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  • Writer's pictureMonica Jones

Frame of reference

Updated: Mar 15

A Cognitive Behavioral Frame of Reference (CB-FoR) can guide treatment and rehabilitation directly using the lens of occupation and an action-based approach while incorporating the foundational principles of occupational therapy which include client-centered practice that is occupation-focused and grounded in evidence-based concepts (Duncan, 2020; AOTA, 2020). CBT concepts were incorporated into occupational therapy owing to the idea that it is the responsibility of the occupational therapist to assist their client in the use of adaptive behaviors to enable engagement in activities in an effective, evidence-based manner (Duncan, 2020). Components of CBT, such as methods of assessment, flexibility to cater to individual clients, and collaboration are similarly valued in occupational therapy (Duncan, 2020). This allows for easier application and incorporation of cognitive behavioral approaches into traditional occupational therapy interventions. A meta-analysis by Ikiugu et al. (2017) concluded that occupational therapy interventions based on a behavioral or cognitive behavioral framework may improve occupational performance and wellness in clients living with a mental health disorder.

Incorporation of the CB-FoR into occupational therapy includes the key elements of being problem-focused, working in the present, and being collaborative, time-limited, and occupation-focused. These elements are applied to occupational therapy treatment through occupational performance problem identification via an occupational performance measure, action plan development to implement new skills outside of treatment sessions, collaborative goal setting related to identified problem areas, tapering of session frequency as client progresses with the client demonstrating independence in skill application at discharge, and a treatment focus on occupational and cognitive adaptation. The change process occurs as the client learns to challenge core beliefs of self, utilize adapative strategies, assess situations more accurately, develop a more realistic sense of self, and increase self-efficacy through cognitive behavioral strategies. The change process leads to independent application of cognitive behavioral strategies across occupations and contexts to improve performance and satisfaction in valued roles and routines. Concepts of the CB-FoR theory from Duncan (2020) have been visually mapped below.

Visual map of key elements in the causal pathway of the CB-FoR (Jones, 2024).


American Occupational Therapy Association. (2020). Occupational therapy practice framework: Domain et process. PDF, American Occupational Therapy Association.

Duncan, A.S.E. (2020). Foundations for Practice in Occupational Therapy. Sixth Edition, 147.

Ikiugu, M. N., Nissen, R. M., Bellar, C., Maassen, A., & Van Peursem, K. (2017). Clinical effectiveness of occupational therapy in mental health: A meta-analysis. The American Journal of Occupational Therapy, 71(5), 1-10.

Jones, M. (2024). A cognitive behavioral approach to improving performance and satisfaction in meaningful occupations in the outpatient mental health occupational therapy setting. Occupational Therapy in Mental Health.

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