Peer Group

Presentation
on
Recreational Therapy
Play Therapy
Music Therapy

Subject: Psychiatric Mental Health

Nursing

Submitted to : Dr.Rajesh Konnur

HOD Psychiatric dept
SGRD CON Vallah,
ASR

Submitted by: Ms.Monika joseph

M.Sc (n) 1st year
Roll no: 1118
SGRD CON
Vallah,ASR
Submitted on: 5/23/2012
 SGRD COLLEGE OF NURSING, VALLAH
AMRITSAR
THERAPIES

INTRODUCTION:

Therapy is the attempted remediation of a health problem, usually following a diagnosis. In

the medical field, it is synonymous with the word "treatment".

RECREATIONAL THERAPY

INTRODUCTION

Recreation and leisure may seem to describe time spent doing nothing of importance, but an
allied health-care professional will quickly tell you that recreation and leisure are essential to
good health – not just physical but mental health as well. Recreation therapy programs
prepare people to use leisure activities to promote health and healing in patients. Students
learn counselling and leisure program planning. They also learn about human growth and
ways to work with people with special needs.

Recreation is a form of activity

therapy used in most psychiatric settings. Therapeutic recreation can occur as informal ping
pong and card games, structured soft ball, basket ball or volley ball games, as trips outside
the hospital, attending sport event and so on. Recreation or play activities provide patients
with the opportunity for fun and for feeling good. It tends balance to their daily schedule and
helps in treating the whole patient.
Play is one kind of recreation therapy. It is considered as a variety of occupations that
constitute a pleasurable way of passing time and are also the medium through wide range of
skills can be learned and rehearsed.
It can be scheduled in the morning to help patients feel better physically as they start
their day and give them a sense of accomplishment and participation. It is beneficial for
hyperactive patients because it channels their energy constructively within a specific
framework.
The chief emphasis of recreational therapy is on the social re education of the
patient, and the basic objective may be described as the restoration of some function e.g.
power of attention is previously learned but for the time being inhibited or temporarily lost
because of some personality change due to mental illness. The principle of “learning by
doing” is more used in recreational therapy.

APPLICATION OF RECREATION THERAPY:

The integration of recreation therapists to the multi-disciplinary team which includes :

- A psychiatrist
- Social workers,
 - Nurses

they all reflects emerging best practice recognizing evidence-based reporting on the benefits
of exercise and stress reduction techniques to patients’ overall health and well-being.

DEFINITION

Recreation is a form of activity therapy used in most psychiatric settings. It is planned

therapeutic activity that enables people with limitations to engage in recreational experiences.

AIMS

- To encourage social interaction.

- To decrease withdrawal tendencies.
- To provide outlet for feelings.
- To promote socially acceptable behaviour.
- To develop skills, talents and abilities.
- To increase physical confidence and a feeling of self worth.
- To train memory and concentration
- To re- educate mentally, physically and socially
- To give a sense of responsibility, e.g. by giving an opportunity to organize or lead a
game.
- To stimulate interest
- To stimulate or recreate self confidence.
- To arouse an develop attention
- To give opportunity for self expression
- To replace unhealthy trends by healthy one.
- To substitute encouragement for discouragement
- To improve the circulation
- To improve the appetite.
- To improve respiration
- To strengthen the tone of the muscle
- To develop a sense of rhythm
- To develop a good posture

POINTS TO BE KEPT IN MIND

- Provide non threatening and non-demanding environment.

- Provide activities that are relaxing and without rigid guidelines and time-frames.
- Provide activities that are enjoyable and self satisfying.

TYPES OF RECREATIONAL ACTIVITIES

 - MOTOR FORMS: These can be further divided into fundamental and accessory.
Based on whether the motor element is the main purpose of the activity or merely
incidental to it. Among the fundamental forms are such games as hockey and football,
while the accessory forms are exemplified by play activity and dancing. Fundamental
forms are such games as hockey and football.
- SENSORY FORMS: These can be either visual. For example: Looking at motion
picture, play or auditory such as listening to a concert etc.
- INTELLECTUAL FORMS: These include reading, debating and so on. recreation is
regarded in its every sphere, and the following shows the wide range in which it is
used:
a) Goal games, e.g hide and seek
b) Team games, e.g. hockey and football
c) Country sports, e.g. shooting, fishing
d) Combats, e.g. wrestling, boxing
e) Curiosity play, e.g. crossword puzzles
f) Creative play, e.g. play-acting
g) Vicarious play, e.g. viewing at motion pictures
h) Imitative play, e.g . follow the leader in folk dancing
i) Social play, e.g. party games
j) Aesthetic play,e.g. painting and clay modeling
k) Acquisition play, e.g. collecting antiques or stamps

SUGGESTED RECREATIONAL ACTIVITIES FOR PSYCHIATRIC DISORDER

a) ANXIETY DISORDER: Aerobic activities like walking, jogging etc.

b) DEPRESSIVE DISORDER: Non- competitive sports, which provide outlet for
anger like jogging, walking, running etc.
c) MANIC DISORDER: One to one basis individual games like shuttle badminton, ball
badminton etc.
d) SCHIZOPHRENIA (PARANOID): Activities requiring concentration like chess,
puzzles.
e) SCHIZOPHRENIA (CATATONIA): Social activities to give patient contact with
reality like dancing, Athletics.
f) DEMENTIA: Concrete, repetitious crafts and projects that breed familiarization and
comfort.
g) CHILDHOOD AND ADOLESCENT DISORDER: It is better to work with the
child on a one-to-one basis and give him a feeling of importance. Employ activities
such as playing, storytelling and painting. Adolescents fare better in groups provide
gross motor activities like sports and games to use up excess energy.
h) MENTAL RETARDATION: Activities should be according to the patient’s level of
functioning such as walking, dancing, swimming, ball playing etc.

CONCLUSION
 Nurses can use a recreational activity as a foothold for establishing a therapeutic relationship
with patients or as a platform for therapeutic encounters with patients who are frightened,
withdrawn or reluctant to participate. Some patients view games as being non-threatening and
are able to tolerate informal interaction during a game of pool, ping pong or soft ball. Patients
who play games with each other experience predictability, security, order and success they
can see, feel and acceptance by a group. Nurse can be role models of healthy behaviours for
patients if they can display a sense of humor while engaging in therapeutic recreation. It helps
the patient to discharge tension and anxiety.
Recreational therapy may also use community
resources to help patients identify socialization activities that they can become involve with
after discharge from the hospital. Movement or dance therapy is a specific example of how
the body can be used as a medium for change. Since body and mind cannot be separated,
through dance, nurses work toward integrating the muscular and cognitive expressions of the
patient’s feelings and thoughts.

PLAY THERAPY
INTRODUCTION:

Play is a natural mode of growth and development in children. Through play a child learns to
express his emotions and it serves as a tool in the development of the child. To understand
play therapy, it is necessary to consider how children learn. “A child play is his work”, the
old saying goes. Infants first learn about object and people in their environment by touching
and exploring. Later in creative play, children reveal their understanding of the world and
their relationship to it. Children are unable to verbalize many of their thoughts, feelings,
wishes and fears. In play therapy toys became medium of communication between child and
therapist.

GOALS OF PLAY THERAPY

 Helping the child better understand feelings, and how feeling relate to behavior.
 Helping the child find more appropriate ways of expressing feelings.
 Helping the child find ways to solve personal problems.

PHASES OF PLAY THERAPY:

I. INTRODUCTORY PHASE:
The first task of the therapist is to gain child’s trust. This may happen in 5 min or in 5
months, depending on the personality and prior experience of the child. Until trust has
been firmly established and the child is able to reveal inner thoughts and feelings it is
difficult to accomplish other goals.

II. HONEYMOON PHASE:

 Children, like adults in therapy, usually go through a honeymoon period when the relief
from finally being able to express some of their anxieties is so great that their demeanor at
home and school improves dramatically.

III. REBELLIOUS PHASE:

At this point the child often voices strong anger about having to attend therapy sessions.
Usually the child is voicing strong anger about almost everything else as well, and parents
begin to wonder whether therapy is constructive or destructive endeavor. This sudden
rebellion, the constant venting of anger is actually a positive sign. It indicates that a
repressed feeling that has resulted in much anxiety or depression is beginning to surface.
In the therapy the child is encouraged to express feelings. Temper tantrum are more likely
to appear.

IV. THE WORKING THROUGH PHASE:

Becoming aware of what one is feeling, learning more productive methods of expressing
feelings, and developing healthier defense are some of the tasks achieved in this phase.
Occasionally the behavior may actually deteriorate or symptoms may intensify. Such
period is relatively short. Such regressive episode may indicate that old defense is
weakening.
The old defense that served to ward off feelings of insecurity is no longer
operative. While this may increase the child’s distress, it provides an opportunity for an
examination of the underlying feelings of worthlessness the child has harbored all along,
so the healthier defense against external threats to his self confidence can be developed.

V. TERMINATION PHASE:
The longer and more intense the sessions have been, the more difficult termination will be
for the child. Many of the child original symptoms do reappear. This due to the stress
ceased by the termination; it may be child way of convincing everyone that the therapy is
still needed. If proper time is not allowed to work through the emotions generated by the
separation, therapeutic gains may not be maintained.
The therapist must help the parents be as realistic as possible in setting goals
for the child. I the end the therapy is like a education, the condition for learning are
provide but it is up to the child to accept or reject the available possibilities for growth
and change.

CURATIVE FUNCTIONS

 It releases tension and pent- up emotions

 It allows compensation for loss and failures.
 It improves emotional growth through his relationships with other children.
 It provides an opportunity to the child to act out his fantasies and conflicts, to get rid
of aggression and to learn positive qualities from other children.

DIAGNOSTIC FUNCTIONS

 Play therapy gives the therapist a chance to explore family relationships of the child
and discover what difficulties are contributing to the child’s problems.
  Play therapy allows studying hidden aspects of the child’s personality.
 It is possible to obtain a good idea of the intelligence level of the child.
 Through play inter- sibling relationships can be adequately studied.

TYPES OF PLAY THERAPY

1) INDIVIDUAL Vs GROUP PLAY THERAPY: In individual therapy the child is

allowed to play by himself and the therapist’s attention is focused on this one child
alone. In group play therapy other children are involved.
2) FREE PLAY Vs CONTROLLED PLAY THERAPY: In free play the child is
given freedom in deciding with what toys he wants to play. In controlled play therapy,
the child is introduced into a scene where the situation or settings is already
established.
3) STRUCTURED Vs UNSTRUCTURED PLAY THERAPY: Structured play
therapy involves organizing the situation in such a way so as to obtain more
information. In unstructured play therapy no situation is set and no plans are followed.
4) DIRECTIVE Vs NON-DIRECTIVE PLAY THERAPY: In directive play therapy,
the therapist totally sets the directions, whereas in non- directive play therapy, the
child receives no direction. Play therapy is generally conducted in a playroom. The
playroom should be suitably stocked with adequate play material, depending upon the
problems of the child.

ADVANTAGES OF PLAY THERAPY

- The non directive play therapy offers the child an opportunity to experience growth
under the most favorable conditions.
- Play is the child’s natural medium for self expression, he uses the therapy time to play
out his accumulated feelings of fear, tension, frustration and aggression.
- When the child plays out his feelings, he allows them to surface, faces them and learns
to control, accept and abandon them.
- Through this process the child gradually realize that he is an individual in his own
right and is capable of thinking and marking decision for him.

MUSIC THERAPY
INTRODUCTION

Music is a moral law. It gives soul to the universe, wings to the mind, flight to the
imagination, a charm to sadness gaiety and life to everything. It is the essence of order, and
leads to all that is good and beautiful.
.

DEFINITION:
The national association of music therapy has defined music therapy as the therapeutic tool
for the restoration, maintenance and improvement of mental and physical health.
It is the systemic
application of music, as directed by the music therapist in a therapeutic environment to bring
about desirable changes in behavior. Such changes enable the individual undergoing therapy
to experience a greater understanding of himself and the concepts about him, there by
achieving a more appropriate adjustment to the society.
(Reddemma)
Music therapy is defined as “the prescribed use of music by a qualified person to effect
positive changes in the psychological, physical, cognitive, or social functioning of individuals
with health or educational problems”
(AMTA, 1997).
GOAL:

The goal of music therapy is to reduce psycho- physiological stress, pain, and anxiety. Music
therapy leads to slower heart rate, respiration rate and blood pressure.

ADVANTAGES

 It facilitates emotional expression.

 It improves cognitive skills like learning, listening and attention span.
 Social interaction is stimulated.

MECHANISM:

Even though the exact mechanism by which the music works out is not fully understood but it
is assumed to is an effective therapy because it stimulates peptides, endomorphism and
natural opiates secreted by the hypothalamus that produces pleasurable feelings and reduces
the unwanted stimuli.
The music therapy has the potential to synchronize body
rhythms with rhythm of the music. The synchronization and entertainment is thought to
decrease the sympathetic nervous system activity leading to relaxation response. The pitch
also affects the autonomic nervous system, increasing tension when high and relaxing it when
low, therefore music with slow, steady relaxing rhythm and low pitch orchestral effects
would be appropriate for the patient.

EFFECTS OF MUSIC THERAPY:

 Music has distinct effects on the human organism. Soothing music can be used to
achieve an alpha wave brain state which initiates a state of relaxed awareness.
 Soothing music with a flowing, lyrical, melody, single, harmony and soft tone helps
to stimulate the relaxation response.
 Music can stimulate the release of endorphins from the brain, reduce the levels of
adrenocorticalcotrophic hormone and increase phenylethlamine secretion. Neural
impulses triggered by soothing music can trigger autonomic nervous system and
produce relaxation in muscle tone, brain wave frequency, galvanic skin response and
papillary reflexes. Music also facilitates emotional homeostasis.
  Barbara Crowe(1982), the former president of association of music therapy, said that
music makes the difference between isolation and interaction, between chronic pain
and comfort, between demoralization and dignity.
 Music therapy influence the physiological variables lick blood pressure, heart rate,
respiration, EEG measurements, body temperature and galvanic skin response.
 Alleviates pain, anxiety, nausea, fatigue and depression.
 Lowers apical heart rates and raises peripheral temperature.
 Reduces stress and anxiety, decreases blood pressure and heart rate during music
therapy.

GERONTOLOGICAL CONSIDERTIONS:
 Music therapy provides comfort to the elderly
 Music relieves the stress and anxiety
 Music therapy minimize the pain
 Enhances sleep, minimizes the pain
 Improves the heart rate, respiratory rate and oxygen saturation.

MUSIC THERAPY MAKES A DIFFERENCE WITH ELDERLY:

 Music stimulates all the senses and involves the elderly at many levels. The multi
model approach facilitates many skills related to activities of daily living.
 Quality relearning and maximum participation occurs, when the elderly is permitted
to experience the joy of activity with music. The medium of music therapy allows his/
her activity to occur naturally and frequently.
 Music is highly motivating, yet it can also have relaxing effect. Enjoyable music
activities are designed to be success oriented and elderly to feel better about them.
 Music is can encourage socialization, self expression, communication and motor
development.
 Because the brain processes music, in both hemispheres, music can stimulate
cognitive functioning and may be used for recommendation of some speech and
language skills.

CONCLUSION :

Music therapy takes this natural tendency a leap further by utilizing music as a therapeutic tool that
not only decreases anxiety and amplifies mood, but also enhances critical thinking abilities and
motor skills, affects cognitive and behavioural attitudes, and promotes physical healing.

REFERENCES
- Lalitha . k. (2007) “mental health and psychiatric nursing”, (edn 1), VMG book house,
banglore , p.p 224-234

- Neerja . K.P, (2008 ) “essentials of mental health and psychiatric nursing” , (edn 1 st )
volume 1 , jaypee brothers, New Delhi, p.p 337-342

- Sreewani R (2008) “ mental health and psychiatric nursing” (edn 2 nd ), Jaypee brothers,
New delhi, p.p 186
- Townscend . C .M (2007) “ psychiatric mental health nursing” (edn 1st ), Jaypee brothers ,
New delhi, p.p 156,

- Varcolis M. Elizabeth (2002) “Foundation of psychiatric mental health nursing, a clinical

approach” (edn 4th ), W.B. Saunders Company, Philadelphia, p.p 479, 876 -79