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OTB 525- Mental Health > Week 8 to 15 > Flashcards

Week 8 to 15 Flashcards

1
Q

What is Sleep?

A

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.

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2
Q

Circadian Clock”

A

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.

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3
Q

Internal clock

A

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.

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4
Q

Sleep debt

A

owes” sleep hours towards rest

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5
Q

What are the sleep stages?

A

REM sleep:

Non REM (NREM) sleep:

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6
Q

Poor Sleep:

Cognitive functioning ….

A

declines due to lack of sleep are often what adults complain about most often because of the general effects of thinking on functioning.

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7
Q

True or False?

Sleep is an important component to the current Practice Framework

A

True

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8
Q

A poor night’s sleep hurts your memory in two big ways:

What are they?

A
  • 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.
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9
Q

When does your brain organize what you learned during the day?

A

at night

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10
Q

What are some effects of sleep deprivation?

A 
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
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11
Q

Too much stress can lead to problems with learning, sleep, and memory.
Describe the two types
Acute Stress:
Chronic Stress:

A

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

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12
Q

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:?

A 
The most common are:
Sleep environment	
Sleep scheduling
Sleep routine
Lifestyle changes
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13
Q

Sleep Schedule

A

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

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14
Q

Sleep Routine

A

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

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15
Q

Sleep Disorders: Insomnia

Symptoms:

A

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

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16
Q

Sleep Disorders: Insomnia

Treatment

A

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
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17
Q

Sleep Disorders: Hypersomnolence Disorder

Symptoms:

A

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

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18
Q

Sleep Disorders: Hypersomnolence Disorder

Treatment

A

Extend and regulate sleep period

Scheduled naps, lifestyle adjustment

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19
Q

Sleep Disorders: Narcolepsy

Symptoms:

A

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,

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20
Q

Sleep Disorders: Obstructive Sleep Apnea Hypopnea

Symptoms?

A

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

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21
Q

Sleep Disorders: Central Sleep Apnea

A

Occur in elderly, absence of breathing due to lack of respiratory effort, Like OSA but NO breathing is seen in abdominals or chest

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22
Q

Sleep Disorders: Central Sleep Apnea

What are the 3 subtypes?

A

3 subtypes:

  1. Idiopathic central sleep apnea: high CO2 in arteries, low CO2 in veins, daytime sleepiness, wake up with shortness of breath
  2. 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
  3. Central sleep apnea co-morbid with opioid use: causes impairment of neuro-muscular respiration
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23
Q

Circadian Rhythm Sleep-Wake Disorders

A

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

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24
Q

Parasomnias

A

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

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25
Q

Sleep Related Movement Disorders

A

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,

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26
Q

Substance Abuse and Addictive Disorders

What substance has the most impact on mental health?

A

Sedatives

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27
Q

Substance Abuse and Addictive Disorders

What are the different type of alcohol disorders?

A

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

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28
Q

Hallucinogen Related Disorders

A

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

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29
Q

Inhalant related Disorders

A

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

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30
Q

Opioid Treatment & Overdose

A 
Overdose TX
Methadone
Therapeutic Communities
Needle Exchange 
Narcotics Anonymous
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31
Q

Stimulant Related Disorders

A

Patterns of use
Withdrawal
Treatment

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32
Q

Other Substance Use and Addictive Disorders

A 
Gambling Disorder
4 Phases
http://www.gamblersanonymous.org/ga/content/recovery-program 
Sex (Impulse control)
Video gaming (Impulse control)
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33
Q

EBP: Recovery from Substance Abuse Among Zimbabwean Men

A

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

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34
Q

EBP: Metacognition in persons with Substance abuse

A 
Research Question
Metacognition defined
Measures used
Findings:
Applications of findings to OT practice:
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35
Q

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?

A

1) Caffeine
2) Weed
3) Alcohol

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36
Q

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:

A

Covert obstructionism, procrastination, stubbornness, and inefficiencies, excuses for delays, find fault in others. Try to get in a position of dependence.

Differential Dx:

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37
Q

Other Personality Disorders: Depressive

What is it?

Epidemiology

Diagnosis (Table 22.7)

Clinical Features (What would they look like on Intake?)

Differential Diagnosis:
Treatment:

A

Pessimistic, duty bound, self doubting, chronically unhappy, lonely solemn, gloomy, submissive, self deprecating

Intake:

Differential DX:

Treatment:

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38
Q

What are the 4 Dimensions of Temperament

A

Harm Avoiding
Novelty Seeking
Reward Dependence
Persistence

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39
Q

Define Harm Avoiding

A 
High = pessimistic, fearful, shy, fatigable
Low = optimistic, daring, outgoing, energetic
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40
Q

Define Novelty Seeking

A 
High = exploratory, impulsive, extravagant, irritable
Low = Reserved, deliberate, thrifty, stoical
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41
Q

Define Reward Dependence

A

High = sentimental, Open warm, affectionate

Low = detached, aloof, cold, independent

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42
Q

Define Persistence

A

High = industrious, determined, enthusiastic, perfectionist

Low = lazy, spoiled, underachiever, pragmatist

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43
Q

Personality Disorders Impact on Occupational performance

  • Social Participation
  • Emotional Modulation
  • Coping
A

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

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44
Q

Personality Disorders Occupational Therapy Interventions

A
  • 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

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45
Q

What are the 4 therapeutic relationship strategies ?

A

Therapeutic Relationship
4 Strategies:
Building and maintaining a collaborative relationship
Consistency in treatment
Validation
Building and maintaining motivation for change

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46
Q

Personality Disorders Occupational Therapy Interventions

A
  • 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

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47
Q

Personality Disorders : Occupational Dysfunction & Prevention

A 
Interpersonal skills
Life skills groups
Coping skills
Anxiety
Relaxation Activities
Successful Activities 
Work and Employment
Leisure
Prevention
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48
Q

Creation of PEO was influenced by:
Three interdependent elements

What are they?

A

Person
Environment
Occupation

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49
Q

PEO: Person

What is this similar to?

A
  • Person is mind, body, and spirit
  • Personal skills, motivation, and self concept
  • Person can be individual, group, organization, or communities
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50
Q

PEO: Environment

A

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

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51
Q

PEO: Occupation

A

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

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52
Q

Allen defines six cognitive levels and 52 modes of performance

Range…?
Below level 1 is ….?
Level 6 is ….?
Level 4.6 is …..?

A

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)

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53
Q

ACL: At what level can a person live alone?

A

4.6 Live alone

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54
Q

ACL

  1. 0
  2. 6
  3. 0
  4. 6
  5. 2
  6. 0
  7. 6
  8. 8
  9. 2
  10. 8
  11. 4
  12. 0
A
  1. 0 Premeditated activity
  2. 6 Social Bonding, Anticipates safety, Driving, Child care
  3. 0 Intonations in speech
  4. 6 Live alone
  5. 2 Discharge to street
  6. 0 Independent Self Care
  7. 6 Cause & Effect
  8. 8 Grab bars
  9. 2 Walking
  10. 8 Pivot Transfer
  11. 4 Swallow
  12. 0 Conscious
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55
Q

ACL: Level 1

A

Level 1

Custodial care

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56
Q

ACL: Level 2

A

Level 2

Mobile but Dependent in self care

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57
Q

ACL: Level 3

A

Level 3

24 hr S and Mod A

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58
Q

ACL: Level 4

A

Level 4
Min A IADLs
Self care I but off
Cannot adapt – Routines vital

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59
Q

ACL: Level 5

A

Level 5
Independent living
Periodic support
Poor planning

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60
Q

ACL: Level 6

A

Level 6

Independent

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61
Q

ACL Overview:

Cognitive level changes only through …..?

A

change in brain chemistry and physiology

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62
Q

ACL Overview:

Training: The practice and learning of routines and habits can prolong …?

A

independent functioning in dementia clients or those with chronic illness

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63
Q

Prep for Administering ACLS

A 
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

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64
Q

Running stitch: Task

A

Completion criteria: 3 correct running stitches in consecutive holes
Interested in seeing how you follow directions and concentrate
Can provide up to two demonstrations

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65
Q

Whipstitch: Task 2

A

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

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66
Q

Single cordovan stitch: Task 3

A

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:

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67
Q

Task Analysis for Cognitive Level

A

-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
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68
Q

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?

A

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

69
Q

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?

A

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)

70
Q

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

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

71
Q

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?

A

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

72
Q

Defense Mechanisms: Splitting

What is the definition?

A

the people whom patients’ are feeling ambivalent are divided into good and bad

73
Q

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?

A

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

74
Q

Occupational Engagement Can Promote Recovery By:

A

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

75
Q

What are some Examples of specific recovery-oriented interventions:

A

Wellness Recovery Action Plan

The Recovery Workbook
SAMHSA’s Illness

Management and Recovery

76
Q

PEO:

What are the dimension of space?

A

Dimension of Space
Location:
Emotional Space:
Mental Health and View of Space

77
Q

PEO model enables OTs to….?

A

maximize fit to optimize occupational performance

78
Q

PEO: Use PEO to find a match between worker preferences/abilities (Person), job demands (Occupation), and workplace environment (Environment)

Job accommodations =

A

change the environment or change the way the job is done (Occupation)

79
Q

PEO model used to …? (hint: it’s 4 things)

A

to 1) structure studies
, 2) structure development of assessment tools,
3) organize interview guides, 4) structure the interventions

80
Q

Narcissistic Personality Disorder

A

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

81
Q

Sadomasochistic
Sadism =
Masochism =

A

Sadism = the desire to cause others pain

Masochism = the achievement of sexual gratification by inflicting pain on themselves

82
Q

Canadian Triple Model

A

Defines how humans experience meaning through occupations and interaction between the person and environment that makes it possible

83
Q

Canadian Process Practice Framework

A

8 steps for delivering services that promote enablement of occupations in a client-centered manner

84
Q

Canadian Model of Client-Centered Enablement (CMCE)

A

Identifies and develops a range of enablement skills for occupations with sensitivity to collaboration, power, equity, and justice

85
Q

Canadian Triple Model : View of Health & Disorder

A

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

86
Q

Canadian Triple Model :
Theoretical Assumptions
2 assumptions

A
  • 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
87
Q

CMOP - E: Canadian Model of Occupation Performance and Engagement

Occupations =
Personal level components =
Essence of Person =
Environment =

A

Occupations = self care, leisure, and productivity

Personal level components = physical, affective, cognitive

Essence of Person = Spirituality

Environment = physical, institutional, cultural, and social

88
Q

Canadian Practice Process Framework

8 action points for client centered, goal directed, and evidence based OT

A

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

89
Q

CMCE: Canadian Model of Client Center and Enablement

Describes how OT can be enabling or disabling
What are examples of each?
Enabling =
Disabling =

A

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

90
Q

Application of CMOP

A

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

91
Q

Strengths of CMOP

A

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

92
Q

Limitations of CMOP

A

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?

93
Q

Cognitive Behavioral Frame of Reference and Pschosocial OT:

When to consider using this FOR

A

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

94
Q

Cognitive Behavioral Frame of Reference and Pschosocial OT: Change

A

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

95
Q

CBT Techniques:

5 different techniques what are they?

A

-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

96
Q

Best Practices for OT using CBT

A

-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:
97
Q

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:

A

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

98
Q

OT Evaluation with Cognitive Behavioral:

In practice: Psychoeducational Groups

A

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

99
Q

OT Evaluation with Cognitive Behavioral:

In practice: Social and Life Skills Groups

A

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
100
Q

OT Evaluation with Cognitive Behavioral:

In Practice: Self Regulation Program

A

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

101
Q

Occupation & Meaning:
Theoretical Assumptions

  • Meaning Associated with Engagement in Everyday Occupations
  • Meaning and Subjective Experience
  • Meaning in Everyday Life and Meaning in Life
A

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

102
Q

Occupation & Meaning:

Dimensions of meaning as psychosocial determinants of health
Meaning of connections:
Meaning of contributing:

A

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

103
Q

Occupation & Meaning:

Meaning, Loss of meaning, and meaninglessness

Meaning found in 3 ways:
4 Human needs of meaning:

A
  • 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
104
Q

Occupation & Meaning:
Assessments

Informal:
Standardized:

A

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

105
Q

Occupation & Meaning:

Engagement in meaningful activities Survey (EMAS)

A

Interview followed by 12 statements about meaningfulness rated on a 5 pt likert scale
“The activities I do ………”

106
Q 
Occupation & Meaning:
Occupational Value (OVal-9)
A

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

107
Q

Occupation & Meaning:

Profiles of Occupational Engagement in people with Schizophrenia (POES)

A

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

108
Q

Occupation & Meaning:

Satisfaction with Daily Occupations

A

Brief measure
9 items = work, leisure, domestic tasks, self care
Yes/no and then rated 1 - 7 on satisfaction

109
Q

Occupation & Meaning: Occupational Alienation

A

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”
110
Q

Occupation & Meaning:

4 dimensions of meaning that develop through occupational engagement:

A

Doing, Being, Becoming, & Belonging

111
Q

Drive & Motivation for Occupation:

What is motivation?
Why humans do what they do

A

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

112
Q

Drive & Motivation for Occupation:

View of Health

A

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

113
Q

Drive & Motivation for Occupation:

View of Disorder

A

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

114
Q

Drive & Motivation for Occupation:

Theoretical Perspectives on Motivation (Biological)

A

Motivation is fundamental for survival, instinctual to participate/engage

Drive theories = humans are motivated to maintain equilibrium

115
Q

Drive & Motivation for Occupation:

Theoretical Perspectives on Motivation (Psychological)

A

External incentives

Avoid outcomes

Intrinsic incentives

Flow Theory = activities are intrinsically rewarding when goal directed, engrossed in task, and just right challenge

116
Q

Drive & Motivation for Occupation:

Theoretical Perspectives on Motivation (Social)

A

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:

117
Q

Drive & Motivation for Occupation:

OT purpose of assessment:

A

1) developing and interpreting contributing factors that need to be considered in intervention
2) identifying strengths related to occupation that may help motivate

118
Q

Drive & Motivation for Occupation:

What are the 4 Intervention Approaches

A

1) Goal setting using Goal Attainment Scaling
2) Action over Inertia
3) Personal Projects
4) Re-motivation process

119
Q

Drive & Motivation for Occupation:
Define the following Intervention Approaches
- (1) Goal setting using Goal Attainment Scaling

A 
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
120
Q

Drive & Motivation for Occupation:
Define the following Intervention Approaches
2) Action over Inertia

A

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 =

121
Q

Drive & Motivation for Occupation:
Define the following Intervention Approaches

3) Personal Projects

A
  • 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
122
Q

Drive & Motivation for Occupation:
Define the following Intervention Approaches

4) Remotivation process

A
  • 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:
123
Q

Drive & Motivation for Occupation:

Practice Principles

A

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

124
Q

Drive & Motivation for Occupation: Motivation for Therapeutic Change

A 
Health & Disorder
Theoretical Perspectives
Health Belief Model
Theory of Planned Behavior
Transtheoretical Model of Change
125
Q

Drive & Motivation for Occupation: Motivation for Therapeutic Change

What are the Readiness for change (6 stages)?

A 
Precontemplation
Contemplation
Determination
Action
Maintenance
Potential for Relapse
126
Q

Model of human Occupation (MOHO) :

What are the Features of MOHO?

A

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

127
Q

Model of human Occupation (MOHO) :

Health =

Disorder =

A

Health = occupational perspective of health

Disorder = seeks to understand and address disruptions and challenges that impact choosing, organizing, and orchestrating everyday occupations

128
Q

Theoretical Assumptions

A

Interplay among personal factors, environmental factors, and what people do (occupations)

129
Q

Person and Environment are dynamically linked, this contributes to ………

A

how a person chooses, organizes, and performs occupations

130
Q

A person’s occupations result from interaction between a…….

A

person’s inner characteristics (volition, habituation, performance capacity) and the environment

131
Q

A person’s inner capacities, motives, abilities, and routines are shaped, maintained, and changed through engaging in …….

A

occupations

132
Q

A person’s inner characteristics (volition, habituation, performance capacity) and the environment contribute to change ……

A

through occupational engagement

133
Q

Volition:

Cycle of Volition:

1) Anticipating possibilities for doing =
2) Choosing what to do =
3) Experience while doing =
4) Interpreting the experience =

A

1) Anticipating possibilities for doing =
2) Choosing what to do =
3) Experience while doing =
4) Interpreting the experience =

134
Q

Habituation:

Maintain patterns through habits and roles
Habit =
Role =

A

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 =

135
Q

Performance Capacity

Objective understanding of performance =

Subjective =

A

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

136
Q

Key Concepts:

Environment

A

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

137
Q

Key Concepts:

Doing

Occupational identity =
Occupational competence =

A 
Doing
3 interconnected levels of doing: Skills, Performance, and Participation
Crafting an Occupational Life
Occupational identity = 
Occupational competence =
138
Q

MOHO Assessments

A

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)

139
Q

MOHOST

F=
A=
I=
R=

A

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

140
Q

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 =

A

1) Choose/decide =
2) Explore =
3) Commit =
4) Identify =
5) Negotiate =
6) Plan =
7) Practice =
8) Re-examine =
9) Sustain =

141
Q

MOHO in Practice

6 Steps of Therapeutic Reasoning

A

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

142
Q

Psychodynamic Frame of Reference and OT:

Unconscious mental life

A

There are things that make us feel vulnerable and we look away

143
Q

Psychodynamic Frame of Reference and OT: The mind in conflict

A

Inner dissonance is part of the human condition (inner conflict)
Freud’s = Id, Ego, Superego are fighting

144
Q

Psychodynamic Frame of Reference and OT: Past is alive in the present

A

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

145
Q

Psychodynamic Frame of Reference and OT: Transference

A

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

146
Q

Psychodynamic Frame of Reference and OT: Defending

A

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

147
Q

Psychodynamic Frame of Reference and OT: Psychological Causation

A 
Psychological symptoms (disrupted thoughts and feelings) serve a function and occur within a context = psychic determinism/ psychic continuity
Free association =
148
Q

Psychodynamic Frame of Reference and OT: Layers of consciousness (topographic model)

Conscious =
Preconscious =
Unconscious =

A

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

149
Q

Psychodynamic Frame of Reference and OT:Developmental model/ genetic viewpoint =

A

Psychosexual stages

150
Q

Psychodynamic Frame of Reference and OT: Structural model =

A

Id, Ego, Superego

151
Q

Psychodynamic Frame of Reference and OT:Ego Psychology

A

Ego helps us adapt and have coherence, identity, and organization
Ego defenses that ward off anxiety to protect self from harm

152
Q

Psychodynamic Frame of Reference and OT: Self Psychology

A

Need for ambitions, ideals, and self esteem

Mirroring =

153
Q

Psychodynamic Frame of Reference and OT: Self Psychology

A

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)
154
Q

Psychodynamic Frame of Reference and OT: Object relations and relational theories

A

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

155
Q

Psychodynamic Frame of Reference and OT: Psychodynamic in OT Practice: Early Influences/
–Process =

A

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

156
Q

Psychodynamic Frame of Reference and OT: Psychodynamic in OT Practice: Early Influences/

  • Process =
  • Use of art media =
  • Analytic FOR =
A

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)

157
Q

Psychodynamic Frame of Reference and OT:

Therapeutic use of self
Transference =
Projection =
Containment =

A

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

158
Q

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 =

A

Reflective practice = OT must reflect and consider all possibilities

Peer supervision = want to support each other, support
OT’s to help build skills

159
Q

Psychodynamic Frame of Reference and OT: Examples in Practice: Relational Model of OT

7 dynamic elements

A

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

160
Q

The tree Theme Method (TTM)

Doing/Being/Becoming

A
  • 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

161
Q

Health Promotion and Wellness & the Role of OT:

Health Promotion Action Strategies

A

Building healthy public policy

Create supportive environments

Strengthen community actions

Develop personal skills

Reorient health services

162
Q

Health Promotion and Wellness & the Role of OT:

Health as defined by WHO

A

a state of complete physical, mental, and social well-being

163
Q

Health Promotion and Wellness & the Role of OT:

Wellness applied to those with MI

A

growth towards a healthy physical, mental, spiritual lifestyles in healthy environments, and reduction of comorbid conditions.

164
Q

Health Promotion and Wellness & the Role of OT:

Determinants of health

A

Social and economic environment, physical environment, and individual characteristics and behaviors

165
Q

Health Promotion and Wellness & the Role of OT: Occupation on health and wellness

A

Occupation based interventions and programs to support health and well-being

166
Q

Health Promotion and Wellness & the Role of OT:

Environment on health and wellness

A

Physical, social, and economic environments impact health

Public health practices began around water supply, & waste management

Environment key

External barriers to recovery & wellness:

167
Q

Health Promotion and Wellness & the Role of OT:

Behavioral changes on health and wellness

A

Behaviors/lifestyle either support or place at risk for overall health and wellbeing

Population level =

168
Q

Health Promotion and Wellness & the Role of OT:

A

there’s more on this topic refer to the ppt…seems like basic knowledge

OTB 525- Mental Health (4 decks)

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