Effect of Combining the Canadian Occupational Performance Measure with Cognitive Behavioral Therapy to Enable Occupation in a Client with Depression: A Case Study in Home-Visiting Support

Abstract

It is important to focus on an individual's occupation and to select appropriate interventions for enabling occupation in a client with depression. The Canadian Occupational Performance Measure (COPM) is an useful method for focusing on the occupation of a client [1]. Schindler [2] showed that an occupation-based practice increased client scores on satisfaction and performance of occupational performance problems identified on the COPM in psychiatric disorders. Cognitive behavioral therapy (CBT) is one effective intervention for depression [3, 4]. When appropriately self-assessing themselves, clients with depression tend to have difficulty in recognizing positive results. Although the self-assessment of positive changes in daily activity by using the COPM might promote the effect of CBT, few studies in depression show the effect of combining the COPM with CBT. The purpose of this study was to outline the therapy process conducted by combining the COPM with CBT for enabling occupation of a client with depression. Signed informed consent for this study was obtained from the client. Abstract: Introduction: Few reports describe interventions combining the Canadian Occupational Performance Measure (COPM) with cognitive behavioral therapy (CBT) although both are important in enabling occupation for a client with depression. We outline the therapy process conducted by an occupational therapist combining the COPM with CBT to enable occupation for a client with depression. Methods: A single-system research design was implemented. The intervention was based on behavioral activation, and the cognitive restructuring was divided into three phases: baseline (Phase I), intervention 1 (Phase II), and intervention 2 (Phase III). Baseline consisted of behavioral activation only. In intervention 1, the COPM was used in addition to the baseline action. In intervention 2, cognitive restructuring was conducted in addition to intervention 1. Results: There was no significant difference in the client's frequency per week of going out in Phase II compared with Phase I (p = 0.062), but the rate increased significantly in Phase III compared with Phase II by binomial test (p = 0.002). As assessed by the COPM, the performance and satisfaction scores for going out were 4 and 3 at the 5th week, but they improved to 7 and 6 at the 17th week. Conclusion: Combining the COPM with CBT significantly increased the frequency of going out that a client with depression hoped to attain. The present intervention might facilitate enabling occupation for clients with depression. Our findings suggested that in clients with depressive symptoms, enabling occupation is possible by combining the COPM with CBT.