Worksheets and Resources
Table of Contents
Chapter One: Preparing to use this workbook
Worksheets
1.1: Evaluating current activity patterns (service provider version).
1.2: Evaluating benefits of current activity patterns (service provider version).
1.3: My current activity patterns.
1.4: Benefits of my current activities.
1.5: What do others say about my activity patterns?
Chapter Two: Understanding personal activity patterns
Worksheets
2.1: Daily time-use log.
2.2: My daily time use.
2.3: Considering the balance of my activities.
2.4: Am I getting enough physical activity?
2.5: My daily routine and structure.
2.6: Finding meaning in my activities.
2.7: Satisfaction with activities.
2.8: Social interaction through activities.
2.9: Accessing my community.
2.10: Activity Engagement Measure.
Resources
2.1: Levels of activity engagement.
2.2: Daily activity codes.
2.3: Time use of adult and retired Canadians.
Chapter Three: A first step — making quick changes in activity
Worksheet
3.1: Record of activity experiments.
Resource
3.1: Some ideas for ‘quick activity changes’.
Action Over Inertia
Addressing the activity-health needs of individuals with serious mental illness
Terry Krupa, Megan Edgelow, Shu-ping Chen, Carol Mieras, Andrea Almas,
Andrea Perry, Debbie Radloff-Gabriel, Jennifer Jackson, Marla Bransfield
Chapter Four: Providing education about activity, health and mental illness
Worksheets
4.1: The health and well-being benefits of my current activities.
4.2: Reducing stress in activity participation.
4.3: Coping with stress in activity participation.
4.4: Understanding how substance use impacts my activities.
Resources
4.1: The multiple “well-being” benefits of activity.
4.2: One activity, many benefits.
4.3: Making clear the benefits of activities.
4.4: The recovery benefits of activity participation.
4.5: How are mental illness and activity participation connected?
4.6: Overcoming potential barriers to activity participation.
4.7: Moving beyond stress in activity participation.
4.8: Substance use, activity and well-being.
Chapter Five: Making longer-term changes
Worksheets
5.1: Preparing for changes in activity participation.
5.2: Prioritizing plans for activity change.
5.3: Planning for activity change.
5.4: Giving shape to plans for activity change.
Resources
5.1: Managing challenges to activity change.
5.2: Road bumps on the path from inertia to action.
5.3: Road bumps on the path from inertia to action [example].
Chapter Six: Supporting and evaluating activity change
Worksheets
6.1: Reflecting on practices of supporting activity change (service provider).
6.2: Enabling sustained commitment by supporting activity performance.
6.3: Enabling sustained commitment by supporting positive activity experiences.
6.4: Identifying changes in my activity patterns.
6.5: Thinking about changes in my activity patterns.
6.6: Measuring changes in my activity patterns over time.
Chapter Seven: Focusing on activity-health to inform service development
Worksheet
7.1: A framework for presenting program-level information
Resources
7.1: Preparing for continuous improvement applied to activity-health: Mission and goals.
7.2: Preparing for continuous improvement applied to activity-health: Engaging the support of
leaders.
7.3: Preparing for continuous improvement applied to activity-health: Taking stock of resources
and structures.
7.4: A framework for presenting program-level information (example).
Worksheet 1.1
Evaluating current activity patterns
(service provider)
Date: ______/________/_____
Name: ______________________________________________________________________
Service provider’s name: _____________________________________________________
If you have checked off three (3) or more of these criteria, this individual may benefit from intervention approaches directed
to enabling activity-health.
Criteria
The person’s daily activities demon-
strate an imbalance between self-care,
productivity and leisure.
The person spends a large amount
of time without defined activity on a
day-to-day basis.
Much of the individual’s day is spent
in passive activities or rest.
There is a lack of organized routine/
structure to the person’s daily activity.
The person’s daily activities limit their
contact with others.
The person’s daily activities limit
their access to a range of community
environments.
The person cannot define activities
that are meaningful or of personal
interest.
The person experiences distress, or is
easily overwhelmed by activity.
The person’s involvement in activity
is impacted by a limited experience of
enjoyment.
Examples
a
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Action Over Inertia © CAOT PUBLICATIONS ACE 2010
Worksheet 1.2
Evaluating benefits of current activity patterns
(service provider)
Date: ______/________/_____
Name: ______________________________________________________________________
Service provider’s name: _____________________________________________________
This person engages in activities
that provide the opportunity for…
Skill and/or knowledge development
Making a contribution to society
Gaining physical health benefits
The enjoyment of beautiful things
Self-expression and creativity
A range of social interactions
Meeting personal goals, experiencing
accomplishment
Expressing personal values
Earning a personal income
Giving to others, such as family or
friends
Examples/comments
Check 7-10: Experiences a full range of well-being and health benefits through activity.
Check 4-6: Experiences of well-being and health through activity are compromised.
Check 3 or less: Experiences of well-being and health through activity are seriously limited.
a
My current activity patterns
Date: ______/________/_____
Name: ______________________________________________________________________
Criteria
My days are not balanced with time for fun,
work, taking care of myself, and rest.
I have lots of time, but nothing to do.
I spend most of my day resting, listening to
others or watching television.
I do not have a regular routine.
I don’t see many other people during my day or
week or do many things with other people.
I do not go to many different places to do
things during my day or week.
I can’t think of many things I do that are really
enjoyable to me.
I get easily upset or overwhelmed when I do
activities.
I wish that I could find some things to do that
are really enjoyable to me.
There are things I would like to do, but there
are barriers to why I don’t do them, such as lack
of money, transportation, or a friend to go with.
Examples
Are you generally satisfied with your daily time use and activities?
Add any other thoughts or ideas here:
Consider each statement and check all that apply
Worksheet 1.3
a
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Benets of my current activities
Date: ______/________/_____
Name: ______________________________________________________________________
My daily activities give me the
opportunity to …
Develop new skills and knowledge
Feel as though I am making a valuable
contribution to society
Remain physically active and healthy
Enjoy beautiful parts of life, such as nature,
music, and art
Express my thoughts and feelings
Interact with other people socially
Achieve goals and feel as though I have
accomplished something
Express values that are personally important
to me
Earn a personal income
Interact with important people in my life
(family, friends, etc.) and make them feel good
Examples/comments
Check all of the items that apply to you.
Worksheet 1.4
a
Action Over Inertia © CAOT PUBLICATIONS ACE 2010
What do others say about
my activity patterns?
Date: ______/________/_____
Name: ______________________________________________________________________
1. People tell me that I should be more active throughout the day.
NEVER SOMETIMES OFTEN
2. People tell me I need to find things to do.
NEVER SOMETIMES OFTEN
3. People sometimes question if I am happy with my activities.
NEVER SOMETIMES OFTEN
4. People have told me I should socialize and interact more with others.
NEVER SOMETIMES OFTEN
5. People worry that I have nothing to look forward to during my typical days.
NEVER SOMETIMES OFTEN
6. People tell me I should get more involved in my community.
NEVER SOMETIMES OFTEN
7. People tell me I should get out to visit different places in my community more often.
NEVER SOMETIMES OFTEN
Circle the most appropriate response to each statement below:
Worksheet 1.5
Action Over Inertia © CAOT PUBLICATIONS ACE 2010
Daily time-use log
Date: ______/________/_____
Name: ______________________________________________________________________
The activity was done:
Time Activity Where? alone/with someone else
In the chart below, fill in how you have recently spent a typical day.
Worksheet 2.1
12
midnight
12:30 am
1:00 am
1:30 am
2:00 am
2:30 am
3:00 am
3:30 am
4:00 am
4:30 am
5:00 am
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Worksheet 2.1
The activity was done:
Time Activity Where? alone/with someone else
5:30 am
6:00 am
6:30 am
7:00 am
7:30 am
8:00 am
8:30 am
9:00 am
9:30 am
10:00 am
10:30 am
11:00 am
11:30 am
Daily time-use log
Name: _________________________________________________ Date: ______/________/_____
Action Over Inertia © CAOT PUBLICATIONS ACE 2010
Worksheet 1.2
The activity was done:
Time Activity Where? alone/with someone else
12 noon
12:30 pm
1:00 pm
1:30 pm
2:00 pm
2:30 pm
3:00 pm
3:30 pm
4:00 pm
4:30 pm
5:00 pm
5:30 pm
6:00 pm
Daily time-use log
Name: _________________________________________________ Date: ______/________/_____
Action Over Inertia © CAOT PUBLICATIONS ACE 2010
Worksheet 2.1
The activity was done:
Time Activity Where? alone/with someone else
6:30 pm
7:00 pm
7:30 pm
8:00 pm
8:30 pm
9:00 pm
9:30 pm
10:00 pm
10:30 pm
11:00 pm
11:30 pm
Daily time-use log
Name: _________________________________________________ Date: ______/________/_____
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Action Over Inertia © CAOT PUBLICATIONS ACE 2010
My daily time use
Date: ______/________/_____
Name: __________________________________________________________________________
Looking at your time use logs, label each activity you recorded as self-care, produc-
tivity, or leisure. Total the hours spent in each category for one day. This will give
you a visual image of the balance of your activities.
Worksheet 2.2
Hours Spent
Self-Care Productivity Leisure
12
11
10
9
8
7
6
5
4
3
2
1
0
Category Hours Spent
Self-care
Productivity
Leisure
Rest
My Time
Action Over Inertia © CAOT PUBLICATIONS ACE 2010
Considering the balance of my activities
Date: ______/________/_____
Name: ______________________________________________________________________
Worksheet 2.3
Self-care Examples of my Time
activities Examples activities spent
Productive Examples of my Time
activities Examples activities spent
Personal care • bathing
• dressing
Health-related care • attending appointments
• lling prescriptions
Paid work • work for an employer
for pay
• self-employment for
pay
Unpaid work • work for an employer
without pay
Volunteer and other • unpaid work for a
civic work community organi-
zation or association
Education and • attending school
related • attending workshops
or training
• web-based learning
Day programs • attending treatment
programs or services
Parenting • taking care of children
Home management • cleaning
activities • renovating
• shopping for goods
and services
Action Over Inertia © CAOT PUBLICATIONS ACE 2010
Worksheet 2.3
Considering the balance of my activities
(continued)
Name: _________________________________________________ Date: ______/________/_____
Leisure Examples of my Time
activities Examples activities spent
Rest Examples of my Time
activities Examples activities spent
Active leisure • sports
• clubs
• attending
entertainment events
Passive leisure • reading
• watching TV
• listening to music
Socialization • sharing a coffee with
a friend
• attending a dinner
party
• talking with a friend
on the telephone
• joining a friend’s
Facebook site
• writing a letter to a
friend
Night Sleep • the time of day when
you get the bulk of
your sleep
Naps • incidental sleep
during the day
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Am I getting enough physical activity?
Date: ______/________/_____
Name: ______________________________________________________________________
Time needed depends on effort…
Very light effort Light effort Moderate effort Vigorous effort Maximum effort
60 minutes 30-60 min. 30-60 min.
Strolling Light walking Brisk walking Aerobics Sprinting
Dusting Volleyball Biking Jogging Racing
Easy gardening Raking leaves Hockey
Stretching Swimming Basketball
Dancing Fast swimming
Water aerobics Fast dancing
Look at your time use logs.
Did you get enough physical activity? Yes No
Are you getting back to activity after a break from routine physical activity? Yes No
How could you incorporate more activity into your day?
Health Canada recommends that you get 60 minutes of light effort activities per day,
or 30 – 60 minutes of moderate or vigorous activities.
Worksheet 2.4
Suggestions for beginners
(or those returning to activity after a break):
• Work up to 60 minutes of light effort activity every day.
• Activities can be in blocks of 10 minutes and can be added
up to reach the 60 minutes recommended.
• For those just starting out, add ten minutes of activity
every couple of days to avoid getting injured.
• Add moderate effort activities as you progress and are
more comfortable.
Source: Endurance: Kingston, Frontenac and Lennox & Addington Public Health (October 2008). What is Your Intensity? Motiv8. Retrieved from
http://www.kapublichealth.ca/motiv8/les/EnduranceBooklet.pdf.
Action Over Inertia © CAOT PUBLICATIONS ACE 2010
My daily routine and structure
Date: ______/________/_____
Name: ______________________________________________________________________
Answer yes or no where required and provide examples if possible.
What things do you do everyday?
Are there particular activities that structure your day and you plan your days around? Yes No
Is there a difference between your routine on weekdays and weekends? Yes No
Do you tend to plan your days in advance? When you wake up in the morning, do you typically have
a plan for the rest of the day? Yes No
Do you have particular activities or events that you look forward to? Yes No
Daily structure
Worksheet 2.5
Action Over Inertia © CAOT PUBLICATIONS ACE 2010
Answer yes or no where required and provide examples if possible.
Do you have routine sleep time? Yes No
Do you have naps throughout the day? Yes No
Do you use caffeine regularly? Yes No
Do you have difculty sleeping? Do you wake up throughout the night? Yes No
Do you wake up feeling rested? Yes No
Do you take medications that affect your activity patterns? How do they inuence your activities?
Sleep Schedule
My daily routine and structure
(continued)
Name: _________________________________________________ Date: ______/________/_____
Worksheet 2.5
Action Over Inertia © CAOT PUBLICATIONS ACE 2010
Finding meaning in my activities
Date: ______/________/_____
Name: ______________________________________________________________________
I would like to participate in activities
that…
contribute to my income
make the world better for others
are exciting and active
contribute to the wellbeing of people I love
increase my mental health
increase my physical health
allow me to feel peaceful
help me to nd love and intimacy
contribute to my sense of security
are enjoyable and meet my interests
fulll me spiritually
show my special skills and knowledge
make a contribution to my community
earn me respect and admiration
contribute to my knowledge
help me nd friendship and social connections
let me appreciate the natural world
allow me to appreciate art or other creative
expressions
Other meaning:
Very Kind of Not
important important important
Rate the following statements in terms of how important each is to you in terms of your partici-
pation in activities.
Worksheet 2.6
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Satisfaction with activities
Date: ______/________/_____
Name: ______________________________________________________________________
Worksheet 2.7
Consider the activities you identified on your daily time-use logs:
Which activities brought you feelings of satisfaction or well-being?
Which of these activities was the least enjoyable or satisfying?
Do any of the activities bring you feelings of distress or discomfort?
Are there particular times of the day when you are most satised and least satised with your
activities?
Think of your overall activity patterns — do they bring you satisfaction?
What activities have you done in the past that have brought you enjoyment and satisfaction? Have
you been able to enjoy these activities lately?
What changes in your activity patterns might bring you more satisfaction?
Action Over Inertia © CAOT PUBLICATIONS ACE 2010
Social interaction through activities
Date: ______/________/_____
Name: ______________________________________________________________________
People I see
Friends?
Family?
Neighbours?
Colleagues or co-workers?
Service workers?
Other:
Activities that we do
Do these people include… Who are these people?
In the chart that follows, list all the people that you saw over the course of your “typical” days.
Add those people who you see often, but who may not be included on the time-use logs. Also,
record the activities that you usually do with these people.
Worksheet 2.8
a
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Worksheet 2.8
Social interaction through activities
(continued)
Date: ______/________/_____
Name: ______________________________________________________________________
Are you satised with the social interactions you now have? Yes No
Is there a certain type of social interaction that you would like to experience more?
Are there certain people that you would like to see more? Who are these people?
Do you enjoy interacting with animals or pets? Yes No
Do you have the opportunity to interact with animals or companion animals (pets) as much as you
would like? Yes No
Action Over Inertia © CAOT PUBLICATIONS ACE 2010
Accessing my community
(Note: some sections have been derived from Aubry & Miner, 1996)
Date: ______/________/_____
Name: ______________________________________________________________________
Worksheet 2.9
Look back over your time-use diaries.
List all of the different environments that you visited.
How much time did you spend at home vs. in the community?
What time of day are you usually at home?
What time of day are you usually out?
Where do you spend the majority of your time, aside from home?
What activities do you do there?
Does anyone know where you are during the day? Yes No
Do you feel safe in your neighbourhood? Yes No
Do you speak with your neighbours when you see them on the street? Yes No
Do you have neighbours that you could ask to watch over your home or check your mail while you
are away? Yes No
Action Over Inertia © CAOT PUBLICATIONS ACE 2010
Worksheet 2.9
Accessing my community
(continued)
Date: ______/________/_____
Name: ______________________________________________________________________
Think of all of the activities you may have done in the past week.
Check off all that apply.
___ Visited a shopping centre
___ Gone to a movie, concert, or sports event
___ Played a sport outside or went for a walk
___ Went to a restaurant, bar, or coffee shop
___ Visited a community centre, library, church, or place of worship
___ Went to a barber or beauty salon.
Are there places that you used to visit that you don’t anymore?
Are there certain places in the community that you would like to visit but don’t?
Action Over Inertia © CAOT PUBLICATIONS ACE 2010
Activity Engagement Measure
Date: ______/________/_____
Name: ______________________________________________________________________
Worksheet 2.10
1. Balance in my life: I could benefit from more balance between my self-care, leisure, productivity,
and rest activities.
Rate how true this statement is for you.
1 2 3 4 5 6 7 8 9 10
very true somewhat true not true
2. Physical activity: I could benefit from more “physical” activity in my life.
Rate how true this statement is for you.
1 2 3 4 5 6 7 8 9 10
very true somewhat true not true
3. Structure/routine: I could benefit from more structure and routine in my day.
Rate how true this statement is for you.
1 2 3 4 5 6 7 8 9 10
very true somewhat true not true
4. Meaning: I could benefit from more activities that I find meaningful in my day.
Rate how true this statement is for you.
1 2 3 4 5 6 7 8 9 10
very true somewhat true not true
5. Satisfaction: I could benefit from more satisfaction from activities in my day.
Rate how true this statement is for you.
1 2 3 4 5 6 7 8 9 10
very true somewhat true not true
Action Over Inertia © CAOT PUBLICATIONS ACE 2010
Activity Engagement Measure
(continued)
Date: ______/________/_____
Name: ______________________________________________________________________
Worksheet 2.10
6. Social interactions: I could benefit from having more social interactions through my daily
activities.
Rate how true this statement is for you.
1 2 3 4 5 6 7 8 9 10
very true somewhat true not true
7. Accessing community environments: I could benefit from activities that take me to a broader
range of community environments.
Rate how true this statement is for you.
1 2 3 4 5 6 7 8 9 10
very true somewhat true not true
Ratings:
Fill in the scores that you assigned to each area above. A lower score in any area suggests that
the area could benet from direct attention and perhaps be given a higher priority for change.
Area of activity engagement Rating
1. Balance
2. Physical activity level
3. Structure and routine
4. Meaningfulness of activity
5. Satisfaction derived though activity
6. Social interaction
7. Accessing community environments
Activity dimensions are adapted from the work of Bejerholm (2007) and Bejerholm, Hansson, & Eklund (2006).
Action Over Inertia © CAOT PUBLICATIONS ACE 2010
Resource 2.1
Levels of activity engagement
Occupational
balance and
physical activity
Structure and
routine
Meaning of activity
Satisfaction with
activity
Social interactions
Access to
community
environments
Disengagement
• most of time spent
in passive leisure
• few peaks of
activity
• organized around
meeting basic
needs, like eating
• quiet activity used
to distance self
from reality
• may not leave
house until
afternoon
• to bed early, with
naps throughout
day
• little meaning
overall due to long
periods of time in
passive leisure
• some meaning
during activity
peaks
• little satisfaction
overall
• activity peaks may
be satisfying
• limited social
interaction
• little time spent in
few public places
Some engagement
• day has mix
of periods of
engagement and
periods of passive
leisure
• organized around
one or two main
activities
• long periods of quiet
activity to ll empty
time frames
• rst hour or two
after waking spent in
passive activity
• to bed early, with
naps throughout day
• peaks of activity
experienced as
meaningful
• long periods of
inactivity not
meaningful
• satisfaction high
during activity
• may have some
social interaction
• some time spent in
community
Engagement
• continuous ow
of small activities
during the day
• organized around
many different
activities
• quiet activity used
as break between
periods
• leave home soon
after early morning
waking
• reasonable amount
of night sleep
• ongoing meaning
derived from
activity throughout
the day
• high satisfaction,
even in passive
leisure
• social interaction
with multiple
people
• visits to a variety
of community
environments
Activity dimensions are adapted from the work of Bejerholm (2007) and Bejerholm, Hansson, & Eklund (2006).
Action Over Inertia © CAOT PUBLICATIONS ACE 2010
Daily activity codes
Resource 2.2
Self-care activities
Productive activities
PERSONAL CARE
• religious services/prayer/bible readings
• travel to religious services
• meals, snacks, and coffee
• relaxing, thinking, resting
• washing, dressing
• getting a haircut
• other personal care activities
PAID WORK
• work for pay at main job, including
overtime work
• waiting/delays or coffee/other breaks at
work
• hobbies or crafts done for sale or
exchange
• looking for work
• idle time before/after work
• travel to/from work
UNPAID WORK
• work for an employer without pay
• travel to unpaid work site
EDUCATION AND RELATED
• attending full-time or part-time classes
• watching credit courses on television
• attending special lectures
• doing homework
• taking a course for career or
self-development
• breaks/waiting for class
• travel related to educational activities
PARENTING
• baby or child care
• helping/teaching/reprimanding
• play with children
• medical care for children
• other child care
• travel related to child care
HEALTH-RELATED CARE
• medical/health care at home
• medical/health appointments
• lling prescriptions
• travel to medical/health appointments
VOLUNTEER AND OTHER CIVIC WORK
• participating in a union or political/civic
activity
• participating in child, youth, or family
organizations
• participating in religious, fraternal and social
organizations
• participating in support groups (i.e., al-anon,
AA)
• participating in volunteer work
• helping someone with housework and
cooking
• unpaid babysitting
• care for disabled or ill
• unpaid help for a business or farm
• coaching
• travel for volunteer and civic activities
DAY PROGRAM ACTIVITIES
• work at program site for pay
• attend outing for meal/coffee
• prepare meal at site
• attend eld trip
• attend presentation/meeting/class
• eat meal at site
• attend recreational event
• attend support group
• attend social club
• socialize at the site
• travel to day program activities
Action Over Inertia © CAOT PUBLICATIONS ACE 2010
Daily activity codes
(continued)
Resource 2.2
Productive activities
HOME MANAGEMENT
• meal/coffee preparation and cleanup
• indoor cleaning & tidying
• outdoor cleaning
• laundry/ironing, folding
• mending/shoe care
• dressmaking and sewing
• interior and exterior maintenance and
repair
• vehicle maintenance
• other home improvements
• gardening/grounds maintenance
• pet care
• care of house plants
• household administration (i.e., pay bills)
• stacking and cutting rewood
• putting groceries away
• shopping for groceries, clothing, gas, etc.
• buying take-out food
• shopping for durable household goods
• nancial services (i.e., banking)
• other repair services (i.e., TV)
• waiting for purchases/services
• other shopping and services
• travel to shopping for goods/services
Leisure activities
ACTIVE LEISURE
• playing sports and games
like miniature golf,
Frisbee, catch, bowling,
and billiards
• outdoor activities like
hunting, shing, camping,
skiing and ice skating
• walking, hiking, biking
• board games, cards and
video/computer games
• music, drama, dance
• exercise like yoga and
weight lifting
• attending sports and
music events
• going to fairs or zoos
• going to movies or lms
• going to opera, ballet,
theatre
• going to museums, art
galleries, heritage sites
• travel related to active
leisure
PASSIVE LEISURE
• listening to radio, CDs,
tapes, records
• sitting
• smoking
• watching TV
• lying down
• passing time without
activity
SOCIALIZING
• restaurant meals with
others
• socializing at a home
• talking, conversation,
phone
• socializing at bars, clubs
• socializing at malls,
hospitals
• going to social gatherings
like weddings
• going for a pleasure drive
with another or on a tour
bus
• travel to social activities
Rest activities
NIGHT SLEEP
• night sleep/essential sleep
NAPS
• incidental sleep, naps
Source: Adapted from Statistics Canada’s 1998 Time-Use Survey
Action Over Inertia © CAOT PUBLICATIONS ACE 2010
Time use of adult and
retired Canadians
Resource 2.3
Time Use of Adult Canadians
Time Use of Retired Canadians
Self-care
Productivity
Leisure
Rest
Self-care
Productivity
Leisure
Rest
Source: Adapted from Statistics Canada’s 1998 Time-Use Survey
Activity
Activity
Hours Hours
Action Over Inertia © CAOT PUBLICATIONS ACE 2010
Record of activity experiments
Date: ______/________/_____
Name: ______________________________________________________________________
Activity experiment Date Comments about the experience and
progress made
List your selected activity experiments, the date and brief comments about the experiment:
Worksheet 3.1
Action Over Inertia © CAOT PUBLICATIONS ACE 2010
Resource 3.1
Some ideas for ‘quick activity changes’
Personal Care
Dressing
• Wearadifferentshirt.
• Trytomix/matchatopandbottom
differently.
Bathing
• Haveabathorshower.
• Tryanewbodywashorshampoo.
Eating
• Havebreakfast.
• Tryanewfruitorvegetable.
• Tryanewrestaurant.
• Tryanewethnicfood–maybeonethata
friendenjoys.
Hygiene
• Shave.
• Getahaircutortryadifferenthairstyle.
• Tryadifferenttoothbrushingroutine.
• Haveorgiveamanicure/pedicure.
• Tryanewcolourofnailpolish.
• Tryossingyourteeth.
Health
• Getaushot.
• Bookanappointmentforamedical
checkup.
• Throwoutyourexpiredmedicines.
Here is a list of activities that are quick, simple and require little preparation. Consider any that
sound interesting to you. Then, try one, two, or a few — you may be surprised how good you feel
when you’re finished!
A. Examples of small “activity experiments” in the area of self-care:
Community Management
Transportation
• Trytakingabus.
• Goforabikeride.
• Walkashortdistance.
• Goforaridewithafriend.
Shopping
• Tryadifferentstoreforgroceryshopping.
• Goshoppingwithafriend.
• Combineadrugstorevisitwitharestatthelocalcoffeeshop.
• Gowindowshoppinginadifferentareaoftown
Finances
• Recordwhatyouarespendingeachdayforaweek.
• Checkoutthethriftshop.
• Lookattheyersforsales.
Action Over Inertia © CAOT PUBLICATIONS ACE 2010
Some ideas for ‘quick activity changes’
(continued)
Resource 3.1
Paid/Unpaid Work
• Lookonlineatthevolunteerpositionsposted.
• Digoutyouroldresume.
• Visitthelocalemploymentagency.
• Doaninterestinventorytodeterminewhatyouareinterestedin.
• Visitavolunteercoordinator.
B. Examples of small “activity experiments” in the area of productivity:
C. Examples of small “activity experiments” in the area of Leisure:
Household Management
Cleaning
• Cleanoffacounterortablesurface.
• Spend30minutesperdayononeroom.
• Organizeonedraweroroneshelfinyour
storagecloset.
• Recycleyournewspapersandcans.
• Giveyouroldclothestoalocalcharity.
Laundry
• Dooneloadofwashinganddrying.
• Foldandputawayclothesthathavebeen
inthelaundrybasket.
Cooking
• Planandprepareyourfavouritefood.
• Tryanewrecipe.
• Watchacookingshow.
• Eatbycandlelight.
Quiet Recreation
Pleasurable activities/hobbies/crafts:
• Findanunnishedproject.
• Lookthroughhobbymagazinestoseeif
thereisanythingofinterest.
• Lookthroughthelocalcollegeorcityparks
andrecreationcataloguetoseeifthereisa
classofinterest.
• Playamusicalinstrument.
• Listentoyourfavouritemusic.
• Listentoasymphony.
• Watchasunset.
• Repotaplant.
• Listentoacomedianortakeinafunnymovie.
• Cookavegetariandinner.
• Tryanewtypeoftea.
• Writeapoem.
• Singintheshower.
• Tryanewavouroficecream.
• ReduceyourtimeinfrontoftheTVbya
halfhour.
• Takeanap.
• Visitanewwebsiteonthecomputer.
Reading:
• Findashortstorybookandreadone
story.
• Readamagazinearticle.
• Borrowatalkingbookfromthelibrary
andtrylisteningtoit.
• Tryadifferentnewspaper.
Action Over Inertia © CAOT PUBLICATIONS ACE 2010
Resource 3.1
Some ideas for ‘quick activity changes’
(continued)
3. Examples of small “activity experiments” in the area of Leisure continued:
Active Recreation
Sports:
• Stretchafterawarmshower.
• Rentayoga,pilates,orTaiChiDVDfromthelibraryorstore.
• Dancearoundthelivingroom.
• Walkalongthewaterfront.
• Makealistofallthesportsyouhavetriedandonesyouareinterestedin.
• WatchanewsportsshowonTV.
• Readastoryaboutaninspiringathlete.
• Takeafreeyogaclass.
• Takethestairsinsteadoftheelevator.
Outings:
• Visitanartgallery,museumorfacilitythatyouhavenottriedbefore.
• Tryanewfoodfromadifferentculture(i.e.,Indian,Vietnamese,Greek,Japanese,Chinese).
• Gotoalocalevent.
• GothelocallibraryandborrowaCD,DVD,orbook.
• UsetheInternetatyourlocallibrary.
• Visityourseniors’centre.
• Paddleorrowaboat.
• Flyakite.
• Findanactivitypartner;itismorefunwithafriend.
Gardening
• Plant,dig,prune,rakeorweed.
Travel:
• Takeadifferentbus.
• Rentamovieaboutatraveldestination.
• Gotoanewcommunityinyourareawithafriend.
Socialization
Visiting/phone calls/parties/
correspondence:
• Inviteafriendforacupofteaatyour
homeoralocalshop.
• Callanoldfriend.
• Callyourfavouriterelative.
• Sendacardtosomeone.
• Sendane-mail.
• SetupaFacebookaccount.
• SendsomeoneyourfavouriteYouTube
video.
Action Over Inertia © CAOT PUBLICATIONS ACE 2010
The health and well-being benefits
of my current activities
Date: ______/________/_____
Name: ______________________________________________________________________
Health and well-being benefits I receive from these
activities
Worksheet 4.1
Self-care activities:
Leisure activities:
Productivity activities:
Action Over Inertia © CAOT PUBLICATIONS ACE 2010
Reducing stress in activity participation
Date: ______/________/_____
Name: ______________________________________________________________________
Strategy to reduce
sources of stress
Be aware of situations that
were stressful in the past
Set reasonable expecta-
tions for myself
Consider how stressful
aspects of an activity can
be modified or changed
Maintain good health
habits that reduce my
experience of stress
Seek out supportive
relationships that can help
me manage stress
Avoid situations with
arguments and criticism
Give myself credit for
talents and strengths
Balance out the amount
of stress I have across
activities
Other:
I use this strategy
effectively
I would like to use this
strategy or improve the way
I use this strategy
Adapted from: National Mental Health Information Center (2003). Illness Management and Recovery Implementation Resource Kit. Washington,
D.C.: United States Department of Social Services. Retrieved from http://mentalhealth.samhsa.gov/cmhs/CommunitySupport/toolkits/illness/.
Worksheet 4.2
Action Over Inertia © CAOT PUBLICATIONS ACE 2010
Coping with stress in activity participation
Date: ______/________/_____
Name: ______________________________________________________________________
Strategy for coping
with stress in activity
Talk to someone about my
feelings and experiences
Use relaxation techniques
Use positive self-talk
Keep a sense of humor
Use religion or other form
of spirituality
Take a walk or exercise
Write in a journal
Work on solving problems
Develop my social skills
Learn new skills for the
activity
Identify and manage my
relapse triggers
Other:
I use this
strategy
Adapted from: National Mental Health Information Center (2003). Illness Management and Recovery Implementation Resource Kit. Washington,
D.C.: United States Department of Social Services. Retrieved from http://mentalhealth.samhsa.gov/cmhs/CommunitySupport/toolkits/illness/.
Worksheet 4.3
I would like to try this strategy or
improve the way I use it
Action Over Inertia © CAOT PUBLICATIONS ACE 2010
Understanding how substance use
impacts my activities
Date: ______/________/_____
Name: ______________________________________________________________________
Use these questions to consider how substance use might be impacting your activity participation
and well-being.
Worksheet 4.4
Substance use is a part of
my daily routine
I regularly use substances
over the course of a typical
week
My use of substances
tends to be linked to
certain activities
Using substances helps
me to deal with bad
feelings or moods
I regularly participate in a
range of activities that do
not involve substance use
My use of substances
could put activities I value
at risk
My use of substances has
been a source of conflict
with important people in
my life
The money I spend on
using substances limits
my ability to participate in
other valued activities
Using substances
helps me to cope with
the anxiety or stress
I sometimes feel in
activities
Yes/No
Comments/examples
Action Over Inertia © CAOT PUBLICATIONS ACE 2010
The multiple “well-being” benefits of activity
Resource 4.1
Every person needs to have the opportunity to experience a variety of activities in order to
experience wellness and satisfaction with their life.
Through activities, you have the potential to experience all of these benefits!
Contributing to Society
Making Money
Expressing
Yourself
Interacting with other People
Meet your Goals
Enjoy
Beautiful
things
Being Physically Active
Developing
new Knowledge
& Skills
Doing Things that are
Important to You
Making Others
Feel Good
Taking off with healthy activity!
Action Over Inertia © CAOT PUBLICATIONS ACE 2010
Resource 4.2
One activity, many benefits!
Any one activity may provide several benefits. For example, a person who works part-time at
the public library could experience all of the following personal benefits:
Developing knowledge and skills:
Part-time work can help to develop important work skills, particu-
larly when an individual has experienced a lengthy period out
of the workforce. It also requires the development of skills
to complete the job (for example, learning how books are
catalogued or how to use technology for library searches). This
work would also give access to reading and other resources for
personal interest.
Interacting with others:
Working at the library could allow for social contacts with both
the staff and the patrons. It also provides an experience that can
be shared with family and friends.
Personal income:
Part-time work will provide an income that might be small but
could provide extra funds to meet expenses or to save for an
important purchase. It could also supplement pocket money and
be used for social opportunities such as going to the movies with
a friend, or buying a gift for a family member.
Contributing to society:
The library is a public resource that depends on community
members to keep it going.
Try to choose activities that provide more than one benefit. For
example, if you are going for a walk, invite a friend or neighbour
along. This will help to get the most from activities.
Action Over Inertia © CAOT PUBLICATIONS ACE 2010
Making clear the benefits of activities
Resource 4.3
Activity
Exercise
Preparing and
enjoying meals
Socializing
Work and
Volunteering
Grooming
Routines
Relaxation
Benefits
• Improvedmoodandfeeling“t”
• Maintainahealthybodyweight
• Decreasetheriskofdiseasessuchascancer,diabetesandheart
disease
• Betterendurance,staminaandexibilityforotherdesiredactivities
• Goodnutritionandmaintainingahealthyweightlowersriskformany
diseases such as Type II diabetes
• Propernutritioncangiveenergytoparticipateinactivities
• Anactivitythatcanbeenjoyedwithothers
• Learnaboutthehabitsandroutinesofotherculturesanddevelop
skills in the kitchen that will be appreciated by others
• Socialsupportscanhelpintimeofcrisisandsadness
• Asocialnetworkcanofferpracticalhelp
• Socialcontactscanencourageandsupportparticipationinarangeof
activities
• Socialcontactsappeartoprotectpeopleagainstsomeformsofillness
• Itfeelsgoodtogivesupporttoothers
• Havingajoborvolunteerpositioncangiveasenseofpurposeand
importance
• Personalaptitudesandinterestscanbeusedinworkandvolunteer
activities
• Newskillscanbelearned
• Socialskillscanbepracticedintheworkplaceandnewfriendscanbe
made
• Workingcanprovidenancialbenets
• Canimproveself-esteemandincreasecomfortinpublicsituations
• Canbeanimportantformofself-soothingthathelpstoreduceanxiety
or distress
• Canreducethecostsassociatedwithcostlyhealth/dentalcare
• Anantidotetostress
• Canimprovemoodandreducefrustration
• Cansharpenthinkingskills
• Reducesphysiologicaleffectsthatcanleadtopoorhealth
Here are some benefits of a few common activities.
Think about your own activity patterns – what benefits do you get?
Action Over Inertia © CAOT PUBLICATIONS ACE 2010
Resource 4.4
The recovery benefits of activity participation
Activity
Patterns
Individualized
Strengths-based
Personal meaning
Self-determination
Becoming
empowered and
exercising citizenship
Participating in activities
provides the context for
havinga“voice”and
influence in the
community
Overcome stigma
Social stigma is reduced
through positive inter-
actions with people
with mental illness in
important social
activities
Renew hope
Activity participation
provides evidence of
possibilities beyond
illness
Finding
social support
Through activities
important social
connections are
made
Redefine self
Through activities,
personal and social
identity (beyond
the illness) are
realized
Assume control
Activities provide
the means to exercise
choice and to become
actively involved with
the world in a way that
supports personal
well-being
Live a full life –
not an illness
A range of daily life
activities define an
individual’s life. The
illness experience is
only part of this
“whole”life
Manage
symptoms
Participation in
important activities
provides the
context for learning
to manage
symptoms
Action Over Inertia © CAOT PUBLICATIONS ACE 2010
How are mental illness and activity
participation connected?
Resource 4.5
Biological, psychological and social explanations
People with mental illness often describe tremendous changes in the way they experience their daily
activities. These descriptions have typically included:
• difcultieswithfeeling motivated and sustaining interest
in activity;
• weakened sense of enjoyment and pleasure from
activities;
• unpleasant emotions such as anxiety associated with
activity participation;
• few opportunities for activity participation that holds
meaning and value;
• difficulty in activities with particular types of social
interactions;
• more difficulty planning and following through with
activities;
• cognitivechangesorchangesinthinkingsuchasreduced
attention, working memory (i.e., holding information in
your mind), and flexibility in thinking processes; and
• sensory overload or understimulation in activity.
These changes can be uncomfortable both for the individual experiencing them, and for their family,
friends and others.
The reasons for these changes are complex and not completely understood.
This resource is meant to provide you with information about some of the ways that mental illness is
believed to impact the experience of daily activities. These are grouped into biological, psychological
and social explanations.
Not every explanation will apply to each individual; you are encouraged to talk to your health provider
to discuss how these ideas might apply to you.
It is important to remember that, regardless of the reason, many positive elements of activity
participation remain and changes in the experience of activity participation can be addressed.
Achieving the health and well-being benets of activity is possible!
Action Over Inertia © CAOT PUBLICATIONS ACE 2010
Resource 4.5
Biological explanations
Biological explanations focus on the structures, physiology and functions of the human body that
could account for disruptions experienced in activity and activity patterns.
Brain structure
The brain is divided into two halves- the left and right hemispheres. Each
hemisphere contains four lobes: frontal, parietal, occipital and temporal.
One area that has been found to play a role in activity participation
in people with mental illness is the frontal lobe. The frontal lobes are responsible for complex
thought processes, such as:
• planningactivities;
• makingdecisions;
• interactingwithothers;
• controllingbehaviour;
• processingemotions;and
• personality.
An impact on the frontal lobes through illness or injury can lead to changes in personality and
behaviour including, for example, difficulties controlling emotions and behaviour, and higher
levels of disorganization. This can interfere with motivation to do things that were once enjoyable
and the sense that the thinking and planning involved is overwhelming.
The frontal lobes are adjacent to the temporal lobes, and their
functions overlap. The temporal lobes contain the limbic system,
whichisknownasthe“rewardcentre”ofthebrain.Thelimbic
system is important for motivation and pleasure. Changes in the
limbic system associated with mental illness may be another reason
why activities are experienced as less rewarding.
Some forms of mental illness have also been associated with
enlarged lateral ventricles. Ventricles are cavities within the brain
that are adjacent to many important brain structures. Enlarged
lateral ventricles have been associated with lower energy and motivation, less social interaction,
lack of enjoyment, and decreased ability to sustain attention – all likely to impact the experience of
engaging in activities.
Action Over Inertia © CAOT PUBLICATIONS ACE 2010
Resource 4.5
Neurophysiological changes
Neurotransmitters are the chemical messengers that neurons or nerve cells use to communicate
with each other. Neurons carry information from the body to the brain and vice versa. There are
billions of neurons in the brain.
Impulses from other neurons are received by the dendrites and sent to the cell body of the
neuron. The cell body receives all impulses and keeps track of all of the inputs. If enough inputs
are received, the cell body reaches its threshold and transmits the impulse down the axon. When
information travels along the axon, it is called an action potential. The axon is covered with
myelin, which is a fatty layer that acts as an insulator and speeds up the rate at which information
travels along the neuron.
At this point, the impulse has traveled the full length of the neuron. For the impulse to be trans-
mitted, it has to be passed on to another adjoining neuron. Passing impulses between two
neurons is called synaptic transmission. A synapse is the space between the synaptic terminal of
one neuron and the dendrites of the receiving neuron.
Howistheimpulsetransmittedacrossthesynapse?Itispassedalongbychemicalscalled
neurotransmitters stored in packets called synaptic vesicles that are at the end of the axon. When
the action potential reaches the end of the axon, it signals to the release of neurotransmitters
which then spills into the synapse or synaptic cleft, and lands on receptors on the postsynaptic
membrane of the receiving neuron, where the whole process begins again.
What do neurotransmitters have to do with the experience of enjoying occupation?
Changes in neurotransmitters appear to be involved in the way people with mental illness
experienceactivities.Researchersarenotexactlycertainwhatrolesneurotransmittersplay,but
they do know that they are involved. Dopamine, serotonin, and glutamate (among others) are
neurotransmitters that have been associated with a wide range of mental illnesses. Disruptions
in neurotransmitters in the context of mental illness might affect the experience of activities, by
impacting motivation rewards, enjoyment, attention, energy, and so on.
The impact of medications on activity
Medications taken to treat mental illness and their side effects may also change the experience
of activities. While medications prescribed for mental illness can be very effective in reducing
symptoms and avoiding relapse of acute mental illness, managing medications may require
the development of coping strategies to deal with the impact on activity. Common side effects
of medications that impact activity participation include: feeling tired; lack of motivation and/or
energy;difcultyconcentratingorfeeling“foggy”;weightgain;changesinbodymovements.
Action Over Inertia © CAOT PUBLICATIONS ACE 2010
Resource 4.5
Psychological explanations
The psychological elements of particular relevance are those mental
functions that lie at the heart of human potential for growth and
change. These are the psychological processes that influence how
humans think about themselves in relation to activities and how this
influences their participation and engagement.
Humansarebelievedtobeinherentlymotivatedtoparticipateinactivities–thismotivationisfunda-
mental to survival. Motivation is a complex psychological process that includes initiating human
activity, giving it direction and sustaining involvement. Motivation can be quickly and profoundly
disturbed by experiences with mental illness.
The following are a few ways this disruption in motivation for activity can occur:
Hopefulness vs. hopelessness
Ongoing symptoms of mental illness, personal limitations experienced in the wake of mental
illness, and the disruption of important life plans and activities can interfere with an individual’s
ability to imagine a future with new possibilities and potential.
Active involvement vs. inactivity/passivity
Individuals experiencing mental illness can feel that they have lost control of their health and
well-being — and of their present and future lives.
Activity-promoting self-evaluations vs. activity-inhibiting self-evaluations
Negative experiences with mental illness can impact self-confidence and self-esteem and belief in
one’s own abilities. This self-doubt can lead to caution and even avoidance of activities.
Feelings of pleasure vs. distress
Mental illness can be associated with an increase in feelings of distress in activity. For example,
anxiety, worry, and fear in activity can cause discomfort, even when the desire to participate in a
particular activity is present.
Coping and adaptation
Participation in valued activities requires ongoing coping and adaptation for everyone. Partici-
pation in valued activities while living with a mental illness requires the development of new
coping strategies and the resilience to bounce back and learn from successes and problems.
Action Over Inertia © CAOT PUBLICATIONS ACE 2010
Resource 4.5
Social explanations
Social explanations focus on factors “external” to the individual that can impact activity patterns.
They can occur in an individual’s immediate environment, reflect social and cultural expectations,
or emerge from the structure or organization of important resources in the community.
Impact on “typical” developmental milestones
For many individuals, mental illness is first experienced in youth or young
adulthood, at a critical time period for the creation of activity opportu-
nities, learning important skills, and establishing the social networks that
will support activity engagement. For example, engaging in education is
a typical activity of youth, but when it is disrupted by mental illness it can
have far reaching implications for the individual as they age — impacting
career opportunities if courses are not completed, influencing the ability to
secure good references, and constraining the ability to develop a good support network that will
enable intimacy and romance, family life, work, career and leisure possibilities.
Spending time in hospital or other settings removed from daily routines and
activities
Receivingtreatmentisanimportantresourceforindividualswhoexperiencementalillness.For
some people that treatment might be delivered in a hospital setting. If the hospital stays are
relatively brief and infrequent they may pose only a minor disruption to activity participation and
patterns. For some people, hospital stays, or other time away from the community where daily
activities occur, can have a significant impact on activity experiences and participation. While
in hospital, daily routines and activities may be curtailed and offer few
choices.Hospitalrulesorproceduresmaylimitaccesstocertaintypes
of activity opportunities. Following a hospital stay, some people report
the need for a period of recuperation, overwhelmed by their absence
from daily activities and unsure how to reengage.
Stigma and discrimination
Societal stigma and discrimination have been described as particularly powerful forces
constraining the opportunities for individuals with mental illness to engage fully in personally and
socially valued activities. Societal stigma that constrains activity participation comes from at least
two sources:
1. Powerful assumptions held within the public about the ability of people with mental illness to
participate in important activities in the community. For example, assumptions might include
faulty information about the abilities and strengths of people who experience mental illness.
2. The inclusion of these assumptions into policies, standards and other social structures
surrounding important activities. For example, hiring procedures for paid or volunteer work
might be designed in a way that discriminates against (even inadvertently) people with mental
illness.
Stigma is a particularly powerful force when it is accepted by the person – a process referred to as
“internalizedstigma.”
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Resource 4.5
Social explanations
(continued)
Limited resources and opportunities
Full participation in meaningful activities depends on access to resources: things, people and
opportunities. People who experience mental illness can find themselves with constrained
nancialmeansthatlimitstheiraccesstothe“things”requiredtoparticipate.Forexample,
students may have limited access to the money required for tuition, working may be constrained
by limited access to easy transportation or suitable clothing, and leisure may be impacted by
limited funds for equipment or entrance fees. Doing activities is supported by social networks,
and to the extent that people with mental illness find themselves experiencing reduced social
contacts, this situation will decrease their opportunities for participation.
Activity participation has not been a primary area of concern of service provision in the mental
health system. Indeed mental health service providers may not see the active support for activity
participation as a primary area for attention and they may hold faulty assumptions about the
relationship between activity and mental health. The mental health system has been slow to take
up interventions and practices shown to support activity participation.
Understanding the factors that might be involved in supporting or limiting activity participation
can be helpful in taking steps to move ahead.
Remember…
Health remains — even when illness is present
Capacity and ability remain — even when disability is present
Opportunities exist — even when participation has been affected
Action Over Inertia © CAOT PUBLICATIONS ACE 2010
Overcoming potential barriers to activity participation
Resource 4.6
Factors constraining activity participation may be present, but are not necessarily insurmountable.
Herearejustafewexamplestogetyouthinking:
Stigma
Some people who have not experienced
mental illness hold misguided attitudes about
mental illness. These attitudes may make
it difficult for people with mental illness
to maintain healthy self-esteem or to be
included in important community activities/
opportunities.
Anxiety
Feelings of anxiety and worry, whether due
to mental illness or because of stigma and
negative experiences, can make it difficult to
engage in new activities or return to activities
once enjoyed.
Stress
The fear that stress could prompt a relapse is
often a barrier to participating in activity.
Changes to social networks
Social contacts can change or be lost during
the course of mental illness. Confidence to
socialize can be shaken. Changes in activity
patterns can also affect the opportunity to
meet new people.
Financial barriers
People with mental illness on a limited income
may find their activity options limited. Activ-
ities can be costly, which may be a barrier to
participation. Disability income may impact
work opportunities.
Overcoming stigma
Being active in the community can help
to change people’s attitudes about mental
illness. Through such positive interactions
stigma and discrimination is lessened.
Overcoming anxiety
Being bored can also create feelings of
anxiety and depression. When people are
inactive, they tend to spend a lot of time
alone, which also increases anxiety. Being
active is an effective distraction from
worry, and learning relaxation and anxiety
management techniques can help.
Overcoming stress
Engaging in valued activities is important in
learning to manage illness and experience
recovery. Best practice in mental health
matches activity participation with supports
to enhance coping, manage expectations and
demands and ensure much needed supports
are in place.
Developing new social networks
Friends provide social support that can help
to enjoy and manage day-to-day activities. By
participating in new activities, opportunities
to meet new people and develop new friend-
ships can present.
Dealing with financial barriers
Activities do not have to be costly. Low cost
(or no cost) activities exist. Funds may be
available to cover some costs of working.
Familiarity with the policies related to income
can ensure that all opportunities for activity
participation are pursued.
Action Over Inertia © CAOT PUBLICATIONS ACE 2010
Resource 4.7
Moving beyond stress in activity participation
Consider these strategies to actively manage stress experienced in activity:
i. Choosing Activities
Choose activities that hold personal meaning and value
This can help you sustain your commitment in activity if the
going gets rough.
Choose activities that are a good match for your strengths, skills,
abilities and past experiences
Capitalize on your many strengths to reduce the experience
of stress in activity.
Learn more about your own experience of stress
Use this information to help you in planning your activity
involvement.
ii. Managing Stress in Activity
Learn new skills necessary to participate in the activity
Consider the task and social skills required and create the opportunities to learn these skills.
Take stock of your coping style and skills and learn new skills to help you adapt
Consider what coping strategies have worked for you and which haven’t.
Try out new coping strategies.
Learn to identify signs/symptoms of your mental illness in activity
Byidentifyingpotential“triggers”youareinagoodpositiontolearnnewwaystoactively
manage your illness while continuing with important activities.
Develop supports and resources to assist you with your activity participation
Supportive people can provide emotional support; help you learn new skills; and ways
to cope. Consider what resources might make it easier for you to participate and work with
your supports to get these resources where possible.
iii. Reducing the Experience of Stress in Activity
Consider how the activity might be changed to support your participation and reduce stress
Mostactivitiescanbeadaptedtocreateabetter“match”forindividuals.Thesemodications
aresometimescalled“accommodations.”
Action Over Inertia © CAOT PUBLICATIONS ACE 2010
Substance use, activity and well-being
Resource 4.8
While the use of street drugs and overuse of alcohol has been shown to increase symptoms and
community living problems associated with mental illness, it can also interfere with the ability to
experience the benefits of participation in activities.
Consider reducing your use of substances. Services and resources are available to help.
Ask your mental health service providers for more information!
Here are a few examples:
• Substancescanbeexpensive, taking away from
money that could be spent doing valued or potentially
rewarding activities.
• Usingstreetdrugsandothernon-prescriptiondrugs
may be difficult and dangerous to get. Getting these
drugs may deplete energy - energy that could be put
into other rewarding and valued activities.
• Abusingsubstancescancauseisolation from
important family and friends. Activities that do not
depend on substance use are more likely to provide
opportunities for positive social connections.
• Theeffectsofusingdrugsoralcoholmaymakeit
unsafe, difficult, or even impossible to do other
activities.
• Frequentsubstanceusecanreduce the opportunity to
experience the pleasure and good feelings that can be
associated with activity.
• Whileusingsubstancesmightreduceanxietyorother
distress associated with participating in valued activ-
ities, in the long run it can seriously limit opportu-
nities for learning healthy ways of participating.
Action Over Inertia © CAOT PUBLICATIONS ACE 2010
Preparing for changes in activity participation
Date: ______/________/_____
Name: ______________________________________________________________________
Worksheet 5.1
The activities that I enjoy doing now are:
Activities that provide structure and order to my days are:
The most meaningful activities I now do are:
Thinking about the way I now spend my time, the things I don’t want to change are:
The activities I do now that I don’t enjoy are:
If I could change one thing about the way I spend my time it would be:
My ideal day would include these activities:
Action Over Inertia © CAOT PUBLICATIONS ACE 2010
Prioritizing plans for activity change
Date: ______/________/_____
Name: ______________________________________________________________________
A. Look back at the Worksheet 2.10: Activity engagement measure. Fill in the chart below using
your ratings for each dimension from this measure.
Remember that a LOWER rating indicates that you could benefit from attending to this
dimension of activity more in your life.
Worksheet 5.2
Area of Activity Engagement Rating (out of 10)
Balance in my life
Physical activity level
Structure and routine
Meaningfulness of activity
Satisfaction derived though activity
Social interaction
Accessing community environments
Based on these scores, what three areas would you rate as the most important to improve?
1.
2.
3.
Action Over Inertia © CAOT PUBLICATIONS ACE 2010
Prioritizing plans for activity change
(continued)
Date: ______/________/_____
Name: ______________________________________________________________________
Worksheet 5.2
B. Look back on all of the worksheets and reflections. What activities or activity patterns have
you identified as perhaps requiring change? Write them down here.
Add other new activities or activity pattern changes that you have been thinking of:
C. Could any of these activities help you improve those areas of activity participation you
prioritized above in section A? How?
D. What changes to your activities or activity patterns would you most like to make?
Activity dimensions are adapted from the work of Bejerholm (2007) and Bejerholm, Hansson, & Eklund (2006).
Action Over Inertia © CAOT PUBLICATIONS ACE 2010
Challenges
Personal learning
Material resources
Illness management
Emotional needs
Managing social judgments
Activity modifications or
accommodations
Social supports
Other
Examples
1. List ONE desired activity change: __________________________________________________________
2. What challenges or issues do you expect might arise in making this activity change?
Use Resource 5.1 and Resource 5.2 to help guide you in this exercise.
Planning for activity change
Date: ______/________/_____
Name: ______________________________________________________________________
Worksheet 5.3
a
Action Over Inertia © CAOT PUBLICATIONS ACE 2010
Planning for activity change
(continued)
Date: ______/________/_____
Name: ______________________________________________________________________
Worksheet 5.3
Challenges
How can this challenge be reduced or managed?
3. Consider each of the challenges listed in the previous section. How might these issues or
challenges be managed to help you participate successfully in this activity? What supports might
you need to address these challenges?
Action Over Inertia © CAOT PUBLICATIONS ACE 2010
Giving shape to plans for activity change
Worksheet 5.4
Date: ______/________/_____
Name: ______________________________________________________________________
1. I would like to make the following change to my activity participation:
2. In order to make this change I will: (Outline the steps to be taken.)
3. The following people will be involved in helping me achieve this plan for change: (Identify
the people and explain how they will be involved.)
4. The changes I expect as a result of this change are:
5. I will monitor my progress on this activity change by:
Action Over Inertia © CAOT PUBLICATIONS ACE 2010
Resource 5.1
Managing challenges to activity change
Challenges
Personal learning
New activities might require new
information/knowledge or skills or
“tuning up” old skills
Material resources
Every activity will require access to
things such as transportation, new
clothing, equipment, etc.
Illness management
Understanding how experiences
of illness present in new activities
and learning how to manage is
important
Emotional needs
Keeping up involvement in any new
activity depends on experiencing
positive emotions and a sense of
well-being
Managing social judgments
Addressing misguided attitudes
about mental illness that other
people hold can help make activity
participation more pleasurable and
rewarding
Activity modifications or
accommodations
There are aspects of activities that
can be changed or modified when
activity participation is difficult.
Social supports
Activity participation is enhanced
when practical, emotional or infor-
mation support is available from
other people
Examples
- Practice asking co-workers for assistance or asking a
supervisor for clarification
- Learn about a new area of town or transportation
services
- Learn how to use a new or updated computer
program
- Secure employment supports available through
government financial assistance
- Gain access to a computer to use social networking
programs
- Update clothing for a job interview
- Speak with the doctor about a medication schedule
that reduces morning fatigue
- Identify symptom “triggers” in the activity and learn
to avoid or manage these triggers
- Build rest times into the day to give energy to
manage symptoms
- Learn relaxation techniques to help deal with
feelings of anxiety
- Identify negative thought patterns that are affecting
the experience
- Remember the positive experiences of activity to
counterbalance any negative emotional aspects
- Decide what to “disclose” about mental illness and
practice how to disclose
- Connect with supportive people while participating
in activity
- Become familiar with legal rights protecting
involvement in community activities
- Work schedules can be flexible to accommodate
the need for a later start because of early morning
fatigue
- Training time can be increased to give more opportu-
nities to meet learning needs
- Private space can reduce distractions
- Identify a friend who is willing to participate with
you
- Find a confidante who will give another perspective
or help with problem solving
- Organize your time to be with other people just for
fun – to offset other activities that are challenging.
Action Over Inertia © CAOT PUBLICATIONS ACE 2010
Activity Challenge
or Problem
Road bumps on the path
from inertia to action
Resource 5.2
Before the Activity
Could be related to:
• Activity
• Situation
• Thoughts
• Beliefs
• Feelings
• Body response
• People
What was the
situation?
• Beliefs about activity
• Things you did
• What did you think?
• What did you feel?
• Describe your body’s
reaction
Contributes to
Action
Contributes to
Inertia
• Which of your strengths could be
used to change this cycle?
• Are there some ways that you’ve
coped with previous challenges
that might work now?
• What is one thing you could do
differently to overcome a piece of
this challenge or problem?
Activity
• Thoughts
• Feelings
• Beliefs
• Physical response
• What did you do?
• Was there a benefit?
• What in this situation contributes
to inertia?
Action Over Inertia © CAOT PUBLICATIONS ACE 2010
Resource 5.3
Activity Challenge
or Problem
Road bumps on the path
from inertia to action (example)
Before the Activity
I want to exercise
but I don’t do it!!
• Put on weight
• More self-conscious
about looks
• Get stopped before I
even put on my
runners
• Afraid I’ll run into
people I know
• Don’t want people to
see me
• Frustrated with myself
• Keep thinking of how
many times I’ve tried
and failed at this
Contributes to
Action
Contributes to
Inertia
Ideas generated:
• Start with 10 min. walk around the
block
• Get exercise equipment for house
• Exercise with a TV program
• Buy a beginners exercise DVD
(e.g., Yoga, Tai Chi)
• Exercise early in morning/late at
night/during when fewer people are
likely to see me
• Ask a friend to do it with me
• Decide to do it at my best time of
day – after lunch
• Reward myself with a cup of
favourite tea
• The 95% ‘doable’ idea to experiment
with this week is: walk around
the block every day after my early
supper
• Make excuses
• Feel worse
• Distract myself with other things in
the house to keep from going out
• Eat more
• Smoke more cigarettes
• Drink more coffee
• Sleep more
• More bored
• Feel worse about myself
• Become more isolated from friends
and family
Action Over Inertia © CAOT PUBLICATIONS ACE 2010
Worksheet 6.1
Reflecting on practices of supporting
activity change
(service provider)
Date: ______/________/_____
Name: ______________________________________________________________________
Service provider’s name: _____________________________________________________
What knowledge/evidence do I have that assures me that the planned activity changes hold
personal meaning for the individual?
From my knowledge of this individual I think my support actions will need to be sensitive to
the following issues:
How will I deliver my practice efforts so that they are attentive to these sensitivities?
How will I ensure that my efforts to support change with this individual are collaborative and
person-centred?
Action Over Inertia © CAOT PUBLICATIONS ACE 2010
Enabling sustained commitment by supporting
activity performance
Date: ______/________/_____
Name: ______________________________________________________________________
Supporting activity performance
Balance difficulties that emerge with attention
to the person’s strengths and capacities that
emerge in activity participation.
Build on strengths and capacities rather then
focusing on personal weaknesses or inabilities.
Refine or modify the context or conditions
of the activities to promote success and
well-being.
Develop additional human supports to support
performance, with particular attention to
engaging the support of people that also
participate in the activity or “natural supports.”
Access new material resources that will
enhance performance.
Identify and support the learning of new
knowledge and skills needed to perform the
activity well.
Specific efforts
The following checklist provides an opportunity to consider how specific enabling processes to
support the positive performance of activity are implemented with an individual. The information
gained from this worksheet can be used to make explicit these enabling processes for discussion
with the individual, other health service providers and for documenting and recording.
Worksheet 6.2
Action Over Inertia © CAOT PUBLICATIONS ACE 2010
Worksheet 6.3
Enabling sustained commitment by supporting
positive activity experiences
Date: ______/________/_____
Name: ______________________________________________________________________
Support action
Convey an attitude of experimentation – an
attitude where there is no failure only new
learning and growth.
Decrease the assistance of formal supports in
activities as the natural benefits of activities
emerge and the individual gains confidence.
Make explicit the benefits the individual experi-
ences with changes in activity patterns. Use
the dimensions of health through activity to
identify and expand upon benefits.
Highlight any positive impacts on important
friends, family, and other social connections,
which emerge in the context of new activity
patterns.
Specific efforts
The following checklist provides an opportunity to consider how specific enabling processes to
support the positive experience of activity are implemented with an individual. The information
gained from this worksheet can be used to make explicit these enabling processes for discussion
with the individual, other health service providers and for documenting and recording.
Action Over Inertia © CAOT PUBLICATIONS ACE 2010
Worksheet 6.3
Enabling sustained commitment by supporting
positive activity experiences
(continued)
Date: ______/________/_____
Name: ______________________________________________________________________
Support action
Validate and address difficult emotional experi-
ences and help to equip the individual with
the knowledge and skills to manage these
emotions.
Identify and address situations that leave the
individuals vulnerable to experiences of trauma
or victimization.
Assist with refining activities and activity
patterns to match individual needs through
periods of instability of mental health.
Provide ongoing support to refine activities so
that they most closely reflect the meaning and
purpose that the individual associates with the
activity.
Validate concerns related to stigma and
discrimination and assist the individual with
developing personal disclosure plans and ways
to manage social evaluations or judgments in
activity.
Build in ways to celebrate achievements in the
process of changing activity patterns.
Specific efforts
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Identifying changes in my activity patterns
Date: ______/________/_____
Name: ______________________________________________________________________
Worksheet 6.4
Area of activity
engagement that I
wanted to work on…
My activity changes
that target this area…
What changes have I
actually experienced
in this area? How has
this area changed?
Look back at the areas of change you prioritized (e.g., Worksheet 5.2: Prioritizing activity change).
Are these areas being improved by your participation in these new activities?
Fill in the chart below.
1.
2.
3.
Action Over Inertia © CAOT PUBLICATIONS ACE 2010
Thinking about changes in my activity patterns
Date: ______/________/_____
Name: ______________________________________________________________________
Worksheet 6.5
Think about the activity changes you have been working on over the past _______ (time
period). How would you answer these questions?
The most difficult change to make in my daily activities was:
It was difficult because:
I managed these challenges by:
The easiest change to make in my daily activities was:
It was easy because:
The most enjoyable change I made to my activities was:
It was enjoyable because:
What benefits did you experience as a result of these activity changes?
Is there anything about your activity changes that you have been unhappy or concerned
about? If so, what are these concerns?
Action Over Inertia © CAOT PUBLICATIONS ACE 2010
Balance in my life
Physical activity
Structure/routine
Meaning
Satisfaction
Social interactions
Access to community
environments
Time 1 Ratings
Date completed
Time 2 Ratings
Date completed
Change: Positive
change yes/no
This form is meant to be used along with Worksheet 2.10: Activity engagement measure.
Directions:
Use this form to keep track of the change in your ratings on the different aspects of your activity
patterns over time. List the ratings given for each of the dimensions of activity for both time 1
and time 2. Examine these ratings to identify changes. In the final column, note if positive change
(a higher ranking) has occurred.
Worksheet 6.6
Activity dimensions are adapted from the work of Bejerholm (2007) and Bejerholm, Hansson, & Eklund (2006).
Measuring changes in my activity patterns over time
Date: ______/________/_____
Name: ______________________________________________________________________
Action Over Inertia © CAOT PUBLICATIONS ACE 2010
A framework for presenting
program-level information
Date: ______/________/_____
Name: ______________________________________________________________________
Activity Engagement
Measure
I could benefit
from more of the
following in my
day…
Balance
Physical activity
Structure/routine
Meaning
Satisfaction
Social interactions
Accessing community
environments
Ratings: number of people
1 2 3 4 5 6 7 8 9 10
I. Activity-health – Baseline status
Total number of people completing the Activity Engagement Measure: N= __________
Worksheet 7.1
Activity dimensions are adapted from the work of Bejerholm (2007) and Bejerholm, Hansson, & Eklund (2006).
Action Over Inertia © CAOT PUBLICATIONS ACE 2010
A framework for presenting program-level
information about activity-health
(continued)
Worksheet 7.1
Activity Engagement
Measure
I could benefit from
more of the following
in my day….
Balance
Physical activity
Structure/routine
Meaning
Satisfaction
Social interactions
Accessing community
environments
Baseline
evaluation
(Mean)
Follow-up
evaluation
at ____
months
(Mean)
Follow- up
evaluation
at ____
months
(Mean)
Difference between
baseline and last
follow-up:
(check all
that apply)
-ve = 2 or more point
decrease
Neutral = no change
+ve = 2 or more point
increase
II. Activity-health – Tracking change over time
Total number of people completing the Activity Engagement Measure (baseline): N= __________
(follow up 1): N= __________
(follow up 2): N= __________
( ) – ve
( ) Neutral
( ) + ve
( ) – ve
( ) Neutral
( ) + ve
( ) – ve
( ) Neutral
( ) + ve
( ) – ve
( ) Neutral
( ) + ve
( ) – ve
( ) Neutral
( ) + ve
( ) – ve
( ) Neutral
( ) + ve
( ) – ve
( ) Neutral
( ) + ve
Action Over Inertia © CAOT PUBLICATIONS ACE 2010
Preparing for continuous improvement applied
to activity-health: Mission and goals
Resource 7.1
Are the mission and goals of my service/program consistent with attending to the
activity patterns of people served?
Does the philosophy underlying the service mission and goals support attention
directed to activity patterns and the dimensions of health supported by activity
patterns?
What specific concepts or ideas in the mission and goals are consistent with attention
to activity-health?
What values espoused by the service or program are consistent with a focus on
activity-health?
What service priority goals may compete with efforts directed to activity-health?
What knowledge/research will help to explicitly link activity-health to the mission,
goals and values of the service?
Action Over Inertia © CAOT PUBLICATIONS ACE 2010
Resource 7.2
Preparing for continuous improvement applied
to activity-health: Engaging the
support of leaders
1. Identifying key leaders
Who are the “leaders” in this service who are in a good position to influence the extent to which
intervention approaches focused on improving health and well-being through activity are integrated
into daily service delivery?
Who are the formal leaders?
Who are the informal leaders?
2. Informing key leaders
What information do these leaders need in order to increase their appreciation of health through
activity for this service and its intended outcomes?
What evidence can I share with these leaders that will raise the profile of the importance of services
directed to health through activity for people receiving this service?
How might the evaluation of services related to health through activity be integrated into program
evaluation activities?
3. Securing the support of key leaders
What ideas can I share about how attention to health through activity might be developed as a funda-
mental part of service delivery?
What are the challenges I can expect to the integration of health through activity in daily service
delivery? How can ideas about service delivery related to activity-health be presented to key leaders
in a manner that remains sensitive to these challenges?
How can I explicate the link between activity-health and the mission and goals of the service in order
to secure support?
Action Over Inertia © CAOT PUBLICATIONS ACE 2010
Preparing for continuous improvement applied
to activity-health: Taking stock of
resources and structures
Resource 7.3
1. Who are the people connected to this service who will have a particular interest, and commitment
to activity-health?
2. What experiences, knowledge and training of service providers and other stakeholders can be used
to move forward an activity-health approach? How might these be mobilized to encourage dialogue
and increase awareness of activity health?
3. What service structures can be used to increase awareness of and commitment to activity-health
approaches and outcomes? For example, could service meetings, service-level communications,
educational sessions, and so on, be used to support dialogue and interest?
4. What written organizational structures do or could provide support for an activity-health approach?
For example, do service descriptions, job descriptions, annual reports, intake assessments, and so
on, currently include information related to activity-health? Could they be developed or modified to
include an explicit activity-health focus?
5. What program-level evaluation resources and activities currently exist? Do they include evaluation
of service processes and outcomes that are consistent with activity-health? Could they be modified
or developed to include an activity-health perspective?
Action Over Inertia © CAOT PUBLICATIONS ACE 2010
Resource 7.4
A framework for presenting program-level information
about activity-health (example)
Background:
Jamie and Afsanah collected the completed responses from the initial Activity
Engagement Measures for all individuals who received services focusing on their
activity patterns over a two year period. They first compiled the resources into
a format that provided an easy to understand description of these responses at
baseline (the initial completion of the activity measure). In total they had responses
for 40 people. This represented 25% of the total population of people who were
served by their program in this time period.
The responses at baseline were consistent with a picture of individuals who
experience their activity patterns as lacking in important dimensions of health and
well-being. While ratings suggested a need for attention across all dimensions,
responses were particularly low for physical activity, satisfaction experienced in
activity and access to community environments.
The Activity Engagement Measure was readministered at six months and one year
for these individuals. Only 34 people actually completed both follow-up periods.
Jamie and Afsanah calculated the means for each dimension across the three time
periods. They noted that for each dimension ratings either improved or stayed the
same. Positive change was particularly noticeable in the areas of balance, physical
activity, meaning, and access to community environments. Changes in social interac-
tions and satisfaction did not improve appreciably.
Jamie and Afsanah presented these results at a service meeting. Excited by the
changes, there was interest in adapting the scale to allow for examining the statis-
tical significance of change. The service member responsible for program evaluation
agreed to work with Jamie and Afsanah to develop this. Discussions also focused on
the area of social interactions and how specifically this was being addressed by the
service. Jamie and Afsanah were charged with taking these evaluation findings out to
people using the service to get their impressions of the findings and the implications
for the services they receive.
Activity dimensions are adapted from the work of Bejerholm (2007) and Bejerholm, Hansson & Eklund (2006).
Action Over Inertia © CAOT PUBLICATIONS ACE 2010
A framework for presenting program-level
information about activity-health (example)
Resource 7.4
Activity Engagement
Measure
I could benefit
from more of the
following in my
day…
Ratings: number of people
1 2 3 4 5 6 7 8 9 10
4 5 10 4 10 4 3 0 0 0
7 10 9 10 4 0 0 0 0 0
3 2 4 10 10 6 4 1 0 0
6 7 10 10 6 1 0 0 0 0
5 8 10 10 6 1 0 0 0 0
6 9 7 7 10 0 0 1 0 0
7 8 10 9 6 0 0 0 0 0
I. Activity-health – Baseline status
Total number of people completing the Activity Engagement Measure: N= 40
Very true
Not true
Balance
Physical activity
Structure/routine
Meaning
Satisfaction
Social interactions
Accessing community
environments
Action Over Inertia © CAOT PUBLICATIONS ACE 2010
Resource 7.4
Activity Engagement
Measure
Baseline
evaluation
(Mean)
Follow-up
evaluation
at 6
months
(Mean)
Follow- up
evaluation
at one year
months
(Mean)
Difference between
baseline and last
follow-up:
(check all
that apply)
-ve = 2 or more point
decrease
Neutral = no change
+ve = 2 or more point
increase
( ) – ve
( ) Neutral
( √ ) + ve
( ) – ve
( ) Neutral
( √ ) + ve
( ) – ve
(√ ) Neutral
( ) + ve
( ) – ve
( ) Neutral
( √ ) + ve
( ) – ve
( √ ) Neutral
( ) + ve
( ) – ve
( √ ) Neutral
( ) + ve
( ) – ve
( ) Neutral
( √ ) + ve
3.9 4.1 6.2
2.85 3.4 5.8
4.07 5.8 5.8
3.15 3.9 5.20
3.17 3.05 4.10
3.23 3.30 3.42
2.98 3.52 5.3
Balance
Physical activity
Structure/routine
Meaning
Satisfaction
Social interactions
Accessing community
environments
A framework for presenting program-level
information about activity-health
(continued)
II. Activity-health – Tracking change over time
Total number of people completing the Activity Engagement Measure (baseline): N= 40
(follow up 1): N= 38
(follow up 2): N= 34
Action Over Inertia © CAOT PUBLICATIONS ACE 2010