0

Coping with Mental Health Challenges

Daily coping strategies for prevention along with coping interventions when symptoms are first noticed are extremely useful for managing mental health and behavioral challenges.  Many individuals confront mental health and behavioral challenges at some times in their life. Particularly those experiencing difficulties with substance abuse, extreme stress, developmental disorders or subtle sensory motor disorders (e.g., hyper-responsiveness, hypo-responsiveness, involuntary movements) benefit from regularly using coping strategies to manage their mental health and behavioral challenges. Mental health and behavioral challenges are eventually diagnosed as a depression, anxiety, Autism Spectrum, Post-Traumatic Stress, Borderline Personality, Psychotic or some other disorder that carries a stigma not seen in other illnesses.  While help is available it is up to each person to manage their mental health and behavioral strategies by actively using coping strategies.

The most inexpensive evidence-based coping strategy to reduce distress from mental health and behavioral challenges is doing aerobic exercise 30 minutes daily. The best exercises are the ones that individuals enjoy doing regularly. Any combination of walking, yard work, biking, running, swimming, fitness classes, karate, dance and sports are effective. In addition to lowering distress, aerobic exercise contributes to weight management and physical well-being.

Wallpushups

The second coping strategy that is important for people who experience mental health and behavioral challenges to do daily is a relaxation activity. Relaxation activities include progressive relaxation, visualization, yoga, mindfulness, breathing, meditation, Tai chi, Chi Gong and prayer. Like exercise the best forms are any an individual is motivated to do daily for thirty minutes. Relaxation activities can be reinforced through participating in a weekly group class that can be found for little or no cost.

MindfulClk1MindfulClk2ToesSquat

Despite the proven benefit of regular exercise and relaxation to reduce mental health and behavioral challenges many people experience problematic mental health and behavioral symptoms anyway, and will need to immediately be assessed for their need of counseling and/or medication as appropriate coping strategies. These coping strategies need to be assessed by a licensed mental health counselor, child/adolescent psychiatrist or adult psychiatrist. It is crucial to quickly find a mental health counselor and psychiatrist you trust. In addition,  some individuals also find it helpful to receive services from a licensed massage therapist for stress reduction or occupational therapist to modify their daily routines and life activities. Many individuals experience mental health and behavioral challenges and benefit from regular use of coping strategies to manage them successfully.

References

Brown, R. P. & Gerbarg, P. L. (2012). The healing power of breath. Boston, MA: Shambhala.

Cramer, S. C., Sur, M., Dobkin, B. H., O’Brien, C., Sanger, T. D., Trojanowski, J. Q. . . . & Vinogradov, S. (2011). Harnessing neuroplasticity for clinical applications. Brain, 134(6), 1591-1609.

Levit-Binnun, N., Davidovitch, M., & Golland, Y. (2013). Sensory and motor secondary symptoms as indicators of brain vulnerability. Journal of Neurodevelopmental Disorders, 5, 26. www.jneurodevdisorders.com/content/5/1/26

Perry, B. D. (2009). Examining child maltreatment through a neurodevelopmental lens: Clinical applications of the neurosequential model of therapeutics. Journal of Loss and Trauma, 14(4), 240-255.

Talwar, U. K., Sharma, V., & Singh, R. (2010). Role of Yogic Exercises in Bipolar Affective Disorder and Schizophrenia. Delhi Psychiatry Journal, 13(1), 117-22.

0

Light touch and Holding Interventions

Light touch and holding strategies promote body awareness and social-emotional skills in children and adolescents with behavioral challenges. Deep pressure touch is a more common therapeutic intervention. However, light touch and holding are valuable therapeutic options for promoting attention, body awareness and social-emotional skills.

KONICA MINOLTA DIGITAL CAMERA

KONICA MINOLTA DIGITAL CAMERA

Body awareness, stress and somatic pain challenges negatively impact behavior in many children and adolescents with developmental, sensory processing, Post-Traumatic Stress Disorder, internalizing behavioral concerns and other psychiatric disorders.  Attention, body awareness, stress and somatic pain problems can be addressed through the use of light touch and holding strategies.  Light touch and holding strategies are particularly useful for improving and directing functional attention, and provide a valuable option for reducing stress, somatic pain, and social-emotional problems when deep pressure massage is contraindicated.  Particularly for young people experiencing acute pain, edema, taking analgesic medications (e.g., which can decrease pain perception) or taking antidepressant medications (e.g., which can cause light headedness and dizziness) light touch and holding are preferred.

Recent research indicates that positively perceived slow, light touch specifically activates CT afferent fibers connecting to the Insular Cortex that convey social-emotional interactions and our internal sense of self.  FAB Strategies utilizing light touch and holding include: Vibration to the Back, Arms, & Body as well as the Rolling the arm, Back X, Spine crawl, Head crown, and Foot input.  These light touch and holding techniques which are components of FAB Strategies will be described below.

It can be clinically useful to provide extremely irritable children and adolescents who have significant body awareness challenges repeated sensory experiences of the front, back, top and bottom of their bodies. FAB Strategies light touch and holding techniques were developed to provide sensory experiences of the front, back, top and bottom of the body as a foundation for improved body awareness and social-emotional skills.  In addition to the light touch and holding strategies the awareness of the front, back, top and bottom of the body is practiced through several FAB Strategies deep pressure touch and mindful movement activities.

Vibration to the Back, Arms, & Body provide light touch input.  Vibration can also be applied to various body parts with eyes open and closed, to increase body awareness by having clients identify each body part as it is touched (e.g., arm, left ankle).  Light touch can also be provided through the Rolling the arm strategy.  The therapist rolls the arm in a palm open, thumb lateral direction providing relaxation.

Trager and me Original

The Back X involves drawing an X across the back with your fist, while the Spine crawl involves moving up the spine to give awareness of the back. The Back X and Spine Crawl can be done as part of the X Marks the spot light touch game

XMarkstheSpot

The Head Crown involves 10 second holding on the head, first on both sides then on the front and back of the head.

HoldingHeadTx

Foot input involves massage and holding of the feet to provide improved sensory awareness of the feet as the foundation and bottom of the body.  Foot input can be followed by stretching exercises to help decrease the likelihood of habitual toe walking.  Light touch and holding strategies are a valuable intervention to improve attention, body orientation and social-emotional skills through interpersonal touch.  Light touch and holding can also decrease stress, pain, and provide comfort when more intense massage is contraindicated.

References:

Beider, S., Mahrer, N. E., Gold, J. I. (2007). Pediatric massage therapy: An overview for clinicians. Pediatric Clinics of North America, 54(6), 1025-1041.

Bjornsdotter, M., Loken, L., Olausson, H.., Valbo, A., & Wessberg, J. (2009). Somatotopic organization of gentle touch processing in the posterior insular cortex. The Journal of Neuroscience, 29(29) 9314-9320.

Koester, C. (2012). Movement based learning for children of all abilities. Reno, NV: Movement Based Learning Inc.

McGlone, F., Wessberg, J., & Olausson, H. (2014). Discriminative and affective touch: Sensing and feeling. Neuron, 82(4), 737-755.

Perini, I., & Olausson, H. (2015). Seeking pleasant touch: Neural correlates of behavioral preferences for skin stroking. Frontiers in Behavioral Neuroscience, 9.

0

School Occupational Therapy for Developmental Trauma

School occupational therapists emphasis on therapeutic relationships, mental health, sensory processing, attachment, development, purposeful activity and self-regulation offer a unique contribution for improving the behavior of students with developmental trauma disorder. School behavioral problems related to developmental trauma are seen in students who have experienced early chronic abuse. Many students with developmental trauma difficulties have significant sensory modulation, emotion regulation, attachment, self-regulation, sensorimotor, somatic, and developmental challenges.  Working in conjunction with school psychologists, social workers, and guidance counselors, occupational therapists can help improve the mental health and behavior of students who have developmental trauma challenges http://www.aota.org/-/media/Corporate/Files/AboutOT/Professionals/WhatIsOT/CY/Fact-Sheets/OT%20%20School%20Mental%20Health%20Fact%20Sheet%20for%20web%20posting%20102109.pdf http://www.aota.org/-/media/Corporate/Files/Practice/Children/SchoolMHToolkit/Reducing-Restraint-and-Seclusion.pdf

Occupational therapy for improving the behavior of students with developmental trauma can include energy level modulate, sensory processing, deep pressure touch, and mindfulness strategies. The energy level modulate strategy involves increasing students’ awareness of their arousal level and teaching them to modulate dysfunctional high or low energy levels to better participate in school learning tasks. It can be introduced by explaining that “some students who have had difficult experiences early in their life can get into trouble by overreacting when they have really big feelings”. The energy level modulate strategy teaches students to identify whether their current energy level feels “High” (hyper, off the wall, with stiff muscles like raw spaghetti), “Medium” (just right and ready to learn) or “Low” (tired, numb, with loose muscles like over cooked spaghetti).

Visual chart for rating arousal level and if it feels comfortable

Visual chart for rating arousal level and if it feels comfortable

The energy level modulate strategy is extremely useful in school settings for students with sensory modulation difficulties who become aggressive following activities that raise their energy levels extremely high. While many students can use the energy level modulate strategy with teacher encouragement, some students with sensory modulation difficulties and developmental trauma need assistance. For example, a student receiving occupational therapy attended a wild physical education class where the students ran, screamed and threw balls at each other. His classmates behaved appropriately upon returning to class. However, this student who had significant sensory sensitivity and developmental trauma challenges was unable to sit down upon returning to class and threw a chair.

Following this experience the occupational therapist taught the school physical education teachers and mental health therapists the energy level modulate strategy so students could rate their energy levels before returning to class. The teacher or therapist would bring students who rated their energy level as uncomfortably high to a designated staff member (e.g., occupational therapist, speech therapist, principle, resource room teacher) who would help the student do pushups or other individualized sensory coping strategies to lower their energy level before returning to class.

The most effective strategies for normalizing energy levels involve deep pressure through the joints with slow linear movements. Activities such as regular or wall pushups, moving furniture, moving mats, delivering messages or boxes of books throughout the school, or wheelbarrow walking on your hands over a therapy ball can help achieve this.

Wallpushups

Special consideration can be given in the energy level modulate strategy for students with both sensory modulation and developmental trauma challenges who have become use to maintaining a high energy level that interferes with appropriate attention and behavior for school functioning. This difficulty can be indicated by students who describe their energy level as “Hyper and comfortable” and students who actively resist efforts by their teachers and therapists to calm down to a functional energy level where they can pay attention to classroom activities. For students who resist regulating their energy to a functional level it is helpful for the therapist to begin by matching the student’s initial energy level, then support the student during individual sessions to gradually modulate their energy level.  http://www.traumacenter.org/products/pdf_files/Body_Change_Score_W0001.pdf 

Individual OT sessions using sensory processing, deep pressure touch, and sensory mindfulness strategies help students with self-regulation and developmental trauma challenges improve their attention, seated attention, and behavior for participation in school learning tasks.

ComicCopingMindfulClock1ChairlegsTheraband

These interventions emphasize child-focused activities that optimally challenge students to discover activities that will enable them to modulate dysfunctional arousal levels for improved school functioning. Sensory processing interventions promote attachment relationships combining child-directed activities at their optimal level of challenge with an attitude of PACE (playfulness, acceptance, curiosity and empathy). Offered respectfully with choices to decline, firm pressure touch strategies can enhance attachment, relationships, and self-control in students with behavioral and developmental trauma challenges. Attached is a link showing integrated use of behavioral, sensory processing, PACE, and FAB Pressure Touch strategies. While this treatment was done with a preschooler who had Asperger’s syndrome, a similar approach is often also helpful for students with behavioral and developmental trauma challenges https://www.youtube.com/watch?v=W8fMdJ6l0AM

References

Beider, S., Mahrer, N. E., Gold, J. I. (2007). Pediatric massage therapy: An overview for clinicians. Pediatric Clinics of North America, 54(6), 1025-1041.

Engel-Yeger, B., Palgy-Levin, D., & Lev-Wiesel, R. (2013). The Sensory Profile of People With Post-Traumatic Stress Symptoms. Occupational Therapy in Mental Health, 29(3), 266-278.

Hanson, J. L., Chung, M. K., Avants, B. B., Shirtcliff, E. A., Gee, J. C., Davidson, R. J., & Pollak, S. D. (2010). Early stress is associated with alterations in the orbitofrontal cortex: a tensor-based morphometry investigation of brain structure and behavioral risk. The Journal of neuroscience30(22), 7466-7472.

http://www.jneurosci.org/content/30/22/7466.long

Hughes, D. A. (2011). Attachment-focused family therapy workbook. New York, NY: W. W. Norton & Co.

Warner, E., Koomar, J., Lary, B., & Cook, A. (2013). Can the body change the score? Application of sensory modulation principles in the treatment of traumatized adolescents in residential settings. Journal of Family Violence, 28(7), 729-738.

1

FAB Strategies to Improve Body Scheme

FAB “Functionally Alert Behavior” Strategies promoting body scheme can improve behavior in children and adolescents with sensory processing, developmental, learning, and mental health challenges.  Improving body scheme is particularly important for children and adolescents because it impacts the development of their behavior and learning.  Improving body scheme can also promote self-esteem, organization, and motor planning skills.

Body scheme difficulties can negatively impact behavior and learning skills.  Although body scheme difficulties are commonly described in children and adolescents with trauma histories, inappropriate behavior, and psychiatric disorders limited attention is given to body scheme by mental health therapists.  The sensory integration frame of reference provides body scheme assessment and intervention strategies (see Sensory Discrimination and Praxis Disorders in my previous blog post Making Sense out of Sensory Integration).  Sensory Integration, pressure touch, and basic mindfulness are combined in FAB “Functionally Alert Behavior” Strategies to improve body scheme.

Sensory integration intervention is not a school service, so any use of the sensory integration frame of reference by school occupational, speech, or physical therapists must be directed toward school goals required for the child to benefit from their learning program.  An examples of a school occupational therapy goal for a first grader that includes intervention to improve body scheme is: Given repeated verbal prompts as needed the student will maintain a seated position for ten consecutive minutes on 4 out of 5 occasions (e.g., will not fall or get out of their seat with out permission).  It is important to measure the child’s baseline skills so achievement of school therapy goals shows the child’s improved learning and behavioral functioning.

The following pictures were taken of a group of kindergarten age children with a diagnosis of Pervasive Developmental Disorder who had body scheme and motor planning challenges.  I led the group assisted by the children’s wonderful parents as well as undergraduate occupational therapy students.  Fun activities were included involving child-directed movement combining graded touch (tactile), deep pressure (proprioception), and vestibular (movement) sensory input.

AirMatFun

Strategies for repeated use at home and school are particularly helpful to improve body scheme.  FAB Strategies that promote body scheme include: Touch vibration on the Back and Arms, FAB Pressure Touch, Back X, Spine crawl, Nose breathe, Mindful clock, Bird, Tense & relax, Focus on feet, Body scan, Focus on palms, and Wall pushups. The picture below shows an elementary student using my occupational therapy bulletin board to feel his palms while doing wall pushups.

WallPushup

FAB Strategies intervention including Sensory Integration, Pressure Touch, and Mindfulness activities can improve body scheme for improved behavioral, self-esteem, organizational, and motor planning skills.

References:

Ayres, A. J. (1985).  Developmental dyspraxia and adult-onset apraxia.  Torrance, CA: Sensory Integration International.

Flook, L., Smalley, S., Kitil, M., Galla, B., Kaiser-Greenland, S., Locke, J., Ishijima, E., Kasari, C. (2010).  Effects of mindful awareness practices on executive functions in elementary school children.  Journal of Applied School Psychology, 26, 70-95.

Silva, L. M., Schalock, M. (2013).  Prevalence and significance of abnormal tactile responses in young children with Autism.  North American Journal of Medicine and Science, 6(3), 121-127.