Anxiety and Hyperthyroidism January 31, 2011

Anxiety Disorders affect 18% of the American population every year (National Institute of Mental Health, 2009), and is characterized by disproportionate and near-constant stress and worry. Anxiety disorders can include several manifestations including, Panic Attacks, Agoraphobia, Specific Phobia, Social Phobia, Obsessive-Compulsive Disorder, Posttraumatic Stress Disorder, Acute Stress Disorder and Generalized Anxiety Disorder (APA, 2000). To determine a diagnostic hypothesis for Anxiety Disorder, a psychology professional must differentiate between this disorder and other related disorders. Other issues, such as a general medical condition or substance use must be ruled out before determining Anxiety Disorder as a diagnostic hypothesis (First, et al., 2002, Schneider, 2001).
Hyperthyroidism is a medical condition that is caused by an overactive thyroid gland which can cause a variety of symptoms. Hyperthyroidism may mimic an anxiety disorder as symptoms can include difficulty concentrating, nervousness and restlessness which can be misconstrued as an anxiety disorder (National Institutes of Health, 2010). Additionally, the thyroid hormones elevated by hypothyroidism can cause anxiety disorders (Asland et al, 2005).
The hypothesis of hyperthyroidism and increased mental complaints is a topic studied by many researchers. In associated studies, the relationship between increased anxiety, other mental and physical disorders and hypothyroidism was researched thoroughly. A study initiated by Aslan et al. found that in patients studied, dysfunction of the tyroid is associated with mental disorder, however, there was no support for a clinical association of hypothyroidism and anxiety (2005). Interestingly, Grabe et al. and Aslan et al. who directly studied this relationship as well determined that despite their initial hypothesis, there was little relationship between hyperthyroidism and anxiety disorder (2005). Engum et al., determined through their study that despite this lack of association, a history of hypothyroidism or hyperthyroidism was associated. Additionally, it is indicated that the relationship between anxiety and thyroid disorder may still need to be studied (2002). All studies presented empirical first hand research with strong theoretical analysis of all research presented. However, as it is indicated that this topic still needs significant study to persuade. As hypothyroidism has been presented as a medical condition which can cause anxiety, it would be misguided to simply rule out the possibility. It is clear that much more studies on this topic must be completed.

Additionally Hyperthyroidism should be ruled out by a full medical evaluation before diagnosing an anxiety disorder. It is possible that a hyperthyroidism or another medical condition may be causing or mimicking an anxiety disorder.

References

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text revision, DSM-IV-TR). Washington, D.C.: Author

Aslan, S., Ersoy, R., Kuruoglu, A., Karakoc, A., & Cakir, N. (2005). Psychiatric symptoms and diagnoses in thyroid disorders: A cross-sectional study. International Journal of Psychiatry in Clinical Practice, 9(3), 187-192.

Engum, A., Bjøro, T., Mykletun, A., & Dahl, A. (2002). An association between depression, anxiety and thyroid function – a clinical fact or an artefact?. Acta Psychiatrica Scandinavica, 106(1), 27-34.

Elmore, K., Schneider, R.K. (2001). Medical Mimics of Anxiety Disorders. Retrieved from http://www.eric.vcu.edu
First, M.B., Frances, A. & Pincus, H.A. (2002). DSM-IV-TR handbook of differential diagnosis. Arlington, VA: American Psychiatric Publishing

Grabe, H. J., Völzke, H. H., Lüdemann, J. J., Wolff, B. B., Schwahn, C. C., John, U. U., & … Freyberger, H. J. (2005). Mental and physical complaints in thyroid disorders in the general population. Acta Psychiatrica Scandinavica, 112(4), 286-293

Moutier, C.Y., Stein, M.B. (1999). The history, epidemiology, and differential diagnosis of social anxiety disorder. Journal of Clinical Psychiatry, 60, 4-8.
National Institutes of Health (2010). Hyperthyroidism. Retrieved from http://www.nlm.nih.gov

National Institute of Mental Health. (1999). Mental Health: A Report of the Surgeon General—Executive Summary. Retrieved from http://www.surgeongeneral.gov
National Institute of Mental Health. (2009). Anxiety Disorders. [Online version]. Retrieved from http://www.nimh.nih.gov/

Self – Report Limitations January 22, 2011

xx Relying on clients to describe issues honestly or self-report on certain aspects of their life or their symptoms is an integral part of the clinical assessment process. Clients inform psychology professionals about issues are troublesome, family histories, medical histories, mental health information, symptoms and much more. However, there are some limitations in relying on self reporting. Inaccuracies may occur in self-reporting due to many issues. Such inaccuracies may result from deliberate deception, response biases, cultural tendencies or diathesis-stress issues.

Gathering information on a client through written survey may produce less than advantageous results as such self-reporting tactics may result in varying response styles, such as: inconsistent responding, acquiescence, negativism, extreme responding, or moderacy. Inconsistent responding involves answering in a random manner. For example, an inconsistent responder may vary their answers for similar questions without reason. Acquiescent respondents tend to choose positive choices, while negativism responders will choose to prefer negative choices, for instance, when asked if they like something, the acquiescent responder will say yes; the negative responder will say no, regardless of the statement’s validity. Additionally, there is extreme responding, where the respondent will tend to respond in extremes, and moderacy, where the respondent will neutralize answers (McGrath et al., 2010). These are examples of self-reporting biases in measurement, generally found in written questionnaires, however, there are also biases that occur in verbal assessments that are used in diagnosing mental disorders.

Biases in verbal assessment that may occur are: positive impression management, negative impression management, inaccurate responding cultural tendencies, or diathesis-stress issues. Positive impression management involves the respondent omitting or underreporting information that may not be desirable for their self-image. For instance, a client who does not disclose the full severity of their symptoms because they want to give a good impression (Hunsley, et al.,1996; McGrath, et al, 2010; Paulhus, 1984). Negative impression management involves the respondent exaggerating or over-reporting information. For instance, a client that makes up symptoms to qualify for disability insurance (Hunsley, et al.,1996; McGrath, et al, 2010). Inaccurate respondents lack the required self-awareness to be fully informed about their symptoms (McGrath, et al., 2010; Siebert, et al., 2010). The inability to respond in a helpful manner is not based on a desire to deceive, yet may be due to a psychopathology, or substance or alcohol abuse that makes it impossible to respond honestly (Seibert, et al., 1996). Cultural tendencies involve a response style that is manifested through learned behavior of a particular culture. For example, a client who responds in a dialectic thinking style that may appear contradictory (Hamamura, Heine & Paulhus, 2008). Diathesis-stress issues may occur when a client has a predisposition for a disorder, i.e., depression in women, cause the respondent to answer in a way that is concurrent with their predisposition (Driscoll, Lopez, & Kistner, 2009).

Psychology professionals place great importance on determining truth. The truth from their clients assist in producing truthful diagnoses. As shown, there are many complications that may cause errors in the assessment process of clients. Many different bias indicator tests have been developed for use in assessment to reduce misrepresentations, however it has been hypothesized that simply inconsistent responding may be a clear indicator for biases in self-reporting (McGrath et al. 2010). At any rate, It is important for psychology professionals to be aware of the many ways self-reporting may cause inaccuracies as it directly affects diagnosis of disorders.

References

Driscoll, K.A., Lopez, C.M., & Kistner, J.A. (2009). A diathesis-stress test of response styles in children. Journal of Social and Clinical Psychology, 28(8), 1050-1070.

Hamamura, T., Heine, S.J., & Paulus, D.L. (2008). Cultural differences in response styles: The role of dialectical thinking. Personality and Individual Differences, 44, 932-942.

Hunsley, J., Vito, D., Pinsent, C., James, S., & Lefebvre, M. (1996). Are self-report measures of dyadic relationships influenced by impression management biases? Journal of Family Psychology, 10(3), 322-330.

McGrath, R.E., Michell, M., Kim, B.H., & Hough, L. (2010). Evidence for response bias as a source of error variance in applied assessment, 136(3), 450-470.

Paulhus, D.L. (1984). Two-component models of socially desirable responding. Journal of Personality and Social Psychology, 46(3), 598-609.

Seibert, L.A., Miller, J.D., Few, L.R., Zeichner, A., & Lynam, D.R. (2010). An examination of the structure of self-report psychopathy measures and their relations with general traits and externalizing behaviors. Personality Disorders: Theory, Research, and Treatment.

Recommended Treatments December 4, 2010

As different diverse groups may present problems specific to their unique issues it is important for psychology professionals to adapt and determine treatments appropriate for different groups. This post will focus on treatments for three different diverse groups: Older adults, Muslims, and Lesbian, Gay and Bisexual clients.

Older adults clients of age 65 and older present issues such as appraisal of lifespan, restricted timeframes, death of friends and family members (Laidlaw & Baikie, 2007). For these issues, it would be helpful to use a form of Contemplative Psychotherapy. Contemplative Psychotherapy combines meditation, yoga and consciousness. Clients are encouraged to view life’s issues authentically, courageously, and maturely. Concepts include tools to enhance well being, transforming and reducing negative emotions, redirecting motivation and increasing wisdom, among other concepts. Through this therapy, the unique issues of older adults can be dealt with in a way that will allow the client to further understand personal and human significance. (Walsh, 2008). Thus, clients can deal with life and death from a viewpoint of more awareness of the entire lifespan and not the end of one. Additionally, if therapy is combined with yoga, it will allow older adults to remain psychically active, reducing some physical illnesses that are caused by inaction.

Muslim clients view mental health issues from a religious perspective (Weatherhead & Daiches, 2010), and may benefit from Client-Centered Therapy. Client Centered Therapy allows clients to enter into a relationship of unconditional positive regard and empathic understanding with their therapist. Through this relationship the client uses their own resources and experiences for change and awareness. Thus, the client would be able to integrate their religious views into their sessions quite effectively.
Lesbian, Gay and Bisexual (LGB) clients often present issues involving identify development, family, ‘coming out’ and discrimination (Pachankis & Goldfried, 2004). These clients may benefit from Existential Psychotherapy. Existential Psychotherapy involves a collaborative relationship between the therapist and client, the therapist guides the client to move to a more authentic self and shares experiences with the client (Mendelowitz & Schneiger, 2008). Through this partnership, the therapist and client examine the world the client has created, and determines which aspects can be improved for a more authentic life.

References

Laidlaw, K., & Baikie, E. (2007). Psychotherapy and demographic change: Why psychotherapists working with older adults need to be aware of changing demographics now. Nordic Psychology, 59(1), 45-58. doi:10.1027/1901-2276.59.1.45

Mendelowitz, E., & Schneiger, K. Existential psychotherapy. In R. Corsini & D. Wedding (Eds.), Current psychotherapies (pp. 295-327). Belmont, CA: Thompson

Pachankis, J., & Goldfried, M. (2004). Clinical Issues in Working With Lesbian, Gay, and Bisexual Clients.Psychotherapy: Theory, Research, Practice, Training, 41(3), 227-246. doi:10.1037/0033-3204.41.3.227

Raskin, N.J., Rogers, C.R., & Witty, M.C. (2008). Client-centered therapy. In R. Corsini & D. Wedding (Eds.), Current psychotherapies (pp. 141-186). Belmont, CA: Thompson

Walsh, R. (2008). Contemplative psychotherapies. In R. Corsini & D. Wedding (Eds.), Current psychotherapies (pp. 437-480). Belmont, CA: Thompson

Weatherhead, S., & Daiches, A. (2010). Muslim views on mental health and psychotherapy. Psychology & Psychotherapy: Theory, Research & Practice, 83(1), 75-89.

Diversity Considerations December 2, 2010

Adapting for different clients is an important skill for the psychology professional. It is sometimes easy to get lost in one’s own paradigms and forget that there may be different aspects that need to be considered when evaluating and working with different clients. This post will focus on three different diverse groups: Older adults, Muslims, and Lesbian, Gay and Bisexual clients.

Older adults include adults age 65 and up. Under this requirement, 20% of the United States Population is currently considered an older adult and those numbers are growing with adults over 85 rising faster than all other age groups (APA, 1998). Psychology professionals working with older adults present unique problems, such as appraisal of lifespans, restricted timeframes, death of friends and family members and dementia. Laidlaw and Baike suggested the psychology professional working with this group be well informed of the issues that older adults face and the challenges they face. Older adults may enter therapy for mental issues, but they may seek help with personal growth or relationship help. Additionally, therapists need to understand that in addition of mental issues, older adults will invariably face physical illnesses as well (Laidlaw & Baike, 2007). Understanding why older adults may enter therapy and how co-morbidity affects this particular group will be most helpful in determining how to treat this population of clientele.

The second largest religion worldwide is Islam and there has been a significant rise to the Muslim population in the United States (Carter & Rashidi, 2004). Due to various factors, the negative view and portrayal of Muslims in the media may affect the mental health of this group. Additionally Muslims may view mental health issues from a religious perspective of having an unsound spiritual heart or other religious sub-themes. Weatherhead and Daiches suggest incorporating the Islam faith into therapy treatments and being aware of issues of spirituality and mindfulness for these clients (Weatherhead & Daiches, 2010). Consequently, focusing on more holistic or humanistic approaches with this group may prove to be advantageous.

Lesbian, Gay and Bisexual (LGB) clients have shown to attempt psychotherapy treatment more often than any other group (as cited in Pachankis & Goldfried, 2004). LGB clients often present issues involving identify development, family, ‘coming out’ and discrimination. Pachankis and Goldfried suggest that in addition to being sensitive to these problems, the psychology professional will need to be consider that as the profession of psychology historically condemned sexual minorities and as such, will need to show they are able to treat the LGB client without bias.

Although there are unique differences that apply to each of these diverse groups, it is important to remember that there is further diversities among the make-up of each population. It is important for the psychology professional to avoid making sweeping generalizations about any diverse population, yet it is indeed important to recognize the issues and concerns that each group faces and to apply this to treatments. It is also necessary for the psychology professional to identify and deal with any biases one may have against any particular group. Learning how to treat a client with sensitivity and tolerance is paramount for any psychology professional.

References

American Psychological Association. (1998). What practitioners should know about working with older adults. Professional Psychology: Research and Practice, 29(5), 413-427. doi:10.1037/0735-7028.29.5.413

Carter, D., & Rashidi, A. (2004). East meets West: integrating psychotherapy approaches for Muslim women. Holistic Nursing Practice, 18(3), 152-159.

Laidlaw, K., & Baikie, E. (2007). Psychotherapy and demographic change: Why psychotherapists working with older adults need to be aware of changing demographics now. Nordic Psychology, 59(1), 45-58. doi:10.1027/1901-2276.59.1.45

Pachankis, J., & Goldfried, M. (2004). Clinical Issues in Working With Lesbian, Gay, and Bisexual Clients.Psychotherapy: Theory, Research, Practice, Training, 41(3), 227-246. doi:10.1037/0033-3204.41.3.227

Weatherhead, S., & Daiches, A. (2010). Muslim views on mental health and psychotherapy. Psychology & Psychotherapy: Theory, Research & Practice, 83(1), 75-89.

Treating Depression in African American Women with CBT November 30, 2010

Depression has been characterized by symptoms including a “lack of interest and pleasure in daily activities, significant weight loss or gain, insomnia or excessive sleeping, lack of energy, inability to concentrate, feelings of worthlessness or excessive guilt and recurrent thoughts of death or suicide” (APA). Depression is the most widespread mental illness in America, affecting about 20% of the population, with women diagnosed more often than men, as women account for 7 million depression diagnoses per year (Gotlieb & Hammen, 2002; Carrington, 2006).  Despite this, African American women are less likely to seek care for their depression than Caucasian women (Jones, 2007).  Depression in African Americans has been under-researched and under-diagnosed, yet it has been surmised that despite this, it is probable that the rate of depression in African Americans are much higher than other races (Hunn & Craig, 2009).  Depression in African American women often goes untreated due many factors such as: stigmatization, health care avoidance, health care mistrust, and psychosocial beliefs (Nicolaidis et al., 2010, Miranda et al., 2006). When depression is treated, it has been found that there are inaccuracies in assessments and diagnosis due to the differences in the manifestations of depressive symptoms in African American women (Hunn & Craig, 2009). The lack of data on African American women in clinical trials, also contributes to the misdiagnosis and  under-treatment (Carrington, 2006). Thus, it is essential to identify a psychotherapy that is appropriate to this type of clientele.

When working with African American women, it is important to recognize the issues that African American women face when attempting depression treatment.  Some research has shown that African Americans tend to conceal symptoms of depression and stress (as cited in Hunn & Craig, 2009) and when symptoms are discussed, the manifestation of symptoms are relatively different than the traditional symptoms of sadness, lost interests, and worthless feelings. African American women often present symptoms of anger, irritability, and self hatred; such behaviors can be misconstrued and make it difficult to diagnose and treat this disorder (Kohn et al., 2002; Hunn & Craig, 2009). As depression is a common mental illness, there are many types of psychotherapies that attempt to treat it, but which treatment might be most applicable for African American women?

Freudian psychoanalysis is arguably the first mental images people may see when they think of seeing a psychologist.  Psychoanalysis is a psychodynamic theory that encompasses Freudian psychoanalysis, Adlerian psychotherapy and Jungian psychotherapy. Psychodynamic therapy attempts to understand individuals through the unconscious mind through clinical associations, therapeutic listening, therapeutic responding, and therapeutic alliance. There is a focus on childhood memories, sexual development, defense mechanisms and transference (Luborsky, O’Rielly-Landry, & Arlow, 2008; Maniacci & Mosak, 2008).  Although psychoanalysis may be affective for a particular clientele, the focus on the unconscious mind may not allow for the direct discovery and treatment of depression.  In addition, the transference process may not be possible with an African American client, due to the high probability that the therapist will be of another race and there may be too much of a cultural separation for transference.  Thus, psychoanalysis may not be right for this clientele.

Another psychotherapy is client centered therapy, which is a form of humanistic therapy. Client centered therapy aims to focus on the client, and not the ‘problems’.  The client in this therapy also guides the therapeutic process.  The therapist in this form of therapy is seen as entering a unique relationship with their clients, which is unlike psychodynamic therapy. Therapists follow three core conditions in this relationship: congruence, unconditional positive regard, and empathic understanding. Therapists exhibit these conditions by being aware and accepting of experiences, accepting the client and their thoughts and feelings, and regarding their client with true understanding (Raskin, Rogers & Witty, 2008). This form of therapy may be best for the highly motivated client.  As African Americans are less likely to have experienced previous therapy experiences, client centered therapy may prove to be difficult.  As a result, this form of therapy might not be helpful for this clientele.

Cognitive Behavioral Therapy (CBT) brings several approaches that are not considered by other psychotherapies.  CBT introduces new concepts such as collaborative empiricism, which involves the therapist and patient working together to find evidence to support or discredit the clients thoughts. Guided discovery, involves the therapist ‘guiding’ the maladaptive behaviors of the client in behavioral experiments that allow for new skills to develop (Beck & Weishaar, 2008; Wilson, 2008).  The CBT approach allows clients to challenge and correct maladapted and distorted thoughts (Forsyth et al., 2010).  CBT can be as effective as pharmacotherapy, which is recommended by the American Psychiatric Association as the first treatment course for depression (Forsyth et al, 2010; Jackson, 2006). However, there is stigma associated with anti-depressant use in the African American culture (Nicolaidis et al., 2010) and thus, CBT may be preferable.  Therapists working with CBT may use collaborative empiricism to challenge depressive symptoms in African American women regardless of whether the traditional symptoms are presented or not.  Collaborative empiricism can be used to discover if feelings of anger, irritability and self hatred are evidence based and if not, can change such feelings. Guided discovery allows for the therapist and client to work through various issues to ensure the client’s recovery.

Depression may be effectively treated with CBT, as several empirically based articles attest.  Forsyth et al., reported clients who participated in a study of CBT presented less symptoms of depression, more positive thinking with a decrease in maladaptive thoughts (Forsyth et al., 2010; Coleman, Cole, & Wuest, 2010). As depression in the African American woman is under-researched, there are a lack of empirically based research articles.  However, many empirical articles which focused on depression in African American women identify CBT as the preferred psychotherapy treatment for such clients. This may be due to CBT’s core concepts which enable the client to deal actively with their feelings and maladaptive thoughts.  This process can positively affect clients regardless of their symptom manifestations.  Miranda et al., (2006) presented a study of African American women clients assigned to different treatments.   They hypothesized symptoms of depression would be lowest with the most remission rates with CBT through examination of an one year study of African American women randomly assigned to CBT, medication or community health centers.  The results showed that CBT presented continued effectiveness for African American women with depression.  CBT proved to have a remission rate equal to medication treatment and resulted in improved social functioning(Miranda et al., 2006).  As an African American woman’s experience and culture may affect depressive symptoms, a more specialized treatment of CBT may prove beneficial.

The benefits of an adapted CBT program were presented by Kohn et al., (2002) in which a CBT program specifically tailored for African American women was studied. It was hypothesized that an adapted CBT approach specifically created to address the aspects of the African American culture would result in decreased depressive symptoms when compared to a traditional CBT treatment.  Concepts of the CBT program were emphasized with figures, role-models, and anecdotes from African American culture and literature.  Therapy modules were made specific to cultural issues and the African American experience.  The CBT treatment was presented in group therapy sessions, which appealed to this particular clientele.  When tested, it was determined that a specially adapted treatment program resulted in decreased depressive symptoms (Kohn et al., 2002).  These results further support evidence that CBT, particularly in a group setting, works for African American women. A study by Jones (2008) determined that evidence based treatment, such as CBT, in a group setting resulted in improvement for clients and the group environment is particularly advantageous for working with this particular population.  A group setting allows for a client to experience camaraderie with other group members when there is cultural and gender similarities (Jones, 2008).  However, for clients new to therapy or for clients with unique problems, it may be favorable to begin with initial one-on-one sessions.

While depression treatment in African American women will continued to be studied until much more empirical evidence has been obtained, it appears that CBT provides auspicious evidence of having a beneficial affect on such clientele. CBT provides an impressive array of therapeutic tools in which the African American depressed client may advance past cultural and societal barriers to improve their psychological disorder.  As CBT can be made adaptable and customizable for clients, it further allows for this clientele to ensure they are getting the most out of their therapeutic experience.  Consequently, of the aforementioned psychotherapies, CBT presents the most concepts than can be adapted for applicable treatment with African American women.

References

APA (2009). Depression. Retrieved from http://www.apa.org/topics/depress/index.aspx.

Beck, A.T & Weishaar, M.E. (2008). Cognitive therapy. In R. Corsini & D. Wedding (Eds.), Current psychotherapies. (pp. 263-294). Belmont, CA: Thompson.

Carrington, C. (2006). Clinical depression in African American women: Diagnoses, treatment, and research. Journal of Clinical Psychology, 62(7), 779-791.

Coleman, D., Cole, D., and Wuest, L. (2010). Cognitive and psychodynamic mechanisms of change in treated and untreated depression. Journal of Clinical Psychology, 66(3), 215-228.

Forsyth, D., Poppe, K., Nash, V., Alarcon, R., & Kung, S. (2010). Measuring Changes in Negative and Positive Thinking in Patients With Depression. Perspectives in Psychiatric Care, 46(4), 257-65.

Gotlib, I.H. and Hammen, C.L., (2009). Handbook of Depression. [google books version]. Retrieved from books.google.com

Hunn, V.L. and Craig, C.D. (2009). Depression, sociocultural factors and african american women. Journal of Multicultural Counseling and Development, 37, 83-93.

Jackson, A. (2006). The use of psychiatric medications to treat depressive disorders in African American women. Journal of Clinical Psychology, 62(7), 793-800.

Jones, V. L. (2008). Preventing depression: culturally relevant group work with black women. Research on Social Work Practice, 18(4), 626-634.

Kohn, L.P., Oden, T., Munoz, R.F., Robinson, and A., Leavitt, D. (2002). Brief report: Adapted cognitive behavioral group therapy for depressed low income african american women. Community Mental Health Journal, 38(6), 497-504.

Luborsky, E. B., O’Rielly-Landry, M. and Arlow, J. A. (2008). Psychoanalysis. In R. Corsini & D. Wedding (Eds.), Current psychotherapies. (pp. 15-62). Belmont, CA: Thompson.

Maniacci, M. and Mosak H. H. (2008). Alderian psychotherapy. In R. Corsini & D. Wedding (Eds.), Current psychotherapies. (pp. 63-106). Belmont, CA: Thompson.

Miranda, J., Siddigue, J., Belin, T., Green, L.G., Krupnick, J.L., Chung, J., and Revicki, D. (2006). One year outcomes of a randomized clinical trial treating depression in low income minority women. Journal of Counseling and Clinical Psychology,74(1), 99-111.

Nicolaidis, C., Timmons, V., Thomas, M., Waters, A., Wahab, S., Mejia, A., et al. (2010). “You don’t go tell white people nothing”: African american women’s perspectives on the influence of violence and race on depression and depression care. American Journal of Public Health, 100(8), 1470-1476. doi:10.2105/AJPH.2009.161950

Raskin, N.J., Rogers, C.R., & Witty, M.C. (2008). Client-centered therapy. In R. Corsini & D. Wedding (Eds.), Current psychotherapies. (pp. 141-186). Belmont, CA: Thompson.

Wilson, G.T. (2008). Behavior therapy. In R. Corsini & D. Wedding (Eds.), Current psychotherapies. (pp. 223-262). Belmont, CA: Thompson.

Depression in African American Women and CBT November 25, 2010

Depression is defined by the APA as a “lack of interest and pleasure in daily activities, significant weight loss or gain, insomnia or excessive sleeping, lack of energy, inability to concentrate, feelings of worthlessness or excessive guilt and recurrent thoughts of death or suicide”.  Depression in African American women often goes untreated due to stigmatization of mental illness in the African American Community and inaccuracy in assessments as the manifestation of depressive symptoms is quite different in the African American community (Hunn, V.L. and Craig, C.D. 83-87).  Additionally, depression in African American women is generally under-researched and overlooked for empirical studies (Hunn, V.L. and Craig, C.D. 83).  Despite this, I was able to identify five journal articles which addresses this disorder and/or focuses on the the particular subset I have chosen.  Interestingly, the majority of articles focusing on depression and African American women identify Cognitive Behavioral Therapy (CBT) as the psychotherapy treatment for these clients. Miranda, J., Siddigue, J., Belin, T., Green, L.G., Krupnick, J.L., Chung, J., and Revicki, D. (2006) presented a study in which they studied the one year outcomes of a clinical trial which assessed  the long term outcomes of clients assigned to CBT, medication, or community mental health centers. Through this clinical trial, it was determined that CBT had the best long term outcomes.  Also studying CBT, Kohn, L.P., Oden, T., Munoz, R.F., Robinson, and A., Leavitt, D. (2002) created a CBT program specifically tailored for African American women.  When tested, it was determined that a specially adapted program treatment resulted in decreased depressive symptoms.  Jones (2008) determined that evidence based treatment  in a group setting resulted in improvement for clients and the group environment is particularly advantageous for working with this particular population.  Coleman, D., Cole, D., and Wuest, L. (2010), posited that CBT treatment, again, results in decrease of depressive symptoms.   The articles selected present good empirical evident of CBT for depression.  Limitations, however, of the articles which specifically studied African American women are due to the previously stated lack of research on this topic.  However, all articles are in strong agreement that the best treatment for depression is CBT.

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Resources

 

 

APA (2009). Depression. Retrieved from http://www.apa.org/topics/depress/index.aspx

 

Coleman, D., Cole, D., and Wuest, L. (2010). Cognitive and psychodynamic mechanisms of change in treated and untreated depression.  Journal of Clinical Psychology, 66(3), 215-228.

 

Hunn, V.L. and Craig, C.D. (2009). Depression, sociocultural factors and african american women. Journal of Multicultural Counseling and Development, 37, 83-93.

 

Jones, V. L. (2008). Preventing depression: culturally relevant group work with black women. Research on Social Work Practice, 18(4), 626-634.

 

Kohn, L.P., Oden, T., Munoz, R.F., Robinson, and A., Leavitt, D. (2002). Brief report: Adapted cognitive behavioral group therapy for depressed low income african american women. Community Mental Health Journal, 38(6), 497-504.

 

Miranda, J., Siddigue, J., Belin, T., Green, L.G., Krupnick, J.L., Chung, J., and Revicki, D. (2006). One year outcomes of a randomized clinical trial treating depression in low income minority women. Journal of Counseling and Clinical Psychology.,74(1), 99-111.

 

 

 

Neonarcissism November 24, 2010

In their article, Bugental and Bracke presented an interesting view on the future of existential-humanistic psychotherapy. They posit that existential-humanistic psychotherapy is most helpful to individuals who suffer from inauthentic beliefs or emptiness and what they define as ‘neonarcissism’ (Bugental & Bracke 29). Neonarcissism is described as “liberated but doubting the reality of his or her own existence, sexually frustrated, fiercely competitive for approval, superficially cooperative while restraining a deep anger, and demanding immediate gratification yet living in a state of perpetually unsatisfied desire” (as cited in Bugental & Bracke, 1992). This definition may describe quite a few people, especially with the advent of web 2.0 and social networks, which, by their very existence, fuel narcissism. As such, and as recognized by Bugental and Bracke, these individuals may feel empty, aimless, purposeless and alone. The emptiness that may be felt from neonarcissism, is not from being empty but from division of living life for others and not for oneself (Bugental & Bracke 29-30). Existential-humanistic psychotherapy, with it’s focus on authenticity can effectively treat such issues. As the individual focus on remaining true to themselves and on not living for others, they will enjoy more gratification. This article, with its focus on the particular problem of neonarcissism seems to explain how helpful existential-humanistic psychotherapy may be for individuals in modern life. Modern culture may cause many problems, as it does not generally allow for people to discover their authentic selves. Existential-humanistic psychotherapy’s concepts all challenge these issues so individuals can be directed to a better way of life.

Reference

Bugental, J., & Bracke, P. (1992). The future of existential-humanistic psychotherapy. Psychotherapy: Theory, Research, Practice, Training, 29(1), 28-33. doi:10.1037/0033-3204.29.1.28

Mendelowitz, E.D., & Schneider, K. (2008). Existential psychotherapy. In R. Corsini & D. Wedding (Eds.), Current psychotherapies (pp. 293-327). Belmont, CA: Thompson

Existential Psychotherapy November 24, 2010

Existential psychotherapy was developed from existential philosophy. The concept of Existential psychotherapy is based on the philosophy of Martin Heidegger. Heidegger posited that there are two patterns of being. The inauthentic mode in which individuals live anonymously and live automatically and the authentic mode in which individuals assume responsibility for their life and remain true to themselves. Existential psychotherapy involves a collaborative relationship between the therapist and client. This is what this learner views as the strength in this form of psychotherapy. The therapist is considered to be a guide who enables the client to move to a more authentic self and shares experiences with the client. Thus, the client has a ‘partner’ of sorts to help them understand lives trials and tribulations. This ‘encounter’, as it is described, is a critical concept of this therapy. The existential therapist/client relationship is unique, in that it allows the therapist to share their own experiences with their client to help guide and teach their clients. The weaknesses of this therapy are the limitations of the effectiveness for patients with more severe mental illnesses. In addition, this therapeutic approach may not work for patients who have very simple complaints, as Mendelwitz and Schneider state that these patients have not “yet confronted squarely the givens of existence” (Mendelowitz and Schenider, 2008, p. 311), and thus are still living inauthentically. It appears that other psychotherapy theories, such as Cognitive Therapy, Behavioral Therapy or Rational Emotive Behavioral Therapy may be useful to help these individuals move to an authentic state of being.

Reference
Mendelowitz, E.D., & Schneider, K. (2008). Existential psychotherapy. In R. Corsini & D. Wedding (Eds.), Current psychotherapies (pp. 293-327). Belmont, CA: Thompson

Career Plan November 23, 2010

This is an essay I wrote at the end of last quarter.

As my first Capella University course comes to an end, I am determined, more than ever to pursue my chosen Master’s Degree Program specialization and career plan of Clinical Psychology.  The APA College Dictionary of Psychology defines Clinical Psychology as “the branch of psychology that specializes in the research, assessment, diagnosis, evaluation, prevention, and treatment of emotional and behavioral disorders. The clinical psychologist is a doctorate-level professional who has received training in research methods and techniques for the diagnosis and treatment of various psychological disorders. Clinical psychologist work primarily in health and mental health clinics, in research, or in group and independent practices. They also serve as consultants to other professionals in the medical, legal, social-work, and community-relations fields.” (“Clinical Psychology”, 2009) I originally chose this specialization because, like many, I have a desire to help other people.  Psychology has always interested me and from having personal experience with clinical psychology and having seen the positive effects, I wanted, very much, to positively affect others.

Helping people solve their respective problems and learn to live a better life is, in my opinion, one of the most rewarding professions there is.  As Jeffery A. Kottler reminds us, “…there is no other profession, that can be as fulfilling and satisfying, no other job that provides as many opportunities for continual learning and growth.  Being a therapist is truly a lifelong journey, one which we accompany others on a road toward enlightenment or peace or salvation. (p. 1)” On the other spectrum of clinical psychology of severe mental health issues, solving maladaptive behaviors and how to correct or lessen psychological issues is extremely interesting to me.  Thus, enrolling in Capella University’s Clinical Psychology program was the logical next step.

Capella University’s requirements to complete a Master’s Degree in Clinical Psychology are the completion of a fourteen required courses, eight core and six specialization courses, totaling 70 quarter credit hours.  Included in these course requirements are 3 six-day residential colloquia.  As I enter my second quarter at Capella University I am en-route to completing Capella’s requirements for degree completion.  Currently, I intend on following the Capella ‘Recommended Course Sequence’ of two courses per quarter.  It is most important, while following this recommended course, to practice time management, as I am a nontraditional student I have many ‘hats to fill’, as it were.

As stated by the American Psychological Association of Graduate Students Committee on Ethnic Minority Affairs (2009), “Some graduate students, especially nontraditional students, play multiple roles and may have dependents in their care.  This requires navigating between their academic pursuits, family responsibilities, and their personal life.  Thus, maintaining balance in life while in graduate school is critical in the management of stress” (p. 7).  Maintaining said balance is critical to obtaining success, not only academic success, but familial and personal success as well.  This balance will also assure success after graduation.

To become a practicing clinical psychologist in New York State, there are several steps I must take.  After earning a Master’s Degree in Clinical Psychology, I must apply to be a doctoral candidate for clinical psychology in an accredited school. I must complete the doctoral degree in three years of full-time study, or the part-time equivalent. I am also required to have one year of supervised practicum, internship, field experience, or applied research. Additionally, I will need two years of full time post-graduate supervised field experience under a licensed supervisor. After this post-graduate experience, I must complete child abuse training and pass the New York State Examination for Professional Practice in Psychology.  Many people stress about successfully passing this exam.  However, I am confident I will encounter little to no problems.  I have been lucky enough to test very well on most standardized tests.   After passing Licensure I plan to work both in a mental health clinic and private practice. I hope to focus on African American mental illnesses and try to reduce the stigma associated with mental illness and counseling in the African American Community.

 

Whilst in my first Capella University course, I had the opportunity to interview a prominent African American psychology professional in my area.  I interviewed Dr. Karen Greene, Ph.D of the Rockland County Psychiatric Center in New York State.  I very much enjoyed talking to Dr. Greene.  She was very personable and informative.  She answered all of my interview questions in great detail and offered much advice for my continuing education.  The advice which affected me the most was her suggestion to do a sort of statistical power analysis of what I want to achieve and to map on what I need to do to get there.  Dr. Greene also informed me of the initiative New York State is taking for public mental health, such as companies employee psychologists to be available to staff for particular problems.  I was not aware of this initiative and was very interested to hear more about it.  Dr. Greene was also able to inform me of her personal experiences while in education.  As an African American woman, Dr. Greene may have faced some difficulties, however she did not let this deter her from her career path.  I was quite surprised by a comment she made regarding marketable skills.  Dr. Greene indicated that clinics are interested in people who can get make a fast turnaround with clients.  I was surprised by this because as I understood it, psychotherapy can be a lengthy process.  However, Dr. Greene explained that clinics want psychology professionals who can help clients quickly and give people the skills they need to get on with their life.  Explained in that manner, her comment made sense.  Dr. Greene was very knowledgable in the current hot topics in psychology.  She indicted Post Traumatic Stress Disorder is one of the most expanding areas of interest in the field.  Interestingly enough, this topic is within my profession of interest.

 

As I have chosen Clinical Psychology as a specialization, I would like to enter the psychotherapy profession.  This field allies itself with my goals as, as Raymond Corsini stated, “All modes of trying to help people improve themselves via symbolic methods can be called psychotherapy” (pg. 3).  As I have stated above, want to help people, and as such, psychotherapy does just that.  To be successful in the psychotherapy field one must have certain personal attributes.  A psychotherapist must exhibit compassion, interest in other people and in solving problems and require the ability to be open enough to engage in a healing relationship with another person.  A psychotherapist must also be aware of many different types of psychotherapies as what works for one patient, may not necessarily work for another.  Thus, a through education, such as at Capella is the best starting point.  I am excited and ready for my continuing education at Capella University and for entering my profession in the years ahead.

 

 

 

References

 

American Psychological Association of Graduate Students Committee on Ethnic Minority Affairs. (2009). APAGS resource guide for ethnic minority graduate students. Washington, DC: The American Psychological Association of Graduate Students.

“Clinical Psychology” (2009). VandenBos, G. (Ed.), APA college dictionary of psychology, (1st Ed.).Washington, DC: American Psychological Association

Corsini, R. J. (2010). Introduction.. In R. Corsini & D. Wedding (Eds.), Current psychotherapies (pp. 1-14). Belmont, CA: Thompson

Kottler, J. A. (2010). The therapist’s journey. On being a therapist. (pp.1-20). San Francisco, CA: Jossey-Bass.

 

Socioeconomic Status and Childhood Development November 22, 2010

A child’s language and reading development can generally be predicted through developmental stages.  However, socioeconomic status may affect the language and reading development of children.  Researcher Erika Hoff posits that “family socioeconomic status (SES) is a powerful predictor of many aspects of child development” (Hoff, 2003, p. 1368). Language development and reading development can correlate with socioeconomic status as children of a high socioeconomic status largely perform better than children of a lower socioeconomic status.  This is accounted for by the differences of family functioning, affluence, and macro-system of different socioeconomic status families.  Research has shown that families of lower socioeconomic status are, on the whole, of lower family interaction, lower affluence, more poverty stricken, and live in poorer areas than families of higher economic status.  These factors have been proven to have an affect on the language and reading development of children.

 

References

 

Berk, L. E. (2008). Exploring lifespan development (1st Ed.). Boston, Ma: Allyn & Bacon.

 

Broderick, P. C. & Blewitt, P. (2010). The life span: Human development for helping professionals (3rd Ed.). Upper Saddle River, NJ: Pearson.

 

Gray, P. (2007). Psychology. (5th Ed.). New York, NY: Worth

 

Hoff, E. (2003). The specificity of environmental influence: Socioeconomic status affects early vocabulary development via maternal speech. Child Development, 74(5), 1368-1378. doi:10.1111/1467-8624.00612