Desensitization Presented by: APS Healthcare Southwestern PA Health Care Quality Unit (HCQU)

1. DesensitizationPresented by: APS HealthcareSouthwestern PA Health Care Quality Unit(HCQU) November 2011 alt

2. Disclaimer Information or education provided by the HCQU is not intended to replace medical advice from the consumer’s personal care physician, existing facility policy or federal, state and local regulations/codes within the agency jurisdiction. The information provided is not all inclusive of the topic presented. Certificates for training hours will only be awarded to those who attend a training in its entirety. Attendees are responsible for submitting paperwork to their respective agencies.

3. Note of Clarification While mental retardation (MR) is still recognized as a clinical diagnosis, in an effort to support the work of self-advocates, the APS SW PA HCQU will be using the terms intellectual and/or developmental disability (I/DD) to replace mental retardation (MR) when feasible.

4. Objectives Upon completion of the session the Participant will: Recognize signs/symptoms of anxiety associated with fears Define desensitization Design an appropriate desensitization program as a tool to help individuals with their fears

5. Phobias • Type of anxiety disorder • Persistent irrational fear of an object or a situation that is generally considered to be harmless • May be accompanied by a desire to avoid the thing that is feared

6. Fear vs. Phobia • Fears are not necessarily phobias • Phobias interfere with everyday living • Phobias may require treatment

7. Special Considerations for Individuals with I/DD • General fears and anxieties may be intensified to the level of a phobia • Related to • Limited coping mechanisms • Limited ability to process information • Co-existing mental health issues

8. Triggers for Anxiety in People with I/DD • Negative past experience • Lack of trust • The unknown • Sensory differences • Medical examinations

9. Signs of Anxiety or Fear in People with I/DD • Physical Symptoms • Behavioral Changes

10. Treatment for Phobias • Medication • Anti-Anxiety medications • Given before the appointment • Therapy • Desensitization

11. Desensitization • Technique where a person is gradually exposed to the thing that is feared • Individualized plan

12. Components of a Desensitization Plan • Relaxation • Gradual exposure to the item that is feared

13. Things to Consider When Writing a Desensitization Plan • Determine relaxation techniques that are effective for the individual • Determine the hierarchy of events leading to the thing that is feared • Determine where the person is on the hierarchy of events and start the plan at the next step

14. Implementing the Desensitization Plan Attain a state of complete relaxation Begin to imagine the items in the hierarchy of events list

15. Application of Desensitization Techniques • No longer than 30 minutes at a time • At least 2 times a week • Exposure to no more than 3 items on the hierarchy list per session • Begin with the last item from the previous session

16. Modifications for Individuals with I/DD • Individualized • General Principles • SIMPLE relaxation techniques • GO SLOW • Repeat as necessary • Frequency based on reaction of the individual

17. Simple Relaxation Techniques • Deep breathing • Sensory techniques • Visual techniques • Creative expression techniques • Progressive muscle relaxation

18. Go Slow: Frequency Based on Individual Reaction • Watch for • Willingness to continue with the plan • Physical signs of anxiety

19. Repeat as Necessary • Repeat slowly and clearly several times during a session • Allow the individual several minutes to process what was said • Show patience

20. Desensitization for Medical Appointments • Lack of health care can lead to increased illness • Pain or discomfort related to an illness may increase self injurious behaviors or aggression towards others

21. GROUP ACTIVITYHow to Assist at a Medical Appointment

22. GROUP ACTIVITYWrite a Desensitization Plan

23. References • Lankasky, Kathleen BA MLE. Table Manners and Beyond. www.bhawd.org/sitefiles/TblMrs.html • Sprague, Alison M.S.S., Wilson, Janet M.D., Nowell, Nancy M.P.A., and The Elizabeth Blackwell Health Center for Women. A Practitioner’s Guide: Providing GYN Care to Women With Special Needs. • Tepper, Mitchell S. PhD, MPH. Men’s Sexual Health. www.sexualhealth.com • Brown, Allisno A. BA and Gill, Carol J. PhD. Women with Developmental Disabilities: Health and Aging. www.biomedcentral.com/1534-5874/2/219

24. References • Latrophobia, Do You Fear Going to the Doctors?Retrieved from http://iatrophobia.com/treatment.htm, retrieved on October 6, 2008. • Mayo Clinic. (2007, January 10). Phobias. Retrieved on December 8, 2008 from http://www.mayoclinic.com/print/phobias/DS00272/DSECTION=all&METHOD=print • The Phobia List. (1995, July 17). The indexed phobia list. Retrieved on December 9, 2008 from http://phobialist.com/index.html • Idaho State University. Systematic Desensitization of Test Panic. Retrieved on December 12, 2008 from http://www.isu.edu/ctl/cls/handouts/StressManagement/testPanic.pdf

25. References • Dr. Raymond Lloyd Richmond, PhD. A Guide To Psychology and Its Practice. (1997-2008). Systematic Desensitization. Retrieved on December 12, 2008 from http://www.guidetopsychology.com/sysden.htm

26. To register for future trainings,orfor more information on this or any other physical or behavioral health topic, please visit our website at www.hcqu.apshealthcare.com

28. EvaluationPlease take a few moments to complete the evaluation form found in the back of your packets.Thank You!

29. Test ReviewThere will be a test review after all tests have been completed and turned in to the Instructor.