Occupational Therapy in Anxiety Disorder

Role of Occupational Therapy in Anxiety disorder-

The anxiety is an important feature of almost all psychiatric disorders. The occupational therapist working in a psychiatric setup has to deal with the common problems like anxiety and depression. The role of occupational therapist in anxiety is to find out the symptom causing conditions or stimuli through detail assessment and providing therapy to them. The main role is to correct the behavior by providing different approaches and activities.

What is Anxiety?

Anxiety is the commonest psychiatric symptoms in clinical practice. And anxiety disorders are one of the commonest mental disorder in the general population.

Anxiety is a ‘normal’ phenomenon, which is characterized by a state of apprehension or unease arising out of anticipation of danger.  Mostly, anxiety doesn’t fall under the disorder category until it comes frequently.

Normal anxiety becomes pathological when it causes significant subjective distress and/or impairment in functioning of an individual.

The symptoms of anxiety should last for at least a period of 6 months for a diagnosis of generalized anxiety disorder.

Clinical Symptoms of Anxiety-

Physical Symptoms-

• Motor Symptoms – Tremors; restlessness; muscle twitches; fear full facial expression.
• Autonomic and Visceral Symptoms- Palpitations; sweating; Hyperventilation; Vomiting; Frequent micturition.

Psychological Symptoms-

• Cognitive Symptoms- Poor concentration; negative thoughts; easy distractibility.
• Perceptual Symptoms- Derealization; Depersonalization.
• Affective Symptoms- Vague sense of apprehension; fearfulness; inability to relax.
• Other – Insomnia; increased sensitivity to noise.

Occupational therapy Assessment in patient with anxiety-

As we have mentioned, anxiety is the commonest problem in psychiatric patients. The symptoms or features of anxiety are very well observed and not much assessment is needed to label it as an anxiety. The occupational therapist assesses anxiety through different scales and by taking interview.

Generalized anxiety disorder comes under the category of neurosis and stress related disorders. The patient can tell others, that he/she feels very anxious while doing some particular thing or in a specific environment.

Here, occupational therapist assesses the stress causing agent and stimuli. Without identifying the symptom causing stimuli, it will be difficult to deal with the problem.

Environmental assessment is also necessary in occupational therapy point of view. Sometimes, the home or the office premises or closed surrounding can aggravate the symptoms of anxiety.

Occupational Therapy goals and objectives in Anxiety-

Occupational therapist sets some objectives and goals before implementing the therapeutic activities. Some are the examples of goal setting-

• To relieve the stress.
• To relieve the anxiety.
• To improve the skills.
• To cut down the anxiety causing stimuli.
• To provide healthy and supportive environment.

Occupational Therapy Management in Anxiety-

The occupational therapy treatment is based on the assessment done by the therapist. Occupational therapist uses different approaches to deal with the problems. Different frames of reference can be used by the occupational therapist like psychodynamic frame of reference, cognitive behavioral frame of reference, model of human occupation.

In the case of anxiety, the establishment of good therapist-patient relationship is often the first step in therapy intervention. If bonding is good, patient can share the real problem she/he facing. So, it will be easy to solve the problem.

Relaxation Techniques-

In patients with mild to moderate level of anxiety, relaxation techniques can do wonders. These techniques can be learned by the patient himself and can perform on a daily basis plus whenever he/she feel anxious.

The relaxation techniques include Jacobson’s progressive relaxation technique, Yoga, Pranayama, Meditation, counting of 10, breathing exercise and mind diversion techniques. These techniques can be very beneficial for the patient.

Coping Strategies-

The coping mechanism is a voluntary and conscious mechanism of defense,  which an individual employs to deal with daily external and conscious fear and conflicts.

Occupational therapist focused on the problem focused strategies. In this approach, the patient is supported to tackle the problem directly. Before using this, therapist motivates and provide positive support to the patient.

Analyze the situation => skills training => repetition => mastery of skill => face the real situation. These steps used by the occupational therapist in skill building.

Systematic Desensitization-

In this approach, therapist identifies the symptoms causing factors. First, establish an anxiety stimulus hierarchy- patient is asked to give ranking to trigger point that provokes anxiety. Then, he is asked to list them in a descending order of anxiety provocation. Then, at first, the lowest item in the hierarchy is faced. The patient is advised to signal whenever anxiety occurs, with each signal he/she is asked to use relaxation techniques to calm down. Repetition is the key to achieving success.

Physical Exercise –

Physical exercise can be suggested by the occupational therapist. General exercise protocol and aerobic exercise help to boost the confidence and relieve the stress.

Exercise is also considered important for maintaining mental fitness, and it can reduce stress. Studies show that it is very effective at reducing anxiety/stress, improving alertness and concentration, and at enhancing overall cognitive function. This can be especially helpful when occupational therapist involves the patient in meaningful activities, improved attention and cognitive function help the patient to respond in a better way.

Functional / Creative Activities-

Functional activity is a synonym for Occupational therapy. Above mentioned therapeutic approach can be applied by others, but the occupational therapist uses these approaches along with the functional activities.

The patient with anxiety to prefer the familiar activity, less challenging activity initially. Similar activities provided by the occupational therapist. Art, Drama, music, pottery, and a certain type of writing, these activities provided by the occupational therapist to anxiety patient.

Occupational activities can also be provided if the anxiety is because of the occupational circumstances or due to occupational environment. Occupational skills can be broken down into parts, and it will be easier for the patient to tackle the situation.

Summary –

Occupational therapy in anxiety has its own importance, anxiety is one of the common symptoms of a psychiatric disorder, and occupational therapist deals with it. Occupational therapist uses different approaches to solve the problem of anxiety.

Read More…

Occupational Therapy in Mental Health,

Occupational Therapy in Depression,

Occupational Therapy in Schizophrenia.

References-

Niraj Ahuja, A short textbook of psychiatry. 6^th Ed. Jaypee Brothers.

Jennifer Creek, Lesley Lougher. Occupational therapy and Mental Health. 2011. 1^st Ed. Elsevier Publication.