A Quick Mental Health Treatment Guide for Clinicians: Emerging/Recent Therapies

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If there’s one thing aspiring health professionals and clinicians can agree on, it’s the fact that there’s always something new to learn about medicine. Though there are plenty of well-known mental health treatment options, learning about recent or emerging alternative therapies offers you some additional options for patients who aren’t responding to traditional treatments. So, let’s review a few evidence-based treatments and innovative mental health interventions, so you’re up-to-date and empowered to offer your patients the most current, well-rounded care!

Transcranial Magnetic Stimulation (TMS)

Let’s start exploring new emerging therapies! Transcranial Magnetic Stimulation is a noninvasive therapeutic procedure that generates a magnetic field through a coil placed on the scalp, stimulating certain mood-controlling areas of the brain to increase neurotransmitter release and improve impaired neuron function.

TMS is generally used for treatment-resistant major depressive disorder. About 30% of patients don’t respond to first-line depression treatment, like medication and psychotherapy. A TMS study found that 83% of patients who underwent TMS had a significant reduction in their depressive symptoms, with 62% reporting continued symptom relief after one year. In a separate study, researchers concluded that TMS outperformed antidepressants in terms of cost-effectiveness in patients with treatment-resistant depression. (Learn more about TMS study outcomes.)

Transcranial Magnetic Stimulation is also used to treat obsessive compulsive disorder (OCD), with one study showing a significant reduction in repetitive behaviors known as compulsive urges, after TMS was administered. Yet another study found that 38% of patients responded favorably to TMS compared to the 11% in a placebo group.

Although TMS is approved for the treatment of obsessive-compulsive disorder (OCD) and major depressive disorder (MDD), ongoing research is also exploring its potential in treating other psychiatric disorders such as schizophrenia, Tourette’s syndrome, and PTSD. This line of research suggests a promising future for TMS, and it’s exciting to see how clinicians can use it to treat a wider range of psychiatric disorders in the future!

When considering offering TMS to patients, make sure to make them aware of the potential side effects, including:

Scalp pain or discomfort
Lightheadedness
Twitching of the facial muscles
Headaches
Seizures
Mania
Hearing loss

When considering offering TMS to patients, it’s important to remember that the frequency of sessions can be tailored to each individual. While the standard is five times a week for about four to six weeks, accelerated TMS, which includes more sessions in a shorter time frame, is being investigated for its potential effectiveness. Understanding these factors helps clinicians to individualize care and provide long-lasting symptom relief for their patients.

Ketamine Infusion Therapy

Originally developed in the 1960s for use in medical and veterinary procedures, ketamine is a rapid-acting dissociative anesthetic drug with hallucinogenic properties. Researchers have linked depressive symptoms to dysfunctional NDMA receptors, low levels of glutamate, and brain-derived neurotrophic factor (BDNF). Ketamine blocks the NDMA receptors in the brain while elevating the amount of glutamate, activating AMPA receptors that allow neurons to communicate along different pathways. Researchers are still working to determine the exact way that ketamine infusions work. However, they seem to deliver rapid antidepressant effects, providing patients with treatment-resistant depression as well as those with bipolar disorder and acute suicidality with another treatment option.

Along with rapid antidepressant effects, ketamine infusions also quickly reduce suicidal thoughts. One study found that about half of the participants with frequent suicidal thoughts had a huge drop in these impulses. Additionally, after just eleven days of ketamine infusions, 52% of participants stated that their depressive symptoms reduced so much that they achieved remission. For the 40% of patients with treatment-resistant major depressive disorder with cognitive deficits, ketamine infusions also positively affect their level of cognition by improving memory and processing speed.

In addition to offering Ketamine infusions administered intravenously (IV), there’s also a nasal spray called Esketamine (Spravato) approved for use, which has been shown to reduce depressive symptoms and suicidal thoughts, all without the need for an IV. The challenge is that using a different type of drug delivery also means that the treatment interacts differently with brain receptors. Therefore, further research is needed to compare drug effectiveness and side effects for each type of administration.

Potential side effects of Ketamine infusions and nasal spray include:

Nausea and vomiting
Blurry vision
High blood pressure
Alterations in the perception of noises, time, textures, and colors
Out-of-body experiences (dissociation)

The severity and timing of these side effects may differ between the two drug administration methods, but more research is needed to confirm this.

While ketamine works quickly to improve depressive symptoms, it’s essential to keep in mind that it also has addictive properties, and patients with a history of substance use disorder should thoroughly discuss this treatment option with their provider before giving it a try.

There are also questions about how safe it is to use ketamine long-term, along with the cost-effectiveness of IV ketamine. When administering ketamine infusions, patients should have their vital signs and level of consciousness monitored, along with checking for signs or symptoms of ketamine toxicity and dissociative effects. Monitoring doesn’t stop in the treatment facility, so patients and caregivers should be well educated on potential safety concerns and establish an emergency response plan. It’s important to consider these factors when deciding on a treatment plan for patients.

Psychedelic-Assisted Therapy

Another emerging therapeutic technique is psychedelic-assisted psychotherapy, which combines hallucinogenic psychedelic drugs and psychotherapy to address treatment-resistant depression and PTSD. MDMA (street name of Ecstasy or X) and psilocybin (mushrooms) are used in this treatment technique. MDMA increases serotonin, norepinephrine, and dopamine levels in the brain, as well as decreases anxious and depressive feelings, which leads to increased feelings of empathy, self-compassion, extraversion, and introspection, along with altering patients’ body image, sense of self, and perception. Overall, this type of therapy can help PTSD patients tackle their traumatic experiences with less fear and avoidance, allowing them to work through their experiences with a therapist.

Research on MDMA-assisted psychotherapy is ongoing, with one study noting that 76% of patients no longer met the criteria for PTSD after this therapeutic technique, and with no side effects observed from the MDMA. Another study found that MDMA treatment in patients with severe PTSD was well-tolerated and did not increase the risk of illegal substance use.

Psilocybin-assisted psychotherapy is used for treatment-resistant depression. Psilocybin affects the serotonin 2A receptor, causing alterations in visual perception, improved mood, increased feelings of connection, and the ability for patients to recollect old memories. Patients who use psilocybin enter a dream-like euphoric state and may see or hear things that are not truly there. For some, it’s a blissful experience; for others, it’s frightening. Research is ongoing, with some studies finding that psilocybin quickly reduces depressive symptoms and improves mood long-term, with some patients experiencing sustained remission of depression after one treatment with psilocybin. Overall, psychedelic-assisted psychotherapy appears to aid in introspection, cognitive shifts, and releasing emotions, which is very beneficial in patients living with PTSD or treatment-resistant depression.

It’s important to note that there aren’t rigid treatment guidelines for psychedelic-assisted psychotherapy, meaning it will require further safety research, including what patients cannot use this form of therapy, as well as developing an individualized treatment approach for patients who can. If the FDA approves it as a treatment, it will need to be administered under the guidance of a psychedelic therapist, requiring an expansion in the psychiatry field and coverage by insurance. Unfortunately, at this time, one session can range from $10,000 to $15,000, making it inaccessible for patients since it’s not currently covered by insurance.

Dialectical Behavior Therapy (DBT)

Dialectical Behavior Therapy (DBT) uses techniques such as mindfulness, emotional regulation, distress tolerance, and interpersonal skills to help patients with difficulty regulating emotions. Mindfulness anchors people to the present to help them avoid worrying about the past or future. Emotional regulation helps people gain awareness and control over their feelings. Distress tolerance helps patients manage their emotions in difficult situations to avoid responding with unhelpful behaviors. Improving interpersonal skills involves helping patients understand how to assert personal boundaries while remaining respectful of themselves and others.

DBT can help patients accept their reality, understand how their behaviors affect their lives, and provide a way to develop skills to change their lives for the better. It’s particularly effective for those who deal with complex and intense emotions, such as patients with:

DBT can take up to a year in different settings, such as:

Individual therapy
Group skills training
Phone coaching

Several studies have shown that DBT reduces suicidality in patients with BPD, along with improving their mood stability and social functioning, reducing the impulsivity and hospitalization rates of patients treated with DBT. Another study highlighted that 92% of patients who underwent DBT also had minimal depression. If you’d like to learn more, take a few minutes to read this study on how DBT affects anxiety, mindfulness, quality of life, and more in patients.

Virtual Reality Therapy (VRT)

Virtual Reality Therapy (VRT) is another new, interesting therapeutic tool that’s been shown to be effective in treating phobias, anxiety disorders, and PTSD. Much like standard exposure therapy, VRT works by placing patients in anxiety-provoking or stressful situations, but in the safety of virtual reality. Through VRT, patients can practice skills, decrease fears, boost confidence, and work through a challenging situation they’ve faced in the past while controlling the intensity of the exposure.

While exposure therapy can be done without the use of virtual reality, VRT is an excellent option for treating a patient’s phobia of an object or situation that can be potentially dangerous. For example, an individual may have a phobia of a specific wild animal, and instead of exposing them to that animal in person, it can be done using VRT. VRT is also beneficial in treating PTSD by helping patients face traumatic memories or situations in a controlled setting.

In terms of effectiveness, one study concluded that VRT reduces PTSD symptoms, with the benefits continuing for about three months after treatment ended. VRT has also been shown to reduce symptoms of anxiety and depression by teaching skills like self-compassion and assistance with the visualization techniques used in cognitive behavioral therapy (CBT).

Other Emerging Therapies

Developed in the 1980s as a behavioral therapy integrating mindfulness and acceptance strategies with commitment and behavior-change techniques to increase psychological flexibility, Acceptance and Commitment Therapy (ACT) emphasizes accepting unfavorable experiences to help patients deal with their difficult emotions and commit to choosing actions that reflect their values. The goal of ACT is not to eliminate negative experiences, but instead to increase patients’ involvement in activities reflective of their personal values, using six processes aimed at empowering patients to make better choices despite difficult circumstances. Those processes include:

Identifying values
Committing to meaningful action
Observing themselves as separate from their feelings
Detaching from thoughts (cognitive diffusion)
Acceptance of thoughts and feelings
Staying engaged in the present

ACT can treat various conditions such as eating disorders, OCD, psychosis, substance use disorder, MDD, generalized anxiety disorder, chronic pain, and stress.

Speaking of mindfulness, another emerging therapy is Mindfulness-Based Stress Reduction (MBSR). MBSR incorporates techniques like breathing techniques, yoga, meditation, gratitude journaling, and group sessions to aid in pain management, stress relief, managing anxiety and depression, along with high blood pressure, and more.

Mindfulness works by helping patients to be present and aware of their breath, thoughts, bodily feelings, and to observe them without reaction or judgment. MBSR research shows mindfulness improves memory and attention, as well as influencing areas of the brain related to attention and emotional regulation, demonstrating that mindfulness is a protective factor for mental health.

Neurofeedback Therapy emphasizes a mind-body connection using sensors to measure respiratory rate, pulse, temperature, and muscle-to-tension rates while giving patients feedback through audio or visual cues. An electroencephalography (EEG) monitors the patient’s brain waves, and, through this noninvasive feedback technique, patients learn to regulate their brain activity.

Neurofeedback therapy research can treat conditions such as attention deficit hyperactivity disorder (ADHD), learning disorders, PTSD, substance use disorders, anxiety, and trauma. It’s often combined with traditional talk therapy, but more research is needed to develop best practices and treatment guidelines.

The final type of therapy we’re discussing is Compassion-Focused Therapy (CFT), which aims to teach skills of self-compassion, comfort, and compassion for others, along with mindfulness techniques. Typically, patients treated with CFT struggle to be kind to themselves, have strong feelings of shame, and are very self-critical. By using CFT and the skills cultivated throughout the sessions, patients become better at mood regulation and creating a sense of safety for themselves.

CFT is typically used to treat mood disorders, personality disorders, eating disorders, hoarding disorder, and psychosis. Research shows that it’s effective in improving self-compassion, self-reassurance, and decreasing depressive symptoms. While CFT shows promise, more research is needed to determine the long-term effects and if it’s more effective than the current standards of care.

Embracing Innovative Therapies for Better Patient Outcomes

There are a variety of psychotherapy advancements and exciting new mental health therapies to discover, with many showing encouraging outcomes. As a clinician, it’s critical to remain curious and seek to explore new treatment options and integrate them into your practice. However, to expand on mental health treatments, accessibility, and training, we need ongoing education and research on these new therapeutic tools. So while there’s a lot to learn, Osmosis has your back with a wide selection of helpful clinician guides to encourage you to keep learning and seeking the best treatment options for your patients.

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