This study examined the associations between visual themes in masks created by 370 active-duty military service members with traumatic brain injuries and psychological health conditions during art therapy sessions, and their scores on standardized measures of post-traumatic stress, depression, and anxiety. The study found that depictions of psychological injury were associated with higher stress and depression scores, while depictions of military unit identity, nature, and cultural symbols were associated with lower scores. Color symbolism and fragmented military symbols were linked to higher anxiety, depression, and stress. The emergent patterns of resilience and risk embedded in the images could help patients, clinicians, and caregivers.
Art Therapy For Mind Healing
Art therapy is a form of psychotherapy that promotes creative self-expression on a symbolic level,
through the creative use of art media that leads to the safe expression of emotions and internal
conflicts.
1Running Head ART THERAPYExpressive Arts Th.docxdrennanmicah
1
Running Head: ART THERAPY
Expressive Arts Therapy: Art Therapy
Emily Brooks, Cassie Hurst, Janice Mattie, and Chelsea Sheridan
Brenau University
History and Development of Art Therapy
Over the history of psychology, many practitioners have been drawn to the use of artistic expression while working with clients. This practice dates to 1912. German psychiatrist Emil Kraepelin and Karl Jaspers notice drawings by the patients could be beneficial in understanding psychopathology. Freud and Jung both had theories that state art expression plays a vital role in psychiatric evaluation and treatment. Freud believed in an unconscious mind, while Jung believed in universal archetypes. Jung explored his psyche, along with his patients through art expressions (Malchiodi, 2007, p.16).
Art therapy has only existed since the mid-20th century. It is based on a variety of artistic forms. This kind of treatment sees the person as a creative being. This therapy allows the client to be the artist of their own story (Reis, 2014). British artist Adrian Hill knew how important it was for one to be their artist. While working with a tuberculosis patient, this idea became very relevant. Margaret Naumburg is recognized as one of the earliest practitioners to define art therapy and its form. She proposed that images were a form of symbolic speech (Malchiodi, 2007, p.17).
Donald Winnicott, a child psychiatrist, saw the value of this therapy. He believed art to be a transitional object. Winnicott knew this therapy to reflect one's thoughts and feelings. Using this type of reflection, you would be able to define the conflicts as well. Many have gone on to specialize in this field. Art therapy has specialized education and standards of practice. Counselors and social workers working with children find this treatment engaging. Experimental activities provide children a way of expressing their emotions (Malchiodi, 2007, p.17).
Some see art therapy as a hybrid that forms from both art and psychology. The formations of these two fields generated two different theories on why art therapy is useful. The first sees art expression as a form of visual language that creates an outlet for people to express feelings in which they would not usually be able to put into words. The second theory claims that this type of expression can be a way to communicate a problematic past. Many victims of sexual, verbal, or physical abuse find emotional relief (Malchiodi, 2007, p.18).
Many mental and medical settings have influenced art therapy as a form of intervention. Art therapy was used primarily before in psychiatric and day treatment facilities to help better communicate with those who have a mental illness. However, art therapy has evolved and has been multiplying. This therapy is known as a vital tool to help treat those suffering from substance abuse, trauma, eating, and behavioral disorders. With new preventative health programs emerging art therapy has become a more.
Art Therapy in Neurocognitive Disorders: Why the Arts Matter in Brain Health_...Crimsonpublisherssmoaj
Art Therapy in Neurocognitive Disorders: Why the Arts Matter in Brain Health by Angel C Duncan* in Crimson Publishers: Annals of Medicine and Surgery
Art has been in existence since mankind. From cave paintings to modern day society, art has been used as to tell a story, document history and provide a voice when words have become lost. We would not have the knowledge of our past had it not been for art. Medically and psychologically, art is often used for self-expression, to find an inner release and explore the process of creativity through physical and emotional pain and healing. For persons with neurocognitive impairments, such as Alzheimer’s disease (AD), where memory, judgement, and reasoning are disrupted, art has been able to unlock memories thought to be lost, improve behaviors i.e. agitation, depression, and give insight into what the person may be feeling or thinking. Take for example famed artist, Willem de Kooning, some art experts may argue his brilliance as an artist was not fully recognized until his paintings became more rudimentary and abstract. What many do not know is that de Kooning was in the throes of Alzheimer’s disease during his fame.
https://crimsonpublishers.com/smoaj/fulltext/SMOAJ.000540.php
For more open access journals in Crimson Publishers
Please click on: https://crimsonpublishers.com/
For more articles on Annals of Medicine and Surgery
Please click on link: https://crimsonpublishers.com/smoaj/index.php
Please follow the below link for our LinkedIn page
https://www.linkedin.com/company/crimsonpublishers
Art Therapy For Mind Healing
Art therapy is a form of psychotherapy that promotes creative self-expression on a symbolic level,
through the creative use of art media that leads to the safe expression of emotions and internal
conflicts.
1Running Head ART THERAPYExpressive Arts Th.docxdrennanmicah
1
Running Head: ART THERAPY
Expressive Arts Therapy: Art Therapy
Emily Brooks, Cassie Hurst, Janice Mattie, and Chelsea Sheridan
Brenau University
History and Development of Art Therapy
Over the history of psychology, many practitioners have been drawn to the use of artistic expression while working with clients. This practice dates to 1912. German psychiatrist Emil Kraepelin and Karl Jaspers notice drawings by the patients could be beneficial in understanding psychopathology. Freud and Jung both had theories that state art expression plays a vital role in psychiatric evaluation and treatment. Freud believed in an unconscious mind, while Jung believed in universal archetypes. Jung explored his psyche, along with his patients through art expressions (Malchiodi, 2007, p.16).
Art therapy has only existed since the mid-20th century. It is based on a variety of artistic forms. This kind of treatment sees the person as a creative being. This therapy allows the client to be the artist of their own story (Reis, 2014). British artist Adrian Hill knew how important it was for one to be their artist. While working with a tuberculosis patient, this idea became very relevant. Margaret Naumburg is recognized as one of the earliest practitioners to define art therapy and its form. She proposed that images were a form of symbolic speech (Malchiodi, 2007, p.17).
Donald Winnicott, a child psychiatrist, saw the value of this therapy. He believed art to be a transitional object. Winnicott knew this therapy to reflect one's thoughts and feelings. Using this type of reflection, you would be able to define the conflicts as well. Many have gone on to specialize in this field. Art therapy has specialized education and standards of practice. Counselors and social workers working with children find this treatment engaging. Experimental activities provide children a way of expressing their emotions (Malchiodi, 2007, p.17).
Some see art therapy as a hybrid that forms from both art and psychology. The formations of these two fields generated two different theories on why art therapy is useful. The first sees art expression as a form of visual language that creates an outlet for people to express feelings in which they would not usually be able to put into words. The second theory claims that this type of expression can be a way to communicate a problematic past. Many victims of sexual, verbal, or physical abuse find emotional relief (Malchiodi, 2007, p.18).
Many mental and medical settings have influenced art therapy as a form of intervention. Art therapy was used primarily before in psychiatric and day treatment facilities to help better communicate with those who have a mental illness. However, art therapy has evolved and has been multiplying. This therapy is known as a vital tool to help treat those suffering from substance abuse, trauma, eating, and behavioral disorders. With new preventative health programs emerging art therapy has become a more.
Art Therapy in Neurocognitive Disorders: Why the Arts Matter in Brain Health_...Crimsonpublisherssmoaj
Art Therapy in Neurocognitive Disorders: Why the Arts Matter in Brain Health by Angel C Duncan* in Crimson Publishers: Annals of Medicine and Surgery
Art has been in existence since mankind. From cave paintings to modern day society, art has been used as to tell a story, document history and provide a voice when words have become lost. We would not have the knowledge of our past had it not been for art. Medically and psychologically, art is often used for self-expression, to find an inner release and explore the process of creativity through physical and emotional pain and healing. For persons with neurocognitive impairments, such as Alzheimer’s disease (AD), where memory, judgement, and reasoning are disrupted, art has been able to unlock memories thought to be lost, improve behaviors i.e. agitation, depression, and give insight into what the person may be feeling or thinking. Take for example famed artist, Willem de Kooning, some art experts may argue his brilliance as an artist was not fully recognized until his paintings became more rudimentary and abstract. What many do not know is that de Kooning was in the throes of Alzheimer’s disease during his fame.
https://crimsonpublishers.com/smoaj/fulltext/SMOAJ.000540.php
For more open access journals in Crimson Publishers
Please click on: https://crimsonpublishers.com/
For more articles on Annals of Medicine and Surgery
Please click on link: https://crimsonpublishers.com/smoaj/index.php
Please follow the below link for our LinkedIn page
https://www.linkedin.com/company/crimsonpublishers
Art therapy in clinical psychology .pptxtashaadam04
art therapy
The term “Art Therapy” was first coined by British artist and art educator Adrian Hill. Art therapy is a treatment approach with the creative process to improve well-being.
Art therapy is a form of psychotherapy that utilizes the creative process of making art to improve and enhance individuals' physical, mental, and emotional well-being. It is based on the belief that creating art can be therapeutic, allowing individuals to explore and express their thoughts, feelings, and experiences in a non-verbal way. It involves using creative techniques such as drawing, painting, collage, coloring, or sculpting.
see detail on https://adamt04.blogspot.com/2024/01/technique-of-art-therapy.html
Sample 1:The population that really shocked me was the populatio.docxjeffsrosalyn
Sample 1:
The population that really shocked me was the population with AIDS. I never really thought of art therapy or therapy at all being used to help with medical issues or diseases. It makes sense though, as they can really effect someones mentality especially if it something that will be a struggle for life.
The psychiatric population was the least surprising to me. When you think about therapy or art therapy you typically think about individuals with mental illness and hospitals designated to their care. This is the population that most often portrayed in the movies as working with therapists of all kinds.
I don't think that any population benefits more or less just because of the group that they fit into. I believe that it is all about what you give to the sessions and therapist and your willingness to receive the help. I think that some populations would have it a little bit harder to find help such as the homeless but if they were able to and put the effort into therapy they would benefit from it just as much as anyone else would. Whether or not you benefit from something has more to do with you as an individual than it does what population you belong to. Just like many other things.
Reply:
Hi Leann! It was surprising for me too when I read that clients with AIDS benefits from art therapy. I like your explanation though, about the disease effecting a person's mentality. I also like your points about what kind of populations might be more likely to receive help. I wrote in my own post that some populations might actually go to their appointments more over other populations, so they at least have more potential to get help, but I also like your point about how it is all about the client's willingness to receive help, this is exactly what I was trying to say!
Sample 2:
The population that surprised me the most by being served by art therapists was prostitutes. I think this surprised me most because a few girls I graduated high school with became strippers and they want everyone to know how proud they are of it, so at first I wasn't sure prostitutes might feel the opposite; however, when I think about it it makes sense. As said in the article, prostitutes have a lot of substance abuse, childhood trauma, and sexual abuse.
As for the least surprising population for me was children and psychiatric clients. This is because communication might be difficult for children and those with mental illnesses, so utilizing art therapy would be help them easily considering not much, if any, speech needs to be used.
Populations that might benefit more or less from art therapy, I am not sure about. I think different populations could benefit more, for example as I previously said, children and psychiatric patients might benefit the most. They would be more likely to actually attend therapy, children are brought by their parents and some psychiatric patients might have to stay in an institution, so they might not be able to change their minds like .
352 BUMC PROCEEDINGS 2001;14:352–357
The technological advances of the past century tended tochange the focus of medicine from a caring, service-oriented model to a technological, cure-oriented model.
Technology has led to phenomenal advances in medicine and
has given us the ability to prolong life. However, in the past few
decades physicians have attempted to balance their care by re-
claiming medicine’s more spiritual roots, recognizing that until
modern times spirituality was often linked with health care.
Spiritual or compassionate care involves serving the whole per-
son—the physical, emotional, social, and spiritual. Such service
is inherently a spiritual activity. Rachel Naomi Remen, MD, who
has developed Commonweal retreats for people with cancer, de-
scribed it well:
Helping, fixing, and serving represent three different ways of see-
ing life. When you help, you see life as weak. When you fix, you
see life as broken. When you serve, you see life as whole. Fixing
and helping may be the work of the ego, and service the work of
the soul (1).
Serving patients may involve spending time with them, hold-
ing their hands, and talking about what is important to them.
Patients value these experiences with their physicians. In this
article, I discuss elements of compassionate care, review some
research on the role of spirituality in health care, highlight ad-
vantages of understanding patients’ spirituality, explain ways to
practice spiritual care, and summarize some national efforts to
incorporate spirituality into medicine.
COMPASSIONATE CARE: HELPING PATIENTS FIND MEANING IN
THEIR SUFFERING AND ADDRESSING THEIR SPIRITUALITY
The word compassion means “to suffer with.” Compassionate
care calls physicians to walk with people in the midst of their
pain, to be partners with patients rather than experts dictating
information to them.
Victor Frankl, a psychiatrist who wrote of his experiences in
a Nazi concentration camp, wrote: “Man is not destroyed by suf-
fering; he is destroyed by suffering without meaning” (2). One
of the challenges physicians face is to help people find meaning
and acceptance in the midst of suffering and chronic illness.
Medical ethicists have reminded us that religion and spiritual-
ity form the basis of meaning and purpose for many people (3).
At the same time, while patients struggle with the physical as-
pects of their disease, they have other pain as well: pain related
to mental and spiritual suffering, to an inability to engage the
deepest questions of life. Patients may be asking questions such
The role of spirituality in health care
CHRISTINA M. PUCHALSKI, MD, MS
From The George Washington Institute for Spirituality and Health (GWish), The
George Washington University Medical Center Departments of Medicine and
Health Care Sciences, and The George Washington University, Washington, DC.
Presented at Baylor University Medical Center on February 28, 2001, as the Baylor-
Charles A. Sammons Cancer Center Charlotte ...
This research is based on general practice in the psychiatric institutions. It involves a qualitative research method that that uses three peer-reviewed journal article containing information about the scope of psychiatry, emerging issues in accommodating patients and highlight on medication of mental illness
Please readRobert Geraci, Russia Minorities and Empire,” in .docxTatianaMajor22
Please read:
Robert Geraci, “Russia: Minorities and Empire,” in Abbott Gleason, ed., A Companion to Russian History (Oxford: Wiley-Blackwell, 2009), 243-260.
And discuss:
How does Geraci portray the legacy of the early Russian history for the make-up of 18-19th century Russia?
Please read: Leonard Victor Rutgers, “Roman Policy Towards the Jews: Expulsions from the City of Rome during the First Century C.E.,” in Classical Antiquity, Vol. 13, No. 1 (Apr., 1994), pp. 56-74.
And discuss: Rutgers surveys the different reasons historians have given for the expulsion of the Jews from Rome in the first century C.E. Who place did Jews have in Roman society at this time? Were they expelled because of their religious practices, or because they were ‘unruly’ as Rutgers argues? If so, what caused them to act in this way? What kind of historical evidence does the author use?
There are 2 essay, each one should write at least 300-350 words and plus one reference page.
MLA format. Must use quote( “ ”) for every source you use from website. And put (author, page number) behind quote.
Roman Policy towards the Jews: Expulsions from the City of Rome during the First Century
C.E.
Author(s): Leonard Victor Rutgers
Source: Classical Antiquity, Vol. 13, No. 1 (Apr., 1994), pp. 56-74
Published by: University of California Press
Stable URL: http://www.jstor.org/stable/25011005 .
Accessed: 26/08/2011 13:35
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content in a trusted digital archive. We use information technology and tools to increase productivity and facilitate new forms
of scholarship. For more information about JSTOR, please contact [email protected]
University of California Press is collaborating with JSTOR to digitize, preserve and extend access to Classical
Antiquity.
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LEONARD VICTOR RUTGERS
Roman Policy towards the Jews:
Expulsions from the City of Rome
during the First Century c. E.
Tant de causes secretes se melent souvent a la cause apparente, tant de ressorts
inconnus servent a persecuter un homme, qu'il est impossible de demeler dans les
siecles posterieures la source cachee des malheurs des hommes les plus consider
ables, a plus forte raison celle du supplice d'un particulier qui ne pouvait etre
connu que par ceux de son parti.
-Voltaire, Traite sur la tolerance (1763)
IN THIS ARTICLE I want to discuss the evidence for expulsions of Jews from
the city of Rome in the first century C.E. Scholars have long been interested in the
reasons underlying these expulsions. Because the anci.
Ford VS ChevroletThere are many reasons that make the Chevy.docxTatianaMajor22
Ford VS Chevrolet
There are many reasons that make the Chevy’s and Ford’s motors two most common trucks. Studies reveal that that they are the most popular vehicles on sales today. It is because they are powerful, versatile and reasonably priced. They also come in a wide variety of configurations and styles. However, many buyers and sellers have questioned themselves on the better vehicle compared to the other in terms of quality, Wi-Fi, price ranges, value, and costs. To compare and contrast on this subject, let us take an example of two vehicles each from each company to facilitate comparison.
Ford offers the full-size track with automatic high-beam control, automatic parallel parking and power-retractable running boards. Fords are elegant, and they are mostly aluminum making them save weight and bolster gas mileage. None of these features are offered Chevy’s. Chevrolets have outstanding quality. They are mostly comprised of steel, for instance, the Chevrolet Silverado. This makes them good for rough roads and difficult terrains.
Fords have employed the use of up to date Wi-Fi technology. Ford intends to provide the Ford Sync, which will provide robust connections for occupants. Latest Chevrolet brands Malibu utilize the 4G LTE Wi-Fi Technology that provides rich in-vehicle experiences. This technology is powerful compared to Ford Sync, and is used for connecting devices and executing few remote operations within the car.
From the value and cost standpoint, Ford can consume a little more, and its payload capacity is a little higher. Additionally, its mileage is too better. The prices vary from nation to nation. Chevrolet seems to be a little cheaper, and reasonably priced going for $33,044, which is slightly less than Ford, but the differences are not serious to propel buyers towards one truck leaving the other
Technophiles are likely to put their preferences on Ford to Chevrolet. On overall, Fords have many features as compared Chevy’s. However, they may be hard to maintain. Compared to Fords, Chevrolets are reliable and cheaper. However, the two brands are equally good performers. It is, therefore, prudent to pick what one thinks would fit his or her usage and preference and personal style
Ethical Systems, Research Paper, Spring 2015, Douglas Green, Page 1 of 1
Ethical
Systems/Final
Research
Paper
2,000
words
minimum,
double-‐spaced
Final
Draft
Due:
Tuesday,
April
28,
12:00
pm
(afternoon)
Please
email
your
final
research
paper
to
me
via
MS
Word
attachment
AND
by
cutting/pasting
the
entire
document
into
the
body
of
your
email.
IF
YOU
DO
NOT
RECEIVE
A
CONFIRMATION
EMAIL
BACK,
I
DID
NOT
RECEIVE
YOUR
ESSAY
AND
YOU
WILL
LOSE
ALL
CREDIT
FOR
THIS
REQUIREMENT.
NO
LATE
WORK
WILL
BE
ACCEPTED…
PERIOD!
.
Fairness and Discipline Weve all been disciplined at one.docxTatianaMajor22
Fairness and Discipline
We've all been disciplined at one time or another by a parent or a teacher. What disciplinary experiences have you had as a child that took a non-punitive approach?
I need paragraph or half page with reference
.
Appendix 12A Statement of Cash Flows—Direct MethodLEARNING .docxTatianaMajor22
Appendix 12A
Statement of Cash Flows—Direct Method
LEARNING OBJECTIVE
6
Prepare a statement of cash flows using the direct method.
To explain and illustrate the direct method, we will use the transactions of Computer Services Company for 2014, to prepare a statement of cash flows. Illustration 12A-1 presents information related to 2014 for Computer Services Company.
To prepare a statement of cash flows under the direct approach, we will apply the three steps outlined in Illustration 12-4.
Illustration 12A-1
Comparative balance sheets, income statement, and additional information for Computer Services Company
STEP 1: OPERATING ACTIVITIES
DETERMINE NET CASH PROVIDED/USED BY OPERATING ACTIVITIES BY CONVERTING NET INCOME FROM AN ACCRUAL BASIS TO A CASH BASIS
Under the direct method, companies compute net cash provided by operating activities by adjusting each item in the income statement from the accrual basis to the cash basis. To simplify and condense the operating activities section, companies report only major classes of operating cash receipts and cash payments. For these major classes, the difference between cash receipts and cash payments is the net cash provided by operating activities. These relationships are as shown in Illustration 12A-2.
Illustration 12A-2
Major classes of cash receipts and payments
An efficient way to apply the direct method is to analyze the items reported in the income statement in the order in which they are listed. We then determine cash receipts and cash payments related to these revenues and expenses. The following pages present the adjustments required to prepare a statement of cash flows for Computer Services Company using the direct approach.
CASH RECEIPTS FROM CUSTOMERS.
The income statement for Computer Services Company reported sales revenue from customers of $507,000. How much of that was cash receipts? To answer that, companies need to consider the change in accounts receivable during the year. When accounts receivable increase during the year, revenues on an accrual basis are higher than cash receipts from customers. Operations led to revenues, but not all of these revenues resulted in cash receipts.
To determine the amount of cash receipts, the company deducts from sales revenue the increase in accounts receivable. On the other hand, there may be a decrease in accounts receivable. That would occur if cash receipts from customers exceeded sales revenue. In that case, the company adds to sales revenue the decrease in accounts receivable. For Computer Services Company, accounts receivable decreased $10,000. Thus, cash receipts from customers were $517,000, computed as shown in Illustration 12A-3.
Illustration 12A-3
Computation of cash receipts from customers
Computer Services can also determine cash receipts from customers from an analysis of the Accounts Receivable account, as shown in Illustration 12A-4.
Illustration 12A-4
Analysis of Accounts Receivable
Illustration.
Effects of StressProvide a 1-page description of a stressful .docxTatianaMajor22
Effects of Stress
Provide a 1-page description of a stressful event currently occurring in your life.
Discuss I am married work a full time job as an occupational therapy assistant am taking two courses
Have to take care of a home feed the animals attend to laundry
Think of my pateitns worry about their well being and what I can do for them ( I bring home my patients issues)
Constantly doing paper work for work such as documentation for billing
I feel like I have no free time for me some days I don’t even eat dinner or lunch because I don’t have time to make anything or am just too tired to cook
On top of this I am married and married ppl do argue and my husband am I have been bunting heads on finances.
Then, referring to information you learned throughout this course, address the following:
· What physiological changes occur in the brain due to the stress response?
· What emotional and cognitive effects might occur due to this stressful situation?
· Would the above changes (physiological, cognitive, or emotional) be any different if the same stress were being experienced by a person of the opposite sex or someone much older or younger than you?
· If the situation continues, how might your physical health be affected?
· What three behavioral strategies would you implement to reduce the effects of this stressor? Describe each strategy. Explain how each behavior could cause changes in brain physiology (e.g., exercise can raise serotonin levels).
· If you were encouraging an adult client to make the above changes, what ethical considerations would you have to keep in mind? How would you address those ethical considerations?
In addition to citing the online course and the text, you are also required to cite a minimum of four scholarly sources. For reputable web sources, look for .gov or .edu sites as opposed to .com sites. Please do not use Wikipedia.
Your paper should be double-spaced, in 12-point Times New Roman font, and with normal 1-inch margins; written in APA style; and free of typographical and grammatical errors. It should include a title page with a running head, an abstract, and a reference page.
The body of the paper should be at least 6 pages in length total
not including the reference or title page
Assignment 1 Grading Criteria
Maximum Points
Described a stressful event.
20
Explained the physiological changes that occur in the brain due to the stress response.
36
Explained the emotional and cognitive effects that may occur due to this stressful situation.
32
Analyzed potential differences in physiological, cognitive, and emotional responses in someone of a different age or sex.
32
Discussed the physical health risks.
28
Provided three behavioral strategies to reduce the effects of the stressor and explained how each could cause changes in brain physiology.
40
Analyzed ethical considerations in implementing behavioral strategies and offered suggestions for addressing these.
40
Integrated at least two scholarly references .
Design Factors NotesCIO’s Office 5 People IT Chief’s Offi.docxTatianaMajor22
Design Factors
Notes
CIO’s Office
5 People
IT Chief’s Office
5 People
LAN/WAN Maint.
20 People
Reception
4 People
Telecommunications
20 People
LAN Management
50 People
Server Room A
2 Person
Server Room B
4 Person
Equipment:
Patch Cable
Computer to Wall
Patch Cable
LAN Room
Cable Trays/Runs
Horizontal Runs
Cisco Border Router
Research: Attached to 5 Floor Switches
Server Room A
10 Servers
Server Room B
10 Servers
Computers
One Per Person
Standard floor (first floor) Lesson 2 Project Plan info
Design Factors
Notes
CIO’s Office
5 People
IT Chief’s Office
5 People
LAN/WAN Maint.
20 People
Reception
4 People
Telecommunications
20 People
LAN Management
50 People
Server Room A
2 Person
Server Room B
4 Person
Equipment:
Patch Cable
Computer to Wall
Patch Cable
LAN Room
Cable Trays/Runs
Horizontal Runs
Cisco Border Router
Research: Attached to 5 Floor Switches
Server Room A
10 Servers
Server Room B
10 Servers
Computers
One Per Person
Basement floor
Design Factors
Notes
Vertical Riser Run
On Outside Wall of LAN Room on Each Floor.
Fiber-Optic Multimode
Riser Runs: Backbone
SC Connectors
Fiber-Optic Cable
Cisco Catalyst: Switch: WS-C3750G-24PS-S: 24 Ports
Leave a Minimum of four ports free on each switch
Color Laser Printer
Minimum of One per Room or One per 20 people
Vertical Riser Run
On Outside Wall of LAN Room on Each Floor and Server RM B on this floor.
Fiber-Optic Multimode
Riser Runs: Backbone
SC Connectors
Fiber-Optic Cable
Cable Trays/Runs
Horizontal Runs
Horizontal Runs
Leave a Minimum of four ports free on each switch
Applicataion
U.S. Minimum Requirement Ranges
Space per Employee - 1997
Two people, such as a supervisor and an employee, can meet in an office with a table or desk between them
60" to 72" x 90" to 126:/5.78m2 to 11.7m2
280Sq. Ft./26.0m2
Worker has a primary desk plus a return
60" to 72"x60"to 84"/5.78 to 7.8m2
193Sq. Ft./17.9m2
Executive office - three to four people can meet around a desk
105 to 130"x96 to 123"/9.75 to 11.4 m2
142Sq. Ft./13.2m2
Basic workstation such as a call center
42" to 52" x 60" to 72"/3.9 to 6.7 m2
114Sq. Ft./10.6 m2
NT1310: Project
Page 1
PRO JECT D ESC RIPT ION
As the project manager for the Cable Planning team, you will manage the creation of the cable plan for
the new building that will be built, with construction set to begin in six weeks.
The deliverables for the entire Cable Plan will consist of an Executive Summary, a PowerPoint
Presentation and an Excel Spreadsheet. You will develop different parts of each of these in three parts.
The final organization should contain these elements:
The Executive Summary:
o Project Introduction
o Standards and Codes
Cable Standards and Codes
Building Standards and Codes
o Project Materials
o Copper Cable, Tools, and Test Equipment
o Fiber-Optic Cable, Tools, and Test Equipment
o Fiber-Optic Design Considerations
o Basement Server Comp.
Question 12.5 pointsSaveThe OSU studies concluded that le.docxTatianaMajor22
Question 1
2.5 points
Save
The OSU studies concluded that leaders exhibit two main types of behavior: structure behavior and consideration behavior.
True
False
Question 2
2.5 points
Save
Fiedler suggests when there is a mismatch between the type of situation in which leaders find themselves, and the leaders style of leadership:
leaders should shift to situations for which they are best suited
the situation should be changed
immediate training is necessary no matter how long it may take
any leadership style is appropriate
the leaders should be flexible enough to adapt to the new situation
Question 3
2.5 points
Save
The OSU studies concluded that leaders exhibit two main styles of behavior:
employee-centered behavior and job-centered behavior
structure behavior and consideration behavior
boss-centered behavior and subordinate-centered behavior
consideration behavior and job-centered behavior
structure behavior and employee-centered behavior
Question 4
2.5 points
Save
The life cycle theory of leadership maintains that:
as a manager becomes more mature, he/she should become more participatory
the organization should match the individual with a specific leadership situation
a manager's leadership style should be independent of the follower's maturity levels
the leader's abilities will peak when the leader is 45 years old, and decline thereafter
a manager's leadership style will be effective only if it is appropriate for the maturity level of the followers
Question 5
2.5 points
Save
According to the characteristics of the emerging leader versus characteristics of the manager, which of the following would be associated with the leader?
problem-solving
independent
consulting
stabilizing
authoritative
Question 6
2.5 points
Save
Under which of the following conditions would Fiedler say a considerate leader would be most effective?
good leader-member relations, high task structure, and strong leader position power
moderately poor leader-member relations, high task structure, and weak leader position power
moderately poor leader-member relations, weak task structure and weak leader position power
good leader-member relations, high task structure, and weak leader position power
good leader-member relations, weak task structure, and weak leader position power
Question 7
2.5 points
Save
Which approach to leadership suggests successful leadership requires a unique combination of leaders, followers, and leadership situations?
transformational leadership
the trait approach
the situational approach to leadership
contingency approach
the contemporary leader approach
Question 8
2.5 points
Save
According to the Vroom-Yetton-Jago Model, when a manager and subordinates meet as a group to discuss the situation, and the group makes the decision, it is the ________ de.
Case Study 1 Questions1. What is the allocated budget .docxTatianaMajor22
Case Study 1 Questions:
1. What is the allocated budget ? $250,000
2. Where does the server room located? Currently, there is no server room
3. What is the number of users with PCs inside each existing site?
Currently there are
4. What is the current cabling used in each location? (cat5e or cat6) Current cabling does not meet the company’s current and future needs
5. Do want us to upgrade token Ring or use a completely new Ethernet network What is your recommendation and why?
6. regarding the ordering system , it is not clear what the we should do , do you want to talk about how to connect the system to the network or how to built the ordering online system because it is more software engineering than networking . Talk about the kind of network (hardware) you recommend based on the business requirements
7. all the sites should have access to our servers in the main branch? yes
8. Regarding the order software, do you need more details about the way it works or just about its connection with the network? Your solution should be from a network point of view
9. Distances are given in Meters or feet? feet
10. Shipment is done by truck, or ships? Currently, only trucking
11. In Dimebox branch, where are administration offices located? See Business goals # 4
12. What is the current network connectivity status? How many devices are currently on the network? How they are physically laid out? Is cabling running all over the floor, hidden in walls or threaded through the ceiling? What are the switches used and its speed? Currently, only the office is networked (token ring) NOVELL
13. What is the minimum Internet speed wanted? See Business Goals on page 2 – I only can tell you what we need the network for, you must tell me what we need to meet the business needs
14. Will the corporation provide wireless access? If yes will it be in all department and buildings? Wireless access would be helpful if we can justify the cost
15. Are there phones in offices? yes
16. What is the internet speed available now? What speed do you want for future? Internet access is through time warner cable company which is not very reliable
17. Do employees access their emails outside the company? yes
18. Do you have plans for future expansion? We like to increase our customer base by 20% over the next year
REMEMBER, you are the IT expert, I’m only a business person who must rely on your expertise.
Network Design and Performance
Case Study
Dooma-Flochies, Inc. with headquarters located on Podunk Road in Trumansburg, NY, is the sole manufacturer of Dooma-Flochies (big surprise). They currently have a manufacturing facility in, Lake Ridge, NY (across Cayuga Lake) on Cayuga Dr. and have recently diversified by purchasing a company, This-N-That, on Industry Ave. in, Dime Box Texas. This-N-That is the sole competitor of Domma-Flochies with their product Thinga-Ma-Jigs. This acquisition gives Dooma-Flochies, Inc a monopoly in this mark.
Behavior in OrganizationsIntercultural Communications Exercise .docxTatianaMajor22
Behavior in Organizations
Intercultural Communications Exercise Response Paper –
Week 5
The most overt cultural differences, such as greeting rituals and name format, can be overcome most easily. The underlying, intangible differences are very difficult to overcome. In this case, the underlying cultural differences are
· Assumptions about the purpose of the event (is the party strictly for fun and for relationship building, or are their business matters to take care of?).
· Assumptions about the purpose and the nature of business relationship.
· Assumptions about power and leadership relationships (who makes the decisions and how?).
· Response styles (verbal and nonverbal signals of agreement, disagreement, politeness, etc.).
Many (though not all) cultural differences can be overcome if you carefully observe other people, think creatively, remain flexible, and remember that your own culture is not inherently superior to others.
The Scenario
Three corporations are planning a joint venture to sponsor an international concert tour. The corporations are Decibel, an agency representing the musicians (from the US, Britain, and Japan); Images, a marketing firm which will handle sales of tickets, snacks and beverages, clothing, and CDs; and Event, a special events company which will hire the ushers, concessionaires, and security officers; print the programs; and clean up the arenas after the shows. The companies come from three different cultures: Blue, Green, and Red. Each has specific cultural traits, customs, and practices.
You are a manager in one of these companies. You will attend the opening cocktail party in Perth, Australia the evening before a 3-day meeting during which the three companies will negotiate the details of the partnership. Your management team includes a Vice President and a number of other managers.
During the 3-day meeting, the companies have the following goals:
Decibel
· As high a royalty rate as possible on sales of T-shirts, videos, and CDs
· Aggressive marketing and advertising to increase attendance and sales
· Good security, both before and during the show Image
Image
· Well known bands that will be easy to market
· As much income as possible from the concerts
· Smoothly functioning event so that publicity from early concerts is positive
Event
· Bands that are not likely to provoke stampedes, riots, or other antisocial behavior
· Bands that are reliable and will show up on time, ready to play
· As much income as possible from the concerts
The cultures that are assigned to the various companies are:
BLUE CULTURE
Image (Marketing Company)
Beliefs, Values, and Attitudes that Underlie This Culture’s Communication
Believe that fate and luck control most things.
Believe in feelings more than reasoning.
An authoritarian leader makes the ultimate decisions.
Nonverbal Traits of This Culture
Treat time as something that is unimportant. It is not a commodity that can be lost.
Conversation distance is close (about 15 inches, face-.
Art therapy in clinical psychology .pptxtashaadam04
art therapy
The term “Art Therapy” was first coined by British artist and art educator Adrian Hill. Art therapy is a treatment approach with the creative process to improve well-being.
Art therapy is a form of psychotherapy that utilizes the creative process of making art to improve and enhance individuals' physical, mental, and emotional well-being. It is based on the belief that creating art can be therapeutic, allowing individuals to explore and express their thoughts, feelings, and experiences in a non-verbal way. It involves using creative techniques such as drawing, painting, collage, coloring, or sculpting.
see detail on https://adamt04.blogspot.com/2024/01/technique-of-art-therapy.html
Sample 1:The population that really shocked me was the populatio.docxjeffsrosalyn
Sample 1:
The population that really shocked me was the population with AIDS. I never really thought of art therapy or therapy at all being used to help with medical issues or diseases. It makes sense though, as they can really effect someones mentality especially if it something that will be a struggle for life.
The psychiatric population was the least surprising to me. When you think about therapy or art therapy you typically think about individuals with mental illness and hospitals designated to their care. This is the population that most often portrayed in the movies as working with therapists of all kinds.
I don't think that any population benefits more or less just because of the group that they fit into. I believe that it is all about what you give to the sessions and therapist and your willingness to receive the help. I think that some populations would have it a little bit harder to find help such as the homeless but if they were able to and put the effort into therapy they would benefit from it just as much as anyone else would. Whether or not you benefit from something has more to do with you as an individual than it does what population you belong to. Just like many other things.
Reply:
Hi Leann! It was surprising for me too when I read that clients with AIDS benefits from art therapy. I like your explanation though, about the disease effecting a person's mentality. I also like your points about what kind of populations might be more likely to receive help. I wrote in my own post that some populations might actually go to their appointments more over other populations, so they at least have more potential to get help, but I also like your point about how it is all about the client's willingness to receive help, this is exactly what I was trying to say!
Sample 2:
The population that surprised me the most by being served by art therapists was prostitutes. I think this surprised me most because a few girls I graduated high school with became strippers and they want everyone to know how proud they are of it, so at first I wasn't sure prostitutes might feel the opposite; however, when I think about it it makes sense. As said in the article, prostitutes have a lot of substance abuse, childhood trauma, and sexual abuse.
As for the least surprising population for me was children and psychiatric clients. This is because communication might be difficult for children and those with mental illnesses, so utilizing art therapy would be help them easily considering not much, if any, speech needs to be used.
Populations that might benefit more or less from art therapy, I am not sure about. I think different populations could benefit more, for example as I previously said, children and psychiatric patients might benefit the most. They would be more likely to actually attend therapy, children are brought by their parents and some psychiatric patients might have to stay in an institution, so they might not be able to change their minds like .
352 BUMC PROCEEDINGS 2001;14:352–357
The technological advances of the past century tended tochange the focus of medicine from a caring, service-oriented model to a technological, cure-oriented model.
Technology has led to phenomenal advances in medicine and
has given us the ability to prolong life. However, in the past few
decades physicians have attempted to balance their care by re-
claiming medicine’s more spiritual roots, recognizing that until
modern times spirituality was often linked with health care.
Spiritual or compassionate care involves serving the whole per-
son—the physical, emotional, social, and spiritual. Such service
is inherently a spiritual activity. Rachel Naomi Remen, MD, who
has developed Commonweal retreats for people with cancer, de-
scribed it well:
Helping, fixing, and serving represent three different ways of see-
ing life. When you help, you see life as weak. When you fix, you
see life as broken. When you serve, you see life as whole. Fixing
and helping may be the work of the ego, and service the work of
the soul (1).
Serving patients may involve spending time with them, hold-
ing their hands, and talking about what is important to them.
Patients value these experiences with their physicians. In this
article, I discuss elements of compassionate care, review some
research on the role of spirituality in health care, highlight ad-
vantages of understanding patients’ spirituality, explain ways to
practice spiritual care, and summarize some national efforts to
incorporate spirituality into medicine.
COMPASSIONATE CARE: HELPING PATIENTS FIND MEANING IN
THEIR SUFFERING AND ADDRESSING THEIR SPIRITUALITY
The word compassion means “to suffer with.” Compassionate
care calls physicians to walk with people in the midst of their
pain, to be partners with patients rather than experts dictating
information to them.
Victor Frankl, a psychiatrist who wrote of his experiences in
a Nazi concentration camp, wrote: “Man is not destroyed by suf-
fering; he is destroyed by suffering without meaning” (2). One
of the challenges physicians face is to help people find meaning
and acceptance in the midst of suffering and chronic illness.
Medical ethicists have reminded us that religion and spiritual-
ity form the basis of meaning and purpose for many people (3).
At the same time, while patients struggle with the physical as-
pects of their disease, they have other pain as well: pain related
to mental and spiritual suffering, to an inability to engage the
deepest questions of life. Patients may be asking questions such
The role of spirituality in health care
CHRISTINA M. PUCHALSKI, MD, MS
From The George Washington Institute for Spirituality and Health (GWish), The
George Washington University Medical Center Departments of Medicine and
Health Care Sciences, and The George Washington University, Washington, DC.
Presented at Baylor University Medical Center on February 28, 2001, as the Baylor-
Charles A. Sammons Cancer Center Charlotte ...
This research is based on general practice in the psychiatric institutions. It involves a qualitative research method that that uses three peer-reviewed journal article containing information about the scope of psychiatry, emerging issues in accommodating patients and highlight on medication of mental illness
Please readRobert Geraci, Russia Minorities and Empire,” in .docxTatianaMajor22
Please read:
Robert Geraci, “Russia: Minorities and Empire,” in Abbott Gleason, ed., A Companion to Russian History (Oxford: Wiley-Blackwell, 2009), 243-260.
And discuss:
How does Geraci portray the legacy of the early Russian history for the make-up of 18-19th century Russia?
Please read: Leonard Victor Rutgers, “Roman Policy Towards the Jews: Expulsions from the City of Rome during the First Century C.E.,” in Classical Antiquity, Vol. 13, No. 1 (Apr., 1994), pp. 56-74.
And discuss: Rutgers surveys the different reasons historians have given for the expulsion of the Jews from Rome in the first century C.E. Who place did Jews have in Roman society at this time? Were they expelled because of their religious practices, or because they were ‘unruly’ as Rutgers argues? If so, what caused them to act in this way? What kind of historical evidence does the author use?
There are 2 essay, each one should write at least 300-350 words and plus one reference page.
MLA format. Must use quote( “ ”) for every source you use from website. And put (author, page number) behind quote.
Roman Policy towards the Jews: Expulsions from the City of Rome during the First Century
C.E.
Author(s): Leonard Victor Rutgers
Source: Classical Antiquity, Vol. 13, No. 1 (Apr., 1994), pp. 56-74
Published by: University of California Press
Stable URL: http://www.jstor.org/stable/25011005 .
Accessed: 26/08/2011 13:35
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content in a trusted digital archive. We use information technology and tools to increase productivity and facilitate new forms
of scholarship. For more information about JSTOR, please contact [email protected]
University of California Press is collaborating with JSTOR to digitize, preserve and extend access to Classical
Antiquity.
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LEONARD VICTOR RUTGERS
Roman Policy towards the Jews:
Expulsions from the City of Rome
during the First Century c. E.
Tant de causes secretes se melent souvent a la cause apparente, tant de ressorts
inconnus servent a persecuter un homme, qu'il est impossible de demeler dans les
siecles posterieures la source cachee des malheurs des hommes les plus consider
ables, a plus forte raison celle du supplice d'un particulier qui ne pouvait etre
connu que par ceux de son parti.
-Voltaire, Traite sur la tolerance (1763)
IN THIS ARTICLE I want to discuss the evidence for expulsions of Jews from
the city of Rome in the first century C.E. Scholars have long been interested in the
reasons underlying these expulsions. Because the anci.
Ford VS ChevroletThere are many reasons that make the Chevy.docxTatianaMajor22
Ford VS Chevrolet
There are many reasons that make the Chevy’s and Ford’s motors two most common trucks. Studies reveal that that they are the most popular vehicles on sales today. It is because they are powerful, versatile and reasonably priced. They also come in a wide variety of configurations and styles. However, many buyers and sellers have questioned themselves on the better vehicle compared to the other in terms of quality, Wi-Fi, price ranges, value, and costs. To compare and contrast on this subject, let us take an example of two vehicles each from each company to facilitate comparison.
Ford offers the full-size track with automatic high-beam control, automatic parallel parking and power-retractable running boards. Fords are elegant, and they are mostly aluminum making them save weight and bolster gas mileage. None of these features are offered Chevy’s. Chevrolets have outstanding quality. They are mostly comprised of steel, for instance, the Chevrolet Silverado. This makes them good for rough roads and difficult terrains.
Fords have employed the use of up to date Wi-Fi technology. Ford intends to provide the Ford Sync, which will provide robust connections for occupants. Latest Chevrolet brands Malibu utilize the 4G LTE Wi-Fi Technology that provides rich in-vehicle experiences. This technology is powerful compared to Ford Sync, and is used for connecting devices and executing few remote operations within the car.
From the value and cost standpoint, Ford can consume a little more, and its payload capacity is a little higher. Additionally, its mileage is too better. The prices vary from nation to nation. Chevrolet seems to be a little cheaper, and reasonably priced going for $33,044, which is slightly less than Ford, but the differences are not serious to propel buyers towards one truck leaving the other
Technophiles are likely to put their preferences on Ford to Chevrolet. On overall, Fords have many features as compared Chevy’s. However, they may be hard to maintain. Compared to Fords, Chevrolets are reliable and cheaper. However, the two brands are equally good performers. It is, therefore, prudent to pick what one thinks would fit his or her usage and preference and personal style
Ethical Systems, Research Paper, Spring 2015, Douglas Green, Page 1 of 1
Ethical
Systems/Final
Research
Paper
2,000
words
minimum,
double-‐spaced
Final
Draft
Due:
Tuesday,
April
28,
12:00
pm
(afternoon)
Please
email
your
final
research
paper
to
me
via
MS
Word
attachment
AND
by
cutting/pasting
the
entire
document
into
the
body
of
your
email.
IF
YOU
DO
NOT
RECEIVE
A
CONFIRMATION
EMAIL
BACK,
I
DID
NOT
RECEIVE
YOUR
ESSAY
AND
YOU
WILL
LOSE
ALL
CREDIT
FOR
THIS
REQUIREMENT.
NO
LATE
WORK
WILL
BE
ACCEPTED…
PERIOD!
.
Fairness and Discipline Weve all been disciplined at one.docxTatianaMajor22
Fairness and Discipline
We've all been disciplined at one time or another by a parent or a teacher. What disciplinary experiences have you had as a child that took a non-punitive approach?
I need paragraph or half page with reference
.
Appendix 12A Statement of Cash Flows—Direct MethodLEARNING .docxTatianaMajor22
Appendix 12A
Statement of Cash Flows—Direct Method
LEARNING OBJECTIVE
6
Prepare a statement of cash flows using the direct method.
To explain and illustrate the direct method, we will use the transactions of Computer Services Company for 2014, to prepare a statement of cash flows. Illustration 12A-1 presents information related to 2014 for Computer Services Company.
To prepare a statement of cash flows under the direct approach, we will apply the three steps outlined in Illustration 12-4.
Illustration 12A-1
Comparative balance sheets, income statement, and additional information for Computer Services Company
STEP 1: OPERATING ACTIVITIES
DETERMINE NET CASH PROVIDED/USED BY OPERATING ACTIVITIES BY CONVERTING NET INCOME FROM AN ACCRUAL BASIS TO A CASH BASIS
Under the direct method, companies compute net cash provided by operating activities by adjusting each item in the income statement from the accrual basis to the cash basis. To simplify and condense the operating activities section, companies report only major classes of operating cash receipts and cash payments. For these major classes, the difference between cash receipts and cash payments is the net cash provided by operating activities. These relationships are as shown in Illustration 12A-2.
Illustration 12A-2
Major classes of cash receipts and payments
An efficient way to apply the direct method is to analyze the items reported in the income statement in the order in which they are listed. We then determine cash receipts and cash payments related to these revenues and expenses. The following pages present the adjustments required to prepare a statement of cash flows for Computer Services Company using the direct approach.
CASH RECEIPTS FROM CUSTOMERS.
The income statement for Computer Services Company reported sales revenue from customers of $507,000. How much of that was cash receipts? To answer that, companies need to consider the change in accounts receivable during the year. When accounts receivable increase during the year, revenues on an accrual basis are higher than cash receipts from customers. Operations led to revenues, but not all of these revenues resulted in cash receipts.
To determine the amount of cash receipts, the company deducts from sales revenue the increase in accounts receivable. On the other hand, there may be a decrease in accounts receivable. That would occur if cash receipts from customers exceeded sales revenue. In that case, the company adds to sales revenue the decrease in accounts receivable. For Computer Services Company, accounts receivable decreased $10,000. Thus, cash receipts from customers were $517,000, computed as shown in Illustration 12A-3.
Illustration 12A-3
Computation of cash receipts from customers
Computer Services can also determine cash receipts from customers from an analysis of the Accounts Receivable account, as shown in Illustration 12A-4.
Illustration 12A-4
Analysis of Accounts Receivable
Illustration.
Effects of StressProvide a 1-page description of a stressful .docxTatianaMajor22
Effects of Stress
Provide a 1-page description of a stressful event currently occurring in your life.
Discuss I am married work a full time job as an occupational therapy assistant am taking two courses
Have to take care of a home feed the animals attend to laundry
Think of my pateitns worry about their well being and what I can do for them ( I bring home my patients issues)
Constantly doing paper work for work such as documentation for billing
I feel like I have no free time for me some days I don’t even eat dinner or lunch because I don’t have time to make anything or am just too tired to cook
On top of this I am married and married ppl do argue and my husband am I have been bunting heads on finances.
Then, referring to information you learned throughout this course, address the following:
· What physiological changes occur in the brain due to the stress response?
· What emotional and cognitive effects might occur due to this stressful situation?
· Would the above changes (physiological, cognitive, or emotional) be any different if the same stress were being experienced by a person of the opposite sex or someone much older or younger than you?
· If the situation continues, how might your physical health be affected?
· What three behavioral strategies would you implement to reduce the effects of this stressor? Describe each strategy. Explain how each behavior could cause changes in brain physiology (e.g., exercise can raise serotonin levels).
· If you were encouraging an adult client to make the above changes, what ethical considerations would you have to keep in mind? How would you address those ethical considerations?
In addition to citing the online course and the text, you are also required to cite a minimum of four scholarly sources. For reputable web sources, look for .gov or .edu sites as opposed to .com sites. Please do not use Wikipedia.
Your paper should be double-spaced, in 12-point Times New Roman font, and with normal 1-inch margins; written in APA style; and free of typographical and grammatical errors. It should include a title page with a running head, an abstract, and a reference page.
The body of the paper should be at least 6 pages in length total
not including the reference or title page
Assignment 1 Grading Criteria
Maximum Points
Described a stressful event.
20
Explained the physiological changes that occur in the brain due to the stress response.
36
Explained the emotional and cognitive effects that may occur due to this stressful situation.
32
Analyzed potential differences in physiological, cognitive, and emotional responses in someone of a different age or sex.
32
Discussed the physical health risks.
28
Provided three behavioral strategies to reduce the effects of the stressor and explained how each could cause changes in brain physiology.
40
Analyzed ethical considerations in implementing behavioral strategies and offered suggestions for addressing these.
40
Integrated at least two scholarly references .
Design Factors NotesCIO’s Office 5 People IT Chief’s Offi.docxTatianaMajor22
Design Factors
Notes
CIO’s Office
5 People
IT Chief’s Office
5 People
LAN/WAN Maint.
20 People
Reception
4 People
Telecommunications
20 People
LAN Management
50 People
Server Room A
2 Person
Server Room B
4 Person
Equipment:
Patch Cable
Computer to Wall
Patch Cable
LAN Room
Cable Trays/Runs
Horizontal Runs
Cisco Border Router
Research: Attached to 5 Floor Switches
Server Room A
10 Servers
Server Room B
10 Servers
Computers
One Per Person
Standard floor (first floor) Lesson 2 Project Plan info
Design Factors
Notes
CIO’s Office
5 People
IT Chief’s Office
5 People
LAN/WAN Maint.
20 People
Reception
4 People
Telecommunications
20 People
LAN Management
50 People
Server Room A
2 Person
Server Room B
4 Person
Equipment:
Patch Cable
Computer to Wall
Patch Cable
LAN Room
Cable Trays/Runs
Horizontal Runs
Cisco Border Router
Research: Attached to 5 Floor Switches
Server Room A
10 Servers
Server Room B
10 Servers
Computers
One Per Person
Basement floor
Design Factors
Notes
Vertical Riser Run
On Outside Wall of LAN Room on Each Floor.
Fiber-Optic Multimode
Riser Runs: Backbone
SC Connectors
Fiber-Optic Cable
Cisco Catalyst: Switch: WS-C3750G-24PS-S: 24 Ports
Leave a Minimum of four ports free on each switch
Color Laser Printer
Minimum of One per Room or One per 20 people
Vertical Riser Run
On Outside Wall of LAN Room on Each Floor and Server RM B on this floor.
Fiber-Optic Multimode
Riser Runs: Backbone
SC Connectors
Fiber-Optic Cable
Cable Trays/Runs
Horizontal Runs
Horizontal Runs
Leave a Minimum of four ports free on each switch
Applicataion
U.S. Minimum Requirement Ranges
Space per Employee - 1997
Two people, such as a supervisor and an employee, can meet in an office with a table or desk between them
60" to 72" x 90" to 126:/5.78m2 to 11.7m2
280Sq. Ft./26.0m2
Worker has a primary desk plus a return
60" to 72"x60"to 84"/5.78 to 7.8m2
193Sq. Ft./17.9m2
Executive office - three to four people can meet around a desk
105 to 130"x96 to 123"/9.75 to 11.4 m2
142Sq. Ft./13.2m2
Basic workstation such as a call center
42" to 52" x 60" to 72"/3.9 to 6.7 m2
114Sq. Ft./10.6 m2
NT1310: Project
Page 1
PRO JECT D ESC RIPT ION
As the project manager for the Cable Planning team, you will manage the creation of the cable plan for
the new building that will be built, with construction set to begin in six weeks.
The deliverables for the entire Cable Plan will consist of an Executive Summary, a PowerPoint
Presentation and an Excel Spreadsheet. You will develop different parts of each of these in three parts.
The final organization should contain these elements:
The Executive Summary:
o Project Introduction
o Standards and Codes
Cable Standards and Codes
Building Standards and Codes
o Project Materials
o Copper Cable, Tools, and Test Equipment
o Fiber-Optic Cable, Tools, and Test Equipment
o Fiber-Optic Design Considerations
o Basement Server Comp.
Question 12.5 pointsSaveThe OSU studies concluded that le.docxTatianaMajor22
Question 1
2.5 points
Save
The OSU studies concluded that leaders exhibit two main types of behavior: structure behavior and consideration behavior.
True
False
Question 2
2.5 points
Save
Fiedler suggests when there is a mismatch between the type of situation in which leaders find themselves, and the leaders style of leadership:
leaders should shift to situations for which they are best suited
the situation should be changed
immediate training is necessary no matter how long it may take
any leadership style is appropriate
the leaders should be flexible enough to adapt to the new situation
Question 3
2.5 points
Save
The OSU studies concluded that leaders exhibit two main styles of behavior:
employee-centered behavior and job-centered behavior
structure behavior and consideration behavior
boss-centered behavior and subordinate-centered behavior
consideration behavior and job-centered behavior
structure behavior and employee-centered behavior
Question 4
2.5 points
Save
The life cycle theory of leadership maintains that:
as a manager becomes more mature, he/she should become more participatory
the organization should match the individual with a specific leadership situation
a manager's leadership style should be independent of the follower's maturity levels
the leader's abilities will peak when the leader is 45 years old, and decline thereafter
a manager's leadership style will be effective only if it is appropriate for the maturity level of the followers
Question 5
2.5 points
Save
According to the characteristics of the emerging leader versus characteristics of the manager, which of the following would be associated with the leader?
problem-solving
independent
consulting
stabilizing
authoritative
Question 6
2.5 points
Save
Under which of the following conditions would Fiedler say a considerate leader would be most effective?
good leader-member relations, high task structure, and strong leader position power
moderately poor leader-member relations, high task structure, and weak leader position power
moderately poor leader-member relations, weak task structure and weak leader position power
good leader-member relations, high task structure, and weak leader position power
good leader-member relations, weak task structure, and weak leader position power
Question 7
2.5 points
Save
Which approach to leadership suggests successful leadership requires a unique combination of leaders, followers, and leadership situations?
transformational leadership
the trait approach
the situational approach to leadership
contingency approach
the contemporary leader approach
Question 8
2.5 points
Save
According to the Vroom-Yetton-Jago Model, when a manager and subordinates meet as a group to discuss the situation, and the group makes the decision, it is the ________ de.
Case Study 1 Questions1. What is the allocated budget .docxTatianaMajor22
Case Study 1 Questions:
1. What is the allocated budget ? $250,000
2. Where does the server room located? Currently, there is no server room
3. What is the number of users with PCs inside each existing site?
Currently there are
4. What is the current cabling used in each location? (cat5e or cat6) Current cabling does not meet the company’s current and future needs
5. Do want us to upgrade token Ring or use a completely new Ethernet network What is your recommendation and why?
6. regarding the ordering system , it is not clear what the we should do , do you want to talk about how to connect the system to the network or how to built the ordering online system because it is more software engineering than networking . Talk about the kind of network (hardware) you recommend based on the business requirements
7. all the sites should have access to our servers in the main branch? yes
8. Regarding the order software, do you need more details about the way it works or just about its connection with the network? Your solution should be from a network point of view
9. Distances are given in Meters or feet? feet
10. Shipment is done by truck, or ships? Currently, only trucking
11. In Dimebox branch, where are administration offices located? See Business goals # 4
12. What is the current network connectivity status? How many devices are currently on the network? How they are physically laid out? Is cabling running all over the floor, hidden in walls or threaded through the ceiling? What are the switches used and its speed? Currently, only the office is networked (token ring) NOVELL
13. What is the minimum Internet speed wanted? See Business Goals on page 2 – I only can tell you what we need the network for, you must tell me what we need to meet the business needs
14. Will the corporation provide wireless access? If yes will it be in all department and buildings? Wireless access would be helpful if we can justify the cost
15. Are there phones in offices? yes
16. What is the internet speed available now? What speed do you want for future? Internet access is through time warner cable company which is not very reliable
17. Do employees access their emails outside the company? yes
18. Do you have plans for future expansion? We like to increase our customer base by 20% over the next year
REMEMBER, you are the IT expert, I’m only a business person who must rely on your expertise.
Network Design and Performance
Case Study
Dooma-Flochies, Inc. with headquarters located on Podunk Road in Trumansburg, NY, is the sole manufacturer of Dooma-Flochies (big surprise). They currently have a manufacturing facility in, Lake Ridge, NY (across Cayuga Lake) on Cayuga Dr. and have recently diversified by purchasing a company, This-N-That, on Industry Ave. in, Dime Box Texas. This-N-That is the sole competitor of Domma-Flochies with their product Thinga-Ma-Jigs. This acquisition gives Dooma-Flochies, Inc a monopoly in this mark.
Behavior in OrganizationsIntercultural Communications Exercise .docxTatianaMajor22
Behavior in Organizations
Intercultural Communications Exercise Response Paper –
Week 5
The most overt cultural differences, such as greeting rituals and name format, can be overcome most easily. The underlying, intangible differences are very difficult to overcome. In this case, the underlying cultural differences are
· Assumptions about the purpose of the event (is the party strictly for fun and for relationship building, or are their business matters to take care of?).
· Assumptions about the purpose and the nature of business relationship.
· Assumptions about power and leadership relationships (who makes the decisions and how?).
· Response styles (verbal and nonverbal signals of agreement, disagreement, politeness, etc.).
Many (though not all) cultural differences can be overcome if you carefully observe other people, think creatively, remain flexible, and remember that your own culture is not inherently superior to others.
The Scenario
Three corporations are planning a joint venture to sponsor an international concert tour. The corporations are Decibel, an agency representing the musicians (from the US, Britain, and Japan); Images, a marketing firm which will handle sales of tickets, snacks and beverages, clothing, and CDs; and Event, a special events company which will hire the ushers, concessionaires, and security officers; print the programs; and clean up the arenas after the shows. The companies come from three different cultures: Blue, Green, and Red. Each has specific cultural traits, customs, and practices.
You are a manager in one of these companies. You will attend the opening cocktail party in Perth, Australia the evening before a 3-day meeting during which the three companies will negotiate the details of the partnership. Your management team includes a Vice President and a number of other managers.
During the 3-day meeting, the companies have the following goals:
Decibel
· As high a royalty rate as possible on sales of T-shirts, videos, and CDs
· Aggressive marketing and advertising to increase attendance and sales
· Good security, both before and during the show Image
Image
· Well known bands that will be easy to market
· As much income as possible from the concerts
· Smoothly functioning event so that publicity from early concerts is positive
Event
· Bands that are not likely to provoke stampedes, riots, or other antisocial behavior
· Bands that are reliable and will show up on time, ready to play
· As much income as possible from the concerts
The cultures that are assigned to the various companies are:
BLUE CULTURE
Image (Marketing Company)
Beliefs, Values, and Attitudes that Underlie This Culture’s Communication
Believe that fate and luck control most things.
Believe in feelings more than reasoning.
An authoritarian leader makes the ultimate decisions.
Nonverbal Traits of This Culture
Treat time as something that is unimportant. It is not a commodity that can be lost.
Conversation distance is close (about 15 inches, face-.
Discussion Question Comparison of Theories on Anxiety Disord.docxTatianaMajor22
Discussion Question:
Comparison of Theories on Anxiety Disorders
There are numerous theories that attempt to explain the development and manifestation of psychological disorders. Some researchers hold that certain disorders result from learned behaviors (behavioral theory), while other researchers believe that there is a genetic or biological basis to psychological disorders (medical model), while still others hold that psychological disorders stem from unresolved unconscious conflict (psychoanalytic theory). How would each of these theoretical viewpoints explain anxiety disorders? Does one explain the development and manifestation of anxiety disorders better than the others?
200- 400 words please
Three min resources with
in text citations and examples
you can use the following as a module reference
cite as university 2014
Anxiety Disorders
Anxiety disorders such as panic disorder, specific phobias, and social anxiety disorder feature a heightened autonomic nervous system response that is above and beyond what would be considered normal when faced with the object or situation that the person reacts to. For example, a person with a specific phobia of spiders (called arachnophobia) experiences a heightened autonomic response when confronted with a spider (or even an image of a spider). This anxiety response must result in significant distress or impairment. In general, anxiety disorders have been linked to underactive gamma-aminobutyric acid (GABA) in the brain, resulting in overexcitability of the amygdala and the anterior cingulate cortex. Additionally, genetic research shows that anxiety disorders demonstrate a clear pattern of genetic predisposition
Charles Darwin's Perspective
We talked about Charles Darwin when discussing evolution and natural selection. Darwin was also very interested in emotions. One of his books published in 1872,The Expression of Emotions in Man and Animals, was devoted to this topic.
Darwin believed that emotions play an important role in the survival of the species and result from evolutionary processes in the same way as other behaviors and psychological functions. Darwin's writing on this topic also prompted psychologists to study animal behavior as a way to better understand human behavior.
James–Lange Theory of Emotions
Modern theories of emotion can be traced to William James and Carl Lange (Pinel, 2011). William James was a renowned Harvard psychologist who is sometimes called the father of American psychology. Carl Lange was a Danish physician. James and Lange formulated the same theory of emotions independently at about the same time (1884). As a result, it is called the James–Lange theory of emotions. This theory reversed the commonsensical notion that emotions are automatic responses to events around us. Instead, it proposes that emotions are the brain's interpretation of physiological responses to emotionally provocative stimuli.
Cannon–Bard Theory of Emotions
In 1915, Harvard physiologist Walt.
I have always liked Dustin Hoffmans style of acting, in this mov.docxTatianaMajor22
I have always liked Dustin Hoffman's style of acting, in this movie he takes on a sexually deprived young male just out of college, and has never been with a female, and is duped by horny older woman that feels neglected. Dustin Hoffman takes the characters form of a young male, goofy, respectful virgin and intelligent male, missing something but not really sure at the beginning till Ann Bancroft coaxes him with seduction to fulfill her own needs. In an other movie called "The life of Little Big Man" he plays almost the same character but as a white child raised by the Native Americans and a wise old chief that deeply care and loves him as his own, and Fay Dunaway plays a Holy rollers wife that is older and sexually deprived and feeling neglected by her husband and also she goes through major changes in her life from devoted wife, to a honey bell/ house hooker, whats funny Dustin Hoffman is a awesome actor but has to have his surrounding characters bring his character to life. The Graduate was Dustin Hoffman's first big movie of his career.
I actually liked movie "Little Big man" way better due to he went through major changes in his life, from being a Native boy warrior, captured by Yankees, meets Fay Dunaway who loves to give baths, to finding his sister who teaches him to be a gunslinger and then returns to his Grand Father to be a native again and tells his blind Grand Father the world of the white man is a crazy one, then his see the Psyho Col. Custer and gets his revenge by telling Custer the truth. The movie Little Big Man makes you laugh, teaches you things about people and survial and cry at times... its a must see...
Although a stray away from the Benjamin Braddock written about in the novel The Graduate, Dustin Hoffman does an awesome job with this character on film. When you first meet Ben he is at a party that his parents are throwing in his academic honor upon his graduation from school and return home. The whole night, Hoffman stumbles though various conversations and tries to coyly escape from the festivities. Small things such as this Hoffman did a great job at, conveying the hesitance and crisis that Ben was going through as a graduate. There are multiple times in the movie he hardly expresses anything at all, yet it clearly shows you that Ben is having a very hard time internally with everything going on. Even through his relationships with Mrs. Robinson and her daughter Elaine you see the young man struggling with himself through either failed attempts at affection or lack thereof.
.
Is obedience to the law sufficient to ensure ethical behavior Wh.docxTatianaMajor22
Is obedience to the law sufficient to ensure ethical behavior? Why, or why not? Support your answer with at least three reasons that justify your position.
100 words
Discuss the differences between an attitude and a behavior. Provide 4 substantive reasons why it is important for organizations to monitor and mitigate employee behavior that is either beneficial or detrimental to the organization's goals and existence.
150 words
.
If you are using the Blackboard Mobile Learn IOS App, please clic.docxTatianaMajor22
If you are using the Blackboard Mobile Learn IOS App, please click "View in Browser." V BUS 520Week 9 Assignment 4 Paper
I need the paper as soon as possible
Students, please view the "Submit a Clickable Rubric Assignment" in the Student Center.
Instructors, training on how to grade is within the Instructor Center.
Assignment 4: Leadership Style: What Do People Do When They Are Leading?
Due Week 9 and worth 100 points
Choose one (1) of the following CEOs for this assignment: Larry Page (Google), Tony Hsieh (Zappos), Gary Kelly (Southwest Airlines), Meg Whitman (Hewlett Packard), Ursula Burns (Xerox), Terri Kelly (W.L. Gore), Ellen Kullman (DuPont), or Bob McDonald (Procter & Gamble). Use the Internet to investigate the leadership style and effectiveness of the selected CEO. (Note: Just choose one that is easier for you to right about.) It does not matter to me which CEO you pick
Write a five to six (5-6) page paper in which you:
1. Provide a brief (one [1] paragraph) background of the CEO.
2. Analyze the CEO’s leadership style and philosophy, and how the CEO’s leadership style aligns with the culture.
3. Examine the CEO’s personal and organizational values.
4. Evaluate how the values of the CEO are likely to influence ethical behavior within the organization.
5. Determine the CEO’s three (3) greatest strengths and three (3) greatest weaknesses.
6. Select the quality that you believe contributes most to this leader’s success. Support your reasoning.
7. Assess how communication and collaboration, and power and politics influence group (i.e., the organization’s) dynamics.
8. Use at least five (5) quality academic resources in this assignment. Note: Wikipedia and other Websites do not qualify as academic resources.
Your assignment must follow these formatting requirements:
· Be typed, double spaced, using Times New Roman font (size 12), with one-inch margins on all sides; citations and references must follow APA or school-specific format. Check with your professor for any additional instructions.
· Include a cover page containing the title of the assignment, the student’s name, the professor’s name, the course title, and the date. The cover page and the reference page are not included in the required assignment page length.
The specific course learning outcomes associated with this assignment are:
· Analyze the formation and dynamics of group behavior and work teams, including the application of power in groups.
· Outline various individual and group decision-making processes and key factors affecting these processes.
· Examine the primary conflict levels within organization and the process for negotiating resolutions.
· Examine how power and influence empower and affect office politics, political interpretations, and political behavior.
· Use technology and information resources to research issues in organizational behavior.
· Write clearly and concisely about organizational behavior using proper writing mechanics.
Click here.
Is the proliferation of social media and communication devices a .docxTatianaMajor22
Is the proliferation of social media and communication devices a good thing or a bad thing for society? Use personal examples to support your opinion.
( I’m currently a freshmen in university)
.
MATH 107 FINAL EXAMINATIONMULTIPLE CHOICE1. Deter.docxTatianaMajor22
MATH 107 FINAL EXAMINATION
MULTIPLE CHOICE
1. Determine the domain and range of the piecewise function.
A. Domain [–2, 2];
B. Domain [–1, 1];
C. Domain [–1, 3];
D. Domain [–3/2, –1/2];
2. Solve:
A. 3
B. 3,7
C. 9
D. No solution
3. Determine the interval(s) on which the function is increasing.
A. (−1.3, 1.3)
B. (1, 3)
C. (−∞,−1)and (3,∞)
D. (−2.5, 1)and (4.5,∞)
4. Determine whether the graph of y = 2|x| + 1 is symmetric with respect to the origin,
the x-axis, or the y-axis.
A. symmetric with respect to the origin only
B. symmetric with respect to the x-axis only
C. symmetric with respect to the y-axis only
D. not symmetric with respect to the origin, not symmetric with respect to the x-axis, and
not symmetric with respect to the y-axis
5. Solve, and express the answer in interval notation: | 9 – 7x | ≤ 12.
A. (–∞, –3/7]
B. (–∞, −3/7] ∪ [3, ∞) C. [–3, 3/7]
D. [–3/7, 3]
6. Which of the following represents the graph of 7x + 2y = 14 ?
A. B.
C. D.
7. Write a slope-intercept equation for a line parallel to the line x – 2y = 6 which passes through the point (10, – 4).
A.
B.
C.
D.
8. Which of the following best describes the graph?
A. It is the graph of a function and it is one-to-one.
B. It is the graph of a function and it is not one-to-one.
C. It is not the graph of a function and it is one-to-one.
D. It is not the graph of a function and it is not one-to-one.
9. Express as a single logarithm: log x + log 1 – 6 log (y + 4)
A.
B.
C.
D.
10. Which of the functions corresponds to the graph?
A.
B.
C.
D.
11. Suppose that a function f has exactly one x-intercept.
Which of the following statements MUST be true?
A. f is a linear function.
B. f (x) ≥ 0 for all x in the domain of f.
C. The equation f(x) = 0 has exactly one real-number solution.
D. f is an invertible function.
12. The graph of y = f(x) is shown at the left and the graph of y = g(x) is shown at the right. (No formulas are given.) What is the relationship between g(x) and f(x)?
y = f (x) y = g(x)
A. g(x) = f (x – 3) + 1
B. g(x) = f (x – 1) + 3
C. g(x) = f (x + 3) – 1
D. g(x) = f (x + 1) .
If the CIO is to be valued as a strategic actor, how can he bring.docxTatianaMajor22
If the CIO is to be valued as a strategic actor, how can he bring to the table the ethos of alignment, bound to the demands of process strategic planning to move IT to the forefront of the organization's future? Is there a lack of information on strategic planning? Nope. I think the process of planning is poorly understood, and rarely endorsed. The reasons are simple enough. Planning requires a commitment of resources (time, talent, money); it requires insight; it requires a total immersion in the corporate culture. While organizations do plan, planning is invariably attached to the budget process. It is typically here that the CIO lays out his/her vision for the coming year Now a few years ago authors began writing on the value of aligning IT purpose to organizational purpose. They wrote at a time when enterprise architectural planning was fairly new, and enterprise resource management was on the lips of every executive. My view is that alignment is a natural process driven by the availability of the tools to accomplish it. Twenty years ago making sense of IT was more about processing power, and database management. We are in a new age of IT, and it is the computer that is the network, not the network as an independent self-contained exchange of information. If you will spend some time reviewing the basic materials I provided on strategic planning and alignment, we can begin our discussions for the course. Again, here is the problem I would like for us to tackle: If the CIO is to be valued as a strategic actor, how can he bring to the table the ethos of alignment, bound to the demands of process strategic planning to move IT to the forefront of the organization's future? Most of the articles I bundled together for this week are replete with tables and charts. These can be a heavy read. Your approach should be to review these articles for the "big ideas" or lessons that are take away. I think these studies are significant enough that we will conclude our first week with an understanding of the roles between executive leaders, and how they see Information Technology playing a role in shaping a business strategy.
Read the articles to answer the question. Please No Plagerism or verbatim but you are allowed to quote from the article.
Achieving and Sustaining
Business-IT Alignment
Jerry Luftman
Tom Brier
I
n recent decades, billions of dollars have been invested in intormation tech-
nology (IT). A key concern of business executives is alignment—applying IT
in an appropriate and timely way and in harmony with business strategies,
goals, and needs. This issue addresses both how IT is aligned with the busi-
ness and how the business should be aligned with IT Frustratingly, organizations
seem to find it difficult or impossible to harness the power of information tech-
nology for their own long-term benefit, even though there is worldwide evi-
dence that IT has the power to transform whole industries and markets.' How
can companies.
I am showing below the proof of breakeven, which is fixed costs .docxTatianaMajor22
I am showing below the proof of breakeven, which is fixed costs/ contribution margin.
We start with the definition of breakeven and proceed using elementary algebra to derive the formula. Breakeven is a number and is created by knowing fixed and variable costs, and the retail sales price. It is thus not a point of discussion but is based on the assumptions of these variables.
Proof of Breakeven
Definition of BreakevenVolume: Total Revenue = Total Expenses
Definition
1.Total Revenue = Total Expenses
Breakdown of Definition
2. Retail Price * Volume = Fixed Expenses + Variable Expenses
Further Analysis
3. Retail Price * Volume = Fixed Expenses + (Volume * Unit Variable Expenses)
Subtract (Volume * Unit Variable Expenses) from both sides
4. Fixed Expenses = (Retail Price * Volume) — (Volume * Unit Variable Expenses)
Factor
5. Fixed Expenses = Volume * (Retail Price – Unit Variable Expenses)
Divide both sides by (Retail Price – Unit Variable Expenses)
6. Volume = Fixed Expenses
(Retail Price – Unit Variable Expenses)
Substitution based on Definition
7. Since (Retail Price — Unit Variable Expenses) is called Contribution Margin,
Therefore:
Breakeven Volume = Fixed Expenses / Contribution Margin
NAME_________________________________________________ DATE ____________
1. Explain some of the economic, social, and political considerations involved in changing the tax law.
2. Explain the difference between a Partnership, a Limited Liability Partnership (LLP) and a Limited Liability Company (LLC). In each structure who has liability?
3. How is “control” defined for purposes of Section 351 of the IRS Code?
4. What are the advantages and disadvantages of using debt in a firm’s capital structure?
5. Under what circumstances is a corporation’s assumption of liabilities considered boot in a Section 351exchange?
6. What are the tax consequences for the transferor and transferee when property is transferred to a newly created corporation in an exchange qualifying as nontaxable under Section 351?
7. Why are corporations allowed a dividend-received deduction? What dividends qualify for this special deduction?
8. Provide 3 examples of a Constructive Dividend. Are these Constructive Dividends taxable?
9. Discuss the tax consequences of a new Partnership Formation and give details to gain and losses and basis?
10. Provide 2 similarities and 2 differences when comparing Sections 351 and 721 of the IRS Code.
11. What is the difference between inside and outside basis with a partnership?
12. ABC Partnership distributes $12,000 of taxable income to partner Bob and $24,000 of tax-exempt income to Partner Bob. As a result of these two distributions, how does Bob’s basis change?
13. On January 1, Katie pays $2,000 for a 10% capital, profits, and loss interest in a partnership.
Examine the way in which death and dying are viewed at different .docxTatianaMajor22
Examine the way in which death and dying are viewed at different points in human development.
Using only my text as a reference:
Berger, K.S. (2011). The developing person through the life span (8th ed.).
I need 3 detailed PowerPoint slide with very detailed speaker notes. There must be detailed speaker notes on each slide. The 4th slide will be the reference.
.
Karimi 1 Big Picture Blog Post First Draft College .docxTatianaMajor22
Karimi 1
Big Picture Blog Post First Draft
College Girls in Media
Sogand Karimi
Media and Hollywood movies have affected and influenced society’s perception on
female college students. Due to Hollywood movies and media, society mostly recognizes the
negative stereotypes of a college women. Saran Donahoo, an associate professor and education
administration of Southern Illinois University, once said, “The messages in these films
consistently emphasized college as a place where young women come to have fun, engage in
romances with young men, experiment with sex and alcohol, face dilemmas regarding body
image, and encounter difficulties in associating with other college women.” In this essay I will
be talking about the recurring stereotypes and themes portrayed in three hollywood movies,
Spring Breakers, The house bunny and Legally Blond and how these stereotypes affect our
society.
The movie Spring Breakers is about four college girls who are bored with their daily
routines and want to escape on a spring break vacation to Florida. After realizing they don’t have
enough money, they rub a local diner with fake guns and ski masks. They break the laws in order
to get down to Florida, just to break more rules and laws once they’re there. During the film, you
will notice a lot of partying, drugs and sexual activity. The four girls wear bikinis for majority of
the film and are overly sexual. These are some common themes and stereotypes seen in all three
movies. Media and movies like spring breakers have made it a norm to constantly want to party,
get drunk and have sex as a college woman. In an article by Heather Long, she mentions how the
movie can even be seen as supporting rape culture. She believes because of these stereotypes
always being shown in media, it is contributing to the “girls asking for it” excuse when it comes
to rape cases with young girls. Long also said “...never mind the fact that thousands of college
students are spending their spring break not on a beach, but volunteering with groups like Habitat
for Humanity and the United Way, especially after Hurricanes Katrina and Sandy.” THIS shows
how media only displays one side of a certain group or story. Even though not all college girls
like to party and lay on a beach naked for spring break, that’s what media likes to portray. Not
only does this give the wrong message to our society but it influences bigger issues like rape, as
the author mentioned.
http://www.huffingtonpost.com/2010/03/10/alternative-spring-break_n_494028.html
http://www.huffingtonpost.com/2010/03/10/alternative-spring-break_n_494028.html
Karimi 2
The movie House bunny. The House bunny is a movie about an ex playmate or girlfriend
if Hugh Hefner that gets kicked out of the Playboy Mansion due to her aging. She then becomes
a mother of an unpopular sorority with girls that are bit geeky, and unusual compared to other
girls on campus. The story.
Please try not to use hard words Thank youWeek 3Individual.docxTatianaMajor22
Please try not to use hard words Thank you
Week 3
Individual
Problems and Goals Case Study
Select one of the following three case studies in Ch. 6 of The Helping Process:
· Case Susanna
· Case James and Samantha
· Case Alicia and Montford
Identify three to five problems in the case study you have selected.
Write a 500- to 700-word paperthatincludes the following:
· A problem-solving strategy and a goal for each problem
· The services, resources, and supports the client may need and why
· A description of how goals are measurable and realistically attainable for the client
Here is the case studies
Exercise 3: Careful Assessment
The following case studies are about Susanna, James, Samantha, Alicia, and Montford, all
homeless children attending school. The principal of the school has asked you to conduct
an assessment of these children and provide initial recommendations.
Before you begin this exercise, go to the website that accompanies this book: www.
wadsworth.com/counseling/mcclam, Chapter Three, Link 1, to read more about homeless
families and children.
Susanna
Susanna is 15 years old. Th e city where she lives has four schools: two elementary, one
middle, and one high school. Th ere are about 1,500 students enrolled in the city/county
school district and about 450 in the local high school that Susanna is attending. For the
past six months, Susanna has been living with her boyfriend and his parents. Prior to this,
she left her mother’s home and lived on the streets. She is pregnant and her boyfriend’s
parents want her to move out of their home. Her father lives in a town with his girlfriend,
about 50 miles from the city. Her mother lives outside the city with Susanna’s baby brother.
Right now Susanna’s mother is receiving child support for the two children. Susanna wants
to have a portion of the child support so that she can find a place of her own to live. Her
mother says that the only way that Susanna can have access to that money is to move back
home. Susanna refuses to move back in with her mother.
You receive a call from the behavior specialist at Susanna’s high school. Susanna’s
mother is at the school demanding that Susanna be withdrawn from school. Susanna’s
mother indicates that Susanna will be moving in with her and will be enrolling in another
school district.
Currently Susanna is not doing very well in school. She misses school and she tells the
helper it is because she is tired and that she does not have good food to eat. She has not told
the helper that she is looking for a place to live. Right now she is failing two of her classes
and she has one B and two Ds. Her boyfriend has missed a lot of school, too.
James and Samantha
James is 10 years old and he has a sister, Samantha, who is 8. At the beginning of the
school year, both of the children were attending Boone Elementary School. Both children
live with their aunt and uncle; their parents are in prison. In the middle of the scho.
Embracing GenAI - A Strategic ImperativePeter Windle
Artificial Intelligence (AI) technologies such as Generative AI, Image Generators and Large Language Models have had a dramatic impact on teaching, learning and assessment over the past 18 months. The most immediate threat AI posed was to Academic Integrity with Higher Education Institutes (HEIs) focusing their efforts on combating the use of GenAI in assessment. Guidelines were developed for staff and students, policies put in place too. Innovative educators have forged paths in the use of Generative AI for teaching, learning and assessments leading to pockets of transformation springing up across HEIs, often with little or no top-down guidance, support or direction.
This Gasta posits a strategic approach to integrating AI into HEIs to prepare staff, students and the curriculum for an evolving world and workplace. We will highlight the advantages of working with these technologies beyond the realm of teaching, learning and assessment by considering prompt engineering skills, industry impact, curriculum changes, and the need for staff upskilling. In contrast, not engaging strategically with Generative AI poses risks, including falling behind peers, missed opportunities and failing to ensure our graduates remain employable. The rapid evolution of AI technologies necessitates a proactive and strategic approach if we are to remain relevant.
A Strategic Approach: GenAI in EducationPeter Windle
Artificial Intelligence (AI) technologies such as Generative AI, Image Generators and Large Language Models have had a dramatic impact on teaching, learning and assessment over the past 18 months. The most immediate threat AI posed was to Academic Integrity with Higher Education Institutes (HEIs) focusing their efforts on combating the use of GenAI in assessment. Guidelines were developed for staff and students, policies put in place too. Innovative educators have forged paths in the use of Generative AI for teaching, learning and assessments leading to pockets of transformation springing up across HEIs, often with little or no top-down guidance, support or direction.
This Gasta posits a strategic approach to integrating AI into HEIs to prepare staff, students and the curriculum for an evolving world and workplace. We will highlight the advantages of working with these technologies beyond the realm of teaching, learning and assessment by considering prompt engineering skills, industry impact, curriculum changes, and the need for staff upskilling. In contrast, not engaging strategically with Generative AI poses risks, including falling behind peers, missed opportunities and failing to ensure our graduates remain employable. The rapid evolution of AI technologies necessitates a proactive and strategic approach if we are to remain relevant.
Francesca Gottschalk - How can education support child empowerment.pptxEduSkills OECD
Francesca Gottschalk from the OECD’s Centre for Educational Research and Innovation presents at the Ask an Expert Webinar: How can education support child empowerment?
Model Attribute Check Company Auto PropertyCeline George
In Odoo, the multi-company feature allows you to manage multiple companies within a single Odoo database instance. Each company can have its own configurations while still sharing common resources such as products, customers, and suppliers.
Honest Reviews of Tim Han LMA Course Program.pptxtimhan337
Personal development courses are widely available today, with each one promising life-changing outcomes. Tim Han’s Life Mastery Achievers (LMA) Course has drawn a lot of interest. In addition to offering my frank assessment of Success Insider’s LMA Course, this piece examines the course’s effects via a variety of Tim Han LMA course reviews and Success Insider comments.
Instructions for Submissions thorugh G- Classroom.pptxJheel Barad
This presentation provides a briefing on how to upload submissions and documents in Google Classroom. It was prepared as part of an orientation for new Sainik School in-service teacher trainees. As a training officer, my goal is to ensure that you are comfortable and proficient with this essential tool for managing assignments and fostering student engagement.
TESDA TM1 REVIEWER FOR NATIONAL ASSESSMENT WRITTEN AND ORAL QUESTIONS WITH A...
[page 18]
1. [page 18] [Mental
Illness 2014; 6:5354]
Art therapy: an underutilized,
yet effective tool
Robert A. Bitonte,1 Marisa De Santo2
1Department of Physical Medicine and
Rehabilitation, University of California,
Irvine Medical Center, Orange, CA;
2University of California, Irvine, CA, USA
Abstract
Art therapy has been recognized as beneficial
and effective since first described by Adrian Hill
in 1942. Even before this time, art therapy was
utilized for moral reinforcement and psycho-
analysis. Art therapy aids patients with, but not
limited to, chronic illness, physical challenges,
and cancer in both pediatric and adult scenarios.
Although effective in patient care, the practice of
art therapy is extremely underutilized, especially
in suburban areas. While conducting our own
study in northeastern Ohio, USA, we found that
only one out of the five inpatient institutions in
the suburban area of Mahoning County, Ohio,
that we contacted provided continuous art ther-
apy to it’s patients. In the metropolitan area of
Cuyahoga County, Ohio, only eight of the twen-
ty-two inpatient institutions in the area provided
art therapy. There could be many reasons as to
why art therapy is not frequently used in these
2. areas, and medical institutions in general. The
cause of this could be the amount of research
done on the practice. Although difficult to con-
duct formal research on such a broad field, the
American Art Therapy Association has succeed-
ed in doing such, with studies showing improve-
ment of the patient groups emotionally and men-
tally in many case types.
Early works
Art is known as one of the earliest forms of
communication, dating back to the cave art of
the Paleolithic age.1 Art therapy has been
increasingly recognized as beneficial and
effective in the treatment of various types of
both mental and physical conditions. For
example, art therapy has shown to be effective
as a treatment for traumatic brain injury,
schizophrenia, sexual abuse, breast cancer,
post-traumatic stress disorder, as well as
numerous other conditions.2-6
This has been described and studied since
Adrian Hill’s published work in 1942. Art ther-
apy has been shown to be effective in a broad
range of conditions. It has been generally rec-
ognized that art therapy enhances communi-
cation, and bolsters self-esteem. Despite the
apparent effectiveness of art therapy, and its
ready acceptance by patients, the prevalence of
the utilization of art therapy was this studies’
inquiry. Despite ongoing and recent studies
showing art therapy to be beneficial, it’s uti-
lization appears to be underutilized for rea-
3. sons unknown at this time.
Adrian Hill is generally known as the first
person to use the term Art Therapy in 1942.
Many of his works of art are displayed in the
Imperial War Museum in London, works that
he painted from the front lines as an official
war artist during World War I. Hill personally
discovered the therapeutic quality of art mak-
ing when he was recovering from tuberculosis
himself in 1938, and recorded his ideas in 1945
in Art versus Illness.6 He was employed as the
first official art therapist in 1946 by the
Netherene, a state psychiatric hospital in the
United Kingdom. He later became the presi-
dent of the British Association of Art
Therapists. Hill’s contributions became a mile-
stone for the acceptance and practice of what
we know today as art therapy.
More developed practices
Art therapy is not specific in it’s practices,
making it customizable to the ever-changing
life of a patient. Adolescents who experience
abuse, low self-esteem, depression, or any
other psychological issues tend to withdraw
from their parental figures, which works
against traditional verbal therapy. Art therapy
is a way for these troubled adolescents to feel
expressive in a non-judgmental environment.7
Art therapy is also increasingly important with
children and adolescents facing chronic ill-
ness. These practices are used to enhance the
young patient’s emotional, physical, and cogni-
tive development. A very important example is
4. within the field of pediatric oncology, where
restoring self image for the patient is crucial to
continue battling their illness. Furthermore,
art therapy can provide some end-of-life care
for patients to create mementos for their fam-
ily before death, to help cope, and say
goodbye.6 These same principles are applicable
to adults as well. In adult oncology, art therapy
has been used to help survivors create a life
outside of cancer, helping these individuals
find their identity past their survivor label.6 Art
therapy in the healthcare setting has also been
used in adult cases of hemodialysis, HIV/AIDS,
Alzheimer’s, and traumatic brain injury. In
addition, adults with schizophrenia, bipolar
disorder, borderline personality disorder,
PTSD, trauma from sexual abuse, dementia,
and many other conditions can find lasting
benefits from art therapy.8 Again, although it
may be difficult to quantify the effectiveness of
art therapy, studies have repeatedly shown that
art therapy is beneficial to patients within a
broad spectrum of conditions.
Specific applications
Traumatic brain injury
In a pilot study addressing group art therapy for
patients with traumatic brain injury, six subjects
with traumatic brain injury between the ages of
24 and 71 participated in five one hour art therapy
sessions. The subjects were evaluated before and
after the study using the Depression Anxiety and
Stress Scales. Throughout the sessions, the sub-
jects participated in low-anxiety activities like
making collages and working with 3D figures.
5. After the study was completed, 4 of 6 subjects had
a decrease in depression, 3 of 6 had a decrease in
anxiety, and 5 of 6 had a decrease in stress.2
Schizophrenia
Several studies have been produced to show
the effectiveness of art therapy for schizophren-
ics. An interesting example is an 83-year-old male
schizophrenic who was not responding to med-
ications, and was reported by caretakers to have
very unusual behaviors. A psychiatrist initiated
art therapy practices with him, having him depict
parts of his life through drawing. The patient’s
verbal resistance began to disappear and the
patient’s progress was able to be documented.3
Sexual abuse
In a four-year follow up of a pilot study, it was
shown that for sexually abused children and ado-
lescents, art therapy, paired with cognitive behav-
ioral therapy, was an effective intervention to
reduce symptoms that are commonly associated
with childhood sexual abuse.4
Epilepsy in children and adoles-
cents
In a focus group with children with epilepsy,
the use of art enabled said children and adoles-
Mental Illness 2014; volume 6:5354
Correspondence: Marisa De Santo, 34102 Blue
Lantern, Dana Point, CA 92629, USA.
7. group, rather than social isolation that can
become common in these cases.6
Acute stress disorder
In an intervention with a 48-year-old woman
who had injured a motorcyclist three weeks
prior in a car accident, the treatment seeked to
lower her overwhelming anxiety, sleep prob-
lems, heart palpitations, and excessive flash-
backs of the accident. With certain drawing
techniques and manipulation of various medi-
ums, and discussion of such in relation to her
experience with the art therapist, the client
was able to rearrange the sensory and cogni-
tive overexcitation, and thus feel a sense of
control over the traumatic experience.6
Study interest and design
The first author’s interest in the treatment
of traumatic brain injury, and the second
author’s interest in art, were the impetus of
interest for this study. Studied were two areas
in Ohio. An urban area Cuyahoga County
(which includes Metropolitan Cleveland), and
a more rural suburban Trumbull and Mahoning
counties were examined. The inquiry was to
determine the availability of art therapy servic-
es in both if these rural and urban atmos-
pheres in Northeast Ohio, in the midwest sec-
tion of the Unites States. The survey was per-
sonally conducted by the second author by
phone. Each listed inpatient psychiatric unit
was successfully contacted.
8. Results
Our study found that in urban Cuyahoga
County, only 8 of 22 (36%) inpatient facilities
utilize art therapy as a treatment modality. In
Trumbull and Mahoning counties, 1 of 5 (20%)
inpatient institutions offered and utilized art
therapy (Figure 1). Contrary to expectations,
we believed the practice of art therapy would
be much higher in urban areas, and our study
concluded that this is not necessarily true. We
attempted to clarify why art therapy was not
used in the non-utilizing-institutions. The
questionnaire included the response options
of i) lack of instructors; ii) lack of interest or
demand by staff or patients; iii) lack of support
personnel or administration; or iv) lack of
funding. This study was unable to locate per-
sons qualified to answer this inquiry and has
been left for further study.
Conclusions
Our concluding thoughts on this study is
that art therapy, although having the ability to
be beneficial to various patient populations, is
underutilized for unknown reasons at this
time. The underutilization of art therapy must
be studied and understood before progress can
be made. Advocacy can then be tailored to rem-
edy the precise reason for underutilization of
art therapy.
References
9. 1. Roberts J.M. The new penguin history of
the new world. London: Penguin Books;
2007. pp 23-26.
2. Graves G. Group art therapy for patients
with traumatic brain injuries: a pilot study.
Degree Diss.; Virginia Commonwealth
University, Richmond, Virginia; 2006.
3. Morrow R. The use of art therapy in a
patient with chronic schizophrenia.
Jefferson Journal of Psychiatry. 1985.
Available from: http://jdc.jefferson.edu/cgi/
viewcontent.cgi?article=1084&context=je
ffjpsychiatry
4. Pifalo T. Art therapy with sexually abused
children and adolescents: extended
research study. Art Therapy 2006;23:181-5.
5. Chang F. From emptiness to energizing
body. In: Malchiodi CA, ed. Art therapy and
health care. New York: The Guilford Press;
2013. p 154.
6. Malchiodi CA. Art therapy and health care.
New York: Guilford Press; 2013.
7. Riley S. Art therapy with adolescents.
Western J Med 2013;175:54-7.
8. Rivera RA. Art therapy for individuals with
severe mental illness. Masters Diss.;
University of Southern California, Los
Angeles, USA; 2008.
10. Review
Figure 1. Institutions that conduct and do not conduct at therapy
in Trumbull and
Mahoning Counties versus Cuyahoga County.
1Kaimal G, et al. BMJ Open 2018;8:e021448.
doi:10.1136/bmjopen-2017-021448
Open access
Observational study of associations
between visual imagery and measures
of depression, anxiety and post-
traumatic stress among active-duty
military service members with traumatic
brain injury at the Walter Reed National
Military Medical Center
Girija Kaimal,1 Melissa S Walker,2 Joanna Herres,3 Louis M
French,2,4
Thomas J DeGraba2
To cite: Kaimal G, Walker MS,
Herres J, et al. Observational
study of associations between
visual imagery and measures of
depression, anxiety and post-
traumatic stress among active-
duty military service members
with traumatic brain injury at
11. the Walter Reed National Military
Medical Center. BMJ Open
2018;8:e021448. doi:10.1136/
bmjopen-2017-021448
► Prepublication history for
this paper is available online.
To view these files, please visit
the journal online (http:// dx. doi.
org/ 10. 1136/ bmjopen- 2017-
021448).
Received 11 January 2018
Revised 11 May 2018
Accepted 18 May 2018
For numbered affiliations see
end of article.
Correspondence to
Dr. Girija Kaimal;
[email protected] drexel. edu
Research
AbstrACt
Objectives The study aimed tocompare recurring
themes in the artistic expression of military service
members (SMs) with post-traumatic stress disorder
(PTSD), traumatic brain injury and psychological health
(PH) conditions with measurable psychiatric diagnoses.
Affective symptoms and struggles related to verbally
expressing information can limit communication in
individuals with symptoms of PTSD and deployment-
related health conditions. Visual self-expression through
art therapy is an alternative way for SMs with PTSD
12. and other PH conditions to communicate their lived
experiences. This study offers the first systematic
examination of the associations between visual self-
expression and standardised clinical self-report measures.
Design Observational study of correlations between
clinical symptoms of post-traumatic stress, depression and
anxiety and visual themes in mask imagery.
setting The National Intrepid Center of Excellence at the
Walter Reed National Military Medical Center, Bethesda,
Maryland, USA.
Participants Active-duty military SMs (n=370) with a
history of traumatic brain injury, post-traumatic stress
symptoms and related PH conditions.
Intervention The masks used for analysis were created
by the SMs during art therapy sessions in week 1 of a
4-week integrative treatment programme.
Primary outcomes Associations between scores on the
PTSD Checklist–Military, Patient Health Questionnaire-9
and Generalized Anxiety Disorder 7-item scale on visual
themes in depictions of aspects of individual identity
(psychological injury, military symbols, military identity and
visual metaphors).
results Visual and clinical data comparisons indicate that
SMs who depicted psychological injury had higher scores
for post-traumatic stress and depression. The depiction
of military unit identity, nature metaphors, sociocultural
metaphors, and cultural and historical characters was
associated with lower post-traumatic stress, depression
and anxiety scores. Colour-related symbolism and
fragmented military symbols were associated with higher
anxiety, depression and post-traumatic stress scores.
Conclusions Emergent patterns of resilience and risk
embedded in the use of images created by the participants
could provide valuable information for patients, clinicians
and caregivers.
13. IntrODuCtIOn
Since 2001, more than 2.7 million servicemen
and servicewomen have been deployed in
support of combat operations around the
world.1 A survey conducted by the Veterans
Administration from 2006 to 2010 estimated
strengths and limitations of this study
► This study offers the first systematic examination
of the associations between visual self-expression
and how it relates to standardised clinical self-report
measures.
► This is the first study to demonstrate patterns of risk
and resilience as they relate to visual imagery creat-
ed by military service members with traumatic brain
injury and symptoms of post-traumatic stress.
► The visual imagery was created in art therapy ses-
sions and cannot be applied to other contexts of art
making.
► The study was performed within the framework of
a comprehensive integrative outpatient assessment
and treatment programme.
► The findings are associative and correlational in
nature, which precludes attribution of any causal
relationships.
► The study findings are limited to men and women
actively serving in the US military.
http://bmjopen.bmj.com/
14. http://dx.doi.org/10.1136/bmjopen-2017-021448
http://dx.doi.org/10.1136/bmjopen-2017-021448
http://dx.doi.org/10.1136/bmjopen-2017-021448
http://crossmark.crossref.org/dialog/?doi=10.1136/bmjopen-
2017-021448&domain=pdf&date_stamp=2018-06-11
2 Kaimal G, et al. BMJ Open 2018;8:e021448.
doi:10.1136/bmjopen-2017-021448
Open access
that post-traumatic stress disorder (PTSD) has affected
about 480 748 service members (SMs).1 Additionally,
379 5192 military SMs were diagnosed as having suffered
a traumatic brain injury (TBI), the vast majority of them
in the mild range.3 Recent research has highlighted the
co-occurrence of these severe diagnoses in military SMs,
with the total financial costs of treating these disorders
estimated as high as $6 billion for those with PTSD and
$910 million for those with TBI.4 Effective care for those
with persistent neurological and behavioural symptoms
from these injuries is imperative, both for the society and
for the military health system. PTSD and TBI are condi-
tions that are particularly prevalent among veterans.3 5
Individually complex, the effects of these conditions are
exacerbated when they occur together.6 Because the
neuroanatomical disturbances and the symptoms of
PTSD and TBI may be similar, it is possible that they share
some common mechanisms.6 Individuals with TBI often
develop PTSD and experience psychological health (PH)
symptoms such as irritability, anger, heightened arousal,
lack of concentration and sleeping difficulties.7 Psycho-
logical disorders such as depression and anxiety have also
been found to be common comorbid conditions in indi-
viduals with PTSD and TBI.8 9 In addition, demographic
15. characteristics like time in the service, including multiple
deployments,10–13 race/ethnicity,14 15 and rank (officer
or enlisted SM)16 17 have been associated with severity of
symptoms.
One of the challenges with treating PTSD can be the
limited ability of the patient to express his or her symp-
toms verbally.18–20 Thus alternative forms of communi-
cation such as visual self-expression through art therapy
are increasingly accepted as treatments for individuals
with PTSD, TBI and PH.21–26 Mask-making is one such art
therapy approach that has shown significant promise.27–29
Specifically, ‘trauma masks’ have assisted military SMs
to visually communicate the effects of combat-related
trauma to help build a coherent sense of self postin-
jury.30–32 Through the use of symbols and sensations that
are externalised and shaped into a narrative, art therapy
can assist in the processing of traumatic material,30
making the traumatic material more tolerable through
its externalisation, and enable narrative construction
of fragmented trauma memories.25 32–35 Art therapy is a
particularly useful approach for symptoms of combat-re-
lated PTSD, such as avoidance and emotional numbing,
while also attending to underlying issues for this popu-
lation, including relaxation, non-verbal expression,
containment, symbolic expression, externalisation and
pleasure.24 25
Although cognitive processing therapy is the first line
of psychotherapy in the military,36 other approaches like
art therapy have been shown to decrease anxiety in adults
with a variety of mental health conditions.37 –41 Results
from the combination of cognitive behavioural therapy
and art therapy indicate that art therapy could be a viable
addition, particularly for patients with panic disorder
with agoraphobia and generalised anxiety disorder who
16. are not responsive to verbal therapies.41 By creating
visible depictions of their internal psychological states
in art therapy sessions, patients have the opportunity to
observe a tangible externalised object. This process and
the resulting image may aid them in developing strategies
to cope with feared situations, thereby desensitising them
to the fear at hand38 41 and helping them to engage their
senses to foster a connection between the mind and the
body.42 Similarly, art therapy has been found to reduce
depressive symptoms35 through evoking the expression of
positive emotions through the creative process, building
social connections43 and providing an alternative form of
self-expression.44
Most of the findings in art therapy and the military
have tended to be based on clinical observations and
small pilot studies.24 25 Despite clinical reports of the
potential of art therapy to address symptoms of depres-
sion and anxiety, no one has examined the associations
between the imagery created in art therapy sessions with
standardised measures of clinical symptoms. Analysis
of SMs’ visual representations in masks indicates that
they depict a range of experiences related to PTSD and
TBI, including the use of visual metaphors, depictions
of psychological injuries and reflections on the experi -
ences of belonging in the military and deployment in a
war zone. We present the associations between themes
in the mask imagery made during art therapy sessions
and corresponding measures of depression, anxiety and
PTSD.26
MethODs
setting
The National Intrepid Center of Excellence (NICoE)
located at the Walter Reed National Military Medical
17. Center (Bethesda, Maryland, USA) offers an interdis-
ciplinary intensive outpatient programme that uses an
integrative holistic model of care to serve active-duty SMs
with a history of TBI, a comorbid PH condition and symp-
toms that have not responded to first-line treatments. On
referral and acceptance, six new SMs and their families,
as available, are admitted to the centre each Monday and
move through the 4-week programme as a therapeutic
cohort. SMs undergo a standardised evaluation using core
assessment tools, which includes contact with 17 medical
and integrative health disciplines. As part of the initial
behavioural health assessment and treatment, all SMs
engage in a group art therapy mask-making session in
week 1 of their 4-week integrative treatment programme.
A series of neurological, psychiatric and psychological
assessments are conducted concurrently with the art
therapy sessions. The intake surveys are completed in the
same week as the mask-making (week 1), but prior to the
mask-making session as part of a battery of intake assess-
ments on admission.
The authors obtained the consent of the SMs to use all
of their clinical data for research purposes.
3Kaimal G, et al. BMJ Open 2018;8:e021448.
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Patient and public involvement
Patients and the public did not participate in the research
design or data analysis for this study.
Participants
18. Participants in the study included SMs (n=370). They
ranged in age from 20 to 50 years and included SMs from
all branches of the Armed Services, including the National
Guard, who were referred to the Walter Reed National
Military Medical Center (NICoE intensive outpatient
treatment programme). These individuals had a history
of mild TBI and comorbid PH concerns, including mood
problems, stress symptoms (or overt PTSD) or other
related conditions.
Data sources
All data at the NICoE are archived in a specialised de-iden-
tified database that can link mask images, participants’
narrative descriptions of mask imagery, experiences in art
therapy as described in the clinical notes of the therapists
and standardised measures of psychological functioning.
In a previous publication, we described the process of
identifying thematic classifications in the mask-making
products created by SMs.26 Figures 1–8 describe the prom-
inent themes in the masks used for analysis and a sample
image visually depicting those themes. (Artwork credit:
NICoE and Veterans Affairs National Center for Ethics
in Health Care.) The thematic classifications generated
from this analysis were converted into a database that
Figure 1 Psychological injury (depiction of psychological
struggles with sadness, anger, inability to verbalise and social
isolation).
Figure 2 Identification with military unit (depiction of
sense of belonging to a military unit, for example, explosive
ordnance disposal badge, also known as the ‘crab’).
Figure 3 Use of fragmented military symbols (depiction
of fragmented symbols associated with the military such as
19. flags, camouflage fabric and dog tags).
4 Kaimal G, et al. BMJ Open 2018;8:e021448.
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included dichotomous variables (1=theme present and
0=theme absent). Thus, each SM’s mask included a 0 or
1 for each classification that was identified for the whole
data set. The data were coded by four members of the
research team. Two of the coders coded all the data and
then two more coders checked these codes. Discrepancies
in coding were reviewed, and a final code was assigned
as apt in consultation with the lead author. Masks were
coded for more than one thematic category if more than
one was represented in the image. Every mask had more
than one theme associated with the imagery and all of the
themes were included in the analysis. Additional details
on the coding process are described in a previous publica-
tion.26 Given that some of the themes recurred many times
and others only a few times, we chose a cut-off of n=20 for
the classifications to be included in the database in order
to have an adequate number for analyses. The coded
database was then integrated with the standardised data
from the PTSD Checklist-Military (PCL-M),45 the Patient
Health Questionnaire-9 (PHQ-9)46 and the Generalized
Anxiety Disorder 7-item (GAD-7)47 scale for further anal-
ysis. These questionnaires were administered to the SMs
during the same week as the mask-making art therapy
sessions. Although the data were collected at the Walter
Reed National Military Medical Center, the de-identified
data set was transferred to Drexel for analysis, per prior
20. agreement. No coded linkage information was kept at the
Walter Reed National Military Medical Center.
Data analysis
The data were first summarised using descriptive statistics
of study variables. For subsequent analyses, we focused
especially on the most frequently occurring elements
represented in the masks.26 Using the unique ID number
provided for each SM, we ran independent sample t-tests
to examine whether the mean scores for post-traumatic
stress symptoms as measured by the PCL-M, for depres-
sive symptoms as measured by the PHQ-9 and for anxiety
symptoms as measured by the GAD-7 differed depending
on whether the participants’ themes were psycholog-
ical injury, military identity or metaphors. Finally, we
explored the metaphor themes further by conducting
analysis of covariance tests to examine the unique effects
of the different uses of metaphors on the symptom scales.
Given that metaphors were represented in four different
ways, we wanted to examine if the type of visual metaphor
would be associated with symptoms of post-traumatic
stress, depression and anxiety.
results
Overall, based on clinical notes maintained by the art
therapist, when referring to the experience of making the
masks, SM participants reported that art therapy helped
Figure 4 Metaphors (depiction of inner psychological states
through a visual image).
Figure 5 Colour symbolism (specific individual colours as
metaphorical representations of experiences and emotions).
21. 5Kaimal G, et al. BMJ Open 2018;8:e021448.
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mainly with enjoyment (n=136), with focus and concen-
tration (n=72) and with relaxation/calming (n=52). In
addition, SMs (n=74) said the mask-making helped with
socialisation and with opening up about their injuries,
treatment processes and struggles. A small proportion
of participants (n=11) did not report a positive experi -
ence and cited reasons like dissatisfaction with the final
product and disinterest in art making. Table 1 shows
the descriptive statistics for the study variables.
Table 2 shows differences in mean symptoms for the
mask themes of ‘psychological injury’ and ‘metaphors’.
Participants whose masks reflected evidence of psycholog-
ical injury (n=102) in the mask-making reported higher
PTSD symptoms, whereas those whose masks coded
positive for metaphors (n=125) had lower anxiety symp-
toms. Those who used symbols that included fragmented
representations of military symbols (n=44) reported more
anxiety, whereas those who used representations of their
military unit identity (n=41) reported less PTSD and
depression. Fragmented refers here to pieces of items
associated with the military such as camouflage fabric
and pieces of weapons, flags and tags. Table 3 provides
three univariate analyses of covariance used to determine
whether there were mean differences in the subtypes of
the broad theme of metaphors while controlling for time
in the service, race/ethnicity and officer status. These
covariates were chosen as controls based on the literature
in order to account for any effects that might be related
to these demographic variables. As shown, participants
22. whose masks showed evidence of colour symbolism (use
of colour as a metaphor) (n=46) had higher PCL-M and
PHQ-9 scores. Participants whose masks showed evidence
of cultural/historical characters (n=21) and cultural/
societal symbols (n=42) had lower GAD-7 scores and
tended to have lower depressive symptom scores. In addi -
tion, the use of nature-related imagery (n=33) trended
towards lower post-traumatic stress symptom scores, indi-
cating the potential health-promoting aspect when SMs
depicted such imagery.
DIsCussIOn
This study examined participants’ experiences of art
therapy and associations between the visual imagery in
the masks and clinical data from standardised measures
of symptoms of post-traumatic stress, depression and
anxiety. The findings indicate that there are patterns of
recurring associations between clinical symptoms in the
visual imagery created by SMs in art therapy sessions.
Some of the specific findings of note are that participants
whose masks depicted psychological injury reported
Figure 6 Cultural or historical characters (depiction of
characters from history, films and literature).
Figure 7 Sociocultural symbols (inclusion of images from
objects commonly seen in society).
6 Kaimal G, et al. BMJ Open 2018;8:e021448.
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higher scores on the PCL-M scale. This finding indicates
23. a potential clinical significance when SMs depict their
psychological injuries and that this could be helpful to
direct specific focus on the clinical care of PTS symp-
toms when such imagery is depicted, such that depic-
tion of psychological struggles might be an indicator of
heightened symptoms of post-traumatic stress requiring
targeted care. When we reviewed artwork of combat
veterans with PTSD, we found evidence of ‘post-traumatic
conflict being experienced and depicted by the graphic
themes of war and the telling of self-portraits of disfig-
urement symbolic of alteration of one’s previous self’
(p44).30 SMs might be less likely to report mental health
issues due to the social stigma that these issues may be
misinterpreted as weakness or laziness.48–51 The associa-
tion between post-traumatic stress scores and visual depic-
tion of psychological injury suggests that this might be a
forum for safe self-expression.
Those participants whose masks coded positive for
metaphors also reported lower anxiety symptoms, indi-
cating that the use of metaphors is associated with the
SM reaching a level of insight into the psychological
issues in order to lower the level of anxiety and perhaps
develop some inner resilience that enables the SM to
depict images that involved imaginative variations on the
lived psychological experience. Further examination of
subtypes of metaphors revealed potential differences in
the associations with clinical data. For example, the use
of colour symbolism (eg, when an SM said that the colour
represented something specific like red represented
victory or blue represented sadness) was associated with
higher scores for PTSD and depression. These patterns
of association were also seen prominently in the use of
military symbols. Those who used fragmented military
symbols (eg, flag fragments, pieces of camouflage fabric
or dog tags) reported more anxiety. These fragmented
24. associations were associated with higher anxiety scores.
In contrast to fragmented symbols, those who used
visual symbols of their military unit reported less PTSD
and depression. These differences might imply that
representation of the military unit is akin to identifying
with a community and potentially reinforcing a sense of
belonging. The development of a group identity in the
military is well established as a means to ensure trust
and effectiveness in a war zone through shared commit-
ment and social cohesion.52–55 The findings highlight
the protective role of a sense of belonging and group
identity in the treatment process, beyond the period
of deployment in the war zones. In fact, a strong sense
of belonging could protect Air Force convoy opera-
tors against depression before and after their deploy-
ments.51 53 Some of the healing elements seen in art
therapy are the promotion of self-exploration, self-ex-
pression, symbolic thinking, creativity and sensory stim-
ulation.55 In a study of depression and dependency in
SMs, it was found that art therapy offered a sense of
control and served to integrate past experiences with
present connections.55
Figure 8 Nature images (inclusions of images from nature in
mask).
Table 1 Descriptive statistics for demographics and clinical
study variables
n % of sample
Male 361 97.0
African–American 14 3.8
25. Asian or Pacific Islander 8 2.2
Caucasian 329 89.2
Hispanic 15 4.1
Air Force 33 8.9
Army 119 32.2
Coast Guard 1 0.3
Marines 50 13.5
Navy 167 45.1
Officer 54 14.6
M SD
Age, years 36.08 7.62
Time in service, years 14.61 7.31
PCL-M score 51.98 15.86
PHQ-9 score 13.10 6.17
GAD-7 score 10.65 6.01
GAD-7, Generalized Anxiety Disorder 7-item scale; PCL-M,
PTSD
Checklist for DSM-5; PHQ-9, Patient Health Questionnaire-9;
PTSD, post-traumatic stress disorder.
26. 7Kaimal G, et al. BMJ Open 2018;8:e021448.
doi:10.1136/bmjopen-2017-021448
Open access
The use of nature metaphors trended towards associ-
ation with lower PTSD scores. This finding suggests that
when SMs represented nature imagery, they might have
been tapping into inner resources of strength and resil -
ience. Reference to cultural historical characters was
also associated with less depression and anxiety. Taken
together, these visual metaphors might in general be
indicative of sources of creativity and resilience. However,
fragmented associations like depicting colours for specific
emotions might not be associated with the higher levels
of illness seen in PTSD and depressive symptoms. Imagery
that represents this integration might be associated with
more positive clinical scores compared with those repre-
senting more fragmented imagery.
This study has several limitations. All of the data related
to the masks are self-reported secondary data collected
as part of clinical practice. The findings indicate patterns
of occurrence in visual imagery and scores on stan-
dardised clinical symptoms and are not representative of
any causal relationships and must be interpreted accord-
ingly. The control variables in the study including time
in service, race/ethnicity and rank (officer or enlisted
SM) were selected based on information in the literature.
Most of the data are from male SMs; thus it is unclear if
similar patterns might be seen among female SMs. Addi-
tional research is needed to determine why metaphorical
depictions can denote the presence of different levels
of psychological risk and resilience and how they relate
27. to the demographic characteristics of the SM. In addi-
tion, further research is needed to determine why some
themes were more strongly associated with specific clin-
ical symptoms than others. One explanation for inconsis-
tent findings across symptom scales is the varying number
of participants who completed each scale. It is possible
that the study was underpowered for identifying differ-
ences in the GAD that were consistent with the PCL and
PHQ findings when the control variables were added to
the model.
In conclusion, this study addresses a new area of enquiry
associating patient clinical data with imagery to begin to
develop a framework for how psychological states might
be represented in visual media. The findings have the
potential to help clinicians identify sources of strength
and of risk factors for SMs with PTSD and TBI.
Table 2 Mean and SD for the symptom scores across mask
classifications
Outcome
Psychological injury Metaphors
No Yes t No Yes t
PCL-M (n=349) 50.66 (16.26) 55.51 (14.24) −2.72** 52.06
(15.94) 51.83 (15.78) 0.132
PHQ-9 (n=282) 12.95 (6.16) 13.54 (6.22) −0.710 13.25 (6.23)
12.84 (6.09) 0.530
GAD-7 (n=75) 9.96 (5.74) 12.83 (6.47) −1.79 11.96 (6.05) 8.46
(5.36) 2.52*
28. Outcome
Military symbols Identification with military unit
No Yes t No Yes t
PCL-M (n=349) 51.51 (16.05) 55.54 (14.07) 1.53 52.59 (15.73)
42.52 (15.33) 2.847**
PHQ-9 (n=282) 13.03 (6.26) 13.72 (5.41) −0.572 13.3 (6.10)
9.75 (6.57) 2.255*
GAD-7 (n=75) 10.23 (5.87) 18.25 (2.22) −6.128** 10.93 (6.01)
6.80 (5.07) 1.497
*P<0.05, **p<0.01, ***p<0.1.
GAD-7, Generalized Anxiety Disorder 7-item scale; PCL-M,
PTSD Checklist for DSM-5; PHQ-9, Patient Health
Questionnaire-9; PTSD, post-
traumatic stress disorder.
Table 3 Mean differences in symptom scores for those whose
masks showed evidence of metaphor subtypes
Variable (%
coded positive)
PCL-M (η2 =0.23)
sη2
PHQ-9 (η2 =0.28)
sη2
GAD-7 (η2 =0.50)
sη2No Yes F(1, 306) No Yes F(1, 245) No Yes F(1, 54)
29. Colour symbolism
(12.2%)
51.14 58.34 8.23** 0.03 13.92 16.96 7.18** 0.03 10.08 9.22
0.07 0.002
Cultural/historical
characters (5.7%)
55.71 53.78 0.27 0.001 16.80 14.07 3.53*** 0.02 13.10 6.20
9.19** 0.20
Sociocultural
symbols (11.4%)
56.08 53.41 0.88 0.001 16.33 14.54 2.09 0.003 13.22 6.08 6.57*
0.15
Nature metaphors
(8.9%)
57.46 52.03 3.38*** 0.01 16.11 14.77 1.23 0.003 10.53 8.76
0.92 0.01
All three analyses of covariance tests were controlled for time
in service, ethnicity and officer status.
*P<0.05, **p<0.01, ***p<0.1
GAD-7, Generalized Anxiety Disorder 7-item scale; PCL-M,
PTSD Checklist for DSM-5; PHQ-9, Patient Health
Questionnaire-9; PTSD, post-
traumatic stress disorder.
8 Kaimal G, et al. BMJ Open 2018;8:e021448.
doi:10.1136/bmjopen-2017-021448
30. Open access
Author affiliations
1Creative Arts Therapies, Drexel University College of Nursing
and Health
Professions, Philadelphia, Pennsylvania, USA
2National Intrepid Center of Excellence, Walter Reed National
Military Medical
Center, Bethesda, Maryland, USA
3Department of Psychology, The College of New Jersey,
Stockton, New Jersey, USA
4Center for Neuroscience and Regenerative Medicine,
Uniformed Services University
of the Health Sciences, Bethesda, Maryland, USA
Acknowledgements We are grateful to Dr Jesus Caban, Ms
Kathy Williams, Ms
Pamela Fried, Ms Rebekka Dieterich-Hartwell and Ms Adele
Gonzaga for help with
gathering literature and preparing the data set for analysis.
Contributors All the authors contributed to the study as follows:
GK led the study
and conducted the review of the masks with MSW. JH
conducted the statistical data
analysis. LMF and TJD helped with manuscript review,
including the discussion and
implications sections. TJD designed the database protocol from
which the clinical
data for the analysis were used and patient consents were
obtained.
Funding We are grateful to the National Endowment for the
Arts’ Creative Forces:
The NEA Military Healing Arts Network for providing funding
31. to support this study.
Competing interests None declared.
Patient consent Not required.
ethics approval The study was conducted with approval from the
Walter Reed
National Military Medical Center (Bethesda, Maryland, USA)
institutional review
board, in accordance with all federal laws, regulations and
standards of practice, as
well as those of the Department of Defense and the Departments
of the Army, Navy
and Air Force and the partnering university.
Provenance and peer review Not commissioned; externally peer
reviewed.
Data sharing statement The raw data were shared between the
institutions as
part of a data-sharing agreement. These data are not available
for public sharing.
Open access This is an open access article distributed in
accordance with the
Creative Commons Attribution Non Commercial (CC BY-NC
4.0) license, which
permits others to distribute, remix, adapt, build upon this work
non-commercially,
and license their derivative works on different terms, provided
the original work is
properly cited and the use is non-commercial. See: http://
creativecommons. org/
licenses/ by- nc/ 4. 0/
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43. BY-NC 4.0) license, which permits others to distribute, remix,
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upon this work non-commercially, and license their derivative
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Observational study of associations between visual imagery and
measures of depression, anxiety and post-traumatic stress
among active-duty military service members with traumatic
brain injury at the Walter Reed National Military
Medical CenterAbstractMethodsSettingPatient and public
involvementParticipantsData sourcesData
analysisResultsDiscussionReferences
C
p
c
H
S
a
b
a
45. atients with medically unexplained symptoms in primary
health
are in England: Practice-based evidence
elen Payne, MPhil, PhD, UKCP Reg. Psychotherapist,
ADMP UK, AVR a,∗ ,
usan D.M. Brooks, BSc, MA, MA, MBA b
School of Education, University of Hertfordshire, De Havilland
Campus, Hatfield, Hertfordshire AL10 9EU, England, United
Kingdom
Pathways2wellbeing, 27 Bridge Street, Hitchin, Herts SG5 2DF,
England, United Kingdom
r t i c l e i n f o
rticle history:
vailable online 18 December 2015
eywords:
he BodyMind ApproachTM
edically unexplained symptoms
rimary care
ractice-based evidence
a b s t r a c t
This article builds on Payne (2015) and reports on
practice-based evidence arising out of the delivery
of a new and innovative service using The BodyMind
ApproachTM (TBMA) for the treatment of patients
with medically unexplained symptoms (MUS) in primary
care in the National Health Service (NHS) in
Hertfordshire, a county near London, England, in the UK.
The analysis of data collected for three groups
46. (N = 16) over 18 months used standardised assessment
tools and other relevant information at pre, post
and at a 6 month follow up. The outcomes for patients in
this small scale piece of practice based evidence
indicated that there were reductions in sympto m distress,
anxiety and depression, increased overall
wellbeing and improvement in activity levels. Patients
developed self-management of their symptoms
through understanding, acceptance and coping strategies.
The increased knowledge, exchange of expe-
riences together with understanding and acceptance from
others promoted a sense of wellbeing. Thus,
the programme was experienced to be a beneficial
intervention. In addition to the clinical outcomes
reported here there are other benefits for NHS England for
example, savings on medication and referral
costs and General Practitioner (GP) capacity enhanced. The
clinical service is based on previous research
conducted by Payne and Stott (2010). This article focusses
solely on the analysis and interpretation of
clinical outcomes from the practice-based evidence.
ntroduction
The innovative clinical service reported in this article is being
ffered to primary care patients with medically unexplained
symp-
oms (MUS) through the National Health Service (NHS) in a
county
n England. Edwards, Stern, Clarke, Ivbijaro, and Kasney (2010)
efine MUS as ‘a clinical and social predicament, includes broad
pectrum of presentations, difficulty accounting for symptoms
ased on known pathology’ (p. 1). They go on to say in Diagnos-
ic and Statistical Manual for Mental Disorders (DSM IV-TR)
that
48. energy devoted to these symptoms of health concerns
(Diagnostic
and Statistical Manual of Mental Disorders-5, 2013). It states
that
somatic symptom and related disorders includes the diagnoses
of
somatic symptom disorder, illness anxiety disorder, conversion
dis-
order (functional neurological symptom disorder), psychological
factors affecting other medical conditions, factitious disorder
other
specified somatic symptom and related disorder, and
unspecified
somatic symptom and related disorder. All of the disorders
share
a common feature: the prominence of somatic symptoms associ -
ated with significant distress and impairment. Such patients are
dx.doi.org/10.1016/j.aip.2015.12.001
http://www.sciencedirect.com/science/journal/01974556
http://crossmark.crossref.org/dialog/?doi=10.1016/j.aip.2015.12
.001&domain=pdf
mailto:[email protected]
mailto:[email protected]
http://www.herts.ac.uk
http://www.herts.ac.uk
http://www.herts.ac.uk
http://www.herts.ac.uk
http://www.herts.ac.uk
http://www.pathways2wellbeing.com
http://www.pathways2wellbeing.com
http://www.pathways2wellbeing.com
http://www.pathways2wellbeing.com
dx.doi.org/10.1016/j.aip.2015.12.001
49. 5 ts in P
c
h
M
a
t
M
t
A
t
g
(
t
c
M
f
2
r
t
e
e
w
s
p
t
g
T
e
p
r
H
51. ommonly found in primary care and less encountered in mental
ealth settings. The term is thought to be more useful than that of
US in primary care (Creed et al., 2010).
SSD includes the former somatisation disorder, undifferenti -
ted somatoform disorder, and pain disorder. The change is that
he diagnostic criteria are no longer based on the presence of
US, but focuses on one or more somatic symptoms that are dis-
ressing and/or result in significant disruption of everyday life.
lthough there are criticisms (Frances, 2013; Voigt et al., 2012)
his change removes the diagnostic problem of having to distin-
uish between medically explained and unexplained symptoms
Creed et al., 2010). The shortcomings of the MUS category is
he mind-body dualism present in the unreliable classification of
omplaints as medically explained or not (Creed, 2009; Sharpe,
ayou, & Walker, 2006) and the random categorisation into dif-
erent somatoform disorders (Leiknes, Finset, Moum, &
Sandanger,
008).
This dualism reinforces the GP training to address physical
ather than mental health issues and the patient’s perception that
heir symptom is purely physical because of the sensory experi-
nce. It reinforces dualistic thinking and the idea that illness is
ither biological or psychological. The term defines the illness
by
hat it is not, i.e. it implies no organic cause which is not neces -
arily accurate and limits treatment. Research has shown that
most
atients prefer a positive description of symptoms, i.e. an
explana-
ion of what it is rather than what it is not. The term MUS may
52. seem
lib communicating that nothing can be done. Cognitive
Behaviour
herapy (CBT) with relaxation and/or graded exercise has some
ffectiveness for some symptoms (Whiting et al., 2001).
Although
sychological treatment may work in some cases this does not
eflect that the symptoms are necessarily psychological (Creed,
enningsen, & Fink, 2011). Other terms in use in a Department
f Health (DH) recent document on MUS (DH, 2014) are
claimed
o be more acceptable to patients such as persistent physical
symp-
oms or functional syndromes/symptoms (FS) (Stone et al.,
2002). The
erm “functional” here is used because it is assumed that the
disor-
er is one of function, which may be physical and/or
psychosocial
unction, rather than anatomical structure (Sharpe, 2000).
The clinical outcomes of TBMA as a treatment reported here are
ased upon the definition and criteria for MUS used in DSMIV,
i.e.
efore the changes made with reference to MUS in DSM-5.
The treatment service is delivered in the English NHS primary
are setting by a University of Hertfordshire spin-out company
athways2Wellbeing (P2W)TM. Primary care in the NHS refers
to
he first port of call for patients in the community which
involves
Ps working in local practices. Secondary care involves hospitals
nd other medical establishments or treatments to which GPs
refer
atients. GPs act as the access, by way of referral, to any
53. specialist
nterventions in either primary or secondary care. The treatment
ervice offered by P2W is called Symptoms Groups to patients
and
he MUS Clinic to the GPs referring patients with various
medically
nexplained symptoms (such as fibromyalgia, IBS, chronic pain
or
hronic fatigue) from primary care. At no time is the term MUS
used
ith patients.
The groups use TBMA, which is based on a bio-psychosocial
odel derived from aspects of interpersonal therapy, embodied
roup psychotherapy (dance movement psychotherapy/authentic
ovement), the arts and mindfulness. It is not designed as a form
of
sychotherapy, but an adaptation for non-psychologically minded
atients deriving from an integration of the above. The groups
are
alled workshops and the treatment is a course. This approach
has
een hitherto researched and delivered as a service in the NHS
ith patients with medically unexplained symptoms (MUS) (pre-
iously termed psychosomatic conditions). These patients have
ery limited pathways for supporting their wellbeing in primary
are and are high health utilisers (Bermingham, Cohen, Hague, &
sychotherapy 47 (2016) 55–65
Parsonage, 2010). They suffer with chronic, physical symptoms
54. or
conditions which do not appear to have an organic, medical
diagno-
sis and normally with co-occurring anxiety and/or depression.
The
negative impact of the conditions and lack of curative
treatments
means effective non-pharmacological interventions that promote
better coping abilities need to be developed.
TBMA treatment aims to bridge the gap between mental and
physical health services for these patients with chronic MUS. It
uses the inter-relationship between body and mind for the treat-
ment of such patients with these persistent symptoms. Further
details on the approach can be found in Payne (2015) and Lin
and
Payne (2014). The University’s newly endorsed company P2W
is
the vehicle for the service with the knowledge arising from the
pilot research being transferred into a real world service
delivery
as clinical progress reporting. This recent service delivery
project
(2012–2013) was funded by the DH initiative Quality, Innova-
tion, Productivity and Prevention (QIPP) scheme in a
competitive
bid from the authors and Hertfordshire Primary Care Trust
(Men-
tal Health). The delivery took place in community settings with
patients referred by GPs from primary care. The service was
free
at the point of delivery. The naturalistic delivery and the
lessons
learned from the experience are documented in Payne (2015).
This
article focusses solely on an evaluation of the clinical outcomes
55. for the patients from a small scale implementation of TBMA in
the
NHS. The small sample size (N = 16) and the lack of a control
arm
means that the outcomes cannot be generalised with any confi-
dence. However, the indicative outcomes which are very
positive
are consistent with a previous pilot study conducted at the
Univer-
sity of Hertfordshire (Payne & Stott, 2010) and may be
transferable.
Medically unexplained symptoms
Patients with chronic MUS (presenting for over 6 months with
the same symptom/s) are quite complex and are high health
utilisers for whom there are few pathways for support and self-
management other than (for a few symptoms) CBT and/or pain
relief. In a recent practice guideline published by the UK DH,
(July
2014) as a part of Improving Access to Psychological Therapies
(IAPT) initiative, it is concluded that “community mental health
teams and primary care mental health services have not been
suc-
cessful in engaging with patients experiencing MUS, as patients
often do not perceive their condition to be related to mental
health
problems, and attempting to engage them in traditional mental
health approaches is often ineffective” (DH, 2014, p. 5).
Therefore to review the research on self-management in CBT is
not relevant to the purpose of this article.
A systematic review of research (Du et al., 2011) was conducted
for the self-management programmes on pain and disability for
chronic musculoskeletal pain conditions (not necessarily MUS).
56. For chronic back pain, there was insufficient evidence to deter -
mine the effectiveness of self-management programmes. In a
more
recent review (Oliveira et al., 2012) for non-specific low back
pain
results showed moderate-quality evidence that self-management
has small effects on pain and disability which challenge the
endorsement of self-management in treatment guidelines.
MUS patients are high utilisers of health care resources. In
2008–2009 approximately £3 billion was spent on patients with
MUS in the NHS (11% of total budget) rising to £18 billion
includ-
ing the cost to the wider economy through lost productivity
(Bermingham et al., 2010).
No serious medical cause was the diagnosis in 25–50% of all
pri-
mary care visits (Barsky & Borus, 1995) and only 10–15% of
the
14 common, physical symptoms seen in half of GP consultations
over 12 months were found to be caused by an organic illness
(Morriss, Dowrick, & Salmon, 2007), resulting in 85–90% being
of
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nknown biological aetiology. These patients are often taking
med-
cation, regularly visit health professionals (more than five times
er year) and for longer consultations than the 11 min per visit
er symptom allowable in the NHS. Furthermore, they use many
esources accounting for as many as one in five new
consultations
Bridges & Goldberg, 1985). They frequently have high cost
referrals
o secondary care for tests and scans and usually present with
anx-
ety and/or depression, which is understandable (Aguera, Failde,
59. ervilla, Diaz-Fernandez, & Mico, 2010; Simon, VonKorff,
Piccinelli,
ullerton, & Ormel, 1999).
Dimsdale, Sharma, and Sharpe (2011) showed that although
US/somatoform disorders are common, for those health pro-
essionals seeing such patients there is considerable confusion
egarding the diagnostic terminology and a reluctance to use
hese diagnostic labels. For example, GPs rarely use the terms
US or somatoform disorder to their patients, instead diagnosing
bromyalgia, ME, IBS, chronic fatigue, etc. Neither do GPs
routinely
se the ICD-10 subcategories of various somatoform disorders.
onsequently, in the experience of the authors the specific
number
f this huge population in each GP practice is hidden from the
GP
ractice database. However, GPs can identify those known as
heart-
ink, frequent flyer and fat file patients whom they refer to the
MUS
linic. As a result of a systemic lack of classification many
patients
ho have MUS/somatoform disorder are not able to be identified
o receive the support of the MUS Clinic.
Grover et al. (2014) found no significant differences between
he various subcategories of somatoform disorders with regard
o the prevalence of somatic symptoms (including somatoform
ain disorder), anxiety or depression and psychological
correlates
f alexithymia, hypochondriasis and somato-sensory amplifica-
ion. Their findings also supported the co-occurrence of anxiety
60. nd depression in two-thirds of this population. Anxiety disor-
er (formally hypochondriasis) or functional neurological
disorder
formally conversion) may also be diagnosed.
Khan, Khan, and Harezlak (2003) call for better management
trategies to be developed in primary care for prevalent,
medically
nexplained, persistent somatic symptoms which are a health
care
riority and a long-term condition. Currently patients either
attend
hysical or mental health services and the treatment is separately
elivered as medication/pain management or psychological ther -
pies, respectively. This system is unhelpful to the patient since
t splits off mental from physical health aspects. In England,
CBT
or three conditions: IBS; chronic fatigue and fibromyalgia, has
een found to help mental health in the short term and encour-
ged through a government initiative called Improving Access to
sychological Therapies (IAPT) which also targets people with
long-
erm conditions in which MUS can be categorised. However,
only a
hird of MUS patients with varied symptoms attend this
treatment
Hague, 2008), probably due to their physical explanation for
their
ymptoms and the stigma attached to mental health services.
Thus
t seems CBT is unacceptable to this patient population, they
require
n accessible and integrated approach which acknowledges their
odily based physical experience whilst exploring this at
emotional
nd cognitive levels.
61. he research on which TBMA is founded
A pilot study into the TBMA intervention took place near Lon-
on, England in 2005–20071 (Payne, 2009; Payne & Stott, 2010).
rom these earlier research studies, specifically the proof of
concept
ilot study (Payne & Stott, 2010), patient benefits from TBMA
inter-
ention were improved wellbeing and activity levels; decreased
1 Funded by the East of England Development Fund and The
University of Hert-
ordshire.
sychotherapy 47 (2016) 55–65 57
symptom/anxiety/depression levels; improved self-management
of symptoms; and lower or stabilised medication levels. For GPs
the benefits included reduced attendance at GPs and/or hospitals
and reduced costs of medication.
Furthermore, a previous health economic analysis of TBMA
com-
pared with CBT showed that the cost savings would be large in
primary care but that secondary care they would be even greater
(Payne & Fordham, 2008) the findings of which are supported
by a
report from the DH (2012). Thus this evidence makes TBMA
courses
attractive for the NHS due to the current austerity situation in
England.
Following extensive consultation with primary care GPs in a
market research study by Payne, Eskioglou, and Story (2009),
62. funded by the East of England Development Agency, a need was
identified by the GPs for a pathway for the treatment and sup-
port of this patient population, for most of whom they thought
CBT/psychological therapies was inaccessible and/or
inappropriate.
In support of the lack of accessibility for patients of
psychological
therapies and/or referrals from GPs psychologists in IAPT com-
plained that they were not getting enough referrals from GPs.
When
TBMA was described to these GPs in a focus group (and later in
the
QIPP project) as a possible pathway it was welcomed
enthusiasti-
cally as being more acceptable and providing choice for
patients.
The pilot study led to the development of a manual for the
delivery of TBMA by experienced and qualified Masters level
dance movement psychotherapists trained in TBMA by path-
ways2wellbeing. This manual is not a recipe for sessions but
rather
offers nudges for the planning, specific themes which need to be
covered and when and for the conducting of group sessions. The
mind-set/attitude of the facilitator is described as the most
impor-
tant ingredient for promoting change. The facilitator is
encouraged
to be mindful, sensitive, adapting practices to each group’s
needs,
ensuring interventions, aims and outcomes are explained clearly
to patients and addressing needs as they arise rather than being
prescriptive. The manual content gives examples of sessions and
case studies, emphasising the facilitator’s competencies
expected.
The manual was further refined as the QIPP service delivery
63. was
conducted in an evaluation by the facilitators during the
delivery,
and no doubt it will be honed still further with each new
delivery
of the groups by more facilitators.
As well as the manual being continuously updated TBMA is
being evaluated as an on-going process during delivery of the
service. Manuals developed for conducting psychological
therapies
in research studies are not widely distributed and their contents
do not appear to have been evaluated (Payne, Westland, Karkou,
& Warneke, 2014). Research findings based on the application
of
treatment manuals have led to the endorsement of psychological
treatments based on the use of brand names, e.g. Body Orien-
tated Psychotherapy, CBT or Interpersonal Therapy. Endorsing
brand-named treatments assumes they are practised in a man-
ner consistent with the research treatment manuals but without
evidence to support this assertion. In this service delivery treat-
ment integrity has been ensured by a triangulation (a three-way
comparative analysis) between what patients have said about
their
experience of the approach what the facilitator says she did in
the
pilot study (Payne, 2009), and the manual which will continue
to
be evaluated by the facilitators and by expert opinion evaluators
external to the delivery.
The BodyMind ApproachTM
There are many different definitions of psychotherapy, for
example ‘The treatment of disorders of the mind or personal-
ity by psychological methods’ (Oxford English Dictionary,
2015)
64. or ‘the informed and intentional application of clinical methods
5 ts in P
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66. 8 H. Payne, S.D.M. Brooks / The Ar
nd interpersonal stances derived from established psychologi -
al principles for the purpose of assisting people to modify their
ehaviours, cognitions, emotions, and/or other personal
character-
stics in directions that the participants deem desirable’
(Campbell,
orcross, Vasquez, & Kaslow, 2013, p. 98). It is normally the
esponse to specific or non-specific signs of clinically
diagnosable
nd/or existential crises, often dubbed talking therapy aiming to
elp clients to fulfil their potential or cope better with the emo-
ional problems of life.
Whilst TBMA is not psychotherapy in the narrow definition of
he term it has its roots in a psychotherapy school of thought. It
orks not only with the mind, emotions and cognition but also
ith the physical symptoms, it is a bio-psychosocial model.
TBMA can be seen as one solution to the problem of patients
with
US. It has been designed specifically to be accessible to this
patient
opulation and to provide choice. It aims towards integrating
body
nd mind, starting with the bodily symptom and its sensory expe-
ience to promote self-management and wellbeing in people with
hronic MUS. It employs somatic mindfulness (or bodymindful-
ess) – movement, a moment-to-moment awareness of the body
n motion or stillness, from the discipline of Authentic
Movement
67. Adler, 2002; Chodorow, 1992; Payne, 2006; Whitehouse, 1999)
hich is sometimes employed in dance movement psychotherapy.
uthentic movement is where the mover moves spontaneously
ith eyes closed/downwardly focussed in the presence of a wit-
ess. In TBMA authentic movement is coupled with mindfulness
ractices, adapted to be accessible to people with persistent
symp-
oms employing simple practices scaffolding them into elements
f the final form. There is no pressure to engage with anything
ith which patients might be uncomfortable. The facilitator
always
ffers alternatives and choices.
Kabat-Zinn (1982), Kabat-Zinn, Lipworth, and Burney (1985)
nd Kabat-Zinn, Lipworth, Burney, and Sellers (1986) pioneered
the
evelopment of mindfulness meditation with patients with
chronic
ain and a mindfulness stress reduction programme for psoriasis
Kabat-Zinn et al., 1998) as well as applying it to patients wi th
anxi-
ty (Miller, Fletcher, & Kabat-Zinn, 1995). Since then there has
been
prolific study of mindfulness. It has been shown to reduce
depres-
ion as well as anxiety. Hofmann, Sawyer, Witt, and Oh (2010)
onducted a meta-analysis of 39 studies that explored the use
f mindfulness-based stress reduction. The researchers concluded
hat mindfulness-based therapy may be useful in altering affec-
ive and self-regulatory processes that underlie multiple clinical
ssues particularly anxiety and/or depression. Others have sup-
orted these findings, for example, Vøllestad, Nielsen, and
Nielsen
2012), Roemer et al. (2009) and an earlier study by Grossman,
68. ieman, Schmidt, and Walach (2004). A systematic review con-
ucted by Sharma and Rush (2014) found that out of 17 studies
ombining mindfulness meditation and yoga 16 demonstrated
pos-
tive changes in psychological or physiological outcomes related
o anxiety and/or stress. Williams (2008) reviewed four stud-
es showing a correlation between measures of mindfulness as a
rait and cognitive features of depressive vulnerability,
specifically
ecreased rumination, avoidance of internal experiences and an
ncrease in the relinquishment of negative thoughts and unattain-
ble goals. Other studies demonstrate that a mindful or
experiential
ode of self-attention in depressed subjects is relatively more
onducive to both improved memory for autobiographical events
Watkins & Teasdale, 2004) and improved problem solving
ability
Watkins & Moulds, 2005).
Nevertheless none of these approaches address the lived bodily
elt sensory experience from a phenomenological perspective
r address the importance of body awareness as a vehicle for
hange. The subjective experiencing body (Gallagher & Zahavi,
007), whether engaging with the world’s affordances (Gibson,
979) through the tactile sense, movement or in stillness, is
sychotherapy 47 (2016) 55–65
the fundamental basis for all feelings, sensations, perceptions or
object manipulation which in turn actively underlies cognition
and meaning-making (Dewey, 1991; Merleau-Ponty, 1962,
1965).
There is thus an integration of physical and mental aspects, per -
69. ception and action, doing and being. TBMA builds on this
notion
of the body functioning as a dynamic constituent of the mind
rather than serving the mind. This enactive, subjectively body-
felt
sense, as described by Gendlin (1982), expresses basic mean-
ing from a sensory–motor modality and reflects the individual’s
life history and current situation. It is pre-verbal and prelimi-
nary to habitual/pre-conceptual/abstract thinking patterns.
During
TBMA the body is therefore experienced from inside-out, as a
lived container of sensations, images, thoughts and feelings,
etc.
Joint attention with the facilitator or another participant as wit-
ness extends the experience as reflections are embodied from
the
outside-in as well. This opportunity to experience the
connection
between the body and mind whilst doing/being it opens up
possi-
bilities for new discoveries about the nature, and the meaning
of,
symptoms as located in the bodymind. This is an embodied way
of knowing (Panhofer & Payne, 2011), contrasting with
conceptual
knowing.
Several disciplines cultivate mindfulness, such as yoga, tai chi
and qigong, although most of the research literature has concen-
trated on mindfulness developed through mindfulness
meditation.
This self-regulation practice trains attention and awareness to
bring mental processes under greater voluntary control thereby
promoting wellbeing and/or capacities such as calmness, clarity
and concentration (Walsh & Shapiro, 2006).
70. Mindfulness refers to a psychological state of awareness, the
practices that promote this awareness, a mode of processing
information and a character trait and can be defined as a
moment-
to-moment awareness of one’s experience without judgement. In
this sense, mindfulness is a state and not a trait. While it might
be
promoted by certain practices or activities, such as meditation,
it
is not necessarily synonymous with them. TBMA by using
kinetic
mindful practices engages with the patient’s attention to, and
rela-
tionship with, their bodily symptoms (including pain), for
example
by exploring the sensory experiences, and engaging in action-
based
inquiry such as examining the nature and purpose of the
symptoms.
This mindful relationship to the body and symptoms helps
patients
become less attached to/identified with their symptoms as well
as
less reactive to them which diminishes their experience of them.
TBMA coaches patients through exercises involving postures
and movement, breath and voice, mindfulness and body aware-
ness. Practicing such exploratory exercises regularly in the
group
session (and at home) the patient may regain balance and self-
regulation. For example, practising focussing on the breath (or
the
symptoms), then noticing any thoughts, images or bodily sensa-
tions, followed by re-focussing on the breath, and then
reflecting
on the experience through the creative arts thus nurturing a deep
71. awareness of the body. By putting difficult emotions and
sensations
in a bodily context an indication of a new perspective and
accom-
panying meanings can be gained. By holding all these aspects,
including pain, in direct sensory awareness metaphor/imagery
can
be generated spontaneously. These can be drawn, made out of
clay or written about in a personal journal often leading to
further
meaning-making and understanding of the role/nature/purpose
of
the symptoms. Participants are engaged in synchronous, effort-
ful movement together in a circle (accompanied by music or
not)
which has been shown to reduce pain and act as a way to
increase
group cohesion (Tarr, Launay, Cohen, & Dunbar, 2015).
TBMA helps patients to connect cognitive and emotional
aspects
with reference to their sensory/bodily states through the enact-
ment of expressive movement in structured exercises. Cognitive
activities are inseparable from the body as the brain takes an
impor-
tant part in intentionality which involves the process of
perceiving
ts in P
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74. here is no explicit involvement of any underlying psychological
onflicts or the interpretation/identification (or subsequent modi -
cation of) unhelpful thought patterns. Patients learn to notice
their
odily signals and explore their symptoms often without the need
or verbalisation (McWhinney, Epstein, & Freeman, 1997),
thoughts
hange as a result of the embodied experience.
TBMA differs significantly from CBT in that it focuses on the
hysical symptom within an experiential inquiry-led learning
ramework to support patients to live well and cope better in a
ore meaningful way. There is an evidence base for the practice
f CBT with some specific conditions included in the MUS cate-
ory, e.g. IBS (Mahvi-Shirazi, Fathi-Ashtian, Rasoolzade-
Tabatabaei,
Amini, 2012) and fibromyalgia (Woolfolk, Allen, & Apter,
2012)
ut the method does not address the body-felt sensory experience
f the symptoms, favouring solely the mental aspects of depres-
ion and/or anxiety. CBT has been researched in large trials and
s recommended by the National Institute for Clinical and Health
are Excellence (NICE) for chronic fatigue and fibromyalgia.
How-
ver, patients and GPs in the service delivery reported in this
rticle spoke about patients’ reluctance to attend anything con-
erned with psychological/mental ill health, etc. There is
evidence
Sartorius, 2007) to suggest that these patients are very wary of
he stigma attached to any mental health label. It can be
concluded
hat patients with MUS may be less willing to access CBT as
they
elieve they have an organic cause rather than give a psycholog-
75. cal explanation for their symptoms. Allen and Woolfolk (2010)
nd Gonzalez, Williams, Noel, and Lee (2005) demonstrate that
this
atient population are often resistant to CBT.
In contrast TBMA is not presented to patients as a
psychological
herapy. It allows patients in the early phase to concentrate on
their
ensory experience and action patterns involved in the symptom.
owever, there is often a subtle psychological component to the
reatment discovered by the patient later in the process. Hence
atients do not concern themselves with the question of stigma
n relation to participating in the treatment. Furthermore, TBMA
ddresses a range of symptoms and the symptom itself. It can
nclude a number of different symptoms for a number of patients
n the same group, together with various accompanying aetiology
uch as alexithymia (Ogrodniczuk, Joyce, & Piper, 2013), in
which
here is confusion between emotions and bodily experiences,
poor
ffect regulation and a fearful/insecure attachment style (Payne,
016).
In TBMA the patient directs her/his attention to inner expe-
iences of self, actively reflecting and commenting on bodily
ensations as they are raised into awareness. Gradually
participants
ecome more connected to their embodied, direct experience of
elf. A more positive re-association with the body emerges which
as often become dissociated due to the patient’s symptom
distress.
76. n embracing the wisdom held by the symptom through the
embod-
ed, enactive dream state the patient enters into a more
meaningful
ialogue with their body. Levy Berg, Sandahl, and Bullington
(2010)
n a study of patient perspectives of the process of change in
ffect-focussed body psychotherapy for generalised anxiety
disor-
er found that ‘getting in touch with one’s body’ was a key (p.
151).
his in turn gave rise to feelings of being in control, for example
oticing bodily signals such as muscular tension and being able
to
nfluence them, and understanding the link between bodily
symp-
oms and emotions. They found that patients managed to
integrate
odily feelings into their perception of themselves resulting in a
eeper experience of their lived body.
tructure of the TBMA course
TBMA groups are short term for up to 12 patients per group;
here are three groups per programme. Each session is two hours
sychotherapy 47 (2016) 55–65 59
for 12 sessions over 10 weeks as in brief therapy (Yalom &
Leszcz,
2005). Groups are run locally in a suitable community setting.
Following the groups in phase one, in phase two, and over the
following 6 months contact is maintained. For example, a self-
addressed letter written by the participant in session 12 is sent
8 weeks after the end of the group, as is a letter personalised for
each participant written by their facilitator in month three after
77. the
end of the group. Finally, a text/email message is sent asking
how
they are doing, and, if indicated by their response to the
question,
in month nine, a referral to a self-help group is made, otherwise
a
discharge letter is sent to their GP.
Practice-based evidence
As well as the traditional trials in the evidence-based practice
paradigm another form of evidence is being derived from
natural-
istic practice settings termed practice-based evidence (Barkham
&
Mellor-Clark, 2000).
Practice-based evidence is described by Guy, Thomas,
Stephenson, and Loewenthal (2011) as complementary to the
quantitative, and dominant, randomised control trial-based
approach to evidence. A United Kingdom Council for
Psychother-
apy (UKCP) report (Ryan & Morgan, 2004, cited in Thomas,
Stephenson, & Loewenthal, 2006) suggests that practitioners
and
service users need to be given a voice, acknowledging that they
have direct knowledge and experience of what works and alter-
natively what needs to change, and how. Practice-based
evidence
can give them these opportunities.
P2W employs this practice-based methodology, albeit with
smaller numbers. It contrasts with evidence-based practice in
that
it starts with practitioners and patients in real-world settings
78. and builds up the evidence rather than as with the traditional
top down evidence-based medical paradigm. Furthermore, it
uses
national/common psychological therapies and primary care out-
come measures such as PHQ9 for measuring depression. Patient
evaluations of experience and outcomes form an important part
of
the evidence. Additionally, it is using real-world patients
electing
to participate in the treatment group, rather than selected
samples
willing to participate in research to which they would be blindly
allocated to either the treatment/treatment as usual without
exert-
ing any choice.
With this practice-based methodology and its evaluation using
qualitative and quantitative patient feedback and the
standardised
psychological assessment tools there is an opportunity to build
an
evidence base rooted in routine service delivery. This could
com-
plement the Cochrane data base2 and together with it, yield a
more
robust knowledge base for the psychological/arts therapies.
This methodology values expert opinion and acknowledges the
need to adjust practice according to the needs and preferences
of
the client and their socio-economic background. This
complemen-
tary paradigm of practice-based evidence also provides a means
for practitioners to own and generate an evidence base
embedded
in routine practice. Both paradigms are needed as the aim for all
79. practitioners and researchers alike is best practice.
Description of patients in the sample
Ethnicity: White British – 10; Chinese – 2; Indian – 4 (we do
not
know if born in Britain from this background or if their country
of
2 An international not-for-profit organisation preparing
maintaining and promot-
ing the accessibility of systematic reviews of the effects of
health care.
6 ts in P
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81. •
•
•
•
•
•
•
•
•
hospital visits and improvement in their social support.
For the majority of patients’ depression scores were mild or
moderate reducing to zero, one patient reduced in her score
from severe to moderate. The literature (Löwe, Spitzer,
Williams,
0
20
40
60
80
Percent age Improveme nt
Percentage Im proveme nt
0 H. Payne, S.D.M. Brooks / The Ar
ssessment to follow up at 6 months. This reflects the literature
hereby more women than men somatise.
Age distribution: Results from this small sample of 16 suggest
hat adults of all ages are likely to experience MUS. The biggest
ge group category was the 50–59 year olds (5/16 were from this
ategory). The youngest patient was just below 20 years of age
and
82. he eldest patient was over 80 years old.
Number of patients in each group: Group 1: four; Group 2: six;
roup 3; six.
Number at completion: 16/19 patients completed the full pro-
ramme over the two phases to the end of the 6 month follow -
up.
The number of group sessions attended per patient ranged from
to 11.
Attendance figures: Group 1 had 67%, Group 2 – 86% and for
Group
it was 90%.
The following shows engagement throughout the programme:
Number entering treatment groups: 19 (one missed the intake
eeting but attended the first two sessions then withdrew, a fur -
her one withdrew after first two sessions as too unwell and one
ad to have an operation and could not drive so had to
discontinue).
Number remaining in treatment: 17 (one remained until session
0 but could not sustain thereafter).
Number completing TBMA group treatment through to follow
up:
6.
nalysis of questionnaire data
The majority of patients were in the moderate or mild cate-
ories for anxiety which is broadly consistent with the literature
hich states that at least two-thirds of patients with MUS will
83. ave anxiety (Grover et al., 2014). Higher levels of anxiety show
ore of an improvement than at these lower levels. The majority
f patients were women, a finding consistent with the literature
Speckens, VanHemert, Bolk, Rooijmans, & Hengeveld, 1996).
They
ere of a mixed educational background similar to that found by
imnuan, Hotopf, and Wessely (2001). Some studies claim that
hose unemployed, senior women and those from a non-Western
rigin experience more MUS (Verhaak, Meijer, Visser, &
Wolters,
006). However, participants in this project were from a variety
of
ackgrounds and ages. This is inconsistent with some other stud-
es which found, for example, the older age group to be overly
epresented or, in contrast, younger, employed women to be
over
epresented (Nimnuan et al., 2001). However, all of these
outcomes
n the demographics in the project are consistent with the
previous
ilot study.
Educational background: Patients came from a range of educa-
ional backgrounds.
Employment status: 5/16 retired, one of which was due to ill
ealth. 7/16 patients were in full-time employment; two in part
ime employment; one was unemployed and one a student.
Types of symptoms: There were 26 different symptoms for the
hole cohort of 16 patients completing the programme to follow
p. These included:
84. breathlessness,
headaches,
chronic pain,
tiredness,
insomnia,
hand pain,
leg pain,
chronic fatigue,
IBS,
ME,
palpitations,
seeing white lights,
sychotherapy 47 (2016) 55–65
• pain in the chest,
• backache,
• leg spasm and
• insomnia.
Assessment measures
Patients were assessed using standardised measures over the
telephone by a clinical psychologist on three occasions. Firstly
at
pre-group, secondly in the final week of the group and thirdly at
6
months follow up. The measures used were:
PHQ9: This is a client rated tool for depression. It scores each
of
the nine depression DSM-IV criteria as “0” (not at all) to “3”
(nearly
every day).
85. Measure Your Medical Outcomes Profile (MYMOP2): This is an
individualised outcome questionnaire, problem-specific
(measures
two symptoms chosen by the patient), including general
wellbeing
and impact of symptoms on a chosen activity. The greater the
score,
the more severe the symptoms will be experienced.
Generalised Anxiety Disorder 7 (GAD7): This is a brief
measure
for assessing Generalised anxiety disorder on a 7-item self-
rating
scale. It scores each item as “0” (not at all) to “3” (nearly every
day)
for each item. Severity of generalised anxiety is graded based
on the
GAD7 score as 0–4 none/5–9 mild/10–14 moderate/15–21
severe.
The Global Assessment of Functioning Scale (GAF): A clinician
rat-
ing tool used to measure overall level of psychological, social
and
occupational client functioning on a scale ranging from 1 to
100.
The higher the score, the higher the level of functioning will be.
GAF covers the range from positive mental health to severe psy-
chopathology.
P2W questionnaire: During a telephone interview the asses-
sor collected self-reported information on the participant’s age,
gender, ethnicity, socio economic group, occupation,
educational
levels, type and number of symptoms, amount of leisure activ-
ity, social support, work/school attendance, use of medication,
86. and
attendance at GP/hospital. In addition, GP referrals contained
case
histories and medical information.
Post-group outcomes from the standardised assessments
The outcomes are also presented as pie charts for greater visual
impact and ease of interpretation by the general reader.
Interpretation of outcomes pre to post group
Improvements are noted in all areas shown from pre to post
group on the Pie Charts 1–7 and in Graph 1. Particularly impor-
tant are improvements in the scores from pre to post group as
shown in Table 2 indicating decreased levels of depression,
anxiety
and symptom severity. There are also improved feelings of
overall
wellbeing, social support, activity levels and global functioning.
In
addition, patients report decreased GP visits, medication usage
and
medica�on social
support
GP visits Hospita l
visits
Pie Chart 1. Patients reporting reduced feelings of depression
81.25% of patients
reported a reduction in depression.
H. Payne, S.D.M. Brooks / The Arts in Psychotherapy 47 (2016)
87. 55–65 61
depression
81.25% re duce d
6.25% increased
12.5% no change
Pie Chart 2. Percentage of patients reporting improved global
functioning 81.25%
of patients report and improvement in global functioning.
global func�oning
81.2 5% improved
6.25% redu ced
12.5% no change
Pie Chart 3. Percentage of patients reporting increased overall
score for MYMOP
including activity, symptom severity and wellbeing 81.25% of
patients report
improvement in overall scores.
mymop overall
81.2 5% in creased
6.25% de creased
12.5% no change
Pie Chart 4. Percentage of patients reporting reduced anxiety
levels 68.75% of
patients reported a reduction in anxiety.
anxi ety