Clinical considerations in designing brief exposure interventions for primary care behavioral health settings.

Abstract

Introduction: Prevalence rates of anxiety disorders and symptoms in primary care (PC) settings are very high. Behavioral health consultants in primary care behavioral health (PCBH) settings enable increased access to evidence-based anxiety treatment. Despite strong extant support for exposure-based therapy for anxiety disorders, the use of exposure to treat anxiety in PC settings is low. Although barriers to exposure therapy (ET) may be exacerbated in PC settings, many anxiety presentations in PC warrant an exposure-based approach to treatment. Thus, exploration of feasibility and efficacy of ET in PC represents a critical area for advancing evidence-based treatment of anxiety symptoms. Methods: The current article addresses this gap through the presentation of two case examples of ET conducted in PCBH. Theoretical and practical information regarding the implementation of exposure using a brief (≤30 min), time-limited (4–6 visit) approached are presented. Results: Results from the case examples demonstrate feasibility of conducting exposure in a brief format consistent with a PCBH approach. Additionally, patient outcomes presented suggest that ET conducted in PCBH reduces anxiety symptoms and may facilitate referral to specialty care settings. Discussion: Exposure may offer promise in improving the quality of anxiety treatment in PC. Future work documenting both effectiveness and implementation outcomes of exposure in PC in clinical work and research trials is needed.

Integrated care and the behavioral health primary care provider

“…Alternatively, a fully integrated behavioral health specialist is present at clinician meetings, advocates for mental health services in the clinic, and implements initiatives to meet quality measures. The services offered by the fully integrated behavioral health specialist are not limited to traditional 1-hour therapy sessions, but include warm handoffs, reverse handoffs, and brief goal-focused therapy 4. The fully integrated behavioral health specialist has a presence in the clinic that influences all patient outcomes 2,3,5,12…”

“…The services offered by the fully integrated behavioral health specialist are not limited to traditional 1-hour therapy sessions, but include warm handoffs, reverse handoffs, and brief goal-focused therapy. 4 The fully integrated behavioral health specialist has a presence in the clinic that influences all patient outcomes. 2,3,5,12 A fully integrated behavioral health specialist provides patients access to mental health care in the most convenient way; however, the behavioral health specialist and PCP must traverse a professional divide: These two professionals do not use the same jargon and may not have the same treatment goals, resulting in treatment missteps.…”

“…This model uses a behavioral health specialist to provide psychiatric care alongside the PCP, most often with a referral to a behavioral health specialist or colocation of a behavioral health specialist in primary care. Barriers to behavioral health specialist integration include overcoming the professional divide, a shortage of mental health care providers, and transitioning from a traditional therapy mindset to a collaborative mindset 3,4. To transcend some of these barriers, PCPs can obtain additional psychiatric training, allowing them to transition to the role of behavioral health specialist 5…”

“…Barriers to behavioral health specialist integration include overcoming the professional divide, a shortage of mental health care providers, and transitioning from a traditional therapy mindset to a collaborative mindset. 3,4 To transcend some of these barriers, PCPs can obtain additional psychiatric training, allowing them to transition to the role of behavioral health specialist. 5 The concept of a behavioral health PCP is scarce in the literature; however, this idea is encouraging from the lens of integrated care.…”