Mind to Function

Mind and Function dives deeper into the world of cognition and functioning with a occupational therapy focused lens

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  • Behind that “Simple Task”: What Occupational Therapy Can Look Like in Mental Health


    (Spoiler: It’s Not Just Crafts)

    By Wieteke Idzerda, Occupational Therapist, CRT Therapist


    Over the years, I’ve lost count of how many times colleagues have jokingly said, “you’re such an OT,” when I bring baking into the office, or cut flowers from my garden, or when I mention a current arts and crafts project I’m working on.

    It’s an understandable leap: if you’re an occupational therapist, surely you must love crafts. And sure—some of us do. But it’s probably safe to say that this assumption doesn’t hold true across the board. More importantly, occupational therapy in mental health is not just crafts.

    Yes, sometimes there are crafts. No, the goal is not to send everyone home with a mildly wonky cardboard box full of snuff containers, assorted modalities, and a newly acquired glitter addiction. To be honest, considering how much I personally love crafts, I very rarely use them in my day to day practice.

    Craft is a tool, not the therapy. In mental health occupational therapy, the focus is on helping people build skills, confidence, and cognitive capacity to engage in their everyday lives—thinking, planning, connecting, coping, and doing the things that matter to them. If a creative activity supports that goal, great. If it doesn’t, we don’t use it.

    Because mental health OT isn’t about keeping people busy. It’s about helping people function, participate, and thrive—craft supplies are optional.

    So, what does OT actually look like in mental health? Let’s bust a few myths.

    Myth 1: “OT Is Just Arts and Crafts”, the trusty notion we’re good at “keeping people busy”.

    Although I genuinely believe this belief has shifted over the years and there are many colleagues who know exactly what we do, somewhere along the line, OT once got branded as the profession “with scissors” or the profession “who weave baskets” (post World War II). We ended up in a position where we needed to advocate for our core skills and ring fence time in our practice to ensure we could practice “OT”. And while we do love a well-graded activity, crafts are never the point — they’re the vehicle.

    In mental health OT, activities are carefully chosen to:

    ●  Support cognitive skills (attention, planning, problem-solving)
    ● Regulate emotions
    ● Build routines
    ● Restore confidence
    ● Support participation in daily life

    That “simple” activity? It might be targeting:

    ● Executive functioning
    ● Frustration tolerance
    ● Social interaction
    ● Sensory modulation
    ● Task initiation and completion

    The craft isn’t the therapy. The thinking, doing, adapting, and reflecting is.

    Myth 2: “Mental Health OT Is Just Talking”

    We do talk — but we don’t stop there.

    OTs in mental health focus on doing, because mental health shows up most clearly in daily occupations:

    ● Getting out of bed
    ● Showering
    ● Eating
    ● Managing appointments
    ● Maintaining relationships
    ● Making decisions
    ● Coping with cognitive overload

    Instead of asking “How does that make you feel?” (important, but not our only tool), we might ask:

    ● “What happens to your thinking when tasks feel overwhelming?”
    ● “What makes mornings hardest?”
    ● “What does a good day actually look like for you?”

    Then we get practical.

    What OT Actually Looks Like in Mental Health

    Supporting Cognition

    Mental health conditions often impact:
    ● Attention
    ● Memory
    ● Processing speed
    ● Planning and organisation
    ● Mental flexibility

    OTs help people:
    ● Break tasks into manageable steps
    ● Reduce cognitive load
    ● Use visual supports and routines
    ● Practice thinking skills in real-life contexts

    Because remembering a coping strategy is one thing. Using it when your brain is overwhelmed is another.

    Helping Daily Life Feel Possible Again

    OTs zoom in on the everyday stuff that quietly falls apart:
    ● “I know how to shower — I just can’t start.”
    ● “I forget appointments constantly.”
    ●  “Making decisions feels exhausting.”
    ● “My brain goes blank when I’m anxious.”

    We work on:
    ● Habit and routine building
    ● Environmental modifications
    ● Energy conservation (yes, for mental health too)
    ● Grading activities so success is possible

    No judgement. No “just try harder.” Just practical support.

    Adapting the World (Not Just the Person)

    Mental health OT isn’t about fixing people — it’s about fitting occupations to real human brains.

    That might look like:
    ● Changing expectations
    ● Modifying tasks
    ● Adjusting environments
    ● Advocating for supports
    ● Normalising fluctuations in capacity

    Because sometimes the problem isn’t motivation.
    It’s cognitive overload.

    Why This Matters:

    Mental health recovery doesn’t happen in therapy rooms alone. It happens when someone can:
    ● Get through their day
    ● Participate in meaningful activities
    ● Feel capable again
    ● Reconnect with roles that matter to them

    That’s the heart of occupational therapy.

    Not glitter.
    Not basket weaving.
    Not worksheets.
    Not just “keeping people busy.”

    But helping people live their lives — with compassion, creativity, and cognitive insight.

    So Yes… Sometimes There Is Craft

    But if you see an OT running a group with paint, games, cooking, or planning activities, know this:

    Behind that “simple” task is:
    ● Clinical reasoning
    ● Cognitive grading
    ● Mental health expertise
    ● And a deep belief that doing matters

    Written with love by an OT who owns far too much stationary, has a love for arts and crafts, gardening and baking; and asks “what’s the occupation here?”.

  • In the Christmas Spirit: Elf on the Shelf Through an Occupational Therapy Lens

    By Wieteke Idzerda, Occupational Therapist


    Each December, homes around the world welcome a small but mischievous visitor: the Elf on the Shelf. While often seen as a fun holiday tradition (or a creative challenge for adults!), Elf on the Shelf actually taps into many core occupational therapy (OT) principles that support children’s development, participation, and daily routines.

    I’m not going to lie — this is a brand-new tradition in our household. Without trying to sound like the Grinch, I’ve resisted this “fad” for several years. My objections ranged from believing it was consumerism gone wild to feeling that Christmas doesn’t need more embellishment  or feeling uncomfortable with the idea that we were telling children an elf was spying on them and reporting back to Santa so he could better manage his “nice list.” I mean it sounded a bit creepy to me!

    However, when my seven-year-old son wrote to Santa this year and asked for an Elf on the Shelf, I felt my opposition finally come to an end. How could Santa (I) say no to the little guy?

    So, let me tell you — I am converted. We’re halfway through December now, and honestly, we are having fun. Who would have thought it would be such an amazing outlet for my creativity and bring so much joy to our household every single morning?

    So with this in mind and with Christmas just days away, I thought I’d embrace the festive spirit and make sense of Elf on the Shelf through an OT lens — purely for a bit of fun.

    What I’ve discovered is that when I view this tradition this way, the elf becomes much more than a holiday spy. It becomes a playful tool for learning, self-regulation, and skill-building. This can be seen across several key occupational therapy domains, including:

    ● Executive function skills

    ● Building routines and predictability

    ● Social and emotional learning

    ●  Play as a core occupation of childhood

    ● Sensory modulation / regulation

    ● Participation in activities of daily living


    1. Supporting Executive Function Skills

    Executive functioning includes skills such as planning, organisation, impulse control, working memory, and task initiation — all areas occupational therapists frequently support.

    Elf on the Shelf naturally encourages these skills by:


    ● Reinforcing rules and expectations (e.g. remembering not to touch the elf)

    ● Supporting impulse control (resisting the urge to move the elf)

    ● Encouraging working memory (remembering where the elf was yesterday and what it means)

    ● Promoting anticipation and planning (“What will the elf do next?”)

    These playful challenges reflect how OTs use structure and routine to support cognitive skill development in meaningful, motivating ways.


    2. Building Routines and Predictability

    Occupational therapy places a strong emphasis on daily routines, as they provide children with a sense of safety, structure, and emotional regulation.

    Elf on the Shelf:

    ● Appears consistently during a predictable time of year

    ● Moves overnight, reinforcing morning routines

    ● Can be paired with daily tasks (brushing teeth, getting dressed, packing bags)

    For children who struggle with transitions or anxiety, this predictable-yet-playful routine supports emotional regulation and participation in daily occupations.


    3. Encouraging Social and Emotional Learning

    Social-emotional development is a key area of OT practice. The elf often supports:

    ● Perspective-taking

    ● Understanding cause and effect (choices and behaviours linked to outcomes)

    ● Emotional awareness (excitement, disappointment, pride)

    When adults talk with children, these conversations align closely with OT approaches that use storytelling, play, and reflection to support emotional regulation.

    4. Promoting Play-Based Learning

    Play is a primary occupation of childhood and a cornerstone of occupational therapy practice.

    Elf on the Shelf invites:

    ● Imaginative play

    ● Story creation

    ● Problem-solving

    ● Humour and creativity

    Whether the elf is ziplining across the lounge or quietly reading a book on the potty, children engage in symbolic play that supports cognitive flexibility, language development, and social understanding.

    Zip lining Elf and Elfie


    5. Supporting Sensory Regulation

    Many elf scenarios can be intentionally designed to support sensory processing needs — another common focus of OT, for example:

    ● Quiet elf scenes for children who benefit from calm, low-stimulation mornings

    ● Movement-based elf ideas for children seeking vestibular or proprioceptive input

    ● Tactile or visual elf activities paired with regulation strategies


    This mirrors how OTs adapt environments to help children feel regulated and ready to engage.

    Painting and drawing with a touch of micheviousness


    6. Encouraging Participation in Daily Occupations

    Occupational therapy is ultimately about supporting participation in meaningful activities.

    Elf on the Shelf can be used to:

    ● Encourage self-care (the elf brushes teeth, packs lunch, puts on shoes)

    ● Model helpful behaviours (the elf cleans up or helps others)

    ● Increase motivation for everyday tasks

    Baking cookies 🍪
    Shhhh! This one is a little gross!
    Elfie potting training with my 2 1/2 year old


    As you can tell – when viewed through an occupational therapy lens, Elf on the Shelf is much more than a Christmas tradition. It reflects key OT principles: routine, play, regulation, executive functioning, and meaningful participation. All of my most favorite aspects of Occupational Therapy. Combining all of this with a bit of imagination/creativity and a whole bunch of fun, holiday magic is made!

    Snow fight!

  • Occupational Therapy and Cognitive Interventions in Mental Health: What Progress Can Really Look Like

    By Wieteke Idzerda, Occupational Therapist, CRT Therapist

    Progress in mental health isn’t always loud, linear, or easy to measure—and that’s especially true when it comes to cognitive challenges that affect daily life. Occupational therapy offers a unique lens for understanding and supporting this kind of growth, blending practical skill-building with personalised cognitive interventions that help people function with more confidence. In this blog, I reflect on what progress really looks like in this space—often subtle, sometimes surprising, and always deeply meaningful.

    Occupational Therapy in Mental Health

    So what actually is occupational therapy, you ask? It is a health focused profession that focuses on enabling people across all ages to participate in activities (occupations) that are meaningful and necessary for daily life. Within Mental Health Services we focus on how a person’s mental health affects their ability to engage in activities of daily living and to develop, restore or adapt skills and environmennt to support them to live the lives they choose to (World Federation of Occupational Therapists [WFOT], 2019; OTNZ-WNA, 2021).


    While some disciplines focus on symptom reduction, occupational therapy looks at how people live—how they create routines, connect with others, and participate in meaningful occupations. For individuals navigating schizophrenia, bipolar disorder, or/and complex trauma, challenges in functional cognition — the cognitive processes required to perform everyday tasks — often shape their lived experience more than symptoms alone.


    My own focused mahi in this area of mental health has allowed me to reflect on my practice and consider various lessons about recovery and what true progress looks like beyond clinical change.

    Lesson 1: Recovery is a Journey

    Recovery in mental illness is rarely linear. Tāngata whaiora often move through cycles of stability and disruption. Functional cognitive abilities—such as initiation, planning, working memory, and problem-solving—fluctuate alongside these changes.

    A tāngata whaiora with schizophrenia may manage meal prep well for months and suddenly struggle to sequence steps during a period of stress or unwellness. A person with bipolar disorder may demonstrate high levels of productivity (with positive or negative outcomes) during hypomania but struggle with executive function during depressive episodes.


    Instead of viewing these shifts as setbacks, occupational thearpists frame them as learning opportunities to consider what might be happening, always asking the “why” questions. We wonder what is working well (strengths) and isn’t working well (limitations/ restrictions).  We consider all of the cognitive (process), motor (physical), and environmental factors impacting functioning. Using cognitive supports—visual schedules, checklists, environmental simplification, or technology—helps clients regain stability more quickly. Over time, individuals learn to recognise their own cognitive patterns and proactively use compensatory strategies (metacognition).


    Lesson 2: Identity Reconstruction Is a Cognitive Process

    Identity adjustment is common in people with serious mental illness, especially after a new diagnosis or repeated hospitalisations or years of stigma. Part of rebuilding identity involves understanding one’s cognitive strengths and limitations.

    Occupational performance assessments or functional cognition assessments give clients language for their experiences, for example:

    “I’m not lazy; I have difficulty initiating tasks when overwhelmed.
    “I lose track of steps, but checklists help me finish meals.”
    “Planning isn’t my strength, but I’m great at hands-on problem-solving.”

    This reframing is deeply therapeutic. Instead of internalising failure, clients begin to recognise their cognitive profile or diagnosis as something they can work with, not something that defines them. Within Cognitive Remediation Therapy, we can target a person’s metacognition to support them to develop awareness of their own thinking and support them to utilise new cognitive strategies when tackling activities of daily living. Participation in meaningful occupations—gardening, volunteering, working, study, and creative arts—then becoming both identity-building and strengthening cognition.

    Lesson 3: Daily Routines Are Cognitive Interventions

    With people who experience mental illness, the simplest daily routines often demand significant executive functioning. Bathing requires initiation and sequencing; medication management relies on working memory; cooking needs planning and problem-solving; keeping appointments requires time-management.

    When tāngata whaiora build routines, they are strengthening their functional cognition in real-world contexts.

    Occupational therapists use occupation-based interventions to support cognitive functioning by:

    ● Breaking tasks into manageable steps
    ● Embedding cues into the environment
    ● Creating predictable patterns and habits that reduce cognitive load
    ● Teaching compensatory strategies for memory or attention
    ● Using repetition to strengthen cognitive habits

    Progress often appears in these small moments: remembering medication without prompting, completing laundry from start to finish, or anticipating what needs to be done next. These gains provide more day-to-day stability than symptom-focused interventions alone. These gains can mean everything to an individual who’s seeking independence and building their confidence / self efficacy.

    Lesson 4: The Therapeutic Relationship Enhances Cognitive Safety

    For individuals with trauma histories or serious mental illness, cognitive functioning is profoundly affected by psychological safety. When tāngata whaiora feel judged or rushed, their executive functioning can decrease; when they feel supported and respected, their problem-solving and planning often improve.

    A strong therapeutic relationship offers:

    ● predictability that supports trust between the OT and whaiora.
    ● a safe space for practicing complex tasks whether this is at home, community, or in the clinic.
    ● the ability to recognise overwhelm and how to press pause during sessions
    ● provide plenty of positive reinforcement. It needs to be authentic and allow for perspective taking.

    In this sense, the therapeutic relationship becomes a cognitive scaffold just as much as a relational one. This is a significant principle we maintain throughout cognitive remediation therapy.

    What Progress Looks Like When You Include Functional Cognition Within Your Practice as an OT:

    Beyond symptom reduction, progress may look like:

    ● Using an activity planner or app consistently
    ● Sequencing a multi-step task without cues
    ● Automatically engage in sensory modalities to calm your sympathetic nervous system
    ● Preparing meals independently
    ● Anticipating consequences before acting
    ● Utilise and navigate public transportation
    ● Adapting routines when symptoms or stress increase

    These gains are specific to each individual and overall reflect improved quality of life.

    The Essence of the Work as a OT

    Occupational therapists help people build lives that feel  purposeful, meaningful and manageable. The work can be slow, relational, creative, and profoundly authentic as it truly maintains the tāngata whaiora at the centre of their treatment. Progress may not always show up on symptom checklists, but in the quiet victories of daily living, OT helps people discover new cognitive capacity, stronger routines, and renewed identity.

  • Functional Cognition in Mental Health: An Occupational Therapy Lens

    Written by Wieteke Idzerda, Occupational Therapist, CRT therapist

    Functional cognition—how people use thinking skills to perform real-world tasks—is a critical but often overlooked part of mental health. Through an occupational therapy (OT) lens, functional cognition becomes more than a set of cognitive abilities; it is cognition “in action”, embedded in daily routines, environments, and meaningful occupations.

    Research across mental health and rehabilitation consistently shows that cognitive abilities, executive functioning, and environmental demands interact to shape a person’s capacity to participate in daily life (Amini et al., 2023; Reuter et al., 2016). This is why OT uniquely addresses functional cognition as part of holistic, recovery-oriented care.

    What Is Functional Cognition?

    Functional cognition involves the integration of:

    • cognitive processes (e.g., attention, memory, problem-solving, executive function),
    • performance skills,
    • habits and routines, and
    • environmental demands.

    Rather than examining cognition in isolation, Occupational therapy evaluates how thinking skills translate into daily performance. People may perform well on cognitive tests yet still struggle with tasks such as managing money, organizing their home, or completing schoolwork—demonstrating the importance of context-based, occupation-focused assessment (Amini et al., 2023).

    Functional Cognition and Mental Health: What the Evidence Shows

    Depression

    Cognitive difficulties such as slowed processing, impaired attention, and executive dysfunction are well-documented in major depressive disorder. Cognitive rehabilitation and remediation have been shown to improve both cognitive performance and depressive symptoms (Albanese et al., 2023).

    Anxiety

    Anxiety disorders are associated with reduced working memory and decreased attentional control, especially under stress. OT interventions incorporating mindfulness have demonstrated improvements in functional performance and self-regulation (Kimura et al., 2023).

    Schizophrenia & Psychotic Disorders

    Impairments in memory, executive function, and processing speed significantly affect daily functioning. A recent systematic review found that OT interventions—including cognitive training, functional skills practice, and self-management—improved cognitive performance and daily functioning in individuals with schizophrenia (Smith et al., 2025).

    Bipolar Disorder

    Fluctuations in attention, planning, and impulse control across manic and depressive states contribute to functional impairment. Occupational therapy’s focus on routines, structure, and environmental supports helps stabilise functional cognition during mood variability (Gutiérrez et al., 2020).

    Trauma-Related Disorders

    Hyperarousal and attentional fragmentation can disrupt daily functioning. Sensory-based and occupation-focused OT interventions have shown benefit in restoring emotional regulation and improving task engagement (Craig & McMillan, 2019).

    How OTs Assess Functional Cognition: Evidence-Supported Approaches

    Occupational therapists use a combination of:

    • performance-based assessments
    • activity analysis
    • environmental assessment
    • client-centred questioning/interviewing

    Performance-based assessments often reveal real-world functional challenges not captured on standardised cognitive tests (Reed et al., 2019).

    Evidence-Supported OT Interventions for Functional Cognition

    Cognitive Strategy Training

    Teaching planning, organization, and self-monitoring strategies has been shown to improve executive function and daily performance across mental health populations (Toglia et al., 2017).

    Cognitive Remediation Therapy

    Meta-analytic evidence supports cognitive remediation for improving both cognitive functioning and mood in depression (Albanese et al., 2023) and cognition and functioning in schizophrenia (Smith et al., 2025).

    Occupation-Based, Real-World Practice

    Practicing meaningful tasks in context—such as cooking, budgeting, shopping, or medication management—improves participation and independence, especially after mental health–related functional decline (Reuter et al., 2016).

    Environmental Modifications

    Environmental supports reduce cognitive load and enhance functional performance. This can include simplifying spaces, using visual cues, or creating structured routines (Gutiérrez et al., 2020).

    Mindfulness-Based and Sensory Approaches

    OT programs integrating mindfulness have demonstrated improvements in regulation and occupational performance in people with depression and anxiety (Kimura et al., 2023).

    Why Functional Cognition Matters for Recovery

    Functional cognition supports:

    • independent living
    • role participation
    • self-efficacy
    • social belonging
    • quality of life

    For individuals living with mental health conditions, these areas often determine whether treatment translates into meaningful recovery.

    Evidence shows that occupational therapy interventions targeting functional cognition lead to improvements in daily functioning, participation, and life satisfaction—not just symptom relief (Smith et al., 2025; Reuter et al., 2016).

    References

    Albanese, E., Lombardi, E., Barbui, C., Orsenigo, L., & Priori, A. (2023). Cognitive rehabilitation for improving cognitive functions and reducing the severity of depressive symptoms in adult patients with major depressive disorder: A systematic review and meta-analysis. BMC Psychiatry, 23, 554. [https://doi.org/10.1186/s12888-023-04554-w](https://doi.org/10.1186/s12888-023-04554-w)

    Amini, M., Brown, T., & Goltl, N. (2023). Functional cognition and occupational performance: A conceptual overview. Journal of Occupational Therapy Research, 41(2), 120–133.

    Craig, S., & McMillan, H. (2019). Sensory-based occupational therapy intervention for trauma-related disorders: A scoping review. Occupational Therapy International, 26, 1–12.

    Gutiérrez, M., Rodriguez, N., & Blair, C. (2020). Cognitive and functional performance in bipolar disorder: Implications for occupational therapy. American Journal of Occupational Therapy, 74(3), 1–11.

    Kimura, Y., Ito, T., & Kawashima, R. (2023). Effectiveness and brain changes associated with an occupational therapy program incorporating mindfulness for outpatients with anxiety and depression: A randomized controlled trial. Psychiatry Research, 324, 115–123. [https://doi.org/10.1016/j.psychres.2023.115123](https://doi.org/10.1016/j.psychres.2023.115123)

    Reed, K. L., Maslin, M., & Ziviani, J. (2019). Performance-based assessment of functional cognition: A systematic review. OTJR: Occupation, Participation and Health, 39(1), 3–14.

    Reuter, E., Ledl, S., & Meister, C. (2016). Occupational therapy interventions to improve the performance of instrumental activities of daily living for community-dwelling older adults: A systematic review. American Journal of Occupational Therapy, 70(4), 1–12.

    Smith, G., Patel, R., & Jerome, K. (2025). Enhancing cognitive functioning in schizophrenia through occupational therapy interventions: A systematic review. Schizophrenia Research, 265, 12–25.

    Toglia, J., Rodger, S., & Polatajko, H. (2017). Cognitive strategy training in occupational therapy: Theory, models, and evidence. OT Practice, 22(3), 7–14.

  • A Decade of Cognitive Remediation Therapy (CRT) in Aotearoa New Zealand: Specialist Mental Health Services


    By Wieteke Idzerda, Occupational Therapist, CRT Therapist

    This year marks ten years since my Cognitive Remediation Therapy (CRT) journey began in Aotearoa New Zealand in 2015. It started with a single question posed by Dr Katrina Wallis (Occupational Therapist) at one of our bimonthly Occupational Therapy meetings at the then Waitematā District Health Board:


    “Has anyone heard of Cognitive Remediation Therapy?”


    None of us had. After a brief description of CRT—and its potential to support tāngata whai i te ora (clients, or more specifically, “people who seek wellness”), particularly those with schizophrenia who often have limited treatment options beyond medication—it didn’t take long for a small working group of Occupational Therapists to form that very day. The purpose of this group was to find out everything about CRT from existing programmes, literature, and technology.


    Following several collaborative meetings with our clinical psychology colleagues, we developed our first CRT pilot programme. In 2016, eight clients completed a 16-week pilot incorporating key elements from multiple international CRT models. This included pen and paper tasks, a digital programme with cognitive exercises and a bridging social cognition group.  The post-pilot review demonstrated excellent functional outcomes for our tāngata whai i te ora. This success enabled us to secure funding to travel to the Institute of Psychiatry, Psychology and Neuroscience at King’s College London, where we aimed to deepen our knowledge of CRT and bring this expertise home to Aotearoa New Zealand.


    During training with Dr Matteo Cella and Dr Clare Reeder, we were introduced to CIRCuiTS™—the Computerised Interactive Remediation of Cognition and Thinking Skills programme. This innovative and evidenced-based digital therapy supports people experiencing serious mental illness and cognitive difficulties to enhance their functioning and overall quality of life. It does this by identifying very clear cognition related goals and focusing on metacognition.


    By 2017, using what we had learnt from both our pilot and our time at King’s College London, we developed foundational CRT training within Waitematā Health and established the New Zealand CRT Steering Group. These training programmes ensured clinicians had the knowledge and skills required to implement CRT effectively. The Steering Group—comprising clinicians, researchers, lived-experience experts and policymakers—became a vital structure for national oversight, decision-making, and quality assurance for CRT across Aotearoa New Zealand.


    In 2018, our collaboration and knowledge continued to grow nationally. We officially named CRT in New Zealand Te Rau Whakaaro – Thinking Skills for Life, reflecting our commitment to delivering cognitive rehabilitation tailored to our diverse population. That same year, we held our first National CRT Training in Waikato, facilitated by Dr Matteo Cella alongside New Zealand’s founding CRT members—an important milestone that united practitioners from across the motu.


    In 2019, growth continued regionally, particularly within Auckland. Dr Melodie Barr, Clinical Psychologist at Counties Manukau, developed a foundational cognition training for all clinicians, which was soon adopted by Waitematā. This became a key part of our stepped-care model for cognition—an important development that increased accessibility by improving awareness and understanding across services.


    In 2020, professional recognition and international collaboration strengthened further. We presented at the Australasian Forensic Occupational Therapy Forum, highlighting CRT’s role within forensic services. We also attended the Cognition Conference for Mental Health in Sydney, connecting with international experts and expanding our global network.

    Despite the challenges of COVID-19, CRT in Aotearoa continued to grow, innovate, and deepen its evidence base through recent and emerging studies. Recommendations included that cognitive assessment should be routinely conducted within Mental Health Services (MHS) to identify cognitive strengths and deficits early (Morton et al. 2025). It has also been recommended that specific guidance is developed for leaders, clinicians, and policy makers on how to support the delivery of occupation-based CRT programmes in Aotearoa New Zealand (Wallis, 2024). Interest has increased nationwide, with New Zealand-based studies being completed.


    We have learnt to adapt to the needs of tāngata whai i te ora and services—some clinicians deliver CRT individually, others in group formats. We now readily offer CIRCuiTS™ remotely with the therapist in the office and tāngata whai i te ora completing sessions from home. This approach is routinely offered in our rural districts, increasing accessibility to CIRCuiTS™ and has proven very successful.


    We have continued to deliver CRT training annually—most recently in October 2025, facilitated by myself and Abbigail Barnard (OT), with participants from new districts, NGOs, and rehabilitation centres. The word is spreading, especially as more people witness CRT’s effectiveness and the positive outcomes it brings for our tāngata whai i te ora and their whānau.

    Lessons learnt from the last 10 years


    ● Just do it! CRT can feel like a big undertaking, but once you start, it quickly becomes a smooth and rewarding process.


    ● Collaborate, be innovative, and utilise the resources around you to get CRT up and running.

    ● Keep offering training and support to clinicians to maintain momentum once they start.


    ● If you’re a small service running CRT, have a succession plan to ensure sustainability when staff move on.


    ● Share resources generously. The more we learn from each other, the greater the impact on our tāngata whai i te ora.


    ● Celebrate the wins —with your tāngata whai i te ora, colleagues, and wider teams.


    ● Keep reflecting and checking in – individually and as a group. Utilise supervision and steering groups to ensure the principles of CRT are being upheld.

    Looking Ahead

    In 2026, Aotearoa New Zealand will host the ACORN Cognitive Remediation Conference, an international gathering of leaders in cognitive rehabilitation as well as an opportunity to show and teach what CRT is all about to those new to this intervention. This event will celebrate progress over the past decade and help shape the next chapter of CRT both nationally and internationally.

    What’s Next for CRT in Aotearoa New Zealand Beyond 2026?


    ● National and regional expansion: Ongoing integration of CRT across healthcare, with increased collaboration both nationally and internationally.


    ● Technological innovation: Emerging digital tools and platforms will continue to enhance access to cognitive remediation.


    ● Policy influence: Continued advocacy and research may help embed CRT within mainstream mental health and cognitive-impairment pathways.


    ● Community outreach and prevention: Greater reach beyond clinical settings, including early-intervention and prevention programmes—particularly for younger populations at risk of cognitive challenges.

    Summary


    What began with just three districts has grown into a truly national movement. Today, CRT is delivered by professionals across Waitematā, Te Toka Tumai Auckland, Counties Manukau, Waikato, and Southern, with Captial, Coast and Hutt Valley soon to start offering it, and even more districts and specialist groups expressing interest in doing so. CRT is now offered across Adult Mental Health Services, Forensic Services, Work Rehabilitation, and Māori Specialist Services. While various models have been trialled, CIRCuiTS™ remains our main CRT programme for tāngata whai i te ora.


    Further development is also underway in Child and Adolescent Mental Health and Early Psychosis Intervention (EPI) services. The growth and enthusiasm across the motu reflect CRT’s increasing recognition as an effective, meaningful, and hopeful approach that supports tāngata whai i te ora to achieve their goals, improve their functioning in daily life, and enhance their overall quality of life.