The scientific significance of the study lies in its deductive design. Rather than letting themes emerge freely from interview data, the researchers deliberately mapped participants’ narratives onto the CHIME framework, a widely accepted conceptual model of personal recovery developed through systematic review. CHIME stands for Connectedness, Hope and optimism, Identity, Meaning and purpose, and Empowerment, and it has become something of a gold standard for characterising what recovery from mental health problems actually involves. By testing whether the experiences of Balancing Everyday Life participants fit this established framework, the investigators could determine both whether the intervention promotes recovery in the sense that the field recognises and whether it offers anything the framework itself has overlooked.

The data came from a re-analysis of in-depth qualitative interviews originally collected during and after a randomised controlled trial of the intervention. From nineteen original interviewees, the researchers purposefully selected eleven information-rich cases: nine women and two men aged between thirty and sixty-three, with an average age of forty-six. Their diagnoses spanned bipolar disorder, psychosis, emotionally unstable personality disorder, ADHD, PTSD, eating disorders, panic disorder, depression, stress-related problems and previous substance abuse. Crucially, all had been interviewed at the completion of the intervention, allowing the researchers to capture recovery reflections at a consistent point in time. Semi-structured interviews lasting between thirty minutes and two and a half hours were transcribed verbatim and then analysed using the three phases of deductive content analysis: preparation, organising and reporting.

The results were striking in their breadth. Every one of the five CHIME categories was represented in the participants’ accounts, and most of the framework’s subcategories appeared as well. Two categories dominated the narratives, however: Connectedness and Empowerment. Participants repeatedly described how the safe, accepting climate of the group allowed them to open up to others, share experiences, exchange tips and support each other’s goals. One participant described recognising fellow group members as comrades in a shared fight, even when their specific goals differed. Another explained that the group was the first place she felt able to talk with people who had also been through hardship, expanding a social network she had not previously had and breaking a cycle of isolation that many mental health service users know intimately.

The importance of trusting relationships extended beyond the peer group to the healthcare staff who led the sessions. Participants emphasised that group leaders who listened without rushing, who radiated calmness and who responded to missed sessions with empathy rather than critique strengthened their confidence in the care system and in themselves. Support from family, friends and even new acquaintances made through the intervention also featured prominently, with one participant describing how a friend introduced through a fellow group member helped her get to a gym activity and became a source of mutual inspiration. These findings align with a substantial body of occupational therapy research showing that group-based activity interventions carry therapeutic value precisely because belonging and shared occupation reinforce one another.

The Empowerment category proved equally central. Participants spoke about personal responsibility in their own care, including having a voice in decisions about medication, and about regaining control over daily life through concrete strategies. One participant set a goal of reducing his sleeping pills and valued the freedom to experiment with his doctor rather than simply following a prescription. Others described learning to set limits, to tell an employment agency when they could not cope with too many changes, to break housework into manageable half-hour segments, and to let go of activities that drained them, such as one participant who abandoned a photography hobby when the fear of failure outweighed the joy. Balancing rest and activity, setting realistic goals matched to one’s abilities, and pacing oneself step by step emerged as practical recovery tools that participants carried into their everyday lives.

Beyond confirming the CHIME categories, the study made a discovery with potentially broader implications: two recovery experiences that the framework does not cover appeared consistently in the data. The first was occupational balance, the sense that daily activities are satisfyingly mixed, aligned with personal values and matched to one’s abilities. Because Balancing Everyday Life is explicitly built around learning about and self-analysing occupational balance, its prominence among participants’ recovery experiences may reflect what is distinctive about occupational therapy as a discipline. The second was self-esteem and self-confidence, which participants reported had grown through the course and which the researchers suggest could be added to CHIME’s Identity category. These additions hint that recovery frameworks developed in psychology and psychiatry may benefit from incorporating occupational science concepts that capture how people structure and experience their daily doing.

The study’s findings also illuminate the temporal nature of recovery. Categories such as Hope and optimism, Identity and Meaning and purpose appeared in the narratives but less prominently, and not all of their subcategories were identified. The researchers propose a plausible explanation: participants were interviewed shortly after completing the intervention, at a relatively early stage of what is often a long, multi-phase recovery journey. People earlier in that journey may experience belonging and connection most vividly, while hope, a redefined identity and a rebuilt sense of meaning may consolidate later. This interpretation is supported by the intervention’s randomised trial data, which showed that quality-of-life improvements among Balancing Everyday Life participants emerged only at a six-month follow-up rather than immediately after completion. The authors therefore call for follow-up studies that track recovery after occupational therapy interventions over longer horizons.

Methodologically, the researchers took deliberate steps to ensure trustworthiness. Two occupational therapy students coded transcripts independently and reached consensus under supervision, while one author independently re-analysed an entire interview, with discrepancies resolved through iterative discussion at the subcategory level. The selection of participants across different regions, group leaders, genders, ages and service contexts strengthened dependability, and illustrative participant quotes bolstered credibility. The authors acknowledge that the interview data was originally collected for earlier inductive studies and that the interview guide did not probe recovery specifically, but they argue that this openness was actually a strength, since questions framed around CHIME would have led participants toward the framework’s own concepts rather than testing whether those concepts genuinely fit their experience.

The clinical implications are concrete. The study concludes that Balancing Everyday Life supports recovery in the way the field has conceptualised it, providing evidence that practitioners can use when encouraging service users to enrol. Perhaps more importantly, it demonstrates that an occupational therapy intervention, grounded in everyday activity rather than symptom management, can foster the connectedness, hope, identity, meaning and empowerment that define personal recovery. For a population that research consistently shows to be under-occupied, isolated at home and struggling with imbalanced daily routines, the message is quietly radical: recovery can be built through the ordinary architecture of daily life, one goal, one homework assignment and one shared group session at a time. As mental health systems worldwide search for recovery-oriented services, this Swedish study suggests that the humble tools of occupational therapy, goal setting, self-reflection, activity strategies and peer belonging, deserve a central place in that conversation.

The broader context of the study’s intervention is worth noting. Balancing Everyday Life was evaluated in a randomised controlled trial across community-based and specialist psychiatry units in southern and western Sweden, where it demonstrated significant gains in occupational engagement, activity level and occupational balance compared with standardised treatment. The intervention itself unfolds over sixteen weeks through fourteen themed group sessions covering topics such as meaning and motivation, daily habits and social activities. Between sessions, participants pursue individually chosen homework activities, a structure rooted in self-reflection, goal setting and the testing of activity strategies in real-world settings.

The concept of personal recovery that anchors the analysis has its own history. Established during the 1990s as an alternative to purely biomedical notions of clinical recovery, it emphasises that individuals can experience health and well-being despite persisting symptoms, regaining control over their lives and participating more actively in meaningful activity. The CHIME framework was developed to bring clarity to this process and is now used in both research and clinical practice internationally.

The study also situates itself within a documented problem: mental health service users tend to live low-active lives, spending much of their time on sleep, meals, self-care and quiet pursuits, with isolation at home common and under-occupation far more frequent than overload. Occupational balance, defined as a subjectively satisfying mix of work, leisure, housework and rest aligned with personal values, has been shown to link with well-being and recovery, making it a natural target for therapeutic attention. The study was approved by the ethical review board in Lund and conducted in accordance with the Declaration of Helsinki.

Subject of Research: Recovery experiences of mental health service users participating in the Balancing Everyday Life occupational therapy intervention, analysed with the CHIME recovery framework

Article Title: Recovery experiences among mental health service users going through the Balancing Everyday Life™ intervention – A deductive qualitative study

Article References: Eklund, M., & Argentzell, E. (2025). Recovery experiences among mental health service users going through the Balancing Everyday Life ™ intervention – A deductive qualitative study. Scandinavian Journal of Occupational Therapy, 32(1), Article 2451267. https://doi.org/10.1080/11038128.2025.2451267

Image Credits: AI Generated

DOI: 10.1080/11038128.2025.2451267

Keywords: occupational therapy, mental health recovery, Balancing Everyday Life, CHIME framework, personal recovery, occupational balance, empowerment, connectedness, qualitative research, group intervention, mental illness, Lund University

The study was led by Marie Gudmundsson, a doctoral student and registered occupational therapist at Lund University, together with Anna Maria Pálsdóttir of the Swedish University of Agricultural Sciences, Daniel Sutton of Auckland University of Technology, and Ulrika Bejerholm and Elisabeth Argentzell of Lund University. Using Charmaz’s constructivist grounded theory approach, the team conducted in-depth, face-to-face interviews on site at a farm-based rehabilitation centre in southern Sweden, surrounded by deciduous and coniferous forest, brooks, valleys, ridges and pastures. The interviews were transcribed verbatim — including participants’ sighs, deep breaths, tears and laughter, which the researchers treated as embodied data — and analysed iteratively with NVIVO 14 until theoretical saturation was reached. The result is a core concept the authors call ‘a process of embodied recovery’, built from three interlocking concepts: experiencing interconnection, processing inner connection and feeling intra-connected.

The intervention itself was deliberately designed to work ‘body-up’ rather than ‘head-down’. Delivered in groups of about eight participants, the 24-week programme ran in two phases. In the first phase, participants attended the farm three days a week for three hours; in the second, two days a week with less staff support and more shared responsibility. Early activities emphasised self-rewarding occupational value — being guided to relax and unwind by a fire, near a brook, beneath a tree or while resting on horseback. Only gradually did participants take on work-like tasks such as mucking out pastures, cleaning water tubs or helping build fences. Every activity was presented as a suggestion, with participants free to join or not, a design feature that proved central to the recovery process. The programme drew on the Alnarp method of nature-based rehabilitation and on more than two decades of practice in equine-assisted therapy, and the therapy horses were trained and prepared according to international IAHAIO welfare guidelines.

The first concept, ‘experiencing interconnection’, describes how transactions between participants and their environment — nature, horses, other animals, peers and staff — initiated a recovery that had long been stalled. Participants repeatedly contrasted the low-demand, person-centred atmosphere of the farm with earlier experiences of mental health care that they perceived as stressful, demanding and impersonal. One participant, given the pseudonym Steve, described the relief of arriving without any formal introductions: ‘You kind of feel like you belong, you’re not standing out.’ Another, Lucy, speculated that if she had been referred to such a programme after her previous full-time sick leave, she might have returned to work three years earlier. The natural environment itself was described as a kind of co-worker and even a form of medicine; one participant said a guided forest walk felt ‘as if you inject a bit of the forest into your veins’.

Interacting with horses emerged as one of the most valued and effective components of the entire intervention. Participants described lying on a horse’s back while the animal grazed, head resting against its flank, listening to it chew, and experiencing what one called ‘total peace’. Several said this gave them an entirely new reference point for what relaxation actually feels like. One participant realised she had been physically tense and stressed for years without knowing it, and that resting on the horse produced ‘a physiological shift in the body’ that ordinary rest did not. The researchers suggest that co-regulation with the horse’s calm nervous system may facilitate a depth of relaxation that talk-based strategies alone struggle to reach — a mechanism consistent with evidence that human-animal contact raises oxytocin levels and promotes attachment, and that nature exposure reduces sympathetic autonomic activity and even amygdala activity after a single walk.

The second concept, ‘processing inner connection’, describes how multisensory experiences opened a reflective process in which participants began to recognise their own needs and emotions again. Many described a sudden, unexpected change of emotional state — one participant’s therapist independently noticed that her ‘façades just disappeared along the way’. Others needed more time: one woman initially disliked the horses entirely, finding them smelly and shedding, and only after several sessions did resting on horseback begin to work for her. The multisensory dimension was striking. One participant described her perception shifting from a flat ‘2D painting’ into three dimensions the moment her sense of smell returned, recalling that ‘the first time I could actually smell something, I was happy’. Others reported slowly regaining access to a full palette of feelings — more sadness, but also more joy — after years of emotional shutdown, and developing an almost physical longing for the smells of the stable and the forest that revealed how much they had needed to be outdoors.

The third concept, ‘feeling intra-connected’, captures how participants integrated these new embodied experiences into a whole sense of self and carried them into daily life. Participants described empowerment through self-understanding — one said she finally understood her illness and what she could do to get well, as if ‘some sort of code has been cracked’. Others made concrete life changes: one began keeping a diary spontaneously, another planned to move to a house with a garden after realising that ‘gardening really calms me’, and another recreated the programme’s rhythms at home, lying down under blankets with her dog after walks in nature. Participants contrasted this with sick leave alone, which one said may have protected her from breaking down ‘but it didn’t make me feel better’. Childhood memories resurfaced in the forest, strengthening identity and family connections, and participants described learning to say no, set boundaries and make healthier choices throughout the day.

The researchers frame these findings through the lens of personal recovery — the subjective, individualised process of living a meaningful life despite persistent symptoms, as captured in the widely used CHIME framework of connectedness, hope, identity, meaning and empowerment. What the new study adds is a theoretical model showing how those elements can be reached through the body rather than the mind alone. Drawing on Merleau-Ponty’s phenomenology of perception and on occupational science, the authors argue that the intervention moved beyond the mind–body dualism that still dominates much of Western health care. Transactions with the environment grounded in each person’s earlier embodied experiences enabled trust and self-discovery; reflection on those experiences lowered participants’ guards and opened what one cited study calls ‘sensory channels’; and integration of the embodied self with the social and natural world produced belonging, hope and empowerment in daily life.

The clinical implications are significant. The participants, who had on average nearly ten years of psychiatric care behind them, reported solely positive experiences of the intervention — a finding the authors acknowledge may partly reflect relief and gratitude after years of treatments that offered little progress, and which they flag for further study. They argue that mental health services should complement medication and talk-based therapies with interventions offering safe, supportive, positive multisensory experiences, and that professional education should prepare staff to support recovery from a holistic, embodied perspective. The importance of duration also echoes earlier findings that longer nature-based rehabilitation, up to 24 weeks, supports more sustainable recovery and faster return to work than shorter programmes. The authors note that implementing longer, more complex interventions may require greater initial investment, depending on whether they add to or replace existing treatments.

The study also acknowledges its limitations: interviews were conducted on site in the natural environment, which may have coloured participants’ responses; the analysis was conducted after all interviews; and combining interviews with direct observation might have captured negative experiences more fully. Member-checking with two former participants, one of whom had not been interviewed, refined the final model and strengthened its realism. Even so, the researchers present their tentative model as a new conceptual depiction of how nature-based intervention can be experienced as an embodied journey towards recovery — one in which the body, the environment and meaningful occupation work together to re-open a path that medication and conversation alone had failed to clear. For a growing group of service users whose recovery has stalled in conventional care, the message is that healing may begin not with words, but with the smell of a stable, the sound of a horse chewing, and the felt sense of finally being safe enough to rest.

Subject of Research: Mental health service users' embodied experiences of personal recovery during a nature-based intervention including equine-assisted therapy

Article Title: ‘An Embodied Journey Towards Recovery’: A Grounded Theory of Mental Health Service Users’ Experiences of a Nature-based Intervention

Article References: Gudmundsson, M., Pálsdóttir, A. M., Sutton, D., Bejerholm, U., & Argentzell, E. (2026). ‘An Embodied Journey Towards Recovery’: A Grounded Theory of Mental Health Service Users’ Experiences of a Nature-based Intervention. Scandinavian Journal of Occupational Therapy, 33(1), Article 3. https://doi.org/10.1007/s44474-026-00003-5

Image Credits: AI Generated

DOI: 10.1007/s44474-026-00003-5

Keywords: nature-based intervention, equine-assisted therapy, mental health recovery, embodiment, occupational therapy, grounded theory, sensory processing, anxiety, depression, exhaustion disorder, animal-assisted therapy, rehabilitation