Purpose in Life as an Explicit Outcome of Occupational Therapy.

Purpose in life is increasingly understood to be important to health and well-being. Despite occupational therapy's long history of using occupations to advance health and the linkage between a subclass of occupations and purpose in life, the term is nearly absent from the American Occupational Therapy Association's documents and the profession's empirical literature. We propose that the profession explicitly name purpose in life as among our intervention outcomes and address disruptions of purpose in life in practice. This can be accomplished by first investing in purpose in our own lives, discussing the topic with colleagues and students, identifying possible purpose disruptions in our clients, and using direct or indirect intervention approaches to help clients reconnect to purpose in their lives. By explicitly naming purpose in life as part of the domain of occupational therapy, we become poised to leverage human occupation to address both a broad societal gap and our clients' needs for a renewal of purpose in life.

The feasibility of a purpose-renewal intervention after treatment for early stage breast cancer: A brief report.

This feasibility study evaluated the acceptability, implementability, and preliminary efficacy of a brief purpose renewal intervention (the Compass Course) using a one-group pretest-posttest design. Fifteen women who had completed treatment for early-stage breast cancer enrolled in the study. Twelve completed the eight-session group intervention that was designed to help participants identify daily priorities (actual and aspired) that most align with their personal strengths, values, and sources of meaning, that is, their inner compass. The intervention was found to be acceptable and implementable. Preliminary pre- and post-intervention outcomes suggested that participants experienced greater purpose in daily life at posttest but that they did not make demonstrable changes in their activities or roles. Results suggest that the Compass Course was feasible and further study related to purpose renewal for adults with early-stage cancer is warranted.

Implementation Intentions for Self-Selected Occupational Therapy Goals: Two Case Reports.

OBJECTIVE: We evaluated the feasibility of an intervention combining metacognitive strategy instruction (MSI) with training in implementation intentions for adults with mild traumatic brain injury (mTBI). Implementation intentions are written premade decision statements specifying when, where, and how goal behaviors are to be enacted. METHOD: Two participants with mTBI received a six-session intervention that included setting a daily implementation intention for an occupational therapy goal. A scoring rubric was used to evaluate the quality of implementation intentions; goal achievement was measured using the Canadian Occupational Performance Measure (COPM) and goal attainment scaling. RESULTS: All implementation intentions received perfect quality scores, suggesting participants learned to correctly craft implementation intentions. Improvements in COPM self-ratings exceeded minimal detectable change values; goal attainment levels indicated better-than-expected goal achievement. CONCLUSION: An intervention combining MSI and implementation intention training appears to be feasible. As an adjunct to MSI, implementation intentions may contribute to clients' ability to achieve their own occupational performance goals. Further study is needed.

Effectiveness of Interventions to Address Cognitive Impairments and Improve Occupational Performance After Traumatic Brain Injury: A Systematic Review.

OBJECTIVE: To determine the effectiveness of interventions addressing cognitive impairments to improve occupational performance for people with traumatic brain injury. METHOD: A total of 37 studies met inclusion criteria: 9 Level I systematic reviews, 14 Level I studies, 5 Level II studies, and 9 Level III studies. RESULTS: Strong evidence supports use of direct attention training, dual-task training, and strategy training to optimize executive functioning, encoding, and use of memory compensations, including assistive technology. However, in most studies, occupational performance was a secondary outcome, if it was evaluated at all. CONCLUSION: Although evidence supports many intervention approaches used by occupational therapy practitioners to address cognitive impairments of adults with traumatic brain injury, more studies are needed in which occupational performance is the primary outcome of cognitive intervention.

Feasibility of a Group-Based Purpose Renewal Intervention for Cancer Survivors Via Zoom.

The COVID-19 pandemic contributed to both existential distress and the rapid adoption of telehealth-based services. Little is known about the feasibility of delivering group occupational therapy intervention to address purpose-related existential distress via face-to-face synchronous videoconferencing. The objective of the study was to evaluate the feasibility of providing a purpose in life renewal intervention to breast cancer survivors via Zoom. Descriptive data were collected on acceptability and implementability of the intervention. Limited-efficacy testing involved a prospective pretest-posttest study where participants with breast cancer (n = 15) received an eight-session purpose renewal group intervention plus a Zoom tutorial. Participants completed standardized measures of meaning and purpose at pretest and posttest, and a forced-choice Purpose Status Question. The purpose renewal intervention was acceptable and implementable via Zoom. Pre-post changes in purpose in life were not statistically significant. Group-based purpose in life renewal intervention is acceptable and implementable when delivered via Zoom.

Can service members with mild traumatic brain injury learn to develop implementation intentions for self-identified goals?

PURPOSE: Goal achievement relies heavily on executive functions, which may be compromised following mild traumatic brain injury (mTBI). Implementation intentions (II) have been found to help people act in accordance with their goals. II are written statements that describe a behavior that a person plans to enact when they encounter some form of anticipated trigger or stimulus. We evaluated the feasibility of teaching participants with mTBI to develop II for self-identified goals within the context of cognitive rehabilitation. METHODS: Soldiers with mTBI were recruited from a traumatic brain injury clinic. During the intervention, participants were assigned to develop an II for one of three self-identified goals every day. Descriptive methods were used to examine implementability and acceptability of the II training protocol as well as the extent to which participants learned to develop II for their own goals. RESULTS: The II training protocol was found to be highly implementable and acceptable to participants. Overall, participants (n = 16) were able to develop II related to their self-identified goals, which primarily focused on managing cognitive problems. For the most part, participants developed II that involved event- rather than time- or somatic/feeling-based triggers. CONCLUSION AND IMPLICATIONS: Participants with mTBI were able to learn to develop II for their self-identified goals. Further study is needed to determine whether adding II to cognitive rehabilitation advances patient goal achievement.IMPLICATIONS FOR REHABILITATIONIt is feasible to incorporate training in implementation intentions (predetermined "if/when-then" plans that are intended to link specific situational triggers with actions) in metacognitive strategy instruction for patients with mild traumatic brain injury.Participants with mild traumatic brain injury in this study demonstrated that they were able to develop implementation intentions for multiple self-identified rehabilitation goals, which holds promise for also teaching patients with mild cognitive impairment from other conditions.Learning to develop implementation intentions may help patients with mild traumatic brain injury initiate a range of other cognitive strategies in their everyday lives.Implementation intentions have the potential to help patients enact goal behaviors associated with their rehabilitation goals, making cognitive rehabilitation more "customizable" and relevant to clients' specific needs.

Preliminary Efficacy of an Occupation-Oriented Purpose in Life Intervention After Breast Cancer.

Background. Purpose in life is important to health and well-being; purpose disruption often goes unidentified after breast cancer. Purpose. To evaluate the efficacy of a purpose renewal intervention and utility of a screening question for identifying people with purpose-related distress. Method. In this prospective pretest-posttest study, participants with breast cancer received an 8-session purpose renewal group intervention (n = 35). Participants completed standardized measures of meaning and purpose at pretest, posttest, and two-month follow-up and a forced-choice Purpose Status Question (PSQ) at pretest. Findings. Participants made statistically significant pretest-to-posttest and pretest-to-follow-up improvements. The PSQ demonstrated construct validity: 40% of participants lacked purpose direction at pretest and this subgroup made significantly greater improvements than participants who reported purpose direction at pretest. Implications. The PSQ warrants further study as a screener to identify people with purpose-related distress. Many breast cancer survivors may benefit from a purpose in life intervention; a subgroup may benefit more.

Cognitive Dysfunction: Feasibility of a Brief Intervention to Help Breast Cancer Survivors.

BACKGROUND: Many cancer survivors experience cancer-related cognitive dysfunction (CRCD), which is believed to be the result of multiple contributing biologic, situational, and personal factors. Efficacious, clinically implementable interventions addressing the multifactorial nature of CRCD are needed. OBJECTIVES: This study evaluated the feasibility of an intervention to help breast cancer survivors mitigate the effects of modifiable factors that contribute to CRCD and improve cognitive functioning. METHODS: A single-group pre-/post-test design was used. Treatment fidelity was tracked to evaluate implementability; attendance rates, experience surveys, and homework engagement were used to characterize acceptability. Pre- and post-test cognitive functioning, stress, fatigue, and mood were measured to evaluate preliminary efficacy. FINDINGS: The intervention was implementable and acceptable to participants. Participants made statistically significant improvements.