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Introduction

This is Clint’s fifth occupational therapy session to help treat his PTSD related to his hockey accident. This session is his first cognitive behavioral therapy (CBT) session focused on techniques to help restructure his negative maladaptive thinking into more positive thinking. CBT is a form of therapy that is guided by the cognitive model which proposes that dysfunctional thinking and unrealistic appraisals of life event can negatively influence behavior and feelings.

(Taylor, 2011)

Theory

Cognitive behavioral therapy (CBT) focuses on changing the the way one thinks to change their behaviors and the way they feel to improve emotional states. CBT includes cognitive restructuring, coping skills, and problem solving methods. Cognitive restructuring is a core technique commonly used in anxiety disorders that changes how you think internally. CBT is useful for treating psychological symptoms that accompany stressors related to anxiety. Anxiety affects one’s well-being, life roles, and has a negative impact on completing daily occupations.

(Taylor, 2011)

Evidence for CBT

In a meta-analysis by Hofmann and colleagues Cognitive Behavioral Therapy (CBT) was found to positively affect sleep dysfunction, anxiety sensitivity, and relaxation in people with anxiety. CBT showed immediate improvements when implemented on patients with phobias, panic disorders, PTSD, and social anxieties. CBT’s ability to improve multiple types of anxieties  evidenced by the meta-analysis shows the effectiveness of cognitive behavioral interventions.

(Hofmann, Asnaani, Vonk, Sawyer, & Fang, 2012)

Case Study

Clint is a 25 year old male who goaltends for the Florida Panthers hockey team. About a month ago, his neck was slashed with another player’s skate during a game, almost killing him. Following this incident, he is plagued by PTSD, alcoholism, OCD, and has made a suicide attempt. Previously, playing hockey gave Clint a feeling of purpose; however, now he no longer believes that he is capable of returning to work. Clint feels he is a failure and only brings down his hockey team. He has participated in multiple OT sessions but due to his negative perspective the therapist has decided to try a cognitive behavioral approach to help him improve his negative thoughts.

Intervention Plan

Problem statement: Client is unable to return to work secondary to his negative thoughts related to his abilities and performance

2 long term goals:

• Client will independently identify distorted thinking in the real world context for increased work participation in 4 months.
• Client will independently implement thought testing and problem-solving in response to distorted thinking in the real world context for increased participation in work in 4 months.

3 short term goals:

• Client will identify 3 negative thoughts he would like to change into positive ones to increase participation in work in 2 months.
• Client will utilize relaxation techniques 3 out of 4 times when he begins to think irrational thoughts to increase participation in work in 2 months.
• Client will log negative automatic thoughts and the evidence for and against those assumptions in a journal at least 3 out of 7 days a week for increased participation in work in 2 months.

Intervention format:

• Individual

Description of setting:

• Clint will meet with the occupational therapist at the outpatient health clinic at the Florida Panthers arena for one hour once a week for 4 months.

Supplies:

• Table, Chairs, Worksheet for homework, Notepad, Pens

Agenda:

-Interview and assess Clint’s problems and goals (10 mins)

-Empower Clint to create problem list (10 mins)

-Set goals with Clint (10 mins)

-Determine the appropriateness of CBT (5 mins)

-Educate on the concept and effectiveness of CBT (5 mins)

-Assign homework assignments (10 mins)

-Summarize the session (10 mins)

Documentation

S: Client stated “I can’t go back to playing hockey I am a failure and I am just going to bring my team down by trying to play again”. Client stated he would like to be able to go back to work without having interfering thoughts bringing him down.

O: Client presented for a 1 hour treatment session. At the beginning of the session he was interviewed and assessed based on his most recent struggles with negative thoughts. The client created a problem list and collaborated with the therapist to identify appropriate goals for himself. The client then received education on the concept and effectiveness of CBT. Once education was provided the client was assigned homework to create a list of assumptions and evidence for and against those assumptions.

A: Client shared many negative thoughts about his ability to return to play hockey. His negative thoughts support the need for CBT. The client problem list demonstrated that he had lack of insight into the cause of his negative thoughts but was eager to find a way to improve.
P: Client will benefit from structured homework assignments that were self identified in client’s problem list. By targeting client’s problems through homework assignments client will be able to become aware of negative thoughts and behaviors to change the way he feels. Client will continue skilled OT services for one hour once a week for four months.

References

Hofmann, S., Asnaani, A., Vonk, I., Sawyer, A., & Fang, A. (2012). The efficacy of cognitive behavioral therapy: A review of meta-analyses. Cognitive Therapy and Research, 36(5), 427-440. doi:10.1007/s10608-012-9476-1

Taylor, R. R. (2011). Cognitive behavioral therapy for chronic illness and disability. New York: Springer.