New tool helps people with chronic mental health problems enrich lives

Silhouette of woman in forest

A new study by Colorado State University researchers has demonstrated that for people with chronic mental health conditions, sometimes simple changes to daily routines can significantly improve their quality of life.

In 2017, Associate Professor Karen Atler of CSU’s Department of Occupational Therapy and her graduate students explored the relationship between the daily activities and experiences of individuals with mental health conditions. Former graduate student Jade Studee spent several months conducting sessions with people in the Denver area who have chronic mental health issues, to assess their day-to-day activities and identify little things they could do to enrich their lifestyle. Some of their results were published last fall in the British Journal of Occupational Therapy, in an article co-authored by Atler and her former master’s student Anna Fox.

It was one of the first studies to show that a tool called the Daily Experiences of PPR (Pleasure, Productivity and Restoration) Profile was effective at helping people reconfigure their patterns of how they spend their time and bring to mind what is important to them. Atler’s team recruited nine participants from a community behavioral health center to chronicle and rate their daily activities on a seven-point scale, identifying areas that were unsatisfying. Most said they were unsatisfied in multiple areas of their lives.

Karen Atler
Karen Atler

‘Enjoy what we do’

Then the researchers helped the participants make small changes to reduce stress and increase fulfillment.

“We have a basic human need to enjoy what we do,” Atler said. “And we also need to feel productive and restore our energy after something draining. It’s different for everybody, so the goal is to discover each person’s sense of what’s meaningful. For instance, someone who gets fulfillment from their job may feel a big hole when they retire.”

Atler and Studee, who got her master’s degree in December 2018, said most of the participants in the study identified paperwork — filling out forms for disability insurance or health care, for example — as the biggest source of anxiety and frustration in their lives. One participant, who Studee identified only as “Scott,” found himself putting off his paperwork, which made him feel unproductive. He watched sports on TV as a coping mechanism to distract him from his anxiety about paperwork, but then felt guilty about not doing something more productive, like reading, visiting with friends, walking or cooking. The solution for Scott was to set aside a block of time in his routine for paperwork “productive time,” which helped him gain more enjoyment from his other daily activities.

Altering routines

The researchers found that an effective element in changing routines and beginning to develop new habits was to set up visual cues or smartphone alarms to trigger engagement in activities that evoked desired experiences. One participant put a sticky note on his computer screen to remind him to brush his teeth in the morning before turning on his computer, because otherwise he’d put it off all day. Another participant placed a word search puzzle book near his television to remind him to do a puzzle before watching TV. A third, who was homeless, spent a lot of time just sitting in her car. After working with Studee, she decided to put her walking shoes in the front of the vehicle so that she’d be reminded to take walks in the park with friends, providing both physical activity and social interaction.

Jade Studee
Jade Studee

“It was an amazing experience,” Studee said of the project. “It highlighted the power of what we do in our everyday lives, and the meaning we can find in our day-to-day life.”

“This tool brings to light a certain awareness,” Atler added. “Often we live our lives subconsciously, just going through the motions, asking ‘What did I actually do today? Did it support my sense of health and well-being?’ Discovering what we do and how we feel about our lives isn’t easy; it takes time. It’s about being more aware of what we’re doing and how we’re experiencing it.”

Common challenges

She explained that those with chronic mental health conditions like anxiety, depression, bipolar disorder and schizophrenia often face challenges related to things that others take for granted, like transportation. Atler said the study showed that many participants were just hanging out at home and not really doing anything, partly because they felt like they’d lost control over elements of their lives.

“This was about helping to give them a sense of purpose and control over what they do,” Atler said, adding that the results are preliminary, and more research is needed. “It shows us that with some guidance from an occupational therapist, people with chronic mental health problems can create and implement goals to provide more meaning in their lives.”

Atler and her former doctoral student Brett Berg have since created a new version of the PPR Profile that adds a fourth element to pleasure, productivity and restoration: social connection. It’s called the Occupational Experience Profile, and Atler’s team is currently testing its efficacy on people who have Type 2 diabetes.

The Department of Occupational Therapy is part of CSU’s College of Health and Human Sciences.