Coping and Resilience

Approaches when talking to an individual with suicidal ideations

1) Listening to the individual and affirming his/her importance 2) Spending time with the individual engaged in meaningful activities 3) Informally assessing whether the individual is feeling suicidal or if they have formulated a plan 4) Coming to understand underlying feelings and problems 5) if suicidal or in need of help, going directly with the individual to the crisis center or local mental health provider

Traditions in which stress assessment and relationship to health are considered

1. Environmental tradition: Focused on events and experiences as they are objectively associated with adaptation and daily life demands 2. Psychological tradition that emphasizes individual evaluation of coping abilities to meet life demands 3. Biological tradition aimed at measuring the activation of physiological systems during times of stress

Children, self-esteem, and resilience

A child's self-esteem affects personal resilience and the ability to cope Personal perception is affected by success and failure experiences

Personal factors that distinguish people who cope most successfully with life's challenges

A sense of confidence of belief in one's ability to successfully deal with adversity and challenge A sense of personal commitment that provides the drive to keep going when things get tough An orientation toward continuous growth and self-development

Forms of adaptation

Adaptation can be gradual and biological, or it can be immediate

Children and adolescents and coping

Adult life event checklists often are not relevant to pediatric populations Four factor model of coping should be considered (active, distraction, avoidance, support seeking)

Chronic permanent stressors

An agent, condition, or other stimulus that continuously causes stress to an individual

Chronic intermittent stressors

An agent, condition, or other stimulus that persistently but irregularly causes tress to an individual

Resilience

An individual's ability to endure stressful situations without suffering the physiological or psychological consequences that can be associated with such adversity

Aspects that contribute to successful aging

Autonomy Environmental mastery Personal growth Positive relations with others Purpose in life Self-acceptance

Categories of coping strategies

Behavioral Avoidance Cognitive

Avoidance strategies of coping

Can involve withdrawal, distraction, use of substances, or other methods of staying away from the stressor

Formal and information observation

Client observations in both natural and structured settings provides the therapist with insights into occupational performance OT is uniquely suited to make observations regarding a client's problem-solving capabilities, adaptive skills, and ability to cope with stress

Assumptions under the psychodynamic-object relations approach

Clients are personal experts on their own lives and are capable of increased understanding of the self and others Human behavior is influenced by the conscious and unconscious Activities provide a means of personal exploration and feelings expresssion Structured activities provide improved functional performance, self-control, and personal safety The client-therapist relationship is of signficance The creation of an atmosphere of mutual respect contributes to personal safety and optimal group milieu

Emotion-focused coping strategies

Concentration on reducing the sense of anxiety rather than the source of the anxiety

Meyers and the Diathesis stress model

Created it Convinced that the stressful demands of living and the personal and social resources that people had available to assist them with coping were key factors to understanding mental illness

What disorders have the diathesis stress model been inferred

Depression Bipolar disorder Schizophrenia

Tips when working with youth in suicidal prevention

Develop positive coping strategies Help facilitate positive adult and peer relationships Maintain open lines of communication between teens and adults Develop skill building in youth to handle daily stressors

Problem-focused coping strategies

Directed at solving a specific problem through active efforts

Emotional expression coping strategy

Directing anger or humor at the situation

Mental illness and the family

Dynamic interplay between the individual with mental illness, the family's response to the mental illness, and services available to facilitate personal and familial coping

Cognitive restructuring coping strategy

Efforts to find and embrace the positive aspects of a situation

7 areas in the Resilience factor inventory

Emotional regulation Impulse control Optimism Causal analysis Empathy Self-efficacy Reaching out

Principles of promoting self-esteem in children

Emphasize the child's input in creating success (just right challenge) Enjoy and celebrate the child's accomplishments (breaking down tasks; token economy) Reinforced the child's competence by engaging in environmental engineering (family centered approach) Give strengths time to develop (education) Accept the unique strengths of each child

Psychoeducation interventions

Emphasizes a multifaceted intervention approach to provide resources and education surrounding the client's illness Helps to reduce the stress of the client and family members so they can better understand how to cope with the illness Can be done individually or in a group Often used in conjunction with skills training and a holistic, client-centered approach

Diathesis Stress Model

Emphasizes an interface of genetic or biological, psychological, or situational factors that contribute to the development of an illness

Occupation-based approaches to stress and coping

Focuses on how an individual's daily occupations support or hinder personal health MOHO (volition/motivation; habituation; performance capacity)

Adaptation

General term for human change based on challenges in the environment

Characteristics of hardiness

Hardy people -believe that they can influence their life situations and act according to that belief -Consistently consider how they can change situations for personal advantage and seldom accept events at face value -Regard change as part of the normal course of events and see it as an opportunity for positive growth and development Remain committed to learning and self-development

Recovery model and assessment

Helped to transition the view of individuals with mental illness being dependent to those who have an active role in their intervention, but which practitioners are no longer viewed as authorities, but helpers

Holmes and Rahe and life stress

If people experience too much adversity in their lives, it will overwhelm their ability to cope and illness will result The link between the body and adverse effects is the mind (how we process and respond to information)

Grief/loss and bereavement impacts

Important to return to healthy routines and engage in meaningful activities Individuals with mental illness may experience additional challenges with regard to managing grief

Physiological measures as complementary stress and coping measures

In health care settings usually include heart rate, BP, and skin temp (Blood draw also can be used to assess hormone and protein levels)

Cognitive strategies of coping

Include efforts to analyze the situation to fully understand the nature of the threat or challenge

Children coping therapeutic goals

Increasing child's ability to discuss emotions, problem solve, use adaptive coping techniques, and improve self-efficacy

Impact of mental illness on family and caregivers

Individuals with mental illness from families with high levels of expressed emotion (patterns of hostility, criticism, and overinvolvement) were more likely to experience psychiatric relapse Daily activities can be disrupted by stress, time, and energy involved in caring for a family member with a mental illness (can lead to maladaptive coping strategies)

Interpersonal skills training

Interpersonal skills and assertiveness may reduce anxiety and depression in social situations and may increase goal attainment in a socially acceptable manner Provides direct feedback Role play is often used to develop skills (rehearsal, modeling, and coaching)

Behavioral strategies of coping

Involve some type of action to manage stress, such as confronting a person about a conflict or engaging in physical activity to manage the feelings

Transactional model

Involves a series of appraisals (situational assessments) Initial appraisal: The situation or event is seen as irrelevant, benign, positive, or stressful A stressful event is one with potential harm or loss, threat, or challenge that warrants a coping response. The secondary appraisal considers available options and likely outcomes of choosing those options Once a coping response is selected and applied, the situation is reappraised, and the appraisal process begins again

Coping process

Involves information processing, volition, self-appraisal, choice, self-determination, and emotional response A person encounters a situation, appraises the situation as a potential threat, and then assumes a course of action to address the situation

Child and Adolescent Interventions

Lack of well-developed theories Often parallel adult techniques while considering the developmental age of the child within the contextual framework Usage of play and media Targeted self-esteem and coping Peer relationships and the development of friendships

Assessments for children and coping

Life events coping inventory for children Children's coping strategies checklist Life Events checklist Adolescent perceived events scale Response to stress questionnaire

Psychodynamic-object relations approaches to intervention

Major principles include: Importance of client's mental state Unconscious utility of symbols Creative expression to promote insight into one's self Therapist-client relationship is significant Foundations are empathy, compassion, humility, and unconditional positive regard

Relaxation and meditation interventions

Mindfulness meditation focuses on the present in a nonjudgmental way to attending to what is (leads to decreased anxiety and increased positive emotions) Progressive muscle relaxation can enhance personal self-control and reduce arousal levels

Coping

More specifically describes the explicit actions taken by individuals as they encounter difficulty conditions in their daily lives

Self-report instruments

Most commonly used method of assessing stress and coping Assessment tools in which the client provides his or her own perspective Select a measure based on the purpose of assessment and the client's condition

Resilience measures

Often include personal checklists The resilience factor inventory The resilience scales for children and adolescents

Coping Assessments

Problem-focused is considered to be healthier than emotion focused Active strategies are considered to be healthier than avoidant Ways of Coping Checklist-Revised Coping Responses Inventory Coping Strategies inventory Response to Stress Questionnaire

Skills that help with resilience

Problem-solving Influencing Organization Managing resources Having a network of friends and associates

Stress diaries

Provides a means for clients and therapists to track stress and coping over time Generally involves journal or recording of the times and events surrounding stress, personal reactions to events, and coping strategies used Linehand's stress diary used with DBT Track daily activities and sleep diaries

Writing

Psycho-dynamic approach Free writing and flow writing, stream of consciousness, journal writing, open dialog, and expressive creative writing Following completion, the client is asked to write a follow-up dialogue from a perspective of a friend

Creative expression

Psychodynamic Free-form art, sculpture, and improvisational drama or play Seeks to free underlying emotions and conflicts in order to heal the psyche

Assessment purpose in OT

Purpose is to explore areas of current stress and personal coping in the context of their impact on quality of life and occupational performance

Threat minimalization coping strategies

Putting distressing thoughts out of one's mind as a type of denial or avoidance

Areas for observation in stress and coping

Reaction to occupational performance in expected daily activities Relationship and interactions with significant others Client factors such as emotional state, reaction to stress, and ability to cope Client appraisal of the situation as compared with actual facts Other relevant information related to context

Four purposes of TIC

Realizes the widespread impact of trauma Recognizes signs and symptoms in clients Responds through integrated policies and practices Works against re-traumatization

Diathesis

Refers to a predisposition, perhaps created by genetics or other background factors, that makes a person more vulnerable to the challenges of living

Self-blame coping strategy

Refocusing attention as part of avoidance

Stressor sequences

Represent a cascade of adversity, often resulting from a single event

Principles to foster healing in youth following trauma

Restoration of sense of safety Developing positive bonds with adults Normalizing trauma reactions Developing healthy rituals and routines Facilitating self and emotional regulation Moving from a victim toward a survivor mode of thinking

Six key principles of TIC

Safety Trustworthiness and transparency Peer support and mutual help Collaboration and mutuality Empowerment, voice, and choice Cultural, historical, and gender issues

Information seeking coping strategy

Seeking information and advice about the situation and active coping strategies used by others

Interviews as complementing stress and coping measures

Serve to expand on information gained in inventories and allow therapist to use clinical reasoning in the selection of areas for further inquiry Formal or informal (can use specific guides or not) Family stress coping interview Canadian Occupational Performance Measure Occupational Case analysis interview and rating scale

Acute stressors

Short-term events that go away quickly

Protective factors against suicide

Social and family responsibility Positive survival and coping skills Religious and moral objections to suicide Life satisfaction Knowledge that suicide can solve life's problems Fear of humiliating one's children The importance of living in harmony with nature

Stress measurement

Social readjustment scale (suggests that stressful life events correlated with the onset of illness) Recent life changes questionnaire Occupational stress inventory-revised Stress symptom checklist Ardell Wellness Self-assessment stress test

Wish-fulfilling fantasy coping strategy

Spending time imagining an improved situation

Four key principles of army resilience training programs

Strengths-based model Small group interactions Deployment cycle specific training Use of deployment cycle specific video vignettes

Cognitive Behavioral Interventions

Stresses the role of one's thought process in influencing emotions and behaviors Identifies maladaptive behaviors and thinking patterns Restructures these patterns with adaptive thoughts and actions Can include mindfulness and relaxation inventories

Stress and Mind-Body Connection

Studied through psychoneuroimmunology Emotions resulting from events create changes in the endocrine system The endocrine system prepares the body to respond to threats Over time, the hormones released in response to threats can be harmful and create circumstances that damage the body's natural defensive systems

Mental illness and coping

Symptoms of mental illness and personal societal stigma add to difficulty in coping with everyday stressors

Trauma Informed Care

Systematic approach approach that seeks to recognize, understand, and respond to the effects of trauma

Warning signs of suicide

Talking about or threatening to kill or harm self Looking for a means to kill self Talking or writing about death, suicide, or harming self Expressing feelings of hopelessness/feeling trapped Uncontrolled anger or rage Increased alcohol or drug use Withdrawing from family, friends, society Change in sleep patterns Feeling anxious or agitated Experiencing dramatic mood changes Having a lack of purpose in life

Immune system and anxiety

The immune system wears down with repeated activation from anxiety

Health, wellness, nutrition, and exercise

The incorporation of healthy life choices is effective in decreasing illnesses that lead to mortality, enhance well-being, decrease depression and anxiety, improve mood

Generalized adaptation syndrome

The predictable biological pattern that the body uses to return to homeostasis after exposure to stress

Bereavement

Time of grief and mouring Importance of meaning making and creation of identity while mitigating bereavement CBT can help Continued support is important

Personality and stress

Type A personality and Type B were coined to describe the distinction between people whose lifestyles and personal attributes foster more stressful circumstances and those who attitudes and pace of life are such that their emotional responses to circumstances are less likely to evoke physiological stress responses

Suicide prevention and crisis awareness (PPT)

Understand the community's needs Developed specific to population to address specific developmental, cognitive, and emotional needs

Areas of practical difficulties encountered by families affected by mental illness

Understanding the disease Managing the symptoms Coordinating therapy services (including the family in evaluation and intervention helps mediate difficulties often associated with caregiving)

Allostasis

process by which the body achieves homeostasis after responding to various stressors