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Immediate and long-term effectiveness of adding an Internet intervention for depression to routine outpatient psychotherapy: Subgroup analysis of the EVIDENT trial. J Affect Disord 2020; 274:643-651. [PMID: 32663998 DOI: 10.1016/j.jad.2020.05.122] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 04/27/2020] [Accepted: 05/17/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To examine immediate and long-term effectiveness of an adjunctive Internet intervention for depression in a large sample of patients undergoing routine psychotherapy. METHOD The current study evaluated a subgroup of patients from the Evident trial, a randomized investigation of a 12-week minimally guided Internet intervention (Deprexis) for the treatment of mild to moderate depression. 340 adults (mean age = 43.3 years; 71.7 % female) of the original sample received routine outpatient psychotherapy during the trial period, resulting in a standard psychotherapy group (n = 174) and an augmented therapy group (n = 166). Outcomes were assessed at baseline, post-treatment and 6-month follow-up. RESULTS Intention-to-treat analyses indicated that combined treatment led to a greater reduction in symptoms of depression (effect size d = 0.32; p = .002), improved therapeutic progress (d = 0.36; p = .003), and higher mental health-related quality of life (d = 0.34; p = .004). There was no intervention effect on physical health-related quality of life. The same pattern was found at 6-month follow-up, and adjunctive treatment also resulted in increased rates of clinical improvement. Treatment success was independent from therapeutic orientation of combined face-to-face therapy. CONCLUSION Results indicate that the adjunctive use of the investigated intervention can produce additional and lasting effects in routine outpatient psychotherapy for mild to moderate levels of depression. The study adds to the ongoing evidence on augmented effects of blended treatment. Future studies should investigate different types of blends in diverse populations by means of change-sensitive assessment strategies.
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102
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Guo C, Ashrafian H, Ghafur S, Fontana G, Gardner C, Prime M. Challenges for the evaluation of digital health solutions-A call for innovative evidence generation approaches. NPJ Digit Med 2020; 3:110. [PMID: 32904379 PMCID: PMC7453198 DOI: 10.1038/s41746-020-00314-2] [Citation(s) in RCA: 116] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 07/22/2020] [Indexed: 02/06/2023] Open
Abstract
The field of digital health, and its meaning, has evolved rapidly over the last 20 years. For this article we followed the most recent definition provided by FDA in 2020. Emerging solutions offers tremendous potential to positively transform the healthcare sector. Despite the growing number of applications, however, the evolution of methodologies to perform timely, cost-effective and robust evaluations have not kept pace. It remains an industry-wide challenge to provide credible evidence, therefore, hindering wider adoption. Conventional methodologies, such as clinical trials, have seldom been applied and more pragmatic approaches are needed. In response, several academic centers such as researchers from the Institute of Global Health Innovation at Imperial College London have initiated a digital health clinical simulation test bed to explore new approaches for evidence gathering relevant to solution type and maturity. The aim of this article is to: (1) Review current research approaches and discuss their limitations; (2) Discuss challenges faced by different stakeholders in undertaking evaluations; and (3) Call for new approaches to facilitate the safe and responsible growth of the digital health sector.
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Working Alliance Inventory for Online Interventions-Short Form (WAI-TECH-SF): The Role of the Therapeutic Alliance between Patient and Online Program in Therapeutic Outcomes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17176169. [PMID: 32854381 PMCID: PMC7503297 DOI: 10.3390/ijerph17176169] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 08/17/2020] [Accepted: 08/19/2020] [Indexed: 11/18/2022]
Abstract
Background: Therapeutic alliance (TA) between the patient and therapist has been related to positive therapeutic outcomes. Because Internet-based interventions are increasingly being implemented, a tool is needed to measure the TA with Internet-based self-guided programs. The Working Alliance Inventory for online interventions (WAI-TECH-SF) was adapted based on the WAI Short Form (Hatcher & Gillaspy, 2006). The objectives of this study were: (1) to analyse the psychometric properties of the WAI-TECH-SF; (2) to explore the differences in the WAI-TECH-SF scores according to different categories of the sample; and (3) to analyse whether the WAI-TECH-SF can predict therapeutic outcomes and satisfaction with the treatment. Methods: 193 patients diagnosed with depression were included and received blended Cognitive-Behavioural Therapy. Measures of preferences, satisfaction, and credibility about the treatment, TA with the online program, depressive symptoms, and satisfaction with the treatment were administered. Results: An exploratory factor analysis revealed a one-dimensional structure with adequate internal consistency. Linear regression analyses showed that the WAI-TECH-SF predicted changes in depressive symptoms and satisfaction with the treatment. Conclusions: WAI-TECH-SF is a reliable questionnaire to assess the TA between the patient and the online program, which is associated with positive therapeutic outcomes and satisfaction with the treatment.
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Baumeister H, Terhorst Y, Grässle C, Freudenstein M, Nübling R, Ebert DD. Impact of an acceptance facilitating intervention on psychotherapists' acceptance of blended therapy. PLoS One 2020; 15:e0236995. [PMID: 32785245 PMCID: PMC7423074 DOI: 10.1371/journal.pone.0236995] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 07/17/2020] [Indexed: 11/19/2022] Open
Abstract
Blended therapy is a new approach combining advantages of face-to-face psychotherapy and Internet- and mobile-based interventions. Acceptance is a fundamental precondition for its implementation. The aim of this study was to assess 1) the acceptance of psychotherapists towards blended therapy, 2) the effectiveness of an acceptance facilitating intervention (AFI) on psychotherapists' acceptance towards blended therapy and 3) to identify potential effect moderators. Psychotherapists (N = 284) were randomly assigned to a control (CG) or an intervention group (IG). The IG received a short video showing an example of blended therapy, the CG an attention placebo video. Both groups received a reliable online questionnaire assessing acceptance, effort expectancy, performance expectancy, facilitating conditions, social influence and internet anxiety. Between group differences were examined using t-tests and Mann-Whitney tests. Exploratory analysis was conducted to identify moderators. Psychotherapists in CG showed mixed baseline acceptance towards blended therapy (low = 40%, moderate = 33%, high = 27%). IG showed significantly higher acceptance compared to CG (d = .27, pone-sided = .029; low = 24%, moderate = 47%, high = 30%). Bootstrapped confidence intervals were overlapping. Performance expectancy (d = .35), effort expectancy (d = .44) and facilitating conditions (d = .28) were significantly increased (p < .05). No effects on social influence and internet anxiety were found (p>.05). Exploratory analysis indicated psychodynamic oriented psychotherapists profiting particularly from the AFI. Blended therapy is a promising approach to improve healthcare. Psychotherapists show mixed acceptance, which might be improvable by AFIs, particularly in subpopulations of initially rather skeptical psychotherapists. Forthcoming studies should extend the present study by shifting focus from attitudes to the impact of different forms of AFIs on uptake.
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Affiliation(s)
- Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Yannik Terhorst
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Cora Grässle
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Maren Freudenstein
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Rüdiger Nübling
- Chamber of Psychotherapists Baden-Württemberg, Stuttgart, Germany
| | - David Daniel Ebert
- Faculty of Behavioural and Movement Sciences, Clinical, Neuro- & Developmental Psychology, VU Amsterdam, Amsterdam, The Netherlands
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105
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Hegerl U, Oehler C. Promises and risks of web-based interventions in the treatment of depression
. DIALOGUES IN CLINICAL NEUROSCIENCE 2020; 22:161-168. [PMID: 32699516 PMCID: PMC7366945 DOI: 10.31887/dcns.2020.22.2/uhegerl] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Major depression (MD) is a highly prevalent and severe disorder with many patients
having no access to efficient treatments such as pharmaco- and psychotherapy. Web-based
interventions promise to be a method to provide resource-efficient and widespread access
to psychotherapeutic support. Meta-analyses summarizing studies that use face-to-face
psychotherapy as a comparator provide evidence for equivalent antidepressant efficacy.
Web-based interventions seem to be particularly efficacious when they are accompanied by
some form of professional guidance. However, they are also associated with a variety of
possible risks (eg, suicidal crises can be overlooked) and unwanted effects (eg,
increase in rumination and somatization due to self-monitoring) that are so far
under-studied. Although some naturalistic studies yield smaller effect sizes than
randomized controlled trials (RCTs), well-designed interventions with adequate guidance
have been shown to be successfully integrable into routine care.
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Affiliation(s)
- Ulrich Hegerl
- President of European Alliance Against Depression, Senckenberg Distinguished Professorship, Department of Psychiatry, Psychosomatics and Psychotherapy, Goethe-Universität Frankfurt, Germany
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106
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Davies F, Shepherd HL, Beatty L, Clark B, Butow P, Shaw J. Implementing Web-Based Therapy in Routine Mental Health Care: Systematic Review of Health Professionals' Perspectives. J Med Internet Res 2020; 22:e17362. [PMID: 32706713 PMCID: PMC7413287 DOI: 10.2196/17362] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 06/05/2020] [Accepted: 06/11/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Web-based therapies hold great promise to increase accessibility and reduce costs of delivering mental health care; however, uptake in routine settings has been low. OBJECTIVE Our objective in this review was to summarize what is known about health care professionals' perceptions of the barriers to and facilitators of the implementation of web-based psychological treatments in routine care of adults in health care settings. METHODS We searched 5 major databases (MEDLINE, EMBASE, PsycINFO, CINAHL, and the Cochrane Library) for qualitative, quantitative, or mixed-methods studies exploring health professionals' views on computer- or internet-based psychological treatment programs. We coded included articles for risk of bias and extracted data using a prepiloted extraction sheet. RESULTS We identified 29 eligible articles: 14 qualitative, 11 quantitative, and 4 mixed methods. We identified the following themes: patient factors, health professional factors, the therapeutic relationship, therapy factors, organizational and system factors, and models of care. Health professionals supported web-based therapies only for patients with relatively straightforward, low-risk diagnoses, strong motivation and engagement, high computer literacy and access, and low need for tailored content. They perceived flexibility with timing and location as advantages of web-based therapy, but preferred blended therapy to facilitate rapport and allow active monitoring and follow-up of patients. They emphasized the need for targeted training and organizational support to manage changed workflows. Health professionals were concerned about the confidentiality and security of client data for web-based programs, suggesting that clear and transparent protocols need to be in place to reassure health professionals before they will be willing to refer. CONCLUSIONS Without health professionals' support, many people will not access web-based therapies. To increase uptake, it is important to ensure that health professionals receive education, familiarization, and training to support them in incorporating web-based therapies into their practice, and to design systems that support health professionals in this new way of working with patients and addressing their concerns. TRIAL REGISTRATION PROSPERO CRD42018100869; https://tinyurl.com/y5vaoqsk.
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Affiliation(s)
- Fiona Davies
- Psycho-Oncology Co-operative Research Group, School of Psychology, The University of Sydney, Sydney, Australia
| | - Heather L Shepherd
- Psycho-Oncology Co-operative Research Group, School of Psychology, The University of Sydney, Sydney, Australia
| | - Lisa Beatty
- Flinders Centre for Innovation in Cancer, College of Medicine & Public Health, Flinders University South Australia, Adelaide, Australia
| | - Brodie Clark
- Psycho-Oncology Co-operative Research Group, School of Psychology, The University of Sydney, Sydney, Australia
| | - Phyllis Butow
- Psycho-Oncology Co-operative Research Group, School of Psychology, The University of Sydney, Sydney, Australia
| | - Joanne Shaw
- Psycho-Oncology Co-operative Research Group, School of Psychology, The University of Sydney, Sydney, Australia
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Digital interventions in adult mental healthcare settings: recent evidence and future directions. Curr Opin Psychiatry 2020; 33:422-431. [PMID: 32427592 DOI: 10.1097/yco.0000000000000614] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW Internet and mobile-based interventions (IMI) can be used as online delivered forms of psychotherapeutic mental health treatments. These interventions can be an effective as well as time and cost-efficient treatment with the potential to scale up mental healthcare. In this review, we map implementation possibilities into routine mental healthcare settings and provide the most recent evidence. RECENT FINDINGS Fourteen articles on digital mental healthcare approaches published in the last 18 months were included. Despite the limited number, the studies provide evidence for the effectiveness of IMI in treating inpatients and outpatients with various disorders in different mental healthcare settings. IMI were investigated as stand-alone interventions, in combination with other treatment forms (blended-care), or as aftercare. SUMMARY Although there is encouraging evidence for the effectiveness of IMI in mental healthcare settings, several limitations have to be considered. The small number of studies conducted within the healthcare system, especially with inpatient samples, calls for more collaboration between researchers and clinical practitioners to unravel barriers and develop efficient protocols for the integration into routine care. Nonetheless, IMI are a promising tool for the endeavour of closing the treatment gap and should, therefore, be further explored in varying settings.
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108
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Grondin F, Lomanowska AM, Békés V, Jackson PL. A methodology to improve eye contact in telepsychotherapy via videoconferencing with considerations for psychological distance. COUNSELLING PSYCHOLOGY QUARTERLY 2020. [DOI: 10.1080/09515070.2020.1781596] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- F. Grondin
- École de psychologie, Université Laval, Québec (QC), Canada
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Québec (QC), Canada
- CERVO Brain Research Center, Québec (QC), Canada
| | | | - V. Békés
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA
| | - P. L. Jackson
- École de psychologie, Université Laval, Québec (QC), Canada
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Québec (QC), Canada
- CERVO Brain Research Center, Québec (QC), Canada
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Hoffmann M, Wensing M, Peters-Klimm F, Szecsenyi J, Hartmann M, Friederich HC, Haun MW. Perspectives of Psychotherapists and Psychiatrists on Mental Health Care Integration Within Primary Care Via Video Consultations: Qualitative Preimplementation Study. J Med Internet Res 2020; 22:e17569. [PMID: 32554369 PMCID: PMC7333073 DOI: 10.2196/17569] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 03/18/2020] [Accepted: 04/03/2020] [Indexed: 12/13/2022] Open
Abstract
Background Many patients with mental disorders remain untreated. Video-based mental health care demonstrates comparable effectiveness to face-to-face treatments and is a promising mode for delivering specialized care within primary care. Nevertheless, professionals struggle with implementing video consultations in their daily practice. Specifically, little is known about mental health specialists’ acceptance of mental health video consultations in routine practice. The PROVIDE (ImPROving cross-sectoral collaboration between primary and psychosocial care: An implementation study on VIDEo consultations) project aims to improve cross-sectoral collaboration between primary and psychosocial care through implementing video consultations in primary care. To increase the uptake of video consultations, it is crucial to account for necessary prerequisites and to tailor interventions to the needs of the target group prior to implementation. Objective The aim of this study was to explore the acceptance of video consultations embedded in primary care from the perspectives of mental health specialists in Germany. Methods We conducted a qualitative, exploratory, preimplementation study in urban and rural counties. We conducted three semistructured focus groups with 11 mental health specialists. We used qualitative content analysis combining an inductive-deductive approach, applying the Tailored Implementation in Chronic Diseases (TICD) framework to the text material, which comprises individual health professional factors; patient factors; professional interactions; incentives and resources; capacity for organizational change; social, political, and legal factors; and guideline factors. Results Against the background of long waiting times and a shortage of mental health specialists, especially in rural areas, participants valued video consultations as a potential means to improve access to mental health care. With respect to the TICD framework domains, the participants most often discussed individual health professional factors, followed by patient factors. All participants highlighted the importance of a trusting relationship between the patient and the therapist and doubted whether such a relationship could be established through video consultations (11/11, 100%). However, participants considered mental health specialist video consultations to be particularly suited for patients in rural areas, those with impaired mobility, and those who may otherwise remain untreated (6/11, 55%). Most participants expected video consultations to help the aforementioned patient groups avoid tedious searching for an available therapist and save on travel time and, therefore, improve access to specialized care for patients (7/11, 64%). Moreover, the participants expected video consultations to improve collaboration with the family physician (6/11, 55%). Finally, participants identified organizational aspects, such as reliable scheduling, the duration of the individual consultation (9/11, 82%), and reimbursement conditions (7/11, 67%), as key drivers for the acceptance and adoption of the model. Conclusions While mental health specialists expect video consultations to improve access to specialized care for some patients, they consistently wonder whether such consultations can establish a trusting patient-therapist relationship. When implementing video consultations, these concerns should be addressed by training providers in managing technology-based treatment settings, with extra consideration for fostering the patients’ and therapists’ engagement. Trial Registration German Clinical Trials Register DRKS00012487; https://tinyurl.com/uhg2one
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Affiliation(s)
- Mariell Hoffmann
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Heidelberg, Germany
| | - Michel Wensing
- Department of General Practice and Health Services Research, Heidelberg University, Heidelberg, Germany
| | - Frank Peters-Klimm
- Department of General Practice and Health Services Research, Heidelberg University, Heidelberg, Germany
| | - Joachim Szecsenyi
- Department of General Practice and Health Services Research, Heidelberg University, Heidelberg, Germany
| | - Mechthild Hartmann
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Heidelberg, Germany
| | - Hans-Christoph Friederich
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Heidelberg, Germany
| | - Markus W Haun
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Heidelberg, Germany
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Aafjes-van Doorn K, Békés V, Prout TA. Grappling with our therapeutic relationship and professional self-doubt during COVID-19: will we use video therapy again? COUNSELLING PSYCHOLOGY QUARTERLY 2020. [DOI: 10.1080/09515070.2020.1773404] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Katie Aafjes-van Doorn
- Clinical Psychology Doctoral Program, Ferkauf Graduate School of Psychology, Yeshiva University, New York, NY, USA
| | - Vera Békés
- Clinical Psychology Doctoral Program, Ferkauf Graduate School of Psychology, Yeshiva University, New York, NY, USA
| | - Tracy A. Prout
- Clinical Psychology Doctoral Program, Ferkauf Graduate School of Psychology, Yeshiva University, New York, NY, USA
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111
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Smoktunowicz E, Barak A, Andersson G, Banos RM, Berger T, Botella C, Dear BF, Donker T, Ebert DD, Hadjistavropoulos H, Hodgins DC, Kaldo V, Mohr DC, Nordgreen T, Powers MB, Riper H, Ritterband LM, Rozental A, Schueller SM, Titov N, Weise C, Carlbring P. Consensus statement on the problem of terminology in psychological interventions using the internet or digital components. Internet Interv 2020; 21:100331. [PMID: 32577404 PMCID: PMC7305336 DOI: 10.1016/j.invent.2020.100331] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 05/18/2020] [Accepted: 05/31/2020] [Indexed: 12/21/2022] Open
Abstract
Since the emergence of psychological interventions delivered via the Internet they have differed in numerous ways. The wealth of formats, methods, and technological solutions has led to increased availability and cost-effectiveness of clinical care, however, it has simultaneously generated a multitude of terms. With this paper, we first aim to establish whether a terminology issue exists in the field of Internet-delivered psychological interventions. If so, we aim to determine its implications for research, education, and practice. Furthermore, we intend to discuss solutions to mitigate the problem; in particular, we propose the concept of a common glossary. We invited 23 experts in the field of Internet-delivered interventions to respond to four questions, and employed the Delphi method to facilitate a discussion. We found that experts overwhelmingly agreed that there were terminological challenges, and that it had significant consequences for conducting research, treating patients, educating students, and informing the general public about Internet-delivered interventions. A cautious agreement has been reached that formulating a common glossary would be beneficial for the field to address the terminology issue. We end with recommendations for the possible formats of the glossary and means to disseminate it in a way that maximizes the probability of broad acceptance for a variety of stakeholders.
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Affiliation(s)
- Ewelina Smoktunowicz
- Department of Psychology, SWPS University of Social Sciences and Humanities, Chodakowska 19, 31 03-815 Warsaw, Poland,Department of Psychology, Stockholm University, Frescati Hagvag 8, 114 19 Stockholm, Sweden
| | - Azy Barak
- Department of Counseling and Human Development, University of Haifa, Israel
| | - Gerhard Andersson
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Rosa M. Banos
- Universidad de Valencia, Valencia, Spain,CIBER Fisiopatologia Obesidad y Nutrición (CIBEROBN), Instituto Salud Carlos III, Madrid, Spain
| | - Thomas Berger
- Department of Clinical Psychology and Psychotherapy, University of Bern, Switzerland
| | - Cristina Botella
- CIBER Fisiopatologia Obesidad y Nutrición (CIBEROBN), Instituto Salud Carlos III, Madrid, Spain,Uiversitat Jaume I, Valencia, Spain
| | - Blake F. Dear
- Department of Psychology, Macquarie University, Sydney, Australia
| | - Tara Donker
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit, Amsterdam, the Netherlands
| | - David D. Ebert
- Faculty of Behavioural and Movement Sciences, Clinical, Neuro- & Developmental Psychology, Vrije Universiteit, Amsterdam, the Netherlands
| | | | | | - Viktor Kaldo
- Department of Psychology, Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden,Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Sweden
| | - David C. Mohr
- Center for Behavioral Intervention Technologies, Department of Preventive Medicine, Northwestern University, Chicago, IL, USA
| | - Tine Nordgreen
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | | | - Heleen Riper
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit, Amsterdam, the Netherlands
| | - Lee M. Ritterband
- Center for Behavioral Health & Technology, Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville, VA, USA
| | - Alexander Rozental
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden,Institute of Child Health, UCL, London, UK
| | - Stephen M. Schueller
- Department of Psychological Science, University of California, Irvine, Irvine, CA, USA
| | - Nickolai Titov
- Department of Psychology, Macquarie University, Sydney, Australia
| | - Cornelia Weise
- Department of Psychology, Division of Clinical Psychology and Psychotherapy, Philipps–University of Marburg, Marburg, Germany
| | - Per Carlbring
- Department of Psychology, Stockholm University, Frescati Hagvag 8, 114 19 Stockholm, Sweden,Corresponding author at: Department of Psychology, SE-106 91 Stockholm, Sweden.
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112
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Bagarić B, Jokić‐Begić N. Measuring therapists' attitudes toward integration of technology in psychotherapy and predicting their use of technology. J Clin Psychol 2020; 76:1151-1172. [DOI: 10.1002/jclp.22967] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 03/31/2020] [Accepted: 04/13/2020] [Indexed: 11/12/2022]
Affiliation(s)
- Branka Bagarić
- Croatian Association for Behavioral‐Cognitive Therapies (CABCT)Zagreb Croatia
| | - Nataša Jokić‐Begić
- Department of Psychology, Faculty of Humanities and Social SciencesUniversity of ZagrebZagreb Croatia
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Probst T, Stippl P, Pieh C. Changes in Provision of Psychotherapy in the Early Weeks of the COVID-19 Lockdown in Austria. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E3815. [PMID: 32471295 PMCID: PMC7312759 DOI: 10.3390/ijerph17113815] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 05/16/2020] [Accepted: 05/26/2020] [Indexed: 12/19/2022]
Abstract
Reducing personal contacts is a central measure against the spreading of the novel coronavirus disease (COVID-19). This troubles mental health, but also mental health care as treatments usually take place in personal contact and switching to remote treatments might be necessary in times of COVID-19. The present study investigated the question how the provision of psychotherapy changed in the early weeks of the COVID-19 lockdown in Austria and whether there were differences between the four therapeutic orientations eligible in Austria (psychodynamic, humanistic, systemic, behavioral). Psychotherapists (N = 1547) completed an online survey. They entered their number of patients treated on average per week (in personal contact, via telephone, via Internet) in the early weeks of the COVID-19 lockdown in Austria as well as (retrospectively) in the months before. The number of patients treated on average per week in personal contact decreased (on average 81%; p < 0.001), whereas the number of patients treated on average per week via telephone and via Internet increased (on average 979% and 1561%; both p < 0.001). Yet, the decrease of psychotherapies through personal contact was not compensated for by increases of remote psychotherapies (p < 0.001). No differences between the four therapeutic orientations emerged. Results imply an undersupply of psychotherapy in the COVID-19 lockdown and that further changes are necessary to cover the increased need for timely psychotherapy in times of COVID-19.
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Affiliation(s)
- Thomas Probst
- Department for Psychotherapy and Biopsychosocial Health, Danube University Krems, 3500 Krems, Austria;
| | - Peter Stippl
- Austrian Federal Association for Psychotherapy, 1030 Vienna, Austria;
| | - Christoph Pieh
- Department for Psychotherapy and Biopsychosocial Health, Danube University Krems, 3500 Krems, Austria;
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114
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Mendes-Santos C, Weiderpass E, Santana R, Andersson G. Portuguese Psychologists' Attitudes Toward Internet Interventions: Exploratory Cross-Sectional Study. JMIR Ment Health 2020; 7:e16817. [PMID: 32250273 PMCID: PMC7171568 DOI: 10.2196/16817] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 12/10/2019] [Accepted: 01/26/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Despite the significant body of evidence on the efficacy and cost-effectiveness of internet interventions, the implementation of such programs in Portugal is virtually non-existent. In addition, Portuguese psychologists' use and their attitudes towards such interventions is largely unknown. OBJECTIVE The aim of this study was to explore Portuguese psychologists' knowledge, training, use and attitudes towards internet interventions; to investigate perceived advantages and limitations of such interventions; identify potential drivers and barriers impacting implementation; and study potential factors associated to previous use and attitudes towards internet interventions. METHODS An online cross-sectional survey was developed by the authors and disseminated by the Portuguese Psychologists Association to its members. RESULTS A total of 1077 members of the Portuguese Psychologists Association responded to the questionnaire between November 2018 and February 2019. Of these, 37.2% (N=363) were familiar with internet interventions and 19.2% (N=188) considered having the necessary training to work within the field. 29.6% (N=319) of participants reported to have used some form of digital technology to deliver care in the past. Telephone (23.8%; N=256), e-mail (16.2%; N=175) and SMS (16.1%; N=173) services were among the most adopted forms of digital technology, while guided (1.3%; N=14) and unguided (1.5%; N=16) internet interventions were rarely used. Accessibility (79.9%; N=860), convenience (45.7%; N=492) and cost-effectiveness (45.5%; N=490) were considered the most important advantages of internet interventions. Conversely, ethical concerns (40.7%; N=438), client's ICT illiteracy (43.2%; N=465) and negative attitudes towards internet interventions (37%; N=398) were identified as the main limitations. An assessment of participants attitudes towards internet interventions revealed a slightly negative/neutral stance (Median=46.21; SD=15.06) and revealed greater acceptability towards blended treatment interventions (62.9%; N=615) when compared to standalone internet interventions (18.6%; N=181). Significant associations were found between knowledge (χ24=90.4; P<.001), training (χ24=94.6; P<.001), attitudes (χ23=38.4; P<.001) and previous use of internet interventions and between knowledge (χ212=109.7; P<.001), training (χ212=64.7; P<.001) and attitudes towards such interventions, with psychologists reporting to be ignorant and not having adequate training in the field, being more likely to present more negative attitudes towards these interventions and not having prior experience in its implementation. CONCLUSIONS This study revealed that most Portuguese psychologists are not familiar with and have no training or prior experience using internet interventions and had a slightly negative/neutral attitude towards such interventions. There was greater acceptability towards blended treatment interventions compared to standalone internet interventions. Lack of knowledge and training were identified as the main barriers to overcome, underlining the need of promoting awareness and training initiatives to ensure internet interventions successful implementation.
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Affiliation(s)
- Cristina Mendes-Santos
- Department of Culture and Society, Linköping University, Linköping, Sweden
- NOVA National School of Public Health, Public Health Research Centre, Universidade Nova de Lisboa, Lisboa, Portugal
| | | | - Rui Santana
- NOVA National School of Public Health, Public Health Research Centre, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Gerhard Andersson
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
- Department of Clinical Neuroscience, Psychiatry Section, Karolinska Institutet, Stockholm, Sweden
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Apolinário-Hagen J, Hennemann S, Kück C, Wodner A, Geibel D, Riebschläger M, Zeißler M, Breil B. Exploring User-Related Drivers of the Early Acceptance of Certified Digital Stress Prevention Programs in Germany. Health Serv Insights 2020; 13:1178632920911061. [PMID: 32206013 PMCID: PMC7074489 DOI: 10.1177/1178632920911061] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 02/14/2020] [Indexed: 12/29/2022] Open
Abstract
Electronic mental health services represent innovative instruments to increase the dissemination of stress programs in primary prevention. However, little is known about facilitators of their uptake. This study aimed to explore determinants of the acceptance of centrally certified digital stress coping programs and preferences for service delivery modes among adult members of German statutory health insurances. Participants completed a multi-construct 45-item questionnaire covering acceptance of digital stress prevention (behavioral use intention) and potential predictors we assessed using hierarchical regression analysis-(1) socio-demographic variables and time spent online, (2) openness to experience, (3) perceived stress, and (4) attitudes toward e-mental health. Preferences in terms of the willingness to use online, face-to-face and blended programs were analyzed using paired t-tests. Participants (N = 171, 66% female, 18-69 years) reported a moderate acceptance of digital stress management (M = 2.76, SD = 1.16, range: 1-5). We identified younger age (ß = -0.16, P = .009), openness to experience (ß = 0.17, P = .003), and positive attitudes (ß = 0.61, P < .001) as predictors of acceptance (R 2 = .50, P < .001). Face-to-face was preferred over online (d = 0.40) and blended (d = 0.33), and blended over stand-alone online delivery mode (d = 0.19; all P < .001). Our findings indicate that promoting favorable attitudes toward digital stress prevention through tailored information may be a starting point to facilitate their adoption.
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Affiliation(s)
- Jennifer Apolinário-Hagen
- Institute of Occupational, Social and Environmental Medicine, Centre for Health and Society, Faculty of Medicine, University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Severin Hennemann
- Department of Clinical Psychology, Psychotherapy and Experimental Psychopathology, Institute of Psychology, University of Mainz, Mainz, Germany
| | - Christina Kück
- Faculty of Psychology, University of Hagen, Hagen, Germany
| | | | - Dorota Geibel
- Faculty of Psychology, University of Hagen, Hagen, Germany
| | | | - Martin Zeißler
- Faculty of Psychology, University of Hagen, Hagen, Germany
| | - Bernhard Breil
- Faculty of Health Care, Hochschule Niederrhein, University of Applied Sciences, Krefeld, Germany
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Wind TR, Rijkeboer M, Andersson G, Riper H. The COVID-19 pandemic: The 'black swan' for mental health care and a turning point for e-health. Internet Interv 2020; 20:100317. [PMID: 32289019 PMCID: PMC7104190 DOI: 10.1016/j.invent.2020.100317] [Citation(s) in RCA: 375] [Impact Index Per Article: 93.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 03/18/2020] [Accepted: 03/18/2020] [Indexed: 11/14/2022] Open
Affiliation(s)
- Tim R. Wind
- Foundation Centrum '45, Oegstgeest, The Netherlands
- partner in Arq Psychotrauma Expert Group, Nienoord 5, 1112 XE Diemen, the Netherlands
| | - Marleen Rijkeboer
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, the Netherlands
| | - Gerhard Andersson
- Department of Behavioural Science and Learning, Linköping University, Linköping, Sweden,Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Heleen Riper
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit, Amsterdam, the Netherlands,Department of Research and Innovation, GGZ in Geest/Amsterdam University Medical Center, VU University Medical Center, Amsterdam, Netherlands,Corresponding author at: Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit, Amsterdam, the Netherlands.
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117
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Kerst A, Zielasek J, Gaebel W. Smartphone applications for depression: a systematic literature review and a survey of health care professionals' attitudes towards their use in clinical practice. Eur Arch Psychiatry Clin Neurosci 2020; 270:139-152. [PMID: 30607530 DOI: 10.1007/s00406-018-0974-3] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 12/19/2018] [Indexed: 12/30/2022]
Abstract
Smartphone applications ("apps") may contribute to closing the treatment gap for depression by reaching large populations at relatively low costs. The general public seems open towards the use of apps for mental disorders but less is known about the attitudes of health care professionals. Therefore, the aim of this study was to examine the available evidence on the effectiveness of apps for depression and to explore the attitudes of health care professionals towards their use in practice. A systematic literature search was performed aimed at studies utilizing smartphone applications for depression. In addition, a survey was conducted to explore health care professionals' attitudes towards using these treatment apps in clinical practice. Twelve articles were identified in the systematic literature review. All included trials reported a decline in depressive symptoms after the intervention periods. In the survey, 72 health care professionals participated. Significant differences were found between the level of technology experience and how much the health care professional would consider the use of mobile applications in clinical practice. Survey participants reported openness towards therapeutic app use but very little knowledge and experience in the field. Apps appear to be a promising self-management tool for reducing depressive symptoms. Despite some concerns, health care professionals' attitudes towards the use of smartphone applications in clinical practice are quite positive. The provision of information on the potential benefits of e-health interventions as well as the training of professionals in the application of new technologies may increase health care professionals' awareness and knowledge about mobile apps for the treatment of mental disorders.
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Affiliation(s)
- Ariane Kerst
- Department of Psychiatry, Medical Faculty, LVR-Klinikum Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany.
- WHO Collaborating Center for Quality Assurance and Empowerment in Mental Health, Düsseldorf, Germany.
| | | | - Wolfgang Gaebel
- Department of Psychiatry, Medical Faculty, LVR-Klinikum Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany
- WHO Collaborating Center for Quality Assurance and Empowerment in Mental Health, Düsseldorf, Germany
- LVR-Institute for Healthcare Research, Cologne, Germany
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118
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Mol M, van Genugten C, Dozeman E, van Schaik DJF, Draisma S, Riper H, Smit JH. Why Uptake of Blended Internet-Based Interventions for Depression Is Challenging: A Qualitative Study on Therapists' Perspectives. J Clin Med 2019; 9:E91. [PMID: 31905834 PMCID: PMC7019532 DOI: 10.3390/jcm9010091] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Revised: 12/10/2019] [Accepted: 12/20/2019] [Indexed: 02/06/2023] Open
Abstract
(1) Background: Blended cognitive behavioral therapy (bCBT; online and face-to-face sessions) seems a promising alternative alongside regular face-to-face CBT depression treatment in specialized mental health care organizations. Therapists are key in the uptake of bCBT. This study focuses on therapists' perspectives on usability, satisfaction, and factors that promote or hinder the use of bCBT in routine practice; (2) Methods: Three focus groups (n = 8, n = 7, n = 6) and semi-structured in-depth interviews (n = 15) were held throughout the Netherlands. Beforehand, the participating therapists (n = 36) completed online questionnaires on usability and satisfaction. Interviews were analyzed by thematic analysis; (3) Results: Therapists found the usability sufficient and were generally satisfied with providing bCBT. The thematic analysis showed three main themes on promoting and hindering factors: (1) therapists' needs regarding bCBT uptake, (2) therapists' role in motivating patients for bCBT, and (3) therapists' experiences with bCBT; (4) Conclusions: Overall, therapists were positive; bCBT can be offered by all CBT-trained therapists and future higher uptake is expected. Especially the pre-set structure of bCBT was found beneficial for both therapists and patients. Nevertheless, therapists did not experience promised time-savings-rather, the opposite. Besides, there are still teething problems and therapeutic shortcomings that need improvement in order to motivate therapists to use bCBT.
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Affiliation(s)
- Mayke Mol
- Department of Research and Innovation, GGZ inGeest, Specialized Mental Health Care, 1081 Amsterdam, The Netherlands; (C.v.G.); (E.D.); (D.J.F.v.S.); (S.D.); (H.R.); (J.H.S.)
- Department of Psychiatry, Amsterdam Public Health Research Institute, VU University Medical Center, 1081 Amsterdam, The Netherlands
| | - Claire van Genugten
- Department of Research and Innovation, GGZ inGeest, Specialized Mental Health Care, 1081 Amsterdam, The Netherlands; (C.v.G.); (E.D.); (D.J.F.v.S.); (S.D.); (H.R.); (J.H.S.)
- Department of Psychiatry, Amsterdam Public Health Research Institute, VU University Medical Center, 1081 Amsterdam, The Netherlands
| | - Els Dozeman
- Department of Research and Innovation, GGZ inGeest, Specialized Mental Health Care, 1081 Amsterdam, The Netherlands; (C.v.G.); (E.D.); (D.J.F.v.S.); (S.D.); (H.R.); (J.H.S.)
- Department of Psychiatry, Amsterdam Public Health Research Institute, VU University Medical Center, 1081 Amsterdam, The Netherlands
| | - Digna J. F. van Schaik
- Department of Research and Innovation, GGZ inGeest, Specialized Mental Health Care, 1081 Amsterdam, The Netherlands; (C.v.G.); (E.D.); (D.J.F.v.S.); (S.D.); (H.R.); (J.H.S.)
- Department of Psychiatry, Amsterdam Public Health Research Institute, VU University Medical Center, 1081 Amsterdam, The Netherlands
| | - Stasja Draisma
- Department of Research and Innovation, GGZ inGeest, Specialized Mental Health Care, 1081 Amsterdam, The Netherlands; (C.v.G.); (E.D.); (D.J.F.v.S.); (S.D.); (H.R.); (J.H.S.)
- Department of Psychiatry, Amsterdam Public Health Research Institute, VU University Medical Center, 1081 Amsterdam, The Netherlands
| | - Heleen Riper
- Department of Research and Innovation, GGZ inGeest, Specialized Mental Health Care, 1081 Amsterdam, The Netherlands; (C.v.G.); (E.D.); (D.J.F.v.S.); (S.D.); (H.R.); (J.H.S.)
- Department of Psychiatry, Amsterdam Public Health Research Institute, VU University Medical Center, 1081 Amsterdam, The Netherlands
- Department of Clinical, Neuro and Developmental Psychology, Clinical Psychology Section, Vrije Universiteit Amsterdam and the Amsterdam Public Health Research Institute, 1081 Amsterdam, The Netherlands
- Telepsychiatry and E-Mental Health, Department of Clinical Research, University of Southern Denmark, 5000 Odense, Denmark
| | - Jan H. Smit
- Department of Research and Innovation, GGZ inGeest, Specialized Mental Health Care, 1081 Amsterdam, The Netherlands; (C.v.G.); (E.D.); (D.J.F.v.S.); (S.D.); (H.R.); (J.H.S.)
- Department of Psychiatry, Amsterdam Public Health Research Institute, VU University Medical Center, 1081 Amsterdam, The Netherlands
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119
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Rasing SPA, Stikkelbroek YAJ, Bodden DHM. Is Digital Treatment the Holy Grail? Literature Review on Computerized and Blended Treatment for Depressive Disorders in Youth. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 17:E153. [PMID: 31878249 PMCID: PMC6982181 DOI: 10.3390/ijerph17010153] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 12/18/2019] [Accepted: 12/20/2019] [Indexed: 12/11/2022]
Abstract
Computerized and blended treatments seem to be an attractive treatment for adolescents as an alternative to face-to-face treatment, but mental health professionals seem hesitant to use these treatment modalities. This review provides an overview of factors contributing to and withholding from using computerized or blended treatment in routine care. Three databases were searched with terms related to (1) adolescents, (2) depression, (3) computerized or blended, and (4) treatment. Of the 33 articles identified, 10 focused on unguided computerized treatments, six on guided, two on blended, two compared unguided, blended- and face-to-face treatment to no treatment, and eight studies on games. Further, two articles that were focused on an online monitoring tool and three on intervention characteristics or preferred modes of help-seeking. Evidence for effectiveness, adherence, drop-out, and forming therapeutic relations were suspected to be barriers, but are no reason to reject computerized or blended treatment. Improvement in mental health literacy and the possibility to tailor the intervention are facilitators. However, adolescents' intention to seek help, acceptability of computerized treatment, symptom severity, time spent by therapist, and other facilities are identified as barriers and they need to be taken into account when using computerized or blended interventions. Nevertheless, computerized and blended are promising treatments for depressed youth.
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Affiliation(s)
- Sanne P. A. Rasing
- Child and Adolescent Studies, Utrecht University, P.O. Box 80140, 3508 TC Utrecht, The Netherlands; (Y.A.J.S.); (D.H.M.B.)
- Child and Adolescent Psychiatry, GGZ Oost Brabant, P.O. Box 3, 5427 ZG Boekel, The Netherlands
| | - Yvonne A. J. Stikkelbroek
- Child and Adolescent Studies, Utrecht University, P.O. Box 80140, 3508 TC Utrecht, The Netherlands; (Y.A.J.S.); (D.H.M.B.)
- Child and Adolescent Psychiatry, GGZ Oost Brabant, P.O. Box 3, 5427 ZG Boekel, The Netherlands
| | - Denise H. M. Bodden
- Child and Adolescent Studies, Utrecht University, P.O. Box 80140, 3508 TC Utrecht, The Netherlands; (Y.A.J.S.); (D.H.M.B.)
- Developmental Psychopathology, Radboud University, P.O. Box 9104, 6500 HE Nijmegen, The Netherlands
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120
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Apolinário-Hagen J, Hennemann S, Fritsche L, Drüge M, Breil B. Determinant Factors of Public Acceptance of Stress Management Apps: Survey Study. JMIR Ment Health 2019; 6:e15373. [PMID: 31697243 PMCID: PMC6873149 DOI: 10.2196/15373] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 09/12/2019] [Accepted: 10/11/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Chronic stress is a major public health concern. Mobile health (mHealth) apps can help promote coping skills in daily life and prevent stress-related issues. However, little is known about the determinant factors of public acceptance of stress management in relation to preferences for psychological services. OBJECTIVE The aim of this survey study was to (1) assess determinant factors of public acceptance (behavioral use intention) of stress management apps based on an adapted and extended version of the Unified Theory of Acceptance and Use of Technology (UTAUT) model and (2) explore preferences for mHealth apps compared with other mental health services. METHODS Using convenience sampling, participants completed a multiscale 54-item Web-based survey. Based on significant correlations with acceptance, hierarchical stepwise regression analysis was performed within three blocks: (1) background and stress-related control variables, (2) beliefs and attitudes toward using mHealth, and (3) the core UTAUT determinants. The preference for mHealth apps in comparison with nine other mental health services (operationalized as readiness to use) was analyzed using paired t tests. RESULTS Of 141 participants, nearly half (69/141, 48.9%) indicated prior mHealth use. Acceptance of stress coping apps was moderate (mean 3.10, SD 1.03, range 1-5). Hierarchical stepwise regression including four of 11 variables (R2=.62; P=.01, f2=1.63) identified positive attitudes toward using mHealth for stress coping (beta=0.69, P<.001, 46% R2 increase above block 1, f2=0.85), skepticism/perceived risks (beta=-0.14, P=.01, f2=0.16), and stress symptoms (beta=0.12, P=.03, f2=0.14) as significant predictors of acceptance. UTAUT determinants added no predictive contribution beyond attitudes (all P>.05, R2 increase of 1%), whereas post hoc analysis showed significant R2 increases of attitudes and skepticism/perceived risks beyond UTAUT determinants (all P<.001, R2 increase of 13%). The readiness to use apps was equivalent to or significantly higher than most service types, but lower than information websites. CONCLUSIONS Attitudes may be at least as predictive for the acceptance of stress management apps as for more elaborated outcome beliefs. Efforts aimed at improving the public adoption of mHealth could put more emphasis on the pleasant aspects of app use, address misconceptions, offer stress screening tools on health websites, and increase options to try high-quality apps.
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Affiliation(s)
- Jennifer Apolinário-Hagen
- Institute of Occupational, Social and Environmental Medicine, Faculty of Medicine, Centre for Health and Society, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Severin Hennemann
- Department of Clinical Psychology, Psychotherapy and Experimental Psychopathology, Institute of Psychology, University of Mainz, Mainz, Germany
| | - Lara Fritsche
- Department of Health Psychology, Faculty of Psychology, University of Hagen, Hagen, Germany
| | - Marie Drüge
- Psychotherapy Research, Department of Clinical Psychology, Institute of Psychology, University of Zurich, Zurich, Switzerland
| | - Bernhard Breil
- Faculty of Health Care, Niederrhein University of Applied Sciences, Krefeld, Germany
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121
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Topooco N, Byléhn S, Dahlström Nysäter E, Holmlund J, Lindegaard J, Johansson S, Åberg L, Bergman Nordgren L, Zetterqvist M, Andersson G. Evaluating the Efficacy of Internet-Delivered Cognitive Behavioral Therapy Blended With Synchronous Chat Sessions to Treat Adolescent Depression: Randomized Controlled Trial. J Med Internet Res 2019; 21:e13393. [PMID: 31682572 PMCID: PMC6858617 DOI: 10.2196/13393] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 07/17/2019] [Accepted: 07/28/2019] [Indexed: 01/17/2023] Open
Abstract
Background Depression is a common and serious problem among adolescents, but few seek or have access to therapy. Internet-delivered cognitive behavioral therapies (ICBTs), developed to increase treatment access, show promise in reducing depression. The inclusion of coach support in treatment is desired and may be needed. Objective The aim of this study was to determine the efficacy of an ICBT protocol blended with weekly real-time therapist sessions via chat; blended treatment, for adolescent depression, including major depressive episode (MDE). The protocol has previously been evaluated in a controlled study. Methods In a two-arm randomized controlled trial, adolescents 15 to 19 years of age were recruited through a community setting at the national level in Sweden (n=70) and allocated to either 8 weeks of treatment or to minimal attention control. Depression was assessed at baseline, at posttreatment, and at 12 months following treatment (in the intervention group). The primary outcome was self-reported depression level as measured with the Beck Depression Inventory II at posttreatment. The intervention was offered without the need for parental consent. Results Over two weeks, 162 adolescents registered and completed the baseline screening. Eligible participants (n=70) were on average 17.5 years of age (SD 1.15), female (96%, 67/70), suffered from MDE (76%, 53/70), had no previous treatment experience (64%, 45/70), and reported guardian(s) to be aware about their depression state (71%, 50/70). The average intervention completion was 74% (11.8 of 16 modules and sessions). Following the treatment, ICBT participants demonstrated a significant decrease in depression symptoms compared with controls (P<.001), corresponding to a large between-group effect (intention-to-treat analysis: d=0.86, 95% CI 0.37-1.35; of completer analysis: d=0.99, 95% CI 0.48-1.51). A significant between-group effect was observed in the secondary depression outcome (P=.003); clinically significant improvement was found in 46% (16/35) of ICBT participants compared with 11% (4/35) in the control group (P=.001). Conclusions The results are in line with our previous study, further demonstrating that adolescents with depression can successfully be engaged in and experience significant improvement following ICBT blended with therapist chat sessions. Findings on participants’ age and baseline depression severity are of interest in relation to used study methods. Trial Registration ClinicalTrials.gov NCT02363205; https://clinicaltrials.gov/ct2/show/NCT02363205
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Affiliation(s)
- Naira Topooco
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden.,Center for m2Health, Palo Alto, CA, United States
| | - Sandra Byléhn
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | | | - Jenny Holmlund
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Johanna Lindegaard
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Sanna Johansson
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Linnea Åberg
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Lise Bergman Nordgren
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Maria Zetterqvist
- Center for Social and Affective Neuroscience, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.,Department of Child and Adolescent Psychiatry, Region Östergötland, Linköping, Sweden
| | - Gerhard Andersson
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden.,Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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122
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Gaffney H, Mansell W, Tai S. Conversational Agents in the Treatment of Mental Health Problems: Mixed-Method Systematic Review. JMIR Ment Health 2019; 6:e14166. [PMID: 31628789 PMCID: PMC6914342 DOI: 10.2196/14166] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 06/30/2019] [Accepted: 07/18/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The use of conversational agent interventions (including chatbots and robots) in mental health is growing at a fast pace. Recent existing reviews have focused exclusively on a subset of embodied conversational agent interventions despite other modalities aiming to achieve the common goal of improved mental health. OBJECTIVE This study aimed to review the use of conversational agent interventions in the treatment of mental health problems. METHODS We performed a systematic search using relevant databases (MEDLINE, EMBASE, PsycINFO, Web of Science, and Cochrane library). Studies that reported on an autonomous conversational agent that simulated conversation and reported on a mental health outcome were included. RESULTS A total of 13 studies were included in the review. Among them, 4 full-scale randomized controlled trials (RCTs) were included. The rest were feasibility, pilot RCTs and quasi-experimental studies. Interventions were diverse in design and targeted a range of mental health problems using a wide variety of therapeutic orientations. All included studies reported reductions in psychological distress postintervention. Furthermore, 5 controlled studies demonstrated significant reductions in psychological distress compared with inactive control groups. In addition, 3 controlled studies comparing interventions with active control groups failed to demonstrate superior effects. Broader utility in promoting well-being in nonclinical populations was unclear. CONCLUSIONS The efficacy and acceptability of conversational agent interventions for mental health problems are promising. However, a more robust experimental design is required to demonstrate efficacy and efficiency. A focus on streamlining interventions, demonstrating equivalence to other treatment modalities, and elucidating mechanisms of action has the potential to increase acceptance by users and clinicians and maximize reach.
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Affiliation(s)
- Hannah Gaffney
- Division of Psychology & Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Warren Mansell
- Division of Psychology & Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Sara Tai
- Division of Psychology & Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
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March S, Donovan CL, Baldwin S, Ford M, Spence SH. Using stepped-care approaches within internet-based interventions for youth anxiety: Three case studies. Internet Interv 2019; 18:100281. [PMID: 31890629 PMCID: PMC6926334 DOI: 10.1016/j.invent.2019.100281] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 09/03/2019] [Accepted: 09/03/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND There are a lack of clear guidelines for the dissemination of Internet-based cognitive behaviour therapy (ICBT) for childhood and adolescent anxiety in routine care. While self-guided ICBT has greater reach than therapist-guided ICBT, it is plagued by problems of low program adherence and many young people are not successfully treated. It is important that we identify models of ICBT that are accessible, but provide the right support, at the right time to those who need it. Stepped-care models of ICBT offer one potential solution. OBJECTIVE This case study examined the application of stepped-care within an ICBT intervention for childhood and adolescent anxiety, in which young people were stepped up from self-guided to therapist-guided ICBT. METHODS Three case studies are presented and include young males (aged 11-12 years) who participated in BRAVE Stepped-Care, a new ICBT program incorporating two treatment steps: Step 1 - five sessions of self-guided ICBT and Step 2 - five sessions of therapist-guided ICBT. Participants completed diagnostic assessments at pre- and post-treatment, along with a battery of self-report questionnaires. Step-up requirements were determined at a mid-treatment assessment. Treatment response was determined by change on diagnostic severity and presence of diagnosis and changes in self-reported anxiety symptoms (through T-scores and Reliable Change Indices). RESULTS In-depth examination of the three case studies showed that decisions to step-up from Step 1 to Step 2 were complex and required consideration of program engagement and adherence, as well as changes on self-reported anxiety, behavioural indicators of anxiety and parent perspectives. Results showed that non-responders at mid-treatment who were stepped-up to therapist-guided ICBT after Step 1 were able to increase engagement and response to treatment in Step 2, such that they were free of their primary anxiety diagnosis at post-treatment. CONCLUSIONS The findings highlight the importance of early assessment of engagement and non-response within self-guided ICBT programs for youth anxiety and the positive changes that can subsequently occur when therapist-guidance is introduced mid-treatment for non-responders. The efficacy of stepped-care ICBT models needs to be confirmed in larger randomised controlled trials.
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Affiliation(s)
- Sonja March
- University of Southern Queensland, School of Psychology and Counselling and Centre for Health, Informatics and Economics Research, Springfield, QLD 4300, Australia,Corresponding author at: 37 Sinnathamby Boulevard, Springfield Central, QLD 4300, Australia.
| | - Caroline L. Donovan
- Griffith University, School of Applied Psychology, Mt Gravatt, QLD, Australia
| | - Sarah Baldwin
- University of Southern Queensland, Centre for Health, Informatics and Economics Research, Springfield, QLD 4300, Australia
| | - Martelle Ford
- University of Southern Queensland, School of Psychology and Counselling and Centre for Health, Informatics and Economics Research, Springfield, QLD 4300, Australia
| | - Susan H. Spence
- Griffith University, Australian Institute for Suicide Research and Prevention, Mt Gravatt, QLD, Australia
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Heesacker M, Perez C, Quinn MS, Benton S. Computer-assisted psychological assessment and psychotherapy for collegians. J Clin Psychol 2019; 76:952-972. [PMID: 31476251 DOI: 10.1002/jclp.22854] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE This article reviews research on computerized and computer-assisted psychological assessment and psychotherapy for college and university students. METHOD Published reviews of outcome research on the topic are reviewed, along with individual clinical trials and other relevant studies not covered by reviews, as well as reviews of closely-related research. RESULTS Computer-assisted assessment and psychotherapy have proven effective with collegians across samples, nations, and presenting concerns. CONCLUSIONS Currently-available digital technologies can address these mental health service delivery challenges: cost, limited human resources, failure of students to seek help, stigmatization of collegians seeking help, premature termination, inadequate process and outcome data to assess and improve treatment effectiveness, and lack of real-time data-based treatment selection.
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Affiliation(s)
- Martin Heesacker
- Department of Psychology, University of Florida, Gainesville, Florida
| | - Caroline Perez
- Department of Counseling Psychology and Community Services, University of North Dakota, Grand Forks, North Dakota
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125
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Mendes-Santos C, Weiderpass E, Santana R, Andersson G. A guided internet-delivered individually-tailored ACT-influenced cognitive behavioural intervention to improve psychosocial outcomes in breast cancer survivors (iNNOVBC): Study protocol. Internet Interv 2019; 17:100236. [PMID: 30949435 PMCID: PMC6430035 DOI: 10.1016/j.invent.2019.01.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 01/31/2019] [Accepted: 01/31/2019] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Internet-delivered interventions can provide remarkable opportunities in addressing breast cancer survivors' unmet support care needs, as they present an effective strategy to improve care coordination and provide access to efficacious, cost-efficient and convenient survivorship care. Nevertheless, research focusing on improving survivors' psychosocial needs using internet-based tools is scarce and its practical implementation is limited. OBJECTIVES To study the acceptability, feasibility, efficacy and cost-effectiveness of iNNOVBC, a 10 weeks guided internet-delivered individually-tailored Acceptance and Commitment Therapy (ACT)-influenced cognitive behavioural (CBT) intervention developed to improve mild to moderate anxiety and depression in Breast cancer survivors when compared to treatment as usual (TAU) in a waiting list control group (WLC). METHODS A two-arm, parallel, open label, multicentre, waiting list randomized controlled trial will be conducted to investigate the efficacy and cost-effectiveness of INNOVBC. The primary outcomes in this research will be anxiety and depression. Secondary outcomes will include psychological flexibility, fatigue, insomnia, sexual dysfunction and Health Related Quality of Life (HRQoL). ETHICAL APPROVAL This study has been reviewed and approved by Comissão Nacional de Proteção de Dados; Instituto Português de Oncologia do Porto Francisco Gentil; Unidade Local de Saúde de Matosinhos, EPE; Centro Hospitalar de São João and Ordem dos Psicólogos ethical committees. EXPECTED RESULTS It is anticipated that iNNOVBC will show to be an efficacious and cost-effective program in improving the outcomes of interest in this study, as opposed to a WLC under TAU. The results of this research will be published in accordance with CONSORT-EHEALTH guidelines. CONCLUSIONS This study will inform on the acceptability, feasibility, efficacy and cost-effectiveness of iNNOVBC, in improving psychosocial outcomes in breast cancer survivors when compared to TAU in a WLC. Its conclusions will contribute to understand the idiosyncrasies of designing and implementing internet-delivered interventions in breast cancer survivors.Trial Registration code: INNOVBC (NCT03275727).
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Affiliation(s)
- Cristina Mendes-Santos
- Department of Culture and Communication (IKK), Linköping University, Linköping, Sweden
- Public Health Research Center (CISP), Escola Nacional de Saúde Pública, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Elisabete Weiderpass
- Department of Research, Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway
- Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Genetic Epidemiology Group, Folkhälsan Research Center, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Rui Santana
- Public Health Research Center (CISP), Escola Nacional de Saúde Pública, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Gerhard Andersson
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
- Department of Clinical Neuroscience, Psychiatry Section, Karolinska Institutet, Stockholm, Sweden
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Kemmeren LL, van Schaik A, Smit JH, Ruwaard J, Rocha A, Henriques M, Ebert DD, Titzler I, Hazo JB, Dorsey M, Zukowska K, Riper H. Unraveling the Black Box: Exploring Usage Patterns of a Blended Treatment for Depression in a Multicenter Study. JMIR Ment Health 2019; 6:e12707. [PMID: 31344670 PMCID: PMC6686640 DOI: 10.2196/12707] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 05/23/2019] [Accepted: 06/10/2019] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Blended treatments, combining digital components with face-to-face (FTF) therapy, are starting to find their way into mental health care. Knowledge on how blended treatments should be set up is, however, still limited. To further explore and optimize blended treatment protocols, it is important to obtain a full picture of what actually happens during treatments when applied in routine mental health care. OBJECTIVE The aims of this study were to gain insight into the usage of the different components of a blended cognitive behavioral therapy (bCBT) for depression and reflect on actual engagement as compared with intended application, compare bCBT usage between primary and specialized care, and explore different usage patterns. METHODS Data used were collected from participants of the European Comparative Effectiveness Research on Internet-Based Depression Treatment project, a European multisite randomized controlled trial comparing bCBT with regular care for depression. Patients were recruited in primary and specialized routine mental health care settings between February 2015 and December 2017. Analyses were performed on the group of participants allocated to the bCBT condition who made use of the Moodbuster platform and for whom data from all blended components were available (n=200). Included patients were from Germany, Poland, the Netherlands, and France; 64.5% (129/200) were female and the average age was 42 years (range 18-74 years). RESULTS Overall, there was a large variability in the usage of the blended treatment. A clear distinction between care settings was observed, with longer treatment duration and more FTF sessions in specialized care and a more active and intensive usage of the Web-based component by the patients in primary care. Of the patients who started the bCBT, 89.5% (179/200) also continued with this treatment format. Treatment preference, educational level, and the number of comorbid disorders were associated with bCBT engagement. CONCLUSIONS Blended treatments can be applied to a group of patients being treated for depression in routine mental health care. Rather than striving for an optimal blend, a more personalized blended care approach seems to be the most suitable. The next step is to gain more insight into the clinical and cost-effectiveness of blended treatments and to further facilitate uptake in routine mental health care.
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Affiliation(s)
- Lise L Kemmeren
- Department of Research and Innovation, GGZ inGeest Specialized Mental Health Care, Amsterdam, Netherlands.,Psychiatry, Amsterdam Public Health Research Institute, Amsterdam Universitair Medische Centra, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Anneke van Schaik
- Department of Research and Innovation, GGZ inGeest Specialized Mental Health Care, Amsterdam, Netherlands.,Psychiatry, Amsterdam Public Health Research Institute, Amsterdam Universitair Medische Centra, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Johannes H Smit
- Department of Research and Innovation, GGZ inGeest Specialized Mental Health Care, Amsterdam, Netherlands.,Psychiatry, Amsterdam Public Health Research Institute, Amsterdam Universitair Medische Centra, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Jeroen Ruwaard
- Department of Research and Innovation, GGZ inGeest Specialized Mental Health Care, Amsterdam, Netherlands.,Psychiatry, Amsterdam Public Health Research Institute, Amsterdam Universitair Medische Centra, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Artur Rocha
- Centre for Information Systems and Computer Graphics, Institute for Systems Engineering and Computers, Technology and Science, Porto, Portugal
| | - Mário Henriques
- Centre for Information Systems and Computer Graphics, Institute for Systems Engineering and Computers, Technology and Science, Porto, Portugal
| | - David Daniel Ebert
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander University of Erlangen-Nürnberg, Erlangen, Germany
| | - Ingrid Titzler
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander University of Erlangen-Nürnberg, Erlangen, Germany
| | - Jean-Baptiste Hazo
- Eceve, Unit 1123, Inserm, Université de Paris, Paris, France.,Unité de Recherche en Economie de la Santé, Assistance Publique, Hôpitaux de Paris, Paris, France.,World Health Organization Collaborating Centre for Research and Training in Mental Health, Lille, France
| | - Maya Dorsey
- Eceve, Unit 1123, Inserm, Université de Paris, Paris, France.,Unité de Recherche en Economie de la Santé, Assistance Publique, Hôpitaux de Paris, Paris, France.,World Health Organization Collaborating Centre for Research and Training in Mental Health, Lille, France
| | - Katarzyna Zukowska
- Faculty of Psychology, SWPS University of Social Sciences and Humanities, Warsaw, Poland
| | - Heleen Riper
- Department of Research and Innovation, GGZ inGeest Specialized Mental Health Care, Amsterdam, Netherlands.,Psychiatry, Amsterdam Public Health Research Institute, Amsterdam Universitair Medische Centra, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Institute of Telepsychiatry, University of Southern Denmark, Odense, Denmark
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Ose SO, Færevik H, Kaasbøll J, Lindgren M, Thaulow K, Antonsen S, Burkeland O. Exploring the Potential for Use of Virtual Reality Technology in the Treatment of Severe Mental Illness Among Adults in Mid-Norway: Collaborative Research Between Clinicians and Researchers. JMIR Form Res 2019; 3:e13633. [PMID: 31199315 PMCID: PMC6598419 DOI: 10.2196/13633] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 03/28/2019] [Accepted: 04/14/2019] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Virtual reality (VR) technology is not currently used in the treatment of severe mental health illness in Norway. OBJECTIVE We aimed to explore the potential of VR as a treatment for severe mental health illness in Norway, through collaborative research between clinicians and researchers. METHODS A collaborative research team was established, comprising researchers, the manager at a district psychiatric center, and the manager of the local municipal mental health service. An all-day workshop with eight clinicians-four from specialist mental health services and four from municipal mental health services-was conducted. The clinicians watched three different VR movies and after each one, they answered predefined questions designed to reflect their immediate thoughts about VR's potential use in clinical practice. At the end of the workshop, two focus group interviews, each with four clinicians from each service level, were conducted. RESULTS VR technology in specialist services might be a new tool for the treatment of severe mental health illness. In municipal mental health services, VR might particularly be useful in systematic social training that would otherwise take a very long time to complete. CONCLUSIONS We found substantial potential for the use of VR in the treatment of severe mental health illness in specialist and municipal mental health services. One of the uses of VR technology with the greatest potential was helping individuals who had isolated themselves and needed training in social skills and everyday activity to enable them to have more active social lives. VR could also be used to simulate severe mental illness to provide a better understanding of how the person with severe mental illness experiences their situation.
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Effectiveness of Mindfulness-Based Stress Management in The Mental Health of Iranian University Students: A Comparison of Blended Therapy, Face-to-Face Sessions, and mHealth App (Aramgar). IRANIAN JOURNAL OF PSYCHIATRY AND BEHAVIORAL SCIENCES 2019. [DOI: 10.5812/ijpbs.84726] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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129
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Schuster R, Kalthoff I, Walther A, Köhldorfer L, Partinger E, Berger T, Laireiter AR. Effects, Adherence, and Therapists' Perceptions of Web- and Mobile-Supported Group Therapy for Depression: Mixed-Methods Study. J Med Internet Res 2019; 21:e11860. [PMID: 31066700 PMCID: PMC6533044 DOI: 10.2196/11860] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 10/10/2018] [Accepted: 10/27/2018] [Indexed: 02/07/2023] Open
Abstract
Background Blended group therapy (bGT) has been investigated a several times for anxiety and depression, but information on patients’ adherence to and therapists’ perception of the novel format is nonexistent. Furthermore, many studies investigated mainly female and highly educated populations, limiting the validity of previous findings. Objective This study aimed to reduce the gaps and limitations of the previous findings by evaluating an integrated internet- and mobile-supported bGT format. Methods A total of 27 patients diagnosed with major depression (14/27, 52% female and 7/27, 25.9% compulsory education) participated in a 7-week treatment at a university outpatient clinic. Furthermore, 8 novice therapists participated in semistructured interviews and a subsequent cross-validation survey. Results Primary symptom reduction was high (d=1.31 to 1.51) and remained stable for the follow-up period. Therapists identified advantages (eg, patient engagement, treatment intensification, and improved therapeutic relation) and disadvantages (eg, increased workload, data issues, and undesired effects) of bGT. The required online guidance time was 10.3 min per patient and week, including guidance on exercises (67% or 6.9 min) and intimate communication (33% or 3.4 min). Concerning patients’ adherence to bGT, tracked completion of all Web-based and mobile tasks was high and comparable with group attendance. Conclusions Results suggest high feasibility of bGT in a gender-balanced, moderately educated sample. bGT provides group therapists with tools for individual care, resulting in an optimization of the therapy process, and high completion rates of the implemented bGT elements. The limited work experience of the involved therapists restricts the study findings, and potential drawbacks need to be regarded in the development of future bGT interventions.
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Affiliation(s)
- Raphael Schuster
- Center for Clinical Psychology, Psychotherapy and Health Psychology, Department of Psychology, University of Salzburg, Salzburg, Austria
| | - Inanna Kalthoff
- Center for Clinical Psychology, Psychotherapy and Health Psychology, Department of Psychology, University of Salzburg, Salzburg, Austria
| | - Alexandra Walther
- Center for Clinical Psychology, Psychotherapy and Health Psychology, Department of Psychology, University of Salzburg, Salzburg, Austria
| | - Lena Köhldorfer
- Department of Applied Psychology: Health, Development and Promotion, Faculty of Psychology, University of Vienna, Vienna, Austria
| | - Edith Partinger
- Department of Applied Psychology: Health, Development and Promotion, Faculty of Psychology, University of Vienna, Vienna, Austria
| | - Thomas Berger
- Department of Clinical Psychology and Psychotherapy, University of Berne, Berne, Switzerland
| | - Anton-Rupert Laireiter
- Center for Clinical Psychology, Psychotherapy and Health Psychology, Department of Psychology, University of Salzburg, Salzburg, Austria.,Department of Applied Psychology: Health, Development and Promotion, Faculty of Psychology, University of Vienna, Vienna, Austria
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130
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Vis C, Ruwaard J, Finch T, Rapley T, de Beurs D, van Stel H, van Lettow B, Mol M, Kleiboer A, Riper H, Smit J. Toward an Objective Assessment of Implementation Processes for Innovations in Health Care: Psychometric Evaluation of the Normalization Measure Development (NoMAD) Questionnaire Among Mental Health Care Professionals. J Med Internet Res 2019; 21:e12376. [PMID: 30785402 PMCID: PMC6401675 DOI: 10.2196/12376] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 12/21/2018] [Accepted: 01/20/2019] [Indexed: 11/13/2022] Open
Abstract
Background Successfully implementing eMental health (eMH) interventions in routine mental health care constitutes a major challenge. Reliable instruments to assess implementation progress are essential. The Normalization MeAsure Development (NoMAD) study developed a brief self-report questionnaire that could be helpful in measuring implementation progress. Based on the Normalization Process Theory, this instrument focuses on 4 generative mechanisms involved in implementation processes: coherence, cognitive participation, collective action, and reflexive monitoring. Objective The aim of this study was to translate the NoMAD questionnaire to Dutch and to confirm the factor structure in Dutch mental health care settings. Methods Dutch mental health care professionals involved in eMH implementation were invited to complete the translated NoMAD questionnaire. Confirmatory factor analysis (CFA) was conducted to verify interpretability of scale scores for 3 models: (1) the theoretical 4-factor structure, (2) a unidimensional model, and (3) a hierarchical model. Potential improvements were explored, and correlated scale scores with 3 control questions were used to assess convergent validity. Results A total of 262 professionals from mental health care settings in the Netherlands completed the questionnaire (female: 81.7%; mean age: 45 [SD=11]). The internal consistency of the 20-item questionnaire was acceptable (.62≤alpha≤.85). The theorized 4-factor model fitted the data slightly better in the CFA than the hierarchical model (Comparative Fit Index=0.90, Tucker Lewis Index=0.88, Root Mean Square Error of Approximation=0.10, Standardized Root Mean Square Residual=0.12, χ22=22.5, P≤.05). However, the difference is small and possibly not outweighing the practical relevance of a total score and subscale scores combined in one hierarchical model. One item was identified as weak (λCA.2=0.10). A moderate-to-strong convergent validity with 3 control questions was found for the Collective Participation scale (.47≤r≤.54, P≤.05). Conclusions NoMAD’s theoretical factor structure was confirmed in Dutch mental health settings to acceptable standards but with room for improvement. The hierarchical model might prove useful in increasing the practical utility of the NoMAD questionnaire by combining a total score with information on the 4 generative mechanisms. Future research should assess the predictive value and responsiveness over time and elucidate the conceptual interpretability of NoMAD in eMH implementation practices.
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Affiliation(s)
- Christiaan Vis
- Department of Clinical, Neuro-, & Developmental Psychology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Mental Health, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Jeroen Ruwaard
- Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, Netherlands.,Research and Innovation, GGZ inGeest Specialized Mental Healthcare, Amsterdam, Netherlands
| | - Tracy Finch
- Department of Nursing, Midwifery & Health, Northumbria University, Northumbria, United Kingdom
| | - Tim Rapley
- Department of Social Work, Education & Community Wellbeing, Northumbria University, Northumbria, United Kingdom
| | - Derek de Beurs
- Mental Health, Netherlands Institute For Health Services Research (NIVEL), Utrecht, Netherlands
| | - Henk van Stel
- Julius Center Research Program Methodology, Department of Public Health, Healthcare Innovation & Evaluation and Medical Humanities, University Medical Center Utrecht, Utrecht, Netherlands
| | | | - Mayke Mol
- Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, Netherlands.,Research and Innovation, GGZ inGeest Specialized Mental Healthcare, Amsterdam, Netherlands
| | - Annet Kleiboer
- Department of Clinical, Neuro-, & Developmental Psychology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Mental Health, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Heleen Riper
- Department of Clinical, Neuro-, & Developmental Psychology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Mental Health, Amsterdam Public Health Research Institute, Amsterdam, Netherlands.,Research and Innovation, GGZ inGeest Specialized Mental Healthcare, Amsterdam, Netherlands
| | - Jan Smit
- Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, Netherlands.,Research and Innovation, GGZ inGeest Specialized Mental Healthcare, Amsterdam, Netherlands
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131
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Andersson G, Titov N, Dear BF, Rozental A, Carlbring P. Internet-delivered psychological treatments: from innovation to implementation. World Psychiatry 2019; 18:20-28. [PMID: 30600624 PMCID: PMC6313242 DOI: 10.1002/wps.20610] [Citation(s) in RCA: 313] [Impact Index Per Article: 62.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Internet interventions, and in particular Internet-delivered cognitive behaviour therapy (ICBT), have existed for at least 20 years. Here we review the treatment approach and the evidence base, arguing that ICBT can be viewed as a vehicle for innovation. ICBT has been developed and tested for several psychiatric and somatic conditions, and direct comparative studies suggest that therapist-guided ICBT is more effective than a waiting list for anxiety disorders and depression, and tends to be as effective as face-to-face CBT. Studies on the possible harmful effects of ICBT are also reviewed: a significant minority of people do experience negative effects, although rates of deterioration appear similar to those reported for face-to-face treatments and lower than for control conditions. We further review studies on change mechanisms and conclude that few, if any, consistent moderators and mediators of change have been identified. A recent trend to focus on knowledge acquisition is considered, and a discussion on the possibilities and hurdles of implementing ICBT is presented. The latter includes findings suggesting that attitudes toward ICBT may not be as positive as when using modern information technology as an adjunct to face-to-face therapy (i.e., blended treatment). Finally, we discuss future directions, including the role played by technology and machine learning, blended treatment, adaptation of treatment for minorities and non-Western settings, other therapeutic approaches than ICBT (including Internet-delivered psychodynamic and interpersonal psychotherapy as well as acceptance and commitment therapy), emerging regulations, and the importance of reporting failed trials.
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Affiliation(s)
- Gerhard Andersson
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
- Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden
| | - Nickolai Titov
- MindSpot Clinic, Macquarie University, Sydney, Australia
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - Blake F Dear
- MindSpot Clinic, Macquarie University, Sydney, Australia
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - Alexander Rozental
- Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden
- Institute of Child Health, University College London, London, UK
| | - Per Carlbring
- Department of Psychology, Stockholm University, Stockholm, Sweden
- Department of Psychology, University of Southern Denmark, Odense, Denmark
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132
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Schuster R, Pokorny R, Berger T, Topooco N, Laireiter AR. The Advantages and Disadvantages of Online and Blended Therapy: Survey Study Amongst Licensed Psychotherapists in Austria. J Med Internet Res 2018; 20:e11007. [PMID: 30563817 PMCID: PMC6315274 DOI: 10.2196/11007] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 06/27/2018] [Accepted: 06/28/2018] [Indexed: 12/21/2022] Open
Abstract
Background Web-based and blended (face-to-face plus Web-based) interventions for mental health disorders are gaining significance. However, many licensed psychotherapists still have guarded attitudes toward computer-assisted therapy, hindering dissemination efforts. Objective The objective of this study was to provide a therapist-oriented evaluation of Web-based and blended therapies and identify commonalities and differences in attitudes toward both formats. Furthermore, it aimed to test the impact of an information clip on expressed attitudes. Methods In total, 95 Austrian psychotherapists were contacted and surveyed via their listed occupational email address. An 8-minute information video was shown to half of the therapists before 19 advantages and 13 disadvantages had to be rated on a 6-point Likert scale. Results The sample resembled all assessed properties of Austrian psychotherapists (age, theoretical orientation, and region). Therapists did not hold a uniform overall preference. Instead, perceived advantages of both interventions were rated as neutral (t94=1.89, P=.06; d=0.11), whereas Web-based interventions were associated with more disadvantages and risks (t94=9.86, P<.001; d=0.81). The information clip did not excerpt any detectable effect on therapists’ attitudes (r95=−.109, P=.30). The application of modern technologies in the own therapeutic practice and cognitive behavioral orientation were positively related to the given ratings. Conclusions This study is the first to directly compare therapists’ attitudes toward Web-based and blended therapies. Positive attitudes play a pivotal role in the dissemination of new technologies, but unexperienced therapists seem to lack knowledge on how to benefit from technology-aided treatments. To speed up implementation, these aspects need to be addressed in the development of new interventions. Furthermore, the preference of blended treatments over Web-based interventions seems to relate to avoidance of risks. Although this study is likely to represent therapists’ attitudes in countries with less advanced electronic health services, therapists’ attitudes in more advanced countries might present differently.
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Affiliation(s)
- Raphael Schuster
- Outpatient Center for Clinical Psychology, Psychotherapy and Health Psychology, Department of Psychology, University of Salzburg, Salzburg, Austria
| | | | - Thomas Berger
- Department of Clinical Psychology and Psychotherapy, University of Berne, Berne, Switzerland
| | - Naira Topooco
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Anton-Rupert Laireiter
- Outpatient Center for Clinical Psychology, Psychotherapy and Health Psychology, Department of Psychology, University of Salzburg, Salzburg, Austria.,Faculty of Psychology, University of Vienna, Vienna, Austria
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GPs' attitudes towards digital technologies for depression: an online survey in primary care. Br J Gen Pract 2018; 69:e164-e170. [PMID: 30559111 PMCID: PMC6400634 DOI: 10.3399/bjgp18x700721] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 08/20/2018] [Indexed: 11/17/2022] Open
Abstract
Background Digital or electronic mental health (e-mental health) interventions can be useful approaches in reducing the burden of depression, with tools available for use in prevention, treatment, or relapse prevention. They may have specific benefit for primary care, as depression is often managed in this setting. However, little is known about attitudes and barriers among GPs towards e-mental health interventions for depression. Aim This study aimed to assess attitudes, knowledge, use, and barriers for depression-focused e-mental health among GPs across the UK. Design and setting An online survey of self-selecting GPs in the UK conducted over a 10-day period in December 2017. Method The survey consisted of 13 multiple choice questions posted on the Doctors.net.uk (DNUK) website. Results In all, 1044 responses were included; 72% of GPs reported using at least one type of e-mental health intervention for depression. Overall, GPs reported that e-mental health interventions are most effective when delivered in a guided way, rather than in an unguided manner. In addition, 92% of GPs reported that neither they nor their colleagues received e-mental health training. Conclusion A moderate number of GPs use e-mental health for depression in their services, and report it is likely that its use will increase. There is a gap in training and awareness of effective interventions. GPs consider guided e-mental health interventions to be most effective, in contrast to the unguided way it is mostly offered in primary care.
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Apolinário-Hagen J, Menzel M, Hennemann S, Salewski C. Acceptance of Mobile Health Apps for Disease Management Among People With Multiple Sclerosis: Web-Based Survey Study. JMIR Form Res 2018; 2:e11977. [PMID: 30684408 PMCID: PMC6334710 DOI: 10.2196/11977] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 10/24/2018] [Accepted: 11/22/2018] [Indexed: 01/19/2023] Open
Abstract
Background Mobile health (mHealth) apps might have the potential to promote self-management of people with multiple sclerosis (MS) in everyday life. However, the uptake of MS apps remains poor, and little is known about the facilitators and barriers for their efficient utilization, such as technology acceptance. Objective The aim of this study was to examine the acceptance of mHealth apps for disease management in the sense of behavioral intentions to use and explore determinants of utilization among people with MS based on the Unified Theory of Acceptance and Use of Technology (UTAUT). Methods Participants for this Web-based cross-sectional study were recruited throughout Germany with the support of regional MS associations and self-help groups. To identify determinants of intention to use MS apps, a measure based on the UTAUT was adapted with 4 key determinants (performance expectancy, effort expectancy, social influence, and facilitating conditions) and extended by Intolerance of Uncertainty (IU) and electronic health literacy. Potential influencing effects of both MS and computer self-efficacy (C-SE) as mediators and fatigue as a moderator were analyzed using Hayes’s PROCESS macro (SPSS version 3.0) for IBM SPSS version 24.0. Results A total of 98 participants (mean age 47.03 years, SD 10.17; 66/98, 67% female) with moderate fatigue levels completed the survey. Although most participants (91/98, 92%) were daily smartphone users, almost two-thirds (62/98, 63%) reported no experience with MS apps. Overall, the acceptance was moderate on average (mean 3.11, SD 1.31, minimum=1 and maximum=5), with lower scores among persons with no experience (P=.04) and higher scores among current users (P<.001). In multiple regression analysis (R2=63% variance explained), performance expectancy (beta=.41) and social influence (beta=.33) were identified as significant predictors of acceptance (all P<.001). C-SE was confirmed as a partial mediator in the relationship between IU and acceptance (indirect effect: B=−.095, 95% CI −0.227 to −0.01). Furthermore, a moderated mediation by C-SE was shown in the relationship between IU and behavioral intentions to use MS apps for low (95% CI −0.42 to −0.01) and moderate levels (95% CI −0.27 to −0.01) of fatigue. Conclusions Overall, this exploratory pilot study indicates for the first time that positive expectations about the helpfulness for self-management purposes and social support might be important factors to be considered for improving the acceptance of MS apps among smartphone users with MS. However, given some inconsistent findings, especially regarding the role of effort expectancy and IU and self-efficacy, the conceptual model needs replication with a larger sample of people with MS, varying more in fatigue levels, and a longitudinal assessment of the actual usage of MS apps predicted by acceptance in the sense of behavioral intentions to use.
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Affiliation(s)
| | - Mireille Menzel
- Department of Health Psychology, Faculty of Psychology, University of Hagen, Hagen, Germany
| | - Severin Hennemann
- Department of Clinical Psychology, Psychotherapy and Experimental Psychopathology, Institute of Psychology, University of Mainz, Mainz, Germany
| | - Christel Salewski
- Department of Health Psychology, Faculty of Psychology, University of Hagen, Hagen, Germany
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135
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Hennemann S, Farnsteiner S, Sander L. Internet- and mobile-based aftercare and relapse prevention in mental disorders: A systematic review and recommendations for future research. Internet Interv 2018; 14:1-17. [PMID: 30510909 PMCID: PMC6205252 DOI: 10.1016/j.invent.2018.09.001] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 08/17/2018] [Accepted: 09/04/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Mental disorders are characterized by a high likelihood of recurrence. Thus, aftercare and follow-up interventions aim to maintain treatment gains and to prevent relapse. Internet- and mobile-based interventions (IMIs) may represent promising instruments in tertiary prevention. This systematic review summarizes and evaluates the research on the efficacy of IMIs as aftercare or follow-up interventions for adults with mental health issues. METHODS A systematic database search (PsycInfo, MEDLINE, CENTRAL) was conducted and studies selected according to predefined eligibility criteria (RCTs, adult population, clinical symptoms/disorder, assessed with validated instruments, clinical-psychological intervention rationale, aftercare/follow-up intervention, web-/mobile-based, minimum follow-up measurement of three months, inclusion of a control group). Inspected outcomes were symptom severity, recurrence- and rehospitalization rates, functioning, quality of life and adherence to primary treatment.Systematic review registration: PROSPERO CRD42017055289. RESULTS Sixteen RCTs met the inclusion criteria, covering trials on depression (n = 5), eating disorders (n = 4) and transdiagnostic interventions (n = 7). The majority of the interventions were based on Cognitive Behavioral Therapy (CBT) principles and were web-based (n = 11). Methodological quality of included studies was suboptimal. Limitations included attrition bias and non-specification of routine care co-interventions. IMIs yielded small to medium post-treatment effects for symptom severity (d = -0.08 - d = -0.45) in comparison to control groups. Best evidence base was found for symptom severity of depression and anxiety. Study results regarding recurrence and rehospitalization were inconsistent. DISCUSSION There is some evidence, that IMIs are feasible instruments for maintaining treatment gains for some mental disorders. However, further high quality, large-scale trials are needed to expand research fields, improve adherence to and uptake of IMIs and facilitate implementation of effective interventions into routine care.
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Affiliation(s)
- Severin Hennemann
- University of Mainz, Institute of Psychology, Department of Clinical Psychology, Psychotherapy and Experimental Psychopathology, Wallstraße 3, 55122 Mainz, Germany
| | - Sylvia Farnsteiner
- University of Mainz, Institute of Psychology, Department of Clinical Psychology, Psychotherapy and Experimental Psychopathology, Wallstraße 3, 55122 Mainz, Germany
| | - Lasse Sander
- University of Freiburg, Institute of Psychology, Department of Rehabilitation Psychology and Psychotherapy, Engelbergerstraße 41, 79085 Freiburg, Germany
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Vernmark K, Hesser H, Topooco N, Berger T, Riper H, Luuk L, Backlund L, Carlbring P, Andersson G. Working alliance as a predictor of change in depression during blended cognitive behaviour therapy. Cogn Behav Ther 2018; 48:285-299. [PMID: 30372653 DOI: 10.1080/16506073.2018.1533577] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Blended Cognitive Behaviour Therapy (bCBT) is a new form of treatment, mixing internet-based modules and face-to-face therapist sessions. How participants rate the therapeutic alliance in bCBT has not yet been thoroughly explored, and neither is it clear whether therapist- and patient-rated alliances are predictors of change in depression during treatment. Depression and alliance ratings from 73 participants in a treatment study on bCBT (part of the E-COMPARED project) were analysed using growth curve models. Alliance, as rated by both patients and therapists, was high. The therapist-rated working alliance was predictive of subsequent changes in depression scores during treatment, whereas the patient-rated alliance was not. A therapeutic alliance can be established in bCBT. The role of the therapist-rated alliance seems to be of particular importance and should be carefully considered when collecting data in future studies on bCBT.
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Affiliation(s)
- Kristofer Vernmark
- a Department of Behavioural Sciences and Learning , Linköping University , Linköping , Sweden
| | | | - Naira Topooco
- a Department of Behavioural Sciences and Learning , Linköping University , Linköping , Sweden
| | - Thomas Berger
- b Department of Clinical Psychology and Psychotherapy , University of Bern , Bern , Switzerland
| | - Heleen Riper
- c Department of Clinical, Neuro-, & Developmental Psychology, Faculty of Behavioural and Movement Sciences , VU Amsterdam , Amsterdam , The Netherlands
| | - Liisa Luuk
- a Department of Behavioural Sciences and Learning , Linköping University , Linköping , Sweden
| | - Lisa Backlund
- a Department of Behavioural Sciences and Learning , Linköping University , Linköping , Sweden
| | - Per Carlbring
- d Department of Psychology , Stockholm University , Stockholm , Sweden.,e Department of Psychology , University of Southern Denmark , Denmark
| | - Gerhard Andersson
- a Department of Behavioural Sciences and Learning , Linköping University , Linköping , Sweden.,f Department of Clinical Neuroscience , Karolinska Institutet , Stockholm , Sweden
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137
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Topooco N, Berg M, Johansson S, Liljethörn L, Radvogin E, Vlaescu G, Nordgren LB, Zetterqvist M, Andersson G. Chat- and internet-based cognitive-behavioural therapy in treatment of adolescent depression: randomised controlled trial. BJPsych Open 2018; 4:199-207. [PMID: 29988969 PMCID: PMC6034465 DOI: 10.1192/bjo.2018.18] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 03/07/2018] [Accepted: 03/26/2018] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Depression is a major contributor to the burden of disease in the adolescent population. Internet-based interventions can increase access to treatment. AIMS To evaluate the efficacy of internet-based cognitive-behavioural therapy (iCBT), including therapist chat communication, in treatment of adolescent depression. METHOD Seventy adolescents, 15-19 years of age and presenting with depressive symptoms, were randomised to iCBT or attention control. The primary outcome was the Beck Depression Inventory II (BDI-II). RESULTS Significant reductions in depressive symptoms were found, favouring iCBT over the control condition (F(1,67) = 6.18, P < 0.05). The between-group effect size was Cohen's d = 0.71 (95% CI 0.22-1.19). A significantly higher proportion of iCBT participants (42.4%) than controls (13.5%) showed a 50% decrease in BDI-II score post-treatment (P < 0.01). The improvement for the iCBT group was maintained at 6 months. CONCLUSIONS The intervention appears to effectively reduce symptoms of depression in adolescents and may be helpful in overcoming barriers to care among young people. DECLARATION OF INTEREST N.T. and G.A. designed the programme. N.T. authored the treatment material. The web platform used for treatment is owned by Linköping University and run on a non-for-profit basis. None of the authors receives any income from the programme.
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Affiliation(s)
- Naira Topooco
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Matilda Berg
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Sofie Johansson
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Lina Liljethörn
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Ella Radvogin
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - George Vlaescu
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Lise Bergman Nordgren
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden, and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Maria Zetterqvist
- Centre for Social and Affective Neuroscience, Department of Clinical and Experimental Medicine and Child and Adolescent Psychiatry, Linköping University, Linköping, Sweden
| | - Gerhard Andersson
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden, and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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138
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Titzler I, Saruhanjan K, Berking M, Riper H, Ebert DD. Barriers and facilitators for the implementation of blended psychotherapy for depression: A qualitative pilot study of therapists' perspective. Internet Interv 2018; 12:150-164. [PMID: 30135779 PMCID: PMC6096333 DOI: 10.1016/j.invent.2018.01.002] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 12/29/2017] [Accepted: 01/04/2018] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Blended therapies (BT) combine face-to-face (f2f) sessions with internet- and mobile-based interventions (IMIs). However, the use of blended interventions in routine care is still rare and depends on the acceptance of key health care professionals such as the therapists. Little is yet known about the therapists' perspective on and experiences with blended approaches. The aim of this pilot study was to identify barriers and facilitators, as perceived by psychotherapists, for implementing a blended therapy for depression. METHODS Semi-structured expert interviews were conducted with five therapists, who were part of the German study arm of the FP7-project E-Compared (www.e-compared.eu). All patients (N = 173) were treated in the context of a registered RCT (DRKS00006866) in which the clinical and cost-effectiveness of BT for depression, consisting of ten internet- and mobile-based cognitive behavioral therapy modules and six f2f sessions, was compared to the treatment usually provided by general practitioners. To identify barriers and facilitators an interview guide based on the theoretical domains framework (TDF) was developed. The interviews were audio-recorded, transcribed verbatim and analyzed using a qualitative content analysis by two independent coders. RESULTS The results revealed 29 barriers and 33 facilitators, which are hindering or enabling factors on the levels of 'implementation in the health care system', 'therapy', 'therapists' and 'patients'. Key barriers stated by all therapists were 'Limited customizability and autonomy of decisions concerning blending the therapy' (number of statements, k = 44); 'Disease-related contraindications for BT' (k = 25); 'Negative affect was caused by burden through technical problems' (k = 18); 'Limited number of f2f sessions hindered the therapy process'; and 'Establishment of therapeutic alliance was burdened by technical issues' (each k = 15). Key facilitators stated by all therapists were: 'Patients' interest, willingness and motivation to participate' (k = 22); 'Patients' access to online content between f2f sessions and after therapy end' (k = 20); 'Preset structure of IMI-part guided the treatment course of BT' (k = 18); and 'Effective help with BT in a short time frame' (k = 15), as well as 'Reduction of the treatment gap' (k = 13). DISCUSSION Therapists supported the implementation of BT for depression. Results indicated the consideration of a wide range of determinants: among others, the possibility of individualizing the treatment; the autonomy of decision making in respect to the ratio and number of online and f2f sessions; the necessity of providing training; the need to develop a concept of embedding BT in the health care system and funding the additional effort; and the use of sophisticated technical solutions.
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Affiliation(s)
- Ingrid Titzler
- Friedrich-Alexander University Erlangen-Nürnberg, Institute of Psychology, Department of Clinical Psychology and Psychotherapy, Erlangen, Germany
| | - Karina Saruhanjan
- Friedrich-Alexander University Erlangen-Nürnberg, Institute of Psychology, Department of Clinical Psychology and Psychotherapy, Erlangen, Germany
| | - Matthias Berking
- Friedrich-Alexander University Erlangen-Nürnberg, Institute of Psychology, Department of Clinical Psychology and Psychotherapy, Erlangen, Germany
| | - Heleen Riper
- VU University Amsterdam, Faculty of Behavioral and Movement Sciences, Section of Clinical Psychology, Amsterdam, Netherlands
| | - David Daniel Ebert
- Friedrich-Alexander University Erlangen-Nürnberg, Institute of Psychology, Department of Clinical Psychology and Psychotherapy, Erlangen, Germany
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Hill C, Creswell C, Vigerland S, Nauta MH, March S, Donovan C, Wolters L, Spence SH, Martin JL, Wozney L, McLellan L, Kreuze L, Gould K, Jolstedt M, Nord M, Hudson JL, Utens E, Ruwaard J, Albers C, Khanna M, Albano AM, Serlachius E, Hrastinski S, Kendall PC. Navigating the development and dissemination of internet cognitive behavioral therapy (iCBT) for anxiety disorders in children and young people: A consensus statement with recommendations from the #iCBTLorentz Workshop Group. Internet Interv 2018; 12:1-10. [PMID: 30135763 PMCID: PMC6096322 DOI: 10.1016/j.invent.2018.02.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 02/13/2018] [Accepted: 02/14/2018] [Indexed: 12/21/2022] Open
Abstract
Initial internet-based cognitive behavioral therapy (iCBT) programs for anxiety disorders in children and young people (CYP) have been developed and evaluated, however these have not yet been widely adopted in routine practice. The lack of guidance and formalized approaches to the development and dissemination of iCBT has arguably contributed to the difficulty in developing iCBT that is scalable and sustainable beyond academic evaluation and that can ultimately be adopted by healthcare providers. This paper presents a consensus statement and recommendations from a workshop of international experts in CYP anxiety and iCBT (#iCBTLorentz Workshop Group) on the development, evaluation, engagement and dissemination of iCBT for anxiety in CYP.
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Affiliation(s)
- Claire Hill
- School of Psychology & Clinical Language Sciences, University of Reading, UK
| | - Cathy Creswell
- School of Psychology & Clinical Language Sciences, University of Reading, UK
| | - Sarah Vigerland
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Sweden
- Stockholm Health Care Services, Stockholm County Council, Sweden
| | - Maaike H. Nauta
- Clinical Psychology and Experimental Psychopathology, University of Groningen, The Netherlands
| | - Sonja March
- School of Psychology and Counselling & Institute for Resilient Regions, University of Southern Queensland, Australia
| | | | - Lidewij Wolters
- Norwegian University of Science and Technology (NTNU), Faculty of Medicine, Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU Central Norway), Trondheim, Norway
- Academic Center for Child and Adolescent Psychiatry, de Bascule, Amsterdam, The Netherlands
| | - Susan H. Spence
- Australian Institute of Suicide Research and Prevention and School of Applied Psychology, Griffith University, Australia
| | - Jennifer L. Martin
- NIHR MindTech Cooperative, Faculty of Medicine & Health Sciences, University of Nottingham, UK
| | - Lori Wozney
- Centre for Research in Family Health, IWK Health Centre, Halifax, Canada
| | - Lauren McLellan
- Centre for Emotional Health, Department of Psychology, Macquarie University, Australia
| | - Leonie Kreuze
- Clinical Psychology and Experimental Psychopathology, University of Groningen, The Netherlands
| | - Karen Gould
- Centre for Emotional Health, Department of Psychology, Macquarie University, Australia
| | - Maral Jolstedt
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Sweden
- Stockholm Health Care Services, Stockholm County Council, Sweden
| | - Martina Nord
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Sweden
- Stockholm Health Care Services, Stockholm County Council, Sweden
| | - Jennifer L. Hudson
- Centre for Emotional Health, Department of Psychology, Macquarie University, Australia
| | - Elisabeth Utens
- Academic Center for Child and Adolescent Psychiatry, de Bascule, Amsterdam, The Netherlands
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center, Rotterdam, The Netherlands
- Research Institute of Child Development and Education, University of Amsterdam, The Netherlands
| | - Jeroen Ruwaard
- Department of Clinical Psychology, VU University, Amsterdam, The Netherlands
| | - Casper Albers
- Department of Psychometrics & Statistics, University of Groningen, The Netherlands
| | - Muniya Khanna
- OCD & Anxiety Institute, Plymouth Meeting, PA, USA
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | | | - Eva Serlachius
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Sweden
- Stockholm Health Care Services, Stockholm County Council, Sweden
| | | | - Philip C. Kendall
- Child & Adolescent Anxiety Disorders Clinic, Temple University, Philadelphia, PA, USA
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Apolinário-Hagen J, Fritsche L, Bierhals C, Salewski C. Improving attitudes toward e-mental health services in the general population via psychoeducational information material: A randomized controlled trial. Internet Interv 2018; 12:141-149. [PMID: 30135778 PMCID: PMC6096329 DOI: 10.1016/j.invent.2017.12.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 12/27/2017] [Accepted: 12/27/2017] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION In recent years, effective Internet-delivered electronic (e-) mental health services have been developed to overcome the limited resources in face-to-face health care. For the successful dissemination of e-mental health services, individual predictors for their uptake and utilization need to be explored. For instance, little is known about the role of different information sources in attitudes toward Internet therapies. On the basis of technology acceptance framework, this pilot study aimed to identify differences in both attitudes and intentions to use e-mental health treatment services after providing psychoeducational information. METHODS 439 participants (mean age 33 years, SD = 10.6 years; 72% female) were randomly assigned to one of three text-based information groups (neutral text: n = 111; expert evaluation: n = 108; user evaluation: n = 112) or a control condition (no information: n = 108). We assessed attitudes toward e-mental health treatments using a 15-item German e-therapy attitudes measure. RESULTS Descriptive analyses revealed overall neutral attitudes toward Internet therapies. Ambivalent perceptions were found in terms of Perceived Usefulness (positive attitude) and Relative Advantage (negative attitude). The awareness of Internet therapies was rather low. Most participants evaluated self-help books, health websites and face-to-face counselling as more useful than web-based counselling and therapies and reported higher intentions to use conventional services in case of emotional problems. As hypothesized, variance analyses demonstrated that text-based information, especially expert evaluations, were associated with significantly more positive attitudes toward e-mental health treatment services compared to the control condition. CONCLUSIONS Taken together, this pilot study suggested a positive connection between the provision of general facts about e-mental health treatment services and attitudes as well as behavioral intentions to future use such services. However, a limitation was the omission of baseline attitudes assessment. Thus, further research is needed to gain deeper insights into the impact of information on attitudes.
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141
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Andersson G. Internet interventions: Past, present and future. Internet Interv 2018; 12:181-188. [PMID: 30135782 PMCID: PMC6096319 DOI: 10.1016/j.invent.2018.03.008] [Citation(s) in RCA: 150] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 03/30/2018] [Accepted: 03/30/2018] [Indexed: 02/07/2023] Open
Abstract
Internet interventions have been around now for about 20 years. While the field still suffers from a scattered terminology a large number of programs and studies exist. In the present paper I present an overview of my experiences of studying internet-supported cognitive-behaviour therapy (ICBT), but also mention other approaches including the use of smartphones. The paper covers the history of ICBT, short-term effects in controlled trials for a range of conditions, long-term effects, comparisons against face-to-face therapy, effectiveness studies, prediction studies, how the treatment is perceived, critique, and finally future directions. I conclude that we have now reached a stage in which we have numerous evidence-based treatments and procedures, and increasingly internet interventions including ICBT are disseminated.
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Affiliation(s)
- Gerhard Andersson
- Department of Behavioural Sciences and Learning, Linköping University, Campus Valla, SE-581 83 Linköping, Sweden.
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142
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Ahmadvand A, Gatchel R, Brownstein J, Nissen L. The Biopsychosocial-Digital Approach to Health and Disease: Call for a Paradigm Expansion. J Med Internet Res 2018; 20:e189. [PMID: 29776900 PMCID: PMC5984274 DOI: 10.2196/jmir.9732] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2017] [Revised: 02/10/2018] [Accepted: 02/10/2018] [Indexed: 01/22/2023] Open
Abstract
Digital health is an advancing phenomenon in modern health care systems. Currently, numerous stakeholders in various countries are evaluating the potential benefits of digital health solutions at the individual, population, and/or organizational levels. Additionally, driving factors are being created from the customer-side of the health care systems to push health care providers, policymakers, or researchers to embrace digital health solutions. However, health care providers may differ in their approach to adopt these solutions. Health care providers are not assumed to be appropriately trained to address the requirements of integrating digital health solutions into daily everyday practices and procedures. To adapt to the changing demands of health care systems, it is necessary to expand relevant paradigms and to train human resources as required. In this article, a more comprehensive paradigm will be proposed, based on the ‘biopsychosocial model’ of assessing health and disease, originally introduced by George L Engel. The “biopsychosocial model” must be leveraged to include a “digital” component, thus suggesting a ‘biopsychosocial-digital’ approach to health and disease. Modifications to the “biopsychosocial” model and transition to the “biopsychosocial-digital” model are explained. Furthermore, the emerging implications of understanding health and disease are clarified pertaining to their relevance in training human resources for health care provision and research.
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Affiliation(s)
- Alireza Ahmadvand
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Robert Gatchel
- Department of Psychology, College of Science, University of Texas at Arlington, Arlington, TX, United States
| | - John Brownstein
- Department of Pediatrics, Harvard Medical School, Boston, MA, United States.,Computational Health Informatics Program, Boston Children's Hospital, Boston, MA, United States
| | - Lisa Nissen
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Australia
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143
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Apolinário-Hagen J, Harrer M, Kählke F, Fritsche L, Salewski C, Ebert DD. Public Attitudes Toward Guided Internet-Based Therapies: Web-Based Survey Study. JMIR Ment Health 2018; 5:e10735. [PMID: 29764797 PMCID: PMC5974457 DOI: 10.2196/10735] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 05/03/2018] [Accepted: 05/03/2018] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Internet interventions have been proposed to improve the accessibility and use of evidence-based psychological treatments. However, little is known about attitudes toward such treatments, which can be an important barrier to their use. OBJECTIVE This study aimed to (1) determine attitudes toward guided internet interventions, (2) assess its acceptability compared with other internet-based formats, and (3) explore predictors of acceptance. METHODS A convenience-sample Web-based survey (N=646) assessed attitudes toward guided internet therapies (ie, perceived usefulness and helpfulness, and advantage relative to face-to-face therapy), preferences for delivery modes (ie, e-preference: guided internet interventions, unguided internet interventions, or videoconferencing psychotherapy), and potential predictors of attitudes and preferences: sociodemographics, help-seeking-related variables, attachment style, and perceived stress. RESULTS Although most participants perceived internet interventions as useful or helpful (426/646, 65.9%), a few indicated their advantage relative to face-to-face therapy (56/646, 8.7%). Most participants preferred guided internet interventions (252/646, 39.0%) over videoconferencing psychotherapy (147/646, 22.8%), unguided internet interventions (124/646, 19.2%), and not using internet interventions (121/646, 18.8%; missing data: 1/646, 0.2%). Attachment avoidance and stress were related to e-preference (all P<.05). Moreover, preference for therapist-guided internet interventions was higher for individuals who were aware of internet-based treatment (χ26=12.8; P=.046). CONCLUSIONS Participants assessed therapist-guided internet interventions as helpful, but not equivalent to face-to-face therapies. The vast majority (523/646, 81.0%) of the participants were potentially willing to use internet-based approaches. In lieu of providing patients with only one specific low-intensity treatment, implementation concepts should offer several options, including guided internet interventions, but not limited to them. Conversely, our results also indicate that efforts should focus on increasing public knowledge about internet interventions, including information about their effectiveness, to promote acceptance and uptake.
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Affiliation(s)
| | - Mathias Harrer
- Department of Clinical Psychology and Psychotherapy, Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Fanny Kählke
- Department of Clinical Psychology and Psychotherapy, Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Lara Fritsche
- Institute of Psychology, Department of Health Psychology, University of Hagen, Hagen, Germany
| | - Christel Salewski
- Institute of Psychology, Department of Health Psychology, University of Hagen, Hagen, Germany
| | - David Daniel Ebert
- Department of Clinical Psychology and Psychotherapy, Alexander-University Erlangen-Nuremberg, Erlangen, Germany
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144
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Drozd F, Haga SM, Lisøy C, Slinning K. Evaluation of the implementation of an internet intervention in well-baby clinics: A pilot study. Internet Interv 2018; 13:1-7. [PMID: 30206512 PMCID: PMC6112086 DOI: 10.1016/j.invent.2018.04.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 04/19/2018] [Accepted: 04/27/2018] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Despite promising results, internet interventions are not widely accessible or well-integrated in health services. The objective of this study was, therefore, to examine the implementation of an internet intervention ('Mamma Mia') for the prevention of perinatal depression in Norwegian well-baby clinics (i.e., primary care). METHODS Mamma Mia begins in mid-pregnancy and lasts up to 6 months after childbirth. It consists of 44 online sessions, supported by midwives and public health nurses at up to 5 contact points during this period, following principles of empathic communication. Well-baby clinics offer free, universal services to all pregnant women and children aged 0 to 5 years in Norway and were recruited via an intermediary organization for this study. Data were collected at pre- and post-training, but before the delivery of Mamma Mia in clinics, and at 3 and 6 months follow-up. Quantitative and qualitative data were used to evaluate the training in Mamma Mia, examine program implementation (i.e., number of pregnant women registered for the program), and identify barriers and enablers of implementation. RESULTS Twenty-four self-selected healthcare professionals from 14 well-baby clinics were recruited, for this study. Training increased participants' knowledge about Mamma Mia and exceeded their expectations. The program review and implementation plan were necessary training components. Implementation climate was related to the number of colleagues working with Mamma Mia and overall satisfaction with implementation, while characteristics of the intervention predicted the number of registered women at 6 months. Organizational re-structuring, leadership, and competing activities were identified as barriers to implementation that need to be considered further. CONCLUSIONS The dissemination and implementation of a health-service supported internet intervention appears to be promising but requires further research.
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Affiliation(s)
- Filip Drozd
- Department for Infant Mental Health, Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway,Corresponding author at: Department for Infant Mental Health, Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, P.O. Box 4623, Nydalen, N-0405 Oslo, Norway.
| | - Silje Marie Haga
- Department for Infant Mental Health, Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway
| | - Carina Lisøy
- Department for Infant Mental Health, Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway
| | - Kari Slinning
- Department for Infant Mental Health, Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway,Department of Psychology, University of Oslo, Oslo, Norway
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145
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Arjadi R, Nauta MH, Bockting CL. Acceptability of internet-based interventions for depression in Indonesia. Internet Interv 2018; 13:8-15. [PMID: 30206513 PMCID: PMC6112096 DOI: 10.1016/j.invent.2018.04.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 04/27/2018] [Accepted: 04/27/2018] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND In Indonesia, internet-based interventions may represent a promising strategy to reduce the mental health gap given that the level of internet usage in the country continues to increase. To check the acceptability of internet-based interventions, this study investigates factors that contribute to the use of internet-based interventions for depression in Indonesia. METHOD The survey was conducted online and had 904 participants recruited from specific social networks on mental health and general social media (Mean age = 27.07, 50.22% females). The three dependent variables were (1) behavioral intention to start using internet-based interventions for depression, (2) preference to use it as a substitute for regular treatments and (3) preference to use it to complement regular treatments. The predictor variables included sociodemographic characteristics, perceived mental health conditions, personal situational characteristics, personal innovativeness toward online services, and depression level. RESULTS A large majority reported to be open to using internet-based interventions for depression (73.7%), as well as to use it as a substitution (73.3%) or as a complementary (73%) to regular treatments. Personal innovativeness toward online services was the strongest significant predictor for all types of use, even when corrected for current depression level. When added to the analyses separately, depression level was the second strongest predictive factor for all dependent variables. CONCLUSION The majority of Indonesians showed openness to use internet-based interventions for depression. To increase the adoption of internet-based interventions for depression, it is important to first promote internet usage to more people across the country, especially for those who are currently depressed.
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Key Words
- AVE, average variance extracted
- B·INT, behavioral usage intention
- COMP, complementary use
- DIST, distance to mental health service facilities
- Depression
- EDU, education level
- HIC, high income country
- HIST, history of mental health service usage
- IDS-SR, Inventory of Depressive Symptomatology-Self Report
- IIAQ-ID, Internet-based Interventions Acceptability Questionnaire-Indonesia
- Indonesia
- Internet-based interventions
- LMIC, low-middle income country
- Mental health gap
- Online therapy
- PERC∙MH, perceived mental healthiness
- PERC∙MV, perceived mental health vulnerability
- P·INNOV, personal innovativeness toward online services
- SES, socioeconomic status
- SUBS, substitutive use
- mhGAP, mental health Gap Action Programme
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Affiliation(s)
- Retha Arjadi
- Faculty of Psychology, Atma Jaya Catholic University of Indonesia, Jl. Jendral Sudirman No.51, Jakarta Selatan, 12930, DKI Jakarta, Indonesia,Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS Groningen, The Netherlands
| | - Maaike H. Nauta
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS Groningen, The Netherlands
| | - Claudi L.H. Bockting
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS Groningen, The Netherlands,Department of Psychiatry, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands,Corresponding author at: Department of Psychiatry, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
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146
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Feijt MA, de Kort YA, Bongers IM, IJsselsteijn WA. Perceived Drivers and Barriers to the Adoption of eMental Health by Psychologists: The Construction of the Levels of Adoption of eMental Health Model. J Med Internet Res 2018; 20:e153. [PMID: 29691215 PMCID: PMC5941096 DOI: 10.2196/jmir.9485] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 02/20/2018] [Accepted: 02/23/2018] [Indexed: 12/05/2022] Open
Abstract
Background The internet offers major opportunities in supporting mental health care, and a variety of technology-mediated mental and behavioral health services have been developed. Yet, despite growing evidence for the effectiveness of these services, their acceptance and use in clinical practice remains low. So far, the current literature still lacks a structured insight into the experienced drivers and barriers to the adoption of electronic mental health (eMental health) from the perspective of clinical psychologists. Objective The aim of this study was to gain an in-depth and comprehensive understanding of the drivers and barriers for psychologists in adopting eMental health tools, adding to previous work by also assessing drivers and analyzing relationships among these factors, and subsequently by developing a structured representation of the obtained findings. Methods The study adopted a qualitative descriptive approach consisting of in-depth semistructured interviews with clinical psychologists working in the Netherlands (N=12). On the basis of the findings, a model was constructed that was then examined through a communicative validation. Results In general, a key driver for psychologists to adopt eMental health is the belief and experience that it can be beneficial to them or their clients. Perceived advantages that are novel to literature include the acceleration of the treatment process, increased intimacy of the therapeutic relationship, and new treatment possibilities due to eMental health. More importantly, a relation was found between the extent to which psychologists have adopted eMental health and the particular drivers and barriers they experience. This differentiation is incorporated in the Levels of Adoption of eMental Health (LAMH) model that was developed during this study to provide a structured representation of the factors that influence the adoption of eMental health. Conclusions The study identified both barriers and drivers, several of which are new to the literature and found a relationship between the nature and importance of the various drivers and barriers perceived by psychologists and the extent to which they have adopted eMental health. These findings were structured in a conceptual model to further enhance the current understanding. The LAMH model facilitates further research on the process of adopting eMental health, which will subsequently enable targeted recommendations with respect to technology, training, and clinical practice to ensure that mental health care professionals as well as their clients will benefit optimally from the current (and future) range of available eMental health options.
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Affiliation(s)
- Milou A Feijt
- Human-Technology Interaction, Department of Industrial Engineering & Innovation Sciences, Eindhoven University of Technology, Eindhoven, Netherlands
| | - Yvonne Aw de Kort
- Human-Technology Interaction, Department of Industrial Engineering & Innovation Sciences, Eindhoven University of Technology, Eindhoven, Netherlands
| | - Inge Mb Bongers
- Tranzo, Tilburg School of Social and Behavioural Sciences, Tilburg University, Tilburg, Netherlands
| | - Wijnand A IJsselsteijn
- Human-Technology Interaction, Department of Industrial Engineering & Innovation Sciences, Eindhoven University of Technology, Eindhoven, Netherlands
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147
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Vis C, Mol M, Kleiboer A, Bührmann L, Finch T, Smit J, Riper H. Improving Implementation of eMental Health for Mood Disorders in Routine Practice: Systematic Review of Barriers and Facilitating Factors. JMIR Ment Health 2018; 5:e20. [PMID: 29549072 PMCID: PMC5878369 DOI: 10.2196/mental.9769] [Citation(s) in RCA: 109] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 02/07/2018] [Accepted: 02/08/2018] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Electronic mental health interventions (eMental health or eMH) can be used to increase accessibility of mental health services for mood disorders, with indications of comparable clinical outcomes as face-to-face psychotherapy. However, the actual use of eMH in routine mental health care lags behind expectations. Identifying the factors that might promote or inhibit implementation of eMH in routine care may help to overcome this gap between effectiveness studies and routine care. OBJECTIVE This paper reports the results of a systematic review of the scientific literature identifying those determinants of practices relevant to implementing eMH for mood disorders in routine practice. METHODS A broad search strategy was developed with high sensitivity to four key terms: implementation, mental health care practice, mood disorder, and eMH. The reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) framework was applied to guide the review and structure the results. Thematic analysis was applied to identify the most important determinants that facilitate or hinder implementation of eMH in routine practice. RESULTS A total of 13,147 articles were screened, of which 48 studies were included in the review. Most studies addressed aspects of the reach (n=33) of eMH, followed by intervention adoption (n=19), implementation of eMH (n=6), and maintenance (n=4) of eMH in routine care. More than half of the studies investigated the provision of mental health services through videoconferencing technologies (n=26), followed by Internet-based interventions (n=20). The majority (n=44) of the studies were of a descriptive nature. Across all RE-AIM domains, we identified 37 determinants clustered in six main themes: acceptance, appropriateness, engagement, resources, work processes, and leadership. The determinants of practices are expressed at different levels, including patients, mental health staff, organizations, and health care system level. Depending on the context, these determinants hinder or facilitate successful implementation of eMH. CONCLUSIONS Of the 37 determinants, three were reported most frequently: (1) the acceptance of eMH concerning expectations and preferences of patients and professionals about receiving and providing eMH in routine care, (2) the appropriateness of eMH in addressing patients' mental health disorders, and (3) the availability, reliability, and interoperability with other existing technologies such as the electronic health records are important factors for mental health care professionals to remain engaged in providing eMH to their patients in routine care. On the basis of the taxonomy of determinants of practices developed in this review, implementation-enhancing interventions can be designed and applied to achieve better implementation outcomes. Suggestions for future research and implementation practice are provided.
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Affiliation(s)
- Christiaan Vis
- Department of Clinical, Neuro-, & Developmental Psychology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Department of Mental Health, Amsterdam Public Health Research Institute, Vrije Universiteit Medical Center / Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Mayke Mol
- Department of Mental Health, Amsterdam Public Health Research Institute, Vrije Universiteit Medical Center / Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Department of Research and Innovation, Specialized Mental Health Care, GGZ InGeest, Amsterdam, Netherlands
| | - Annet Kleiboer
- Department of Clinical, Neuro-, & Developmental Psychology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Department of Mental Health, Amsterdam Public Health Research Institute, Vrije Universiteit Medical Center / Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Leah Bührmann
- Department of Clinical, Neuro-, & Developmental Psychology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Department of Mental Health, Amsterdam Public Health Research Institute, Vrije Universiteit Medical Center / Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Tracy Finch
- Healthcare & Implementation Science, Department of Nursing, Midwifery & Health, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Jan Smit
- Department of Mental Health, Amsterdam Public Health Research Institute, Vrije Universiteit Medical Center / Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Department of Research and Innovation, Specialized Mental Health Care, GGZ InGeest, Amsterdam, Netherlands
| | - Heleen Riper
- Department of Clinical, Neuro-, & Developmental Psychology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Department of Mental Health, Amsterdam Public Health Research Institute, Vrije Universiteit Medical Center / Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Department of Research and Innovation, Specialized Mental Health Care, GGZ InGeest, Amsterdam, Netherlands.,Telepsychiatric Unit, Faculty of Health Science, University Hospital / University of Southern Denmark, Odense, Denmark
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148
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Schuster R, Fichtenbauer I, Sparr VM, Berger T, Laireiter AR. Feasibility of a blended group treatment (bGT) for major depression: uncontrolled interventional study in a university setting. BMJ Open 2018; 8:e018412. [PMID: 29530905 PMCID: PMC5857649 DOI: 10.1136/bmjopen-2017-018412] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE This study investigated the feasibility of a novel blended (face-to-face and computer-based) group intervention for the reduction of depressive symptoms in major depression. DESIGN Patient-centred uncontrolled interventional study. SETTING University setting in a general community sample. A multimodal recruitment strategy (public health centres and public areas) was applied. PARTICIPANTS Based on independent interviews, 26 participants, diagnosed with major depressive disorder (81% female; 23% comorbidity >1 and 23% comorbidity >2), entered treatment. INTERVENTION Acceptance and mindfulness based, as well as self-management and resource-oriented psychotherapy principles served as the theoretical basis for the low-threshold intervention. The blended format included face-to-face sessions, complemented with multimedia presentations and a platform featuring videos, online work sheets, an unguided group chat and remote therapist-patient communication. MAIN OUTCOME MEASURES The Center for Epidemiological Studies-Depression scale and the 12-item General Health Questionnaire. RESULTS Large to very large within group effect sizes were found on self-reported depression (F(2, 46.37)=25.69, p<0.001; d=1.80), general health (F(2,46.73)=11.47, p<0.001; d=1.32), personal resources (F(2,43.36)=21.17, p<0.001; d=0.90) and mindfulness (F(2,46.22)=9.40, p<0.001; d=1.12) after a follow-up period of 3 months. Treatment satisfaction was high, and 69% ranked computer and multimedia use as a therapeutic factor. Furthermore, participants described treatment intensification as important advantage of the blended format. Half of the patients (48%) would have preferred more time for personal exchange. CONCLUSION The investigated blended group format seems feasible for the reduction of depressive symptoms in major depression. The development of blended interventions can benefit from assuring that highly structured treatments actually meet patients' needs. As a next step, the intervention should be tested in comparative trials in routine care. TRIAL REGISTRATION NUMBER DRKS00010894; Pre-results.
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Affiliation(s)
- Raphael Schuster
- Department of Psychology, University of Salzburg, Salzburg, Austria
| | - Isabelle Fichtenbauer
- Department of Applied Psychology: Health, Development and Promotion, Faculty of Psychology, University of Vienna, Wien, Austria
| | - Verena Maria Sparr
- Department of Applied Psychology: Health, Development and Promotion, Faculty of Psychology, University of Vienna, Wien, Austria
| | - Thomas Berger
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| | - Anton-Rupert Laireiter
- Department of Psychology, University of Salzburg, Salzburg, Austria
- Department of Applied Psychology: Health, Development and Promotion, Faculty of Psychology, University of Vienna, Wien, Austria
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149
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Folker AP, Mathiasen K, Lauridsen SM, Stenderup E, Dozeman E, Folker MP. Implementing internet-delivered cognitive behavior therapy for common mental health disorders: A comparative case study of implementation challenges perceived by therapists and managers in five European internet services. Internet Interv 2018; 11:60-70. [PMID: 30135761 PMCID: PMC6084870 DOI: 10.1016/j.invent.2018.02.001] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 01/31/2018] [Accepted: 02/01/2018] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Internet-delivered cognitive behavior therapy programs have been developed and evaluated in randomized controlled trials during the past two decades to alleviate the rising demand for effective treatment of common mental health disorders such as anxiety and depression. While most of the research on internet-based cognitive behavior therapy (iCBT) has focused on efficacy and effectiveness only little attention has been devoted to the implementation of iCBT. The aim of this study was to identify the main implementation challenges perceived by therapists and managers involved in the practical operation of iCBT services in routine care settings in five European countries. METHOD The study was designed as a multiple comparative case study to explore differences and similarities between five different iCBT services in Sweden, Norway, Denmark, The Netherlands and Scotland. Field visits were carried out to each of the five services including interviews with the management of the service (n = 9), focus group interviews with key staff (n = 15) and demonstration of online programs. The data material was processed through thematic, comparative analysis. RESULTS The analysis generated four transversal themes: 1) integration in the mental health care system; 2) recruitment of patients; 3) working practice of therapists; and 4) long-term sustainability of service. The main results concerned the need to address the informal integration in the health care systems related to the perceived skepticism towards iCBT from GPs and face-to-face therapists, the role of referral models and communication strategies for the stable recruitment of patients, the need for knowledge, standards and material for the training of therapists in the provision of online feedback, the need to improve the possibilities to tailor programs to individual patients, and the need for considerate long-term sustainability planning of the transitions from local projects to permanent regional or national services. CONCLUSION The present study gives an overview of the main implementation challenges regarding the practical operation of iCBT services perceived by the therapists and managers of the iCBT services. Future studies into specific details of each challenge will be important to strengthen the evidence base of iCBT and to improve uptake and implementation of iCBT in routine care.
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Affiliation(s)
- Anna Paldam Folker
- University of Southern Denmark, National Institute of Public Health, Studiestræde 6, 1455 Copenhagen K, Denmark
| | - Kim Mathiasen
- University of Southern Denmark, Department of Psychology, Campusvej 55, 5230 Odense M, Denmark
- Mental Health Services of Southern Denmark, Centre for Telepsychiatry, Heden 11, 5000 Odense C, Denmark
| | - Sigurd Mørk Lauridsen
- University of Southern Denmark, National Institute of Public Health, Studiestræde 6, 1455 Copenhagen K, Denmark
| | - Ellen Stenderup
- Mental Health Services of Southern Denmark, Centre for Telepsychiatry, Heden 11, 5000 Odense C, Denmark
| | - Els Dozeman
- GGZ inGeest, onderzoek en innovatie, Locatie Oldenaller, Oldenaller 1, Postbus 74077, 1070 BB Amsterdam, Netherlands
| | - Marie Paldam Folker
- Mental Health Services of Southern Denmark, Centre for Telepsychiatry, Heden 11, 5000 Odense C, Denmark
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150
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Evaluating an e-mental health program ("deprexis") as adjunctive treatment tool in psychotherapy for depression: Results of a pragmatic randomized controlled trial. J Affect Disord 2018; 227:455-462. [PMID: 29154168 DOI: 10.1016/j.jad.2017.11.021] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 09/08/2017] [Accepted: 11/06/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND Depressive disorders place a significant disease burden on individuals as well as on societies. Several web-based interventions for depression have shown to be effective in reducing depressive symptoms. However, it is not known whether web-based interventions, when used as adjunctive treatment tools to regular psychotherapy, have an additional effect compared to regular psychotherapy for depression. METHODS Adults (N = 98) with a unipolar affective disorder were recruited in routine outpatient psychotherapy practices in Germany from therapists over the course of their initial sessions and randomized within therapists to one of two active treatment conditions: regular psychotherapy or psychotherapy plus a web-based depression program ("deprexis"). Primary outcome was depressive symptoms measured with the Beck Depression Inventory (BDI-II) at 12 weeks. Secondary outcomes were anxiety symptoms, somatic symptoms and quality of life at 12 weeks and six months follow-up. The study also included an assessment of the working alliance after six and 12 weeks. RESULTS The combination of psychotherapy with the web-based program was more effective than psychotherapy alone at 12 weeks, with medium between-group effect sizes on primary depressive symptoms (Cohen's d = .51) and small to medium between-group effect sizes on secondary outcomes (Cohen's d = .07-.55). Furthermore, we did not observe negative side effects in the blended format, e.g., a lower working alliance than in psychotherapy alone. LIMITATIONS The study had a smaller than planned sample size and the dropout rate at follow-up was high. CONCLUSIONS This study provides first evidence that the use of a web-based program as an adjunctive tool in regular psychotherapy could be a promising option to consider in future treatment for depression.
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