Healing Tools Series: Managing Behavioral Health Issues in Primary Care: Six Five-Minute Tools

Practical five-minute strategies for family physicians to support patients with depression, anxiety and other behavioral health issues

“Healing Tools” summaries are a collection of evidence-based resources to help providers and patients use integrative health approaches to improve health and wellbeing.

This tool is for: Providers: CME available

This tool was created by: Michelle D. Sherman, PhD, Laura W. Miller, MD, Megan Keuler, MD, MPH, Lisa Trump, MS, and Michele Mandrich, MSW

SUMMARY

What is this tool for?

About 75% of a family physician’s patients are likely to have a psychological or behavioral health problem, in addition to their clinical problem. Most patients with psychological problems go to their primary care physician for help.

“Managing Behavioral Health Issues in Primary Care: Six Five-Minute Tools” provides six practical five-minute strategies to support patients with depression, anxiety and other behavioral health issues. The American Academy of Family Physicians published the article in Family Practice Management Journal (2017 Mar-Apr;24(2):30-35).

The six strategies

  1. “Encourage the patient to draw on social support.”
  2. “Increase the frequency of visits.”
  3. “Assist the patient in focusing on gratitude.”
  4. “Teach breathing and mindfulness exercises.”
  5. “Prescribe physical exercise.”
  6. “Encourage behavioral activation by helping the patient create a routine or schedule.”

Social support

Encourage the patient to seek support from family, friends, support groups, religious groups and others. Consider providing information about volunteer opportunities, social groups and other resources.

More frequent visits

Offer support to patients who are reluctant to see a therapist through more frequent visits. This may increase willingness to later try medication, therapy or a referral to a specialist.

Gratitude

Suggest that the patient focus on positive life events by keeping a daily or weekly gratitude journal.

Breathing and mindfulness exercises

Teaching simple breathing exercises can help the patient manage stress, anxiety and depression. For some patients, mindfulness, prayer and meditation also help.

Physical exercise

Help the patient choose realistic physical activity that’s appropriate for his/her condition and lifestyle and set attainable goals. Providing an exercise prescription highlights this.

Behavioral activation

Help the patient create and commit to a regular routine that focuses on decreasing avoidance and isolation while doing more enjoyable activities.

The article also includes:

  • Information about handling resistance
  • Tips and sample scripts for talking about behavioral health issues

How providers can use these strategies

Providers can select the most appropriate strategy, each of which can be used in less than five minutes, for each patient.

How does this contribute to an integrative approach?

Combining conventional medicine, self-care, and complementary and alternative medicine can help patients achieve optimal health and wellbeing. Caring for patients’ emotional wellbeing using these strategies helps family physicians enhance their ability to prevent, diagnose and treat many chronic illnesses.

What does the evidence say about this tool?

The tips provided in this article are well-studied strategies that primary care physicians can learn to use within a patient visit. Regular visits improve the patient-provider relationship by allowing for deeper discovery. Mind-body strategies lessen stress and related conditions. Changes in the patient’s life-space empower patients to become active participants in their care.

What are the drawbacks to using this tool?

While providers may not initially feel comfortable using these strategies, the authors say that with practice, they will gain confidence about and be more effective in managing behavioral health issues.

Who created this tool?

Michelle D. Sherman, PhD, Laura W. Miller, MD, Megan Keuler, MD, MPH, Lisa Trump, MS, and Michele Mandrich, MSW, wrote this article, which was published in the American Academy of Family Physicians’ Family Practice Management Journal (2017 Mar-Apr;24(2):30-35).

All of the authors are affiliated with the University of Minnesota:

  • Dr. Sherman:
    • Licensed clinical psychologist and professor, Department of Family Medicine and Community Health
  • Dr. Miller:
    • Assistant professor, Department of Family Medicine and Community Health
  • Dr. Keuler:
    • Family medicine resident, Broadway Family Medicine Clinic/North Memorial Family Medicine Residency Program
  • Ms. Trump:
    • Licensed marriage and family therapist and doctoral candidate in family social science
  • Ms. Mandrich:
    • Social worker, certified medical practice executive and clinic director, Broadway Family Medicine Clinic

The American Academy of Family Physicians (AAFP) represents more than 115,900 family physicians, family medicine residents and medical students.

The five-minute tools are available:

  • For free to AAFP members and subscribers
  • By buying the article or issue

ABOUT THESE INTEGRATIVE HEALTH TOOLS

At Samueli Integrative Health Programs, we believe that achieving optimal health and wellbeing requires an integrative health approach—one that combines and coordinates conventional medicine, self-care, and complementary and alternative medicine.

Translating Evidence into Action

The goal of these summaries is to help providers and patients learn about and access evidence-based integrative health tools. Each featured tool has been vetted by Samueli Integrative Health Programs. Read about more Healing Tools.

Disclosures:

Samueli Integrative Health Programs is a public service of H&S Ventures and does not profit from any of the tools featured in these summaries.

 Patients: Contact your provider before starting any new health program.  Show him/her these resources.