MODULE I BRIEF BIOLOGICAL HISTORY OF MAN: EVOLUTION OF BEHAVIOR Lesson I: Beginning of MAN Exercise #1 In separate sheet of paper, give

your comments in the origin of man. The incredible story of our evolution from ape ancestors spans 6 million years or more, and features the acquirement of traits from bipedal walking, large brains, hairlessness, toolmaking, hunting and harnessing fire, to the more recent development of language, art, culture and civilisation. Over the last century, many spectacular discoveries have shed light on the history of the human family. Somewhere between 12 and 19 different species of early humans are recognised, though palaeoanthropologists bitterly dispute how they are related. Lesson II. Earliest MEN Exercise#2 Compare and contrast the features of the earliest man based on the recovered fossils and the modern man of today. Hominids
To be a hominid, a fossil must have an anatomy suitable for standing erect and walking feet. Bipedalism  Human anatomy differs from that of an ape largely because humans are bipedal while apes are quadrupedal. on two

Lucy
A reconstruction of Lucys skeleton Lucy is ~ 3.5-million-years-old  Australopithecus afarensis  adaptations in Lucys hip, leg and foot allowed a fully bipedal means of locomotion

Homo Erectus
 Dubois calls it Pithecanthropus erectus initially, also dubbed Java Man  finds in China called Sinanthropus  994 cc brain size (compare to 612 for H. habilis)  Acheulean tool industry

Homo Neanderthnlensis
 discovered in the Neander Valley (Tal) near Dusseldorf, 1856  massive brain--about 1,400cc on average  large torso, short limbs, broad nasal passages  later remains show decrease in robustness of the front teeth and face, suggesting use of tools replaced teeth  retained occipital torus, some mid-facial prognathism

Neanderthals
 Neanderthal (H. neanderthalensis) skeletons were first discovered in Germanys Neander Valley.  Skeletons date back 200,000 years. Massive brow ridges with protruding nose, jaws, and teeth. Heavily muscled. Culturally advanced. Manufactured variety of tools

Homo Sapiens
 Archaic 100,000 to 35,000 years BP  Sometimes called Homo sapiens and Homo sapiens neanderthalensis  Modern 35,000 years BP to present  Anatomically modern  Sometimes called Homo sapiens sapiens

Cro-Magnon Man
 35,000 years B.P. in western Europe to 17,000 years B.P.  1,600 cc cranial capacity  Oldest fossils to be designated H. sapiens.  Modern humans who entered Asia and Europe from Africa 100,000 years ago.

Homo Floresiensis
 one meter high  lived in Flores 12,000 yrs ago  Upright posture  380 cc cranial size (like a chimp)

Modern Man  1500 cc cranial size  Has 32 teeth

Lesson III. Evolution of MAN Exercise#3 Define biological and environmental processes of development and explain how these two processes interact.

Biological development. Gradual changes in size, shape, and function during an organisms life that translate its genetic potentials (genotype) into functioning mature systems (phenotype). It includes growth but not repetitive chemical changes (metabolism) or changes over more than one lifetime (evolution). DNA directs the development of a fertilized egg so that cells become specialized structures that carry out specific functions. In humans, development progresses through the embryo and fetus stages before birth and continues during childhood. A biological process is a process of a living organism. Biological processes are made up of any number of chemical reactions or other events that results in a transformation. Regulation of biological processes occurs where any process is modulated in its frequency, rate or extent. Biological processes are regulated by many means; examples include the control of gene expression, protein modification or interaction with a protein or substrate molecule. Physiological process, those processes specifically pertinent to the functioning of integrated living units: cells, tissues, organs, and organisms. y y y Reproduction Digestion Response to stimulus, a change in state or activity of a cell or an organism (in terms of movement, secretion, enzyme production, gene expression, etc.) as a result of a stimulus. y Interaction between organisms. the processes by which an organism has an observable effect on another organism of the same or different species. y Also: fermentation, fertilisation, germination, tropism, hybridisation, metamorphosis, photosynthesis, transpiration.

Environmental development

The complex of physical, chemical, and biotic factors that act upon an organism or an ecological community and ultimately determine its form and survival.The Earths environment is treated in a number of articles. The major components of the physical environment are discussed in the articles atmosphere, climate, continental landform, hydrosphere, and ocean. The relationship between the principal systems and components of the environment, and the major ecosystems of the Earth are treated in the article biosphere. The significant environmental changes that have occurred during Earths history are surveyed in the article geochronology. In the natural world, no organism is an autonomous entity isolated from its surroundings. It is part of its environment, rich in living and non-living elements, all of which interact with each other in some fashion. An organism's interactions with its environment are fundamental to the survival of that organism and the functioning of the ecosystem as a whole. In ecology, predation describes a biological interaction where a predator feeds on its prey . Predators may or may not kill their prey prior to feeding on them, but the act of predation always results in the death of its prey and the eventual absorption of the prey's tissue through consumption...), to mutual benefit (mutualism).The interactions between two species need not be through direct contact. Due to the connected nature of ecosystems, species may affect each other through intermediaries such as shared resources or common enemies. Consider an environment in which pollution of a particular type is maximum. Let us consider the effluents of a starch industry (aka Sago industry) which has mixed up with a local water body like a lake or pond. We find huge deposits of starch which are not so easily taken up for degradation by microorganisms except for a few exemptions. We isolate a few micro-organisms from the polluted site and scan for any significant changes in their genome like mutations or evolutions. The modified genes are then identified. This is done because, the isolate would have adapted itself to degrade/utilize the starch better than other microbes of the same genus. Thus, the resultant genes are cloned onto industrially significant micro-organisms and are used for more economically significant processess like in pharmaceutical industry, fermentations...etc. Similar situations can be elucitated like in the case of oil spills in the oceans which require cleanup, microbes isolated from oil rich environments like oil wells, oil transfer pipelines...etc have been found having the potential to degrade oil or use it as an energy source. Thus they serve as a remedy to oil spills. Still another elucidation would be in the case of microbes isolated from pesticide rich soils These would be capable of utilizing the pesticides as energy source and hence when mixed along with biofertilizers, would serve as excellent insurance against increased pesticide-toxicity levels in agricultural platform.

But the counter argument would be that whether these newly introduced microorganisms would create an imbalance in the environment concerned.The mutual harmony in which the organisms in that particular environment existed may have to face alteration and we should be extremely careful so as to not disturb the mutual relationships already existing in the environment to which we are introducing the newly discovered and cloned microorganisms

MODULE II ANTHROPOLOGICAL STUDIES OF HEALTH AND ILLNESS BEHAVIOR Lesson I: Anthropological Influence on Human Health Behavior Exercise #1 Enumerate and discuss some of folk medicine being used in your locality. Had you ever used any of this folk medicine?  Pusuh lanut -use in Mamaguh -for baguh  Ha-un leaves -use in Mamaguh -for baguh  Bagihun leaves -pound the leaves, extract the juice and drink -for all types of poisoning  Tambis leaves -boil with Guava leaves -for diarrhea  Cactus plant that bears small flower -boil the leaves -for hypertension  Guyabano leaves -get three leaves then tie around the head -for colds and headache  Heart-heart -wash and boil the whole plant -for edema and kidney disease  Sibukaw bark -boil the bark -for TB and hemoptysis Yes, but sometimes only. Even though folk medicine is not clinically tested, some of it has the same effect. It is not expensive compare to clinically tested drugs. Lesson II: Medical Practitioner Exercise#2 Interview a folk doctors present in your locality (mangngilut), herbalista, mangngagas, mannuma, mangallag) ask them how they treat their clients. Imam Sali Sali Tara or Imam Sali a sixty-three year-old, is a man of faith and endurance. As young as eight years old, he stopped schooling and began his lifes journey as a vendor. Truly, it was hard for a boy like Imam Sali, but his determination to survive win him through his quest. He got married in his twenties, had thirteen children but four died from sickness. Imam Sali has been healing few years before his first marriage. Though the death of his wife was a grief, Imam Sali recently devoted himself to a nice young woman. Childless with her second wife, he remained a good father and a partner. He does his role daily as a sari-sari store vendor, and a mobile healer willing to help the sick. Dreams, perhaps is the most common medium of divine retribution. Another folk healer, Imam Sali, claimed he also acquired his healing ability thru dreams. It all began with my dream of herbal plants.

I saw clearly, what the plants looked like. In the morning, I jot down the names of the herbs revealed to me. I found out later that the herbs truly exist! Then it was followed by another dream, as if someone was teaching me, reciting to me prayers. But, I can see no one, I just heard a voice telling me that I should use the prayers to cure human illness. Imam Sali maintained that the divine virtue imbued in his dreams should be shared to other people and in his case, thru healing. Similar experience was declared by Kah Iyong, which I mentioned earlier. Manang Arlene

This next healer is a fifty year-old woman from a Visayan tribe, in Negros Oriental, Pamplona but she`s now leaving in Marikina City. Her name is Arlene Roamar-Timan, a nice and cheerful lady who grew up and attended school in Pamplona, but made it only to second grade. Her Lola (grandmother) who happened to be a traditional birth attendant and a healer has raised Manang Arlene into a fine woman. At the age of eighteen, Manang Arlene was not able to resist her hearts calling and married a boy of her age. She was forced to leave her homeland and stayed beside his husband and ten children in Malusu, Basilan. They stayed there for years, until she can no longer put up with her husband; due to some personal reason, they later got divorced. She raised her children on her own, exerting all the efforts to support them. Then after years of being a full-time mother of ten, Manang Arlene faced her personal life again. She got married for the second time, a young man who is twenty-three years younger than her age. However, her husband is a dependable man who brought her whole family to Bongao in search for a quality living. Today, Manang Arlene manages her own small eatery and is a happy, contented woman and a renowned healer of Barangay Pasiagan. Folk medical beliefs and practices may differ from one healer to another or culture to culture. However, the process by which they are passed on- from person to person and generation to generation by word of mouth or writings is common. Manang Arlene is an example of this course. Her grandmother was a parteira, or a traditional midwife, who attends childbirth and a popular folk healer as well. She recalled that at the age of nine, she already knew how to manage a delivery. Since I was still a little girl, I always go with my Lola (grandmother) when she is called to assist in delivery. I really observed and remember every move she executed. I felt proud of my Lola. After years of watching my Lola do her job as a parteira, when I was about nine years old, she finally consented me to deliver one of her clients. That was when I started as a parteira. Even with the advent of modern medical care, traditional method of delivery is still widely sought today, perhaps perpetually. Still many pregnant mothers prefer a parteira to an obstetrician. Reason can be attributed to health beliefs passed on-from many generations ago. When asked regarding her knowledge on folk healing, Manang Arlene maintained she owed everything to her grandmother. My grandmother did not only teach me how to manage delivery, but several herbs and rituals as well. She taught me a lot on herbal remedies. In fact, I remember so well, when I was fifteen

years old that I practiced simple therapy with the use of herbs. Lola died when I was twenty-three, then someone came to me for help. It was a man, I have forgotten his name, he was complaining of painful urination and told me that he has a stone in the kidney. I recalled my Lolas teaching to boil banaba leaves and nituh. Of course I supported the decoction with tawal also taught by my grandmother. The man was so happy he was cured. It was later found out that the little green house (see inside herhealing room is also a source of healing ability. Sadness crossed her face when she revealed the story behind her unborn childs house. That same house according to Manang Arlene helps her a lot in taking care of patients, especially with the diagnosis. I was forty-four and three months pregnant with my second husband, when I had an abortion. It was hard for me, but what can I do, God wants my baby. Then a year after, my husband was very ill. We have been to many doctors in Basilan and Zamboanga, but his illness keeps recurring that eventually made him so very weak and thin. Then someone advised us to consult an Imam to know the cause. We complied, and the Imam told us that we have to house our son who was not brought to life. The moment we built the little house, my husband felt better and later regained his good health since then. My sons house has to be offered food and even toys from time to time. I can see him but no one else can, even my husband. The story of Manang Arlene was beyond the belief of many people, but actually very common in Bongao. Part of the culture is the belief in the eternal connection of the dead with those who are living. The one who passed away still exists in earth but are unseen, only those with bestowed special power who can see and summon the dead. It usually involves various rituals and duwaa or prayers. MODULE TEST: In your own perception, discuss how the following influence your health behavior. 1. Religion For me, religion greatly affects peoples health behavior. For one, almost all of us believe in different things involving health practices. An example of this is that Adventists refuse to do or undergo blood transfusion because for them it is dirty or impure. This reflects the effect or outcome of the different beliefs and religions that people practice especially in health practices. Another side of this is that religion not only deals with the views whether to use a certain health practice or procedure on the person but also it discusses how a person can deal with the certain illness he or she is experiencing. He or she may use his religion as a foundation for his strength that he or she may overcome by the illness. The support that the patient will be having from his religion and his co-members in their community may be of good help and guidance for the progression of his or her illness. 2. Childbearing

For childbearing, people also have different views on influencing their health behavior. As far as I know, some people especially those living far from civilization, choose not to visit a doctor for regular check-ups but they rather ask a midwife from their baranggay or RHU for check-up. They even ask the midwife or RHU that they will be the ones to help them give birth with only using conventional instruments found at home. 3. The presence of folk doctors With the presence of folk doctors, most people from far places call them for curing the sick person instead of just bringing him or her to the nearest hospital or baranggay health center. They believe that sickness is much brought about by supernatural beings that are why they rely on folk doctors. Not knowing that some procedures done by the folk doctors are unnecessary and they are just prolonging and worsening the condition of the person. If they had just brought the patient immediately to the hospital then the sickness may be resolved right away. Most folk doctors just brainwash the people for believing that supernatural beings bring about the illness that people experience. Health doctors must help resolve this problem by bringing to far places proper mediacl practices so that people will become aware.

MODULE III ILLNESS AND SICK ROLE BEHAVIOR Lesson I: Definition of Health Exercise#1 Discuss how healthy you are, taking into consideration the different dimensions of health. There are 7 dimensions of health and these include physical, emotional, mental, spiritual, social, environmental and occupational. I personally see myself health in all dimensions. First, physically I am healthy because I weigh normally and not underweight or overweight or even obese in terms of my height. Not only that, I do not have any illness physically like Diabetes, Heart problem etc... I eat and exercise regularly and sleep approximately 8 hours a day. Second, in terms of emotional I can say that I am also health because I deal with my emotions perfectly and not let it drag me down as much as possible because it may affect my health as a whole. I try to view things in a positive way and try to fix my problems as soon as possible. Third, spiritually I can say that I am also healthy because I am a good Catholic. I attend to mass every Sunday and pray most of the time before I sleep. I bring to me everyday a rosary for guidance and spiritual help. Next, socially I am again healthy because I have a lot of good friends and I do not feel like an outsider or aloof myself. I am not shy and I make it a point to socialize with my colleagues and patients when I interact with them. Fifth, in terms of environment I can also say that I am healthy because I live in a clean environment and I try to be a good citizen by helping to clean my environment. Sixth, mentally I am healthy because I do not have any mental illness and also I am capable of learning new things. Not only that I am not that stupid and I know how things works just like a normal person. Lastly, occupational I am healthy in a way because I am employed and I am satisfied with my job and my salary as well. I have a good working relationship with my co-workers and the management. All of these proves that I am a healthy human being inside and out. Lesson II: Models of Health and Illness Quiz#1 a. Differentiate health from illness Illness (sometimes referred to as ill-health or ailment) is a state of poor health. Illness is sometimes considered another word for disease. Others maintain that fine distinctions exist. Some have described illness as the subjective perception by a patient of an objectively

defined disease. Conditions of the body or mind that cause pain, dysfunction, or distress to the person afflicted or those in contact with the person can be deemed an illness. Sometimes the term is used broadly to include injuries, disabilities, syndromes, infections, symptoms, deviant behaviors, and atypical variations of structure and function, while in other contexts these may be considered distinguishable categories. Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. Health is the general condition of a person in all aspects. It is also a level of functional and/or metabolic efficiency of an organism, often implicitly human.The state of being free from illness or injury". b. Enumerate and discuss 2 models of health and illness

1. Health-illness continua
Dunns High-Level Wellness Grid

 composed of two axiss

a health axes which ranges from peak wellness to death a environmental axes which ranges from very favorable to very unfavourable.

 the two axiss form four quadrants a. high-level wellness in a favorable environment
e.g., a person who implements healthy life-style behaviors and has the biopsychosocialspiritual resources to support this life-style

b. emergent high-level wellness in an unfavorable environment

e.g., a woman who has the knowledge to implement healthy life-style practices but does not implement adequate self-care practices because of family responsibilities, job demands, or other factors

c. protected poor health in a favorable environment

e.g., an ill person whose needs are met by the health care system and who has access to appropriate medications, diet, and health care instruction

d. poor health in an unfavorable environment

e.g., a young child who is starving in a drought ridden country 2. Travis Illness-Wellness Continuum

 composed of two arrows pointing in opposite directions and joined at a neutral

point

movement to the right on the arrows (towards high-level wellness) equals an increasing level of health and well-being

1. achieved in three steps: a. awareness b. education c. growth  movement to the left on the arrows (towards premature death) equates a
progressively decreasing state of health

2. achieved in three steps: a. signs b. symptoms c. disability  most important is the direction the individual is facing on the pathway
if towards high-level health, a person has a genuinely optimistic or positive outlook despite his/her health status

if towards premature death, a person has a genuinely pessimistic or negative outlook about his/her health status

 compares a treatment model with a wellness model

if a treatment model is used, an individual can move right only to the neutral point

e.g., a hypertensive client who only takes his medications without making any other life-style changes

 if a wellness model is used, an individual can move right past the neutral point
e.g., a hypertensive client who not only takes his medications, but stops smoking, looses weight, starts an exercise program, etc.

c. Discuss how illness affects your behavior Illness affects our behavior greatly. When we are sick we tend to view things differently especially in a bad way. We blame other people; you and even God if we get ill. We most of the time feel down and hopeless when we are ill. Sometimes most of us are desperate enough just to get well and even try to nag our doctors to remove the illness we are feeling. There are different types of illness and when we say illness it does not only talk about physical illness but also the other dimensions of health. So if a person is ill it may be due to other things that may result to effects in our behavior which are mostly negative especially if things get worse. Lesson IV: Stages of Illness Behavior Exercise#2 Have you ever been ill? How did you cope with your illness? How did it affect you and your family? As any human being, I have been sick once or twice. One is when I was hospitalized due to fever and lowering of platelet count. Good thing it did not result completely to dengue fever and it was immediately resolved through increasing my fluid through Intravenous Therapy. I got scared when I found out that my platelet was lowering but then I needed to be strong to cope with my illness. I know that I will get well soon because I have faith with my doctors then. My family was always there for me especially my mother. She helped me get well because she was there to take care of me. Even my siblings, they were there to support me and give me courage to get well. And yes, I did get well. MODULE TEST: a. As a nurse, why is there a need for you to understand the different behaviors of an ill individual? It is important as a nurse to understand the different behaviors of an ill individual because it is through that that we can provide proper care to them. It is also through this that we would know how to approach them and give care to them as a nurse. All of us have different behaviors and we should understand and ponder onto these things because not all the time we can encounter same old patients all throughout. We must learn how to adapt to situations that may arise to us. And we must be flexible enough for us to work properly and offer our services to them as a nurse.

b. How does the Dunn`s model of Health helps you in your understanding of health and illness? Dunns model of health composed of two axis: a health axes which ranges from peak wellness o death and an environmental axes which ranges from very favourable to very unfavourable. It is then divided into four quadrants: high-level wellness in a favourable environment, emergent high-level wellness in an unfavourable environment, protected poor health in a favourable environment and poor health in an unfavourable environment. Through this model we can clearly understand what health and illness is. Both aspects are mainly influenced by environment. If a person who implements healthy life-style behaviors and has the biopsychosocialspiritual resources to support his life-style then he can be considered as healthy person in a favourable environment. When we speak of environment, this speaks of the totality of the environment and not only the place itself all of which then affects our health. If the environment is unfavourable then a person may lead to illness or even death. c. Discuss the stages of Illness Behavior. Stage 1: Symptom Experience The person is aware that something is wrong. A person usually recognizes a physical sensation or a limitation in functioning but does not suspect a specific diagnosis. Stage 2: Assumption of the Sick People If symptom persist and become severe, clients assume the sick role. At this point, the illness becomes a social phenomenon, and sick people seek confirmation from their families and social groups that they are indeed ill and that they be excused from normal duties and role expectations. Stage 3: Medical Care Contact If symptoms persist despite the home remedies, become severe or require emergency care, the person is motivated to seek professional health services. In this stage the client seeks expert acknowledgement of the illness as well as the treatment. Stage 4: Dependent Client Role

The client depends on health care professionals for the relief of symptoms. The client accepts care, sympathy and protection from the demands and stresses of life. A client can adopt the dependent role in a health care institution, at home, or in a community setting. The client must also adjust to the disruption of a daily schedule. Stage 5: Recovery and Rehabilitation This stage can arrive suddenly, such as when the symptoms appeared. In the case of chronic illness, the final stage may involve in an adjustment to a prolong reduction in health and functioning.

MODULE IV BEHAVIORAL SCIENCE AND SOCIAL EPIDEMIOLOGY Lesson I: Communication Exercise#1 Site instances where you able to apply positive communication technique. Effectively communicating can produce positive results. Whether the communication is between friends, parents and children, or with a boss and the employee, it's important to practice positive techniques when relaying messages between one person and another. Poor communication between two people can sometimes be the reason a relationship comes to an end. One instance is when talking to my patients I try to be attentive to what they are saying during assessment period. This shows a positive communication technique because we tend to adhere to what they are saying and addressing it properly. Listening attentively does not only involve a one way communication but also we should reciprocate or respond to what they are saying. I for one is not afraid to ask question or respond to their question if needed. Another instance wherein a positive communication technique is shown is I see to it that my body language is proper with what I am saying. I do not roll my eyes or even cross my hands or even slouch when I speak to a person. It is said that actions speak louder words so it is important to have a good body language. Lastly, another instance is that I set aside or allow time for conversation to occur. I do not force a conversation to start or even end in that manner. Lesson II: Personality Development Exercise#2 a. Make a comparison between Piaget`s Cognitive Theory and that of Kohlberg`s Theory. Piaget, a cognitivist and pioneer of the Cognitive Development Theory, focused on the cognitive aspect of human development. He gave a detailed picture of how thinking is processed among individuals, concluding that the difference between adults' and children's thinking is qualitative and not quantitative. He

asserted that development occurs in distinct, measurable, and observable stages. Additionally, he made an assumption that developmental growth is independent of experience and based on a universal characteristic. Piaget's theory assumes that development is unidirectional with all children reaching each stage at approximately at the same age. Using case studies that were in descriptive methods, Piaget strengthened his works to cite reliable facts about the real world in children. It can be reflected upon his presentation of the mental growthfrom sensorimotor stage, to preoperational stage, then to concrete operational stage and lastly, to formal operational stage where several features and characteristics were keenly monitored and recorded.

Kohlberg, an American psychologist,tried to expand the theory of morality that Piaget gave briefly. He assumes that there are 3 levels of morality that each individual faces Pre conventional, Conventional, Post Conventional that are then subdivided in stages. According to him, children in middle childhood, begin to perceive themselves as responsible to others because of the importance of getting along and of being a good citizen. They seek to act appropriately because people matter to them, not just to avoid punishment. Childrens developing psychological understanding heightens their sensitivity to human needs and contributes to empathy for others. Whereas a preschooler may sympathize with another but not know what to do, older children are more likely to assist a classmate who is attacked by a bully or to raise money to help children in a developing country. In Kohlbergs theory of Moral Development, he emphasized what could be the current state of morality that a person has if he/she is in that age. In the last activity performed, it was found that the preconventional children depends their action to the possible outcome, might be, if there would be a punishment or a reward. This proves that the theory is reliable. b. Please make a self introspection based on one of the personality development. Introspection is a process of reflection that focuses on personal reactions, behavior patterns and attitudes, similar to meditation. The difference between introspection and introversion is that the latter refers to the direction in which energy naturally moves, while the former refers to self-examination. Neither introverts nor those with a well-developed thinking function have a monopoly on introspection.

In order to reflect within ourselves, we must first take into consideration what is personality development. Personality development has been a major topic of interest for some of the most prominent thinkers in psychology. Our personality is what make us unique, but how exactly do we become who we are today? In order to answer this question, many prominent theorists developed stage theories to describe various steps and stages that occur on the road of personality development. The following theories focus on various aspects of personality development, including cognitive, social and moral development. Now, lets take focus on one personality development and there will be able to perform self introspection. What interests me in discussing is cognitive development by Jean Piaget. Jean Piagets theory of cognitive development remains one of the most frequently cited in psychology, despite being subject to considerable criticism. While many aspects of his theory have not stood the test of time, the central idea remains important today: children think differently than adults. Jean Piagets theory provided many central concepts in the field of developmental psychology and concerned the growth of intelligence, which for Piaget, meant the ability to more accurately represent the world and perform logical operations on representations of concepts grounded in the world. The theory concerns the emergence and acquisition of schemataschemes of how one perceives the worldin "developmental stages", times when children are acquiring new ways of mentally representing information. Piaget divided schemes that children use to understand the world through four main periods, roughly correlated with and becoming increasingly sophisticated with age: Sensorimotor period (years 02), Preoperational period (years 27), Concrete operational period (years 711), Formal operational period (years 11 and up). In my case, I have surpassed the lower levels or schemas because as you can see Im not anymore in the bracket of 0 11 years old. And also, I can say that I can definitely think like an adult and not as a child. I view things in how things are supposed to be. I can perform task that are done by an adult. I have already performed the tasks needed in each year and I am still learning things as I grow older. Lesson III: Concept of anxiety Exercise#3

Discuss when you consider anxiety to be normal or abnormal Generally, normal anxiety is a reasonable reaction to a stimulus. Abnormal anxiety is either when you become anxious without any stimulus or when the reaction to a stimulus is beyond that which is considered reasonable. When anxiety begins to interfere with your life and your daily actions, then it may be time to seek help. Anxiety becomes a problem when it overstays its welcome (duration), and/or is of an intensity or frequency which begins to interfere with a person's functioning and overall well-being. These three factors - duration, intensity, and frequencydistinguish normal, adaptive anxiety from abnormal, pathological anxiety. As such, abnormal anxiety is different from normal anxiety because it is disproportionate to the situation that elicited the anxious response. When the intensity, duration, and/or frequency of anxiety become distressful and chronic, such that it interferes with a person's functioning, it is often referred to as pathological anxiety. Anxiety disorders represent variant forms of this pathological anxiety. Therefore, the difference between normal anxiety and abnormal anxiety is this: anxiety is considered normal and adaptive when it serves to improve peoples' functioning or to preserve their well-being; in contrast, abnormal anxiety is a chronic condition which impairs peoples' functioning and interferes with their well-being, thereby causing them significant distress.

A) Normal anxiety is caused by worrying about personal matters, while abnormal anxiety is caused by worrying about global problems. B) Normal anxiety does not have any physical symptoms, while abnormal anxiety is coupled with heart palpitations, nausea, and sweating. C) Normal anxiety is caused by worrying about everyday things, while abnormal anxiety can interfere with daily functioning. D) Normal anxiety is caused by stress and fatigue, while abnormal anxiety is caused by physical problems. Quiz#1 a. What are the distinguishing features of each of anxiety disorder?

Anxiety states, usually referred to as anxiety disorders, can be defined as conditions primarily characterized by pathological anxiety. This anxiety must not be a part of or better explained by a more severe psychiatric disorder (e.g. psychotic illness), it is not associated with substance use (e.g. alcohol), and is not caused by physical illness (e.g. hyperthyroidism). Anxiety states encompass panic disorder (with or without agoraphobia), generalized anxiety disorder (GAD), social anxiety disorder (SAD; social phobia, generalized and non-generalized subtypes), and specific phobias. The conceptualization and classification of anxiety disorders have been dominated by the 'splitters'. That is, previous diagnostic entities have undergone division into subtypes and 'smaller' diagnostic categories. Several studies have addressed directly or indirectly the issues of the characteristic features of various anxiety disorders and boundaries between them. The following is a list of some of the more common anxiety disorders, along with the primary distinguishing features of each: y Specific Phobia is a marked and persistent fear of a particular object or situation. Common objects of phobia include spiders, dogs, heights, flying, catching an illness, water, storms or elevators. Specific phobias can also include fear of losing control, panicking, and fainting when confronted with feared object. Some treatments: exposure therapy, energy psychology y Social Phobia is an excessive and unreasonable fear of social situations such as parties, meetings, interviews, meeting new people or dating. Social phobics fear that they will do something or act in a way that will be humiliating or embarrassing. The feared situation is either avoided or endured with intense anxiety. This diagnosis is made if the avoidant behavior interferes with functioning at work or in usual social situations or if the person is markedly distressed about the problem. Some treatments: cognitive therapy, exposure therapy, group role playing, social skills training y Panic Disorder Periods of intense discomfort that come on unexpectedly and peak within 10 minutes. The discomfort is accompanied by symptoms such as chest pain, pounding heart, difficulty breathing, dizziness, faintness, trembling shaking, fear of going crazy or dying, and more. About 10% of adults have had some panic attacks. Panic attacks can lead to avoidant behavior and agoraphobia. Some treatments: Relaxation training, breathing retraining, exposure therapy, cognitive therapy, EMDR (Eye Movement Desensitization Reprocessing) y Agoraphobia An irrational and often disabling fear of being out in public. Persons may develop a pervasive avoidance of a variety of situations such as being in a crowd, crossing a bridge, or leaving home alone. If the person forces exposure to the feared situation, it is only considerable dread. Some treatments: Exposure therapy, cognitive therapy, medication y Generalized Anxiety Disorder (GAD) An unrealistic, excessive level of anxiety that lasts for 6 months or longer. The person with GAD is bothered by his or her circumstances almost constantly. They are likely to feel constantly "on edge" and tired and to complain of muscle tension. They may feel irritable and have trouble concentrating and may experience shortness of

breath, increased heart rate, cold hands, digestive problems and more. Some treatments: Cognitive therapy, relaxation training, problem solving skills training y Acute Stress Disorder Comes after a traumatic experience such as war, rape, terrorism, violent crime, earthquake or flood. The person re-experiences the traumatic event and avoids stimuli that remind them of the event. They may have insomnia, impaired functioning, and may feel numb or detached. May suffer from intense guilt and a variety of physical symptoms. If Acute Stress Disorder lasts for more than one month the diagnosis is Post Traumatic Stress Disorder. Some treatments: Cognitive-behavioral therapy, self-regulation therapy, EMDR or energy psychology, guided imagery. y Obsessive-Compulsive Disorder (OCD) Can include obsessions, compulsions or both. Obsessions are recurrent or persistent thoughts, images or impulses experienced as intrusive or inappropriate and causing anxiety or distress. Compulsions are repetitive behaviors or mental acts that a person feels driven to perform to prevent or reduce distress or a dreaded event. Examples include checking and rechecking, counting, washing, repeating actions, or lining things up symmetrically. Some treatments: Exposure therapy, cognitive therapy, relaxation training, mindfulness y Substance-Induced Anxiety Disorder -- The symptoms of this condition may resemble Panic Disorder, GAD, Phobia, or OCD. In this case the anxiety symptoms are due to the direct physiological effects of a drug, medication, or exposure to a toxin. Some treatments: Rehabilitation, drug & alcohol counseling, motivational interviewing In a long-term follow-up study, a poor stability of the diagnoses of panic disorder and GAD was reported: after 12 years, 3% of patients with GAD retained this diagnosis, 28% were diagnosed with dysthymic disorder or major depressive episode, and 11% received diagnoses of other anxiety disorders. Among patients with panic disorder, 10% retained this diagnosis, 8% were diagnosed with agoraphobia without panic, 26% received a diagnosis of major depressive episode or dysthymic disorder, and 12% were diagnosed with other anxiety disorders. These findings were interpreted to provide support for a broad concept of 'general neurotic syndrome', which includes mixed anxiety-depression and personality disorder, and within which there are no clear boundaries between various anxiety states. In contrast, one studycompared patients with 'pure' GAD to patients with 'pure' panic disorder with agoraphobia, and found that intolerance of uncertainty was specifically associated with the diagnosis of GAD, and that this cognitive construct could therefore reliably differentiate one condition from the other. Intolerance of uncertainty might not be specific for GAD, however, as it was found to characterize OCD patients with compulsive checking and analogue OCD in a sample of undergraduate students. Another cognitive construct, anticipation of specific catastrophic consequences, may not be consistently associated with the corresponding anxiety disorders. While panic disorder was reported to be

distinguishable from other anxiety disorders on the basis of the intensity of physical catastrophe cognitions (e.g. anticipation of a life-threatening illness or death), it was the intensity of social catastrophe cognitions (e.g. anticipation of embarrassment or humiliation) - otherwise typical of SAD - that was most closely associated with a poorer treatment outcome. Taking a different approach, Hoehn-Saric et al. compared patients with panic disorder and GAD in terms of their physiologic recordings and self-report during daily activities. The study found similarities between the two groups (diminished autonomic flexibility and less precise perception of bodily states), and reported that GAD patients were less sensitive to bodily changes and that they experienced a less severe and less frequent anxiety. The heart rate increase was associated with both panic attacks and a heightened tension and anxiety. Taken together, these findings do not provide a very strong support for the notion that panic disorder and GAD are distinct conditions. Another study found that panic disorder and GAD shared a very similar genetic risk structure. Agoraphobia and, to a lesser extent, SAD were also reported to be genetically related to panic disorder and GAD, which may explain a high rate of co-occurrence of these disorders. The study found a different genetic predisposition for specific phobias (except for the blood-injury phobia). These results suggest that the anxiety states may be divided into a group consisting of panic disorder, GAD, agoraphobia and perhaps SAD, and a group comprising most of the specific phobias. b. Enumerate the causes of anxiety. Genetics: Some research suggests that family history plays a part in increasing the likelihood that a person will develop GAD. This means that the tendency to develop GAD may be passed on in families. There is evidence that anxiety disorders run in families. If parents or other close relatives have an anxiety disorder, children are at higher risk of developing an anxiety disorder in the future. Being raised in a family where fear and anxiety are shown on a constant day to day basis can affect a person in adulthood. The brain and its learned behavior is inherited which is reason enough to believe anxiety is heredity. By changing the way one thinks, and changing thought patterns with Cognitive Behavior Therapy, one can overcome anxiety. Brain chemistry: GAD has been associated with abnormal levels of certain neurotransmitters in the brain. Neurotransmitters are special chemical messengers that help move information from nerve cell to nerve cell. If the neurotransmitters are out of balance, messages cannot get through the brain properly. This can alter the way the brain reacts in certain situations, leading to anxiety. In a large number of

cases, individuals with symptoms of anxiety disorders are usually prescribed medications that change or alter the chemicals of the brain. Because symptoms of anxiety disorders are, in most cases, helped by medication, experts believe that brain chemistry seems to play a part in the trigger of anxiety disorders. Chemical messengers, or Neurotransmitters, in the brain that regulate thought and feeling sometimes have a problem with brain messages sent out because of a chemical imbalance. Two of the primary neurotransmitters that affect thought and feeling are serotonin and dopamine. When these chemicals have an imbalance, one can feel depressed or anxious. Scientific evidence tells us that anxiety-related problems such as stress, panic, and exaggerated fears are the result of a imbalance between the right and left hemispheres of the brain. Positron emission tomography or (PET) scans are being done to study this evidence. Environmental factors: Trauma and stressful events, such as abuse, the death of a loved one, divorce, changing jobs or schools, may lead to GAD. GAD also may become worse during periods of stress. The use of and withdrawal from addictive substances, including alcohol, caffeine, and nicotine, can also worsen anxiety.

Life Experiences: Researchers believe that the relationship between anxiety disorders and a life of abuse, violence, or poverty is grounds for further study, as these life experiences may affect an individual's exposure to these disorders. Experts believe that anxiety is a learned behavior that can be unlearned. Events in childhood may lead to certain fears that, over time, develop into a anxiety disorder. In some cases anxiety can be triggered by caffeine, cocaine, and amphetamines. It is a known fact that cocaine use over time can cause feelings of panic, and this terror often continues for years after the drug is stopped. Exhaustion and other stimulants, and even the side effects of certain medications can cause the symptoms of anxiety. Being taught to hold back negative feelings such as anger, or an excessive need for approval, can also be possible triggers. However, there may be no clear reason why a person feels anxious. It could be a combination of one's personality, the things that have happened to them, or lifechanges such as pregnancy, a new job, or loss of a loved one.

Some people who have the symptoms of anxiety have feelings of being out of control. This might be due to rising debts, along with work or study pressures. For another, anxiety could stem from a stressful situation or experience. Lesson IV: Crisis Theory and Crisis Intervention Exercise#4 a. Have you ever experienced a crisis situation? How did you handle such crisis? One crisis that I will never ever forget would probably when we got affected by the Ondoy typhoon 2 years ago. I live at Marikina and that time our house was submerged in water due to the flood for almost a day. My family was almost trapped inside our house but as soon as the water level was rising, they immediately went to our neighbours house which has three floors in it. We did not get to save anything from the flood. It is still a blessing that my family was safe and nothing happened to them. I was not there physically when that happened because I was at our school (UERMMMCI) during the incident and I was also stranded there. I got scared because we do not have any food and water in there and the flood was really high. You can see the cars moving due to the current of the water and chairs floating in the streets. That is how bad the incident was. I arrived at our house the next day and I found my family cleaning up the mess caused by the flood. All of our things were covered by mud and water as well. But despite what happened, I stayed calm and strong for my family. We took one day at a time in cleaning our house. With the help of my girlfriend and our batch mates, we cleaned the house and tried to fix broken things. They also helped us by giving us their old clothes and also groceries like food and toiletries. We lived each day as normal as possible and we helped each other throughout the crisis. At the same time, we did not forget to pray to God for guidance and support to overcome the obstacle that came our way. b. Have you ever interact with clients in crisis? How did you handle it? I for one have experienced a patient with a crisis. She was a friend of mine and she got pregnant at an early age. That thing happened 3 months before our graduation and she got worried because she might not graduate because of her condition and also at the same time she is concerned to the fact that she will be taking the board exam soon. And her family does not know about it. When I found out what happened to her, I immediately told her that she need not worry because we are there for her without judgment and indifferent treatment. I talked to her of

what happened to her and that she needs to talk to her family because they will help her a lot emotionally, financially and physically. Even if the father of the child is not there for them, at least her family and friends are. I also advised her to talk to the guidance councillor and advisor about her condition because they will surely understand her situation. Another thing is that she needs to talk to other single teen parents who are in the same situation as hers. c. What preparation do you feel would improve your ability to be crisis clinician? Based on what I know, it is better as a crisis clinician to listen attentively and practice good communication skills. It is also better if we do this in every situation that we may be present of. Thinking on positive note would also help as a crisis clinician and not linger on the negative ones. Being pessimistic will not help because it would just result to an uglier situation by making it worse. Starting with yourself will greatly help you as a crisis clinician.