A screening tool for assessing satisfaction with daily occupations among people with mental illness has been devised - the Swedish version of the Satisfaction with Daily Occupations (SDO) instrument - comprising a satisfaction scale and an activity level scale. The aim was to investigate the SDO for content validity, clinical utility, sensitivity to change and discriminant ability. Nine occupational therapists evaluated the content validity of the SDO. Sensitivity to change was assessed on a sample of 36 clients in psychosocial occupational therapy. Discriminant ability was evaluated by comparing four samples: (1) 103 clients with a diagnosis of severe mental illness, (2) 55 clients attending an outpatient mental health clinic, (3) 36 women with a diagnosis of systemic sclerosis and (4) 40 healthy women. The SDO rendered positive ratings regarding content validity, but some rewording of items was indicated as well as clearer instructions. Both the satisfaction scale and the activity level scale were found to be responsive to change. Discriminant ability was shown in that, in particular, the activity level score distinguished the mentally ill participants from the other samples. The SDO was shown to reflect the targeted phenomenon satisfactorily and to be sensitive enough to detect change following an occupational therapy intervention. However, so far only the Swedish version of the SDO has been studied, but an English version is available whose cross-cultural validity should be examined.

Background/Aim: In occupational therapy research and in clinical practice there is a need for valid, reliable and easily administered measures. For research and screening purposes, the Satisfaction with Daily Occupations (SDO) instrument was developed. It addresses work, leisure, domestic tasks and self-care and generates a satisfaction and an activity level score. This study investigated its construct validity, internal consistency and test–retest reliability in 55 clients visiting occupational therapists in outpatient mental health care.

Methods: The SDO was administered on two occasions with a 1-week interval, and data on the Canadian Occupational Performance Measure (COPM), psychosocial functioning and self-rated health were collected on the first of these occasions.

Results: In contrast to what was expected, the relationships between the SDO scores and the COPM scores were low. The strongest relationship between the SDO satisfaction score and any other variable was to psychosocial functioning. These variables shared 23% of the variance. Internal consistency for the satisfaction score was acceptable, alpha = 0.75 on the second occasion, and the test–retest reliability was good; r_s = 0.84 for the satisfaction score and r_s = 0.92 for the activity level.

Conclusions: The results indicated that the SDO has satisfactory reliability. The instrument targets a specific construct, as compared to the COPM and the measurements of self-rated health and psychosocial functioning. Thus, the SDO and the COPM satisfaction scale seem to assess different phenomena, probably because the SDO has predefined items, not specifically targeting a certain client's problematic occupations, whereas the COPM is based on self-defined problems. The instruments may therefore supplement each other.

The Tree Theme Method (TTM) is an intervention based on sessions involving creative activities and life storytelling/story-making, in which the client paints trees representing various periods of his/her life. The aim of this study was to investigate clients' experiences of participating in a TTM intervention and their perceptions of the therapeutic relationship. Thematic interviews were undertaken. Twenty clients attending general outpatient mental healthcare units were recruited after having participated in the intervention. A qualitative content analysis resulted in six categories: “From feeling a pressure to perform to becoming focused and expressive”, “Expressing oneself and one's life situation led to awakening of memories and feelings”, “New perspectives of self-image, everyday life and relations to others”, “Story-making led to shaping and reconstructing one's life story”, “Interaction was of importance when reconstructing one's life story” and, finally, “The attitude of the occupational therapist was of importance for the development of the therapeutic relationship”. There seemed to be a close association between the intervention and the therapeutic relationship in starting a process of opening up new perspectives on everyday life, but there is a need for further studies including therapists' experience of using the TTM and their perception of the client–therapist relationship.

Denna FoU-rapport ger dig en introduktion och översiktlig beskrivning av The Tree Theme Method® (TTM), en strukturerad och klientcentrerad metod. TTM är avsedd att användas av arbetsterapeuter efter fördjupad teoretisk och praktisk kurs (ges bland annat i FSAs regi). Metoden används huvudsakligen på klienter inom psykiatrisk vård men även klienter inom primärvård och smärtrehabilitering kan ha nytta av TTM. Klientens livssituation uttrycks i bildskapande och livsberättelse. I bildskapandet används trädet som symbol. Olika trädteman blir ett redskap för att uttrycka klientens känslor, tankar och erfarenheter. I livsberättelsen ligger fokus på vardagliga aktiviteter och att skapa en vision av framtida mål. I kontakten med arbetsterapeuten kan klienten identifiera viktiga vändpunkter och möjliga förändringar i vardagen.

Background/aim: The Tree Theme Method (TTM) is an intervention in which the client paints trees representing certain periods in his/her life. The intervention comprises five sessions, using trees as a starting point to tell one's life story. This study, which is part of an implementation project, aimed to examine the therapeutic alliance and client satisfaction, in relation to perceptions of everyday occupations and health-related factors, with clients going through a TTM intervention.

Methods: Nine occupational therapists recruited 35 clients, at general outpatient mental health care units, for the TTM intervention. Self-rating instruments, targeting therapeutic alliance (HAq-II), different aspects of daily occupations (Canadian Occupational Performance Measure, Satisfaction with Daily Occupations), health-related factors (Sense of Coherence measure, Mastery Scale, Symptom Checklist-90-R) and client satisfaction (Client Satisfaction Questionnaire), were administrated before and after the intervention.

Results: A good initial therapeutic alliance, experienced by both therapists and clients, was correlated to increased changes regarding occupational performance and self-mastery. According to the therapists’ ratings, a good initial therapeutic alliance was correlated to increased sense of coherence and a decreased level of psychiatric symptoms. The results showed positive significant changes in occupational performance and health-related factors. High ratings of the therapeutic alliance by the therapists were also related to high client satisfaction.

Conclusions: The TTM seemed to function well in psychosocial occupational therapy, but there is a need for further implementation studies to deepen our understanding of the treatment process, comprising both technique and formation of the therapeutic alliance.

INTRODUCTION: Depression and anxiety disorders affect individuals' everyday lives, and treatments that can help them to perform everyday occupations are needed. Occupational therapy for this group has been evaluated from a short-term perspective but not from a long-term perspective; further research is thus warranted. The aim of the study was to investigate the longitudinal outcomes of the Tree Theme Method (TTM) compared with care as usual, provided by occupational therapists, in terms of everyday occupations, psychological symptoms, and health-related aspects.

METHODS: This randomised controlled trial comprised a follow-up 3 and 12 months after an intervention. A total of 118 participants (19-64 years) with depression or anxiety disorders and problems with everyday occupations completed the base line questionnaires, 100 completed the follow-up at 3 months, and 84 completed the follow-up at 12 months. Imputations of missing data were performed using the last observation, and parametric analysis was used.

RESULTS: Both groups showed significant improvements (P value ≤ 0.01) in everyday occupations, psychological symptoms and health-related aspects after 3 and 12 months. No significant differences were found between the groups.

CONCLUSION: This study contributes with knowledge about the outcomes of occupational therapy for clients living with depression and anxiety disorders. Both TTM and care as usual lead to significant improvements over time concerning everyday occupations, psychological symptoms, and health-related aspects. The fact that both occupational therapy methods were associated with improvements for clients with depression and anxiety supports client-centredness in enabling an occupational therapist to choose the method best suited for the individual.

This study aimed to describe the Tree Theme Method (TTM) as a method for intervention in psychosocial occupational therapy. The TTM is based on theories concerning creative activities and occupational storytelling and story making. In order to exemplify the method a case study of a treatment process with follow up was undertaken. The participant was a female client suffering from anxiety and depression. During an interview the client painted symbolic trees on five different occasions with specific variations of the tree theme: a tree symbolizing her present life, her childhood, adolescence, adulthood, and, finally, a tree representing her future. The trees were used as starting points for the client to tell her life story. The intention was that she would find new strategies for how to change her daily life. Three years later there was a follow up stage where the client painted new trees and told her story. Some life themes were identified. The TTM appears suitable for intervention in psychosocial occupational therapy. In future studies the TTM should be subjected to evaluation research based on several clients in order to develop a deeper understanding of the process and what kind of results changes in the TTM intervention may provide.

This study investigated how occupational therapists experience utilization of the Tree Theme Method, an intervention based on creative activities and life-story telling and making. The Tree Theme Method is comprised of five sessions in which the therapist asks the client to paint symbolic trees, with specific themes representing their present life situation, childhood, adolescence, adulthood, and the future. Nine occupational therapists in mental health care were asked about their experiences when using the Tree Theme Method. The informants formed two focus groups and each group was interviewed twice. Qualitative content analysis was used to identify five categories including: (1) therapeutic frames, (2) therapist requirements, (3) client requirements, (4) the therapeutic relationship, and (5) the Tree Theme Method as a multi-dimensional process. Overall the informants were satisfied with the intervention with some variation as to therapists' perception about the helpfulness of the tool. The Tree Theme Method was experienced as a structured method of starting a therapeutic process and initiating a therapist-client relationship. The therapeutic attitude, self-knowledge, and expert knowledge seemed to be important prerequisites for the therapists when using the Tree Theme Method intervention.

Background: There is need for interventions for people with depression and anxiety, not only focusing on psychological symptoms, but also how to cope with everyday life. The TTM involves that individuals during five sessions, paint and tell their life story. The focus is on everyday occupations, and finally, they create a picture of their future goals. In this study, the TTM was compared to regular occupational therapy.

Objective: The aim of this study was to evaluate the TTM compared to regular occupational therapy regarding everyday occupations, psychological symptoms and health in people with depression and/or anxiety disorders.

Methods: 118 clients, 18-65 years, diagnosed with depression or anxiety in primary care and mental health care were randomized to the TTM or regular occupational therapy. Before and after treatment as well as 3 and 12 months afterwards they answered self-assessment questionnaires. Parametric statistical analysis was used.

Results: There were continued positive significant outcomes of everyday occupations, psychological symptoms and health shown in both groups; 3 months as well as 12 months after completed treatment. No significant differences were found between the groups.

Conclusions: The TTM can contribute to an increased number of interventions for people suffering from depression and anxiety.

Depression and anxiety disorders are a major concern in western countries, and because these often have a negative affect on everyday life interventions based on activities in everyday life are needed. The Tree Theme Method® (TTM) is a client-centred occupational therapy intervention designed to increase the ability to cope with, and to enhance satisfaction with, everyday life, both at home and at work. The aim of this study was to compare the short term outcomes of the TTM intervention with regular occupational therapy treatment for people with depression and/or anxiety disorders.

Bakgrund/Syfte

Stressrelaterad ohälsa är ett stort samhällsproblem. Vi har utvecklat en hälsofrämjande behandlingsmetod med fotostödda samtal, Be-Well^TM, med förhoppningen att bidra till att minska den stressrelaterade ohälsan. Metoden fokuserar på det som främjar hälsa och välbefinnande trots ohälsa och inte på symtom och problem i vardagen. Be-Well^TM bygger på kunskap om betydelsen av hälsa, välbefinnande, vardagliga aktiviteter och aktivitetsbalans. Be-Well^TM baserat på erfarenheter från tidigare studie i primärvården där kvinnor med stressrelaterad ohälsa fotograferade sådant som relaterade till deras välbefinnande trots stress. I intervjuerna framkom att kvinnorna blev uppmärksamma på sitt välbefinnande, vilket möjliggjorde perspektivförskjutning från det som inte fungerar i vardagen till det som fungerar.

Syftet är att utvärdera Be-Well^TM för personer i primärvården med diagnosticerad stressrelaterad ohälsa.

Metod/Tillvägagångssätt

Be-Well^TM innebär att deltagare tar fotografier med mobil på sådant som ger välbefinnande i vardagen, för att sedan använda dem som utgångspunkt för reflekterande samtal med behandlare vid sammanlagt 12 tillfällen. 

I en pågående kontrollerad studie i primärvården får interventionsgruppen Be-Well^TM av arbetsterapeut som tillägg till sedvanlig behandling.  Inklusionskriterier är personer i yrkesverksam ålder med stressrelaterad ohälsa. Data från frågeformulär, intervjuer och fotografier samlas in före och efter intervention, samt sex månader efter intervention och behandlarna intervjuas också. Datainsamling beräknas vara avslutad början av 2023. Kvantitativa som kvalitativa analyser kommer att genomföras.

Resultat/Preliminärt resultat

Indikationer från intervjuer tyder på att patienter och behandlare uppskattar metoden. Vi planerar att presentera metoden Be-Well^TM samt preliminära resultat i samband med Arbetsterapiforum.

Slutsats/Praktisk tillämpning

Presentationen ger kännedom om en möjlig behandlingsmetod som är enkel att införa i primärvården.

BACKGROUND: Stress-related illnesses constitute a huge problem in society. The primary care services in Sweden form the first line of care whose role is to coordinate interventions for reducing symptoms, as well as health-promoting interventions. There is lack of knowledge concerning health-promoting interventions for these illnesses. The aim of this study is to evaluate whether photo-supported conversations about well-being (Be Well™) as an intervention, in addition to care as usual within the primary care services, improves health and well-being for patients with stress-related illnesses. The intervention will be compared to a control group, who receive care as usual. A further aim is to conduct a process evaluation.

METHODS/DESIGN: This ongoing project has a quasi-experimental design, using quantitative and qualitative methods, and includes patients from primary care centres in two Swedish counties. Seventy patients, 20-67 years, with stress-related illnesses will be recruited. They constitute an intervention group, which receive the intervention together with care as usual, and a control group, which receive care as usual. The intervention, photo-supported conversations about well-being, involves 12 sessions. Care as usual entails medication, occupational therapy, physiotherapy and/or psychotherapy. Data collection is carried out at baseline, and outcomes are assessed directly after the intervention, as well as six months after completion of the intervention. The outcomes are evaluated based on factors related to health, well-being and everyday occupations. Furthermore, data concerning experiences of well-being and perceptions of the intervention will be collected in interviews. The therapists will also be interviewed about their experiences of performing the intervention. Data will be analysed with non-parametric statistics, and qualitative methodology.

DISCUSSION: The project is based on the concept that focusing on well-being despite living with stress-related illness may positively impact health and well-being as well as activity-related aspects, and that photo-supported conversations about well-being can contribute a complement to other treatment and rehabilitation. A strength is the use of a wide range of methods: such as quantitative measures, photographs, and qualitative interviews with participants and therapists. The results will thus provide knowledge about potential effects of this health-promoting intervention. Trial registration Clinical Trials.gov: NCT04832295; retrospectively registered 2nd April 2021 https://clinicaltrials.gov/ct2/show/NCT04832295.

Background: The health-promoting intervention BeWell™, which includes photo-supported conversations, is intended for people with stress-related illnesses. Its focus is on improving the individual’s health and well-being by addressing what contributes to well-being from the patient’s own perspective. There is no current knowledge of the experiences of occupational therapists of using BeWell™ in primary health care. It is thus important to gain knowledge of their experiences of using this intervention as part of investigating its feasibility.

Aim: To describe the occupational therapists’ experiences of photo-supported conversations about well-being (BeWell™) with patients diagnosed with stress-related illnesses.

Material and methods: Six occupational therapists, working in primary health care, who had conducted the photo-supported conversations about well-being (BeWell™), were interviewed individually, and one focus group discussion was also conducted. Systematic text condensation was used as the analysis method.

Results: Three main themes with two to three subgroups in each were identified; Discovering well-being through images, Enhancing patient’s own efforts towards well-being, and Contributing to one’s own well-being.

Conclusions and significance: The results provide important knowledge for the continued research work with BeWell™ by investigating how the users of the intervention experienced it.

Background: Anxiety and depressive disorders are common in western societies and related to occupational problems.

Objective: To describe occupational balance in people with anxiety and/or depression and associations with higher occupational balance.

Methods: Clients (20 men and 98 women), aged 18 to 65 years were recruited from outpatient mental health care or primary health care. They had a diagnosis of anxiety and/or depression as well as occupational problems.

The participants answered questionnaires about occupational balance, occupational performance, satisfaction with occupational performance, quality of life, and psychological problems.

Results: The participants rated generally low occupational balance. However, the level of occupational balance differed depending on their self-rated level of anxiety and depression; quality of life; occupational performance; and satisfaction with the occupational performance.

High occupational balance was, in a logistic regression, associated with high satisfaction with occupational performance, high quality of life, and low level of depression.

Conclusion: The results indicate that satisfaction with occupational performance is a relevant aspect in relation to occupational balance in clients with anxiety and depression.