Balancing Mind and Body

By talkingdementia on August 1, 2024

My name is Gail Hogg, and I am a Band 6 Mental Health Occupational Therapist, working in Fife Health and Social Care, I work with Older Adults Mental Health service, Young Onset and Mild Cognitive Impairment and have done this for the last 25 years. In conjunction with my colleagues Lead Occupational Therapist Jacqueline Chung, Assistant Practitioner Carol Prattis and Health Care Support Worker Liz Davidovic, we got together to look at how we could improve and maintain the aforementioned population to improve or maintain their own mental health and well being.

We wanted to be able to provide people with appropriate tools and strategies, to enable their self management of their current diagnosis or conditions. We endeavoured to include some of the national work that we had been involved in through, Connecting People Connecting Support and work of Home based Memory Rehabilitation, Journeying Through Dementia and Brain Health, because of the positive outcomes we had experienced, when using these interventions as well as the successes we have in using them. We came up with the idea of a group, we called 'Balancing Mind and Body'!

Balancing Mind and Body is a group we created to provide an opportunity for individuals, to build an awareness and approach towards connecting what goes on in the mind and how it can impact the body; and vice versa. This group was established within the Older Adults Occupational Therapy Mental Health Service, in West Fife. As older people often present with psychological difficulties for a number of reasons, including as a result of disability, feelings of loss (possibly in roles), routines, social isolation and signs of early stage mild cognitive impairment, (MCI). "The overall conclusion about psychotherapy with older people is that there is good evidence that psychotherapy is effective for depression and anxiety" (Scottish Government 2015). This can also be the case for people with a MCI (Brain Health), which supports the use of interventions such as Cognitive Behaviour Therapy (CBT) and Behavioural Activation as appropriate mediums in changing individual lifestyles to prevent development or progression of cognitive decline. The documents also note that "psychotherapy can also be offered as a low intensity intervention such as self-help" which is the approach offered within the Balancing Mind and Body Group.

The group aims are to introduce individuals to the basic principles of CBT, relaxation and mindfulness. The group also focuses on activities on the basis of Sangy Guptas (2022) Five

Pillars Model of Move, Discover, Relax, Nourish and Connect; looking at exercise, involvement in new hobbies/activities, relaxation and tai chi, to unwind, healthy eating and socialisation, as well as taking part in creative activities should the person feel that this medium is best in supporting them with relaxation and minimising symptoms of anxiety/ depression/ MCI symptoms.

Therapeutic Group work

Group work has long been used as an intervention medium within psychiatry; in 1985 Yalom identified group work as an effective treatment method in psychiatry and Sten and Tallant (1988) further discussed the positive benefits achieved by creating inner relationships and personal interactions, Therefore it was felt there was much to be gained by introducing techniques that would support people within a group setting, being careful to ensure the group is adapted to meet the level of the participant's needs as further reinforced by the work of Finlay (1996) who states:

"grade the demands of an activity and the amount of stimulation or pressure within the environment."

The impact of peer support within a group setting should not be underestimated, and during previous work within the occupational therapy service this factor is often noted as a positive and supportive element of the delivery of any intervention. The feeling of not being alone and being amongst others that understand your journey and therefore can share their own experiences and knowledge can be a great support.

Feedback from group participants included statements such as: -

"I benefit from sharing thoughts with others"

"When the group is together, I feel I benefit from the closeness and peer support"

"I felt tense when I started the group, but as session progressed I felt more relaxed and good about myself"

"It helped me concentrate well and I look forward to coming each week"

"Being taught a technique on how to relax and speak about inner fears, has really helped me"

"I particularly enjoyed the session on Brain Health, as it made us aware of the importance of a healthy diet in maintaining a healthy brain and body".

Session Content

A literature search carried out on the effectiveness of relaxation as a treatment medium for depression and anxiety yielded minimal evidence that supports the effectiveness of relaxation as a therapeutic intervention. However, a Cochrane Collaboration Review concluded that compared to no or minimal treatment, relaxation techniques were found to be effective at reducing self-rated depressive symptoms (Jorm AF, Morgan AJ and Hetrick SE 2009). The BBC Health website states that "relaxation is one of the most effective self-help activities for mental health" (BBC Health 2012) and provides the public with advice and guidance on how to make relaxation an effective part of your everyday life, whilst recognising that relaxation is a skill that requires practice, the group aims to further promote this for the participants, motivating them to participate in relaxation out with the group.

As noted, Cognitive Behaviour Therapy (CBT) has a strong record as a treatment for common mental health problems in older adults; for example, depression in later life (Laidlaw, 2010 and Laidlaw, 2003, p21). This approach with older people is now recognised as effective for the treatment of depression and anxiety (Scottish Government 2015). It is effective, skill based and straightforward to use, aiming to empower the individual in dealing with challenges. These qualities can make CBT an attractive prospect for therapy for older people, who can hold strong beliefs about problem-solving and their own independence. Within the Balancing Mind and Body group, basic principles of CBT are introduced at a low level, including introducing participants to the Five Areas Model which aims to offer an approach that delivers the CBT model in an accessible and practical way that people engage with (Wright et al 2002). Information provided is supplemented by the use of activities and exercises such as The Poisoned Parrot (Adapted from "The Malevolent Parrot" by Kristina Ivings) with the use of written handouts which individuals can take with them.

Further research into service users' views of Occupational Therapy interventions in acute mental health services found that group interventions which are meaningful, relevant and with an occupational focus are the most beneficial (Lim, KH, Morris, J and Craik, C 2007). This group has an emphasis on equipping people with a variety of skills which they can use independently, to ensure that the group is relevant and meaningful to them. Therefore, alongside the work on relaxation and CBT, practical advice and information is provided relating to the use of meaningful activity and the importance of maintaining engagement in occupations. This may include for example information relating to sleep or the impact of food on mood, and aims to be as practical and informative as possible, and also includes linking in with other services or colleagues within the health service as appropriate.

Further research by Brain Health and Alzheimer Scotland has also shown that, if we eat, exercise and sleep well we can help keep our brains healthy and fuelled with oxygen and nutrients. No matter our age, we need to stimulate our brains by being with people and learning new skills. And it is crucial we manage stress to stay as calm as possible at home and work. (Brain Health Scotland 2022).

Group aims to:

use an occupational focus to encourage participants to incorporate techniques in their everyday lives, to enable management of anxiety and stress/fear around developing a cognitive decline.
promote approaches such as relaxation techniques, mindfulness, low level CBT as a coping strategy to promote a healthier mind and lifestyle.
provide the group members with the basic skills required to practice techniques of sleep hygiene, breathing techniques and anxiety management, independently.
encourage participants to use these techniques out with the group environment on a regular basis.
provide the group with the opportunity to explore other occupational skills, hobbies and interests and to encourage increased social interaction
provide the group with the opportunity to monitor their own progression of health, wellbeing and mental health throughout the duration of the group.
support the group in the use of new technology to access websites from Brain Health Scotland, AHP Dementia and Alzheimer Scotland, to improve/maintain their mental Health and wellbeing.

Participant Feedback, included statements such as: -

The group has been really educational, learning a lot from Brain Health and Food and Mood.

I particularly enjoyed the sessions on Brain Health, in relation to how diet is an important factor in maintaining a good healthy mind, as well as the importance of exercise and social contacts.

Learn to breath properly and felt it benefitted his personal goals, reported they found the whole experience very helpful.

Also reported, found being able to speak with others with similar experiences felt helpful as well as the peer support which was provided throughout the group. The ability to discuss with others the impact of mental health issues and found that being part of a group and information packs were very helpful too. Being in a group situation and feeling confident to speak about own fears with others who understood.

The groups have been running and evolving over the last 4 to 5 years and continued to run during the pandemic, (virtually), using Near Me to deliver the weekly sessions and posting out of the weekly session handouts, prior to the session. This acted as a prompt for people to remember the upcoming sessions.

Summary

All in all the group has been running very well, and every person has taken the time to provide the positive feedback, outlined above, which has enabled us to review and reflect on the group and evolve it, to create a planner for a specific medium to help and support the residents of Fife, with a bespoke group to meet their needs around Mental Health and wellbeing, self management.

Also the evidence from changes in their observed daily functioning and results from the outcome measure, 'The Warwick Edinburgh', as well as weekly group feedback sheets, indicates an all round improvement in these patients mental health and wellbeing.

So what next?

We are looking forward to team up with Elaine to develop booklets for Balancing Mind and Body and share with other Occupational Therapists who may be interested in trialling this group in their areas of Older Adult Mental Health services, or perhaps for people who receive Young Onset or Mild Cognitive Impairment Diagnoses.

Contributor

Gail Hogg, Specialist Occupational Therapist, NHS Fife @GailHogg6