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Introduction

Skills training is an intervention that teaches people life skills that will allow them to live independently. Skills training targets ADLs and IADLs that have not been learned, forgotten or impaired. Skills training involves:

1. Identifying the life skill that the client needs/wants to learn
2. Prioritizing the most important problem
3. An activity analysis of the selected task
4. TeachIng component skills of the selected task
5. Repeated practice of the component skills
6. Practice of the full skill                                                        (Brown 2011)

Anxiety may impair participation in ADLs and IADL because of behaviors such as restlessness, difficulty concentrating, and sudden/ repeated attacks of intense fear. Our client Clint has expressed both his participation in leisure as well as work participation are being hindered by his anxiety and physiological responses to these triggers. He acknowledged through motivational interviewing that he is most motivated to return to work and playing hockey. He wants to be able to cope with his anxiety and expresses his need to learn relaxation skills in order to overcome his overwhelming physiological responses to his triggers.

Theory:

Skills training is based on learning theories. This training is aimed at skill acquisition to improve overall function for optimal performance in an environment. According to the learning theory the therapist essentially teaches what needs to be learned. Requires the ability to learn new information (i.e. couldn’t be used with someone with dementia or diminished capacity to learn). It often uses behavioral and learning principles in teaching, where skills are mastered with repetitive practice.

 (Brown 2011)

Evidence:

The study, The effect of mental skills training on competitive anxiety in schoolboy rugby players by Nathanael C.H. Ong and Konstadina Griva used block randomization to evaluate the effect of mental skills training on pre-match competitive anxiety in schoolboy rugby players. According to the results Mental skills training can change the manner by which athletes appraise their competitive environment and endow them with the skills and ability to change their cognitions even while completing.This form of skills training has been shown to moderate the direction and intensity of competitive anxiety symptoms.

http://dx.doi.org.ezproxy.fiu.edu/10.1080/1612197X.2016.1153129

Case study

Clint, is a 25 year old male who was a goaltender 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 the thought of the sport causes him to break out in a sweat and he is experiencing difficulty sleeping. This near death experience and his acquired anxiety disorder has kept him from returning back to work, and it is also affecting his roles at home as a father and a husband. Despite these feelings, Clint wants to return to work and provide for his family.

Intervention plan

Problem Statement

• Clint is unable to return to work due to his inability to cope with his maladaptive physiological responses to anxiety

2 Long term Goals

• Clint will implement learned deep breathing techniques into his daily routine in preparation for returning to work in 4 weeks.
• Clint will tolerate 1 practice session for 30 minutes without overt symptoms of anxiety in preparation for returning to work in 4 weeks.

3 Short term Goals

• Clint will identify 3 coping strategies to maintain physical health and well-being in 2 weeks.
• Clint will identify 3 coping strategies to maintain physiological responses to anxiety triggers in 2 weeks.
• Clint will identify the onset of physiological responses (ie. shortened breath, rapid heartbeats, rapid pulse rate, perspiration) to anxiety triggers within 2 weeks.

Intervention format

• Individual

Description of the setting 

• Clint will meet with the occupational therapist at the outpatient clinic for 30 minutes twice a week for 1 month.

Supplies

• None

Agenda

-Continue to build rapport with Clint by asking how client’s week went (4 mins)

-Have Clint identify 3 physiological responses he feels before a panic attack comes on and 3 ways to cope with them (6 mins)

-Practiced coping strategies with client (5 mins)

-Engage in role play activity with client (15 mins)

Documentation

S: Client stated that he has panic attacks when he thinks about having to return to work and has trouble calming himself down. Client reported that he was only able to attend team practice for 5 minutes before leaving due to a panic attack.

O: Client presented for a 30 min session using a skills learning approach. Client identified 3 physiological responses he feels before a panic attack comes on and 3 ways to cope with them. Client practiced coping techniques completing 5 mins of repetition and then engaged in hockey game through role playing. Client was able to identify the onset of these responses and implement the coping techniques in role 2 out of 3 times.

A: During role play the client experienced physiological responses 3 times which shows the degree of his anxiety disorder and how he is physically affected by the triggers that are associated with hockey. The client is progressing in his ability to cope with his anxiety as demonstrated by the client being able to implement the coping techniques almost every time after practicing them and during role play.

P: Client will be seen for a 30 minutes OT session, twice a week, for one month to continue to work on health management and maintenance skills. He would benefit from further role play and eventual in-vivo exposure to make sure he has the ability to generalize the learned skills to cope with his anxiety.

References:

Brown, C., Stoffel, V.C., & Munoz, J.P. (2011). Occupational therapy in mental health: A vision for participation. Philadelphia, PA:F. A. Davis Company. ISBN-10: 0-8036-1704-6

Ong, N. C. H., & Griva, K. (2017). The effect of mental skills training on competitive anxiety in schoolboy rugby players. International Journal of Sport and Exercise Psychology, 15(5), 475-487. doi:10.1080/1612197X.2016.1153129