than his peers. Instead of moving
him into another engineering position, the personnel bureau and
his assignment officer decided that Lieutenant Colonel Adams
would benefit from a tour in which he could expand his
professional background and experience. Consequently, he was
assigned to Base X as the commanding officer of the
administration branch. Base X was an airbase with
approximately 5,000 military and civilian personnel.
As the administration officer, Adams was the senior human
resource officer and the principal adviser to the base
commander on all human resource issues. Adams and his staff
of 135 civilian and military personnel were responsible for
personnel issues, food services, recreation, family support, and
medical services. In addition, Lieutenant Colonel Adams was
assigned to chair the Labor–Management Relations Committee
for the base.
At the end of the Cold War, as part of the declared peace
dividend, the government decided to reduce its defense budget.
In February, barely 6 months after Adams took over command
of the administration branch, the federal government announced
a significant reduction in the size of the military and the closure
of many bases. Base X was to be closed as an air base and
reassigned to the Army. The closure was to take place within 1
year, and the base was to be prepared for the arrival of the first
Army troops in 2 years. As part of the reduction program, the
federal government initiated voluntary retirement programs for
civilian and military personnel. Those wanting to retire had
until April 1 to decide.
Orders for the conversion of the airbase included the following:
• The base will continue normal operations for 6 months.
• The squadrons—complete with aircrews, equipment, and
families (1,000)—must be relocated to their new bases and
operational by August 1.
• The remaining base personnel strength, both civilian and
military, must be reduced by 30%.
• The base must continue to provide personnel for operational
missions.
• The reduction of personnel must be consistent with federal
voluntary early-retirement programs.
• The base must be prepared with a support structure to accept
2,000 new soldiers, expected to arrive in 2 years.
Adams was assigned to develop a human resource plan that
would meet the imposed staff levels for the entire base while
ensuring that the base was still able to perform the operational
tasks it had been given. Faced with this daunting task, Adams
conducted an extensive review of all of the relevant orders
concerning the base transformation, and he familiarized himself
with all of the rules concerning the early-retirement program.
After a series of initial meetings with the other base branch
chiefs, he laid out a plan that could be accomplished by the
established deadlines. At the same time, he chaired a number of
meetings with his own staff about how to meet the mandated
reductions within his own branch.
After considering the target figures for the early-retirement
program, it was clear that the mandated numbers could not be
reached. Simply allowing everyone who had applied for early
retirement to leave was not considered an option because doing
so would devastate entire sections of the base. More job cuts
were required, and choices had to be made as to who would
stay, why, and in what areas. Adams met stiff resistance in the
meetings to determine what sections would bear the brunt of the
additional cutbacks.
Adams conducted his own independent analysis of his own
branch before consulting with his staff. Based on his thorough
examination of the data, he mandated further reductions in his
sections. Specifically targeted were personnel in base housing,
single-person accommodations, family services, and
recreational sections. He also mandated a further 10% cut of
military positions in his sections.
After meeting the mandated reduction targets, Lieutenant
Colonel Adams was informed that the federal government would
accept all personnel who applied for early retirement, which
was an unexpected decision. When superimposed on the already
mandated reductions, this move caused critical shortages in key
areas. Within weeks of implementation of the plan, the base
commander was receiving mounting complaints from both
civilian and military members over the implementation of the
plan.
Incidents of stress, frustration, and discontent rose dramatically.
Families trying to move found support services cut back or
nonexistent. Members of the transition staff were forced to
work evenings and weekends. Family support services were
swamped and asking for additional help.
Despite spending a large amount of overtime trying to address
the diverse issues both base-wide and within his branch, Adams
found himself struggling to keep his head above water. To make
matters worse, the base was having difficulty meeting its
operational mission, and vital sections were critically
understaffed. The base commander wanted answers. When
pressed, Adams stated that his plan met all of the required
deadlines and targets, and the plan conformed to all of the
guidelines of the early retirement programs. “Maybe so,”
replied the base commander, “but you forgot about the bigger
picture.”
Questions
1. Based on the skills model, how would you assess Lt. Col.
John Adams’s ability to meet the challenges of the base
administration position?
2. How would you assess his ability to meet the additional tasks
he faced regarding the conversion of the base?
3. If you were to coach Adams on how he could improve his
leadership, what would you tell him
Mwaisumo 1
Relation Between Dementia, Depression and Anxiety and the
Impact of Losing a Loved One. Comment by Ed Schultze:
Excellent
Introduction
It is estimated that over 44million adults have a mental health
condition in the United States whereas the rate of youth
experiencing a mental health condition continues to rise from
11.93% to 12.63% (Mental Health America). Mental illness
refers to a wide range of mental health conditions disorders that
affect people’s mood, thinking and behavior. Mental illness
disorders include; depression, anxiety and addictive behaviors.
When people experience mental health concerns from time to
time, becomes a mental health as ongoing signs and symptoms
cause frequent stress and affect ability to function. Mental
illness disorders have been a big challenge to many people as it
causes problems to people’s lives such as in relationships, work
and in the family. From the mental illness disorders, the
following is a discussion about depression and anxiety.
Comment by Ed Schultze: Nice way to start. Numbers/stats
really make a paper stand out Comment by Ed Schultze:
Conditions/disorders or conditions and/or disorders
Comment by Ed Schultze: Minor point better to just use
addiction. There is more to addiction than addictive behaviors
Depression refers to an illness that involves the body, mood,
and thoughts and that affects the way a person eats, sleeps, feels
about himself or herself. Depression is a common and serious
medical disorder that negatively affects people’s mood and
behavior. People suffering from depression normally experience
persistent feelings of sadness and hopeless and always lose
interest in activities they once enjoyed. According to the
Journal of the American Medical Association, the lifetime
incidence of depression in the United States is more than 20-
26% for women and 8-12% for men (Lieber, A,2018).
Depression can happen at any age, but often begins in the teens
or early 20s or 30s. Comment by Ed Schultze: Good
Comment by Ed Schultze: Avoid absolutes; you likely will
not be able to defend them. Instead consider qualifiers such as:
“most of the time, may, could, likely, characteristically,
expectedly’, see comment below
Comment by Ed Schultze: Good use of research. It seems
to me these staats differ from NIMH stats
There various types of depression, some of them are;
· Major Depression: this depression usually refers to depressive
in general. Major depression is also known as unipolar. Major
depression involves a low mood, losing interest of something
that once used to be enjoyable. This depression normally last
for at least two weeks or longer and can be classified as mild,
moderate or sew. The Unipolar depression signifies a difference
between major depression and bipolar depression. Bipolar
depressive is an oscillating state depression and mania whereas,
Unipolar depression is solely focused on the lows or the
negative emotion and symptoms that a person may have
experienced. Comment by Ed Schultze: The depressive
episode the depression lasts indefinitely Comment by Ed
Schultze: severe
· Psychotic Depression: psychotic depression is a subtype of
major depression that occurs when a severe depressive illness
includes some form of psychosis. People with psychosis may
hear voices or they may have strange illogical ideas. Such
people usually think that other people can hear their thoughts or
are trying to harm them. According to the National Institute of
Mental Health, a person who is psychotic is out of touch with
reality (Goldberg, J,2017).
· Catatonic Depression: This type of depression is characterized
by the inability of a person to move normally. People that suffer
from this type of depression usually remain motionless and
speechless for a long period of time.
· Melancholic Depression: This type of depression makes
people move more slowly. Also, such people normally suffer
from low mood, sadness and often lose pleasure in almost
everything.
· Agitated depression: Agitated depression is also known as
mixed mania and occurs more among middle aged and elderly
people than children and teens. This depression is a major
depressive disorder with restlessness and motor excitement.
Medical experts describe agitated depression as anxious
depression or distraught depression.
· Situational Depression: This type of depression is also known
as adjustment disorder. This type of depression occurs after a
traumatic change such as change in person’s life, divorce,
losing a job or death of a close loved one.
· Bipolar disorders: These disorders also known as manic
disorders, generally alternate from extremely low moods to
periods of extreme highs. Bipolar causes serious shifts in mood,
energy, thinking, and behavior from the highs of mania on one
extreme, to the lows of depression on the other. Bipolar
disorder symptoms include excitement, poor judgement, racing
thoughts and high energy. There are four subtypes under these
disorders.
1. Bipolar 1: characterized by people who have at least one
manic episode.
· Bipolar 11: Characterized by mild hypomanic episodes as well
as depression.
· Cyclothymic disorder: Having chronic fluctuating moods in a
period at least two years or more. Comment by Ed Schultze: I
like your list it is good
Depression has many symptoms including:
· Feelings of sadness, tearfulness, emptiness or hopelessness
· Angry outbursts
· Irritability or frustration, even over small matters
· Loss of interest or pleasure in most or all normal activities,
such as sex, hobbies or sports
· Sleep disturbances, including insomnia or sleeping too much
· Tiredness and lack of energy, so even small tasks take extra
effort
· Anxiety, agitation or restlessness
· Decreased energy or fatigue
· Slowed thinking, speaking or body movements
· Feelings of worthlessness or guilt, fixating on past failures or
self-blame
· Trouble thinking, concentrating, making decisions and
remembering things
· Frequent or recurrent thoughts of death, suicidal thoughts,
suicide attempts or suicide
· Moving or talking so slowly Comment by Ed Schultze: Or
rapidly
· Loss of appetite or weight changes
· Unexplained physical problems, such as back pain or
headaches
Anxiety is an emotional characterized by feelings of tension,
worried thought and physical changes like increased blood
pressure. The Anxiety Disorders Association of America reports
that anxiety disorder is the most common mental health
condition in America, affecting around 18 percent of the entire
population (Thorpe, Jr, 2016) Comment by Ed Schultze:
Anxiety may be characterized by:…..
There several types of anxiety disorders, these include;
· Generalized anxiety disorder: this type of depression is
marked by excessive anxiety for no logical reasons. GAC is
diagnosed when extreme worry about a variety of things lasts
six months or longer. Comment by Ed Schultze: GAD
Comment by Ed Schultze: There are many more
components
· Obsessive Compulsive Disorder (OCD); Obsessive
Compulsive Disorder results in repeated, unwanted thoughts and
rituals that interfere with everyday living. People with OCD
may feel overwhelmed with the desire to perform rituals
(compulsions) repeatedly or experience intrusive and unwanted
thoughts that can be distressing (obsessions). Common
obsessions include concerns about cleanliness or aggressive
impulsive.
· Post-traumatic stress disorder (PTSD); PTSD develops after
people have experienced or witnessed something traumatic. The
traumatic experience that triggers PTSD may be prompted by a
variety of events, such as serving in the military or being the
victim of rape or childhood abuse.
· Social anxiety disorder; this disorder involves a paralyzing
fear of social situations and of being judged or humiliated by
others. This severe social phobia can leave one feeling ashamed
and alone.Comment by Ed Schultze: This is now referred to as
Social Phobia
· Panic Disorder; this type of disorder is characterized by panic
attacks. Panic attacks usually subside after about half an hour
but can leave people feeling fatigue. Physical symptoms of
panic disorder include heart palpitations, chest pain, and
shortness of breath.
Symptoms of anxiety disorders include;
· Panic, fear, and uneasiness
· Sleep problems
· Not being able to stay calm and still
· Cold, sweaty, numb or tingling hands or feet
· Shortness of breath
· Heart palpitations
· Dry mouth
· Nausea
· Tense muscles
· Dizziness
Relationship between Anxiety Disorder and Depression and
Dementia.
Anxiety and Depression disorders are not the same but have
similar elements. As depression is mostly considered a low
energy state, anxiety is considered a high energy state.
Depressed people often experience emotions such as
hopelessness and anger. Such people often are overwhelmed by
their relationships and daily activities tasks. While for the
people with anxiety disorder, experience fear and panic. In
today’s world, most people suffer from both anxiety and
depression. Depression exacerbated by anxiety has a higher
suicidal rate than depression alone. According to one study,
92% of depressed patients who had attempted suicide were also
plagued by severe anxiety (Croft, H, 2016). Both depression and
anxiety have similar treatment. The dementia-to-depression in
the potentially causal relationship between the two disorders is
supported by findings that people with dementia appear to have
a higher prevalence of depression. However, prevalence rates
vary widely depending on the study population (psychiatric
outpatients, Alzheimer registries, old-age homes), instruments
used, and diagnostic definitions. Comment by Ed Schultze:
May be considered Comment by Ed Schultze: Be a little
careful here. Individuals with anxiety may also experience
problems with relationships and daily activities. This is a case
study and not a research paper so this is not critical
Comment by Ed Schultze: Not really You can probably
assert that many experience both Comment by Ed Schultze:
Excellent Comment by Ed Schultze: ‘dementia to depression
hypothesis, connection, ???? Comment by Ed Schultze: yes
Comment by Ed Schultze: excellent qualification
The main purpose of the following case study was to examine
how people with dementia can have possible symptoms of
depression and anxiety. The study focused more on the
individual’s behavior change and the treatment they were
provided. The study also showed how one can be affected after
witnessing a death of the spouse since it is a traumatic event.
Comment by Ed Schultze: he was provided or the subject
was provided
A case Study of a 68 Years Old Man suffering from Dementia
with depression and Anxiety and a 50 years old Lady Impacted
by The Husband’s Death. Comment by Ed Schultze: excellent
You get special credit for depth and scope
Background
Mr. John is a 68 years old man who lives at Frederick MD. John
has been an elementary teacher at Lincoln for 4o years. He
retired at the age of 60 whereby, he decided to sometimes travel
in different places he never did. Mr. John enjoys playing golf
and football. He has been a fan of Redskins since childhood.
Teaching has been the best part of his life. He enjoyed having
children around him, making them laugh as well as teaching
them the proper way of behaving and talking to one another. He
was known as the kindest teacher that ever existed at Lincoln
elementary school. John was a sport teacher and taught children
how to play various games. He is always remembered by many
especially the kids who experienced their lives with him.
Comment by Ed Schultze: good for him for playing
football at 68 that may be rare
John and his wife Mary were able to have three children. The
oldest son is in his early 30s, the second in the late 20s and the
last who is a female, in her early 20s. All his three children
have their own children, making John have six grandchildren in
total. During vacations and holidays especially in Christmas and
Thanksgiving, John, Mary and the three children with their
families would spend together at Frederick MD. John is always
exited meeting his children and grandchildren during holidays.
They rarely see each other, hence when they meet, they all
become so excited. John enjoys spending time at the parks as
well as visiting museums in Baltimore and Washington DC with
his grandchildren. During nighttime, while looking at the stars,
John would always tell a lot of stories to his grandchildren
about how their parents used to be and do at their early and late
childhood. The attachment between John and his grandchildren
was so strong. His grandchildren would always count down days
to meet their grandfather before having holidays.
Due to passion of children to the students, John always visited
Lincoln elementary schools and see how the school has been
going on. John knew each area of the Lincoln elementary that he
could never get lost each year he visited the school. All staff
members would be exited seeing John at school. John
participated a lot of school activities for children because he
enjoyed. John would play basketball and attend some of the
school’s parties. Such kind of activities made John enjoy his
life more.
One morning, as his usual schedule, John decided to visit the
elementary school. During evening, walking around the school,
John could not recognize were he parked his car. For the first
time since John has been in the school, he asked one of the
teachers where the parking lot was. John did not understand
what the problem was and did not take it as a serious matter.
Comment by Ed Schultze: good this seems very real
Dementia is a situation that occurs when there is loss of
cognitive functioning, thinking, remembering, reasoning and
behavioral abilities to such an extent that it interferes with a
person's daily life and activities. These functions include
memory, language skills, visual perception, problem solving,
self-management, and the ability to focus and pay attention. As
seen above, among the signs of dementia is when a person does
not remember some stuffs happening in his or her life. John’s
situation of not having the ability to remember some stuffs and
forgetting what he did in a short period of time made the family
realize that he may be having a dementia problem. When he was
taken to the hospital, they realized that he had an Alzheimer's
Disease which is the common cause of his dementia. Mary
reported to the doctor that her husband had experienced marked
impairment in his ability to engage in activities of daily living
over the past months. Mary also reported a gradual decline in
her husband’s cognitive functioning, including poor memory,
especially for conversations and instructions, and
disorientation. Cognitive functions are mental processes that
allow people to carry out any task. They allow the subject to
have an active role in the processes of receiving, choosing,
transforming, storing, processing and retrieval of information,
allowing the subject to navigate the world around him or her
(Neuro up). Checking John’s condition, he had a history of
chronic obstructive pulmonary disease (COPD), and prostate
cancer but he was never diagnosed or treated. One of the factors
Mary mentioned to the doctor is that his husband sometimes
used to be anxious. Comment by Ed Schultze: include problems
or limitations or impaired function in: memory…. Comment by
Ed Schultze: Some events or some information… Comment by
Ed Schultze: Avoid absolutes; you likely will not be able to
defend them. Instead consider qualifiers such as: “most of the
time, may, could, likely, characteristically, expectedly’, see
comment below
Alzheimer’s disease is an irreversible, progressive brain
disorder that slowly destroys memory and thinking skills and,
eventually, the ability to carry out the simplest tasks. The
disease is named after Dr. Alois Alzheimer. In 1906, Dr.
Alzheimer noticed changes in the brain tissue of a woman who
had died of an unusual mental illness. Her symptoms included
memory loss, language problems, and unpredictable behavior.
After she died, he examined her brain and found many abnormal
clumps (now called amyloid plaques) and tangled bundles of
fibers (now called neurofibrillary, or tau, tangles). Alzheimer’s
disease falls under Dementia. Dementia occurs due to a variety
of conditions, the most common of which is Alzheimer’s
disease. (NIH, 2017).
Mary had a difficult time living with his husband in such
condition. John’s depression and anxiety behaviors were so
overwhelming for Mary. Mary’s effort of needing to support her
husband also became so exhausted for her. Each one of them
became depressed in a different way. John was more depressed
whenever he forgot where he kept some of his stuffs and not
accepting that he needed help and could not drive anymore. The
wife was also depressed seeing the husband’s condition. Due to
depression, John lacked enough sleep and he would sometimes
wake up in the middle of the night. John lacked appetite
whereby he could not eat his favorite food he used to enjoy.
John was also frustrated with a lot of issues. When his
grandchildren visited, John could not go out in the parks or
travel to museums as he used to because, he thought he was a
useless grandfather. John never asked of going to Lincoln and
pay a visit to the teachers and students anymore. Comment by
Ed Schultze: This can be a very significant turning point for
many, for the individual and for the caretakers
When John retired, Mary has been the one working because she
enjoys keeping herself busy. Mary is just 50 years old. Mary has
a small business whereby she owns a bakery store. Mary sells
various baked products such as cakes and bread in her store.
Mary’s business has been doing great for the past months. But
since Mary had been depressed recently, the depression led her
business not doing great. Due to depression, Mary had difficulty
sleeping as she could not go to sleep early and normally woke
up during the night. Mary lost appetite and was always anxious
too. Comment by Ed Schultze: Avoid absolutes; you likely will
not be able to defend them. Instead consider qualifiers such as:
“most of the time, may, could, likely, characteristically,
expectedly’, see comment below
Few months later, John’s condition got worsen because of
medical issues. The chronic obstructive disease as well as post
cancer made John’s condition get worsen. Mary and children
decided to hospitalize John. John was hospitalized for about
seven months. After he was discharged, John could not have
balance in walking. John would fall and sometimes he would
scream and cry when that happened. With all of what was going
on, John’s children advised their mother to send their dad in an
assistant home living since she could not take care of their
father by herself. Being in an assistant living home, made John
more depressed and he always started overgeneralizing things.
John would always think that the wife and children abandoned
him, and they never loved him anymore although they used to
visit him often. John also had a change in his behavior.
According to the doctors, it was discovered that John was
diagnosed with generalized anxiety disorder and specific phobia
(fear of falling). The initial assessment revealed that John
worried frequently about being left alone and being abandoned.
He was also fearful of falling and staying in his wheelchair,
even though his physical condition would have allowed him to
walk short distances. John’s symptoms included poor sleep, low
energy, trembling and heart palpitations. While in an assistant
home living, John’s physical therapy always encouraged John to
try walking and have speech. The therapist would always ask
John to speak about the family or his life.
Mary and the children also participated on John’s physical
therapy. John started participating in some sessions over weeks.
John met with a therapist once a week with session for about
half an hour. The first session John had, mostly focused more
on anxiety monitoring and deep breathing. The lesson about
deep breathing enabled John to use whenever he felt anxious.
John would always be asked to take a deep breath by the
therapist. Later, John was introduced in a behavior activation
session known as cognitive behavioral therapy.
Cognitive behavioral therapy (CBT) is a common type of talk
therapy (psychotherapy) whereby one works with a mental
health counselor (psychotherapist or therapist) in a structured
way, attending a limited number of sessions. Cognitive
Behavior Therapy helps a person become aware of inaccurate or
negative thinking so that he/she can view challenging situations
more clearly and respond to them in a more effective way
(Mayo clinic staff). Cognitive Behavior Therapy also aims to
reduce anxiety by teaching coping skills to deal with stress that
may accompany Post Traumatic Disorder. The main goal for
this therapy is to teach people to react differently to their
symptoms. This is done through teaching different types of
coping skills, but is not limited to, breathing retraining, muscle
relaxation, cognitive restructuring, and assertiveness skills
(Bell, E). John’s children got involved in their father’s therapy.
His children would always assist their father during walking
sessions using a walker. John could not agree to cooperate more
with other care givers than his children. When the care givers
from the assistant home living would try helping him, John
would sometimes curse them or treat the caregivers in a harsh
way. John’s personality and behavior changed since he started
having dementia symptoms. John has never been harsh to
anybody nor used any bad languages to anybody. John treated
the caregivers in such a behavior because he had anger and did
not agree with the fact that he is in a such condition. John did
not want to agree that he could not walk properly or do
activities he used to do. In most of his therapist sessions, John’s
children and wife would always praise him for trying and that
gave John more courage for attending more of his therapy
sessions. John’s children used modeling to improve their
father’s communication by praising him after the therapy
session finished for the day. Comment by Ed Schultze: Perfect
Comment by Ed Schultze: Avoid absolutes; you likely will
not be able to defend them. Instead consider qualifiers such as:
“most of the time, may, could, likely, characteristically,
expectedly’, see comment below Comment by Ed Schultze:
Very good
John’s condition got better in some few months together with
his behavior. At least John could sleep for three to four hours
at night unlike the past days where he slept for only few
minutes and could stay awake the whole night. John tried eating
properly and would always write all his favorite things in a
notebook the therapist gave it to him. Comment by Ed
Schultze: Avoid absolutes; you likely will not be able to defend
them. Instead consider qualifiers such as: “most of the time,
may, could, likely, characteristically, expectedly’, see comment
below
People with Alzheimer’s and other types of dementia tend to be
at a high risk of falling. They are more than three times more
likely to fracture their hip when they fall, which leads to
surgery and immobility. The rate of death following a hip
fracture for those with Alzheimer's is also increased. Thus, fall
prevention for people with dementia is critical (Heerama, E).
One night, John was trying to get out of the bed by himself. As
he was approaching his wheel, the hand slip and fell. John had
fallen so bad because he fell on his right leg and hand whereby,
he once had a fracture on the same right leg. John’s condition
got worsen after the accident. John could not go out of the bed
for several weeks. The pain medication he was given, made
John drowsier. John was more frustrated and anxious. When
John’s wife, Mary visited his laying husband on bed, John
would always tell Mary that he wants to die and blamed her why
she was keeping him alive. John saw himself as a burden to the
wife and children. Mary was always frustrated whenever the
husband spoke such words to her. After six months since John
fell, his condition had been worsening as he had pain and other
diseases such as chronic obstructive pulmonary disease (COPD),
and prostate cancer which ended up his life. The traumatic
experience Mary witnessed is seeing her husband not breathing
as he was talking to him during his death. Mary was so confused
because it was so sudden although his condition was worse.
John died before few days to his birthday at the age of sixty-
eight. Comment by Ed Schultze: Really good point good for
you for including this Comment by Ed Schultze: Wheel chair
???
Mary’s new chapter
John’s death frustrated and made Mary more depressed. Among
the reasons for Mary’s depression is witnessing her husband’s
death. Post-traumatic stress disorder (PTSD); PTSD develops
after people have experienced or witnessed something
traumatic. The traumatic experience that triggers PTSD may be
prompted by a variety of events, such as death of a spouse.
Anxiety isn’t one of the five stages of grief, but many mental
health professionals suggest that it should be. When a person
suffers a loss, the effects can feel paralyzing. Grieving people
often feel that they have lost their sense of safety and control in
life, and they find themselves panicking or worrying
excessively about what or whom else they could lose in the
future. They also may have trouble sleeping or taking care of
themselves, which can put them at higher risk for anxiety
(Smith, K). Comment by Ed Schultze: How did you get into
this
John has been a favorite partner and supporter in Mary’s life.
Mary never knew to live a life without her husband. When John
used to live in an assistant home living, Mary used to visit the
husband very often sometimes even twice a day. Among serious
mental health problems that cause sadness and loss of interest in
activities in many people is depression. When people are
depressed, it affects their thinking, behavior as well as
emotions. As stated by Krisch. J, dealing with the death of a
loved one may be one of the most universally significant
emotional experiences. Among the emotional experiences Mary
had was having a sad mood often, loss of interest in cooking
which she enjoyed a lot, feeling guilt for everything. Mary also
lacked enough sleep during the night, she would always
complain of headaches especially during nights. Mary also
experienced a borderline personality disorder which resulted her
mood and behavior change. Mary had an appetite change
whereby she could not eat properly. Mary also had control
fallacies as she thought everything that happened to her husband
was her fault. Mary would always blame herself for her
husband’s death. Mary thought the best way he could make the
husband alive is staying by his side and not sending him to an
assistant home living. Mary also had anxiety symptoms
whereby, she always had panic, fear, and uneasiness, Mary
could not stay calm and still. She also complained of cold,
sweaty, numb or tingling hands or feet. Comment by Ed
Schultze: The list is getting bigger Where did this come from??
Mary’s children got concerned on their mother’s condition and
it was hard seeing their mother in such condition since they just
grieved their father. John’s children would often travel to
Frederick MD so as to visit their mother and give her company
and make her not feel lonely. As john’s children visited their
mother, Mary would at least not feel as much anxious as she
was when her children were not around. Mary’s children sent
their mother to the hospital so as the doctor can offer them any
medications for her mother’s illness. Among the things the
doctor offered were attending some physical therapy sessions.
Mary attended the therapy sessions twice a week. As Mary’s
depression was associated with psychological stress,
interpersonal problems and personality disorders, she attended
the psychotherapy. Psychotherapy, or talk therapy, is a way to
help people with a broad variety of mental illnesses and
emotional difficulties. Psychotherapy can help eliminate or
control troubling symptoms so a person can function better and
can increase well-being and healing (Parekh, R). Mary’s
children enabled their mother to get involved during the therapy
sessions as they were also involved in the sessions. Mary
always shared her personal feelings to the therapist and told the
therapist that she was not ease since she caused the death of her
husband. Also, she told the therapist that she could sometimes
see her husband in the dream while she was asleep. Mary was so
open to her therapist which managed her recovery from
depression and anxiety become a short period of time. Mary
always did all the assignment the therapist told her to do such
as writing what they discussed and her favorite stuffs in life.
Comment by Ed Schultze: Avoid absolutes; you likely will
not be able to defend them. Instead consider qualifiers such as:
“most of the time, may, could, likely, characteristically,
expectedly’, see comment below
Mary’s condition improved within few months. Mary could start
participating on her favorite activities like spending time in her
store and cooking her favorite dishes. Mary participated more in
the community activities such as volunteering in some of the
facilities like the rescue mission for homeless people. Mary
would spend most of her time helping providing food for the
homeless as well as kitchen activities like cooking and washing
dishes because she enjoyed a lot. Not only did Mary participate
much in volunteering, she also participated in church activities.
Mary taught Sunday school to the little children at her church
and participated in most of her church activities like travelling
to Israel so as she could learn more on the bible teachings.
Conclusion;
For most part, patients with depression and anxiety need to have
supportive family members and friends that would support them
during such condition especially the dementia old people in the
nursing homes and assistant living facilities. If Mary’s children
were not supportive enough for their mother, then their
mother’s condition would have gotten worse. Mary’s children
participated in their mother’s illness from the beginning their
father was ill until their mother’s recovery. The main medical
treatment for depression is physical therapy. If a person
identifies some symptoms of depression from a friend or family
member, send the person to the hospital so as she /he could seek
for an earlier therapy session. Late treatment for depression, can
cause more illness to the patient. It is believed that it is difficult
to identify an adult with depression and anxiety than the young
people due to their experiences of everyday life difficulties.
Most people should also know what to provide for people with
depression and how to communicate with such people like
sharing on the best events they ever experienced together.
Comment by Ed Schultze: You are very correct. Support
makes so much difference. However, it can be extremely hard
for caretakers to go through this and to be supportive. The
caretakers also need support. Comment by Ed Schultze: Not
really the main treatment may be psychiatric assessment and
treatment
Reference
Bell E. Treatment for PTSD. Anxiety and Depression
Association with America. ttps://adaa.org/understanding-
anxiety/posttraumatic-stress-disorder-ptsd/treatment
Cohut, M. (2019). Newsletter. Medical News Today. Can
genetic variants predict depression risk in young people?
https://www.medicalnewstoday.com/articles/324927.php
Croft, H. (2016). Healthy place, Relationship Between
Depression and Anxiety.
https://www.healthyplace.com/depression/anxiety-and-
depression/relationship-between-depression-and-anxiety
Goldberg, J. (2017). WebMD, Psychotic Depression.
https://www.webmd.com/depression/guide/psychotic-
depression#1
Han, S. (2019). Medical News Today, what are the early signs
of dementia?
https://www.medicalnewstoday.com/articles/324516.php
Heerema, E. (2019). Very Well Health, Common Causes of Falls
in People With Dementia.
https://www.verywellhealth.com/causes-of-falls-in-people-with-
dementia-98558
Krisch, J, A. (2019). Fatherly, HEALTH & SCIENCE. The
Death of a Parent Affects Even Grown Children Psychologically
and Physically. https://www.fatherly.com/health-science/parent-
death-psychological-physical-effects/
Lieber, A. (2018). Pychom, Major Depression (Unipolar
Depression)
https://www.psycom.net/depression.central.major.html#statistic
s
Mayo Clinic. (2015). Mental illness, Patient Care & Health
Information Diseases & Conditions.
https://www.mayoclinic.org/diseases-conditions/mental-
illness/symptoms-causes/syc-20374968
Mayo Clinic Staff. March 2019. Cognitive behavioral therapy,
Mayo clinic.https://www.mayoclinic.org/tests-
procedures/cognitive-behavioral-therapy/about/pac-20384610
Mental Health America. The State of Mental Health in America,
http://www.mentalhealthamerica.net/issues/state-mental-health-
america
National Health. Institute. (2017). what Is Alzheimer's disease?
BASICS OF ALZHEIMER’S DISEASE AND DEMENTIA.
https://www.nia.nih.gov/health/what-alzheimers-disease.
National Institutes of Health. U.S. Department of Health and
Human Services. Depression: What You Need to Know.
https://www.nimh.nih.gov/health/publications/depression-what-
you-need-to-know/index.shtml
Neuro up. Areas of Intervention / Cognitive
Functions.https://www.neuronup.com/en/areas/functions
Parekh, R. (2019). American Psychiatric Association, What is
Psychotherapy? https://www.psychiatry.org/patients-
families/psychotherapy
Smith, K. Psycom. Generalized Anxiety Disorder (GAD), What
is GAD? Why do I have it? How do I cope?
https://www.psycom.net/bookstore.anxiety.html
Thorpe Jr. (2016). Bustle, How To Explain Anxiety To People
Who Don't Understand.
https://www.bustle.com/articles/159599-how-to-explain-
anxiety-to-people-who-dont-understand
depression and anxiety. You really did a nice job. I also notice
definite improvement in the writing (keep working on it ) . I
hope you are proud of this paper.

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  • 1. Mokom 1 Case study on Cognitive Dissonance psychological phenomena Comment by Windows User: Good for you for selecting a less popular subject Abstract The human mind enables us to perceive and understand things differently, our perception on things is highly influenced by our psychological stability. A phenomenon is therefore anything that is perceived to exist, it may be natural phenomena such as force of gravity, biological processes, visual phenomena such as peripheral drift, social phenomena such as social or economic networking and then psychological phenomena which is the focus of this research paper. Comment by Windows User: FYI the abstract is generally a summary of the paper. This paragraph provides more of an introduction. Not a big deal but for the future it may be better to write the abstract after you have prepared your paper and then in just a few sentences summarize the main points or a ‘boiled down’ version of the case Introduction; What is a psychological phenomenon? Moving around at work places, home and even at school you may realize that people behave differently at different moments, sometimes these behavior may be as a result of the prevailing environmental, social, and economic factor, it is relatively correct to say that most of human behavior is influence by psychological factors such as depression. Through your observation, you will realize that you get results that are reliably in an empirical systematic manner. Therefore, a psychological phenomenon is generated through human behavior and how human responds to influences around him. Comment by Windows User: These behaviors or
  • 2. this behavior Comment by Windows User: Reliable Comment by Ed Schultze: How a human Comment by Windows User: how humans respond to influence or perhaps how humans are influenced Comment by Windows User: it seems the intent of this opening paragraph is to introduce the idea that underneath most behavior our motives and forces including psychological forces. This could be clearer Cognitive Dissonance is a psychological phenomenon that occurs when one experiences a conflict of attitude, behavior, or beliefs. Someone’s behavior determines hi/her cognition creating a cognition dissonance. This is a state of having inconsistent thoughts, believes or attitude as relating to behavior decisions and attitude change. Sometime clinical psychotherapy sessions don’t make complete use of the researches that have been formulated on trial/ tests concerning psychology that are available. This case study paper aims at providing both sociological, philosophical, and psychological understanding of this phenomena, how it affects the affected individuals and trying to provide a scientific approach and medical approach of assisting the individual either to completely recover and how to leave with the situation. Comment by Windows User: good Comment by Windows User: his/her Comment by Windows User: Not necessarily. (1) Behavior or action may result in a cognition, a thought, and (2) some behaviors may result in cognitive dissonance Comment by Windows User: do not Comment by Windows User: this sentence is unclear Comment by Windows User: monitor agreement this paper aims… and tries (as opposed to trying) Comment by Windows User: unclear This case study paper explores, the key indicators that of cognitive dissonance, how the condition affects the affected individuals and psychotherapy measures that can be employed to assist the affected individuals. This paper is a representation of a month case study that I carried out on one of my relative who for some time has been experiencing intra-personal conflicts. For many years he was addicted to smoking and
  • 3. excessive drinking habits, after efforts to keep him in a rehabilitation center for nine months, the habit seemed to have changed and he seemed to be a changed person who was ready to be incorporated back to his job that he lost as a result of his excessive drinking habits. After reading this article the reader will be able to understand what Cognitive Dissonance really is and how one can understand/ know if he is facing such a psychological phenomenon and how he/can go about controlling the situation. Comment by Windows User: Relatives and 2. I am impressed that you spent a month on this Good for you. I hope this is not your real cousin as we discussed in class You get a lot of credit for this Comment by Windows User: Caps not needed here Comment by Windows User: write gender neutral he or she consistently Comment by Windows User: Comment by Windows User: Background To some extent, psychological phenomena have been at the core of psychological disorders, such as depressions, and these disorders have been among the factors that lead to interpersonal conflicts as a result of misunderstanding between the affected individuals and the people around them who may not be aware of such phenomena, these factors have somehow played a role in the rising cases of people committing suicides when the affected individuals feel that the people around them and those that are close to them don’t understand them. A good example is when someone who has had a bad criminal record reforms but later the aspect of his past criminal life starts coming back to him creating a conflict situation within him as to whether he should just assume what people will say and get back to his old ways, or strive to maintain his new ways of life, if there is no one around to encourage such an individual in his new ways, he may face a state of depression given that he may opt that in order to in the state of his new life, he should start drinking or smoking to help him control the urge. Comment by Windows User: can be seen as Comment by Windows User: run on sentence 111 words break it down
  • 4. Case study situation. When he was released from a rehabilitation center, my cousin seemed like he had completely recovered from his drinking and smoking habits, but for the past few months he has been experiencing personal dis-satisfaction with everything he does and wants, to level of even avoiding being seen at some hours of the day or even talking to people directly. The paper is a result of a one-month case study on cognitive dissonance and its effects. Comment by Windows User: dissatisfaction not hyphenated Comment by Windows User: do not use absolutes. There are almost always exceptions qualify your statements Comment by Ed Schultze: is this personal dissatisfaction and avoidance the product of withdrawal, anxiety and/or cognitive dissonance? How could you tease each of these out? Methodology Observation; for a start I had to take a close observation on every move made by the persona under study to try and his physical behaviors and how he was relating with everyone and everything around him. Keen observation helps in providing the first hand information about anything. Comment by Windows User: good sentence short and sweet, clear and strong Spending time with the person of interest; spending time with the person of interest provided a good avenue to understand his thinking and how he reacted to the factors in the environment around him. Spending time with the person under study gave me a good time to create a more close relationship with him with the aims of building great trust between us. Spending more time together also gave him a chance to ask me questions on how people viewed him when he was in the rehabilitation center and how people view him today now that he recently came out the center and he is struggling to get back on track and gain something constructive out of his life. Comment by Windows User: great basis for a case study. I hope you are disguising the subject’s identity Interviewing; this was carried out in a psychotherapy manner
  • 5. and at set time and on specific days. This aimed at finding out how he was viewing things psychologically and physically, wanted to find out whether the current environment outside the rehabilitation institution was helping him keep up and maintain his new habit or was the environment challenging for him to keep maintaining a sober mind from alcoholism and smoking habits. Comment by Windows User: do you mean there was a structure to your interviews and data gathering? A regular time and routine? Evaluation and review of paste case study articles on cognitive dissonance; the articles helped in providing key information on the expected results of the case study, guidelines on other steps to take to ensure effective and positive results from the study. Comment by Windows User: past Comment by Windows User: excellent Results and findings. Close observations showed that my person of interest was experiencing frequent aspects of anxiety, high tempers and a sense of being almost angry at everything around him, factors that made him to hind from people so that he can smoke and drink with notion of relaxing his mind and feel relived from himself. The observation enabled me to understand that my cousin was having a big problem fighting the temptations of smoking and drinking, he was having problems on deciding whether he should be open and share what he was experiencing with his parents and the people around him. Comment by Windows User: hide Comment by Windows User: how much could the anxiety, frustration and anger be attributed to (1) psychological withdrawal, usually follows physical withdrawal, (2) adjustment re-adjustment inpatient to outpatient to step down (3) what replaces the addictive substance/process??? (4) what about you? How do you factor in your involvement. What biases, feelings, thinking and reactions are stirred up just due to your presence/involvement much less study of him?? How could you measure this??? Spending time with the person under study gave us a good time
  • 6. to create an aspect of openness to each other something that enabled him to be open with me, through this I found out the fact was the urge of him smoking always came upon him whenever he was alone and thought of his past life. Spending time at the rehabilitation facility even though it helped him stop his habits, the situation of him being away from his parents and siblings made an aspects of hatred towards his parents, he always felt that they took him there because they never liked him and not that they wanted to correct him and make him a better person, the stay at the facility had helped him change from the habit of drinking and smoking, but somehow affected his emotions and created two different personas in him, one person that seemed changed and wanted to start and wanted to have a new life, and at the same time another person who had a high degree of hatred towards his own parents and especially his dad. And given that he never wanted to show his dad, he still viewed smoking and drinking as a way that can help him control his emotions. Comment by Windows User: Addiction, nicotine besides strong physical addiction there is considerable learning (think classical conditioning) going on over all the years he has been smoking. Feelings are glued to certain behaviors that revolve around smoking. If he smoked for 20 years that can constitute some strong gluing- superglue Comment by Windows User: Run on sentence 126 words Comment by Windows User: So he was admitted with resentment and doubt regarding his parents true feelings towards him ( get rid of him, look down their noses at him get him needed help. These conflicting thoughts connected to some focused and intense feelings towards his father. At the same time this conflict may also connect to his identity and comfort with a transformation becoming a ‘straight’ version of himself. You could really explore this in some depth what this might mean to him at various levels. If he believes his parents did not act out of caring could he then believe a transformation on his part- going straight was ‘caving’ and conforming to others version of him which can also equate to devaluing oneself
  • 7. Given that the time we spent together created a sense trust between us, the interview sessions were not hard to handle even though the feedbacks and reactions were the same as those that I noted whenever we hanged out. Comment by Windows User: This seems very important. No matter how you set this up and no matter how you intended to balance out being his friend and cousin and also a ‘researcher’ the relationship between the two of you was changing. Can you think about this and then how this might have effected him? Data The figure below is a representation of the process of cognitive dissonance. From the above diagram we realize that inconsistency in attitude, thoughts and behavior are the key factor that lead to a state of dissonance which in turn leads to unpleasant arousal or results. The diagram suggests that these effects can be reduced by creating environment that will help in removing these inconsistencies in thoughts, attitude and behavior. Comment by Windows User: I love the chart!!!!! Comment by Windows User: Most times after dissonance is exposed and anxiety comes along as fuel then a change occurs in thinking, actions and/or feelings. Discussion What are the effects of prolonged cognitive dissonance? From the above study, I found that cognitive dissonance provides a clear picture of someone’s intrinsic desire for consistency a situation that may psychological discomfort, therefore there is need to create measures that will help avoid situations that may lead to this psychological phenomenon. Generally, people have the character of describing how the world is and how it works and not understanding how it works creates an aspect of cognitive dissonance. The theory of cognitive dissonance provides several dimensions most those based on region aspects or virtues. Religion virtues play a key role in giving explanations and directions to follow in life. An aspect that enables us to be consistent in our thoughts, attitude
  • 8. and behavior towards the natural phenomena and the nature of science. Therefore, if we don’t understand this phenomena, we will be in a state of cognitive dissonance. From my case study I can say that given that the person under study never got that love he expected to get when he came out of the correction facility from the people close to him, his attitude towards them and any other person that seemed hostile to him, grew towards a negative direction and something that also affected his thoughts and behavior, making him believe that the best way to remain in a good state of mind is hiding so that he can drink and smoke. And after smoking he would remain angry and annoyed at everyone and everything around him. Given that neither of his parents cared to listen to him so that they can understand what was happening to him, he preferred spending time alone. Creating a conducive environment would really help in avoiding this phenomenon and make him live a normal life with everyone and even motivate him to completely transform into a new person that he aspired to be after getting from the rehabilitation facility. Comment by Ed Schultze: May produce psychological discomfort Comment by Ed Schultze: So one response might be to avoid exposure to experiences that can potentially activate cognitive dissonance. Is this the primary response to cognitive dissonance?? Comment by Ed Schultze: Religion?? Or religious aspects?? Comment by Windows User: Religious virtues Comment by Ed Schultze: Incomplete sentence Comment by Ed Schultze: Do not use contractions in formal academic papers Sigmund Freud describes cognitive dissonance as an experience of something that is known to a person not entirely new or strange something he called in Germany as “uncanny” crates a paradox situation to the person experiencing it and it may sometime lead to outright rejection of that which is morally and ethically right since the situations makes the person not think critically and rationalize factors around him/her. Originally and under normally circumstances, emotional
  • 9. response is influenced by the neuroscientific literature in understanding cognitive dissonance as a physical phenomenon. Basing our understanding on motivational directions model which states that the mind should regulate and individual’s response to their own anger and if the prevailing circumstances are not changed by either the individual himself/herself or those around them, their motivation to control their anger and other emotions may not develop. The fact is frequent cases of cognitive dissonance re-arises the previous emotional aspects that ought to be controlled by the rationalization criteria and if rationalization does not take place, and the emotion controlled effectively by the person, then the previous character may grow and take better of him/her and lead to mood control complications such as depression, anxiety, or post-traumatic stress disorders. Comment by Ed Schultze: An individual’s Comment by Ed Schultze: Run on sentence Effects of cognitive dissonance at work places. Cognitive dissonance is not a phenomenon that affects people only at homes or at schools but also at work place and it is a key reason professional stress where by one will find it hard supporting the daily programs of the company and in an organization, in areas such as risk management, human resource departments given that these are some of the key areas in a company or an organization where staffs may be coerced towards handling and tolerating, supporting and executing daily obligations. Work places require great ethical traits therefore is fundamental to emphasize the importance of these traits .never the less it comes out that even though people are faced with stressful situations at work places, they are still able to carry out their duties as per the regulations of the company or the organizations they are working for, the following factors influence this aspects; 1. Positional respect; this is where they do things because the information to them has been passed from a position higher than their positions. 2. Normalization; this refers to a state in intrinsic justification
  • 10. i.e. When someone feels that something is not pleasant to him/her, but he/she has to do it since its part of the job and others are doing it. Comment by Ed Schultze: Spell out in other words in essence however For example may be better 3. Emotional trading; this is where an employee is forced to think of the future benefits of his/her obedience to those in a higher office. The above factors are just a sample of personal justification techniques that when is forced to follow when faced with an actual choice situation at a work place. This means that sometime people try to convince themselves to take a hard choice even if it is against their inner notions and believes or even if they are not in the mood to do it, a state that creates intrinsic conflict. It is within the human nature to avoid getting into conflicts, arguments and confrontations with their bosses at places of work but it is also good for those in managerial offices to understand this factor for them to treat their staff in accordance with good work ethical norms to avoid a situation where staff are forced to struggle fighting with personal conflicts and conflicts with the management at the same time. It is always good to create a working environment that will enable the employees to deliver their work mandates effectively despite the personal problems that they may be facing at any given moment. Comment by Ed Schultze: Did you mean bekiefs? If the cognitive dissonance remain unsolved or unattended to, they may lead to the falling problems at work place; increased cases of absenteeism, withdrawal and disengagement, high level of reduced performance by staff, negative and unethical behavior at work that include; intentional efforts by staff to block and disrupt daily activities of the company or organization something that may cause negative impacts to the company, malicious compliance, cases of aggression and sabotage. On the other when the cognitive dissonance issues are addressed the following will be achieved at work places; high staff turnover, improved health impacts and work place stress
  • 11. control. From the above scenarios, we get that even though people may not understand the impacts that cognitive dissonance has to the affected people, a lot has to be reviewed in regard to depression cases and suicidal cases that arise daily in different parts of the country from homes to schools and even at work places, as much at this phenomenon seems like a factor that can be dealt with and solved in a simple manner, the truth is understanding this phenomenon may be challenging given that it is a brain related issue that to a high degree requires psychiatric expertise to evaluate and create control measures. Apart from affecting individuals as personal levels, cognitive dissonance also has negative effects on the person’s ability to learn and understanding; in a case study carried out by emerald insight, it become clear that psychological discomfort creates state that prevents people from gaining and learning new concepts in the process of transformation over a given timeframe. Even though productive HR habits may help in controlling an individual’s inconsistent attitude and unpleasant psychological states and improve their learning work behavior. This therefore means that in constructing and control organizational learning needs basic transformation in the manner in which we think and reason, behave, relate with other during the process, the effective HR practices can assist in avoiding dissonance and this involves learning behavior in the work place. Comment by Ed Schultze: Spell out Conclusion, implications and reaction Understanding cognitive resonance has to be though a psychological approach and given that this is complication of the human mind, and when identified psychological measures have to be put in place to facilitate effective treating and control of the affected individual. And in order to reduce this phenomenon, the following three criteria need to be considered; 1. Change of behavior, this refer to doing away with old/ current personal character of an individual, this helps in reducing the cognitive dissonance phenomenon.
  • 12. 2. Change of personal beliefs; our minds are constantly filtering out conflicting data to support our beliefs. So, a person who smokes may look for, and believe, scientific research that says smoking does not necessarily cause cancer. That way, when they continue their behavior, they experience less dissonance. 3. Justify your beliefs and behavior. A good example of this is a person who spends money frivolously. They might convince themselves that throwing their money away is ok, saying things such as “you can’t take it with you.” Another example is when a person who engages in risky behavior says “you’ve got to live every day to the fullest. You never know when it will be your last” in an attempt to rationalize their risky behavior. References Beauvois, J. L., Joule, R. V., 1996. A radical dissonance theory. London: Taylor and Francis. Cooper, J. (2007). Cognitive dissonance: 50 years of a classic theory. London: Sage Publications. Festinger, L. (1957). A Theory of Cognitive Dissonance. California: Stanford University Press. Harmon-Jones, E., Mills, J., Cognitive Dissonance: Perspectives on a Pivotal Theory in Social Hull, A.M. (2002). Neuroimaging findings in post-traumatic stress disorder. The British Journal of Psychiatry 181: 102-10. R. A. Wicklund, J. W. Brehm. (1976). Perspectives on Cognitive Dissonance.
  • 13. Harmon-Jones, E., Mills, J., Cognitive Dissonance: Perspectives on a Pivotal Theory in Social Psychology. American Psychological Association, Washington, DC, pp. 71– 99. 0-10 points 10 minimum word count 0-5 points 3 Grammar, spelling and word usage 0-5 points 3 Thematic development and clarity 0-5 points 5 Clearly connects focus of case study to course material 0-5 points 5 Connects Theory, Research and Practice 0-10 points 10 Demonstrates a thoughtful understanding and explanation of a psychological phenomena 0-5 points 4 Effectively uses the case study format to communicate the above 0-5 points 5 Insightful and meaningful conclusions 0-50 points 45 Total Very interesting. You are the first person to focus on a cognitive dissonance. As mentioned, I do hope this is fabricated subject (re your cousin). Cognitive dissonance essentially explains the force or drive associated to contradiction between one’s beliefs, thoughts and actions. This force can cause significant anxiety and can be a good force in driving change. In your paper you point to many contradictions and ‘disconnects’(e.g., (a) maintain new behaviors and identity or return to substance use, this may be compounded by negative feelings and thoughts towards his parents (hating them or appreciating them); (b) the fantasy of how the real world might treat and view him and the reality of new experiences (c) options at discharge: tolerate the distrust he may have for some key family members or go back to hiding and secrets which contradicts a path to sobriety) Each of these
  • 14. and more can cause considerable tension and anxiety. Following the theory of cognitive dissonance this anxiety should push a change in either the thinking, belief or behavior. It could push him either way. This makes this a great area for critical thinking and exploration. Since anxiety seems very related to substance use, cognitive dissonance can provide support for a psychodynamic explanation for addiction. You extend your critical thinking by noting that cognitive dissonance can be a significant factor for many at work This is a very good paper and demonstrates some excellent critical thinking. Please address the writing. It was difficult to get to these points and appreciate the depth and creativity that you have provided. The writing needs to be clearer. Case 3.2 A Shift for Lieutenant Colonel Adams Lt. Col. John Adams was an aeronautical engineer in the Air Force who was recognized as an accomplished officer; he rose quickly through the ranks of lieutenant, captain, and major. In addition, he successfully completed a number of professional development courses in the Air Force and received a master’s degree in engineering. In the earlier part of his service, his career assignments required overseeing 15- to 20-person shifts that were responsible for routine maintenance schedules for squadron and base aircraft. As he progressed in rank, he moved to engineering projects, which were supported by small technical staffs. Based on his strong performance, Major Adams was promoted
  • 15. to lieutenant colonel earlier than his peers. Instead of moving him into another engineering position, the personnel bureau and his assignment officer decided that Lieutenant Colonel Adams would benefit from a tour in which he could expand his professional background and experience. Consequently, he was assigned to Base X as the commanding officer of the administration branch. Base X was an airbase with approximately 5,000 military and civilian personnel. As the administration officer, Adams was the senior human resource officer and the principal adviser to the base commander on all human resource issues. Adams and his staff of 135 civilian and military personnel were responsible for personnel issues, food services, recreation, family support, and medical services. In addition, Lieutenant Colonel Adams was assigned to chair the Labor–Management Relations Committee for the base. At the end of the Cold War, as part of the declared peace dividend, the government decided to reduce its defense budget. In February, barely 6 months after Adams took over command of the administration branch, the federal government announced a significant reduction in the size of the military and the closure of many bases. Base X was to be closed as an air base and reassigned to the Army. The closure was to take place within 1 year, and the base was to be prepared for the arrival of the first Army troops in 2 years. As part of the reduction program, the federal government initiated voluntary retirement programs for civilian and military personnel. Those wanting to retire had until April 1 to decide. Orders for the conversion of the airbase included the following: • The base will continue normal operations for 6 months. • The squadrons—complete with aircrews, equipment, and families (1,000)—must be relocated to their new bases and operational by August 1. • The remaining base personnel strength, both civilian and military, must be reduced by 30%. • The base must continue to provide personnel for operational
  • 16. missions. • The reduction of personnel must be consistent with federal voluntary early-retirement programs. • The base must be prepared with a support structure to accept 2,000 new soldiers, expected to arrive in 2 years. Adams was assigned to develop a human resource plan that would meet the imposed staff levels for the entire base while ensuring that the base was still able to perform the operational tasks it had been given. Faced with this daunting task, Adams conducted an extensive review of all of the relevant orders concerning the base transformation, and he familiarized himself with all of the rules concerning the early-retirement program. After a series of initial meetings with the other base branch chiefs, he laid out a plan that could be accomplished by the established deadlines. At the same time, he chaired a number of meetings with his own staff about how to meet the mandated reductions within his own branch. After considering the target figures for the early-retirement program, it was clear that the mandated numbers could not be reached. Simply allowing everyone who had applied for early retirement to leave was not considered an option because doing so would devastate entire sections of the base. More job cuts were required, and choices had to be made as to who would stay, why, and in what areas. Adams met stiff resistance in the meetings to determine what sections would bear the brunt of the additional cutbacks. Adams conducted his own independent analysis of his own branch before consulting with his staff. Based on his thorough examination of the data, he mandated further reductions in his sections. Specifically targeted were personnel in base housing, single-person accommodations, family services, and recreational sections. He also mandated a further 10% cut of military positions in his sections. After meeting the mandated reduction targets, Lieutenant Colonel Adams was informed that the federal government would accept all personnel who applied for early retirement, which
  • 17. was an unexpected decision. When superimposed on the already mandated reductions, this move caused critical shortages in key areas. Within weeks of implementation of the plan, the base commander was receiving mounting complaints from both civilian and military members over the implementation of the plan. Incidents of stress, frustration, and discontent rose dramatically. Families trying to move found support services cut back or nonexistent. Members of the transition staff were forced to work evenings and weekends. Family support services were swamped and asking for additional help. Despite spending a large amount of overtime trying to address the diverse issues both base-wide and within his branch, Adams found himself struggling to keep his head above water. To make matters worse, the base was having difficulty meeting its operational mission, and vital sections were critically understaffed. The base commander wanted answers. When pressed, Adams stated that his plan met all of the required deadlines and targets, and the plan conformed to all of the guidelines of the early retirement programs. “Maybe so,” replied the base commander, “but you forgot about the bigger picture.” Questions 1. Based on the skills model, how would you assess Lt. Col. John Adams’s ability to meet the challenges of the base administration position? 2. How would you assess his ability to meet the additional tasks he faced regarding the conversion of the base? 3. If you were to coach Adams on how he could improve his leadership, what would you tell him Mwaisumo 1 Relation Between Dementia, Depression and Anxiety and the Impact of Losing a Loved One. Comment by Ed Schultze:
  • 18. Excellent Introduction It is estimated that over 44million adults have a mental health condition in the United States whereas the rate of youth experiencing a mental health condition continues to rise from 11.93% to 12.63% (Mental Health America). Mental illness refers to a wide range of mental health conditions disorders that affect people’s mood, thinking and behavior. Mental illness disorders include; depression, anxiety and addictive behaviors. When people experience mental health concerns from time to time, becomes a mental health as ongoing signs and symptoms cause frequent stress and affect ability to function. Mental illness disorders have been a big challenge to many people as it causes problems to people’s lives such as in relationships, work and in the family. From the mental illness disorders, the following is a discussion about depression and anxiety. Comment by Ed Schultze: Nice way to start. Numbers/stats really make a paper stand out Comment by Ed Schultze: Conditions/disorders or conditions and/or disorders Comment by Ed Schultze: Minor point better to just use addiction. There is more to addiction than addictive behaviors Depression refers to an illness that involves the body, mood, and thoughts and that affects the way a person eats, sleeps, feels about himself or herself. Depression is a common and serious medical disorder that negatively affects people’s mood and behavior. People suffering from depression normally experience persistent feelings of sadness and hopeless and always lose interest in activities they once enjoyed. According to the Journal of the American Medical Association, the lifetime incidence of depression in the United States is more than 20- 26% for women and 8-12% for men (Lieber, A,2018). Depression can happen at any age, but often begins in the teens or early 20s or 30s. Comment by Ed Schultze: Good Comment by Ed Schultze: Avoid absolutes; you likely will not be able to defend them. Instead consider qualifiers such as: “most of the time, may, could, likely, characteristically,
  • 19. expectedly’, see comment below Comment by Ed Schultze: Good use of research. It seems to me these staats differ from NIMH stats There various types of depression, some of them are; · Major Depression: this depression usually refers to depressive in general. Major depression is also known as unipolar. Major depression involves a low mood, losing interest of something that once used to be enjoyable. This depression normally last for at least two weeks or longer and can be classified as mild, moderate or sew. The Unipolar depression signifies a difference between major depression and bipolar depression. Bipolar depressive is an oscillating state depression and mania whereas, Unipolar depression is solely focused on the lows or the negative emotion and symptoms that a person may have experienced. Comment by Ed Schultze: The depressive episode the depression lasts indefinitely Comment by Ed Schultze: severe · Psychotic Depression: psychotic depression is a subtype of major depression that occurs when a severe depressive illness includes some form of psychosis. People with psychosis may hear voices or they may have strange illogical ideas. Such people usually think that other people can hear their thoughts or are trying to harm them. According to the National Institute of Mental Health, a person who is psychotic is out of touch with reality (Goldberg, J,2017). · Catatonic Depression: This type of depression is characterized by the inability of a person to move normally. People that suffer from this type of depression usually remain motionless and speechless for a long period of time. · Melancholic Depression: This type of depression makes people move more slowly. Also, such people normally suffer from low mood, sadness and often lose pleasure in almost everything.
  • 20. · Agitated depression: Agitated depression is also known as mixed mania and occurs more among middle aged and elderly people than children and teens. This depression is a major depressive disorder with restlessness and motor excitement. Medical experts describe agitated depression as anxious depression or distraught depression. · Situational Depression: This type of depression is also known as adjustment disorder. This type of depression occurs after a traumatic change such as change in person’s life, divorce, losing a job or death of a close loved one. · Bipolar disorders: These disorders also known as manic disorders, generally alternate from extremely low moods to periods of extreme highs. Bipolar causes serious shifts in mood, energy, thinking, and behavior from the highs of mania on one extreme, to the lows of depression on the other. Bipolar disorder symptoms include excitement, poor judgement, racing thoughts and high energy. There are four subtypes under these disorders. 1. Bipolar 1: characterized by people who have at least one manic episode. · Bipolar 11: Characterized by mild hypomanic episodes as well as depression. · Cyclothymic disorder: Having chronic fluctuating moods in a period at least two years or more. Comment by Ed Schultze: I like your list it is good Depression has many symptoms including: · Feelings of sadness, tearfulness, emptiness or hopelessness · Angry outbursts · Irritability or frustration, even over small matters · Loss of interest or pleasure in most or all normal activities, such as sex, hobbies or sports
  • 21. · Sleep disturbances, including insomnia or sleeping too much · Tiredness and lack of energy, so even small tasks take extra effort · Anxiety, agitation or restlessness · Decreased energy or fatigue · Slowed thinking, speaking or body movements · Feelings of worthlessness or guilt, fixating on past failures or self-blame · Trouble thinking, concentrating, making decisions and remembering things · Frequent or recurrent thoughts of death, suicidal thoughts, suicide attempts or suicide · Moving or talking so slowly Comment by Ed Schultze: Or rapidly · Loss of appetite or weight changes · Unexplained physical problems, such as back pain or headaches Anxiety is an emotional characterized by feelings of tension, worried thought and physical changes like increased blood pressure. The Anxiety Disorders Association of America reports that anxiety disorder is the most common mental health condition in America, affecting around 18 percent of the entire population (Thorpe, Jr, 2016) Comment by Ed Schultze: Anxiety may be characterized by:….. There several types of anxiety disorders, these include; · Generalized anxiety disorder: this type of depression is marked by excessive anxiety for no logical reasons. GAC is diagnosed when extreme worry about a variety of things lasts six months or longer. Comment by Ed Schultze: GAD Comment by Ed Schultze: There are many more components · Obsessive Compulsive Disorder (OCD); Obsessive Compulsive Disorder results in repeated, unwanted thoughts and rituals that interfere with everyday living. People with OCD may feel overwhelmed with the desire to perform rituals
  • 22. (compulsions) repeatedly or experience intrusive and unwanted thoughts that can be distressing (obsessions). Common obsessions include concerns about cleanliness or aggressive impulsive. · Post-traumatic stress disorder (PTSD); PTSD develops after people have experienced or witnessed something traumatic. The traumatic experience that triggers PTSD may be prompted by a variety of events, such as serving in the military or being the victim of rape or childhood abuse. · Social anxiety disorder; this disorder involves a paralyzing fear of social situations and of being judged or humiliated by others. This severe social phobia can leave one feeling ashamed and alone.Comment by Ed Schultze: This is now referred to as Social Phobia · Panic Disorder; this type of disorder is characterized by panic attacks. Panic attacks usually subside after about half an hour but can leave people feeling fatigue. Physical symptoms of panic disorder include heart palpitations, chest pain, and shortness of breath. Symptoms of anxiety disorders include; · Panic, fear, and uneasiness · Sleep problems · Not being able to stay calm and still · Cold, sweaty, numb or tingling hands or feet · Shortness of breath · Heart palpitations · Dry mouth · Nausea · Tense muscles · Dizziness Relationship between Anxiety Disorder and Depression and Dementia. Anxiety and Depression disorders are not the same but have similar elements. As depression is mostly considered a low energy state, anxiety is considered a high energy state. Depressed people often experience emotions such as
  • 23. hopelessness and anger. Such people often are overwhelmed by their relationships and daily activities tasks. While for the people with anxiety disorder, experience fear and panic. In today’s world, most people suffer from both anxiety and depression. Depression exacerbated by anxiety has a higher suicidal rate than depression alone. According to one study, 92% of depressed patients who had attempted suicide were also plagued by severe anxiety (Croft, H, 2016). Both depression and anxiety have similar treatment. The dementia-to-depression in the potentially causal relationship between the two disorders is supported by findings that people with dementia appear to have a higher prevalence of depression. However, prevalence rates vary widely depending on the study population (psychiatric outpatients, Alzheimer registries, old-age homes), instruments used, and diagnostic definitions. Comment by Ed Schultze: May be considered Comment by Ed Schultze: Be a little careful here. Individuals with anxiety may also experience problems with relationships and daily activities. This is a case study and not a research paper so this is not critical Comment by Ed Schultze: Not really You can probably assert that many experience both Comment by Ed Schultze: Excellent Comment by Ed Schultze: ‘dementia to depression hypothesis, connection, ???? Comment by Ed Schultze: yes Comment by Ed Schultze: excellent qualification The main purpose of the following case study was to examine how people with dementia can have possible symptoms of depression and anxiety. The study focused more on the individual’s behavior change and the treatment they were provided. The study also showed how one can be affected after witnessing a death of the spouse since it is a traumatic event. Comment by Ed Schultze: he was provided or the subject was provided A case Study of a 68 Years Old Man suffering from Dementia with depression and Anxiety and a 50 years old Lady Impacted by The Husband’s Death. Comment by Ed Schultze: excellent You get special credit for depth and scope
  • 24. Background Mr. John is a 68 years old man who lives at Frederick MD. John has been an elementary teacher at Lincoln for 4o years. He retired at the age of 60 whereby, he decided to sometimes travel in different places he never did. Mr. John enjoys playing golf and football. He has been a fan of Redskins since childhood. Teaching has been the best part of his life. He enjoyed having children around him, making them laugh as well as teaching them the proper way of behaving and talking to one another. He was known as the kindest teacher that ever existed at Lincoln elementary school. John was a sport teacher and taught children how to play various games. He is always remembered by many especially the kids who experienced their lives with him. Comment by Ed Schultze: good for him for playing football at 68 that may be rare John and his wife Mary were able to have three children. The oldest son is in his early 30s, the second in the late 20s and the last who is a female, in her early 20s. All his three children have their own children, making John have six grandchildren in total. During vacations and holidays especially in Christmas and Thanksgiving, John, Mary and the three children with their families would spend together at Frederick MD. John is always exited meeting his children and grandchildren during holidays. They rarely see each other, hence when they meet, they all become so excited. John enjoys spending time at the parks as well as visiting museums in Baltimore and Washington DC with his grandchildren. During nighttime, while looking at the stars, John would always tell a lot of stories to his grandchildren about how their parents used to be and do at their early and late childhood. The attachment between John and his grandchildren was so strong. His grandchildren would always count down days to meet their grandfather before having holidays. Due to passion of children to the students, John always visited Lincoln elementary schools and see how the school has been going on. John knew each area of the Lincoln elementary that he could never get lost each year he visited the school. All staff
  • 25. members would be exited seeing John at school. John participated a lot of school activities for children because he enjoyed. John would play basketball and attend some of the school’s parties. Such kind of activities made John enjoy his life more. One morning, as his usual schedule, John decided to visit the elementary school. During evening, walking around the school, John could not recognize were he parked his car. For the first time since John has been in the school, he asked one of the teachers where the parking lot was. John did not understand what the problem was and did not take it as a serious matter. Comment by Ed Schultze: good this seems very real Dementia is a situation that occurs when there is loss of cognitive functioning, thinking, remembering, reasoning and behavioral abilities to such an extent that it interferes with a person's daily life and activities. These functions include memory, language skills, visual perception, problem solving, self-management, and the ability to focus and pay attention. As seen above, among the signs of dementia is when a person does not remember some stuffs happening in his or her life. John’s situation of not having the ability to remember some stuffs and forgetting what he did in a short period of time made the family realize that he may be having a dementia problem. When he was taken to the hospital, they realized that he had an Alzheimer's Disease which is the common cause of his dementia. Mary reported to the doctor that her husband had experienced marked impairment in his ability to engage in activities of daily living over the past months. Mary also reported a gradual decline in her husband’s cognitive functioning, including poor memory, especially for conversations and instructions, and disorientation. Cognitive functions are mental processes that allow people to carry out any task. They allow the subject to have an active role in the processes of receiving, choosing, transforming, storing, processing and retrieval of information, allowing the subject to navigate the world around him or her (Neuro up). Checking John’s condition, he had a history of
  • 26. chronic obstructive pulmonary disease (COPD), and prostate cancer but he was never diagnosed or treated. One of the factors Mary mentioned to the doctor is that his husband sometimes used to be anxious. Comment by Ed Schultze: include problems or limitations or impaired function in: memory…. Comment by Ed Schultze: Some events or some information… Comment by Ed Schultze: Avoid absolutes; you likely will not be able to defend them. Instead consider qualifiers such as: “most of the time, may, could, likely, characteristically, expectedly’, see comment below Alzheimer’s disease is an irreversible, progressive brain disorder that slowly destroys memory and thinking skills and, eventually, the ability to carry out the simplest tasks. The disease is named after Dr. Alois Alzheimer. In 1906, Dr. Alzheimer noticed changes in the brain tissue of a woman who had died of an unusual mental illness. Her symptoms included memory loss, language problems, and unpredictable behavior. After she died, he examined her brain and found many abnormal clumps (now called amyloid plaques) and tangled bundles of fibers (now called neurofibrillary, or tau, tangles). Alzheimer’s disease falls under Dementia. Dementia occurs due to a variety of conditions, the most common of which is Alzheimer’s disease. (NIH, 2017). Mary had a difficult time living with his husband in such condition. John’s depression and anxiety behaviors were so overwhelming for Mary. Mary’s effort of needing to support her husband also became so exhausted for her. Each one of them became depressed in a different way. John was more depressed whenever he forgot where he kept some of his stuffs and not accepting that he needed help and could not drive anymore. The wife was also depressed seeing the husband’s condition. Due to depression, John lacked enough sleep and he would sometimes wake up in the middle of the night. John lacked appetite whereby he could not eat his favorite food he used to enjoy. John was also frustrated with a lot of issues. When his grandchildren visited, John could not go out in the parks or
  • 27. travel to museums as he used to because, he thought he was a useless grandfather. John never asked of going to Lincoln and pay a visit to the teachers and students anymore. Comment by Ed Schultze: This can be a very significant turning point for many, for the individual and for the caretakers When John retired, Mary has been the one working because she enjoys keeping herself busy. Mary is just 50 years old. Mary has a small business whereby she owns a bakery store. Mary sells various baked products such as cakes and bread in her store. Mary’s business has been doing great for the past months. But since Mary had been depressed recently, the depression led her business not doing great. Due to depression, Mary had difficulty sleeping as she could not go to sleep early and normally woke up during the night. Mary lost appetite and was always anxious too. Comment by Ed Schultze: Avoid absolutes; you likely will not be able to defend them. Instead consider qualifiers such as: “most of the time, may, could, likely, characteristically, expectedly’, see comment below Few months later, John’s condition got worsen because of medical issues. The chronic obstructive disease as well as post cancer made John’s condition get worsen. Mary and children decided to hospitalize John. John was hospitalized for about seven months. After he was discharged, John could not have balance in walking. John would fall and sometimes he would scream and cry when that happened. With all of what was going on, John’s children advised their mother to send their dad in an assistant home living since she could not take care of their father by herself. Being in an assistant living home, made John more depressed and he always started overgeneralizing things. John would always think that the wife and children abandoned him, and they never loved him anymore although they used to visit him often. John also had a change in his behavior. According to the doctors, it was discovered that John was diagnosed with generalized anxiety disorder and specific phobia (fear of falling). The initial assessment revealed that John worried frequently about being left alone and being abandoned.
  • 28. He was also fearful of falling and staying in his wheelchair, even though his physical condition would have allowed him to walk short distances. John’s symptoms included poor sleep, low energy, trembling and heart palpitations. While in an assistant home living, John’s physical therapy always encouraged John to try walking and have speech. The therapist would always ask John to speak about the family or his life. Mary and the children also participated on John’s physical therapy. John started participating in some sessions over weeks. John met with a therapist once a week with session for about half an hour. The first session John had, mostly focused more on anxiety monitoring and deep breathing. The lesson about deep breathing enabled John to use whenever he felt anxious. John would always be asked to take a deep breath by the therapist. Later, John was introduced in a behavior activation session known as cognitive behavioral therapy. Cognitive behavioral therapy (CBT) is a common type of talk therapy (psychotherapy) whereby one works with a mental health counselor (psychotherapist or therapist) in a structured way, attending a limited number of sessions. Cognitive Behavior Therapy helps a person become aware of inaccurate or negative thinking so that he/she can view challenging situations more clearly and respond to them in a more effective way (Mayo clinic staff). Cognitive Behavior Therapy also aims to reduce anxiety by teaching coping skills to deal with stress that may accompany Post Traumatic Disorder. The main goal for this therapy is to teach people to react differently to their symptoms. This is done through teaching different types of coping skills, but is not limited to, breathing retraining, muscle relaxation, cognitive restructuring, and assertiveness skills (Bell, E). John’s children got involved in their father’s therapy. His children would always assist their father during walking sessions using a walker. John could not agree to cooperate more with other care givers than his children. When the care givers from the assistant home living would try helping him, John would sometimes curse them or treat the caregivers in a harsh
  • 29. way. John’s personality and behavior changed since he started having dementia symptoms. John has never been harsh to anybody nor used any bad languages to anybody. John treated the caregivers in such a behavior because he had anger and did not agree with the fact that he is in a such condition. John did not want to agree that he could not walk properly or do activities he used to do. In most of his therapist sessions, John’s children and wife would always praise him for trying and that gave John more courage for attending more of his therapy sessions. John’s children used modeling to improve their father’s communication by praising him after the therapy session finished for the day. Comment by Ed Schultze: Perfect Comment by Ed Schultze: Avoid absolutes; you likely will not be able to defend them. Instead consider qualifiers such as: “most of the time, may, could, likely, characteristically, expectedly’, see comment below Comment by Ed Schultze: Very good John’s condition got better in some few months together with his behavior. At least John could sleep for three to four hours at night unlike the past days where he slept for only few minutes and could stay awake the whole night. John tried eating properly and would always write all his favorite things in a notebook the therapist gave it to him. Comment by Ed Schultze: Avoid absolutes; you likely will not be able to defend them. Instead consider qualifiers such as: “most of the time, may, could, likely, characteristically, expectedly’, see comment below People with Alzheimer’s and other types of dementia tend to be at a high risk of falling. They are more than three times more likely to fracture their hip when they fall, which leads to surgery and immobility. The rate of death following a hip fracture for those with Alzheimer's is also increased. Thus, fall prevention for people with dementia is critical (Heerama, E). One night, John was trying to get out of the bed by himself. As he was approaching his wheel, the hand slip and fell. John had fallen so bad because he fell on his right leg and hand whereby,
  • 30. he once had a fracture on the same right leg. John’s condition got worsen after the accident. John could not go out of the bed for several weeks. The pain medication he was given, made John drowsier. John was more frustrated and anxious. When John’s wife, Mary visited his laying husband on bed, John would always tell Mary that he wants to die and blamed her why she was keeping him alive. John saw himself as a burden to the wife and children. Mary was always frustrated whenever the husband spoke such words to her. After six months since John fell, his condition had been worsening as he had pain and other diseases such as chronic obstructive pulmonary disease (COPD), and prostate cancer which ended up his life. The traumatic experience Mary witnessed is seeing her husband not breathing as he was talking to him during his death. Mary was so confused because it was so sudden although his condition was worse. John died before few days to his birthday at the age of sixty- eight. Comment by Ed Schultze: Really good point good for you for including this Comment by Ed Schultze: Wheel chair ??? Mary’s new chapter John’s death frustrated and made Mary more depressed. Among the reasons for Mary’s depression is witnessing her husband’s death. Post-traumatic stress disorder (PTSD); PTSD develops after people have experienced or witnessed something traumatic. The traumatic experience that triggers PTSD may be prompted by a variety of events, such as death of a spouse. Anxiety isn’t one of the five stages of grief, but many mental health professionals suggest that it should be. When a person suffers a loss, the effects can feel paralyzing. Grieving people often feel that they have lost their sense of safety and control in life, and they find themselves panicking or worrying excessively about what or whom else they could lose in the future. They also may have trouble sleeping or taking care of themselves, which can put them at higher risk for anxiety (Smith, K). Comment by Ed Schultze: How did you get into this
  • 31. John has been a favorite partner and supporter in Mary’s life. Mary never knew to live a life without her husband. When John used to live in an assistant home living, Mary used to visit the husband very often sometimes even twice a day. Among serious mental health problems that cause sadness and loss of interest in activities in many people is depression. When people are depressed, it affects their thinking, behavior as well as emotions. As stated by Krisch. J, dealing with the death of a loved one may be one of the most universally significant emotional experiences. Among the emotional experiences Mary had was having a sad mood often, loss of interest in cooking which she enjoyed a lot, feeling guilt for everything. Mary also lacked enough sleep during the night, she would always complain of headaches especially during nights. Mary also experienced a borderline personality disorder which resulted her mood and behavior change. Mary had an appetite change whereby she could not eat properly. Mary also had control fallacies as she thought everything that happened to her husband was her fault. Mary would always blame herself for her husband’s death. Mary thought the best way he could make the husband alive is staying by his side and not sending him to an assistant home living. Mary also had anxiety symptoms whereby, she always had panic, fear, and uneasiness, Mary could not stay calm and still. She also complained of cold, sweaty, numb or tingling hands or feet. Comment by Ed Schultze: The list is getting bigger Where did this come from?? Mary’s children got concerned on their mother’s condition and it was hard seeing their mother in such condition since they just grieved their father. John’s children would often travel to Frederick MD so as to visit their mother and give her company and make her not feel lonely. As john’s children visited their mother, Mary would at least not feel as much anxious as she was when her children were not around. Mary’s children sent their mother to the hospital so as the doctor can offer them any medications for her mother’s illness. Among the things the doctor offered were attending some physical therapy sessions.
  • 32. Mary attended the therapy sessions twice a week. As Mary’s depression was associated with psychological stress, interpersonal problems and personality disorders, she attended the psychotherapy. Psychotherapy, or talk therapy, is a way to help people with a broad variety of mental illnesses and emotional difficulties. Psychotherapy can help eliminate or control troubling symptoms so a person can function better and can increase well-being and healing (Parekh, R). Mary’s children enabled their mother to get involved during the therapy sessions as they were also involved in the sessions. Mary always shared her personal feelings to the therapist and told the therapist that she was not ease since she caused the death of her husband. Also, she told the therapist that she could sometimes see her husband in the dream while she was asleep. Mary was so open to her therapist which managed her recovery from depression and anxiety become a short period of time. Mary always did all the assignment the therapist told her to do such as writing what they discussed and her favorite stuffs in life. Comment by Ed Schultze: Avoid absolutes; you likely will not be able to defend them. Instead consider qualifiers such as: “most of the time, may, could, likely, characteristically, expectedly’, see comment below Mary’s condition improved within few months. Mary could start participating on her favorite activities like spending time in her store and cooking her favorite dishes. Mary participated more in the community activities such as volunteering in some of the facilities like the rescue mission for homeless people. Mary would spend most of her time helping providing food for the homeless as well as kitchen activities like cooking and washing dishes because she enjoyed a lot. Not only did Mary participate much in volunteering, she also participated in church activities. Mary taught Sunday school to the little children at her church and participated in most of her church activities like travelling to Israel so as she could learn more on the bible teachings. Conclusion; For most part, patients with depression and anxiety need to have
  • 33. supportive family members and friends that would support them during such condition especially the dementia old people in the nursing homes and assistant living facilities. If Mary’s children were not supportive enough for their mother, then their mother’s condition would have gotten worse. Mary’s children participated in their mother’s illness from the beginning their father was ill until their mother’s recovery. The main medical treatment for depression is physical therapy. If a person identifies some symptoms of depression from a friend or family member, send the person to the hospital so as she /he could seek for an earlier therapy session. Late treatment for depression, can cause more illness to the patient. It is believed that it is difficult to identify an adult with depression and anxiety than the young people due to their experiences of everyday life difficulties. Most people should also know what to provide for people with depression and how to communicate with such people like sharing on the best events they ever experienced together. Comment by Ed Schultze: You are very correct. Support makes so much difference. However, it can be extremely hard for caretakers to go through this and to be supportive. The caretakers also need support. Comment by Ed Schultze: Not really the main treatment may be psychiatric assessment and treatment Reference Bell E. Treatment for PTSD. Anxiety and Depression Association with America. ttps://adaa.org/understanding- anxiety/posttraumatic-stress-disorder-ptsd/treatment Cohut, M. (2019). Newsletter. Medical News Today. Can genetic variants predict depression risk in young people? https://www.medicalnewstoday.com/articles/324927.php
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  • 35. Human Services. Depression: What You Need to Know. https://www.nimh.nih.gov/health/publications/depression-what- you-need-to-know/index.shtml Neuro up. Areas of Intervention / Cognitive Functions.https://www.neuronup.com/en/areas/functions Parekh, R. (2019). American Psychiatric Association, What is Psychotherapy? https://www.psychiatry.org/patients- families/psychotherapy Smith, K. Psycom. Generalized Anxiety Disorder (GAD), What is GAD? Why do I have it? How do I cope? https://www.psycom.net/bookstore.anxiety.html Thorpe Jr. (2016). Bustle, How To Explain Anxiety To People Who Don't Understand. https://www.bustle.com/articles/159599-how-to-explain- anxiety-to-people-who-dont-understand depression and anxiety. You really did a nice job. I also notice definite improvement in the writing (keep working on it ) . I hope you are proud of this paper.