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Tag Archive for: mental health

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The Role of Occupational Therapy in Adolescent Eating Disorders

Guest Blogger: Carolyn Rocca, Student Occupational Therapist, 2017

According to Statistics Canada, in 2012 over 130,000 Canadians over the age of 15 years old reported that they have been diagnosed by a health professional as having an eating disorder. Considering these high rates, and the likely underestimation of reported diagnoses, eating disorders remain a form of mental illness that are not openly talked about.

Eating disorder is an umbrella term for several categories of diagnoses, with anorexia nervosa, bulimia nervosa, binge eating disorder, and eating disorders not otherwise specified being the most common. Although symptoms vary based on the diagnosis, some overall symptoms experienced with eating disorders include a pre-occupation with body weight, body dissatisfaction, behaviours to prevent weight gain, perfectionism, emotional dysregulation, depressed mood (including suicidality), anxiety, and low self-esteem. Naturally, these symptoms can lead to secondary impacts such as physical adverse effects, social isolation, and a compromise of occupation in the areas of self-care, daily living, leisure, and productivity (NCCMH, 2004).

The treatment and recovery of adolescents with eating disorders involves the collective work of many healthcare professionals including physicians, dietitians, nurses, psychiatrists, psychologists, social workers, teachers, child and youth counselors, and, yes, occupational therapists (Norris et al., 2013). Each of these team members works collaboratively to deliver the best practice approaches of pharmacotherapy, nutritional rehabilitation, and psychosocial interventions, including cognitive behavioural, dialectical behavioural, interpersonal, and family based therapies, among others (APA, 2006; NCCMH, 2004). Several of the healthcare professionals working with adolescents with eating disorders can deliver these therapies, including occupational therapists.

This means that occupational therapists work effectively with several disciplines to deliver best practice approaches, while also integrating their unique focus on occupational functioning to the team. Occupational therapists’ unique contribution is their ability to holistically address the physical, cognitive, behavioural, and psychosocial aspects of adolescent eating disorders through occupation-based approaches to improve adolescents’ self-worth and self-esteem (Kloczko & Ikiugu, 2006). As mentioned previously, eating disorders commonly have a substantial impact on adolescents’ function in the areas of leisure, self-care, daily living, and productivity (NCCMH, 2004), meaning many youth have difficulty balancing their family and social lives, education, employment, extra-curricular participation, ability to regulate their own activities, and thus overall health.

Occupational therapists have the expertise to work closely with adolescents and their family to help them with their goals around succeeding in school, work, leisure, and overall re-engagement in meaningful activities. In fact, Occupational Therapists are skilled at using meaningful activities as a vessel to get to the underlying problem of the eating disorder.  Sessions don’t focus on eating, food or binging behavior, but on being productive, enjoying life, and accomplishing things that matter.  The indirect influence is better choices in other areas (including diet) and recognizing the link between mental and physical health, quality of life and wellness.

If you know a teen (or adult for that matter) that may be dealing with an eating disorder, encourage them get help.  There is a team of professionals, including occupational therapy, that are skilled at assisting teens to recover from these, and other mental health issues.

 

References & Resources:

American Psychiatric Association (APA). (2006). Practice guideline for the treatment of patients with eating disorders (3rd ed). Retrieved from https://www.guideline.gov/summaries/summary/9318/practice-guideline-for-the-treatment-of-patients-with-eating-disorders

Kloczko, E., & 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. doi:10.1300/J004v22n01_05

National Collaborating Centre for Mental Health (NCCMH). (2004). Eating disorders: Core interventions in the treatment and management of anorexia nervosa, bulimia nervosa and related eating disorders. Retrieved from https://www.nice.org.uk/guidance/cg9/evidence

Norris, M., Strike, M., Pinhas, L., Gomez, R., Elliott, A., Ferguson, P., & Gusella, J. (2013). The Canadian eating disorder program survey–exploring intensive treatment programs for youth with eating disorders. Journal of the Canadian Academy of Child and Adolescent Psychiatry, 22(4), 310.

Statistics Canada: http://www.statcan.gc.ca/pub/82-619-m/2012004/sections/sectiond-eng.htm

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Monitoring Your Mood

In our previous post, Blue Monday and Beyond – Tips to Beat the Winter Blues we discussed how some research suggests that up to 15% of people in Ontario experience the “winter blues” and 2-3% of the population suffer from Seasonal Affective Disorder (SAD).

If you are suffering from depression, anxiety, SAD or simply the “winter blues” being aware of your feelings, thoughts, emotions and overall mood can help you to understand and cope.  The following printable “Mood Diary” will help you to track when you are feeling a certain emotion, the intensity of it, the situational aspects and the effectiveness of your coping mechanisms.  Doing so will give you and your healthcare professionals a better understanding of the problem.

For more helpful tools visit our Printable Resources Page.

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Recognizing Mental Illness in Children

According to The Canadian Mental Health Association “it is estimated that 10-20% of Canadian youth are affected by a mental illness or disorder – the single most disabling group of disorders worldwide.”  Parents can often easily identify and seek help for physical problems in their children, but mental illness can be harder to recognize.  The following from Psychology Today provides changes and signs to watch for, and advice on how to seek help for a child.

Psychology Today:  13 Concerning Signs of Mental Illness in a Child

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Blue Monday and Beyond — Tips to Beat the Winter Blues

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

I made a comment after the Holidays that I was slowly recovering from Christmas Affective Disorder.  For me, Christmas is stressful, hectic and challenging.  I struggle with it every year.  After the seasonal rush, it takes me days, or even weeks, to get back to my normal equilibrium.  However, really, winter despair is not a joke and for some, can be debilitating.

In fact, some research suggests that up to 15% of people in Ontario experience the “winter blues”. These leave you feeling tired, groggy, and maybe even sad or irritable.  While this causes discomfort, it is not incapacitating.  However, a more serious form of the winter blues, known as Seasonal Affective Disorder (SAD), can be.  While occurring less frequently at 2-3% of the population, the symptoms can prevent individuals from leading a normal life.  Symptoms of SAD include decreased energy, changes in appetite, especially leading to cravings for starchy or sweet foods, oversleeping and weight gain, among other things.  If you feel this is you, talk to your doctor and have your symptoms investigated.

The problem is not always the blues, but how these create a negative behavior cycle.  When you feel down, you revert, avoid, or change habits.  This leads to feeling worse and the cycle continues.  Occupational therapists (OTs) recognize the importance of being engaged in activities that are meaningful, active and productive, and understand how these contribute to health and well-being. In fact, one of the best treatments for beating the winter blues involves just “keep on keeping on” by doing what you normally do every day.  Some tips include:

 1.       Use behavioral activation to keep your normal routine.  Make the bed, have a shower, prepare a decent breakfast, walk to the mail box.  Don’t change habits that are ingrained just because it is winter.  Never underestimate how damaging it can be if you avoid even small things that ultimately add up to a productive day.  Gradually try to get back to those important tasks if you have found that your daily behaviors have become unproductive.

2.       Stay active.  Those that love the winter do so because they get outdoors.  Walk, ski, skate, toboggan – something to help you appreciate how wonderful a change of seasons can be.  This is best facilitated by proper clothing that will keep you warm.  If exercise is tough for you, build it into your day by default – park farther from the door, use the stairs, make a few trips from the car with the groceries to get the blood flowing.

3.       Consider light therapy.  Sit by the window at lunch, get some fresh air when the sun is out, or consider purchasing an artificial light for your use at home.

4.       Up the nutrients.  When some bad eating habits creep into your winter these can be hard to break come spring, and only contribute to further mood declines.  Shop in the fruit and veggie isles, and avoid the isles that house the bad foods you seem to be eating too much of.

Finding ways to help you do the things you want to, need to, or enjoy, is at the heart of occupational therapy. While the winter months can be long, dark, and cold, ultimately how we adapt to the seasonal change is up to us.  If moving or going south is not an option, consider some of the above tips to make the winter bearable, or dare I say, even enjoyable?


Seasonal Affective Disorder. (Canadian Mental Health Association, 2013) http://www.cmha.ca/mental_health/seasonal-affective-disorder-sad/
Beat The Winter Blues (Readers Digest, no date) http://www.readersdigest.ca/health/healthy-living/beat-winter-blues
Kurlansik, SL & Ibay, AD. (2012).
Seasonal Affective Disorder. Am Fam Physician. 2012 Dec 1;86(11):1037-1041.
10 Winter Depression Busters for Seasonal Affective Disorder (Borchard, no date) http://psychcentral.com/blog/archives/2012/12/30/10-winter-depression-busters-for-seasonal-affective-disorder/

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PTSD and Occupational Therapy

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

From when I was a teen I have been highly sensitive to movies, news stories, songs or videos that involve violence (particularly against women).  In fact, I avoid movies and shows in general (beyond thoughtless sitcoms or socially interesting reality TV), fearing that I will see (or hear) a bothersome scene.  If my screening process fails and I catch something disturbing, I have problems sleeping for days as the images or sounds replay in my mind.   In talking to my friend about this, she asked me a pointed question:  Do you think you have PTSD?

Her question was referring to her knowledge of my experience as a teenager in 1991:  My former elementary classmate Leslie Mahaffy and later Kristen French were both abducted, tortured, sexually assaulted and murdered by the notorious Paul Bernardo and his wife Carla Homolka.  Kristen’s body was found near my community.  Not long after, Nina de Villier was abducted and murdered after leaving for a run from the tennis club where I played and her brother was my double’s partner.  I was part of the search party for Nina in the days of her disappearance and following these tragedies my mother became involved in an organization developed by Nina’s mother Prescilla called “Canadians Against Violence” (CAVEAT).  Over the next few years I assisted with the organization at times, meeting many people whose lives were horribly impacted by the tragic loss of a daughter or sister, or who were victimized, stalked and threatened (some ongoing) by men.  Now, as a mother of four girls, I recognize that these experiences still foundationally impact how I parent and I try to not let my fears about the safety of my girls restrict them from experiencing the important milestones of growing up.

Whether I have friend-diagnosed PTSD or not, according to the Canadian Mental Health Association, PTSD is a mental illness. It involves exposure to trauma involving death or the threat of death, serious injury, or sexual violence.  In general, the traumatic event involves real or threatened physical harm to the self or to others, and causes intense fear, hopelessness, and/or horror. Emotional impairment results due to anxiety, depression, recurrent flashbacks, difficulty sleeping and concentrating, and feelings of guilt of having survived when others may not have (Stats Canada).  In the military, one in six are reported to experience PTSD as a result of their service (Learn more from the Globe and Mail).

Occupational therapy, a profession vested in helping people to function safely and independently in their life-roles, is often one of the many health care providers that can assist people to overcome the symptoms associated with PTSD.  Problems like anxiety, depression, flashbacks, difficultly sleeping and concentrating, and overcoming feelings of guilt can be tackled through: cognitive and / or behavioral strategies aimed at increasing activity participation slowly over time; by identifying, recording and sharing thoughts and feelings; and through engagement in healing-focused activities.  Occupational therapists break down life tasks into smaller and manageable chunks to grade the successful return to meaningful roles.  Over time, previously challenging tasks become easier as we help people master the roadblocks that are preventing their successful engagement in function.

However, with something as significant as PTSD, it will be the collaboration of multiple professionals helping the client to overcome their challenges that will have the most impact.  Medical doctors, social work, psychology, psychotherapy, even massage, art or yoga therapy can help to provide a holistic approach to helping people move beyond these often crippling experiences.  If you have PTSD and this is impacting your ability to do the things you need or want to do, please seek the help of professionals.

As for me, I don’t currently have the goal of wanting to return to watching movies and shows riddled with violence, rape and murder.  I personally don’t find that entertaining and actually wonder why other people do.  I am not sure I will ever understand, PTSD or not, why people derive pleasure watching (even if simulated) images of people’s horrible mistreatment.  So, I will stay in my bubble for now enjoying Modern Family, Survivor and The Amazing Race.  However, if my past does start to impact my ability to parent my girls, participate in activities I would otherwise enjoy, or snags my engagement in any other necessary or important area of my life, I will surely reach out for help.

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Depression and Disability Insurance

Depression is a common and serious health condition that Health Canada estimates about 11 per cent of men and 16 per cent of women in Canada will experience at some point in their lives.  Learn more about potential treatment options and the importance of disability benefits for those suffering from Depression in the following post by Brad Moscato of Howie Sacks and Henry Personal Injury Law.

Long-Term Disability Series: Depression’s Impact On Life & Work – The Importance of Disability Insurance Benefits

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What’s Your Emotional IQ?

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

I have four daughters – two are teens and two are tweens.  That is a lot of estrogen in our house.  Yet it is an interesting time for our family – as our girls are navigating the perils of adolescence I too am finding myself in a stage I am calling “adultescence” whereby my thoughts, feelings and emotions are changing as theirs are.  This creates an interesting ebb and flow of all of us learning together what it all means as a teen girl to “grow up” and as an adult to start “letting go”.

I had one of those adultescent “ahaha” moments the other day with one of my teen daughters.  She is very socially driven and relationships are very important to her.  Over the last few months as school has resumed, she has been struggling with some of her friendships.  One girl just suddenly stopped responding to messages, one takes pleasure in forwarding hurtful messages, and another treats my daughter as the weekend “last resort”.  In talking to my daughter about these events, my “ahaha” moment came when I realized that my daughter, already, is highly emotionally intelligent.  She has the ability to put herself in the position of others and regulates her own behavior (so far) on how she would feel as the recipient.  This is a gift for her, but puts her at a relationship disadvantage as many of her peers are not there yet.   She “feels” in a relationship like she is 25, but is trying to rationalize the emotional behavior of kids 13 and 14.

According to psychology today, Emotional Intelligence includes three skills:

1. Emotional awareness, including the ability to identify your own emotions and those of others;

2. The ability to harness emotions and apply them to tasks like thinking and problem solving;

3. The ability to manage emotions, including the ability to regulate your own emotions, and the ability to cheer up or calm down another person.

Emotional intelligence then includes:  self-awareness, self-regulation, motivation, empathy, and social skills.  It can affect: personal relationships, workplace (or school) performance, physical and mental health, and how you deal with situations such as loss or disability.

The good news is that experts believe that emotional intelligence can be learned, even in adults.  How do you know if you are emotionally intelligent?  Perhaps reflect on your relationships – are you able to sustain positive and loving bonds with others?  Can you empathize and relate to people during their struggles, and do they know that you “get it” and are emotionally available to them?  Do you regulate your own behavior based on how others might feel if you act a certain way, or say certain things?  Before sending that text, email or calling someone in anger do you consider how you want them to “feel” following your interaction?  Do you take pleasure in being right even if that makes others feel bad?  If you want to test your level of emotional intelligence, or raise your emotional IQ, take a quiz to see where you’re at:  Emotional Intelligence Quotient Quiz.

Do you think you need to improve in this area?  Some suggestions include:

  • practice mindfulness – in social situations, at work, at home with family relationships.
  • Stay in touch with your feelings through journaling or meditation “check-ins”.
  • Connect your feelings to the situation and try to separate the person from their behavior.
  • Check your thoughts – how you think can become how you feel, and the good news is you can change how you think!
  • Communicate with others and don’t be afraid to be vulnerable to those close to you to help sort through feelings, thoughts and emotions.
  • And if you can, don’t take the comments of others personally.  Their thoughts about you do not need to become the thoughts you have about yourself.
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Recognizing Psychological Tramua in Kids Following An Accident

As Occupational Therapists we use a holistic approach to help our clients.  After an accident we assess and treat not only the physical effects, but the emotional impact such a traumatic experience can have on one’s life.  The following article by Roger Foisy, a Canadian Personal Injury Lawyer, discusses how approximately “15-25% of children involved in car accidents show symptoms of depression that remain even months after the accident.”  Take a look at the article to learn how to recognize the signs and some great ways to help children cope after the traumatic experience of a car accident.

Roger Foisy:   Helping Children Overcome Psychological Trauma after Car Accidents

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The Healing Power of Animals

Animals are amazing.  Dogs specifically have been known to help reduce stress, provide companionship, and trigger the release of helpful chemicals in the brain.  Therefore, they are helpful, not only as guide dogs and service animals, but as companion animals for those suffering from mental illness.  The following from the Huffington Post shares an amazing story of how one dog helped a young woman manage her anxiety and depression.

The Huffington Post:  How a Dog Helped Me Manage My Anxiety and Depression

Be sure to check out our previous posts related to dogs and service animals:  Dog Awesomeness and Service Dogs are in the Grocery Store, Why Not the Schools?