Intended for healthcare professionals

  1. Education
  2. Brief behaviour change...
  3. Brief behaviour change strategies for distressed patients in primary care
Practice Practice Pointer

Brief behaviour change strategies for distressed patients in primary care

BMJ 2019; 366 doi: https://doi.org/10.1136/bmj.l5360 (Published 24 September 2019) Cite this as: BMJ 2019;366:l5360
  1. Amber M Gum, associate professor1,
  2. Gary P Epstein-Lubow, associate professor2,
  3. Brandon A Gaudiano, associate professor3,
  4. Marsha Wittink, associate professor4,
  5. Carol Horvath5
  1. 1Department of Mental Health Law and Policy, Louis de la Parte Florida Mental Health Institute, University of South Florida
  2. 2Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University; Department of Health Services, Policy and Practice, School of Public Health, Brown University, and Psychosocial Research Program, Butler Hospital
  3. 3Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University; Department of Behavioral and Social Sciences, School of Public Health, Brown University, and Psychosocial Research Program, Butler Hospital
  4. 4Departments of Psychiatry and Family Medicine, University of Rochester School of Medicine
  5. 5Tampa, Florida
  1. Correspondence to AM Gum ambergum{at}usf.edu

What you need to know

  • Encouraging patients to write down their concerns before they meet with you can help make better use of the consultation

  • Help the patient to identify his or her priorities and set goals that involve specific behaviours

  • Behaviours that can affect mood include planning to address a specific problem; doing more valued, enjoyable activities; relaxation strategies; and health behaviours like increasing physical activity and improving sleep or nutrition

  • Motivate a patient to choose a behaviour change s/he feels ready to try by discussing why the behaviour change may be beneficial and how they can make a step-wise action plan

  • Behaviour change can be difficult—empathise with their concerns and barriers, and review progress and obstacles at future visits

A middle aged woman, divorced many years, presents to her general practitioner for a routine follow-up visit with arthritis, weight gain, and intermittent migraines. She appears stressed and tired. Upon questioning, she reports strain, fatigue, poor sleep, and worry. She is caring for her mother, who lives with her and has Alzheimer’s disease, and she is adjusting to having her daughter’s family (husband and three young children) move in with her due to unemployment.

Many patients present to primary care in emotional distress, simply referred to as “distress” hereafter. Brief behavioural interventions offered in primary care can reduce distress in the moment and may confer longer term benefits as well, potentially helping patients achieve personally meaningful goals, reduce distress, and improve physical outcomes. In doing so, providers also may experience benefits in their relationships with patients and job satisfaction.1

In this Practice Pointer, we present an approach for non-specialists to use in their consultation with patients in distress. Figure 1 presents an overview. These behavioural strategies can be used with distressed patients whether or not they are taking psychiatric medications.23 Most …

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