The Role of Recreation Therapy in Mental Health Treatment Dr. Karen Bibbins, CTRS Eastern Michigan University 3/21/16

Treatments in Recreation Therapy Within a behavioral health setting Recreation Therapy uses a therapeutic approach that allows patients with various mental health diagnoses to engage in actions, movements, and activities to face problems and concerns and improve their quality of life.

Leisure Education Improve social skills Build better relationships Identify what types of leisure they are interested in Find community resources for participation Improve leisure skills Use leisure based activities to explore patterns of behavior and teach healthy coping skills

Types of Treatment Rock Climbing Meditation Therapeutic Outings Cardio Strength Exercise Yoga Equine Assisted Therapy Animal Assisted Therapy

Dialectical Behavior Therapy (DBT) Dialectical Behavior Therapy (DBT) is a cognitive behavioral treatment that was originally developed to treat chronically suicidal individuals diagnosed with borderline personality disorder (BPD) and it is now recognized as the gold standard in psychological treatment for this population. In addition, research has shown that it is effective in treating a wide range of other disorders such as substance dependence, depression, post-traumatic stress disorder (PTSD), and eating disorders (www.behavioraltech.org).

Skills Taught in DBT DBT includes four sets of behavioral skills. Mindfulness: the practice of being fully aware and present in this one moment Distress Tolerance: how to tolerate pain in difficult situations, not change it Interpersonal Effectiveness: how to ask for what you want and say no while maintaining self-respect and relationships with others Emotion Regulation: how to change emotions that you want to change

Recreation Therapy and DBT Many concepts reinforced in Recreational Therapy align with treatments like DBT. The skills of mindfulness, regular participation in pleasant events and building mastery are all core components of both DBT and Recreational Therapy

Clinical Diagnosis Ages 6-12 PTSD Depression ADHD Mood Disorder NOS Suicidal Ideation (Thoughts) Anxiety Eating Disorders Oppositional Defiant Disorder (ODD) Hx. Of Trauma-physical or sexual Self Injurious Behavior

Expressive Therapy Interventions for Children Ages 6-12 Art Therapy Music Therapy Dance & Movement Therapy Recreation Therapy Play Therapy Creative Writing Psycho-education Daily gym and outdoor

Specific Activities Ages 6-12 Anger Management Feelings in a Jar Temper Tamers The Un-Game Chill Skills Mad Libs Life Skills

Most Common Clinical Diagnosis Ages-13-17 Major Depressive Disorder (MDD) Anxiety Eating Disorder OCD PTSD SI Substance Abuse ODD DMDD Bi-polar SI Hx. of Suicide Attempts Substance Abuse Family Conflicts Hx. of Smoking Panic Disorder Self-Injurious Behaviors

Specific Activities Ages-13-17 Anger Management Self-Esteem Life Skills The Un Game for Teenagers Physical Activities Cyber Dilemmas for Teens Leisure Education Coping Skills Communication skills Daily Gym and outdoors time

Most Common Clinical Diagnosis for Adolescent Boys Sex-Offenders Impulse Control Hx. of Physical and Sexual Abuse PTSD Substance Abuse MDD Anxiety Disorder Conduct Disorder Autism Spectrum Disorder

Recreation Therapy Treatment for Adolescent Sex Offenders Recreation Therapy uses activity-based interventions that include an onsite low-element ropes course to improve each child’s physical, mental, emotional, and social functioning. Daily activity therapy groups are designed to improve physical abilities including muscle strength, balance, coordination, flexibility, physical stamina and agility as well as to provide opportunities that build self-esteem and confidence. Source: New Hope Carolinas Psychiatric Residential Treatment Facility

Recreation Therapy Treatment It encourages youth to: set challenging goals to do their best, express feelings, improve stress tolerance, learn new approaches for problem solving, develop new leisure interests, and learn how to use leisure in positive and constructive ways. Other benefits include helping youth gain greater self-reliance, increasing interpersonal skills by encouraging youth to join in activities that nurture social relationships.

Co-occurring Disorders Treatments Adults with both mental illness and substance abuse symptoms. Meditation Physical exercise Psycho-education CBT Life skills What specific interventions do you think would work well with this population?

Severe and Persistent Mental Illness (SPMI) Schizophrenia Schizo-affective disorder Bi-polar disorder Psychosis Suicidal Behaviors What do you think some of the functioning levels would be for this population? What specific interventions in recreation therapy would be beneficial?

SPMI Functioning Levels Grossly Psychotic Poor reality orientation Confused Inability to Focus Non-directable Poor ADL’s Poor insight Poor impulse control Disruptive

In Conclusion… Leisure involvement can provide a sense of purpose and meaning in one’s life, as well as strengthening individual identity or one’s sense of who they are. Recreational Therapist motivate and guide someone experiencing mental health difficulties to leisure that provides the specific benefits suited to their needs.

Resources Rectherapyideas.blogspot.co m theteencompass.org www.free-mandala.com www.doodle-art-alley.com Pinterest.com Making choices: Life skills for adolescents Leisure Education: A Manual of Activities and Resources www.freespirit.com National Institutes of Health (NIH) Department of Health & Human Services (DHHS) www.therapistaid.com American Counseling Association theteencompass.org The RecKing Yard of Games & Activities Life Skills ChildworkChildplay.com Brightspotgames.com Leisure Education II: More Activities Leisure Education III: More Goals Leisure Education IV: Activities for Individuals with Substance Addictions Norma Stumbo