Dissertation – A Critical Evaluation of the Effectiveness of Cognitive Behaviour Therapies for Children and Adolescents with Anxiety Disorders
Research into the effectiveness of cognitive behavioural therapy for anxiety disorders has previously mainly focused on adults. However, there has been an increase of research into the effectiveness of cognitive behaviour therapy for children and adolescents, albeit studies remain scarce. This dissertation aims to examine the effectiveness of cognitive behavioural therapies available to children and adolescents with anxiety disorders.
This critical literature review analyses the available literature, offering a critical evaluation of the most used forms of cognitive behaviour therapy: group and family cognitive behavioural therapy, individual cognitive behavioural therapy and computerised cognitive behavioural therapy.
Cognitive Behaviour Therapy
Furthermore, this research outlines a range of key findings, identifying numerous difficulties found in treating children and adolescents with anxiety disorders as well as considering what is needed for cognitive behaviour therapy to be effective. Some of the issues found to affect the overall effectiveness of cognitive behaviour therapy include non-compliance, parental involvement, drop-out and the strength of the therapeutic relationship. The main conclusions propose that cognitive behavioural therapies for children and adolescents with anxiety disorders are effective from the outset, but upon further analysis, may not be as effective as many professionals suggest.
The aim of this dissertation is to examine the effectiveness of cognitive behavioural therapy (CBT) in children and adolescents with anxiety disorders. Through carrying out an extensive literature review using secondary data, this piece of research will gather and critically analyse evidence for and against the effectiveness of cognitive behaviour therapy for children and young people with anxiety disorders.
More specifically, this dissertation will critically analyse the effectiveness of the most widely used forms of CBT: family and group based cognitive behaviour therapy, individual cognitive behaviour therapy and computerised cognitive behaviour therapy. A comparison between approaches will be made in the discussion whereby suggestions will be made upon which form of CBT is the most effective for children and adolescents with anxiety disorders.
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Cognitive neuroscience is the study of the neurobiological substrates which is responsible for human cognition and seeks to reveal the neural circuits hidden in the human mental processes. This included learning, perception about things and events, and attention. The focus of the cognitive neuroscience researchers understands the brain mechanism responsible for auditory functions, musical processing and emotional exhibitions (Mataró, 2017).
Cognitive neuroscience also seeks to understand the neural mechanisms that enable predictive processes and the effects they might have on perception. It also sees to how the predictions that were formulated can influence the understanding of our environment. It is also included in this study, the calculation strategies used in solving arithmetical problems, and the level of difficulties that mathematics enthusiasts face when engaged in numerical analysis.
Neuropsychology is a clinical application of findings in the field of neuroscience. It seeks to know how brain disorders or brain injuries can cause a defect in cognitive functions and human behavior. Another area in neuroscience is the analysis which happened to cognitive ability resulting from aging and deteriorative illness, and also the mechanism used in brain reorganization following a fatal brain injury (Mataró, 2017). It studies how cognitive function can be improved in patients who have slight cognitive deficiency through the use of non-invasive stimulated techniques. Part of the neuro-scientific studies is finding out the effects of cerebrovascular diseases and that of the neuroprotective interventions in neurobiological mechanisms such as cognitive training and physical exercises.
Other research areas have their focus on the differentiating factors in central nervous system functioning of people with normal weight and obese (overweight), as well as the coexistence of severe mental disorders and substance use disorders. It also does the analysis of learning disorders such as nonverbal learning disability and dyslexia.
Some of the techniques used by neuroscientists include genetic studies, cognitive test, and neuro-imaging techniques likes of magnetic resonance imaging.
Neuro-imaging is conceived as techniques which are used in producing brain images without necessarily performing surgery on patients with brain damages or problems, nor cutting of the skin, or any form of contact with the endo-body (Jnguyen, 2012).
Neuro-imaging techniques give doctors and neuroscientists the clear view of activities and problems occurring in the brain without carrying out brain surgery on the patient (Demitri, 2016). There are more than five safe neuro-imaging techniques used in medical facilities throughout the world, but three are most common. These techniques include; functional Magnetic Resonance Imaging (fMRI), Computerized Tomography (CT), and Positron Emission Tomography (PET) (Jnguyen, 2012). Others include electroencephalography (EEG), Magnetoencephalography (MEG), and Near Infrared Spectroscopy (NIRS) (Demitri, 2016).
Functional Magnetic Resonance Imaging (fMRI)
Functional magnetic resonance imaging is a technique of measuring the activities of the brain, through the analysis of how blood is flowing in the brain. An MRI scanner detects changes in blood oxygenation and flow that occurs as a result of neural activity. This is because, when the brain is at work, it uses more oxygen at the active area. (Demitri, 2016).
A functioning MRI scanner uses a strong electromagnet which helps to generate forms strong magnetic field within the scanner. It causes randomly spinning protons in the brain which align with the direction of the field. Also, the proton will continue to spin while they are in alignment and exhibits a wobbling top behavior. The frequency of their wobbling is referred to as resonance.
The protons, when placed in a strong magnetic field and energy, is delivered to them at a particular resonant frequency, they will absorb energy with a great efficiency. In MRI, radio waves are used to provide the force needed to make the protons move (Jnguyen, 2012).
The benefits of using fMRI include the fact that it does not involve radioactivity, and there have been no reports of side effects resulting from the use of magnetic field and radio waves. Also, fMRI is not expensive, non-invasive, and readily available and provide a wide range of excellent temporal and partial resolution.
Computerized Tomography (CT)
Computerized tomography is a neuroimaging technique that makes use of x-rays in generating pictures of the inside of the body. It gives a picture of the human brain in accordance with the differential absorption of x-rays. It has been used widely in medical diagnosis to plan, guide and monitor brain therapy.
A computerized tomography makes use of X-rays placed at different angles to produce images of the human brain.
When conducting computerized tomography scans, a movable x-ray source will be rotated around the subject’s head. Detectors are put in place to record the intensity of the rays that are transmitted while the computer simultaneously combines the snapshots taken by the movable x-ray machine and arrange them to form a 3D cross-sectional image. This can be used by the doctors and researcher to get more information about the brain (Jnguyen, 2012).
Advantageously, computerized tomography scan is painless, cost effective and fast in usage. It can provide images of bones, tissues and blood vessels simultaneously. However, the patient is exposed to the risk of cancer as result of exposure to radiation from the x-ray scanner.
Positron Emission Tomography (PET)
Positron Emission Tomography uses tracers or radioactivity labeled molecules in the blood stream which have been taken up by active neurons. When these materials become decay as a result of radioactivity, a positron will be emitted; this can be picked up by the detector. PET studies the flow of blood through the brain and the metabolic activities of the brain which helps to picture changes in biochemical processes of the brain (Demitri, 2016). PET is however used to indicate whether the brain is functioning properly.
The trace is a substance like glucose which can be broken down into the activities of cells in the body, where it is labeled with a radioactive isotope. The risk involved is very low because the amount of radiation is low and the isotope can be easily removed from the body by urination.
When the tracer is introduced into the bloodstream, the isotope will start to decay which makes it less radioactive later. During this process, a positron is released, and when it collides with an electron, it will produce gamma ray as a result of the positron and electron eliminating one another. The two produced gamma rays will travel in opposite directions and they will try to leave the patient’s body. These rays can then be detected by two detectors set at 1800 from each other, and it is recorded as a coincidence event. The computer will then determine the source of the gamma rays in the subject’s brain and then generate a 3D image.
As an added advantage, PET can detect other diseases in the body system which often occurs before one can observe the changes in the anatomy. Also, the movement of the subject does not affect the quality of the output, although the image may not be very clear in some cases. Also, the use of radiation can be injurious to the subject’s health.
These are some of the popular techniques used by neuroscientists in neuroimaging, all of them have their own advantage and their disadvantages. However, they are used in the treatment of neuro-diseases such as Alzheimer, Dementia, and Parkinson.
Alzheimer’s disease has been found to be a generic cause of dementia, and it has been confirmed to be responsible for about 50% of identified dementia cases. This is because a loss of memory is the symptom that is mostly identified with affected patients (EssayEmpire, 2017).
Alzheimer is known to be a progressive and degenerative disease known to cause sporadic regression in the cognitive ability of an individual. It is identified by the prevalence of neuron and synapse loss. It often leads to the appearance of plaques and tangles (B-amyloid and tau aggregate) in the human brain (Bussey, 2015).
The German physician and neuropathologist, Alois Alzheimer was the first to identify the presence of plaques and tangles in the human brain. In 1907, he carried out an autopsy on a woman who died of dementia, and he discovered the occurrence of histopathologic alterations in form of neurofibrillary tangles and neuritic plaques.
Another characteristic of this disease is the change in the function of the affective domain; the patient tends to be partial in judgment and reasoning. In addition, the patient may have a defect in his language function, constructional abilities.
Dementia is a gradual and persistent occurrence of deterioration in the cognitive function of human brain. It affects the intellectual abilities and behavioral pattern of an individual. It can affect the individual’s ability to excel in certain daily activities like housekeeping, driving, attending social functions, keeping daily sales record etc. Changes are also noticed in personality and the individual’s emotions (CNADC, 2017).
As against the widespread beliefs, dementia is not peculiar to aging, it results from diseases which affect the brain. The influence of dementia is felt on all aspects of mind and behavioral pattern, including language ability, ability to give concentrations, visual perception, temperament, memory, sound judgment ability, social interaction etc.
Dementia should however not be perceived as a single disease, it is a combination of signs and symptoms indicating multiple diseases or even injury in the brain (CNADC, 2017).
Parkinson disease is a disorder caused by degeneration of the nervous system and affects the mostly the motor system (NINDS, 2016). It cannot be easily detected as the symptom comes very slowly as one grows in age. The first sets of signs that occur include shaking of the arms and legs, difficulty in walking and slow movement. With this is thinking and behavioral problems, depression, and anxiety are also noticed with people suffering from Parkinson disease. Also, Parkinson patients tend to suffer a lack of sleep, sensory problems and emotional problems (Sveinbjornsdottir, 2016).
The causes of Parkinson disease has been traced to both genetic and environmental factors. They are easily transferred among generations especially in families where it has been occurring. Also, when an individual is exposed to some form of pesticides or he has a brain injury, he is likely to have Parkinson disease. However, smoking tobacco or consuming coffee does not really have any effect on the likelihood of suffering from the disease (Kalia & Lang, 2015).
Bussey, T. (2015) Alzheimer’s Disease. Retrieved April 29, 2017, from Translational Cognitive Neuroscience Lab.
CNADC. (2017) Memory, Dementia & Alzheimer’s Disease. Retrieved April 27, 2017, from Northwestern Medicine | Northwestern University.
Demitri, M. (2016, July 17) Types of Brain Imaging Techniques. Retrieved April 28, 2017, from Psych Central.
EssayEmpire. (2017) Alzheimer’s Disease Research Paper. Retrieved April 29, 2017, from Research Paper.
Jnguyen. (2012, April 02) Neuroimaging. Retrieved April 29, 2017, from Huntington’s Outreach Project for Education.
I hope you enjoyed reading this post on Cognitive Neuroscience Diseases. There are many other Nursing Dissertation Titles that should be of interest to marketing students and practitioners. There are many dissertation titles that relate to other aspects of marketing such as branding, corporate advertising, marketing strategy and consumerism to name a few. I would be grateful if you could share this post via Facebook and Twitter. Feel free to add your thoughts in the comments section. Thank you.
The many aspects of mental health education among mental health consumer groups or their families; case study of Schizophrenia
The traditional format of the health care involves a clinician or a health worker being the major decision making factors on the modality of treatment, with a relatively insignificant proportion of inputs from the consumers. However, in modern settings such inputs from the targeted consumer population are highly appreciated, especially in chronic and debilitating disease management, where concerted efforts of the clinical staff, patients and their families is essential in tackling the disease. A key to such inputs and interactions is to raise the awareness of the targeted consumers or their families on the various aspects of the disease, its monetary and social costs, as well as to raise the psychological acceptance of the patients in the society. Mental health is one such area where beneficiary interactions between the patients/caretakers and the providers of health services on the many aspects of the decision making could be of maximum utility. This is because of mental health disorders are not only generally chronic in nature, but also because social interactions play equal role as much as medicine in the successful treatment of the disease.
Schizophrenia is a chronic and debilitating mental health disorder, with an abnormal social behaviour and failure of objective thinking. Confused state of mind, hallucinations, abject thinking and lack of motivational thinking are some of the general symptoms of the disease. There is also a higher rate of suicidal thinking among the schizophrenic patients. While both a genetic makeup as well the conditions of upbringing have been shown to influence the disease, the general understanding is that schizophrenia is a syndrome, with multiple or complex causative factors. Due to the complex and the chronic nature of the disease, prolonged or even lifelong treatment is essential. In addition, social rehabilitation as well as sympathetic public perception and counselling are extremely necessary for the successful management of the disease condition. Due to the generally poor social interactions and abject thinking, it is important that the patients and associated family members or caregivers are aptly educated on the various available modalities of therapy as well as being provided with the necessary moral support of the institutions and health workers who are involved in the treatment of the patient.
Benefits of educating the consumers of schizophrenia treatment
Close observation, sympathetic care, timely therapeutic interventions are extremely essential for schizophrenia cases and it is important that the care givers are also educated on the many aspects of successful and prolonged care. In many developing countries, the family of the patient is the primary effectors for the care of the patient due to constraints of money, lack of physician’s effective attention time and poor number of supporting staff. In such a scenario proper education of the consumers not only ease the process, but also helps in relieving the psychological distress of the patient. Proper education also helps in dealing with the caregiver’s stress and maintaining a healthy environment around the patient who needs a social support more than the medicines. If the family of a patient is properly educated, they are well informed about the illness and are more “skilled” to deal with their deceased relative. Moreover, it also helps in a smooth process of settling insurance claims, money management and availing welfare benefits from the designated agencies. At a national level, there should be a streamlined education program and a process so that each care giver knows which physician to consult, how to reach the hospital for consultation, and how to mange the initial expenditure. It is essential to consider the psycho-sociological impact of the nature of this syndrome.
Potential barriers to effective education with the selected group
Schizophrenic patients generally have poor social interactions, and some of the symptoms such as suicidal instincts, auditory hallucinations and abject thinking, make the sufferers alienated from the general population where the patients form part of. Such alienation at work place, educational institutions or close societies could be detrimental for the patient and could in turn lead to increased social reticence and suicidal tendencies. Similarly, like other chronic mental health disorders, the family members of schizophrenic patients face unfriendly behaviour from close societies, in addition to the difficulties in managing the patients. In totality, a schizophrenic patient’s family is itself not in a healthy frame of mind and hence special concerns or skills should be employed to properly educate them. Caregivers at hospitals, mostly have to deal with a higher number of patient’s per head basis and are already under stress. Money is another potential barrier and the caregivers also point to the need of proper transport, medical insurance and food in developing countries. Most of the time in a developing country, it is a cultural problem, the family is not highly educated and if the case is the first in their family, they do not know how to proceed at the first hand. Effective communication skills to a larger group with different social background are another potential barrier in a multiethnic, multilingual society such as India and Australia. Education cannot be provided to each and every individual on a personal basis in highly populated societies where the patient load is higher. Hesitation to participate in a community based rehabilitation program is another constraint as you have to convince maximum number of the individuals to get educated and participate in such an event. ‘Self determined medical discontinuation’ is another hindrance as many patients would stop consulting the physician and discontinue taking their psychotic medication. Hence, the patients should be educated on a recurrent basis and should be informed well that even if they think they are healthy they should continue their follow up management. Schizophrenia patients also suffer from a vocational impairment due to various reasons and according to the social drift hypothesis they are driven towards are social backwardness. This has to be addressed not only by proper education from therapy point of view, but also from the point of view of vocational empowerment. Psychosis and Schizophrenia in children poses an additional barrier as it shows a worse prognosis and educating the consumer in such cases needs special skills.
Skills required by the nurses
Schizophrenia cases involved an enhanced psychological stress and many a times the situation gets complicated by the family attitude, patients’ failure to adhere to the treatment regime, tolerability issues, embarrassment and recurrence. In such a scenario the educating nurse should exhibit an exceptional degree of restraint, compose in their behaviour and control of their own stress.
Since the patient itself and its family have an educational gap with respect to the medical field, a nurse should have the ability to bridge the gap between a layman and a professional. The nurse should have exceptional communication skills, should be available during off hours, should be willing to tolerate seemingly off the subject queries and should be able to understand the needs of the consumer. Most of the needs of the consumers are related to money, medical reimbursement and insurance issues and as such the nurse should be well acquainted with the relevant subject, although not directly related to medicine. Many a time’s patients are unwilling to adhere to the schedule. The severity of the side effects of the schizophrenia treatment such as sedation, weight gain or pain etc is the major concern of the patients. The nurse should in such cases educate the patient as well as their family about the alternative methods such as long acting injectable (LAIs) instead of oral therapy, etc. Nurse should be able to identify the patient’s strength area and make use of that strength for proper counselling approach. It has been observed that the preferences of patients and their family doctors vary, say for example, patient does not like the idea of shared care records while the health practitioner advocate for it. In such case the responsibility of the educating nurse is to ensure that patient and their family members are educated in the benefits of community participation. In many cases of patients undergoing treatment with the second generation antipsychotics, we have to induce them for a regular exercise schedule. Nurses should be able to motivate the patients and hence a nurse should also have motivational skills. Proper fitness is also required as the nurse should lead by example, that regular exercise is beneficial.
Schizophrenia is not only a medical problem, but a socioeconomic crisis. It not only harms the patient per se, but also affects its family as well as the whole community. Consumer education that involved counselling of the patient as well as educating the family and involving the whole community is an important tool for improved outcome. It not only reduces the stress environment, but also helps in improving adherence to the treatment regime, delaying the reduction in the social attainment, delay in the loss of cognitive skills and improve the overall status. Nurses imparting the education hence have an added social responsibility in addition to their medical duty and thus should be equipped with special communication skills. Controlling the stress, inspirational and motivational behaviour and above all a positive attitude is the most important requirement.
Beebe, L. H., Smith, K., Burk, R., McIntyre, K., Dessieux, O., Tavakoli, A., Velligan, D. (2011). Effect of a motivational intervention on exercise behavior in persons with schizophrenia spectrum disorders. Community Ment Health J, 47(6), 628-636.
Brooke-Sumner, C., Petersen, I., Asher, L., Mall, S., Egbe, C. O., & Lund, C. (2015). Systematic review of feasibility and acceptability of psychosocial interventions for schizophrenia in low and middle income countries. BMC Psychiatry, 15, 19.
Chen, M., Wu, G., Wang, Z., Yan, J., Zhou, J., Ding, Y., Song, L. (2014). Two-year prospective case-controlled study of a case management program for community-dwelling individuals with schizophrenia. Shanghai Arch Psychiatry, 26(3), 119-128.
Geerts, P., Martinez, G., & Schreiner, A. (2013). Attitudes towards the administration of long-acting antipsychotics: a survey of physicians and nurses. BMC Psychiatry, 13, 58.
Girma, E., & Tesfaye, M. (2011). Patterns of treatment seeking behavior for mental illnesses in Southwest Ethiopia: a hospital based study. BMC Psychiatry, 11, 138.
Heresco-Levy, U., Ermilov, M., Giltsinsky, B., Lichtenstein, M., & Blander, D. (1999). Treatment-resistant schizophrenia and staff rejection. Schizophr Bull, 25(3), 457-465.
Karthik, M. S., Warikoo, N., Chakrabarti, S., Grover, S., & Kulhara, P. (2014). Attitudes towards antipsychotics among patients with schizophrenia on first- or second-generation medications. Indian J Psychol Med, 36(3), 288-293.
Kasckow, J., Appelt, C., Haas, G. L., Huegel, S., Fox, L., Gurklis, J., Daley, D. (2012). Development of a recovery manual for suicidal patients with schizophrenia: consumer feedback. Community Ment Health J, 48(5), 564-567.
Kendall, T., Hollis, C., Stafford, M., Taylor, C., & Guideline Development, Group. (2013). Recognition and management of psychosis and schizophrenia in children and young people: summary of NICE guidance. BMJ, 346, f150.
Kheirabadi, G. R., Rafizadeh, M., Omranifard, V., Yari, A., Maracy, M. R., Mehrabi, T., & Sadri, S. (2014). Effects of needs-assessment-based psycho-education of schizophrenic patients’ families on the severity of symptoms and relapse rate of patients. Iran J Nurs Midwifery Res, 19(6), 558-563.
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Omranifard, V., Yari, A., Kheirabadi, G. R., Rafizadeh, M., Maracy, M. R., & Sadri, S. (2014). Effect of needs-assessment-based psychoeducation for families of patients with schizophrenia on quality of life of patients and their families: A controlled study. J Educ Health Promot, 3, 125.
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Health Studies Dissertation Examination of Eating Habits That Affect Adult BMI
The dissertation will determine whether or not there is a close relationship between the identified dependent (i.e. the adult students’ actual BMI level) and independent variables (i.e. the habit of eating in fast food restaurants, adult students’ wealth or disposable income, and heavy marketing activities and advertisements on fast food logo/brand).
The dissertation accurately determine whether or not there a close relationship between the identified dependent (i.e. the adult students’ actual BMI level) and independent variables (i.e. habit of eating in fast food restaurants, the adult students’ disposable income or wealth, and heavy marketing activities and advertisements on fast food logo/brand), a total of 50 adult students will be invited to participate in the actual quantitative research study.
After requiring each of the 50 research participants to complete the research survey questionnaire, the researcher will gather and analyse the gathered data. As such, a regression analysis was performed in this study. Some of the quantitative data was analysed based on multiple regression, R Square (R2), t stat, P-values, and significance F values. Regression analysis result shows no direct relationship between increase in the adult students’ BMI level and factors such as the habit of eating in fast food restaurants, the adult students’ wealth or disposable income, and heavy marketing activities and advertisements on fast food logo or brand.
The main objective of this study is to examine the perception of students with regards to the relationship between the identified dependent and independent variables. In this study, independent variables include habit of eating in fast food restaurants, adult students’ wealth or disposable income, and heavy marketing activities and advertisements on fast food logo or brand whereas dependent variable is the adult students’ actual BMI. Based on the students’ perception, is there a close relationship between the identified dependent and independent variables? As such, this study will focus on testing the following research hypotheses:
H1 = There is a relationship between the students’ actual BMI and the adult students’ wealth or disposable income
H2 = There is a relationship between the students’ actual BMI and heavy marketing activities and advertisements on fast food logo or brand
H3 = There is a relationship between the students’ actual BMI and the habit of eating in fast food restaurants.
Becoming overweight and obese can lead to the development of controllable diseases. Therefore, it is necessary to continuously examine and identify all factors that can contribute the increase in the student’s weight and adult BMI level. The adult students’ increase in adult BMI level is highly dependent on so many factors. Poor eating habits, sedentary lifestyle, and poor socio-economic factors such as low income could increase a person’s risks of becoming obese.
It appears that the coupling between energy intake and energy expenditure is at the heart of the obesity epidemic, both of which are greatly influenced by psycho-social factors and the environment in which we live and work. Currently the evidence points to changes in the level of physical activity and food system, which is producing more processed, affordable, and effectively marketed high-energy food. These changes in my opinion have led to a positive energy balance causing the obesity epidemic. Policies that encourage and promote physical activities and a change towards healthier food are needed to reverse the epidemic.
1 – Introduction
Background on Obesity and BMI
Statement of the Problem
Purpose of the Proposed Investigation
Research Questions and Hypotheses
2 – Literature Review
General Information about BMI
Significance of Race and Ethnicity in the Accuracy of BMI
Impact of Fast Food on BMI
Other Factors that Can Affect Changes in a Person’s BMI
3 – Research Methodology
Primary Research Study Design
Data Collection Tools
Sample and Population of Research Participants
4 – Research Findings and Discussion
Demographic Profile of Research Respondents
Eating Health and Well-Balanced Food
Lifestyle and Physical Activities
Budget Allocation for Fast Food Restaurants
Common Reasons for Eating in Fast Food Restaurants
Adult Students’ Perception of the Given Statements
Relationship between Dependent and Independent Variables
5 – Conclusion and Recommendations
Recommendations for Future Research Study
I do hope you enjoyed reading this post on eating habits and how it affects adult BMI. There are many other titles available in the health studies dissertation collection that should be of interest to construction management students and building professionals. There are many dissertation titles that relate to other aspects of health and nursing such as project management within the NHS, midwifery, nursing techniques and treatment of mental health to name a few. It took a lot of time to write this post and I would be grateful if you could share this post via Facebook and Twitter. Feel free to add your thoughts in the comments section. Thank you.