Importance: Depressive and anxiety symptoms across physical disability inpatient rehabilitation (IPR) patient groups are well documented and negatively affect functional recovery. The strategies within the occupational therapy scope of practice to address these symptoms in IPR are unclear. Objective: To determine what interventions within the occupational therapy scope of practice have been used to address depressive and anxiety symptoms in IPR and to determine intervention efficacy. Data Sources: Nine databases for all publication years were searched (PubMed, Scopus, Embase, Web of Science, PsycINFO, Cochrane Library, AgeLine, OTseeker, and CINAHL). Study Selection and Data Collection: Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used for abstracting data and assessing quality. Included articles were peer reviewed, based in the United States, in English, controlled clinical trials or randomized controlled trials, in the IPR setting, and within the occupational therapy scope of practice. Two reviewers independently screened articles, with disagreements resolved by consensus. Findings: Five of 8,082 articles met inclusion criteria. Diagnoses included stroke (n = 1), traumatic brain injury (n = 1), spinal cord injury (n = 1), and musculoskeletal conditions (n = 2). Results are discussed among four categories: study design and outcome variables, intervention type, intervention intensity, and intervention efficacy. Conclusions and Relevance: Limited, moderate-quality evidence exists within the occupational therapy scope of practice for addressing depressive and anxiety symptoms in the physical disability IPR setting. Interventions primarily included cognitive and behavioral strategies. Further research among diverse patient populations is needed to support occupational therapy practitioners in facilitating client participation and functioning. What This Article Adds: This systematic review provides an evaluation of the evidence within the occupational therapy scope of practice to address depressive and anxiety symptoms within the physical disability IPR setting. This research can support occupational therapy practitioners to comprehensively address physical and mental health for participation in IPR.

Importance: Virtual reality in head-mounted displays (HMD-VR) may be a valuable tool in occupational therapy to address anxiety. Findings from the virtual reality exposure therapy (VRET) literature may facilitate translation of HMD-VR to occupational therapy psychosocial practice. Objective: To explore how HMD-VR has been used to treat anxiety through VRET and could be translated to occupational therapy. Data Sources: We searched seven electronic databases for articles published between 2000 and 2020: CINAHL, Cochrane Library, Embase, ERIC, Ovid MEDLINE, PsycINFO, and Web of Science. Search terms included HMD-VR constructs, products, and therapy concepts. Study Selection and Data Collection: We used Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to report studies implementing VRET to treat anxiety. At least two reviewers assessed each citation, and a third resolved disagreements. Articles were included if they were in English, reported experimental data, and used HMD-VR. Letters, commentaries, book chapters, technical descriptions, theoretical papers, conference proceedings (≤4 pages), and reviews were excluded. Findings: Twenty-eight studies used HMD-VR to treat posttraumatic stress disorder (n = 3), specific phobias (n = 19), and performance-based social anxiety (n = 6); protocols and levels of evidence varied (randomized controlled trials, n = 11; controlled trials without randomization, n = 6; case–control or cohort studies, n = 11). Qualitative examination indicates HMD-VR is an effective treatment tool. Conclusions and Relevance: HMD-VR can be a valuable tool for occupational therapy to simulate environments where clients with anxiety disorders participate. Eliciting presence through multisensory features and body representation may enhance outcomes. What This Article Adds: Drawing from the VRET literature, this scoping review suggests that HMD-VR can be used by occupational therapy practitioners to simulate ecologically valid environments, evaluate client responses to fearful stimuli, and remediate anxiety though immersion in virtual tasks when participation in natural contexts is unfeasible. Having ecologically valid environments is particularly important for people with anxiety disorders because they need support to cope when they encounter triggers in everyday life environments.

Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. Results showed that about 70% of the students had some stress management strategies. However, 19% of them experienced toxic levels of stress, 33% of them used negative appraisal for coping, and one-third of them showed clinically significant anxiety and depression, resulting in negative impact on occupational engagement. OT students may benefit from learning different types of coping strategies that promote development of resilience to better manage stress and reduce mental illness. Primary Author and Speaker: Megan C. Chang Additional Authors and Speakers: Sarah Hagen, Stephanie Geneza, Maiko Ibay, Megan Karburn, Alexandra Kautz, and Elaine Lau

Date Presented 04/20/21 This pilot study investigated the effect of yoga on mood and occupational engagement in older adults. Five participants completed a 6-week yoga group. Changes in occupational performance pre- and postintervention were explored via interviews and questionnaires. Results show perceived improvement in occupational engagement and mood for four of five participants. Preliminary findings suggest meditative movement is an effective OT intervention for improving occupational engagement. Primary Author and Speaker: Christina Befanis Additional Authors and Speakers: Cherae C. Reeves Contributing Authors: Alyssa Raiber, Megan K. Hamann

Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. This systematic review examined interventions for anxiety and depressive symptoms among inpatient physical rehabilitation patients. Results were framed by intervention type, context, and concentration of current literature among patient groups. Setting specific analyses does not seem to be common, because patient groups are often considered regardless of therapeutic setting and therefore regardless of recovery stage. Setting-specific information can aid resource development and literature navigation. Primary Author and Speaker: Janell Pisegna Additional Authors and Speakers: Sarah E. Anderson Contributing Authors: Jessica L. Krok-Schoen

Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. Individuals on the autism spectrum and their families face a host of social obstacles to inclusion in society at large. Data from an ongoing phenomenological study of autism in the community shows that parent anxieties around interactions with police are a significant barrier to community inclusion and participation for individuals with autism spectrum disorder. The experiences of families in the community related to police affect feelings of comfort and safety and may contribute to occupational deprivation. Primary Author and Speaker: David Turnbull Contributing Authors: Contributing Author

Date Presented 04/19/21 Higher screen time exposure relates to increased physiological and social anxiety levels within university students, and the majority of their screen time is within leisure occupations. OTs can utilize this information when educating clients about strategies to decrease anxiety. Primary Author and Speaker: Barbra Katerberg, OTR/L Additional Authors and Speakers: Casey Humphrey Contributing Authors: Aaron Sciascia

Importance: Coronavirus disease 2019 (COVID-19) has had a severe psychological impact on frontline and second-line medical workers. However, few empirical reports have been published on its impact on occupational therapists. Clarifying the mental health status of occupational therapists is important to maintain care quality and prevent psychological problems in this population. Objective: To investigate the psychological impact of COVID-19 on Japanese occupational therapists in prefectures with and without severe pandemic-related restrictions and elucidate factors associated with psychological problems such as anxiety, depression, and insomnia. Design: A cross-sectional online survey using region-stratified two-stage cluster sampling conducted May 28–31, 2020. Participants: The sample included 371 participants (63.1% women) in the prefectures under specific cautions (i.e., where residents were strictly advised to refrain from outings) and 1,312 in the prefectures without such cautions (61.9% women). Results: The increase in workload due to the pandemic was significantly related to an increase in anxiety, depression, and insomnia, and an attempt to avoid talking face to face with others was significantly related to an increase in anxiety regardless of area. In prefectures under specific cautions as of May 25, 2020, the provision of sufficient information on COVID-19 by the workplace significantly reduced the risk of insomnia. In other prefectures, the provision of sufficient information significantly reduced the risk of depression. Conclusions and Relevance: These results demonstrate the severe negative psychological impact of the increase in workload resulting from COVID-19 and suggest the importance of psychological support for occupational therapists, such as the provision of sufficient information by the workplace. What This Article Adds: This study highlights the importance of providing psychological support for occupational therapists worldwide.

Importance: Sensory integration modalities, such as weighted blankets, are used in occupational therapy practice to assist with emotional and physical regulation. However, the research related to the use and effectiveness of weighted blankets is sparse. Objective: To identify, evaluate, and synthesize the current literature to help develop the impetus needed to launch a research study into the effectiveness of using weighted blankets to decrease anxiety and insomnia. Data Sources: A literature search was conducted between January 23, 2018, and March 1, 2018. Databases and sites included the Cochrane Library, PubMed, PsycINFO, CINAHL, OTseeker, Web of Science, and Nursing Reference Center Plus. Search terms included weighted blanket, deep pressure, and occupational therapy as well as combinations of these terms. Study Selection and Data Collection: This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Articles were included if the study used weighted blankets as the modality of deep pressure stimulation. Data from presentations, conference proceedings, non–peer-reviewed literature, dissertations, and theses were excluded. Findings: Only 8 studies were included: 4 Level I, 2 Level III, and 2 Level IV studies. The outcomes of these studies suggest that weighted blankets have the potential to be beneficial in limited settings and populations. Conclusion and Relevance: Weighted blankets may be an appropriate therapeutic tool in reducing anxiety; however, there is not enough evidence to suggest they are helpful with insomnia. What This Article Adds: Evidence-based research on the effectiveness of weighted blankets in reducing anxiety and insomnia is sparse. More research is needed to define guidelines for the use of weighted blankets in clinical practice and to investigate the underlying mechanism of action. This systematic review can be used to begin an investigation of the use of weighted blankets for larger and more diverse populations.

Importance: Although attachment is associated with sensory modulation among children and adolescents and insecure attachment is associated with pain severity among adolescents, relationships among sensory modulation, attachment, and function have not previously been demonstrated in a clinical sample of children and adolescents with complex persistent pain. Objective: To investigate relationships among sensory modulation, attachment, function, and quality of life (QOL) in a pediatric population with persistent pain. Design: Cross-sectional quantitative design. From October 2015 to July 2017, all children, adolescents, and parents attending a clinic for assessment completed questionnaires and were provided information and consent forms. Those who consented completed sensory modulation and attachment questionnaires. Setting: Tertiary pain management clinic. Participants: Children (ages 8–12 yr) and adolescents (ages 13–18 yr) with persistent pain (pain of >3 mo duration or a specific pain disorder) and the capacity to answer questionnaires independently. Measures: Standardized sensory modulation, attachment, pain intensity, functional disability, and QOL questionnaires. Hypotheses were generated before data collection. Results: Of 152 children and adolescents, 114 children (30 girls, 9 boys) and adolescents (68 girls, 7 boys) met study criteria and consented to participate. Hierarchical multiple regression analyses revealed that sensory sensitivity predicted disability for children and adolescents, and attachment anxiety mediated the relationship between low registration and poorer school-related QOL. Conclusion and Relevance: Behaviors related to insecure attachment patterns provide a mediating pathway from sensory modulation to functional disability; addressing such behaviors clinically may facilitate engagement in daily activities for children and adolescents with persistent pain. What This Article Adds: Results support the need to consider the interactions between sensory modulation and attachment when addressing functional abilities with occupational therapy treatment.

Importance: Adults with intellectual and developmental disabilities (IDD) are twice as likely as their peers without disabilities to have had a physical exam in the past year; however, as a result of challenging behavior during office visits, they are significantly less likely to have received recommended health screenings. Challenging behaviors in clinical settings have been identified as a barrier to providing adequate care for this population. Objective: This scoping review examined the within-session effects of multisensory environments (MSEs) on people with IDD to determine the clinical utility of MSEs for this population. Data Sources: Studies published between January 1, 2000, and August 1, 2018, were identified using Summon and Google Scholar. Study Selection: Studies were included in the review if they systematically collected and reported data on within-session effects of an MSE intervention on people with IDD. Findings: Thirteen studies met criteria for this review: 4 with Level I evidence, 2 with Level II evidence, 3 with Level III evidence, and 4 with Level IV evidence. Studies examined the effects of MSEs on maladaptive behaviors, positive behaviors, distress and discomfort, activity and alertness states, and cost of care for people with IDD. Conclusion and Relevance: Preliminary support was found for the use of MSEs in clinical settings to reduce anxiety and challenging behaviors in patients with IDD during clinical care. Further research is needed to determine the efficacy of MSEs for producing the effects described in this review. What This Article Adds: The findings support the potential of MSEs as a tool that occupational therapy practitioners can use to support their clients with IDD who have sensory sensitivities in clinical settings. This article also highlights a multidisciplinary approach whereby medical providers and occupational therapy practitioners could work together in nontraditional ways to support this population.

Date Presented 04/04/19 Stress and anxiety have major negative implications for student quality of life (QOL). We designed a study to examine effects of animal-assisted therapy (AAT) or progressive muscle relaxation (PMR) on stress and anxiety in graduate students. Preliminary results of physiological and psychological tests showed a decrease in heart rate and state anxiety in both AAT and PMR groups. This study provides evidence of interventions to improve QOL and health in graduate students. Primary Author and Speaker: Brandi Hertel Contributing Authors: Regina Abel

OBJECTIVE. This pilot study is the first to examine the effects of an occupational therapist–led African drumming group on mental well-being among adult psychiatric inpatients with mood disorders. METHOD. We used a quasi-experimental, uncontrolled, one-group, pretest–posttest design. We collected data for six different drumming groups (N = 13) using the Stellenbosch Mood Scale, the Primary Health Questionnaire–9, the Generalized Anxiety Disorder–7 scale, and the Enjoyment of Interaction Scale. RESULTS. Participants significantly improved on all six domains of the Stellenbosch Mood Scale, with a large clinical effect. Participants with higher self-reported anxiety and depression benefited the most. According to the Enjoyment of Interaction Scale results, all the participants enjoyed the drumming “a great deal.” CONCLUSION. Our positive findings suggest that drumming may be an effective intervention for adults with acute mood disorders. We recommend further research that uses a control intervention.

OBJECTIVE. Anxiety disorders are the most prevalent psychological disorders among children and youths. There is growing interest in intervention options for anxiety. Yoga is widely used in clinical, school, and community settings, but consolidated sources outlining its effectiveness in reducing anxiety are limited. METHOD. This systematic review examined the evidence base (1990–2014) for yoga interventions addressing anxiety among children and adolescents (ages 3–18 yr). RESULTS. We identified 2,147 references and found 80 articles that were eligible for full-text review. The final analysis included 16: 6 randomized controlled trials, 2 nonrandomized preintervention–postintervention control-group designs, 7 uncontrolled preintervention–postintervention studies, and 1 case study. CONCLUSION. Nearly all studies indicated reduced anxiety after a yoga intervention. However, because of the wide variety of study populations, limitations in some study designs, and variable outcome measures, further research is needed to enhance the ability to generalize and apply yoga to reduce anxiety.

Experience sampling examined how temporality, the lived experience of time, varied related to specific activity qualities and experiences in everyday life. Thirty-five students completed electronic surveys regarding their current activity and feelings and rated the activity's novelty and complexity, their depth of emotional and intellectual engagement, the direction and depth of attention, and the demands of the activity on their skills. Using configural frequency analysis and an analysis of narrative responses, configurations of factors (types) associated with variations in perceived temporalities were described. Four composite types identified occurred with any temporality. In most habitual activities, time was perceived as passing the same as clock time. Most faster or timeless temporalities occurred in complex, novel, and skill-requiring activities that engaged participants. Unexpected activity configurations were also associated with accelerated perceptions of time. Occupational therapists may use this knowledge to assist clients to redesign activities that promote positive experiences without high activity demands.

Objective. One symptom common to many persons with autism is a high arousal or anxiety level. This study investigated the effects of deep pressure on arousal and anxiety reduction in autism with Grandin’s Hug Machine, a device that allows self-administration of lateral body pressure. Method. Twelve children with autism were randomly assigned to either an experimental group (receiving deep pressure) or a placebo group (no receiving deep pressure but in the disengaged Hug Machine). All children received two 20-min sessions a week over a 6-week period. Arousal was measured behaviorally with the Conners Parent Rating Scale and physiologically with galvanic skin response (GSR) readings. Results. Behavioral results indicated a significant reduction in tension and a marginally significant reduction in anxiety for children who received the deep pressure compared with the children who did not. Additionally, children in the experimental group, whose GSR measure decreased, on average, after deep pressure, were somewhat more likely to have higher GSR arousal a priori. Conclusion. These preliminary findings support the hypothesis that deep pressure may have a calming effect for persons with autism, especially those with high levels of arousal or anxiety.