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A systematic review of the effectiveness of occupational therapy interventions for improving functioning and mental health for individuals with anxiety and stress-related disorders.

Jackie Fox1*, Lena-Karin Erlandsson2 and Agnes Shiel1
  • 1 NUI Galway, Discipline of Occupational Therapy, Ireland
  • 2 Lund University, Department of Health Science, Sweden

Background: Anxiety disorders are highly persistent over the lifetime (Kessler et al., 2009) and are associated with poor functioning in many activities of daily life (Iancu et al., 2014). Interventions demonstrating some evidence for effectiveness in treating anxiety disorders include cognitive-behavioural therapy (Păsărelu et al., 2017), meditative therapies (Chen et al., 2012), mindfulness and acceptance-based therapies (Vollestad et al., 2012) and exercise (Jayakody et al., 2014). The comparative efficacy of various pharmacological therapies has also been reviewed systematically (Baldwin et al., 2011). Given the impact of anxiety on daily life functioning, researchers have called for interventions which focus on improving this outcome as well as mental health symptoms (Rodriguez et al., 2005). The effectiveness of occupational therapy-led interventions for improving functioning and mental health is under-researched and systematic reviews are urgently required (Bannigan and Spring, 2012). Objective: To determine the effectiveness of interventions designed/led by occupational therapists to improve functioning and mental health outcomes for individuals with anxiety and stress-related disorders. Method: The guidelines by the Centre for Reviews and Dissemination, Oxford (2009) and the PRISMA checklist (Moher et al., 2009) were used to inform the design of this review. A protocol was registered on the PROSPERO database of systematic reviews (Fox et al., 2015). A comprehensive search of SCOPUS, EMBASE, MEDLINE, the Cochrane Library, PsycInfo, CINAHL and databases of unpublished theses was conducted. Search terms used included anxiety, psychological stress and occupational therapy and Boolean logic was applied to broaden and focus the search. Inclusion criteria included those studies published between 1994 and 2016 with participants who met the criteria for diagnosis of an anxiety or stress-related disorder and which described interventions led/designed by occupational therapists. Exclusion criteria were studies which had multidisciplinary interventions or lack of detail regarding diagnoses of participants. The first author completed the initial searches and excluded duplicates and any papers clearly not meeting the inclusion criteria. The other authors independently reviewed any papers with the potential to be included, and any disagreement was resolved through discussion. A data extraction form was designed based on guidance from the Centre for Reviews and Dissemination (2009) and data extracted included; participants, treatment, control group, outcomes measured and results. The included papers were assessed for methodological quality using a critical appraisal tool (Law and MacDermid, 2014). A framework for completing narrative synthesis in systematic reviews was used to synthesise the results (Popay et al.). Results: Twenty-four papers describing eighteen studies were included in this review. There were a range of methodologies used including randomised controlled trials, quasi-experimental designs, pre-test/post-test designs and single-subject designs. The paper with the highest quality methodology showed no significant improvements in anxiety outcomes for an occupational therapy-led anxiety management group, compared to a nurse-led psychoeducational group (Kitchiner et al., 2009). Both the OPTIMAL (O'Toole et al., 2013) and Redesigning Daily Occupations programmes (Eklund & Erlandsson, 2011) used high quality methodologies and showed non-significant trends towards effectiveness in improving mental health symptoms and participants demonstrated significant improvements in participation in daily life activities. The lifestyle modification intervention described by Lambert et al. (2007) in an RCT resulted in significant reduction in anxiety symptoms for individuals with panic disorder. For individuals with PTSD specifically, several studies showed statistically significant improvements in PTSD symptoms, although the interventions varied from high-intensity sport (Rogers et al., 2014), to driving rehabilitation (Classen et al., 2014) to life-skills (Helfrich et al., 2011). Positive pre test - post test outcomes from some studies should be interpreted with caution due to limited description of the intervention (Kohn et al., 2012), limited discussion of the outcome measures used (Crouch, 2008) and a lack of independent assessment (Champagne, 2011) Discussion: Studies varied widely as to the quality of the methodology, content of the intervention, method of delivery, population included and assessments used. The review showed that occupational therapy-led interventions have potential for improving mental health and functioning for individuals with anxiety disorders, but a definitive conclusion about effectiveness was not reached. Many interventions were only represented once in the literature, some only in single-subject case descriptions, so there is an urgent need for larger-scale research in this area of occupational therapy. Conclusion: The results of this review highlighted the broad range of interventions which have the potential to improve outcomes for individuals with anxiety and stress-related disorders and are within the scope of practice of occupational therapists. Further research should focus on replicating interventions showing emerging trends towards effectiveness in particular populations e.g. the Redesigning Daily Occupations programme for women with stress-related conditions (Eklund and Erlandsson, 2011), life skills programmes for homeless individuals with mental health difficulties (Helfrich et al., 2011), and a lifestyle approach for improving outcomes for people with panic disorder in primary care (Lambert et al., 2007). Limitations of this review were the small team of reviewers involved, and the length of time taken in the search process. Strengths of the review were that searches were repeated so as to be up to date and a systematic approach to data extraction and critical appraisal was taken.

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Keywords: Occupational Therapy, Anxiety Disorders, Systematic review, functioning, Stress, Psychological

Conference: ISAD LONDON 2017: Perspectives on Mood and Anxiety Disorders: Looking to the future, London, United Kingdom, 6 Jul - 7 Jul, 2017.

Presentation Type: Poster

Topic: Rehabilitation

Citation: Fox J, Erlandsson L and Shiel A (2019). A systematic review of the effectiveness of occupational therapy interventions for improving functioning and mental health for individuals with anxiety and stress-related disorders.
. Front. Psychiatry. Conference Abstract: ISAD LONDON 2017: Perspectives on Mood and Anxiety Disorders: Looking to the future. doi: 10.3389/conf.fpsyt.2017.48.00016

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Received: 26 May 2017; Published Online: 25 Jan 2019.

* Correspondence: Ms. Jackie Fox, NUI Galway, Discipline of Occupational Therapy, Galway, Ireland, jackie.fox@nuigalway.ie