FINAL FINAL FINAL. NO MORE MENTAL HEALTH!!

Question 1

BPD-the moro article

Answer 1

4 categories of thought that lead to self mutilation

1. it is acceptable
2. ones body and self are disgusting and deserving of punishment
3. action is needed to reduce unpleasant feelings
4. overt action is needed to communicate ones feelings to others

things that will help: snapping a rubbing band or mark area with a marker.
communicate positive qualities to others instead of negative ones.
long term cognitive therapy sessions
ot focus on maladaptive behavior that limits occupational performance
use DBT. standard DBT treatment last for a year and involves behavioral and cognitive-behavioral perspective.
4 problem areas addressed are emotion regulation, distress tolerance, interpersonal effectiveness, and mindfulness.

Question 2

BPD-use of sensory integration approaches

Answer 2

9 factors

1. sensory seeking
2. emotionally reactive
3. low endurance/tone
4. oral sensitivity
5. inattention
6. poor registration
7. sensory sensitivity
8. sedentary
9. fine motor/perceptual

tactile stimulation to decrease self-mutiliation
massage to provide sensory input
sensory room

used to self sooth during hyper arousal and flopping back and forth (about 4 on ACL)

Question 3

BPD-symptoms

Answer 3

Borderline Personality Disorder: a pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts. Five or more of the following:

1. frantic efforts to avoid real or imagined abandonment
2. pattern of unstable relationships
3. identity disturbance
4. impulsivity in areas potentially self-damaging
5. recurrent suicidal gestures
6. intense unstable moods
7. chronic feelings of emptiness
8. intense anger with frequent displays of temper
9. stress-related paranoid ideation or severe dissociative symptoms.

Question 4

treatment for BPD

Answer 4

B. Treatment and intervention: Highly structured programs work better, with clearly articulated expectations and goals that focus on self-regulation and normalization of daily roles, routines, habits. Address role performance, self-management strategies, and interpersonal skills. Set achievable goals that are client-centered. Provide clear boundaries, consistency, and reliable structure.

Question 5

DBT

Answer 5

• Populations: Adapted for a number of populations, including people who are chronically suicidal, BPD, and seemingly intractable behavior disorders involving emotion dysregulation, substance dependence, depressed adolescents and elderly, as well as the forensic population.
• Fundamentals:
o CBT: change based strategies rather than insight-oriented approaches. Look at patterns of reinforcement for maladaptive behaviors. Uses homework, goal setting, logs, psychoeducation, and other CBT methods.
o Acceptance-based approaches: validate experience, antidote to avoidance and dissociation. Start with where people are.
o Dialectics: change is constant, opposites can be integrated, ambiguity can be tolerated, work toward greater flexibility and tolerance of change. Everyone is doing the best they can and everyone in group can do better. Step out of black/white, either/or thinking and experiencing.

Question 6

DBT focuses on?

Answer 6

• Focuses on:
o building interpersonal as well as self-regulation skills (emotion regulation) and distress tolerance
o modifying personal and environmental factors that reinforce dysfunctional behaviors
o CBT and Mindfulness skills training to modify habitual patterns such as rigid, dichotomous thinking.
o Mindfulness training: build skills to maintain non-judgmental, present-centered attention and acceptance-based strategies
o CBT change strategies focus on behavioral analysis, modifying maladaptive behaviors, and using exposure based strategies, cognitive modification, etc.
o Capacity building
o Balances change and acceptance strategies

Question 7

DBT stage 1

Answer 7

o Stage One: Stabilization
 decrease life-threatening/suicidal behaviors and thinking, intentional self-harm
 develop therapeutic relationships and ground rules as well as behaviors that support treatment (decrease therapy interfering behaviors, e.g. frequent hospitalizations to manage distress, non-attendance, sporadic completion of homework, non-collaboration with therapists),
 harm reduction such as reduced substance abuse, eating disorders
 address quality of life issues such as unemployment or housing issues, social isolation, feeling depressed and anxious all the time
 skills training for distress tolerance, emotion regulation, and regulation of attention, i.e. stay in the present rather than ruminating or worrying
 skills training such as interpersonal skills, psychoeducation on emotion regulations, etc.

Question 8

DBT stage 2

Answer 8

o Stage Two: focus on non-traumatic emotional experiencing and reduce habitual dissociation or avoidance so that people are able to experiencing emotions fully. “In control of behavior but are in quiet desperation”. Experience without shutting down.

Question 9

DBT stage 3

Answer 9

o Stage Three: Building an ordinary life. Work on problems like interpersonal conflict, job dissatisfaction, career goals, etc.

Question 10

DBT stage 4

Answer 10

o Stage Four: Experiencing wholeness/connection. Many clients change career paths, relationships, or seek meaning through spiritual path.

Question 11

targets of treatment

Answer 11

Cutting: Need to develop alternative methods for self-soothing, distress tolerance, and emotion regulation. • Coping strategy: manage rage, venting frustration, reduce depersonalization or feelings of unreality.
• Titillation: sensation-seeking, produces feelings of euphoria, may become an addiction
• Communication/attracting attention: people may not have other ways of attracting attention, communicating suffering, or having a sense of control. May be attempt to obtain attention for distress.

Question 12

BPD affects who?

Answer 12

history of significant trauma (sexual abuse), not always but very common.

Question 13

DBT dialectical thinking

Answer 13

o Dialectics: change is constant, opposites can be integrated, ambiguity can be tolerated, work toward greater flexibility and tolerance of change. Everyone is doing the best they can and everyone in group can do better. Step out of black/white, either/or thinking and experiencing.

Question 14

ACIS

Answer 14

Designed to gather data on a persons communication and interaction skills while interacting with others in an occupation. it only identifies whether a skills is present and its effects on the current social occupation.

follows MOHO
designed off the belief that an individuals capacity to perform in social context is influenced by MOHO’s subsystems: volition, habituation, and performance skills.

only used for adults.
used in the form of an observation. observe 19 social skills which is divided into 3 communication and interaction domains: physicality, informational, relational
observe clients communication and interaction skills while engaging with others to complete an occupational task.
20-60 min

Question 15

Occupational therapy task observation scale (OTTOS)

Answer 15

look in lab manual

Question 16

BAFPE

Answer 16

Type/Purpose of Test: To assess components of functioning that are needed for daily living. There is a task-oriented assessment that looks at the person’s ability to act on the environment in goal-directed ways. There is a social interaction scale that assesses the ability to relate appropriately to other people in the environment. It also includes a client self-assessment of social behavior that provides additional information about the client’s own insight into his or her relationships with others.
Population: It was developed for both inpatient and outpatient mental health facilities, but it may also be used with developmentally or physically disabled client to gather clinical information about task-oriented functioning. Norms are only proved for the psychiatric setting.

Scoring Procedures: The administrator will fill out a rating sheet for each of the 5 tasks while the client is performing the task. General Observations will also be entered on the rating sheet. The scores will then be transferred from the rating sheet to the summary score sheet that combines all 5 tasks together. The administrator will then calculate the cognitive, performance, and affective components of each task and will combine the scores to get a parameter total for the task-oriented assessment. The administrator will also be looking at areas where the client scored high and low to gather information about strengths and weaknesses. Low scores indicate and area of difficulty.

Question 17

eating disorder- motivational interviewing

Answer 17

a directive client centered counseling style for eliciting behavior and change by helping clients to explore and resolve ambivalence. the goal is a collaborative shoulder to shoulder relationship in which the therapist and client tackle the problem together.

5 principles: express empathy, develop discrepancy avoid argumentation, roll with resistance (don’t give a lot of attention, go with it), and support self-efficacy (motivate support areas of strength or find past areas of strength).
mirroring, build relationship, no judgment.
good for addictions

Question 18

etiology of ED

Answer 18

personality- fragile and anxious personalities as well as low-self esteem, difficulties with identify, difficulty with meaningful relationships, negative self-image

biology- serotonin plays a huge role in ED

family functioning- genetics, and whole fam is affected if someone has an ED

social and cultural influences- media

Question 19

what type of ED is associated with a trauma history?

Answer 19

bulimia

Question 20

ED and CBT and mindfulness based eating disorders

Answer 20

CBT-leading evidence based treatment for adults with ED and also adapted for younger patients.
based on persons thoughts, emotions, and behaviors are interconnected and can be restricted to support new, healthier thoughts and actions.

cognitive- over evaluation of weight and shape, negative body image, core beliefs about self-worth, negative self-eval, perfectionism

behavioral- weight control behaviors including dietary restraint, restriction, binge-eating, purging, self-harm, body checking and body avoidance.

MCBT- controlling your mind, not letting your mind control you.
designed to cultivate non-judgmental and non-reactive observation and acceptance of bodily sensations, perceptions, cognitions, and emotions.
may reduce compulsive overeating, address associated behavioral and emotional dysregulation, and promote internalization of change.

Question 21

ED and OT treatment

Answer 21

stress management techniques, physical exercise, food diaries, assertiveness training, meal prep, clothes shopping, money management, education of ED, and relaxation training,.

Question 22

Co-occurring dx- typical cognitive distortions:

Answer 22

…..

Question 23

Bipolar disorder- Occupational performance problems:

Answer 23

• Difficulty completing and finishing tasks
• Cognitive difficulty (solving problems, making decisions, remembering, concentrating)
• Behavioral disturbances (motivation, task completion)
• Social changes (withdrawal, eye contact, listening skills, interpersonal conflicts)
• Physiological (sleep difficulties, restlessness, fatigue).

Question 24

Bipolar disorder- Areas of assessment in OT:

Answer 24

Bech-Rafaelsen Mania Scale - assess 11 symptoms associated w mania
Assessment of motor and process skills: evaluates quality of ADL performances and determines ass. for living.
Role Checklist: Assesses occupational role performance
Mood Continuum: provides limitations and structure for act. based on mood aleration.
Work-Environment Impact Scale: interview focusing on impact of work setting on workers performance, satisfaction, and well being from workers point of view.

Other possible assessments: OSA, COPM, AOF

Question 25

Bipolar disorder: How OT’s help:

Answer 25

• identifying triggers
• establish routines and identify roles
• psycho-education
• therapeutic use of self
• encourage engagement in meaningful occupation
• creative positive environments
• modify tasks and act. making them structured and simple

Question 26

Bipolar disorder- Intervention approaches:

Answer 26

CBT
MBCT
Interpersonal and social rhythm therapy- focuses on links btw mood symptoms, quality of social relationships, and social roles
Family focused therapy- psycho-education and skills based training group offered to family and client over 9 mon. period following an episode.
Electroconvulsive therapy- seizure inducing treatment
**Self-reflection act:

Question 27

Bipolar disorder- early intervention with youth:

Answer 27

• Provide adolescents w the opportunity to complete simple goal oriented act. promotes feelings of success and opportunities for positive feedback which can decrease low self-esteem.
• OT’s act as advocates and educators during this process. including family members, caregivers, and teachers in intervention process. OT presents opportunities to provide education on the immediate and long-term mental health benefits of structured and meaningful act.
• MOHO is the theoretical base for a majority of the assessments and interventions used w this pop.

Question 28

Bipolar disorder: Relevance of cognitive level in occupational performance (revisit ACL levels 3-6):

Answer 28

….

Question 29

Anger Management groups: Typical group structure and topics:

Answer 29

max enrollment of 10 clients. meet once a week 9-10 times for 90 min. assisted by 2 OT’s whom discuss development of therapeutic group process, explain theories and concepts, and teach and demonstrate a variety of anger management techniques.

Question 30

Anger Management groups: What are people learning and how?

Answer 30

-enhancing coping skills so that clients are able to express their anger in a constructive way and respond to anger appropriately when directed towards them.
Anger management and self-regulation groups are used in schools to help students who are unable to manage anger, which is affecting overall school performance.
-groups are provided to reduce the overall experience of intense anger, improve cognitive and behavioral coping mechanisms, and improve anger control after treatment fort he future.
-Assertive training, problem-solving training, and relaxation tech. are provided to help deal w anger.
The Anger Workbook- weekly schedule for each session.
Homework-increase group discussion and feedback (CBT)
Relaxation tech- decrease stress level
Journal (hassle log)- records anger provoking situations that occur during the week
Role playing and case studies- practice real life situations while receiving and giving constructive feedback.

(Children)
Alert program- helps understand physical response
Emotional toolbox- strategies for problems w anger
exploring feelings- learn about emotions and connecting cognition, affect and behavior

Question 31

Antisocial personality disorder- Characteristic behaviors and presentation:

Answer 31

CLUSTER B: Primarily oriented to others or toward themselves and their own needs.
-Antisocial Personality Disorder: pervasive pattern of disregard for and violation of the rights of others characterized by such things as unlawful behavioral, lying or conning, cheating, stealing, physical aggression, impulsivity, lack of remorse. Must be preceded by conduct disorder in childhood or adolescence.

Question 32

Co-occurring dx- typical cognitive distortions:

Answer 32

….

Question 33

Co-occurring dx- How should OT’s respond to relapse?
What factors contribute to relapse?
What is a relapse prevention plan and what is the role of the OT in developing relapse prevention plans?

Answer 33

II. Relapse Prevention using CBT:
A. Relapse: rates between 7l-9l%. Relapse prevention involves developing patterns of behavior and thinking that support sobriety. Relapse always indicates a failure to develop effective alternatives for dealing with day-to-day life stresses in a constructive manner. Relapse
can confront the alcoholic with the undeniable reality of his illness and need to pursue treatment, or, reinforce mistaken attitudes about the disease of alcoholism. It is imperative that alcoholics pursuing sobriety be able to recognize the precursors to relapse and develop an effective prevention plan.

   B.  	“Behavioral set-ups”:  habitual patterns developed during the active drinking periods of alcoholism 	that carry over into sobriety.  Set-ups are not willfully created, however, actions to eliminate these 	behaviors have not been taken by the alcoholic.  Action can be taken at any point in 			relapse to interrupt negative patterns of behavior.

     		l. Change in attitude:  private thoughts in which the alcoholic convinces himself 				that alcoholism is no longer a priority issue in his life and other issues are more important.
      		2. Decision to abandon positive problem-solving approaches and experiment with old behavior 		as an alternative.  Extensive use of denial systems.
      		3. Life change creates discomfort.  Makes return to drinking desirable.  Person either uses new 			strategies to cope with distress or returns to old behaviors and denies consequences of choice.

 C.	Response to relapse:  look at set-ups and focus on understanding precursors in order to avoid future 	relapse.  Modify lifestyle and reinforce relapse prevention strategies.  

 D.  	Relapse prevention (Barrett, Marlatt):  cognitive behavioral approach         

1. Skills training:  cognitive and behavior skills such as resisting social pressure to drink, 	increased assertiveness, relaxation and stress management, and interpersonal communication. 
  	2. Identify high-risk situations for relapse and behavioral indicators:
       		a. negative emotional state (35%):  such as frustration, anger, anxiety, depression, boredom were 		conditions
        		b. interpersonal conflict (l6%):  in any significant relationship at home or  work.  Increased 			arguments, conflict, confrontation. 
        		c. social pressure (20%):  either direct pressure to drink or indirect pressure by virtue of 				being in the company of others who are drinking.  Person must be assertive in counteracting 			pressure to respond by joining in drinking.  Must be a degree of self-efficacy “I can cope with 			this”.  As person does cope effectively, increases self-efficacy 	which increases relapse prevention. 
        		d. expectation of positive effects of alcohol or drug use while simultaneously ignoring negative 			consequences.  Combination of being unable to cope in high risk situations coupled with 				expectation of positive outcome will increase likelihood of relapse.  Immediate gratification 			outweighs cost of potential negative effects in future.  Cognitive distortions such as denial and 			rationalization make it easier to set up one’s 	relapse episode.  
        		e. Denial and rationalization over time:  ex.  taking home bottle of sherry just in case 				someone drops by and wants a drink, or, blaming circumstances rather than self.
        		f. Degree of life-style balance has a significant impact on the individual’s desire for 				indulgence or immediate gratification.  Balance between shoulds (external demands) and 				I want to (self-fulfillment) including enjoyed activities, leisure pursuits, time with friends.  			Self-deprecation can result in desire for indulgence and gratification.  
		 3. Treatment areas:       
		a. restructuring the environment:  reduce physical and emotional factors 					in the sequence leading to use.   Evaluation of substance abuse 						problem and general life-style pattern.  Identify and anticipate high-risk 					situations.  Diary which identifies craving patterns. Look at adequacy of 					coping strategies.  Possible skills training:  relaxation training, anger 						management, communication skills, marital therapy, social skills, stress 					management.  Emphasis on active coping and verbalization of 							methods used to cope with stressors rather than willpower.  Imagine 						high risk situation and use of effective coping to enhance self efficacy.  	Lifestyle 				changes:  diary of duties and obligations balanced with leisure. Look at health habits.  				Alternative ways to cope with cravings. 

		b. cognitive therapy:  examine connection between thoughts, feelings, and actions.  				Identify typical patterns of thinking that lead to substance use and show how to change 				these patterns to promote recovery (in psychotherapy)  
   		4. Social Support in couples and families:  promote improved communication and problem 			solving between spouses. Both need psychoeducation and ways to deal 	with conflict.

Question 34

Co-occurring dx- What is the role of the OT with pts undergoing inpatient detox?

Answer 34

stabilization, structure, routine (self-care), eating, sleep

thought diary, exercise/mvnt. social skills.

Question 35

Co-occurring dx- What are the phases of tx and the role of OT in each? (Roush article)

Answer 35

III. Read and understand Roush, (2008)
A. Stages of Treatment (read associated case study in article) Move back and forth toward Recovery phase and relapse prevention with continuous assessment and interventions matched to needs. Build connections within community, trusting relationship, structured routines and roles that are satisfying and health promoting. OT involved long term.
1. Engagement: motivational approaches, active outreach, flexibility in dealing with ambivalence or resistance to engagement attempts, practical assistance with life problems such as housing to build trust. Can last several years with no direct focus on management of substance abuse or psychiatric disability. Rather, focus on solving day to day problems in living, i.e. immediate needs of food, clothing, shelter, public support programs such as Food Stamps.

2. Persuasion:  help client to see that the benefits of actively managing COD outweigh 			benefits of continuing with maladaptive lifestyle.  Look at negative consequences of 			continuing to drink, for instance.  Continue to address real life problems to build trust.  			Introduce the possibility of living life without substance abuse and changing patterns of 			daily life to promote health.  These are difficult steps to take.  
3. Active Treatment:  skill building, developing support networks, 
4. Relapse Prevention:  use resources to maintain recovery such as peer support, faith 			community, family support - OT role: using a recovery perspective, adopt multi problem view point when they develop an occupational profile that outlines clients strengths, limitations , supportive and limiting context, occupational history, priorities, and goals.

Question 36

Co-occurring dx- What is integrated tx and why is it important?

Answer 36

• treatment that integrates substance abuse and mental health services into a seamless single system is considered to be best practice, with the most evidence supporting efficacy.

Question 37

Co-occurring dx- What are the questions associated w the CAGE screening tool?

Answer 37

• 1. Have you ever felt you should cut down on your drinking?
     
     2. Have people annoyed you by criticizing your drinking?
     3. Have you ever felt bad or guilty about your drinking?
     4. Have you ever had a drink first thing in the morning to steady your nerves or to get rid of a hangover (eye-opener)?

Question 38

Co-occurring dx- compare and contrast PTSD checklist and Depression Inventory

Answer 38

PTSD- 1-5 (“how you experienced it?”) 17 questions
Depression- 1-3 (ranges days ex: 5-7) 20 questions
both a list of symptoms/ trouble doing

Question 39

Adolescent mental health: Typical areas of occupational impairment w youth dx w conduct disorder and ODD:

Answer 39

• rest and sleep
• play and leisure
• education
• social and family participation

Question 40

Adolescent mental health: Best overall approach for eval of teens w psychiatric probs in an inpatient setting:

Answer 40

• observations, interviews, questionnaires
• informal observations will take place on daily basis while observing them in their natural setting such as; groups, leisure time w peers, meal times, and in school environment.
• creative writing, art, drama, and mind and music therapy

Question 41

Adolescent mental health: Areas of intervention for youth at risk in community setting:
How are groups used w teens and why?

Answer 41

• OT groups for HOPE each intervention group is organized into 3 major segments:
  seg 1 introductory conversation time
  seg 2 participation in a short leisure occupation
  seg 3 short closure discussion
  -in addition to group interventions referrals are made for specific individual interventions such as anxiety management

Question 42

Theoretical model of change: Identify stages of change

Answer 42

1. pre-contemplation (not ready)
2. contemplation (getting rdy)
3. preparation (ready)
4. Action
5. Maintenance