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Archive for category: Mental Health

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Occupational Therapy Approaches for Substance Use in Clients with Brain Injuries

Julie Entwistle, MBA, BHSc (OT), BSc (Health / Gerontology)
Co-written by Ashley Best, Student Occupational Therapist

In our previous blog post titled “Brain Injury and Substance Use”, we discussed how the cognitive and emotional changes associated with brain injury can overlap with substance use.  But what wasn’t covered was the role of the Occupational Therapist when working with clients who have these challenges.  While our role is complex in cases like these, we have tried to simplify how we use function and meaningful activity in combination with direct treatment to address some common themes as outlined below.

1. Harm Reduction

Arguably the most important strategy of any professional working with someone who uses substances is Harm Reduction. An Occupational Therapist can work with a client to better understand the process of using a substance with the same skill used for analyzing other daily activities. By breaking down what a client’s substance use looks like, from the trigger to being under the influence, the OT can identify areas of potential harm or danger. Some common concerns with substance use, and some OT intervention examples are:

 

 

 

 

 

 

 

 

 

 

It is important to recognize that the above strategies are not meant to encourage substance use but ensure the safety of the client when they are not willing or able to stop.  Sometimes just reducing the harm is all we can offer until the harm can be eliminated.

Clinical Example: A man with previous regular alcohol use prior to an accident, now has seizures when he does not have alcohol in his system. Thus, it is actually more harmful to ask this client to not use alcohol. Instead, monitoring the amount he drinks and ensuring he has regular supports at home are two strategies that can reduce the harm that alcohol may cause.

2. Recognizing Substance Use as a Barrier to Goals

The financial, behavioural, and health effects of substance use often negatively impact a client’s ability to reach their goals. An occupational therapist can help a client to understand and hopefully address the gap between substance use and being able/unable to move forward in other areas of life. An OT may also strategize ways to achieve goals despite substance use by planning use around occupations and this, in turn, may help decrease use over time.

Clinical Example: An individual with a brain injury has a goal to return to work but does not have the insight to recognize how using narcotics would impact their success on the job. Thus, helping the client break down the requirements of a job, recognize poor fits, and then implementing strategies to change substance use behaviour so that it doesn’t impact work (in the case that abstaining from use is not an option) could be an intervention focus.

3. Using Activity to Avoid Triggers

Often, substance use is time-consuming between acquiring, using, and coming down from the influence. This becomes a major challenge when people stop using because there is a lot of free time that may lead to boredom and relapse. This is an important place for occupational therapists to intervene by helping the client identify meaningful activities to engage in when they are feeling an urge to use. This could involve interests and values, or just discussing past activities that the client would like to resume.

In the case of someone with a brain injury, more guidance may be required to identify triggers (if the client has low insight what is triggering). In addition, activities that the client can perform may be different following a brain injury, and thus they may need support in finding new meaningful activities to fill the time that was previously taken up with substance use.

What is the take-home message?

As the above indicates, implementing any of these strategies will require the client to exercise a high level of control over their addiction. Thus, an OT can help support and accommodate each client’s unique situation by providing remedial and compensatory strategies to help clients transition from the occupation of substance use, to other, ideally more meaningful and healthy alternatives.

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Brain Injury and Substance Use

Julie Entwistle, MBA, BHSc (OT), BSc (Health / Gerontology)
Co-written with Ashley Best, Student Occupational Therapist

As clinicians working in the community with clients who have a brain injury, we all too often see the challenges of recovery impacted by the use of illicit drugs and alcohol.  And while we treat both the brain injury and substance use as they impact function and the ability to participate in life roles, we often wonder, which came first? 

Statistics show that individuals with brain injuries have higher rates of substance use than the general population. However, statistics also show that individuals with brain injuries have higher pre-injury rates of substance use.  While this does not explain a “causal relationship” or answer the “which came first” question, we know the interplay is complicated and that acquiring a brain injury can change the way the brain processes information which may influence substance use behaviours and patterns.

Here are some examples of how this can happen:

  1. Cognitive Changes: Having a brain injury can result in cognitive changes from mild to severe difficulties with memory and concentration, communication, processing speed, problem-solving, and more.
  2. Emotional and Personality Changes: A brain injury can also result in emotional and personality changes such as impulsivity, irritability, and lack of insight.

The changes and symptoms mentioned above occur as a result of injury to the brain’s frontal lobe. The frontal lobe is responsible for more complicated cognitive processes. It helps us to problem solve everyday challenges and consider the positive and negative impacts of our decisions. When a person hits their head or is jolted quickly, the frontal lobe will often impact against the skull – bruising, damaging, and disrupting the connections between the brain cells in this region.

So how does this relate to substance use?

Well, there are reward pathways in the brain which react and process substance use triggers and the associated emotional response. These pathways respond to the positive feelings associated with substance use and strengthen the more the substance is used, telling the brain to seek more. These pathways recognize triggers of substance use and respond by sending the “craving” to the frontal lobe. The frontal lobe determines whether or not the substance will be sought after, and if so, how the substance will be obtained and used.

When we think about individuals with brain injuries and associated cognitive and emotional challenges, we can see how if a person has difficulty with impulsivity, for example, then ignoring a craving may be more difficult than it would be pre-accident. In addition, when a person with a brain injury decides to engage in substance use, challenges such as poor planning and problem-solving may make the use even more unsafe.

Though we may not have evidence to connect brain injury to substance use directly, the cognitive changes in the brain are likely to make managing, using and even recovering from substance use much more difficult.

So now that we have talked about how substance use behaviours and patterns may change after acquiring a brain injury, the question remains, What can be done to help an individual who has both a brain injury and problems with substance use?  This question will be answered in part 2 of our blog post: The Comorbidity of Substances and ABI – the Role of the OT…stay tuned!

 

References:

Bjork, J. M. & Grant, S. J. (2009). Does traumatic brain injury increase risk for substance abuse. Journal of Neurotrauma, 26, 1077 – 1082.

Ilie, G., Adlaf, E. M., Mann, R. E., Ialomiteanu, A., Hamilton, H., Rehm, J.,… Cusimano, M. D. (2015). Associations between a history of traumatic brain injuries and current cigarette smoking, substance use, and elevated psychological distress in a population sample of Canadian adults. Journal of Neurotrauma, 32, 1130 – 1134.

West, S. L. (2011). Substance use among persons with traumatic brain injury: A review. Neurorehabilitation, 29, 1 – 8.

WETA. (2017). Facts about concussion and brain injury. Retrieved from https://www.brainline.org/article/facts-about-concussion-and-brain-injury

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What is Hygge and How Can it Help You Survive Winter?

Hygge (pronounced hue-guh) defined as, a quality of coziness and comfortable conviviality that engenders a feeling of contentment or well-being (regarded as a defining characteristic of Danish culture), is becoming very popular.  Its basic principles revolve around creating an environment that is comfortable, full of love, warm, and cozy – sounds like a great way to make it through a cold Canadian winter if you ask me!  Learn more about Hygge and its benefits in the following care of HealthLine.

HealthLine:  What the Heck Is Hygge and Why Do You Need Some This Winter?

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O-Tip of the Week: Give Yourself a Pat on the Back

Our O-Tip of the week series we will be providing valuable “OT-Approved Life Hacks” to provide you with simple and helpful solutions for living. 

For the month of February, our O-Tip of the week series will talk about Self-Esteem, which is defined as confidence or belief in one’s own worth or abilities.  Self-esteem issues affect more than just teenagers and encompass more than physical insecurities.  Follow along this February to learn more about self-esteem, its importance and some simple ways give yourself a boost! 

This week we invite you to reflect on and record your accomplishments.  Big or small, past or present, make a list of all the things you have achieved and refer to this when you are feeling down or need a boost. 

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What’s Your Love Language… And Why Does it Matter?

Julie Entwistle, MBA, BHSc (OT), BSc (Health / Gerontology)

I have a few online Goddesses I follow.  Women entrepreneurs who have built an empire educating other women on how to be successful.  Much like my own blog, they are comfortable sharing their stories of success and failure and want others to benefit from the knowledge they have.

In watching my online videos I will occasionally stumble upon a gem.  A piece of knowledge, a book to read, a way of thinking, or an exercise that truly moves me forward.  I recently had one of those experiences.

The video, by my career-crush and woman with the best hair in the world Marie Forleo (www.marieforleo.com), was on ways to appreciate and be appreciated.  Be it your spouse, children, parents or colleagues at work, we all strive to be loved and appreciated by those that matter to us, and to demonstrate this in return.  Marie was suggesting that in work and life it is helpful to understand how people experience and interpret love and appreciation so the efforts you make towards them can truly have an impact.  While a bit unorthodox, her suggestion was to engage people in the test of their Love Language.  She mentioned that this really helped her and her team know how to work together and ultimately appreciate each other best.  So, I took the test.  And my husband took the test.  And my children.  And my team.  The results were fascinating and helpful.

In my own family, our languages are different.  Personally, I appreciate it most when people take things off my plate.  My mind is a web of things to do so one less thing to think about is hugely valuable and appreciated by me.  Be it “I grabbed the kitty litter, put that envelope in the mail, or will send that email” – it resonates and helps me feel loved.  And call me cold, but I don’t resonate with physical touch (recall MC Hammer “Can’t Touch This”).

My girls are all different.  While most of them ranked “quality time” as their # 1, some prefer “words of affirmation” and one “physical touch”.  Not surprising, my physical touch kid is the one that is always asking for hugs and snuggling up to me on the couch.  Of great interest to me was that the one whose highest score was “words of affirmation” is also the kid that has a really hard time with conversations about things she did wrong or ways she let us down.  That makes sense now as people with this love language “thrive on hearing kind and encouraging words” and can be “shattered by insults”.  While we would never intentionally insult her, indicating that her school work is sloppy will make her feel unloved.  Good to know.  After we took the test and talked about it as a family, I took all of our ratings and put these in a chart by the door where we come and go.  I wanted these to be in plain sight and a regular reminder that our Love Languages are different and this matters when we want or need to be loved and appreciated by one another.  In a chaotic family of 6, this understanding is essential.

So I then took this experience a step further.  I asked the very important women I work with to also take this test.  The results again were interesting.  While my business partner and I tend to use small gifts as a way to show them appreciation, none of them ranked this as important.  Most would rather have unsolicited compliments (“words of affirmation”) then a surprise Edible Arrangement.  Some also prefer “acts of service” or being given “quality time” to feel valued.  At work, we can easily implement appreciation actions by offering to help them complete a burdensome task, providing unsolicited compliments, or making sure they have our undivided attention when they need it.

I consider the masterpiece that is myself to be always “under construction” and as such, I am repeatedly interested in ways to be better, do better, and spread love.  Love does not need to be considered romantic and according to 5 Love Languages, can be cast over all we meet with through simple gestures, kind words, a pat on the back, a small token of appreciation, or by sparing some time from a packed schedule.  Take the test here and see how you interpret love and appreciation and share that knowledge with those around you.

 

Originally posted July 2015

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O-Tip of the Week: Life’s too Short to Keep Up with the Jones

Our O-Tip of the week series we will be providing valuable “OT-Approved Life Hacks” to provide you with simple and helpful solutions for living. 

For the month of February, our O-Tip of the week series will talk about Self-Esteem, which is defined as confidence or belief in one’s own worth or abilities.  Self-esteem issues affect more than just teenagers and encompass more than physical insecurities.  Follow along this February to learn more about self-esteem, its importance and some simple ways give your self a boost! 

One way you can harm your self-esteem is through constant comparison of yourself to others.  However, putting a stop to this is, in fact, a difficult ask – magazines, tv shows, movies, social media… all of these things serve as channels to fill your mind with false images of how you “should be.”  Check out this great article care of Psychology Today which provides some great ways to get you to stop comparing yourself to others and see the amazingness within!

Psychology Today:  How to Stop Comparing Yourself to Others

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How Anxiety and Depression Can Impact Cognition

Julie Entwistle, MBA, BHSc (OT), BSc (Health / Gerontology)
Co-written with Ashley Carnegie, Occupational Therapist

As a student working with an Occupational Therapist in the community, I realized early in my placement that many clients struggle with anxiety and depression in combination with cognitive challenges like decreased attention, concentration and focus, difficulties with memory, and slower information processing abilities. This spiked my interest, as I was unaware of the possible impact anxiety and depression could have on cognition and how these symptoms could be related.  I decided to look into this further, and am sharing my findings below.

Occupational Therapists work in a wide variety of settings including the community. As the hospitals become less and less able to accommodate people long-term, community-based occupational therapy services are becoming more and more common. Working in the community allows occupational therapists to reach a wide variety of clients, and therapists utilize a strength-based approach to build on the client’s current strengths to promote wellness and productivity.

Depression and anxiety are the most common types of mental illness throughout the world, including Canada. From my community placement experience as a student Occupational Therapist, I have found that the majority of the clients I have seen are experiencing depression and/or anxiety, often in combination with other primary diagnoses.

Interestingly, depression and anxiety can negatively impact the way the brain thinks, learns, and processes information and thus how it functions.  However, the relationship is complicated as a decrease in cognition may also lead to an increase in depression and/or anxiety which can then perpetuate the cycle.

Research has highlighted how anxiety and depression can negatively impact several aspects of cognition including:

  • Psychomotor speed
  • Attention
  • Executive functioning
  • Problem-solving
  • Attentional switching
  • Cognitive flexibility
  • Visual learning
  • Memory

The result for most people tends to be poor functional outcomes in their daily lives. Additionally, the brain regions believed to be responsible for these functions have been shown to be abnormal in people that also suffer from anxiety and depression  (e.g. hippocampus, amygdala, temporal lobes, and prefrontal cortex). Decreased memory, slowed information processing, and issues with verbal communication can negatively impact multiple areas of people’s lives. This information demonstrates the importance of the need to detect and treat anxiety and depression as early as possible as well as the need for early cognitive interventions for clients with anxiety and depression.

As a student Occupational Therapist, I wanted to further investigate how Occupational Therapists can help. I found evidence that Occupational Therapists can help clients in reducing functional decline, while also reducing the probability of relapse by treating cognitive deficits. Occupational Therapist’s target these areas by teaching client’s cognitive remediation and compensation strategies during their interventions and treatment monitoring.

Examples of remediation interventions may include:

  • Retraining higher-level cognitive skills (e.g. strategy use, self-monitoring, self-correction, problem-solving, self-evaluation)
  • Education
  • Relaxation and stress management techniques to regain control
  • Divided attention training (e.g. learn tasks separately and then combine tasks)
  • Imagery
  • Rehearsal strategies

Examples of compensatory interventions may include:

  • Modifying the environment (e.g. dim lights, reduce distractions)
  • Altering the task, (e.g. use of rest breaks, breaking the task into smaller components, repetition of instructions)
  • Use of both internal and external cueing/reminders (e.g. use of mnemonics, post-it notes, organizers, applications)

With both, often, a cognitive behavioural approach is taken.  Cognitive behavioural therapy (CBT) works to change clients thought structure to allow positive mood change, enhance coping strategies/problem solving, and help challenge faulty beliefs.

Anxiety and depression are common and are known to negatively impact a person’s cognition.  Worsening cognition then can deteriorate anxiety and depression further.  Early intervention is key to break this cycle and to promote function and wellness.   Occupational therapists play a vital role in providing interventions for those with anxiety and/or depression by implementing interventions for these issues, as well as treating the common resulting cognitive deficits.  Both remediation and compensatory techniques are used, often through cognitive behavioral therapy.  If you, or someone you know, is struggling with anxiety or depression this may present as cognitive difficulty, or if cognitive issues are present, anxiety and depression may also surface.  Consider occupational therapy if you would like support and strategies to improve these symptoms and to reduce their effect on your daily life.

 

References:

1. Carrier, A., & Raymond, M. H. Community occupational therapy practice in Canada: A diverse and evolving practice.

2. McRae, L., O’Donnell, S., Loukine, L., Rancourt, N., & Pelletier, C. (2016). Report summary-Mood and Anxiety Disorders in Canada, 2016. Health promotion and chronic disease prevention in Canada: research, policy and practice, 36(12), 314.

3. Statistics Canada (2014) Survey on Living with Chronic Diseases in Canada (SLCDC). Retrieved from http://www23.statcan.gc.ca/imdb/p2SV.pl?Function=getSurvey&SDDS=5160

4. Lee, R. S., Hermens, D. F., Porter, M. A., & Redoblado-Hodge, M. A. (2012). A meta-analysis of cognitive deficits in first-episode major depressive disorder. Journal of affective disorders, 140(2), 113-124.

5. Jaeger, J., Berns, S., Uzelac, S., & Davis-Conway, S. (2006). Neurocognitive deficits and disability in major depressive disorder. Psychiatry research, 145(1), 39-48.

6. Bora, E., Fornito, A., Pantelis, C., & Yücel, M. (2012). Gray matter abnormalities in major depressive disorder: a meta-analysis of voxel based morphometry studies. Journal of affective disorders, 138(1), 9-18.

7. Femenía, T., Gómez-Galán, M., Lindskog, M., & Magara, S. (2012). Dysfunctional hippocampal activity affects emotion and cognition in mood disorders. Brain research, 1476, 58-70.

8. Lorenzetti, V., Allen, N. B., Fornito, A., & Yücel, M. (2009). Structural brain abnormalities in major depressive disorder: a selective review of recent MRI studies. Journal of affective disorders, 117(1), 1-17.

9. Fleming, J. (2017). An occupational approach to cognitive rehabilitation. Workshop presented through the Canadian Association of Occupational Therapists, Toronto, ON.

10. Grieve, J. I., & Gnanasekaran, L. (2008). Intervention for Cognitive Impairments. Grieve, JI, & Gnanasekaran, L.(3rd ed. ed.). Neuropsychology for occupational therapists: cognition in occupational performance. Oxford. Malden, Mass.: Blackwell.

11. Haran, D. (2009). Cognitive-behavioral therapy for depression. The Israel journal of psychiatry and related sciences, 46, 269.

12. Knapp, P., & Beck, A. T. (2008). Cognitive therapy: foundations, conceptual models,  applications and research. Revista Brasileira de Psiquiatria, 30, s54-s64.

 

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Social Outings Rx

We’ve said this before and we will say it again… being social is good for your health.  Occupational Therapists recognize the importance of social interaction within leisure activities for persons with and without disabilities. We work with clients to explore their interests to help find activities that offer opportunities for social interaction and, if needed, find ways to address the different barriers to engaging in these meaningful past times.

Great news!  Your family doctor can help with this too. There is now a pilot program in Ontario that allows physicians to write prescriptions for social activities and the ROM is assisting with this initiative.  Learn more in the following care of CBC News.

CBC News:  Doctor’s orders: ‘Social prescriptions’ have been shown to improve health

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Youth Anxiety and Depression on the Rise

The Centre for Addiction and Mental Health (CAMH) has released the results of the latest Ontario Student Drug Use and Health Survey and the results are showing rising instances of anxiety and depression in grades 7-12 students.  Learn more about the results and how gender may play a role in the following care of CAMH.

The Centre for Addiction and Mental Health:  Half of female students in Ontario experience psychological distress, CAMH study shows

 

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Giving Back this Holiday Season

Julie Entwistle, MBA, BHSc (OT), BSc (Health / Gerontology)

Tis the season for me to carefully balance my dislike for the Holiday season with my desire to not bring those around me down with my “baa-hum-bug” attitude.  My hate-on for Christmas started in my late 20’s probably around the time I had four kids under age 5 and through some lack of communication among my family, my kids had like 15 presents to unwrap EACH.  No, I am not complaining that my kids have access to such “abundance” by some very loving and well-meaning people, but with this display of affection comes a parent’s concern that their child will love Christmas because of the stuff.  And the more stuff they get, the more they want.  The more they want, the more they miss the point on the difference between want and need and the more they expect the “bar” to be raised with each passing year.

So, in my search to not pass on my “hate-on for the holidays” gene to my children, I landed on charity and acts of service to balance the fact that they, like most of their friends, live in abundance but still need to be mindful and grateful that they get a lot of what they want, while “needing” nothing.  After all, most of us can give something and there are so many options for this.  This new approach has been helping me to beat the Holiday Blues for the last few years.  It helps me to slow down, reflect, and be mindful and grateful for the things I have and can provide others, and for the pleasures of my own life. 

But in stepping out and getting my girls involved in local charities over the holidays, I have realized that there is an art to “giving” that can have the most impact.

Here are my Top 5 Things to Consider when Giving Back This Holiday Season:

Donate Money – good and responsible charities are appreciative of every dollar.  From the Salvation Army Bell Ringers to putting in a payment online or in the mail.  Money does help.  Search online with your kids to find a charity close to your heart, and have every member of the family donate.

Donate Items – some charities collect food, clothing, toys, or housewares to provide to those in need.  Time to purge those things you don’t need or use.  But before you donate items, ASK the charity what they need and HOW they want the items provided.  If they want new toys, these need to be packaged and un-used.  If they want them unwrapped then don’t take the time to wrap them – it only adds cost and time for you, and cost and time for the charity to unwrap the item before distributing.  Also, ASK what age groups they have a hard time providing for.  I was volunteering at the Good Shepherd recently and they had an abundance of items for small children, but very few for teens.  If you ask them, they will tell you the age categories they struggle to provide for.  Lastly, be sensitive.  If the charity is serving refugees or people immigrating from war-torn countries, toys that involve violence or war (i.e. guns or tanks) might not be appropriate and will need to be screened out by the charity before providing it to the recipient, again adding time and administration during a busy season.

Purchase Charity Goods – some charities sell “goods” that provide an item with a donation.  World Wildlife Federation sells small stuffed animals to represent an “endangered species” and most of the cost of the animal goes to the charity.  So, for $40.00 my child gets an “endangered stuffie” with a certificate about the animal they have adopted, and the charity gets $32.00 as a donation to their cause.  This is also true of other charities that aim to sell farm animals or agriculture supplies that are provided to third world countries.

Support Events – many charities offer dinners, auctions, or other seasonal events to raise money.  This is a great way to donate while engaging in an “experience” with a friend, partner or as a family.

Donate Time – sometimes donating your time reaps the best reward for you and the charity.  Not only does it provide you with an opportunity to see how the organization operates and allow you to be “hands on” in making a difference, it saves the charity from needing to fund staffing to manage the busy holiday season.  I have been at the Good Shepherd three times this month doing anything from sorting clothing donations, food donations, stocking housewares on the shelves in their store, and sorting toys for their Christmas hampers.  There are many organizations that just need some extra hands during the holiday season and sometimes our time is our most impactful gift.

Next week on our blog we begin our annual tradition of giving back to our readers with the 12 Days of Inspiration.  We hope you find these uplifting stories a source of inspiration and hope this Holiday Season.  

Previously Posted December 2016