Psychosocial Occupational Therapy
Mental health conditions, therapeutic approaches, and psychiatric rehabilitation
Table of Contents
1. Mental Health Conditions
Mood Disorders
Major Depressive Disorder (MDD)
- Depressed mood most of day
- Anhedonia (loss of interest/pleasure)
- Weight/appetite changes
- Sleep disturbance
- Fatigue, loss of energy
- Feelings of worthlessness
- Concentration difficulties
- Suicidal ideation
5+ symptoms for 2+ weeks
Bipolar Disorder
Alternating manic/depressive episodes
- Manic: Elevated mood, grandiosity, decreased sleep need, pressured speech, racing thoughts, risky behavior
- Bipolar I: Full manic episodes
- Bipolar II: Hypomanic + depressive episodes
Anxiety Disorders
| Disorder | Key Features |
|---|---|
| Generalized Anxiety Disorder (GAD) | Excessive worry for 6+ months; restlessness, fatigue, concentration problems |
| Panic Disorder | Recurrent unexpected panic attacks; fear of future attacks |
| Social Anxiety Disorder | Fear of social situations; fear of judgment/embarrassment |
| Specific Phobia | Excessive fear of specific object/situation |
| Agoraphobia | Fear of situations where escape is difficult |
Schizophrenia Spectrum
Positive Symptoms
- Hallucinations: Auditory most common
- Delusions: Paranoid, grandiose, referential
- Disorganized speech: Loose associations, tangentiality
- Disorganized behavior: Catatonia, bizarre behavior
Negative Symptoms
- Avolition: Lack of motivation
- Alogia: Reduced speech
- Anhedonia: Lack of pleasure
- Affective flattening: Reduced emotional expression
- Asociality: Social withdrawal
Personality Disorders
| Cluster | Disorders | Characteristics |
|---|---|---|
| Cluster A | Paranoid, Schizoid, Schizotypal | "Odd, eccentric" - suspicious, detached |
| Cluster B | Antisocial, Borderline, Histrionic, Narcissistic | "Dramatic, emotional" - impulsive, attention-seeking |
| Cluster C | Avoidant, Dependent, Obsessive-Compulsive | "Anxious, fearful" - inhibited, submissive |
Trauma & Stressor-Related Disorders
PTSD
- Intrusion: Flashbacks, nightmares
- Avoidance: Avoiding reminders
- Negative cognitions: Blame, detachment
- Arousal: Hypervigilance, startle response
Adjustment Disorder
- Emotional/behavioral symptoms to stressor
- Within 3 months of stressor
- Marked distress or impairment
- Resolves within 6 months of stressor ending
2. Therapeutic Approaches in Mental Health OT
Cognitive Behavioral Therapy (CBT)
Core Principle: Thoughts, feelings, and behaviors are interconnected. Changing maladaptive thoughts leads to changes in feelings and behaviors.
CBT Techniques in OT
- Cognitive restructuring: Identifying and challenging negative thoughts
- Behavioral activation: Scheduling meaningful activities
- Activity pacing: Balancing activity and rest
- Problem-solving training: Structured approach to challenges
- Exposure therapy: Gradual confrontation of fears
Dialectical Behavior Therapy (DBT)
Developed by Marsha Linehan for Borderline Personality Disorder. Balances acceptance and change.
Four DBT Modules
Mindfulness
"What" skills (observe, describe, participate) and "How" skills (non-judgmentally, one-mindfully)
Distress Tolerance
TIPP, ACCEPTS, crisis survival skills
Emotion Regulation
Identifying, understanding, and managing emotions
Interpersonal Effectiveness
DEAR MAN, GIVE, FAST skills
Psychoeducation
- Teaching clients about their condition
- Medication management education
- Symptom identification and monitoring
- Relapse prevention planning
- Lifestyle factors (sleep, exercise, nutrition)
- Family education and involvement
Therapeutic Use of Self
The OT practitioner's conscious use of their own personality, perceptions, and judgments as part of the therapeutic process.
Intentional Relationship Model (Taylor)
- Advocating: Speaking on behalf of client
- Collaborating: Equal partnership
- Empathizing: Understanding feelings
- Encouraging: Providing hope and support
- Instructing: Teaching skills
- Problem-solving: Finding solutions together
3. Group Interventions
Yalom's Therapeutic Factors
- Instillation of hope: Seeing others improve
- Universality: "I'm not alone"
- Imparting information: Psychoeducation
- Altruism: Helping others
- Corrective family experience: Working through issues
- Development of social skills: Practice interaction
- Imitative behavior: Modeling
- Interpersonal learning: Feedback from others
- Group cohesiveness: Belonging
- Catharsis: Emotional release
- Existential factors: Meaning and responsibility
Group Leadership Styles
Directive
Leader structures and controls; lower functioning groups
Facilitative
Leader guides but allows discussion; moderate functioning
Advisory
Minimal leader involvement; high functioning groups
Types of OT Groups
| Group Type | Purpose | Examples |
|---|---|---|
| Task Groups | Develop skills through activity completion | Cooking, crafts, work simulation |
| Developmental Groups | Meet needs based on developmental level | Parallel, project, egocentric-cooperative, cooperative, mature |
| Psychoeducational | Teach knowledge and skills | Stress management, medication education |
| Support Groups | Emotional support and shared experience | Peer support, recovery groups |
| Social Skills | Practice interpersonal skills | Assertiveness training, conversation skills |
Mosey's Developmental Groups
| Level | Interaction | Description |
|---|---|---|
| Parallel | Minimal | Side by side; leader provides all structure |
| Project | Short-term | Shared task requiring brief interaction |
| Egocentric-Cooperative | Selective | Longer task; meets own needs through group |
| Cooperative | Mutual | Mutual support; group needs considered |
| Mature | Balanced | Heterogeneous roles; flexible; minimal leader |
4. Recovery Model
Recovery is a process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential. Recovery is person-centered, not symptom-centered.
SAMHSA's Four Dimensions of Recovery
Health
Managing one's disease and making healthy choices that support physical and emotional well-being
Home
Having a stable and safe place to live
Purpose
Meaningful daily activities and the independence, income, and resources to participate in society
Community
Relationships and social networks that provide support, friendship, love, and hope
Ten Guiding Principles of Recovery
- Recovery emerges from hope
- Recovery is person-driven
- Recovery occurs via many pathways
- Recovery is holistic
- Recovery is supported by peers
- Recovery is supported through relationships
- Recovery is culturally-based
- Recovery is supported by addressing trauma
- Recovery involves individual, family, community strengths
- Recovery is based on respect
Recovery-Oriented OT Practice
- Client-centered: Goals based on client's priorities
- Strengths-based: Build on existing abilities
- Hope-inspiring: Emphasize possibility of recovery
- Empowerment: Support self-determination and choice
- Community integration: Focus on participation in real-world settings
- Peer support: Value of shared lived experience
5. Substance Use Disorders
Stages of Change Model (Prochaska & DiClemente)
| Stage | Description | OT Approach |
|---|---|---|
| Precontemplation | Not considering change; unaware of problem | Raise awareness; non-judgmental support |
| Contemplation | Ambivalent; weighing pros and cons | Motivational interviewing; explore values |
| Preparation | Planning to take action | Goal setting; identify supports |
| Action | Actively making changes | Skill building; healthy routines |
| Maintenance | Sustaining new behaviors | Relapse prevention; coping strategies |
Motivational Interviewing
A collaborative, goal-oriented style of communication that strengthens personal motivation for change
OARS Technique
- Open-ended questions - Encourage elaboration
- Affirmations - Acknowledge strengths and efforts
- Reflections - Mirror back what you hear
- Summaries - Pull together key points
OT in Substance Use Treatment
- Developing healthy routines and habits
- Time management and structure
- Identifying triggers and high-risk situations
- Building coping strategies
- Stress management
- Leisure exploration and participation
- Social skills and sober support networks
- Vocational rehabilitation
- Life skills (budgeting, cooking)
- Relapse prevention planning
6. Stress Management
Stress Response
General Adaptation Syndrome (Selye)
1. Alarm
Fight-or-flight response; sympathetic activation
2. Resistance
Body attempts to adapt; elevated cortisol
3. Exhaustion
Resources depleted; physical/mental breakdown
Relaxation Techniques
Progressive Muscle Relaxation (PMR)
- Systematically tense and release muscle groups
- Start from feet, work up to head
- Tense 5-7 seconds, release 20-30 seconds
- Notice difference between tension and relaxation
Diaphragmatic Breathing
- Breathe from diaphragm, not chest
- Belly rises on inhale
- Slow exhale (longer than inhale)
- 4-7-8 technique: Inhale 4, hold 7, exhale 8
Mindfulness
- Present-moment awareness
- Non-judgmental observation
- Body scan meditation
- Mindful activities (eating, walking)
Guided Imagery
- Visualize peaceful scene
- Engage all senses
- Use for relaxation or rehearsal
- Can be self-guided or with recording
Coping Strategies
Problem-Focused Coping
Addressing the stressor directly
- Problem-solving
- Time management
- Seeking information
- Taking action
Emotion-Focused Coping
Managing emotional response
- Relaxation techniques
- Seeking social support
- Reframing/reappraisal
- Acceptance
7. Community Mental Health
Treatment Settings
| Setting | Description | OT Role |
|---|---|---|
| Acute Inpatient | Crisis stabilization; short stay | Safety, basic ADLs, discharge planning |
| Partial Hospitalization (PHP) | Day treatment; 4-6 hours/day | Groups, skills training, transition planning |
| Intensive Outpatient (IOP) | 3+ hours/day, 3+ days/week | Groups, community integration |
| Outpatient | Individual or group sessions | Community living skills, vocational |
| Clubhouse | Member-run; work-ordered day | Vocational, social, transitional employment |
Assertive Community Treatment (ACT)
Intensive, community-based team approach for individuals with serious mental illness
- Multidisciplinary team (OT, psychiatrist, nurse, social worker)
- Low caseload (10:1 ratio)
- 24/7 availability
- Services provided in natural environment
- No time limits on services
Supported Employment
Individual Placement and Support (IPS) Model
- Zero exclusion: Anyone who wants to work is eligible
- Competitive employment: Real jobs in community
- Rapid job search: Within 30 days
- Job development based on preferences: Client choice
- Integrated with mental health treatment
- Ongoing support: Follow-along services
Housing Continuum
- Housing First: Permanent housing without treatment prerequisite
- Supported Housing: Independent living with services
- Group Home: Shared residence with supervision
- Transitional Housing: Time-limited with skill building
Key Takeaways for the Board Exam
- ✓Positive symptoms (schizophrenia): Hallucinations, delusions (things added)
- ✓Negative symptoms: Avolition, alogia, anhedonia (things removed)
- ✓DBT modules: Mindfulness, Distress Tolerance, Emotion Regulation, Interpersonal Effectiveness
- ✓Yalom: 11 therapeutic factors of groups (universality, hope, altruism...)
- ✓Stages of Change: Precontemplation → Contemplation → Preparation → Action → Maintenance
- ✓OARS: Open questions, Affirmations, Reflections, Summaries (MI)
- ✓Recovery dimensions: Health, Home, Purpose, Community
- ✓Mosey's groups: Parallel → Project → Egocentric-Cooperative → Cooperative → Mature