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

The research team, led by Ana H. Alarcón Aguilar and colleagues, framed their work around a growing international consensus that well-being is not a luxury but a core component of health. Since the World Health Organization defined health in 1948 as a state of complete physical, mental and social well-being, researchers have accumulated evidence that people with high well-being live longer, recover faster and develop fewer chronic conditions. Meta-analyses have linked positive psychological states to lower cardiovascular risk, slower illness progression and reduced mortality, making well-being both an outcome worth studying and a potential lever for public health policy. In an era when governments are scrambling to cope with ageing populations, understanding what sustains mental health in old age has become a strategic priority enshrined in the United Nations 2030 Agenda.

Spain presents a particularly urgent case. People over 65 currently make up 20.1 percent of the Spanish population, a share projected to climb to roughly 30.4 percent by around 2050. Data from the European Quality of Life Survey, which has tracked well-being across the continent since 2003 using the same instrument employed in the new study, show that Spanish well-being declines with age, and that older Spanish adults score lower than their Nordic counterparts while resembling the pattern seen across the Mediterranean and Balkan regions. Within Spain, women consistently report lower mental well-being than men, a gap the new study reproduces in detail.

The participants, all residents of Castelló de la Plana, completed a battery of validated questionnaires administered by three experienced psychologists over two weeks. Psychological well-being was measured with the WHO-5 Well-Being Index, a five-item scale asking how often over the previous two weeks respondents felt cheerful and in good spirits, calm and relaxed, active and vigorous, fresh and rested on waking, and that daily life was filled with interesting things. Raw scores from zero to 25 are multiplied by four to yield a percentage, with scores below 50 traditionally flagged as a screening threshold for depression. Life satisfaction was assessed with Diener’s Satisfaction with Life Scale, loneliness with the six-item Spanish version of the De Jong Gierveld Loneliness Scale, and physical health with the physical health dimension of the WHOQOL-BREF quality-of-life instrument, covering daily activities, energy, mobility, pain, sleep and work capacity.

The headline result was a mean WHO-5 score of 60.21, with a standard deviation of 18.80, indicating moderate overall well-being but with substantial individual variation. Women averaged 57.66 while men averaged 64.42, a statistically significant difference. All instruments showed satisfactory internal consistency, with Cronbach’s alpha values ranging from 0.70 for loneliness to 0.81 for life satisfaction, giving the team confidence that the scales were measuring stable, coherent constructs in this older Spanish sample.

The analytical centerpiece was a hierarchical multiple linear regression, a technique that enters blocks of predictor variables in sequence to reveal how much explanatory power each adds. The first block contained sociodemographic variables: gender, age, living alone, marital status, education and employment. It explained less than three percent of the variance in well-being. Adding life satisfaction raised the explained variance to 35 percent. Physical health pushed it to 47 percent, and loneliness completed the model at 49 percent. The final model was highly significant, with an F-statistic of 22.56 and a statistical power of 1.00, and diagnostic checks confirmed the assumptions of homoscedasticity, normally distributed residuals and independent errors, with a Durbin-Watson statistic of 1.94.

Four predictors emerged as significant in the final model. Being male was associated with higher well-being, with a coefficient of minus 4.86 for the female category. Each additional point of life satisfaction added 2.04 points of well-being, and each point of better perceived physical health added 1.67. Loneliness worked in the opposite direction, subtracting 1.87 points per unit of perceived loneliness. Notably, age, living alone, marital status, educational level and employment status all failed to reach significance, a pattern the authors link to prior international work by Geerling and Diener showing that demographic predictors exert small or very small effects on older people’s well-being compared with psychosocial factors such as perceived social support.

The gender gap deserves particular attention. The authors note that women’s lower well-being is consistent with European survey data and with literature showing that women report more depressive symptoms, a condition strongly and negatively correlated with well-being. Yet they also raise a methodological caveat: men may systematically underreport depressive symptoms because of social desirability bias, meaning the true gender difference could be either real or inflated by measurement artifacts. Either way, the study argues that older women should be a priority target for well-being interventions, especially those with lower educational attainment, who previous research identifies as being at elevated risk.

The study’s limitations temper its conclusions but do not undermine its central message. The cross-sectional design captures associations, not causal arrows, and the authors emphasize that the relationships between loneliness, health, life satisfaction and well-being are likely bidirectional: lonely people become less healthy, and less healthy people become lonelier. The convenience sample, recruited by approaching people over 55 in the streets of Castelló, was predominantly female, retired and highly educated, limiting generalizability to Spain’s older population as a whole. The authors also flag the absence of income, frailty, self-perceptions of ageing and self-compassion from the model, all of which prior studies suggest could add explanatory power, and they call for longitudinal designs and probability sampling in future work.

What the study loses in causal certainty it gains in practical direction. Because life satisfaction, physical health and loneliness are all modifiable, they are actionable targets in a way that age and gender are not. The authors point to community-based programmes that strengthen intergenerational ties, adapted physical activity initiatives that improve both mobility and mood, and digital literacy training that helps older adults maintain meaningful online connections. Interventions built on self-compassion and positive self-perceptions of ageing have also been shown to reduce depressive symptoms and may even protect against cognitive decline. With Spain’s over-65 population swelling toward nearly a third of the country, and with the study’s well-being means slightly below the European survey benchmarks of 63 in 2016 and 65.4 in 2012, the message for policymakers is clear: the cheapest and most effective investments in healthy ageing may lie not in demographics but in connection, health and the way older people evaluate their own lives.

Subject of Research: Predictors of psychological well-being among Spanish older adults, including loneliness, physical health, life satisfaction and gender

Article Title: Psychological Well-Being in Spanish Older Adults

Article References: Aguilar, A. H. A., Hornero, A. C., Riera, A. J. L., Hidalgo, M. R., & Miedes, A. C. (2026). Psychological Well-Being in Spanish Older Adults. Trends in Psychology. https://doi.org/10.1007/s43076-026-00521-y

Image Credits: AI Generated

DOI: 10.1007/s43076-026-00521-y

Keywords: psychological well-being, older adults, loneliness, life satisfaction, physical health, WHO-5, ageing, Spain, gender differences, hierarchical regression, mental health, healthy ageing