A treatment method is the structure for how the Recreational Therapist provider delivers health care services while engaged in an activity. 

Just like different tools are used for different tasks (a hammer for nails and a screwdriver for screws), a Recreational Therapist uses different methods for Psychosocial Rehabilitation (PSR), Physical Rehabilitation & Chronic Conditions or Peak Wellness.

• Guided Imagery.
• Functional Independence.
• Multisensory therapy (MST).
  
• Progressive Relaxation Training (PRT), also known as Progressive Muscle Relaxation.
  

• Biofeedback
• Diaphragmatic Breathing
• Autogenic Training
  

"Psychological flexibility, the core treatment process in ACT, is defined as the capacity to persist or to change behaviour in a way that is 

(a) open to experiences that are encountered, even if these are uncomfortable; 

(b) connected to what is present in the situation, in the current moment; and 

(c) guided by goals and values[.] 

[...]It is behaviour that is aware, sensitive and engaged. It is not free of uncertainty and anxiety; it embraces uncertainty and anxiety when these are partly successful goal-directed acts. [...] 

When uncertainty, anxiety, resistance and discord present barriers and are unmovable, perhaps it is time to embrace these, keep a focus on goals, and promote active engagement with the process of change." 

- Barker E, McCracken LM. From traditional cognitive-behavioural therapy to acceptance and commitment therapy for chronic pain: a mixed-methods study of staff experiences of change. Br J Pain. 2014 Aug;8(3):98-106. doi: 10.1177/2049463713498865. PMID: 26516541; PMCID: PMC4590121.

"In ACT, you would learn to accept your situations and negative feelings as a typical part of life. By accepting difficulties, ACT focuses on your values and what motivates you." 

- PsychCentral

"Acceptance and Commitment Therapy (ACT) is the latest therapeutic approach in cognitive behavioral therapy, focusing on acceptance rather than modifying dysfunctional thoughts and feelings[.][...] ACT does not encourage patients to avoid thoughts, feelings, or physical sensations but allows patients to experience them as they are.[...]ACT had a significant effect on primary insomnia and secondary symptoms, especially anxiety related to insomnia."

- Shin JW, Kim S, Shin YJ, Park B, Park S. Comparison of Acceptance and Commitment Therapy (ACT) and Cognitive Behavior Therapy (CBT) for Chronic Insomnia: A Pilot Randomized Controlled Trial. Nat Sci Sleep. 2023 Jul 5;15:523-531. doi: 10.2147/NSS.S409981. PMID: 37431325; PMCID: PMC10329838.

- Mayo Clinic

- Cully, J.A., Dawson, D.B., Hamer, J., & Tharp, A.L. 2020. A Provider’s Guide to Brief Cognitive Behavioral Therapy, pg. 6, Department of Veterans Affairs South Central MIRECC, Houston, TX. 

- Shuanghu Fang, Dongyan Ding, The differences between acceptance and commitment therapy (ACT) and cognitive behavioral therapy: A three-level meta-analysis, Journal of Contextual Behavioral Science, Volume 28, 2023, Pages 149-168, ISSN 2212-1447, https://doi.org/10.1016/j.jcbs.2023.03.015. (https://www.sciencedirect.com/science/article/pii/S2212144723000352)

- Mayo Clinic

- Cully, J.A., Dawson, D.B., Hamer, J., & Tharp, A.L. 2020. A Provider’s Guide to Brief Cognitive Behavioral Therapy, pg. 6, Department of Veterans Affairs South Central MIRECC, Houston, TX. 

- Barker E, McCracken LM. From traditional cognitive-behavioural therapy to acceptance and commitment therapy for chronic pain: a mixed-methods study of staff experiences of change. Br J Pain. 2014 Aug;8(3):98-106. doi: 10.1177/2049463713498865. PMID: 26516541; PMCID: PMC4590121.

"Identifying and changing unhelpful thoughts and behaviors sets CBT apart from third-wave therapies such as acceptance and commitment therapy, mindfulness-based therapies, and dialectical behavior therapy." 

- Cully, J.A., Dawson, D.B., Hamer, J., & Tharp, A.L. 2020. A Provider’s Guide to Brief Cognitive Behavioral Therapy, pg. 6, Department of Veterans Affairs South Central MIRECC, Houston, TX. 

"[A] form of cognitive–behavioural therapy [is] called acceptance and commitment therapy [ACT.]"

- Barker E, McCracken LM. From traditional cognitive-behavioural therapy to acceptance and commitment therapy for chronic pain: a mixed-methods study of staff experiences of change. Br J Pain. 2014 Aug;8(3):98-106. doi: 10.1177/2049463713498865. PMID: 26516541; PMCID: PMC4590121.

"[CBT] stresses the importance of dealing with and tolerance of uncertainty and teaches ways to suppress or control thoughts, while ACT encourages better awareness and acceptance of positive and negative internal events[.]"

- Shuanghu Fang, Dongyan Ding, The differences between acceptance and commitment therapy (ACT) and cognitive behavioral therapy: A three-level meta-analysis, Journal of Contextual Behavioral Science, Volume 28, 2023, Pages 149-168, ISSN 2212-1447, https://doi.org/10.1016/j.jcbs.2023.03.015. (https://www.sciencedirect.com/science/article/pii/S2212144723000352)

- WebMD 

"Co-treatments provide the opportunity to expand the scope of recovery. For example, a psychiatrist can implement the clinical components of CBT through individual sessions to assist in cognitive restructuring with the recreational therapists providing additional interventions to apply CBT during recreation and leisure activity to assist the individual with integrating the activities as coping mechanisms to help maintain or prevent symptoms experienced during recovery."

- Use of Evidence-Based Practices in Recreational Therapy for Schizophrenia Spectrum Disorder Recovery: A Descriptive Study of Current Practices, p.146,  Therapeutic Recreation Journal, Vol. LIV, No. 2, pp. 128–149, 2020, https://doi.org/10.18666/TRJ-2020-V54-I2-9962

"Dialectical behavior therapy (DBT) is a type of talk therapy for people who experience emotions very intensely. [...]“Dialectical” means combining opposite ideas. DBT focuses on helping people accept the reality of their lives and their behaviors, as well as helping them learn to change their lives, including their unhelpful behaviors.[...]The main goal of therapists who use dialectical behavior therapy (DBT) is to strike a balance between validation (acceptance) of who you are and your challenges and the benefits of change. Your therapist will help you learn new skills to improve emotion regulation." 

- Cleveland Clinic

"Psychological flexibility and DBT skills predicted anxiety symptom change."

- Webb CA, Beard C, Kertz SJ, Hsu KJ, Björgvinsson T. Differential role of CBT skills, DBT skills and psychological flexibility in predicting depressive versus anxiety symptom improvement. Behav Res Ther. 2016 Jun;81:12-20. doi: 10.1016/j.brat.2016.03.006. Epub 2016 Mar 30. PMID: 27057997; PMCID: PMC4860036.

"DBT demonstrates efficacy in stabilizing and controlling self-destructive behavior and improving patient compliance."

- Panos, P. T., Jackson, J. W., Hasan, O., & Panos, A. (2014). Meta-Analysis and Systematic Review Assessing the Efficacy of Dialectical Behavior Therapy (DBT). Research on Social Work Practice, 24(2), 213-223. https://doi.org/10.1177/1049731513503047

"The Functional Independence Measure (FIM®) was used to describe a patient's level of independence in motor and cognitive skills at rehabilitation admission and discharge[.]"

- Gassaway J, Dijkers M, Riders C, Edens K, Cahow C, Joyce J. The SCIRehab project: treatment time spent in SCI rehabilitation. Therapeutic recreation treatment time during inpatient rehabilitation. J Spinal Cord Med. 2011;34(2):176-85. doi: 10.1179/107902611X12971826988138. PMID: 21675356; PMCID: PMC3066511.

-"[T]he functional independence measure (FIM™) is the most widely utilized outcome measure evaluating motor and cognitive functioning. This 18-item measure is completed by the multidisciplinary team at admission and discharge, and measures overall functioning on two subscales—motor and cognition function. Individuals are scored from zero (did not occur) to seven (total independence) as they complete specified tasks. The lower the score, the more dependency the individual demonstrates[.]" 

- Melissa Zahl, Michelle Bateman, Jason M. DeFreitas, Mwarumba Mwavita, Greg Horneber, The Role of Recreational Therapy and Allied Therapies in Rehabilitation after Spinal Cord Injury, Vol. LIV, No. 1, pp. 1–16, 2020 https://doi.org/10.18666/TRJ-2020-V54-I1-9617

"Regardless of the therapies provided, the overall purpose of inpatient rehabilitation after an SCI, is to increase an individual’s ability to be functionally independent and integrate into the community[...].[...]The multidisciplinary team uses interventions that assist individuals who received an SCI to maximize their independence with activities of daily living, life roles, and other functional tasks[.][...]  

Each team member, from different disciplines, works toward the outcome of maximal independence, but does so in slightly different frameworks and potentially smaller goals. 

For example, physical therapy (PT) will look to maximize independence in physical functioning in domains such as motor function, range of motion, musculoskeletal pain, propelling a wheelchair, and rolling in bed[.] [...]

Occupational therapy (OT) will maximize independence of function within a spectrum of life skills[.][...] 

Speech-language pathology will maximize independence with cognition and communication functioning, swallowing, voice, and motor speech[.][...]

Recreational therapy will maximize independence in realistic leisure options as well as promote an independent active lifestyle[.]

[...]The results of this study highlight that no one therapy is superior influencing changes in outcomes (e.g., FIM™ change) from admission to discharge.."    

- Melissa Zahl, Michelle Bateman, Jason M. DeFreitas, Mwarumba Mwavita, Greg Horneber, The Role of Recreational Therapy and Allied Therapies in Rehabilitation after Spinal Cord Injury, Vol. LIV, No. 1, pp. 1–16, 2020 https://doi.org/10.18666/TRJ-2020-V54-I1-9617

Guided Imagery: "A technique in which a person visualizes positive images or scenarios in their mind. During guided imagery, a person uses all their senses in their imagination to help relax the body and develop a sense of well-being. Guided imagery may be used to help relieve stress, pain, anxiety, and depression and to help with symptoms related to disease, such as cancer. Also called guided visualization and imagery therapy." 

- National Cancer Institute at the National Institutes of Health

"Results: Significantly greater knee strength and significantly less reinjury anxiety and pain for treatment group participants at 24 weeks postsurgery than for placebo and control group participants. Conclusions: Relaxation and imagery may be beneficial to ACL rehabilitation, thus warranting further research on mechanisms of obtained effects." 

- Cupal, Deborah D.,Brewer, Britton W., Effects of relaxation and guided imagery on knee strength, reinjury anxiety, and pain following anterior cruciate ligament reconstruction. Rehabilitation Psychology, Vol 46(1), Feb 2001, 28-43

"Multisensory therapy (MST), sometimes known as Snoezelen,™ is a sensory stimulation treatment method designed to help improve the lives of people with disabilities[...] MST involves simultaneously stimulating several of the five human senses. Modes of stimulation typically used include visual, tactile, auditory, and olfactory[;] to activate or stimulate the senses and enhance emotions[.] [MST] includes the provision of sensory stimulation and prompts is designed to engage participants in sensorial and emotional exploration, and is used to bring leisure, enjoyment, and relaxation to individuals with disabilities[.]" 

- Alexis McKenney, Mary Ellen Broach, Laura Vogel Mullen, A Comparison of the Effects of Multisensory Therapy and Progressive Relaxation Training on Time on Task of Participants with Behavior Disorders, Therapeutic Recreation Journal, Vol. LII, No. 4, pp. 329–348, 2018 https://doi.org/10.18666/TRJ-2018-V52-I4-9032

"This research has indicated that multi-sensory therapy may have a positive effect on the mood of those with dementia, in terms of an increase in observers’ ratings of happiness, enjoyment and relaxation, and a reduction in sadness, fear and boredom[...] There is much published research into the use of multi-sensory therapy in the management of chronic pain (e.g. Reference SchofieldSchofield, 2000), and it has been shown to reduce recorded pain levels, depression and disability of functioning (e.g. physical, psychosocial, sleep) and to help sufferers cope." 

- Baillon S, van Diepen E, Prettyman R., Multi-sensory therapy in psychiatric care. Advances in Psychiatric Treatment. 2002;8(6):444-450. doi:10.1192/apt.8.6.444

"Multisensory therapy promoted participants’ positive emotions and relaxation[.]However, there was no evidence that multisensory therapy was superior to activity therapy in reducing aggressive behaviour and stereotypic self-stimulating behaviour or promoting adaptive behaviour. [...]Multisensory therapy could be used to provide leisure and promote psychological well-being, rather than for reducing problem behaviour."

- Sally Chan, Maggie Yuen Fung, Chien Wai Tong, David Thompson, The clinical effectiveness of a multisensory therapy on clients with developmental disability, Research in Developmental Disabilities, Volume 26, Issue 2, 2005, Pages 131-142, ISSN 0891-4222, https://doi.org/10.1016/j.ridd.2004.02.002.

 (https://www.sciencedirect.com/science/article/pii/S089142220400071X)

Multisensory stimulation environment (MSSE) "seems to prove evidence that multisensory stimulation environments produce immediate positive effects on the behavior and mood of people with dementia. Based on the above, we think it can be a useful nonpharmacological intervention on neuropsychological symptoms[...] Since it does not appeal to cognitive abilities, it is one of the few approaches suitable for reaching persons with severe or very severe dementia whose possibilities for verbal communication are limited[.]"

- Sánchez A, Millán-Calenti JC, Lorenzo-López L, Maseda A. Multisensory Stimulation for People With Dementia: A Review of the Literature. American Journal of Alzheimer’s Disease & Other Dementias®. 2013;28(1):7-14. doi:10.1177/1533317512466693

"[Progressive Muscle Relaxation] PMR is a two-step relaxation practice to reduce stress and build awareness of sensations of tension and deep relaxation in various muscle groups. The first step in this practice is to create tension in specific muscle groups and begin to notice what tension feels like in this body part. The second step is to then release this muscle tension and begin to notice what a relaxed muscle feels like as the tension drains away. By moving through the body by alternately tensing and relaxing different muscle groups in a certain order, one builds awareness of how to recognize and differentiate between the associated feelings of a tensed muscle and a completely relaxed one." 

- U.S. Department of Veterans Affairs,Whole Health Library

"Two commonly used recreational therapy (RT) interventions in the rehabilitation process of patients with various disabilities and disorders include sensory stimulation [and] PRT[.] [...]Progressive Relaxation Training (PRT), also known as Progressive Muscle Relaxation is "to reduce stress-related problems such as anxiety and muscle tension[.]"

- Alexis McKenney, Mary Ellen Broach, Laura Vogel Mullen, A Comparison of the Effects of Multisensory Therapy and Progressive Relaxation Training on Time on Task of Participants with Behavior Disorders, Therapeutic Recreation Journal, Vol. LII, No. 4, pp. 329–348, 2018 https://doi.org/10.18666/TRJ-2018-V52-I4-9032

"PMR was originally used to treat symptoms of anxiety, but more recently it has been found to be effective for treating tension headaches, migraines, temporomandibular joint disorder (TMJ), neck pain, insomnia, bipolar disorder, anxiety, backaches, and high blood pressure. [...] PMR is a recommended practice to relax the body and mind at bedtime to fall asleep more easily and get a deeper night sleep. It was rated an effective nonpharmacologic treatment of chronic insomnia by the American Academy of Sleep Medicine (1999)." 

- U.S. Department of Veterans Affairs, Whole Health Library

"Recreational therapy has the same foundation as any traditional therapy program and has benefits in every facet of human recovery from trauma or illness. Recreational therapy can also have a positive effect on a client's perception of locus of control. Through recreational therapies, traumatic brain injury patients are provided an environment and opportunity for naturally calming activities. The recreational therapist plays a critical role in assessing the patient's abilities and deficits while in the community."

- Mark Sell, Gregory J. Murrey, Recreational Therapy Program for Patients with Traumatic Brain Injury, Alternate Therapies in the Treatment of Brain Injury and Neurobehavioral Disorders (2006) 9781315097381

"The use of [progressive muscle relaxation training] PMRT significantly decreased state anxiety and improved generic quality of life in the experimental group (P<0.05), especially in the domains of physical health, psychological health, social concerns and environment.[...]The use of PMRT should be incorporated in the long-term care of colorectal cancer patients, as it can improve their psychological health and quality of life. "

- Cheung, Y.L., Molassiotis, A. and Chang, A.M. (2003), The effect of progressive muscle relaxation training on anxiety and quality of life after stoma surgery in colorectal cancer patients. Psycho-Oncology, 12: 254-266. https://doi.org/10.1002/pon.638

"[R]elaxation techniques can be effective for improving the students’ anxiety that in turn will improve their quality of life[.]"

- Nahid Dehghan-nayeri, Mohsen Adib-Hajbaghery, Effects of progressive relaxation on anxiety and quality of life in female students: A non-randomized controlled trial, Complementary Therapies in Medicine, Volume 19, Issue 4, 2011, Pages 194-200, ISSN 0965-2299, https://doi.org/10.1016/j.ctim.2011.06.002.

 (https://www.sciencedirect.com/science/article/pii/S0965229911000823)

"What is autogenic training? Autogenic training is a relaxation technique that uses the Power of the Mind to relax the body. The term autogenic means “coming from within.” You can also think of it as a form of self-hypnosis. Establishing a routine practice may improve your overall health."

- U.S. Department of Veterans Affairs, Whole Health, Autogenic Training

Autogenic Training - "The patient tries to concentrate exclusively on the body. The patient lies relaxed on the back or seated like a rag doll. The basic exercises include the following.

• Weight exercise: the patient initially concentrates on a specific part of the body, usually an arm or a leg. The therapist may say: ‘My arm is very heavy’. The heaviness can later be extended to other parts of the body and the whole body.
• Warmth exercise: as for the weight exercise, it is initially suggested that a certain part of the body is feeling very warm, then the pleasant feeling of warmth is spread across the whole body.
• Breathing exercise: the formula repeated by the therapist may be: ‘My breathing is very quiet’.
• Abdominal exercise: concentration is on the upper abdomen and the patient attempts to guide warmth into this area of the body.
• Heart exercise: the heart is influenced by concentrating on an even and quiet heartbeat.
• Forehead exercise: the formula repeated by the therapist may be: ‘My head is light’.

The patient is guided through the exercises by an experienced therapist and after several practice sessions the patient actually feels that the body react to the suggested sensation.
The statements must be spoken in a quiet and gentle voice and must always be positive: a negative should not occur. Thus ‘My arm is very heavy’, not ‘My arm is not light’.

- Christine Irnich, in Myofascial Trigger Points, 2013, 24.2.1 Autogenic training

"Research shows autogenic training can help with many health concerns, including the following: • Tension and migraine headaches • High blood pressure • Disease of the blood vessels • Asthma • Pain without an obvious physical cause • Depression and anxiety • Sleep problems • Irritable Bowel Syndrome (IBS) • Some symptoms caused by Parkinson’s disease[.]"

- U.S. Department of Veterans Affairs, Whole Health, Autogenic Training

"The main psychophysiological effects of AT include autonomic cardiorespiratory changes paralleled by central nervous system activity modifications and psychological outputs. Studies demonstrate consistent efficacy of AT in reducing anxiety and medium range positive effects for mild-to-moderate depression."

- Breznoscakova D, Kovanicova M, Sedlakova E, Pallayova M. Autogenic Training in Mental Disorders: What Can We Expect? Int J Environ Res Public Health. 2023 Feb 28;20(5):4344. doi: 10.3390/ijerph20054344. PMID: 36901353; PMCID: PMC10001593.

"During diaphragmatic breathing, you consciously use your diaphragm to take deep breaths. When you breathe normally, you don’t use your lungs to their full capacity. Diaphragmatic breathing allows you to use your lungs at 100% capacity to increase lung efficiency.[...]

- Cleveland Clinic

"Diaphragmatic breathing exercises can significantly improve respiratory function; the number of breaths, holding the breath, and exhalations; static balance, dynamic balance, and quality of life in older women. Therefore, using these exercises for courses of prevention, performance improvement, and Rehabilitation is recommended for different people and ages."

- Mahdi Abadi F, Bagheri S, hoseini Y. The efficacy of diaphragmatic breathing practice on respiratory function, balance, and quality of life in elderly women. koomesh. 2022;24(5):e152768.