Urban Planning and decision-making in Dubai Essay

Urban Planning and decision-making in Dubai - Essay Example n of this paper that the biggest concerns Dubai seems to have at this point are: 1) sustainability 2) cultural considerations 3) labor relations and 4) traffic. Sustainability is an issue that can best be judged from a future point. The cultural considerations are also elements that are being worked out in many ways. So labor and transport issues become the central themes of this paper. The biggest complaint to date is traffic problems. The planning of roads seems to have lost its way. This, in contrast to the other planning elements, seems a small problem but it is becoming more and more of an issue as Dubai becomes popular and established as an international city. What role does the public play in the decision-making process during the development of Dubai? To what extent did the government maintain a monopoly over these decisions? How active of a role did the private sector play in the urbanization of the city? How has globalization affected the decision-making process? A review of Leonie Sandercock’s â€Å"Toward Cosmopolis† shows that Sandercock writes about the cultural pluralism of planning theory in a way that is highly idealistic (Blanco 1998). She is said to discuss her social project in a political and economic vacuum, failing to address the underlying causes of the social problems. Cosmopolis is, for Sandercock, â€Å"a common civic culture which has embraced the social project of tolerance, alterity, and inclusion† (Blanco 1998). Sandercock states that there are three forces that create the major cultural politics of difference: migration and multiculturalism, postcolonialism, and the age of women and minorities. She believes that the history of planning has supported segregation and discrimination. These are major forces at work in Dubai’s planning. A perceived threat of marginalization (Aarts 1999) by less developed countries has often led to their full interaction with the world economy, before they may be ready. Aart feels that

Business Analytics Assignment Example | Topics and Well Written Essays - 500 words - 1

Business Analytics - Assignment Example - Data driven processes often create issues (noise) which are not relevant to the goals of the project. In this respect, logic-driven analytics processes will result in more clear and concise solutions. This depends on the project and the maturity of the audience/stakeholders. In an environment where the KPIs are not already established and the data is not well known, it might be appropriate to start with a logic driven process to focus the process on the most impactful issues. This keeps the noise to a minimum and keeps a project smaller in scope while not creating distractions. A data-driven approach can be added as a second step in this case. In a more sophisticated environment where basic KPIs are established, there is an opportunity to find the hidden levers in a process by using a data-driven process to provide deeper insight. Again, these choices are not universal and depend on the maturity of the audience and company, the quality, availability and knowledge of the data and the appetite of the organization for a complex project - The choice of an analytic model to use does indeed depend on many factors, including the nature of the project and the environment. It is worth noting that both logic driven and data driven models can co-exist and complement each other. In my opinion, a data driven approach is more suited to a situation where the data is not known, since a logic driven approach requires an intimate understanding and anticipation of the data before a model can be constructed. What would an effect hybrid first analytics project look like for an organization that has not approached true analytics in the past and what elements from each methodology would you apply? Assume the organization is relatively mature (in life cycle) but novice in deep analytics and has relatively clean and accessible data as well as well educated users. The main advantage I can see using a logic driven analytics (as one of the requirement) is

HISTORY of western civilization Essay Example | Topics and Well Written Essays - 1000 words

HISTORY of western civilization - Essay Example There were activists, propagandists and scientists in the Enlighteners who wanted to understand the world in a new insight and change it. The Enlightenment had its impact in France, Britain, Germany, Spain, Portugal, America, Italy and the Netherlands and resulted in great historical developments like the establishment of the United States of America and French Declaration of the Rights of Man and of the Citizen. The Enlightenment was not a single movement nor was it carried out by a unified group of individuals. Instead, it happened piecemeal and to have a clear idea of its impact on human life, one has to assess the history from the second half of seventeenth century to the beginning of eighteenth century. The beginning of Enlightenment is visible in the thinking of Francis Bacon who lived during the Renaissance period as he strongly supported pragmatic thought which was the basis of enlightenment. There was Benjamin Franklin who was an efficient statesman, scientist and political philosopher. He made two crucial scientific inventions; bifocal spectacles and lightning conductors as a scientist and also played a crucial role in the development of the new American Republic (Porter, 3). Another eminent Enlightener was the French philosopher and writer Denis Diderot who is famous as the editor of Encyclopedie. Giving up Roman Catholicism, he started philosophical materialism. Yet another prominent figure was Condorcet who argued that social ills take place not due to human nature, but due to ignorance and mistake. Another very important Enlightener is Voltaire who fought against the religious dogma of the time and vehemently supported social reform. Some others who had their role in this great revolution are Thomas Hobbes, Spinoza, Kant and Hegel. Montesquieu, d’Alembert, Turgot, the Britons, Locke, Hume and Gibbon, The Genevan, Rousseau, d’Holbach and Herder too were prominent influences in the movement. In the simplest possible terms, the aim of E nlightenment thinkers was to fight ignorance, superstition and despotism for the creation of a better world. As it was in eighteenth century, the main culprits that suppressed the free thinking of man, according to Enlighteners, were the Catholic Church and the hereditary aristocracy that existed all over Europe. An understanding of the social situation prevailed in Europe will show how urgent a social change was for them. The 17th century Europe was totally restless by wars in the name of religion and also in the name of imperial invasion. Both the church and the state were hand in hand in torturing people in the name of religion and state. Even the scriptures were twisted and used for the advantages of the church and the state. Those who tried anything against the state or religion were imprisoned or executed. From the above, it is clear that Enlightenment was the need of the time, which freed human mind from the dogmas of religion, which insisted that logic is the way to truth. I nstead, Enlighteners claimed that logic should be accompanied by reason, and that experience and experiment are the way to real truth. It is seen that Enlighteners were mainly against the dogmatism and irrationality present in Christianity. Enlightenment thinkers aimed mainly at the religion as it was the Catholic Church that chained the brain of people from thinking rationally. One of the earliest critics was Thomas Hobbes.

Themes of Crhistian Faith Essay Example | Topics and Well Written Essays - 1000 words

Themes of Crhistian Faith - Essay Example For how can one fully know or predict the end when he employs mind closed at recognizing paths that wind to a triumphant outcome. As I see it with his tone of reactions on course placement, clearly, he hasn’t been properly acquainted to an in-depth assessment of theology or his limited former knowledge might have been brought across at the wrong approach so there is not a way he can be expected to entertain the course in the competitive framework of the academe. Because the formation of his argument lacks structure, rational profundity and barely sounds discerning, I am gradually convinced to disagree with his vie. I find it sufficient as well to disagree on the ground that due to reluctance, he has not at all considered looking over a few lessons which may yield to recognition of advantages other than academic. Mr. Dawkins’ position is weak, having sought no development from an educated process of arriving at a decision and I suppose that every person with similar influence is not likely to figure any relevance in a religious subject and would amount to the same set of reasons that draw support based on the common philosophic undertakings and working principle in which science, in the absence of God, lies at the core. Theology, in its basic essence or with lengthy technical definition taken off, is by terms of origin, a word (logos) of god (theos) from which to explore limitless possibilities how it may be done so to obtain answers required upon discovery of innumerable questions with rising complexities, since no physical evidence is available to testify how or what spiritual entity and faith are in form. So then accordingly, one can at least claim that theology, as a study of god, proceeds to be identified as making an abstract concept raise to the level of tangibility, or reality, which we know must take a definitive form if individual truth allows its perceived

Behavioral Tools Essay Example | Topics and Well Written Essays - 500 words

Behavioral Tools - Essay Example On the contrary, plastic or unrelated humor also generates laughter but fails to signal anything about their connection. According to Parisi and Smith (p.217), ‘laughter between sincere friends is open, unreserved, and joyful. Laughter provides the bonding gains of increased mutual trust that permit parties to exploit profitable opportunities.’ Exemplifying this statement is one of my friends who is known to have the best sense of humor in our group. We consider this friend as lively, bubbly, and full of enthusiasm. He is also extremely smart and a go-getter. He knows the knack of converting any kind of situation or moment, whether serious, dull, tiring, and anxiety, to a lively atmosphere filled with laughter. Applying Freud’s postulation that pleasure attached to humor makes one think like a child and thereby escape the constraints of rationality and logic on cognitive functioning (Levine, 9). This is precisely my friend does most of the times, either to convince people unto doing something that they do not intend, to divert attention of individuals or groups or even to drive home the point he wants to make. Instances of potential disruption between friends and within families were also regulated through his humor by a simple distraction of thought processes and emotions of the people involved in such situations. Laughter is said to reduce tensions and naturally arising hostilities in relationships. Although the intention behind cracking jokes is to induce laughter and distract people from usual boredom or impending emotional disturbances, it may also lead to serious consequences. One such instance can be traced to the day our final results were announced. All except one of our group members had cleared the examination, and this certainly was a sad moment for all of us. In an attempt to lighten everyone’s

Balance of Payment Essay Example for Free

Balance of Payment Essay Definition: BOT is the difference between the various export and import of visible goods of a country during a time. If the value of visible export exceed than the value of visible import than the balance of trade is said to be in favor. OR â€Å"The value of goods and services bought and sold in the world market.† Cause of Adverse Balance of Payment Since independence of Pakistan, balance of payment condition was not satisfactory. Accept few years, Pakistan is facing deficit in her balance of payment. The deficit is met by the loans. The deficit is increasing day by day. †¢ Import Of Machinery Developing countries are importing machines and technology to improve the industrial sector. It has made the balance of payment unfavorable because the value of capital goods is increasing day by day and we want to industrialize our economy. †¢ Export Of Raw Material Exports of Pakistan depend upon raw material and semi-manufactured goods. The price of raw material is very low in the world market. So our balance of payment remains unfavorable. For instance the product of cotton reduced in 1995 due to virus, so it also affected adversely our balance of payment, because we imported cotton instead of exporting. †¢ Political Unrest Many less developed countries like Pakistan are facing political unrest, which is the main cause of low production. Ultimately balance of payment remains unfavorable. In this situation investors fears to do the investment. †¢ Import Of Wheat Pakistan is facing the food shortage problem and spending a huge amount of foreign exchange on its import. In the past we imported many times like wheat and it has affected our balance of payment. †¢ Increase In The Sick Industrial Units Due to Nationalization a number of units are suffering a loss. These are not producing goods according to their full capacity. The low production has reduced the exports and increased the deficit of the budget. †¢ Domestic Problem Floods problem and Nationalization of industries reduced the production and exports of the country. Up till now majority of afghan refugees is living in Pakistan and most of them have got National identity cards in Pakistan. Characteristic of Under-Developed Country ââ€" ª High Capital Output Ratio Capital output ratio is the relationship in a given economy or in an industry for a given time period to the output of that economy or industry for similar time period. Capital output ratio in developing countries is very high because of uneconomic use of capital resources. ââ€" ª Dependence On Agriculture Most of the less developed countries like Pakistan depend upon agriculture sector. The majority of population is engaged in agriculture. But unfortunately agriculture is hopelessly in a backward stage in the developing countries, the average land holding and per acre yield is low. ââ€" ª Lack Of Capital Another common characteristic of developing countries is that there is a shortage of capital because of low level of incomes, low rate of saving, low rate of investment and unequal distribution of wealth. ââ€" ª Vicious Circle Of Poverty A poor country is trapped in its own poverty. In the less developed countries production per capital income, saving and investment is low, so low investment leads to low production. ââ€" ª Unequal Economic And Political Power For many less developed countries, a significant factor contributing to the persistence of low levels of living, rising unemployment, and growing income unequal distribution of economic and political power between the rich and the poor.  Hoarding In the developing countries like Pakistan, people have the habit of hoarding precious metals, stones and currency. Gold and silver are used as ornaments instead of productive purpose.

Evaluation of Cognitive Behavioural Therapy Effectiveness

Evaluation of Cognitive Behavioural Therapy Effectiveness Introduction The following discussion will critically evaluate the research evidence which is available regarding the efficacy and effectiveness of Cognitive Behavioural Therapy (CBT). It will particularly focus upon its application to the treatment of Schizophrenia Initially, a brief explanation of what is meant by CBT will be given along with an outline of the model which underpins it. A consideration of the use of CBT for the treatment of Schizophrenia will then be made. A series of 25 studies which have been conducted to investigate the efficacy and effectiveness of the use of CBT for the treatment of Schizophrenia have been critically analysed. The results of this analysis will be presented with reference to the following key factors: the determinant and measurement of quality of life, social functioning and occupational status, hospital readmission/relapse, compliance with pharmacological and non-pharmacological treatments, dropping out and compliance to CBT, general impression of clinical/ professionals and others, unexpected and unwanted effects, economic outcomes and the management of change. 2.0 Cognitive Behavioural Therapy (CBT) It has been said that the thoughts people have of a situation, and the way IN WHICH they interpret and understand it, are largely influenced by their beliefs about themselves and the world (Nelson 1997). Such a view is congruent with the underlying principles of Cognitive Behavioural Therapy (CBT). The 1980s saw pioneering work being conducted by Aaron Beck using Cognitive Therapy (Beck Rector 2000). This was later merged with the principles of Behavioural Therapy to produce what was entitled CBT. The Cognitive-Behavioural approach is fundamentally based on the three factors: Cognition, Behaviour and Emotion which are displayed in Figure 1 overleaf: In other words, this concept suggests that the way in which an individual thinks about and interprets a situation will directly influence their behaviour within the situation. This in turn will impact upon how they feel after performing the behaviour (Kinderman Cooke 2000) Thus on a very basic level, a person’s views regarding smoking will influence whether or not they are a smoker and how they feel about it. These principles provide the foundation upon which the rationale for treating an individual is built. If one wishes to change the way in which an individual is feeling, one must address the associated behaviours and underlying thoughts. CBT could therefore be used to help a person to stop smoking. An attempt would be made to change the way in which the person thought about smoking which would then, in theory, influence their behaviour in terms of whether or not they smoked and how they felt as a consequence. The same principles and procedure could be used to treat other addictions and phobias whilst also being applicable to depression and anxiety related problems. In order for this process to be most effective, CBT relies heavily on a trusting and collaborative relationship being formed between the therapist and the patient. An alliance is formed through which positive changes can be facilitated. The Therapist and the patient work together in order that any problems are identified and that an appropriate treatment programme is worked out (Beck 1995). It is important therefore that the patient is committed and willing to take part in the treatment so that the probability that the treatment is effective can be maximised. 2.1 The development of CBT CBT was originally developed and applied to the treatment of neurosis (Haddock et al 1998). It was mainly used for the treatment of people suffering from depression and anxiety. More recently, CBT has started to be applied to a wide range of other problems such as phobias and addictions. The success of such applications has led its supporters to advocate the use of CBT to the treatment of psychosis (Thornicroft Susser 2001). This incorporates illnesses such as Paranoid Schizophrenia and Bipolar Disorder. Morrison (2002) provides a wide variety of case studies in which CBT was used as a treatment method. 3.0 Research Evidence Any decision regarding the use of a given treatment must be based upon the scientific documentation which has assessed the treatment’s effectiveness and efficacy (Carpenter 2001). Thus one needs to consider the empirical research which has assessed the psychological management of psychotic symptoms. This research will now be discussed with reference to acute psychotic symptoms, long term psychotic symptoms and research which has been conducted in a clinical setting. The research which has been conducted to assess the efficacy and effectiveness of CBT for the treatment of Schizophrenia will now be critically analysed with reference to the nine different evaluation areas. 3.1 Determinant and Measurement of Quality of Life The first key issue in the debate surrounding the use of CBT in the treatment of Schizophrenia concerns how a person’s quality of life is determined and how it can best be measured. Clearly one of the central aims of medicine in general, and in mental health care in particular, is to improve the quality of life of the patient. A number of studies have attempted to investigate the quality of life of Schizophrenic patients after undergoing CBT. One of the larger studies was conducted by Lewis et al (2002) and involved a sample of 315 Schizophrenic patients being given CBT along side routine care and supportive counselling. It was reported that a significantly faster clinical improvement was made by those within the CBT condition relative to a control group. Lewis et al (2002) concluded that CBT enabled Schizophrenic patients to reach remission more quickly and that this was associated with an increase in their quality of life. This approach suggests that quality of life, therefo re, is determined by a removal of the symptoms associated with the illness. However, the conclusions made by the research have been questioned as significant improvements were made by the CBT group only in terms of a reduction in auditory hallucinations and not in terms of delusions, positive symptoms and the total Symptom Scores. Other relevant research was conducted by Jenner et al (1998) regarding the measurement of quality of life. CBT and coping skills training was given to 40 patients experiencing therapy-refractory auditory hallucinations. Significant improvements were found regarding overall symptomotology and in daily quality of life. This improvement in quality of life was said to be determined by improvements in daily functioning and social interactions. Auditory hallucinations were found to be eradicated for 20% of patients. Therefore, research in this field has suggested that CBT can improve the quality of life of Schizophrenic patients. This is determined by factors such as remission from symptoms and improvements in both daily functioning and social interactions. However, the measurement of ‘quality of life’ is a difficult concept as it is difficult to obtain relevant objective data. One must rely more on the subjective ratings of the patients, their family and the clinician involve d. Such measures need to be standardised such that the determinants and measurement of quality of life can be assessed and made based on sound empirical research evidence. 3.2 Social Functioning and Occupational Status An improvement in a patient’s quality of life is inevitably going to be linked with their social functioning and their ability to find employment. A study which focused on social functioning was conducted by Wiersma et al (2001). A sample of 40 patients received CBT and coping skills training over a period of 4 years. The therapy focussed upon addressing auditory hallucinations and on improving social functioning. The results found that there was a significant reduction in the frequency of hallucinations and their burden on the patient. It was also reported that 18% of the patients experienced a complete disappearance of their auditory hallucinations. Sixty per cent showed significant improvements in terms of anxiety, loss of control and disturbance of thought. Finally, 67% of those involved with the study showed significant improvements regarding social functioning. Having said this, there are a number of important limitations within the methodology used within this study whi ch ensure that it is difficult to confidently accept any findings. No control condition was evident, the assessors were not independent and the baseline measures used were made retrospectively. Furthermore, it was also reported that booster sessions were required to strengthened the skills and to enhance them in specific social situations. These limitations ensure that one needs to consider other research in this area in order to accurately assess the efficacy and effectiveness of using CBT for the treatment of psychosis. Barrowclough et al (2001) conducted a study which involved integrating the use of routine care with motivational interviewing, CBT and Family Therapy. Subsequent analysis revealed that this approach had facilitated significant improvements in the patients’ general functioning and abstinence from alcohol and/or substance abuse. Barrowclough et al (2001) suggest that the co-morbidity of symptoms alongside those involved with Schizophrenia can ensure that the patient finds it very difficult to find appropriate work. Thus this integrated treatment approach has been shown to increase social functioning and this could be theorised to then improve the patients’ chances of enhancing their occupational status. Such an assertion requires further empirical investigations such that the strength of this association can be determined. 3.3 Hospital Readmission and Relapse Research has been conducted which has assessed the effectiveness of using CBT for treating people who had been experiencing persistent psychotic symptoms for at least six months (Tarrier et al 1998). Participants either received CBT or supportive counselling for 20 hours over a 10 week period. The supportive counselling focussed on unconditional positive regard and developing rapport. One benefit of this research was that the assessors were both blind and independent. Those within the CBT group were found to be more likely to experience a 50% reduction in symptomotology and to spend fewer days in hospital. This study was subsequently criticised as significant differences were not found between the outcomes of those within the CBT and supportive counselling groups. However, it does provide some evidence that CBT can reduce the number of days that a Schizophrenic patient spends in hospital. This finding was supported by the results of the Bechdolf et al (2001) study which compared the benefits of CBT and Psycho-Education in the treatment of Schizophrenia. The results from the 88 participants found that those within the CBT group were significantly less likely to be re-hospitalised. In terms of relapse rates, an important study was reported by Gumley (2003). A group was identified as being at high risk from relapse. They were targeted such that their fear of relapse could be reduced, their management of the risk of relapse could be educated regarding the key warning signs and provided with booster sessions to further help prevent relapse. The targeting took place at the initial stage of the recovery process. At the 12 month follow up period, 15.3% of those within the experimental group were found to have relapsed compared to 26.4% of those who were ‘treated as usual’ Thus it was possible to significantly reduce the relapse rates of the Schizophrenic patients. Again this result was supported by the Bechdolf et al () study which reported lower relapse rates for patients given CBT relative to those who were treated as usual. In contrast, Tarrier et al (2004) found that there were no significant benefits in terms of relapse rates when CBT was given to p eople after their first psychotic episode compared to those being treated as usual. Therefore CBT does appear to help to reduce the relapse rates of those suffering with Schizophrenia but such benefits may not be significant for all forms of the illness. 3.4 Compliance With Pharmacological and Non-Pharmacological Treatments A key element of most medical treatments is that the patient is compliant where necessary. Clearly if they are not compliant then this has the potential to reduce the effects of the treatment. The problem of non-compliance in the treatment of psychotic symptoms has been identified within previous research. For example, Perkins and Repper (1999) suggested that non-compliance is an issue with approximately 43% of admissions to psychiatric units. One study which has investigated Schizophrenic patients and their compliance with CBT was reported by Bechdolf et al (). They compared CBT with the use of Psycho-education and found that the compliance levels were significantly higher for the CBT group. This is an encouraging finding in the light of the importance which can be placed on the patient’s compliance with treatment in terms of its effect on the overall success of CBT as a treatment option. 3.5 Dropping Out and Compliance to CBT The issue of compliance and the possibility of patients dropping out of treatment is a significant one. This is particularly the case with CBT is it relies upon a trusting relationship being formed between the therapist and the patient (Beck 1995). If the patient is not willing to be part of such a relationship then this will likely result in CBT being a less effective option than it otherwise could be. The study conducted by Jenner et al (1998) investigated this and found that 9% of their participants dropped out of the treatment programme. Although this is a relatively small number, it still represents a significant issue and one which merits consideration by both researchers and mental health professionals. 3.6 General Impression of Clinical/Professionals and Others It is important that a 360 degree perspective of the use of CBT for the treatment of Schizophrenia is gained so that a comprehensive picture of how its use is perceived can be obtained. This approach will need to take account of the views of the mental health professionals involved, the family of the patient and the patient themselves. With regards to the clinicians, the significant research findings have led many to advocate the use of CBT for the treatment of Schizophrenia (Thornicroft and Susser 2001). Therefore it would appear that it is an approach which is supported by the clinicians and professionals involved. Other quantitative research conducted by Jenner et al (1998) has found that 78% of the family of patients and the patients themselves were satisfied with their experience of CBT for treating Schizophrenia. Further research has focused on the patient in particular. For example, Messari and Hallam (2003) conducted in-depth qualitative interviews with four in-patients and o ne out-patient, all of which were suffering with Schizophrenia. The patients reported that they were in favour of the educational aspect of the CBT approach. They also noted that although the therapist was trying to change their beliefs, this was because the beliefs were false and not because it was a form of coercion One participant was against the use of CBT treatment. They indicated that it was unhelpful and that they were merely passively complying to the treatment as part of the powerful medical profession. Therefore, CBT appears to be a popular treatment for Schizophrenia amongst clinicians/professionals, the families of patients and the patients themselves. However, question marks do remain over patient opinions as not all of those involved in the Messari and Hallam research reported positive opinions. Further investigations of patient views need to be conducted with larger samples in order that a more confident conclusion can be drawn regarding patient views of the use of CB T for Schizophrenia. 3.7 Unexpected or Unwanted Effects As within the evaluation of any treatment programme, one must consider the negative as well as the positive aspects and effects. Some studies within this field have demonstrated that there is no significant benefit of using CBT compared to when the patients are treated as usual. This was the case with the research reported by Haddock et al (1999). Although this was a project which used a relatively small sample, it does indicate that CBT may not be appropriate in all circumstances in the treatment of Schizophrenia. Further investigations are required in order that the most appropriate application of CBT in this field can be determined. Rather than showing negative effects, other research has served to demonstrate that CBT did not have the positive effects which were expected. For example, Lewis et al (2002) found that CBT did not lead to the expected improvement in delusions, positive symptoms or Total Symptom Scores. Such drawbacks are highlighted by Turkington and McKenna (2003) wh o argue that inappropriate conclusions have been drawn based on the research evidence in this field. The results of some of the more prominent studies in this research field are summarised in Table 1 overleaf. Table 1 Effect sizes for improvement with cognitive–behavioural therapy (CBT) in studies using blind evaluation and a control intervention Turkington and McKenna (2004) suggest that if a drug had been tested and found to have the results displayed in Table 1 then it would have been consigned to history. As the clear benefits of CBT for the treatment of Schizophrenic patients are not yet fully understood, unexpected research findings will continue to be reported. Thus, research in this field has not always revealed the findings which were anticipated by the researchers. 3.8 Economic Outcome When one is evaluating any treatment, the economics of its application must be taken into consideration. Even if a treatment is shown to be very effective, its use may not prove to be economically viable. With health care units working within strict budgets, any proposed treatments need to fit within the economic constraints which are placed upon those selecting the treatments to be used. CBT can be a costly approach. Within the Drury et al (2000) study patients were given eight sessions of CBT a week over a six month period. Although this was possible within the experimental setting, the extent to which such an intense treatment programme would be economically viable within clinical environments would be questionable. However, Bechdolf et al () does argue that the use of CBT can lead to cost savings through a reduction in the number of hospital days which are required and the probability that a patient will experience a relapse. It is unclear whether or not such cost savings exceed those involved in the cost of implementing CBT as a treatment option. 3.9 Management of Change A significant amount of research has been conducted regarding the management of the change of Schizophrenic symptoms via the use of CBT. A number of benefits have been highlighted by this research (Turkington and Kingdon 2000, Rector et al 2003). Recent research has indicated that different forms of CBT can be effective such as individual and group CBT (Warman 2005) and Functional CBT (Cater 2005). These benefits have been demonstrated with regards to acute, chronic and more specific psychotic symptoms. The management of each of these three areas will now be briefly considered. The management of acute psychotic symptoms has been achieved with CBT within research. Tarrier et al (2004) found that CBT speeded up the recovery of those who had experienced their first psychotic episode. Furthermore, Startup et al (2004) found that CBT could be used to manage Acute Schizophrenia Spectrum Disorder. The management of these acute and initial psychotic episodes has been highlighted as very important in determining the long term course of the patient’s recovery (Birchwood and Tarrier 1992). CBT has also been used in the management of more persistent psychotic symptoms (Temple and Ho 2005). Kuipers et al (1998) found that CBT could be used to significantly reduced the frequency of more persistent symptoms and delusional distress. These benefits were still found to be significant at the nine month follow-up stage. A major study in this area was conducted by Sensky et al (2000) involving participants in the post-acute stage of psychosis. Improvements were found in both negative and positive symptoms and these improvements remained at the 18 month follow-up period. This study used a relatively robust methodology which overcame many of the limitations associated with previous research. The use of blind assessors and a low intensity of treatments means that the data is more likely to be reliable and that it is likely that the findings would generalise to a clinical setting. Some research has been conducted to assess the use of CBT in the management of psychotic symptoms within a clinical setting. The Tayside-Fife clinical trial found that CBT was related to significantly more clinical improvement relative to participants who had been given supportive counselling or who had been treated as usual. Furthermore, patients given CBT were found to be more satisfied with their treatment compared to those in the other groups. Morrison (2002) also provided evidence to suggest that the benefits of CBT can be translated to a community setting. This effect was found to still be significant at a 12 month follow-up. Finally, research has also shown that CBT can be used to target specific symptoms which are associated with Schizophrenia. For example, Trower et al (2004) found that CBT can help manage ‘commanding’ hallucinations in which the patient is being instructed to perform certain behaviours by voices in their head. Halperin et al (2000) also provided evidence which suggested that CBT can be used to treat the social anxiety which can be associated with Schizophrenia. 4.0 CONCLUSIONS Throughout history a wide range of different approaches have been taken to the treatment of Schizophrenia. Medication, Electro-Convulsive Therapy and Family-Focused Therapy have all been applied to the treatment of Schizophrenia. In more recent times, researchers and therapists have been seen to advocate the use of Cognitive Behavioural Therapy as a feasible and effective treatment method. This discussion has considered the CBT approach and the theoretical model which underpins it. The development of CBT has been addressed and the research evidence which has been provided to evaluate the use of CBT in the treatment of Schizophrenia has been critically analysed. This analysis particularly focused on a set of 25 research studies and was conducted with reference to the following nine key areas: Determinants and measurement of quality of life, social functioning and occupational status, hospitalisation and relapse, compliance with pharmacological and non-pharmacological treatments, drop out and compliance with CBT, general impressions of CBT, unexpected and unwanted effects, the economic outcomes of CBT and its use in the management of change. Discussions within each of these areas has demonstrated that CBT appears to have the potential to be an effective and feasible approach for the treatment of Schizophrenia. However, further research is required to help clarify the benefits of CBT and to identify the circumstances in which it is most effective and the factors which have a significant impact on this effectiveness. CBT could be used throughout the treatment programme from those who are at high risk of experiencing psychotic episodes (Morrison et al 2004) through to the treatment of Schizophrenia patients and then to help minimise the probability that they will relapse and require further time in hospital. The research evidence suggests that CBT can be effective for acute and chronic psychotic symptoms. There is also some research evidence that these benefits can be successfully transferred to clinical and community settings. CBT certainly has a role to play within the multi-disciplinary approach which is now taken to the treatment of mental illness. As part of this comprehensive treatment package the potential benefits of CBT can be realised and steps can be taken to help prevent any possible drawbacks. This will help to ensure that a Schizophrenic patient will receive a feasible, comprehensive and effective treatment package which will effectively address all of their psychotic symptoms and ultimately facilitate an improvement in their mental health. REFERENCES Barrowclough,, C., Haddock, G., Tarrier, N., Lewis, S. W., Moring, J., Schofield, N. and McGoven, J. (2001). Randomized Control Trial of Motivational Interviewing, Cognitive Behaviour Therapy, and Family Intervention for Patients with Co morbid Schizophrenia and substance Use disorders. American Journal Psychiatry. 158, 1706-1713. Bechdolf, A., Knost, B., Kuntermann, C., Schiller, S., Klosterkotter, J.(, Hambrecht, M. and Pukrop, R. 2004). A randomised comparison of group cognitive-behavioural therapy and group psycho education in patients with schizophrenia. Acta Psychiatric Scand. 110, 21-28. Beck, J. S. (1995) Cognitive Therapy: Basics and Beyond. Guildford: New York University Press Beck, A.T., Rector, N.A. 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