Designing Daily Life: Occupational Therapy Program Shows Promise Against Stress

Stress has quietly become one of the most pervasive health problems of modern working life. Across Europe, an estimated 28 percent of the workforce experiences work-related stress, making it the second most common work-related health problem on the continent. In Denmark alone, the National Research Centre for Working Environment calculates that stress costs workplaces at least 16.4 billion Danish kroner every year, and the proportion of Danes reporting high stress scores rose by 8.5 percent between 2010 and 2021. Against this backdrop, a new pilot study published in the Scandinavian Journal of Occupational Therapy offers a fresh and surprisingly practical answer: instead of treating stress primarily as a problem of the mind, it treats it as a problem of how we design our daily lives.

The intervention, called Livsdesigneren, or The Life Designer, was developed by occupational therapist Dan Ravn of Copenhagen University College, working with Anette Enemark Larsen. Its premise is rooted in occupational science, which holds that health and well-being emerge from what people do every day. Rather than focusing on a single psychological technique, the program asks participants to identify, prioritize, and plan their occupations, meaning their daily activities, across monthly, weekly, and daily horizons. The goal is a balanced and sustainable everyday life, built through structured problem-solving and reflection on the activities that fill it.

The program’s architecture is distinctive. It organizes life into twelve distinct domains and thirty-six occupational focuses, with a symbolic black hole at the center representing time that is neither planned nor intentionally used. Participants move through an initial semi-structured interview and coaching session, followed by four facilitated sessions called sprints, each lasting between one and four weeks depending on the participant’s preference. In each sprint meeting, the participant and therapist evaluate the previous period’s activities, analyze the most and least beneficial occupations, examine any activity that was unintentionally omitted, and then plan the next sprint. A physical workbook structures the process, and an online catalogue of 377 occupation ideas provides inspiration.

To test the program, the researchers recruited sixteen participants in two groups. The Working Group consisted of nine people connected to the labor market for whom stress was the primary condition, recruited through LinkedIn. The Non-Working Group comprised seven individuals with limited resources and no labor market connection, for whom stress was secondary to physical or mental illnesses including anxiety, PTSD, autism, ADHD, and schizophrenia. All participants scored above 17 on Cohen’s 10-item Perceived Stress Scale, the Danish threshold at which stress becomes clinically concerning. The study used a mixed-methods design with convergent parallel data collection, measuring stress and well-being at baseline, immediately after the intervention, and again after a four-week washout period.

The quantitative results were striking, particularly for working participants. The Working Group’s mean PSS-10 score fell from 27.1 at baseline, where seven of nine participants scored above the treatment threshold of 25, to 15.1 after the intervention, a mean reduction of 45 percent. After the washout period the score remained at 15.3, showing the gains held. Seven of the nine working participants achieved stress reductions exceeding the minimal clinically important change of 28 percent. Well-being improved in parallel: the group’s mean WHO-5 score rose from 36.9, well below the risk threshold of 50, to 56.4 after the intervention and 61.1 at follow-up, a 39 percent increase. All nine participants improved their stress scores from baseline to follow-up.

The Non-Working Group showed more modest and variable results. Their mean PSS-10 score dropped from 25.7 to 18 after the intervention and 17 at follow-up, a reduction of roughly 28 percent that only four of seven participants individually exceeded. Yet their well-being gains were substantial, with WHO-5 scores rising 28 percent on average, from 35.4 to 53.1. The researchers suggest this pattern reflects the nature of the group’s stressors, which stem from illness, unemployment, financial insecurity, and low predictability in daily life, factors that a planning-focused program alone cannot resolve. Nevertheless, across both groups combined, fourteen of the sixteen participants improved on both stress and well-being measures.

The qualitative interviews, conducted by independent consultants to avoid bias, revealed five themes: planning and overview, new insight, empowerment, facilitation and the therapeutic alliance, and regaining meaningful occupations. Participants described their previous schedules as overly ambitious and packed, and planning became what one called a solid platform to stand on, removing the chaotic approach to daily life. Many realized they had gradually and unconsciously abandoned small but meaningful activities that had once anchored their well-being, and the program helped them reintegrate those occupations. Others emphasized the shift from purely cognitive approaches to a practical, activity-based framework, noting that it is entirely possible to maintain an unhealthy work-life balance while practicing mindfulness or meditation.

A Content Validity Index questionnaire added a quantitative layer to these experiences. Six of the twelve program elements achieved I-CVI scores above the 0.78 threshold for sufficient agreement across both groups, including the twelve life domains framework, brainstorming occupation ideas, weekly planning, and activity analysis of the most and least beneficial occupations, the latter receiving a perfect score of 1.0 from both groups. Two elements fell short in both groups: daily planning, which participants may have found overwhelming and rigid, and an acceptance exercise before planning, which may have been redundant given the facilitated reflections. These components are candidates for removal or redesign in future iterations.

The authors are careful about the study’s limits. It was a pilot with a small, non-randomized convenience sample, skewed toward women, with no control group, and the program developer also administered the intervention, a potential source of interpretive bias that the team mitigated through external interviewers and independent coding. Some participants misunderstood the flexible sprint durations, and two working participants had untreated clinical depression, which the program was not designed to address. The authors recommend excluding clinical depression in future trials and suggest that the Non-Working Group may need extended or more intensive support to sustain its gains.

Even with these caveats, the findings point toward a meaningful shift in how stress might be managed clinically. Rather than asking people to think differently about their stress, Livsdesigneren asks them to act differently within their days, using the core occupational therapy competencies of activity analysis, environmental adjustment, and structured prioritization. For occupational therapists working in mental health, vocational rehabilitation, or primary care, the program offers a concrete, person-centered template. The researchers now call for a randomized controlled trial to confirm effectiveness and to test whether the benefits endure. If validated, the idea that redesigning ordinary daily occupations can measurably reduce stress could reshape how clinicians approach one of the defining health burdens of the modern workplace.

Subject of Research: Evaluation of an occupational therapy intervention using daily occupation planning to reduce stress and improve well-being

Article Title: Evaluating ‘livsdesigneren’: An occupational therapy intervention for stress reduction

Article References: Ravn, D., & Larsen, A. E. (2025). Evaluating ‘livsdesigneren’: An occupational therapy intervention for stress reduction. Scandinavian Journal of Occupational Therapy, 32(1), Article 2570539. https://doi.org/10.1080/11038128.2025.2570539

Image Credits: AI Generated

DOI: 10.1080/11038128.2025.2570539

Keywords: occupational therapy, stress reduction, well-being, daily occupations, Livsdesigneren, pilot study, PSS-10, WHO-5, mental health, workplace stress, Denmark, mixed methods