Letter to the Editor     August 2020  

Piloting Relaxation Techniques as Part of Occupational Therapy Programme in an In-patient Psychiatric Setting

By Humera Saeed1, Shameel Khan1, Natasha Farid1

Affiliations

  1. Department of Psychiatry, The Aga Khan University Hospital, Karachi, Pakistan

Sir,

People with mental health issues can have impairments in the activities of daily living.1 We looked at the efficacy of relaxation techniques and explored challenges in setting up relaxation groups in a psychiatric in-patient unit at the Aga Khan University Hospital, (AKUH).  It has an active occupational therapy programme that supports and encourages active engagement in patients’ recovery.

The rationale behind introducing relaxation techniques is based on the theory that these techniques help to focus on attention in a relaxed environment, can improve interpersonal skills, by reducing symptoms and speeding recovery.2,3 We conducted 18 pilot sessions from May 2017 to October 2017. Approval from Ethical Review Committee of AKUH and consent from the participants were sought. Written feedbacks (with standardised questions) were collected before and after each session. Pre-selected relaxation audios were used. The samples comprised of both in-patients and those attending day hospital, nurses, and trainee doctors / occupational therapists. Acutely unwell patients were excluded. The group met on weekly basis, led by two facilitators. Duration of each session was 30-40 minutes. Relaxation techniques utilised were mindful breathing, floating visualisation and loving and kindness techniques.

Group reflection followed each session to explore effectiveness of newly acquired skills.

Out of total 96 participants, 77 (80.2%) were in-patients; 16 (16.66%) were out-patients and 3 (3.1%) were trainee nurses, occupational therapist or doctor. Responses documented by the patients before the sessions were: feelings of sadness, anxiety, fear, fatigue, and worry. Afterwards, more than three quarters of the participants (89, 92.7%) reported feeling relaxed and calm. Response was similar with all three techniques.

Results of these controlled sessions demonstrate positive impact on the overall emotional state of participants. Calm, happy, relaxed were the frequent emotions encountered on feedbacks. These findings are consistent with previous literature highlighting importance of relaxation techniques.4,5 However, a number of technical and administrative challenges were identified like preliminary availability of appropriate venue, disturbance in the form of speaker, and lack of standardized verbal instructions. These all were addressed.

This was a single centre study with a small sample, which had quiet a few limitations. We used a standard feedback, which might be improved in future studies with bigger sample and specific scales. Even with limitations, we were successful in highlighting the benefits of relaxation techniques as part of management of patients with mental health issues; and its incorporation in occupational therapy programmes will improve overall patient care.

CONFLICT OF INTEREST: 
The authors declared no conflict of interest.

AUTHORS' CONTRIBUTION: 
HS: Conception and design, drafting, data acquisition, analysis and interpretation, critical revision, final approval.
SK: Conception and design, critical revision, final approval.
NF: Drafting, data acquisition, final approval

REFERENCES

  1. Fairburn CG, Fairburn SM. Relaxation training in psychiatric admission units. British J Occupational therapy 1979; 42(11).
  2. Evans S, Ferrando S, Findler M, Stowell C, Smart C, Haglin D. Mindfulness-based cognitive therapy for generalized anxietydisorder. J Anxiety Disord 2008; 22(4):716-21.
  3. Singh Y, Goel A, Kathrotia R, Patil PM. Role of yoga and meditation in the context of dysfunctional self: A hypothetico-integrative approach. Adv Mind Body Med 2014; 28(3):22-5.
  4. Falk-Kessler J, Momich C, Perel S. Therapeutic factors in occupational therapy groups. Am J Occupational Ther 1991; 45(1):59-66.
  5. Marchard WR. Mindfulness meditation practices as adjunctive treatments for psychiatric disorders. Br J Occupational Ther 2013; 36(1):141-52.