Stress-related illnesses are rising across society, and in Sweden they are treated mainly within primary health care. These conditions take a heavy toll: people living with them commonly describe mental and physical problems that disrupt everyday life, and the costs of work-related stress extend to society as a whole. While primary care already offers interventions aimed at reducing symptoms, including occupational therapist-led groups focused on lifestyle change and arts-on-referral programs that engage patients in singing, acting, or crafting, researchers argue that more health-promoting treatment options are still needed. BeWell™ was developed to fill that gap as an individual, person-centred alternative that deliberately shifts attention away from symptoms and problems and toward what helps each person feel well.

The mechanics of the treatment are deceptively simple but carefully structured. BeWell™ consists of twelve individual sessions divided into three phases. Before each of the first four sessions, participants photograph whatever they associate with their well-being, then meet an occupational therapist in person to discuss what the images show about what sustains them and how those sources of well-being might be strengthened or transferred to other settings, such as the workplace. The next six sessions are shorter and virtual, conducted by computer or phone, with patients continuing to photograph and send images that the therapist acknowledges and uses to support their progress. The final two sessions return to in-person meetings, where all the photographs are gathered—spread on a table or hung on a wall—as a visual foundation for reflecting on the patient’s life situation and formulating goals for the future.

To capture how patients experienced this process, the researchers interviewed 35 people aged 29 to 62, most of them women, who had been diagnosed with stress-related conditions corresponding to the ICD-10 diagnoses F43.8 (exhaustion syndrome) and F43.9 (reaction to severe stress). The participants were recruited through six primary care centres in two regions of southern Sweden, all similar in treatment methods, socio-economic conditions, and population served. Interviews, conducted in person or digitally between 2020 and 2023 and lasting between 15 and 59 minutes, took place directly after participants completed the treatment. The researchers analyzed the transcripts using qualitative content analysis, moving from meaning units to codes, subcategories, and finally categories, and reported the study according to the COREQ checklist for qualitative research.

The analysis yielded three categories describing the patient experience. The first, ‘the combination of the core parts gives strength,’ captures how taking photographs, the images themselves, conversations, and reflections worked together to produce benefits greater than any single component. Participants described how the act of photographing forced them to think about what their images symbolized—one participant noted that photography became different from casual social media snapping because they now had to consider what each picture represented. The photographs served as documentation and, as several participants explained, a stronger motivator to actually do the things that brought them well-being and keep doing them. When all the images were finally viewed together, patterns emerged: many photographs depicted home, friends and family, nature, or creative occupations, and some participants could trace a visible progression from the first picture to the last, such as moving from having no personal recovery time to carving it out.

The interplay between photographs and conversation proved central. Participants said that talking with the occupational therapist revealed more about their well-being than the images alone could, with the photographs acting as a starting point, a tool for maintaining focus during sessions, and even a source of calm by giving the gaze somewhere to rest. The conversations were described as rewarding and focused on the positive aspects of everyday life, offering new perspectives on what stimulated well-being. Alongside the sessions, participants reflected continuously on their well-being after the very first meeting, sometimes with agreed reflection tasks—such as one participant, a self-described outdoor person, who was asked to identify indoor situations where she felt calmer and more content. This ongoing reflection made positive aspects of life visible that had previously been overshadowed by lack of energy, anxiety, and inability to perform occupations.

The second category, ‘influences on the experience,’ describes what shaped how participants received the treatment. The structure was generally appreciated and was described by one participant as a genuine wake-up call. Weekly sessions, whether in person or digital, each had trade-offs: digital meetings required less preparation and energy but felt less social and sometimes suffered from technical difficulties, while in-person meetings were valued especially at the start of treatment. Participants offered concrete suggestions for improvement, including greater flexibility in the number and length of sessions, a follow-up appointment after completion, printed or enlarged photographs, themes and supporting questions to ease getting started, and written summaries for those with memory problems. Life circumstances mattered too—those on sick leave found participation easier, while those working struggled with time and energy. Notably, when the therapist also served as a rehabilitation coordinator, sessions sometimes drifted to other topics, which participants experienced negatively.

The therapists themselves emerged as a decisive factor. Participants described the occupational therapists as competent, calm, good listeners who took their time, asked questions, and were easy to talk to—sometimes even feeling like friends. The therapists shared their own experiences, offered suggestions and guidance, and were perceived as analytical, encouraging reflection and occasionally asking provocative questions in a positive way to test understanding. A strong sense of trust and connection generally developed, although a few participants reported less positive personal chemistry. This supportive, guiding stance aligns closely with the occupational therapy profession’s focus on facilitating everyday occupations and promoting health through meaningful activity.

The third category, ‘contribution to enhanced everyday life,’ documents the outcomes participants attributed to the treatment. Improvements ranged from reduced anxiety and worry to greater physical capacity, more energy, and increased participation in social life—one participant described being able to take longer walks, while another said that the disappearance of heart palpitations and tremor allowed her to cook dinner and drive to a friend’s house instead of becoming isolated. Participants also gained new perspectives: greater acceptance of limited energy, lowered performance expectations, and a new appreciation for small moments, such as one participant who rediscovered nature and began keeping plants at home. Many resolved never to return to their previous treadmill pace. Crucially, participants continued using the tools afterward—calendars, planned rest, breaking occupations into steps, and photographs displayed at home or work as daily reminders—suggesting the treatment fosters a durable occupational balance rather than a temporary boost.

The authors conclude that BeWell™, delivered by occupational therapists, was perceived to have a positive impact on health, well-being, and everyday life, and that the combination of its components generated value beyond that of each part on its own. Because it is an individual treatment, it may suit patients for whom group interventions are impractical or unappealing, and groups can take considerable time to assemble. The researchers caution that the findings are limited to similar patient groups in primary care and cannot be generalized to people with neuropsychiatric diagnoses, who were excluded. Still, with 35 participants—a comparatively large sample for qualitative research—rich quotes, and an analysis reaching consensus across researchers with diverse clinical backgrounds, the study offers compelling patient-level evidence that pointing a camera at what makes life worth living can be a genuine therapeutic act. Further research, the authors note, is needed on how BeWell™ influences participants and their everyday lives over time.

Subject of Research: Patient experiences of the photo-supported occupational therapy treatment BeWell™ for stress-related illness in primary care

Article Title: Patients’ experiences of the treatment BeWell™, in a primary care context

Article References: Segerström, M., Gunnarsson, A. B., Hörberg, U., & Wagman, P. (2025). Patients’ experiences of the treatment BeWell™, in a primary care context. Scandinavian Journal of Occupational Therapy, 32(1), Article 2575997. https://doi.org/10.1080/11038128.2025.2575997

Image Credits: AI Generated

DOI: 10.1080/11038128.2025.2575997

Keywords: BeWell, occupational therapy, stress-related illness, primary care, well-being, health promotion, photographs, qualitative research, exhaustion syndrome, person-centred care, everyday occupations, Sweden