Approaches to Treatment and Therapy: Case Study

Approaches to Treatment and Therapy: Case Study Case Study 1 (Phillip) Background Phillip is displaying multiple adverse psychological symptoms that would best fit the diagnosis of obsessive compulsive disorder (OCD). Specifically Phillip is a compulsive washer as he maintains a high level of cleanliness, having showers up to three times a day. He also only eats frozen food in order to avoid contamination and organises his furniture, making sure that they are all perpendicular to the wall. These compulsions are repetitive, purposeful behaviours designed to prevent or reduce anxiety (De Silva, 2003). Some, if not most, of Phillip’s anxiety arises from the intrusive thought of stabbing his mother which has become a clinical obsession because he believes that the thought has personal significance and meaning. This may be because Phillip has an inflated sense of responsibility and so believes that he is responsible for preventing the intrusive thought from actually happening (Rheaume et al., 1994). This has led to Phillip avoiding people, his Mother especially, but this has only increased the frequency and severity of his compulsions. It appears that Phillip is stuck in a vicious cycle of his obsessions and his compulsions feeding off one another and so intervention will be needed in order to help him. Theoretical Framework There are two central aspects of OCD, the cognitive aspects which include intrusive thoughts, obsessions and cognitive distortions, and the behavioural aspect of compulsions. In cognitive theory, intrusive thoughts (e.g. I want to stab my mother) occur automatically and usually have no emotional significance but can take on significance, depending on the context in which intrusions happen (England Dickerson, 1988). Such thoughts are very common and have been reported to occur in almost 90% of the population (Rachman de Silva, 1978) but once an individual deems these thoughts as significant it can cause distress and the belief that they are personally responsible for preventing the thought from actually happening. The distress caused by high levels of perceived responsibility has been found in multiple studies (Shafran, 1997; Roper Rachman 1975) as obsessional patients felt a lot more uncomfortable performing checking rituals when they were on their own and calmer when the therapis t was there as the patient felt less responsibility. This sense of responsibility is associated with both worry (Wells Papageorgiou, 1998) and OC symptoms (Salkovskis et al., 2000a). Specifically, the lowering of responsibility is associated with a significant drop in discomfort and need to check (Lopatka Rachman, 1995). One explanation for inflated responsibility is the ‘thought-action fusion’ (TAF) theory which suggests that obsessions occur in people who believe that thinking about a disturbing event is the same as doing it and that having an intrusive thought is morally equivalent to acting on said thought (Rachman, 1993; Shafran, Thordarson Rachman, 1996). TAF is an example of ‘thinking errors’ outlined by Beck (1976) which are used by most people all the time but can be detrimental when thinking errors become central to thought processes (Nisbett Ross, 1980). The most prevalent thinking error in those with OCD is that having any influence over the outcome means that you are responsible for the outcome. Due to the distress caused by the appraisal of intrusive thoughts, individuals aim to neutralise the anxiety caused through mental reassurance and overt compulsions (such as washing and checking) (Salkovskis, 1985). However attempts to neutralise the thought can sustain and potentially increase responsibility beliefs and the occurrence of intrusive thoughts. A common type of neutralising behaviour which is present in Phillip’s case is compulsive washing. Almost 50% of patients with OCD are compulsive washers (APA, 1994) and it is even more common in childhood cases of OCD like Phillip’s with 85% of young patients displaying washing rituals (Swedo et al., 1989b). It has been suggested that one of the main attributes of compulsive washers is perfectionism (Tallis, 1996). Tallis claims that most compulsive washers do not exhibit such behaviour because they are concerned about contamination or illness, instead they are more concerned with maintaining their environment perfe ctly and thus feeling fully in control. Research has found that there is a significant link between perfectionism and OCD in general, not just in compulsive washing (Bouchard et al., 1999). As Phillip appears to be displaying the perfectionist personality trait, it is important to consider this in therapy. As perfectionism has been found to correlate with depressive symptoms (Enns Cox, 1999; Flett et al., 1991) it is possible that a negative mood may be a factor in Phillip’s thinking errors. The mood-as-input theory (Martin et al., 1993) suggests that people use their mood as a factor to decide whether or not they have completed a task. When people are in a positive mood they are more likely to take their affect as a sign that they are progressing in a task and achieving more (Hirt et al., 1996). Whereas those in a negative mood experience the opposite and interpret their mood to mean that they haven’t progressed enough and so must continue with the task (Schwarz Bless, 1991; Frijda, 1988). This may occur because people in negative moods have been found to process tasks more extensively than those in positive moods (Mackie Worth, 1989). This is a significant theory for Phillip’s case as individuals with OCD tend to use internal states that are difficult to achie ve such as ‘having a gut feeling’ to help them decide when to stop compulsive behaviour (Salkovskis, 1998). They therefore have stricter personal requirements for making decisions and so what should be an automatic decision becomes a strategic one and the strict criteria have to be met before anxiety is reduced and the compulsive behaviour can stop (Salkovskis et al., 2000a). Problem Formulation Phillip presents all of the issues outlined in the theoretical framework which will act as the foundations for intervention. Figure 1 shows the main aspects of Phillip’s case and highlights his rules for living and the cycle in which he is trapped. From the information given in Phillip’s case, it appears as though the bottom line of his psychology is â€Å"I have to have full control over every aspect of my life† which may have been caused by authoritarian parenting (Timpano et al., 2010) or childhood trauma (Lochner et al., 2002) which have both been found to significantly correlate with OCD symptoms. Whilst there isn’t enough information about Phillip’s childhood to speculate if such things have happened to him, these are factors to bear in mind during treatment. This strict bottom line in Phillip’s life has led to certain maladaptive rules of living including his perfectionism (control over actions) and inflated responsibility (control over thoughts and feelings). He also has a generally negative mood as an input to his thought processes because he can never fully satisfy the strict standards that he sets himself. Then, when Phillip was a teenager he began experiencing intrusive thoughts about stabbing his mother. Such intrusive thoughts are not usually enough to trigger anxiety but due to Phillip’s rules of living, he finds personal meaning in the thought and feels responsible for preventing the thought from happening. This triggers anxiety and so he seeks to neutralise the thought through compulsive washing, arranging furniture and socially isolating himself. When these neutralising behaviours reduce his anxiety it reinforces Phillip’s thinking errors, his rules of living and his bottom line. Thus, when his anxiety is triggered again he repeats the behaviour and so Phillip is trapped in a cycle of his compulsions and obsessions reinforcing one another. Figure 1. Problem Formation flow chart for Phillip Treatment Intervention Phillip’s treatment can start with cognitive therapy aiming to focus and modify his thinking errors and inflated sense of responsibility. At the same time as this Phillip can take part in group therapy designed specifically to treat perfectionists. After these treatments and once Phillip feels ready to, he can move on to exposure and response prevention (ERP) using virtual reality to simulate dirty and contaminated environments. This will help him to control his compulsions and get him out of the obsessive-compulsive cycle. For Phillip, cognitive therapy will start by focussing on the distinction between intrusive thoughts and his negative appraisal of those thoughts. As outlined by Menzies and de Silva (2003), this begins by asking patients to reflect upon the last time they had an intrusive thought and what their behavioural reaction was to this thought. Phillip will then be encouraged to recognise that it was not the thought itself that cause his subsequent behaviour but how he interpreted the thought. It is important that the client understands the distinction between his intrusions and their appraisal before moving on to further intervention as it may otherwise confuse them. Next, Phillip taught about how common intrusive thoughts can be, to help him dismiss any feelings of shame or guilt that he may be feeling. It is suggested by Salkovskis (1999) that patients should be encouraged to view intrusive thoughts as a potentially positive and useful occurrence that can help with problem solving and for esight. The goal of this is not to eliminate their intrusions but to help them feel more positive by normalising them. Phillip is also encouraged to modify his responsibility appraisals in order to reduce his inflated sense of responsibility. Van Oppen Arntz (1994) found that even when people with OCD understand how unlikely it is that their intrusive thoughts will become reality, they continue to show compulsive behaviours because they feel a sense of responsibility to stop it from happening. Van Oppen Arntz (1994) suggest creating a pie chart with patients that they can divide up to represent the importance of factors that may contribute to a feared outcome. Once Phillip assigns percentage values to each factor he will be able to visualise that his role of responsibility is much smaller than he originally thought. This technique will help Phillip to reassess the overestimation of his responsibility and realise the importance of other uncontrollable factors. Whilst undergoing cognitive therapy Phillip will join group therapy to help him with his perfectionism. Ferguson and Rodway (1994) outlined a group therapy programme for perfectionism based on cognitive-behavioural theory. This programme will aim to help Phillip understand the problems that can arise from perfectionism and what strategies can be used in order to change his perfectionist way of thinking. The therapy will also be based on the outline provided by Kutlesa and Arthur (2007) which applies a psycho-educational approach to perfectionism, using interpersonal theory (Yalom,1995) as the psychological component which will ask Phillip and others in the group to focus on the present rather than worrying about the future. The educational component will use elements of cognitive-behavioural theory (Ellis, 1991; Beck, 1993) to teach the group about the thinking errors involved in perfectionism and skills to cope with and change these thinking errors. Once Phillip has made progress in both treatments and feels ready for the next step he will move on to ERP as a treatment for his compulsive behaviour. Firstly, Phillip will be steadily and gradually exposed to environmental triggers. He will write a list of situations in which he could be contaminated, started with the one that makes him the least anxious and working his way up to the worst. Most ERP treatments ask participants to experience these situations either through images or in vivo but a new method of virtual reality (VR) is being used in the treatment of OCD and it has been found to be effective (Kim et al., 2009; Belloch et al., 2014). Using VR, Phillip will then be exposed to the items on his list one by one, experiencing each one repeatedly until anxiety is completely reduced and Phillip is ready for the next item. Another aspect of this treatment is response prevention which aims to help patients control their compulsions in advance of triggering events (Meyer et al., 1974). This involves strategies such as using alternative behaviours and modifying compulsive rituals which can be integrated into the VR exposure. This treatment aims to expose Phillip to his triggers in a safe way reducing his anxiety for those situations and learning to control his compulsions in the process. Evaluation Using cognitive and behavioural treatments together is crucial for Phillip’s intervention as they both deal with either the obsessions and the thinking errors or the compulsions but not both. If only one of these elements is dealt with then it is likely that the other will return. Whilst cognitive therapy has been found to be potentially effective on its own (Cottraux et al., 2001) studies have found that when ERP is combined with cognitive therapy it produces lower dropout rates, greater general coping and decreased obsessive-compulsive symptoms (Kyrios et al., 2001; Freeston et al., 1997). A major aspect of Phillip’s case that wasn’t dealt with in cognitive-behavioural therapy that was not covered was his perfectionism. Research has found that CBT doesn’t significantly reduce perfectionist symptoms (Egan Hine, 2008) whereas Richards etal. (1993) found lower scores on perfectionism and depression scales and increased levels of self-reported wellbeing and self-esteem in response to group therapy. The incorporation of VR is a modern approach to ERP but it is one that is becoming very popular in the treatment of many anxiety disorders (Kim et al., 2009) and has been found to be as effective as in vivo exposure (Belloch et al., 2014). One aspect that wasn’t addressed in Phillip’s treatment is that of his family. As mentioned earlier it is possible that authoritarian parenting (Timpano et al., 2010) or childhood trauma (Lochner et al., 2002) could be involved in Phillip’s case as these are common causes of childhood OCD. There are family-based therapies that are shown to be effective in these cases (Lebowitz, 2013) but there wasn’t enough information about Phillip’s family to make such assumptions. If, in therapy, similar issues are revealed then family-based therapy may be very useful for Phillip. Also, little attention was given to biological factors even though pharmacological treatments are very effective in the treatment of OCD (Abramowitz, 1997; de Haan et al., 1997). This is because it would only tackle Phillip’s symptoms whereas cognitive therapy with ERP and group therapy will help Phillip to understand his rules of living, his bottom line, and how to potentially c hange or cope with this. References

An Inspector Calls - The Role Of the Inspector Essay -- English Litera

An Inspector calls - The Role Of the Inspector. The character of Inspector Goole is the catalyst for the evening's events and is quite a mystery and fascination to many people. He is described and comes across as able to create 'an impression of massiveness, solidity and purposefulnessà ¢Ã¢â€š ¬Ã‚ ¦' He speaks carefully, weightily and has a disconcerting habit of looking hard at the person he addresses. I will be carefully looking at how he manages to be so powerful and authoritative, mainly concentrating on the specific language and use of rhetorical speaking that he uses throughout the play. I will also mention the mystery of whether the inspector was an impostor and look at the broad possibilities, of which he may be, One of the most effective things that the Inspector manages to do is to have large power and control over the other characters and is seen by the reader as an immense man, despite the stage directions clearly stating that 'he need not be big'. He appears to be 'massive' because of the stares he gives people, and how he makes them feel so uneasy. He often stares the truth out of a character by doing so until they admit to have not been sincere with their story. He has a disconcerting way of speaking, a certain tone and pace of his voice, but also cleverly structures sentences as if he has planned it all out and using rhetorical speaking. He asks question after question, to the Birlings always receiving information but never giving anything, the most striking thing being that he is never once surprised at what he hears, as if he knows everything even before he hears it. On the account for the inspectors knowing and understanding the history of Eva Smith, Sheila says: 'Why - you fool - he knows... ...ew it all already, and then involved himself giving his view on their actions, criticising and blaming them. He seems very unprofessional and gets too worked up and emotional on such small things: 'Don't stammer and yammer at me again, man. I'm losing all patience with you people' This is a very unprofessional thing to say and shows that he does not treat the Birlings with the professional respect that should be expected. For dramatic effect he also goes into unnecessary detail of how Eva suffered and at some points gets quite personal and delicate with what he tells the Birlings about her. Again this is very unprofessional. No one will ever know exactly who the Inspector is, whether he is a time traveller from the future, Eva smiths ghost? And this leaves a great sense of mystery about the play, which I believe is one of its great qualities.

Effect of Stress on Beet Cells

The Effect of Temperature on Beet Cell Membranes Introduction In this lab, we are going to learn how the stress of temperature affects fresh beets. We have come to learn that cell membranes organize the chemical activities of cells. All cells are made of plasma membranes, often called fluid mosaics. It is sometimes described as a mosaic because it is made of protein molecules that are embedded into phospholipids. Phospholipids are the main structural support of the membrane and the proteins perform most of the functions of a membrane. Together they form boundaries or barriers between the cell itself and its surroundings, like the membrane of an egg. Plasma membranes also control what substances come in and out and also dispose of the cells waste. The membrane itself is composed primarily of phospholipids. Phospholipid molecules have two parts and form a sheet that has two layers, called a bi-layer. They are made up of two fatty acids which make up the tail end and the head is phosphate group. The head of this molecule is hydrophobic, which mean it is attracted to water and their tail is hydrophobic which means they dislike water. Together they form a bobby-pinned shaped barrier. Listed below is my hypothesis for this experiment. I hypothesize that tube 1 at 70 ° c the color intensity of leaked betacyanin will be 10. I hypothesize that tube 2 at 55 ° c the color intensity of leaked betacyanin will be 8. I hypothesize that tube 3 at 40 ° c the color intensity of leaked betacyanin will be 6. I hypothesize that tube 4 at 22 ° c the color intensity of leaked betacyanin will be 0. I hypothesize that tube 5 at 5 ° c the color intensity of leaked betacyanin will be 8. I hypothesize that tube 6 at -5 ° the color intensity of leaked betacyanin will be 10. Method The first thing that I did was label each test tube with numbers 1-6 and listed each corresponding temperature on the label. I cut six pieces of beet in the measurements that were given and rinsed them under tap water for 2 minutes. I then patted them with a paper towel to get off the excess water. I kept the pieces of beet in the paper towel while I got the other items ready. For the cold treatment I put one piece of beet in each beaker (5 and 6) and put tube 5 in the refrigerator and tube 6 in the freezer. I left them in there for 30 minutes. After 30 minutes, I covered each one with the same amount of tap water and let them soak for 20 minutes. After 20 minutes I took each beet out of the test tube, threw the beet away, but saved the colored water so I could chart later. For the room temperature and hot treatments I put each piece of beet into its marked test tube. For tube 1 (70 °c), I had to simmer water to get it to the correct temperature. I put the piece of beat into the beaker of water and waited one minute, I took it out and put it in beaker one, covered it with room temperature water and waited 20 minutes. Beet 2, 3 and 4 were all conducted the same way. I put the correct temperature of water into the beaker, let the beat soak for one minute, took the beet out of the beaker and covered with tap water in the test tube for 20 minutes. After 20 minutes I discarded all the beets so I could record my findings with the colored water that was left behind. Results: From doing this experiment I found that the more stressful environments you subject an item to the differently they act. It is cause and reaction. In tube number one the color intensity leak was at a ten, the highest number on the chart. I found that the heat seemed to open the pores of the beet to let the dye permeate the water. In tube 2 the color was at a 7. The water was still warm enough to allow the dye molecules to pass through the membrane. In tube 3, the water was at 40. This is still warm but not the color was not nearly as intense as the previous tube. The next tube charted was tube number 4. The beet was subjected to a temperature of only 22 °c. That temperature I would chart as â€Å"room temperature†. I found that the least amount of dye was leaked from the beet. For the cold methods I concluded that the amount of betacyanin that escaped from the cell membrane was intense, like the hot treatment results. I concluded that it didn’t have to be hot temperature stress to release betacyanin. Tube number 5 was placed into the refrigerator and the level of dye that permeated the water was charted at a 6. Tube 6 was placed in the freezer and was documented at a level of color intensity of a ten. Also, when the tube was pulled from the freezer the specimen has noticeably changed. It has a slight white, almost white frost or texture to it. Please see attachment and table below. Test Tube numberTreatment  °CColor Intensity (0 – 10) 170 10 255 7 340 5 422 1 55 6 6-5 10 Discussion I believe the result came out the way they did because of level of stress I put the beet through. When damage is done to a cell membrane it affects the entire vegetable. When the beet was put in such hot temperatures the cell membrane started to break down and leak the pigment through the cell wall, since the cell is semi-permeable. Like we spoke about in our text book, the cell membrane lets small molecules to pass through. When the beet was heated to 70 °c or cooled to -5 °c it was subjected to much more stress that at a normal room temperature, which the beet is grown and stored at. The various temperatures make the beet release its pigments. The extreme hot and cold acted as energy for the beet to release the red dye. The structures need to have a stable environment in order to establish their structure. My hypotheses were correct, for the most part. My numbers were not exact, but I had the general idea of what I thought would happen. I thought that the more stress you put on to a beet the great amount of pigment you would receive out of it. I figured that beets were stored at room temperature so if you put them in water that was the same temperature as the room it wouldn’t cause stress on the membrane, hence the least amount of pigment leakage. I was surprised at the amount of pigment that came from the beet. When I first cut the beet the pigment was all over the cutting board and the knife, not to mention by hands. Accuracy is key. Unfortunately, no matter how hard we strive to do things perfectly sometimes there are variables that can affect how the results are derived. In my experiment, I tried to cut each beet with precision. It is almost impossible to cut each beet the exact same and this could have slightly affected how my beets reacted to each session. The larger the surface of the beet the more pigment the beet has in it to release. Another variable could also be the freshness of the beets. My beets where purchased 1200 kilometers and two countries away from where I did the experiment and weren’t extremely firm like they should be. After doing research, I found that the older the beet is the more pigment it has. That could give me not as true of a reading. The last variable I could have experienced was the temperature of the room. The day the experiment was held it was 1 °c outside , so the heater was running full speed all day. I think the experiment could have had more true results if the room was at a more normal temperature. I think while doing the experiment the beets could have dried out slightly from the air in the house being so warm. When working with patients you need to understand the symptoms they have in order to help them. Let’s say I had a man with cancer come into the hospital and I was in charge of monitoring his pain level. If the man was on two different pain medications I would need to know how the two medications worked with each other in order to successfully help him. I would have to know how Morphine worked with Aspirin or how Motrin interacted with Tylenol. Having done this experiment, it has helped me understand how there is cause and effect to everything that we do on a daily basis. If I gave the man 10 cc’s of Motrin I can give him a Fentanyl lozenge later in the day if he is still in pain. That way I keep the side effects, such as nausea, to a minimum without overdoing the amount of morphine I give him. Also doing this experiment has given me the faith in myself to know that I can take action and do experiments, charting, researching and investigation if I want to know why something happens the way it does.

5 Youtube Vloggers That Will Teach You How to Study

Have you ever thought about an older student mentoring you through the studies? If you haven’t met such a person yet, you can find one on YouTube. You can subscribe to one of the popular student vloggers and get first-hand studying tips from them. They will share their own experience of being a student and provide you with the necessary tricks to deal with various assignments in the situations when you’re short of time. We’ve picked 5 YouTube channels below. You can check out all of them or pick one vlogger and stick with him or her. 1. Study with Jess Source: https://www.youtube.com/watch?v=6odItDlW8zI Jess, an Australian-based vlogger, has 76,000 subscribers to her YouTube channel. In her bio, she mentions that she studies Psychology, is â€Å"obsessed with yoga and business,† and that she can help her viewers become more effective in their studies. In her videos, she gives tips on how to better organize time or how to beat procrastination, how to learn a foreign language, or how to process information faster. If you can’t find a tip on something in particular, you can contact Jess via the comments on her channel, one of her email addresses, or by writing her a real paper letter —  she’s provided her home address and her About page as well. 2. Ana Mascara Source: https://www.youtube.com/watch?v=p9MIjLPrhdc Ana Mascara states that her mission is to make the studies fun. A Romanian-born vlogger from Canada with over 3,500 subscribers says that she had to deal with her studies on her own, which is why she wants to share her experience with fellow students around the world. Apart from tips on taking tests, getting the most of textbooks, and listening to boring lectures, Ana also talks about her favorite books, modelling, and many other things. She also has a psychology-themed playlist where she talks about things like overcoming fears and sadness. 3. Jane Jady Source: https://www.youtube.com/watch?v=j7Dgodvj7Uw You will find this vlog useful especially if you are studying in med school. Jane and Jady are ready to take you through the typical life of a medical student in the US. In their videos, they are mostly talking about things, driving a car, attending lectures, or traveling. They also have a playlist with school-related videos where they share their experience of, for example, having four exams in one day. They have over 15 thousand subscribers. 4. Clarissa Source: https://www.youtube.com/watch?v=13F1G7exfOo Clarissa started her YouTube channel 6 years ago. At first, it was a beauty-and-health blog, and then she added some great college-related videos on studying tips and the student life. Clarissa has over 5,000 subscribers, and you can join too if you want to get useful tips on different things from writing an essay to eating healthily on budget. 5. College Info Geek Source: https://www.youtube.com/watch?v=ib98J80AUNs Thomas Frank has nearly 180,000 subscribers, and he majored in Management Information Systems. He has been active on YouTube for a year, and before that, he wrote a college-related blog. Thomas’ channel is both helpful and entertaining, and you will find it useful in battling procrastination or studying more effectively. Here are only 5 vloggers that will help you with your studies. There are more of them on YouTube who are also worth watching. Hopefully, you’ll find your personal mentor among them who will help you to be a happier and more successful student.