Integrated Treatment for Substance Use and Depression

Integrated Treatment for Substance Use and Depression Mental Health: Simone Case Scenario Dual diagnosis, co morbidity and co-occurring disorders are terms often used interchangeably to describe mental ill health and substance abuse (drugs and/or alcohol) in various combinations. These disorders may occur at the same time or one may follow the other. Even though the diseases of mental illness and drug abuse are comorbid, causality is not implied and either condition may precede the other (Fortinash and Holoday Worret, 2012). The symptoms of one condition may mask or conceal the symptoms of the other, with either condition assuming priority at any given time. Alcohol is the most widely used drug. The National Institute for Clinical Excellence (NICE) estimated in 2011 over 24% of people in England consume alcohol levels that are potentially or actually detrimental to health. The co morbidity of depression and alcohol dependence are two of the most prevalent psychiatric disorders affecting the general population. Evidence suggests that alcohol use disorders are linked to depressive symptoms and that alcohol dependence and depressive disorders co-occur to a larger degree than expected by chance. However, it is not clear whether the depression causes alcohol problems, whether the alcohol consumption or alcohol problems caused depression, or whether both could be attributed to a third cause (Royal College of Psychiatrists, 2015). This assignment will consider the case scenario of Simone part time social worker, aged 43 with depression and alcohol abuse. Simone lives with her three children and the intervention of choice is Cognitive Behavioural Therapy (CBT). This section will define CBT and its uses and adopt the Critical Appraisal Skills Programme (CASP) toolkit (2013) to critically evaluate and discuss two CBT research articles in treating depression and alcohol abuse to evidence why this is an appropriate intervention for Simone. CBT is defined as a talking therapy that can help individuals manage their problems by changing the way they think and behave (Frances and Robson, 1997). Commonly used to treat a range of mental health issues including depression, anxiety disorders, phobias, but also deemed valuable in treating alcohol misuse, especially as part of an overall programme of recovery. The goal of cognitive behavioural therapy is to teach the person to become aware of incidences and situations which trigger the need to drink, to learn to avoid putting themselves in these situations and to develop coping strategies to deal with other problems and behaviours which may lead to drinking. Until recently the effectiveness of CBT for comorbid alcohol had not been studied, however, the first of two research articles will now be critically evaluated and discussed below. Developing an Integrated Treatment for Substance Use and Depression Using Cognitive Behavioural Therapy (Osilla et al, 2009) is an American qualitative research article. The research goal was to design and develop a treatment programme for delivery by substance abuse counsellors in outpatient mental health settings. This was thought to be important because earlier research had indicated the effectiveness of CBT in depression and alcoholism separately. The research developed a group based integrated 18 session treatment plan involving 3 modules (thoughts, activities and people interactions) linking mood and alcohol use and provided strategies for identifying and modifying harmful thoughts and activities. Drawing on previous studies (Hepner, Watkins, Woo and Wiseman, 2006) they involved a treatment development team including researchers, clinicians, stakeholders and CBT experts. Recruited participants (N=7; 4 male, 3 female) were already enrolled in outpatient substance misuse treatmen t who had met the criteria for mild depression using the 9 item Patient Health Questionnaire with scores of 5 or > (no indication given whether other people had chosen not to take part as this sample is small). Client focus groups were conducted following the group treatment sessions led by two clinical psychologists who had observed the group sessions from behind a one way mirror, thus the methodology used is entirely appropriate for addressing the research goal. The article states that the clients provided informed consent but there is no information regarding how the research was explained to participants, whether ethical approval was sought or whether ethical standards were maintained. The data analyses consisted of the researchers reviewing notes and transcripts independently from the client focus groups to select, group and label salient issues that point to the acceptability of integrated CBT. Notable points with similar concepts were categorised if different participants had said the same things on a number of occasions over a given time frame e.g. comments which stated that alcohol and mood influenced each other. Underlying themes were generated from the data and quotes were analysed and identified that fitted each of the relevant themes. Each researcher independently sorted quotes by theme and together they reached a consensus on any discrepancies. Findings indicated that treatment was widely accepted by clients and counsellors. Clients stated that applying CBT skills help to treat both their depression and alcohol misuse whilst positively affecting other areas in their lives. Clients felt the treatment had built their confidence and the group process was helpful in learning from each other. The article produced no evidence of triangulation but stated that there were limitations to the study that affect the generalization of the results. The study evaluated a single case implementation, so future studies would be necessary to examine client views in several clinics over time with different treatment sessions in order to judge whether integrated treatment is truly acceptable and feasible given funding constraints. Clearly, integrated CBT for depression and alcohol misuse evaluated as being useful and beneficial but the research concluded that there is a need to develop more web based training or other innovative ways that effect ively train substance abuse counsellors to a reasonable standard with minimal costs to provide a unified CBT approach to manage comorbid depression and alcohol misuse. A Randomized Controlled Trial of Cognitive Behavioural Treatment for Depression versus Relaxation Training for Alcohol – Dependent Individuals with Elevated Depressive Symptoms (Brown et al, 2011). The goal of this Rhode Island trial was to evaluate the efficacy of adding CBT versus relaxing training to partial hospital treatment for individuals misusing alcohol with elevated levels of depressive symptoms. This was deemed important because it was expected that the addition of CBT would result in reduced levels of depressive symptoms and in decreased quantity and regularity of alcohol use.166 men and women were recruited (aged 16 65 years) from an alcohol and drug treatment unit provided they met the Diagnostic and Statistical Manual of Disorders, Fourth Edition (2000) criteria for alcohol dependence and had a Beck Depression Inventory of 15 or more. Participants were informed about the study, consent was obtained and they were randomly assigned to receive 8 individual session s of CBT (n = 81) or relaxation training (n = 84). The article didnt mention whether the personnel were blinded. Treatment conditions did not differ on demographics, individual alcohol consumption or depression related variables. Results indicated significant improvement in depressive and alcohol use over time for all participants. Compared with the relaxation training, the CBT group had significantly reduced levels of depressive symptoms at the 6 week follow up as measured by the Beck Depression Inventory. This effect was found to be inconsistent because there was no difference in the Modified Hamilton Rating Scale (MHRD) for Depression between conditions at that point in time or at any subsequent follow up. There was no significant in alcohol use between groups. The researchers were clearly disappointed that this study did not replicate the results of an earlier pilot study in 2007. However, plausible reasons given included the average length of hospital stay had reduced from 21.2 days to 3.9 resulting in treatment sessions being conducted in an outpatient setting making it difficult to compare results. The setting for this study was a private hospital with educated Caucasian patients and caution should be used in generalizing findings to populations with different characteristics. Interview data and treatment adherence had not been subject to reliability ratings. The need for the trial was clearly documented and further studies evaluating the efficacy of CBT in individuals with alcohol misuse and elevated depressive symptoms is required. Overall, the benefits outweighed the harm. Depressed people with alcohol misuse like Simone have complex needs which pervade every aspect of daily life including psychiatric, psychological, education, employment and social care. Supporting someone with depression and alcohol misuse is one of the biggest challenges facing mental health services (DH, 2006).Traditionally, substance misuse and mental health services developed separately but a national drug and alcohol dependence strategy was published in December 2010 (HMG, 2010), and a mental health strategy a few months later (HMG, 2011). Both strategies acknowledge the association between mental health problems and drug and alcohol problems. Successful outcomes for both problems need early intervention and effective joint working between drug and alcohol treatment and mental health services in integrated, recovery-oriented local systems. Furthermore, a NICE guideline (2011) includes principles of care, identification and assessment in all assessment areas and principles for in terventions, underpinned by best available evidence (due for review in 2015). Regarding impact on future practice, co morbidity requires nurses to adapt multiple roles in order to achieve a comprehensive level of care. A primary diagnosis isnt necessary as both depression and alcohol misuse can be treated simultaneously. A non judgemental, person centred approach recognising that treatment will be long term is required. Good communication skills with multiple professionals and services are essential. Clinical skills include specialist alcohol misuse assessments, mental health and risk assessments, the provision of specialist advice on reduction and harm minimisation, appropriate interventions, treatment advice to other care professionals and the ability to work in a multidisciplinary team. In practice, it is not possible for nurses to be an expert in all of the skills required, however they should have a working knowledge of some. Training is required to deliver comprehensive alcohol programmes through developing skills particularly in cognitive behavioural th erapy which seems to produce beneficial effects on both depression and alcohol outcomes. Bibliography Brown, A.B., Ramsey, S.E., Kahler, C.W., Palm, K.M., Monti, P.M., Abrams, D., Dubreuli,.M., Gordon,.A. and Miller.I.W. (2011) A Randomized Controlled Trial of Cognitive Behavioural Treatment for Depression versus Relaxation Training for Alcohol – Dependent Individuals with Elevated Depressive Symptoms. Journal of Studies on Alcohol and Drugs 72(2): 286-296 Critical Appraisal Skills Programme (2013) Qualitative Research Check List. Oxford UK. Critical Appraisal Skills Programme (2013) Randomised Control Trial Check List. Oxford UK. Department of Health (2006) The Dual Diagnosis Good Practice. Diagnostic and Statistical Manual of Disorders (2000), 4th Edition, Text Revision (DSM-IV-TR). American Psychiatric Association.Washington DC. Fortinash, K.M and Holoday Worret,P.A (2012) Psychiatric Mental Health Nursing, 5th edition. Australia, Mosby. Frances, R. and Robson, M (1997) Cognitive Behavioural Therapy in Primary Care. Jessica Kingsley Publishers. London. Hepner, K.A, Watkins, K.E., Woo, S. and Wiseman, S. (2006) Group Cognitive Behavioural Therapy for Depression in Substance Abusers: Substance Abuse and your Mood. Treatment Manual for non traditional providers. HM Government (2010). Drug Strategy 2010 Reducing Demand, Restricting Supply, Building Recovery: Supporting People to live a Drug Free life. HM Government (2011). No Health without Mental Health: A Cross-Government Mental Health Outcomes Strategy for People of all Ages. National Institute of Clinical Excellence (2011) Alcohol-use disorders: diagnosis, assessment and management of harmful drinking and alcohol dependence. London: National Institute for Health and Clinical Excellence. Osilla, K.C., Hepner, K.A, Munoz, R.F, Woos. S and Watkins, K. (2009) Developing and Integrated Treatment for Substance Use and Depressing Using Cognitive Behavioural Therapy. Journal of Substance Abuse Treatment 37(4);412-420 Royal College of Psychiatrists (2015) Improving the Lives of People with Mental Illness (online) available from:  http://www.rcpsych.ac.uk/healthadvice/problemsdisorders/alcoholdepression.aspx  (Accessed 13th April 2015) Lynskey,M.T.(1998 ) The comorbidity of alcohol dependence and affective disorders: treatment implications. Drug and Alcohol Dependence 52:201- 209 Miller, I.W.,Bishop,S.,Norman,W.H. and Maddever,H.(1995) The Modified Hamilton Rating Scale for Depression;reliability and validity. Psychiatry Research 14: 131-142 Mitcheson, L., Maslin, J., Meynen, T., Morrison, T., Hill, R. and Wanigaratne, S. (2010). Applied Cognitive and Behavioural Approaches to the Treatment of Addiction: A Practical Treatment Guide. Chichester: Wiley-Blackwell. NHS Information Centre for Health and Social Care (2011), Statistics on Alcohol: England 2011. The Health and Social Care Information Centre. NICE (2007). NICE clinical guideline 51. Drug Misuse: Psychosocial Interventions. London: National Institute for Health and Clinical Excellence. Raistrick, D.,Heather, N and Godfrey. ,C (2006) Review of the effectiveness of treatment for alcohol problems. The National Treatment Agency for Substance Misuse. Weaver, T., Madden, P., Charles, V., Stimson, G., Renton, A., Tyrer, P., Barnes, T., Bench, C., Middleton, H., Wright, N., Paterson, S., Shanahan, W., Seivewright, N and Ford, C. (2003). Comorbidity of substance misuse and mental illness in community mental health and substance misuse services. British Journal of Psychiatry, 183, 304-313.

Why Gender Matters in Understanding September 11th :: September 11 Terrorism Essays

Usually when the word gender is used in a political sense often times what is described is the role of women in a certain aspect of politics. This paper is a look at certain social norms that are directly related to women and their rights that seem to allow and harbor terrorist. The idea of the article that I am basing this paper on is by Amy Caiazza Ph.D. who suggests that if we were to change some of our ways in society regarding women we might have been able to foresee the events of the September 11th attacks. Historically women have taken a back seat to men in almost every aspect of life we were always second choice. Fortunately for us as the time moves forward we see a dramatic increase in the role that women play in society today. Though our progress has been great there are still women who are not satisfied with the place in society that women have. Locally here in the U.S. women have it pretty good and most of them tend not to complain but there are those feminist that want women abroad to be able to experience the same freedoms that the women of America enjoy and some times take for granted. Women in our traditional roles or as some may say in our natural state are known as the child bearers, family care takers, household keeper, and nurturer of all. The list that I just stated is only the beginning of what a woman can do. In other countries for example in Afghanistan in 1997 when the now popular Taliban first came into power they put into practice a radical form of Islamic rule known as Sharia. This radical rule that they governed with limited women in so many ways the women of Afghanistan were not allowed to educate themselves. These women were also not allowed to participate in any form of activism and were not able to even have a physical position in their own society. When women have been found in violation of these rules the end results were never too good. In fact many women have been beaten and put to death once they were caught breaking the rules.   Ã‚  Ã‚  Ã‚  Ã‚  These acts of disrespect and violence against women are no secret to the United States of America. America jokingly is often called the world police and is known for â€Å"sticking their nose in other peoples business† but for some unknown reason they have taken no action against the Taliban for these injustices they are imposing on the women of Afghanistan.

Gender Differences in Peer and Parental In?uences: Body Image Disturbance

Journal of Youth and Adolescence, Vol. 33, No. 5, October 2004, pp. 421–429 ( C 2004) Gender Differences in Peer and Parental In? uences: Body Image Disturbance, Self-Worth, and Psychological Functioning in Preadolescent Children Vicky Phares,1 Ari R. Steinberg,2 and J. Kevin Thompson3 Received April 17, 2003; revised January 20, 2004; accepted February 11, 2004 The connections between body image disturbance and psychological functioning have been well established in samples of older adolescent girls and young women. Little is known, however, about body image in younger children. In particular, little is known about possible gender differences in preadolescent children. The current study explored self-reported body image disturbance and psychological functioning in relation to peer and parental in? uences in 141 elementary school-aged girls and boys aged 8–11. Results suggest that girls are more concerned about dieting and are more preoccupied with their weight than are boys. Girls also reported a greater drive for thinness and a higher level of family history of eating concerns than did boys. Correlations suggested that girls’ experiences of body image concerns (body dissatisfaction, bulimia, and drive for thinness) were related to a number of factors (such as family history of eating concerns, peer in? uences, teasing, depression, and global self-worth) whereas boys’ experiences of body image concerns were related to fewer factors. On the basis of these ? ndings, the assessment and treatment of body image concerns in preadolescent children (especially girls) are of great importance. Implications for intervention and prevention programs are discussed. KEY WORDS: body image; peers; parents. The prevalence of weight and body image concerns among preadolescent children is overwhelming. Between 30 and 50% of adolescent girls are either concerned about their weight or are actually dieting (e. g. , Thompson and 1 Vicky Phares, Ph. D. is a Professor and Director of Clinical Training at the University of South Florida. She received her Ph. D. in Clinical Psychology from the University of Vermont. Her major research interests are fathers and developmental psychopathology. She recently published a textbook, Understanding Abnormal Child Psychology with Wiley and Sons. To whom correspondence should be addressed at University of South Florida, Department of Psychology, 4202 E. Fowler Avenue, PCD 4118G, Tampa, Florida 33620; e-mail: [email  protected] cas. usf. edu. 2 Ari R. Steinberg, Ph. D. graduated from the University of South Florida, where she earned her M. A. in Psychology and her Ph. D. in Clinical Psychology. Her major research interests are cognitive and psychosocial correlates to the development of body image; e-mail: [email  protected] cas. usf. edu. 3 J. Kevin Thompson, Ph. D. is a Professor of Psychology at the University of South Florida. He received his Ph. D. in Clinical Psychology from the University of Georgia. His major research interests are body image and eating disorders. Smolak, 2001). Such concerns about size and/or appearance have been found to predict onset of eating disturbances prospectively (Cattarin and Thompson, 1994; Stice, 2001). Although most of the previous research on eating disorders has focused on adult women and adolescent girls, it has recently been shown that weight concerns and body image disturbance exist in younger girls and boys (Cusumano and Thompson, 2001; Field et al. 2001; Ricciardelli and McCabe, 2001; Ricciardelli et al. , 2000; VanderWal and Thelen, 2000). Self-esteem concerns appear to be related to body image disturbance in young children, but there does not appear to be a causal link between self-esteem and body image disturbance (Mendelson et al. , 1996). Speci? cally, body image disturbance and poor self-esteem appear to develop concurrently in young boys and girls. Given the se important issues, the current study attempted to examine the psychological, familial, and social correlates of weight concerns and eating disturbances in preadolescent girls and boys. 21 0047-2891/04/1000-0421/0 C 2004 Springer Science+Business Media, Inc. 422 BODY IMAGE AND DIETING BEHAVIOR IN ADOLESCENTS AND CHILDREN The connections between body image disturbance and psychological maladjustment in adolescence have been well documented. There appears to be pervasive concerns among adolescents with respect to their weight, body image, dieting, and eating behavior (Smolak and Levine, 2001; Thompson et al. , 1999). In fact, averageweight adolescent girls are almost as likely to be dieting as their overweight peers (Rodin et al. , 1985). These patterns are evident in both clinical and nonclinical samples. Bunnell et al. (1992) investigated body shape concerns among 5 samples of female adolescents: anorexia nervosa clients, bulimia nervosa clients, subclinical anorexia, subclinical bulimia, and noneating disordered females. They found that body shape dissatisfaction was a prominent concern for most adolescent girls regardless of their level of eating pathology. Thus, by the time of adolescence, the majority of girls have developed weight and body concerns and many have tried dieting or other strategies to alter their physical appearance. Although these issues have received less research attention in preadolescent children, many of the same patterns have emerged in studies of younger children. Children as young as 6 years old express dissatisfaction with their body and a substantial amount (40%) have attempted to lose weight (Thelen et al. , 1992). There is evidence that children as young as 7 are reliable in their reports of dieting (Kostanski and Gullone, 1999). In a sample of thirdthrough sixth-graders, children were very knowledgeable about weight control methods (Schur et al. , 2000). Body dissatisfaction appears to be related to dietary restraint rather than age. In a study that compared 9-year-olds and 14-year-olds, girls with highly restrained eating patterns in both age groups showed low body esteem, and discontent with their body shape and weight (Hill et al. , 1992). Consistent with research on adolescents and young adults, young girls tend to show this dissatisfaction to a greater extent than boys. In samples of children between the ages of 5 and 11 (Collins, 1991; Cusumano and Thompson, 2001; Williamson and Delin, 2001; Wood et al. 1996), girls reported signi? cantly greater body dissatisfaction than did boys. More girls than boys were dieting in a sample of 10–12 year olds (Sands et al. , 1997). Thus, the â€Å"normative discontent† that is shown in adolescent girls and young women (Rodin et al. , 1985) appears to be present in younger girls as well. FAMILIAL INFLUENCES ON BODY IMAGE A logical question relates to why these body image disturb ances occur in such young children. Theories of Phares, Steinberg, and Thompson body image disturbance include biological, sociocultural, familial, and peer-related in? ences (Smolak and Levine, 2001; Steinberg and Phares, 2001). Recently, a great deal of attention has been focused on familial and peer in? uences in the development of body image. Regarding familial in? uences, 2 primary mechanisms have been proposed: parental modeling of dysfunctional eating attitudes and behavior, and parents’ in? uence over their children by direct transmission of weight-related attitudes and opinions, such as comments or teasing. There has been support for both mechanisms in adolescent samples. When compared with mothers of daughters in a nonclinical control group, mothers of adolescent girls with disordered eating patterns showed greater eating disturbance, had a longer history of dieting, and wanted their daughters to lose more weight (Pike and Rodin, 1991). Rieves and Cash (1996) found that daughters’ eating disturbances were related to their perceptions of maternal concern with appearance and preoccupation with being overweight. These studies suggest that adolescent girls may be modeling dysfunctional eating attitudes and behaviors from their parents. There is evidence that parents in? ence their adolescents’ eating disturbances and body image through direct transmission of weight-related attitudes and opinions. Thelen and Cormier (1995) found that mothers’ and fathers’ encouragement of weight control were related to daughters’ desire to be thinner, daughters’ weight, and dieting behaviors. When actual body weight was controlled statistically, only the relationship between daughters’ dieting and fathers’ encouragement to diet remained signi? cant. Direct parental comments about children’s weight had a strong relation with children’s body image, especially mothers’ comments about their daughters (Smolak et al. 1999). Thus, it appears that both maternal and paternal in? uences may be relevant to the development of body image concerns and related issues. These ? ndings suggest that parents can in? uence their attitudes and opinions of weight through direct transmission, although the relative salience of mothers versus fathers has yet to be established. Negative verbal commentary within the family, also known as teasing, has received attention recently. Teasing can be considered an indirect transmission of parental attitudes and opinions. In a sample of lder adolescent college students, parental teasing of females, but not of males, was related to body image dissatisfaction ( Schwartz et al. , 1999). In addition, higher levels of teasing and appearance-related feedback predicted higher levels of psychological disturbance. Taken together, these studies all point to the relationships between adolescents’ body image concerns and parental attitudes and behaviors. Few studies, however, have addressed these issues in younger children. Gender Differences in Peer and Parental In? uences PEER INFLUENCES ON BODY IMAGE The same point can be made for peer in? uences on body image. Although signi? cant relationships have been found in samples of adolescents, few studies have explored these issues in younger children. When investigating adolescents, one study found that adolescents’ disturbed eating and weight concerns were related to the dieting and weight control strategies of peers as well as to the amount they reported talking with peers about dieting (Levine et al. , 1994). In addition, adolescent girls reported their peers as one of the primary sources of information on weight control and dieting (Desmond et al. , 1986). Adolescent girls, more so than adolescent boys, worried about their weight, ? ure, and popularity with peers (Wadden et al. , 1991). Negative verbal commentary by peers has been explored in relation to body image disturbance. Teasing by peers seems to have a strong in? uence on the development of eating and weight concerns (Rieves and Cash, 1996; Thompson, 1996; Thompson and Heinberg, 1993). Teasing by peers tends to be common durin g childhood with physical appearance and weight as the primary focus. Cash (1995) reported that 72% of college women recalled being teased as children, usually with respect to their facial features or body weight and shape. In a study of adolescent girls, Cattarin and Thompson (1994) found that teasing was a signi? cant predictor of overall appearance dissatisfaction above and beyond the in? uence of age, maturational status, and level of obesity. In one of the few studies done with children, Oliver and Thelen (1996) found that children’s perceptions of peers’ negative messages and increased likability by being thin in? uenced their body image and weight concerns. Overall, peers’ attitudes and teasing appear to in? uence body image concerns. Taken together, these studies suggest patterns of familial and peer in? ence on the development of body image concerns. Little is known, however, about the associations of these issues within young children. Even less is known about how familial and peer in? uences are related to body image concerns and psychological functioning in young girls versus young boys. THE CURRENT STUDY On the basis of the ? ndings with adolescent and young adult popul ations, the current study extends these research questions to preadolescent girls and boys. Because the majority of previous research was limited to maternal in? ences on body image (Phares, 1996), the current study will also extend this line of research to explore paternal in? uences on body image. It was hypothesized that gender effects would be revealed concerning young chil- 423 dren’s body image concerns, with young girls reporting more body dissatisfaction and weight-appearance-related concerns than young boys. It was expected that both girls and boys who reported higher levels of body image concerns would show more psychological problems as exhibited by higher levels of depression and lower levels of perceived competence. Both familial in? uences and peer in? ences were expected to be related to girls’ and boys’ body image and eating concerns. METHOD Participants A total of 141 children (64 boys and 77 girls) from two public elementary schools in a large urban area in the southeast participated in the study. On the basis of a power analysis (? level = 0. 05, power = 0. 80, and a medium effect size), it was determined that a minimum sample size of 64 boys and 64 girls would be adequate to test the hypotheses (Cohen, 1992). The mean age of the overall sample was 9. 23 years (SD = 1. 08) and did not differ between boys (M = 9. 31; SD = 1. 04) and girls (M = 9. 7; SD = 1. 12; t(139) = 0. 79; p = 0. 434). The sample was ethnically diverse (63. 1% Caucasian, 21. 3% African American, 12. 8% Hispanic/Latino/Latina, 0. 7% Asian American, and 2. 1% other). With respect to grade level, 14. 2% were in the second grade, 44. 0% were in the third grade, 27. 6% were in the fourth grade, and 14. 2% were in the ? fth grade. The distribution of girls and boys did not differ for race/ethnicity or for grade level ( ps > 0. 05). A total of 77 mothers and 48 fathers participated in the study. Measures Family In? uences Two measures were used to assess fun ctioning within the family. The Perceptions of Teasing Scale (POTS) is a revised and extended version of the Physical Appearance Related Teasing Scale (Thompson et al. , 1995). The measure has been used with children as young as 10 years old, therefore, the 8- and 9-year-old participants in this study were younger than previous participants who completed the POTS. The Weight Teasing Scale, which consists of 6 questions concerned with the frequency of appearancerelated teasing, was used in the current study. Participants answered these questions for their mother and father separately, and scores were totaled for an overall frequency of parental teasing score. Higher numbers on this 5-point scale re? ect greater frequency of negative verbal commentary. Coef? cient ? s in the current study were adequate for 424 reports of mothers (0. 72) and fathers (0. 84). Note that only 24% of the children in this sample scored above a 0 on this measure. Children, mothers, and fathers completed the Family History of Eating (FHE-Child and FHE-Parent; Moreno and Thelen, 1993). Both versions of the FHE are scored along a 5-point Likert scale and are used to assess attitudes concerning body shape and weight, dieting, and familial eating patterns and behaviors. The parent version assesses parents’ perceptions whereas the child version focuses on the child’s perception of the family. Higher numbers re? ect greater familial concern with body shape and weight. Reliabilities in the current study were adequate based on the coef? cient ? for children (0. 80), mothers (0. 77), and fathers (0. 75). Peer In? uences Children completed the Inventory of Peer In? uence on Eating Concerns (IPIEC; Oliver and Thelen, 1996), which is a 30-item measure of peer in? uence on children’s eating and body shape concerns. The measure consists of 5 factors: Messages, Interactions/Girls, Interactions/Boys, Likability/Girls, and Likability/Boys. The Messages factor re? ects the frequency with which children receive negative messages from peers regarding their body or eating behaviors. The Interactions factors address the frequency with which children interact with peers (boys and girls) about weight and eating habits. The Likability factors measure the degree to which children believe that being thin will increase the degree to which they are liked by their peers (boys and girls). Items are rated on a 5-point Likert scale, where higher numbers re? ect greater peer in? uence. For the present study, total mean scale scores of all items were used to calculate a total peer in? uence score. The coef? cient ? in the current study (0. 94) was strong. Obesity Level The Quetelet’s Index of Fatness is a body mass index (BMI) that is computed for each child with the following formula: weight/(squared height). The Quetelet’s Index is used routinely as an index of adiposity and is correlated highly with skinfold and other fatness measures. Height and weight were obtained by self-report. Previous research has shown that young adolescents’ self-reports are highly correlated with actual measurements of weight and height (Brooks-Gunn et al. , 1987; Field et al. , 2002). Eating Disturbance and Body Image Children completed the Eating Disorder Inventory for Children (EDI-C; Garner, 1984), which measures self- Phares, Steinberg, and Thompson perceptions of eating disturbances and body image. Items are answered on a 6-point Likert scale and subscales are averaged to produce mean scale scores. Three of the eight subscales were used in the present study: Drive for Thinness (excessive concern with dieting, preoccupation with weight, and extreme fear of weight gain), Body Dissatisfaction (dissatisfaction with overall shape and with the size of those body regions of most concern to individuals with eating disorders), and Bulimia (thinking about and engaging in uncontrollable overeating, or binging behaviors). Coef? cient ? s were adequate in the current sample for the Drive for Thinness subscale (0. 83), the Body Dissatisfaction subscale (0. 63), and the Bulimia subscale (0. 76). On all subscales, higher numbers re? ect higher levels of body image concerns or related behaviors. Psychological Functioning Children completed 2 measures that assess their psychological functioning. The Children’s Depression Inventory (CDI; Kovacs, 1992) is a widely used self-report measure of affective, cognitive, and behavioral symptoms of depression in children. Items are scores on a 0- to 2-point scale, with higher scores re? ecting higher levels of depression. The total CDI score, which showed good reliability in the current sample (coef? cient ? = 0. 91) was used. Children also completed the Self-Perception Pro? e for Children (Harter, 1985), which assesses children’s perceptions of themselves across different domains. For the current study, the global self-worth subscale was used. Note that the global self-worth scale consists of questions that are separate from any of the other domains (e. g. , the physical appearance domain is not subsumed under the global se lf-worth rating). Higher scores on the 4-point scale re? ect higher perceptions of global self-worth. Adequate reliability (coef? cient ? = 0. 79) was shown in the current sample. Procedures Active parental consent and child assent were given for involvement in the study. Once consent and assent were obtained and data collection was initiated, no children dropped out of the study nor did any children refuse to take part in the study. Participating children completed questionnaires in small groups at school. Examiners read each question aloud and children put their answers on the questionnaires individually. Parents were mailed their questionnaires (the FHE-P and a brief demographics form) and were asked to return their completed questionnaires to the researchers in a postage-paid envelope. Multiple mail- Gender Differences in Peer and Parental In? uences Table I. Means and t-Tests for Gender Comparisons Variable Body mass index (BMI) Body Dissatisfaction Bulimia Drive for Thinness Family History of Eating—Child Inventory of Peer In? uence on Eating Concerns Perceptions of Teasing—Frequency Depression Global Self-Worth a Statistically 425 Girls (n = 77), mean (SD) 18. 91 (3. 80) 20. 29 (10. 10) 13. 38 (7. 32) 18. 21 (9. 64) 19. 99 (8. 38) 1. 80 (0. 84) 1. 62 (4. 62) 48. 83 (12. 06) 19. 06 (4. 74) Boys (n = 64), mean (SD) 19. 01 (3. 80) 18. 38 (8. 83) 15. 05 (7. 63) 13. 13 (6. 61) 17. 56 (5. 54) 1. 66 (0. 73) 1. 33 (2. 97) 49. 13 (13. 47) 18. 92 (4. 75) t 0. 09 ? 1. 18 1. 32 ? 3. 58 ? 1. 98 ? . 02 ? 0. 44 0. 14 ? 0. 18 p 0. 932 0. 239 0. 188 0. 000a 0. 049a 0. 311 0. 660 0. 892 0. 859 signi? cant. ings were sent in an attempt to obtain maximum parental participation. The ? nal response rate was 54. 6% (n = 77) for mothers and 34. 0% (n = 48) for fathers. RESULTS Gender Comparisons As expected, girls showed somewhat greater concern over weight and body image issues than did boys. Signi? cantly more girls (61. 0%) than boys (35. 9%) wanted to lose weight, ? 2 (2) = 13. 38, p < 0. 001. As can be seen in Table I, there were additional gender differences on body image, restriction, and disturbed eating behaviors measures. When compared with boys, girls reported a higher drive for thinness, t(139) = ? 3. 58; p < 0. 001, and a more troubled family history of eating concerns, t(139) = ? 1. 98; p < 0. 05 (i. e. , girls reported receiving more messages regarding weight and dieting from their parents than did boys). Girls and boys did not differ signi? cantly on body mass index, body dissatisfaction, bulimic behaviors, peers’ eating concerns, or frequency of parental teasing. There were also no gen- der differences in depressive symptoms or global selfworth. Thus, there was some limited support for gender differences. Relations Between Body Image and Psychological Functioning Correlational analyses were computed in order to investigate the relations between body image and psychological functioning. As can be seen in Table II, signi? cant correlations were revealed for all of the measures for girls and most of the measures for boys. Girls’ reports of body dissatisfaction, bulimic tendencies, and drive for thinness were related to higher levels of depression and lower levels of global self-worth. For boys, body dissatisfaction was related to higher levels of depression and lower levels of global self-worth. Bulimic tendencies were not significantly related to either depressive symptoms or global self-worth. Drive for thinness was related to lower levels of global self-worth but was not signi? cantly related to depression. Thus, the expected pattern of results was found for girls consistently, and partial support was found for boys. Table II. Correlations Between Eating Disturbance and Psychological Functioning Variables 1 1. Body Dissatisfaction 2. Bulimia 3. Drive for Thinness 4. Family History of Eating—Child 5. Inventory of Peer In? uences on Eating Concerns 6. Perceptions of Teasing—Frequency 7. Depression 8. Global Self-Worth — 0. 42 0. 42 0. 32? 0. 26? 0. 44 0. 37 ?0. 42 2 0. 47 — 0. 25? 0. 23 0. 10 0. 29? 0. 14 ? 0. 01 3 0. 56 0. 55 — 0. 67 0. 32? 0. 60 0. 19 ? 0. 39? 4 0. 53 0. 56 0. 58 — 0. 12 0. 41 ?0. 03 ? 0. 03 5 0. 49 0. 55 0. 48 0. 53 — 0. 18 0. 29? ?0. 21 6 0. 32 0. 34 0. 27? 0. 44 0. 38 — 0. 29? ?0. 37 7 0. 58 0. 60 0. 55 0. 63 0. 59 0. 45 — ? 0. 58 8 ? 0. 64 ?0. 48 ?0. 49 ?0. 52 ?0. 52 ?0. 35 ?0. 71 — Note. Boys are in the lower left quadrant and girls are in the upper right quadrant. ? p < 0. 5; p < 0. 01; p < 0. 001. 426 Relations Between Parental In? uences, Peer In? uences, and Body Image Disturbance Table II also reports the results of correlations for parental in? uences, peer in? uences, and body image disturbance. For girls, all of the correlations were signi? cant. Speci? cally, girls’ body dissatisfaction, bulimia, and drive for thinness were related to higher levels of family history of eating concern s, peer in? uences on eating concerns, and perceptions of teasing. For boys, 7 of the 9 correlations were signi? cant. Speci? cally, boys’ body dissatisfaction was signi? antly related to higher levels of family history of eating concerns, peer in? uences on eating concerns, and perceptions of teasing. Boys’ tendency toward bulimia was signi? cantly related to perceptions of teasing, but not family history or peer in? uences. Boys’ drive for thinness was related to family history, peer in? uences, and perceptions of teasing. Overall, there was somewhat more support for the connections between parental in? uences, peer in? uences, and body image disturbance for girls, but there was clear evidence of connections for boys when body dissatisfaction and drive for thinness were considered. Phares, Steinberg, and Thompson of family history and children’s reports of eating disturbance and body image concerns. These ? ndings suggest that children’s perceptions of family history and parents’ perceptions of family history are not related strongly. Missing Parental Data To assess whether there were systematic differences between parents who did or did not participate, t tests were conducted to examine any possible differences between children whose parents returned questionnaires and those children whose parents did not return questionnaires. With the exception of family history, t(139) = 2. 33, p < 0. 02, no other signi? cant differences were revealed. Children whose parents returned questionnaires reported signi? cantly higher levels of family emphasis on weight and body shape (M = 20. 15, SD = 7. 90) than children whose parents did not return questionnaires (M = 17. 32, SD = 6. 20). There were no signi? cant differences between children with parental data and children without parental data on the following variables: Body Dissatisfaction (from the EDI-C), Bulimia (from the EDI-C), Drive for Thinness (from the EDI-C), peer in? ences (from the IPIEC), or perceptions to teasing (from the POTS). Thus, the exploratory analyses with parental data are likely to be generalizable for all of the variables other than family history. Parental Data For exploratory purposes, paired t tests were conducted to examine the differences in mothers’ and fathers’ reports of parental in? uence regarding weight and body shape co ncerns. Mothers (M = 18. 57, SD = 5. 32) placed more emphasis on weight and body shape concerns than did fathers (M = 15. 94, SD = 5. 29), t(47) = ? 3. 96, p < 0. 001. Further examination of parental differences revealed that mothers reported placing more importance on weight and body image concerns than did fathers for both their daughters, t(29) = ? 2. 93, p < 0. 006, and sons, t(27) = ? 2. 61, p < 0. 01. These results suggest that, regardless of child gender, mothers tend to place more emphasis on weight and dieting than do fathers. To examine the relationship between children’s selfreports and parental reports, correlations were conducted for parents’ reports of family history of eating concerns and children’s reports of eating disturbance and psychological functioning. A signi? cant correlation was revealed for mothers’ reports of family history and children’s reports of family history, r (77) = 0. 25, p < 0. 05. These results suggest that mothers and children perceived similar familial in? uences regarding weight and body shape. In addition, signi? cant correlations were revealed for maternal report of family history and children’s report of global self-worth, r (77) = ? 0. 27, p < 0. 05. No other signi? cant correlations were revealed for maternal or paternal reports DISCUSSION Overall, the results of this study support and extend previous research suggesting that both parental and peer in? uences are related to the development of body image and weight concerns in preadolescent girls and boys. It is likely that both factors play an integral part in children’s formations of maladaptive beliefs, attitudes, and expectations concerning weight, physical appearance, and body image. Further, there appear to be some differences but some similarities in how girls and boys experience these issues. Similar to previous research, girls in this study exhibited a somewhat greater degree of concern regarding weight and body image issues than did boys. Not only were they more aware of issues surrounding weight and dieting, but girls were more active in attempts to become and/or remain â€Å"thin. † In addition, it appears that girls received more messages within the family setting regarding weight and body image concerns. Although most investigations of body image concerns tend to recruit only female participants (e. g. , Attie and Brooks-Gunn, 1989; Cattarin and Thompson, 1994), the studies of gender differences Gender Differences in Peer and Parental In? uences in body image have used primarily adolescent samples (e. g. , Childress et al. , 1993; reviewed in Cohane and Pope, 2001). The present results support similar ? ndings for preadolescent children, which indicates that these gender differences begin to develop at an earlier age, prior to any pubertal changes (Collins, 1991; Oliver and Thelen, 1996; Shapiro et al. , 1997; Wood et al. , 1996). The results of this study provide support for a relationship between body image concerns and depressive symptoms (Herzog et al. 1992) and self-esteem (Wood et al. , 1996). Overall, children who expressed higher levels of body image disturbance reported higher rates of depressive symptoms and lower levels of global self-worth. Although this pattern was more evident in girls, the same pattern existed for boys when body dissatisfaction was considered. Prior research has revealed support for both parental (Sanftner et al. , 1996; Thelen and Cormier, 19 95) and peer (Cattarin and Thompson, 1994; Oliver and Thelen, 1996) in? uences on children’s eating and body image concerns. This study found support for peer and parental in? ences for girls and to a lesser extent, for boys. Most of the research on peer in? uences has been conducted with adolescent populations of girls (Levine et al. , 1994). In this study, similar patterns emerged for boys and girls when body dissatisfaction (as opposed to bulimic tendencies) were evaluated. It may be that preadolescent boys are struggling with body dissatisfaction, but in such a manner that is not captured by the measurement of bulimic tendencies. The measurement of parental teasing from the POTS measure was particularly useful in helping to understand boys’ experiences. A number of previous studies have documented the connections between negative verbal commentary and body image concerns in girls (Cattarin and Thompson, 1994; Schwartz et al. , 1999). In the current study, boys’ perceptions of parental teasing were related to higher levels of body dissatisfaction, bulimic tendencies, drive for thinness, family history of eating concerns, and depression and lower levels of global self-worth. Thus, further exploration of perceptions of parental teasing in both boys and girls may be fruitful. On the basis of the results of this study, the implications for prevention and intervention are numerous. Given the wealth of support for the existence of body image concerns in preadolescent children (Collins, 1991; Shapiro et al. , 1997; Thelen et al. , 1992; Wood et al. , 1996), it is imperative to address weight and body image concerns with children prior to adolescence. Psychoeducational programs could be helpful to inform children of the parental, peer, and sociocultural in? uences on their attitudes and beliefs concerning weight and physical appearance. Several universal psychoeducational programs 427 have been instituted and evaluated for school-aged children (reviewed in Levine and Smolak, 2001). Although this study found some gender differences in preadolescent children’s experiences of body image disturbance, the common pattern of associations among variables for both boys and girls would suggest that preventive efforts could be targeted to girls and boys together. Intervention programs are also necessary given the connections between familial in? uences and body image concerns in young children and the resultant connections between body image concerns and eating disorders (Cattarin and Thompson, 1994; Steinhausen and Vollrath, 1993; Thompson et al. 1999). Parents need to be educated about the negative consequences of their own weight and body image issues on the development of related problems in their children (Archibald et al. , 1999). Treatment programs should take family functioning into account and should address the strong connections between body image concerns and poor psychological functioning (Steinberg and Phares, 2001). There are several limitations to t he study indicating that these results should be interpreted with caution. First, the ross-sectional nature of the study precludes interpretations related to causality. For example, it could be that higher levels of depression lead to higher rates of body dissatisfaction in both boys and girls. A prospective study of girls and boys from early childhood to adolescence and even adulthood could help answer the direction of causality. In addition, because there was a signi? cant difference in family history of eating concerns (FHE-C) between children with and without completed parental data, the preliminary analyses of parental reports have to be viewed cautiously. Although other studies have found relatively few differences between participating and nonparticipating mothers and fathers (Phares, 1995), the differences in this sample suggest that the parental data may not be representative of the larger population. This study attempted to limit common method variance by including parents rather than just relying on children’s self-reports. This inclusion of parents, however, led to other dif? culties. Future studies in this area could bene? t from more intense efforts to recruit and maintain parents for participation in research. Even with these limitations, this study provided support for parental and peer in? uences on the development of body image disturbance in preadolescent girls and boys. It is likely that both peers and family members contribute to the development of body image disturbance and weight concerns of young children. 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BULLYING AS DEVIANT BEHAVIOR Essay - 2162 Words

BULLYING AS DEVIANT BEHAVIOR Deviance acts as a violation of social norms characterized as any thought, feeling or action that members of a social group judge to be a violation of their values or rules.1 Social norms are viewed as the actions or behaviors and cues within a society or group. This sociological term has been defined as the rules that a group uses for appropriate and inappropriate values, beliefs, attitudes and behaviors.†2 It indicates the established and approved ways of doing things, of dress, of speech and of appearance. Social norm is also described as the customary rules of behavior that coordinate our interactions with others.3 These rules may be explicit or implicit. They are often incorporated in the law and†¦show more content†¦This is one of the most easily identifiable forms of bullying. Bullies attacks their victims physically by hitting/punching, pushing, pinching, slapping, elbowing, shoving in a hurtful or embarrassing way, kicking, restraining, taking/stealing or dama ging belongings or other property, fighting or even using available objects as weapons. Verbal bullying is any malicious statements or accusations that cause the victim too much emotional distress. Examples includes name calling/using derogatory terms or playing with the persons name, insulting, tormenting, harassment, being laughed at, repeated teasing, racist remarks/other harassment, threats, intimidation, and commenting negatively on someones looks, clothes, body etc.-personal abuse. The indirect bullying behaviors are consists of social/relational and psychological or emotional abuse. Emotional bullying is any form of bullying that causes damage to a victim’s psyche and/or emotional well-being. Examples include: gossiping or spreading malicious rumors about people, destroying reputations, destroying status within a peer group, keeping certain people out of a group (social rejection or isolation), making fun of certain people, destroying and manipulating relationships, humiliation and embarrassment, or negative body language (facial expressions). Other bullying behavior that can be both direct and indirect is well-known as cyber bullying. Cyber-bullying is any bullying done through the use of technology. This