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Thought Content Predicts Mal Adjustment Cognitive theories of adjustment propose that repetitive thinking predicts adjustment to environmental challenges e. Various forms of repetitive thought have been identified including worry, rumination, mental simulation, cognitive and emotional processing, and reflection Watkins, , which have both adaptive and maladaptive outcomes with respect to adjustment and well-being.

Post-event cognitive processing e. However, other forms of repetitive thinking, notably rumination and worry, have been associated with negative outcomes in the context of adjustment e.

Attempts to integrate the seemingly contradictory effects of repetitive thought have resulted in dimensional approaches, which propose that the positive or negative effects of cognition on adjustment depend on its content Segerstrom et al.

Several important dimensions have been identified: valence, purpose, and level of construal. Positively valenced repetitive thoughts tend to be associated with positive outcomes, especially when thoughts involve a searching purpose i.

For example, daydreaming may be associated with depression only when episodes are unintentional Deng et al. Additionally, daydreams with a positive emotional content Poerio et al.

Thus, rather than viewing repetitive thoughts or daydreams as inherently adaptive or maladaptive, their effects depend on the content of cognitions and context in which they occur. Although dimensional approaches have helped to make sense of how thinking can have adaptive and maladaptive outcomes, they do not typically consider the social content of thought.

As an exception, Segerstrom et al. This finding dovetails with the consistent relationship observed between self-focused attention and negative affect Mor and Winquist, and indicates that self-focused negative thinking is particularly detrimental. Although self-focused thinking may have negative outcomes, research has yet to fully document the effects of more other-focused thinking on adjustment. Social Daydreams and Socio-Emotional Well-Being Although research has not yet examined how imagining others is related to adjustment, social daydreaming has been linked with positive effects on socio-emotional well-being, in particular, loneliness.

Mar et al. This suggests that lonely individuals engage in more social daydreaming to counteract loneliness; however, only daydreaming about close others confers a socio-emotional benefit, whereas daydreaming about non-close others may exacerbate loneliness.

Likewise, research on imagined interactions—internal dialogs with real-life significant others Edwards et al. Chronically lonely individuals report experiencing fewer, less satisfying, and more negative imagined interactions Honeycutt et al. Studies examining the effects of individual social daydreams on momentary socio-emotional well-being also show that certain types of social daydreaming can regulate and shape emotional well-being. Poerio et al.

Interestingly, this association was only observed when participants were low in these feelings before daydreaming and when their daydreams involved close others implying that daydreams about close others may function to regulate social emotions. Consistent with this, directed daydreaming about close others has been shown to promote positive social feelings connection, love, belonging after induced loneliness Poerio et al.

Although previous research is consistent with the proposal that positive characteristics of social daydreaming may promote socio-emotional adjustment, they are limited, because they do not examine social daydreaming during the process of adjustment.

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Cross-sectional research has examined the daydreams of individuals, who are currently adapted or maladapted e. This assumes that individuals display consistent patterns of daydreaming over time, does not account for the dynamic nature of daydreaming, and cannot capture the process of adaptation over time. Adaptation is often examined as a state rather than a process Luhmann et al.

The problem with this approach is that associations e. Although experimental designs have enabled consideration of daydreaming within a specific context e. Laboratory experiments are also only able to examine the short-term effects of daydreaming, which, again, cannot capture the process of adjustment over time.

Adjustment is a temporal process, which means that to properly understand, how social daydreams are related to adjustment, it is necessary to capture repeated observations of daydreaming over time in a situation where adjustment is required.

In addition to examining daydreaming as a dynamic process it is also necessary to consider daydreaming as heterogeneous and measure the characteristics of daydreams. The previously reviewed literature suggests some important social daydreaming characteristics that might be expected to predict adjustment: their emotional outcomes connection, loneliness, and positivity , valence, and the relationship quality between the daydreamer and the most central other person involved in the daydream.

Other literature also suggests that the fanciful nature of daydreams may relate to adjustment because fanciful thinking has been previously associated with negative outcomes e.

Consistent with dimensional approaches, social daydreams per se should not predict adjustment, but their characteristics and patterns of change over time should. If social daydreams were part of an adaptive response then they should, over time, become more constructive.

Specifically, they should be associated with more positive emotional outcomes greater connection and positivity, and less loneliness , become more positively valenced, involve higher quality relationships, and become less fanciful. This pattern of constructive change over time should then predict later socio-emotional adjustment. The Present Study To capture the dynamic and heterogeneous nature of social daydreams over time and their relationship to adjustment, we used experience-sampling methodology to sample social daydreams during a period of naturally occurring adjustment.

To examine, how social daydreaming was related to socio-emotional adjustment during this transition, we measured the characteristics of social daydreams described above i.

We measured adjustment outcomes loneliness and social adjustment to university after 2 and 4 weeks of the study. We chose these measures to index adjustment at two time points in the study although other outcomes indicative of adjustment such as subjective well-being or levels of depression might also have been warranted due their relevance to the particular transition and the socio-emotional aspects of that transition, which was our main focus.

The social adaptation to university scale measures the extent to which students feel that they have integrated socially to university life and is therefore directly relevant for capturing perceptions of social adjustment within the study context. The measurement of loneliness is an adjustment outcome consistent with previous daydreaming research and pertinent to the university transition because it has been identified as a commonly experienced feeling and issue for transitioning students, particularly in the first months of the transition Cutrona, ; Shaver et al.

The repeated measurement of social daydreaming and its characteristics enabled an examination of the temporal process of daydreaming during adjustment to university. Daydreaming Over Time We predicted that positive features of daydreaming would increase over time indicative of adjustment. For this reason, we examined how social daydreams changed over time during the earlier and later stages of the transition separately.

We expected social daydreams to show positive and constructive patterns of change in the last weeks when students are adapting but not the first weeks when students are reacting.

We also examined how feelings in general changed over time, specifically feelings of connection, positivity, and negativity. Like social daydreaming, we expected feelings to change over time, becoming increasingly positive, but only in the last weeks of the study.

Emotional Inertia as an Index of Adjustment As additional evidence of the role of social daydreams in adjustment, we drew on the concept of emotional inertia. Emotional inertia describes resistance to emotional change over time and is thought to reflect psychological maladjustment Kuppens et al.

Evidence that high emotional inertia is indicative of a maladaptive response comes from studies demonstrating that emotional inertia predicts depression Kuppens et al. We reasoned that if social daydreams were linked to successful adjustment, then we would expect the emotional outcomes of daydreaming to show less evidence of inertia i. Social Daydreaming and Later Adjustment Based on daydreaming research, we also predicted that positive features of social daydreaming would predict better socio-emotional adjustment.

We used loneliness and social adaptation to university to index adjustment, and measured them after 2 T1 and 4 T2 weeks. If, as we propose, social daydreams promote socio-emotional adjustment, then the positive features of social daydreams should predict better adjustment at T2 controlling for T1.

A higher score indicates more disability. A lower total score indicates more disability. Legend: Indicating patient satisfaction with cosmetic appearance of their operated arm Patient reported pain will be recorded for pain in general and for pain in the bicipital groove.

Patient reported quality of life will be assessed using the EQ-5D [ 22 , 23 ]. This questionnaire covers five domains mobility, personal care, daily activities, pain, and mood , as well as a point thermometer on general health. Each domain has three response categories; no problems, moderate problems or severe problems.

In addition, the clinician will make a digital photograph of the biceps, using a standardised protocol. The ESI is calculated by dividing elbow flexor power with the lower arm in full supination by that of the contralateral upper extremity using a dynamometer www. Absence of the biceps tendon in the bicipital groove confirms a successfully performed LHB tenotomy. Absence of the biceps tendon in the bicipital groove confirms failed LHB tenodesis.

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The rotator cuff is classified as fully healed, partially healed or recurrent rupture. Also the quality of the rotator cuff is scored according to Patte and Goutallier [ 25 , 26 ]. Duration of surgery and complications Surgeons will report the start and end times of their tenotomy and tenodesis procedures, so the duration of surgery can be calculated.

In Kukkonen et al. Based on these data we performed a calculation of the sample size. Anticipating a difference of less than ten points on the Constant Score and a standard deviation of 16 points in both groups, we calculated the sample size using Study size 2. Analyses will be performed according to the intention to treat principle.

To further compare recovery after the two surgical interventions, longitudinal data analysis mixed model or generalized estimating equations GEE [ 28 ] will be used. In the primary model, the Constant score will be included as the dependent variable, and treatment allocation between subjects and time within subjects will be included as the key independent variables. Other variables that may affect outcome e. The interaction between group and time will be assessed to evaluate whether the two treatment groups differed in change over time.

The secondary outcome variables e. To evaluate the relation between patient-reported and clinical measures of function, we will calculate correlation coefficients for continuous outcome measures e.

After the data entry, paper data collection forms will be stored in an archive. Steering- and data monitoring committee No official steering committee or data monitoring committee has been appointed for this study. The ethical committee judges whether the safety of the patients is jeopardized and whether the trial can be continued or not. Data entry will be performed by one of the researchers LV.

Discussion With this multicentre, prospective patient blinded randomized level I study we will contribute to elucidating the controversy in the treatment of LHB tendon pathology in arthroscopic rotator cuff surgery. If our main outcome measure, the Constant score, is not lower in the group that underwent tenotomy, this increases the level of evidence to support previously reported findings that functional outcome is similar between treatments.

Our thorough assessment of Popeye deformity by the patient, the treating surgeon, and blinded assessors using digital pictures, complemented with MRI imaging will reveal how this patient population values cosmetic appearance. A limitation of this study is that our comparison of costs is limited to the duration of surgery, without taking into account any other financial aspects.

With regard to surgical material, no differences are expected, as tenodesis can be performed with the same anchor that is already used for the rotator cuff repair.


One could speculate that tenotomy may allow for earlier return to work or activities, but this potential advantage would be masked by our study design as both groups received the same post-operative rehabilitation instructions.

The results of this study will strengthen the evidence on potential risks and benefits associated with tenotomy and tenodesis.

Insight in the differences between treatment effects is very important, as managing patient expectations is critical in current orthopaedic practice.

Notes Acknowledgements The authors thank all colleagues in the BITE collaboration group for the time and effort they invest in data collection. Erik E.

Zijl, St. Antonius Ziekenhuis, Utrecht Kiem G. Auw Yang, St. This emotional evaluation that you make of things that cross your path happens instantly through your amygdala, faster than you can rationally think about such things. Linear Perception, Verbal Ideation. Your amygdala compass is indicating through positive emotions that you are headed in the right way, towards where you want to go.

Besides that, if anyone picked on me, those girls could just shred anybody, verbally or any way. In other words, the results you see are dependent upon where you are looking and who is doing the observation. When your frontal lobes are happily at work, that tickles your yohr even more. This one is a yout run: Unlike a trout, your frontal lobes can figure out that a delicious looking worm on a hook may not taste so good after you bite it.

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Original Research ARTICLE

Tenotomy or tenodesis for the long head of biceps lesions in shoulders: a systematic review and meta-analysis.

Daydreams occur when an individual encounters goal-relevant information in situations where overt action toward goals is not possible.

A comparison of 2 case series with isolated lesions. This fits well with the proposal that social daydreams become more frequent during times of social challenge.

Wood Siding. Positively valenced repetitive thoughts tend to be associated with positive outcomes, especially when thoughts involve a searching purpose i.

For example, daydreaming may be associated with depression only when episodes are unintentional Deng et al.

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