A basic assumption of ACT is that suffering is a normal and unavoidable part of human experience and that it is actually people’s attempts to control or avoid their own painful experiences that lead to much long-term suffering.  ACT helps people learn ways to let go of the struggle with pain, be more mindful, get clarity on what really matters to them, and to commit to living full, vibrant lives.

ACT uses mindfulness practices to help people become aware of and develop an attitude of acceptance and compassion toward painful thoughts and feelings. Additionally, ACT heavily emphasizes the role of values to help people create meaningful lives.  ACT is centered on such questions as “What do you really want your life to be about?” or “If you lived in a world where you could have your life be about anything, what would it be?”

ACT has also been adapted to create a non-therapy version of the same processes, called Acceptance and Commitment Training.  This training process, oriented toward the development of mindfulness, acceptance, and values skills in nonclinical settings, such as businesses or schools, has also been investigated in a handful of research studies with good preliminary results.

BA is designed to manage the consequences often seen with someone who is suffering from depressed mood.  BA focuses on the depressed person’s behaviours that keep him or her stuck in depression.  The Psychotherapist helps the client examine their triggers for depression-related behaviours, as well as the effects of depressive behaviour on mood and pursuit of important activities (e.g. attending work) and encourages the client to engage in behaviours that disrupt the cycle of depression.  Clients who participate in BA learn how to examine the interactions among their behaviours and moods, how to stop the cycle of depression, and how to prevent future depressive episodes.

PE is specifically designed to address the symptoms of Post-traumatic Stress Disorder (PTSD).  Early in counselling, the client creates a list of situations that are safe, but typically avoided because they cause anxiety.  Together with the Psychotherapist, the client learns to approach each situation on the list, starting with the easiest ones, and stay in each situation for a specific amount of time.  By staying in previously avoided situations, the client develops new skills for handling anxiety, learns how to re-evaluate their perceptions of danger, and increases their self-confidence.  Additionally, PE includes processing the traumatic event by talking about it in a safe and supportive atmosphere.  Because approaching avoided situations and reimagining traumatic events can be very difficult, our Psychotherapists work in a compassionate and collaborative manner to help people achieve success with PE.

Behaviour Therapy (BT) focuses on an individual’s learned, or conditioned, behaviour and how this can be changed.  The approach assumes that if a behaviour can be learned, then it can be unlearned (or reconditioned), therefore, it is useful for dealing with issues such as phobias or addictions.

Behaviour therapy helps a person understand how changing his or her behaviour can lead to positive changes in his/her life.  Often, the focus is on helping the person engage in positive or value-consistent behaviours.  The Psychotherapist works with the client to examine the barriers to or difficulties in engaging in these types of behaviours. The Psychotherapist also teaches the client to analyze their own behaviour, as well as the effects their behaviours have on mood and other areas of life.  This approach tends to be more time-limited and focused on a specific problem that the person is encountering.

Cognitive Therapy (CT) deals with thoughts and perceptions, and how these can affect feelings and behaviour.  By reassessing negative thoughts, an individual can learn more flexible, positive ways of thinking, which can ultimately affect their feelings and behaviour towards those thoughts.

Dialectical Behaviour Therapy (DBT) is a cognitive behavioural treatment that was originally developed to treat chronically suicidal individuals diagnosed with borderline personality disorder (BPD) and it is now recognized as the gold standard of psychological treatment for this population.  In addition, research has shown that it is effective in addressing a wide range of other disorders such as substance dependence, depression, post-traumatic stress disorder (PTSD), and eating disorders.

Flor and Turk in Melzack and Wall’s Textbook of Pain 5th Edition (2006) state:

“The negative reinforcement of activity levels is an important process in the development of disability.  People with chronic pain typically attempt to base their decisions about the amount of physical activity or work they perform on the level of pain they experience or anticipate.  Patients with fibromyalgia syndrome tend to overestimate the extent of their physical limitations.  This overestimation may lead to a self-fulfilling prophecy and inhibit their activities because they view themselves as more disabled than they actually are.  A specific activity (e.g. walking) is performed until pain sets in, at which point the activity is interrupted and replaced by rest.  Subsequently the pain will be reduced.

This reduction of pain negatively reinforces the cessation of activity.  The cessation of activity has to be made dependent on the amount of activity achieved, quota based, rather than on the amount of pain.  Thus the pain reinforcing quality of rest is eliminated.  This formulation supports the strategy of encouraging patients to perform activity to meet a specific quota” (that is not based upon level of pain).”

At OHS our Kinesiologists use both graduated cardiovascular training and progressive resistance training depending on a client’s presenting difficulties, current level of physical functioning and requirements of the job to assist the individual to gradually resume their pre-disability level of functioning.

The clients we see at OHS often describe avoidance and withdrawal as a primary coping strategy in order to manage their symptoms of pain.  It is therefore not surprising that the very vicious cycle of physical and emotional withdrawal results in diminished meaningful interactions or activities that an individual would typically find rewarding or vital in their life. OHS guides clients through a graduated return to meaningful activity while assisting them to incorporate recommended strategies for pain management.  Unlike traditional pain management programs, clients are supported to achieve attainable, measurable reactivation goals that result in clients safely resuming activities of daily living while managing the experience of pain.

For people with chronic physical conditions, sleep disruption is a common problem.  This includes trouble falling asleep, waking up during the night and waking earlier than desired.  In addition, many such individuals describe not feeling refreshed in the morning when they awaken, a sleeping problem termed “non-restorative sleep”.  At OHS, the aggressive management of sleep disturbance is an important treatment objective.  We address two important factors: the individual’s personal habits and their sleeping environment.  The things a person does during the day and leading up to sleeping at night can impact sleep just as much as the environment that they choose to sleep in.  Learning how to optimize both their personal habits and sleep environment is paramount to successful sleep.

Mindfulness meditation is based on ancient Eastern meditation practices that focusses on paying attention to the present moment with openness, curiosity, and acceptance.  Mindfulness helps people to accept their experiences, both physical and mental, rather than react to them with aversion and avoidance. In this way mindfulness can help our clients to transform their relationship with painful thoughts and feelings in a way that reduces their impact and influence over their lives.

At OHS we believe that it is important to both provide information and clear up misconceptions in order to increase the likelihood of better outcomes.  The Kinesiologists at OHS use bibliotherapy, education related to the individual’s chronic condition and collaboration with the client’s health care providers to ensure that each client has accurate, up to date information on which to base their decisions about how to make changes in their lives.  It is important for long term success that the client is able to self-manage their chronic condition in the future.

For an individual who has been off work for an extended period of time, the key to a successful outcome is the preparation for a return to work.  Our work hardening process is designed to utilize real or simulated work activities intended to restore physical, behavioural and vocational functions.  Work Hardening addresses the issues of productivity, safety, physical tolerances and worker behaviours.  At OHS we use both cognitive and physical work hardening strategies.