title: The Tree Theme Method® (TTM), an occupational therapy intervention for treating depression and anxiety: study protocol of a randomized controlled trial.
abstract: BACKGROUND
  Depression and anxiety disorders are increasing among the general population in the Western world. Individuals may need several kinds of treatment in order to maintain health, such as cognitive behavioural therapy (CBT) and drug treatment. However, having an everyday life that "works" is also important, suggesting a need for interventions based on activities that facilitate a satisfying everyday life. There is still lack of such evidence-based interventions. The Tree Theme Method(®) (TTM) is an occupational therapy intervention designed for a client-centred context in which an individual develops strategies to become an actor in his or her everyday life. Previous studies of the TTM have focused on process evaluation; therefore, further studies are needed to evaluate the method's effects. The aim of this paper is to outline an intervention that can evaluate the effects of the TTM in terms of psychological symptoms, as well as everyday occupations and well-being, in patients suffering from depression and anxiety.
  
  
  METHODS
  This randomized clinical trial includes patients from three Swedish counties randomized to either intervention or treatment as usual. Men and women aged 18-65 years who have been diagnosed with either depression or anxiety are eligible for inclusion. Data collection is carried out at baseline, and outcomes are assessed at the end of intervention, as well as at 3 months and 12 months after intervention ends. The outcomes measured are psychological symptoms, everyday activities, and health-related factors.
  
  
  CONCLUSIONS
  Depression and anxiety may create difficulties for individuals in the activities of their everyday lives to the extent that they require diagnosis and intervention. Despite this reality, evidence-based interventions that focus on everyday activities are lacking. Therefore, it would be useful to design a specific method for occupational therapy intervention that does precisely that. This study provides insight into the effects of the TTM, comparing it to occupational therapy treatment as usual.
  
  
  BACKGROUND
  ClinicalTrials.gov: NCT01980381; registered November 2013.
authors.affiliation: Department of Research and Development, Region Kronoberg, PO Box 1223, SE-351 12, Växjö, Sweden. birgitta.gunnarsson@kronoberg.se.|Department of Clinical Neuroscience and Rehabilitation, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden. birgitta.gunnarsson@kronoberg.se.
authors.forename: A Birgitta
authors.initials: AB
authors.lastname: Gunnarsson
authors.affiliation: Department of Rehabilitation, School of Health and Welfare, Jönköping University, Jönköping, Sweden. petra.wagman@ju.se.
authors.forename: Petra
authors.initials: P
authors.lastname: Wagman
authors.affiliation: Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden. carita.hakansson@med.lu.se.
authors.forename: Carita
authors.initials: C
authors.lastname: Håkansson
authors.affiliation: Department of Research and Development, Region Kronoberg, PO Box 1223, SE-351 12, Växjö, Sweden. katarina.hedin@kronoberg.se.|Department of Clinical Sciences in Malmö, Family Medicine Lund University, Lund, Sweden. katarina.hedin@kronoberg.se.
authors.forename: Katarina
authors.initials: K
authors.lastname: Hedin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001008:Anxiety Disorders / Q000628:therapy*; D002985:Clinical Protocols; D015928:Cognitive Behavioral Therapy / Q000379:methods; D003866:Depressive Disorder / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009788:Occupational Therapy / Q000379:methods*; D017063:Outcome Assessment, Health Care; D055815:Young Adult