Recreational Therapy: An IntroductionChapter 4: Behavioral Health and Psychiatric Disorders

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Behavioral Health and Psychiatric Disorders: A Large Area of Practice in RT

Behavioral/mental health is the single largest area of practice for recreational therapists, employing 35% of all nationally certified practitioners.

Mental illness defined:

Mental illness “refers collectively to all of the diagnosable mental disorders. Mental disorders are characterized by abnormalities in cognition, emotion or mood, or the highest integrative aspects of behavior, such as social interactions or planning of future activities.”

(U.S. Department of Health and Human Services, 1999)

U.S. manual to classify mental disorders:

Diagnostic and Statistical Manual of Mental Disorders

(5th edition).

(Known as the DSM-5 and published by the American Psychiatric Association, 2013)

International manual to classify mental disorders:

International Statistical Classification of Diseases and Related Health Problems (10th edition).

(Known as the ICD-10 and published by the World Health Organization, 2005)

Schizophrenia

Schizophrenia is marked by psychotic features such as delusions, hallucinations, disorganized thought and speech, and disorganized or abnormal motor behavior.

Delusions

Delusions are beliefs that are relatively fixed and unchanging even in the face of evidence to the contrary that they are incorrect.

These beliefs have themes such as persecution (e.g., the belief that you are being surveyed), reference (e.g., belief that a popular song contains a message specifically for you), grandiosity (e.g., belief that you have special abilities), religious (e.g., belief that you are Jesus), and somatic (e.g., belief that you are missing internal organs).

Hallucinations

Hallucinations are perceptual experiences that occur in the absence of external stimuli. Although hallucinations may exist in any sensory form, auditory hallucinations are the most common.

Mood and Affective Disorders

Major depressive disorder. Major depressive disorder (or major depression) is identified by symptoms such as depressed mood, diminished interest in previously satisfying activities, significant change in weight, sleep disturbance, change in activity level, fatigue, feelings of worthlessness, diminished ability to communicate, recurrent thoughts of death (including thoughts of suicide).

Bipolar disorder. In bipolar disorder a person experiences episodes of depression and/or mania. Mania is a condition in which a person experiences an elevation of energy and activity as well as enhanced mood and feeling of well-being.

Anxiety, stress, and trauma-related disorders

Anxiety and stress-related disorders are characterized by fear and anxiety associated with situations that are not currently dangerous.

Fear is characterized by an emotional response to a real or imagined present threat. Anxiety is associated with real or imagined threat in the future.

Post-traumatic stress disorder (PTSD) is one disorder in this group. Disorders associated with obsessive thoughts and compulsive behaviors are also included within this group of disorders.

Behavioral disorders

Behavioral disorders are principally identified through patterns of behavior that are dysfunctional and may or may not be distressing to the individual such as eating disorders, sleep disorders, and sexual dysfunction.

Among the eating disorders, bulimia nervosa and anorexia nervosa appear with the greatest prevalence.

Personality disorders

Personality disorders are characterized by patterns of experience and behavior that are markedly different from the expectations of one’s culture and situation. In addition, the pattern of behavior is enduring, frequently inflexible, and although they affect a range of domains of behavior they are particularly disruptive to social relationships.

Personality disorders include: antisocial, avoidant, borderline, narcissistic, obsessive-compulsive, and schizotypal (see Table 4.3 for details).

Serious mental illness

The term serious in the case of serious mental illness recognizes that the experience is pervasive, in both duration and impact, and affects multiple areas of functioning.

The majority of persons with serious mental illness have diagnoses of schizophrenia spectrum disorder or bipolar disorder; however, persons with major depression and severe anxiety disorder are sometimes included. All have impairment that affect major life areas such as work, school, interpersonal interactions and relationships, and community, social, and civic life.

Purposes of RT

The purpose of RT within psychiatric rehabilitation should be in concert with other health professionals’ services and the client’s overall plan of care. This may mean that RTs in psychiatric settings focus on reducing symptoms such as mood disturbances or cognitive dysfunction or improving functional abilities such ass developing and maintaining interpersonal relationships or developing stress coping skills.

In addition, although cure is possible in some disorders, in terms of complete remediation of symptoms and return to pre-disorder function approaches with other disorders such as serious mental illnesses are focused on care to reach the highest possible level of function despite the presence of a persistent mental illness.

Examples of empirical evidence supporting practice Physical activity and exercise

Behavioral activation

Social skills training

Commonly sought outcomes: Three domains

Clinical status

Functional status

Subjective well-being

Role of the RT

RTs frequently focus on developing life and coping skills through exercises and activities. RTs may also use games and activities to identify patterns of interpersonal behavior, as well as dysfunctional cognitive models. In addition, the focus on developing healthy lifestyle patterns is increasing, particularly among persons with serious illnesses.