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Clough BA, Alderson A, Savage S, Farrer L, Kebbell M. Can you tell me more about that? An examination of self-disclosure in videoconference and face-to-face psychological interviewing. Psychol Psychother 2024; 97:518-530. [PMID: 38923149 DOI: 10.1111/papt.12539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 05/28/2024] [Accepted: 06/14/2024] [Indexed: 06/28/2024]
Abstract
OBJECTIVES Videoconference psychotherapy (VCP) is a crucial component of many health care systems, allowing for remote delivery of services. However, little is known about the mechanisms of change within VCP. Previous research has suggested that self-disclosure may be greater in VCP than face-to-face modalities and was investigated in the current study. DESIGN Young adults aged 18-25 years (N = 57) were randomly allocated to face-to-face or VCP interview conditions, with measures completed pre- and post-interview. METHODS Participants completed an autobiographical memory task, requiring them to describe specific memories in response to positive and negative valence cue words. Measures included self-reported self-disclosure, blind observer-rated self-disclosure, memory specificity, and mean number of words per response. RESULTS No significant differences were found between conditions with regard to self-reported self-disclosure, capacity to recall specific memories, or words uttered per response. However, observer-rated depth of self-disclosure was significantly higher for participants in the face-to-face than VCP condition. Self-disclosure and memory specificity were also significantly greater for negative than positive valence cue words, regardless of condition. CONCLUSIONS The findings indicate that whilst participants may be able to draw on memories with equal ease regardless of interview modality, in VCP, emotional processing of these memories may require increased support and guidance from the therapist.
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Affiliation(s)
- Bonnie A Clough
- School of Applied Psychology, Griffith University, Mt Gravatt, Queensland, Australia
- Griffith Centre for Mental Health, Griffith University, Southport, Queensland, Australia
| | - Angie Alderson
- School of Applied Psychology, Griffith University, Mt Gravatt, Queensland, Australia
| | - Stacey Savage
- School of Applied Psychology, Griffith University, Mt Gravatt, Queensland, Australia
| | - Louise Farrer
- Centre for Mental Health Research, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Mark Kebbell
- School of Applied Psychology, Griffith University, Mt Gravatt, Queensland, Australia
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2
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Thurmann I, Leukhardt A, Eichenberg C. [Indication and Contraindication of Video-Based Psychotherapy: A Qualitative Delphi Survey to Capture Psychotherapists' Reflection and Deliberation Processes]. Psychother Psychosom Med Psychol 2024; 74:331-340. [PMID: 38710217 DOI: 10.1055/a-2255-3800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
OBJECTIVE The Corona pandemic forced many psychotherapists to make a rapid transition to video setting. Even after the acute phase of the pandemic, video-based treatments can be determined to a certain extent in practice. Thus, indication and contraindication recommendations are essential to ensure treatment quality. However, empirical studies are almost completely lacking in this regard. In the context of this work, the decision-making and consideration processes of psychotherapists regarding video-based treatments are to be recorded and those factors that can have an effect on the indication are to be identified. METHODS Two-stage, qualitative Delphi survey with psychodynamically oriented psychotherapists (n=9) and behavioural therapists (n=7) who can be assigned to the fields of research and practice. RESULTS The quality of the therapeutic alliance guides the participants' choice of setting. An indication for video setting results from the feasibility of therapeutic interventions and the respective treatment goal. The therapists weighed the costs and benefits of video setting for various disorders. The changed feeling of control on both sides and the possibility of improving health care are decisive factors. DISCUSSION Based on the results, a decision tree for psychotherapists was created, which includes the identified indication criteria.
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Affiliation(s)
- Isabelle Thurmann
- Department Psychotherapiewissenschaft, Sigmund Freud PrivatUniversität - Berlin, Berlin
| | - Alena Leukhardt
- Department Psychotherapiewissenschaft, Sigmund Freud PrivatUniversität - Berlin, Berlin
| | - Christiane Eichenberg
- Institut für Psychosomatik an der Med. Fakultät, Sigmund Freud PrivatUniversität - Wien, Wien, Österreich
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McCoy K, Moreland-Johnson A, Wade S, Quinones K, Swiecicki C, Hanson R. Therapist Participation in a Learning Collaborative on Trauma-Focused Cognitive Behavioral Therapy: Impact of COVID-related Stressors and Challenges. Community Ment Health J 2024; 60:1006-1016. [PMID: 38619697 DOI: 10.1007/s10597-024-01256-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 02/17/2024] [Indexed: 04/16/2024]
Abstract
The rise in mental health problems during the COVID-19 pandemic amplified the need to improve access to evidence-based treatments (EBT) and necessitated changes in treatment delivery and training of mental health providers (MHPs). There is limited information on how the pandemic may have impacted MHPs' participation in training and treatment delivery. This study included 269 MHPs who participated in a Learning Collaborative (LC) focused on an EBT. Qualitative interviews conducted with 15 MHPs who participated in the LC during the pandemic identified facilitators and barriers to training participation and EBT delivery that included social support, technology challenges, and difficulty completing cases following the transition to telehealth. Quantitative results showed that MHPs in the peri-COVID cohorts completed significantly fewer cases and fewer consultation calls compared to those prior to the pandemic. Findings suggest that providing support to train MHPs and promote EBT delivery may be beneficial during times of heightened stress.
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Affiliation(s)
- Kelsey McCoy
- Department of Psychiatry, Medical University of South Carolina, South Carolina, USA.
- Present Address: Milestones Psychology, 28 W. 25th Street 10th Floor, New York, NY, 10010, USA.
| | | | - Shelby Wade
- Department of Psychiatry, Medical University of South Carolina, South Carolina, USA
| | - Kathy Quinones
- Department of Psychiatry, Medical University of South Carolina, South Carolina, USA
| | - Carole Swiecicki
- Department of Psychiatry, Medical University of South Carolina, South Carolina, USA
| | - Rochelle Hanson
- Department of Psychiatry, Medical University of South Carolina, South Carolina, USA
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Edelbluth S, Schwartz B, Lutz W. The Effects of Switching to Video Therapy on In-Session Processes in Psychotherapy During the COVID-19 Pandemic. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2024; 51:428-438. [PMID: 38483750 PMCID: PMC11196328 DOI: 10.1007/s10488-024-01361-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2024] [Indexed: 06/25/2024]
Abstract
OBJECTIVE AND AIM This study aimed to assess the impact of switching from face-to-face (f2f) psychotherapy to video therapy (VT) due to the COVID-19 pandemic on in-session processes, i.e., the therapeutic alliance, coping skills, and emotional involvement, as rated by both patients and therapists. METHODS A total of N = 454 patients with mood or anxiety disorders were examined. The intervention group (IG) consisted of n = 227 patient-therapist dyads, who switched from f2f to VT, while the control group (CG) consisted of n = 227 patient-therapist dyads, who were treated f2f before the pandemic. To evaluate the effects of switching to VT on in-session processes, three longitudinal piecewise multilevel models, one per process variable, were fitted. Each process variable was regressed on the session number with a slope for the three sessions before switching to VT and a second slope for up to six VT sessions afterwards. RESULTS The therapeutic alliance significantly increased after switching from f2f to VT across the two groups (IG and CG) and raters (patients and therapists) with no differences between IG and CG. On average, patients rated the therapeutic alliance better than therapists. Coping skills significantly increased after switching from f2f to VT across the two groups and raters, but the CG rated coping skills higher than the IG after the switch. Overall, therapists rated coping skills higher than patients. Emotional involvement did not significantly increase after switching to VT across the two groups and raters and there was no significant difference between patient and therapist ratings. DISCUSSION In conclusion, the switch to VT had no negative impact on the therapeutic alliance and emotional involvement. However, more coping skills were reported in the CG than in the IG after the switch to VT, which was mainly due to a stagnation in patient-rated coping skills in the IG.
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Affiliation(s)
- Susanne Edelbluth
- Department of Clinical Psychology and Psychotherapy, University of Trier, 54286, Trier, Germany.
| | - Brian Schwartz
- Department of Clinical Psychology and Psychotherapy, University of Trier, 54286, Trier, Germany
| | - Wolfgang Lutz
- Department of Clinical Psychology and Psychotherapy, University of Trier, 54286, Trier, Germany
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Aafjes-Van Doorn K, Békés V, Luo X, Hopwood CJ. Therapists' perception of the working alliance, real relationship and therapeutic presence in in-person therapy versus tele-therapy. Psychother Res 2024; 34:574-588. [PMID: 37011405 DOI: 10.1080/10503307.2023.2193299] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 03/14/2023] [Indexed: 04/05/2023] Open
Abstract
Objective: Although teletherapy is increasingly common, very little is known about its impact on therapeutic relationships. We aimed to examine differences between therapists' experiences of teletherapy and in-person therapy post-pandemic with regard to three variables pertinent to the therapeutic relationship: working alliance, real relationship, and therapeutic presence. METHODS In a sample of 826 practicing therapists, we examined these relationship variables, as well as potential moderators of these perceived differences including professional and patient characteristics and covid-related variables. RESULTS Therapists reported feeling significantly less present in teletherapy and their perceptions of the real relationship were somewhat impacted, but there were no average effects on their perceived quality of the working alliance. Perceived differences in the real relationship did not persist with clinical experience controlled. The relative reduction in therapeutic presence in teletherapy was driven by the ratings of process-oriented therapists and therapists conducting mostly individual therapy. Evidence for moderation by covid-related issues was also found, with larger perceived differences in the working alliance reported by therapists who used teletherapy because it was mandated and/or not by choice. CONCLUSION Our findings might have important implications for generating awareness around the therapists' lowered sense of presence in teletherapy compared to in-person teletherapy.
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Affiliation(s)
| | - Vera Békés
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA
| | - Xiaochen Luo
- Department of Counseling Psychology, Santa Clara University, Santa Clara, CA, USA
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Schoenenberg K, Martin A. Empathy, working alliance, treatment expectancy and credibility in video and face-to-face psychotherapeutic first contact. Psychother Res 2024; 34:626-637. [PMID: 37436800 DOI: 10.1080/10503307.2023.2233685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 07/01/2023] [Indexed: 07/13/2023] Open
Abstract
Objective Video-based therapy has been used increasingly since the onset of the COVID-19 pandemic. Yet, video-based initial psychotherapeutic contact can be problematic due to the limitations of computer-mediated communication. At present, little is known about the effects of video first contact on important psychotherapeutic processes. Method: Forty-three individuals (nvideo = 18, nface-to-face = 25) were recruited via an outpatient clinic waiting list and were randomly assigned to video or face-to-face initial psychotherapeutic sessions. Participants rated treatment expectancy before and after the session, and the therapist's empathy, working alliance, and credibility after the session and several days later. Results: Empathy and working alliance ratings of patients and therapists were high and did not differ between the two communication conditions after the appointment or at follow-up. Treatment expectancy increased to a similar extent for the video and face-to-face modalities from pre to post. Willingness to continue with video-based therapy increased in participants who had video contact, but not in those with face-to-face contact. Conclusion: This study indicates that crucial processes related to the therapeutic relationship can be initiated via video, without prior face-to-face contact. Given the limited nonverbal communication cues in video appointments, it remains unclear as to how such processes evolve.Trial registration: German Clinical Trials Register identifier: DRKS00031262..
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Affiliation(s)
- Katrin Schoenenberg
- Department for Clinical Psychology and Psychotherapy, University Wuppertal, Wuppertal, Germany
| | - Alexandra Martin
- Department for Clinical Psychology and Psychotherapy, University Wuppertal, Wuppertal, Germany
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Aafjes-van Doorn K, Spina DS, Horne SJ, Békés V. The association between quality of therapeutic alliance and treatment outcomes in teletherapy: A systematic review and meta-analysis. Clin Psychol Rev 2024; 110:102430. [PMID: 38636207 DOI: 10.1016/j.cpr.2024.102430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 11/28/2023] [Accepted: 04/08/2024] [Indexed: 04/20/2024]
Abstract
OBJECTIVE The strength of the therapeutic alliance is widely understood to impact treatment outcomes, however, the alliance-outcome relationship in teletherapy has remained relatively unexamined. The aim of this meta-analysis is to systematically summarize the relationship between therapeutic alliance and treatment outcomes in teletherapy with adult patients conducted via videoconferencing or telephone. METHODS We conducted a systematic search of the databases PsycINFO, PsycARTICLES, ProQuest Dissertation Databases, EMBASE, The Cochrane Library, MEDLINE, Google Scholar, and PubMed for studies published before June 26, 2023. We identified 31 studies with 34 independent samples (4862 participants). RESULTS The average weighted effect size was 0.15, p = .001, 95% CI [0.07, 0.24], k = 34. reflecting a small effect of therapeutic alliance on mental health outcomes. There was significant heterogeneity in the effect sizes, which was driven by between-study differences in the alliance-outcome correlation. The alliance-outcome effect was larger when the alliance was measured late in treatment and when the outcome was measured from the patient's perspective. CONCLUSION Very few teletherapy treatment studies were identified that initially reported on alliance-outcome associations, underlining that this is an under-researched area. The association between alliance-teletherapy outcomes in this meta-analysis was small but significant, and somewhat weaker than the alliance-outcome associations reported for in-person treatments and other online interventions. This might indicate that there are other processes at play in teletherapy that explain variance of treatment outcomes, or that the therapist (and the relationship) has less influence on the treatment outcomes than in in-person therapy.
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Affiliation(s)
| | - Daniel S Spina
- Pennsylvania State University, Psychology Department, PA, USA
| | - Sarah J Horne
- Yeshiva University, Ferkauf Graduate School of Psychology, New York, USA
| | - Vera Békés
- Yeshiva University, Ferkauf Graduate School of Psychology, New York, USA
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8
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Bradford AB, Johnson LN, Anderson SR, Banford-Witting A, Hunt QA, Miller RB, Bean RA. Call me maybe? In-person vs. teletherapy outcomes among married couples. Psychother Res 2024; 34:611-625. [PMID: 37703549 DOI: 10.1080/10503307.2023.2256465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 08/24/2023] [Accepted: 08/28/2023] [Indexed: 09/15/2023] Open
Abstract
Objective: The objective of this study was to investigate the effectiveness of teletherapy compared to in-person couple therapy in outcomes such as couple satisfaction, sexual satisfaction, and the therapeutic alliance.Method: Data from 1157 married clients seeking couple therapy were examined. Individual growth curve models were used to analyze changes in the aforementioned outcomes, with teletherapy as a predictor. The study also examined client age and clinic type as moderators.Results: The results indicated that overall, teletherapy is as effective as in-person therapy in improving outcomes. However, there were notable differences in the development of the therapeutic alliance. The alliance improved at twice the rate in in-person therapy as in teletherapy. Clinic type was also found to be a moderator of changes in sexual satisfaction. Clients in group and private practices reported improvements in sexual satisfaction; whereas clients seen in training clinics reported decreases in sexual satisfaction.Conclusion: The study concludes that although teletherapy may be a viable alternative to in-person couple therapy, there are nevertheless differences in the development of the therapeutic alliance that warrant care and further investigation. The setting of the therapy also plays a role in the effectiveness of therapy, although not specific to therapy modality.
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9
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Davis KA, Zhao F, Janis RA, Castonguay LG, Hayes JA, Scofield BE. Therapeutic alliance and clinical outcomes in teletherapy and in-person psychotherapy: A noninferiority study during the COVID-19 pandemic. Psychother Res 2024; 34:589-600. [PMID: 37399573 DOI: 10.1080/10503307.2023.2229505] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 06/16/2023] [Accepted: 06/20/2023] [Indexed: 07/05/2023] Open
Abstract
Objective The current study aimed to inform the varied and limited research on clinical variables in the context of teletherapy. Questions remain about the comparative quality of therapeutic alliance and clinical outcome in the context of teletherapy compared to in-person treatment.Methods We utilized a cohort design and a noninferiority statistical approach to study a large, matched sample of clients who reported therapeutic alliance as well as psychological distress before every session as part of routine clinical practice at a university counseling center. A cohort of 479 clients undergoing teletherapy after the emergence of the COVID-19 pandemic was compared to a cohort of 479 clients receiving in-person treatment before the onset of the pandemic. Tests of noninferiority were conducted to investigate the absence of meaningful differences between the two modalities of service delivery. Client characteristics were also examined as moderators of the association between modality and alliance or outcome.Results Clients receiving teletherapy showed noninferior alliance and clinical outcome when compared to clients receiving in-person psychotherapy. A significant main effect on alliance was found with regard to race and ethnicity. A significant main effect on outcome was found with regard to international student status. Significant interactions on alliance were found between cohort and current financial stress.Conclusions Study findings support the continued use of teletherapy by demonstrating commensurate clinical process and outcome. Yet, it will be important for providers to be aware of existing mental health disparities that continue to accompany psychotherapy - in person and via teletherapy. Results and findings are discussed in terms of research and clinical implications. Future directions for researching teletherapy as a viable treatment delivery method are also discussed.
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Affiliation(s)
- Katherine A Davis
- Department of Psychology, The Pennsylvania State University, University Park, PA, USA
| | - Fanghui Zhao
- Department of Educational Psychology, Counseling, and Special Education, The Pennsylvania State University, University Park, PA, USA
| | - Rebecca A Janis
- Counseling and Psychological Services, The Pennsylvania State University, University Park, PA, USA
| | - Louis G Castonguay
- Department of Psychology, The Pennsylvania State University, University Park, PA, USA
| | - Jeffrey A Hayes
- Department of Educational Psychology, Counseling, and Special Education, The Pennsylvania State University, University Park, PA, USA
| | - Brett E Scofield
- Counseling and Psychological Services, The Pennsylvania State University, University Park, PA, USA
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Nassif RM, Husseini ME, Beaini N, Choueiri T, Tarazi-Sahab L, Moro MR. Working through multiple crises: the experience of psychotherapists and psychoanalysts in Lebanon. BMC Psychol 2024; 12:303. [PMID: 38807244 PMCID: PMC11134674 DOI: 10.1186/s40359-024-01810-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 05/22/2024] [Indexed: 05/30/2024] Open
Abstract
INTRODUCTION This research explores the impact of the COVID-19 pandemic on psychotherapists' practices and their ability to maintain a framework despite a shared reality with their patients. The specific focus in this article is on the Lebanese context, which is characterized by a series of crises including economic collapse, the COVID-19 pandemic, and the Beirut blast. The objective of this study was to examine how the destabilization of the meta-frame due to crises necessitates adaptations in theoretical knowledge, practice, and setting. METHODS We conducted a qualitative study among a population consisting of mental health professionals, which were recruited in Lebanon through associations and societies of psychologists, psychotherapists, and psychoanalysts. Data was collected using semi-structured individual interviews. The interviews were analyzed using interpretative phenomenological analysis (IPA), which allowed for a dynamic exploration of the participants' experiences. RESULTS Our study revealed four superordinate themes: (1) The strained frontiers; (2) The cumulative traumatic reality and its impact; (3) A challenged professional identity; (4) The creativity stemming from collective trauma. CONCLUSIONS Our results highlight the insecurity caused by external reality infiltrating the therapeutic setting. Online therapy allowed for continued work, but uncertainty about the online environment's impact on therapeutic relationships was observed. The study underscores the importance of adaptability, containment, and support for therapists navigating crises, particularly in the online setting.
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Affiliation(s)
- Rose Marie Nassif
- University Sorbonne Paris Nord, Villetaneuse, 93430, France.
- UVSQ, Inserm, CESP, Team DevPsy, University of Paris-Saclay, Villejuif, 94807, France.
| | - Mayssa' El Husseini
- UVSQ, Inserm, CESP, Team DevPsy, University of Paris-Saclay, Villejuif, 94807, France
- University of Picardie Jules Verne CHSSC EA 4289, Amiens, France
| | | | | | - Layla Tarazi-Sahab
- UVSQ, Inserm, CESP, Team DevPsy, University of Paris-Saclay, Villejuif, 94807, France
- Saint Joseph University, Beirut, Lebanon
| | - Marie-Rose Moro
- UVSQ, Inserm, CESP, Team DevPsy, University of Paris-Saclay, Villejuif, 94807, France
- APHP, Hôpital Cochin, Maison de Solenn, Paris, 75014, France
- University of Paris Cite, PCPP, Boulogne-Billancourt, 92100, France
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Kersten L, Alfano J, Erlanger TE, Helfenstein F, Lanz L, Weiss S, Chilla C, von Planta B, Kapoor M, Borel N, Rocco T, Papageorgiou A, De Brito CF, Bajrami A, Savary V, Mayor M, Hurschler J, Traut A, Brunner D, Vriends N, Stadler C. START NOW WebApp-promoting emotion regulation and resilience in residential youth care and correctional institutions: study protocol for a cluster randomized controlled trial. Trials 2024; 25:341. [PMID: 38778383 PMCID: PMC11112814 DOI: 10.1186/s13063-024-08180-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 05/16/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Adolescents and young adults in residential care and correctional institutions face various challenges, leading to negative life outcomes. Implementation barriers within these institutions, such as limited financial and spatial resources, pose significant hurdles to providing necessary support. Web-based approaches address these challenges by offering cost-effective, accessible solutions. This study aims to assess the efficacy of a newly developed web-based version of the existing evidence-based START NOW skills training in fostering emotion regulation and resilience among institutionalized adolescents and young adults. We present the study protocol (Version 5, August 2023) of the trial titled "Implementation of an e-version of the skills training START NOW for promoting emotion regulation and resilience in residential youth care and correctional institutions". METHODS The study is a monocentric, prospective, confirmatory randomized controlled trial with 150 institutionalized adolescents and young adults with a need to improve resilience (predefined cut-offs). Participating institutions will be randomized to one of three conditions: (i) 9-week web-based group training guided by a facilitator, (ii) 9-week web-based self-help training, (iii) and treatment as usual. The primary endpoint is the change in psychological flexibility, assessed by the Avoidance and Fusion Questionnaire for Youth score, from baseline to follow-up 12 weeks post skills training. Secondary objectives encompass assessing pre-post changes in psychological flexibility and other psychological health-related outcome measures in participating adolescents, young adults, and caretakers from baseline, to post training, and to 12- and 24-week follow-ups. DISCUSSION This study evaluates the efficacy of START NOW as web-based training for institutionalized adolescents and young adults, providing valuable insights into web-based interventions and aiming to optimize support levels. TRIAL REGISTRATION {2A AND 2B}: ClinicalTrials.gov NCT05313581. Registered on 6 April 2022.
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Affiliation(s)
- Linda Kersten
- Department of Child and Adolescent Psychiatry, University Psychiatric Clinics Basel, University of Basel, Wilhelm Klein-Strasse 27, 4002, Basel, Switzerland
| | - Janine Alfano
- Department of Child and Adolescent Psychiatry, University Psychiatric Clinics Basel, University of Basel, Wilhelm Klein-Strasse 27, 4002, Basel, Switzerland
| | - Tobias E Erlanger
- Department of Clinical Research, University of Basel and University Hospital Basel, Basel, Switzerland
| | - Fabrice Helfenstein
- Department of Clinical Research, University of Basel and University Hospital Basel, Basel, Switzerland
| | - Lelia Lanz
- Department of Child and Adolescent Psychiatry, University Psychiatric Clinics Basel, University of Basel, Wilhelm Klein-Strasse 27, 4002, Basel, Switzerland
| | - Stefan Weiss
- Department of Child and Adolescent Psychiatry, University Psychiatric Clinics Basel, University of Basel, Wilhelm Klein-Strasse 27, 4002, Basel, Switzerland
| | - Chiara Chilla
- Department of Child and Adolescent Psychiatry, University Psychiatric Clinics Basel, University of Basel, Wilhelm Klein-Strasse 27, 4002, Basel, Switzerland
| | - Beryll von Planta
- Department of Child and Adolescent Psychiatry, University Psychiatric Clinics Basel, University of Basel, Wilhelm Klein-Strasse 27, 4002, Basel, Switzerland
| | - Madlaina Kapoor
- Department of Child and Adolescent Psychiatry, University Psychiatric Clinics Basel, University of Basel, Wilhelm Klein-Strasse 27, 4002, Basel, Switzerland
| | - Nathalie Borel
- Department of Child and Adolescent Psychiatry, University Psychiatric Clinics Basel, University of Basel, Wilhelm Klein-Strasse 27, 4002, Basel, Switzerland
| | - Tabea Rocco
- Department of Child and Adolescent Psychiatry, University Psychiatric Clinics Basel, University of Basel, Wilhelm Klein-Strasse 27, 4002, Basel, Switzerland
| | - Andreas Papageorgiou
- Department of Child and Adolescent Psychiatry, University Psychiatric Clinics Basel, University of Basel, Wilhelm Klein-Strasse 27, 4002, Basel, Switzerland
| | - Catarina Fernandes De Brito
- Department of Child and Adolescent Psychiatry, University Psychiatric Clinics Basel, University of Basel, Wilhelm Klein-Strasse 27, 4002, Basel, Switzerland
| | - Arzie Bajrami
- Department of Child and Adolescent Psychiatry, University Psychiatric Clinics Basel, University of Basel, Wilhelm Klein-Strasse 27, 4002, Basel, Switzerland
| | - Valentine Savary
- Department of Child and Adolescent Psychiatry, University Psychiatric Clinics Basel, University of Basel, Wilhelm Klein-Strasse 27, 4002, Basel, Switzerland
| | - Melanie Mayor
- Department of Child and Adolescent Psychiatry, University Psychiatric Clinics Basel, University of Basel, Wilhelm Klein-Strasse 27, 4002, Basel, Switzerland
| | - Jana Hurschler
- Department of Child and Adolescent Psychiatry, University Psychiatric Clinics Basel, University of Basel, Wilhelm Klein-Strasse 27, 4002, Basel, Switzerland
| | - Alex Traut
- Department of Child and Adolescent Psychiatry, University Psychiatric Clinics Basel, University of Basel, Wilhelm Klein-Strasse 27, 4002, Basel, Switzerland
| | - Donja Brunner
- Department of Child and Adolescent Psychiatry, University Psychiatric Clinics Basel, University of Basel, Wilhelm Klein-Strasse 27, 4002, Basel, Switzerland.
| | - Noortje Vriends
- Department of Child and Adolescent Psychiatry, University Psychiatric Clinics Basel, University of Basel, Wilhelm Klein-Strasse 27, 4002, Basel, Switzerland
| | - Christina Stadler
- Department of Child and Adolescent Psychiatry, University Psychiatric Clinics Basel, University of Basel, Wilhelm Klein-Strasse 27, 4002, Basel, Switzerland
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Schwab-Reese L, Short C, Jacobs L, Fingerman M. Rapport Building in Written Crisis Services: Qualitative Content Analysis. J Med Internet Res 2024; 26:e42049. [PMID: 38748472 PMCID: PMC11137431 DOI: 10.2196/42049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 08/21/2023] [Accepted: 03/26/2024] [Indexed: 06/01/2024] Open
Abstract
BACKGROUND Building therapeutic relationships and social presence are challenging in digital services and maybe even more difficult in written services. Despite these difficulties, in-person care may not be feasible or accessible in all situations. OBJECTIVE This study aims to categorize crisis counselors' efforts to build rapport in written conversations by using deidentified conversation transcripts from the text and chat arms of the National Child Abuse Hotline. Using these categories, we identify the common characteristics of successful conversations. We defined success as conversations where help-seekers reported the hotline was a good way to seek help and that they were a lot more hopeful, a lot more informed, a lot more prepared to address the situation, and experiencing less stress, as reported by help-seekers. METHODS The sample consisted of transcripts from 314 purposely selected conversations from of the 1153 text and chat conversations during July 2020. Hotline users answered a preconversation survey (ie, demographics) and a postconversation survey (ie, their perceptions of the conversation). We used qualitative content analysis to process the conversations. RESULTS Active listening skills, including asking questions, paraphrasing, reflecting feelings, and interpreting situations, were commonly used by counselors. Validation, unconditional positive regard, and evaluation-based language, such as praise and apologies, were also often used. Compared with less successful conversations, successful conversations tended to include fewer statements that attend to the emotional dynamics. There were qualitative differences in how the counselors applied these approaches. Generally, crisis counselors in positive conversations tended to be more specific and tailor their comments to the situation. CONCLUSIONS Building therapeutic relationships and social presence are essential to digital interventions involving mental health professionals. Prior research demonstrates that they can be challenging to develop in written conversations. Our work demonstrates characteristics associated with successful conversations that could be adopted in other written help-seeking interventions.
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Affiliation(s)
- Laura Schwab-Reese
- Department of Public Health, Purdue University, West Lafayette, IN, United States
| | - Caitlyn Short
- Department of Public Health, Purdue University, West Lafayette, IN, United States
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Woodrow N, Gillespie D, Kitchin L, O'Brien M, Chapman S, Chng NR, Passey A, Aquino MRJ, Clarke Z, Goyder E. Reintroducing face-to-face support alongside remote support to form a hybrid stop smoking service in England: a formative mixed methods evaluation. BMC Public Health 2024; 24:718. [PMID: 38448869 PMCID: PMC10916048 DOI: 10.1186/s12889-024-18235-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 02/29/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND During the COVID-19 pandemic, United Kingdom (UK) stop smoking services had to shift to remote delivery models due to social distancing regulations, later reintroducing face-to-face provision. The "Living Well Smokefree" service in North Yorkshire County Council adopted a hybrid model offering face-to-face, remote, or a mix of both. This evaluation aimed to assess the hybrid approach's strengths and weaknesses and explore potential improvements. METHODS Conducted from September 2022 to February 2023, the evaluation consisted of three components. First, qualitative interviews involved 11 staff and 16 service users, analysed thematically. Second, quantitative data from the QuitManager system that monitored the numbers and proportions of individuals selecting and successfully completing a 4-week quit via each service option. Third, face-to-face service expenses data was used to estimate the value for money of additional face-to-face provision. The qualitative findings were used to give context to the quantitative data via an "expansion" approach and complementary analysis. RESULTS Overall, a hybrid model was seen to provide convenience and flexible options for support. In the evaluation, 733 individuals accessed the service, with 91.3% selecting remote support, 6.1% face-to-face, and 2.6% mixed provision. Remote support was valued by service users and staff for promoting openness, privacy, and reducing stigma, and was noted as removing access barriers and improving service availability. However, the absence of carbon monoxide monitoring in remote support raised accountability concerns. The trade-off in "quantity vs. quality" of quits was debated, as remote support reached more users but produced fewer carbon monoxide-validated quits. Primarily offering remote support could lead to substantial workloads, as staff often extend their roles to include social/mental health support, which was sometimes emotionally challenging. Offering service users a choice of support options was considered more important than the "cost-per-quit". Improved dissemination of information to support service users in understanding their options for support was suggested. CONCLUSIONS The hybrid approach allows smoking cessation services to evaluate which groups benefit from remote, face-to-face, or mixed options and allocate resources accordingly. Providing choice, flexible provision, non-judgmental support, and clear information about available options could improve engagement and match support to individual needs, enhancing outcomes.
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Affiliation(s)
- Nicholas Woodrow
- Sheffield Centre for Health and Related Research (SCHARR), University of Sheffield, Sheffield, UK.
| | - Duncan Gillespie
- Sheffield Centre for Health and Related Research (SCHARR), University of Sheffield, Sheffield, UK
| | - Liz Kitchin
- Sheffield Centre for Health and Related Research (SCHARR), University of Sheffield, Sheffield, UK
| | - Mark O'Brien
- Living Well Smokefree Service, North Yorkshire Council, York, UK
| | - Scott Chapman
- Living Well Smokefree Service, North Yorkshire Council, York, UK
| | - Nai Rui Chng
- MRC/CSO Social and Public Health Sciences Unit, School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Andrew Passey
- School of Health, Leeds Beckett University, LS1 3HE, Leeds, UK
| | - Maria Raisa Jessica Aquino
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Zoe Clarke
- Sheffield Centre for Health and Related Research (SCHARR), University of Sheffield, Sheffield, UK
| | - Elizabeth Goyder
- Sheffield Centre for Health and Related Research (SCHARR), University of Sheffield, Sheffield, UK
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14
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Aydınlar A, Mavi A, Kütükçü E, Kırımlı EE, Alış D, Akın A, Altıntaş L. Awareness and level of digital literacy among students receiving health-based education. BMC MEDICAL EDUCATION 2024; 24:38. [PMID: 38191385 PMCID: PMC10773083 DOI: 10.1186/s12909-024-05025-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 01/03/2024] [Indexed: 01/10/2024]
Abstract
BACKGROUND Being digitally literate allows health-based science students to access reliable, up-to-date information efficiently and expands the capacity for continuous learning. Digital literacy facilitates effective communication and collaboration among other healthcare providers. It helps to navigate the ethical implications of using digital technologies and aids the use of digital tools in managing healthcare processes. Our aim in this study is to determine the digital literacy level and awareness of our students receiving health-based education in our university and to pave the way for supporting the current curriculum with courses on digital literacy when necessary. METHOD Students from Acibadem University who were registered undergraduate education for at least four years of health-based education, School of Medicine, Nutrition and Dietetics, Nursing, Physiotherapy and Rehabilitation, Psychology, Biomedical Engineering, Molecular Biology, and Genetics were included. The questionnaire consisted of 24 queries evaluating digital literacy in 7 fields: software and multimedia, hardware and technical problem solving, network and communication/collaboration, ethics, security, artificial intelligence (A.I.), and interest/knowledge. Two student groups representing all departments were invited for interviews according to the Delphi method. RESULTS The survey was completed by 476 students. Female students had less computer knowledge and previous coding education. Spearman correlation test showed that there were weak positive correlations between the years and the "software and multimedia," "ethics," "interest and knowledge" domains, and the average score. The students from Nursing scored lowest in the query after those from the Nutrition and Dietetics department. The highest scores were obtained by Biomedical Engineering students, followed by the School of Medicine. Participants scored the highest in "network" and "A.I." and lowest in "interest-knowledge" domains. CONCLUSION It is necessary to define the level of computer skills who start health-based education and shape the curriculum by determining which domains are weak. Creating an educational environment that fosters females' digital knowledge is recommended. Elective courses across faculties may be offered to enable students to progress and discuss various digital literacy topics. The extent to which students benefit from the digital literacy-supported curriculum may be evaluated. Thus, health-based university students are encouraged to acquire the computer skills required by today's clinical settings. REGISTRATION This study was approved by Acıbadem University and Acıbadem Healthcare Institutions Medical Research Ethics Committee (ATADEK) (11 November 2022, ATADEK registration: 2022-17-138) All methods were carried out in accordance with relevant guidelines and regulations. Informed consent was obtained from the participants.
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Affiliation(s)
| | - Arda Mavi
- Acibadem University School of Medicine, Istanbul, Türkiye
| | - Ece Kütükçü
- Faculty of Engineering and Natural Sciences, Acibadem University, Istanbul, Türkiye
| | - Elçim Elgün Kırımlı
- Faculty of Engineering and Natural Sciences, Acibadem University, Istanbul, Türkiye
| | - Deniz Alış
- Department of Radiology, Acibadem University School of Medicine, Istanbul, Türkiye
| | - Ata Akın
- Faculty of Engineering and Natural Sciences, Acibadem University, Istanbul, Türkiye
| | - Levent Altıntaş
- Department of Basic Sciences, Acibadem University School of Medicine, Istanbul, Türkiye.
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15
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Jenkins PE, Wake S. Therapeutic alliance in two forms of guided self-help for binge eating. Clin Psychol Psychother 2024; 31:e2959. [PMID: 38344858 DOI: 10.1002/cpp.2959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 01/14/2024] [Accepted: 01/22/2024] [Indexed: 02/15/2024]
Abstract
The role of therapeutic alliance within psychological treatments for eating disorders (EDs), including those delivered remotely, is well established. However, few studies have investigated alliance in guided self-help, a widely recommended first-line treatment for EDs characterised by regular binge eating. Using data from a randomised controlled trial, the current study examined both facilitator and patient assessments of alliance within e-mail-assisted and face-to-face guided self-help and looked at associations between alliance, ED symptoms and ED-related impairment. One hundred thirteen patients and 11 facilitators completed measures of alliance during and following a course of guided self-help. Whilst ratings were reliable across patients and facilitators, alliance scores were higher both in the patient sample and in the face-to-face condition. Ratings of alliance showed no correlations with ED symptoms at post-treatment, and early alliance was not significantly associated with outcome, which could inform how early symptom change is encouraged in guided self-help.
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Affiliation(s)
- Paul E Jenkins
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Shannon Wake
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
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16
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Parsons CE, Purves KL, Davies MR, Mundy J, Bristow S, Eley TC, Breen G, Hirsch CR, Young KS. Seeking help for mental health during the COVID-19 pandemic: A longitudinal analysis of adults' experiences with digital technologies and services. PLOS DIGITAL HEALTH 2023; 2:e0000402. [PMID: 38055730 DOI: 10.1371/journal.pdig.0000402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 11/04/2023] [Indexed: 12/08/2023]
Abstract
The COVID-19 pandemic brought about dramatic changes in how patients access healthcare from its outset. Lockdown restrictions and remote working led to a proliferation of digital technologies and services, which also impacted mental health provisions. Against the backdrop of new and changing support services, along with an unprecedented emphasis on mental health, relatively little is known about how adults sought out and received support for their mental health during this period. With a sample of 27,574 adults assessed longitudinally online over 12 months of the pandemic in the UK, we analysed reports of help-seeking for mental health, as well as sources of treatment or support and the perceived helpfulness of treatments received. We observed that the proportions of participants who reported seeking help remained relatively consistent throughout the 12-month period (ranging from 12.6% to 17.0%). Online talking therapies were among the most frequently sought sources (15.3%), whereas online self-guided treatments were among the least frequently sought sources (5%). Telephone lines, both NHS and non-governmental, had marked treatment 'gaps'. These treatment gaps, where individuals sought treatment but did not receive it, were especially evident for men and older adults. Our findings underscore online talking therapies as being a widely-sought and helpful source of mental health support. This is important given the current global need for accessible treatment options.
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Affiliation(s)
- Christine E Parsons
- Department of Clinical Medicine, Interacting Minds Center, Aarhus University, Aarhus, Denmark
| | - Kirstin L Purves
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
- NIHR Maudsley Biomedical Research Centre, King's College London, United Kingdom
| | - Molly R Davies
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
- NIHR Maudsley Biomedical Research Centre, King's College London, United Kingdom
| | - Jessica Mundy
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Shannon Bristow
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
- NIHR Maudsley Biomedical Research Centre, King's College London, United Kingdom
| | - Thalia C Eley
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
- NIHR Maudsley Biomedical Research Centre, King's College London, United Kingdom
| | - Gerome Breen
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
- NIHR Maudsley Biomedical Research Centre, King's College London, United Kingdom
| | - Colette R Hirsch
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Katherine S Young
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
- NIHR Maudsley Biomedical Research Centre, King's College London, United Kingdom
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17
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de Beurs E, Rademacher C, Blankers M, Peen J, Dekker J, Goudriaan A. Alcohol use disorder treatment via video conferencing compared with in-person therapy during COVID-19 social distancing : A non-inferiority comparison of three cohorts. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2023; 47:2208-2217. [PMID: 38226749 DOI: 10.1111/acer.15184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 08/28/2023] [Accepted: 08/28/2023] [Indexed: 01/17/2024]
Abstract
BACKGROUND Social distancing measures during the COVID-19 pandemic forced an abrupt transformation of treatment delivery for mental health care. In mid-March 2020, nearly all in-person contact was replaced with video conferencing. The pandemic thus offered a natural experiment and a unique opportunity to conduct an observational study of whether alcohol use disorder treatment through video conferencing is non-inferior to in-person treatment. METHODS In a large urban substance use disorder treatment center in the Netherlands, treatment evaluation is routine practice. Outcome data are regularly collected to support shared decision making and monitor patient progress. For this study, pre-test and post-test data on alcohol use (Measurements in the Addictions for Triage and Evaluation), psychopathology (Depression Anxiety Stress Scales), and quality of life (Manchester Short Assessment of Quality of Life) were used to compare outcomes of cognitive behavioral therapy treatment for three cohorts: patients who received treatment for a primary alcohol use disorder performed prior to (n = 628), partially during (n = 557), and entirely during (n = 653) the COVID-19 lockdown. RESULTS Outcome was similar across the three cohorts: No inferior outcomes were found for treatments that were conducted predominantly through video conferencing during lockdown or treatments that started in-person, but were continued through video conferencing, compared to in-person treatments that were conducted prior to COVID-19. The number of drop-outs were also similar between cohorts. However, there was a difference in average treatment intensity between cohorts, with treatment partially or fully conducted during the COVID-19 pandemic lasting longer. CONCLUSIONS Treatment for a primary alcohol use disorder, provided partially or predominantly through video conferencing during the COVID-19 pandemic resulted in abstinence rates and secondary outcomes similar to traditional in-person care, in spite of the potentially negative effects of the COVID-related lockdown measures themselves. These results from everyday clinical practice corroborate findings of randomized controlled studies and meta-analyses in which video conferencing appeared non-inferior to in-person care in clinical effectiveness.
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Affiliation(s)
- Edwin de Beurs
- Department of Clinical Psychology, University of Leiden, Leiden, The Netherlands
- Arkin GGZ, Amsterdam, The Netherlands
| | - Clara Rademacher
- Department of Clinical Psychology, University of Leiden, Leiden, The Netherlands
| | - Matthijs Blankers
- Arkin GGZ, Amsterdam, The Netherlands
- Department of Psychiatry, University of Amsterdam, Amsterdam, The Netherlands
- Trimbos Institute, Utrecht, The Netherlands
| | - Jaap Peen
- Arkin GGZ, Amsterdam, The Netherlands
| | - Jack Dekker
- Arkin GGZ, Amsterdam, The Netherlands
- Department of Clinical Psychology, Vrije Universiteit, Amsterdam, The Netherlands
| | - Anneke Goudriaan
- Arkin GGZ, Amsterdam, The Netherlands
- Amsterdam Institute for Addiction Research, Amsterdam, The Netherlands
- Department of Psychiatry, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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18
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Meier JV, Noel JA, Kaspar K. Understanding psychology students' perspective on video psychotherapy and their intention to offer it after graduation: a mixed-methods study. Front Psychol 2023; 14:1234167. [PMID: 37928577 PMCID: PMC10620503 DOI: 10.3389/fpsyg.2023.1234167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 09/27/2023] [Indexed: 11/07/2023] Open
Abstract
Introduction Video psychotherapy (VPT) demonstrated strong clinical efficacy in the past, with patients and psychotherapists expressing satisfaction with its outcomes. Despite this, VPT only gained full recognition from the German healthcare system during the COVID-19 pandemic. As society increasingly relies on new media, it seems likely that VPT will become even more relevant. Previous studies surveyed practicing psychotherapists and patients about advantages and disadvantages of VPT. In contrast, our approach targets a younger generation, specifically psychology students intending to become licensed practitioners after graduation. Methods Our mixed-methods study was conducted in an online survey format and had two main objectives. Firstly, we investigated which person-related variables are associated with psychology students' behavioral intention to offer VPT after graduation, using a multiple regression analysis. Secondly, we explored psychology students' perception of advantages and disadvantages of VPT and identified their desired learning opportunities regarding VPT in their study program, using qualitative content analysis. Results A sample of 255 psychology students participated. The multiple regression model explains 73% of inter-individual variance in the intention to offer VPT, with attitudes toward VPT showing the strongest relationship with intention to offer VPT. Expected usefulness, satisfaction with video conferencing, and subjective norm also showed significant relations. The students provided 2,314 statements about advantages, disadvantages, and desired learning opportunities, which we coded by means of three category systems. In terms of advantages, the most frequently mentioned categories were low inhibition threshold, flexibility in terms of location, and no need to travel. For disadvantages, the predominant categories included lack of closeness between patient and psychotherapist, lack of nonverbal cues, and problems with technology or internet connection. Regarding desired learning opportunities, training for technical skills, practical application through role-playing and self-experience, and general information about VPT were the most mentioned categories. In addition, we identified numerous other aspects related to these topics, reflecting a differentiated and balanced assessment of VPT. Discussion We discuss the theoretical and practical implications of our findings for training the next generation of psychotherapists and outline a specific five-step plan for integrating VPT into study programs.
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19
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Snoswell CL, Chelberg G, De Guzman KR, Haydon HH, Thomas EE, Caffery LJ, Smith AC. The clinical effectiveness of telehealth: A systematic review of meta-analyses from 2010 to 2019. J Telemed Telecare 2023; 29:669-684. [PMID: 34184580 DOI: 10.1177/1357633x211022907] [Citation(s) in RCA: 136] [Impact Index Per Article: 136.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION To promote telehealth implementation and uptake, it is important to assess overall clinical effectiveness to ensure any changes will not adversely affect patient outcomes. The last systematic literature review examining telehealth effectiveness was conducted in 2010. Given the increasing use of telehealth and technological developments in the field, a more contemporary review has been carried out. The aim of this review was to synthesise recent evidence associated with the clinical effectiveness of telehealth services. METHODS A systematic search of 'Pretty Darn Quick'-Evidence portal was carried out in November 2020 for systematic reviews on telehealth, where the primary outcome measure reported was clinical effectiveness. Due to the volume of telehealth articles, only systematic reviews with meta-analyses published between 2010 and 2019 were included in the analysis. RESULTS We found 38 meta-analyses, covering 10 medical disciplines: cardiovascular disease (n = 3), dermatology (n = 1), endocrinology (n = 13), neurology (n = 4), nephrology (n = 2), obstetrics (n = 1), ophthalmology (n = 1), psychiatry and psychology (n = 7), pulmonary (n = 4) and multidisciplinary care (n = 2). The evidence showed that for all disciplines, telehealth across a range of modalities was as effective, if not more, than usual care. DISCUSSION This review demonstrates that telehealth can be equivalent or more clinically effective when compared to usual care. However, the available evidence is very discipline specific, which highlights the need for more clinical effectiveness studies involving telehealth across a wider spectrum of clinical health services. The findings from this review support the view that in the right context, telehealth will not compromise the effectiveness of clinical care when compared with conventional forms of health service delivery.
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Affiliation(s)
- Centaine L Snoswell
- Centre for Online Health, The University of Queensland, Australia
- Centre for Health Services Research, The University of Queensland, Australia
| | - Georgina Chelberg
- Centre for Online Health, The University of Queensland, Australia
- Centre for Health Services Research, The University of Queensland, Australia
- Australian eHealth Research Centre, Commonwealth Scientific and Industrial Research Organisation, Australia
| | - Keshia R De Guzman
- Centre for Online Health, The University of Queensland, Australia
- Centre for Health Services Research, The University of Queensland, Australia
| | - Helen H Haydon
- Centre for Online Health, The University of Queensland, Australia
- Centre for Health Services Research, The University of Queensland, Australia
| | - Emma E Thomas
- Centre for Online Health, The University of Queensland, Australia
| | - Liam J Caffery
- Centre for Online Health, The University of Queensland, Australia
- Centre for Health Services Research, The University of Queensland, Australia
| | - Anthony C Smith
- Centre for Online Health, The University of Queensland, Australia
- Centre for Health Services Research, The University of Queensland, Australia
- University of Southern Denmark, Denmark
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20
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von Wirth E, Willems S, Döpfner M, Kohl LT. Effectiveness of videoconference-delivered psychotherapy for children, adolescents, and their parents: A meta-analysis of randomized controlled trials. J Telemed Telecare 2023:1357633X231199784. [PMID: 37715649 DOI: 10.1177/1357633x231199784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/18/2023]
Abstract
INTRODUCTION Over the last years, videoconference-delivered psychotherapy (VCP) has found its way into clinical practice. This meta-analysis is the first to evaluate the effectiveness of VCP for children and adolescents with a mental disorder and their parents. METHODS A systematic literature search was performed to identify randomized controlled trials (RCTs) that compared the effectiveness of VCP for youths with a mental disorder to a control condition. Twelve studies were included. Two reviewers independently extracted data and rated study quality. RESULTS Effect size estimates for measures of children's symptoms of mental disorders were large for comparison between VCP and waitlist (posttreatment: Hedges's g = -1.26, k = 5) and negligible for comparisons between VCP and in-person treatment (posttreatment: g = 0.00, k = 6; follow-up: g = -0.05, k = 3). Similarly, effect size estimates for measures of children's functional impairments were large for comparison between VCP and waitlist (posttreatment: g = -1.10, k = 3) and negligible for comparisons between VCP and in-person treatment (posttreatment: g = -0.23, k = 3; follow-up: g = 0.04, k = 2). VCP more effectively reduced symptoms in children with an internalizing disorder (g = -0.88, k = 5) compared to externalizing disorders (g = 0.25, k = 2) or tic disorders (g = -0.08, k = 3). DISCUSSION The results provide preliminary evidence that VCP is an effective treatment for youths with a mental disorder and their parents. VCP was equally effective as in-person treatment in reducing children's symptoms and functional impairments. Limitations include the limited number of RCTs and incomplete reporting of methodological features.
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Affiliation(s)
- Elena von Wirth
- School of Child and Adolescent Cognitive Behavior Therapy (AKiP), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Department of Clinical Child and Adolescent Psychology and Psychotherapy, University of Trier, Trier, Germany
| | - Sarah Willems
- School of Child and Adolescent Cognitive Behavior Therapy (AKiP), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Manfred Döpfner
- School of Child and Adolescent Cognitive Behavior Therapy (AKiP), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Lea Teresa Kohl
- School of Child and Adolescent Cognitive Behavior Therapy (AKiP), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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Laczkovics C, Blüml V, Kapusta N, Hoffmann-Lamplmair D, Casini E, Bazan M, Torres MAG, Lendvay J, Normandin L, Nowacki H, Snigur V, Doering S, Yeomans F, Clarkin J, Preti E. Videoconferencing psychotherapy from a psychodynamic point of view. A qualitative analysis. Front Psychiatry 2023; 14:1235478. [PMID: 37779629 PMCID: PMC10540621 DOI: 10.3389/fpsyt.2023.1235478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 08/28/2023] [Indexed: 10/03/2023] Open
Abstract
There is a growing interest in delivering videoconferencing psychotherapy (VCP) due to the enormous impact of the COVID-19 pandemic on our lives since the beginning of severe restrictions worldwide in March 2020. Scientific literature has provided interesting results about the transition to remote sessions and its implications, considering different psychotherapy orientations. Less is known about whether and how VCP affects psychodynamic psychotherapeutic approaches and reports on remote work with severe and complex mental health problems such as severe personality disorders are still scarce. The aim of the study was to examine the experiences of psychodynamic psychotherapists, mainly delivering Transference-Focused Psychotherapy (TFP), with the transition and delivery of VCP during the first wave of the COVID-19 pandemic. Four hundred seventy-nine licensed psychotherapists completed an online survey during the peak of the pandemic. Survey data were analyzed using qualitative analysis. Results are presented and discussed concerning advantages and disadvantages regarding the access to psychotherapy, the specificity of the online video setting, bodily aspects, the quality of the therapeutic relationship, the therapeutic process including technical aspects and therapist's experience. Furthermore, we analyzed and discussed the statements concerning transference and countertransference reactions differentiating between high-level borderline and neurotic patients and low-level borderline patients. Our results support the importance to identify patients who potentially benefit from VCP. Further research including more prospective randomized controlled trials are needed to investigate the therapeutic implications of the findings.
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Affiliation(s)
- Clarissa Laczkovics
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Victor Blüml
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Nestor Kapusta
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | | | - Erica Casini
- Department of Psychology, University of Milano-Bicocca, Milano, Italy
| | - Maria Bazan
- Polish Society for Psychodynamic Psychotherapy, Cracow Psychodynamic Center, Kraków, Poland
| | - Miguel Angel Gonzalez Torres
- Department of Neuroscience. University of the Basque Country, San Sebastian, Spain
- Department of Psychiatry, Basurto University Hospital, Bilbao, Spain
- CIBERSAM, Spanish Network of Research in Mental Health, Bilbao, Spain
- Biocruces-Bizkaia Research Institute, Barakaldo, Spain
| | - Judit Lendvay
- Personality Disorders Institute, Weill Cornell Medical College, White Plains, NY, United States
- Columbia Center for Psychoanalytic Training and Research, New York, NY, United States
| | - Lina Normandin
- École de Psychologie, Université Laval (Québec), Québec, QC, Canada
| | - Henryk Nowacki
- Polish Society for Psychodynamic Psychotherapy, Cracow Psychodynamic Center, Kraków, Poland
| | - Vladimir Snigur
- Russophone Society for the Transference Focused Psychotherapy, Moscow, Russia
| | - Stephan Doering
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Frank Yeomans
- Personality Disorders Institute, Weill Cornell Medical College, White Plains, NY, United States
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States
| | - John Clarkin
- Personality Disorders Institute, Weill Cornell Medical College, White Plains, NY, United States
| | - Emanuele Preti
- Department of Psychology, University of Milano-Bicocca, Milano, Italy
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22
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Romero V, Paxton A. Stage 2: Visual information and communication context as modulators of interpersonal coordination in face-to-face and videoconference-based interactions. Acta Psychol (Amst) 2023; 239:103992. [PMID: 37536011 DOI: 10.1016/j.actpsy.2023.103992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 06/23/2023] [Accepted: 07/21/2023] [Indexed: 08/05/2023] Open
Abstract
Interpersonal coordination of body movement-or similarity in patterning and timing of body movement between interaction partners-is well documented in face-to-face (FTF) conversation. Here, we investigated the degree to which interpersonal coordination is impacted by the amount of visual information available and the type of interaction conversation partners are having. To do so within a naturalistic context, we took advantage of the increased familiarity with videoconferencing (VC) platforms and with limited visual information in FTF conversation due to the COVID-19 pandemic. Pairs of participants communicated in one of three ways: FTF in a laboratory setting while socially distanced and wearing face masks; VC in a laboratory setting with a view of one another's full movements; or VC in a remote setting with a view of one another's face and shoulders. Each pair held three conversations: affiliative, argumentative, and cooperative task-based. We quantified interpersonal coordination as the relationship between the two participants' overall body movement using nonlinear time series analyses. Coordination changed as a function of the contextual constraints, and these constraints interacted with coordination patterns to affect subjective conversation outcomes. Importantly, we found patterns of results that were distinct from previous research; we hypothesize that these differences may be due to changes in the broader social context from COVID-19. Taken together, our results are consistent with a dynamical systems view of social phenomena, with interpersonal coordination emerging from the interaction between components, constraints, and history of the system.
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Affiliation(s)
- Veronica Romero
- Psychology Department, Colby College, Waterville, ME, USA; Davis Institute for Artificial Intelligence, Colby College, Waterville, ME, USA.
| | - Alexandra Paxton
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, USA; Center for the Ecological Study of Perception and Action, University of Connecticut, Storrs, CT, USA
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23
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Sousa J, Smith A, Richard J, Rabinowitz M, Raja P, Mehrotra A, Busch AB, Huskamp HA, Uscher-Pines L. Choosing Or Losing In Behavioral Health: A Study Of Patients' Experiences Selecting Telehealth Versus In-Person Care. Health Aff (Millwood) 2023; 42:1275-1282. [PMID: 37669481 PMCID: PMC10762624 DOI: 10.1377/hlthaff.2023.00487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/07/2023]
Abstract
It is not known how the growth of telehealth has affected patients' choice of visit modalities (telehealth versus in person). In 2023 we conducted a mixed-methods study that paired a nationally representative survey of 2,071 adults (including 571 who used behavioral health services) and semistructured interviews with twenty-six people with depression or bipolar disorder. We explored patients' experiences with visit modality selection and their agency in the decision. Approximately one-third of patients receiving therapy or medication visits reported that their clinicians did not offer both modalities. Thirty-two percent reported that they did not typically receive their preferred modality, and 45 percent did not believe that their clinician considered their modality preferences. Qualitative findings revealed that some clinicians did not elicit patients' modality preferences. Perceived lack of choice affected satisfaction and rapport with clinicians and encouraged some people to seek care elsewhere. These findings highlight trade-offs in policies to preserve patient choice and approaches that clinicians can take to identify and accommodate patients' preferences.
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Affiliation(s)
- Jessica Sousa
- Jessica Sousa , RAND Corporation, Boston, Massachusetts
| | - Andrew Smith
- Andrew Smith, Depression and Bipolar Support Alliance, Chicago, Illinois
| | | | | | - Pushpa Raja
- Pushpa Raja, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California
| | - Ateev Mehrotra
- Ateev Mehrotra, Harvard University and Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Alisa B Busch
- Alisa B. Busch, Harvard University and McLean Hospital, Belmont, Massachusetts
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24
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Békés V, Aafjes-van Doorn K, Luo X, Balarajan S, Hopwood CJ. Mastery of teletherapy is related to better therapeutic relationship and presence in teletherapy: the development of the teletherapy intervention scale. Front Psychol 2023; 14:1206960. [PMID: 37599754 PMCID: PMC10433166 DOI: 10.3389/fpsyg.2023.1206960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 07/11/2023] [Indexed: 08/22/2023] Open
Abstract
Introduction Providing teletherapy requires a unique therapeutic approach and mastery of the teletherapy context. We aimed to develop a self-report scale for therapeutic interventions pertinent to teletherapy, and to examine its relationship with teletherapy process variables, and therapists' attitudes towards teletherapy technology. Method A total of 839 therapists participated in a survey study that included standardized measures of therapeutic process (real relationship, working alliance, therapeutic presence), attitudes towards and intention to use teletherapy in the future, and a list of 13 teletherapy intervention items that we hypothesized to be specific to the teletherapy format. Results Twelve of the 13 teletherapy intervention items loaded on one factor, with good reliability. The 12-item Teletherapy Intervention Scale was positively related to working alliance, the real relationship, therapeutic presence in teletherapy sessions, as well as to positive attitudes towards teletherapy and intention to use teletherapy in the future. Discussion Aspects specific to the practice of teletherapy may be successfully captured by a self-report scale, and adequately navigating the challenges and opportunities of teletherapy might enhance the therapeutic process. Further studies are needed to provide additional validation of the scale, and in how to best use this Teletherapy Intervention Scale in research and clinical training.
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Affiliation(s)
- Vera Békés
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, United States
| | | | - Xiaochen Luo
- Department of Counseling Psychology, Santa Clara University, Santa Clara, CA, United States
| | - Sanjeev Balarajan
- Department of Counseling Psychology, Santa Clara University, Santa Clara, CA, United States
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25
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Adams L, Adamo N, Hollocks MJ, Watson J, Brewster A, Valmaggia L, Jewitt E, Edwards J, Krisson M, Simonoff E. Autistic young people's experiences of remote psychological interventions during COVID-19. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2023; 27:1616-1627. [PMID: 36645009 PMCID: PMC9845848 DOI: 10.1177/13623613221142730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
LAY ABSTRACT Recently, therapy has been delivered at a distance (i.e. remotely) to help control the spread of coronavirus. Clinicians have voiced concerns that remote delivery is unsuitable for certain individuals, including those who are autistic, but they have also highlighted potential benefits for autistic individuals. Benefits include some individuals feeling more comfortable receiving therapy at home. This is the first study to interview autistic individuals about their experience of remote therapy. Participants were six young people aged 15-18 years and eight clinicians. Participants described their experience of remote delivery, including challenges, benefits, and suggestions. Most of these supported previous research findings, but some were new or provided further insight into those already identified. A newly identified challenge was knowing online social etiquette. All participants found aspects of the experience challenging, but all identified benefits and most voiced that remote sessions should be offered to young people. Participants further identified individual characteristics that may make someone less suited to remote delivery (e.g. shyness). They also identified ways of making the experience of remote delivery easier (e.g. sitting with a pet). Young people's and clinicians' views were similar overall, with only subtle differences. For example, young people uniquely voiced that remote delivery was similar to in-person, that benefits were hard to identify, and provided distinct reasons for the social interaction feeling less intense remotely. Findings may be used to improve remote delivery, for guiding future research, and as a case for continuing to offer it to those who may most benefit.
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Affiliation(s)
- Lucy Adams
- King’s College London, UK
- South London and Maudsley NHS Foundation Trust, UK
| | - Nicoletta Adamo
- King’s College London, UK
- South London and Maudsley NHS Foundation Trust, UK
| | - Matthew J Hollocks
- King’s College London, UK
- South London and Maudsley NHS Foundation Trust, UK
| | | | | | - Lucia Valmaggia
- King’s College London, UK
- South London and Maudsley NHS Foundation Trust, UK
| | - Emma Jewitt
- South London and Maudsley NHS Foundation Trust, UK
| | | | | | - Emily Simonoff
- King’s College London, UK
- South London and Maudsley NHS Foundation Trust, UK
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26
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Swartz HA, Bylsma LM, Fournier JC, Girard JM, Spotts C, Cohn JF, Morency LP. Randomized trial of brief interpersonal psychotherapy and cognitive behavioral therapy for depression delivered both in-person and by telehealth. J Affect Disord 2023; 333:543-552. [PMID: 37121279 PMCID: PMC10228570 DOI: 10.1016/j.jad.2023.04.092] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 04/12/2023] [Accepted: 04/24/2023] [Indexed: 05/02/2023]
Abstract
BACKGROUND Expert consensus guidelines recommend Cognitive Behavioral Therapy (CBT) and Interpersonal Psychotherapy (IPT), interventions that were historically delivered face-to-face, as first-line treatments for Major Depressive Disorder (MDD). Despite the ubiquity of telehealth following the COVID-19 pandemic, little is known about differential outcomes with CBT versus IPT delivered in-person (IP) or via telehealth (TH) or whether working alliance is affected. METHODS Adults meeting DSM-5 criteria for MDD were randomly assigned to either 8 sessions of IPT or CBT (group). Mid-trial, COVID-19 forced a change of therapy delivery from IP to TH (study phase). We compared changes in Hamilton Rating Scale for Depression (HRSD-17) and Working Alliance Inventory (WAI) scores for individuals by group and phase: CBT-IP (n = 24), CBT-TH (n = 11), IPT-IP (n = 25) and IPT-TH (n = 17). RESULTS HRSD-17 scores declined significantly from pre to post treatment (pre: M = 17.7, SD = 4.4 vs. post: M = 11.7, SD = 5.9; p < .001; d = 1.45) without significant group or phase effects. WAI scores did not differ by group or phase. Number of completed therapy sessions was greater for TH (M = 7.8, SD = 1.2) relative to IP (M = 7.2, SD = 1.6) (Mann-Whitney U = 387.50, z = -2.24, p = .025). LIMITATIONS Participants were not randomly assigned to IP versus TH. Sample size is small. CONCLUSIONS This study provides preliminary evidence supporting the efficacy of both brief IPT and CBT, delivered by either TH or IP, for depression. It showed that working alliance is preserved in TH, and delivery via TH may improve therapy adherence. Prospective, randomized controlled trials are needed to definitively test efficacy of brief IPT and CBT delivered via TH versus IP.
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Affiliation(s)
- Holly A Swartz
- University of Pittsburgh, Pittsburgh, PA, United States of America.
| | - Lauren M Bylsma
- University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Jay C Fournier
- The Ohio State University, Columbus, OH, United States of America
| | | | - Crystal Spotts
- University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Jeffrey F Cohn
- University of Pittsburgh, Pittsburgh, PA, United States of America
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27
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Shaker AA, Austin SF, Storebø OJ, Schaug JP, Ayad A, Sørensen JA, Tarp K, Bechmann H, Simonsen E. Psychiatric Treatment Conducted via Telemedicine Versus In-Person Modality in Posttraumatic Stress Disorder, Mood Disorders, and Anxiety Disorders: Systematic Review and Meta-Analysis. JMIR Ment Health 2023; 10:e44790. [PMID: 37277113 PMCID: PMC10357375 DOI: 10.2196/44790] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 04/28/2023] [Accepted: 05/22/2023] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND Telemedicine has played a vital role in providing psychiatric treatment to patients during the rapid transition of services during the COVID-19 pandemic. Furthermore, the use of telemedicine is expected to expand within the psychiatric field. The efficacy of telemedicine is well described in scientific literature. However, there is a need for a comprehensive quantitative review that analyzes and considers the different clinical outcomes and psychiatric diagnoses. OBJECTIVE This paper aimed to assess whether individual psychiatric outpatient treatment for posttraumatic stress disorder, mood disorders, and anxiety disorders in adults using telemedicine is equivalent to in-person treatment. METHODS A systematic search of randomized controlled trials was conducted using recognized databases for this review. Overall, 4 outcomes were assessed: treatment efficacy, levels of patient satisfaction, working alliance, and attrition rate. The inverse-variance method was used to summarize the effect size for each outcome. RESULTS A total of 7414 records were identified, and 20 trials were included in the systematic review and meta-analysis. The trials included posttraumatic stress disorder (9 trials), depressive disorder (6 trials), a mix of different disorders (4 trials), and general anxiety disorder (1 trial). Overall, the analyses yielded evidence that telemedicine is comparable with in-person treatment regarding treatment efficacy (standardized mean difference -0.01, 95% CI -0.12 to 0.09; P=.84; I2=19%, 17 trials, n=1814), patient satisfaction mean difference (-0.66, 95% CI -1.60 to 0.28; P=.17; I2=44%, 6 trials, n=591), and attrition rates (risk ratio 1.07, 95% CI 0.94-1.21; P=.32; I2=0%, 20 trials, n=2804). The results also indicated that the working alliance between telemedicine and in-person modalities was comparable, but the heterogeneity was substantial to considerable (mean difference 0.95, 95% CI -0.47 to 2.38; P=.19; I2=75%, 6 trials, n=539). CONCLUSIONS This meta-analysis provided new knowledge on individual telemedicine interventions that were considered equivalent to in-person treatment regarding efficacy, patient satisfaction, working alliance, and attrition rates across diagnoses. The certainty of the evidence regarding efficacy was rated as moderate. Furthermore, high-quality randomized controlled trials are needed to strengthen the evidence base for treatment provided via telemedicine in psychiatry, particularly for personality disorders and a range of anxiety disorders where there is a lack of studies. Individual patient data meta-analysis is suggested for future studies to personalize telemedicine. TRIAL REGISTRATION PROSPERO International Prospective Register of Systematic Reviews CRD42021256357; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=256357.
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Affiliation(s)
- Ali Abbas Shaker
- Psychiatric Department, Region Zealand Psychiatry, Psychiatric Research Unit, Slagelse, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Stephen F Austin
- Psychiatric Department, Region Zealand Psychiatry, Psychiatric Research Unit, Slagelse, Denmark
- Department of Psychology, University of Southern Denmark Faculty of Health Sciences, Odense, Denmark
| | - Ole Jakob Storebø
- Psychiatric Department, Region Zealand Psychiatry, Psychiatric Research Unit, Slagelse, Denmark
- Department of Psychology, University of Southern Denmark Faculty of Health Sciences, Odense, Denmark
| | - Julie Perrine Schaug
- Psychiatric Department, Region Zealand Psychiatry, Psychiatric Research Unit, Slagelse, Denmark
| | - Alaa Ayad
- Psychiatric Department, Region Zealand Psychiatry, Psychiatric Research Unit, Slagelse, Denmark
| | - John Aasted Sørensen
- Department of Engineering Technology and Didactics, Research unit: AI, Mathematics and Software, Technical University of Denmark, Ballerup, Denmark
| | - Kristine Tarp
- Research Unit for Digital Psychiatry, Mental Health Services in the Region of Southern Denmark, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Henrik Bechmann
- Department of Engineering Technology and Didactics, Research unit: AI, Mathematics and Software, Technical University of Denmark, Ballerup, Denmark
| | - Erik Simonsen
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Mental Health Services East, Copenhagen University Hospital - Psychiatry Region Zealand, Roskilde, Denmark
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28
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Rutkowska E, Furmańska J, Lane H, Marques CC, Martins MJ, Sahar NU, Meixner J, Tullio V, Argo A, Bermeo Barros DM. Determinants of psychotherapists' attitudes to online psychotherapy. Front Psychiatry 2023; 14:1196907. [PMID: 37426099 PMCID: PMC10324565 DOI: 10.3389/fpsyt.2023.1196907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 06/05/2023] [Indexed: 07/11/2023] Open
Abstract
Introduction Online psychotherapy is a form of work that is becoming more and more popular. Public health problems, such as COVID-19, forced mental health professionals and patients to incorporate new methodologies such as the use of electronic media and internet to provide follow-up, treatment and also supervision. The aim of this study was to investigate which factors shape the therapists' attitudes toward online psychotherapy during a pandemic taking into account: (1) attitudes toward the COVID-19 pandemic (fear of contagion, pandemic fatigue, etc.), (2) personal characteristics of the psychotherapists (age, gender, feeling of efficacy, anxiety, depression, etc.), and (3) characteristics of the psychotherapeutic practice (guideline procedure, client age group, professional experience, etc). Materials and methods Study participants were 177 psychotherapists from four European countries: Poland (n = 48), Germany (n = 44), Sweden (n = 49), and Portugal (n = 36). Data were collected by means of an individual online survey through the original questionnaire and the standardized scales: a modified version of the Attitudes toward Psychological Online Interventions Scale (APOI), Fear of Contagion by COVID-19 Scale (FCS COVID-19), Pandemic Fatigue Scale (PFS), Hospital Anxiety and Depression Scale (HADS), Social Support Questionnaire (F-SozU K-14), and the Sense of Efficiency Test (SET). Results Determinants that impacted psychotherapists' attitudes toward online therapy were: COVID-19 belief in prevention-keeping distance and hand disinfection, pandemic behavioral fatigue, previous online therapy experience (including voice call), working with youth and adults. Our study showed that belief in the sense of prevention in the form of taking care of hand disinfection before the session, pandemic behavioral fatigue and experience in working with adults were significant predictors of negative attitudes of therapists toward online psychological interventions. On the other hand, belief in the sense of prevention in the form of keeping distance during the session had a positive effect on general attitudes toward therapy conducted via the internet. Discussion The online therapy boom during the COVID-19 pandemic has spawned a powerful tool for psychotherapists. More research in this area and training of psychotherapists are needed for online psychological interventions to become an effective therapy format that is accepted by patients and therapists alike.
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Affiliation(s)
- Emilia Rutkowska
- Institute of Psychology, University of Szczecin, Szczecin, Poland
| | - Joanna Furmańska
- Institute of Psychology, University of Szczecin, Szczecin, Poland
| | - Hakan Lane
- Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Brandenburg, Germany
| | - Cristiana C. Marques
- Center for Research in Neuropsychology and Cognitive and Behavioral Intervention (CINEICC), Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
| | - Maria João Martins
- Center for Research in Neuropsychology and Cognitive and Behavioral Intervention (CINEICC), Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
- University of Coimbra Health Services, University of Coimbra, Coimbra, Portugal
| | - Najam us Sahar
- Fatima Jinnah Women University, Rawalpindi, Punjab, Pakistan
| | - Johannes Meixner
- Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Brandenburg, Germany
| | - Valeria Tullio
- Department of Health Promotion, Maternal and Child Care, “G. D’Alessandro”, University of Palermo, Palermo, Sicily, Italy
| | - Antonina Argo
- Department of Health Promotion, Maternal and Child Care, “G. D’Alessandro”, University of Palermo, Palermo, Italy, University of Palermo, Palermo, Sicily, Italy
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Hilty DM, Groshong LW, Coleman M, Maheu MM, Armstrong CM, Smout SA, Crawford A, Drude KP, Krupinski EA. Best Practices for Technology in Clinical Social Work and Mental Health Professions to Promote Well-being and Prevent Fatigue. CLINICAL SOCIAL WORK JOURNAL 2023; 51:1-35. [PMID: 37360756 PMCID: PMC10233199 DOI: 10.1007/s10615-023-00865-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 04/16/2023] [Indexed: 06/28/2023]
Abstract
The shift to communication technologies during the pandemic has had positive and negative effects on clinical social worker practice. Best practices are identified for clinical social workers to maintain emotional well-being, prevent fatigue, and avoid burnout when using technology. A scoping review from 2000 to 21 of 15 databases focused on communication technologies for mental health care within four areas: (1) behavioral, cognitive, emotional, and physical impact; (2) individual, clinic, hospital, and system/organizational levels; (3) well-being, burnout, and stress; and (4) clinician technology perceptions. Out of 4795 potential literature references, full text review of 201 papers revealed 37 were related to technology impact on engagement, therapeutic alliance, fatigue and well-being. Studies assessed behavioral (67.5%), emotional (43.2%), cognitive (57.8%), and physical (10.8%) impact at the individual (78.4%), clinic (54.1%), hospital (37.8%) and system/organizational (45.9%) levels. Participants were clinicians, social workers, psychologists, and other providers. Clinicians can build a therapeutic alliance via video, but this requires additional skill, effort, and monitoring. Use of video and electronic health records were associated with clinician physical and emotional problems due to barriers, effort, cognitive demands, and additional workflow steps. Studies also found high user ratings on data quality, accuracy, and processing, but low satisfaction with clerical tasks, effort required and interruptions. Studies have overlooked the impact of justice, equity, diversity and inclusion related to technology, fatigue and well-being, for the populations served and the clinicians providing care. Clinical social workers and health care systems must evaluate the impact of technology in order to support well-being and prevent workload burden, fatigue, and burnout. Multi-level evaluation and clinical, human factor, training/professional development and administrative best practices are suggested.
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Affiliation(s)
- Donald M. Hilty
- Department of Psychiatry & Behavioral Sciences, UC Davis, 2230 Stockton Boulevard, Sacramento, CA 95817 USA
| | | | - Mirean Coleman
- National Association of Social Workers, Washington, DC USA
| | - Marlene M. Maheu
- Coalition for Technology in Behavioral Sciences, Telebehavioral Health Institute, Inc, 5173 Waring Road #124, San Diego, CA 92120 USA
| | - Christina M. Armstrong
- Department of Veterans Affairs, Connected Health Implementation Strategies, Office of Connected Care, Office of Health Informatics, U.S., 810 Vermont Avenue NW, Washington, DC 20420 USA
| | - Shelby A. Smout
- Virginia Commonwealth University, 3110 Kensington Ave Apt 3, Richmond, VA 23221 USA
| | - Allison Crawford
- Ontario Mental Health at CAMH, Toronto, Canada
- University of Toronto, Toronto, Canada
- Suicide Prevention Service, 1001 Queen St West, Toronto, ON M6J 1H4 Canada
| | - Kenneth P. Drude
- Coalition Technology in Behavioral Science, 680 E. Dayton Yellow Springs Rd, Fairborn, OH 45324 USA
| | - Elizabeth A. Krupinski
- Department of Radiology & Imaging Sciences, Emory University, 1364 Clifton Rd NE, Atlanta, GA 30322 USA
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30
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Abstract
OBJECTIVE The Association of American Medical Colleges (AAMC) has recommended that the provision of telemedicine services become an entrustable professional activity (EPA). Given its increased scope, medical student comfort with telemedicine was explored. METHODS An institutional review board-approved 17-question, anonymous voluntary survey was created based on the AAMC's EPAs and administered to students at Northeast Ohio Medical University across 4 weeks. The primary outcome of this study was to assess medical students' self-reported telemedicine comfort levels. RESULTS The response rate was 141 students (22%). At least 80% of students believed that they were able to gather essential and accurate patient information, counsel patients and families, and communicate effectively across a broad range of social, economic, and cultural backgrounds using telemedicine. In total, 57% and 53% of students, respectively, believed that they were able to gather information and diagnose patients using telemedicine as well as they did in person, 38% of respondents believed that their patient's health outcome was the same via telemedicine or in-person visits, and 74% of respondents wished that telemedicine was formally taught in school. Most of the students believed they could effectively gather essential information and counsel patients via telemedicine, but there was a notable decrease in confidence for medical students when comparing telemedicine and in-person care directly. CONCLUSIONS Despite the EPAs created by the AAMC, students did not self-report the same comfort level with telemedicine as they had with in-person patient visits. There are opportunities for improvement in the telemedicine medical school curriculum.
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Affiliation(s)
- Akanksha Dadlani
- From the Department of Psychiatry, University of Cincinnati Medical Center, Cincinnati, Ohio
| | - Simone Bernstein
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
| | - Randon Welton
- Department of Psychiatry, Northeast Ohio Medical University, Rootstown, Ohio
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31
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van Rooij FB, Weeland J, Thonies C. Youth care in time of COVID-19: Experiences of professionals and adolescent clients with telehealth. CHILDREN AND YOUTH SERVICES REVIEW 2023; 148:106874. [PMID: 36817405 PMCID: PMC9925417 DOI: 10.1016/j.childyouth.2023.106874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/18/2023] [Accepted: 02/08/2023] [Indexed: 05/07/2023]
Abstract
Measures aimed at preventing the COVID-19 virus from spreading restricted all aspects of public life, including possibilities for meeting in-person. Youth care professionals were forced to turn to telehealth tools, such as video calling and e-health methods, to be able to continue support and treatment of children, adolescents, caregivers, and families. This study consists of two qualitative interview studies on the experiences with and transition to telehealth during COVID-19: (1) interviews with youth care professionals (N = 20), and (2) interviews with adolescents who used mental health care support (N = 14). We specifically asked participants about five themes which were selected based on pre-COVID literature on telehealth: (1) tools (i.e., which programs are being used), (2) privacy, (3) methods (i.e., what was the same and what was different compared to in-person sessions), (4) relationship/therapeutic alliance, and (5) effectiveness (i.e., what was their impression of effectiveness of telehealth). The majority of professionals reported that they had very little to no experience with telehealth prior to the pandemic. Both professionals and adolescent clients mentioned benefits and limitations of telehealth. On several themes professionals and adolescent clients mentioned similar barriers in the transition to telehealth during COVID such as limitations of the available hard- and software (theme 1: tools); forced changes in the content and methods of the sessions (theme 3: methods); and difficulties with non-verbal communication (theme 4: alliance). However, whereas most professionals expressed the intention to keep using several aspects of telehealth after restrictions due to COVID are lifted, most adolescent clients expressed they see telehealth as a temporary solution and prefer meeting professionals in person. Their experiences and the barriers and enabling aspects they mentioned may provide important insights in the acceptability and usability of telehealth for youth care organizations, youth care professionals, researchers and higher educational training programs.
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Affiliation(s)
- Floor B van Rooij
- Research Institute of Child Development and Education, University of Amsterdam, the Netherlands
| | - Joyce Weeland
- Erasmus School of Social and Behavioural Sciences, Erasmus University Rotterdam, the Netherlands
| | - Carlo Thonies
- Herlaarhof, Centre of Child and Adolescent Psychiatry, Reinier van Arkel, the Netherlands
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32
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von Wirth E, Meininger L, Adam J, Woitecki K, Treier AK, Döpfner M. Satisfaction with videoconference-delivered CBT provided as part of a blended treatment approach for children and adolescents with mental disorders and their families during the COVID-19 pandemic: A follow-up survey among caregivers and therapists. J Telemed Telecare 2023:1357633X231157103. [PMID: 36883237 PMCID: PMC9996161 DOI: 10.1177/1357633x231157103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 01/29/2023] [Indexed: 03/09/2023]
Abstract
INTRODUCTION Psychotherapy delivered via videoconferencing (teletherapy) was a well-accepted treatment option for children and adolescents during the early phases of the COVID-19 pandemic. Information on the long-term satisfaction with teletherapy in routine clinical practice is missing. METHODS Caregivers (parents) and psychotherapists of n = 228 patients (4-20 years) treated in a university outpatient clinic completed a follow-up survey on satisfaction with videoconference-delivered cognitive-behavioral treatment (CBT). The follow-up survey (T2) was conducted about 1 year after initial assessment of treatment satisfaction in 2020 (T1). RESULTS At follow up, therapists reported that 79% of families had received teletherapy as part of a blended treatment approach including in-person and videoconference delivery of CBT. Wilcoxon tests revealed that satisfaction with teletherapy was stable over time. In addition, parent ratings of the impact of teletherapy on treatment satisfaction and the therapeutic relationship did not change over time. Therapists' ratings of the impact of teletherapy on the therapeutic relationship with the caregiver were more negative at T2 compared to T1. Satisfaction with teletherapy was higher for patients with less pandemic-related stress, less externalizing behavior problems, and older age (all r < .35). CONCLUSION The high level of satisfaction with teletherapy for children and adolescents treated in routine clinical practice reported in 2020 was maintained after social distancing regulations were eased in 2021. Teletherapy provided as part of a blended treatment approach is a well-accepted method of treatment delivery for youths with mental health problems. The study was registered in the German Clinical Trials Register (DRKS00028639).
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Affiliation(s)
- Elena von Wirth
- School of Child and Adolescent Cognitive Behavior Therapy (AKiP), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Lea Meininger
- School of Child and Adolescent Cognitive Behavior Therapy (AKiP), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Julia Adam
- School of Child and Adolescent Cognitive Behavior Therapy (AKiP), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Katrin Woitecki
- School of Child and Adolescent Cognitive Behavior Therapy (AKiP), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Anne-Katrin Treier
- School of Child and Adolescent Cognitive Behavior Therapy (AKiP), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Manfred Döpfner
- School of Child and Adolescent Cognitive Behavior Therapy (AKiP), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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Bechtold S, Hall M, Scherner PV, Kaven L, Rubel J. [Therapists' Perspectives on Changes in the Therapeutic Relationship after Switching from in-Person to Online Video Therapy Due to Corona: A Qualitative Analysis]. Psychother Psychosom Med Psychol 2023; 73:221-230. [PMID: 36878308 DOI: 10.1055/a-2017-5338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Abstract
OBJECTIVE The aim of this study was to investigate the extent to which the therapeutic relationship changed as a result of the COVID-19-related switch from face-to-face to video therapy. METHOD Twenty-one psychotherapists, who had changed the setting of therapy from face-to-face to video therapy were interviewed. The interviews were then transcribed, coded and superordinate themes were created in the context of a qualitative analysis. RESULTS More than half of the therapists reported that the therapeutic relationship with their patients remained stable. In addition, the majority of therapists described uncertainties in dealing with and responding to non-verbal signals, as well as maintaining an appropriate distance to their patients. Overall, both an improvement and a deterioration of the therapeutic relationship was reported. DISCUSSION The stability of the therapeutic relationship was mainly attributed to the therapists' previous face-to-face contact with their patients. The uncertainties expressed could be interpreted as risk factors for the therapeutic relationship. Although the sample represented only a small portion of working therapists, the findings from this study represent an important milestone in understanding how psychotherapy has changed as a result of the COVID-19 pandemic. CONCLUSION The therapeutic relationship remained stable despite the change from face-to-face to video therapy.
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Affiliation(s)
- Sara Bechtold
- Abteilung für Psychotherapieforschung, Justus Liebig Universität Giessen
| | - Mila Hall
- Abteilung für Psychotherapieforschung, Justus Liebig Universität Giessen
| | | | - Leonie Kaven
- Professur für Klinische Psychologie und Psychotherapie, Universität Greifswald
| | - Julian Rubel
- Abteilung für Psychotherapieforschung, Justus Liebig Universität Giessen
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Schein SS, Roben CKP, Costello AH, Dozier M. Assessing Changes in Parent Sensitivity in Telehealth and Hybrid Implementation of Attachment and Biobehavioral Catch-Up During the COVID-19 Pandemic. CHILD MALTREATMENT 2023; 28:24-33. [PMID: 35081800 PMCID: PMC8841399 DOI: 10.1177/10775595211072516] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
During the COVID-19 pandemic, home visiting services for families with young children pivoted to continue providing services virtually. One such service was Attachment and Biobehavioral Catch-up (ABC), a brief prevention/intervention program targeting increased parental sensitivity. 70 families participated in a sensitivity assessment before and after receiving ABC. Forty-three families received the program fully through telehealth, and 27 families received the program through an in-person/telehealth hybrid format. Parent sensitivity was assessed pre- and post-intervention, and results suggested that when ABC was delivered through a telehealth or hybrid format, parents showed increased following the lead and decreased intrusiveness from pre- to post-intervention, with moderate effect sizes. Ongoing supervision in the model, weekly fidelity maintenance checks, and the flexibility of families and parent coaches likely contributed to the maintenance of significant change in parental sensitivity from pre- to post-intervention during the move from face-to-face home visiting to the provision of virtual services.
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Affiliation(s)
- Stevie S. Schein
- Department of Psychological and Brain Sciences, University of Delaware, Newark, DE, USA
| | - Caroline K. P. Roben
- Department of Psychological and Brain Sciences, University of Delaware, Newark, DE, USA
| | - Amanda H. Costello
- Department of Psychological and Brain Sciences, University of Delaware, Newark, DE, USA
| | - Mary Dozier
- Department of Psychological and Brain Sciences, University of Delaware, Newark, DE, USA
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Farrer LM, Clough B, Bekker MJ, Calear AL, Werner-Seidler A, Newby JM, Knott V, Gooding P, Reynolds J, Brennan L, Batterham PJ. Telehealth use by mental health professionals during COVID-19. Aust N Z J Psychiatry 2023; 57:230-240. [PMID: 35360958 PMCID: PMC10080222 DOI: 10.1177/00048674221089229] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To examine and describe telehealth use and attitudes among mental health professionals in Australia and New Zealand during the initial stages of the COVID-19 pandemic. METHODS Participants completed a brief online survey between May and July 2020. Participants were recruited via peak and professional organisations and through psychology-focused social media groups and networks. The survey examined frequency of telehealth use, reasons for non-use, telehealth modalities, prior use, attitudes towards use, plans for future use, and training, information or resource needs. RESULTS A total of 528 professionals (85.2% female) participated in the survey, of which 98.9% reported using telehealth and 32.2% reported using telehealth exclusively. Respondents were less likely to use telehealth if they worked with clients experiencing complex issues (e.g. trauma), had more hours of weekly client contact, had a choice about whether to use telehealth or felt less positive about using technology. Respondents were more likely to hold positive views towards telehealth if they were female, had used online programmes with clients previously, were frequent telehealth users and were comfortable using technology. Participants expressed mixed views on client safety and the impact of telehealth on therapeutic process and effectiveness. CONCLUSION Telehealth has a clear and ongoing role within mental healthcare and there is a need for strong guidance for professionals on how to manage client risk, privacy, security and adapt therapy for delivery via telehealth. In particular, there is a need for individual-, organisational-, professional- and policy-level responses to ensure that telehealth remains a viable and effective healthcare medium into the future.
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Affiliation(s)
- Louise M Farrer
- Centre for Mental Health Research, The Australian National University, Acton, ACT, Australia
| | - Bonnie Clough
- School of Applied Psychology, Griffith University, Southport, QLD, Australia
| | | | - Alison L Calear
- Centre for Mental Health Research, The Australian National University, Acton, ACT, Australia
| | | | - Jill M Newby
- Black Dog Institute, University of New South Wales, Sydney, NSW, Australia.,School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Vikki Knott
- Australian College of Applied Psychology, Brisbane, QLD, Australia
| | - Piers Gooding
- Melbourne Law School, The University of Melbourne, Carlton, VIC, Australia
| | - Julia Reynolds
- Research School of Psychology, The Australian National University, Canberra, ACT, Australia
| | - Leah Brennan
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
| | - Philip J Batterham
- Centre for Mental Health Research, The Australian National University, Acton, ACT, Australia
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Abstract
Telemental health-the use of videoconferencing or audio only (telephone) in mental health care-has accelerated tremendously since the start of the covid-19 pandemic. Meta-analyses have examined the reliability (ie, concordance) of assessment and the efficacy/effectiveness of telemental health compared with in-person care. Results indicate that telemental health assessment and clinical outcomes are similar compared with in-person care but there is much unexplained variability, as well as evidence that patient clinical and demographic characteristics can influence these findings. Further, gaps exist in the literature regarding specific patient populations (eg, psychotic disorders, children/adolescents), treatment modalities (eg, group therapy), audio only telemedicine, and hybrid care that mixes in-person with telemental health care. These gaps provide important directions for the next generation of telemental health research. Comprehensive clinical guidelines from mental health organizations are available to telemental health practitioners and focus on five content themes: legal and regulatory issues, clinical considerations, standard operating procedures and protocols, technical requirements, and considerations of specific populations and settings.
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Affiliation(s)
| | - Alisa B Busch
- McLean Hospital, Harvard Medical School, Belmont, MA
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Jerkku M, Nordin J, Kaiser N. Emotional activation in video conferences equals that in in person meetings. Digit Health 2023; 9:20552076231183551. [PMID: 37361443 PMCID: PMC10286213 DOI: 10.1177/20552076231183551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 06/05/2023] [Indexed: 06/28/2023] Open
Abstract
Objective The purpose of this study was to increase our understanding of VCPs' impact on the therapeutic factor emotion processing by investigating possible differences in emotional activation during autobiographical recall in VCPs and in person. Methods We recruited 30 adult participants aged 21-53 (M = 26.50, SD = 6.68) with no current psychiatric diagnoses to join a controlled experiment. All participants completed two relaxation sessions and two autobiographical recall sessions. Each type of session was delivered once over a VCP and once in person. Emotional activation was measured by heart rate, skin conductance and self-assessment of affects during each session. Results No significant differences in activation during autobiographical recall between VCP and in person. Conclusions This result may indicate the viability of VCPs for work with emotion processing. We discuss the results in light of clients' and therapists' concerns about using VCPs in emotional work, with the caution that further practical implications should be considered.
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Affiliation(s)
| | - Jonas Nordin
- Department of Psychology, Umeå University, Umeå, Sweden
| | - Niclas Kaiser
- Department of Psychology, Umeå University, Umeå, Sweden
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38
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[Video-based psychotherapy: current framework conditions, developments, and recommendations for practical implementation]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2023; 66:154-159. [PMID: 36648497 PMCID: PMC9843682 DOI: 10.1007/s00103-022-03644-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 12/06/2022] [Indexed: 01/18/2023]
Abstract
Video-based psychotherapy is a digital way to deliver psychotherapeutic treatment when traditional on-site psychotherapy cannot be provided due to structural barriers, such as those related to the COVID-19 pandemic. The use of this digital approach has proven to be both effective and accepted among therapists and patients. Legal frameworks for German therapists and recommendations for practical implementation are summarized in this article.
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Negev M, Magal T, Kaphzan H. Attitudes of psychiatrists toward telepsychiatry: A policy Delphi study. Digit Health 2023; 9:20552076231177132. [PMID: 37312951 PMCID: PMC10259121 DOI: 10.1177/20552076231177132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 05/04/2023] [Indexed: 06/15/2023] Open
Abstract
Objectives To delineate areas of consensus and disagreements among practicing psychiatrists from various levels of clinical experience, hierarchy and organizations, and to test their ability to converge toward agreement, which will enable better integration of telepsychiatry into mental health services. Methods To study attitudes of Israeli public health psychiatrists, we utilized a policy Delphi method, during the early stages of the COVID pandemic. In-depth interviews were conducted and analyzed, and a questionnaire was generated. The questionnaire was disseminated amongst 49 psychiatrists, in two succeeding rounds, and areas of consensus and controversies were identified. Results Psychiatrists showed an overall consensus regarding issues of economic and temporal advantages of telepsychiatry. However, the quality of diagnosis and treatment and the prospect of expanding the usage of telepsychiatry to normal circumstances-beyond situations of pandemic or emergency were disputed. Nonetheless, efficiency and willingness scales slightly improved during the 2nd round of the Delphi process. Prior experience with telepsychiatry had a strong impact on the attitude of psychiatrists, and those who were familiar with this practice were more favorable toward its usage in their clinic. Conclusions We have delineated experience as a major impact on the attitudes toward telepsychiatry and the willingness for its assimilation in clinical practice as a legitimate and trustworthy method. We have also observed that the organizational affiliation significantly affected psychiatrists' attitude, when those working at local clinics were more positive toward telepsychiatry compared with employees of governmental institutions. This might be related to experience and differences in organizational environment. Taken together, we recommend to include hands-on training of telepsychiatry in medical education curriculum during residency, as well as refresher exercises for attending practitioners.
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Affiliation(s)
- Maya Negev
- School of Public Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Tamir Magal
- School of Public Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Hanoch Kaphzan
- Department of Neurobiology, Faculty of Natural Sciences, University of Haifa, Haifa, Israel
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40
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Morgan A, Davies C, Olabi Y, Hope-Stone L, Cherry MG, Fisher P. Therapists' experiences of remote working during the COVID-19 pandemic. Front Psychol 2022; 13:966021. [PMID: 36591020 PMCID: PMC9802664 DOI: 10.3389/fpsyg.2022.966021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 11/15/2022] [Indexed: 12/23/2022] Open
Abstract
Objectives To explore the experiences of therapists who delivered remote psychological therapy during the COVID-19 pandemic. Design This was a qualitative, phenomenological study. Interpretative Phenomenological Analysis elicited themes from semi-structured interviews. Methods A purposive sample of eight therapists was recruited from breast cancer services in the United Kingdom. Results Analysis identified three superordinate themes. Participants spoke about how their experience of remote working changed over time from an initial crisis response to a new status quo. They adapted to the specific practical and personal challenges of remote working and struggled to connect with clients as the use of technology fundamentally changed the experience of therapy. Conclusion Consideration should be given to the impact of remote working on therapists and the quality of their practise. Adjustments to ways of working can help to maximize the advantages of remote working while minimizing potential issues.
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Affiliation(s)
- Andrew Morgan
- Primary Care and Mental Health, University of Liverpool, Liverpool, United Kingdom,Department of Psychological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Cari Davies
- Primary Care and Mental Health, University of Liverpool, Liverpool, United Kingdom,Department of Psychological Sciences, University of Liverpool, Liverpool, United Kingdom,*Correspondence: Cari Davies,
| | - Yasmine Olabi
- Primary Care and Mental Health, University of Liverpool, Liverpool, United Kingdom,Department of Psychological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Laura Hope-Stone
- Primary Care and Mental Health, University of Liverpool, Liverpool, United Kingdom,Department of Psychological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Mary Gemma Cherry
- Primary Care and Mental Health, University of Liverpool, Liverpool, United Kingdom,Department of Psychological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Peter Fisher
- Primary Care and Mental Health, University of Liverpool, Liverpool, United Kingdom,Department of Psychological Sciences, University of Liverpool, Liverpool, United Kingdom
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Rodgers B, Tudor K, Sutherland A. An integrative review of the person‐centred and experiential therapy literature on delivering individual video counselling and psychotherapy. COUNSELLING & PSYCHOTHERAPY RESEARCH 2022. [DOI: 10.1002/capr.12600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Affiliation(s)
- Brian Rodgers
- The University of Auckland Auckland Aotearoa New Zealand
| | - Keith Tudor
- Auckland University of Technology Auckland Aotearoa New Zealand
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Carretier E, Bastide M, Lachal J, Moro MR. Evaluation of the rapid implementation of telehealth during the COVID-19 pandemic: a qualitative study among adolescents and their parents. Eur Child Adolesc Psychiatry 2022; 32:963-973. [PMID: 36370315 PMCID: PMC9652600 DOI: 10.1007/s00787-022-02108-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 10/26/2022] [Indexed: 11/15/2022]
Abstract
The Coronavirus Disease 2019 (COVID-19) pandemic catalysed an abrupt explosion in the use telepsychiatry for the delivery of mental health services. We aimed to explore the experience of telemedicine use during this period among adolescent outpatients and inpatients and their parents. This qualitative study took place in a French adolescent medicine and psychiatry department during the first lockdown. Data collection by purposive sampling continued until we reached theoretical sufficiency. The interviews were analysed by applying Interpretative Phenomenological Analysis which is based on an iterative, inductive process. It included 20 participants: 10 adolescents and 10 parents. The analysis showed three themes: (1) facilitators of a switch from face-to-face to tele-consultation: (a) the context of health emergency, (b) the integration of parents in the treatment, (c) the choice between telephone or video consultation; (2) distance from the therapist's gaze and its consequences: (a) an obstacle to decrypting clinical nonverbal communication, (b) effectiveness depends on the severity of the adolescent's symptoms, (c) and on the previous quality of the therapeutic relationship; (3) awareness of the value of the face-to-face therapeutic space. In the post-COVID era, practitioners would benefit from combining both approaches, face-to-face and remote, based on the quality of the therapeutic alliance, the pathology, the parents' availability for in-person participation, and the patient's age. Future quantitative research will also be necessary to establish the extent to which the experiences described by the participants in this study reflect those of a broader population.
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Affiliation(s)
- Emilie Carretier
- Paris Cité University, PCPP, 92100, Boulogne-Billancourt, France. .,Paris-Saclay University, UVSQ, Inserm, CESP, Team DevPsy, 94807, Villejuif, France.
| | | | - Jonathan Lachal
- Paris-Saclay University, UVSQ, Inserm, CESP, Team DevPsy, 94807 Villejuif, France ,CHU de Clermont-Ferrand, Service de Psychiatrie de l’Enfant et de l’Adolescent, 63000 Clermont-Ferrand, France ,Université Clermont Auvergne, 63000 Clermont-Ferrand, France
| | - Marie Rose Moro
- Paris Cité University, PCPP, 92100 Boulogne-Billancourt, France ,Paris-Saclay University, UVSQ, Inserm, CESP, Team DevPsy, 94807 Villejuif, France ,APHP, Cochin Hospital, Maison de Solenn, 75014 Paris, France
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Giordano C, Ambrosiano I, Graffeo MT, Di Caro A, Gullo S. The transition to online psychotherapy during the pandemic: a qualitative study on patients' perspectives. RESEARCH IN PSYCHOTHERAPY (MILANO) 2022; 25:638. [PMID: 36373388 PMCID: PMC9893047 DOI: 10.4081/ripppo.2022.638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 09/19/2022] [Indexed: 11/09/2022]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has substantially increased online psychotherapies due to the impossibility of participating in vis-a-vis settings. In the last years, research about online therapy has been quickly growing. However, until now, few studies investigated patients' perspective about the transition to online psychotherapy and, specifically, no qualitative research in group therapy has been done on this topic. This study aimed to explore the experience of 51 patients (39 group patients and 12 from individual psychotherapies) who continued psychotherapy in the online setting during the COVID-19 outbreak. A structured online questionnaire with open answers investigated the following topics: setting online, effectiveness, psychotherapy relationship, specific dynamics of online psychotherapy. Patients' answers were analysed by means of Consensual Qualitative Research, modified version (CQRM), an inductive method that allows analysing a large sample and relatively brief written answers. The results show the impact of shift to online platforms on patients and explore how easy or difficult it is for them to adapt to therapeutic processes are in online therapy (vs in-person therapy), by highlighting potential barriers and resources to practice implementation. Participants' responses have been arranged into three main domains: setting online, content/effectiveness of online therapy and therapeutic relationship. A fourth domain, specific for online group therapy, collected responses referred to the changes perceived regarding the group dynamics. From the patient's perspective, online therapy is effective and satisfying. Patients perceived a positive quality of therapeutic relationship in online setting, whereas produced more controversial judgments concerned the changes due to the online setting. Finally, patients in group therapy gave more attention and importance in showing and seeing private personal spaces than the ones in individual therapy.
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Affiliation(s)
- Cecilia Giordano
- Department of Psychology, Educational Sciences and Human Movement, University of Palermo, Palermo, Italy,Department of Psychology, Educational Sciences and Human Movement, University of Palermo, viale delle Scienze, Edificio 15, 90128 Palermo, Italy. +39.091.23897718.
| | | | - Maria Teresa Graffeo
- Department of Psychology, Educational Sciences and Human Movement, University of Palermo, Palermo, Italy
| | - Alessandro Di Caro
- Department of Psychology, Educational Sciences and Human Movement, University of Palermo, Palermo, Italy
| | - Salvatore Gullo
- Department of Psychology, Educational Sciences and Human Movement, University of Palermo, Palermo, Italy
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Gori A, Topino E, Brugnera A, Compare A. Assessment of professional self-efficacy in psychological interventions and psychotherapy sessions: Development of the Therapist Self-Efficacy Scale (T-SES) and its application for eTherapy. J Clin Psychol 2022; 78:2122-2144. [PMID: 35615900 PMCID: PMC9796675 DOI: 10.1002/jclp.23391] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 02/20/2022] [Accepted: 05/13/2022] [Indexed: 01/07/2023]
Abstract
OBJECTIVE This study aimed to develop the Therapist Self-Efficacy Scale (T-SES), and test its validity in a sample of Italian mental health therapists, to assess their professional self-efficacy concerning their practice of eTherapy in a synchronous video-based setting. METHODS A sample of 322 Italian mental health professionals (37.6% psychologists, 62.4% psychotherapists; Mage = 38.48, SD = 8.509) completed an online survey. RESULTS The T-SES showed a clear, one-factor structure with good psychometric properties. Significant associations were found with insight orientation, general self-efficacy, self-esteem, and personality traits of openness, conscientiousness, and agreeableness. The results showed no differences between psychologists and psychotherapists, or differences based on years of experience. CONCLUSION The T-SES is an agile and versatile self-report measure for mental health professionals to assess their self-efficacy concerning their therapeutic activity, which can provide information for tailoring training for eTherapy.
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Affiliation(s)
- Alessio Gori
- Department of Health SciencesUniversity of FlorenceFlorenceItaly
- Integrated Psychodynamic Psychotherapy Institute (IPPI)FlorenceItaly
| | - Eleonora Topino
- Department of Human SciencesLUMSA University of RomeRomeItaly
| | - Agostino Brugnera
- Department of Human and Social SciencesUniversity of BergamoBergamoItaly
| | - Angelo Compare
- Department of Human and Social SciencesUniversity of BergamoBergamoItaly
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Bouchard S, Dugas MJ, Belleville G, Langlois F, Gosselin P, Robillard G, Corno G, Marchand A. A Multisite Non-Inferiority Randomized Controlled Trial of the Efficacy of Cognitive-Behavior Therapy for Generalized Anxiety Disorder Delivered by Videoconference. J Clin Med 2022; 11:5924. [PMID: 36233791 PMCID: PMC9572194 DOI: 10.3390/jcm11195924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 09/27/2022] [Accepted: 09/28/2022] [Indexed: 11/25/2022] Open
Abstract
Delivering psychotherapy by videoconference has been studied in a number of clinical trials, but no large controlled trial has involved generalized anxiety disorder (GAD). This multicenter randomized controlled non-inferiority trial was conducted to test if cognitive-behavior psychotherapy delivered by videoconference (VCP) is as effective as cognitive-behavior psychotherapy delivered face-to-face, using a strict margin of tolerance for non-inferiority. A total of 148 adults received a 15-session weekly manualized program. The treatment was based on the intolerance of uncertainty model of GAD. The impact of treatment was assessed using primary (GAD severity), secondary (worry, anxiety, and intolerance of uncertainty) and tertiary (general functioning) variables measured before and after treatment and at 6-month and 12-month follow-ups. Results showed that: (a) the treatment was effective; (b) VCP for GAD was statistically non-inferior to face-to-face psychotherapy on primary, secondary and tertiary measures at all assessment points; (c) change in intolerance of uncertainty significantly predicted change in the primary outcome measure over and above important clinical factors common to all psychotherapies (motivation, working alliance, perceived therapist competence, and client satisfaction). These findings support the use of VCP as a promising treatment option for adults with GAD. Clinical trial registry: ISRCTN#12662027.
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Affiliation(s)
- Stéphane Bouchard
- Département de Psychologie et de Psychoéducation, Université du Québec en Outaouais, Gatineau, QC J8X 3X7, Canada
- Centre de Recherche du Centre de Santé et des Services Sociaux de l’Outaouais, Gatineau, QC J8T 4J3, Canada
| | - Michel J. Dugas
- Département de Psychologie et de Psychoéducation, Université du Québec en Outaouais, Gatineau, QC J8X 3X7, Canada
- Centre de Recherche du Centre de Santé et des Services Sociaux de l’Outaouais, Gatineau, QC J8T 4J3, Canada
| | | | - Frédéric Langlois
- Département de Psychologie, Université du Québec à Trois-Rivières, Trois-Rivières, QC G8Z 4M3, Canada
| | - Patrick Gosselin
- Département de Psychologie, Université de Sherbrooke, Sherbrooke, QC J1K 2R1, Canada
| | - Geneviève Robillard
- Département de Psychologie et de Psychoéducation, Université du Québec en Outaouais, Gatineau, QC J8X 3X7, Canada
| | - Giulia Corno
- Département de Psychologie et de Psychoéducation, Université du Québec en Outaouais, Gatineau, QC J8X 3X7, Canada
| | - André Marchand
- Département de Psychologie, Université du Québec à Montréal, Montréal, QC H2L 2C4, Canada
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Shaker AA, Austin SF, Sørensen JA, Storebø OJ, Simonsen E. Psychiatric treatment conducted via telemedicine versus in-person consultations in mood, anxiety and personality disorders: a protocol for a systematic review and meta-analysis. BMJ Open 2022; 12:e060690. [PMID: 36171023 PMCID: PMC9528631 DOI: 10.1136/bmjopen-2021-060690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Major advancements in technology have led to considerations how telemedicine (TM) and other technology platforms can be meaningfully integrated in treatment for psychiatric disorders. The COVID-19 pandemic has placed a further focus on use of TM in psychiatry. Despite the widespread use of TM, little is known about its effect compared with traditional in-person (IP) consultation. The objective of this systematic review is to examine if individual psychiatric outpatient interventions for adults using TM are comparable to IP in terms of (1) psychopathology outcomes, (2) levels of patient satisfaction, (3) working alliance and (4) dropout from treatment. METHODS AND ANALYSIS This review will only include randomised controlled trials for adult participants with mood disorders, anxiety or personality disorders. The primary outcome is psychopathology, and secondary outcomes include patient satisfaction, treatment alliance and dropout rate. Systematic searches were conducted in MEDLINE, APA PsycINFO, Embase, Web of Science and CINAHL. The inverse-variance method will be used to conduct the meta-analysis. Effect sizes will be calculated as standardised mean difference (Hedges' g) for the primary outcome, mean difference for patient satisfaction and working alliance, and risk ratio for the dropout rate. Effect sizes will be supplemented with 95% CI. We will calculate the I² statistic to quantify heterogeneity and Chi-square statistic (χ²) to test for heterogeneity for the primary outcome. Potential clinical and methodological heterogeneity moderators will be assessed in subgroup and sensitivity analysis. The risk of bias will be assessed by Cochrane Risk of Bias Tool V.2, and confidence in cumulative evidence will be assessed by Grading of Recommendations Assessment, Development and Evaluation. ETHICS AND DISSEMINATION No ethical approval is required for this systematic review protocol. Data sets will be deposited in the Zenodo repository. The findings of this study will be published in a peer-review scientific journal. PROSPERO REGISTRATION NUMBER CRD42021256357.
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Affiliation(s)
- Ali Abbas Shaker
- Psychiatric Research Unit, Psychiatric Services Region Zealand, Slagelse, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Stephen F Austin
- Psychiatric Research Unit, Psychiatric Services Region Zealand, Slagelse, Denmark
- Department of Psychology, University of Southern Denmark Faculty of Health Sciences, Odense, Denmark
| | | | - Ole Jakob Storebø
- Psychiatric Research Unit, Psychiatric Services Region Zealand, Slagelse, Denmark
- Department of Psychology, University of Southern Denmark Faculty of Health Sciences, Odense, Denmark
| | - Erik Simonsen
- Psychiatric Research Unit, Psychiatric Services Region Zealand, Slagelse, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Eichenberg C, Aranyi G, Rach P, Winter L. Therapeutic alliance in psychotherapy across online and face-to-face settings: A quantitative analysis. Internet Interv 2022; 29:100556. [PMID: 35942217 PMCID: PMC9350857 DOI: 10.1016/j.invent.2022.100556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 06/30/2022] [Accepted: 07/04/2022] [Indexed: 11/23/2022] Open
Abstract
Lockdown enacted by government in response to the Covid-19 pandemic in Austria forced psychotherapy practice into an online-only setting for several months in 2020. Although there is evidence supporting the effectiveness of psychotherapy in remote settings, research investigating therapeutic alliance in online psychotherapy is still limited, with a specific need for research in assessing possible effects of changes in therapeutic setting from face-to-face to online and vice versa. We measured therapeutic alliance in client-therapist dyads using the Helping Alliance Questionnaire (HAQ) at the Adult Outpatient Clinic of Sigmund Freud University, Vienna. Eighty-seven dyads completed HAQ twice, assessing three time-points: after switching from face-to-face to online therapy, providing a retrospective assessment of their alliance before the setting change as well as a concurrent account of their experience during online therapy, then another assessment after switching back to face-to-face setting after lockdown restrictions were lifted. Data were analysed by fitting a multilevel linear model, where the variables person (client/therapist) and time (before online therapy; online therapy; back to face-to-face) were nested within the client-therapist dyad. We found a statistically significant small improvement in the quality of therapeutic alliance over time, but no differences due to change in therapeutic setting. Separate analysis of HAQ sub-scales revealed that clients rated their relationship statistically significantly higher than their therapists with medium effect size, while there were no differences in success ratings over time and settings, nor between clients and therapists. The findings support the feasibility of online therapy in terms of therapeutic alliance in general, and alternating between face-to-face and online therapy settings in particular.
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Affiliation(s)
- Christiane Eichenberg
- Sigmund Freud Private University, Institute of Psychosomatic, Faculty of Medicine, Vienna, Austria
| | - Gabor Aranyi
- Institute of Education and Psychology at Szombathely, Faculty of Education and Psychology, Eotvos Lorand University, Hungary
- Sigmund Freud Private University, Faculty of Psychotherapy Science, Vienna, Austria
| | - Paul Rach
- Sigmund Freud Private University, Faculty of Psychotherapy Science, Vienna, Austria
| | - Lisa Winter
- Sigmund Freud Private University, Faculty of Psychotherapy Science, Vienna, Austria
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Rosen V, Blank E, Lampert E, Dominick K, Will M, Erickson C, Pedapati E, Lamy M, Shaffer R. Brief Report: Telehealth Satisfaction Among Caregivers of Pediatric and Adult Psychology and Psychiatry Patients with Intellectual and Developmental Disability in the Wake of Covid-19. J Autism Dev Disord 2022; 52:5253-5265. [PMID: 35987932 PMCID: PMC9392497 DOI: 10.1007/s10803-022-05712-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2022] [Indexed: 11/01/2022]
Abstract
Telehealth has been shown to be both acceptable and effective in many areas of healthcare, yet it was not widely adopted prior to the SARS-CoV-2 (COVID-19) pandemic. Additionally, previous evaluations of telehealth for autism spectrum condition (ASC) and intellectual and developmental disability (IDD) populations are limited in both number and scope. Here, we investigated satisfaction amongst Psychology and Psychiatry patient caregivers at Cincinnati Children’s Hospital Medical Center (CCHMC) after the onset of the COVID-19 pandemic. Results (640 responses) showed high rates of satisfaction across departments, appointment types, and diagnoses, with 92% indicating overall satisfaction with their appointment. There were, however, notable decreases in satisfaction among Group Therapy respondents, and those whose diagnosis was classified as Other.
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Rusu VA, van der Lans RM, Vermeiren RRJM, Hauber K, de Lijster JM, Lindauer RJL, Nugter A, Hoekstra PJ, Nooteboom LA. Training is not enough: child and adolescent psychiatry clinicians' impressions of telepsychiatry during the first COVID-19 related lockdown. Eur Child Adolesc Psychiatry 2022; 32:987-993. [PMID: 35986802 PMCID: PMC9391644 DOI: 10.1007/s00787-022-02042-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 06/25/2022] [Indexed: 11/03/2022]
Abstract
To ensure the continuity of care during the COVID-19 pandemic, clinicians in Child and Adolescent Psychiatry (CAP) were forced to immediately adapt in-person treatment into remote treatment. This study aimed to examine the effects of pre-COVID-19 training in- and use of telepsychiatry on CAP clinicians' impressions of telepsychiatry during the first two weeks of the Dutch COVID-19 related lockdown, providing a first insight into the preparations necessary for the implementation and provision of telepsychiatry during emergency situations. All clinicians employed by five specialized CAP centres across the Netherlands were invited to fill in a questionnaire that was specifically developed to study CAP clinicians' impressions of telepsychiatry during the COVID-19 pandemic. A total of 1065 clinicians gave informed consent and participated in the study. A significant association was found between pre-COVID-19 training and/or use of telepsychiatry and CAP clinicians' impressions of telepsychiatry. By far, the most favourable impressions were reported by participants that were both trained and made use of telepsychiatry before the pandemic. Participants with either training or use separately reported only slightly more favourable impressions than participants without any previous training or use. The expertise required to provide telepsychiatry is not one-and-the-same as the expertise that is honed through face-to-face consultation. The findings of this study strongly suggest that, separately, both training and (clinical) practice fail to sufficiently support CAP clinicians in the implementation and provision of telepsychiatry. It is therefore recommended that training and (clinical) practice are provided in conjunction.
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Affiliation(s)
- Vlad-Alexandru Rusu
- Curium LUMC, Oegstgeest, The Netherlands. .,Karakter, Wageningen, The Netherlands. .,de Bascule, Duivendrecht, The Netherlands. .,GGZ Noord-Holland-Noord, Heerhugowaard, The Netherlands. .,Accare, Assen, The Netherlands.
| | - R. M. van der Lans
- Curium LUMC, Oegstgeest, The Netherlands ,grid.461871.d0000 0004 0624 8031Karakter, Wageningen, The Netherlands ,grid.491096.3de Bascule, Duivendrecht, The Netherlands ,grid.491220.c0000 0004 1771 2151GGZ Noord-Holland-Noord, Heerhugowaard, The Netherlands ,grid.459337.f0000 0004 0447 2187Accare, Assen, The Netherlands
| | - R. R. J. M. Vermeiren
- Curium LUMC, Oegstgeest, The Netherlands ,grid.461871.d0000 0004 0624 8031Karakter, Wageningen, The Netherlands ,grid.491096.3de Bascule, Duivendrecht, The Netherlands ,grid.491220.c0000 0004 1771 2151GGZ Noord-Holland-Noord, Heerhugowaard, The Netherlands ,grid.459337.f0000 0004 0447 2187Accare, Assen, The Netherlands
| | - K. Hauber
- Curium LUMC, Oegstgeest, The Netherlands ,grid.461871.d0000 0004 0624 8031Karakter, Wageningen, The Netherlands ,grid.491096.3de Bascule, Duivendrecht, The Netherlands ,grid.491220.c0000 0004 1771 2151GGZ Noord-Holland-Noord, Heerhugowaard, The Netherlands ,grid.459337.f0000 0004 0447 2187Accare, Assen, The Netherlands
| | - J. M. de Lijster
- Curium LUMC, Oegstgeest, The Netherlands ,grid.461871.d0000 0004 0624 8031Karakter, Wageningen, The Netherlands ,grid.491096.3de Bascule, Duivendrecht, The Netherlands ,grid.491220.c0000 0004 1771 2151GGZ Noord-Holland-Noord, Heerhugowaard, The Netherlands ,grid.459337.f0000 0004 0447 2187Accare, Assen, The Netherlands
| | - R. J. L. Lindauer
- Curium LUMC, Oegstgeest, The Netherlands ,grid.461871.d0000 0004 0624 8031Karakter, Wageningen, The Netherlands ,grid.491096.3de Bascule, Duivendrecht, The Netherlands ,grid.491220.c0000 0004 1771 2151GGZ Noord-Holland-Noord, Heerhugowaard, The Netherlands ,grid.459337.f0000 0004 0447 2187Accare, Assen, The Netherlands
| | - A. Nugter
- Curium LUMC, Oegstgeest, The Netherlands ,grid.461871.d0000 0004 0624 8031Karakter, Wageningen, The Netherlands ,grid.491096.3de Bascule, Duivendrecht, The Netherlands ,grid.491220.c0000 0004 1771 2151GGZ Noord-Holland-Noord, Heerhugowaard, The Netherlands ,grid.459337.f0000 0004 0447 2187Accare, Assen, The Netherlands
| | - P. J. Hoekstra
- Curium LUMC, Oegstgeest, The Netherlands ,grid.461871.d0000 0004 0624 8031Karakter, Wageningen, The Netherlands ,grid.491096.3de Bascule, Duivendrecht, The Netherlands ,grid.491220.c0000 0004 1771 2151GGZ Noord-Holland-Noord, Heerhugowaard, The Netherlands ,grid.459337.f0000 0004 0447 2187Accare, Assen, The Netherlands
| | - L. A. Nooteboom
- Curium LUMC, Oegstgeest, The Netherlands ,grid.461871.d0000 0004 0624 8031Karakter, Wageningen, The Netherlands ,grid.491096.3de Bascule, Duivendrecht, The Netherlands ,grid.491220.c0000 0004 1771 2151GGZ Noord-Holland-Noord, Heerhugowaard, The Netherlands ,grid.459337.f0000 0004 0447 2187Accare, Assen, The Netherlands
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Aafjes-van Doorn K, Békés V, Prout TA, Hoffman L. Practicing Online During COVID-19: Psychodynamic and Psychoanalytic Therapists' Experiences. J Am Psychoanal Assoc 2022; 70:665-694. [PMID: 36047620 DOI: 10.1177/00030651221114053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
During the Covid-19 pandemic, psychotherapists quickly transitioned to provide online therapy, while facing many challenges. This study aimed to explore psychodynamic and psychoanalytically oriented therapists' (N = 1450) experiences with online therapy during the first weeks of the pandemic and two months later. Results showed that therapists had little pre-pandemic experience with providing online therapy and even less training in it, and that younger therapists reported more challenges in the transition to online therapy. During the first weeks of the pandemic, most therapists thought that online therapy was less effective than in-person therapy, and they reported a wide range of relational and technical challenges, feeling more tired, less confident and competent, and less connected and authentic in online sessions, compared to previous in-person sessions. At follow-up, therapists viewed online therapy as more comparable to in-person therapy; the majority felt connected and authentic as they had during the initial weeks of the pandemic, or more so, but were still as tired as before. The most challenging aspect of online therapy was distraction in sessions, which increased over time. This study demonstrates the professional adaptability of therapists and highlights the need for more training and professional support for clinicians providing remote psychotherapy.
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