Latest in Lifestyle Redesign®
May 2026
LR IRL — Lifestyle Redesign in Real Life
Metaphorical Momentum
For much of Gregory’s life, he had experienced challenges with his mental health and, over time, was diagnosed with generalized anxiety, major depressive disorder, attention and concentration deficit, and abnormal weight loss. By his mid-thirties, Gregory found himself feeling like he wasn’t where he wanted to be in life yet unsure of how to make a change. He recognized that he had become socially isolated over the last few years following the end of a long-term relationship; working as a delivery truck driver became his main reason for leaving home. More recently, he had begun to reduce the number of shifts he picked up each week and was no longer showering or brushing his teeth at a frequency that felt representative of what self-care meant to him. After sharing these noticeable functional changes with his psychiatrist, Gregory was referred to Lifestyle Redesign services where he met his occupational therapist (OT), Dr. Emma Schiewe.
During their initial meeting, Gregory’s self-awareness was a valuable asset in helping Emma better understand how OT could be of support. While Gregory did not experience challenges with his work participation, he was requiring significant mental and emotional preparation to physically get himself to work and cope with work-related frustrations. As a delivery driver, Gregory had limited control over his work routines, especially when and where he would be able to take a break to use the restroom or eat lunch. With a better understanding of Gregory’s lived experience, and his affinity for metaphors, Emma took the opportunity to introduce the Law of Inertia from an OT lens: an object at rest stays at rest, an object in motion stays in motion.
Following that very first meeting, Gregory began taking steps to overcome inertia. His first set of short-term goals included brushing his teeth at least once a day, and showering at least twice a week to support him in gaining the momentum to go to work. Emma guided Gregory in building self-awareness around how daily self-care could have a domino effect: maintaining his hygiene helped him feel good about himself, which made it easier for him to engage in activities outside of the home, such as going to work or attending medical appointments. The opportunity to explicitly connect the dots between his habits and the impact they have on his self-efficacy and, consequently, his willingness to leave home, was enough for Gregory to take initiative and sustain the change he desired.
From there, sessions focused on identifying strategies for increasing Gregory’s work attendance. Initially, he described his experience as tunnel vision: only able to focus on the stressors and barriers immediately ahead of him. Emma expanded on this metaphor, inviting Gregory to consider that if he left the tunnel there would be a vast landscape around him. The permission to zoom out and assess the bigger picture resonated with Gregory, who felt like he was ready to push through the tunnel to see the landscape on the other end. To prepare him for this, the pair created an individualized decision tree that supported Gregory in determining what his next steps were for the day, depending on how he felt upon waking up, if he had already missed a day of work that week, and other relevant factors. This tool, which lived on his bedroom wall, was key to reducing the cognitive load that would typically exacerbate Gregory’s anxiety; he now had a map for exiting the tunnel. To begin moving through the tunnel, and developing the motivation to continue moving, Emma guided him in an exercise to explore why it was important to go to work and make money, eventually landing on Gregory’s motivation to enjoy life by travelling and playing golf. These motivators were strategically externalized onto sticky notes that would join the decision tree on Gregory’s wall and encourage him every morning to go to work so that he can afford the hobbies he enjoyed. Within a few weeks, going to work consistently had become less cognitively and emotionally taxing and was beginning to feel habitual again.
Reengaging with work inevitably led to addressing the stressors Gregory experienced while at work. They discovered that he found it valuable to externalize his thoughts by writing them down, so Gregory began carrying a journal in his backpack so that he could access it anytime he needed. Given the nature of his job, Gregory had become accustomed to eating only once per day and drinking a lot of soda since he had no consistent space to take a break or eat lunch. After receiving education on how his diet could be contributing to his low mood and lack of appetite, especially with consideration for the psychiatric medications he was taking, Gregory was willing to explore ways he could increase his caloric intake while reducing his sugar intake. Their sessions became spaces for collaborative problem solving, exploring combinations of quick snacks, meal prepped sandwiches, and healthier drive-thru options. Over time, Gregory was planning a week’s worth of lunches around his anticipated delivery routes, ensuring that he was eating something while “on the clock” and incorporating enough variety to make eating enjoyable again.
By the end of his 16-session plan of care, spanning over a year’s time, Gregory had stayed in motion and exited the tunnel. He was grooming himself daily, attending work regularly, eating three meals per day, and even gained a healthy amount of weight. Gregory recognized that the gradual shifts in his appearance and engagement nurtured his growing self-efficacy, motivating him to continue the momentum he had built and reconnect with the hobbies that allowed him to pour into himself. Emma attributes Gregory’s success in OT to his readiness for change and openness to new ideas.
When asked what she hopes other OTs can learn from Gregory’s story, Emma shared:
“We are the provider that fills the gaps and helps patients visualize their future and what they’re wanting for themselves. Lifestyle Redesign leans on the perspective that change is a domino effect: if we can help someone make one change, everything else falls in line just a little bit more than it did before. Allowing yourself to go into these [therapeutic relationships] with the confidence that you can help make a change, even if it seems overwhelming at first, is a wonderful opportunity to help someone.”
— Emma Schiewe, OTD, OTR/L, LRC
Research Spotlight
Lifestyle Redesign OT pays off: Primary Care Integration Cuts Emergency and Hospital Use
“Occupational therapy (OT) is not just an “add-on” service; it can fundamentally reshape how patients engage with healthcare. When OT is embedded within primary care, we see a shift away from reactive, crisis-driven utilization toward more proactive, preventive, and routine care. That shift matters for both patient outcome trends and system sustainability.
This work contributes to a growing body of evidence that positions OT as a meaningful primary care service provider with impact, providing systems-level solutions rather than just individual-level interventions.
In the US fee-for-service healthcare landscape, driven by cost-benefit analysis, healthcare services must, at a minimum, justify cost containment rather than prevent negative health outcomes for populations. OT has the potential to make a unique contribution by addressing the daily habits, routines, and environmental factors that drive chronic disease management issues and costly healthcare utilization.
This is especially critical in safety-net primary care settings, where patients often face complex social and structural barriers. If we want to reduce avoidable crisis-responsive utilization and improve long-term outcomes, we need interventions that meet people where they are in their everyday lives, and that is exactly where OT operates.
If OT is going to be meaningfully included in Medicare and Medicaid reform, integrated care teams, or primary care settings, we must continue to produce and elevate outcomes data that speaks the language of the system: utilization, costs, and measurable clinical impact.”
— Valerie Tapia, OSOT PhD Candidate (Primary Author)
Upcoming Opportunities
Perinatal Transitions: Conceptualizing an Application of the Lifestyle Redesign® Framework
Free Webinar | Wednesday, June 24, 2026
Date: Wednesday, June 24, 2026
Time: 11am – 12pm Pacific Time
Location: Zoom
Audience: This is an introductory level activity designed for OT practitioners, however, all levels of experience and disciplines are welcome.
Cost*: This webinar is free to attend; registration is required to join.
In this 1- hour webinar, participants will explore the transition to parenthood from preconception through postpartum, with a particular emphasis on nesting, place-making, and resource seeking. The role of occupational therapy practitioners utilizing the Lifestyle Redesign intervention framework will be considered in the context of providing family-centered interventions for birthing and supporting parents within their wider social networks. Through an evidence-based lens, participants will consider the implications of different environmental contexts and gain a deeper understanding of the impact transitioning into parental roles has on occupational participation.
Course Series Corner
NEW Special Topics Course: Chronic Headache
Our course options continue to grow! The new Chronic Headache Special Topics course is designed for participants to obtain understanding of Lifestyle Redesign intervention for chronic headache management.
All Special Topics courses are online, asynchronous, and available on-demand!
CEUs: 3 contact hours (0.3 CEU)
Cost: $100
AOTA Members & USC Chan Alumni: $90
Last Chance to Register for the Summer Mentored Practicum
Online, Synchronous CE Course
The Mentored Practicum in Lifestyle Redesign is the gateway to begin accruing practice hours for certification in Lifestyle Redesign. Earn continuing education (CE) credit while you apply the intervention framework to your clinical practice, and receive mentorship along the way from a Lifestyle Redesign Certified instructor. A payment plan option is now available!
Last Chance to Register: Compressed Timeline: May 18 - Aug. 14, 2026
Weekly synchronous class times (14 total). Choose between:
- Mondays, 8-10am Pacific Time
- Wednesdays, 4-6pm Pacific Time
(New) Extended Timeline*: Sept. 14, 2026 - Mar. 8, 2027
Biweekly synchronous class times (14 total), scheduled for Mondays, 5-7pm Pacific Time.
*This course offering is subject to minimum enrollment requirements.
Enhance Your Practice at Your Own Pace
Interested in evidence-based interventions? Check out our on-demand Lifestyle Redesign continuing education (CE) courses, and build confidence in implementing lifestyle interventions in your clinical practice.
The online, asynchronous (3) Core Courses and (6) Special Topics can be completed on-demand, at a pace that works for YOUR schedule!
Certification Section
Next Certification Info Session
Join us Friday, May 15th @ 10am PST to learn about the Lifestyle Redesign certification process and get your questions answered! Info sessions are online events, hosted via Zoom. For additional details about this and future info sessions, visit our calendar.
If you’re unable to attend, feel free to submit any questions you may have via the contact form.
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