Occupational Therapy for Anxiety and OCD: How OT is Changing Treatment at Mountain Valley

A Practical Approach to Healing Through Engagement

At Mountain Valley, the focus is not just on reducing anxiety and OCD symptoms but on helping teens heal, rehabilitate, and develop the real-world skills they need to engage in life with confidence. While traditional therapy is a critical piece of the puzzle, occupational therapy (OT) plays an equally vital role in supporting young people as they overcome fears, build life skills, and re-engage with everyday activities.

Under the leadership of Zack Schafer, an occupational therapist (OT) and the Executive Director of Mountain Valley, OT has been woven into the very fabric of the treatment model, ensuring that healing is not just about talking through fears but about actively confronting and overcoming them through purposeful, real-life activities.

What Is Occupational Therapy, and Why Is It Essential for Anxiety Treatment?

Unlike traditional talk therapy, occupational therapy focuses on action and engagement. It introduces teens to purposeful activities that help them develop the skills needed to navigate daily life, increase independence, and manage challenges in real-world situations. For those struggling with anxiety and OCD, OT is a game-changer because it shifts the focus from talking about fears to actively confronting and working through them.

At its core, OT helps individuals engage with their environment in meaningful ways. Whether it’s learning to wake up on time, manage personal hygiene, cook a meal, navigate a conversation, or be of service, occupational therapists help teens practice and master their ability to participate in daily life.

At Mountain Valley, OT is seamlessly integrated into every level of treatment—from program-wide scheduling to individual therapy sessions—ensuring that each resident gains the tools to translate therapeutic progress into real-world success.

How Mountain Valley Integrates Occupational Therapy into Treatment

Mountain Valley’s OT framework operates on three levels:

1. The Macro Level: How OT Shapes the Entire Program

At the macro level, OT principles guide the structure and daily routine at Mountain Valley. The goal is to mimic real-life environments and responsibilities so that teens develop skills they can carry with them beyond treatment.

One key concept guiding Mountain Valley’s approach is the Five Cs of Occupational Engagement, adapted from the work of occupational scientist Dr. Rachel Thibault:

• Centering – Activities that are routine, repetitive, and provide a sense of calm and focus (e.g., walking, breathing exercises, knitting, laundry, dishes).
• Contemplation – Activities that foster reflection and experiences of awe (e.g., journaling, nature walks, prayer, meditation).
• Connection – Activities that foster relationships and a sense of belonging (e.g., group activities, community meetings, team-building exercises).
• Contribution – Activities that provide opportunities to be of service (e.g., farm work, meal preparation, community service, community responsibilities).
• Creativity – Activities that encourage imagination, self-expression, and problem-solving (e.g., art, music, storytelling, role-playing).

Every group activity, chore, and therapeutic module at Mountain Valley is designed with these core occupational needs in mind, ensuring that the entire treatment environment supports both healing and skill development.

2. The Meso Level: OT as a Consultant in Treatment Planning

At the meso level, OT plays a consultative role, supporting both clinicians and residential staff in developing strategies that help teens overcome functional challenges.

Some key ways OT is used in treatment planning at Mountain Valley include:

• Customizing exposure therapy – Helping clinicians design and adapt exposures in ways that feel manageable, structured, and functional.
• Supporting executive functioning – Providing visual schedules, step-by-step guides, and organizational tools for teens struggling with time management and task completion.
• Helping with sensory and emotional regulation – Teaching staff about residents’ sensory processing needs and ensuring the environment provides the necessary sensory input for regulation.
• Guiding life skills training – Teaching residential staff how to scaffold daily living skills so that teens gradually gain independence.

For example, if a teen struggles with cleaning their room, the OT might:

• Create a visual checklist to break down tasks into manageable steps.
• Work with staff to introduce verbal and physical prompts as needed.
• Gradually reduce support as the teen becomes more independent.

This approach ensures that daily activities don’t just feel like rules or chores—they become essential parts of the therapeutic journey.

3. The Micro Level: Direct OT Interventions with Teens

At the micro level, occupational therapy sessions focus on hands-on skill-building and individualized coaching, helping teens foster self-awareness and confidence so they can re-engage in everyday activities that may have felt overwhelming before.

Some key areas where direct OT interventions help include:

1. Activities of Daily Living (ADLs)

Many teens with anxiety and OCD struggle with basic self-care routines. OT sessions help them:

• Develop functional morning and evening hygiene routines (brushing teeth, showering, skincare).
• Learn how to dress appropriately and comfortably.
• Build confidence in cleaning and organizing personal space.

For some teens, these are not just tasks—they are significant barriers to independence. Something as simple as learning how to shower properly can dramatically improve self-esteem and quality of life.

2. Social Participation & Communication Skills

Social anxiety can make even basic interactions feel overwhelming. OT helps teens:

• Role-play social situations to build confidence in real-world interactions.
• Learn conflict resolution and assertiveness skills.
• Develop comfort in group settings through structured, supportive activities.

For many teens, learning to navigate social interactions in therapy makes it easier to apply these skills in real life.

3. Life Skills & Exposure Therapy Integration

One of the most powerful aspects of OT at Mountain Valley is how seamlessly it integrates with Exposure and Response Prevention (ERP).

Rather than just talking about fears, OT helps teens engage in real-life activities that naturally challenge their anxiety. Examples include:

• Shopping trips – Practicing interactions with cashiers, handling money, and managing social anxiety.
• Cooking projects – Encouraging independence and responsibility in meal preparation while building executive functioning skills.
• Public transportation practice – Gradually exposing a teen to navigating public spaces, asking for directions, and following schedules.

This practical approach ensures that exposure therapy feels purposeful and meaningful rather than just a clinical exercise.

4. Sensory Processing and Regulation

Each resident at Mountain Valley participates in a sensory assessment with the OT to develop self-awareness of their sensory system. This assessment includes practical recommendations for sensory-based strategies that can support emotional and overall well-being. Examples include:

• Chewing gum to improve focus.
• Using movement to increase alertness.
• Using deep pressure and touch to promote calmness.

Why Occupational Therapy Is Essential for Long-Term Success

Many teens struggling with anxiety and OCD know what they need to do, but their anxiety keeps them from doing it. Occupational therapy bridges this gap by helping them take action in a way that feels structured, manageable, and supportive.

By focusing on real-world skills, independence, and engagement, OT helps teens not only reduce anxiety symptoms but also build a life worth living.

If you or a loved one is struggling with anxiety or OCD, occupational therapy could be the missing piece in treatment.

Learn More: Listen to the Fear Less Podcast Episodes on OT

🎧 Listen to Zack interview Camille Wrege:
Occupational Therapy & Mental Health: Camille’s Journey to Helping Teens Overcome Anxiety

🎧 Solo episode with Zack on OT at Mountain Valley:
How Occupational Therapy Is Changing Mental Health Care at Mountain Valley