Isobel is a 40 year old lady with a diagnosis of Post Traumatic Stress Disorder. At the time of her referral to Occupational Therapy she had been off work for a significant period of time. She worked in middle management and had always enjoyed her work. She lives with her mother in her own home and has two pet dogs. Isobel had a history of childhood trauma which caused her PTSD.
Reason for Referral
Isobel was referred to Occupational Therapy by her Mental Health Nurse as she had experienced a sudden decline in her occupational functioning, had been off work for a significant period and had very little structure to her day. Her relapse had been triggered by an event in the media which had led to a significant increase in her PTSD symptoms.
Occupational Therapy Assessment
Isobel was assessed by occupational therapy using a variety of standardised and non standardised tools. An initial Occupational Therapy Assessment was conducted which drew on a number of occupational therapy models and treatment strategies including the Model of Human Occupation.
This assessment identified that:
- The flashbacks had greatly increased Isobel’s emotional vulnerability and she had fallen back on old coping strategies such as self-harm to try and help her manage her emotions. She had also increased her use of medication to try and address her symptoms;
- Isobel’s flashbacks were most prevalent at night and interrupted her sleep pattern making her very tired during the day which often caused her to return to bed and reduced her motivation to complete tasks;
- Isobel had become very fearful of being out in public and was only going out with the support of her mother at quiet times of the day;
- Isobel did not believe that she would be able to return to work given the amount of time she had been absent and consequently felt quite hopeless about her future.
Occupational Therapy Intervention
Isobel was initially offered 12 weekly Occupational Therapy sessions which focused on:
- Developing positive coping strategies to help her manage her emotions as an alternative to more harmful coping strategies such as self-harm;
- Developing a structured plan to gradually increase the number and variety of activities she was able to engage in on a weekly basis;
- Developing a target hierarchy and graded treatment plan to gradually increase her confidence in venturing outside the house starting with walking her dogs with her mother and building up to meeting a friend for a coffee in a local cafe;
- Exploring the thoughts that caused her to feel fearful of going out in public and developing strategies to challenge these thoughts by challenging her thinking and utilising mindfulness;
- Problem solving the barriers preventing her from making contact with work and breaking down the steps required and goals to be achieved to enable her to return to work.
On completion of the Occupational Therapy programme Isobel was able to:
- Increase the structure to her day and not return to bed during the daytime as a result of which her sleep had improved and her flashbacks had reduced in frequency;
- Increase her skills in challenging her thoughts and goal setting which had increased her confidence in going out in public – she was able to walk her dogs independently, meet a friend for coffee on several occasions and attend a family meal at a local restaurant;
- Develop the skills in goal setting and continue her graded exposure plan independently;
- Significantly reduce her reliance on medication;
- Make contact with her manager at work and attend several informal meetings thus increasing her confidence in returning to work;
- Increase her ability to manage her emotions through the use of positive coping strategies – she had not self-harmed for six weeks by the end of her programme.
In addition, on the recommendation of her Occupational Therapist, Isobel was referred for psychological intervention to help her manage her PTSD symptoms/flashbacks.