psychosocial 1

Why do OTs use groups?

"Client-centered groups offer a structured way to facilitate client self-expression, awareness of choices, and empowerment for self-direction"

OT quote

"Man, through the use of his hands, as they are energized by the mind and will, can influence the state of his own health."

Catharsis

"ahah" moment -emotional release

What is a 'group'?

"an aggregate of people who share a common purpose which can be attained only by group members interacting and working together"

Group BUILDING AND MAINTENANCE ROLES:

-Elaborator -Coordinator -Orienter -Evaluator-critic -Energizer -Procedural Technician -Recorder

operant conditioning

Proposed by Edwin Thorndike (1898) who concluded that when a response is followed by a positive event it is more likely to be repeated; conversely, if a response is followed by a negative event it is likely to cease.

conditioned response (CR)

A response elicited by a conditioned stimulus !bell in the above example> alone. that is, without the presentation of the unconditioned stimulus (food in the above example).

Displacement

Shifting repressed desires and impulses from a dangerous object to one that is more safe and acceptable

positive psychology

A science of positive subjective experience, positive individual traits, and positive institutions promises to improve quality of life and prevent the pathologies that arise when life is barren and meaningless.

core of treatment

Client's Values, Beliefs, and Spirituality surrounding areas that influence these areas are -Practitioner Values, Beliefs, and Spirituality -Institutional Mission and Vision and Professional Values

mental illness

Diagnosis of a mental disorder (e.g., depression, schizophrenia, anxiety, etc.) with low levels of functioning

Language Dysfunction

Dysarthia vs. Unusual Content - Echolalia - Clanging - Neologism - Loose associations - Perseveration - Tangentiality

According to Seligman and Csikszentmihalyi

The disease model of treating mental illness has been helpful but not as effective as it might be. Instead, they see the greater strides as coming from a perspective focused on systematically building competency, not on correcting weakness (a public health approach). The human strengths that act as buffers in mental illness include: -Courage; future mindedness; optimism; interpersonal skills; faith; work ethic; hope; honesty; perseverance; the capacity for flow; insight.

cognitive restructuring.

The focus of related treatments generally is to alter cognitions and cognitive processes in order to facilitate behavioral and emotional changes.

Multicultural values

Understanding is key to your "therapeutic use of self"

Psychiatric vs Psychosocial

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Leadership Styles

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PPT: Occupational Therapy and Public Health

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Role of Leader's Values in the Group (and in Intervention)

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reading : mental health

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reading: Psychological theories and their treatment methods in mental health practice

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reading: a public health approach to mental health

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How do our values develop?

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PPT: Self-Awareness and Values

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PPT: THERAPEUTIC GROUPS IN OT

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reading: HS Ch. 5 Role of the Leader in the Functional Group

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reading: Intro to positive psychology

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PPT: Positive Psychology

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Leadership Skills

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PPT: Psychosocial Dimensions of Occupational Function

VVVv review: -well-being = in balance, need to restore energy -values allow clients to set goals, importance of functions

Client Factors (OTPF-III)

Values, beliefs, and spirituality are included in the Occupational Therapy Practice Framework -Table 2. Page S22

Meaning

We are at our best when we dedicate time to something greater than ourselves. This might be religious faith, community work, family, politics, a charity, a professional or creative goal, etc.

Constructs of Well-Being

Wellbeing is achieved when identifying what features constitute a quality life, that life is balanced, and it results in feelings of satisfaction.

principle of behaviorism

all behavior is learned -not consistent with the philosophy and practice of occupational therapy, which acknowledges that behavior can be influenced by a wide array of factors, such as interaction with the environment and sensory modulation, in addition to learning

Tier 1—Universal services are provided to

all individuals with or without mental health or behavioral problems, including those with disabilities and illnesses

explicit memory

also referred to as declarative memory, is conscious long-term memory that is easily and intentionally recalled and recited -retrievable

Self Concept

an idea of the self constructed from the beliefs one holds about oneself and the responses of others -how does this person describe themselves, what is important to share

Attributions are

an individual's beliefs about cause-and-effect relationships. -Occupational therapists using a cognitive approach may help clients make more rational and adaptive attributions to support the individual's roles and routines.

A sociogram

an instrument that provides data on a communication pattern in the group. It charts specifically who talks to whom. By using this technique, the observer can follow the flow of the conversation and identify members who speak often, members who speak seldom, and members who receive comments or questions

Application

apply what they did and come into the next session and describe their outcome

ier 3-Intensive interventions

are provided for individuals with identified mental, emotional, or behavioral disorders that limit daily functioning, interpersonal relationships, feelings of emotional well-being, and the ability to cope with challenges in daily life. It is well documented that people with serious mental illness experience occupational disruptions and higher incidences of many chronic medical conditions

Tangentiality

tendency to speak about topics unrelated to the main topic of discussion. -off topic, like ADHD

psychoanalytic theories now recognize

that change takes place in the pres ence of another person, and we can no longer think that change takes place in an individual alone

leadership

the ability to promote those behaviors that lead to the satisfaction of group needs

Selective Attention

the capacity for or process of reacting to certain stimuli selectively when several occur simultaneously. -able to focus on task at hand

Pleasure is

the good feeling that comes from satisfying homeostatic needs such as hunger, sex, and bodily comfort.

Enjoyment refers to

the good feelings people experience when they break through the limits of homeostasis--when they do something that stretches them beyond what they were--in an athletic event, an artistic performance, a good deed, a stimulating conversation.

Groups of neurons form brain regions, such as

the hindbrain, midbrain, and fore brain

Member Role Observation

the members' names are placed at the top of the form, and a checkmark is placed in the column corresponding to the role that the member plays most often in the group. By filling out this form, lead ers can quickly arrive at a rating of the different types of roles that were as sumed by the participants in the group. This form also allows the observer to note any important roles that were not assumed by group members.

Self-determination theory investigates three related human needs:

the need for competence, the need for belongingness, and the need for autonomy

Body Image

the perception that a person has of their physical self and the thoughts and feelings that result from that perception. These feelings can be positive, negative or both, and are influenced by individual and environmental factors

an efficacy expectation is

the person's belief that he or she can, in fact, perform the behavior necessary to produce the desired outcome despite obstacles.

"positivism;'

the research perspective that assumes that scientific knowledge can only come from studying and measuring directly observable phenomenon

The task in a task group is not the point of the group!!!

the task is a vehicle

behaviors

the ways in which group members react to a particular pattern or style of leadership

functions

the ways in which the leader helps the group achieve its goals and strengthen itself

Altruism

therapeutic because it gives a sense of purpose knowing you can give back

Loose associations

thread that unites phrases -ex: "I like the color blue, my car is blue, I feel blue, I wish I had a job..."

Co-leadership

two leaders equally positioned, sharing the responsibilities of leadership

The field of positive psychology at the subjective level is about valued subjective experiences:

well-being, contentment, and satisfaction (in the past); hope and optimism (for the future); and flow and happiness (in the present).

Sharing

what specifically/how do you want to share -what prompts to ask

Generalizing

what to do now, how should the group apply/use this information

Processing

what to take away from it -deeper meaning -functional impact

implicit memory

which is an indirect, unconscious form of memory -just know how

It is important to know that OT originated in

working with people with mental illness

Group cohesiveness

you belong here, everyone in the group has something in common

Imitative behavior

you, as an OT and a leader, are the role model of behavior for the group

Psychosocial Responses to Illness and Disability

• All-encompassing, including the emotional response to mental or physical disability • Impacts all areas of occupation • Can influence and change client factors, performance skills, and patterns

to increase the effectiveness of the group

• At the beginning of any group's life, help the group come to a clear under standing of the goals that it wants to reach. • Help the group become aware of its own procedures. • Help the group understand the skills, talents, and resources within its own membership. • Help the group develop group methods of evaluation so that both leader and members can find ways of improving their procedures. • Help the group learn to accept new ideas and members without conflict. • Assist the group in creating new tasks and terminating outdated ones.

Experience of self and time

• Body image • Self concept • Self-esteem -all impact function

Thought: DYSFUNCTION

• Concrete thinking • Delusions • Obsessions -concrete vs abstract = concrete is straight forward (ex: autism) and abstract has gray areas (ex: excessive with schizophrenia) -obsessions, won't stray from beliefs -delusions = build trust (follow through, be direct) --> orient/inform

DYSFUNCTION of Perception and Sensation

• Distorted sense of time • Poor visual perception & body awareness • Hyper- or hyposensitivity • Decreased pain & temperature sensitivity • Hallucinations -could lack a sense of time or awareness -hyper = easily triggered -hypo = information passing over them -decreased pain and temp sensitivity = risk for self harm -hallucination = auditory most common, happens with all senses though

Thought: FUNCTION

• Intellect • Abstraction • Reasoning • Judgment • Analysis -adaptable, can come to a decision

DYSFUNCTION of Affect

• Lability • Depression • Mania -side effects from Rx can effect this -can be simply out of norm for specific person

Affect

• Observable behavior • Change can be from illness or secondary to treatment or intervention

when selecting a group activity ...

• The goals of the activity should have meaning for the group members. The meaning of any activity will vary, depending on the stages of development of the group. The activity should be useful to individual members and re lated to their interests and roles. • The group members should be able to participate in choosing or adapting the given activity, thus assuring a minimum level of self-initiated mental or physical participation in the process. • The task should enable members to take an active role in the group. They should be interested in the task; the demands of the task should elicit an adaptive response, and the members' response should be supported by its organization at the subcortical level. • The activity should be adaptable and assessable according to member skills, ages, or performance levels. This includes an awareness of the indi vidual's relationship to and role in the group.

psychosocial

• The psychological and social factors that influence mental health • Addresses the interpersonal aspects as they relate to possible problem situations, diseases, illness, or hospitalization • How a person adjusts and relates their body to the social environment -ex: if I place high values on physical appearance and now have to use a wheelchair = new opinion of self (neg)

Orientation

• Time, place, person • Problems usually in this order -most patients know their name, -places and time more effected (time most significantly effected)

2 categories of leadership function

task function maintenance function

brain plasticity,

"the ability of the nervous system to change" indicates that neurons grow and change throughout the lifespan in reaction to new experiences through the growth of new neurons and the dendritic branching of existing neurons to connect with other neurons

unconditioned response

(UCRl) A response that is reliably produced by a desired Stimulus <food in the above example> without prior training <Gormezano, Prokasy, & Thompson, 1987>.

Neurotransmitter problems may include:

(a) excessive or insufficient amounts of neurotransmitter substances in the synapse (b) too few receptor sites on the postsynaptic membrane (c) the presence or absence of other chemicals that interfere with neural transmission (d) the interrelationships between different neurotransmitter systems (environmental factors such as stress can also inhibit neural transmission)

The hypothalamus regulates endocrine system functioning in one of two ways:

(l) by releasing hormones directly into the bloodstream, and (2) by emitting hormone release factors, which stimulate the anterior pituitary gland to release the appropriate hormone into the bloodstream. -hormones circulate throughout the body until they bind to target receptors.

Sensory processing:

- Attaining information via senses - Cognitive processing & interpreting the information -all senses have to be in a healthy place to absorb information

Higher-level cognition

- Attention - Memory - Perception - Thought - Sequencing - Emotions - Experience of self and time -perception = the way you interpret it (sensory info)

Global mental functions

- Consciousness - Orientation - Temperament and personality - Energy and drive - Sleep (physiological process) -orientation = person, place, time (situation, do I know why I am here)

Mental Illness

- Difficulty recognizing and expressing emotions/needs - Poor self-esteem - Low self-confidence - Imbalance --> stress! • Poor interpersonal relationships • Difficulty with ADLs • Decreased employment opportunities -poor self-esteem = know by confidence/perception of self (ex: I am not good at this), mumble, poor eye contact, withdrawal from activity -imbalance = increased stress = symptoms increase

Mental Health

- Organize and express thoughts, feelings, and actions appropriately - Positive attitude toward self - Personal growth, life-long learning - Balanced lifestyle - Responsible for actions - Accurate perceptions of reality - Mastery of work, leisure, self-care - Ability to adapt -interested in learning/developing -able to consider adaptation as well

Level 2: Conventional

-"Good boy" and "nice girl" orientation -Characterized by conformity to social conventions and expectations -"I probably should...because everyone expects me to." -Law and order orientation -Characterized by respect for authority and society's laws -"I ought to... because of duty to obey the rules." -about perception of self based on others (someone you admires, parent, peers, boss, etc., opinion of you) -recognizes and follows laws and order -wants recognition from others

Advisor (Laissez-faire)

-"Hands-off" style of leader -Group is on its own -Unproductive -Lower morale -Uses: consultation, evaluation of group members, groups that need to explore capabilities and limitations -leader takes on an advisory role -provides resources, but group run -functioning at a high level, focusing on the group members = specific functions, but can be unproductive (lack of efficiency)

Historical Overview Cont...

-1800s: Moral Treatment Philosophy -1917: National Society for the Promotion of OT -1946: National Mental Health Act -1963: Community Mental Health Centers Act -1952: DSM first published -lit a fire = those participating in occupation had better mental health -National Mental Health Act = promoting mental health

FLOW

-A way of achieving meaning and happiness -Facilitated by engagement in purposeful/meaningful activities -Can be observed by OT's during treatment -Underscores the importance of the just-right challenge in OT intervention -so immersed in something that you forget about time -be in mind of what takes us to flow

What will be OT's future in MH?

-AOTA has targeted ways to redevelop mental health (public health approaches) -Mental health services are now promoted in school settings and in the community

Tier I: Promotion of MH (Universal Interventions)

-Addressing decreasing levels of physical activities across the whole population -Developing coping strategies and resiliency in children -Targeting older populations who are isolated -Implementation of supports to enhance the participation of life-enhancing activities

Equality

-All individuals have the same fundamental human rights -Demonstrated by fairness and impartiality -even if you disagree, everyone gets the same treatment -not all patients are going to be of the same ethical background (ex: could have to treat someone who is a criminal, still have to respect them and care for them according to their condition)

7 Core OT Professional Values

-Altruism -Equality -Freedom -Justice -Dignity -Truth -Prudence

Sigmund Freud: Early 1900's

-Austrian neurologist--father of psychiatry -He believed illness was due to unconscious, conflicts from past -He developed psychoanalysis --"talking cure"

OT professional values

-Beliefs and principles that govern practice -Clarify expectations between the recipient and the provider -Empower the profession and build trust among ourselves and with others -we are required to respect our clients, they don't need to give it back

Future of mental health treatment

-Brain imaging has become critical to MH research -Research shows that structures of the brain are changed as a result of our life experiences -Trauma-informed treatment

Positive Psychology (late 1990's)

-Building a meaningful and rewarding life -Developed from behavioral theories - i.e. cognitive behavioral therapy -Looks at character strengths and promotes acceptance of individual positive attributes -what makes you happy, motivates you, makes you mindful -optimistic perspective (neutral to positive) -self talk/self honesty/self communication -OT is adapting to this

Client-Centered Approach

-Clients are no longer seen as passive vessels responding to stimuli. -Clients are seen as decision-makers with choices, preferences, and the possibility of becoming masterful and efficacious -Ex. The WRAP (Wellness Recovery Action Plan) -knowing the patient and they capacity -client is actively involved in their care -WRAP = client provides information on self (reactions/what hypes them up, getaways, ways to calm them down, etc.)

Altruism

-Concern for the welfare of others -An individual's ability to place the needs of others before their own -unselfish concern -client comes first

Characteristics of an effective group leader

-Courage -Willingness to model -Presence - allow self to experience own feelings -Good will and caring - not only say but show -Belief in group process -Openness -Self awareness -Coping - ability to deal with attacks -Personal power - power over self, confidence; not absolute control over self -Stamina - need outside sources of mental and emotional support and nourishment -Sense of humor -Inventiveness -Willing to seek new experiences -stamina = can only give what you have, fill yourself back up -invent = bringing in something new/fresh every session

Mid 1900's

-Discovery of psychotropic medications changed the face of psychiatry -Lithium, 1949--Used to treat Bipolar Disorder (then called Manic Depression) -Thorazine, 1952--First anti-psychotic medication -Psychiatry began to research role of neurotransmitters in mental illness

Mary Reilly, EdD, OTR, FAOTA

-Dr. Reilly became internationally renowned during the 60s and 70s -Developed a frame of reference for occupational behavior that described the biopsychosocial nature of man through the human occupations of work, play, and self-care -Other occupation-based models followed (MOHO, Ecology of Human Performance, PEO) -supply intervention --> see outcome, was it beneficial --> change if needed

Children/Adolescents

-Early Detection & Identification for the Prevention of Psychosis Program (EDIPPP) -Trauma-informed Care (TIC), Sensory-Based Approaches and Occupational Therapy. -Zones of Regulation curriculum to provide a systematic, cognitive behav- ior approach to teach children about their emotional and sensory needs in order to self-regulate and control emotions and impulses, manage sensory needs, and improve the ability to solve conflicts. -Occupation-Based Groups for Low-Income Youth in an After-School Setting -Transition From Foster Care to Independent Adulthood -Occupation-Based Group Emphasizing Social and Emotion- al Skills and Friendship for Students Experiencing Anxiety and Bullying -Drive Thru Menus for Relaxation & Stress Busters; and Attention & Strength.

Applying A Public Health Approach to Children's Mental Health In School and Community Practice:

-Embedded classroom strategies: fostering mental health literacy and self-regulation with a student with disabilities -Comfortable Cafeteria: 6-week program embedded during lunch to create a positive lunch environment for all students to enjoy their meal and socialize with friends. Goal is to educate and coach cafeteria super- visors in helping students with and without disabili- ties and mental health challenges -Refreshing Recess: 6-week program embedded during recess to help all children enjoy play and socializing with friends. OTs educate and coach recess super- visors in creating a positive recess experience for students with and without disabilities and mental health challenges.

Stages of group development

-Every group is unique & dynamic -BUT most follow general development -Builds upon the feedback between participants -be prepared to pivot (complications, more time spent in one area/on one topic, etc.) -facilitate communication with feedback (feedback to leader and with others)

Freedom

-Everyone has choice (independence, initiative, and self direction) -Freedom of choice to pursue goals that have personal and social meaning -refusal/choice, they have the right to deny -ex: refusing to go into the OT kitchen because they do not want to cook ever

Lorna Jean King OTR/L, FAOTA (mid 1970's)

-Expanded sensory theories to use with individuals with schizophrenia -Noted that individuals with schizophrenia responded well to gross motor movement to improve sensory adaptation -based off Gene Eerrs and sensory integration (used for children) -individuals with schizophrenia related to sensory theory -techniques used by Eerr used on individuals with schizophrenia = engagement, standing straighter, breaking of closed actions

Benefits of therapeutic groups

-Facilitates participation -Built in social support -Enhances communication and self-expression -Nonjudgmental acceptance -Application of therapeutic techniques -Cost effective -this is a safe place -cost effective = increase in quality

Justice

-Fairness, equity, truthfulness, and objectivity -Objective relationship with all those served -Respect legal rights of individuals -Understand and abide by the local, state, and federal laws

Truth

-Faithful to facts and reality -Be accountable, honest, forthright, accurate, and authentic in our attitudes and actions -Provide accurate information in oral and written forms -documentation aligns with what we did (appropriate charting)

Other attitudes to consider/look out for

-Fear and anxiety -Hopelessness -Apathy -Hostility -Interrupting or talking over others -Resistance -Sarcasm or disrespect -Aggression or rage -Bullying -Cliques -anxiety = non-productive movement, tense, ticks -apathy = blankness, don't care -hostility = defensive -sarc = passive

Values

-Forces that guide our conduct -Concepts which have meaning to us -Guide us to live our life "on purpose" and with purpose (intention) -May involve our desires and fears -"Operational belief which one accepts as one's own and which determines ones behavior" -Standards that guide us toward satisfaction, fulfillment, meaning -what are our personal values, where do they come from, how do we use them in occupation -usually come face to face with them in situations of discomfort -unique to you, have your own interpretation (adolescence = usually the time to challenge parent's values)

Tuckman's Group Stages

-Forming -Storming -Norming -Performing -Ending or conclusion -forming = expectations, rules, process -storming = who is in charge, challenge tasks/rules/leaders, tested -norm = more harmony, learn to trust each other -ending = have some skill set, impacting own like and others, accomplish end goal/focus

Types of roles within the group:

-Group task roles -Group building and maintenance roles -Individual roles (will talk about this later)

Occupational Perspective of Health

-Health is primarily determined by social factors (changing) -The measure of health is what people do and become -Health is a fundamental human right and responsibility -ex: health promoting = eating healthy, exercising, check ups, etc. (become = learned activity/job) -quality to all activity -be aware of delivery of service methods

What is the rationale for using task groups in OT?

-Human occupation is essential to life and health -Occupation promotes and maintains health -Doing things together, not talk therapy -Interaction within a social context -engagement -meaningful -more normative/natural

Commission on Mental Health: recommended

-Increase awareness of mental health -Care should be consumer and family driven -Reduce disparity in mental health services -Make mental health screenings common practice -Increase research to improve mental health care -Increase access to mental health care and information through technology -change from paternal (parent knows best) --> patient knows best

Tier 3: Interventions with Individuals Who Have Mental Illness

-Individuals who have attempted suicide -Individuals who are unable to maintain employment -Individuals who lack adaptive life skills or life balance -Individuals who lack healthy, supportive social relationships -Individuals who are homeless -Individuals with drug or alcohol addictions -build target interventions for them

Ann Cronin Mosey

-Influenced by Fidler and the psychodynamic frame of reference -Believed, "OT attempted to bring...unconscious content to consciousness and integrate it with conscious content" -Incorporated projective instruments (e.g. collage, painting, clay, mosaic, etc.) which can provide information about unconscious/preconscious ideas, issues related to control or anger, ego defense mechanisms, etc. -Use of projective instruments requires advanced training by OTs, often in collaboration with psychologists or psychiatrists -influence from Freud -projective instruments (ex: ink blot test)

Gradual changes in treatment

-Inpatient length of stay significantly declined -More and more treatment was done on an acute or outpatient basis -Fewer OTs go into mental health -Laws were passed ensuring the rights of the mentally ill to choose or refuse treatment

Different growth groups

-LIFE MANAGEMENT SKILLS GROUP -REMINISCENCE GROUPS -all ADLs -grief management -etc.

Tasks can be easily structured

-Less threatening for clients -They have control over the activity -Task removes focus from the individual and from relating to others in an unstructured setting -Relatively easy to arrive at predictable outcomes -guides conversation/actions to individual comfort

Kohlberg's Moral Development Model

-Level 1: Pre-conventional -Level 2: Conventional -Level 3: Autonomous or post-conventional 3 stages to developing morally

Tasks can be graded

-Level of difficulty: choose task that is within each member's ability to achieve -Proportions of the task: can break task into manageable components -Gradually increase difficulty as members' competence increases -can challenge the patient -parallel play = give the client something to do to engage/support group activities -breaking up tasks = always have an end product to show for example/end goal

Communication

-Listening and Responding -Feedback (timing important) -Concreteness (honest/straight forward) -Confrontation -Self-Disclosure (honesty about feelings toward others) -Meeting Evaluations

Co-leadership Advantages

-Mutual support -Increased objectivity -Collective knowledge -Models for each other -Different roles -having a person to process with

Mental Health Treatment Today

-Newer medications (SSRIs, SNRIs and atypical anti-psychotics) have fewer side effects and are more effective -Emphasis on evidence-based medicine has increased research and refined treatment -Development of cognitive behavioral therapy and dialectical behavior therapy improved results of counseling techniques -Funding is still an issue for people with mental illness despite renewed interest -Mental Health Parity Act (2008) -Jails and prisons now provide a significant amount of mental health treatment -Fewer OTs practice in mental health - only 3%

Adults/Older Adults

-Nutrition and Exercise for Weight Loss and Recovery (NEW-R)—Adults with serious mental illness have high levels of obesity, which can lead to chronic medical conditions -Development and Use of Community Living Skills (CLS) -Intensive Individualized Occupational Therapy improved indicators of recovery (social functioning) within a pilot controlled study of individuals with psychotic conditions -An Occupation-Based Perspective on Interventions for Persons With Substance-Use Disorders -Yoga to Reduce Combat Stress -Increase Well-Being in Cardiac Rehabilitation -Effective Interventions for Adults With Psychological or Emotional Impairment After Stroke -Reduce Depression in Stroke Survivors -Stepping Stones Program: occupation-based program for individuals with early stage Alzheimer's disease and their caregivers, improves quality of life -Community Behavioral Health Centers -DVD Training to Enhance Therapists' Mental Health Practices and Depression Identification and Treatment in Older Adults -Applying a Public Health Approach to Workplace Health at the Organizational Level -Lifestyle Intervention With the Well Elderly -Driver Safety Programs for Older Adults -Understanding How Sensory Dissonance Provokes Nega- tive Mental States and Distress

Psych OT in 1940s-50s

-OT Gail Fidler key influence in OT at this time -Followed influence of psychoanalysis -Psychodynamic approach in OT was conceived -good to talk, but we need to do more

Claudia Allen, MA, OT, FAOTA (late 1960's)

-Observed patterns of performance difficulty in people with psychiatric disorders -Developed assessment of functional cognition that predicts capabilities and environmental needs -acute psychiatric facility in LA (lots of homelessness) -assessment = is this person safe? unsafe? -leather lacing = assessment = makes a stitch and the patient repeats --> gets more complicated with success --> evaluates cognitive levels (can this person interpret, function, take feedback, etc.)

Tier 2: Prevention of Mental Illness and Psychosocial Deficits with People Who are at Risk

-Overcrowding (i.e. prison population, public housing, etc.) -Poor nutrition -Underachievement -Discrimination of minorities and immigrants -Victims of human trafficking -Victims of domestic violence -Those with insecure employment -Degradation of environments (work, live, play)

Group cohesiveness

-Sense of solidarity, meaning, & value -Common purpose for participation -Common emotions and issues -Common needs or focus -Cooperation, caring, trust, & support -up to you as a leader to establish this -sense of comfort, meaning, etc.

Facilitative (Democratic)

-Shares leadership - group decides -Acts democratically -Somewhat efficient and productive -High morale -Uses: Motivating and involving clients, peers -sense of sharing responsibilities, everyone has input and value -takes more time to get everything/every idea of the group together, but can be more productive -also good for/used for clients who are transitioning to bigger steps (ex: moving into the community)

Roles of the leader

-Plan the group activity -Express genuineness and empathy -Maintain control -Set limits -Model positive behavior -Reality testing -Communicating -Self-disclosure -sympathy vs empathy -self-disclosure = don't need to express life issues/successes, but rather express success with others in their position; lose credibility when expressing times when thinking/doing like the group (ex: be hypocritical and talking about drinking at an AA meeting) -plan = focus on guidelines and the goal of the group, members should be able to participate in the process -make those feel hear and helped without defensiveness -have to be able to redirect/get back on track -be able to role play, create learning opportunity, in the moment -reality = call people out, make them aware of their actions/actions effects -feedback without judgement or evaluation feeling = communication

The PERMA Model of Well-Being

-Positive Emotion -Engagement -Relationships -Meaning -Accomplishment

Influences in 1900s

-Psychoanalysis -Psychosurgical therapy - lobotomies -Electroconvulsive therapy -Psychotropic medications -Psychoanalysis = Freud = talking therapy (not sufficient for OT) -ECT = still used today, but for different purposes

Physical modalities

-Psychosurgical treatment -Lobotomies used extensively in 1930's to 1950's

Level 1: Pre-conventional

-Punishment and obedience orientation -Characterized by satisfying one's own needs -"I must obey the authority figure or else..." -reward or punishment = obedience

Prudence

-Reason and judgment in the OT process -Value judiciousness, discretion, vigilance, moderation, care, and circumspection -Intelligent reflection and rational thought -good stuarts of resources, align accurately with client goals

Trauma-informed care

-Recent research on trauma has contributed to an understanding of veterans, victims of violence, and accident victims -Sanctuary Model (Bloom)

Dignity

-Recognizes the inherent worth and uniqueness of each person -Respect the unique interaction of the mind, body, and spirit (holistic) -Engage in meaningful occupations regardless of disability -people are holistic human beings

A healthy dissolution

-Review -Acknowledge -Give feedback -Help generalize and apply -review = reflect back, acknowledge what you think you are seeing -feedback = need, be prepared to give/get it in the moment, know when to give it and how to give it (reality checks when needed), only helpful if they can do something with it (intention to help)

Level 3: Autonomous or post-conventional

-Social contract orientation -Conformity to values and demands of society -"I may ...because of my role in society, but I often question the values of society." -Oriented by universal ethical principles -Characterized by one's conscience holding one responsible for doing what it right -"I will ...because I know it is the right thing to do." -this is truly what I want to do (I have thought about it) -know it is the right thing to do based on personal morals

Methods of Observation

-Sociogram -Interaction Process Analysis -Member Role Observation -Content and Process Analysis -Analysis of Group Behavior

Integration of Public Health and OT - examples

-Solo-practice OTs -OTs that work within a practice that solely provides rehabilitative services -OTs in a co-located space -OTs in a large practice with multiple sites

Co-leadership Disadvantages

-Splitting -Competition -Unequal contribution -splitting = individual client's can try to split up the leaders (ex: "you're my favorite, I wish you could lead everything") -competition = I want to be the better leader

Directive (Autocratic)

-Strong, directive leader -Makes all decisions -Efficient, productive -Lower morale -Uses: Groups with limited verbal skills, impaired cognition -you know who is in charge, they make all the decisions -advantage = efficient -disadvantage = can't provide your input, lowers morale (not as invested) -also good for/used for non-functional groups (a lot of acting out behavior)

1990's through early 2000's: Renewed Interest in Mental Health Parity

-Surgeon General Report -ADA -Mental Health Parity Act -OTs lost QMHP designation -parity = mental health isn't/shouldn't be treated periodically -qualified mental health professional = QMHP

The Task-Oriented Group as a Context for Treatment

-Task-oriented groups offer a dimension missing from group therapy (and all talk groups), the integration of feelings, perceptions, thinking, and behavior. -Task - oriented toward product or service for others -doing a task = integration of...

Framework Informing Health Promotion

-Technically a scientific/psychological area of study -Developed by Martin Seligman -Supported by the work of Mihaly Csikszentmihalyi -People want to lead meaningful and fulfilling lives, to cultivate what is best within themselves, and to enhance their experiences of love, work, and play -Mahaly = flow --> person is absorbed in what they are doing (in the zone)

Leader-Member Continuum

-The influence a leader exerts over a group can be seen on a continuum from near total control to virtual lack of control -OT needs to develop skills for a variety of group levels and styles from autocratic (directive) to laissez-faire (client-centered) and be able to apply these skills as needed -recognize what is needed and morph into that leader

Psychological Theories

-Theories attempt to explain how mental health problems develop and how a therapist may help someone deal with them. -Although these theories are used to greater or lesser extents today, many of our therapy techniques are based on them. -A theory provides a set of principles that can be used to organize, explain, and predict observable phenomena -allows for prediction

Professional Values

-Underlie the core of the profession and guide the interactions of each practitioner -Helps determine where the priority lies in a given situation -Guides us to solve ethical dilemmas -mandated

Increasing professional self-awareness is also key:

-Understand and accept your own emotions as you work with others yet act in a professional manner -It helps to have an increased openness to other's needs and to recognize other's pain and desire to succeed

Values will vary by

-Upbringing and teachings -Age -Gender -Rural vs. urban background -Vocation -Educational level -Religion -Language -Ethnic background -Degree of acculturation -Personal beliefs and personality -acculturation = how invested are they in culture (the strictness or intensity of the culture)

Sensorimotor

-Uses sensory stimulation especially music -Movement activities like WHOGA, tai chi -Deep breathing to increase relaxation -most powerful music experienced from age 17-21 -meaning to it, has value, memories -WHOGA = wheel chair yoga -interoception -awareness, mindfulness

As an occupational therapist you must:

-Utilize therapeutic use of self -Treat holistically -Establish rapport with clients--make a connection -Communicate clearly with active listening, unambiguous speech, and checking for understanding -Motivate your clients -Utilized evidence-based interventions

When we fail to follow or values

-We experience disharmony -We feel painful emotions such as guilt -We act in ways we regret -We are open to rebuke, censure, discipline, or worse

Psychosocial

-Working with people who have varied diagnoses and conditions whose primary diagnosis is not typically a psychiatric one but who may have symptoms seen in psychiatric disorders -Working on adaptation, skill development, and prevention due to problems in living (context and environment) -OT is more psychosocial -what are you doing? not doing? what works?

Video: TED Talk of exposure to adversities during childhood and its effect on the brains and overall health of people

-childhood trauma study of its affects on health outcomes/ACE score (higher score = more severe health abnormalities/diseases/dysfunctions) -neurological reasons behind trauma and high risk behaviors = increased fight or flight response trigger because of the exposure to higher level diversity ("bear comes every night" = not scared of snakes --> decreased immune responses due to the adaptation to intense stressors) -public health crisis -interrupt progression of health issues = goal -importances of early intervention -behavioral responses can be presented when viewing therapeutically -tier 1 = informed the public, screened everyone -tier 2 = preventative measures (providing education, multi-disciplinary team) -tier 3 = look at individual and adapt approach -OT definitely has a role in all this

Activity is based on

-health condition (disorder or disease) -body functions and structure -participation -environmental factors and personal factors

How do OTs use groups?

-stimulation -reminiscence -work -simulation -endurance -support -ADLs -IADLs -role play/social skills -coping skills -dealing with trauma -stress management -anger/aggression management -communication skills -motivation/goal setting -grief or loss -addiction -time management -organization -channeling energy -community -reintegration -transition -adaptation -sleep -pre voc/work -exercise/healthy choices -money/budgeting -meditation -play/leisure -decision making -self confidence/self-esteem -parenting -trust building -spirituality

What are some types of therapeutic groups?

-stimulation -reminiscence -work -simulation -endurance -support -ADLs -IADLs -role play/social skills -coping skills -dealing with trauma -stress management -anger/aggression management -communication skills -motivation/goal setting -grief or loss -addiction -time management -organization -channeling energy -community -reintegration -transition -adaptation -sleep -pre voc/work -exercise/healthy choices -money/budgeting -meditation -play/leisure -decision making -self confidence/self-esteem -parenting -trust building -spirituality

3 Tiered Public Health Approach in OT

-top = Intensive -middle = Targeted -bottom = Universal

Introduction

-warm up -ex: ice breaker aligned with the topic at hand -explain concepts/topics of the session

Individual Roles in the Group

1. Aggressor 2. Blocker 3. Recognition-seeker 4. Self-Confessor 5. Playboy 6. Dominator 7. Help Seeker 8. Special Interest Pleader -usually just want attention -disrupt group flow -playboy = flirt -help seek = needy -special = cant something specific

Mosey Further Defined Types of Activity/Task Groups

1. Evaluation: Used to assess functional performance 2. Task-oriented: Exploration of self-awareness, thoughts, feelings, actions via hands on activities 3. Developmental: Designed to teach social interaction skills 4. Thematic: Designed to learn set of skills for specific occupations (self-care group) 5. Topical: Used to teach a specific type of knowledge or skill (stress management, assertiveness, self-esteem, grief & loss, etc.) 6. Instrumental: Help participants maintain function in their chosen areas (ADLs, leisure, finances, planning for discharge, etc.) -ex: shield -guiding process as OT

Steps for Writing a Group Protocol

1. Identify your client population 2. Select a frame of reference 3. Select a focus for intervention 4. Write a group intervention outline -main goals = global/broader -outline = time, activities, goal -writing it for an outline, over time, how they progress

results of leadership styles

1. The democratic leadership style resulted in a more satisfying, efficient lead ership than did the laissez-faire. 2. Autocratic leadership resulted in a slightly higher group productivity than did the other two leadership styles but showed a significantly poorer qual ity of work than did the group with democratic leadership. 3. The autocratic leadership style created hostility and aggression in the group members. 4. There was greater dependency and less individuality in the autocratically led group than in the democratic group. 5. A greater degree of group cohesiveness, a sense of comradeship, and a high morale were seen more in the democratic group than in either of the other two groups.

Basic Characteristics of Therapeutic Groups

1.) Group structure 2.) Group cohesiveness 3.) Stages of development

11 Therapeutic Factors in Group Therapy

1.) Instillation of hope 2.) Universality 3.) Imparting of information 4.) Altruism 5.) Corrective recapitulation of the primary family group 6.) Development of socializing skills 7.) Imitative behavior 8.) Catharsis 9.) Existential factors 10.) Group cohesiveness 11.) Interpersonal learning

Depression

A mental health disorder characterized by persistently depressed mood or loss of interest in activities, causing significant impairment in daily life.

Denial

A primitive or early defense mechanism by which a person disavows or refUses to acknowledge the external source of anxiety

Classical Conditioning

A process developed by Ivan Pavlov of learning by temporal association. For example, noticing that dogs salivated by the presence of food (an unconditioned response). he then paired another stimulus (a bell) with the food. Soon. dogs did not need the food to salivate but salivated just with the presence ofthe bell (termed a conditioned response)

Psychosexual stages

A theory of development based on sexuality, included stages called oral, anal, phallic, and genital referring to parts of the body on which an infant focused for gratification. Adjustment depended on moving through the stages. Maladjustment meant a "fixation" or being stuck in one of the stages.

Reaction Formation

Adopting behavior that is in direct opposition to one's unacceptable impulses or desires

Identification

Adopting the values and feelings of a person who causes anxiety in an attempt to increase self-worth

Universal

All individuals with or without issues - Health-promoting occupations and health literacy for all

Institutional Values

Also important as a professional

Future of mental health treatment

Alzheimer's research will come to the forefront as Baby Boomers continue to age

Legislation and Politics: Impact on OTs

American's with Disability Act (ADA) -Disability: "a physical or mental impairment that substantially limits one or more major life activities of an individual" -Mental disorder: "mental retardation, organic brain syndrome, emotional or mental illness, and specific learning disabilities." -Title II and the Olmstead decision -Least restrictive environment -looked at impact in work environment/schools/ etc.

Targeted

At-risk populations - MH prevention - Promotion of competencies

Projection

Attributing personally unacceptable impulses or desires to the external world

Mosey's Group Interaction Skills

Based on the members' abilities to participate: ~ Parallel ~ Project ~ Egocentric Cooperative ~ Cooperative ~ Mature -parallel = working on one thing at a time/their own thing (step by step directions given) -project = emphasizing accomplishment of something with others (facilitated socializing) -EC = sense of cooperation that takes us further (we have to see each other again and work on this longer, so might as well make it work/enjoyable) -cooperative = interested in others, share feelings about the same things, support -mature = come together, establish own goals and routes to goals

OT's Use of Practice Models in Mental Health

Because performance of occupation is the chief concern of occupational therapy, any theory useful to occupational therapy practitioners must explain how people's occupation affects their mental health and how their mental health affects their occupation.

Positive and negative reinforcement

Behavior followed by a positive consequence !i.e., reward> will result in an increase in that behavior and behavior followed by a negative consequence (i.e., punishment) will result in a decrease in that behavior:

Trending in psychology and psychiatry (mid 1900s)

Cognitive psychology was born (focus on the brain's abilities for memory, problem solving, learning) OT adopted techniques from the cognitive psychologists (cognitive retraining) -cognitive psych = developed from brainlessness (life skills --> actor care) -cognitive therapy = see what motivates you (+ or - reinforcement)

President's New Freedom

Commission on Mental Health Created by G.W. Bush in 2002 Recognized -Fragmentation and gaps in care for adults with serious mental illness -High unemployment and disability for people with serious mental illness -Lack of care for older adults with mental illness -Lack of national priority for mental health and suicide prevention filled in the gaps

conscious

Contains elements of the mind that are easily accessed and a person is aware of

unconscious

Contains elements, such as instincts or drives, that actively seek to become conscious but may be viewed as unacceptable for expression by the ego !creating anxiety> or by the superego creating guilt and, therefore, prevented from being expressed consciously. A large portion of mental activity is unconscious. meaning that it occurs outside a person's normal awareness and is not readily accessible.

Group structure

Context Climate Composition Purpose & Goals Leader-Member interactions/relationship Norms Size -context = setting, length of session, services offered, groups, funding, billing/contracts, discharge location -climate = reoccurring patterns of behavior, energy of the surroundings, time of day, group interplay -composition = staffing, cluster of diagnoses -L-M = connections, authority style, maturity levels -norms = rules, consistency, goals of group/task, what you want true in your group -size = ideal 6-12

TASK SKILLS GROUP

Craft projects, horticultural therapy activities, beading, greeting cards, sleep pillows, fragrant sachets for relaxation

Mental Illness or "mental disorder"

DSM-5 definition of mental disorder a.) a clinically significant behavioral or psychological syndrome or pattern that occurs in an individual b.) is associated with present distress (e.g., a painful symptom) or disability (i.e., impairment in one or more important areas of functioning) or with a significantly increased risk of suffering death, pain, disability, or an important loss of freedom c.) must not be merely an expectable and culturally sanctioned response to a particular event, for example, the death of a loved one d.) a manifestation of behavioral, psychological, or biological dysfunction in the individual e.) neither deviant behavior (e.g., political, religious, or sexual) nor conflicts that are primarily between the individual and society are mental disorders unless the deviance or conflict is a symptom of a dysfunction in the individual -at what point does it become dysfunctional? -normal and acceptable to have brief negative reactions to certain life events, concern with abnormal grief/behavior -dont confuse passion with dysfunction

Task Function

Deals with the group goals or task

Maintenance Function

Deals with the maintenance of the group as a group, i.e. the members and how they function together -making sure things run smoothly

Group Intervention Design Process

Design and structure the group for a particular context -First: Create a Group Protocol with particular client group in mind -Second: Design the Individual Sessions

Relationships

Everyone needs someone. We enhance our well-being and share it with others by building strong relationships with the people around us (family, friends, coworkers, neighbors, etc.) -who we let into our lives effects us (social/support circle)

Sublimation

Expressing sexual and aggressive impulses in a socially acceptable manner

Nee-Freudian Theories

Freudian theory has been altered over the years by many theorists who believe strongly in the power ofthe unconscious and intrapsychic conflict but who disagree with other aspects of Freud's theory.

Types of Therapeutic Groups

Growth Groups

OTPF - Mental Functions

Higher-level cognition Global mental functions

Universality

I am not alone, there are others like me/thinking like me/in the same boat

Prospective Memory

I need to remember this/pay attention to this for the future

Defense Mechanisms

In an effort to control unacceptable ld impulses and reduce the anxiety and/or guilt they arouse, the ego develops unconscious coping responses, called ego defense mechanisms by Anna Freud (1936/1974). to protect the self Defense mechanisms are unconscious methods generated by the ego to protect itself from anxiety and guilt related to unacceptable id impulses.

Conflict of values with group members

Incidence Manifestation Risks Management -manifest over time, occur , risk in talking about values (especially different values, deal with acceptingly), manage differences (never hurts to reevaluate) -ex: leading a stress management group and a person says "it is okay if I have only 4 beers a night, that's normal" (you know it isn't right, but they might think it is) -people develop values over a LONG period of time = we only have so much of an influence

Group TASK ROLES: Get the Work Done!

Initiator/contributor Information seeker Opinion seeker Information giver Opinion giver Coordinator Orienter Evaluator-Critic Energizer Procedural Technician Recorder -information seeker = have all the information to do this well/right -information giver = sending results, giving direction -orient = make sure they know the norms of the group -energizer = keep the mood and motivation of the group all support accomplishing a specific task

Superego

Is comprised of two components, the conscience and the ego ideal. It is the conscience that reminds us that certain behaviors, thoughts, and emotions are acceptable or unacceptable. The ego ideal repre sents the person we are striving to become; it incorporates all the values and standards of our caregivers.

Meeting Evaluations

Leaders can ask members to evaluate meetings at the end of a session by completing evaluation forms. -members checked whether they felt that the meeting was good, fair, or poor and whether they were able to express these feelings to the group

Leadership Functions

Leadership serves to help group meet its needs; two types: -Task Function -Maintenance Function

Genetic Factors in Psychopathology

Many theorists who follow the biological perspective believe that inherited vulner abilities mediate psychological disorders. Certain personality traits, temperamen tal styles, and specific disorders may have a genetic component -twin studies -nature and nurture

Occupational Therapy's Foundation

Mental (and physical) illness affects an individual's ability to participate in every day occupations

Diagnostic and Statistical Manual of Mental Disorders - 5th ed. - Text Revised (American Psychiatric Association, 2013)

Numerous changes from DSM-IV: - No longer a multi-axial system: axes removed - Spectrum disorders are emphasized - Re-organization/re-categorization of many disorders - Specifiers used more heavily -certain dynamic when working with someone with personality disorder (could be manipulative, depressed, functionally not motivated, etc.) -know physical limitations with disorder

OT Today

OT recognized as a suggested provider for CBHCs -AOTPAC continues to push for QMHP designation for OT Mental Health Reform Act (includes OT in mental health care) Official AOTA Documents -OT's Role in Community Mental Health -Specialized Knowledge and Skills in Mental Health Promotion, Prevention, and Intervention

There is a big difference:

Our personal self and values vs. Our professional self and values -profession mandates that we have good values as OTs

Historical Overview: Prior to mid-1800s

Persons with mental illness were 'cared for' in: - Homes - Workhouses, poorhouses - Prison - Asylums or madhouses In USA, only 2 hospitals: Pennsylvania Hospital and Lunatic Asylum in NY Hospital

Other influences in the 1900's

Physical modalities: Electroconvulsive Therapy (ECT) 1940-1950s

Cole's Seven Steps of A Group Session

Planning individual sessions from a group protocol Introduction Activity Sharing Processing Generalizing Application Summary

Legislation and Politics: Impact on OTs

Post-WWII and through 1960's: Increased opportunities for OTs in mental health both in the community and hospital (creation of NIMH, Medicare, and Medicaid) 1970's: Right to treatment in least restrictive environment (deinstitutionalization) -poor/poverty = receiving health aids -OTs were there to teach

Mid 1960's to Mid 1970's

President John Kennedy signed legislation to change custodial institutional mental health care to comprehensive community based care (1963) State hospitals for the 'insane' were de-institutionalized

repression

Preventing unacceptable impulses or desires from becoming conscious

OTs Role in Mental Health: Promotion, prevention, and intervention

Promotion of positive mental health Prevention of mental illness using risk reduction efforts Assessment and intervention to minimize symptoms present in mental illness -promote advocacy (response of those around you about mental health) -prevention = identifying those with risk factors (ex: risks for depression = lack of internal tools, support, and resources) = help before it occurs

Modeling

Proposed by Albert Bandura (1977, 1997, 1986) that learning occurs through observation and imitation of the behaviors of others and that persons can learn by observing the consequences that people receive for their behaviors.

Principle of reinforcement

Proposed by B. F. Skinner (1938, 1953, 1971) that behavior can be modified by its consequences. Reinforcement is the primary mechanism for learning and for explaining human behavior

Chaining

Proposed by Skinner (1938, 1953, 1971), chaining refers to a method of reinforcement involving the linking of component skills to teach a more complex behavior: This procedure involves reinforcing in a particular sequence simple behaviors that are already in the individual's repertoire in an effort to teach more complex skills (Deitz, 1985a, 1985b). Chaining can be accomplished in either a forward or backward format

Shaping

Proposed by Skinner (1938, 1953, 1971). involves reinforcing a person for closer and closer approxima tions of a target behavior: Initially, only a simple response is required. The criteria for reinforcement are then gradually made more stringent in an attempt to elicit more complex or refined target behaviors

Extinction of behaviors

Refers to the decline in rate of a target behavior and ultimate elimination of that behavior. For example, in the case of phobias, if you can create an acceptable stimulus (such as relaxation) and pair it with the presentation of a feared stimulus (such as snakes). the anxiety that results from the fears will ultimately be eliminated or extinguished.

Ego

Represents the rational aspect ofthe mind that conforms to society or civilizations demands. The ego involves planning, reasoning, remembeling, evaluating, and decision-making processes. That is, the ego deter mines whether it is safe or dangerous to express an impulse by consider1ng the factors present in reality. The ego experiences anxiety and/or guilt when the ld presses to make its desires conscious or get them gratified.

Intellectualization

Repressing of the emotional components of one's experience, but not the informational components

Regression

Retreating to an earlier; more immature developmental stage in response to anxiety

Matrix of Needs and Satisfiers

SUBSISTENCE PROTECTION AFFECTION UNDERSTANDING PARTICIPATION IDLENESS CREA TION IDENTITY FREEDOM

cognitive processes can be divided into those that are short term and those that are long term

Short-term pro cesses, including expectations, appraisals, and attributions, are processes of which we either are or can become aware through practice. On the other hand, long-term processes, including beliefs, are generally not readily available to consciousness.

Also trending in psychology and psychiatry at the time (early to mid 1900s)

Skinner and Pavlov - behavioral theories OTs in mental health arenas adopted behavioral approaches to intervention (reward systems)

Pie of Life

Slices" might include: Family Friends Spirituality Romance Health Work Recreation Personal growth Money Physical surroundings Etc.

Gail Fidler

Strong proponent of "ego integration and maturation" -Through object relations increase self concept -Client can deal with emotions through actions, in art and craft occupations -"Occupational therapy provides the patient with a laboratory for living, a situation in which he can learn and practice new skills in living, experiment in a give-and-take relationship with others, utilize insights gained in psychotherapy, and learn and test more effective means of communication." -She went on to create OT Lifestyle Performance Model

Challenge level x skill level

Table slide 7: -low skill level and low challenge level = apathy -high skill level and high challenge level = flow (not easily reached) -high challenge and low skill = anxiety -low challenge and high skill = relaxation

lobes function

The frontal lobe is involved in higher mental functions such as thinking and planning, as well as in the control of the body muscles. The parietal lobe pro cesses information about pain, pressure, and body temperature. The temporal lobes are involved in memory, perception, and language processing, and the occipital lobe is responsible for visual processing.

parts of the brain and what they contain

The frontal lobe is located near the front of the brain and contains the motor cortex. The parietal lobe contains the somatosensory cortex. The temporal lobes are located on the sides of the brain and contain the auditory cortex, and the occipital lobe, at the back of the brain, contains the visual cortex. Finally, the limbic system is located at the base ofthe forebrain and includes portions of the thalamus, hypothalamus, and amygdala.

ld

The innate structure ofthe mind that represents an individual's instinctual needs, drives. and impulses. The id was viewed by Freud to be the primary motivating force in personality. The id strives for immediate and constant gratification according to seeking what is pleasurable.

Analysis of Group Behavior

The leader can gain an understanding of group behavior by making observa tions of the nonverbal behavior of the members

Maslow defined a pyramidal hierarchy representing five levels of needs.

The lower levels ofthe pyramid comprise "deficiency;' or survival-based, needs (i.e., physi ological needs, safety needs, the need to be loved, and the need to belong to a social group). As one moves up the hierarchy, needs become less survival driven and more focused on the components of happiness and personal success. Among these higher level needs, or "meta-needs;' is the need for esteem. Self-actualization, the point at which a person has realized fully his or her potential, lies at the peak of the pyramid. According to Maslow (1968), a person is only able to concentrate on and meet higher level needs after lower-level needs have been met.

If psychologists wish to improve the human condition, it is not enough to help those who suffer.

The majority of "normal" people also need examples and advice to reach a richer and more fulfilling existence.

Human Scale Development (1991) by Manfred Max-Neef

The matrix of "needs and satisfiers" that are part of this model succinctly describes the individual's fundamental human needs and how they are connected to society at large.

the task should accomplish

The task may be recreational, physical, academic, or vocational, but regardless of its nature, the task must facilitate the attainment of group goals, as well as individual treatment goals

Psychoanalysts who first believed in these two-person concepts were called object-relationists

They believed that the first object in an infant's life, one's mother, shaped the infant's world and that the infant's development could not be separated from their environment. -influence of the caregiver on an infant

Assessing Well-Being

Think of the pie's outer edge as being completely satisfied (10) and the center as being totally dissatisfied (0). Give a rating to your level of satisfaction in each of the areas you've listed by placing a dot to indicate the level of satisfaction you have in each particular area of your life.

Intensive

Those with identified disorders - Recovery model - Client-centered

Sources of Public Health Concerns

When health care fails as a system to provide patients with good and equitable care, it becomes a public health issue. -Cost -Complexity -Mistrust -Access -is health care a right/should everyone have equal treatment? -complexity = how easy/available is health care? (ex: can't see a dr for months = condition gets worse, people start to self medicate, etc. --> adapt negatively) -mistrust = due to the history of negativity

Engagement

When we focus on doing the things we truly enjoy and care about, we can begin to engage completely with the present moment and enter the state of being known as "flow" -be fully present mindful (disciplined)

Leader's Responsibility for the Group

Who is responsible for the direction and outcome of the group?

Psychiatric

Working specifically with people who have WHO-ICD or APA-DSM diagnoses or conditions, a psychiatric condition on a continuum

Interaction Process Analysis

a method for analyzing verbal interactions made during a group meeting -distinguish between communications that give in formation and those that seek information. -differentiated between emotionally negative and positive expressions and between behavior and verbal content.

situations

a particular set of group circumstances that determines how a leader will behave -groups select leaders based on how well their skill or knowledge meets the needs of the situation

outcome expectation is

a person's belief that a given behavior will lead to a desired outcome

Gail S. Fidler has been credited as being the first occupational therapist to use

a psychodynamic approach in treatment -a person's relationships with objects in the envi ronment to be integral to the development ofthe ego -"the potential of activities in their own right to represent, reflect, and infer social, cultural, and per sonal meanings and to communicate and call into play certain physical, affective, and cognitive responses"

Mental and behavioural disorders are

a set of disorders as defined by the International statistical classification of diseases and related health problems (ICD-10). While symptoms vary substantially, these disorders are generally characterized by some combination of abnormal thoughts, emotions, behavior and relationships with others.

Lability

a sign or symptom typified by exaggerated changes in mood or affect in quick succession. Sometimes the emotions expressed outwardly are very different from how the person feels on the inside. -labile behavior when it shifts in one second

Mania

a state of abnormally elevated arousal, affect, and energy level, or "a state of heightened overall activation with enhanced affective expression together with lability of affect"

PROMIS

a website -assessments available for OTs (from NIH)

Sustained Attention

ability to focus on an activity or stimulus over a long period of time -important to be productive

leadership styles

autocratic democratic laissez-faire

Biological

biological perspectives -ex: low serotonin leads to depression

Attending to the complex array of biological, intrapsychic, and inter personal factors that may be creating and/or maintaining mental dysfunction allows for a comprehensive

biopsychosocial focus

Abraham Maslow (1968) and Carl Rogers (1951) proposed more global and healthy perspectives of human functioning than these other paradigms,

both held as basic the beliefthat individuals were innately good and driven to achieve self-actualization (i.e., realize their potential as whole and self-contained beings).

Empathy

caring for and understanding another indi vidual, is another skill of the effective group leader

expectations

cognitions that anticipate future events. -Albert Bandura assessed the impact of expectations on the performance of learned behaviors (learning must involve expectations in addition to operant conditioning principles)

Cognitive

cognitive perspective -reactions to sensory information, do we react/how do we react/when do we react? -determines independent or dependent living

Solo-practice OTs

collaborate with other practices with a goal of sharing data or collaborate with a community-based organization that many of your patients frequent, creating a more seamless environment to understand the health of your patients post-treatment in an effort to improve health and promote rehabilitation.

Self-esteem

confidence in one's own worth or abilities; self-respect.

OTs in a large practice with multiple sites

connect with a University or County health department to discuss information sharing that might be useful for improving education and awareness of the most salient issues seen in your practices.

medulla

controls heart rate, respiration, and gastro intestinal function

democratic

decision making power under control of the group but under guidance of the leader

laissez-faire

decision making power was left entirely to the individuals of the group

autocratic

decision making power was under the control of the designated leader

dysarthria

difficulty enunciating (can't understand, slurred speech)

Victor Frankl

disagreed with Rogers and Maslow that the motivating drive toward fulfillment in life is self-actualization. Instead, he postulated that there was a basic drive toward meaning in life and, therefore, that psychiatric disturbances arose from an inability to find meaning in life. sserted that there was an anxiety, shared by all humans, that resulted from the knowledge that death, or "nonbeing;' is a known outcome of being.

sympathy vs empathy

empathy -drives connection (perspective taking, out of judgement, recognizing emotion and communicating that) -connect with something in self that relates to that person's current emotions sympathy = "at least you have this"

Aaron Beck

emphasizes automatic thoughts as causal agents of psychological disorder; in fact, he argues that emotion states are always preceded by related thought processes. In therapy, the individual is taught to slow down and become aware of relevant negative automatic thoughts so that they may then be restructured

Psychodynamic

emphasizes systematic study of the psychological forces that underlie human behavior, feelings, and emotions and how they might relate to early experience

recovery model

focuses on enabling persons with mental health challenges through a client-centered process to live a meaningful life in the community and reach their potential

The humanistic perspective

emphasizes the value, worth, and potential of the individual, with a focus on the integrity of the client-therapist relationship -humanism pays careful attention to the individual's concept of self as well as personal values. -the importance of the individual client in determining his or her own outcomes. -the ability to look beyond the psychiatric disease, unconscious conflicts, and environmental precursors of behavior and toward the inherent worth of each individual. -It is the humanist perspective in both psychology and occupational therapy that provides the focus on the whole human being and acknowledges the interconnectedness of the mind, body, and spirit, as well as with the community at large.

Most contemporary therapists use an eclectic approach,

employing ideas and techniques from a variety of perspectives in order to understand and treat effectively a client's presenting problem -an individual chooses the best of each and synthesizes the features into an overall approach. -success is variable

Occupational therapy services focus on mental health promotion and prevention for all:

encouraging participation in health-promoting occupations (e.g., enjoyable activities, healthy eating, exercise, adequate sleep); fostering self-regulation and coping strategies (e.g., mindfulness, yoga); promoting mental health literacy (e.g., knowing how to take care of one's mental health and what to do when experiencing symptoms associated with mental ill health)

Summary

ending remarks -thank them -next meeting time evaluate yourself and how things worked at the end

Imparting of information

enlightened to new information/ideas/ways from those struggling similarly

What is the role of the leader?

every =one feels safe, learning is possible, assume primary responsibility (depending on the age level/development of the group), enforces therapeutic agents, primary role model

Accomplishment

everyone needs to win sometimes. To achieve well-being and happiness, we must be able to look back on our lives with a sense of accomplishment "I did it, and I did it well"

Empathy refers to .

experiencing the world from the client's perspective. This is accomplished through the use of active listening and reflecting techniques in which the therapist communicates an understanding and ac ceptance of the client

Development of socializing skills

group members will call you out on negative and positive behavior

The biological perspective

has sought to understand the physiological mechanisms underlying behavior. This knowledge allows us to understand the behavior of clients from a biological or medical perspective -symptoms of psychological disorder are caused by underlying biological factors -attempts to identify the physiological mechanisms underlying brain pathology

Health care

has traditionally been viewed as a person-centered approach to improving health: one treatment, one patient at a time. -more individualized

Echolalia

hearing something and repeating it (schizophrenia)

The hypothalamus

helps regulate body temperature, hunger, satiety, thirst, and the sex drive. It also controls the release of hormones by the pituitary and modulates feelings of pleasure and aggression

Divided Attention

higher-level skill where you have to perform two (or more) tasks at the same time -multitasking -focusing on more than one thing

What do we do when our values and attitudes differ from those of our clients?

ignore it and treat them the same

thalamus

important in processing and relaying informa tion between other regions of the central nervous system and the cerebral cortex. Specifically, it directs incoming sensory information from the visual, auditory, and somatosensory systems to the correct locations within the cerebral cortex.

OTs that work within a practice that solely provides rehabilitative services

improve communication between providers by hosting a weekly meeting to better understand the more global patterns that may be evolving in your patient population, preventing declines in health.

Occupational therapy's distinct value is to

improve health and quality of life through facilitating participation and engagement in occupations, the meaningful, necessary, and familiar activities of everyday life. Occupational therapy is client-centered, achieves positive outcomes, and is cost-effective.

Enjoyment, rather than pleasure, is what leads to

personal growth and long-term happiness

Biochemical factors,

including neurotransmitter dysfunction and hormonal imbalances, have been implicated as possible causal factors in many psychological dis orders. -neurotransmitter substances receiving particular attention in psychopathology research are serotonin, dopamine, gamma-aminobutyric acid (GABA), glutamate, and norepinephrine

Interpersonal learning

input = I get direct feedback from other members (negative or positive) output = how do I deal with/fix this action

personality traits of a leader

intelligence, warmth, decisiveness, and assertiveness "leadership is a relation that exists between persons in a social situation, and that persons who are leaders in one situation may not necessarily be leaders in other situations"

Sigmund Freud

interest in hypnosis as a form of treatment for hysterical illnesses (i.e., physical ailments with no apparent medical explanation) -theory of psychoanalysis, which was the first truly psychological theory of normal and abnormal behavior = postulates that unconscious factors are responsible, not only for hysterical illnesses, but for all psychological functioning, both normal and abnormal

interoception

internally in touch with your body

pons

is involved in sleeping, waking, and dreaming; it is also a pathway for motor information traveling from the cerebral hemispheres to the cerebellum.

The amygdala

is involved in the coordination of the autonomic nervous system and the endocrine system, as well as emotional states.

Mental health

is not merely the absence of mental illness, but the presence of a cluster of characteristics including positive affect, positive psychological and social functioning, and the ability to adapt to change and cope with life challenges

Mindfulness or mindfulness-based cognitive therapy

is used by occupational therapists to address everyday appraisals and how they relate to managing stress, depression, and cultivating a healthy lifestyle -mindfulness "allows an individual to first take ownership and have awareness and acceptance of a situation in order for change to take place"

At the individual level,

it is about positive individual traits: the capacity for love and vocation, courage, interpersonal skill, aesthetic sensibility, perseverance, forgiveness, originality, future mindedness, spirituality, high talent, and wisdom.

At the group level,

it is about the civic virtues and the institutions that move individuals toward better citizenship: responsibility, nurturance, altruism, civility, moderation, tolerance, and work ethic

Carl Rogers

it is only through the process of trying to achieve self-actualization that an individual develops an increasingly differentiated self-concept. Reflecting on Maslow's need hierarchy, Rogers proposed that human beings have a basic need for positive regard, especially from parents and significant others in their lives. Rogers conceptualized positive regard as a freely provided and unconditional liking for another person as an individual, without demands or expectations on that person's behavior. client-centered therapy = a non-directive therapeutic approach focused on helping individuals realize their potential by creating a safe, supportive environment to promote self-enhancement.

Being the group leader

keen therapeutic use of self (primary tools = task, environment, self) (strongest factor is self) (this is important, trust me, I respect you, enjoyment in engagement) change approach to adapt to the group

Semantic Memory

knowing little facts/tidbits of information (explicit time)

Positive Emotion

positive emotions are an essential part of our well-being. Happy people look back on the past with gladness; look into the future with hope; and they enjoy and cherish the present -happiness promotion

optimism

leads to a better mood

Existential factors

life or death questions -some topics trigger personal incorporate learning how to just exist as part of something larger than oneself. This factor brings a client into the awareness that life will continue on, with pain, death, sadness, regret, and joy

Neologism

making up new words

Content and Process Analysis

may be used by group lead ers for their own analysis or by all group members for evaluation and discus sion

Perseveration

mental trick, thinking about conversation -ex: "I wish I had said that" -ask many questions

Behavioral

nature vs nurture based -how were we praised/what were we praised for/what were we scolded for

Short term Memory

need information right here rn

genuine

one who can be themself while instructing with other people and maintain an openness to the feelings and attitudes that are experienced -spontaneity -non-defensiveness

Psychotherapy

or talk therapy, is a way to help people with a broad variety of mental illnesses and emotional difficulties. -not necessarily doing -laid the foundation for OT

positive psychology has further confirmed that

participating in meaningful occupations that result in positive emotions helps build resilience and fuel mental well-being -in pediatric occupational therapy practice, for example, indicate that activity-based interventions involving play, leisure, and recreation help improve children's social interaction, self-esteem, and positive feelings, and they reduce behavior problems

Occupational therapy practitioners provide services to

people across the lifespan who experience a range of mental health and ill health based on genetic predisposition and/or life stressors (e.g., disability, injury, trauma)

Tier 2—Targeted services are designed to

prevent mental health problems in persons who are at risk of developing mental health challenges, such as those who have emotional experiences (e.g., trauma, abuse), situational stressors (e.g., physical disability, bullying, social isolation, obesity) or genetic factors (e.g., family history of mental illness). Individuals at this level are often not identified as needing mental health services and may include persons with mild mental disorders, physical disabilities, and those living or working in stressful environments.

The psychodynamic perspective

primarily focuses on the emotional and personality development of the individual and emphasizes early childhood experiences as formative. According to psychodynamic theorists, both normal and abnormal behaviors are largely determined by unconscious psychological forces and internal processes. It is the interaction among these forces that creates behavior, thoughts, and emotions. Abnormal behavior results when these dynamic forces come in conflict (defined as intrapsychic conflict). all behavior can be seen as the product of forces beyond the immediate awareness and control of the individual.

cerebellim

receives and processes information from peripheral sensory structures (i.e., hair cells ofthe inner ear, joint receptors, and muscle spindles). It also is responsible for processing feedback from the motor centers of the cortex (e.g., the coordination of head/eye movements, force and timing when reaching for an object, etc.).

Coleadership

recommended whenever possible -particularly for relatively inexperienced group leaders. -more than one viewpoint on group -splitting up tasks = less stress on leaders

Public Health

refers to all organized measures (whether public or private) to prevent disease, promote health, and prolong life among the population as a whole (WHO) - e.g. vaccinations, tobacco control, etc -more universal

"meaning attribution."

refers to the tendency of the group leader to clarify, explain, understand, and in terpret what is happening in the group.

maintenance function

relates to helping the group build and maintain a process that enables the group to strengthen itself.

task funciton

relates to the achievement of the group goals or tasks

Corrective recapitulation of the primary family group

reminiscence and comfort -transference = client treats you like someone they know unconsciously (client thinks you look like their sister and starts being overly protective of you) -counter-transference = you fall into the roll unconsciously (ex: you let the client be overprotective without concern)

amplify strengths rather than.

repair the weaknesses

Meaning

represents different things to different peo ple. It does not have to represent actions toward a specific goal, but it may represent the freedom to take responsibility for an attitude or belief, even if unspoken.

Genuineness involves

responding to the client as a human and not just as a therapist. It also requires that therapists stay in touch with their own feelings and be able to communicate them to the client in an effective, appropriate manner.

The reticular activating system

screens incoming information and stimulates other brain regions whose pathways pass through the pons and medulla; it is thought to be primarily responsible for the mediation of states of arousal

Memory

senses will decide capacity to lay down information accurately

The cerebral cortex is primarily responsible for

sensory processing, motor control, and higher mental functions, such as learning, memory, planning, and judgment.

OTs in a co-located space

serving patients in a primary care practice, discuss patients in a weekly round table. This weekly practice could produce incredible therapeutic results for patients once providers share information they thought irrelevant or unimportant. Furthermore, providers will have an opportunity to discuss system issues that need remedied, ultimately influencing the entire patient population. -collaboration = patient success in health and well-being in all areas -go beyond direct treatment of the person in front of you

n environment of unconditional positive regard

should be created so that clients feel comfortable and secure when engaging in the change process. That is, clients should not feel judged in this environment; they should feel valued and accepted regardless of their thoughts, behaviors, and emotions

Activity

should have sense of concepts and experience

Instillation of hope

someone exists and feels just like me/with the same condition and accomplished so much, this is possible

Procedural Memory

steps to task

four different personal traits that contribute to positive psychology:

subjective well-being, optimism, happiness, and self- determination.

Concepts of mental health include

subjective well-being, perceived self-efficacy, autonomy, competence, intergenerational dependence, and self-actualization of one's intellectual and emotional potential, among others.

glia

support cells in the brain

Clanging

unusual rhyming -sentences rhyme but make no sense

Long term Memory

using information later on, storing it to retrieve later