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Cognitive Behavior Therapy and Dialectical Behavior Therapy


Dialectical behavior therapy mostly entails the strengthening of poor behavioral skills. This is achieved by homework assignments to the patients, behavioral training and generalization of strategies. These key strategies enable one to acquire emotional regulation. However, cognitive behavior therapy (CBT) mostly applies for worse psychiatric cases, which appear rather impossible to treat (Barlow, 2004). This involves people with extremely low stress regulation. Cognitive stress therapy involves psychological homework done through dialectical behavior therapy, considering the patients mental situation. Most psychological patients who undergo cognitive stress therapy reduce their stress level and improve their stress management.

My patient showed high levels of emotional distress. Kelly was suffering from a various stress motivators. For instance, her family environment motivated stress upon her. Her parent’s divorce led to a wide gap in family relations. Her mother’s economical struggle also affected her negatively. Further, the pressure mounted upon her academically also aroused stress. In addition, she was clearly experiencing a negative emotional attachment towards her father. Consequently, her career choice also created a stressful environment due to lack of support towards her career choice by her parents.

Cognitive behavior therapy deals with regular behavioral cases and the common behavioral changes done. However, dialectical behavior therapy distinguishes every patient individually by looking at their environment and other factors that seem to cause stress on them. Kelly clearly showed borderline personality disorder.

This was characterized by her poor interpersonal relationships. Judging from her lifestyle, she had poor interpersonal relationships. For instance, she had only three main friends and her unusual relationship with a relatively older man. She also confessed having high anxiety, and fear. She had a poor personal image judging from how she had dressed during the therapy session. Her stress maintenance level was too weak. This is evident from her overdose and suicidal thoughts.

In such psychiatric cases, homework and strategy planning on the patient work best (Barlow, 2004). Homework is given to the patient to determine her stress vulnerability and maintenance levels. For instance, putting the patient in certain scenarios and observing their reaction. In addition, homework entails critical examination of the patient’s environment and change suggestions. The patient tries the suggested behavior change and reports her comfort or improvement after the change.

This homework enables the therapist to ascertain whether the measures taken are sufficient or not. Furthermore, strategies involve team therapy where the patient is taught necessary emotional skills and they are training how and when to use them. Homework allows patients to employ their learnt skills in their stressful situations and analyze whether they work or not. Homework may take different period of time depending on the patient’s improvement level. Strategies enable psychiatric patients to avoid getting back to their stressful situations after therapy (Barlow, 2008).

The goals for therapy were to reduce suicidal ideation, depression, anxiety, and substance abuse. To treat Kelly I used DBT to decrease her suicide ideation. During stage 2 of the treatment, I used CBT within the DBT model to decrease her depression and anxiety. This treatment lasts one year with weekly individual sessions, weekly group sessions, and phone calls in between.

The first stage entailed getting Kelly to commit to her therapy sessions fully, so that she would last for the treatment period. In order to convince Kelly that the treatment was for her own good, I kept on convincing Kelly that I would only help her help herself. This made her feel like she was the one in charge of her situation. I established simple problems and solutions where Kelly saw massive improvement, thus she became motivated.

Further, I developed a guiding system where I required her to write in her dairy her daily emotional struggles and the people involved. In situations where I encouraged her to try reacting differently, I she would write on her dairy the challenges she faced using a different approach. I gave her phone calls during the week to inquire on her progress. She slowly got interested and committed to the treatment.

One of the most essential therapy theories regarding biosocial behavior entails enhancing the patient’s skills in emotional regulation. For instance, in Kelly’s case, she was vulnerable towards negative emotions. This led to an increased suicide ideation. I engaged her in DBT practices to improve her self confidence. I gave her an individual homework, which was basically to wear a certain dress that I had bought her and long heel shoes during the next therapy. This was in a bid to study how she viewed her body image and reduce her self-conscious. This would enable her reduce depression caused by self-conscious. In addition, I asked her to come alone during the next session.

During her next session I advised my secretary and other staff to give her positive opinions about her look. I wanted to create a positive personal image on her. Further, my staff observed her behavior when she came alone. She seemed anxious but with routine practice she got used to it.

Consequently, I also worked on her distress tolerance. This was in order to help her improve herself stress management and hopelessness. I asked her a couple of smooth and hard questions regarding her father. For instance, the things she loved about him and the things she hated about him. I wanted to improve her acceptance to reality, awareness and situation management. I discussed with her the issues she faced with her father’s long distance relationship. She slowly began to open up about the situation, and using CBT theories I made her focus on being in charge of the situation. We came up with ways in which she would have pleasurable interactions with her father.

I dedicated some of the therapy sessions to deal with Kelly’s interpersonal effectiveness. I gave her simple homework such as going out on blind dates and adding at least one new friend every week. I also inquired about her obstacles in interpersonal obligations. I did this to improve her interpersonal relations skills such as self-respect, relationship functioning and goal attainment. We focused on reducing her obstacles in interpersonal obligations, and this improved her commitment to therapy.

Behavioral therapy was necessary to reduce her substance abuse. Her substance abuse was as a result of increased anxiety and the bad thoughts of fateful things happening to her family. We engaged Karen in various activities which included cognitive restructuring and relaxation training. For instance, we engaged her in gym sessions and interactive activities such as going fishing with her mother. The psycho-analytic view attributes that the symptom is produced as a counter way to reduce tension. Her fishing interactions with her mother and gym sessions enabled Kelly reduce her anxiety and phobia tendencies substantially.

Finally, I focused on strategic assignments that would enable Kelly describe, observe and participate fully in her normal environment. This involved group therapy where we trained her on how to relieve body stress and also emotional stress. We also gave her different handouts with important information on social skills and behavioral skills. In addition, the group therapy sessions also entailed asking her various questions on how she would react to different scenarios. In the group sessions we also gave her challenges such as cracking jokes in order to entice her to be in a jovial mode. Further, we engaged her wholly in the therapy sessions. With time she developed good communication skills and skillful behavior.

    
 References

Barlow, D. H. (2008). Clinical handbook of psychological disorders: A step-by-step treatment manual. New York: Guilford Press.
Barlow, D. H. (2004). Anxiety and its disorders: The nature and treatment of anxiety and panic. New York: Guilford.
    




Health Access Movement


Table of Contents


Background of the Health Access movement in the United States……………………………3
Introduction………………………………..........………………………………………………...…3
Why Health access movements were formed........................................................................5
Tit for Tat strategy………………………………........……………………………………………..6
The Prisoner’s dilemma……………………………….......………………………………………..7
Tragedy of the commons and the anti-commons………...………………………………………8
Conclusion…………………………………………………….........………………………………..9
References…………………………………………………………….......………………………..10
 

Health Access movement Background of the Health Access movement in the United States

Introduction
 
The United States has a history of social reform from grassroots social movements or changes from below. It is imperative to note that the national health reform campaigns that were held in the 20th century were mainly initiated as well as run by elites who were more concerned with defending attacks from various interest groups as compared to popular mobilization and grassroots reforms (Hoffman, 2003).

However, the grass root health access movements mushroomed in the 20th century due to the fact that most of them demanded the access to the American Dream. Workers, African Americans, welfare recipients and seniors organized a change in the society by ensuring that they were recognized by the government. It is imperative to understand that although the groups and movements had its leaders, each of them relied on grass root participation in a bid to continue and expand (Hoffman, 2003).
 
Early in the 20th century, the Industrial America faced one major problem; the problem of sickness. This is when workers were unable to go to work because they were had ill health; this often meant that their wages were considerably reduced (Hoffman, 2003). Therefore, this loss of income due to ill health and the burden of cost medical care considerably made sickness to be a major cause of poverty.

For this reason, in the year 1915, there was the organization of several progressive reformers who decided to come together and proposed a system of compulsory health insurance in order to protect workers again both the medical costs and wage loss that resulted from sickness (Hoffman, 2003). There was widespread debate throughout the country and there was the successful legislation of the bill into law in several U.S states. The American Association for Labor legislation AALL proposal was however, set without the lack of co-operation between popular movements and the reform leaders (Hoffman, 2003). This was because the AALL consisted of academic scholars who drafted their proposal without the input from the people that it would cover; the common worker.
 
It is important to understand that civil rights activism has often been at logger heads with the elite-led health campaigns. This was because most of the progressive Era as well as the New Deal reformers often deliberately left the black domestic workforce and agricultural groups out of their schemes (Hoffman, 2003). Further, the Blacks and other minorities were excluded from the their studies and for this reason, the racial discrimination meant that the African Americans were deprived of their right to basic health care and were consequently forced to build their own institutions such as fraternal societies, community public health movements as well as insurance companies (Hoffman, 2003). Therefore, the civil rights movements often rejected the proposals put forward that explicitly maintained segregation or when others ensured that the inequality existed within other means.
 
The Great Depression was also very instrumental in shaping health access movements in the United States. This is because during the great depression was the time of extraordinary and popular upheavals. Most Americans such as farmers, workers, elderly Americans, communists and socialists marched in the streets of Washington calling for justice and relief (Hoffman, 2003).

These demands were centered on the economic security of the workers as well as the aged, therefore, during the height of the depression, the ravages that rocked the United States in terms of unemployment and the national economic collapse constituted to more immediate action to unemployment rather than medical care. However, there were also some grass root health access movements that were formed during this time (Hoffman, 2003). However, the high end health access movements were not yet in touch with the grass root participation and support as most of them drafted laws without the consultation of the suffering public.
 
It is in the 1960’s that again the possibilities for grass root mobilization resurfaced again over the debate over medical care (Hoffman, 2003). The health reformers had thought of ways, in which they could sufficiently insure the elderly, this idea was supported by John Kennedy as well as his successor Lyndon Johnson. It is at this time that the medical care became a part of war on poverty and most health access groups decided to endorse legislation as the way to go.

There was the organization of senior citizens who signaled the rise in new reform constituency (Hoffman, 2003). It is imperative to note that although the pro-medical care struggle was initiated by the trade Unions, the pro-medical care retiree groups successfully ensured that they mobilized the elderly citizens and gave them health care.
 
The health access groups engaged in campaigns to promote the Right to Health for each and every citizen living in America. The health access movements have been able to diversify in terms of the organizing style, the tactics, goals and even the memberships (Hoffman, 2003). However, whatever the differences that exists within the health access movements, they all have come to a conclusion that all state and national reform groups should ensure that there is grass root mobilization in order to better the common man’s health.
 
Why Health access movements were formed?

Health access movements were formed as a result of the deprivation theory. The deprivation theory argues that social movements often have their foundations among people who feel that indeed they have been deprived of certain resources. In this case, the health access movements were formed because people felt that they were deprived of health care insurance or general health care in whole.

This theory argues that individuals who often feel deprived and lack some service are likely to organize a social movement in order to improve and better their conditions. Albert O. Hirschman was one proponent of this theory. However, he furthered the argument by arguing that there were three ways in which a person could come with dissatisfaction of an organization. The first one was exit, this involved the member to actually quit a certain organization or quit the initiative.

Therefore, in the case of the health care movement it was to completely ignore the situation and quit from the initiative of fighting for the health rights and being contended to the current situation. The second option is the person to voice his or her concerns. This was why the health access movements were formed in the first place, to voice their concerns and worries about health care reforms. However, as seen in the background section, most of the organizations that were formed were in loggerheads with the grass root people.

Therefore, the three options of Albert O. Hirschman were also available to the persons inside the organization. According to Hirschman if one was discontented with the way the health organization were run, then they would have the choice of exiting or expressing their displeasure by voicing their concerns. Loyalty on the other is sticking to the organization or movement without asking any questions. The interplay of these three concepts often turns out to create an illumination into the economic, political and social phenomenon.

Tit for Tat strategy
 
The TFT strategy is imperative in the study of how to reduce conflict. Research has been able to indicate that in many cases people who have been in competition for a long time no longer trust each other, and therefore, the most effective competition is the use of the TFT strategy. In this strategy, the involved individuals often engage in what is referred to as behavioral assimilation (Minsos, 2004).

This is a process by which an individual tends to match his or her own behaviors with those that have been displayed by their counterparts. Therefore, according to the Tit for Tat strategy, if one member becomes co-operative then consequently the other also becomes co-operative (Minsos, 2004). This can be seen in the context of health access movements where when the health access movements co-operated, the government also was seen to be in co-operation.

For example, when research reformers decided to co-operate with the government in a bid to create a medical coverage for the elderly, the government adopted the tit for tat strategy and it decided to adopt the plan for medical coverage (Minsos, 2004). Further, it can also be seen that when the civil rights movements were in upheaval the government also put a hard stance on what it could do in terms of health care. For example, during the great depression, there were outcries regarding to the deteriorating health care mechanisms in the United States (Minsos, 2004). Street action was a common thing, however, the government also responded with the same strategy where it effectively refused to sign any bill into law that provided universal health care for the unemployed Americans.
 
The Prisoner’s dilemma

Another way in which the health access movements can be described is through the prisoner’s dilemma (Rapoport, 1970). The prisoner’s dilemma deals with whether one should co-operate or not co-operate for the greater good. The theory takes its name from the scenario that one and his criminal associate is busted. However, fortunately most of the evidence is shredded and they are both facing one year in prison (Rapoport, 1970).

However, the prosecutor wants to nail someone and offers a deal. If one squeals on the associate, who will automatically lead to a five year stretch, the prosecutor will make sure that six months are taken off the sentence. However, the other associate has also been given the same deal (Powers, 2002). Therefore, in this case, there are two available options either to co-operate with each other or to co-operate with the prosecutor.

However, if one co-operates with the associate, the associate might decide to squeal therefore, it becomes a gamble. In the health access movements, the same motif is often used; if the people decide to go and look for health care alone they might not defeat the ‘prosecutor’ who in this case is the government. However, with co-operation, it becomes extremely easy for the people to come together and form social movements which in turn persists and brings the desired goals to its members.
 
Tragedy of the commons and the anti-commons

The tragedy of the anti-commons can best be described as a type of a co-ordination breakdown that often affects the performance of a certain social group. It occurs where a single resource often has numerous right holders who also prevent others from using it. This action is therefore, frustrating and it means that the social group cannot advance in terms of its goals as there is no co-ordination between the partners (Barros, 2010).

This can be seen in the Health access movement groups where there were a lot of different parties all looking for the same thing. There were indigenous stakeholders who felt that it was their right to fight for universal health care for all Americans and there was the elite group who drafted the laws without the proper consulting of the people in the grassroots. Therefore, this brought about the tragedy of the anti-commons as the health services sector could not be improved as there was a co-ordination breakdown that existed between the different social groups that were in advocacy for better health care in the United States.
 
The tragedy of the commons on the other hand argues that there is often the depletion of a shared resource by different individuals who have self interest (Barros, 2010). This is often despite the mutual understanding that the depletion of this common resource is contrary to the long term interests of the said group. This can be seen lucidly through the health access movements. The common resource in this case was to get universal health coverage for all, however, there were thousands of health access movements that came up during this time and all of them refused to form a collective body where they could easily have the bargaining chip (Barros, 2010).

This they did with the perfect knowledge that without consolidation, their chances of negotiating with the government and getting a respectable deal were extremely low. Therefore, the unrestricted demand that existed for health care, ultimately worked against it as more and more organizations were formed which shifted the bargaining chip to the government. Consequently, this meant that the organizations had experienced what Hernando De Soto described as the tragedy of Commons and Anti-commons.
 
Conclusion

In conclusion, most of the national health reform campaigns and the formation of health access movements were formed in the 20th century. This was because at this time, there was a public outcry in regards to healthcare (Haslam, 2004). Veterans, farmers, workers and the minorities felt that they were being ignored in terms of healthcare and decide to ‘voice’ their opinions in regards to health care as compared to keeping quiet. However, there was a row as most of the movements were initiated as well as run by the elite who were concerned with preventing possible attacks from other interest groups as compared to popular mobilization (Machan, 2001).

On the other hand, there were the grass root movements who concentrated on activist actions that wanted immediate as well as incremental changes as compared to the complete transformation of the health care system itself. There are various theories that can sufficiently explain why the health access movements were formed, how they grew and why there existed friction inside them. These theories include the tit for tat strategy, the exit, voice, loyalty theory, and the tragedy of commons and anti-commons. The health access movements all demanded their equal share of access to what was promised in the American Dream.
 
    References

Barros, D. B. (2010). Hernando de Soto and property in a market economy. Farnham, Surry: Ashgate Pub.
Hoffman, B., (2003) Health Care Reform and Social Movements in the United States, Public Health 93(1): 75-85
Minsos, S. F. (2004). Weird tit-for-tat: The game of our lives. Edmonton: Spotted Cow Press.
Rapoport, A., Chammah, A. M., & Orwant, C. J. (1970). Prisoner's dilemma: A study in conflict and cooperation. Ann Arbor, Mich: Univ. of Michigan Press.
Powers, R. (2002). Prisoner's dilemma. New York: HarperPerennial.
Machan, T. R. (2001). The commons: It's tragedies and other follies. Stanford, Calif: Hoover Institution Press, Stanford Univ.
Haslam, S. A. (2004). Psychology in organizations: The social identity approach. London [u.a.: Sage.





    

Spiritual diversity


Buddhism religion has its main followers in the Asian community. However, the religion still has a lot of presence in the rest of the world. The religion is strange in that it does not have a universally applied code of conduct put into writing. The followers of the religion follow the teaching of an Indian prince that turned into a Buddha. The word Buddha when loosely translated means the enlightened one.

The religion can be termed to be a chameleon religion since it has the capability to exist in many cultures. It fits into the environments since most of the people that subscribe to it absorb the teachings, and they amalgamate them into their cultures. The religion lacks godhead, unlike the other religions (Burnard & Naiyapatana, 2004). It does not have the beliefs instead; the followers abide to the recommended way of life that they received from the Buddha.

Lack of a belief is not indicative of the lack of procedure for the Buddhists. The traditions of the Buddhists have to be overseen by monks and nuns. The leaders of the religion guide the nurses in practices that involve the Buddhist patients. In order to provide accurate care to the Buddhists it is important for the practicing nurse to understand the religion beliefs of the people on care of patients (Grice & Greenan, 2008).

When it comes to birth, the Buddhists prefer that the process take place in a quiet environment that will facilitate the attainment of the meditative state. The nurses should not conduct any ritual such as circumcisions since the religion does not subscribe to infant rituals.

In the case of contraceptives, the Buddhists are assimilated into the society. They may be okay with the conventional methods. However, the followers of the Buddha cannot agree to the issue of abortion since this is a contravention of the teaching of sanctity of life.

Gender is not an issue for the Buddhists although some of the ordained nuns may need the presence of a chaperone of the same sex when they are in the presence of members of the opposite gender.

The Buddhists have keen eyes for the diet that they take. They would prefer taking vegetables even though the teachings of the Buddha are not clear on this matter. The feeding time of the Buddhist patients may be prohibited to the early morning. They may take the food after midday if it is necessary for their health.

Meditation is an instrumental mode of dealing with mental illnesses. The nurse ought to incorporate this approach when dealing with patients belonging to the Buddhist religion.
Euthanasia is not acceptable in the teachings of the Buddha. The nurses dealing with patients that belong to the religion ought to allow the karma to take its unaided toll. The act is a manifestation of violence, which is against the teachings of the Buddha.

Resuscitation of the dying patients is an acceptable practice although some of the sects of the religion believe in different approaches to death. The sects may require that the body stay at the place of death in order to ensure safe passage of the spirit to the other life. During the last stages, some spirit men may be present to chant the spirit into the second world.

Buddhists may resist taking sedatives and opiates since the drugs affect their awareness. Organ and tissue donation are welcome to the Buddhist communities. However, some of the families that subscribe to this faith may harbour different points of view on the same issues. Therefore, the nurse should consult widely with the chaplain and families when deciding on the way forward.

There are many Jews that live in the world today some of them live in Israel while others are scattered all over the world. When dealing with Jewish patients, it is important to establish whether the patients have a strict observance of religion or that they are assimilated into the contemporary cultural environment. Judaism has different divisions. The main divisions are orthodoxy, which is made up of members that live in the modern society while observing the law and members that live in separate parts of the society and have distinctive dress codes. The second major division is the non-orthodox Jews, which is a group of Jews that thinks that they are set apart from the other Jews since they have liberal ideas. They are flexible and are susceptible to change (Leininger, 2002).

The liberal Jews are not strict in the practices followed by the orthodox followers of Judaism. This paper will lean more to the Orthodox Judaism practices than to the liberal Jews since the practices are not universally applied or accepted by the unorthodox Jews. Jews believe in one God who is both omnipotent and eternal. The followers of the Judaism faith are highly disciplined (Lewenson & Truglio-Londrigan, 2008). The teachings of the Torah are more of ways of life than religion. The believers worship in synagogues under the guidance of the rabbi who are the teachers in certain communities. The Jews believe in the Torah, which has two main sections. The first section is the written law and it are made up of the 5 books of Moses. The subsequent section is made up of the Jewish code of law also known as Talmud.

The first encounter with a Jewish of the orthodox section, one should know that the physical contact between the opposite sexes is a reserve for the family only (Potter, 2011). Therefore, the ultra orthodox Jewish patients may be comfortable being tended by a nurse of the same gender.

The Jews are particular about their clothes. The women put on a cap to distinguish the maidens from the married. This cap ought to remain unless in the events of an emergency.
The food taken by the Jews has to be prepared in accordance with the law. The preparation of food for the Jewish patients has to meet some standards. Some foods ought not to be served to the patients. The nurses taking care of Judaist patients must ensure that they serve their patients kosher meals. The timing of the food must be adhered to since the Judaists take milk and meat six hours apart.

Most medications are acceptable except for the throat sweets that have gelatin.

Sabbath is sacred. The Judaists cannot do anything that is considered as work. They cannot even use the hospital buzzer to call the nurses in times of emergency.
The sexual relations between the married couples are not allowed during the menstrual cycle. This fact is important to the nurses that will be have the role of taking care of the reproductive health patients.

In conclusion, the research on the effect of the religious beliefs on the provision of health care has been instrumental in dispelling some of the notions that I had. The notion that people have a similar approach to the healthcare turned out to be a fallacy (Rosdahl & Kowalski, 2012). The research has educated me that the people and their approach to the healthcare cannot be generalized at all. I have also managed to accord the necessary respect to the religious convictions and practices of the other people.

References

Burnard, P. & Naiyapatana, W. (2004). Culture and communication in Thai nursing: a report of an ethnographic study. International journal of nursing studies, 41 (7), 755--765.
Grice, T. & Greenan, J. (2008). Nursing. Oxford: Oxford University Press.
Leininger, M. (2002). Culture care theory: A major contribution to advance transcultural nursing knowledge and practices. Journal of transcultural nursing, 13 (3), 189--192.
Lewenson, S. & Truglio-Londrigan, M. (2008). Decision-making in nursing. Sudbury, Mass.: Jones and Bartlett Publishers.
Potter, P. (2011). Basic nursing. St. Louis, Mo.: Mosby Elsevier.
Rosdahl, C. & Kowalski, M. (2012). Textbook of basic nursing. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.