Responding to Systems and Behaviors

Mon/Wed

Framework of Concepts About Symptoms - Unmet Conflicts

symptoms may result as expression of unmet needs.

Framework of Concepts About Symptoms - Symptoms Not the Disease

behavioral evidence of the disease.

Framework of Concepts About Symptoms - Responses to Events

response to what’s going on or expression of needs and meet need before behavior/symptom occurs again.

Framework of Concepts About Symptoms - Personality/Personal Experiences

symptoms may be characteristics of individual’s personality.

Framework of Concepts About Symptoms - Individual Strengths

strengths can help control and master the symptoms.

Response Variables

self, environment, and activity.

Self Response Variable

the therapist’s own personality.

Environment Response Variable

context in which your interaction with the client takes place.

Activity Response Variable

the thing that you and the client can do together.

Determining Response Strategies Based on Symptoms

definition (what unmet need is it hiding), diagnosis (for which this symptom often occurs), therapeutic use of self, environmental modifications, and characteristics of suitable activities.

Anxiety

state of tension and uneasiness and change can increase this; a symptom of almost every diagnostic category; encourage talking about what is bothering them and then, redirect to neutral topics.

Anxiety Environment

best environment for this is a calm, comfortable one.

Anxiety Interventions

should be successful without too much detail, able to get up/walk/come back, exercise (ex. Tai Chi), cognitive technique (ex. journal writing, nature walks, sensory rooms), and stress management techniques (time management, meditation, relaxation).

Depression

feeling of intense sadness/despair/hopelessness, seen in a wide range of disorders such as organic mental disorders, schizophrenia, personality disorders, substance abusers; talk about what is bothering them, focus on how they feel and why.

Depression Environment

best environment would be a safe and subdued one.

Depression Interventions

simple/structured/short/familiar activities; 1st should be successful, then done without interaction, gross motor may help, and always prevent against suicide.

Mania

disturbance of mood characterized by euphoria/generosity/irritability/distractibility/increased activity level, primary symptom of an affective disorder (manic episode), can occur with substance abuse, schizophrenia, personality disorders.

Mania Precaution

be cautious of giving any praise or approval, instead be firm and gentle with focus on how to make behavior more appropriate – patient attempts to manipulate you.

Mania Environment

control the environment to help the pt function.

Mania Interventions

short term, structured, gross motor activities that allow for carryover of skills – very short attention span until meds kick in.

Hallucinations

sensory experience that does not correspond to external reality; can occur in a wide range of psychiatric disorders such as schizophrenia, manic and depressive, organic mental disorders, and substance abuse.

Hallucinations Precautions

reassure the client and help them understand what is going on- DO NOT argue whether or not the hallucinations are real and acknowledge how the hallucination makes patient feel without agreeing that it is real.

Hallucinations Environment

best environment would be a calm, quiet, and non-distracting one.

Hallucinations Interventions

highly structured activities and interaction with few trusted people; don’t work alone and don’t require fine detail.

Delusions

a belief that is contrary to reality as experienced by others in one’s cultural group, psychotic and personality disorders; avoid discussing the delusions and redirect the person’s attention to something else (pointless to argue; relate to him/her as an intelligent adult).

Delusions Environment

best environment would be a relatively stimulating environment – real life activities one.

Delusions Interventions

all activities suited to the person’s intellectual level.

Paranoia

type of thinking in which persecutory and grandiose ideas predominate; paranoid schizophrenia.

Paranoia Precautions

avoid sudden approaches, be clear, consistent, directive, and unambiguous; don’t whisper around them and OTA must stay in control; not another group member.

Paranoia Environment

do not change environment, keep stable and reliable as possible.

Paranoia Interventions

activities must be one the person can control.

Anger

strong feeling of displeasure.

Hostility

unfriendly and threatening attitude.

Aggression

an attack on person or object and can be verbal, physical or both.

Psychotic Disorders

paranoid schizophrenia, manic-depressive psychosis, psychotic depression, organic mental disorders, substance abusers, and antisocial personality disorders.

Anger/Hostility/Aggression Precautions

be sensitive to clients’ feelings (watch body language) and stand 4-5 feet away, do not face the person directly, do not touch the client.

Anger/Hostility/Aggression Interventions

large forceful movements or activities that encourage self-expression and teach stress management, assertiveness training.

Seductive Behavior and Sexual Acting Out

any behavior that would normally be seen as explicitly sexual or as provoking a sexual response from others; usually only occurs in those who are psychotic; tell the client when they are acting inappropriately in a calm, nonjudgmental manner and excuse them if needed.

Seductive Behavior and Sexual Acting Out Environment

crowded situations in which close personal contact is not a good idea.

Seductive Behavior and Sexual Acting Out Interventions

forceful gross motor activities, social skills to teach appropriate social behavior.

Cognitive Deficits: Confusion and Impaired Memory

impairment or deficit in one or more of the mental functions needed for thinking, organic mental disorders (dementia, physical disease, head trauma, drugs abuse), and approach each person as an individual and according to their various levels of functioning.

Cognitive Deficits: Confusion and Impaired Memory Environment

the three principles for the environment are safety, desired behavior, and removal of triggers.

Cognitive Deficits: Confusion and Impaired Memory Interventions

simple, short term activities based on their abilities.

Attention Deficits and Disorganization

problems in directing attention to a task or in sustaining attention for a reasonable length of time; disorganization is the lack of planning and order; organic mental disorders, ADHD, and drug/alcohol abuse; use firm touch, loud voice.

Attention Deficits and Disorganization Environment

have the person work alone in a non-distractive environment.

Attention Deficits and Disorganization Interventions

simple, well delineated activities – use Allen to guide.

WRAP

wellness recovery action plan; recognize, reduce, and eliminate troubling symptoms.

WRAP Should Include

daily maintenance list, list of personal triggers and of personal early warning signs, ways to recognize symptoms, and a crisis plan or advance directive.