By Erin Buchanan
The OT Magazine Jan/Feb17
Generalised anxiety disorder is a long-term condition that causes you to feel anxious on a daily basis about a range of situations rather than just one specific event. The UK government statistics find 4.4% of adults (18-64) to be affected by generalised anxiety disorder (GAD) and 90.4% of those have experienced comorbidity with another psychiatric condition (UK government, 2008).
The main feature for diagnosis is excessive worry about a number of different events associated with heightened tension (NICE guidelines, 2011) and it can result in both psychological symptoms such as restlessness and having difficulties concentrating as well as physical symptoms – dizziness and heart palpitations (NHS Choices, 2016). Both physical and psychological symptoms can have an impact on the person’s occupations.
When a client with generalised anxiety is referred to the occupational therapy team they will be offered an initial appointment. In this appointment the occupational therapist will explain their role and assess the client to gain an understanding of how the condition is impacting on their life and the person’s thoughts and feelings around their condition. This is done through conversation using an initial interview form and/or standardised assessment- commonly the Occupational Circumstances Assessment Interview and Rating Scale (OCAIRS) – to gather and evaluate information. Further MOHO (Model of Human Occupation) assessments like the Occupational Self Assessment (OSA) are also commonly used to gain a client’s perspective of their illness. The occupational therapist will gain an understanding of how anxiety is affecting the person and their occupations (all activities of daily living in the areas of self-care, productivity and leisure) and the environments in which the client functions in. The occupational therapist will work collaboratively with the client to set individualised goals following the NICE guidelines for person-centred care (2011). The goals are written in a SMART format to make them as clear as possible; this is Specific, Measurable, Achievable, Realistic and Timely. A plan will be made in collaboration with the client as to how the client will achieve the goals and the Occupational Therapist will approach this using various techniques explained below.
ACTIVITY ANALYSIS AND GRADING ACTIVITIES
The occupational therapist will use activity analysis and a graded approach to activities which cause the client anxiety. This allows the occupational therapist to observe the client in activity, support them to carry out the activity and to make the activity more or less challenging depending on the need. The occupational therapist breaks down identified anxiety provoking activities and will agree with the client one part of the activity they feel they could try. The occupational therapist will support the client with this activity and make it more or less challenging for the next session based on the outcome of the session and how the client is feeling. Sessions will be done regularly with encouragement for the client to practice by themselves or with someone else out with treatment time. An example of a graded activity is a client using the bus. They may have stopped doing this as they become very anxious in this situation. In context, this can be a particular problem in Moray as it is a very rural area. Without transport the person won’t be able to access occupations such as going to work, visiting family or attending the leisure centre. The occupational therapist will break down using the bus and suggest that the first session maybe only walking to the bus stop and checking what time would be suitable to get the bus. The next session they may try to stay on the bus for one or two stops, slowly building this up till the client is able to visit their desired location and use the bus to get where they want and need to go. Another element of grading is for the client to get the bus without support. The occupational therapist could then get on at a later stop or meet the client off the bus with the aim of the client eventually being fully independent in this area.
The client may not have a good understanding of their condition, where changes need to be madeor occupational therapy treatment received. In these situations, psycho-education is an appropriate intervention. Psycho-education is providing information to clients in a way they understand to promote awareness and pro-activity around their condition. Occupational therapists would explain their role in increasing the person’s independence and ability to engage in occupations while living with their condition. There is a lack of literature relating to occupational therapists’ role in psycho- education. However, a key part of this is the client understanding their limitations and setting goals which is part of the occupational therapy process. A case study where occupational therapists led psycho-education in an acute mental health setting found that the occupational therapists were best placed to explain the meaning behind activity in relation to the person’s condition (Eaton, 2002). Psycho-education is therefore relevant to occupational therapy treatment with clients who have a diagnosis of Generalised Anxiety. In this community mental health setting this technique is used to provide comprehensive treatment sessions that impart information and apply learning through practical goal setting.
Once the client understands their condition and how they can work with the occupational therapist they can then begin to learn how they can manage their anxiety and put learned techniques into practice. This can include breathing techniques, muscle relaxation, challenging thinking and managing physical symptoms of anxiety. The client will identify where they feel anxious and which techniques they can use in this situation to manage these symptoms. They will then practice using these techniques in the situation either by themselves or with the occupational therapist and see how effective these techniques are in situation.
Full story available in The OT Magazine Jan/Feb 17 issue.
Each issue The OT Magazine features a different type of mental health issue in our mental health series. If you would like to get involved email firstname.lastname@example.org.