Journal of Happiness Studies

, Volume 20, Issue 7, pp 2027–2053 | Cite as

Guidelines for Occupational Therapy Interventions Based on Meaningful and Psychologically Rewarding Occupations

  • Moses N. IkiuguEmail author
  • Whitney Lucas-Molitor
  • Diana Feldhacker
  • Cassidy Gebhart
  • Mallory Spier
  • Lauren Kapels
  • Riley Arnold
  • Rebecca Gaikowski
Research Paper


The purpose of this paper is to describe a newly developed set of guidelines for use of meaningful and psychologically rewarding occupations as therapeutic media in occupational therapy interventions for better therapy outcomes among occupational therapy service users. We begin with a report of the results from meta-analyses indicating that participation in and/or interventions based on meaningful and psychologically rewarding occupations have a positive effect on perceived health and well-being. Using these findings from meta-analysis as a foundation, we present step-by-step guidelines regarding how to evaluate a service user in order to identify personally meaningful and psychologically rewarding occupations; assess the occupational performance issues that are a priority for the service user; plan and implement evidence-based and theory-based interventions that are centered on personally meaningful and psychologically rewarding occupations; and evaluate therapeutic outcomes. Finally, we provide a case example to illustrate application of the intervention guidelines. We recommend that the guidelines be tested through clinical trials in order to determine their clinical effectiveness in typical occupational therapy practice settings.


Meaningfulness Psychological rewards Perceived health Well-being Occupational therapy 


  1. Aiken, F. E., Fourt, A. M., Cheng, I. K. S., & Polatajko, H. J. (2011). The meaning gap in occupational therapy: Finding meaning in our own occupation. Canadian Journal of Occupational Therapy, 78(5), 294–302. Scholar
  2. American Occupational Therapy Association. (2014). Occupational therapy practice framework: Domain and process (3rd ed.). American Journal of Occupational Therapy, 68(Supplement_1), S1–S48. Scholar
  3. American Occupational Therapy Association. (2017). AOTA occupational profile template. Retrieved from Accessed 14 Feb 2017.
  4. *Baker, F. A., Rickard, N., Tamplin, J., & Roddy, C. (2015). Flow and meaningfulness as mechanisms of change in self-concept and well-being following a songwriting intervention for people in the early phase of neurorehabilitation. Frontiers in Human Neuroscience, 9(article 299), 1–10. Scholar
  5. Bar, M. A., & Jarus, T. (2015). The effect of engagement in everyday occupations, role overload and social support on health and life satisfaction among mothers. International Journal of Environmental Research and Public Health, 12(6), 6045–6065. Scholar
  6. Bartolucci, A. A., & Hillegas, W. B. (2010). Overview, strengths, and limitations of systematic reviews and meta-analyses. In F. Chiappelli, X. M. CaldeiraBrant, N. Neagos, O. O. Oluwadara, & M. H. Ramchandani (Eds.), Evidence-based practice: Towards optimizing clinical outcomes (pp. 17–33). Berlin: Springer. Scholar
  7. Bennett, S., Tooth, L., McKenna, K., Rodger, S., Strong, J., Ziviani, J., et al. (2003). Perceptions of an evidence-based practice: A survey of Australian occupational therapists. Australian Journal of Occupational Therapy, 50, 13–22.CrossRefGoogle Scholar
  8. Borenstein, M., Hedges, L. V., Higgins, J. P., & Rothstein, H. R. (2009). Introduction to meta-analysis. Chichester: Wiley.CrossRefGoogle Scholar
  9. Butler, A. C., Chapman, J. E., Forman, E. M., & Beck, A. T. (2006). The empirical status of cognitive-behavioral therapy: A review of meta-analyses. Clinical Psychology Review, 26, 17–31.CrossRefGoogle Scholar
  10. Centers for Disease Control. (2016). Health-related quality of life (HRQOL): Well-being concepts. Retrieved from Accessed 2 Aug 2017.
  11. Choi, E., Tang, F., Kim, S., & Turk, P. (2016). Longitudinal relationships between productive activities and functional health in later years: A multivariate latent growth curve modeling approach. The International Journal of Aging and Human Development, 83(4), 418–440. Scholar
  12. Clark, F., Jackson, J., Carlson, M., Chou, C., Cherry, B., Jordan-Marsh, M., et al. (2011). Effectiveness of a lifestyle intervention in promoting the well-being of independently living older people: Results of the well elderly 2 randomized controlled trial. Epidemiology and Community Health. Scholar
  13. Costa, U. (2014). Meaningful activity as health-promoting factor. Outcomes of KRAH®-based intervention (Sinnvolle Handlung als gesundheitsfördernder Wirkfaktor.). Ergoscience, 9(2), 46–56.Google Scholar
  14. Csikszentmihalyi, M. (1997). Finding flow: The psychology of engagement with everyday life. New York, NY: Basic Books.Google Scholar
  15. Dehghanizade, Z., Zargar, Y., Honarmand, M. M., Kadkhodaie, A., & Eydibaygi, M. (2015). The effectiveness of cognitive behavior stress management on functional dyspepsia symptoms. Journal of Advances in Medical Education & Professionalism, 3(2), 45–49.Google Scholar
  16. Dezutter, J., Casalin, S., Luyckx, K., Wachholtz, A., Hekking, J., & Vandewiele, W. (2013). Meaning in life: An important factor for the psychological well-being of chronically ill patients? Rehabilitation Psychology, 58(4), 334–341. Scholar
  17. Duval, S., & Tweedie, R. (2000). Trim and fill: A simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics, 56(2), 455–463. Scholar
  18. Ekelman, B., Bazyk, S. B., & Bazyk, J. (2013). The relationship between occupational engagement and well-being from the perspective of university students with disabilities. Journal of Occupational Science, 20(3), 236–252. Scholar
  19. Eklund, M., Tjörnstrand, C., Sandlund, M., & Argentzell, E. (2017). Effectiveness of Balancing Everyday Life (BEL) versus standard occupational therapy for activity engagement and functioning among people with mental illness—A cluster RCT study. BMC Psychiatry, 17(363), 1–12. Scholar
  20. Esch, T., & Stefano, G. B. (2004). The neurobiology of pleasure, reward processes, addiction and their health implications. Neuro Endocrinology Letters, 25(4), 235–251.Google Scholar
  21. Gallagher, M., Muldoon, O. T., & Pettigrew, J. (2015). An integrative review of social and occupational factors influencing health and wellbeing. Frontiers in Psychology, 6(article 1281), 1–11. Scholar
  22. *Graff, M. J. L., Vernooij-Dassen, M. J., Thijssen, M., Dekker, J., Hoefnagels, W. H., & OldeRikkert, M. G. (2007). Effects of community occupational therapy on quality of life, mood, and health status in dementia patients and their caregivers: A randomized controlled trial. Journal of Gerontology, 62A(9), 1002–1009. Scholar
  23. Green, S., Sixsmith, J., Ivanoff, S. D., & Sixsmith, A. (2005). Influence of occupation and home environment on the wellbeing of European elders. International Journal of Therapy and Rehabilitation, 12(11), 505–509. Scholar
  24. Gutman, S. A., & Schindler, V. P. (2007). The neurological basis of occupation. Occupational Therapy International, 14(2), 71–85. Scholar
  25. Hakansson, C., Lissner, L., Björkelund, C., & Sonn, U. (2009). Engagement in patterns of daily occupations and perceived health among women of working age. Scandinavian Journal of Occupational Therapy, 16, 110–117. Scholar
  26. *Haslam, C., Haslam, S. A., Jetten, J., Bevins, A., Ravenscroft, S., & Tonks, J. (2010). The social treatment: The benefits of group interventions in residential care settings. Psychology and Aging, 25(1), 157–167. Scholar
  27. Hilleras, P. K., Jorm, A. F., Herlitz, A., & Winblad, B. (2001). Life satisfaction among very old: A survey on a cognitively intact sample of aged 90 years or above. International Journal of Aging and Human Development, 52(1), 71–90. Scholar
  28. Hofmann, S. G., Asnaani, A., Vonk, I. J., Sawyer, A. T., & Fang, A. (2013). The efficacy of cognitive behavioral therapy: A review of meta-analyses. Cognitive Therapy Research, 36(5), 427–440. Scholar
  29. Ikiugu, M. N. (in press). Meaningful and psychologically rewarding occupations: Characteristics and implications for occupational therapy practice. Occupational Therapy in Mental Health.Google Scholar
  30. Ikiugu, M. N. (2007). Psychosocial conceptual practice models in occupational therapy: Building adaptive capability. St. Louis, MO: Elsevier.Google Scholar
  31. Ikiugu, M. N., Hoyme, A. K., Mueller, B., & Reinke, R. (2016). Difference between meaningful and psychologically rewarding occupations: Findings from two pilot studies. Journal of Occupational Science, 23(2), 266–277. Scholar
  32. Ikiugu, M. N., & Pollard, N. (2015). Meaningful living across the lifespan: Occupation-based intervention strategies for occupational therapists and scientists. London: Whiting & Birch.Google Scholar
  33. Ikiugu, M. N., & Smallfield, S. (2011). Ikiugu’s eclectic method of combining theoretical conceptual practice models in occupational therapy. Australian Occupational Therapy Journal, 58(6), 437–446. Scholar
  34. Ikiugu, M. N., Smallfield, S., & Condit, C. (2009). A framework for combining theoretical conceptual practice models in occupational therapy practice. Canadian Journal of Occupational Therapy, 76(3), 180–188. Scholar
  35. Jain, S., & Angural, V. (2017). Use of Cronbach’s alpha in dental research. Medico Research Chronicles, 4(3), 285–291.Google Scholar
  36. *Johansson, A., & Björklund, A. (2017). The impact of occupational therapy and lifestyle interventions on older persons’ health, well-being, and occupational adaptation. Scandinavian Journal of Occupational Therapy, 23(3), 207–219. Scholar
  37. *Jones, M., Kimberlee, R., Deave, T., & Evans, S. (2013). The role of community centre-based arts, leisure and social activities in promoting adult well-being and healthy lifestyles. International Journal of Environmental Research and Public Health, 10, 1948–1962. Scholar
  38. Kielhofner, G. (2008). Model of human occupation: Theory and application (4th ed.). Philadelphia, PA: Lippincott, Williams, & Wilkins.Google Scholar
  39. Kielhofner, G. (2009). Conceptual foundations of occupational therapy practice (4th ed.). Philadelphia: F. A. Davis.Google Scholar
  40. *Killen, A., & Macaskill, A. (2015). Using a gratitude intervention to enhance well-being in older adults. Journal of Happiness Studies, 16(4), 1–19. Scholar
  41. Krause, N. (2004). Stressors arising in highly valued roles, meaning in life, and the physical health status of older adults. Journal of Gerontology, 59(5), S287–S297. Scholar
  42. Law, M. (2002). Participation in the occupations of everyday life. American Journal of Occupational Therapy, 56(6), 640–649. Scholar
  43. Leech, N. L., Barrett, K. C., & Morgan, G. A. (2015). IBM SPSS for intermediate statistics: Use and interpretation (5th ed.). New York: Routledge Taylor & Francis Group.Google Scholar
  44. Liberati, A., Altman, D. G., Tetzlaff, J., Mulrow, C., Gøtzsche, P. C., Ioannidis, J. P., et al. (2009). The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: Explanation and elaboration. PLoS Medicine, 6(7), e1000100. Scholar
  45. Lloyd, K., & Gee, B. (2016). Use of occupation-based practice by therapists: A national practice pattern analyzed. American Journal of Occupational Therapy, 70(4), 7011505119p1. Scholar
  46. Lu, Y. Y. F., Bakas, T., Yang, Z., Weaver, M. T., Austrom, M. G., & Haase, J. E. (2016). Feasibility and effect sizes of the revised daily engagement of meaningful activities intervention for persons with mild cognitive impairment and their caregivers. Journal of Gerontological Nursing, 42(3), 45–58. Scholar
  47. Lyman, G. H., & Kuderer, N. M. (2005). The strengths and limitations of meta-analyses based on aggregate data. BMC Medical Research Methodology, 5(14), 1–7. Scholar
  48. *Mansbach, W. E., Mace, R. A., Clark, K. M., & Firth, I. M. (2017). Meaningful activity for long-term care residents with dementia: A comparison of activities and raters. Gerontologist, 57(3), 461–468. Scholar
  49. McIntyre, G., & Howie, L. (2002). Adapting to widowhood through meaningful occupations: A case study. Scandinavian Journal of Occupational Therapy, 9, 54–62. Scholar
  50. Moher, D., Hopewell, S., Schulz, K. F., Montori, V., Gotzsche, P. C., Devereaux, P. J., et al. (2010). CONSORT 2010 explanation and elaboration: Updated guidelines for reporting parallel group randomized trials. BMJ, 340, c869. Scholar
  51. Nakamura, J., & Csikszentmihalyi, M. (2009). The concept of flow. In C. R. Snyder & S. J. Lopez (Eds.), Oxford handbook of positive psychology (pp. 89–105). New York: Oxford University Press.Google Scholar
  52. Polatajko, H. J., Townsend, E. A., & Craik, J. (2007). Canadian Model of Occupational Performance and Engagement (CMOP-E). In E. A. Townsend & H. J. Polatajko (Eds.), Enabling occupation II: Advancing an occupational therapy vision for health, well-being & justice through occupation. Ottawa, ON: CAOT Publications ACE.Google Scholar
  53. *Pooremamali, P., & Eklund, M. (2017). Well-being and perceptions of everyday activities among those who attend community-based day centres for people with mental illness in Sweden—Does an immigrant background make a difference? International Journal of Social Psychiatry, 63(6), 539–549. Scholar
  54. Salazar, M. S. (2015). The dilemma of combining positive and negative items in scales. Psicothema, 27(2), 192–199. Retrieved from
  55. Speer, M. E., Bhanji, J. P., & Delgado, M. R. (2014). Savoring the past: Positive memories evoke value representations in the striatum. Neuron, 84(4), 847–856. Scholar
  56. Stein, F. (2003). Stress management questionnaire. Portland: Delmar Learning.Google Scholar
  57. Townsend, E., & Polatajko, H. (2013). Enabling occupation II: Advancing an occupational therapy vision for health, well-being, and justice through occupation (2nd ed.). Ottawa, ON: CAOT Publications ACE.Google Scholar
  58. Wensley, R., & Slade, A. (2012). Walking as a meaningful leisure occupation: The implications for occupational therapy. British Journal of Occupational Therapy, 75(2), 85–92. Scholar
  59. Wilson, N. J., & Cordier, R. (2013). A narrative review of Men’s Sheds literature: Reducing social isolation and promoting men’s health and well-being. Health and Social Care in the Community, 21(5), 451–562. Scholar
  60. World Health Organization. (2005). Constitution of the World Health Organization. Retrieved from Accessed 2 Aug 2017.
  61. Comprehensive Meta-Analysis (Version 3.0) [Computer software]. Englewood, NJ: Biostat.Google Scholar
  62. Young, C. B., & Nusslock, R. (2016). Positive mood enhances reward-related neural activity. Social Cognitive and Affective Neuroscience, 11(6), 934–944. Scholar
  63. Zhang, C., McCarthy, C., & Craik, J. (2008). Theory meets practice. Students as translators for the Canadian Model of Occupational Performance and Engagement. Occupational Therapy Now, 10(3), 3–5.Google Scholar

Copyright information

© Springer Nature B.V. 2018

Authors and Affiliations

  1. 1.Occupational Therapy Department, School of Health SciencesUniversity of South DakotaVermillionUSA

Personalised recommendations