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‘Prescribing’ behavioral and lifestyle changes

Vol. 5, No. 7 / July 2006

Psychiatrists commonly treat persons whose first words during an office visit are: “I need something for…”—usually sleep problems, obesity, anxiety, or low energy.

Although these difficulties could point to a psychiatric or medical disorder, unhealthy behaviors such as poor sleep hygiene, substance abuse, lack of exercise, or inadequate diet often are to blame. Despite the patient’s expectations, medication might not be therapeutic or clinically indicated.

For such cases, I use my prescription pad to “prescribe” problem-focused, medically appropriate, nondrug treatments. Handwritten prescriptions reinforce the targeted behavioral change or lifestyle modification discussed during our session.

A written prescription doesn’t replace verbal recommendations, but I believe it provides concrete treatment instructions that lead to positive behavioral changes.

How behavioral ‘prescriptions’ work

Suppose a person with insomnia who drinks coffee and caffeinated sodas throughout the day requests sleep medication. I write a prescription for “doses” of coffee (“Drink no more than three cups a day”) and when the doses should be taken (“Do not take coffee or soda after 4 PM”).

If a patient is sedentary and gaining weight, I write a prescription to reduce calories (“Avoid eating cookies, cake, and ‘junk food’”) and to begin an easy, graded exercise program (“Start walking 30 minutes per day, four times per week”). For a patient whose anxiety symptoms do not improve after therapeutic medication trials, I prescribe relaxation techniques (“Practice deep-breathing exercises twice daily for the next 14 days”).

These written prescriptions include the date, patient’s name, and my signature. To guard against forgeries, I leave no blank spaces. I hand the prescription to the patient and instruct him or her to post it in a conspicuous place, such as the refrigerator door, coffee maker, or bathroom mirror. Most patients respond positively even though the prescription is not for medication, because it directly addresses their stated problem.

As with written orders for medications, I keep copies of behavioral/lifestyle prescriptions in the patient’s chart and refer to them when discussing adherence, to reinforce progress, and to adjust behavior modifications.

The prescription pad holds therapeutic power, but not all prescriptions we hand our patients need to be for medicine.

Dr. Christensen is associate professor of psychiatry, University of Florida College of Medicine, Jacksonville, and director of the university’s community psychiatry program.

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