Occupational Therapy for Depression: Assessment, Goals and Activities
How OT helps depression: how symptoms affect daily life, assessment, sample goals, activity scheduling, CBT in action, groups and safety.
Occupational therapists work with people with depression in mental health settings. The OT tries their best to help the person overcome depressive feelings by providing positive situations and worthwhile pleasure. The occupational therapist involves the person in meaningful and pleasurable activities, which help them tackle the depression.
Depression is one of the most common mental health problems. It is a mood disorder. The World Health Organization estimates that about 322 million people worldwide live with depression, around 5% of adults, and it is more common in women than in men.
The most important features of depression are low mood and loss of interest. Depression affects our daily lives and occupational skills, and can range from mild to severe.
The depression–inactivity cycle
Depression and inactivity feed each other. This is exactly where occupational therapy steps in.
Low mood
Tired, sad, hopeless
Doing less
Staying in bed, cancelling plans
Fewer rewards
No pleasure or achievement
Guilt
"I'm useless"; problems pile up
OT breaks the cycle at 'doing less': small, planned, achievable activities bring back pleasure and achievement, which lift mood a little, which makes the next activity easier.
Clinical features of depression
Doctors diagnose depression (using criteria such as DSM-5 or ICD-11) when a person has several symptoms most of the day, nearly every day, for at least two weeks, and these include low mood or loss of interest.
1. Depressed mood and loss of interest
Loss of interest or pleasure in almost all activities. This sadness is different from the “normal” sadness of a bad day or grief. Loss of interest in daily activity leads to social withdrawal, reduced ability to function at work and in relationships, and less involvement in previously enjoyable activities.
2. Depressive ideas
Low mood is usually linked with pessimism, which may lead to ideas of hopelessness, helplessness and worthlessness. Ideas of worthlessness can lead to guilt. In severe cases, suicidal thoughts may be present.
Other features relevant to occupational therapy are:
- Difficulty thinking and concentrating
- Poor memory
- Indecisiveness
- Lack of initiative and energy
3. Psychomotor changes
Some people become slowed down, moving and speaking slowly. Others are agitated, with marked anxiety, restlessness (wringing hands, unable to sit still) and a feeling of unease.
4. Biological functions
Disturbance of biological functions is common:
- Insomnia, or sometimes sleeping more
- Loss of appetite and weight, or sometimes weight gain
- Loss of sexual drive
| Symptom | Effect on daily life | What the OT may do |
|---|---|---|
| Low energy | Can't get up, shower or cook | Break tasks into small steps; schedule the hardest task at the best time of day |
| Loss of interest | Hobbies and friends dropped | Use the Interest Checklist to find past enjoyable activities and reintroduce one at a time |
| Poor concentration | Can't read, work or follow a recipe | Short tasks, written steps, quiet environment |
| Indecisiveness | Stuck choosing what to wear or eat | Offer two choices, then build up to open choices |
| Worthlessness | Avoids tasks for fear of failing | Guarantee early success; recognise effort |
| Sleep problems | Day–night routine lost | Regular wake time, daytime activity and light, wind-down routine |
Occupational therapy assessment of depression
The occupational therapist assesses all areas of impairment through structured or unstructured interviews with the person and caregiver, focusing on areas related to OT intervention:
- Performance skills (cognitive, perceptual, psychological and social) and their impact on occupations
- Client factors and physical conditions or limitations that affect occupational performance
- The roles and behaviours expected of the person by society, or needed to reach their own goals
- Suicidal and aggressive behaviour
- History of behaviour patterns
- The person’s goals, values, interests and attitudes
- Activities of daily living
To assess these areas the OT uses interviews (the occupational profile), standardised tests, clinical observation, rating scales and questionnaires:
| Purpose | Examples |
|---|---|
| General mental status | Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA) |
| Cognition and mood | Allen Cognitive Level Screen; depression scales such as the Beck Depression Inventory, Geriatric Depression Scale and Hamilton Depression Rating Scale (often completed with the team) |
| Occupational performance and roles | Canadian Occupational Performance Measure (COPM), Occupational Circumstances Assessment Interview and Rating Scale (OCAIRS), Role Checklist, Interest Checklist |
Occupational therapy goals for depression
The occupational therapist sets short-term and long-term goals after assessing the person and identifying the areas to work on:
- Improve mood
- Involve the person in meaningful activity
- Improve activities of daily living
- Reduce depressive ideas by providing emotional support
- Reduce anxiety and restlessness linked with depression
- Improve physical strength and fitness
- Improve social interaction
Problem 1Neglected self-care
GoalWill complete a morning self-care routine independently on 5 of 7 days within 3 weeks.
- Showers and dresses by 10 a.m. using a checklist on the bathroom mirror
- Records each completed day on a chart
Problem 2Social withdrawal
GoalWill take part in one social activity each week within 6 weeks.
- Attends a weekly OT group and contributes one comment
- Phones or meets one friend each week
Problem 3Loss of productive role
GoalWill spend 2 hours a day on a productive activity within 8 weeks.
- Completes one household task daily
- Volunteers or does work tasks for 1 hour, three times a week
Occupational therapy intervention for depression
The occupational therapist understands the person’s psychology and tries to relieve stress and depressive feelings, aiming to meet their emotional needs.
Emotional needs
- To be loved, accepted and to belong
- Reassurance (without being over-solicitous)
- Approval as an individual
- A temporary dependency relationship
- Lessening of guilt
- Expressing hostility constructively, within social limits and without abnormal fear of retaliation
Approaching the person in the early phase
The therapist must learn the skill of working with someone who is depressed. The therapist’s voice and pace should match the person’s, and the therapist must be aware of the person’s perceptions, emotions and physical responses.
- Speak slowly and in a way the person can understand, allowing time to respond
- Limit what you say to the points the person needs to focus on
- Focus the person’s attention by using their name
- Move slowly
Meeting emotional needs in practice
The therapist expects only minimal verbal or physical responses at first, and doesn’t become discouraged by the person’s inactivity. They neither approve nor disapprove of the person’s behaviour.
The therapist accepts the person as they are. Frequent but short periods of attention show the therapist is there for them. Early activities are solitary, short, simplified and structured. The therapist recognises the person’s effort, and avoids pushing them to show pleasure.
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Therapist decides
Offer one activity: "Let's sand this board together." Request, don't force.
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Small choices
"Which of these two colours will you use?"
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Shared decisions
"Let's work this out together."
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Own choices
"Choose whatever you'd like to make."
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Own plans
The person plans their week and takes responsibility for it.
Meeting dependency needs: at first the therapist stays close to guide the person in new or unfamiliar short tasks, makes the decisions, avoids lengthy discussions and gives opportunities for small decisions. Decision making is increased as the person can comfortably tolerate decisions and take responsibility for them.
Expressing hostility constructively: the therapist offers an outlet for hostility within the person’s current tolerance, at first towards an object and non-verbally, such as kneading clay, hammering or sanding. Early activities are only mildly aggressive, because the person may fear their hostile impulses; the aggressive component is increased later.
The relationship should be accepting and reciprocal, so the person can express, and eventually accept, understand and respect their feelings: expressing dislike or disapproval within socially acceptable limits, and anger when the situation warrants it, without guilt afterwards.
Occupational therapy activities
The therapist provides opportunities for the constructive use of activity. Activities should be structured, organised, repetitive, precise and meaningful.
Promoting initiation and participation: together with the person, the therapist identifies the reasons for low participation, such as attention problems, embarrassment or the depression itself.
Motivational hints: people are more likely to take part in activities that address issues of interest or concern to them. The more ownership they have of the activity, the more they participate. Success, fun, positive feedback and rewards are motivating.
Activity scheduling
Activity scheduling, part of behavioural activation, is one of the best-supported strategies for depression, and fits naturally with occupational therapy.
| Time | Activity | Type | Mood before → after (0–10) |
|---|---|---|---|
| 9:00 | Shower and dress | Achievement | 3 → 4 |
| 11:00 | 10-minute walk to the shop | Achievement and pleasure | 3 → 5 |
| 15:00 | Listen to three favourite songs | Pleasure | 4 → 5 |
| 18:00 | Cook a simple dinner | Achievement | 4 → 5 |
Start with a few small activities, not a full day. The ratings show the person, in their own words and numbers, that doing something helps.
Group therapy
A depressed person often avoids social interaction and may be reluctant to meet others because of depressive ideas. Group therapy is very helpful. One-to-one sessions come first, followed by group sessions. Groups can motivate people to discuss topics or start activities. Low competition in the group helps members succeed and feel worthwhile.
Cognitive behavioural therapy (CBT) in activity
CBT is a popular, evidence-based psychotherapeutic approach that changes the way people think and behave. It looks at thoughts, feelings and behaviour, breaks problems into smaller parts and builds on positive feedback. Occupational therapists often combine CBT strategies with purposeful activities related to the person’s occupations. Using real activity during CBT gives it a true occupational therapy flavour.
Example: a man thinks, “I can’t cook anymore; I’ll mess it up.” The OT and he plan a simple omelette, he cooks it, and then they compare what happened with what he predicted.
The occupational therapist also tries to identify the factors contributing to the depression. It becomes much easier to address the situation once the therapist understands them.
Improving self-esteem
A person with depression usually lacks self-esteem and a sense of their own value. The occupational therapist helps them regain self-esteem, values and life roles. Creative, functional, occupational and pleasurable activities are planned to boost self-esteem and a sense of importance.
Summary
Depression takes away the interest and energy people need for their daily lives, and inactivity then deepens the depression. Occupational therapy breaks this cycle with carefully graded, meaningful activity, activity scheduling, CBT strategies in action, groups and support to rebuild roles, always as part of a team and with safety in mind. Read more:
- Occupational therapy in mental health
- Occupational therapy for schizophrenia
- Occupational therapy for anxiety disorders
- Model of Human Occupation (MOHO)
Theory behind this: the OT approaches in this guide draw on cognitive-behavioural, MOHO and the Kawa model.
References
- World Health Organization. Depressive disorder (depression): fact sheet. 2026.
- Ahuja N. A Short Textbook of Psychiatry. Jaypee.
- Sadock BJ, Sadock VA, Ruiz P. Kaplan and Sadock’s Synopsis of Psychiatry. Wolters Kluwer.
- Creek J, Lougher L, eds. Occupational Therapy and Mental Health. Elsevier.
- American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed., text revision (DSM-5-TR). 2022.
Frequently asked questions
How does occupational therapy help with depression?
What activities do occupational therapists use for depression?
What is activity scheduling?
What assessments do OTs use for depression?
Can occupational therapy replace medication or psychotherapy for depression?
Written by
Payal Mehta, OT
Payal Mehta is a practising occupational therapist and co-founder of Occupational Therapy OT. She writes on pediatrics, sensory integration, and mental-health practice.
All articles by Payal →This article is for general education and is not a substitute for individualized assessment or treatment by a licensed occupational therapist. Always seek the guidance of a qualified professional for specific concerns.
