Addressing Anxiety and Depression in the Allergy Clinic Through Motivational Interviewing, Brief Cognitive Behavioral Therapy, and Curious Questions

Abstract

Allergic diseases, particularly food allergy, can be associated with significant psychosocial impairment. Allergist-immunologists can provide evidence-based information to correct misperceptions and misunderstandings regarding food allergy that may perpetuate cycles of fear and anxiety. Whereas motivational interviewing can be an empathetic approach to empower patients to actualize health goals, cognitive behavioral therapy (CBT) aims to provide disease-state insight to facilitate an understanding of risk that can transform health beliefs and behaviors. Brief CBT is a clinical approach that can help address ineffective management paradigms through conversations that begin with curious questions. In this review, we discuss evidence supporting implementation of an integrated method of CBT in the Allergy-Immunology clinic and provide resources for this approach.

Keywords: Allergic diseases; Allergic rhinitis; Anxiety; Asthma; Cognitive behavioral therapy; Empowerment; Food allergy; Mental health.

FIGURE 1.

Brief CBT in the Allergy-Immunology clinic. A cognitive-behavioral cycle exists between feelings thoughts, beliefs, and behaviors. Within CBT, therapeutic interventions can be leveraged at each level.

FIGURE 2.

Food-allergy fatality risk framing. Correcting false beliefs is critical, as in the example of patients who misunderstand the true risk of food-allergy fatality. Risk framing can be helpful in this regard to keep perspective. (Reproduced with permission from Turner PJ, Jerschow E, Umasunthar T, Lin R, Campbell DE, Boyle RJ. Fatal anaphylaxis: mortality rate and risk factors. J Allergy Clin Immunol Pract 2017;5:1169–78.)