Ph.D/Psy.D scope of practice - lightboxes, exercise, diet, supplements

[hemipepsis5p]

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Hi all,

I'm wondering if a Ph.D/Psy.D can recommend something like lightbox therapy to someone with SAD, or Omega 3's for ADHD/melatonin for sleep, or various types of exercise for depression, or a non-processed food diet for mood, etc...

Or is all of that psychiatry only?

 

[WisNeuro]

You can recommend evidence based things for mood and whatnot within bounds. I'd stay away from supplements, personally. One, most aren't empirically supported, and two, that can definitely be seen as practicing outside of your scope to a board if you ever get a complaint. We recommend exercise for a variety of things, just always include the caveat of talking with your physician about limitations, etc.

 

[erg923]

Hi all,

I'm wondering if a Ph.D/Psy.D can recommend something like lightbox therapy to someone with SAD, or Omega 3's for ADHD/melatonin for sleep, or various types of exercise for depression, or a non-processed food diet for mood, etc...

Or is all of that psychiatry only?

I mean, yea. If you feel confident is has a solid evidence base for it. Psychologists often explicitly recommend medications to help too, although not specific ones and defer to a PCP or Psychiatry ultimately for the decision. Omega 3 for ADHD seems suspect. And while melatonin is pretty benign, I would always couch that as being time-limited and in conjunction with proper sleep hygiene/behavior. Exercise? Of course. We are obese in this country. Just check for date of last physical exam and any heart and/or pulmonary conditions/contraindications, etc.

 

[AcronymAllergy]

I wouldn't see anything wrong with recommending behaviorally-based interventions/treatments/etc., such as exercise. In my case, I just make sure to always state something similar to, "if medically appropriate" and encourage the patient to check with their PCP. With medications, I've never and likely will never recommend specific medications, unless I somehow, some way end up prescribing. I may state something like, "research indicates use of XX in the case of YY condition is associated with ZZ results" and encourage the patient to then follow-up with their medical provider(s). But that's as far as I go.

I've never recommended a specific supplement, primarily because I've yet to see a solid enough evidence base for most of what might be relevant. I also agree with the above that it could be seen as skirting the lines of your scope of practice, even if supplements aren't controlled. If I were to recommend a supplement, I'd likely do so in the way I mentioned above RE: medications (e.g., "research indicates use of..."), and would always recommend they check first with their medical provider(s), particularly for potential interactions with any medications they're taking or conditions they have.

 

[AbnormalPsych]

I read a medical paper a couple years back where they looked at the composition of supplements, particularly the ones for sleep related things, and would it surprise you to know the composition was not what it was supposed to be in an alarming manner of cases. I won't touch anything related to those topics. PCP referral it is.

I think reviewing the scientific literature for things like light boxes is fair game, exercise is within the scope if you are discussing behavioral activation approaches to depressive d/o, those kinds of things make sense. I would never recommend a specific light box, or type of light/prescribe a frequency, that kind of thing.

 

[allantois]

Do you mean to tell me you don't send patients to their psych/pcp telling them they need Xanax like some therapists I've known about??

 

[cara susanna]

In our clinic, therapists "prescribe" lightboxes all of the time. And exercise is often my go-to when I do behavioral activation.