Guided Discovery: Problem-Solving Therapy Integrated Within the Socratic Method

Feasibility of Telehealth Occupational Therapy for Behavioral Symptoms of Adults With Dementia: Randomized Controlled Trial

IMPORTANCE

Supporting community residency of adults with Alzheimer's disease (AD) is a critical public health initiative. Occupational therapy can contribute to this goal.

OBJECTIVE

To assess the feasibility of a novel telehealth intervention to support occupational engagement in community-residing people with AD.

DESIGN

Single-blind, three-arm, parallel, randomized controlled trial.

SETTING

Occupational therapy delivered through telehealth in participants' homes.

PARTICIPANTS

People with AD who reside in the community with behavioral symptoms and their care partners (dyads).

INTERVENTIONS

(1) HARMONY (Helping older Adults cReate & Manage OccupatioNs successfully), a telehealth intervention that applies principles of individualized guided discovery with environmental cueing for caregivers of persons with AD to promote activity participation and manage behavioral symptoms; (2) standardized training regarding the use of a sensory-based approach in dementia care; and (3) a control, including home safety education and weekly monitoring of behaviors.

OUTCOMES AND MEASURES

Feasibility was assessed as the primary outcome measured by completion of at least 75% of the telehealth sessions. Secondary outcomes included change in functional activity performance and neuropsychiatric behavioral symptoms.

RESULTS

Twenty-eight dyads participated. The intervention was feasible, with high adherence to weekly visits (M number of visits = 5.4 for HARMONY, 4.9 for standardized training, and 4.6 for control), with high participant retention in the intervention arms. HARMONY demonstrated promise in improving patient performance and behavioral symptoms.

CONCLUSIONS AND RELEVANCE

HARMONY is feasibly delivered through telehealth service and has a positive effect on occupational performance and behavioral symptoms of AD. Additional studies are needed to explore effectiveness in a broader population. What This Article Adds: Use of HARMONY for community-residing adults with AD is feasible and has promise for improving functional activity performance and behavioral symptoms, as well as caregiver satisfaction.

The art and science behind socratic questioning and guided discovery: a research review

Socratic questioning is used to enhance the process of guided discovery in psychotherapy sessions.

OBJECTIVE

Socratic questioning and guided discovery are defined, and assorted clinical examples are provided.

METHODS

The limited research on the impact of Socratic questioning is reviewed and integrated with 30 + years of clinical experience.

RESULTS

The scant research suggests that Socratic questioning significantly reduces depression from one session to the next, particularly for patients with a pessimistic cognitive bias, but there is no research on patient improvements at the end of psychotherapy.

CONCLUSION

Socratic questions and guided discovery can facilitate sensitivity to issues related to diversity and can be useful in psychotherapy training. The Socratic approach relies on an integration of the research evidence, ancient philosophy, and contemporary cognitive therapy.

Evaluation of an occupational therapy reentry program: Achieving goals to support employment and community living after incarceration

BACKGROUND

Individuals released from prisons to community supervision often experience unstable housing, unemployment, substance misuse, mental ill-health, and lack of support systems contributing to high rates of recidivism. Occupational therapy practitioners have distinct value in promoting engagement in new habits and routines to support "occupation," or development of daily living skills to support community reentry.

OBJECTIVE

We developed an occupational therapy (OT) program within a Department of Corrections (DOC) Community Supervision Center in the Midwest United States. The purpose of this study was to determine feasibility and efficacy of an OT program for community reentry.

METHOD

The program was piloted with a sample of five justice-involved men received OT interventions. Pre- and posttest assessments included a behavioral health interview, demographic survey, five Patient-Reported Outcomes Measurement Information System (PROMIS) assessments, the Vulnerability Index-Service Prioritization Decision Assistance Tool (VI-SPDAT) and Activity Card Sort-Advancing Inclusive Assessment. Descriptive analyses were performed to determine goal attainment and compare pre- and post-test scores over time and to a reference population (PROMIS). Staff of the DOC were also interviewed to assess perceived feasibility and efficacy of this pilot.

RESULTS

Significant health changes were reported in participant self-efficacy, managing emotions, anxiety, and sleep disturbances (1 >  SD). Moderate changes were seen in reduced feelings of social isolation (0.5 >  1SD).

CONCLUSION

It was feasible to implement an OT program with tailored reentry interventions based on unique needs of criminal justice involved individuals. Initial findings suggest OT offers health promotion benefits to reduce risk of recidivism and prepare individuals for community reentry following incarceration.

(Dis)Ability-informed Mentors Support Occupational Performance for College Students with Learning Disabilities and Attention-Deficit/Hyperactivity Disorders through Problem Solving and a Focus on Strengths

Introduction

Students with learning disabilities (LD) and Attention-Deficit/Hyperactivity Disorder (LD/ADHD) are well-represented on college campuses. However, they experience challenges to meeting occupational and role expectations associated with being in college. Mentors serve as natural supports for young people within college environments. This study investigates the ways in which graduate-student mentors, who were supported in understanding LD/ADHD and their mentee's strengths and challenges through an occupational lens, provided problem solving supports for undergraduate mentees with LD/ADHD.

Methods

Thematic qualitative analysis was used to investigate problem solving supports provided by mentors (N = 57) of undergraduate mentees (N = 52) with LD/ADHD.

Results

Three themes, Executive Functioning, Adult Life Skills, and Academics, represent areas in which mentors worked with mentees in guiding and co-creating strategies to address academic, social, and daily life challenges. Mentors' understandings of their mentees' disability-related challenges and strengths within everyday life situations was important for fostering the occupational performance of mentees.

Conclusion

The inclusion of biopsychosocial approaches is needed in the development of disability-related mentorship interventions where occupational therapists can leverage disciplinary understanding of disabilities and the fostering of occupational performance to support social functioning and participation in college.

Strategies for Coping with Time-Related and Productivity Challenges of Young People with Learning Disabilities and Attention-Deficit/Hyperactivity Disorder

Learning disabilities (LD) and attention deficit hyperactivity disorder (ADHD) are characterized by neurological differences that result in difficulties meeting learning and productivity expectations. Young people with LD and ADHD experience difficulties in self-managing academic, social, daily living, and health/wellness demands. Students with LD/ADHD must work longer and harder than peers, which makes managing time and productivity a critical skill for school success. This study examined the strategies that college students with LD/ADHD used to overcome obstacles related to time and productivity within their everyday life contexts. A qualitative phenomenological design was used to examine the phenomenon of coping and productive-task performance through strategy use among 52 college students with LD/ADHD. Strategies classified as habit and routine use, reframing, and symptom-specific strategies were identified. Strategy use for addressing time-related and productivity challenges are multidimensional and entailed a mix of cognitive, behavioral, psychological, and socio-environmental strategies. Effective strategy use across life's contexts was critical to self-managing as a young person with a chronic developmental condition within a college context. The findings provide a much-needed understanding of the multi-faceted challenges and solutions within young adult contexts that are important for guiding the development of interventions for young people with LD/ADHD.

Socratic Questions With Children: Recommendations and Cautionary Tales

This clinically focused article offers cognitive behavior therapists recommendations and cautionary tales for using the Socratic method when working with children. The importance of the therapeutic relationship in combination with developmental considerations is discussed. The use of Socratic method in various cognitive behavioral modules is illustrated by means of case examples. Dialogues provide examples of how the cognitive specificity hypothesis and downward arrow technique can be used to support young clients in eliciting negative automatic thoughts. The importance of pacing, the mixing of closed and open-ended questions, and behavioral experiments to aid cognitive restructuring are also highlighted through extracts from clinical conversations. Finally, the article emphasizes that the purpose of the Socratic method is to broaden thinking and to access new knowledge rather than just giving young clients new thoughts and problem solving strategies.