Psychosocial

You will learn about a few conditions that have psychosocial functional limitations. You will learn techniques to help individuals when experiencing psychosocial crisis.

Psychosocial impairments involve both psychological and social aspects of an individual and are not usually visible but are very real and can have a  physical and daily effect on an individual’s functioning. We are able to observe people that have psychosocial impairment through their emotions and behaviors at a given time. Quite often we are able to support people that are experiencing difficulties through creating a safe relationship with individuals or the environment.

Below are a few conditions that have psychosocial consideration. Practice and identify ways you can support a person that has functional limitations.

Post-Traumatic Stress Disorder (PTSD)

• PTSD is a disorder that can develop after seeing or living through a shocking, scary, or dangerous experience 
• Fear and the “fight or flight” response are natural and healthy reactions that keep people safe. However, when these reactions persist for more than one month, even when the person is no longer in danger, then they may have PTSD. 
• May include: re-experience, avoidance, arousal, cognition, and abrupt mood changes. Individuals may avoid interaction with groups and crowds, may be hyper-alert and hyper-sensitive to noise and quick movements. 
• Participants may exhibit unresponsive behavior, staring at something, blurred or fast speech/irritability, nonsensical speech, isolating behavior (ie – getting out of water),  uninterested in activities (ambivalence), controlling behavior, desire to show no weakness, delayed response, and cognition and memory difficulties.

Relaxation Techniques for PTSD

• Engage in non-threatening conversations
• Remain calm, and maintain an open communication line.  Check your non-verbal communication.
• Notice eye contact and share eye contact with individual when accepted.
• Give space, slow down  speech, break tasks down into simple steps. Lower tone/volume of voice. Avoid directives unless in life threatening situations. Give them a heads-up and let them take the lead in his/her actions. 
• Maximize the participant’s control of the situation. Let them know you are there if they need any help. 
• Use guided visualization
• Use guided breathing 1:2 counts
• Use paradoxical relaxation: concentrate on small muscles in your face and head. Note that one that is slightly more tense than the one next to it. Now, pay complete attention to this muscle, feeling and sensing it alone; this will then get the rest of the body to relax.  
• Use attention and active rest techniques: popping ears, brushing/shaking
• Quick priority list: think solutions not problems
• Meditation, prayer, mantra, affirmative self-talk
• Reality check-in:  what is the threat, locus of controls

TBI Techniques 

• Be sensitive to nonverbal communication and behaviors that may exhibit the stress response.
• Set appropriate pace during activities and take breaks when needed.
• Have participant wear sunglasses to accommodate for light sensitivity.
• Provide alternative ways to give activity instruction: hands-on, verbal, written, pictures, demonstration.
• Simplify instructions as needed – use short, concise instructions given one at a time.
• Use adaptive equipment as needed – built-up handles for different outdoor equipment, straps, seating, and outriggers to help with stability, pulley systems for climbing, helmets, hiking poles for balance, sit-ski, adaptive bikes, etc.
• Provide one-on-one instruction as needed.
• Encourage participants to write things down if they have a hard time remembering.

Depression Techniques

• Repeated encouragement: tell the person what they are doing well.
• Talk to them: engage them and ask them about and their likes and dislikes.
• Explain the day’s activities and actively involve the person in simple decision-making.
• Make the person feel that their presence is wanted and needed, that they matter.
• Be positive, even with irritable or anxious participants.
• Ease the person into the activity – be calm and don’t force it.

Anxiety Techniques

• Acknowledge small steps to confront anxieties.
• Use guided meditation techniques to help calm the person if anxiety levels rise
  • http://www.chopra.com/ccl/guided-meditations guided meditation sound bites can be downloaded from this site and uploaded onto a phone or mP3 player for use. 
• Speak calmly and quietly.
• Inform the person of what the activity entails and what to expect.
• Place an anxious person next to a key leader or staff member.
• Instill confidence, show them that you are knowledgeable and that they are safe.
• If possible, remove objects creating anxiety, or move to another area.
• Give the person a specific job during the activity for them to focus on.
• Engage the person in a conversation to take the focus off of anxious thoughts.

Autism Spectrum Disorder (ASD)

ASD is a developmental disorder that has characteristics of: impaired social interaction, impaired communication (expressive and/or receptive), repetitive behaviors (banging, waving, spinning) and a limited number of activities/interests. These are usually present before age 3 and do not all have to be present.  No two persons are the same with this condition.

How Does it Affect Participation?

• Lack of social connection – this may include limited or no eye contact, limited social conversation skills and not understanding jokes. The participant may have difficulty relating to others in the group or forming friendships/relationships. 

• Perceived experience – the participant may attach to a particular portion of the activity, focusing on it and not attending to other aspects of an activity as typical participants would (i.e. loving to splash the paddle in the water but not making strokes). The participant may experience anxiety with changes in their typical routine or established outdoor activity routines (adapting to changes may be difficult).

• Spectrum – there is a great range of characteristics and degrees of ASD. Be open to the individual’s needs and habits. If less verbal and unable to communicate their needs, the participant may demonstrate behaviors such as mood swings, temper tantrums, and lack of focus when frustrated.

What to do?

1. Prepare the individual by talking or using visuals to share what to expect during the day.
2. Engage in conversations.
3. Explain social cues.
4. Ask about concrete topics.
5. Be aware of food sensitivities or allergies.
6. Use “if, then…” phrases.
7. Be sensitive to sensory difficulties (refer to sensory systems).