PSYCHOLOGICAL WELL BEING AMONG ALCOHOL DEPENDENCE SYNDROME PATIENTS ADMITTED IN
SELECTED DE-ADDICTION CENTERS, AT TIRUNELVELI DISTRICT.
DISSERTATION SUBMITTED TO
THE TAMIL NADU Dr.M.G.R.MEDICAL UNIVERSITY CHENNAI
IN PARTIAL FULFILLMENT FOR THE DEGREE OF MASTER OF SCIENCE IN NURSING
OCTOBER 2019
PSYCHOLOGICAL WELL BEING AMONG ALCOHOL DEPENDENCE SYNDROME PATIENTS ADMITTED IN
SELECTED DE-ADDICTION CENTERS, AT TIRUNELVELI DISTRICT.
BY
Ms. P. ABIRAMI
DISSERTATION SUBMITTED TO
THE TAMILNADU Dr. M.G.R. MEDICAL UNIVERSITY CHENNAI
IN PARTIAL FULFILLMENT FOR THE DEGREE OF MASTER OF SCIENCE IN NURSING
OCTOBER 2019
Affiliated To The Tamil Nadu Dr. M.G.R. Medical University, K.R. Naidu Nagar, Paruvakudi, Sankarankovil - 627 753
Tirunelveli District, TAMIL NADU.
CERTIFICATE
This is a bonafide work of Ms.P.ABIRAMI, M.Sc., Nursing II year (2017-2019 Batch) student of Sri K.Ramachandran Naidu College of Nursing,
Sankarankovil- 627 753. Submitted in partial fulfillment for the Degree of Master of Science in Nursing under the Tamil Nadu Dr.M.G.R. Medical University, Chennai.
SIGNATURE: _________________________
Dr.Prof.(Mrs).N.SARASWATHI, M.Sc. (N), Ph.D (N)., Principal & Head of the Department of Paediatric Nursing, Sri K. Ramachandran Naidu College of Nursing,
K.R.Naidu Nagar, Paruvakudi,
Sankarankovil (TK) - 627 753,Tirunelveli (Dist), Tamil Nadu.
COLLEGE SEAL
PSYCHOLOGICAL WELL BEING AMONG ALCOHOL DEPENDENCE SYNDROME PATIENTS ADMITTED IN
SELECTED DE-ADDICTION CENTERS, AT TIRUNELVELI DISTRICT.
APPROVED BY THE DISSERTATION COMMITTEE ON
RESEARCH GUIDE
Dr.Prof.(Mrs).N.SARASWATHI, M.Sc. (N), PhD (N), Principal & Head of the Department of Paediatric Nursing, Sri K.Ramachandran Naidu College of Nursing,
K.R.Naidu Nagar, Paruvakudi, Sankarankovil (TK) - 627 753, Tirunelveli (Dist), Tamil Nadu.
CLINICAL GUIDE
Ms.M.CHANDRA, M.Sc (N),
Lecturer, Department of Mental Health (Psychiatric) Nursing, Sri K.Ramachandran Naidu College of Nursing,
Sankarankovil, Tirunelveli - 627 753, Tamil Nadu.
MEDICAL EXPERT
Dr.C.PANNEER SELVAN, M.B.B.S. MD (Psy) NIMHANS Consultant Psychiatrist,
Sneka Mind Care Centre,
South Bye Pass Road, Tirunelveli - 627 005, Tamil Nadu.
DISSERTATION SUBMITTED TO
THE TAMIL NADU Dr. M.G.R. MEDICAL UNIVERSITY CHENNAI
IN PARTIAL FULFILLMENT FOR THE DEGREE OF MASTER OF SCIENCE IN NURSING
OCTOBER 2019
I thank God, the “Almighty” and my immense belief on him which helped me in each and every step for enabling me to undertake this programme and to complete my dissertation to my optimal satisfaction.
At the outset, I the researcher of this study express my honest and sincere gratitude to Mr.R.Vivekanandan, Chairman and Mrs.G.Premsantha, Managing Trustee of Sri.K.Ramachandran Naidu College of Nursing for giving me the precious opportunity to be a part of this esteemed institution.
I, the researcher of this study considered privileged to express my honest and sincere gratitude to Dr.Prof.(Mrs).N.Saraswathi, M.Sc (N)., Ph.D (N)., Principal &
Head of the Department of Pediatric Nursing, Sri.K.Ramachandran Naidu College of Nursing who taught the concept of research and provided her constant support, encouragement and expert guidance throughout my research.
I am indeed thanks to Mr.C.Selgin Leons, M.Sc (N), Reader, Department of Mental Health (Psychiatric) Nursing, for his constant source of inspiration, whose encouragement, guidance for the successful completion of this study and support in every phase of my study.
My deepest gratitude and immense thanks to Clinical Guide Ms.Chandra.M, M.Sc (N), Lecturer, Department of Mental health (Psychiatric) Nursing, for her constant supervision valuable suggestions which helped me to complete this study.
I convey my profound thanks to Mrs.G.Thangasubbulakshmi, M.Sc (N), Reader, class coordinator M.Sc (N) II Year and Mrs.A.Meena, M.Sc (N) Reader, class co-coordinator M.Sc (N) I Year for the constant supervision, patience and valuable suggestion which helped me to complete the study.
(Psychiatry) NIMHANS, Consultant Psychiatrist, Sneka mind care centre for his encouragement, valuable suggestions and technical guidance throughout the study.
I extend my sincere thanks to Dr.Karthick Duraisamy, M.B.B.S, M.D (Psychiatry) NIMHANS, Consultant Psychiatrist, Sneka mind care centre for his encouragement, valuable suggestions and technical guidance throughout the study.
I acknowledge my genuine gratitude to Mr.Senthil Kumar, M.A (statistics) Professor, for his suggestions and guidance in data analysis and interpretation of data.
I extend my humble thanks to all the Medical and Nursing Experts, who have given their enlighten ideas in giving shape to the study in its early stage and giving their valuable guidance and suggestions towards modification of the tool of the data collection.
I extend my sincere thanks and honest gratitude to the authorities of Bala Saranya rehabilitation center and Thanvanthri De-addiction center, Tirunelveli for permitting me to conduct the study in their esteemed institution.
I extend my deep sense of gratitude and thanks to all Alcohol Dependence Syndrome patients for their participation and cooperation in completion of the study.
I extend my warmest thanks to Mr.Ravi jesudas M.Phil., Ph.D., in English and Mrs. Kavitha M.Phil., Ph.D., in Tamil for editing my content in English and Tamil.
I express my thanks to the Librarians of Sri.K.Ramachandran Naidu College of Nursing for rendering the help in appropriate use of library resources.
I extend my grateful thanks to all the teachers and those who have helped me directly and indirectly during my project work.
by beloved my Parents, Mr.R.Ponvel, Mrs.P.Muthulingamaheswari, for their constant inspiration, psychological and financial support throughout this study for their unending words of encouragement and constant support throughout this study.
This study would not be possible without the co-operation and constant support of the member of the family with their prayer and motivation.
At last but not least a bottomless and abundance of thanks to my beloved lovable family Supporters Mr.T.Ravishankar, Mr.S.Vijaykumar, Mr.M.karthik, Ms.P.Akilarani, Ms.Archanadevi and my friends for their constant inspiration, psychological and financial support throughout this study support in all aspect .
CHAPTER No.
CONTENTS PAGE
No.
I. INTRODUCTION 1-12
Background of the study 1-5
Need for the study 5-8
Statement of the problem 8
Objectives 8
Hypotheses 9
Operational definitions 9-11
Assumptions 11
Delimitations 12
Projected outcome 12
Conceptual framework 13-18
II. REVIEW OF LITERATURE 19-32
Review of related literature 19
III. RESEARCH METHODOLOGY 33-52
Research approach 34
Research design 34
Variables 35
Setting of the study 35-36
Population 36
Sample 36
Sample size 37
Sampling technique 37-38
Criteria for sample selection 38
Development and description of the tool 39
Development of Intervention 40-45
Content Validity 45
Reliability 45-46
Pilot study 46-47
Procedure for data collection 47-51
Plan for data analysis 51-52
Protection of human rights 52
IV. DATA ANALYSIS AND INTERPRETATION 53-83
Organization of data 53-55
Presentation of data 56-83
V. DISCUSSION 84-91
VI. SUMMARY, CONCLUSION, LIMITATIONS, NURSING IMPLICATIONS, AND
RECOMMENDATIONS.
92-99
BIBLIOGRAPHY APPENDICES
TABLE NO.
TITLE PAGE
NO.
1. Frequency and percentage distribution of demographic variables among alcohol dependence syndrome patients in experimental group and control group.
56-57
2. Frequency and percentage distribution of the pre-test level of psychological wellbeing among alcohol dependence syndrome patients in experimental group and control group
67
3. Frequency and percentage distribution of the post-test level of psychological wellbeing among alcohol dependence syndrome patients in experimental group and control group.
70
4. Mean and standard deviation of the pre-test level of psychological wellbeing among alcohol dependence syndrome patients in experimental group and control group.
72
5. Mean and standard deviation of the post-test level of psychological wellbeing among alcohol dependence syndrome patients in experimental group and control group.
73
6. Mean and standard deviation of the pre-test and post-test level of psychological wellbeing among alcohol dependence syndrome patients in experimental group.
74
7. Mean and standard deviation of the pre-test and post-test level of psychological wellbeing among alcohol dependence syndrome patients in control group.
76
8. Association between the post-test level of psychological wellbeing among alcohol dependence syndrome in experimental group with their selected demographic variables.
78-79
9. Association between the post-test level of psychological wellbeing among alcohol dependence syndrome in control group with their selected demographic variables.
81-82
FIGURE NO.
TITLE PAGE
NO.
1. Conceptual framework based on Modified Imogene Kings
Goal Attainment theory (1890). 18
2. Schematic representation of Research methodology. 33 3. Schematic representation of Research design. 34 4. Percentage distribution of age of alcohol dependence
syndrome patients in experimental group and control group. 61 5. Percentage distribution of education of alcohol dependence
syndrome patients in experimental group and control group. 61 6. Percentage distribution of religion of alcohol dependence
syndrome patients in experimental group and control group. 62 7. Percentage distribution of occupation of alcohol dependence
syndrome patients in experimental group and control group. 62 8. Percentage distribution of family monthly income of alcohol
dependence syndrome patients in experimental group and control group.
63
9. Percentage distribution of marital status of alcohol dependence
syndrome patients in experimental group and control group. 63 10. Percentage distribution of number of children of alcohol
dependence syndrome patients in experimental group and control group.
64
11. Percentage distribution of dietary pattern of alcohol dependence syndrome patients in experimental group and control group.
64
12. Percentage distribution of area of living of alcohol dependence
syndrome patients in experimental group and control group. 65 13. Percentage distribution of duration of alcohol consumption of
alcohol dependence syndrome patients in experimental group and control group.
65
control group.
15. Percentage distribution of the pre-test level of psychological well being among alcohol dependence syndrome patients in experimental group and control group.
69
16. Percentage distribution of the post-test level of psychological well being among alcohol dependence syndrome patients in experimental group and control group.
71
17. Mean and standard deviation of the pre-test and post-test level of psychological well being among alcohol dependence syndrome patients in experimental group.
75
18. Mean and standard deviation of the pre-test and post-test level of psychological well being among alcohol dependence syndrome patients in control group.
77
S. NO ABBREVATIONS
1. HIV/AIDS – Human Immuno Virus / Acquired Immuno Deficiency Syndrome.
2. US – United States
3. AUD – Alcohol Use Disorder
4. AUDIT – Alcohol Use Disorder Identification 5. ADS – Alcohol Dependence Syndrome 6. NIAB – National Institute of Alcohol Abuse
7. NSDUH – National Survey on Drug Use and Health 8. WHO – World Health Organization
9. GI – Gestalt Therapy
10. CBT – Cognitive Behavior Therapy
APPENDIX TITLE
A. Letter seeking and granting permission for conducting the study
B. Letter seeking experts opinion for content validity C. Certification for Content validity
D. List of experts for content validity E. Certificate of English editing F. Certificate of Tamil editing G. Certificate of Informed consent
H. Copy of the tool for data collection – English I. Copy of the tool for data collection – Tamil J. Certificate of Gestalt Therapy
K. Intervention
L. Certificate of plagiarism
“A study to assess the effectiveness of Gestalt group therapy on psychological well being among Alcohol Dependence Syndrome patients admitted in selected De-addiction centers, at Tirunelveli District”. The study was conducted by Miss.Abirami.P in partial fulfillment of the requirement for the degree of Master of Science in Nursing at Sri K. Ramachandran Naidu College of nursing under the Tamilnadu Dr.M.G.R.Medical University during the year of October 2019.
The objectives of the study were,
To assess the pre-test and post-test level of psychological well being among alcohol dependence syndrome patients in experimental group and control group.
To find out the effectiveness of gestalt group therapy on psychological well being among alcohol dependence syndrome patients in experimental group.
To compare the pretest and post-test level of psychological well being among alcohol dependence syndrome patients in experimental group and control group.
To associate the post test level of psychological wellbeing among alcohol dependence syndrome patients in experimental group and control group with their selected demographic variables like age, education, religion, occupation, family monthly income, marital status, number of children, dietary pattern, area of living, duration of alcohol consumption and duration of stay.
All Hypotheses were tested at 0.05 level of significance
RH1 - The mean post-test level of psychological well being among alcohol dependence syndrome patients in experimental group will be significantly higher than the mean post-test level in control group.
RH2 - The mean post-test level of psychological well being among alcohol dependence syndrome patients in experimental group will be significantly higher than their mean pre-test level.
RH3 - The mean post-test level of psychological well being among alcohol dependence syndrome patients in control group will be lower than their mean pre-test level.
RH4 - There will be a significant association between the post test level of psychological well being among alcohol dependence syndrome patients in experimental group and control group with their selected demographic variables like age, education, religion, occupation, family monthly income, marital status, number of children, dietary pattern, area of living, duration of alcohol consumption and duration of stay.
The study was based on the Modified Imogens king’s goal attainment theory.
Quantitative research approach was used. Quasi experimental pre-test and post-test control group design was adopted for this study. The study was conducted in Bala saranya rehabilitation centre and Thanvanthri de-addiction centre in Tirunelveli district. Non probability purposive sampling technique was used to select the samples. Thirty alcohol dependence syndrome patients were selected from Bala saranya rehabilitation centre for experimental group and thirty alcohol dependence
group.
The tool used for data collection was Ryff’s psychological well being scale.
The reliability of the tool was established by Karl Pearson correlation coefficient formula. The reliability of the tool was 0.09. The tool was found to be reliable. Pilot study was conducted to find out the feasibility of the main study. Followed by that pre-test was conducted for both the groups. Patients with mild and moderate level of psychological well being were selected as a sample. Gestalt group therapy was given to experimental group and no intervention for control group. The post-test level of psychological well being was assessed by using same tool. The obtained data were analyzed in terms of both descriptive and inferential statistics.
The major findings of the study were:
In experimental group the pre-test mean value of psychological well being was 145.6 with the standard deviation of 28.19. In experimental group the post-test mean value of psychological well being was 182.2 with the standard deviation of 33.97. The calculated ‘t’ value was 4.63
In control group the pre-test mean value of psychological well being was 142.5 with standard deviation of 26.90. In control group the post-test mean value of psychological well being was 143.5 with standard deviation of 25.90. The calculated
‘t’ value was 3.12.
There was a significant association between the post test level of psychological wellbeing among alcohol dependence syndrome patients in experimental group with the demographic variables like age, religion, family monthly income, marital status and dietary pattern at p<0.05 level and there was a no significant association between the post test level of psychological wellbeing among
demographic variables like education, occupation, number of children, area of living, duration of alcohol consumption and duration of stay at p<0.05 level.
There was no significant association between the post test level of psychological wellbeing among alcohol dependence syndrome patients in control group with the selected demographic variables.
On the basis of the findings of the study it is recommended that:
The following studies can be undertaken to improve the psychological well being of alcohol dependence syndrome patients.
A true experimental study can be conducted to assess the effectiveness of group therapy on psychological well being among alcohol dependents
A study can be conducted to assess the effectiveness of the group therapy to reduce the negative behavior on level of depression and psychological well being among alcohol dependence syndrome patients.
An experimental study can be done to assess the effectiveness of gestalt therapy on improving self-awareness among alcohol dependence syndrome patients.
CONCLUSION
From the result of the study it was concluded that practicing gestalt group therapy to the alcohol dependence syndrome patient was very effective in improving the level of psychological well being. Therefore the investigator felt that more importance should be given for gestalt group therapy to improving the level of psychological well being.
CHAPTER – I INTRODUCTION
“Drinking Isn’t Cool!
It Makes You Act Like A Fool”
-Tim Gay
BACKGROUND OF THE STUDY
Alcohol is derived from the Arabic word alchemical jargon, and it is a beverage that produces intoxication. “Alcohol” comes from the Arabic word “al- kuhl,” which means “BODY EATING SPIRIT,” (whoa) and this actually serves as the origin for the English word “ghoul.” An ghoul is an evil demon believed to eat human bodies. (Jason Christoff., 2018).
Alcohol is a depressant, which means it can disrupt the balance, affecting our thoughts, feelings and actions and sometimes our long-term mental health. The people know that alcohol has psychological symptoms of increased depression and anxiety.
(Poun Charles., 2012).
“Alcoholism has been known by a variety of terms including alcohol abuse and alcohol dependence. It is also referred to as alcohol use disorder.” (Darla Burke 2017).
Alcohol use disorder is a pattern of alcohol use that involves problems controlling the drinking, being preoccupied with alcohol continuing to use alcohol even when it causes problems, having to drink more to get the same effect or having withdrawal symptoms when rapidly decrease or stop drinking. (NIAAA., 2018).
Alcoholism is a disease in the sense that over time there are neurological or
functional changes that happen as a result of heavy continuous drinking.
(Dr. Kenneth lenord., 2019).
Alcoholism is a very complex disease. There is no single cause of alcoholism.
There are number of risk factors that play a role in the development of an alcohol addiction. Both internal and external factors contribute to the development of alcoholism. Internal factors include genetics, psychological conditions, personality, personal choice and drinking history. External factors include family, environment, religion, social and cultural norms, age, education and job status. (Jeffery juergens., 2019).
Alcohol has immediate effect which includes slowed reaction time, blackouts, inability to walk properly, impaired judgment, memory impairment and slurred speech.
Alcohol use disorders can lead to permanent and debilitating health condition.
Thiamine deficiency, sleep trouble and mental health disorder such as catatonic schizophrenia cognitive problems include diminished attention span and problems with motor co ordination a condition that causes a voluntarily flap or shake their hands. In severe cases, hepatic encephalopathy can develop. (Debra Emmettie., 2015).
Alcohol use disorder develops while drinking so much of alcohol and that causes chemical changes in the brain. These changes increase the pleasurable feelings.
This makes them want to drink more often, even if it causes harm and the person with alcohol use disorder will engage in drinking to prevent withdrawal symptoms. These withdrawal symptoms can be quite unpleasant and even dangerous. (Timothy J., 2017).
Treatment for alcohol use disorder often begins with "detox" or detoxification, which is the body's withdrawal from alcohol. After the body is clean of alcohol, the alcoholic enters a counseling program. The goal of counseling is to help the alcoholic face emotional issues that lead to drinking and to learn ways to stop drinking.
Medications may be given to curb a physical craving for alcohol. Treatment programs
can last from a few weeks to years. Places for treatment include hospitals, live-in treatment centers, clinics, and counseling offices. (Cleve., 2014).
People who abuse alcohol often suffer psychological distress. The negative social consequences of alcohol consumption and stressful life events may trigger psychological, biological or behavioral responses that may interfere with the individual’s ability to adapt thus leading to emotional distress reactions and occupational impairment. Psychological distress or psychiatric morbidity may result from either social or work-related factors. (Adentuji.,2018).
People affected by alcoholism undergo lasting brain changes that interfere with their emotional and psychological function. The physiological and psychological effects of alcoholism causes of mental illness. People suffering from alcoholism have increased chances of developing symptoms of mental illnesses. Psychological well being is used to describe an individual’s emotional health and overall functioning.
(Springer., 2017).
Psychological well being consists of positive relationship with others, personal mastery, autonomy, a feeling of purpose and meaning in life and personal growth and development. Psychological well being in terms of internal experience of these respondents and their own perception of their lives. (Johnes., 2012).
Gestalt therapy was developed by Fritzand Laura in 1940’s. It is a revision of psychoanalysis and focuses on an experiential and humanistic approach. Gestalt therapy rejects the dualities of mind and body, body and soul, thinking and feeling and action. The word “Gestalt” (of german orgin) refers to a “whole, configuration, integration or pattern of form. (Stew., 2011).
Gestalt therapy is the quiet an interesting therapy. Most therapies tend to focus on someone’s past. But this technique focuses the present situation. So it’s an
intriguing approach. The gestalt therapy which is given to the anger, alcohol dependence syndrome patient, substance use, psychosis, schizophrenia etc. Gestalt group therapy includes various techniques such as pending issues, dialogue technique or the empty chair; I’m responsible, practice the continuum of consciousness, affirmations, role playing, dreaming and confrontations. In this techniques empty chair technique is one of important technique which will help to bring self- awareness, reducing anger. The main goal to bring more self-aware and to learn about negative thoughts are preventing them from living a productive life. (Julia Thomas., 2019).
Empty chair technique is a method of facilitating the role taking dialogue between the patient and others or between parts of the patient’s personality. It is generally used in a group situation. Two chairs are placed facing each other, one represents the patient or one aspect of the patient’s responsibility and the other represents another person or the opposing part of the personality. As the patients alternates the role, he or she sits in one or the other chair. (Hamilee., 2014).
In the empty chair technique the interaction must acquire a spontaneously meaningful quality this happens steadily increasing fashion or suddenly at any point which is designed to allow to work through interpersonal or internal conflicts. It helps the situation from a perspective and gain insight in the feelings and behaviors (Sarah fader., 2019)
A study was conducted to find out the effectiveness of gestalt therapy for anxiety in practice-based setting. Gestalt therapy has claimed to be an effective alternative, but there is little empirical evidence on its efficacy with anxiety. The Single-Case Experimental Design with Time Series Analysis was used. Evidence on ten clients diagnosed with anxiety disorders is presented, supporting the claim that
Gestalt therapy can be a useful treatment for this. Detailed analysis of one case illustrates the changes in symptom and well-being scores, indicating turning points during the therapy. This study discusses the use of this methodology for creating a practice-oriented research network. (Pablo Herrera et al.,2012)
NEED FOR THE STUDY
In the United States, nearly 88,000 people per year die from alcohol related causes. Globally alcohol accounts 3.3 million deaths. Six percent fall in accident deaths each year. Sixteen million people were affected in the United States.
(National Institute of Alcohol Abuse., 2010).
Alcohol use disorders in the US estimated 6.2% of adults over about 15.1 million people had an alcohol use disorder. The prevalence of heavy drinking, binge drinking and alcohol use disorders are highest among men aged between 18 to 24 years who are unemployed. (Luseer ferrick., 2018).
In American Indians / Alaska Natives 49.1 per 1 million of peoples died by alcoholic poisoning. More than fifteen million people struggle with an alcohol use disorder in the United States, but less than eight percent of those receive treatment.
More than 65 million Americans report binge drinking in the past month, which is more than forty percent of the total of current alcohol users. Teen alcohol use kills 4,700 people each year. (World Health Organization., 2014).
Ninety seven thousand students between the age of 18 and 24 years experiencing alcohol-related sexual assault or date rape. About 1 in 4 college students reported academic consequences from drinking, including missing class, falling behind in class, doing poorly in exams or papers, and receiving lower grades overall. Alcohol poisoning kills six people every day. Of those, seventy six percent
are adults ages between 35 - 64 years, and three of every four people killed by alcohol poisoning are men. (World Health Organization., 2014).
In 2010, there was about 63% of males and 17% of females with alcohol abuse patients got admitted in in-patient department. Approximately 2.3 million people die each year from the harmful use of alcohol, accounting for approximately 3.8% of all deaths worldwide. An estimated 4.5% of the global burden of disease as measured in disability-adjusted life years is caused by harmful use of alcohol. In India, alcohol consumption has now become a social activity and is accepted as a casual behavior.
A nationwide survey on drug abuse showed that the prevalence of alcohol abuse was 21% among men and 2% among women in India. Though this is less compared to international statistics, half of them fall under hazardous category and one-fifth are dependent drinkers. (World Health Organization., 2010).
In 2015, 26.9% of people aged 18 years or older reported that they engaged in binge drinking in the past month, 70% reported that they engaged in heavy alcohol use in the past month. In that 15.2 million adults age 18 years and older people were included in that, 9.8% were men and 5.3 million were women. In that about 6.7% of adults with Alcohol use disorder in the past year who received treatment. (NSDUH., 2015).
Harmful use of alcohol was the cause for six percent of all deaths occurred globally. India is the third largest market for alcoholic beverages in the world with estimated sixty three million alcohol user in 2013. In southern India, the prevalence of current alcohol use varied between 33% and 35%. Alcohol kills more teenagers than all other drugs combined. (WHO., 2019).
Alcohol use increases the risk of cancers of the mouth, throat, esophagus, liver and colon in men. Globally, 6.2% of all male deaths are attributable to alcohol,
compared to 1.1% of female deaths. Men also have far greater rates of total burden attributed to alcohol than women 7.4% for men compared to 1.4% for women. Men out of four women’s, one in weekly episodes of heavy drinking most probably the reason for their higher death and disability rates. Men also have much lower rates of abstinence compared to women. (Antom Folmin., 2010).
A Study was conducted to assess the effectiveness of gestalt group therapy on psychological wellbeing among alcohol dependents. In this study empty chair technique was used. Pre-experimental research design with one group pre-test and post-test was adopted. Forty samples were used and divided into four groups it was given twice a week for two hours for four weeks and data collected by using structured interview schedule. This study finding reveals that the group therapy is effective to bring about changes in the level of psychological wellbeing among alcohol dependents. The data reveals that the effectiveness of gestalt therapy on level of psychological well being. Hence the investigator stated that gestalt group therapy increasing the level of psychological wellbeing. (Mrs.Arumugam Indira.,2017)
Alcoholism is an emerging social problem in our country. Most of the problems are aroused due to alcoholism. The complications also increasing because of prevalence of alcoholism. Alcohol dependence syndrome patient’s psychological well being and a quality of life get affected because of alcoholism. There are limited techniques to improve psychological well being in our country setup. Gestalt group therapy was also a one of the technique to improve psychological well being of alcohol dependence syndrome patients. There are very minimal studies are done in this area.
Based on the review of literature, prevalence and incidence of alcohol dependence syndrome. The researcher felt that gestalt group therapy may be
beneficial to the alcohol dependence syndrome patients and it was motivated to do a study on gestalt group therapy. Hence the researcher wants to do the research on gestalt therapy to improve psychological wellbeing among alcohol dependence syndrome patients.
STATEMENT OF THE PROBLEM
A Study to assess the effectiveness of Gestalt group therapy on psychological wellbeing among Alcohol dependence syndrome patients admitted in selected De- addiction centers, at Tirunelveli District.
OBJECTIVES
To assess the pre-test and post-test level of psychological well being among alcohol dependence syndrome patients in experimental group and control group.
To find out the effectiveness of gestalt group therapy on psychological well being among alcohol dependence syndrome patients in experimental group.
To compare the pretest and post-test level of psychological well being among alcohol dependence syndrome patients in experimental group and control group.
To associate the post test level of psychological well being among alcohol dependence syndrome patients in experimental group and control group with their selected demographic variables like age, education, religion, occupation, family monthly income, marital status, number of children, dietary pattern, area of living, duration of alcohol consumption and duration of stay.
HYPOTHESES
RH1 - The mean post-test level of psychological well being among alcohol dependence syndrome patients in experimental group will be significantly higher than the mean post-test level in control group.
RH2 - The mean post-test level of psychological well being among alcohol dependence syndrome patients in experimental group will be significantly higher than their mean pre-test level.
RH3 - The mean post-test level of psychological well being among alcohol dependence syndrome patients in control group will be lower than their mean pre-test level.
RH4 - There will be a significant association between the post test level of psychological well being among alcohol dependence syndrome patients in experimental group and control group with their selected demographic variables like age, education, religion, occupation, family monthly income, marital status, number of children, dietary pattern, area of living, duration of alcohol consumption and duration of stay.OPERATIONAL DEFINITIONS
ASSESS
In this study, it refers to the process of systematically and continuously, collecting, validating and communicating the patient data regarding the level of psychological well being among alcohol dependence syndrome patients.
EFFECTIVENESS
In this study, it refers to the process of determining the effectiveness of Gestalt group therapy on level of psychological well being among alcohol dependence syndrome patients and was measured by Ryff’s Psychological well being scale.
GESTALT GROUP THERAPY
Gestalt therapy is a complex psychological system that stresses the development of client self awareness and personal responsibility.
In this study, it is a type of psychotherapy which involves 8 sessions such as orientation, alcoholic history, family history and interpersonal problems, identity, dependence, intimacy and interdependence, empty chair technique and group
involvement and termination. This therapy was used to bring self awareness. It was given to the alcohol dependence syndrome patients for 45 minutes a day, twice in a week for 4 weeks.
PSYCHOLOGICAL WELL BEING
It refers to the extent to which people experience positive emotions and feelings of happiness and attained by achieving of balance affected by both challenging and rewarding life events.
In this study, it refers to the positive relationship with others, personal mastery, autonomy, a feeling of purpose and meaning in life and personal growth and development. The researcher selected the alcohol dependence syndrome patients with mild and moderate level of psychological well being. It was measured by Ryff’s Psychological well being scale.
ALCOHOL DEPENDENCE SYNDROME PATIENTS
It is defined as a strong desire or sense of compulsion to take the alcohol frequently.
In this study, it refers to the individual person with in the age group of 20-60 years consuming alcohol without control and diagnosed as alcohol dependence syndrome as per ICD (International classification of Diseases) criteria by psychiatrist and admitted in de-addiction centre.
DE-ADDICTION CENTRE
It refers to the centre which has multidisciplinary team who are giving treatment, diagnosis and prevention of complication for the substance abuse patients.
In this study, it refers to the centre run by an individual authority, which provides treatment, food, shelter, recreational activities, gardening, occupational therapy, recreational therapy yoga and play activity for the persons with alcohol dependence syndrome on payment basis. The researcher selected the alcohol dependence syndrome patients from Balasaranya de-addiction centre and Thanvanthri de addiction centre at Tirunelveli district.
ASSUMPTIONS
Alcohol dependence syndrome patients may have poor psychological well being.
Gestalt group therapy may help the alcohol dependence syndrome patients to improve their psychological well being.
LIMITATIONS
The study was delimited to a period of one month.
The study was delimited to 60 samples.
The study was delimited to selected de-addiction centers in Tirunelveli district.
PROJECTED OUTCOME
The findings of the study will help the mental health nurse to provide gestalt group therapy for improving the psychological well being of alcohol dependence syndrome patients.
The findings of the study will help the mental health nurse to gain better knowledge about the application of empty chair technique for alcohol dependence syndrome patients.CONCEPTUAL FRAMEWORK
The conceptual framework is a set of interrelated concepts that are assembled together in some rational scheme, in virtue of their relevance to a common theme.
Conceptual framework helps to stimulate research and extensive knowledge.
Conceptual frame work is the base.
The conceptual framework for research study presents the measures on which the purpose of study is based. The framework provides the perspective from which the investigator views the problems
The study is based on the concept that the effectiveness of Gestalt group therapy on psychological well being among alcohol dependence syndrome patient.
The investigator adopted the Imogene kings Goal Attainment theory as a base for developing the conceptual framework.
Imogene Kings Goal Attainment theory was proposed by Imogene King in 1890. The Goal Attainment theory was based on the personal and interpersonal systems and social system which includes the following:
Nursing was defined by Imogene Kings as a process of human interactions between the nurse and the clients whereby each perceives the other and the situation through communication. They set goals, explore means and agree on means to achieve goals.
CONCEPTS OF IMOGENS KING GOAL ATTASINMENT THEORY Personal System
Perception Self
Growth and development Body image
Time Space
Interpersonal System Interactions Communication Transaction Role
Stress Social System
Authority Power Status
Decision Making Control
PERSONAL SYSTEM Perception
It refers to person’s representation of reality. It is universal yet highly subjective and unique to each person. Here the investigator perceives that the alcohol dependence syndrome patients may have a poor psychological well being.
Self
It refers to a persons subjective environment, which constitutes everything that makes up the persons. Hence the investigator identifies the alcohol dependence syndrome patients may identify them selves and bring self awareness.
Growth and development
It refers to the changes occur in orderly manner, predictable, function to genetic endowment and environment. In this study growth refers to improvement in the intervention, which processes in people’s life through which they move from a potential for achievement to actualization of self. After completion of intervention which gives improvement in psychological well being, that means this study is said to be effective.
Body image
It refers to the manner in which one perceives ones body and the reaction of others. Hence the investigator identifies the alcohol dependence syndrome patients whether have good body image or not.
Time
It refers to a universal, relational, unidirectional, measurable and subjective.
At this stage the investigator analyze the time to make conversation to bring self awareness among alcohol dependence syndrome patients. Duration between one event and another as uniquely experienced by each human being. If the time maintained in the therapy gives good results.
Space
It refers to the immediate physical territory occupied by a person and person’s behavior. Hence the investigator identifies the space between the alcohol dependence syndrome patients and investigator.
INTERPERSONAL SYSTEM Interaction
It refers to the verbal and nonverbal behavior of individual and the environment or between two or more individuals with a purpose to achieve goal. It
includes the goal directed perception and communication. The investigator understands the verbal and non verbal behavior of alcohol dependence syndrome patients.
Communication
It refers to the nurses and patients communicate information, set mutual goal, and then act to achieve those goals. This is also the basic assumption of the nursing process. The researcher communicates with the patient to understand about the patient feeling and maintain good interpersonal relationship. Here the investigator provided empty chair techniques to improve the psychological well being of the alcohol dependence syndrome patients.
Transaction
It refers to an observable, purposeful behavior of individual interaction with in their environment to achieve desired goal. At this stage the investigator analyze the psychological well being among alcohol dependence syndrome patients. If positive outcome is achieved then the intervention is said to be effective. If there is a negative outcome reassessment to be done.
Role
The investigator and the alcohol dependence syndrome patients set mutual goals between them to play a role in the therapy.
Stress
It refers to the role performance, role expectations as perceived by the nurses and patient are congruent, transaction will occur it refers to the stress occurs there is an any deviation occurs in the period of study intervention will break so the investigator can find out the stress to prevent the breakage of intervention.
SOCIAL SYSTEM Authority
It refers to the observable behavior of providing guidance and order and being response of actions. Here the investigator has authority to administer the intervention.
Power
It refers to situation dynamic and goal oriented. Here the investigator has a power to achieve a goal that is improving the level of psychological well being.
Status
It refers to a position occupied by a person in a group in a position by a group in relation to others groups in as organization. Here the investigator identifies the group and organize the group till the end of the therapy.
Decision making
It refers to making results from developing and acting on perceived choices for goal attainment. Here the researcher makes a decision regarding organizing, formulation, selection and decision making of the group.
Control
It refers to the control over all the duties, privileges, obligations, achievements for goal attainment. Here the researcher totally controlling the whole group in problem solving and assess the level of psychological well being at the end of the intervention.
sSS
Demographic variables
Age Education Religion Occupation Family monthly income
Marital Status Number of children Dietary pattern Area of living Duration of alcohol consumption Duration of stay
PRE-TEST Assess the pre- test level of psychological well being among alcohol dependence syndrome patients by using Ryff’s psychological wellbeing scale.
Experimental Group (n=30) Moderate level of
psychological well being Mild level of psychological well being
Control Group (n=30) Moderate level of
psychological well being
Mild level of psychological well being
POST-TEST- Assess the post- test level of psychological well being among alcohol
dependence syndrome patients by using Ryff’s psychological wellbeing scale
POST-TEST- Assess the post- test level of psychological well being among alcohol
dependence syndrome patients by using Ryff’s psychological wellbeing scale Provided Gestalt
Group therapy to the alcohol dependence syndrome patients for 45 minutes a day twice in a week for 4 weeks
Moderate level of psychological well being Mild level of psychological well being Normal level of
psychological well being
No improvement in the level of psychological well being.
FIGURE 1: MODIFIED IMOGENE KING GOAL ATTAINMENT THEORY – (1890) Not included in the study
Re assessment No
intervention
18
CHAPTER II
REVIEW OF LITERATURE
Review of literature refers to an extensive and systematic examination of publication relevant to the research project. One of the most satisfying aspects of the literature review is the contribution it makes to the new knowledge of the researches.
(Basavanthappa B.T., 2000).
Researcher almost never conducts a study in an intellectual vacuum. Their studies are undertaken with in context of an existing knowledge base. Researcher generally undertakes the literature review to familiarize himself / herself with the knowledge base. (Polit and Hungler., 1999).
The review of literature in the research report is a summary of current knowledge about a particular practice problem and includes what is known and not known about the problem. The literature is reviewed to summarize knowledge for use in practice or to provide a basis for conducting a study. (Burns., 1997).
The review of literature is organized under the following sections.
Section – A Studies related to prevalence of alcohol dependence syndrome.
Section - B Studies related to psychological well being.
Section - C Studies related to psychological well being among alcohol dependence syndrome patients.
Section - D Studies related to effectiveness of gestalt group therapy on other conditions.
Section - E Studies related to gestalt group therapy on psychological well being among alcohol dependence syndrome patients.
Section – A Studies related to prevalence of Alcohol dependence syndrome
Michaela Begsteider et al., (2018) conducted a study to assess the prevalence
of alcoholism in United States in 2014, among 15-year-old Americans. Thirty five percent have reported having had at least one drink and about 22.7 percent reported drinking within the past 30 days. That included 23 percent of males and 22.5 percent of females. Among U.S. college students, 58.4 percent of full-time student’s ages 18 years to 22 years reported drinking alcohol in the past 30 days, compared to 50.6 percent of others in the same age. An estimated 39 percent of college students reported binge drinking in the past month and 12.7 percent admitted to heavy drinking. All of these percentages are significantly higher for the same age group among non-college students.
Osaki Hussari et al., (2018) conducted a cross sectional study to assess the prevalence and trends of alcoholic patients in Egypt. Subjects were chosen through a stratified two-stage randomized sampling method. Alcohol Use Disorders Identification Test was used. In 2003, the surveys obtained responses from 2547 people (73% response rate); in 2008, 4123 people (55% response rate); and in 2013, 4153 people (59% response rate). The gender difference of prevalence of problem drinking is getting smaller. The binge drinking and heavy episodic drinking were observed especially younger generation. The survey observed many hidden alcoholic patients and showed the possibility that the healthcare facilities and health screening became the place of screening and intervention for alcohol dependence.
Yash Jairam Verenkar et al., (2018) conducted a cross-sectional study to assess the prevalence of alcoholism in Goa medical college. The period of study was one month. Students pursuing MBBS Course in all semesters for the academic year
2015-16 were the study participants. Data collected by interviewing the students. The pre-tested structured questionnaire used to collect the data. Alcohol consumption pattern was assessed by using alcohol use disorder identification test. Prevalence of alcohol consumption was found to be 39.4%. Prevalence among females was higher (40.6%) compared to Males (38%). Among the alcohol consumers 82.3% were light drinkers, 17.7% were identified as heavy drinkers. Hazardous alcohol consumption was identified in 46.7% of alcohol consumers. Twenty of alcohol consumers showed signs of alcohol dependence.
Rajeev A et al., (2017) conducted a community study to find out the alcohol consumption in a rural area of South India, Thiruvalla, Kerala. Data were collected by house to house survey of adult males and it was carried out by using the alcohol use disorders identification test (AUDIT) questionnaire. The Prevalence of problem drinking was 12.8% across the age groups with the highest drinking prevalence in the age group under 40 years, 19% percentage of alcohol users were in the younger age groups. Only 38.3% of the young populations were abstinence. Even the proportion of heavier drinkers was more among the younger population. More than half of the populations of youngsters were consuming alcohol regularly at various intervals. The population above the age of 60 years had the highest level of abstinence (86.5%).
Dr.Suchithra V. et al., (2017) conducted a cross sectional study to assess the prevalence of alcohol dependence syndrome among females in fisherman community, Pondicherry Stratified sampling technique was used to collect samples. The subjects were interviewed individually. The size of the sample was 186. AUDIT questionnaire was used to assess the samples. At the end of the study results, females having addictive effect and the problem of female substance abuse is higher.
Rajendra Harnagle et al., (2017) conducted a study to find prevalence of alcohol dependence syndrome and role of alcoholics anonymous in prevention and de-addiction in an urban community of Jabalpur. A simple random sampling methodology was used. Pre-test was conducted by using semi structured questionnaire. Of the 3586 samples about 434 (12.01%) were found to have alcohol dependence syndrome in that 434 were taken up for the study, only 280 samples (64.5%) were improved at the end of 12 months by Alcoholic Anonymous. The prevalence of alcohol dependence syndrome patients is increasing globally as well as in developing country in India. The ADS had significantly reduced by Alcoholic Anonymous Counseling.
Charles et al., (2016) conducted a comparative study to assess prevalence and patterns of alcohol use among college students comparing scenario in Arunachal Pradesh and Kerala. A self administered questionnaire survey done among college students in the selected districts of Arunachal Pradesh (352 students) and Kerala (703 students). Scientific stratified sampling method was used to select students. The CAGE questionnaires were adopted in this study. In Arunachal Pradesh family members were present at initial drink in majority (63.3%) whereas it was only 24.5%
in Kerala. The study highlights increased prevalence of alcohol among college students and emphasizes on regional difference in the practices and beliefs attached alcohol.
Vijay Ramananr. V et al., (2016) conducted a cross sectional study on alcohol use and its related health and social problems in rural Puduchery. The prevalence of alcohol use among 18 years of age was 9.7% and exclusively among males was 17.1%. The highest prevalence was among 46-55 years of age groups and the resident of joint family 37%. Random walk method was used. Data was collected
by using structured questionnaire. The overall prevalence of alcohol use in puduchery was low and restricted to males only. The prevalence was high among low uneducated farmers and labors. About one-third of users had alcohol dependence problems and one fifth had chronic health problems.
Rakshase Bal et al., (2015) conducted a descriptive study to assess the prevalence of alcohol dependence and association between socio demographic factors and alcohol dependence among males in Thiruvanathapuram district, Kerala. The total sample size was 288. Simple random sampling technique was used to collect the samples. The samples were collected by using structured questionnaire. This study proves that Alcohol Dependence among males in Thiruvananthapuram is as high as 38.41%. Moreover, socio- demographic factors such as marital disharmony, poor income, poor education and unemployment are significantly associated with Alcohol Dependence. Religious factors influence alcohol use. There is no urban- rural difference in Alcohol Dependence.
Guslin et al., (2015) conducted a cross-sectional study to find out the association between debut of alcohol or drug use and alcohol related and drug related problems and mental health among adolescents. Nine hundred and forty three students from 13 schools (middle and upper secondary schools) of the Bari district were enrolled in the study. In each school one class for each age was randomly selected.
The research was carried out by an anonymous, self-administered questionnaire which investigated alcohol consumption, knowledge of alcohol consumption of parents and knowledge of the law regulating alcohol consumption. The results showed that the higher prevalence of alcohol habits and the poor knowledge on alcohol law seemed to indicate the need of improving public health efforts in the prevention of alcohol consumption among Italian adolescents.
Ruma Dutta et al., (2014) conducted a cross sectional population based study on alcoholism among adult males in a rural area at Kuthampakkam village, in Poonamallee block of Tiruvallur district in Tamil Nadu, India. The study population included adult male population. Simple random sampling method was adopted. A structured questionnaire was used to collect information regarding the background characteristics, history of alcoholism and certain social factors. A total of 157 adult male were enrolled in the study. Among them only 4.5% who presented with symptoms of chronic alcoholism had taken treatment. The results showed that these developments have raised concerns about the public health and social consequences.
Muthurajesh Eswaran et al., (2014) conducted a community based cross sectional study to measure the prevalence and determinants of alcohol consumption among adult men in a coastal area of Pondicherry that comes under the field practice area of Department of Community Medicine, Pondicherry Institute of Medical Sciences. Study population consisted of 500 men aged 18 and above. A systematic random sampling was used for sample selection. Data were collected by house-to- house survey using a predesigned questionnaire were analyzed. The prevalence of alcohol consumption was found to be 59.6%. Factors such as lower literacy level, having family history of alcohol consumption, and cigarette smoking were found to be positively associated with alcohol consumption. The prevalence of alcohol consumption was found very high in Pondicherry compared to national levels.
Sujit D Rathod et al., (2013) conducted a population-based cross-sectional study to assess the prevalence of alcoholism between men and women among adults.
Three thousand two hundred and twenty adult (≥18 years of age) residents were participated. Nearly one in four men (23.8%) had consumed alcohol in the past 12 months, while few (0.6%) women were consumers, Questions adapted from the Client
Service Receipt Inventory were used to assess the prevalence of the study. While 49.2% of men with AUDs felt embarrassed by their problems with alcohol, only 2.8%
had sought treatment in the past 12 months. A need exists for effectively identifying and treating adults with AUDs. Health promotion services, informed by commonly- expressed stigmatized beliefs held among those affected by AUDs and which are targeted at the most affected communities, may be an effective step in closing the treatment gap.
Ganesh kumar et al., (2011) conducted a community based cross sectional study to assess the prevalence and pattern of alcohol consumption in India. Nine hundred and forty six subjects were aged 10 years and above. Data on Alcohol Use Disorder Identification Test (AUDIT) Scale. Data was analyzed by unvaried and multiple logistic analysis and collected by making house to house visit. Over all the prevalence of alcohol was found to be 9.4%, prevalence was more among males (16.8%) compared to that of females (1.3%). Prevalence of alcohol use is high, in males.
Section–B Studies related to Psychological well being.
Moses icanco ugan et al., (2018) conducted a study on impact of coping strategies on psychological well being among students of Federal University, Lafia, Nigeria. The study examined the impact of coping strategies on students’
psychological well-being in a Nigerian university. One hundred and forty nine students comprising 81 (54.36%) males and 68 (45.64%) females, ranging from 18 to 33 years, with a mean age of 23.16 years responded to the coping strategies inventory and scales of psychological well-being, via a cross sectional survey design. The results showed significant and impact of coping strategies on psychological well- being accounted approximately 29.2% of the variability. Based on the findings, the
researcher concluded that coping strategies may enhance and/or exacerbate psychological wellbeing. Students were advised and others to embrace appropriate strategies to avoid negative consequences.
Mojan yarish et al., (2017) conducted a descriptive study on psychological well-being in people with multiple sclerosis and their primary caregivers. It was conducted among 200 Multiple sclerosis patients and 200 primary caregivers. Simple random sampling technique was used in this study. The tool consists of Ryff's standardized questionnaire with 84 questions for determining these people's psychological well-being. The same questionnaire was also completed by the primary caregivers of these patients. Data was collected by Ryff’s questionnaire was used to determine psychological well-being of these individuals. The findings showed that psychological well being subscales was significantly different in patients and their caregivers.
Rajvee arvindsamy et al., (2017) a cross sectional study to assess the psychosocial problems of adolescents at higher secondary school students. The study sample was among 300 secondary and higher secondary school students in three government aided institutions in Central Kerala. Random sampling technique was used in this study. Data on basic demographic variables were collected. General Health Questionnaire and Adolescent Alcohol Drug Involvement Scale were used to collect information on psychological wellbeing and alcohol use. Mean age was 14.49 years with a standard deviation of 1.31. Males were 64.5% and 82.6% belonged to nuclear family. Psychological wellbeing was significantly better in males compared to females (p=0.025). Males (7.6%) and females (4.3%) were found to be using alcohol by AADIS questionnaire. The findings of the study showed that Prevalence of poor
psychological wellbeing and substance abuse among adolescents was 7.8% and 6.4%
respectively. Females were more emotionally unstable than males. Substance abuse cause further deterioration of mental function in adolescents.
Johnson et al., (2012) conducted
a
study to assess the psychological well being of the adolescent children of alcoholic parents of coastal and non-coastal areas of kerala. Researcher used proportionate random sampling. From each district one hundred and fifty respondents were selected as sample from the list available. It means out of 50% (150) samples in a district 75 respondents were selected from coastal and 75 respondents are selected from non-coastal area. Ryff’s Psychological Well-Being Scales was used in this study. Alcoholic addiction of parents have decisive role in the formation of behavior formation and academic performance of the children. The results showed that the Kerala being one of the highest alcohols consuming state in the country has most of the parents, mostly fathers or head of the house consume alcohol and often a minority becomes addicted to it.Section – C Studies related to psychological wellbeing among alcohol dependence syndrome patients.
Adetunji odinji et al., (2018) conducted a cross sectional survey was to determine the pattern of alcohol use and factors associated with psychological well- being of health care workers at a University Teaching Hospital. Alcohol Use Identification Test and General Health Questionnaire were adopted. Stratified sampling technique was used. A total of 256 participants of medical and surgical specialties at the State University Teaching Hospital in Nigeria were interviewed.
Fifteen (5.9%) of the respondents were either hazardous or harmful drinkers.
Psychological distress was reported among 17.2% of the respondents and this was
significantly associated with marital status, years of practice, specialty of practice, and presence of ongoing chronic illness, current stressors and level of alcohol use. Efforts should be geared towards identifying these factors so as to ensure effectiveness and well-being of health workers.
Rajlakhmy aiyapapn et al., (2018) conducted a cross-sectional study regarding psychological well being and substance abuse among adolescent (13 to 19 years) in Central Kerala among 300 secondary and higher secondary school students in three government aided institutions in Central Kerala. Simple random sampling technique was used. General Health Questionnaire and Adolescent Alcohol Drug Involvement Scale were used to collect information on psychological wellbeing and alcohol use. Psychological wellbeing was significantly better in males compared to females (p=0.025). Prevalence of poor psychological wellbeing and substance abuse among adolescents was 7.8% and 6.4% respectively. Females were more emotionally unstable than males. Substance abuse cause further deterioration of mental function in adolescents.
Section - D Studies related to effectiveness of gestalt group therapy on other conditions.
Fahimeh Nazararzedeh et al., (2015) conducted a comparative study to assess the effectiveness of Gestalt therapy and cognitive therapy to improve the quality of life in patients with Hypertension. Simple random sampling method was adopted. The quality of life questionnaire was used for data collection. The sample size was 150. After scoring, randomized 15 patients in the experimental group and 15 patients were enrolled in the control group. Eight sessions of group counseling, group practices Gestalt therapy and cognitive therapy were consolidated and the control group received no treatment. Data were analyzed using analysis of covariance. The
