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birth date on Buy write my paper biology, resume This page explains how to write a British-style CV (curriculum vitae, or resume, or personal history) and paper, covering letter, used when applying for jobs in my paper biology the UK. Author: Corinne Mills. Date: January 2009. Author: Tracey Whitmore. Publisher: How To Books Ltd. Your CV ( curriculum vitae ) is paper century a summary of your work experience and education, used for job applications. A resume (properly written as resumé) is an American English term for a CV. Buy Write My Paper Biology! A covering letter is a letter sent with your CV which explains details about your application to a particular company. A reference is a formal letter to English century an employer, from somebody who knows you well, describing your character or ability.

A referee is a person who provides a reference for you. How should I design the Buy write my paper, layout of pro life my CV? There are many ways to design a CV. My Paper Biology! This section gives an example. Print your CV on english potraviny, good quality white paper. The paper size should be A4 (this is 21.0 cm wide and 29.7cm tall). Usually you should not attach a photograph.

Leave wide margins (there should be a gap of at my paper least 2 centimetres on the top, bottom, left and mba thesis help, right). A good font size to use is 12 (or 10 if you want to put more information on your CV). The document should use only one font style, for example Times New Roman. Use bold ( Bold ) or italics ( Italics ) to emphasise important words. Only underline section titles (or do not underline any words). If you make a list (for example, a list of your job achievements), consider using bullet points.

Try to keep the CV on one side of paper, or use two sides if you have a lot of relevant work experience or qualifications. Keep your sentences short and simple. A typical section order is: There is an example CV shown below. When writing your name, always put your own name first and your family name last (even if you write the biology, family name first in your own country). Include the full postcode in parts your address. Make sure that you will be able to collect all mail sent to my paper this address (if you move, ask the owner to forward letters to you).

If you have a mobile telephone, put this number on paper online offline, your CV, so that you can be contacted easily. Buy Write! If you use a voicemail service, it will be easier for callers to leave a message for you. If you do not have a mobile telephone, give the number of the help, telephone at my paper biology your accommodation. The telephone number should start with the area code, written in brackets; for example, a London number should be written (020) xxxx xxxx. If the telephone has an answering machine, make sure that you check the messages every day. If you are sharing someone else's telephone, ask that person's permission before using their number on your CV. Write your e-mail address next to your telephone number, and check your messages regularly. Pro Life! Create two columns. Use the left-hand column for dates.

For start and end dates, use either full years (eg 1998-2000) or the Buy write biology, first three letters of the month followed by the last two digits of the year (eg Jun 98-Sep 00) In the right-hand column, provide information about each of divorce your job roles. Start by Buy write writing the Dissertation parts, name of the company (in bold) and its location. On the my paper, next line you might give a brief description of what the company does. You might give a title for mba thesis help your job (and perhaps a department name) on another line (highlighting this in biology bold italics) You should list your main responsibilities and achievements within each role (perhaps using bullet points) Give more detail for recent jobs. Make sure that you mention skills which may be useful in the job for which you are now applying. Dissertation! If possible, avoid any date gaps unless they are covered within the Education section. Don't mention how much you were paid. When describing your achievements, use positive action verbs (for example: achieved, arranged, assisted, co-ordinated, completed, dealt with, developed, established, expanded, handled, helped, implemented, improved, increased, interviewed, introduced, maintained, managed, negotiated, organised, planned, processed, programmed, proposed, promoted, purchased, redesigned, reduced, reorganised, revised, sold, solved, streamlined, supervised, trained, translated, worked, wrote). You should not use the Buy write, word I on your CV; this is understood. For example, you might write Increased sales at the shop, but not I increased sales at the shop. Remember that the person reading your CV may not be familiar with the education system in your country.

Create two columns. Use the left-hand column for the dates. For start and end dates, use either full years (eg 1998-2000) or the first three letters of the month followed by the last two digits of the pro life, year (eg Jun 98-Sep 00) In the right-hand column, list the name of the school or university on one line, followed by further details (the course name or the biology, number of exam subjects passed) on the next line. List formal educational qualifications only in this table (eg university and secondary school, but not a language school or part-time courses), stating the most recent (and highest level) qualifications first. If you have been to a post-graduate school or college, put the name of this after a label such as Post-graduate studies: so that the level is clear. If you have been to a university, use the word University in Dissertation the name, or put a label such as University: before the name so that the level is clear. My Paper Biology! If the Buy a research paper offline, university is one of the top universities in your country, state this fact (the interviewer may not know it). State the name of the town and country after the university's name. In the Buy write my paper biology, description, put the literature, name of the main subject studied (try to my paper biology avoid using the words major or minor, which are used in paper offline American English). My Paper Biology! If you studied English, the subject should perhaps be described as English language and literature, not just English literature.

Avoid mentioning grades unless they are particularly good; if you do mention grades, make sure that they are clear (e.g. 80%, or top grade) - the British university grade system is probably different from that in Buy a online your country. You should list any schools you have attended between the ages of about 15 and 18, but not before this age. You should add the label Secondary school: before the name of the school, or include the words High School in the name. If you took exams in a wide range of subjects, you may prefer to list only the number of biology subjects passed instead of the subject names, or if you have been to parts university you may choose not to list any secondary school qualifications. If you are studying in the UK, you may want to include details of this course. If so, write this in a line under the main table.

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You may want to English write Gender:, followed by Male or Female, if this is not obvious to a British person from your name. Whether you are a man or a woman may be relevant for my paper some jobs. Write Work status:, followed by a description of the status implied by the stamp in your passport, for Essay pro life example, Student visa or EC citizen (no work permit required). Write Interests: followed by Buy write my paper biology a short list of perhaps 3 or 4 main hobbies or interests. As you have come to the UK to study, you can probably include interests such as travel, learning languages, or international cultures.

Don't list anything which you wouldn't be happy to parts discuss at an interview. Include interests which may show the interviewer that you have good social or team-working skills, that show your dedication / enthusiasm / success, or that highlight additional skills that may be useful in the job (for example, computer or language skills). If you think it is necessary, write References:, followed by Buy write biology Available on Dissertation, request. You should only provide references if your employer asks for biology them. Essay Uk! If you do need to Buy write biology give a reference, make sure that you have asked the person beforehand. Possible referees include a teacher or previous employer. It may complicate your application if you give the parts, name of a referee who lives abroad; if you want to do this, make sure that the person will be able to provide comments in English, and give an e-mail address so that delays can be minimised. 52 Orchard Street, London W2 3BT.

Telephone: 020-7654 3210; Mobile: 07960 999999; E-mail: akiko9999@hotmail.com. · Advised the main shop's customers about organic and health foods. · Developed new business in smaller satellite stores, explaining the benefits of supplements and organic food to potential new customers. · Increased sales at Buy write biology both the main and the satellite shops. The extra profits were used to expand the research paper online offline, business by establishing a new shop. · Examined incoming mail and redirected this to the appropriate division. · Translated foreign letters (written in English) into Japanese. · Dealt with customs enquiries and procedures. Computer literate: good knowledge of Word and Excel, as well as e-mail and the internet. Fluent in Japanese; practical knowledge of Buy write biology English and Pixwords english potraviny, Korean. Buy Write My Paper Biology! If you are sending an help, application directly to a potential employer, you should write a one-page letter to accompany your CV (a covering letter). The covering letter may either be typed (better if you are applying to a large company) or written neatly by Buy write hand (better if you believe that a typed letter may appear too formal). There is an example covering letter shown below. State what type of visa you have, so that the potential employer knows that you will be able to work legally. You may want to mba thesis mention the level of your English ability.

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Otherness, Subjectivity and Incommunicability. by William Shannon. In this essay I will analyze the stories The Broken Globe and Two Sisters in Geneva by Henry Kreisel from Buy write my paper a largely psychosocial point of view in terms of the problems of otherness, subjectivity, and incommunicability. For the Dissertation parts purposes of this essay, I will define those terms as follows, both with respect to the internal experiences of the Buy write characters in the stories, and also with respect to the narrator’s point of english view. Otherness is a sense of apartness, distinctiveness and/or strangeness experienced as largely insurmountable. My Paper Biology? Subjectivity, as I use the paper term, relates both to the subjectivity of experience – the Buy write my paper biology same event can have different meanings for different people (Lye 2002), and to a character’s belief that she or he has the power to be the autonomous subject of paper 1 nineteenth century her or his actions. The term incommunicability will also be used in two senses. The first sense relates to the limitation on the level of true communication that two characters from my paper biology different backgrounds can meaningfully achieve; the second sense is more philosophical and relates to the notion that some things (including individuals) cannot change what they truly are, although they may change some of their attributes.

In the context of these stories, incommunicability in the second sense refers to paper offline the impossibility of a character’s truly leaving behind her or his origins and background. My Paper? That is, the Buy a research paper online offline new world can only be so new insofar as one is biology forced to bring the old into it, whether one wants to or not. One always brings into the new world individual and pro life uk, cultural elements, both inherited and acquired, from the old and in that way it can be said that one is Buy write my paper only able to with filing ny change one’s attributes but not one’s essence. I will focus on The Broken Globe because it brings these issues to Buy write my paper the surface in a very compelling and emotional way through the fractured relationship of Nick Solchuk and his father. After analyzing The Broken Globe, I will contrast it with the more straightforward depiction of difference between the title characters in Two Sisters in Geneva. Kreisel’s The Broken Globe is told retrospectively in the past tense in Essay pro life the voice of an internal narrator, whose name we never learn and about whom the author tells us virtually nothing. Because we know so little about the narrator himself, his role as a protagonist trying to my paper bridge the gap between the other two characters takes on a kind of otherness, and serves to Help divorce ny emphasize the distance between the other two characters and the distances between each of the characters and the narrator. The narrator is like a blank slate on which Nick Solchuk and his father can write their own versions of the past.

The ostensible premise of the story is simple enough. The narrator’s colleague, Nick Solchuck, asks the narrator to visit his father after he is settled in Alberta. Nick prepares the narrator for his father by advising him that [w]hen once my father believed something, it was very hard to shake him (129) . From a perspective afforded by distance in space and time, Nick seems to have come to terms, on at least a superficial level, with what he considers his father’s mistaken worldview. Nick tells the narrator that I suddenly realized that [my father] wasn't mad, but that he lived in the universe of the my paper medieval church (129). Thus, Nick imputes a theology to his father: The earth for him was the research paper center of the Buy write my paper biology universe . My father never said all that in filing papers ny so many words, mind you, but that is what he believed. Everything else was heresy (129-130). While this attitude permits Nick to explain his father to himself on Buy write, some level, at the same time it permits Nick to discount the importance of his father’s worldview both to his father and to himself. As a man of science, Nick’s perception of his father as medieval is not so much a way for Nick to understand his father, as it is a way to further distance himself from his father. By characterizing his father’s attitude as medieval, Nick is not making an effort to truly understand his father’s attitude from research online his father’s point of view, and he refuses to acknowledge that his father’s worldview has had a significant influence on Nick.

This appears to be the modus operandi for all the historical interactions between Nick and his father described in the story. The relationship between Nick and his father illustrates all three problems of otherness, subjectivity and Buy write, incommunicability. Each character feels far apart from the other in pro life attitude and Buy write, purpose. Nick, as a scientist, feels he is the subjective author of his own destiny and does not acknowledge explicitly the influences of his background on his current life, except insofar as Nick acknowledges to Essay uk the narrator his desire for a sense of distance and of space (127). Nick and his father have not truly communicated with each other since Nick’s childhood, and neither character tries to meet the other halfway.

Nevertheless, Nick wants the narrator to my paper visit his father and tell him that Nick has not gone to the devil (131). Literature Paper Century? It is not clear why Nick thinks that his father’s hearing this news from someone from Nick’s world (as opposed to someone from the father’s world) will make a difference in their relationship. This makes one wonder what Nick really wants. Does he want to assure his father that he is doing fine, or does he want to continue the biology dispute that began in his childhood? The fact that the narrator is impressed with the grandeur and the monumental monotony of the journey west from Dissertation parts Montreal (131) sets him up to at least be sensitive to Nick’s father’s point of view. It is not clear where or how Nick and the narrator met, but it seems that the narrator is new to the Canadian West. The narrator contrasts the expansive Canadian landscape to the tidy, highly cultivated countryside of Buy write England and of France where the Pixwords english potraviny consciousness of nature [is] humanized (131). The narrator comments that all motion seemed suspended, and Buy write my paper biology, only the sun moved steadily (131). This description foreshadows Nick’s father’s attitudes, and opens up the possibility that the narrator may come to understand Nick’s father better than Nick does, reminding us of his role as a bridge-builder.

Nick’s father’s lack of parts response to the narrator’s letter asking for permission to my paper visit implies that Nick’s father did not want the visit (132). Upon arriving in town, the narrator learns that the whole town knows about the Pixwords help differences between Nick and my paper biology, his father (133). They think Nick is involved in making atomic bombs – perhaps symbolic for the destructiveness of the Buy a online offline modern worldview on medieval attitudes like those of Buy write Nick’s father. But at the same time, the Pixwords english potraviny storekeeper seems proud that someone from the prairie made a name for himself (134). Paradoxically, the storekeeper seems both attracted to and repelled by Nick’s apparent success, reminding us that the unknown can be simultaneously attractive and repellent. The narrator’s presence in Buy write biology town leads the storekeeper to conclude that Nick has not forgotten his roots. Indeed, the narrator tells the storekeeper that [s]ome day [Nick] plans to return (134), although the truthfulness of that statement is potraviny doubtful. Perhaps it is simply the narrator’s way of making the storekeeper feel comfortable with an outsider’s presence. Nick’s father seems to have been expecting the narrator, even though he hadn't responded to the narrator’s letter. The scene is described with an aura of anticipation.

The house seems to be a reflection of the father’s attitudes: The door was low and I had to stoop a bit to get into the room (135). If this is true of the my paper narrator, it must also have been true of Nick’s father, a tall, massively built old man (134). Essay Uk? Perhaps the cramped nature of the entrance to the house symbolizes what Nick and the narrator see as the father’s cramped attitudes and beliefs? Little light enters through a small window, keeping the house perpetually dusk (135), perhaps symbolizing the intellectual darkness in which Nick believes that his father lives because of his medieval beliefs. The narrator notes the physical similarities between Nick and his father – the same determined mouth, and the same high cheekbones and the same dark, penetrating eyes (135), reminding us that Nick carries his father within him whether he likes it or not – a kind of incommunicability in the second sense described above. Nick’s father explains to the narrator that Nick is tampering with the Buy write earth (135). For Nick’s father, tampering with the Buy a offline earth is equivalent to sacrilege, something else reinforcing the separateness between Nick and his father, the biology incommensurability of their worldviews, and their inability (unwillingness?) to truly communicate.

Nick’s father is puzzled by the narrator’s visit – as if an attempt to reach out to him from this other world is most unexpected: [Nick] sent me to bring you greetings and to tell you he is filing papers ny well (136). Nick’s father acknowledges Nick’s vicarious outreach and softens his demeanor a bit, setting the stage for the embedded internal narrative that follows. The embedded internal narrative in which Nick’s father recounts the story of how Nick contradicted his father in front of the entire family and the hired help underlines the biology lack of communication (i.e., incommunicability in the first sense) between Nick and his father. We can see how the event must have sorely wounded the father’s pride, causing him to lash out at Nick in frustration. English Literature Paper 1 Nineteenth Century? Perhaps the way the events unfolded made it difficult or impossible for the father to consider that Nick’s scientific ideas might be correct? It appears that Nick did not apologize for putting his father on the spot, and that the father did not apologize for Buy write my paper, hitting Nick. The memory of the event clearly still angers Nick’s father (137-138), and underpins the present separateness between Nick and pro life, his father. The father’s intended audience during the embedded narrative is not only the narrator, but himself – as if the father is trying to re-convince himself that he handled the situation correctly so many years ago.

The father tried to lock up Nick in the house to keep him away from school (138). Buy Write? His sense of impotence was palpable. Both Nick and Dissertation, his father are stubborn. Nick brought home the globe to try to convince his father that he was right (138), but the toy globe proved nothing to the father other than the fact that his son did not respect his worldview (139). By shattering the globe, the my paper father was trying to pro life uk shatter the threat to his world that the globe represented. Buy Write Biology? Neither party tried to understand the other, but instead tried to convince the other of the error of his ways. We must wonder if Nick’s father kept the eponymous broken globe around as a way of maintaining contact with his son, as a way of Buy a research paper online offline refusing to give up on him despite the rubbish (136) he learned in school and around which he built his life away from his father.

We must be skeptical of the father’s statement that he found the globe in the attic and was going to throw it away but he forgot (137); the timing of the narrator’s visit and the presence of the globe must be more than coincidental. Buy Write Biology? Maybe the father kept the globe in preparation for the narrator’s visit, or maybe it was there all along waiting for a visit from Nick? Regardless of Custom why he keeps it around, Nick’s father says the globe belongs in the garbage because it is a false thing. In his view, only that which is before him is real and worthy of attention. In response to the father’s question, the Buy write my paper narrator reluctantly tells him that he agrees with Nick’s view of the world. The father doesn’t seem to hold this against the narrator, but rather blames it on the fact that Satan has taken over all the world (140). Thus, the father is willing to paper grant the narrator a measure of flexibility he denies his own son. Perhaps this is because the narrator took the time to reach out, while Nick has not. But the my paper biology narrator’s attempts to Dissertation smooth things over –to bridge the two worlds represented by Nick and his father, is less than successful. Nick’s father is concerned that there will be no one to tend his land after he dies.

To Nick’s father, tending the beloved land (141) in front of you is Buy write more important than tampering with God’s earth (140). Nick’s father believes what his senses show to be true – she [the earth] is flat, and she stands still. Still, the father asks the narrator to send greetings to Nick, and thus the English literature paper 1 nineteenth century narrator has managed to at least partially bridge the gap between Nick and his father, if only as a messenger confirming their differences. The sense of otherness experienced by the title characters in Two Sisters in Geneva is very apparent and less psychologically nuanced than that portrayed in The Broken Globe. My Paper? Once again, Kreisel uses a disinterested third party to attempt to bridge the gap between two family members who seem to inhabit different planets.

But this time the story is told from the point of view of an external narrator standing outside the story. Thus, we know a bit more about with filing, Warren Douglas, our bridge-building character, in this story, and my paper, his role is more obviously drawn. Help? And as a student of history he is sensitive to the cultural differences represented by Buy write my paper the sisters’ pasts, and understands the implications of their present journey. It is significant that the action takes place in Geneva — a meeting place of European cultures where several languages coexist and where the ill-fated League of Dissertation Nations started. Buy Write? Like the train station in which the action takes place, Geneva is a way station between cultures, mirroring the state of transit in which the characters find themselves. The sisters’ present journey harkens back to Dissertation parts their separate journeys 36 years ago when they set off in different directions from England – one to Canada and one to Italy. They are only Buy write now returning together for a visit to England for the first time in 36 years. The journey home is parts a tense one. It lacks the joy that one might expect such a journey to evoke. This lack of joy is only reinforced by Buy write my paper biology the weather – It has been raining all day (115). From the beginning, Mrs.

Miller’s brusque new world demeanor is contrasted with Emily’s easygoing European style, as illustrated by their interactions with the porter (116). Even Emily’s name emphasizes the Buy a research online distance between the sisters – Mrs. Miller calls her Emily and she calls herself Emilia; her name evokes the internal sense of otherness that Emily/Emilia must carry around within herself. The sisters appear so different that Warren would not have thought they were sisters (118). From the beginning, we see that Emilia is more comfortable at the intersection of cultures than Mrs. Miller.

Emilia must remind her sister that [i]t’s not foreign money to the people who live here (117). Mrs. Miller tries to find common ground with Warren in their common country of Canada (117), although even that common ground reflects otherness, subjectivity and incommunicability – Warren is from Toronto and Mrs. Miller is from Edmonton, two very different regions with strikingly different qualities and Buy write my paper biology, different ways of Help with ny life. Mrs. Miller is convinced of the superiority of Canada over Italy and nothing can persuade her otherwise. Mrs.

Miller mentions several times that Mr. Miller left her well provided for (118-119), and she thinks it is awful that Emily lives in a furnished room (118). In contrast, Emilia is quite happy with her situation in Florence (124). As if to underline the differences between them, Mrs. Buy Write My Paper Biology? Miller cannot understand why Emilia would rather live alone in a room in Italy instead of in a house with her own flesh and paper offline, blood (119) in England or Canada. In this story, Warren clearly sympathizes with Emily’s point of view in contrast to the narrator in The Broken Globe who appears ready to empathize with both sides. Buy Write? Mrs. Miller’s attitude toward Europe is summed up in this statement: I'll be glad when I get back to a place where you can understand what people are saying, though. It’s a weird feeling hearing people jabbering away and you not understanding a word they’re saying (120).

For Warren and Emilia, Europe represents art and culture and a vibrancy of Custom mba thesis life that Mrs. Miller cannot see. For Mrs. Miller, there is no benefit to exposure to other cultures, and being in Europe is nothing but a nuisance. The story is biology structured to give us each sister’s point of view through their comments to Warren as he sits with them individually and hears them out. In contrast to Mrs. Miller’s husband, who left her well-provided for, Emily tells Warren that her husband was a very interesting man and to live with him was a great privilege (122), emphasizing the beauty of the experience over any economic considerations. Emilia’s coughing spells suggest that Italy as a more healthy environment for her (122), as if the wet and the rain reinforce the fact that she is out of her element on this journey to the grayness of England, and possibly to the winters of Canada. Emilia seems able to analyze the otherness, subjectivity and incommunicability between her and century, her sister with a measure of dispassion when she notes that [w]e have been living in different worlds. Much too different (123). Buy Write? Emilia does not appear to hold Mrs.

Miller’s differences against her like Mrs. Miller does with respect to Emilia; rather, Emilia seems to accept them as the natural result of their different paths over english potraviny, the years. They are simply from different worlds with nothing to talk about (122-123). But Emilia can at least see that Mrs. Miller is kind and Buy write my paper, well-meaning – a sharp contrast with The Broken Globe, in which the Custom mba thesis help father and son clearly do not accept their differences and see nothing positive in them, and also in contrast with Mrs. Miller who sees nothing positive in Emilia’s way of life. For Emilia, home is where you make it, not where you come from. She longs to go back home to Italy (123) and has no intention of ultimately going to Canada (124): To live in a strange land in Buy write a strange city with my sister would be – well, not exactly like the Inferno, but like Purgatorio (124). Warren clearly understands and sympathizes with this attitude.

Emilia accepts the otherness, subjectivity and incommunicability separating her from her sister. In contrast to the family members in Essay uk The Broken Globe, it is the journey that is tense, not the family members’ feelings for Buy write biology, each other. In both stories, the characters are trying to reconcile their origins with their present situation and their desires for the future. Each story in its own way poses the questions of english potraviny whether one can totally do away with one’s past (an issue of incommunicability), and whether there is a limit to my paper the common ground achievable by those with seemingly incommensurable attitudes (issues of otherness and English literature 1 nineteenth century, subjectivity). Neither of the stories answers these questions definitively, leaving it to the reader to biology see pieces of her or himself in the stories and learn from the characters some of the ways in which these issues are forced upon Dissertation parts, us in my paper spite of ourselves. Indeed, E.D.

Blodgett (1982) points out that Kreisel makes no distinction [in his works] between ‘immigrant’ and ‘ethnic.’ I think this fact makes Kreisel’s depictions of Pixwords otherness, subjectivity and incommunicability in stories like these all the more compelling for the reader, since one can readily identify with the Buy write biology experiences portrayed in his stories, regardless of English paper century ethnic background or immigrant experience. © Copyright 2005 William Shannon. Note: All page references are to The Almost Meeting and Buy write my paper, Other Stories by Henry Kreisel, unless otherwise noted. Blodgett, E. Parts? D. Fictions of Ethnicity in Prairie Writing. Configuration: Essays on Buy write, the Canadian Literatures . Ed. E.D. Blodgett. Pro Life Uk? Toronto: ECW Press, 1982. 85-111. Kreisel, Henry. My Paper? The Almost Meeting and Other Stories . 1981.

Edmonton: NeWest Press. 2004. Lye, John. Narrative Point of View: Some Considerations. (7/9/2002). Dissertation Parts? 9/9/2005. Updated February 12 2015 by biology Student Academic Services.

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Diagnosis and Treatment of PTSD-Related Compulsive Checking Behaviors in Buy write Veterans of the Iraq War: The Influence of Military Context on the Expression of PTSD Symptoms. This case study presents an overview of the conceptualization and treatment of two veterans of the Iraq War who presented for combat-related treatment at a Veterans Administration Medical Center. In addition to literature posttraumatic stress disorder (PTSD) symptoms of reexperiencing, arousal, and avoidance, the veterans exhibited compulsive checking behaviors that appear to Buy write be influenced by theater-specific combat duties and traumatic events. Paper Offline! These cases represent what the authors believe to be an increasingly common expression of PTSD in my paper veterans of the Iraq and Afghanistan wars. Pro Life Uk! Both veterans were treated with prolonged exposure therapy, which includes imaginal and in vivo exposure to anxiety-provoking stimuli, processing of traumatic events, and self-assessment of anxiety. Biology! Treatment also included in vivo exposure with response prevention techniques borrowed from the literature on obsessive-compulsive disorder to address compulsive checking behaviors within the ecological context of each patient’s symptom presentation. Measures related to PTSD and depression were obtained before, during, and after treatment. Essay Pro Life! Treatment was associated with significant declines in symptom severity and my paper, improved functioning for both veterans.

The unique nature of the conflict in the Middle East represents role challenges for Pixwords help soldiers that affect symptom presentation. Variations in symptom presentation can in Buy write turn complicate efforts to identify and divorce papers ny, appropriately address PTSD-related health concerns in this population. Thus, clinicians and Buy write my paper biology, researchers must remain cognizant of how theater-specific duties influence the manifestation and treatment of PTSD in english help order to provide optimal care to a new generation of veterans. Since 2001, more than 1.5 million U.S. troops have been deployed to Iraq or Afghanistan as part of Operations Iraqi Freedom and Enduring Freedom (OIF/OEF) (1) . A significant number have returned with psychiatric problems and Buy write my paper, concomitant mental health service needs. A recent large-scale study of OIF/OEF Army and Marine personnel indicated that 10%–20% of personnel meet criteria for posttraumatic stress disorder (PTSD), depending on the stringency of the diagnostic standard used (2) . With Ny! A similar picture emerged from the Army Surgeon General’s Mental Health Advisory Team V (3) and from a report by the Rand Corporation (1) , both indicating that up to 20% of OIF/OEF personnel experience symptoms of PTSD.

These data suggest that hundreds of thousands of individuals returning from Iraq and Afghanistan suffer from at Buy write my paper least some posttraumatic stress symptoms. Although such estimates of Dissertation risk for Buy write biology PTSD may seem inflated, it is reasonable to expect that multiple deployments, the help experiencing of numerous traumas, and Buy write biology, the long periods of sustained threat associated with OIF/OEF deployment would increase the risk of developing PTSD. When the sheer scale of these military efforts is taken into account, even more modest estimates of risk translate into large numbers of individuals who may need mental health services. Help With Filing Papers! Even using the most conservative criteria, the number of troops returning with postdeployment PTSD will be in the tens of thousands. My Paper Biology! Such projected estimates raise public health concerns that may transcend the capacities of the Department of Dissertation parts Defense and Buy write biology, Department of Veterans Affairs (VA) health care systems. While efficacious cognitive-behavioral interventions for PTSD have been developed (4 , 5) , we need to improve methods for disseminating such treatments to community- and hospital-based clinics where mental health professionals provide day- to-day services to patients with PTSD. Although meeting the mental health needs of OIF/OEF personnel presents challenges, doing so provides new opportunities to refine our understanding of PTSD and continue to improve on methods of identification, engagement, and Essay uk, treatment of the disorder.

One important aspect of refining our understanding of combat-related PTSD may be to consider how theater-specific duties and experiences affect symptom presentation and treatment. Our clinical observation suggests that compulsive checking as a safety behavior may be a frequent component of my paper biology OIF/OEF-related PTSD symptom presentation (25%–30% of help OIF/OEF veterans diagnosed with PTSD who present to our clinic engage in compulsive checking); however, appropriate research has not been conducted to investigate this observation. The clinical sample that forms the basis of these observations is not ideal for establishing base rates for checking behaviors in PTSD patients in my paper biology general or for investigating the correlates of PTSD-related checking behavior. Online Offline! Such data are also difficult to biology gather without objective measures in place to assess checking behaviors in a reliable and valid manner or otherwise establish objective criteria for distinguishing general hypervigilance from compulsive checking. Very little is known about the most effective way to identify and uk, operationalize this clinical presentation of symptoms. Our goal in this article is to discuss how to biology conceptualize and treat what we believe to English literature paper 1 nineteenth century be a common expression of PTSD in OIF/OEF veterans.

To that end, we present a case study overview of two veterans of the war in Iraq with combat-related PTSD served by a VA medical center in the southeastern United States. In addition to PTSD symptoms of reexperiencing, avoidance, and arousal, the veterans also presented with compulsive checking behaviors that were clearly influenced by the context of their traumatic event exposure. The compulsive checking behaviors did not qualify these patients for a concomitant diagnosis of obsessive-compulsive disorder (OCD) because the criteria for OCD specify that compulsions cannot be restricted to the context of another axis I diagnosis—in this case, PTSD. The patients are not presented as unique idiosyncratic cases, but rather as two examples that appear to represent a sizable proportion of returning OIF/OEF veterans with PTSD—veterans with PTSD and combat-specific compulsive checking behaviors. We then discuss these case presentations within the broader context of OIF/OEF-related PTSD, particularly with regard to implications of compulsive checking behaviors for diagnostic considerations and Buy write biology, treatment planning. Three instruments for diagnostic assessment and ongoing treatment planning were used in both of the cases presented: the PTSD module of the research online Structured Clinical Interview for Buy write my paper biology DSM-IV (SCID) (6) ; the PTSD Checklist–Military Version (7) , and the Beck Depression Inventory–II (BDI) (8) . Both patients were treated with prolonged exposure therapy (9) , which included imaginal and in vivo exposure exercises, processing of traumatic events, and patient self-assessment using subjective units of distress (10) . In addition to traditional in vivo exposure, treatment also included the use of in vivo exposure with response prevention techniques (11 , 12) borrowed from the treatment literature on OCD to address compulsive checking symptoms. Exposure with response prevention involves exposure to stimuli that cause unrealistic fear or distress paired with an active preventing of the compulsive rituals that patients use to manage such stress (13 , 14) . The VA clinicians delivering treatment were clinical psychologists employed in the medical center’s posttraumatic stress clinical team. Most treatment was delivered on-site, but out-of-office visits (15 , 16) were also used to conduct in vivo exposure with response prevention within the ecological context of each patient’s target symptoms. A 24-year-old Caucasian Marine veteran with a history of one deployment to Iraq presented to the VA medical center to establish health care. On intake to primary care, he screened positive for parts PTSD and was referred for specialty services to my paper the posttraumatic stress clinical team.

The patient reported that his primary combat duties included going from house to house and pro life uk, clearing rooms one at a time to secure neighborhoods. In the context of that duty he reported being exposed to multiple life-threatening situations and firefights, witnessing dead and mutilated bodies, making many split-second life-or-death decisions, and losing two of his friends to combat-related death. My Paper! After returning to Buy a research the United States he began to my paper experience at least eight distinct intrusive memories and research offline, nightmares from these combat experiences. He engaged in avoidance through attempted thought suppression, excessive work, and alcohol abuse. He avoided crowds and social situations and dropped out of college because he felt unable to Buy write my paper focus on his academic duties as a result of his symptoms. On presentation to the posttraumatic stress clinical team, he was diagnosed with PTSD according to the SCID, and he scored in the clinical range on the PTSD Checklist (a score of 69 out of a possible 85) and the BDI (a score of 30 out of a possible 63). In addition to his other symptoms, the patient reported engaging in compulsive checking behaviors. He reported checking his front door lock 10 to 30 times a day and research paper offline, peeking out of his window blinds 30 to 50 times per day. The patient also reported engaging in checking behaviors whenever he had an intrusive memory or nightmare, whenever he heard anything “suspicious” (e.g., a car door closing or a dog barking), and whenever he was about to Buy write relax, as a preemptive measure to assuage potential anxiety. One month before beginning prolonged exposure therapy, the patient was treated with the selective serotonin reuptake inhibitor (SSRI) citalopram at a maximum dose of 40 mg daily.

Although SSRIs have established efficacy for treating OCD (17) and Dissertation, PTSD, the patient continued to have functionally impairing PTSD symptoms, including compulsive checking behaviors. The patient was an active participant in prolonged exposure treatment and presented to all 12 of his 90-minute sessions on time. The in-session imaginal exposure exercises consisted of vivid retelling and visualizations of the traumas he experienced as intrusive memories and my paper biology, nightmares. The imaginal exposures began with his most frequent and distressing intrusive memory and subsequently focused on less distressing intrusions as the Dissertation parts patient began to experience symptom amelioration. The patient’s homework consisted of in vivo exposures to safe situations that the patient had been avoiding (i.e., going to the post office to mail his bills or to the food court at biology the mall during a weekday). The patient’s intrusions responded fairly quickly with regard to both symptom frequency and intensity after in-session imaginal exposure exercises. After five sessions, the patient scored a 40 on the PTSD Checklist and a 22 on the BDI, and he expressed having some relief from his intrusions. However, he retained a SCID diagnosis of PTSD and reported having difficulty habituating to his in vivo exposure exercises. During this period of treatment, the patient’s compulsive door and window checking were reduced as a result of the amelioration of intrusions, which were often the impetus for his checking in the first place. However, the actual behavioral reinforcement of checking whenever he did feel anxious continued and remained clinically significant. The pattern sustained as treatment progressed—that is, the overall frequency and severity of the patient’s intrusions decreased, but his compulsive checking behaviors were maintained.

The treatment team hypothesized that the behavioral reinforcement he received via immediate anxiety reduction on checking was interfering with his progress on in vivo homework exposures. That is, the patient’s self-reinforcing checking behaviors in Buy a research online offline response to anxiety at Buy write my paper home made it more difficult for him to tolerate any anxiety long enough to potraviny experience success outside the home in regaining prepathological social functioning. Attempts to assign him in vivo homework not to check were unsuccessful. As he explained, “It’s so easy to do [checking to Buy write my paper biology relieve symptoms] and so hard to stop.” Attempts at cognitive restructuring were also largely unsuccessful, perhaps because the patient’s checking process was already ego-dystonic. As the patient explained, “Sitting here [in the clinic], I know that a bunch of Iraqi insurgents are not going to bust in parts my door, but at home when I’m amped up, I can’t help myself, I’m up and I’m checking.” The eighth treatment meeting consisted of an in-home exposure session where response prevention was added to the in vivo exposure paradigm. The patient and therapist sat in the patient’s living room and waited for naturally occurring sounds—car doors closing, dogs barking, trucks going over potholes, and the like—from the Buy write my paper outside to ny induce anxiety. When such a sound occurred, the patient was counseled and encouraged not to check the window or door lock. The patient used self-reported subjective units of distress and other skills he had learned via earlier imaginal and in vivo exposures to monitor his anxiety. Anxiety-inducing sounds occurred about biology, every 4 minutes on average.

The patient was able to refrain from Pixwords help checking behaviors and also was able to my paper habituate to normal neighborhood sounds within the Pixwords english help potraviny session. My Paper Biology! The treatment team hypothesized that the Buy a research online offline patient was able to Buy write my paper biology experience such success because of the increased support and accountability resulting from the with divorce therapist being present in Buy write biology the ecological context of his symptoms. Once the patient habituated to the normal sounds of his neighborhood in the presence of the therapist, the therapist went outside and Help with filing papers, periodically made additional noises. The patient knew the therapist was going to do this and was instructed not to check the window. Buy Write Biology! Although the patient knew the english potraviny therapist was making the noise, he reported having a more difficult time not checking because the noise was “a little louder and closer.” The patient described “muscle memory” involving springing toward the window on hearing the sounds and Buy write biology, having to sit back down after he had “caught” himself unintentionally off of the couch. The therapist had also noticed such automatic movements during the earlier exposures. These movements may explain why cognitive restructuring, emotional processing of the patient’s traumas, and assigned in vivo homework had not led to extinction of the checking behaviors; the patient’s checking behaviors were ingrained enough to be “overlearned” and Essay pro life, appeared to be operating, at least in part, independently of executive functioning. Buy Write Biology! However, focused and Custom mba thesis, repeated practice of in vivo exposure and response prevention led to within-session extinction of the urge to check. The patient also reported that the home visit session helped him to begin decreasing his checking behavior by himself. Buy Write! The remaining four sessions focused on Pixwords help potraviny, consolidating treatment gains concerning the patient’s intrusions, strengthening his ability to refrain from checking behaviors, and expanding his tolerance for my paper participating in social and Buy a research offline, functional activities that involved crowds.

Our hypothesis that the checking behaviors at home interfered with the patient’s frustration tolerance while attempting out of home in vivo exposures cannot be empirically confirmed. However, subsequent to the home visit, the patient was much more willing to engage in his in vivo homework assignments and experienced greater success in doing them. After the 12-session treatment the patient no longer met criteria for a SCID diagnosis of PTSD, his PTSD Checklist score was 23, and his BDI score was 9. A 38-year-old married black Army veteran of two deployments to Iraq presented to the VA medical center posttraumatic stress clinical team stating, “My commanding officer suggested that I get help.” The patient’s primary duties during both of his tours included providing security for truck convoys by patrolling alongside them in an armed Humvee. In the biology course of these duties he was exposed to multiple life-threatening situations, witnessed an improvised explosive device detonate during a convoy, witnessed dead and paper 1 nineteenth, mutilated bodies, witnessed a motor vehicle run over my paper biology a little girl, and was responsible for checking the English 1 nineteenth century convoy trucks and accompanying vehicles for bombs. My Paper Biology! At the time of intake he was experiencing more than 10 distinct intrusive memories. He engaged in avoidance through attempted thought suppression, doing his errands late at night to avoid people, and Essay pro life, staying home as much as possible while not at work. On presentation to the posttraumatic stress clinical team, he was diagnosed with PTSD according to SCID criteria and scored in the clinical range on the PTSD Checklist (a score of 68) and my paper, the BDI (a score of with filing ny 31). The patient also engaged in compulsive checking behaviors. He checked under his car and under the hood of his car for bombs every time he needed to drive (two to Buy write eight times per day). He expressed insight that his car checking behavior was not normative and that he was embarrassed by it, but he felt that the Essay danger of someone placing a bomb under his car was too great not to check.

The patient was treated with citalopram, at a maximum dose of 40 mg, for 7 weeks before beginning prolonged exposure therapy but continued to have a significant PTSD symptom burden, including compulsive behaviors. The patient was an active participant in prolonged exposure therapy and arrived on time to 15 sessions. Early in treatment, he evidenced an especially low tolerance to his PTSD-related physiological arousal during initial imaginal exposure exercises (e.g., speeding heart, shortness of breath, and tingling in his hands). My Paper! Accordingly, treatment incorporated interoceptive exposure (18) exercises to help desensitize the english help potraviny patient to these specific physiological symptoms. The interoceptive exercises involved helping the patient to become aware of and tolerate his physiological symptoms, without overinterpreting their significance as somehow dangerous or “out of control.” The exposures were conducted without the use of specific external trauma cues; that is, target physical symptoms were induced through doing jumping jacks, breathing through a straw, and rubbing both hands with force. Thus, the patient learned to sit with and tolerate the simulated feeling of his activated sympathetic nervous system.

The interoceptive exercises were completed by both the patient and the clinician, improving rapport, encouraging levity in the treatment process, and instilling a sense of teamwork. Additionally, as suggested by earlier work investigating augmentation of PTSD-oriented exposure therapy with other cognitive-behavioral techniques (19) , the Buy write interoceptive exposures were done in addition to Help with divorce papers ny imaginal and in vivo exposures. That is, overall treatment time was expanded to accommodate the added component of the Buy write my paper interoceptive exposures without encroaching on time devoted to imaginal and in uk vivo exposures. After the patient experienced success at anxiety reduction through the interoceptive exercises, he more eagerly approached the imaginal exposures to the traumatic memory in session. The patient’s reexperiencing symptoms often manifested as a rapid succession of Buy write my paper biology intrusive memories. That is, he reported that whenever one intrusive memory was cued, all of them would “cycle through.” Because the intrusive memories seemed related and were experienced with high levels of distress at the same time, it would often take the patient 2 or 3 weeks to realize that he had not experienced a distinct intrusive memory subsequent to exposure and processing. This aspect complicated treatment progress because the patient was not comprehending or experiencing positive reinforcement (i.e., the knowledge of symptom amelioration) for engaging in prolonged exposure therapy. Nonetheless, the patient and therapist maintained good rapport, and the patient began to realize significant decreases in intrusive memories by the ninth session (PTSD Checklist score=45, BDI score=19). At the same time, however, the patient was making little progress in limiting his car checking behaviors or in successfully habituating to, or completing, in Essay vivo exposure activities. The 10th treatment session consisted of my paper biology in-home in Custom help vivo exposure and response prevention exercises.

The patient and therapist practiced leaving the biology patient’s home and getting into his car without checking under the car or the Buy a paper online offline car hood for bombs. Much like the Buy write my paper first patient described above, this patient also exhibited an overlearned “muscle memory” for the checking behavior evidenced by a quick jerky hand movement toward the hood release latch while opening the help car door. After 30 consecutive trials of getting into the car and getting out of the car without checking, the patient was able to get into his car and start the engine without experiencing distress. The patient’s behavior logs over the next 5 weeks indicated a successive decrease in car checking behavior, going 7 days in a row without checking by biology, the last week of treatment. The patient also began to experience success in his in vivo community exposure exercises—shopping during the day, going to church, and taking his wife out on dates. At the Pixwords help 15th session the patient scored 32 on the PTSD Checklist and 17 on the BDI. The PTSD-related compulsive checking behaviors presented here appear to Buy write biology have a functional role similar to general PTSD hypervigilance. Both behaviors are negatively reinforced as a means of anxiety control, and Essay uk, the impetus for both can be explained by a failure to completely process traumatic experiences.

The distinction between the two may be important only inasmuch as it can inform differential treatment delivery and outcomes. In theory, in vivo exposure (to address hypervigilance) and exposure with response prevention (to address compulsive checking) differ only in biology that the latter focuses on preventing a patient’s specific compulsive response(s) to anxiety-provoking stimuli. However, in practice, in vivo exposure also prevents a patient’s behavioral response to anxiety, which typically involves avoidance and withdrawal. Furthermore, working from the basic principles of nonavoidance and anxiety tolerance to objectively safe stimuli, any experienced exposure therapist would encourage his or her patients with PTSD not to Custom mba thesis repeatedly check locks or check cars for bombs. My Paper! However, one potentially important distinction for treatment is that there is a robust OCD literature and history concerning the filing divorce ny benefits of conducting in my paper biology vivo exposure and response prevention within the ecological context of the symptoms by using out-of-office therapist-assisted sessions (14 , 15) . Although in vivo exposure, by definition, emphasizes the Pixwords english help need to my paper biology address symptoms within the parts context in which they occur, the technique is usually assigned to patients as “homework,” to be done without the direct presence and support of a therapist. Often patients excel at Buy write my paper completing and Custom help, habituating to their homework assignments, especially if the in vivo exposure hierarchies are graded appropriately (10) . However, many patients who, like those presented in these two case studies, have more severe symptoms and less intrinsic coping skills have a difficult time tolerating anxiety by themselves long enough to succeed at or even sincerely attempt in vivo homework assignments. For such patients, out-of-office therapist visits can be a useful tool to help them address their checking behaviors and increase tolerance for anxiety. Expert consensus in the treatment of OCD converges on the usefulness of home visits for patients with particularly severe symptoms (14) . While this question is not addressed in the PTSD literature, clinicians treating PTSD can borrow knowledge from the Buy write my paper OCD literature on effective ways to address treatment-resistant, negatively reinforced checking behaviors. Parenthetically, the cases presented here provide anecdotal evidence that even one home visit can yield significant positive clinical outcomes. The adaptation of compulsive checking measures, such as the Yale-Brown Obsessive Compulsive Scale (20) , for Essay pro life use in PTSD populations may give researchers a useful tool for assessing the impact of home visits on compulsive checking behaviors. The cases presented, and the observed frequency of such cases in OIF/OEF veterans in general, are also of interest from the Buy write my paper perspective of historical context.

The patient described in English paper the first case took part in multiple forceful home intrusions as part of his military duties, and Buy write my paper, these experiences subsequently had an impact on his sense of safety at home. Behaviors that started as executive functioning decisions to check his windows and doors turned into overlearned automatic reactions to anxiety. Research Offline! By the time the behaviors were ingrained, it was not only thoughts about his home being invaded that spurred checking, but anxiety of any kind. Similarly, the patient in the second case routinely checked under cars for bombs as part of his duty. Buy Write My Paper! That behavior directly translated into Buy a research, car checking after he returned home. Buy Write My Paper! The military context, the rigid following of procedures and orders that the Essay uk military ingrains and relies upon for the survival of its troops, may also play a role in symptom presentation and maintenance. Whereas a civilian victim of violence with PTSD may find himself rechecking locks or scanning the environment, in most cases these behaviors were never socially and professionally reinforced. Multiple, repetitive, and sustained manifestations of hypervigilance are rewarded in many OIF/OEF combat situations, by both superiors and peers.

This reward structure may operate as a parallel process to PTSD which encourages the manifestation of PTSD symptoms as repetitive checking behaviors and biology, socially ingrains those behaviors so as to make extinction more difficult. We presented these cases to stimulate discussion on what we believe to be an increasingly common expression of century combat-related PTSD (i.e., PTSD with combat-specific compulsive checking behaviors). Buy Write My Paper! It will be important for Help with clinicians and researchers to remain mindful of how OIF/OEF veterans present with symptoms and how they subsequently respond to traditional treatments for the disorder. Buy Write My Paper! As noted in the case presentations, the inclusion of Help filing response prevention within the ecological context of each patient’s symptoms appears to Buy write biology have resulted in significant treatment gains that may not have occurred otherwise. Furthermore, the manifestation of research specific compulsive checking behaviors is of interest from my paper biology a broader historical perspective.

Military historians have noted that the context and circumstances in which traumas occur can influence symptom presentation and how we conceptualize the disorder (21) . That is, while combat exposure can obviously cause significant distress and pathology, there is reason to believe that specific reactions to combat are to some degree mediated by historical context and military culture. Historical reviews indicate that the prevalence of combat-related PTSD and particular symptoms can change over time within a population, and these changes are only paper century partly explained by improvements in diagnostic procedures (21 – 24) . Buy Write! The nature of the conflicts in Pixwords english potraviny Iraq and Afghanistan creates unique role challenges for our veterans that will likely shape symptom presentation and Buy write biology, clinical outcomes. Papers! Variations in my paper symptom presentation can in turn complicate mental health efforts to identify and appropriately address PTSD-related public health concerns. We encourage ongoing consideration of the cases and issues presented here in Buy a research offline order to ensure that OIF/OEF veterans receive mental health services that are appropriately tailored to their needs. Received Sept. 3, 2008; revision received Jan. 3, 2009; accepted Jan. 21, 2009 (doi: 10.1176/appi.ajp.2009.08091315). From the Ralph H. Johnson Veterans Affairs Medical Center, Post Traumatic Stress Clinical Team, Charleston, S.C.; the Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston; and the Department of Psychiatry, Center for the Treatment and Study of Anxiety, University of Pennsylvania, Philadelphia. Address correspondence and reprint requests to Dr.

Tuerk, Charleston VAMC, Mental Health 116, 109 Bee St., Charleston, SC 29401; Tuerk@musc.edu (e-mail). Drs. Tuerk and Grubaugh report no competing interests. Buy Write! Dr. Buy A Paper! Hamner has received research grant support from Janssen, Organon, and Otsuka and holds stock in Merck and Pfizer. Dr. Buy Write My Paper Biology! Foa reports research support from Pfizer, Solvay, Eli Lilly, SmithKlineBeecham, GlaxoSmithKline, Cephalon, Bristol-Myers Squibb, Forest, Ciba Geigy, and pro life uk, Kali-Duphar. She has also been a speaker for Pfizer, GlaxoSmithKline, Forest Pharmaceuticals, and Jazz Pharmaceuticals and a consultant for Acetelion Pharmaceuticals. We have redesigned the delivery of The American Journal of Psychiatry’s continuing medical education courses (AJPCME). AJPCME courses are available through the biology American Psychiatric Association’s online education portal.

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