Weaving Wellness into
Your Therapeutic
Practice
Kelly Phillips-Henry, Psy.D
AspenPointe Health Services
Teaching our Clients to
Understand the Links
Mind and body can not be separated
Stress impacts all aspects of our lives – especially physical
Stress is a causal factor in at least 60% of all medical illnesses
Stress reduces the immune’s system ability to function and fight off illness
If mind-body links are clear, why don’t most people practice good wellness care?
Thirty Days to a Habit
Start with building knowledge
Begin skill building in client expressed areas
Exposure to new experiences in moderate amounts with positive experiences builds desire
Set weekly targets and build off positive experiences
Next Steps in Session
Identify areas of balance/imbalance early in assessment
Set wellness/balance goals in treatment plan
Make appropriate referrals to support goals
Check in each session on these goals to emphasize importance of goals
Celebrate small successes!
Meditation/Tai Chi/Yoga*EMDR*Cognitive Behavioral Therapy *Dialectical
Behavior Therapy*Mindfulness Based Stress Reduction*The Relaxation
Response*Exercise*Laughter*Biofeedback *Tai
Chi*hypnosis*EMDR*Massage*Exercise* Autogenic Training* Exercise*
Art Therapy*Music Therapy*Guided Visualization*
Nutrition*Yoga*Progressive Relaxation* Journaling* Imagery *Pain
Management
A HEALTHY MIND IN A HEALTHY
BODYMichele Willingham
Community Reach Center
Mind/Body practices increase the mind’s capacity to
affect health and bodily function. Research shows they
decrease mental health symptoms and chronic diseases.
A Healthy Lifestyle will improve health and quality of life.
A study, conducted by the National Association of State Mental Health Program Directors and the Medical Directors Council noted that suicide and injuries
cause up to 40 percent of excess deaths among the mentally ill, while,
60 percent of premature deaths of people with schizophrenia “are due to medical conditions such as cardiovascular, pulmonary and infectious disease.”
People with mental illness also face additional risk factors of obesity and tobacco usage that could be modified or eliminated, the study said.
The problem is that people with serious mental illness tend to be low on the socioeconomic totem pole and often don't get the best available health care. Frequently, their own doctors pay little heed to their patients' physical health. "Medical doctors think, 'Well, they're crazy,' so they don't take their concerns seriously," says Wendy Brennan, executive director of the National Alliance on Mental Illness (NAMI) in New York City. "Their very real physical symptoms are often dismissed."
Read more: http://www.time.com/time/health/article/0,8599,1863220,00.html#ixzz109KNS7D3
CHRONIC STRESS
Stress is closely associated with hypertension, heart
disease, stroke, arthritis, gastro-intestinal disorders, and other
health problems. According to The American Academy of
Family Physicians, two-thirds of office visits to family doctors
are for stress related symptoms.
Chronic Stress can cause anger or rage, fear or
terror, fragmented and distorted thinking, emotional
liability, memory loss, anxiety, and depression.
STRESS MANAGEMENT IS A VITAL WELLNESS SKILL That
can HELP the MENTALLY ILL overcome these acute and
chronic stress issues.
How Stress Management HELPS
Mind-Body interventions promote healing
Effect positive changes in brain activity
Improve emotional processing
Enhance immune functioning
EVEN BETTER….
Improved rate of recovering from many diseases
Improved circulation and stamina
Management of chronic pain
AND most of all…..
Reduce anxiety, fear and depression
greater mental clarity and peace of mind
experience of INSIGHTS relating to
one’s social, psychological,
and PHYSICAL WELLBEING.
READY TO GET STARTED?
SCALING STRESS
Wellness Interactive Interventions with Scaling
HOW IS YOUR STRESS?
HOW IMPORTANT IS IT TO YOU TO REDUCE STRESS?
WHAT ARE YOU DOING TO REDUCE STRESS?
HOW CONFIDENT ARE YOU IN YOUR ABILITY?
Add it to the Treatment Plan
George will use 3-6 Stress Management/ Wellness
skills daily.
Walking for 10-20 minutes,
Eating fruits/veggies/whole grains,
Tai Chi Breathing,
Laugher and Joy in life every day in every way
Targeting smoking to promote
wellness
Recent research on health disparities
found the average life expectancy of
someone with a significant mental illness
to be as much as 25 years shorter.
Americans with mental illness are nicotine
dependent at rates two to three times
higher than the general population.
1. Create a smoke free
environment
Use “Positively No Smoking” campaigns in
your organization
Is smoking allowed in your residential unit?
Do employees have support and incentives to
stop smoking?
Are there visible signs and messages that no
smoking is allowed, and about the supports
that are available to consumers?
2. Be aware of myths and work to
overcome them.
“Smoking is the least of my client’s
problems.”
“My client needs to overcome other
addictions first.”
“This is not a good time to work on
smoking.”
From a client, “I was told that smoking
would help me with my illness.”
3. Know the Stages of Change
Prochaska & DiClementePre-contemplation
Contemplation
Preparation
Action
Maintenance
Relapse
4. Bring it up, often
Make sure clients are getting consistent messages from case managers, therapists, medical staff. Even administrative staff have a role in enforcing “PNS” and referring to resources.
Ask every consumer at every visit.
Use non-judgmental and open ended questioning, match to client’s stage of change. What concerns do you have about smoking?
Have you ever tried to quit?
Have you ever thought about cutting down?
What are other changes you have made that were difficult?
How do you think your smoking will impact your health in the next 5 to 10 years?
If you decided to quit, how confident are you that you would be successful?
What are some advantages of not smoking?
5. Connect to a range of resources
Colorado quit line: 1.800.Quit.Now
Coaching, groups, or kits offered through
local health department.
“The Easy Way to Stop Smoking” by Allen
Carr.
6. Offer nicotine replacement
therapies, target short term use
Buproprion
Nicotine gum
Nicotine lozenge
Nicotine inhaler
Nicotine patch
7. Use interventions that work
Motivational Interviewing: Elicit change talk, work with ambivalence within stage of change model, increase self-efficacy, develop discrepancies between smoking behavior and values.
Behavioral interventions: Make list of activities that smoking is not associated with.
Distress Tolerance: Increasing ability to tolerate negative emotions (DBT “crisis survival strategies”)
Social Support
8. Incorporate into existing groups
and programs
Acute Treatment Unit
Group therapy
Empowerment Center and Peer Support
Activities
Medication check ups
Coordinate care with client’s PCP
9. Identify and build skills to
improve coping
Assertiveness
Stress management and Relaxation
https://members.kaiserpermanente.org/redirects/listen/
Mindfulness
Exercise
Assist Clients in developing a WRAP (wellness, recovery action plan).
10. Celebrate and reinforce moves
toward change
Provide encouragement when clients acknowledge they want to quit
Reflect sense of confidence in clients’ ability to succeed when they set a quit date.
Celebrate quit anniversaries in groups.
Acknowledge clients who stay quit through difficult times.
Congratulate employees who have quit.
Objectives
Assessing pain levels
Understanding how to apply Gate Control
Theory
Tool kit for working with chronic pain
Assessing Chronic Pain
Rating for understanding
Creating common language
Providing yardstick for
improvement
George
Chronic Low Back Pain
Contributing factors:
Weight gain secondary to
meds
Increase sedentary lifestyle
Repeated injury – poor body
mechanics
Smoker
Poor nutrition
George’s Ratings
Pain Ratings 0 – 10 scale
Average: 5
Highest: 12
Lowest: 3
Describes Pain
Stabbing
Burning
Sharp
Behavioral Strategies
Relaxation Strategies
Diaphragmatic breathing
Body Scanning
Relaxation Response
Autogenics
Physical Exercise
Pacing
Modify Your Environment
Modify Activities
Cognitive Strategies
Acceptance
Skillful versus Unskillful responses
Watching our thoughts
Awareness of our stories
Choice based on values not pain
Emotional Strategies
Stress Management
Treating Depression and Anxiety
Dealing with Anger
Serenity Prayer