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In this episode, we have Taylor Gurley, a professor of occupational therapy as our guest. She will be discussing the new recommendation by the United States Preventive Services Task Force for primary care physicians to screen their patients for mental health concerns, specifically anxiety. The recommendation comes after a peak in the prevalence of mental illnesses in 2020, with 1 in 3 young adults experiencing a mental illness leading to a 31 percent increase in mental health-related emergency room visits. Taylor will be talking about how occupational therapy can be a pathway to meaningful care for patients, and how it can be used as an early intervention method. Tune in to learn more about how occupational therapy can help patients with anxiety and how it can be integrated into primary care.

Taylor Gurley is a professor of occupational therapy.

She shares her story and discusses her KevinMD article, “U.S. adults should get routine anxiety screening. But then what?”

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Transcript

Kevin Pho: Hi, and welcome to the show. Rate and review at KevinMD.com/rate. Subscribe at KevinMD.com/podcast. Today on the show we have Taylor Gurley. She’s a professor of occupational therapy. Her KevinMD article is titled “U.S. adults should get routine anxiety screening. But then what?” Taylor, welcome to the show.

Taylor Gurley: Thank you for having me.

Kevin Pho: So we’ll get into the article in a little bit, but first off, briefly share your story and journey to where you are today.

Taylor Gurley: Absolutely. So yes, currently I’m a professor of occupational therapy at the University of Indianapolis. Prior to transitioning full time into academia, I was a full-time practitioner working primarily in outpatient pediatrics, serving families who have children with disabilities from birth to about 18 years.

Kevin Pho: All right. So what’s something about occupational therapy that’s not immediately obvious to my clinician audience?

Taylor Gurley: Yeah, so I feel that occupational therapy is generally assumed by everyone to be working on your job or helping kids with handwriting. I feel like those are the two pigeonholes we get stuck into, and it’s really a diverse field. We graduate entry-level practitioners to work across the lifespan.

So we really just help increase the use of everyday occupations and make sure people can be successful and independent completing those. That could be anything from being able to shower independently to commuting to work, so all the different cognitive and physical skills that are involved in a wide array of activities.

Kevin Pho: So say I’m a primary care physician in a primary care setting. What are some pictures of patients or tip-offs that would make me think in the back of my mind, “Hey, maybe occupational therapy would be right for this patient in this setting”?

Taylor Gurley: Absolutely. So in primary care, occupational therapy can work with people in pretty much three different areas. For someone who is on the cusp of maybe meeting the diagnostic criteria for, let’s say, type 2 diabetes, we could work with that individual to create new, healthier habits and routines to decrease the likelihood that they may meet that diagnostic classification.

We could also work with someone who’s newly diagnosed with maybe multiple sclerosis, or any sort of cognitive decline, any mental health diagnoses, anything that would really impact their ability to complete those daily activities to their highest level.

And then the last category of patient would be anyone living with a condition that has some irreversible components. So we would then look at how we can adapt the environment to better serve them, and how we can modify how they’re currently completing tasks, again to promote the highest level of independence. So that’s where it fits in primary care. Again, it could be across the lifespan, but those are the three main areas.

Kevin Pho: Let’s talk about your KevinMD article. It’s titled “U.S. adults should get routine anxiety screening. But then what?” Now, in your world of occupational therapy, how did you get interested in anxiety?

Taylor Gurley: Yes. So when I was a pediatric outpatient therapist, my employer was gracious enough to let me work with a lot of families whose children were having high rates of anxiety. These kiddos could not complete their homework assignments, and they were having disruptions in school. And then what we really saw was that this untreated anxiety was affecting the entire family unit. So I spent a lot of my clinical career addressing anxiety and depression within family systems.

And then when I moved into academia, I started studying it, researching it, and receiving more training on how to address these two conditions from the occupational therapy lens, regardless of age or diagnosis. So that’s really what led me to write this article. I was thrilled to see that the United States Preventive Services Task Force created this guideline, but then I felt it really left a gap in what primary care physicians do next. We’re screening for all of these things, and I thought this is a really great entry for how to advocate for my profession to be integrated a little bit better into that setting.

Kevin Pho: And you talk about the U.S. Preventive Services Task Force. As you rightly note, it now recommends that all primary care physicians screen for anxiety as standard practice. So tell us what options are typically available once a primary care clinician screens for anxiety and comes up with signs and symptoms that may be suggestive of that.

Taylor Gurley: Sure. It would vary depending on each patient. If a patient came to their primary care physician and said, “I’m experiencing all these negative things, and I need a little bit more direction,” that could be the first indicator that the screening is going to take place. A patient like that might be open to being a little bit more high level in their treatment in terms of following whatever recommendation is given by the physician. So they may take physician recommendations for increasing the quantity and quality of sleep, and maybe changing their exercise routine and some of their eating habits, to have a natural reduction of anxiety symptoms. Or they might be willing to follow a recommendation for the use of a pharmaceutical.

The group of people I would want to be targeting as an OT are the ones where the physician is noticing, “There’s something going on here. I’m seeing some red flags for anxiety, for depression,” and then asking the patient, “Would it be OK if we went ahead and screened you for this? I think we might have something going on.”

Kevin Pho: What would some of those red flags be?

Taylor Gurley: Some of those red flags would be perseverating on any physical ailment that they may be experiencing, not having any success following through on prior recommendations given by the physician, and worrying. Physically, this can show up with some hair pulling and skin picking. Any negative sort of behavioral tendencies can develop from untreated anxiety, and those have their own diagnostic classifications, so we would want to catch that up front if that was happening.

Kevin Pho: And these are the cases that you think would be best suited, where an occupational therapy approach would be an option for these types of patients?

Taylor Gurley: Absolutely. So the patients who are maybe just overwhelmed with life, who feel they don’t have a whole lot of time to make these changes, we’re the ones that can come alongside them and show them how that is done. And the reason OT is so successful in this is because we directly embed it into their daily routine. So we’re not necessarily asking them to do this whole new thing that they have never done. We’re going to take what they’re currently doing, and we’re going to modify and adapt it to fit right in with their routines. We’re just hopefully going to make those healthier for them.

Kevin Pho: So tell us a story or a case study. Let’s say I recognize these symptoms in one of my patients, and I decide to send this patient to occupational therapy for anxiety. Tell us a story about what you would do and how that would move the needle.

Taylor Gurley: Sure. So if we had a patient who was experiencing restlessness, who can’t steady their thoughts, and whose worries are increasing, we might use some cognitive behavioral techniques with them to help them move toward a more mindful state. So that means coming into their body and out of their mind, doing breath work, doing a little meditation, something that they are interested in. And that’s the key. That’s the professional norm. We’re not going to recommend or have them do things that they don’t value.

So once we identify what’s valuable and what that motivator could be, we’re going to use that, and we’re going to say, “All right, right before bed, when you turn your lights out, we’re going to have you do this routine as you’re lying in bed preparing for sleep.” And then we’re going to track that, and we’re going to collect data to see whether that was successful in calming your thoughts, organizing yourself, and slowing your heart rate down so that you could be more relaxed.

Kevin Pho: In the example of, you know, increasing sleep quality, how often would that patient have to come see you?

Taylor Gurley: That would just be determined by each clinician, who would have to make that clinical judgment based on evaluation time and treatment time. But really, in primary care, the great thing is that we can bill occupational therapy services on our own, as our own service provider. So we would work with the patient as well as their insurance to see how much occupational therapy can be approved per year. And then we would work with that person on determining, “Do we need to see you once a week, biweekly?” and just come up with a treatment plan for them that would be the most beneficial.

We can also work from a telehealth platform. So we might be able to see them in the office for an evaluation and then touch base and do our treatment sessions on a virtual platform if that’s more feasible.

Kevin Pho: Now, in general, you know, within the spectrum of what you offer as occupational therapists, what proportion does anxiety play in terms of what you guys do?

Taylor Gurley: Sure. So there’s only about 3 percent of occupational therapists that work only in a mental health setting. However, regardless of what setting you are practicing in, if your patient has unmanaged anxiety or any other mental health condition, that’s going to become a barrier and a roadblock. So one thing I always teach my students is that you might say you’re not going to be a mental health occupational therapist, but you will always be addressing mental health, in a hand clinic, in a rehabilitation facility, in a skilled nursing home. Those are barriers that we have to actively work to overcome in order for our patients to reach their goals.

Kevin Pho: Now, is treating anxiety within the scope of training of all occupational therapists? Do you have to look for someone who has a special interest or specializes in behavioral health?

Taylor Gurley: Sure, that’s a great question. So it is within the scope of all occupational therapists who are credentialed, licensed, and board-certified in our specialty. Now, it is the ethical responsibility of each entry-level practitioner to receive continuing education within those more specialized areas that they want to practice in. However, it could be anxiety, it could be any label you want to give it: If it’s interfering with an individual’s ability to complete their daily routines, that’s in the scope of OT. So we’re really not treating a diagnosis. We’re treating a person and the deficits that are coming because of a diagnosis.

Kevin Pho: Now, we focus specifically on anxiety, but as you can imagine, there are a variety of other behavioral health issues that can affect occupational therapy issues. Would you address some of those other behavioral health issues outside of anxiety?

Taylor Gurley: Absolutely. And it’s honestly pretty uncommon for any of us to have a patient with only anxiety. That might be what is most obvious on the surface, but then when we start really working with them, we’re able to see some of the deeper issues that are there. Is it decreased self-esteem, self-worth? How does that change the way that they show up in the world, and in their workplace or in their school?

Kevin Pho: We’re talking to Taylor Gurley. She’s a professor of occupational therapy, and her KevinMD article is titled “U.S. adults should get routine anxiety screening. But then what?” Taylor, what are some of your take-home messages that you want to leave with the KevinMD audience?

Taylor Gurley: I would love to leave the audience with just an increased understanding that occupational therapy can be a wonderful support service in the primary care setting. So we would be there to help your patients do the things that you are asking them to do. So if you’re a physician and you’re finding yourself a little bit frustrated that things are not happening each time you see your patient, we could be a support in order to help increase the infrastructure that surrounds you.

Kevin Pho: Taylor, thank you so much for sharing your time and insight, and thanks again for being on the show.

Taylor Gurley: Thank you so much for having me.