The Importance of Vanity in Acute Care OT: Strategies to Improve Mental Health

Alyssa M. Garcia, OTD, OTR/L

Acute care therapists are hypervigilant in preventing the secondary effects that come from prolonged hospitalization, but beyond the bedsores and contractures are a variety of secondary effects deteriorating patients' mental health (Alzahrani, 2021). The factors of hospitalization that affect patients’ mental health are forced dependency, lack of physiological control, feeling overwhelmed by lines and equipment, pain, fear, loneliness, delirium, sleep deprivation, disorientation, and, at times, an inability to communicate (Halvorsen et al., 2021). These factors, combined with the patients’ prior mental health history, increase the likelihood of developing mental health challenges such as depression, anxiety, and PTSD (Halvorsen et al., 2021). Additionally, prolonged hospitalization can whittle away at patients' sense of self, self-esteem, and sense of control (Basile et al., 2021). Overall, this creates a cycle of reduced ADL engagement which leads to feelings of shame and helplessness which further exacerbates the patients’ mental health to perpetuate the cycle (Lianur et al., 2025). As experts in the intimate relationship between physical health, mental health, and occupational engagement, OTs are perfectly positioned to address this major concern (Smith et al., 2025).

Traditional acute care mental health interventions leave more to be desired. ICU journals allow patients to record their experiences to improve recollection and processing of inpatient events; however, patients have reported that this intervention increases psychological burden and can cause re-traumatization (Sun et al., 2021). Virtual reality headsets can reduce stress and provide calming distractions for patients, but it is new and lacks sufficient supporting research (du Plessis & Jordaan, 2024). Environmental sensory stimulation is helpful when tailored to each patient, but it is best combined with other interventions (Ma et al., 2021). There is a need for more holistic interventions than can be easily incorporated into each session.

Within ROM exercises lies an opportunity to improve self-havening. Self-havening is a mannerism or gesture that provides a sensory distraction to ease emotional distress by increasing dopamine and serotonin and decreasing cortisol (Hodgson et al., 2023). There are a variety of self-havening types, but the most common ones are scrubbing your face, wringing your hands, and rubbing your arms, with facial self-havening being the most common (Ruden, 2019; Spille et al., 2022). On average, facial self-havening occurs at least 800 times a day and more during emotional distress (Spille et al., 2022). When a patient has decreased AROM, they lose the ability to self-haven which decreases their ability to cope during prolonged hospitalization (Hodgson et al., 2023). To address this, ROM exercises can be retailored to improve self-havening rather than just increasing degrees of motion or occupational engagement. For example, when facilitating elbow flexion, allow the patient’s hand to linger on their face. Not only does this improve the hand-to-face pattern needed for ADLs, but it also allows the patients’ abilities to self-haven. 

Another opportunity for holistic mental health care lies in ADL engagement. Oftentimes in the hospital, only the ADLs associated with basic hygiene are met leaving other grooming ADLs, bathing, and preferred clothing dressing to the wayside (Amini, 2023). With grooming specifically, hair care is often unaddressed which affects the patients' self-esteem, social participation, overall affect, and motivation in therapy (McGonigle, 2022). Barriers to addressing hair care are environmental constraints, lack of supplies, and limited time (McGonigle, 2022). This is especially true for patients with textured hair because of lack of knowledge on the OT's part and lack of proper tools (Friedman & Sison, 2022; MacDonald et al., 2025). The American Occupational Therapy Association has a helpful document on how to care for various hair types titled "AOTA’s Guide to Culturally Inclusive Hair Care Services and Incorporating Cultural Humility Into Practice." Furthermore, participating in facial hair care is just as meaningful for patients (Goldenhart & Nagy, 2022). Moreover, taking the extra time and effort to gather supplies and increase hair care knowledge not only improves patients' overall cleanliness but it also boosts their mental health by making them feel more like a person and less like a patient (Basile et al., 2021).

Another important ADL to address is dressing in preferred clothing, especially when it relates to religious and cultural practices. Many patients find hospital gowns dehumanizing and immodest (Frankel et al., 2021). Assisting patients in dressing in their preferred clothing is an opportunity to improve the overall hospitalization experience and decrease emotional distress (Ruggiero et al., 2022). Religious and/or cultural head coverings should always be incorporated (Rahman et al., 2021) as well as respecting patients' privacy with closed doors during toileting or dressing whenever possible (Basile et al., 2021). However, it is important to note that changing clothing must be cleared by nursing staff to ensure there is proper access to lines and surgical sites. 

The last proposed mental health intervention is mirror viewing. Prolonged hospitalization manifests itself physically in the form of deconditioning, discoloration, and overall wear on the body. Because of the immobilization associated with prolonged hospitalization, oftentimes, patients go weeks without seeing their reflections. The first mirror viewing after a time without can cause mirror trauma when the patients witness the effects of their admission and experience a cognitive dissonance between their perceived self-image and the image looking back at them (Freysteinson, 2020). This can be mitigated by preparing the patients prior to viewing and facilitating positive self-talk and evaluation once in front of the mirror (Adelle et al., 2025; Freysteinson, 2020). By utilizing therapeutic use of self, active listening, and an overall supportive attitude, OTs can help to reframe the mirror viewing experience to make it a more positive and encouraging event (Freysteinson, 2020).

These interventions may seem like a promotion of vanity or a focus on the aesthetics, but, in reality, they are a promotion of patients' mental health by allowing them to improve their sense of self, self-esteem, and sense of control (Adelle et al., 2025). All of which are crucial to improving patients’ coping skills, resiliency, and overall wellness (Smith et al., 2025).

References

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