Activity therapy uses planned, purposeful activities — work, crafts, art, music, movement, recreation, cooking, and daily-living tasks — to improve mental health and function. The process of doing the activity, and what the client learns from it, matters more than the finished product.

Therapeutic goals

• Improve reality testing and orientation
• Build social and interpersonal skills (cooperation, patience, sharing, conflict management)
• Restore self-esteem, a sense of achievement, and control through success experiences
• Improve concentration, sequencing, planning, and problem solving
• Provide a safe outlet for tension, energy, and emotions
• Structure the day and reduce withdrawal and boredom
• Prepare for independent living and work (psychosocial rehabilitation)

Activity therapy is delivered by occupational therapists, recreational therapists, creative-arts therapists, and nurses, usually in groups on inpatient units, day programs, and community centers.

Types of activity therapy

Before planning, assess:

• Current level of functioning — cognition, attention span, energy, motor skills
• Interests, culture, past hobbies, and personal goals
• Symptoms that affect participation: withdrawal, psychosis, mania, anxiety, suicidality
• Physical limitations and medication effects (sedation, orthostatic hypotension, heat sensitivity)
• Safety risks from equipment (scissors, knives, cords, glass)
• Response during activities: attention, frustration tolerance, cooperation, mood, interaction

Planning principles

1. Base the activity on the client's current functioning level and interests — choose tasks with a high chance of success, then increase complexity gradually
2. Set clear, individualized goals linked to the care plan
3. Start with simple, structured, short activities and individual or small-group formats for low-functioning or withdrawn clients
4. Grade social demand: one-to-one → small group → large group
5. Emphasize process over product; avoid competition and pressure for perfect results
6. Include a processing (debriefing) phase after the activity

Structure of an activity group: planning → introduction (purpose, rules) → activity → processing (discuss feelings, thoughts, and behaviors that came up and link them to real life) → closure.

Sample processing questions

• "How did you feel when you started the task, and how do you feel now?"
• "What made it easier or harder to work with others today?"
• "When you felt frustrated, what did you do? What else could you try?"
• "Where could you use what you practiced today after discharge?"

Special age groups

• Children: play therapy uses toys, drawing, and games to express feelings they cannot put into words; keep sessions short and structured
• Adolescents: peer-based, skill-building, and physical activities; allow choice to support autonomy
• Older adults: reminiscence, music, gentle exercise, and familiar tasks; adapt for vision, hearing, mobility, and fatigue

Matching activities to symptoms

Medication-related safety during activities

• Antipsychotics: sedation, orthostatic hypotension, impaired temperature regulation (heat stroke risk) — provide fluids, shade, and rest in hot weather; some (e.g., chlorpromazine) cause photosensitivity — sunscreen and protective clothing
• Lithium: heavy sweating and dehydration raise lithium levels and risk toxicity — ensure fluids and salt intake during exercise and heat
• Tricyclic antidepressants: orthostatic hypotension and anticholinergic effects (reduced sweating) — rise slowly, hydrate
• Benzodiazepines and sedating drugs: drowsiness and falls — supervise activities requiring coordination or tools

Listed in priority order.

1. Ensure safety — account for sharp tools and equipment; supervise clients at risk of self-harm; adjust for medication effects and fall risk
2. Match activity to function and symptoms (table above); start where the client can succeed
3. Act as facilitator, not instructor or judge — create a supportive, nonjudgmental atmosphere; encourage without pressure; do not criticize or rank results
4. Encourage participation gently — invite withdrawn clients personally; allow observing first
5. Limit stimulation for manic, psychotic, or agitated clients; redirect excess energy into safe physical tasks
6. Lead processing — ask what the client felt, noticed, and learned, and how it applies outside the unit
7. Evaluate — focus on how the client participated and what changes in function, mood, and social behavior were observed, not on the product; document objectively
8. Coordinate with occupational and recreational therapists and include activity goals in the care plan

• Regular physical activity improves mood, sleep, and energy and helps prevent weight gain from medications
• Plan enjoyable and meaningful activities into each day, especially during low mood
• Develop sober and healthy leisure activities to replace substance use or isolation
• Hydrate and protect from sun and heat when taking antipsychotics or lithium
• Continue activities after discharge through community centers, clubhouses, or peer groups

• Plan by current functioning level and interests, choosing tasks with high success potential
• Goal = reality testing, social skills, self-esteem, achievement, control — not a perfect product
• Process over product; the nurse is a facilitator
• Processing phase = discuss feelings, thoughts, and behaviors from the activity
• Withdrawn schizophrenia: simple, structured tasks (simple crafts, drawing)
• Depression: simple achievable individual tasks → sense of mastery and control
• Mania: solitary, noncompetitive, repetitive, gross-motor activities; low stimulation
• Social anxiety: grade from 1:1 → small group → large group
• Reality orientation = time, place, person cues for disoriented clients
• Group cooking builds cooperation and problem solving (substance use) and concentration and sequencing (schizophrenia)
• Evaluate participation and functional change, not product quality
• Watch heat intolerance with antipsychotics and dehydration with lithium