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Literature Review

DQ1

DQ1
Kayla Machingo

        One internal method for the dissemination of the early mobility change proposal is the house wide shared governance council. This council incorporates ethics, quality, and leadership into each department. It does so by each unit having representatives for a specific topic that research new evidence-based practices and aid in implementation. It is very important to have this large group of nurses involved as they are the foundation of Mission Hospital. More specifically, they can help advocate for the change proposal by requesting funds, creating newsletters, and sharing the new knowledge with other units. Being that I am apart of this council, my communication strategy would be more friendly and engaging, as I know many of the individuals. This would be more of a group bonding experience and could really lead to something great!

           One external method for dissemination of the proposal would be the American Nurses Association (ANA). This organization has an entire webpage directed to mobility programs and aids nurses in mobilizing patients safely. More specifically, they advocate for the use of lift devices to prevent injury for the nurses (American Nurses Association, 2022). This would be an important foundation to have by my side, as this project involves a lot of activity from the nurses including the use of the lift device. Therefore, the ANA can be a great resource for providing mobility education and support for the nurses working at the bedside. This form of communication would be extremely formal and would provide detail about the project and its goals.

Reference



American Nurses Association. (2022). Health and safety. https://www.nursingworld.org/practice-policy/work-environment/health-safety/handle-with-care/

DQ1
Virginia Gallardo

One important aspect is ensuring the dissemination of our evidence-based proposal, which can be achieved via internal and external methods. The goal of dissemination is to gather the created evidence and communicate it to the population of interest (Zhu et al., 2017). Disseminating such information can be challenging because we deal with multiple barriers affecting our healthcare system, like underfunding and understaffing. Internal methods include sharing our change proposal with the hospital board via email, individual, or group discussions. A poster or podium presentation can be an efficient means of sharing one’s scholarly work (Astroth & Hain, 2019). I have chosen to disseminate information through nurse leaders via unit huddles. Nurse leaders add information to this huddle that they want to discuss with staff. During huddles, nurses and other healthcare providers discuss any problems the organization has. This strategy allows me and those supporting my project to receive instant feedback as we see how nurses feel regarding the issue and the planned interventions to address the problem. It also will enable nurses to ask questions and have them answered promptly. 

An external method for disseminating my evidence-based proposal may be through a professional organization. There are various organizations, and many health professionals turn to these organizations to gain new knowledge on evidence-based practice. These organizations hold various conferences allowing us to meet multiple nurses of different backgrounds and share information like our change proposal. Sharing information via an external method like a professional nursing organization will provide more access to nurses outside of my organization. 

Reference

Astroth, K. S., & Hain, D. (2019, September 1). Disseminating Scholarly Work through Nursing Presentations. Nephrology Nursing Journal46(5), 545.

Zheng Zhu, Weijie Xing, Yan Hu, Yingfeng Zhou, & Ying Gu. (2018). Improving Evidence Dissemination and Accessibility through a Mobile-based Resource Platform. Journal of Medical Systems42(7), 118. https://doi-org.lopes.idm.oclc.org/10.1007/s10916-018-0969-7

Neoma Rice

For my change project, it is going to be proposed for a small privately own neurology clinic. So, the internal method for dissemination would be with the doctor and his nurse practitioners, who are all open about potentially implementing this practice of proper nutritional assessment and education for multiple sclerosis patients by nursing. I’m slightly troubled trying to think of what would be my external method of dissemination, but as I thought more I thought I could reach out to my National Multiple Sclerosis Society representative, Emily. She has a world of knowledge as someone who lives with MS, but she also works for the organization that has plentiful resources. I feel it would be important to share with Emily as she could provide me the latest and greatest nutritional recommendations that are being studied to aid me in helping these patients. Emily and i mostly communicate through email. She sent me an email today with new webinars of different MS related topics. 

It has been founded that technology and training can play an important role with dissemination and implementation of an evidence-based practice (Novins et al, 2013). 

Novins, D. K., Green, A. E., Legha, R. K., & Aarons, G. A. (2013). Dissemination and implementation of evidence-based practices for child and adolescent mental health: a systematic review. Journal of the American Academy of Child and Adolescent Psychiatry52(10), 1009–1025.e18. https://doi.org/10.1016/j.jaac.2013.07.012

DQ2

Kayla Machingo

Evaluation will be important in the early mobility capstone. The main idea I have been considering for evaluation is having patients complete a mini- evaluation on day of discharge and then again 6 months from day of surgery. I was considering using the Microsoft team’s application which has a poll application that can be sent out to individuals via email. This e-mail is secured and would represent Providence hospital. This form of evaluation seems the easiest for both me and the patients. The poll can be no more than ten questions, can have a time restriction and can be sent to all the patients (Microsoft, 2022). Once the results are back, a PDF can be created which will be useful in identifying if the early mobility project was effective (Microsoft, 2022). After a six-month period, I can compare these results with audits from 2021 to determine if the length of stay was decreased by ten percent or greater. If the evidence shows improved/shortened length of stay, then I will know that the project made a difference in practice.

Reference

Microsoft. (2022). Create a poll in teams. https://support.microsoft.com/en-us/topic/92bc2481-b5e4-4650-8a87-d90103ee95a1

Literature Review

In PSY-452: Experimental Psychology in Topic 8 you completed the Research Report assignment. In this course you will revise components from the PSY-452 assignment and use those revised components to create a research proposal at the end of this course. You should treat this assignment as a potential portfolio piece or writing sample for future grad school applications or job interview.

In 1,250-1,500 words, revise the literature review from the PSY-452 Research Report.
Using the peer-reviewed journal articles included on your Title and Reference Page assignment submitted in Topic 2, add additional information to the literature review section. Keep in mind the purpose of this literature review is to provide background information and research that is related to the topic being proposed to study. Within the sections being added/revised, make sure to include the following:

1. Using information from the Identifying Themes in Literature assignment in Topic 2, create headings and subheadings to organize the research in the literature review section. Avoid using direct quotes. Remember you are not writing article summaries.

2. Expand the list of resources included in the Topic 2 Title Page and Reference assignment by incorporating updated articles to the literature review section. Cite a minimum of 13-15 peer-reviewed journal articles.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center.

IDENTIFYING THEMES IN LITERATURE ASSIGMENT:

Berenbaum, S. A., & Beltz, A. M. (2016). How early hormones shape gender development. Current opinion in behavioral sciences7, 53-60.

Calzo, J. P., & Blashill, A. J. (2018). Child sexual orientation and gender identity in the Adolescent Brain Cognitive Development Cohort Study. JAMA pediatrics172(11), 1090-1092.

Eskenazi, B., Rauch, S. A., Tenerelli, R., Huen, K., Holland, N. T., Lustig, R. H., … & Harley, K. G. (2017). In utero and childhood DDT, DDE, PBDE and PCBs exposure and sex hormones in adolescent boys: The CHAMACOS study. International journal of hygiene and environmental health220(2), 364-372.

Jarin, J., Pine-Twaddell, E., Trotman, G., Stevens, J., Conard, L. A., Tefera, E., & Gomez-Lobo, V. (2017). Cross-sex hormones and metabolic parameters in adolescents with gender dysphoria. Pediatrics139(5).

Kaltiala-Heino, R., & Lindberg, N. (2019). Gender identities in adolescent population: methodological issues and prevalence across age groups. European Psychiatry55, 61- 66.

Porta, C. M., Gower, A. L., Brown, C., Wood, B., & Eisenberg, M. E. (2020). Perceptions of sexual orientation and gender identity minority adolescents about labels. Western journal of nursing research42(2), 81-89.

Martinez, C., Rikhi, R., Haque, T., Fazal, A., Kolber, M., Hurwitz, B. E., … & Brown, T. T. (2020). Gender identity, hormone therapy, and cardiovascular disease risk. Current problems in cardiology45(5), 100396.

Murphy, T. F. (2019). Adolescents and body modification for gender identity expression. Medical Law Review27(4), 623-639.

Ristori, J., Cocchetti, C., Romani, A., Mazzoli, F., Vignozzi, L., Maggi, M., & Fisher, A. D. (2020). Brain sex differences related to gender identity development: Genes or hormones?. International Journal of Molecular Sciences21(6), 2123.

Turban, J. L., King, D., Kobe, J., Reisner, S. L., & Keuroghlian, A. S. (2022). Access to gender- affirming hormones during adolescence and mental health outcomes among transgender adults. Plos one17(1), e0261039.

Vigil, P., Del Rio, J. P., Carrera, B., Aranguiz, F. C., Rioseco, H., & Cortés, M. E. (2016). Influence of sex steroid hormones on the adolescent brain and behavior: An update. The Linacre Quarterly83(3), 308-329.

Zhou, Y., Hu, L. W., Qian, Z. M., Chang, J. J., King, C., Paul, G., … & Dong, G. H. (2016). Association of perfluoroalkyl substances exposure with reproductive hormone levels in adolescents: by sex status. Environment international94, 189-195.

Literature Review

Project Topic: The Impact of Nursing Shortage on Healthcare

While the implementation plan prepares students to apply their research to the problem or issue they have identified for their capstone project change proposal, the literature review enables students to map out and move into the active planning and development stages of the project.

A literature review analyzes how current research supports the PICOT, as well as identifies what is known and what is not known in the evidence. Students will use the information from the earlier PICOT Question Paper and Literature Evaluation Table assignments to develop a 750-900 word review that includes the following sections:

1. Title page

2. Introduction section

3. A comparison of research questions

4. A comparison of sample populations

5. A comparison of the limitations of the study

6. A conclusion section, incorporating recommendations for further research

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to LopesWrite


Literature Review


Topic 7: Capstone Change Project Evaluation Plan

Apr 25-May 1, 2022

Students must develop skills related to systematic evaluation for intervention effectiveness. The content covered this week prepares students to evaluate the effectiveness of interventions and develop communication plans for the dissemination of information related to project outcomes. Synthesis of information from the process of evaluating outcomes (whether outcomes were met or not) generates new knowledge and adds to the body of knowledge for nursing practice.

Objectives:

1. Determine how the capstone project change proposal could be disseminated to leadership.

2. Create a plan to evaluate outcomes of the proposed nursing practice intervention used in the change proposal.

3. Integrate reflective practice into the practicum reflective journal.

4. Demonstrate interprofessional collaboration during the creation of the capstone project change proposal.

DQ1

Describe one internal and one external method for the dissemination of your evidence-based change proposal. For example, an internal method may be the hospital board, and an external method may be a professional nursing organization. Discuss why it is important to report your change proposal to both of these groups. How will your communication strategies change for each group?

DQ2

In order to evaluate an evidence-based practice project, it is important to be able to determine the effectiveness of your change. Discuss one way you will be able to evaluate whether your project made a difference in practice.

Capstone Change Project Evaluation Plan

SUBMIT ASSIGNMENT

Review your strategic plan to implement the change proposal, the objectives, the outcomes, and listed resources. Develop a process to evaluate the intervention if it were implemented. Write a 150-250 word summary of the evaluation plan that will be used to evaluate your intervention.

The assignment will be used to develop a written implementation plan.

Literature Review

R E V I E W A R T I C L E

Review on parameter estimation techniques of solar
photovoltaic systems

Radhakrishnan Venkateswari1 | Natarajan Rajasekar2

1VIT University, Vellore, India
2Solar Energy Research Cell, School of
Electrical Engineering, Vellore Institute of
Technology, Vellore, Tamil Nadu, India

Correspondence
Natarajan Rajasekar, Solar Energy
Research Cell, School of Electrical
Engineering, Vellore Institute of
Technology, Vellore, Tamil Nadu 632 014,
India.
Email: nrajasekar@vit.ac.in

Summary

Beyond meeting power demand, switching to solar energy especially solar

photovoltaic (PV) offers many advantages like modularity, minimal mainte-

nance, pollution free, and zero noise. Yet, its cell modeling is critical in design,

simulation analysis, evaluation, and control of solar PV system; most impor-

tantly to tap its maximum potential. However, precise PV cell modeling is

complicated by PV nonlinearity, presence of large unknown model parameter,

and absence of a unique method. Since number of model parameters involved

is directly related to model accuracy, and efficiency; determination of its values

assume high priority. Besides, application of meta-heuristic algorithms via

numerical extraction is popular as it suits for any PV cell/module types and

operating conditions. However, existence of many algorithms have drawn

attention toward assessment of each method based on its merits, demerits,

suitability/ability to parameter estimation problem, and complexity involved.

Hence, few authors reviewed the subject of PV model parameter estimation.

But existing reviews focused on comparative analysis of analytical and meta-

heuristic approaches, analysis of models, and application of meta-heuristic

methods for model parameter extraction. Thus, lack a comprehensive analysis

on methods based on different objective function, assessment on

List of Symbols and Abbreviations: ABC, artificial bee colony; ABSO, artificial bee swarm optimization; ADEA, adaptive differential evolution
algorithm; AIS, artificial immune system; BBO, biogeography based optimization; BFA, bacteria foraging algorithm; BMO, bird mating optimization;
CBSA, backtracking search algorithm with competitive learning; CGBO, chaotic-GBO; COA, coyote optimization algorithm; CPSO, chaotic particle
swarm optimization; CSA, crow search algorithm; CSO, cat swarm optimization; CSO, cuckoo search optimization; CWOA, chaotic whale
optimization algorithm evolution; DDM, double diode model; DET, differential evolution technique; DPDE, directional permutation differential
evolution algorithm; EJaya, enhanced Jaya; ELPSO, enhanced leader particle swarm optimization; EO, equilibrium optimizer; EO-Jaya, elite
opposition-based Jaya; ER-WCA, evaporation rate based water cycle algorithm; FF, firefly; FPA, flower pollination algorithm; FPSO, flexible particle
swarm optimization; GA, genetic algorithm; GCPSO, guaranteed convergence particle swarm optimization; GGHS, grouping-based global harmony
search; GOBL, generalized opposition-based learning; GWO, grey wolf optimization; GWOCSA, grey wolf optimization and cuckoo search algorithm;
HFAPS, hybrid firefly and pattern search; HSA, harmony search algorithm; IADE, improved adaptive DE; ICA, imperialist competitive algorithm;
ICSO, improved cuckoo search optimization algorithm; IGHS, innovative global harmony search; IJaya, improved Jaya; ILSA, improved learning
search optimization algorithm; ImSMA, improved version slime mould algorithm; ISCA, improvement sine cosine algorithm; ITLBO, improved
teaching-learning-based optimization; MPSO, mutant particle swarm optimization; MPSO, mutant PSO with adaptive mutation strategy;
NMSOLMFO, Nelder-Mead Moth Flame; ORcr-IJADE, onlooker-ranking-based mutation operator-improved adaptive differential; PGJaya,
performance-guided Jaya; PS, pattern search; PSO, particle swarm optimization; PSOGWO, particle swarm optimization and grey wolf optimization;
Rcr-IJADE, repaired adaptive differential evolution; RLWOA, refraction-learning-based whale optimization algorithm; RMSE, root mean square
error; SA, simulated annealing; SDM, single diode model; SEDE, self-adaptive ensemble-based differential evolution; SFO, sunflower optimizer; SFS,
stochastic fractal search; SMA, slime mould algorithm; SSA, salp swarm algorithm; TGA, tree growth algorithm; TLBO, teaching learning based
optimization; TVACPSO, time-varying acceleration coefficients particle swarm optimization; WDO, wind-driven optimization; WOA, whale
optimization algorithm.

Received: 8 February 2021 Revised: 5 August 2021 Accepted: 9 September 2021

DOI: 10.1002/2050-7038.13113

Int Trans Electr Energ Syst. 2021;31:e13113. wileyonlinelibrary.com/journal/etep © 2021 John Wiley & Sons Ltd. 1 of 72

https://doi.org/10.1002/2050-7038.13113

environmental conditions, and cumulative analysis on selective set of algo-

rithm based on efficiency. Therefore, this work reviews optimization algo-

rithms presented for parameter estimation focusing on (a) objective function

used, (b) modeling type, (c) algorithm employed for parameter extraction, and

(d) PV technology. Further, provides a comprehensive assessment on various

modules types used for validation, comparisons made with methods, advan-

tages and disadvantages associated with each method with respect to parame-

ter estimation platform, critical analysis on each method at STC, and varying

irradiance conditions. In addition, a critical evaluation on specific set of algo-

rithm based on objective function values is also carried out. Thus explores and

display the characteristics of various techniques related to PV cell modeling

and serve to be a single reference for researchers working in the field of PV

parameter estimation.

K E Y W O R D S

meta-heuristics methods, parameter estimation, PV cell modeling, solar PV

1 | INTRODUCTION

Preserving the last residues of the fossil fuel created thrust toward utilization of abundantly available renewable energy
sources.1 Increased penetration and its continuous influence in the power sector is phenomenal and the most promising
in creation of secure and sustainable energy.2 Among many renewable energy resources, solar photovoltaic (PV) made
prodigious contribution toward sustainable power generation.3 This energy resource remains at an unprecedented
height by generating 480 GW of power supplying 2.8% of the world’s electrical demand approximately by the end of the
year 2020.4

Albeit solar energy is abundant, and leads the way in forefront5; its growth is obstructed by factors such as partial
shading,6 intermittent nature,7 high initial cost,8 and expensive storage requirement.9 Thus, precise modeling becomes
obligatory and inevitable to predict the PV system performance before implementation.10 Moreover, the prophecy of PV
panel working characteristics is pivotal in the design, simulation analysis, evaluation, and control of solar PV system.11

Further, modeling helps in understanding the working principle and operating characteristics of a solar PV system
under various atmospheric conditions.12

However, limited by virtue of inherent data unavailability13; PV cell modeling approaches so far applied
analytical,14 iterative,15 and meta-heuristic methods16 to model PV panel characteristics. Wherein, all the methods
intend to rebuild the PV characteristics by identifying the missing unknown parameters.17 Modeling using analytical
method is complex and lack efficiency as it involves additional equations.18,19 Likewise, iterative technique is bound to
considerable computational complexity; since mathematical procedure for “n” iterative times are executed until the
desired output is attained.20 Meanwhile, application of meta-heuristic algorithms via numerical extraction is popular as
it suits for any PV cell/module types and operating conditions.21

Eventually, variety of meta-heuristic based parameter extraction techniques have been investigated so far.22 How-
ever, existence of many algorithms have drawn attention toward assessment of each method based on its merits,
demerits, suitability/ability to parameter estimation problem, and complexity involved. Hence, few authors reviewed
the subject of PV model parameter estimation. For instance, in Reference 23 review on various meta-heuristic algo-
rithms involved in identifying the parameters of single and double diode model (SDM and DDM) is expounded. A
detailed comparative study between analytical and meta-heuristic approaches is presented.24 A synergetic review work
on stochastic algorithms employed for evaluating one and two diode model parameters of PV and fault detection of a
PV system is explained.25 However, the reviews mentioned has one or more of the following limitations, (a) Only works
related to one and two diode model is discussed, (b) limited discussions are made concerning objective function values
and the identified parameters, and (c) number of works considered for analysis is minimal and details pertinent to the
suitability analysis of the optimization method for various PV module selected is found missing.26 Therefore,

2 of 72 VENKATESWARI AND RAJASEKAR

understanding the importance of parameter estimation techniques in PV cell efficiency enhancement, a detailed review
on parameter estimation techniques is proposed in this article. The significant contributions made in this review article
can be summarized as:

1. This work reviews optimization methods to a greater extent such that a collection of nearly 29 algorithms with its
variants published till date has been studied.

2. Brief discussion on each algorithm highlighting its merits and demerits is presented and a detailed comparison table
on recent published works is portrayed.

3. The review consolidates the different objective function used with emphasis on root mean square error (RMSE)
objective function. Further, the best-suited algorithm for every case study is presented.

4. This article expounds a detailed survey on (a) modeling types, (b) algorithm employed for parameter extraction,
(c) PV technology, and (d) type of panel used for research work.

5. Six case studies based on manufacturing technology and modeling at STC and various atmospheric conditions have
been discussed.

6. To facilitate decision making for PV researchers involved in the Parameter estimation works, a discussion on PV
materials, modeling, performance metrics, various algorithms, and its results have been analyzed and presented.

This review article is structured as follows: Section 1 presents an introduction. Followed by the introduction, an over-
view of the solar cell and its I-V and P-V characteristics is expounded in Section 2. Section 3 presents a detailed descrip-
tion of the modeling of solar PV. Section 4 provides information about the methods involved in parameter evaluation of
solar PV and a detailed discussion on above-mentioned algorithms is provided in Section 5. To evaluate the results and
effectiveness of each algorithm, comparative result analysis is performed in Section 6. Finally, in Section 7 conclusion
and future work is presented.

2 | SOLAR PV AND ITS CHARACTERISTICS

The basic building block of a PV module is its solar cell; capable of generating electrical power in mow is connected in
serial/parallel to form a module.27 For high power applications, these modules are further interconnected to form a PV
array.28 The pictorial transformation of solar PV cell to a PV array is represented in Figure 1.

The major limitation of PV based power generation is its limited availability and dependency on factors such solar
insolation, temperature, tilt angle, and the materials used.30 The primary being insolation and temperature greatly
influences the amount of current generated and output voltage. For instance, irradiation controls the short circuit cur-
rent delivered by the panel31; while temperature defines the open-circuit voltage.29 To imply its significance typical
solar PV panel of Kotak 80 W V-I characteristics at different insolation and temperature is shown in Figure 2. From the

FIGURE 1 Formation of photovoltaic (PV) cell, module, and an array29

VENKATESWARI AND RAJASEKAR 3 of 72

characteristics curves, it is understood both these nature controlled parameters influence largely on PV performance.
Hence, should be accounted during PV modeling.

2.1 | Solar cell materials on its performance

Having understood the importance of solar cells, rigorous research on its efficiency improvement led to the develop-
ment of three tangible PV types.32 However, the generations they belong are defined based on the materials used.33 In
each generation substantial improvement that fundamentally makes the solar cell compact, highly efficient,34 and com-
mercially viable35 are introduced. The materials that correspond to first,36 second,37 and third21 generation solar cells
are silicon,38 Cd Te,39 and nanocrystals organic40 polymer materials, respectively.41 The solar cell material classification
based on manufacturing technology is depicted in Figure 3.

It is noteworthy to mention that more than 90% of present solar cells are silicon-based first-generation type with
efficiency of 29%43; wherein the conversion efficiency of Single-crystalline PV panel is 14% to 17.5%43 and of poly-
crystalline solar cell vary between 12% and 14%.43 Polycrystalline solar cells are economical, stronger compared to
monocrystalline type. On the other hand, the thin-film cells are equally good and popular use CIGS and Cd Te material
holding a higher efficiency of approximately 9% to 12%.43

Amorphous silicon type solar cell exhibit 40 times absorption capacity than monocrystalline cell and also does not
require high temperature for its manufacturing. Nonetheless, its efficiency is 5% to 7% still poorer than polycrystalline
type.43 Similarly, the contribution of a third-generation solar cell comprising DSSC, nano, polymer, and perovskite in
PV growth is steadily increasing.44 These third-generation solar cells show increased efficiency at a reduced cost. Even

FIGURE 2 I-V curves of solar photovoltaic (PV) panel under varying irradiance at constant temperature and vice versa

Silicon
based

Thin films
cells

Multi layer
cells

Organic, polymer, nano
materials, perovskite,
DSSCs

Mono-crystalline
poly-crystalline

Copper Indium Gallium
Selenide (CIGS) cell,
Cadmium Telluride
(CdTe)Cell, Amorphous
silicon

PV growth

FIGURE 3 Generations of photovoltaic (PV) growth42

4 of 72 VENKATESWARI AND RAJASEKAR

though the DSSC is economical, the sunlight absorption capability of this type of cell is feeble45; while the complexity
in mass production of nano cells is elevated.25 Only perovskite-type solar cell among the third generation is promis-
ing.46 The efficiency chart of various solar cell materials types is illustrated in Figure 4.

2.2 | Modeling methods of solar PV

Generally, a solar PV cell is modeled using electrical equivalent circuit that ideally comprises of diode, resistors, and a
current source. Because of the nonlinearity present, several PV cell modelling methods have evolved in recent past. The
major classification of PV cell models are one diode,47 two diode,48 and three diode model.49 The number of diodes pre-
sent in the model determines the I-V curve prediction accuracy.

Conventionally, ideal single diode that consists of a diode in parallel to the current source is used.50 This ideal
equivalent circuit is later modified with introduction of series resistor (RS)

51 and shunt resistance (RP) to take into
account the losses that occur due to the metallic junction and carrier recombination, respectively.52 The model with
resistors RS, RP included is called SDM.

53 Due to its simplicity, accuracy, and reliability, SDM are commonly used in
practice for modeling and simulation purpose.54 For certain cases, the performance of a SDM is found to be satisfactory,
even after neglecting recombination losses existing in the diode.55 However, for accurate curve reproduction, inclusion
of recombination losses is helpful hence lead to the development of DDMs.4 Further, inclusion of another diode
improved its modeling performance and accuracy even at low irradiance conditions but at the cost of increased com-
plexity.56 Similarly, evolution of modeling leads to the development of three diode model as well to enhance accuracy.57

The equivalent circuit model, its design equations and the particulars of unknown parameters are showed in Table 1
(Figure 5). The table also indicates that as the number of diodes increases, the model parameters to be estimated also
increases thereby increasing the complexity.59

3 | PV MODULE PARAMETER ESTIMATION

Apart from model selection, another important step that improves the cell modeling of solar PV is its unknown parame-
ter estimation. In the process of PV modeling, accurate estimation of every unknown parameter is equally important.
For better understanding, the various process involved in PV modeling and its parameter estimation methods is shown
in Figure 6. One of the simplest methods to determine unknown parameters of solar PV is by applying specific operat-
ing conditions, and solve using trial and hit process. Undoubtedly, this technique produces the lowest efficiency as the
predicted values vary largely.

Two commonly followed procedure in unknown parameter determination is (a) analytical60 and (b) meta-heuristic
optimization61 methods. In the case of an analytical method, a nonlinear solar PV characteristic is attained by applying
different operating condition together with available manufacturer datasheet values.62 While meta-heuristic method fol-
lows curve fit procedure to predict the IV curve63; wherein every data point on the IV curve predicted is matched with
the actual values.

FIGURE 4 Efficiency of various photovoltaic (PV) materials43

VENKATESWARI AND RAJASEKAR 5 of 72

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6 of 72 VENKATESWARI AND RAJASEKAR

Apart from model selection, another important step that improves the cell modeling of solar PV is its unknown
parameter estimation.64 In the process of PV modeling, accurate estimation of every unknown parameter is equally
important.65 For better understanding, the various process involved in PV modeling and its parameter estimation
methods is shown in Figure 6. One of the simplest methods to determine unknown parameters of solar PV is by apply-
ing specific operating conditions, and solve using trial and hit process. Undoubtedly, this technique produces the lowest
efficiency as the predicted values vary largely.36 Two commonly followed procedure in unknown parameter determina-
tion is (a) analytical and (b) meta-heuristic optimization methods. In the case of an analytical method, a nonlinear solar
PV characteristic is attained by applying different operating condition together with available manufacturer datasheet
values. While meta-heuristic method follows curve fit procedure to predict the IV curve; wherein every data point on
the IV curve predicted is matched with the actual values.

For both the cases, to model PV cell, maker’s specific data like (a) current at maximum power (Imp), (b) Voltage at
maximum power (Vmp), (c) Short circuit current (Isc), and (d) Open circuit voltage (Voc) are necessary. Besides, the
other values required for modeling an efficient PV solar model are (a) Diode saturation current (Io), (b) PV current
(Ipv), (c) diode ideality factor (A), (d) series resistance (Rs), and (e) parallel resistance (RP).

66 Undoubtedly these data
are unknown and also unavailable in the manufacturer’s spec sheet. Thus, for obtaining an exact I-V curve through soft-
ware simulation requires information about these unknown parameters.58 Further, to lessen the computation burden

FIGURE 5 Modeling of solar photovoltaic (PV).23 (A) Equivalent circuit of single diode model (SDM),58 (B) equivalent circuit of double
diode model (DDM),54 and (C) equivalent circuit of triple diode model (TDM)56

FIGURE 6 Process involved in photovoltaic modeling and its parameter estimation

VENKATESWARI AND RAJASEKAR 7 of 72

and to enhance the performance, the meta-heuristic algorithms are employed.46 Even these methods can be combined
with analytical techniques for superior performance.

3.1 | Meta-heuristic method-based solar PV parameter estimation

Existence of several unknown parameters, difficulty in mathematical formulation, involvement of large number of
mathematical equations, and use of operating conditions such as Voc, Isc, Vmpp, and Impp restricts the use of analytical
methods for PV modelling.59 Further, solving such equations is complex, consumes quality time, and requires more
attempts to find accurate result.65

Hence, as an alternative to overcome the shortcomings of an analytical method, meta-heuristic optimization
methods are used for accurate PV parameter extraction.19 Moreover, it is observed that the obtained result matches well
with the actual characteristics curve of solar PV with minimal error.24 Further, any dynamic variation either in insola-
tion and temperature can also be reproduced.35 Hence, meta-heuristic algorithms are desirable in PV cell modeling
compared to analytical methods.23 Generally, they are categorized into (a) evolution based, (b) nature-based,
(c) human-based, and (d) bio-inspired techniques. Categorization of the different method is illustrated in Figure 7.

3.2 | Performance metrics—an overview

Performance metrics defined play an integral role in a method success since it decides the overall quality of the predic-
tion.70 The various metrics defined so far for optimization techniques are Root Mean Square Error (RMSE),71 Mean
Square Error (MSE),72 Mean Bias Error (MBE),73 Absolute Error (AE),74 Individual Absolute Error (IAE),75 Relative
Error (RE),76 and Sum of Squared Error (SSE).77 Among all, RMSE is widely used as objective function to determine
the efficiency of a method.78 Various other functions used to measure the quality of meta-heuristic methods output are
listed in Table 2.

4 | VARIOUS META-HEURISTIC METHODS FOR PV PARAMETER
ESTIMATION

As highlighted in the previous discussion, meta-heuristic methods are the most preferred choice for PV parameter esti-
mation. Numerous methods were applied for improved PV characteristics prediction. Among many the most prominent
29 parameter estimation algorithms covering evolutionary-based DE, GA algorithms, Nature-inspired based PS, SA,
WDO, ERWCA, FPA, Bio-inspired based PSO, BFA, ABC, CSO, FF, CS, GWO, BMO, CSA, WOA, SSA, Elephant water
search, Shark Smell, and human-based HS, ICA, SA, Jaya, AIS, BBO algorithms are selected and analyzed further. An
intensive comparative analysis based on the efficiency of all meta-heuristic algorithms to find the best meta-heuristic
algorithm (MA) in estimating the parameters of the PV panel is performed.

This efficiency analysis on each algorithm is performed by considering the RMSE factor; wherein the algorithm with
the lowest RMSE value is considered as more effective in parameter assessment of solar PV.79 In all the cases, the
parameters and RMSE values obtained by all the algorithms at STC is alone considered.80 The technology utilized for
the manufacturing of solar is also given due importance and considered as one of the main factors in this investigation.
The commonly used technologies were monocrystalline81 based SM55, SW245, SP190, STM6-40/36, 1STH-235-WH,
SQ85, HIT-215, S75, thin film80 based 752 GaAs, ST50, and polycrystalline82 based KS20T, kC200GT, RTC France, S36,
SP70, ST36, RSM50, SM255, PWP201, Sharp ND-R250A5, SX3200N, KD210GH-2PU, and ST40 were also considered
during the analysis. The various optimization algorithms involved in estimating the parameters are explained as
follows:

4.1 | Pattern search algorithm

Pattern search (PS) algorithm developed by Hooke and Jeeves in the year of 1961 is a numerical based MA employed
for solving the optimization problems.82 The two main steps involved in this algorithm are (a) exploratory search and

8 of 72 VENKATESWARI AND RAJASEKAR

(b) PS. In case of exploratory search, the initial search starts by considering “n” random point termed as Base Point
(BP) and proceeds further search by forming a mesh with “2n” points covering “2n” coordinate directions. Meanwhile,
it also monitors the solution at each search step.83 In PS, if the search process is progressive; the BP is replaced by the
new value in the same direction by considering the previous BP.83 The process is mathematically expressed as

XkBp ¼ XkBp þ XkBp �Xk�1Bp
h i

ð1Þ

If the current move is successful, then the perturbation is done with the new “XBp+k,” and if the move is a failure, then
the pattern exploration proceeds with old “XBp

k.”

Wind optimization algorithm (WOA)

Evaporation rate based water
Cycle algorithm (ERWCA)

Simulated annealing (SA)

Pattern search (PS)

Flower pollination algorithm (FPA)

Piece-wise
approximation

Special
transformation

theory

Particle swarm optimization (PSO)

Bacterial foraging optimization (BFO)

Artificial bee colony (ABC)

Cat swarm optimization (CSO)

Cuckoo algorithm (CA)

Whale optimization algorithm (WOA)

Crow search algorithm (CSA)

Salp swarm algorithm (SSA)

Grey wolf optimization (GWO)

Bird mating optimization (BMO)

Differential evolution (DE)

Genetic algorithm (GA)

Artificial i mmune system (AIS)

Harmony search (HS)

Imperialistic competitive algorithm (ICA)

Teaching learning based optimization (TLBO)

Biogeography based optimization (BBO)

Newton-
raphson

Least
square

Gauss
seidal

A
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JAYA algorithm

Brain storming algorithm

Gravitational search algorithm

Artificial bee swarm optimization

Fire fly (FF)

Shark smell optimization(SSO)

Elephant swarm water search algorithm

FIGURE 7 Various algorithms in identifying the parameters of solar photovoltaic18,23-25,51,67-69

VENKATESWARI AND RAJASEKAR 9 of 72

4.2 | Simulated annealing algorithm

It is a probabilistic search technique that adopts the metallurgical annealing process involved in producing high quality
defect-less steel.84 The two main steps involved in the heat treatment process are (a) increasing the temperature near to
the melting point and (b) process of cooling. Simulated Annealing (SA) methods treat the cost function and control
parameter for the optimization as the energy state and temperature of the metal. Since, the rate of cooling is the decid-
ing factor in obtaining the optimal solution that is, lesser the cooling rate, lesser the acceptance of the worst solution
(solution with poor fitness).85 The basic equation involved in SA algorithm is

Tnew ¼ s * Told ð2Þ

where “Told” and “Tnew” are old and new temperature, “s” is the cooling rate.

4.3 | Genetic algorithm

Genetic algorithm (GA) optimization proposed by John Holland in the year 1970is a nature-enthused optimization
technique inspired by the biological evolution of humans.86 The keystone steps involved in this algorithm are selection,
crossover, and mutation. Thus through the process of reproduction new individuals randomly selected from existing
population are allowed in creation of healthy succeeding generation. The steps involved in GA are illustrated in
Figure 8.87

TABLE 2 Tabulation of performance metrics

S. no. Performance metrics Formulae

1. Root Mean Square Error (RMSE)

RMSE ¼

ffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiPN
i¼0

Iest,j�Im,j

Literature Review

8

Investigating the Relationship between the Hormone Exposure and Gender Identity during Adolescence

DeAnna Fleming

Grand Canyon University

Professor Carter

PSY-452

December 2, 2021

Abstract

The adolescence of a major stage of development of the life of a human being. It is during this stage that the transition from childhood to adulthood takes place. During this time, different changes take place in the life of the adolescents that affect their transition. In some cases, the effects have few effects while in other cases, the effects are adverse. One of the effects of this transition stage is the hormone exposure that is related to the gender identity of the adolescents. Teens of different gender go through different hormonal imbalances during this period. In this study, the exposure of effects of exposure to both male and female hormones will be explored and how they affect gender during adolescence period. During this period, the major function of the hormones is to determine the moods, emotions, and impulse reactions of teenagers. The methodology that will be used by the study is descriptive and a sampling technique will be used to determine the sample population. Questionnaires will be used to collect data from the participants.

Introduction

The second stage of human life is puberty stage which comes immediately after adolescence. The stage occurs when a section of the brain that is referred to as the hypothalamus starts to produce a hormone that affects the tests for boys and the ovaries for girls which leads to an increase in the hormones that are responsible for sex. In girls, estrogen is formed while in boys, testosterone is formed. During the adolescence period, teenagers experience many social changes and behaviors (Ristori et al., 2020). One of the behavioral changes is the one related to testosterone. This leads to the development of dominance behavior. It alters the neural transmission of vasopressin that lies within the forebrain circuit. Studies have suggested that testosterone treatment only affects the behavior and gender identity in males during adolescence.

Scholars have also suggested that teen hormones determine the mood swings of teens. These experiences are caused by the fluctuations in estrogen, progesterone, and testosterone which determine the sexual orientations of teenagers. The hormones also play a very significant role in the way teenagers conduct themselves when it comes to matters of dating and sexuality. The purpose of this study is to determine how hormone exposure affects the gender identity of teenagers during adolescence (Hruz, 2020). By doing so, the group of young boys and girls who are going through a transition period will get the necessary support that will help them to cross from childhood to adulthood safely.

Problem statement

During the puberty stage, teens face several changes that lead to major changes to their body systems and behavior. If the teens are not well taken care of, some of them get lost in the whole process. Studies suggest that some of them fail to identify roles that come with them being either male or female. During this period, teenagers need to learn what it entails being either a boy or a girl and be supported to go be positive to the whole transition process. It is there important to ensure that the teens get training and counseling that will enable them to go through the process successfully. This is a normal process, and the teens should not be condemned for behaving abnormally just because of the development process (Moravek, 2019). The study will also ensure that all stakeholders come on board to ensure that the teens have been guaranteed support that will help them take the abnormal behavior and physical changes positively during the adolescence stage.

Hypothesis

The study aims at investigating whether there is a relation between hormone exposure in the uterus and gender identity in adolescents. The other hypothesis that the study aims at testing is whether urine and blood contain hormones that affect gender identity during the adolescence period.

Objectives

1. To investigate what hormone exposure is and how it affects adolescents.

2. To establish the relationship between hormone exposure in the uterus and gender identity in adolescents

3. To investigate how gender identity can be achieved by teens during the adolescence period.

Literature Review

Scholars have suggested that several important psychological characteristics exhibit differences in sexuality which are a result of sex hormones that occur at different periods of development. Sex hormones play a very crucial role in the early developmental stages of teenagers especially when it comes to the differential impacts of prenatal androgens and their effects on the development of gender (Berenbaum, 2018). Another study suggests that prenatal androgens have facilitative characteristics on the activities that are related to the interests of the males, their spatial abilities, but they play very minimal roles in gender identity. A recent study tries to explain and put a lot of emphasis on the psychological mechanisms that determine the effects, and neural substrates of the effects of androgen (Martinez et al., 2020). Other studies have suggested that hormones in conjunction with other social environments are responsible for producing trajectories in terms of gender development and clarification of mechanisms by which androgens are used to affect behavior.

Several studies have been performed on how the behavior and genders of teenagers change during the adolescence period. According to these studies, the behavior changes because of high levels of hormones that are produced in the bodies of teenagers. Scholars have suggested that a lot needs to be done to teenagers during this period to help them to balance their hormones so that their behavior and body changes do not adversely affect their behavior. Most of the studies that have been done in this field have not been in a position to address how the change of behavior can be handled scientifically to ensure that the transition is smooth for the teens (Bastista et al., 2019). It is, therefore, necessary for more studies to be conducted to come up with more recommendations on how this can be done for the interest of teenagers.

Methodology

The methodology for this study will be carried out in two phases. In the first phase, the sample population where the study will be conducted will be identified. The sampling technique will be used to select participants randomly from the whole population who will be involved in the study. The participants need to know that taking part in the study is voluntary and that the data collected will only be for this study. Descriptive research will be adopted in this study. Data will be collected using oral and written interviews. In written interviews, questionnaires will be administered to the participants (Reisman et al., 2019). After filling out the questionnaires, they will be collected and qualitative data analyzed to obtain the quantitative data. Some of the data that will be collected will include age, gender, the time when the hormone exposure effects started being experienced, and how the hormone exposure affects gender identity in adolescents. The quantitative data collected was represented using bar graphs and pie charts. The table below is a sample of the data that will be collected in this study.

Boys

Girls

Percentages (Boys)

Percentage (Girls)

Total

25

15

62.5

37.5

100

From the hypotheses started by the study, the table below shows the number of teenagers whose hormone exposure is likely to enhance their character identity.

Boys

Girls

Percentages (Boys)

Percentage (Girls)

Total

20

10

80

66.7

100

Discussion

From the data samples collected above, it is evident that most of the teenagers’ gender identity is greatly determined by hormones exposure during the adolescence period. From the sample that was collected, 80 percent of the boys and 66.7 percent of the girls strongly agreed that their gender identity has greatly been affected by hormones during adolescence. In this regard, it is therefore important that the adolescence period has to be handled with a lot of care because of the very significant role it plays in the transition process from childhood to adulthood.

Conclusion

From the study, it is clear that gender identity takes place during adolescence. During this period, teenagers experience different changes in behavior and their bodies. Some of them grow so big because of hormonal imbalances. It is during this time that boys identify with men and girls identify with women. Their sexual organs fully develop, and they fully become aware of themselves.

References

Batista, R. L., Inacio, M., Arnhold, I. J. P., Gomes, N. L., Faria Jr, J. A. D., de Moraes, D. R., … & Mendonça, B. B. (2019). Psychosexual aspects, effects of prenatal androgen exposure, and gender change in 46, XY disorders of sex development. The Journal of Clinical Endocrinology & Metabolism, 104(4), 1160-1170.

Berenbaum, S. A. (2018). Evidence needed to understand gender identity: Commentary on Turban & Ehrensaft (2018). Journal of Child Psychology and Psychiatry, 59(12), 1244-1247.

Hruz, P. W. (2020). Deficiencies in scientific evidence for medical management of gender dysphoria. The Linacre Quarterly, 87(1), 34-42.

Martinez, C., Rikhi, R., Haque, T., Fazal, A., Kolber, M., Hurwitz, B. E., … & Brown, T. T. (2020). Gender identity, hormone therapy, and cardiovascular disease risk. Current problems in cardiology, 45(5), 100396.

Moravek, M. B. (2019). Fertility preservation options for transgender and gender-nonconforming individuals. Current Opinion in Obstetrics and Gynecology, 31(3), 170-176.

Reisman, T., Goldstein, Z., & Safer, J. D. (2019). A review of breast development in cisgender women and implications for transgender women. Endocrine Practice, 25(12), 1338-1345.

Ristori, J., Cocchetti, C., Romani, A., Mazzoli, F., Vignozzi, L., Maggi, M., & Fisher, A. D. (2020). Brain sex differences related to gender identity development: Genes or hormones?. International Journal of Molecular Sciences, 21(6), 2123.

Literature Review

I need a literature review done. The information can date back 5years only. The source can be articles and academic journals.  

Topic:

 “How Online Collaboration and Remote Work Has Impacted Accounting, Finance, and Management.” 

Sub-topic:

1. To what extend is this problem affecting the work environment.

2. What are the factors contributing to the increasing level of online collaboration and remote  working for example COVID-19

3. How new emerging trends affect finance, accounting and management

4. Challenges face when implementing online collaboration and remote working

  • 2 months ago
  • 20

Literature review

2

11

Patient Violence Against Nursing Staff and De-Escalation Courses: Literature Review

Name

NSG 410 Research and Evidence- Based Nursing Practice

Dr. Coffin

Patient Violence Against Nursing Staff and De-Escalation Courses: Literature Review

Overview and Introduction

Patient violence against nursing staff is an ongoing, and rising, issue in the healthcare field not just in the U.S., but worldwide. According to The Joint Commission (2018), workplace violence (WPV) occurs four times more in nurses in hospital settings than any other worker in the private sector. Nurses working in emergency departments are at the greatest risk of verbal and/or physical assault than any other unit of nursing due in part to being the first point of contact with the patient from the outside (Wong et al., 2015). That being said, WPV still occurs in all nursing fields putting each nurse working bedside at risk. Using meticulous technique, a literature review was conducted using primary sources in the span of several weeks. Search terms such as “violence in nursing”, “workplace violence”, “occurrences”, and “de-escalation training” were combined and inputted into databases such as ProQuest, National Institutes of Health, and CINAHL with additional search terms applied when needed for clarification. The articles that will be discussed in this review were chosen because they are primary sources that moved the discussion forward on solutions to reduce patient violence against nurses. Knowles’ Adult Learning Theory was the theoretical framework used to guide this research with the understanding that adult learning is mainly self-directed and self- motivated, so in order to be able to implement successful education programs, such as that of this intervention, this understanding must be acknowledged (Casey, 2019). Comment by Rebecca Coffin: The problem is clearly presented and data is provided to show the magnitude of the problem Comment by Rebecca Coffin: Search terms are provided Comment by Rebecca Coffin: No need to use a theory to guide your paper, but you are welcome to do so if you wish Comment by Rebecca Coffin [2]: Great introduction!

Clinical Question

The clinical research question in focus for this literature review is as follows: Among nursing staff in acute hospital units, what is the effect of de-escalation training courses in reducing the number of violent events compared with learning de-escalation on the job, within 12 months of implementation. Comment by Rebecca Coffin [2]: PICOT

Appraisal of Articles

With Knowles’ Adult Learning Theory in mind, articles were chosen that exemplified the integration of adult learning into their interventions. In the article “Management of Aggressive Patients: Results of an Educational Program for Nurses in Non- Psychiatric Settings,” by Casey (2019), a non- experimental one-group, pre-post test design was used to evaluate the effectiveness of an education program that utilized multiple teaching strategies. The study recruited 36 registered nurses from a neurological unit in an adult hospital in southern United States. The program was delivered in a hybrid format over 6 weeks that utilized online presentations as well as in person classroom sessions. In line with the theoretical framework, the researchers utilized case studies to foster critical thinking, face to face role play was used demonstrate and build up de-escalation techniques, and group reflections were used to collectively bring together what was learned. Data was collected using self- reported Likert scale questionnaires that were validated by experts in emergency and psychiatric nursing. Analysis of the data concluded significant improvement in demonstration of preparedness and increased confidence in managing aggressive behaviors through the use of the designed educational program. Comment by Rebecca Coffin [2]: Don’t need to include the title of the article in APA style

The major limitation of the study was the small sample size not being significant enough to be generalizable. There was also time constraints limiting the amount of time for learning but was necessary in this study to feasibly allow maximum number of participants due to having to work around shift schedules. The researcher in this study recommends expanding similar interventions into other acute hospital units.

The article, “Reducing conflict and containment rates on acute psychiatric wards: The Safewards cluster randomized controlled trial” by Bowers et al. (2015) implemented 10 carefully selected interventions into a clustered randomized control trial to study its effects on rates of conflict and containment. The study came about from the understanding that there is a need for RCT’s in this topic. The study comprised of 15 psychiatric wards surrounding central London with inclusion criteria being acute psychiatric inpatient wards and were excluded if the wards had any major changes coming up in the course of the 18-month study, if they didn’t have a permanent nurse manager on post, and if the staff vacancy rate was greater than 30%. With these criteria put in place, nurses in the included wards chose to participate bringing the total number of participants to 564 (88% of the potential total). The confidence in this sample size was confirmed in each category with a power analysis. Baseline data was collected for 8 weeks, then participants had 8 weeks to implement the trained interventions, and 8 weeks additional were for observation of the implementation. This study was double blind in that both researchers and participants were unaware of which was the control and which was the intervention. Wards were visited 2-3 times a week by researchers who delivered and collected questionnaires and answered any questions about the interventions in order to ensure strong reliability. Results showed the interventions implemented in the Safewards interventions were significantly effective in reducing patient conflict and containment. Given that the primary source of data collection came from questionnaires, the main limitation of this study was missing data from unsubmitted questionnaires by charge nurses working the participating shifts. After accounting for these deficits however, they concluded that the missing data was not significant enough to shift the findings. The second limitation and recommendation for future research was that the study length was too short of a time period to really see significant change after implementation. Comment by Rebecca Coffin: Good critique! Look for whether a power analysis was performed in quantitative studies Comment by Rebecca Coffin [2]: What effect does this have on the study? Is this a good thing to do?

This study understood that there was a lack of quantitative research on violence against nurses in the form of randomized control trials, so the research design itself was created with the hopes of being the trailblazers for future research to continue RCT’s in the study of this concept. By explicitly highlighting each limitation set forth in their study, they were able to use their limitations to pave the path for future research.

In the study “Educational and Managerial Policy Making to Reduce Workplace Violence Against Nurses: An Action Research Study” Hemati- Esmaeili et al. (2018), look beyond education at the bedside nurse level to go a step up the ladder to include managerial interventions. This study took place in Iran but many issues presented in this study are parallel universally to many other hospital settings. With a sample size of 44 nurses confirmed by a p value test, a workplace violence prevention program was developed in conjunction with the development of a new nursing position called the violence prevention nurse, whose role was to screen patients and their families upon arrival to the hospital for potentially aggressive behaviors. Careful analysis using SPSS software analyzed the results of the self-report surveys and focus groups and concluded that the implementation of the program significantly reduced fear associated with these violent events because the nurses felt more prepared to handle them. This study went a step further than the previously discussed studies by including a managerial intervention where a protocol was put in place of how to take care of staff who had been attacked. Comment by Rebecca Coffin [2]: Good point to highlight!

This study did an excellent job of highlighting the need for interventions that are individualized to each unique unit. They explained that many aspects of the design, such as altering the questionnaire scales used to better suit Iranian culture, was a big step in improving fidelity in the study because the nurses could answer more accurately. Unique to this study and also not included in the previously mentioned studies, was a follow up survey four months after conclusion of the study. Researchers could still see strong evidence of the interventions being implemented. Follow up studies should be included in future research in this topic to measure long term effects. Comment by Rebecca Coffin [2]: That is a good thing to do to check how long the effect lasts

The study “Coordinating a Team Response to Behavioral Emergencies in the Emergency Department: A Simulation- Enhanced Interprofessional Curriculum further enhance the findings from all the previously mentioned studies by integrating teamwork into simulation scenarios using larger sample sizes. Wong et al. (2015) hoped that through implementation of an interprofessional curriculum into simulation enhanced education, teamwork and staff attitudes toward patient violence would improve. Ten 3-hour simulation sessions were conducted for this study. In the simulation, formal roles were predetermined, meaning each member of the healthcare team knew exactly what their roles were immediately once a violent event was occurring. The study recruited 162 ED staff members. Surveys used to collect data were published from a British nursing education group that showed reliability and internal validity. Data collected was reflective of participant’s changing attitudes through the duration of the course. Risk for bias in response was present though in that evaluators of the program were in leadership positions within the participating department, which may have confounded responses with staff members answering in responses favorable to the evaluators. As was the main theme with all the studies discussed thus far, the main limitation of the study was time constraints and lack of longitudinal data. Comment by Rebecca Coffin: Another great critique!

Given the emotional magnitude of this research topic, it was necessary to include a qualitative study into this review to increase the magnitude of its relevance to the nursing profession and place further emphasis that research in this field is what the people directly involved want. The qualitative phenomenological study “The Patient Care Paradox: An Interprofessional Qualitative Study of Agitated Patient Care in the Emergency Department” by Wong et al. (2016), took their research further from the previously discussed study to look at the experience of these healthcare workers to provide a broader perspective of ED patient violence. Convenience, but purposive, sampling was used to recruit participants. This study took careful measures to reduce bias in all aspects of the study. For example to balance out and decrease bias during data collection, the research team consisted of 2 board certified ED physicians, but also 2 nurses working outside of the ED (palliative and midwifery) so as to maintain an insider/ outsider approach and to bracket potential personal biases which could have skewed the data collection. In the research design, 1 member of the research team with no prior relationships to any of the participants was trained for qualitative data collection while another member assisted in equipment setup and took field notes. The interview process was standardized and data was cross-checked. Interview responses and focus group discussions were all recorded, transcribed, and later professionally transcribed by a third party. In this study, data saturation was reached at 31 participants. Comment by Rebecca Coffin: Spell out “two” Comment by Rebecca Coffin: Here also, “two” should be spelled out Comment by Rebecca Coffin [2]: Spell out numbers <10 per APA style Comment by Rebecca Coffin [2]: Good!

Three themes were discovered as a result of these interviews. The first is the patient care paradox: that in the process of providing high- quality care for these potentially aggressive patients, staff are putting themselves at greater risk of a violent incident, and finding a balance is not easy. Under this theme, direct quotes were included that talked about injuries many of the participants sustained as a result of trying to provide quality care. The second theme was that teamwork is key to resolution of a violent situation, however, pre-existing conflicts up the linear ladder of command make it hard to fluidly work as a team. In this particular hospital, quotes were included that talked about how techs can’t do anything to de-escalate a situation unless the nurse is involved, and the nurse can’t prophylactically prevent a violent incident unless he/she gets orders from a doctor, and it causes delay in action when not all members are on the same page. The third theme was environmental factors that further exacerbate aggressive behaviors such as lack of privacy, volume of people. The main limitation of this study is that while data saturation was reached, this data may not be generalizable to all ED’s because it was conducted in a heavy volume, urban ED in New York City. Researchers also stated that descriptions of patient population were reliant on descriptions from participants and not confirmed with demographic statistical data, thus increasing the likelihood of personal and recall bias. Comment by Rebecca Coffin [2]: Fantastic review of the articles! The articles were relevant to the PICOT and you captured all the highlights

Conclusion

A literature review was conducted using five primary sources to examine the effect of de-escalation courses and interventions on patient violence against nursing staff in acute hospital units. Across each article presented in this literature review was the same recurring theme: change needs to occur to decrease the rate of patient violence against nurses and healthcare staff. The articles in review were not limited to the United States to allow a comparison of occurrence of patient violence worldwide. The similarities in research topic of each of these articles is enough to attest to the ongoing need for a long-lasting intervention. Each article highlighted that this is a significant problem that is only getting worse with time. Each article was able to recognize that any intervention showed improvements than no intervention. Comment by Rebecca Coffin [2]: Was there one intervention that was better than others? Why or why not?

Limitations encountered in the search for literature included a saturation of studies conducted in emergency departments and psychiatric wards. The study by Casey (2019) was conducted in an adult neurological unit but even in their discussion they explained how they borrowed scales more suited for emergency departments. Another limitation noted in these studies was that no matter what statistical data is published on rates of workplace violence in nursing, the number is always higher because there is always the incidences that don’t get reported. One strength of these studies was their use of self-report data collection to foster an outlet for these nurses and healthcare workers to have their thoughts heard that they might otherwise have been too scared to report for fear of job security or backlash. The limitation of time led to many gaps and inconsistencies in the results of a number of these studies. For example, the articles by Wong(year) and Bowers (year)both explained how implementing a new protocol for an entire hospital unit is a very time- consuming task in and of itself. They both explained how by the time their interventions were taught at the level suitable to continue on with the study, weeks had already gone by. In both discussions, it was highlighted that longer time for data collection would have allowed more significant results. Research must continue on this topic for the improvement of the nursing field as a whole. Comment by Rebecca Coffin [2]: Not surprising, I’m sure! Comment by Rebecca Coffin [2]: Yes but what do we know about the limitations of self-report? Comment by Rebecca Coffin [2]: Nicely done! I think you could have had a more definitive conclusion, but you did a great job in comparing / contrasting the studies overall


References Comment by Rebecca Coffin: References are formatted per APA guidelines

Bowers, L., James, K., Quirk, A., Simpson, A., Stewart, D., & Hodsoll, J. (2015). Reducing conflict and containment rates on acute psychiatric wards: The Safewards cluster randomized controlled trial. International Journal of Nursing Studies, 52(9), 1412-1422.

Casey, C. (2019). Management of aggressive patients: Results of an educational program for nurses in non-psychiatric settings. MEDSURG Nursing, 28(1), 9-21.

Hemati-Esmaeili, M., Heshmati-Nabavi, F., Pouresmail, Z., Mazlom, S., & Reihani, H. (2018). Educational and managerial policy making to reduce workplace violence against nurses: An action research study. Iranian Journal of Nursing and Midwifery Research23(6), 478–485. https://doi.org/10.4103/ijnmr.IJNMR_77_17

The Joint Commission. (2018). Physical and verbal violence against health care workers. Sentinel Event Alert.

Wong, A. H., Wing, L., Weiss, B., & Gang, M. (2015). Coordinating a team response to behavioral emergencies in the emergency department: A simulation- enhanced interprofessional curriculum. The Western Journal of Emergency Medicine, 16(6), 859-865.  https://doi.org/10.5811/westjem.2015.8.26220

Wong, A. H., Combellick, J., Wispelwey, B.A., Squires, A., & Gang, M. (2016). The patient care paradox: An interprofessional qualitative study of agitated patient care in the emergency department. Academic Emergency Medicine, 24(2), 226-235. https://doi.org/10.1111/acem.13117

literature review

I need a summary for literature review of these specific papers; 

ESG and financial performance: aggregated evidence from more than 2000 empirical studies by Friede, Busch and Bassen (2015)

ESG performance and firm value: The moderating role of disclosure By Fatemi, Glaum and Kasier

ESG Integration and the Investment Management Process: Fundamental Investing Reinvented by Duuren, Plantinga and Scholtens (2016)

The role of ESG in predicting bank financial distress: cross-country evidence by Neitzert and Petras (2019)

Environmental, social, and governance and company profitability: Are financial intermediaries different? By Brogi and Lagasio(2018)

Is sustainability reporting (ESG) associated with performance? Evidence from the European banking sector by Buallay (2019),

Environmental, social, governance (ESG), and financial performance of European banks by Batae, Dragomir and Feleaga (2020)

    • 20

    Literature Review

    3 articles used for my literature review.

    https://www.sciencedirect.com/science/article/abs/pii/S0377123720302306

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4205528/

    https://www.researchgate.net/profile/Thomas-Birk-2/publication/313827455_Principles_for_Developing_an_Interprofessional_Education_Curriculum_in_a_Healthcare_Program/links/58c6b6a845851538eb8ef339/Principles-for-Developing-an-Interprofessional-Education-Curriculum-in-a-Healthcare-Program.pdf

    Literature Review

    Discussion Questions

    You must access the following article to answer the questions:

    Boyle, D. K., & Thompson, S.A. (2020). CMSRNs’ continuing competence methods and perceived value of certification: A descriptive study. MEDSURG Nursing, 29(4), 229-254. 
    https://chamberlainuniversity.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=a9h&AN=145282314&site=eds-live&scope=site (Links to an external site.)

    1. Locate the literature review section. Summarize using your own words from one of the study/literature findings. Be sure to identify which study you are summarizing.

    2. Discuss how the author’s review of literature (studies) supported the research purpose/problem. Share something that was interesting to you as you read through the literature review section.

    3. Describe one strategy that you learned that would help you create a strong literature review/search for evidence. Share your thoughts on the importance of a thorough review of the literature.

    Houser, J. (2018). Nursing research: Reading, using, and creating evidence (4th ed.). Jones and Bartlett.

    · Chapter 1: The Importance of Research as Evidence in Nursing, pp. 24-26 (WOs 4, 5)

    · Chapter 5: The Successful Literature Review (WOs 1, 2, 3, 4, 5)


    Literature Review


    Literature Review Prompt

    Literature reviews are necessary in any lengthy scholarly writing, especially senior papers, theses, and dissertations. Students should know the basics of literature reviews before contributing new work to their specific disciplines. Literature reviews go over research that has already been completed in order to provide a backdrop for the student’s research, proof that the student is knowledgeable on said topic, and is, in fact, writing a new contribution to the research within their discipline. Writing a literature review will also help students find most of their resources, perform their research, and ensure that they are paving a “new path” within their discipline before they waste ample time only to discover their topic has already been heavily researched and/or discussed.

    Assignment:

    · Students will choose any topic for this assignment (this will prepare you for your final assignment so make sure you are writing about something that interests you and has plenty of academic sources!).

    · The paper should include multiple sources about your topic, why each source is important (or not), and how they contribute to said topic.

    · Students must read the following link in its entirety: (this will be extremely helpful!)

    ·
    https://owl.purdue.edu/owl/research_and_citation/conducting_research/writing_a_literature_review.html (Links to an external site.)

    Important notes:

    This literature review should be 500 – 750 words (2 – 3 pages).

    Students need to include word count on last page.

    You must utilize 
    scholarly sources
    , including scholarly journals or books (websites outside of academic journals, YouTube videos, movies, and other similar sources do not count). Use a minimum of 3 sources (this assignment is resource-heavy so students will more than likely use more). I will mark off points for any sources that are not from an academic journal, academic meeting, or academic book.

    Literature Review

    For this assignment, please choose five peer-reviewed articles that will be in the literature review of your final paper. For each article, include 2-4 sentences on its relevance to your topic and/or model. Formally cite each article you list using the APA style.

    Recall that you will draw upon these articles when explaining and justifying the model (industry, resource, or institution) that you use to analyze your company or industry  .

    Note that many papers have been written on these models (not just the ones we read in class). If you would like to get a general idea of this peer-reviewed literature, a good start is to use “google scholar” and simply search for “industry/resource/institution-based view of strategy” (or something along these lines). 

    Some of the top strategy journals include the Journal of Management, Academy of Management Review, Strategic Management Journal, Journal of International Business Studies, Academy of Management Journal, and the Strategic Entrepreneurship Journal. However, the articles in your literature review can come from any peer-reviewed journal. If you are unsure whether a source is peer-reviewed or not, ask the professor.

    Literature review

    Safwan Alhawsawi

    ENG 108

    Dr. Nicholas Barlow

    4/3/2022

    Homesickness Among International Students

    Homesickness is a major issue for international students. It is among the most frequently reported issues of international college learners in the United States. International learning involves, leaving family, and friends as a home culture in pursuit of an academic opportunity abroad. The is interested in this form of an issue due to an experience with homesickness. International students tend to experience homesickness at least once. They tend to miss people as well as places, establish new social networks as well as adjusting new cultural and environmental needs. It is thus not surprising to hear that about 50% of international learners report frequent feelings of home sicknesses (Oghenerhoro, 2020). Homesickness can as well be perceived as mini grief in which relocation and adjustment to college life may turn into major stressors when resources, as well as coping techniques, are not sufficient. Therefore, in this review, we will major in the impact of homesickness among international students.

    Causes of Homesickness among international students

    International students tend to have issues with feeling alone as well as in relationships. When the majority of the international learners come abroad, there are no families and no friends. They tend to be lonely and thus international students tend to do everything by themselves. Additionally, at times it is hard to contact families and friends due to time differences. Basically, they tend to be so lonely and thus they try making friends abroad. Some people have the ability to make friends in an easy way, however, some people do not have the ability to match other people. If international learners cannot make friends easily, they tend to be so uncomfortable (Oghenerhoro, 2020). International learners tend to be emotional or wish to go back to their nation. Therefore, international learners can become home as soon as they get to the new nation.

    According to Gebregergis (2018), language is another main reason behind homesickness is language. International students are always required to study a second language, though they do not have the ability to speak well, and they cannot listen well. Therefore, international learners may experience challenges with language. For instance, when they wish to complain to someone, they may not be in the capacity to tell one why they want to say it. These factors may result in homesickness. Culture shock is another aspect that may result in homesickness. International students live abroad and therefore there are various cultures. In addition, in college, there are many students that have various cultures. International learners tend to get culture shock on food, money, and other things. Majorly, food tends to be the main factor for homesickness. Although international learners are hungry, they cannot eat sufficient food due to the different foods in their countries. They tend to get uncomfortable, and they get sick. International students cannot get energy without eating. It is difficult to understand the various cultures of international learners when they come to the nation. In addition, local people do not really understand the different cultures (Thomas, 2020). Thus, at times, international learners are in trouble in different cultures.

    According to Ferrara (2020), an individual’s geographic distance away from home is a risk factor. The further away an individual is from home, the high the likelihood of experiencing homesickness. The longer the physical distance from home and the less frequent physical contact a person has with the people and places that they miss, the higher the chances of experiencing homesickness. Therefore, the inability to contact home and attachment figures places learners at a high risk of suffering from homesickness. Mainly in higher education, the learners that were away from home were at a high risk of experiencing feelings of home sicknesses.

    Effects of Homesickness among the International Students

    When a learner is homesick in college it tends to easily show. While some learners may come right out and say what they are experiencing those feelings, others may not be so forthcoming. By understanding what the symptoms of homesickness are, one can maximize the chances of identifying it. The signs of homesickness can differ from one learner to the other. Some of the signs which can be easily identified by learners include anxiety, depression, feeling as though they do not fit in, reduced motivation, loneliness, sadness, irritability, desiring a connection with someone, and a sense of grief as well as loss.

    Basically, being a homesick college student tends to be distressing, and it can inappropriately affect their lives. For instance, they may miss classes since they feel sad as well as depressed to attend or may struggle to remain focused thus leading to tumbling grades. Avoiding social activities as well as isolating themselves are as well potential signs of homesickness (Kegel, 2009). Basically, homesickness impacts the academic performance of college students negatively. Excessive acculturative stress tends to lead to eating and sleeping issues, low energy as well as migraines. Additionally, there have been several studies that bring out the connection between homesickness and depression. Homesickness is highly related to depression scores. Some alarming impacts of homesickness-based depression among college learners have been documented including suicide.

    Interventions

    Assisting international learners to develop friendships in the host nation is among the mainstay of acculturation techniques for college students. Poyrazli and Devonish (2020), advocate for initiatives to enhance the quality of social networks rather than an improvement on the number of close friends. Thus, a counselor may assess the degree of social support that learners have and if support is limited as a result of personal features which may include shyness as well as language barriers and environmental aspects. The majority of the international learners tend to stay in groups of fellow nationals through major interactions with the host natation students tends to be predictive of better cultural adjustment. Thus, peer programs that connect internationals with host county peers may be an appropriate technique for minimizing homesickness. Basically, peer pairing programs that connect international learners with host nation students tend to be more productive in comparison to the formal counseling techniques.

    According to Rathakrishan, et al (2021), designing acculturative techniques for distinct subgroups of international learners can be of benefit. For example, since African international students lie forbearance as a coping technique, it is essential to provide informal outreach workshops offering training on the essentiality of getting professional assistance when acculturative stress maximizes. In regard to cultural collectivist traditions, counseling staff may tap the existing social support of Asian as well as Latin American International learners through counseling initiatives.

    It will as be essential for the learners to embrace as well as accept the new school. They should major in exploring the school as well as its surroundings. They should embrace new opportunities to assist them to feel better in addressing the issue of homesickness in school. They should focus on the reason why they came to the facility. This can be achieved by noting the reasons why they chose the new school as well as the reason why they came to study in the nation. They should as well major in staying active. Staying active by going for walks, hitting the gym as well as exploring the new campus are effective methods of feeling more energetic as well as positive. Learners should as well consider staying connected to home even when they are far away. This aids in making it easy to feel as though one is missing out back at home (Billedo, Kerkhof, & Finkenauer, 2020). One may consider staying connected through regular chats, staying connected with social media, and sharing one’s culture.

    The number of learners choosing to attend a university far away from their home country tends to be increasing. Though studying abroad tends to be an exciting transition for international students’ cultural relocation is related to increased psychological distress. Due to the increase of homesickness among international learners and its illustrated relationship with depression, it is important for the university counseling centers to develop alternative, culturally based services for the population. Maybe the main researchers and counselors alike are the main gap between learners’ interpersonal expectations for learning in other nations as well as real experiences. Developing the detailed impact of social expectation in comparison to social reality may enhance the clarity of the main nature of homesickness among international learners. Homesickness prevention initiatives provide them with social support for international college learners which may improve the emotional toll that is caused by homesickness.

    References

    Billedo, C. J., Kerkhof, P., & Finkenauer, C. (2020). More facebook, less homesick? Investigating the short-term and long-term reciprocal relations of interactions, homesickness, and adjustment among international students. International Journal of Intercultural Relations75, 118-131. https://doi.org/10.1016/j.ijintrel.2020.01.004

    Ferrara T. (2020). Understanding Homesickness: A Review of the Literature. Journal for Leadership and Instruction.
    https://files.eric.ed.gov/fulltext/EJ1255848.pdf

    Gebregergis, W. T. (2018). Major causes of acculturative stress and their relations with sociodemographic factors and depression among international students. Open Journal of Social Sciences6(10), 68-87. https://doi.org/10.4236/jss.2018.610007

    Kegel, K. (2009). Homesickness in International College Students. Compelling Counseling Interventions, 67-76. https://www.counseling.org/resources/library/vistas/2009-V-Print/Article 7 Kegel.pdf

    Oghenerhoro, A. A. (2020). Homesickness among International Students in Famagusta, North Cyprus (Master’s thesis, Eastern Mediterranean University (EMU)-Doğu Akdeniz Üniversitesi (DAÜ)). http://i-rep.emu.edu.tr:8080/jspui/handle/11129/5034

    Poyrazli, S., & Devonish, O. B. (2020). Cultural Value Orientation, Social Networking Site (SNS) Use, and Homesickness in International Students. International Social Science Review96(3), 2. https://digitalcommons.northgeorgia.edu/issr/vol96/iss3/2/\

    Rathakrishnan, B. A., Bikar Singh, S. S., Kamaluddin, M. R., Ghazali, M. F., Yahaya, A., Mohamed, N. H., & Krishnan, A. R. (2021). Homesickness and socio-cultural adaptation towards perceived stress among international students of a public university in Sabah: an exploration study for social sustainability. Sustainability13(9), 4924.https://www.mdpi.com/2071-1050/13/9/4924

    Thomas, D. (2020). Factors that contribute to homesickness among students in Thailand. Kasetsart Journal of Social Sciences41(1), 136-141. https://so04.tci-thaijo.org/index.php/kjss/article/view/235043

    Literature review

    International Homesickne.docx
    by Safwan M Alhawsawi

    Submission date: 03-Apr-2022 03:12AM (UTC-0700)
    Submission ID: 1800082006
    File name: International_Homesickne.docx (23.85K)
    Word count: 1622
    Character count: 9614

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    36%
    SIMILARITY INDEX

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    INTERNET SOURCES

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    PUBLICATIONS

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    International Homesickne.docx
    ORIGINALITY REPORT

    PRIMARY SOURCES

    www.counseling.org
    Internet Source

    scholarshipsforexcellence.com
    Internet Source

    Submitted to Acknowledge Education Pty Ltd
    Student Paper

    Submitted to British University in Egypt
    Student Paper

    Submitted to University of Worcester
    Student Paper

    www.scirp.org
    Internet Source

    Submitted to University of Arizona
    Student Paper

    www.impossiblepsychservices.com.sg
    Internet Source

    Submitted to London School of Commerce
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    www.researchgate.net
    Internet Source

    Şenol Sezer, Nermin Karabacak, Muhammet
    Narseyitov. “A multidimensional analysis of
    homesickness based on the perceptions of
    international students in Turkey: A mixed
    method study”, International Journal of
    Intercultural Relations, 2021
    Publication

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    International Homesickne.docx
    GRADEMARK REPORT

    GENERAL COMMENTS

    Instructor

    PAGE 1

    Add citation

    This piece of information looks like it came from a source; therefore, you need to cite that
    source here, using either a (parenthetical) citation.

    Choose different words

    Try choosing different words here. I know what you’re saying, but the point is unclear.

    Additional Comment

    Missing words?

    Add citation

    This piece of information looks like it came from a source; therefore, you need to cite that
    source here, using either a (parenthetical) citation.

    Wrong Word

    wrong word

    Additional Comment

    “focus on” would work well

    Add citation

    This piece of information looks like it came from a source; therefore, you need to cite that
    source here, using either a (parenthetical) citation.

    PAGE 2

    Cite Consistently

    Consistently cite:

    QM

    QM

    QM

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    QM

    QM

    Use consistent citations as you incorporate information from sources. Don’t worry about having too
    many citations- worry about having too few!

    PAGE 3

    Comment 1

    Some of the points from sources should be included as quotations. At least one quotation is
    required in the paper. When you use a complete sentence from a source (or much of a
    complete sentence), consider including it as a quotation.

    Paraphrase too close to the original

    This paraphrase too close to the original. It should either be a quote, or your paraphrase
    should contain more of your own words.

    Add citation

    This piece of information looks like it came from a source; therefore, you need to cite that
    source here, using either a (parenthetical) citation.

    PAGE 4

    Paraphrase too close to the original

    This paraphrase too close to the original. It should either be a quote, or your paraphrase
    should contain more of your own words.

    PAGE 5

    More evaluation of sources

    Your commentaries tend to focus on the topic, but in an LR, it is more standard to comment
    on the strengths/shortcomings of the sources.

    Additional Comment

    Also, it isn’t common in this genre to offer advice using “should”. In academic writing, these
    kinds of statements need to be supported with citations and information from sources.

    Paraphrase too close to the original

    This paraphrase too close to the original. It should either be a quote, or your paraphrase
    should contain more of your own words.

    Add citation

    This piece of information looks like it came from a source; therefore, you need to cite that
    source here, using either a (parenthetical) citation.

    Comment 2

    If any of these suggestions came from sources, it would be helpful to add a citation to that
    source. Doing so would lend credibility to your idea.

    PAGE 6

    PAGE 7

    Literature Review

      

    Summarize each of the research papers in a separate paragraph (e.g., 4 paragraphs total for 4 research papers). 

    1. Describe the motivation the authors had for their work. What makes their work so important? (You may find it useful to provide some background and context here.)

    2. Who would be interested in reading this paper (domain experts, GVSU departments, outside organizations, etc.)?

    3. What are the paper’s main research hypotheses or contributions?

    4. What did the researchers do to test their hypotheses or achieve their research contributions?

    5. What are the long-term contributions that will still be relevant 10, 20, 30, … years from now?

    6. Which of its citations appear to be the most relevant resources for exploring this topic further? 

    Note: you do NOT need to locate, download, and read any of the articles citations/references, but you should clearly list the papers that you would locate and read to learn more.

    It is highly recommended (but not required) that you use Overleaf (https://www.overleaf.com/) to write your summaries using the IEEE VIS paper format (http://junctionpublishing.org/vgtc/Track/vis-tvcg.html). This will help make writing your reports for your project easier since you will already have familiarity with Overleaf. You may also find that some of the papers you read for this assignment are useful to your project, and you are encouraged to find a topic related to your project for this very reason.

    • a month ago
    • 15

    Literature Review

     After looking at your resources and examining your topic in light of your research, post an outline of your literature review. What are the main points that you need to make to support your thesis? Include sub-points as well. You may use the Literature Map provided in the Course Resource tab or you may use a more traditional outline. 

      • 50

      Literature Review

        

      Literature Review

      (30 points; with at least eight citations from academic journals and related to relationship or the variables under study. For the citations, the more relative the better; one or more citations from the introduction part can be used but the points from those citations should not be repetitions. Needs to discuss how researchers have known about the variables and their relationship so far so that your study will not repeat previous studies and “reinvent the wheel”. Three points deduction for each citation missing. This part should contain at least three paragraphs, two paragraphs about the findings of the two variables, and one paragraph about the findings of their relationship, with each paragraph containing at least 150 words. At the end clearly state your research hypothesis if you have enough confidence for your prediction of the relationship based on your review of previous studies or research question if you are still not sure about the relationship based on the literature reviewed.)

      RQ/H: (choose one and remove the other, and then state your RQ or H here)

      • a month ago
      • 10

      Literature review

      4 articles are attached below to review -Summarize each article in one page. -Cover all aspects in the paper. -Clear comparison between splinted & unsplinted, and mention if there is an advantage over the other.

      • a month ago

      Literature Review

      •• Rejoinder

      Walking the Talk:
      Implementing the Prevention Guidelines and
      Transforming the Profession of Psychology

      Sally M. Hage
      Teachers College, Columbia University

      John L. Romano
      University of Minnesota, Twin Cities

      Robert K. Conyne
      University of Cincinnati

      Maureen Kenny
      Boston College

      Jonathan P. Schwartz
      University of Houston

      Michael Waldo
      New Mexico State University

      The Major Contribution aimed at strengthening a prevention focus in psychology, so as to
      more effectively and equitably promote the well-being of all members of psychology com-
      munities. The 3 reactions (L. A. Bond & A. Carmola Hauf, 2007 [this issue]; L. Reese,
      2007 [this issue]; E. Rivera-Mosquera, E. T. Dowd, & M. Mitchell-Blanks 2007 [this
      issue]) give strong support for the best practice prevention guidelines, while providing
      new insights for their implementation in the field of psychology. In this rejoinder, the
      authors make an effort to build upon their colleagues’ ideas, by addressing the topics of
      community-based collaboration, prevention across the life span, and implementation of
      the best practice guidelines. The authors urge further interdisciplinary collaboration by
      members of the American Psychological Association, and others interested in prevention,
      and invite genuine action to expand prevention efforts.

      Undoubtedly, the expression—“You can talk the talk, but can you walk
      the walk?”—is familiar to many people. A shortened variation of the orig-
      inal phrase, “Walk the talk,” may be less well known but can be found in
      the Encarta World English Online Dictionary (2006), and is defined as “to
      act on what you profess to believe in or value.” The words suggest that real

      After the first two authors listed above, the remaining authors of this article are listed in alpha-
      betical order. Correspondence concerning this article should addressed to Sally M. Hage,
      Teachers College, Columbia University, Counseling and Clinical Psychology Department,
      Box 102, 426A Horace Mann, New York, NY 10027; e-mail: hage@tc.columbia.edu.

      THE COUNSELING PSYCHOLOGIST, Vol. 35, No. 4, July 2007 594-604
      DOI: 10.1177/0011000006297158
      © 2007 by the Division of Counseling Psychology

      594

      change happens when leaders not only say they want change and advance-
      ment but also match their words with actions. We are grateful to the authors
      who provided reactions to our article (Bond & Carmola Hauf, 2007 [this
      issue]; Reese, 2007 [this issue]; Rivera-Mosquera, Dowd, & Mitchell-Blanks,
      2007 [this issue]). Their thoughtful commentary and suggestions highlight
      the importance of moving these Prevention Guidelines (Hage et al., 2007
      [this issue]) from a publication in a scholarly journal to genuine actions for
      change in the field of psychology. We are also grateful to The Counseling
      Psychologist (TCP) Editor Robert T. Carter who gave us the opportunity to
      develop the article into a Major Contribution manuscript, and to receive
      reactions to these guidelines by eminent scholars in the field.

      The reaction articles in this Major Contribution include authors from
      specialties in social work, clinical psychology, and counseling psychology.
      In addition, they represent work settings as diverse as university psychol-
      ogy departments, a government mental health department, a community
      advocacy agency, and a medical school. The work of prevention is multi-
      disciplinary, and it is critically important that researchers, practitioners, and
      policy makers from across the professional landscape collaborate and form
      partnerships to advance a prevention agenda. We are extremely pleased and
      honored that these scholars, from different specialties and professional
      work environments, have given their reactions to the guidelines. In the lim-
      ited space in this rejoinder, we will address several of the issues presented
      by the reaction articles.

      COMMUNITY-BASED COLLABORATION

      Bond and Carmola Hauf (2007), Reese (2007), and Rivera-Mosquera
      et al. (2007) all identified the importance of collaboration as a central com-
      ponent of best practices in prevention. Although our guidelines did not
      explicitly address collaboration, our third practice guideline emphasizes
      the importance of including “clients and other relevant stakeholders in all
      aspects of prevention planning and programming” and thus recognizes the
      necessity of forming community partnerships in prevention work (p. 508).
      That being said, the reactants did a service by further emphasizing the
      importance of collaboration as an integral component of best practices at
      several levels. All three reaction articles note that the perspectives and
      knowledge base of any single profession are limited in informing and
      guiding the practice of prevention. Indeed, these authors collectively
      describe why collaboration should occur at the local community level,
      with other helping professionals, and with scholars and researchers from
      other disciplines.

      Hage et al. / WALKING THE TALK 595

      Bond and Carmola Hauf (2007) maintain that interdisciplinary scholar-
      ship should provide the theory and research base for effective prevention.
      They effectively explain how community collaboration is critical to the
      development of comprehensive and multisystemic interventions. In addi-
      tion, Rivera-Mosquera et al. (2007) advocate for collaboration across the
      health and mental health professions, including counseling and clinical psy-
      chologists, social workers, nurses, and public health workers. Reese (2007)
      similarly notes that the knowledge base of multiple disciplines, such as epi-
      demiology, health, economics, and sociology, are integral to public health
      practice and prevention. By insulating ourselves from other disciplines and
      professions, we are likely to miss important research knowledge. Similarly,
      by cutting ourselves off from the communities we serve, we may miss an
      understanding of local needs and knowledge. Furthermore, from a training
      perspective, learning the art of collaboration represents an example of an
      area where even more “how to” guidance is needed. Some authors (e.g.,
      Kenny, Sparks, & Jackson, in press) are documenting their work in collab-
      oration in efforts to identify lessons to further guide training and practice in
      interprofessional collaboration. Developing and sustaining effective collab-
      orations with multiple stakeholders and then negotiating and reconciling
      the competing needs represented by varied perspectives are challenging
      tasks.

      Similarly, as Bond and Carmola Hauf (2007) suggest, community-based
      collaboration enables more accurate and relevant prevention research. One
      potential function of Waldo and Schwartz’s (2003) prevention research
      matrix presented in thisis to point out how diverse sources of exper-
      tise available through community and interdisciplinary collaboration can be
      integrated to conduct comprehensive prevention research. For example,
      community members can provide unique information on the epidemiology
      of problems within their community; they can inform the design of preven-
      tive interventions, ensuring they are targeted on the most salient variables
      and are sensitive to community norms; and they can identify the systems
      and resources within a community that will allow wide and sustained deliv-
      ery of prevention services.

      The expertise of different disciplines may also make unique contribu-
      tions in each of these service areas. For example, the field of public health
      is especially suited to clarifying epidemiology, clinical psychology is
      strong in the design and evaluation of interventions, and the social work
      profession is adept at creation and assessment of service delivery systems.
      Rivera-Moquera et al. (2007) eloquently state that “each of us brings a
      unique experience and set of skills that are needed to begin to address the
      serious societal problems facing our country and our world” (p. 590).
      Hence, the diverse communities and professional disciplines must work

      596 THE COUNSELING PSYCHOLOGIST / July 2007

      together in “sharing our skill sets, lessons learned, and methodology to
      bring about real social change” (Rivera-Mosquera et al., 2007, p. 590).

      Nevertheless, in spite of our strong agreement with all three of the reac-
      tants that collaborative community partnerships are critically important to
      the work of prevention specialists, we are reluctant to identify the forming
      of such partnerships as the “overarching best practice” of prevention. The
      major reason for our hesitation to adopt this perspective, as argued by Bond
      and Carmola Hauf (2007), is that “community” is too often interpreted nar-
      rowly. A framework of “community” may not give sufficient visibility to
      educational training of psychologists or political advocacy for prevention.
      As Rivera-Mosquera et al. (2007) comment, the four conceptual areas of
      the guidelines, which include practice, research, training, and social advo-
      cacy, provide a necessary conceptual framework. In addition, a community
      is not a single voice and may, for example, include parents, teachers, busi-
      nesses, workers, social services agency leaders, clergy, and youths. In addi-
      tion to a divergence in voices emanating from the field, these voices may
      not be congruent with those from multiple professions and scholarly disci-
      plines. Thus, although better practice may eventually emerge, the processes
      through which this happens are not always clear. Indeed, Bond and
      Carmola Hauf (2007) recognize the tensions that often exist when preven-
      tionists attempt to apply prevention interventions across diverse groups of
      people.

      One method to address specific needs across divergent groups or to assess
      in-group differences is through a process called “elicitation research”
      (Flores, Tschann, & Marin, 2002). This research process collects informa-
      tion during the development phase of a prevention intervention to better
      understand relevant personal cognitions and social norms important to a
      group or population receiving the intervention, thus strengthening the rele-
      vancy of the intervention for those receiving it. Conducting elicitation
      research prior to finalizing a prevention intervention increases the chances
      of a successful outcome for behavior change by addressing variables impor-
      tant to the group being served. Romano and Netland (in press) demonstrated
      how elicitation research and the theory of reasoned action (Ajzen &
      Fishbein, 1980; Albarracin, Fishbein, Johnson, & Muellerleile, 2001) can
      address within-group differences in the development and implementation of
      prevention interventions.

      PREVENTION ACROSS THE LIFE SPAN

      Reese (2007) notes that many of the examples of prevention interventions
      provided in our set of Prevention Guidelines were drawn from practice with

      Hage et al. / WALKING THE TALK 597

      young people, despite the fact that prevention theory and practice cut across
      the life span. We concur with Reese on his point and hope that our examples
      of effective interventions with youths do not lead readers to think of pre-
      vention as an activity only for the early years. Prevention is not only for chil-
      dren and adolescents but also must be applied throughout the life cycle,
      including the development of preventative interventions for diverse groups
      of women and men at midlife and communities of older adults. Indeed,
      developmental challenges, risks, and opportunities for positive development
      occur across the life span, and these many stages of life represent significant
      opportunities for prevention-minded psychologists to engage in active col-
      laborative efforts across the disciplines. It is possible that many of our
      examples emerge from youth work because schools and colleges have been
      available settings for prevention interventions, and they also offer opportu-
      nities for funding of prevention research. As we move to increase the reality
      of prevention across the life span, we will need to find mechanisms to fund
      and house prevention activities for all phases of life.

      There are indications that the field of psychology is increasing its atten-
      tion to the unique needs of older adults. For example, interventions have
      addressed the prevention of suicide and depression in older adults (Heisel
      & Duberstein, 2005; Whyte & Rovner, 2006). In addition, the American
      Psychological Association (APA) Public Interest Directorate has estab-
      lished an Office on Aging, which coordinates APA activities pertaining to
      aging and geropsychology. The Office on Aging also supports the work of
      the APA Committee on Aging, which has published a handbook on psy-
      chology and aging (American Psychological Association Committee on
      Aging, 2006). This work recognizes that not only are people 65 years of age
      and older the fastest growing segment of the U.S. population, with an
      increasing number of these older adults of immigrant status or members of
      ethnic or racial minority groups, but that more than 5 million older adults
      have incomes below the poverty level or are classified as poor. Adulthood
      is also a period of life where adults confront a variety of changes related to
      families, interpersonal relationships, careers, health, and end-of-life issues.
      Prevention has a role to play in helping adults manage and prevent the
      adverse effects of these changes.

      Hence, we welcome Reese’s (2007) reminder to “cast a broad net” in the
      goal of expanding our prevention efforts. He insightfully challenges psychol-
      ogists to more effectively address the interface of physical and mental health,
      and reminds us of the imperative to decrease health disparities and improve the
      quality of life of communities in the United States and abroad. His remarks
      reflect the social justice orientation out of which the Prevention Guidelines
      emerge. This perspective demands that we become aware of how the numer-
      ous systems that are part of U.S. society, including economic, governmental,

      598 THE COUNSELING PSYCHOLOGIST / July 2007

      and educational structures, define truth for the entire community (Dounce,
      2004; Dworkin & Yi, 2003). Prevention work can and should begin within the
      local context (e.g., to apply the social justice model in our own communities)
      but also needs to be thoughtfully concerned with systemic practices and the
      state of power and oppression around the globe. Our efforts must aim to
      enhance personal and collective well-being and to create social and political
      change aimed at improving environments where people live, learn, and work
      (Hage, 2005).

      Similarly, we endorse Bond and Carmola Hauf’s (2007) recognition of the
      importance of moving beyond a focus on strengths and protective factors at
      the individual level, to also address such strengths at multiple systemic levels
      (e.g., microsystem, organizations and institutions, community, sociopolitical,
      cultural–environmental). While strength-based models related to individuals
      have received attention in the literature, there is much less focus on strengths
      and protective factors of communities, organizations, and institutions. Hence,
      it is important to consider the strengths, as well as the limitations, of institu-
      tions, such as schools, cultural centers, faith communities, and community
      organizations, when planning and implementing prevention interventions.

      IMPLEMENTATION OF THE PREVENTION GUIDELINES

      In their reaction articles, Rivera-Mosquera et al. (2007) and Reese (2007)
      recognize the significance of moving beyond the “ivory tower” and the level
      of “rhetoric” to make the Best Practices Prevention Guidelines a reality.
      Similarly, Bond and Carmola Hauf (2007) remind us that prevention review
      articles of this nature have been presented in other professional journals, with
      remarkably similar conclusions. We would like to recognize the validity
      of these concerns, while also providing further explanation of the process of
      development of these guidelines. Members of the Prevention Section of
      Division 17 developed these Prevention Guidelines with the goal of eventu-
      ally bringing them forth for adoption by APA and other professional organi-
      zations and government entities, as suggested by Reese (2007). Therefore,
      the Prevention Guidelines were formulated in accordance with Criteria for
      Practice Guideline Development and Evaluation, developed by APA in 1995
      and later revised and approved by the APA Council of Representatives
      (American Psychological Association, 2002). The APA criteria specify that
      proposed guidelines, such as those presented in our article, need to focus on
      educating and informing the practice of psychologists, as well as stimulating
      debate and research. As such, the APA document specifies that guidelines
      “must be reasonable, well researched, aspirational in language, and appropri-
      ate in goals” (Section 1.1). Hence, the specificity of these requirements meant

      Hage et al. / WALKING THE TALK 599

      that content related to the implementation of the Prevention Guidelines was
      mostly left out of our article. However, despite this limitation, the Prevention
      Guidelines are the first set of comprehensive prevention guidelines that
      encompass the major areas of prevention work (i.e., practice, research, train-
      ing, and social advocacy) that have been prepared for eventual adoption by
      APA. Finally, as noted in our article, these guidelines are an “initial step” in
      what we hope will be a broader collaboration of psychologists working
      together to enhance and implement these recommendations for prevention
      within the Society of Counseling Psychology, other appropriate APA divi-
      sions, as well as APA and other professional organizations.

      We share the concern voiced by Rivera-Mosquera et al. (2007): If further
      efforts beyond the publishing of these guidelines are not made, this work
      may likely “fail to provide forceful guidance for significant change”
      (p. 587). Hence, while the guidelines may be recognized, as Reese (2007)
      notes, as a “next step” in stimulating counseling psychologists to engage in
      prevention, they represent just one step, and further discourse on implemen-
      tation and process is essential to move prevention more visibly from the
      fringes of the field to center stage in the profession. Similar comments were
      made by two past presidents of Division 17, Rosie Bingham and Derald
      Wing Sue, at the 2006 APA Symposium addressing the implications of these
      guidelines (Hage & Romano, 2006). In their presentations, Bingham and
      Sue drew comparisons between the Prevention Guidelines and the
      Guidelines on Multicultural Education, Training, Research, Practice, and
      Organizational Change for Psychologists (American Psychological
      Association, 2003) in terms of their movement from an academic article to
      implementation and action. In summary, the challenge for prevention spe-
      cialists as well as the larger community of scholars and practitioners is to
      develop creative ways to advance a prevention agenda, and we hope that
      these Guidelines provide guidance.

      We appreciate the specific recommendations put forth by the reactants for
      how best to advance the dissemination of the Prevention Guidelines, and
      would like to highlight some of their suggestions. Education and training,
      both at the pre- and the postdoctoral levels, was cited as one essential area for
      implementation. We strongly concur with Rivera-Mosquera et al. (2007) and
      with Reese (2007) in their recommendation that prevention theory, research,
      and practice need to be included within counseling psychology curricula
      at all levels. The challenge that demands further attention is how we move
      forward to infuse prevention practice and research not only in counseling
      psychology training but also throughout psychology education.

      Reese’s (2007) suggestion that the Prevention Guidelines become part of
      “any reading packet for courses on prevention” is well taken, as is the rec-
      ommendation to include implementation of the Prevention Guidelines on the

      600 THE COUNSELING PSYCHOLOGIST / July 2007

      Hage et al. / WALKING THE TALK 601

      agenda for discussion at the annual meeting of the Council of Counseling
      Psychology Training Programs. We would also suggest that the guidelines
      be included in the training of doctoral students and be discussed by other
      psychology training groups (e.g., Council of School Psychology Training
      Programs). Reese also suggests partnerships with professional organizations
      outside of psychology (e.g., public health), government entities (e.g., U.S.
      Department of Health and Human Services), and stakeholders in the com-
      munity. We would add other academic disciplines (e.g., social work, coun-
      seling) as well as accreditation bodies such as the APA’s Committee on
      Accreditation, the Council for Accreditation of Counseling and Related
      Educational Programs, and psychology as well as other mental health licens-
      ing boards to the list of disciplines and partnering organizations. Moreover,
      Rivera-Mosquera et al. (2007) note the importance of addressing the ethics
      of prevention. This need has begun to be addressed, although not as broadly
      as we would like (e.g., Hage & Schwartz, 2006; Schwartz & Hage, in press).
      Prevention practica are also urgently needed, as Reese (2007) suggests.
      Finally, developing the equivalents of “preventive medical residency pro-
      grams” for counseling psychologists, as well as pre- and postdoctoral intern-
      ships in prevention research and practice, are excellent suggestions that
      deserve careful consideration.

      In addition, one of the most innovative ideas for dissemination of these
      guidelines comes from Rivera-Mosquera et al. (2007), who point out that the
      economics of prevention has been a major obstacle in furthering prevention
      efforts. Their unique contribution is the suggestion that preventive services be
      viewed as a type of therapeutic program. They argue that by conceptualizing
      prevention as a “therapeutic intervention,” new avenues to support the work of
      prevention (e.g., third-party reimbursement) may emerge. By extension, if
      third-party reimbursement were to become possible for prevention, then the
      place of prevention in psychology education and training programs will be
      more fully secured. This perspective is an interesting one to consider and mer-
      its close attention and further discussion among scholars, practitioners, and pol-
      icy makers. However, it may be more effective to develop financial models that
      can prove the cost-effectiveness of prevention, rather than compromising the
      conceptualization of prevention. For example, several recent studies have found
      that teaching clients interventions based on cognitive–behavioral therapy is
      cost-effective in preventing the onset of a full-blown depressive disorder
      (Churchill et al., 2001; McCrone et al., 2004; Schulberg, Raue, & Rollman,
      2002; Smit et al., 2006). The dissemination of more findings like these studies
      on depression is critical in convincing policy makers and funding organizations
      that prevention is cost-effective.

      Reese (2007) issues a similar call for prevention research that is relevant,
      disseminated, and utilized. We agree that too much good prevention research

      602 THE COUNSELING PSYCHOLOGIST / July 2007

      remains academic, and thus fails to realize its potential to improve lives,
      particularly in communities disadvantaged by disparities in resources. We
      believe that including a focus on service delivery systems as an integral com-
      ponent of programmatic prevention research has significant potential for cor-
      recting this deficit. For example, we recommend that investigators examine
      the practical utility and economic feasibility of their research by utilizing the
      prevention research matrix presented in this issue, and by examining how a
      research project relates to the third category—Prevention Service Delivery
      Systems. The prevention research matrix provides a tool to understand the
      need for research and how the outcome of this research can inform the field.
      Understanding this process will often lead to more open and informed com-
      munication with participating communities about the meaning and scope of
      the prevention program at each step of the intervention.

      CONCLUDING OBSERVATION

      A final observation we would like to make is to underline the significance
      of the reaction articles being intentionally authored by a clinical psychologist,
      a counseling psychologist, and a social worker. This effort by TCP represents
      an excellent attempt at reflecting an important reality about prevention: It is
      an interdisciplinary science and practice that requires interdependent collab-
      oration in order to be effective. We need more efforts like this one, includ-
      ing applications to education and training in prevention. In addition, Reese
      (2007) provides a valuable perspective as a counseling psychologist who pre-
      viously was employed by the Centers for Disease Control and Prevention,
      and currently is in the Department of Community Health and Preventive
      Medicine, Morehouse School of Medicine. He observes that psychology
      must move prevention more forcefully from the margins of the field to the
      heart of the profession, and that the Society of Counseling Psychology ought
      to take the lead for all of psychology in making this transformation happen.
      We whole-heartedly agree with this perspective, and we invite psychologists
      and others interested in prevention to join this effort by becoming involved in
      the Prevention Section (http://www.div17.org/preventionsection).

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      Literature Review

      Towards a Cultural–Clinical Psychology

      Andrew G. Ryder1,2*, Lauren M. Ban1,2 and Yulia E. Chentsova-Dutton3
      1 Concordia University
      2 Sir Mortimer B. Davis-Jewish General Hospital
      3 Georgetown University

      Abstract

      For decades, clinical psychologists have catalogued cultural group differences in symptom presenta-
      tion, assessment, and treatment outcomes. We know that ‘culture matters’ in mental health – but
      do we know how it matters, or why? Answers may be found in an integration of cultural and
      clinical psychology. Cultural psychology demands a move beyond description to explanation of
      group variation. For its part, clinical psychology insists on the importance of individual people,
      while also extending the range of human variation. Cultural–clinical psychology integrates these
      approaches, opening up new lines of inquiry. The central assumption of this interdisciplinary field
      is that culture, mind, and brain constitute one another as a multi-level dynamic system in which
      no level is primary, and that psychopathology is an emergent property of that system. We illustrate
      cultural–clinical psychology research using our work on depression in Chinese populations and
      conclude with a call for greater collaboration among researchers in this field.

      Horace Cho
      1

      is a 57-year-old businessman from Hong Kong who has resided in Vancouver for fif-
      teen years, referred for insomnia, fatigue, loss of appetite, gastrointestinal distress, and depressed
      mood. Mr. Cho was raised in Hong Kong, completed his MBA in California, and moved to Van-
      couver to join his wife’s family and start a new business. Despite Mr. Cho’s excellent English and
      knowledge of North American practices, his business is in difficulty. He attributes business troubles
      to the effects of his physical symptoms, rather than seeing these symptoms as resulting from psychoso-
      cial stress.

      Mr. Cho lives in a majority Chinese suburb and encourages his children to stay close to Chinese
      traditions; however, his daughters desire greater participation in North American society. He describes
      his wife as much more traditional than he is, but to his surprise it is she who encourages the children
      to participate in mainstream society. At the initial interview, Mr. Cho denies depressed mood but
      agrees that symptoms, business difficulties, and values conflicts in his family are ‘upsetting some-
      times’.

      What is Mr. Cho’s ‘culture’, and is it the same as his wife’s? Does he have a mental
      health problem and, if so, what is it? In what ways does culture shape the experience,
      expression, and communication of his distress? Where can psychologists look for ways to
      think about such questions?

      Over the past few decades, scholars from several disciplines have examined the interrela-
      tion of culture and mental health. Many more have taken on cross-cultural comparisons in
      mainstream psychology. That ‘culture matters’ in clinical psychology is nothing new,
      although it bears frequent repetition in an era of biological reductionism. Rather, our claim
      is threefold: first, that there is relatively little cultural research in clinical psychology that
      aspires to explanation, to telling a culturally-framed story about what is observed; second,
      that the means for achieving this can be found in greater integration of cultural and clinical

      Social and Personality Psychology Compass 5/12 (2011): 960–975, 10.1111/j.1751-9004.2011.00404.x

      ª 2011 Blackwell Publishing Ltd

      psychology, to the benefit of both; and third, that the result is a new field. Cultural–clinical
      psychology has in some sense been around for a while, pursued by a small number of
      researchers. Nonetheless, it has not yet coalesced as an established field of study or as an
      approach to culture and mental health research. This paper aims to promote these ends.

      We start by locating ourselves with respect to ‘cultural psychology’ and ‘clinical psy-
      chology’, and then present some first steps toward a cultural–clinical psychology. Central
      to this integration is the idea of mutual constitution – that culture, mind, and brain form
      a single system in which no level can be understood without the others. We then draw
      on our own research, pertaining to depression in Chinese populations, to provide some
      empirical examples. We conclude with a brief critique of these studies, considering ways
      in which they could be improved and interpreted in light of cultural–clinical psychology.
      Concrete suggestions to improve cultural–clinical psychology research are summarized in
      the Appendix and referenced throughout.

      Cultural–Clinical Psychology: A Brief Introduction

      Cultural psychology

      In positioning cultural–clinical psychology, we begin by grounding the first term in the
      ‘cultural psychology’ perspective (e.g., Markus & Kitayama, 1991; Shweder, 1990). The
      word ‘culture’ has long been used in psychology to stand for ethnicity or nationality, and
      invoked as a black-box explanation: groups differ because of ‘culture’, but the specific
      ways in which this happens remain unclear. Cultural psychology represents a move away
      from cataloguing differences to understanding culture and how it shapes psychological
      variation (e.g., Betancourt & López, 1993; Cohen, Nisbett, Bowdle, & Schwarz, 1996;
      Heine and Norenzayan, 2006; Kitayama, Markus, Matsumoto, & Norasakkunkit, 1997).
      Differentiating between culture and ‘cultural group’ emphasizes that individual group
      members can partially adhere to or reject aspects of culture. For example, Mr. Cho and
      his wife have different views about the acculturation of their children, and not in ways
      that are obviously predictable from their own degree of traditionalism (Appendix: 1.1).

      Is culture best understood as ‘in the head’ or ‘in the world’? These views are held in
      tension and they sometimes conflict but, as with cognition and behavior in clinical psy-
      chology, neither is sufficient alone. People do not simply carry out behaviors. Rather,
      they perform ‘acts of meaning’ (Bruner, 1990), intended by the actor and understood by
      observers as meaningful. These acts are framed by the cultural meaning system and their
      enactment contributes to shaping this system (Kashima, 2000). Nisbett and Cohen (1996),
      for example, conducted an important series of studies on the ‘Culture of Honor’ in the
      American South, reporting that southerners have more favorable attitudes towards vio-
      lence in cases where honor is at stake. Moreover, they demonstrated experimentally that
      southerners whose honor has been challenged are more physiologically reactive and take
      longer to step out the way of a confederate walking toward them in a narrow corridor.
      Cultural variation is captured here by both opinions and behaviors, and the behaviors of
      both participant and confederate are understood as meaningful.

      The idea of cultural scripts can bridge these perspectives, as they both reflect meaning
      structures in the head and guide behavioral practices in the world (DiMaggio, 1997).
      Scripts refer to organized units of knowledge that encode and propagate meanings and
      practices. They serve as mechanisms that allow for rapid automatic retrieval and use of
      information acquired from the world while shaping how that information is perceived.
      Enacted as behavior, scripts are observable to others and become part of the cultural

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      context, shaping assumptions about what others think and expectancies about how they
      will behave (Chiu, Gelfand, Yamagishi, Shteynberg, & Wan, 2010). Moreover, people
      can access multiple cultural scripts, primed by different contextual cues (Hong & Chiu,
      2001). If while at home Mr. Cho scolds his children for pursuing a ‘Western lifestyle’, he
      is accessing available scripts for cultural preservation while his actions and others’
      responses contribute to shaping these scripts, and passing them to his children. In work
      contexts, these same scripts may be primed rarely if at all. Mr. Cho’s wife can understand
      him according to their shared meaning system even as she accesses a different available
      cultural script – promoting her children’s well-being by ensuring they can function in a
      new society (Appendix: 2.2).

      Clinical psychology

      In using the term ‘clinical’ in cultural–clinical psychology, we are thinking primarily of
      researchers trained as scientists or scientist-practitioners in clinical psychology, health psy-
      chology, or experimental psychopathology. Although not all of these researchers are
      directly engaged with both science and practice, there is an emphasis on moving between
      theory and research about groups on the one hand, and the experiences and needs of
      individual sufferers on the other. Clinical psychology is concerned both with describing
      pathological phenomena and with using psychological principles to intervene with these
      phenomena therapeutically.

      As a health discipline, clinical psychology inevitably discusses ‘symptoms’ and ‘syn-
      dromes’ – specific pathological experiences and the ways in which they are grouped. Mr.
      Cho’s reported symptoms are insomnia, fatigue, loss of appetite, and gastrointestinal dis-
      tress, with some evidence of depressed mood. A clinician trained in DSM-IV has over
      300 syndromes to consider, but would most likely consider Major Depressive Disorder
      (MDD). Clinical psychology has long had a certain willingness to critique diagnostic sys-
      tems accompanied by a preference for evidence-based symptom dimensions (Achenbach
      & Edelbrock, 1983; Krueger & Markon, 2006). This openness benefits cultural studies of
      psychopathology, as diagnostic systems are themselves cultural products (Gone & Kirma-
      yer, 2010; Lewis-Fernández & Kleinman, 1994). Moreover, Kleinman (1988) argues that
      rigid application of a diagnostic system conceals cultural variation. He has shown how
      The International Pilot Study of Schizophrenia reliably identified patients meeting diag-
      nostic criteria for schizophrenia, but in doing so eliminated a large proportion of psy-
      chotic patients at each site – precisely those patients who showed the most variability
      across the cultural groups (Appendix: 1.2).

      Cultural–clinical psychology: what’s new?

      In an era both of fragmentation and interdisciplinarity in psychology (Cacioppo, 2007) it
      is easy to argue that two areas can benefit from collaboration on topics of shared concern.
      We wish to make a stronger claim in this case: a new field emerges at their intersection.
      For this to be plausible, we must first establish that clinical psychology is altered by con-
      sideration of cultural questions. More challenging, we must also establish that cultural
      psychology is altered by clinical questions, not simply given new content. Research in
      cultural–clinical psychology should tell us something new about the cultural contexts
      under study, not just the pathologies. Finally, we must demonstrate that new questions
      and methods for addressing them emerge from this sub-discipline, or at least that the
      potential is there (Appendix 2.1).

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      Clinical psychology encounters cultural psychology. A central issue for clinical psychology –
      what is disorder? – cannot be fully understood without considering deep cultural influ-
      ence. The oft-used distinction between illness and disease defines illness as the socially-sit-
      uated experience of having a particular disorder and disease as the corresponding
      malfunction in biological or psychological processes (Boorse, 1975; Kleinman, 1977).
      Wakefield (1992) similarly defines disorder as harmful dysfunction, in which harm indi-
      cates that the disorder is problematic in a given cultural context and dysfunction indicates
      the failure of a biological system evolutionarily adapted for particular ends.

      While these approaches ostensibly give equal credit to culture and biology, uncritical
      acceptance plays into biases of mainstream clinical psychology. Researchers can end up
      exemplifying Geertz’s (1984, p. 269) characterization of the behavioral sciences, in which,
      ‘‘culture is icing, biology, cake…difference is shallow, likeness, deep’’. We prefer to see
      disorder as both biological and cultural, in a fundamentally inseparable way. Depressed
      mood has many biological and cultural constituents worthy of focused study for specific
      purposes, but there is no depressed mood until these constituents come together and are
      experienced by someone.

      Methodologically, clinical research has much to gain from incorporating the cultural
      psychology perspective. Integration of findings on the cultural shaping of psychological
      functioning can allow clinical psychologists to develop a broader and more nuanced view
      of normal human experience. Cultural psychology is well positioned to help clinical psy-
      chology move beyond conceptualizations of mental illnesses as products of solitary minds
      to thinking of it as contextually embedded in networks of local meanings, norms, institu-
      tions, and cultural products (e.g., Adams, Salter, Pickett, Kurtis, & Phillips, 2010). Finally,
      cultural psychology can inform our understanding of the ways in which people, including
      both patients and clinicians, incorporate contextual information in detecting, reporting
      and interpreting symptoms of mental illness (for examples of these cultural psychology
      ideas, not yet adapted for clinical questions, see Heine, Lehman, Markus, & Kitayama,
      1999; Hong, Morris, Chiu, & Benet-Martı́nez, 2000; Masuda & Nisbett, 2001; Uchida,
      Norasakkunkit, & Kitayama, 2004. In Mr. Cho’s case, the institutional demands of a
      mental health clinic may have tilted the emphasis toward symptoms and attributions and
      away from the understandable suffering caused by business and family difficulties (Appen-
      dix: 2.3).

      The idea of scripts can help us think about specific ways in which mental health is
      shaped by cultural context. Although by definition abnormality violates expectations of
      what is normal, people nonetheless have scripts to help them make sense of pathology as
      best they can. Confusing and frightening experiences, such as emerging psychopathology,
      have a particularly strong need for scripts (Philippot & Rimé, 1997; Taylor, 1983). The
      large but finite number of ways to be physically or psychologically distressed is further
      molded by cultural-historical context, so that specific disorders draw upon a pool of avail-
      able symptoms (Shorter, 1992). Cultural scripts can then be seen as mapping the sufferer’s
      experience to what is available in this ‘symptom pool’, focusing on and thereby amplify-
      ing those symptoms that best serve explanatory and communicative purposes. Denial of
      depressed mood and acknowledgement that his problems are upsetting can be seen as
      serving Mr. Cho’s communication goals in a particular health care setting.

      Cultural psychology encounters clinical psychology. Beyond providing new content, potential
      contributions of clinical psychology begin with two of cultural psychology’s core
      concerns: heterogeneity of cultural groups and limited coherence of cultural contexts
      (Kashima, 2000). These concerns do not necessarily require clinical psychology, but the

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      study of mental disorder serves as an engine to generate many examples of each. Psycho-
      pathological phenomena also shed new light on culture; as with the lesion studies that
      propelled neuroscience, we learn new things about cultural processes when the normal
      cultural scripts no longer work (For a similar idea, not specific to psychopathology, see
      Beckstead, Cabell, & Valsiner, 2009). North American studies of social phobia patients
      highlight the central role fear of negative evaluation plays when healthy interpersonal func-
      tioning breaks down (see Hofmann & Barlow, 2002). These findings also reveal some of
      the assumptions of normal social relationships in North America: one is to portray one’s
      true self and have it be positively evaluated by others. Studies of socially anxious patients in
      other cultural groups can serve the same function, showing for example how fear of caus-
      ing discomfort to others – perhaps by inappropriately revealing one’s true self – is a central
      concern for many socially anxious people in East Asian contexts (Rector, Kocovski, &
      Ryder, 2006; Sasaki & Tanno, 2005; Zhang, Yu, Draguns, Zhang, & Tang, 2000).

      Methodologically, clinical psychology has a rich tradition of modeling ways in which
      abnormal behavior is shaped by constraints imparted by physiological and environmental
      influences, and their interactions. For example, contemporary research on depression
      spans multiple levels of analysis ranging from genes to hormones, brain anatomy and
      function, attention, memory, emotional reactivity, personality, and interpersonal function-
      ing (Hammen, 2003; for a thorough review, see chapters in Gotlib & Hammen, 2009).
      Clinical psychology can also provide tools for theorizing about the ways in which psy-
      chological processes become functional or dysfunctional in a cultural context. For exam-
      ple, cultural innovation and propagation depends on specific abilities, such as harnessing
      novel associations or conveying negative emotions (Chentsova-Dutton & Heath, 2007),
      that are also associated with predisposition to certain forms of psychopathology.

      Cultural–clinical psychology: mutual constitution of culture–mind–brain

      The core claim of cultural psychology is not simply that groups differ or ‘culture matters’,
      but rather that human culture and human psychology are each grounded in the other:
      that culture and mind ‘make each other up’ (Shweder, 1991). Clinical psychology
      research, in keeping with trends in psychological science and in psychiatry, tends to focus
      more on the interrelation of mind and brain (Andreasen, 1997; Barrett, 2009; Ilardi &
      Feldman, 2001). We argue that the best approach for cultural–clinical psychology emerges
      from the joint concerns of the two fields, leading us to discuss mutual constitution of cul-
      ture, mind, and brain. This approach follows recent trends in cultural psychiatry (Kirma-
      yer, forthcoming) and cultural psychology (Chiao, 2009; Kitayama & Park, 2010;
      Kitayama & Uskul, 2011), in which culture, mind, and brain are thought of as multiple
      levels of a single system, here called the culture–mind–brain (Appendix: 3.1).

      Culture and mind. The mutual constitution of culture and mind develops through pro-
      cesses that are an integral part of socialization, in that minds develop in cultural contexts
      that are themselves composed of minds (Cole, 1996; Valsiner, 1989). We cannot under-
      stand human minds unless we understand them in cultural context, and we cannot under-
      stand human culture unless we understand minds. The goal is to find ways of thinking
      and studying the psychological and the cultural so that neither is seen as the ultimate
      source of the other (Markus & Hamedani, 2006; Shweder, 1995).

      Mind and brain. It is increasingly untenable to propose models of mental health that have
      no room for the brain, as shaped by the genome and in turn by evolutionary processes.

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      While we agree wholeheartedly with Geertz (1973) that, ‘‘it is culture all the way
      down’’, we also simultaneously make the opposite claim: it is biology all the way up.
      Both must be true for mutual constitution to have any meaning. Rather than seeing mind
      as the subjective epiphenomenon of brain, however, we prefer a view of mind as funda-
      mentally social and tool-using, even as extended beyond the brain (Clark & Chalmers,
      1998; Hutchins, 1995; Kirmayer, forthcoming; Vygotsky, 1978). Habitually used tools
      and close others are partially incorporated into one’s mind: the online calendar can
      become part of the mind’s memory system; the close friend can become part of the mind’s
      emotion regulation system.

      Culture and brain. It does not necessarily follow from a tripartite model of culture, mind,
      and brain in this way that mind mediates all culture-brain links. The human brain is
      adapted to acquire culture and responds to cultural inputs with marked plasticity, espe-
      cially early in development (Wexler, 2006). Indeed, the emergence of a recognizable
      human mind may require these transactions between culture and brain. At the same time,
      biology constrains culture. There are a large number of possible ways in which culture
      can be configured, yet the number of impossible configurations is practically infinite (Gil-
      bert, 2002; Mealey, 2005; Öhman & Mineka, 2001). That this is true does not compro-
      mise the equally important observation that human possibilities are many, diverse, and
      deeply shaped by culture (Marsella & Yamada, 2010; Tseng, 2006).

      The ecology of culture–mind–brain. Describing the interrelations of culture, mind, and brain
      as a triangle of linked associations might imply three interrelated systems. We prefer to
      think of culture–mind–brain as one dynamic multilevel system, an information network
      instantiated in neuronal pathways, cognitive schemata, human relationships, culturally-
      mediated tools, global telecommunications, corporations, political actors, health care sys-
      tems, and so on. Cultures, minds, and brains cannot be understood in isolation from one
      another. As yet, there is little research that engages with all three levels simultaneously,
      although a promising avenue has been opened by Kim, Sherman, Taylor, et al. (2010a).
      These researchers showed that cultural context and variations in certain serotonin recep-
      tor genes interact to predict locus of attention. Specifically, one of the variants predicts a
      tendency to attend to context in Korean participants, and the same variant predicts an
      especially strong tendency to attend to the focal object in Euro-American participants.

      Psychopathology is an emergent property of culture–mind–brain, with no ultimate
      cause at any one level. While changes at one level affect all levels, it does not follow that
      disorder at one level means disorder at other levels, let alone that disorder at a higher
      level must be caused by disorder at a lower level. A disordered brain circuit does not
      require malfunctioning neurons, nor does a disordered neuron require malfunctioning
      molecules, although neither makes sense in the absence of neurons or molecules. Pathol-
      ogy can emerge from problematic feedback loops in which the response to a problem
      exacerbates the problem, even when all components of the loop are working normally
      (Hacking, 1995; Kirmayer, forthcoming). A conditioned fear that goes on to cause prob-
      lems in living is a disorder, it involves the brain, but it does not require a disordered
      brain. Values conflict between Mr. Cho and his wife can create a stressful environment
      for their children, but not because a lower-level disorder leads them to adhere to patho-
      logical values.

      Disorder at higher levels can also lead to disorder at lower levels. Cultural norms, eco-
      nomic conditions, and political response might interact to produce violent conflict, with
      consequences that include damage to brains from traumatic stress. It is incomplete at best

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      to claim that psychological consequences of that damage are caused by the brain without
      acknowledging political or economic causes. Similarly, Mr. Cho’s depression might make
      sense as psychosocial stress coupled with preexisting vulnerability, but the depression has
      lasting consequences for the brain (Kendler, Thornton, & Gardner, 2000). A mind-level
      intervention such as Cognitive-Behavior Therapy (CBT), moreover, impacts on the brain
      (DeRubeis, Siegle, & Hollon, 2008) – unsurprising, as culture–mind–brain is a single
      system (Appendix: 3.2).

      Before considering an example of three recent cultural–clinical psychology lines of
      research focused on an interrelated set of questions, let us briefly return to the case of
      Mr. Cho.

      After the initial assessment, Mr. Cho began a 16-week course of CBT for depression. The
      case at first appeared to be a textbook case of ‘Chinese somatization’; somatic symptoms were
      discussed almost exclusively, unlinked to psychosocial stressors. Sustained discussion of these
      stressors would sometimes lead to marked tearfulness and inability to maintain emotional compo-
      sure. Once rapport was established, depressed mood was acknowledged fairly quickly, along with
      guilt and pessimism, primarily described as reactions to how the physical symptoms had impacted
      his business and family life.

      Mr. Cho asked several times how CBT could help him with his primary concern – the somatic
      symptoms – and as treatment turned to depressed mood, guilt, and pessimism, he began to miss ses-
      sions. We reframed treatment in line with CBT approaches to Chronic Fatigue Syndrome – empha-
      sizing holism of mind and body, talking more openly about somatic symptoms, and incorporating
      some somatic approaches such as sleep hygiene and diet regulation. Psychological and physical causes,
      psychological and physical symptoms, all became legitimate topics for discussion.

      Cultural–Clinical Psychology: Empirical Examples

      We are each involved in independently developed lines of research taking a cultural psy-
      chology approach to clinically-relevant questions about Chinese-origin participants and
      depression. To illustrate the potential of cultural–clinical psychology, we turn to a more
      sustained discussion of this work.

      Cultural psychology research on depression

      Somatic and psychological symptoms. In a now classic study, Kleinman (1982) argued that
      Chinese psychiatric patients tend to emphasize somatic symptoms relative to ‘Western’
      norms (see also Parker, Cheah, & Roy, 2001). Ryder et al. (2008) used multiple assess-
      ment methods with Han Chinese and Euro-Canadian psychiatric outpatients. Results
      generally showed greater somatic symptom reporting in the Chinese group and greater
      psychological symptom reporting in the Euro-Canadian group. The tendency to devalue
      the importance of one’s emotional life was also higher in the Chinese group and medi-
      ated the relation between cultural group and symptom presentation.

      Devaluation of one’s emotional life does not fit well with readily accessible cultural
      scripts in North America. This tendency was measured using a tool designed to mea-
      sure pathology, the Externally-Oriented Thinking (EOT) subscale of the Twenty-item
      Toronto Alexithymia Scale (TAS-20; Bagby, Parker, & Taylor, 1994). Whereas EOT
      might capture pathological beliefs in a cultural context that fosters ideals of healthy
      emotional expression, it may simply represent adherence to an accessible cultural
      script in Chinese contexts (see Dion, 1996; Kirmayer, 1987). In a comparison of
      Chinese- and Euro-Canadians, group difference in EOT was mediated by adherence to

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      ‘Western’ values (Dere, Falk, & Ryder, forthcoming). People vary in accessibility of
      cultural scripts about emotional expression, and cultural contexts vary in terms of how
      normal these scripts are perceived to be. Mr. Cho had access to multiple scripts but
      the Chinese somatic script predominated – he emphasized somatic symptoms while
      increasingly considering psychological symptoms, and tended to see the latter as conse-
      quences of somatic symptoms.

      Emotional expression. Studies comparing depressed Euro-Americans and Asian-Americans
      to their non-depressed counterparts show that depression is associated with culturally-spe-
      cific patterns of emotional reactivity. For Euro-Americans, depression is characterized by
      dampened emotional reactivity in response to positive and negative emotional films (see
      Bylsma, Morris, & Rottenberg, 2008). Chentsova-Dutton et al. (2007) replicated this
      pattern with negative films in Euro-Americans using self-report, facial coding, and
      physiological measures, but failed to find it – and at times, found the inverse – in Asian-
      Americans (primarily Chinese-Americans). More surprisingly, Chentsova-Dutton, Tsai,
      and Gotlib (2010) replicated the pattern using positive films, so that on certain measures
      such as cardiac reactivity, depressed Asian-Americans were actually more reactive …

      Literature Review

      2

      Annotated Bibliography

      Anna Spence

      January 2, 2022

      Annotated Bibliography

      Milgram Psychology of Obedience

      Abbott, A. (2016). The Modern Milgram experiment sheds light on the power of authority. Nature530(7591), 394-395. https://doi.org/10.1038/nature.2016.19408

      The perceptions can assist with understanding the reason why individuals can cause fiendishness and damage others when forced. An accomplished writer, Abbot knows about the restrictions and the moral worries of the analysis. In any case, the creator depends on his perspective that the Milgram explore reveals insight into and understanding intellectual brain science. The discoveries from the examination don’t make the unsafe activities right, the discoveries assist us with seeing how individuals feel when following requests and why they follow orders in any event when they realize the order will hurt others.

      Dolinski, D., & Grzyb, T. (2020). How did Milgram do it? The Social Psychology of Obedience Towards Authority, 14-28. https://doi.org/10.4324/9781003049470-3

      Dolinski and Grzyb draw from the Milgram test just as their exploration on the brain science of dutifulness towards power to clarify why individuals will cause malevolence and damage others when on order and request. The creator’s diagram principal realities that help the discoveries of the Milgram analyze

      The creators reevaluate the Milgram try and investigate the issues of congruity and dutifulness of individuals to power. From the Milgram explore and other examinations, the creators build up different speculations regarding the matter of submission. The creators likewise clarify different elements that make people respectful in different conditions.

      The article helps in acquiring understanding and reflection on how individuals can distinguish risk and stay away from dutifulness that might lead o obliteration. the article is useful in the field of social and intellectual brain research in attempting to comprehend social issues that are complicated in the public arena.

      Dolinski, D., & Grzyb, T. (2020). Individual differences and behavior during the experiment. The Social Psychology of Obedience Towards Authority, 86-102. https://doi.org/10.4324/9781003049470-10

      Dolinski and Grzyb assess and analyze the Milgram investigate the practices of the members of the examination their practices. The creators clarify utilizing social and intellectual brain science why the members act how they do.

      Individuals act contrastingly under various states of tension. Individuals go through mental changes when on orders and will hurt others. Dutifulness has added to a ton of fiendish behaviors in the public eye. Individuals subliminally show compliance to power and will follow orders in any event, when evil. The creators clarify why individuals in the public arena are unethical and follow indecent orders

      The article adds to a superior comprehension of submission as friendly conduct and clarifies practices that are connected to dutifulness. The creators have given a savvy survey of the observational history of the examination that was led more than 60 years prior.

      Frings, D. (2018). Conformity and obedience. Social Psychology, 123-146. https://doi.org/10.4324/9781315147888-9

      This article inspects the interaction between fundamental congruity and obedience. It sees how gatherings can impact one to act distinctively and how we react to individuals who neglect to adjust. The section inspects thoughts around congruity and compliance by checking out various exemplary examinations investigating how individuals adjust and are devoted to, experts in gatherings. It investigates how minorities can now and then not adjust and additionally change the accepted practices of the larger part.

      Gibson, S. (2020). Milgram’s experiments on obedience to authority. Oxford Research Encyclopedia of Psychologyhttps://doi.org/10.1093/acrefore/9780190236557.013.511

      Gibsons examines and explains the major contributions of the Milgram experiment in I the field of psychology. The social behavior of obedience has changed over the years. People’s propensity to follow orders has also changed.

      The article contributes to how obedience is viewed in experiments. The author, however, rather than viewing the experiments as people just following commands, explains that in the Milgram experiment that the participants did not follow orders, their psychological behaviors changed that made them blindly follow orders despite the orders being destructive. Obedience to authority has been programmed in every person bran from birth. People have been following destructive obedience and following illegal orders.

      The article contributes to the field of psychology and the study of obedience and authority. By analyzing the results of the Milgram experiment, the article has given an overview of how obedience is perceived in society. Milgram’s tests on obedience to power are a compelling and social logical examination at any point directed. The evaluation of the Milgram experiment by the author is significant with regards to brain research as it assists with foreseeing how obedience can bring about change in the field of psychology and understanding human behavior.

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      Annotated Bibliography

      Anna Spence

      January 2, 2022

      1

      Annotated Bibliography

      Anna Spence

      January 2, 2022

      Literature Review

      Guidelines for Prevention in Psychology

      American Psychological Association

      The effectiveness of prevention to enhance human func-
      tioning and reduce psychological distress has been demon-
      strated (Catalano, Berglund, Ryan, Lonczak, & Hawkins,
      2002; Greenberg, Domitrovich, & Bumbarger, 2001; Na-
      tional Research Council & Institute of Medicine, 2009).
      Successful preventive interventions are typically theory
      driven, culturally relevant, developmentally appropriate,
      and delivered across multiple contexts (Nation et al., 2003).
      Preventive services and interventions help to further the
      health and well-being of individuals, communities, and
      nations (Satcher, 2000; World Health Organization, 2008).
      Expanding preventive services reduces the costs of mental
      health care (Tolan & Dodge, 2005), while emerging tech-
      nological innovations (e.g., telehealth) offer promise for
      preventive interventions (Bull, 2011; Chinman, Tremain,
      Imm, & Wandersman, 2009).

      From infancy through adulthood, access to preventive
      services and interventions is important to improve the
      quality of life and human functioning and reduce illness
      and premature death (Grunberg & Klein, 2009; Konnert,
      Gatz, & Hertzsprung, 1999). Prevention has typically taken
      a developmental approach, focusing on children and ado-
      lescents, in order to facilitate trajectories leading to positive
      outcomes (National Research Council & Institute of Med-
      icine, 2009). Children and adolescents are at significant risk
      for substance abuse, violence, and sexually transmitted
      infections, and their access to quality health services is
      limited (Centers for Disease Control and Prevention, 2007;
      Weissberg, Walberg, O’Brien, & Kuster, 2003). Thus, nor-
      mal development may be impeded at large costs to society,
      and additional strains imposed on families. In any given
      year, 14%–20% of children and adolescents experience a
      mental, emotional, or behavioral disorder (National Re-
      search Council & Institute of Medicine, 2009). In addition,
      national surveys show that the majority of youth who could
      potentially benefit from mental health services do not re-
      ceive services (Ringel & Sturm, 2001). Early and focused
      interventions can limit the length and severity of symptoms
      and enhance functioning (Cicchetti & Toth, 1992; Durlak,
      Weissberg, & Pachan, 2010). Prevention also includes the
      collaborative design and delivery of strengths-based health
      promotion and environmental improvement strategies (e.g.,
      Cowen, 1985). Health promotion approaches equip people
      with life skills and coping competencies, such as problem-
      solving skills, contributing to their capacity to live more
      fully while being better able to withstand future stressful
      life events.

      Preventive services and interventions also address is-
      sues of health, educational, and social inequities that reflect
      disparities across demographic groups such as those based
      on race, gender, and socioeconomic class. Environmental

      improvement prevention strategies, such as consultation to
      improve community–family–school coordination or inter-
      ventions to help communities create well-paying jobs, aim
      to inform social policy, which can minimize or eliminate
      factors contributing to unhealthy functioning.

      The importance of prevention is consistent with the
      Patient Protection and Affordable Care Act (2010), which
      calls for expansion of preventive services to maximize
      positive health outcomes, as well as with the U.S. National
      Prevention Strategy (National Prevention Council, 2011),
      which “provides an unprecedented opportunity to shift the
      nation from a focus on sickness and disease to one based on
      wellness and prevention” (National Prevention, Health Pro-
      motion, and Public Health Council, 2011, p. 1) throughout
      the life span. Several disciplines other than psychology
      have been historically and currently active in prevention
      (e.g., public health, social work). However, beginning in
      the mid-20th century with the field of community psychol-
      ogy, psychology began to play an increasingly important
      role (e.g., Eby, Chin, Rollock, Schwartz, & Worell, 2011).
      Even with the increased focus on prevention, psychology
      training programs rarely require specific courses on pre-
      vention (O’Neil & Britner, 2009). In particular, conceptu-
      alizations about best practices in prevention, particularly at
      the environmental level, are lacking (Snyder & Elliott,
      2005). In addition, the Ethical Principles of Psychologists
      and Code of Conduct (American Psychological Associa-
      tion [APA], 2010) do not fully address unique ethical
      issues that may arise in prevention (e.g., Schwartz & Hage,
      2009). Therefore, psychologists engaged in prevention can
      benefit from a set of guidelines that address and inform
      prevention practices.

      This article was published Online First November 4, 2013.
      These guidelines were approved by the American Psychological Associ-
      ation (APA) Council of Representatives in February 2013. The guidelines
      were developed by APA’s Prevention Guidelines Work Group. The Work
      Group members, listed alphabetically after the chair, included John L.
      Romano (chair), G. Anne Bogat, Robert K. Conyne, Sally M. Hage,
      Arthur M. Horne, Maureen E. Kenny, Connie Matthews, Jonathan P.
      Schwartz, Anneliese Singh, Michael Waldo, and Y. Joel Wong.

      The Work Group wishes to acknowledge and thank many groups,
      committees, and organizations, including APA’s Board of Professional
      Affairs and Committee on Professional Practice and Standards, as well as
      individuals too numerous to list here, who contributed to the development
      of the Prevention Guidelines during the review process and comment
      periods.

      This document is scheduled to expire as APA policy in February
      2020. After this date, users are encouraged to contact the APA Practice
      Directorate to confirm that this document remains in effect.

      Correspondence concerning this article should be addressed to the
      Practice Directorate, American Psychological Association, 750 First
      Street, NE, Washington, DC 20002-4242.

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      285April 2014 ● American Psychologist
      © 2013 American Psychological Association 0003-066X/14/$12.00
      Vol. 69, No. 3, 285–296 DOI: 10.1037/a0034569

      Purpose
      APA (2002, p. 1050) refers to guidelines as

      statements that suggest or recommend specific professional be-
      havior, endeavors, or conduct for psychologists. Guidelines differ
      from standards in that standards are mandatory and may be
      accompanied by an enforcement mechanism . . .. guidelines are
      aspirational . . . intended to facilitate the continued systematic
      development of the profession and to help assure a high level of
      professional practice . . .. Guidelines are not intended to be man-
      datory or exhaustive and may not be applicable to every profes-
      sional and clinical situation. They are not definitive and they are
      not intended to take precedence over the judgment of
      psychologists.

      Accordingly, the Guidelines for Prevention in Psychology
      (cited as Prevention Guidelines or Guidelines for the re-
      mainder of this document) are intended to “inform psychol-
      ogists, the public, and other interested parties regarding
      desirable professional practices” (APA, 2002, p. 1049) in
      prevention.

      The Prevention Guidelines are, in part, practice guide-
      lines and different from treatment guidelines as defined by
      APA (2002). The Guidelines are recommended for the
      practice of psychology across areas that engage psycholo-
      gists. The Guidelines are consistent with federal and state
      laws and regulations. In the event of a conflict between the
      Guidelines and any federal or state law or regulation, the
      law or regulation in question supersedes these Guidelines.
      Psychologists are encouraged to use their education and
      skills to resolve any conflicts in a way that best conforms
      to both law and ethical practice. The Guidelines are con-
      sistent with the Ethical Principles of Psychologists and
      Code of Conduct (APA, 2010), particularly Principles D
      (justice) and E (respect for people’s rights and dignity).

      Background
      APA convention symposia (Hage & Romano, 2006;
      Kenny, 2003; Romano, 2002) initiated the development of
      these Guidelines, followed by an article describing preven-
      tion best practices (Hage et al., 2007). These Guidelines
      were later introduced as new business for the APA Council
      of Representatives, whereupon they underwent significant
      review, including APA governance and public comment
      periods, in accordance with Association policy relevant to
      guidelines (APA, 2013, Association Rule 30-8). The
      Guidelines were approved by the APA Board of Directors
      in December 2012 and by the APA Council of Represen-
      tatives in February 2013.

      Definitions
      Prevention has been conceptualized as including one or
      more of the following: (a) stopping a problem behavior
      from ever occurring; (b) delaying the onset of a problem
      behavior, especially for those at-risk for the problem; (c)
      reducing the impact of a problem behavior; (d) strengthen-
      ing knowledge, attitudes, and behaviors that promote emo-
      tional and physical well-being; and (e) promoting institu-
      tional, community, and government policies that further
      physical, social, and emotional well-being of the larger

      community (Romano & Hage, 2000). This conceptualiza-
      tion is consistent with Caplan’s (1964) definition that iden-
      tified prevention interventions as primary, secondary, and
      tertiary prevention, and with the definition by Gordon
      (1987) that identified prevention interventions as universal,
      selected, and indicated for those not at risk, at risk, and
      experiencing early signs of problems, respectively. Gor-
      don’s conceptualization was adopted by the Institute of
      Medicine (1994). A follow-up report from the Institute of
      Medicine broadened this universal, selective, and indicated
      framework to include “the promotion of mental health”
      (National Research Council & Institute of Medicine, 2009,
      p. 65).

      Throughout this document, the terms prevention, pre-
      ventive intervention(s), preventive program(s), and preven-
      tive services are used. Activities subsumed by these rubrics
      could focus on any of the five aspects of prevention in-
      cluded in the Romano and Hage (2000) conceptualization
      of prevention. Although space precludes a thorough exe-
      gesis of all types of programs, decisions about how and
      when to intervene might lead to different outcomes, differ-
      ent ancillary effects, and different ways of approaching
      issues within cultures and settings.

      Documentation of Need
      The Prevention Guidelines are recommended based on
      their potential benefits to the public and the professional
      practice of psychology. The Guidelines support prevention
      as an important area of practice, research, and training for
      psychologists. The Guidelines give increased attention to
      prevention within APA, encouraging psychologists to be-
      come involved with preventive activities relevant to their
      area of practice.

      The National Research Council and Institute of Med-
      icine’s (2009) Committee on the Prevention of Mental
      Disorders and Substance Abuse Among Children, Youth
      and Young Adults: Research Advances and Promising In-
      terventions stated, “Infusing a prevention focus into the
      public consciousness requires development of a shared
      public vision and attention at a higher national level than
      currently exists” (p. 5). The Guidelines provide added
      visibility to the importance of prevention across profes-
      sional practice areas and among the public. The Guidelines
      also support the U.S. Department of Health and Human
      Services’ calls for health promotion and prevention in its
      Healthy People publications outlining national health goals
      (e.g., U.S. Department of Health and Human Services,
      2000). Healthy People 2020 (U.S. Department of Health
      and Human Services, 2010) continues the tradition of ear-
      lier publications by setting goals to eliminate preventable
      disease, achieve health equity, eliminate health disparities,
      create social and physical environments to promote good
      health, and promote healthy development and healthy be-
      haviors across the life span. Other U.S. government bodies
      have also emphasized the importance of prevention to the
      overall health and well-being of the population (Mrazek,
      2002).

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      286 April 2014 ● American Psychologist

      The Patient Protection and Affordable Care Act
      (2010) includes preventive services as an important com-
      ponent of overall health care. The legislation strives to
      make wellness and preventive services affordable and ac-
      cessible by requiring health plans to cover preventive ser-
      vices without copayments. These services include counsel-
      ing to improve habits of lifestyle (e.g., proper nutrition,
      weight management), counseling to reduce depression, and
      preventive services to foster healthy birth outcomes.

      The contributions and leadership of psychologists are
      critical in implementing a prevention focus in the health
      care system. Evidence increasingly suggests that mental
      illness, such as depression, is linked to chronic health
      issues such as heart disease and diabetes (Volgelzangs et
      al., 2008). Therefore, the Guidelines identify best practices
      for psychologists who engage in preventive activities re-
      lating to the interface between physical health and emo-
      tional well-being.

      The Guidelines also respond to policies and legislation
      that aim to prevent and reduce problems such as chemical
      addictions, depression, suicide, school bullying, social vi-
      olence, and obesity (Institute of Medicine, 1994). The
      Guidelines respond to social disparities, discrimination,
      and bias against people based on (but not limited to) their
      race, ethnicity, immigrant status, sexual orientation, age,
      gender identity, socioeconomic status, religion, HIV se-
      rostatus, physical and psychological health status, and gen-
      der (APA, 2003, 2007; Kenny, Horne, Orpinas, & Reese,
      2009). The Guidelines offer recommendations to psychol-
      ogists as they respond to public policy and legislative
      initiatives that promote positive health behaviors in the
      name of prevention and health promotion (National Re-
      search Council & Institute of Medicine, 2009). In addition,
      the Guidelines endeavor to apply the science and practice
      of psychology to address major social issues and real-world
      problems through education, training, and public policy
      positions (Anderson, 2011).

      The Guidelines offer guidance to psychologists on
      several levels, including supporting the value of prevention
      as important work of psychologists and providing recom-
      mendations that give greater visibility to prevention among
      psychologists regardless of specialty area or work setting
      (Snyder & Elliott, 2005).

      Expiration
      Given the evolving nature of prevention, the Guidelines are
      scheduled to expire in the year 2020. After this date, users
      are encouraged to contact the APA Practice Directorate to
      determine if the document remains in effect. The year 2020
      was selected because it coincides with the decennial
      Healthy People publications, which set national health
      goals for the United States every 10 years. In addition, it is
      expected that the Patient Protection and Affordable Care
      Act (2010) will be implemented fully by 2014, providing a
      reasonable time frame for these Guidelines, given the
      evolving nature of health care and psychology’s place
      within the spectrum of health care services and research.

      Guidelines
      Guideline 1. Psychologists are encouraged to
      select and implement preventive
      interventions that are theory- and evidence-
      based.

      Rationale. Preventive interventions that demon-
      strate sustained effectiveness can be considered as meeting
      the highest standard for efficacy and maximum benefits to
      the consumer (National Institute of Mental Health, 1998).
      Consistent with foundational principles in psychology, the-
      ory and research should be inseparably tied to prevention
      practice. Research suggests that programs developed from
      a sound theoretical framework are more effective than
      programs that are not theoretically based (Weissberg,
      Kumpfer, & Seligman, 2003). Also, preventive programs
      that are based on theory and regularly evaluated are more
      likely to consider risk and protective factors that operate
      across multiple contexts (Black & Krishnakumar, 1998),
      especially for groups who are historically marginalized
      (e.g., women, people of color). Accountability to client
      populations, funding agencies, and policymakers demands
      that prevention practices be grounded in theory and re-
      search (Vera & Reese, 2000).

      Application. Psychologists are encouraged to
      conduct preventive programs that have been rigorously
      evaluated (Guterman, 2004; Weissberg, Kumpfer, & Selig-
      man, 2003). While no single theoretical perspective is
      suggested, psychologists are encouraged to select theoret-
      ically based preventive approaches when considering their
      prevention goals. The theoretical frameworks and interven-
      tion strategies of positive psychology, positive youth de-
      velopment, applied developmental science, risk and resil-
      ience, health promotion, competence enhancement, and
      wellness, among others, can be selected and integrated
      when designing preventive interventions that will simulta-
      neously prevent negative outcomes and enhance positive
      outcomes (Weissberg, Kumpfer, & Seligman, 2003). It is
      recommended that preventive programs be selected based
      on a careful review of empirical evidence in order to
      choose programs that are empirically supported for their
      specific contexts and specified goals, in addition to identi-
      fying how these relate to both multicultural issues and
      concerns generated by social inequities. Therefore, it is
      recommended that psychologists stay informed regarding
      current outcome research in prevention science to help
      ensure that the preventive programs they implement offer
      the most promise for the identified goals and population.

      Guideline 2. Psychologists are encouraged to
      use socially and culturally relevant
      preventive practices adapted to the specific
      context in which they are implemented.

      Rationale. Given the increasing diversity of the
      U.S. population, it is crucial that preventive programs be
      designed, selected, and implemented with consideration of
      cultural relevance and cultural competence. Historically,
      many preventive programs were developed by profession-
      als working with urban and suburban middle-class com-

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      287April 2014 ● American Psychologist

      munities and reflect heterosexual European American val-
      ues and methods; furthermore, many did not address the
      unique issues faced by persons with disabilities. Preventive
      programs that lack relevance to the lives of participants will
      often fail (Lerner, 1995). Even when a preventive program
      is effective in one setting, it may not be effective in another
      setting with different populations (e.g., rural vs. urban
      communities, individuals above and below the federal pov-
      erty guidelines). Research suggests that programs per-
      ceived as socially and culturally relevant by their constit-
      uents have a greater likelihood of being sustained (Vera &
      Reese, 2000). As Trickett et al. (2011) noted, “Culture is
      not seen as something to which interventions are tailored;
      rather, culture is a fundamental set of defining qualities of
      community life out of which interventions flow” (p. 1412).

      Because risk and protective factors are found within
      individuals and in the multiple social contexts in which
      individuals are situated, prevention programs that attend to
      both individual and contextual factors are most advanta-
      geous. Focusing only on individuals and the more proximal
      context of the family may place undue responsibility and
      blame on the individual and the individual’s milieu without
      recognizing the roles played by social institutions and
      culture in determining and sustaining positive human out-
      comes (Kenny & Hage, 2009). Therefore, psychologists
      strive to understand the cultural worldviews and commu-
      nity contexts of individuals in order to strengthen preven-
      tion interventions, especially interventions that have been
      developed for one cultural group and implemented in an-
      other (National Research Council & Institute of Medicine,
      2009).

      Application. Psychologists are encouraged to be
      aware of and to articulate the evidence that supports their
      selection of specific prevention programs for implementa-
      tion in different cultural contexts (Reese & Vera, 2007).
      Along this line, existing programs may need significant
      adaptation, or new programs may need to be developed, to
      meet social, cultural, community, and developmental
      norms of program participants and to ensure access to all
      members. Technological advances, such as the use of web-
      based preventive interventions and social media to pro-
      mote, deliver, and assess prevention interventions, can as-
      sist with this process. Psychologists are encouraged to
      recognize the diversity that exists within cultural groups as
      cultural values may differ by race, ethnicity, social class,
      family income, gender, gender identity, sexual orientation,
      geographic region, education, ability, and acculturation
      level (Kumpfer, Alvarado, Smith, & Bellamy, 2002). Psy-
      chologists are encouraged to examine cultural assumptions
      and biases of specific preventive programs and to consult
      the APA’s (2003) “Guidelines on Multicultural Education,
      Training, Research, Practice, and Organizational Change
      for Psychologists” and its “Guidelines for Assessment of
      and Intervention With Persons With Disabilities” (APA,
      2012a) in integrating considerations of culture in the de-
      sign, implementation, and evaluation of prevention inter-
      ventions. It is important for psychologists to acquire and
      demonstrate cultural competence across prevention activi-
      ties and to strive to work sensitively with diverse popula-

      tions. This typically means that the psychologist must
      immerse him- or herself in the community and culture in
      order to be a sensitive partner with the community.

      Psychologists endeavor to include relevant stakehold-
      ers in all aspects of prevention planning and implementa-
      tion to ensure program fit with the local culture and to build
      community investment in the program. In order to ensure
      that preventive programs meet local norms, it is recom-
      mended that psychologists engage in careful planning and
      ongoing monitoring and evaluation of programs (Nation et
      al., 2003). Dynamic trial designs have been proposed that
      avoid problems associated with randomized clinical trials
      and focus on whether significant information is lost as the
      intervention proceeds (Jason & Glenwick, 2012), whether
      there are unintended consequences (positive and negative)
      that result from the intervention, and how to consider issues
      of diversity when statistical power may be low (Rapkin &
      Trickett, 2005).

      Guideline 3. Psychologists are encouraged to
      develop and implement interventions that
      reduce risks and promote human strengths.

      Rationale. Early prevention interventions fo-
      cused on reducing risks or causes of psychological dys-
      function (Conyne, 2004). However, psychological research
      has identified personal and environmental protective fac-
      tors that may also mitigate the probability of negative
      outcomes in the face of risk and that contribute to optimal
      health. Research indicates that prevention is most benefi-
      cial when attempts to reduce risk are direct and are com-
      bined with efforts to build strengths and protective factors
      (Eccles & Appleton, 2002; Vera & Reese, 2000). Focusing
      only on building competencies or only on preventing prob-
      lems may not be as effective as addressing both competen-
      cies and problems (Catalano, Berglund, et al., 2002).

      Application. Psychologists are encouraged to
      consider and ameliorate factors that contribute to risk and
      also to recognize and promote factors that enhance human
      strengths. Prevention programs can seek to reduce or elim-
      inate factors, such as socioeconomic disparities, negative
      peer influences, family dysfunction, and school failure, or
      they can seek to increase social competencies and other
      protective factors (National Research Council & Institute
      of Medicine, 2009). Although psychologists may consider
      only the benefits of either a risk-reduction or a strength-
      promotion approach, an optimal approach is to address
      both. Protective factors, such as socioemotional skills, in-
      terpersonal connection, ethical decision making, graduat-
      ing from high school, school-to-work transitions, civic
      engagement, and proper nutrition, might be selected as foci
      of interventions based upon their malleability and their
      relevance to daily life (Eccles & Appleton, 2002; Nation et
      al., 2003; Stone et al., 2003). For instance, a focus on
      expanding the resilience that historically marginalized
      groups have demonstrated despite obstacles might also
      serve to enhance strengths in other arenas of life (Singh,
      Hays, & Watson, 2011; Singh & McKleroy, 2011).

      An emphasis on simultaneously reducing risks and
      developing competencies is consistent with research on

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      288 April 2014 ● American Psychologist

      positive youth development, empowerment, advocacy, and
      participatory community research. Positive youth develop-
      ment posits that (a) protective factors reduce the likelihood
      of maladaptive outcomes under conditions of risk and (b)
      freedom from risk is not synonymous with preparation for
      life (Catalano, Hawkins, Berglund, Pollard, & Arthur,
      2002; Pittman, Irby, Tolman, Yohalem, & Ferber, 2001).
      The APA Presidential Task Force on Prevention: Promot-
      ing Strength, Resilience, and Health in Young People rec-
      ommended that prevention encompass the goals of reduc-
      ing health problems and promoting health and social
      competence (Weissberg, Kumpfer, & Seligman, 2003).

      Similarly, empowerment interventions focus on help-
      ing individuals master and maintain control over life situ-
      ations. Inherently, empowerment is concerned with com-
      petencies and strengths (Zimmerman, 1995; Zimmerman,
      Israel, Schulz, & Checkoway, 1992). Advocacy interven-
      tions also have been implemented with populations such as
      adjudicated youth (e.g., E. P. Smith, Wolf, Cantillon,
      Thomas, & Davidson, 2004), and women experiencing
      intimate partner violence (Allen, Bybee, & Sullivan, 2004).
      Finally, participatory action research (PAR) interventions,
      which focus on researcher–participant collaborations and,
      thus, on utilizing strengths and competencies of the partic-
      ipants, have been successfully implemented with diverse
      groups of youth (e.g., Foster-Fishman, Law, Lichty, &
      Aoun, 2010; Jason, Keys, Suarez-Balcazar, Taylor, & Da-
      vis, 2003; L. Smith, Davis, & Bhowmik, 2010). It is
      recommended that PAR be a genuine community–re-
      searcher partnership (i.e., the development of shared goals,
      shared methods, and shared sense of the value of the
      project and the findings) to successfully implement the
      methodology (Trickett, 2011).

      Guideline 4. Psychologists are encouraged to
      incorporate research and evaluation as
      integral to prevention program development
      and implementation, including consideration
      of environmental contexts that impact
      prevention.

      Rationale. Prevention research encompasses
      “theory and practice related to the prevention of social,
      physical, and mental health problems, including etiology,
      methodology, epidemiology, and intervention” (National
      Research Council & Institute of Medicine, 2009, p. xxvii).
      At its best, prevention research addresses multifaceted con-
      texts (biological, psychological, and sociocultural levels)
      and functions (preintervention epidemiology, preventive
      interventions, and preventive service delivery systems; Na-
      tional Institute of Mental Health, 1998). The contexts and
      functions of prevention research can inform each other.
      Problems and their prevention occur at interrelated biolog-
      ical, psychological and sociocultural levels. Epidemiolog-
      ical research can identify targets for preventive interven-
      tions; evaluation of interventions can identify preferred
      approaches that can be incorporated into service delivery
      systems; the effectiveness and efficiency of service deliv-
      ery systems can be assessed by examining their impact on
      epidemiology. At all stages of the research process, the

      dynamic interactions between biological, psychological,
      and sociocultural environments are important to …

      Literature Review

      9

      Running Head: CONCEPT PAPER

      Comment by Ricky Fenwick: Add the title of your research concept paper. A title should be 12 words or less.

      Concept Paper Comment by Ricky Fenwick: Add the title.

      Literature Review

      [The psychological phenomenon is known as “groupthink” happens when a group of people’s drives for uniformity or harmony leads to illogical and unreasonable decision-making. By concealing opposing ideas and separating them from outside influences, group thinking aims to reduce conflict and reach a decision without examining differences in viewpoints. The goals of this paper are to provide a more detailed explanation of “groupthink,” its causes and effects on project management, as well as personal perspectives on the subject(Bang& Frith, .2017).] Comment by Ricky Fenwick: Delete bracket Comment by Ricky Fenwick: delete Comment by Ricky Fenwick: drive Comment by Ricky Fenwick: This is the beginning of your research concept paper. You need to describe a research topic and its significance in this section. This section serves as the Introduction to your research concept paper. Comment by Ricky Fenwick: Add a space after subject Comment by Ricky Fenwick: Delete period Comment by Ricky Fenwick: Delete bracket

      Theoretical Orientation for the Research Concept

      [“I use the term groupthink as a quick and easy way to refer to the mode of thinking that humans participate in when concurrence-seeking becomes so prevalent in a cohesive in-group that it tends to overwhelm rational appraisal of alternative courses of action,” said Irving Janis, an American physiologist. Groupthink is a term similar to those used by George Orwell in his dystopian future of 1984 in his newspeak lexicon. In this context, the term “groupthink” has a derogatory connotation. (Street, .1997.) This impression can be strictly intended because the phrase refers to a decline in mental efficiency, reality checking, and moral judgments due to communal pressures. He referenced the Bay of Pigs catastrophe and the Japanese attack on Pearl Harbor as case studies, claiming that it took decisions due to Groupthink, which prevented alternative viewpoints from being adequately conveyed and assessed. (Esser,2018) Comment by Ricky Fenwick: Delete bracket Comment by Ricky Fenwick: Provide a citation with the year and the page number for the quote. Comment by Ricky Fenwick: Provide a citation with the year. Comment by Ricky Fenwick: Move the period to the end of the citation so that the citation is included as part of the sentence. Comment by Ricky Fenwick: Delete period Comment by Ricky Fenwick: Do not capitalize Comment by Ricky Fenwick: Move the period to the end of the citation so that the citation is included as part of the sentence. Comment by Ricky Fenwick: Add a space after the comma

      Another example is the 1986 Challenger Space Shuttle catastrophe. NASA management and engineers were aware of malfunctioning equipment months before the flight but remained silent to avoid negative publicity. Bias in critical judgments, as history has proven, can have terrible consequences and, in the worst-case scenario, end in people getting killed.] Comment by Ricky Fenwick: indent Comment by Ricky Fenwick: Provide a citation. Comment by Ricky Fenwick: Provide a citation. Comment by Ricky Fenwick: Delete bracket

      Review of the Literature

      [Invulnerability, Rationale, Morality, Stereotypes, Pressure, Self-Censorship, Unanimity, and “Mind guards” are eight symptoms that lead to Groupthink. When group members provide unwarranted certainty and encourage other members to take excessive risks, this is invulnerability. Janis coined the phrase “illusion of invulnerability” to describe how their optimism blinds them to their choices’ obvious hazards. This has the effect of making group members overlook warnings and other forms of negative input that, if taken seriously enough, might cause them to reconsider their decision. The group’s morality can also impact the group’s morality excessive faith in its integrity, allowing them to disregard the moral/ethical ramifications of their decisions. Other opposing groups were stereotyped as weak, dumb, or biased due to their genuine adherence due to trophies. Members who express doubt in the group or question the legitimacy of an alternative option not chosen by the majority are urged to recant to keep the status quo. This leads to self-censorship in the group, with members forced to remain silent and avoid deviating from the group consensus for fear of being harassed and isolated. Because no one wants to say anything, their silence is perceived as acceptance. This anxiety generates a sense of unanimity among the group, which leads to a mistaken assumption about the consensus’ integrity. Unless there is an apparent dispute in the group when a group comes to a consensus position, each member will most likely believe that it must be true. Hence, reliance on consensual rationalization tends to supersede critical thinking ( Mackenzie, .2018). As Janis said, the term “mind guard” alludes to members electing themselves to protect the leader or other members from any dissenting information that would compromise their shared satisfaction with the efficiency and ethics of their previous judgments. Critical thinking is vital to a project team’s effectiveness in a project management setting, and contrasting opinions are beneficial to a project manager since it ensures that can reach a consensus without jeopardizing the team’s integrity.] Comment by Ricky Fenwick: Delete bracket. Comment by Ricky Fenwick: Do not capitalize Comment by Ricky Fenwick: Do not capitalize Comment by Ricky Fenwick: Provide a citation. Comment by Ricky Fenwick: Provide a citation. Comment by Ricky Fenwick: Provide a citation. Comment by Ricky Fenwick: Provide a citation. Comment by Ricky Fenwick: Provide a citation. Comment by Ricky Fenwick: Provide a citation. Comment by Ricky Fenwick: Provide a citation. Comment by Ricky Fenwick: Provide a citation. Comment by Ricky Fenwick: Provide a citation. Comment by Ricky Fenwick: Provide a citation. Comment by Ricky Fenwick: Provide a citation. Comment by Ricky Fenwick: Provide a citation. Comment by Ricky Fenwick: Delete bracket Comment by Ricky Fenwick: You only have one citation in your literature review. The review needs to be expanded to show what is in the literature on groupthink.

      Synthesis of the Research Findings

      A failing project resulting from Groupthink could cost the company millions of dollars in losses and lead to employee termination. Even though Groupthink has excellent intentions, such as greater cooperation, established harmony, and decreased stress levels among group members, the disadvantages far exceed the benefits, with sub-par decision making, projects of poor quality. Long-term relationships potentially wrecked (Pautz & Forrer, .2013).] Comment by Ricky Fenwick: Delete bracket.

      This section is supposed to be a synthesis of the article reviewed in the literature review.

      Critique of Previous Research Methods

      [With the above literature review effort, writers played a critical part in decision-making at many levels. The authors, for example, have expressed concern over how students have been trained to relate to people from various leadership structures. The researchers’ findings aided in developing more promising fair and competent approaches to dealing with difficulties in decision-making for all individuals, independent of status differences. Even though the discoveries were essential to the field of research, some of them supplied little or inaccurate information.] Comment by Ricky Fenwick: Delete bracket Comment by Ricky Fenwick: Provide a citation. Comment by Ricky Fenwick: Provide a citation. Comment by Ricky Fenwick: Provide a citation. Comment by Ricky Fenwick: Delete bracket.

      In this section, you review the different research methods used by researchers reviewed in the literature review.

      Summary

      [Groupthink is a fascinating issue to consider. When decision-making is rushed and organizations turn a blind eye to alternate options, Groupthink is a valuable tool for illustrating the consequences. A project manager’s job in the project management industry is to make sure that the work done on a project’s outcomes matches the expectations of the stakeholders or consumers. (Rose, .2016.) Even though the concept of Groupthink may have good intentions such as improved cooperation, established harmony, and lower stress levels among group members, the disadvantages outweigh the benefits; with sub-par decision making, projects of poor quality, and long-term relationships potentially being ruined, the cons outweigh the benefits.] Comment by Ricky Fenwick: Delete bracket. Comment by Ricky Fenwick: Delete bracket.

      Assignment 2 ends here and goes to References.

      Group thinking principles and fundamentals in organization

      [In layman’s words, Groupthink is the tendency for people in a group to think alike due to peer pressure and a desire to avoid isolation. Individuals’ creativity, originality, and independent thinking are harmed by Groupthink because it forces them to avoid discussing any controversial concerns or matters or even coming up with alternate solutions to a problem. This causes team members to become fragmented, resulting in an “in-group” that believes, with inflated certainty, that the best decision has been made. The “in-group” vastly overestimates its decision-making capabilities while grossly underestimating the capacities of those who do not comply, or the “out-group.”]

      Background

      [Janis’ study project’s significant ideas are to work on group thinking concepts and decision-making skills. Janis described three forerunner reasons to Groupthink in his book Groupthink: Psychological Studies of Policy Decisions and Fiascoes: “High group cohesion,” “Structural flaws,” and “Situational context.” According to Janis, Groupthink is caused by a high level of cohesiveness. It’s no surprise that project teams that aren’t cohesive will make poor decisions; yet they aren’t prone to Groupthink. Structural faults are when a group or team organizes itself in ways that compromise information communication and begin to engage in careless decision-making. This can be further broken down by four criteria: “Insulation of the group”, where inaccurate postulations on matters that the group is dealing with are promoted, leading to flawed solutions to the issue. The “lack of impartial leadership” refers to where leaders completely control the flow of the group discussion by planning what is discussed and the questions that are permitted to be asked. The “lack of “norms requiring methodological procedures” means the lack of a formalized approach for dealing with decision-making tasks. Finally, there is “homogeneity of individuals’ social origins and ideology,” which means that all team members have the same values. Low self-esteem as a result of recent failures can lead to group acceptance for fear of being labeled “weak.” Groupthink can be induced by difficulty in making decisions and time demands where members are more concerned with speed than quality. Finally, moral challenges such as conflicting feelings might lead to group thought in a team.]

      Research Problem

      [He defines group thought as a psychological phenomenon in which members of a group try to reach an agreement. He sees it as a willingness to put aside opinions and personality traits to fit in with the greater group. The groupthink hypothesis is widely regarded as one of the most influential theories in organizational leadership. Members of the decision-making class have been known to build such close bonds that they cannot go against the group’s decisions and agree upon them. Compliance is required regardless of the decision’s impact on the individual. The silence of minority opinions over those of the majority, on the other hand, can have disastrous consequences. It could have catastrophic consequences, such as the abandonment of ethics, the endorsement of destructive policies, and the distortion of reality.]

      Research Question

      [The publication is significant in my research since it is a quantitative study of the phenomenon of group mentality. It is the first work to demonstrate the validity of the concept of Groupthink through the use of qualitative data.]

      Goals and Objectives

      The primary objective of the research is to research the effects of Groupthink being either a positive or a negative force in a business. The article was submitted to the journal of international energy policies and accepted. The author argues that the business environment being what it is today, it is necessary to have a form of Groupthink that will ensure that the organization has effective leadership. In turn, it will follow the leader in the decision they make, thus working as a unit towards attaining the goal. The article is essential in my research because it points towards the critical role that leaders play in the creation of a group mentality (Wagner & Hollenbeck, .2020)

      1. Goal one. to establish groupthink norms that are fundamental strategies to decision making

      2. Goal two. Technological devices possess inherent features and resources that are instrumental in contributing to working as a group but ultimately deciding as an individual

      3. Goal three. Point off decision errors made by leaders

      Population and Sample

      [As such, for any organization to be effectively competitive, then the power to make the big decisions must be left to individuals. Such is the case with some of the largest companies that were dependent upon deciding to ensure they soared. Examples include Facebook with Zuckerberg, Amazon with Jeff Bezos, Microsoft with Bill Gates, and Tesla Motors with Elon Musk. The assertions by Wagner are in line with other arguments that are against Groupthink. Groupthink creates the group’s comfort to fall back on, and as a result, people do not think about the adverse effects of their decisions. It is an argument that will be essential when factoring Groupthink hinders creativity.

      Methodology and Procedures

      Quantitative Research

      N/A

      References

      Bang, D., & Frith, C. D. (2017). Making better decisions in groups. Royal Society open science, 4(8), 170193. https://dx.doi.org/10.1098%2Frsos.170193 Comment by Ricky Fenwick: Place the journal title and Volume number in italics. Capitalize each word in a journal title.

      Esser, J. K. (2018). Alive and well after 25 years: A review of groupthink research
      . Organizational behavior and human decision processes, 73(2-3), 116-141. https://doi.org/10.1006/obhd.1998.2758 Comment by Ricky Fenwick: Remove italics. Comment by Ricky Fenwick: capitalize Comment by Ricky Fenwick: Place the Volume number in italics.

      Mackenzie, K. D. (2018). A theory of group structures: Basic theory. Routledge. Comment by Ricky Fenwick: Place the book title in italics.

      Miranda, S. M. (1994). Avoidance of groupthink: Meeting management using group support systems. Small-Group Research, 25(1), 105-136. https://doi.org/10.1177%2F104649649425100 Comment by Ricky Fenwick: Place the journal title and Volume number in italics.

      Pautz, J. A., & Forrer, D. A. (2013). The dynamics of groupthink: The Cape Coral experience. Journal of International Energy Policy (JIEP), 2(1), 1-14. Comment by Ricky Fenwick: delete

      Rose, J. D. (2016). Diverse perspectives on the Groupthink theory–a literary review. Emerging Leadership Journeys, 4 (1), 37–57.

      Street, M. D. (1997). Groupthink: An examination of theoretical issues, implications, and future research suggestions. Small-Group Research, 28(1), 72-93. https://doi.org/10.1177%2F1046496497281003 Comment by Ricky Fenwick: Place the journal title and Volume number in italics.

      Wagner, J. A., & Hollenbeck, J. R. (2020). Organizational behavior: Securing competitive advantage. Routledge. Comment by Ricky Fenwick: Make the first line flush with the left margin. Comment by Ricky Fenwick: Place the book title in italics.

      Literature Review

      Guidelines for Prevention in Psychology. (2014). American Psychologist, 69(3), 285–296. https://doi.org/10.1037/a0034569.

      Hage, S. M., Romano, J. L., Conyne, R. K., Kenny, M., Schwartz, J. P., & Waldo, M. (2007). Walking the talk: Implementing the prevention guidelines and transforming the profession of psychology. The Counseling Psychologist, 35(4), 594-604. doi:10.1177/0011000006297158.

      Rivera-Mosquera, E., Dowd, E. T., & Mitchell-Blanks, M. (2007). Prevention activities in professional psychology: A reaction to the prevention guidelines. The Counseling Psychologist, 35(4), 586-593. doi:10.1177/0011000006296160.

      Ryder, A. G., Ban, L. M., & Chentsova-Dutton, Y. E. (2011). Towards a cultural-clinical psychology. Social & Personality Psychology Compass, 5(12), 960-975. doi:10.1111/j.1751-9004.2011.00404.x

      Literature Review

       For this specific assignment, you are to synthesize the research you found for the Week 4 Annotated Bibliography assignment. Do not simply copy the annotations you did for the Week 4 assignment; that is not a literature review. Rather, you are to review and synthesize the research you have found into a cohesive discussion on your selected topic. 

      Literature Review

      See Ryder, Ban, & Chentsova-Dutton (2011) “Towards a Cultural-Clinical Psychology,” American Psychological Association (2014) “Guidelines for Prevention in Psychology,” Hage, et al. (2007) “Walking the Talk: Implementing the Prevention Guidelines and Transforming the Profession of Psychology,” and Rivera-Mosquera, et al. (2007) “Prevention Activities in Professional Psychology: A Reaction to the Prevention Guidelines” articles all attached.Clinical and counseling psychology is a dynamic field that is constantly evolving and striving toward better treatment options and modalities. In this literature review, explore and integrate psychological research into a literature review, addressing current trends in three major areas of clinical and counseling psychology: assessment, clinical work, and prevention.In the review, include the following headings, and address the required content.(1)Assessment:Support this section with information from the Ryder et al. (2011) article “Towards a Cultural-Clinical Psychology” and at least one additional scholarly peer-reviewed article(a)Compare the assessments currently in use by clinical and counseling psychologists(b)Explain the trend towards cultural-clinical psychology and the suitability of clinical assessments with diverse clients(2)Clinical work:Support this section using a minimum of three scholarly peer-reviewed articles. The recommended articles attached may be useful in generating the response in addition to the three scholarly peer-reviewed articles(a)Compare and contrast technical eclecticism, assimilative integration and theoretical integration(b)Provide a historical context and identify the major theorists for each perspective(c)Assess the trends in psychotherapy integration(d)List three pros and cons for each perspective, sharing which perspective most closely aligns with your own(e)Analyze the major trends in psychology and explain the connection between evidenced-based practices and psychotherapy integration(3)Prevention:Review the “Guidelines for Prevention in Psychology” (American Psychological Association, 2014), and support this section with information from the Hage, et al. (2007) “Walking the Talk: Implementing the Prevention Guidelines and Transforming the Profession of Psychology,” and Rivera-Mosquera, et al. (2007) “Prevention Activities in Professional Psychology: A Reaction to the Prevention Guidelines” articles(a)Describe general prevention strategies implemented by clinical and counseling psychologists at the micro, meso, exo, and macro levels?

      Literature Review

      Prevention Activities in Professional Psychology:
      A Reaction to the Prevention Guidelines

      Evelyn Rivera-Mosquera
      Department of Mental Health, Columbus, Ohio

      E. Thomas Dowd
      Kent State University

      Marsha Mitchell-Blanks
      Cleveland State University

      In this reaction article, the authors provide a historical context for prevention activi-
      ties and their place in psychological practice. They then discuss the prevention guide-
      lines in the Major Contribution authored by S. M. Hage et al. (2007 [this issue]) and
      provide their critique. Finally, the authors offer ideas for the future specific applica-
      tions of these general guidelines and illustrate with a case example.

      Hage et al. (2007 [this issue]) are to be commended for their compre-
      hensive, thorough, and thoughtful contribution. They have managed to pull
      together the relevant literature regarding prevention efforts and its support-
      ing research, as well as organize this work into a set of aspirational guide-
      lines. The scope of their efforts is truly impressive—a scope that has its
      own problems as well as its obvious successes. This response will first pro-
      vide a brief historical context for prevention activities, and then provide a
      general response to these guidelines. We will conclude with ideas of our
      own for future applications of these guidelines and prevention in general.

      HISTORICAL OVERVIEW OF PREVENTION

      Hage et al. (2007) correctly state that prevention activities have histor-
      ically been an important aspect of the practice of counseling psychology
      (p. 497). This is consonant with counseling psychology’s developmental
      approach to mental health as compared with the more remedial approach of
      clinical psychology and the more case management approach of social work.
      Community psychology as a professiponal psychological specialty was

      Correspondence concerning this article should be addressed to Evelyn Rivera-Mosquera,
      Minority Behavioral Health Group, 1293 Copley Road, Akron, OH 44320; e-mail: rivera-mosquera
      @sbcglobal.net.

      THE COUNSELING PSYCHOLOGIST, Vol. 35, No. 4, July 2007 586-593
      DOI: 10.1177/0011000006296160
      © 2007 by the Division of Counseling Psychology

      586

      Rivera-Mosquera et al. / PREVENTION GUIDELINES 587

      originally intended to focus more on prevention (and ironically consists pri-
      marily of clinical psychologists), but it has never had the impact its
      founders envisioned. Although prevention has been an important part of
      counseling psychology since its early years, the authors note the paradoxi-
      cal finding that despite a growing interest in prevention, counseling psy-
      chologists’ actual prevention activities are quite limited (Hage et al., 2007,
      p. 498). The reasons, we suspect, are largely economic. The field of mental
      health, like that of physical health to which status it has consistently aspired,
      is now and always has been remedial in orientation. There is little money to
      be made in prevention, and during the 1970s and 1980s counseling psy-
      chology attempted to play “catch-up” to clinical psychology in obtaining
      third-party reimbursements for its services to individuals. Third-party pay-
      ers in both medicine and psychotherapy typically do not pay for prevention,
      although in the long run it is cheaper than remediation. Therefore, advo-
      cating for preventive mental/physical health activities is likely to be a hard
      sell indeed, especially given the comprehensive, multiple causal factors,
      contexts, and domains to which Hage et al. argue we should devote our
      efforts (p. 529).

      REACTION TO THE GUIDELINES

      Overall, the guidelines appear to be well grounded in research, and the
      authors do a superb job of building their case for prevention. They demon-
      strate how the development of these guidelines evolved over time and were
      based in sound research as well as systemically discussed by key stake-
      holders before they were promulgated. This process gives the guidelines
      much more credence and potential for acceptance by the entire psycholog-
      ical community. The authors have taken a complex and convoluted area of
      practice/research and narrowed it down to guidelines that can help psy-
      chologists conceptually organize how they might best begin to engage in
      prevention work. While the guidelines are phrased in very cautious lan-
      guage that may make them more politically acceptable in some quarters,
      they may also fail to provide forceful guidance for significant change in the
      practice of psychology.

      The authors’ categorization of the guidelines into four conceptual areas
      (practice, research and evaluation, education and training, and social and
      political advocacy) is critical because it sets up the conceptual framework
      for the areas in which psychologists should be engaging in order to do
      prevention (Hage et al., 2007, p. 501). These domains will be discussed in
      more detail in the following sections.

      Practice

      The practice guidelines set the broad overarching guidelines for the
      practice of prevention. Guidelines 1–5 describe the basic elements neces-
      sary for the practice of prevention. Hage et al. (2007) use this section to call
      for psychologists to actively engage in the practice by (a) developing pro-
      active programs that prevent human suffering; (b) basing prevention pro-
      grams in empirical research; (c) using culturally relevant prevention
      practices as well as engaging key stakeholders in all levels of the planning
      and implementation process; (d) addressing both individual and social con-
      textual factors; and (e) focusing on both reducing risks and promoting the
      strengths of the targeted groups (pp. 501-519). These best practices build upon
      the general principle of justice and respect for people’s rights and dignity
      (Hage et al., 2007, p. 495). We agree that these should be the core compo-
      nents in the practice of prevention, and are especially pleased that cultur-
      ally relevant prevention was included as one of the top three guidelines. It
      is critical that programs targeting marginalized groups such as ethnic
      minorities, the hearing impaired, Appalachian, lesbian/gay/bisexual/trans-
      gender, and other cultural groups adapt their programs to meet the cultural
      and linguistic needs of the population as well as involve the stakeholders
      from these communities at all levels of the planning and implementation
      process (Reese & Vera, 2007).

      Research and Evaluation

      This domain (Guidelines 6–9) was the most difficult for us to “wrap our
      heads around” conceptually; in part, this may be because of the sheer com-
      plexity of prevention literature. Although the term prevention science was
      coined at a National Institute of Mental Health prevention conference in 1991,
      it does not appear to have infiltrated the field of psychology to its fullest extent.
      Thus, psychologists may not be as familiar with the field as other disciplines
      such as public health and social work (Hage et al., 2007, pp. 519-533).
      Undoubtedly, the field of psychology needs to actively engage in prevention
      efforts that are accurately targeted, efficiently executed, rigorously evaluated
      and that focus on the systemic empirical study of risk and protective factors
      impacting health and psychological dysfunction (Bloom, 1996).

      We liked the authors’ use of the National Institute of Mental Health’s cate-
      gorization of prevention research that classifies prevention research into three
      functions (preintervention epidemiology, preventive intervention [primary,
      secondary, and terciary], and prevention service delivery system) and three
      levels (biological, psychological, and sociocultural; Hage et al., 2007, p. 520).
      This classification matrix can guide prevention researchers toward literature

      588 THE COUNSELING PSYCHOLOGIST / July 2007

      they need to examine prior to conducting their studies, as well as help them
      identify future directions for research based on their findings (Waldo &
      Schwartz, 2003).

      We agree wholeheartedly with Guideline 7 that calls for psychologists to
      be competent in a variety of cross-disciplinary research methods, both quali-
      tative and quantitative. We want to point out that the potential number of con-
      textual variables and the possible interaction effects that Guideline 8 alludes
      to, which may occur in prevention research, are truly mind-boggling.
      Guideline 9 (ethical issues) is very important and perhaps deserves a domain
      of its own because prevention research can be fraught with ethical dilemmas.

      Education and Training

      This domain (Guidelines 11 and 12), in our estimation, is one of the
      most important sections because psychologists must be educated early in
      their training on the how and why to engage in prevention and social jus-
      tice issues, if they are to do so later in their careers. The guidelines appear
      to be geared toward psychologists who have completed their PhD training
      rather than current PhD students. We would like to see prevention theory,
      research, and practice worked into the curriculum of every psychology stu-
      dent at all levels (BA, MA, PhD, and PsyD) in order to prepare future psy-
      chologists in the prevention field, much like social work has done in the
      National Association of Social Workers’ policy statement on mental health
      (National Association of Social Workers, 2003–2006). This prevention
      training should seek to expand psychologists’ repertoire of skills to include
      cross-disciplinary training in advocacy, grant writing, program develop-
      ment, and grassroots community involvement needed by psychologists
      to perform prevention work (Bluestein, Goodyear, Perry, & Cypers, 2005).
      It could also include training on the ecological prevention approach
      espoused by the field of social work (Kriste-Ashman, 2000).

      SOCIAL AND POLITICAL ADVOCACY

      This domain is made up of Guidelines 13–15, which are equally as criti-
      cal because they call for psychologists to step out of their traditional roles
      and engage in political processes in order to improve the world in which
      they live. Many decisions affecting physical/mental health care are made on
      the basis of political considerations, rather than on scientific or educational
      merit. Whether because of insecurity, disinterest, or disdain, it is tempting
      for psychologists to leave this work to others, not recognizing that psychol-
      ogists are the experts in behavior change. The skills psychologists possess

      Rivera-Mosquera et al. / PREVENTION GUIDELINES 589

      could be applied to any arena in which behavior change is warranted,
      including but not limited to the political process as well as the more traditional
      areas of schools, health care, violence prevention, and so forth. Psychologists
      need to become part of solving these serious social problems facing our
      country and world (Albee, 1986). Unfortunately, these are exactly the areas
      in which our efforts may be most controversial and, thus, uncomfortable for
      our profession.

      WHERE DO WE GO FROM HERE?

      Although these guidelines provide an overarching set of best practices,
      they fall short in that they do not provide the necessary information for
      “how to” do this work. These guidelines are broadly stated and therefore
      may not provide the direction or structure a psychologist may need in order
      to become competent in prevention work. Nevertheless, the guidelines
      serve as the springboard for further investigation into how the field of psy-
      chology will actually train, cultivate, and develop psychologists who will
      engage in proactive, socially just prevention work.

      The choice to have a clinical and a counseling psychologist as well as a
      social worker respond to this article was purposeful. Clearly, each of us
      brings a unique experience and set of skills that are needed to begin to address
      the serious societal problems facing our country and our world. We must
      work together as professional disciplines, sharing our skill sets, lessons
      learned, and methodology to bring about real social change. As eloquently
      argued by Hage et al. (2007), prevention work needs to be at the forefront
      of a comprehensive mental health agenda (p. 494). We would argue, however,
      that the term prevention may need to be expanded in order for this to occur.
      Prevention is often juxtaposed with remediation, as if they were dichotomous
      constructs. It is our premise that prevention and remediation lie on a continuum,
      with group-based interventions occupying a space somewhere in between.

      We would argue that prevention should be viewed as one of the tools on
      the continuum of therapeutic/treatment services and that the paradigm shift
      should consist of the acknowledgement that some of what we are labeling
      as prevention could actually be considered therapeutic interventions that
      are empirically based, well grounded in theory, and developed from a thor-
      ough assessment of need (Nation et al., 2003). For example, the first author
      (a clinical psychologist), along with her training director and fellow coun-
      seling psychology interns, while on their American Psychological Association
      internship at the University of Akron’s Testing and Career Center, developed
      a grassroots career and college preparation program called Latinos on the
      Path to Higher Education (Rivera-Mosquera, Phillips, Castelano, Martin, &

      590 THE COUNSELING PSYCHOLOGIST / July 2007

      Mowry, 2007). The goals of the program were to reduce the dropout rate
      and improve the college entrance of Latino youths—both serious societal
      problems facing the United States. The interns, utilized the first author’s
      strong clinical assessment and treatment skills, in addition to the counsel-
      ing psychology interns strong career development and educational preven-
      tion skills, to design and implement the program in a local Hispanic church.
      Most of the students recruited for this program could have been treated
      individually by any number of disciplines within psychology in an office
      environment, and the therapist could have secured third-party payment
      based on issues of learning/academic difficulties. The difference was that
      insurance covered interventions provided under the individual remedial
      model and not under the prevention model. It is our premise that prevention
      programs that are grounded on clinical and counseling theories of psycho-
      logical behavioral change are actually psychotherapeutic in nature and,
      thus, should be called psychotherapeutic prevention programs that could be
      reimbursed as treatment interventions by third-party payers.

      The question then becomes: How do psychotherapeutic prevention pro-
      grams differ from group therapy? The goal of group therapy is, of course,
      for the group process to facilitate behavior change in the individuals in that
      group. This is also true for psychotherapeutic prevention. Perhaps the pri-
      mary difference is the targeted audience. Psychotherapeutic prevention pro-
      grams are generally larger in scope, may address more issues simultaneously,
      and usually reach a larger audience. We propose that well-researched and
      well-designed psychotherapeutic prevention programs be viewed as a form of
      group therapy and, thus, be considered as psychological treatment interven-
      tions. Viewing prevention as a treatment tool opens the doors for innovative
      programs to be developed and funded that may not only prevent symptoms
      from developing in targeted populations but could also provide a group ther-
      apeutic process to change behavior on a larger scale.

      There are several skills that psychologists will need to develop in order to
      conduct prevention work, particularly when working with difficult-to-reach
      communities such as ethnic minorities. First and foremost, psychologists
      need to develop a strong personal relationship with the targeted community.
      The success of the Latinos on the Path to Higher Education program was
      based primarily on the quality of the relationship between the first author and
      the community. We recommend that psychologists and other mental health
      providers go out into the community and cultivate these essential relation-
      ships of trust early on in their training so that the stage will be set for program
      development later. Professors and students must venture out of the “ivory
      towers” and into the community (churches, mental health clinics, and social
      service agencies) to explore and experience the social environment and issues
      surrounding them. Ethically, psychologists should not develop prevention

      Rivera-Mosquera et al. / PREVENTION GUIDELINES 591

      programs if they have not ever ventured into or experienced firsthand the
      community in which they plan to research or work.

      In addition to developing a trusting relationship, psychologists will also
      need to cultivate a number of other skills such as advocacy, program develop-
      ment, grant writing, cultural competence/cultural humility, social justice, and
      qualitative and quantitative evaluation skills—just to name a few (Romano &
      Hage, 2000). Unfortunately, these skills are not necessarily taught in tradi-
      tional psychology programs, not even at the doctoral level. Psychology pro-
      grams should embrace a cross-disciplinary model and allow students to take
      courses in other fields that focus on systemic change and/or advocacy such as
      social work, public health, nursing, anthropology, and forth. Training models
      such as the one used in the Latinos on the Path to Higher Education program
      could be readily taught and integrated into doctoral training programs. The
      program benefited all of those involved because the youths and their parents
      obtained a set of self-efficacy skills, and the interns had an enriched training
      experience that enhanced their skills in the area of community engagement,
      outreach, advocacy, and cultural competence. In addition, models of training
      such as the two pedagogical strategies (service learning and problem-based
      learning), which Hage et al. (2007) discuss in their article, could be quite
      effective in teaching psychotherapeutic prevention models in psychology
      courses (p. 539). The authors even include a mock syllabus for one of the
      strategies, making it easier for instructors to develop a prevention course.
      Throughout their article, Hage et al. offer practical advice and exposure to
      practical prevention research, which can be quite useful to psychologists
      seeking to engage in prevention work.

      CONCLUSION

      Hage et al. (2007) have provided a valuable service to the field of psychol-
      ogy by providing a set of guidelines that can be used as a springboard for fur-
      ther research and development in the field of prevention. Undoubtedly, an
      increased emphasis on prevention will require that the field cultivate psychol-
      ogists who are community-oriented and committed to social justice as well as
      to political advocacy so that psychotherapeutic prevention programs may
      flourish. Students of psychology must be exposed to important issues faced by
      American society early in their training. Practical experiences with marginal-
      ized individuals such as ethnic and cultural minorities, the hearing impaired,
      lesbian/gay/bisexual/transgender groups, and others are needed so that stu-
      dents can begin their training on psychotherapeutic prevention development
      and programming. Psychology students should first understand and acquiesce
      to the social justice model as well as develop an empathic connection with the

      592 THE COUNSELING PSYCHOLOGIST / July 2007

      Rivera-Mosquera et al. / PREVENTION GUIDELINES 593

      movement of marginalized groups or affected societal segments before they
      can effectively develop, plan for, and engage in psychotherapeutic prevention
      work. Psychology students also need to volunteer and become active in the tar-
      geted group in order to develop a strong relationship of trust with that com-
      munity. This relationship is the cornerstone for the effective delivery of
      prevention work. Psychology departments, as well as placement and intern-
      ship sites, must make a concerted effort to not only integrate prevention into
      their curriculums but also to help students connect to and engage in experien-
      tial learning in the targeted communities. In addition, psychologists need to
      become active and lobby for the funding of psychotherapeutic prevention pro-
      grams as treatment interventions. Fortunately, the President’s New Freedom
      Commission, which President George W. Bush established in 2002, seems to
      be leading the charge for establishing prevention as a viable treatment tool in
      the arena of mental health. This prevention-focused paradigm shift may have
      finally begun to take root.

      REFERENCES

      Albee, G. W. (1986). Toward a just society: Lessons from observations on the primary pre-
      vention of psychopathology. American Psychologist, 41, 891-898.

      Bloom, M. (1996). Primary prevention practices. Thousand Oaks, CA: Sage.
      Blustein, D. L., Goodyear, R. K., Perry, J. C., & Cypers, S. (2005). The shifting sands of coun-

      seling psychology programs’ institutional contexts: An environmental scan and revitaliz-
      ing strategies. The Counseling Psychologist, 33, 610-634.

      Hage, S. M., Romano, J. L., Conyne, R. K., Kenny, M., Matthews, C., Schwartz, J. P., &
      Waldo, M. (2007). Best practice guidelines on prevention practice, research, training, and
      social advocacy for psychologists. The Counseling Psychologist, 35, 493-566.

      Kirst-Ashman, K. (2000). Human behavior, communities, organizations and groups in the macro
      environment (pp. 19-25). Belmont, CA: Brooks/Cole.

      Nation, M., Crusto, C., Wandersman, A., Kumpfer, K., Seybolt, D., Morrissey-Kane, E., &
      Davino, K. (2003). What works in prevention: Principles and effective prevention pro-
      grams. American Psychologist, 58, 449-546.

      National Association of Social Workers. (2003–2006). Social work speaks. Washington, DC:
      Author.

      Reese, L., & Vera, E. M. (in press). Culturally relevant prevention: Scientific and practical
      considerations of community-based programs. The Counseling Psychologist, 35.

      Rivera-Mosquera, E. T., Phillips, J., Castelano, P., Martin, J., & Mowry, E. (in press). Design
      and implementation of a grassroots pre-college program for Latino youth. The Counseling
      Psychologist, 35.

      Romano, J. L., & Hage, S. M. (2000). Prevention and counseling psychology: Revitalizing
      commitments to the 21st century. The Counseling Psychologist, 28, 733-763.

      Waldo, M., & Schwartz, J. P. (2003, August). Research competencies in prevention. Paper pre-
      sented at the Prevention Competencies Symposium at the 111th Annual Convention of the
      American Psychological Association, Toronto, Ontario, Canada.

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      /DAN …

      Literature Review

      O R I G I N A L R E S E A R C H

      Effects Of Modified Mindfulness-Based Stress

      Reduction (MBSR) On The Psychological Health

      Of Adolescents With Subthreshold Depression:

      A Randomized Controlled Trial
      This article was published in the following Dove Press journal:

      Neuropsychiatric Disease and Treatment

      Jia-Yuan Zhang
      1,
      *

      Xiang-Zi Ji
      2,
      *

      Li-Na Meng
      1

      Yun-Jiang Cai
      1

      1Department of Psychological Nursing

      Science, Harbin Medical University,

      Daqing, Heilongjiang Province, People’s
      Republic of China; 2Department of

      Nursing Science, Suzhou Vocational

      Health College, Suzhou, Jiangsu Province,

      People’s Republic of China

      *These authors contributed equally to

      this work

      Background: Sub-threshold depression (SD) has been associated with impairments in

      adolescent health which increase the rate of major depression. Researchers have shown the

      effectiveness of mindfulness on mental health, however whether the traditional mindful skills

      were suitable for youngsters, it was not clear. This study investigated the effects of a tailed

      Mindfulness-based stress reduction (MBSR) on their psychological state.

      Methods: A double-blind, randomized controlled trial was carried out. 56 participants who

      met the inclusion criteria agreed to be arranged randomly to either the MBSR group (n=28)

      or the control group (n=28). Participants in MBSR group received a tailored 8-week, one

      time per week, one hour each time group intervention. The effectiveness of intervention was

      measured using validated scales, which including BDI-II, MAAS, RRS at three times (T1-

      before intervention; T2-after intervention; T3-three months after intervention). A repeated-

      measures analysis of variance model was used to analyze the data.

      Results: The results showed significant improvements in MBSR group comparing with

      control group that depression level decreased after the 8-week intervention and the follow up

      (F =17.721, p < 0.00). At the same time, RRS score was significantly decreased at T2 and T3

      (F= 28.277, p < 0.00). The results also showed that MBSR promoted the level of mind-

      fulness and the effect persisted for three months after intervention (F=13.489, p < 0.00).

      Conclusion: A tailored MBSR intervention has positive effects on psychology health

      among SD youngsters, including decrease depression and rumination level, cultivate

      mindfulness.

      Keywords: mindfulness, adolescent, subthreshold depression

      Introduction
      Subthreshold depression (SD), also known as subsyndromal depression, subclinical

      depression, or mild depression, refers to a state or a subpopulation of individuals

      who have certain depressive symptoms but do not meet the diagnostic criteria for

      major depressive disorder.1 A previous study found that the incidence of subthres-

      hold depression was significantly higher than that of major depressive disorders,

      with an estimated prevalence rate of 25% worldwide, and it had a serious impact on

      individual life and social psychological function.2 However, there is little agree-

      ment on how to address the diagnosis of subthreshold depression; modern classi-

      fication systems such as the Diagnostic and Statistical Manual of Mental Disorders,

      Correspondence: Li-Na Meng; Yun-Jiang Cai
      Department of Psychological Nursing
      Science, Harbin Medical University, No. 39
      XinYang Street, Daqing, Heilongjiang
      Province 163319, People’s Republic of China
      Email 2935855397@qq.com;
      2622340324@qq.com

      Neuropsychiatric Disease and Treatment Dovepress
      open access to scientific and medical research

      Open Access Full Text Article

      submit your manuscript | www.dovepress.com Neuropsychiatric Disease and Treatment 2019:15 2695–2704 2695
      DovePress © 2019 Zhang et al. This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.

      php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the
      work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For
      permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php).

      http://doi.org/10.2147/NDT.S216401

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      Fourth Edition (DSM-IV) have established diagnostic

      categories for subsyndromal depressive symptoms, includ-

      ing “dysthymia,” “brief recurrent depression,” and “minor

      depressive disorder”.3 Subthreshold depression is consid-

      ered to be the precurative stage of major depressive dis-

      order and can predict the occurrence of major depressive

      disorder in individuals in the future. It should be made

      clear that it is increasingly recognized that individuals with

      subthreshold depression do not have a similar prognosis to

      those who are asymptomatic, and are in fact at elevated

      risks of later depression and suicidal behaviors.4

      Individuals with subthreshold depression have an odds

      ratio of more than 5 for having a first lifetime episode of

      major depression disorder.5 Meanwhile, subthreshold

      depression has also increased the risk of adverse outcomes

      such as drug abuse and dependence. In recent years, the

      incidence of subthreshold depression in adolescents has

      grown rapidly and as high as 36.56%.2 There are adoles-

      cents with subthreshold depression who have not yet met

      the diagnostic criteria for depression, but subthreshold

      depression has caused a decline in their social function

      and has placed them at a higher risk of experiencing

      depressive episodes, which should be highly concerning.6

      However, there are limited studies focus on investigating

      an effective and feasible way to help adolescents with

      subthreshold depression improve their psychological

      health.

      Mindfulness, derived from Buddhist meditation, is

      described as a state of being purposeful and giving non-

      judgemental attention to the present moment. Its core

      elements are “the ability to focus on the present” and

      “keep a curious, open and receptive attitude”.7

      Mindfulness intervention is a psychological treatment,

      which refers to a series of psychological training methods

      based on “mindfulness,” that can help individuals cultivate

      and enhance mindfulness. In the late 1970s, American

      psychologist Kabat-Zinn introduced and developed mind-

      fulness-based stress reduction (MBSR) psychotherapy,

      which was praised as “the third wave of behavioral and

      cognitive therapy”.8 MBSR is a systematic non-drug psy-

      chological therapy that includes four basic mindfulness

      skills. Through mindfulness meditations, body awareness

      and yoga, MBSR can awaken inner mindfulness and

      improve self-regulation to help people relieve stress. At

      present, MBSR has been widely used in medical treatment

      and has become an important part of the biopsychosocial

      approach medical system to promote psychology and phy-

      sical health.9 Studies have shown that MBSR can alleviate

      anxiety and depression among cancer patients.10,11

      A recent meta-analysis showed that yoga-based interven-

      tions, including mindfulness practice, had significant ben-

      eficial effects for pregnant women with mild depressive

      symptoms.12 However, due to differences in cultural and

      religious beliefs and economic levels, whether MBSR is

      suitable for the Chinese adolescent population needs

      further investigation.

      Mindfulness therapy includes formal and informal tech-

      niques. The traditional form of mindfulness-based stress

      reduction therapy is group intervention. Each group is lim-

      ited to approximately 30 people with 8 practice times of 2

      to 2.5 hrs each.13 However, due to time constraints or hard-

      to-grasp core skills, many people suspend or quit psycho-

      logical treatment. For adolescents, due to their immature

      psychological adjustment mechanism, it is difficult for them

      to grasp the core of mindfulness skills related to meditation

      in a short amount of time.14 The best way to perform

      psychological intervention is to allow adolescents to apply

      the techniques to their life and integrate them into their life

      over time, thus improving their psychological health. Fewer

      studies have focused on the longitudinal effects of mind-

      fulness skills on adolescents in China.15 Therefore, a tai-

      lored MBSR programme for adolescents with rigorous and

      well-controlled randomized trials is needed to further test

      the long-term effects of modified MBSR on the psycholo-

      gical health of adolescents.

      This study was designed to evaluate the effects of a

      tailored simplified MBSR on the psychological health of

      adolescents with subthreshold depression, including

      depression levels, rumination and mindfulness levels, in

      a randomized controlled trial. We hypothesized that mod-

      ified MBSR training would provide evidence for improv-

      ing psychological health, thus decreasing depression and

      rumination levels and increasing mindfulness in Chinese

      adolescents with subthreshold depression.

      Methods
      Study Design
      This study was a randomized controlled design with dou-

      ble-blind subjects. All participants were divided equally

      into the MBSR training group and the control group using

      the random number table by staff members who were

      independent from the study. All participants received the

      anonymous letters and they were blinded to their random

      assignment until the end of the session. When the study

      was completed, the control group received the same

      Zhang et al Dovepress

      submit your manuscript | www.dovepress.com

      DovePress
      Neuropsychiatric Disease and Treatment 2019:152696

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      intervention according to their own wishes. The interven-

      tion was conducted at the psychological interview room

      carried out by a qualified psychologist. The anonymous

      data were collected and analyzed by an assistant who was

      blinded to the group assignment and all the trials. The

      design of the entire study is illustrated in a flow diagram

      in Figure 1.

      Sample And Setting
      The sample-size estimation in this study was calculated by

      using the G*POWER version 3.1 program with a power

      (1−β) of 0.80 in the paired-samples t-test and a signifi-

      cance level of 0.05. Based on the related data,16 we estab-

      lished an effect size (d) of 0.796; consequently, the total

      sample size was 52 participants. Allowing for a 5–10%

      dropout rate, we recruited 56 students in September 2017.

      Participants were enrolled by putting up a poster on cam-

      pus. We used two steps to recruit the participants. First, all

      of the interested students completed questionnaires (Beck

      depression inventory, BDI and self-rating depression scale,

      SDS). Participants who had a BDI>14 and an SDS>53

      were defined as the preliminary screening group. Second,

      the structured clinical interview for DSM (SCID) was

      conducted among the preliminary screening group by a

      psychologist to perform the second screening. The exclu-

      sion criteria were as follows: i) had recently suffered from

      major stress events; and/or ii) had major depressive dis-

      order, bipolar disorder or other types of mental illnesses. A

      total of 291 students agreed to participate in the study, and

      in the end, the study included 56 participants who met the

      following inclusion criteria: i) volunteered for this study

      and agreed to obey the rules during the intervention and ii)

      had subthreshold symptoms of depression (as defined by

      the questionnaires and structured interviews). Participants

      who had participated in or were participating in similar

      interventions (such as yoga or meditation) were also

      excluded. All participants provided their written consent.

      The study was approved by the institutional review board

      at Harbin Medical University (Daqing) and this trial was

      conducted in accordance with the Declaration of Helsinki.

      Intervention
      The MBSR Intervention Group

      Participants allocated to the MBSR training groups

      received 8 weeks of modified MBSR training. Based on

      traditional MBSR theory, the intervention was tailored

      according to the characteristics of adolescents and empha-

      sized teaching them to apply formal techniques such as

      body scanning, sitting meditation, and mindfulness yoga to

      Figure 1 Study flow diagram: enrollment to analysis.

      Dovepress Zhang et al

      Neuropsychiatric Disease and Treatment 2019:15
      submit your manuscript | www.dovepress.com

      DovePress
      2697

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      all aspects of the practitioner’s life, including experiencing

      the pleasant/sad moments in life, walking, sleeping, eating,

      breathing and exercising to keep the attitude of “mind-

      fulness”. The intervention plan was designed and adminis-

      tered by a qualified psychological expert who has been

      involved in MBSR treatment for 5 years. Participants in

      the MBSR group were divided into 4 groups with 7 people

      per group. Each group received training sessions for 8

      weeks, and the sessions occurred once a week for one

      hour at a time. Each session included 10 mins of free

      talk (feeling about homework), 15 mins of demonstration

      and explanation, 20 mins of practice and guidance, and

      15 mins of group imitation training. Each session was

      followed by homework, which was available for the trai-

      ner to understand the practice situation of each person.

      Combined with daily activity, the themes of the interven-

      tion were derived from “eye”, “ear”, “nose”, “tongue”,

      “body” and “thinking”. More details of each session are

      listed in Table 1.

      The Control Group

      Students in the control group continued with their lives as

      usual. No specific intervention was implemented in the

      control group. To avoid possible overlap (contamination)

      with components of the MBSR programme, the students in

      the control group who planned to attend related associations

      such as yoga clubs during the intervention period (8 weeks)

      were excluded. After completion of the study, each student

      in the control group was provided with the same MBSR

      course according to their own wishes.

      Measures
      Beck Depression Inventory-II (BDI-II)

      The primary outcome was the severity of depressive symp-

      toms assessed with the BDI-II. The scale was a well-

      validated and widely used measure of depression that

      assesses the frequency of depressive symptoms over the

      previous 2 weeks. It consists of 21 items that are rated on a

      4-point scale, with scores ranging from 0 to 63, and cut-off

      points of 0–13, 14–19, 20–28 and 29–63, which represent

      no, mild, moderate and severe levels of depression, respec-

      tively. The scale has been used in the Chinese adolescent

      population, revealing good reliability and validity.17

      Mindful Attention And Awareness Scale (MAAS)

      Participants’ self-reported mindfulness level was measured

      with the MAAS.18 The scale contains 15 items that assess

      the most important characteristics of mindfulness. Items

      are rated on a 6-point scale and scored as (1) almost

      always to (6) almost never, with higher scores reflecting

      a greater mindfulness state. The scale has been tested

      among Chinese college students, revealing good internal

      consistency reliability (α=0.85) and test-retest reliability

      (r=0.54).19

      Ruminative Response Scale (RRS)

      The RRS was compiled by Nolen-Hoeksema and assesses

      the response to depression. It consists of 22 items rated on

      a 4-point scale that are scored as (1) never to (4) very

      often, with scores that ranged from 22 to 88. Higher scores

      represent a greater level of rumination. It has 3 factors:

      symptom rumination, forced thinking and introspection.

      The Chinese version of the Perceived Stress Scale

      (CPSS) was translated by Han20 and has been tested

      among Chinese college students, revealing good internal

      consistency reliability (α = 0.90) and test-retest reliability

      (r=0.68–0.85).

      Procedure
      After approval from the institutional review board and

      ethics committee, we put up a poster on campus for

      recruitment. The modified 8-week MBSR intervention

      was carried out by a qualified psychologist. The question-

      naires were delivered and collected by two staff members

      who were independent of our study. All students com-

      pleted questionnaires at three points. The first point was

      the initial baseline orientation when the MBSR interven-

      tion started, the second point was the end of the 8-week

      intervention, and the last point was 3 months after the

      intervention.

      Statistical Methods
      All data analyses were performed using IBM SPSS 21.0

      (version 21.0, IBM Corp., New York, NY, United States)

      with bilateral inspection by two dependence assistants.

      The continuous variables were assessed by means with

      standard deviations or medians with ranges. Baseline

      data were compared using a t-test or chi-square test

      between the two groups. A repeated-measures analysis of

      variance model was used to directly test the outcomes

      (depression, mindfulness and rumination) between the

      two groups. Statistical significance was set at p<0.05. A

      p value of less than or equal to 0.05 was considered

      statistically significant.

      Zhang et al Dovepress

      submit your manuscript | www.dovepress.com

      DovePress
      Neuropsychiatric Disease and Treatment 2019:152698

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      T
      a
      b
      le

      1
      T
      h
      e
      M
      B
      S
      R
      In
      te
      r
      v
      e
      n
      ti
      o
      n
      G
      ro
      u
      p
      S
      e
      ss
      io
      n
      D
      e
      ta
      il
      s

      W
      e
      e
      k
      -T

      im
      e

      T
      h
      e
      m
      e
      s

      C
      o
      n
      te
      n
      ts

      H
      o
      m
      e
      w
      o
      rk

      M
      a
      in

      P
      ro

      b
      le
      m
      s

      S
      o
      lu
      ti
      o
      n
      s

      1
      -1

      A
      p
      p
      ro
      a
      c
      h
      in
      g

      m
      in
      d
      fu
      ln
      e
      ss

      a
      n
      d
      M
      B
      S
      R

      1
      .
      In
      tr
      o
      d
      u
      c
      e
      e
      a
      c
      h
      o
      th
      e
      r
      a
      n
      d
      b
      e
      c
      o
      m
      e
      fa
      m
      il
      ia
      r
      w
      it
      h
      e
      a
      c
      h
      o
      th
      e
      r.

      2
      .
      S
      te
      p
      in
      to

      a
      n
      d
      c
      u
      lt
      iv
      a
      te

      m
      in
      d
      fu
      ln
      e
      ss
      .

      3
      .
      In
      tr
      o
      d
      u
      c
      e
      M
      B
      S
      R
      a
      n
      d
      th
      e
      fo
      rm

      a
      l
      te
      c
      h
      n
      iq
      u
      e
      s.

      P
      ra
      c
      ti
      c
      e
      m
      in
      d
      fu
      ln
      e
      ss

      b
      re
      a
      th
      in
      g
      e
      v
      e
      r
      y

      d
      ay
      .

      A
      b
      se
      n
      t-
      m
      in
      d
      e
      d

      N
      e
      v
      e
      r
      m
      in
      d
      th
      e
      d
      is
      tr
      a
      c
      ti
      o
      n
      s
      a
      t
      th
      e

      b
      e
      g
      in
      n
      in
      g
      o
      f
      th
      e
      p
      ra
      c
      ti
      c
      e
      .
      L
      e
      t
      it
      b
      e
      .

      2
      -2

      E
      y
      e

      m
      in
      d
      fu
      ln
      e
      ss

      1
      .
      E
      x
      p
      la
      in

      th
      e
      c
      o
      re

      o
      f
      o
      b
      se
      r
      v
      in
      g
      m
      in
      d
      fu
      ln
      e
      ss

      a
      n
      d
      te
      a
      c
      h
      th
      e

      sk
      il
      ls
      to

      b
      e
      m
      in
      d
      fu
      ln
      e
      ss
      .

      2
      .
      T
      e
      a
      c
      h
      h
      o
      w

      to
      fo
      c
      u
      s
      o
      n
      o
      n
      e
      ’s
      m
      in
      d
      o
      n
      th
      e
      m
      o
      m
      e
      n
      t
      a
      n
      d

      w
      it
      h
      o
      u
      t
      ju
      d
      g
      e
      m
      e
      n
      t

      P
      ic
      k
      o
      n
      e
      p
      ic
      tu
      re

      to
      o
      b
      se
      r
      v
      e
      w
      it
      h

      m
      in
      d
      fu
      ln
      e
      ss

      a
      n
      d
      re
      c
      o
      rd

      y
      o
      u
      r
      fe
      e
      li
      n
      g
      s.

      In
      te
      rr
      u
      p
      te
      d

      N
      o
      ju
      d
      g
      e
      m
      e
      n
      t
      a
      n
      d
      n
      o
      a
      n
      x
      ie
      ty
      .
      D
      o
      y
      o
      u
      r

      b
      e
      st
      .

      3
      -3

      E
      a
      r

      m
      in
      d
      fu
      ln
      e
      ss

      1
      .
      E
      x
      p
      la
      in

      th
      e
      m
      e
      a
      n
      in
      g
      o
      f
      so
      u
      n
      d
      m
      in
      d
      fu
      ln
      e
      ss
      .

      2
      .
      L
      e
      a
      d
      th
      e
      te
      a
      m

      fo
      r
      h
      e
      a
      ri
      n
      g
      tr
      a
      in
      in
      g
      ,
      fe
      e
      li
      n
      g
      a
      ro
      u
      n
      d
      so
      u
      n
      d

      th
      ro
      u
      g
      h
      th
      e
      w
      av
      e
      s
      la
      p
      p
      in
      g
      ,
      d
      is
      ti
      n
      g
      u
      is
      h
      in
      g
      so
      u
      n
      d
      a
      n
      d
      so

      o
      n
      to

      g
      e
      t
      p
      h
      y
      si
      c
      a
      l
      a
      n
      d
      m
      e
      n
      ta
      l
      re
      la
      x
      a
      ti
      o
      n
      .

      3
      .
      A
      t
      th
      e
      sa
      m
      e
      ti
      m
      e
      ,
      le
      a
      rn

      h
      o
      w

      to
      e
      x
      p
      e
      ri
      e
      n
      c
      e
      th
      e
      c
      h
      a
      n
      g
      e
      s

      w
      it
      h
      th
      e
      so
      u
      n
      d
      s.

      C
      h
      o
      o
      se

      a
      g
      e
      n
      tl
      e
      so
      n
      g
      to

      li
      st
      e
      n
      w
      it
      h

      m
      in
      d
      fu
      ln
      e
      ss

      a
      n
      d
      re
      c
      o
      rd

      y
      o
      u
      r
      fe
      e
      li
      n
      g
      s.

      S
      n
      e
      a
      k
      o
      ff

      T
      r
      y
      in
      g
      to

      fo
      c
      u
      s
      y
      o
      u
      r
      m
      in
      d
      o
      n
      th
      e
      p
      re
      se
      n
      t

      m
      o
      m
      e
      n
      t;
      if
      y
      o
      u
      c
      a
      n
      n
      o
      t,
      le
      t
      it
      b
      e
      .

      4
      -4

      N
      o
      se

      m
      in
      d
      fu
      ln
      e
      ss

      1
      .
      Il
      lu
      st
      ra
      te

      th
      e
      b
      a
      si
      s
      o
      f
      sm

      e
      ll
      m
      in
      d
      fu
      ln
      e
      ss

      a
      n
      d
      le
      a
      d
      te
      a
      m

      m
      e
      m
      b
      e
      rs

      to
      tr
      a
      in

      th
      e
      m

      h
      o
      w

      to
      u
      se

      th
      e
      ir
      n
      o
      se

      to
      fe
      e
      l
      a
      n
      d

      c
      o
      m
      p
      re
      h
      e
      n
      d
      th
      e
      w
      o
      rl
      d
      .

      2
      .
      G
      u
      id
      e
      te
      a
      m

      m
      e
      m
      b
      e
      rs

      to
      c
      o
      m
      m
      u
      n
      ic
      a
      te

      a
      n
      d
      d
      is
      c
      u
      ss

      sm
      e
      ll

      tr
      a
      in
      in
      g
      .

      C
      h
      o
      o
      se

      o
      n
      e
      k
      in
      d
      o
      f
      fr
      u
      it
      a
      n
      d
      sm

      e
      ll

      w
      it
      h
      m
      in
      d
      fu
      ln
      e
      ss

      a
      n
      d
      re
      c
      o
      rd

      y
      o
      u
      r

      fe
      e
      li
      n
      g
      s.

      G
      iv
      in
      g
      u
      p

      P
      ra
      c
      ti
      c
      e
      m
      a
      k
      e
      s
      p
      e
      rf
      e
      c
      t.

      B
      e
      li
      e
      v
      e
      in

      y
      o
      u
      r
      h
      e
      a
      rt
      .

      5
      -5

      T
      o
      n
      g
      u
      e

      m
      in
      d
      fu
      ln
      e
      ss

      1
      .
      T
      e
      a
      c
      h
      m
      e
      m
      b
      e
      rs

      h
      o
      w

      to
      a
      p
      p
      ly
      m
      in
      d
      fu
      ln
      e
      ss

      to
      d
      ri
      n
      k
      in
      g
      a
      n
      d

      e
      a
      ti
      n
      g
      .

      2
      .
      T
      a
      st
      e
      m
      in
      e
      ra
      l
      w
      a
      te
      r
      a
      n
      d
      a
      n
      a
      p
      p
      le

      w
      it
      h
      7
      st
      e
      p
      s:
      h
      o
      ld
      ,
      lo
      o
      k
      ,

      to
      u
      c
      h
      ,
      sm

      e
      ll
      ,
      re
      le
      a
      se
      ,
      sw

      a
      ll
      o
      w

      a
      n
      d
      fe
      e
      l.

      M
      in
      d
      fu
      ln
      e
      ss

      e
      a
      ti
      n
      g
      tr
      a
      in
      in
      g
      w
      it
      h

      ra
      is
      in
      s.

      Im
      a
      g
      in
      e
      th
      e
      fo
      o
      d
      so
      u
      rc
      e
      a
      n
      d
      th
      e

      p
      ro
      c
      e
      ss

      w
      h
      e
      n
      e
      a
      ti
      n
      g
      a
      n
      d
      re
      c
      o
      rd

      y
      o
      u
      r

      fe
      e
      li
      n
      g
      s.

      E
      m
      o
      ti
      o
      n
      a
      l

      in
      st
      a
      b
      il
      it
      y

      D
      o
      n
      o
      t
      ru
      sh
      .
      S
      to
      p
      w
      h
      e
      n
      in
      a
      b
      a
      d
      st
      a
      te
      .
      T
      a
      k
      e

      a
      b
      re
      a
      k
      a
      n
      d
      b
      ri
      n
      g
      b
      re
      a
      th

      to
      th
      is
      m
      o
      m
      e
      n
      t

      a
      n
      d
      k
      e
      e
      p
      a
      p
      e
      a
      c
      e
      fu
      l
      m
      in
      d
      .

      6
      -6

      B
      o
      d
      y

      m
      in
      d
      fu
      ln
      e
      ss

      1
      .
      In
      tr
      o
      d
      u
      c
      e
      b
      o
      d
      y
      sc
      a
      n
      ,
      w
      h
      ic
      h
      e
      n
      ri
      c
      h
      e
      s
      th
      e
      c
      o
      n
      te
      n
      t
      o
      f

      p
      ra
      c
      ti
      c
      e
      th
      ro
      u
      g
      h
      th
      e
      e
      st
      a
      b
      li
      sh
      m
      e
      n
      t
      o
      f
      p
      h
      y
      si
      c
      a
      l
      a
      n
      d

      p
      sy
      c
      h
      o
      lo
      g
      ic
      a
      l
      re
      sp
      o
      n
      se
      s
      to

      st
      re
      ss

      2
      .
      T
      e
      a
      c
      h
      a
      p
      p
      ro
      p
      ri
      a
      te

      y
      o
      g
      a
      -b
      a
      se
      d
      st
      re
      tc
      h
      e
      s,
      w
      h
      ic
      h
      in
      c
      lu
      d
      e

      ly
      in
      g
      a
      n
      d
      st
      a
      n
      d
      in
      g
      p
      o
      st
      u
      re
      s.

      1
      .
      D
      o
      b
      o
      d
      y
      sc
      a
      n
      fr
      o
      m

      h
      e
      a
      d
      to

      to
      e
      .

      2
      .
      A
      c
      c
      o
      rd
      in
      g
      to

      o
      n
      e
      ’s
      o
      w
      n
      a
      b
      il
      it
      y
      d
      o

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      (C
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      Dovepress Zhang et al

      Neuropsychiatric Disease and Treatment 2019:15
      submit your manuscript | www.dovepress.com

      DovePress
      2699

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      Powered by TCPDF (www.tcpdf.org)

      Results
      Sociodemographic And Clinical

      Characteristics Of Participants
      The average age of the participants was 18.94 ± 1.31

      years, with a range of 17–22 years. Table 2 displays the

      characteristics of the two groups.

      Efficacy Of MBSR On BDI, MAAS, RRS
      A repeated-measures analysis of variance model was con-

      ducted to examine changes across time between the inter-

      vention and comparison conditions on measures of BDI,

      MAAS, RRS. Table 3 reveals descriptive statistics with

      mean scores of pre-post measures and significance of the

      group, time and time-group interactions. The results

      revealed a significant interaction between time and condi-

      tion for BDI (F=17.721, p<0.001, η2=0.577), MAAS
      (F=13.489, p<0.001, η2=0.509), and RRS (F=81.566,
      p<0.001, η2=0.863).

      Discussion
      This study is the first RCT pilot study to apply tailored

      mindfulness-based stress reduction to mental health on

      subthreshold depression college students to evaluate the

      effects of MBSR on their psychological health.

      Specifically, the benefits of modified MBSR on partici-

      pants have been tested, such as a decrease in depression

      and rumination level and an increase in mindfulness state.

      Although researchers have been studying subthreshold

      depression for decades, subthreshold depression is still

      not recognized enough due to the lack of clear and unified

      diagnostic criteria, and no authoritative academic institu-

      tions have issued clear epidemiological reports.21 There

      has been little research on SD in related academic fields in

      China.15 Influenced by Chinese cultural values, most peo-

      ple are reluctant to seek psychological counselling or

      clinical psychotherapy, even if they have clinical symp-

      toms that lead to an increase in the prevalence of major

      depression in recent years.22 Studies have shown that the

      incidence of subthreshold depression among adolescents

      has reached 30~40%.23 Although subthreshold depression

      does not meet the diagnosis of a clinical depressive epi-

      sode, it affects the physical and mental health of indivi-

      duals; thus, it is very necessary for early intervention.24

      Mindfulness skills have been systematically used in

      psychotherapy, and related guidelines have been recom-

      mended by NICE for the treatment of depression in the

      UK.25 However, for Chinese adolescents, the relatedT
      a
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