The Drowning Journal Technique

Journaling is a widespread practice, yet many people feel it is not for them. There is a stereotype, especially among adult men, that it is juvenal or feminine. Research has shown that it is an effective coping mechanism for people of every gender and at every stage of life. Additionally, it does not look the same for everyone. The classic trope that one needs a dedicated diary where they gush about there deepest feelings in paragraph after paragraph of vivid ink is untrue. There is no right way to journal.

Let me repeat that, there is no correct way to journal. Each person does it their own way. Here is how I define journaling. The act of writing down things that clog or stick in your mind. The primary use for journaling in my view, is to help control and focus ones thoughts. Writing paragraphs is perfectly fine. Many people feel they do not have time for that. Here, I want to share a simple technique that is quick but impactful. It can be used in almost any location, private or public. 

When would you use this technique? When you feel you are drowning emotionally. When thoughts are stuck in your mind. When your thoughts are racing or overwhelming. When you are having trouble focusing your thoughts, or when you are having difficulty relaxing. You can use it at any time.

All that is needed is a writing utensil and a surface to write on. Alternatively, you can do this on a digital device, but I prefer paper or a white board. The technique begins by simply writing down the things that are racing through or clogging your mind. Start with one- to two-word descriptions (e.g. finances, pain, car trouble, sickness, stress, my mother, my job, etc). Do not write them in a list. Instead, write each word over top of the former. When you are done, it should be difficult or impossible to read any of the words you wrote. You have just drowned your problems in ink.

As I write my problems over top of each other. I like to turn the page all the way around, writing each word at a slightly different angle. Then I end up with a large circular blot of scribbles. I will sometimes write the same thought down multiple times if it is especially persistent in my mind. When I am done, I feel more calm. Because none of the words are discernable, it is entirely private. You can simply throw the piece of paper away along with your worries. At least it makes me feel better to think about it like that.

To be sure, it does not fix all your problems. But this exercise will calm your mind and allow you to focus or relax. It helps to just put your thoughts down on paper. It only takes 1-2 minutes. It slows the frantic thoughts jumbled in your mind. It works kind of like Dumbledore's pensive in the Harry Potter series. Although sadly we don't have a magic wand to solve our problems. At least afterword, you can relax or focus on whatever is at hand. 

An alternative for those with disabilities who cannot write is to turn on a recording device and speak aloud the things that are crowding your mind. It is very therapeutic. 

Feel better.

David F. Garner OTR/L

The Survey of Spiritual Needs (SOSN)

Developed by David Garner OTR/L, MOT with contribution by LaVoy Garner M. Div, CC

Description:

The Survey of Spiritual Needs is a short, seven question survey to assess for spiritual distress, depression and patient needs and wishes related to these issues. This survey can be completed in two to five minutes. It is intended for adult and older teen populations with abstract reasoning skills.

Purpose:

Screening for spiritual needs can be conducted by any healthcare personnel including patient care technicians and certified nursing assistants. The SOSN is a brief survey that will enable any healthcare professional to assess for spiritual distress and disruptions in spiritual engagement thoroughly yet quickly. It will also enable the examiner to identify solutions to help their patient re-engage with this occupation and begin to resolve present distress. It will enable the examiner to connect the patient with other appropriate resources and determine if further screening is necessary. No prior training is required.

Settings:

This tool is intended for use in any setting. While spiritual distress is more common in overnight medical facilities, it can impact health in every setting. Spiritual distress rarely resolves on its own when a patient is discharged back home. It can persist as can any disease. It may be less visible, but can still pose a barrier to returning to a prior level of function and independence. It can also impact caregivers also.

This survey is appropriate to any setting where healthcare workers serve including home health, prisons, schools, and independent living centers as well as more traditional settings such as hospitals and nursing homes. It is even applicable to telemedicine. Spiritual distress can impact a person at any stage of life and in any situation. Therefore, medical staff should be prepared to screen for it in all settings and refer to local spiritual care resources.


Definitions:

- Spirituality: this is a broad term that may be defined differently by different people. No attempt should be made to define it too narrowly while completing the survey. The primary definition used in the SOSN is “a concern for or sensitivity to things of the spirit or soul, especially as opposed to materialistic concerns.”

- Spiritual distress: 1) “a disruption in a person’s belief or value system.” Can often be accompanied by emotional distress. 2) not currently feeling at peace.

- Spiritual and religious occupations: 1) “Engaging in religious or spiritual activities, organizations, and practices for self-fulfillment”; 2) “Finding meaning or religious or spiritual value; engaging in spiritual contemplation”


Recommended Contraindications for Use:

Alert and Oriented to less than 2.
Moderate to severe cognitive impairment as indicated by:
Brief Interview for Mental Status score less than 13.
Mini Mental State Examination score less than 21.
Severe aphasia or physical limitations that impair communication including speaking or writing.


Instructions:

This survey can be completed in less than five minutes but may take longer if the patient/client is talkative. It is recommended to allow them time to talk if they desire. Active listening without judgment is the best approach.


Before beginning the survey, consider the environment and any aids that will help communication. Is the environment quiet and private? Are they hard of hearing? Do they need a translator? For some patients/clients it may be easier for them to read the survey and fill in answers. If so, utilize glasses, large print and a well lit room as needed. To create a large print version of this survey, simply copy the below questions into a word processing program and print in a plain, large font that is at least 16 to 18 points.


Survey:


Name_____________________________ Date____________ Patient Number __________

State: “You seem stressed. Would it be ok if I asked you some questions about that?” If they are agreeable, proceed to ask the following questions. If not, let them know you are willing to listen if they change their mind.

1) Are you at peace?

2) Do you feel unhappy or distressed?

If the patient responds “yes” ask: Would you like to discuss those feelings with someone?

3) What are your sources of hope, strength, and comfort?

4) What spiritual practices or religious practices do you have?

If the patient responds other than “none” ask: Do you need assistance with that?

AND

Do you need items or reading material for that?

5) Are there any ways we (the staff) can support you better?

6) Would you like help connecting with someone important to you?

7) Would you like to talk to a chaplain or a mental health professional? (Any preference for chaplain: Catholic, Protestant, Jewish, Muslim, other?)

Closing: Thank them for their honesty and courage in sharing with you.



Further steps:

It may be beneficial to share the results of this survey with the patient’s case manager and the treatment team. However, if they indicate they do not wish the results to be shared their wishes should be respected unless suicidal ideation is suspected. If indicated in question two, make recommendations to social work or psychiatric services for follow-up. Also if indicated, assist the patient as needed to participate in spiritual practices or connect with spiritual/religious community, mentor or chaplain services of choice. If Chaplain services are available at facility, refer patient to them if indicated in question seven. Consider further assessments such as those below. If suicidal thoughts are suspected, consider screening for suicidal ideation with the questionnaire below. Consider repeating the SOSN as follow up.


Further assessments and resources:

Article Recognizing Spiritual Distress by Joy Freeman.

Patient Health Questionnaire for Depression and Anxiety (the PHQ-4). Less than 3 minutes.

H.O.P.E. Questionnaire (HOPE) for spiritual assessment by Gowri Anandarajah and Ellen Hight. 10-15 minutes.

Spiritual Distress Assessment Tool, (SDAT) by Monod SM. 15 min assessment.

Suicidal Ideation Questionnaire to screen for suicidal thoughts. 2-5 minutes.

Smiley-Face Assessment Scale A faces scale for assessing mood. 1 minute. Explanation: This is a scale similar to the Wong-Baker faces scale for pain that is designed to assess the current mood and emotional state of persons with decreased cognition. It utilizes five faces from frowning to neutral to smiling. Each face correlates to the moods of, very sad, somewhat sad, neutral, somewhat happy, very happy. This scale may be more practical for patients with limited communication or cognition than the SOSN or other spiritual or emotional assessments listed above. It was developed by the New York Museum of Modern Art’s Alzheimer's Project. You can find the scale and the research behind it in the publication MeetMe produced by the Department of Education, The Museum of Modern Art, New York in 2009 on page 89. Link MeetMe_FULL.pdf (moma.org).