Under the Waves™

Mindfulness basedoccupational therapy for SCUBA

diving

Naomi Achondo, OTD,OTR/L, SWC

Objectives

• Awareness for possible intervention setting option for persons with mental health issues especially veterans• WAVES PROJECT’s UNDER THE WAVES OT PROGRAM

• Advocate for community based settings for increased inclusion• Reduce the stigma • Involve more veterans into the program • Involve family members in the process• Use OT mindfulness strategies for PTSD

www.ncptsd.va.gov https://www.ptsd.va.gov/public/ptsd-overview/basics/what-is-ptsd.asp

Post Traumatic Stress Disorder

“Mental health problem

that is developed after

experiencing or witnessing

a life-threatening event”

Prevalence of PTSD

• 7-8 out of 100 (7-8% of population) will experience some PTSD

• 8 million adults every year

• 10 out 100 women (10%) vs 4 out of 100 men (4%)

• 5.5 million children; 30% of which is abuse

• 3-10 million witness violence or abuse

• 15-43% of girls vs 14-43% boys experience at least 1 trauma• 3-15% girls; 1-6% boys PTSD

Prevalence of PTSD

• Operations Iraqi Freedom (OIF) and Enduring Freedom (OEF): ~ 11-20 out of every 100 Veterans (or between 11-20%)

• Gulf War (Desert Storm): ~ 12 out of every 100 Gulf War Veterans (or 12%)

• Vietnam War: About 15 out of every 100 Vietnam Veterans (or 15%) were currently diagnosed with PTSD

• Estimated that about 30 out of every 100 (or 30%) of Vietnam Veterans

65%

35%

Post-9/11 Combat Theatre Veterans 2.2 Million

Estimated number of

Post 9/11 veterans

suffering from PTSD

=770,000

http://www.xpowerpoint.com/Veterans-and-Penal-Code-1170-9--PPT.html

PTSD Symptoms• Lasts longer than 3 months• Causes great stress• Disrupts daily living, occupation, leisure and quality of life

Reliving the event• Nightmare• Flashbacks• Triggger

Avoiding situations that remind of the event• Avoiding crowds/ isolation• Avoiding sensory experiences

Negative changes in beliefs/feelings• No love or empathy towards others• Forgetting happy events• Mistrust

Feelings hyped [hyperarousal]• Easily irritable, angry, jittery• Difficulty sleeping• Issues with concentration

https://www.ptsd.va.gov/public/PTSD-overview/basics/symptoms_of_ptsd.asp

Alcohol Abuse• Excessive alcohol drinking

and related harms are common among military personnel.

• 43.2% of active duty military personnel reported at least oneepisode of binge drinking in the

past month vs 26.1% for comparable age civilians

(Stahre et al., 2008)

Google images

Substance Abuse

• 90% of severely wounded soldiers survive & face additional challenges imposed by significant PAIN.

• Chronic pain increases the risk of mental health disorders including substance abuse.

• Exposure to opiate medications for the treatment of chronic pain can results in opiate addiction.

Google images

PTSD and Domestic Violence

§ A significant link between the severity of PTSD and violence severity

§ Aggression toward others reported by up to one-third of Iraq and Afghanistan war veterans.

§ 1:3 veterans with TBI demonstrate significant aggressive behavior during the first six months after their injury.

§ Violent crimes are often omitted from criminal justice treatment programs.

(Elbogen, 2012; Gerlock, 2004; Tateno et al, 2003)

Google images

Veteran Suicide

22 veterans commit suicide in a day

Double the national average

www.ptsd.va.gov

Veterans Combat Experience

• 56.9% Received incoming artillery

• 57.1% Knew someone seriously injured or killed

• 47.4% Saw dead bodies or human remains

• 45.4% Had member of unit become a casualty

• 34.1% Saw dead or seriously injured Americans

Office of the Surgeon Multi-National Corps-Iraq, Office of the Surgeon General U.S. Army Medical Command. Mental Health Advisory Team (MHAT) VI OIF 07-09. May 8, 2009

Why did we start the

WAVES Project?

LCpl. Jon Schumacher

Courtney Schumacher

…from that one conversation,

We have grown

501 3 (C)Non- Profit

Organization

THE WAVES PROJECT

THE WAVES PROJECT

The WAVES Project, initially

started as a way to share

our love of SCUBA diving

with combat wounded

veterans.

At first, just a way to have

some fun & our way of

giving back.

THE WAVES PROJECT

During our journey, we discovered with SCUBA diving

as our platform,

we were able to tap into the

therapeutic values of water,

resulting in tremendous

physical & emotion benefits!

Under the WavesMindfulness based

occupational therapy for SCUBA diving

Naomi Achondo, OTD,OTR/L, SWCSteve RubinRandy Lung

Juan Ramirez

Objectives

• Emerging Niche for Occupational Therapy

• Develop opportunities for occupational & social justice

• Collaboration with SCUBA dive instructors, dive masters • Recognizing signs and symptoms of PTSD, GAD, mental

health issues• Providing OT mindfulness strategies during SCUBA

certification, diving and in daily living

OCCUPATIONAL THERAPY

Occupational therapy is a science-driven, evidence-based profession that enables people of all ages to live life to its fullest by helping them promote health and prevent—or live better with—illness, injury or disability

(AOTA, 2014)

OT & PTSD: How it works?

Comprehensive performance skills, lifestyle assessments Customized treatment interventions Comprehensive home and job site evaluations Adaptive equipment recommendations and usage trainingSupport & training for caregivers

HOW IT BENEFITS DIVERS with PTSD

PARTNERSHIP WITH THE WAVES PROJECT, INC

To improve one's ability to perform daily activities thru SCUBA

Overall performance skills assessments & recommendations

Use of mindfulness based OT strategies

Guidance to family members & caregivers.

UNDER the WAVES Research Study

• Initial study completed in 2016

• 9 SCUBA certified divers with ratings from VA on PTSD

• 8 SCUBA divers completed the Advance Certification Training

• 8 dives were completed between Catalina and La Jolla, CA

• UNDER THE WAVES OT mindfulness program was implemented during the dives

• COPM pre & post test interview; PCL-5 pre and post test

Under the WAVES™

• Pilot intervention using OT mindfulness based strategies and SCUBA diving to reduce symptoms of PTSD on American veterans.

• Under the Waves is comprised of three components:• Introduction to occupational therapy and its role in

PTSD;• OT mindfulness-based strategies before each dive

session;• Group reflections after each day’s dives.

UNDER THE WAVES GROUP GUIDELINES AND EXPECTATIONS

1. BE PRESENT. YOU ARE ENCOURAGED TO ATTEND EVERY SESSION, ON TIME. IF YOU ARE UNABLETO ATTEND, PLEASE NOTIFY THE WAVES TEAM OR THE UNDER THE WAVES RESEARCH TEAM, 24 HOURS PRIOR TO THE MEETING.

2. BE RESPECTFUL. YOU ARE TO RESPECT EVERY MEMBER OF THE TEAM AT ALL TIMES. RESPECT THECONFIDENTIALITY OF WHAT IS BEING SHARED WITH THE GROUP. RESPECT YOURSELF.

3. BE MINDFUL. USE SAFE AND APPROPRIATE LANGUAGE. AVOID ENCROACHING OTHER’S SPACE. TRY TO ACCEPT DIFFERENCES IN OPINIONS, ATTITUDES, AND BELIEFS.

4. BE ACTIVE. PARTICIPATE IN THE ACTIVITIES, INTERVENTIONS, AND EDUCATION SESSIONS. ENGAGEWITH PEERS IN A SAFE AND RESPECTABLE MANNER.

5. BE INVOLVED. SHARE IN THE EXPERIENCES THAT WILL BE OFFERED BY UNDER THE WAVESPROGRAM.

MINDFULNESS

§ Conscious act of simply being fully present within a moment without filters or judgement

§ Cultivate mind body awareness, remain in the here and now, and take each moment one by one

§ Focus on ACCEPTANCE§ less energy is focused on trying to control, avoid, or turn off

negative emotional and stressful events in our daily lives

§ Be SELF-COMPASSIONATE and LOVE ourselves.

Cuellar, 2008; Kim, Schneider, Bevans, Kravitz,,Mermier, Qualls & Burge. 2013

Acknowledgement

• WAVES PROJECT www.wavesproject.org

• 9 WAVES Veterans and Dive Instructors

• Sarah Cho, OTS

• Seka Metran, OTR

• Taylor Miller, OTR

• Monique Nguyen, OTR

REFERENCES• American Occupational Therapy Association. (2007). American Occupational Therapy Association’s Centennial

Vision and Executive Summary. American Journal of Occupational Therapy, 61, 613-614. http://dx.doi.org/10.5014/ajot.61.6.613

• American Occupational Therapy Association. (2014). Occupational therapy practice framework: Domain and process (3rd edition). American Journal of Occupational Therapy, 68, S1-S48.

http://dx.doi.org/10.5014/ajot.2014.682006

• Caldwell, K., Harrison, M., Adams, M., Quin, R., & Greeson, J. (2010). Developing mindfulness in college students through movement-based courses: effects on self-regulatory self-efficacy, mood, stress, and sleep quality. Journal Of American College Health, 58(5), 433-442.

• Carin-Levy, G., & Jones, D. (2007). Psychosocial aspects of scuba diving for people with physical disabilities: An occupational science perspective. Canadian Journal of Occupational Therapy, 74(1), 6-14.

• Cuellar, N. G. (2008). Mindfulness meditation for veterans-implications for occupational health providers. Workplace Health & Safety, 56(8), 357.

• Kim, S. H., Schneider, S. M., Bevans, M., Kravitz, L., Mermier, C., Qualls, C., & Burge, M. R. (2013). PTSD symptom reduction with mindfulness-based stretching and deep breathing exercise: Randomized controlled clinical trial of efficacy. Journal Of Clinical Endocrinology & Metabolism, 98(7), 2984-2992 9p. doi:10.1210/jc.2012-3742

• Plach, H. L., & Sells, C. H. (2013). Occupational performance needs of young veterans. American Journal of Occupational Therapy, 67, 73-81. http://dx.doi.org/10.5014/ajot.2013.003871

References• Rogers, C., Mallinson, T., & Peppers, D. (2014). High-intensity sports for posttraumatic stress disorder and depression:

Feasibility study of ocean therapy with veterans of operation enduring freedom and operation Iraqi freedom. American Journal of Occupational Therapy, 68(4), 395-404.

• Stoller, C. C., Greuel, J. H., Cimini, L. S., Fowler, M. S., & Koomar, J. A. (2012). Effects of sensory-enhanced yoga on symptoms of combat stress in deployed military personnel. American Journal of Occupational Therapy, 66(1), 59-68.

• Tanielian, T., & Jaycox, L. H. (2008). Invisible wounds of war. Santa Monica, CA: Rand Center. Retrieved from http://carolinahealthspan.com/wp-content/uploads/2016/03/RAND-Invisible-Wounds-of-War.pdf

• U.S. Departments of Veterans Affairs. (2015). PTSD: National center for PTSD. Retrieved from http://www.ptsd.va.gov/public/PTSD-overview/basics/what-is-ptsd.asp

• U.S. Department of Veterans Affair (2016) PTSD: National center for PTSD. Statistics. Retrieved from http://www.va.gov/vetdata/docs/QuickFacts/SCD_quickfacts_FY2014.PDF Retrieved on October 15, 2017

• U.S. Departments of Veterans Affairs. (2016). PTSD: national center for PTSD. Retrieved from http://www.ptsd.va.gov/professional/assessment/adult-sr/ptsd-checklist.asp Retrieved on October 15, 2017