Category: Cognitive Behavioral Therapy

Smartphone, the Internet-enabled device incorporated with computer applications and software, has become an inevitable part of life. Because of its portability and user-friendly nature, this device has attracted more and more people. According to Statista (2020), 3.5 billion people in the world use smartphone, which translates to 45.04% of the world’s population. Smartphone helps people to work, study, acquire or share information. It also helps people to maintain social relationships and enjoy leisure activities. Education is another field, which benefits from the use of smartphones. In fact, educators and parents appreciate the ability of students to use them. As a result, students practice autonomy on the use of smartphones as classroom tools without supervision.

Even though, students profit from the use of smartphones when it comes to speed of learning and better understanding, overuse of this tool has led to problematic smartphone use. The increased frequency of mobile use leads to addiction, as mentioned by Goodman (1990), characterized by dependency and compulsion. This dependency becomes problematic, when students start to use it as an important mechanism to relieve stress, loneliness or depression. The gratification produced by the use of this device makes them engage in this activity more and more, leading to compulsion. As a result, they decline in maintaining real social relationships and academic achievements. In the long run, the persistent and recurrent use of smartphones also result in both physical and psychological problems, such as deterioration of health and well-being and maladaptive behaviors.

In order to prevent the negative impacts of smartphone use, those addicted to it have to focus on its positive benefits that they may get from this device. They need to concentrate on how to prevent the misuse of smartphones rather than preventing the use itself. AlBarashdi et al. (2016) suggest six stages of Transtheoretical Model (TTM) of cognitive behavioral approach to focus on the decision-making process of those who have developed addiction to it (also called addicts): pre-contemplation, contemplation, preparation, action, maintenance and termination. In the first stage, the addicts break the denial of the problem. In the second stage, they intend to make a change in the behavior. In the third stage they are ready to take an action, and in the succeeding stage they enact it. In the maintenance stage, they prevent the relapse and once they have realized the envisioned change, therapy may be terminated. Motivational interviews, combined with mindfulness meditations, are included to enhance awareness about the cues that trigger the misuse (AlBarashdi et al., 2016). These interventions can challenge and emphasize personal choice and responsibility, thus leading to decrease the tendency of problematic use of smartphones.

However, many investigations have been conducted to reduce the negative impact of the problematic use of smartphones, limiting them only to their functions or applications. The solutions suggested by those studies were either the deletion of the programs or performance of some positive self-fulfilling activities. According to AlBarashdi et al. (2016), in the TTM approach the addicts themselves become their own therapists, developing their own awareness and making strong decisions that result in the modification of behavior.

The TTM approach, combined with mindfulness meditation, seems to be a good solution against the problematic use of smartphones.

This review will focus on the therapeutic interventions for children who have experienced traumatic experience of abuse and neglect. Furthermore, it will explore the link between the effective interventions and the projects in Peopleknowhow People Know How’s(PKH) provided for the childrenPositive Transitions Service supporting children and young people.

Child maltreatment is a vital public health concern. Abuse and neglect include physical, emotional sexual abuse, as well as physical, emotional neglect such a Child maltreatment including all types of abuse and neglect is predominantly common lead to children traumatic experience. Child maltreatment address the act of commission or omission by parents or any caregivers, which may cause potential harm or threat to a child (Leeb et al., 2008). Also, apart from maltreatment from family, abuse and neglect also exist in the community, in school, in public place from other adults and from peers (bully victimization) (Radford et al, 2011).

Exposure to maltreatment in childhood through abuse and neglect are more common than we thought. The prevalence rate across countries for sexual abuse (12.7%, girls 18% and boys 7.6%), for physical abuse (22.6%), for emotional abuse (36.3%), for physical neglect 16.3 and for emotional neglect (18.4%) (Stoltenborgh et al., 2014). In population survey in the UK regarding the rate of children maltreatment and other victimization, 2.5% of children (under 11 yrs) and 6% of young people (aged 11-17) reported experienced one or more times of maltreatment in the past year (Radford et al., 2013). Though the responding rate of children protection has increased in UK, the situation evaluation of 0.5% children has been recognized as vulnerability for maltreatment each year. By 2016, there is an substantial increasing trend for physical neglect and emotional abuse in the child protection registration, whereas a slightly decrease in physical abuse and sexual abuse (DeIngli Esposti et al., 2019).

These experiences have been linked to trauma-related symptoms across domains in childhood and later life. Symptoms of mental health problems can appear soon f traumatic following traumatic event, but in some cases symptoms will not show until years later (Buss, Warren & Horton,, 2015). Children exposure to trauma has been proven to be linked with depression, attention deficit/hyperactivity disorder, and developmental crisis in psychosocial functioning (American Psychiatric Association, 2013). Emotion maltreatments, specifically, are strongly associated with internalizing problems (Moylan et al., 2010; Vanmeter et al., 2020) such as depression (Humphreys et al., 2020), social anxiety, trait anxiety and self-esteem and self-concept formation in children (Berzenski & Yates, 2011), while physical abuse and neglect is more related to externalizing problem such as aggressive behavior. In fact, children who experienced abuse or neglect showed substantial rate of PTSD, with which up to 50% (????). Therefore, therapeutic interventions for children with experience of abuse or neglect must be effective on reducing post-traumatic stress disorder (PTSD) symptoms. As the devastating and long-lasting impact on emotion and psychosocial development and interpersonal relationship, interventions applicable in the setting of clinical situation, school and community are all warranted for children at risk of abuse or neglect or with exposure to abuse or neglect who need to seek help.

This article reviews the existing evidence and evaluate the three more popular therapies, including Trauma Focused-Cognitive Behavioral Therapy (TF-CBT), Eye movement desensitization and reprocessing (EMDR) and art therapy. In addition, it will also evaluate the link between the popular and effective interventions within the current project in Peopleknowhow People Know How’s current projects including such as aArts therapyTherapies, befriendingBefriending, social work support Family Support, and art Art befriendingBefriending.

TF-CBT conducted in the ways as group intervention and individual intervention with or without the involvement of parents are regarded as well-established interventions (Dorsey et al., 2017). TF-CBT consists psychoeducation about trauma, stress coping skills, emotion regulation strategies, relaxation to manage the anxiety and fear. In addition, it includes exposure via creative techniques in a gradual manner to correct the maladaptive cognitions. TF-CBT is developed based on the theory of social learning and cognition, and can be addressed the (symptoms from conditioned and learned behavioral responses (Berwin, 1989, (ART c CBT). TF-CBT for children with comorbid aggressive behavior will also address delivery of positive interpersonal behavior.

The exposure session can be conducted in a graduated manner utilizing a series of creative techniques will be utilized such as imagining of the trauma. To be specific, distressing disclosure regarding trauma related memory will be avoided at the beginning, as the session gradually progressed children will encouraged to convey the detail of traumatic experience with a series of creative techniques.

As to the narrative component, for example, for children with exposure to intimate partner violence (IPV), the goal of the narrative component is to enable their recognition of maladaptive cognitive process via expression trauma related feelings and experience (Cohen, Mannarino & Iyengar, 2011). Furthermore, it aims to develop their ability to differentiate between real threat and their emotions of anxiety and fear.

Cohen and his colleague (2011) conducted a randomized control study to examine the effect of TF-CBT in the community setting for children aged 7-14 with experience of intimate partner violence. The finding indicated that brief community TF-CBT has largely lower the level of PTSD related symptoms (i.e. hyperarousal and avoidance) and anxiety compared to Child Centered Therapy. The great improvement may due to the focus of TF-CBT model, as it focused on developing children ability of discrimination of the real danger and relaxation strategies to make them feel safer when confronted violent experience.

A study examined the potential impact of Trauma Narrative (TR) in TF-CBT for children with experience of child sexual abuse. The study demonstrated that the eight session programme with TN component is not only effective in improving behavioral functioning and PTSD- related symptoms but also most efficient to ameliorate the trauma-related emotional distress for both children and parents (Deblinger et al., 2011). Maintained impacts of the TF-CBT were observed in follow-up assessment 6 or 12 months after the intervention for all conditions, with no difference between conditions (Mannarino et al., 2012).

The external validity has been demonstrated in the community setting, while the internal validity is relatively low attributed to the high dropout rate (39.5%) of the project in community (Cohen et al., 2011). As to the generalizability of TF-CBT, two study examining the effectiveness of interventions on youth experienced multiple types of trauma extended the effecacy of TF-CBT beyond the sexual abuse (Hensen et al., 2014; Murray et al., 2013).

EMDR mainly aims to restore stressful and painful memories but also can applied as a technique for age-specific modification. In two studies, the group using EMDR with a focus on emotion and cognition as well as distressful memories and externalizing problems show a significant decrease on post traumatic symptoms than waitlist group (Soberman et al. 2002; Ahmad et al. 2007). As EMDR is incorporated with the CBT simply as a component of the whole intervention in some research, the effect of EMDR failed to be evaluated separately (De Roos et al., 2011; Farkas et al., 2010). Besides, the intervention with EMDR component is limited by the small sample size (Silverman et al., 2008). Therefore, large sample size study is needed to provide further evidence to the effect of EMDR.

Although the practice of art therapy has been in existence for many years, until very recently, the efficacy of art therapy has not been empirically addressed. Art therapy intended to address the cognitive and emotional issues via art activity through which the young children can express their thought and feeling. There is limited research to date to validate the effect of art therapy. The study conducted by Lyshak-Stelzer et al. (2007) utilizing the arts-and craft-making activity in art treatment compared to treatment as usual. The finding provided supporting evidence to take art as an effective tool for traumatized children. Overall, The lack of evidence might due to unmeasureable outcomes, unstandardized procedure, the unspecific methods in most research as well as the methodological limitations (Eaton, Doherty & Widrick., 2007). Besides, although numerous case studies in art therapy can give more insight of the theory, more group study is warranted due to the limited generalizability of case study.

Pifalo and T (2007) proposed to combined TF-CBT with art therapy. Art therapy facilitates the children affective processing when children recalling the painful and stressful situation of trauma, and also improve their coping skills. However, two study examine a classroom-based intervention combined Creative expressive component and CBT utilizing the techniques such as music, drama to express and drawing for exposure among children with experience of war. The findings indicated the reduction of PTSS at the completion and follow-up, but in one study no significant was found between intervention group and waitlist group. However, some research proposed that the art as a method facilitate the client and therapist to form safe relationship, which is very critical to the intervention outcomes. A meta-analysis provided support to the notion (Asay & Lambert, 1999)

In terms of treatment across all types of interventions, the component of parent involvement exhibited a rather mixed effect. There is little difference between groups with or without parent involvement for depression, and post trauma stress symptoms and externalizing problems, whereas it produced large effect for the anxiety ((Dorsey et al., 2017). In the review of Silverman et al. (2008) parent session conducted along with the child session in the TF-CBT, the finding indicated that the parent involvement component does not account for most outcomes of the treatment. Whether parents should be involved in the treatment remain unclear and debated (Leenarts et al., 2013).

The art therapy project in PKH People Know How’s Arts Therapies project aims to provide children the chance to communicate their emotions and explore the support they need in a supportive environment. Though verbal skills developed fast during early childhood, children are limited by their communication abilities to express their feelings and thoughts (Cohen, 2010). Many art therapists noted that young children are the population can benefit a lot from the art therapy, as they more willing to articulate themselves in an imaginative way (Clements, 1996).

While trauma narrative has been proven to be effective in reducing children trauma-related painful feeling, children in the 16-session programme without NT also show a reduce in the trauma-related painful feelings. Although the children are not encouraged in the programme, coping strategies and body skills also help for the processing of trauma. Despite the befriending project do not address the expression of the experience of trauma event or feeling, it provide a safe and trustful environment which can allow the children and the volunteers to share their feelings and discuss about the coping strategies rather than direct discussion of the trauma.

Art befriending is intended to carried out to utilized the art as the tool to create a safe environment for the volunteers and the children as well as facilitate them to form a trustful relationship.

As six common components have been identified in the majority of effective treatments for children with exposure to trauma, some of this could be considered to be incorporated the project of People knowhowKnow How. For example, psychoeducation about trauma prevalence, impact and intervention; training in emotion regulation strategies such as relaxation, emotion differentiation, and coping skills) can be incorporated in social work support project the or be delivered in the befriending project.

Introduction

An eating disorder is a mental disorder defined by abnormal consuming behavior that negatively affects someone’s physical or psychological health (APA, 2013). According to the American Psychiatric Association, eating disorders happen along with side other mental disorders like panic, anxiety, depression, obsessive-compulsive disorder, and alcohol and substance abuse problems. Consisting of DSM-V, eating disorders are illnesses during which people experience severe disturbances in their eating behaviors and related thoughts and emotions (APA, 2013). However, with proper medical aid, people who suffer eating disorders perhaps could restart appropriate eating behavior and return to raise mental and emotional health. People with eating disorders usually grow to be preoccupied with food and their weight. Without treatment of both the emotional and physical symptoms of those problems, malnutrition, coronary heart problems, and other potentially fatal conditions might also happen (Hay, 2009). Based on my opinion, people with an eating disorder can hold the secret for decades, as their look could be commonly routine, and they could often eat in public. Cultural idealization of thinness believes it could be a factor to contribute to some eating disorders (Rikani et al., 2013). It could be argued that that is a result of such societies putting stress at the value of particular body types, especially among women. It is also essential to keep in mind whether or not there are cultural differences within societies. Even as it is clear that females are more likely to experience eating disorders than males, there was a significant growth within the identification of men with eating disorders in the latest years (APA, 2013). There may also be a more occurrence among those in at-risk professions where there is a focus on body shape and weight, such as dancers, athletes, models (Arcelus, et al., 2014).

Bulimia Nervosa

According to NICE guidelines, bulimia nervosa is characterized, utilizing recurrent binge consuming, excessive weight-manage behavior, and over concern about body shape and weight. Bulimia nervosa is significantly more common than anorexia nervosa within the population, though services are frequently more centered on the care of anorexia nervosa. The disorder generally begins in late adolescence or early adulthood (APA, 2013). Nevertheless, after a few months or years, the nutritional restrict turns into punctuated with the aid of repeated binges. Compensatory behaviors follow these binges, in most instances, self-triggered vomiting or the misuse of laxatives in an attempt to reduce their effect on body weight (Hay, 2009). In-among binges, there are also usually persevering with efforts to limit ingesting. Notwithstanding this, any weight loss tends to be progressively regained, and similarly, weight gain is a common consequence (Hay, 2009).

Statistics

Followed by the Diagnostic and Statistical Manual of Mental Disorder (DSM-V), people who had bulimia might be preoccupied with their body shape and weight. They are probably dwelling in fear of gaining weight, feeling a loss of manage at some point of bingeing, and forcing themselves to vomit or workout an excessive amount of to maintain from gaining weight after bingeing (DSM-V, 2013). There also have individuals who use laxatives, diuretics, or enemas after ingesting. Besides, fasting, limiting calories, or averting certain ingredients between binges also a particular manner of purging. A few people even using nutritional dietary supplements or natural products, excessively for weight reduction (DSM-V, 2013). Being obese as a child or teen might also increase the risk. Mental and emotional issues, which include depression, anxiety disorders, or substance use disorders, are intently related to eating disorders (APA, 2013). In a few instances, traumatic activities and environmental stress can be contributing factors — individuals who weight-reduction plan are at higher risk of developing eating disorders. Many people with bulimia significantly limit calories among binge episodes, which can also cause an urge to eat once more and then purge (Kendler et al., 1991). Other triggers for bingeing can consist of strain, negative body self-image, food, and boredom. Bulimia may additionally motive extreme or even life-threatening complications (Harrington, 2015).

What Do Studies Say?

According to some research, Cognitive-Behavioral Therapy has the most reliable scientific evidence of all the proven psychological aid for bulimia nervosa (Fairburn, Marcus, & Wilson, 1993). The cognitive-behavioral treatment of eating disorders emphasizes the reduction of destructive thoughts about body appearance and the act of ingesting and tries to regulate harmful and dangerous behaviors that might be concerned in and continue consuming issues (Walter, 2012). Comply with Fairburn’s research record that the enhancements in bulimic sufferers who have acquired CBT seem like nicely maintained. Studies indicate that the outcomes of cognitive-behavioral therapy within the remedy of bulimia nervosa are appropriately managed. An evaluation of the literature suggests that healing modifications are nicely maintained over the six to one year following treatment (Fairburn et al., 1995). Cognitive-behavioral therapy, as handling for bulimia nervosa, has been substantially studied (Murphy et al., 2010).

The Problem of CBT

The primary findings which have been recognized are as follows: CBT has considerable useful consequences on all factors of the psychopathology of bulimia nervosa (Dattadeen, 2015). Some of the research has established a noticeable decrease within the rate of purging and binge ingesting, reduced nutritional control in addition to development in cognition about weightiness and configuration (Dattadeen, 2015). Further, those essential effects are typically related to a lower within the level of broad psychiatric signs and symptoms and enhancements in self-confidence and interpersonal performance (Dattadeen, 2015). Besides, CBT has been proven to be stronger than numerous different mental care, consisting of stress control remedy, supportive psychotherapy, dialectical behavior modification, and supportive-expressive psychotherapy (Wilson & Fairburn, 2002). The capital exception is interpersonal psychotherapy (IPT), which has been proven to have similar consequences to CBT (Fairburn et al., 1993; Agras et al., 2000).

Therapists can also guide sufferers during a self-help model of Cognitive-Behavioral Therapy for bulimia nervosa (Fairburn, Marcus, & Wilson, 1993). The primary section includes training regarding weight and therefore the harmful physiological effects of binge consuming, purging, and severe dieting, and facilitates the patient set up a daily pattern of intake, to withstand the urge to binge eat and purge, and the proper weight tracking schedule (Fairburn, 2008). The therapist and affected person utilize specified statistics of food intake, episodes of binge consuming, and purging in addition to related cognition and feelings (Wilson, 1997). Within the second section, the primary goal shifts to lowering shape and weight issues and weight-reduction plan conduct, and figuring out precipitants to any final binge-purge episodes (Fairburn, 2008). The third phase specializes in preserving alternate after the treatment has ended. In this stage, relapse prevention techniques used to prepare for ability setbacks with treatment (Fairburn, Marcus, & Wilson, 1993).

Jane is a 22 years old Chinese female. She is currently a uni-students study fashion design, and her also a dancer. She is presently single and from a middle-class socioeconomic background. Jane is of average height and is medium-built. During the interview, she has dressed appropriately and possessed a pleasant demeanor. She was open and honest with her responses and maintained good eye contact when speaking with the therapist. Jane is a referral by her doctor for Cognitive-Behavioral Therapy.

Jane presented with complaints of depressed mood, anxiety, concentration difficulties, loss of control over the eating, and sleep disturbances. She cannot sleep in the night and constantly going to the bathroom right after eating, during meals or for long periods of time. She reported experiencing these symptoms for the last three months. In addition to these symptoms, Jane said that continually worrying about being fat, causing her to have much anxiety. She also reported an inability to control her anxiety and had to use dietary supplements or herbal products excessively for weight loss. According to Jane, she has attempt suicide before by cutting herself to stop that behavior.

Jane said she was a dancer in year one and prepared for a competition. Thus, she must keep a good body figure. Jane reported that the competition only chooses the best dancer to perform, and it is an international competition, will invite many famous dancers as judges. Therefore, a lot of stress and anxiety coming out as she needs to challenge with other dancers to get the chance. However, Jane mentioned that she used to binge to release stress, and she could not be able to control her food intake. Her classmates started laughed and teased at her because of her body size getting fat and always said some bad words to hurt her like you are a loser, fat women cannot dance. Jane reported that until now, she still felt like someone was looking at her and criticized her body size. She has to eat secretly and purging after her meal to keep weight.

According to Jane, she grew up in a single-parent family with her mother. Her father divorced her mother because her mother was getting fatter and almost become obesity after born Jane. She had these core beliefs when she grew up that slim people are pretty. She believes that people more likely to like a thin person rather than fat people as her mother was an example. There is significant stress for ladies to comply with feminine beauty beliefs, and, since thinness is prized as female, many girls sense disillusioned with their body shape. Body dissatisfaction is a precursor to extreme mental troubles, including depression, social tension, and eating disorders (Jefferson & Stake, 2009).

Jane mentioned that her classmates have a slim body shape and the food amount of them only half of her. In her belief, people who are thin or have an attractive look will have more friends. She had seen some students being a bully by other students because of their body size and a large amount of eating. Therefore, she believes that if she had a skinny body size, her classmates would be more likely to befriend her. Due to this situation, she was kept worried and anxious about her body size will be criticized by her classmates.

According to Jane,she had learn some healthy coping skills to deal with her stress more effectively. She felt lucky and energize that her mother was supportive of going to exercise together with her. Her boyfriend also never left her alone when she was having a lot of anxiety but still by her side. They provide support and let her understand that she was not alone. Her boyfriend even suggests she make an appointment with some counselor to solve her problem as well as can normalize her eating behavior and recovery.

According to NICE guidelines, treatments of bulimia nervosa usually have up to 20 sessions over 20 weeks (4 to 5 months) (NICE, 2017). Sessions divided into four parts: a review of the patient’s self-monitoring form; setting and implementing the agenda for the meeting; a wrap-up of what was covered during the session; and the assignment of specific homework tasks.

Generally, in the first few sessions, it will more likely become a chit-chat setting to know more about the client and build a therapeutic alliance. During the treatment, the therapist must be genuine in relating to the client. Having a strong therapeutic alliance with the client would be more useful and more comfortable to gather the client data and apply the therapy on the clients to solve the problem. When a good relationship had built between client and therapist, the counseling session would be more effective because of trust and cooperation. The therapist must pay particular attention to this aspect of therapy, as the client has an inherent need to please others. The therapist should also be willing to listen to what Jane has to say while exhibiting patience, warmth, and interest. Further, the therapist must be willing to accept her without making judgments about her thoughts, feelings, or actions.

Self-symptoms measure usually done before the treatment start. Jane has to do a self-report measure while in the waiting room. This is a way to evaluate baseline functioning in addition to therapeutic progress (Cully, & Teten, 2008). After Jane completed, it will be assessed by the clinician throughout the consultation. Frequently self-report measures can function as a recurring schedule object in the course of CBT sessions and might spotlight critical enhancements and persevering with signs and symptoms (Cully, & Teten, 2008). Data acquired from these self-report inventories can also provide perception into the manner the affected person thinks and behaves and factors that are probably vital areas of need (Cully, & Teten, 2008). It might be helpful and faster for the therapist to understand the condition of the clients.

Before everything going on, the client has to know about the Cognitive-Behavioral Therapy model (Fairburn, Marcus, & Wilson, 1993). During the first few session usually begins with the psycho-education. Jane needs to have a strong understanding of the cognitive model to ensure the therapy effectively. Cognitive-Behavioral Therapy is based on the idea that our thoughts, feelings, and behaviors are continually interacting and influencing one another. Core beliefs are developed from an individual’s unique personal experiences (Bulter, 2006). Therefore, Jane had the core belief that fat people will be bully and dislike by others was strengthened since she grew up. After constructing a public knowledge of the cognitive model, they will learn how to become aware of their cognitive distortions. Jane had to understand how her belief was affecting her thought and behavior. If the client has the insight and knows the link between their cognition and behavior, more likely, it will be easier for the client to stop the negative thought.

After Jane understood the model, treatment will continue by setting a treatment goal. The objective is to help Jane reduce abnormal eating behavior and normalize her life. The purpose of therapy should be discussed with the client to ensure that both sides are ready to make the changes and motivate them to do it. Perhaps it will also enhance the therapeutic alliance. It is essential to set a goal for the treatment to make sure that everyone is following in the same direction. Throughout the procedure, Jane could provide some feedback about the therapy to resolve some misunderstanding and able to keep track of the client’s condition. Treatment goals can be changed at any time during the treatment (Cully, & Teten, 2008).

After every therapy session, Jane will need to do thought the report for recording experiences, together with the mind, emotions, and behaviors. This homework will assist her to turn out to be aware of cognitive distortions that formerly went disregarded and unquestioned. With practice, she may discover ways to pick out cognitive distortions for the time being and right now challenge them (Manus, 2012). Jane has to report her thought and behavior daily, and the scenario that she came out that binge behavior. Cognitive-behavioral therapy to help the client normalize their eating patterns and identify unhealthy, negative beliefs and behaviors and replace them with a healthy and positive way (Fairburn, 2008).

Conclusion

According to Agras study, it recommend that cognitive behavior modification, while implemented to patients with bulimia nervosa, operates via mechanisms particular to the present remedy and is stronger than both interpersonal psychotherapy and a simplified behavioral model of cognitive behavior therapy (Agras, 2000). Cognitive-behavioral therapy is a more effective treatment for adults in Eating disorder-Bulimia Nervosa. However, if patients are adolescents or children, treatment will be more recommend family therapy perhaps the parents can support their kids in changing their eating behavior. Although CBT is an effective therapy for eating disorders, however, it only is beneficial in some situations. There are a few studies had proven that CBT consists of some limitations. Cognitive-behavioral therapy relies on the desire of the patient. Each person must be invested in themselves for cognitive behavioral therapy to figure. Homework is arguably the first crucial element of cognitive-behavioral therapy. Cognitive-Behavioral Therapy might not be useful for individuals with specific learning difficulties.

Deliberate self-harm is the action of purposefully wounding one’s own physical form. Some examples include cutting or slicing their skin with sharp objects or scorching their body with fire. A long standing belief holds this specific type of self-injury to not include and suicidal intentions. Relatively, this form of self-physical damage is a risky manner to manage mental-emotional pain, extreme rage, and defeat. Some self-injurers may experience a fleeting sense of serenity and freedom from pressure, trailed by culpability, humiliation, and reoccurrence of the uncopiable feelings. Additionally, regardless of intent, with self-injury arises the risk of severe deadly self-aggressive activities. A singular cause that primes someone to self-injure has yet to be discovered. Overall, self-injury may perhaps result from several potential complex foundations, such as the inability to cope with psychosomatic discomfort by utilizing only positive behaviors or any deficiency in the process of emotion management, modification, communication, or empathy. Feelings of irrelevance, isolation, dread, rage, onus, dismissal, self-loathing, or sexuality confusion may also be present. Receiving suitable treatment, such as cognitive behavioral therapy, can educate a self-injurer on several optional and positive methods of coping.

Principal self-mutilation, such as self-directed surgical enucleation, genital disfigurement, and abstraction, is a relatively intermittent symptom principally interconnected with psychotic disorders and acute hedonism. General self-mutilation is repetitious conduct that maintains an equitably static configuration of manifestation. Artificial restrained self-mutilation is the utmost established form and embraces scorching, skin-cutting, interfering with helical restoration, and widespread scraping (Favazza, 1992).

The most common locations of self-injury are the fingers, palms, wrists, abdomen, and thighs, nevertheless self-injurers can hurt themselves anyplace on the physique (DeAngelis, 2015). Research also finds, individuals who self-injure similarly are further disposed to depression, desperateness, and disconnection (Tantam, 1992). Thus, examiners are learning the role of emotion dysregulation, struggle discerning between emotional states, or knowing in what way to manage through or disengage oneself from destructive emotional states, and discovering a solid relationship with self-injury (DeAngelis, 2015).

In a 2013 study testified in the Journal of Adolescent Health, study writers and associates monitored 1,466 undergraduates at five American universities over six semesters. Learners who self-injured at the commencement and denied having any morbid beliefs, strategies, or engagements, yet later engaged in a minimum of twenty self-injuring activities, stood 3.4 times more probable to attempt suicide prior to the end of the study. Further risk aspects encompassed an individual’s pain tolerance, truncated mental state of dignity, inclination to objectify their physical appearance, and co-occurring illness. Journalist Jennifer Muehlenkamp, Ph.D. focuses primarily on inspecting body objectification as a crucial element in the progress and preservation of self-injury. The concept embraces that once individuals perceive their identifiable body as an thing, the consequence of co-opted social and ancestral stresses, they equally gain the ability to theoretically sever ties between their physical body and psychological being and thus hurt themselves without difficulty. A 2013 study conducted entitled Suicide and Life-Threatening Behavior, supports this premise. Individuals with negative self-image, who co-morbidly scored high on emotion dysregulation, were noted as ensuring greater probability to self-injure than persons with reduced emotional standard yet normal self-image. The conclusions advocate a hypothetically substantial cohesion between self-injury and consumption maladies, which present in up to fifty-five percent of self-injurers (Abrams M.P.H., 2013).

‘Body objectification, body devaluation, and a lack of internal bodily awareness are also prevalent in that population and to become more mindful means you have to become more in tune with your body, more connected to it, more integrated with it. (DeAngelis, 2015)’

Muehlenkamp similarly desires to research the mindfulness element of dialectical behavior therapy. Dialectical behavior therapy communicates body cognizance which could in theory destabilize an individual’s predisposition to objectify their body, therefore decreasing possibility of self-injury, she speculates.

As an infrequent comportment, it presents in several disorders, including, borderline, histrionic, antisocial, and dissociative personality disorders, post-traumatic stress disorder, anorexia, and bulimia (American Psychological Association , 2017). As a repetitive reaction to disconcerting psychological or environmental happenings, it satisfies the criteria for an impulse control disorder (Favazza, 1992). Self-mutilation is historically viewed as a symptom of numerous psychological disorders. The concept that it has capacity to constitute a distinctive disorder alone emerged in the 1960s when a number of authors termed ‘wrist-cutting’ and ‘delicate self-cutting’ syndromes (Abrams M.P.H., 2013). In 1974, continual self-cutting was termed an impulse neurosis. In England, Catharine Morgan, a research associate, defined a ‘deliberate self-harm’ syndrome, which included self-mutilation, drug overdoses, and suicide endeavors (American Psychological Association, 2017). In 1983, researchers Harriett Pattison and Emil Kohan redefined Morgan’s syndrome in which they excluded factual suicide efforts, narcotic intoxications, and offered effective criteria. They considered the syndrome as a disorder of impulse control. In 1986, psychologists J. Hubert Lacey and C. D. H. Evans offered a ‘multi-impulsive disorder’ that encompassed transposable indicators such as binging, drug abuse, alcohol dependency, kleptomania, and self-mutilation. American psychiatrist and writer Armando Favazza further developed this concept of a distinct syndrome to which he renamed, repetitive self-mutilation (Favazza, 1992) .

Repetitive self-mutilation, also known as self-harm, typically transpires privately in a ritualistic manner that habitually leaves superficial skin lacerations. Individuals who self-injure usually employ many different methods to inflict themselves harm. Distress can trigger urges to self-injure. A large portion of individuals self-injure only a limited amount and terminate. For incalculable others, self-injury becomes a continuing and repetitive behavior (National Collaborating Centre for Mental Health (UK), 2012).

Non-suicidal self-injury is thought to be the result of an incapability to cope in strong ways with inner agony where as an individual has difficulties amending, conveying, or accepting feelings (ICW Group, 2018). The combination of emotions that prompts self-injury is multifaceted. For example, the manifestation of triviality, seclusion, anxiety, rage, onus, refutation, self-denigration, or disorganized sexuality. By utilization of self-injury, the person could be attempting to cope with or diminish severe anguish or disquiet and deliver a sense of reprieve. Other goals of self-injurious behavior are to offer a diversion from agonizing emotions through fleshly discomfort, to gain a feeling of control over their bodies, emotions, or circumstances, to feel to some degree or everything or else feeling expressively void, to express internalizations as externalized, to explain melancholy to others, or as penance for alleged errors (Shammas, 2018).

There are some influences that may increase the threat of self-injury. Individuals with self-injurious friends, victims of neglect, abuse victims, or those who experienced severe trauma. These individuals could now be adults in an unbalanced domestic setting, or adolescents and teens inquisitorial about their sexuality. Most sufferers are socially secluded, very self-critical, and lack adequate problem-solving skills. Furthermore, self-injury is generally connected with definite mental illnesses. These include borderline personality, anxiety, post-traumatic stress, manic depressive, and eating disorders. An increasing number of self-injurious people exhibit the negative behaviors while under the influence of drugs and alcohol (Mayo Clinic Staff, 2018).

When the self-injury is co-occurring with a mental health illness like borderline personality disorder, the treatment concentration will be on the illness. Treatment for self-harming behavior is arduous, challenging, and an individual must possess the drive and ambition for recovery. Unfortunately, there exists no pharmaceutical maintenance practice considered to precisely treat self-injurious conduct. Management options embrace cognitive behavioral therapy (CBT), which helps individuals to identify corrupt and damaging beliefs or actions so that they can be substituted with positive and adaptive thoughts. Dialectical behavior therapy is a type of CBT that explains how to gain behavioral abilities that assist in ensuring tolerance of emotions and improvement of interpersonal relationships. Individual, family, and group therapy is also recommended.

Learning and using adequate coping skills are a necessity for an effective recovery from self-harm (National Collaborating Centre for Mental Health (UK), 2012). Coping tactics that battle self-harming ideas include having a strong support network, avoidance of all negative thought provoking media, positive emotional expression, maintaining appropriate mental balance, and improvement of oneself.

Depression is one of the most common mental health issues concerning individuals in the US and it is the most common cause for student disability amongst college students. It causes negative educational, social, economic outcomes, and even suicide. Depression treatment effectiveness is specific to each individual. Animals have been used throughout history to assist human interaction and wellbeing. Particularly, emotional support animals have shown to aid in reducing the biobehavioral processes associated with depression. It is important to research all treatment options in order to make them available for individuals’ specific condition. This study seeks to support the hypothesis that if individuals with depression have an emotional support animal, then their levels of depression will be reduced.

Depression has become one of the most common mental health concerns. It is now affecting more than 16 million American adults each year. Depression is common predominantly amongst those who have occurrences of social or personal conflicts, health related disabilities, deaths of close family or friends, and social seclusion (Branson, Boss, Cron, & Kang, 2016). It can be caused by several different factors. These may include difficult life events, medication side effects, a family history of depression, imbalance of neurotransmitters, or negative thinking patterns. It may also co-occur along with another condition such as cancer, diabetes, heart disease, or a hormonal disorder. Individuals with depression may exhibit signs of sad or anxious mood, abnormal sleeping patterns, irritability, persistent pain, digestive conditions, trouble with focusing or decisions, lethargy, feelings of guilt or hopelessness, self-harm, and suicidal thoughts or actions. Being such an impairing mental condition, adequate and effective treatment may be difficult to find.

Research shows that depression is considered to be among the most commonly diagnosed and treated of all psychiatric disorders (He, Zhang, et al., 2019). More specifically, in the population of students with disabilities within college campuses, 24 percent reported that they have a mental health condition or depression making this group the largest proportion (Agarwal & Kumar, 2014). Depression during this stage can result in negative educational, social, and economic outcomes. In particular, suicide is reported to be the leading cause of death in college students in the United States (Acharya, Jin, & Collins, 2018). Study results are reflective of the importance of depressive symptoms in relation to suicide ideation among college students and suggest that depressive symptoms must be a key focus of the conceptualization and assessment of risk (Cukrowicz, Schlegel, Smith, Jacobs, Van Orden, Paukert, Pettit, & Joiner, 2011). It may be possible that because depression in college students is more often a first onset disorder it can be treated better as opposed to a recurrent depressive disorder. With college years being such a critical period for individuals with depression, alternate treatment options should be further explored and made available.

There are several options for individuals with this condition. Among the several forms of therapy there is psychotherapy which is a method which involves treating a phycological disorder through communication with a mental health professional. The most common form of psychotherapy for depression is cognitive behavioral therapy. This therapy is considered to be a goal-oriented approach intended to change patterns of thought in order to change the way the individual feels. Various forms of psychotherapy are used in the treatment of depression along with other forms of treatment. Studies show that CBT has enhanced treatment efficacy when used along with antidepressant medication treatment (He, Zhang, et al., 2019). Group therapy was also compared to individual therapy in a study by Cujipers et al. (2016) suggesting that individual treatment is more effectual than group therapy among college students. Psychotherapy has been used in combination with other methods of treatment but considering the diversity of the individuals with depression it is difficult to find effective treatment that fits each individual’s needs.

Medication treatment is also a common recommendation for individuals with depression. Antidepressants have become a recommended alternative or addition to psychotherapy. These medications regulate the balance of neurotransmitters in the brain that directly affect mood and emotions. Their goal is to regulate daily life by increasing positive mood, increase appetite, increase concentration, and regulate sleep patterns. Despite the benefits of taking antidepressant medication, its adherence has been subject for concern. 30-60% of all patients who commence treatment with antidepressant medication discontinue taking the medication within the first 12 weeks causing reduction of treatment effectiveness, risk of relapse and reoccurrence of depression (Buus, Johannessen, & Stage, 2011). This is particularly concerning because the guidelines for antidepressant medications require patients to take their medication for at least 6-9 months to prevent relapse after the remission of a depressive episode (Rheker, Winkler, Doering, & Rief, 2016). Medication therapy for depression encounters several hindrances that reduce its efficacy.

Antidepressant mediations have many side effects that may also cause medications to be managed inappropriately including dose reduction and voluntary secession. Previous research has shown that side effects were regarded a primary cause of non-compliance (Kikuchi, Suzuki, Uchida, Watanabe, & Mimura, 2012). Common side effects of antidepressants are daytime sleepiness, insomnia, dry mouth, loss of interest in sexual activity, nausea, and weight gain (Rheker et al., 2016). These side effects specifically can produce issues with college students because they may cause additional impairments to an already emotionally impaired individual. Additional deficiencies can become hinderances in the lives of college students affecting even further their productivity with coursework. There are other pharmaceutical options added to those the show symptoms of specific side effects. However, there is little information found regarding the adherence of antidepressant medication after receiving additional medication for its side effects.

Another kind of intervention for depression is animal assisted therapy. For centuries animals have been used to assist human beings with physically, mentally, or socially impaired functioning in various ways (Schramm, Hediger, & Lang, 2015). Animal assisted therapy is considered to be an intervention involving an animal to improve cognitive behavioral or social and emotional functioning. Pets are an integral part of the everyday lives of many people in this country and there have been numerous studies on the physical and mental health benefits of animal companionship to people, including stress buffering and facilitation of social interaction (Adams, Sharkin, & Brottnelli, 2017). There is an increasing amount of research indicating positive outcomes regarding human interactions with animals that improve human health and well-being (Schramm, Hediger, & Lang, 2015).

More specifically, emotional support animals have been becoming more frequently used by individuals with mental health conditions especially. Emotional support animals are considered to be a service animal by the criteria that it has been shown to have the innate ability to assist a person with a disability requiring only obedience training (Ensimger & Thomas, 2013). An emotional support animal may be a dog, cat, rabbit, or any species allowed under local law which is not trained to do specific tasks but who’s mere presence assists in providing relief from symptoms associated with a disability (Kogan, Schaefer, Erdman, & Schoenfeld-Tacher, 2016). During the past 10 years, college campuses have been seeing a rising number of appeals from students to bring pets to campus in order to help them manage with emotional symptoms associated with diagnosable conditions such as anxiety, depression, and post-traumatic stress (Adams, Sharkin, & Brottnelli, 2017).

Particularly, Branson et al. (2016) found that companion animals reduce the negative biobehavioral processes associated with depression. Despite the popularity of emotional support animals in college campuses there is a lack of information regarding researching its effectiveness. Depression has various treatment options, and each should be researched in detail in order to make them easily available to individuals for whom it might benefit. This study seeks to support the hypothesis that if individuals with depression have an emotional support animal, then their levels of depression will be reduced.

The participants in this study included 232 Florida International University students. Participants included 110 males and 122 females. All participants were between the ages of 18-22. All participants were recruited on a volunteer basis through the recommendation of the Florida International University Counseling and Psychological Services department. All of the participants were previously diagnosed with depression within 6 months prior to the study by the university’s psychological services department. All of the participants were open to adopting an emotional support animal and were non pet owners prior to the study. Participants were randomly assigned to one of the two conditions.

A demographic questionnaire was issued to all referred participants with using pen and paper in the Counseling and Psychological Services Department (see Appendix A). The demographic questionnaire consisted of 30, both multiple choice and open-ended anchor questions. The demographic questionnaire included questions regarding whether the participants had been diagnosed with depression, how long ago their diagnosis was, if they are currently under any kind of treatment, and if they were willing to adopt an emotional support animal. Those participants who qualified for the study were given a consent form regarding the procedures, benefits, and risks of participation.

Emotional support dogs were provided to participants who were assigned to the corresponding condition. These emotional support animals were dogs adopted through the Miami Dade County Animal Shelter. The breed of dog chosen for this study were Labrador retrievers. The dogs were all within the ages of 1-3. These animals all were provided with basic obedience training with a dog trainer who was certified with the Certification Council for Professional dog trainers and the Association of Pet dog trainers in the animal shelter prior to adoption. Each of these dogs were provided to the participants along with the materials necessary for caring for the animal. These materials included a leash, collar, name tag, bowls, and food. The emotional support animal certification was obtained with the licensed mental health provider who the participants were referred by in the form of an ESA letter in order for participants to be allowed access to public locations with their dogs.

Cognitive behavioral therapy sessions were conducted in the Counseling and Psychological services department of Florida International University in an office setting for each individual participant by a licensed mental health provider.

The Beck Depression Inventory was used after 6 months of cognitive behavioral therapy and having the emotional support animal to evaluate depression levels of participants. The Beck Depression inventory contains 21 questions with each answer scored on a scale from 0 to 3. The score for each question is added up and the higher the total score is the more severe the depressive symptoms are. The total scores are put into four categories; 0 to 13 meaning minimal depression, 14-19 meaning mild depression, 20-28 meaning moderate depression, and 29-63 meaning severe depression (Beck et al., 1961). Participants answered these questions in a computer form in the office of Counseling and Psychological services. The data collected from the Beck Depression Inventory was analyzed using SPSS.

This study was a simple between subjects research design. The independent variable had two levels. One level was receiving an emotional support animal along with receiving cognitive behavioral therapy and the second condition was only receiving cognitive behavioral therapy. The dependent variable was the severity of depression of the participant and it was measured using the Beck Depression Inventory (Beck et al., 1961).

Participants were screened using a demographic questionnaire (see Appendix A) using pen and paper in the Counseling and Psychological Services Department. The participants that qualified for the study received a consent form describing the procedures, benefits, and risks of participation. At this time the participants were provided the contact information of the researchers in case necessary throughout the course of the study. Participants were then randomly assigned to either the emotional support animal condition or the cognitive behavioral therapy condition. All participants attended three, weekly, one-hour sessions of individual cognitive behavioral therapy with a licensed mental health professional in an office setting within Florida International University Counseling and Psychological Services department for a period of 6 months. In addition, the participants in the experimental group were provided with an emotional support dog to take home for a period of 6 months.

After the six months all participants were provided with the Beck Depression Inventory in the same office setting within Florida International University Counseling and Psychological Services department where they had received cognitive behavioral therapy. Participants were afterwards debriefed that the purpose of the study was to study the effectiveness of emotional support animals in treating depression and which condition they were in. Participants were thanked for their contribution in the study and asked if they had any questions regarding their involvement. Participants who received an emotional support animal were given the option to officially adopt and become the owners of their emotional support dog after the study. The emotional support dogs that were not adopted were later rehomed by the researchers.

The data acquired during this study was analyzed using SPSS. Analysis was performed on the dependent variable comparing both independent variable conditions using an independent samples t-test. The Levene’s test was used to test for homogeneity of variance.

The Socratic method also has non-classroom applications. For example, it’s frequently used as a therapeutic technique to help patients explore and analyze their own thoughts and behaviors (Center for Deployment Psychology). When used in cognitive behavioral therapy, the Socratic method serves as a non-confrontational approach to challenging the client’s ideas (Clark and Egan 3), while also providing them an opportunity to sort out discrepancies in their rationale (5). Currently, research suggests that the Socratic method encourages cognitive reappraisal, which has been proven to improve patient well-being (Clark and Egan 9). Cognitive reappraisal refers to mentally reframing an experience in an effort to “change its emotional impact” (Troy, et. al). Therefore it is reasonable to include that usage of Socratic-style questioning in psychotherapy can lead to improved patient outcomes. There is a lack of empirical data on whether or not the Socratic method itself res. The efficacy of the Socratic method in cognitive behavioral therapy most likely stems from the fact that insights and conclusions are more influential when the patient discovers them themselves, versus being told something by their therapist (Clark and Egan 4). Because the Socratic method is based on ideas of self-discovery and independent thinking, it is a key aspect of effective cognitive behavioral therapy.

There are some limitations to the Socratic method’s usefulness in a therapeutic setting. Like with education, relying too heavily on Socratic questioning can be harmful. The best practice is to switch between Socratic-style questioning and non-Socratic dialogue (Clark and Egan 6). Additionally, due to the nature of psychotherapy and the Socratic method, namely the wide variation of issues and methods it employs, current research cannot say for certain whether the usage of the Socratic method is solely responsible for the success of cognitive behavioral therapy (Clark and Egan 2). Therefore the Socratic method should be treated as merely a tool for cognitive behavioral therapists to utilize, and not as a cure-all solution to psychological problems.

In conclusion, despite its old age, the Socratic method remains an effective tool with many applications. The open-ended, inquisitive and challenging structure encourages participants to think critically, analyze deeply, and defend their rationale. It leads to heightened awareness of one’s thought processes and behaviors, and its self-discovering nature leads to more effective and lasting learning than other strategies. Considering these factors, the Socratic method is an invaluable and enduring technique that can and should be used for years to come.

Our nation is in the midst of a chronic pain epidemic–according to a study released in 2011 by the Institute of Medicine, over 100 million people are living in pain. In the face of this crisis, how can psychological methods help with the treatment and prevention of chronic pain?

No single panacea exists for chronic pain. Similarly, no single treatment method for chronic pain involving psychology exists. However, here are five psychologically-informed approaches to pain that have proven to be helpful.

Cognitive-behavioral therapy is a type of psychotherapy in which you attend a limited number of structured sessions, aimed at making you aware of unhealthy and inaccurate thought patterns so that you can handle and respond to them more effectively.

In terms of chronic pain specifically, CBT has been shown to be effective at helping treat pain by helping patients develop coping skills that manage pain and better psychological functioning, including structured relaxation, and assertive communication, among others. With these strategies, CBT can improve on a patient’s disability in addition to reducing a patients’ tendencies to pain-catastrophize.

Read more about pain-catastrophizing and its relationship to mindfulness and pain acceptance here!

Another psychologically-informed method of treating chronic pain is Acceptance and Commitment Therapy, or ACT. While CBT practitioners are focused on changing thought patterns and interrupting negative thought cycles, therapists who use ACT are more focused on helping their patients learn to accept the pain they have. It approaches treating pain with the idea that thoughts and events do not need to be changed; instead, we can change our responses to thoughts and events which in turn minimizes the negative effects of those thoughts or events.1

ACT has been shown to be effective in treating chronic pain in that it can help to minimize the effects of issues that accompany chronic pain, like anxiety and distress disability, and number of medical visits.1

Mindfulness-Based Stress Reduction (MBSR) operates in a similar way to ACT. Instead of focusing on getting rid of pain or the thoughts around pain, practitioners of MBSR seek to remove or mitigate the negative reactions surrounding the experience of pain. Through mindfulness and meditation techniques such becoming aware of your breath and your body, MBSR helps clients relearn attitudes toward pain, with the end-goal of reframing pain as a distinctly temporary event. MBSR has helped people who suffer from certain conditions that cause chronic pain, such as irritable bowel syndrome and fibromyalgia; additionally, it has helped with the mental health concerns that some people who have these diseases also suffer from.1

Pain Science Education is the process of teaching patients who suffer from chronic pain about the pain that they are experiencing; specifically, it teaches patients how the pain they are feeling is created in their nervous system. The mentality behind educating patients about the pain they are experiencing and its source is that by uncovering and explaining the complicated processes that cause pain, practitioners can help alleviate anxiety and stress that patients have surrounding their chronic pain. In some cases, such as in groups that suffer from lower back pain, Pain Science Education has created some positive improvements in short-term pain suffering.

Psychologically Informed Physical Therapy (PIPT) is the incorporation of certain cognitive principles into the practice of physical therapy. By including cognitive-behavioral techniques like reframing thoughts, mindfulness, breathe work, relaxation training, education about the importance of sleep, positive coping skills, and planning for pleasant and enriching activities, PT’s are able to address physical and psychosocial factors of pain care. Additionally, the expectation is that physical therapists should be able to recognize pain that comes from psychosocial distress and to adjust their course of treatment accordingly.

Hopefully, through these psychologically-based methods and others that focus on treating pain in a more holistic way, we can combat this national pain epidemic we currently encounter.

When you look at the statistics on mortality rates over all mental disorders, statistics showing that Anorexia Nervosa has the highest mortality rate, it would be a reasonable assumption that it would have the highest funding for recovery treatment research. Unfortunately, this is nowhere near the case, and not only do they have the least recorded research, but one of the lowest rates of funding. It is important that psychologists reveal the quickest and most efficient recovery strategies for each eating disorder because of the extreme toll on the body and brain functions. Within this study we will go through each eating disorder and determine the best route for treatment, as each of these have very different root causes. The goal in the end is to reveal to the general public that these eating disorders are not solely about weight but also the individuals mental well being. Why certain people find their sense of control from past trauma or anxiety through food should be better understood.

Despite the rapid influx in disordered eating, for the past twenty years, they are still under funded. Recovery treatment covered by health insurance are almost nonexistent, and societal expectations to have the perfect body continue to diminish the self esteem of many. Even though eating disorders, according to physicians, tend to afflict girls ages 11 to 22 does leave men exempt from this mental disorder. Eating disorders are organized into a few categories which are as follows: anorexia nervosa, bulimia nervosa, night eating syndrome, binge eating disorder and eating disorder not otherwise specified (EDNOS).

The more we can learn about the differences in each type of eating disorders, the better we can treat them. Whether some people with eating disorders have a higher recovery rate using cognitive behavioral therapy, others may do better with family therapy. Treatment cannot have a one size fits all approach, because this type of disease (like most) is far too complex and broad to ever have a single treatment option. It is extremely pertinent that physicians watch for common signs in every patient and use a screening method like SCOFF. SCOFF is a questionnaire consistent of five questions. If two are answered with a yes then there is a diagnosis of either anorexia nervosa or bulimia nervosa. It is important for physicians, especially pediatric physicians, have patients fill out this questionnaire if they show even the slightest sign of having an eating disorder.

Anorexia Nervosa is classified by obtaining thinness through starvation and other methods. This brings the result of a body weight way below the average range. The person has an emaciated appearance. Typically it will start to form in the adolescence years (majority of the time it will affect girls and young women). Unfortunately patients with AN not only are they extremely rare they are also extremely difficult when conducting trials because of the unwillingness to recover. Rutgers, Grilo, and Vitousek (2007) discovered that “throughout the past 20 years, only 15 comparative trials have been completed and published”(p.199). For adolescents, the best form of treatment is a “conjoint” format in which all family members are together. Once parental authority is established coaching the patient on rehabilitation becomes effective and in studies there was a 90% symptom free at 5 years after recovery (Rutgers et al., 2007). Unfortunately for those with a longer history or were older at onset of the disease, this method does not show to be effective and many patients fall out of treatment. For adults the “separated” format produced better results than the conjoint model.

According to Sim et al. (2010), “The most effective method of treatment for BN is a specific form of psychotherapy and cognitive behavioral therapy (CBT)”(p.748). Treatment should focus on maintaining control of binge eating behaviors and purging. Some research has shown that Fluoxetine (Dose of 60 mg/d), an antidepressant, can benefit the patient regardless of symptoms of depression. It should be noted that this drug contraindicates itself because of the high risk for seizure in patients with eating disorders. For BN, medication plays a huge role in reducing BN behaviors but only deemed effective when paired with some form of psychosocial treatment (Hay & Claudino,2011, p. 212). The best form of treatment for binge eating disorder (BED) is cognitive behavioral therapy (CBD). For patients without cardiovascular complications, Sibutramine has been shown to be the best form of medication to treat this disorder from the rates of recovery and weight loss in patients taking it. With the nature of this, disorder weight loss and nutritional guidance should be a portion of treatment focus along with a combination of psychotropic medications and psychotherapy (Hay & Claudino,2011, p. 212).

“Night-eating syndrome was initially described by Stunkard et al47 as early as the 1950s as a syndrome consisting of morning anorexia, evening hyperphagia, and insomnia” discovered by Sim et al.(2010). Physicians should encourage meals to be eaten earlier in the day to shift the late eating pattern. Seeing a dietician regularly has shown patient improvement as well for nutritional guidance. For those patients that are influenced by moods or stress, seeing a behavioral psychologist would be beneficial for recovery.

Most patients that show signs of an eating disorder but do not fit into a specific category may be labeled with an eating disorder not otherwise specified (EDNOS). For example, someone who shows all signs of having Anorexia Nervosa but still menstruates would be classified with EDNOS or someone with bulimia nervosa but only binge and purge twice a week would also be diagnosed with EDNOS. Even if these patients cannot be diagnosed with a known eating disorder treatment is still extremely necessary because most of these patients have some form of psychiatric illness symptoms.

With the little amount of research done on this topic and how fragile the participants can be, it is important to handle trials with the utmost of care. In this situation I would conduct a case study of each section of the eating disorder family. I would follow the treatment process of individuals going through it and gather as much data on what methods were used and the outcome of each. Each eating disorder would need to have multiple case studies to have the most accurate results.

Introduction Title (Cause and Effect Design Map) In sad fact, there are many children who suffer from child depression and suicidal depression which is causing a lot of child deaths each year. As an illustration Webster dictionary defines suicidal as destructive to one’s own interests. Whereas they define ideation as the capacity or the act of forming or entertaining ideas. So with those definitions, suicidal ideation means to have thoughts of suicide. In fact, 2% of preschoolers and school-age children are affected by depression. Sadly according to Ryan’s story a presentation in 2003 Ryan Halligan a 12-year-old boy committed suicide. One reason for his suicide was school bullies who even broke his arm and one of them even got charged by the police in youth court. The main cause to his suicide was cyberbullying one example is he told an online friend that he was going to take his own life, and his online friend said, “The last time I hear u complain? Ur finally gonna kill urself?! It’s about (Blank)ing time.” Ryan had responded by saying, ”You’ll hear about it in the papers tomorrow. In 2003 Ryan was found hanging by his sister.

One example of the problem now is that 1/9 or .111% of high school kids who have suicidal thoughts or commit suicide have tried it before. Surprisingly A study from 2014 showed 2 to 3 percent of children who were ages 6 to 12 had at least one major depressive episode. According to CNN Hope Witsell was another 13-year-old girl who had committed suicide. Hope Witsell had sent a nude picture to her boyfriend and another girl had got it and sent it to a lot of people. When that happened things began to get worse for her that students would walk up to her and call her a ‘slut’ ‘whore’ and even a ‘skank’, and it got so bad that her friends had to make a wall surrounding her and she was scared to walk alone. After that things got worst that the kids wrote mean things on myspace, made a page called “Shields Middle School Burn Book” and they made a “Hope hater page”.

The suicide happened on September 12th, 2009 when she helped her father mow the lawn, and they made a dinner as a family then hope went to her room to hang herself with her favorite scarves from the canopy bed. Clearly, if the problem with suicidal ideation and child depression is not resolved then many children will have suicidal thoughts and will possibly even commit suicide such as Hope Witsell and Ryan Halligan. There are many causes of child depression which leads to suicidal ideation or even suicide. Clearly, the environment a child is in can cause depression. Rashmi Nemadethe author of lifestyle factors and environmental causes of depression says, “Some authors consider events like childhood abuse, long-term stress at home or work, coping with the loss of a loved one, or traumatic events as environmental”. Researchers have found that electric pollution can be linked to mood disorders, but electrical pollution is odorless, silent, tasteless, and invisible, but they found the particular radio wavelengths promote depression and rage.

Another, cause of child depression is school and the stress it puts on people. In fact, National Institute of Mental Health (NIMH) said, “An estimated of 3.1 million adolescents aged 12-17 had at least one major depressive episode.” In sad fact, between 2010 and 2014 about 20 children and young adults killed themselves annually. Indeed those are some causes of depression and suicidal ideation in children. With the causes of suicidal ideation and depression in children, there are also many effects of depression and suicidal ideation such as academic decline. In fact, one effect for child depression in academic failure and an academic decline. Elijah R. says, ”when you have one of your ‘episodes’ so to speak, you just sit in class and can’t take anything in or concentrate, then you don’t learn, and when it happens often you find yourself having no idea what’s been going on for months”. Also, depression makes people feeling anxious, agitated, irritable, and unable to focus, but it makes another find that they’re not interested in hobbies, or learning new things. Another, effect of depression and suicidal ideation is substance abuse. Substance abuse during depression for some is to feel normal, but sometimes substance abuse may start as early as 10 .years old due to child depression. According to Savannah, she had two addicted parents and she became depressed and said, “I was only 7 when my drug use started”. If the causes are not solved then these effects will be happening to many children which could even lead to suicide if things are not fixed and treated. Title of Solution #1 As many as 1 in 10 people use antidepressants in America.

Antidepressants were created by chance when scientists in a Swiss asylum were seeking a treatment for schizophrenia. They, fount it out when they found the drug tweaked the balance of the brain’s neurotransmitters, which are molecules used by the nervous system to transmit messages between neurons. Antidepressants were discovered in the 1950s. They were discovered by a group of researchers in MunsterLingen asylum in Switzerland. The oldest or the first antidepressant that was founded was Tricyclic. Klaus Schmiegel is a famous chemist who founded Prozac and moved to America in 1951. Prozac hit the U.S market in 1987 then Zoloft in 1991 and Paxil hit the market in 1992. The drug had provided relief to 60% to 80% of patients. The drug was such a success that in 1987 analysts predicted Prozac would make 105 million a year, but in 1989 they make 350 million. Prozac was taken by 10 million people around the world in 1993. In 1990 Prozac was the most prescribed antidepressant in the country. Also, the article that said these are the countries that consume the most antidepressants said, “Statista had visualized the data, in 2013, with Iceland ranking the highest for consumptions.” First top 10 list for antidepressants says, “researchers ranked the top 10 drugs in the journal. The Lancet. Zoloft and Lexapro came in first”.

Antidepressant help depression by tweaking the balance of the brain’s neurotransmitters. Antidepressants usually are taken daily, and the goal is to relieve symptoms in the first few weeks and months or possibly make depression go away. People sometimes stop taking antidepressants when they start feeling better, but this makes it more likely for depression it has many side effects such as nausea, weight gain, fatigue and drowsiness, insomnia, constipation, etc. To get antidepressants you need to get them prescribed from the doctor. It is also proven that one in 5 Americans takes some kind of drug, but it’s mostly antidepressants and twice as many white people take it more than African-Americans. How to keep SSRI from ruining sex life says, “sexual side effects include a decrease in sexual interest.” Antidepressants and differences say, “Examples of SSRIs include, Prozac, Paxil, Zoloft, Celexa, Luvox, Lexapro, Viibryd”. The article Antidepressants are More than Placebo treating depression says that “ The researchers found that every type of antidepressant they studied was more effective at lessening depression…”. Antidepressants are also more effective for reducing symptoms in severe or modern depression. Also, some believe antidepressants are much more modest that widely though and that there are fewer benefits than harms. Others believe that they work and their life-changing. Also, most antidepressants are safe, but they are required by the Food and Drug Administration to carry black box warnings. Researchers have found out that more than 12,500 patients for drugs were approved between 1987 and 2004, and about 50% were positive and antidepressants performed better than placebo, but the other 50% were negative. Antidepressants are very successful that studies show that 40 to 60% of 100 people noticed an improvement.

Although antidepressants are successful certain antidepressants such as Paxil change people’s personality traits. Clearly, antidepressants are successful and help depression. Obviously, antidepressants are very successful for most people and can help many children with depression and suicidal ideation. Title of Solution #2 Another really strong solution for depression and suicidal ideation children is Cognitive Behavioral Therapy that can be as or even better than antidepressants. In 1950 Rational Emotive Behavior Therapy or REBT was one of the two earliest forms of Cognitive Behavioral Therapy or CBT which was developed by Albert Ellis. Also, CBT was bounded by Aaron T. Beck in the 1960s. The Merriam Webster Dictionary says that CBT is, ”Psychotherapy that combines cognitive therapy with behavior therapy by identifying faulty or maladaptive patterns of thinking, emotional response, or behavior substituting them with desirable patterns of thinking, emotional response, or behavior”. The author of History of Cognitive Behavioral Therapy said that “Cognitive behavioral therapy (CBT) was pioneered by Dr. Aaron T. Beck in the 19’60, while he was a psychiatrist at the University of Pennsylvania”. CBT was invented because Aaron T. Beck formulated an idea for therapy when one of his patients had internal dialogues and they were almost forms of them talking to themselves. CBT is one of the most effective treatments for depression that it is as effective as antidepressants. CBT does not only help depression it also helps, physical conditions such as rheumatism, timitys, and chronic pain. Although CBT can help many things its best use is for depression.

Ben Martin author of In-Depth Cognitive Behavioral Therapy says, “ Its goal is to change patterns of thinking of behavior that are behind people difficulties, and to change the way they feel.”Usually, you will meet a therapist for CBT between five and twenty weekly sessions and each session lasts 30-60 minutes. Also, CBT costs 175-290 for a licensed therapist while it’s only 140 for a therapist that’s pre-licensed. Most of the insurances cover CBT, but some do not. The author of NHS’s overview of CBT says that. “During sessions, you’ll break down your problems into their separate parts, such as your thoughts, physical feeling, and actions”. CBT therapies are usually taken or usually take place in clinics. CBT can be used as a short-term intervention, or it also can be applied over a long period. CBT is also the most researched psychotherapeutic model. CBT is also designed to help people learn techniques to work with their own problems. CBT is very successful that it is even the most effective psychological treatment for any depression.

CBT is so effective that is it even as effective as antidepressants. Dan Vladon author of 10 facts you need to know about CBT says, “CBT has been researched more than any other psychotherapeutic model.” which shows why it is so effective. Dan Bladon also said that “CBT is designed ultimately to help people learn techniques to work through their own problems without becoming reliant on therapy.” which helps people help themselves with depression. CBT is also the most used and really effective for anxiety disorders. Also, a survey of 2,300 people in the United States showed that 69% of people used CBT. CBT is also considered the gold standard of therapies. That is how successful and effective CBT is. With those stats and examples, it is obvious that CBT is one of or the best solution for child depression and child suicidal ideation. Argument Towards Successful Solution Many children have depression and suicidal ideation. Cognitive Behavioral Therapy is a better solution because it has fewer side effects and is a drug-free solution. Both parents and children should care because for the parents they want their child to feel better and the child wants to feel better. Also, many people should care because of how many children dying because of being depressed. Undoubtedly, CBT is the best solution because it is a drug-free solution and it does not have many side effects. Some side effects of CBT are anger, stress, flashbacks, etc, where other solutions have many more side effects. It is also a drug-free solution so there are no hallucinations and it is not as much of a risk.

Another reason CBT is better is because it is a better long-term and it also helps physical conditions. One reason it is better is that the physical conditions it can help such as, tinnitus, and chronic pain. Dan Bladon said, “CBT is designed ultimately to help people learn techniques to work through their own problems without becoming reliant on therapy. Clearly, CBT is the best solutions for many different reasons such as the low amount of side effects and how it helps more than just depression. Although Cognitive Behavioral therapy is a good solution, some may believe that antidepressants are a better solution for many reasons. In fact, some people will argue that antidepressants are better because of how quick it is to use it. One reason people think it is a better solution is that it takes a couple of seconds while CBT takes 30 minutes each session. Also, antidepressants only take up to 8 to 12 weeks to work which is quicker than other solutions. Another reason people think antidepressants are better is that they don’t affect your memory. The New York Times article, In Defense of Antidepressants, says, “ Antidepressants are good at treating post-stroke depression and good at preventing it. They also help protect memory”.

They are also better with memory because CBT can cause some flashbacks. Although antidepressants are a much quicker solution, Cognitive Behavioral Therapy benefits outweigh the side effects of antidepressants. When looking at the high percentage of the success rate of CBT and it helping child depression it is obvious that CBT is a better solution for child depression. In fact, if depression and suicidal ideation in children is not treated, then a lot of children will lose their lives because of it. One example is 14 year old Hannah Smith who had a lot of people making fun of her weight and making fun of a family death. She killed herself by hanging herself, and she said, “As I sit here day by day I wonder if it’s going to get better. I want to die, I want to be free. I can’t live like think any more. I’m not happy”. After her death, her sister Jo was getting messages from people, “ mocking her loss and blaming her grieving father parenting skills for the tragic death.

Since the loss of a child life so young is so devastating, especially because it was a loss of a young child because of suicide, it is really important that parents make sure their children is fine at school and they help children through their depression, and that children stay out of bad situations such as cyberbullying. Clearly, therapy is a great solution for depression. Cognitive behavioral therapy is the strongest way to get rid of child depression.

According to the Diagnostic and Statistical Manual of Mental Disorders, fifth edition, social anxiety disorder is classified through overarching features of excessive fear, anxiety and behavioral manifestations. It is the most common type of anxiety disorder, also referred to as social phobia. Social anxiety is developed and maintained by complex physiological, cognitive, and behavioral mechanisms. Today, behavioral treatment including cognitive behavioral therapy, composed mainly of short-term treatments, are among the most widely used approaches for managing psychological and behavioral problems, including but not limited to social anxiety disorder, SAD. CBT is an empirically valid form of psychotherapy that focuses on how a person’s thoughts, beliefs and attitudes affect their feelings and behaviors. CBT does not exist as a distinct therapeutic technique. Through CBT, one can distinguish between facts and irrational thoughts, stop fearing the worst, and describe, accept and understand rather than judge themselves or others. There are an arrays of CBT skills used for SAD treatment such as goal setting, agenda setting, homework, relaxation, identifying and challenging maladaptive thoughts and beliefs. We will further look into cognitive behavioral therapy and the role it plays in treating clients with social anxiety disorder.

Cognitive behavioral therapy is a form of treatment that can be used with clients who have been diagnosed with social anxiety disorder. Social anxiety disorder most commonly appears during early childhood or adolescents, and most individuals with this disorder do not seek treatments. Social anxiety is actually more common than not, and that is why a lot of the characteristics experienced by people are often minimized, involving little drug or psychological interventions. While behavioral therapy is another accepted approach, CBT is still the best form of treatment for social anxiety disorder. From a cognitive perspective, anxiety consists of three components. First, autonomic hyperarousal symptoms are experienced such as heart racing, sweating, shortness of breath and trembling. The second component is negative cognitions, which can include impending thoughts of impending doom. The third component is behavioral and prototypically involved either escape or avoidance of situations associated with the anxiety. According to the NCS-R, which assessed over 9,000 noninstitutionalized individuals, throughout the U.S, found that over 12% of people have social anxiety disorder, SAD. People with this disorder report having their work, school and social life impaired by their fears. Some studies even show that people with social anxiety disorder have trouble making friends, dating, marrying and even work at jobs below their level of educational attainment. There are many fears associated with this disorder such as fear of social interactions, performance and observation fears. The DSM-V includes a performance-only subtype, focusing on individuals having to speak or perform in public. The process of this disorder begins when the individual is in the presence of their audience. People with this anxiety perceive their audience as essentially critical and as having standards that they are unlikely to meet. The image of the self is further influenced by external and internal cues. Internal cues can include anything from heart beating fast to sweating. External cues may include reactions from other people such as people’s attention or facial expressions. The fear of any evaluation, especially, negative evaluation, is sought to be the core fear in social anxiety disorder. CBT has gained substantial empirical support for their high levels of efficacy and effectiveness for treating SAD.

Different forms of treatment include social skills training, cognitive therapy, relaxation training, exposure and interpersonal psychotherapy. There are a number of measurements taken to identify those for treatment for SAD. For example, there was a study done on 58 individuals, of ages 17 and 65 among a pool of ethnicities, recruited through online postings, targeting those with elevated symptoms of social anxiety. The first tools of measurement were the online versions of the Social Phobia Inventory and the Personal Report of Confidence as a Speaker. Those who scored 19 or above on the SPIN and 16 or above on the PRCS were invited to participate with the full study (Carter, Sbrocco, 2018). Other measures of participants included The Intervention Acceptability and Helpfulness Scale, IAHS, which is an 8-item self-report questionnaire that was designed to measure views related to credibility, perceived helpfulness, likability, and predicted continued use of psychotherapeutic strategies, created by Devilly & Borkovec. Most success is made after a long period of time, sometimes up to five years. However, the combination of exposure and cognitive restructuring has been the most frequently studied form of psychosocial interventions for social anxiety disorder. Exposure to what the client fears’ are and cognitive restructuring are the most effective intervention for social anxiety disorder. Exposure is extremely beneficial because it allows the opportunity to test dysfunctional beliefs and generate more realistic ways of understanding the self and others. It also allows clients to experience the natural anxiety reduction that comes with staying in a feared situation for prolonged periods of time, while allowing the client to practice long-avoided behavioral skills. Exposure based CBT is the treatment of choice for anxiety disorders (Craske, 2015). Exposure therapy usually starts with a situation that’s only mildly threatening and works up from there. This step-by-step approach is called systemic desensitization. This allows for gradual challenges of fears, building confidence, and mastering skills for controlling panic. The patient is taught relaxation skills in order to control fear and a hierarchy of fears are created. Cognitive restructuring allows the client to learn to treat their anxiety-provoking thoughts as hypothesis. The therapist will help the client restate a question as a statement of what he or she feared. For example, instead of a client asking themselves, “what will other people think if me”, the client can think, “other people will think I am unprepared for this presentation”. Cognitive restructuring allows a client to identify errors such as fortune-telling, mind reading and catastrophizing among others. Behavior therapy emphasizes the importance of learning, both in the development of behaviors and the strategies for changing them (Shikatani, B.K., Anthony, 2019). Both cognitive and behavior therapy are empirical, present centered, and problem oriented, requiring explicit identification of problems and that situations in which they occur, as well as of the resulting consequences. For example, simple exposure to anxiety filled situations while verbalizing negative automatic thoughts may lead to improvement on cognitive measures. The more clients view the situation as less threatening the more willing they would confront their fears. When their fears are confronted, social tasks and performance may increase. The sooner a client is able to assess the situation as “non-danger” the situation becomes more realistic, allowing the psychological symptoms to diminish. With these forms of treatment, there should be a reduction in symptoms pertaining to this disorder, improved functionality, as well as an overall positive sense of well-being and life satisfaction.

The main role the therapist plays is to help the patient clarify goals, and a strong way to achieve this is through a collaborative relationship. The ideal therapist has a strong background in the theoretical underpinnings of CBT for anxiety disorders, experience conducting exposures, good basic therapy skills, and experience with social anxiety in particular. The cognitive therapist does not tell the client that the beliefs are irrational or wrong or that the beliefs of the therapists should be adopted. Instead, the therapist asks questions to elicit the meaning, function, usefulness and consequences of the patient’s beliefs; CBT is not the substitution of positive beliefs for negative ones. It is based in reality, not in wishful thinking. Cognitive change can promote behavioral change by allowing the patient to take risks. The therapist maintains a right therapeutic alliance at all times. The therapist functions as a guide who helps the patient understand how beliefs and attitudes interact with affect and behavior. The therapist is also a catalyst who helps devise corrective experiences that lead to cognitive change and skills acquisition. The role of the therapist is to actively pursue the patient’s point of view by using warmth, accurate empathy and genuineness. The therapist specifies problems, focuses on important areas and teaches specific cognitive and behavior techniques. To continue to maintain collaboration, the therapist elicits feedback from the patient, usually at the end of each session. Feedback focuses on what the patient found helpful or not, whether the patient has concerns about the therapists or overall therapy, and whether the patient has questions. Another form of collaboration is when the patient is provided with a rationale for each procedure used. This allows for a better understating of the therapy process, increases patient’s’ participation and reinforces a learning paradigm in which patient’s gradually assume more responsibly for therapeutic change (Wedding, Corsini, 2019).

The therapeutic relationship is collaborative. In cases of sever social anxiety, clients may initially need the therapist to take a directive role. As part of the collaboration, the client provides the thought, images and beliefs that occur in various situations, as well as the emotions and behaviors that accompany the thoughts. The client also shares responsibility by helping to set the agenda for each session as well as doing homework between sessions. Homework helps therapy proceed more quickly and gives the patient an opportunity to practice newly learned skills and perspectives. Some homework may include, talking to strangers, speaking up in groups or giving presentations, being assertive, revealing personal information about oneself, and feeling less embarrassed about visible anxiety symptoms. An alliance refers to the affective quality of the client-therapist relationship and the level of client-therapist agreement with the therapeutic activities. Both alliance and client involvement are considered critical to the success of CBT for social anxiety (Mcleod, et al., 2013). Client involvement is defined as the client’s level of participation in therapeutic activities and has been linked to positive outcomes in CBT for SAD.

Cognitive behavioral therapy emphasizes a relationship between people’s belief systems, their emotions and behavior (Wedding, Corsini, 2019). However, studies have shown, that along with CBT, mindfulness and acceptance and commitment therapies have similar findings when dealing with anxiety disorder (Wedding, Corsini, 2019). Some of the goals throughout treatment are to help clients by providing corrective learning experience that lead to changes in behavior, broadly defined. According to an individual CBT for social anxiety disorder, a treatment can comprise of 1-hour sessions within a period of 16-20 weeks. A workbook is included for homework purposes, and chapters have to be read preferably before each session. The workbook is brought to each session, with both the therapist and client having the ability to write down key concepts. Writing things down during sessions help clients better to track and process the information being covered and is a required component of the treatment. Therapists are expected to help clients to experience and deepen affect as appropriate to the situation. The client and clinician need to reach a joint decision that social anxiety will be the focus of treatment. The patient should always be reminded of the original treatment contract and goals, and encouraged to “avoid avoidance.” Throughout treatment, the client practically becomes his/her own therapist through the learned and implemented coping skills that results in a reduction of anxiety and an improved daily functioning.

CBT models argue that dysfunctional cognitive schemes sustain maladaptive behaviors. The aim of the therapist is to challenge the patients’ core beliefs, which are believed to maintain dysfunction or psychopathology. The therapeutic relationship is regarded as “third wave”. Third wave cognitive behavioral therapies are a group of merging approaches to psychotherapy that represent both an extension of and deviation from traditional CBT approaches. Unlike traditional CBT, the “third wave” behavioral therapies focus on changing the function of psychological events that people experience, rather than on changing or modifying the events themselves. Critics of these approaches maintain that the collaboration is actually an attempt to get the patients to conform to and comply with the therapist’s advice and guidance. Is it important that the therapist is not biased, or mistakenly change’s the clients views to reflect society, or their own view. Therapeutic relationship may be negatively affected if the collaboration is not kept, and will continue to evolve as a by-product of the process. Some view the therapeutic relationship as secondary in relations to the techniques being applied throughout treatment. The relationship needs to be a partnership in which both the therapist and clients are working together to reach the client’s goal.

Social anxiety disorder is conceptualized as excessive function or malfunction of normal survival mechanisms. Psychological responses prepare the body for fight or flight. The anxious person’s perception of danger is either based on false assumptions or are exaggerated. Anxious individuals have difficulty recognizing cues of safety and other evidence that would reduce the threat of danger. Self-monitoring is a CBT technique that refers to the systemic observation and recording of one’s behaviors or experiences over a period of time. This technique could be useful as a therapeutic intervention because it helps the patient to evaluate his/her thoughts, emotions, and behaviors, recognize the feared situations and find appropriate solutions. Assertiveness training can be an effective part of treatment for those who wish to improve their interpersonal skills and sense-respect and it is based on the idea that assertiveness is not inborn, but a learned behavior. In other words, anyone can learn to be more assertive. Role-playing can be done with the therapist in order to acquire assertiveness training skills. Behavioral techniques are designed to challenge specific maladaptive beliefs, promote new learning, as well as to expand patients’ response repertories, relax them or make them active, prepare them for avoided situations or expose them to feared stimuli. These techniques foster change and is crucial to know the patients’ perceptions, thoughts and conclusions after each behavioral experiment (Wedding, Corsini, 2019). Relaxation training is a behavioral technique where the client learns breathing retraining, guided mental imagery and progressive relaxation. The goal of CBT is to correct faulty information and help patients modify assumptions that maintain maladaptive behaviors and emotions. CBT and behavioral methods are used to challenge dysfunctional beliefs and promote more realistic adaptive thinking. CBT initially address symptoms relief, but its ultimate goals are to remove systemic biases in thinking and modify the core beliefs that predispose the person to future distress. In cases of anxiety, cognitive content revolved around themes of danger or fear. The Liebowitz Social Anxiety Scale (LSAS) was used in a research study to assess social anxiety symptoms severity. The LSAS has been shown to be a reliable measure for the assessment of individuals experiencing social anxiety (Barlow, 2014). Researchers have investigated the efficacy of a broad range of treatments for social anxiety disorder, including social skills training, cognitive therapy, relaxation training, exposure, interpersonal psychotherapy, dynamically oriented supportive psychotherapy and various pharmacotherapies. In a study conducted by Heimberg, Dodge, and colleagues, treatment was compared to an attention control treatment that comprised education about social anxiety disorder and nondirective supportive group therapy. Findings reported that less anxiety was experienced during an individualized behavioral test (Barlow, 2014). Other measure of social anxiety is the Social Phobia Scale, which assesses fear of being observed by others. Multiple studies suggest that the SIAS and SPS are reliable and valid measures, sensitive to the effects of CBT.

Therapists without a string background in CBT or exposure therapy may be at risk for changing the focus of treatment too readily. The issue of the CBT therapist adjusting the client to the norms of societally sanctioned roles remains a strong challenge to this approach. A major ethical issue is that CBT therapist run the risk of imposing a socially conformist ideology on the client (Wedding, Corsini, 2019). However, researchers of psychological treatments should consider including credibility and acceptability as variables. Behavioral tests demonstrate that the anxiety measurements reports are largely inaccurate and are essentially example of distorted beliefs. Another issue arising from this theoretical orientation is that there are relatively few psychotherapists who have the training and experience to qualify them as experts in CBT. It takes a skilled clinician to be able to motivate patients to change behaviors that occur in the context of strong and long-standing reinforces. CBT therapists often run the risk of being unnecessarily verbose and dominating sessions. This can result in receiving less input from the patient resulting in a case formulation that is not collaboratively derived. Other common errors in this approach are when the therapist inadequately defines goals that are disconnected from the patient’s presenting problem and this happens when a detailed functional analysis of the problem is not conducted. Another clinical error is getting stuck in the cycle of exploring and challenging beliefs when a behavioral approach will do (Kim, S.D, Olatunji 2016).

Experience in applying new behaviors can validate the new perspective. Emotions can be moderated by enlarging perspectives to include alternative interpretations of events. Emotions play in cognitive changes because learning is enhanced when emotions are triggered. Thus, the cognitive, behavioral and emotional channels interact in the therapeutic process. However, CBT emphasizes the primacy of cognition in promoting and maintaining therapeutic change. Aside from these applications, issues arise with these theoretical approaches. Sometimes people’s personal beliefs are at odds with the cultural values around them. Other times, a person’s beliefs may be changing with cultural changes and discrepancies may cause distress (Wedding, Corsini 2019). There was a study on participants of different demographic with a number of perceived barriers to treatment were examined for social anxiety disorder. Barriers to this treatment included shame, stigma followed by logistical and financial barriers, with more barriers experienced by ethnic minorities. Increased education and culturally sensitive outreach initiatives are needed to reduce barriers to mental health treatment. Fear of what others might say was among the top barriers to seeking treatment for social anxiety (Barlow, 2014).

Several recent studies have found that common measures of anxiety developed from a cognitive framework and validated among non-Hispanics Caucasians are not culturally equivalent psychometrically among African Americans. According to a CBT model of anxiety, based on African Americans, ethnic identity is thought to influence those who seek treatment. For example, if one strongly identifies with African American cultures, one might have less trust in Western treatment approaches and consequently be more likely to seek alternative sources or no treatment altogether (Carter, Sbrocco, 2018). Through a recent study developed specially for African Americans, a basic CBT model was used as treatment, however implications of cultural equivalence needed to be assessed. In other words, ethnicity matters. The overall concluded many findings, such as that anxiety disorders have more chronic course among African Americans even after a 2-year treatment. Evidence has shown that African Americans were more likely to report greater pathology than their non-Hispanics counterparts, and that the use of the SIAS could lead to biased conclusions in the interethnic comparison. For example, these measurements might represent a performance concern rather than in interaction concern. However, reports showed significant improvement in symptoms that was maintained at a 4-month follow up period. With a diverse population, CBT may be an issue due to the race-related stress of being African American. This stressor directly affects their expression of anxious pathology and plays an important role in the development and expression of anxiety symptoms. For example, to African Americans, what may appear to be social anxiety may be based on the belief that others are paying attention because of their ethnicity, being African American, and not because of inadequacy on their part (Carter, Sbrocco, 2018). Authors postulated that what one learns to fear, how one interprets symptoms, and where he or she seeks treatment are inextricable linked to the concept of ethnicity. In a World Mental Health Japan Survey, findings estimated lower rates of SAD prevalence in Asia compared with Western countries. But issues arose because this form of therapy and interviewing was not suitable for Asian people. The face-to-face interview may have inhibited participants from answering the questions truthfully. Similarly. Japanese people also suffer from a culturally specific type of social anxiety, which is characterized as a fear of offending others (Shirotsuki, Nomura 2014). A challenge with CBT is finding ways to encourage clients to use methods that may not fit with their cultural assumptions and beliefs or to adapt behavioral methods so they are more consistent with the client’s values or expectations. Overall, culture can influence a client’s behaviors and response to treatment in many ways. Culture may also affect most psychotherapies, client’s reactions to the therapist, and cultural difference may create language barriers that make psychotherapy difficult. For most psychotherapies, there is relatively little research on treating individuals from ethnic minority groups, including cognitive behavioral therapy (Wedding, Corsini, 2019).

Overall, cognitive behavioral therapy is skills-focused treatment aimed at altering maladaptive emotional responses by changing the patient’s thoughts, behaviors, or both. Cognitive therapy focuses on changing cognitions, which is proposed to change emotions and behaviors. Exposure therapy, cognitive restructuring, applied relations, and many other techniques have yielded great results in the treatment for many anxiety disorders. Treatment is dependent upon the relations between the client and the therapist. It is vital that the therapist focuses on developing a level of trust with the client, providing empathy and support, to encourage the client to feel safe in expressing his/her symptoms. It is important that the therapist discusses and revisits treatment plans/goals, as well as assign psychoeducational material on the specified disorder. The client must be actively involved in his or her own recovery, having a sense of control throughout the treatment process. CBT is short term, but most effective with follow ups. CBT works by providing a hands-on practical approach to problem-solving.

All in all, cognitive behavioral therapy helps you learn to control thinking, maintain that control and self-confidence and learn new coping skills that are helpful throughout one’s entire life.