Childhood Obesity among Aboriginal and Torres Strait Islander children living in Rural Queensland

Author: Sana Rehman

Part A: Impact of Childhood Obesity at the Level of Individual, Community and Population 

Childhood obesity has become the most concerning issue of the current time. The action plan is needed to prevent childhood obesity in rural Queensland. For developing the action plan, the adverse impact of childhood obesity is crucial to identify. The impact of childhood obesity, key areas to make changes, and action plan are mentioned below.

 

According to the 2016 census, the ratio of Aboriginal and Torres Islander children in the rural island is 4.0% (Queensland Government Statistician’s Office, 2016). In the recent five years, the Aboriginal and Torres Strait Islander residents of Queensland rural area ratio has been increased to 19.7% (30,658) (Sherriff et al., 2019). The growing proportion of aboriginal and Torres Strait islander is adversely impacting the health conditions of the general population and the children’s as well. The ever increasing ratio is developing economic issue to meet the necessities of the population, and the most prevalent issue which has been observed is childhood obesity.

Childhood obesity is very prevalent among Aboriginal and Terror Strait Australian Children living in rural Queensland (Thurber, Dobbins, Neeman, Banwell, & Banks, 2017). In particular, the burden of disproportionate morbidity and mortality are very common among obsess children’s of rural Queen land (Phillips, Morrell, Taylor, Daniels, 2014). In 2012 to 2013 the one-third of Aboriginal and Strait Islander child (age range 12-14) estimated to be overweight (Phillips, Morrell, Taylor, & Daniels, 2014: Australian Bureau of Statistics, 2013). The impact of childhood obesity is alarming for physical, emotional, psychological and social life (Schwarzman et al., 2019). 

The physical impact of childhood obesity liked to develop type 2 diabetes. It adversely affects the life expectancy of the child for up to 27 years. Childhood obesity adversely affects the emotional well-being of the child, and they start to display inappropriate emotion in a diverse situation. The recent researches have demonstrated the positive correlation between childhood obesity and emotional problems (Phillips, Morrell, Taylor, & Daniels, 2014). 

The psychological impact of physical obesity includes low self-esteem, negative self-concept, and anxiety and body dysmorphic symptoms. The literature suggested that childhood obesity is positivity associated with the psychological disturbance, which may deteriorate the personal, social and occupational life of the children (Schwarzman et al., 2019). 

The social impact of childhood obesity adversely affect the occupational functioning of the child as further leads to isolation and leads to much antisocial behaviour (Chung et al., 2016). Therefore for the emotional, psychological, and behavioural well-being of the children, their physical fitness is crucial.

The socio-economic factors determine the prospect of any area. The lack of nutrients and medical facilities leads to poor health and low life expectancy (Sherriff et al., 2019). The environment of rural Queensland poses lack of health and nutrient facility. These deprivation are leading to childhood obesity and related issues. The Aboriginal and terror strait island child experience substantial hurdles if rural Queensland. Therefore there is dire need to devise a plan for changing the alarming current condition. 

B: Key areas where change can be made to reduce the impact of health issues

The risk factor for childhood obesity can be seen in three clusters such as biological, socio-economic and behavioural. Firstly, according to the biological perspective, obesity has some predisposed effect. According to researches, obsess parents are more at risk of having obese children’s compared to slim ones. Secondly, as mentioned earlier, Childhood obesity is interlinked with the poor socio-economic condition of children living in rural Queensland. 

The food and health care deprivation among children’s of rural areas are the primary determinants of childhood obesity. According to recent data, the proportion of childhood obesity is significantly correlated with disadvantages background (Schwarzman et al., 2019). The lack of adequate socio-economic facilities leads to childhood obesity.

 

As the rural areas posses with the least medical and nutrients facility and children with low socio-economic status bound to buy cheap and unhealthy foods (Kim et al., 2017). Furthermore, the lack of adequate medical facilities also contributes to developing health-related issues. The two main areas which have been identifying to make change are unhealthy food leads and lack of medical facilities in rural areas of Queensland. Thirdly, unhealthy behaviours are also very strong determents of childhood obesity (Australian Institute of Health and Welfare, 2018). The children often commit unhealthy behaviour due to inadequate rural environment. Therefore, the prevention of childhood obesity is essential by making changes in these areas. 

The change in reducing childhood obesity can be made by following a few steps. Initially, childhood obesity can be curbed among children of rural areas of queen land through policymaking, considering the social-economic context. The Government should take collaborative steps with the Aboriginal community for reducing nutrition deficiency and other related health issues. More actions should be taken to promote the Minjilang Health and Nutrition Project (Northern Territory; 1989-199029) in rural Queensland for the aboriginal and terror islander children (Australian Bureau of Statistics. (2016). The Government should facilitate the peoples of rural Queen land with basic health care measures.

 

There is dire need to hire more health care staff, funding aids, and workforce training in rural areas so that childhood obesity can be control. Furthermore, another is that needs attention to children behaviour. The children’s are indulged in the poor behavioural chain of food intake and routine habit. In order to break their food intake and unhealthy health habit chain, health equality policies should be promoted (Guzys, Brown, Halcomb, & Amp; Whitehead, 2017). 

The aboriginal and terror island children do not get equal, housing, medical, education and social facilities. Unequal rights lead to unhygienic or unhealthy behaviour. The implication of the Looma Healthy Lifestyle Project (Western Australia; initiated in 1993 and still ongoing) is needed for childhood obesity prevention (Schwarzman et al., 2019). The obesity itself is not that dangerous, but a risk factor for causing multiple deadly diseases. Therefore the prevention programs are essential to developing. 

C: Action plans to address the health issues

The best nursing practice is primarily associated with promoting health and fabric in the community as the current issue of childhood obesity in rural Queensland is very prevalent (Queensland Government Statistician’s Office, 2016). Here the role of a registered nurse is very crucial to develop health-related behaviour to prevalent the proportion of childhood obesity. The health promotion empowers the infected individual, family and community to develop insight by educating and developing skill to combat against disease (Edelman, Mandle, &Kudzma, 2014). 

The targeted area that needs change to overcome obesity in rural Queensland is health-related behaviour. The obsess children of rural areas found to be indulged in health risk behaviour such as cheap and malnutrient foods, improper daily routine, unhygienic habits and residential issues (Fleming & Parker, 2019). The issues should be resolve at border spectrum as Government and policymaker should invest their time and expenditures to improve the condition of the children’s. The Government and policymakers would indulge in this action plan and informed about the necessities of the medical staff, financial aid, funding and other related things. As far as the action plan for the nursing perspective is concerned, by taking multiple steps the childhood obesity can be control. 

The very first step of an action plan for the promotion of health and the prevention of childhood obesity is the regular assessment of the children. The assessment includes diet, sedentary behaviours and physical activity. The second step is the assessment of family environment such as parenting, acceptance, rejection, and quality time etc. The obtained information from this initial assessment would provide sufficient details to design an intervention plan for the children. On the basis of these assessments, it can be concluded that intervention should be universally applied or individually. 

What population should be targeted, such as children, parents, caregivers, teachers and neighbours?  

In the current issue of obesity, children will be asses on a regular basis for identifying their health habits, including nutrients, sedentary lifestyles, and physical activity. The cheap and unhealthy food and lack of physical activity will be reduced following behaviour modification technique. The children will be educated through stories, video clips and other interesting activities about how malnutirents food and lack of health activities leads to childhood obesity. The parents or caretaker of the children’s would also be psycho-educate about unhealthy health habits and would assist in developing health-related behaviour to prevent obesity among children’s. The effectivity of the action plan would be assessed through post-assessment. This action plan would help in controlling the obesity issues in rural Queensland. 

Conclusion 

The childhood obesity has arisen to an alarming extent in rural Queensland, but with appropriate aid and action plan, the issue can be controlled. Further longitudinal researchers, case studies and systematic reviews are crucial to conducting for the identification of the latest epidemiological issues so that more intervention plan can be designed. 

What is Body Dysmorphic Disorder?

Author: Sana Rehman

Body Dysmorphic Disorder Definition

Body dimorphic disorder is a serious mental health condition, in which a person experiences extreme dissatisfaction with their outer appearance. The dissatisfaction towards personal flaws isn’t often reality or evidence-based.

Body Dysmorphic Disorder Symptoms

Extreme preoccupation with perceived flaws

A strong belief that one’s have a defect and it will make them look ugly or deformed

Unnecessary comparison

Recurrent Mirror Checking

Tireless efforts to fix one’s flaw

Body Dysmorphic Disorder Definition in DSM-V

Besides the above definition and symptoms, the DSM V recommends a person's social, personal, and occupational functioning also deteriorates during this disorder.

Body Dysmorphic Celebrities

Many media celebrities have been diagnosed with BDD such as Andy Warhol, Franz Kafka, Salviya Plath, Shirley Manson, Kim Karadashian, Rober Pattinson, Illeana D’Cruz, Hayden panettiere, and Mickel Jackson. Apart from this many celebrities were having Body dysmorphic symptoms as a result they preferred plastic surgeries. Ayesha Takiya, Vani Kapoor, Aishwariya Rai, Shruti Hassan, Sara Ali, Priyanka Chopra are the examples of celebrities with plastic surgeries.

 The trend of Plastic surgery has prevailed in Pakistani culture as many Pakistani actors and actresses have gone through the process. Sadia Imam, Mehwish Hayat, Fawad Khan, Hadiqa Kiyani, Fiza Ali, Amna Haq, Sara Loren, Nadia Hussain, Sadaf kanwal and Sidrah Batool have undergone plastic surgery. It shows that the dissatisfaction with facial feature and body are becoming more trendy with time. As the ratio of body dysmorphic symptoms or body, dimorphic disorders are very high, therefore there is a need to understand the causes and treatment of BDD.

Body Dysmorphic Disorder Causes

Body Dysmorphic and Socioeconomic Status. BDD is interlinked with socio-economic status. The person who belongs to high socio-economic status is more vulnerable towards BDD. The people with high socioeconomic status spend more money on beauty products compared to people with low socioeconomic status.

Body Dysmorphic and Family System. According to the literature family system also plays a significant role in developing body dysmorphic disorder. The people who live in an individual family system found to be least prone to developing BDD compared to the people who live in a nuclear family system.

Body Dysmorphic and Gender. Females found to be more sensitive for BDD and spend a considerable amount of time on remedies to enhance their beauty.

Body Dysmorphic and Literacy. Literacy is also another predictor of BDD as the literature suggested that literate people focus more on their physical appearance compared to rural people.

Body Dysmorphic and Occupation. Occupations are also very important in developing BDD as media actors found to be very sensitive for their outer look. The dissatisfaction with their facial and body traits found to be very common among them. Plastic surgeries ratio among celebrities have been seen very persistence since last few decades

Body Dysmorphic and Stress. Does BBD beget stress or stress begets BDD? It is a very complicated question and research indicates that in certain situations stress leads to BDD disorder. As unrealistic beauty standards cause stress and stress further leads to BDD. While BDD itself a disorder in which a person experiences extreme stress and dissatisfaction with his/her appearance.

Body Dysmorphic and Depression. The person wit BD experience depression. The dual diagnoses of BDD and depression are very common among people.

Body Dysmorphic and Anxiety. anxiety and BDD are highly correlated as researches are enriched with the evidenced-based studies in which anxiety has been found both an antecedent and consequence of BDD.

Body Dysmorphic Disorder Diagnosis

Diagnosis of Body Dysmorphic disorder can be made by considering the following points.

1. A psychological or clinical evaluation that investigates risk factors, thoughts, behavior, and feelings related to a negative self-image.
2. Family, social, personal and medical history
3. Symptoms list from Diagnostic and Statistical Manual, Published by American Psychiatric Association

Body Dysmorphic Literature 

The literature for the empirical studies depicts the connection between Body Dysmorphic weight-related studies. The most common BDD is overweight issues, as people report dissatisfaction with their weight and often develop BDD. Another wide study issue of BDD is Death. Body Dysmorphic Disorder and Death have been studied widely in multiple countries and the ratio of suicide due to BD symptoms found to be higher in multiple countries.

Body Dysmorphic Disorder Treatment

Body Dysmorphic Disorder and Cognitive Behavior Therapy. CBT found to very effective for the treatment of BDD. Cognitive behavior therapy deals with irrational o faulty cognitions. The dissatisfaction with the personal body or appearance is irrational thinking. Many people found to be vulnerable to suicide depression and other mental health issues due to dissatisfaction with their bodies. Their irrational thoughts towards beauty standards can be changed through CBT. The A-B-C cycle of thoughts feelings and behavior is mandatory to understand for developing change.

Body Dimorphic Disorder and Behavior Therapy. Sometimes unhealthy behavior such as excessive movies watching and overeating leads to obesity or underweight issues. Through behavior therapy, healthy habits can be learned. According to behavior therapy, healthy behavior can be learned through modeling, rewards, and punishment.

Body Dimorphic Disorder and Medication. Apart from cognitive and behavior therapies, medications are very important to treat BDD. The most effective and well-known medications for BDD are Paroxetine, sertraline, fluoxetine, and citalopram.

 

 

 

 

How to Make Money Online: the most Common Mental Health Issue

Author: Sana Rehman

The online business is gaining tremendous progress in the current times. Multiple options are available for online business such as marketing, freelancing, advertisements, social media management, a consultancy business, web management, sales consulting, online blogging, and designing. Every individual is interested in knowing ‘’how to make money online’’. Although the online business has contributed to the economy of Pakistan, it is also leading many mental health issues. The most common factors that are leading to mental health issues among people due to online business are as under.

First of all online businesses have raised new competition among people. People from different academic backgrounds are interested in running an online business despite a lack of knowledge in this field. The mismatch between academic background and professional selection leads to multiple career issues. For example, a person with a psychology background prefers to become a blogger. If he is not aware of HTML language, Robotix, Fetching, Google indexing, Google analytics, and Google search console, so he may not run the blog successfully. 

The business without proper knowledge is wastage of time and leads to failures in carrier development. Similarly, a high ratio of people is interested in running their YouTube channel and most commonly they prefer entertainment niche, but again lack of knowledge about Google analytics leads to multiple issues as result they stop putting effort. Besides this many people choose the YoTube niche as opposed to their academic or personal skills, which again leads to drop out of the business. The failures and drop out in online busses lead to multiple psychological issues such as depression, anxiety, stress, and mood disorders.

Secondly, the reliance on online business fascinates the people as it seems to require the least effort and hard work. Unfortunately, it’s a misconception; an online business requires proper time and mental hard work compared to traditional businesses. In the current mechanical life, people are more interested in robotic jobs. Physical activity has become the least preferable in jobs or carrier, therefore the online business has become the first choice of every individual. Unfortunately, the people who are running their online business considered more successful as they can earn in dollars with the least efforts. 

The people who cannot earn through online work experience substantial psychological distress.

Thirdly, many people invest money in online jobs without verifying websites. As a result, they experience scams. The encounter of scams is one of the most leading causes of frustration and psychological distress.

 

Fourthly, the advertisement for online business with exaggerated income set unrealistic carrier margins among people. In response to these unrealistic business profits, people start putting efforts for online earning. When they cannot earn according to their preplanned mindset, as a result, they feel frustration, anxiety, depression and distort their connection with reality.

Fifthly, online businesses are distracting the people who are successfully running their traditional business. The negative thoughts about earning more through online business rather than traditional one can cause a feeling of distress. Furthermore, the automatic thoughts for having a successful online business may decrease their passion for their work. As a result, they may underperform and may destroy their already established business.

Lastly, the population of Pakistan is least familiar with the internet advanced technology. Digital illiteracy is associated with many mental health issues such as negative self-concept, inferiority complex, and low self-esteem. The knowledge and facilitation provision for digital literacy is very important to promote among Pakistani youth so that they can run their online business. This particular aim requires substantial and efforts of IT experts to spread awareness among people.

The trend for an online business is beneficial for the economic prosperity of the people. As it provides many opportunities for unemployed people, but the gluttony for an online business is just a root cause of mental issues. The people must verify the websites before starting any online job or business, so that obnoxious consequences can be avoided. Also developing realistic expectations from an online business is very important to avoid mental health issues. 

A more social media awareness campaign for scams and safety measures are needed to protect the mental health of the people. Furthermore, raining workshops, webinars and conferences should be designed to train the students, businessmen, and women to run their online business. The search for ‘’How to make money’’ should be used productively rather than developing mental health disorders. The Government, Policymakers, and education departments should take collaborative steps to mitigate the psychological or mental health issues by providing authentic sources for online education.

 

Coping Strategies or Therapeutic Intervention for COVID-19

Author: Sana Rehman

The COVID-19 outbreak and its eventual impact are not only developing the risk for physical sufferings, but also unbearable psychological and mental health loss. There is a dire need to develop self-hell skills among teachers and student to combat a stressful situation (Yang et al., 2014).. The self-help coping strategies are not only helpful for reducing psychological symptoms but also for the academic prospect of the student. 

The interventions of the students and teachers psychological problems have been divided into two categories i.e. therapeutic interventions and self-help skills. In therapeutic interventions, the therapist and counsellor play their best role to promote the well-being among the targeted population. While in self-help skills the students, teachers or other targeted population can reduce the psychological burden through self-assistance. 

1- Therapeutic Interventions 

Psycho-education. The first and foremost step in therapeutic intervention is psycho-education about the current situation is and how people can deal with it. The awareness about stressful and safety precaution may reduce the risk for disease and also release the anxiousness and depression. Therefore the students and teachers will be psycho educate about the possible effect of online education and mismanagement through online workshops and meetings. Furthermore, it will be explained how they can overcome the psychological symptoms to increase their performance during online learning.  

Role play. The counsellor and student or teacher can overcome their fear through role play. It has been observed that the unconscious mind is primarily associated with intense emotion or behavioural reaction. Fore-example, if a person is not good in technological use, so the unconscious mind gives the continuous message’’ I can’t do it. To replace the I can’t do it a statement with I can do it is very crucial for moving towards success. 

Through role-play and role reversal the positive mind the rigid schemas can be changed. Similarly, if a person has a childhood experience of losing someone and develop more fear during pandemic regarding fear of death. Therefore it is mandatory to reduce the level of fear using role play. The client can play the role of a therapist and describe the way how fear and anxiousness can be reduced. 

Catharsis. The literature is enriched with the evidence-based studies recommended that catharsis for a stressful situation may ameliorate better consequences. The student may feel relax after expressing their emotional disturbed thoughts and reactions. The students and teachers will be encouraged to express their thoughts and emotions to make them feel better. Furthermore, they will be guided to manage their automatic negative thoughts, feelings and behaviour through self-help skills.

 

2- Self-help coping skills. 

Assertive training or Thought Stopping. The anxiety, uncertainty about life or future prospect and other negative automatic thoughts during a pandemic are very common.

Cost and benefit analysis. The anxiety for academic loss and life uncertainty is justified and normal, but excessive fear and anticipation is associated with more mental and physical health issues. Usually, the students overestimate the adverse consequences of the situation and as a result, they experience substantial mental health issues. The cost and benefit analysis of the effects of COVID-19 or online education may develop a realistic approach. The students and teachers will be guided on how they can realistically evaluate the current situation by conduction cost and benefit analysis. 

Deep breathing. COVID-19 attacks the lungs and respiratory systems and physical exercise may develop positive consequences.

Sleep hygiene. The stress anxiety and depression primarily affects our sleep cycle, therefore it is mandatory to take normal sleep. Through a few concrete steps students and teachers can improve their quality of sleep during a global pandemic.

Focus here and now. As mentioned earlier COVID-19 is associated with uncertainty about the future life. Therefore, it is mandatory to focus on here and now principals to keep themselves calm and relax. 

Yoga. In stress management yoga is very effective and universally available to everyone

Naturopathy. Hers and naturopathy (liquorice, ependhra and ginger) have been used to treat many viral diseases such as influenza, flu and respiratory problems.

Progressive Muscle Relaxation. The online education or excessive screen time adversely affects the muscles and nerves. Muscle relation techniques may ameliorate better consequences (Ozamiz-Etxebarria, Dosil-Santamaria, Picaza-Gorrochategui, & Idoiaga-Mondragon, 2020). The students and teachers will be taught how they can relax their tense muscles. 

 

What is Cognitive Behavior Therapy during 2020: The significance of CBT during COVID-19 Pandemic

Author: Sana Rehman

Cognitive Behaviour Therapy Definition and Overview

Psychotherapeutic intervention plays a significant role in helping people to change their disruptive, destructive or disturbing thoughts during a stressful situation like COVID-19 pandemic. Psychotherapeutic interventions have many types that influence behaviour and emotions; cognitive behaviour therapy is one of them. CBT was originated by the Aron Beck, when he was working on thinking and emotional problems. 

Cognitive behaviour therapy helps in modifying the automatic negative thoughts that contribute to develop emotional difficulty, depression and anxiety. The automatic negative thoughts are imperative to treat, otherwise it leaves the detrimental effects on emotions and mood. With the help of Cognitive behaviour therapy, these automatic or negative thoughts can be challenged, identified and replaced with more rational and realistic thoughts.

Cognitive behaviour therapy examples depict that it  is not limited to identification of thought patterns, rather it is comprised of numerous strategies which help people to reduce the frequency of thoughts. The most effective CBT techniques are relaxation, role-playing, journaling and mental distraction.

Types of Cognitive Behavior Therapy (CBT)

 Cognitive behaviour therapy comprised of a range of approaches and techniques that addresses behaviour, thoughts and emotion. These can range from self-help material to structured psychotherapies. The approaches of CBT are mentioned below

Dialectical Behavioral Therapy. It helps to change thinking patterns and behaviour using effective strategies such as mindfulness and emotional regulation.

Cognitive Therapy. Cognitive therapy definition depict that its a process of modifying the distorted thinking patterns, behaviour and emotional responses. Cognitive therapy types such as replacing automatic negative thoughts with balanced thought, or maintaining through records are very effective. 

Rational Emotive Behavioral Therapy. It involves in the identification, management and modification of irrational beliefs. Rational emotive behavioural therapy journal provides substantial data that support the effectiveness of REBT. The Rational Emotive behavioral therapy examples in the clinical history cannot be overlooked. 

Multimodal Therapy. According to practices of multimodel theory, the psychological problems must be treated using seven different traits such as behaviour, affect, cognition, sensation, biological consideration and interpersonal factors.Each kind of cognitive behaviour therapy deals with the underlying thoughts processes and intends to mitigate the psychological distress.

Cognitive Behaviour Therapy Uses and Treatments 

Cognitive behaviour therapy can be used to treat multiple disorders as a short term treatment approach. It helps people to focus on present beliefs and thoughts to reduce psychological disturbances. The range of disorders that CBT treat includes

1. Phobias
2. Problems with stress
3. Depression
4. Eating disorder
5. Panic attack
6. Anxiety
7. Anger issue
8. Addiction
9. Substance abuse disorder
10. Sexual disorders
11. PTSD
12. Schizophrenia
13. Dissociative Disorder
14. Personality disorder
15. Sleep disorder
16. Personality disorders
17. Somatization
18. Bipolar Disorder

CBT is a highly focused and goal-oriented, with the therapist active participation. The therapist and client work on mutually established goals. The goals of each session explained in detail and people are given homework to complete during and after the sessions. 

Cognitive behaviour therapy examples and impact

The underlying concept of cognitive behaviour therapy is that thought plays a significant role in developing any behaviour. For example, if a person all the time thinks that he shall get contagion may indulge in overprotective behaviour. These recurrent thoughts further lead to obsession and compulsive behaviour. The goal of CBT is to guide people that they cannot have control over the world and miserable conditions, but they can have control over the way of thinking. CBT has gained tremendous popularity in recent time, in particular, the significance of cognitive behaviour therapy during COVID-19 has increased to some extent among mental health practitioners. The popularity of cognitive behaviour therapy has increased due to several reasons which includes

1. The insight about negative thoughts has helped several people to keep control over recurrent negative thoughts and spend a healthier life.
2. Cognitive behaviour therapy found to be effective short-term psychotherapy.
3. CBT helps people to deal with their emotional distress without medication.
4. The empirical data has shown that CBT is one of the effective therapeutic technique that helps people to change their maladaptive behaviours.
5. The implementation of CBT is widespread because it is a cheap therapy compared to other therapies.

The most important advantage of cognitive behaviour therapy is that it helps the patients to develop coping skills that can be functional in present as a well future prospect.

Cognitive Behavior Therapy Techniques or Strategies

People frequently experience such circumstances that reinforce certain beliefs and develop negative thinking patterns. These thoughts and beliefs further develop problematic or undesirable behaviours, which further deteriorates many life areas such as relationships, career, academic and personal life. The 

Identification of negative thinking patterns. It is imperative to be master in identifying negative thoughts, situation and feeling that develop maladaptive or abnormal behaviours. The process of identification can be challenging for those who are weak in introspection, but it can direct towards self-discovery and insight that are an important part of treatment.  

Practice New Skills. While practising CBT treatment, a patient needs to practice and rehearse new skills. For example, a drug addict should learn to avoid those social situations that may cause a relapse.

Set Goals. Setting goals in life is very important to live a productive life and to avoid negative thoughts. A clinician or therapist can help the client to set realistic goals in life. The goal-setting not merely help the client to spend a productive or healthy life, but one should know the identification, priorities, long and short term goals. All individuals are unique and they can have diverse goals in life so identification of goals according to choices and needs attainable goals can be made.

Problem Solving. The problem-solving skill is also very effective in helping the client to identify and solve the problems that emerge from stressful life situations. The problem solving comprised of five steps i.e. identification of the problem, enlisting possible solutions, evaluation of the pros and cons of each solution, selecting a solution for implementation and implementation of the solution.

Self-monitoring. In cognitive behaviour therapy, the self-monitoring is a very effective technique, as it helps the clinician or therapist to gather the required information. For example, if a person is having an eating disorder so self-monitoring technique would be very effective to keep a record of eating habit and further it would assist in the habit change process.

Progress gradually. Behaviour change is a gradual process and the desired results can only be achieved with patience and persistent work. For example, phobic patient for contagions can practice recovery through verbalizing safety statements. By persistently working on thought process, gradually the goals can be achieved.

Cognitive Behaviour Therapy Limitations or Pitfalls

Cognitive behavior therapy exercises have some limitations or pitfalls, which are listed below. 

Change is hard to make. The identification of irrational thought is not enough to make a significant change in inpatient life. Replacing the irrational thought with an alternative or balanced though is more important for the recovery of the patients.

Cognitive Behavior Therapy is Structured. Like the psychoanalytical approach, cognitive behavioural therapy does not focus on underlying thoughts buried in the unconscious. It is more appropriate for the client who is more comfortable with structured therapy, in which the therapist or clinicians takes an instructor role. Furthermore cognitive behavior therapy implement the principles of both cognitive therapy and behavioural therapy, therefore considered a most effective approach.

People must be willing to change. The positive results of Cognitive behaviour therapy can only be achieved when the patients show their willingness to embrace the intervention. The self-analysis and homework’s of CBT can produce better results if the patients want to make a change in their thoughts and behaviour.

The need for Cognitive Behavior Therapy during COVID-19 Pandemic

According to Cognitive behaviouraal theory the need for CBT during crises such as COVID-19 outbreak has increased as people are dealing with depression and anxiety. The E-CBT approach is reported to be effective in managing anxiety, depression and related issues of the people.

Community Services for Child with Special Needs: An Exploratory Case Study of a Young Child

Author: Sana Rehman

The client is ten years old male referred to sexual and physical trauma. He was also having developmental delays such as limited interaction and communication skill compared to his age mates.

The cognitive, emotional, physical and social developmental stages help to identify developmental delays that limit the interaction, communication and behavioural deficit among children. The multiple theories provide evidence regarding the sexual and physical pathologies in the behaviour of the patient. The Erickson Psychosocial stages of development, Abraham Maslow’s Hierarchy of needs, Jean Piaget theory of cognitive development, and Trauma and attachment theory provides a clear description of every stage of human development and pathologies. The question regarding developmental milestones would be asked by the mother or caregiver of the client.

Abraham Maslow postulated the theory of hierarchal needs. According to him, the very first need of human being is a biological need, which is mandatory for the essence of life. If a child of deprived of basic needs in the prenatal, postnatal or early stages of his life, his physical development might deteriorate. As a result of a lack of nutrients, many cognitive and behavioural deficits may occur. The second stage is safety and security; the child feels secure and safe in the presence of caretaker and parents as the above case indicated that the child had traumatic experience due to his father. It can be assumed that his safety needs have been in threatening that leads to limited interaction and communication issues. The third need is love and belongingness. The lack of love and belongings leads to isolation and other psychological disturbances. The fourth stage is the self-esteem stage if the child feels of self-esteem due to parental rejection or parental abuse or neglect. As a result, he may suffer from physical and sexual trauma.

Piaget theory of cognitive development comprised of four stages. The sensory-motor stage preoperational stage, operational and formal stage. All the four stages provide a detailed description of each developmental stage, which millstones a child in each stage. Such as in the sensory-motor stages, the child explores the world through his senses and mouth. In the preoperational stage, the child develops the egocentrism. The egocentrisms reflect that the child cannot view the world from others perspective. This stage s very crucially as the child is considered more self-centred. The operational stage the child developed the concrete thinking and began to understand the complex concept to some extent, in the formal stage, the child began to develop the logical and abstract thinking.

In the current case, the child is ten years old and stands in the operational stage of the Piaget, but has not achieved the milestones, such as his communication and understanding with the world is limited. The Erickson stage of psychosocial development provides an understanding of how each stage is crucial in the psychological and sexual development of the child. The trust vs mistrust stage develops the secure vs insecure attachment styles towards the caregiver. The child considers that other people will always be there to support him. 

If he finds a lack of support, the crises began to start, and as a result, he develops the mistrust, insecurity and fear. All these psychological aspect increases with the passage of time and the child develop the anxious or antisocial personality in the later life. The second stage of autonomy vs shame and doubt/guilt is the second stage of psychosocial development. The child in this stage strives to develop personal skill and independence. The parental support to provide freedom, appreciation and love for accomplishing their task lead to the degree of virtue.

In contrast, the lack of support and freedom and overly criticism make the child doubtful about his skills. The third stage is initiative vs guilt, the stage of assertiveness. The children interacted with peers in schools and strived to take the initiative role in play activities. If they provide opportunities to take the lead to control the activities and make an informed decision, they develop positive incline for decision making. Otherwise, they began to mistrust their ability to take control of situation and decision making. Another important stage is industry vs inferiority, that deals with competence among children. In this stage, the child began to play the role of student, and teacher-student interaction develops a need for approval.

The teacher asks a student multiple questions and the child answer the questions to feel competent. If the child could not answer the question, he develops the inferiority complex, which further psychological issues. In the above case, they must have been fixation at any stage of the psychosocial development that leads him towards psychological issues. Attachment theory describes the parent-child attachment patent. According to the theory, there are four basic attachment style, authoritative, authoritarian, submissive and negligence. 

The authoritative parenting does not allow a child to make their decision and practice strict parenting regardless of child needs, wants and desires. Such parenting style leads to insecure attachment with the child. The other types of parenting style lead to secure attachment style to some extent. The trauma theory also suggests that any obnoxious experience or event adversely affect the development of the child. 

The signs of trauma are significant to eliminate the development of the child. On the basis of above theories, the questions would be asked, and after initial diagnoses, the child would be referred to a doctor for further assessment. As the child was having the developmental and psychosocial issues, he will be referred to the child psychologist or the pediatric who deals with the developmental issues of the child. Multiple centres are working for the assessment and management of the child problem; the child will be referred to the one of the following centres.

Government and Non-government Services

Centre for intellectual and developmental disabilities is the leading research centre that deals with the assessment and management of the developmental issues of the children. 

•    Centre for developmental disorder focus on autism, intellectual disability, down syndrome and numerous other developmental disorders impact on daily living and propose unique interventions plan.

•    Centre for intellectual and developmental disabilities research aimed to conduct high-quality research for the betterment of children with developmental disabilities.

•    Child developmental services deal with the special developmental needs of the children to enhance their potential.

•    The Tizard centre provides the best services to provide the high-quality care to the children’s with developmental disabilities.

•    Children identity developmental services provide assistant to the children to identify their identities.

•    Child development centre works for the treatment and assessment of the children with developmental needs.

•    Developmental behaviour pediatric clinic diagnose the children with developmental delays.

•    Newham child developmental centre strives to meet the multiple developmental needs of the children.

•    Development vision clinic assists the children with developmental vision issues and other developmental delays.

•    The centre for disability studies conducts scientific research for the management of of child developmental issues.

•    Child development centre fulfils the needs of the paediatrics with developmental dilemmas.

•    Developmental service resources centre provides support to the children having developmental disabilities

•    The lighthouse child development centre aimed to benefit the parent and children dealing with developmental delays.