37th International Conference on Psychiatry and Psychosomatic Medicine

As we all know that it was scheduled to be held on June 17, 18, 2020 in London, UK as a physical event, but due to this pandemic situation, understanding the security and safety of our participants, we are running this as a webinar. I hope everyone will contribute to make it a successful one.

The urgent necessity to address mental health and to support those people who are most vulnerable and to psychological disorder is what brought all of us together from all across the globe to join in this webinar. I hope our aim to share knowledge and advancement in approaches to improve global mental health will be successful with this meeting.

I think we shall start a program now.

In this meeting today we have two keynotes speaker and one guest speaker and seven plenary talks. I hope everyone will join us soon.

Now I would like to call Dr. Yossihiro Katera from University of Derby to give his keynote talk on Positive Psychology for Mental Health in UK, Social Work Students. You can start doctor.

Okay, thank you. Can you all hear me?

Yes.

Good, very good.

Okay, so I'm going to share my slides to start my presentation.

Okay, all right. Okay, so, let's see, share my slides. I'm going to see my screen. Yes, I can see that. Good, good, good.

Okay, so the title has a slide. Yeah, are you okay? Yeah, it is. Good. Okay, so I'm going to put this on full screen mode.

Okay, good. So, you're from Cameroon? Yes. All right. How's the weather in Cameroon? It's very hot. Yes, it's hot now.

Yeah, and how's COVID-19 going around in Cameroon? We are managing. Very good.

In the UK, we are not. So, okay. So, this presentation is about, based on my studies, exploring mental health of healthcare students.

And after this study, we've developed further of exploring what contributes to or damages mental health of healthcare students.

And then in this presentation, I'm going to talk about what contributes to mental health.

And first, I want to look at those images. And then, you know, for example, if I Google some word, and then I got those pictures, yeah, I want you to make a guess what word I looked up on Google to find these pictures.

What do you think? What word is I put in Google? You can use chat box or you can just speak to microphone, but. I typed in vegetables.

Yeah, I typed in vegetables.

Yeah. How about this one? What did I look up to find those images?

I looked at flowers to find those.

And the last one is most important. This one, what did I type in to find those images on Google?

There is a small child. Yes. It's also a plant. It's a plant.

Yeah. And also people with flowers and leaves.

Yeah.

Very good. Very good.

Yeah. And also people running very kind of strong mana and also this little boy, very cute, looking, you know, tough, strong.

And also there's a ball bouncing.

Yeah.

Yeah. So the word I Googled this time was resilience.

Yeah. Resilience.

Yeah.

Resilience is often used, you know, emotional resilience, you know, ability to bounce back from difficult time.

And then, you know, compared to other two slides, the images of resilience is rather diverse.

You know, some picture is about plants and other pictures about people or other plants about balls bouncing.

This somehow tells us, you know, resilience can be taken in many ways, but overall this kind of ability to bounce back or strength in your cycle.

Yeah. Concept.

So resilience is one of the keywords in my findings.

So resilience is that ability to bounce back from difficulties and ability to practice professionally utilizing the empathy, optimism, stability, honesty, and self-awareness.

And then probably in health field and also educational field, those caring professions, we often hear emotional resilience, you know, importance of resilience.

So in this study, first we thought, let's explore resilience, how that matters to our mental health.

And then this is a mental health state of UK students.

Quota of UK students have a mental health program. So there are about two million students in the UK. So it comes to half million students estimated to have mental health programs. So it's not small, it's big, big ratio.

And then as for social work students, the social work being top 10 popular subjects in the UK about thought, all of them have depressive episodes. So that's a rather high number of mental distress.

And then often social work students are pressured for their practice requirements and also academic requirements. And they feel mental distress. And 40% of social work students have suicidal thoughts in life. This is also a big number, like almost half of them have suicidal thoughts. That's really big.

And that relates to the depressive episodes.

So mental health by itself is not good. But what's bad about poor mental health and negative consequences.

So what for mental health relates to what kind of outcomes?

Yeah, so negative consequences, social work, a high rate of work related stress.

Yeah, a highest rate of work with the stress in the UK.

So among UK professions, social work is not a high, most stressed professions.

And 80% of social workers are emotionally distressed. And majority of social work graduates become social workers.

So yeah, when you register for social work programming programs are in the UK, 90% of them become social workers at the end, but within six months, 70% of them become social workers.

So very high number of students become social workers.

This is interesting. Later on, we talk about different types of mental distress. But this very narrow pathway, yeah, that gives them stress.

If you compare with business students who have more wider career options, they have less degree of stress.

But the business students had higher level of anxiety than social work students. This is very interesting.

The stress, you know, the stressor of mental distress, while anxiety, you don't know what's happening, what's the cause of anxiety. So probably, you know, social work students know their career pathways, but feel pressure of the standard, while business students do not have clear pathway.

Therefore, they feel more of anxiety, unknownness.

And I forgot to mention that those findings in publications, and the most relevant paper about this is in British Journal of Social Work. Yeah, it's a good journal in the social work field.

And moving on to our next one, negative consequences is that so mental health, yeah, poor mental health relates to a lack of reduced creativity or performance or activity and academic engagement. Probably this is not hard for you to understand or feel, you know, when you don't feel good, mentally, your creativity suffers and also engagement suffers. And then this can be detrimental because risk management is the heart of social work. Social workers are related to helping professions, caring professions. So it matters, you know, how they feel during their workplace, during their work is very important for their performance that often relates to, you know, person's health.

So this is very important topic to explore.

So importance of resilience in social work, this has been highlighted more and more recently, resilience is often used in social work field or other healthcare field. Important resilience, core skill for social workers and service users focus on positives, and social workers cope with difficult situations. So by using resilience, you can help your service users or clients feel more positive.

And also for healthcare professionals by themselves using resilience, they can cope with difficult situations.

Resilience is often used in this reframing effects. I just gave a couple of webinars yesterday and last week about self-care and we practiced this reframing and that's very popular among healthcare workers.

And then, yeah, seeing the situation differently or thinking about your qualities differently is often useful.

The exercise I often do with healthcare workers or other workers is that think about, you know, the personal qualities that you don't like much and then reframe that quality.

Yeah, if you can see it from different perspective or if you can put that same content in different contexts, you can feel better about those or understanding of that quality about reframing.

So yeah, reframing, good example, my favorite example of reframing is that very popular song and resolve the red nose reindeer you hear during Christmas time and resolve the red nose reindeer song.

Yeah, that's a very good example of reframing.

So resolve first felt very ashamed, yeah, of having red shiny nose, but Santa Claus reframed it. Because of your shiny nose, I can see things around.

Yeah, I was happy to go around that day. So his state has changed from being ashamed to motivated.

So yeah, as, you know, line manager of results, Santa Claus enhanced results, work productivity or work engagement, you know, drastically. This is called a context reframing.

You think about better context of the same quality. And then, you know, as a manager or as a colleague, you can provide, you know, but your quality is really important. Just the things kind of that that's very that gives very different impression, relationship about your qualities.

Reframing is very important. And importance of resilience in social work is that if your resilience gets higher, your mental health is better, and you feel more confident self efficacy, and compassionate, which is very important in caring profession, and also be mindful, you know, the ability to paying attention to here and now, that's also important.

Often, you know, mental distress comes from thinking about future, or thinking about past.

Interestingly, in Japanese, or in Chinese as well, I think, the mindfulness is written as heart up now, the two parts, the top part is now, bottom part is heart. So bringing your heart now is mindfulness.

And that's very important to have good mental health.

And resilience can be developed and maintained with psychological resources such as motivation, self regression, optimism, and a positive mindset.

So some theories say that resilience is inherent, has inherent parts.

Now it's been discussed whether true or not, but differently, there is an element that can be developed. And that can be developed with psychological resources, motivation, regular self-regulation, optimism, and positive mindset.

So exploring this is useful, that it can be changed, it can be trained.

In this picture, the guy is feeling really shameful, ashamed.

Social work students had high shame and negative attitudes about mental health problems, MHP, mental health problems.

We have published a mental health shame paper about social work students or other populations as well, that this means that they feel ashamed of having mental health problems.

And then a primary reason for social work students feeling the same about mental health is that we also looked at looked into this. It's called caregiver identity.

They have a strong identity as a caregiver. So, you know, they believe they must be the one to give care because I want to be a social worker or I am a social worker. Because of this identity, they feel more ashamed when they actually have mental health distress. I mean, they want to give care, receive care, that kind of thoughts going on.

So shame is very important aspect to explore.

Positive psychological approach.

So earlier studies, we found that mental health shame is high among this population, not only them, but also, you know, social work students, one of them.

And, you know, if you feel shameful about mental health, approaching them with mental health training, mental health seminars is not really effective because they feel ashamed about mental health. So they wouldn't come to training or even if they are in the mental health training, they wouldn't be engaged or they wouldn't disclose because they feel shameful about mental health.

So it's not a really effective approach.

Think about something that you feel ashamed about. And then someone comes to you, you know, saying, you know, do you want to, you know, come to shameful training? Of course, you wouldn't.

Yeah. Or you would go, but you feel still not completely open, completely engaging with training.

So and also, it's hard to, you know, think about something that to be removed, to be reduced.

Yeah. If I tell you, you know, do not think about do not think about pink elephant. Of course, you think about pink elephant.

Yeah.

So if you approach with, you know, depression, you know, depression training, of course, you know, first thing you think about is depression.

So instead of leading to that way, probably it's better to clarify what needs to be strengthened in those training. That's why we export a psychological aspect, a positive psychological. And the positive human functioning. So positive psychology is relatively new concepts, but becoming very popular now that positive function, positive human function.

So studying happiness, well-being, positivity, and the one benefit of this study is that you can focus on what to be enhanced.

Yeah. So this is probably, you know, easy to our brain that, you know, like I'm identifying what to be strengthened, what to be expanded.

Yeah. So if I say, you know, resilience, okay, let's learn resilience. And there's not much, not much shame about, you know, running resilience.

And so specifically, we are looking into, we looked into self compassion, kindness to the self during difficult times and intrinsic motivation. You do it because it is inherently interesting and satisfying. And this is motivation theory that self-determination theory categorizes motivation into largely two, but largely two intrinsic motivation is that you are inherently interested, curious, while extrinsic motivation is that you do it because you want to get something else external.

So, you know, often people are motivated to some people, some people are motivated to get a money fame status. That's the extrinsic motivators.

And the motivation study says that extrinsic motivation is related to poor mental health. It's not hard to imagine, right? And intrinsic motivation is related to better mental health.

And my study reported that we found that even ethical judgment, you know, make right, you know, ethical judgment suffers if you are extrinsically motivated.

Yeah. So yeah, this is very interesting, like intrinsic, you know, intrinsic motivated people make fair ethical judgment while extrinsically motivated people have more, a little bit less ethical judgment, because they are so obsessed with this external incentives.

And then what else is interesting is that hopefully today's participants are all in caring profession.

Boa, are you in health field?

Yes. Yes. I'm a clinical psychologist.

Great. Great. Okay, good.

And Sam, are you also in health field?

I'm a professor of psychology in several universities.

Great. Great. Okay, great.

Yeah. So, okay. What I'm going to say is not going to offend anybody.

Great. Yeah, we also compared, you know, motivation between healthcare students and business students. And healthcare students had higher intrinsic motivation, while business students had higher extrinsic motivation.

So yeah, you know, we know which group will make ethical judgment.

Anyway, yeah. Also, also locus of control is different.

Yeah, true. True.

Yeah, yeah. Great. Thank you.

YeahThank you. Yeah.

And okay. And the last part is that engagement.

Yeah, this is very popular topic in like, you know, for example, organizational psychology, and also educational psychology, engagement, how much you are engaged, and probably, you know, in your organization, you have to report your staff engagement.

By the way, I put those pictures. One of those boys is my son. Now, this is back then to three years old, but now he's five years old. And last year, we got triplets, three babies at the same time. Yeah, and they're turning one year old in three days.

This has been extremely challenging, but we are still living, we are still alive.

So I think it's an achievement.

But yeah, I think I needed lots of resilience and self compassion and then yeah, those kind of things.

Yeah.

Okay. Good. So, so what does this study aim to find out is that the mental health symptoms will be related to resilience and these are our hypothesis, self compassion, motivational engagement.

So we explore relationship and also predictors of mental health symptoms. So we yeah, analyzed whether resilience, self compassion, motivational engagement will predict a large degree of mental health symptoms.

And then methods is that this amount of students and then those four students withdrew or didn't complete responses, but we didn't ask for reasons, for ethical reasons, ethical grounds, and they didn't report any complaint or anything. So I think that they could finish it in time or they have to do something else.

And then mostly female students, this matches with the general preparation of the social workers and majority undergrad students and age range varies.

But this, you know, Ali Thattis is also a typical social work students demographic and mostly from UK. It's also, yeah, as much as with a typical UK social work program.

And we explore those five constructs using those five scales. We try to choose short scales to reduce their workload. And yeah, these are used. And we analyze for hypothesis one, H1 is correlation study, and then H2 is regression study.

And then what do you find?

This is descriptive study, which doesn't so doesn't say much about only as only this, but correlation study, correlation analysis that we found that, as you can see, that mental health symptoms negatively related to resilience and self compassion and engagement, yeah, very strongly.

So this means that, you know, higher resilience means lower mental health symptoms, mental health problems.

Yeah, so they are at this point in line with literature saying, you know, resilience is very important, you know, for your mental health, and also self compassion is very important.

Also engagement is very important. So mental health symptoms were negatively associated with resilience, self compassion, engagement, and resilience was positively associated with constructs.

And the last part, yeah, negatively associated with a motivation. A motivation means that you have no motivation to study or do anything.

And this is regression results, the only key point. And this was very interesting, because that self compassion negatively predicted mental health symptoms, this is the same as similar to correlation analysis.

But intrinsic motivation positively predicted mental health symptoms, meaning that if you see a student who are in social care students in the UK, who are intrinsically motivated, you can predict that students also have poor mental health, you know, more mental health problems.

So this was, yes, rather original or unexpected findings from our research, and also resilience didn't predict mental health symptoms.

Okay, so mental health symptoms are related to those other four variables partially supported.

And then second hypothesis about resilience, for example, you know, predicting mental health was not supported. So hypothesis two was not supported.

So what can you say about those findings?

Is that the correlation, if you look at coefficients that self- compassion and mental health problems had higher coefficients than resilience.

So that means, you know, self- compassion is more strongly related to mental health symptoms.

And this is important because most of social work students will become social workers and compare themselves against social work standards.

Yeah, this is a Yeah, so yeah, this is another part and it may explain the high self criticism and negative mental health attitude.

Yes. This population in our another study, we found that they are very self critical. And partly because they consistently have to compare themselves against social work framework social work standard.

So where they pay attention to is that what they lack compared to those standards. Therefore, they may become more self critical.

And then this relates to another part, another surprising finding of our results that intrinsic motivation as positive predictor of mental health symptoms, it may be that passion is backfiring to their mental health. And this may be because they are high self criticism.

There's a concept called obsessive passion, instead of harmonious passion, that they are passionate indeed, they are passionate about helping others. But because they are at the same time, very self critical.

Yeah, passion may backfire to their mental health. Yeah.

And in compassion studies, there's a concept called submissive compassion. Submissive compassion means that you are compassionate to others, because you don't feel good about yourself.

So by becoming nice to others, you can feel good about yourself kind of motivation, yet that kind of motivation to be nice to compassionate to others is often linked to for mental health.

So if you know, social work students may be feeling that way to be compassionate, that can also be related to this dynamics of intrinsic motivation that has been, you know, always previously always reported as good for mental health, linked to for mental health.

And importance of self compassion for mental health of social work students.

One resilience was featured in the practice framework. Self- compassion was more strongly related.

So yeah, this may be that now the word resilience is used almost like buzzword. Anywhere you go in education or, you know, health settings, they talk about resilience. And literature reports that resilience sometimes is misused as that inherent or, you know, black and white quality, whether you have it or not. And if you don't have it, you feel shameful kind of thing, while resilience can be nurtured, can be developed. So maybe overused.

And also, also ecological concept of resilience is also important that resilience, the word was made by studying children who grew up in difficult, difficult environment in Hawaii in 1958, or something like 1960, that kind of time.

And then they found that, you know, those who grew up in difficult situations had very, you know, fulfilling very well, well being life after that, then, you know, a psychologist or scientist developed this concept of resilience.

But originally resilience studies looked at whole environment of that individual, rather one specific category. But now because of our residents being so popular, I used so many different contexts, people may not see holistic view of resilience and only see partially, then that may be also contributing to this misunderstanding or overuse of resilience.

So conclusion is that the resilience as focused in social work, but self-compassion was more strongly associated with mental health symptoms.

Self-compassion predicted mental health symptoms, while resilience did not.

And self-compassion as key factor influence in mental health insights for, yeah, this is probably useful for social work curriculum, and self-compassion, self-care needs to be more emphasized.

We did additional analysis that it's a path analysis, whether, yeah, whether self-compassion will mediate relationship between resilience and mental health. And as expected, self-compassion completely mediated this dynamics, meaning that people say resilience is good for mental health.

But who is doing the job is actually self-compassion is affecting mental health. So, yeah, this means that, you know, probably the current curriculum of social work should also focus on self-compassion.

Yeah.

And then at my university, we are teaching social work students self-compassion. And then it's been very popular. So I think there's a need for more wider implementation.

Okay. Okay. That's all for my presentation. Yeah. Thank you for listening.

And then questions, we have a bit of time.

Questions, comments or research point. This was a very good presentation. Maybe if you could provide us the link for the study. Of course. Yeah. Of course. Yeah. It's all in my research guides page and also a specific one I can give you. Okay. Thank you. Of course. Yeah. For sharing your research.

Or is there time? Of course.

You can ask, right?

Did you ever, did you ever come across any studies or in your work regarding correlation between narcissism and resilience?

Interesting. We haven't specifically looked into those two, but what we have explored is that we explored sex addicts.

And this, we invited for keynote speak February and that was very interesting. But yeah. So for sex addiction narcissism and also a very important also, sorry, you were sorry.

Yeah.

Also attachment.

Yeah. I can, maybe I can quickly review that study.

Yeah. It was, yeah. Okay. Okay. Good. Yeah.

So yeah, narcissism is, is often linked to fragility and vulnerability. Actually it's a fragile, it's a rigid, rigid structure, but very brittle.

Okay.

Okay. And so theoretically it should be negatively correlated with resilience.

Yeah.

Yeah. That's differently. Very interesting.

Because you mentioned self-compassion and it's a thin line.

Yes.

Yeah. That's very good point.

Most current study found that, you know, resilience and self-compassion very closely linked. It's almost like, you know, coefficient of 70.7.

Yeah. So as you said, yeah, yeah, yeah. Are you expert in narcissism?

My work is mainly narcissism.

Yes.

I have seen you somewhere on media.

I have a very popular YouTube channel and I gave lots of interviews, documentaries and so on. So I talk a lot about narcissism.

Yeah.

I think, I think I saw you at the, and I found that very interesting.

Thank you.

Okay.

Good, good to see you here.

Yes. Thank you. Thank you for your presentation. Interesting.

Thank you.

Thank you. I have a great presentation. Thank you.

Hi. Hello. Hi. I'm from India. Yeah.

It is a great presentation. I just have a question that is, do you think self-compassion is also related to the experiences of the person in their childhood and in a different phase?

Yes. Differently, differently.

Yeah.

Self-compassion matters to their life experience. And yeah.

Yeah, yeah.

And then this, yeah, just that the self-sex study that I was talking about with Sam earlier, we also explore self-compassion and also trauma, childhood trauma.

Yeah.

And the relationship.

Yeah. So that could also lead to better resilience and we're talking about in their mental, well-being experiences could be connected to their mental well-being too.

Yeah.

Yeah.

Differently.

Some people feel more, you know, resilient.

Oh, yeah. And then also, resistance studies often find that correlation with age, interestingly.

Yeah.

Yeah.

Yeah. So, yeah. We saw in this sample of students that olderstudents, mature students had high resilience.

Yeah. Yeah. Yeah.

Yeah. Yeah. It doesn't mean, you know, young people don't have any dance, but, you know, just just a trend.

Yeah. Yeah. So, yeah. But thank you. That's it.

Yeah, go ahead. It was so nice to hear you. Thank you very much.

Thank you. Thank you. I have a question.

The difference between resilience and coping.

Sorry? You didn't talk about resilience in your presentation.

Yes. Can you give me the difference between resilience and coping? Coping. Coping. Coping.

Yeah. You didn't talk about coping.

Yeah.

Yeah. Coping.

Yes. Yes. Yeah. Coping. Yeah. It's, yeah. It relates to coping, definitely.

Yeah.

Yes. Yeah. Yeah. It's an important concept.

And then for people who are more resilient, are able to better cope with daily stress.

Okay.

Yeah. Coping is important. Yeah. Thank you.

Okay.

So, I think, yeah. If you interested, all of you, please get in touch with me. And I'm happy to stay connected. And if we can explore after the other in the future, that would be great.

I think I put my information here. My Twitter is this. And, yeah, maybe I can put my email address as well.

Yeah. It's okay to put in chat box that so that we can contact each other.

Is that okay?

Okay.

Yeah. I think probably we'll have some rest of something later then we can, yeah.

Okay. Okay. That's all for my presentation. Thank you for listening. Thank you.

Thank you.

Thank you.

Thank you. Thank you, Doctor, for sharing your research. Thank you. Thank you. Okay. Now, I would like to call our second keynote speaker, Dr. Sam Wacken from Southern Federal University to give his valuable speech on habit forming in the time of pandemic.

How valuable remains to be seen, but I will do my best.

It's my first time with WebEx. Am I on the screen? Do you all see me? Because I'm looking at the document and I don't know. I'm not sure if I'm on the screen.

I see you. I've seen you. Yes.

My face is on the screen.

Yeah. Yeah. Because I'm reading from a document. I'm not seeing you. I'm seeing the document.

Okay.

So my first time with WebEx, usually I use Zoom.

Okay. There's always a first time, you know, I'm developing resilience.

Okay. Briefly, my name is Sam Bakhny. I'm visiting professor of psychology. Actually, now professor of psychology in Southern Federal University. It's one of the five federal universities of Russia. And I'm also a professor of finance and a professor of psychology in the outreach program of CS, the consortium of universities, Center for International Advance and Professional Studies. Today, so this self-promotion is finished and how we get to business. Today, I would like to discuss habit forming and habituation during the pandemic. And my presentation would be much less rigorous than.

Sorry.

I can't hear you, sir.

You can't hear me.

Why is that? It's strange.

I can't hear you. You can hear me.

Yes.

Is there anyone else who cannot hear me? Can you hear me? I can't hear you very well.

Can you hear me well?

I can hear you. I'm also seeing you. You can hear me and see me.

Can everyone hear me and see me? Yes. Yes. Yes. Yes. Is there anyone who? Sorry. Anyone with a problem or can we proceed? Yeah. We can proceed. So today I would like to discuss habituation and habit forming during the pandemic. And my presentation would be much less rigorous than the previous keynote speaker. I would like to focus a bit on theory rather than experimentation and so on and so forth. Not that I'm underestimating experiments, of course. All our theories are based on experiments. But these are general observations also from practice because I'm a practicing counselor. So I've access to clients and patients and so on and so forth.

So a few rudimentary observations, not rigorous, not peer reviewed, not tested, not anything. So in many ways, not science and very anecdotal.

But you know, when psychoanalysis started, it was 100% anecdotal. So anecdotes have their value, as we all know.

So I would like to start with the concept of comfort objects or transitional objects. It was a very famous experiment. I can send you later the order. It's in my videography in the abstract that I submitted.

But anyhow, there was a famous experiment where students were asked to take a lemon, lemon, you know, this more round thing, yellow. So they were asked to take a lemon home and to talk to it and to get used to it.

And three days later, the lemons were all mixed in a pile. But the students were able to identify to single out their lemon from a pile of identical lemons. In other words, the students seem to have developed basic attachments, a kind of bonding in a form of relationship with the lemon that resembles very much the kind of relationship we have with a comfort object as children, a transitional object, for example, a teddy bear.

And so this raises very fundamental and deep questions regarding what is love? What is bonding? What is coupling? What is the role of social interactions? Do we simply get used to other human beings, to pets, to objects?

Now, why is this important?

It is important because the first thing this pandemic has done, it had constricted the world, it had narrowed, it had limited our lives, our ability to interact socially, our ability to go out and observe familiar objects, like streets and buildings, and landmarks, and our corner pub or corner restaurant. We couldn't meet friends and so on so forth.

And what I'm proposing is that we begin to reconceive of these things as comfort objects, the equivalent of a teddy bear when you are two years old. Your friends, the neighborhood corner pub, the restaurant across the street, your favorite library, if anyone still frequents libraries.

All these things are comforting. They provide a sense of safety and a sense of comfort.

And if we borrow a term from attachment theory, they provide safe bases. They're like a safe base.

And so the first casualty of the pandemic I propose is that we had lost the vast majority of our comfort objects. And therefore, we don't feel safe. We don't feel that we have a base, so we feel unmoored. We feel detached. We feel floating in space. And we don't feel safe. We have lost our sense of safety.

Now, if you put the two together, they are the basic, the most fundamental elements of a dissociative process.

We have three types of dissociative processes.

We have derealization. We have depersonalization. And we have dissociative amnesia.

Now, in derealization and depersonalization, people who have described these experiences to us, the only way we could learn, yes, is what's missing is a sense of familiarity, a sense of base, something that holds you aground, that holds you more like an anchor for a ship, you know? So a sense of base, a sense of safety, which is the derivative of the sense of familiarity.

People describe, in the case of derealization, a feeling that they have entered an alternative or virtual reality. And in the case of depersonalization, people describe themselves as having exited their bodies, observing themselves from outside and on a kind of autopilot.

Now, when we lose comfort objects, we have exactly the same reactions.

And what I'm proposing is that the pandemic made us lose, forced us to lose the vast majority of our comfort objects, human and inanimate objects in the real sense, and consequently has engendered and generated mass dissociation, collective dissociation, or at the very least, collective dissociative processes.

And if you talk to people, many of them describe numerous occasions and numerous incidents of forgetfulness and so on and so forth. And of course, Sigmund Freud was the first to describe in the psychopathology of daily life, the first to describe the linkage between dissociative processes or dissociation and forgetfulness, procrastination, paralysis, action paralysis, and so on and so forth. He described all this, you know, the famous example, you lose your ease and all this.

So the pandemic forced us to dissociate, first of all, because it's horrible. It's a nightmare. And we need to dissociate as a defensive post-traumatic reaction.

But we are also dissociating, because we don't have anchors, we are suddenly floating in space, all our comfort objects have disappeared. Habit forming in humans seems to be reflexive, seems to be a reflex. We change ourselves, and we change our environment in order to attain maximum comfort and well-being. It is the effort that goes into these adaptive processes that forms a habit. It's like the famous sunk cost fallacy. The more we invest, or to borrow a term from psychoanalysis, the more we affect, the more we have a process of cathexis, the more we invest emotionally in a way of doing things, in a specific object, in a specific location, in a specific person, the more we form a habit. So the habit is intended to prevent us from, it's an economizing measure. It's intended to prevent us from constantly experimenting, constantly risk-taking, and constantly relearning. It's the path of least resistances. It's an economic measure.

But of course, the main thing, the main mechanism employed in habit forming is dissociation. When you drive a car, you dissociate. You don't think about your driving. You don't think, oh, now I'm going to turn the wheel, now I'm going to look at the mirror. You don't do this. You do it automatically.

And this word automatically is colloquial speech. What you are doing clinically, you are dissociating. Habits are ingrained, ossified, fossilized, rigid dissociations.

The greater our well-being, the better we function, the longer we survive, the higher our resilience, presumably, and they all depend critically on habits, which are in effect forms of functional dissociation.

So habits can be thought of as obsessive compulsive rituals intended to reduce and to fend off anxiety in unfamiliar settings and to provide cognitive closure. They also have a pronounced social function, and they foster, as I said before, bonding, attachment, group interdependence.

Now, what the pandemic has done, it had removed our ability to exercise habits and left us only with a dissociative background. It had removed the objects of the habits because habit is directional when we implement the habit and when we act habitually, we act habitually on something, on someone, in somewhere. There's no habit in the air. Habit is critically dependent on context.

Take away the context, and what you're left of, what you're left with, I'm sorry, is merely dissociation without the complementary way of coping with dissociation, which is habit.

Actually, when we get used to something or to someone, we are getting used to ourselves. In the object of the habit, we see a part of our history all the time, all the effort that we have put into forming the habit and into the object of the habit.

It is an encapsulated version of our acts, our intentions, our emotions, our reactions while forming the habit. It is a mirror reflecting that part of us which formed the habit in the first place.

So, to cut a very long story short, habits are critical determinants, critical determinants of our identity, and it is virtually impossible to form certain types of memory without habits.

That's why when we force people to change their habits abruptly, they develop memory disturbances.

So, all this creates a feeling of comfort. Comfort, we really feel comfortable with our own selves through the agency of our habits and our habitual objects.

And because of this, we tend to confuse habits with identity.

Very often when you ask someone, who are you? You ask someone, who are you?

So, the first thing they will say, they will communicate their habits. They will describe their work. They will describe their loved ones. They will describe their pets, their affiliations, their friendships, their hobbies, the place of residence, biography, accomplishments, material positions.

So, all these are habitual.

When you say, when you ask someone, who are you? What they do actually, in most cases, they provide you with an inventory list of everything in their lives, which is repeated, routine, habitual, in the good sense of the word.

Sartre, the existentialist philosopher, he called this propensity bad faith. He thought it's a bad thing. He thought that when people asked, who are you? They should talk about their essence, their quiddity.

But the fact is, the reality is that it's very difficult to divorce our identity, our essence, and our quiddity from what we do habitually.

Take away all our habits, and you take away who we are.

And this is the greatest, greatest, possibly irreversible damage of this pandemic.

It has damaged severely, shattered in many cases, our identity.

There's been a study published a few days ago, if I remember correctly, by the National Institutes of Mental Health in the United States, but I apologize if I get it wrong, but there was a study that right now, 34%, that's three, four, 34% of the population of the United States, the adult population of the United States, have developed clinical depression, what major depressive episode, clinical depression, coupled with anxiety disorders. 20% of them have comorbidity, or dual diagnosis, comorbidity in this case, anxiety and depression. Many of them have dual diagnosis, coupled with substance abuse.

So there is a tsunami, there is a real pandemic coming, a tsunami of mental health disorders.

And we need to ask ourselves, why? What has happened?

We just ask people to stay at home for two months, you know, they weren't confined, they weren't incarcerated, they weren't threatened, you know, in any meaningful way, if they stayed at home, they couldn't consume Netflix, it's as good as anything.

Why? Why did they disintegrate, decompensate, and in many cases acted out? What led to all this?

And I propose that what led to all this is that the pandemic abruptly shattered the integrative process of our identity, which crucially relies and depends on daily habits, the familiar, the predictable, the safe.

It took away our safety, and it took away our behavioral patterns, and it took away the complexities, the emotional investment in these behavioral patterns, and it left us bereft, floating, dissociative, derealized, and personalized.

In other words, people prefer to describe or to identify themselves with a derivative or secondary identity, rather than a primary or autonomous identity.

Most people, if you talk to them, they will make themselves somehow to something. If you isolate a student, some students are human beings, so if you isolate a student in a laboratory, and you ask them to describe this, their self, to talk about their selves in almost, I would say, the Jungian sense, the constellated self, could not, very few would talk about internal processes, internal landscape, psychodynamics, very few, if any. Most of them will immediately start to talk about their environment, human environment, non-human environment, social environment, including aspirations and inspirations.

So in other words, most of them will give you a contextual answer, a derivative secondary identity, an identity that is derived from whatever, from materialistic goods, from social roles, for example, anti-racism, from whatever, but always derivative.

Extremely few of them will talk about primary or autonomous identity, the stable sense of one's kernel of self and one's self-worth, very few.

And surely all these extenalia and paraphernalia, they do not constitute identity, but they are like boundaries. They're the equivalent of boundaries. They demarcate identity. They delineate identity. They tell us where we stop and the world starts.

And indeed, we begin to develop habits, even when we are a few months old, ask any breastfeeding mother. Habit is the first thing to develop long before cognition. Long before emotions, long, long, long before empathy. And you know what? Long before we have a brain, we have like half a brain, one third of a brain, 10% of a brain when we are born.

And yet the first thing we do is develop a habit. And removing these habits has catastrophic effect on people.

These people feel comfortable and relaxed, and they feel comfortable and relaxed. These people feel comfortable and relaxed with habits. They feel they have an identity with habits in the truest and deepest sense.

And taking away the habits is not just a minor issue of adjustment. It's a challenge, challenge to mental health. It's a single mechanism of deception that binds people together.

Deception, I'm using this word, judicious. A mother feels that her offspring are part of her identity. Why? Because she's used to them. Her well-being depends on their existence and availability. Any threat to her children is perceived by a mother as a threat to her own self.

A reaction, therefore, is strong and enduring and can be recurrently elicited by threatening the children.

And why is that?

Because we all create narcissistic spheres, narcissistic in the good sense.

Now, narcissistic spheres, where we appropriate, where we kind of merge with, fuse with everyone and everything around us, we get emotionally bonded to objects, inanimate objects.

Ask anyone with a car. You know, people get attached to cars. They get attached to the smartphones. They get attached to the wives, hopefully. Smartphones.

Smartphones, I'm sure.

But why is that? So they get attached to the inanimate and to the animate because we tend to have a sphere. We don't have a pinpointed identity. That's an idealization that we are using in psychology. Exactly like in physics or mathematics, in mathematics, we use a point. Point doesn't exist in physics. And a point doesn't exist in psychology, but we come to physics and mathematics without it.

Similarly, we assume a point identity. But of course it doesn't exist. We are all spheres of influence. We all radiate a giant wave which takes into our identity everyone and everything around us.

Take everyone and everything around us away. And we have no identity left.

And why do we call such a condition? Why do we call a condition where identity is challenged?

Hyper reflection is psychosis. Psychotic condition.

Psychosis doesn't have to be a raving maniac like in the movie Joker. Psychosis is a pernicious state of mind. It can be very slow. It can be even in non-detectable.

As early as 1942, Harvey Cletley wrote the book The Mask of Sanity, where he compared psychopaths to psychotics. And he says very clearly in the book, and he's right. He dealt with psychotics for decades.

He says very clearly in the book, you know, psychosis is a process and very, very often non-detectable process, underground process, pernicious process by osmosis.

And the pandemic provoked, I venture to say, psychotic processes in all of us, even if we think that we had been spared because we are in a webinar, we have not been spared. All of us are reacting extremely badly.

And the character and nature of some of our reactions would easily qualify as psychotic.

The truth in the case, in the example of the mother is, of course, that her children are part of her identity, even if it is only in a superficial manner. You remove the children, you make this mother a different person. It's true, you make her a different person in the phenomenological sense.

So some may argue that it's a shallow sense. Most mothers would disagree.

The deep-set true identity of a mother does change if you remove her children.

Children are taken away. Children die at times. The mothers go on living, but they are changed.

So other people are critical to us.

What is this kernel of identity that I'm referring to?

This immutable entity, which is who we are and what we are, and which ostensibly is not influenced by other people. Is there such a thing? Can we resist the breakdown of habits, the removal of habits, the removal of everything that's familiar? Our isolation? Can we survive all this?

I propose the question about copy.

Well, I don't think so, honestly. Anyone who had conducted studies on prisoners in isolation, you know, there have been studies on prisoners in isolation, including by the famous Robert Hare and others. He collected himself, conducted studies on prisoners, Cartman, others. So the prisoners react very, very fast. It takes weeks for the prisoner to totally, these are tough cookies. They're not, you know, these are tough people. And they disintegrate completely.

So this elusive, loosely interconnected, interacting pattern of reactions to our changing environment, this thing that we call personality, like the brain itself, it's difficult to define or capture or like the soul if you are religiously or spiritually inclined. So you could even argue that it doesn't exist, that it's a fictitious idealized convention.

But I don't think so.

Now, everyone, we know that we have a personality, we feel it, we experience it. That's enough.

We don't need to measure it. We don't need to capture it in a lab.

If it has an effect on us, even if it is a mere construct, like the ego, it's a construct.

But it's a meaningful construct. It is an organizing principle. It is an hermeneutic principle, provides us with explanation, imbues our lives with meaning, the concept of personality, encourages us, encourages us to do things, self compassion.

What is self compassion without a self?

You need a self to have self compassion.

So sometimes it encourages us to do things, sometimes it prevents us from doing things.

It can be supple, it can be rigid, it can be benign, malignant, open, close, I agree. It's very variable. It's power. The power of this construct is exactly because it's loose. It's open ended, it's able to combine, recombine, permute in hundreds of unforeseeable ways, because there are hundreds or thousands of millions of personalities, metamorphosis.

And the consistency of these changes, it is exactly what gives us a sense of identity.

And I'm coming back now to the pandemic.

The pandemic constricted a world created artificial constriction. Because it created artificial constriction. It rigidified our personalities.

Why?

Because change is prohibited. Change is prevented. We can't change. We need to change all the time.

Personality is a dynamic construct.

Take away the dynamics, you don't have psychodynamics.

So the pandemic, I would say, reduced the velocity, you know, in economics, in my other head, I'm economic advisor to governance.

So in economics, we have a concept called the velocity of money. It's how many times money changes hands. The bigger the velocity of money, the more it changes hands, the more healthy the economy.

It's the same with a soul, with a personality, whatever you want to call it. The more it changes, the more it is exposed to the environment, the more it is reactive, the more it is dynamic, the healthier it is.

Personal growth is fostered and engendered by challenges, by changes, by mutating environments. That's how we thrive.

And the pandemic took away all this.

And actually, when the personality is rigid to the point of being unable to change in reaction to shifting circumstances, how do we call this? We call this personality disorder.

One has a personality disorder. When one's habits substitute for one's identity, when there's no growth or change, such a person identifies himself with his environment, taking behavioral, emotional, cognitive cues exclusively from the environment.

And his inner world is vacated. His true self is kind of an apparition, or a shadow, or to use Jung's expression.

And so such a person is incapable of loving, incapable of living. And he's capable of loving because to love another person, he must first love himself, and there's no self.

And in the absence of a self, everything is possible. In the long term, such a person is incapable of living. His life is a struggle toward multiple goals in a changing environment. It's a striving, it's a drive at something. Life is change.

He who cannot change, cannot live.

And this is what the pandemic took from us. The ability to change, the exposure to a mutating ever transformative protean environment, the objects with which we interact as a safe base, emerging from safety to change, and the familiarity of it all.

And so we ended up living in the equivalent of a nightmare from which we cannot wake up.

And this is as good a description of psychosis or psychotic disorder as I've ever had.

Thank you for suffering me.

Thank you, Dr. Sam, for sharing your views. Any question, guys?

We talked about the habit and identity.

Yes, I'm with you. I just can't see anyone. It's strange.

Can you see me? Because I can't see anyone.

I'm seeing you. I'm seeing you.

Okay, my condolences.

Okay. You talked about habit and identity. I didn't notice. I beg your pardon. I want to say that I'm a free speaker so that I just manage with English. So just try to support me. I want to know the real difference.

Thank you.

I wanted to know the real difference.

Because when you give a definition of identity, it seems that it's the same thing. It's habit and identity. So I want to know if it's a real difference between two concepts.

Let's start with the basics. There's no identity without memory. If I take away your memory, for example, in Alzheimer's disease, there's no identity.

Identity disappears. And there's no memory without habits. If you take someone, take someone, there have been such experiments. And you put them in a totally unfamiliar environment, totally. In some theme parks, you have these rooms. And the rooms are diagonal.

So when you enter the room, everything looks very strange. Some people look shorter than you. Some people look taller than you. So it's unfamiliar.

And the feeling of disorientation is so extreme in such rooms that actually it's very difficult to form a memory.

So what happens is memories crucially rely on some coefficient, some component of familiarity. You can have like 10% new, 10% change, 10% unfamiliar. And you assimilate it, you absorb it, and you modify your memory.

But if 100% is not familiar, you will be so disoriented, you will not be able to form a coherent memory because you cannot link this memory to previous memories. You need a chain of memory for identity.

This is where habits are very crucial. These habits they introduce familiarity.

Because habits make the world familiar and safe, you can experience some new things and connect them to other previous experiences and create a chain of memories which all have a common denominator.

What is this common denominator? You. You are the common denominator.

And it is through this constant linking of the chain with a common denominator that is you, that you emerge, yourself emerges from this.

That's how babies form the self until about two years old, the baby doesn't have a self. He begins to have a self.

When he separates from mommy, when he begins to individuate, he begins to leave mommy, you know, I don't know if you're a mother, but is your mother?

All right, so you know, baby, baby hugs your leg, hugs your leg, then begins to run a few steps, then runs back to you.

Why the baby is running back to you to hug your leg?

Because you are the safe base. You are the familiar. You are the familiar.

The baby goes a few steps into the unfamiliar, but he needs to come back to you to make the link, to make the link to the familiar. By making this link between you, his mommy, who is familiar, and the unfamiliar world that is exploring, by making this link, he creates his own self.

There is a self born out of this.

Now what the pandemic has done, it took away our mommies. It took away the self, the safe, the safety. We don't have anything safe anymore. We cannot meet our friends. We cannot meet our family. We cannot go out to see the familiar objects of everyday life. We cannot go to restaurants. We cannot go to pubs or bars. We cannot do anything. We don't have anything familiar around.

The pandemic itself is not familiar because the virus is new, the novel coronavirus is new. Everything is new, too much new, too much new, and not enough familiar.

This combination creates effectively such extreme dissociation that I propose that we are entering a psychotic space.

The dissociation is so massive that our psychology breaks down, is disintegrating. We are becoming a bit psychotic. That's what I'm saying.

I hope I answered your question.

Yes, thank you very much. Thank you.

Thank you, Professor Sam. It was so wonderful. Thank you.

Thank you, Dr. Sam, for sharing your views.

Thank you. My pleasure. Thank you for being there.

Any more questions?

Okay.

I think the organizers should share between all of us, if possible, all our contact details, bibliography and everything. Not to burden the webinar all the time.

I would also repeat what I offer to the organizers. I have a YouTube channel with 24 million views, so it's a bit popular. I've been delighted to upload the webinar to my YouTube channel if I'm provided with a recording, so I'm making this offer again online to the organizers.

Sure, Dr.

Sam Vaknin. Thank you. Thank you.

Thank you. I apologize. I have a court appearance, so I have to say goodbye. It's been a pleasure.

Thank you all. No problem. Thank you, Dr. Sam. Thank you.

Now have a 20-minute break for refreshments.

Okay. We will be back at 1130 GMT for a guest talk by Dr. Pu Cheng. So see you soon, guys.

See you soon.

Let's continue with the program.

Now I would like to call our guest speaker, Dr. Pu Cheng, to give his speech.

Dr. Pu Cheng received his medical degree from Shanghai Medical University, China. He is triple board certified in journal psychiatry, community psychiatry, and addiction medicine. He is the inpatient director of Meridian Health Services and volunteer clinical assistant professor in psychiatry at Indiana University School of Medicine in Muncie.

Let's start, Dr. Pu Cheng. Thanks for the introduction. So I will show the theater screen for my blind first. We'll be able to see the slides.

Yeah, Dr.

All right. Great.

Thanks.

Hello, everyone. This is Dr. Pu Cheng. I'm a psychiatrist from the United States, and thanks a lot for the second somatica conference for giving me this chance to share with you about my experience of providing peer support and crisis intervention to frontline health care personnel in both China and the United States during this pandemic.

So first, please allow me to briefly introduce myself. I received my psychiatric residency and fellowship training in Case Western at Cleveland, Ohio. I'm currently practicing psychiatry in Indiana as inpatient director for Meridian Health Service. I'm also a volunteer clinical assistant professor in psychiatry of Indiana University School of Medicine. I'm triple boarded in general psychiatry, community psychiatry, and addiction medicine. I'm the founder of Wuhan Peer Support Project and also the co-founder of Physician Support Line. Both are grassroots peer support group, which I will talk in detail a little bit later.

First disclosure, I have no financial disclosure or conflict of interest with the presented material in this presentation.

Nowadays, COVID-19 is the biggest topic, and it should be, as it affects the entire world and the millions of lives. So we all work together to cope with this change and try to find an effective way to fight this pandemic.

So first, let's see how it started and spread all around the world. So we can see here in December 2019, that's the first case reported in Wuhan, China. Then January 16th, the first case that surfaced in Japan. And on January 20th, the first case reported both in South Korea and the United States. And on January 23rd, that's the date of lockdown of Wuhan, the whole city, with about 11 million population. So it was eventually lifted on April 7th, a total of 77 days after.

So starting in January, you can see the virus quickly spread all around the world. And on March 12th, that's the time WHO announced COVID-19 outbreak as a pandemic. And then the very next day, the United States declared a national emergency.

So let's take a look at the current data. As of June 15th, current WHO worldwide, the total confirmed case is almost 8 million, with 130,000 new cases and 435,000 confirmed deaths. The total of 216 countries are involved.

And you can see here in the graph below, the region of Americans, not only the United States, the whole America, North and South America, has the highest number of cases, which is in orange color. And as of June 15th, the United States has over 2 million confirmed cases and over 100,000 confirmed deaths. That's the top one country in the world.

For the United Kingdom, it has about 300,000 confirmed cases and 40,000 confirmed deaths. And it appears trending down right now, which is a good sign.

So while no one will argue that COVID is indeed a pandemic, more and more people now realize that it's also a mental health crisis.

While focusing on finding the cure for the virus infection, we shall also address this secondary mental crisis, which can be even more damaging, in my opinion.

As while COVID-19 affects certain percentage of the population, mental health crisis might affect everyone. And many organizations and professionals already notice this, such as WHO published the article regarding mental health and psychosocial considerations, and professional organizations such as American Medical Association and American Psychiatric Association are publishing guidelines and resources for mental health and psychosocial considerations during the COVID-19 outbreak.

U.S. government officials and agencies are currently making policy changes accordingly. And professional organizations such as American Medical Association are publishing guidelines and resources for health care workers to follow as references.

There are also a lot of media coverage about this incoming crisis, both on traditional media and the Internet. And there are many stressors leading to mental health crisis in this pandemic.

I divided them into two main categories, primary stressors, including people constantly worrying about getting the virus.

And if someone indeed gets infected, he might worry about that immersing, as it can indeed be lethal. Or someone witness the family members or others dying from COVID, and it can be very traumatic.

Second, stressors including losing jobs, such as the United States now currently experiencing the highest unemployment rate that can lead to financial stress. And the stay-at-home order has already been here for almost three months, and everyone is really stressed out. And children staying in the home cannot go out, cannot go to school, can certainly cause a lot of stress to themselves and leading to conflict with family members as well. All these can lead to mental health crisis.

And there are particularly some populations more vulnerable to this mental health crisis.

So for the public as a whole, anxiety is the most common issue. And for people who are in, I call, sub-optimal mental health status, it can be easily pushed over the edge and develop mental illness.

Existing mental health patients can also have symptom exacerbation due to decreased access to mental health care. And patients suffering from other illness might experience disruption of care because of the reallocation of the medical resource.

And frontline healthcare personnel constantly facing danger and risk during this pandemic.

A certain ethnic group has a black population disproportionately having more infected cases than death, an Asian population being blamed as spreading the virus. So also other special populations such as homeless, inmates, and detainees, they are also vulnerable as well.

So we just talked about healthcare personnel as one of vulnerable population.

And here's why we need to, quote, heal the healers.

So in a medical training, we are all trained to be tough and independent and handle things on our own. As we are all reluctant to ask for help. We also respect our profession and took oath to help patients. So we feel compelled to help patients even we ourselves are scared. And we have high ego. We always want to help, but not willing to be a burden to others.

And there is still strong stigma towards mental illness, such as during application for personal license and clinical privilege. It's often mandatory to report a mental issue and treatment. And we already work constantly in a stressful environment and many already suffering from chronic burnout and other related work related risks, including increased infection risk, facing patient deaths, so feeling guilty and frustrated about that. And often need to make hard choices when medical resources are really limited. And other external issues such as bureaucracy, lacking of personal protection, and even furlough or layoff.

So here I want to talk about two grassroots groups I founded with focus on helping the healthcare personnel.

The first one is Top Gun Wuhan Project, which was established on January 24th, 2020. It is an important time point, as is the very next day of Wuhan lockdown. So this project was already successfully concluded on March 28th, 2020.

The project goal is to provide peer support and crisis intervention to frontline healthcare workers in Wuhan, the then epicenter of China. We established an interdisciplinary team of 45 members. All of us are mental health professionals, including psychiatrists, psychologists, social worker, counselor, therapist, and registered nurse. Most of our members are located in North America, and all of us are bilingual, fluent in English and Chinese. We also set several principles during the practice.

First, no harm, as even we don't prescribe medication, but sometimes inappropriate psychological information can cause harm too. So our members all have the proper training to do this line of work.

Second, confidentiality. Although China does not have a particular law about confidentiality, but we all held ourselves to high standards to keep strict confidentiality. And we emphasize this is a peer-to-peer support instead of a patient-doctor relationship. And we only provide a short-term crisis intervention and not long-term relationship.

And our goal is pure and simple, which is to help our colleagues on the front line and no conflict of interest at all. And we have implied a novel approach using the most popular social media in China, it's called WeChat, which is similar to WhatsApp, who conducted the intervention. This is because it's the most accessible way for us to engage the Chinese frontline healthcare personnel. And we set up two chat rooms in WeChat, parallel to each other. One is for our team members, just like the back office. And the other one is our main workplace. And it has about 300 local frontline healthcare workers.

Basically, we engage the healthcare workers in a work group. They invite them to a private chat room with consent and do the most intervention there.

We also do some groups as well. We mainly use cognitive behavior therapy and motivational interviewing techniques, while other therapy techniques are also used. We set up an on-call system, it covers up to 16 hours a day.

So here's a list of some of the techniques that we used.

And among those, the self-disclosure is kind of unusual for us to use a novel work environment. But in this situation, it serves an important role in this online communication to gain the trust, especially in the beginning of this project. And active and reflective listening is the most important and effective tool we use, provides a safe and trustworthy environment for them to speak out their deep feelings. It's a very important and powerful intervention.

So here is our series of 10 emotional stages derived from our observation of the emotional changes of Wuhan frontline healthcare personnel in our online work.

So I'll briefly explain the stages here.

The stage one is a development. So at the beginning of this pandemic, people are confused by conflicting information from multiple resources, including government.

Then stage two is shock, is when they finally figure out the impending danger. The stage three is the anger, mostly towards authorities due to slow response and inaccurate information.

And then they move to stage four, which is anxiety.

For healthcare personnel, they mostly worry about themselves and family well-being.

And the stage five burnout, because a lot of patients rush into the hospital, jam the hospital system, and the healthcare system is close to breaking down.

So the healthcare workers, they are overwhelmed about the works and the chaos.

And stage six is desperation, and they start to lose hope because they don't have any effective treatments, and they see things are only getting worse.

And stage seven is acceptance. They start to face the reality and try to find a way to deal with it and find the treatment.

And stage eight is hope.

So with the improvement of the situation slowed down of the pandemic, they start to regain hope.

And stage nine is recovery.

And stage 10 is aftermath, as they possibly chronic mental illness issues start to surface, such as PTSD.

So here is a graph to show the time correlation of the involvement of the epidemic in China, and these 10 emotional stages.

For example, you can see stage six desperation happened at the peak of the pandemic, and stage eight hope happened when the curve was clearly trending down.

At the end of the project, we did some analysis, showing that 58% of the healthcare personnel who had an individual session with us are doctors, while 26% are nurses.

Some advantages of using social media.

Nowadays, almost everyone has a smart phone and using some sort of social media. Therefore, this model is easily adoptable.

And the easy action instant response is very important in this kind of work. And able to keep anonymous and provide them a great sense of security. And especially in this pandemic, it can provide mental health support while we also keep social distancing and reduce risk of infection.

But there's also some disadvantages, which are difficult to engage, especially in the beginning of the beginning phase, which we experienced during this project as well.

And there's some concern of confidential issues, so that we try to keep them all anonymous to mitigate the risk.

And there's also problem of lack of feedback and difficult to collect the data, at least in our projects.

So we published an article in Community Mental Health Journal as a summary of this work. I put the link there. Here is the list of our team members, 25 of them total, including myself.

So now I want to move on, talk about another grassroots project I co-founded, the physician support line, which was influenced by the Wuhan project and established on March 23rd. This is still ongoing project. We have a five person admin and we recruited over 700 US psychiatrists and volunteers in this project. It went live on March 30th, which was US National Doctors Day.

Kim, I want to remind you of this table of 10 emotional status, as we found that the US healthcare personnel were experiencing similar stages of emotional changes with Chinese colleagues while facing this pandemic.

For both US and China project, we started intervention at stage three and four, anger and anxiety.

We think at stage one or two, it might be too early and people might not have the need.

And at stage five or six to intervene, it might already been too late and the damage is already done.

Here is a brief introduction of this ongoing project. Physicians support line or PSL, again, this is a grassroots project where all volunteers are not belong to any organization. We're providing a nationwide service serving US based physicians.

Comparing to Wuhan project, this is a more traditional hotline system, although our volunteers do have a smartphone app to connect into hotline to provide a service. This is a physician to physician service and our 700 plus volunteers are all licensed psychiatrists and we provide peer to peer support to physicians of all specialties on the frontline and volunteers to sign up on one hour shift and the service time is from 8am to midnight.

And this is our flyer and our hotline number.

Physicians from all over the US can call this number during the service time to be connected to one of our volunteer psychiatrists to get service for peer support and crisis intervention, all free, anonymous and confidential.

And this is our leadership team. Dr. Masood is the founder and leader of the team. Dr. Song, Dr. Carlton, Dr. Gunton and me are the admin team leaders.

And this is our website and volunteer portal. The website is www.physiciansportline.com.

And here are some media coverage and recognitions of our work.

Here is a comparison of these two projects.

First, both are grassroots projects and second, both are focused on peer support and crisis intervention only.

And there's no patient-doctor relationship established.

The top one project to use the interdisciplinary team model involving psychiatrists, psychologists, therapists, social worker and nurses while PSL only recruits psychiatrists.

PSL is relatively a bigger scale project both for team size and service territory. It is at national level compared to Top Gun only focused on one city.

But Top Gun aims to all frontline healthcare personnel while PSL only serves physicians.

Approaches are also different. Top Gun uses novel methods of social media, which I just mentioned, and providing a more continuous encounter as the members are all in the chat room for this period of time of almost a little bit over two months of time. So we're providing both group and individual intervention in that project while PSL is more a traditional hotline while most of the time there are only one time encounter and individual intervention only.

It is not to say which one is better or superior, but it's just sort of different purpose and it can be other models as well.

And I also want to point out the volunteer members, they also can get traumatized as well, especially when ourselves are facing all the stressors associated with pandemic at the same time. So close monitoring the burnout side of the team members is very important and providing intra-team support for us to make rest if needed is important.

Something else to consider including legal issues such as licensure requirements, malpractice insurance and privacy laws, and also cultural awareness and political environment should also be carefully considered as well.

So COVID is a pandemic affecting the whole world and COVID induced mental health crisis affects everyone. Hence, it will need all hands on deck, including government, professional groups, grassroots organizations, individuals, involvement to fight it.

This shall be truly a global effort just like this international conference having speakers from all over the world to share their expertise. And the United States is not the only one, the other country affected.

I think we should, you know, community each other to find the best way to cope and fight this pandemic.

At United, we stand strong.

This is the end of my talk. Thank you very much and stay safe.

Thank you.

Thank you, Dr. Chang for sharing your research.

Thank you. Any question, guys?

So big.

You can ask your question.

I have no question. I was saying that the project is so big.

They are doing a lot of job.

It couldn't be possible to do such projects.

Every country is different.

Thanks a lot.

Thank you, Dr. Chang. We have to continue our program with the plenary talks.

I would like to call the first plenary speaker, Dr. Tazeen Jamal Siddiqui from Mancha Educational Society, India, to give her talk.

Very good evening. And first, I'm very thankful to the 37th International Conference on Psychiatry for giving me the opportunity to share my knowledge and also hear the great minds of the world. And I really felt nice and a few. You all were amazing.

But in this pandemic, the key is that what we are kind of keeping in mind because the fear is getting embedded in our hearts.

At this pandemic, what one thing that we really need today is a leadership.

And, you know, every human is a born leader, but few make it to the strength of its words.

As among all the people, only a few realize the true strength to lead themselves and others through a journey of excellence with the true guidance of vision and perseverance to their strength to rise each day to create a better version of themselves.

Leadership is not about a good leader or a bad leader.

Well, it's about understanding the functioning of the system of heart and mind aligned to decide excellence with love, care and kindness with firm perseverance to positive outcomes.

So when we talk about leadership, let us now first learn about that when leaders at their childhood, what were the experiences that made them great leaders.

Let's talk about Mahatma Gandhi, the great leader.

Now, in his childhood, he always believed that we have to lead by example. He always believed that nonviolence is the most powerful weapon to bring on excellence and success. He also believed since childhood that discrimination on the basis of caste, creed, color, religion was absolutely wrong.

There is an incident where his mother gave Gandhiji few sweets and he took the sweets in his hand and ran to his friend Uka and said, Uka, see what I've bought for you.

But Uka, Siddhi went few steps back and stopped Gandhiji saying, no, no, please don't come near me. I am an untouchable. I am person from a lower caste.

And Gandhiji was so surprised and shocked and he immediately said, we are no different. We are the same.

And when he went to his house, his mother asked him to take a bath because he touched Uka.

But Gandhiji said, no, we are no different. We are the same.

And this was a thought process at such an early age that he nurtured and became a great leader.

And same goes with Nelson Mandela. In his childhood, he also believed that discrimination on the basis of caste, on the basis of color was absolutely wrong.

And these thought process at the very childhood actually transformed the heart and mind to change, not just himself, but others with excellence and transform the whole nation.

Now on the contradiction, if we talk about Hitler, he was also a leader.

But why he was an aggressive leader?

Because Hitler in his childhood was very, went through a lot of pain. And he was beaten up with his father and he was always into a dilemma, into so much anxiety and into so much stress of not having the power. He felt helpless when he was back.

Well, a voice in their heart later. So he was always, that's why he was into this chaos that why am I so helpless?

And he was so much into intensified need of power that when he got the power, he instead of transforming it into a good way, he actually, because of his experiences, he actually transformed into an aggressive leader just because of the childhood leadership policy.

So the childhood transformation of thoughts, the childhood transformation actually realizes a person what is right and what is wrong, no matter what the world says.

But if the child has this thought process that what he's thinking is into the right direction, wherever the right direction of justice, the right direction of love, the right direction of kindness actually make a person a great human being and a great leader.

Now, how does that connect to the non-legal leadership?

I believe that leadership starts when you start realizing with your heart that whatever I'm going to do is not just for myself, it's for each person around me and also in the nation and that's what is leadership about.

When you achieve yourself, it's a success.

But when you help each and every person achieve, that is an achievement.

And that's what is leadership all about.

So there are nine qualities that makes an amazing leader, which is called non-again leadership grit.

And I recently got this published.

Non-again leadership has nine amazing qualities of leadership.

Number one is timing, number three is decision making, number four, positional intelligences, number five, locus of self-control, number six, passion, interpersonal communication skills, positivity, and when we break these qualities and these leadership grit, then on we bring on the great leadership.

Let's talk about the timing first.

When I say timing, it has nothing to do with the clock.

It's all about your timing of the right words that you use during discussion with your friends and colleagues.

It's your right timing of non-verbal communication in the situation when you meet the person for the first time, informal and formal.

Well, you should greet, initiate, and start a great conversation with a smile to bring the other person in the comfort zone of interaction.

So this is what timing is all about.

Second, contingency intelligences.

Now, what is contingency intelligences?

Well, and this contingency intelligences is very much required in this pandemic.

A leader must have the situational intelligences to deal with any situation coming their way in the surprise wrapped with complexities and as a leader, third person observing it very closely at every end and by considering the situation in the viewpoint of the parties at both ends and situational outcome of your decision must bring a positive outcome.

So in an emergency, your decisions should help the organization from getting into any loss, keeping in view that emotional casualties can be well-handled to recover hearts, to maintain the trust of togetherness and stay calm.

So a contingency leader should know how to handle the emotional casualties.

And that's what is happening right now, that the first casualty of this pandemic of COVID-19 as an emotional casualty, even the doctors are going through the same, the patients are going through the same.

So when you have this contingency intelligence, you're able to manage all this in a better way.

Then the next step is positional intelligence.

A leader must possess the intelligence of appointing people at the right time and identifying their expertise areas and positioning them to their expertise area to raise the organization with excellence and utilizing their expertise in the most of the way.

Because that must be aligned to the objective of the organization and its role.

But positional intelligences is the most important factor for organizational growth.

What happens is that sometimes we are unable to identify the real expertise area of the person.

And that's what happens that when we are unable to realize the expertise area, we tend to put them in the wrong place.

And that leads to not just an emotional setback, but also a professional setback for the person.

And next comes decision making, decision making intelligence.

Well, decision making leadership is the most important element of organization efficiency.

And once it's handled with the right attitude, considering the variables attached and bringing out stable strategies to witness the positive and efficient outcome, so decision making is most important element to bring efficiency and it should be dealt with considering the variables attached, variables attached with it external or internal.

Before making a decision, we need to understand that we need to observe, consider and analyze the internal as well as external variables affecting the decision so that you can actually form the proper strategy with efficient outcome.

Next comes the most important is empathy, where heart and mind are two major elements that acts as a backbone of our decisions, actions, reaction and justness.

When your heart encourages kindness and love towards everyone, that comes the major end of the threat that can hurt the team spirit of love and togetherness.

It almost ends that threat of love of not being into love and togetherness because empathy is something where you actually care for others, you actually try your best to help others when they are in immense need.

And this is the best quality of a leader and that's what transform not just the whole society, the community or the state, but the whole world.

Next comes locus of self-control.

When we interact in the organization, there are internal and external variables that affect the functioning of organization and people.

And to have control over these variables, we need to have the major control over the variables within our heart and mind once we settle and align our thoughts in the right direction, we control all the conditions.

So we need to actually first analyze our heart and mind, channelize our heart and mind and align it to the vision and our objective that is going to lead to the efficiency of the organization, city, state or the world.

So locus of self-control is that we need to understand our strengths, our weaknesses and likewise align it to our vision, to our objective and to our passion.

So self-locus of control plays a very important role in the excellent leadership.

Next comes the interpersonal skills, which is of course the most important one where we learn to interact with each other and positivity in communication is very important.

So the efficiency of communication is directly linked with your thought process that is being guided by your heart when we align our thoughts towards our communication improves efficiently, internally and externally.

Verbal and non-verbal communication both play an important role to connect and build relationship as it's the way we interact with people that represent our heart and mind to the other person that makes your communication pleasant.

Like if I say what is your name or if I ask may I know your name please is the art of communication that we actually need to inculcate in our personalities, in ourselves so that we can have a better version of not just ourselves but also have others happy and ready to learn from you at every stage of life.

Next is positivity.

Positivity is not just confined about thinking good all the time.

It's basically about understanding situation at both ends of the people.

Once we start understanding the reaction and judgment of other person in regard with his situation, experiences and his problems our attitude towards everything happening with and around that person changes amazingly.

Once we start analyzing the situation as a third person considering each aspect of the situation we understand every problem in an appropriate way which results into immediate solutions of each problem occurring and brings an end to negativity.

So once we see the problem as a third person and analyze ourselves by understanding the point of the other person at the other end and ourselves and understanding that person's reaction to his experiences to what he has gone through or whether he has some problem then it will give a different approach to our attitude, a different approach to our reactions and a different approach to our discipline.

So this is what positivity is all about.

Next is the passion.

Yes, to excel in any department of life.

First, we need to love that particular thing, thought and vision intensely to give your best.

When you start loving what you want to do in life then you start rising with excellence and this defines your passion.

The main ingredients of the passion are sincerity, honesty, love and dedication.

So these nine pillars of leadership actually helps a person to become a great leader and also helps a person to handle each situation and it's over integrated.

So when we talk about leaders, when we talk about their childhood, when we talk about different phases of their lives, we learn that they have been people of great thought process and each vision and each thought process of great leaders had justice in it, had love and kindness in it and also the right to understand their laws, also to understand their rights so that they could live a better life in the country and across the world with their transformed thought process to bring on a different action, a transformed action so that every person who meets you can understand you in a better way and it should be that every person should not just understand things from you but also lead the way you lead because it's important to lead by example.

There's one incident about Mahatma Gandhi that a mother bought a child and said he eats lots of sugar, please ask him not to eat the sugar.

So Gandhi said you come after some time.

So when the mother came after some time, then he asked the child not to eat sugar.

So the mother asked, why didn't you tell her at that time?

So Gandhi said because I was eating too much.

So when I left myself first, then I started guiding, then I have the right to guide other people to do the same.

So these are the things that ignite leadership in every heart and mind because it's not just about mind, it's about the alignment of heart and mind to rise with excellence which includes all these emotional leadership.

So here we are.

If there is any question that you need to ask, you're most welcome to us.

Are there any questions, my friends?

No presentation.

Thank you very much.

Thank you, Dr. Tazin.

Any question, guys?

No.

It was truly a blessing for me, interacting with such amazing minds like you all.

Thank you very much.

Thank you, Dr.

Thank you.

Thank you.

Now I would like to call Dr. Rama Sundry Nag from Usmanya University India to give her talk.

Hello.

Hello, everybody.

Hello.

I'm Mrs. Rama Sundry.

Thank you for giving me this opportunity to share my research with you all.

I'll connect to my optimized video.

One second, please.

Okay, start.

Hello.

I'm Mrs. Rama Sundry.

Hello.

PowerPoint, really.

So.

Hello, doctor.

Can you hear me, please?

Yes, we can hear you.

Can you hear me?

Yes, we can hear you.

My first time in webinar, please be tolerated a little, please.

Yeah.

My research is about enhancing the emotional competencies.

Yeah.

So the emotional competencies are the emotional skills or abilities like awareness of emotional self emotions, understanding the causes consequences of emotional expression, managing emotions and understanding the influence of emotional expressions.

And these are some of the emotional competence skills.

The emotionally competent individual can deal with any situation, can deal with any situation, showing these abilities, and they have more greater potential to acquire strategies for regulation of negative emotions and develop positive emotions.

Emotions can give a meaning to our brain. As per the meaning, it creates the information, the information takes one of the two parallel parts involved in the brain.

When a fearful object appears, attended, the brain takes directly to the amygdala, the fastest route to react immediately.

The second prolonged path goes to the visual cortex when it is categorized with the connected memories. And then an emotional and cognitively apprised message is sent to the amygdala.

Emotional competencies create a balance between emotions and cognition and make the become aware of the emotional experience and connects the cognition so that the brain takes the second part to the Hello, one second.

Hello, doctor. You can share your screen.

Yeah.

Yeah.

My slides are not moving.

So I'm doing that on the phone because my laptop is not connecting to the web.

So Okay, you can give your talk.

Yeah, one second.

The main hypothesis of my study is to see the current relation, whether there is a positive relation between the emotional competencies and the emotional competencies and the resilience and self-efficacy.

And the second hypothesis is my slides are not moving.

And the second hypothesis is to see the impact of my intervention on the enhancing the emotional competencies.

And the third hypothesis is to see the impact of the enhanced emotional competencies on the efficacy, self-efficacy and resilience of the adolescence.

The why is it? Oh, my God.

You can share your PPT in your laptop.

Yes, ma'am. You can share your PPT in your laptop.

Now, can you share?

Yeah. One second, please. I think you don't have a proper network connection.

Screen broadcast. Actually, I'm sharing it. But why it is stop sharing? I'm sharing the laptop.

These slides. Can you please tell me? We are able to see your slides.

But maybe due to network connection, it is getting blur.

Yeah.

No problem. You can give your talk like this only.

Yeah. Yeah. Okay.

So the the the sample I have collected was 259 out of which from three randomly from three schools, different schools from Hyderabad, India. And the age is 13 to 15 years old.

Okay. And this code, the students at the pretest was given after taking the permission from the schools. And then the pretest was conducted using three instruments.

One is emotional and social competency, emotional and social competencies.

And the second scale inventory scale by boys and a goal by Goldman and the second one is the self-efficacy scale by self-efficacy scale by Maurice.

And the third one is the Wagnell Resilience Scale for children by Wagnell and Yang.

Okay. So this pre-test, after pre-test, the scores of the children are categorized into low, medium and high. And the low and medium students are selected for the intervention.

The low and medium students have come up to 198, which are further divided into 99 for experimental group and 99 for control group. Okay. These students, the experimental group had further divided into nine students each group, nine to ten students each group into ten groups.

These ten groups are taken individually each group for intervention for eight sessions. And in between each session, there is 15 days gap between the sessions. And each session has 45 minutes duration. And the intervention is about techniques used in the intervention are to enhance the emotional competencies, guided observation, mindful experiencing, analyzing the connections between behavior, thoughts and emotions.

For the intervention, the activities are taken from the book by Shawl J. 2017 and were adopted and modified to suit the selected sample and objectives.

And the intervention was in increased awareness, regulation of and changing the painful emotion to pleasant emotion, based on the principles of emotion focused therapy by Greenberg, LS 2004.

Now the seven sessions are completed and the eight session is the feedback session, where the children are given a emotion to change from the negative emotion to positive emotion using all the principles given in the first seven sessions.

Now the posters have been conducted, and the relation between the emotional competencies and the true correlation means STs correlation, let me preschool means ST and correlation and t test were calculated for the free test for the posters course.

So, yes posters course, and the correlation between the competencies and the emotional self efficacy and the resilience were calculated, the academic self efficacy has three components, the academic self efficacy, the social self efficacy and the emotional self efficacy, the academic self efficacy and social self efficacy are some and emotional self efficacy, all the emotional competencies are positively correlated, but in the resilience is also positively correlated.

I will send all the slides through email to your sir.

Okay, so now coming to the second session, these results have been discussed in the three sections, the first section was the correlation table.

And the second section was the t test means and ST and t test for the pre and post test scores of the students, the in the four clusters or domains of emotional competencies of emotional emotional intelligence, the emotional self awareness is the competency in the self awareness cluster, which has 18.72 as the means, all the competencies, 12 competencies in the four clusters are significantly, very significantly, highly significantly, highly significantly.

The difference is there between the pre and post test scores of the students that shows the impact of the emotional competencies.

Yes, I can read the means of comparison between experimental and control group students in the self awareness cluster.

The self awareness cluster, the pre experimental group students have the pre test 18.27 and the post test mean as 21.59 and it's significant at point 000 level, the control group, whereas the control group, the pre test is 19.59 and the post test mean is 19.56.

And it is not significant as it is 0.95 more than 0.05.

The discussion is that from the competency in the self awareness cluster could have been enhanced because from the first session of the intervention, the perception of one's own emotion through facial expressions, the awareness of bodily changes during the emotional experience, the evaluation of context to know the cause of an emotional experience, to describe the emotional experience, to the conceptual awareness of emotion eliciting event and their emotional response to such event and awareness of emotional intensity and duration of emotion through storytelling and integrating opposite valence about the same target and rapid oscillation between multiple emotion causing aspects of relationship or situation which while group activity of storytelling could have facilitated the learning of emotional self awareness to take place.

Students also have been given assignments after each session, end of the session, so that for another 15 days, they will be practicing the principles which have been role played or in the activity in the session in the day to day everyday life situations.

Whereas the control group was not exposed to intervention, so there is no significant difference change in this emotional self awareness which supports the study of Phillips and Sylvia, 2005 study which states that if emotional awareness is low, the self discrepancies are weakened and cause non-significant relations to emotion.

As the self awareness was high, the self discrepancies are strongly predicted, emotional experience, that is how because the intervention was given, the emotional awareness has increased, students in the experimental group have shown the difference while the control group because of their low emotional awareness, they could not have the change in their self awareness.

Now coming to the self management cluster, there are 4 competencies in the self management cluster, can you all hear me please?

Hello, yes doctor. Okay, emotional self control which has a mean of 17.89 and 19.90 which is significant and whereas control group, the pre test has 17.86 mean and the post test mean is 18.61 which is also significant at 0.00 level.

Well, the adaptability in experimental group, adaptability competency, experimental group mean has, pre test mean has 17.58 and 17.58 is significant, shall I skip the means or do you want me to read the means please?

The experimental group post test mean is 22.29 is significant at the level of 0.00 and the control group post test mean, pre test mean and post test mean there is no change and it is not significant as the t value is 1.55.

The achievement orientation competency is again in experimental group it is significant at the level of 0.00 and the control group also is significant at the level of 0.00 and the positive outlook experimental group is significant at 0.00 level and the control group is also 0.00 level but the difference is that in the achievement orientation the control group means have decreased from 22.59 to 21.30.

And in positive outlook also though it is significant the control group means have been decreased from 21.31 to 20.45.

So, the increase of the competency shows that the activities in the sessions of intervention which could have been enhanced, the emotional self control, achievement orientation, adaptability and positive outlook.

One instance of role play may not bring this change but as students also observe other nine students in the group during the role play and rating them could have brought the change through vicarious learning.

Each session students from every group would receive assignment sheets and because of the practice could have brought the enhancement in their competencies.

Whereas in the control group adaptability has not changed but emotional self advocacy, emotional self control has significant change from pre to post.

This could have happened because of natural learning process of regulation, self regulation which could have been self suppression.

This finding supports the study of Cooley, Pullman and Martin 2016 which states that low adaptability was associated with higher negative behavioral engagement like disengagement and self handicapping because the students are selected are low and medium self emotional competencies.

And with control group did not have any intervention, their adaptability is low so they have self control has increased so that they might have changed to the using by using self suppression through achievement orientation and positive outlook competencies have significant difference.

But the pre and post has decreased, has been seen.

This finding is in contents with the study Smith, Sinclair and Chapman which says that changes in students achievement motivation, attributes and effective distress can occur between the beginning of the term and prior to the examination period.

And also, Lorian Smith study states that students can develop a decline in the motivation and confidence in the loss of enjoyment.

So, next we come to the study which shows the social cluster with empathy and organizational awareness.

Empathy and organizational awareness also are the two components in the social awareness cluster.

These two are also have increased their self from pre test to post test and significantly at 00 level.

This could have happened because of the sequence in the intervention, which continue from first session to seventh session, ranging from simple to complex, the activities with the role play applied to diverse situation, focusing on their emotional and observation by the students while rating finally strengthening the concept and practice through assignments could have enhanced the competencies of the students in social awareness cluster.

Now, if we come to the fourth relationship management cluster, we have five competencies in that team work, coach and mentor, influence, inspirational leadership and conflict management.

In all these five competencies, there was a significant increase from pre test main to post test main due to the due to the intervention given.

So, they do to the intervention given the scores have shown significant interest, which confirms the studies.

So, we have seen now from this above, I'm sorry, because I'm really, really sorry. I'm not able to show you the slides. I don't know how much I'm sorry.

But my study shows that the effect of intervention on enhancing the emotional competencies has been very effective, significantly effective.

And then the third section, which concerns with the concerns with the emotional effect of enhancing the emotional competencies on the self efficacy and on the self efficacy and resilience shows that economic self efficacy and emotional self economic self efficacy and social self efficacy were not shown any impact of enhanced emotional competencies on them.

That means there is no pre and post difference, but emotional self efficacy has shown a highly significant change in the pre and post levels due to the enhanced emotional competencies on the emotional self efficacy.

And resilience also has shown a significant difference on the test because of the effect of the emotional competencies is the intervention was given to enhance the emotional competencies, but not the resilience or the self efficacy.

Now, my conclusions, the conclusions are that the first hypothesis that we agree to the first hypothesis is saying that there is a positive relationship between emotional competencies and self efficacy and resilience.

The second hypothesis is the impact of intervention on the emotional competencies is there, so it's very significant.

So, we can say the second, we agreed to the second hypothesis, the impact of emotional competencies, enhanced emotional competencies on self efficacy is only on emotional self efficacy is significantly and resilience.

And so the third hypothesis is partially accepted.

So, this is my, my acknowledgments to the, my respect and regards to my supervisor, Professor Solojna Reddy, who guided me through this research, my thankfulness to my Professor Hargopalsar for the resistance in analyzing the data, and I thank the heads of the education institutes and students for their cooperation in the collection of the data. And I thank the organizers of this conference to give me this platform to share my research, though, with the problem of the Webex and this thing, I could not share my slides, but I will email them to my organizers.

Thank you so much. And welcome. Welcome to any questions, please.

Thank you, guys.

If you have any question you can ask her.

I don't have any questions. It could be better to have a slide.

Tell me.

Yeah, she has some problem with the network. I think that is the reason she is not able to share a slide.

Okay. Thank you, Dr. Rama.

Thank you so much, Jenny. Thank you so much for all of your tolerance.

Yeah.

Thank you, Dr.

I don't know how to show that.

Yeah. Can you show the slides in the camera by flipping?

Yeah. Can you see?

No, I don't know. Can you see the slides?

No.

No, you can.

Doctor, you can send that slide to us. No problem.

Okay. Okay.

Thank you so much. Thank you so much.

Okay. Okay.

Fine.

I hope I didn't miss any question.

No, no, no, no, doctor. Thank you so much.

So, guys, now we will have one hour break for our lunch.

So, let's continue with the program.

Now, I would like to call Dr. Susan Kamal from King Saud University for Health Sciences, Saudi Arabia to give her talk.

Yeah.

Yeah, doctor.

Your voice is not that much audible.

Hello, doctor.

Yes.

Is she audible to everyone?

No, not very good.

Yeah.

The volume is very low.

Dr. Susan, you're not that much audible.

Can you speak louder?

Okay. Now, you can listen and hear me.

Yes, I'm here. Not very much.

Try to increase the volume.

Yeah, you need to keep your mic near to you and you need to be a little louder.

I will now share my presentation.

And present now you can share your screen with us and you can present.

No, doctor, you have to share your screen.

One option will be there. You have to share your screen.

Share the content.

You can find an option.

Share content.

Yeah.

Doctor, your volume is very low.

We are not.

Yes.

Thank you, Senator.

Thank you.

Thank you.

college students, approximately one out of seven students may experience education for their college years.

Education can have negative impact on their lives and academic achievements.

So there are some studies that correlate accepted skills with the division.

Studies have shown leadership in accepted skills and division, which is the more accepted the nurses are the less division they have.

The study is to identify the relationship in accepted skills and division among the undergraduate nursing students.

A cross-sectional study design was carried out in King Saud University for Health Sciences College of Nursing, Jeddah, Saudi Arabia.

It is a sample size of 179 nursing students.

Regarding the data collection tool, we used a socio-demographic data sheet developed by the researcher to collect subject personal data such as age, title, status, and identity.

And we also used a schedule of education. Ethical consideration was considered during the study.

As the researcher proposed an education subject to the College of Nursing, Jeddah, Research, University, College of Nursing, and Centre for Key Marketing Education, once we have the I.R.

A.

group started our data collection.

We also used a schedule of education subject to collect subject personal data such as age, title, status, and identity.

Regarding the relevant of the study, it can be observed from the table that 68.7% of students are in the classroom, and that 68.7% of students are in the classroom.

We also used a schedule of education subject to collect subject personal data such as age, title, status, and identity.

Regarding the distribution of students according to the level of service, it can be observed that 46.9% show somewhat assertive, followed by 31.7% their assertive.

Regarding the correlation in assertiveness skills and mission, it can be observed that 68.7% show equal 0.40% of students are in the classroom.

The result of our conclusion is the result of the result of the study of statistical significance among the undergraduate students.

Our conclusion for the study, focusing on empowering students during study at the practice of psychological aspects, by providing nurses that help them with their skills.

To discuss the issues that we want them to encounter, please please switch to the next session.

Establish a little bit of talk about some of these skills and how to apply for the practice of choosing purpose.

Hello?

You can hear me? Hello?

Yes, we can hear you, Doctor. Yes, we can hear you.

No, volume was not very high, so that the volume is very low.

Yes.

Okay.

It should be better to have a slide for the presentation slide so that you can take more.

It could be better to send a slide to the organization committee so that you can share it.

Are you getting me?

Okay, fine, I can send it. Okay, okay, Doctor, you can share your slides with us.

Do you? Yeah.

Yeah, you can WhatsApp us, you can mail us.

Any questions, guys?

We want anything to be repeated by her side.

No, really, when she saw the methodology, I didn't notice how she managed to have a population.

As the volume was down, I didn't understand.

Okay, we will again explain the method.

Yes, to have a sample.

Because I mean, sample size, and I think.

Okay.

Okay.

Okay, so I hope you got your answers.

Yes, thank you.

Okay, thank you, Dr. Susan. Thank you for your research.

Now we would like to proceed further.

Now I would like to call Mrs. Rene Floray from University of Yonday Cameroon to give a talk.

Okay, thank you for giving me the floor. I don't know if it's the floor or the web. I don't know how to call it. It's my first time to take part in a webinar, so that.

Yeah, Doctor, we can understand.

Okay, we will talk about people with disabilities.

Most of the parents, because I've conducted a study with the parents. I used to work with parents, parents from we have children with disabilities.

Here in Cameroon, the number of disabled, the number of disabled person is estimated at nearly 3 billion person, 3 million people.

Means that more than 5% of the population suffers from at least one handicap.

Are you getting me?

Yes, Doctor.

Okay.

These alarming figures lead us to look into the issue of children with disabilities and their impact on the head of their parents.

The ability is an empowerment that limits subjects in the efficient performance and action.

The number of people with disabilities is estimated to be more than 1 billion people, including in about 15% of the world.

So we have a lot of kind of disabilities can be sensual, can be motor, can be mental or social.

Disabilities always pose a social problem.

And with the parents, because they don't have, they don't know how to express their emotion, they are sometimes affected by the difficulties to have by having disabilities, children.

So, several families or parents want to give the maximum of their handicapped child.

Unfortunately, the face of our difficulty suffering, which can disadvantage amongst other individuals, other learning of the ideal child, the fear of relieving the same experience, and the inadequacy in our environment on the infrastructural level.

From this question, in our various actions with the parents of disabled people, we noted that several parents had psychological illness linked to their child's disabilities.

We asked ourselves questions, whether there are no accidents, child handicapped could lead to psychological illness. How can we help them? What types of psychotherapy will respond better and appropriate to their suffering?

From this question, we thought that you can use a test. We used one test, this is spring, used to evaluate recent trauma.

So we used it with those parents. And then for those who had a high score, we started IEMDR-TRP with them to check their suffering, to check their enjoy memories, to handicap to their children.

What is IEMDR? IEMDR is a psychotherapy. We call it is a high movement design decision processing. It's an integrative psychotherapy technique used to soften psycholutile stress.

Francine Shapiro developed the theory by the end of 1980. Today, that therapy is very efficient. The theory has become very popular in the treatment of post trauma syndrome, depression, anxiety attack, and fear.

IEMDR therapy has a principle.

Then the protocol needs eight stages.

How does that therapy work?

To start, we have a first phase one with the treatment history and the planning. In that stage, we saw a lot of events.

So we discussed with the patient and then tried to identify the different events that they had in their life in order to notice injury memories.

Then the second phase is preparation. Here we talk about, we make a psycho education, I can say it like this.

Then we discuss about the patient concerning this therapy. We tell them what is the therapy about.

The third phase stage is the evaluation.

In this phase, we have a lot of things that we can find. We can find a negative condition, we can find a shock image, we can find the unique subject of disturbance, a lot of elements that we can find on this stage in order to start treatment.

In phase four, we will start with treatment till phase seven. In phase seven, we will stop the treatment by this kind of body.

Then when we scan the body, we can just reevaluate the situation to finish with the session or with the therapy.

So a session can take at least 15 minutes to 18 minutes.

It's very important to notice which kind of trauma the patient is suffering from.

Yes, it's very important.

So when you, the therapist, notice that if the trauma is simple, complex, what do you call it?

It's a small, small thing that the patient suffer from the childhood.

And then he had a lot of injuries.

EMDR therapy allows the brain to process emotional information in order to move to the record in the naval stress system.

So I will talk about methanology now.

To conduct our research, we first take contact with association. We contact webling association, another association with a little prince, Andy Moabi.

Having obtained the various meetings, we organize ourselves for the meeting with the target parents.

Once there, after a detailed explanation for the subjects of our research, we were allowed to call an appointment with the parent consent.

When the day came, we started out as a kind of a touch with all of the parent prisons.

So we discussed with the parent in one room, let's say like this, we give them a lot of information concerning our research, the importance to be part of that research for them.

After the phase of collecting meetings, which at least you can take, used to take 20 minutes, we drink alone each parent to an individual and private interview.

So at that time, we can know, we can try to evaluate the parents to know if whether the parent is suffering from the disability of the child or not.

So that is how we proceed to put our simple.

Okay, when all the criteria was done, the first criteria to be part of the research was to beat a parent from the child, from the bed or each door.

A parent would deny the handicap of the child. The parent would have a psychological disorder linked to his child's handicap and above.

And then the parent or the patient, that patient have to have a high score of spring.

Yes, that spring, the high score of spring need was to start therapy with him. All of this condition being met, we asked the parent to ask us any question they like concerning the study.

So after these preliminary stages, we start with the appointment for the preparation and the therapy.

Seven cases.

The first case is 30 years old man, woman, who is Bamileke. Bamileke is an ethnic tribe in our country. And she's, she have her academic level is class from four, from four I don't know how to translate it, how to explain it to you.

So it's a secondary school, it's 40 years in the secondary school. She exercises a very common informal activity here in Cameroon called Bayam Selam.

She consists to bike and input the food products and the exits of the field to convert them to the market of the city and to sell them in detail. So, she has service herself of five siblings, and her child is 15 years old, suffering from schizophrenia.

During the interview, she happened to be very conscious.

The second case is a chameleon, a young chameleon, always 42 years old. The level of school is second year of the university. She has what we call it a BTS. I don't know how to translate it. It's one year before the graduation, the first graduation in the university.

So, she's not employed anywhere. She's the mother of a boy who is 18, 21 years old suffering from autism. A woman who is 55 years old, a first school G3, she's a housewife, and then she has eight children. The child who has an handicap is the second of the seven children she has.

That child has a mental child. Another case is a woman who is 48 years old. This is Phulbe. Phulbe is Muslim. She didn't go to school, and then she's mother of seven children. The one who has a disability is the first of the seven children, and then the child has Down syndrome.

Another case is 45 years old man. We have an A-level colleague here in Baccalaurea, and he's a service provider. He's the father of the child who has a disability handicap. The child is 22 years old. Another case is 30 years old man. He's a Gabbani living here in Cameroon. He's a soldier. He's a soldier taking care of the child with disabilities. The child also has a schizophrenia. Another case is a Gulu 38 years housewife. Gulu 18 years old. She doesn't have formal education. She's my mother of three children. The child who has handicap has coaches.

Okay, so we had 10 patients. From these 10 patients, we had the five mothers and two dads. Those parents had, let's say, a mental heat, a kind of injury due to the disabilities or the handicap of their children.

Before starting therapy, we made sure that the type of trauma that each parent could have since the arrival of the disabled child could be just the trigger for so free.

After each session, we passed the parent a stressful event-related skill called spring in order to evaluate the action of the therapy. By doing so, we were able to take care of the seven parents according to the individual children.

In the period of two months, we held, on average, five sessions of 60 to 90 minutes each. The element which made it possible to start therapy are stored in the priority table.

I did not put the table here because it's too long. In that table, we score some elements like image, like negative cognition, like some policy cognition that we can use as objective to the end of the therapy or to the end of the session.

We also score, let's say, the unit. We evaluate the unit, the disturbance unit, the level of disturbance by one unit. We call it SOUT.

On another scale, we use it for the therapy.

VOC is like to evaluate how the trueness of the positive condition the patient will give us at the beginning of the session.

As a result, we noticed that EMDR actions are based on the association of psychological and neurological processes techniques and allow the patient to revisit the traumatic event.

This therapeutic action is understood as an information processing therapy during which the patient related the traumatic events by means of his cognitive, emotional, and psychological characteristics while focusing visually and audibly on bilateral movement of stimulus.

As time went on today, psychological distress evoked by traumatic memories dismisses or disappears, so that what we used to do is just concerning, depending on the parent, we can use eyes by neutral movement or by neutral movement, also by tapping.

We use it and then treat the injured memory.

We experimented with this EMDR therapy that for some parents, just after two months of care, they recovered the smile, the thought was lost forever.

For most cases, the first EMDR session was very satisfactory for the parents because for parents, their VOC is the scale of the trueness.

I was talking about concerning the positive condition.

They go up to seven and their third is a subjective unit of disturbance, went down to two.

And then for the older parents, that VOC went gradually during the session to reach seven and through the sixth session with an economy start.

Because for some parents, they don't like to say that they are no more suffering. They like to keep their soul, let's say, at one.

Then we call it economic.

The other type of therapy, which are equally effective, EMDR has the particularity that does not expect special vaporization attacks from patients, which will constitute the action of the KLC.

The long-term effect of EMDR are loss to launch than cognitive and behavioral therapies, which facilitate the rapid recovery of parents who may not feel well just by vaporizing their suffering.

The main advantage of EMDR is that it's a very brief application of the technique.

Indeed, when it's well indicated, it acts directly and shows positive effects at the first session.

EMDR has been performed on a randomized control trial with a waiting list of placebo control groups showing definite therapy.

This Rebecca Bradley, I told you for her.

In conclusion, our work highlights the action of EMDR therapy on the psychological problem with parents who have children with disability.

For these parents, at the end of the therapy, each parent would at the third, first offering, just at the site of his disabled child, would himself satisfy with his life on above all fun qualities to be amplified to consolidate each acquire in his different child.

The results are very satisfactory.

Managing is essentially psychotomatic and comprehensive.

It would be interesting to check the stability of the results in a few years by observing the parent consent over the years in the area of short and effective therapy.

EMDR is yet another promising tool. Thanks for listening.

No.

Thank you, Mrs. Renee. Any questions, guys?

No question.

No questions.

I would like to say something. I would like to say something. It is the first time I'm working with a conference series, the first time I wanted to buy in 2018, second time last year in Madrid, 2019, and this time webinar.

It's a good initiative that can bring us to visit the world and then meet a lot of scientists.

So I wish that this COVID-19 case can go very far from us and then we shall start with our journey and meet people physically.

It's not easy to talk like this without knowing if people are following us or not.

I finish.

Thank you, Mrs. Renee, for your research and your views.

Thank you.

So for the next talk, our speakers not present here. So we will move on to the next talk.

So I will be taking the last talk. So I would like to call Miss Suniti Ramprasath from BPP University UK to give her talk.

Hello, Suniti.

We are not getting a voice.

You're not audible to us. Can you hear me? Hello.

Okay, so I'm going to share the screen. So, any idea, okayshares web browser. I'm going to share the screen. I'm just trying to share the content.

Basically, I'm a student from the BPP University UK, but this study I had conducted when I was, I think, two years back, when I was still doing my BA in counseling.

So, given the rise of teenage mothers and teenage pregnancies in Mauritius, I decided to conduct these studies, the life experiences of teenage mothers and the impact of such experiences on their sexual lives.

Mauritius is a very multicultural society. Hence, the issue of sexuality is still considered very taboo, though from the 2019, the ministry has implemented a comprehensive sexual education in the curriculum.

But there are still many, I would say, a minority of people that see the importance of providing sexual education for their children as well for the people.

So, the aim for this study was mainly to understand the life experiences and assess what's the impact of these issues on the children.

The objectives for this study was to identify the factors that influence teenagers to engage in early sexual activities, to understand the living condition of the teenage mothers, to assess the impacts that teenage pregnancy has on different variables, like the economy, teenager, family, society, education, and the newborn child.

To assess the consequences an early pregnancy has on the life of teenagers, to understand how teenage mothers cope after their pregnancy.

I would like to highlight that I was doing my internship at a very popular NGO in Mauritius, and I've been able to work with teenage mothers and sexually abused children. And this has pushed me to continue in this field.

So, for the next slide, I'm going to background of study, I'm not going to a bit a lot into the literature, but just highlighting a bit about sexuality and what we as human, we think about it.

So, humans are born beings with animalistic tendencies from thousands of years, and the urge to have sex or to need to explore and consummate their sexual urge is a very natural habit.

Sex is a need that is linked to the core of all mothers. Sexuality is a way people express themselves through physical, emotional, erotic, biological, social behaviors and feelings. It includes not only body parts and sex, but also the sexual orientation, gender role, gender identity, sexual experiences, fantasies, intimacy, love, compassion, as well as a body image.

The problem here is that we have been able to notice that in 2004, 12.1% of girls were already pregnant with increased compared to 10.9% from 2002. From December 2017 to March 2018, there has been several girls of 12 and 13 years old who have delivered preterm babies.

The statistical division of the Ministry of Health, which is formaceous, issued an article in April 2018 stating that in 2015, 10% of the pregnancy registered were below the age of 15 years.

The Ministry of Health and Quality of Life, monthly building of March 2018, it can be deduced that there has been an increase of teenage pregnancy since the last three years. 8.5% of life births took place for age group 15 to 19, which includes 27 life births occurred to mothers age less than 15 years in 2015 and 24 in the year 2016. 113 cases of teenage pregnancy were reported at the NGO MFA Dublevia at the end of June 2017. And on the next year, from the statistic of June 2018, we can see that 218 cases of teenage pregnancy were registered.

The Child Protection Unit, which is under the Ministry of Gender and Quality of Life in Worsches, has published on their website that nearly all the cases registered in hospitals, police stations or child protection units for teenage mothers have few things in common, which are, they come from a peculiar group that is a lower middle class.

Many of the girls come from broken or difficult familial backgrounds. They did not use contraceptives, nor did they know that they had to make use of it. They did not know one term sexual activity or first time sex could lead to pregnancy. They did not know they could get STIs through sex. They did not know they were pregnant until it was too late.

Now we're going to, from the literature, we can see that there are several factors that affect teenage pregnancies, like the intrinsic factors, which is self desire to satisfy curiosity, social fitness, quest for educational excellence.

We also have extrinsic factors like the economic challenges, broken homes, poor parenting, indecent media content, social or religious activities.

For this study, I have used a qualitative research methods, which has helped the interaction to take place among participants as they rely upon the remarks, observations, perspective, assessments and the thoughts of individuals.

This research focused mainly on case studies, personal interviews, as well as telephone interviews.

This study sexually active teenage mothers who visited the drop-in center at the NGO for counseling and treatment. The reason for choosing this category of adolescent was because there has been an increase in the number of teenage pregnancies in nurses.

The teenage mothers age range was from 11 to 18 years and mostly of them come from difficult families and underprivileged areas.

These teenage mothers either go for counseling or medical sessions at the NGO.

The difficulties I had during this research was concerning all the measures to avoid bias. Some weaknesses were identified, mainly participants from different remote areas were contacted, but they had several issues while coming for the interview at the center, which is mostly traveling and financial issues. It was time-consuming and then interviewers postponed on regular basis. The interviewer as myself also had difficulty because it was a very sensitive issue.

We are interviewing participants of 12 and 13 years.

Even though we had the consent forms that we had to show the parents, there was still this nagging in the parents' mind about confidentiality, about whether the children are going to be judged or stuff like that.

During the sensitivity of this issue, I had to be very cautious while asking questions and directing the interview towards the sexual experience, which most of the time the participants within the range age of 11 to 13 were very hesitant to share experiences, which led them to their early sexual intercourse.

The result of this study was that the behavior and attitude of the teenage mothers were done in a systematic way that involves collecting data through interviews and case studies on their practice, knowledge, attitude and perception.

For the practice, whether the teenage mother was sexually active or not after delivery initiation, age of sexual intercourse, how often are they engaged in sexual intercourse?

Knowledge. Did the teenage mothers know the risk of sexual intercourse before being pregnant? Did they know that there are many diseases other than pregnancies that every person can get through sexual intercourse? Are they taking any family planning method after giving birth?

Attitude. How adolescents cope with different factors affecting their pregnancy? And life as teenage mothers, are they happy? And whether they are having troubles to cope with the situation?

Perception. How do the teenage mothers perceive their future and that of their child? What have they planned to do for the future? How do they perceive themselves as young mothers? How do they feel as a society and family treat them as young mothers?

Here I'm going to show you it's a demographic profile of the participants.

Since Mauritius is a multicultural society, all the participants came from different cultural backgrounds.

Here for these studies, the participants were given fictitious names to give them value. These were done according to the ethnicity and to maintain anonymity and confidentiality.

The total of 20, 40 female students were used for this survey.

Again, even though we have a very large number of participants, I mean, as teenage mothers, teenage pregnancy in Mauritius, it is very difficult to conduct a study on this subject.

So we just have to take a small amount to represent it as a survey.

For the case study here on the table, you're going to see that there are several, I think there are six participants for case studies which have been given fictitious names.

But the age and the other information provided are the same.

As you can see, we have Yoshini, who is 12, the youngest for the case study.

From the six case study, only two participants were sexually active after giving birth since they were still with their partners and the rest were impregnated after the first sexual intercourse itself, with the exception of Yoshini, who had several sexual intercourse with her partner before getting pregnant.

Now for the face-to-face interviews, I had several of them, I think they say 14, 14 or 20, something like that. It's 24 participants here.

The face-to-face interviews were very helpful, as I have been able to study not only the verbal and the nonverbal communication as well, their body postures, the tone, the pitch of their voice.

In these 24 interviews, only nine adolescents were accompanied by their parents, by their partner, sorry, and had declared their child.

Here we can see that in Mauritius, there are several children who are born, I mean, from teenage mothers who are not declared by the partner.

In the nine couples, only three of them were married and the rest intended to marry after some time.

Hence, not many of them were sexually active.

All the participants had some issues either in their family or the environment in which they lived.

This has been one major factor that triggered these adolescents to look for comfort and care and love outside the family casual.

For the telephone interviews, most of them had initiated their first sexual act at a very young age starting at 11, 12 and 13 years.

Most of them had no knowledge into what they were engaging themselves, and all of them had health issues like hybrid pressure, anemic condition resulting in scissor and deliveries, and preterm babies kept these young mothers on roller coasters for quite some time.

Unfortunately, Rabia lost her baby on her second term of pregnancy due to extreme stress.

All the adolescent interviewed for the study had to drop out of college before the delivery, and many of them could no longer pursue their studies after having the child.

Though there are some who have come forward to wish to join a cause or to start college in you, many of them have undecided about their future.

Many face health issues are hybrid pressure and diabetes resulting in scissor and there are some babies who were bored with malm formations like short leg, short arm, a hole in the heart, and body parts or organs not well formed.

Many were subjected to taunts from their family, relatives, or members of their locality.

Some teenagers lost their friends and some were so stressed that they had miscarriage.

I'm going to show you some statements of the participants just to highlight a bit what is going on exactly with these teenagers.

I'm going to take a statement from Rabia where she stated that when I first came to know about my pregnancy, I was so scared that I went into shock for a few days.

When my parents came to know about it, they were very angry and the boy clearly said he didn't want to have anything with me or the child.

My parents were thinking I was very much stressed. Though I was not showing yet, I was one month pregnant, but I knew that they would come too.

My appetite and sleep were greatly affected. I was barely eating or sleeping and within two weeks I was bleeding and having severe pain in my abdomen.

My mother took me to a hospital where I came to know I had a miscarriage.

Some other statements, some short statements I'm going to show you that were challenged during the interview, but I have pinpointed.

I've written a bit shorter version here.

I mean, part of them, like no one understood me, my feelings, my emotions or what I wanted.

My parents were too strict, so I rebelled. It was fun to be with him.

So I had never realized the consequences.

Mirabel, I was fed up with a constant fight between my parents. Sometimes it would become violent.

So I ran away at my boyfriend's place.

Abigail, I wanted to explore sexuality. All my friends were talking about it on videos and I even saw them having sex.

I wanted to try.

Parvin, I was fed up with other rules and regulations. Don't do this or that because it's haram.

I wanted to enjoy life like my friends, but my parents never tried to say things from my perspective.

They are very strict.

Fatima said, we are an extended family with no privacy. Everything is shared in my house. I hate it.

I always wanted some me time, but my parents never seemed to understand that.

Here also, we have some statement from Eshwari. She says, I live in my Akka.

She's a Tamil girl. Akka means elder sister. It's a remote region in Mauritius.

She is married and the house is very small. I saw them once. When I mentioned it to my friends, they explained me about sex and even showed me videos when I insisted.

Sevan, they stated, my parents have always over protected me and I did not like it. I was not allowed to go anywhere without them.

They even dropped and collected me from school every day. It was suffocating.

They stated, I live with my elder brother and his wife. She does not like me very much. My parents are dead for me.

You guys mentioned that it just happened. I know I have a normal family. Mine is nothing serious.

My parents love me and love them very much. I'm the only child. So they do spoil me from time to time.

Ling mentioned, I have everything a child ever wants except attention, love and care of my parents and grandparents.

They have a lot of money to give me, but they don't have time for me.

Here we have a statement from Yoshini case study.

During her first counseling, even after a lot of probing and advice, how to cater for her future needs.

She never did realize the intensity of the situation.

For a girl of her age, her physique looked like that of a 22 year old female. Well-built and seemed in very good health. Even the gynecologist report stated that she was in good health.

She had an attitude problem and replied very rudely to the question asked to her.

Though she was the youngest of four children, her parents were divorced and her partner were none other than the lover of her mother.

She said that she said to want to marry the young man later in life and male condoms were being used as a method.

During two sessions, she mentioned that many people in her locality were talking about her and she did not like it.

Though she has dropped out of college, she did not have any specific idea what she would do in future.

We have another statement from Zubayda. She was actually active and she had already conducted Nika, which is the religious marriage for Muslim. Her husband and her lived together with a baby girl and have sex once every week.

She was influenced by her college friends as nearly everyone had a boyfriend and was enjoying the sexual pleasures.

She did not want to be left behind and her curiosity got over her.

She never realized she could get pregnant from the first time.

She had a difficult labor, high blood pressure that resulted in C-section delivery, but she was happy with her little family and did not want anything more.

Her family supported her at every step and she was keen to make her marriage work as she did not see herself as a working woman.

She is currently using IUD as a family planning method.

She did not want another child for another two years.

Here, the research has been able to conclude the dire need of communication between parents and their children, as well as the importance to talk to the adolescent on sexuality.

A comprehensive sexual education starts from a very young age where youngsters are told the importance of their body, good touch, bad touch or prior focus and the need to protect themselves.

The effects of being a teen mother has been noted in every case, not only through what the client and parents are complaining said, but also through their body language, pitch of tone language and the reasoning used during the sections.

There is also the limitations, limitation to counseling. Therapists are available only at particular time and place which becomes difficult for teenage mothers as they are unable to attend sessions due to the fact that a minor is always supposed to be accompanied by an adult.

Parents or guardians of a teen may not find time to bring them from time to time absenting from their workplace.

Teenage mothers may not want to interact with a particular counselor, a psychologist and not willing to cooperate on the long term only to result in a waste of time for the therapist, whereby he could have offered the services to another needy teen, but also there is a risk of counter-transference, which might occur during the session, as something might trigger an issue that the therapist had undergone in his or her past, and has not fully get over the issues.

There is a constant need for training to keep therapists up to date with the changing environment, and some organizations do not provide this facility to their employees, whereby the therapist remains at the same level and the same knowledge he had.

Jenna and Wash 2016 mentioned that there is no progress in terms of new techniques and means to deliver and make counseling sessions more effective.

Though there are intrinsic factors and extrinsic factors that are highlighted in the literature review of this study, the factors mostly influenced the teenagers to engage in early sexual behavior from the data collected, were to satisfy their curiosity to experience sex, to be accepted by their peers, broken homes and poor parenting, love, affection and care, and support in decent media content as well as the environment in which the teenagers were growing up.

Many of the teenagers in this research had divorced parents, were over-facing financial problems since a very young age.

The first subtitle for this result is to satisfy their curiosity.

Leila wrote that many youngsters are having sex from a very young age and are using less contraception.

Satisfying their curiosity on sexuality is one of the reasons why there is an increase of early sexual behaviors among teenagers.

This is because they are exposed to many things related to sexuality from a very young age that increase their curiosity to probe and experience.

For this study, Abigail mentioned, I wanted to expose sexuality.

All my friends were talking about it other than videos and I even saw them having sex.

I wanted to try.

Here the issue about influence, not only influence, but curiosity is highlighted in a teenager, whereby they have not been able to have a proper channel to talk about their curiosity, to be accepted by their peers, according to Krotchkra 2017, and Alonzo said me frequently and you the strain to make more companions and turn out to be one out of like their friends.

Bethany mentioned in this study that all my friends were no more virgin with the exception of me. They were laughing at me and most of the times I was left out of many conversations.

Regularly, youngsters have intercourse just to extend that they are cool and wooden and wind up with teen pregnancy.

Subsequently, many adolescents end up in a sexual relationship, even though they are not fully prepared for it just because of peer pressure.

The third one is broken homes and poor parenting.

Divorce parents, death of parents, remarriage, step siblings, and being neglected or being spoiled when parents of current issues teenagers are facing nowadays.

Roshni stated that they always fight at my place. I wanted to be loved.

Broken homes and poor parenting have a negative impact on the lives of adolescents that result in them adopting ways that are not only harmful to their lives, but also result in having an impact for lifetime.

Love, affection, care, and support. Even adults need them.

But here, adolescents are the ones who need them the most.

Shashira stated, I loved him. I thought he did too. He cared for me and used to be always present. Whenever I needed him, my parents never had time for me.

It is typical for young people to be ill-humored or appear to be uncommunicated.

However, despite everything, they still have the need to have their close ones around them.

Adolescents show their families and need them to be associated with their life, despite the fact that on many occasions, the state of mind, conduct, and nonverbal education may appear not to want anyone or rather him.

UBOT can be a troublesome time for us. Adolescents experience quick physical changes and emotional issues.

Teenagers go through the period of self-fighting with themselves to be a child and to become a mature person.

In the search of the identity crisis, they become very vulnerable and if they are not well channeled by their families, they could easily be influenced by peers and people who would like to take advantage of their inexperience.

Last but not the least, they have inter-media content, environment, or the teenagers who are growing up.

Photography and innocent media content like videos and photos are for others.

According to Physical Health, 2016 is a day and age till blessing to comprehend the job of media and innovation play in the lives of youngsters and the impact they have on high school conduct.

According to the National Center for Biotechnology Information, on an average of 8 to 18 years old, use media effectively for 6 to 21 minutes every day, sorry, 6 hours and 21 minutes every day, frequently utilizing numerous types of media in the meantime.

Flory stated, my family is very poor. We live in a one-bedroom teen house.

I always had free time and no one cared for what I was doing or not as we are seven siblings.

The same author mentioned that youngsters who experience childhood in destitution are additionally at a more serious hazard for conduct issues and are uncovered at a more prominent rate to network viciousness and unlawful exercises.

It is likewise obvious that rebuffing encounters, for example monetary pressure, intensify negative impacts like despondency outrage or hostility. These encounters can put a strain on nuclear families and push adolescents to take part in risky behaviors like engaging in early sexual activities.

The conclusion and recommendation for these studies, there have been several that have been pointed only for in this PowerPoint.

Teenage pregnancy is an emergency that impacts the infant's gardens, different memories from the family and society.

Roughly 750,000 young females between the age of 15 to 19 wind up pregnant on a yearly basis.

In spite of the various components that can impact teenage pregnancy, for some adolescents the absence of safe sex education from schools' gardens of the main driver of high school pregnancy.

Young people are not shown in regard to the methods for anti-conception medication and have to react with companions who urge them into having sex before they are ready.

The government can sensitize people through sensitization campaigns like the through TV, radio, advertising, posters and banners.

Vouches and debates for youth as well as the working force in merges.

Social media can be used as a great means to pass on information.

Small videos on teenage pregnancy and dramas can be made by the local office to have a greater impact on the people.

Continuous training for the existing staff and recruiting and providing adequate training for them in the field.

The government and the NGO must work together to decrease this flow.

Moreover, the importance of disclosure must put emphasis on.

Educating people of all ages on sexuality as well as to protect themselves must be made a priority given the rights of teenage mothers. People must be sensitized and educated to avoid stigmatization.

Children must be made aware of the dangers of early motherhood and the measures to take if they find themselves pregnant.

Even though there has been an implementation in the school curriculum for the comprehensive sexual education since 2019, there's still a growing need to train people in the field of sexual health with the right education, right training and right exposure.

So thank you for your attention if you have any questions.

That was a very wonderful talk. Thank you Miss Suniti.

Thank you. Thank you to you.

Guys, if you have any question, you can raise your question.

I think there is no question. Thank you.

Thank you so much for this opportunity. Thank you Miss Suniti.

Now I would like to call Dr. Mohammed Fami Zaid from Alexandria University, Egypt to give his talk.

Yeah, Dr.

Hello.

Yes, we are able to hear you.

Okay, good afternoon everybody.

Actually, I am a new surgeon, professor of neurosurgery on Alexandria University.

I think I have already invited for this meeting, which is, I think it would be so spectacular, because I have a good cooperation between different countries.

And let me discuss on a few points about the strategy of brain tumour said.

My voice is okay.

Yes, Dr.

Next.

First is our introduction, meningioma are most commonly benign intratrenal tumor.

Betas meningioma remain affordable challenge for radical excision.

Actually, because I have got a basal attachment in relation to the skull piece, and it's a delicate anatomical relation of the cranial nerve, and also major structure.

But theoretically, they should be differentiated from other reason due to impact on the management, and of course on the outcome.

Next.

And what's the patient's population 25 cases where the study re operatively by neuro imaging. Of course, CT scan and especially MRI.

And this study, we are stressing the point of attachment of meningioma, which would be so clear in MR study, because it gives us what is called a sign on the ideology, I think, especially after contrast injection.

All cases were studied, most of the operatively for the extent of the tumor removal or clinical estate and the follow up period.

Andof course, just to historical verification, most common presenting symptom would be headed.

An outpatient underwent, of course, a city as I said on the MR scan, including the enhancement, nation toward divided into three main group, according to the location of the tumor attachment to the vitro.

I need to stress this point, because this is a new point for this particular study.

The median group anatomically, we give it a name of and the lateral Subaru group.

B, of course, I will put this by slide for anatomical clarification and the lateral inferior one and the zone two or zone C and that is because I need to find this a little bit further.

Actually, this is the by random shear of the beta. This is the yellow things here. It is clear.

So, this triangle here. And this is the rich anatomical range of the beta.

So we can imagine together. We have a triangle.

And this triangle have been divided by the range of the pictures.

Did you know what is the structure attached here?

Okay, that auditorium.

And the Venus channel, important superhero.

Okay, so again, we have a triangle.

And this triangle is on the lateral aspect, which is divided by the beta stretch.

And if we look carefully here, we found the in few triangle of the media have been also subdivided by a very important structure, which is called the internal.

So that's why we have zone A and zone B and the zone B have been divided.

Medially and later for easy classification we can divide the approach typically for this area media, whether for to view or in few triangle.

If the humor is attached in that location, it's called bit reply, but many job.

One of the most famous sculpt is many in Joma, and of course, difficult to reach or difficult to handle.

So I need to stress this on rabbit and rabbit for this is a beta strangle divided into two zone, the infero, the internal auditors. I am internal auditors.

So, if you're trying to into two zone, where's the media, it's called the media.

I said the technique have adopted a different type of course so which is famous Korean orbital approach.

And there's a September approach. This is a different type of approach which could reach the different region on that battle for removing of the business in Joma.

And there's a basic mind betrothed approach and the letter and sub occipital retrospect mind.

And the last one.

Approach, excuse me, because this is a lot of different approach would be a little bit so strange for the psychological and psychoneurotic position.

Okay, this is another way of declaration. This is a triangle once more. I've been divided into superhero and the infero.

And if you want, we have the landmark on the middle third actually, which is internal auditors. We have the media.

Regardless, this is the media. So, you have the medium in fear and the lateral in fear. So, again, this is a B, this is C, this is D, and this is D.

A, of course, network live. See related to Metro or cerebellum one time.

And again, meaning you are not sure no, we are our topic about many job.

And D is related to the inferior lateral. Again, and the Subaru is B, which is related to the temporal loop.

And we can, of course, reach to that area by the sub temporal approach.

Next, please.

Again, this is a rabbit classification, which you can make a little thing is expecting is easy for the surgeon or neurosurgeon or young the neurosurgeon.

Again, a CD was a different color. Next, please.

This is again, as a different type of surgical technique. Can you orbital approach, sub temporal approach?

Is our pre-sigmoid betrothal approach? Lateral suboxibita?

And the trans-laprinsine, trans-cochlear, and the last one is trans-bitters.

We will see now which is suitable to the different region.

Again, we classify the region according to the basal attachment with a time getting a very large, similar to different area, but we are looking carefully on the contrast MRI for this a little bit attachment to the bone.

Next. Evaluation of the treatment extent of the tumor rover was evaluated.

Inter-operative observation and also post-operatively by CT scan or MRI scan. Also, post-musological verification was confirmed as a meningioma.

It's not as a religion for example, schwannoma or exhalation as a post-operative clear status were reported on the phone for at least three years.

This is very important to be a little bit, I'm not sure, because we are caring about a total radicality. This is, in my knowledge, we need to remove it totally.

Or if you leave something, it cannot care even after a few years. Please raise up.

The mission is ranging between 29 to for this.

Is that mean to 65? Is that mean age is 51 years? There were 8 men and it means 72% men.

And the woman, as we expected, is more common in meningioma. So, 1% is 68%. Meningioma are more common in women than men, because we have, of course, to know that it's an estrogen receptor for meningioma.

And that's why meningioma generally, whether scalp bees or not, are more common in women than men.

The average antenna from the onset of 17 to the diagnosis was about 36 months.

Next, please.

The biological findings are maximum tumor diameter, range between 15 millimeter to 60 millimeter. This is a little bit large. This is a diameter of six centimeters.

We found this sometimes on the metoclival meningioma.

It is not very important here, remark that six centimeters to give a symptom or to patient to notice that he got a tumor when we started the vision and found a very large tumor.

In addition to different zones, zone A, which is better private, is above 4Ks. Zone B, which is a subial triangle, is 4Ks, which is, of course, easy by a September approach.

Whereas a group, C and D, contained on A case, 4Ks have extension to both zones, A, which is median, and C, C, which is on the middle and funeral triangle. That means an important remark of radiological findings, that the tumor has extended through hiatus, territorial hiatus, I mean, of course.

So, extend from weather to internal hiatus to territorial hiatus to the subial compartment, or the next one, which is around the internal auditory matrix. 5Ks had a very large, huge tumor extension to also, of course, this is, should be around diameter of six centimeters.

A radical surgical remover was achieved on 85%, subtotal on five cases.

Whereas the tumor left was less than 20%, this is a definition of the subtotal. If we left about one-fifth of the tumor, we call it subtotal remover.

Incomplete tumor removal on four cases, whereas the tumor left was more than 20%, mean 40% or 15%

can say this is incomplete. Of course, the cause of incomplete or subtotal is that the tumor increasing the measured vascular structure, like the internal auditory matrix, while it is passing before the cavernous sinus or the tumor invading the posterior end of the cavernous sinus, etc. Next. As this is a distribution, I think this is also important slide. This is a distribution of the different region with the different approach. Let me see this. We have the yellow thing here,

which is the medial one. We found the most appropriate approach is the cranioorbital approach and the cranioorbital-terional approach, or cranioorbital approach. We can reach you to zone A. What is the zone A? It's the median one cell of the uterus. Okay, this is the yellow thing here, and this is a different approach with the cranioorbital-terional or cranioorbital. Group B, this is the subiro triangle, which is September, of course, which will be easy. It is above the tent because the tent, as we know, is attached here on the veterans' ridge. Let's come to see. This is the red thing here. See, this is the middle cell of the inferior triangle below the ridge around the internal auditory matrix. Actually, this is one of the most difficult approaches with the group A, because here there is a lot of structure of

the North Korean nerve. We have the patient nerve here with the cochlear nerve here. Also, we are so close to the trigeminal ganglia here, maybe. The most appropriate approach here is the pre-sigmoid betrosa. We can come through this way. Here, this is the lateral. Here, this is, again, the median. We come from

the lateral. The sigmoid means before the curvature of the sigmoid sinus. We can come through this way because from here to here, actually, there is no important structure. Just we need a little bit of retraction of the subiro lateral surface of the cerebellum. And below this area here, this is the tent attached. So we actually have the ceiling above is the tent and the bureau, the inferior medially is the cerebellum. We can come to this region by the pre-sigmoid betrosa or by the trans labyrinthine approach.

But the drawback of trans labyrinthine retrosigmoid is actually if the patient have a good hearing, mostly he will lose the hearing or the acuity of hearing will be a little bit decreased.

This is the V. This is the blue suit here. This is the lateral infill.

This is easy by retrosigmoid. Of course, retrosigmoid is burst of reverse of britsigmoid.

Retrosigmoid, burst sigmoid. Here, the britsigmoid or the curvature of the submoid side.

That seems here.

Where is that?

Sometimes we found the attachment, believe it or some case, attached to all this area. All this area means a subrandein for a tentoria.

Here is the subrandein for a tentoria.

How we can reach all these four or five regions?

By britsigmoid betrosa. Why?

Or trans betrosa. Again, why?

Because if we come making a good flat, we can reach above the tent and below the tent.

Then, before the sigmoid sinus, we can cut the tent near to the sigmoid sinus.

We convert this two compartment of anatomy into one compartment.

By this way, we can reach to these four difficulties.

As I said before, removal of a britrus or a huge britrus from any genre, especially between a new surgeon, we are seeing this is the battle against the proof of the brits.

Actually, this is the battle.

Next. Okay. Wait, wait. Back.

This is MRI. This is a two-weighted image.

We found here a tumor, as I said, above and below the tent and the median to the tent.

What do you think is the most appropriate approach for this?

Could be the britsigmoid. What is my guess? Could be the britsigmoid.

Here is the sigmoid sinus lateral.

It could be the britsigmoid betrosa approach.

Cutting is a middle serve, the median to the tent.

We can reach to this area.

Transfering this two compartment onto one operative surgical compartment, we can handle both.

The sub-temporal and, of course, the medial aspects, which is going here, all these areas of the student force.

Again, this is the first event to get compressed and then to the other side.

Here, this is the temporal hole.

Here, no temporal hole.

It is compressed by the tumor, all from the medial.

This is possibly converted inside the cavernous side.

This is the lateral wall of cavernous sinus partially involved.

What is the new partially involved?

As we know, the lateral wall of the cavernous sinus is composed of the two layers.

The other side we can compare with the other side.

This is the lateral wall of the cavernous side.

Next, please.

This is another case of the huge betras mirin gioma.

This is the middle serve.

This is group B, group C, group A.

What is this?

This is also on the ribbon tie.

This is coming across on the front of the wall.

This is involving the five or six region.

Honestly speaking, no single approach for this particular case can remove the tumor totally, because it extends to five or six zones.

The most difficult one is actually this is here in this area, ribbon tie, and between the two cavernous sinus.

In this case, we make a surgery.

We can remove this and this.

And then we're going to the, this is the medial part, but not, of course, on the single session.

Even on two session, it's surgical session may take more than 12 hour continuously.

Next, please.

This is a little bit rotated.

This is a CT scan of another huge case.

She's a difference here between this is the CT scan.

This is all the CT scanners.

You cannot see the actual attachment like an MRI.

I would just call it to see the difference between the clarity of VU, between the MRI and the CT scan.

Here, of course, this is the CT scan without contrast.

You'll find the better support, the lesion is all high density.

Look like the lesion is falling.

Next, please.

I think this is another one, very huge, a CT scan.

I'm all the one.

The difference is huge between the MRI contrast and the CT scan without contrast.

It's only when you see this, we need to ask the patient to do an MRI with different modality with contrast, of course.

Next, please.

Here, this is a clear view of meningioma by MRIs.

Here, it's involving the inferior surface.

Look here.

This is very important, this is the tail, the attachment on the scalp.

The attachment of the tumor on the urine.

This is the urine.

When you found this on the MR, you did show that it's a meningioma.

Not sure, no one of us.

Here, it's also extended.

Also, of course, on the posterior faucet, you see here the forced ventral is compressed and deviated to the other side.

Next, please.

Another huge case of MRI was a case brought to be meningioma.

But here, the clarity or the variety of density of meningioma here is a little bit more.

And the tumor is extended to the September region.

How extended?

This trans-haita, trans-tent across, maybe the tumor is originated from here possibly.

And here, we can found the tail, meningioma, and extended to the September through the hiatus of the tent.

Next, please.

Conclusion, beters meningioma often lie adjacent or composed or involved a large number of high-crossed vital structures, especially the high vital structure by name of vascular or arterial venous or the cranial nerve.

Cranial nerve, obviously, was the most common frequency-encounted complication post-operatively.

Next.

By comparing our results with other reports, we can conclude the following.

Leisure on Zoom A, again, Zoom A, as the media said, could be managed by cranial or arterial approach, or by September trans-tentators approach.

But the easier to be, honestly, is the cranial nerve anterior.

While the lesion on Zoom B, where is Zoom B?

It's the outer subir triangle in September.

Or Zoom B, where is Zoom B?

It's the outer cell of the anterior triangle.

Only has a high chance for medical removal was good, was to over-result because, of course, they are lateral and there is no crossing vital structure.

This is the key point or key word here.

No crossing vital structure between your approach and your target.

Of course, the target is the attachment of the tumor within your body.

The suboptimal result is usually confronted with a reason, of course, Zoom A and the Zoom C.

Zoom A is the media set and the Zoom C around the anterior co-editeric meat.

Next.

Meningioma at 4 Zoom, A, B, C, D, or A, C, or C only could be managed by lateral mastoid or Briseworthy approach, especially the hearing loss intake, but not the trans-eloprene sign, as I said during my previous slide.

While the hearing is lost already, is the tumor compressing and abusing the patient hearing on one side, of course.

The other side of the patient can hear normally.

The choice between trans-eloprene sign or trans-cochlear, because it was affecting markedly on the hearing.

All trans-eloprene is made different on the direction of the tumor, essentially, or as a carrier neuromus.

Next.

Thank you.

My name, again, is Professor Dr. Mohammed Fani, Professor of Neurosurgery at the University of Egypt.

Also, I am the Chair of the Egyptian Society of Brain and the Skull, and the main office of that society will be on Alexandria.

Thank you.

Thank you, Dr. Fani.

Is there any questions?

I think there's no questions, Dr. Fani.

Okay. Thank you.

Thank you, Dr. Fani, for the valuable research. Thank you.

Thank you.

Thank you.

Well, now we have the complete program for psychosomatic medicine 2020.

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Thanks to our keynotes and guest speakers for giving their valuable time to this webinar.

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