Things Have Changed: Lessons of growth, adaptation and ...Things Have Changed: Lessons of growth,...
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Things Have Changed: Lessons of growth, adaptation and change after successful rTMS treatment Louise W. Sammons, R.N., Ed.D, M.P.H, Elizabeth Orman, B.A., Robert A. Sammons Jr., M.D., Ph.D. Objective A study to understand post rTMS treatment issues and provide examples of content disseminaon and discussion points to meet group’s needs. Background Depression has been shown to negavely affect relaonships (Knox, 2004). When clients begin to recover, changes in systems may result in increased tension due to role reassignment. Relavely lile is known about the relaonship recovery process aſter rTMS treatment. The purpose of this study was to determine the needs of a group of post rTMS treatment paents to renegoate relaonships with family, friends and co-workers. Method This presentaon represents observaons of issues that arose over a two year period of a TMS support group. It began as a tradional support group and was established with assessment and educaon about depression and their impact on relaonships as the key foci. Clients met approximately once a week for the first year and every other week the second year. Inially My Wellness Recovery Acon Plan (WRAP) developed by Mary Ellen Copeland was used to iniate structure for group discussion and acvies. Addional assessments of desired behavioral goals of the group and idenficaon of selecve, effecve strategies to help meet these goals were accomplished. Specifically, biopsychosocial influences of depression were reviewed. Then triggers of depression and comorbid anxiety were explored with behavioral recommendaons being made. Participants: 13 parcipants (eleven females and two males; mean age 76.3 years) with age range from 36 yr. to 85 yr. Average Pre-Treatment PHQ-9 score: 16 (range: 27 - 9) Average Post-Treatment PHQ-9 score: 5 (range: 14 - 0) www.TMSsoluons.com QR for Poster Results Over the course of two years, familiar themes of depression topics were discussed and some seemed to be specific to TMS treatment. This may be due to the rapid reducon in depression symptomatology in 6 weeks aſter a long history of chronic, treatment resistant depression. As in all groups, trust was a threshold requirement for the group to coalesce and develop over me. Intervenons were developed to address the needs of the variance in the knowledge base, personality variables and acceptance of changed behaviors. The following are examples of recurrent themes in the group discussed over two years: • How do I become more asserve in telling family and friends how I want to be treated? Many group members felt beholding to family and friends for taking care of them when they were depressed and they did not want to seem ungrateful. • How do I let my family and friends know I am not superhuman and can sll get sad at mes? • Now that I am not depressed, is it my responsibility to help people feel comfortable to talk to me again? • How do I change my appearance/presentaon to be consistent with feeling beer? • How do I stay posive when facing challenges and frustraons while trying to maintain my sense of improvement? • How do I “cut myself some slack” when I make mistakes? • Is it OK to use the group as a place to pracce independence or other behavioral changes? • How can I talk with authority again and feel worthy to express opinions? • How to manage disparaging comments from others about the degree of my former depression? • How do I reacquire skills of ADL? • Is the group a place where I can get validaon about the appropriateness of my comments and interacons with others? • Discussed strategies for not geng overwhelmed: - Streamlining acvies - Compensang for deficits - Taking a me out - Geng family to help Conclusion Geng well has unintended consequences. Praconers and therapists can help paents maintain their improvement by recognizing roadblocks to recovery and providing therapeuc intervenon with individual therapy or through a group seng as described. References: Knox, David. Choices in relaonships. Wadsworth Publishing, 2002. M108 B 041618 Other Group Components: •Role play of ancipated stressful interacons •Occupaonal therapy component: - Some group members were less analycal and less exuberant than others - Members oſten needed craſt acvies to help them focus while discussing difficult issues
Transcript of Things Have Changed: Lessons of growth, adaptation and ...Things Have Changed: Lessons of growth,...
Things Have Changed: Lessons of growth, adaptation and change after successful rTMS treatment
Louise W. Sammons, R.N., Ed.D, M.P.H, Elizabeth Orman, B.A., Robert A. Sammons Jr., M.D., Ph.D.
ObjectiveA study to understand post rTMS treatment issues and provide examples of content dissemination and discussion points to meet group’s needs.
BackgroundDepression has been shown to negatively affect relationships (Knox, 2004). When clients begin to recover, changes in systems may result in increased tension due to role reassignment. Relatively little is known about the relationship recovery process after rTMS treatment. The purpose of this study was to determine the needs of a group of post rTMS treatment patients to renegotiate relationships with family, friends and co-workers.
MethodThis presentation represents observations of issues that arose over a two year period of a TMS support group. It began as a traditional support group and was established with assessment and education about depression and their impact on relationships as the key foci. Clients met approximately once a week for the first year and every other week the second year.
Initially My Wellness Recovery Action Plan (WRAP) developed by Mary Ellen Copeland was used to initiate structure for group discussion and activities. Additional assessments of desired behavioral goals of the group and identification of selective, effective strategies to help meet these goals were accomplished.
Specifically, biopsychosocial influences of depression were reviewed. Then triggers of depression and comorbid anxiety were explored with behavioral recommendations being made.
Participants: 13 participants (eleven females and two males; mean age 76.3 years) with age range from 36 yr. to 85 yr.
Average Pre-Treatment PHQ-9 score: 16 (range: 27 - 9) Average Post-Treatment PHQ-9 score: 5 (range: 14 - 0)
www.TMSsolutions.com
QR for Poster
Results Over the course of two years, familiar themes of depression topics were discussed and some seemed to be specific to TMS treatment. This may be due to the rapid reduction in depression symptomatology in 6 weeks after a long history of chronic, treatment resistant depression.
As in all groups, trust was a threshold requirement for the group to coalesce and develop over time. Interventions were developed to address the needs of the variance in the knowledge base, personality variables and acceptance of changed behaviors. The following are examples of recurrent themes in the group discussed over two years:
• How do I become more assertive in telling family and friends how I want to be treated? Many group members felt beholding to family and friends for taking care of them when they were depressed and they did not want to seem ungrateful.
• How do I let my family and friends know I am not superhuman and can still get sad at times?
• Now that I am not depressed, is it my responsibility to help people feel comfortable to talk to me again?
• How do I change my appearance/presentation to be consistent with feeling better?
• How do I stay positive when facing challenges and frustrations while trying to maintain my sense of improvement?
• How do I “cut myself some slack” when I make mistakes?
• Is it OK to use the group as a place to practice independence or other behavioral changes?
• How can I talk with authority again and feel worthy to express opinions?
• How to manage disparaging comments from others about the degree of my former depression?
• How do I reacquire skills of ADL?
• Is the group a place where I can get validation about the appropriateness of my comments and interactions with others?
• Discussed strategies for not getting overwhelmed: - Streamlining activities - Compensating for deficits - Taking a time out - Getting family to help
ConclusionGetting well has unintended consequences. Practitioners and therapists can help patients maintain their improvement by recognizing roadblocks to recovery and providing therapeutic intervention with individual therapy or through a group setting as described.
References: Knox, David. Choices in relationships. Wadsworth Publishing, 2002. M108 B 041618
Other Group Components: •Role play of anticipated stressful interactions •Occupational therapy component: - Some group members were less analytical and less
exuberant than others - Members often needed craft activities to help
them focus while discussing difficult issues
