Unit XIII - Treatment of Abormal Behavior Flashcards
(176 cards)
1
Q
psychotherapy
A
treatment involving PSYCHOLOGICAL techniques; consists of INTERACTIONS
between a trained THERAPIST and someone seeking to overcome psychological DIFFICULTIES or achieve personal GROWTH
2
Q
biomedical therapy
A
prescribed MEDICATIONS or PROCEDURES that act
directly on the person’s PHYSIOLOGY
3
Q
How might an illness be treated in psychotherapy?
A
EXPLORE a client’s early RELATIONSHIPS, encourage the client to adopt new ways of THINKING,
or coach the client in replacing old BEHAVIORS with new ones.
4
Q
How might an illness be treated in biomedical therapy?
A
prescribe ANTIDEPRESSANTS for a person with severe depression or may suggest, ELECTROCONVULSIVE SHOCK THERAPY (ECT), or DEEP-BRAIN STIMULATION
5
Q
What is the eclectic approach to psychotherapy?
A
an approach to psychotherapy that uses
techniques from VARIOUS forms of therapy
6
Q
eclectic psychotherapy example
A
therapist may use DREAM INTERPRETATION or FREE ASSOCIATION during sessions (psychoanalytic), but also help you to change your flawed or faulty THINKING PATTERNS (cognitive).
7
Q
What is psychoanalysis?
A
patient’s
free associations, resistances,
dreams, and transferences—and the therapist’s interpretations of them—released previously
repressed feelings, allowing the patient to gain self-insight
8
Q
What are the underlying beliefs of psychoanalysis?
A
I - in therapy, people could achieve HEALTHIER, LESS ANXIOUS living by RELEASING
the energy they had previously devoted to ID-EGO-SUPEREGO CONFLICTS
II - we do not fully know ourselves - REPRESSION
9
Q
How does free association work?
A
Telling the therapist whatever may come to mind in a RELAXED state
10
Q
How does our editing of our thoughts happen?
A
NOTICING certain qualities of thoughts -> trivial, irrelevant, or shameful
Changing topics
11
Q
What is resistance?
A
BLOCKING from
CONSCIOUSNESS of ANXIETY-LADEN material
12
Q
How can an analyst notice resistance?
A
mental BLOCKS & EDITING during free association
ANXIETY -> INSIGHT
13
Q
What is interpretation?
A
analyst’s NOTING supposed
dream meanings, resistances, and other SIGNIFICANT BEHAVIORS and EVENTS in order to promote INSIGHT
14
Q
How might interpretation help with therapy?
A
USED at the RIGHT moment can ILLUMINATE underlying wishes, feeling, & conflicts
15
Q
What is transference?
A
patient’s TRANSFER to the analyst
of EMOTIONS linked with other RELATIONSHIPS
16
Q
How does transference appear in the interaction with your therapist?
A
experiencing strong positive or negative feelings for your analyst
TRANSFERRING feelings experienced in earlier relationships
17
Q
What are some drawbacks to traditional psychoanalysis?
A
RARELY offered
NOT supported by RESEARCH
SUBJECTIVE
EXPENSIVE
18
Q
What is psychodynamic therapy?
A
therapy deriving from the PSYCHOANALYTIC tradition; views individuals as responding to UNCONSCIOUS forces and CHILDHOOD experiences, and seeks to enhance SELF-INSIGHT
19
Q
psychodynamic therapy vs psychoanalysis
A
Don’t talk about id-ego-superego conflicts
Tries to help by FOCUSING on important RELATIONSHIPS,
20
Q
What are some differences in psychodynamic therapy?
A
OCCASIONAL client-therapist meetings
FACE-TO-FACE interactions
EXPLORATION of feelings
21
Q
What are the insight therapies?
A
therapies that aim to IMPROVE psychological
functioning by increasing a person’s AWARENESS of underlying MOTIVES and DEFENSES
22
Q
Insight therapies examples
A
psychodynamic
humanistic
23
Q
In what ways is humanistic therapy different from psychoanalytic therapy?
A
BOOST people’s SELF-FULFILLMENT -> self-awareness and self-acceptance taking IMMEDIATE RESPONSIBILITY PROMOTING GROWTH CONSCIOUS thoughts -> important focuses on PRESENT & FUTURE
24
Q
What is client-centered therapy?
A
humanistic therapy, developed by Carl Rogers, in which the therapist uses techniques such as
ACTIVE LISTENING within an ACCEPTING, GENUINE, EMPATHETIC environment to facilitate clients’ GROWTH
25
Client-centered therapy is non-directive which means
Client leads the discussion
26
What were Carl Roger’s beliefs about growth
MOST people possess resources for GROWTH
| Encourages therapists to exhibit ACCEPTANCE, GENUINENESS, AND EMPATHY.
27
How to help clients achieve the beliefs?
When therapists enable their clients to feel unconditionally ACCEPTED , drop their FACADES and genuinely EXPRESS their true feelings, and EMPATHICALLY sense and reflect their clients’
feelings, the clients may DEEPEN
their self-understanding and self-acceptance.
28
What is active listening?
EMPATHETIC listening in which the listener ECHOES, RESTATES, AND CLARIFIES
29
How does active listening impact modern therapy?
Active listening is now an accepted part of counseling practices in many schools, colleges, and clinics.
30
What is unconditional positive regard?
a CARING, ACCEPTING, NONJUDGMENTAL attitude, which Carl Rogers believed would help clients
DEVELOP SELF-AWARENESS AND SELF-ACCEPTANCE
31
How does unconditional positive regard help people?
people
may accept even their worst traits and feel valued
and whole.
32
How can we listen more actively?
paraphrase
invite clarification
reflect feelings
33
paraphrase
Check your understanding by SUMMARIZING the person’s words out loud, in your own words.
34
invite clarification
“What might be an example of that?” may ENCOURAGE the person
| to say more.
35
reflect feelings
“It sounds frustrating” might MIRROR what you’re sensing from the
person’s body language and intensity.
36
How does behavior therapy differ from psychodynamic and humanistic therapy?
BEHAVIOR THERAPISTS assume that PROBLEM BEHAVIORS ARE THE PROBLEMS.
37
How does insight therapies expect people's problem to diminish?
By gaining INSIGHT into their unresolved
| and UNCONSCIOUS tensions and as people get in touch with their FEELINGS.
38
How can maladaptive behaviors be learned?
Humans LEARN behaviors & emotions through CLASSICAL CONDITIONING
39
Learned maladaptive behvaiors includes ...
phobias, anxiety, depression
40
What is counterconditioning?
behavior THERAPY procedures that use classical CONDITIONING to evoke new responses to STIMULI that are triggering UNWANTED behaviors
41
Counterconditioning includes ...
exposure therapies and aversive conditioning.
42
Pairing the fear-provoking stimulus with new, positive responses can
can change the behavior.
43
What are exposure therapies?
behavioral techniques that treat anxieties by EXPOSING people
(in imaginary or actual situations)
to the things they FEAR AND AVOID
44
Exposure therapies includes
desensitization and virtual reality exposure therapy
45
Exposure therapies try to change people's reaction by
repeatedly exposing them to
stimuli that trigger unwanted reactions.
ADAPTATION
46
What is systematic desensitization?
a type of exposure therapy that ASSOCIATES a PLEASANT relaxed state with GRADUALLY increasing
ANXIETY- triggering stimuli
47
What is one way systematic desensitization can be used?
develop an anxiety HIERARCHY of stimuli that are causing fear and help the patient to WORK through each step on the hierarchy,
48
How does systematic desensitization work?
flying phobia
I -> relax when looking at airline sale ads
II -> relax when driving by airport
III -> relax when visiting museum of aircraft
EVENTUALLY, patient sit on plane
49
What is virtual reality exposure therapy?
a counterconditioning
technique that treats anxiety through CREATIVE ELECTRONIC SIMULATIONS in which people can SAFELY face their GREATEST fears
50
How does virtual reality exposure therapy work?
Wears VR goggles
| VIVID simulations of feared stimuli
51
What is aversive conditioning?
type of counterconditioning that associates an UNPLEASANT STATE with an UNWANTED BEHAVIOR
52
Aversive conditioning example
treat nail biting, the therapist may suggest painting the fingernails with a nasty-tasting nail polish.
53
How does aversion therapy work?
```
Drug = US -> nausea = UR
Alcohol = NS + Drug = US -> UR = nausea
Alcohol = CS -> Nausea = CR
```
54
What is behavior modification?
REINFORCING behaviors considered DESIRABLE, and FAILING to reinforce—or sometimes PUNISHING—behaviors considered UNDESIRABLE
55
How do therapists practice behavior modification?
In a step-by-step manner, they rewarded closer and
| closer approximations of the desired behavior.
56
What research has been conducted on behavior modification?
19 withdrawn, uncommunicative 3-year-olds with AUTISM
| Parents ATTEMPTED to shape BEHAVIOR by positively reinforcing desired behaviors/ ignoring negatived behaviors
57
What were the results of the study?
By first grade, 9 of the 19 were functioning successfully in school and exhibiting normal intelligence.
Compared to 40 autistic children not undergoing treatment, only one showed similar improvement
58
What is a token economy?
OPERANT conditioning procedure in which people earn a TOKEN for exhibiting a DESIRED behavior and
can later exchange tokens for PRIVILEGES or treats
59
What can be used as a token?
a chip, stamp or other non-monetary item
60
What are two criticisms of behavior modification?
How DURABLE are the behaviors? -> DEPENDENCY on EXTRINSIC rewards
Is it RIGHT for one human to control another’s behavior? -> FREEDOM to choose
61
What is cognitive therapy?
therapy that teaches people new, more ADAPTIVE ways of THINKING
62
Cognitive therapy is based on the assumption that thoughts ...
INTERVENE between EVENTS and our emotional REACTIONS
63
What is the cognitive perspective on psychological disorders?
The person’s emotional reactions are produced NOT directly by the EVENT but by the person’s
THOUGHTS in RESPONSE to the event.
64
How can internal beliefs so that two outcomes are possible from losing a job?
I- I'm worthless. It's hopeless. -> DEPRESSION
| II - It wasn't a good fit. I deserve something better. -> NO DEPRESSION
65
What is rational-emotive behavior therapy (REBT)?
CONFRONTATIONAL cognitive therapy, developed
by Albert Ellis, that VIGOROUSLY CHALLENGES people’s ILLOGICAL, SELF-DEFEATING attitudes and
assumptions
66
According to Albert Ellis, many problems arise from
IRRATIONAL THINKING
67
How has Aaron Beck contributed to the field?
Realized CHALLENGING people's automatic NEGATIVE thoughts could be THERAPEUTIC
CHANGING people's THINKING can change their FUNCTIONING
68
What is catastrophizing?
relentless,
| overgeneralized, self-blaming behavior
69
Catastrophizing before the test
"This test’s probably going to be impossible. Everyone seems so relaxed and confident. I wish I were better prepared. I’m so nervous I’ll forget everything.”
70
What cognitive therapy techniques reveal beliefs?
I ->Questioning interpretations
| II ->Ranking thoughts & emotions
71
What cognitive therapy techniques test beliefs?
I -> Examining consequences
| II -> Decatastrophize thinking
72
What cognitive therapy techniques change beliefs?
I -> Taking appropriate responsibility
| II -> Resisting extremes
73
Questioning interpretations example
EXPLORE beliefs, revealing FAULTY assumptions
74
Ranking thoughts & emotions
GAIN perspective by ranking thoughts & emotions from MILDLY to EXTREMELY upsetting
75
Examining consequences
EXPLORE difficult situations, ASSESS possible consequences and challenging FAULTY reasoning
76
Decatastrophize thinking
Work through actual WORST-CASE consequences of situation you face to COPE with real situation you face
77
Take appropriate responsibility
CHALLENGE total self-blame/ NEG thinking, noting aspects of responsibilities/ not responsibilities
78
Resisting extremes
DEVELOP new ways of thinking & feeling to replace MALADAPTIVE habits
79
What is cognitive-behavioral therapy (CBT)?
a popular INTEGRATIVE therapy that combines COGNITIVE
| therapy (changing self-defeating thinking) with BEHAVIOR therapy (changing behavior)
80
How do cognitive therapists help people with eating disorders?
guide people toward NEW ways of EXPLAINING their GOOD and BAD experiences
81
new way of explaining experiences example
Recording positive events and enabling them, people may be more MINDFUL/ SELF-CONTROLLING/ OPTIMISTIC
82
What is group therapy?
therapy conducted with GROUPS rather than individuals, providing benefits from GROUP INTERACTION
83
What is family therapy?
therapy that treats people in the context of their FAMILY SYSTEM AND VIEWS an individual’s UNWANTED behaviors as influenced by, or directed at, other family members
84
.What are the benefits of group therapy?
Helps MORE people
CHEAPER
FEEDBACK
CONNECTIONS
85
What are the benefits of family therapy?
COMMUNICATION
New ways of resolving/ preventing conflicts
IDENTIFY roles in social system
86
What are self-help groups?
SMALL religious, interest, or support groups that meet REGULARLY—with 9 in 10 reporting that group members “support each other emotionally
87
What is the evidence that psychotherapy works?
90% of the 2900 Consumer Reports readers who related their experiences with mental health professionals were at least “fairly well satisfied.”
Among those who recalled feeling fair or very poor when beginning therapy, 9 in 10 now were feeling “very good, good, or at least so-so.”
88
What reasons do critics note to be skeptical of the success of psychotherapy?
People credit therapy and not PASSING OF TIME for crisis management
PLACEBO EFFECT of therapy
Clitents want to BELIEVE therapy was wotht time and effort
SPEAK KINDLY of therapists
89
Do clinicians (psychologists) believe psychotherapy works?
psychotherapist claims may also be subject to HUMAN BIAS. As with other enduring questions, psychologists turn to RESEARCH.
90
What is meta-analysis?
procedure for STATISTICALLY COMBINING the results
| of many DIFFERENT research studies
91
In meta-analysis, researchers uses
hundreds of similar studies and summarize the data using statistics to paint a larger picture.
92
What does meta analysis show about the success of psychotherapy?
80% of untreated people have poorer outcomes than average treated person
93
Does psychotherapy actually work?
Those not undergoing therapy often improve, but those undergoing therapy are MORE LIKELY to improve—and to improve more quickly and with less risk of relapse.
94
Which disorders respond favorably to therapy?
SPECIFIC PROBLEMS, PHOBIAS, PANIC, unassertive personality has a better chance of resolution
DEPRESSION/ANXIETY -> relapse later
95
Which therapies seem most effective with which disorders?
Cognitive and cognitive-behavioral therapies—anxiety, PTSD, insomnia,
and depression.
Behavioral conditioning therapies— specific behavior problems,phobias, compulsions, marital problems, and
sexual dysfunctions.
96
Which additional therapies seem most effective with which disorders?
Psychodynamic therapy— depression and anxiety
Nondirective (client-centered) counseling—
mild to moderate depression
97
What is evidence-based practice?
clinical decision making that INTEGRATES the best available RESEARCH with clinical EXPERTISE
and patient CHARACTERISTICS and PREFERENCES
98
How does clinicians use evidence-based practice?
After rigorous evaluation, clinicians apply therapies suited to their own skills and their patients’ unique situations.
99
What is evidence-based clinical decision making?
Based on three ASPECTS:
research evidence
clinical expertise
knowledge of the patient.
100
What is eye movement desensitization and reprocessing (EMDR)?
client pulls back TRAUMATIC memories and simultaneously focus on EXTERNAL stimuli or an external focal point
101
What do skeptics state about the alternative therapy EMDR?
what is THERAPEUTIC is NOT the eye movements
| but combination of EXPOSURE THERAPY / PLACEBO EFFECTS
102
What is light exposure therapy?
give people a timed daily dose of intense light.
103
What research has been conducted on light exposure therapy?
One study exposed some people with a seasonal
pattern in their depression symptoms to 90 minutes of bright light and others to a sham placebo treatment—a hissing “negative ion generator” that was just producing white noise.
104
What were the results?
After four weeks, 61% of those exposed to morning light had greatly improved, as had 50% of those exposed to evening light and 32% of those exposed to the placebo.
105
Does light exposure therapy actually work?
Studies have shown that 30 minutes of morning exposure to 10,000-lux white fluorescent light produces relief for most depressed people.
106
What three benefits do all psychotherapies share?
Hope
New perspective
Empathetic, trusting, caring relationship
107
Hope
any psychotherapy offers the expectation that, with COMMITMENT from the therapy seeker, things can and will get BETTER.
108
A new perspective
: every therapy offers people a PLAUSIBLE EXPLANATION of their symptoms.
109
An empathetic, trusting, caring relationship
effective therapists are empathetic. They seek to understand the
client’s experience. They communicate care and concern, and they earn trust through respectful listening, reassurance, and guidance.
110
What is a therapeutic alliance?
a bond of TRUST and MUTUAL UNDERSTANDING between a therapist and client,
who work together CONSTRUCTIVELY
to OVERCOME the
client’s problem
111
What should a person look for when selecting a therapist?
Treatment approach
Values
Credentials
Prices
112
How does culture impact the client-therapist relationship?
Western -> individualism -> personal desires/ identity
| Asian -> collectivism --> trouble thinking about own well-being
113
Why might clients not seek therapy?
Admission to weakness
| Minority groups-> reluctant to seek therapy/ quick to leave it
114
Why might the therapist and the client be mismatched?
Religious values -> important when connecting with therapists
115
When should a person seek therapy?
```
Hopelessness
Depression
Self-destructive behavior
Disruptive fears
Sudden mood shifts
Suicide
Compulsive rituals
Hallucinations/ Delusions
```
116
What training do clinical psychologists undergo?
Ph. D or Psy. D
Internship
Training
117
What training do psychiatrists undergo?
Prescribing medications
Might have training in psychotherapy
Most serious patients
118
What training do clinical/ psychiatric social workers undergo?
2 year master social work graduate program/ post-grad supervisions
119
What training do counselors undergo?
Marriage/ family -> family relations
Clergy -> ambiguous
Abuse -> Substance/ domestic
Master's degrees needed
120
What is a lifestyle
```
Exercise
nutrition
relationships
recreation
relaxation
religious/ spiritual engagement
```
121
how does a lifestyle
| impact mental health?
Influences BRAIN & BODY
| Affect MENTAL HEALTH
122
How were humans designed?
Physical activity
Social engagement
Group activities
123
How important is physical activity?
outdoor activity in a natural environment reduces stress and promotes health.
124
How important is aerobic activity?
INCREASES fitness/ vitality
stimulates ENDORPHINS
Rivals healing power of anti-depressant drugs
At least 3 times weekly for 30 minutes
125
examples of aerobic activities
```
basketball
walking
running
swimming
soccer ball
```
126
How important is socializing?
Less alone time and at least two meaningful social engagements weekly helps satisfy human need to belong
127
How important is sleep?
Goal of 7 to 8 hours/ night
INCREASES energy/ alertness/ boosts immunity
IMPROVE mood/ energy
128
Do lifestyle changes help relieve depression?
An initial study showed that participants engaging in lifestyle change therapy experienced relief from depressive symptoms.
129
What is psychopharmacology?
study of the effects of drugs on mind and behavior
130
How did psychopharmacology impact mental health institutions?
resident population of U.S. state and
| county mental hospitals is now a small fraction of what it was in the mid-twentieth century.
131
How was psychopharmacology initially received?
Almost any new treatment, including drug therapy, is greeted by an initial wave of enthusiasm as many people apparently improve.
132
What are antipsychotic drugs?
drugs used to treat schizophrenia and other forms of severe thought disorder
133
How do antipsychotic drugs work?
By dampening responsiveness to irrelevant stimuli
| Helped the most with those experiencing auditory hallucinations/ paranoia
134
What are some side effects of antipsychotic medication?
sluggishness, tremors,
| and twitches similar to those of Parkinson’s disease
135
Long term use of antipsychotics can produce
tardive dyskinesia, with involuntary movements of the facial
| muscles (such as grimacing), tongue, and limbs.
136
What is the impact on dopamine from antipsychotic medications?
Antipsychotic drugs act as an antagonist
| for dopamine. -> occupying receptor sites
137
What are antianxiety drugs?
drugs used to control anxiety and agitation
138
How do antianxiety drugs work?
By depressing the CNS activity
139
How can antianxiety drugs work to help those with PTSD and OCD?
Used in combo with therapy to enhance exposure to extinction of learned fears
140
What are anti depressant drugs?
drugs used to treat depression, anxiety disorders, OCD, and PTSD
141
How do anti depressant drugs work?
increasing the AVAILABILITY
| of neurotransmitters, such as norepinephrine or serotonin, which ELEVATE arousal and mood
142
What are SSRI’s
Selective serotonin reuptake inhibitors
| Widely used antidepressant drugs
143
What is the function of SSRI's?
by prolonging the time serotonin molecules
| remain in the brain’s synapses.
144
Common examples of SRI's
Prozac, Zoloft and Paxil
145
How does neural transmission with serotonin typically work?
Neural message sent across synaptic gap with release of serotonin/ received in receptor sites on post-synaptic neuron
Excess serotonin is reabsorbed in reuptake
146
How does Prozac work?
partially blocks normal reuptake of the neurotransmitter serotonin; excess serotonin in synapse enhances its mood-lifting effect.
147
What do double-blind trials regarding the placebo effect?
placebos produced improvement comparable to about 75 percent
| of the active drug’s effect.
148
How does the placebo effect impact those with severe depression?
the placebo effect is less and the added drug benefit somewhat greater
149
Considering the placebo effect, what is the recommendation for use of antidepressants?
LIMITED antidepressant use
LAST RESORT
as there are alternatives
150
What are mood-stabilizing drugs?
help to control the manic, out-of-control feelings that often come with bipolar or other disorders
151
Examples of mood-stabilizing drugs
Depakote
| Lithium
152
What does research show about the benefits of lithium?
About 70% of those with bipolar disorder benefit from long term daily dose
Correlates with lower risk of suicide among those with BP disorder
153
What is electroconvulsive shock therapy (ECT)?
a BIOMEDICAL therapy for severely depressed patients in which a brief electric CURRENT is sent through the
BRAIN of an anesthetized patient
154
How does ECT procedures work?
General anesthetic/ muscle relaxant given
Brief pulse of electrical current -> 30 to 60 second seizure
No memory
155
How effective is ECT?
the results of ECT in treating severe depression are among the MOST positive
treatment effects in all of medicine
156
What is transcranial direct current stimulation (tDCS)?
Only administers a weak 1- to 2-milliamp current to the scalp
Can be considered to be a treatment to depression
157
How does tDCS work??
The psychiatrist applies a weak current to the scalp.
158
What is repetitive transcranial magnetic stimulation (rTMS)?
the application of repeated pulses of magnetic energy to the brain; used to stimulate or suppress
brain activity
159
Conditions of rTMS?
performed on wide-awake patients over several weeks
| No side effects besides headaches
160
How does rTMS work?
The psychiatrist sends a painless magnetic field through the skull
to the surface of the cortex to alter brain activity.
161
What is deep-brain stimulation (DBS)?
experimental treatment pinpointing a neural hub that bridges the thinking frontal lobes to the limbic system.
162
Helen Mayberg 2003 DBS
treat some 200 depressed patients via implanted electrodes in the subcallosal cingulate, a brain area that functions as the neural “sadness center.”
163
Is there a depression switch?
Helen Mayberg identified a brain area that appears active in people who are depressed or sad, and whose activity may be calmed by deep-brain stimulation.
164
How does DBS work?
Psychiatrist stimulates electrodes
| implanted in “sadness centers” to calm those areas.
165
What is psychosurgery?
surgery that removes or destroys brain tissue in
| an effort to change behavior
166
Why is psychosurgery the last biomedical intervention?
Effects are irreversible
167
What is a lobotomy?
a psychosurgical procedure once used to calm
| uncontrollably emotional or violent patients
168
How does a lobotomy work?
By cutting the nerves connecting the frontal lobes with emotion-controlling centers of inner brain calmed patients.
169
Rosemary Kennedy
Failed lobotomy
confined to a hospital with an infantile mentality
until her death in 2005 at age 86.
170
Is psychosurgery still used today?
Precise, micro-scale psychosurgery is sometimes used in extreme cases such as uncontrollable seizures.
171
What is the traditional thinking regarding disorders?
Therapies tend to LOCATE CAUSE of disorders within a person- > LABELING & DISTINGUISHING these people -> TREATMENT
172
What is the societal change viewpoint?
Disorders as responses to a disturbing and stressful society.
Prevent a problem by REFORMING an unhealthy situation and developing COPING COMPETENCIES
173
What is resilience?
the personal strength that helps most people cope with stress and recover from adversity
and even trauma
174
Resilience in 9/11 attack
More than 9 in 10 New Yorkers, although stunned and grief-stricken by 9/11, did not have a dysfunctional stress reaction.
175
What is posttraumatic growth?
positive psychological changes as a result
| of struggling with extremely challenging circumstances and life crises
176
posttraumatic growth in cncer survivors
reported a greater appreciation for life, more meaningful relationships, increased personal strength, changed priorities, and a richer spiritual life.
