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- 16 Apr 2017
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Occupational therapy or ergotherapy has a wide spectrum of treatment goals, such as training of occupational skills, teaching social competencies, supporting activation, relaxation, and well-being or caring for patients in hospitals while they wait for other treatments. There is a wide range of therapeutic interventions (DRV, 2012; DVE, 1995; Hillert et al., 2009; Jerosch-Herold et al., 1999; Linden, 2013; Presber, 2003; WFOT, 2010). What exactly is or should be done in occupational therapy depends on the setting, the type of patients and most of all on individual experiences and preferences of the occupational therapists. Regarding psychiatric patients, there are some studies on the effects of occupational therapy in gerontology (Dooley & Hinojosa, 2004; Graff et al., 2008, Hogan et al., 2004; Lawton, 1997), pediatrics and prevention (Barlow & Parsons, 2003; Foxcroft et al., 2003; Neil & Christensen, 2007; Waddel et al., 2007), or neurology (Barclay-Goddard et al., 2011), depression (Blackwell et al., 2012 ) or unselected patient groups (Bryant et al., 2014; Buchain et al., 2003; Reuster 2006). Because of the many facettes of occupational therapy, it is difficult to standardise treatment procedures, so that there is a lack of specified therapeutic concepts and a need of controlled clinical studies (Steultjens et al., 2005). Scientific evidence and standardisation of procedures is of importance for teaching and training of occupational therapists, for guiding treatment and for quality assurance (Myers & Lotz, 2017; Szucs et al., 2017; Zarafonitis et al., 2014).
The objective of the present study has been to develop treatment manuals and methods for quality assurance in occupational therapy, to allow therapists to follow evidence-based procedures. We chose two different treatment modes, resistance- and regeneration-oriented treatments. These are standard procedures in occupational therapy for patients with mental disorders. In the resistance-oriented treatment, patients are supported to learn how to overcome difficulties and hardiness by learning endurance and resilience. In the regeneration-oriented treatment, the goal is to help patients recover and get back their strengths. Additionally, we wanted to develop an instrument that allows to assess protocol adherence.
The study was performed in a department of behavioural and psychosomatic rehabilitation (Dept. of Behavioral and Psychosomatic Medicine at the Rehabilitation Center Seehof of the Federal German Pension Fund, Teltow/Berlin, Germany). All patients were routinely treated with about 6 h of occupational therapy per week; individual psychotherapy, sports therapy or social therapy was added to the medical treatment. They were asked whether they would participate in a special seminar on stress management. After giving their informed consent, they were either allocated to the regeneration or the recreation group.
There were three study group sessions per week, each lasting 90 min. The average treatment duration was 5 weeks, so participation in sessions on all topics was possible. Treatment was given by specially trained therapists and supervised by the head occupational therapist (JH) and the study coordinator, a clinical psychologist and behaviour therapist (JO). During the study period of 12 months, 972 patients were admitted as inpatients, 231 were interested in participating in the additional treatment offer and 10 dropped out before the first session. A total of 108 patients were assigned to the regeneration group and 29 dropped out during the treatment. A total of 113 patients were assigned to the resistance group and 33 dropped out early. Complete data were available for 70 patients in the regeneration group and 75 patients in the resistance group.
Additionally, a convenience sample of 124 who had not participated in the special groups but only in routine occupational therapy (treatment as usual, TAU) patients was interviewed at the end of the hospital stay.
Patients were, on an average, 50.8 (s.d. 9.7) years old; 62.6% were female, 27.9% had a high school or university education and 53.5% were married. About 55.2% of the patients were in a full-time job, 18.9% were in a part-time job and 23.9% were unemployed. Primary clinical diagnoses were affective disorders (F30-F39: 43.4%), anxiety and somatoform disorders (F40-F49: 33.2%) and personality disorders (F60-F69: 11.5%). There were no significant differences between groups.
Regeneration-oriented occupational therapy has a hedonic and salutotherapeutic focus (Linden & Weig, 2009) and wants to help the patients to relax, to distract oneself from the burdens of life and also to recover. Treatment interventions include engaging in positive activities, hobbies, self-care or mindful indulgence (Fava & Tomba, 2009; Lutz, 2008). Resistance-oriented therapy has the goal to promote endurance, hardiness, coping with stressors, readiness and motivation to work. Interventions are to confront patients with work-related tasks or specific hardiness training with reframing after successful tasks (Kobasa, 1979). According to these different approaches, the two treatment manuals were written. On the basis of discussions with occupational therapists, interventions that were used in their routine were collected. These were grouped in regeneration-oriented and in resistance-oriented activities. There were 5 thematic blocks and 15 technical recommendations per treatment, which are listed in Table 1. Occupational therapists were instructed to adhere to the manuals as good as possible. They were already well experienced in the individual methods and techniques that were requested.
Therapeutic interventions in the regeneration and the resistance group
| Resistance group | Regeneration group |
|---|---|
| Frustration training (origami) | Recreational activities (collection and planning of hobbies and activities) |
| Endurance training (soap stone) | Ability to relish and hedonic rules (eating, tea ceremony, mindfulness cooking) |
| Accuracy training (silhouette cuttings, basketry) | Self-care and relaxation (wax bath, relaxation and imagination exercises, mindfulness walks) |
| Goal orientation and acceptance of undesired tasks (working with hard wood) | First impression formation (clothing, hairstyle, situational adjustment) |
| Acceptance of stress and criticism (enkaustik, aquarelle painting, soap stone with swapping with the neighbour during working on the task) | Interaction and small talk (parlour games, small talk) |
Therapists in both the groups were encouraged to have a supportive and warm relationship with the patients. At the beginning of each session, they had to greet patients and then inform them about the ‘topic of the day’, that is, which treatment block was the goal of this session. This was supported by short written information with daily topics such as ‘If you feel bad, then take care of yourself’ or ‘If you feel bad, just go on’. These were specific for the treatment of this particular session and for the different treatments. Then patients were asked to work, for example, on soapstone and train according to the topic of the day either to withstand adversity or to relax and distract.
There are many instruments to measure protocol adherence in psychotherapy (Flückiger et al., 2015; Horvath & Greenberg, 1986; Höger & Eckert, 1997; Linden & Langhoff, 2010; Pohl et al., 2000; Staats et al., 2003). We referred to the Behavior Therapist Competency Checklist (BTCC; Linden et al., 2007, Linden & Langhoff 2010), which can be adjusted to different treatments. The technical concept of the BTCC is to give characteristic samples of the treatment. Patients or therapists are then asked whether a respective activity has occurred during treatment. Table 2 lists the items that cover resistance and regeneration items, such as ‘
Patient ratings on the therapy competency checklist (TAU: routine occupational therapy only, RG: regeneration group, RS: resistance group, scale:1 = not, 7 = completely)
| All(N = 259) | TAU(N = 119) | RG(N = 67) | RS(N = 73) | ANOVA TAU vs. RG vs. RS | T-Test TAU vs. RG & RS | RG vs. RS | |
|---|---|---|---|---|---|---|---|
| mean (SD) | mean (SD) | mean (SD) | mean (SD) | ||||
| Regeneration | |||||||
| 1 We talked about pleasant and compensatory activities | 5.05(1.50) | 4.99(1.42) | 5.73(1.04) | 4.51(1.75) | F(2,256) = 12.85, p < 0.001 | TAU vs. RG (p = 0.003), TAU vs. RS (p = 0.07) | RG vs. RS (p <0.001) |
| 2 We looked at the difference between former and current pleasant activities | 3.74(1.74) | 3.74(1.73) | 4.10(1.65) | 3.41(1.79) | F(2,255) = 2.82 p = 0.06 | TAU vs. RG (p = 0.50), TAU vs. RS (p = 0.62) | RG vs. RS (p <0.001) |
| 3 We planned pleasant activities for the time after discharge from the hospital | 3.61(1.93) | 3.68(1.95) | 4.13(1.80) | 3.04(1.88) | F(2,254) = 6.03, p = 0.003 | TAU vs. RG (p = 0.36), TAU vs. RS (p = 0.07) | RG vs. RS (p = 0.002) |
| 4 I was able to experience moments of indulgence | 4.56(1.85) | 4.33(1.83) | 5.40(1.46) | 4.16(1.97) | F(2,259) = 10.31, p < 0.001 | TAU vs. RG (p < 0.001), TAU vs. RS (p = 1.00) | RG vs. RS (p <0.001) |
| 5 We focussed on eating as a part of pleasure | 3.59(2.20) | 3.59(1.94) | 5.16(1.44) | 2.18(1.82) | F(2,259) = 49.06, p < 0.001 | TAU vs. RG (p < 0.001), TAU vs. RS (p < 0.001) | RG vs. RS (p <0.001) |
| 6 I had nice and relaxing conversations with the other patients | 5.57(1.45) | 5.47(1.48) | 6.01(1.20) | 5.32(1.54) | F(2,257) = 4.63, p = 0.01 | TAU vs. RG (p = 0.04), TAU vs. RS (p = 1.00) | RG vs. RS (p = 0.01) |
| 7 I was able to test creative techniques in relation to my personal well-being | 5.25(4.13) | 4.72(1.77) | 5.24(1.39) | 5.30(1.60) | F(2,256) = 0.01, p = 0.99 | TAU vs. RG (p = 1.00), TAU vs. RS (p = 1.00) | RG vs. RS (p = 1.00) |
| 8 We spoke about my first impression in social situations | 3.13(2.19) | 2.83(2.07) | 4.81(1.92) | 2.05(1.66) | F(2,253) = 38.32, p < 0.001 | TAU vs. RG (p < 0.001), TAU vs. RS (p = 0.02) | RG vs. RS (p <0.001) |
| 9 I got tips on how to improve my first impression | 2.93(2.06) | 2.86(2.05) | 4.34(1.89) | 1.78(1.36) | F(2,253) = 33.57, p < 0.001 | TAU vs. RG (p < 0.001), TAU vs. RS (p < 0.001) | RG vs. RS (p <0.001) |
| 10 I was animated to talk to others | 5.02(1.74) | 4.68(1.79) | 5.75(1.21) | 4.87(1.90) | F(2,208) = 7.34, p = 0.001 | TAU vs. RG (p = 0.001), TAU vs. RS (p = 1.00) | RG vs. RS (p = 0.02) |
| RG scale (sum score) | 4.21(1.24) | 4.09(1.20) | 5.05(1.00) | 3.63(1.09) | F(2,259) = 25.17, p < 0.001 | TAU vs. RG (p < 0.001), TAU vs. RS (p = 0.01) | RG vs. RS (p <0.001) |
| Resistance | |||||||
| 1 I learned to improve my frustration tolerance | 3.81(1.75) | 3.52(1.77) | 3.92(1.55) | 4.19(1.82) | F(2,256) = 3.58, p = 0.03 | TAU vs. RG (p = 0.39), TAU vs. RS (p = 0.03) | RG vs. RS (p = 1.00) |
| 2 I learned to improve my level of detachment when I get frustrated | 4.10(1.74) | 3.95(1.72) | 4.03(1.69) | 4.41(1.79) | F(2,255) = 1.68, p = 0.19 | TAU vs. RG (p = 1.00), TAU vs. RS (p = 0.23) | RG vs. RS (p = 0.58) |
| 3 I was trained to enhance my level of stamina in dealing with tasks | 4.01(1.77) | 3.87(1.82) | 3.81(1.64) | 4.42(1.77) | F(2,256) = 2.82, p = 0.06 | TAU vs. RG (p = 1.00), TAU vs. RS (p = 0.11) | RG vs. RS (p = 1.00) |
| 4 I learned that preservation is important while dealing with strains | 4.58(1.80) | 4.37(1.91) | 4.50(1.58) | 4.97(1.78) | F(2,252) = 2.61, p = 0.08 | TAU vs. RG (p = 1.00), TAU vs. RS (p = 0.08) | RG vs. RS (p = 0.37) |
| 5 I trained my adherence to instructions | 4.07(1.90) | 3.70(1.92) | 3.89(1.70) | 4.81(1.88) | F(2,251) = 8.46, p < 0.001 | TAU vs. RG (p = 1.00), TAU vs. RS (p < 0.001) | RG vs. RS (p = 0.01) |
| 6 I trained my accuracy in task processing | 3.75(1.95) | 3.50(1.94) | 3.41(1.82) | 4.43(1.94) | F(2,252) = 6.73, p = 0.001 | TAU vs. RG (p = 1.00), TAU vs. RS (p < 0.001) | RG vs. RS (p = 0.01) |
| 7 I trained my discomfort tolerance | 3.38(1.94) | 3.03(1.94) | 3.24(1.79) | 4.10(1.91) | F(2,255) = 7.46. p=0.001 | TAU vs. SP (p = 1.00), TAU vs. RS (p = 0.02) | RG vs. RS (p = 0.02) |
| 8 I have increased my readiness to overcome personal deficits | 3.52(1.81) | 3.13(1.68) | 3.55(1.85) | 4.12(1.82) | F(2,251) = 7.06, p = 0.001 | TAU vs. RG (p = 0.39), TAU vs. RS (p < 0.001) | RG vs. RS (p = 0.17) |
| 9 I learned to endure unpleasant tasks | 3.85(1.92) | 3.17(1.82) | 3.70(1.79) | 5.04(1.63) | F(2,254) = 25.74, p <0.001 | TAU vs. RG (p = 0.15), TAU vs. RS (p < 0.001) | RG vs. RS (p <0.001) |
| 10 I was able to improve my flexibility | 4.33(1.79) | 3.89(1.78) | 4.30(1.64) | 5.05(1.71) | F(2,255) = 10.37, p <0.001 | TAU vs. RG (p = 0.37), TAU vs. RS (p < 0.001) | RG vs. RS (p = 0.03) |
| RS scale (sum score) | 3.93(1.36) | 3.60(1.26) | 3.82(1.29) | 4.55(1.40) | F(2,257) = 12.26, p < 0.001 | TAU vs. RG (p = 0.82), TAU vs. RS (p < 0.001) | RG vs. RS (p = 0.003) |
| I was asked in all sessions to refer to the topic of the day | 4.23(2.17) | - | 4.28(2.17) | 4.20(2.25) | F(2,253) = 0.01, p = 0.99 | - | RG vs. RS (p=0.99) |
The study groups were added to the routine care; so that the patients not only got everything they would have received during the regular treatment but even more treatment. The type of treatment in the special groups is part of any occupational therapy so that no special risks for patients are to be expected.
Patients were asked to give their written consent after they had been informed about the study by the occupational therapists and by written information.
The study was approved by the internal review board of the Federal German Pension Agency.
Table 2 shows the average scores for the items of the protocol adherence measure and the two global scales. The global item which asks whether the topic of the day has been presented is answered similarly in both groups, as this has been done in both groups alike.
There are significant differences in the sum scores of the two subscales between the treatment groups according to the treatment content (Figure 1; Table 2). The overall ANOVA showed highly significant results for both subscales (regeneration subscale: F(2,259) = 25.17, p < 0.001; resistance subscale: F(2,257) = 12.26, p < 0.001). When comparing subgroups, the significant differences in the expected direction were also observed (regeneration subscale: TAU vs. RG p < 0.001, TAU vs. RS p = 0.012, RG vs. RS p < 0.001; resistance subscale: TAU vs. RG p = 0.82, TAU vs. RS p < 0.001, RG vs. RS p = 0.003).
When looking at individual items (Table 2), all regeneration items showed significant differences between the groups in the expected direction, except for ‘I have tested different creative techniques for their effects on my well-being’. In respect to the resistance items, no differences were observed found for ‘I was trained to enhance my level of stamina in dealing with tasks’, ‘I learned how to cope with the burdens’ and ‘I learned that preservation is important while dealing with strains’. Obviously, patients in the regeneration group also had, to some degree. the idea that they should learn to overcome adversities.
In comparison to the patients in routine care (TAU), significant higher regeneration scores were observed in the regeneration group and lower regeneration scores were observed in the resistance group. In respect to the resistance items, no significant differences between the routine and regeneration patients were observed, but there is a significant difference for 7 of 10 items in comparison to the resistance group.
This, to our knowledge, is the first study that standardised and manualised two different treatment approaches in occupational therapy and assesses protocol adherence in a hospital setting. The two manuals describe two treatment modes that are widely used in ergotherapy for patients with mental disorders. The support of regeneration, recreation, relaxation, distraction and positive activities are frequent interventions in occupational therapy (Pollänen, 2015). The same is true for the training of skills and capacities, endurance, hardiness, stress tolerance and the ability to work.
Figure 1
Sum scores of the BTCC subscales for regeneration and resistance-oriented ratings in the TAU, RG and RS groups, indicating the amount of respective interventions per treatment group.
The study shows that it is possible to describe different treatment processes with different therapeutic focuses in occupational therapy in a manual and that occupational therapists are able to learn and apply different treatment rationales and provide treatment according to the protocol. This is the prerequisite for the development of different occupational treatments for the targeting of treatment according to the needs of different disorders (Ikiugu & Nissen, 2016). It is also important in the education of occupational therapists.
The study also shows that it is possible to measure protocol adherence in occupational therapy. The measurement of protocol adherence, as used in this study, is of high validity, as it does not refer to ratings of therapists but of patients. When the therapists are asked about their treatment, they may report what they intended to do. This is not necessarily what they did. What is more important is what patients recognised and experienced during the treatment. From this perspective, there were different interventions in both groups, as the data show significant and meaningful differences between groups on the protocol adherence scale.
Once it is possible to measure and ascertain treatment according to protocol, it is possible to study which treatment is best for which patient and has which result, similar to that done in other forms of psychotherapy. Occupational therapy can and should be evidence based like all other treatments (Myers & Lotz, 2017).
Limitations of the study are that it has been done in a specific inpatient setting, with special treatments and with well-trained occupational therapists, so that results might be different under other circumstances. In future studies, observational ratings could be of interest.
Figure 1
j.gp-2018-0010.tab.036.w2aab3b7c10b1b6b1ab2b3ad107Aa
| □ | If you want success, go on even if you feel bad |
| □ | Do not allow distress to distract you from your responsibilities |
| □ | What must be done has to be done |
| □ | If you can not change it, accept it |
| □ | There is no choice, then make the best out of it |
| □ | Business over pleasure |
| □ | _________________________________________________________ |
Patient ratings on the therapy competency checklist (TAU: routine occupational therapy only, RG: regeneration group, RS: resistance group, scale:1 = not, 7 = completely)
| All(N = 259) | TAU(N = 119) | RG(N = 67) | RS(N = 73) | ANOVA TAU vs. RG vs. RS | T-Test TAU vs. RG & RS | RG vs. RS | |
|---|---|---|---|---|---|---|---|
| mean (SD) | mean (SD) | mean (SD) | mean (SD) | ||||
| Regeneration | |||||||
| 1 We talked about pleasant and compensatory activities | 5.05(1.50) | 4.99(1.42) | 5.73(1.04) | 4.51(1.75) | F(2,256) = 12.85, p < 0.001 | TAU vs. RG (p = 0.003), TAU vs. RS (p = 0.07) | RG vs. RS (p <0.001) |
| 2 We looked at the difference between former and current pleasant activities | 3.74(1.74) | 3.74(1.73) | 4.10(1.65) | 3.41(1.79) | F(2,255) = 2.82 p = 0.06 | TAU vs. RG (p = 0.50), TAU vs. RS (p = 0.62) | RG vs. RS (p <0.001) |
| 3 We planned pleasant activities for the time after discharge from the hospital | 3.61(1.93) | 3.68(1.95) | 4.13(1.80) | 3.04(1.88) | F(2,254) = 6.03, p = 0.003 | TAU vs. RG (p = 0.36), TAU vs. RS (p = 0.07) | RG vs. RS (p = 0.002) |
| 4 I was able to experience moments of indulgence | 4.56(1.85) | 4.33(1.83) | 5.40(1.46) | 4.16(1.97) | F(2,259) = 10.31, p < 0.001 | TAU vs. RG (p < 0.001), TAU vs. RS (p = 1.00) | RG vs. RS (p <0.001) |
| 5 We focussed on eating as a part of pleasure | 3.59(2.20) | 3.59(1.94) | 5.16(1.44) | 2.18(1.82) | F(2,259) = 49.06, p < 0.001 | TAU vs. RG (p < 0.001), TAU vs. RS (p < 0.001) | RG vs. RS (p <0.001) |
| 6 I had nice and relaxing conversations with the other patients | 5.57(1.45) | 5.47(1.48) | 6.01(1.20) | 5.32(1.54) | F(2,257) = 4.63, p = 0.01 | TAU vs. RG (p = 0.04), TAU vs. RS (p = 1.00) | RG vs. RS (p = 0.01) |
| 7 I was able to test creative techniques in relation to my personal well-being | 5.25(4.13) | 4.72(1.77) | 5.24(1.39) | 5.30(1.60) | F(2,256) = 0.01, p = 0.99 | TAU vs. RG (p = 1.00), TAU vs. RS (p = 1.00) | RG vs. RS (p = 1.00) |
| 8 We spoke about my first impression in social situations | 3.13(2.19) | 2.83(2.07) | 4.81(1.92) | 2.05(1.66) | F(2,253) = 38.32, p < 0.001 | TAU vs. RG (p < 0.001), TAU vs. RS (p = 0.02) | RG vs. RS (p <0.001) |
| 9 I got tips on how to improve my first impression | 2.93(2.06) | 2.86(2.05) | 4.34(1.89) | 1.78(1.36) | F(2,253) = 33.57, p < 0.001 | TAU vs. RG (p < 0.001), TAU vs. RS (p < 0.001) | RG vs. RS (p <0.001) |
| 10 I was animated to talk to others | 5.02(1.74) | 4.68(1.79) | 5.75(1.21) | 4.87(1.90) | F(2,208) = 7.34, p = 0.001 | TAU vs. RG (p = 0.001), TAU vs. RS (p = 1.00) | RG vs. RS (p = 0.02) |
| RG scale (sum score) | 4.21(1.24) | 4.09(1.20) | 5.05(1.00) | 3.63(1.09) | F(2,259) = 25.17, p < 0.001 | TAU vs. RG (p < 0.001), TAU vs. RS (p = 0.01) | RG vs. RS (p <0.001) |
| Resistance | |||||||
| 1 I learned to improve my frustration tolerance | 3.81(1.75) | 3.52(1.77) | 3.92(1.55) | 4.19(1.82) | F(2,256) = 3.58, p = 0.03 | TAU vs. RG (p = 0.39), TAU vs. RS (p = 0.03) | RG vs. RS (p = 1.00) |
| 2 I learned to improve my level of detachment when I get frustrated | 4.10(1.74) | 3.95(1.72) | 4.03(1.69) | 4.41(1.79) | F(2,255) = 1.68, p = 0.19 | TAU vs. RG (p = 1.00), TAU vs. RS (p = 0.23) | RG vs. RS (p = 0.58) |
| 3 I was trained to enhance my level of stamina in dealing with tasks | 4.01(1.77) | 3.87(1.82) | 3.81(1.64) | 4.42(1.77) | F(2,256) = 2.82, p = 0.06 | TAU vs. RG (p = 1.00), TAU vs. RS (p = 0.11) | RG vs. RS (p = 1.00) |
| 4 I learned that preservation is important while dealing with strains | 4.58(1.80) | 4.37(1.91) | 4.50(1.58) | 4.97(1.78) | F(2,252) = 2.61, p = 0.08 | TAU vs. RG (p = 1.00), TAU vs. RS (p = 0.08) | RG vs. RS (p = 0.37) |
| 5 I trained my adherence to instructions | 4.07(1.90) | 3.70(1.92) | 3.89(1.70) | 4.81(1.88) | F(2,251) = 8.46, p < 0.001 | TAU vs. RG (p = 1.00), TAU vs. RS (p < 0.001) | RG vs. RS (p = 0.01) |
| 6 I trained my accuracy in task processing | 3.75(1.95) | 3.50(1.94) | 3.41(1.82) | 4.43(1.94) | F(2,252) = 6.73, p = 0.001 | TAU vs. RG (p = 1.00), TAU vs. RS (p < 0.001) | RG vs. RS (p = 0.01) |
| 7 I trained my discomfort tolerance | 3.38(1.94) | 3.03(1.94) | 3.24(1.79) | 4.10(1.91) | F(2,255) = 7.46. p=0.001 | TAU vs. SP (p = 1.00), TAU vs. RS (p = 0.02) | RG vs. RS (p = 0.02) |
| 8 I have increased my readiness to overcome personal deficits | 3.52(1.81) | 3.13(1.68) | 3.55(1.85) | 4.12(1.82) | F(2,251) = 7.06, p = 0.001 | TAU vs. RG (p = 0.39), TAU vs. RS (p < 0.001) | RG vs. RS (p = 0.17) |
| 9 I learned to endure unpleasant tasks | 3.85(1.92) | 3.17(1.82) | 3.70(1.79) | 5.04(1.63) | F(2,254) = 25.74, p <0.001 | TAU vs. RG (p = 0.15), TAU vs. RS (p < 0.001) | RG vs. RS (p <0.001) |
| 10 I was able to improve my flexibility | 4.33(1.79) | 3.89(1.78) | 4.30(1.64) | 5.05(1.71) | F(2,255) = 10.37, p <0.001 | TAU vs. RG (p = 0.37), TAU vs. RS (p < 0.001) | RG vs. RS (p = 0.03) |
| RS scale (sum score) | 3.93(1.36) | 3.60(1.26) | 3.82(1.29) | 4.55(1.40) | F(2,257) = 12.26, p < 0.001 | TAU vs. RG (p = 0.82), TAU vs. RS (p < 0.001) | RG vs. RS (p = 0.003) |
| I was asked in all sessions to refer to the topic of the day | 4.23(2.17) | - | 4.28(2.17) | 4.20(2.25) | F(2,253) = 0.01, p = 0.99 | - | RG vs. RS (p=0.99) |
j.gp-2018-0010.tab.040.w2aab3b7c10b1b6b1ab2b3ad119Aa
| □ | Do not allow everything to touch you |
| □ | If I am mad on me, it is myself who is mad on me |
| □ | This is life: sometimes you win, sometimes you loose |
| Take it as it is | |
| Be happy don’t worry | |
| □ | ___________________________________________ |
j.gp-2018-0010.tab.017.w2aab3b7c10b1b6b1ab2b3ac46Aa
| Time (Min) | Contents | Materials | Tasks of Therapist |
|---|---|---|---|
| 0 – 5’ | Welcoming of participants, Reiterate motto of the day | List of participants | Check the list of participants, welcome new participants |
| 5’ - 20’ | Introduction to the concept of first impression formation, give example of prominent persons | MED (minimal emotional dysfunction) rating form | Give information about first impression |
| 20‘ – 40‘ | MED rating (minimal and observer emotional rating, dysfunction) comparison self of both ratings, focus on clothing | MED rating form, pencil | Be careful and helpful, point to positive aspects of positive and negative ratings |
| 40’ - 80’ | Set up small groups, participants should provide and receive individual feedback, suggestions for improvement | MED rating form, digital camera | Point to aspects which can be improved, specify what can be changed |
| 80’ – 90’ | Summary of session and explanation of treatment take care topic: of yourself „Here when you can stressed”. learn to Termination of session | List of participants | Give a summary |
j.gp-2018-0010.tab.028.w2aab3b7c10b1b6b1ab2b3ac82Aa
| □ | Never throw in the towel too early |
| □ | Only those who keep a stiff upper lip will succeed |
| □ | Giving in is not an option |
| □ | If something is difficult, just try harder |
| If you want to play the piano, you have to practice | |
| Rome was not build in a day | |
| □ | __________________________________________ |
j.gp-2018-0010.tab.019.w2aab3b7c10b1b6b1ab2b3ac52Aa
| Time (Min) | Contents | Materials | Tasks of Therapist |
|---|---|---|---|
| 0 – 5’ | Welcoming of participants, Reiterate motto of the day | List of participants | Check the list of participants, welcome new participants |
| 5’ - 20’ | Information about importance of first impression formation in different situations, („How do I have to look, if..“, „Shall I go to a first date like this“?) | Fill-in MED questionnaire, in regard to prominent persons | Encourage discussion of participants |
| 20’ - 80’ | Individual transfer: what are important situations in my life?, When and where should I change my attire and outlook? Set up small groups to give feedback per person | Focus on goals in different situations; what do I want to achieve | |
| 80’ – 90’ | Summary of session and explanation of treatment topic: „Here you can learn to take care of yourself when stressed”. Termination of session | List of participants | Give a summary |
j.gp-2018-0010.tab.033.w2aab3b7c10b1b6b1ab2b3ac97Aa
| Time (Min) | Content | Material | Tasks of Therapist |
|---|---|---|---|
| 0 – 5’ | Welcoming of participants | List of participants | Check welcome the list new of participants participants |
| 5’-15’ | Introduction into the topic accuracy, presentation of silhouette cutting, exchange of experiences of patients, link to general framework of session | Sheet for individual motto on the topic of „accuracy“, pencils | Explain the exercise and prepare the transfer into real life |
| 15’-30‘ | Set a time frame for making a first silhouette, Explain the need of concentration and accuracy | Examples, scissors, paper | Support the patient to go on; discuss the topic in reference to different areas in life |
| 30 – 40 | Summary, what was easy, what diffficult | Get response from patients | |
| 40 – 75 | Make another silhouette | Paper, scissors, template | Support the patient to go on; discuss the topic in reference to different areas in life |
| 75 – 80 | Presentatin of results in the group | accuracy, Focus on irrespective strategies to of reach results | |
| 80’ – 90’ | Summary of session and explanation of step treatment to improve topic: your „Here coping you can skills learn with step stress” by Termination of session | List of participants | Give a summary |
j.gp-2018-0010.tab.029.w2aab3b7c10b1b6b1ab2b3ac84Aa
| Time (Min) | Content | Material | Tasks of Therapist |
|---|---|---|---|
| 0 – 5’ | Welcoming of participants | List of participants | Check welcome the list new of participants participants |
| 5’-15’ | Introduction into the topic endurance, presentation of the material „soap stone“, exchange of experiences of patients, link to general framework of session | Sheet for individual motto on the topic of „endurance“, pencils | Explain the exercise and prepare the transfer into real life |
| 15’- 80‘ | Set a time frame for making a simple soap stone figure | stone Template figures, with soap pictures stone, of MCD sheet to remind patient of his personal goals | Support the patient to go on; discuss the topic in reference to different areas in life |
| 80’ – 90’ | Summary of session and explanation of treatment topic: „Here you can learn step by step to improve your coping skills with stress” Termination of session | List of participants | Give a summary |
j.gp-2018-0010.tab.023.w2aab3b7c10b1b6b1ab2b3ac66Aa
| Time (Min) | Content | Material | Tasks of Therapist |
|---|---|---|---|
| 0 – 5’ | Welcoming of participants | List of participants | Check welcome the list new of participants participants |
| 5’-25’ | Introduction to the concept of minimal cerebral dysfunctions (MCD) and skills needed to cope with stress | Pictures and illustrative material | education about the MCD concept and stress coping skills |
| 25’-40‘ | Completion of the MCD-scale | MCD scale | Support participants questionnaire to fill in the |
| 40’ – 75’ | Group discussion on „compensation strategies“ for personal problems | Marker pen and flipchart | Collect ideas of participants, add your own suggestions |
| 75’ - 80’ | Listing of individual goals ⌷ „This is what I want to practice“ | Small index cards for each patient | Help participants to specify their training goals |
| 80’ – 90’ | Summary of session and explanation of treatment topic: „Here you can learn step by step to improve your coping skills with stress” Termination of session | List of participants | Give a summary |
j.gp-2018-0010.tab.026.w2aab3b7c10b1b6b1ab2b3ac75Aa
| Time (Min) | Content | Material | Tasks of Therapist |
|---|---|---|---|
| 0 – 5’ | Welcoming of participants | List of participants | Check welcome the list new of participants participants |
| 5’-15’ | Presentation of the task („today we are going to fold a more difficult figure than last time“) | Written instruction, Origami paper for each participant, individual motto on the topic of „frustration tolerance“ | Explain the exercise |
| 15’-80‘ | Give a time frame | MCD-sheet to remind the patient of stress coping skills to be learned; Origami materials | Make patients fold origamis, Support the patient to go on; discuss the topic in reference to different areas in life |
| 80’ – 90’ | Summary of session and explanation of treatment topic: „Here you can learn step by step to improve your coping skills with stress” Termination of session | List of participants | Give a summary |
Therapeutic interventions in the regeneration and the resistance group
| Resistance group | Regeneration group |
|---|---|
| Frustration training (origami) | Recreational activities (collection and planning of hobbies and activities) |
| Endurance training (soap stone) | Ability to relish and hedonic rules (eating, tea ceremony, mindfulness cooking) |
| Accuracy training (silhouette cuttings, basketry) | Self-care and relaxation (wax bath, relaxation and imagination exercises, mindfulness walks) |
| Goal orientation and acceptance of undesired tasks (working with hard wood) | First impression formation (clothing, hairstyle, situational adjustment) |
| Acceptance of stress and criticism (enkaustik, aquarelle painting, soap stone with swapping with the neighbour during working on the task) | Interaction and small talk (parlour games, small talk) |
j.gp-2018-0010.tab.014.w2aab3b7c10b1b6b1ab2b3ac37Aa
| Time (Min) | Contents | Materials | Tasks of Therapist |
|---|---|---|---|
| 0 – 5’ | Welcoming of participants, Reiterate motto of the day | List of participants | Check the list of participants, welcome new participants |
| 5’ - 45’ | Introduction music in the to background, tea ceremony, different calm and kinds relaxing of tea | Tea kettle, cups, supplies music (candy, player, honey), lemon cutlery, juice, evaporated milk | let the group have a chat |
| 45’ - 60’ | Debriefing of tea ceremony, what was pleasant? Reference to hedonic rules | Individual materials on hedonic rules | Focus on pleasant experiences |
| 60’-80’ | General information about tea, cultural characteristics (far eastern countries), exchange of experiences/knowledge in patient group, on the basis of journeys, reading | Give information about tea and simultaneously include ideas of the patients | |
| 80’–90’ | Summary of session and explanation of treatment topic: „Here you can learn to take care of yourself when stressed”. Termination of session | List of participants | Give a summary |
j.gp-2018-0010.tab.021.w2aab3b7c10b1b6b1ab2b3ac58Aa
| Time (Min) | Contents | Materials | Tasks of Therapist |
|---|---|---|---|
| 0 – 5’ | Welcoming of participants, Reiterate motto of the day | List of participants | Check the list of participants, welcome new participants |
| 5’ - 20’ | Introduction of the topic social interaction as method to reduce stress | Give information and encourage discussion | |
| 20‘ – 80‘ | Play parlour games and encourage small talk | Different parlour games | Encourage ion participants small talk to engage |
| 80’ – 90’ | Summary of session and explanation of treatment care of yourself topic: when „Here stressed”. you can learn Termination to take of session | List of participants | Give a summary |
j.gp-2018-0010.tab.030.w2aab3b7c10b1b6b1ab2b3ac87Aa
| Time (Min) | Content | Material | Tasks of Therapist |
|---|---|---|---|
| 0 – 5’ | Welcoming of participants | List of participants | Check the list new of participants, participants welcome |
| 5’-15’ | Repetition of the experiences of the last session, link to general framework of session (topic:„endurance “) and repetition of individual mottos | Individual materials on the topic of „endurance“ | Prepare transfer into real life |
| 15’-80‘ | Set a time frame for making a moderately severe soap stone figure | Template with pictures, soap stone, MCD work sheet | Support the patient to go on; discuss the topic in reference to different areas in life |
| 80’ – 90’ | Summary of session and explanation of treatment topic: „Here you can learn step by step to improve your coping skills with stress” Termination of session | List of participants | Give a summary |
j.gp-2018-0010.tab.027.w2aab3b7c10b1b6b1ab2b3ac78Aa
| Time (Min) | Content | Material | Tasks of Therapist |
|---|---|---|---|
| 0 – 5’ | Welcoming of participants | List of participants | Check welcome the list new of participants participants |
| 5’-15’ | Presentation of the task („today we are going to fold a real difficult figure “) | Written instruction, Origami paper for each participant, individual motto on the topic of „frustration tolerance“ | Explain the exercise |
| 15’-80‘ | Give a demanding time frame | MCD-sheet to remind the patient of stress coping skills to be learned; Origami materials | Make patients fold origamis, Support the patient to go on; discuss the topic in reference to different areas in life |
| 80’ – 90’ | Summary of session and explanation of treatment topic: „Here you can learn step by step to improve your coping skills with stress” Termination of session | List of participants | Give a summary |
j.gp-2018-0010.tab.018.w2aab3b7c10b1b6b1ab2b3ac49Aa
| Time (Min) | Contents | Materials | Tasks of Therapist |
|---|---|---|---|
| 0 – 5’ | Welcoming of participants, Reiterate motto of the day | List of participants | Check the list of participants, welcome new participants |
| 5’ - 20’ | Information about importance of body care and hairstyle, refer to prominent persons | Pictures of prominent persons, ideally with different hair styles | Give information about first impression |
| 20’ - 80’ | All participants should get individual feedback on their hairstyle and suggestions for improvement, everybody should try something new (hairstyle, cosmetics) | MED rating, cosmetic preparations for hair and body, digital camera | encourage change and experiments with hair and cosmetics |
| 80’ – 90’ | Summary of session and explanation of care treatment of yourself topic: when „Here stressed”. you can learn Termination to take of session | List of participants | Give a summary |
j.gp-2018-0010.tab.010.w2aab3b7c10b1b6b1ab2b3ac25Aa
| Time (Min) | Contents | Materials | Tasks of Therapist |
|---|---|---|---|
| 0 – 5’ | Welcoming of participants, Reiterate motto of the day | List of participants | Check the list of participants, welcome new participants |
| 5’ - 15’ | Repeat hedonic rule | worksheet with hedonic rules | Encourage repetition |
| 15’ - 65’ | Set up small groups, preparation of different spreads | worksheet with recipes, ingredients for spreads | Encourage patients to communicate and have small talk, appreciate small progresses |
| 65’ - 85’ | Jointly eating of prepared foods, eat slowly, concentrate on taste and concomitant emotions | Cutlery and plates, nice background music | Join the conversation of participants, discriminate differences in tastes, focus on pleasant experiences |
| 85’ – 90’ | Summary of session and explanation of treatment take care topic: of yourself „Here when you can stressed”. learn to Termination of session | List of participants | Give a summary |
j.gp-2018-0010.tab.003.w2aab3b7c10b1b6b1ab2b3ab4Aa
| Time (Min) | Contents | Materials | Tasks of Therapist |
|---|---|---|---|
| 0 – 5’ | Welcoming of participants | List of participants | Check the list of participants, welcome new participants |
| 5’-30’ | Presentation of the RADL list (Recreational Activities of Daily Living), What is it about? Explanation of the general framework (activities despite impairment, What comes to my mind when filling in the list? | completion of RADL list by each participant | Collect ideas by of participants, support the exchange of personal experiences |
| 30’-40’ | Focus of collection on recreational activities in the past (each participant writes down at least 3 activities) | Pencil and paper for each participant | Support the exchange of experiences and give examples |
| 40’ – 85’ | Specify individual goals („Which pleasant things do I want to do again?“) | Pencil and paper for each participant | Make sure that discussion is focused on exchange, without evaluation, reinforce small progresses and ideas |
| 85’ – 90’ | Summary of session and explanation of treatment topic: „Here you can learn to take care of yourself when stressed”. Termination of session | List of participants | Give a summary |
j.gp-2018-0010.tab.012.w2aab3b7c10b1b6b1ab2b3ac32Aa
| □ | Recover energy by pampering yourself |
| □ | To avoid decay means to maintain |
| □ | I spoil myself, because I am worth it |
| □ | Before you can help others, you must help yours |
| □ | feel the power you gain from calmness |
| □ | ________________________________________________ |
j.gp-2018-0010.tab.035.w2aab3b7c10b1b6b1ab2b3ad103Aa
| Time (Min) | Content | Material | Tasks of Therapist |
|---|---|---|---|
| 0 – 5’ | Welcoming of participants | List of participants | Check welcome the list new of participants participants |
| 5’-15’ | Repetition of what has been learned | MCD worksheet | Summarize results |
| 15’-80’ | Continuation of basket weaving, focus on difficulties and compensatory strategies | Materials for basket weaving for each patient | Specify compensatory strategies, support transfer into real life |
| 80’ – 90’ | Summary of session and explanation of step treatment to improve topic: your „Here coping you can skills learn with step stress” by Termination of session | List of participants | Give a summary |
j.gp-2018-0010.tab.020.w2aab3b7c10b1b6b1ab2b3ac56Aa
| □ | Two heads know more than one |
| □ | If you start a long journey, take a friend along |
| □ | A problem shared is a problem halved |
| □ | We all need friends and company |
| □ | __________________________________________ |
j.gp-2018-0010.tab.008.w2aab3b7c10b1b6b1ab2b3ac20Aa
| □ | Meals are a wonderful opportunity to make me happy |
| □ | Eating is more than just taking in food |
| □ | If you feel bad, spoil yourself |
| □ | Feeling, tasting and smelling can all cheer you up |
| □ | ______________________________________________ |
j.gp-2018-0010.tab.011.w2aab3b7c10b1b6b1ab2b3ac28Aa
| Time (Mind | Contents | Materials | Tasks of Therapist |
|---|---|---|---|
| 0 – 5’ | Welcoming of participants, Reiterate motto of the day | List of participants | Check the list of participants, welcome new participants |
| 5’ - 15’ | What is important for a good meal except the food: table decoration, how does my table at home look like? | Show pictures of different tables | Motivate participants to exchange thoughts about „pleasant/unpleasant“ table decoration |
| 15’ - 80’ | Preparation of a table decoration as group activity, seasonal differences? (Easter, spring, summer) | Serviettes, fabric belts, other decoration materials, flowers etc | Support group activities, review feasibility, appreciate proposals, encourage casual exchange |
| 80’ – 90’ | Summary of session and explanation of treatment care of yourself topic: when „Here stressed”. you can learn Termination to take of session | List of participants | Give a summary |
j.gp-2018-0010.tab.024.w2aab3b7c10b1b6b1ab2b3ac70Aa
| □ | When it matters, I do not let myself be impressed by adverse conditions |
| □ | The ascent is especially worth it, if it takes a rocky way |
| □ | Life ´s not a bowl of cherries |
| □ | One has to accept the reality: eaten bread is soon forgotten |
| □ | _________________________________________________ |
j.gp-2018-0010.tab.041.w2aab3b7c10b1b6b1ab2b3ad121Aa
| Time (Min) | Content | Material | Tasks of Therapist |
|---|---|---|---|
| 0–5’ | Welcoming of participants | List of participants | Check the list of participants, welcome new participants |
| 5’-15’ | Repetition of the mottos on the topic of „Acceptance of stress and criticism “, preparation of transfer ⌷ Where could I use it? | individual mottos for each participant | Compile the results, motivate participants, refer to individual mottos |
| 15’-35‘ | Block of tasks I: Solving of simple brain teasers under time pressure and competitive pressure | package with brain teaser for each participant | Pay attention to time regulation |
| 35’-45’ | Evaluation of the first block of tasks, „What was easy?“, „What was difficult?“, „What was stressful?“, „Does the stress remind me of other situations?“ | MCD work sheet | Specify compensatory strategies, focus on transfer perspective |
| 45’-65’ | Block of tasks II: Solving of difficult brain teasers under time pressure and competitve pressure, evaluation of results in the group | package with brain teaser for each participant | Compile the results, motivate participants, refer to individual mottos |
| 65’-80’ | Evaluation of the second block of tasks, „What was easy?“, „What was difficult?“, „What was stressful?“, „Does the stress remind me of other situations?“, comparison with first task | MCD work sheet | Specify compensatory strategies, apply topic across different areas in life |
| 80’–90’ | Summary of session and explanation of step treatment to improve topic: your „Here coping you can skills learn with step stress” by Termination of session | List of participants | Give a summary |
j.gp-2018-0010.tab.039.w2aab3b7c10b1b6b1ab2b3ad115Aa
| Time (Min) | Content | Material | Tasks of Therapist |
|---|---|---|---|
| 0 – 5’ | Welcoming of participants | List of participants | Check the list of participants, welcome new participants |
| 5’-15’ | Presentation of today´s contents: Presentation of the motto of the day “goal orientation and acceptance of undesired tasks“ | Personal motto on “goal orientation and acceptance of undesired tasks“ | support participants to find their own motto |
| 10’-30‘ | Moderately severe brain teaser | Package of brain teasers for each participant | encourage Pay attention participants to time, to gon on |
| 30’-40’ | Discussion of task, Where are my own limits? | Motto on flexibility | Specify compensatory strategies |
| 50’-80’ | Work on wood with sandpaper | Wooden blocks, sandpaper for each participant | encourage Pay attention participants to time, to go on |
| 70’-80 | Presentation of results in the group by each participant, what were the difficulties, feedback on performance, suggestions for improvement | MCD sheet | Ask participants specifically about compensatory strategies, reinforce effort independent of result |
| 80’ – 90’ | Summary of session and explanation of treatment topic: „Here you can learn step by step to improve your coping skills with stress” Termination of session | List of participants | Give a summary |
j.gp-2018-0010.tab.005.w2aab3b7c10b1b6b1ab2b3ac10Aa
| Time(Min) | Contents | Materials | Tasks of Therapist |
|---|---|---|---|
| 0 – 5’ | Welcoming of participants, Reiterate motto of the day | List of participants | Check the list of participants, welcome new participants |
| 5’ - 30’ | Refer to RADL list, now we do the transfer into real life Presentation of the weekly activity schedule, Every participant fills in a plan for the next week. Quantity is less important than performance | For each patient a template of a weekly activity schedule, pencils | Collect ideas by interviewing the participants, support exchange of ideas |
| 30’ - 50’ | fill in the activity schedule | Help participants to fill in the schedule, reinforce creativity and little progresses | |
| 50’ – 65’ | Evaluation of weekly schedule for each category of the RADL | Summarize main categories, reinforce own ideas and progress | |
| 65’ - 80’ | Set up groups participants according to favorite activities (Are there persons, who do things together? (go to cinema, go out for a mea). Arrangement of appointments | Write appointments on flipchart | Stimulate openness, record appointments, praise ideas and progresses |
| 80’ – 90’ | Summary of session and explanation of treatment topic: „Here you can learn to take care of yourself when stressed”. Termination of session | List of participants | Give a summary |
j.gp-2018-0010.tab.007.w2aab3b7c10b1b6b1ab2b3ac16Aa
| Time (Min) | Contents | Materials | Tasks of Therapist |
|---|---|---|---|
| 0 – 5’ | Welcoming of participants, Reiterate motto of the day | List of participants | Check the list of participants, welcome new participants |
| 5’ - 70’ | Present creative activities, painting, nitting, handycraft, etc., refer to RADL list, what have I done in former times ? Motivate patients to try out new techniques | Materials for craft activity, RADL list of participant | Encourage patient to freely try out, give instructions if needed, also encourage to interact |
| 70‘ – 80‘ | Presentation of results, exchange in the group | Guide open also discussion, minor details appreciate | |
| 80’ – 90’ | Summary of session and explanation of treatment care of yourself topic: when „Here stressed”. you can learn Termination to take of session | List of participants | Give a summary |
j.gp-2018-0010.tab.004.w2aab3b7c10b1b6b1ab2b3ab8Aa
| □ | Under stress you need recreation |
| □ | Always keep a balance between work and leisure |
| □ | There is a time for everything, work and relaxation |
| □ | Creativity is pleasure, which pretends to be work |
| □ | ________________________________________________ |
j.gp-2018-0010.tab.032.w2aab3b7c10b1b6b1ab2b3ac94Aa
| □ | If you do the work properly from the beginning, you save time |
| □ | Doing something correctly is better than doing it sloppy |
| □ | Sloppiness is not a virtue |
| □ | _________________________________________________________ |
| □ | _________________________________________________________ |
j.gp-2018-0010.tab.016.w2aab3b7c10b1b6b1ab2b3ac44Aa
| □ | Your outer appearances decides about how others see you |
| □ | Look the way you want to be seen |
| □ | If one feels bad, one should at least not look bad |
| □ | If the world is grey, put glitter on it |
| □ | _____________________________________________________ |
j.gp-2018-0010.tab.015.w2aab3b7c10b1b6b1ab2b3ac40Aa
| Time (Min) | Contents | Materials | Tasks of Therapist |
|---|---|---|---|
| 0 – 5’ | Welcoming of participants, Reiterate motto of the day | List of participants | Check the list of participants, welcome new participants |
| 5’ - 15’ | Introduce manual activities as method of relaxation. Refer to session 4 | Discuss with patient their prior experiences | |
| 15‘ – 65‘ | Stimulate work on creative activities, painting, nitting, handycraft, etc | Materials for craft activitiy, RADL list of participant | Encourage patients to engage in an interesting activity, give help if needed, encourage interaction between patients |
| 65‘ – 80‘ | Exchange about relaxation by activity | Free discussion, aspects focus on positive | |
| 80’–90’ | Summary of session and explanation of treatment take care topic: of yourself „Here when you can stressed”. learn to Termination of session | List of participants | Give a summary |
j.gp-2018-0010.tab.013.w2aab3b7c10b1b6b1ab2b3ac34Aa
| Time (Min | Contents | Materials | Tasks of Therapist |
|---|---|---|---|
| 0 – 5’ | Welcoming of participants, Reiterate motto of the day | List of participants | Check the list of participants, welcome new participants |
| 5’ - 20’ | Presentation of hedonic rules, exchange of own ideas | Individual materials on the topic of: „ability to relish“ | Give information on hedonic rules |
| 20’ - 25’ | Presentation of paraffin bath and focus on practicing an hedonic rule | Pencil for patients to tick off one hedonic rule | only one aspect should be practised |
| 25’ - 70’ | Paraffin bath with pleasant and relaxing music | Paraffin disinfectant bath, gloves | Help participants to paraffin, concentrate create on results a calm and of relaxing atmosphere |
| 70’ - 80’ | Which hedonic rule do I want to practice this week? (transfer in real life) | A pencil and small index cards for every patient to write down the hedonic rule he wants to practice | |
| 80’ – 90’ | Summary of session and explanation of treatment topic: „Here you can learn to take care of yourself when stressed”. Termination of session | List of participants | Give a summary |
j.gp-2018-0010.tab.042.w2aab3b7c10b1b6b1ab2b3ad124Aa
| Time (Min) | Content | Material | Tasks of Therapist |
|---|---|---|---|
| 0 – 5’ | Welcoming of participants | List of participants | Check welcome the list new of participants participants |
| 5’-15’ | Discussion of the topic „Acceptance of stress and criticism“ | Personal motto on acceptance of stress and criticism | Support participants to find their own specific motto of the day |
| 15’-25‘ | Explain „Tangram“, hand out materials, give an easy task, set out time frame | Tangram-packages for each participant | Pay attention to time, encourage participants to go on |
| 25’-35’ | Second Tangram task, moderately severe task | Tangram-participant packages for each | encourage Pay attention participants to time, to go on |
| 35’-45’ | Summary: What was the task, what were the difficulties, how did you manage to go on? | MCD work sheet | Summarize and transfer ideas of participants to real life |
| 45’-65’ | difficult Tanagram task | Tanagram-packages for each participant | Pay attention to time, encourage participants to go on |
| 65’-80 | Summary: What was the task, what were the difficulties, how did you manage problems? | MCD work sheet | Summarize and transfer ideas of participants to real life |
| 80’ – 90’ | Summary of session and explanation of step treatment to improve topic: your „Here coping you can skills learn with step stress” by Termination of session | List of participants | Give a summary |
j.gp-2018-0010.tab.031.w2aab3b7c10b1b6b1ab2b3ac90Aa
| Time (Min) | Content | Material | Tasks of Therapist |
|---|---|---|---|
| 0 – 5’ | Welcoming of participants | List of participants | Check welcome the list new of participants participants |
| 5’-15’ | Repetition of the experiences of the last session, link to general framework of session (topic:„endurance “), remind of individual mottos | Individual materials on the topic of „endurance“ | Prepare transfer into real life |
| 15’-80‘ | Set time frame to work on a severe soap stone figure, give on written instructions (building on past experiences) | Template with pictures, soap stone, MCD work sheet | Support the patient to go on; discuss the topic in reference to different areas in life |
| 80’ – 90’ | Summary of session and explanation of step treatment to improve topic: your „Here coping you can skills learn with step stress” by | List of participants | Give a summary |
j.gp-2018-0010.tab.006.w2aab3b7c10b1b6b1ab2b3ac13Aa
| Time (Min) | Contents | Materials | Tasks of Therapist |
|---|---|---|---|
| 0 – 5’ | Welcoming of participants, Reiterate motto of the day | List of participants | Check the list of participants, welcome new participants |
| 5’ - 20’ | Summary of current state of knowledge. Why are pleasant activities important? What did I already learn? | Individual materials on the topic of „spontaneous and recreational activities“ | Collect ideas by interviewing the participants, support the exchange of ideas |
| 20’ - 40’ | Work on an individual weekly schedule for the time after treatment, completion of RADL, How to put the ideas in practice | Empty weekly schedule. RADL list for the time after the end of therapy, pencils | Help participants if needed, reinforce creativity and small progresses |
| 40’ – 50’ | Presentation of the concept of a „hedonistic niche“. How could a respective room look like? | Pictures of different rooms from furniture catalogues | Guide open discussion, appreciate also minor details (e.g. flowers, candles etc.) |
| 50’ - 85’ | How can I establish a hedonistic niche in my room? Set up small groups of patients to discuss solutions | Worksheets for documentation of events and own ideas | Specify solutions, reinforce even small steps, focus only on positive aspects |
| 80’ – 90’ | Summary of session and explanation of treatment care of yourself topic: when „Here stressed”. you can learn Termination to take of session | List of participants | Give a summary |
j.gp-2018-0010.tab.022.w2aab3b7c10b1b6b1ab2b3ac61Aa
| Time (Min) | Contents | Materials | Tasks of Therapist |
|---|---|---|---|
| 0 – 5’ | Welcoming of participants, Reiterate motto of the day | List of participants | Check the list of participants, welcome new participants |
| 5’ - 20’ | Repeat experience of last session, What is difficult, what easy in regard to small talk | ||
| 20‘ – 60‘ | Play parlour games and encourage mutual supportive communication | Different parlour games | Encourage participants to encourage, console and support each other, especially when somebody is loosing or making mistakes |
| 60‘ – 80‘ | Feedback on experience with communication | Encourage discussion, focus on positive aspects | |
| 80’–90’ | Summary of session and explanation of treatment take care topic: of yourself „Here when you can stressed”. learn to Termination of session | List of participants | Give a summary |
j.gp-2018-0010.tab.037.w2aab3b7c10b1b6b1ab2b3ad109Aa
| Time (Min) | Content | Material | Tasks of Therapist |
|---|---|---|---|
| 0 – 5’ | Welcoming of participants | List of participants | Check the list of participants, welcome new participants |
| 5’-15’ | Presentation of the motto of today “goal orientation and acceptance of undesired tasks“ | Personal motto on „ “goal orientation and acceptance of undesired tasks” | support find their participants own motto to on acceptance of undesired tasks |
| 15-30’ | Introduction to wood carving | Illustrative material | Explain how wood to work with |
| 30’-70’ | Work on wood with sandpaper | Wooden blocks, sandpaper for each participant | encourage Pay attention participants to time, to go on |
| 70’-80 | Presentation of results in the group by each participant, what were the difficulties, feedback on performance, suggestions for improvement | MCD sheet | Ask participants specifically about compensatory strategies, reinforce effort independent of result |
| 80’ – 90’ | Summary of session and explanation of treatment topic: „Here you can learn step by step to improve your coping skills with stress” Termination of session | List of participants | Give a summary |
j.gp-2018-0010.tab.038.w2aab3b7c10b1b6b1ab2b3ad112Aa
| Time (Min) | Content | Material | Tasks of Therapist |
|---|---|---|---|
| 0 – 5’ | Welcoming of participants | List of participants | Check welcome the list new of participants participants |
| 5’-15’ | Presentation of the motto of the day: “goal orientation and acceptance of undesired tasks”, repetition of earlier experiences | Individual motto of the day regarding “goal orientation and acceptance of undesired tasks “ | Reiterate the results from past session |
| 15’-25‘ | Work on Rubick cube and brain teaser | Rubick cube for each participant | Explain the Rubick cube task, motivate to go on at the beginning and then step back |
| 25’-30’ | Discussion limits? on Collection current of task, ideas Where on solutions are my own | MCD sheet | Specify compensation strategies |
| 30’-80’ | Continue work on complex wood structures with sandpaper | Wooden blocks. Sandpaper for each participant | Pay attention to time, encourage participants to go on |
| 80’ – 90’ | Summary of session and explanation of step treatment to improve topic: your „Here coping you can skills learn with step stress” by Termination of session | List of participants | Give a summary |
j.gp-2018-0010.tab.034.w2aab3b7c10b1b6b1ab2b3ad100Aa
| Time (Min) | Content | Material | Tasks of Therapist |
|---|---|---|---|
| 0 – 5’ | Welcoming of participants | List of participants | Check welcome the list new of participants participants |
| 5’-15’ | Repetition of past learned lessons, what has been | MCD sheet | Collect group responses |
| 15’-25‘ | Instruction to weaving of a wicket basket | Materials for each basket patient weaving for | Pay attention participants to time, to go encourage on |
| 25’-80’ | Basket problems weaving in reference and focusing to MCD on personal sheet | MCD sheet | Specify compensatory strategies |
| 80’ – 90’ | Summary of session and explanation of step treatment to improve topic: your „Here coping you can skills learn with step stress” by Termination of session | List of participants | Give a summary |
j.gp-2018-0010.tab.025.w2aab3b7c10b1b6b1ab2b3ac72Aa
| Time (Min) | Content | Material | Tasks of Therapist |
|---|---|---|---|
| 0 – 5’ | Welcoming of participants | List of participants | Check welcome the list new of participants participants |
| 5’-10’ | Introduction in the topic „frustration tolerance“, ask for individual mottos | Worksheet for each participant, pencils | Provide assistance if participants do not understand the task, discuss the topic in reference to different areas in life |
| 10’- 15‘ | Introduction of „Origami“, „What does frustration tolerance have to do with it?“ | Origami + template | Clarify transfer to life burdens |
| 15’ – 70’ | Explanation and implementation of technique by therapists, Tutorial to fold a figure/template | Template for each patient, Origami-Paper | Explain the, motivate the patient to go on |
| 70’ - 80’ | Feedback: „What have I learned or practiced regarding my frustration tolerance” or stress coping skills? | Worksheet for personal selection-optimization- compensation (SOC) strategies | Each participant should have the opportunity to participate in the discussion |
| 80’ – 90’ | Summary of session and explanation of treatment by step to topic: improve „Here your you coping can learn skills step with stress” Termination of session | List of participants | Give a summary |
j.gp-2018-0010.tab.009.w2aab3b7c10b1b6b1ab2b3ac22Aa
| Time (Min) | Contents | Materials | Tasks of Therapist |
|---|---|---|---|
| 0 – 5’ | Welcoming of participants, Reiterate motto of the day | List of participants | Check the list of participants, welcome new participants |
| 5’ - 25’ | Eating as What a source does of eating well-being, mean? clarify the difference to nutrition counselling | Guide a brainstorming of patients, reinforce good ideas | |
| 20’ - 25’ | Set up small groups of patients. What does eating mean for me? Discuss regional differences, exchange of information on special meals and methods of preparation, personal rituals: Which meal is the most important for me? | Map of the country/world, indicate the origin of participants, worksheet to collect individual eating rituals | Reinforce interest in unknown meals |
| 35’ - 45’ | What was special Evaluation in each of group group? work What was new, what did I learn? | Summarize results, create a calm and relaxing atmosphere | |
| 45’ - 80’ | Exercise with scents, refer to hedonic rules, what was pleasant and why? | „sample of aromas“, worksheet with hedonic rules | Focus on pleasant experiences, transfer into real life, what does this smell remind me of? |
| 80’ – 90’ | Summary of session and explanation of treatment topic: „Here you can learn to take care of yourself when stressed”. Termination of session | List of participants | Give a summary |
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