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Introduction

Cognitive intervention consists of therapeutic activities that can help people with cognitive impairments to successfully engage in activities that these individuals find difficult due to their deficits. Cognitive impairments contribute to psychiatric disability across many different diagnoses. There is great variability in the type of impairment associated with a particular mental illness and within individuals. It involves such cognitive skill as processing, attention, vigilance, memory, and executive function and can impede people’s ability to participate in a variety of meaningful occupations (Brown, 2011).

Occupational therapists can use cognitive therapy to encourage independent daily functions such as self-care, work/learning and productivity by working on improving individuals’ thought processes and cognition. They use a concept of neuroplasticity based on the premises that engagement in activities that target specific cognitive functioning enhances neuroprocessess and improve function (Park & Bischof, 2013).

Theory

Interpersonal and Social Rhythm Therapy (IPSRT) is designed to help people improve their moods by understanding and working with their biological and social rhythms. It is most commonly used for people with mood disorders and it is based on the belief that disruption to routines can exacerbate symptoms of mental illness. It supports the implementation of regular, daily patterns of activity in order to facilitate recovery of circadian biological processes and also to improve mood (Haynes, 2016).

Evidence

A review conducted by Haynes, Gentler, and Kelly (2016) explored the theories behind Social Rhythms Therapies (SRT), including Interpersonal and Social Rhythms Therapy (IPSRT). According to the review, SRT is based on the social rhythm hypothesis of depression and the Instability Model. The social rhythm hypothesis of depression believes that stressful events may cause instability in an individual’s biological rhythms, such as sleep. Furthermore, the instability model argues that this instability can exacerbate depressive symptoms and provoke mood dysregulation. Therefore, SRT looks to encourage individuals with mood disorders to develop and maintain daily routines. Doing so, will promote stability in biological rhythms, thus contributing to mood regulation. IPSRT combines SRT with interpersonal therapy, which is already proven to be an effective treatment for individuals with unipolar depression.
Additionally, the review took a look at current literature of outcomes for IPSRT used with individuals who have mood disorders. Researches concluded that IPSRT is an effective treatment for mood disorders. Studies showed that IPSRT is helpful in improving mood symptoms, as well as, preventing mood episodes.

Case Study

Roy is a 58-year-old married man who was diagnosed 4 years ago with depression secondary to type 2 diabetes.  He is mildly obese and hypertensive, but otherwise has no evidence of coronary heart disease or other complications of diabetes. He uses insulin and has insufficient control of hyperglycemia. Six months ago, Roy started having difficulty falling and staying asleep. As a result, he felt tired and fatigued most of the time. He became less physically active, stopped exercising, and gained 12 lb. Then he gradually stopped socializing and eventually lost interest in most things, including sexual activity. During this time, he earnestly denied feeling sad or depressed. He has continued to work but has trouble concentrating, frequently forgets things, and feels impatient, irritable, and frustrated. For the past month, the constellation of symptoms has been persistent and interfering.

Intervention Plan

Problem Statement

Roy’s difficulty in maintaining an adequate sleep schedule impedes his ability for functional performance in daily activities.

Long Term Goals

1. Roy will demonstrate correct use of self chosen relaxation techniques 5/7 days by maintaining a daily log to improve his sleeping patterns by d/c.
2. Roy will develop a bedtime schedule with regular, consistent bedtime and wake-up times by maintaining a daily log to improve his daily bedtime routine by d/c.

Short Term Goals

1. Roy will identify 2 relaxation techniques for 15 mins/ per day to increase his ability to fall and stay asleep by next session.
2. Roy will identify 3 factors contributing to his inability to maintain an adequate sleeping pattern by next session.
3. Roy will create a list of healthy habits that improve quality of sleep and increase energy levels during the day in 1 week.

Intervention Format

Individual

Setting

Outpatient

Supplies

None

Agenda

• Greet Roy (2 min)
• Review and discuss goals (5 min)
• Assess Roy’s motivation for change (5 min)
• Discuss recent changes in health management (8 min)
• Brainstorm techniques to improve sleep quality (10 min)
• Practice relaxation techniques (10 min)
• Session reflection and feedback (5 min)

Documentation

S: The client stated “ I want to feel like myself again. It seems that lately I’ve been feeling impatient, irritable, and frustrated.”

O: Client participated in a 45-minute session focused on identifying 2 relaxation techniques to increase sleep, identifying factors contributing to his inability to maintain an adequate sleeping pattern and creating a list of healthy habits to improve quality of sleep. Client identified that his disturbed sleeping cycle results in chronic fatigue and a loss of interest in socialization and in any physical activities.

A: Client presented with ineffective strategies resulting in an irregular sleep cycle. Client demonstrated good insight by identifying his lack of control of hyperglycemia and erratic daily schedule. Client’s ability to demonstrate adequate understanding and implementation of learned relaxation techniques indicate high potential for improving his sleep schedule. Client would benefit from skilled OT services to continue advancing his willingness to implement an adequate sleep schedule to increase functional performance in daily activities.

P: Client will continue to see OT 2x/week for 30 minutes each. During the next treatment session, client will continue to be monitored for maintaining a daily sleeping log and developing consistency in his bedtime routines.

References

Brown C. (2011). Cognitive Skills. In C. Brown  & V. C. Stoffel, (Eds.), Occupational Therapy in Mental Health (pp. 350-351). Philadelphia, PA: F.A. Davis Company.

Haynes, P. L., Gengler, D., & Kelly, M. (2016). Social Rhythm Therapies for Mood Disorders: an Update. Current Psychiatry Reports, 18, 75. http://doi.org/10.1007/s11920-016-0712-3

Park, D. C., & Bischof, G. N. (2013). The aging mind: neuroplasticity in response to cognitive training. Dialogues in Clinical Neuroscience, 15(1), 109–119.