This chapter aims to help clinicians learn stabilization interventions for use in the Preparation Phase of eye movement desensitization and reprocessing (EMDR) treatment. Using these interventions will aid clients in developing readiness for processing trauma, learning how to manage symptoms of dissociation, dealing with affect regulation, and developing the necessary internal cohesion and resources to utilize the EMDR trauma-processing phase. Earlier negative experiences stored dysfunctionally increase vulnerability to anxiety disorders, depression, and other diagnoses. When assessing a client with a complex trauma history, clinicians need to view current symptoms of post-traumatic stress disorder (PTSD) or depression as reflections of the earlier traumas. The chapter outlines the strategies dealing with dissociative symptoms, ego state work, and internal stability that help clinicians to develop an individualized treatment plan to successfully guide the client through the EMDR phases of treatment.
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- Go to chapter: Stabilization Phase of Trauma Treatment: Introducing and Accessing the Ego State System
This book provides the foundations and training that social workers need to master cognitive behavior therapy (CBT). CBT is based on several principles namely cognitions affect behavior and emotion; certain experiences can evoke cognitions, explanation, and attributions about that situation; cognitions may be made aware, monitored, and altered; desired emotional and behavioral change can be achieved through cognitive change. CBT employs a number of distinct and unique therapeutic strategies in its practice. As the human services increasingly develop robust evidence regarding the effectiveness of various psychosocial treatments for various clinical disorders and life problems, it becomes increasingly incumbent upon individual practitioners to become proficient in, and to provide, as first choice treatments, these various forms of evidence-based practice. It is also increasingly evident that CBT and practice represents a strongly supported approach to social work education and practice. The book covers the most common disorders encountered when working with adults, children, families, and couples including: anxiety disorders, depression, personality disorder, sexual and physical abuse, substance misuse, grief and bereavement, and eating disorders. Clinical social workers have an opportunity to position themselves at the forefront of historic, philosophical change in 21st-century medicine. While studies using the most advanced medical technology show the impact of emotional suffering on physical disease, other studies using the same technology are demonstrating CBT’s effectiveness in relieving not just emotional suffering but physical suffering among medically ill patients.
This chapter discusses the social psychology of humor, starting with a walk through how the presence of other people can make things seem funnier. It shows how humor can have a positive or a negative tone and it can focus on ourselves or on those around us. Self-enhancing humor makes stress tolerable. It can keep folks from viewing minor annoyances as unbearable disasters. The chapter sketches how humor can function to maintain the status quo. People who report using self-enhancing humor show less anxiety, neuroticism, and depression; better psychological well-being and self-esteem, and more extraversion, optimism, and openness to experience. When it comes to hierarchies, getting a feel for who’s cracking jokes and laughing can communicate who’s top dog. The chapter finally focuses on gender differences, and then sees how humor contributes to developing friendships, finding a date, and maintaining an intimate relationship.Source:
- Go to chapter: Overview of the Problem-Solving Therapy Process, Introductory Sessions, and the Case of “Megan”
This chapter presents the therapy manual detailing the specific treatment guidelines encompassing problem-solving therapy (PST). It is important during the initial sessions with a new client to develop a positive therapeutic relationship. Upon obtaining a brief version of the client’s story, it becomes important early in treatment to provide an overview of PST that includes a rationale for why it is relevant to, and potentially effective for, this individual. Problem solving can be thought of as a set of skills or tools that people use to handle, cope with, or resolve difficult situations encountered in daily living. Research has demonstrated that social problem solving is comprised of two major components. The first is called problem orientation. The second major component is one’s problem-solving style. The chapter also presents the case of a 27-year-old woman suffering from multiple concerns, including anxiety, depression, fears of “going crazy”, and prior alcohol abuse.
When Charles, a 46-year-old divorced male with an extensive psychiatric history of depression, substance abuse, and disordered eating resulting in a suicide attempt, erratic employment, and two failed marriages, began treatment with a clinical social worker trained in dialectical behavior therapy (DBT), he was an angry, dysphoric individual beginning yet another cycle of destructive behavior. This chapter provides the reader with an overview of the standard DBT model as developed by Linehan. Dialectical behavior therapy, which engages vulnerable individuals early in its treatment cycle by acknowledging suffering and the intensity of the biosocial forces to be overcome and then attending to resulting symptoms, appears to be the model most congruent with and responsive to the cumulative scientific and theoretical research indicating the need for the development of self-regulatory abilities prior to discussions of traumatic material or deeply held schema.
Neuroscience for Psychologists and Other Mental Health Professionals:Promoting Well-Being and Treating Mental Illness
This book presents information about brain function and its chemical underpinnings in a way that contributes to a conceptual understanding of distress and subjective well-being. Chapter 1 of the book provides a history of thought in psychiatry and explains how we arrived at our current system for categorizing distress. The second chapter offers information on physiology, including brain circuits undergirding anxiety and depression, circuits for emotional or impulse regulation, and circuits for robust motivated behaviors. Information on pharmacology, including the major classes of drugs used to influence behaviour, and the issues over the regulation of pharmaceuticals are presented in the third chapter. This is followed by five chapters that consider categories of distress that afflict adults, namely, depression, anxiety disorders, psychotic disorders, bipolar disorders and addictions. Chapter 9 focuses on categories of distress in children such as pediatric bipolar disorder and depression. The last chapter of the book considers whether current diagnostic practices have served us well, looks at an alternative focus for delivering mental health services, and deals with those behaviors that promote flourishing and well-being.
This chapter covers major depression and discusses the syndrome of depression as defined by criteria in the various versions of the Diagnostic and Statistical Manuals (DSMs) issued before the newly minted DSM-5. It considers the prevalence in time and across national boundaries. The chapter discusses the role of events and genetics in bringing on depression. It provides the link between depressive behaviors and systemic inflammation, and reviews the efficacy, and side effects for various treatments. There has been speculation that brain-derived neurotrophic factor (BDNF) might play a causal role in creating symptoms of depression. Repetitive transcranial magnetic stimulation (TMS), which involves external application of an electrode, is a Food and Drug Administration (FDA)-approved treatment for major depression. In the clinical literature, exercise has demonstrated efficacy in ameliorating major depression. Cognitive behavioral therapy is as effective as antidepressants, although it may be slower to achieve results.
This chapter describes family, friends and enemies, dating and love, tv and media, technology and cyberbullying. Children with close family relationships during middle childhood are more likely to have closeness in these relationships during adolescence than those with detached family relationships during middle childhood. Studies indicate that adolescents with high levels of parental monitoring are less likely to engage in problem behaviors than those with little or no parental monitoring. Many adolescents have little or no conflict, and those with elevated levels of conflict are often experiencing other difficulties in their lives such as substance abuse or depression. The way in which adolescents engage in victimization shifts from primarily physical aggression, which is more common during middle childhood, to social or relational bullying. An additional aspect of the reorganization of an adolescent’s social network discussed earlier involves a shakeup of the peer group to include more cross-sex interactions.
The adolescent stage of life does not occur in isolation from other developmental stages. When an adolescent is experiencing difficulties with parents and friends leading to feelings of sadness, studies of average adolescents and their natural propensity toward difficulties during the adolescent years can help us assess whether this particular adolescent’s problems go beyond the norm. Understanding normative adolescent development can help clarify for professionals working with teens if the issue they encounter with a client is clinical or developmental. The majority of the time, when a teen is experiencing sadness it is an expression of a normal part of the adolescent experience. Understanding normal adolescent development can help in making the types of determinations thoughtfully, without jumping to conclusions and over diagnosing adolescents with major depression when all they are experiencing is a normal developmental process.
Medical problems challenge older adults’ abilities to cope with illness, and at times they experience co-occurring psychological disorders. Therefore, social workers must provide services to assist older adults who are experiencing acute or chronic medical conditions. Older adults experiencing arthritic pain often experience a co-occurring depression. The major cancers experienced by older adults are breast cancer; chronic lymphocytic leukemia; lymphocytic lymphoma; colorectal cancer; lung cancer; mouth, head, and neck cancers; multiple myeloma; prostate cancer; skin cancers; and vulvae cancer. Those older adults suffering from diabetes have a greater chance of co-occurring vascular and cardiovascular conditions and a greater rate of institutionalization and subsequent mortality. Coordination with family members and caregivers about self-care issues, medicine compliance, safety issues, health socialization, and exercise is important because social workers often overlook psychoeducation with medically ill clients.
- Go to chapter: Evidence-Based Interventions for Posttraumatic Stress Disorder in Children and Adolescents
This chapter presents an overview of posttraumatic stress disorder (PTSD) in childhood and adolescence, including how symptoms may present and what factors are associated with risk of developing PTSD. It provides a review of the research literature and a step-by-step guide for practice for two empirically validated treatments for youth PTSD. The symptoms of PTSD are grouped into four clusters: intrusion symptoms, avoidance symptoms, cognition and mood symptoms, and arousal and reactivity symptoms. Trauma-focused cognitive behavioral therapy (TF-CBT) was initially developed to address trauma associated with child sexual abuse and has subsequently been adapted for use with children who have experienced other trauma types. Research indicates that TF-CBT is effective in treating PTSD, depression, and related behavioral problems in children exposed to traumatic events. The chapter provides a step-by-step breakdown of TF-CBT and Prolonged Exposure for Adolescents (PE-A) interventions, including descriptions of core components and standard implementation practices.
The concept of being an old gay male adult, old lesbian adult, old bisexual adult, or old transgender adult is remote and insignificant to most people. There is an abundance of literature about the younger lesbian, gay, bisexual, and transgender (LGBT) community and a dearth of literature about the older LGBT community. Coming out is a difficult process for anyone, at any developmental stage. It is most difficult when old gay men or old lesbians do not initiate a decision to disclose their sexual identity until late life. Older adults with HIV disease are a significant subpopulation of the current older adult cohort. Transgender older adults are more likely to have a history, as compared with nontransgender people, of sex work, substance and alcohol abuse, and depression. Advocacy model can be adapted to meet the social and clinical needs of the LGBT community.
This chapter describes the need for a specific focus on counseling women and girls. It discusses the fundamental tenets of empowerment feminist therapy (EFT). Gender and gender differences are not inherently problematic; however, issues arise when they become markers for which individuals are esteemed or devalued. Violence against women is a serious public health issue in every country in the world. Violence against women and girls takes many forms, some of which are accepted cultural practices that have severe negative repercussions for females’ physical and psychological well-being. Child marriage and female genital mutilation are two of these cultural practices. Due in part to trauma, oppression, and gender-role expectations, women and adolescent girls experience the highest rates of anxiety, depression, and posttraumatic stress disorder (PTSD). Out of the feminist movement, and in response to the biases inherent in mental health treatment, feminist therapy came into existence.
Anxiety is often a normal reaction to stress, and there will always be situations that create stress and discomfort. In social work practice, recognition of the primary types of anxiety-related mental health disorders and the medications used to treat these disorders is an essential first step for comprehensive treatment. When medication alone is not enough, psychosocial interventions can assist the client in controlling anxious feelings. This chapter emphasizes the importance of being familiar with the medications and supplemental psychosocial interventions that can be effective in treating these disorders. Social work professionals often provide key services, including assessment and diagnostic and treatment services, to those who suffer from anxiety conditions. In terms of direct intervention efforts, many of the techniques described in the chapter can be used to help clients suffering from depression because the symptoms of anxiety and depression frequently overlap.
Anger, depression, and anxiety that cause distress are sometimes hard for clients to manage and gain control over. Deconstructing the problem to find out why such reactions are occurring does not lead to solutions; rather, it provides more reasons to suggest that a normal life is impossible. This chapter shows how identifying the effects of such descriptions slow down the progress of the person’s triumph over the problem. There is a special moment in a therapy session when a therapist suggests that the client “stand up for himself against the anger”. With clients who come to therapy and present with diagnoses, it is very important to remain respectful of their attempts to understand why they are experiencing distress. Externalizing a problem or diagnosis allows clients to separate themselves from the dominant stories that have shaped their lives and relationships.
This chapter suggests that Irrational Beliefs (IB’s) play a major role in the creation of human disturbance, and that people make themselves disturbed mainly by escalating their goals, desires, and preferences into absolutistic musts and demands. Rational Emotive Behavior Therapy (REBT) hypothesizes that Irrational Beliefs rarely exist by themselves, but are preceded by or associated with rational ones. One can use modeling techniques with resistant clients by showing them that no matter how difficult they find it to reduce their disturbed feelings, as well as to reduce their anxiety and depression about these feelings. They can also read and learn about other very disturbed people who have used REBT, Cognitive Behavior Therapy (CBT), and other therapy methods to considerably help themselves. Encouraging clients to do an effective cost-benefit analysis of their various forms of resistance seems to be mainly a cognitive method of therapy.
This chapter discusses several topics relevant to older adults' mental health including access and use of mental health services, prevalence of common mental health diagnoses, assessment of mental health symptoms, and empirically supported treatments for older adults. Although some topics presented in this chapter need additional research focused specifically on an older adult population, several conclusions can be drawn from the material. First, several studies have documented that older adults use mental health services less frequently than other age groups, although it is unclear why this is the case and likely involves a combination of barriers/access to treatment and stigma. Second, several of the mental health problems discussed may present differently among older adults, such as the specific symptoms of depression that older adults endorse. Third, assessment instruments for older adults need to be selected cautiously to ensure that adequate validity and reliability has been established for this population.
This chapter begins with a description of multiple systematic reviews and meta analyses of problem-solving therapy (
PST) interventions. The number of studies evaluating PSThas increased over the past decade, so more reviews has been conducted. The chapter discusses PSTfor various mental and physical health problems and depression. Following this it also discusses PSTin primary care and among older adults. It briefly describes PSTfor diabetes self-management and control; vision-impaired adults and social problem-solving therapy in school settings. The chapter describes PSTas a transdiagnostic approach. It briefs the listing of PSTinvestigations and supports the characterization of this approach as a transdiagnostic intervention. The chapter also demonstrates its flexibility of applications. Finally, it highlights certain aspects of the recent outcome literature featuring various clinical problems (e.g., health and behavioral health disorders), populations (e.g., older adults, children, ethnic minorities), and modes of delivery (e.g., telehealth).
The value of efficiency is quite important in practically all psychotherapy, but is often neglected. Feeling better has a great advantage, but it is limited in many respects. In Rational Emotive Behavior Therapy (REBT), an existential view of depth-centeredness in psychotherapy has various advantages over less depth-centered views. Pervasiveness in psychotherapy may be defined as a therapist helping his or her clients to deal with many of their problems, and in a sense their whole lives, rather than with a few presenting symptoms. Extensiveness in psychotherapy means that clients can be helped not only to minimize their disturbing negative feelings for example, anxietizing, depressing, and raging but also to maximize their potential for happy living that is, to be more productive, creative, and enjoying. Efficiency in therapy, particularly with resisting clients, therefore consists of convincing them thoroughly that they’d better go for a more elegant, rather than a less elegant, change.
The basic theory of Rational Emotive Behavior Therapy (REBT) says that its practitioners never dispute or argue with clients’ strong preferences, desires, and goals all of which are considered “rational” in REBT. REBT practitioners accept all clients with their many varieties of cultural, religious, political, and other standards; and they only question how rigidly clients adhere to their cultural goals and how they sometimes sabotage themselves by their absolutism and rigidity. Culture seems to have a biological as well as a social learning basis. REBT helps people who do not strictly follow the rules of their original culture to feel healthily sorry and regretful about flouting these rules instead of feeling as many of them do when they first come to therapy unhealthily guilty, depressed, and self-downing. Psychotherapy in general and REBT in particular promote unconditional self-acceptance (USA) and unconditional other-acceptance (UOA).
This chapter presents a case study of a woman who finds a counselor for her 11-year-old son. The son’s family possessed many qualities characteristic of “growth-fostering relationships” defined in relational-cultural theory (RCT). The woman portrayed the son as a healthy young boy with few developmental problems or health concerns. The priorities for his counseling goals included: to assess the risk that he might harm himself and put in place interventions for safety; to determine what significant life events contributed to his anxiety and depression; to increase his feelings of connection to others; to reduce the occurrence of his nightmares; to support him in developing a stronger voice in order to ask for help when he needed it and to express his needs. Adlerian play therapy and mutual storytelling proved to be a good fit for him, and helped the author understand his view of self and his world.
This book provides us with what we need to sleep well. It provides the tools and techniques to reverse insomnia and improve sleep long-term. Insomnia, persistent trouble getting to sleep or staying asleep, affects our daytime functioning and wellbeing. The book breaks down the principles of cognitive behavioral therapy for insomnia (
CBT-I), the sleep program considered first-line treatment in the clinic, into a step-by-step and reader friendly program that can be easily followed at home. Written by a clinical psychologist and researcher who has worked in the sleep field for 40 years, the book uses data from a real patient to illustrate each step of the process. The book is complete with detailed sleep diaries, worksheets, and more, all of which are also available online to download and use on your own journey to sleeping better now and into the future. Guiding readers through this self-directed sleep therapy program, the book features updated information and new scientific findings on key topics for patients and health care providers including: tried-and-true CBT-Imethods of sleep management; successful cognitive therapy methods to deal with racing thoughts at bedtime; different sleep needs for women and men through life and health conditions; influence of nutrition, exercise, and sex on sleep in a brand-new chapter; depression, anxiety, and traumatic stress and how they intersect with sleep; and prescribed and non-prescribed medications, herbal remedies, and cannabis for sleep.
Years of research have revealed that certain techniques reliably lead to improved quality and quantity of sleep and increased satisfaction with sleep. Together these techniques can be called “cognitive behavioral therapy for insomnia” (
CBT-I). In the mid-1990s two important reports were published on these techniques. These reports were based on meta-analyses. In a meta-analysis, the research data from many studies of a given treatment are carefully combined to provide the overall story on the treatment’s usefulness. In these particular meta-analyses, the authors reviewed studies that had compared CBT-Itechniques with no treatment or with a placebo treatment. Research shows that CBT-Iis useful even if one have some mild to moderate symptoms of anxiety or depression, or some long-lasting medical problem like chronic pain or cancer. This book shows how to deal with and overcome insomnia if one has insomnia that has lasted longer than 4 weeks.
- Go to chapter: Some of the Basic Principles of Rational Emotive Behavior Therapy (REBT) and Cognitive Behavior Therapy (CBT)
Some of the Basic Principles of Rational Emotive Behavior Therapy (REBT) and Cognitive Behavior Therapy (CBT)
This chapter explores many kinds of resistance to psychotherapy and to self-help therapy and describes how one, as a therapist, can effectively deal with them. Obviously, however, it will favor Rational Emotive Behavior Therapy (REBT) that started in 1955 and that has developed into Cognitive Behavior Therapy (CBT) in the 1960s and 1970s. Therefore, for REBT and CBT to be effective, one had better convince clients of the importance of their beliefs and show them that it is quite possible to change them and thereby improve their disturbing Consequences (C’s). The chapter emphases on a number of cognitive, emotive, and behavioral techniques, and is therefore similar to what Arnold Lazarus calls multimodal therapy. REBT, more than the other Cognitive Behavior Therapies, particularly differentiates healthy negative feelings, such as concern, sorrow, regret, frustration, and annoyance from unhealthy or destructive feelings, such as panic, depression, and rage.
This chapter discusses the counseling process of an older adolescent, and his family as they negotiated their boundaries, communication styles, and relational connections. It reviews how they learned to differentiate between enabling behaviors and loving support. Within his familial, peer, institutional, and educational systems, the patient learned to evade difficult moments, escape into oblivion, and disarm people with a charming smile. The adolescent began drinking at age 12, started smoking marijuana regularly at age 14, and began smoking heroin at age 16. He suffered from both substance dependence and major depression. The patient was prepared for treatment, and the treatment concentrated on aftercare planning, living arrangements, social support, and outpatient counseling to focus on family issues, grief, addiction, and mental health recovery. The chapter concludes that addicts show demonstrably different brain structures and functioning than nonaddicts and genetic differences predict addiction and these preexisting neurological differences predispose people to addiction.
- Go to chapter: Mental Illness Across the Life Cycle: Children, Adolescents, Adults, and Older Adults
This chapter describes the types of mental illness that can develop over the life course. Childhood mental disorders often focus around issues of attention, anxiety, depression, eating disorders, and behavioral problems that cause distress for the child and others. The chapter discusses mental health problems of emerging adulthood. It examines trends in mental healthcare for children and adolescents. The chapter demonstrates an understanding of the difficulties of assessing the mental health problems of older adults, including distinguishing between dementia and depression. Mental health is a pressing issue for active duty members of the armed forces as well as for veterans. Reducing psychiatric hospitalizations is a positive step for clients and families and an important way to conserve resources. Social workers are the professionals most likely to work with clients and families in all stages of life and can bring considerable expertise to improving and expanding interventions across the life cycle.
Trauma-Informed Approaches to Eating Disorders is clearly a much needed and long overdue book about treatment, written by a diverse group of clinicians and carefully edited to focus on the needs and strengths of clinicians. The complexities and challenges that undergird, surround, and even haunt the nature, diagnosis, treatment, management, and understanding of eating disorders (EDs)-in-relation-to-trauma are so great, even for veteran clinicians, that they can leave practitioners at any level of experience feeling helpless and exhausted. This book, in a way that would be appreciated by practitioners of acceptance and commitment therapy, accepts the reality of those feelings and is committed to improving treatment, understanding, and compassion. The book is designed to foster respect for complexity and link it to humility in the presence of tragedy, tribulations, and suffering, framed all too often by our own shortcomings as healers. EDs are dangerous, ubiquitous, usually chronic in nature, and difficult to treat. Anorexia nervosa (AN) has the highest fatality rate (4%) of any mental illness. Bulimia nervosa reveals a fatality rate of 3.9%. EDs offer an enormous challenge to therapists because of their complexity, which includes severe medical risk, co-occurring anxiety, depression and personality disorders, an addiction component, and body image distortion—all of this within a mediadriven culture of thinness in which starving and purging can for some become lifestyle choices. This complexity is further exacerbated by the presence of painful life experiences or trauma. The book elucidates the connection between trauma and EDs by offering a trauma-informed phase model, as well as chapters describing the ways in which various therapeutic models address each of those phases. It offers an in-depth exposition of a fourphase model of trauma treatment.
Women with disabilities constitute one of the largest and most disadvantaged populations in the United States. This chapter helps rehabilitation counselors understand the myriad factors that affect the psychological and social health of women with disabilities. After giving some background on the historical roots of the rehabilitation response to women and a description of the demographic and health characteristics of this population, the chapter presents a heuristic, holistic model for understanding the reality of our lives and strategies for helping us achieve optimal health. It first discusses the pivotal construct of self-esteem, followed by social connectedness, its polar opposite abuse and the consequences of disparities stress and depression. The chapter ends with recommendations on strategies that the rehabilitation researchers and practitioners can use to include gender in their examination of individual and program outcomes, and thereby advance the field.
This chapter aims to highlight and clarify the particular ways in which scientific disciplines have approached understanding the variety of experiences people call depression, and to demonstrate how the knowledge generated by science has shed light on their human understanding of depression and resulted in improved identification and treatment of these conditions. Diagnoses of depressive disorders differ from colloquial meanings of the term depression often used to refer to more temporary reactions to those more troubling manifestations of the concept that are the province of psychopathological research. One important difference is that diagnoses fit the concept of a syndrome. A syndrome is a set of signs and symptoms that appear together in time in a coherent pattern. In the case of psychiatric disorders such as depression, symptoms are those problems that can be described by someone experiencing them but that are not readily observable by others, such as thoughts of hopelessness.Source:
This book serves as the pillar for clinical care teams to improve health equity among homeless older adults. Interdisciplinary care teams are essential in complex homeless older population clinical practice, as all disciplines must work together to address medical, surgical, behavioral, nutritional, and social determinants of health. All clinicians who treat older adults, from the independent to the frail, should approach problem solving via an inclusive approach that includes social work, pharmacy, nursing, rehabilitation, administrative, and medicine inputs. The social determinants of health that contribute to the complexities of clinical care outcomes cannot be addressed within silos. The book reflects a holistic care model to assist clinicians in the complicated homeless population that is continuing to change in the instability of the homeless environment. The book is divided into 14 chapters. The chapters in are organized by problems most commonly faced by clinicians in servicing homeless populations: mental, social, medical, and surgical challenges. Chapter one presents definition and background of geriatric homelessness. Chapter two discusses chronic mental health issues (psychosis) in the geriatric homeless. Chapters three and four describe neurocognitive disorders, depression, and grief in the geriatric homeless population. The next two chapters explore ethical, legal, housing and social issues in the geriatric homeless. Chapters seven and eight discuss infectious diseases in homeless geriatrics population. Chapter nine is on cardiovascular disease in homeless older adults. Chapter 10 describes care of geriatric diabetic homeless patients. Chapter 11 discusses geriatric nutrition and homelessness. Chapter 12 presents barriers and applications of medication therapy management in the homeless population. Chapter 13 describes dermatologic conditions in the homeless population. Finally, the book addresses end-of-life considerations in homelessness and aging.
Any theoretical model of depressive disorders must be consistent with people’s broader understanding of human psychology, including the origins and functions of their psychological processes. A number of theorists have offered models of depressive disorders that emphasize the possible adaptive significance to their species of these conditions and related emotions. The purpose of such models is twofold: to provide a conceptualization of depression that is consistent with evolutionary theory, and to describe how the etiology of depression may be understood as involving normal processes of adaptation. If depressive disorders and normal experiences of grief, sadness, and guilt emerge from shared mechanisms, then perhaps depression shares with these normal experiences their adaptive functions as well. Many of the evolutionarily based models generated to explain the existence of depression focus on the interpersonal and social contexts of depression.Source:
Diabetes mellitus (DM) is one of the most common chronic conditions in older, homeless adults. This chapter provides brief description on DM and prediabetes, and discusses post-hospital admission and clinical manifestations of DM. Careful and deliberate data gathering must take place to understand current health behaviors. Importantly, the patient’s health literacy, memory, and performance of activities of daily living and instrumental activities of daily living will help assess functional status. The chapter covers topics such as nutrition status and food security, fall risk assessment, depression, cognitive impairment, vision, social history, and polypharmacy. It discusses physical exam, diagnostic tests, further work-up, patient education and self-management, prevention, and treatment of DM. The chapter finally provides description on noninsulin versus insulin and oral versus injection, oral noninsulin medications, and strategies to reduce common diabetic complications.
Adventure therapy, or therapy in an outdoor setting, has many origins. Most researchers agree that adventure therapy evolved from the Outward Bound tradition. In the 1960s and 1970s, Outward Bound gained reputation as an alternative treatment to incarceration for delinquent adolescents. Early researchers of adventure therapy posited that change occurred because of Hahn’s orientation toward character development. Activities that required the engagement of clients were seen as essential change elements of adventure therapy. Activities and consequences may be core elements of adventure therapy; however, their effectiveness was suspected without an empathic connection to staff. Adventure therapy seemed to work with clients who had experienced trauma, exhibited conduct-problem behaviors, or suffered from lack of trust, interpersonal problem-solving deficiencies, depression and anxiety. However, more research is needed to define the underlying basis for change within this population when treated in the outdoors.
For many clients, shame is hidden beneath other aspects of a client’s presentation, such as chronic anger, depression, substance dependence, or general social withdrawal. And, for other clients, chronic shame is not at all hidden, but is a very visible part of the client’s initial presentation in therapy. When a client comes into therapy with very low self-esteem—a lack of confidence and a self-definition of inadequacy, badness, unworthiness, or deficiency—and these qualities have little or no apparent basis in that person’s abilities or behavior, the therapist should be alert to the possibility that the client’s negative self-assessment is serving a defensive purpose. A defense is any mental action or behavior that has a function within the personality of preventing full conscious awareness of disturbance connected with trauma. Shame or self-blame does not feel very good.
Nursing facilities often provide care for many different types of residents including those with diagnoses of dementia and mental illness. These diagnoses often have accompanying behavioral difficulties. Currently, there are three primary models used by mental health consultants in nursing facilities: the psychiatrist-centered models, the multidisciplinary team models, and the psychiatric nurse-centered models. Each of these models focuses on reducing symptoms and supporting staff interventions. The routine presence of qualified mental health clinicians in the nursing homes to provide consultation and to provide follow-up has been suggested as being very beneficial to both residents and staff in the nursing facility. This chapter discusses the role of the mental health team in the nursing facility, how referrals and assessments for mental healthcare are managed, the social worker’s role in relation to the mental health team, and some of the barriers to mental health services.
- Go to chapter: Thriving Versus Succumbing to Disability: Psychosocial Factors and Positive Psychology
Perhaps the most crucial and significant question rehabilitation researchers have sought to answer over the past several decades is: How is it that some persons with disabilities appear to excel and succeed in life beyond all expectations, whereas others seemingly succumb or yield to the limits imposed by their disabilities and society? This chapter explores the multiple factors that contribute to this dichotomy. It focuses on disability from a salutogenic orientation (focusing on the traits of healthy and successful persons) as opposed to the traditional pathological approach (focusing on the reasons and treatment of those beleaguered with ongoing mental and physical health problems) (Antonovsky, 1987). The chapter briefly explores several of the more common disabling conditions in the United States, specifically substance use disorder (SUD), depression, anxiety, and suicide. It also explores the literature behind positive psychology and also the environmental and social barriers that obstruct wellness.
The importance of diagnosing depression and providing subsequent treatment to nursing home residents has been acknowledged and supported by the Centers for Medicare & Medicaid. The Mood section of the Minimum Data Set (
MDS) 3.0 includes the Patient Health Questionnaire, Nine Questions ( PHQ-9), in order to help identify depression. Depression is also associated with other chronic diagnoses such as Alzheimer’s disease, Parkinson’s disease, cancer, and arthritis. Substance use is often seen in the nursing home as a co-morbidity of depression for older adults. Depression and the diagnosis of depressed mood is a significant concern for social workers in long-term care. The social worker should be familiar with key signs and symptoms of depression, as well as the current modes of intervention, drug treatment, and psychotherapy.
Aging and physical vulnerability go hand in hand, so it is not surprising that older adults pay particular attention to what they eat and drink. Dehydration, constipation, hypertension, overweight, and malnourishment are just some of the age-related challenges facing older adults. Nutrition screenings examine characteristics known to be associated with dietary and nutritional problems, in order to identify high-risk individuals. One such screening initiative resulted in the production of a manual that begins with a checklist, “Determine Your Nutritional Health”. The manual includes a variety of screening tools on nutrition and related topics, including body mass index, eating habits, functional status, cognitive status, and depression. Medicare recognizes that not only is obesity a disease, but it is an epidemic in America. By offering free weight-management counseling for older adults, this is a step in the right direction.
Elimination disorders include encopresis and enuresis; both conditions can have medical as well as emotional origins. Research demonstrates comorbidity of elimination disorders in children already diagnosed with sensory processing disorder, attention deficit/hyperactivity disorder, anxiety, depression and conduct disorder or oppositional defiant disorder. Systemic clinicians use a variety of interventions based on their theoretical focus and framework such as: ecosystemic structural family therapy, narrative therapy, behavioral family therapy, and intergenerational family therapy. This chapter addresses interventions associated with the various therapeutic approaches for elimination disorders. Given the social, environmental, family functioning and transgenerational factors, using a family systems approach when working with children diagnosed with an elimination disorder would seem to be an acknowledged treatment practice and review of the research has demonstrated that systemic treatment is effective. The chapter also presents a case study that illustrates how the interaction of family members influences behaviors in the system.Source:
Mental health is a multifaceted concept and difficult to define. Clinicians and researchers refer to
DSMguidelines or state how a condition deviates from them. Critics of the guidelines may argue that the number of clinical characteristics that identify a mental illness, and the time parameters that are employed for having these characteristics, are arbitrary. But flawed though they may be, there is no consensus on guidelines that could even be criticized, much less adopted, for the components of mental health. Thus, this chapter attempts to correct this imbalance and reflects a combination of the two perspectives: mental health and mental illness. As is true of most of the literature, the author has organized chapter subheadings largely around mental illness terms and also attempted to focus as much overall attention on mental health content as on mental illness. In addition to examining a topic like depression, the chapter explores life reviews, and in addition to examining Alzheimer’s disease, it explores cognitive stimulation.
Fibromyalgia or the fibromyalgia syndrome (FMS) is a chronic pain disorder characterized by fatigue, muscle pain, tenderness, and sleep difficulties. This syndrome is referred as “soft-tissue rheumatism”. Fibromyalgia is a disorder that intrudes upon the daily life of people and is a worldwide phenomenon. Fibromyalgia might also include other symptoms such as concentration and memory problems, labile mood, depression, anxiety, sleep problems, painful menstrual cramps, and numbness. Because FMS has no relevant organic pathology, it is placed in the realm of medically unexplained physical symptoms. Recent studies are providing early evidence for the use of eye movement desensitization and reprocessing (EMDR) therapy for chronic pain patients. Also, EMDR therapy is being used for other pain conditions, including fibromyalgia. Therefore, the EMDR Fibromyalgia Syndrome Protocol created includes the three-pronged protocol and an in-depth history of the client’s FMS and trauma. More research is needed to support this new protocol.
Gender dysphoria is the feeling of discomfort or distress that might occur in people whose gender identity differs from their sex assigned at birth or sex-related physical characteristics. The cases in this chapter include two cases of adolescent gender dysphoria. In the first case, the adolescent is considering future transition against the backdrop of family acceptance and cultural issues while the other adolescent highlighted in this chapter has transitioned and manages depression and a history of child abuse. Questions for consideration follow each case.
For decades, televisions have been referred to as “boob tubes”. The “tube” side of the slang term referred to the huge cathode-ray tubes that powered the viewing screen in the Stone Age of television. This basic belief persists, that time spent on entertainment media, particularly visual media is associated with reduced intelligence or academic performance. On the other hand, some investigators are examining whether newer forms of media can be used to promote learning. This chapter examines these concerns and beliefs and elucidates to what degree consuming entertainment media influences our academic achievement. Children who had watched fast-paced cartoon had reduced executive functioning compared to an educational show, or to perform a controlled drawing task. The American Academy of Pediatrics (AAP) has released a host of policy statements on media issues. These have ranged from media violence to “Facebook Depression”, the belief that time spent on social media causes depression.Source:
Psychological trauma can occur when a person experiences an extreme stressor that negatively affects his or her emotional or physical well-being. Trauma can cause emotionally painful and distressing feelings that overwhelm a person’s capacity to cope and leave him or her with feelings of helplessness. Traumatic events can lead to Posttraumatic stress disorder (PTSD) and myriad other reactions, such as depression, substance abuse, sleep problems, and potentially chronic health problems, such as heart disease, diabetes, and cancer. Trauma exposure cuts across all walks of life, regardless of age, race, ethnicity, socioeconomic status, religion, and cultural background. The types of traumatic events includes child maltreatment, intimate partner violence/domestic violence, rape or sexual violence, military sexual trauma, sex trafficking, combat-related trauma, civilian war trauma and torture, disasters, serious accidents, and life-threatening medical illness. This book provides an overview of the rich and varied research conducted on psychological trauma over the past 3 decades.Source:
This book offers an in-depth look at the ways in which contemporary undergraduate students may differ from past generations, as well as noting how some things never change, such as needs related to finding social support, romantic intimacy, and academic achievement. It first provides a brief overview of the various developmental transformations that are taking place within the many levels of cognitive, affective, and physiological development of emerging adults. The book then considers the typical counseling concerns that counselors can expect to meet across the academic year. Next, it addresses the social concerns of students as they seek to find the best way to fit in on campus. It addresses the growing diversity of college campuses as well as provides counselors with guidance on helping their clients connect into the campus community. Then, the book moves into ways to assist clients who are facing unexpected hurdles, including grief over the loss of significant others; difficulties with self-esteem and self-image presented by the competitive culture of college-age females; and navigational challenges in romantic relationships that may be more intense and sexually tinged than prior high school relationships had been. Specific mental health disorders that frequently appear in the college-age population are also addressed in the book. The book provides guidelines for treatment and intervention that are relevant to college counselors working within a brief counseling framework. Topics include eating disorders, substance abuse, depression, anxiety, self-injury, suicidal students, obsessive-compulsive disorder, and impulse-control disorders. Finally, the book provides readers with ideas for promoting student well-being beyond the counseling office.
Psychological trauma can have long-term effects on health. When considering the impact of trauma on health, most people tend to focus on immediate consequences, such as injury. And these needs can be substantial. Patients who reported four or more types of childhood adversity, including sexual, physical, and emotional abuse; exposure to domestic violence; and parental mental illness, criminal activity, and substance abuse, were at significantly increased risk for such diverse conditions as ischemic heart disease, cancer, stroke, chronic bronchitis, emphysema, diabetes, and hepatitis. Human beings are meant to have social relationships with others. Unfortunately, trauma survivors often have difficulties in their relationships. Depression and Posttraumatic stress disorder (PTSD) are common sequelae of trauma. Depression is one of the most commonly occurring sequelae of trauma. Given the serious often life-threatening conditions that trauma survivors often have, an adequate health care system response is perhaps the most pressing need of survivors of traumatic events.Source:
This book for undergraduate and graduate survey courses encompasses a wide range of key issues in occupational health psychology (OHP) from a North American perspective. It draws from the domains of psychology, public health, preventive medicine, nursing, industrial engineering, law, and epidemiology to focus on the theory and practice of protecting and promoting the health, well-being, and safety of individuals in the workplace and improving the quality of work life. The book addresses key psychosocial work issues that are often related to mental and physical health problems, including psychological distress, burnout, depression, accidental injury, obesity, and cardiovascular disease. It examines leadership styles as they impact organizational culture and provides specific recommendations for reducing employee-related stress through improved leader practices. Also addressed is the relationship between adverse psychosocial working conditions and harmful health behaviors, along with interventions aimed at improving the work environment and maximizing effectiveness. Additionally, the book discusses how scientists and practitioners in OHP conduct research and other important concerns such as workplace violence, work/life balance, and safety.
Occupational health psychology (OHP) is an exciting field with a bright future. One part of that bright future is in the excitement of conducting research that aims to uncover knowledge on the interplay of work and health. The other part of that bright future is in the application of that knowledge to making the lives of working people healthier. OHP is likely to see advances in research that better integrate mental health outcomes and working conditions with assessments of individual differences. OHP research on the relation of psychosocial working conditions to intermediate outcomes such as relatively small elevations in blood pressure does not negate the need for research on biological endpoints such as heart attack and stroke. OHP-related research has done much to document the baleful effects of unemployment and job insecurity, which include psychological distress, depression, suicide, and heart disease.
Numerous studies have documented the immediate and long-term health effects for first responders. These effects are often disaster specific as a result of the unique composition of the disaster and accompanying response and recovery tasks. Studies have found that respiratory illness is common in responders and cleanup workers after the World Trade Center (WTC) attacks, including short- and long-term effects. Several health surveillance programs have been put in place to track health effects of responders and citizens, including the WTC Health Registry. Along with health effects, literature suggests that mental health effects are also a possibility for responders, ranging from minimal, short-term symptoms to more significant long-term illness. Lay volunteers are at higher risk for probable symptoms of PTSD, depression, and anxiety. Training, including elements of crisis intervention, is imperative to equip responders with the tools needed to effectively respond. Perhaps the most essential aspect of this training is self-care.
This chapter examines the impact of psychosocial working conditions on medical-related outcomes, concentrating on cardiovascular disease (CVD). It explores the relation of psychosocial working conditions to musculoskeletal problems. The chapter examines three health-related outcomes: sickness absence, self-rated health, and fatigue. The term “CVD” refers to a set of conditions including atherosclerosis, ischemic heart disease, myocardial infarction, angina pectoris, and hypertension. The first general pathway from psychosocial working conditions to CVD is potentially through the health behaviors. The second general pathway involves chains of biological links from psychosocial stressors to CVD. The relation of psychosocial working conditions to depression and distress is not always acknowledged in research on working conditions and CVD. Research findings suggest that psychosocial factors, apart from the physical demands of the workplace, play a role in the development of musculoskeletal problems. The DC factors likely influence health beyond their impact on depression, heart disease, and musculoskeletal problems.