Wk 8 - Mood, Anxiety, Obsessive and Trauma-related Disrders

The Wellness Model

The 8 Dimensions of Wellness

“FOSSIEE-F”

1. Emotional

2. Intellectual

3. Physical

4. Social

5. Occupational

6. Environment

7. Financial

8. Spiritual

1 - Emotional

(description)

• Awareness and acceptance of one's feelings.

• Ability to manage stress and cope with challenges.

1 - Emotional

(OT application)

1. Coping Skills Training

2. Emotional Regulation Strategies

3. Stress Management

2 - Intellectual

(description)

• Engagement in creative and stimulating mental activities.

• Learning and problem-solving.

2 - Intellectual

(OT application)

1. Cognitive Stimulation

2. Skill-Building Activities

3. Psychoeducation

3 - Physical

(description)

Need for physical activity, nutrition, sleep, and self-care.

3 - Physical

(OT application)

1. Sleep Hygiene

2. Physical Activity Routines

3. Meal Planning and Preparation

4 - Social

(description)

Developing and maintaining meaningful relationships with others.

4 - Social

(OT application)

1. Social Skills Training

2. Group Activities

3. Community Participation.

5 - Occupational

(description)

Personal satisfaction and enrichment from one's work, volunteering, or meaningful activity.

5 - Occupational

(OT application)

1. Vocational Rehabilitation

2. Work Simplification

3. Activity Scheduling

6 - Environmental

(description)

Safe, supportive, and stimulating physical surroundings.

6 - Environmental

(OT application)

1. Environmental Modification

2. Home Safety Assessment

3. Sensory-Friendly Spaces.

7 - Financial

(description)

• Satisfaction with current and future financial situations.

• Resource management.

7 - Financial

(OT application)

1. Budgeting Activities

2. Resource Linkage

3. Money Management Skills.

8 - Spiritual

(description)

Search for meaning and purpose; connection to values and beliefs.

8 - Spiritual

(description)

1. Meaning-Making Activities

2. Values Clarification

3. Mindfulness and Reflection

Thinking Guide

• Assist students in navigating the clinical reasoning process when working with clients in mental health settings.

• It is NOT intended to serve as a formal or standardized framework, but rather as a practical tool to support your thinking as you begin to plan and implement occupational therapy interventions.

• It is meant to be a companion to your clinical practice.

• Please note that this seven-step process is not limited to the steps indicated below.

  • It is a flexible guide, not a rigid checklist.

  • The steps are meant to be a starting point for your thinking, not a constraint on it.

Components of Thinking Guide

1. Diagnosis

2. Occupational Problem / Client Complaint / Client’s Goal

3. Person-Task-Environment (PTE)

4. Performance Skills & Patterns, and Client Factors

5. Framework / Model

6. Activity

7. Grading

Thinking Guide: Diagnosis

• The diagnosis provides the clinical context—symptom clusters, functional impact, course, and prognosis.

• However, it does NOT prescribe the activity; it provides the backdrop but NOT the client’s values, occupational history, or unique limitations.

Thinking Guide: Occupational Problem / Chief Complaint / Goals of the Px

• Occupational Problem: Actual disruption in the client’s daily life and the primary target of intervention.

  • Any difficulty in performing activities, roles, and routines that are meaningful and necessary, including self-care, productivity, leisure, or social participation.

• It is identified through client interview and formal and informal

assessments.

Thinking Guide: Person-Task-Environment (PTE)

• The PTE analysis explains WHY the occupational problem exists and what factors maintain it.

• Person: Strengths, limitations, values, interests, and symptoms.

• Task: Physical, cognitive, sensory, social, and emotional demands of the activity.

• Environment: Physical setting, sensory stimuli, social support, cultural context, and safety considerations

Thinking Guide: Performance Skills, Patterns and Client Factors

• Skills: Motor, process, and social interaction domains.

• Client Factors: Specific body functions and structures affected.

• Identifying these specific deficits allows the OT to select interventions that directly address them.

Thinking Guide: Framework and Model

• The framework is selected based on the occupational problem, not the diagnosis.

• Behavioral FOR = Avoidance due to fear indicates.

• Cognitive Behavioral FOR = Cognitive distortions.

• Sensory Modulation = Sensory overload or hyperarousal.

• Psychodynamic FOR = Unresolved inner conflicts or defense.

• MOHO = Low motivation or loss of meaning

• PEO or CMOP-E = Environmental barriers.

Thinking Guide: Activity

• The activity is the therapeutic medium through which intervention is delivered.

• It must address the occupational problem, be meaningful and purposeful to the client, be capable of being graded up or down, be safe in the current environment, match the client's current capacity, and have the potential to lead to independent occupational performance.

• It should be occupation-based—a real-life task the client needs or wants to do.

Thinking Guide: Grading

• Grading s the deliberate adjustment of task demand to achieve the "just-right challenge.”

• Grade Down = Simplifying the task, providing more cues, reducing steps, or modifying the environment.

• Grade Up = Include increasing complexity, reducing support, adding distractions, or increasing time demand.

Mood Disorders: Vital Diagnostic Information

1. Major Depressive Disorder (MDD)

2. Bipolar I Disorder

3. Bipolar II Disorder

Major Depressive Disorder (MDD)

Key Clinical Features:

• Depressed mood, anhedonia (loss of pleasure), fatigue, psychomotor underactivity or agitation, sleep disturbance (insomnia or hypersomnia), appetite changes, difficulty concentrating, feelings of worthlessness or guilt.

Duration: At least 2 weeks

Functional Impact:

• Difficulty with self-care (hygiene, grooming), work (absenteeism, reduced productivity), leisure (loss of interest), social (withdrawal, isolation).

Bipolar I Disorder

Key Clinical Features:

• Manic episodes (elevated or irritable mood, decreased need for sleep, grandiosity, pressured speech, racing thoughts, impulsivity, risk- taking behavior) alternating with depressive episodes.

Duration: At least 1 week for mania

Functional Impact:

• During mania: impaired judgment, risk-taking (spending, driving), occupational disruption, interpersonal conflict)

• During depression: functional decline, withdrawal, self-care neglect.

Bipolar II Disorder

Key Clinical Features:

• Hypomanic episodes (less severe than mania, no significant impairment) alternating with major depressive episodes.

Functional Impact:

• Hypomanic episodes (less severe than mania, no significant impairment) alternating with major depressive episodes.

Mood Disorder: Intervention for Person

1. Energy Conservation Techniques

2. “One Small Thing” Rule

3. Physical Activity

4. Medication Adherence Support

5. Sensory Modulation for Depression

Person: Energy Conservation Techniques

Description:

• Teach pacing, prioritization, and rest breaks to manage fatigue.

Gist:

• Client lists activities by priority; schedules rest breaks between tasks.

Person: “One Small Thing” Rule

Description:

• Identify one, achievable task per day (e.g., making the bed, drinking a glass of water).

Gist:

• Therapist and client agree on one task; client reports completion the next session.

Person: Physical Activity

Description:

• Encourage regular physical activity to improve mood and energy.

Gist:

• Client engages in 10-15 minutes of walking or light exercise; track mood before and after.

Person: Medication Adherence Support

Description:

• Help client manage medication schedule and monitor side effects.

Gist:

• Use a pill organizer; set alarms; educate on side effects.

Person: Sensory Modulation for Depression

Description:

• Use alerting sensory input to address hypoarousal and low energy.

Gist:

• Client uses cold water (face wash), bright light (open curtains), or upbeat music (OPM) to increase arousal before activities.

Mood Disorder: Intervention For Task

1. Routine Building

2. Graded Task Assignment

3. Activity Scheduling with Mastery and Pleasure Ratings

Task: Routine Building

Description:

• Structure the task of daily routines to improve sleep, self-care, and occupational balance.

• Preventing overexertion

Gist:

• Create a visual daily schedule.

Task: Graded Task Assignment

Description:

• Break down large tasks into smaller, achievable steps to reduce task demand.

Gist:

• Example: Making a simple Filipino breakfast (pandesal at kape). Steps: (1) Fill kettle with water, (2) Boil water, (3) Prepare coffee, (4) Toast pandesal, (5) Serve.

Task: Activity Scheduling with Mastery and Pleasure Ratings

Description:

• Restructure the task of planning daily activities to include self-rating of mastery and pleasure.

Gist:

• Provide a simple notebook or worksheet; client rates each activity from 1-10.

• Review patterns and identify activities that provide mastery and pleasure.

Mood Disorder: Intervention for Environment

1. Environmental Modification

2. Family and Caregiver Education

3. Interprofessional Collaboration

4. Community Resource Linkage

Environment: Environmental Modification

Description:

• Modify the physical environment to prevent occupational deprivation and support performance.

Gist:

• Reduce clutter; improve lighting; create a designated activity space; ensure safety (e.g., remove tripping hazards).

Environment: Family and Caregiver Education

Description:

• Change the social environment by educating family on mood disorders and how to support recovery.

Gist:

• Teach family about symptoms, medication side effects, and how to respond to crises; reduce expressed emotion.

Environment: Interprofessional Collaboration

Description:

• Modify the care environment by collaborating with the mental health team.

Gist:

• Refer to psychiatrist, psychologist, nurse, and social worker regarding the client's functional progress and needs.

Environment: Community Resource Linkage

Description:

• Change the community environment by connecting client with resources.

Gist:

• Refer to barangay health center, support groups, or vocational rehabilitation services.

Anxiety Disorder: Vital Diagnostic Information

1. Panic Disorder

2. Agoraphobia

3. Specific Phobia

4. Social Anxiety Disorder (Social Phobia)

5. Generalized Anxiety Disorder (GAD)

Panic Disorder

Key Clinical Features:

• Recurrent unexpected panic attacks (intense fear palpitations, sweating, trembling, shortness of breath, chest pain, fear of losing control or dying).

• Persistent concern about future attacks or maladaptive changes in behavior.

Functional Impact:

• Avoidance of places/situations where attacks occurred; occupational restriction; fear of losing control; social withdrawal.

Agoraphobia

Key Clinical Features:

• Fear of situations where escape might be difficult or help unavailable (e.g., public transport, crowds, open spaces, being outside the home alone).

Functional Impact:

• Avoidance of community mobility; difficulty attending appointments or work; social isolation.

Specific Phobia

Key Clinical Features:

• Intense fear of a specific object or situation (e.g., heights, animals, needles, flying).

Functional Impact:

• Avoidance of occupational tasks involving the phobic stimulus; interference with daily routines.

Social Anxiety Disorder (Social Phobia)

Key Clinical Features:

• Fear of social situations and negative evaluation; avoidance of social interaction; fear of embarrassment.

Functional Impact:

• Fear of social situations and negative evaluation; avoidance of social interaction; fear of embarrassment.

Generalized Anxiety Disorder (GAD)

Key Clinical Features:

Excessive, uncontrollable worry about multiple domains

(work, family, health, finances); restlessness, fatigue, difficulty concentrating, irritability, muscle tension, sleep disturbance.

Duration: At least 6 months

Functional Impact:

• Difficulty concentrating; restlessness; occupational interference; fatigue; sleep disturbance.

Anxiety Disorders: Intervention for Person

1. Thought Record

2. “Worst, Best, Most Likely”

3. Zones of Regulation

4. Breathing and Relaxation Training

5. Social Skills Training

Person: Thought Record

Description:

• Client records a situation, the automatic thought, the emotion, and evidence for and against the thought.

Gist:

• Provide a notebook; client writes:

  • Situation: Nag-away kami ng kaibigan ko.

  • Thought: Galit siya sa akin.

  • Emotion: Takot, 90/100.

• Column 1: Write the situation (facts only).

• Column 2: Write the automatic thought and rate belief (0-100).

• Column 3: Write an alternative thought (0-100)

• Then add: Emotion rating before and after

Person: “Worst, Best, Most Likely”

Description: Client identifies the worst-case, best-case, and most likely outcome of a feared situation.

Person: Zones of Regulation

Description:

• Teach client to identify their state and choose a strategy.

Gist:

• Client uses a simple chart (blue, green, yellow, red) to identify and regulate arousal.

Person: Breathing and Relaxation Training

Description: Teach diaphragmatic breathing and progressive muscle relaxation.

Person: Social Skills Training

Description:

• Teach and practice social skills for clients with social anxiety.

Gist:

• Role-play greetings, conversations, and assertiveness; practice in group activities.

Anxiety Disorders: Intervention for Task

1. Graded Exposure

2. Activity Pacing

3. Occupational Analysis and Adaptation

Task: Graded Exposure

Description:

• Gradually increase the task demand of feared situations within meaningful occupations.

Gist:

• Client practices riding a jeepney for one stop, then progresses to a longer route; therapist accompanies initially.

Task: Activity Pacing

Description:

• Alter the task demand by balancing activity and rest to prevent overstimulation and fatigue.

Gist:

Client schedules 15-minute breaks between tasks; uses a timer; practices "stop and breathe" before next task.

Task: Occupational Analysis and Adaptation

Description:

• Modify the task itself to reduce anxiety triggers.

Gist:

• Break tasks into smaller steps; provide written instructions; reduce time pressure.

Anxiety Disorder: Intervention for Environment

1. Environmental Adaptation

2. Family and Caregiver Education

3. Community Resource Linkage

Environment: Environmental Adaptation

Description:

Modify the physical environment to prevent anxiety triggers.

Gist:

• Client uses noise-canceling headphones or sits near the door in group settings; therapist grades task demands.

Environment: Family and Caregiver Education

Description:

• Change the social environment by educating family on anxiety disorders.

Gist:

• Teach family about symptoms, triggers, and how to respond during panic attacks.

• Reduce accommodation behaviors.

Environment: Community Resource Linkage

Description:

• Change the community environment by connecting client with resources.

Gist:

• Refer to barangay health center, support groups, or anxiety support networks.

Obsessive-Compulsive and Related Disorders: Vital Diagnostic Information

1. Obsessive-Compulsive Disorder (OCD)

2. Body Dysmorphic Disorder

3. Hoarding Disorder

4. Trichotillomania (Hair-Pulling Disorder)

5. Excoriation (Skin-Picking) Disorder

Obsessive-Compulsive Disorder (OCD)

Key Clinical Features:

• Recurrent obsessions (intrusive, unwanted thoughts) and/or compulsions (repetitive behaviors performed to reduce anxiety).

• Symptoms are time-consuming (more than 1 hour per day) and cause significant distress or impairment.

Functional Impact:

• Time-consuming rituals interfere with daily tasks; difficulty completing occupations; social embarrassment; avoidance of triggers.

Body Dysmorphic Disorder

Key Clinical Features:

• Preoccupation with perceived defects in appearance that are not observable or appear slight to others.

• Repetitive behaviors (mirror checking, grooming, seeking reassurance).

Functional Impact:

• Avoidance of social situations; repetitive behaviors consume time; difficulty concentrating on tasks.

Hoarding Disorder

Key Clinical Features:

• Persistent difficulty discarding possessions, regardless of their actual value.

• Results in clutter that congests living spaces and compromises safety.

Functional Impact:

• Unsafe living environment; difficulty with ADLs (cooking, cleaning, moving); social isolation; fire hazard.

Trichotillomania (Hair-Pulling Disorder)

Key Clinical Features:

• Recurrent pulling of one's hair, resulting in hair loss. Repeated attempts to stop.

Functional Impact:

• Visible hair loss; social embarrassment; sensory- based urges (tension before pulling, relief after).

Excoriation (Skin-Picking) Disorder

Key Clinical Features:

• Recurrent skin picking, resulting in skin lesions.

• Repeated attempts to stop.

Functional Impact:

• Skin damage; infection risk; social embarrassment; time-consuming.

Obsessive-Compulsive and Related Disorders: Intervention for Person