Psychology

The effects of compassion fatigue and burnout have recently become an important issue in many of the professions which provide assistance.  The data from the Udipi (2008) study found out that the empathic engagement that counselors have with the problems of their patients plays a critical role in the counselors risk to experience compassion fatigue. The same study indicated that factors, such as, being self-critical and giving up in stressful situations, experiencing burnout, and having a high number of patients and stressful clinical events, pose a greater risk of compassion fatigue to the medical workers and other people engaged in professions providing assistance.

Scholarly works name several notions reflecting a persons negative mental condition burnout, compassion fatigue, secondary traumatic stress and vicarious trauma. These different, but related terms are often used interchangeably in literature that leads to confusion and difficulty in analyzing and comparing the research results of various studies.

A review of the literature was conducted utilizing the Psych Info, Psych Articles, and ERIC databases. The key terms used during the literature review included burnout, compassion fatigue, vicarious traumatization, vicarious trauma, secondary stress syndrome, secondary traumatic stress, compassion satisfaction, validation, validity, reliability, mental health worker, counselor, psychotherapist, therapist. A research was also conducted using a list of key authors (e.g., Figley, Pearlman, Maslach) in order to find out their publication histories, and information on the conducted tests and measures (e.g., The  HYPERLINK javascriptvoid(0) Maslach Burnout Inventory, HYPERLINK javascriptvoid(0) Compassion Fatigue Self Test, the  HYPERLINK javascriptvoid(0) Professional Quality of Life Scale, the HYPERLINK javascriptvoid(0) Life HYPERLINK javascriptvoid(0) Scale, the Traumatic Belief Institute Scale, the  HYPERLINK javascriptvoid(0) Secondary Traumatic Stress Scale, and the HYPERLINK javascriptvoid(0) Burnout Inventory).

Compassion Fatigue
Compassion fatigue (CF), the concept that was developed by Charles Figley, has been characterized as a phenomenon that causes the caregivers reduced  HYPERLINK javascriptvoid(0) interest in being empathic or bearing suffering of clients and the  HYPERLINK javascriptvoid(0) natural consequent HYPERLINK javascriptvoid(0) behaviors and emotions resulting from knowing about a traumatizing event experienced or suffered by a person (Adams, 2006). The research has shown that CF affects those in helping professions, such as nurses, mental health professionals, physicians and clergy due to the amount of empathy expressed for their patients (Meadors, 2008). Similarly, the compassion satisfaction measures the extent to which the genetic counselors derive pleasure from helping patients, families and the society through their work as health system care givers. In some instances, the providers become exposed to the secondary traumatization, which is characterized by a professional who is affected by knowing about the traumatizing events of their patients (Meadors, 2008). This form of compassion fatigue leads to a variety of symptoms that are usually seen when one cannot deal with the possibility that they are unable to help their patient from the pain of their traumatizing situation (Adams, 2006). Often, professionals in helping careers are also exposed to an array of problems that their patients may be experiencing which may cause them to be personally affected by the primary traumatization. The primary traumatization, also a form of compassion fatigue, may occur when clients reveal their experience of abuse or even the significant suffering that was caused from a diagnosis or trauma to professionals. Dealing with such complex issues from clients can cause those in helping professions to experience the symptoms associated with compassion fatigue is often visible when the professional has unhealthy coping strategies (Meadors, 2008  HYPERLINK javascriptvoid(0) ). Reliving aspects of the trauma, avoiding reminders of the trauma, HYPERLINK javascriptvoid(0) heightened irritability, sleep disturbances, quick HYPERLINK javascriptvoid(0) withdrawal, and task avoidance are some of the many symptoms of CF that are unavoidable and unrecognizable (Benoit, 2007). In professionals who are unable to handle such symptoms, CF can be very devastating to both their career and personal lives. Just like others in helping professions, the genetic counselors also endure compassion fatigue. In addition to the primary and secondary traumatization,  HYPERLINK javascriptvoid(0) there are a number of factors HYPERLINK javascriptvoid(0) that bring about compassion fatigue in counselors. One of such factors explored by Benoit and colleagues is the personality. They concluded that a counselors personality can also cause them to experience compassion fatigue.

Compassion satisfaction and Burnout
The compassion satisfaction has bee defined by Beth Stamm (2005) as the pleasure that one receives from their ability to do their job well (Alkema et al, 2008). The compassion satisfaction can be seen in all professions and careers. Feeling the compassion satisfaction has also been known to be a protective mechanism against the experiences of the compassion fatigue and burnout. Factors, such as the positive effect, being optimistic, maintaining good health, and leading a balance life can all cause compassion satisfaction (Sprang et al, 2007). Furthermore, by having and utilizing various social resources individuals are able to combat stress and maintain the proper level of satisfaction in their careers. The promotion of self-care plays a critical role in compassion satisfaction. The professional career, good  HYPERLINK javascriptvoid(0) health, interaction with positive and supportive people and the adaptation to ones job environment all contribute to one being satisfied with their jobs (Alkema et al, 2008). In a recent study, it was reported that individuals within helping professions gain the greatest amounts of compassion satisfaction when they are a part of a supportive and productive team of colleagues. Witnessing the clients recovery and interacting with a supportive supervisor also allows helping professionals to have increased amounts of compassion satisfaction. For individuals who do not work in supportive environments or interact with positive people the possibility of experiencing job dissatisfaction can lead to compassion fatigue and burnout.
According to Figley (1995), there are three content domains of symptoms associated with compassion fatigue, namely, the following (1)  HYPERLINK javascriptvoid(0) re-experiencing of the HYPERLINK javascriptvoid(0) traumatic, HYPERLINK javascriptvoid(0) (2) avoidance of reminders HYPERLINK javascriptvoid(0) the face of reminders and (3) persistent arousal. Compassion fatigue  HYPERLINK javascriptvoid(0) is associated with a sense of helplessness, confusion, isolation from family and friends, and is triggered by the experiences of others (Figley, 2002). Furthermore, Figley (1995 1999) believes that the compassion fatigue is different from burnout in that it can occur suddenly and without any warning symptoms unlike the burnout which occurs during a gradual regression of a helpers emotions. Adams, Boscarino, and Figley (2006) suggest that the high emotional involvement without HYPERLINK javascriptvoid(0) adequate support HYPERLINK javascriptvoid(0) feelings ofthe  HYPERLINK javascriptvoid(0) personal accomplishment may leave professionals vulnerable to burnout suggesting  HYPERLINK javascriptvoid(0) that the job burnout and the secondary trauma HYPERLINK javascriptvoid(0) are likely central and critical clinical features of compassion fatigue (p. 104). This suggests that the burnout and compassion fatigue, while theoretically different, have related and overlapping associated factors. The compassion fatigue is associated with hyper-arousal symptoms, sleep disturbances, concentration difficulties, agitation, irritability, hyper-vigilance, diminished affect, distress and physiological reactions to reminders of their clients experience, a decrease in pleasurable activities, and contagion effect, resulting in the transmission of distancing, and emotional withdrawal to the helpers family and friends (Figley, 1995 Salston  Figley, 2003). These symptoms are nearly  HYPERLINK javascriptvoid(0) identical to those of the post-traumatic stress disorder HYPERLINK javascriptvoid(0) the exception that the traumatic event experienced is one that the client has shared with the helping professional (Salston  Figley, 2003). The term compassion fatigue has begun to be used synonymously as secondary traumatic stress. Figley (1995) has stated that compassion fatigue is a term that is used due to its less derogatory companion secondary traumatic stress. Several variables have been shown to be significantly related to compassion fatigue including the personal trauma history, the meaning of traumatic events the social support, the coping style, the amount and type of caseload, the type of client (trauma vs. non-trauma) professional development, current stressors, and supports (Folette, et al., 1994 Figley, 1995 Pearlman  MacIan, 1995 Ortlepp  Friedman, 2002 Stevens  Higgins, 2002 Nelson-Gardell  Harris, 2003).

Burnout
The burnout has been characterized as a psychological syndrome that is defined by chronic interpersonal stressors at work (Ozyurt et al, 2006). The burnout is comprised of three dimensions that can lead to serious issues if not resolved. Feelings of ineffectivenessthe lack of accomplishment, depersonalization and emotional exhaustion are the components of the burnout (Bernhardt, 2009). Like the compassion fatigue, burnout is seen among professionals who are involved in high levels of interpersonal interactions and personal investments (McPhillips et al, 2006). If not managed, burnout may cause poor health conditions, sleep disturbances and an impaired job performance. The burnout may also lead to both job dissatisfaction and compassion fatigue. Several studies have indicated that burnout can easily develop into compassion fatigue if one is not careful (Ozyurt et al, 2006). Barbara Bernhardt and colleagues (2009) studied the burnout among individuals within the profession of genetics and revealed that being a genetic counselor, working in a university setting, and having fewer years in practice are all factors that contribute to the burnout. Her study also indicated that the genetic counselors were four times more likely to consider leaving the profession in comparison to other genetics professionals. Issues related to the reimbursement problems, the lack of institutional support, and the low earning potential may all be reasons why genetic counselors are more likely to consider leaving the field. Genetic counselors are more likely to experience burnout due to the moral distress they may encounter when providing patients with non-directive and unbiased counseling to enable the patients to make the best decision for themselves (Benoit et al, 2007). The moral distress is an emotional andor physical suffering that is experienced by an individual when either their internal or external constraints prevent them from the course of action that they believe is right (Bernhardt et al, 2009).

The workload and work performance  HYPERLINK javascriptvoid(0) have been found to be HYPERLINK javascriptvoid(0) related to burnout, with higher workloads resulting in  HYPERLINK javascriptvoid(0) higher levels of burnout (e.g., Greenglass HYPERLINK javascriptvoid(0) 2000 Shinn et al., 1984), higher levels of emotional exhaustion predicting poorer future work performance (Wright  Bonnett, 1997), the work pressure and the demands being related to higher levels of emotional exhaustion (Savicki  Cooley, 1994) and that burnout is negatively related to the job satisfaction and commitment (Bakker et al, 2004 Jenaro et al, 2007). Various consequences of the burnout include job turnoverabsenteeism, physical exhaustion, somatic difficulties, insomnia, substance abuse, marital and family problems, aggression, irritability, anxiety, depression, guilt, pessimism, difficulty concentrating, and withdrawal from others (Figley, 1995 Maslach, 1997 Collins  Long 2003 Salston  Figley, 2003 Bakker, et al., 2004).

The burnout affects a person in five different domains physical, emotional, behavioral, work-related, and interpersonal (Figley, 1999). While burnout shares similar characteristics to the constructs of  HYPERLINK javascriptvoid(0) compassion fatigue, secondary traumatic stress, and vicarious trauma, it  HYPERLINK javascriptvoid(0) does not lead to HYPERLINK javascriptvoid(0) changes in trust, feelings of control, intimacy, esteem needs, safety concerns, and intrusive imagery (Trippany et al., 2004).

According to Farber (2000), the burnout is a result of the increased external pressures, multiple obligations, inadequate financial rewards, and work incentives, such as the personal advancement, resulting in a feeling of inconsequentiality, a perception that efforts to help others are ineffective, the task is endless, and personal payoffs are few (recognition, advancement, accomplishment, appreciation) (p.590). Farber further suggests that burnout today is a social trend, as compared to the classic burnout of yester-year, in which individuals would work harder and harder to the point of physical and emotional exhaustion in order to pursue socially meaningful goals. Rather than looking at burnout as an interaction between biology and the environment, as one would with depression, it is more a manifestation of the interaction of personality with external stressors (organizational and societal) (Farber, 2000). The burnout then can be seen as a result of difficult and stressful work conditions and restrictions, high workloads, demands from administrators, managers or clients, feeling one has little autonomy or social support, and that there are few rewards in return for ones work.

Personality Factors and Compassion Fatigue and Burnout
Basic personality factors can be explained by five factors which are called the Big
Five (Bakker AB, 2006). They include the following (1) extraversion, (2) agreeableness, (3)
conscientiousness, (4) neuroticism, and (5) openness.

The extroversion has been defined as individuals who have a tendency to be self-confident, dominant, active, and excitement seeking. They also show positive emotions, have a higher frequency and intensity for personal interactions, and an increased need for stimulation (Bakker AB, 2006). Individuals, who are optimistic, have cheerful temperaments, and reappraise their problems positively are all considered to be extraverts. When working, these individuals have characteristics that negatively correlate them with depersonalization and exhaustion (Bakker AB, 2006).

Those who are altruistic, caring, trustworthy, modest, sympathetic, and warm
may be defined as having the factor of agreeableness. Agreeableness has also been
shown to be negatively correlated with the emotional exhaustion, but positively correlated
with the personal accomplishment (Bakker, 2006). Research has suggested that nurses
have the ideal stereotype of agreeableness (Bakker AB, 2006).

Characteristics, such as self-discipline, striving for achievement, dutifulness and
high competence are all used to describe individuals who are conscientious. These persons
also exhibit a positive relationship with the personal accomplishment, and in a research, involving call center workers, it was revealed that conscientious call center
workers, who experienced a high volume of calls were emotionally exhausted (Bakker, 2006).

Neurotic individuals have distressing emotions and possess traits, such as
fearfulness, irritability, low self-esteem, social anxiety, poor inhibition of impulses, and
helplessness. Individuals who suffering from the high levels of neuroticism tend to set high goals for themselves and then underestimate their own performance (Zellars KL, 2000). They also use coping strategies like denying, wishful thinking, and self-criticism to work through issues instead of using problem solving and proactive behaviors. The neurotic individuals do not work well under stressful situations, which cause them to have increased experience with physical illness (Bakker, 2006).

People who have a tendency to attempt to learn something valuable from taxing
experiences characterize the last factor of openness. They also strive for the personal growth and are thought to be flexible, imaginative and use humor to deal with stress and difficult situations (Adams, 2006). Positive relationships between the openness and the personal accomplishment exist, but the negative relationships between openness and depersonalization must be taken into account as well.

The Helping Professionals, Compassion Fatigue and Personality
Individuals who choose to pursue careers in helping professions are often exposed to an array of problems that their patients may encounter. Professionals involved in such careers are expected to be concerned with their patients on an extremely intense and personal level. The helping profession involves more the communication process that deals with human problems. It is through this process that the helping professionals are expected to be helpful in ways beyond the medical treatment, ensure that patients understand their options for coping with conditions, assist patients in making decisions that are in line with their goals, and to also make the best possible adjustment (Ellington et al, 2006). All these responsibilities can be extremely overwhelming for a genetic counselor and, if heshe is unable to handle the demands of the career, stress and compassion fatigue may occur. Research has implied that genetic counselors with the personality traits such as the desire to be liked, wanting to control a patients reaction, and perfectionism have all been speculated to be at an increase risk to experience compassion fatigue (Benoit, 2007).

The research has indicated that the personality plays an important role in the development of burnout, which has been closely linked to compassion fatigue (Zellars, 2000). The personality has been found to have a correlation to health, longevity, burnout, and even how individuals parent their children (Garcia LF, 2006). However, there has been no correlation to how personality relates to compassion fatigue or how the personality and compassion fatigue affect  counselors.

Caring for patients is also a considerable component of counseling and may lead to the compassion fatigue because certain counselors have a desire to be liked by their patients. Emotionally applying many efforts may be beneficial to the patient, but this also makes the counselor more vulnerable to the patients reactions. In some situations, the genetic counselors may believe that they have had a negative impact on the  patients life. They are constantly reminded of the time that they presented devastating or difficult news to a patient or to their family members. Delivering such news may cause guilt within the patient or other family member and may also change the patients family dynamics (Figley, 2002). Having such stress along with the desire to be liked by their patient can cause compassion fatigue in the counselor.

Some of the negative outcomes that could result from having characteristics such as perfectionism, wanting to control the patients emotions, and having the desire to be liked by their patients include countertransferance and detachment There are times when empathic connections with patients can lead to counter-transference and not being able to realize this type of relationship will cause compassion fatigue.

Counter-transference occurs when a counselor projects their emotional reaction or the behavior towards a client (Gladding, 2004). Within the field of counseling, there are two forms of countertransferance associative reactions and projective identification. The associative reactions occur when a clients experience provokes the counselor to have their own associations, thoughts, and images (Benoit, 2007). In these situations, the counselor is no longer focused on the client and is now focused on his or her own internal feelings. The projective identification, on the other hand, involves the counselor identifying with the client and then expecting the client to feel the same way as them. These types of counter-transference evoke painful emotions in the counselor (Benoit, 2007).

The last factor that contributes to the compassion fatigue is detachment issues that counselors may struggle with. Detachment is described as the counselors ability to detach themselves from patients and separate their work life from their home lives (Benoit, 2007). Detachment becomes a problem when counselors begin having dreams about patients, having intrusive thoughts, compartmentalizing or separating situations at work, selectively forgetting to carry out important tasks and rationalizing situations that have bad outcomes. With all of the factors that can contribute to or lead to compassion fatigue, it is important that counselors can effectively measure and assess the signs of the compassion fatigue.

Conclusion
In the field of any helping profession, it is important that counselors express some of regard, non-directiveness, and empathy (Eunpu, 2007). Such qualities make certain individuals are highly suitable for the profession. However, the research has also pointed out that counselors that are perfectionists, controlling, and have a desire to be liked by their patients are thought to be at an increased risk for the compassion fatigue (Benoit, 2007). Through numerous studies and researches, perfectionism has been known to have both good and bad implications. The consequences that are consistent with perfectionism are a future that is vulnerable to distress, a chronic sense of failure, indecisiveness, procrastination, and shame (Bieling, 2004). Perfectionism that includes such characteristics is deemed unhealthy and is called maladaptive perfectionism (Bieling, 2004). This type of perfectionism is also believed to be consistent with people who are concerned about how others evaluate them, express self- doubt, and worry about making mistakes that could lead to problematic behaviors (Bieling, 2004). The responsibilities of having to deliver bad news, not knowing what to say or having to disclose numerous abnormal results can be a difficult task to complete daily (Benoit, 2007). Counselors who have the characteristic of the maladaptive perfectionism may have problems with such tasks that are required in the profession of the genetic counseling.

Often counselors feel responsible for the patients suffering when having to convey abnormal test results counselors may feel that in some way they have caused the patients pain (Benoit, 2007). In addition, counselors may feel overwhelmed after giving bad news and the realization that the next discussion with their patient will be on topics of termination or continuation of their pregnancy can also result in the compassion fatigue (Benoit, 2007). Another area that causes the compassion fatigue in counselors has to deal with difficult patient issues, such as the terminal illness, where a family member or baby has died due to the genetic condition which can be very taxing on a counselor. Moreover, having to effectively counsel patients with mental health disorders, or not being able to diagnose a patient symptoms or condition may lead to fatigue. Situations in which counselors identify their patients and other family members as being high risk can be stressful for the counselor (Benoit, 2007). It is now the counselors responsibility to ensure that the patient fully understands the importance of the information at hand and is able to communicate the news with other family members. This in turn, causes counselors to be concerned about the legal ramifications when there is no documentation that states that the patient was informed of their risk and the risk of other family members (Figley, 2002). Having such feelings is where the characteristic of being able to control the patient and their emotions could lead to an increase in experiencing the compassion fatigue within the counselor.

Sports in almost every way are involved with risks, some with greater damage or higher occurrences than others. In case of extreme sports, these risks dwell even closer to each individual due to the nature of activities involved. Despite this fact however, many seek for even more extreme sports possibly engaging themselves in the line of life and death. According to Slanger and Rudestam (1997) people are drawn in favour to sensation seeking and self-efficacy which leads to extreme and high-physical risk taking behaviour. People are also constantly being called upon to prove themselves in a society where reference points are both countless and contradictory and where values are in crisis, people are seeking, through a radical one-to-one contest, to test their strength of character, their courage and their personal resources. By putting themselves in the line of danger it is observed that these people are able to overcome fear and much more forward in taking risks pressure. Even though physical danger occurs from time to time, these people react to environment with pressure much better than those who are not usually exposed to the danger. Slanger and Rudestam (1997) also suggested that risk takers can overcome the potentially inhibiting influences of anxiety, fear, and the recognition of danger. This in turn leads to better risk management for the people involved in the extreme sports with proper safety measure to the risk of physical danger.

Looking at risks of extreme events as discussed by Slovic and Weber (2002), risk management is unseparated from risk analysis or assessment itself. Extreme events, by definition, cause much harm to people, property, and the natural world. People caught into such extreme events  willingly or not  is facing the games against nature. Not only looking into extreme sports, the authors described many types of risk involved from different field studies and try to understand how each of them can be associated with one universal perception on how to deal with risks. While this could serve as general guidance, risks in extreme sports is rather unique compared to another field. In the extreme sports, people are well aware of the risk involved in it, but it is the risk that they are chasing and this is the part the authors of said papers missing. If the authors could look into the mental state of the people who are accustomed to risks, risk management process might change a lot.

One of the examples of extreme sports is snowboarding. Rooted from older conventional surfing sports according to Donelly (2006), snowboarding is one of the fastest growing extreme sports in the world and considered middle-class to high-class sport for the youth due to the cost of the snowboards, snowboarding gear, lift passes, and transportation to the resorts. According to the author snowboarding became popular to the results of teens trying to find themselves sports other than their parents sports which are skiing. Teens who are playing snowboarding while considered in the middle-class or higher-class sectors are exposed to the same danger as those children who are seeking cheaper and easier to practice sport such as the normal skate boarding. This can be the starting point to assess the risk management for both types of children and finding out how the risks might differs from one another.

Sports risk management are also brought to control by many governing sports association underlying the basics of the sport activities. In fact, one of the major responsibilities for each governing sports association is to identify the levels of risks factors and the level of damage associated with the activities (Fuller  Drawer, 2004). This is information is to be used by the sports governing bodies to identify preventive and therapeutic interventions. Fuller and Drawer however pointed out that the acceptability of risk within specific sports, however, is dependent on the perceptions of the participants involved. This is particularly true in extreme sports. Acceptability of risk by people practicing extreme sports can be perceived as pleasure cutting action when rules are created out of the fair discussion with people involved in it.

While many people minds quickly aligned to risks when it comes to extreme sports it is however important to enter the mindset of people who loves to do such sports and understand that risks might be the last thing on their minds. While risk of death is much to be concerned, according Breton (2000) death in extreme sports is such as natural cause as any other accident that could happen on earth. The sensation of death occurs often to the athletes involved in extreme sports, but very little actually went to the other side because of it. Breton gathered many athletes comments from many sources and found out that many of them had ever experienced sensation of death while in the middle of the extreme sport and survived because of the sense of pleasure coming from the sense of death. In one particular source one man who attempted to cross the Atlantic in a microlight said he saw death many times and they are pushing him above his limits every time. While Breton managed to achieve collectively it can also be a good starting point to show that while risk is the main driving point of the extreme sports, what might be able to be done to reduce risks at the same time does not reduce the thrill produced by the sport itself.

To further explore the mindset of people involved in sports with high risk we can take a look in to the book by Armstrong (2000) titled Performing in Extreme Environment which clearly describe what people think and do when they are in extreme environment or when they think they are. Extreme environment as described here is an environment that radiates threat of risks to people and thus creating stress. Physical state of people is going through significant changes when people minds recognize danger or risk such as the increase of heart rate due to the hormones though the actual case might be the people might not be in that severe of danger as they think they are. Stress, is what activates the hormones and forces the body quickly and try to adapt to the changing environment. The same factor in turn, could result in personal growth, temporary perturbations or permanentdeleterious effects. This varies in each people to respond to challenges, danger and threats but however the author pointed out that every person is capable of taking significant amount of stress and achieves growth as permitted by their own limit. This growth is critically dependant on the emotional response to the environmental situation such as the pleasure of completing tracks in jungle track and also number of similar previous experiences. Armstrong (2000) at the same time stressed that people exposed to such stress and risk and managed to meet physical or psychological demands successfully usually granted with increased physical stamina and more effective coping style.

Adolescents participate in sports for a variety of reasons but many of them seem to enjoy participating in what some might consider very-high-risk or extreme sports activities. Patel and Luckstead (2000) stated that for some adolescents risk taking becomes pervasive and can be detrimental to normal health and development. The majority of adolescents will do well in the context of athletics, and the many positive benefits of regular physical activity and sports participation should be appropriately emphasized. While the risk involved is high, many associations must think of a much better way of managing the risk that does not take off the thrill from the risk involved. It is very possible that risk management that favours in the extreme sports fans to be applied than a risk management that restrict the essence of the extreme sport itself. Exposing people to extreme environment results in growth as described earlier and at the same time allow people to adapt to risk in real environment. This is major point that we should be looking at and any risk management that people should do towards extreme sports if being directed to lower the physical damage and not to reduce the risk might be more appreciated. As brought forward by Berton (2000) the legitimacy of surviving in such extreme sports brings to light the radical truth for the subject, as the more intense the suffering, the more the achievement has a reassuring personal significance, the more fulfilling the satisfaction of having resisted the temptation to give up. People do grow a lot from danger, risk and most importantly from the success of going past it.

Most of the previous study such as Armstrong (2000), Berton (2000), Donelly(2006), Fuller  Drawer (2004), Pater  Luckstead (2000), however, lack of the motivation to relate extreme sport and risk management. Much of the study proven that risks have the impact that critically chained to extreme sports, and such impact are often viewed as a positive benefit such as better physical stamina, satisfaction and better reaction to risk exposure. The purpose of this paper then, is to observe the direct relation of individual risk management quality of those who were able to finish the job (exclusively towards extreme sport that has the ending state) compared to those who did not and a statistical measurement to be taken to see the correlation between them.

Methods
Participants would include 20 male risk taking snowboarders and 20 male snowboarders with moderate risk appetite. The participants will be selected from the registry maintained by the United States Snowboard Association. The snowboarders mentioned in the registry would be given numbers. The participants are randomly selected with the assistance of numbers assigned to snowboarders. The participants will be compensated by giving free entry to them for the events organized by American Snowboarders Association.

Apparatus
Ten snowboard trainers would be used in order to identity the attitude of participants towards risk.  In addition 40 computer-based simulators will be used. The simulator will allow participants to experience rotational motion of snowboard. The simulator will also consist of input and output, which can be connected with a TV or Personal Computer. Before embarking the experiment, the participants will be given training through video simulation. Participants will be given specific instructions concerning the dangers that they face while using this apparatus. A video scene of snowboarding event will be used to give further training to the participants. The video scene will be from Colorado, the actual snowboard terrain. Previously recorded video will be used to assist participants in understanding the terrain. They are expected to complete their ride on a terrain, which approximately covers the distance of ten miles. Forty snowboards will be used. The participants will be allowed to bring their own snowboards so as to enhance their comfort level, while indulging in this extreme sport. The participants will be asked to bring free ride snowboards, which can be used for terrains with fast and sudden turns. The snowboards will be connected to a remote electronic device, comprising a video camera, which can be used to measure the speed of the rider and response of the rider to difficult riding situations.

Procedure
The conditions of this project involve division of participants into two control groups and one video visualization group. The first control group will consist of high risk taking, but highly skilled snowboarders. The second control group comprises moderate risk taking snowboard riders with moderate and high level of skill in riding the snowboard. Representatives from these two control groups would become part of video visualization group. The two control groups will be asked to participate in this sport. They need to ride for a period of five days-one hour each day. Over this period, the different experiences of the riders will be recorded through video recording, remote electronic devices, and interviews with selected participants. Such procedures are necessary to know the different attitudes exhibited by riders while riding difficult terrain. The data for five days will be collected and collated for the reference of researchers. On the sixth day, the participants will be asked to take part in snowboard race. The experiment expects that high risk taking sportsmen will ride snowboard freely without any fear and they will exhibit better satisfaction with their snowboard session, whereas moderate risk taking snowboarders exhibit less passion with snowboard sport. The video of the final day race will be taken. This video will try to identify the changing emotions of participants when they counter dangerous terrains such as long turn and sudden fall. The performance of participants will be studied. If the moderate risk taking group shows greater risk taking ability, such videos will be showed to the participants. On the other hand, when the two control groups continue to exhibit their assumed risk taking ability, it will be considered as the data supporting the experiment. The final race will include representatives from both the groups. The participants will be asked to participate in this event as if they are trying to win the top position.  If the high risk taking group exhibits better skills, ability, and show enjoyment despite dangers involved in this sport, then it will imply that the hypothesis is vindicated. During this period participants will be asked to use snowboard in a normal way, without any changes in their routine playing strategy. Social cognition explanation will be used in order to identify differences in the attitudes of participants towards extreme risk sports. The participants will be showed video of their performance and they will be asked specific questions. There will be questions such as Why did you take risk while riding the snowboard Why do you show fear while playing this sport How did you learn the skills What are your priorities while playing this sport Despite possessing defensive gears why do you show fear Answers given by participants can be used to strengthen the conclusion reached by researchers. The participants answers will be compared with the data collected from actual experimentation in the form of behavior of two control groups and video visualization group. The researchers will collect and collate data that they obtained during the period five day sessions and the final day race between two control groups.

Aurelius Clemens Prudentiuss Psychomachia remains an important piece of the early Latin works of the Biblical content involving the seven heavenly virtues and the seven deadly sins. This richly allegorical poem addresses the universal theme and presents several theological tenets analogous to human psychology. Even some forms of the Christian churches have later been influenced by the grounding rationale of Prudentius work. Pentecostal Christianity is among the few vertices to have been shaped by the moral considerations of behavior, as exemplified through the battle between the good and the evil in Psychomachia.      

Introduction
In Christian theology, the concept of the seven heavenly virtues stands in opposition to that of the seven deadly sins. Ever since the Dark Ages, humankind has been battling perpetually to win over the evils dwelling within. More often than not, it is the nature of the internal turmoil that has led to serious psychological debates among scholars and thinkers. To get an accurate insight into how human minds work, it is imperative to analyze the contextual ground upon which the concept of the virtues and the vices were first conceived of. As early as during the Celtic period, the parochial worldviews on religion and theology began to take comprehensible forms in terms of documentations. The Celtic people questioned the biblical allusions and verified them from nature itself. Such was the influence of the Celtic mythology that Christians, as a matter of fact, borrowed the quintessential elements of psychology from the pluralistic Celtic cultures (Davies  OLoughlin, 1999, p.3). The ensuing times witnessed innumerable instances of moderation and arbitration by the ecclesiastical authorities to introduce a well documented set of ethical guidelines that would alleviate cardinal strife for the loftier sake of salvation. However, it was not before the publication of Psychomachia by the eminent Latin poet Prudentius that any clear analogy regarding the relative position of the virtues and the vices was established. This poem muses over the battle between virtues and vices as depicted in Virgils magnum opus Aeneid and also, albeit at a secondary level of understanding, reinforces the deep-seated Christian faith in the power of goodness. The paper will reflect on the virtues embodied in Prudentius epic poem. It will also incorporate the contemporary exegeses of virtue in the light of what is stated in Psychomachia.

Thematic Outline
In Psychomachia, Prudentius pairs the sins with the virtues to bring out the allegorical significance of the verse. Prior to the publication of this poem, the literary genre of personification allegory was not explored by any other poet. Moreover, this poem laid the foundation of other types of literary compositions, namely, plays and novellas, in the years to come. An abundance of graphic representations of the battle between the seven virtues and the seven vices is typical of Prudentius work. Each of the seven virtues, namely, Fides, Pudicitia, Patientia, Mens Humilis, Sobrietas, Operatio and Concordia, is challenged by its respective counterpart and comes off with flying colors but not before a gory bloodbath. Rosenwein (1998) sums up the basic theme in the following way

. . . Prudentius constructed his epic poem of seven battle scenes between pairs of personified virtues and vices. Humility forthrightly decapitates the fallen figure of Pride so also Chastity pierces the throat of Lust. Patience, however, with Job at her side, practices nonviolence, for when Anger and Patience square off, Ira unleashes a lethal pike and then a shower of javelins at Patientia, but as these slide harmlessly off the latters helmet and armor, Ira explodes in uncontrollable fury, becomes desperate, and commits suicide (p. 14).  

Taylor (2009) posits that Prudentius led the way for many upcoming poets during the Middle Ages to compose allegorical poems similar to Psychomachia (p. 279). Similarly, the epic formation of a poem that essentially deals with a universal theme like the battle between good and evil calls for a grandiose of treatment, which is perfectly fulfilled by the structural components used to compose the verse.

Biblical Allusion The Great Commandments
Discipleship features quite prominently in the Evangelist discourse of Christianity, particularly in Jesuss commandment to his disciples to teach them to observe all that I have commanded you (Quinn, 2006). Evidently, there is a clear hint to Christ being ascribed a pedagogic role for the redemption of all His disciples (Kieschnick, 2006). When it comes to the seven virtues and their connection with the discipleship preached by Matthew in The Great Commandment, it is quite interesting to note that intrinsic virtues are closely aligned with following of a supreme order of being, viz., Jesus Christ Himself. Given that a disciple surrenders completely to the service to the Lord, hisher faith will be restored and heshe will get an opportunity to make amends for sins and other vices. The projection of Jesus as a divine instructor in The Great Commandment makes it possible to understand the overwhelming role of a guide. Human life is essentially futile and full of discouraging proponents. So even from a personal point of view it is necessary to cling onto the virtuous attributes like faith, hope, restraint and humility to procure strength and vitality for the self as well for the community. Thus, Prudentius Psychomachia can be referred back to this Biblical scripture for a comprehensive and realistic illustration of the seven virtues.        

Theology  Religion
As regards the theological implications of Psychomachia, it may be noted that the Christian theological framework adopts a naturalistic worldview of both the seven sacred virtues and the seven deadly sins. There is a liberal and fluid mechanism of exegesis that underpins natural theology. Far from carrying mere religious undertones, natural theology is based on a rationale that is cryptic enough to be considered profoundly elemental. Therefore, one can almost trace a logical consequence of the battle between the good and the evil, and can in fact relate to the philosophical dimensions of religious collectivity taken as an analogical summation. God is monistic in essence as far as natural theology is concerned. Hence, contrary to religious theology, there is no logical ground to debate on whether god is embodied in objective personifications of varied beings. From this analogy, it is safer and perhaps all the more easier to draw the inference that the battle between the good and the evil, as portrayed in Prudentius Psychomachia, hinges on a universal thematic groundwork which is above religion. It seeps through a philosophical space which is uninhabited by myriad complications of pluralistic theism. On one hand, this battle is a poetic representation of the absolute where virtues and vices are set against each other in an extreme manner and for a motive ruthless and unforgiving. It is the prerogative of natural theology to induct this strictly discursive framework pertaining to truth. When it comes to the battle between the good and the evil, this truth manifests itself through instances of absolutism  whatever happens on the battlefield can be allegorically projected into the real world impersonality in that basic virtues propound a stance based on values and not on rhetorical reverberations. Shelp (1985) notes,

Psychomachia, whose very title tells us the thrust of the work, the personified virtues and vices engage in mortal combat. Faith vanquishes idolatry modesty routs voluptuousness patience overcomes anger humility beheads pride sobriety destroys sensuality mercy conquers avarice and finally concord defeats heresy (p. 31-2).    

Psychological Impact on Me
It is quite evident from the above passage that the objective rationales behind the working of these virtues are very much pinned on moralistic grounds. Now, in the context of the modern generation, the prevalent trend is akin to accepting the good and the bad with equal tolerance and arbitration. Thus, there is no reason to completely shun the conjecture that the cogency of Prudentius Psychomachia becomes rather meek in todays world. It is worth noting Strauchs argument that In Aristotles theory of the Mean, moral virtue is a mean located between extremes of excess and defect, a sensible measure and control of our biological pleasures (Strauch, 2001, p. 166). Now going by this argument one would be tempted to disregard the extremities of the Medieval psychology. However, it wont be entirely unjust to do so. This is because modern era, as opposed to the time when Psychomachia was written, takes a far less ambivalent stance with regard to meting out justice for all. Calling a spade is a spade is more prevalent in the modern times than in the dark ages. It was only the moral pitfalls that were magnified by Prudentius work. Ethical degradations were underlined distinctly by the recalling of the divine muse to settle the perpetual contest. But the modern society does not function in similar ways. It is a lot more tolerant to deviant behaviours and ways. Furthermore, the relevance of the virtues and the vices becomes even weaker as todays world seeks to maintain a balance between the extreme ends of existence. Being in my forties, Psychomachia affects me most profoundly in shaping my personality and outlook. Life has taught me to appreciate the virtuous qualities people around me have. In a way, I can look beyond the sinful deliberations for the greater sake of goodness. I would suppose that people of my age acquire a capacity to overlook the detestable lineaments of life and make the necessary adjustments for acknowledging the brighter aspects life offers to everyone.

Pentecostal Christianity
In Pentecostal Christianity, repentance and restraint are given greater emphasis as virtues than in any other forms of ecclesiastical worldviews. The cardinal virtues are considered to be elemental to a life of giving and salvation. Praying to the Lord is believed to have an overriding effect on purgation from sinful deeds. Unlike the pluralistic worldviews, God is believed to be omnipotent and omnipresent, manifesting His presence through various appellations. So if the virtues are garnered, it would only help ordinary men overcome the dreary outcomes of vices and sins. Moreover, Pentecostal beliefs regard knowledge, godliness, fraternity, and love as the principle determinants of an enriching and superior existence. This existence can only be delimited and harmonized by qualities of the most eternal virtue called faith (in the Almighty).

Conclusion
In essence, the relevance of Prudentius epic verse is difficult to undermine in the overall context of Christianity as it emerged from the dark ages. On one hand, Christian dogmas on righteousness were challenged in the end of the poem where vices get the better of the virtues. On the other hand, the heroic battle between the dark forces and their counterparts underscore the theological basis of secularism and ethical psychology. By putting in sharp contrast the opposing and seemingly infallible forces, Prudentius succeeds in showing that a heroic battle can end just as arbitrarily as the morale of the battle may demand.              

Marijuana has been one of the most rampant drugs since time immemorial, yet there are various effects or inscrutability concerning its health effects on the intake in relation to human nature. Marijuana can also be referred to as Cannabis sativa is a preparation of a crushed flower and buds of feminine hemp plant. In resent reports it is indicated that the plant has been in existence as early as 1500-1200 BC. In some countries like China the plant (marijuana) has been described as an analgesic as early as 200 AD. Since its conception or intake through the general flow of generation it has been made clear that it ha varied effect on human beings. The effects of cannabis sativa or marijuana have been categorized to be either psychological or physical in relation to the health status of human beings.

Psychological effects of smoking marijuana or cannabis sativa
Generally the effects of marijuana to the health of human beings nave passed a great deal of criticism since the when it was banned in the year 1937. Harry J. Anslinger, who is the head of Federal Bureau of Narcotics and Dangerous Drugs (FBNDD) as from 1931 to 1962 and his  associates as William Randolph used a research that has been termed as  yellow journalism  in the process of spreading news about the effects of marijuana ingestion in the human body.

This journalism has basically been interested in exploring on the bad or ill effects of marijuana which in general perspective develops and hence damages parts of human body as well as the mind. Through this process of carrying out this research it was evident that marijuana is one of the most addictive drugs of all time and cause psychosis and also induced violent behaviors.

As time moved, people who were against the intake of marijuana came up with various ill effects that were geared towards making it illegal. The section that is discussed below will basically view marijuana as it goes through the body to the lungs from its intake, to the effects it has in the lungs, then its effects on heart and finally the diversified effects that are spread all through the body to the human brain. Particularly this section will address the effects, forbearance, addiction prospective, cancer and anti-motivational disorder.

Methods of ingestion
In discussing the effects it is also of great significance to basically look at some of the methods of ingestion. I this case smoked marijuana have been always viewed to be more effective medicine for an assortment of ailments in comparison to orally ingested capsules. There are various methods of smoking marijuana, some of which helps in reducing the inhalation of the inherent demerits of hot haze that contains particulate matters. Some of the common methods include the pipe that at times is usually similar to tobacco pipes, rolled joint that resembles cigarette, and some of several types of water pipes.

According to Aronow  Cassidy (1974) in most of the studies pertaining to the psychological effects of cannabis sativa have use the method of joints in administering the smoke. This is a method that is applicably used by lower grade or casual users of marijuana, but it is generally incompetent. Studies show that about 10 to 20 per cent of the contents that are evident in the original marijuana is then converted into the mainstreams that eventually flow to the body of human beings. Fortunately, not all the contents are immersed in the lungs of the person smoking.

However, the most appropriate means of smoking has been proved to through the water pipes as they posses a several advantages over the conventional pipes. In the onset, virtually none of the smoke is lost to the air or  side-stream smoke . This is realized through the act of loading the bowl a it can be done through inhalation in one breath.

The process involves the smoker drawing all the smoke into the chambers of the water pipe and in the due course leads to combustion of marijuana which is thereafter cleared by the chambers in one breath. This is an advantageous method as the hot smoke is then passed through cool water before it reaches the throat of the person smoking. The advantage is two folded as the smoke is first cooled and then passed through water and then filtered through the water.

A study is currently underway at the Institute for Smoking and Health in New York, which is headed by Dr, Hoffman. The study is basically aimed at reducing the intake as well as the absorption of the drug in the human body (Benowitz  Jones, 1975). It is also aimed at opposing other methods of smoking and only recommends the use of water pipes.

This study will also determine the most effective water pipe to be used and thus determining the smoke that it provides the smoker with. It will also look at the feasibility and the effectiveness of the vaporizer. In general, the device does not have diverse effects on the smoker and that is why it recommended by the researchers.

Effects of Marijuana Smoking in the Lungs
There is a basic argument that has been presented by those people who oppose the legalization of medical marijuana. They say that smoking anything not only marijuana is even more harmful a compared to tobacco. They claim that there are over 450 chemicals in  crude  cannabis sativa and therefore sick people should be prohibited in using such drugs. They also claim that there are more than 800 carcinogens that are present in marijuana smoking victims as compared to tobacco smokers. One of the adversaries of the intake of marijuana to sick people is Gabriel Nahas who claims that therapeutic marijuana is a brutal hoax.
 
The National Institute on Drug Abuse also said in its 1990 report on pulmonary effects of marijuana and they found that there are no differences in the prevalence of chronic cough, production of sputum, was noted between marijuana and tobacco. The ill effects of marijuana and tobacco are viewed to have difference in the manner in which it affects the lungs. Tobacco smoking causes the degeneration of peripheral airways and some of the alveolated regions of the lungs while on the other hand marijuana affected the main pathways in the lungs.

Brill  Nahas (1984) state that the other different study was also carried out in determining the misuse or chronic use of marijuana. The experiment was carried by using 62 rhesus monkeys on various effects on heavy exposure which was estimated as more that twice a week and chronic or heavy daily smoking. Thereafter after a year elapsed, some of the monkeys were sacrificed to autopsies.

The research that was carried out by National Center for Toxicological Research made a conclusion that the expose monkeys did not experience diverse effects. It also indicated that the general health of monkeys was not compromised through a year of marijuana smoke exposure as indicated by weight gain, carboxyl-hemoglobin and clinical hematology. This is referred to as the study of the oxygen-carrying capacity in the red blood cells.

Generally, there are inherent risks that are related to inhalation of hot vapor, particularly those that contain particulate matter which are usually found in smoke. This is one of the facts that are undisputed but it is true that dangers associated with intake or inhalation of marijuana is not as harmful as some people might put it. All in all the risks that are related to the intake of marijuana can be avoided through some of the prevalent methods of ingestion.

However when an individual smokes most of the times per day, accumulation of THC in blood-serum may persist. Marijuana can also in most cases lead to postural hypertension. If the blood pressure drops the consequence could be perilous in those persons with compromised blood flow to heart or brain, in cases where there are volume-depleted or in cases when other drugs have led to distortion of reflex power of their blood vesicles or vessels. In older patients treated by delta-9-THC or who had smoked marihuana for glaucoma, orthostatic hypotension has been disabling and a risk factor of cardiovascular complications.

Effects of Marijuana Smoking on the Heart
Primarily, the consequence of marijuana smoking on the heart is tachycardia, which is generally accompanied by an increased blood pressure. The rate or the volume of normal heart remains constant all through exposure, and therefore the ill but net effect of the heart is an increased work that is performed. The consequences are more or less similar to the effects that are usually caused through stress. The prevalent of these consequences prevents the heart from performing its delegated duties which as a result may lead to heart failure.

People with ailments that are related to heart diseases or heart failure may lead to a higher level or an increased ailment on the normal functioning of the heart. These are some of the complications that may arise from smoking of marijuana (Campbell et al. 1971). All the same, the difficulties caused through smoking of marijuana are generally similar to those effects that are induced by nervous tension, which show a discrepancy in composure. For that matter, more studies are supposed to be done so as to curb and assess the risks of people with heart and circulatory problems.

But all the same the there is a very promising g fact that there is nowhere in the medical history has ever died from marijuana related or induced heart failure. The circulatory system is generally affected if one extremely uses marijuana in most of his time which as a result will lead to heart failure.

It is therefore, important to note that heart is on e and the only component that should not be exposed to various threats like smoking of marijuana as this definitely leads can paralyze the functioning of the heart. Marijuana appears to intensify the effects of the sympathetic nervous system on the heart, an undesirable consequence in patients with coronary artery disease.

Effects of Marijuana Smoking on the Brain
According to Chesher et al. (1985) this is the most general part that needs to be looked at as it entails a very much complex understanding on the effects of marijuana. There are various but complicated effects of marijuana on the human brain. The psychoactive constituent of marijuana has consequences on the brain in a more deeply intricate manner as compared to other drugs such as heroine, cocaine among others. These drugs are basically associated with the dopamine pathways in human brain system which happens to be subject to high rate of abuse. This was seen through the self-administration experiment that was carried out with animals.

In the olden days, the research was not regarded as valid and the main way of determining whether the drug has some effects on human brain was through the observation of the behavioral trends of the smokers. This means that the effects of marijuana on brain were made limited by the technology of time. Due to this unlimited knowledge about the consequences of marijuana has therefore led to the cultural biases to persist and maintain fallacies that marijuana acted in the same way as heroine.

The research that was carried out since the inception of THC receptor in the brain has led to counter of these facts in the past decade. The congressional Office of Technology Assessment found that some of the research done through the intervention of Dr. Miles Herkenham of the National Institute of Mental Health (NIMH) has led to the justifications tat marijuana does not have consequences on dopamine-related brain system.

What is dopamine This is the in the brain that is biologically associated with pleasure as communicated in the human brain. The neuron-system that runs in connection with dopamine is known as  brain reward system . The system of neural are usually associated with limbic system which is an area in the brain that is mandated with control of behaviors as well as emotions. As it have been mentioned earlier, highly addictive drugs such as marijuana, cocaine, and heroine when absorbed in the body and transmitted to the brain can increase that rate of dopamine in the brain.

Marijuana, cocaine, and amphetamines block re-absorption of dopamine which as a result leads to diverse, prolonged, and intensifying effects in the human brain. Marijuana and opiates are used in the activation manufacture of dopamine by blocking the inhibitory signal, gamma-amino butyric acid, which eventually leads to blockage of dopamine manufacturing components in the brain
Research that was conceded on animals in observing addicts in the population indicated that animals are likely to forsake their own good. The though is about whether animals should forego food which to some animal who depend on leaves eat marijuana and water, in order to fuel the brain rewarding structure. Whether or not drugs increase the rate at which dopamine-associated pathways, is largely determined by haw much the drug is addictive. The capacity to producing of producing reinforcement effect is one of the most effective to any drug that significantly has the potential maltreatment to the functioning of the mind. Cannabinoids generally do not lower the rate at which the animal gets stimulated in the brain reward system.

Another signal indicating that a drug has the potential to enhance addiction and abuse is the drug s aptitude to encourage forbearance. Many drugs such as marijuana and cocaine create forbearance by disenabling the dopamine receptor in the brain. In cases when the percentage of the receptors gets worn out with each exposure, the consumer must therefore increase the rate at which he or she takes the drug so as to register the same effect.

In the brain of a mammal, the brain creates equilibrium through the manipulation of the number of the active receptors so as to ensure that effectiveness of the drug is put at a halt. It is also relevant to note that the more marijuana an individual takes the fewer the receptors remain active in the long run. If an individual smokes not frequently, then it is probable that the receptors will remain functioning throughout.

The psychological effects of marijuana are not necessarily based on the Tetra-hydrocanabinol (THC) but the THC remains the main psychoactive component that guarantees the responsibility of the altered sense in the recognition of exhilarated feelings. Euphoric feeling is another component of the smoke that is produced by marijuana which as a result leads to the generation of only the depressant effect in the brain operation system.

Since time immemorial, people have used various methods to alter the normal physiological function of their bodies.  HYPERLINK httpen.wikipedia.orgwikiAltered_state_of_consciousness l cite_ref-pmid12006123_0-0 Bundzen, Korotkov, and Unestahl (2002) described altered state of consciousness as, any condition which is significantly different from a normal waking beta wave state (p.153-165). This induced alertness interferes with the Central Nervous System (CNS) to render an artificial alertness (referred to as high) and is mostly done by use of chemicals-drugs. However, with advances in technology, specifically designed machines have been developed for instance dream machines and binaural beats that induces waves of different frequencies into someones brains. The use andtrading in most widely-used drugs is outlawed by authorities almost worldwide and people therefore deal in them secretly.

Nevertheless, from the societys point of view, a handful of drugs such as alcohol, cigarettes and khat are perceived not to be harmful and therefore their use is legitimized. Besides, a range of benefits that drug users claim to derive, there are couple of adverse psychological effects (positive and negative), stipulated later in this document, that haunts people users. The only state of altered consciousness recognized, is only when one is put on medication by a medical doctor -anesthesia and other side effects that result on taking prescribed drugs (such as drowsiness). Today, increased case of diseases like liver cirrhosis, lung cancer, crime and sexually transmitted diseases among others, is being attributed to high level of intake of these drugs. Although people are aware of the drug effects, they however use them to lessen anxiety andor induce a high state of mental alertness that allows sleep at ease and relaxation that they value in their as a way of life.

As earlier stated, drugs are the most common means in which people alter their consciousness. Andrew (2010) is his report on drug abuse, put psychoactive drugs into categories that included
Alcohol, classified as seductive, that gives its user a sense of relaxation and increases socialization with other members of the society. The report further states that consumption of alcohol over a long period of time leads to addiction and in the long term it is associated with long term damage of brain and liver.

Narcotics such as morphine and heroin are perceived by users to modify the secondary reception of sensory stimuli and aid them not to perceive pain as when in normal conscious. Problems associated with them includes among others, hepatitis, crime and mental deterioration.

Amphetamines and cocaine that arouses the bodys nervous system and interferes with release of hunger-stimulating hormones in the hypothalamus center in the brain. Advanced consumption may lead to malnutrition because one loses appetite.

Toxins and anesthetics include substances such as glue plus other solvents that inhaled into the respiratory system. The report states that most of these petroleum distillates are highly toxic to the liver if somebody is also taking alcohol. Anesthetics include chemical substances such as ether and ethanol.

Severe brain damage has been associated related to over-consumption of drugs mentioned above because they directly stimulate the central nervous system. In addition to the above, other artificial methods for altering consciousness include

Meditation which comprises of techniques involving focusing attention on an object, a word, breathing or body movement in order to block out distractions (Wood et al., 2001, p.111-142). Body movements include whirling around to experience dizziness and choking someones neck to cause fainting.

Dream machines triggers a near state of drowsiness when they are looked at. The do so by releasing flashes that stimulate optic nerves in the eyes and creating waves in the brains.

Sleep deprivation is another way that people apply. In most case it is induced by taking highly concentrated drink containing caffeine. Then, hallucinations are experienced for a period of at least 48 hours.

Lucid dreaming involves dreaming while being aware of what you are doing. Therefore one is able to manage the content of the dream. This type of dreaming robs you the natural conscious.

To conclusively give an opinion on whether the process of altering consciousness is necessary or not is relative. The reason being that though people witness cases in which some of them suffer from adverse health complications, they still continue to take these drugs. It also depends on the purpose for which one is doing it. If it is done as a means andor in the process of treating (for instance in hospitals for the purpose of depressing pain) a person, then I would recommend it.  A number of alcohol, cigarette, and khat victims among others, still continue to be on drugs even if they are advised by medical doctors to stop the habit and this depicts varied perceptions among individuals. All type of chemical substances has drastic effects on the bodys health. Users of hard drugs like heroin and cocaine becomes addicted and as a result, a number of them suffer from mental complications, sexually transmitted diseases AIDS and chronic diseases liver cirrhosis. Besides, this constrains them financially when they seek medical attention in hospitals andor in rehabilitation centers.  

Disclosures
Stephanie Its good to see you... Im gonna talk about... I live in a very isolated place, and its very hard to get to know people. I have a job that kinda keeps me in one area all the time. And Id like to meet people and have fun but, Im kinda limiting the people I see on a daily basis. And I spend so much time at work. When I get home, I do not want to talk about work. And the only people I know are the people I work with

What makes it worst is that, I used to have a little close relationship to my mom, my best friend. And after I went to college it kinda was really hard to keep in touch, and she hated that I ran away to school cause she is my best friend ... But   when I was in college she said shes drinking, and really became alcoholic during the summer, and her personality has changed  

So, I just feel very isolated, and alone ...

Therapist Do you wanna contact your mom   and (get that relationship back)...

Stephanie Exactly, exactly.
This part of the conversation clearly reflects the function of disclosures in a conversation. In this part, the client, Stephanie was able to uncover several revealing things about her personal life. For one, Stephanie easily disclosed about her being work-centered during the past months of her life. This revelation easily gave the therapist an idea about how Stephanies life is lately, and whether or not her being work-centered has something to do with anxiety that she has been going through. Apart from this, Stephanie was also able to reveal one very sensitive part of her personal life, which is the issue between her and her mother. As Stephanie reveals how close she was to her mother and how her mother grew to become an alcoholic when she ran away to college, the therapist easily gained entrance to Stephanies circle of intimacy. Considering how disclosures were elaborated in the Goodman and Esterlys Talk Book, it can be considered a closer relationship that may be built between the therapist and the client is understandable since it has been easy for the two of them to disclose sensitive matters. This is good, especially in this kind of conversation (therapeutic) since both parties are required to hear and know about each other in order to eventually end up with a therapeutic and relieving result.

Reflections
Therapist Are you an only child
Stephanie No. No. I have one brother and four step brothers and sisters.
Therapist ...persons you had to let go
Stephanie Yeah.
Therapist Which is why shes on housing...
Stephanie No. Shes actually at (...) now... and my step brothers.. creates a lot of anxiety...
Therapist ...shes in a lot of well... shes doing it alone. Now.. a little kind of...
Stephanie the same way.
Therapist ...shes starting with it.
Stephanie exactly.

Reflection was said to be the missing link in in the ever ambiguous and dynamic process of communication. According to the Talk Book, a reflection shall require having the other part of the conversation reflect or present back the other ends experience (1988). The part of Stephanie and the therapists conversation presented above shows how the therapist reflected on what her client said. When Stephanie revealed that she is not an only child, the therapist immediately reflected on her situation and assumed that indeed, there were a lot of special people in Stephanies life she had to let go. Stephanie apparently affirmed the assumption and this created a situation that seems to show that the two parties are finally understanding each other already. In the latter part of this conversation, the understanding appears to be deeper as the therapists reflections to what Stephanie says appear to be more accurate and certain. As the conversation progressed, it appeared easier for the therapist to complete what her client was trying to say, and there were also times when she would supplement what the client says. To sense some level of reflection especially in an intimate conversation is indeed necessary. It lets the other end of the conversation feel that he or she is well understood. However, in the context of this conversation, although it is apparent that the therapist manifested some sense of reflection, some of her words appeared short of what seems to be a more perceivable reflection of Stephanies experiences.

Interpretations
Therapist Have you expressed how you felt
Stephanie No. No. But, its my fault. Of course she likes to come back too, and its my fault that Im on a job... Its my fault that I have my friends.
Therapist How was it when she started at alcohol
Stephanie Excruciating. Excruciating cause are good choices Ive made... because there are things that I love and I like to do ... When I talk to her I just want to be heard. I mean... that everythings gonna be okay... I dont get that... just deal with it.
Therapist Are you an only child
Stephanie No. No. I have one brother and four step brothers and sisters.
Therapist ...persons you had to let go
Stephanie Yeah.
Therapist Which is why shes on housing...
Stephanie No. Shes actually at (...) now... and my step brothers.. creates a lot of anxiety...
Therapist ...shes in a lot of well... shes doing it alone. Now.. a little kind of...
Stephanie the same way.

As it appears, interpretations, as a form of response is one of the most common when it comes to conversations between intimate people like siblings or friends. Interpretations serve to let one end of the conversation share his or her analysis on the experience, thought, idea or action of the other end of the conversation (Goodman  Esterly, 1988). In this part of the conversation, an attempt to interpret Stephanies words can be observed when the therapist started asking a series of questions on Stephanies feelings. The therapist also made some short assumptions on Stephanies mothers actions which can be seen as another way of interpreting their situation. However, this kind of interpretation is not that effective in the sense that, it does not appear to help the client have realizations in relation to the experiences she was sharing to the therapist. The therapist could have interpreted Stephanies feelings and her mothers actions more elaborately so as to give Stephanie the feeling that the therapist was really trying to help. The therapist could have extracted more of Stephanies experiences and interpreted them more extensively through her own words. This could have given Stephanie more assurance that she is being heard.

Advisements
Therapist Do you wanna contact your mom   and (get that relationship back)...
Stephanie Exactly, exactly.
Therapist So, going back to what happened when you left.
Stephanie I think its inevitable. Now shes   I guess shes working... But I know shes good. Im glad that she has something... I think she thought of my Dad. Cause my Dad wanted me to be that away to school... so that shell think that its his fault. And now she thinks that its my fault. Shes just close, I think shes just close... and abandoned.
Therapist Have you expressed how you felt
Stephanie No. No. But, its my fault. Of course she likes to come back too, and its my fault that Im on a job... Its my fault that I have my friends.

This form of response appears common among consultations. This response is usually given by experts who are being asked for advise or suggestions. This form of response is commonly always taken seriously as these are typically ideas that help in alleviating a situation or solving a dilemma. After going through the entire conversation of Stephanie and her therapist, it clearly appears that the conversation is more of a sharing rather than a consultation. The therapist wanted to hear what Stephanie had to share, and these information shall be analyzed in her objective to understand where Stephanies anxieties are coming from. In this part of the conversation, some short statements somehow appear to be attempts of advisements. In the beginning, the therapist asked whether Stephanie wants to contact her mom to get their relationship back to how it was before. Although this idea was said in an interrogative manner, it somehow appeared like an attempt to advise Stephanie to contact her mom. The therapist also mentioned in the end about Stephanies expression of her feelings. Again, although this statement was said in a question form, it also appears to be a subtle advise to Stephanie to try at least expressing to her mom how she feels. Considering the fact that this was not a consultation session, it is understandable that the therapist did not give much advisements. However, it could have helped if she did give serious and straighforward advisements so as to make Stephanie feel that the therapist cared.

Questions
Therapist Do you wanna contact your mom   and (get that relationship back)...
Stephanie Exactly, exactly.
...
Therapist Have you expressed how you felt
Stephanie No. No. But, its my fault. Of course she likes to come back too, and its my fault that Im on a job... Its my fault that I have my friends.
Therapist How was it when she started at alcohol
Stephanie Excruciating. Excruciating cause are good choices Ive made... because there are things that I love and I like to do ... When I talk to her I just want to be heard. I mean... that everythings gonna be okay... I dont get that... just deal with it.
Therapist Are you an only child
Stephanie No. No. I have one brother and four step brothers and sisters.
Therapist ...persons you had to let go
Stephanie Yeah.

Question was said to be  the most popular piece of language  (Goodman  Esterly, 1988). Most of the time, questions are being uttered in the objective of finding out a significant piece of knowledge from another person. This form of response has been observed mostly among children since children are the most curious and inquisitive people. However, this form of speech or response can also be very evident in consultation and therapeutic and analytical conversations since the other end is supposed to work on discovering things about the client that are important in analyzing or interpreting his or her situation. This was the case in the context of this conversation between Stephanie and her therapist. It is quite obvious that it became necessary for the therapist to ask questions since some unsaid information may appear relevant in her analysis of Stephanies anxieties or dilemmas. In observing how the therapist asked questions, it was obvious that she was plainly aiming to collect information from Stephanie as what is apparent from her short questions. The questioning appeared to ber effective though, as most of it were not just simply answered rather, Stephanie willingly elaborated on such questions which made it a lot easier for the therapist to extract valuable information from her client.

Silences
Stephanie But   when I was in college she said shes drinking, and really became alcoholic during the summer, and her personality has changed   and that she cant not drink. So our whole dynamic has changed, and I dont like to condone what she does, so it makes it very hard for me to contact her. Because I want her to get help, and I want her to work through it... just to teach her... so I dont want that to affect her work, I know how much that will hurt her. Its not gonna happen ... So, I just feel very isolated, and alone  
Therapist Do you wanna contact your mom   and (get that relationship back)...
Stephanie Exactly, exactly.
Therapist So, going back to what happened when you left...

This was the part of Stephanies conversation with her therapist that had the most silences. According to Goodman and Esterly (1988), silences serve as cues or signs of a more meaningful message. In understanding the context of this conversation, Stephanie suddenly toned down a little bit and seemed to paused more when she shifted her discussion from her dilemmas at work to her problems in relation to her mother, who just became an alcoholic. In this context, the silence of Stephanie may appear to mean a deeper kind of feeling. As Stephanie revealed that she used to be very close to her mother before, the silences became a much more understandable. Apparently, those silences where due to some sudden flash of negative emotions that might have been brought by Stephanies thoughts on communicating with her mom. These silences are very important to note and observe on the side of the therapist since these pauses may really convey deeper meanings. However, these pauses are also easy to be misunderstood. Thus, it also takes a critical and a more sensitive judgment before the real meanings of these pauses are revealed. However, as it appears from the therapists corresponding queries, her understanding of the pauses were accurate as what can be observed when she asked Stephanie if she wants to contact her mom. This implies that the therapists understanding of such pauses has been effective, and her sensitivity and critical judgment on her clients silences has been very accurate.

Transcription of audio file Stephanie_Gelb_-_beginning.wav

Therapist Its so good to see you.
Stephanie Its good to see you... Im gonna talk about... I live in a very isolated place, and its very hard to get to know people. I have a job that kinda keeps me in one area all the time. And Id like to meet people and have fun but, Im kinda limiting the people I see on a daily basis. And I spend so much time at work. When I get home, I do not want to talk about work. And the only people I know are the people I work with. Its very, very odd hours, so I cant just go to the gym or sign up for a class or meet someone there a little bit or something like that   I thought, oh I can meet with people doing this... go have fun together, lets go to the movies alone. What makes it worst is that, I used to have a little close relationship to my mom, my best friend. And after I went to college it kinda was really hard to keep in touch, and she hated that I ran away to school cause she is my best friend ... But   when I was in college she said shes drinking, and really became alcoholic during the summer, and her personality has changed   and that she cant not drink. So our whole dynamic has changed, and I dont like to condone what she does, so it makes it very hard for me to contact her. Because I want her to get help, and I want her to work through it... just to teach her... so I dont want that to affect her work, I know how much that will hurt her. Its not gonna happen ... So, I just feel very isolated, and alone ...
Therapist Do you wanna contact your mom   and (get that relationship back)...

Stephanie Exactly, exactly.
Therapist So, going back to what happened when you left.
Stephanie I think its inevitable. Now shes   I guess shes working... But I know shes good. Im glad that she has something... I think she thought of my Dad. Cause my Dad wanted me to be that away to school... so that shell think that its his fault. And now she thinks that its my fault. Shes just close, I think shes just close... and abandoned.
Therapist Have you expressed how you felt
Stephanie No. No. But, its my fault. Of course she likes to come back too, and its my fault that Im on a job... Its my fault that I have my friends.
Therapist How was it when she started at alcohol
Stephanie Excruciating. Excruciating cause are good choices Ive made... because there are things that I love and I like to do ... When I talk to her I just want to be heard. I mean... that everythings gonna be okay... I dont get that... just deal with it.
Therapist Are you an only child
Stephanie No. No. I have one brother and four step brothers and sisters.
Therapist ...persons you had to let go
Stephanie Yeah.
Therapist Which is why shes on housing...
Stephanie No. Shes actually at (...) now... and my step brothers.. creates a lot of anxiety...
Therapist ...shes in a lot of well... shes doing it alone. Now.. a little kind of...
Stephanie the same way.
Therapist ...shes starting with it.
Stephanie exactly.
Therapist Are you in contact when you were away... is it by phone or..
Stephanie Yes. Over the phone. And over the phone here is better... for when she comes here   its just drama. Drama, drama.. Drinking and cutting me out.. and you know. Not motherly bonding, that I know I get to see her once a year.. or two times a year... or she going... not talk to her... I know my Mom... you know.
Therapist ...is your best friend... So we are now evaluating Stephanie.

Asthma is a significant health problem among Hispanic communities.  Despite the increase however, Mexican American children have lower asthma prevalence rates as compared to the non-Hispanic children in the United States.  This is more rampant to those that have low education levels that usually lack some health insurances.

Lifestyle and health behavior appear to be very important in the health of a person.  Low acculturation level and the use of native languages led the Hispanic communities to lower mortality rates and better health as compared to any other ethnic groups.  Hispanic paradox does exist despite controversy.  Certain lifestyles and health behaviors of the Hispanic community led to lower mortality rates despite depression, life stress, and less health insurances.  Biological advantages were rampant among the Hispanic communities.

One current remarkable issue in relation to life-span development revolves around acculturation and its effects on asthma burden among Hispanic communities.  According to Molly Martin, Madeleine Shalowitz, Tod Mijanovich, Elizabeth Clark-Kauffman, Elizabeth Perez, and Carolyn Berry (2007) in their article entitled The Effects of Acculturation on Asthma Burden in a Community Sample of Mexican American Schoolchildren, Asthma prevalence and mortality rates are increasing among Mexican American children (p. 1290).  This makes asthma a significant health problem among Hispanic communities.  Despite the increase however, Mexican American children have lower asthma prevalence rates as compared to the non-Hispanic children in the United States.  This is more rampant to those that have low education levels that usually lack some health insurances.  Because many of the Mexican American people are immigrants who have been born in Mexico, it gives the notion that acculturation has some effects on asthma burden among Mexican American children by reflecting low acculturation levels and higher biological benefits.

Main Body
Asthma burden
In the study that Molly Martin et al (2007) conducted, they studied Mexican American schoolchildren and their effects of acculturation against asthma.  They used variables in studying the children, and gathered data from an observational study, such as the childrens diagnosed asthma and the total diagnosed plus possible asthma.  They used regression models directed for the caregivers level of acculturation, education, marital status, depression, life stress, and childrens insurances (Martin et al., 2007, p. 1290).  In the end they concluded that the level of acculturation of caregivers was mediated by social factors, especially in relation to life stress (Martin et al., 2007, p. 1290).  In addition, foreign birth was more predictive of disease status than was language use or years in country (Martin et al., 2007, p.1290).  It appears that increased acculturation among Mexican American schoolchildren do not generally lead to greater asthma risk, giving the notion that low acculturation among healthy immigrants reflect biological advantages, which can be related to health behaviors and life-span development.

Acculturation
Martin et al. (2007) defined the term acculturation as a process of culture learning and behavioral adaptation that takes place when individuals are exposed to a new culture (p. 1290).  It is a process wherein individuals undergo changes in their language use, cognitive style, personality, identity, attitude, and stress level (Martin et al., 2007, p.1290).  However, studies show that
Low acculturation levels among US Hispanics with low socioeconomic status have been linked to lower infant mortality rates, better immunization status, higher life expectancy, lower mortality from cardiovascular disease and cancer, and less cigarette smoking and drug use. (Martin et al, 2007, p.1290)

Because Mexican American immigrants reflect lower diagnosed asthma rates when compared to those born in the United States, it concludes that there is greater risk of diagnosed asthma to those born in the United States, as opposed to those born in Mexico.  They also found that caregivers usually had less diagnosed asthma, especially those who preferred to use their native language instead of the English language.  This reflects Hispanic paradox, indicating that there are better relative health outcomes to the newly migrated Mexican Americans, as compared to other ethnic groups in an equal environment.

Controversy behind Hispanic paradox
Eileen Crimmins, Jung Ki Kim, Dawn Alley, Arun Karlamangla, and Teresa Seeman (2007) has concluded that Hispanics in the United States have better or similar health to that of non-Hispanic Whites, despite Hispanics having lower incomes and less education (p. 1305).  The Hispanics have comparatively lower mortality rates, which reflect the Hispanic paradox.  Empirical findings that support the existence of this paradox were seen in low mortality rates, especially among aged men who were immigrants in the United States.  However, there are also studies that show that there are no difference in mortality between Hispanics and Whites (Crimmins et al., 2007, p. 1305), claiming that there is no truth behind the Hispanic paradox, and ethnic differences show fewer clear-cut concerning function, disability, and morbidity (Crimmins et al., 2007, p. 1305).  There are even studies that show Hispanics report worse health than Whites (Crimmins et al., 2007, p. 1305), indicating that the term Hispanic paradox is merely a lie.

Because there are more studies in the area of life-span development (Kuznia, 2009, p. 1), it is an indication that the controversy has enhanced the study of life-span development, and more people support the idea that Hispanics are indeed healthier when compared to the Blacks and the Whites.  As indicated in the article, Hispanics, despite their socio-economic hurdles, on average live longer than blacks by seven years, and whites by five years (Kuznia, 2009, p. 1).  This is according to Dr. David Hayes-Bautista, a professor of medicine at UCLA.  The controversy has enhanced the study of life-span development.

Conclusion
Lifestyle and health behaviors appear to be very important in the health stage of a person.  Low acculturation level and the use of native languages have led the Hispanic communities to lower mortality rates and better health as compared to any other ethnic groups who have migrated to the United States.  Hispanic paradox does exist, and certain lifestyles and health behaviors of the Hispanic community led to lower mortality rates despite higher levels of depression, life stress, and less health insurances.  The Hispanic culture reflects some biological advantages (e.g., breastfeeding) related to life-span development.