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The study also showed that impairment is most marked in the absorption phase as opposed to the elimination phase and that frequent cannabis users become less impaired than infrequent users cheap cipro online visa antibiotic resistant bacteria in dogs. More recent studies (69) conducted with volunteer marijuana smokers who were actually driving found that the main effect of marijuana was to increase lateral movement of the vehicle moder- ately within the driving lane on a highway (70 purchase discount cipro infection night sweats,71) order cipro 500 mg with mastercard antimicrobial journals impact factor. Opiates Single doses of narcotics can have marked effects on performance cheap generic cipro uk antibiotics for acne clindamycin, such as reaction time. However, most studies of opiates among regular users sug- gest that they do not present a hazard or exist as a significant factor in driving. Traffic Medicine 373 One study compared the effects of alcohol, diazepam, and methadone on cli- ents commencing or stabilized on a methadone program. The battery of tests showed no evidence for an effect of the acute dose of methadone; thus, cli- ents on a methadone program should not be considered impaired in their abil- ity to perform complex tasks, such as driving a motor vehicle. Thus, in the United Kingdom, persons on a stable methadone program who have not abused other drugs for 1 yr and who have clear urine drug screening tests regularly are allowed a driving license subject to annual review. However, it should be remembered that users of heroin are also prone to heavy use of other psycho- active drugs, such as cocaine, alcohol, and tranquilizers, which are all dan- gerous when it comes to driving. Thirty-four methadone substitution patients, all of them volunteers, were sub- jected to a battery of psychological tests. Twenty-one of these patients had to be excluded from the study because the toxicological analysis of repeated blood and urine samples revealed the presence (or possibly chronic use) of substances other than methadone. Of the remaining 13 (age range 26 to 42 years, 8 males and 5 females) 6 were selected who, based on the impression of the physicians, could be described as optimal methadone patients. Although some personality scales and psychopathological findings revealed shortcomings for a few of these patients, they could not be regarded as factors ruling out driver fitness, and the authors concluded that under certain conditions, long-term methadone mainte- nance patients under strict medical supervision do not suffer significant driv- ing impairment, providing that no other drugs have been taken. Cocaine and Methamphetamine Although the argument often goes unchallenged in court, all drugs do not, by definition, produce impairment. In fact, low to moderate acute doses of cocaine and amphetamine can be expected to increase positive mood, energy, and alertness, especially in nontolerant individuals (74). For that reason, radar operators and pilots of both Allied and Japanese armies were issued supplies of amphetamine. Many of the performance tasks related to driving can be improved, at least in the laboratory, by treatment with stimu- lants (75). Although the results of one retrospective autopsy study suggest that methamphetamine users seem more likely to be involved in traffic acci- dents (76), a driving simulator study (77) of young people who had taken 374 Wall and Karch ecstasy (3,4-methylenedioxymethamphetamine) showed that basic vehicle control is only moderately affected but risk taking is increased. It seems likely that abrupt discontinuation of either drug in a chronic user could result in driving impairment, but that situation has never been tested (70). Large doses can result in toxic psychosis with symptoms indistinguishable from paranoid schizophrenia, a condition that is extremely unlikely to improve driving per- formance. Sedative Hypnotics Benzodiazepines impair psychomotor performance in nontolerant indi- viduals, generally in a dose-dependent manner. Most of the widely prescribed benzodiazepines increase lateral lane movement and slow response time to a lead car’s change in speed. Several of the benzodiazepines (50 mg of oxazepam, 30 mg of flurazepam, and 2 mg of lormetazepam) predictably impair driving the morning after. Diazepam (15 mg) impaired performance on a clinical test for drunkenness, which comprised 13 tests assessing motor, vestibular, men- tal, and behavioral functioning (78,79). A recent study (80) showed a clear relationship between dose of benzodiazepines and risk of impairment, which the authors believed probably supported a limit for benzodiazepines and driv- ing as low as within the therapeutic range. Acute doses of many benzodiazepines slow response time in simple or choice visual reaction time tests and impair attentional performance and cause deficits that do not result from sedation. In fact, the impairment of sustained attention and vigilance in benzodiazepine users is the direct result of some as yet uncharacterized direct action on perceptual sensitivity (70). Multiple Drug Use Polydrug use is common and can result in complex interactions, with the drugs having additive, antagonistic, or overlapping effects. In a study on alcohol and can- nabis (81), it has been shown that when they are administered together, the result was one of additive impairment. However, in the laboratory setting, simultaneous administra- tion of alcohol and cocaine seems to minimize alcohol-related deficits (75). Over-the-Counter Preparations An increasing number of drugs can now be bought over the counter from pharmacies. The newer nonsedating antihistamines, such as terfenadine and astemizole, generally do not impair driving. However, one study that measured driving performance across differing doses of terfenadine found that performance was impaired at very high doses (240 mg), stressing the need to establish the behavioral effects of drugs over a range of doses (85). The second-generation group of antihistamines is less lipophilic than the pre- vious generation and thus cross the blood–brain barrier less readily, which accounts for the lower levels of sedation observed with the newer drugs. Thus, although the second-generation antihistamines generally produce less seda- tion than first-generation compounds, if therapeutic doses are exceeded, the so-called nonsedating antihistamines become sedating and can impair driving. Assessment in the Field by Police In the United Kingdom, if a police officer stops a driver, for whatever reason, and believes the driver is unfit to drive, it is highly likely that a road- side breath test will be conducted. That is not the case in the United States, where field breath testing is only permitted in some states, and then only for drivers under the age of 21 years (22). Stopping a vehicle is a seizure, but it may be reasonable if the police officer has a justifiable suspicion that an offense is being committed. This then gives them the probable cause to carry out subsequent tests similar to the Sec- tion 4 procedure to prove impairment. Until recently in the United Kingdom, police traf- fic officers received little or no training in the recognition of signs and symp- toms of drug effects. Police officers were trained to observe and document known indicators of drug use and impairment. Instead of breath testing, a series of standardized field sobriety tests, which include psychomotor and divided attention tests, is conducted. If alco- hol is suspected, the following tests are carried out: walk and turn test, one-leg stand, and the horizontal gaze nystagmus test. In addition, if drugs are sus- pected, a Romberg balance test is also carried out. Unlike chemical tests (with refusal to submit possibly resulting in immediate license suspension), drivers in the United States are not legally required to take any field sobriety tests; however, if the driver submits, the results can be introduced as additional evi- dence of impairment. These tests are all divided attention tests, which assess the individual’s balance and coordination, as well as the ability to follow simple instructions (i. They are as follows: • Horizontal gaze nystagmus: nystagmus may be caused by any number of condi- tions, but its presence could indicate drugs or alcohol. Eight impairment indicators are measured; if two of the eight are present, impairment would be indicated. Some drugs alter the body’s inter- nal clock and make the person act faster or slower than normal. Interview with the arresting officer: the purpose is to ascertain baseline informa- tion, including the circumstances of the arrest, whether an accident occurred, whether drugs were found, and if so, what they looked like. Preliminary examination: the purpose of the preliminary examination is to deter- mine whether if there is sufficient reason to suspect a drug offense and to try to exclude any underlying medical problems. General observations and details of any current medical problems are ascertained, and the first measurement of the pulse is taken. If no signs of drug influence are found, the procedure is termi- nated; if any medical problems are found, a medical assessment is obtained, and if drugs are still suspected, a full assessment is carried out.

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She finding greater meaning in life cipro 1000mg with visa virus and antibiotics, and of reach- found that the nursing partnership was very impor- ing new dimensions of connectedness with tant to the families as they struggled to make sense other people and the world” (1) buy 250mg cipro fast delivery antimicrobial wood sealer. The evolving pattern of these families included the social and political forces within the educational discount cipro 500 mg on-line antibiotics vs antibodies, disabilities support buy genuine cipro on-line antimicrobial guidelines 2013, and health care systems, as well as community patterns References of caring, prejudice, and racism (Falkenstern, 2003). Expanding the dialogue on praxis in nursing logue as these stories are shared and reflected upon. Pattern recognition as a nursing intervention ing communities in dialogue about what is mean- with Japanese women with ovarian cancer. Creating action re- on the task of engaging her or his country’s nurses search teams: A praxis model of care. Partnering of researcher and practicing nurses for transfor- doubt experience an expanded sense of health. Creating a healing environment for staff and practice and in the lives of their patients. The focus is not on predetermined monary obstructive disease: Isolation and being closed in. Life patterns of people with chronic ob- on fixing the patient, but rather is on part- structive pulmonary disease: Isolation and being closed in. Journal of Advanced Nursing, states, “The theory asserts that every person 47(3), in press. Symposium presentation at the International Council of Nurses 22nd versal process of expanding consciousness— Quadrennial Congress, Copenhagen, Denmark. Newman’s Theory of Health as Expanding Consciousness and Its Applications 233 Kiser-Larson, N. Evolution of the theory of health as doctoral thesis, University of Minnesota, Minneapolis. The process of health patterning in fam- Nursing Education, The nurse theorists: Portraits of excellence ilies with young children who have been repeatedly hospitalized. Unpublished doctoral thesis, University of New York: National League for Nursing Press. Pattern recognition as a nursing interven- Newman’s theory of health as expanding consciousness: A tion with adolescents convicted of murder. International Journal for Human Caring, toral thesis, University of Minnesota, Minneapolis. Health as expanding consciousness Web through a nursing partnership with adolescents convicted of site. Journal as expanding consciousness in research, theory, and practice of Gerontological Nursing, 12, 16–18. Health as expanding consciousness (2nd sciousness in research, theory, and practice. Newman’s theory of health as expanding ple with dementia living in a nursing home. King Introducing the Theorist Introducing the Theory Use of King’s Conceptual System and Theory Summary Introducing the Theorist nursing adults in hospitals. While working my way through college, I worked in a physician’s office as a My postsecondary education experiences included school nurse and as an occupational health nurse. John’s Hospital have always believed that as a teacher one must also School of Nursing in St. Louis, baccalaureate and be an excellent practitioner, so my experience as a master’s degrees in nursing from St. Louis Univer- teacher of nursing at undergraduate and graduate sity, and a doctor of education from Teachers levels included practice. Postdoc- sity, Chicago; the Ohio State University; and the toral study included work in advanced statistics, University of South Florida, advancing from assis- systems research, and computers. Continuing tant professor to full professor and now as profes- education is an ongoing process. The history, and philosophy with emphasis on science most recent are the Jessie Scott Award for Leader- and ethics. The University of Tampa (Society) Department of Nursing named the annual research award given to students the “Imogene M. I also appear in Who’s (Individuals) Who in America, American Women, and Who’s Who in Nursing. Introducing the Theory Continuous discoveries in telecommunications and technology, and a daily bombardment of infor- mation about world events bring complexity to one’s life that is unprecedented in history. As in- process for developing a conceptual system is dividuals, we are born, grow, and develop within explained. A goal attainment from my conceptual system is sense of a global community can be understood as demonstrated. The application of this conceptual we view the interactions of individuals and groups system and Theory of Goal Attainment is discussed with linguistic, ethnic, and religious differences. My first theory publication pronounced the prob- The commonality in my worldview is human lems and prospect of knowledge development in beings who communicate and interact in their nursing (King, 1964). Over 30 years ago, the prob- small groups within their nations’ social systems; lems were identified as (1) lack of a professional that is, human environments as well as physical en- nursing language; (2) atheoretical nursing phe- vironments. Concept development is a continuous represent interconnected links for information pro- process in the nursing science movement (King, cessing in a high-tech world of health care and 1988). This conceptual system provides one ap- My rationale for developing a schematic repre- proach to structure a world community of human sentation of nursing phenomena was influenced beings, who are the recipients of nursing care. King’s Theory of Goal Attainment 237 interaction in those works influenced my ideas rel- framework”), and the result was the publication of ative to organizing a conceptual frame of reference a book entitled Toward a Theory of Nursing (King, for nursing, as shown in Figure 16–1. From being, commonly referred to as an “individual” or a my initial set of ideas in 1968 and 1971, my con- “person. For example, the concept of ings (ontology) and to the nature of knowledge perception has been studied in psychology for (epistemology). The literature indicated that most of the early studies dealt with sensory perception. From this research literature, I in systems research, I was introduced to a philoso- identified the characteristics of perception and de- phy of science called General System Theory (Von fined the concept for my framework. This philosophy of science searching literature for knowledge of each of the gained momentum in the 1950s, although its roots concepts in my framework. Von Bertalanffy, credited “Searching for scientific knowledge in nursing is an with originating the idea of General System ongoing dynamic process of continuous identifica- Theory, defined this philosophy of science move- tion, development, and validation of relevant con- ment as a “general science of wholeness: systems of cepts” (King, 1975). A concept is elements in mutual interaction” (Von Bertalanffy, an organization of reference points. This philosophy different types according to the different sources of gave me the impetus to focus on knowledge their meaning.... A concept is a term to which development as an information-processing, goal- meaning has been assigned. System Theory provides a holistic approach to The concept development and validation study nursing phenomena as an open system and process is as follows: frees one’s thinking from the parts-versus-whole dilemma.

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To integrate the tasks (12–20 years) role mastered in the previous confusion stages into a secure sense of self Young adult- Intimacy vs discount cipro 1000mg on-line treatment for dogs coughing and gagging. To form an intense cheap 250mg cipro antibiotics reduce bacterial biodiversity, lasting hood isolation relationship or a commit- (20–30 years) ment to another person purchase cipro 1000mg antibiotics for dogs cephalexin, a cause buy 1000mg cipro visa antibiotics used for facial acne, an institution, or a creative effort Adulthood Generativity To achieve the life goals while vs. Differentiation Commencement of a primary recogni- tion of separateness from the mothering figure 10–16 b. Practicing Increased independ- months ence through loco- motor functioning; increased sense of separateness of self 16–24 c. Rapprochement Acute awareness of months separateness of self; learning to seek “emotional refueling” from mothering figure to maintain feeling of security 24–36 months d. Consolidation Sense of separate- ness established; on the way to object constancy (i. Punishment and Behavior is moti- (common from obedience vated by fear of ages 4 to orientation punishment 10 years) 2. Interpersonal Behavior is (common from concordance motivated by ages 10 to 13 orientation the expecta- years and into tions of others; adulthood) strong desire for approval and acceptance 4. Social contract Behavior is moti- tional (can legalistic vated by respect occur from orientation for universal adolescence on) laws and moral principles and guided by an internal set of values 6. Psychiatric/mental health nursing: Concepts of care in evidence-based practice (6th ed. She acknowl- alcohol Preventing attended edge the every day unaccept- nursing existence and cannot able or school to of a real stop fails to undesirable please her situation or acknowl- thoughts or parents. Identifica- A teen- Repression: An accident tion: ager who Involuntar- victim can An attempt required ily blocking remember to increase lengthy unpleasant nothing self-worth rehabilita- feelings and about his by acquir- tion after experiences accident. Intellectuali- S’s husband Sublimation: A mother zation: is being Rechan- whose son An attempt transferred neling of was killed to avoid with his job drives or by a drunk expressing to a city far impulses driver actual emo- away from that are chan- tions asso- her parents. Introjection: Children Suppression: Scarlett Integrating integrate The O’Hara the beliefs their par- voluntary says, “I and values ents’ value blocking of don’t want of another system unpleasant to think individual into the feelings and about that into one’s process of experiences now. On his feeling tone and raped, experience way home or emotion without that one he stops associated showing finds intol- and buys with it. Projection Sue feels a Attributing strong sexual feelings or attraction impulses to her track unacceptable coach and to one’s self tells her to another friend, “He’s person. Psychiatric/mental health nursing: Concepts of care in evidence-based practice (6th ed. This is congruent with Peplau’s (1962) identification of counseling as the major subrole of nurs- ing in psychiatry. If Sullivan’s (1953) belief is true, that is, that all emotional problems stem from difficulties with interpersonal relationships, then this role of the nurse in psychiatry becomes especially meaningful and purposeful. The therapeutic interpersonal relationship is the means by which the nursing process is implemented. Tasks of the relationship have been categorized into four phases: the preinteraction phase, the orientation (introductory) phase, the working phase, and the termination phase. Although each phase is presented as specific and distinct from the others, there may be some overlapping of tasks, particularly when the interaction is limited. The Preinteraction Phase The preinteraction phase involves preparation for the first encounter with the client. Obtaining available information about the client from the chart, significant others, or other health-team members. Examining one’s feelings, fears, and anxieties about work- ing with a particular client. For example, the nurse may have been reared in an alcoholic family and have ambivalent feel- ings about caring for a client who is alcohol dependent. All individuals bring attitudes and feelings from prior experi- ences to the clinical setting. The nurse needs to be aware of how these preconceptions may affect his or her ability to care for individual clients. The Orientation (Introductory) Phase During the orientation phase, the nurse and client become acquainted. Establishing a contract for intervention that details the expectations and responsibilities of both the nurse and client 3. Developing a plan of action that is realistic for meeting the established goals 8. Exploring feelings of both the client and the nurse in terms of the introductory phase. Introductions are often uncom- fortable, and the participants may experience some anxiety until a degree of rapport has been established. Several interactions may be required to fulfill the tasks associated with this phase. The Working Phase The therapeutic work of the relationship is accomplished during this phase. Maintaining the trust and rapport that was established dur- ing the orientation phase 2. Overcoming resistance behaviors on the part of the client as the level of anxiety rises in response to discussion of painful issues 5. A plan for continuing care or for assistance during stress- ful life experiences is mutually established by the nurse and client. Through these interactions, the client learns that it is acceptable to un- dergo these feelings at a time of separation. Through this knowledge, the client experiences growth during the pro- cess of termination. Note: When the client feels sadness and loss, behaviors to delay termination may become evident. If the nurse experi- ences the same feelings, he or she may allow the client’s behaviors to delay termination. For therapeutic closure, the nurse must establish the reality of the separation and resist being manipulated into repeated delays by the client. Giving Allows the client to “What would you like to broad take the initiative talk about today? Placing the Clarifies the relation- “What seemed to lead event in ship of events in up to...? Helps the “What was your client recognize life response the last experiences that tend time this situation to recur as well as occurred? Perhaps you especially well with and I can discuss it a client who is mov- together. This technique is not therapeutic, how- ever, with the client who is very anxious. Exploring Delving further into a “Please explain that subject, idea, experi- situation in more ence, or relation- detail. Especially “Tell me more about helpful with clients that particular who tend to remain situation. However, if the client chooses not to disclose further in- formation, the nurse should refrain from pushing or prob- ing in an area that obviously creates discomfort. Seeking Striving to explain “I’m not sure that I un- clarifica- that which is vague derstand.

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Broadbent’s infor- $20 had been given a justification for lying: they could mation theory of attention buy discount cipro 250mg antibiotic resistance medical journals, learning cipro 750mg discount antibiotics sinus infection npr, and memory; and tell themselves that their actions made some kind of Miller buy cipro with paypal infection knee replacement, Galanter generic cipro 750mg online antibiotic nasal rinse, and Pribram’s analysis of planning and sense. Thus they acted to re- ment duce the dissonance by changing their original belief. Children have shown similar responses to experi- Further Reading mental situations involving cognitive dissonance. New Those children who had accommodated the polite request York: Oxford University Press, 1987. However, the children who were threatened felt no pressure to change their opinions about the toy since they had a logical reason for giving it up. In post-decision dissonance, a person must de- cide between two choices, each of which has both posi- An influential concept in the study of the relation- tive and negative components (in other contexts, this type ship between attitudes and behavior. Forced compliance dissonance occurs when people First proposed by Leon Festinger in 1957, the theo- are forced to act in ways that conflict with their beliefs ry of cognitive dissonance is based on the principle that and can not find any way to justify their actions to them- people prefer their cognitions, or beliefs, to be consistent selves. Dissonance also occurs when people are exposed with each other and with their own behavior. Various group situations also generate cognitive makes people uneasy enough to alter these ideas so that dissonance. Cognitive processes (which may involve language, symbols, or imagery) include perceiv- ing, recognizing, remembering, imagining, conceptualiz- ing, judging, reasoning, and processing information for planning, problem-solving, and other applications. Some cognitive psychologists may study how internal cogni- tive operations can transform symbols of the external world, others on the interplay between genetics and en- vironment in determining individual cognitive develop- ment and capabilities. Still other cognitive psychologists may focus their studies on how the mind detects, selects, recognizes, and verbally represents features of a particu- lar stimulus. Among the many specific topics investigat- ed by cognitive psychologists are language acquisition; visual and auditory perception; information storage and retrieval; altered states of consciousness; cognitive re- structuring (how the mind mediates between conflicting, or dissonant, information); and individual styles of thought and perception. The challenges of studying human cognition are ev- ident when one considers the work of the mind in pro- cessing the simultaneous and sometimes conflicting in- formation presented in daily life, through both internal and external stimuli. For example, an individual may feel hunger pangs, the external heat of the sun, and sensa- Group situations sometimes create cognitive dissonance. A tions of bodily movement produced by walking while si- potential member of a group will change his or her opinions multaneously talking, listening to a companion, and re- to conform to the group’s collective opinion. Although important inroads continued to be made into the study of mental processes—including the Further Reading Festinger, Leon. Since the 1950s, cognitive approaches have assumed Cognitive psychology a central place in psychological research and theorizing. An approach to psychology which focuses on the One of its foremost pioneers is Jerome Bruner, who, to- relationship between cognitive or mental processes gether with his colleague Leo Postman, did important and behavior. De- which approached development from a different angle spite skepticism that computer-generated “thought” will than—and mostly complement—those of Piaget, focus ever match human cognition, the study of artificial in- on the environmental and experiential factors influencing telligence has helped scientists learn more about the each individual’s specific development pattern. In turn, this type of psychological research is expected to aid in the development of more sophisti- In 1957, Leon Festinger advanced his classic theory cated computers in the future through links between the of cognitive dissonance, which describes how people psychological study of cognition and research in electro- manage conflicting cognitions about themselves, their be- physiology and computer science. Festinger posited that con- nitive engineering focuses on the application of knowl- flict among such cognitions (which he termed disso- edge about human thought processes to the design of nance) will make people uncomfortable enough to actual- complex systems for aviation, industry, and other areas. Thus, for example, the conflict- At one time, the study of cognitive processes was ing cognitions “I smoke” and “smoking is bad” will lead specific to cognitive psychology. As research began to a smoker either to alter the first statement by quitting, or yield information regarding the applicability of these the second one by telling himself or herself that smoking processes to all areas of psychology, the study of cogni- is not bad. Miller tive processes was taken up and applied in many other established the Harvard Center for Cognitive Studies, subfields of psychology, such as abnormal and develop- which became influential in the “cognitive revolution. Today, the term “cognitive perspec- As a result, an increasing number of experimental psy- tive” or “cognitive approach” is applied in a broader chologists abandoned behaviorist studies of rats and sense to these and other areas of psychology. This trend in psychology paralleled ad- therapy; Cognitive development; Information-processing vances in several other fields, including neuroscience, approach mathematics, anthropology, and computer science. In 1953, the term “psycholin- guistics” was coined to designate an emerging area of Cognitive therapy common interest, the psychology of language, and Noam Chomsky,aprofessor at the Massachusetts Insti- Cognitive therapy is a psychosocial therapy that as- tute of Technology, became its most famous proponent. The treatment focuses on changing ture, of all languages is the same and that human mastery thoughts in order to adjust psychological and per- of it is genetically determined, not learned. Berlyne’s work on curiosity and in- formation seeking; George Kelly’s theory of personal Psychologist Aaron Beck developed the cognitive constructs, and investigations by Herman Witkin, Riley therapy concept in the 1960s. The treatment is based on Gardner, and George Klein on individual perceptual and the principle that maladaptive behavior (ineffective, self- cognitive styles. In- The emergence of cybernetics and computer science stead of reacting to the reality of a situation, an individ- have been central to contemporary advances in cognitive ual automatically reacts to his or her own distorted view- psychology, including computer simulation of cognitive point of the situation. Cognitive therapy focuses on processes for research purposes and the creation of infor- changing these thought patterns (also known as cognitive mation-processing models. Herbert Simon and Allen distortions), by examining the rationality and validity of Newell created the first computer simulation of human the assumptions behind them. This process is termed thought, called Logic Theorist, at Carnegie-Mellon Uni- cognitive restructuring. Other major contributions in this Cognitive therapy is a treatment option for a number area include D. It is also tures of behavioral modification into the traditional cog- frequently prescribed as an adjunct, or complementary, nitive restructuring approach. In cognitive-behavioral therapy for patients suffering from back pain, cancer, therapy, the therapist works with the patient to identify rheumatoid arthritis, and other chronic pain conditions. Patients may have certain fundamental core beliefs, known as schemas, which are flawed, and are having a Cognitive therapy is usually administered in an out- negative impact on the patient’s behavior and function- patient setting (clinic or doctor’s office) by a therapist ing. For example, a patient suffering from depression trained or certified in cognitive therapy techniques. Ther- may develop a social phobia because he/she is convinced apy may be in either individual or group sessions, and he/she is uninteresting and impossible to love. A cogni- the course of treatment is short compared to traditional tive-behavioral therapist would test this assumption by psychotherapy (often 12 sessions or less). Therapists asking the patient to name family and friends that care are psychologists (Ph. The therapist asks the patient to defend behavioral techniques such as conditioning (the use of his or her thoughts and beliefs. If the patient cannot positive and/or negative reinforcements to encourage de- produce objective evidence supporting his or her as- sired behavior) and systematic desensitization (gradual sumptions, the invalidity, or faulty nature, is exposed. The patient is asked to imagine a ly reintroduce the patient to social situations. When the patient Preparation is confronted with a similar situation again, the re- Cognitive therapy may not be appropriate for all pa- hearsed behavior will be drawn on to deal with it. The therapist and patient then review lationship is critical to successful treatment. Individuals the journal together to discover maladaptive thought interested in cognitive therapy should schedule a consul- patterns and how these thoughts impact behavior. The consultation session is similar to an in- reinforce insights made in therapy, the therapist may terview session, and it allows both patient and therapist to ask the patient to do homework assignments. During the consultation, the may include note-taking during the session, journaling therapist gathers information to make an initial assess- (see above), review of an audiotape of the patient ses- ment of the patient and to recommend both direction and sion, or reading books or articles appropriate to the goals for treatment. They may also be more behaviorally focused, learn about the therapist’s professional credentials, applying a newly learned strategy or coping mecha- his/her approach to treatment, and other relevant issues.

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