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Wellness Program for Anxiety & depression

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Seminar about the Wellness Program for Anxiety & depression. It covers a wide area of implementation...!!

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Wellness Program for Anxiety & depression

  1. 1. PHINOJ K ABRAHAM I I ND M O T S T U D E N T ALL INDIA INSTITUTE OF PHYSICAL M E D I C I N E & R E H A B I L I TAT I O N , (AIIPM&R) MUMBAI
  2. 2. Overview 2  Definition of Key Terms  Clinical Depression  Clinical Anxiety  Impact of Depression & Anxiety on Human life: OT Perspective  Wellness Program for Depression & Anxiety
  3. 3. Definitions of Key Terms 3 Fear  Fear – is a response to a known, external, definite, or non conflictual threat. Anxiety  Anxiety – is a response to threat that is unknown, internal, vague, or conflictual.  The main psychological difference b/w the 2 emotional response is the suddenness of fear and the insidiousness of anxiety.
  4. 4. Key Terms Cont… 4 Depression  Is an emotion charecterized by “sadness,” crying, withdrawal from others, and feeling of in adequacy. Intro to Psycho 7th edn, CT Morgan 1993  Resulting from a past experience
  5. 5. Key Terms Cont… 5 Yes Present ? Yes Fear No Avoidable ? Anxiety No Depression (meeting a Snake) (hearing hissing sound of Snake ) (I will not escape from the Snake)
  6. 6. Key Terms Cont… 6  Anxiety  Fear Future Present  Depression  PTSD Past
  7. 7. Key Terms Cont… 7 Stress  Stress is a condition or feeling experienced when a person perceives that demands exceed the personal and social resources the individual is able to mobilize. Richard S Lazarus  This depends on how a person perceives, thinks, and acts on external events or internal drives.  Stressors: the situation/events which cause stress.
  8. 8. Cont… 8
  9. 9. Definition of Depression: DSM-IV-TR 9  Major depressive episodes: Affective disorders characterized by “sad” feelings & persistent problems in other areas of life. Intro to Psycho 7th edn, CT Morgan 1993  A major depressive disorder occurs without a history of a manic, mixed, or hypo manic episode.  DSM-IV: one of the following must be present for at least two weeks:  Depressed mood  Lack of pleasure (anhedonia)
  10. 10. Definitions 10  Other symptoms:  Feelings  Blunt  Lack of overwhelming sadness and/or fear affect of pleasure  Weight gain or loss  Disturbed sleep patterns  Psychomotor  Fatigue, agitation nearly every day mental or physical.
  11. 11. Cont.. 11  Intense feelings of guilt, nervousness, helplessness, hopelessness, isolation or anxiety  Cognitive problems: concentrating, keeping focus, poor memory  Recurrent  Suicide thoughts of death attempt or a specific plan for committing suicide  A total of five symptoms must be present to diagnose a major depressive disorder
  12. 12. Some Facts & Figures About Depression 12  Nearly 5-10% of persons in a community at a given time are in need of help for depression.  As much as 8-20% of persons carry the risk of developing depression during their lifetime.  The average age of the onset of major depression in between 20 and 40 years.  Women have higher rates of depression than men.  Marital status: depression more common in persons without close IP relationship / among Divorced single person  Race or ethnicity does not influence the prevalence of depression Ref : Conquering Depression: You can get out of the blues WHO
  13. 13. Causes 13 1. Life experiences & Environmental Stress  “Stressful life events more often precede first, rather than subsequent, episodes of mood disorders”  Life event most often associated with development of depression is losing a parent before age 11.  The environmental Stressor most often associated with the episode of depression is the loss of Spouse.
  14. 14. Causes Cont… 14 2. Personality Factors  No single personality trait or type uniquely predispose a person to depression  Person with certain personality disorder like OCD, histrionic & borderline – may be at grater risk.
  15. 15. Causes Cont… 15 3. Social Interaction • High frequencies of unpleasant un rewarding events • Less hope & energy in activities / Social Interactions • This, make them less rewarding to be around • Thus others tends to avoid depressed people • This deepens their depression
  16. 16. Causes Cont… 16 4. Biological factors & Depression  There are four main biological factors that can increase a persons risk for depression  Genetic factors  Biochemical factors  Alterations in hormonal regulation  Sleep abnormalities.
  17. 17. Causes – Psychological Theories 17 1. Psychodynamic Theory  According to this theory “depression is resulting from an overly demanding super ego – one that sets standard too high for the person to live up to – and from early loss of attachment figures”  Un realistic/achievable Goals – Edward Bibring  Depressed people have lived for their lives for some one else (principle, ideal, institution / individual) – Silvano Arieti  Parents fails to give the child a positive sense of self esteem & self cohesion – Heinz Kohut (Self Psychological Theory)  Traumatic childhood events – Johm Bowlby  Child victimized by a tormenting parent. – Edith Jacobson
  18. 18. Causes – Psychological Theories Cont… 18 2. Cognitive theory  According to this theory depression results from “specific cognitive distortions present in person susceptible to depression”  AARON BECK suggest a cognitive triad of depression that consists of Views about self – a negative self respect About the environment – a tendency to experience the world as hostile & demanding About the future – the expectation of suffering & failure.
  19. 19. Causes – Psychological Theories Cont… 19 3. Behavioral Theory  Learned Helplessness : this theory connects depressive phenomena to the experience of uncontrollable life events.  EX: Dog exposed to repetitive electric shocks from which they could not escape Reacted initially  Then they reminded passively  According to Behavioral theory “Dog learned that outcomes were independent of response” so they had  Cognitive Motivational deficit – not attempted to escape  Emotional deficit – decreased reactivity.
  20. 20. Causes – Psychological Theories Cont… 20 Behavioral Theory cont…  In human depression,  Uncontrollable stress events produce loss of self esteem.  Behavioral theory stresses that “improvement of depression is dependent on the patients learning a sense of control & mastery of environment”
  21. 21. Types of Depressive Disorders 21  Major Depressive Disorder  Dysthymic Disorder  Minor Depressive disorder  Recurent Brief Depressive disorders  Full Unipolar Spectrum.
  22. 22. Depression; It’s not only a state of mind. 22 Symptoms of Depression Emotional Symptoms Include: Physical Symptoms Include: Sadness Vague aches and pains Loss of interest or pleasure Headache Overwhelmed Sleep disturbances Anxiety Fatigue Diminished ability to think or concentrate, indecisiveness Back pain Excessive or inappropriate guilt Significant change in appetite resulting in weight loss or gain Reference: American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Fourth Edition,Text Revision. 2000:345-356,489.
  23. 23. Depression – The Physical Presentation 23  In primary care, physical symptoms are often the chief complaint in depressed patients In a New England Journal of Medicine study, 69% of diagnosed depressed patients reported unexplained physical symptoms as their chief compliant1 Reference: Simon GE, et al. N Engl J Med. 1999;341(18):1329-1335.
  24. 24. The Importance of Emotional and Physical Symptoms 24 • 76% of compliant depressed patients with lingering symptoms of depression relapsed within 10 months 94% of depressed patients who experienced lingering symptoms had mild to moderate physical symptoms1 Reference: Paykel ES, et al. Psychol Med. 1995;25:1171-1180.
  25. 25. Complications 25          Alcohol abuse Substance abuse Anxiety Heart disease and other medical conditions Work or school problems Family conflicts Relationship difficulties Social isolation Suicide
  26. 26. 26
  27. 27. Anxiety Disorders 27  A condition characterized by extreme, chronic anxiety that disturbs mood, thought, behavior and/or physiological activity. www.psychiatric-disorders.com  Anxiety Disorders: DSM-IV-TR Panic Disorder  Agoraphobia  Social Phobia  Specific Phobia  Obessive Compulsive Disorder  Generalized Anxiety Disorder (GAD) The most commonly diagnosed  Separationa Anxiety Disorder 
  28. 28. Diagnosis 28  To better differentiate between GAD and other anxiety or depressive disorders, 4 “first rank” and at least 1 “second rank” symptoms are needed  First     Inability to relax, restlessness Fatigueability Exaggerated startle response Muscle tension
  29. 29. Diagnosis Cont… 29  First Cont…    Sleep disturbances Difficulty in concentrating Irritability Second     Nausea or abdominal complaints Dry mouth Tachycardia Tremor
  30. 30. Epidemiology 30  Incidence & Prevalance  National prevalence rates of Anxiety Neurosis Median 18.5 ; Mode 11-70 Indian Journal of Community Medicine Vol. 26, No. 4 (2001-10 - 2001-12)  Sex  Women : 30.5 % life time prevalence  Men : 19.2 % life prevalence National Co-morbidity Study, USA
  31. 31. Anxiety Facts 31  Most common mental illness in the U.S. with 19 million of the adult (ages 18-54) U.S. population affected.  Anxiety is highly treatable (up to 90% of cases), but only one-third of those who suffer from it receive treatment  People with an anxiety disorder are three-to-five times more likely to go to the doctor and six times more likely to be hospitalized for psychiatric disorders than non-sufferers.  Depression often accompanies anxiety disorders Ref: 2003 Anxiety Disorders Association of America
  32. 32. Common Causes 32  There is no one cause for anxiety disorders. Several factors can play a role  Genetics  Brain biochemistry  Overactive "fight or flight" response  Can be caused by too much stress  Life circumstances/experiances  Personality  People who have low self-esteem and poor coping skills may be more prone  Certain drugs  In very rare cases, a tumor of the adrenal gland (pheochromocytoma) may be the cause of anxiety.
  33. 33. Causes – Psychological Theories 33 1. Psychoanalytic Theories  Sigmund I. II. Freud distinguished two types of anxiety: Traumatic – arising from the person being overwhelmed by stressors Neurotic – anticipation of negative consequences that activates defensive processes 2. Behavioural Theory  Postulate that anxiety, is a conditioned response to a specific stimulus.
  34. 34. Causes – Psychological Theories Cont… 34 3. Existential Theories  “…. Person experience feeling of living in a purposeless universe“ 4. Charles D. Spielberger’s State–Trait Anxiety Inventory (STAI)  State Anxiety : Anxious personality  Trait Anxiety : momentary anxiety to a stimulus
  35. 35. Symptoms 35  Anxiety is an emotion often accompanied by various physical symptoms, including:        Twitching or trembling Muscle tension Headaches Sweating Dry mouth Difficulty swallowing Abdominal pain (may be the only symptom of stress especially in a child)
  36. 36. Additional Symptoms 36          Dizziness Rapid or irregular heart rate Rapid breathing Diarrhea or frequent need to urinate Fatigue Irritability, including loss of your temper Sleeping difficulties and nightmares Decreased concentration Sexual problems
  37. 37. Recent Studies 37 ‘Freedom From Fear’ conducted a survey among 410 attendees during National Anxiety Disorders Screening Day on May 7, 2003. The results :  An increase in physical aches and pains is directly attributed to anxiety disorders and depression  60% of the respondents with undiagnosed medical conditions said that on days when they feel anxious or depressed, there is a moderate (41%) to severe (19%) change in their physical symptoms or aches and pains.
  38. 38. Recent Studies Cont… 38  These physical symptoms or aches and pains include  Backaches (13%)  Vague aches and pains (14%)  Headaches (14%),  Digestive pain (11%)  Dizziness (8%).  50% of respondents with diagnosed medical conditions, such as arthritis, migraines, diabetes, heart and respiratory diseases, reported that on days when they feel anxious or depressed, there is a moderate (38%) to severe (12%) change in their physical symptoms or aches and pains.
  39. 39. Complication 39  Emotional Complication  risk for depression  Substance Abuse  Physical Complications  Heart disease, and high blood pressure  Sudden death from a heart attack or cardiac event.  Gastrointestinal disorders  Migraine and tension headaches  Obesity as well as anorexia.
  40. 40. Vulnerable People 40  Students  Symptoms of anxiety and symptoms of depression were prevalent in medical students (43% and 14%, respectively) and in humanities students (52% and 12%, respectively). International Journal of Social Psychiatry, Vol. 54, No. 6, 494-501 (2008)  Main Causes: Improper Time management, Stress, Personal Demands, body image perception & acceptance, un healthy Competition etc..  Job losers & Job seekers  A 2002 study at the University of Michigan found “that secondary stressors of job loss such as financial strain and loss of personal control are the true culprits that lead to depression. The study also found that elevated levels of depression ‘may reduce the likelihood of reemployment.’”
  41. 41. Cont… 41  Among workers  In Unorganized sectors  out of 457 million workers in India, 395 million (93%) are employed in the unorganized sectors like construction, agriculture, weaving and fishing and contribute to about 60% of national income.  About 7 % of the total work force is employed in the formal or organized sector  Suicides epidemic is high in this sector.  In Organized Sector  Anxiety & Depression is because of  Excessive Job demand  Problems related to payment  Un safe Job environment  Job Dissatisfaction / Loosing Interest
  42. 42. Cont… 42  Among Elderly  Prevalence of depression 19.8%.  The elderly living in a nuclear family system were 4.3 times more likely to suffer from depression than those living in a joint family system BMC Psychiatry 2007, 7:57doi:10.1186/1471-244X-7-57  Common causes:  Changes within the family  Chronic pain and illness  Difficulty getting around  Frustration with memory loss  Loss of a spouse or close friend
  43. 43. Cont… 43  Among People with Chronic Disabilities  The rate for depression occurring with other medical illnesses is quite high:  Heart attack: 40%-65%  Coronary artery disease (without heart attack): 18%-20%  Parkinson’s disease: 40%  Multiple sclerosis: 40%  Stroke: 10%-27%  Cancer: 25%  Diabetes: 25% www.cchs.net/health/health-info/docs/2200/2282.asp?index=9288  Spinal Cord Injury: 22% - major depressive <2 months post injury (Krause, Bombardier and Carter, 2008), 11.4% after 1 yr. Krause et al. (2000)
  44. 44. 44
  45. 45. Impact of Depression & Anxiety on Human life: OT Perspective 45  “From an occupational therapy perspective, people with depression (or anxiety) typically do not have the energy or drive to participate in the things that are important to them,” Lisa Mahaffey, MS, OTR/L,  OT Evaluation Model Of Human Uniform n Occupation (MOHO) Gray Kielhofner Terminology for Occupational Therapy 3ird
  46. 46. Model Of Human Occupation (MOHO) 46  The Model of Human occupation seeks to explain the occupational functioning of person.  It focuses on how person choose, order, and perform in everyday occupational behavior.  This model also stresses the Motivation for mastery, control, personal effectiveness & the need of persons to maintain a positive self – image.
  47. 47. 47 MOHO Conceptualize the Human being as an Open System
  48. 48. MOHO : Concepts 48 Knowledge of Self Experience Decision Making Physical Social Environment
  49. 49. MOHO : Person & Environment 49 Volition Participation Occupational Identity Habituation Performance Occupational Adaptation Performance Capacity Skill Throughput Output Occupational Competence Feedback s Model of Human Occupation – (based on diagram by Gary Kielhofner)
  50. 50. Evaluation & Intervention Process using MOHO 50  Evaluation Process  “…. Collect and use data to help clients understand how their personal perceptions and subjective views lead to occupational performance actions and patterns. Gary Kielhofner  Therapeutic Intervention  The process of self-maintenance and change is supported by allowing the person to participate in freely chosen occupations in therapy Gary Kielhofner
  51. 51. Case Study 51  The application of MOHO in the treatment of a patient with depression in Taiwan: A case study Methods: Multiple Chinese version MOHO assessments were applied to her at initial stage. The therapeutic relationship with the patient was developed through the discussion of the results of the assessment and treatment planning.  Results: The patient obtained high scores on all symptom checklists and lower satisfaction of her lifestyle and performance initially. A set of meaningful occupations were constructed with her and the steps to apply to her life were negotiated. Before her discharge in a month, her daily living function, role performance, occupational identification and competence improved from previous state.  The MOHO is a useful theoretical base in the clinical assessment and treatment of patients with minor mental disorder.  Yun-Ling Chen et., al MOHO Center Taiwan, Nov 29, 2008
  52. 52. Uniform Terminology for Occupational Therapy 52  According to AOTA, uniform terminology for OT is “…. indented to provide a generic outline of the domains of concerns of Occupational Therapy and is designed to created common terminology for the profession & to capture the essence of OT for succinctly others”  Domains of Concerns are,  Performance Areas  Performance Components  Performance Contexts
  53. 53. Uniform Terminology Cont… 53  Performance Areas     Performance Components     Activities of Daily Living Work & productive activities Play & Leisure activities Sensory-motor components Cognitive Integration & Components Psychosocial Skills & Components Performance Contexts   Temporal Aspects Environmental Aspects
  54. 54. 54
  55. 55. 55  “Every tomorrow has two handles. We can take hold of it with the handle of anxiety or the handle of faith.” Henry Ward Beecher
  56. 56. Wellness 56  Wellness is a state of optimal well-being that is oriented toward maximizing an individual’s potential.  This is a life-long process  Dimensions: physical, intellectual, emotional, social, spiritual, and environmental well-being. How? - by adapting patterns of behavior
  57. 57. Wellness Program for Depression & Anxiety 57 Levels  Intra – personal       Creative Self Coping Self Essential Self Physical Self General Feeling of Well-Being Inter-personal  Social Self
  58. 58. Creative Self 58  Thinking. Being mentally active and open-minded. The ability to     be creative and experimental. Having a sense of curiosity. The ability to apply problem-solving strategies to social conflicts. Emotions. Being aware of or in touch with your feelings. The ability to express appropriately positive and negative feelings. Control. Beliefs about your competence, confidence, and personal mastery. Beliefs that you can usually achieve the goals you set out for yourself. Work. Satisfaction with your work. Feeling that your skills are used appropriately. Feeling you can manage one’s workload. Feeling a sense of job security. Feeling appreciated in the work you do. Positive Humor. Being able to laugh at your own mistakes. The ability to use humor to accomplish even serious tasks.
  59. 59. Coping Self 59  Leisure. Satisfaction with your time spent in leisure. Feeling that your skills are used appropriately.  Stress Management. On-going self-assessment of your coping resources. The ability to organize and manage resources such as time, energy, and setting limits.  Self-Worth. Accepting who and what you are, positive qualities along with imperfections. A sense of being genuine within yourself and with others.  Realistic Beliefs. Ability to process information and perceive reality accurately. The absence of persistent irrational beliefs and thoughts and need for perfection.
  60. 60. Essential Self 60  Spirituality. Personal beliefs and behaviors practiced as part of the recognition that we are more than the material aspects of mind and body. Belief in a higher power. Hope and optimism. Practice of worship, prayer, and/or meditation; purpose in life. Compassion for others. Moral values. Transcendence (a sense of oneness with the universe).  Gender Identity. Satisfaction with and feeling supported in one’s gender. Ability to be androgynous.  Cultural Identity. Satisfaction with and feeling supported in one’s cultural identity. Cultural assimilation.  Self-Care. Taking responsibility for one’s wellness through selfcare and safety habits that are preventive in nature.
  61. 61. Physical Self 61  Nutrition. Eating a nutritionally balanced diet. Maintaining a normal weight (within 15% of the ideal).  Exercise. Engaging in sufficient physical activity through exercise or in your work to keep in good physical condition.
  62. 62. General Feeling of Well-Being 62  Perceived Wellness. The extent to which you believe you have achieved wellness in all areas, or total wellness. Your estimate of your total wellness.  Perceived Safety. The extent to which you believe you are safe in your home, neighborhood, and community, and the extent to which you feel safe from harm by terrorists.  Context. The extent to which your wellness is influenced, in a conscious manner, by individual, institutional, and global contexts, and the extent to which you are aware of and intentional in responding positively to changes in wellness over time.
  63. 63. Social Self 63  Friendship. Social relationships that involve a connection with others individually or in community. Having a capacity to trust others. Having empathy for others. Feeling understood by others.  Love. The ability to be intimate, trusting, self-disclosing with another. The ability to give as well as express affection with significant others and to accept others without conditions.
  64. 64. Implementation of Mental Wellness Program 64  Among,      Students Job losers & Job Seekers Employers/workers  In Organized Sectors  In Un organized sectors Elderly People People with Disabilities
  65. 65. Students 65  Methods  Creating a nurturing learning environment  Identifying and assisting struggling students  Counseling  Promoting self-awareness  Teaching skills for stress management  Helping students promote personal health  Activity Scheduling &Time management Mayo Clin Proc December 2005;80(12):1613-1622
  66. 66. Job Losers 66  OT’s can teach/advice/ impliment the following things  Stick to a schedule after losing job  Spend time each day looking for work.  Get plenty of exercise  Enjoy with family during this time of uncertainty Take your kids to the park or go on a walk. Volunteer at your kid's school.  Seek professional help.
  67. 67. Job seekers 67  By incorporating MOHO concepts, OT’s can do Prevocational , Work capacity evaluation and can suggest suitable vocation for the person based on his personal factors  Aim: “Right Job for Right Person”  Variables Include; • Volition Personal Causation Values Interests • Habituation Roles Habits • Performance Skills
  68. 68. Employers / workers 68  In Organized Sectors  Discuses & find out possible solution for the problems of employers with the employee.  Suggest a Nurturing working environment  Activity Scheduling & Time management  Arranging Recreational Activities like trips, sports or cultural activities  Encourage Meditation, Yoga, Relaxation techniques activities  Music Therapy
  69. 69. Employers / workers 69  In Un-organized Sectors  Social security  Social Support groups   Arranging Community Recreational Activities Counseling Cells
  70. 70. Elderly People 70  Early Screening  Social supports  Family Support  Engaging In Fruitful/Productive activities  Spend More time for Recreational activities  Relaxation techniques, Yoga, Meditation, Music Therapy
  71. 71. People with Disabilities 71  Counseling  Behavioral Technique : Modeling  CBT : Biblio-therapy by reading; & Counseling, engaged in meaningful activities  Self help groups  EX: MSSI. AAA  Arranging Recreational Activities, Seminars, Gatherings etc  Physical Exercises programs  Good Nutrition  Self Management skills  Relaxation techniques, Yoga, Meditation, Music Therapy
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