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Added Stress to Mentally Ill after 9/11
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This
week's Health section of the Washington Post addressed
the additional assault of terrorism on the psyche and emotions
of individuals already challenged by mental illness.
Across the country, community mental health services and support
groups are experiencing the same surge in numbers, as are
houses of worship. For this week, I gathered references
on the role of occupational therapy in addressing anxiety,
panic, fear, stress, or crisis intervention with this population.
Baldwin, L.C.
(1995). Spirituality, Health, and Occupational Therapy.
IN: American Occupational Therapy Association, Inc. Conference
Abstracts and Resources 1995. Bethesda, MD: AOTA, pp.
165-166.
ABSTRACT: Humans
have demonstrated the ability to overcome tremendous adversity.
They find meaning and hope in the most deplorable of circumstances.
Frankl (1962) wrote of the ability of concentration camp victims
to grow spiritually in spite of physical and mental torture.
But what is spirituality? Colliton (1981) defined spirituality
as "the life principle that pervades a person's entire
being, including volitional, emotional, moral ethical, intellectual,
physical dimensions, and the capacity for transcendent values"
(p.248). Occupational therapists, as holistic practitioners,
have traditionally stressed the interconnectedness of body,
mind, and spirit (White, 1986). A rapidly increasing
number of health care professionals have begun to investigate
spirituality and how it affects one's health. One indicator
of spirituality used by many researchers is spiritual well-being,
"...an affirmation of life and of the lives of others,
together with concerns for one's community, society, and the
whole of creation" (Moberg, 1979, p.2). Spiritual
well-being has been operationalized by Paloutizian and Ellison
(Ellison, 1983) who developed the spiritual well-being scale.
This scale measured both religious and existential well-being.
Using the scale, a variety of researchers have found spiritual
well-being to relate in a positive manner with hardiness (Carson
& Green, 1992); acceptance of morality and feelings of
well-being among the terminally ill (Reed, 1987); hope (Carson,
Soeken, and Grimm, 1988); acceptance of mortality and feelings
of loneliness (Miller, 1985); decreased anxiety (Kaczorowski,
1988); and purpose of life (Burns and Smith, 1991).
Spiritual well-being has been found to be negatively correlated
with depression (Fehring, Brennen, and Keller, 1989).
Individuals who are terminally ill, those who are depressed,
have limited function, or have chronic pain may experience
feelings of hopelessness, isolation, loneliness, alienation,
and decreased self worth. Caring, concerned occupational
therapists can learn to facilitate spiritual growth through
the use of art, music, photography, literature, dance, and
story telling.
Courtney, C. &
Escobedo, B. (1990). A stress management program: Inpatient-to-outpatient
continuity. The American Journal of Occupational Therapy,
44(4), 306-310.
ABSTRACT: Stress
is a factor in many modern illnesses. The development of coping
skills to deal with stress is an occupational therapy goal
for many patients. The program presented here uses stress
management techniques to improve the situational coping skills
of adult psychiatric patients. When discharged to the outpatient
clinic, the patients in this program continue to learn and
practice stress management techniques to increase relaxation
and lessen anxiety. A case example is presented.
Feder, J.
(1990). Occupational stress and the depressed female client.
Work: A Journal of Prevention, Assessment & Rehabilitation,
1(2), 55-62.
ABSTRACT: Occupational
stress and stress management are hardly modern topics, even
though in recent years there has been an increased emphasis
on the role of stress in illness. If the 1960s was termed
the Age of Anxiety, then the 70s and 80s brought us into the
Age of Stress. However, the recognition of stress management
programs developed for, and implemented in, psychiatric hospitals
are rarely mentioned in the psychiatric literature. To fill
that void, this article presents an overview of occupational
stress theories and research. It then shifts focus to discuss
how occupational stress affects the female worker and compounds
depression. In addition, occupational stress management intervention
techniques will be presented as part of a brief focused rehabilitation
strategy for depressed female office workers.
Halford, M.R.
(1985). Anxiety management: Application in acute psychiatry
and within the community. The Journal of the New Zealand
Association of Occupational, 36(1), 16-18.
Jacobs, T.
(1982). An occupational therapy view of crisis intervention.
The Australian Occupational Therapy Journal, 29(4), 153-160.
ABSTRACT:
The following paper outlines the roles and functions of a
multidisciplinary team working on a controlled experiment
to assess the feasibility of introducing a permanent crisis
intervention team to a regional mental health service. Rationale
for forming the team, and some results of the research are
included. The research has shown similar results to
those found in comparable experiments overseas.
Larson, K.B.
(1990). Activity patterns and life changes in people
with depression. The American Journal of Occupational Therapy,
44(10), 902-906.
ABSTRACT:
The Activity Pattern Indicator (API) (Diller, Fordyce, Jacobs
& Brown, 1978) and the Schedule of Recent Experience (SRE)
(Holmes, 1981) were used to determine activity patterns and
life changes for 15 depressed patients admitted to an acute
care mental health unit. Eight categories on the API
were correlated with six categories on the SRE to determine
the relationship between activity patterns 1 week and 1 month
before hospitalization and life changes for the past year.
Two correlations indicated that as the total number of life
changes and home and family life changes increase, activity
related to personal care decreases. Other correlations showed
that as life changes related to health, work, and finance
increase, such activities as passive recreation, homemaking,
socializing and personal care also increase. Because
activity is the cornerstone of occupational therapy, occupational
therapists, in treating patients with depression, might include
facilitating close inspection of the patients' activity patterns
in relation to the changes that have occurred in their lives.
Miller, R.J., Cullen,
B. & O'Brien, R. (1981). Are you sitting comfortably?
Psychological approaches to the management of stress and anxiety.
The British Journal of Occupational Therapy, 44(1),
5-9.
Miller, V. &
Robertson, S. (1991). A role for occupational therapy
in crisis intervention and prevention. The Australian Occupational
Therapy Journal, 38(3), 143-146.
ABSTRACT:
This paper presents some of the basic concepts in crisis intervention
theory and crisis prevention and their application to current
service provision in mental health. Occupational therapists
already possess many of the skills required to intervene in
a crisis. The authors present these concepts with a
view to encouraging therapists to regard crisis work as a
legitimate area of practice in mental health care. The "buck
stops here" level of responsibility is a new challenge
for occupational therapists.
Mueller, S.
(1983). Starting A Stress Management Programme. Mental
Health Special Interest Section Newsletter, 6(2), 1-3.
Prior, S. (1998).
Determining the effectiveness of a short-term anxiety management
course. The British Journal of Occupational Therapy,
61(5), 207-213.
ABSTRACT:
The effectiveness of a 6-week anxiety management course at
a mental health day hospital was researched. The author
was motivated to research these sessions due to her own observations
of the clients' progress in the groups. There was also
an increasing demand for anxiety management groups with many
clients being referred by general practitioners. The
subjects were 37 clients. The diagnosis of the clients
varied but anxiety must have been identified as a problem.
Four of the 6-week courses were run over a period of 10 months.
The course was evaluated using three questionnaires: the Hospital
Anxiety and Depression (HAD) Scale, the Spielberger Questionnaire
(state and trait) and the Fear Questionnaire. The clients
completed the questionnaires four times: pre-treatment, at
the beginning and at the end of the course, and 2 months post-treatment.
A control group was used. The data collected from the
questionnaires were analysed using paired t-tests. The
results showed that the anxiety management course was effective,
with statistically significant reduction in symptoms by the
end of the course. The control group did not show significant
change. It was the HAD scale that showed the statistically
significant positive change. The state section of the
Spielberger Questionnaire followed the same pattern as the
HAD Scale and showed a reduction in symptoms, although it
was not statistically significant. The results of the
Fear Questionnaire suggested that the clients' phobias were
not treated by the anxiety management course. A client
satisfaction questionnaire was used and participants made
positive comments about the value of the course.
Prior, S.
(1998). Short report: Anxiety management: Results of
a follow-up study. The British Journal of Occupational
Therapy, 61(1), 284-285.
Rosenfeld, M.S.
(1984). Crisis intervention: The nuclear task approach. The
American Journal of Occupational Therapy, 38(6), 382-385.
Rosenfeld, M.
(1982). OT Education Bulletin: The nuclear task approach -
A unified system for teaching crisis intervention methods
to occupational therapy students. Occupational Therapy
News, 36(9), Insert 4-6.
Rosier, C., Williams,
H. & Ryrie, I. (1998). Anxiety management groups
in a community mental health team. The British Journal
of Occupational Therapy, 61(5), 203-206.
ABSTRACT:
Just as the delivery of care to people with mental health
problems has evolved, so too has the role an occupational
therapist plays in the multidisciplinary mental health team.
This paper highlights the valuable role of occupational therapists
within a particular community mental health team by, first,
acknowledging their specialist skills and then describing
one component of their work: a 7-week closed group for anxiety
management. Finally, it provides recommendations
for others who may wish to set up a similar group, which have
been drawn from the authors' own experiences.
Wykoff, W.
(1993). The psychological effects of exercise on non-clinical
and clinical populations of adult women: A critical review
of the literature. Occupational Therapy in Mental Health,
12(3), 69-106.
ABSTRACT:
A critical review of the research indicates that studies examining
the psychological effects of exercise on both non-clinical
and clinical populations of adult women of various age groups
have increased and improved since the late 1970's/early 1980's.
In general, positive results are implied in terms of alleviating
symptoms of anxiety, depression, mood, and reactivity to psychosocial
stressors as well as improving cognition for both populations.
Overall, however, even the more recent research continues
to suffer qualitative shortcomings. Virtually absent are studies
specific to minority and/or lower class non-clinical or clinical
female subjects, studies specific to clinical female subjects
in general, empirical studies with comparable control groups,
and longitudinal and/or follow-up studies. Moreover,
the positive results of existing research are limited due
to the use of small sample sizes, the use of surveys rather
than outcome measures, and the use of personality measures
(normally administered to detect psychopathology in clinical
populations) on non-clinical populations. Many outcome
studies also suffer from an over-reliance on the combination
of men's and women's data for purposes of analysis in much
of the research conducted on adult subjects of both genders.
Overall, the review indicates that improvements in the current
research are warranted and specific changes are suggested.
A few on-line sources
to assists individuals with mental illnesses to cope with
recent terrorism are:
American
Psychological Association
"Handling
anxiety in the face of the Anthrax Scare"
National
Alliance for the Mentally Ill
"Resources
for responding to trauma and terrorism"
National
Mental Health Association(On home page have "Mental health
in troubled times" and "Coping Resources")
National
Institute of Mental Health
American
Medical Association(full-text article on bioterrorism
)
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