Here's How Therapists Could Combat Vaccine Hesitancy

As of late September, a quarter of adults in the United States have not gotten a COVID vaccine, despite the fact that research has consistently shown that vaccination works at preventing serious illness and hospitalization.

Even with offers like $100 incentives and raffles for full-ride college scholarships, vaccine uptake still isn't as high as experts wish. In September, President Biden ultimately mandated vaccines for some workers. But not everyone will fall under this new mandate.

Now researchers are looking at one untapped resource for promoting vaccination: mental healthcare providers.

"The potential of mental health professionals and agencies to address barriers to COVID-19 vaccination has received inadequate attention," Neetu Abad, PhD, a senior behavioral scientist and co-lead of the Vaccine Confidence Team at the Centers for Disease Control and Prevention (CDC), tells Verywell. "Mental health professionals and teams are trained to use empathy, reflective listening, and cooperative goal setting to help patients address challenges."

Abad and co-author Noel Brewer, PhD, a professor of public health at the University of North Carolina-Chapel Hill and an adviser on vaccination for the World Health Organization (WHO) and the CDC, discuss how mental health professionals can help encourage COVID vaccination, in a viewpoint that was published in the Journal of the American Medical Association (JAMA) Psychiatry in late September.

Mental Health and Vaccination

The link between vaccine behavior and mental health has not been widely studied, but the authors of the recent viewpoint article say that the two are related. For example, anxiety can lead people to fixate on the possible harms of vaccination, overriding facts that show vaccines are safe.

Abad and Brewer write that, in general, mental and physical health are intertwined. For example, people with poor mental health are more likely to contract infectious diseases such as seasonal influenza (the flu), herpes simplex virus (HSV), and hepatitis C. Previous research has also found that having a mental health disorder increases a person's risk of dying from COVID-19.

People with mental health conditions may also be less likely to engage in many routine health behaviors that can prevent these infections. "Mild psychological symptoms and more severe mental illness can interfere with planning and execution of preventive behaviors, likely including vaccination," Abad and Brewer wrote.

Anxiety could lead to intense worry about vaccine side effects even though serious ones are rare. Depression could interfere with the planning and goal-setting required to schedule shots and attentional limitations could make it hard to sift through the information on vaccines, as well as the ability to separate credible sources from fake news.

How Therapists Can Help

In their viewpoint, Abad and Brewer recommend interventions using the Increasing Vaccination Model (IVM), which identifies three main influences on vaccination behavior: what people think and how they feel, their social experiences, and opportunities for direct behavior change.

Changing Minds—and Hearts

What we think and how we feel influence everything we do. So it's no surprise that these factors also lead to vaccine hesitancy. Abad and Brewer write that factors that affect vaccination include disease risk appraisals, vaccine confidence, and motivation.

Affecting disease risk appraisal—a person's perceived risk of the disease and any worry or fear that accompanies it—has not been working. The number of COVID-related illnesses and deaths has risen for more than a year, yet unvaccinated people are more likely to express less concern about the virus.

Vaccine confidence has also suffered. Worries over vaccine side effects and doubts about the speed at which the vaccines were manufactured haven't helped.

Higher vaccine confidence is needed to increase vaccination rates. The FDA's approval of the Pfizer vaccine may help. But Abad and Brewer say that this area is where mental health professionals can really play a key role.

Therapists are trained to help people sort through internal conflicts, as well as facilitate the development of skills that can soothe concerns around vaccination safety and distrust of government.

One research-backed technique that therapists are more likely to be trained in than other health professionals is motivational interviewing (MI); a technique that can be especially useful when discussing vaccines.

In another paper, Graham Easton, PhD, professor of clinical communication skills at the University of London, dives into how MI can help with vaccination. "The great strength of motivational interviewing is that it does not seek to persuade or coerce patients into having the vaccine," Easton wrote.

Easton writes that MI offers an approach where, "the practitioner comes 'alongside' the patient, tries to understand their views, and offers rather than imposes information that might help them weigh up the risks and benefits for themselves, and make a decision that makes sense to them."

Offering Social Support

Abad and Brewer emphasize that being personally recommended or spoken to about the vaccine can have a huge influence—especially if someone trusts their mental health provider. In fact, Abad and Brewer say that clinician recommendations are "one of the strongest motivators of uptake for all vaccines."

Therapists can also work with individuals who remain hesitant because they fear being ostracized by family and friends. For example, a therapist could help a person practice and develop strategies for handling these conversations.

Taking Steps Together

The final techniques discussed directly impact behavior. Abad and Brewer write that "nudges" (which we see at a national level now with vaccine mandates) could also come from therapists in smaller ways that still have a big impact.

Something as simple as helping clients book vaccination appointments or reminding clients to get their second shot could increase full vaccination rates and motivate clients to follow through.

"Around 18% of US adults see a mental health professional in a 12-month period, providing an important opportunity," Abad says. "A better understanding of how mental health affects receipt of COVID-19 vaccines and better defining how mental health professionals can help, particularly for disproportionately affected communities, is fundamentally important now and could strengthen vaccination efforts."

The information in this article is current as of the date listed, which means newer information may be available when you read this. For the most recent updates on COVID-19, visit our coronavirus news page.