The Power of Activity in Rehabilitation Victoria Schindler

The Power of Activity in Rehabilitation Victoria Schindler, Ph. D, OTR, BCMH, FAOTA Richard Stockton College of NJ New Jersey Occupational Therapy Association Annual Conference October 1, 2011

Choose an activity to do for 15 minutes. It should be one that is rewarding, relaxing and/or would elevate your mood. • • • Crossword Puzzle Read a Newsletter Drawing Listen to Music Go for a Walk Talk with a Friend Meditate Take a Nap Any other Activity of your Choice

Take a Handout Use the Handout to Select the words that describe the way you are thinking and feeling right NOW

Take a Handout Select the words that describe the way you were thinking and feeling during the activity

Handout Compare the two lists and note your findings

Power of Activity in Rehabilitation - Agenda • Neurological Underpinnings of Engagement in Positive Activity • Psychological Aspects of Activity • FLOW • Neuroplasticity of the Brain • How to Develop Meaningful Activity • Resistance to Treatment with Activity

Neurological Underpinnings of Engagement in Positive Activity • Imaging scans (e. g. , PET Scans, MRI and EEGs). • Activities as REWARDING • Activities promoting RELAXATION • Activities that ELEVATE MOOD

The Brain’s Reward Center • Mesocorticolimbic system – Cortex, Midbrain, Limbic system • Distinguishes activities that are pleasurable and should be repeated from those which are harmful and should be avoided

Neurological Basis of Activity • Primary Neurotransmitters in the Brain’s reward system – – Dopamine Glutamate • The brain’s reward system is activated and dopamine and glutamate are increased during times we are engaged in positive activity

Activities activating the brain’s reward system • • • Music Eating Sex Engaging in positive conversation Fine arts – Drawing, Painting, Sculpting • Sports – Stimulate reticular receptors – Stimulate vestibular receptors • Humor

– Physiological Responses • Blood pressure, heart rate, respiration – Increased Immune System Responses – Neurological Responses • Alpha, theta and delta wave patterns

Neurological Basis - Relaxation • Characteristics of Activity that Promote the Relaxation Response – Herbert Benson – Performed in quiet environment – Enhances one’s ability to concentrate and focus inwardly on the task at hand – Enhances one’s ability to disregard everyday thoughts and worries – Requires focused attention on a repetitive mental stimulus

– Progressive relaxation – Visualization – Guided imagery – Crafts – Yoga – Meditation – Art – Music

• “the awareness that emerges by paying attention on purpose, in the present moment, and non-judgmentally, to the unfolding of experience, moment-bymoment…with an affectionate, compassionate quality within the attending, a sense of openhearted, friendly presence” – http//www. psych. stanford. edu/pgoldin/Buddhism/MBSR 2003_Kabat-Zinn. pdf

MINDFULNESS • Mindfulness Training – Meditation – Become aware of one’s thoughts • Negative, judgmental, self-destructive thoughts • Catch these thoughts • Challenge their validity • Release them

Elevate Mood • Neural activity in the left hemisphere has been linked to positive mood, feelings of well-being and emotional stability • PET Scans and MRIs have shown that people with depression have a marked decrease of activity and blood flow in the left hemisphere

Elevate Mood • Activities that promote blood flow and neural activity in the left hemisphere have been shown to alleviate feelings of depression

Neurological Response – Elevate Mood • The left hemisphere is responsible for language skills, math skills, categorization skills, and sequencing skills – Example of activities • Word finding puzzles, crossword puzzles • Jewelry making, cooking, crafts • Cognitive Behavioral Frame of Reference

“An optimal experience in which people feel intense pleasure and satisfaction while deeply engaged in desired activity” -Csikszentmihalyi

FLOW • A term that describes the positive feeling we have when we are absorbed in a pleasurable activity • Totally immersed in the present moment • Lose sense of time • Lose sense of fear or anxiety; worries fade • Participating in the activity is its own reward Csikszentmihalyi, M. (1997)

Research on FLOW • Experience Sampling Method – Signal participants at random times – Doing, thinking, alone, or with others – Rate on various numeric scales • Happiness • Concentration • Motivation • Self-esteem – Can follow changes in mood (1997) Csikszentmihalyi, M.

Experiences with FLOW • Female Dx’d with Chronic SCZ; hospitalized for over 10 years • Individuals diagnosed with Depression • Quality of Life • Increasing Flow

Activities that promote FLOW • Sports and exercise • Crafts - Knitting and • • • needlepoint Gardening Hiking Cooking Play a musical instrument Socializing Active Leisure as opposed to Passive Leisure Csikszentmihalyi, M. (1997)

Developing Flow • Develop curiosity and interest – In routine tasks – In new tasks and activities • Reevaluate our present tasks and routines – Are they really necessary? – Control time carefully • Control psychic energy – Control concentration – Control our thoughts

Neuroplasticity • The brain’s ability to change – for better or worse – throughout the life span • Process involves forming neuronal connections in response to information derived from experiences in the environment, sensory stimulation, and normal development. Dodge, 2007; Mc. Cormack, 2009; Merzenich, 2001; Nudo, 2008

Neuroplasticity • The brain’s ability to grow and change into old age as long as it is engaged in meaningful occupations. Christiansen and Baum, 2005; Mc. Cormack, 2009.

What are the characteristics of activity that make it meaningful? • Neurological – – – Promote Reward Promote Relaxation Elevate Mood • Psychological – FLOW

How to Develop Meaningful Activity • Requires both physical and mental involvement • Defined according to each individual; cannot be • • • defined by one individual for another individual Elicits choice Facilitates development Must have meaning for the client Must be related to the client’s goals Must be of interest to the client

How do we Develop FLOW in Activities? • Include the client in the • • selection of activities Help them to identify activities they enjoy Teach our clients to become absorbed in activity Teach our clients to control their concentration thereby decreasing distracting thoughts Use the flow experience to manage anxiety, anger, and depression

Resistance to Engagement in Activity • Create an environment in which choices can be made • Choices range from small to large concerns • Client will reject invitations to choose • Staff must not despair and stop caring • Staff should model hope and continue to offer options • Provide opportunity to fail and to try again

Select the words that describe the way you were thinking and feeling during the activity • What about the activity led to your thoughts and feelings during the activity? • What about this is universal? • What about this is unique to you?

Select the words that describe the way you are thinking and feeling right NOW • What were the components of the activity that produced this “after” effect • How does this relate to the psychological and neurological effects of activity on the brain?

SUMMARY • How can you use this information to influence the way you create and/or choose activities in your practice?

Thank You very much for your attention!

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