Managing Psychological Systems Using Non-Pharmaceutical Methods
Many people who suffer from common mental disorders, such as depression and anxiety, seek help from primary care providers. However, medication is not always the best or the only option for treating these conditions. Non-pharmaceutical interventions, such as psychotherapy, social prescribing, and collaborative care, can offer alternative or complementary forms of care that may be more effective, accessible, and acceptable for some patients.
Psychotherapy is a broad term that encompasses various types of talking therapies, such as cognitive-behavioral therapy (CBT), interpersonal therapy (IPT), and psychodynamic therapy. Psychotherapy can help patients understand the causes of their distress, change their negative thoughts and behaviors, cope with emotions, and improve their relationships. Psychotherapy can be delivered individually or in groups, face-to-face or online, and in short-term or long-term formats. Psychotherapy has been shown to be effective for treating depression, anxiety, post-traumatic stress disorder (PTSD), and other common mental disorders [1].
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Social prescribing is a process that enables primary care providers to refer patients to non-clinical services in the community that can address their social, emotional, and practical needs. For example, a patient with depression may be referred to a gardening group, a patient with anxiety may be referred to a yoga class, or a patient with loneliness may be referred to a befriending service. Social prescribing can help patients improve their wellbeing, reduce their isolation, increase their physical activity, and access other sources of support. Social prescribing has been found to have positive effects on wellbeing, especially for patients who are socioeconomically disadvantaged [2].
Collaborative care is a model of care that involves the integration of primary care and mental health services, with the support of a care manager who coordinates the care plan and monitors the patient’s progress. Collaborative care can enhance the quality and continuity of care for patients with common mental disorders by providing them with evidence-based treatments, such as medication and psychotherapy, tailored to their preferences and needs. Collaborative care can also improve the communication and collaboration between primary care providers and mental health specialists. Collaborative care has been proven to be effective for improving depression and anxiety outcomes in primary care settings [3].
Non-pharmaceutical interventions for common mental disorders have many advantages over medication alone. They can address the psychological and social factors that contribute to mental distress, they can empower patients to take an active role in their recovery, they can reduce the stigma and side effects associated with medication use, and they can prevent relapse and recurrence of symptoms. However, non-pharmaceutical interventions are not widely available or accessible for many patients who need them. There are barriers such as lack of resources, training, referral pathways, and awareness among primary care providers and patients. Therefore, more efforts are needed to implement and evaluate non-pharmaceutical interventions in primary care settings and to ensure that they are accessible and acceptable for all patients who can benefit from them.
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References:
[1] Cuijpers P., Cristea I.A., Karyotaki E., Reijnders M., Huibers M.J.H. How effective are cognitive behavior therapies for major depression and anxiety disorders? A meta-analytic update of the evidence. World Psychiatry 2016; 15(3): 245–258.
[2] Tanner L.M., Wildman J.M., Stoniute A., Still M., Bernard K., Green R., Eastaugh C.H., Thomson K.H., Sowden S. Non-pharmaceutical primary care interventions to improve mental health in deprived populations: a systematic review. British Journal of General Practice 2023; 73(729): e242-e248.
[3] Coventry P.A., Hudson J.L., Kontopantelis E., Archer J., Richards D.A., Gilbody S., Lovell K., Dickens C., Gask L., Waheed W., Bower P. Characteristics of effective collaborative care for treatment of depression: a systematic review and meta-regression of 74 randomised controlled trials. PLoS One 2014; 9(9): e108114.