Latest in Lifestyle Redesign®
November 2025

LR IRL — Lifestyle Redesign in Real Life

Self-Regulated Sleep

The sleepless nights had finally gotten the best of Frank, a family man who loved spending time with his children, but stayed up at night worrying about their safety when they were out doing what young adults do. During a routine check-in, Frank mentioned to his neurologist that his poor sleep had become a barrier to his health, prompting a referral to the USC Occupational Therapy Faculty Practice, where he met his new OT, Dr. Rebecca Cunningham. While the referral read “multiple sclerosis” (MS), a condition Frank had been living with for some time, he made it clear in their first session together that his MS wasn’t his biggest concern.

During their initial evaluation together, Frank, insightfully, shared with Rebecca that the most prevalent factors impacting his quality of life were his persistent anxiety and sleep difficulties. While Frank did not exhibit typical daytime fatigue as a result of consecutive nights of only 4-5 hours of sleep, his ever-present anxiety was driving his energy levels and creating a cycle of rumination and distorted thought patterns that made it difficult to fall asleep and stay asleep. Frank would go half of the week with significant trouble sleeping, followed by his body essentially forcing him to sleep (7 hours) for one night, only for the cycle to repeat itself. Ultimately, the pair collaboratively decided to focus on sleep and self-regulation for Frank’s OT plan of care.

To begin tackling Frank’s disrupted sleep cycle, Rebecca turned to an uncommonly used intervention: sleep restriction. After using a sleep diary to establish Frank’s baseline average time sleeping (4.5 hours/night) compared to time spent awake in bed (8 hours/night), his sleep restriction began with spending only 5 hours per night in bed. The first week was challenging and Frank felt unsuccessful, however, after checking in with Rebecca, they collaboratively identified strategies to mitigate his persistent worries. Prayer was the most effective for Frank, helping him to cognitively reframe his thoughts during sleep preparation and to help fall back asleep when he would wake up in the middle of the night. Journaling exercises and listening to music helped with emotional regulation during sleep preparation, as well. The goal was to increase Frank’s sleep efficiency, gradually increasing the amount of time spent in bed as time asleep increased. After another attempt at sleep restriction, Frank’s average time sleeping had successfully increased to 7.5 hours per night.

To support Frank in remaining activated and maintain the progress he was making, Rebecca relied on occupational self-analysis and narrative reasoning (core techniques of the Lifestyle Redesign intervention framework). By supporting Frank in recognizing his values and tying them back to his goals, Rebecca helped Frank not only envision his future with healthier sleep habits, but make it a reality that he has been able to sustain for over two years. While their initial 8-month plan of care together ended after 12 sessions, Frank and Rebecca have continued to work together over the years, as changes to Frank’s health management arise and new referrals are made to OT. Ultimately, tapping into Frank’s values of family, spirituality, and health, has continued to be a reliable approach to adapting his health management routines as he ages.

In reflecting on this experience with Frank, Rebecca shared that, when it comes to insomnia, there is often an emotional component behind it, along with a need for some amount of emotional regulation. It is not uncommon for people to feel stress/anxiety about sleep, thus self-imposing pressure and stress on the sleep process; this further underscores the need for incorporating self-regulation into sleep-focused plans of care. To put it simply,

“Rarely am I working on insomnia or sleep and not addressing self-regulation [...] be sure to screen for mental health needs by bringing up stress and anxiety with patients…if you try to address [poor sleep] with sleep hygiene alone, it often isn’t enough.” 
— Rebecca Cunningham, OTD, OTR/L, MSCS, LRC

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Research Spotlight

Occupational performance problems in people with depression and anxiety

Depression and anxiety are among the most common mental health conditions and are known to impact daily functioning and engagement. These conditions can lead to difficulty maintaining routines, participating socially, and engaging in everyday tasks. A cross-sectional study was conducted in Sweden utilizing the COPM to explore which everyday occupations are most frequently affected for adults with depression and anxiety.

118 participants ages 18-65 reported low performance and satisfaction in self care, productivity and leisure occupations, with the greatest difficulties occurring in household management, socialization and personal care. This study emphasizes the importance of addressing occupational performance problems through client-centered, occupation-based interventions that empower individuals to rebuild routines, strengthen social connections, and engage more fully in meaningful daily occupations.

Sleep hygiene behaviours mediate the association between health/e-health literacy and mental wellbeing

Understanding and managing health-promoting daily routines, such as maintaining consistent sleep habits, play an important role in supporting mental well-being. Poor sleep hygiene is often associated with challenges such as low mood, poor concentration, and decreased quality of life. A study conducted in Iran examined the relationship between sleep hygiene behaviors and adults’’ ability to understand and use health information to support their mental well-being.

Results of the study showed that participants (n=9775) with higher health and “e-health” literacy were more likely to engage in healthy sleep hygiene practices and report better mental wellbeing. Additionally, sleep hygiene behaviors were significantly associated with mental wellbeing, highlighting that promoting health knowledge and reinforcing healthy sleep habits can have a positive impact on mental well-being. This informs occupational therapy practices as occupational therapists have the skillset to promote mental well-being by educating clients on the importance of health literacy and supporting the development of healthy sleep routines within everyday life.

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Upcoming Opportunities

Using a Lifestyle Redesign® Approach to Increase Adherence to Health Behavior Recommendations After Cancer: a Current Clinical Trial
Free Webinar | Tuesday, December 2, 2025

Date: Tuesday, December 2, 2025
Time: 12–1pm 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.

Join this webinar to learn from Dr. Alix Sleight about the application of Re-Invent, Integrate, Strengthen, Expand (RISE), a health self-management intervention for cancer survivors founded on the principles of occupational therapy Lifestyle Redesign. This webinar will highlight lessons learned from a clinic using the RISE approach in people with a history of cancer at Cedars-Sinai Medical Center and describe the current progress of a federally-funded randomized controlled trial testing RISE efficacy at the University of Southern California. The presentation will include case examples of the RISE intervention in action and describe practical steps required to integrate health self-management into occupational therapy clinical practice across various settings with oncology populations.

 

Empowering Change: A Training for Occupational Therapy Practitioners in Motivational Interviewing
Interactive Course | December 5, 2025 through December 7, 2025

Strengthen your therapeutic communication with motivational interviewing (MI)! Join this interactive, online training to learn and practice MI principles. While this course is designed to be applied to OT practice, the content covered can be applicable to any population- all disciplines are welcome.

This is a 12-hour course held across 3 days (4 hours per day). Participants are expected to fully participate for the entire course.

Dates/Times (Pacific Time):

• Friday, December 5, 2025, 1–5pm
• Saturday, December 6, 2025, 8am–12pm
• Sunday, December 7, 2025, 8am–12pm

Location: Zoom

Cost: US$250
AOTA Members and USC Chan Alumni: $225

CEUs: 12 contact hours (1.2 CEU)

Note: This course satisfies the 12-hour MI training requirement for Certification in Lifestyle Redesign.

 

OTAC Pain Management Subcommittee

Are you an OTAC* member interested in occupational therapy and pain management? Consider volunteering for this NEW subcommittee, aimed at connecting OTPs with shared areas of interest and provide a forum for collaboration to:

• Identify and address current practice issues
• Develop resources and position statements to guide clinicians and ensure best practices
• Advocate with policymakers and payers
• Promote occupational therapy’s role and excellence across practice areas

Once a small group is formed, the vision would be to meet once every 1–2 months for about an hour to address the topics listed above. If you, or someone you know, may be interested, reach out to the subcommittee’s lead, Dr. Lindsey Shomer at Lindsey.Shomer@med.usc.edu.

*Must be a member of the Occupational Therapy Association of California to join the subcommittee.

 

Call for Presentations!

Are you a Lifestyle Redesign Certified (LRC) OTP or a Certification Candidate presenting presenting at an upcoming conference on Lifestyle Redesign, lifestyle management, chronic condition management, or other related topic? We would like to highlight upcoming presentations in future newsletters, so that other members of this community can learn from you!

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Course Series Corner

Scheduled Course Series Track

For those who appreciate a structured pace, this track offers the (3) Core Courses, annually, with…

• Set start and end dates:
• Core Course 1: next offering coming Sept. 2026
• Core Course 2: Nov. 10, 2025 - Mar. 20, 2026
• Core Course 3: Apr. 6 - May 1, 2026
• Access to 1:1 meeting opportunities with course instructor for individualized problem-solving and support.
• Opportunities to attend multiple optional synchronous discussion sessions to connect with other course participants.

Now Available: On-Demand Course Series Track

The new On-Demand versions of the (3) Core Courses and (5) Special Topics courses are now available! In this flexible track…

• Courses can be accessed within 10 business days of registration and should be completed in the window of time allotted (varies per course)
• The window of time to complete a course would begin the day after course access is granted
• (Optional) Meet with the course instructor via monthly Lifestyle Redesign Clinical Office Hours

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Certification Section

Congrats, LRCs!

Earlier this year, 2 occupational therapists became Lifestyle Redesign® Certified (LRC) practitioners! Congratulations to:

• Kelli Moberg, MS, OTR/L, LRC - certified in June 2025
• Elissa Mooney Taylor, OTD, OTR/L, LRC - certified in May 2025

 

Celebrating Certification Candidates!

Candidates for certification are individuals who have completed all didactic and mentored practice requirements and are in the process of accruing practice hours for initial Certification in Lifestyle Redesign. We are pleased to celebrate our current candidates: