Background Childhood anxiety is an increasing concern globally, with rates rising significantly following the COVID-19 pandemic. However, there are relatively few evidence-based interventions specifically designed to directly target and involve younger children under 7 years old. To address this gap, a six-session manualised programme was developed to assist children aged 4-7 in managing their anxiety. The programme integrates Cognitive Behavioural Therapy (CBT) with Sensory Modulation (SM) strategies, providing simple and practical tools to aid young children in coping with anxiety. This study aimed to evaluate the effectiveness, acceptability, and practicality of this CBT-SM intervention when delivered through community-based child and adolescent mental health services (CAMHS).Methods A single-case experimental design (SCED) was employed, involving six children diagnosed with anxiety across two sites. At least three children were reported to have sensory challenges. A psychologist assessed the children's anxiety at three intervals: at the beginning of the study, after the intervention was completed, and 4 weeks later. Parents also completed questionnaires measuring behavioural issues (both internalising and externalising) and the impact of anxiety on daily life at baseline, prior to treatment, and after treatment.Results The study revealed significant reductions in anxiety and improvements in overall functioning. Both parents and therapists reported the programme as acceptable. Notably, four out of six children (67%) no longer met the criteria for an anxiety diagnosis following the intervention and at follow-up.Conclusions These findings provide preliminary support for the effectiveness, acceptability, and practicality of this innovative CBT-SM approach in assisting young children in managing anxiety.

Nature-based interventions (NBIs) have been identified to support a recovery-oriented approach for people experiencing mental health issues. However, there is still limited knowledge related to how mental health service users experience their recovery process when engaged in NBIs. To explore and explain how mental health service users experience the process of personal recovery from participating in a newly developed NBI. The study was conducted using constructivist grounded theory and included 20 participants. The NBI, including equine-assisted therapy, was delivered in groups at a farm-based rehabilitation centre. Purposeful sampling was used, and in-depth interviews were performed on site. Data were analysed in an iterative, comparative process. During the analysis, NVIVO 14 was used to organise and manage the data systematically. The grounded theory of the core concept ‘A process of embodied recovery’, described the participants’ experiences of personal recovery during the NBI and included three concepts: ‘Experiencing interconnection’ through transactions with the environment, ‘Processing inner connection’ through reflection and ‘Feeling intra-connected’ through integration of self and body as a whole in everyday life. The NBI provides positive multisensory experiences to support personal recovery among mental health service users. The findings hold significant implications for the advancement of recovery-oriented services in mental health care, including occupational therapy.

IntroductionMental health service users often have sensory processing difficulties hampering their ability to cope with mental health problems and occupational engagement. However, there is little knowledge of sensory processing and its relation to these factors. Hence, this current study aims to investigate sensory processing patterns in relation to coping and occupational engagement for the target group.MethodsThis cross-sectional study involved 97 mental health service users. Sociodemographic information and self-rated questionnaires were administered; Adolescent/Adult Sensory Profile (AASP), Coping Orientation to Problems Experienced Inventory scale (short version) (Brief-COPE), and Profiles of Occupational Engagement among people with Severe mental illness (POES). Statistical analysis included descriptive statistics and multiple linear regression models.Consumer and Community InvolvementThis study sits within an RCT project where parts were designed collaboratively with research-educated service users.ResultsThe result showed strong relationships between sensory processing patterns and occupational engagement. Low levels of occupational engagement were related to high levels of sensory sensitivity, sensation avoiding, and low registration. Whereas, high levels of occupational engagement were related to high levels of sensation-seeking. Concerning coping styles, high levels of emotion-focused coping were related to high levels of low registration, while high levels of avoidant coping styles were related to high levels of sensation-seeking.ConclusionThe findings indicate that occupational engagement and coping styles are related to outcomes of the sensory profile and thus affect how a person with severe mental health problems interprets and reacts to sensory stimuli in daily life.

Mental health service users often experience difficulties interpreting and regulating sensory stimuli resulting in increased anxiety, decreased abilities to engage in activities and a hampered recovery process. However, there are limited studies on the implementation of such recovery-oriented interventions targeting sensory difficulties via sensory modulation techniques. Therefore, the aim of this study was to investigate staff and manager views on the implementation process of a group-based sensory modulation intervention in mental health outpatient services in Southern Sweden. This mixed method implementation process evaluation included eight outpatient units, which were also study sites for a Randomized Controlled Trial (RCT) (NCT06432114), evaluating the effectiveness of the sensory modulation intervention. Quantitative data were analysed using descriptive statistics and qualitative data were analysed using deductive and inductive content analysis. The results indicated that the intervention was highly accepted by the mental health staff. The dose delivered and received were high and the intervention in general met the needs of the target group. Managers and staff reflections indicated that following the intervention service users seemed to feel better prepared to handle anxiety in daily life due to the acquisition of new sensory coping strategies. Staff expressed that they benefitted from acquiring a different perspective or “new sensory glasses” to apply in their clinical practice. However, managers’ and staff reflections also highlighted the need for an adapted manual for people with cognitive issues and more education for staff. This study contributed to new knowledge of implementing a recovery-oriented sensory modulation intervention in mental health outpatient services. The implementation was generally carried out as intended. Nonetheless, certain challenges emerged during the implementation process, both within the contextual environment and during the delivery of the intervention. Retrospectively registered 20,240,529, in ClinicalTrials.gov NCT06432114.

Purpose Sensory modulation intervention involves using calming and grounding sensory stimuli to support coping with distress and intense emotions. Evaluating the impact of sensory modulation is challenging in inpatient settings due to the numerous variables influencing outcomes in ward environments. This study aims to determine the impact of sensory modulation across all organisational levels including service users, staff confidence and attitudes, ward climate and seclusion events. Design/methodology/approach Organisational case studies were conducted in two Aotearoa New Zealand inpatient mental health services, using qualitative and quantitative data to explore the effects of a sensory modulation programme. Findings Results showed that sensory modulation enhanced staff knowledge and confidence in fostering therapeutic relationships and reducing restrictive practices, positively impacted ward climate and provided service users with sensory strategies to use in everyday life. Practical implications The findings captured the complexity of implementation and impact of sensory modulation programmes at individual, group and organisational levels. It is important to recognise the influencing factors and impact of sensory modulation across all levels of service delivery. Originality/value Organisational case study methodology offered a unique approach to evaluating the impact of sensory modulation within inpatient mental health services. Data analysis suggests that in addition to managing acute service user distress, sensory modulation impacts broader staff, team and service level outcomes.

Purpose - Sensory modulation is an emerging approach that aims to reduce distress and agitation in mental health service users and potentially avoid the necessity for coercive practices such as seclusion and restraint. Despite the growing use of this intervention, there has been limited research exploring the implementation of sensory modulation at an organisational level, both internationally and within the New Zealand context. The purpose of this study is to investigate the implementation of a sensory modulation programme in two New Zealand inpatient mental health services using an exploratory organisational case study design.Design/methodology/approach - Organisational case study design methodology was used to explore the implementation of a sensory modulation programme in two New Zealand acute adult inpatient mental health services. This study explored how key organisational and staff factors (including policies and practices related to de-escalation and seclusion reduction) influence sensory modulation implementation. Cases were described and examined the pattern of findings.Findings - Strategies found to support implementation were identified at environmental, organisational, group and individual staff levels. Aspects highlighted as being particularly important included taking an inter-professional approach in leadership and training, rostering flexibility and leeway in staffing levels to support training attendance and responsiveness to crises.Practical implications - The facilitators and strategies highlighted in this study may be used to support the design and implementation of future sensory modulation programmes in New Zealand and internationally.Originality/value - The complexity of factors that influenced the implementation of the sensory modulation approach within an inpatient setting made determining the effectiveness of the approach challenging. However, the general principles and strategies identified in this study offer useful insights for the design and implementation of future sensory modulation programmes.

BACKGROUND:People with mental health issues often experience difficulties with sensory modulation affecting occupational engagement. Research conducted in inpatient units has shown positive effects of individual sensory modulation interventions, however, research on experiences of group-based interventions in outpatient units is limited. Hence, a group-based sensory modulation intervention was adapted and tested within Swedish mental health outpatient units. AIM:To explore the experiences of participating in a group-based sensory modulation intervention for service users in mental health outpatient units. MATERIAL AND METHODS:This qualitative study involved interviews with 25 informants who had participated in the intervention. The interview data were analysed using reflexive thematic analysis. RESULTS:Synthesis of the interviews resulted in one overarching theme of 'Embodied awareness facilitates improved coping and sense of self' organised into four themes: (1) 'Developing embodied awareness and strategies', (2) 'Taking control of everyday life', (3) 'Creating a stronger sense of self', and (4) 'From alienation to belonging'. CONCLUSION AND SIGNIFICANCE:The informants experienced the intervention to provide new embodied coping strategies that had previously been neglected. This understanding may enrich occupational therapy practice in new ways to support service users' engagement in occupations.

Since the 1990s, New Zealand mental health policy has shifted from a focus on the management of symptoms and risk to the recovery of psychological, social, cultural, and physical well-being. Despite a vision for recovery-oriented services being integrated within national and regional policies, there is growing concern that barriers to recovery-oriented service provision continue to exist. Such barriers include the attitudes, skills, and knowledge of front-line staff, as well as system issues. This study explored the experience and meaning of recovery-oriented practice for 10 nurses working in an acute inpatient mental health service. A phenomenological and hermeneutic lens was used to explore the nurses' experience of working in a recovery-focused manner alongside service users. Stories of practice were collected from participants through open-ended conversational interviews. Transcribed narratives were analysed to explore taken-for-granted aspects of working in acute mental health care and to uncover the meaning of being recovery-oriented in this setting. Findings revealed that although the experience and meaning of recovery-focused care varied among nurses, there were common elements in the practice accounts. The accounts highlighted the nurses' role in creating different therapeutic spaces to promote safety, relational commitment, and healing for service users. However, the nurses faced challenges to recovery-oriented care within the team hierarchical culture and the broader service systems. The nurses were, at times, fearless in advocating for service users and recognized that this was essential for developing recovery-focused services. The findings have implications for nursing practice, as well as training and service development.

There is growing evidence that people with serious mental illness have impaired capacity for processing sensory inputs which affects daily occupation. Although this is known, research regarding the target groups experiences of sensory inputs in daily occupations is lacking. To investigate the experience of sensory input and strategies used in daily occupations among people with serious mental illness. Fourteen people with serious mental illness were interviewed regarding their experiences of sensory processing and strategies for managing sensory inputs in daily occupations. Data were analysed using content analysis. Sensory processing issues affected occupational engagement and strategies to control inputs were intuitively used to cope with sensory challenges. Informants either ignored, reduced or avoided sensory inputs. Informants also enabled daily life through strategies such as creating a home that provides rest, finding a safe place, using nature and animals for relaxing and using effects of calming and alerting occupations. Specific sensory inputs were difficult to process, which was experienced as stressful and affected occupations negatively. The results imply a need for further research exploring the management of sensory input and the use of sensory modulation approaches to enable engagement in daily activities.

Staging plays or pantomimes with the aim of personal growth for participants has a long history within mental health occupational therapy practice. This qualitative descriptive study sought to reveal how taking part in an adult mental health therapeutic theatre project supports mental health recovery. The goal was to increase understanding of therapeutic theatre from an occupational perspective. Data from interviews with six service users and four staff were analysed using qualitative methods. The findings generated insights into how the occupational form of therapeutic theatre facilitates participants' wellbeing and recovery, supports its use, and points to the need for skilled facilitation.

Anxiety is a common mental health issue involving cognitive and physiological hypersensitivity to threat. It negatively affects occupational participation. Sensory modulation intervention aims to use calming sensory input to manage the hypersensitivity and physiological arousal associated with anxiety. The empirical evidence for using sensory interventions for anxiety, however, is limited. This mixed methods single subject case design explored the effectiveness of a 6-week sensory modulation intervention for reducing anxiety and improving occupational participation. Results showed significant reduction in anxiety and improved participation, providing further evidence that sensory modulation is an effective approach for the self-management of anxiety.

Background: Day centers are a common form of mental health service internationally. They are aimed at enhancing occupational engagement and social relations, but there is a need to clarify the outcomes of day center programs, including the impact on important aspects of recovery such as empowerment. Aims: The aim of this study was to explore whether perceived empowerment changed over time among Swedish day center users and whether self-esteem, quality of life, socio-demographic data and self-reported diagnosis, type of program and level of engagement in day center occupations could predict future empowerment. Method: The study involved a re-analysis of longitudinal data from 14 day centers, where measures of perceived empowerment and other individual factors were collected over a 15-month period. Non-parametric statistics were used, including Wilcoxon's signed-rank test and logistic regression analysis. Results: There were no significant changes in day center attendee empowerment scores. Self-esteem and level of engagement in day center occupations were found to be predictors of empowerment, together explaining 34% of the variation. Conclusions: Developing empowerment in the day center context involves a complex interaction of individual, social and material factors. Potential barriers to empowerment are discussed along with considerations related to measuring empowerment as an outcome of day center programs.

Sensory modulation is an emerging occupational therapy intervention within adult mental health services. However, cultural variations in the use of sensory modulation have not been directly explored. In New Zealand, the traditional performing arts of kapa haka are used within Maori services as a cultural intervention. This qualitative study explored Maori mental health consumers' sensory experiences during kapa haka via in-depth interviews. Participants experienced feeling safe, being grounded in their bodies, and having an enhanced cultural identity. The findings support the use of culturally-responsive sensory modulation activities within occupational therapy practice and highlight the need for further research.

The dominant model that informs clinical training for preventing violence and managing aggression posits arousal as mediated downwards from higher cortical structures. This view results in an often-misplaced reliance on verbal and cognitive techniques for de-escalation. The emergence of sensory modulation, via the Six Core Strategies, is an alternative or complementary approach that is associated with reduced rates of seclusion and restraint. Sensory-based interventions are thought to promote adaptive regulation of arousal and emotion, but this connection has had limited theoretical and empirical development. This paper presents results of a pilot trial of sensory-based interventions in four inpatient mental health units in New Zealand. Narrative analysis of interview and focus group data suggest that modifications to the environment and the use of soothing stimuli moderate or optimize arousal and promote an ability to adaptively regulate emotion. Findings are discussed in light of recent advances in the neurophysiology of emotional regulation and the General Aggression Model that posits arousal and maladaptive emotional regulation as precursors to aggression.

In New Zealand, the Intellectual Disability (Compulsory Care and Rehabilitation) Act 2003 provides diversion for persons with an intellectual disability who have been charged with, or convicted of, a criminal offence. This unique Act moves the responsibility for such care recipients from the criminal justice system to a disability sector that values a social model of disability and philosophies of autonomy, choice and normalisation. This research identified dilemmas faced by care managers legally responsible for care recipients. Care managers experienced: tension between imperatives of risk management, rehabilitation and human rights; role ambiguity between custodian or therapist; philosophical incongruity within their services; and ethical dilemmas over decisions to lengthen care orders. The changing care recipient population has intensified these dilemmas: services must now adapt to the needs of young, street-wise people with alcohol and drug problems and histories of criminal behaviour. The article makes recommendations about how these dilemmas can be addressed.

This qualitative descriptive study provides new understandings of family routines in families dealing with adolescent mental illness. Seven parent and adolescent participants recruited from a community child and adolescent mental health service contributed data through individual, semi-structured interviews. Inductive analysis revealed two groups of inter-related themes. The first group focused on the nature of routines and comprised four themes, which revealed that routines function as an indicator of well-being of the adolescent and provide stability and continuity in family life in times of stress. The second group also encompassed four themes and explored the meaning of routines, showing that significance is attributed to routines when they facilitate control, protect well-being, facilitate occupational balance, and support the expression of identity. The findings highlight the importance of supporting families and adolescents with mental illness to recognise, adapt, and maintain routines that promote well-being.

Background. Recovery from mental illness has been described as a process involving personal growth and a search for meaning. Occupation is a primary medium for human development as well as the creation of life meaning, suggesting the exploration of recovery from an occupational perspective is warranted. Purpose. To explore the experience and meaning of occupation for 13 people who self-identified as being in recovery from mental illness. Methods. Recovery narratives were collected from participants in conversational interviews that were recorded and transcribed. The transcripts were analysed using hermeneutic phenomenology. Findings. A range of experiences were evident in the recovery narratives, from complete disengagement to full engagement in occupations. Insights into the experience and meaning of different states of occupation were revealed. Implications. All forms of occupational engagement, including disengagement, can be meaningful in the recovery process. Increased understanding of different modes of occupational engagement will assist therapists to support recovery more effectively.