The Tree Theme Method® (TTM), an occupational therapy intervention for treating depression and anxiety: study protocol of a randomized controlled trial

A Birgitta Gunnarsson, Petra Wagman, Carita Håkansson, Katarina Hedin, A Birgitta Gunnarsson, Petra Wagman, Carita Håkansson, Katarina Hedin

Abstract

Background: Depression and anxiety disorders are increasing among the general population in the Western world. Individuals may need several kinds of treatment in order to maintain health, such as cognitive behavioural therapy (CBT) and drug treatment. However, having an everyday life that "works" is also important, suggesting a need for interventions based on activities that facilitate a satisfying everyday life. There is still lack of such evidence-based interventions. The Tree Theme Method(®) (TTM) is an occupational therapy intervention designed for a client-centred context in which an individual develops strategies to become an actor in his or her everyday life. Previous studies of the TTM have focused on process evaluation; therefore, further studies are needed to evaluate the method's effects. The aim of this paper is to outline an intervention that can evaluate the effects of the TTM in terms of psychological symptoms, as well as everyday occupations and well-being, in patients suffering from depression and anxiety.

Methods/design: This randomized clinical trial includes patients from three Swedish counties randomized to either intervention or treatment as usual. Men and women aged 18-65 years who have been diagnosed with either depression or anxiety are eligible for inclusion. Data collection is carried out at baseline, and outcomes are assessed at the end of intervention, as well as at 3 months and 12 months after intervention ends. The outcomes measured are psychological symptoms, everyday activities, and health-related factors.

Discussion: Depression and anxiety may create difficulties for individuals in the activities of their everyday lives to the extent that they require diagnosis and intervention. Despite this reality, evidence-based interventions that focus on everyday activities are lacking. Therefore, it would be useful to design a specific method for occupational therapy intervention that does precisely that. This study provides insight into the effects of the TTM, comparing it to occupational therapy treatment as usual.

Trial registration: ClinicalTrials.gov: NCT01980381; registered November 2013.

Figures

Fig. 1
Fig. 1
Overview of study procedure

References

    1. Swedish National Board of Health and Welfare [Socialstyrelsen] Nationella riktlinjer för vård vid depression och ångest [The national guidelines for care in cases of depression and anxiety disorders] Stockholm: Socialstyrelsen; 2010.
    1. Nagle S, Valiant Cook J, Polatajko HJ. I’m doing as much as I can: occupational choices of persons with a severe and persistent mental illness. Journal of Occupational Science. 2002;9:72–81. doi: 10.1080/14427591.2002.9686495.
    1. Wieclaw J, Agerbo E, Mortensen PB, Bonde JP. Occupational risk of affective and stress-related disorders in the Danish workforce. Scandinavian Journal of Work, Environment and Health. 2005;31(5):343–351. doi: 10.5271/sjweh.917.
    1. Swedish Social Insurance Agency [Försäkringskassan] Vad kostar olika sjukdomar i sjukförsäkringen? [What are the costs for different diseases in Swedish sickness insurance?] Socialförsäkringsrapport [Social Insurance Report] (Vol. 2011) Stockholm: Försäkringskassan; 2011.
    1. Gunnarsson AB, Jansson JÅ, Eklund M. The tree theme method in psychosocial occupational therapy - a case study. Scandinavian Journal of Occupational Therapy. 2006;13(4):229–240. doi: 10.1080/11038120600772908.
    1. Haglund, L, Lundgren Pierre, B. (2009). Arbetsterapi för personer med depressionssjukdom och/eller ångestsyndrom [Occupational therapy for people in cases of depression and/or anxiety disorders.] Tidskriften Arbetsterapeuten (8).
    1. Perruzza N, Kinsella EA. Creative arts occupations in therapeutic practice: a review of the literature. British Journal of Occcupational Therapy. 2010;73(6):261–268. doi: 10.4276/030802210X12759925468943.
    1. Clark F. Occupation embedded in a real life: interweaving occupational science and occupational therapy. American Journal of Occupational Therapy. 1993;47:1067–1078. doi: 10.5014/ajot.47.12.1067.
    1. Clark F, Larsson EA, Richardson PR. A grounded theory of techniques for occupational storytelling and occupational story making. In: Zemke R, Clark F, editors. Occupational science. The evolving discipline. Philadelphia, PA: F.A Davis Company; 1996. pp. 373–392.
    1. Townsend EA, Polatajko HJ. Enabling occupation II: advancing an occupational therapy vision for health, well-being, & justice through occupation. Ottawa, Ontario: CAOT Publications ACE; 2007.
    1. Gunnarsson AB, Eklund M. The Tree Theme Method as an intervention in psychosocial occupational therapy: client acceptability and outcomes. Australian Occupational Therapy Journal. 2009;56:167–176. doi: 10.1111/j.1440-1630.2008.00738.x.
    1. Gunnarsson AB, Jansson JÅ, Petersson K, Eklund M. Occupational therapists’ perception of the Tree Theme Method™ as an intervention in psychosocial occupational therapy. Occupational Therapy in Mental Health. 2011;27(1):36–49. doi: 10.1080/0164212X.2011.543630.
    1. Gunnarsson AB, Peterson K, Leufstadius C, Jansson JÅ, Eklund M. Client perceptions of the Tree Theme Method™: a structured intervention based on storytelling and creative activities. Scandinavian Journal of Occupational Therapy. 2010;17(3):200–208. doi: 10.3109/11038120903045366.
    1. Gunnarsson AB, Björklund A. Sustainable enhancement in clients who perceive the Tree Theme Method as a positive intervention in psychosocial occupational therapy. Australian Occupational Therapy Journal. 2013;60(3):154–160. doi: 10.1111/1440-1630.12034.
    1. Kazdin AE. Research design in clinical psychology. 4. Boston: Allyn & Bacon; 2003.
    1. Boutron I, Ravaud P, Moher D, Altman DG, Schulz KF. Methods and processes of the CONSORT group: example of an extension for trials assessing nonpharmacologic treatments. Annals of Internal Medicine. 2008;148(4):W-60–W-66.
    1. Derogatis LR. SCL-90-R, Administration, scoring & procedures. Manual II. 2. Towson, MD: Clinical Psychometric Research Inc.; 1992.
    1. Fridell M, Cesarec Z, Johansson M, Thorsen Malling S. Svensk normering, standardisering och validering av symtomskalan SCL-90. [A Swedish standardisation and validity check of the symptom scale SCL-90]. Report nr 4/2002. Västervik: Statens Institutionsstyrelse SiS; 2002.
    1. Montgomery SA, Åsberg M. A new depression scale designed to be sensitive to change. British Journal of Psychiatry. 1979;134(4):382–389. doi: 10.1192/bjp.134.4.382.
    1. Hollañdare F, Andersson G, Engström I. A comparison of psychometric properties between internet and paper versions of two depression instruments (BDI-II and MADRS-S) administered to clinic patients. Journal of Medical Internet Research. 2010;12(5):7. doi: 10.2196/jmir.1392.
    1. Kjærgaard M, Arfwedson Wang CE, Waterloo K, Jorde R. A study of the psychometric properties of the Beck Depression Inventory‐II, the Montgomery and Ásberg depression rating scale, and the hospital anxiety and depression scale in a sample from a healthy population. Scandinavian Journal of Psychology. 2014;55(1):83–89. doi: 10.1111/sjop.12090.
    1. Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatrica Scandinavica. 1983;67(6):361–370. doi: 10.1111/j.1600-0447.1983.tb09716.x.
    1. Lisspers J, Nygren A, Söderman E. Hospital Anxiety and Depression Scale (HAD): some psychometric data for a Swedish sample. Acta Psychiatrica Scandinavica. 1997;96(4):281–286. doi: 10.1111/j.1600-0447.1997.tb10164.x.
    1. Law M, Baptiste S, Carswell A, McColl MA, Polatajko H, Pollock N. Canadian occupational performance measure. 2. Ottawa, ON: CAOT Publications ACE; 1998.
    1. Wressle E, Samuelsson K, Henriksson C. Responsiveness of the Swedish version of the Canadian Occupational Performance Measure. Scandinavian Journal of Occupational Therapy. 1999;6(2):84–89. doi: 10.1080/110381299443771.
    1. Wressle E, Marcusson J, Henriksson C. Clinical utility of the Canadian Occupational Performance Measure – Swedish version. Canadian Journal of Occupational Therapy. 2002;69(2):40–48. doi: 10.1177/000841740206900104.
    1. Eklund M. Satisfaction with daily occupations: a tool for client evaluation in mental health care. Scandinavian Journal of Occupational Therapy. 2004;11(3):136–142. doi: 10.1080/11038120410020700.
    1. Eklund M, Gunnarsson AB. Satisfaction with daily occupations: construct validity and test-retest reliability of a screening tool for people with mental disorders. Australian Occupational Therapy Journal. 2007;54(1):59–65.
    1. Eklund M, Gunnarsson B, Sandlund M, Leufstadius C. Effectiveness of an intervention to improve day centre services for people with psychiatric disabilities. Australian Occupational Therapy Journal. 2014;61(4):268–75. doi:10.1111/1440-1630.12120.
    1. Wagman P, Håkansson C. Introducing the Occupational Balance Questionnaire (OBQ) Scandinavian Journal of Occupational Therapy. 2014;21(3):227–231. doi: 10.3109/11038128.2014.900571.
    1. Antonovsky A. Unraveling the mystery of health: how people manage stress and stay well. San Francisco, CA: Jossey-Bass; 1987.
    1. Eriksson M, Lindström B. Validity of Antonovsky’s sense of coherence scale: a systematic review. Journal of Epidemiology and Community Health. 2005;59:460–469. doi: 10.1136/jech.2003.018085.
    1. Pearlin LI, Menaghan EG, Lieberman MA, Mullan JT. The stress process. Journal of Health and Social Behavior. 1981;22:337–356. doi: 10.2307/2136676.
    1. Marshall GN, Lang EL. Optimism, self-mastery, and symptoms of depression in women professionals. Journal of Personality and Social Psychology. 1990;59(1):132–139. doi: 10.1037/0022-3514.59.1.132.
    1. Priebe S, Huxley P, Knight S, Evans S. Application and results of the Manchester Short Assessment of Quality of Life (MANSA) International Journal of Social Psychiatry. 1999;45:7–12. doi: 10.1177/002076409904500102.
    1. Björkman T, Svensson B. Quality of life in people with severe mental illness. Reliability and validity of the Manchester Short Assessment of Quality of Life (MANSA) Nordic Journal of Psychiatry. 2005;59(4):302–306. doi: 10.1080/08039480500213733.
    1. Luborsky L, Barber JP, Siqueland L, Johnson S, Najavits LM, Frank A, et al. The revised Helping alliance questionnaire (Haq-II). Psychometric properties. Journal of Psychotherapy Practice and Research. 1996;5:260–71.
    1. Swedish Social Insurance Agency [Försäkringskassan] Vad kostar olika sjukdomar i sjukförsäkringen? [What are the costs for different diseases in Swedish sickness insurance?] Socialförsäkringsrapport [Social Insurance Report] (Vol. 2011) Stockholm: Försäkringskassan; 2011.
    1. Larsen DL, Attkisson CC, Hargreaves WA, Nguyen TD. Assessment of client/patient satisfaction: development of a general scale. Evaluation and Program Planning. 1979;2:197–207. doi: 10.1016/0149-7189(79)90094-6.
    1. Eklund M, Erlandsson LK. Quality of life and client satisfaction as outcomes of the Redesigning Daily Occupations (ReDO) programme for women with stress-related disorders: a comparative study. Work (Reading, Mass.) 2013;46(1):51–58.
    1. Nguyen TD, Attkisson CC, Stegner BL. Assessment of patient satisfaction: development and refinement of a service evaluation questionnaire. Evaluation Program Planning. 1983;6:299–314. doi: 10.1016/0149-7189(83)90010-1.
    1. de Wilde EF, Hendriks VM. The client satisfaction questionnaire: psychometric properties in a Dutch addict population. European Addiction Research. 2005;11:157–162. doi: 10.1159/000086396.
    1. World Medical Association. World medical association declaration of Helsinki: ethical principles for medicial research involving human subjects 1964. [cited 2014 Sept 16] Available from: .
    1. Zaitsoff S, Pullmer R, Cyr M, Aime H. The role of the therapeutic alliance in eating disorder treatment outcomes: a systematic review. Eating Disorders. 2015;23(2):99–114. doi: 10.1080/10640266.2014.964623.
    1. Barnicot K, Katsakou C, Bhatti N, Savill M, Fearns N, Priebe S. Factors predicting the outcome of psychotherapy for borderline personality disorder: a systematic review. Clinical Psychology Review. 2012;32:400–412. doi: 10.1016/j.cpr.2012.04.004.
    1. Schnur JB, Montgomery GH. A systematic review of therapeutic alliance, group cohesion, empathy, and goal consensus/collaboration in psychotherapeutic interventions in cancer: Uncommon factors? Clinical Psychology Review. 2010;30:238–247. doi: 10.1016/j.cpr.2009.11.005.

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