Mind to Function

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.