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Introduction

The development of emotional regulation skills has become increasingly important for occupational therapists when studying adult performance and their health outcomes. These skills require the client to be aware of and identify their emotions as well as accept them. The client also needs to be flexible in using strategies to meet individualized goals (Hebert, 2017).

Case Study

Gloria escaped being murdered by the cartel by escaping in a donkey cart in the middle of the night. Her family was murdered after her son stole a block of cocaine. Now living in the United States with her only remaining daughter, Nadia, Gloria has been unable to connect with her remaining grandchildren due to the trauma she sustained. Gloria’s daughter has been under significant strain trying to connect with her mother, citing emotional hardship in the home. Gloria doesn’t participate in any activities like talking to her grandchildren, working, or going to church since she arrived to the United States a year ago. Nadia explained that Gloria now refuses to leave the house after she heard a car backfire which caused her to break down in tears from fear. Gloria lacks emotional regulation, and has wild mood swings, alternating between extreme breakdowns and no emotions at all.

Theory

Cognitive behavior therapy (CBT) is an intervention approach that focuses on uncovering distorted beliefs and faulty thinking patterns (Brown & Stoffel, 2011). These ineffective thinking patterns can lead to maladaptive behaviors that may interfere with occupational roles and activities (Brown & Stoffel, 2011). The goal of CBT is to collaborate with the client by practicing positive thinking patterns that will lead to an increase in effective behaviors (Brown & Stoffel, 2011).

Evidence

According to a study  done by Pineras, Litchety and Pidera (2017), cognitive behavioral therapy (CBT) is an effective treatment for   depressive symptoms among  predominantly U.S. Latino immigrants.  The study investigated  the needs of the growing Latino immigrant population by systematically reviewing peer-reviewed articles of intervention studies that used CBT to treat depressive symptoms. After 11 studies were analyzed, the research concluded that 9 out of the 11 studies  found that Latino immigrants showed a decrease in depressive symptoms.

Intervention Plan

Problem Statement

Client’s social participation is being impeded due to her inability to regulate her emotions.

Short Term Goals

1. Client will identify the pros and cons of not participating in interactions with her remaining family members for social participation in one week.
2. Client will engage in a 15 minute play activity with her grandchildren without any emotional breakdowns  to facilitate social participation in two weeks.
3. Client will attend church two Sundays out of the month to facilitate social participation in one month.

Long Term Goals

1. Client will eat dinner with her family 5 out of 7 times a week to facilitate social participation by discharge.
2. Client will join the the church choir and attend rehearsals 1x per week to facilitate social participation by discharge.

Intervention Format

Individual

Setting

Gloria will meet with the occupational therapist at her home for 30 minutes 2x/week for 4 weeks.

Supplies

Notebook and pen/pencil

Agenda

• Meet Gloria and develop a rapport to establish trust (2 mins)
• Converse with Gloria about the pros and cons of spending time with her family (10 mins)
• Analyze Gloria’s willingness to participate in the therapy session (1 min)
• Have Gloria identify what activities keep her emotions regulated (10 min)
  • Allow Gloria time to ask questions (2 min)
• Provide a summary of the discussion and explain take home activity (5 min)

Documentation

S: Client reported  constantly crying due to her thoughts about her trauma in Venezuela. She also stated that her emotions are hindering her ability to complete her daily tasks and most importantly, her emotions are hindering her from connecting with her family.

O: Client participated in a 30 minute session that focused on identifying the pros and cons of spending time with her family. The client then created a list of emotional regulation activities that can be employed during stress inducing situations. Client wrote three effective techniques that she could use during a time of emotional stress.

A: Client’s ability to identify pros and cons of spending time with family demonstrates her insight into the effect that the trauma has caused and how it has affected her ability to participate in her daily activities. Clients ability to identify stress relieving activities shows her awareness of her maladaptive emotions and behaviors as well as her willingness to change.

P: Client will continue with OT sessions for 30 mins, 2x/week for 4 weeks focusing on reinforcing behaviors identified as stress relievers and practice demonstrating them in order to increase social participation.

References

Brown, C., Stoffel, V., & Munoz, J. P. (2011). Occupational therapy in mental health: A vision for participation. Philadelphia: F.A. Davis

Hebert, K. (2017). The Relationship Between Emotion Regulation and Quality of Life in Healthy Adults: Implications for Occupational Therapy. American Journal of Occupational Therapy. doi: 10.5014/ajot.2017.71S1-PO5107.

Pineros-Leano M, Liechty J, Piedra L. Latino immigrants, depressive symptoms, and cognitive behavioral therapy: A systematic review. Journal Of Affective Disorders [serial online]. January 15, 2017;208:567-576. Available from: CINAHL Plus with Full Text, Ipswich, MA. Accessed February 2, 2018.