Sebuah Jurnal Teori Kaunseling : Mengubah Pemikiran, Emosi dan Tindakan Harian dengan Fokus terhadap Pembangungan Diri

Author  : Muhammad Afiq Shahiri Bin Sapie

Date      : 18/11/2023
Volume : (2) 1-4
Subject  : Sebuah Jurnal Teori Kaunseling :  Mengubah Pemikiran, Emosi dan Tindakan Harian dengan Fokus terhadap Pembangungan Diri, University of UNITAR

A journal of subject theory of counselling : Applying individual psychology theory to My daily life

 Author  : Muhammad Afiq Shahiri Bin Sapie (MC210915114)
Date    : 18/10/2023
Volume  : (3) 1-4
Subject  : A journal of subject theory of counselling :  Applying individual psychology theory to My daily life, University of UNITAR

Ipoh, Perak

Mengaplikasikan teori psikologi individu dalam kehidupan seharian saya

     Adler dikaitkan dengan perkembangan teori psikologi individu, yang memberikan pandangan baru tentang psikologi manusia di samping menyediakan alat berguna untuk pembangunan dan kemajuan peribadi. Teori ini menggalakkan individu untuk menyiasat idea, perasaan, dan tingkah laku mereka sendiri dan memberi penekanan kepada kepentingan memahami orang itu dalam konteks persekitaran sosial mereka. Dengan memasukkan konsep-konsep ini ke dalam aktiviti harian kita, kita boleh membangunkan pemahaman yang lebih mendalam tentang siapa kita dan membuat pelarasan membina yang akan menyumbang kepada peningkatan kesihatan kita. Adalah menjadi harapan saya bahawa dengan mendekati proses penemuan diri dalam rangka teori psikologi individu alfred adler, saya akan dapat memperoleh pemahaman yang lebih mendalam tentang interaksi antara idea, emosi dan tingkah laku saya.

    Penyiasatan saya dibuat berdasarkan latar belakang tumpuan adler pada pencarian kepentingan dan kepentingan peristiwa awal pada pembentukan personaliti. Matlamat saya menyimpan diari ini adalah untuk menyimpan rekod pengalaman harian saya, menggabungkan konsep dari psikologi individu untuk mendapatkan pengetahuan yang lebih baik tentang siapa saya dan untuk menggalakkan perkembangan peribadi saya sendiri.rujukan.

      Memahami maksud menjadi lebih rendah sambil berusaha untuk menjadi penting:

    Saya telah menggabungkan konsep teori ini ke dalam idea peribadi saya sendiri tentang teori psikologi individu untuk membantu saya menavigasi melalui tinggi dan rendah yang merupakan sebahagian daripada kehidupan seharian saya. Saya mempraktikkan idea ini dengan menjalankan analisis mendalam tentang pemikiran saya sendiri. Menurut adler, cara kita secara peribadi mentafsir peristiwa mempunyai kesan yang besar terhadap perasaan dan tingkah laku yang kita alami. Saya dapat menghadapi pemikiran negatif saya dan menyusun semula mentaliti saya supaya saya boleh mengembangkan idea yang lebih positif dan membina dengan menyedari corak pemikiran kebiasaan saya dan mencabarnya.

        Sebagai contoh, jika saya merasakan bahawa saya sentiasa bimbang tentang keadaan yang berada di luar kawalan saya, saya akan mengingatkan diri saya tentang penekanan adler untuk menumpukan perhatian pada aspek kehidupan yang saya kuasai dan akan cuba mengalihkan perhatian saya ke sana. Ini membantu saya memfokuskan semula perhatian saya untuk mencari penyelesaian kepada masalah dan mengambil usaha proaktif ke arah mencapai objektif saya. Oleh kerana saya sedar tentang kaitan yang wujud antara idea dan perasaan saya, saya dapat mewujudkan sikap yang lebih positif dan lebih berjaya menguruskan tekanan saya.

        Hari ini, saya memikirkan beberapa contoh dari sejarah saya yang mungkin menjadi faktor dalam pembangunan kompleks rendah diri. Menurut teori psikologi individu, peristiwa formatif mempunyai kesan yang mendalam terhadap persepsi individu tentang siapa mereka. Saya melihat kembali ingatan awal saya dan melihat corak yang mungkin mempunyai peranan dalam membentuk idea saya sekarang. Menyedari asal usul ini adalah langkah pertama dalam memfokus semula usaha saya untuk mencari kepentingan dengan cara yang lebih bermanfaat dan membantu untuk diri saya dan orang lain.

        Penilaian cara hidup anda dan perasaan anda:

        Saya meneliti rutin dan tingkah laku harian saya berdasarkan tanggapan adler bahawa gaya hidup seseorang adalah cerminan keperibadian mereka, dan saya membuat kesimpulan bahawa saya harus menjalankan penilaian gaya hidup. Adakah keputusan yang saya buat adalah selaras dengan kepentingan yang ingin saya capai? Saya menentukan bidang yang saya perlukan untuk membuat perubahan untuk membentuk cara hidup yang bukan sahaja membantu untuk mencapai objektif utama rekaan saya tetapi juga menggalakkan kesejahteraan keseluruhan saya.

    Memahami kesan yang dimainkan oleh emosi kita dalam mempengaruhi pilihan yang kita buat adalah satu lagi komponen teori psikologi individu yang saya praktikkan dalam kehidupan seharian saya. Emosi adalah petunjuk penting tentang kehendak dan aspirasi kita, oleh itu adalah penting untuk memberi perhatian kepada mereka. Apabila saya memberi perhatian kepada reaksi emosi saya, saya menjadi lebih berhubung dengan sentimen terdalam saya, dan sebagai hasilnya, saya dapat membuat pertimbangan yang berpendidikan yang berdasarkan keinginan tulen saya dan bukannya bertindak terburu-buru dalam bertindak balas terhadap situasi.

    Amalan muhasabah diri yang kerap telah mengajar saya untuk menerima malah menghargai perasaan saya serta melihatnya sebagai sumber maklumat yang penting. Saya membuat satu titik untuk tidak mengabaikan atau menekan perasaan saya; sebaliknya, saya memberi kebenaran kepada diri saya untuk merasakannya sepenuhnya dan mengatasinya dengan cara yang seimbang. Oleh kerana itu, saya dapat bertindak balas terhadap kesukaran dan kesenangan hidup seharian dengan cara yang lebih tulen dan membantu.

       Keprihatinan terhadap masyarakat dalam aktivitinya:

        S

elain itu, teori psikologi individu menekankan kepentingan hubungan interpersonal. Orang dan tempat di sekeliling kita membentuk dan memaklumkan siapa kita. Menggunakan idea ini sebagai panduan, saya berusaha untuk bertemu orang baharu dan mengekalkan rangkaian interaksi yang menggalakkan kesihatan dan kebahagiaan saya. Untuk memupuk pembangunan saya sendiri dan mengekalkan dorongan saya, saya meletakkan diri saya dalam syarikat orang lain yang berfikir dan berusaha dengan cara yang sama seperti yang saya lakukan. Tumpuan Adler pada minat sosial menggalakkan saya menonton interaksi saya dengan orang lain hari ini. Adakah saya mewujudkan hubungan yang bermanfaat? Adakah saya memberi kesan positif kepada orang di kawasan kejiranan saya? Mengambil bahagian dalam aktiviti sosial bukan sahaja membuat perbezaan positif dalam kehidupan orang lain, tetapi juga membantu saya berasa lebih terhubung dengan dunia dan lebih puas dalam kehidupan saya sendiri.

        Kesimpulannya, dengan mengaplikasikan teori psikologi individu dalam kehidupan seharian saya, saya telah belajar tentang diri saya dan membina kaedah untuk meningkatkan kesejahteraan saya. Pendekatan ini menyokong refleksi dan perkembangan diri dengan memberi tumpuan kepada pemikiran, emosi dan tingkah laku. Saya telah mengatasi masalah hidup dengan daya tahan dan kejujuran dengan mempersoalkan corak pemikiran negatif, menerima emosi dan membina hubungan yang menyokong. Teori psikologi individu telah mendedahkan hubungan kompleks antara idea, emosi dan tingkah laku saya. Memahami pencarian saya untuk makna, menghargai pengalaman awal, dan membina minat sosial secara aktif sedang mewujudkan rangka kerja untuk pembangunan peribadi dan kewujudan yang lebih bermanfaat. Diari ini menunjukkan dedikasi saya terhadap psikologi individu dan mengejar makna.

Jurnal terbitan berkala : Gangguan Personaliti di Kalangan Rakyat Malaysia | Personality Disorders in Malaysia

Gangguan Personaliti di Kalangan Rakyat Malaysia

Penerbit: Afiq Shahiri 7 June 2023 

Gangguan personaliti merupakan satu keadaan mental yang dicirikan oleh corak pemikiran, perasaan, dan tingkah laku yang berbeza daripada norma masyarakat dan kekal dalam jangka masa panjang. Ia boleh menjejaskan fungsi harian dan hubungan interpersonal seseorang individu. Di Malaysia, kesedaran tentang gangguan ini semakin meningkat, namun masih terdapat banyak stigma dan salah faham mengenainya.

Jenis-jenis Gangguan Personaliti

Menurut Manual Diagnostik dan Statistik Gangguan Mental (DSM-5), gangguan personaliti boleh diklasifikasikan kepada beberapa kategori utama:

1. Gangguan Personaliti Klasifikasi A (Eksentrik atau Aneh):

   • Paranoid: Mempunyai kepercayaan bahawa orang lain berniat jahat atau tidak boleh dipercayai.
   • Schizoid: Mengelakkan hubungan sosial dan tidak menunjukkan banyak emosi.
   • Schizotypal: Memiliki pemikiran atau kelakuan aneh dan percaya pada perkara yang luar biasa.

2. Gangguan Personaliti Klasifikasi B (Dramatik, Emosional atau Tidak Stabil):

   • Antisosial: Tidak mengambil kira hak atau perasaan orang lain.
   • Borderline: Emosi yang tidak stabil, imej diri yang kabur, dan hubungan yang tidak tetap.
   • Histrionik: Sentiasa mencari perhatian dan cenderung dramatik.
   • Narsistik: Mempunyai perasaan kepentingan diri yang berlebihan dan memerlukan penghargaan berterusan.

3. Gangguan Personaliti Klasifikasi C (Cemas atau Takut):

   • Avoidant: Mengelak daripada situasi sosial kerana rasa takut terhadap kritikan atau penolakan.
   • Dependent: Bergantung secara berlebihan kepada orang lain untuk membuat keputusan dan memenuhi keperluan diri.
   • Obsessive-Compulsive: Terlalu fokus kepada kesempurnaan, peraturan, dan kawalan.

Faktor Penyumbang di Malaysia

Terdapat pelbagai faktor yang boleh menyumbang kepada perkembangan gangguan personaliti di kalangan rakyat Malaysia:

1. Budaya dan Sosial:

   • Tekanan sosial dan harapan budaya yang tinggi, seperti kepentingan keluarga dan kejayaan akademik, boleh mencetuskan atau memperburuk gangguan personaliti.
   • Stigma sosial terhadap gangguan mental menyebabkan ramai individu tidak mendapatkan bantuan yang diperlukan.

2. Ekonomi:

   • Kesempitan hidup dan tekanan ekonomi boleh mempengaruhi kesejahteraan mental seseorang.
   • Perubahan pantas dalam ekonomi negara turut memberi kesan kepada kestabilan emosi dan psikologi rakyat.

3. Keluarga dan Persekitaran:

   • Pengalaman zaman kanak-kanak yang negatif, seperti penderaan atau pengabaian, boleh menyumbang kepada perkembangan gangguan personaliti.
   • Dinamika keluarga yang disfungsional juga boleh menjadi faktor risiko.

4. Genetik dan Biologi:

   • Faktor genetik mungkin memainkan peranan dalam perkembangan gangguan personaliti, di mana sejarah keluarga dengan gangguan mental boleh meningkatkan risiko.

Prevalensi dan Cabaran dalam Penjagaan

Kajian menunjukkan bahawa gangguan personaliti agak umum di kalangan rakyat Malaysia, namun prevalensinya sering diabaikan atau disalah tafsir sebagai masalah sosial atau moral. National Health and Morbidity Survey (NHMS) pada tahun 2015 mencatatkan bahawa sekitar 29.2% rakyat Malaysia mengalami masalah kesihatan mental, yang termasuk pelbagai jenis gangguan personaliti.

Cabaran utama dalam menangani gangguan personaliti di Malaysia termasuk:

1. Kekurangan Kesedaran dan Pendidikan:

   • Masih terdapat banyak salah faham dan kurang pengetahuan tentang gangguan ini.
   • Usaha pendidikan awam masih kurang, menyebabkan kesedaran masyarakat terhadap isu ini berada pada tahap yang rendah.

2. Akses kepada Rawatan:

   • Kekurangan sumber dan kemudahan perubatan untuk rawatan kesihatan mental di kawasan luar bandar.
   • Kurangnya pakar psikologi dan psikiatri yang terlatih dalam menangani gangguan personaliti.

3. Stigma dan Diskriminasi:

• Individu dengan gangguan personaliti sering berhadapan dengan stigma dan diskriminasi, yang menyukarkan mereka untuk mendapatkan bantuan atau rawatan.
• Tanggapan negatif masyarakat terhadap gangguan mental menghalang mereka daripada mendapatkan sokongan yang diperlukan.

Intervensi dan Sokongan

Untuk mengatasi masalah gangguan personaliti di kalangan rakyat Malaysia, beberapa langkah boleh diambil:

1. Meningkatkan Kesedaran dan Pendidikan:

   • Melalui kempen kesedaran awam dan program pendidikan di sekolah untuk mengurangkan stigma dan meningkatkan pemahaman mengenai gangguan personaliti.
   • Penglibatan media dalam menyebarkan maklumat yang betul dan mengurangkan stereotaip negatif tentang gangguan ini.

2. Memperbaiki Akses kepada Rawatan:

   • Meningkatkan bilangan pakar kesihatan mental dan kemudahan di seluruh negara, terutamanya di kawasan luar bandar.
   • Menyediakan latihan untuk profesional kesihatan agar mereka lebih bersedia untuk menangani kes gangguan personaliti.

3. Menyokong Keluarga dan Komuniti:

   • Menyediakan sokongan dan sumber untuk keluarga dan individu yang terjejas, seperti kumpulan sokongan dan perkhidmatan kaunseling.
   • Menggalakkan persekitaran yang inklusif dan penyayang dalam komuniti untuk membantu individu yang menghadapi gangguan personaliti.

4. Mengembangkan Polisi dan Sokongan Kerajaan:

   • Kerajaan perlu menggubal dasar yang menyokong penjagaan kesihatan mental yang komprehensif dan mudah diakses.
   • Meningkatkan pembiayaan dan sumber untuk program kesihatan mental di seluruh negara.

Gangguan personaliti adalah isu yang signifikan dan memerlukan perhatian serius di Malaysia. Dengan meningkatkan kesedaran, memperbaiki akses kepada rawatan, mengurangkan stigma, dan menyediakan sokongan yang berkesan, kita boleh membantu mereka yang terjejas oleh gangguan ini untuk menjalani kehidupan yang lebih baik dan lebih bermakna. 

Rujukan 

1. American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). American Psychiatric Association.
2. Institute for Public Health. (2015). National Health and Morbidity Survey (NHMS) 2015. Ministry of Health Malaysia.
3. Teoh, H. J., & Rose, P. (2001). Child mental health: An integrated approach to the planning and delivery of services with respect to culturally diverse communities. Asia Pacific Journal of Social Work and Development, 11(2), 80-91.

PERKONGSIAN KHAS : KAJIAN KES UNTUK JURNAL "Persuasion Knowledge in the Marketplace: A Meta-Analysis" DAN "For Women in Advertising, It’s Still a ‘Mad Men’ World."

Journal 1

Persuasion Knowledge in the Marketplace: A Meta-Analysis

Written by: Martin Eisend & Farid Tarrahi

First published: 09 June 2021 https://doi.org/10.1002/jcpy.1258 Citations: 4

 

Introduction – Case Study

    This study relies on the notion of persuasion to anticipate reactions to marketers' attempts to convince customers with varying levels of persuasion expertise. The report includes a meta-analysis of the findings from 148 studies and 171 separate data sets. Persuasion knowledge effects are significant when compared to persuasion attempts, but it cannot suppress or eliminate persuasion effects in the marketplace since it only reaches roughly 50% of the explanatory power of persuasion. The impacts of persuasion knowledge on assessments and coping are dependent on the parameters of the persuasive process. All persuasion factors assist customers in identifying and better understanding benefits not just for themselves, but also for marketers and how marketers realize those benefits.

 

Discussion

    According to Campbell & Kirmani in their 2008 research in terms of the substance and structure of persuasion knowledge effects, research shows that persuasion knowledge enhances consumers' coping reactions and leads to fewer positive ratings. Additionally, other studies indicate that the persuasive impact is not as positive. However, other studies claim that they have discovered a wide range in the impact of persuasive information and that in some circumstances, it may even result in a favourable assessment of the persuasive agent.

    Other than that, we go to another side of researchers said consumers' understanding and opinions about marketers' attempts at persuasion, as well as their motivations and strategies behind those efforts, are referred to as their level of persuasion knowledge. It is the notion of persuasion is at the heart of persuasion knowledge, thus knowing what persuasion comprises is necessary to define persuasion knowledge. The prevalent understanding of persuasion is that it is a deliberate attempt through communication to influence a recipient who has some degree of freedom of choice, despite the fact that there are several definitions, conceptualizations, and persuasion models. In conclusion, persuasiveness in business is advantageous to all parties involved, including the sender and the influencer This, together with persuasive expertise, is a typical assumption in persuasion models.

    After that, we also want to take you to another angle to think about the definition of the concept of persuasion, knowledge of persuasion can apply to and have an impact on results that the influencer either intends or does not intend. This means the judgments, intentions, behaviour, and recollections of customers that are connected to a brand, a channel, or a company are referred to as the influencers' desired results in a marketing setting. If customers learn persuasive strategies that are advantageous to both them and the marketer, and if they notice that marketers employ potentially manipulative tactics and may even be trying to limit consumers' options. Finally, they found out that This overwhelming response is the result that the marketer did not intend. they develop resilience and response to persuasion results.

 

Jakarta 2022

Article critique

From the Journal sentence criticism 1: In this study, we refer to the concept of persuasion to systematize consumer responses triggered by persuasion knowledge and to identify relevant moderators of persuasion knowledge effects.

    In my point of view, this journal should provide a comprehensive study, in terms of the response of persuasion in marketing. This is because it can happen in many forms and persuasive advertising can be quite impersonal, unlike direct sales, when the salesperson often talks one-on-one with the consumer. Advertisers can only customize advertising so much without compromising their mass appeal because they want their ads to reach as many potential customers as possible.

From the Journal sentence criticism 2: Insights about persuasion knowledge effects are of interest to researchers, marketers, consumers, and public policymakers because they carry major implications for marketing actions’ effectiveness and consumers’ susceptibility to these actions.

         This is because in my perception this kind of action is not professional and It will attempt to influence the most fundamental human emotions and utilize that manipulation to take advantage of unsuspecting clients. An illustration of an unethical commercial is one that exploits people's fears. It can appear that if customers do not buy the offered goods, their health would be in jeopardy.

          In conclusion, the persuasive strategy plays on the buyer's fears and emphasizes what they would lose if they didn't buy the good or service. In my opinion, I would like to suggest some things for improvement in this strategy without jeopardizing their investments to buy goods from marketers. To provide a basis for future research ideas on persuasion knowledge is very necessary to ensure the quality of goods and public knowledge. Limitations in giving persuasion can reduce pressure on buyers and anxiety about the situation.

Mood Disorder !!!!!! 🙇 Jom Baca - Kalau nak selamat 😭

Mood disorders introduction

▪ DSM-IV-TR recognizes two broad types of mood disorders: those that involve only depressive symptoms (depressive disorders) and those involve manic symptoms (bipolar disorders).

Depressive disorders 🙇

▪ The symptoms of depression include profound sadness and/or an inability to experience pleasure. 

▪ When people develop a depressive disorder, their heads may reverberate with self-recriminations. They may become focused on their flaws and deficits. 

▪ Paying attention can be so exhausting that they have difficulty absorbing what they read and hear. They often view things in a very negative light, and they tend to lose hope. 

▪ Physical symptoms of depression are also common, including fatigue and low energy as well as physical aches and pains. Depressive disorders 

▪ Although people with depression typically feel exhausted – they may find it hard to fall asleep and may wake up frequently. Other people sleep throughout the day. 

▪ They may find that food tastes bland or that their appetite is gone, or they may experience an increase in appetite. 

▪ Sexual interest disappears. 

▪ Thought and movement may slow for some (psychomotor retardation), but others can’t sit still – they pace, fidget, and wring their hands (psychomotor agitation). 

▪ When people become utterly dejected and hopeless, thoughts about suicide are common. Depressive disorders 

▪ Under depressive disorders, there are another two types of disorders as mentioned in DSM-IV-TR. They are: 

1. Major depressive disorder (MDD)

2. Dysthymic disorder (also called dysthymia). 

Major depressive disorder

▪ The DSM-IV-TR diagnosis of major depressive disorder (MDD) requires depressive symptoms to be present for at least 2 weeks. 

▪ As shown in the DSM-IV-TR criteria, at least 4 additional symptoms must be present. They are: 

i. Changes in sleep

ii. Changes in appetite; 

iii. Changes in concentration and decision-making

iv. Feeling of worthlessness; v. Suicidal

vi. Psychomotor agitation or retardation.

▪ MDD is called an episodic disorder – because symptoms tend to be present for period of time and then clear. Even though episodes tend to dissipate over time, an untreated episode may stretch on for 5 months or even longer. 

▪ Major depressive episodes tend to recur – once given episode clear, a person is likely to experience another episode.     

Dysthymic disorder

▪ Dysthymic disorder shares many of the symptoms of major depressive disorder but differ in its course. The symptoms are somewhat milder but remain relatively unchanged over long period of time, sometimes 20 or 30 years or more. 

▪ Dysthymic disorder is defined as a persistently depressed mood that continues at least 2 years, during the patient cannot be symptom free for more than 2 months at a time. 

▪ Dysthymic disorder differs from a major depressive episode only in the severity, chronicity, and number of its symptoms, which are milder and fewer but last longer. 

▪ Typically, dysthymic disorder develops first, perhaps at an early age, and then one or more major depressive episodes occur later. 

Bipolar disorders

▪ DSM-IV-TR recognizes 3 forms of bipolar disorders: 

1. Bipolar I disorder

2. Bipolar II disorder

3. Cyclothymic disorder. 

▪ Manic symptoms are the defining feature of each of these disorders. 

▪ These disorders are labelled “bipolar” because most people who experience mania will also experience depression during their lifetime 

▪ What is mania? 

▪ People may experience with abnormally exaggerated elation, joy, or euphoria. 

▪ In mania, individuals find extremely pleasure in every activity: they become extraordinary active (hyperactive), require little sleep, and may develop grandiose plan, believing they can accomplish anything they desire. 

▪ Speech is typically rapid and may become incoherent (attempting to express so many exciting ideas at once: flight of ideas) 

▪ Hospitalization may require – if individual was engaging self-destructive activities. 

Bipolar I disorder

▪ In DSM-IV-TR, the criteria for diagnosis of bipolar I disorder (formerly known as manic-depressive disorder) include a single episode of mania or a single mixed episode during the course of a person’s life.

Bipolar II disorder

▪ DSM-IV-TR also includes a milder form of bipolar disorder, called bipolar II disorder.  

Cyclothymic disorder

▪ A milder but chronic version of bipolar disorder called cyclothymic disorder is similar in many ways to dysthymic disorder. 

▪ Cyclothymic disorder is a chronic alternation of mood elevation and major depression that does not reach the severity of manic or major depressive episodes. 

▪ Individual who have this tend to be in one mood state or the other years with relatively few periods of neutral mood. 

Causes of mood disorders 

▪ Neurotransmitters: 

▪ 3 neurotransmitters have been studied the most in terms of their possible roles in mood disorders: 

▪ Norepinephrine; 

▪ Dopamine; 

▪ Serotonin. 

 

▪ Original models suggested that depression would be tied to low levels of norepinephrine and dopamine. 

▪ Mania would be tied to high levels of norepinephrine and dopamine

▪ Mania and depression were also both posited to be tied to low levels of serotonin. 

▪ Researchers initially believed that mood disorders would be explained by absolute levels of neurotransmitters in the synaptic cleft that were either too high or too low. 

▪ Brain imaging studies: 

▪ Brain imaging studies suggest that episodes of MDD are associated with changes in many of the brain systems that are activated when a person without symptoms of depression experiences strong emotions. 

▪ As one might expect, many different brain structures become involved when a person experiences emotion: the person needs to attend to and interpret the stimuli that are causing the emotion and then must make plans to deal with those stimuli. 

 ▪ Psychological: 

▪ Various aspects of personality and its development appear to be integral to the occurrence and persistence of depression. 

▪ Although depressive episodes are strongly correlated with adverse events, a person's characteristic style of coping may be correlated with his or her resilience. 

▪ In addition, low self-esteem and self-defeating or distorted thinking are related to depression.

▪ Social: 

▪ Poverty and social isolation are associated with increased risk of mental health problems in general. 

▪ Child abuse (physical, emotional, sexual, or neglect) is also associated with increased risk of developing depressive disorders later in life. 

▪ Abuse of the child by the caregiver is bound to distort the developing personality and create a much greater risk for depression and many other debilitating mental and emotional states. 

▪ Disturbances in family functioning, such as parental (particularly maternal) depression, severe marital conflict or divorce, death of a parent, or other disturbances in parenting are additional risk factors.  

▪ Medications: 

▪ The effectiveness of antidepressants is none to minimal in those with mild or moderate depression but significant in those with very severe disease. 

▪ The effects of antidepressants are somewhat superior to those of psychotherapy, especially in cases of chronic major depression. 

▪ Antidepressant medication treatment is usually continued for 16 to 20 weeks after remission, to minimize the chance of recurrence, and even up to one year of continuation is recommended 

 

Treatment of Mood Disorders 

▪ Electroconvulsive Therapy and Transcranial Magnetic Stimulation (ECT): 

1. Electroconvulsive therapy (ECT) is a procedure whereby pulses of electricity are sent through the brain via two electrodes, hospital psychiatrists may recommend ECT for cases of severe major depression that have not responded to antidepressant medication or, less often, psychotherapy or supportive interventions.  
2. ECT can have a quicker effect than antidepressant therapy and thus may be the treatment of choice in emergencies such as catatonic depression where the person has stopped eating and drinking, or where a person is severely suicidal. 

▪ Psychological treatments for depression: 

▪ Cognitive-Behavioral Therapy: 

1. ▪ Clients are taught to examine carefully their thought processes while they are depressed and to recognize “depressive” errors in thinking. ▪ Clients are thought that errors in thinking can directly cause depression. 
2. ▪ Treatment involves correcting cognitive errors and substituting less depressing and more realistic thoughts and appraisals.

▪ Interpersonal Psychotherapy: 

▪ After identifying life stressors that seem to precipitate the depression, the therapist and patient work collaboratively on the patient’s current interpersonal problems’: 

1. Dealing with interpersonal role disputes – marital conflicts; 
2. Adjusting to the loss of a relationship; 
3. Acquiring new relationships; 
4. Identifying and correcting deficits in social skills. 

▪ After helping identifying the dispute… the next steps? 

1. ✓Negotiation stage – both partners are aware it is a dispute, and they are trying to renegotiate it. ✓Impasse stage – the dispute smolders beneath the surface and results in lowlevel resentment, but no attempts are made to resolve it. 
2. ✓Resolution stage – the partners are taking some action, such as divorce, separation or recommitting to the marriage. 

Pengurusan Stress (Management Stress ilness) !!

 What is stress 

  Stress is your body's way of responding to any kind of demand. 

 It can be caused by both good and bad experiences. 

 When people feel stressed by something going on around them, their bodies react by releasing chemicals into the blood. 

 These chemicals give people more energy and strength, which can be a good thing if their stress is caused by physical danger. 

 But this can also be a bad thing, if their stress is in response to something emotional and there is no outlet for this extra energy and strength

What cause of stress

  Many different things can cause stress. 

 From physical (such as fear of something dangerous) to emotional (such as worry over your family or job) – these often referred as “stressors.” 

 Some of the most common sources of stress are: 

 Survival Stress - You may have heard the phrase "fight or flight" before. This is a common response to danger in all people and animals. When you are afraid that someone or something may physically hurt you, your body naturally responds with a burst of energy so that you will be better able to survive the dangerous situation (fight) or escape it all together (flight). This is survival stress. 

 Internal Stress - Have you ever caught yourself worrying about things you can do nothing about or worrying for no reason at all? This is internal stress and it is one of the most important kinds of stress to understand and manage. Internal stress is when people make themselves stressed. This often happens when we worry about things we can't control or put ourselves in situations we know will cause us stress. Some people become addicted to the kind of hurried, tense, lifestyle that results from being under stress. They even look for stressful situations and feel stress about things that aren't stressful. 

 Environmental Stress - This is a response to things around you that cause stress, such as noise, crowding, and pressure from work or family. Identifying these environmental stresses and learning to avoid them or deal with them will help lower your stress level. 

 Fatigue and Overwork - This kind of stress builds up over a long time and can take a hard toll on your body. It can be caused by working too much or too hard at your job(s), school, or home. It can also be caused by not knowing how to manage your time well or how to take time out for rest and relaxation. 

Good stress vs Bad stress

 So if stress can be so bad for you, how can there be "good" or "positive" stress? 

 If you are suffering from extreme stress or long-term stress, your body will eventually wear itself down. But sometimes, small amounts of stress can actually be good. 

 Understanding your stress level is important. If nothing in your life causes you any stress or excitement, you may become bored or may not be living up to your potential. If everything in your life, or large portions of your life, cause you stress, you may experience health or mental problems that will make your behavior worse.

Understanding the illness link about the stress:

 Neurobiological perspectives: 

 The body pays a price if must constantly adapt to stress. 

 This ‘price’ can be expressed in terms of what is referred to as allostatic load - (allostatic (or allotasis) - is the process of achieving stability, or homeostasis, through physiological or behavioral change). 

 If the body is exposed to high levels of stress hormones such as cortisol and becomes susceptible to disease because of altered immune system functioning – a high allostatic load.

  Psychodynamic perspectives: 

 Franz Alexander (1950) – repressed emotional impulses created a chronic negative emotional state that impacted health, thus setting the stage for problems like ulcers, asthma, or essential hypertension.

  Cognitive and personality perspectives: 

 Physical threats obviously create stress – so do negative emotions such as resentment, regret, and worry. 

 Negative emotions stimulate sympathetic nervous system activity and may keep the body’s stress systems aroused and the body in a continual state of emergency, sometimes for far longer than it can bear, as suggested by the notion of allostatic load. 

 Personality traits have been linked to immune system functioning – e.g. negative emotions linked to slow antibody production. 

Physical and mental signs of short-term stress

 Often occurring in quick 'bursts' in reaction to something in your environment, short-term stress can affect your body in many ways. Some examples: 

• •Making your heartbeat and breath faster
• •Making you sweat more
• •Leaving you with cold hands, feet, or skin
• •Making you feel sick to your stomach
• •Tightening your muscles or making you feel tense
• •Leaving your mouth dry
• •Making you have to go to the bathroom frequently
• •Increasing muscle spasms, headaches, fatigue, and shortness of breath. 

 While this burst of energy may help you in physical situations where your body needs to react quickly, it can have bad effects on your mind and performance if there is no outlet or reason for your stress. These effects may include: 

• •Interfering with your judgment and causing you to make bad decisions
• •Making you see difficult situations as threatening
• •Reducing your enjoyment and making you feel bad
• •Making it difficult for you to concentrate or to deal with distraction
• •Leaving you anxious, frustrated or mad
• •Making you feel rejected, unable to laugh, afraid of free time, unable to work, and not willing to discuss your problems with others. 

Physical and mental signs of short-term stress

 Long-term stress or stress that is occurring over long periods of time can have an even greater effect on your body and mind. Long-term stress can affect your body by: 

• Changing your appetite (making you eat either less or more)
• Changing your sleep habits (either causing you to sleep too much or not letting you sleep enough)
•  Encouraging 'nervous' behavior such as twitching, fiddling, talking too much, nail biting, teeth grinding, pacing, and other repetitive habits
• Causing you to catch colds or the flu more often and causing other illnesses such as asthma, headaches, stomach problems, skin problems, and other aches and pains
• Affecting your sex life and performance
• Making you feel constantly tired and worn out. 

 Long-term stress can also have serious effects on your mental health and behavior: 

• Worrying and feeling anxious (which can sometimes lead to anxiety disorder and panic attacks) 
• Feeling out of control, overwhelmed, confused, and/or unable to make decisions
• Experiencing mood changes such as depression, frustration, anger, helplessness, irritability, defensiveness, irrationality, overreaction, or impatience and restlessness
• Increasing dependence on food, cigarettes, alcohol, or drugs
• Neglecting important things in life such as work, school, and even personal appearance
• Developing irrational fears of things such as physical illnesses, natural disasters like thunderstorms and earthquakes, and even being terrified of ordinary situations like heights or small spaces.  

Stress Management

 Relaxation training – the most common form of relaxation training is progressive muscle relaxation, which involves systematically tensing and then relaxing each major muscle group in the body. 

 Cognitive restructuring – includes approaches to alter people’s belief systems and reduce the negativity of their interpretations of experience. 

 Behavioral skills training – practice in skills such as time management and effective prioritizing. 

Abnormal Breathing Technique

Breathing exercises such as this one should be done twice a day or whenever you find your mind dwelling on upsetting thoughts or when you are experiencing pain: 

• Place one hand on your chest and the other on your abdomen. When you take a deep breath in, the hand on the abdomen should rise higher than the one on the chest. This insures that the diaphragm is pulling air into the bases of the lungs. 
• After exhaling through the mouth, take a slow deep breath in through your nose imagining that you are sucking in all the air in the room and hold it for a count of 7 (or as long as you are able, not exceeding 7). 
• Slowly exhale through your mouth for a count of 8. As all the air is released with relaxation, gently contract your abdominal muscles to completely evacuate the remaining air from the lungs. It is important to remember that we deepen respiration not by inhaling more air but through completely exhaling it. 
• Repeat the cycle four more times for a total of 5 deep breaths and try to breathe at a rate of one breath every 10 seconds (or 6 breaths per minute). At this rate our heart rate variability increases which has a positive effect on cardiac health. 

Case Study : End of life Decisions : What is the story and what is dilemma !!!! Read Read Read Now 😟😞

End of life Decisions: Case Study

By: Afiq Shahiri 12 January 2022 2(4)

Ethical quandaries develop when individuals or communities are forced to make difficult judgements involving moral principles or values that are in contradiction with one another. These quandaries frequently give rise to challenges and disputes. Because they require individuals to make decisions between opposing interests, ethical dilemmas can offer substantial problems. However, there is not always a straightforward answer to these conundrums. Its include decision-making conflicts, stakeholder conflicts, legal and regulatory conflicts, public perception and reputation and emotional distress.

It is essential to confront ethical conundrums in a methodical and reflective manner, taking into account a variety of viewpoints, ethical frameworks, and the potential outcomes of one's actions. Participating in open discourse, looking for ethical counsel, and fostering a culture of ethical awareness are all things that may help reduce the likelihood of disputes and make it easier to deal with these issues. The decision to put an end to one's life presents complicated obstacles and tensions since it requires one to make challenging choices regarding medical treatment, care, and the preservation of human life in the face of severe circumstances or terminal sickness. This moral conundrum emerges when individuals, families, and healthcare professionals are put in a position where they must make decisions that will have an effect on the persons' quality of life, autonomy, and dignity as they draw closer to the end of their lives.

Communication that is both open and empathic is necessary to address the problems and tensions that are inherent in end-of-life choice dilemmas. This communication must involve patients, their families, healthcare providers, and other stakeholders. Access to palliative care, advance care planning, and ethical frameworks, such as shared decision making models can all be helpful in navigating these issues and promoting compassionate decision-making in end of life circumstances.

1.     Case Study 1 

Adam was a 2-year-old child with congenital acute myeloid leukemia. He was admitted to the pediatric intensive care unit (PICU) after receiving an allogeneic bone marrow transplant. One week after the transplant, a severe pulmonary infection developed, resulting in irreversible lung injury; he was ventilator dependent. Adam was a patient in the PICU for 2 months and he had good and bad days. On his bad days, the PICU staff struggled to manage his hypoxemia, hypercapnia, and hemodynamic instability. He had several close calls to death, including being resuscitated twice after having cardiac arrests. Neurologically at times, he opened his eyes; he had limited motor ability. When he became restless, he was given sedative drugs.

Several family meetings occurred over his 2-month PICU stay. The palliative care team was consulted 5 weeks into his stay. At the most recent meeting, the palliative care APRN reviewed Adam’s illness trajectory, discussed his current condition and told Adam’s parents that the team would like to consider a change in the focus of Adam’s care.

The pediatric intensivist discussed Adam’s poor prognosis and his parents were given time to ask questions. The palliative care APRN discussed the possibility of focusing Adam’s care on comfort and suggested that it was time to consider decisions such as withholding cardiopulmonary resuscitation (CPR) if Adam’s heart were to stop again. She asked Adam’s parents whether they would support this decision. Adam’s mother said that she agreed that CPR should not be started if her son’s heart stopped. Adam’s father became angry and stated that the staff was giving up on his son. He absolutely wanted all treatment continued, including CPR. He got up and stormed out of the conference room.

Adam’s PICU nurse was not sure whether to stay in the meeting or leave. She decided to leave and look for Adam’s father. She found him sitting at his son’s bedside crying. He told her that he needed a little time alone, so the nurse left and gave him time with his son. When she returned, she acknowledged how difficult it must be to participate in these types of decisions. Adam’s father told her that he did not want to give up on his son. The nurse reinforced what good parents both he and his wife were. Adam’s father said that he needed time to think about everything. He had hoped that his son would recover and he was just starting to realize that he might not. The PICU nurse emphasized that Adam would continue to receive the best care possible, regardless of what decision was made, and that the team was there to help not only Adam but also his family. (Wiegand, 2015, pg. 145)

This case study presents a conflicting decision between both parents of a terminally ill 2-year-old boy with acute myeloid leukemia. Despite a poor prognosis as well as multiple resuscitations from cardiac arrests, the father refused to discontinue resuscitation attempts with the perception that the medical team is giving up on his son. The mother, however, was accepting of the decision due to the condition of her son. The medical team, however, was adhering to the ethical principle of autonomy, by allowing both of the parents, the autonomous legal guardian of their son, to give their final decision on this end-of-life matter. Despite wanting to provide the best treatment that may benefit the patient (beneficence), the medical team also would like to reduce and minimize any harm that may be inflicted on the 2-year-old boy (non-maleficence).

One of the dilemmas that may be seen here is the contradiction between the father’s decision from the medical team’s advice. Other than the literal physical definition of ‘alive’ towards the patient, the decision-maker, in this case, the parents, must also consider the weight of their son’s quality of life should the treatment and resuscitation be continued, apart from the consideration of their cultural and religious norm. The process of end-of-life decision-making should consider the well-being of the patient from all aspects; physical, emotional, religious, and even personal beliefs (Puteri, 2015). Though admittedly, a 2-year-old may have less consideration for religion and personal beliefs, the consideration of end-of-life decisions should also include the immediate family and guardian.

The counsel team did a praiseworthy job in assuring the parents that they will strive in providing the best care possible for whichever path the parents choose to decide. Should the parents choose the continue treatment, the medical team will work hard in providing the best treatment that benefits the patient, and if the parents choose to discontinue treatment and resuscitation, the medicals team will also give as much effort in maximizing comfort and care if the provision of the best palliative care for their son, Adam.

Ethically, this end-of-life decision may only be made by the parents and should not be interfered with by any other party. However, the medical team and the psychological support team, if any, should be ready to be transparent and honest (veracity) in providing a full, detailed explanation of Adam’s condition to both parents. The parents should be able to make a fully informed decision and psychological and emotional support services should be made available to the parents should they need them. End-of-life care is an all-hands-on-deck situation where every party serves a huge role in ensuring the best outcome for the patient, the parents as well as the medical team. Despite everyone’s involvement, both decisions of continuing or discontinuing treatment are not ethical violations as long as all information is given and received by all parties involved

     2.     Case Study 2

The case of Ms. Rahimah is a hypothetical case study of a 65-year-old woman with end-stage chronic obstructive pulmonary disease (COPD), a condition characterized by the progressive deterioration of the airways in the lungs. Despite undergoing various treatments for her condition over the years, her COPD has continued to worsen, and she has now reached a point where her doctors have determined that there are no more viable treatment options available. They have explained that her condition will ultimately lead to her death, and they have suggested that she and her family begin to think about her end-of-life care.

Rahimah has expressed to her doctors and family that she does not want to prolong her suffering any further, and she has decided to elect hospice care. Hospice care is a form of palliative care that provides comfort and pain relief to patients who are dying, and it often involves the withdrawal of life-preservation interventions such as intubation or resuscitation. Ms. Rahimah's decision to elect hospice care reflects her desire to prioritize comfort and quality of life overextending her life at all costs.

While Ms. Rahimah's decision may be a difficult one for some family members to understand, it is ultimately her right to self-determination, as she is entitled to make decisions about her healthcare based on her values and preferences. Her decision is an example of the importance of open and honest discussions about end-of-life care and the role that patients, families, and healthcare professionals play in these discussions. By taking an approach to end-of-life care, we can help patients and families make informed decisions that prioritize comfort, dignity, and quality of life.

End-of-life decisions are complex and require careful consideration of the patient's preferences and values. The case of Ms. Rahimah illustrates the importance of respecting a patient's autonomy in making these decisions, and providing care that prioritizes comfort, relief from suffering, and an increase in quality of life.

Autonomy is a fundamental principle in ethics and is especially important in end-of-life care. It involves allowing a patient to make their own healthcare decisions, including decisions about their end-of-life care. By treating a patient as autonomous person, we respect their dignity and agency, and we help to ensure that their values and preferences are considered in care planning.

In the case of Ms. Rahimah, it was important to respect her autonomy in making her decision to elect hospice care. She had the right to make this decision, and it was not appropriate for others to impose their own beliefs or values on her. Healthcare professionals should provide information, support, and guidance to help patients make informed decisions, but they should not pressure patients to choose a particular course of care.

Aside from respecting autonomy, it is also important to provide care that is non-maleficent or that does not cause harm. Hospice care is designed to provide comfort and relief from suffering, rather than to prolong life at all costs. Healthcare professionals should ensure that they are not providing treatments or interventions that could cause harm or prolong suffering and should instead focus on providing palliative care that addresses the patient's needs and aims to improve their quality of life.

In addition to non-maleficence, it is also important to provide care that is beneficial or that brings about good. End-of-life care should not only be about avoiding harm but should also be about providing benefits to the patient, such as relief from pain and distress, and an increase in their quality of life. Palliative care is designed to do just that, and healthcare professionals should take a holistic approach to care that addresses the patient's physical, emotional, and spiritual needs.

Finally, justice is a principle that requires individuals to be treated fairly and equitably and not be subjected to discrimination or bias. In the case of Ms. Jones, it is important that healthcare professionals do not discriminate against her based on her age, or gender.

3.     Case Study 3

John Anderson, a 68-year-old man, has been living with end-stage heart failure for the past two years. Current Condition severe shortness of breath, fluid retention, declining organ function. Despite various medical interventions, his condition has progressively worsened. John's heart function has significantly declined, leading to severe shortness of breath and fluid retention. He is frequently hospitalized for complications related to his heart failure. The medical team believes that John is approaching the end stages of his illness.

 Ethical Dilemma:

John's family and healthcare providers are facing an ethical dilemma regarding end-of-life decisions. John's condition is unlikely to improve, and his quality of life is greatly compromised. The medical team and family members have different opinions on the best course of action. Some family members advocate for continuing

aggressive interventions, while others believe that focusing on comfort care and ensuring a peaceful end is more appropriate.

Options Considered:

Continuation of Aggressive Interventions:

Continue with advanced medical treatments, such as cardiac interventions, mechanical circulatory support, or transplantation, with the goal of extending John's life. Engage in ongoing discussions with the medical team to assess the potential benefits, risks, and burdens of these interventions. Understanding these factors will help John and his loved ones make informed decisions regarding the continuation of aggressive treatments. Ensure that John's goals and preferences are considered in the decision-making process.

 Transition to Palliative Care and Symptom Management:

Transitioning to palliative care signifies a shift in the treatment approach, placing emphasis on improving John's quality of life. Instead of pursuing aggressive interventions, the focus now shifts to providing holistic care that addresses his physical, emotional, and spiritual well-being. Palliative care aims to alleviate symptoms, manage pain, and enhance overall comfort, allowing John to make the most of his remaining time. Symptom management is a vital aspect of palliative care. Medications are commonly used to alleviate symptoms such as pain, nausea, anxiety, and shortness of breath. The palliative care team, in collaboration with John, will develop an individualized plan tailored to his specific needs. This approach ensures that medication regimens are optimized, providing effective relief while minimizing potential side effects. Shortness of breath is a distressing symptom often experienced by individuals with advanced medical conditions. In palliative care, oxygen therapy and non-invasive ventilation can significantly improve John's breathing and enhance his comfort. These interventions aim to alleviate breathlessness, allowing him to engage in activities that bring joy and maintain a sense of independence.

 Shared Decision-Making and Advance Care Planning:

Shared decision-making is crucial in the continuation of aggressive interventions. It involves collaboration between John, his family, and the medical team. By providing comprehensive information about the available treatment options, their potential outcomes, and associated risks, the medical team can empower John and his family to actively participate in the decision-making process. This collaborative approach ensures that the final decision aligns with John's values, preferences, and long-term goals.

4.     Conclusion 

From the case study presented, there are 3 prong conflicts that can be observed regarding decision-making for end-of-life care; the patient’s advocate vs healthcare worker, the patient vs her family member, and the patient’s family member vs the healthcare worker.

In this dire situation, everyone involved does have their best intention at heart, aiming for the best outcome for the patient, but when it concerning the end of life care, the willingness to participate in the conversation is varied, both for the patient’s themself and their relatives as it is emotionally challenging (Gjerberg, E. et al, 2015) and it poses communication challenge even with the healthcare provider (Naomi, R. et al. 2016). Adding the weight of the situation is when the patient can’t exercise their autonomy, the responsibility to make the decision will fall onto their legal next-of-kin, as this has always been part of hospital policies.

However, many of the patient’s relatives did not really know what the patient’s needs were, despite the patient’s belief in them (Georg Bollig et al. 2016).

Since all the case studies happen in hospital settings and involve palliative care, referring to Palliative Care Services Operational Policy 2010 by the Ministry of Health (MOH) is essential as it provides ethical guidelines for handling the situation. As palliative care is generally a new medical specialty recognized by MOH in 2005, another guideline that can be helpful to assist in the decision-making for the professional parties is Handbook in Palliative Medicine in Malaysia, developed in 2015. The reasons this was emphasized was that this policy and handbook can assist in making better solutions for the case studies, as it is coherence with Principal A: Beneficence and Non-Maleficence, of APA General Principle (2010) when the psychologists' scientific and professional judgments and actions may affect the lives of others, they need to be alert and guarded against personal, financial, social, organizational, or political factors that might lead to misuse of their influence.

According to the policy, effective communication skills are essential tools in palliative care and healthcare providers must develop these skills, including effective listening, providing information, facilitating decision making and coordinating care among the patient, family, and other healthcare providers, as this has proven to better prepare the patient for their final outcome and reduce moral distress for their relatives (Georg Bollig et al. 2016). This provision is aligned with Principle E: Respect for People's Rights and Dignity, of APA General Principle (2010), where individual differences are respected and taking these differences into consideration when working with others.

Managing end-of-life care decision’s making can also be guided by the Resolution on Palliative Care and End-of-life Issues, adopted by the APA Council of Representatives, which “endorses the principles that care for individuals with advanced serious illness should be comprehensive, high quality, integrated, interdisciplinary, patient-centered and family oriented, coordinated across all providers and settings; accessible, and available through governmental and private health insurers and care delivery programs. Individuals should have the opportunity to engage in conversations about their health care, the results of which should be incorporated into ongoing care plans.” (2017, para 74).

5.     Reference

• American Psychological Association (2017) Ethical Principles of Psychologists and Code of Conduct from https://www.apa.org/ethics/code?item=7#405
• American Psychological Association (2017) Resolution on Palliative Care and End-of-life Issues from https://www.apa.org/about/policy/palliative-care-eol
• eorg Bollig, Eva Gjengedal and Jan Henrik Rosland (2016) They know! —Do they? A qualitative study of residents and relatives’ views on advance care planning, end-of-life care, and decision-making in nursing homes. Palliative Medicine Vol. 30(5) 456–470 DOI: 10.1177/0269216315605753 
• Gjerberg, E., Lillemoen, L., Førde, R. et al. (2015) End-of-life care communications and shared decision-making in Norwegian nursing homes - experiences and perspectives of patients and relatives. BMC Geriatric 15  https://doi.org/10.1186/s12877-015-0096-y
• Naomi R. George, Jennifer Kryworuchko, Katherine M. et al. (2016) Shared Decision Making to Support the Provision of Palliative and End-of-Life Care in the Emergency Department: A Consensus Statement and Research Agenda. Academic Emergency Medicine https://doi.org/10.1111/acem.13083
• Jahn Kassim, P. N., & Alias, F. (2015). End-of-life decisions in Malaysia: Adequacies of Ethical Codes and Developing Legal Standards. Journal of Law and Medicine.
• Wiegand, D. L., MacMillan, J., dos Santos, M. R., & Bousso, R. S. (2015). Palliative and end-of-life ethical dilemmas in the Intensive Care Unit. AACN Advanced Critical Care, 26(2), 145–146. https://doi.org/10.4037/nci.0000000000000085
•  American Heart Association. (2017). Shared Decision-Making in Advanced Heart Failure: A Scientific Statement from the American Heart Association. Circulation: Heart Failure, 10(9), e000025.
• National Hospice and Palliative Care Organization. (2021). What is Palliative Care? Retrieved from https://www.nhpco.org/patients-and-caregivers/palliative-care/.
• National Consensus Project for Quality Palliative Care. (2021). Clinical Practice Guidelines for Quality Palliative Care, 4th edition. Retrieved from https://www.nationalcoalitionhpc.org/ncp/.
• Meier, D. E. (2011). Increased access to palliative care and hospice services: Opportunities to improve value in health care. The Milbank Quarterly, 89(3), 343-380.
• World Health Organization. (2018). WHO Definition of Palliative Care. Retrieved from https://www.who.int/cancer/palliative/definition/en/.
• Upadhyay, A., & Mello, M. M. (2014). The ethics of chronic pain management. In J. C. Ballantyne & D. J. Sullivan (Eds.), The Oxford Textbook of Palliative Medicine (5th ed., pp. 126-134). Oxford University Press.
• Akdeniz, M., Yardımcı, B., & Kavukcu, E. (2021). Ethical considerations in end-of-life care. SAGE Open Medicine, 9, 20503121211000918.
• Cavallaro, V. (2014). Advance Directive Accessibility: Unlocking the toolbox containing our end-of-life decisions. Touro L. Rev., 31, 555.
• Parks, S. M., Winter, L., Santana, A. J., Parker, B., Diamond, J. J., Rose, M., & Myers, R. E. (2011). Family factors in end-of-life decision-making: Family conflict and proxy relationship. Journal of palliative medicine, 14(2), 179-184.

HOW MIGHT THE INCREASE OF ADAPTIVE BEHAVIOUR BE A DISADVANTAGE FOR STUDENTS INTRINSICALLY MOTIVATED TO LEARN? ( PSYCHOLOGY OF LEARNING) - AFIQ SHAHIRI

    

 PSYCHOLOGY OF LEARNING

MUHAMMAD AFIQ SHAHIRI BIN SAPIE 

(December 2021)

Table of Content 

1.     INTRODUCTION 3 - 4 

2.     HOW MIGHT THE INCREASE OF ADAPTIVE BEHAVIOUR BE A DISADVANTAGE FOR STUDENTS INTRINSICALLY MOTIVATED TO LEARN? 5 - 8 

3.     WHAT ARE THE EDUCATIONAL IMPLICATIONS OF THE POTENTIAL FOR CONCRETE REWARDS TO DIMINISH INTRINSIC MOTIVATION FOR A GIVEN TASK? 9-11 

4.     CONCLUSION 12 

5.     REFERENCES 13 

INTRODUCTION

        In order to be successful, rewards must stimulate the recipient. It is critical to determine what the youngster really desires, either through direct questioning or via careful observation. Often, incentives might be in the form of a chance to do something desired, such as stand at the front of the line or make a statement over a loudspeaker. 

    Other than that it may also be something tangible, such as a toy or a cookie. It may be beneficial to adopt a token system for older children, in which youngsters get a sticker for each period of excellent conduct. When a specified amount of rewardearned stickers are used, the game is considered complete. 

    Furthermore, providing students with a reward helps to encourage good and proper conduct among kids in your class. By rewarding students for excellent behaviors such as following class rules, being courteous to one another, and maintaining safety as a priority, you may encourage positive behaviors to be expressed in your classroom. Teachers are able to devote more time to lesson material and interactive activities that engage students in learning rather than to classroom discipline as a result of good student conduct. 

    Next is if student success leads to student happiness, and in order to have a classroom full of happy kids, instructors could consider using a reward system. Offering incentives to kids who are productive in their study both at home and at school may motivate them to continue their learning. Students are more likely to be motivated to be more productive when they get rewards because they experience a sense of pride and accomplishment. 

    Finally, When students feel a feeling of belonging and respect in the classroom, they are more likely to experience intrinsic drive to study, according to research. When evaluative components of the classroom are de-emphasized and students feel that they have some influence over the learning environment, internalization may be facilitated more effectively. Furthermore, giving students with activities that are tough yet attainable, as well as a justification for participating in different learning activities, might help them to become more intrinsically motivated to complete such tasks. 

HOW MIGHT THE INCREASE OF ADAPTIVE BEHAVIOUR BE A DISADVANTAGE FOR STUDENTS INTRINSICALLY MOTIVATED TO LEARN?

    Intrinsic motivation student has the ability to learn without wanting to getting external reward and they usually motivate themselves to learn because they are willing. While extrinsic motivation student mostly depends on rewards to learn something. If teachers regularly give reward to drive positive behavior, later on, the student will be bored with the same reward and they will demand more expensive reward. Don’t forget that the institution of learning is established for every child to go through learning process to make them more prepared for their own future. But, if the student learns not by himself wanting to learn, how long do you thing the knowledge he gets will last? If a student applies adaptive behavior to get reward, do you think he will still learn if there’s no reward? That’s why school should put limitation on the use of concrete rewards since it can be a disadvantage mostly for students who are intrinsically motivated to learn. 

    Kids that always get reward after competing in certain task given by the teacher in class can influence his classmates either positive or negative way. He or she can drive motivation away or give motivation to his fellow classmates. As an example of negative influence, an extrinsically motivated student said to his fellow classmate behind teachers back “There’s no need for you to study properly from its root. You just need to memorize properly and know how to answer it so you can get the reward from teacher”. In this situation, we can conclude that this kid learns only to get the reward. While student who are intrinsically motivated will spend more time to study each knowledge properly because of their passion and love to learn. Some of intrinsically motivated student take time longer time to understand certain knowledge better. Extrinsically motivated student can promote bad example to intrinsically motivated student. Furthermore, if intrinsically motivated student happens to always need to compete with extrinsically motivated student, he or she will feel pressure or feel that the learning process is no fun anymore and later, it will result to their passion for learning decrease or extinct. 

    The use of concrete rewards to increase adaptive behaviors can create competitive nature among student. It’s great to create healthy and positive environment but there’ also a bad side to it. As a matter of fact, competition can make student develop self-discipline but if teachers not properly handling competition in education, it can discourage learning. 

    Some student can drive themselves to learn while others need encouragement or motivation and that’ s where we need the present of external stimulus which is reward. Once the reward is present, the student aim will change toward the reward. But what happen if the reward is easily given? The student will lose its independent self and tend to cling on the reward. In certain cases, if the reward is no longer serve, the student will no longer follow the adaptive behaviors. The dependency to the reward may lead to the changes of attitude of some student. Imagine, a kid always gets the latest toy whenever he does homework, but one day, when his aunty take care or him, she didn’t give toys to the kid after he finish his homework. He asks many times and still didn’t get the toy. So, he starts to throw tantrum because of the privileged he usually got no longer exist. Later on, the kid starts to ignore his homework as a protest. It’s the same as the student case, when there’s no longer reward, so they no longer want to develop adaptive behaviors. So, in the end, the intrinsically motivated student who are willing to learn becomes unwilling to learn. That’s the reason why teacher should plan properly on when to us the concrete reward. 

    Other than that, Intrinsic motivation also defined as the doing of an activity for its inherent satisfaction rather than for some separable consequence. When intrinsically motivated, a person is moved to act for the fun or challenge entailed rather than because of external products, pressures, or rewards. Intrinsic motivation occurs when students are engaged because of internal rewards, like a love of learning or interest in a subject. When a student has an intrinsic desire, he or she does not require any form of incentive or punishment to do things because the activity itself has been able to meet the satisfaction and the internal needs of the student. This statement makes it clear that not all behaviors can formed through a reinforcement scheme. This is because there are certain behaviors it is done because the individual in question gets some form of satisfaction internal or an intrinsic motivation resulting from it (Mahmood Nazar Mohamed, 1990: 294). 

    Behavior modification is a way of managing classroom discipline and is appropriately used to address problematic behaviors, whether negative or positive. The purpose of using behavior modification is to change the negative behavior or misbehavior of students detected in the classroom to positive behavior and then resolve the behavior. These steps are done to create a disciplined and conducive classroom climate so that teaching and learning activities run smoothly. 

    Interpersonal methods are things related to the way people are treated another. There are many types of good interpersonal skills such as communication, conflict management, and empathy for others. Communication skills are one of those interpersonal skills good that people can use in their daily lives. Communication is very important in understanding the world around and others. Students are also able to build relationships with new people when communicating which is effectively intertwined. In addition, students are able to communicate well with everyone when we come up with ideas that build discussion. Conflict resolution can also be made when effective communication occurs. In conclusion, communication is important for interpersonal as it plays a large role in adaptive skills. 

    A person forms perceived abilities from the assessment of his abilities by others. Perceived abilities from the assessment regarding his actual abilities. The higher a student’s achievement, the more likely the student is to assess himself or herself as capable. These perceived abilities affect how the student feels about himself. Students with high perceived abilities are more likely to have self-confidence. These students love challenges, have a curious nature and act independently to achieve skills. Individual behaviors and tasks are influenced by their abilities and ways of controlling situations. A positive self -concept gives confidence to the individual that he or she is capable of performing a task. In addition, individuals can determine their own tasks. He will be involved in the task as well as the goals that bring success to him. An individual will only have a self -concept that he is capable of and can control his efforts if he has the intrinsic motivation to strive high. There are various ways that can be done to help students in improving their intrinsic motivation. 

    In conclusion, the relationship between teachers and students is forged through teaching and learning in schools. Teachers should observe teaching and learning in the context of using materials that aid in teaching. In addition, teachers also need to be aware of the processes experienced during teaching, namely the implicit elements that stimulate the smooth process of teaching and learning in the classroom. Motivation in learning cannot deny the presence of extrinsic and intrinsic motivation in approaching human motivation.

WHAT ARE THE EDUCATIONAL IMPLICATIONS OF THE POTENTIAL FOR CONCRETE REWARDS TO DIMINISH INTRINSIC MOTIVATION FOR A GIVEN TASK?

    Extrinsic motivation (concrete rewards) involves doing something to obtain something else. Concrete rewards are things given to the students by others, like grades, free time, and other things. Extrinsic motivation is often influenced by external incentives such as rewards and punishments. It is a tangible recognition of one's endeavor. While Intrinsic motivation involves the internal motivation to do something for its own sake. An intrinsic reward is an intangible award of recognition, a sense of achievement, or a conscious satisfaction. Below are the educational implications of the potential for concrete rewards to diminish intrinsic motivation for a given task. 

• Undermine a student’s desire or passion to learn. 

    According to Tegano, Moran, and Sawers (1991), as cited in Eisenberger, Pierce, & Cameron (1996), "students who initially display a high level of interest in a task, an expected reward makes them much less likely to take risks or approach a task with a playful or experimental attitude. For example, the student could possibly behave well or study harder only when he or she is offered a concrete reward. Indirectly, It diminished intrinsic motivation. 

• Decrease creativity and intrinsic motivation 

    The presentation of a reward orients the student to goal-relevant stimuli and diverts attention from the task and environment that may be used to achieve a creative solution. Students who are motivated by extrinsic factors complete activities in order to receive a concrete reward. As a result, it will diminish intrinsic motivation because they will not work out events on their own but only work to receive a reward like grades, candy, free time, and other things. 

• Negative effects on students' future learning and motivation 

    The concrete reward diverts motivation away from the achievement of learning itself and toward an external reward in which the outcome is merely a representation of the produced behaviour and not what the student internalised or learned due to the activity. As a result, the use of extrinsic motivators has negative effects on the future learning and motivation of students. Indirectly, it will diminish intrinsic motivation. 

• Lead to helplessness in the face of difficulty as well as selfconsciousness 

    Henderlong and Lepper (2002) found that when praise is given for exceptionally easy tasks, it can lead students to believe that they are of low ability level and that their competence and relatedness will negatively affect their intrinsic motivational orientation. Because praise is evaluative in nature, it can instil a sense of self-worth that can lead to helplessness in the face of difficulty as well as self-consciousness (Kamina & Dweeck, 1999, as cited in Henderlong & Lepper). Giving verbal reinforcement to students may decrease their intrinsic motivation and have other negative effects on them. 

• The student could possibly behave well or study harder only when he or she is offered a concrete reward. 

    This could have significant implications because students could display a lower level of achievement or effort if the rewards are eliminated at some point. Apart from not being the best learning strategy, it could affect them long-term as, in the real world, people are not always rewarded constantly. 

• Students would anticipate a shift from learning for the sake of learning to learning in order to earn a reward. 

    This would undermine the foundation on which traditional institutions of higher learning are built. Dependence on extrinsic rewards may cause problems later in life (post-school) when there are not typically extrinsic rewards for learning. 

• Students will refuse to change their behavior. 

    If used incorrectly or too often, concrete rewards can cause students to become set in their ways. Change is a constant in school because every day is a different task. Students need to adapt to stay competitive. However, if students are accustomed to concrete rewards for specific behaviours, they may be resistant to change because they think they might not be rewarded for a different kind of behavior. Students need to know that concrete rewards are related to outcomes, not just their behavior. 

CONCLUSION 

    The enthusiasm that should be shown to the students is the competition between them. This is because although rewards are great for giving a paradigm shift to students to be more diligent. But these days it is very easy for humans to hope for something without having to properly. 

    The more perfect thing is where parents and teachers also work together to give them moral support. In addition, every activity they participate in has the support of all parties. That can also be the reward of mental psychology to continue to succeed. 

    Therefore, teachers and parents need to work together to create a healthy atmosphere such as getting attention and support for what they are doing. When it comes to the learning process, motivation is the most critical factor to consider. No matter how well a teacher teaches, if a student is not motivated, it is unlikely that the intended outcomes would be achieved. Positive reinforcement is one method of assisting pupils in remaining motivated while studying. Positive reinforcement includes a variety of methods, the most common of which are prizes, which are most often utilised by instructors in schools. Indeed, incentives are the most powerful motivators in anyone's life, and this is especially true for students. 

    Conclusion is, students that get incentives will almost always be motivated to retain their current levels of performance or to aim for greater levels of accomplishment. Furthermore, the influence might be seen by their other students as well. Their buddies will likewise strive to do their best in order to gain the benefits that have been made available. 

REFERENCES 

1. Santrock, J. W. (n.d.) Educational Psycology. Dallas: University of Texas 
2. Wagner, K (February 2007). Intrinsicially Motivated Classrooms a Perspective For Teachs. All Regis University Theses. 
3. Journal of Student Engagement: Education matters 
4. Mahmood Nazar Mohamed, 1990: 294 
5. John W. Santrock, 2021, Educational Psychology