This document provides instructions for a strategic evaluation assignment. Students are asked to evaluate potential business, corporate, and global strategies for an organization and recommend a strategy or combination of strategies. They are to insert their assessment and evaluation into tables provided in an attached document and include these tables in their paper. The paper must be at least 1,050 words.
Neurofeedback shows promise as a treatment for anxiety, depression, and other conditions. Research indicates it can significantly reduce test anxiety and symptoms of generalized anxiety. Studies found neurofeedback reduced anxiety scores more than relaxation training or no treatment. Clinical reports also suggest neurofeedback may effectively treat mild to severe depression. It has produced significant, enduring changes in mood and depression symptoms in approximately 80% of patients. Neurofeedback also seems to have minimal risks and be less invasive than other treatments like antidepressants. More research is still needed, but it qualifies as an evidence-based treatment for certain anxiety disorders and could be an effective alternative treatment for modifying dysfunctional brain patterns associated with psychiatric conditions.
Efficacy of individualized homeopathic treatment and fluoxetine for moderate ...home
his study is the first trial of classical homeopathy that will evaluate the efficacy of homeopathic
individualized treatment using C-potencies versus placebo or fluoxetine in peri- and postmenopausal women with
moderate to severe depression. It is an attempt to deal with the obstacles of homeopathic research due to the
need for individual prescriptions in one of the most common psychiatric diseases.
This randomized controlled trial examined whether cognitive behavioral therapy for insomnia (CBT-I) delivered by a therapist is more effective than self-help CBT-I materials at reducing insomnia and depression in individuals with comorbid insomnia and depression being treated with antidepressants. 41 participants were randomized to receive either 4 sessions of CBT-I or self-help materials over 8 weeks. Compared to the self-help group, the CBT-I group showed significantly greater reductions in both insomnia and depression scores post-treatment and at 3-month follow-up. The results suggest that targeting insomnia through CBT-I can effectively treat comorbid insomnia and depression and should be considered an important adjunct treatment for patients whose depression has not fully
Insomnia is defined as repeated difficulty initiating or maintaining sleep that impairs daytime functioning. Approximately one third of adults experience some insomnia symptoms, while 6-10% meet diagnostic criteria. Insomnia is more common in women, older adults, shift workers, and those with medical/psychiatric conditions. Chronic insomnia lasting over 1 month can have numerous health consequences and is associated with impaired daily life and increased healthcare costs. Evaluation involves assessing sleep history, habits, and impairment through diaries and interviews to determine if insomnia is primary, comorbid, or secondary to another condition.
Please I need a response to this case study.1 pagezero plagi.docxcherry686017
Please I need a response to this case study.
1 page
zero plagiarism
three references
The Case:
The sleepy woman with anxiety
This week’s discussion presents a case study involving a 44-year old woman with a chief complaint of anxiety beginning at age 15 years old. She has a long history of mental illness and continued therapies. The purpose of this discussion is to analyze her case history to determine medication and treatment effectiveness.
Client Questions
Question 1. Are you having feelings of harming yourself or harming someone else?
Rationale: This is a possibly uncomfortable yet important set of questions to ask each client. Primary care providers may be in a unique position to prevent suicide due to their frequent interactions with suicidal patients. Reviews suggest that among patients who committed suicide, 80 percent had contact with primary care clinicians within one year of their death, whereas only 25 to 30 percent of decedents had contact with psychiatric clinicians within the year of their death (Stene-Lars & Reneflot, 2017).
Question 2. What was happening in your life as a teenager when the anxiety started and you began to self-medicate?
Rationale: Per our report, this patient began suffering signs and symptoms of anxiety at 15-years old. Asking these types of questions we may gain insight into an underlying cause or triggering event. Anxiety disorders are the most common psychiatric disorders with onset in childhood, with prevalence estimates ranging from 10 to 30 percent. Nearly 37 percent of behaviorally inhibited preschool-age children had social anxiety disorder at age 15, compared with 15 percent of non- behaviorally inhibited children
.
Children with anxiety disorders are more likely to have persistent anxiety disorders into adulthood. (Rapee, 2014).
Question 3. What was happening in your life a year ago when these symptoms returned and became debilitating? Let’s discuss what the triggering events may have been.
Rationale: Self-discovery of triggering events may help the client to come to terms with the determinants of her anxiety and depression. Studies have shown that specific types of stressors were found to differentially predict increases in specific facets of anxiety sensitivity; health-related stressors predicted increases in disease-related concerns and fear of mental incapacitation, whereas stressors related to family discord predicted increases in fear of feeling unsteady, fear of mental incapacitation, and fear of having publicly observable symptoms of anxiety (McLaughlin & Hatzenbuehler, 2009).
Support System
The support system as reported by our client is her husband. She states he is supportive and has little to no contact with the family of origin. She has a few friends and a few outside interests. As PMHNP, discussing relationships with the client is one avenue to gain insight into anxiety patterns and coping mechanisms as seen by outside support. With the client’s permissio.
1.Freeman, S. (2011). Improving cognitive treatments for delus.docxjeremylockett77
1.
Freeman, S. (2011). Improving cognitive treatments for delusions. Schizophrenia Research, 132, (2–3), 135-139. doi:10.1016/j.schres.2011.08.012
generation CBT for psychosis was successful but the strength of the treatment was weak and as the author states similar to those of clozapine (an antipsychotic used as a last resort for psychosis). Therapy is not up to date as it should be for delusions as delusion are understood quite well and therapy needs to catch up. The treatment of CBT for psychosis is similar to CBT treatment for anxiety.
Pay attention to single symptoms in psychosis
2.
Munro, Alistair (May 1992) Psychiatric Disorders Characterized by Delusions: Treatment in Relation to Specific Types. Psychiatric Annals, 22, 5, ProQuest Central pg. 232
3.
Ho-wai So, S., Roisin Peters, E., Swendsen, J., Garety, P.A., & Kapur, S. (2014) Changes in delusions in the early phase of antipsychotic treatment – An experience sampling study. Psychiatry Research 215, 568-573
Summarize including the research question addressed in the source, if applicable, and major findings.
Evaluate the usefulness of the source for your literature review, making sure to directly state why the source is informative for your specific topic
Three dimensions of delusions are always present in factor analyses and they are a conviction, distress, preoccupation, and disruption to life. More studies need to be done to learn how delusions respond to antipsychotic. Conviction has been least amenable to change shows the studies. Many studies ponder the question, “why does conviction exist?” There have been studies that show that reasoning bias including “Jumping to conclusion (JTC)” bias and by patients being inflexible contributes to the maintenance of delusions. JTC has also shown that the dimension of conviction of delusions and the severity of delusions is influenced by JTC. Delusions improve during the first few weeks of treatment and some studies show improvement in the first few hours.
It was hypothesized that delusion distress and preoccupation would reduce significantly over two weeks of antipsychotic treatment; but not a conviction. Female participants showed a higher response on all four delusion dimensions compared to the male participants. 57% of the participants showed the JTC bias. The no-JTC group showed a larger improvement in conviction and distress and with their delusions in general.
This study is important for my literature review and further studies because the three dimensions of delusions: distress, preoccupation, and conviction are important for the clinical implications of treatment. If we take into account these three dimensions it will benefit further research and treatments.
4.
The efficacy of a new translational treatment for persecutory delusions: study protocol for a randomized controlled trial (The Feeling Safe Study)
Freeman et al. (2016) Trials, 17:134. doi:10.1186/s13063-016-1245-0
Summarize including the research questi ...
Treating Insomnia in Depression Insomnia Related Factors Pred.docxturveycharlyn
Treating Insomnia in Depression: Insomnia Related Factors Predict
Long-Term Depression Trajectories
Bei Bei
Monash University and Royal Women’s Hospital, University of
Melbourne
Lauren D. Asarnow
Stanford University
Andrew Krystal
University of California, San Francisco
Jack D. Edinger
National Jewish Health, Denver, Colorado, and Duke University
Medical Center
Daniel J. Buysse
University of Pittsburgh
Rachel Manber
Stanford University
Objective: Insomnia and major depressive disorders (MDD) often co-occur, and such comorbidity has
been associated with poorer outcomes for both conditions. However, individual differences in depressive
symptom trajectories during and after treatment are poorly understood in comorbid insomnia and
depression. This study explored the heterogeneity in long-term depression change trajectories, and
examined their correlates, particularly insomnia-related characteristics. Method: Participants were 148
adults (age M � SD � 46.6 � 12.6, 73.0% female) with insomnia and MDD who received antidepressant
pharmacotherapy, and were randomized to 7-session Cognitive Behavioral Therapy for Insomnia or
control conditions over 16 weeks with 2-year follow-ups. Depression and insomnia severity were
assessed at baseline, biweekly during treatment, and every 4 months thereafter. Sleep effort and beliefs
about sleep were also assessed. Results: Growth mixture modeling revealed three trajectories: (a)
Partial-Responders (68.9%) had moderate symptom reduction during early treatment (p value � .001)
and maintained mild depression during follow-ups. (b) Initial-Responders (17.6%) had marked symptom
reduction during treatment (p values � .001) and low depression severity at posttreatment, but increased
severity over follow-up (p value � .001). (c) Optimal-Responders (13.5%) achieved most gains during
early treatment (p value � .001), continued to improve (p value � .01) and maintained minimal
depression during follow-ups. The classes did not differ significantly on baseline measures or treatment
received, but differed on insomnia-related measures after treatment began (p values � .05): Optimal-
Responders consistently endorsed the lowest insomnia severity, sleep effort, and unhelpful beliefs about
sleep. Conclusions: Three depression symptom trajectories were observed among patients with comorbid
insomnia and MDD. These trajectories were associated with insomnia-related constructs after commenc-
ing treatment. Early changes in insomnia characteristics may predict long-term depression outcomes.
What is the public health significance of this article?
This study identified three distinct depression trajectories in patients with comorbid major depression
and insomnia disorders during treatment and 2-year follow-up. Those with the largest and most
sustained improvements in depression consistently scored the lowest on postbaseline insomnia and
insomnia-related cognitions. Early changes in insomnia symptoms and insomnia-related character ...
Neurofeedback shows promise as a treatment for anxiety, depression, and other conditions. Research indicates it can significantly reduce test anxiety and symptoms of generalized anxiety. Studies found neurofeedback reduced anxiety scores more than relaxation training or no treatment. Clinical reports also suggest neurofeedback may effectively treat mild to severe depression. It has produced significant, enduring changes in mood and depression symptoms in approximately 80% of patients. Neurofeedback also seems to have minimal risks and be less invasive than other treatments like antidepressants. More research is still needed, but it qualifies as an evidence-based treatment for certain anxiety disorders and could be an effective alternative treatment for modifying dysfunctional brain patterns associated with psychiatric conditions.
Efficacy of individualized homeopathic treatment and fluoxetine for moderate ...home
his study is the first trial of classical homeopathy that will evaluate the efficacy of homeopathic
individualized treatment using C-potencies versus placebo or fluoxetine in peri- and postmenopausal women with
moderate to severe depression. It is an attempt to deal with the obstacles of homeopathic research due to the
need for individual prescriptions in one of the most common psychiatric diseases.
This randomized controlled trial examined whether cognitive behavioral therapy for insomnia (CBT-I) delivered by a therapist is more effective than self-help CBT-I materials at reducing insomnia and depression in individuals with comorbid insomnia and depression being treated with antidepressants. 41 participants were randomized to receive either 4 sessions of CBT-I or self-help materials over 8 weeks. Compared to the self-help group, the CBT-I group showed significantly greater reductions in both insomnia and depression scores post-treatment and at 3-month follow-up. The results suggest that targeting insomnia through CBT-I can effectively treat comorbid insomnia and depression and should be considered an important adjunct treatment for patients whose depression has not fully
Insomnia is defined as repeated difficulty initiating or maintaining sleep that impairs daytime functioning. Approximately one third of adults experience some insomnia symptoms, while 6-10% meet diagnostic criteria. Insomnia is more common in women, older adults, shift workers, and those with medical/psychiatric conditions. Chronic insomnia lasting over 1 month can have numerous health consequences and is associated with impaired daily life and increased healthcare costs. Evaluation involves assessing sleep history, habits, and impairment through diaries and interviews to determine if insomnia is primary, comorbid, or secondary to another condition.
Please I need a response to this case study.1 pagezero plagi.docxcherry686017
Please I need a response to this case study.
1 page
zero plagiarism
three references
The Case:
The sleepy woman with anxiety
This week’s discussion presents a case study involving a 44-year old woman with a chief complaint of anxiety beginning at age 15 years old. She has a long history of mental illness and continued therapies. The purpose of this discussion is to analyze her case history to determine medication and treatment effectiveness.
Client Questions
Question 1. Are you having feelings of harming yourself or harming someone else?
Rationale: This is a possibly uncomfortable yet important set of questions to ask each client. Primary care providers may be in a unique position to prevent suicide due to their frequent interactions with suicidal patients. Reviews suggest that among patients who committed suicide, 80 percent had contact with primary care clinicians within one year of their death, whereas only 25 to 30 percent of decedents had contact with psychiatric clinicians within the year of their death (Stene-Lars & Reneflot, 2017).
Question 2. What was happening in your life as a teenager when the anxiety started and you began to self-medicate?
Rationale: Per our report, this patient began suffering signs and symptoms of anxiety at 15-years old. Asking these types of questions we may gain insight into an underlying cause or triggering event. Anxiety disorders are the most common psychiatric disorders with onset in childhood, with prevalence estimates ranging from 10 to 30 percent. Nearly 37 percent of behaviorally inhibited preschool-age children had social anxiety disorder at age 15, compared with 15 percent of non- behaviorally inhibited children
.
Children with anxiety disorders are more likely to have persistent anxiety disorders into adulthood. (Rapee, 2014).
Question 3. What was happening in your life a year ago when these symptoms returned and became debilitating? Let’s discuss what the triggering events may have been.
Rationale: Self-discovery of triggering events may help the client to come to terms with the determinants of her anxiety and depression. Studies have shown that specific types of stressors were found to differentially predict increases in specific facets of anxiety sensitivity; health-related stressors predicted increases in disease-related concerns and fear of mental incapacitation, whereas stressors related to family discord predicted increases in fear of feeling unsteady, fear of mental incapacitation, and fear of having publicly observable symptoms of anxiety (McLaughlin & Hatzenbuehler, 2009).
Support System
The support system as reported by our client is her husband. She states he is supportive and has little to no contact with the family of origin. She has a few friends and a few outside interests. As PMHNP, discussing relationships with the client is one avenue to gain insight into anxiety patterns and coping mechanisms as seen by outside support. With the client’s permissio.
1.Freeman, S. (2011). Improving cognitive treatments for delus.docxjeremylockett77
1.
Freeman, S. (2011). Improving cognitive treatments for delusions. Schizophrenia Research, 132, (2–3), 135-139. doi:10.1016/j.schres.2011.08.012
generation CBT for psychosis was successful but the strength of the treatment was weak and as the author states similar to those of clozapine (an antipsychotic used as a last resort for psychosis). Therapy is not up to date as it should be for delusions as delusion are understood quite well and therapy needs to catch up. The treatment of CBT for psychosis is similar to CBT treatment for anxiety.
Pay attention to single symptoms in psychosis
2.
Munro, Alistair (May 1992) Psychiatric Disorders Characterized by Delusions: Treatment in Relation to Specific Types. Psychiatric Annals, 22, 5, ProQuest Central pg. 232
3.
Ho-wai So, S., Roisin Peters, E., Swendsen, J., Garety, P.A., & Kapur, S. (2014) Changes in delusions in the early phase of antipsychotic treatment – An experience sampling study. Psychiatry Research 215, 568-573
Summarize including the research question addressed in the source, if applicable, and major findings.
Evaluate the usefulness of the source for your literature review, making sure to directly state why the source is informative for your specific topic
Three dimensions of delusions are always present in factor analyses and they are a conviction, distress, preoccupation, and disruption to life. More studies need to be done to learn how delusions respond to antipsychotic. Conviction has been least amenable to change shows the studies. Many studies ponder the question, “why does conviction exist?” There have been studies that show that reasoning bias including “Jumping to conclusion (JTC)” bias and by patients being inflexible contributes to the maintenance of delusions. JTC has also shown that the dimension of conviction of delusions and the severity of delusions is influenced by JTC. Delusions improve during the first few weeks of treatment and some studies show improvement in the first few hours.
It was hypothesized that delusion distress and preoccupation would reduce significantly over two weeks of antipsychotic treatment; but not a conviction. Female participants showed a higher response on all four delusion dimensions compared to the male participants. 57% of the participants showed the JTC bias. The no-JTC group showed a larger improvement in conviction and distress and with their delusions in general.
This study is important for my literature review and further studies because the three dimensions of delusions: distress, preoccupation, and conviction are important for the clinical implications of treatment. If we take into account these three dimensions it will benefit further research and treatments.
4.
The efficacy of a new translational treatment for persecutory delusions: study protocol for a randomized controlled trial (The Feeling Safe Study)
Freeman et al. (2016) Trials, 17:134. doi:10.1186/s13063-016-1245-0
Summarize including the research questi ...
Treating Insomnia in Depression Insomnia Related Factors Pred.docxturveycharlyn
Treating Insomnia in Depression: Insomnia Related Factors Predict
Long-Term Depression Trajectories
Bei Bei
Monash University and Royal Women’s Hospital, University of
Melbourne
Lauren D. Asarnow
Stanford University
Andrew Krystal
University of California, San Francisco
Jack D. Edinger
National Jewish Health, Denver, Colorado, and Duke University
Medical Center
Daniel J. Buysse
University of Pittsburgh
Rachel Manber
Stanford University
Objective: Insomnia and major depressive disorders (MDD) often co-occur, and such comorbidity has
been associated with poorer outcomes for both conditions. However, individual differences in depressive
symptom trajectories during and after treatment are poorly understood in comorbid insomnia and
depression. This study explored the heterogeneity in long-term depression change trajectories, and
examined their correlates, particularly insomnia-related characteristics. Method: Participants were 148
adults (age M � SD � 46.6 � 12.6, 73.0% female) with insomnia and MDD who received antidepressant
pharmacotherapy, and were randomized to 7-session Cognitive Behavioral Therapy for Insomnia or
control conditions over 16 weeks with 2-year follow-ups. Depression and insomnia severity were
assessed at baseline, biweekly during treatment, and every 4 months thereafter. Sleep effort and beliefs
about sleep were also assessed. Results: Growth mixture modeling revealed three trajectories: (a)
Partial-Responders (68.9%) had moderate symptom reduction during early treatment (p value � .001)
and maintained mild depression during follow-ups. (b) Initial-Responders (17.6%) had marked symptom
reduction during treatment (p values � .001) and low depression severity at posttreatment, but increased
severity over follow-up (p value � .001). (c) Optimal-Responders (13.5%) achieved most gains during
early treatment (p value � .001), continued to improve (p value � .01) and maintained minimal
depression during follow-ups. The classes did not differ significantly on baseline measures or treatment
received, but differed on insomnia-related measures after treatment began (p values � .05): Optimal-
Responders consistently endorsed the lowest insomnia severity, sleep effort, and unhelpful beliefs about
sleep. Conclusions: Three depression symptom trajectories were observed among patients with comorbid
insomnia and MDD. These trajectories were associated with insomnia-related constructs after commenc-
ing treatment. Early changes in insomnia characteristics may predict long-term depression outcomes.
What is the public health significance of this article?
This study identified three distinct depression trajectories in patients with comorbid major depression
and insomnia disorders during treatment and 2-year follow-up. Those with the largest and most
sustained improvements in depression consistently scored the lowest on postbaseline insomnia and
insomnia-related cognitions. Early changes in insomnia symptoms and insomnia-related character ...
Integrated Psychological Therapy (IPT) and Wellness Self-Management (WSM) are two multimodal workbook-based treatments for individuals with schizophrenia. IPT was developed in 1994 and focuses on remediating cognitive deficits through group exercises before building social skills. Research shows IPT improves neurocognition, symptoms, and functioning. WSM was developed in 2001 from Illness Management and Recovery and uses a personal workbook to build competencies like medication management. Over 80% of facilities using WSM continued ten months later. Both treatments aim to improve functioning through cognitive and social rehabilitation, though IPT has more extensive research support currently.
Fricchione psychosomatic medicine in mental healthjasonharlow
This document discusses the global burden of mental illness and the role that psychosomatic medicine can play in addressing it, particularly in Africa. It notes that mental disorders account for 13% of the global burden of disease and reviews strategies like integrating mental health treatment into primary care. Psychosomatic medicine is well-suited to contribute through its expertise in managing co-morbid medical and psychiatric conditions and working at the interface of different medical fields. The document argues that training consultation-liaison psychiatrists could help address Africa's lack of psychiatric resources and lack of treatment for co-occurring conditions.
1) Schizophrenia and psychosis greatly impact normal brain processes and functioning, making it difficult for clients to think clearly and function in daily life.
2) Proper diagnosis and treatment under close supervision from a mental health practitioner can help clients thrive.
3) Assessing client history and factors is important to develop personalized treatment plans, considering how medications may impact each client differently based on pharmacokinetic and pharmacodynamic processes.
The document discusses sleep disturbance in patients with chronic pain. It notes that sleep disturbance is common in this population, occurring in 50-80% of patients, and that there is a bidirectional relationship between pain and sleep, where pain can interfere with sleep and poor sleep can exacerbate pain. It reviews tools for assessing sleep disturbance and discusses non-pharmacological interventions like cognitive behavioral therapy for pain, insomnia, or a combination, as well as pharmacological options for improving sleep.
Can you provide tips or strategies for managing insomnia while seeking treatm...tharahiniindhu
we will explore
for managing insomnia treatment in Chennai. We will
delve into the strategies recommended by top to optimize sleep and improve overall well-being
Visit: https://www.chennaiminds.com/anxiety-ocd/
As her final thesis topic for London College of Osteopathy and Health Sciences (LCO) Diploma in Osteopathic Manual Practice (DOMP) program, Dr. Fadila Naji examines the effects of osteopathy on patients' psychology.
Hani hamed dessoki, side effects of psychotherapyHani Hamed
This document discusses psychotherapy and its potential negative effects. It begins with an introduction to psychotherapy and definitions. It then discusses the history of recognizing potential negative effects. Several perspectives on psychotherapy are provided, including that it generally helps people but may increase anxiety initially for some. The document outlines some potential negative effects like worsening of symptoms, acquiring new symptoms, or dependency. It emphasizes the importance of informed consent in psychotherapy and discusses challenges in defining and identifying negative effects. Overall, it presents a balanced view of psychotherapy's benefits but also stresses the need for therapists to be aware of potential risks.
Review the objectives. Conduct a self-reflection of your learMoseStaton39
Review the objectives. Conduct a self-reflection of your learning and how you personally have met each of the objectives.
400 words in length.
Objectives
1. Apply a knowledge base of community health nursing and health teaching skills to the development an educational project with a focus on illness prevention, health promotion and/or health maintenance of individuals, families and groups.
2. Demonstrate use of information technology in data gathering and analysis of a community or a specific population group.
3. Analyze a community assessment to plan a health teaching project that meets the needs of communities and populations
4. Create an educational project that can be utilized by public and community health nurses to improve the health status and eliminate health disparities of individuals, families, communities and populations.
5. Implement the planned teaching project to the selected target population.
6. Collaborate with community partners to provide education designed to improve population health.
1
Course Paper Outline
Student Name
PSY102: Fundamentals of Psychology II
Psychology Program, Post University
Instructor Name
Due Date
Author Note
Mental disorders are not covered in PSY102 and are
therefore not an appropriate topic for this assignment.
However, this outline still provides a good sample of the
attention to detail required for this assignment, as well as
APA and scholarly source requirements.
2
Course Paper Outline
A. Introduction
a. Topic sentence: GAD Generalized Anxiety Disorder (GAD) involves persistent worry
for at least 6 months, along with feelings of apprehension about day-to-day events.
This disorder also causes physiological symptoms that effects social and occupational
functioning (Arul, 2016).
b. Those with this disorder are known to be high health care utilizers because they visit
their primary care physician very often (Culpepper, 2014).
c. More than 24 million people ages 15-54 suffer from anxiety disorders, costing the
U.S billions every year (Culpepper, 2014).
d. This is a crisis for the mental health industry because in many cases, anxiety can
effect daily functioning and lead to other problems. It can cause decreased work
productivity, missed days from work, and even unemployment (Culpepper, 2014).
B. Theme 1: Causes
a. Topic sentence: There are different reasons as to why people may develop this
disorder.
b. One study was conducted of 30 participants with GAD. They were male and female
ages 15-46. They were compared to 30 individuals that did not have this condition.
Several scales were used (Arul, 2016).
c. As a result, those with GAD went through more negative life events than the other
group. Family conflict was the biggest issue, along with marital problems, trouble
with neighbors, and sexual issues (Arul, 2016). This shows that negative life events
may be a possible cause of GAD in some people.
3
d. Genetics is also a probable cause fo ...
This research article examines whether a questionnaire measure of executive function (EF) can predict treatment outcomes for anxiety and depression following cognitive behavioral therapy (CBT). 206 outpatients with major depression or an anxiety disorder completed the Revised Dysexecutive Questionnaire (DEX-R) to assess EF before undergoing group CBT. The DEX-R measures EF across factors of inhibition, volition, and social regulation. Higher DEX-R scores indicate greater executive dysfunction. Results showed that executive dysfunction predicted concurrent anxiety and depression symptoms after controlling for comorbidity. Specifically, inhibition predicted anxiety and volition predicted depression. Executive dysfunction also predicted post-treatment anxiety symptoms but not depression following CBT. The study concludes that EF deficits are associated
Previous research shows deficits in Executive Function (EF) in patients with anxiety and depression. Recent studies have shown that EF measured by neuro-imaging and neuropsychological tests predicts treatment outcomes for depression, but it is unclear whether they predict outcomes for anxiety. Neuro-imaging and neuropsychological tests are effective but intensive procedures that may not always be accessible to clinicians. Previous research has explored the viability of questionnaire measures of EF. A previous study suggests that the Revised Dysexecutive Questionnaire (DEX-R) predicts concurrent depression and anxiety; however, it is unclear how comorbidity influenced these results.
Previous research shows deficits in Executive Function (EF) in patients with anxiety and depression. Recent studies have shown that EF measured by neuro-imaging and neuropsychological tests predicts treatment outcomes for depression, but it is unclear whether they predict outcomes for anxiety. Neuro-imaging and neuropsychological tests are effective but intensive procedures that may not always be accessible to clinicians.
This document summarizes a meta-analysis of cognitive-behavioral therapy (CBT) for symptoms of schizophrenia. The meta-analysis included 34 studies examining overall symptoms, 33 examining positive symptoms, and 34 examining negative symptoms. It found small effect sizes favoring CBT across symptoms. However, effect sizes were larger in studies that masked outcome assessments, indicating masking reduced bias. The analysis also examined potential biases from randomization, incomplete data, and type of control group, but found little effect of these factors on results. While meta-analyses have found CBT effective for schizophrenia, biases like lack of masking in some studies may inflate apparent benefits.
This document summarizes the theoretical framework, instruments, and design of a study evaluating the effectiveness and cost-effectiveness of long-term psychoanalytic treatment. The study uses a multiple cohort design to follow patients in four cohorts representing different phases of treatment: before treatment, one year into treatment, at the end of treatment, and two years post-treatment. Outcome measures assess symptomatic functioning and structural change, using both theory-based and a-theoretical instruments. The study aims to expand the evidence base for psychoanalytic treatment given difficulties with randomized controlled trials for long-term interventions.
Case # 29- The depressed man who thought he was out of options. .docxannandleola
Case # 29- The depressed man who thought he was out of options.
Depression has become a common mental disorder in our elderly population. This has caused a global concern for occur, geriatric patients, as depression often results in a significant burden for families as well as communities. Elderly people who suffer from depression may have an inferior baseline and record for medical assessments than those individuals without depression. Despite consistent evidence of the effectiveness of antidepressants for many with depression,
3
particularly those with more severe depression, remission rates are disappointingly low. An AHRQ-sponsored report found that only 46% of patients experienced remission from depression during 6 to 12 weeks of treatment with second-generation antidepressants. One major reason for this issue is non-adherence to medications and treatment plans. Studies have shown that patients' age, race and ethnicity are consistently associated with predictions of outcomes. (Rossom et al., 2016).
This case study involves a 69-year old man whose chief complaint is unremitting, chronic depression. After several years of medications and treatments, he feels hopeless for a recovery from his chronic depression. This assignments seeks to explore his family and social support systems, diagnostic testing, differential diagnosis and pharmacologic treatment options for this patient.
Questions for the client
How have you been sleeping lately?
How many times in the last week have you had feelings of hopelessness?
Are you having thoughts of harming yourself? Do you have a plan?
These questions are an important yet simple place to start when treating patients. Sleep disturbances plague much of the world's population and have shown to be a major indicator for mental health issues. Changes in sleep neurophysiology are often observed in depressive patients, and impaired sleep is, in many cases, the chief complaint of depression (Armitage, 2007). Depressed patients with sleep disturbance are likely to present more severe symptoms and difficulties in treatment. In addition, persistent insomnia is the most common residual symptom in depressed patients and is considered a vital predictor of depression relapse and may contribute to unpleasant clinical outcomes (Hinkelmann et al., 20120. Questions involving feelings of hopelessness and suicidal ideations with or without a plan relate to issues of patient safety. Across psychiatric disorders, hopelessness is associated with suicidal ideation and behavior. A meta-analysis of 166 longitudinal studies (sample size not reported) found that hopelessness was associated with an increased risk of ideation (Ribeiro, Huang, Fox, & Franklin, 2018).
Family and social support system
Family and social support systems are imperative for any patient in recovery. If the patient is agreeable to discussions with family members, then a discussion with his wife would be helpful. Researc.
Cognitive behavioral therapy is identified as the most effective intervention for preventing postpartum depression based on evidence from multiple studies. CBT has been shown to significantly reduce depressive symptoms and decrease the risk of depressive episodes occurring through randomized controlled trials and meta-analyses. While CBT can be delivered in various ways, individual therapy in the postpartum period tends to be most effective. Further research is still needed to explore additional prevention interventions for reducing the burden of postpartum depression.
The document discusses alternative treatment methods for insomnia, specifically cognitive behavioral therapy (CBT). It reviews studies that show CBT alone or combined with medication is more effective than medication alone for treating insomnia. The document proposes a relaxation group program using progressive muscle relaxation as an alternative or addition to medication. It outlines steps to implement the program and evaluate its effectiveness.
This document describes a case study of a 31-year-old male patient presenting with insomnia. The patient reports his insomnia has worsened over the past 6 months following the loss of his fiancé. He has difficulty falling and staying asleep. The patient works as a forklift operator and his insomnia is affecting his job performance. He has a history of opiate abuse but has not had a prescription in 4 years. Recently, he has been using alcohol to help fall asleep. The patient is presented with three decision points to choose a medication to treat his insomnia.
A CROSS-SECTIONAL STUDY ANALYSING THE LEVEL OF DEPRESSION AND ITS CAUSATIVE F...amsjournal
Depression is a pathological state of the mind characterised lack of self-confidence and self-esteem. The
cause of depression is multi factorial and various physical, psychological, environmental and genetic
factors have been implicated in the causation of depression. Despite being a serious condition in all age
groups, depression is more common and significant in the geriatric population as it is associated with
significant morbidity and mortality. Various scales have been developed to assess depression of which the
Geriatric Depression Scale is most suited for elderly population. It has a long form and short form, the
latter being more appropriate for elderly patients with dementia. In our study, we aim to analyse the
prevalence of depression among elderly patients visiting the outpatient departments of a tertiary care
hospital and determine the factors influencing depression in them. The study was an Observational cross sectional
study carried out on 51 elderly patients over the age of 60 years attending the various outpatient
departments of PSG Hospital. The Geriatric Depression Scale Short form was used to determine the
prevalence of depression. A self-designed questionnaire considering various factors causing depression
was administered to determine the factors influencing depression. It was found that among 51 elders in the
age group of 60 to 80 years, 58.8% were depressed of which 54% were males and 68% were females.
Financial fears regarding future and income insufficiency were the most important factors contributing to
depression. This shows that monetary fear is a major factor resulting in depression. The most effective
strategy to combat depression is to ensure appropriate self-report. The government and other organizations
must ensure that better support, both financial and other services like healthcare are provided to the
elderly in order to prevent depressive illnesses.
The document discusses depression, somatization disorders, and their treatment. For somatization disorder, cognitive behavioral therapy and tricyclic antidepressants can be effective treatments. Symptoms can be evaluated before and during treatment using the PHQ-15 questionnaire. Depression is associated with changes in neurotransmitters like serotonin and treatments include SSRIs, psychotherapy, and evaluating response using scales like the HAM-D. Reducing stigma around depression involves education about mental health and advocating for greater rights. For adolescent depression, CBT and SSRIs are commonly used treatments, with education about potential increased suicide risks from antidepressants.
Milestones Navigating Late Childhood to AdolescenceFrom the m.docxjessiehampson
Milestones: Navigating Late Childhood to Adolescence
From the movie, Lila, Eight to Thirteen in this week's materials, identify 2–3 developmental milestones Lila reaches, and assess whether or not you think she successfully navigates her way through them as she prepares for adolescence. Support your assertions with evidence from your text and this week's materials.
.
Migration and RefugeesMany immigrants in the region flee persecu.docxjessiehampson
Migration and Refugees
Many immigrants in the region flee persecution and then return after they are liberated. For example, 700,000 Jews were allowed to leave the former Soviet Union and enter Israel in the 1990s. There has also been a migration of Palestinian people. Discuss the following:
Why do you think that Israel is such an important place for the Jews?
What is the importance of the area to the Palestinians?
What do you think the impact would be on you and your families if you participated in such long-distance migration?
No references needed, need response within 3 hours!
.
More Related Content
Similar to Week 4 Assignment - Strategic Plan, Part 3 Strategic Evaluation.docx
Integrated Psychological Therapy (IPT) and Wellness Self-Management (WSM) are two multimodal workbook-based treatments for individuals with schizophrenia. IPT was developed in 1994 and focuses on remediating cognitive deficits through group exercises before building social skills. Research shows IPT improves neurocognition, symptoms, and functioning. WSM was developed in 2001 from Illness Management and Recovery and uses a personal workbook to build competencies like medication management. Over 80% of facilities using WSM continued ten months later. Both treatments aim to improve functioning through cognitive and social rehabilitation, though IPT has more extensive research support currently.
Fricchione psychosomatic medicine in mental healthjasonharlow
This document discusses the global burden of mental illness and the role that psychosomatic medicine can play in addressing it, particularly in Africa. It notes that mental disorders account for 13% of the global burden of disease and reviews strategies like integrating mental health treatment into primary care. Psychosomatic medicine is well-suited to contribute through its expertise in managing co-morbid medical and psychiatric conditions and working at the interface of different medical fields. The document argues that training consultation-liaison psychiatrists could help address Africa's lack of psychiatric resources and lack of treatment for co-occurring conditions.
1) Schizophrenia and psychosis greatly impact normal brain processes and functioning, making it difficult for clients to think clearly and function in daily life.
2) Proper diagnosis and treatment under close supervision from a mental health practitioner can help clients thrive.
3) Assessing client history and factors is important to develop personalized treatment plans, considering how medications may impact each client differently based on pharmacokinetic and pharmacodynamic processes.
The document discusses sleep disturbance in patients with chronic pain. It notes that sleep disturbance is common in this population, occurring in 50-80% of patients, and that there is a bidirectional relationship between pain and sleep, where pain can interfere with sleep and poor sleep can exacerbate pain. It reviews tools for assessing sleep disturbance and discusses non-pharmacological interventions like cognitive behavioral therapy for pain, insomnia, or a combination, as well as pharmacological options for improving sleep.
Can you provide tips or strategies for managing insomnia while seeking treatm...tharahiniindhu
we will explore
for managing insomnia treatment in Chennai. We will
delve into the strategies recommended by top to optimize sleep and improve overall well-being
Visit: https://www.chennaiminds.com/anxiety-ocd/
As her final thesis topic for London College of Osteopathy and Health Sciences (LCO) Diploma in Osteopathic Manual Practice (DOMP) program, Dr. Fadila Naji examines the effects of osteopathy on patients' psychology.
Hani hamed dessoki, side effects of psychotherapyHani Hamed
This document discusses psychotherapy and its potential negative effects. It begins with an introduction to psychotherapy and definitions. It then discusses the history of recognizing potential negative effects. Several perspectives on psychotherapy are provided, including that it generally helps people but may increase anxiety initially for some. The document outlines some potential negative effects like worsening of symptoms, acquiring new symptoms, or dependency. It emphasizes the importance of informed consent in psychotherapy and discusses challenges in defining and identifying negative effects. Overall, it presents a balanced view of psychotherapy's benefits but also stresses the need for therapists to be aware of potential risks.
Review the objectives. Conduct a self-reflection of your learMoseStaton39
Review the objectives. Conduct a self-reflection of your learning and how you personally have met each of the objectives.
400 words in length.
Objectives
1. Apply a knowledge base of community health nursing and health teaching skills to the development an educational project with a focus on illness prevention, health promotion and/or health maintenance of individuals, families and groups.
2. Demonstrate use of information technology in data gathering and analysis of a community or a specific population group.
3. Analyze a community assessment to plan a health teaching project that meets the needs of communities and populations
4. Create an educational project that can be utilized by public and community health nurses to improve the health status and eliminate health disparities of individuals, families, communities and populations.
5. Implement the planned teaching project to the selected target population.
6. Collaborate with community partners to provide education designed to improve population health.
1
Course Paper Outline
Student Name
PSY102: Fundamentals of Psychology II
Psychology Program, Post University
Instructor Name
Due Date
Author Note
Mental disorders are not covered in PSY102 and are
therefore not an appropriate topic for this assignment.
However, this outline still provides a good sample of the
attention to detail required for this assignment, as well as
APA and scholarly source requirements.
2
Course Paper Outline
A. Introduction
a. Topic sentence: GAD Generalized Anxiety Disorder (GAD) involves persistent worry
for at least 6 months, along with feelings of apprehension about day-to-day events.
This disorder also causes physiological symptoms that effects social and occupational
functioning (Arul, 2016).
b. Those with this disorder are known to be high health care utilizers because they visit
their primary care physician very often (Culpepper, 2014).
c. More than 24 million people ages 15-54 suffer from anxiety disorders, costing the
U.S billions every year (Culpepper, 2014).
d. This is a crisis for the mental health industry because in many cases, anxiety can
effect daily functioning and lead to other problems. It can cause decreased work
productivity, missed days from work, and even unemployment (Culpepper, 2014).
B. Theme 1: Causes
a. Topic sentence: There are different reasons as to why people may develop this
disorder.
b. One study was conducted of 30 participants with GAD. They were male and female
ages 15-46. They were compared to 30 individuals that did not have this condition.
Several scales were used (Arul, 2016).
c. As a result, those with GAD went through more negative life events than the other
group. Family conflict was the biggest issue, along with marital problems, trouble
with neighbors, and sexual issues (Arul, 2016). This shows that negative life events
may be a possible cause of GAD in some people.
3
d. Genetics is also a probable cause fo ...
This research article examines whether a questionnaire measure of executive function (EF) can predict treatment outcomes for anxiety and depression following cognitive behavioral therapy (CBT). 206 outpatients with major depression or an anxiety disorder completed the Revised Dysexecutive Questionnaire (DEX-R) to assess EF before undergoing group CBT. The DEX-R measures EF across factors of inhibition, volition, and social regulation. Higher DEX-R scores indicate greater executive dysfunction. Results showed that executive dysfunction predicted concurrent anxiety and depression symptoms after controlling for comorbidity. Specifically, inhibition predicted anxiety and volition predicted depression. Executive dysfunction also predicted post-treatment anxiety symptoms but not depression following CBT. The study concludes that EF deficits are associated
Previous research shows deficits in Executive Function (EF) in patients with anxiety and depression. Recent studies have shown that EF measured by neuro-imaging and neuropsychological tests predicts treatment outcomes for depression, but it is unclear whether they predict outcomes for anxiety. Neuro-imaging and neuropsychological tests are effective but intensive procedures that may not always be accessible to clinicians. Previous research has explored the viability of questionnaire measures of EF. A previous study suggests that the Revised Dysexecutive Questionnaire (DEX-R) predicts concurrent depression and anxiety; however, it is unclear how comorbidity influenced these results.
Previous research shows deficits in Executive Function (EF) in patients with anxiety and depression. Recent studies have shown that EF measured by neuro-imaging and neuropsychological tests predicts treatment outcomes for depression, but it is unclear whether they predict outcomes for anxiety. Neuro-imaging and neuropsychological tests are effective but intensive procedures that may not always be accessible to clinicians.
This document summarizes a meta-analysis of cognitive-behavioral therapy (CBT) for symptoms of schizophrenia. The meta-analysis included 34 studies examining overall symptoms, 33 examining positive symptoms, and 34 examining negative symptoms. It found small effect sizes favoring CBT across symptoms. However, effect sizes were larger in studies that masked outcome assessments, indicating masking reduced bias. The analysis also examined potential biases from randomization, incomplete data, and type of control group, but found little effect of these factors on results. While meta-analyses have found CBT effective for schizophrenia, biases like lack of masking in some studies may inflate apparent benefits.
This document summarizes the theoretical framework, instruments, and design of a study evaluating the effectiveness and cost-effectiveness of long-term psychoanalytic treatment. The study uses a multiple cohort design to follow patients in four cohorts representing different phases of treatment: before treatment, one year into treatment, at the end of treatment, and two years post-treatment. Outcome measures assess symptomatic functioning and structural change, using both theory-based and a-theoretical instruments. The study aims to expand the evidence base for psychoanalytic treatment given difficulties with randomized controlled trials for long-term interventions.
Case # 29- The depressed man who thought he was out of options. .docxannandleola
Case # 29- The depressed man who thought he was out of options.
Depression has become a common mental disorder in our elderly population. This has caused a global concern for occur, geriatric patients, as depression often results in a significant burden for families as well as communities. Elderly people who suffer from depression may have an inferior baseline and record for medical assessments than those individuals without depression. Despite consistent evidence of the effectiveness of antidepressants for many with depression,
3
particularly those with more severe depression, remission rates are disappointingly low. An AHRQ-sponsored report found that only 46% of patients experienced remission from depression during 6 to 12 weeks of treatment with second-generation antidepressants. One major reason for this issue is non-adherence to medications and treatment plans. Studies have shown that patients' age, race and ethnicity are consistently associated with predictions of outcomes. (Rossom et al., 2016).
This case study involves a 69-year old man whose chief complaint is unremitting, chronic depression. After several years of medications and treatments, he feels hopeless for a recovery from his chronic depression. This assignments seeks to explore his family and social support systems, diagnostic testing, differential diagnosis and pharmacologic treatment options for this patient.
Questions for the client
How have you been sleeping lately?
How many times in the last week have you had feelings of hopelessness?
Are you having thoughts of harming yourself? Do you have a plan?
These questions are an important yet simple place to start when treating patients. Sleep disturbances plague much of the world's population and have shown to be a major indicator for mental health issues. Changes in sleep neurophysiology are often observed in depressive patients, and impaired sleep is, in many cases, the chief complaint of depression (Armitage, 2007). Depressed patients with sleep disturbance are likely to present more severe symptoms and difficulties in treatment. In addition, persistent insomnia is the most common residual symptom in depressed patients and is considered a vital predictor of depression relapse and may contribute to unpleasant clinical outcomes (Hinkelmann et al., 20120. Questions involving feelings of hopelessness and suicidal ideations with or without a plan relate to issues of patient safety. Across psychiatric disorders, hopelessness is associated with suicidal ideation and behavior. A meta-analysis of 166 longitudinal studies (sample size not reported) found that hopelessness was associated with an increased risk of ideation (Ribeiro, Huang, Fox, & Franklin, 2018).
Family and social support system
Family and social support systems are imperative for any patient in recovery. If the patient is agreeable to discussions with family members, then a discussion with his wife would be helpful. Researc.
Cognitive behavioral therapy is identified as the most effective intervention for preventing postpartum depression based on evidence from multiple studies. CBT has been shown to significantly reduce depressive symptoms and decrease the risk of depressive episodes occurring through randomized controlled trials and meta-analyses. While CBT can be delivered in various ways, individual therapy in the postpartum period tends to be most effective. Further research is still needed to explore additional prevention interventions for reducing the burden of postpartum depression.
The document discusses alternative treatment methods for insomnia, specifically cognitive behavioral therapy (CBT). It reviews studies that show CBT alone or combined with medication is more effective than medication alone for treating insomnia. The document proposes a relaxation group program using progressive muscle relaxation as an alternative or addition to medication. It outlines steps to implement the program and evaluate its effectiveness.
This document describes a case study of a 31-year-old male patient presenting with insomnia. The patient reports his insomnia has worsened over the past 6 months following the loss of his fiancé. He has difficulty falling and staying asleep. The patient works as a forklift operator and his insomnia is affecting his job performance. He has a history of opiate abuse but has not had a prescription in 4 years. Recently, he has been using alcohol to help fall asleep. The patient is presented with three decision points to choose a medication to treat his insomnia.
A CROSS-SECTIONAL STUDY ANALYSING THE LEVEL OF DEPRESSION AND ITS CAUSATIVE F...amsjournal
Depression is a pathological state of the mind characterised lack of self-confidence and self-esteem. The
cause of depression is multi factorial and various physical, psychological, environmental and genetic
factors have been implicated in the causation of depression. Despite being a serious condition in all age
groups, depression is more common and significant in the geriatric population as it is associated with
significant morbidity and mortality. Various scales have been developed to assess depression of which the
Geriatric Depression Scale is most suited for elderly population. It has a long form and short form, the
latter being more appropriate for elderly patients with dementia. In our study, we aim to analyse the
prevalence of depression among elderly patients visiting the outpatient departments of a tertiary care
hospital and determine the factors influencing depression in them. The study was an Observational cross sectional
study carried out on 51 elderly patients over the age of 60 years attending the various outpatient
departments of PSG Hospital. The Geriatric Depression Scale Short form was used to determine the
prevalence of depression. A self-designed questionnaire considering various factors causing depression
was administered to determine the factors influencing depression. It was found that among 51 elders in the
age group of 60 to 80 years, 58.8% were depressed of which 54% were males and 68% were females.
Financial fears regarding future and income insufficiency were the most important factors contributing to
depression. This shows that monetary fear is a major factor resulting in depression. The most effective
strategy to combat depression is to ensure appropriate self-report. The government and other organizations
must ensure that better support, both financial and other services like healthcare are provided to the
elderly in order to prevent depressive illnesses.
The document discusses depression, somatization disorders, and their treatment. For somatization disorder, cognitive behavioral therapy and tricyclic antidepressants can be effective treatments. Symptoms can be evaluated before and during treatment using the PHQ-15 questionnaire. Depression is associated with changes in neurotransmitters like serotonin and treatments include SSRIs, psychotherapy, and evaluating response using scales like the HAM-D. Reducing stigma around depression involves education about mental health and advocating for greater rights. For adolescent depression, CBT and SSRIs are commonly used treatments, with education about potential increased suicide risks from antidepressants.
Similar to Week 4 Assignment - Strategic Plan, Part 3 Strategic Evaluation.docx (20)
Milestones Navigating Late Childhood to AdolescenceFrom the m.docxjessiehampson
Milestones: Navigating Late Childhood to Adolescence
From the movie, Lila, Eight to Thirteen in this week's materials, identify 2–3 developmental milestones Lila reaches, and assess whether or not you think she successfully navigates her way through them as she prepares for adolescence. Support your assertions with evidence from your text and this week's materials.
.
Migration and RefugeesMany immigrants in the region flee persecu.docxjessiehampson
Migration and Refugees
Many immigrants in the region flee persecution and then return after they are liberated. For example, 700,000 Jews were allowed to leave the former Soviet Union and enter Israel in the 1990s. There has also been a migration of Palestinian people. Discuss the following:
Why do you think that Israel is such an important place for the Jews?
What is the importance of the area to the Palestinians?
What do you think the impact would be on you and your families if you participated in such long-distance migration?
No references needed, need response within 3 hours!
.
Min-2 pagesThe goal is to develop a professional document, take .docxjessiehampson
Min-2 pages
The goal is to develop a professional document, take a stake in your company (its a t-shirt and apparel company; see attached) as a business owner, and develop a business plan with the aim of securing financing to expand one’s business for an established firm.
Complete the following: (using the business plan working document)
10.0 Financials Plan
*Annotated plan has additional details if you have questions or need explanation
.
Mingzhi Hu
First Paper
3/5/2020
POLS 203
Application of Realism Theory on Civil war in Syria and International Relations
International relation can be best understood through the various schools of thought or
rather theories. They are significant in giving a comprehensive detail of the constructs that make
international relations. Realism theory still remains one of the most influential tools in
understanding events related to international relations. This is because it provides a pragmatic
approach in examining current events in the sphere of international relations (Maghroori, pg. 17).
Realism is divided into three subdivisions, seeking to explain causes of state conflict. This
include classical realism that argues that the conflict comes from the nature of man, neorealist
which associates conflict the elements of the state, and neoclassical realism which associates it to
both human nature and elements of the state. This school of thought is grounded on some
fundamental principles that make the core of its arguments.
The first assumption in realism is the idea that a country, usually referred to as a state,
serves as the main actor in international relations. It acknowledges the fact that there are other
actors like individuals and organizations, which have limited influence (Maghroori 11).
Secondly, the state is considered a unitary player, which is expected to work harmoniously, with
regard to matters of national interest. In addition, realists believe that the people who make
decisions are rational players, since this rationality is required in pursuing the interest of the
nation. In essence, the leaders are believed to understand these assumptions regardless of their
Laci Hubbard-Mattix
90000004849605
But selfish
Laci Hubbard-Mattix
90000004849605
Laci Hubbard-Mattix
90000004849605
What do you mean by "work harmoniously"
Laci Hubbard-Mattix
90000004849605
It is not clear what this sentence means.
political position, so ensure their sustainability and continuity. Consequently, it is assumed that
states exist in an anarchy context, where there is no single international leader. In this
theorization, the role of nature in influencing human action is not ignored. It asserts that nature
influence people to continue acting in repetitive tendencies. In this assumption, it comes out that
people desire power because of the egoistic nature. The innate selfishness of human beings,
mistrust and their thirst for power explains the unpredicted consequences that can result from
their actions (Maghroori 20). Such human tendencies can explain the unending wars among
nations. Bearing the fact that nations are governed by human beings, their nature contributes
largely to their behavioral tendencies, which in turn influence its security.
Realist therefore assume that leaders have the responsibility to promote the security of
their country in all fronts. This can be realized through consta.
Miller, 1 Sarah Miller Professor Kristen Johnson C.docxjessiehampson
Miller, 1
Sarah Miller
Professor Kristen Johnson
CHID 230
2 April 2019
The Myth of Disability as Isolating in Tim Burton’s Edward Scissorhands
Jay Timothy Dolmage discusses the common disability myths that condition our
understanding of disability in his work Disability Rhetoric. He argues that these myths create the
perception that disabled people are “others”, through the portrayal of them as lesser, surplus, or
improper (Dolmage, 31). One of the myths that Dolmage examines is disability as isolating or
individualizing, which is perpetrated through narratives of disabled people living in isolation,
rarely having romantic relationships or friendships, and often being left alone at the end
(Dolmage, 43). This myth can be seen in the film Edward Scissorhands, directed by Tim Burton.
Edward is a human being created by an inventor, yet the inventor’s death before his completion
leaves him with scissor blades for hands. Edward lives in a gothic mansion atop a hill,
completely in isolation until local Avon saleswoman Peg Boggs visits. She is initially frightened
by his appearance, yet decides to take him home with her upon the realization that he is
harmless. Edward’s disability causes his transition into society to be largely unsuccessful, as he
is objectified and used by other people for their benefit, and at the end of the film he is forced to
return to living in isolation after their perception of him turns to one of fear and scorn.
Edward’s isolation from society is symbolically portrayed through many film design
techniques. The mansion in which he lives at the beginning and the end of the film starkly
contrasts the community in which the able-bodied society lives. The mansion is gothic, dark, and
partially in ruins, whereas the rest of the houses are brightly colored in pinks, yellows, and
Miller, 2
greens, all with perfectly manicured green lawns. His appearance also separates him from the
rest of society, as he has very pale skin, dark under-eyes, black untamed hair, and wears gothic
industrial clothes. The able-bodied individuals often wear colorful or light clothes and appear
quite “ordinary”. The contrast created between Edward and society through set, clothing,
makeup, and hair design work to portray Edward and his disability as unusual, creepy, and
“other”. Peg even attempts to “normalize” his appearance by giving him different clothes to wear
and attempting to cover his scars with makeup, in the hopes that it will ease his transition into the
community. This film phenomenon is discussed by Martin F. Norden in his book The Cinema of
Isolation: A History of Physical Disabilities in the Movies. He argues that filmmakers will
separate disabled characters from their able-bodied peers not only through the storyline, but also
through a number of design elements. He also states that this technique allows filmmakers to
reflect an able-bodied point of view and reduce d.
Migrating to the Cloud Please respond to the following1. .docxjessiehampson
"Migrating to the Cloud" Please respond to the following:
1. Imagine that you are a CIO and you have been tasked to examine the process of moving from one host server or storage location to another. Predict two foreseen challenges of migrating an application to the cloud in a live migration and high- availability setting. Propose a preventative measure or a solution for each of these challenges.
2. Imagine that you are the CIO for a midsized organization in this industry. Determine, in 10 or less steps, the timeline for a live migration to the cloud in your organization. Determine the three greatest risks in this deployment.
.
Mike, Ana, Tiffany, Josh and Annie are heading to the store to get.docxjessiehampson
Mike, Ana, Tiffany, Josh and Annie are heading to the store to get some snacks. Mike has $1, Ana has $2, Tiffany has $3, Josh has $4, and Annie has $5.
What's the average (mean) amount of cash the five kids have? What's the median? A few days later, Annie's family won the lottery, and the kids go together to the store to get some snacks again. This time Mike has $1, Ana has $2, Tiffany has $3, Josh has $4, and Annie has wad of cash totaling $5,000.
What's the average (mean) amount of cash the five kids have this time? What's the median?
From part a, how have the mean and the median changed?
Which one - the mean or the median - is a better reflection of how much money they have together? Take you time before answering.
.
Michelle Wrote; There are several different reasons why an inter.docxjessiehampson
Michelle Wrote;
There are several different reasons why an intervention fails, such as the wrong intervention being selected or trying to solve the wrong problem. It is important that when performing and intervention that every thing have been severely observed and taken into consideration. I worked with an organization that was a travel agency, and they operated off of the commission that was collected from the booking that are processed, but they also provided a discount to the members that was taken out of the commission total. The issue was that when they initially opened the department there was no budget plan done and no guidelines were given, the agents were told to use discretion, and all though the department was a huge success in booking reservations they were still failing, because they were not withholding enough commission for the organization to operate under. Where the intervention process failed is that they never had formal training, which would have been a focus group to define the exact percentage to give to customer and the amount the organization needed to cover their overhead. During the meeting process there should have been definite guidelines to lead employees and managers from the accounting department so that the employees did not need to play the guessing game. Although they had the meeting nothing changed, because the problem was not solved with the employees and managers and was not addressed by the accounting department. The business is now in danger of folding because of the poor communication practices.
William Wrote:
Although what I am going to talk about is not my workplace but the place that I volunteer my time to sit on the board of directors for a non profit agency. As a board member we oversee the agency as a whole but we also break down into small committee groups to address needs as they arise. One of the committees that I am on is the planning committee. A change that was implemented by administration, program staff, and the board was all departments would start entering all their own data. At the time the agency had two data entry personal that was entering all agency data. So the change we made was that instead of hiring another data entry person we would require all programs to enter their own data into the collection software. This ended up being a failure that could have been huge had we not pulled reports the first two quarters of the year. What we found was some programs were right on target with getting their information entered with the first quarter. The Executive Director addressed this with staff. When the second quarter reports were pulled the data did not get any better. As an agency this failed due to program staff just did not have the appropriate time to take on more data entry. The agency ended up where we should have to start off, hiring another data entry staff member. I will say with this failure it actually turned into a very positive experience over all.
.
Midterm Lad Report 7
Midterm Lab Report
Introduction
Cellular respiration refers to all the metabolic processes and chemical reactions that take place in living organisms, particularly at the cellular level. These processes focus on the extraction of energy from nutrients. It is also responsible for converting the biochemical energy into 'adenosine triphosphate' (ATP) by the breakdown of sugars in the cells (Bennet 58). Cellular respiration is also responsible for the process by which cells release chemical energy required for conducting cellular activities. The reactions and processes facilitate the release of waste products from the cells. This experiment seeks to conduct a study of the processes and reactions involved during cellular respiration. The experiment will include several activities, such as having a study on the amount of Carbon dioxide produced during the experiment.
The number of levels of the growth of a yeast medium as a dependent variable will also be monitored during the experiment. There are other several independent variables associated with the experiment. These independent variables include sugar and temperature, among others, and their role in the experiment were also monitored. The experiment design involved the use of airtight balloons capped over reaction chambers that were used to collect the Carbon dioxide produced during the experiment. The reaction chambers contained sugars and yeast medium, which facilitated the reactions. Thermometers and pH scale were used to monitor the changes in temperature and acidity levels during the experiment. The paper involves a lab design that institute steps such as arranging the bottles used on the experiment. Notably, a proper arrangement to make sure that all the carbon dioxide released during the respiration process is well tapped in the bottles for correct lab results
Methodology
The actual procedure for experimenting involved taking measurements and recording of all observations made during the experiment. For accurate results, measures were taken three times, and a mean measurement was calculated and recorded. Winzler asserts that the mean obtained from the measurements should be used to calculate the standard deviation, which in turn facilitated the calculation of uncertainty (276). Below are the steps for conducting the experiment. It is essential to read the instructions carefully safety and accuracy during the experiment. Notably, all the lab and experiment results were well observed and thus making sure that there are limited errors in the whole process.
Consequently, all the steps required in the lab report were also clearly followed to help in getting the correct data and even not to affect the whole experiment process. The experiment involved setting the apparatus as per the set standard and the requirement. As per this concept, all the apparatus were set in a proper way to avoid vague results. Notably, to get the correct measurement and results, it is import.
MicroEssay Identify a behavioral tendency that you believe.docxjessiehampson
MicroEssay
Identify a behavioral tendency that you believe you have inherited (one that is determined, at least in part, by your genetic make-up). Explain the ways you think this trait has been affected by your environment by applying the different types of gene x environment correlations to your example (passive, evocative, and active)? What does this suggest about the nature-nurture debate?
.
MILNETVisionMILNETs vision is to leverage the diverse mili.docxjessiehampson
MILNET
Vision
MILNETs vision is to leverage the diverse military experience of Crawford employees to create awareness opportunities that help forester an appreciation, understand, and respect for the military culture and members we serve
Benefits
· Know our Members
· Support recruiting and retention
· Facilitate transition from military to Crawford
· Centralized source to connect with peer veterans
· Provide Member Experience, Marketing, and other Crawford initiatives and expert knowledge base.
MILNET Leadership Team (Volunteer position)
· Event & Volunteer Lead- Plan and execute mandatory enterprise events
· Technology Lead- Maintain MILNET budget throughout the year and reports overview or expenses monthly
· MILNET Spouse Lead- Ensures connect of sites are up to date/accurate, to include Veteran/Military Spouse Registration
· Secretary-Manages relationships by identifying opportunism for partnership
· Communications/Marketing Lead- Communicates to the MILNET community regularly via multiple channels (Email, Internal Social) regarding upcoming events, announcement, and other communications.
Background
Grandfather Air force
Parents- Army
Myself- Army
Spouse Army
Skills
Knowledgeable
Passionate
Qualified
Education
-Associates Accounting
-Bachelor’s in business and HR
-MRA w/ HR concentration
1 – Paragraph for each question (Professional answers)
Question 1- What is your visions of MILNET?
Question 2-How would your selection impact the Leadership Team?
.
midtermAnswer all question with proper number atleast 1 and half.docxjessiehampson
midterm
Answer all question with proper number atleast 1 and half page
APA FORMAT SIZE 12
1. Why is culture important to political scientists?
2. How is political science an interdisciplinary major?
3. How can politics be treated as a science?
4. Describe how modern liberalism differs from classical liberalism and explain how modern conservatism related to classical liberalism?
5. Explain how nationalism can be dangerous to a nation. Use both theoretical ideas and concrete examples to support your claims
6.
Evaluate the "end of ideology" argument by considering the facts that fit and contradict this view on today's world
7. What are the means by which power is institutionalized? What makes for good institutions? Provide examples from the United States and one other country
8. Identify the purposes of constitutions and explain why they are necessary
9. Describe how the principle of separation of powers is manifested in the U.S. Constitution and explain how this principle has evolved over time in the United States.
10. Bonus Question: What are the 10 Bill of Rights
.
Midterm QuestionIs the movement towards human security a true .docxjessiehampson
Midterm Question
Is the movement towards human security a true paradigm shift? In answering this question make sure to consider which of the authors whom you have read in Weeks one to four of the course support your view and which do not. *The sole use of attached readings is required for the midterm*
Midterm Assignment – Instructions (Read Carefully)
In university courses, assignments (or assessments) are meant to give students the opportunity to demonstrate what they have been learning in the course – and give instructors evidence that such learning is occurring within the classroom. Because of these objectives, it is imperative to incorporate the specifics of what you’ve been studying in the course into your writing assignments. You accomplish this by answering the Midterm question in the assessment via the course objectives and readings from the course. The midterm will cover the following objectives:
1. Describe the role of rapid globalization in changing perceptions of security
2. Identify key threats to human security (food security, personal security, environmental security)
3. Apply the concepts of human security
4. Compare and contrast traditional international relations approaches to security with the doctrine of human security.
Additional Instructions
To answer the Midterm question you will write an analytical essay. The analytical essay is a practical approach to solving a problem. So think of this essay question as you would an assignment from your boss: “I need you to take a look at this problem and solve it for me using things from your IR toolkit (what you have learned, or know). Present a well-written, concise answer to me in four pages. I need it by tomorrow morning.” This is how it happens in the real world, and this is what we want to prepare you to do. To achieve this structure of the essay please keep the following tips in mind:
1. Remember that the analytical essay is highly-structured. Each paragraph should look like the others in terms of style and substance. Writing to the limit of four pages is an art and something you need to learn to do. So, don’t write fewer than four pages and don’t write more. You may need to write over just a little and then edit away the extra parts of the essay to reach the concise four pages.
2. Review your submission and make sure that you have covered the requirements of the assignment using only material from the lessons and readings.
Format for the Essay:
1. Do not use a cover page. Instead, create a header with your name, assignment name, and date. To do this in Word, go to “insert” and then “header.” Do the same thing to insert a ‘footer’ and include page numbers. If you need help, use the ‘help’ function to learn more within Word.
2. Your submission should be four pages (no more, no less) and look like this:
a. Introduction: Introduce your topic & include a thesis. To help you set up your analytical essay include three reasons why you agree or disagree with the midterm quest.
MGT/526 v1
Wk 2 – Apply: Organizational Analysis
MGT/526 v1
Page 2 of 2
Wk 2 – Apply: Organizational AnalysisInstructions
Complete the worksheet based on your chosen organization. Use Business Source Complete and your selected company’s website, annual report, and other available sources. Part 1: Organization Information
Organization
Define your chosen company and its industry.
Mission and Vision
Identify the mission and vision of the organization.
Mission
Vision
Organizational Initiatives
Outline 1-2 major initiative for this organization. What are they currently doing to support these initiatives?
Organizational Plans
Describe the plans employed by the organization. Determine which types of managers create each type of plan.
Type of Plan
Description
Type of Manager
SWOT Analysis
There are various factors within the external environment of an organization that impacts its strategy.
Analyze the organization’s SWOT analysis. Identify the internal and external factors. Include a link to the SWOT analysis in the Reference section of this worksheet.
Internal Factors
External Factors
Part 2: Evaluation
Evaluate if the mission, vision, planning process, and SWOT analysis meets the current needs of the organization. Include the following in your evaluation:
· Describe the unmet need, (not limited to product or service, can be new demographic, new mode of delivery, etc.).
· Analyze your competitive advantages.
· Based upon the SWOT analysis, is there another business that is doing something similar that can be referred to? Provide examples.
· If there is not another business, describe how what you’re doing is a unique product or service offering.
· Propose a competitive business initiative to address the unmet need.
· Create a high-level timeline and operational steps necessary to implement your solution. References
Include a link to theSWOT analysis.
Copyright 2020 by University of Phoenix. All rights reserved.
Copyright 2020 by University of Phoenix. All rights reserved.
COUN 6785: Social Change in Action:
Prevention, Consultation, and Advocacy
Social Change Portfolio
M. Negrón
Contents
Introduction
Scope and Consequences
Social-ecological Model
Theories of Prevention
Diversity and Ethical Considerations
Advocacy
INTRODUCTIONAdressing Teen Pregnancy in Pittsburg, California
In more recent years, there has been an effort in my community to address teen pregnancy due to its growing rates. Over the years teen pregnancy rates have continued to rise in Contra Costa County as well as surrounding counties. Unfortanately, the town I come from is a small town within Contra Costa County so resources are limited. In order to address teen pregnancy there needs to be easier access to resources to prevent teen pregnancy from occurring. Teen pregnancy can lead to a number of different problems such as low socioeconomic status, greater chance of contracting a sexually transmitted infec.
Microsoft Word Editing Version 1.0Software Requirement Speci.docxjessiehampson
This document provides a software requirements specification for Microsoft Word 2016. It includes an introduction, purpose, scope, definitions, and overview. Use cases are defined for signing in, opening, creating new files, saving, saving as, exporting, printing, and changing fonts. Requirements cover performance, usability, supportability, configurability, and recoverability. The 8 use cases are then described in more detail with normal and alternate flows and screenshots.
Microsoft Windows implements access controls by allowing organiz.docxjessiehampson
Microsoft Windows implements access controls by allowing organizations to define users, groups, and object DACLs that support their environment. Organizations define the rules, and Windows enables those rules to be enforced.
Answer the following question(s):
Do you think access controls are implemented differently in a government agency versus a typical information technology company? Why or why not?
2. Do you think access controls differ among private industries, such as retail, banking, and manufacturing? Why or why not?
.
MGT520
Critical Thinking Writing Rubric - Module 10
Exceeds
Expectation
Meets Expectation Below Expectation Limited Evidence
Content, Research, and Analysis
21-25 Points 16-20 Points 11-15 Points 6-10 Points
Requirements Exceeds
Expectation -
Includes all of the
required
components as
specified in the
assignment.
Meets Expectation-
Includes most of
the required
components as
specified in the
assignment.
Below Expectation-
Includes some of
the required
components as
specified in the
assignment.
Limited Evidence -
Includes few of the
required
components as
specified in the
assignment.
21-25 Points 16-20 Points 11-15 Points 6-10 Points
Content Exceeds
Expectation -
Demonstrates
substantial and
extensive
knowledge of the
materials, with no
errors or major
omissions.
Meets Expectation-
Demonstrates
adequate
knowledge of the
materials; may
include some
minor errors or
omissions.
Below Expectation-
Demonstrates fair
knowledge of the
materials and/or
includes some
major errors or
omissions.
Limited Evidence -
Fails to
demonstrate
knowledge of the
materials and/or
includes many
major errors or
omissions.
25-30 Points 19-24 Points 13-18 Points 7-12 Points
Analysis Exceeds
Expectation -
Provides strong
thought, insight,
and analysis of
performance
management
system, concepts
and applications.
Meets Expectation-
Provides adequate
thought, insight,
and analysis of
performance
management
system, concepts
and applications.
Below Expectation-
Provides poor
thought, insight,
and analysis of
performance
management
system, concepts
and applications.
Limited Evidence -
Provides little or no
thought, insight,
and analysis of
performance
management
system, concepts
and applications.
13-15 Points 10-12 Points 7-9 Points 4-6 Points
Sources Exceeds
Expectation -
Sources go above
and beyond
required criteria,
and are well
chosen to provide
effective
substance and
perspectives on
the issue under
examination.
Meets Expectation-
Sources meet
required criteria
and are adequately
chosen to provide
substance and
perspectives on the
issue under
examination.
Below Expectation-
Sources meet
required criteria,
but are poorly
chosen to provide
substance and
perspectives on the
issue under
examination.
Limited Evidence -
Source selection
and integration of
knowledge from
the course is
clearly deficient.
Mechanics and Writing
5 Points 4 Points 3 Points 1-2 Points
Demonstrates Exceeds Meets Expectation- Below Expectation- Limited Evidence -
MGT520
Critical Thinking Writing Rubric - Module 10
college-level
proficiency in
organization,
grammar and
style.
Expectation -
Project is clearly
organized, well
written, and in
proper format as
outlined in the
assignment. Strong
sentence and
paragraph
structure; contains
no errors in
grammar, spelling,
APA style, or APA
citations and
references..
Midterm PaperThe Midterm Paper is worth 100 points. It will .docxjessiehampson
Midterm Paper
The Midterm Paper is worth 100 points. It will consist of a 500 word written description and analysis of a work of art using terminology from Chapters 2-5.
For this assignment, you are to discuss the form, content, and subject matter of a work of art chosen from the list provided. This is an exercise in recognizing visual elements and principles of design in works of art and demonstrating an understanding of how they relate to each other to create meaning. This paper is about looking and seeing. This is not a research paper; you will not need to do additional research. Please follow the outline provided below.
First: Select a work of art
Select one of the following listed works of art:
Circle of Diego Quispe Tito.
The Virgin of Carmel Saving Souls in Purgatory
. Late 17th century. Fig. 1.22, pg. 17.
Henri Matisse.
Large Reclining Nude
. 1935. Fig. 4.24, pg. 85.
Faith Ringgold.
Tar Beach
. 1988. Fig. 13.18, pg. 219.
Henry Ossawa Tanner.
The Banjo Lesson
. 1893. Fig. 21.15, pg. 373
Andy Warhol.
Marilyn Diptych
. 1962. Fig. 24.23, pg. 447.
Format
Describe the use of each visual element and principle of design in the order they are listed in the outline. You can simply list each term and address how it is used in the painting. If you write in paragraph form be sure to identify each term clearly. Any term not addressed will receive 0 points. Provide specific examples. For example, don’t just say “there are lines,” give specific examples of how line is used in the piece you’ve selected.
Papers should be 500 words minimum (not including images), double-spaced, 10 or 12 point, with 1" margins. The preferred format is Microsoft Word (.doc or .docx). If these formats are not available, other acceptable formats are ASCII (.txt), rich text format (.rtf), Open Office (.odt), and PDF. Make sure you proofread your papers for incorrect grammar, spelling, punctuation, and other errors.
The Midterm Paper is due at 11:59 pm CT Sunday of Week 4.
Midterm Paper Outline
Introduction (First Paragraph)
In the first paragraph, called the introduction, you will include:
An identification of the work of art you selected: The name of the artist, title (which is underlined or italicized every time you use the title in your paper), date, and medium.
Your initial interpretation of the subject based on your initial observations.
Description
Describe how each of the following is used in the piece you selected.
Visual Elements
:
Line: what types of lines do you see in the piece? Provide examples.
Shape: what types of shapes do you see? Provide examples.
Mass: How is mass implied?
Space: How is the illusion of space created in the piece?
Time and Motion: Are time and motion evident in tis piece? How so?
Light: How is light used here?
Color: How does the artist use color?
Texture: How does the artist create the illusion of texture, or incorporate actual texture
Principles of Design
Unity and Variety: In what way is this pi.
Miami Florida is considered ground zero for climate change, in parti.docxjessiehampson
Miami Florida is considered ground zero for climate change, in particular rising seas will not only drown coastal sections of the city but will disrupt our local supply of drinking water.
Based on what you have learned so far from this class, discuss the following:
Explain where the drinking water from South Florida primarily comes from and why would rising sea levels disrupt this supply?
What efforts can be made and are being made to mitigate the effects of rising seas on our drinking water?
If you were a local politician, what advice would you give to state and federal officials on the best way to ensure residents in South Florida had a steady supply of drinking water for many years to come?
.
MGT230 v6Nordstrom Case Study AnalysisMGT230 v6Page 2 of 2.docxjessiehampson
MGT/230 v6
Nordstrom Case Study Analysis
MGT/230 v6
Page 2 of 2
Nordstrom Case Study Analysis
Nordstrom—“High Touch” with “High Tech”
How does Nordstrom stay profitable despite dips in consumer spending, changing fashion trends, and intense competition among retailers? One answer: Acute attention to detail and well-laid plans.
All in the Family
The fourth generation of family members that runs Nordstrom has brought the store’s time-honored and successful retail practices into a new era. “Nordstrom, it seems, is that rarity in American business: an enterprise run by a founding family that hasn’t wrecked it,” says one business writer. The company provides a quality customer experience via personalized service, a compelling merchandise offering, a pleasant shopping environment, and increasingly better management of its inventory.
Secret of Success
The secret of this company’s success lies in its strategic planning efforts and the ability of its management team to set broad, comprehensive, and longer-term action directions, all of which are focused on the customer experience. The current generation of Nordstrom family members was quick to spearhead an ultramodern multimillion-dollar, Web-based inventory management system. This upgrade helped the company meet two key goals: (1) correlate purchasing with demand to keep inventory as lean as possible, and (2) give customers and sales associates a comprehensive view of Nordstrom’s entire inventory, including every store and warehouse.
Demand Planning
Instead of relying on one-day sales, coupon blitzes, or marking down entire lines of product, Nordstrom discounts only certain items. “Markdown optimization” software assists in planning more profitable sale prices. According to retail analyst, Patricia Edwards, this helps Nordstrom calculate what will sell better at different discounts and forecast which single items should be marked down. If a style is no longer in demand, the company can ship it off to its Nordstrom Rack outlet stores. It’s all part of Nordstrom’s long-term investment in efficiency. “If we can identify what is not performing and move it out to bring in fresh merchandise,” says Pete Nordstrom, “that’s a decision we want to make.”
Inventory Planning
Although inventory naturally fluctuates, Nordstrom associates can easily locate any item in another store or verify when it will return to stock. Customers on their smart phones and associates behind sales counters see the same thing—the entire inventory of Nordstrom’s stores is presented as one selection, which the company refers to as perpetual inventory. “Customer service is not just a friendly, helpful, knowledgeable salesperson helping you buy something,” says Robert Spector, retail expert and author of The Nordstrom Way. “Part of customer service is having the right item at the right size at the right price at the right time. And that’s something perpetual inventory will help with.”
The upgraded inventory management system was an .
This slide is special for master students (MIBS & MIFB) in UUM. Also useful for readers who are interested in the topic of contemporary Islamic banking.
Main Java[All of the Base Concepts}.docxadhitya5119
This is part 1 of my Java Learning Journey. This Contains Custom methods, classes, constructors, packages, multithreading , try- catch block, finally block and more.
How to Build a Module in Odoo 17 Using the Scaffold MethodCeline George
Odoo provides an option for creating a module by using a single line command. By using this command the user can make a whole structure of a module. It is very easy for a beginner to make a module. There is no need to make each file manually. This slide will show how to create a module using the scaffold method.
The simplified electron and muon model, Oscillating Spacetime: The Foundation...RitikBhardwaj56
Discover the Simplified Electron and Muon Model: A New Wave-Based Approach to Understanding Particles delves into a groundbreaking theory that presents electrons and muons as rotating soliton waves within oscillating spacetime. Geared towards students, researchers, and science buffs, this book breaks down complex ideas into simple explanations. It covers topics such as electron waves, temporal dynamics, and the implications of this model on particle physics. With clear illustrations and easy-to-follow explanations, readers will gain a new outlook on the universe's fundamental nature.
ISO/IEC 27001, ISO/IEC 42001, and GDPR: Best Practices for Implementation and...PECB
Denis is a dynamic and results-driven Chief Information Officer (CIO) with a distinguished career spanning information systems analysis and technical project management. With a proven track record of spearheading the design and delivery of cutting-edge Information Management solutions, he has consistently elevated business operations, streamlined reporting functions, and maximized process efficiency.
Certified as an ISO/IEC 27001: Information Security Management Systems (ISMS) Lead Implementer, Data Protection Officer, and Cyber Risks Analyst, Denis brings a heightened focus on data security, privacy, and cyber resilience to every endeavor.
His expertise extends across a diverse spectrum of reporting, database, and web development applications, underpinned by an exceptional grasp of data storage and virtualization technologies. His proficiency in application testing, database administration, and data cleansing ensures seamless execution of complex projects.
What sets Denis apart is his comprehensive understanding of Business and Systems Analysis technologies, honed through involvement in all phases of the Software Development Lifecycle (SDLC). From meticulous requirements gathering to precise analysis, innovative design, rigorous development, thorough testing, and successful implementation, he has consistently delivered exceptional results.
Throughout his career, he has taken on multifaceted roles, from leading technical project management teams to owning solutions that drive operational excellence. His conscientious and proactive approach is unwavering, whether he is working independently or collaboratively within a team. His ability to connect with colleagues on a personal level underscores his commitment to fostering a harmonious and productive workplace environment.
Date: May 29, 2024
Tags: Information Security, ISO/IEC 27001, ISO/IEC 42001, Artificial Intelligence, GDPR
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Week 4 Assignment - Strategic Plan, Part 3 Strategic Evaluation.docx
1. Week 4 Assignment - Strategic Plan, Part 3: Strategic
Evaluation
For this Assignment, you will explore a variety of strategies.
You will then make your recommendations for a strategy or a
combination of strategies for the organization (the same
company that was used for your Week 2 & Week 3
Assignments).
Instructions:
In this section, you will be evaluating various strategies and
making recommendations for the organization.
Write a 1,050-word minimum strategic evaluation in which you
include the following:
· Evaluate potential business level strategies for the
organization.
· Assess potential corporate level strategies for the
organization.
· Assess potential global strategies for the organization.
· Recommend a strategy or combination of strategies the
organization should implement, and include a rationale for that
recommendation.
NOTE
· The tables in the attached 'Week 4 Assignment - Potential
Strategies Evaluation Frameworks' documentprovide the
frameworks to be used for evaluating various strategies and
making recommendations.
· Please add the assessment and evaluation of the strategies and
the recommendations into the tables and insert these tables into
your paper.
2. The effect of non-pharmacological sleep
interventions on depression symptoms: a
meta-analysis of randomised controlled
trials
Article
Accepted Version
Gee, B., Orchard, F., Clarke, E., Joy, A., Clarke, T. and
Reynolds, S. (2019) The effect of non-pharmacological sleep
interventions on depression symptoms: a meta-analysis of
randomised controlled trials. Sleep Medicine Reviews, 43. pp.
118-128. ISSN 1532-2955 doi:
https://doi.org/10.1016/j.smrv.2018.09.004 Available at
http://centaur.reading.ac.uk/79287/
It is advisable to refer to the publisher’s version if you intend to
cite from the
work. See Guidance on citing .
To link to this article DOI: http://dx.doi.org/10.1016/j.smrv.201
8.09.004
Publisher: Elsevier
All outputs in CentAUR are protected by Intellectual Property R
ights law,
including copyright law. Copyright and IPR is retained by the cr
eators or other
copyright holders. Terms and conditions for use of this material
are defined in
the End User Agreement .
3. http://centaur.reading.ac.uk/71187/10/CentAUR%20citing%20g
uide.pdf
http://centaur.reading.ac.uk/licence
www.reading.ac.uk/centaur
CentAUR
Central Archive at the University of Reading
Reading’s research outputs online
http://www.reading.ac.uk/centaur
RUNNING HEAD: EFFECT OF NON-PHARMACOLOGICAL
SLEEP INTERVENTIONS ON DEPRESSION SYMPTOMS
1
The Effect of Non-Pharmacological Sleep Interventions on
Depression Symptoms: A
Meta-Analysis of Randomised Controlled Trials
Brioney Gee1,2, Faith Orchard3, Emmet Clarke1, Ansu Joy1,
Tim Clarke1,2, Shirley Reynolds3
1Norfolk and Suffolk NHS Foundation Trust, UK
2Norwich Medical School, University of East Anglia, UK
4. 3School of Psychology and Clinical Language Sciences,
University of Reading, UK
Corresponding Author:
Dr Brioney Gee
Norfolk and Suffolk NHS Foundation Trust
80 St Stephens Road, Norwich, UK. NR1 3RE
Email: [email protected] Tel: +44 (0)1603 201455
Acknowledgments
We would like to thank Drs Matthew Blake, Kenneth Lichstein
and Ron Postuma for sharing
additional data for inclusion in the meta-analysis and the staff
of Norfolk and Suffolk NHS
Foundation Trust Frank Curtis Library for their assistance in
accessing articles. This review
was not supported by any specific funding. We have no
conflicts of interest to declare.
RUNNING HEAD: EFFECT OF NON-PHARMACOLOGICAL
SLEEP INTERVENTIONS ON DEPRESSION SYMPTOMS
2
5. Summary
Poor sleep is a significant risk factor for depression across the
lifespan and sleep problems
have been hypothesised to contribute to the onset and
maintenance of depression symptoms.
However, sleep problems are usually not a direct target of
interventions for depression. A
range of non-pharmacological treatments can reduce sleep
problems but it is unclear whether
these interventions also reduce other depression symptoms. The
aim of this review was to
examine whether non-pharmacological interventions for sleep
problems are effective in
reducing symptoms of depression. We carried out a systematic
search for randomised
controlled trials of non-pharmacological sleep interventions that
measured depression
symptoms as an outcome. Forty-nine trials (n=5908) were
included in a random effects meta-
analysis. The pooled standardised mean difference for
depression symptoms after treatment
for sleep problems was -0.45 (95% CI: -0.55,-0.36). The size of
the effect on depression
6. symptoms was moderated by the size of the effect on subjective
sleep quality. In studies of
participants with mental health problems, sleep interventions
had a large effect on depression
symptoms (d=-0.81, 95% CI: -1.13,-0.49). The findings indicate
that non-pharmacological
sleep interventions are effective in reducing the severity of
depression, particularly in clinical
populations. This suggests that non-pharmacological sleep
interventions could be offered as a
treatment for depression, potentially improving access to
treatment.
Keywords: depression; mood; sleep; insomnia; intervention;
treatment; meta-analysis
RUNNING HEAD: EFFECT OF NON-PHARMACOLOGICAL
SLEEP INTERVENTIONS ON DEPRESSION SYMPTOMS
3
Glossary
Cognitive behavioural therapy for insomnia: A multi-component
psychological intervention
comprising a range of strategies designed to target the
behavioural and cognitive
7. underpinnings of insomnia.
Forest plot: Graphical representation of the results of a meta-
analysis.
Funnel plot: Used to detect bias in trials included in a meta-
analysis. Publication bias will
result in asymmetry in the plot.
Heterogeneity: Variability in observed effect sizes that is
greater than would be expected by
chance alone.
Meta-regression: A statistical technique that allows the
association between continuous, as
well as categorical, study characteristics and the intervention
effects observed to be
investigated.
Paradoxical intention: Instructing the client to stop trying to fall
asleep and instead stay
awake for as long as possible in order to lessen anxiety about
falling asleep.
Rosenthal’s failsafe N: The number of additional studies in
which the intervention effect was
zero that would need to be included in a meta-analysis to
increase the P value to above 0.05.
8. Sleep restriction therapy: Limiting the time spent in bed to the
actual time spent sleeping in
order to increase sleep efficiency.
Stimulus control therapy: Providing the client with instructions
designed to re-associate the
bed/bedroom with sleep.
RUNNING HEAD: EFFECT OF NON-PHARMACOLOGICAL
SLEEP INTERVENTIONS ON DEPRESSION SYMPTOMS
4
Introduction
Depression is a common mental health problem, with a lifetime
prevalence of approximately
15% in high income countries [1]. It is among the leading
causes of disability globally [2],
but only a small minority of individuals experiencing
depression receive adequate treatment
[3]. More than 65% of adults with major depressive disorder
report sleep difficulties [4,5],
including difficulty falling asleep, frequent awakenings during
the night, early morning
9. awakening and non-restorative sleep [6], and around 40% report
sleep disturbance severe
enough to warrant a diagnosis of insomnia [7]. Among
adolescents with depression, recent
research indicates that up to 90% present with disturbed sleep
[8,9]. In both children and
adults, those who experience sleep problems present with more
severe depression than
depressed individuals without sleep problems [10,11].
Depression has often been conceptualised as a cause of sleep
problems [12], reflected in the
inclusion of sleep disturbance in the diagnostic criteria for
depressive disorders in both
commonly used diagnostic manuals (DSM-5 [13] and ICD-10
[14]). However, sleep
problems often predate the onset of depression [15,16], and are
among the most commonly
reported residual symptoms after the remission of a depressive
disorder [17]. Thus it has been
suggested that, rather than sleep problems being a symptom or
consequence of depression,
that depression and sleep disorders may constitute separate
syndromes that co-occur as a
10. result of shared causal pathways [18].
Longitudinal research suggests a bidirectional relationship
between depression and sleep,
with sleep disturbances predicting later depressive episodes as
well as vice versa [19]. In a
RUNNING HEAD: EFFECT OF NON-PHARMACOLOGICAL
SLEEP INTERVENTIONS ON DEPRESSION SYMPTOMS
5
meta-analysis of longitudinal studies, the risk of non-depressed
individuals with insomnia
subsequently developing depression was found to be twice that
of people without sleep
difficulties [20]. Studies examining the prospective role of
sleep in the development of
depression have found sleep problems to be a risk factor for
subsequent depression across the
lifespan, from adolescence [21] through to older adulthood [22].
Further, there is some evidence to support the hypothesis that
poor sleep might play a causal
11. role in the onset and maintenance of depression symptoms
[23,24]. In experimental and
quasi-experimental studies, sleep deprivation has been found to
increase negative mood [23],
decrease positive emotional responses to goal-enhancing events
[25] and bring about poorer
memory for positively valenced words [26]. In addition, healthy
adult volunteers subjected to
six days of sleep curtailment have been found to show
electroencephalography abnormalities
and endocrine disturbances usually observed in depression [18].
In adolescents, even modest
sleep restriction over five nights has been found to result in
worsened mood, increased
irritability and decreased ability to regulate negative emotions
[27].
Given the hypothesis that poor sleep might contribute to the
onset and maintenance of
depression, it is plausible that treatments that are successful in
improving sleep might also
lead to reductions in symptoms of depression. Pharmacological
sleep treatments have been
found to produce short-lived improvements in sleep but are not
recommended for longer-term
12. sleep problems due to poor efficacy [28] and concerns about
dependence and other adverse
effects [29].
RUNNING HEAD: EFFECT OF NON-PHARMACOLOGICAL
SLEEP INTERVENTIONS ON DEPRESSION SYMPTOMS
6
Non-pharmacological interventions are effective in improving
sleep, both in individuals with
insomnia [30,31], and in those with sleep problems in the
context of medical and psychiatric
disorders [32–34]. Insomnia is the most common sleep
complaint, both in individuals with
depression [5,11] and in the general population [34]. A range of
non-pharmacological
interventions have been found to be effective treatments for
insomnia, including stimulus
control therapy, relaxation training, sleep restriction therapy,
biofeedback, paradoxical
intention and multicomponent cognitive behavioural therapy for
insomnia (CBT-I) [35].
13. Depression symptoms are often measured as a secondary
outcome in trials of non-
pharmacological interventions designed to improve sleep. A
number of previous reviews
have included analyses of the effect of interventions targeting
sleep problems on depression
symptoms. The results of previous meta-analyses suggest that
both internet-delivered [36]
and group-based [37] CBT-I have small but significant effects
on depression symptoms,
despite these symptoms not being specifically targeted.
However, a recent network meta-analysis of behavioural and
cognitive behavioural
interventions for adults with insomnia [38] found that only
individual, face-to-face CBT-I
had a significant effect on depression symptoms when compared
to a placebo condition.
Studies were included in this analysis if the trial intervention
incorporated sleep restriction,
and depression was measured using a standardised measure. The
authors grouped the CBT-I
interventions trialled into six classes according to their
14. treatment components and delivery
mode, and compared each class of intervention to placebo
conditions (pills or behavioural
placebo). Significant moderate-sized mean effects were found
for individual CBT-I, but no
significant effects were found for other treatment classes.
However, the conclusions that
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could be drawn were limited by significant heterogeneity that
was not explained by the
clinical, demographic or methodological characteristics
examined, which included age, sex,
whether participants with comorbidities were excluded, and risk
of bias.
One possible source of heterogeneity in the effect of sleep
interventions on depression is
variation in the size of effect on the sleep symptoms directly
targeted. The authors of a recent
review of CBT-I in adults with co-morbid major depressive
15. disorder [39] suggest that
improvement in depression following CBT-I may be mediated
by improvement in insomnia
symptoms. There are plausible mechanisms through which
improvements in sleep might lead
to improvements in depression symptoms. These include the
impact of improved sleep on
quality of life, emotion regulation and cognitive functioning
[40,41], as well as reductions in
neurobiological abnormalities common to both mood and sleep
disturbances [42]. However,
there are also a range of non-specific factors that might account
for the effect of sleep-
interventions on depression, for instance increased motivation
or hope as a result of
developing a therapeutic relationship or participation in a
therapeutic process [43]. As such,
the extent to which improvements in depression symptoms are
accounted for by improved
sleep warrants investigation.
The aim of the current review was to identify and synthesise the
results of all randomised
controlled trials of non-pharmacological interventions designed
16. to improve sleep that
reported depression symptoms as an outcome. Eligible
interventions were designed to
improve the amount, quality or timing of sleep, including but
not limited to interventions for
insomnia. The review was not restricted to a particular
intervention or client group, and the
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impact of the age of trial participants and presence or absence
of mental health comorbidities
was examined.
A secondary goal was to examine whether improvements in
symptoms of depression were
moderated by improvements in subjective sleep quality in order
to assess whether
heterogeneity in the effect of sleep interventions on depression
can be explained by variation
in how effective the intervention is in improving perceived
sleep quality. Better
17. understanding the impact of non-pharmacological sleep
interventions on depression
symptoms will be important in enabling us to assess in which
cases interventions targeting
sleep might be appropriately harnessed as treatment options for
depression.
Methods
Search strategy
The review was conducted in accordance with guidance in the
‘preferred reporting items for
systematic reviews and meta-analyses’ (PRISMA) statement
[44]. The protocol was
registered with the PROSPERO registry prior to implementation
of the search strategy and
can be accessed at:
http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=
CRD42017054940.
The search strategy aimed to identify all eligible trials reported
in the English language in a
peer-reviewed journal. Four electronic databases, PsycINFO,
Medline, CINAHL and
18. CENTRAL, were searched from their inception until 1st May
2018. The following search
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terms were used: (sleep OR insomnia OR “sleep treatment” OR
“sleep disorders”) AND
(intervention OR treatment OR therapy OR help OR hygiene OR
support OR education)
AND (depressi* OR mood). Limiters were used to narrow the
search to clinical trials and
English language publications. We also hand searched the
reference lists of eligible articles
and key review papers to identify any eligible articles missed by
the electronic search.
Eligibility Criteria
The inclusion criteria employed were as follows: (1) randomised
controlled trial; (2) trial
intervention was a non-pharmacological intervention
specifically designed to improve sleep
(amount, quality or timing); (3) trial included a control
19. condition not designed to improve
sleep; (4) depression symptoms were measured (as either a
primary or secondary outcome)
using a validated instrument; (5) the trial was reported in the
English language in a peer
reviewed journal. Studies that met any of the following criteria
were excluded: (1) the trial
intervention included a pharmacological component (including
traditional/herbal remedies);
(2) all trial arms received an intervention designed to improve
sleep (for instance, the only
control condition was a pharmacological sleep aid or sleep
hygiene); (3) trial intervention
was designed to treat parasomnias, sleep apnoea or fatigue (as
these are thought to have
causal factors distinct from other sleep problems).
Study selection
The titles and abstracts of all retrieved articles were screened
by one reviewer (BG). A
subsample of 10% of articles (selected using a random number
generator) was screened
independently by a second reviewer (AJ) to check that no
potentially eligible articles were
20. RUNNING HEAD: EFFECT OF NON-PHARMACOLOGICAL
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10
excluded. The full texts of all articles deemed potentially
relevant were obtained and assessed
for eligibility against the inclusion/exclusion criteria by two
reviewers independently (BG
and one of FO, EC, AJ, TC or SR). All disagreements regarding
eligibility were discussed by
the two reviewers and, if consensus not reached, resolved by a
third reviewer. Where multiple
publications describing the same trial were identified, only the
article reporting on the larger
sample was included.
Data extraction and quality assessment
Data were extracted independently by two reviewers (BG and
EC) and cross-checked to
ensure accuracy. The following information was recorded using
a customised data extraction
spreadsheet: study characteristics (authors, title, year of
21. publication), intervention type, age of
sample, psychiatric comorbidities, depression measure used,
subjective sleep quality measure
used, size of intervention and control groups, baseline and
outcome data (at first time-point
post-intervention) for depression and sleep quality (means and
standard deviations). Where
insufficient outcome data were reported for the study to be
included in the meta-analysis, we
contacted corresponding authors to request this data. The
methodological quality of included
studies was assessed by one reviewer (AJ) using the Cochrane
collaboration’s risk of bias
tool [45]. For a random subsample of 10% of included studies,
the risk of bias assessment
was independently verified by a second reviewer (BG) and
discrepancies resolved through
discussion.
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22. Data synthesis
All eligible studies for which sufficient data on depression
outcomes were reported or could
be obtained from the corresponding author were included in a
random effects meta-analysis.
Review Manager Version 5.3 [46] was used to perform the
meta-analysis. Standardised mean
differences of depression scores at post-intervention and their
95% confidence intervals were
calculated for each study, and weighted according to sample
size via the random effects
model. Standardised mean differences greater than 0.8 were
considered large, 0.5 moderate
and 0.2 small [47].
Where more than one non-pharmacological intervention
designed to improve sleep was
included in the trial, data for the most intensive intervention
was included in the meta-
analysis. The most intensive intervention was determined by
consensus of two reviewers
based on the amount of face-to-face contact the intervention
included (so that interventions
23. delivered in a self-help format were classed as less intensive
than therapist-delivered
interventions). A random effects model was selected as we
expected there would be
heterogeneity in study effect sizes because of diversity in their
target populations and the
specific interventions trialled. Statistical heterogeneity was
assessed using the Chi2 and I2
statistics. Significant heterogeneity is indicated by a Chi2
statistic greater than the degrees of
freedom and a p value<0.05; I2 values range from 0% to 100%,
with higher values indicating
greater heterogeneity [48]. Publication bias was assessed via
construction and visual
inspection of a funnel plot and by calculating Rosenthal’s
failsafe N.
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Two planned subgroup analyses were carried out to investigate
24. sources of heterogeneity. The
first divided the studies into those that recruited from
populations who had sleep problems in
the context of mental health problems and those that recruited
from populations without
clinical mental health problems. Studies were classified as
recruiting from a population with
mental health problems if all participants either (a) meet
standardised diagnostic criteria for at
least one functional mental disorder (determined via chart
review or diagnostic interview) or
(b) scored above the clinical threshold on a validated measure
of mental health
symptomatology. The second planned subgroup analysis divided
the studies according to the
age range of participants: children/adolescents (aged up to 19),
adults (aged 18+), older adults
(aged 50+). Additionally, a post-hoc subgroup analysis was
conducted to investigate the
impact of the depression measure employed on the effect size
detected. Only trials that
measured depression using an instrument employed by at least
two other trials were included
in this analysis.
25. Finally, a random effects meta-regression was carried out to
assess whether the effect of an
intervention on depression symptoms was predicted by its effect
on subjective sleep quality.
This was achieved by calculating effect sizes (standardised
mean difference) for all studies
that reported subjective sleep quality post-intervention and
entering these as covariates in a
meta-regression using Field and Gillett’s SPSS syntax files
[49].
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Results
Study selection
The study selection process is illustrated in Figure 1. Sixty-one
papers were identified that
met the inclusion criteria, however three were secondary
analyses of already included trials
26. and we were unable to obtain sufficient depression data for
inclusion in the meta-analysis
from the published report or by contacting the corresponding
author for nine studies.
Therefore data from 49 articles are included in the meta-
analysis.
[Inset Figure 1]
Characteristics of included studies
Characteristics of the 49 trials included in the meta-analysis are
summarised in Table 1. The
meta-analysis included data on 5908 participants, of whom 2731
were randomised to receive
the trial sleep intervention. The included trials were all of
psychological interventions. The
majority (39 out of 48 studies) were described by the study
authors as CBT-I or CBT-
informed interventions. Sixteen studies trialled interventions
delivered in a self-help format,
online or via a mobile application. The remaining trials were of
face-to-face interventions, 27
delivered individually and five delivered in a group format.
Control conditions included
27. active interventions not specifically targeting sleep (e.g. dietary
advice, exercise
programmes), and passive controls, such as medical treatment as
usual and waitlist.
Most participants were adults; only four studies included young
people aged under 18
(n=292) and none included children under 11 years. Many of the
studies recruited participants
with physical health problems (e.g. chronic pain, heart failure,
cancer), for whom sleep was a
secondary or additional problem. Twenty studies recruited
participants with sleep problems
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14
and no other comorbidity. Half of the included studies excluded
participants deemed to have
clinical levels of depression symptoms (defined either as
meeting diagnostic criteria for a
depressive disorder or scoring above a specified cut-off on a
measure of depression
28. symptoms). A wide range of measures of depression symptoms
were used and included
widely used self-report questionnaires, as well as observer
rating scales (e.g. the Hamilton
rating scale for depression). Subjective sleep quality (including
self-reported insomnia
severity) was measured by 43 of the 49 included studies. The
trials were conducted in high
and upper-middle income countries across four continents
(Europe, North America, Asia and
Australasia).
[Insert Table 1]
Risk of bias
The Cochrane collaboration’s risk of bias tool was used to
assess the quality of the included
studies and a risk of bias summary graph produced (Figure 2).
The majority of studies were
judged to be of high quality, though few studies were able to
blind participants and research
personnel, and most papers included insufficient information to
be able to determine the risk
of bias due to poor allocation concealment or selective
reporting. The measures of depression
29. used in the studies had sound psychometric properties, and
where young people under 18
were included, had been validated for use with adolescents.
[Insert Figure 2]
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Meta-analysis of effect on depression symptoms at post-
treatment
The results of the random effects meta-analysis are illustrated in
Figure 3. There was a small
to moderate effect of non-pharmacological sleep interventions
in reducing depression
symptoms in comparison to control conditions not designed to
improve sleep (standardised
mean difference = -0.45, 95% CI -0.55, -0.36, p<0.001, k=49).
The statistical heterogeneity
in effect sizes among studies was moderate (I2=56%, χ2=108.8,
df=48, p<0.001).
30. [Inset Figure 3]
Subgroup analyses and meta-regression
Comorbid mental health difficulties
Seven of the included studies recruited from participants with
clinical mental health problems
(typically anxiety, depression and PTSD) in addition to sleep
difficulties. The subgroup
analyses showed that the pooled effect on depression symptoms
for these seven studies was
large (standardised mean difference = -0.81, 95% CI -1.13, -
0.49, p<0.001, k=7) and the
statistical heterogeneity among these studies was small
(I2=27%, χ2=8.19, df=6, p=0.22). In
comparison, the subgroup of studies that recruited participants
without clinical mental health
difficulties (k=42) found a small effect on depression symptoms
(standardised mean
difference = -0.41, 95% CI -0.51, -0.31, p<0.001) and these
effect sizes were more
heterogeneous (I2=56%, χ2=93.45, df=41, p<0.001).
31. RUNNING HEAD: EFFECT OF NON-PHARMACOLOGICAL
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Adolescents, adults and older adults
The majority of included studies recruited adults of all ages.
Four of the studies recruited
adolescents (all participants under the age of 20) and three
recruited only adults over the age
of 50. The four trials in adolescents had the smallest pooled
effect on depression symptoms
(standardised mean difference = -0.27, 95% CI -0.50, -0.04,
p=0.02, k=4), with no statistical
heterogeneity (I2=0%, χ2=1.99, df=3, p=0.57). The pooled
effect on depression symptoms for
the studies with adult participants was small to moderate
(standardised mean difference = -
0.46, 95% CI -0.57, -0.36, p<0.001, k=42) with moderate
heterogeneity (I2=59%, χ2=100.75,
df=41, p<0.001). The three studies that recruited adults over the
age of 50 had the largest
pooled effect size but wide confidence intervals (standardised
mean difference = -0.60, 95%
32. CI -1.12, -0.08, p=0.02, k=3) and moderate heterogeneity
(I2=47%, χ2=3.76, df=2, p=0.15).
Depression measure
The centre for epidemiological studies depression scale (CESD)
was the most commonly
used depression measure in the included studies (k=11),
followed by the Beck depression
inventory (BDI) (k=10), hospital anxiety and depression scale
(HADS) (k=8), nine item
patient health questionnaire (PHQ-9) (k=4) and the Beck
depression inventory version II
(BDI-II) (k=3). All other measures were employed in less than
three of the included trials.
The standardised mean difference was largest for trials that
measured depression using the
PHQ-9 (-0.70, 95% CI -1.00, -0.41, p<0.001), followed by the
BDI (-0.56, 95% CI -0.76, -
0.36, p<0.001), the CESD (-0.45 95% CIs -0.67, -0.24,
p<0.001), and the HADS (-0.34, 95%
CIs -0.57, -0.11, p=0.003). It was smallest in trials that used the
BDI-II (-0.12, 95% CIs -
0.36, 0.13, p=0.34).
33. RUNNING HEAD: EFFECT OF NON-PHARMACOLOGICAL
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Effect on subjective sleep quality
The standardised mean difference for subjective sleep quality at
post-intervention could be
calculated in the case of 40 of the 49 included studies. There
was a positive linear
relationship between the standardised mean difference of the
sleep interventions on
depression symptoms and the standardised mean difference for
subjective sleep quality. The
meta-regression revealed that the size of the effect on subjective
sleep quality was a
significant continuous moderator of the effect on depression
symptoms (β=0.447, 95% CI
0.29, 0.60, p<0.001). The residual variation was non-significant
(χ2=41.89, p=0.306)
suggesting the statistical heterogeneity in the size of the effect
of the studied sleep
interventions on depression symptoms can be explained by
variation in their effect on
34. subjective sleep quality.
Publication bias
Inspection of the funnel plot suggested that effect sizes might
be slightly inflated in some
smaller studies, with one small study a notable outlier.
However, this might be explained by
clinical diversity among the populations studied since trials that
recruited participants with
sleep problems in the context of mental health problems tended
to find larger effect sizes and
to have smaller samples than the studies that recruited
participants without clinical mental
health problems. Rosenthal’s failsafe N was 3593.46, indicating
that 3593 studies with zero
effect sizes would be needed to nullify the pooled effect.
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35. Discussion
We reviewed the evidence of the effect of non-pharmacological
interventions designed to
improve sleep on the severity of depression symptoms. The
meta-analysis showed that non-
pharmacological sleep interventions reduce the severity of
depression symptoms immediately
post-intervention, and this finding was robust to the possibility
of publication bias. The
pooled effect on depression severity was in the small to
moderate range. This is comparable
to the effect size of targeted non-pharmacological interventions
for depression delivered in
primary care [50,51] and to non-pharmacological interventions
for depression that is
comorbid with physical health problems [52–54]. The effect is,
however, somewhat smaller
than the effect sizes of non-pharmacological interventions for
depression delivered to
individuals with major depression disorder [55].
As would be expected given that most eligible trials were of
CBT-I, or CBT-informed
interventions for insomnia, the effect on depression symptoms
36. we identified is comparable to
the effects on depression symptoms reported in previous meta-
analyses of CBT-I [36–38].
The size of reduction in depression symptoms is also similar to
the effect on anxiety
symptoms in a meta-analysis of CBT-I trials [56], suggesting
that non-pharmacological sleep
interventions are similarly effective in reducing both depression
and anxiety.
Whilst the pooled effect of non-pharmacological sleep
interventions on depression symptoms
is small to moderate, there was considerable heterogeneity in
the size of effects observed.
This heterogeneity is in line with previous research [38] and
unsurprising given the variation
in the participants recruited and the type of interventions
trialled by the included studies. For
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participants with mental health problems, sleep interventions
37. had a large effect on symptoms
of depression. Such interventions have previously been found to
have large effects on sleep
symptoms in individuals with mental health problems [57].
Therefore, sleep interventions
might be of particular benefit to this group.
The pooled effect size for studies that recruited children and
adolescents was small compared
to the effect sizes for those studies that recruited adults and
older adults. These relatively
modest effects on depression symptoms are in line with the
small effect sizes that have been
found in studies of non-pharmacological therapies directly
targeting depression in children
and young people [58,59]. However, none of the studies
included in this review investigated
the effect of non-pharmacological sleep interventions on
children or adolescents with clinical
level mental health difficulties, including depression, for whom
sleep difficulties are both
common and distressing [8,9]. Given the effect of sleep
interventions on depression
symptoms was larger in studies that recruited participants with
38. sleep problems in the context
of mental health problems, the small effect on depression in
studies of children and
adolescents might be partially accounted for by the lack of trials
including young people with
clinical-level mental health problems. Therefore, the potential
effects of sleep interventions
for depressed children and adolescents warrants further
evaluation.
There was a strong association between the change in subjective
sleep quality brought about
by an intervention and its effect on depression symptoms. The
statistical heterogeneity in the
effect sizes for depression symptoms was nullified by the
introduction of the effect size for
subjective sleep quality as a covariate in the random effects
meta-regression, indicating that
the heterogeneity on the effect of the interventions on
depression can be explained by
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39. heterogeneity in their effect on subjective sleep quality. This
might support the contention
that changes in the severity of depression symptoms were
brought about by changes in
subjective sleep quality.
However, it is also possible that the observed relationship
between effects on depression
symptoms and subjective sleep quality is a consequence of non-
specific features of the
intervention or study context impacting on both sleep and
depression symptoms
independently. Further research is needed to fully understand
the nature of the relationship
between the effect of sleep interventions on sleep and their
effect on depression. Studies
incorporating objective measurement of sleep variables in
addition to self-reported sleep
quality would potentially be informative.
Clinical implications
Currently, only a small minority of individuals experiencing
depression receive adequate
40. treatment [3]. The stigma associated with mental health
problems has been identified as an
important barrier to help-seeking and treatment adherence [60].
The effectiveness of non-
pharmacological sleep interventions on depression symptoms
suggests that the use of non-
pharmacological interventions that target sleep (and not mental
health difficulties) may offer
a relatively low stigma means of reducing depression symptoms
in individuals who have both
sleep and mental health difficulties. Offering sleep
interventions as a treatment option for
those who report depression symptoms might also be
particularly useful for individuals
reluctant to engage in a targeted treatment for depression.
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Non-pharmacological sleep interventions can be successfully
delivered in a variety of
41. relatively low-cost formats [28], therefore providing these as a
treatment option for people
with depression has the potential to be cost-effective. However,
caution should be exercised
in offering non-pharmacological sleep interventions as a
standalone intervention for
depression symptoms; residual depression symptoms should be
monitored and additional
interventions offered as necessary.
Limitations
A limitation of the current review is that, because diagnostic
criteria for depression include
sleep problems as a symptom, measures of depression typically
incorporate one or more
items assessing sleep symptoms. Since these items account for
only a small proportion of the
total scale score, it is unlikely that changes on these items alone
after treatment for sleep
problems could account for the size of the effects observed.
However, lack of item level data
meant that it was not possible to isolate the effect of the
interventions trialled on non-sleep
42. depression symptoms. Future trials should use depression
measures that do not include items
assessing sleep symptoms or report item-level data to enable the
effect of sleep interventions
on non-sleep depression symptoms to be investigated.
A further consideration in interpreting the results of this meta-
analysis is that many studies
excluded people who reported elevated symptoms of depression
or a history of major
depression. Thus, while we cannot be certain what effect this
had on the pooled effect size, it
is possible that relatively low levels of depression before
treatment for sleep problems
reduced the overall effect of treatment on depression symptoms.
We were also unable to
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assess whether participants in the included trials were offered
treatment for depression or
provided with mood management techniques before or after
43. their participation in the sleep
interventions trialled as this was not consistently reported.
The meta-analysis only included trials that reported adequate
data on depression symptoms at
post-treatment. We could not include nine trials identified as
eligible for inclusion in the
meta-analysis as we were unable to obtain sufficient data on
depression outcome to calculate
the standardised mean difference. Also, we focused on outcomes
immediately post-
intervention so are unable to comment on the longevity of the
effects on depression observed.
Further, we only included trials that measured depression
symptoms as an outcome. It is
possible that trials of non-pharmacological sleep interventions
that did not measure
depression symptoms as an outcome might have differed from
those that did in some fashion
that would impact the size of the effect obtained.
Conclusions
Non-pharmacological interventions designed to improve sleep
have a positive impact on
44. depression symptoms. The size of the effect on depression is
moderated by the effect on
subjective sleep quality and is largest for participants
experiencing sleep problems in the
context of mental health difficulties. Further research
investigating the mechanisms by which
sleep interventions impact depression symptoms is warranted.
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Practice points
1. Available randomised controlled trial evidence indicates that
non-pharmacological
interventions designed to improve sleep have a small to
moderate effect on depression
symptoms when these are measured as a secondary outcome.
2. The size of the effect on depression symptoms is moderated
45. by the effect of the
intervention on subjective sleep quality.
3. The effect on depression symptoms appears to be larger in
adult than in children and
adolescents but this may be an artefact of the participants who
were recruited.
4. We found evidence of a large effect for studies that recruited
participants experiencing
sleep problems in the context of mental health difficulties.
Offering non-
pharmacological sleep interventions to users of mental health
services who are
experiencing concomitant mood and sleep problems may lead to
significant
improvements in depression symptoms as well as sleep quality.
Research agenda
1. Future trials of sleep interventions should measure depression
symptoms as an
outcome and report this data at item level where the depression
instrument used
includes an item(s) assessing sleep problems.
2. Future studies should investigate the mechanisms through
which sleep interventions
46. lead to improvements in depression symptoms.
3. The effect of sleep interventions on depression in children
and adolescents with
mental health problems should be trialled.
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Tables
Table 1. Characteristics of studies included in the meta-analysis
Study County Participants Intervention Depression
measure
Sleep
measure
Blake et al. 2016 [61] Australia Adolescents (aged 12–17) with
high anxiety and sleep difficulties
CBT/mindfulness-based
group sleep intervention
84. CESD PSQI
Casault et al. 2015 [62] Canada Adults diagnosed with cancer
with comorbid insomnia
Self-help CBT-I with
telephone support
HADS ISI
Chang et al. 2016 [63] Taiwan Adults with heart failure
Educational supportive care
programme
HADS PSQI
Christensen et al. 2016 [64] Australia Adult internet users with
insomnia
and subclinical depression
Online insomnia self-help
85. programme
PHQ-9 ISI
Currie et al. 2000 [65] Canada Adults with insomnia secondary
to chronic pain
Group CBT-I BDI PSQI
Currie et al. 2004 [66] Canada Adult recovering alcoholics with
insomnia
Brief CBT-based insomnia
programme
BDI PSQI
RUNNING HEAD: EFFECT OF NON-PHARMACOLOGICAL
SLEEP INTERVENTIONS ON DEPRESSION SYMPTOMS
86. 34
Dewald-Kaufmann et al.
2014 [67]
Netherlands Adolescents (aged 12-19) with
chronic sleep reduction
Gradual sleep extension and
sleep hygiene advice
CDI CSRQ
Ebert et al. 2015 [68] Germany Adult teachers with sleeping
problems
Online CBT-I based recovery
training programme
87. CESD PSQI
Edinger et al. 2001 [69] USA Adults with chronic primary
sleep-maintenance insomnia
Individual CBT-I BDI ISQ
Edinger et al. 2007 [70] USA Adults with primary sleep-
maintenance insomnia
Individual CBT-I BDI ISQ
Freeman et al. 2017 [71] UK Adult university students with
insomnia
Online CBT-I delivered via a
media-rich web application
PHQ-9 ISI
88. Galovski et al. 2016 [72] USA Adult female interpersonal
assault
survivors with sleep impairment
Sleep-directed hypnosis BDI-II PSQI
Gradisar et al. 2011 [73] Australia Adolescents (aged 11-18)
diagnosed with delayed sleep
phase disorder
Individual CBT plus morning
bright light
MFQ None
Ho et al. 2014 [74] China Adult internet users with insomnia
Online self-help CBT-I with HADS PSQI
RUNNING HEAD: EFFECT OF NON-PHARMACOLOGICAL
89. SLEEP INTERVENTIONS ON DEPRESSION SYMPTOMS
35
telephone support
Horsch et al. 2017 [75] Netherlands Adult with insomnia and
an
Android mobile phone
CBT-I delivered via an
automated mobile phone app
CESD PSQI
Hou et al. 2014 [76] China Adults with end stage renal
disease and comorbid insomnia
Individual CBT-I SCL-90 PSQI
Irwin et al. 2017 [77] USA Adult survivors of breast cancer
90. with insomnia
Group CBT-I IDS-C PSQI
Jungquist et al. 2010 [78] UK Adults with insomnia comorbid
with chronic pain
Individual CBT-I BDI ISI
Kapella et al. 2011 [79] USA Adults with insomnia and chronic
obstructive pulmonary disease
Individual CBT-I POMS-D PSQI
Lancee et al. 2012 [80] Netherlands Adult internet users with
insomnia Online self-help CBT-I
CESD SLEEP-50
Lancee et al. 2015 [81] Netherlands Adult internet users with
insomnia Online self-help CBT-I
91. CESD ISI
Lancee et al. 2016 [82] Netherlands Adult internet users with
insomnia Online guided CBT-I CESD ISI
RUNNING HEAD: EFFECT OF NON-PHARMACOLOGICAL
SLEEP INTERVENTIONS ON DEPRESSION SYMPTOMS
36
Lancee et al. 2017 [83] Netherlands Adult internet users with
insomnia
Attentional bias modification
training
CESD ISI
92. Lichstein et al. 2000 [84] USA Older adults (aged 58+) with
insomnia secondary to illness
Sleep hygiene, stimulus control
and relaxation
GDS None
Margolies et al. 2013 [85] USA Adult veterans with PTSD and
sleep disturbance
CBT-I combined with imagery
rehearsal therapy
PHQ-9 PSQI
McCurry et al. 1998 [86] USA Older adult (aged 50+) dementia
caregivers with sleep problems
93. Group educational and
behavioural intervention
CESD PSQI
McCurry et al. 2012 [87] USA Older adults with dementia
resident in small care homes
Sleep education for care-staff CSDD None
Mimeault & Morin 1999
[88]
Canada Adults with primary insomnia Self-help CBT-I with
telephone support
BDI PSQI
Morin et al. 2005 [89] Canada Adults with insomnia symptoms
94. Self-help CBT-I BDI-II PSQI
Moseley et al. 2009 [90] Australia Adolescent high school
students CBT-I-based classroom sleep DASS-21 None
RUNNING HEAD: EFFECT OF NON-PHARMACOLOGICAL
SLEEP INTERVENTIONS ON DEPRESSION SYMPTOMS
37
(aged 15/16) education programme
Nguyen et al. 2017 [91] Australia Adults with traumatic brain
injury
and sleep/fatigue complaints
Individual CBT-I adapted for
traumatic brain injury
HADS PSQI
95. Pigeon et al. 2012 [92] USA Adults with co-occurring chronic
pain and chronic insomnia
CBT for insomnia and pain CESD ISI
Riedel et al. 1998 [93] USA Adults with insomnia
Individual stimulus control
sessions
BDI None
Rios Romenets et al. 2013
[94]
Canada Adults with Parkinson’s disease
and insomnia
Sleep hygiene training, CBT-I
96. and bright light therapy
BDI ISI
Ritterband et al. 2012 [95] USA Adult internet users in
remission
from cancer with secondary
insomnia
Online CBT-I HADS ISI
Savard et al. 2005 [96] Canada Adult women with insomnia
secondary to breast cancer
Group CBT-I HADS ISI
Savard et al. 2014 [97] Canada Adult women with breast cancer
and insomnia symptoms who
Individual CBT-I HADS ISI
97. RUNNING HEAD: EFFECT OF NON-PHARMACOLOGICAL
SLEEP INTERVENTIONS ON DEPRESSION SYMPTOMS
38
received radiation therapy
Stremler et al. 2013 [98] Canada Adult women who had
recently
given birth for the first time
Sleep education and advice EPDS GSDS
Suzuki et al. 2008 [99] Japan Adult workers with a desire to
improve their sleep quality
Online CBT-based self-help
programme
98. K6 PSQI
Swift et al. 2012 [100] UK Adults who responded to a flyer
advertising sleep workshops
One-day CBT-I workshop BDI ISI
Talbot et al. 2014 [101] USA Adults with PTSD and insomnia
Individual CBT-I BDI ISI
Tang et al. 2012 [102] UK Adults with chronic pain and
insomnia
Individual hybrid CBT for
insomnia and chronic pain
HADS ISI
Taylor et al. 2014 [103] USA Adult college students with
99. insomnia
Individual CBT-I QIDS PSQI
Thorndike et al. 2013 [104] USA Adult internet users with
insomnia
Online self-help CBT-I BDI-II ISI
RUNNING HEAD: EFFECT OF NON-PHARMACOLOGICAL
SLEEP INTERVENTIONS ON DEPRESSION SYMPTOMS
39
Ulmer et al. 2011 [105] USA Adult veterans meeting criteria for
PTSD and insomnia
Sleep intervention for PTSD
100. (CBT and imagery rehearsal
therapy)
PHQ-2 PSQI
van Straten et al. 2009
[106]
Netherlands Adults with insomnia symptoms Self-help CBT-I
delivered via a
book and television
CESD SEF
van Straten et al. 2014
[107]
Netherlands Adults with insomnia Online CBT-I with support of
online coach
101. CESD PSQI
Wagley et al. 2013 [108] USA Adult psychiatric outpatients
with
low sleep quality and depression
symptoms
Two session individual CBT-I PHQ-9 PSQI
Watanabe et al. 2011 [109] Japan Adult psychiatric outpatients
with
depression and insomnia
Individual CBT-I HDRS PSQI
Abbreviations. BDI = Beck depression inventory; CBT-I =
cognitive behavioural therapy for insomnia; CDI = children’s
depression inventory;
CESD = centre for epidemiological studies depression scale;
CSDD = Cornell Scale for Depression in Dementia; CSRQ =
102. chronic sleep
reduction questionnaire; DASS = depression anxiety stress
scale; GDS = geriatric depression scale; GSDS = general sleep
disturbance scale;
HADS = hospital anxiety and depression scale (depression
subscale); HDRS = Hamilton depression rating scale; ISI =
insomnia severity index;
RUNNING HEAD: EFFECT OF NON-PHARMACOLOGICAL
SLEEP INTERVENTIONS ON DEPRESSION SYMPTOMS
40
K6 = Kessler psychological distress scale; MFQ = mood and
feeling questionnaire; PHQ = patient health questionnaire;
POMS-D = profile of
mood states depression subscale; PSQI = Pittsburgh sleep
quality inventory; SCI = sleep condition indicator; SCL-90 =
symptom checklist
103. RUNNING HEAD: EFFECT OF NON-PHARMACOLOGICAL
SLEEP INTERVENTIONS ON DEPRESSION SYMPTOMS
41
Figure Legends
Figure 1. Flow diagram of study selection process
Figure 2. Risk of bias graph
Figure 3. Forrest plot for meta-analysis of the effect of non-
pharmacological sleep
interventions on depression symptoms.
104. Section I
Evaluation of Potential Business Level Strategies
Factor/Consideration
Description
Business Level Strategy (Evaluate each of the five types below
for your selected company)
Assess the suitability of each strategy for the firm below
1. Cost leadership
2. Differentiation
3. Focused cost leadership
4. Focused differentiation
5. Integrated cost leadership/differentiation
105. Description of target customer/s for the selected strategy or set
of strategies
Value Chain Activities that allow firm to create value through
the selected strategy/strategies
Support Functions that allow firm to create value through the
selected strategy/strategies
Section II
Evaluation of Potential Corporate Level Strategies
Factor/Consideration
Description
Levels of Diversification – Low/Medium/High
106. Reasons for Diversification
Degree of Operational Relatedness
Degree of Corporate Relatedness
Market Power
Section III
Evaluation of Potential International Strategies
Factor/Consideration
Description
Benefits of adopting an International Strategy to the firm
107. Evaluate type of International Strategy for the firm
1. Multi-domestic
2. Global
3. Trans-national
Core Competency/ Mode of Entry
Expected Strategic Competitive Outcomes