Wellness Perspectives Of Obesity Health And Social Care Essay

It has been observed that those with high abdominal splanchnic adiposeness or huge sums of splanchnic adiposeness in general ( fleshiness ) are at increased hazard for the metabolic syndrome. This is due to effects of inordinate fat shops on the vasculature and on endothelial map. Per Bjorntorp offered grounds to back up that hormonal instabilities, specifically of hydrocortisone and sex endocrines, are of import in the pathogenesis of insulin opposition, which is besides a lending factor to increased hazard for the syndrome. Genetics plays an implicit in function in the forecast of the metabolic syndrome, every bit good. Restrictions of utilizing the metabolic syndrome in clinical scenes as a diagnostic tool include concluding such that it ‘s non clearly understood which individual or combination of status ( s ) described above ( ATP3 diagnostic standards ) really are responsible for increasing hazard or doing any cardiovascular or metabolic upsets in the long tally, and the fact that the arbitrary figure ( 3 ) of conditions met measure up a patient for holding the syndrome. Metabolic syndrome is besides a gray country in foretelling wellness result due to the manner wellness professionals approach intervention – some tackle one status at a clip while others prescribe a general life style intercession. The metabolic syndrome has evolved into its name from â€Å" Syndrome X † over the old ages ; Syndrome X addressed a bunch of symptoms associated with insulin opposition and when cardiovascular abnormalcies were added to the diagnosing the name changed to the â€Å" metabolic syndrome † . There is a disagreement as to whether or non the construct metabolic syndrome should be dismissed, due to the obscure nature of its being as neither a true disease nor a true syndrome. 2. Describe why the metabolic syndrome is sometimes depicted as a syrupy rhythm. ( 10 points ) We live in a society where sedentary life styles are common and nutrient is aplenty, two factors that addition likeliness for positive energy balance. When genetic sciences and constructs like the â€Å" thrifty cistron † theory are factored into the equation the likeliness for weight addition is raised even more. Once an single becomes obese they are at hazard for certain features that represent the metabolic syndrome – or all of them – harmonizing to ATP3 guidelines. They besides may meet some of the emotional effects of being overweight, such as depression or deficiency of ego esteem – both can potentially originate and fuel â€Å" nerve-racking feeding † and take to farther weight addition and wellness complications. This cycling mentioned so far is merely in footings of weight, which sets the phase for farther jobs in association with the metabolic syndrome. At the cellular degree, one thing tends to engender another, whether it ‘s an aggravation of one factor or the induction of a different 1. For illustration, as insulin opposition is brought on by hapless dietetic and exercising wonts ( but particularly the self-contradictory free fatso acid flux associated with fleshiness[ 2 ]) , it causes greater insulin opposition. Besides, insulin – being a growing factor that can advance adipogenesis – has the possible to heighten production of ectopic fat in its ability to heighten lipoprotein lipase ( LPL ) activity and suppress hormone-sensitive lipase ( HSL ) activity. This ( over ) production causes inflammatory markers to be called upon to assist relieve the state of affairs, and their presence in and of itself serves to decline insulin opposition. Girod et al 20032 explains this rhythm in great item in a superb article. The diagram below was taken from the article and depicts the rhythm ‘s chief flow and major points. 3. Define weight cycling. Discuss the grounds about weight cycling being â€Å" risky † to wellness. ( 10 points ) Weight cycling is insistent weight loss and recover over clip. It is besides referred to as â€Å" yo-yo † dieting, and is normally measured by how many witting dieting efforts an person has made. Cycling is in regulation with Elfhag ‘s belief that losing weight and maintaining it off is highly hard.[ 3 ]She and several others stand steadfastly behind the impression that weight care is disputing. Despite the increased prevalence of weight cycling and the increasing figure of rhythms carried out per individual, diet crazes and weight loss plans are at full steam with new constructs and â€Å" advanced † merchandises being placed on the market continually. Though the mechanisms are non good understood weight cycling appears to hold an association with increased all-cause and cardiovascular mortality.[ 4 ],[ 5 ]There are several factors that may turn to this job. It may hold to make with the evident alterations in organic structure composing related to loss and regain ; those who regain tend to recover mass in the signifier different types of fat – chiefly splanchnic fat – and it appears to roll up mostly around the middle of the organic structure.[ 6 ]Two specific factors are at drama here for increased hazard for cardiovascular issues, one is the high sum of splanchnic fat and the 2nd is the accretion of this fat around the center, increasing waist perimeter. Both of these are besides mostly involved with the oncoming of insulin opposition, another reported complication of weight cycling.[ 7 ]The addition in cardiovascular mortality may besides be a consequence of the changeless fluctuation of certain markers that affect endothelial map, which include blood force per unit area, serum glucose and serum lipoids ( lessenings in HDL are associated with weight cycling[ 8 ]) .[ 9 ]Kidney map is besides affected during cycling by a fluctuating glomerular filtration rate.[ 10 ]One more factor is the pronounced alterations in sympathetic nervous system activity during the restriction/overfeeding cycling, which significantly insult blood force per unit area and bosom map and finally impacts overall cardiac burden. To farther support that weight cycling is â€Å" risky † , Hooper et Al observed pronounced additions in appetite-stimulating endocrine profiles ( increased ghrelin, lower glucose, and lower androgen degrees, specifically ) in postmenopausal adult females who reported a history of repeated turns of weight cycling[ 11 ]– this would increase the likeliness for weight regain. It has besides been reported that weight cycling is associated with an increased prevalence of eating disorders/disordered feeding, bone breaks, malignant neoplastic diseases, type 2 diabetes, high blood pressure and psychological upsets. 4. Define and depict what is meant by chronic emphasis. ( 10 points ) Chronic emphasis is continual exposure to certain stimulations that elevates and maintains a degree of allostatic activity in the organic structure. Chronic emphasis can originate from a figure of state of affairss, whether environmental or internal. The â€Å" stress response † refers to the manner the organic structure reacts under emphasis, and it depends on the strength and continuance of the abuse. When an person is under chronic emphasis, the allostasis involves alterations in energy flow which affects several factors such as appetency, energy storage mechanisms and alimentary use. Stress endocrines such as hydrocortisone, corticotropin-releasing endocrine ( CRH ) , epinephrine and norepinephrine are released in effort to restart stableness in a fight-or-flight- or defeat reaction-type state of affairs that has been imposed on the organic structure, via either the hypothalamic pituitary suprarenal gland ( HPA ) axis or the sympathetic-adrenomedullary ( SAM ) system. Chro nic emphasis has been linked to increased hazard for going corpulence or corpulent. 5. Describe how chronic emphasis it is related to splanchnic fleshiness and clinical manifestations of the metabolic syndrome. Define and depict the part of the SNS system, the HPA axis, and wellness behaviours on splanchnic fleshiness and metabolic syndrome. ( 30 points ) . The HPA axis is a cardinal control hub of the emphasis response cascade, located in the hypothalamus and encephalon root, and regulated by CRH. It runs on a feedback system, in which adrenocorticotropic endocrine is secreted from the anterior hypophysis and Acts of the Apostless on the adrenal cerebral mantle to excite cortisol secernment ; in bend hydrocortisone studies back to the encephalon to close off production of more hydrocortisone. The SAM works in concurrence with the HPA axis to run the emphasis response and is located in the venue ceruleus on the Ponss – though it is typically called upon in state of affairss where the emphasis abuse is non perceived as overly-threatening. During the response to chronic emphasis, the presence of adrenaline serves to close down digestive procedures and diverts all attending to the sympathetic activity in an effort to supply the organic structure with the ability to get by with the emphasis. Cortisol release, nevertheless is associated with eating and increased feelings of hungriness. Chronic elevated hydrocortisone degrees is besides known to do splanchnic fat accretion and deposition ; a good known factor of fleshiness and the metabolic syndrome. Adipose tissue – particularly intra-abdominal – contains more glucocorticoid ( hydrocortisone ) receptors, which finally yields greater glucocorticoid metamorphosis in the abdominal country compared to other parts. Within splanchnic adipose tissue, in the presence of insulin the hydrocortisone serves to forestall lipid mobilisation for usage and supports fat accretion alternatively, in either of two ways: one, through stimulation of lipoprotein lipase activity or two, through the repressive effects hydrocortisone has on growing endocrine, which promotes lypolitic activty when permitted to work freely. Cortisol besides suppresses the consumption and usage of glucose in musculus tissue, and at the same time promotes the dislocation of protein in an attempt to originate gluconeogenesis in the liver. Epinephrine and noradrenaline are received and processed by sympathomimetic receptors. Two types of receptors exist, alpha and beta. Alpha receptors initiate a cascade consequence to let go of free fatty acids, while beta receptors inhibit this cascade and therefore the release of free fatty acids and alternatively advance fatty acerb storage. When free fatso acids are released into the portal system, unless they are used right off ( i.e. , to back up energy demands of physical activity ) they remain in circulation and it can be risky to hepatic metamorphosis and insulin sensitiveness. Both of these complications are markers associated with the metabolic syndrome. The presence of hydrocortisone stimulates hunger which can take to â€Å" nerve-racking feeding † and, accordingly, weight addition particularly in the signifier of splanchnic adipose via mechanisms mentioned above. The more hydrocortisones released in response to emphasize the higher the inclination to eat more of calorically heavy nutrients. There is grounds to propose that consumption may be affected by neuropeptide Y, CRH and leptin every bit good as opioid and endocannabinoid signaling in concurrence hydrocortisone activity.[ 12 ]In footings of the theoretical account of reward-based feeding, cognitive restraint of indulging in a peculiar nutrient outputs a signifier of emphasis that increases hydrocortisone concentrations which impact NPY, insulin and leptin degrees ; hunger work stoppages hard while the wages tracts are initiated and while the individual gives in and devour the point the circulating endocrines and hydrocortisone act to heighten fatty acerb storage in th e signifier of splanchnic adipose and supress insulin sensitiveness. Currently-overweight females and those with a history of high dietetic restraint are most likely to digest this destiny. Repeated Acts of the Apostless of this step will finally take to increased hazard for weight addition and farther, the metabolic syndrome. 6. Using the Obesity Atlas and/or other resources, describe and compare the function and influences of biology/genetics, physical activity behavior/ eating behaviour and environment on the etiology of fleshiness. Which of these facets has the strongest impact? Why? Which of these may be the most promising to prosecute for bar or intervention of fleshiness. Why? ( 30 ) The etiology of fleshiness can non be represented by any one individual factor ; alternatively there are a battalion of influences on energy balance and weight fluctuations that are really loosely grouped into: biological science and genetic sciences, physical activity/inactivity, dietetic wonts, and the psychosocial influences from the envrionment. While physiology and familial make-up are the strongest forecasters of phenotype, they are about impossible to alter after creative activity of a human being. On the other manus, the physical universe around us and our concsious daily determinations are extremely dynamic, and therefore these are the 1s that should be targeted for intercession and intervention. There is grounds to back up that genetic sciences work in concurrence with the environment to lend to obesity on a planetary degree. Research has shown there are specific internal biological and physiological procedures that can be influenced by heritable traits ; one such illustration set Forth is the thrifty cistron hypothesis ( Neel, 1961 ) with which it was proposed that the organic structure can be predisposed for extremely efficient food hive awaying mechanisms, therefore seting them at a disadvantage for increased hazard of weight addition compared to the non-thrifty-gene-carrying population. Another illustration is the set point theory ( Bennet et al, 1982 ) , which entails that an internal control system dictates and regulates how much fat a individual carries throughout their life-time. Geneticss have besides been linked to weight loss as good – Shin et Al, 2006 found that certain SNPs in the ADIPOQ cistron ( influences alterations in go arounding adiponectin degrees ) can find how good, or ill, one responds to dietary & amp ; exercising intercessions. Mager et Al, 2008 observed mutants in the ghrelin receptor cistron which were associated with fleshiness and glucose metamorphosis in people with impaired glucose tolerance, and found that specific SNPs in this cistron besides influenced how one responds to burden loss intercessions. However, good beyond the negligible sum of research behind the familial part to fleshiness is the other, good established offender – the external environment in which we live and its afloat pool of abuses. The society we are constructing around us begets eternal options and short cuts – 1s that were non available in the times of our early ascendants ; therefore, they are non contributing to proper direction of our organic structures the manner nature intended. The grounds is all around us, from McDonalds Dollar Menu to the Dollar Store and from wireless cyberspace to Segway scooters ; it ‘s all about money and ease these yearss. And so to prod us while we ‘re down after lading up on cheap, high fat nutrient we have the amusement industry, which has drawn voluminous sums of attending to an overdone image of the â€Å" perfect organic structure † over the old ages, making this mute criterion of and spliting line between how we should and should n't look . Now the sudden rush in diet and weight loss pills, plans and regimens has left us in even more of a dither, scared to look one manner or the other in fright of being stared at, smirked at, laughed at, judged or ridiculed for the manner we appear on the exterior. So we stagger on, and our caputs down and custodies in the bowl of comfort. emphasis could ne'er be the exclusive cause of and be an effectual mark for intercession and intervention for the rise in fleshiness. There are merely excessively many extra confounding factors – genetic sciences and hapless dietetic and exercising wonts are the major wrongdoers. The construction of American society is by no agencies conducive to easy, healthy life, with widespread economical instability and far, far excessively many cutoff options. You ‘re stressed at work so you mindless make for the tremendous bowl of Halloween confect in the common country ; you are short on hard currency so you head into McDonalds for their dollar bill of fare choice ; you do n't experience like walking the stat mi to work so you get into your auto or hop on the coach.

Analysis of Albert Ellis’s Life Experiences and Psychological Philosophies Essay

At the age of 12 his parents divorced (DiGiuseppe 1989, Ellis 1992, , Sheehy 1997). These two life-altering events were, in part, what led him to begin focusing his mind on understanding people (DiGiuseppe 1989, Ellis 1992, , Sheehy 1997). In junior high Albert Ellis dreamed of becoming a great novelist (DiGiuseppe 1989, Ellis 1992, , Sheehy 1997) but by the time he reached college age, he decided it might be more practical to become an accountant instead. However, he planned to retire by the age of 30 so that he could then take up writing at his own leisure (DiGiuseppe 1989, Ellis 1992, , Sheehy 1997). Due in part to the Great Depression, his goals changed but he did go on to graduate college in 1934 with a degree in business (DiGiuseppe 1989, Ellis 1992, , Sheehy 1997). After graduation he and his brother became entrepreneurs and started their own business. They sold pants purchased from the garment district (DiGiuseppe 1989, Ellis 1992, , Sheehy 1997). In 1938 a gift and novelty firm employed him as their personal manager. Some of his controversial articles included The Influence of Heterosexual Cultures on the Attitudes of Homosexuals (1951) and Prostitution Re-assessed (1951) both of these articles were written for the International Journal of Sexology (DiGiuseppe 1989, Ellis 1992, , Ellis 2004). Albert Ellis’ writings were groundbreaking material that opened the door to the sexual revolution of the 1960s and the gay and lesbian rights movement in the 1970’s (Ellis 1992). These writings were controversial at that time and may have stigmatized or put a negative label on Albert Ellis. However, these writings as well as references from his friends was how he formed his client base (DiGiuseppe 1989, Ellis 1992, , Ellis 2004). Most of Albert Ellis’ early clients were individuals and couples suffering from sex, love and marital problems (DiGiuseppe 1989, Ellis 1992, , Ellis 2004). Albert Ellis also grew his private practice through publicity from his talks, workshops, radio, and television presentations which led to referrals from a number of psychologists with whom he had no personal relationship with (Ellis 1997). Besides maintaining a full-time private practice, Albert Ellis also found the time to become the first Chairman of the first Committee on Private Practice of the Division of Clinical Psychology of the American Psychological Association (Ellis 1997). During that time he conducted a study of the members of the American Psychological Association (Ellis 1997). This study showed that only 56% of the American Psychological Association members were engaged in some kind of paid private practice, and only 30% devoted 20 or more hours a week (Ellis 1997). Only a few individuals including Albert Ellis were in full-time private practices (Ellis 1997). Albert Ellis also worked with Reverend Ilsley Boone on a New York District Federal Court to legally sell nudist magazines (Ellis 1997)_. _ They lost the New York District Federal court case and immediately start working on a brief for the United States Supreme Court and alternately reversed and New York district Federal Court decision (Ellis 1997). This was a major victory for nudists across the country (Ellis 1997). Albert Ellis quickly became an â€Å"Idol† for many American nudists (Ellis 1997). Philosophical and Psychological Beliefs Albert Ellis experimented with various forms of psychotherapy keeping therapies that he believed work better than others and disregarded everything else. Albert Ellis began building his own therapeutic process and started questioning traditional Freudian psychoanalysis. In 1953 Albert Ellis started calling himself a â€Å"psychotherapist† instead of the traditional â€Å"psychoanalyst† label (DiGiuseppe 1989 , Ellis 1997, 2004). Albert Ellis thought that this change of title would separate him from the classical psychoanalytic practices (DiGiuseppe 1989 , Ellis 1997, 2004). Albert Ellis had a passion for reading early philosophy e. g. Epictetus and Spinoza (DiGiuseppe 1989 , Ellis 1992). Albert Ellis also read famous works from the leading psychologist of his time e. g. Alfred Adler and Karen Horney (DiGiuseppe 1989 , Ellis 1997, 2004). His study of philosophy and psychology also led him to become interested in understanding the philosophy of happiness. Albert Ellis came to the conclusion that if an individual’s basic needs were met, the individual would be happy. He found that basic needs were only part of the equation for personal happiness. Albert Ellis then focused on negative thoughts. Albert Ellis thought that if people had a rational philosophy of life they would rarely be emotionally disturbed (DiGiuseppe 1989 , Ellis 1997, 2004). Albert Ellis formulated a theory that psychological issues and emotional issues of the individual were causing the negative thoughts or what Albert Ellis called irrational beliefs (Ellis 1997, 2004). Rational Emotive Behavioral Therapy Basics Rational Emotive Behavioral Therapy (REBT) is a therapy in which individuals change their perceived believes about perceived negative events. Albert Ellis acquired several disabilities such as diabetes, tired eyes, deficient hearing, as well as other physical handicaps (Ellis 1997). Albert Ellis used Rational Emotive Behavioral Therapy (REBT) to overcome his negative perceptions of his disabilities. † If you really accept it, and stop whining about it, you can turn some of its lemons into quite tasty lemonade† (Ellis 1997). Albert Ellis used rational emotive behavioral therapy (REBT), on himself, in 1943 soon after he became a practicing psychologist (Ellis 1997, 2004). Rational Emotive Behavioral Therapy (REBT) is an important and useful therapy still used today. First, an individual must be aware of their irrational thoughts or explain to the individual that the way they perceive an event is irrational. Then, the individual must replace the irrational thought with rational thought. Finally the individual believes in â€Å"unconditional self acceptance (USA)† (Ellis 1997, 2004). Unconditional self acceptance (USA) is when an individual learns to accept and love their self for who they are rather than what they do. The unconditional self acceptance (USA) is reached when the low frustration tolerance (LFT) is raised and ultimately achieves high frustration tolerance (HFT) (Ellis 1997, 2004). The ABC’s of REBT Albert Ellis believed emotional problems that an individual suffers from are the link to a set of irrational beliefs held about themselves, others, and the world they live in. These rational beliefs perpetuate negative self talk in the individual’s consciousness. The negative self talk puts emphasis on â€Å"shoulds†, â€Å"oughts†, and â€Å"musts† of irrational thinking. Rational emotive behavioral therapy attempts to replace these irrational beliefs with new rational thoughts. The process of helping the client change their irrational believes is a two step process. The first step is setting up or choosing for themselves certain happiness producing values, purposes, goals, or ideals; and effective, flexible, scientific, logico-empirical [sic] ways to achieve these values and goals and upload boarding contradictory or self defeating result (Ellis 1997, 2004). Rational beliefs or irrational beliefs shape who we are how we act. Albert Ellis created an ABC model to help both the client and the therapist engage and treat unrealistic, immature, and absolutist modes of thinking into realistic, mature, logical, and a realistic approach to thinking (DiGiuseppe 1989 , Ellis 2004). The â€Å"A† in the ABC model refers to the â€Å"activating an event†. Activating events are events that trigger or cause our beliefs and perception. The Activating event could be a real situation that the individual had experience are could be inferred event were individual their own meeting contrary to what the situation was (DiGiuseppe 1989, Ellis 2004). In Either case the activating event is negative stimuli cause by an event or situation triggers any irrational belief (Ellis 2004). The â€Å"B† in the ABC model is beliefs that shape an individual emotions and behaviors (DiGiuseppe 1989 , Ellis 2004). In other word, an individual who experiences an activating event then forms a belief based upon that activating event affecting their decision-making about their consequences and/or reaction to other stimuli (Ellis 2004). These Beliefs can either be you’re rational or rational (Ellis 2004). The â€Å"C† in the ABC model stands for the consequences of the irrational beliefs (DiGiuseppe 1989 , Ellis 2004). There are emotional and behavioral consequences, either positive or negative, to a set of beliefs about the activating event (DiGiuseppe 1989 , Ellis 2004). Individuals that suffer from irrational beliefs about a given situation will likely suffer from unhealthy negative emotions (DiGiuseppe 1989 , Ellis 2004). Unhealthy negative emotions are extreme emotions that can manifest themselves in a variety of forms e. g. guilt, anxiety, andor depression (Ellis 2004). The extreme negative feelings are so intense that the individual afflicted with these emotions often cannot function normally (DiGiuseppe 1989 , Ellis 2004). Albert Ellis does not believe that one should live a life free of negative emotions (Ellis 2004). Albert Ellis believed that healthy negative emotions were emotions that were relatively â€Å"low in intensity† (Ellis 2004). Albert Ellis believed that the healthy negative emotions experienced in a mentally healthy individual can modify behavior for the betterment of the individuals’ life (DiGiuseppe 1989, Ellis 2004). Albert Ellis later added the (D), (E), and (F) to his ABC’s ofRational Emotive Behavioral Therapy (Ellis 2004). The â€Å"D† is disputing the irrational beliefs that the individual possesses about the activating event (Ellis 2004). The â€Å"E† or effect the person feels is only achieved when the individual or client successfully disputes the irrational belief and replaces the irrational belief with a rational belief (Ellis 2004). This will ultimately lead to a new effect in the persons behavior. The effect will then lead the individual to a healthier and happier way of feeling â€Å"F† (Ellis 2004). The application of the rational emotive behavioral therapy’s ABC model allows people to visualize how their reactions to events are formed (Ellis 2004). Once an individual visualizes how irrational beliefs are formed and changes their behavior negatively therapy will, more than likely, be successful. The 4 steps of applying the ABC model Rational emotive behavioral therapy is an approach that makes the client participates in an active role in the therapy process. There are four steps in applying the ABC model. As the client Progresses through the four steps will work through an individual’s irrational beliefs and use certain skills to combat any irrational beliefs that may arise after private counseling has ended (Ellis 2004). Step one is to reveal the individuals or clients irrational beliefs in their current mode of thinking (Ellis 2004). In many cases the individuals of clients have had these irrational beliefs for so long that they cannot distinguish their irrational beliefs from normal rational beliefs (Ellis 2004). Also when the individual or the client has family and friends reinforcing their irrational beliefs, even though the irrational beliefs may not fall into societal norms, only reinforces the idea that their irrational beliefs are rational or normal (Ellis 2004). The first step, basically, outlines the treatment plan and formulates a plan of action to dispute the irrational beliefs. Clients must be aware of their irrational and rational beliefs and distinguish the differences between the two different beliefs. In step two the client or individual expands their understanding of what is irrational and what is rational (Ellis 2004). This step is similar to step one, but step two the therapy is more in-depth and intense. In step two the client or individual must be made aware of their irrational beliefs and how the individuals’ irrational beliefs are perpetuating their own turmoil (Ellis 2004). If the client or individual continues to think unreasonable or irrational, they will repeat their irrational behavior and have continued unpleasant feeling that interrupt their normal way of life (Ellis 2004). In showing the individual or client the pattern of their irrational beliefs and the consequences their irrational beliefs impose on them is detrimental to the success of their treatment (Ellis 2004). Only when the client can distinguish the difference between rational beliefs and irrational beliefs, can realize that the negative problems they are having are in direct correlation with their irrational beliefs, and can see the pattern they follow when irrational beliefs are present (Ellis 2004). Step three begins once the previous objectives have been met. In step three the individual or client will learn how to stop illogical or irrational beliefs and change the irrational and negative pattern into a new logical and rational mode of thinking and behaving (Ellis 2004). This is achieved when the individual ceases the negative self talk and stop the irrational beliefs from affecting their mode of thinking (Ellis 2004). Many individuals have their irrational beliefs so embedded in their mode of behaving and their mode thinking that the individual may not even be aware that their irrational beliefs are irrational (Ellis 2004). The client with help from their therapist will attempt to identify the irrational beliefs from the rational beliefs (Ellis 2004). In the fourth and final step the client has identified their irrational beliefs (Ellis 2004). The client along with the help of the therapist, work to modify the clients negative way of thinking and identify and change the clients irrational beliefs into rational modes of thinking (Ellis 2004). The therapist works with the client until a new set of rational beliefs are fashioned (Ellis 2004). Once the irrational belief system is replaced by a more rational and logical belief system the client will notice negative feelings and negative behaviors change into a more positive feelings and positive behaviors (Ellis 2004). The rational emotive behavioral theapry techniques used by the therapist to dispute irrational beliefs can vary from client to client depending on the type of the client and modes of irrational thinking REBT Techniques Rational Emotive Behavioral Therapy is a multimodal form of therapy (Ellis 2004). Some of the different techniques used in Rational Emotive Behavioral Therapy include â€Å"Disputing the client’s irrational beliefs†, â€Å"changing the language of the client†, and emotive techniques like â€Å"role playing† and â€Å"rational emotive inventory† (Ellis 2004). These different techniques can be used to modify several types or irrational behaviors caused by irrational beliefs e. g. anxiety, depression, anger, and addictions (Ellis 2004). These techniques show the client how to refute their irrational beliefs in a precise and rapid method. Disputing the client’s irrational beliefs technique is a technique that makes the client challenge their beliefs and modes of thinking (Ellis 2004). In this technique the therapist presents a series of questions such as: Why do you assume this? or Why must it be this way? When the client answers these questions the client start to realize that the way they are thinking is irrational (Ellis 2004). The language of the client technique disputes â€Å"the shoulds† and â€Å"the oughts† in the client’s way of thinking (Ellis 2004). In most cases the language used by the client forms their irrational way of thinking (Ellis 2004). By changing â€Å"the shoulds† and â€Å"the oughts† into wishes, wants, and desires may change the client’s irrational beliefs (Ellis 2004). Example of Self-Application of REBT The techniques outlined by Albert Ellis shows how simplistic but meaningful Rational Emotive Behavioral Therapy (REBT) can be (Ellis 2004). Take for example when Albert Ellis gets impatient or angry about his various limitations (Ellis 2004). Albert Ellis says to himself: â€Å"Too damn bad! I really do not like taking all this time and effort to deal with my impairments and wish to hell that I didn’t have to do so. But alas, I do. It is hard doing so many things to keep myself in a relatively healthy condition, but it is much harder in the long run and much more painful and deadly, if I do not keep doing this. There is no reason whatsoever why I absolutely must have it easier than I do. Yes it is unfair for me to be more afflicted than many other people are. But, damn it, I should be just as afflicted as I am! Unfairness should exist in the world—to me, and to whomever else it does exist—because it does exist! Too bad that it does—but it does! † sic Albert Ellis lived a full and rich life filled with controversy and an outspoken attitude. Albert Ellis fought for gay and lesbian rights and the right to send uncensored or â€Å"obscene† mail through the Federal mail system. Albert Ellis was also one of the first individuals start their own private practice as a psychologist.

Academic Strategies for the Business Professional Essay

Academic Strategies for the Business Professional course was great for helping me develop into a very decent student. It was a great class with lots of information for school learning and use in the career field. It has assisted me to learn to use better time management skills. The more I use these skills the less stressed I will be. As I use the different styles of time management, it helps me determine which tool works the best for each activity I am doing. This also has helped me in my personal life. As I juggle school, kids, work, laundry, cleaning and a multitude of things that just pop up time management has become most important. It has allowed me the ability to work fulltime, go to school and still spend time with my family. My family is my number one priority! This class has been a blessing in disguise because it has helped me in many ways to still have that desired time. This course was able to show me a better me. I did not know how I learned the best until we had to take some quizzes in Unit 2 reading. According to EducationPlanner.org, I am an auditory/visual learner. I use all three types of learning. The one I scored the least in was tactical, which for me is true. I do use that the least. When I learn I like a visual example first, then auditory if, I do not understand it. Being able to see something physically done at least once is the most helpful to me. Depending on the situation, I find it helpful to be talked through it while doing it. Mostly though I find that just being shown how to do something while I do, it is the best learning style for me. This will make me a better candidate in the business world because I know my strengths and weakness and will be able to apply myself in a productive manner. This course is a wonderful learning experience and I hope all my classes are like this. As I go forward in my educational goal, I will use all the neat tricks and skills we have been exposed to. My education is my short-term goal and I will mostly use SRI that we learned about in Unit 6 reading to help me with studying. (pg.4) I will also use the note taking skills also addressed in Unit 6. I am use to the outline system but I really like the Cornell System that I never knew existed until this class. (pgs. 6 and 8) I will have to start using the writing skills to my advantage in the future to ensure a great grade and hopefully a very enjoyable job in the future. As I work towards my long time goal, the S.M.A.R.T. goal setting system is going to be my new comrade. It is easy to write up and break down the goal into smaller pieces. (pg. 6) Without this skill I would be going, â€Å"I do not know what I want to do in the future.† This skill helped me figure out my short-term and is helping work on the long-term. It is not fully there yet but it is always a work in progress. Once you finish one goal, you tend to start another. References EducationPlanner.org http://www.educationplanner.org/students/self-assessments/learning-styles.shtml Unit 6 Reading page 4, 6, & 8 Unit 7 Reading page 6

Tourism and employment Essay Example | Topics and Well Written Essays - 1000 words

Tourism and employment - Essay Example The competition involved shows growth in the tourism sector. There is a need to meet the requirements of the ever growing tourism sector through innovations and upgrade of tourism products. There is also an increase in the number of hotels. This calls for more employment to cater for manpower, so many people are employed as caterers. Tourism has provided 10% of global employment as stated by the International Labour Organisation. Tourism as a service industry will require high workforce (GheorghilaÅŸ and DincÄÆ' 90). Gender: Tourism has created many opportunities for women usually in the hotel and accommodation sector. In this sector, 60% are women employees (GheorghilaÅŸ and DincÄÆ' 92). Many women are employed on a full time basis while a few are part timers in many countries. Age: Generally, the tourism accommodation sector offers jobs to young people. 40% of all tourism employees are young people mainly below the age of 35 years. This is due to their productivity in this sector. Many countries prefer young people, as opposed to old people, for their energetic nature, high rate of social networking and an advertisement strategy to win many customers. Qualifications: The level of education will determine the number of opportunities an individual can get in the tourism sector. Tourism accommodation has a high number of employees with a lower level of education while employees in management, human resource, and accounting in tourism normally hold university degrees. Therefore, tourism can accommodate a high number of employees who are not highly learned but have basic skills. Job status: Tourism offers both temporal and permanent jobs. Full time jobs depend on the duration of work. Usually tourism offers part time jobs and temporary jobs depending on the tourist turnover. Temporal jobs include tour guides and accommodation staff. Time of the year: Seasonal outcome factors the number of employees to be employed, so a high tourist turnover will result in a

Historical Land Qwnership as Depicted in the Movie, the Field by Jim Essay

Historical Land Qwnership as Depicted in the Movie, the Field by Jim Sherindan - Essay Example The setting of the movie is in a small country village located in the southwestern part of Ireland. Bull McCabe is an individualist who has spent several hard years of labor cultivating a small rented land. He nurtures it from barren rock into fertile land, which becomes beneficial. Bull has always claimed the land his and had dreamed of buying it, as it is being put up currently for auction. McCabes intimidate pose intimidation of several townspeople out of bidding in auction to the auctioneer Mick Flanagan. Galwayman Dee is from England where he has been living for several years with his plan for the field. The play reaches its climax McCabes comes face to face Dee. The encounter ends in struggle and finally death. This essay will look into the succinct analysis of the play with regard to the Irish view of land ownership and home. To begin with, the first scene talks of the man carrying out the cultivations on a vast land, which he claims to be his. This gives the illustration on t he Irish land ownership rights. The action shows that laws regarding land ownership in Ireland are not legally organized or planned to facilitate peace among societal members (Baker 34). The man simply start working tirelessly on a barren land, which to him, is an empty unutilized land which should be put into appropriate use. This is the reason behind the conflict that arises between the two Irish men. Dee had believed that he the land was his even in his absence. To him, he had the ownership which qualified him as the legal owner of the place, therefore, the idea of another man thinking of the land as a free place and unused property is illegal. The fact that the widows make a step to put the land in auction without considering McCabe’s work is unlawful itself. Allowing a citizen to work on a large rocky land turning it into a fertile land, and auctioning it, is not a fair deal and shows some shortcomings in the Irish land (Deane 67). The law does not consider much the plig hts of the low class people in the region. The bright lighting in the play serves the role of stressing some ideas in the film. For instance, the director has used bright light to accentuate the suffering and oppression of the low class individuals in the Irish society. He has done the same in all other cases representing the ways in which people of high social class live in comparison to those of low classes. The sound patterns in the play is that of higher tones with speech and low tones of background sound. This is meant to ensure that the listeners and viewers get enough comprehension of the video, in terms of its thematic contents. Historically, Ireland land ownership was characterized by English elite rule. The rule involved the division of the country into large estates, and authority was passed down to the supporters of Scottish Protestants. This is reported to have been a political plot to bring down Ireland and wipe out the issue of Roman Catholicism in Britain. It is indi cated too in the historical texts that majority of the notable landowners were absent; and could more often employ agents who were of Ireland origin to take care of the land. The agents could, in turn, become tenants who had no tangible security of tenure and thus they could be chased out in case their rent went to arrears or otherwise. The management of estates was always poor as the tenants lacked motivation and the necessary incentive to develop or improve the land

What does it mean to be Canadian Is it worth it for the Chinese to Essay

What does it mean to be Canadian Is it worth it for the Chinese to come here and build Canadian Pacific Railway - Essay Example Although the people come from a diversified background, they identify themselves as being Canadians and having attributes which makes them proud to be associated with Canada. To a great extent, a key role is played by the television, media, and literature in promoting feelings of nationalism and unity within Canadians despite their varied backgrounds. In particular, emotions have been creatively used to have an overwhelming impact on its audiences in order to stimulate feelings of patriotism and loyalty towards Canada (Burke, 104-107). Canadians take pride in belonging to a country which has a fascinating social, cultural, and historical background and they have a positive attitude towards the country (Cohen, n.pag.). Its inhabitants may be different in appearance however all Canadians share similar values and encourage the expression of personal beliefs and thoughts on their identity as a Canadian. Marusya Bociurkiw in Feeling Canadian: Television, Nationalism and Affect examined th e part played by television in the construction and dissemination of feelings of nationalism among its inhabitants. Canada has often been described as being similar to the USA however American and Canadian sentiments as to what it means to be a Canadian differs greatly. It is also important to account for the considerable diversity present in the Canadian society. Burke analyzes how Bociurkiw has considered sensory and emotional aspects of television content and how a sense of national belonging is created through the television programs (104-107). Television provides a great way of connecting the public with the society through affective perceptions. A documentary film by Robert Cohen named Being Canadian is in the making which addresses the crucial question of what it means to be a Canadian (Cohen, n.pag.). The documentary is based on several interviews with Canadians while on a journey across Canada. This journey provided Cohen with a deep insight regarding the perception of peop le about being a Canadian. The responses make up the documentary and explain how positive people are about being a Canadian and the pride they take in belonging to this land. However, after generations of immigrants in Canada, it seems that the cultural value and the sense of Canadian identity is reducing among its dwellers. The creators of the documentary explore the Canadian territories and the invaluable assets which Canada is proud of. Along the way, several Canadians have been interviewed to describe the qualities, attributes, and values involved in being a Canadian and what it means to them. Diakiw in his essay considers the role of school in forming a feeling of Canadian identity as children try to assimilate the cultural values under Canadian settings (2). Although many immigrants have developed a sense of affiliation with the culture and identify themselves as Canadians, many are facing identity crisis as a result of mixed values and the multi-cultural nature of the country . Schools act as important educational centers for the dissemination of political and cultural views and because of a diversified community there is not single perspective of political or cultural view being communicated. Since schools are central curators of national outlook, it is necessary that schools are regulated in what they want to promote (Diakiw, 5). The Canadian government has promoted a multi-cultural policy and has developed easy procedures encouraging immigrants to migrate to

The Benefits of Having a Good Boss Essay Example | Topics and Well Written Essays - 1250 words

The Benefits of Having a Good Boss - Essay Example A good boss increases productivity and promotes healthy working relationship while a bad boss hampers the growth of a company. The two kinds of boss are similar in terms of their professional roles in an organization. Both have people working under them, possess power over others, work towards the success of the company, and implement rules of the company. In an organization, employees look up to their bosses and make them the role model. Serving as role models, bosses should possess admirable qualities that others may imitate. In particular, the boss should behave according to the mission and goals of the company. He should have ideal professional qualities and imbibe the principles of goodwill, justice, and honesty in his profession. However, personal qualities are as important as professional ones to promote good-working relationship with employees. According to Brusman (2), the way a boss treats people is what differentiates him from others. It is the aspect in which many bosses commit mistakes, thus it is one aspect that easily distinguishes a good boss from a bad one. Another aspect is decision-making strategy. As the superior, a boss holds the highest power in an organization but such power may be equally divided among employees if a boss wishes to. Furthermore, the life goals of a boss differentiate a good one from a bad one. Life goals include those accomplishments that a boss wants to attain for himself, his employees, and organization. Treating employees positively is one of the characteristics of a good boss. Positive treatment of employees may be challenging especially with the presence of tension and pressure from work. Deadlines, work quality, and other factors may affect the way a boss deals and treats his employees, thus they can serve as the real margin to distinguish a good boss from a bad one. Despite pressure, a good boss shows good examples that others imitate while a bad one acts in the dismay of his subordinates. A good boss is friendly and deals nicely with others. He is neither feared nor avoided. Rather, subordinates work freely in his presence. In the morning, employees wait for him to arrive and wish to see him in the meeting to discuss issues that need to be resolved. In contrast, a bad boss terrorizes his employees with his presence alone. Subordinates do not feel comfortable when he is around. They are alarmed by his presence, and sometimes pretend to be busy when the boss is around. Likewise, in a meeting, employees do not wish to see the boss, but they still attend because they are afraid of being scolded at. Moreover, employees talk behind the back of a bad boss. They make fun of him and draw funny caricatures, and laugh at his mistakes. In sum, the friendly boss causes a positive atmosphere in the office while the terror boss brings about a negative climate. Athough the bad boss may decrease cases of absenteeism due to the fear of employees to be reprimanded, he may in turn increase employee turnover be cause subordinates could have a hard time dealing with him. A good boss knows how to sympathize with others while a bad one does not care about others’ feelings. As a leader, a boss acts as the parent of the organization. Therefore, he should be concerned of all employees, eventhough they are not directly under them. As such, he should know show sympathy when they need it. Showing sympathy to others could be as simple as giving condolences to bereaved employees, sending get-well-soon cards, calling up employees to check why they are absent, and so on. Likewise, a good boss knows how to appreciate the efforts of his people. He says â€Å"thank you† for favors done for him, greets people on their birthdays, and celebrates birthdays with them. However, a bad boss lacks all the

Current Issues and Critical Assessment Essay Example | Topics and Well Written Essays - 1000 words

Current Issues and Critical Assessment - Essay Example So, therefore having said all the above we see from the given article that diabetics has increased to a dramatic level in even a developed nation such as Canada. These are also illustrative of the fact that unhealthy habits such as the junk food syndrome and absence of exercising habits among many Canadians was a chief cause too. Ontario one the largest province in Canada witnessed these rise in figures which I even more stark ling but should not come as a surprise because the article itself has terms which clearly identify the fact that why Ontario saw these figures to shoot up. e.g. â€Å"sedentary† and â€Å"supersized food portion† that is to say desk bound culture and as said earlier junk food culture are the enemies of such a society. The article features some very important points as to the fact that issue relating to marketing to ethnic segments are as critical as might be targeting the market as a whole. Being a Student of human geography it is of critical importance to value diversity of human existence where it exist, so be it for marketing or whatever reasons. For instance it clearly points out that even in issues of marketing other ethnic groups which by definition constitute any group which might form a majority in their own region but form a minority where they currently reside, should be taken into consideration. This same could be applied in political, financial and many other contexts. Enough has been said about as to what can be learned about and applied to the practical environment from our course work. So basically what can be taken out these two separate articles is that any topic related to human their practices their well being, their habitats their differences are of utmost importance and each aspect of it no matter how small or how big is to be taken in to account. If we use a bit of rational in our thinking then it can be easily to comprehend that when human began to

Mental health needs assessment for the adult population of Wandsworth Coursework

Mental health needs assessment for the adult population of Wandsworth - Coursework Example The area of Wandsworth is located in south-west London. The town is located on The River Thames on the south bank. The river Wandle flows into the Thames and this is where Wandsworth received its name. It is also the principle settlement in The "London Borough of Wandsworth" (Medics on the Move). It borders the Bouroughs of Lambeth to the east, Merton and the Royal Borough of Kingston Upon the Thames and others. It is surrounded by very wealthy Boroughs. The 2001 Census gave the population of Wandsworth as 260,000 with 78% of the population as White, 9.6% Afro-Caribbean and 6.9% as being South Asian. The list of 354 Districts of England showed that Wandsworth is ranked the largest by area and 24th by population. In population density it ranked 10th and by ethnic diversity it ranted 29th. Today, the projects for Wandsworth show that by the year 2018, there is projected to be 300,000 people in Wandsworth with slightly more women than men. The area is mostly comprised of younger people (47%) between the ages of 20 and 39 with the rest of the population being older (Greater London Authority). NHS Wandsworth shows that in 2009, 290,000 people were living in the Borough. The largest age group is between 20 and 44 while other ages make up the rest of the population. The population is intended to rise in the next five years. Currently, the White race is 78% of the population with "non-whites" making up 22% of the population (includes Black, Asian and those who consider themselves as "other"). The Bourough has a large deprivation within and between the various wards. Wandsworth is ranked 23/30 for deprivation within London PCT and 91/152 for London within PCT's naturally (NHS Wandsworth 6). 1.1 Deprivations The Wandsworth Community Empowerment Fund Project states that the unemployment rate in Wandsworth is currently 8.0%. The following chart shows the income deprivation as of 2007: Although many areas in the Borough show prosperity, household income by ward is a differe nt story. The wealthiest Bourough is Northcote with a mean income of ?51,859 and Roehampton at substantially lower at ?31,141 ("Sustainable Community Strategy"). In terms of crime, Wandsworth has been a relatively safe place to live in 2006/07 but it has changed since then. Currently, the types of crime in this area include violence against the person, theft from motor vehicles, residential burglary and street crime ("Sustainable Community Strategy"). In 2007, there were 1,771 residential burglaries between April and December of that year. Burglary decreased within the last three years. There were 1,442 offenses for street crimes for the same period of time but street crime has also decreased. There were 3,954 offenses for crimes against the person during the same period which is approximately 14.1 offences per 1,000 residents ("Sustainable Community Strategy"). Education is another area for deprivation. There are approximately 51,889 young people and children living in the Borough between the ages of 0 and 19 which is 18% of the population. The 2007 census stated that the majority of children living in the Borough are ethnic minorities and primarily black children, which make up 17.9% of the population. In terms of support from the government, 1,628 children and young people were accessing help and 133 children and young people were registered on the Child Protection Register. The Borough also has 74 out of 174 "local super output areas (SOAs)" that are considered the worst 25% of all SOAs nationally which was only 64 in 2004. There are now 24 SOAs listed in the best 25% nationally for deprivation compared to 20 in 2004 ("Sustainable Community Strategy"). Healthcare in the Borough has some challenges because of the population. Because the majority of the Borough is aged 20 to 44, the younger people do not use

Motivation in work place Assignment Example | Topics and Well Written Essays - 4750 words

Motivation in work place - Assignment Example actor of motivation of the employees in the workplace is extremely important for deciding the performance levels of an organization which functions in the healthcare segment. As such, this research is conducted to evaluate the existing motivation levels, strategies and performance within the organization. Also, the motivation strategies that can be used by the business managers in the organization are considered and their practical application is analysed. The research would be mainly based on secondary research methodology in which data would be gathered from the employee groups working in the NHS foundation Trust. The research report is structured in a methodical and step by step manner. Suitable research aims and objectives are designed followed by a thorough review of the available literatures on the topic of motivation. The literature review would help to provide a base for the development of the research work and for analysing the collected data from a theoretical perspective. The research methodology including data collection techniques and data analysis methods are discussed. This is followed by the finding and interpretations that are derived by analysing the secondary data collected from the research. A well formulated conclusion is given to summarize the findings from the research. Also, a reflective diary that includes the approaches, views and opinions of the researcher is documented. An annotated bibliography is added to review the academic references used for the research work and for highlighting the purpose and use of these literary sources in the paper. The main aim of the research is to evaluate the factor of motivation in workplaces. This is done by understanding what motivation actually is and studying the different dimensions of motivation. The researcher aims to explore motivation form different perspectives and looks into the role of motivation in a workplace. Also, he looks into the different strategies that may be used by the human

Trust Case Assignment Example | Topics and Well Written Essays - 1500 words

Trust Case - Assignment Example tutorials, prompts, guides, to assist and inform the user to execute transaction and or explore task on the website (Studio Archetype/ Sapient, 1999, p.33). b) Presentation is the behavior in which the apparent glance and outlook of the site, both inside and outside of it, communicates significant information to the user. It has 3 elements. Clarity of Purpose implies that the efficiently laid out visuals successfully transmit the idea and the intention of the site. It is to familiarize the customers, that they can buy products when they get to this web site. Craftsmanship is the extent of the skill and proficiency of the development of the website, which the viewer perceives and judges by the first look of it. c) Technology: The number of ways in which the site technically functions. It has 2 elements which are: 1) Functionality: On the whole, how well the website seems to work for the user (Studio Archetype/ Sapient, 1999, p.33). d. Fulfillment is the entire method that the user goes through from the time a particular product’s purchase is initiated until he finally receives the product. Its elements include: 1) Protection of Personal Information: The privacy of the personal information is a must as it should be guaranteed to be used for that particular purpose to be used for no purpose other than what it was provided for. 3) Recourse: The operation process allows for remedy if one faces a problem at any time during the course of action. 4) Return Policy: There should be clarity in explaining the return policy 5) Simplicity of Process: How simple and easy is the purchase process (Studio Archetype/ Sapient, 1999, p.33). Qs2) â€Å"Seals of approval† are described as affirmed, acknowledged and authentic policies of security and encryption (seals of approval). The companies that provide these seals of approval are referred to in this report as â€Å"security brands. The top three â€Å"security brand† seals of approval in terms of percentage of

The existence of high commitment management in unionized workplaces Essay Example for Free

The existence of high commitment management in unionized workplaces Essay The existence of high commitment management in unionized workplaces suggests that such management is compatible with trade unionism. Discuss The relationship between workers and management has historically been an adversarial one. In the process of fighting for employee right and benefits, unions have traditionally created a them and us atmosphere between employees and managers. On the other hand, high commitment management tries to eliminate the them and us atmosphere and instead attempts to replace it with one of partnership where both employees and management work together for the benefit of the firm. Thus, the respective natures of high commitment establishments and unions would imply incompatibility. It is due to this belief that some high commitment firms devote enormous resources to strategies aimed to keep unions away from their firms such as hiring lawyers who specialize in union avoidance and implementing high commitment work practices such as grievance systems and work teams. However, there is a paradox to this belief as studies show that as compared with non-unionized firms, unionized firms in high commitment establishments provide more rights and benefits to workers, give more opportunities to employees to give and receive information, and give a greater voice to employees to voice either constructive suggestion or dissent (WERS 1992). Furthermore, union presence is increasingly popular in HRM organizations, as union density is 47% in organizations which employ at least half of the identified high commitment management practices. In this paper, I will use evidence from various studies to show why high commitment firms and unions are indeed compatible. High commitment management is based on the theory that firms who give more High commitment management is based on the theory that firms who give more to their workforce get back more from it in return. This requires a cooperative relationship based on trust and reciprocity between labor and management. Unions can help in solidifying a high commitment environment by policing management to ensure that certain high commitment goals are met. Unions in high commitment work environments fight to give employees a collective voice in decision making as well as enhancing distributive and procedural justice while in return improving workforce solidarity and aiding in legitimizing change. Thus, the compatibility between management and unions can increase the payoffs of both management and labor while allowing the firm to firm to be driven forward. In the fast pace, ever changing corporate world, responsiveness to change and flexibility within firms are oftentimes required so that firm can readily adapt to ever-changing times. Recent times have seen an increasing amount of firms moving away from traditional authoritarian ways of management towards that of high commitment human resource management. Such drastic changes in work practicess however, are not always easily implemented because a lack of communication between the workforce and managers makes it hard to change the character of employment relationships. Unions however, can aid in making such changes by allowing firms to communicate to the entire workforce quickly and efficiently while giving the workforce the opportunity to respond with input or inquiries. This increases the workforces knowledge and understanding of the new direction that their firm is taking and improves the probability that they will facilitate rather than resist future changes. Such was the case with Tesco, who realized that its inflexible employee involvement structure, as well as its high turnover, relatively low pay and a hands on directive management style were inconsistent with achieving enhanced levels of service to advance in competitive strategy. 1 Tesco wanted their employees to identify with and commit themselves to the company, and it saw the union Usdaw as the means for cultivating and realizing this goal. As a result a partnership between Tesco and Usdaw was formed where Usdaw gave up their strike threat in return for a greater union input to secure improved policy implementations. As a result, employee wages rose, terms and working conditions were improved and staff turnover dropped significantly.2 . Thus, this partnership took a step away from an us and them environment and took one towards unions working with management as team for the benefit of the entire firm. High commitment management is greatly dependent on a partnership between employees and management. This assumes that there arent agency problems because it is expected that employees have a deep understanding of the firms interests and that they go about their job as if those interests were their own. In order for the partnership between employees and management to flourish however, a workforce must have a collective voice in decision-making. Firms encounter many problems when trying to give individual workers decision-making authority. For instance, there is always the fear that a worker will abuse his decision-making authority by using it to further his own ends rather than to help the entire firm advance. Another problem is that it is extremely difficult to have a partnership between management and a fragmented workforce. Unions however facilitate a partnership by providing a channel of communication between management and the entire workforce. 3 This enhanced communication is made possible by unions because just as management speaks with single voice, having a union allows the employees it represents to speak to management with a unified voice. Thus unions give their members decision making authority by taking into account the needs of the workforce and communicating it to managers. As a result, there is an improved match between what employees want and what they get from management and this is an important ingredient in high commitment environments. Allowing workers to have a say in how their firm is managed increases their job satisfaction and is a major reason why on average, turnover is lower in union settings.4 In addition, unions tend to fight more for the benefits of employees with longer tenures in firms. This gives union members an increased incentive to commit themselves to their firm in the long term and also may be a factor contributing to lower turnover. This is compatible with high commitment management strategy in many occupations such as teaching and nursing where goals such as low turnover and worker longevity are important. However, any high commitment based partnership can break down if there is a lack of trust and accountability. Unions though can be trusted by management to act cooperatively because managers know that union officials want to protect their unions reputation with a particular firm and oftentimes this concern for its reputation can be the guarantee that management needs of good, constructive behavior5. In addition, a long-term partnership between unions and management can permit a greater degree of trust and objectivity than can the partnership between management and individual workers. This is because there is a greater frequency of interactions between management and a union. The partnerships experience in collectively dealing with past disputes makes it possible for future disputes to be settled in a promptly in a way that doesnt disturb work practices. This partnership also presents a checks and balance system to ensure that both parties act cooperatively. Just as a union is a party that can be held accountable for the actions of its members6, management can also be held responsible for bad behavior of any single manager. For instance, if a manager is engaging in an activity that the workforce views unfavorably, a union representative can give notice to management to put an end it before it goes too far. One of the biggest obstacles not permitting employees from fully committing themselves to a high commitment firm is if they perceive there to be unjustified unequal treatment. This can decrease employee performance incentives as well as hurt the morale of a high commitment firm. Unions however, have a sword of justice effect and are successful in eliminating many of the adverse affects that occur because of unequal employment opportunities. A major reason for this is that unionized can better monitor firm practices to ensure fairness because they are much more likely to have managers and supervisors who are trained in people management skills and in addition, managers in unionized firms put a greater emphasis on ensuring that there is equal treatment among their employees. Studies indicate that when taking into account workplaces where all the supervisors are required to have training in people management skills, 20% of those in unionized environments, [as] compared with only 12% of those in non-unionized places, have responsibility for equal opportunities.7 Two of the most common and documented forms of unequal opportunities are employee promotions and employee selection. When compared to non-unionized firms, firms with a union presence are four times as likely to monitor promotions by gender and three times as likely to review selection procedures to identify indirect discrimination.8. There is also evidence that the increased monitoring in unionized firms has helped reduce sexual discrimination as it regards to promotions and this has thus helped women advance up firms hierarchy. Studies indicate that about one in seven managers in the union sector reported that the proportion of women in the managerial post had risen markedly in the last 5 years; [while] only one in ten managers in the non-union sector reported this. 9 Furthermore, unions have also traditionally been seen as defenders of an egalitarian pay structure. High commitment work environments value and oftentimes even require worker solidarity. However, when some workers are paid more than others for essentially the same job, the existence of this solidarity is difficult to maintain. A union presence in a high commitment work environments facilitates the presence of solidarity as they prefer to pay each occupational group a single rate. This takes the wages out of competition among co-workers, and ensures that the high-commitment working environment wont be harmed due to ruthless competition practices such as undercutting between co-workers. Thus unionized workers have less wage inequality than their non-unionized counterparts. Studies indicate that the standard deviation is .457 in unionized setting [while it is] .592 in a non-union setting.10 Furthermore, unions help decrease wage inequality by 2.6% between males and females, 1.4% between blacks and whites, .6% between the healthy and those with health problems, and 3.1% between non-manual and manual employees.11. Thus by ensuring that firms pay equal wages for equal work, unions help maintain workforce solidarity which aids firms in maintaining high commitment work environments. In recent years, it had become apparent that the relationship between firms and unions doesnt necessarily have to be an adversarial one. In fact, the popularity of partnerships in high commitment firms indicates that the two institutions are indeed compatible. The evidence stated above indicates that when this partnership is properly utilized, unions can be a great asset to a high commitment management work design. This is because unions facilitate the existence of many of the necessary ingredients that go into high commitment work environments such as flexibility, increased employee voice in decision making, distributive justice, and worker solidarity. Major firms such as Tesco have recently taken advantage of this compatibility and are now realizing the formerly untapped benefits that a partnership between unions and high commitment management schemes can bring about. 1 Industrial Relations Services Partnership delivers the goods at Tesco, IRS Employment Review, August 1999, No. 662 2 Industrial Relations Services Partnership delivers the goods at Tesco, IRS Employment Review, August 1999, No. 662 3 Fernie, Sue. HRM Lecture on 29/01/02 : London: London School of Economics, 2001 4 Baron, James N. , Kreps David M. Strategic Human Resources: Frameworks for General Managers. (New York: John Wiley Sons, Inc., 1999), 127 5 Baron, James N. , Kreps David M. Strategic Human Resources: Frameworks for General Managers. (New York: John Wiley Sons, Inc., 1999), 134 6 Baron, James N. , Kreps David M. Strategic Human Resources: Frameworks for General Managers. (New York: John Wiley Sons, Inc., 1999), 134 7 Fernie, Sue Gray, Helen Women what unions can do for you CentrePiece Summer 2000 8 Fernie, Sue Gray, Helen Women what unions can do for you CentrePiece Summer 2000 9 Fernie, Sue Gray, Helen Women what unions can do for you CentrePiece Summer 2000 10 Metcalf, David Fighting for equality CentrePiece Summer 2000 11 Metcalf, David Fighting for equality CentrePiece Summer 2000

An Outline of the British Education system

An Outline of the British Education system This essay is entitled An outline of the British education system. and it especially concentrates on explaining some relevant issues concerning primary schools in this country. The essay talks about three topics, all of them divided in three paragraphs: the first one is a historical background and a key element that may help us clarify todays structure, referred to in the following paragraph. Since we are living in a society ruled by the new technologies, the last paragraph focuses on the importance given to the ICTs in British schools. The essay concludes by highlighting what, in my opinion, are the main strengths of the educative system in the United Kingdom. As stated by some historians, the roots of British education can be found in the mid sixth century. It was not however until the seventeenth century, when the first schools were built. At that time, education belonged to the Catholic Church which was committed to teaching the principles of Christianity, by building schools. According to the author Denis Haye, the XIX century saw the birth of the first state schools. At that time, these were still controlled by the Church which used to introduce poor children to the main matters of Churchs beliefs. However, it was not until the mid-century when the State starts gaining some control over education, introducing a wider variety of subjects. Among all the education acts that have passed in the history of British education, it is important to focus on two of them, since they may help us clarify the roots of todays structure. The also referred to as The Scottish Act, is born in 1872 and according to the on-line article Key Dates in Education it is known for making school attendance compulsory from the age of 5 to 12 years old. Another education act to be drawn up took place in 1944, and is in my opinion, important to highlight because from this time on primary school children are exempted of paying tuition fees. With this new education act a tripartite system was introduced in British education system, and this led to the creation of so-called technical, grammar and modern schools. While analysing the history of the education system, it is decisive to go back to the year 1988 when the national curriculum is introduced in British schools, including English, Maths, Science, and Religion as compulsory subjects. From 2010 MFLT , which stands for Modern Foreign Languages Teaching is also an obligatory subject. It is indeed the creation of the national curriculum, probably considered the most important fact that may help us achieve a better understanding of todays system. The author Denis Haye who wrote Primary Education: the Key Concepts, claims that in the 20th century, just after the introduction of the national curriculum, children were obligated to study in school from 5 to 11 years old and this primary stage was followed by a specific education which would end at the age of 16. It is because of the national curriculum that todays pupils go to school at the age of 5 and leave when they turn 11. The author also claims that there is a minor quantity of educational centres which accept children from the age of 8 to 12 called deemed middle in his words, while others referred to as first accept 5-8 or 9 year-old pupils. Todays British primary educations structure could not be analysed without bearing in mind what is in my opinion the main strength of the British system: the variety of schools offered to parents and British pupils. On the Department of Educations webpage, some of the main types of schools can be found, establishing a division in three sections: mainstream state schools, state schools with particular characteristics and specialist schools in the first section. Trust and Voluntary controlled/aided schools in the second. Faith schools, academies and grammar schools also belong to the second section. In the third group the Department includes Independent schools. This last kind, as its name shows, is governed by an independent body which according to the Department of Education have their own curriculum and admission policies. Since we are living in a society ruled by the information technologies, without a doubt a valuable aspect to be drawn up, is the use of information and communication technologies in the British education system, paying a special attention to schools. The British Department of Education claims that the adoption of the information and communication technologies (ICTs) to todays primary schools radically improves the education centres level. It was in the year 2002, when the Education and Training inspectorate wrote a report which highlighted the positive aspects of integrating the ICTs in the UK schools. In most schools, both the students learning and the quality of teaching were shown to be satisfactory. Most of them used a great number of applications such as developing web pages, using social networks for educational purposes, sending electronic mails and using web-cams, to mention but a few of them. This report also indicates that the introduction of the ICTs in primary schools cla ssrooms and lessons notably increases the pupils motivation and enthusiasm to learn. The Department of Education also claims that the information and communication technologies have been adapted to the curriculum of several schools in the UK for the past 5 years, including ICT as a compulsory subject. In my opinion, the main advantage of the ICTs probably relies on its positive effects on childrens attention and interest, and this is one of the reasons why there are an even higher number of centers which are incorporating them. While looking for information on this matter, I found two relevant articles in two different newspapers which show a clear example of how these technologies are being adapted to education. The first article belongs to the journalist Borland, and appeared in The Guardian. It talks about a school in the UK which bought a couple of Wiis in order to boost pupils enthusiasm for sport using the new Wii Fit Plus. This new Wii application, the writer claims, is focused on various fitness exercises proved to be beneficial for the childrens health, especially for sedentary ones. Borland also states that although this initiative firstly received a very positive feedback from most people, there were other voices alleging that a video console should never take the place of traditional drills or exercises. Another article to be taken into account, was written by The Telegraph s education editor Graeme Paton who states that a school in the UK has decided to introduce Twitter, the UKs widely known s ocial network as a subject. Children, however, will not only be taught how to use this network for academic purposes (if there are any) but also to communicate by using Skype and develop on-line blogs. To conclude this essay, it is important to mention that the British education system probably stands out for the enormous variety of schools offered to children and parents while in other countries only three or four types of schools. Furthermore, the last paragraph can indeed be interpreted as an example of the adaptation of this system to todays new generation of children, enhancing educational perspectives, and finally catering for wider needs. 1,200 words. Group Research Proposal Research problem: What are the main types of bullying in primary and secondary schools? How can this problem be tackled? Why is this argument important? Bullying is a problem present in current primary and secondary schools, normally affecting children from four to sixteen years old. Not only pupils are involved, but also parents and teachers who, in most cases, do not even know the truth or conceal the abuse. There are different kinds of bullying which, can be divided into five groups: verbal, physical, emotional, cyber-bullying, and homophobic. In the verbal and emotional bullying, the bully uses disrespectful remarks and threatening words which intend to harm the victim. This is probably one of the worst kinds since children are physiologically affected, creating in most cases traumas leading to social issues such phobias to develop relationships with other classmates due to a low self-esteem. In physical bullying, the perpetrator intends to affect physically the target by resorting to violent acts such as hitting, punching or pulling without having a necessary reason to do so. Cyber-bullying is considered to be a relatively new k ind, due to the development of new technologies. It not only affects pupils in the classrooms but outside in the real world, by using slanderous videos publishing the abuse on the internet. The last type, homophobic bullying, is related to the childs sexual orientation using derogatory terms such as gay or even the despicable faggot. These are but a few of an endless list of other kinds of bullying. Studying this problem is important since it not only might help those who need it most, it can also clarify one of the darkest aspects of human behaviour towards the others. Methodology In order to carry on this research, it is vital to access to different sources of information. Not only books can help us with this matter; articles published in scholar or public newspapers, as well as television interviews or scholarly programs can be very helpful. A very relevant documentary on matter, entitled The Red Balloon House aired on the BBC last month will be born in mind while developing the research. This is a charity organization aiming to help children who suffer from school phobia due to bullying abuses. This documentary offers a close expose of this matter, clarifying many aspects about the principal effects of this kind of abuse. Another useful method to be taken into account, however difficult and risky, is carrying on a private interview with a primary source, a victim. Literature Review Aspectos psicolà ³gicos de la violencia juvenil http://portales.educared.net/convivenciaescolar/contenidos/biblioteca002.pdf Bullying http://portales.educared.net/convivenciaescolar/contenidos/biblioteca003.pdf Convivencia escolar y prevencià ³n de la violencia http://portales.educared.net/convivenciaescolar/contenidos/biblioteca015.pdf Convivencia en los centros educativos http://portales.educared.net/convivenciaescolar/contenidos/biblioteca011.pdf Acoso escolar. Guà ­a para chicas y chicos http://portales.educared.net/convivenciaescolar/contenidos/guia.pdf La actuacià ³n ante el maltrato entre iguales en el centro educativo http://www.obrasocialcajamadrid.es/Ficheros/CMA/ficheros/OSSoli_MenorMaltrato.PDF Conclusion Bullying is a social problem that affects more frequently all cycles of education. Everybody should become aware of this problem and try to end up these abuses by the application of methods and efficient solutions to it. Individual Research Proposal Research Problem Tackling bullying in the U.K. primary schools. What are its roots and types? What are the principal effects on the psychological health of todays pupils? Why is this argument important? Bullying in primary and secondary schools in the UK, is indeed a problem that has been haunting British pupils since the first schools were built in the nineteenth century. This leads us to question ourselves about bullyings roots, what they are and how they can help us eradicate this problem from scratch. According to the education reporter Kristin Rushowy form the US newspaper The Star, bullyings roots can be found in the bullys family relationships. In most cases, Rushowy claims, bullies come from blended or single-parent families, and feel they cant rely on their parents who act in an overprotecting way. Although it is a fact that schools are built in order to provide a good education for our societys children, parents also have the duty to educate their children in tolerance, and respect towards their classmates and all the members of society. However, it is not always this way and it is indeed an issue to be analysed in depth. The rise of the new information and communication technologies which as I stated in my essay, are being adapted to todays primary schools in the UK, have a negative effect on this matter. Pupils who are taught how to use social networks as Twitter unconsciously tend to use this knowledge to harass other children. This is a relatively new type of bullying referred as cyber-bullying. As happens to other kinds of bullying such as, homophobic, it has indeed an adverse impact on students mental health. According to Doctor Marc Dombeck in his article The long time effects of Bullying short-termed effects such as anger, depression and suicidal thoughts can lead to the long term increased tendency to be a loner self-esteem problems, and difficulty in trusting people. These are but a few of the negative impact of Bullying and it is indeed a matter to be researched on. Methodology To carry out this research, I will bear in mind some on-line articles published in British and American newspapers, as well as some guides published by the British Department for children, schools and families and an essay I wrote concerning British primary education. Literature Review The first source to be considered is a guide published by the Department for children, schools and families, entitled safe to Learn: Embedding anti-bullying in Schools, since it is a perfect outline of this issue. Another guide published by the previous department entitled homophobic bullying is also to be considered. Various online articles written by experts on this matter as Dr. Marc Dombeck The long time effects of Bullying are also to be born in mind. An essay written by myself entitled An outline of Primary education in the UK which is focused, among other issues on the adaptation of the ICT in todays schools, may help us clarify the roots of cyber-bullying. Conclusion Although Bullying is a problem that has already been researched on by many experts, there are some main issues such as its roots or psychological effects that still need to be examined in depth. Self- Assessment The Cardiff Universitys module entitled Introduction to Academic Study in the UK has notoriously helped me develop and improve my research skills. Although in the degree I am currently studying I had already been taught how to cite using the Modern Language Association (MLA)s style, it is always useful to learn how to quote using the Harvard style, since it is the one that is normally used in the United Kingdom. The Research skills seminar, was also decisive since it taught me to research using academic sources and databases. I had no previous knowledge about it and it helped me while planning essays for some of my modules. The lecture on critical thinking was indeed very advantageous since it was an enormous help while writing my two critical analyses for the module The Victorian Novel from a subjective and critical point of view. The lecture on the ways UK students are assessed and the marks used, was also very appealing and interesting since I come from an overseas University with a totally different structure. To end up I would like to mention that although unfortunately I could not attend the peer-review seminar and therefore it has been impossible for me to analyse other students proposals including my findings in this piece of writing, I have taken into account some feedback I received from the classmates I worked with, in order to write my own research proposal. I have considered rewriting the proposal, being specially focused on changing the research question because it was too broad.

Effective Treatment for Generalized Anxiety Disorder

Effective Treatment for Generalized Anxiety Disorder Introduction In primary care, as in other fields of medical practice, it is essential that doctors are able to apply the findings of scientific research to the circumstances of individual patients as part of their clinical decision-making process. This is known as evidence based medicine. In this review I have taken an illness which often presents in primary care, namely Generalized Anxiety Disorder (GAD), and by researching possible treatments have developed the skills necessary to search various databases for relevant articles and the ability to assess the validity of the evidence found. In this review I focus specifically on Cognitive-Behavioural Therapy (CBT) as a potential treatment for GAD. Generalized anxiety disorder is characterized by chronic, uncontrollable worry associated with a wide range of physical symptoms including fatigue, headaches, muscle aches, difficulty swallowing, trembling, twitching, sweating, nausea and shortness of breath. A diagnosis of GAD is made when a person worries excessively about a variety of every day problems for at least 6 months. The disorder is common in later life, with a prevalence of 11.2% in primary care where older adults most often seek treatment and overall is more prevalent than either severe cognitive impairment or depression in the over 65s. Despite this, anxiety disorders in the ageing population have received relatively little research attention. Anxiety in later life has been linked to increased risk of physical disability, memory difficulties, decreased quality of life and inappropriate use of medical services . There are currently several treatment options available for GAD including drugs such as Benzodiazepines, Selective Serotonin Re-uptake Inhibitors (SSRIs), Azapirones, Barbituates and Pregablins. There are also alternative treatment options such as herbal remedies and psychotherapy such as Cognitive-Behavioural Therapy and Psychodynamic Psychotherapy. Cognitive-behavioral therapy is a form of psychotherapy which targets problematic emotions and behaviours via a range of approaches and can be used alongside medication or as an alternative to it. When used to treat anxiety disorders the principle methods include education and awareness, motivational interviewing, relaxation training, cognitive restructuring, exposure, problem-solving skills training and behavioural sleep management. Unlike anxiolytics, CBT has no known side effects or risk of physical dependence. Anxiolytics are currently the most common treatment for late-life anxiety and surveys suggest that up to 20% of non-instituti onalized elderly persons may be using benzodiazepines. However, the use of these medications as a long term treatment for anxiety disorders is associated with potential risks for elderly patients such as cognitive impairment, falls and hip fractures, drug interactions and toxicity. Also an over-reliance on medication may neglect potentially important psychosocial factors such as social support, coping skills and interpersonal relationships. In light of this it is important that the effectiveness of CBT is assessed as it could prove a useful alternative to long term medication particularly in the ageing population. Method I conducted initial research using textbooks and the internet and then used different databases to search for relevant papers and articles. Searches were primarily conducted using MedLine (Medical Literature Analysis and Retrieval System) as it contains information from a wide range of fields including Medicine, Nursing, Pharmacy, Biology and Biochemistry and contains over 18 million records from approximately 5,000 publications. Web of Knowledge was also used as it encompasses not only MedLine but also other databases such as the Social Sciences Citation Index. I also conducted searches using Scopus and the Cochrane Library but often found that the Cochrane Library yielded few or no results so these searches have been omitted. By beginning with broad search terms it was possible to refine these to yield fewer, more relevant results. An initial search of the terms cognitive-behavioral therapy and generalized anxiety disorder yielded the following results. The search was also limited to include articles which had both these terms in the title and in the abstract. Various spellings and abbreviations such as CBT and GAD were used when searching for cognitive-behavioural therapy and generalized anxiety disorder in order to achieve a high number of results and to ensure articles werent overlooked. After searching through the results, reading abstracts and dismissing articles which werent relevant to this topic or freely available, 4 articles were chosen to be included in this review. I chose to specifically focus on RCTs as this is the strongest study design for testing cause and effect relationships. When critically appraising the papers included in this review, a series of questions primarily derived from the CASP (Critical Appraisal Skills Programme), but also incorporating other sources, were used and articles were judged on how much information they provide and the quality of the evidence. Examples of these questions are as follows. Did the trial have a clear objective? Is an RCT an appropriate study design to answer this question? How were the participants randomized? What was the average age of the participants? What were the exclusion criteria for participants? Were the subjects in each of the groups similar on demographic and baseline clinical variants? How did the trial adjust for attrition? When/how often was data collected from participants during follow up? How were outcomes measured? Were details of effect sizes and statistical significance given? Did the study have enough participants? Does the paper present a clear result? Results Discussion The first study looked at was an RCT published in 1996 entitled Treatments of Generalized Anxiety in Older Adults: A Preliminary Comparison of Cognitive-Behavioural and Supportive Approaches. This trial compared CBT with non directive Supportive Psychotherapy (SP), a form of therapy which involves education, guidance, listening to the patient and encouraging expression of emotions. Results showed significant improvement in all measured outcomes for both interventions and generally large effect sizes. However, no significant differences were found between the the two groups. The authors gave an extensive list of exclusion criteria, including current involvement in psychotherapy and low MMSE scores, which limits confounding factors and therefore the likelihood of type 1 errors. A major limitation of this study however is the high level of attrition. This study design could possibly be improved if it were to include another control group, which receives no treatment, with which to compa re the two interventions with. In this respect the more recent trial Treatment of generalized anxiety disorder in older adults, which is discussed later, improves on this trial and has a significantly lower attrition rate. However, the authors of this trial argue that by failing to include a waiting-list control group they alleviated the need to withhold treatment from any patients, which could be deemed ethically questionable. This trial had a follow-up assessment period of 6 months which is relatively short compared to the other studies in this review, one of which has a follow-up period of 15 months. It is arguable that this will limit conclusions made in this study regarding the long-term durability of treatment. Unlike other studies this study did not measure the effect of either intervention on the participants quality of life which is an important factor to consider as GAD has such a profound effect on the sufferers quality of life. An RCT published February 2003 entitled Treatment of generalized anxiety disorder in older adults, compared CBT with a discussion group (DG) and patients receiving no treatment on a waiting list period (WL). The discussion group was organized around worry provoking topics and was designed to be structurally comparable to CBT. DG consisted of a series of 12 discussions focused on topics known to be worry-provoking for older adults, including memory problems, health concerns, loss of independence and death of friends and family. Both the CBT and DG groups consisted of 4-6 participants and a group leader, one of four advanced doctoral students in clinical psychology. These leaders were spread across the two interventions and each leader chaired at least one CBT group and one DG in order to avoid confounding the effectiveness of the therapist with the effectiveness of the therapeutic model. Participants in both CBT and DG were asked to spend approximately 30 minutes a day on homework exe rcises. The study gave full details of exclusion criteria including commencement of psychotropic medication within the past 2 months. Patients who had started medication more than 2 months ago were included but were asked not to change their dose or type of medication for the duration of the trial. However, in light of this it is possible to argue that including participants on any form of anxiolytic medication restricts conclusions about the impact of CBT without concomitant pharmacological treatment. The authors included a table detailing demographic information about their study sample in order to support the generalisability of their findings. The table showed that participants came from a range of races, had differing marital and work statuses and suffered from a range of different medical conditions, the most common being osteoarthritis (36%) and hypertension (32%). Compared to the first study, participants not only scored themselves but were also assessed by trained research assistants who were unaware of which group the patient had been assigned to. This adds an element of blinding which is not present in the first study. This was the only study in which patients rated their impression of the treatment after the first session. The participants rated the credibility of the intervention, their enjoyment, perceived effectiveness, likelihood of recommending the intervention to a friend, likelihood of participating again in the future and perceived improvement. This is a useful addition to the trial as a patients satisfaction with a treatment method has a big impact on adherence and possibly symptom improvement. The results showed that participants in both CBT and DG improved compared to the waiting period but there was no significant difference between the two interventions. However, when effect sizes were calculated showed large effects whereas DG showed medium sized effects. Essentially this study shows that CBT is better than no treatment but gives no s ignificant evidence to suggest that it is better than other forms of intervention such as group discussion. This is an interesting point which mirrors the findings of the first trial which compared CBT to SP. An RCT published in April 2003 entitled Cognitive- Behavioral Treatment of late-life generalized anxiety disorder (M A Stanley et al. 2002) evaluated the efficacy of CBT compared to minimal contact control (MCC). The results showed a significant improvement in worry, anxiety, depression and quality of life following CBT compared to MCC. 45% of patients were classed as responding to treatment compared with 8% who received MCC. Importantly these gains were maintained or enhanced over a 1 year follow-up. However, as in the other RCTs in this review, patients did not report a complete return to normal functioning or a complete removal of symptoms. When recruiting participants for this trial the Anxiety Disorders Interview Schedule-IV was used as a diagnostic tool. Patients underwent two separate diagnostic interviews conducted by two different evaluators over a period of at least two weeks. These evaluators were unaware of any previous diagnoses made. This shows that all participants in the study had symptoms which were consistent and were not prone to varying over time, which means that any change during follow up assessment was more likely to be due to the intervention than to fluctuations in the severity of their GAD. The study commented on potential variance in results due to gender and explained how they had adjusted for this. Similarly to the last study, this study used not only self-reported scores but also independent clinician rated scores. Unlike previous studies this trial did not include any participants currently receiving medication for their GAD or associated symptoms in order to assess the effectiveness of CBT alone and not in conjunction with medication. A Randomised Control Trial, conducted by M A Stanley et al. entitled Cognitive Behaviour Therapy for Generalized Anxiety Disorder Among Older Adults in Primary Care (2009) compared group CBT conducted in primary care clinics over 3 months with a control of enhanced usual care (EUC). The authors chose to use group CBT rather than individual, one-on-one CBT as they believed that the loss of social support often experienced as a consequence of ageing indicated the potential benefits of group treatment. The results of this trial showed that CBT significantly improved worry severity, depressive symptoms and general mental health but there was no difference in GAD severity between the two groups. The authors clearly set out their objective and gave detailed information on where the study was set, where participants were chosen from, details of the intervention and main outcome measures at the start of the paper. The fact that the patients were recruited exclusively from a primary care sett ing and that the intervention was delivered in primary care makes this evidence particularly useful for this review. During recruitment all potential participants were screened using two questions from the Primary Care Evaluation of Mental Disorders, as well as undergoing the Mini-Mental State Examination and a Structured Diagnostic Interview, in order to ensure that all had the same diagnosis and similar GAD severity. Race and ethnicity of participants were identified and the data used to facilitate conclusions about the generalizability of the data. The authors commented on effect sizes and stated that the effect sizes for symptom improvement were comparable to or greater than those in recent primary care studies of younger adults with GAD and older adults with depression. The authors also commented that participants in this trial scored slightly lower mean change in worry severity over time scores in comparison with Treatment for Generalized Anxiety Disorder in older adults that was conducted several years earlier. One possible limitation of both this study and the previous study is that patients in the control group received minimal contact with health professionals compared to the intervention group. This may leave patients feeling neglected and as they are aware that theyre not receiving any form of treatment, they may not expect to get better and subsequently score themselves lower on assessment than otherwise. In this respect the first two studies are somewhat better designed, as they compare CBT to interventions which involve a similar contact. The second study in particular deals with this issue well by comparing CBT with a discussion group, which requires the patient to be involved with the intervention, and a waiting list period in which the patient is very much aware that they are receiving no treatment. Several studies of anxiety in older adults have been conducted using community or senior centre volunteers with self-diagnosed, subjective anxiety symptoms and therefore the findings from these studies may not be applicable to a clinical population. In contrast the four RCTs included in this review were all conducted on patients with diagnosed GAD and CBT and was delivered in a primary care setting. All the studies gave detailed information on how the participants were randomized and how drop-outs were dealt with and had a follow-up period of at least 6 months. Conclusion In conclusion, all four studies showed that CBT improves levels of anxiety, as well as other associated symptoms of GAD, when compared to both baseline measures and no treatment. However these studies also showed that when CBT is compared to other forms of therapy, namely Supportive Psychotherapy and discussion groups, there are no significant differences between the two interventions. Although CBT does lead to significant alleviation of symptoms, this evidence does not indicate that CBT is a long lasting cure for GAD and it does not prove CBT to be a better treatment option than other forms of psychotherapy. Therefore it is important to question whether or not the benefits felt by participants receiving CBT, SP or DG are due to a placebo effect compared to participants who are left on a waiting list who may feel they are being neglected and do not expect any improvement in symptoms. This raises the issue of blinding which is a limitation of most conceivable trials including CBT as i t is not possible to make the participant unaware of what intervention they are receiving when when they have to actively participate in treatment. The dearth of clinical trials, particularly RCT trials, investigating CBT as a treatment for GAD needs to be addressed if an acceptable amount of evidence in favour of CBT is to be established. Suggestions for future trials include RCTs comparing the effectiveness of group CBT compared with individual CBT for older adults and trials comparing CBT with anxiolytic medications such as benzodiazepines. This is a particularly pertinent issue considering the side effects associated with anxiolytics and old age, as previously mentioned. Future trials should aim to recruit a larger number of participants than seen in most of the studies discussed. In theory this should not be difficult if the prevalence of GAD in the elderly population is as alarmingly high as some statistics indicate.