Presentation
Tess, aged 35, is a mother of two young children, aged five and eighteen months, who self-referred for Mental Health Occupational Therapy following a significant deterioration in her mental health and ability to manage everyday life.
Tess had been experiencing prolonged maternal burnout, chronic stress and severe emotional overwhelm. For an extended period, she had been operating at full capacity, managing parenting, household responsibilities and the constant demands of caring for two young children with very little opportunity for rest, recovery or self-care. By the time of self-referral, Tess described feeling as though her nervous system was constantly on high alert. She experienced racing thoughts, physical tension, irritability, heightened alertness and an inability to properly relax. She frequently felt as though she was operating in a persistent fight-or-flight response, with very little capacity to recover once activated.
Her ability to cope with everyday stressors had significantly reduced. Situations that previously felt manageable could trigger intense anxiety, panic and a sense of losing control. Tess experienced panic attacks when situations felt unpredictable or outside of her control. This had begun to affect her confidence leaving the house with her children, managing busy environments and coping with unexpected changes to her routine. Tess also experienced periods of intense anger and rage, particularly when she was experiencing high levels of sensory and emotional overload. Noise, crying, physical touch, household clutter and multiple competing demands could quickly push her beyond her coping capacity. Following these episodes, she experienced significant guilt and distress about her reactions. At times, Tess described feeling emotionally numb or detached, particularly following periods of intense anxiety and overwhelm. These experiences occurred in the context of significant stress and nervous system dysregulation, highlighting the need for early intervention and wider mental health support.
Tess also described intrusive worries and a strong need to prevent things from going wrong. She demonstrated some traits associated with perinatal OCD, although she did not have a formal diagnosis. Her anxiety was often fuelled by a need for certainty and control, particularly around the safety and wellbeing of her children. Sleep had deteriorated significantly. Even when her children were settled, Tess struggled to switch off mentally and remained alert to potential problems. Poor sleep further reduced her emotional regulation, stress tolerance and ability to manage sensory input and everyday demands. Her usual coping strategies had become ineffective. Tess had reached a point where she was either pushing herself through exhaustion or becoming completely overwhelmed and shutting down. Self-care had largely disappeared, and she had very little time or capacity for activities that supported her own wellbeing.
The severity of her presentation indicated a need for prompt Mental Health Occupational Therapy intervention. Given the level of nervous system dysregulation, panic, functional decline and risk of further deterioration, intervention focused on stabilisation, improving occupational functioning, developing practical coping strategies and reducing the risk of further mental health crisis or potential hospital admission.
Goal
The primary goal was to help Tess move out of a prolonged state of nervous system dysregulation and chronic stress, and develop practical strategies that would support her to regulate, cope and recover while continuing to manage the everyday demands of motherhood.
Specific goals included:
- Understanding the relationship between chronic stress, anxiety, sensory overload and nervous system dysregulation.
- Recognising early warning signs of escalating anxiety, panic and emotional overwhelm.
- Developing practical stress management and anxiety management strategies that could be used within everyday routines.
- Building a personalised set of coping strategies and wellness tools.
- Developing practical nervous system regulation strategies to reduce persistent fight-or-flight activation.
- Improving confidence with leaving the house and participating in family and community activities.
- Developing strategies to manage sensory overload and emotional dysregulation.
- Establishing more supportive routines around sleep, rest and recovery.
- Introducing realistic micro-moments of self-care within the demands of caring for two young children.
- Using pacing and energy management to reduce exhaustion and prevent further maternal burnout.
- Rebuilding greater balance between parenting, household responsibilities, self-care, rest and meaningful activity.
- Developing a clear relapse prevention and wellness plan to recognise and respond to early signs of deterioration.
Intervention
1. Nervous System Regulation Within Everyday Occupations
A central component of intervention was psychoeducation around the nervous system, stress response and fight-or-flight activation, with a focus on how prolonged stress, poor sleep, sensory overload and limited recovery could affect Tess’s ability to function in everyday life. Tess was supported to understand why she could move quickly from feeling capable of managing her day to feeling completely overwhelmed. This helped her develop greater awareness of the early signs that her capacity was becoming depleted, rather than viewing these responses as a personal failure or inability to cope.
A personalised, Occupational Therapy-specific nervous system regulation plan was developed, incorporating strategies that were realistic within the demands of caring for a five-year-old and an 18-month-old. These included paced breathing, grounding, gentle movement, time outdoors, sensory regulation, reducing environmental stimulation and creating brief periods of rest and quiet. The focus was on regulation before crisis. Tess was supported to recognise early signs of escalating arousal and respond proactively before anxiety, overwhelm and sensory overload significantly affected her functioning. Regulation strategies were integrated into her daily routines and occupations so that they became part of how she managed motherhood, rather than something she only used once she had reached crisis point.
2. Identifying Triggers, Early Warning Signs and Coping Strategies
Occupational Therapy assessment focused on identifying the specific situations, occupations and environmental demands that were most likely to overwhelm Tess. These included lack of sleep, excessive noise, multiple competing demands, feeling rushed, unexpected changes, perceived loss of control and prolonged periods without a break. These triggers were considered alongside her physical, emotional, cognitive and behavioural warning signs, including muscle tension, racing thoughts, irritability, increased sensory sensitivity, tearfulness, feeling trapped and an urge to escape.
A personalised set of coping strategies was then developed collaboratively between Tess and her Occupational Therapist, ensuring that the strategies were practical, achievable and relevant to her everyday life. By her sixth session, Tess had developed a comprehensive and practical wellness toolkit that could be adapted according to her level of stress, anxiety and emotional overwhelm. This included tools such as breathing and grounding techniques, movement, sensory regulation, prioritisation and reducing demands, changing her environment, realistic pause moments, and seeking support when needed. Tess was supported to identify which strategies were most useful at different stages of escalation. This helped her move from simply trying to cope with overwhelming situations to recognising when she needed to intervene earlier and adjust her activity, environment or level of demand.
3. Panic and Anxiety Management
Tess’s panic attacks were considered in the context of their impact on her daily functioning, routines and participation in family and community life. Panic and anticipatory anxiety had begun to affect activities that were important to Tess, particularly leaving the house with both children, managing busy environments, attending activities and coping with situations that felt unpredictable.
Occupational Therapy intervention focused on the functional and environmental factors contributing to escalation. Tess and her Occupational Therapist explored how time pressure, fatigue, sensory overload, disrupted routines and managing the practical needs of two young children outside the home could affect her confidence and coping capacity. Practical anxiety management and regulation strategies were incorporated into everyday routines, including down-regulating activities such as stretching or brief yoga, grounding, breathwork, sensory strategies, preparation for higher-demand activities and identifying opportunities to pause and regulate. A graded approach to community participation was also used to support Tess to re-engage with activities she had begun avoiding. Leaving the house with both children was broken down into manageable steps, considering preparation, timing, sensory demands, available support and opportunities for recovery afterwards. Intervention focused on increasing her confidence in her ability to manage everyday occupations while experiencing anxiety, and move through that gently, while helping her gradually rebuild her participation and engagement in family life and her wider community.
4. Sensory Processing and Sensory Regulation
Sensory processing was explored as an important contributor to Tess’s emotional dysregulation and maternal overwhelm. Caring for two young children involved a high level of constant sensory input. Noise, crying, physical touch, clutter, interruptions and the need to respond to children’s needs throughout the day created a significant sensory load. This was particularly difficult when Tess was already sleep-deprived or experiencing high levels of anxiety.
Occupational Therapy focused on identifying the sensory demands within Tess’s home environment and everyday routines. She was supported to recognise her own signs of sensory overload and identify situations where sensory input was becoming difficult to manage. A personalised sensory regulation plan was developed. This included reducing unnecessary background noise, adapting lighting, creating opportunities for quiet, using movement and connection with the outdoors where possible and realistic, taking brief sensory breaks, and tuning in to her individual sensory needs a little more. Tess was supported to understand that sensory regulation was not about avoiding normal family life or the needs of her children. It was about modifying sensory demands and creating opportunities for recovery so that she could remain engaged in parenting and other meaningful occupations without becoming overwhelmed.
5. Stress Management, Routine and Reducing Occupational Load
A key focus of intervention was identifying the occupational, environmental and lifestyle demands contributing to Tess’s daily stress. The demands of parenting, household management, decision-making, constant interruptions and the expectation to remain available to her children were explored. Tess’s typical day was mapped with her Occupational Therapist to identify where demands were accumulating, which transitions were particularly stressful and where unnecessary cognitive load was being created.
Occupational Therapy strategies were used to create greater structure, predictability and routine within her day. This included simplifying routines, reducing unnecessary decision-making, establishing clearer priorities and identifying tasks that could be delayed, delegated or completed differently. Creating a more predictable rhythm to the day helped Tess feel less as though she was constantly reacting to the next demand. Having greater clarity around what needed to happen, and when, reduced the cognitive load of continually planning, prioritising and making decisions while caring for two young children. The focus of stress management was on reducing and restructuring occupational demands so that Tess could manage parenting and household responsibilities with less stress and greater capacity for recovery.
6. Energy Management, Pacing and Burnout Prevention
Tess had become accustomed to pushing through tiredness and continuing with activities until she reached a point of significant exhaustion. Energy management and pacing were introduced to help her work within her available capacity and reduce the repeated cycle of overexertion followed by depletion.
Daily occupations were considered in terms of their physical, cognitive, emotional and sensory energy demands. Tess was supported to recognise which activities were particularly draining and how the cumulative effect of multiple high-demand occupations could affect her ability to cope later in the day. Activities were planned to allow for a more appropriate distribution of energy, with higher-demand tasks balanced with lower-demand activities and opportunities for recovery. Tess was also supported to recognise that rest was most effective when built into her routine before reaching exhaustion, rather than being used when her capacity was depleted. This approach helped Tess become more aware of her energy limits and make more sustainable choices about how she used her available energy across parenting, household responsibilities, self-care and other meaningful occupations.
7. Micro-Moments of Self-Care and Maternal Wellbeing
Traditional approaches to self-care had felt unrealistic to Tess because she did not have large periods of uninterrupted time while caring for a young baby and a five-year-old. Rather than adding another demand to her already full day, Occupational Therapy focused on introducing micro-moments of self-care that could be realistically incorporated into existing routines. These included sitting quietly with a cup of tea while her baby napped, stepping outside for fresh air, listening to calming music, taking a few minutes to pause and focus on her breathing, having a shower without rushing, or taking a short period of rest before the school pick-up.
These moments were framed as nurturing strategies and opportunities for recovery, rather than another task on Tess’s to-do list. The aim was to help her recognise that supporting her own wellbeing was an important part of sustaining her capacity to care for her children.
8. Sleep, Sleep Hygiene and Recovery
Sleep was addressed as an important component of Tess’s maternal mental health, emotional regulation and recovery.
With an 18-month-old baby, uninterrupted sleep was not always achievable. Occupational Therapy therefore focused on realistic sleep hygiene techniques and manageable changes that could support rest and recovery within the reality of parenting young children. Tess’s evening routine was reviewed, including the tendency to use late evenings to catch up on household tasks once her children were settled. Strategies around sleep hygiene involving creating a calmer transition into sleep were explored, while identifying ways to reduce evening stimulation, manage racing thoughts and better prepare her nervous system for sleep. The focus was not on achieving perfect sleep, but to protect opportunities for rest, reduce unnecessary evening demands and improve the quality of recovery available to Tess.
9. Relapse Prevention and Wellness Planning
A personalised relapse prevention and wellness plan was developed to help Tess recognise when she was moving towards another period of significant dysregulation or maternal burnout. Her individual early warning signs were identified, including disrupted sleep, increased sensory sensitivities, irritability, panic symptoms, withdrawing from activities, skipping meals, feeling constantly rushed, increased intrusive worries and a growing sense that she could not manage.
The plan identified practical actions Tess could take at the earliest stage. Some of these included reducing occupational demands, increasing recovery time, using sensory and nervous system regulation strategies, returning to grounding and breathwork, prioritising sleep and self-care, and seeking additional professional and practical, social support. The plan gave Tess a clear framework for early intervention, helping her recognise when she needed to slow down, adjust her routines, reduce demands and seek support early.
Outcome
Following Mental Health Occupational Therapy intervention, Tess developed a much clearer understanding of the relationship between chronic stress, anxiety, sensory processing, nervous system dysregulation and maternal burnout. She became better able to recognise the early signs that her capacity was becoming overwhelmed and developed a personalised set of coping strategies that she could use before reaching a point of panic, rage or shutdown. Tess reported greater confidence using grounding, breathwork and sensory regulation strategies within her everyday routines. She also became more aware of the importance of pacing, energy management, sleep and recovery in maintaining her ability to cope with the demands of parenting two young children. Creating greater structure within her day helped reduce the sense of constantly reacting to the next demand. She was better able to identify what was essential, what could wait and where she needed to conserve her energy.
The introduction of realistic micro-moments of self-care helped Tess begin to prioritise her own maternal wellbeing without needing large amounts of uninterrupted time. Self-care became something that could be incorporated into her rhythm of family life rather than something she had to find additional time for. Her confidence in managing everyday activities, including leaving the house with both children, gradually improved as she developed greater trust in her ability to cope with anxiety, sensory demands and unexpected situations. Most importantly, Tess developed a practical wellness and relapse prevention plan that gave her clear strategies to use when stress began to escalate. Rather than continuing to push through until she reached crisis point, she was better equipped to recognise when she needed to slow down, regulate, reduce occupational demands and seek support.
This case demonstrates the role of Mental Health Occupational Therapy in maternal mental health, particularly when chronic stress, anxiety, sensory overload and the demands of caring for young children contribute to significant nervous system dysregulation and maternal burnout. Through targeted intervention around nervous system regulation, sensory processing, emotional regulation, coping strategies, stress management, routine, sleep, energy management, self-care, occupational balance and relapse prevention, Mental Health Occupational Therapy can help mothers develop sustainable ways of coping with the demands of everyday life while protecting their own wellbeing and functioning.
Confidentiality: This case study is a fictionalised and composite example based on common presentations seen in Mental Health Occupational Therapy. The name, age, circumstances and identifying details have been changed or created to protect client confidentiality. It is intended to illustrate the type of support that Mental Health Occupational Therapy may provide and does not describe one individual client.
