OT Interventions for Bipolar Disorder and Depression

Occupational Profile & Collaborative Goal Setting

-both

-identify meaningful roles, values, & participation gaps

-set client-centered functional goals (ex: laundry, class attendance, morning routine)

Activity Analysis & Task Grading

-both

-creak tasks into manageable steps and modify task demands (create the just right challenge)

-use graded exposure for avoided tasks

-reduce barriers and increase cues/supports

-schedule small, meaningful activities that build mastery/pleasure

Executive Function & Cognitive Strategy Training

-both

-cognitive behavioral therapy

-externalize memory and planning (planners, visual schedules, alarms)

-support initiation (if-then plans)

-Time management (pomodoro); prioritization (must/should/could lists)

-Reduce clutter/ decision fatigue; set up ready-to-go work/school spaces

Rest and Sleep

-both

-establish consistent sleep supports and wind-down routines

-teach pacing, rest breaks, and energy conservation matched to occupational demands

Emotional Regulation

-both

-teach coping skills during real occupations and routines (ex: grounding before class/work; coping kits; de-escalation strategies)

Social Participation & Communication Skills

-both

-peer support

-graduated social re-entry planes to reduce isolation

-assertiveness scripts, boundary setting, conflict de-escalation practice

-group OT options (skills groups, occupation-based groups)

Environmental Modification

-both

-reduce barriers and increase cues/supports (landing zones, labeled bins, simplified stations

-reduce clutter/decision fatigue; set up ready-to-go spaces

Health Management Routines

-both

-support medication routines (alarms, pill organizers; habit pairing)

Appointment management, transportation planning, and self advocacy for accommodations

Vocational/Academic Participation Supports

-both

-return-to-work/return-to-echool planning with graded workload

-accommodations: modified deadlines, structured breaks, flexible start times

-stamina building and consistency tracking

Mood State Monitoring Integrated into Occupations

-BPD

-track mood, sleep and routines alongside daily activity

0identify early warning signs if mania (reduced sleep, agitation, impulsivity, increased goal-directed activity

Rest and Sleep and Routine Stabilization

-BPD

-operationalize consistent sleep/wake, meal timing, work/school blocks, and wind-down rituals

-routines can be protective against mood destabilization

Environmental Modifications (Specific)

-BPD

-reduce overstimulation (light, noise, late-might screen use)

create calm zones and structure evening routines; plan alternatives to high-arousal late night activities

Impulse Control Supports for Risky Occupations

-BPD

-Spending safeguards (spending caps, budgeting tools)

-technology boundaries (shopping blocks, social media limits)

Decision making supports (24-hour pause rule for major decisions

Energy Pacing Across Both Poles

-BPD

-develop a 2-mode plan for low energy (depression) vs. high energy (mania)

-recognize when productivity may indicate escalation and protect routines accordingly

-plan demanding tasks for peak alertness; manage sedation/fatigue related to medications

Functional Safety Planning Around Occupations

-BPD

-create simple routines to protect sleep/meals and reduce triggers during destabilization

create action plans, such as if sleep drops below X hours for 2 nights, contact supports and simplify schedule