By Ryan Porritt, OT, Orem Rehabilitation & Nursing, Orem, UT
Occupational Therapy (OT) used non-pharmaceutical mindfulness-based interventions (HeartMath and Acceptance and Commitment Therapy) to support a patient while the physician reduced anxiety medication that she had been on for years. The patient has several mental health diagnoses, including bipolar disorder, PTSD, generalized anxiety disorder contributing to frequent panic attacks and high levels of anxiety. Her independence and quality of life is further complicated by several physical comorbidities that exacerbate the functional impact of her anxiety. She has a history of significant trauma as measured by scoring a 9/10 on the Adverse Childhood Experience scales.
The following are the step-down dosages of clonazepam:
Staring at 1 mg 3x daily
Reduced to 0.5 mg 3x daily on Jan. 21, 2020
Reduced again to 0.5 every 12 hours on Feb. 1, 2020, to present
The OT trained the patient in several meditations to reduce the emotional struggle resulting from her anxiety in order to increase participation in value-based activities. With assistance, the patient identified three value-based activities: writing poems, quilting and facilitating a weekly bible study group for her religious congregation. After 30 years of not writing poetry, she is able to express her pain, anxiety and other emotions through regular poetry writing. She has assumed a leadership position to prepare and facilitate weekly bible study groups, and she is currently being trained to lead a resident-run quilting group in collaboration with Recreation Therapy and the Therapy Department.
While the patient still faces daily challenges resulting from anxiety, she reports the duration and frequency of panic attacks have reduced and that “I am not struggling with my emotions as much anymore.” With less medication, she reports both increased quality of life and increased participation in value-based activities. While significant progress has been noted, she will require continued skilled OT under a maintenance plan due to the complexities of her physical and mental health. As illustrated by this example, skilled therapists are in an ideal position to have a significant impact on both function and quality of life while assisting physicians to reduce medications.