Occupational Therapy for PTSD: Assessment, Goals and Activities
How OT helps PTSD: symptoms and daily life, trauma-informed assessment, goals, grounding and relaxation, routines and activities for all ages.
The occupational therapist provides treatment to people with PTSD (post-traumatic stress disorder). The treatment approach is similar in many ways to anxiety, stress-related disorders and depression. The occupational therapist understands the person’s psychology and treats them accordingly. A person with PTSD remains under stress because of a past traumatic event. The occupational therapist helps them calm down and refocus on daily life skills and occupational performance.
What is post-traumatic stress disorder (PTSD)?
PTSD arises as a delayed or prolonged response to an exceptionally stressful or threatening event or situation. It can happen to anyone who has experienced or witnessed severe trauma, such as a disaster, war, a car accident, sexual assault, violence or torture. About 6 in every 100 people will have PTSD at some point in their lives (US National Center for PTSD).
Symptoms usually begin within a few months of the event, but can be delayed for much longer. For a diagnosis, they last more than a month and cause significant distress or difficulty in daily life.
| Symptom group | What it looks like | Effect on occupation |
|---|---|---|
| Re-experiencing | Recurrent, intrusive memories, flashbacks (images, thoughts) and nightmares; a sense of reliving the event | Concentration breaks down at work; fear of sleep |
| Avoidance | Marked avoidance of reminders, places, people or conversations | Stops driving, avoids crowds, shopping or the workplace |
| Negative changes in mood and thinking | Emotional numbness, anhedonia (inability to feel pleasure), guilt, shame, detachment | Drops hobbies and friendships; loses valued roles |
| Hyperarousal | Anxiety, feeling on guard, easily startled, irritability, poor sleep | Exhaustion, conflict at home, difficulty with noisy environments |
Occupational therapy assessment in PTSD
The occupational therapist assesses all the areas affected by a stress-related disorder, following the basic principles of assessment, and without asking the person to retell the trauma in detail unless they choose to.
An interview with the person, and with a family member if the person agrees, gives the main details: the history of the trauma, the person’s behaviour, social interaction, occupational performance, level of anxiety or depression, self-care and sleep.
The Model of Human Occupation (MOHO) may be used to assess and plan treatment: volition, habituation, role performance and environment are evaluated. The psychodynamic frame of reference can also be helpful; ego boundaries, defensive functions and reality testing can be explored through projective techniques, with care not to overwhelm the person.
Other useful tools include the Canadian Occupational Performance Measure (COPM), a sleep and activity diary, a sensory profile to understand sensory triggers, and the PTSD Checklist (PCL-5), often used by the team.
Occupational therapy goals and objectives in PTSD
The occupational therapist sets goals and objectives after evaluation. Goals depend on the severity of the illness. Long-term goals may include:
- Relief from stress
- Coming to terms with loss
- Improved occupational performance
- Improved social interaction
- Improved ADL skills
- Better sleep and daily routine
Short-term goals are very simple and easily achievable.
Problem 1Panic and flashbacks when going out
GoalWill use a grounding strategy to stay in a shop for 15 minutes within 4 weeks.
- Practises 5-4-3-2-1 grounding daily
- Completes the first three steps of a graded outing plan
Problem 2Not driving since a car accident
GoalWill drive a familiar local route alone within 12 weeks.
- Sits in the parked car for 10 minutes with anxiety below 4/10
- Drives a short quiet route with a support person
Occupational therapy management in PTSD
Occupational therapy management begins with understanding the stressful event, the person’s actual losses and the real sources of stress. Management is somewhat similar to depression and anxiety. Rapport building is the most crucial step in treating people with post-traumatic stress disorder.
Trauma-informed care
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Safety
Physical and emotional safety in every session.
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Trust
Clear, honest explanations; no surprises.
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Collaboration
Working with the person, not doing to them.
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Choice
The person chooses pace, activities and what to share.
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Empowerment
Building on strengths and the person's own voice.
These are adapted from SAMHSA’s six principles of a trauma-informed approach, which also include peer support and sensitivity to culture, history and gender.
An occupational therapist may use different frames of reference and approaches to manage PTSD:
Therapeutic use of self
“The use of oneself in such a way that one becomes an effective tool in the evaluation and intervention process.” (Mosey, 1986)
Therapeutic use of self is very useful in PTSD. It involves planned interaction with another person to relieve fear, stress or anxiety. The process includes many steps: providing reassurance, obtaining necessary information, giving information, giving advice, and helping the person gain more appreciation, expression and functional use of their own inner resources.
Projective techniques
The therapist can also use projective techniques. They give the person an opportunity to express their stress on paper or through colours, and can be used as an activity. The person decides what to express; the aim is safe expression, not forcing them to revisit the trauma.
Relaxation and grounding techniques
Relaxation techniques help lessen stress. Yoga, meditation, Jacobson’s progressive relaxation and breathing exercises are commonly used by occupational therapists. The person can learn these techniques and use them whenever they feel stressed.
Grounding helps during flashbacks or overwhelming memories by bringing attention back to the present: naming things you can see, hear and touch, holding something cold or textured, or pressing the feet firmly into the floor.
Thinking ↑
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Planning and problem solving
Once calm: plan the next step, review what helped.
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Orienting statements
"I'm in my kitchen. It's 2026. I'm safe now."
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Grounding through the senses
5-4-3-2-1, a cold drink, a textured object.
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Slow breathing and heavy work
Long out-breaths, wall push-ups, carrying something heavy.
Body
When the body is highly aroused, start at the bottom: thinking strategies work better once the body has settled.
Reality orientation and acceptance
Orientation to the present and acceptance of what has happened are very important. Sometimes the loss can’t be recovered, such as the death of a spouse in a car accident, but acceptance, with support for grief, is necessary to refocus on meaningful life roles.
Sleep and daily routine
Nightmares and hyperarousal often disrupt sleep. The OT helps build a predictable daily routine with regular wake and bed times, daytime activity, a calm wind-down routine and a safe, comfortable sleep environment.
Graded return to avoided activities
Avoidance keeps PTSD going and shrinks a person’s life. Together with the treating team, the OT helps the person return step by step to avoided activities, such as shopping, travelling or driving, using the same graded approach as in anxiety.
Therapeutic activities
Therapeutic activities are the mainstream of occupational therapy. PTSD can affect children as well as adults. Play is the best medium for children with PTSD, while meaningful, purposeful work and leisure activities are more beneficial for adults.
| For children | For adults |
|---|---|
| Outdoor play: football, ball catching and throwing, treasure hunts, slides, swings | Gardening and planting |
| Indoor play: painting, drawing, musical chairs, obstacle courses, hide and seek | Homemaking and cooking |
| Sensory play and calming activities, within a predictable routine | Dancing, swimming, gym, yoga and walking |
| Story and puppet play, if the child leads it | Listening to favourite music, art and crafts, volunteering |
These activities are general in nature, but they are effective when the person uses them to shift their mind away from stress and reconnect with enjoyment and achievement.
Meeting emotional needs
People with PTSD often seek love and a feeling of acceptance from others. The occupational therapist guides caregivers and family members to understand the condition and provide support when it’s needed most. The OT also provides occupational activities through which the person can feel self-worth and, most importantly, accept themselves as an important individual.
Managing anger and tension
The occupational therapist may suggest activities when hostility or irritability is present. Because of stress, a person may suffer inside and keep their pain to themselves, which can lead to sudden outbursts. At first, non-aggressive activities are given. When the person can tolerate more, the therapist can introduce more physical activities such as hammering, woodwork or vigorous exercise, so tension is released through safe physical work while the person learns to notice and calm their anger.
Summary
Occupational therapy has an important role in post-traumatic stress disorder. The occupational therapist helps the person relieve stress and return to their work and daily routine. Trauma-informed care, grounding and relaxation, routines, graded return to avoided activities and purposeful activities help the person get back to a full life. Read more:
- Occupational therapy in mental health
- Occupational therapy for anxiety disorders
- Occupational therapy for depression
References
- US Department of Veterans Affairs, National Center for PTSD. How common is PTSD in adults?
- Scaffa ME, et al. The role of occupational therapy in disaster preparedness, response, and recovery. American Journal of Occupational Therapy. 2006;60(6):642.
- Clarke C. Treating post-traumatic stress disorder: occupational therapist or counsellor? British Journal of Occupational Therapy. 1999;62(3):136–138.
- Mosey AC. Psychosocial Components of Occupational Therapy. Raven Press; 1986.
- Substance Abuse and Mental Health Services Administration. SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed Approach. 2014.
Frequently asked questions
How does occupational therapy help with PTSD?
What are the symptoms of PTSD?
What is trauma-informed occupational therapy?
What activities help adults with PTSD?
What activities help children with PTSD?
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.
