Occupational therapy eating disorder case study

1. SEMINAR PRESENTATION
INTERVENTIONS
OT6062
Under Dr. Judi Pettigrew
Assignment 1 - Group Presentation - Thursday 27th April
By Camilla Mahon, Celine O’Brien, Andrea O’Sullivan, Ariadne Bazaldua, Sandra Carey & Louise Moran

2. OCCUPATIONAL THERAPY PROCESS
➤ Evaluate
➤ Repeat or discharge meeting
& planning
➤ Referral (Case Study)
➤ Information Gathering
➤ Initial Interview
➤ OT Model (P.E.O)
➤ OT Frames of Reference
(Psychoanalytical & Cognitive Behavioural)
➤ Assessment (time use diary)
➤ Goal setting and plan
➤ Intervention

3. REFERRAL
PERSON, ENVIRONMENT, OCCUPATION
FOR CAMHS
➤ Agata is 14 years old
➤ She is in 2nd year of secondary school - Limerick City
➤ She was born in Poland - moved to Limerick 8 years ago
➤ She has become irritable with her brothers
➤ She often does not finish her dinner - diagnosed with an
eating disorder
➤ Her father died three years ago
➤ She lives with her mother and three younger brothers
➤ Has become withdrawn from family and friends
➤ Her academic performance is declining
➤ She used to enjoy traditional music but has stopped
attending rehearsals
➤ She swims four times a week - spends a lot of time
running & walking
Person
Environment
Occupation

4. INFORMATION GATHERING
Four influencing factors identified: Culture,
Bereavement, Lifespan & The diagnosis
➤ Longitudinal Acculturation Study with
Polish Immigrant Teenagers in Ireland
(LASPIT) (Sokolowska 2016)
highlighted that Polish parents have
become more strict with their teenagers
in Ireland due to the Irish culture of over
drinking
➤ Polish values and traditions that Agata
grew up with may be causing a divide
between her and her friends as they are
getting older and socialising in different
ways
➤ Death of a parent is one of the most
stressful events that a child can
experience (Brent et al. 2012) and
changes the family’s dynamic forever.
➤ Significantly impacts engagement in
daily life activities or occupations
(Fluegeman et al. 2013)
➤ The bereavement experience can
influence some children to perform
poorly academically (Christ et al, 2002)
Bereavement Culture

5. ➤ Many internal and external factors can
influence Agata’s behaviour - unique skills,
experiences, family or environmental
factors (Abeydeera et al. 2006)
➤ Importance of emotional support as an
adolescent (Moretti 2004; Brown et al.
2011).
➤ Occupational therapist plays a vital role
working as part of an MDT team for children
with eating disorders - will encourage Agata
to engage in meaningful activity which in turn
will bring about a change in herself (Martin
1998).
➤ The occupational therapy interventions
chosen for Agata will complement and
enhance the work she is doing with the
phycologist allowing her a safe area to
practice her new coping skills
➤ Occupational therapy will also allow an
environment where her whole family can
make use of their own resources and coping
strategies (Scholz and Asen 2001).
Lifespan Eating disorder in CAMHS

6. Interventions Considered:
➤ Mindfulness Yoga,
➤ Cooking,
➤ Music group
Frames of reference: Psychoanalytical & Cognitive Behavioural

7. MINDFULNESS YOGA AS A THERAPEUTIC OCCUPATION
➤ A competitive client, like Agata, would
need a class that focus’ on the meditative
aspects of yoga not the physical aspects
(Boudette 2006)
➤ It would be recommended to have no
mirrors in the room where Agata is
practicing yoga, this allows the client to
focus attention inwards rather than their
physical attributes (Hall et al 2016)
➤ Grading of yoga - Begin in trial 1:1
session with therapists, then going into
smaller class or going with her mother as
a bonding occupation
Rationale:
➤ Can help clients release emotional
constrictions, often without using
words (Weintraub 2012)
➤ A complimentary treatment for
anxiety, depression and general ED
symptoms (Mishra and Sinha; Sahasi
et al 1989)
➤ Yoga was found to significantly
decrease eating disorder symptoms
(Carei et al 2010)
Adaptations:

8. ➤ Allow choice (Pierce 2003)
➤ Not qualified yoga instructors - resources for
easy to follow practices, known as, mudras
which can be used in clinical setting
These help client’s self regulation
and increase feelings of control and
self efficacy (Weintraub 2012)
➤ Contacted an occupational therapist in Galway
whom uses Yoga in her therapy
Importance of collaboration with
psychologist
➤ May not be meaningful to Agata
➤ Exploration of many realistic interventions
untie Agata choses one (Stockwell, Duncan
and Levens 1988)
Pierce states that a client finds an intervention
appealing when there is a blend of pleasure,
productivity and restoration
Promotes physical and mental
relaxation through controlled
breathing and meditative practices
It can be seen as productive due to
the patience and practice needed to
master it
Enables Agata to ‘block out the
world’, focusing solely on how her
body feels inside, not how it looks
on the outside
Pleasure, Productivity and
Restoration:
Other Considerations:
Pleasurable activity:
Restorative activity:
Productive activity:

9. COOKING AS A THERAPEUTIC OCCUPATION
➤ Putting a different emphasis on food, focus on the
nutritional benefits of food and healthy eating
(Lock et al. 2012)
➤ Reduction in the chance of relapse if cooking and
food is put in a more positive light (Martin 1998)
➤ A collaborative relationship between Agata and the
Occupational Therapist allows the opportunity to
discuss issues during sessions (Kloczko and Ikiugu
2006)
➤ Cooking can be a graded activity, Agata can work
towards an end goal of cooking a meal for her
family
➤ Reinforcing her role in the family, acknowledging
her own contributions which help form her identity
Rationale:

10. ➤ Agata may also have a negative
association with food therefore it is
important to establish a structured
approach to food
➤ Support - needs family therapy approach
so Agata can be supported at home the
same way the OT supports her (grading
- passed on)
➤ Agata is living in a single parent family
therefore, the Occupational Therapist
needs to be aware that her family may
be on a budget
Humans need food gain energy and for
survival
Giving Agata the freedom of choosing
what she would like to cook and making
sure the therapeutic activity of cooking is
enjoyable
Cooking a meal and having an end product
(Pierce 2003)
Pleasure, Productivity
and Restoration:
Other Considerations:
Restorative Activity:
Pleasurable Activity:
Productive Activity:

11. Week Main Activity Aim of Session
1
Discussion on the importance of healthy
eating and nutrition
Choosing recipes
Putting a different emphasis on food
2 Visit to Supermarket
Collaborative relationship building rapport and grading
the occupation of cooking3 Grocery shopping + cooking
4 Grocery shopping (pre-session) +
cooking
5 Cooking with family members
Scaffolding Agata, OT passing on the supports to her
home life
6 Cooking a meal for the family Reinforcing Agata’s role in the family

12. MUSIC AS A THERAPEUTIC OCCUPATION
➤ Engaging in creative occupations
can increase mood(Coffey et al.
2015)
➤ Participation in leisure activities
can promote self esteem(Clark
and Nayar 2012)
➤ Music can positively affect school
performance(Faulkner et al 2012)
➤ Opportunity to experience
flow(Csikszentmihalyi and
Csikszentmihalyi 1992)
Rationale:

13. ➤ Grading this intervention
for Agata(Macrae 1992)
➤ Selecting appropriate music
➤ Gaining insight on this
intervention from other
professions (Lejonclou and
Trondalen 2009)
Engaging in an occupation that
is meaningful for the individual
Agata could compose music and
improve her skills as a musician
Relaxing process of listening to
music
Pierce (2003)
Pleasure, Productivity
and Restoration: Other Considerations:
Pleasurable activity:
Productive activity:
Restorative activity:

14. DEMONSTRATION OF MUSIC AS A THERAPEUTIC OCCUPATION
• Third session after ground rules have been established
• Variety of musical abilities and backgrounds
• Goal setting
BREAKDOWN OF SESSION
• Pleasure - rhythm games and singing
• Productivity – Performance of a song, writing song lyrics
• Restoration – Listening to music

15. -Led by Ariadne Bazaldua
Presentation of music
intervention seminar

16. LYRICS
Well we’re 1st year OT and this semester’s nearly
ended
We’re trying to keep up but there’s a lot of
module essays
We’ve good fun and craic
And begged the teachers to cut us some slack
The OT process, models and a hundred frames of
reference
We’ve deliberated hours on our last two
placement preferences
We reckon it is soon our turn
To spend the summertime in the sun!

17. Thank you for listening
Any questions?

18. REFERENCES
Abeydeera, K., Willis, S. and Forsyth, K. (2006) 'Occupation focused assessment and
intervention for clients with anorexia', International Journal of Therapy and Rehabilitation,
13(7), 296, available: http://dx.doi.org/10.12968/ijtr.2006.13.7.21403.
Atchison, B. and Dirette, D.K. (2012) Conditions in occupational therapy: effect on occupational
performance, Philadelphia, Pa;London;: Lippincott Williams & Wilkins.
Babu, K. S., Burton, H., Chu, M., Cisek, P., Debowy, D., Diamond, M., Yoshioka, T. (2002).
The somatosensory system: Deciphering the brain’s own body image (ed. R. Nelson). New York,
NY: CRC Press.
Boudette, R. (2006). Question & answer: Yoga in the treatment of disordered eating and body
image disturbance: how can the practice of yoga be helpful in recovery from an eating
disorder? Eating Disorders, 14, 167–170.
Bradford, R., Holliday, M., Schultz, A. and Moser, C. (2015) 'The Role of the Occupational
Therapist in the Treatment of Children with Eating Disorders', Journal of Occupational
Therapy, Schools & Early Intervention, 8(3), 196-210, available:
http://dx.doi.org/10.1080/19411243.2015.1077053.
Brent, D.A., Melhem, N.M., Masten, A.S., Porta, G. and Walker Payne, M. (2012)
'Longitudinal Effects of Parental Bereavement on Adolescent Developmental
Competence', Journal of Clinical Child and Adolescent Psychology, 41(6), 778-791.
Brown, C., Stoffel, V. and Muñoz, J.P. (2011) Occupational therapy in mental health : a vision for
participation, Philadelphia : F.A. Davis Co.

19. Carei, T. R., Fyfe-Johnson, A. L., Breuner, C. C., & Brown, M. A. (2010). Randomized
controlled clinical trial of yoga in the treatment of eating disorders. Journal of Adolescent
Health, 46, 346–351.
Center for Eating Disorders at Sheppard Pratt (October 5, 2012). Occupational therapy.
Retrieved from https://www.youtube.com/watch?v=eBB0YovseoU
Christ, G. H., Siegel, K. and Christ, A. E. (2002) Adolescent grief: 'It never really hit me. Until
it actually happened'. Journal of the American Medical Association, 288, 1269.
Clark, M. and Nayar, S. (2012) 'Recovery from eating disorders: A role for occupational
therapy', New Zealand Journal of Occupational Therapy, 59(1), 13-17.
Coffey, M.S., Lamport, N.K. and Hersch, G.I. (2015) Creative engagement in occupation: building
professional skills, Thorofare, NJ: SLACK Incorporated.
Csikszentmihalyi, M. and Csikszentmihalyi, I.S. (1992) Optimal experience: psychological studies of
flow in consciousness, Cambridge: Cambridge University Press.
Duncan, E.A.S. (2011) Foundations for practice in occupational therapy, Edinburgh: Churchill
Livingstone.
Fluegeman, J.E., Schrauben, A.R. and Cleghorn, S.M. (2013) 'Bereavement support for
children: Effectiveness of Camp Erin from an occupational therapy perspective',
Bereavement Care, 32(2), 74-81, available:
http://dx.doi.org/10.1080/02682621.2013.812820.

20. Giles, G.M. (1985) 'Anorexia nervosa and bulimia: an activity-oriented approach', The American journal of
occupational therapy : official publication of the American Occupational Therapy Association, 39(8), 510.
Hall, A., Ofei-Tenkorang, N. A., Machan, J. T., and Gordon, C. M. (2016). Use of yoga in outpatient
eating disorder treatment: a pilot study. Journal of Eating Disorders. 38 (4), 1-8. DOI:
10.1186/s40337-016-0130-2
Karpowicz, E., Skärsäter, I. and Nevonen, L. (2009) 'Self-esteem in patients treated for anorexia
nervosa', International Journal of Mental Health Nursing, 18(5), 318-325, available:
http://dx.doi.org/10.1111/j.1447-0349.2009.00621.x.
Keel, P.K. and Haedt, A. (2008) 'Evidence-Based Psychosocial Treatments for Eating Problems and
Eating Disorders', Journal of Clinical Child & Adolescent Psychology, 37(1), 39-61, available:
http://dx.doi.org/10.1080/15374410701817832.
Kloczko, E. and Ikiugu, M.N. (2006) 'The Role of Occupational Therapy in the Treatment of
Adolescents with Eating Disorders as Perceived by Mental Health Therapists', Occupational Therapy
in Mental Health, 22(1), 63-83, available: http://dx.doi.org/10.1300/J004v22n01_05.
Lejonclou, A. and Trondalen, G. (2009) '“I've started to move into my own body”: Music therapy with
women suffering from eating disorders', Nordic Journal of Music Therapy, 18(1), 79-92, available:
http://dx.doi.org/10.1080/08098130802610924.
Lock, L., Williams, H., Bamford, B. and Lacey, J.H. (2012) 'The St George’s Eating Disorders Service
Meal Preparation Group for Inpatients and Day Patients Pursuing Full Recovery: A Pilot Study',
European Eating Disorders Review, 20(3), 218-224, available: http://dx.doi.org/10.1002/erv.1134.

21. Macrae, A. (1992) 'Should music be used therapeutically in occupational therapy?', The American journal
of occupational therapy : official publication of the American Occupational Therapy Association, 46(3), 275.
Martin, J.E. (1998) Eating disorders, food and occupational therapy, London : Whurr
Mishra M, Kumar Sinha R. (2001). Effect of yogic practices on depression and anxiety. Journal of
Projective Psychology & Mental Health 8(1), 23–27.
Moretti, M.M. (2004) 'Adolescent-parent attachment: Bonds that support healthy development',
Paediatrics & Child Health, 9(8), 551.
National Collaborating Centre for Mental Health, 2004. Eating disorders: Core interventions in the
treatment and management of anorexia nervosa, bulimia nervosa and related eating disorders.
British Psychological Society (UK)
Ogden, P., Minton, K., & Pain, C. (2006). Trauma and the body: A sensorimotor approach to psychotherapy.
New York, NY: W. W. Norton & Company
Pacanowski, c. R., Diers, L., Crosby, R. D., and Neumark-Sztainer, D. (2017) Yoga in the treatment of
eating disorders within a residential program: A randomized controlled trial, Eating Disorders,
25(1), 37-51, DOI: 10.1080/10640266.2016.1237810
Pierce, D. (2003) Occupation by design: Building therapeutic power, Philadelphia, PA: F.A.Davis.
Robinson, A., Kane, M. and Leicht, S. (2005) 'Psychologists' perceptions of occupational therapy in the
treatment of eating disorders', Occupational Therapy in Mental Health, 21(2), 39-53, available:
http://dx.doi.org/10.1300/J004v21n02_03

22. Sahasi G, Mohan D, Kacker C, Sahasi G, Mohan D, Kacker Chitra. (1989).
Effectiveness of Yogic Techniques in the management of anxiety. Journal of
Personality and Clinical Studies 5(1), 51–55
Scholz, M. and Asen, E. (2001) 'Multiple family therapy with eating disordered
adolescents: concepts and preliminary results', European Eating Disorders Review,
9(1), 33-42, available: http://dx.doi.org/10.1002/erv.364.
Sokolowska, B. (2016) “Sharks and Sprats” Polish Immigrant teenage children in Ireland,
Cambridge Scholars publishing
Stockwell, R., Duncan, S. and Levens, M. (1988). Occupational therapy with eating
disorders. In D.W. Scott and N. Katz. (Eds.). Occupational therapy in mental
health: principles in practice. (pp. 206-218). London: Taylor and Francis Ltd.
Weintraub, A. (2012).Yoga Skills for Therapists: Effective Practices for mood management.
New York: W.W. Norton & Company Inc.
Wilcock, A. A. (1998) ‘Reflections on doing being and becoming’. Canadian Journal
of Occupational Therapy. 65(5), 248-256.
Wilson, G.T., Grilo, C.M. and Vitousek, K.M. (2007) 'Psychological Treatment of
Eating Disorders', American Psychologist, 62(3), 199-216.