The role of psychotherapy as a medical specialty in public health

I n t r o d u c t i o n . Non-psychotic mental disorders are most prevalent mental disorders with the high relapse rate and onset in the early adulthood the most active period of life, psychosocial factors play essential role in their ethiopathogenesis. Psychotherapy as method influencing one’s mind and through the mind affecting ones organism is considered to play an essential role in the treatment system of this patients group as well as in medico-psychological support of the patients with somatic illnesses.

Obj e c t i v e definition of the modern psychotherapy content as independent medical specialty based on the modern data base of its efficacy research systematization, evaluation of its further perspectives development for the provision of the healthcare for the targeted population of the patients with non-psychotic mental disorders as well as organization of the medico-psychological support for the patients with somatic illnesses, taking into account the possibilities offered by digital technologies

М e t h o d s . WHO, PubMed, Scopus, Pubmed, Medline, Web of Science, Russian Science citation index Science Citation Index search was conducted on non-psychotic mental disorders epidemiology, COVID-19 pandemic impact on mental health, psychotherapy efficacy and psychotherapeutic treatment settings, possibilities of digital technologies implementation in modern psychotherapy.

R e s u l t s . The prevalence of non-psychotic mental disorders is constantly growing in the las years, they make a serious impact in the non-communicable diseases burden, with the increase of the treatment costs. The COVID-19 pandemic is characterized by decrease of mental health well-being, growth of the anxiety and depressive disturbances, also because of the somatogenic disorders included in the post-covid syndrome.

The recent studies persuasively demonstrated the efficacy of psychotherapy in the non-psychotic mental disorders treatment, combination of psycho- and pharmacotherapy is defined as the golden standard treatment, the ratio of them should be determined personalized in each individual case. Digital technologies active development, computerized psychotherapeutic programs implementation open new possibilities for the research of the psychotherapeutic treatment mechanisms as well as make psychotherapy more available for the different population groups and can substantially decrease treatment costs in the future.

Mental health care provision optimization should be aimed at the greater psychotherapists involvement as the main specialists for diagnostic and complex treatment of non-psychotic mental disorders treatment, development of psychotherapeutic offices network, they could be a center of this patient group healthcare system, as well as for patients recovering from novel coronavirus infection with psychoneurological complains, and can be used for the medico-psychological support of the patients with somatic illnesses.

Conclusion. Psychotherapy today is recognized as an effective non-psychotic mental disorders treatment method, in the future it can be used as an epigenetic modulator in the personalized medicine framework, it can be considered as an essential part of the medical-psychological support of the patients with somatic illnesses.

1. Decree of the Government of the Russian Federation of February 16, 2022 No. 181 “On Amendments to the Decree of the Government of the Russian Federation of June 1, 2021 No. 852.

2. Kessler R. C., Angermeyer M., Anthony J. C., DE Graaf R., Demyttenaere K., Gasquet I., Gluzman S., Gureje O., Haro J. M. et al. 2007. Lifetime prevalence and age-ofonset distributions of mental disorders in the World Health Organization‘s World Mental Health Survey Initiative. //World Psychiatry. – 2007. – No 6. – P. 168–76.

3. “European Regional Committee, 63 session”; September 16–19, 2013; Chemshe, Izmir, Turkey. 30 s. – URL: http://psychiatr.ru/download/1862?name=63wd11r_MentalHealth-3.pdf&view=1 (Accessed: 01.04.2022).

4. Ferrari A. J., Somerville A. J., Baxter A. J., Norman R., Patten S. B., Vos T., Whiteford H. A. Global variation in the prevalence and incidence of major depressive disorder: a systematic review of the epidemiological literature. // Psychol. Med. 2013. Mar; 43(3). P. 471–81. DOI:10.1017/S0033291712001511.

5. Ferrari A. J., Charlson F. J., Norman R. E., Flaxman A. D., Patten S. B., Vos T., Whiteford H. A. The epidemiological modelling of major depressive disorder: application for the Global Burden of Disease Study 2010. // PLoS One. 2013. Jul 29;8(7): e69637. DOI:10.1371/journal.pone.0069637.

6. Bandelow B., Michaelis S. Epidemiology of anxiety disorders in the 21st century.// Dialogues Clin. Neurosci.// 2015. Sep; 17(3). P. 327–35. DOI:10.31887/DCNS.2015.17.3.

7. Chisholm D., Sweeny K., Sheehan P., Rasmussen B., Smit F., Cuijpers P., Saxena S. Scaling-up treatment of depression and anxiety: a global return on investment analysis.// Lancet Psychiatry. 2016 May; 3(5). P. 415– 24. DOI:10.1016/S2215–0366(16)30024-4.

8. Pierce M., Hope H., Ford T., Hatch S., Hotopf M., John A., Kontopantelis E. et al. Mental health before and during the COVID-19 pandemic: a longitudinal probability sample survey of the UK population. The Lancet. Psychiatry. – 2020. – No 7(10). – P. 883–892. https://doi.org/10.1016/s2215–0366(20)30308

9. Mc Ginty E. E., Presskreischer R., Han H., Barry C. L. Psychological distress and loneliness reported by US adults in 2018 and April 2020. // JAMA. 2020. published online June 3. https://doi.org.10.1001/jama.20209740 (Дата обращения: 01.04.2022).

10. Rajkumar R.P. COVID-19 and mental health: A review of the existing literature. Asian J Psychiatr. 2020 Aug; 52:102066. DOI:10.1016/j.ajp.2020.102066. Epub 2020 Apr 10. PMID: 32302935; PMCID: PMC7151415.

11. Salagay O. O., Soshkina K. V., Letnikova L. I., Starodubov V. I., Drapkina O. M., Khalfin R. A., Kobyakova O. S., Khabriev R. U. Public health in the “year of coronavirus” // Public health. 2021, 1(1):7–18. DOI:10.21045/2782-1676-2021-1-1-7-18.

12. Vasilyeva A. V. Pandemic and adaptive anxiety disorders: the possibilities of therapy // Journal of Neurology and Psychiatry. S. S. Korsakov. 2020;120(5):146– 152. https://doi.org/10.17116/jnevro2020120051146.

13. Shalnova S. A., Evstifeeva S. E., Deev A. D. et al. The prevalence of anxiety and depression in various regions of the Russian Federation and its association with socio-demographic factors (according to the ESSE-RF study) // Therapeutic archive. 2014; 86(12): 53–60.

14. Chazov E. I., Oganov R. G., Pogosova G. V. et al. The COORDINATE program (Clinical and epidemiological program for the study of depression in cardiac practice in patients with arterial hypertension and coronary heart disease): results of the therapeutic part of a multicenter study // Therapeutic archive. 2006; 4:38–44.

15. Belyalov F. I. Mental disorders in the practice of a therapist. Irkutsk: RIO IGMAPO. 2014; 327 p. Smulevich A. B. Depression in general medicine: A guide for doctors. M.: MIA, 2001. – 256 p.

16. Kostyuk, G. P., Masyakin A. V., Starinskaya M. A. On the prospects for the diagnosis and treatment of depressive and anxiety disorders in the general medical network // Medical technologies. Evaluation and choice. – 2017. – V. 4. – No. 29. – P. 70–75.

17. Martynikhin I. A. The use of ICD-10 for the diagnosis of mental disorders in Russia: according to government statistics and the results of a survey of doctors // Consortium Psychiatricum. – 2021. – Vol. 2. – No. 2. – P. 35–44. DOI:10.17816/CP69.

18. Wittchen H.U., Kessler R.C., Beesdo K. et al. Generalized anxiety and depression in primary care: prevalence, recognition, and management. J Clin Psychiatry. 2002; 63(Suppl. 8): S24–S34.

19. Fogarty C.T., Sharma S., Chetty V.K. et al. Mental health conditions are associated with increased health care utilization among urban family medicine patients. J Am Board Fam Med. 2008;21:398–407.

20. Kujanpää T., Jokelainen J., Auvinen J ., Timonen M. Generalised anxiety disorder symptoms and utilisation of health care services. A cross-sectional study from the “Northern Finland 1966 Birth Cohort”. Scand J Prim Health Care. 2016 Jun; 34(2):151–8. DOI:10.3109/02813432.2016.1160631.

21. Martynikhin I.A., Neznanov N.G. (2018). Features of the diagnosis of generalized anxiety disorder by Russian psychiatrists: results of a study using the assessment of brief clinical descriptions // Contemporary Therapy for Mental Disorders, (4), 51–59. https://doi.org/10.21265/PSYPH.2018.47.21796

22. Zomahoun H.T.V., Guénette L., Grégoire J.P., Lauzier S., Lawani A.M., Ferdynus C ., Huiart L., Moisan J. Effectiveness of motivational interviewing interventions on medication adherence in adults with chronic diseases: a systematic review and meta-analysis. Int J Epidemiol. 2017 Apr 1; 46(2):589–602. DOI:10.1093/ije/dyw273. PMID: 27864410.

23. Östbring M.J., Eriksson T., Petersson G., Hellström L. Effects of a pharmaceutical care intervention on clinical outcomes and patient adherence in coronary heart disease: the MIMeRiC randomized controlled trial. BMC Cardiovasc Disord. 2021 Aug 1; 21(1):367. DOI:10.1186/s12872-021-02178-0. PMID: 34334142; PMCID: PMC8327441.

24. Palacio A., Garay D., Langer B., Taylor J., Wood B.A., Tamariz L. Motivational Interviewing Improves Medication Adherence: a Systematic Review and Meta-analysis. J Gen Intern Med. 2016 Aug; 31(8):929–40. DOI:10.1007/s11606-016-3685-3. Epub 2016 May 9.

25. Lewis-Fernández R., Coombs A.A., Balán I.C., Interian A. Motivational Interviewing: Overcoming Disparities in Pharmacotherapy Engagement. J Clin Psychiatry. 2018 May/Jun; 79(3):18ac12150. DOI:10.4088/JCP.18ac12150.

26. Interian A., Lewis-Fernández R., Gara M.A. et al. A randomized- controlled trial of an intervention to improve antidepressant adherence among Latinos. Depress Anxiety. 2013; 30(7):688–696.

27. Lewis-Fernández R., Balán I.C., Patel S.R., Sánchez-Lacay J.A., Alfonso C., Gorritz M., Blanco C., Schmidt A., Jiang H., Schneier F., Moyers T.B. Impact of motivational pharmacotherapy on treatment retention among depressed Latinos. Psychiatry. 2013 Fall; 76(3):210–22. DOI:10.1521/psyc.2013.76.3.210.

28. Hedegaard U ., Kjeldsen L.J., Pottegård A., Henriksen J.E., Lambrechtsen J, Hangaard J, Hallas J. Improving Medication Adherence in Patients with Hypertension: A Randomized Trial. Am J Med. 2015 Dec; 128(12):1351–61. DOI:10.1016/j.amjmed.2015.08.011. Epub 2015 Aug 21.

29. Zubkova T. S., Zamyatnina E. S., Khalturina D. A. The system of indicators of behavioral risk factors in Russia at the national and regional levels // Public health. 2021; 1(4):56 67. https://doi.org/10.21045/2782-1676-2021-1-4-56-67

30. Nikolaeva O. V., Karavaeva T. A. Psychotherapeutic targets and a personalized program of medical and psychological support for cardiosurgical patients // Bulletin of Psychotherapy. – 2021. – No. 79(84). – P. 121–133.

31. Psychotherapy: textbook / ed. A. V. Vasilyeva, T. A. Karavaeva, N. G. Neznanova. – Moscow: GEOTAR-Media, 2022. – 864 p.: ill. – DOI:10.33029/9704-6485-4-VKN-2022-1-864 http://catalog.geotar.ru/lots/NF0021730.html

32. Pugovkina O. D., Nikitina I. V., Kholmogorova A. B., Garanyan N. G. Scientific studies of psychotherapy and its effectiveness: the history of the problem // Moscow Journal of Psychotherapy. – 2009. – No. 1. – P. 35–67.

33. Kholmogorova A. B., Garanyan N. G. Multifactorial model of depressive, anxiety and somatoform disorders // Social and Clinical Psychiatry. – 1998. – No. 1. – P. 94–102.

34. Addis M. E. and Krasnow A. D. 2000. A national survey of practicing psychologist’s attitudes toward psychotherapy treatment manuals. Journal of Consulting and Clinical psychology. – Vol. 68. – P. 1–9.

35. Arkowitz H. 1992. Integrative theories of therapy. History of Psychotherapy. Ed. D. K. Freedhein. Washington: American Psychiatric Association. – P. 261–303.

36. Blatt S. and Felsen I. 1993. Different kinds of folks may need different kinds of strokes: The effect of patient’s characteristics on therapeutic process and outcome. Psychotherapy Research. – Vol. 3. – P. 245–259.

37. View of V. D. Parameters of the psychotherapeutic process and the results of psychotherapy // Review of Psychiatry and Medical Psychology. V. M. Bekhterev. – 1994. – No. 2. – P. 19–26.

38. Cuijpers P., Quero S., Noma H., Ciharova M., Miguel C., Karyotaki E., Cipriani A., Cristea I.A., Furukawa T.A. Psychotherapies for depression: a network meta-analysis covering efficacy, acceptability and long-term outcomes of all main treatment types. World Psychiatry. 2021 Jun; 20(2):283–293. DOI:10.1002/wps.20860

39. Carpenter J.K., Andrews L.A., Witcraft S.M., Powers M.B., Smits J.A.J., Hofmann S.G. Cognitive behavioral therapy for anxiety and related disorders: A meta-analysis of randomized placebo-controlled trials. Depress Anxiety. 2018 Jun;35(6):502–514. DOI:10.1002/da.22728.

40. Van Dis E.A.M., van Veen S.C., Hagenaars M.A., Batelaan N.M., Bockting C.L.H., van den Heuvel R.M., Cuijpers P., Engelhard I.M. Long-term Outcomes of Cognitive Behavioral Therapy for Anxiety-Related Disorders: A Systematic Review and Meta-analysis. JAMA Psychiatry. 2020 Mar 1; 77(3):265–273. DOI:10.1001/jamapsychiatry.2019.3986. Erratum in: JAMA Psychiatry.

41. Karavaeva T. A., Vasil’eva A.V., Poltorak S. V. Principles and algorithms for psychotherapy of neurotic anxiety disorders (anxiety-phobic, panic and generalized anxiety disorders) // Review of psychiatry and medical psychology named after V. M. Bekhterev. 2016; (4):42–51.

42. Vujnovich M., Manukhina O., Reed D. et al. Classification of mental disorders in ICD-11: a single standard for medical documentation and collection of statistical data in health care // Consortium Psychiatricum. – 2021. – Vol. 2. – No. 2. – C. 3–6. DOI:10.17816/CP74

43. Horn E.K., Bartak A., Meerman A.M., Rossum B.V., Ziegler U.M., Thunnissen M., Soons M., Andrea H., Hamers EF, Emmelkamp P.M., Stijnen T., Busschbach J.J., Verheul R. Effectiveness of Psychotherapy in Personality Disorders Not Otherwise Specified: A Comparison of Different Treatment Modalities. Clin Psychol Psychother. 2015 Sep-Oct; 22(5):426–42. DOI:10.1002/cpp.1904. Epub 2014 May 29.

44. Dr. Roel Verheul, Marjolein Herbrink (2007) The efficacy of various modalities of psychotherapy for personality disorders: A systematic review of the evidence and clinical recommendations, International Review of Psychiatry, 19:1, 25–38, DOI:10.1080/09540260601095399

45. Karpenko O. A. Influence of psychoeducation on compliance of patients with the first psychotic episode in a hospital setting. Journal of Neurology and Psychiatry. S. S. Korsakov. 2020; 120 (6 vol. 2):92–98. https://doi.org/10.17116/jnevro202012006292

46. Semenova N. D., Kuzmenko A.Yu., Kostyuk G. P. Psychoeducation: problems and directions of research // Review of psychiatry and medical psychology. 2016; 4:3–11.

47. Neznanov N. G., Shmukler A. B., Kostyuk G. P., Sofronov A. G. First psychotic episode: epidemiological aspects of care organization // Social and clinical psychiatry. 2018; 28(3):5–11.

48. Turkington D., Morrison A.P. Cognitive Therapy for Negative Symptoms of Schizophrenia. Arch Gen Psychiatry. 2012; 69(2):119–120. DOI:10.1001/archgenpsychiatry.2011.141

49. Grant P.M., Huh G.A., Perivoliotis D., Stolar N.M., Beck A.T. Randomized Trial to Evaluate the Efficacy of Cognitive Therapy for Low-Functioning Patients With Schizophrenia. Arch Gen Psychiatry. 2012; 69(2):121– 127. DOI:10.1001/archgenpsychiatry.2011.129

50. Medportal: https://medportal.ru/mednovosti/sozdano-prilozhenie-dlya-stradayuschih-ot-panicheskih-atak/

51. WASP Newsletter February – 2022. https://mental-health-russia.ru/wp-content/uploads/2022/02/WASP-Newsletter-Feb-2022-2.pdf

52. Apolinário-Hagen J., Drüge M, Fritsche L. Cognitive Behavioral Therapy, Mindfulness-Based Cognitive Therapy and Acceptance Commitment Therapy for Anxiety Disorders: Integrating Traditional with Digital Treatment Approaches. Adv Exp Med Biol. 2020;1191:291–329. DOI:10.1007/978-981-32-9705-0_17. PMID: 32002935

53. Freize V. V., Malyshko L. V., Grachev G. I., Dutov V. B., Semenova N. V., Neznanov N. G. Prospects for the use of virtual reality (VR) technologies in the treatment of patients with mental disorders (a review of foreign literature) // Review of psychiatry and medical psychology named after V. M. Bekhterev. 2021; (1):18–24. https://doi.org/10.31363/2313-7053-2021-1-18-24

54. Carl E., Stein A.T., Levihn-Coon A., Pogue J.R., Rothbaum B., Emmelkamp P., Asmundson G.J.G., Carlbring P., Powers M.B. Virtual reality exposure therapy for anxiety and related disorders: A meta-analysis of randomized controlled trials. J Anxiety Disord. 2019 Jan; 61:27–36. DOI:10.1016/j.janxdis.2018.08.003.

55. Wind T.R., Rijkeboer M., Andersson G., Riper H. The COVID-19 pandemic: The ‘black swan’ for mental health care and a turning point for e-health. Internet Interv. 2020 Apr; 20:100317. DOI:10.1016/j.invent.2020.100317

56. Backhaus A., Agha Z., Maglione M. et al. Videoconferencing psychotherapy: A systematic review. Psychological Services, 2012. – Vol. 9 (2). – P. 111–131. DOI:10.1037/a0027924

57. Andersson G., Titov N. Advantages and limitations of internet-based interventions for common mental disorders. World Psychiatry. – 2014. – Vol. 13 (1). – P. 4–11. DOI:10.1002/wps.20083

58. Backhaus A., Agha Z., Maglione M. et al. Videoconferencing psychotherapy: A systematic review. Psychological Services. – 2012. – Vol. 9(2). – P. 111–131. DOI:10.1037/a0027924

59. Treanor C.J., Kouvonen A., Lallukka T., Donnelly M. Acceptability of Computerized Cognitive Behavioral Therapy for Adults: Umbrella Review. JMIR Ment Health. 2021 Jul 6; 8(7): e23091. DOI:10.2196/23091.

60. Bielinski L. L., Berger T. Internet Interventions for Mental Health: Current State of Research, Lessons Learned and Future Directions. Konsul’tativnaya psikhologiya i psikhoterapiya [Counseling Psychology and Psychotherapy]. – 2020. – Vol. 28. – No. 3. – P. 65–83. DOI:https://doi.org/10.17759/cpp.2020280305

61. Stahl S.M. Psychotherapy as an epigenetic ‘drug’: psychiatric therapeutics target symptoms linked to malfunctioning brain circuits with psychotherapy as well as with drugs. J Clin Pharm Ther. 2012 Jun; 37(3): 249–53. DOI:10.1111/j.1365–2710.2011.01301.x.

62. Leichsenring F., Steinert C., Rabung S., Ioannidis J.P.A. The efficacy of psychotherapies and pharmacotherapies for mental disorders in adults: an umbrella review and meta-analytic evaluation of recent meta-analyses. World Psychiatry. 2022 Feb; 21(1):133–145. DOI:10.1002/wps.20941.