For the first time, primary care physicians (PCPs) are being urged to screen their patients, above and below age 65, for mental health concerns alongside screening for physical health conditions. The United States Preventive Services Task Force has published its first recommendation for PCPs to screen adults for anxiety as standard practice. This recommendation followed a peak in the prevalence of mental illnesses in 2020. During this time and continuing to present, 1 in 3 U.S. young adults experience a mental illness leading to a 31 percent increase in mental health-related emergency room visits. Early detection can often mean less time plagued by the impact anxiety has on daily life, such as excessive fear, worry, or intrusive thoughts. The published recommendation places ethical responsibility on the PCP to connect a patient with anxiety to appropriate care, yet it fails to identify pathways on what constitutes appropriate. Occupational therapy is one pathway to meaningful care for patients.
Currently, over 40 million adults experience an anxiety disorder each year, but only about one-third of those receive treatment. Treatment options can be broad and difficult to understand, a problem that can become a barrier to early intervention.
Before selecting a treatment avenue, PCPs may suggest lifestyle modifications to reduce anxiety: “Get more exercise, lose weight, take a new medication, consider seeing a counselor and get more sleep.” Many patients sit, nod, and leave unequipped to follow through.
Making lifestyle modifications is harder than it sounds. It means a patient must adjust already formed habits. This is already an extremely difficult endeavor, but in the presence of anxiety, it can be nearly impossible. And the longer people wait to address their anxiety, the harder it becomes to treat.
Telling someone with anxiety to change anything without showing them how to do it can result in compounded anxiety. This can become a painful cycle when we’ve inadvertently given them an additional source of anxiety even if our intention was to reduce it.
Anxiety activates the stress response in our body. We all respond differently to the stress process, but over time a frequently triggered stress response has negative effects on the brain. If you think of the brain as a battery, anxiety is the pull that drains its power. If our brain is exhausted by processing stress, it will be less capable of using that energy source to problem-solve ways to create new, healthier habits and routines.
Imagine a different scenario. What if the first words out of a PCP’s mouth after an anxiety screening were: “I’d like to support you in making healthy changes, but I understand how difficult that can be. I’d like to introduce you to our occupational therapist (OT), who specializes in this area.”
Same office. Same space. Trusted endorsement from the physician.
Occupational therapy is a broad field where therapists hold an entry-level degree that prepares them to work with patients across the lifespan in various settings: schools, outpatient clinics, mental health facilities, hospitals, inpatient rehabilitation, and, yes, primary care. OTs work with people to help them do the things they want to do, need to do, and must do to improve their physical and mental health through the therapeutic use of everyday activities.
In a primary care setting, an OT would focus on patients in three categorical groups: at risk for developing a chronic disease or condition, living with a newly diagnosed condition, or living with a chronic disease process with irreversible components.
OTs are experts in understanding how a health condition impacts body structures, functions, roles, and routines and how these factors can change based on context and environment. We won’t work on anything the patient doesn’t value, it’s a professional norm. We often quote the words first stated by the former president of the American Occupational Therapy Association, Virginia Stoffel: “What matters to you? Not, What’s the matter with you?” By doing this, we increase a patient’s internal sense of self-efficacy and support their own belief that they can reach their goals. Harnessing this intrinsic motivation enables us to partner with them and create sustainable plans for their future.
If a patient wants to reduce their anxiety, we can help teach them how to modify their daily tasks and thought processes to create healthy habits that support the reduction of their anxiety symptoms, all within daily activities so that what we teach easily becomes embedded.
When occupational therapy is applied in this way, research has shown its success in health care savings. It’s a win for patients and the bottom line for health care costs.
PCPs lead hectic schedules, and our health care system has not granted them enough time for patient education. Nearly 50 percent of PCPs report symptoms of burnout, and a suggested coping strategy to improve their well-being has been the reduction of clinical work hours, a solution that includes increasing the number of support staff. OTs can help carry out these deliverables.
Like anxiety, screening for mental health conditions needs to take place in a primary care setting, just like physical health screenings. But completing these screenings without a proper way to guide a patient after giving them results places them at an even higher health risk.
Occupational therapy is the solution. We can reduce identified barriers to completing lifestyle recommendations given by the PCP through education and occupation-based interventions. Occupational therapy intervention will empower people to take back control of their life and create a paradigm shift in how we accept, approach, and overcome health challenges.
Taylor Gurley is a professor of occupational therapy.