If You Can Make It Visible — Part 1
☕ Welcome to Eva’s Tea
In this next series, we will break down how we can do better when recommending nonpharmacologic interventions as part of a treatment plan.
Why these interventions often fail.
And what we own in that failure.
Hint: the issue is not the evidence.
It’s the delivery.
Start here: What Big Pharma does exceptionally well
Before we improve, we need to observe.
What are they doing so effectively that patients walk into intake already asking for a specific medication?
First—scale matters.
Over $6 billion per year is spent on direct-to-consumer pharmaceutical advertising in the United States.
But the real advantage is the message delivered.
“Take this → feel better.”
Immediate
Visible
They:
Show the problem
Show the solution
Show the outcome
And they make the outcome visible.
Emotion first. Data second.
Pharmaceutical advertising consistently uses imagery of restored normalcy:
Families together.
Time outdoors on a perfect sunny day.
Smiling, laughing, functioning, connected.
This is emotion-first communication.
Meanwhile, in clinical practice
As PMHNPs, we are not anti-medication.
Reducing suffering matters.
The American Psychiatric Nurses Association puts it well: “Whole health begins with mental health.”
Medications are one tool in the toolbox.
But when we recommend non-pharmacologic strategies—many of which are evidence-based—we often sound like this:
“Try to exercise more.”
“Eat healthier.”
“Work on your sleep.”
Meanwhile, patients are immersed in a marketing system that promises:
• Better mood
• Weight loss
• Fast relief
• Visible change
…our non-pharm strategies have no chance of competing this way.
What the data shows about advertising
As summarized by Harvard Health Publishing:
Direct-to-consumer drug ads are designed to sell, not educate, and their language reflects that.
These ads:
Use vague superiority claims (“leading treatment”)
Rely heavily on anecdotes over data
Omit comparisons to equally effective or lower-risk options
Emphasize benefit while minimizing context
At a systems level, they also medicalize normal experiences and can increase anxiety by framing common symptoms as conditions requiring treatment.
Harvard Health Publishing. How direct-to-consumer drug ads hook us. https://www.health.harvard.edu/blog/harvard-health-ad-watch-how-direct-to-consumer-ads-hook-us-201909201968
So, what’s the real problem?
Patients are not resistant.
They are unconvinced.
Not because the intervention is weak
but because the signal is boring, bland or invisible.
A parallel signal we should not ignore
At the same time, another conversation is starting to surface in psychiatry.
Some of the field’s leading voices are calling for a greater focus on when to stop medication—not just when to start it.
Not because medication is wrong.
But because, in practice, it often continues without a clear endpoint.
Patients begin treatment with a plan.
But not always with a reassessment point.
We see a similar pattern diagnostically.
An “adjustment disorder” diagnosis that curiously extends for years.
A label that was meant to be time-limited… becoming static.
Not out of negligence.
But because nothing forced a clear moment for the PMHNP to re-evaluate.
And over time, some meds get… parked.
Stable enough.
Unchanged.
Still taking something that may no longer be doing what it once did.
Deprescribing, in this sense, is not withdrawal.
It is clinical precision.
It requires:
• Timing
• Observation (always use measurement tools when possible)
• Patient alignment
• A clear signal that something has changed
And that last part matters.
Because if a patient cannot see improvement clearly…
they also cannot see when it is time to step things down.
The shift PMHNPs need to make
It’s not an advice problem.
It’s a feedback problem.
☕☕ If you can make the invisible visible, behavior changes.
Where we’re taking this
In the next articles, we will introduce several non-pharm strategies and break them down into specific, usable steps.
Each with one goal:
👉 Make the intervention visible
👉 Make the feedback immediate
👉 Make the behavior sustainable
Final point
Non-pharmacologic interventions often carry:
A very low side effect burden
Greater long-term stability
More patient autonomy
But none of that matters if the patient does not understand the evidence.
They also need to see the benefit early.
They might need additional motivation or support. This is where our psychotherapy skills and Motivational Interviewing comes in.
That is the gap.
And that is what we fix.
As we move forward, share what you’ve done to make this “visible” in practice. Id love to feature the best examples.