Written by Assistant Professor Tawanda Machingura.
Health professionals such as occupational therapists whose role is to enable people to do things they want to, need to or are expected to do, have found their roles much more challenging due to the restrictions imposed to all people across the world during the COVID-19 pandemic. I cannot think of a time in my lifetime when the notion of enabling people to do the things they want to, need to or are expected to do has been more debatable. Nobody can say they are able to do those things they may want to do or need to do or choose to do in this pandemic.
This challenge requires occupational therapist to improve their professional practice as a matter of urgency. For occupational therapists to improve their practice they need to be able to assess it and reflect on it and develop insight. What is challenging is developing insight into what is not currently known to us or the unconscious incompetence. To help explain this I will refer to the Johari Window (Luft & Ingham, 1955) a technique that can help us better understand ourselves see Figure 1, below.
What occupational therapists need to do is to move from a state of unconscious incompetence (which is what some of us are beginning to feel) to a state of unconscious competence (which is where we were before COVID-19) as demonstrated in Figure 2, below. I will use one key issue that is affecting communities like a cancer that occupational therapists need to quickly address in this COVID environment, stress. During the current corona virus pandemic most people are under constant and significant stress. When individuals are stressed life and wellbeing are threatened. Stress is rampant in all communities and if it remains unchecked it can cause havoc amongst the population. It is like a new cancer and it needs urgent attention particularly from occupational therapists.
Occupational therapists already know that the homeostatsis of an individuals’ physiologic functioning is essential for life and wellbeing (Chrousos, 2009). Occupational therapists also understand that individuals’ state of equilibrium is constantly threatened by extrinsic and intrinsic adverse forces (Tsigos et al, 2016). This state is counteracted by physiological and behavioural responses aimed at re-establishing equilibrium. It is already known that acute stress triggers a cluster of changes which under normal circumstances improve the chances of survival and that chronic stress however activates a maladaptive response.
As occupational therapists we do know that when under acute stress individuals rely on an adaptive response system where oxygen and nutrients are channeled to the central nervous system and body sites where they are needed the most. This increases behaviours such as arousal, alertness, focused attention and analgesia whilst inhibiting vegetative functions such as feeding and reproduction. A parallel action, physical responses such as respiratory rate, cardiovascular tone, glucogenesis and lipolysis are increased whilst energy consuming functions such as digestion are also known to be suppressed. We do understand that stress can be rewarding under normal conditions and does the opposite under conditions such as a pandemic.
What we do not know of fully until recently is the relationship between stress and the CLOCK system, which generates the body circadian rhythms and regulates a wide range of physiologic functions. This system is now known to modulate immune functions. This means that the connection with certain diseases is now much more closely linked than previously thought (Tsigos et al, 2016). Stress is now known to be more closely associated with conditions such as depression, eating disorders, OCD, Panic Disorder, Alcohol and drug abuse, obesity, chronic fatigue syndrome, fibromyalgia, and heart disease than previously thought (Tsigos et al, 2016).
What we still do not know is how the disturbances to the CLOCK system caused by COVID 19 are going to impact on those conditions associated with stress in the long-term and how best to prevent that from happening. Occupational therapists have an opportunity to promote health and reduce the likelihood of their patients getting these conditions. Occupational therapists can be at the forefront of helping people manage their stress, but it is not business as usual. They will need to think outside the box, learn, adapt and develop new ways of helping their clients.
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Tsigos C, Kyrou I, Kassi E, et al. (2016). Stress, Endocrine Physiology and Pathophysiology. In: Feingold KR, Anawalt B, Boyce A, et al., editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK278995/
Chrousos GP. (2009). Stress and disorders of the stress system. Nat Rev Endocrinol, 5(7):374-81.
Luft, J.; Ingham, H. (1955). The Johari window, a graphic model of interpersonal awareness. Proceedings of the Western Training Laboratory in Group Development. Los Angeles: University of California, Los Angeles.