Using e-therapies to help address mental health issues

Many GPs may feel suspicious or uncertain of prescribing online treatment for psychological issues, otherwise known as e-therapies. But Dr Jan Orman, GP and general practice services consultant at the Black Dog Institute, has been working to change this mindset, recently publishing a paper on the subject, ‘e-Therapy in primary care mental health’.
 
‘There is a lot of evidence that many patients with mild-to-moderate mental health conditions benefit from online therapy modalities and, in fact, do not need face-to-face therapy,’ Dr Orman told newsGP.
 
Dr Orman believes GPs themselves can also benefit from the use of e-therapies.
 
‘They give GPs another option in mental health treatment planning over and above prescribing and referring,’ she said.
 
‘e-Therapy also provides GPs with a way of having patients experience and learn about psychological interventions and mental health skills without the GPs having to deliver it themselves, if they feel unconfident in that area.
 
‘And the more GPs have patients going online, looking at programs and talking about the skills they’ve learnt, the more they will themselves learn about psychological strategies and how to deliver them.’
 
e-Therapies can be useful for patients who otherwise can’t or won’t access psychological treatment for a variety of reasons, ranging from fear of stigma to geographical isolation. But whatever the reason a patient is using e-therapy, Dr Orman emphasises it should never be a case of ‘set and forget’.
 
‘We need to look at it the same way as prescribing someone an anti-depressant, or sending them to a psychologist,’ she said.
 
‘At the time of recommendation, it is appropriate to make a follow-up appointment a week or two later, to make sure the patient is engaged with the program and that it’s the right program for them and that they’re not deteriorating.’
 
It is also important to remember that e-therapies do not have to be used in isolation, but can be considered another tool in the box for helping patients with mild-to-moderate mental health conditions.
 
‘e-Therapies are actually very good for psychologists and GPs to use in the context of other therapeutic interventions,’ Dr Orman said. ‘The GP or psychologist can go on with deeper relationship-based therapy while the patient is learning the basic skills of psychological resilience on the computer.
 
‘The [practitioner] then has the opportunity to review that skills training, and then go on with the more complex things they need to address.’
 
This type of double-barrel approach can work particularly well for patients with more complicated mental health conditions.
 
‘As an example, many patients with eating disorders have severe anxiety,’ Dr Orman said. ‘Complex patients like these can take up a great deal of a GP’s time.
 
‘If GPs can offload some of the skills training for anxiety management to an online program, following it up in the face-to-face environment, that leaves more time to deal with the complex issues of the disorder.’
 
Dr Orman also believes that e-therapies can be an effective tool in practising preventive mental health care, something for which GPs are very well placed.
 
‘We know that for a lot of bio-psycho-social reasons, certain groups in the population are vulnerable to depression and vulnerable to anxiety,’ she said. ‘You can identify many of those people simply by looking at other members of their family, their past history, their childhood.
 
‘GPs can catch these people before their mental health reaches DSM [Diagnostic and Statistical Manual of Mental Disorders] criteria, and encourage them to go online and learn some skills to help
them be more resilient in terms of their mental health.’
 
In Dr Orman’s view, e-therapies can be prescribed as a form of mental exercise, to help build psychological strength and self-care. Such a process can help sustain patients in the longer-term, as well as during a more acute crisis.
 
‘Giving people pills for their mental health problems is sometimes necessary,’ Dr Orman said. ‘But when just taking a pill for something, you can lose your sense of self-efficacy.
 
‘Learning some psychological skills gives you the additional advantage of having improved self-efficacy, which is incredibly important in mental health care.’
 
Access Dr Jan Orman’s paper, ‘e-Therapy in primary care health’ in the April edition of the Australian Journal of General Practice (AJGP) for more information about the range of e-therapies and resources available for GPs.

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