The research design used in all three case studies is a case study and decided not to use survey method, as it is to the most of research work on the bases of time, budget and population. In this case the author decided to use case study because saving time and being efficiency in the studding the case. The author succeed on understanding the full background of the all characters and understanding the full situation of their condition.
The researcher used the abductive research approach, according to this approach start with surprising facts or puzzles and research process is devoted their explanationBryman .A, Bell. E, (BusinessResearch Method 4th ed,2015). For an example in our case studies,the researcher just observed the patients on how they act and therefore he/she came to find why they are reacted that way. It’s not impossible for the researcher to start observing Josie 57 years of age since she was a kid, that is to say the researcher observed Josie when she was abusing people who pass near her house on the road. That lead him/her to start observing her and start connect her past since she were a child up to the current situation. In abductive interference known the findings lead to generate the conclusion that can be tested.
The researcher used quantitative techniques method because it offers a complete description and analysis of a research subject, without limiting the scope of the research. For an example in Austin case study, the author goes into details on looking his background on how he raised, how the parent situation was, how the relationship was with his parents in his childhood whether if it lead her to affect him on his current situation. If the researcher would choose to go with qualitative techniques, he would get to know only roughly in advance on the case studies.
Data Collection Method and Tools
Data collection method used by the researcher it seem to be an observation to the characters, the researcher spent more time on observing the character. Based on the presentation of the case studies it does not shows that the characters were interviewed, for an example Josie case study, the author is presenting from his observation not on what he/she heard from the character/patient. This technique it is useful but if the researcher would do an interview, he was most likely to get more details of the patient because interview carry successively skills collecting the data (Gill, Johnson 2002).
Sample selection method used by the researcher it seems to be non-probability sampling techniques because sample members are selected on the basis of their understanding knowledge with the phenomena, relationship and expertise regarding research subject (pg6. Langos s. Independent Study 2014 September n,d). In our case studies, researcher present all three characters/patient who are undergoing depression or whose have anhedonia symptoms, therefore researcher succeed on using this technics compared if he would decide to use probability sampling.
In all three case studies are not subjected on ethical issues, firstly the patients was being observed without his/her concern and there is nowhere in the case study where the researcher showed that they were interviewed and also the researcher does not mentioned anywhere that the names and place mentioned their not real. That is to say, there Josie in U.K who her parents are French, she grew in South Africa, and she moved to U.K for her Husband and also the behavior which are highlighted in the case study such as abusiveness, drunk, insulting are there without her concern. This method used by the researcher it’s not good because it is harm or abuse the right of the person on her privacy. Suggestion to the researcher will be to find consent from the character or patient before present it or the researcher to inform that the names and place used in a case studies are synonymous.
As it for every study to has its limitations, as it to these,
- The study was limited to use large sample, where probably the large sample would lead to enhance the reliability of the study and also depending with the research subject needed small sample so to get deeply detailed information regarding depression.
- Qualitave technique it was not applied due to it always consuming time, have high expense and has less ability on generalizing the conclusion and also it is recommended during early stage of the research
- All of case studies were limited on using conception theory on relating with the research subject. The study was all about finding the background of the patients and the current situation, which there are passing through at the moment.
Case Study: Josie, aged 57
- To explain how risk and protective factors may be operating to produce Josie’s current situation.
Risk factors referred as characteristics at the biological, psychological, family, community or cultural level that precede and are associated with higher likelihood negative outcomes while protective factors characteristics associated with a lower likelihood of negative outcome or that reduce a risk factors impact. Protective factors may seen as positive countering events. 2015, February 10(Samhsa). Lack of parental guidance, academically challenges, undiagnosed mental health problems, bad peer influence, aggressive behavior poverty and other similar to it are risk factors
Family, high habit on drinking, low self-esteem, untreated pains and aches, hardy socialization, racism and sexism was risk factors lead to Josie current situation, whereby family support and love, confidence, physical health and fitness are the protective factors on Josie current situation. The following are the risk factors and protective factors on Josie current situation,
Mastery is how people have a control after things happened to them. If a person will person will perceive what happen to him/her as problem and let it disturb her that will be a risk factors to depression, but if he/she will perceive what happened as a challenge and start looking for a solution to it, it will turn to be a protective factors to Depression or anxiety. For example, Josie perceive the death of her husband as a problem, which lead her into intensive fear, anxiety disorder. But if Josie perceived the death of her husband as a normal thing that death is the must for everyone and to let it go, starting taking care of herself and the house, her perceive approach would be as protective factors to depression.
Self-esteem it may stand as risk factors or protective factors to depression, it will just depend the patient will perceive it towards what happened to him/her. Low self-esteem of the person it will be a risk factors to depression while high self-esteem for a person will be protective factor towards depression. (Georgia State University) 2017, October 25. Self-esteem is the confidence one’s own worth. Low self-esteem highly contribute to Josie depression after death of her husband
Family support play an important role as protective factors toward stressor exposure, (P.g 5,WHO, 2012, August, 27). But, if family support will not be there to a person when he/she passing on difficult situation it will be risk factor toward depression. From a Josie case study the researcher did not show that Josie was given support from family support from her children and from her friends and that is what lead Josie into depression.
Cognitive/emotional immaturity and barriers in communication,(P.g 3,WHO, 2012, August, 27) well-being makes up an integral part of an individual's capacity, Josie situation, is now different with other normal human being because she cannot make better decision for herself. But also, Josie had a French Parents but she grew in South Africa and at her 22 years of age she moved to U.K, this tell us her socialization life it had been very tuff with the people around her since she her childhood. Her husband was her only major companion of all time and when he died changed Josie life, Josie feels like everyone else to her is like no body that led her to become so obsessed with other people, insulting them but she feels okay. Josie situation needed to be taken care off, by ways of which will help to manage her mental stability with counseling so she can start interacting with others.
Medical illness and substance use,
Medical illness and substance use for a long would stand as risk factors to depression to a patient, (Robichaud, Dugas, &Conway, 2003 n.d). This is because it makes him/her feel like is not okay like others and that will lead to low his/her confidence and cause stress. For example, Josie she was experiencing aches and pain for quite some time and after losing her husband, she has been experiencing medical illness such as head lightening, shaking, high heartbeat (Anderson et Al, 19987; Lewissohn et al 1998), where all of this are risk factors, which lead to causing depression.Medical attention and physical fitness are protective factors on her current situation.
Social Change and Socialization
Social changeis the alteration of mechanisms within the social structure characterized by changes in cultural symbols, rules of behavior, social organization, or value system Form W &Wilterdink (Sociology: Britannica Encyclopedia). While Socialization is the processwhich people are taught to be proficient member of the society. Little W. &McGivern (Chapter 5, Introduction to Sociology 1st edition Canadian). Social change may stand as risk factors to a depression if person will fail to copy with it, and that will lead to negative imagery event to the person. While socialization will stand as protective factors where it will be reducing the effect of social change by making a person to cope with society. In our case study,Josie her parents were French people but she grew in South African and at her 22 years of age she moved to U.K. She has been changing society since she was young, all the challenges she was passing through on adaptive to a new society it was standing as risk factor to depression. Where by, when she was coping with new society that was socialization which stand as protective factor to depression and that is what shee need more at her current condition now.
Conclusion, Josie she has been affected anxiety disorder, death phobia and anhedonia symptoms, which lead to affect her mental health and cause her fails to make the decisions to suit her life and choosing how she can leave. At this point, she need psychological support on making her mind again and start making positive imagery in her life again. What Josie passing through it has become a global problem, which need attention from all countries on preventing mental detoriation to the citizens.
- Use psychological research and literature to suggest an approach which will help facilitate Josie’s recovery from her current situation
Cognitive behavior therapy (CBT) addresses the cognitive abnormalities in individuals that are a striking feature of depression and anxiety. For patients who suffer from depression biases towards negatively toned emotional expression are common. Changes in social life place a heavy burden on individuals and symptoms such as those exhibited by Josie are common (Anastopoulos et al., 2018). Cognitive behavior therapy is a widely discussed talk therapy that has been constantly compared with medication treatment in achieving better patient outcomes in psychiatric symptom treatment. How CBT works has been explained by Hayes and Hofmann (2017). A therapist helps in identifying the false or negative thoughts as demonstrated by the patient. Thereafter, these thoughts are placed by more realistic and positive ones. First, the therapy makes the patient aware of the feeling and the underlying reasons behind them. The therapist then teaches the patient to swap them for feelings that are positive and motivational. The change in the attitude of the patient leads to behavioral changes. This helps in addressing conditions such as depression and death anxiety. The research stated that decreases in death anxiety and related depression can be significantly reduced through CBT. Therefore CBT can be considered to be useful for addressing Josie’s psychological distress.
The approach to CBT with death anxiety, health anxiety and depression would focus on careful assessment and tailored intervention. In majority of patient scenarios where death anxiety and health anxiety are both major concerns, treatment for both is primarily interwoven (Greer et al., 2010). In the present case it is found that Josie has been suffering from both death anxiety and health anxiety. The other elementary components of the treatment process would be reducing excessive checking, safety and reassurance behavior; increased focus on life goals; cognitive reappraisal; development of a healthy lifestyle and prevention of relapse (Schoulte, 2012). It would be a significant step to carry out a thorough assessment of Josie in relation to her feelings and opinions so that the situations can be better understood. It would be important to ask Josie specifically about the fear she suffers from. General questions are to be asked first regarding her mental status. When they indicate that Josie has been suffering from death anxiety and Anhedonia symptoms, further additional questions are to be asked for broadening the understanding of patient situation. This would also help in establishing a strong therapeutic relationship with the client.
Checking, reassurance seeking and other safety behaviors are crucial in cases of death anxiety and depression. Examples of checking behaviors are monitoring of blood pressure, monitoring pain levels and checking for weight gain or loss. Reassurance checking includes asking a friend or other about death concerns. Safety behaviors include stereotypes use of foods. Josie is to be asked to monitor them using a dairy. The aim would be to identify baseline frequency of such behaviors and the consequence of such behaviors. Josie would as a result be able to identify the actions that make her more vulnerable to anxiety. Recording the situations causing anxiety, the related thoughts, and the initial anxiety level is needed. Understanding the anxiety pattern would be helpful for planning a robust response prevention approach (Easterbrook & Meehan, 2017). Subsequently the therapist is then to discuss approaches to response prevention such as stopping such behaviors or postponing the same. Emphasis is to be given on keeping the behaviors at a realistic level since increased stress would lead to further anxiety and fear. Cognitive reappraisal holds much importance as Josie would be supported to more towards more balanced views of life. At present she has a negative approach towards life and is discontent with her social life. The therapist would be able to provide corrective information on the basis of personal experiences with illness and death. It is evident that the death of her husband has instilled a fear of death in Josie and her thoughts are related to uncertainty of what would happen as she comes in contact with the outer world. Josie is to be encouraged to communicate with people in her neighborhood by visiting to the supermarket and the local park that would help her to develop some acceptance and tolerance of uncertainty (Furer & Walker, 2008).
As opined by Brenes et al., (2015) when clients are in stress and struggle to cope up with the fear of death, the attention is diverted from enjoying life. In the present case, Josie feels uncomfortable with people regularly moving by her home, though these people could have acted as social support to her. For addressing this concern, it is required to plan relaxation time and enjoyable activities that would be aligned with the preferences of Josie. The focus would be on helping her to learn to live the moment instead of having fear of the possibilities of future loss. Such activities include kitting, painting, writing dairy (Egger et al., 2016). Other activities might be interesting reading, watching television and spending time with a friend. Participating in these mindfully takes the patient one step closer to the aim of the therapy. Leading a healthy lifestyle is important for eliminating negative thoughts and feelings. Factors contributing to stress are to be eliminated that reduce satisfaction level in life (Hofmann & Asmundson, 2017). The main concerns in relation to Josie’s lifestyle are isolation, restricted social support, death of partner and unhealthy aspect of lifestyle in the form of drinking. A problem solving approach would be crucial to individually address the highlighted concerns. The important step would be to encourage Josie to quit drinking. This can be done through referring to a local support group for substance abuse.
Most of the clients recovering from death anxiety are prone to suffer increased symptoms even though progress has been achieved. Josie might be losing faith in the coping strategies at different points in time through the therapy. She is therefore to encourage having realistic expectations about how each incidence in life and each social change have implications for the future in a positive manner. Emotional support is pivotal for confronting the challenges faced in daily life due to isolation, and for Josie same is necessary. When patients experience increased anxiety, they are to be given encouragement for continually applying what have been taught to them to prevent relapse of undesirable condition. As a follow up treatment for Josie, she is to be encouraged to handle threats to her life by accepting that no apparent threats to life are present in every life situation (Hofmann & Otto, 2017).
- Identify the barriers and facilitators to effective implementation of this approach
The growing and sustained popularity of CBT has been well noted across practice domains. As highlighted by Dobson and Dobson (2016) the structured nature of the comprehensive process makes it less complicated for application. Nevertheless numerous challenges are faced while implementing the individual steps of CBT and the extent of the barriers depend on the nature of the client. In addition, each patient scenario has certain embedded facilitators for CBT implementation. A therapist is to identify the each of the barriers and facilitators for success of the therapy.
From the present case study it is identified that the age of Josie and her education level would act as the facilitators for successful implementation of therapy. As highlighted by Easterbrook and Meehan (2017) age of the client acts as a crucial factor in the success of cognitive therapies. This relates to the stage of lifespan in which the client is. Since Josie is fifty seven years old and is not much aged, it would be less complicated to proceed with the therapy. in case the patient was an older adult, it would have taken more efforts to carry out the same steps of therapy. Further, Josie has a decent level of education and had been working as a nurse. This implies that she is known to a number of people who have been in contact with her before her retirement. It would be easier to find sources of social support amongst those individuals.
At this juncture it would be advisable to understand the barriers on implementing therapy for Josie. Josie has limited motivation for change as she lives alone and does not have any immediate family member. It might be difficult to establish motivating factors for her in the first stages of the therapy. Helping her to focus on the benefits of the therapy might be difficult. Establishing therapeutic relationship with Josie might also be a problem. Both the therapist and the patient have expensive roles in bringing therapy to practice. Client-therapist is a partnership and since both are to work with equal efforts it might be challenging to demonstrate patience while communicating with Josie since she has the tendency to speak in abusive language (Furer & Walker, 2008). Demonstration of skills is entailed for achieving positive outcomes. The researchers relate that how the relationship between the client and therapist develops provides insight into how fast success would be achieved in care.
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