EFFECTIVENESS OF ATTITUDINIZE PSYCHOTHERAPY IN ENHANCING SELF ESTEEM AND DIMINISHING SUICIDAL IDEATION AMONG ADULTS IN PAKISTAN

Dr. Linah Askari Assistant Professor, Psychology College of Business Management

Institute of Business Management, Karachi Email: dr.linah@iobm.edu.pk ABSTRACT

The Attitudinize Psychotherapy; an Intervention of the New Millennium, is a complete psychotherapy dealing effectively with all the six vital aspects concerning an emotional problem of a human being. In order to test the five hypotheses, the sample comprised of NO THERAPY GROUP; the Fiftytwo Male and Twenty-three Female Adult Students on which NO Attitudinize Psychotherapy would be conducted, and for ATTITUDINIZE THERAPY GROUP; Fifty-four Male and Twenty-three Female Adult Students on which Attitudinize Psychotherapy would be conducted. The data was collected from the Adult students between the ages of 1825 belonging to Iqra University, Karachi. In the Initial Phase of BEFORE THERAPY All the Male and Female students were administered; a) Dysfunctional Attitude Scale (Therapy Form) (Modified by Dr. Linah Askari 2003), b) Queendoms SelfEsteem Test (2003) and c) Adult Suicidal Ideation Questionnaire (William & Reynolds, 2005). In the Final Phase of AFTER THERAPY, Attitudinize Therapy was conducted for fourteen weeks (75 minute session, twice a week) on the ATTITUDINIZE THERAPY GROUP only. At the completion of this phase the whole sample was Readministered All the three Scales, to both the adults of NO THERAPY GROUP and the adults of ATTITUDINIZE THERAPY GROUP. The purpose was to relate the effectiveness of the Attitudinize Therapy with the Enhancement of Self Esteem and Diminishing of Suicidal Ideation within the Adult to build their lives successfully. The results of statistical analysis reveal that (i) In Before Therapy Phase: the adults within NO THERAPY GROUP have Mean Scores of Dysfunctional Attitude = 303.40, Self-Esteem = 51.78 & Suicidal Ideation = 149.25 whereas ATTITUDINIZE THERAPY GP have Mean Scores of Dysfunctional Attitude = 304.83, Self-Esteem = 50.50 & Suicidal Ideation = 150.35 (ii) In After Therapy Phase: the adults within NO THERAPY GROUP have Mean Scores of Dysfunctional Attitude = 309.26, Self-Esteem = 50.33 & Suicidal Ideation = 153.41 whereas ATTITUDINIZE THERAPY GP have Mean Scores of Dysfunctional Attitude = 103.94, Self-Esteem = 124.15 & Suicidal Ideation = 60.15 providing evidence that Ultimately, Attitudinize Psychotherapy would be the BEST CHOICE. Key words: Attitude, Self-Esteem, Suicidal Ideation, Attitudinize, Psychotherapy, Pakistan.

EFFECTIVENESS OF ATTITUDINIZE PSYCHOTHERAPY IN ENHANCING SELF ESTEEM AND DIMINISHING SUICIDAL IDEATION AMONG ADULTS IN PAKISTAN
Dr. Linah Askari Assistant Professor, Psychology College of Business Management

Institute of Business Management, Karachi Email: dr.linah@iobm.edu.pk

Objective The thought/cognitive patterns appear to be negative most of the time within the youth and the adult population. This reveals the presence of dysfunctional Attitudes within the person which in turn lowers the self esteem of an individual and results in higher level of suicidal ideation. Our objective is to prove the effectiveness of the new introduced Attitudinize Psychotherapy, which can prove an economical, practical and innovative intervention to enable the individual to turn their dysfunctional attitudes (within all the six dimensions) into adaptive (functional/positive) attitudes for the benefit of individual to enhance their self esteem and in turn reduce their suicidal ideation to the minimum to build their lives successfully. Introduction An individual enters from the youth into adulthood and steps into the practical life. The aims and expectations from self, environment and the world around them are at the highest peak. The theoretical experiences, knowledge and guidance for the entrance into adulthood seem complete and profound. As soon as the person realizes that the reality is completely different, rather in the opposite direction of what they have expected, the negative (dysfunctional) attitudes evoke. With the increase of environmental pressures the dysfunctional attitudes increase proportionately, which in turn inversely correlates with the self esteem to lower it and simultaneously these dysfunctional attitudes positively, correlates with the suicidal ideation enhancing them proportionately. The self identity existence and self worth are most important for an individual. Shattering experiences for THE SELF provokes negative attitudes (composed of negative thought feeling and behavior) and the person wishes to end up the lowered value of SELF which becomes intolerable. Attitudes means intention called NIYAT in Urdu. All praises to Allah, this psychotherapy is based on the first Hadith of Islam; Innamal Aamaal-u-binniyat meaning All behaviors are from attitudes, according to the preachings of Hazrat Mohammad (PBUH).

The roots of personality grow within the concept of Self Esteem. Each individual has a unique identification, distinct traits, separate innovative ideas, exceptional comprehending skills and extraordinary way of understanding the reality. When these qualities are polished with confidence, trust and encouragement within the environment, they produce a successful Individual. Every person struggles for the survival and reputation of its name or identification. For each and every action/behavior there is an Attitude/Intention behind it. As it is beautifully said in the First Hadith (Preachings of the Holy Prophet PBUH): Innamal Aamaal-u- Binniyaat means All Behaviors arise from Attitudes/Intentions. It means that the bases of every human action and reaction are the attitude/intention. After the arousal of a positive or a negative attitude (intention) to particular stimuli or situation, the person starts thinking on those terms, beliefs due to his/ her past experiences arise accordingly and hence the behavior in the connection is framed. Bartleby (2000) defines, Attitudinize means to assume an affected attitude; Practice or adopt attitudes especially for effect. When Parents, Teachers or other important people within the circle of an individual develop a positive vision for the success of that individual, all of them struggle within their own roles, at each developmental phase and on all stages to guide and mentor the person towards their set goals for the positive achievements. In fact, the individual makes a mindset to prove oneself and come up to the mark for the expectations demanded by himself and others for his success. Webster (2003) defines, Attitude is a complex mental state involving beliefs, feelings, values and dispositions to act in certain ways. In addition, Attitude is a psychological tendency expressed by an evaluative response that can be overt or covert, cognitive, affective or behavioral. Kamradt and Kamradt (1999) define, Attitude is a psychophysical structure that stores related bits of affective, cognitive, and psychomotor learning in a manner that allows instantaneous, subconscious access by its owner (p. 570). They view attitude as the fundamental unit of learning.

Figure1: Components and Structure of a Discrete Attitude (Kamradt & Kamradt, 1999). Attitude makes a difference every hour, everyday, in everything that one does for the entire life. Anything done with a positive attitude will work beneficially, whereas anything done with a negative attitude will work harmfully. If one has a positive attitude, a person looks for ways to solve the problems that one can solve, and let go off things, over which one has no control. One can develop a positive attitude by emphasizing the good, by being tough-minded and by refusing defeat. The greatest discovery of any generation is that human beings can alter their lives by altering the attitudes of their minds (Schweitzer, 2002).

The goal of Attitudinize Psychotherapy; an Intervention of the New Millennium, evidences in disputing maladaptive / dysfunctional attitudes and to replace illogical and maladaptive attitudes with more positive, realistic and logical ones. The Therapy plays an important part to help people successfully overcome their particular emotional problems by developing positive and adaptive attitudes toward a particular person, situation, environment or the world around them (Askari, 2007). Weissman (1979) represented the Human Attitudes by the following Seven Major Value systems: 1. Approval: These attitudes show ones tendency to measure his/her self-esteem based on how people react to him/her and what they think of him/her.

2. 3.

Love: These attitudes deal with an individuals tendency to measure his/her worth on whether or not he/she is loved. Achievement: These attitudes indicate whether the individual is workaholic with a constricted sense of his/her own worth, or whether he/she enjoys creativity and productivity, but do not see them as the exclusive road to self-esteem and satisfaction.

4.

Perfectionism: taboos.

These attitudes are aimed to measure an individuals tendency toward

perfectionism. Does the individual demands perfection in him/her, i.e., mistakes are

5.

Entitlement: These attitudes are aimed at measuring ones sense of entitlement. Does the individual feel that he/she is entitled to things, e.g., success, love, happiness, etc., or does he/she negotiate for what he/she wants, with no inherent reason why things should always go his way?

6.

Omnipotence: These attitudes indicate whether the person sees himself/herself as the center of his/her personal universe and holds himself/herself responsible for much of what goes on around him/her or, whether he/she realizes he/she is not in control of other adults; i.e., he/she is not ultimately responsible for them but only for himself/herself.

7.

Autonomy: These items refer to ones ability to find happiness within him / her. Does the individual assume responsibility for his/her feelings because he/she recognizes that they are ultimately created by himself / herself, or is he/she trapped in the belief that his/her potential for joy and self-esteem comes from the outside? Attitudinize Therapy approach by Askari (2007) is multifaceted and is based on the

assumption that changing the dysfunctional / maladaptive attitudes within the seven major value systems, along the following Six dimensions would effectively deal with the emotional problems. Leaving any one aspect would provide hindrance therapeutically and problems may reoccur later. The six dimensions are:

1.

Psychological: The training within the psychological aspect of the emotional problem includes, Change in the Dysfunctional / Maladaptive Attitudes of the person, to

change the patterns of thinking, beliefs and behavior toward psychological self, environment and the world around.

2.

Terminological: The training within the terminological aspect of the emotional problem includes, Changing of the abusive / invective attitudes and behaviors; altering verbal and non-verbal maladaptive communications, through altering the languageexpression toward self, environment and the world around.

3.

Spiritual: The training within the spiritual aspect of the emotional problem includes, Changing of dysfunctional / maladaptive attitudes toward Allah (the Divine Being), Reducing guilt and fear, and Inculcating the belief of attaining perfect justice for self and others.

4.

Physiological: The training within the physiological aspect of the emotional problem includes, Changing of maladaptive attitudes toward physiological self, through deep breathing exercise to keep oxygen balance in the body, to maintain balanced diet consumption and control the water intake and output to stabilize the body fluids.

5.

Neuro-hormonal: Neuro-hormones are the body's chemical messengers; these hormones stimulate the cells they are attached to. The training within the terminological aspect of the emotional problem includes, Inculcating an attitude that Neuro-hormonal Regulation of ones own body can be easily controlled through muscle relaxation exercises and massage of pressure points of your body.

6.

Time Management: The training within the time management aspect of the emotional problem includes, Changing of maladaptive attitudes toward time management and to become positively creative and remain relaxed for most of the time in your lifetime. Burns (1999) proposed the Development of Better Self Esteem inferring that, Most

people's feelings and thoughts about themselves fluctuate somewhat based on their daily experiences. The grade you get on an exam, how your friends treat you, ups and downs in a romantic relationship all can have a temporary impact on your wellbeing. Your self-esteem, however, is something more fundamental than the normal "ups and downs" associated with situational changes. For people with good basic self-esteem, normal "ups and downs" may lead to temporary fluctuations in how they feel about themselves, but only to a limited extent. In contrast, for people with poor basic self-esteem, these "ups and downs" may make all the difference in the world. Before you can begin to improve your self-esteem you must first believe that you can change it. Change doesn't necessarily happen quickly or easily, but it can happen. You are not powerless! Once you have accepted, or are at least willing to entertain the possibility that you are not powerless, there are three steps proposed by Burns (1999) that a person can take to begin to change their selfesteem:

Step 1: Rebut the Inner Critic: The first important step in improving self-esteem is to begin to challenge the negative messages of the critical inner voice. For example: When the Inner Critic's Voice Catastrophizes: "She turned me down for a date! I'm so embarrassed and humiliated. No one likes or cares about me. I'll never find a girlfriend. I'll always be alone." So Your Rebuttals to Become Objective: "Ouch! That hurt. Well, she doesn't want to go out with me. That doesn't mean no one does. I know I'm an attractive and nice person. I'll find someone." Step 2: Practice Self-Nurturing: Rebutting your critical inner voice is an important first step, but it is not enough. Since our self-esteem is in part due to how others have treated us in the past, the second step to more healthy self-esteem is to begin to treat oneself as a worthwhile person. Start to challenge past negative experiences or messages by nurturing and caring for yourself in ways that show that you are valuable, competent, deserving and lovable. There are several components to self-nurturing such as: Practice Basic Self-Care, Plan Fun & Relaxing Things For Oneself, Reward Yourself For Your Accomplishments, Remind Yourself of Your Strengths & Achievements, Forgive Yourself When You Don't Do All You'd Hoped and Self-Nurture Even When You Don't Feel You Deserve It. Step 3: Get Help from Others: Getting help from others is often the most important step a person can take to improve his or her self-esteem, but it can also be the most difficult. People with low self-esteem often don't ask for help because they feel they don't deserve it. But since low self-esteem is often caused by how other people treated you in the past, you may need the help of other people in the present to challenge the critical messages that come from negative past experiences. Here are some ways to get help from others such as: Ask for Support from Friends, Get Help from Teachers & Other Helpers and Talk to a Therapist. Sometimes low self-esteem can feel so painful or difficult to overcome that the professional help of a therapist or counselor is needed. Talking to a counselor is a good way to learn more about your self-esteem issues and begin to improve your self-esteem. Hence Attitudinize Psychotherapy would be the BEST CHOICE. Reinherz, Tanner, Berger, Beardslee and Fitzmaurice (2006) studied across a wide variety of indicators, with adolescent and adult subjects for suicidal ideation. It was reported that significantly poorer functioning was found by subjects at age 30 for those having suicidal ideation in adolescence as compared to their peers without suicidal ideation in adolescence. Interviewers rated subjects with suicidal ideation as having significantly lower levels of global functioning and social and occupational functioning than subjects without suicidal ideation. Self-reported coping and self-esteem were lower in subjects with suicidal ideation; interpersonal problems and reports of needing social support were higher for this group. Therefore, Adolescent Suicidal Ideation was Predictive of Psychopathology, Suicidal Behavior, and Compromised Functioning at Age 30, in adulthood. Research Findings underscore the importance of considering suicidal ideation in adolescence as a marker of severe distress and a predictor of compromised functioning, indicating the need for early identification and continued intervention. Additional factors that point to an increased risk for suicide in depressed individuals are:

Anxiety, agitation, or enraged behavior Isolation, segregation and seclusion from the environment Drug and/or alcohol use or abuse History of physical or emotional illness Feelings of hopelessness or desperation

Ultimately, Attitudinize Psychotherapy would be the BEST CHOICE. Literature Review The meaning of high self-esteem is currently under close empirical scrutiny. High self-esteem is typically viewed as beneficial for individuals due to its association with markers of psychological adjustment (Diener, 1984; Kaplan, 1975; Robins, Hendin, & Trzesniewski, 2001; Tennen & Affleck, 1993). Secure high self-esteem, which can be traced to the work of Carl Rogers (1959, 1961), reflects positive attitudes toward the self that are realistic, well-anchored, and resistant to threat. So what degree of self-esteem do people have that never even graduated high school? A study conducted at the University of Maine (McCaul, Donaldson, Colodarci, & Davis, 1992) examined just that. The high school and beyond data base was used to investigate the experiences of drop outs and high school graduates (control group), four years after the projected date of graduation. Specifically, dropouts and graduates with no post-secondary education were compared on the following: Selfesteem, satisfaction at work, political/social participation measures, and number of jobs. Multiple regression analyses were used to determine the degree to which dropping out explained variance in these measures. Dropouts differed from graduates on every personal and social adjustment measure. Differences on these measures were much more significant in males (dropouts vs. graduates), than in females (dropouts vs. graduates). In the article published by Goliath (2005), large number of studies has been accumulated within this concern. Adolescent / Adult suicide is a worldwide problem, but it is of particular concern in highly industrialized nations such as the United States (Conner, Duberstein, Conwell, Seidlitz, & Caine, 2001); Kurtz & Derevensky, 1993). The suicide rate in the United States has tripled since 1960, making it the third leading cause of death among adolescents and the second leading cause of death among the college-age population (National Mental Health Association, 1997). Although it is estimated that approximately 14 adolescents in the United States commit suicide each day, the actual number is two to three times higher (American Psychiatric Association, 1996; 1998). Understandably, these alarming statistics have stimulated great concern in the public at large and have led social scientists to warn of an impending rise in the number of suicides and suicidal attempts among adolescents (Berman & Jobes, 1994; Griffiths, Farley, & Fraser, 1986; Watt & Sharp, 2002). Much of the research literature appears to be focused on suicide per se. However, professionals are increasingly paying attention to the antecedent behaviors. According to Bush and Pargament (1995), suicidal behavior is often preceded by thoughts, threats, and unsuccessful attempts at suicide. Similarly, Cole, Protinsky, and Cross (1992) noted that suicide was the completed process of a continuum that began with suicidal

ideation, followed by an attempt at suicide, and finally completed suicide. Suicidal ideation is a preoccupation with intrusive thoughts of ending one's own life (Cole, Protinsky, & Cross, 1992; Harter, Marold, & Whitesell, 1992) while suicide is the completed act of taking ones life (National Mental Health Association, 2002). Because of this progression from thought to action, it is fitting that researchers explore the notion of suicidal ideation in greater depth. (Studies referred from Goliath, 2005). This study examined the phenomenological relationship among stress, self-esteem, and suicidal ideation in adolescents. Much of the research to date has focused on the associations of stress and self-esteem to actual suicide but not to ideation. Moreover, the majority of studies have examined the relationships in clinical populations. Thus, we know little about the associations of these processes in non-clinical populations. The present study investigated the relationship among cumulative negative life experiences (stress), self-esteem, and suicidal ideation in a non-clinical population of college students. Selye (1974) defined stress as a response of the human body to any stimulus that disrupts the individual's homeostasis. Because these responses are unavoidable, individuals are faced with the constant urge to maintain internal balance. Accordingly, any experience that affects one's homeostasis is considered to be stress (Rice, 1992). Social scientists have expanded Hans Selye's notion of physiological stress to include social, cognitive, and psychological or mental stress. Mullis, Youngs, Mullis, and Rathge (1993) proposed that stress is a function of an individual's appraisal of a life stressor and therefore, a cognitive process. Similarly, Lazarus (1993) contended that the extent to which individuals experience stress is determined by their subjective evaluations of their experiences. Therefore, if individuals appraise an event as traumatic, they will experience more stress from the experience than will individuals who appraise the event as non-significant. Researchers (e.g., BartleHaring, Rosen, & Stith, 2002; Ferrer-Wreder, Lorente, Kurtines, Briones, Bussell, Berman, & Arrufat, 2002) have noted the importance of reducing stress by helping youth develop positive perceptions of the self in order to avoid catastrophic socioemotional outcomes such as suicidal behavior. Indeed, exposure to stress by youth has been linked to severe emotional and psychological problems (BartleHaring, Rosen, & Stith, 2002; Gonzales, Tein, Sandler, & Friedman, 2001), a known precursor to suicide (Teen suicide, 1998). (Studies referred from Goliath, 2005). Mc Gee, Williams and Nada-Raja (2001) examined the longitudinal relationship between family characteristics in early childhood, self-esteem, hopelessness and thoughts of self-harm in the midchildhood years, and suicidal ideation at ages 18 and 21. Path analysis was used to establish separate models for boys and girls. The results suggested different pathways to later suicidal ideation for boys and girls. For boys, suicidal ideation seemed to have stronger roots in childhood, with significant paths from low self-esteem and hopelessness to early thoughts of self-harm and thence to later ideation. For girls, self-esteem had a small but significant direct effect on later suicidal ideation. The findings provide support for the idea that individual characteristics such as feelings of hopelessness and low self-esteem act as generative mechanisms, linking early childhood family characteristics to suicidal ideation in early adulthood.

Hong, Li, Fang, Wai, and Xiong

(2007) proposed, China accounts for nearly a half of the

suicides in the world, but little is known about the risk factors of suicidal ideation among general Chinese population. This study examines the association between stressful life events, self-esteem and suicidal ideation among three community-based samples in China: rural residents, rural-to-urban migrants and urban residents. Representative samples of rural-to-urban migrants (n=1006) and urban residents (n=1000) were recruited in Beijing. The sample of rural residents (n=1020) was recruited from 8 provinces from where 75% of migrant sample originated. All participants completed a crosssectional survey. Multivariate logistic regressions were employed for data analyses. The Results evidenced that Approximately 9.2% of total participants had suicidal ideation in the past 6 months, and the rate was slightly higher among urban residents and females. A significant dose-response relationship was observed between the number of stressful life events and suicidal ideation. In multivariate regression model, both stressful life events and self-esteem were significantly associated with elevated risk of suicidal ideation among three groups of participants. No moderating effect of selfesteem was observed in the relationship between stressful life events and suicidal ideation. It was concluded that Stressful life events and self-esteem were two significant risk factors for suicidal ideation among Chinese population. Appropriate intervention and education programs that aim at reducing suicide risks need to consider these two important factors. Sterud, Hem, Lau, and Ekeberg (2008) produced the first paper on suicidal ideation and attempts among ambulance personnel. This study aimed to investigate levels of suicidal ideation and suicide attempts among ambulance personnel, and to identify important correlates and the factors to which ambulance personnel attribute their serious suicidal ideation. In conclusion, ambulance personnel reported a moderate level of suicidal ideation and suicide attempts. Although serious suicidal ideation was rarely attributed to working conditions in general, this study suggests that jobrelated factors like emotional exhaustion and bullying may be of importance which greatly lowers the self-esteem. Wagner, Rouleau, and Joiner (2000) conducted this study to determine whether there are changes in the cognitive factors of attributional style, hopelessness, and self-esteem when suicidal ideation fades in psychiatrically hospitalized children and adolescents. The cognitive factors of attributional style, hopelessness, and self-esteem were assessed in subjects aged 717 years (50 with and 50 without suicidal ideation) at admission and discharge from a psychiatric hospital. The results revealed: For subjects with suicidal ideation, attributional style became significantly more positive and hopelessness was decreased from admission to discharge, by which time suicidal ideation had faded. There was no association between self-esteem and suicidal ideation after control for depression. These changes in cognitive factors were not seen in the group without suicidal ideation. There were no significant differences between children and adolescents in the pattern of results. It was concluded that Change in attributional style was shown to be a factor significantly related to the resolution of suicidal ideation in children and adolescents. This cognitive style could be specifically addressed in psychotherapy with depressed children and adolescents as a means of reducing suicidal ideation. These results may have an implication for reducing the length of psychiatric inpatient stays.

Although low self-esteem has been associated with suicidal ideation in adolescents (De Man & Leduc, 1995), after control for depression in our study, there were no significant changes in the level of self-esteem when suicidal ideation was resolved. Since self-esteem is a depressive symptom, this finding is not particularly surprising. This result is consistent with the findings of Marciano and Kazdin (1994), who reported that self-esteem did not discriminate between children with and without suicidal ideation when depression was controlled for. The cognitive model of psychopathology described by Beck (1976) has led to characterization of the negative thinking that typifies depressed individuals (Beck, 1991). A negative cognitive shift occurs in which a person disregards positive information and focuses on negative information. This results in negative beliefs and assumptions. Beck, Steer and Brown (1993) have examined these dysfunctional attitudes and their relationship to suicidal ideation in adult psychiatric outpatients. They found that although dysfunctional attitudes such as a need for approval were related to suicidal ideation, they were not as significantly related as a history of a suicide attempt and the degree of hopelessness about the future. Pinto and Whisman (1996) reported that negative views of oneself and others led to negative affect and suicidal ideation in a sample of psychiatrically hospitalized adolescents. Attitudinize Psychotherapy Technique includes Motivational Interviewing

elaborated by Group Health Centre for Health Promotion (2003) client-centered, directive method for enhancing intrinsic motivation to change by exploring and resolving ambivalence. The Attitudinize therapy can be learned by the person / client. The person then needs to take what has been learned, practice it at home (when they are alone and not feeling self-conscious, for approximately thirty minutes a day), and through means of repetition, and get that new learning down into the brain over and over again. Just like learning at school or an institution. It enables you to begin believing, feeling and acting, differently. This takes persistence, practice, and patience, but when a person sticks with this therapy, and does not give up, noticeable progress begins to occur. Persistency is the next key. These solutions must be practiced every day for three months or longer. It is essential that the brain receive these new, rational, forward moving messages so that attitude can be changed. The neural pathways in the mind "absorb" the attitudinize therapy and it begins to become a part of the person allowing permanent change to occur. After granting the intricacies, the mastery of these concepts is needed for treating the emotional problems successfully. Method Sample of the present study comprised of 106 Male and 46 Female Adult Students of Iqra University, Karachi. It was selected through Random Sampling Technique. Procedure of the study comprises of Two phases. In order to test the hypotheses, the sample comprised of NO THERAPY GROUP; the Fifty-two Male and Twenty-three Female Adult Students on which NO Attitudinize Psychotherapy would be conducted, and for ATTITUDINIZE THERAPY GROUP;

10

Fifty-four Male and Twenty-three Female Adult Students on which Attitudinize Psychotherapy would be conducted. The data was collected from the Adult students between the ages of 1825 belonging to Iqra University, Karachi. In the Initial Phase of BEFORE THERAPY All the Male and Female students were administered; a) Dysfunctional Attitude Scale (Therapy Form) (Modified by Dr. Linah Askari 2003), b) Queendoms SelfEsteem Test (2003) and c) Adult Suicidal Ideation Questionnaire (William & Reynolds, 2005). In the Final Phase of AFTER THERAPY, Attitudinize Therapy was conducted for fourteen weeks (75 minute session, twice a week) on the ATTITUDINIZE THERAPY GROUP only. At the completion of this phase the whole sample was Re-administered All the three Scales, to both the students of NO THERAPY GROUP and the students of ATTITUDINIZE THERAPY GROUP. The purpose was to relate the effectiveness of the Attitudinize Therapy with the Enhancement of Self Esteem and Reduction of Suicidal Ideation within the Adult students. Statistical Analysis of the obtained scores revealed the significance of differences for the Enhancement of Self Esteem through the application of Attitudinize Psychotherapy between the TWO Groups after completion of the Therapy and No Therapy. The Means, Standard Deviations, Pearson correlation coefficients, one sample t-test, One Way ANOVA were computed along with Mean-plots, Mean Graphs, Pie-Charts and Percent Count Graphs for data analysis. Results The data was statistically analyzed among the following groups. BTNODAS Before Therapy, No Therapy Group, Dysfunctional Attitude Scale. BTNOSET Before Therapy, No Therapy Group, Self-Esteem Test. BTNOASI Before Therapy, No Therapy Group, Adult Suicide Ideation Questionnaire. BTATZDAS Before Therapy, Attitudinize Therapy Group, Dysfunctional Attitude Scale. BTATZSET Before Therapy, Attitudinize Therapy Group, Self-Esteem Test. BTATZASI Before Therapy, Attitudinize Therapy Group, Adult Suicide Ideation Questionnaire. ATNODAS After Therapy, No Therapy Group, Dysfunctional Attitude Scale. ATNOSET After Therapy, No Therapy Group, Self-Esteem Test. ATNOASI After Therapy, No Therapy Group, Adult Suicide Ideation Questionnaire. ATATZDAS After Therapy, Attitudinize Therapy Group, Dysfunctional Attitude Scale. ATATZSET After Therapy, Attitudinize Therapy Group, Self-Esteem Test. ATATZASI After Therapy, Attitudinize Therapy Group, Adult Suicide Ideation Questionnaire. The following Hypotheses proved their significance through the statistical analysis, and the summarized results are presented below: 1) There is More Positive Correlation between scores of Dysfunctional Attitudes and Suicidal Ideation, i.e., The Higher the Dysfunctional Attitudes the Higher will be the Suicidal Ideation, and Vice Versa. 2) There is More Negative Correlation between scores of Dysfunctional Attitudes and Self-Esteem, i.e., The Higher the Dysfunctional Attitudes the Lower will be the Self-Esteem, and Vice Versa.

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3)

After the Therapy; the scores of Dysfunctional Attitudes are Lower within the adults of ATTITUDINIZE THERAPY GROUP as compared to the scores of Dysfunctional Attitudes within the adults of NO THERAPY GROUP.

4)

After the Therapy; the scores of Self-Esteem are Higher within the adults of ATTITUDINIZE THERAPY GROUP as compared to the scores of Self-Esteem within the adults of NO THERAPY GROUP.

5)

After the Therapy; the scores of Suicidal Ideation are Lower within the adults of ATTITUDINIZE THERAPY GROUP as compared to the scores of Suicidal Ideation within the adults of NO THERAPY GROUP.

Descriptive Statistics N BTNODAS BTNOSET BTNOASI BTATZDAS BTATZSET BTATZASI Valid N (listwise) 75 75 75 77 77 77 75 Minimum 221.00 36.00 122.00 222.00 37.00 123.00 Maximum 355.00 75.00 169.00 355.00 73.00 170.00 Mean 303.4000 51.7867 149.2533 304.8312 50.5065 150.3506 Std. Deviation 48.0824 11.7947 13.3407 47.6780 11.5001 13.2196

Descriptive Statistics N ATNODAS ATNOSET ATNOASI ATATZDAS ATATZSET ATATZASI Valid N (listwise) 75 75 75 77 77 77 75 Minimum 228.00 35.00 125.00 60.00 110.00 35.00 Maximum 365.00 74.00 176.00 160.00 141.00 80.00 Mean 309.2667 50.3333 153.4133 103.9481 124.1558 60.1558 Std. Deviation 49.9509 11.4104 13.2951 27.0024 7.8925 12.9372

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O ne-Sample Statistics N BTNODAS BTNOSET BTNOASI BTATZDAS BTATZSET BTATZASI ATNODAS ATNOSET ATNOASI ATATZDAS ATATZSET ATATZASI 75 75 75 77 77 77 75 75 75 77 77 77 Mean 303.4000 51.7867 149.2533 304.8312 50.5065 150.3506 309.2667 50.3333 153.4133 103.9481 124.1558 60.1558 Std. Deviation 48.0824 11.7947 13.3407 47.6780 11.5001 13.2196 49.9509 11.4104 13.2951 27.0024 7.8925 12.9372 Std. Error Mean 5.5521 1.3619 1.5405 5.4334 1.3106 1.5065 5.7678 1.3176 1.5352 3.0772 .8994 1.4743

One-Sample Test Test Value = 1 95% Confidence Interval of the Difference Lower Upper 291.3372 313.4628 48.0729 53.5004 145.1839 151.3228 293.0096 314.6528 46.8963 52.1167 146.3502 152.3511 296.7740 319.7593 46.7080 51.9586 149.3544 155.4723 96.8193 109.0768 121.3645 124.9472 56.2195 62.0922

BTNODAS BTNOSET BTNOASI BTATZDAS BTATZSET BTATZASI ATNODAS ATNOSET ATNOASI ATATZDAS ATATZSET ATATZASI

t 54.466 37.290 96.240 55.919 37.775 99.137 53.446 37.443 99.280 33.455 136.926 40.124

df 74 74 74 76 76 76 74 74 74 76 76 76

Sig. (2-tailed) .000 .000 .000 .000 .000 .000 .000 .000 .000 .000 .000 .000

Mean Difference 302.4000 50.7867 148.2533 303.8312 49.5065 149.3506 308.2667 49.3333 152.4133 102.9481 123.1558 59.1558

13

Correlations BTNODAS Pearson Correlation Sig. (2-tailed) N Pearson Correlation Sig. (2-tailed) N Pearson Correlation Sig. (2-tailed) N Pearson Correlation Sig. (2-tailed) N Pearson Correlation Sig. (2-tailed) N Pearson Correlation Sig. (2-tailed) N BTNODAS BTNOSET BTNOASI ATNODAS 1.000 -.901** .912** -.085 . .000 .000 .469 75 75 75 75 -.901** 1.000 -.852** .132 .000 . .000 .259 75 75 75 75 .912** -.852** 1.000 -.120 .000 .000 . .303 75 75 75 75 -.085 .132 -.120 1.000 .469 .259 .303 . 75 75 75 75 -.879** .970** -.811** .079 .000 .000 .000 .500 75 75 75 75 .876** -.831** .965** -.102 .000 .000 .000 .385 75 75 75 75 ATNOSET ATNOASI -.879** .876** .000 .000 75 75 .970** -.831** .000 .000 75 75 -.811** .965** .000 .000 75 75 .079 -.102 .500 .385 75 75 1.000 -.841** . .000 75 75 -.841** 1.000 .000 . 75 75

BTNOSET

BTNOASI

ATNODAS

ATNOSET

ATNOASI

**. Correlation is significant at the 0.01 level (2-tailed).

14

Correlations BTATZDAS Pearson Correlation Sig. (2-tailed) N Pearson Correlation Sig. (2-tailed) N Pearson Correlation Sig. (2-tailed) N Pearson Correlation Sig. (2-tailed) N Pearson Correlation Sig. (2-tailed) N Pearson Correlation Sig. (2-tailed) N BTATZDAS BTATZSET BTATZASI ATATZDAS ATATZSET ATATZASI 1.000 -.909** .912** .030 .242* .183 . .000 .000 .798 .034 .112 77 77 77 77 77 77 -.909** 1.000 -.862** -.030 -.192 -.138 .000 . .000 .795 .094 .231 77 77 77 77 77 77 .912** -.862** 1.000 .074 .296** .205 .000 .000 . .520 .009 .074 77 77 77 77 77 77 .030 -.030 .074 1.000 .335** .515** .798 .795 .520 . .003 .000 77 77 77 77 77 77 .242* -.192 .296** .335** 1.000 .781** .034 .094 .009 .003 . .000 77 77 77 77 77 77 .183 -.138 .205 .515** .781** 1.000 .112 .231 .074 .000 .000 . 77 77 77 77 77 77

BTATZSET

BTATZASI

ATATZDAS

ATATZSET

ATATZASI

**. Correlation is significant at the 0.01 level (2-tailed). *. Correlation is significant at the 0.05 level (2-tailed).

Oneway ANOVA
ANOVA Sum of Squares Between Groups 9983.087 Within Groups 311.500 Total 10294.587 Between Groups 12300.353 Within Groups 869.833 Total 13170.187 df 52 22 74 52 22 74 Mean Square 191.982 14.159 236.545 39.538 F 13.559 Sig. .000

BTNOSET

BTNOASI

5.983

.000

15

Means Plots
180 170
70

80

160
60

150 140

Mean of BTNOSET

50

Mean of BTNOASI

130 120 110 221.00 230.00 243.00 255.00 315.00 328.00 337.00 344.00 340.00 351.00 354.00 226.00 235.00 247.00 305.00 322.00 333.00 348.00

40

30 221.00 230.00 243.00 255.00 315.00 328.00 337.00 344.00 351.00 354.00 226.00 235.00 247.00 305.00 322.00 333.00 340.00 348.00

BTNODAS

BTNODAS

Oneway ANOVA
ANOVA Sum of Squares Between Groups 9876.413 Within Groups 174.833 Total 10051.247 Between Groups 12500.366 Within Groups 781.167 Total 13281.532 df 55 21 76 55 21 76 Mean Square 179.571 8.325 227.279 37.198 F 21.569 Sig. .000

BTATZSET

BTATZASI

6.110

.000

Means Plots
180

80

170
70

160
60

150

Mean of BTATZSET

50

Mean of BTATZASI
354.00

140

40

130

30 222.00 231.00 244.00 254.00 313.00 325.00 334.00 340.00 348.00 227.00 236.00 248.00 303.00 317.00 330.00 337.00 344.00 351.00

120 222.00 231.00 244.00 254.00 313.00 325.00 334.00 340.00 348.00 354.00 227.00 236.00 248.00 303.00 317.00 330.00 337.00 344.00 351.00

BTATZDAS

BTATZDAS

16

Oneway ANOVA
ANOVA Sum of Squares Between Groups 6444.333 Within Groups 3190.333 Total 9634.667 Between Groups 9664.853 Within Groups 3415.333 Total 13080.187 df 49 25 74 49 25 74 Mean Square 131.517 127.613 197.242 136.613 F 1.031 Sig. .481

ATNOSET

ATNOASI

1.444

.161

Means Plots

17

80

70

60

Mean of ATNOSET

50

40

30 228.00 237.00 251.00 265.00 328.00 340.00 348.00 357.00 364.00 233.00 243.00 256.00 315.00 335.00 345.00 353.00 360.00

ATNODAS

180

170

160

150

Mean of ATNOASI

140

130

120 228.00 237.00 251.00 265.00 328.00 340.00 348.00 357.00 364.00 233.00 243.00 256.00 315.00 335.00 345.00 353.00 360.00

ATNODAS

Oneway ANOVA

18

ANOVA Sum of Squares Between Groups 3967.963 Within Groups 766.167 Total 4734.130 Between Groups 10540.463 Within Groups 2179.667 Total 12720.130 df 55 21 76 55 21 76 Mean Square 72.145 36.484 191.645 103.794 F 1.977 Sig. .044

ATATZSET

ATATZASI

1.846

.062

Means Plots
150 90

80 140 70 130 60

Mean of ATATZSET

120

Mean of ATATZASI

50

110

40

100 60.00 71.00 80.00 89.00 97.00 106.00 115.00 128.00 141.00 155.00 66.00 75.00 84.00 93.00 102.00 110.00 120.00 135.00 145.00

30 60.00 71.00 80.00 89.00 97.00 106.00 115.00 128.00 141.00 155.00 66.00 75.00 84.00 93.00 102.00 110.00 120.00 135.00 145.00

ATATZDAS

ATATZDAS

19

Graphs
400

300

200

100

Mean

0
SI ZA AT T AT SE Z AT S AT DA Z AT AT SI A O N T AT SE O N S AT A D O N AT ASI Z AT T BT SE Z AT S A BT ZD AT BT SI A O N BT ET S O N BT AS D O N BT
400 300 200 100

Mean
0 BTNODAS BTNOASI BTATZSET ATNODAS ATNOASI ATATZSET ATATZASI BTNOSET BTATZDAS BTATZASI ATNOSET ATATZDAS

20

ATATZASI ATATZSET ATATZDAS BTNOSET ATNOASI BTNOASI ATNOSET BTNODAS

ATNODAS

BTATZDAS

BTATZASI

BTATZSET

160000 140000 120000 100000 80000 50 60000 40000 20000 23195 22812 22755 0 11506 11265 111949316 7739 0

Percent

100

Count

Discussion The Means, Standard Deviations, correlation coefficients, one sample t-test, and one way ANOVA were computed shown in Tables 1, 2, 3, 4, 5, 6, 7, 8, 9 & 10 and ALL THE GRAPHS, MEAN PLOTS, PERCENT COUNT & PIE-CHART to examine the relationship between application of Attitudinize Psychotherapy and improvement of Personality within the self Esteem, reduction of dysfunctional attitudes and diminishing of suicidal ideation.

T SE NO T AT ZSE AT T BT SE NO I BT AS Z AT S AT DA Z AT T AT ZSE AT I AT AS NO I BT AS Z AT BT ASI O N S AT DA O N S BT DA Z AT S BT DA NO AT

21

Hypothesis 1: There is More Positive Correlation between scores of Dysfunctional Attitudes and Suicidal Ideation, i.e., The Higher the Dysfunctional Attitudes the Higher will be the Suicidal Ideation, and Vice Versa. a) BTNODAS vs. BTNOASI; Mean BTNODAS = 303.40 & Mean BTNOASI = 149.25, r = 0.912 ** b) ATNODAS vs. ATNOASI; Mean ATNODAS = 309.26 & Mean ATNOASI = 153.41, r = - 0.102 c) BTATZDAS vs. BTATZASI; Mean BTATZDAS = 303.40 & Mean BTATZASI = 150.35, r = 0.912 ** d) ATATZDAS vs. ATATZASI; Mean ATATZDAS = 103.94 & Mean ATATZASI = 60.15, r = 0.515 ** e) One way ANOVA Between & Within Groups for BTNODAS vs. BTNOASI; F = 5.983 at 0.000 Sig. f) One way ANOVA Between & Within Groups for ATNODAS vs. ATNOASI; F = 1.444 at 0.161 Sig. Sig. h) One way ANOVA Between & Within Groups for ATATZDAS vs. ATATZASI; F = 1.846 at 0.062 Sig. (For Pearson Correlation Coefficient r, ** means correlation is significant at the 0.01 level 2tailed & * means correlation is significant at the 0.05 level 2-tailed) The person having higher level of dysfunctional attitudes does not seem to analyze the situation out of the box. Continuous hurt to the self-esteem provides destructive thoughts in all the situations being experienced. The solution for such a person seems to take refuge in gaining sympathy from the people around and flight from the situations by thinking of ending up their lives. Smith, Alloy and Abramson (2006), In order to advance the detection and prevention of suicide, focused recent research on predictors of suicidal ideation and behavior such as negative cognitive styles, dysfunctional attitudes, hopelessness, and rumination. In this study the relationships among these risk factors in the context of the Attention Mediated Hopelessness (AMH) theory of depression are examined. One hundred and twenty-seven undergraduates in the Cognitive Vulnerability to Depression (CVD) project were followed for 2.5 years. The CVD project followed initially non-depressed freshmen, at either high or low cognitive risk for depression, in order to predict onsets and recurrences of depressive disorders. The presence and duration of suicidal ideation were predicted prospectively by rumination and hopelessness, and hopelessness partially mediated the relationship between rumination and ideation and fully mediated the association between rumination and duration of suicidality. Further, rumination mediated the relationship between cognitive vulnerability and suicidal ideation. Hypothesis 2: There is More Negative Correlation between scores of Dysfunctional Attitudes and Self-Esteem, i.e., The Higher the Dysfunctional Attitudes the Lower will be the Self-Esteem & Vice Versa. a) BTNODAS vs. BTNOSET; Mean BTNODAS = 303.40 & Mean BTNOSET = 51.78, r = - 0.901 ** b) ATNODAS vs. ATNOSET; Mean ATNODAS = 309.26 & Mean ATNOSET = 50.33, r = 0.079 g) One way ANOVA Between & Within Groups for BTATZDAS vs. BTATZASI; F = 6.110 at 0.000

22

c)

BTATZDAS vs. BTATZSET; Mean BTATZDAS = 304.83 & Mean BTATZSET = 50.50, r = - 0.909 **

d) ATATZDAS vs. ATATZSET; Mean ATATZDAS = 103.94 & Mean ATATZSET = 124.15, r = 0.335 ** e) One way ANOVA Between & Within Groups for BTNODAS vs. BTNOSET; F = 13.559 at 0.000 Sig. f) One way ANOVA Between & Within Groups for ATNODAS vs. ATNOSET; F = 1.031 at 0.481 Sig. g) One way ANOVA Between & Within Grps for BTATZDAS vs. BTATZSET; F = 21.569 at 0.000 Sig. h) One way ANOVA Between & Within Grps for ATATZDAS vs. ATATZSET; F = 1.977 at 0.044 Sig. Ashby and Rice (2002) in their study examined the association between adaptive and maladaptive dimensions of perfectionism and self-esteem. Confirmatory factor analysis and structural equations modeling were used to develop and test a model derived from theoretical links between perfectionism and self-esteem. Path models revealed that adaptive perfectionism was positively associated with self-esteem and maladaptive perfectionism was negatively associated with selfesteem. Implications of discriminating between adaptive and maladaptive perfectionism in counseling research and practice are discussed. Hypothesis 3: After the Therapy; the scores of Dysfunctional Attitudes are Lower within the adults of ATTITUDINIZE THERAPY GROUP as compared to the scores of Dysfunctional Attitudes within the adults of NO THERAPY GROUP. a) ATNODAS vs. ATATZDAS; Mean ATNODAS = 309.26 & Mean ATATZDAS = 103.94 b) ATNODAS vs. ATATZDAS; ATNODAS one sample t = 53.44 & ATATZDAS one sample t = 33.45 at 95% Confidence Interval of the Difference & at Significant level 0.000 (2 tailed). Dr. Hamamci (2006) proposed for Integrating psychodrama and cognitive behavioral therapy to treat moderate depression. The aim of the study is to compare the effects of psychodrama integrated with cognitive behavioral therapy and cognitive behavioral group therapy in the treatment of depression. Thirty-one university students with moderate depression participated in this study. After the participants were randomly assigned to and control groups, group therapies were conducted for 11 sessions over a period lasting nearly 3 months. The control group received no treatment. The Beck Depression Inventory (BDI), the Automatic Thoughts Questionnaire (ATQ) and the Dysfunctional Attitude Scale (DAS) were administered to the participants at three different occasions: pre-treatment, post-treatment, and 6-month follow-up. A 3 3 ANOVA was used to examine the effectiveness of the treatments. The results indicated that both psychodrama integrated with cognitive behavioral therapy, and cognitive behavioral group therapy alone, led to reduction in the level of depression, negative automatic thoughts, and dysfunctional attitudes of participants. However, there were no significant differences between the two treatments in terms of their effectiveness. Hypothesis 4: After the Therapy; the scores of Self-Esteem are Higher within the adults of ATTITUDINIZE THERAPY GROUP as compared to the scores of Self-Esteem within the adults of NO THERAPY GROUP. a) ATNOSET vs. ATATZSET; Mean ATNOSET = 50.33 & Mean ATATZSET = 124.15

23

b) ATNOSET vs. ATATZSET; ATNOSET one sample t = 37.44 & ATATZSET one sample t = 136.92 at 95% Confidence Interval of the Difference & at Significant level 0.000 (2 tailed). Powell, Newgent and Lee (2006) in this study on Group cinema therapy proposed for using metaphor to enhance adolescent self-esteem. It examines the effectiveness of a cinema therapy intervention at enhancing the perceived self-esteem of 16 youth with a serious emotional disturbance. Participants completed the Rosenberg Self-Esteem Scale (RSE) at pre-, post-, and 1-week follow-up within a 6-week coping skills group in which a brief cinema therapy intervention is introduced to a treatment and delayed treatment group. A control group was used, which only received the coping skills training. Results of a split-plot analysis of variance (ANOVA) with one between-groups factor and one repeated-measures factor revealed no significant differences within or between groups, however, meaningful differences between the three groups were found. Implications for counselors and therapists are discussed. Hypothesis 5: After the Therapy; the scores of Suicidal Ideation are Lower within the adults of ATTITUDINIZE THERAPY GROUP as compared to the scores of Suicidal Ideation within the adults of NO THERAPY GROUP. c) ATNOASI vs. ATATZASI; Mean ATNOASI = 153.41 & Mean ATATZASI = 60.15 95% Confidence Interval of the Difference & at Significant level 0.000 (2 tailed). Schwenk (2004) studied upon Reducing Suicidal Ideation in Elders, stating it is Possible, but Expensive. Primary care-based interventions to reduce suicide risk in older patients are appealing but are relatively unstudied. Researchers enrolled 598 elders (age, >60) with depression diagnoses from 20 primary care practices in the U.S. in a 1-year trial of a primary care-based intervention. Practices were randomized to provide usual care or intervention. The intervention consisted of physician education (with algorithmic approaches to depression treatment); trained care managers with mental health expertise who provided treatment recommendations, clinical monitoring, and frequent followup; and financial support for medication (citalopram, supplied by the manufacturer) and psychotherapy. Results reveal, In the intervention group, the prevalence of suicidal ideation dropped from 29% at baseline to 17% at 8 months and to 15% at 12 months. In the usual-care group, the prevalence dropped from 20% at baseline to 19% at 8 months and to 13% at 12 months. Given the higher baseline prevalence in the intervention group, the decline at 8 months was significantly greater in the intervention group than in the usual-care group. Compared with usual care, intervention yielded significantly larger declines in depression severity (measured by questionnaire scores) at 4, 8, and 12 months; number of patients in remission at 8 or 12 months was similar in both groups. Actual suicide attempts were too uncommon to evaluate (one in each group). The statistical significance of the decline in the suicidal ideation rate with intervention derives mostly from an unexplained higher baseline rate in the intervention group than in the usual-care group. Intervention costs were not calculated, but clearly this approach was expensive and probably could not be supported in usual practice. We would have learned more from this study if medication and psychotherapy had been provided at no cost to both groups. d) ATNOASI vs. ATATZASI; ATNOASI one sample t = 99.28 & ATATZASI one sample t = 40.12 at

24

Statistically significant results reveal that Attitudinize Psychotherapy employs a positive, active, educational approach that focuses on how to change the attitudes and on seeking solutions rather than just simply talking about the past or exploring ones feelings and problems. Attitudinize Psychotherapy is typically provided within an emotionally supportive, empathic relationship, giving opportunity to express feelings and receive caring in addition to working directly on positive attitude change in thinking and lifestyle. The treatment is often short term because it is based on a clear attitude conceptualization that guides the treatment process. Attitudinize Psychotherapy emphasizes a collaborative relationship between the therapist and the client wherein they work together to specify goals and to implement the treatment strategies. Each client is assisted in using strategies / techniques that will help in resolving current areas of difficulty as well as learning skills that will be useful in preventing relapse and in dealing with future life challenges. Attitudinize Psychotherapy directly teaches specific ways to examine and correct dysfunctional thinking patterns or beliefs, those that are causing or contributing to problems in ones life within the personality. Behavioral strategies are often used with Attitudinize Psychotherapy to develop skills such as assertiveness or problem solving. Often we need reality experiments to prove to ourselves that what we fear really is not true, or that we could cope with particular circumstances, or that we are capable of changing certain habits, or that we can easily delete our own low self esteem and lack of confidence, by learning and practicing an effective personality improving strategy. The results of this type of therapy may include a sense of freedom from old patterns, greater opportunity to pursue new life opportunities, improve personality to a maximum level, reduce distress, and enhance a greater sense of confidence and self-esteem. Ramakrishna was born with congenital cataract. By the age of 22, he was totally blind. Today he is General Manager with the Industrial Development Bank of India. He credits his mathematical ability and technology as the two most important pillars of his success. We will let his words do the talking and reflect on his journey to success. Ramakrishna (2007) says: I often question myself, did I really succeed? If so what is the success formula? What is that I would like to share with those who want to succeed? Well, I believe success is a journey, not a destination. I invented a secret recipe of success, which unlike the three or so routine courses of meal, has eight courses to taste and dwell on. These are: vIsion, Dream, focUs, dirEction, mind Tuning, Toughness, perseverAnce and sTruggle. Now collect the capitalized letters of these eight steps and reshuffle them to form the mantra of my success ATTITUDE .

Conclusion It is imperative to constantly keep a check on ones attitudes (cognition/thought, feeling and behavior) in all the six dimensions i.e., Physiologically, Psychologically, Terminologically, within Time Management, Neuro-harmonically and Spiritually. Evidence is provided that attitudinize psychotherapy

25

enables the individual for Self-Conditioning constantly for turning all the dysfunctional attitudes into positive/adaptive attitudes. Once the individual is determined to keep one self tuned into the adaptive attitudes most of the time, towards self, environment and the world around them, enhances the self esteem of the individual to a higher level most of the time and the self identity, meaning of life, worth of life remains intact, boosts the ego and keeps the person motivated enthusiastically for life ahead. Cannon (2003) proposes, Hopelessness is a significant predictor of suicidality, but not all depressed patients feel hopeless. If clinicians can predict hopelessness, they may be able to identify those patients at risk of suicide and focus interventions on factors associated with hopelessness. In this study, we examined potential predictors of hopelessness in a sample of depressed outpatients. Methods: In this study, we examined potential demographic, diagnostic, and symptom predictors of hopelessness in a sample of 138 medication-free outpatients (73 women and 65 men) with a primary diagnosis of major depression. The significance of predictors was evaluated in both simple and multiple regression analyses. Results were Consistent with previous studies, we found no significant associations between demographic and diagnostic variables and greater hopelessness. Hopelessness was significantly associated with greater depression severity, poor problem solving abilities as assessed by the Problem Solving Inventory, and each of two measures of dysfunctional cognitions (the Dysfunctional Attitudes Scale and the Cognitions Questionnaire). In a stepwise multiple regression equation, however, only dysfunctional cognitions and poor problem solving offered non-redundant prediction of hopelessness scores, and accounted for 20% of the variance in these scores. These findings, identifying clinical correlates of hopelessness, provide clinicians with potential additional targets for assessment and treatment of suicidal risk. In particular, clinical attention to dysfunctional attitudes and problem solving skills may be important for further reduction of hopelessness and perhaps suicidal risk. The findings are statistically modest and provide an insight to the effectiveness of the Attitudinize Psychotherapy. Friedenberg and Gillis (2006) in an experimental study reveal that a frequent goal in psychotherapy is the modification of low self-esteem. While such modification is accomplished most often in an indirect manner, it is possible to apply attitude change techniques directly to this purpose. In this study, 36 college students who had scored poorly on a standardized measure of self-esteem were exposed to a videotaped counter-attitudinal message under conditions of either high or low credibility; controls did not view the videotape. Results were consistent across several esteem measures and demonstrated significant positive changes in esteem for Ss exposed to the high credibility communication. The possibilities of adapting attitude change techniques to psychotherapy are considered. Eland (2005) conducted research on Self Esteem Improvement, to know What Does It Takes and How Important Is It? The researcher proposes, To be honest, it probably takes less than most people would ever believe. Your desire, commitment and consistency are the most important success factors - and last but not least good tools to accomplish the task of improving your self esteem and confidence. Only one can tell how important it is. Self-esteem is fundamental. It is related to your self

26

worth and how you value yourself. Thus, building self-esteem is basic for your happiness and a good life. Low self-esteem causes mental illness like depression and anxiety. Other people's desires can seem more important than yours. The Inner, nagging voice of disapproval makes you powerless even minor challenges seem impossible to overcome. This is a condition you don't have to stay in a minute longer! Then, how can I get out of it and really develop a high self-esteem, reduce dysfunctional attitudes and diminish suicidal ideation you may ask? The first is to admit and accept your fear stop denying your bad self image - face it and from there start working with yourself. Then, set your goal as precisely as you can. Commit to your goal. Then follow a plan containing a set of selfesteem building activities to reach it; acceptance of dysfunctional attitudes can greatly help to work for diminishing your suicidal ideation. Be nice to yourself. Reward yourself when you have reached a sub-goal or a milestone. Give yourself a teaser from time to time. This is considered a vital part of the knowledge of how to build self-confidence. Just know that your desire and commitment for improving your self-esteem, reducing dysfunctional attitudes and diminishing suicidal ideation are most important. If you really don't want an improvement, no program or self esteem exercise can help you. But can I get help to develop my desire and commitment, you may ask? Yes, you can. This is a major element in every quality program for improving your self-image, reducing dysfunctional attitudes and diminishing suicidal ideation. ACKNOWLEDGMENT Dr. Linah Askari deeply thanks Almighty Allah Pak for the completion of the research. The President - Mr. Shahjehan S. Karim, Executive Director Admissions Ms. Sabina Mohsin, Executive Director Academics Mr. Talib S. Karim, Dean CBM Dr. Javed Akbar Ansari and Administration Personnel of Institute of Business Management, and my family & colleagues for their guidance and Cooperation, in conducting and compiling the research. And the committee of SELF, Fifth Self Biennial International Conference - UAE University for the opportunity granted for paper presentation.

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a

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