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