Week 8 to 15 Flashcards
What is Sleep?
Sleep is a naturally recurring state and a universal experience across all cultures. Sleep is responsible for the restoration of all bodily functions and especially important for growth and cognitive function.
Circadian Clock”
Some sleep experts believe the sleep stages are tied to our “Circadian Clock” which regulates hormones and temperatures during sleep resulting in effective or restful sleep.
Internal clock
This internal clock also regulates the “perfect” amount of sleep a person needs for best functioning
Generally 7-9 hours per night for most adults.
Functioning significantly becomes impaired when an adult is chronically sleep deprived.
Sleep debt
owes” sleep hours towards rest
What are the sleep stages?
REM sleep:
Non REM (NREM) sleep:
Poor Sleep:
Cognitive functioning ….
declines due to lack of sleep are often what adults complain about most often because of the general effects of thinking on functioning.
True or False?
Sleep is an important component to the current Practice Framework
True
A poor night’s sleep hurts your memory in two big ways:
What are they?
- Being sleepy hurts your concentration.
- Sleeping poorly means the things you learned the previous day are not fully recorded in the memory parts of your brain.
When does your brain organize what you learned during the day?
at night
What are some effects of sleep deprivation?
irritability cognitive impairment memory lapses/losses severe yawning symptoms similar to ADHD impaired immune system risk of diabetes type 11 increase heart rate/heart disease decreased reaction tremors/aches froth suppression risk of obesity decreased temperature
Too much stress can lead to problems with learning, sleep, and memory.
Describe the two types
Acute Stress:
Chronic Stress:
Acute Stress:body stress is normal important for survival; adrenaline cortisol is released; can affect bodies ability to calm down and sleep
Chronic Stress:long exposure to stress; hippo campus functions poorly, accelerated neuron death
Sleep hygiene is related behaviors that a person can do to promote good sleep.
It is habits that you do to optimize sleep. Such as what?
The most common are:?
The most common are: Sleep environment Sleep scheduling Sleep routine Lifestyle changes
Sleep Schedule
Wake up/Go to bed at the same time every day
No napping
If you are awake for more than 15 minutes in bed GET UP
Do your worrying somewhere other than your bed
Do NOT use screens during this time
Important to monitor you sleep wake cycle for patterns
Sleep Diary
Sleep Routine
Have a routine that relaxes you prior to bed. Such as what?
Turn off all screens 30-60 minutes prior to bed
Avoid eating or drinking right before bed
Sleep Disorders: Insomnia
Symptoms:
The most common sleep complaint (can be (30% of the population) transient (we all kind of have this at some time) or 9% of the population persistent-occurs all of the time)
May be associated with anxiety but many have no clear complaint
Psychophysiological insomnia (Conditioned insomnia)- individuals say that can’t sleep in a certain room or bed or they may avoid it- but object has noting to do with their insomnia
Insomnia in Psychiatric patients: common, excessive worry about not being able to sleep, try to hard to sleep, increase muscle tension
Primary Insomnia
Sleep Disorders: Insomnia
Treatment
Prescription and Nonprescription Drugs- (antihistamine/melatonin)
Cognitive Behavioral:
-Sleep Hygiene: Table 16.5-6
focus on 1 to 3 items at a time
avoid caffeine
- Stimulus Control Therapy: de-conditioning, break cycle of problems (go to bed when sleepy, use the bed only for sleeping, don’t lay in the bed and can’t sleep; awaken the same time/avoid napping)
- Sleep Restriction Therapy:increase sleep efficiency , decrease amount of time lying in bed, be aware of daytime sleepiness, don’t sleep at other times of the day,
- Relaxation Therapies: Progressive relaxation, Guided imagery (don’t do with pt who experiences hallucinations), Deep breathing
- Biofeedback: use physiologically marks to increase self-awareness
- Cognitive Training: targets negative emotional thoughts
Sleep Disorders: Hypersomnolence Disorder
Symptoms:
Excessive sleepiness that is serious, debilitating, and can be life threatening
Can be caused by: insufficient sleep, neurological dysfunction of the brain stem, distributive sleep, phase of circadian rhythm
Use sleep history questionnaire: See Table 16.2-6
If you reduce sleep by 1-2 hrs per night for a week sleepiness reaches pathological levels
Individual may lapse unexpectedly into sleep
Impacts attention, concentration, memory, high level cognitive processes
Sleep Disorders: Hypersomnolence Disorder
Treatment
Extend and regulate sleep period
Scheduled naps, lifestyle adjustment
Sleep Disorders: Narcolepsy
Symptoms:
Sleep attacks of irresistible sleepiness leading to 10-20 min of sleep, feel refreshed briefly
May occur at inappropriate times
May include hallucinations, cataplexy (partial loss of muscle tone), and sleep paralysis
REM sleep within 10 min
Prevalence: 0.02 - 0.16% of population, with familial incidence (genetic, begins before 30 yrs old)
Treatment: schedule forced naps, medication management,
Sleep Disorders: Obstructive Sleep Apnea Hypopnea
Symptoms?
Repetitive collapse of the upper airway during sleep
Results in reduced oxygen and transient arousal then respiration resumes
Cessation of breathing for 10 seconds or more
Higher Risk: male, middle age, obese, nasal abnormality
Clinical features: snoring, obese, restless sleep, nocturnal, choking, gasping while sleeping, morning headache, dry mouth
OT Treatment: weight loss, look at diet/ exercise
Sleep Disorders: Central Sleep Apnea
Occur in elderly, absence of breathing due to lack of respiratory effort, Like OSA but NO breathing is seen in abdominals or chest
Sleep Disorders: Central Sleep Apnea
What are the 3 subtypes?
3 subtypes:
- Idiopathic central sleep apnea: high CO2 in arteries, low CO2 in veins, daytime sleepiness, wake up with shortness of breath
- Cheyne-Stokes breathing: prolong hyper-pena, alternating with apena, hypo-pena, respiratory rate changes fast to slow to absent seen in older man with CHF or stroke
- Central sleep apnea co-morbid with opioid use: causes impairment of neuro-muscular respiration
Circadian Rhythm Sleep-Wake Disorders
Delayed sleep phase type: natural biological clocks run slower, more alert in the evening, more tired in the morning (night owl)
Advanced sleep phase type: shifts earlier, wake earlier, tired in the evening, early bird
Irregular sleep-wake type: sleep wake cycle is absent,, sleep is unpredictable, fragments sleep -individuals who has Alzheimer
Free running (24 hour sleep wake type): greater or less than 24 hrs and reset every morning (TBI or blind)
Shift work type: insomnia, excessive sleepiness, results in sleep deprivation
Jet Lag: disorder, travel across time zone (night owl have time traveling east, early birds have trouble traveling west)
Treatments: light of photo therapy, blue light, melatonin
Parasomnias
Non-Rapid Eye Movement
Sleep Arousal Disorders: happen in younger children
- Sleepwalking type: ambulate while sleeping, can do complex acts, risk of injury, difficult to awake, best to lead them to bed, rare in adults (peaks at 4 n 8 y/o)
- Sleep terror type: sudden arousal of fearfulness, unresponsive to stimuli, does not remember (during non-REM sleep)
Other Parasomnias: Sleep enuresis: urinating during sleep, bed wetting,
as OTs want to address embarrassment/shame
Sleep Related Movement Disorders
Restless Legs Syndrome: general twitching
Periodic Limb Movement Disorder = twitch
Sleep-related Bruxism = grinding, clenching teeth
Sleep related movement due to substances, caused by antidepressants/antihistamines,
Substance Abuse and Addictive Disorders
What substance has the most impact on mental health?
Sedatives
Substance Abuse and Addictive Disorders
What are the different type of alcohol disorders?
Alcohol Use Disorder: binge drinking; drink non-alcoholic beverages
Alcohol Intoxication: drunkenness, stumbling
Alcohol Withdrawal: seizure, delirium, if untreated can cause mortality, can occur up to 1 week after stop drinking
Alcohol-induced Persisting Amnestic Disorder: memory loss due to prolong abuse, drinking for a long period of time, rare under 35 yrs old
Alcohol-Induced Mood Disorder: depressant, 80% results in depression
Alcohol-Induced Anxiety Disorder: 80% report panic attacks, agoraphobia
Alcohol-Induced Sexual Dysfunction: unable to perform sexually
Alcohol-Induced Sleep Disorder: difficult sleeping
Other Alcohol-Related Neurological Disorders: fetal alcohol syndrome 35% of risk
Hallucinogen Related Disorders
Intoxicants: associated with panic attack, delirium, mood and anxiety
Synthetic – easily made, easily distributed, sold cheaply
Treatment: removal from substance, detoxify, prevent use in the first place
Inhalant related Disorders
Volatile substances or solvents turn into gastric fumes (aerosol more common gasoline etc) – male/white more common users
Transpulmonary: works fast, essential nervous system depressant
Opioid Treatment & Overdose
Overdose TX Methadone Therapeutic Communities Needle Exchange Narcotics Anonymous
Stimulant Related Disorders
Patterns of use
Withdrawal
Treatment
Other Substance Use and Addictive Disorders
Gambling Disorder 4 Phases http://www.gamblersanonymous.org/ga/content/recovery-program Sex (Impulse control) Video gaming (Impulse control)
EBP: Recovery from Substance Abuse Among Zimbabwean Men
Recovery is a subjective experience
Understanding substance abuse as an occupation
Positive and Negative
Findings:
Substance Abuse as our Occupation
An occupation shaping health and well-being, Our instrument for socialization and our identity, My meaningful use of time and energy
Recovery from Substance Abuse: An Ongoing Transition
Recovery from substance abuse: A change in occupational identity
EBP: Metacognition in persons with Substance abuse
Research Question Metacognition defined Measures used Findings: Applications of findings to OT practice:
What is the most widely consumed psychoactive substance in the world?
What is the most widely used illegal drug?
What disorder contributes to 2 million injuries a year in the USA?
1) Caffeine
2) Weed
3) Alcohol
Other Personality Disorders: Passive Aggressive
What is it?
Epidemiology
Diagnosis (Table 22.7)
Clinical Features (What would they look like on Intake?)
Differential Diagnosis:
Treatment:
Covert obstructionism, procrastination, stubbornness, and inefficiencies, excuses for delays, find fault in others. Try to get in a position of dependence.
Differential Dx:
Other Personality Disorders: Depressive
What is it?
Epidemiology
Diagnosis (Table 22.7)
Clinical Features (What would they look like on Intake?)
Differential Diagnosis:
Treatment:
Pessimistic, duty bound, self doubting, chronically unhappy, lonely solemn, gloomy, submissive, self deprecating
Intake:
Differential DX:
Treatment:
What are the 4 Dimensions of Temperament
Harm Avoiding
Novelty Seeking
Reward Dependence
Persistence
Define Harm Avoiding
High = pessimistic, fearful, shy, fatigable Low = optimistic, daring, outgoing, energetic
Define Novelty Seeking
High = exploratory, impulsive, extravagant, irritable Low = Reserved, deliberate, thrifty, stoical
Define Reward Dependence
High = sentimental, Open warm, affectionate
Low = detached, aloof, cold, independent
Define Persistence
High = industrious, determined, enthusiastic, perfectionist
Low = lazy, spoiled, underachiever, pragmatist
Personality Disorders Impact on Occupational performance
- Social Participation
- Emotional Modulation
- Coping
Social Participation
- Difficulty due to limited interpersonal skills
- Work to improve communication and interaction skills to improve social participation
Emotional Modulation
- Difficulty modulating emotions and responding with appropriate affect
- Dialectical Behavior Therapy
Coping
Personality Disorders Occupational Therapy Interventions
- In general OTs need to know what defense mechanisms the client is utilizing
- General treatments = mood stabilization, increased self concept, self esteem, insight, judgement, interpersonal skills, effective coping strategies, conflict resolution, social skills, assertive communication
Therapeutic Relationship
4 Strategies:
Building and maintaining a collaborative relationship
Consistency in treatment
Validation
Building and maintaining motivation for change
What are the 4 therapeutic relationship strategies ?
Therapeutic Relationship
4 Strategies:
Building and maintaining a collaborative relationship
Consistency in treatment
Validation
Building and maintaining motivation for change
Personality Disorders Occupational Therapy Interventions
- In general OTs need to know what defense mechanisms the client is utilizing
- General treatments = mood stabilization, increased self concept, self esteem, insight, judgement, interpersonal skills, effective coping strategies, conflict resolution, social skills, assertive communication
Therapeutic Relationship
4 Strategies:
Building and maintaining a collaborative relationship
Consistency in treatment
Validation
Building and maintaining motivation for change
Personality Disorders : Occupational Dysfunction & Prevention
Interpersonal skills Life skills groups Coping skills Anxiety Relaxation Activities Successful Activities Work and Employment Leisure Prevention
Creation of PEO was influenced by:
Three interdependent elements
What are they?
Person
Environment
Occupation
PEO: Person
What is this similar to?
- Person is mind, body, and spirit
- Personal skills, motivation, and self concept
- Person can be individual, group, organization, or communities
PEO: Environment
Context in which occupation takes place
Cultural
Physical
Social
Institutional/Organizational
People relate to the environment and the cues it provides to behave appropriately
Environment can have barriers, resources, or supports of occupational performance
Need to respect client’s views of Environment
PEO: Occupation
Everyday life activities that are goal directed, meaningful to individual and culturally relevant
Canadian vs. American organization of Occupations
Include tasks and activities
Vary in importance, level of complexity, and demanding characteristics
Allen defines six cognitive levels and 52 modes of performance
Range…?
Below level 1 is ….?
Level 6 is ….?
Level 4.6 is …..?
Range: 0.8 to 6.8
Below level 1 is basically comatose
Level 6 is normal functioning
Level 4.6 is minimal for living independently (predictive validity)
ACL: At what level can a person live alone?
4.6 Live alone
ACL
- 0
- 6
- 0
- 6
- 2
- 0
- 6
- 8
- 2
- 8
- 4
- 0
- 0 Premeditated activity
- 6 Social Bonding, Anticipates safety, Driving, Child care
- 0 Intonations in speech
- 6 Live alone
- 2 Discharge to street
- 0 Independent Self Care
- 6 Cause & Effect
- 8 Grab bars
- 2 Walking
- 8 Pivot Transfer
- 4 Swallow
- 0 Conscious
ACL: Level 1
Level 1
Custodial care
ACL: Level 2
Level 2
Mobile but Dependent in self care
ACL: Level 3
Level 3
24 hr S and Mod A
ACL: Level 4
Level 4
Min A IADLs
Self care I but off
Cannot adapt – Routines vital
ACL: Level 5
Level 5
Independent living
Periodic support
Poor planning
ACL: Level 6
Level 6
Independent
ACL Overview:
Cognitive level changes only through …..?
change in brain chemistry and physiology
ACL Overview:
Training: The practice and learning of routines and habits can prolong …?
independent functioning in dementia clients or those with chronic illness
Prep for Administering ACLS
Make sure lighting is adequate Space is quiet, minimize distractions Glasses or hearing aids are being used if needed Only starting stitches in place Foster rapport before starting screen
Ensure your ACLS is prepared
Running stitch: Task
Completion criteria: 3 correct running stitches in consecutive holes
Interested in seeing how you follow directions and concentrate
Can provide up to two demonstrations
Whipstitch: Task 2
Completion criteria: 3 correct whipstitches in consecutive holes including recognizing and correcting the cross in back error and the twisted lace error.
Provide demonstration
If mistakes, ask Does yours look like mine?
Can provide second demonstration
Insert problem-solving errors
Single cordovan stitch: Task 3
Completion criteria: 3 correct single cordovan stitches in consecutive holes
Self-directed problem solving
Please try and if you cannot figure it out I will show you.
Provide one verbal cue
Provide up to 2 demonstrations
Now see it completed:
Task Analysis for Cognitive Level
-Therapist’s directions
Demonstrations
Verbalizations
Number of directions
-Task selection Structure of the activity Choice and sample provided Tools Storage of materials/projects Preparation by the therapist
Defense Mechanisms: Fantasy
What is the definition?
What is an example?
(what does it look like in real life)
What personality disorder is likely to utilize?
many persons with schizoid PD, seek solace and satisfaction within themselves by creating imaginary lives & imaginary friends:
They are fearful of intimacy & closeness so they create imaginary lives
As a therapist… do not criticize, recognize their fear of closeness, remain reassuring & considerate
Defense Mechanisms: Dissociation (Denial)
What is the definition?
What is an example?
(what does it look like in real life)
What personality disorder is likely to utilize?
the replacement of unpleasant affects with pleasant ones; they may be labeled as histrionic personalities
To “erase” anxiety, they expose themselves to exciting dangers (e.g. exuberant and seductive behaviors)
As a therapist… consider using displacement (i.e. talk with the patient about the issue of denial in an unthreatening way– empathize with the denied affect without directly confronting patients with facts)
Defense Mechanisms: Isolation
What is the definition?
What is an example?
(what does it look like in real life)
What personality disorder is likely to utilize?
a characteristic of controlled, orderly persons who are often labeled as obsessive-compulsive; patients may show formal social behavior, intensified self-restraint, and obstinacy
*As a therapist… pt’s respond well to precise, systematic, and rational explanations and value efficiency, cleanliness, and punctuality
Whenever possible, therapists should allow pt’s to control their own care & should not engage in a battle of the wills
Defense Mechanisms: Projection
What is the definition?
What is an example?
(what does it look like in real life)
What personality disorder is likely to utilize?
patients attribute their own unacknowledged feelings to others; fault-finding and sensitivity to criticism
As a therapist… confrontation is discouraged– therapists should not agree with the patients’ injustice beliefs, but instead ask whether both “can agree to disagree”.
As a therapist… counterprojection is helpful (i.e. the therapist gives the pts full credit for their feelings & perceptions– they never dispute nor reinforce them
Defense Mechanisms: Splitting
What is the definition?
the people whom patients’ are feeling ambivalent are divided into good and bad
Defense Mechanisms: Passive Aggression
What is the definition?
What is an example?
(what does it look like in real life)
What personality disorder is likely to utilize?
Characterized by covert obstructionism, procrastination, stubbornness, and inefficiency
Procrastinate, resist demands for adequate performance, find excuses for delays, and finds fault with those on whom they depend, they refuse to extricate themselves from the dependent relationships
Lack assertiveness and are not direct about their own needs and wishes
Occupational Engagement Can Promote Recovery By:
Providing a sense of achievement
Facilitating the formation of identity beyond the illness
Providing opportunities for developing social connections
Providing structure to day
Providing a sense of control, self-determination and empowerment
Providing meaning, purpose; facilitates hopefulness
Facilitating symptom management
What are some Examples of specific recovery-oriented interventions:
Wellness Recovery Action Plan
The Recovery Workbook
SAMHSA’s Illness
Management and Recovery
PEO:
What are the dimension of space?
Dimension of Space
Location:
Emotional Space:
Mental Health and View of Space
PEO model enables OTs to….?
maximize fit to optimize occupational performance
PEO: Use PEO to find a match between worker preferences/abilities (Person), job demands (Occupation), and workplace environment (Environment)
Job accommodations =
change the environment or change the way the job is done (Occupation)
PEO model used to …? (hint: it’s 4 things)
to 1) structure studies
, 2) structure development of assessment tools,
3) organize interview guides, 4) structure the interventions
Narcissistic Personality Disorder
Characterized by a heightened sense of self-importance, lack of empathy, grandiose feelings of uniqueness
Underlyingly, their self-esteem is fragile & vulnerable to even minor criticism
They consider themselves special and expect special treatment
Handle criticism poorly
Ambitious to achieve fame or fortune
Sadomasochistic
Sadism =
Masochism =
Sadism = the desire to cause others pain
Masochism = the achievement of sexual gratification by inflicting pain on themselves
Canadian Triple Model
Defines how humans experience meaning through occupations and interaction between the person and environment that makes it possible
Canadian Process Practice Framework
8 steps for delivering services that promote enablement of occupations in a client-centered manner
Canadian Model of Client-Centered Enablement (CMCE)
Identifies and develops a range of enablement skills for occupations with sensitivity to collaboration, power, equity, and justice
Canadian Triple Model : View of Health & Disorder
Health and wellbeing are supported by meaningful occupations therefore occupational health means physical and mental health
Individuals can engage in occupations that provide conditions to improve health
Even with life disruptions occupations can bring wellbeing, stability, adaptation, life quality, and future possibilities
Canadian Triple Model :
Theoretical Assumptions
2 assumptions
- That humans need occupations & that occupation has therapeutic value
- Occupations bring meaning to life, structure and organize daily routines and habits and are highly personal
CMOP - E: Canadian Model of Occupation Performance and Engagement
Occupations =
Personal level components =
Essence of Person =
Environment =
Occupations = self care, leisure, and productivity
Personal level components = physical, affective, cognitive
Essence of Person = Spirituality
Environment = physical, institutional, cultural, and social
Canadian Practice Process Framework
8 action points for client centered, goal directed, and evidence based OT
1) enter/initiate,
2) set the stage,
3) assess/evaluate
4) agree on objectives/plan
5) Implement plan
6) monitor/modify
7) evaluate outcome
8) conclude/exit
CMCE: Canadian Model of Client Center and Enablement
Describes how OT can be enabling or disabling
What are examples of each?
Enabling =
Disabling =
Enabling = core of the profession, try to enable our clients in order to seek out and perform their occupations
ex: OT can provide access to occupations; can help improve occupations/value, address
Disabling = if OT always consider themselves to be the expert; we need to value the relationship between client and therapist
Application of CMOP
Canadian Occupational Performance Measure (COPM)
Theoretical approaches then chosen to further guide assessment and intervention
Residents report increased levels of motivation, empowerment, autonomy, and satisfaction, increased compliance to treatments and engagement in therapeutic interventions
Strengths of CMOP
Client centered approach enables residents focuses on what is valued and important to them
Focus on client strengths and resources rather than illness/deficits
Performance components ensures all client needs are met
COPM helps to determine appropriate referrals
CMOP helps therapists understand the client’s total environment
Helps OTs create group protocols and individual activities
Limitations of CMOP
Limited evidence outside Canada, need more research
Many therapists have difficulty with spirituality at the center when focus is occupation, also spirituality often implies religion which throw therapists and clients off
Difficult to apply to those who cannot make informed decisions
Dangers of adopting just one model of practice = such as what?
Cognitive Behavioral Frame of Reference and Pschosocial OT:
When to consider using this FOR
When there are psychological barriers to activity engagement
Most often used in behavioral health settings
Can be used along a continuum
In general CPT works best with clients who are self aware, and can reason
Used when a client is ready for change and open to developing new coping strategies
Cognitive Behavioral Frame of Reference and Pschosocial OT: Change
Clients change through reinforcement with both internal and external reinforcement providing motivation
Externally often social environment can reinforce old behaviors or be a barrier to new behaviors
Internal thoughts of client can reinforce maladaptive behaviors
CBT Techniques:
5 different techniques what are they?
-Relaxation
OTs can teach clients self initiated strategies to produce relaxation as a way to cope with stressful/anxiety producing situations
-Challenging absolutes
Used to uncover irrational beliefs
Use alternative assumptions
-Visualization
Flooding =
Systematic desensitization =
In general it can be used to used to envision real life situations for teaching purposes:
-Thought Stopping
Way to prevent automatic thoughts (such as in clients with OCD)
Simply say STOP when thoughts begin
Can also use imaginal exposure:
-Self instructions
Teach client to mentally talk to his or herself
Best Practices for OT using CBT
-OT should evaluate cognitive skills prior to beginning treatment
Thinking, processing, communication, attention span, memory, problem solving, judgement, insight
- Determine ways to reinforce and motivate for change
- Help generalize skills by varying the environment
- Facilitate coping and relapse prevention through:
OT Evaluation with Cognitive Behavioral: Self report checklists/assessments overall follow CBT as they rely on the cognitive abilities of the client
Examples of Assessments:
Self reported: Role Check list
Mental status: Folstein’s Mini Mental Status
Mood inventories: Beck’s Depression Scale
Anxiety Scales: The Stress Management Questionnaire
Life Satisfaction inventories
Cognitive level tests: ACLS and LOTCA
Occupational Engagement: Bay Area Functional Performance Evaluation (BaFPE)
ADLs: KELS, Barthel Index
OT Evaluation with Cognitive Behavioral:
In practice: Psychoeducational Groups
OT is the educator/facilitator and designs educational and skill training experiences
Requires clients to use rational thinking to apply new knowledge and skills
Examples: Medication management, living on a budget, meal planning and prep, money management, using public transportation, household safety, parenting/caregiving skills, anger management
OT Evaluation with Cognitive Behavioral:
In practice: Social and Life Skills Groups
Uses psychoeducational approach
Address basic conversational skills
Verbal and non verbal communication Starting a friendly conversation Keeping a friendly conversation going Ending a conversation Putting it all together
OT Evaluation with Cognitive Behavioral:
In Practice: Self Regulation Program
Begin with a stress management questionnaire to determine:
Determine the symptoms of stress =
What everyday situations trigger stress
Everyday activities that reduce stress
Guidelines:
Education on specific health condition and relationship with stress
Increase awareness of how stressors cause symptoms
Educate on psychological mechanism of stress
Learn new ways to manage stress
Learn to use occupations to cope
Teach prevention and self regulation
Stress importance of self regulation and self initiated use of strategies
Occupation & Meaning:
Theoretical Assumptions
- Meaning Associated with Engagement in Everyday Occupations
- Meaning and Subjective Experience
- Meaning in Everyday Life and Meaning in Life
Meaning Associated with Engagement in Everyday Occupations
Meaning is strongly connected to social context and culture
Meanings of participation (Table 5-1)
Meaning and Subjective Experience
Meaning motivates choosing, engaging, and sustaining occupations
Meaning can evolve over a life time
Meaning in Everyday Life and Meaning in Life
Occupation & Meaning:
Dimensions of meaning as psychosocial determinants of health
Meaning of connections:
Meaning of contributing:
Meaning of connections: social connections that provide info, emotional and practical support to manage healthy living (social support system)
Meaning of contributing: creating access to social supports, being able to contribution access to social supports
Occupation & Meaning:
Meaning, Loss of meaning, and meaninglessness
Meaning found in 3 ways:
4 Human needs of meaning:
- Meaning found in 3 ways:
1) doing deeds and creating work
2) life experience, encounter with people
3) suffering and adversity - 4 Human needs of meaning:
1) event has purpose
2) consistent with persons values
3) sense of control
4) self worth of the individual
Occupation & Meaning:
Assessments
Informal:
Standardized:
Informal: conversation; interview;
Standardized:
1) Engagement in meaningful activities survey (EMAS)
2) Occupational Values (Oval-9)
3) Profiles of Occupational Engagement
4) Satisfaction with Daily Occupations
Occupation & Meaning:
Engagement in meaningful activities Survey (EMAS)
Interview followed by 12 statements about meaningfulness rated on a 5 pt likert scale
“The activities I do ………”
Occupation & Meaning: Occupational Value (OVal-9)
9 item self report to evaluate which therapeutic interventions resulted in a positive change
“When I am engaged in this occupation I…..”
3 sources of everyday occupations:
Concrete/Tangible value of occupational engagement
Symbolic value of occupation at personal/cultural level
Value as a self rewarding experience
Occupation & Meaning:
Profiles of Occupational Engagement in people with Schizophrenia (POES)
1) time diary is used to gather information about pattern of occupation
2) A profile is created of the person’s occupational engagement on 9 dimensions
Daily rhythm of activity, variety and range of occupations, place, social context, extend of meaningful occupations, and routines, social interplay, interpretation, and initiating performance
Occupation & Meaning:
Satisfaction with Daily Occupations
Brief measure
9 items = work, leisure, domestic tasks, self care
Yes/no and then rated 1 - 7 on satisfaction
Occupation & Meaning: Occupational Alienation
demeaning tasks to a client
- example giving an older adult task that finds it demeaning “babyish” demeaning tasks to a client
- example giving an older adult task that finds it demeaning “babyish”
Occupation & Meaning:
4 dimensions of meaning that develop through occupational engagement:
Doing, Being, Becoming, & Belonging
Drive & Motivation for Occupation:
What is motivation?
Why humans do what they do
Motivation explains why people engage in behaviors/activities that are bad for their health -
A basic human drive that links energy and effort to a purpose or goal
Drive & Motivation for Occupation:
View of Health
Health
Humans naturally drawn to occupations for health, well-being, and survival
Drive for occupation present from birth (babies reflective actions to suck and cry to stimulate environment to meet their needs)
Assumption that there is variation in motivation from individual to individual
Drive & Motivation for Occupation:
View of Disorder
Disorder
Limited number of goal directed daily activities or pattern of apathy towards occupations
Patterns of indifference or avoidance towards activities that are developmentally important or valued by the client
Can present as self neglect
Drive & Motivation for Occupation:
Theoretical Perspectives on Motivation (Biological)
Motivation is fundamental for survival, instinctual to participate/engage
Drive theories = humans are motivated to maintain equilibrium
Drive & Motivation for Occupation:
Theoretical Perspectives on Motivation (Psychological)
External incentives
Avoid outcomes
Intrinsic incentives
Flow Theory = activities are intrinsically rewarding when goal directed, engrossed in task, and just right challenge
Drive & Motivation for Occupation:
Theoretical Perspectives on Motivation (Social)
Impact of families, communities, cultural values, and social norms of activity choice and participation
Also broader structures of policies, legislation, and regulation can inhibit or facilitate motivation:
Drive & Motivation for Occupation:
OT purpose of assessment:
1) developing and interpreting contributing factors that need to be considered in intervention
2) identifying strengths related to occupation that may help motivate
Drive & Motivation for Occupation:
What are the 4 Intervention Approaches
1) Goal setting using Goal Attainment Scaling
2) Action over Inertia
3) Personal Projects
4) Re-motivation process
Drive & Motivation for Occupation:
Define the following Intervention Approaches
- (1) Goal setting using Goal Attainment Scaling
Goal setting program for inpatient mental health = 1) affirming personal worth, 2) imagining the future, 3) establishing a sense of control, 4) setting goals for the future Identity-Oriented Goal Training
Drive & Motivation for Occupation:
Define the following Intervention Approaches
2) Action over Inertia
Designed to address inactivity in those with serious mental illness. Book can be purchased, 10 week hourly program, explores 7 dimensions of activity engagement:
Includes The Activity Engagement Measure =
Drive & Motivation for Occupation:
Define the following Intervention Approaches
3) Personal Projects
- Based on idea that humans experience well-being through engagement in projects that are personally meaningful and motivation
- Clients identify goal directed activities in daily life prior to stroke and currently, then monitor experience with projects impact on health and wellbeing
Drive & Motivation for Occupation:
Define the following Intervention Approaches
4) Remotivation process
- Grounded in MOHO theory, uses Volitional Questionnaire (therapists observe and score behaviors that are indicative of values, interests, and personal causation)
- Activity engagement through phases:
Drive & Motivation for Occupation:
Practice Principles
Engage the individual in doing
Conditions that can serve as barriers or compromise engagement should be identified and addressed
Challenges that may arise (6-2, pg 102)
Consider a wide range of occupational experiences associated with motivation
Educate individuals on motivation and activity engagement
Advocate to raise the priority of motivational issues and occupational engagement in program/service development
Drive & Motivation for Occupation: Motivation for Therapeutic Change
Health & Disorder Theoretical Perspectives Health Belief Model Theory of Planned Behavior Transtheoretical Model of Change
Drive & Motivation for Occupation: Motivation for Therapeutic Change
What are the Readiness for change (6 stages)?
Precontemplation Contemplation Determination Action Maintenance Potential for Relapse
Model of human Occupation (MOHO) :
What are the Features of MOHO?
Features of MOHO
MOHO offers a framework in which OTs can guide and structure
Occupation focused, widely used by OTs
Emphasis on subjective and contextual nature of occupations so OTs collaborate with client to enable change
Have client talk about everyday life for reflection and new perspectives
MOHO has a range of tools to understand a client’s occupational life and environment
Model of human Occupation (MOHO) :
Health =
Disorder =
Health = occupational perspective of health
Disorder = seeks to understand and address disruptions and challenges that impact choosing, organizing, and orchestrating everyday occupations
Theoretical Assumptions
Interplay among personal factors, environmental factors, and what people do (occupations)
Person and Environment are dynamically linked, this contributes to ………
how a person chooses, organizes, and performs occupations
A person’s occupations result from interaction between a…….
person’s inner characteristics (volition, habituation, performance capacity) and the environment
A person’s inner capacities, motives, abilities, and routines are shaped, maintained, and changed through engaging in …….
occupations
A person’s inner characteristics (volition, habituation, performance capacity) and the environment contribute to change ……
through occupational engagement
Volition:
Cycle of Volition:
1) Anticipating possibilities for doing =
2) Choosing what to do =
3) Experience while doing =
4) Interpreting the experience =
1) Anticipating possibilities for doing =
2) Choosing what to do =
3) Experience while doing =
4) Interpreting the experience =
Habituation:
Maintain patterns through habits and roles
Habit =
Role =
Everyday one must orchestrate a range of occupations –
Often organize into patterns and routines –
Once established a routine allows us to be efficient and integrate multiple occupations
Habit =
Role =
Performance Capacity
Objective understanding of performance =
Subjective =
Sensory, musculoskeletal, neurological, cardiopulmonary, and other bodily systems
Objective understanding of performance = Not done through MOHO, may use another FOR such as Biomechanical, Sensory integration, cognitive
Subjective = Lived experience, how people’s bodies feel to them, how they see themselves in the world
Key Concepts:
Environment
Environment
Physical, social, cultural, economic, and political
Environment can either support or hinder participation
Those with MI often experience economic, attitudinal, and systemic barriers to employment
Key Concepts:
Doing
Occupational identity =
Occupational competence =
Doing 3 interconnected levels of doing: Skills, Performance, and Participation Crafting an Occupational Life Occupational identity = Occupational competence =
MOHO Assessments
Model of Occupation Screening Tool (MOHOST)
Occupational Self Assessment (OSA)
Role Checklist
Occupational Performance History Interview II
Occupational Circumstances assessment interview & rating scale (OCAIRS)
Worker Role Interview (WRI)
Work Environment Impact Scale (WEIS)
Residential environment impact survey (REIS)
Volitional Questionnaire (VQ)
MOHOST
F=
A=
I=
R=
OT rates 24 factors relating to a person’s volition, habituation, performance, and environment
MOHOST can provide a snapshot (single intervention) or a comprehensive summary
F= Facilitates occupational participation,
A= Allows occupational participation,
I= Inhibits occupational participation,
R= Restricts occupational participation
Process and Change in Therapy:
9 dimensions of occupational engagement
1) Choose/decide =
2) Explore =
3) Commit =
4) Identify =
5) Negotiate =
6) Plan =
7) Practice =
8) Re-examine =
9) Sustain =
1) Choose/decide =
2) Explore =
3) Commit =
4) Identify =
5) Negotiate =
6) Plan =
7) Practice =
8) Re-examine =
9) Sustain =
MOHO in Practice
6 Steps of Therapeutic Reasoning
6 Steps of Therapeutic Reasoning
1) Generating questions to guide information gathering
2) Gathering information on, from and with the client
3) Creating an understanding of the client
4) Generating therapy goals and strategies
5) Implementing and monitoring therapy
6) Determining outcomes of therapy
Psychodynamic Frame of Reference and OT:
Unconscious mental life
There are things that make us feel vulnerable and we look away
Psychodynamic Frame of Reference and OT: The mind in conflict
Inner dissonance is part of the human condition (inner conflict)
Freud’s = Id, Ego, Superego are fighting
Psychodynamic Frame of Reference and OT: Past is alive in the present
As humans we view the present based on our past experiences
Disruptions or incomplete development in childhood and create emotional and interpersonal difficulties later in life
Psychodynamic Frame of Reference and OT: Transference
Client transfers expectations, templates, scripts, fears, and desires into the therapist
Countertransference =
OTs need to be able to have client’s reflect on the transference and similarities to earlier relationships
Psychodynamic Frame of Reference and OT: Defending
As the mind fights with itself, defending protects against this fighting
Defense mechanisms
Our ways of defending become patterned and habitual
Resistance, is a form of defending
Psychodynamic Frame of Reference and OT: Psychological Causation
Psychological symptoms (disrupted thoughts and feelings) serve a function and occur within a context = psychic determinism/ psychic continuity Free association =
Psychodynamic Frame of Reference and OT: Layers of consciousness (topographic model)
Conscious =
Preconscious =
Unconscious =
Conscious = what immediately aware of
Preconscious = thoughts not currently aware of, but can pull them out if we want to
Unconscious = thoughts that are actively unconscious due to suppression
Psychodynamic Frame of Reference and OT:Developmental model/ genetic viewpoint =
Psychosexual stages
Psychodynamic Frame of Reference and OT: Structural model =
Id, Ego, Superego
Psychodynamic Frame of Reference and OT:Ego Psychology
Ego helps us adapt and have coherence, identity, and organization
Ego defenses that ward off anxiety to protect self from harm
Psychodynamic Frame of Reference and OT: Self Psychology
Need for ambitions, ideals, and self esteem
Mirroring =
Psychodynamic Frame of Reference and OT: Self Psychology
Need for ambitions, ideals, and self esteem
Mirroring = as children we mirror key traits and developmental needs from those who care for us
- (can cause psychological and behavior problems later in life if we don’t see it)
Psychodynamic Frame of Reference and OT: Object relations and relational theories
Object relations = enduring patters of interpersonal function, inter relationship patterns
Humans are motivated by desire for human contact and relatedness (not sex)
Facilitating or holding environment = infants/ nurturer meets needs and wants
Transitional phenomena = relates to inanimate objects, clients hold meaning to an object (link to the mother but give distance, feeling of security)
Importance of play = use transitional object to link inner and outer realities
Attachment theory = biological need to form relationship with caregiver
Relational approach = mind is fluid, social constructed, products of social interactions
Psychodynamic Frame of Reference and OT: Psychodynamic in OT Practice: Early Influences/
–Process =
real and symbolic meaning of object/activity, response of the pt to the stimuli, feeling/thinking/acting on interpersonal relationships, and collaborate between pt and therapist
Psychodynamic Frame of Reference and OT: Psychodynamic in OT Practice: Early Influences/
- Process =
- Use of art media =
- Analytic FOR =
real and symbolic meaning of object/activity, response of the pt to the stimuli, feeling/thinking/acting on interpersonal relationships, and collaborate between pt and therapist
Process = real and symbolic meaning of object/activity, response of the pt to the stimuli, feeling/thinking/acting on interpersonal relationships, and collaborate between pt and therapist
Use of art media = clay, paints, collage
Projective assessment batteries
Analytic FOR = lack of one’s insight into unconscious impacts occupational functioning. OT used projective techniques to uncover unconscious (1970s)
Psychodynamic Frame of Reference and OT:
Therapeutic use of self
Transference =
Projection =
Containment =
Transference = past relationship is projected onto therapist
Projection = occurs when reject ones attribute and project onto another
Containment = how ct’s verbal and nonverbal is taken by the OT
Psychodynamic Frame of Reference and OT:
Clinical Supervision
Unconscious addressed to empower both supervisor and supervisee
Containment within supervision to provide a safe and secure environmentto explore difficult emotions
Reflective practice =
Peer supervision =
Reflective practice = OT must reflect and consider all possibilities
Peer supervision = want to support each other, support
OT’s to help build skills
Psychodynamic Frame of Reference and OT: Examples in Practice: Relational Model of OT
7 dynamic elements
1) `Evaluation: build relationship through:
1) creation of human with clay, 2) structured task, 3) free painting, 4) magazine collage.
2) The Interactive Process: relationship is similar to that of an infant to a mother/father
3) The setting (space and time): containment, safe place to work, provide structure
4) Choice and play: therapist nurtures
5) Materials and transformation: transformation of materials of the body and mind, connections emotions, inner world is shared with therapist
6) Sensory experience and thought: through sensory experiences, therapist is able to understand the ct’s inner world
7) The nonhuman environment: impact thoughts, feelings of the individual
The tree Theme Method (TTM)
Doing/Being/Becoming
- idea creative activities help with self exploration, help develop; help reveal inner emotions, help get to unconscious level
- by doing: painting a picture (drawing a tree) tree symbols life; growth
- being: reflect on what they created after it’s
- Becoming- having verbal convo between ct and therapist
**occurs over 5 sessions*
Sessions:
1-3:
*progressive relation, represent childhood, adolescence, and adulthood; work in silence
4:
mutual dialogue; client tells their story
5:
story telling, reflection of previous
final tree drawing about the future
usually see positive/satisfaction increase daily occupations; sustain satisfaction
Health Promotion and Wellness & the Role of OT:
Health Promotion Action Strategies
Building healthy public policy
Create supportive environments
Strengthen community actions
Develop personal skills
Reorient health services
Health Promotion and Wellness & the Role of OT:
Health as defined by WHO
a state of complete physical, mental, and social well-being
Health Promotion and Wellness & the Role of OT:
Wellness applied to those with MI
growth towards a healthy physical, mental, spiritual lifestyles in healthy environments, and reduction of comorbid conditions.
Health Promotion and Wellness & the Role of OT:
Determinants of health
Social and economic environment, physical environment, and individual characteristics and behaviors
Health Promotion and Wellness & the Role of OT: Occupation on health and wellness
Occupation based interventions and programs to support health and well-being
Health Promotion and Wellness & the Role of OT:
Environment on health and wellness
Physical, social, and economic environments impact health
Public health practices began around water supply, & waste management
Environment key
External barriers to recovery & wellness:
Health Promotion and Wellness & the Role of OT:
Behavioral changes on health and wellness
Behaviors/lifestyle either support or place at risk for overall health and wellbeing
Population level =
Health Promotion and Wellness & the Role of OT:
there’s more on this topic refer to the ppt…seems like basic knowledge
