The American Flag And Its Growing Controversy Essays -

The American Flag And Its Growing Controversy The American Flag and its Growing Controversy Step 1: Details The American flag, to many, is the symbol of life and liberty. Freedom from oppression and the ability to run one's own life with minimal government intervention is what our country fought for all those years ago. The day after the SpanishAmerican War was declared, schools mandated the worship of the flag (Kaminer). So, when the issue of burning our great flag arises, everyone should be against it, right? Well, not exactly. The first amendment of the Constitution states that American citizens have the right to express themselves through free speech. Essentially, burning the American flag is speech without dialogue. Therefore, according to the Constitution, flag desecration is legal. However, flag protectionists are not going to give up that easy. The main controversy surrounding this issue is whether an amendment forbidding flag burning would infringe on our first amendment rights. In 1989, the Supreme Court ruled that flag desecration was protected under our first amendment rights. In 1995, a constitutional amendment that would have given Congress the power to ban flag desecration was introduced to the Senate and the House of Representatives (Kaminer). The amendment passed through the House but failed in the Senate by a mere three votes. In February 1997, a similar amendment was again introduced to the Senate and the House Sell 2 Of Representatives (Kaminer). It also failed, but it does show the growing concern about the issue of flag burning. Protectors of the flag argue that burning an American flag is like spitting in the face of America and its democracy. On the other hand, flag burners argue that under America's democracy, they were given the right to express themselves freely. Obviously, this issue may never be settled with a positive outcome. Some arguments that flag burners have raised in their own defense include such things as having a flag bumper sticker on a car. They believe that if they cannot burn a flag because it is considered desecration, then an old, faded bumper sticker should be considered desecration as well (Apel). This brings up a valid point. Who decides where the line should be drawn between desecration and patriotism? Step 2: Obligations, Ideals, and Consequences As this issue continues to be brought up in our government, the obligations for everyone involved will continue to rise. Congress has the most important obligation of all. They are not only obligated to resolve the issue, but they are also obligated to American citizens in a way that is supposed to be unbiased. On the other hand, citizens are also obligated to understand and respect the government's decision. Not everyone is going to be happy no matter what decision is made, so we as a society are obligated to respect each other's views and morals. Ideals play a very important role in the issue of flag desecration. Ideals serve as the basis for actions. Obviously, social responsibility is an ideal that needs to surface when an issue is dealing with the Constitution. If an amendment is ever added to the Sell 3 Constitution making desecration of the flag illegal, the public has to be ready to deal with it, and follow it. Our government, however, needs to practice the ideal of fairness and integrity when such an issue is brought up. They need to listen to all sides and decide which course of action will contribute to the greater good of the country. After this issue is finally settled, it will be interesting to learn what consequences are adopted for flag burning (considering it becomes illegal). It will also be interesting to find out where the line would be drawn for flag desecration. Who knows? I might be arrested for wearing my flag swimming trunks to the beach. Again, our government has to be prepared to back up their decision, and that includes such consequences as dealing with protestors. Step 3: Possible Courses of Action Coming to a decision on this issue is going to take time. There will be a group, or groups that will feel like they have been cheated. Nevertheless, they need to realize that the government is taking what they feel is the best possible course

In Retrospect essays

In Retrospect essays Robert McNamara In Retrospect Random House New York, 1995 Vietnam had long since been a place of controversy, and where our government focused its fear of communism for many years. Throughout the Kennedy and Johnson administrations the government maintained that the war between the Communist north and the south can only be won by the South Vietnamese, and that our military cannot win it for them. It stressed that the fall of South Vietnam to communism would threaten the rest of the western world. Robert McNamara, the Secretary of Defense during the Kennedy and Johnson administrations, wrote In Retrospect because he wanted to Put Vietnam in context,(xx). McNamara wanted to explain why the mistakes of Vietnam were made, not to justify them, but to help the American public understand them. He relies not only upon his memories, but upon People have often called Vietnam, McNamaras war, because he made it his responsibility. As he learned more and more about south Vietnam, he became well acquainted with its leader Ngo Dinh Diem. Diem portrayed himself as a man who shared our western values. Though as our government would soon realize he was not the man we had hoped for. Diem needed to be removed from power, he was becoming more and more unpopular with his people. The Kennedy Administration seemed split on how democratic Diem really was. His conflicts between the Buddhists and Catholics were becoming more outrageous than ever. The administration supported a generals coup to get Diem out of power. Diem and his brother Nhu were both assassinated during this coup. On November 22, 1963, Kennedy, himself, was also assassinated on the streets of Dallas. McNamara poses many questions as to whether the war would have continued on the same route had Kennedy not been killed. McNamara feels that had Kennedy lived he would have pulled us out of ...

Most vs. Almost

Most vs. Almost Most vs. Almost Most vs. Almost By Maeve Maddox A reader wonders why some speakers write â€Å"most everybody† when what they mean is â€Å"almost everybody.† For example: Most everyone agrees that children benefit from living with two caring parents. â€Å"Most everyone† is commonly heard in colloquial speech but is avoided in formal speech and writing because most is a superlative. Most refers to the greatest part, number, amount, or extent of something: I have finished most of my chores. Most dogs have tails. That’s the most awesome song on the album. Almost is used to convey the idea of something nearly completed or close to being finished: Mr. Henry has almost finished building the bridge. We almost won the game. Almost everyone agrees that children benefit from living with two caring parents. The objection to â€Å"most everyone,† and â€Å"most anyone† is that most applies to quantities capable of being separated. One can say â€Å"Most dogs have tails,† but not â€Å"Most dog have tails† or â€Å"Most dog have a tail.† Apart from surgery or mutilation, dog is not divisible. Neither are words like everybody, everyone, all, and any. The use of most in the following examples is nonstandard because the word is being used to qualify something that is not divisible: Incorrect: Most everyone agrees that cheating is bad. Correct: Almost everyone agrees that cheating is bad. Incorrect: I think most everybody will agree that summer flies by too fast. Correct: I think almost everybody will agree that summer flies by too fast. Incorrect: I feel like most all of my friends are fake. Correct: I feel like almost all of my friends are fake. If you find yourself writing most when what you mean is nearly or approximately, change it to almost. Want to improve your English in five minutes a day? Get a subscription and start receiving our writing tips and exercises daily! Keep learning! Browse the Misused Words category, check our popular posts, or choose a related post below:How to Structure A Story: The Eight-Point ArcDoes "Mr" Take a Period?What’s the Best Way to Refer to a Romantic Partner?

Personal essay on one thing I would change in the world

Personal on one thing I would change in the world - Essay Example I grew up in a small village, where I saw girls aged five or six, carrying younger siblings, and begging on the streets for food. They were dirty, unkempt and wore clothes that were little more than rags. I wondered, why their parents would not give them enough to eat, till I was told that their parents probably gave them all they had, and went hungry themselves. They lived in hovels, and often while the older children begged, the younger ones were asleep on the roadside probably having exhausted themselves crying. As I grew up, and left the village to pursue my studies in a bigger town, these images stayed with me. However, to my dismay, I found that there were more such beggars there, than I had seen in my village. It struck me then, that I lived in a poor country where poverty was a curse suffered by large numbers of the population. It was at this stage of my life, that I made up my mind to do my bit to ease the pain of these poor, unfortunate people. My parents were happy to see that I felt so much sympathy for those less fortunate than me, and encouraged me to do small things like offering food, sweets or clothes to poor people nearby on my birthday, instead of having a party for my friends. Fortunately, my school too was at the forefront of social work, involving educating those who did not have the means to go to a proper school. We students, were taken to nearby rural areas, to mingle with the villagers and understand their problems. We also sometimes helped the younger children with t heir homework, and encouraged them never to stop their schooling, because many children are forced to stop going to school, and instead help their parents out in small jobs. As I graduated from high school, I realized that the means to end poverty was education. I found that poor children were less healthy, and more prone to disease than their peers in more advantaged homes. Living in unhygienic surroundings, and never having the benefit of being educated in the

Adult Crime, Adult Time Essay Example | Topics and Well Written Essays - 500 words

Adult Crime, Adult Time - Essay Example Other non-violent offenses include skipping classes, violating the curfew laws, and running away from home (Stahl). The US crime law requires the juvenile offenders who are below the age of 18 should be treated rather than be punished. I strongly support the idea that juvenile offenders should not be treated the way adult criminals are being punished. In line with this, several reasons will be provided in order to strengthen this argument. Reasons behind the Argument There is a negative psychological impact associated with the idea of mixing the juvenile offenders with the adult prisoners. Several studies revealed that most children and young adolescents have not yet fully develop their critical thinking abilities. Since the adult offenders can easily influence and affect the emotions, attitude and behavior of the juvenile offenders, the act of mixing the juvenile offenders with the adult offenders could only worsen the situation. According to Siegel and Welsh, â€Å"social issue re lated to racism and despair could lead to the development of juvenile delinquency† (118). It means that the act of labeling a juvenile offender as a criminal offender could make the child accept the idea that he or she is a criminal.

Late Adulthood Essay Example for Free

Late Adulthood Essay As we all get older we wonder what is going to happen to us. What does our body go through and why? Do you ever wonder why things happen when you get older instead of happening in your middle age time of life to prepare you for what is coming and help you deal with things a little easier? What happens to your mind and why does it happen? Well, those are just some of the things that go through the people in the late adulthood. Some of the questions are always asked by people that are in their late adulthood. My research is important because, it will help people in the late adulthood better understand what happens as they get older and help the middle age people understand what they may go through as they get older. Everyone’s body ages differently and some just do not understand what can happen or what may happen. To help the people in the world through life a little easier and maybe even give them a chance to get the help they need before it is too late and things get worse or causes more problems with themselves or their families. The study will help us better understand the different life spans of a human through their different stages in life. Help understand why our mind is not as functional as it was in our middle age time. Help understand why our body changes with time. This study will help the people as much as it will help us. We may be able to find a way to help the middle age prevent from going to memory loss and even psychology show them that there is maybe a way to go through a process in their time of age a little easier to where we can keep them from getting an eating disorder and find out why that happens when they get older. This will help us better understand why Alzheimer’s is just a problem and maybe do some research and see if we could understand mentally where they are in the state of mind they in and better understand this disease. This study will consist of talking to different middle aged and late aged people. We will be doing a lot of different memory test as well as psychological tests. The research that I have done so far as far as the middle age as well as the late age group of people and have found it very interesting how to different age groups are going through similar experiences mentally and physically in life with their body as well as their minds and also and most important emotionally. The similarity was very interesting because, I asked a 40 year old person and then asked a 61 year old person the same questions and one being a female and the other a male and the answers were very similar and that is amazing and made me wonder why and how that is. My intent is to find out the why the middle age starts at a certain age and what the difference between the middle age to the late age besides the ages. Why people feel after they get to a certain age they feel their feelings and emotions change. Why do they feel that they are not attractive besides their age? Why do they start losing their memory at a certain age? Why is the depression is so much stronger when they get to the late adulthood and why it starts hitting at the middle age, people start getting scared and feels that their lives are ending instead of making their lives the best everyday they are alive. This study is a long study that will take a while to do. If we do the right test and a lot of observation we should be able to show some progress and theories on why things happen the way they do. This research will help us better understand the different stages of life and maybe help make it a little better for the process of aging and better understand. As people get older they feel that no one understands what they are going through. Well, I want them to understand that there are some people out that are willing to try to understand what they are going through in life as well as emotionally and physically. There are a lot of people that are denying what is going on with them and they are looking for help. Researchers have tried to understand the different stages of life but, that was in the past. There has been a lot of change and a lot more discoveries in the world today and new research and understanding has to be done. So with the new research we do and explore more depth into our research to figure out what wasn’t figured out in the past or figure out what is new and why that happening is will better help the people as well as the future researches that are going to wonder the same things or start were we left off. Do you sit back and wonder why we deny that we are getting older? Why do you think that is? Do you wonder why you get as depressed as you get older and you feel like you are just not you anymore? Do you wonder why your acceptance of who you are is not the same which in return sends you on many other paths in life? With this research it may answer a lot of these questions and maybe even more. There is so much to learn we just need the chance to do it and better understand the life development.

M Butterfly :: Madama Butterlfy

I think Song's "rules" may possibly be accurate in his/her mind. After all, Song has deceived a somewhat intelligent individual for over twenty years. I saying , Song :"Rule One is " Men always believe what they want to hear." ( 82 ) I don't think that is entirely accurate,but Song has proven it to be throughout the play in dealing with Gallimard. So basically in that area Song's "rule" applies. Gillimard wanted to believe his "love" was indeed a young , Oriental woman. He refused to acknowlege otherwise because that was his " fantasy". However, I must disagree when "Rule One" also states, Song: " So a girl can tell the most obnoxious lies and the guys will believe them every time--" (82 ) Again, as far as Song's relationship with Gillimard is concerned, it is again truthful. However, I think that would be an extreme exaggeration in speaking of "men" in general, even in terms of "men" in this play. I don't think Song could have fooled Marc for very long. I think perhaps we see some of Hwang's own experiences in his life poking through into the play. As Song explains , Rule Two: " The West thinks of itself as masculine--big guns,big industry, big money--so the East is feminine--weak, delicate, poor...but good at art, and full of inscrutable wisdom--the feminine mystique." ( 83 ) It's possible Song interprets the West as such, at this point. If this is so, however, why does he/she also state, Song: "The Chinese men--they keep us down." ? ( 43 ) It seems, at the tender age that Song is, everyone is keeping him/her "down". The men from the West, as well as men from the East. And yet Song seems to think as well, the East is somewhat powerful, deep inside.

Rational Planning Essay

Verifying, defining & detailing the problem (problem definition, goal definition, information gathering). This step includes recognizing the problem, defining an initial solution, and starting primary analysis. Examples of this are creative devising, creative ideas, inspirations, breakthroughs, and brainstorms. The very first step which is normally overlooked by the top level management is defining the exact problem. Though we think that the problem identification is obvious, many times it is not. The rational decision making model is a group-based decision making process. If the problem is not identified properly then we may face a problem as each and every member of the group might have a different definition of the problem. Hence, it is very important that the definition of the problem is the same among all group members. Only then is it possible for the group members to find alternate sources or problem solving in an effective manner. Generate all possible solutions This step encloses two to three final solutions to the problem and preliminary implementation to the site. In planning, examples of this are Planned Units of Development and downtown revitalizations. This activity is best done in groups, as different people may contribute different ideas or alternative solutions to the problem. Without alternative solutions, there is a chance of arriving at a non-optimal or a rational decision. For exploring the alternatives it is necessary to gather information. Technology may help with gathering this information. Generate objective assessment criteria Evaluative criteria are measurements to determine success and failure of alternatives. This step contains secondary and final analysis along with secondary solutions to the problem. Examples of this are site suitability and site sensitivity analysis. After going thoroughly through the process of defining the problem, exploring for all the possible alternatives for that problem and gathering information this step says evaluate the information and the possible options to anticipate the consequences of each and every possible alternative that is thought of. At this point optional criteria for measuring the success or failure of the decision taken needs to be considered. Choose the best solution generated This step comprises a final solution and secondary implementation to the site. At this point the process has developed into different strategies of how to apply the solutions to the site. Based on the criteria of assessment and the analysis done in previous steps, choose the best solution generated. These four steps form the core of the Rational Decision Making Model. Implement the preferred alternative This step includes final implementation to the site and preliminary monitoring of the outcome and results of the site. This step is the building/renovations part of the process. Monitor and evaluate outcomes and results This step contains the secondary and final monitoring of the outcomes and results of the site. This step takes place over a long period of time. Feedback Modify the decisions and actions taken based on the evaluation. 1. Planner defines the problem (not goal) 2. Planner considers several alternatives and analyzes each 3. Preliminary choices of the alternative for best fit considering feedback and impact of the client group 4. Planner designs and implements course of action in the form of an experiment 5. Evaluation of effects of the course of action. Did it alleviate the problem? Any feedback from course of action? 6. On the basis of the feedback should the project or course of action be continued, changed, etc. If effective institutionalize the course of action.[2] Requirements and limitations However, there are a lot of assumptions, requirements without which the rational decision model is a failure. Therefore, they all have to be considered. The model assumes that we have or should or can obtain adequate information, both in terms of quality, quantity and accuracy. This applies to the situation as well as the alternative technical situations. It further assumes that you have or should or can obtain substantive knowledge of the cause and effect relationships relevant to the evaluation of the alternatives. In other words, it assumes that you have a thorough knowledge of all the alternatives and the consequences of the alternatives chosen. It further assumes that you can rank the alternatives and choose the best of it. The following are the limitations for the Rational Decision Making Model: ââ€" ª requires a great deal of time ââ€" ª requires great deal of information ââ€" ª assumes rational, measurable criteria are available and agreed upon ââ€" ª assumes accurate, stable and complete knowledge of all the alternatives, preferences, goals and consequences ââ€" ª assumes a rational, reasonable, non – political world Current status While the rational planning model was innovative at its conception, the concepts are controversial and questionable processes today. The rational planning model has fallen out of mass use as of the last decade. Rather than conceptualising human agents as rational planners, Lucy Suchman argues, agents can better be understood as engaging in situated action.[3]. Going further, Guy Benveniste argued that the rational model could not be implemented without taking the political context into account[4]

The Need of Imposing One Child Policy in the US

Due to the raging rise of population in America, extreme measures with regard to the aim of decreasing the flaming populace had been introduced to the country’s legislative body.   Such attempt had been regarded as that which will eventually help the country’s level of productivity and societal developments aimed for industrialization reasons and thus are expected to raise the welfare of the contemporary society as well as the future of Liberty (Menken). Depletion of resources and environmental degradation The need for the implementation of a law which shall oblige the citizens to take necessary measures and constraints with regard to irresponsible ‘sexual’ intercourse leading to unexpected pregnancy and overpopulation had been sought to be a major problem in America (Fong).   As anticipated with the enormous rise, environmentalists and population development analysts stated that in the near future, with such behavior, America will most likely starve and get intoxicated with their own mess (Fong). One fascinating stand on a peer review stated that such has a big difference between â€Å"water† and â€Å"drinking water,† thus connotes the idea that of this scam of intoxication caused by â€Å"the big kids on the block† themselves, is harmoniously tolerated, then most likely there won’t be enough water for the whole jurisdiction of this country, and worse, it may also affect the production of what is edible, at that standpoint. This paper need not to specify and dwell further on the importance of H2O for this instance to take holistically the perception of the necessity of the aforementioned element to humanity (Menken).   Further, as supported by UN Population Fund, it had been noted that rampant rise of environmental and sociological challenges is manifested because of the uncontrollable mount of population in the country; moreover, the most effective cure of the society’s disease shall be the initiation of measures defining â€Å"behavioral constraints† and that is with the help of a law (Fong). Overpopulation Various advocates and analysts like Ted Turner stressed the need of China’s policy to also be adopted in the country.   Moreover, he has emphasized in his argument that America is becoming â€Å"too populated† due to the rise of migration instances and the increase of liberalism perception among its inhabitants making the concept of â€Å"freedom† expand even until the level of â€Å"sensuality.†Ã‚   With such regard, the increase of number of individuals settling in the country connotes the concept that the echelon of adversity will rise in number, and the need of flexibility among the â€Å"pure Americans† coerces them to divulge in a rather larger scope of adjustment and acceptance in the vortex of status quo (Alternatives). In addition to that, if it may not be too much to take into assumption, competition shall float up in the scenario, this paper does not encourage American couples to bear more fruits, but rather, to engage in â€Å"responsible† parenthood and focus instead in raising their offspring to be highly competitive individuals not only for the benefit of the immediate time, but for future’s sake, at that (Fong). Analysis on stated arguments What seemed to be the problem over the issue is that, many seem to not understand why such policy obliges the legislative body to act upon it in the most immediate time.   Perhaps the rise of complications had not yet been explicitly felt by Liberty’s citizens; however, we take notice with the idiom stating that â€Å"regrets come in the end†.   Taken for example the â€Å"environmental concerns†, Americans must face the truth of nature’s control; moreover, this specific argument is emphasized in John McPhee’s Control of Nature, perhaps it never crossed the mind of one’s rationality, but the tendency of it to occur is vast and, co-related with the perception on ‘overpopulation’. Moreover, the vast changes which had been occurring due to the raging response of human being’s level of rationality as well as with the exploration of new dimensions in making life easier through the use of machineries and other intoxicating components further gives a mount on the ratio of making earth a place of pollution and thus, congruent with the argument revolving around the implication of overpopulation denoting a declination of the economic state of the country anchored on the issue of employment concerns and the array of competition among workers (Menken).   The more diverse the culture outstands, the higher the possibility of racial gaps seemingly surfacing in the scale of development (Alternatives). In comparison with the discussions laid on the table, it is prudent enough to conclude that the main reason why national analysts swim in the idea of imposing ‘one-child policy’ shows their greatly concern of the future of the west and the stability of its economy.   All of the variable elements and commonsensical statements logically fall into one major blast: overpopulation. If diagramed in a web of complexity, the core element of the problem would be overpopulation, inter-connected with the plight of environmental, social, economical and political implications, thus give credit to the impression of making America a ‘one-child policy’ abiding country. Conclusion The threat which haunts the country is a contagious disease which shall surely swallow humankind if not cured in accordance with proper and crucial analysis in expunging the problem.   Industrialization and the art of making love is a freedom vested to individuals, however, the complications comprising an unsolicited control on such hook up with unpredicted circumstances.   The aforementioned essential nature of the proposition is proof enough of humanity’s concern and active involvement on development and stability. Perceivably, the most crucial problem with regard to population is the issue on pollution.   Given the fact that the innovation of technological and machinery advancement emit a raging amount of intoxicating substance, with more people exercising such is most likely the predicted horror which will sooner or later, if not eradicated with the implementation of a policy aiding the ascending population, shall haunt the living daylights of the country in the near future. References: Alternatives, Center for Policy. Progressive Agenda for the States 2006: State Policy Leading America New York: Center for Policy Alternatives, 2005. Fong, Vanessa. Only Hope: Coming of Age under Chinas One-Child Policy. 1 ed. Chicago IL: Stanford University Press, 2004. Menken, Jane. World Population and U.S. Policy: The Choices Ahead. New York: W. W. Norton & Company, 1986.   

Top 10 Womens Health Issues and Causes of Death

Top 10 Women's Health Issues and Causes of Death When it comes to womens health, what are the top 10 womens health issues you should be concerned about? According to a 2004 report by the U.S. Centers for Disease Control, the conditions described below are the top 10 leading causes of death in females. The good news is that many are preventable. Click on the headings to learn how to reduce your risk: 27.2% of deathsThe Womens Heart Foundation reports that 8.6 million women worldwide die from heart disease each year, and that 8 million women in the U.S. are living with heart disease. Of those women who have heart attacks, 42% die within a year. When a woman under 50 has a heart attack, its twice as likely to be fatal as a heart attack in a man under 50. Almost two-thirds of heart attack deaths occur in women with no prior history of chest pain. In 2005, the American Heart Association reported 213,600 deaths in women from coronary heart disease.22.0% of deathsAccording to the American Cancer Society, in 2009 an estimated 269,800 women will die of cancer. The leading causes of cancer deaths in women are lung (26%), breast (15%), and colorectal cancer(9%).7.5% of deathsOFten thought of as a mans disease, stroke kills more women than men each year. Worldwide, three million women die from stroke annually. In the U.S. in 2005, 87,000 women died of stroke as compared to 56,600 men. For w omen, age matters when it comes to risk factors. Once a woman reaches 45, her risk climbs steadily until at 65, it equal that of men. Although women arent as likely to suffer from strokes as men in the middle years, theyre more likely to be fatal if one occurs. 5.2% of deathsCollectively, several respiratory illnesses that occur in the lower lungs all fall under the term chronic lower respiratory disease: chronic obstructed pulmonary disease (COPD), emphysema, and chronic bronchitis. Typically, about 80% of these diseases are due to cigarette smoking. COPD is of particular concern to women since the disease manifests differently in females than males; symptoms, risk factors, progression and diagnosis all exhibit gender differences. In recent years, more women have been dying from COPD than men.3.9% of deathsSeveral studies involving European and Asian populations have indicated that women have a much higher risk of Alzheimers than men. This may be due to the female hormone estrogen, which has properties that protect against the memory loss that accompanies aging. When a woman reaches menopause, reduced levels of estrogen may play a role in her increased risk of developing Alzheimers.3.3% of deathsUnder unintentional injuries are six major c auses of death: falling, poisoning, suffocation, drowning, fire/burns and motor vehicle crashes. While falls are of significant concern to women who are frequently diagnosed with osteoporosis in their later years, another health threat is on the rise accidental poisoning. According to the Center for Injury Research and Policy at Johns Hopkins, in a six-year study between 1999 and 2005, the rate of poisoning deaths in white women age 45-64 increased 230% as compared to the 137% increase experienced by white men in the same age. Diabetes3.1% of deathsWith 9.7 million women in the U.S. suffering from diabetes, the American Diabetes Association notes that women have unique health concerns because pregnancy can often bring about gestational diabetes. Diabetes during pregnancy can lead to possible miscarriages or birth defects. Women who develop gestational diabetes are also more likely to develop Type 2 diabetes later in life. Among African American, Native American, Asian American women and Hispanic women/Latinas, the prevalence of diabetes is two to four times higher than among white women.and2.7% of deathsPublic awareness of the dangers of influenza has spiked due to the H1N1 virus, yet influenza and pneumonia have posed ongoing threats to elderly women and those whose immune systems are compromised. Pregnant women are especially vulnerable to influenzas such as H1N1 and pneumonia.1.8% of deathsAlthough the average woman is less likely to suffer from chronic kidney disease than a man, if a woman is diabetic , her chance of developing kidney disease increases and puts her equally at risk. Menopause also plays a role. Kidney disease occurs infrequently in premenopausal women. Researchers believe that estrogen provides protection against kidney disease, but once a woman reaches menopause, that protection is diminished. Researchers at Georgetown Universitys Center for the Study of Sex Differences in Health, Aging and Disease have found that sex hormones appear to affect non-reproductive organs such as the kidney. They note that in women, the absence of the hormone testosterone leads to a more rapid progression of kidney disease when they are diabetic. 1.5% of deathsThe medical term for blood poisoning, septicemia is a serious illness that can rapidly turn into a life-threatening condition. Septicemia made headlines in January 2009 when Brazilian model and Miss World pageant finalist Mariana Bridi da Costa died from the disease after a urinary tract infection progressed to septicemia. Sources:Deaths From Unintentional Injuries Increase For Many Groups. ScienceDaily.com. 3 September 2009.Estimated New Cancer Cases and Deaths by Sex, United States, 2009. American Cancer Society, caonline.amcancersoc.org. Retrieved 11 September 2009.Heart Disease and Stroke Statistics - 2009 Update at a Glance. American Heart Association, americanheart.org. Retrieved 11 September 2009.Leading Causes of Death in Females, United States 2004. CDC Office of Womens Health, CDC.gov. 10 September 2007.Women and Diabetes. American Diabetes Association, diabetes.org. Retrieved 11 September 2009.Women and Heart Disease Facts. Womens Heart Foundation, womensheart.org. Retrieved 10 September 2009.Women More Likely To Suffer Kidney Disease If Diabetic. MedicalNewsToday.com. 12 August 2007.

Cbt Case Study

She feels unable to discuss her issues with her boyfriend. Her parents both have mental health issues and Jane does not feel able to talk to her mother about her problems. She has an older brother she has a good relationship who lives with his girlfriend, a four hour drive away. Jane is educated to degree level, having studied Criminology and is currently working part-time for her father managing his client accounts for a business he runs from home. A typical day involves organising all receipts and creating spreadsheets for each client’s accounts. Jane states she would like to get a full time job and be normal like her friends. Jane has a small circle of friends from university who she states have all gone onto full time employment. Jane also has a puppy she spends time looking after and taking for regular walks. Assessment Jane was referred following a health check at her GP surgery. She had been prescribed Citalopram 20mg by her GP for anxiety symptoms and panic attacks she had been having for two years. Jane has no previous contact with mental health services. Jane’s father had a diagnosis of Bi-Polar Disorder, her brother has Depression and her boyfriend has a diagnosis of Obsessive Compulsive Disorder which he is continuing treatment for. Jane’s anxiety/panic has increased over the past two years. She had read about Cognitive Behavioural Therapy on the Internet and was willing to see if it was help ease her anxiety symptoms. Jane stated that the problem started due to family issues in 2007. Her brother and father were estranged due to a financial disagreement and this resulted in Jane’s brother leaving the country with his girlfriend, causing Jane to become very distressed. Also during this time she was taking her final exams at University, Jane states this was when she experienced her first panic attack. She had spent the evening before her brother left the country, drinking alcohol with friends, she remembers feeling ‘hung-over’ the next day. While travelling in the car to the airport, with her brother and his girlfriend, Jane states she started to feel unwell, she found it difficult to breathe, felt hot, trapped and felt like she was going to faint. Jane stated she felt â€Å"embarrassed† and â€Å"stupid† and had since experienced other panic attacks and increased anxiety, anticipating panic attacks in social situations. Jane had reduced where she went to, finding herself unable to go anywhere she may have to meet new people. Her last panic attack happened when Jane visited her GP for a health check and fainted during the appointment, Jane has blood phobia and she stated she had not eaten since the day before and was extremely anxious about the any medical interventions. Jane believes it was a panic attack that caused her to faint. The GP prescribed her 20mg of Citalopram, a few weeks prior to her initial assessment with the therapist. When Jane and the therapist met for the initial session Jane described herself as feeling inadequate and as if she was trapped in a cycle of panic. Although Jane felt unhappy she had no suicidal ideation and she presented no risk to others. Jane stated she had become more anxious and that she had panic attacks at least twice a week. Prior to and during therapy, Jane was assessed using various measures. These enabled the therapist to formulate a hypothesis regarding the severity of the problem, also acting as a baseline, enabling the therapist and Jane to monitor progress throughout treatment. (Wells, 1997). The measures utilised in the initial assessment were a daily panic diary, Wells (1997) and a diary of obsessive- compulsive rituals, Wells (1997) a self rating scale completed by the client Jane. Other measures used were, The Panic Rating Scale (PRS) Wells (1997), the Social Phobia Scale, Wells (1997), used by the therapist to clarify which specific disorder was the main problem for Jane. Having collated information from the initial measures, a problem list was created so the therapist and Jane could decide what to focus on first. This list was based on Jane’s account of the worst problems which were given priority over those problems which were less distressing. Problem List 1. Anxiety/Panic attacks 2. Obsessive hand washing. 3. My relationship with my family. 4. Not having a full time job. 5. My relationship with my boyfriend Having collaboratively decided on the problem list, the therapist helped Jane reframe the problems into goals. As the problem list highlighted what was wrong, changing them into goals enabled Jane to approach her problems in a more focused way (Wells, 1997), the therapist discussed goals with Jane and she decided what she wanted to get from therapy. It was important for the therapist to ensure that any goals were realistic and achievable in the timeframe and this was conveyed to Jane (Padesky Greenberger, 1995). Jane wanted to reduce her anxiety and expressed these goals:- 1. To understand why I have panic attacks. 2. To have an anxiety free day. 3. To reduce the amount of time worrying . To reduce obsessive hand washing at home. Case Formulation Jane stated that for about a year she had been repeating certain behaviours, which she believed prevented her from having panic attacks. This involved Jane washing her hands and any surrounding objects at least twice. Jane had a fear of consuming alcohol/drugs/caffeine/artificial sweeteners, she stated she had had her first panic attack the day afte r drinking alcohol and had read that all these substances could increase her anxiety. Jane had not drunk alcohol for 18 months as she felt this caused her anxiety and made her nable to control the panic attacks. Jane stated she feared that if any of these substances got on her hands and then into her mouth she would have a panic attack and faint. These beliefs increased Jane’s anxiety when Jane was exposed to any environment where these substances were present. This unfortunately was most of the time, Jane stated that every time she saw any of these substances consumed or even placed near her, she became anxious and had to wash her hands and any surrounding items which she may come into contact with again. These safety behaviours maintained the cycle of panic, Jane would always continue the routines that she believed prevented a panic attack. The worst case scenario for Jane was â€Å"the panic would never stop and I will go mad, causing my boyfriend to leave me†. Jane felt this would make everyone realise what she already knew, that she was worthless. Her last panic attack happened when Jane had visited her GP; this caused Jane feelings of shame. â€Å"There’s all these people achieving, doing great things and I can’t do the most basic things† The therapist used the Cognitive Model of Panic (Clark, 1986), initially developing the three key elements of the model to help socialise Jane to the thoughts, feelings and behaviour cycle (see diagram below) Cognitive Model of Panic Bodily sensations Emotional response Thought about sensation Clark (1986) Using a panic diary and a diary of obsessive-compulsive rituals, Jane was asked to keep a record of situations during the week where she felt anxious, and this was discussed in the next session. Jane stated she had not had any panic during the week, when discussing previous panic attacks during the session, Jane became anxious and the therapist used this incident to develop the following formulation. Heart beating fast/increase in body temperature Fear/dread I feel hot, I can’t control it Clark (1986) Jane stated she felt like she was sweating, she had difficulty breathing; felt faint, had feelings of not being here and felt like she was going crazy. All these symptoms suggested that Jane was experiencing a panic attack and Jane met the criteria for Panic Disorder, defined in the DSM IV and states that â€Å"panic attacks be recurrent and unexpected, at least one of the attacks be followed by at least one month of persistent concern about having additional attacks, worry about the implications or consequence of the attack, or a significant change in behaviour related to the attacks† (APA, 1994). During the sessions the therapist continued to socialise Jane to the model of panic (Clark, 1986); together Jane and the therapist looked at what kept the cycle going. The therapist continued to use the model formulation, with the addition of Jane’s catastrophic interpretation of bodily symptoms, to illustrate the connection between negative thoughts, emotion, physical symptoms. Social situation I will be unable to stay here Everyone will notice I am not coping I’m going to faint Sweating/breathing fast/dizzy Clark’s (1986) Cognitive Model of Panic. Progress of Treatment The therapist hypothesised that Jane’s symptoms continued due to Jane not understanding the physiological effects of anxiety. The results were a misinterpretation of what would happen to her while being anxious, and this maintained the panic cycle. Although Jane tried to avoid any anxiety by using safety behaviours, she eventually increased the anxiety she experienced. Session 1 After the initial assessment sessions, the therapist and Jane agreed to 8 sessions, with a review after 6 sessions. Jane and the therapist discussed that there may only be a small amount of progress or change during the sessions due to the complexity of Jane’s diagnosis and agreed to focus on understanding the cycle of panic (Clark, 1986) From the information gained from the formulation process, the therapist tried psycho education. The therapist was attempting to illicit a shift in Jane’s belief about what, how and why these symptoms were happening. The therapist discussed with Jane what she knew about anxiety and from this the therapist discovered that Jane was unsure of what anxiety was and the effects on the body. For the first few appointments the therapist knew it could be beneficial to concentrate on relaying information about anxiety, (Clark et al, 1989) focusing on Jane’s specific beliefs anxiety, the therapist wanted to try to reduce the problem by helping Jane recognise the connection between her symptoms. As Jane believed, â€Å"she was going mad†, the therapist was trying to help Jane understand the CBT model of anxiety and to alter Jane’s misunderstanding of the symptoms. The therapist and Jane discussed Jane’s belief that she would faint if she panicked, Jane had fixed beliefs about why she fainted. The therapist attempted to enable Jane to describe how her anxiety affected her during a ‘usual panic’. Instead Jane began to describe symptoms of social anxiety, this suggested to the therapist that the main problems could be a combination of /social phobia and obsessive behaviours; the following dialogue may help to illustrate this. T. When you begin to become anxious, what goes through your head? J. I need a backup plan; I need to know how to get out of there. Especially if it’s in an office, or a small room. T. What would happen if you did not get out? J. I would panic, and then pass out T. What would the reasons be for you to pass out? J. Because I was panicking. T. Have you passed out before when you have panicked? J. I have felt like it. T. So what sensations do you have when you’re panicking? J. The feeling rises up, I feel hot and I can’t see straight. I get red flashes in front of my eyes, like a warning. My vision goes hazy. I think everyone is looking at me. T. Do you think other people can see this? J. Yes. T. What do you think they see? J. That I’m struggling and I cannot cope or, I try to get out of the situation by pretending I feel ill before they notice. T. What would they notice, what would be different about you? J. I stick out like a beacon, I’m sweating, loads of sweat and my face is bright red. T. How red would your face be, as red as that â€Å"No Smoking† sign on the wall? J. Yes! I’m dripping with sweat and my eyes are really staring, feels like they stick out like in a cartoon, it’s ridiculous. T. How long before you would leave the situation? J. Sometimes the feeling goes, like I can control it. But I could not leave. There would be a stigma and then I could not go back, the anxiety would increase in that environment or somewhere similar. The therapist persisted with this example and tried to use guided discovery to help Jane get a more balanced view of the situation. (Padesky and Greenberger, 1995) T. So you would not go back? J. I would if I felt safe, like with my boyfriend or I could leave whenever I wanted to. It’s the last straw if I have to go. It makes it even harder. T. You say that sometimes it goes away. What’s different about then and times when you have to leave? J. It’s like I just know I have to leave. T. What do you think may happen if you stay with the feelings? J. That I will pass out. T. hat would that mean if you passed out? J. It would be the ultimate. It would mean that I could not cope with the situation. T. If you could not cope what would that mean? J. I can’t function, I can’t do anything. I‘m just no use. T. How much do you believe that? Can you rate it out of 100%? J. Now. About 60% if I did faint it would be about 100% T. Have you ever fainted due t o the sensations you have described to me? J. No. I have fainted because I’m squeamish. I don’t like blood. Or having any kind of tests at the GP. T. So do I understand you? You have never fainted due to the panic sensations? J. No. I’ve felt like it. T. So you’ve never passed out due to the symptoms? What do you make that? J. I don’t know, that would mean that what I believe is stupid. It’s hard to get my head around it. Session 2-3 The therapist used a social phobia/panic rating scale measures to ascertain the main problem; this was increasingly difficult as throughout each session the patient expanded on her symptoms. The therapist managed to understand that the patient avoided most social situations due to her beliefs about certain substances; this caused the obsessive hand-washing. This then had an impact on Jane’s ability to go anywhere in case she could not wash herself or objects around her. Jane also believed fainting from blood phobia had the same physical effects as panic, and she would faint if she panicked. It was complicated and the therapist attempted to draw out a formulation. I SEE A PERSON DRINKING ALCOHOL IT’S GOING TO GET ON MY HANDS AND INTO MY MOUTH I FEEL SICK, I’M GOING TO FAINT I FEEL DREAD, I FEEL ANXIOUS, SWEATING I MUST WASH MY HANDS TO STOP THE PANIC GETTING WORSE. Session 4 The formulation shows the extent of Jane’s panic and how her safety behaviours were impacting on all aspects of her life. The therapist attempted again to use information about the causes of anxiety and its effects on the body. The therapist explained what happens when you faint due to blood phobia, this was an attempt to supply Jane with counter evidence for her catastrophic interpretations of her panic. The therapist also used evidence to contrast the effects on the body when fainting and when panicking. After two sessions, the therapist continued to provide and attempted to relay the facts about the nature of anxiety/panic/fainting with the inclusion of behavioural experiments. Educational procedures are a valid part of overall cognitive restructuring strategies, incorporated with questioning evidence for misinterpretations and behavioural experiments (Wells, 1997) The therapist asked Jane to explain to the therapist the function/effects of adrenalin, to see if Jane was beginning to understand and if there had been any shift in her beliefs about panic. The following dialogue may help to illustrate the difficulties the therapist encountered; T. Over the last few sessions, we have been discussing anxiety and the function of adrenalin. Do you understand the physical changes we have looked at? Does it make sense to you? J. Yes. Something has clicked inside my head. I feel less insane now, I understand more about what’s going on. It makes things a little bit easier, but it takes time for it to sink in. T. Do you think you could explain to me what you understand about anxiety/adrenalin? J. As I interpret it is, I like to think of it as, â€Å"I’m not anxious it’s just my adrenalin, It’s just the effects of adrenalin effecting my body† but it’s hard to get from there, to accepting the adrenalin is not going to harm me. I know logically it’s not. But it’s still hard. T. That’s great you’re beginning to question what you have believed and are thinking there may be other explanations for your symptoms. J. Yes. But I still think it’s to do with luck. I have good or bad luck each day and that predicts whether I have a panic or not. I think I’ll be unlucky soon. Session 5-6 The therapist continued to try use behavioural experiments during the sessions to provide further evidence to try to alter Jane’s beliefs about anxiety. The therapist agreed with Jane that they would imitate all the symptoms of panic. Making the room hot, exercising to increase heart rate and body temperature, hyperventilation (ten minutes) Focusing on breathing/swallowing. This continued for most of session 5. As neither the therapist nor Jane fainted, they discussed this and Jane stated it was different in the session than when she with other people. Jane also stated she felt safe and trusted the therapist, she did not believe she could be strong enough to try the experiments alone, as it was â€Å"too scary† The therapist asked Jane to draw a picture of how she felt and put them on the diagram of a person, this then was used to compare with anxiety symptoms, while talking through them with the therapist. The therapist and Jane created a survey about fainting and Jane took this away as homework to gain further evidence. The survey included 6 different questions about fainting e. g. – What people knew about fainting/how they would feel about seeing someone faint, etc. Treatment Outcome The treatment with Jane continues. The next session will be the 6th and there will be a review of progress and any improvements. There has been no improvement in measures as noted yet. The therapist intends to use a panic rating scale (PRS) Wells, (1997) during the next session. The therapist will continue to see Jane for two more sess ions, looking at what Jane has found helpful/unhelpful. Discussion Overall the therapist found the therapy unsuccessful. Although Jane stated she found it helpful, it was difficult for the therapist to see the progress due to the many layers of complexity of Jane’s diagnosis. The therapist has grown more confident in the CBT process and understands that as a trainee, the therapist tried to incorporate all the new skills within each session. The therapist was disappointed that they were unable to guide Jane through the therapy process with a better result. The therapist would have like to have been able to fully establish an understanding of Jane’s complex symptoms earlier on in the therapy. The therapist believes that Jane’s symptoms were very complex and the therapist may have been more successful with a client with a less complicated diagnosis. The therapist would then be able to gain more information via the appropriate measures to enable the formulations in a concise manner. This has been a huge learning curve for the therapist and has encouraged them to seek out continuing CBT supervision within the therapist’s workplace. This is essential to continue the development of the therapist’s skills. The therapist feels that although this has not had the outcome that the therapist would have wanted, it has been a positive experience for Jane. There appeared to be a successful therapeutic relationship, Jane appeared comfortable and able to communicate what her problems were to the therapist from the beginning of therapy. The therapist hopes this will encourage Jane to engage with further CBT therapy in the future and the therapist over the final session hopes to be able to support Jane in creating a therapy blueprint, reviewing what Jane has found helpful. Certificate in CBT September – December 2009 CBT Case Study Panic/Social Phobia/OCD WORD COUNT 3,400 References APA (1994). Diagnostic Statistical Manual of Mental Disorders, Revised, 4th edn. Washington, DC: American Psychiatric Association Padesky, C. A Greenberger, D. (1995). Clinicians Guide to Mind Over Mood. New York: Guilford Padesky, C. A Greenberger, D. (1995). Mind Over Mood. New York: Guilford Wells, A (1997). Cognitive Therapy of Anxiety Disorders. Chichester, UK: Wiley Cbt Case Study She feels unable to discuss her issues with her boyfriend. Her parents both have mental health issues and Jane does not feel able to talk to her mother about her problems. She has an older brother she has a good relationship who lives with his girlfriend, a four hour drive away. Jane is educated to degree level, having studied Criminology and is currently working part-time for her father managing his client accounts for a business he runs from home. A typical day involves organising all receipts and creating spreadsheets for each client’s accounts. Jane states she would like to get a full time job and be normal like her friends. Jane has a small circle of friends from university who she states have all gone onto full time employment. Jane also has a puppy she spends time looking after and taking for regular walks. Assessment Jane was referred following a health check at her GP surgery. She had been prescribed Citalopram 20mg by her GP for anxiety symptoms and panic attacks she had been having for two years. Jane has no previous contact with mental health services. Jane’s father had a diagnosis of Bi-Polar Disorder, her brother has Depression and her boyfriend has a diagnosis of Obsessive Compulsive Disorder which he is continuing treatment for. Jane’s anxiety/panic has increased over the past two years. She had read about Cognitive Behavioural Therapy on the Internet and was willing to see if it was help ease her anxiety symptoms. Jane stated that the problem started due to family issues in 2007. Her brother and father were estranged due to a financial disagreement and this resulted in Jane’s brother leaving the country with his girlfriend, causing Jane to become very distressed. Also during this time she was taking her final exams at University, Jane states this was when she experienced her first panic attack. She had spent the evening before her brother left the country, drinking alcohol with friends, she remembers feeling ‘hung-over’ the next day. While travelling in the car to the airport, with her brother and his girlfriend, Jane states she started to feel unwell, she found it difficult to breathe, felt hot, trapped and felt like she was going to faint. Jane stated she felt â€Å"embarrassed† and â€Å"stupid† and had since experienced other panic attacks and increased anxiety, anticipating panic attacks in social situations. Jane had reduced where she went to, finding herself unable to go anywhere she may have to meet new people. Her last panic attack happened when Jane visited her GP for a health check and fainted during the appointment, Jane has blood phobia and she stated she had not eaten since the day before and was extremely anxious about the any medical interventions. Jane believes it was a panic attack that caused her to faint. The GP prescribed her 20mg of Citalopram, a few weeks prior to her initial assessment with the therapist. When Jane and the therapist met for the initial session Jane described herself as feeling inadequate and as if she was trapped in a cycle of panic. Although Jane felt unhappy she had no suicidal ideation and she presented no risk to others. Jane stated she had become more anxious and that she had panic attacks at least twice a week. Prior to and during therapy, Jane was assessed using various measures. These enabled the therapist to formulate a hypothesis regarding the severity of the problem, also acting as a baseline, enabling the therapist and Jane to monitor progress throughout treatment. (Wells, 1997). The measures utilised in the initial assessment were a daily panic diary, Wells (1997) and a diary of obsessive- compulsive rituals, Wells (1997) a self rating scale completed by the client Jane. Other measures used were, The Panic Rating Scale (PRS) Wells (1997), the Social Phobia Scale, Wells (1997), used by the therapist to clarify which specific disorder was the main problem for Jane. Having collated information from the initial measures, a problem list was created so the therapist and Jane could decide what to focus on first. This list was based on Jane’s account of the worst problems which were given priority over those problems which were less distressing. Problem List 1. Anxiety/Panic attacks 2. Obsessive hand washing. 3. My relationship with my family. 4. Not having a full time job. 5. My relationship with my boyfriend Having collaboratively decided on the problem list, the therapist helped Jane reframe the problems into goals. As the problem list highlighted what was wrong, changing them into goals enabled Jane to approach her problems in a more focused way (Wells, 1997), the therapist discussed goals with Jane and she decided what she wanted to get from therapy. It was important for the therapist to ensure that any goals were realistic and achievable in the timeframe and this was conveyed to Jane (Padesky Greenberger, 1995). Jane wanted to reduce her anxiety and expressed these goals:- 1. To understand why I have panic attacks. 2. To have an anxiety free day. 3. To reduce the amount of time worrying . To reduce obsessive hand washing at home. Case Formulation Jane stated that for about a year she had been repeating certain behaviours, which she believed prevented her from having panic attacks. This involved Jane washing her hands and any surrounding objects at least twice. Jane had a fear of consuming alcohol/drugs/caffeine/artificial sweeteners, she stated she had had her first panic attack the day afte r drinking alcohol and had read that all these substances could increase her anxiety. Jane had not drunk alcohol for 18 months as she felt this caused her anxiety and made her nable to control the panic attacks. Jane stated she feared that if any of these substances got on her hands and then into her mouth she would have a panic attack and faint. These beliefs increased Jane’s anxiety when Jane was exposed to any environment where these substances were present. This unfortunately was most of the time, Jane stated that every time she saw any of these substances consumed or even placed near her, she became anxious and had to wash her hands and any surrounding items which she may come into contact with again. These safety behaviours maintained the cycle of panic, Jane would always continue the routines that she believed prevented a panic attack. The worst case scenario for Jane was â€Å"the panic would never stop and I will go mad, causing my boyfriend to leave me†. Jane felt this would make everyone realise what she already knew, that she was worthless. Her last panic attack happened when Jane had visited her GP; this caused Jane feelings of shame. â€Å"There’s all these people achieving, doing great things and I can’t do the most basic things† The therapist used the Cognitive Model of Panic (Clark, 1986), initially developing the three key elements of the model to help socialise Jane to the thoughts, feelings and behaviour cycle (see diagram below) Cognitive Model of Panic Bodily sensations Emotional response Thought about sensation Clark (1986) Using a panic diary and a diary of obsessive-compulsive rituals, Jane was asked to keep a record of situations during the week where she felt anxious, and this was discussed in the next session. Jane stated she had not had any panic during the week, when discussing previous panic attacks during the session, Jane became anxious and the therapist used this incident to develop the following formulation. Heart beating fast/increase in body temperature Fear/dread I feel hot, I can’t control it Clark (1986) Jane stated she felt like she was sweating, she had difficulty breathing; felt faint, had feelings of not being here and felt like she was going crazy. All these symptoms suggested that Jane was experiencing a panic attack and Jane met the criteria for Panic Disorder, defined in the DSM IV and states that â€Å"panic attacks be recurrent and unexpected, at least one of the attacks be followed by at least one month of persistent concern about having additional attacks, worry about the implications or consequence of the attack, or a significant change in behaviour related to the attacks† (APA, 1994). During the sessions the therapist continued to socialise Jane to the model of panic (Clark, 1986); together Jane and the therapist looked at what kept the cycle going. The therapist continued to use the model formulation, with the addition of Jane’s catastrophic interpretation of bodily symptoms, to illustrate the connection between negative thoughts, emotion, physical symptoms. Social situation I will be unable to stay here Everyone will notice I am not coping I’m going to faint Sweating/breathing fast/dizzy Clark’s (1986) Cognitive Model of Panic. Progress of Treatment The therapist hypothesised that Jane’s symptoms continued due to Jane not understanding the physiological effects of anxiety. The results were a misinterpretation of what would happen to her while being anxious, and this maintained the panic cycle. Although Jane tried to avoid any anxiety by using safety behaviours, she eventually increased the anxiety she experienced. Session 1 After the initial assessment sessions, the therapist and Jane agreed to 8 sessions, with a review after 6 sessions. Jane and the therapist discussed that there may only be a small amount of progress or change during the sessions due to the complexity of Jane’s diagnosis and agreed to focus on understanding the cycle of panic (Clark, 1986) From the information gained from the formulation process, the therapist tried psycho education. The therapist was attempting to illicit a shift in Jane’s belief about what, how and why these symptoms were happening. The therapist discussed with Jane what she knew about anxiety and from this the therapist discovered that Jane was unsure of what anxiety was and the effects on the body. For the first few appointments the therapist knew it could be beneficial to concentrate on relaying information about anxiety, (Clark et al, 1989) focusing on Jane’s specific beliefs anxiety, the therapist wanted to try to reduce the problem by helping Jane recognise the connection between her symptoms. As Jane believed, â€Å"she was going mad†, the therapist was trying to help Jane understand the CBT model of anxiety and to alter Jane’s misunderstanding of the symptoms. The therapist and Jane discussed Jane’s belief that she would faint if she panicked, Jane had fixed beliefs about why she fainted. The therapist attempted to enable Jane to describe how her anxiety affected her during a ‘usual panic’. Instead Jane began to describe symptoms of social anxiety, this suggested to the therapist that the main problems could be a combination of /social phobia and obsessive behaviours; the following dialogue may help to illustrate this. T. When you begin to become anxious, what goes through your head? J. I need a backup plan; I need to know how to get out of there. Especially if it’s in an office, or a small room. T. What would happen if you did not get out? J. I would panic, and then pass out T. What would the reasons be for you to pass out? J. Because I was panicking. T. Have you passed out before when you have panicked? J. I have felt like it. T. So what sensations do you have when you’re panicking? J. The feeling rises up, I feel hot and I can’t see straight. I get red flashes in front of my eyes, like a warning. My vision goes hazy. I think everyone is looking at me. T. Do you think other people can see this? J. Yes. T. What do you think they see? J. That I’m struggling and I cannot cope or, I try to get out of the situation by pretending I feel ill before they notice. T. What would they notice, what would be different about you? J. I stick out like a beacon, I’m sweating, loads of sweat and my face is bright red. T. How red would your face be, as red as that â€Å"No Smoking† sign on the wall? J. Yes! I’m dripping with sweat and my eyes are really staring, feels like they stick out like in a cartoon, it’s ridiculous. T. How long before you would leave the situation? J. Sometimes the feeling goes, like I can control it. But I could not leave. There would be a stigma and then I could not go back, the anxiety would increase in that environment or somewhere similar. The therapist persisted with this example and tried to use guided discovery to help Jane get a more balanced view of the situation. (Padesky and Greenberger, 1995) T. So you would not go back? J. I would if I felt safe, like with my boyfriend or I could leave whenever I wanted to. It’s the last straw if I have to go. It makes it even harder. T. You say that sometimes it goes away. What’s different about then and times when you have to leave? J. It’s like I just know I have to leave. T. What do you think may happen if you stay with the feelings? J. That I will pass out. T. hat would that mean if you passed out? J. It would be the ultimate. It would mean that I could not cope with the situation. T. If you could not cope what would that mean? J. I can’t function, I can’t do anything. I‘m just no use. T. How much do you believe that? Can you rate it out of 100%? J. Now. About 60% if I did faint it would be about 100% T. Have you ever fainted due t o the sensations you have described to me? J. No. I have fainted because I’m squeamish. I don’t like blood. Or having any kind of tests at the GP. T. So do I understand you? You have never fainted due to the panic sensations? J. No. I’ve felt like it. T. So you’ve never passed out due to the symptoms? What do you make that? J. I don’t know, that would mean that what I believe is stupid. It’s hard to get my head around it. Session 2-3 The therapist used a social phobia/panic rating scale measures to ascertain the main problem; this was increasingly difficult as throughout each session the patient expanded on her symptoms. The therapist managed to understand that the patient avoided most social situations due to her beliefs about certain substances; this caused the obsessive hand-washing. This then had an impact on Jane’s ability to go anywhere in case she could not wash herself or objects around her. Jane also believed fainting from blood phobia had the same physical effects as panic, and she would faint if she panicked. It was complicated and the therapist attempted to draw out a formulation. I SEE A PERSON DRINKING ALCOHOL IT’S GOING TO GET ON MY HANDS AND INTO MY MOUTH I FEEL SICK, I’M GOING TO FAINT I FEEL DREAD, I FEEL ANXIOUS, SWEATING I MUST WASH MY HANDS TO STOP THE PANIC GETTING WORSE. Session 4 The formulation shows the extent of Jane’s panic and how her safety behaviours were impacting on all aspects of her life. The therapist attempted again to use information about the causes of anxiety and its effects on the body. The therapist explained what happens when you faint due to blood phobia, this was an attempt to supply Jane with counter evidence for her catastrophic interpretations of her panic. The therapist also used evidence to contrast the effects on the body when fainting and when panicking. After two sessions, the therapist continued to provide and attempted to relay the facts about the nature of anxiety/panic/fainting with the inclusion of behavioural experiments. Educational procedures are a valid part of overall cognitive restructuring strategies, incorporated with questioning evidence for misinterpretations and behavioural experiments (Wells, 1997) The therapist asked Jane to explain to the therapist the function/effects of adrenalin, to see if Jane was beginning to understand and if there had been any shift in her beliefs about panic. The following dialogue may help to illustrate the difficulties the therapist encountered; T. Over the last few sessions, we have been discussing anxiety and the function of adrenalin. Do you understand the physical changes we have looked at? Does it make sense to you? J. Yes. Something has clicked inside my head. I feel less insane now, I understand more about what’s going on. It makes things a little bit easier, but it takes time for it to sink in. T. Do you think you could explain to me what you understand about anxiety/adrenalin? J. As I interpret it is, I like to think of it as, â€Å"I’m not anxious it’s just my adrenalin, It’s just the effects of adrenalin effecting my body† but it’s hard to get from there, to accepting the adrenalin is not going to harm me. I know logically it’s not. But it’s still hard. T. That’s great you’re beginning to question what you have believed and are thinking there may be other explanations for your symptoms. J. Yes. But I still think it’s to do with luck. I have good or bad luck each day and that predicts whether I have a panic or not. I think I’ll be unlucky soon. Session 5-6 The therapist continued to try use behavioural experiments during the sessions to provide further evidence to try to alter Jane’s beliefs about anxiety. The therapist agreed with Jane that they would imitate all the symptoms of panic. Making the room hot, exercising to increase heart rate and body temperature, hyperventilation (ten minutes) Focusing on breathing/swallowing. This continued for most of session 5. As neither the therapist nor Jane fainted, they discussed this and Jane stated it was different in the session than when she with other people. Jane also stated she felt safe and trusted the therapist, she did not believe she could be strong enough to try the experiments alone, as it was â€Å"too scary† The therapist asked Jane to draw a picture of how she felt and put them on the diagram of a person, this then was used to compare with anxiety symptoms, while talking through them with the therapist. The therapist and Jane created a survey about fainting and Jane took this away as homework to gain further evidence. The survey included 6 different questions about fainting e. g. – What people knew about fainting/how they would feel about seeing someone faint, etc. Treatment Outcome The treatment with Jane continues. The next session will be the 6th and there will be a review of progress and any improvements. There has been no improvement in measures as noted yet. The therapist intends to use a panic rating scale (PRS) Wells, (1997) during the next session. The therapist will continue to see Jane for two more sess ions, looking at what Jane has found helpful/unhelpful. Discussion Overall the therapist found the therapy unsuccessful. Although Jane stated she found it helpful, it was difficult for the therapist to see the progress due to the many layers of complexity of Jane’s diagnosis. The therapist has grown more confident in the CBT process and understands that as a trainee, the therapist tried to incorporate all the new skills within each session. The therapist was disappointed that they were unable to guide Jane through the therapy process with a better result. The therapist would have like to have been able to fully establish an understanding of Jane’s complex symptoms earlier on in the therapy. The therapist believes that Jane’s symptoms were very complex and the therapist may have been more successful with a client with a less complicated diagnosis. The therapist would then be able to gain more information via the appropriate measures to enable the formulations in a concise manner. This has been a huge learning curve for the therapist and has encouraged them to seek out continuing CBT supervision within the therapist’s workplace. This is essential to continue the development of the therapist’s skills. The therapist feels that although this has not had the outcome that the therapist would have wanted, it has been a positive experience for Jane. There appeared to be a successful therapeutic relationship, Jane appeared comfortable and able to communicate what her problems were to the therapist from the beginning of therapy. The therapist hopes this will encourage Jane to engage with further CBT therapy in the future and the therapist over the final session hopes to be able to support Jane in creating a therapy blueprint, reviewing what Jane has found helpful. Certificate in CBT September – December 2009 CBT Case Study Panic/Social Phobia/OCD WORD COUNT 3,400 References APA (1994). Diagnostic Statistical Manual of Mental Disorders, Revised, 4th edn. Washington, DC: American Psychiatric Association Padesky, C. A Greenberger, D. (1995). Clinicians Guide to Mind Over Mood. New York: Guilford Padesky, C. A Greenberger, D. (1995). Mind Over Mood. New York: Guilford Wells, A (1997). Cognitive Therapy of Anxiety Disorders. Chichester, UK: Wiley

Dances with the Wolves by Michael Blake Essay Example | Topics and Well Written Essays - 750 words

Dances with the Wolves by Michael Blake - Essay Example At the outset, the reader is given a glimpse of the character of the protagonist. When, in an attempt to commit suicide, Dunbar rides his horse into battle, he has the courage to face death head on and to stand his ground on the battle field. 1863. The war is at a deadlock. Soldiers, exhausted, are taking a momentary respite from the hard day of battle. Lieutenant Dunbar, gains consciousness, to find himself on the operating table with severe injuries, next in line to have his leg amputated. Dunbar shows immense courage when he decides to put on his boots and stumble back to the battlefield. He feels disillusioned, frustrated and helpless. â€Å"He had raised his arms in a final gesture of farewell to this life†¦. He had only wanted to die.†1 However, fate and his skill with a horse ensure that he twists and weaves through the enemy lines unscathed. He holds his ground on the battlefield and charges upon line after line of confederate soldiers. Upon seeing this, the moral e of the union army is boosted and they charge the field resulting in victory. Dunbar is branded a hero and decorated. Arriving at Fort Sedgewick, a deserted outpost, near Indian country, Dunbar showed courage, bravery, and a strong sense of duty by choosing to remain when many would have turned back. Dunbar as a reward chose to be posted at the western frontier. ... He forgot that he was completely naked; neither clothes nor a weapon to protect him, he bellowed at the enemy.2 When he met the rest of the natives (Wind in His Hair) too, he rushed forward fearlessly without any regard to his safety3 or any danger to his life thereby earning the respect of the Sioux tribe. He was surrounded by the Sioux tribe where he was putting up. The tribe tried to intimidate him by attempting to steal his horse and scare. To this Dunbar thought that he needs to have a dialogue with the tribe and sets out to see them, and in the way comes across a tribal woman who was injured. He took her to her tribal house, and in the amazement of everyone around they changed their perception about him and welcomed him. After having praised the tribe with his deeds he starts to live with the tribe on a permanent basis. He begins to build a rapport with the tribe and slowly engages himself in the culture of the tribe. He really appreciates the way the tribe is living and falls in love with the whole way of living which involves simplicity and humility unseen in those days in America. He becomes hero within the tribe when he locates a migrating herd of Buffalo and participates in the hunt. He is given the status of an honoured guest in the tribe and the people love him for helping them hunt the herd of Buffalo for their hunger needs. While at his stay in the tribe, he falls in love with Stands with a Fist and gets the approval of her father to marry her, and while doing so he abandons his fort for ever. He is given the name â€Å"Dances with Wolves† when he was chasing Two Socks and the Sioux were observing his move while he was through the act of