OCD Support and Recovery Group

Here is the poster for the OCD Support and Recovery Group

The group is run alternate mondays 6:30-8:30pm at the Mental Health Independent Support Team (MhIST) in Bolton!

 

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Creative Writing as a Therapeutic Intervention: A Reflection on a Training Course

I attended a training course at the University of Huddersfield yesterday, actually called “Yoga for Creativity”. As much as the course was demonstrating how yoga techniques can enhance well-being, the facilitator asked us to explore how to use creative and meditative writing as a means of therapeutic intervention. The basis of this reflection is how creative and meditative writing can be applied in  mental health settings as a therapeutic intervention, and a further reflection will be written exploring Yoga as a therapeutic intervention.

The first exercise which the facilitator asked the group to engage in really excited me as I started to think that this is an intervention that could be utilised within my practice. The activity was taken from Goldberg (1986) where writing is used as a ‘timed exercise’. The facilitator asked us to:

  1. Write continuously for 10 minutes 
  2. To keep our hands moving with no pauses in writing
  3. No crossing out
  4. Forget the rules of spelling, punctuation and grammar
  5. Lose control, don’t think and forget logic
  6. Go for the jugular (don’t be afraid to dive right into writing that exposes our feelings or makes us feel naked)

After the allocated 10 minutes we could read what we had written and discuss with our neighbours the content (if we so wished). Surprisingly, the activity didn’t end there and the facilitator asked us to highlight up to 8 sentences in our creative writings. These sentences had to ‘jump out’ at us or offer meaning. After choosing our 8 sentences, we were asked to then make a poem out of the sentences in any order. This was brilliant. I began to think about how I could potentially use this as a therapeutic intervention related to mental health, and namely within my OCD Support and Recovery group.

As I was carrying out the exercise, I felt a sense of exposure, but this wasn’t anxiety provoking. It led to more of a curiosity as to what would come out from my 10 minutes writing without pausing. I guess it’s a lot like Freud’s  ‘free association’ but with a little bit of a twist. I like that idea a lot!

I think that if this intervention was used within my group, it has the potential to get a lot of ‘thoughts’ out on paper. For some this could be more anxiety provoking than others, dependent on the nature of OCD and the content of intrusive thoughts and obsessions. This is something that will have to be further explored through talking this activity through with members of the group to hear their perspectives and possible anxieties.

Possible Intervention

Follow the guidelines for intervention above but:

  1. Ask group members to write for 10 minutes continuously on the theme of OCD
  2. Highlight up to 15 positive words or sentences
  3. Adapt those 15 words into a creative poem related to their OCD.

Action Plan

  • I intend to research the evidence base for creative writing as a therapeutic intervention further. I have bought a book titled “Writing Well: Creative Writing and Mental Health” by Deborah Philips, Liz Linington and Debra Penman and also have a couple of chapters photocopied from “Ordinary Magic: Everyday Life as Spiritual Path” by John Wellwood from the training course attended. This will be read and studied further.
  • Speak to group members about their perspectives on using creative writing as a therapeutic activity to inform part  of their Recovery Action Plan.
  • Conduct the adapted activity on myself and see if it works.
  • Reflect further once I have used this activity on myself, and within a therapeutic environment.

References

Goldberg, N. (1986) Writing Down the Bones. Boston: Shambhala

Philips, D. Linington, L. and Penman, D. (1999) Writing Well: Creative Writing and Mental Health. London: Jessica Kingsley Publishers

Wellwood, J. (1992) Ordinary Magic: Everyday Life as Spiritual Path. London: Shambhala

Meditation and Breathing Exercises: A Quick Reflection

I have been attending a Mindfulness Meditation group for the last 8 weeks and during my time as an attendee I have experienced a variety of mediations, breathing exercises, learned some Mudra’s and listened to some interesting excepts from books such as ‘The Power of Now’ by Eckhart Tolle.

Prior to attending this group I had little experience of meditation and breathing exercises. I had used ‘Progressive Relaxation’ with clients who experienced anxiety disorders, but this was the length and breadth of my knowledge of breathing exercises and anxiety management. Today though, I was introduced to a very interesting breathing exercise by a very experienced Yoga and breathing exercises teacher. The exercise encourages you to exercise your entire lungs, and in rather an interesting way by directing your thumbs in different directions (I will write a further blog with pictures to illustrate this with instructions on how to use it). After completing this exercise I was left with a sense of contentment, energised and totally relaxed.

I feel that this particular exercise is easy to do, learn and easy to apply to practice. It has broadened my range of skills in anxiety management, and leaves me with a stronger sense of confidence in applying breathing exercises for my OCD Support and Recovery group.

I believe that this breathing exercise benefits the client by promoting a sense of wellbeing, but it also exercises the entire lungs and aids in increasing lung capacity. This not only would be a useful intervention to utilise in mental health but also possibly in pulmonary rehabilitation with clients with respiratory disorders such as COPD or asthma. Infact, one group member commented how 60 years ago, as a child she had asthma and recalled a similar intervention in hospital to help manage her asthma before inhalers became the norm.

Action Plan

  • I am going to do a write up about this interesting breathing exercise, and will include pictures to show how to position your thumbs.
  • Use this breathing exercise with my clients who may experience anxiety to work on increasing their wellbeing and providing them with an interesting tool to manage their own anxieties to enable optimal occupational participation.
  • Investigate further breathing techniques to broaden my range of skills for anxiety management and document these on my blog.
  • Make enquiries about local Yoga classes to attend to learn techniques to promote my own personal wellbeing and to integrate into my own practice with clients too.

Occupational Therapy Explained!

I think we can all agree that defining occupational therapy is no easy task, and I’m sure we can all understand the almost gasp at the sound of the dreaded question of “What exactly is occupational therapy”. I know I have been there, many a time, and it always fills me with anxiety because it can be so difficult to explain. To be frank, it’s not an easy concept to explain, and even as a student occupational therapist, it took me a long while to really understand the role. It doesn’t help with the differences being so extreme from the physical settings to mental health to learning disabilities to vocational rehabilitation (to mention a few) that it can get confusing not only for health care professionals, but the wider public.

I started to think about how difficult explaining occupational therapy can actually be, what with the scope of practice, range of work settings and very common misconceptions (such as occupational health and vocational style therapy) which makes it not only inaccessible to other health care professionals, but also for newcomers to the profession, students, and most importantly, our clients, their carers and the wider public. So, whilst searching through some literature I happened to stumbled across a couple of interesting articles from two Nursing journals. Both articles explain in simple, and plain language just what occupational therapy is. They’re fantastic!

So here they are attached at the bottom of this blog post, I hope you find them useful (whoever you are reading this piece)!

Understanding the Role of OT 2009

OT Explained

Action Plan for me…

I aim to use these articles as handouts for my clients, and for anyone who wants to understand the role of occupational therapy a little more.

Reflection: Personality Disorders

Following a discussion with a dear friend of mine who has a diagnosis of Borderline Personality Disorder (BPD), I realised that my knowledge base regarding Personality Disorder (PD) was not as up to scratch as I thought it should be. I discussed the topic of BPD but felt that as an occupational therapist who works with people with mental health problems, I should understand this more so that I am equipped with the skills to work with this client group and understand the difficulties they experience and how it affects their occupational performance in their every day lives.

I have had previous discussions with other mental health professionals regarding PD but have never really gone away to think about my lack of knowledge, but this I feel is not acceptable as a health care professional. That said, I feel now is the time where I should understand this client group more so, so that I can offer a service that caters not only for people purely with Obsessive Compulsive Disorder (OCD), as I understand that many people who live with OCD will also experience a PD too.

I will now research PD in general and write a piece dedicated to my updated knowledge of this client group. The aim of this reflection is to increase my scope of practice and to offer a service that is truly client centred, professional and inclusive of all who experience mental health problems.

Action Plan

  • Research the spectrum of PDs provide an evidence based blog post, relating it to how PD can affect occupational performance.
  • Apply this knowledge to practice.

Reflection on Discussion: Child and Adolescent OCD

Reflection

Today I had an interesting conversation with a fellow OT on twitter, I was asked for advice on what best practice would be on working with children and young teens with OCD, this has got me thinking of how occupational therapists can assist in the assessment, treatment and management of OCD in children and young people.

I think this is an area of practice that needs to be explored, and with OCD being cited as the 10th most disabling condition outlined by the World Health Organisation, this is a huge area of practice that has been very unexplored, especially within child and adolescent mental health.

Where to go from here? 

I think it is my duty now to research how occupational therapists can offer assessment, treatment and offer support to children and young people who experience OCD. I will look for articles to inform my practice and pass these on to relevant occupational therapists who would benefit from this information.

Action Plan

  • Research the evidence base
  • Liaise with other mental health professionals
  • Document my findings in another blog post and make this accessible to other occupational therapists

Part 1 of Occupational Therapy and OCD: Positive and Negative Occupations

Introduction

Law et al (1998) assert that occupational therapists believe that a direct link between occupation, health and well-being exists. However, little if anything is proposed to the role of occupation as a root cause for ill-health, distress or be the harbinger of occupational disruption and occupational dysfunction to the lives of  those who live and suffer from obsessive compulsive disorder (OCD). The current view seems to be  that any occupation that deviates from the ‘occupational norm’ is dysfunctional and hold no worth to occupational beings. This piece aims to challenge this notion.

I wish to pursue a discussion for the possibility of what may be perceived as ‘meaningful and purposeful activity’ leading to harm, injury or distress. For the purpose of this discussion I am going to analyse the common compulsion of hand washing related to ‘contamination OCD’ and discuss the potential for endangerment to health, well-being and occupational lives.

As this piece is directed mainly at occupational therapists, said ‘sufferers’ will be termed as ‘occupational beings’. That said, I welcome all to read my work related to OCD in order to raise awareness, understanding and the promotion of occupational therapy as a possible therapy often left unexplored and very misunderstood.

What is OCD?

We may in our own personal lives ignorantly use such phrases such as “I don’t like mess…yes ‘I’m a little bit OCD’ about things like that…”! This is easily done as the true nature of what is OCD is, and the wider symptomatology and behaviours are widely misunderstood. OCD is poorly portrayed by the media, with particular attention placed on cleaning, creating an image of the ‘clean freaks’ disorder or one of those eccentricities often aspired to be had by those who simply fancy a title for a fashion statement or fleeting accessory.

For the purpose of this discussion I will outline a broad description of OCD, but progress only onto the description of contamination OCD as the compulsions for this specific form of OCD will be outlined and analysed in an occupational context.

Smith et al (2012) outline that “Obsessive-compulsive disorder (OCD )is a debilitating disorder characterized by recurring distressing thoughts or images (obsessions), and behaviors intended to reduce distress,including repetitive overt or mental rituals (compulsions; American Psychiatric Association (APA), 2000) and avoidance. The relationship between obsessions and compulsions is such that obsessions evoke anxiety (or another state  of negative affect), and compulsions are enacted to ameliorate the aversive feeling.” (p. 54).

Now for contamination OCD, there are generally two elemental parts commonly referred to as ‘contamination obsessions’ and ‘decontamination compulsions’. There is a popular view that contamination OCD is isolated to fears of germs, dirt and viruses but this is quite a narrow view, for a far broader list of ‘contaminants’ are commonly associated.

Bodily excretions (urine, faeces, mucus, sweat, saliva etc…), blood, semen, rubbish, household chemicals, radioactivity, broken glass, sticky substances, people who appear unwell, dirty, or unclean looking, spoiled food, soap , lead, asbestos, pets, birds, dead animals, newspaper print. 

It is common for those who live with contamination OCD to hold irrational beliefs related their obsessions, such as how small amounts of a contaminant, for example a drop of blood, can ‘contaminate’ a large area, such as the entire person, a house, a car or even everything owned and come into contact with by the individual.  There are other forms of ‘contamination obsessions’, known to be ‘magical’ or those that one fears of contaminating others through a variety of methods or mediums. These can include:

Intrusive thoughts, intrusive mental images, colours, words, notions of bad luck, names of illness/disabilities/deceased, or of those who are ill or are disabled, overweight or unattractive.

An example of potentially contaminating others and fearing of causing harm to another is if one intrusively imagines poisonous substances on their hands and fears everything they touch will cause harm to others or believes that harm would come to those in close proximity to them if certain words, such as ‘death’ or ‘die’ are intrusively thought.

Common decontamination compulsions:

Excessive hand washing, disinfecting and sterilisation, changing of clothes, throwing things away, avoidance of touching certain objects, people or going to particular places and creating ‘clean areas’ where no-one is permitted to go.

(Adapted from the International OCD Foundation). 

Positive Vs Negative

As occupational therapists, we are committed to promoting the independence of others and where dysfunction occurs we problem solve how to enable occupational participation. We are taught that occupations are activities that have meaning and purpose to us as ‘occupational beings’ who engage in a range of dynamic environments, and as explained in the opening paragraph, we believe that these occupations shape our health and well-being (Law et al, 1998).

The following paragraphs will analyse whether what we are taught as occupational therapists offer the fullest perspective of what occupation truly is or if there is a spectrum to consider in the complexity of occupation.

Occupation is commonly researched as something that we engage in that is positive, productive and enabling (Townsend, 1997) however, Twinley and Addidle (2012) argue that not all occupations promote health nor well-being, using violence and anti-social behaviour as their examples. This leads me to question the nature of occupation and what can be classed as a positive or negative occupations? Are occupations simply socially acceptable activities or is there a darker dimension unexplored? In this blog I use OCD to propose how meaningful and purposeful activities can both be positive and negative occupations, related to compulsions.

Hand Washing as an Occupation

Hand washing is what occupational therapists refer to as a self-care occupation and is an essential activity of daily living to avoid the spreading of pathogens to ourselves and others. We learn the importance of having clean hands as children and it inevitably integrates in our daily habituations for the rest of our lives. For some though, hand washing can become a much more important and ritualised occupation than to most and is often the most commonly looked for behaviour to identify signs of OCD.

The ritualistic ‘hand washer’ may spend hours washing their hands. This becomes a dysfunctional method of controlling anxieties, through washing away intrusive thoughts or images, but offers a sense of relief until the next time one may feel contaminated. To the person living with the torture of OCD, hand washing may be perceived as a behaviour with meaning and purpose, as it reducing anxiety and aids in their ability to function temporarily in their occupational lives. But for healthcare professionals, and wider society, this is viewed as dysfunctional behaviour perpetuating the pattern and cyclical continuation of OCD. My analysis of this compulsion leads me to argue that for the person living with OCD, this can be classed as a ‘negative occupation’, that has meaning and purpose.

Excessive Hand Washing and its Effects to Health

Excessive hand washing in OCD can lead to numerous health complaints, some more obvious than others. The most commonly understood effect of over washing is a loss of essential oils in the skin leading to damage to the dermis and dermatitis. Blistering, redness, bumps and peeling skin are common when excessively scrubbing in attempt to rid the hands of perceived contaminants. In more severe cases of OCD, chemicals may be used as a radical means of decontamination, such as the use of bleach. As a result, chemical burns, soreness and ultimately limited range of movement in the hands may be experienced.

Less thought of is the mental effects that hand washing as a compulsion can have on the individual. The compulsion can take over the individuals life to such an extent that participation in any other activities of daily living can be almost impossible due to fears of contamination and a preoccupation of finding sinks to wash in, or avoiding anywhere where washing may be impossible.

Heyman et al (2006) suggest that a greater awareness of the symptoms, presentation and various manifestations of OCD is crucial amongst healthcare and non-healthcare settings and that clinicians need to more confident in recognising the spectrum of signs and symptoms. Therefore, occupational therapists should be more aware of this disorder and consider it an area in which occupational therapy skills can be utilised.

In part 2 of this blog I will propose the potential role of occupational therapy for mild to severe OCD and discuss the possible therapeutic interventions to utilise in the treatment of this disorder.

References

Heyman, I., Mataix-Cols, D. and Fineberg, N. A. (2006) “Obsessive Compulsive Disorder”. British Medical Journal. 333, pp. 424-429.

Law, M., Steinwender, S. and Leclair, L. (1998) “Occupation, Health and Wellbeing”. Canadian Journal of Occupational Therapy. 65 (2), pp. 81-91

Smith, A. H., Wetterneck, C. T., Hart, J. M., Short, M. B., and Bjorgvinsson, T. (2012) “Differences in Obsessional Beliefs and Emotion Appraisal in Obsessive Compulsive Symptom Presentation”. Journal of Obsessive Compulsive and Related Disorders. 1, pp. 54-61

Townsend, E. (1997) “Occupation: Potential for Personal and Social Transformation”. Journal of Occupational Science. 4 (1), pp. 18-26

Twinley, R. and Addidle, G. (2012) “Considering Violence: the Dark Side of Occupation”. British Journal of Occupational Therapy. 75 (4), pp. 202-204

Student Occupational Therapist Role Emerging Experiences: Where are they?

Role emerging practice placements are still in their genisis in the UK, however many of the UK and international Universities are offering these fieldwork placements to their students. Practice placement educators are consistently complaining of the demands in clinical practice and the number of placements provided for students are at crisis level. Role emerging placements can both offer a chance for the development and promotion of occupational therapy in non tradtional practice, and contribute to the prevention of placement crisis.

After researching the evidence base in search of the subjective, lived experiences of students who have undertaken these fieldwork placements, to my disappointment, few studies have been reported. Role emerging practice and the development of occupational therapy is an area of personal interest to me and of vital importance to the profession as a whole. Many research articles are asking occupational therapists to “step outside the box” and seek new areas of practice, and to actively encourage and excite students about occupational therapy and the prospect of role emerging practice. My question is why are Universities failing to report the lived experiences of students in these settings? These are of profound importance as they are an invaluable source of knowledge for role establishment and could offer encouragement to other students, and professionals!