Role of Occupational Therapy in Depression

Role of Occupational Therapy in Depression-

Occupational therapist deals with the depressive patients in mental health care set up. Occupational therapist tries their best to overcome the depressive feeling of the patient by providing positive situation and worthful pleasure. Occupational therapist involves depressive patients in meaningful and pleasurable activities, which help the client to tackle the depression.

Depression is the most common mental health problem seen in an individual. Depression comes under the mood disorder. The world health (mental) report 2001 estimates that there are 121 million people worldwide suffering from depression.

The most important feature of a depression is the sadness of mood or loss of interest. Depression affects our daily lives and occupational skills. Level of depression may vary from slight/mild to severe.

Clinical features of Depression –

1. Depressed Mood-

Loss of interest and/or pleasure in almost all activities. This sadness of mood is different from the sadness encountered in ‘normal’ sadness or grief.

The loss of interest in daily activity results in social withdrawal, decreased ability to function in occupation and interpersonal areas and decreased involvement in previously pleasurable activities.

2. Depressive ideation-

Sadness of mood are usually associated with pessimism, which may result in depressive ideas like, Hopelessness, helplessness, and worthlessness. In severe cases, suicidal ideas may be present.

The ideas of worthlessness can lead to guilt-feeling.

The other features relevant to occupational therapy are –

Difficulty in thinking,
Difficulty in concentration,
Poor memory,
Indecisiveness,
Lack of initiation and energy.

3. Psychomotor Activity-

Agitation is common in depression. And often present with marked anxiety, restlessness (hand wriggling, inability to sit in one place) and a feeling of unease.

4. Biological function-

Disturbance of biological functions is common, some are-
Insomnia (or sometimes increased sleep)
Loss of appetite and weight (or sometimes weight gain) and
Loss of sexual drive.

Occupational therapy assessment of depression-

The occupational therapist assesses all areas of impairments. By taking a structured or unstructured interview with the patient and caretaker. Occupational therapist focuses on some specific areas related to occupational therapy intervention.

Areas addressed in assessment-

1. Performance skills – cognitive, perceptual, psychological, and social. And their impact on performance in areas of occupation.
2. Client factors and physical conditions or limitations that impact on functional behaviors and occupational performance.
3. Identification of the roles and behaviors that are required of the individual either by society or for the achievement of his/her desired goals.
4. Suicidal and aggressive behavior.
5. History of behavior pattern.
6. Individuals goals, values, interests, and attitudes.
7. Activities of daily living.

To assess all these areas occupational therapist may use different methods:

Interviews – occupational profile, standardized tests, clinical observation and rating scales and Questionnaires.

These methods include different scales, such as-

General Assessment of mental status- Mini-Mental State Examination.

Assessments of cognition and affect – Allen Cognitive level Test, Beck Depression Inventory, Elder Depression Scale, and Hamilton depression Rating Scale.

Assessment of task performance and Assessment of occupational performance and occupational roles- Canadian Occupational Performance Measure (COPM) and Occupational Case Analysis Interview Rating Scale (OCAIRS).

Occupational therapy goals and objectives in depression-

Occupational therapist formulates the short term and long term goals in the patient of depression. After assessing the various areas, OT points out the concerned areas where occupational therapist needs to work on.

• To improve the mood.
• To involve them in meaningful activity.
• To improve the activities of daily living.
• To decrease the depressive ideas by providing the mental support.
• To improve the anxiety and restlessness because of depression.
• To improve the physical strength.
• To improve the social interaction.

Occupational therapy intervention for depression –

Occupational therapist understands the psychology of the patient and try to relieve the stress and depressive feeling. They try to satisfy the emotional needs of a patient.

 Emotional needs –

1. To be loved, accepted, to belong-
2. Need for reassurance (not over solicitude).
3. Need for approval as an individual.
4. Need for dependency relationship.
5. Need to lessen the guilt.
6. Constructive externalize hostility-
7. Within social limits.
8. Without abnormal fear of retaliation.

Approaches to the patient in the initial phase of illness –

The therapist must acquire the skill to deal with a depressed person. The voice of the therapist must match with the patient. The therapist must aware about the perception, emotion, and physical response.

• Speak slowly and what the patient can understand allowing time for him to react.
• Limit content of speech to points on which patient must focus.
• Focus patient’s attention by saying his/her name.
• Move slowly.

What therapist do to satisfy the emotional needs-

Therapist anticipates minimal verbal or physical response. They do not become discouraged at patient’s inactivity. They do not show approval or disapproval of clients’ behavior.

Therapist accepts the patient as he/she is: attention of frequent but short duration gives the patient enough support that therapist is around. They provide solitary, short term, simplified, structured activities initially to the patients. They recognize patient efforts, and avoid implying pleasure.

Satisfy the dependency needs:- therapist must be around the patient to guide him/her in new or unfamiliar acts of short term nature. The therapist makes decisions, eliminates discussions and provide opportunities for the patient to take small decisions. Therapist do not force rather request the patient.

Later therapist encourages the patient to participate in decision making- “let’s work this out together”, increase decision making capacity as patient can tolerate decisions comfortably and take responsibility for them. E.g. “which of these will you use” later “choose whatever you want”.

Constructively externalize hostility: therapist provides an outlet for hostility within his/her current tolerance initially towards an object i.e. nonverbal. Provide passively aggressive activities due to fear of hostile impulses. Later, increase aggressive component of the activities.

The relationship of therapist with the patient should be so permissible and reciprocal that the patient is able to express and ultimately accept, understand and respect the feelings.

Patient must express dislike or disapproval within socially acceptable limits. He/she must express anger when the situation warrants it without subsequent guilt feelings.

Occupational therapy Activities – therapist provides an opportunity for constructive use of activities-  It must be structured, organized, repetitious, meticulous and meaningful.

Promote initiation or participation-

Together with the individual therapist, identify the reasons for lack of participation, e.g. attention deficits, embarrassment, and depression.

Motivational hints- individuals are more likely to participate in activities that address issues that are of interest or concern to them. The more ownership patients have in the activity, the more they will participate. Success, fun, positive feedback and rewards are motivating things.

Group therapy –

A depressed person avoids the social interaction and may feel reluctant to meet others because of depressive ideation. Group therapy is very helpful in depressed patients. Initially, one to one session, and then involve them in group may be helpful. Group therapy can be motivating to discus any topic or initiation of any activity in the group. Less competition within the group help to achieve success and a feeling of worth.

Cognitive Behavioral Therapy (CBT)-

Cognitive behavioral therapy is a popular and evidence based psychotherapeutic approach. This approach has changed the way to think and behave. CBT is based on the thoughts, feelings and emotions. CBT helps to cut down the way of processing in the smaller part and provide positive feedback. Occupational therapist uses to prefer CBT along with the purposeful activities like his/her occupation. Involvement of activity during cognitive behavioral therapy provides a real sense of occupational therapy.

Occupational therapist tries to find out the causing factor of depression. It becomes very easy to tackle the situation if the therapist understands the depression causing factor.

Improve Self Esteem –

A depressed patient generally lacks self esteem and values. Here, the role of occupational therapist comes, they help them to regain their self esteem, values and life roles in their lives.

Creative, functional, occupational, and pleasurable activities can be planned by the therapist to boost the self esteem and self importance.

Precautions- avoid the possibility of patient harming self. Be cautious of, especially when the patient having remission. Avoid provoking undue anxiety or apprehension.

Read More.. Occupational Therapy in Mental Health and Occupational Therapy in Schizophrenia

References-

• Niraj Ahuja. A short textbook of psychiatry. 6th Ed.
• Kaplan & saddock. Synopsis of psychiatry. 9th Ed.
• Jennifer Creek. Occupational Therapy and Mental Health: Principles, skills, and practice.