Mindfulness As Part of the Occupational Therapy Scope of Practice

In recent years, mindfulness and meditation have become increasingly common household terms. In a stressed out nation, we are constantly seeking ways to calm our inner anxieties and relieve our depression. And as the focus toward organic and natural living has continued to increase, so has the desire for us to use more natural means of addressing our mental health.

Can we incorporate mindfulness into our occupational therapy scope of practice?

Yes, and we’ll show you how in this article.

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Therapy clinicians are naturally empathetic. Early in my years as an OT I was surprised by how many of my patients would begin to cry when they were working with me. I figured there was just something about me that enabled people to feel comfortable to let it go.

But that’s where I was wrong. It wasn’t just me—it’s most occupational therapists. We see people at their most intimate and vulnerable hour, fighting to regain some semblance of their life and independence before their injury or medical change. Providing emotional support in the face of life changes is part of our daily role. Often this support takes the form of a listening ear, kind words, OT-related advice, or a gentle touch or hug.

Supporting OT Patients With Mindfulness

As clinicians, but not counselors, how can we best support the emotional well-being of our patients? Further, would mindfulness specifically benefit our patients?

Coincidentally, my clinical interest in mindfulness was peaked in the midst of working through a particularly anxious period of my life. I had an introduction to mindfulness during my level II fieldwork, as my clinical instructor at the inpatient mental health facility ran mindfulness-oriented groups. But this was not a practice I had ever considered for myself.

Fast forward twelve years and I found myself grasping at straws to literally calm my brain down (as seen in my article about my own burnout in my OT practice). I found a few free mindfulness apps and read up on how to complete a simple practice and got to work.

While coping through my own anxieties, I began to take a closer look at what exactly some of my patients were dealing with. At one point, I treated an individual whom I felt would benefit more from seeing a psychologist or counselor to heal from PTSD than any treatment I could provide. But some people are reluctant to seek mental health treatment, and this includes those also struggling with brain injury or stroke symptoms.

The US National Institute of Health reported in 2019 that “1 in 5 individuals experience mental health symptoms up to 6 months after a mild TBI” (NIH, 2019) which places them at a higher risk than others for developing depression and PTSD. According to Psychology Today, a 2013 study from Denmark reported “individuals with TBI are four times more likely to develop a mental illness” (Psychology Today, 2016). The article also reported a 2016 study that found experiencing a concussion increased the odds of suicide three fold.

This is scary stuff. And these people need our help. But here’s the big question…

Is Mindfulness In the OT Scope of Practice?

If the increasing number of articles addressing mindfulness published in AJOT is any indication, then—yes. Even the founder of Mindfulness-Based Stress Reduction (MBSR) stated that occupational therapists are “well equipped to implement mindfulness interventions because these interventions complement their existing practice” (Hardison, et al., 2016).

It seems in an effort to address this within the occupational therapy context the focus is more on the relationship between mindfulness and the act of doing occupations (duh.), placing this firmly in our arena.

So Where Do We Begin?

Prior to beginning my clinical mindfulness journey I would often approach the topic with patients I felt would benefit. I would encourage them to download the free VA Mindfulness coach app and typically leave it at that. After taking a mindfulness CEU course, I realized I could do so much more.

Mindfulness and meditation tend to conjure images of silence, and deep breathing. Breathing during exercise is a critical component that we often address – how many times have you had to tell a person to exhale during an exercise? Kyra Salisbury, from Covalent Careers, discusses the use of mindfulness in OT by way of “breathing, body scans, and mindful movement to address mental health-related anxiety” (Mindfulness and OT: Your New Secret Power, 2018).

Incorporating Mindfulness Into Occupations

I think the true beauty of mindfulness and OT in particular is how we can incorporate it into occupations. A study printed in the Scandinavian Journal of Occupational Therapy (Goodman, et al., 2019) discusses “mindful occupation”, “occupational presence”, “occupational awareness”, “occupational engagement”, “occupational well-being”, and “occupational fulfillment”- terms I could see included in our mindfulness related speech as well as OT documentation.

Honestly a very interesting read, the study highlights mindfulness inclusion into occupation by way of identifying one meaningful occupation to practice mindfulness rather than complete a quiet guided meditation, and suggests that through activity meditation is more likely to be completed consistently.

You might have even sat through the mindfulness/awareness presentation that involves placing a raisin in your mouth and feeling the texture, recognizing the taste, how it feels in your mouth, etc. I have twice—surely I’m not the only one, right?

When focusing on occupations, we can take those same awareness principles and apply them to a simple task an individual is completing. For example, when practicing folding laundry recognize the varying texture of the towels, clothes etc. Feel how your arms move in different directions to fold each piece and how your hands and fingers manipulate the items. Slow yourself down and truly focus on the task you are completing.

Attention and Awareness for Task Completion

As a neuro OT, I am strongly interested in principles that can improve attention and awareness to task completion as these are skills I often address. Initial research focused on attention skills and brain injury were not promising (Azulay and Mott, 2016), but more recent research suggests the approach toward teaching mindfulness skills may not have been effective for the target population.

Azulay and Mott altered the approach by using simple activities (in other words, meaningful occupation?) coordinated with mindfulness training, resulting in improved “attention, self efficacy, quality of life, and problem solving abilities.”

Wow! I interpret this to mean the increase in awareness during meaningful occupations can improve functional cognition skills in patients with brain injuries (TBI or CVA, etc.). Further research studies also support the idea that “attention regulation training [does] impact executive control functioning in real-world complex tasks” (Novakovic-Agopian, T., et al. 2018).

If that doesn’t corroborate that mindfulness is within our scope of OT practice, I don’t know what does. What is also interesting is that Azulay and Mott (2016) found that mindfulness intervention directed toward individuals with higher levels of cognitive impairment (namely memory impairment) still found benefits to emotional regulation and general bodily awareness “despite their inability to recall the rationale behind the concept of meditation.” So really, mindfulness is applicable to all of our patient populations.

Practice What You Preach

The general consensus is that if you have a better understanding of how to incorporate mindfulness into daily tasks through personal practice, you will have a much easier time teaching and encouraging your patients to try it out. With so many of us stressed in our jobs, especially with recent healthcare changes, it would benefit us all to develop a meaningful quiet time and reflective period during the day.

Studies related to healthcare providers suggest that developing a consistent mindfulness practice “may reduce stress, burn-out, compassion fatigue, and increase [our] ability to navigate challenging situations” (Goodman, et al., 2018), reason enough that we all should give this a try.

The best way to try it out and stick to our OT roots? Attach movement and sensory awareness, and regulated breathing to an everyday task. I don’t know about you, but my daily post-dinner dish-washing routine just became a lot more relaxing.

Sources and Further Reading

Azulay J, Mott T (2016). Using Mindfulness Attention Meditation (MAO) with a Mixed Brain Injury Population to Engance Awareness and Improve Emotional Regulation. J Psychol Clin Psychiatry 6(5): 00372. DOI: 10.15406/jpcpy.2016.06.00372

Goodman, V., Wardrope, B., Myers, S., Cohen, S., McCorquodale, L., and Kinsella, E.A (2019). Mindfulness and Human Occupation: A Scoping Review, Scandinavian Journal of Occupational Therapy, 26(3), 157-170, DOI: 10.1080/11038128.1483422

Hardison, M.E., & Roll, S.C. (2016). Mindfulness Interventions in Physical Rehabilitation: A Scoping Review. American Journal of Occupational Therapy, 70, 7003290030. http://dx.doi.org/10.5014/ajot.2016.018069

Jackson, Kate (2014, Nov/Dec 2014). “Mindfulness-Based Approaches to Traumatic Brain Injuries”, Social Work Today 14(6), 8.

Novakovic-Agopian, Kornblith, E., Abrams, G., Burciago-Rosales, Loya, F., D’Esposito, M., and Chen, A (2018). Training in Goal-Oriented Attention Self-Regulation Improves Executive Functioning in Veterans with Chronic Traumatic Brain Injury. Journal of Neurotrauma, 35(23). https://doi.org/10.1089/neu.2017.5529.

Stein MB et al. Posttraumatic Stress Disorder and Major Depression After Civilian Mild Traumatic Brain Injury: A TRACK-TBI study. JAMA Psychiatry Jan 30¸2019.