Make PROGRESS by supporting adherence
Instill hope and remind patients that psychiatric illnesses can improve and medications do help reduce symptoms.
Medication nonadherence challenges psychiatrists in most clinical settings.1 Supportive psychotherapy techniques—outlined in the mnemonic PROGRESS—can improve adherence and strengthen the therapeutic relationship. They also can help restore adaptive living skills, promote patient autonomy, minimize relapse, and improve attitudes toward treatment.
Praise. Reinforce positive behavior with genuine praise. Build an inventory of phrases to congratulate patients when they meet their goals or demonstrate a new effort. Follow praise with a question that elicits feedback from patients about their behavior.
Reassure. Because patients may lose faith in medications’ efficacy, use reassurance to explain the time frame for drugs to reach therapeutic levels. Instill hope and remind patients that psychiatric illnesses can improve. Point out that although medications have limitations they do help reduce symptoms.
Optimize regimens. Find an appropriate dosing and frequency that minimizes side effects and facilitates a daily routine of taking medication.2 This will help alleviate patients’ anxiety and support confidence in managing their medications.
Guide. Provide verbal and written guidance about what patients can expect from their medications. Include information about side effects and explore supplemental treatment options such as healthy eating, psychotherapy, community rehabilitation programs, and refraining from substances. If patients are unsure about why they take medication, help identify their goals and point out how pharmacotherapy might improve their symptoms.
Remind. Brainstorm with patients about how they can set up ambient cues to help them remember to take medications. Environmental associations promote autonomous behavior that can become second nature. For example, patients may learn to associate breakfast with taking medications. If patients place their medications on the table where they eat their meals, this may reinforce breakfast as a cue to take their medications.
Encourage patients to complete tasks that could help them achieve their goals. This includes taking medications as prescribed and communicating with mental healthcare providers to report side effects or during times of crisis.
Solidify strengths. Build on patients’ adaptive skills and strengths. Identifying efforts to improve their illnesses may turn roadblocks into opportunities to build rapport.
Support self-efficacy. Commend patients, for example, when they can explain and break down into steps the complexities of refilling and taking their medications.
1. Dolder CR, Lacro JP, Leckband S, Jeste DV. Interventions to improve antipsychotic medication adherence: review of recent literature. J Clin Psychopharmacol 2003;23(4):389-99.
2. Heinssen RK. Improving medication compliance of a patient with schizophrenia through collaborative behavioral therapy. Psychiatr Serv 2002;53(3):255-7.