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On the other hand 150mg bupropion free shipping depression out of the shadows, in the propyl group buy bupropion with american express anxiety 029, the next set of atoms consists of one C and two H atoms bupropion 150mg without prescription depression symptoms test online. For example N C C O as if it were C O C N as if it were C N O C N C (d) Having decided on the priority of the four groups cheap bupropion 150mg on line anxiety leg pain, one has to arrange (rotate) the molecule in such a way that group 4, i. It is then necessary to designate all these stereoisomers using the (R) and (S) system. All four stereoisomers of 2,3,4-trihydroxybutanal (A–D) are opti- cally active, and among them there are two enantiomeric pairs, A and B, and C and D, as shown in the structures below. Other pairs of diastereomers among the stereoisomers of 2,3,4-trihydroxybutanal are A and D, and B and C. However, because one half of the tartaric acid molecule is a mirror image of the other half, we get a meso structure. Hence, we have a meso-tartaric acid and it is achiral (since it has a plane of symmetry, and it is superimposable on its mirror image). Cyclic compounds Depending on the type of substitution on a ring, the molecule can be chiral (optically active) or achiral (optically inactive). For example, 1,2-dichlorocyclohexane can exists as meso compounds (optically inactive) and enantiomers (optically active). When there are substituent groups attached to the double bond, they can bond in different ways, resulting in trans (opposite side) and cis (same side) isomers. The conversion occurs because the p bond breaks when energy is absorbed, and the two halves of the molecule can then rotate with respect to each other before the p bond forms again. G H G G C C C C H G H H trans-Isomer cis-Isomer Substituent G is on opposite sides Substituent G is on same side on the double-bonded carbons on the double-bonded carbons When there is the same substituent attached to the double bonded carbons, as in the above example, it is quite straightforward to designate trans or cis. However, if there are more than one different groups or atoms present, as in the following examples, the situation becomes a bit more complicated for assigning cis and trans. Cl H Cl Cl F H C C C C C C Br Cl Br H I Cl Alkenes with different substituents on the double-bonded carbons To simplify this situation, the E/Z system is used for naming geometrical isomers. Z stands for German zusammen, which means the same side, and E for German entgegen, meaning on the opposite side. So, once the priorities are assigned, we can easily draw the (E)- and (Z)-isomers of 1-bromo-1,2-dichloroethene in the following way. Cl H Cl Cl C C C C Br Cl Br H (Z)-1-Bromo-1,2-dichloroethene (E)-1-Bromo-1,2-dichloroethene The two higher priority groups are on the same side The two higher priority groups are on the opposite side Now, let us have a look at the cyclic compounds. We can use this (E) and (Z) system for a cyclic compound when two or more groups are attached to a ring. For example, if in the following substituted cyclopentane A and B are different groups, each C atom attached to A and B is a chiral carbon or stereocentre. H H H H H H H H B H H H H H H H * * * * A H A B (E)-form (Z)-form The two higher priority groups (A or B > H) The two higher priority groups (A or B > H) are on the opposite side are on the same side In 1-bromo-2-chlorocyclopentane, there are two chiral centres. One is an optically inactive meso isomer (cis or (Z)-isomer) and two are optically active trans or (E)-isomers. Thus, with trans structure, we obtain di-axial and di- equatorial bonds, and with cis structure we obtain axial–equatorial bonds. All drugs are chemical entities, and a great majority (30–50 per cent) of them contain stereocentres, show stereoisomerism and exist as enantiomers. Moreover, the current trend in drug markets is a rapid increase of the sales of chiral drugs at the expense of the achiral ones. In the next few years, chiral drugs, whether enantiomerically pure or sold as a racemic mixture, will dominate drug markets. It is therefore important to understand how drug chirality affects its interaction with drug targets and to be able to use proper nomenclature in describing the drugs themselves and the nature of forces responsible for those interactions. Most often only one form shows correct physiological and pharmacolo- gical action. For example, only one enantiomer of morphine is active as an analgesic, only one enantiomer of glucose is metabolized in our body to give energy and only one enantiomeric form of adrenaline is a neurotransmitter. Not only drug molecules, but also various other molecules that are essential for living organisms exist in stereoiso- meric forms, and their biological properties are often specific to one stereoisomer. Thus, it is important to understand stereochemistry for a better understanding of drug molecules, their action and toxicity. The (R)-form is completely inactive, although it is slowly converted in the body to the active (S)-form. The drug marketed under the trade names, commercially known as 1 1 1 1 1 1 1 Advil , Anadin , Arthrofen , Brufen , Nurofen , Nuprin , Motrin etc. The drug, however, caused severe adverse effects on thousands of babies who were exposed to this drug while their mothers were pregnant. The drug caused 12 000 babies to be born with severe birth defects, including limb deformities such as missing or stunted limbs. Later, it was found that thalidomide molecule can exist in two stereoisomeric forms; one form is active as a sedative, but the other is responsible for its teratogenic activity (the harmful effect on the foetus). O O O * N N * O N H H N H O O O O H Sedative Teratogenic Thalidomide stereoisomers Limonene is a monoterpene that occurs in citrus fruits. Two enantiomers of limonene produce two distinct flavours: (À)-limonene is responsible for the flavour of lemons and (þ)-limonene for orange. Similarly, one enantiomeric form of carvone is the cause of caraway flavour, while the other enantiomer has the essence of spearmint. The pure S-enantiomer works remarkably well in the prevention of migraine and is now under clinical evaluation. In the absence of any chiral influence, the outcome of such reactions is the formation of a racemic form. For example, hydrogenation of ethylmethylketone yields a racemic mixture of 2-hydro- xybutane. To carry out an enantioselective reaction, a chiral reagent, solvent, or catalyst must assert an influence on the course of the reaction. In nature, most of the organic or bioorganic reactions are enantioselective, and the chiral influence generally comes from various enzymes. The active site in any enzyme is chiral, and allows only one enantiomeric form of a chiral reactant to fit in properly. Enzymes are also used to carry out enantioselective reactions in the laboratories. Lipase catalyses a reaction called hydrolysis, where esters react with a molecule of water and are converted to a carboxylic acid and an alcohol. The use of lipase allows the hydrolysis to be used to prepare almost pure enantiomers. Therefore, it is important to purify the racemic mixture so that active enantiomer can be obtained. The separation of a mixture of enantiomers is called the resolution of a racemic mixture. Through luck, in 1848, Louis Pasteur was able to separate or resolve racemic tartaric acid into its (þ) and (À) forms by crystallization.

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Hygroscopicity is a measure of the capability as tablets discount 150 mg bupropion with visa anxiety disorders in children, several creams and ointments discount bupropion 150mg on-line bipolar depression treatments, intraocu- of a drug to absorb water from the atmosphere; lar solutions purchase 150 mg bupropion fast delivery anxiety children, suppositories cheap bupropion 150mg fast delivery bipolar depression and divorce, intrarectal foams, such drugs gain weight with time, are often less injections and eardrops. Even newer drugs, with stable than drugs lacking this property, and may fewer indications than hydrocortisone, seek greater thus predicate an aluminium foil packaging. Stan- market acceptability by providing a variety of dard manuals such as Merck Index provide many of alternative formulations (e. This can achieve Oral formulations include tablets, syrups, wafers and suspension according to the excipients used. Bulking agents (sometimes called relatively low systemic drug concentration, dilutants, or, confusingly for a solid formulation, avoiding toxicity; diluents) include lactose and cellulose; these increase tablet weight, which can improve produc- probably the most common applications of this tion uniformity. Silica and starch may also be used principle are the administration of beta-adrenergic to improve the flow of powder in mass production, agonists bronchodilators by inhalation and the use when they are known as pro-glidants. Coatings are often sugars or Formulation characterization cellulose and may be employed when a drug tastes foul. Particular color schemes can be created with Various physicochemical properties of bulk drug dyestuffs or iron oxide. Benzocaine lozenges are tions should accommodate at least three half intended for the same purpose but to dissolve times of their elimination. For combination therapies, these end points have to be measured and fulfilled for all active compo- Bioequivalence and generic products nents, and the therapies should not be administered separately. Although the subject of their own chapter in this The regulation does not define what a significant book, it should be emphasized here that there is no difference might be, although a commonly applied regulatory requirement for innovative and generic standard seems to be a formulation whose mean drugs to have identical excipients. The À1 the solubility of the drug is <5mgml ; regulation states that bioequivalence is ‘... For example, two oral formula- tions can be compared with an intravenous dose Collection of blood samples for at least three half of equal or unequal size. If the drug is concentrated times of elimination and at a frequency that in the urine but has negligible concentration in captures distribution phase, Cmax and Tmax, all the blood (e. The usual protections for human that have different rates of dissolution and can subjects are required, and, of course, these also be designed to release their contents only in include an approval from the Institutional relatively alkaline environments (i. It is illogical to seek sustained release formulations for drugs with relatively long half times of elimination (amiodarone, Sustained release oral formulations frovatriptan). By definition, sustained release formulations differ pharmaceutically and pharmacokinetically from Oral transmucosal formulations the innovator drug. The excipients and particle sizes (usually larger) of the formulation are The best drugs for oral transmucosal administra- designed to dissolve more slowly and are almost tion are those that have high potency and do not always drugs for chronic diseases. For example, among opioids, buprenor- advantages are reduction in dose frequency (and phine and fentanyl are the two drugs that have thus, hopefully, improved patient compliance; see been successfully developed using this type of that chapter in this book) or reduction of Cmax for a formulation. The disastrous fire inside the command The physics of gases and the partial pressure at capsule of Apollo 3, during a launch rehearsal on which they can achieve anesthesia is beyond the Pad 39B at Cape Kennedy, started in a pure oxygen, scope of this chapter. Reduction in total subject begs the question of how the state of atmospheric pressure and excipient nitrogen has anesthesia can be measured, and this is one of the since been employed in all pressurized American more difficult clinical trial end points. One wit, a space vehicles, but they still contain supra-atmo- famous British cardiothoracic anesthesiologist, has spheric partial pressures of oxygen, and a fire was commented, ‘If you can tell mewhat consciousness recently reported in the Russian–American Space is, then I will tell you what anesthesia is’! Gas flow can be ary to insert, at this point, a graph that relates measured with various devices, and exhaled gas aerosol particle size to the penetration by drugs concentrations (including carbon dioxide) can now of various levels of the airway. A rare adverse event, are stated to commonly impact in the pharynx, malignant hyperthermia, is associated with the those <5 mm are assumed to be ideal for alveolar inhalation of halogenated hydrocarbons (as well delivery and those <0. This is blocking drugs), and this can be treated with intra- an oversimplification. Particle deposition is actually dependent on a There are some uses for gaseous drugs outside of large number of factors, attested to by a vast litera- surgery. Nitrous oxide and oxygen mixtures are ture in the fields of respiratory medicine, pulmon- sometimes used as analgesics during labor or ary physiology and industrial hygiene. These when transferring patients in pain by road or heli- factors include (with example studies) copter. In very cold weather, nitrous oxide can liquefy, reducing the delivered dose; shaking the coughing (Camner et al. The use of this 1985); mixture as prophylaxis against nitrogen narcosis at high inspired pressures (deep sea divers) or to mucous production and ability to expectorate minimized fire hazard is also well described. Patients apnoeic pause at the end of inhalation (Legath are often burned when on oxygen therapy for lung et al. Inhaled insulin is studied on the basis of the physicochemical properties of the drug(s) both pharmacodynamic and pharmacokinetic (Zanen et al. In the absence of the ability to quantitate lung sampling techniques on which exposure calcula- deposition, most modern labels specify the combi- tions are based (Cherrie and Aitken, 1999). The British Association for Lung Research has recognized this complexity and issued a consensus statement (Snell and Ganderton, 1998) which Intranasal formulations recommends, at a minimum, a five-stage collection apparatus, examination of a range of particle sizes The absorptive capacity of the nasal mucosa has 0. The opposite pharmacokinetic aspiration is activated charcoal in to minimize systemic absorp- illustrated by anti-allergy and decongestant drugs tion of drug that was swallowed after affecting the which are now administered via the noses in the oropharynx and further development of better sta- developed world literally by the tonne: here, the tistics for analyzing the data. Cal- domestic refrigerators, industrial refrigeration citonin and vasopressin-like drugs (nonapeptides) plants and cattle-generated methane, this contribu- for diabetes insipidus in patients with panhypopi- tion to protecting the atmospheric ozone layer must tuitarism are examples. Nonetheless, these huge drug re- There is a specific guidance document from the development costs are now being borne by health- International Conference on Harmonization which care systems worldwide. Topical uses include treatments for Can- guideline is to facilitate the development of generic dida albicans, and Trichomonas infections, as well products for use by this route of administration, it as for preparation of the cervix prior to induction of has been challenged on several scientific and tech- labor. At the time of writing (May 2006), Transdermal and topical formulations there is controversy over whether mifepristone is associated with greater clinical hazard when The principal distinction between transdermal and administered per vagina in comparison with topical drugs is that only the former is intended for being swallowed. Both are subject to the same skin irritancy testing prior to human exposures; precli- nical and clinical skin irritancy testing is reason- Injectates (s. The solubility of a drug and the compatibility of a Evading this barrier is not easy, because drugs must particular solvent with the site of injection are traverse both live dermis and dead epidermis. Lipo- interrelated factors governing the suitability of philic drugs tends to form a reservoir in the former, this route of administration and the pharmaceutical even after traversing the hydrophobic latter. The route of admin- oral transmucosal administration, potent drugs, istration may also be governed by tolerability with modest requirements for mass absorbed and aspects associated with the formulation. If a drug reasonable lipophilicity, are the best candidates for cannot be dissolved in a concentrated manner in a transdermal delivery. Fentanyl, nicotine and sco- suitable vehicle, then often dose size must polamine are good examples. For example, intravenous injections of Suppositories are probably the clearest illustra- penicillin-type antibiotics are much more comfor- tion of cross-cultural differences in pharmaceuti- table than when the same dose is administered cals. For the upper limb veins tolerate these alkaline solutions acute treatment of migraine, oral drugs are often with impunity, but the solutions are very damaging vomited (sumatriptan). For treating acute asthma, when administered occasionally and iatrogenically children often cannot use an inhalational device into the cubital fossa; a solution at pH 9 can cause properly (theophyliine).

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The interven- edge development through the scholarship of tion has also been tested with low-income single practice; nursing knowledge is developed in mothers who were identified as being at-risk for de- practice as well as for practice” (Reed discount bupropion 150mg with amex bipolar depression treatments, 1996 buy bupropion 150 mg otc depression definition and meaning, p order cheap bupropion line bipolar depression forums. Peplau used observations in clinical situa- Plans are underway to continue to test the inter- tions as the basis for hypotheses and interven- vention with other at-risk groups to continue to tions that were then tested in clinical practice cheap bupropion 150mg fast delivery mood disorder lithium. Peplau’s Process of Practice-based Theory Development and Its Applications 65 data) provides a creative nonlinear approach to B. Interpersonal theory in nursing practice, as well as extant theories as the basis practice: Selected works of Hildegard Peplau. Journal of Psychiatric and tative, in-depth look at a phenomenon, a Mental Health Nursing, 2, 77–84. Recovering from depression: A one-year an intervention directed at the phenomenon. The evolution of an intervention: The use of highly revolutionary at the time; few of her Peplau’s process of practice-based theory development. Negative thinking mediates the effect of self-esteem on de- based theory development as a research pressive symptoms in college women. The identification of a clinical Preventing depression in high-risk college women:A report of problem and an in-depth look at its etiology, an 18-month follow-up. As interven- Negative thinking and the mental health of low-income single tions were tested and supported in clinical re- mothers. Applied Peplau’s theory to examine the psychosocial factors associated Psychological Measurement, 1, 385–401. Hildegard Peplau meets family systems nursing: Innovation in theory-based practice. Journal of Psychiatric and Mental Health parts: Martha Rogers and Hildegard Peplau. Treating depression through the nurse- ing movement of chronic psychiatric patients from the orien- client relationship. Nursing Clinics of North America, 33, tation to the working phase of the nurse-client relationship 153–172. Professional Nurse, 10(4), versal for women in a primary care setting: A pilot study. Personal, impersonal, and interpersonal rela- Psychiatric Nurses Association, 6, 119–125. Peplau’s Process of Practice-based Theory Development and Its Applications 67 practice... A therapeutic behavior Thoughts on completion of translation of basic principles of scale. Journal of the American Psychiatric Nurses Association, for developing self-awareness. Research in Nursing and Health, 2(1), Perspectives in Psychiatric Care, 18(2), 67–89. A personal responsibility: A discussion of framework for application in nursing practice. Professional closeness as a special kind of involvement with a patient, client or family group. Peplau’s Process of Practice-based Theory Development and Its Applications 69 Peplau,H. Ernestine Wiedenbach, Virginia Henderson, and Ernestine Wiedenbach died in April 1998 at the age Ida Jean Orlando are three of the most important of 98 (Gesse & Dombro, 1992, p. The work of each of these nurse scholars was based on Ida Jean Orlando was born in 1926 in New York. Concepts College School of Nursing where she received a and terms they first used are heard today around diploma in nursing. John’s University in Brooklyn, New York, and these three important twentieth-century nursing in 1954 she completed a master’s degree in nurs- theorists. Orlando’s early work from scholars who have studied or worked nursing practice experience included obstetrics, with these theorists and who wrote chapters about medicine, and emergency room nursing. Her first each for Nursing Theories and Nursing Practice 1st book, The Dynamic Nurse-Patient Relationship: edition. To the extent possible, content written by Function, Process and Principles (1961), was based each of the identified authors is used. For a wealth on her research and blended nursing practice, of additional information on these nurses, scholars, psychiatric–mental health nursing, and nursing ed- researchers, thinkers, writers, practitioners, and ed- ucation. It was published when she was director ucators, please consult the reference and bibliogra- of the graduate program in mental health and phy sections at the end of this chapter. She received a bachelor of arts degree from tative and inductive, using naturalistic inquiry Wellesley College in 1922. As a consultant at McLean Hospital in Johns Hopkins School of Nursing in 1925 (Nickel, Belmont, Massachusetts, Orlando continued to Gesse, & MacLaren, 1992. After completing a study nursing practice and developed a training master of arts at Columbia Univeristy in 1934, she program and nursing service department based on became a professional writer for the American her theory. With two opment of prescriptive theory (Dickoff, James & of her brothers serving in the armed forces during Wiedenbach, 1968). Even after her retirement in World War I and in anticipation of a critical short- 1966, she and her lifelong friend Caroline Falls of- age of nurses, Virginia Henderson entered the Army fered informal seminars in Miami, always remind- School of Nursing at Walter Reed Army Hospital. It ing students and faculty of the need for clarity of was there that she began to question the regimen- purpose, based on reality. She even continued to talization of patient care and the concept of nurs- use her gift for writing to transcribe books for the ing as ancillary to medicine (Henderson, 1991). Her pioneer work in the area of “series of almost unrelated procedures, beginning identifying and structuring nursing knowledge has with an unoccupied bed and progressing to aspira- provided the foundation for nursing scholarship tion of body cavities” (Henderson, 1991, p. Henderson admired Goodrich’s intel- Introducing the Theories lectual abilities and stated: “Whenever she visited our unit, she lifted our sights above techniques Virginia Henderson, sometimes known as the and routine” (Henderson, 1991, p. Henderson modern day Florence Nightingale, developed the credited Goodrich with inspiring her with the definition of nursing that is most well known inter- “ethical significance of nursing” (Henderson, 1991, nationally. Ida Jean Orlando was perhaps the ence forever influenced her ethical understanding first nurse to use qualitative research methods and of nursing and her appreciation of the importance was the first to articulate nursing concepts based on and complexity of the nurse-patient relationship. Each of these She continued to explore the nature of nursing nurses helped us focus on the patient, instead of on as her student experiences exposed her to different the tasks to be done, and to plan care to meet needs ways of being in relationship with patients and of the person. For instance, a pediatric experience caring based on the perspective of the individual as a student at Boston Floating Hospital introduced being cared for—through observing, communicat- Henderson to patient-centered care in which ing, designing, and reporting. Each was concerned nurses were assigned to patients instead of tasks, with the unique aspects of nursing practice and and warm nurse-patient relationships were encour- scholoarship and with the essential question of, aged (Henderson, 1991). She enjoyed the less formal vis- Initial work on Wiedenbach’s prescriptive theory is iting nurse approach to patient care and became presented in her article in the American Journal skeptical of the ability of hospital regimes to alter of Nursing (1963) and her book, Meeting the patients’ unhealthy ways of living upon returning Realities in Clinical Teaching (1969). She entered Teachers tion of prescriptive theory is that:“Account must be College at Columbia University, earning her bac- calaureate degree in 1932 and her master’s degree “Account must be taken of the motivating in 1934. She continued at Teachers College as an in- factors that influence the nurse not only in structor and associate professor of nursing for the doing what she does but also in doing it next 20 years.

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If the odds of a bad outcome are high order bupropion with american express definition for depression in economics, go to the Worst-Case Scenario strategy in the next section of this chapter purchase bupropion with visa mood disorder worksheets, where you can find techniques for coping with bad outcomes cheap 150mg bupropion visa bipolar depression or manic depression. Worksheet 6-22 My Replacement Thought Imagining the worst The preceding section shows you how to rethink risks because buy bupropion us mood disorder 5 year old, in general, when people are depressed or anxious, they greatly overestimate the odds of bad things happening. Chapter 6: Indicting and Rehabilitating Thoughts 95 But just in case you’re starting to think otherwise, we’re not trying to convince you that bad things never happen. Imagining yourself dealing with worst- case scenarios is a useful exercise because it helps you understand that you can get through whatever it is that you fear. The following example shows you how the Worst-Case Scenario Quiz helps Martha make a decision and develop a replacement thought for her malicious thought. Since her painful divorce, she’s had a number of casual dates, but work and raising her child have kept her attention away from develop- ing a serious relationship. Now at age 50, Martha has fallen in love with someone special, and he feels the same way. She predicts that if she commits to the relationship, her companion will ulti- mately reject her, and she couldn’t stand that. Martha identifies her most malicious thought as, “I’d rather be alone forever than risk the pain of rejection again; I don’t think I could deal with that. A year from now, I suspect I’ll be sad, but I think I’ll be getting over the worst of the rejection. If this relationship doesn’t work, I think I’ll volunteer to work with Habitat for Humanity in another country. Now, Martha’s ready to devise a more realistic replacement thought (see Worksheet 6-24). Now I feel more like taking the risk, committing myself to this relationship, and seeing what happens. Take one of your most malicious thoughts and use the Worst-Case Scenario strategy to devise an effective response to that thought. When you find yourself thinking of a worst-case scenario that you think you can’t cope with, write down your most malicious thought. Rehabilitate your malicious thought with a replacement thought written in Worksheet 6-26. Reflections on Chapter 6 This chapter is full of exercises and ideas for overcoming anxious and depressed thinking. After completing the exercises and looking at your thoughts in new and different ways, take time to reflect on your new insights using the space in Worksheet 6-27. Some folks grab glasses off the nightstand, others need to get up and put in their contacts to see better. What most people don’t know is that everyone’s vision of reality is altered by special life- lenses. Life-lenses are strongly held beliefs or assumptions that you have about yourself, your relationships with others, and your world. Life-lenses powerfully influence how you respond to, interpret, and feel about events, but you may not be aware that you look through them. On the other hand, you probably know a few folks who view the world through dark, gloomy shades. Your views of people, events, and even your self-image depend upon which lenses you look through. This chapter helps you realize whether your lenses are dirty, cracked, smoky, colored, or clear. A quiz shows you which lenses you look through and how they may cause you emotional trouble, and the exercises demonstrate how to change problematic life-lenses. For example, it’s not a bad idea to assume that day follows night, taxes must be paid, food is located at grocery stores, most drivers stop at red lights, and hard work usually pays off. Think about how snarled traffic would be if no one assumed that red means stop and green means go. Or just consider how much time you’d waste if you searched for food in department stores, schools, and libraries rather than assuming that you’d find it in grocery stores. These assumptions or beliefs color the way you feel about yourself and the things that happen to you. Or perhaps you have a vulnerable life-lens and thus assume that the world is a dan- gerous place. As we explore assumptions (that is, life-lenses) such as these, you can see that they form the foundation of your most distressing emotions, such as depression, anxiety, worry, irritability, apprehension, and even anger. These themes directly influ- ence the kinds of thoughts you have and, in turn, how you feel about what happens to you. Although Susan and Diane are both well qualified, a nurse from another hospital gets the job. Susan reacts with anger and comments, “I deserved that job; the administration had no right to give that job away. She feels gloomy and says, “I’m sure they made the right deci- sion picking someone else. She believes that she always deserves the best; Susan feels that the world owes her and that if she wants something, it should be hers. She thinks that she’s not good enough and that others have more skill and talent than she does. Diane assumes that she couldn’t do the job even though her supervisor told her she has the appropriate ability and background. Susan’s entitled life-lens makes her prone to tension and anger when her needs aren’t met. Diane’s inadequacy life-lens steers her in the direction of depression when her adequacy is called into question. Susan and Diane apply their respective life-lenses to many different events in their lives. For example, when they’re both caught in an unexpected traffic jam, they view the event through their own life-lenses and thus experience different thoughts and feelings. Susan’s entitled life-lens leads her to feel rage and have thoughts like, “No one in this town knows how to drive. After all, changing the way you feel starts with identifying your problematic life-lenses. If you aren’t aware of your own life-lenses, you’re powerless to do anything about them. The questionnaire in Worksheet 7-1 is designed to clarify which life-lenses may be causing you trouble. After you identify them, we tell you a little more about how they work, where they come from, and most importantly, what you can do about them. Before you start mark- ing the life-lenses in the worksheet that apply to you, consider the following tips: Answer as honestly as possible. Sometimes, people respond how they think they “should” answer rather than responding with honest self-appraisals.

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