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Psychosocial Frames of Reference

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-focus is on the psychological aspect of the client -mainly used in mental health settings

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Behavior

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behaviors are learned -behaviors that have pleasurable results tend to be repeated -behaviors that have negative results tend NOT to be repeated

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Applied Behavioral FOM

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-behavior modification -used since 1940's -includes Pavlov, Skinner, Bandura clientele includes developmental disabilities, mental retardation, mental health conditions and TBI's

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Theoretical Base

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Classical Conditioning (Pavlov) Operant Conditioning (Skinner) facilitates desired behaviors through defining goals and working toward goals -skilled instruction -modeling -coaching -behavioral reinforcement

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Classical Conditioning

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Pavlov Association of stimulus with a response motivated by external reinforcement -certain stimuli can provoke a response (certain song, perfume, specific day of the year)

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Operant Conditioning

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-learned behaviors that occur in the natural environment as a result of reinforcement -behaviors that are reinforced tend to be repeated (learning) while behaviors that are not reinforced tend to disappear (extinction) -negative reinforcement can occur as well

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Assumptions of Applied Behavioral FOR

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-every health condition is viewed with respect to its external observable and measurable consequences -context is a focal point -function is determined by setting behavioral goals and objectives

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Shaping and Chaining

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-shaping is rewarding the client for behavior that is close to the desired result

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Reinforcement

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-OTA's use this approach need to take time to find out what things are motivational to each client (praise, approval, food and money) -when the client demonstrates the desired behavior reinforcement is provided

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Forward Chaining

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-have the client complete the first step in the chain and work towards the end result -performs the ENTIRE chain, not separated into pieces

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Backward Chaining

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the therapist completes the first steps of the task and allows the client to complete the final task -as the client improves the client completes the final 2 steps until the skill is mastered

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Continuous

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gives reward every time a desired behavior is seen

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Fixed-Ratio

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give reward after a specific number or attempts or successes

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Fixed-interval

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Give reward at a specific time intervals

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Intermittant

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Give reward at random or unpredictable time

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Negative

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Withdrawal of attention or other expected outcome

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Token Economies

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System where "token" is given and saved

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Self Reinforcement

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internalized good feelings that result from successfully reching a desired goal

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Behavior Modification

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altering unwanted behaviors such as a compulsive rituals, irrational fears, self destructive behaviors and bad habits

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Extinguishing unwanted Behaviors

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when wanting to change undesirable behaviors OT's pay close attention to environmental contexts within which the behaviors happen -remove cues that can trigger behavior -remove consequences that may be reinforcing

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Assessments in Applied Behavioral FOR

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-ID targeted behaviors -checklists to determine dysfunction -SMQ (stress management questionnaire)

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SMQ

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assists in the ID of symptoms linked to stress, the stressors that trigger the symptoms and the copers that aid in the reduction of stress. A quick and effective tool to provide individuals with a personal stress profile that identifies stressors and provides ideas to help reduce the symptoms of stress

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Cognitive Behavioral FORS

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builds upon behavioral theory by believing that thoughts can be modified -thinking influences behavior -human behavior is shaped by internal thought processes Bandura, Beck and Ellis

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Intervention for applied behavioral

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Stress management is a common intervention area -biofeedback -aimed at target behaviors -developing skills or coping strategies -eliminating unwanted behaviors -teaching skills (chaining, reinforcement) -behavior contracts -relaxation training

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In OT

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When psychological barriers to activity engagement are encountered -emotions, fears, rejection, denial, isolation and motivation

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Assumptions of CB FOR

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use this FOR when psychological barriers to engagement in activities are noted -belief in motivation and motion as contributing factors to function -clients are motivated by both external and internal reinforcement -look at contexts in which the clients perform -look at cognitive component

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OT intervention for CB

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modeling - role playing desired activity self regulation - ability to direct one's own life by setting goals, creating strategies for achieving them, building self reinforcement into one's schedule

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Banduras Hiearchy of Reinforcement

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initial - external (money, food) symbolic - internal images of success and failure social contract - self control because of knowledge of social consequences personal satisfaction - self produced (feeling competent is the best reward

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Banduras Social Learning Theory

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Environment + Person + Behavior

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Bandura's Concepts

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self efficacy - belief in one's own ability to interact effectively with the environment self awareness - realistic understanding of ones strengths and weaknesses, realization of ones effect on others insight - understanding of the change in ones own abilities and disabilities as the result of a health condition

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Beck

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much of his work focused on treatment of depression -emotions associated with depression often result from cognitive distortions and automatic thoughts

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Intervention for CB FOR

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clients should be capable of self awareness -relaxation training (deep breathing, PMR, Yoga, Tai Chi) -self talk (ones personal thoughts, client identifies negative thoughts and replaces with positive ones) -cognitive rehearsal (carrying out a task or situation in ones imagination) -self monitoring (noting and recording negative thoughts and the events that precede them)

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Becks Cognitive Theory

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ABC method A = stimulus situation B = beliefs or thoughts by which clients interpret the situation C = response of behavior

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Evaluation of CB FOR

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Becks Depression Scale Life Satisfaction Inventories Barthel Index

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Cognitive Behavioral Approaches

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Work best with clients who are capable to self awareness and reasoning -they must apply logic to be able to recognize and dispute irrational thinking habits

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Four Types of Groups

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Psychoeducational Social and Life Skills Self Regulation Role Acquisition

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Psychoeducational groups

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1980s as an approach to mental health -ot practictioners play the role of educator-facilitator for groups of clients with mental health issues -requires members to use rational thinking to apply new knowledge and skills through group problem solving -skill deficits can be remedied by direct teaching and training therapist acts as an educator, providing lessons similar to classroom

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Social and Life Skills Groups

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-social skills refer to the teaching of interpersonal skills need to relate to people -skills related to everyday social interactions and socially acceptable behaviors are learned through individualization and collaboration

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Self-Expressive skills

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stating feelings and opinions, stating positive things about oneself, stating one's values and beliefs

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Communication Skills

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controlling tone and quality of one's voice -articulating words clearly and choosing proper words for a situation

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Other enhancing skills

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giving compliments, smiling and expressing interest, giving support and encouragement

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4 phases of social skills training

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Motivation Demonstration Practice Feedback

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Assertive Skills

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making requests, disagreeing with other opinions, refusing requests, questioning other behaviors and setting limits

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Self Regulation Programs

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stress management increasing awareness of how stressors cause sx using occupations as coping strategies

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Role Acquisition

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Mosey learning all of daily life, work and leisure skills that enable one to participate in social and productive roles -help clients gain specific skills needed in occupational roles -develop awareness of what the client is doing and why

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10 roles of role acqusition

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1. client participation - client identifies problems and goals 2. Personalize Goals - reflect clients needs and interests 3. ability based goals - realistic challenge 4. Increase challenges - increase demands as clients capacity increases 5. natural progression - present skills in natural sequence 6. Client Knowledge - clients should always know what, how and why the activity is being done 7. Client awareness - update client on goals and provide positive reinforcement 8. Practice makes perfect - use a variety of contexts to find the best approach 9. parts of the whole - always show the whole activity, sometimes break the activity into parts to teach 10. imitation - people learn by imitating others

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Psychodynamic FOR

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also called the theory of object relations used by OT to address emotional issues explain issues related to anger/frustration/pain looks at uncouncious feelings/meanings Freud

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5 areas of Psychodynamic Concepts

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1. Social Participation and Relationships - relationships occur around shared activities 2. Emotional Expression and Motivation - how do emotions impact areas of occupation? 3. Self awareness - therapeutic use of self, group skills 4. Defense mechanisms - unconscious methods of coping 5. Projective arts and activities - use creativity to project the self to promote self awareness and insight

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Evaluation

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Kinetic House - Tree-person drawings Personality testing (Myers-Briggs) OT Crafts

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Theoretical Base

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Id - immediate gratification Ego - logical and balanced Superego - idealism, perfection, moral code

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Interventions

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leatherwork poetry, drama, creative writing, story telling, journaling, dance, movement, group interventions, pet therapy, reality testing, symbols

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