By Stephanie R. Cimino, Alexandra Thompson, Stephanie Posa, Nivetha Chandran, & Sally Abudiab
Physical distancing. Social distancing. Stop the spread. Flatten the curve.
These are some of the terms and phrases we have learned to associate with the coronavirus 2019 (COVID-19) pandemic. In the months following the outbreak, COVID-19 effectively disrupted life on a global scale. Schools closed. Sports cancelled. Non-essential businesses shut down.
But what do these closures and cancellations mean from an occupational perspective?
Occupation—as understood in rehabilitation sciences—involves all forms of doing, from paid work, to hobbies, to getting dressed. Simply put, occupation refers to any activity that occupies your time (1). An occupational perspective, therefore, is “a way of looking at or thinking about human doing.” (2)
Doing has changed drastically since the pandemic began. In this article, we explore: (a) what these changes in doing mean for mental health; and (b) how an occupational perspective can help people cope with these changes.
We Are All Occupational Beings
The occupational perspective assumes that humans are occupational beings―we have a biological need to do (3). But what happens when our day-to-day doing is interrupted, such as during a pandemic?
A recent review on the mental health impact of COVID-19 suggests that between 16-28% of the general population experienced moderate-to-severe symptoms of anxiety and/or depression during the initial stage of the pandemic (4). In contrast, in 2017, the World Health Organization (WHO) (5) reported that depression impacts roughly 4.4% of the world’s population, while 3.6% experience anxiety disorders. The former statistic shows that symptoms of anxiety and depression appear to be exacerbated in the general population due to the pandemic.
Another review found that frustration and boredom are two of the main stressors reported by people in quarantine (6). From an occupational perspective, this frustration and boredom speaks to the occupational disruption often resulting from social or physical distancing. Occupational disruption is “a temporary state, characterized by a significant disruption of identity associated with changes in the quantity and/or quality of one’s occupations subsequent to a significant life event, transition, or illness or injury.” (7)
Occupational disruption caused by the pandemic can negatively impact the psychological, social, and emotional functioning of an individual (7). Given these circumstances, we ask: what helps people cope with occupational disruption?
Given these circumstances, we ask: what helps people cope with occupational disruption?
A recent review on occupational disruption highlights three adaptive strategies: (a) modifying previous occupations; (b) maintaining order or routine; and (c) adopting new occupations or routines (7). These strategies align with the idea that gradual re-engagement in doing promotes mental health recovery by providing routine and structure, empowerment, sense of self, and connectedness (8). Dr. Rachel Thibeault coined the term “occupational gifts” (9) which are used to describe activities that foster resilience and hope in challenging situations (10,11).
There are five occupational gifts for promoting mental health: centring, contemplation, creation, connection, and contribution. We reflect on how adopting these occupational gifts has helped us cope with occupational disruption and foster mental well-being as graduate researchers during COVID-19.
We also invite you to reflect on your own experiences from an occupational perspective and discover new ways of doing to foster mental well-being during the pandemic and beyond.
Adopting the Five Occupational Gifts
Centring – Stephanie Cimino
The occupational gift of centring refers to activities that make us feel calm, foster presence, and promote awareness (9-11). This gift can be challenging to maintain, as uncertainty about the future weighs heavily on us.
For many people, myself included, physical activity generates a sense of tranquility. Being active interrupts the flow of anxiety by drawing awareness away from our thoughts and focusing attention on our form and breathing, similar to mindfulness practices (12).
The pandemic has created unique challenges for maintaining regular physical activity. Given physical distancing regulations, we must find alternatives to our regular exercise routines. For example, in place of traditional group classes, fitness professionals have begun streaming classes online or posting videos on social media. These alternatives encourage people to stay active, which is important for maintaining mental health (13). From my own experience, being active during the pandemic has helped lower my anxiety levels and improve my mental health.
Contemplation – Nivetha Chandran
The occupational gift of contemplation speaks to activities which provoke wonder and admiration for the world around us (9-11). Activities like meditation, journaling, and exploring are associated with promoting contemplation (14-16).
When we get wrapped up in our daily routines, we tend to be distracted by one aspect of our routine rather than see the whole picture. This gift of contemplation may be more elusive now when the need to stay indoors reduces our experience of the outside world. I have been exploring virtual museums and reading about human history instead of my usual contemplative doing. The knowledge I have gained has increased my appreciation for life beyond our daily routines, like for our rich human history.
This contemplative experience has induced feelings of resilience and hope since humankind has overcome past challenges similar to the COVID-19 pandemic. During these uncertain times, exploring the gift of contemplation has helped me feel more hopeful about the future and appreciative of the world around me.
This contemplative experience has induced feelings of resilience and hope since humankind has overcome past challenges similar to the COVID-19 pandemic.
Creation – Stephanie Posa
The occupational gift of creation refers to wide-ranging artistic pursuits including creative writing, painting, and theatrical performance. Although the mediums may differ, these activities collectively promote imaginative escapes from reality (9-11).
Visual arts can be used to lessen symptoms of anxiety and depression, especially among university students (17). To mitigate my COVID-19-induced anxiety, I have taken up painting as a creative activity. Recently, I created an abstract composition bursting with circular patterns and bright colours. The busyness of the piece embodies the chaos that COVID-19 has caused and the bright colours are symbols of optimism.
The painting represents the negative emotions I am experiencing due to COVID-19—anxiety, despair and fear; however, it also signifies my hope for the future. Overall, the creative doing of painting has allowed me to simultaneously confront and distract myself from the anxiety of living through the COVID-19 pandemic.
Connection – Sally Abudiab
The occupational gift of connection strengthens our sense of belonging, both to each other and to life (9-11). Being connected to others socially is a vital human need (18).
With prolonged social isolation there is a tendency to fall into a mental state of chronic negative thinking (19). Videophone technology and virtual cafés have enabled me to keep connected with family and friends while maintaining social distancing orders. In my downtime, I have also explored other connecting activities, namely nature, spirituality, and religious practice. Some activities, such as walking outside, have been easier than others, such as spiritual reflections.
Time, during the pandemic, has me wondering about what it means to create spaces—virtual or physical—where other people belong. This practice, where individuals strive to understand the feelings and experiences of others, increases a sense of connection and belonging by urging us to connect meaningfully with one another (20).
Contribution – Alexandra Thompson
The occupational gift of contribution fulfills the need to give back to others (9-11). These sorts of activities, like volunteering, have long been understood to promote mental health (21,22).
During the early stages of the pandemic, it was hard to regulate my attention, emotions, and sleep; I was easily distracted, irritable, and disproportionately worried about physical symptoms.
My turning point was deciding to support my peers by participating in my graduate department’s mental health committee. While curating lists of mental health resources and brainstorming ideas for virtual events to connect students, I was noticeably more focused and less worried about physical symptoms.
What I was doing gave me purpose. These activities also reinforced a feeling of hope—hope that our efforts could brighten someone’s day and hope that we were contributing to the fight against mental health stigma.
What I was doing gave me purpose. These activities also reinforced a feeling of hope…
Global Pandemic as a Driver for Universal Mental Health
We are constantly reminded that we are bound by this pandemic, that “we are all in this together.” Unfortunately, the universalism of this statement can only go so far. In a country with historic inequities and present marginalization, many communities are disproportionately vulnerable and/or affected by the pandemic (e.g., working class (23), Indigenous (24), and Black communities (25)).
Ultimately, our social location—the social position we hold within a society (26)—has made it possible for us (the Authors) to still be able to do meaningful activities within our environments with minimal difficulty. That is to say, the occupational gifts and personal experiences we present are not universal solutions for everyone, since we have not experienced universal challenges.
Occupational disruption during COVID-19 has introduced and intensified mental health challenges. These circumstances highlight the power of doing—something that is often taken for granted in our day-to-day lives. Being mindful of your doing and applying Dr. Thibeault’s ‘occupational gifts’ is just one way to channel the power of occupation.
We encourage you to draw from your experiences during the pandemic as inspiration to advocate for occupational engagement and mental health promotion for all. Doing so may be the greater gift that transcends the disruptive nature and timeline of COVID-19.
Featured illustration by Colleen Paris for rehabINK.
To refer to this article, it can be cited as:
Cimino SR, Thompson A, Posa S, Chandran N, & Abudiab S. “Doing” during the COVID-19 pandemic: An occupational perspective on fostering mental health. rehabINK. 2020:9. Available from: https://rehabinkmag.com
- Hitch D, Pépin G, Stagnitti K. In the footsteps of Wilcock, part one: the evolution of doing, being, becoming, and belonging. Occupational Therapy in Health Care. 2014;28(3):231-246.
- Njelesani J, Tang A, Jonsson H, Polatajko H. Articulating an occupational perspective. Journal of Occupational Science. 2014;21(2):226-235.
- Clark, F. Reflections on the human as an occupational being: biological need, tempo and temporality. Journal of Occupational Science. 1997;4(3):66-92.
- Rajkumar RP. COVID-19 and mental health: a review of the existing literature. Asian Journal of Psychiatry. 2020;52:102066.
- Depression and other common mental health disorders: Global health estimates [Internet]. Geneva, Switzerland: World Health Organization Production Services; 2017 [cited 2020 May 10]. Available from: https://apps.who.int/iris/bitstream/handle/10665/254610/WHO-MSD-MER-2017.2-eng.pdf
- Brooks SK, Webster, RK, Smith LE, Woodland L, Wessely S, Greenberg N, et al. The psychological impact of quarantine and how to reduce it: rapid review of the evidence. Lancet. 2020;395(10227):912-920.
- Nizzero A, Cote P, Cramm H. Occupational disruption: a scoping review. Journal of Occupational Science. 2017;24(2):114-127.
- Doroud N, Fossey E, Fortune T. Recovery as an occupational journey: a scoping review exploring the links between occupational engagement and recovery for people with enduring mental health issues. Australian Occupational Therapy Journal, 2015;62(6):378-392.
- Thibeault R. Occupational gifts. In: McColl MA, editor. Spirituality and occupational therapy. 2nd ed. Ottawa, ON: CAOT-ACE; 2011. p. 111-120.
- Hammell KW. Engagement in living during the COVID-19 pandemic and ensuing occupational disruption [Internet]. Ottawa, Canada: Canadian Association of Occupational Therapists; 2020 [cited 2020 Apr 21]. Available from: https://www.caot.ca/document/7179/Ensuring%20Occupational%20Disruption.pdf
- Zafran H. Occupational gifts in the time of a pandemic: How daily meaningful activities can make us more resilient [Internet]. Montréal, Canada: McGill University; 2020 Apr 3 [cited 2020 Apr 21]. Available from: https://www.mcgill.ca/spot/article/occupational-gifts-time-pandemic
- Halliwell E. 5 reasons to bring mindfulness to the body [Internet]. Mindful; 2015 [cited 2020 Apr 24]. Available from: https://www.mindful.org/5-reasons-to-bring-mindfulness-to-the-body/
- Mason OJ, Holt R. Mental health and physical activity interventions: a review of the qualitative literature. Journal of mental health. 2012;21(3):274-284.
- Schreiner I, Malcolm JP. The benefits of mindfulness meditation: changes in emotional states of depression, anxiety, and stress. Behaviour Change. 2008;25(3):156-68.
- Gunnlaugson O, Sarath EW, Scott C, Bai H, editors. Contemplative learning and inquiry across disciplines. New York, United States: State University of New York Press; 2014.
- Ullrich PM, Lutgendorf SK. Journaling about stressful events: effects of cognitive processing and emotional expression. Annals of Behavioral Medicine. 2002;24(3):244-50.
- Drake CR, Searight HR, Olson-Pupek K. The influence of art-making on negative mood states in university students. American Journal of Applied Psychology. 2014;2(3):69–72.
- Wilkinson A, Bowen L, Gustavsson E, Håkansson S, Littleton N, McCormick J, et al. Maintenance and development of social connection by people with long-term conditions: a qualitative study. International Journal of Environmental Research and Public Health. 2019;16(11):1875.
- Martino J, Pegg J, Frates EP. The connection prescription: using the power of social interactions and the deep desire for connectedness to empower health and wellness. American Journal of Lifestyle Medicine. 2017;11(6):466-75.
- Koss-Chioino JD. Spiritual transformation, relation and radical empathy: core components of the ritual healing process. Transcultural Psychiatry. 2006;43(4):652-70.
- Post SG. Altruism, happiness, and health: it’s good to be good. International Journal of Behavioral Medicine. 2005;12(2):66-77.
- Yeung JWK, Zhang Z, Kim TY. Volunteering and health benefits in general adults: cumulative effects and forms. BMC Public Health. 2018;18(1):8.
- Flanagan R. Does COVID-19 discriminate? This is how some Canadians are harder-hit [Internet]. Toronto, Canada: CTV News; 2020 Apr 15 [cited 2020 Apr 26]. Available from: https://www.ctvnews.ca/health/coronavirus/does-covid-19-discriminate-this-is-how-some-canadians-are-harder-hit-1.4897298
- Gawley K. Canada’s ‘colourblind’ coronavirus data could leave officials blind to racial inequities [Internet]. Vancouver, Canada: NEWS 1130. 2020 Apr 7 [cited 2020 Apr 26]. Available from: https://www.citynews1130.com/2020/04/07/canadas-colourblind-coronavirus-data-could-leave-officials-blind-to-racial-inequities/
- Starblanket G, Hunt D. Opinion: Indigenous communities and COVID-19: The virus may not discriminate, but responses to it do [Internet]. Toronto, Canada: The Globe and Mail. 2020 Mar. 27 [cited 2020 Apr 26]. Available from: https://www.theglobeandmail.com/opinion/article-indigenous-communities-and-covid-19-the-virus-may-not-discriminate/
- Anthias F. Hierarchies of social location, class and intersectionality: towards a translocational frame. International Sociology. 2013;28(1):121-38.