Non-pharmacological options, including psychosocial and/or psychological interventions where appropriate

See Reference numbers ^52-54

• exercise and regular physical activity e.g. 30-minute walks
• debt advice and/or money management e.g. seeking advice from appropriate agencies such as Citizens Advice
• hobbies and interests e.g. gardening, crafts, etc
• ensuring a good work-life balance
• lunch clubs and other activities which may help to reduce social isolation
• discussing problems, where appropriate, with a close friend or confidante that is willing and able to listen

The Psychological Therapies Matrix (2015) outlines a matched care approach to support the safe and effective delivery of evidence-based psychological interventions. Both the Matrix and clinical guidelines advocating decisions regarding psychological interventions should be based on a comprehensive assessment of need and consider suitability, individual preference, availability of trained practitioners and be culturally appropriate.^15,58,59 This matched care model considers ‘high volume’ interventions and low intensity interventions for mild to moderate symptoms.

For those presenting with more complex presentations, high intensity and highly specialist interventions, delivered by practitioners with additional competences and access to appropriate supervision are outlined. The Matrix acknowledges those in general practice and primary care regularly identify and support those presenting with psychological issues and mental health disorders and are therefore in a position to provide support for low intensity interventions and referral to specialist mental health services where indicated.

A range of activities can be helpful for people with common mental health and pain conditions. Decisions for signposting and/or referral for psychological interventions should be informed by a comprehensive assessment and shared understanding of the reasons for the underlying anxiety and/or sleep problem.

Some of the following may be useful for people with anxiety and should be considered and discussed before initiating a B-Z for a severe crisis, or continuing a B-Z. Where appropriate and available Community Link Workers may be able to support and enable individuals to access some of these options.

Low intensity interventions for mild to moderate symptoms of insomnia or anxiety include guided self-help and computerised Cognitive Behavioural Therapy (cCBT).⁵⁵ Psychoeducation regarding the specific condition (anxiety, insomnia) can support self-management. A range of evidence-based cCBT programmes and telephone supports are available to support general mental wellbeing, sleep problems (including insomnia) and mild to moderate symptoms of anxiety. These programmes can be accessed via NHS Inform (Mental Health). Please refer to Resources for a detailed description and resource links. NICE provide additional recommendations on sleep hygiene for insomnia.⁵⁶

For individuals who present with moderate to severe symptoms of anxiety and more complex presentations, including within the context of co-occurring substance use, a referral for High Intensity or Highly Specialist Interventions (including Cognitive Behaviour Therapy (CBT) is indicated. These interventions are usually delivered within NHS, or non-NHS, secondary care or specialist services.

(Non-NHS services: ensure any non-NHS practitioners providing psychological therapies are registered with appropriate professional bodies e.g. Health and Care Professions Council, British Association of Behavioural and Cognitive Psychotherapy, British Association of Counselling and Psychotherapy.)