Recreational Therapy: An Introduction
Chapter 4: Behavioral Health and Psychiatric Disorders
PowerPoint Slides
Behavioral Health and Psychiatric Disorders:
A Large Area of Practice in RT
Behavioral/mental health is the single largest
area of practice for recreational therapists,
employing 35% of all nationally certified
practitioners.
Mental illness defined:
Mental illness “refers collectively to all of the
diagnosable mental disorders. Mental disorders are
characterized by abnormalities in cognition, emotion or
mood, or the highest integrative aspects of behavior,
such as social interactions or planning of future
activities.”
(U.S. Department of Health and Human Services, 1999)
U.S. manual to classify mental disorders:
Diagnostic and Statistical Manual of Mental Disorders
(5th edition).
(Known as the DSM-5 and published by the American Psychiatric Association, 2013)
International manual to classify mental disorders:
International Statistical Classification of Diseases and Related
Health Problems (10th edition).
(Known as the ICD-10 and published by the World Health Organization, 2005)
Schizophrenia
Schizophrenia is marked by psychotic features such
as delusions, hallucinations, disorganized thought
and speech, and disorganized or abnormal motor
behavior.
Delusions
 Delusions are beliefs that are relatively fixed and unchanging even in the face of
evidence to the contrary that they are incorrect.
 These beliefs have themes such as persecution (e.g., the belief that you are
being surveyed), reference (e.g., belief that a popular song contains a message
specifically for you), grandiosity (e.g., belief that you have special abilities),
religious (e.g., belief that you are Jesus), and somatic (e.g., belief that you are
missing internal organs).
Hallucinations
Hallucinations are perceptual experiences that
occur in the absence of external stimuli. Although
hallucinations may exist in any sensory form, auditory
hallucinations are the most common.
Mood and Affective Disorders
 Major depressive disorder. Major depressive disorder (or major depression) is
identified by symptoms such as depressed mood, diminished interest in
previously satisfying activities, significant change in weight, sleep disturbance,
change in activity level, fatigue, feelings of worthlessness, diminished ability to
communicate, recurrent thoughts of death (including thoughts of suicide).
 Bipolar disorder. In bipolar disorder a person experiences episodes of
depression and/or mania. Mania is a condition in which a person experiences
an elevation of energy and activity as well as enhanced mood and feeling of
well-being.
Anxiety, stress, and trauma-related disorders
 Anxiety and stress-related disorders are characterized by fear and anxiety
associated with situations that are not currently dangerous.
 Fear is characterized by an emotional response to a real or imagined present
threat. Anxiety is associated with real or imagined threat in the future.
 Post-traumatic stress disorder (PTSD) is one disorder in this group. Disorders
associated with obsessive thoughts and compulsive behaviors are also included
within this group of disorders.
Behavioral disorders
 Behavioral disorders are principally identified through patterns of behavior that
are dysfunctional and may or may not be distressing to the individual such as
eating disorders, sleep disorders, and sexual dysfunction.
 Among the eating disorders, bulimia nervosa and anorexia nervosa appear
with the greatest prevalence.
Personality disorders
 Personality disorders are characterized by patterns of experience and
behavior that are markedly different from the expectations of one’s culture
and situation. In addition, the pattern of behavior is enduring, frequently
inflexible, and although they affect a range of domains of behavior they
are particularly disruptive to social relationships.
 Personality disorders include: antisocial, avoidant, borderline, narcissistic,
obsessive-compulsive, and schizotypal (see Table 4.3 for details).
Serious mental illness
 The term serious in the case of serious mental illness recognizes that the
experience is pervasive, in both duration and impact, and affects multiple
areas of functioning.
 The majority of persons with serious mental illness have diagnoses of
schizophrenia spectrum disorder or bipolar disorder; however, persons with
major depression and severe anxiety disorder are sometimes included. All have
impairment that affect major life areas such as work, school, interpersonal
interactions and relationships, and community, social, and civic life.
Purposes of RT
 The purpose of RT within psychiatric rehabilitation should be in concert with
other health professionals’ services and the client’s overall plan of care. This
may mean that RTs in psychiatric settings focus on reducing symptoms such as
mood disturbances or cognitive dysfunction or improving functional abilities
such ass developing and maintaining interpersonal relationships or developing
stress coping skills.
 In addition, although cure is possible in some disorders, in terms of complete
remediation of symptoms and return to pre-disorder function approaches with
other disorders such as serious mental illnesses are focused on care to reach
the highest possible level of function despite the presence of a persistent
mental illness.
Examples of empirical evidence supporting practice
 Physical activity and exercise
 Behavioral activation
 Social skills training
Commonly sought outcomes: Three domains
 Clinical status
 Functional status
 Subjective well-being
Role of the RT
RTs frequently focus on developing life and coping skills
through exercises and activities. RTs may also use games
and activities to identify patterns of interpersonal behavior,
as well as dysfunctional cognitive models. In addition, the
focus on developing healthy lifestyle patterns is increasing,
particularly among persons with serious illnesses.