Overview of Theories of Mental Health and OT Practice Cara & McRae, 2013, Chap. 5 OT 460A OT Practice

Introduction  Need to view clients from biological, psychological, and socio-cultural factors  Must consider multiple theories of mental illness  Most prominent theories are humanistic,. I biological, psychodynamic, behavioral, and cognitive  These theories drive OT practice 9/11/12 OT 460 A 2

introduction  Need to have a comprehensive Biopsychosocial focus: Attend to biological, intrapsychic, interpersonal factors creating and/or maintaining mental dysfunction  Most therapists have an eclectic approach Choose the best of each and synthesizes these into an overall approach Success with use of an eclectic approach is variable 9/11/12 OT 460 A 3

Humanistic Perspectives  More of a philosophy  Emphasizes value, worth, and potential of the individual  Focus on client-therapist relationship  Therapy is client-centered  Moral treatment- consistent with OT  Focuses on broad dimensions of an individual’s life 9/11/12 OT 460 A 4

Theorists in Humanism  Maslow (Hierarchy of needs) Physiological, safety, belonginess, love, esteem, cognitive, aesthetic, self actualization  Carl Rogers (father of client-centered tx) Unconditional positive regard; empathy; genuineness  Victor Frankl- Existentialist Basic drive to find meaning in life Lack of meaning creates psychiatric disturbances Informed current day Occupational Science Theory 9/11/12 OT 460 A 5

Humanistic application to OT  Focus on “whole person”- Mind, body, spirit  Meaning is pivotal to well being  Empowering client to take an active role in healing  Non-judgmental; rapport with client  Belief that behaviorism and psychodynamic theories were to reductionistic  OT theorists: Mosey; Reilly; Yerxa 9/11/12 OT 460 A 6

Biological Perspectives  Disease caused by: Infections, neuroanatomical defects; biochemical imbalances and genetic predisposition First connection to mental illness was syphillis Psychopharmacology: Problems with neurotransmitters and hormonal imbalances:  Too much or too little NT  Too few receptors on post synaptic membrane  Presence or absence of other chemicals that interfere with neural transmission  Interrelationship between different NT and other factors (such as stress) 9/11/12 OT 460 A 7

OT application of biological perspectives  Symptom recognition and management Associated physical symptoms; side effects of meds Medication management  Biological explanations vs. behavioral Sensory modulation New skills, routines, and learnning influence brain plasticity and neuronal pathways 9/11/12 OT 460 A 8

Psychodynamic Perspectives  Emotional and personality development of individual Emphasis on early childhood experience Unconscious forces and internal processes Abnormal behaviors result when dynamic forces come in conflict (intrapsychic conflict) Proponents: Freud; Charcot & Breuer;  Neo-Freudian:Jung; Horney 9/11/12 OT 460 A 9

Psychodynamic concepts  Structure of the mind Id, ego, superego  Levels of consciousness Conscious; surface awareness; preconscious; unconscious  Defense mechanisms Repression; denial; projection; displacement; reaction formation; intellectualization; regression; identification; sublimation  Psychosexual developmental stages: Oral; anal; phallic; latency; genital 9/11/12 OT 460 A 10

Applications in Psychodynamic OT  Fidler Relationships to objects in environment are integral to development of ego OT uses activities requiring clients to interact with both human and non human objects  Helps to have client reveal feelings and needs  “The potential of activities in their own right to represent, reflect, and infers social, cultural and personal meanings” 9/11/12 OT 460 A 11

Applications in Psychodynamic OT  Mosey Therapist can learn about a client’s self- esteem and the presence of underlying conflicts through expressive activities  Eg. Collages, tile, drawings, clay 9/11/12 OT 460 A 12

Behavioral Perspectives  Proponents: Descartes; Sherrington; Skinner, Pavlov, etc  Interaction of the person and environment Stimulus/ response  All behavior is learned through: Classical / respondent conditioning Operant / instrumental conditioning Modeling 9/11/12 OT 460 A 13

Concepts in behaviorism  Reinforcement Positive= rewards; praise, etc that increases likelihood of behavior Negative= also increases likelihood of behavior (removal of aversive stimulus) Done on continuous or intermittent schedule  Punishment Positive= delivery of aversive stimulus in response to a behavior (spanking) Negative=removal of a positive stimulus in response to a behavior (losing TV) 9/11/12 OT 460 A 14

Behavioral concepts  Shaping-approximating the behavior  Chaining-linking steps/ parts of behavior  Modeling- providing example Social learning- requires:  Attending; form and retain mental image of target behavior; reproduce model behavior from stored image; motivation to learn 9/11/12 OT 460 A 15

OT application of Behavioral concepts  Widely used in society Grades; performance evals; schools  Application to adolescents and children  Applicable to people with cognitive impairment Schizophrenia; MR; Autism; Dementia  Cognitive-Behavior therapy Applicable to people with eating disorders; pain management 9/11/12 OT 460 A 16

Cognitive Perspectives  Take issue with simplicity in behaviorism  Key concepts: Expectations (you are what you believe) Appraisals Attributions Beliefs 9/11/12 OT 460 A 17

Ellis’ Rational Emotive Therapy  Change irrational beliefs: Must be loved and approved by all In order to be worthy must be perfect in all aspects of life Catastrophic when things don’t go my way Unhappiness is externally caused Past history is critical determinant of present behavior There is always a perfect solution to a problem and it is a catastrophe if a perfect solution is not found 9/11/12 OT 460 A 18

Applications in OT  Life skills training  Multiple opportunities to test actions/ ideas  Toglia- Insight and generalization Mental flexibility- multiple solutions Understanding context 9/11/12 OT 460 A 19